Tuberculosis (TB) is second only to HIV/AIDS as the greatest killer worldwide. Unfortunately, the increase in number of drug Resistant Tuberculosis cases and HIV currently constitutes a major source of worry. But, Dr Joshua Olusegun Obasanya, Coordinator, National TB and Leprosy Control Programme, however, assured in this interview with Sade Oguntola that work is ongoing to tackle the disease from all ends.
Tuberculosis control, where are we in Nigeria?
Nigeria is one of the 22 high burden countries for Tuberculosis (TB) in the world. In 1991, the National TB and Leprosy Control Programme was established as a response to the epidemic and since then Nigeria have come a long way.
We started using the short course chemotherapy for the treatment of TB and have also adopted the World Health Organisation (WHO) stop TB strategy, which is called the DOTS strategy.
Now, the number of TB cases we are finding has increased steadily and by 2012, we were able to detect about 98,000 cases from all over the nation.
Now, talking about the burden of the disease, WHO has been giving us some estimation, but the Federal Government and its partners thought it wise that in order to begin to address the problem properly, we need to know the exact burden of the disease in order to be able to do more.
That was why the Federal Government in collaboration with its international partners funded the National TB prevalence survey. That was the aim of the 2011 to 2012 National TB prevalence survey. We have completed this survey and we are analysing its result.
How soon will the result of the survey be made known to the public?
This is certainly very soon. Although, we have estimates of TB prevalence from WHO, we would not like to talk about this because the figures may not be right now.
What are some of the challenges faced in the control of TB in the country?
The HIV epidemic is complicating TB control and this is a challenge. So in order to reduce TB cases, we are collaborating with the HIV programme and all developmental partners working in HIV to reduce the burden of TB in those that are living with HIV and also to reduce the burden of HIV in those living with TB.
Aside this, one other challenge we are having now is the occurrence of drug resistant TB. Drug resistant TB means a type of TB germ that is resistant to the usual drugs that were used for the treatment of TB. Cases of drug resistant TB might have been in Nigeria for a longer time before now, but undiagnosed because it was difficult to do so.
But in 2011, we started nationally to build capacity to make diagnosis of drug resistant TB with the support of our developmental partners, particularly USAID. As a result of this, we have started seeing drug resistant TB cases that we were unable to detect before, meaning that cases that were not visible before were now becoming visible.
So what happens to detected cases of drug resistant TB?
The next thing is now to ensure that all those identified with drug resistant TB are treated. The Federal Government along with its partners, USAID and CDC in particular, are working together to establish across the country treatment centres for drug resistant TB.
Also, organisations like the ILEP, which is the International Agency of Leprosy organisations in Nigeria that were originally supporting the control of leprosy are now active in TB as well. They are also collaborating in this effort to ensure treatment of drug resistant TB.
What is the population of people with drug resistant TB in the country?
To know exactly the number of drug resistant TB cases, we have done a drug resistant TB survey. This is different from the National TB prevalence survey which is strictly on TB. The report on the drug resistant TB survey has been concluded, but its findings are waiting to be disseminated.
Nevertheless, we have eight centres now operating across the nation that are involved in the treatment of drug resistant TB. Before the end of the year, there will be more centres to ensure that any patient wherever in Nigeria that is diagnosed to have drug resistant TB have access to treatment and this is what we are working towards.
What are the plans to ensure that all patients wherever in Nigeria have access to drug resistant TB treatment?
Currently, we have 32 diagnostic centres across the country. By the end of the year we will be having about 62, in essence, there would be increased access to diagnosis.
Aside this, we are also expanding the access to treatment, which means that more treatment centres would be put in place before the end of the year.
We know that there are difficulties for some people to stay in normal treatment centres for a long period of time, so we are putting in place ambulatory treatment of drug resistant TB.
Under this scheme, they will be able to commence treatment after diagnosis early while they live at home. This means they are not taken away from their homes or from their families. It is difficult for someone to stay in a hospital for as long as eight months, when there is no social support.
Of course, we will go to their homes to investigate their contacts which could be their spouses, children or others living in the same house with them to see if they also have TB. This to ensure such are also treated for TB when found infected.
Is it not in every case when you see a person with TB that a person will be very ill, emaciated and so on. They could look apparently healthy, but coughing. For those that are seriously ill, of course, they will be admitted.
For now, our facilities are under pressure. The way we are looking at it is that even when we expand our services, because the treatment for drug resistant TB takes up to two years, there will still be lot of pressure on whatever services that are put in place.
Therefore, it is wise that instead of people being on the waiting list perpetually, they start treatment at home, where they have social support. When the person is on treatment, we will also be monitoring the health of those that are at home also with them.
Will these services and treatment also be free?
Yes, the management of the TB is free. We are providing free services. This will include the drug itself, some social support like support for transportation, monitoring of side-effects of the drug, and so on.
As soon as any side effect is detected, we pick them up and respond to that appropriately. Definitely, we had to set aside some money for that and even their diet will be supported.
Stigma is still a problem with the TB disease, is this appropriate?
Stigma is not peculiar to TB, but it is actually there. Certainly stigma has to be addressed. When offices, companies and some establishments know people that have TB, it may have serious implications. But stigma is something that must be addressed. Education is important in ensuring no health worker or anybody stigmatise any patient.
Prevention of TB, where should it start from?
It starts from the home. Things such as clean environment, ventilation, and prevention of overcrowding are very important in prevention of TB. Overcrowding is everywhere you go. You do not necessarily have to come to a TB DOTs centre. But anywhere there is no ventilation, you can pick TB.
One person that is sick there could infect other people. So we must prevent overcrowding at all times, whether in the waiting room, airport or anywhere we go and ensure good ventilation.
But more importantly the main method of control is early identification and treatment of TB. Anybody that is coughing or has a cough that has lasted for more than two weeks should seek medical help.
If you are not the one coughing, you should encourage any person coughing to seek medical help because the main method of TB control is its early identification and treatment.
Children and TB, is enough being done to prevent and treat TB in this age group?
Children are more vulnerable to TB like many other diseases. TB in children is a problem all over the world. So, we have to do more to ensure that all vulnerable groups, including children have access to diagnosis and treatment as early as possible.
Unfortunately, diagnosis of TB in children is very difficult. Now, we are working with the Paediatric Association of Nigeria and other stakeholders in meeting this challenge and ensuring proper diagnosis of TB in children.
This means, reaching out to all stakeholders, including the paediatricians, and educating all on the signs that can be suggestive of TB.
Also, we are revising our guidelines in line with best practices and acceptable practices stipulated by international organisations; and also ensuring that there are enough drugs to treat patients with TB.
One very important part of measures we are taking is the prevention of TB in children. For example if a mother is sick, we manage the case such that the child of that mother or other children living in that household is prevented from also developing TB.
Of what significance is adherence in TB treatment and ensuring a cure?
Management of TB is far more than dishing out medications. So when clients consult our services, we must educate them properly. We must counsel them properly before they start treatment. This will ensure they understand a lot about their condition, how long they will take their treatment; their responsibilities as patients and our responsibilities as health workers. This will motivate them to complete their treatment.
Source: Nigerian Tribune