Still A Potent Killer 
Published on April 26, 2010 by fari · No Comments
Diagnosis and treatment of tuberculosis, an infection that primarily affects the lungs, is free in Nigeria, yet over 100,000 citizens die from the disease annually. By OLUREMILEKUN OSOBU.
Mr. John Obande, a lawyer, was shocked when his niece, Patience Agbaji, a 24-year-old student, paid him a visit in June last year. Not only had she lost weight considerably, she complained of a protracted bout with cough, chest pain, constant tiredness and fever. He promptly took her to a private hospital, where the doctor advised that Patience would have to undergo chest X-ray, analysis of sputum and skin tests. The tests revealed that she had tuberculosis, otherwise called TB. “Immediately I got the result, I called my uncle and told him. He asked for the procedure of the treatment and advised me to obey the doctor’s instructions for effective recovery,” Patience said.
After six months of intensive treatment, Patience has regained her weight and no longer suffers from any of the earlier symptoms. She has been cured of tuberculosis. “The treatment was very demanding. I had to cope with a daily routine of drugs, their side effects and the proper monitoring and supervision of my family members. I am a living testimony of a successful treatment,” Agbaji enthused.
Patience was lucky that her uncle insisted she undergo medical tests and adhere religiously to a treatment regimen as active tuberculosis kills about two of every three people affected if left untreated. According to Dr. Ifeanyi Onwujekwe, a clinician with Nigeria Institute of Medical Research, NIMR, Yaba, Lagos, “TB is an infectious bacterial disease spread through the air and commonly affecting the lungs. It is mainly transmitted through exposure to bacilli in the saliva of an infected person and the sputum coughed up from the lungs. The level of transmission from one person to another depends on the number of infectious droplets expelled by a carrier, the effectiveness of ventilation, the duration of exposure and the virulence of the mycobacterium tuberculosis strain. Though 80 per cent of TB cases are pulmonary, others, known as extra-pulmonary, may attack any other part of the body.”
Factors that trigger the infection and its development into disease include poverty, crowded living conditions, unhygienic lifestyle, alcoholism, HIV opportunistic infections and homelessness. Smoking, particularly of cigarette and Indian Hemp, also constitute potential risk for TB.
TB bacilli, the microbes that cause TB, were discovered in 1882 by Dr. Robert Koch, and more than two billion people, about one-third of the world’s population, are currently infected. A person with untreated TB can infect between 10 and 15 persons yearly, while one in 10 people infected with bacilli will become sick with active TB in their lifetime.The symptoms of TB include persistent cough over an extended period, say, for more than three weeks; fever, weight loss, tiredness, night sweats, loss of appetite, chest pain and coughing up blood.
There are two types of TB: multidrug-resistant TB, MDR-TB and extensively drug-resistant TB, XDR-TB. With multidrug-resistant TB the bacilli are resistant to at least two of the most potent TB drugs in use –– Isoniazid, INH, and Rifampicin. This type of TB is difficult and expensive to treat. It requires extensive chemotherapy––up to two years of treatment––with second line anti-TB drugs which are costlier than the first line drugs.
Drug-resistant TB develops as a result of poor adherence to the standard six-month treatment course on the part of the patients who stop taking drugs when they start to feel better. This may be due to side effects of the drugs, poor treatment literacy, poverty, other illnesses or unreliable drug supply system.
TB can be diagnosed in several different ways, including chest X-ray, analysis of sputum, and skin tests. Sometimes, the chest X-ray can reveal evidence of active tuberculosis pneumonia. Other times, the X-ray may show scarring (fibrosis) or hardening (calcification) in the lungs, suggesting that the TB is contained and inactive. Examination of the sputum on a slide (smear) under the microscope can show the presence of the tuberculosis-like bacteria. Bacteria of the mycobacterium family, including atypical mycobacteria, stain positive with special dyes and are referred to as acid-fast bacteria, AFB. A sample of the sputum also is usually taken and grown (cultured) in special incubators so that the tuberculosis bacteria can subsequently be identified as tuberculosis or atypical tuberculosis.
The global and national statistics of TB are indeed grim. In 2008, for example, there were 9.4 million new TB cases, 3.6 million of whom were women, including 1.4 million cases among people living with HIV. In 2009, the ailment claimed 1.8 million or 4,500 deaths a day, including 500,000 people living with HIV, making TB the second biggest infectious killer of adults worldwide, said the United Nations Secretary-General, Ban Ki-moon in his message on the World Tuberculosis Day, observed on 24 March 2010.
TB also ranks among the top killers of women of reproductive age as a result of their fragility, susceptibility to sickness and socio-economic factors. “TB is a major public health problem in Nigeria. It is estimated that about 460,000 new TB cases occur annually. TB burden in Nigeria is compounded by a high HIV/AIDS prevalence which currently stand at 4.6 per cent,” said Prof. Babatunde Osotimehin, former minister of Health. He added that HIV and TB form a lethal combination, each spreading the other’s progress because HIV weakens the immune system. In many cases, a person who is HIV-positive and infected with TB is many times more likely to become ill with TB than an HIV negative individual who is exposed to the same TB bacilli.
In Nigeria, diagnosis and treatment is free, yet over 100,000 citizens die from the disease annually. “Nigeria is placed fourth in the global prevalence rate of TB. This calls for improvement in the mode of treatment in Nigeria and globally,” Onwujekwe observed.
Researches on state-by-state analysis of the distribution patterns of TB in Nigeria reveal that the disease is still most prevalent in densely populated cities. Lagos has the highest number of TB-recorded cases in the country. In 2008 alone, the figure for the state reached 10,000 and this accounts for 11 per cent of overall figure for the entire country, followed by Kano, which had about 6,000 cases.
Lagos State coordinator of TB control under the Ministry of Health, Dr. Hussein Abdul-Razaaq said the control of TB entails finding those who are afflicted and successfully treating them, availability of standard drugs, proper monitoring and evaluation of the process. This, he said, informed the recent launch of a new strategy called ‘Stop TB Strategy’. This involves the TB patients coming to the health facility to take their drugs, based on Direct Observer Treatment, DOT, whereby the patients take their drugs in the presence of a health provider. DOT can be administered at home if a relative can be trained to properly supervise the patient.
One common striking feature of their stories was the role of early diagnoses, the monitoring of their treatment by the qualified and committed medical personnel as well as support from families while the treatment lasted.