The World Health Organization (WHO) declared Tuberculosis (TB) a global emergency in 1993. Twenty-five years later, TB remains one of the world’s major causes of illness and death. In fact, it is currently ranked as the 9th leading cause of death worldwide.
The 2017 WHO Global TB report shows that, there were about 10.4 million new cases of TB in 2016 globally. Nigeria is among the 30 countries classified as having a high TB burden. It is currently ranked as the 4th country with the highest number of TB cases and among the seven countries that accounted for 64% of the global burden. Other countries were India, Indonesia, China, Pakistan, Philistines and South Africa.
The report also highlighted Nigeria as among the 10 countries that accounted for 64% of the global gap in TB case finding. India, Indonesia and Nigeria alone accounted for almost half the total gap. In 2017, Nigeria notified a total of 104,904 TB cases which is 26% of the estimated 407,000 TB cases for the country in the same year. With more than three-quarters of TB cases in Nigeria being undetected, these undiagnosed cases serve as a reservoir for continued transmission of TB in the community.
The burden of TB has further been complicated by the emergence of drug resistant tuberculosis and HIV/AIDS. People living with HIV are more likely to develop active TB disease than people without HIV. Equally, Nigeria and India accounted for 48 per cent of global TB deaths among HIV-negative people and for 43 per cent of the combined total TB deaths in HIV-negative and HIV-positive people.
WHAT CAUSES TUBERCULOSIS
Tuberculosis is caused by air-borne infectious bacteria, which primarily affects the lungs. One third of the world’s population – about two billion people – carry the bacteria. Carrier status without active disease is described as Latent TB. Latent TB disease cannot be spread.
About 9 – 10million persons with latent TB will transform to active disease annually. Active TB can be spread to other persons in the community. TB disproportionately affects people in resource-poor settings, particularly in Africa and Asia. TB poses significant challenges to developing economies as it primarily affects people during their most productive years. More than 90% of new TB cases and deaths occur in developing countries.
SYMPTOMS OF TB
Common symptoms of active lung TB are:
- Cough with sputum and blood at times
- Chest pains and sometimes pain on breathing
- Shortness of breath
- Weight loss
- Night sweats
- Loss of appetite
- Swollen lymph node
The WHO currently recommends Xpert MTB/RIF® as the initial diagnostic test in all persons with signs and symptoms of TB. The benefit of this test is that it simultaneously detects TB and resistance to rifampicin, the most important TB medicine. Diagnosis can be made within 2 hours. Tuberculosis is particularly difficult to diagnose in children and as yet only the Xpert MTB/RIF assay is generally available to assist with the diagnosis of pediatric TB.
Diagnosis of TB can also be made from a positive sputum smear microscopy. Trained medical laboratory scientists look at sputum samples under a microscope to see if TB bacteria are present. Microscopy detects only half the number of TB cases and cannot detect drug-resistance.
Treatment usually lasts for 6 month using drugs, provision of accurate clinical information, supervision and support to the patient by a health worker or trained volunteer. When the right treatment is taken correctly, TB can be cured, and this is achieved when treatment adherence is ensured.
TB AND HIV
HIV and TB form a lethal combination, each speeding the other’s progress. In 2016 about 0.4 million people died of HIV-associated TB. About 40% of deaths among HIV-positive people were due to TB in 2016. In 2016, there were an estimated 1.4 million new cases of TB amongst people who were HIV-positive, 74% of whom were living in Africa.
Inappropriate use of anti-TB drugs from incorrect prescription by health care providers, poor quality drugs, and patients stopping treatment prematurely has led to emergence of multidrug- resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) globally.
In MDR-TB, the bacteria do not respond to isoniazid and rifampicin, the 2 most powerful, first-line anti-TB drugs. MDR-TB is treatable and curable by using second-line drugs. However, second-line treatment options are limited and require extensive chemotherapy (up to 2 years of treatment) with medicines that are expensive and toxic.
In XDR-TB the bacteria do not respond to the most effective second-line anti-TB drugs, often leaving patients without any further treatment options. MDR-TB and XDR-TB remain a public health crisis and a health security threat. Worldwide, only 54% of MDR-TB patients and 30% of XDR-TB are currently successfully treated.
Reference: WHO Global TB Report 2017
National TB and Leprosy Control Programme
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