Think T.B

A “Think T.B” slogan appeared in many of the slides during the training presentations last week. There has not been a training that I loved beyond this one on Tuberculosis and HIV co-infection among all the ones I have so far attended in Kyangwali. The two days’ training left me pondering about our fate; given the existing trends of such terrible communicable diseases like Tuberculosis (T.B). Surprisingly, T.B in early stages usually manifests as a simple cough that persists beyond 2 weeks. This simple cough is most times accompanied by night sweats and also weight loss. Our training was endowed with topics on pathogenesis, diagnosis, chemo-therapy and other clinical stuff that most time sound as complex as ancient Greek to lay people. In fact, while the trainer mentioned of terms like; isoniazid, rifampin, pyrazinamide, hemoptysis, adenopathy, pneumonitis and others, it felt as though I was in Medical school which actually was a few yards from our School of public health at University. 

What stood out for me in this training were the public health concerns about tuberculosis especially in our developing communities. Uganda is among the 22 countries with the highest T.B burden worldwide. The fact that T.B is hard to recognize by someone who is not aware of its signs and symptoms poses a significant risk of infecting other close contacts such as relatives and friends. Worse still, about ten to twenty percent (10-20%) of T.B cases are asymptomatic which means that they do not normally present with signs of the infection. The mode of transmission is mainly through inhalation of T.B pathogen contaminated air (usually from an infected patient). This route is quite hard to block off. Just imagine the times you could have been exposed to T.B by just using public transport. Health workers too are at risk and ought to take serious precautions especially while interacting with patients or performing laboratory procedures. Matters made worse, T.B diagnosis (detection) is still quite problematic even at many health centers in our communities and yet missing out on some patients most certainly causes them to infect others. The Tuberculosis and HIV co-infection is quite complex since one infection worsens the other and thus posing higher risks of case fatality. Pulmonary T.B which is the commonest can easily progress to extra pulmonary T.B especially among people with compromised immunity. This mishap implies that T.B could then spread to other body systems besides the lungs and seriously affect the other body organs such as; the bones, brain, kidneys, eyes and others. 

Much as the first line drugs are fairly available for T.B treatment in the Ugandan communities, there is a life threatening condition that is sparking out! A new strain of tuberculosis called Multi Drug Resistant Tuberculosis (MDR-TB) that is resistant to first line medication is on the loose. The current absence of second line T.B drugs in Uganda and their associated unaffordable costs to majority has left the lives of quite a number hanging by a thread. It is estimated by Medecins Sans Frontieres (MSF) that a single complete regimen of around 18 to 24 months treatment for second line TB drugs could cost between 4,000 and 9,000 US Dollars. How many sick people will think of that option yet even so many cannot afford a kilo of sugar (1.5 US Dollars) for months? Uganda is estimated to have 870 MDR-TB cases per year according to the MSF report (From the ground up: Building a drug-resistant T.B program in Uganda, March 2012). People develop this kind of T.B if they are not treated with the appropriate regimen, if they did not follow the treatment regimen as prescribed or if the supply of the drugs is interrupted (these are the secondary routes). Proper adherence to T.B drugs is such a challenge due to pill burden that many patients face with the long T.B dose. The primary route of transmission of MDR-TB is quite shocking! A patient with MDR-TB spreads this same strain of the disease to a normal person just through air. The trainer who works with the National Tuberculosis and Leprosy Program added to our fear on breaking the news that nearly 200 cases of MDR-TB had been so far diagnosed in Kampala (just one of the many districts in the country)  

  

 Protection of oneself from T.B is their responsibility given the complexities of the disease. Watching out for and quickly responding to the warning signs and symptoms of the disease whether from a stranger, relative or self is vital. Seeking for and linking persons to proper diagnosis and medical care is a sound response. However, being an advocate and paying lip service will never cease being your contribution in this good fight. On a good note comprehensive, decentralized and community based care model has been proved by MSF as feasible in combating drug resistant T.B in Uganda. In fact, MSF calls on all key stakeholders to assure quality rapid TB diagnosis, treatment and care, and argues that a scale-up of the decentralized and community-based approach, including access to second-line TB drugs at district level, is the most feasible method of averting the country's current T.B crisis. The DOTS strategy that also worked exceptionally well Peru (South America) and has currently wiped this country off the list of the top countries with most T.B burden also leaves much to learn and emulate in our own country.