‘We are a dy­ing na­tion’

Stake­hold­ers fear the worst over Tu­ber­cu­lo­sis

Lesotho Times - - Feature - Pas­cali­nah Kabi

IT never rains but pours for Le­sotho.

Af­ter leapfrog­ging Botswana into se­cond place in the world on Hiv-preva­lence, the King­dom is now ranked first in Tu­ber­cu­lo­sis (TB) in­fec­tions, with 852 peo­ple in ev­ery 100 000 now said to be suf­fer­ing from the highly in­fec­tious dis­ease, ac­cord­ing to the World Health Or­gan­i­sa­tion’s 2015 Global TB Re­port.

Neigh­bour­ing South Africa is se­cond with 834 peo­ple in ev­ery 100 000 also in­fected with TB, while in HIV, Swazi­land leads the pack with a 26-per­cent preva­lence while Le­sotho is se­cond at 23 per­cent.

A highly con­ta­gious dis­ease caused by var­i­ous strains of my­cobac­te­ria, TB largely at­tacks the lungs, but can also af­fect other parts of the body.

The dis­ease’s trans­mis­sion through the air when peo­ple who have an ac­tive TB in­fec­tion cough, sneeze, or oth­er­wise trans­mit res­pi­ra­tory flu­ids, makes it a very un­pre­dictable if not dan­ger­ous ad­ver­sary.

How­ever, the fact that TB can be treated if de­tected early, is prob­a­bly the only bright spot in an oth­er­wise dark and malev­o­lent world in which those in­fected grad­u­ally waste away and should they lose hope, die and be­come yet an­other sad statis­tic.

The World Health Or­gan­i­sa­tion (WHO) says the prob­a­bil­ity of de­vel­op­ing TB is much higher among peo­ple in­fected with HIV, leav­ing Le­sotho very vul­ner­a­ble due to its high Hiv-preva­lence rate. Third­placed Botswana is at 19 per­cent, ac­cord­ing to WHO fig­ures.

“TB now ranks along­side HIV as a lead­ing cause of death world­wide. HIV’S death toll in 2014 was es­ti­mated at 1.2 mil­lion, which in­cluded the 0.4 mil­lion TB deaths among Hiv-pos­i­tive peo­ple,” reads the WHO re­port.

It is against such a bleak back­ground that the Min­istry of Health is “se­ri­ously” con­sid­er­ing ad­vis­ing Prime Min­is­ter Pakalitha Mo­sisili to de­clare TB a state of emer­gency.

Ac­cord­ing to the Min­istry of Health’s TB Man­ager, Dr Llang Maama, the coun­try’s lat­est Tu­ber­cu­lo­sis rank­ing makes for sad read­ing hence the need to re­act ac­cord­ingly. Var­i­ous non-gov­ern­men­tal or­gan­i­sa­tions (NGOS) op­er­at­ing in Le­sotho have also urged the govern­ment to de­clare TB a state of emer­gency and seek more sup­port from the in­ter­na­tional com­mu­nity.

“Le­sotho has now been ranked num­ber one glob­ally in TB preva­lence due to the high in­ci­dence of 852/100000 and, yes, this is a bad state of affairs to lead the world with an in­fec­tion which spreads so eas­ily. The coun­try is fac­ing an emer­gency which re­quires ex­tra ef­fort to change this pic­ture,” Dr Maama said.

“I strongly agree with the pro­posed move by NGOS and the min­istry is se­ri­ously con­sid­er­ing it, but more con­sul­ta­tions and prepa­ra­tions would need to be done first.”

Le­sotho failed to meet its United Na­tions Mil­len­nium De­vel­op­ment Goal (MDG) to halve TB in­fec­tions by 2015, and Dr Maama at­trib­uted this to the dis­ease al­ways hav­ing been “a huge prob­lem” for the coun­try.

How­ever, Dr Maama pointed out that Le­sotho has not failed in its ef­forts to fight TB, adding the preva­lence rate has not nec­es­sar­ily in­creased.

“It is just that now there has been this quan­tum leap fol­low­ing some ad­just­ments to re­port­ing sys­tems and new def­i­ni­tions used by TB pro­grammes as well as de­nom­i­na­tors used to come up with th­ese es­ti­mates,” Dr Maama said.

“We have not to­tally failed, since we are able to di­ag­nose and treat both sus­cep­ti­ble TB and Multi-drug-re­sis­tant tu­ber­cu­lo­sis (MDR-TB). Our an­tiretro­vi­ral treat­ment cov­er­age among TB pa­tients who are also Hiv-pos­i­tive, has steadily in­creased and is at 72 per­cent, and there are many other ar­eas of im­prove­ment in the min­istry’s TB re­sponse.”

Ac­cord­ing to Dr Maama, sev­eral fac­tors have con­trib­uted to the ap­par­ent lack of progress, among them pa­tients seek­ing treat­ment late.

“For 2015, the coin­fec­tion rate was 74 per­cent. Mal­nu­tri­tion might have been a con­tribut­ing fac­tor, as well as poor liv­ing con­di­tions which fa­cil­i­tate the con­tin­u­ous trans­mis­sion of TB at house­hold and com­mu­nity level. This is ev­i­denced by high rates of drug-re­sis­tant TB among new MDR-TB pa­tients,” Dr Maama said.

Other con­tribut­ing fac­tors, she re­it­er­ated, in­clude the coun­try’s high Hiv-preva­lence, ex­treme poverty, and de­lays in seek­ing treat­ment.

Dr Maama fur­ther cited lim­ited hu­man re­sources to cover at least the ba­sic com­po­nents of TB con­trol at pro­gramme level, such as the ca­pac­ity to di­ag­nose pa­tients.

In­ad­e­quate test­ing fa­cil­i­ties for the dis­ease, as well as lack of in­for­ma­tion among com­mu­ni­ties, and lack of spe­cialised staff in ar­eas of health pro­mo­tion and education in or­der to reach risk groups such as minework­ers, ex-min­ers, tex­tile fac­tory work­ers, chil­dren and cor­rec­tional in­sti­tu­tions, were also con­tribut­ing to the prob­lem, she added.

But ac­cord­ing to Dr Maama, the af­fected lives were far more im­por­tant than sta­tis­tics.

“It is not even about the rank­ing be­cause ev­ery num­ber stands for a pa­tient whose life is im­por­tant. The Na­tional TB and Lep­rosy Strate­gic Plan has been re­vised to ad­dress some of the many chal­lenges faced by the pro­gramme and the coun­try at large,” Dr Maama said.

“The de­clin­ing num­ber of pa­tients will be ad­dressed through the mean­ing­ful en­gage­ment of Civil So­ci­ety Or­ga­ni­za­tions (CSOS) which work at com­mu­nity level but are only fo­cus­ing on HIV. The min­istry, through the Na­tional TB Pro­gramme, will forge a re­la­tion­ship with all th­ese CSOS through their um­brella body and train them on how to in­clude TB in their busi­ness.”

Dr Maama fur­ther said the pro­gramme would con­duct a work­shop to adopt WHO pro­ce­dures aimed at guid­ing the CSOS on how they could con­trib­ute to TB con­trol.

“They can as­sist in find­ing cases so that all TB pa­tients are on treat­ment, sup­port those on treat­ment, re­fer all cases for treat­ment and ed­u­cate pa­tients and the com­mu­nity on TB and the im­por­tance of ad­her­ence to treat­ment. We shall em­bark on a na­tion­wide TB preva­lence sur­vey to bet­ter un­der­stand the bur­den of the dis­ease other than re­ly­ing on the math­e­mat­i­cal modelling used to make es­ti­mates for th­ese im­pact in­di­ca­tors.”

The min­istry would leave no stone un­turned in its ef­forts to erad­i­cate TB and is go­ing to adopt a multi-sec­toral ap­proach that in­cludes in­volv­ing the cor­po­rate sec­tor and com­mu­nity at large, Dr Maama added.

She also said Lo­cal Govern­ment struc­tures would be very in­stru­men­tal in im­prov­ing com­mu­nity in­volve­ment and par­tic­i­pa­tion in TB pro­grammes.

Dr Maama again noted that the govern­ment would be urged to pay at­ten­tion and ad­dress the so­cial de­ter­mi­nants of TB, HIV and other dis­eases and en­sure fam­i­lies do not face ex­or­bi­tant charges when seek­ing care.

“The min­istry will con­tinue to strengthen TB/HIV col­lab­o­ra­tive ac­tiv­i­ties and pur­sue uni­ver­sal cov­er­age for all el­i­gi­ble PLHIV (Peo­ple Liv­ing with HIV/AIDS) and sus­cep­ti­ble TB, and MDR-TB pa­tients.”

Mean­while, Part­ners in Health (PIH)—A United States of Amer­ica-based non-profit health­care or­gan­i­sa­tion founded in 1987—has called on the Prime Min­is­ter to de­clare TB a state of emer­gency.

“I am sur­prised that the coun­try has not de­clared TB a state of emer­gency be­cause do­ing so would al­low in­ter­na­tional part­ners to come in and help fight the dis­ease,” said PIH Tech­ni­cal Di­rec­tor, Dr David Omo­tayo.

“Le­sotho’s TB pro­grammes are funded by Global Fund and PIH has been com­mis­sioned to un­der­take this pro­ject. Since July 2015, we have tested around 18 peo­ple ev­ery month and we con­tinue to find new in­fec­tions, and this is dis­turb­ing.

“TB is an op­por­tunis­tic dis­ease and with the coun­try hav­ing the se­cond high­est HIV preva­lence in the world, it needs the in­ter­na­tional com­mu­nity’s help in fight­ing this dis­ease.

“We are in a cri­sis. Only two years ago, in 2014, we were ranked num­ber three and now we have jumped to num­ber one. This is wor­ry­ing.”

“It is es­ti­mated that 82 per­cent of MDR-TB cases in SADC (South­ern African De­vel­op­ment Com­mu­nity) are found in South Africa and it is easy to trans­mit the dis­ease to Le­sotho due to mi­gra­tion, es­pe­cially by the min­ers.”

Dr Omo­tayo warned that the coun­try needed to re­vamp its health sys­tem, es­pe­cially pri­mary health­care, in or­der to com­bat the dis­ease.

“No coun­try can achieve its set tar­gets with­out pri­mary health­care and Le­sotho needs to in­vest more money in this depart­ment. Mo­bil­is­ing cit­i­zens is also very cru­cial to de­crease TB in­fec­tions,” he said.

Le­sotho, Dr Omo­tayo fur­ther said, needs tech­ni­cal as­sis­tance from the in­ter­na­tional com­mu­nity to fight this dis­ease.

“No one is im­mune to TB as it is con­tracted through bac­te­ria in the air, so we need to be wor­ried by this con­tin­ued in­crease in in­fec­tions,” Dr Omo­tayo said.

Pit­song In­sti­tute of Im­ple­men­ta­tion Re­search, an NGO lead­ing the prime min­is­ter’s Health Sec­tor Re­form, has also said TB should be de­clared a state of emer­gency.

“Health has gone wrong and be­ing ranked num­ber one on TB sim­ply in­di­cates that we have stopped pur­su­ing the in­ter­ests of Ba­sotho but rather, chas­ing MDGS and Sus­tain­able De­vel­op­ment Goals (which suc­ceeded MDGS af­ter their 2015 dead­line),” Mr Tšoele said.

“We are a dy­ing na­tion. Our health sys­tem is ail­ing and is­sues of HIV, TB and Ma­ter­nal and Child mor­tal­ity are all in­di­ca­tors of a dy­ing na­tion. We need help from the in­ter­na­tional com­mu­nity es­pe­cially on is­sues of TB. We are go­ing to ad­vise the Prime Min­is­ter to ur­gently de­clare TB a state of emer­gency so that the in­ter­na­tional com­mu­nity can send ex­perts to Le­sotho to help.”

Mr Tšoele also spoke about the ur­gent need to in­vest in pri­mary health­care as preven­tion is cru­cial.

“The dis­ease bur­den is high be­cause our pri­mary health­care level doesn’t have ad­e­quate re­sources, thereby ne­glect­ing the most im­por­tant as­pect of so­cial mo­bil­i­sa­tion and preven­tion.

“Ev­ery Mosotho should play his or her part in fight­ing TB if we are to win the bat­tle against the dis­ease.”

Min­istry of Health’s tb Man­ager Dr Llang Brid­get Maama

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