Rising TB rates a huge concern for SA

Novel thinking needed to tackle drug-resistant strain

THE COUNTRY’S health sector is under strain from the high prevalence of multi-drug-resistant (MDR) TB and risks buckling under the pressure.

While there were no figures for the number of infected people in South Africa, the figures for 2013 showed that 10 691 people were being treated.

The number represents 10 percent of the total figure of global patients who have the deadly strain.

“This is despite the fact that we are hardly even 2 percent of the worldwide population,” national Health Department director Dr Norbet Ndjeka said.

Last year, 11 500 people were on treatment under the national TB programme, signifying an increase from the previous year’s figures, he said.

MRD-TB and the more deadly extremely drug-resistant strain, XDR-TB, remained largely underdiagnosed and underreported.

“We won’t be able to meet the Millennium Development Goals plan to decrease the incidence by 50 percent,” he said.

Ndjeka and other experts on health were discussing issues and developments on TB at a summit organised by Discovery Health.

The health professionals and academics called for a shift in the mindset of stakeholders dealing with the epidemic.

“We need to relook at how nurses, doctors and other health practitioners are trained so they recognise the danger posed by TB and respond appropriately,” said Professor Mike Sathekge.

Sathekge, who chairs the Medical Research Council, said it was time to think out of the box.

Professor Linda-Gail Bekker, of the Desmond Tutu HIV Centre, said there was an urgent need to concentrate on the control of TB and the management of infected patients.

She said public transport, classrooms and prison cells, among others, were breeding grounds for the quick spread of infection.

“Stakeholders other than those in health need to be roped in if we are to fight this monster,” she said.

“We aren’t doing well with TB, we are failing,” Bekker added. As much effort as had been put into fighting HIV was needed to tackle TB.

“With HIV we know how transmission occurs, we understand how it spreads but we have no idea what happens with TB, which has been around for much longer.”

The head of the World Health Organisation’s TB programme, Dr Sanni Babatunde, agreed that TB was underfunded.

He said: “Not enough money is put into research, innovation and implementation. The fight against TB is struggling.”

Discovery Health’s chief medical officer, Dr Maurice Goodman, said bolder goalsetting was important. “We need more tangible goals,” he said.

The speakers said there were many gaps in information and little research being done on the epidemic and efforts to encourage behavioural change among infected people.

Alcohol abuse and drinking were among the factors that interrupted treatment adherence and led to defaulting.

The fact that there were no programmes that encouraged behaviour change was a letdown, the experts noted.

It was a weakness in the health system and there was no mechanism to motivate the general population to avoid infection and the spreading of the disease.

Ndjeka said the government had initiated a plan to decentralise TB treatment, by taking it to the communities.

Treatment has up until now been largely doctor-driven and hospital-based.

“People lose so much during the treatment phase. They lose an income, they lose relatives and sometimes spouses,” Ndjeka said. Taking treatment closer to home was the best option.

Going back to the basics was what had to be done, and innovations and health facilities had to become agents of change, the experts said.

Goodman said marketing around TB had to be enhanced. Activists had worked hard towards uniting the country in the fight against the disease.

Partnerships between governments, NGOs, universities and academics had to be consolidated if TB were to be wiped out, Ndjeka said.