Cyprien Ntizihigwa a resident of Nyamiyaga sector, Kamonyi district, had a fever and after days of mulling over the thought of going for a checkup, he finally approached a health center. To his shock, he did not only have the tuberculosis bacilli, he had multi-drug resistant tuberculosis.

The 58-year-old had had a cough for over two weeks. Although he knew the symptoms of Tuberculosis, he mistook them for malaria because of a mild bout of fever that occasionally attacked with the cough. After realizing that he had TB, he immediately sought for treatment.

"I am now receiving treatment from Kibagabaga Hospital. When I first went for treatment, I thought I was going to get a malaria checkup but I was surprised when they told me I had TB instead. It’s been one month and a half since I started the treatment,” Ntizihigwa says.

Diagnosis of Tuberculosis

Dr Yves Habimana-Mucyo the Director of Multi-drug resistant tuberculosis unit at Rwanda Biomedical Center notes that the strength in the current fight against TB lies mostly in the efforts present to boost early screening, detection and treatment.

He explains that presumptive TB patients are screened by health caregivers among patients attending the health facilities and among communities by community health workers.

"Patients are also screened,the positive ones are requested to provide samples (sputum samples most of the time) for laboratory testing. Patients with bacteriological confirmation and those clinically diagnosed are initiated on the TB treatment,” Mucyo says.

Some of the equipment used in diagnosis include; Fluorescent microscopy: GeneXpert technique which is available at all district hospitals,. solid (LJ) and liquid (MGIT) cultures

Other services availed for the TB fight

Mucyo points out that services available to fight TB include awareness campaigns, done mostly with the help of Community Health Workers using different platforms including days of Umuganda (community work).

Community Health Workers use such platforms to sensitize masses about the disease, most importantly symptoms o look out for and how it is spread.

The other mode of carrying out sensitizations includes use of radio, television and print media.

TB screening is carried out at all government hospitals and health centers in the country for free.

"The other service I can say which is very important is that all services in relation to testing or screening and diagnostic of TB are all offered for free. So a barrier in terms of financial status cannot be a hindrance; anyone can access the services. Treatment too is done for free.”

Aside from treatment being free and accessed by all, Mucyo points out that medicine is always available and that the issue of scarcity is not a barrier in the fight against TB.

He applauds the work done by Community Health Workers saying that they do a lot when it comes to fighting the bacillici .

Ntizihigwa complements this saying that if it weren’t for Community Health Workers, he wouldn’t have been able to understand that at his age he could actually get the infection.

"When the cough persisted, I remembered that it was one of the signs that the health workers had taught us as a possible sign for TB. However I had a fever so I thoughtit was malaria. But going for an earlier checkup helped me access treatment on time,” he says.

Apart from easy access to screening services, beneficiaries are grateful for the treatment which is accessible and also availed to them for free.

Kofi Nshimiyumukiza, 19, a resident of Masaka has been receiving treatment at Kibagabaga Hospital for over three months now for multi drug resistant tuberculosis.

He says that if it weren’t for the free treatment, his health would have been a story of deterioration because his parents wouldn’t have afforded to pay for such medical expenses.

"Here at the hospital, we receive treatment, feeding and shelter for free and we are getting better. I thank the government for availing such good healthcare for us,” says Kofi.

Treatment of TB

Albertine Tesire, the in-charge of nurses in the management of Multi-drug resistant Tuberculosis says patients of chronic TB at times get it from someone or when the patient does not take the dose of the treatment as prescribed.

Treatment is given to patients depending on the weight of the patient. A balanced diet is ensured for the patients because of the immensity of the medicine.

Patients stay for a period of three to four months.

"Services provided for such patients include treatment, feeding and shelter. For a patient to be discharged there are tests that are done. When it is established that the bacilli is weakened and the patient cannot transmit it through contact, then they are discharged to their homes from where they continue receiving treatment. The government continues with offering financial support for feeding from their respective health centers until they complete medication and are completely free of the bacilli,” Tesire explains.

TB treatment in Rwanda is mainly based on chemotherapy using anti-TB drugs in standard WHO approved treatment regimens:

First line anti-TB drugs: R: Riampicine; H: Isoniazide; Z: Pyrazinamide; E: Ethambutol; S: Streptomycine

Second line anti-TB drugs: Km: Kanamycine; Lfx: Levofloxacin; Mfx: Moxifloxacin: Pto: Prothionamide;

Cs: Cycloserine; Cfz: Clofazimine.

State of progress in fighting TB

According to the Health Sector Annual Report July 2015-June 2016, 45% of all patients with symptoms indicative of TB (presumptive TB cases) were reported by Community health workers, increasing easy and rapid access to TB clinics and care at health facilities.

The detection rate has been constantly decreasing since 2007 from 80% to 50% in 2015.

In 2015, the prevalence of Multi-drug resistant tuberculosis (MDR-TB ) reduced to a 2.1% as compared to 4.6% ten years ago.

The treatment success rate for bacteriologically confirmed new and relapse TB case was 89.3% of the cohort of TB cases registered in 2014-2015 and 85.6 % of MDR-TB cases of the 2012 cohort were successfully treated. This decreases transmission of TB and MDR-TB to healthy people.

Assuma Nikuze, a community health worker in Musanze, says the fight against tuberculosis has gained positive results thanks to the numerous efforts from the Ministry of Health and different stakeholders.

She notes that the fight starts from the grass root and that community health workers are committed to seeing that the ailment is completely driven out of the communities.

"We make a close follow up on families to see if anyone has symptoms of TB, one is then referred to a health center immediately if they have any signs of TB. We also follow up on patients to ensure they take medication as required,” she says.Nikuze believes that with the current efforts in place, the battle against TB will surely be successful.

She resonates Dr Mucyo’s belief who says that it is possible to win the fight against TB in Rwanda as it has been done with developed countries. "However it requires regional efforts because it is an airborne disease. That not withstanding, the disease is preventable and curable. It is with this that Nizerwa calls upon the public to heed advice given through different communications from health workers. "Screening is for free and with this I would advise people to go for early checkup in case they experience any symptoms. It’s been a few months of treatment and I believe that I am going to be well. I also appreciate the free services offered to us at Kibagabaga hospital,’ Nizerwa adds.