TB: Fighting the menace among ‘silent’ sufferers

The whizzing was increasingly getting harsh and he frequentely ran out of breath. The flesh around his ribs and chest was disappearing. 

The whizzing was increasingly getting harsh and he frequentely ran out of breath. The flesh around his ribs and chest was disappearing. 

Yet even when the scald-like cough that had beaten Jean Damascene Gasana for months on degenerated into a level where blood would appear in his sputum, the 53-year-old man from Bugesera continued to use herbs with the vain hope that his condition was just another of the illnesses that come and go.

“At first, I thought I had been poisoned, but after more than a year of this cough and weakening effect, I ruled out the bewitching talk,” he says.

“A community health worker said I could have contracted pneumonia because of waking up too early when it is cold to go procure goods for trading.”

In November, last year, Gasana was convinced to take a TB test. The result returned positive and he was immediately started on treatment. “I could never have imagined that I would have that disease, not when no one I know who has lived closer to me has had it. Maybe in my line of work…”

Tuberculosis is a potentially serious infectious disease that mainly affects your lungs. The bacteria that cause tuberculosis are spread from one person to another through tiny droplets released into the air via coughs and sneezes.

Once rare in developed countries, tuberculosis infections began increasing in 1985, partly because of the emergence of HIV, the virus that causes Aids. HIV weakens a person’s immune system so it can’t fight the TB germs. 

Many strains of tuberculosis resist the drugs most used to treat the disease, according to Mayo Clinic. People with active tuberculosis must take several types of medications for many months to eradicate the infection and prevent development of antibiotic resistance.

Dr John Vianney Ganza, the head of internal medicine at Rwanda Military Hospital, Kanombe, says TB is caused by bacteria called mycobacterium, which is spread through cough droplets from an infected person inhaled by others. 

The organisms multiply within the lungs, causing inflammation, formation of granulation and cavities within the lungs and they latter spread from lungs through blood, lymph or local spread to other body parts like abdomen, bones, spine and brain, Dr Ganza says. This results into multiple complications in different sites.

“The biggest challenge against the TB fight is that of late diagnosis, and patients failing to adhere to dosage instructions,” says Innocent Habiyambere, the in-charge of multi-drug resistance and TB case findings and social management department at Rwanda Biomedical Centre (RBC).

Tuberculosis can infect anyone irrespective of age. However, experts say it takes about two years for the signs and symptoms to materialise in an infected person, although this timeframe reduces significantly when the infected person is also positive for HIV or diabetes.

The big challenge to the TB menace today, besides the disease’s increasing ‘stubbornness’ as it resists multiple drugs or drug combinations, is the hidden lot of infected persons who do not come out to get timely healthcare.

Reaching out

It is in the effort to fight the TB burden among the millions who remain without healthcare that the World Health Organisation, this year, agreed on the theme “Reach the three million: A TB test, treatment and cure for all.”

WHO says the underlying message is that TB is curable, but current efforts to find, treat and cure everyone who gets ill with the disease are not sufficient. 

Of the nine million people who get infected with TB a year, a third of them do not get the TB services they deserve, WHO says. Many of these three million people live in the world’s poorest, most vulnerable communities.

Rwanda today and the rest of the world mark the Word Tuberculosis Day.

The day is designed to build public awareness that tuberculosis remains endemic in much of the world, causing deaths of nearly 1.5 million people every year, especially from developing countries.

 Dr Michel Gasana, the head of TB division at RBC, says as part of  preparations to mark the Day, the media have been involved with disseminating messages on the disease under the theme,  “Everybody should have access to proper TB screening and treatment.”

At least 6,000 TB cases were registered countrywide in 2013. Some 2,000 of these cases were in the capital, Kigali, so this campaign aims at reducing the figures, thus the burden of tuberculosis,” Dr Gasana said.

But with the current WHO figures showing that about one in ten TB patients are not aware of their status (for active cases, not latent infection) and, therefore, not on medication, this could mean the figures are even higher.

Using community health workers, RBC diagnosed and referred 48 per cent of the cases reported countrywide last year alone.

“According to the 2012 WHO report, about 8.6 million cases of TB were reported worldwide and 1.3 million of these died. This is unacceptable because TB is preventable,” Dr Gasana adds.

The Government of Rwanda spends Rwf8 billion annually in the fight against TB, including on treatment, research and others.

In the last two years, the Ministry of Health has acquired about 16 geneXpert machines (for testing the disease), as well as modern diagnostic tools that have reduced dependence on the traditional method of treatment by embracing microscopes.

The Ministry of Health, in an effort to reach out to more of the patients ‘suffering silently’, last year, embarked on screening for the disease in correctional facilities. This has seen 89.5 per cent of inmates countrywide screened for TB, Dr Gasana said. 

Innocent Habiyambere, the in-charge of multi-drug resistance and TB case findings and social management department at RBC, says about 4.6 per cent of TB patients recorded in 2013 died.   

“TB cases have been reducing over the years; for instance, in 2012, about 6,207 cases were registered, but in 2013, they reduced to 5,979,” Habiyambere says, adding that the ministry made it compulsory to test people found with TB for HIV/Aids as well (and the vice versa) so early treatment is started for those found with the infection.

“The burden on the body is worse when an HIV-positive person is infected with TB, since the immune system of the body is heavily compromised, this is why the screening of the two go hand in hand,” Habiyambere says.  

Officials say Rwanda currently has 89.6 per cent of treated TB cases, well above the WHO target of 85 per cent.


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