The World Health Organisation (WHO) has revised upwards, by almost 500,000, the estimated number of people who have TB globally. In its 2014 global TB report, WHO says last year, about nine million people developed TB around the world, up from 8.6 million in 2012. However, the number of people dying from the disease continued to decline, it added. “Following a concerted effort by countries, by WHO and by multiple partners, investment in national surveys and routine surveillance efforts has substantially increased. This is providing us with better data and bringing us closer to understanding the true burden of tuberculosis,” said Dr Mario Raviglione, director of the global TB programme at WHO. The report underlines that a staggering number of lives are being lost to a curable disease and confirms TB is the second biggest killer disease from a single infectious agent. In the long-term, WHO says deaths from TB have dropped by 45 per cent since 1990, while the number of people developing the disease is declining by an average 1.5 per cent a year. The report says about 37 million lives have been saved through effective diagnosis and treatment since 2000. Drug resistant TB The report shows that multi-drug-resistant TB (MDR-TB) remains a global threat, with an estimated 480,000 new cases registered in 2013. MDR-TB is more difficult and expensive to treat, compared to ordinary TB. “The progress that has been made in combating MDR-TB has been hard won and must be intensified. Containing and reversing the epidemic requires immediate and sustained efforts by all stakeholders,” said Dr Karin Weyer, coordinator for laboratories, diagnostics and drug resistance at WHO. Rwandan scope Dr Michel Gasana, the head of TB division at Rwanda Biomedical Centre, said many health facilities in the country still depend on old fashioned microscopes with low sensitivity to diagnose TB, making it difficult to effectively screen ailments like MDR-TB. He adds that the country has few radiologists, about five or six, and most of them are concentrated around Kigali, reducing chances of diagnosing the disease through powerful machines like X-ray or C.T scan. Gasana, however, said government in recent years came up with various measures aimed at reducing TB mis-diagnosis; for instance, in the last two years, about 16 GeneXpert (highly sensitive TB detection) machines were procured and that plans are underway to procure one for every district hospital in the next three years . “The good news is that unlike before, the World Health Organisation has now approved the use of the GenXpert machine even on children, so cases of mis-detection will greatly reduce.” He added that they are planning to use a digital network system that can, for instance, help a doctor and laboratory technician share an X-ray report of a particular patient quickly, helping with interpretation and advising where necessary, regardless of distance. Gasana said the country have also acquired about 50 fluorescence microscopes, which have a 10 per cent higher sensitivity than ordinary ones, and that they are hoping to acquire 200 others over the next three years. About 6,000 TB cases were registered countrywide in 2013. And 2,000 of them are in Kigali alone. Rwanda has 89.6 per cent of treated TB cases, well above the WHO target of 85 per cent. However, late diagnosis and failure by patients to adhere to dosage instructions remains the biggest challenge.
