Major diseases you need to routinely test for

Gustave Kananura, 28, a resident of Kanombe, a Kigali city suburb, confesses that visiting the hospital for a medical engagement is out of the question, unless he is feeling sick.
A lab attendant takes a blood sample from someone.  (Ivan Ngoboka)
A lab attendant takes a blood sample from someone. (Ivan Ngoboka)

Gustave Kananura, 28, a resident of Kanombe, a Kigali city suburb, confesses that visiting the hospital for a medical engagement is out of the question, unless he is feeling sick.

The banker who is also armed with health insurance thinks going for a medical examination when not feeling unwell is not only a waste of resources, but also time.

Medical experts however have a different opinion. They say routine body checkup is necessary, regardless of whether one is sick or not. And some of the priority diseases are listed below.

Hepatitis B and C

Hepatitis is a medical condition defined by the inflammation of the liver. It may occur with limited or no symptoms, but often leads to yellow discoloration of the skin, mucus membranes, and poor appetite. Hepatitis is acute when it lasts less than six months, and chronic when it persists longer. The condition can be self-limiting (healing on its own) or can choose to be chronic.

Dr Osee Sebatunzi, the director of Kibagabaga Hospital Kigali, says the most common types of Hepatitis in Rwanda are B and C.

“It has similar symptoms with malaria and many people confuse them. That is the reason why it’s important to screen early and confirm,” he says.

A survey carried out in 2012 by the Ministry of Health on 12,000 pregnant women in selected health facilities countrywide showed that 3.7 per cent of them had Hepatitis B, while 2.6 per cent had Hepatitis C.

Dr Aimable Mbituyumuremyi, the director of other blood born infections unit at Rwanda Biomedical Centre (RBC), estimates that four out of every 100 people in the country have Hepatitis C. He discloses that a study carried out between 2013 and 2014 in Kigali indicated that 5 per cent of HIV-positive people were found to have Hepatitis B.

“The biggest challenge with Hepatitis B and C is that one can go for up to 30 years without noticing since signs and symptoms take long to show up. It is, therefore, important for anyone who has never gone for screening to do so,” says Stany Ngarukiye, a public health specialist and a member of ROFAH, a local anti-Hepatitis coalition.

Malaria

Malaria is a life-threatening disease transmitted by the Anopheles mosquito. Its symptoms include fever, fatigue, vomiting and headaches. In severe cases it can cause yellow skin, seizures, coma or death.

Mosquitoes are common in tropical settings like Rwanda. And forests, swamps, dark places are common breeding places.

Dr Corine Karema, the head of malaria and other parasitic diseases at the Rwanda Biomedical Centre (RBC), says there is a high prevalence of the disease especially among children. For instance in 2013, around 900,000 cases of malaria were diagonised. And of these, 409 died, with 30 per cent of them being children under five.

Since mosquitoes can find you anywhere, regular screening is crucial to be sure. Malaria comes as fourth killer disease in Rwanda after Neonatal illness, Pneumopathies and Cardio-vascular diseases.

HIV/AIDS

HIV most often spreads through unprotected sex with an infected person. It may also spread by sharing drug needles or through contact with the blood of an infected person. Women can give it to their babies during pregnancy or childbirth.

The first signs of HIV infection may be swollen glands and flu-like symptoms. These may come and go a month or two after infection. Severe symptoms may not appear until months or years later.

There is no cure, but there are many medicines to fight both HIV infection and the infections and cancers that come with it.

Statistics from the Ministry of Health show that on average, one person is infected with HIV every 30 minutes in the country.

Prevalence of the disease among the adult population aged between 15-19 currently stands at 3 per cent.

“The virus remains dormant in the body for several years, which makes the carrier feel that they are healthy, and in the process they end up infecting others, so routine testing is crucial to confirm one’s status,” said Jeannette Mukamusire, a nurse working with Rwamagana Health Centre.

The 2013 UNAIDS Rwanda statistics show that about 200,000 people are living with HIV, and 4,500 people died as a result.

Tuberclosis

Tuberculosis (TB), is an infectious bacterial disease caused by Mycobacterium tuberculosis, which commonly affects the lungs. It is transmitted from person to person via droplets from the throat and lungs of people with the active respiratory disease.

The symptoms of active TB of the lung are coughing, sometimes with blood, chest pains, weakness, weight loss, fever and night sweats.

In Rwanda TB cases are relatively high with 6,000 cases registered countrywide in 2013 alone.

“It’s easy for someone with HIV/Aids to catch TB, since the immune system of the body is broken down. This is why the screening of the two goes hand-in-hand,” says Innocent Habiyambere, the in-charge of Multi-Drug Resistance (MDR) – TB at the Ministry of Health.

Syphilis

Syphilis just like HIV is a sexually transmitted infection, caused by a type of bacteria known as Treponema pallidum.

The first sign of syphilis is a small, painless sore. It can appear on your sexual organs, rectum, or inside your mouth. This sore is called a chancre. Often, people fail to notice it right away.

Some of the symptoms include headaches,swollen lymph glands,fatigue,fever,weight loss,hair loss, and aching joints.

Syphilis can be tricky to diagnose. An infected person can go years without showing any symptoms, that’s why constant screening is recommended.

Syphilis that remains untreated for a long period can cause major damage to important organs like the heart and brain. Since the bacteria can be in one’s body without you knowing it, doctors will often screen pregnant women for syphilis. This is to protect the fetus from getting infected with congenital syphilis.

Brucellosis

Brucellosis is an infectious disease caused by a type of bacteria called Brucella. The bacteria can spread from animals to humans.

There are several different strains of Brucella bacteria. Some types are seen in cows. Others occur in dogs, pigs, sheep, goats, and camels.

Severe brucellosis may cause infection of the central nervous system, Endocarditis (infection of the lining of the heart or valves) and liver abscess. It can also cause long-lasting symptoms that are similar to chronic fatigue syndrome.

Olivier Manzi, an infectious diseases specialist with the University Teaching Hospital of Kigali (CHUK), says that Brucella (the bacteria) can be transmitted through eating raw or half cooked meat from infected animals. It can also be through animal products like milk, ghee, ice cream and butter.

Alfred Gatabarwa, a general practitioner with Abbey Family Clinic, Remera points out that Brucella can also be spread through air. Adding that farmers, laboratory technicians, and slaughterhouse workers are always at risk.

He warns that direct contact with blood, semen or placenta of an infected animal also exposes one to the disease, as bacteria can enter ones bloodstream through a cut or wound.

Typhoid

Typhoid fever is an acute illness associated with fever caused by the Salmonella typhi bacteria.

The bacteria are deposited in water or food by a human carrier and are then spread to other people in the area.

Typhoid fever is contracted by drinking or eating the bacteria in contaminated food or water.

People with acute illness can contaminate the surrounding water supply through stool, which contains a high concentration of the bacteria. Contamination of the water supply can, in turn, taint the food supply. The bacteria can survive for weeks in water or dried sewage.

“About 3%-5% of people become carriers of the bacteria after the acute illness. Others suffer a very mild illness that goes unrecognised. These people may become long-term carriers of the bacteria — even though they have no symptoms,” says Gatabarwa.

Some of symptoms include poor appetite, headaches, generalised aches and pains, fever and diarrhea.

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A lab attendant takes a blood sample from someone. (Ivan Ngoboka)

Cancer

Latest statistics from Butaro Cancer centre show that breast cancer accounts for 40.3 per cent of all the cancers diagnosed.

Dr Faustine Ntirenganya, an oncologist with the University Teaching Hospital of Kigali (CHUK), says that one out of every 10 women, and one out of every 100 men, stand a risk of contracting breast cancer.

However the biggest challenge is that 57 per cent of breast cancer victims show up for screening when the ailment is in the 3rd stage (second last stage) which reduces their chances of survival.

Immaculate Habiyambere, a member of Concur Breast Cancer Association, an umbrella group that brings together breast cancer patients and survivors, says that out of 105 members, 17 had succumbed to the disease in the last two years.

Although treatment of cancer could be expensive, early detection can alleviate the costs.

“Breast cancer treatment is expensive, it can never go below $30, 000 (Rwf20 million),” Habiyambere explains.

Other cancers like prostate cancer and cervical cancer can also be handled easily following early detection.

Dr Alphonse Butoyi, a Gynaecologist at Rwanda Military Hospital is also concerned that only three to four women per week come for consultation on the Pap smear test, a test that is used to detect cervical cancer.

“Cervical cancer is manageable but only one woman out of the four are willing to take a pap smear,” Butoyi says.

Worryingly, statistics from the Ministry of Health show that 2.72 million women are at risk of developing the disease which results from a genital infection caused by the Papilloma (HPV) virus.

This makes breast and cervical cancers most persistent among Rwandan women, affecting 32 percent of all diagnosed cancer cases.

Still according to WHO statistics, Rwanda is ranked among the countries with the highest cervical cancer incidence, estimated at 49.4 per 100,000 women.

With prostate cancer being prevalent in men, early medics agree that if discovered all cancers can be managed.

Diabetes and blood pressure

From March 2013 WHO statistics, non communicable diseases are by far the leading cause of death in the world, accounting for 63 percent of all annual deaths.

More than 36 million people die from related causes globally each year, about 80 percent from low and middle-income countries.

In Rwanda the ailments account for an estimated 29 per cent of all mortality basing on figures from 2008, with the most prevalent being cardiovascular diseases, which accounted for 12 per cent of total deaths across all age groups.

These combined with cancers, non-communicable variants of respiratory diseases and diabetes contribute five per cent, three per cent and two per cent to total mortality respectively.

The head of Non-communicable Diseases at Rwanda Biomedical Centre, Dr Marie Aimee Muhimpundu says that with much advertising of ‘junk food’ in local media, there is more need to address the prevalence of lifestyle diseases.

“People often need to do regular checkups against diabetes and related ailments since these are affecting people more because of their lifestyles,” Muhimpundu says.

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How often do you go for medical checkup?

Bansabire Makile

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Bansabire Makile

Routine testing is one of the most important obligations we have. It’s sad that many people don’t see medical checkup as a life-saving practice. The Ministry of Health should sensitise the public about the benefits of knowing your health status especially pregnant women.

Manzi Antharime

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Manzi Antharime

I don’t think it’s necessary to go for medical checkup when you are healthy. I am told that some screening machines such as the one for x-ray and the CT scan have a negative health effect on someone. Therefore I wouldn’t give it a priority unless I feel ill.

Ruth Dusabeyesu

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Ruth Dusabeyesu

I got to know the importance of routine testing recently when a friend of mine was diagnosed with a serious disease and the doctor said her life would not be in danger if she had gone for a medical check-up early. That taught me to take my life more seriously by testing regularly.

Theoneste Mutabazi

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Theoneste Mutabazi

Any person who values his life must visit the doctor for routine testing because early diagnosis can save a life. Personally I always go for testing and this gives me a full picture of my health condition. This habit has helped me deal with certain illnesses when still at an early stage.

Esperance Mujyawamariya, a nurse

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Esperance Mujyawamariya

We usually receive several people with serious complications resulting from negligence. Lack of routine checkup is usually the problem. I urge people to prioritise their health by visiting the doctor regularly.

Arthur Ntashamaje

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Arthur Ntashamaje

Routine testing has not been part of our culture but with more information, we have come to learn its importance. The Government should continue educating the masses.

Compiled by Dennis Agaba

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