TB Day: How is Rwanda faring?

Tomorrow, the World will mark the Tuberclosis (T.B) day. The day is used to build public awareness that TB remains an epidemic in much of the world, causing deaths of nearly one-and-a-half million people each year, mostly in developing countries.
A lab technician screening for MDR TB at Gicumbi Hospital. (Ivan Ngoboka)
A lab technician screening for MDR TB at Gicumbi Hospital. (Ivan Ngoboka)

Tomorrow, the World will mark the Tuberclosis (T.B) day. The day is used to build public awareness that TB  remains an epidemic in much of the world, causing  deaths of nearly one-and-a-half million people each year, mostly in developing countries.

In Rwanda, TB mortality rate currently stands at 10 people out of every 100,000 patients, according to the 2013 World Health Organisation report.

About 6,000 TB cases were registered countrywide in 2013. And 2,000 of them are in Kigali alone.

“We noticed that many people abandon the dosage because it’s tiringly long and this exposes them to mortality,” says Dr Michel Gasana, the head of TB division at Rwanda Biomedical Centre

Dr Olivier Manzi, a specialist in infectious diseases at the University Teaching Hospital of Kigali (CHUK), says they are currently using a drug combination that takes about 20 months to cure drug-resistant TB.

“A patient does not only take these drugs for 20 months, but also receives daily injections for the first six months, and this usually presents side effects like hearing impairment, blurred vision and kidney problems,” he says.

“We have had TB patients under treatment running out of patience and escaping from hospital increasing chances of spreading the disease,” says Dr Frederick Fundi Gatare, the medical director of Rutongo Hospital in Rulindo District.

“Because the cure of MDR-TB takes long, some patients become depressed for fear that the disease may never cure after all,” Gatare added.

Gasana says that 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.

According to the World Health Organisation (WHO), TB is second only to HIV/Aids as the greatest killer worldwide. For instance In 2013, 9 million people fell ill with TB and 1.5 million died from the disease, and  over 95% of  them (deaths) occur in low-and middle-income countries, and it is among the top 5 causes of death for women aged 15 to 44. The statistics add that an estimated 550,000 children became ill with TB and 80,000 HIV-negative children died of TB in the same year. And it is the leading killer of HIV-positive people causing one fourth of all HIV-related deaths.

The report adds that in the same year, an estimated 480,000 people developed multidrug resistant TB (MDR-TB).

“However, the TB death rate dropped 45% between 1990 and 2013. An estimated 37 million lives were saved through TB diagnosis and treatment between 2000 and 2013,” the report notes.

What is TB?

According to WHO, “TB, is an infectious bacterial disease caused by Mycobacterium tuberculosis, which most 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.”

“Shaking someone’s hand, sharing food or drink, touching bed linens or toilet seats, sharing toothbrushes, or kissing does not spread TB,” says Dr. Cory Couillard, who works in collaboration with WHO’s goals of disease prevention and control.

TB is common amongst individuals with weakened immune systems and HIV/AIDS sufferers. Statistics show that a person living with HIV is about 20 to 30 times more likely to develop active TB, resulting in 25 per cent of HIV-related deaths.

TB is largely driven by factors related to poverty, poor access to healthcare services, and limited awareness and education. Many sufferers of TB live in the poorest and most vulnerable communities such as migrants, miners, prisoners, drug users and sex workers.

The primary causes of DR-TB include inappropriate treatments, incorrect uses of anti-TB drugs and the use of poor-quality medicines.

“We must invest in basic research and research and development for new tools — diagnostics, drugs and vaccines — in order to reach people faster, treat them more quickly and ultimately prevent them from becoming ill with TB,” says Dr Luis Sambo, the WHO regional director for Africa.

Early treatment requires understanding the most common symptoms of TB. Active TB often presents with chest pains, weakness, weight loss, fever, night sweats and a cough with sputum and blood at times.

“A person should see a health care provider anytime they have a cough (especially with sputum) for longer than two weeks. An evaluation is needed in order to make sure that you do not have the actual disease,” Dr. Couillard adds.

TB is a treatable and curable disease. Active, drug-sensitive TB is treated with a standard six-month course of four antimicrobial drugs that are provided with information, supervision and support by a qualified health care worker or trained volunteer.

Way forward

Gasana, however, mentions that government in recent years came up with various measures aimed at reducing TB mis-diagnosis; for instance, between 2012 and 2014, 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 remarks that the country has 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 two years.

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.

According to the 2013 World Health Organisation Report, Rwanda ranks third lowest in the region on newly confirmed cases of MDR-TB, with 58 cases, behind Tanzania and Burundi with 42 and 24, respectively.

Kenya and Uganda have the highest cases, standing at 225 and 89, respectively.