With increased deaths recorded in Nigeria in 2014, tuberculosis may already have a foothold in the country. Busayo Adekoya writes about efforts to check the disease
Mustapha Zainab, 28, a housewife and a mother of two children was rushed to the general hospital in Kaduna by relatives. She had been ill for some weeks now without any sign of improvement. She managed to explain some of the symptoms she has to the doctor which were persistent heavy coughs, chest pain and night sweats.
The x-ray undeniably pointed to the source of her problems, she was diagnosed with tuberculosis — a deadly lung infection transmitted through the air.
It was not the first time Zainab had to deal with such a threatening diagnosis. Two years ago, she and her late husband both tested positive to HIV. Against the doctor’s advice, the husband refused any form of drugs and treatments that could guide against any further infectious diseases. Shortly after, he was diagnosed of tuberculosis that later led to his demise
According to the World Health Organisation (W.H.O), Tuberculosis (TB) is second only to HIV/AIDS as the greatest killer worldwide due to a single infectious agent. In 2013, 9 million people fell ill with TB and 1.5 million died from the disease. Over 95 per cent of TB deaths occur in low- and middle-income countries, and it is among the top 5 causes of death for women aged 15 to 44.
Tuberculosis (TB) is caused by bacteria (Mycobacterium tuberculosis) that most often affect the lungs. Tuberculosis and HIV form a deadly combination, claiming 600,000 lives a year in Nigeria, despite the fact that tuberculosis can both be prevented and treated.
For a long time, Zainab decided to keep her HIV status to herself for fear of being stigmatised. One of the hardest things for HIV and tuberculosis patients to deal with is the loneliness and isolation that this social stigma brings which is why most victims present themselves in late stages.
“I couldn’t tell anyone the cause of my husband’s death. Everyone thinks he died of malaria and typhoid” says Zainab as she narrates her ordeal. “When we were both diagnosed of HIV, he refused to register for free treatments but later I went back to try and register for the free drugs but was told that there was shortage of supply of HIV treatment drugs and it will take awhile before they get. After going to the hospital twice for the drugs and none was yet available, I left the hospital disappointed and I never returned until now,” she says with tears rolling down her cheeks.
Women play a central role in maintaining and improving the health of their children and families. Mothers are known to be caregivers, and when they become affected by disease, their illness leads to time off work, loss of income, and even death.
Several children have been orphaned because of tuberculosis and this deadly infectious disease has made families fell into a vicious downward spiral that may be carried forward to the next generation, pushing people deeper into disease and poverty.
“I cannot afford the treatment of tuberculosis and I don’t want to die now and leave my children orphaned. What will become of them if I die like their father? Who will care for them and bring them up properly?” asked Zaniab in despair.
Recently, the National TB and Leprosy Control Programme (NTBLCP) has said that over 600,000 new cases of tuberculosis have occurred in Nigeria, according to the survey conducted in 2014, with 91,354 cases placed on treatment.
National Coordinator, National Tuberculosis and Leprosy Control Programme, Dr. Gabriel Akang who made this statement during the 2015 World TB Day with the theme ‘Nigeria Unites Against Tuberculosis, in Abuja, said the World Health Organisation (WHO) ranked Nigeria to be 3rd among the 22 highest prevalence of TB burden countries in the world, adding that DOTS services are currently provided in about 6000 health facilities in the country and diagnosis in 1,515 microscopy laboratories.
In curbing these growing numbers of tuberculosis victims in Nigeria, organisations such as the Star Deepwater Petroleum Nigeria Limited, a Chevron Company with its Agbami Co-venturers recently donated fully equipped Chest Clinics and Science Laboratory complex to the Rimi General Hospital, Katsina State, Government Science College, Izom, Niger State, SMOH General Hospital, Kafanchan, Kaduna State and TB and Leprosy Referral Centre Tuberculosis and Infectious Disease Hospital, Chanchagi, Minna, Niger State.
Speaking at Protea Hotel, Asokoro, Abuja, during the handover ceremonies, the Director, Deepwater & Production Sharing Contracts, Mr. Jeffrey Ewing, who was represented by Senator Daniel Olugbenga Aluko, Director, Government Affairs of Chevron Nigeria Limited (CNL) said the Chest Clinic comes fully equipped with a standard X-Ray Machine, male and female wards, treatment rooms, laboratories and Gene Xpert machine while the Science laboratory complex is made of laboratories for physics, biology and chemistry and fully equipped with modern apparatus and regents to ensure the complex is conducive for teaching and learning.
He expressed gratitude to the management of Rimi General Hospital and the Project Manager for their efforts in making the building and equipping of the Chest Clinic a reality.
He said: “From December 2004 when the Agbami Project contract was awarded, Star Deepwater Petroleum Limited with its Co-ventures in the Agbami Field has consistently made it a point of duty to enhance the development of Nigerian capacities and capabilities in the oil and gas industry for maximum positive impact on Nigeria’s economy. These deliberate efforts have resulted in employment generation, higher local contractors’ participation in the design and fabrication of facilities for the project and training.”
“The Agbami Field is located approximately 70 miles (113 Kilometers) offshore Nigeria. However, in line with the Deep Offshore Community Affairs Group (DOCAG) engagement principles, we view the entire country as the Agbami Community. Consequently, the intervention by the group in the areas of education and health is distributed throughout the Nigeria and is adding value to Nigerians,” he said.
In addition to the Chest Clinics, he said: “We have implemented awareness programmes on HIV/AIDS, Malaria and other diseases in several communities across the six geo-political zones in the country. Medications were also made available to the people of such communities.”
The Katsina State Commissioner for Health, Mannir Ibrahim Talba who was represented by Dr. Muhamed Qabashiru, Permanent Secretary, Ministry of Health, Katsina State, said that the Chest Clinic is one of the most needed projects in the state.
He said: “The centre will enable the state handle patients who hitherto were referred to TB clinics far from Katsina State for treatment – especially those who have developed resistant to regular TB medications. We can now efficiently and adequately treat them. I want to assure that the centre will be a good example. It is going to be a center of excellence not only in the state but the world in general. Tuberculosis (TB) is bad and this chest clinic will help us to tackle it. We are ever ready to collaborate with the Agbami Co-venturers.”
Also, Mrs. Meg Irozuru, representative of Petrobras Nigeria Ltd. Said: “This health clinic is one of the projects embarked upon by the partners in line with the programme to help improve quality health care across the country. The partners’ interest and commitment to developing Nigeria’s health sector arises from the fact that we are responsive and responsible corporate citizens of Nigeria.
“Health, they say, is wealth and we believe that by supporting the government to improve healthcare delivery across Nigeria, we are not only fulfilling our Corporate Responsibility to the people, we are also helping to enrich them.”
She added: “We in Petrobras are delighted to see this project come to light. We are confident that the project will benefit the people as it will help to stem the tide of tuberculosis and other chest-related diseases in Katsina State and likewise Kaduna and Niger state while encouraging the communities to make good use of the facility so as to derive the benefit of this support.”
Isah Ibrahim, a worker with TB and Leprosy Referral Centre Tuberculosis and Infectious Disease Hospital, Chachangi, Minna, Niger State in an interview with THISDAY explained that many people think those who are infected with tuberculosis must also have HIV.
“For Zainab this was true, but it is certainly not always the case. TB is spread from person to person through the air. When people with lung TB cough, sneeze or spit, they propel the TB germs into the air. A person needs to inhale only a few of these germs to become infected.” he said.
About one-third of the world’s population has latent TB, which means people have been infected by TB bacteria but are not yet ill with the disease and cannot transmit the disease.
According to WHO, people infected with TB bacteria have a lifetime risk of falling ill. However, persons with compromised immune systems, such as people living with HIV, malnutrition or diabetes, or people who use tobacco, have a much higher risk of falling ill.
“When a person develops active TB (disease), the symptoms (cough, fever, night sweats, weight loss etc.) may be mild for many months. This can lead to delays in seeking care, and results in transmission of the bacteria to others. People ill with TB can infect up to 10-15 other people through close contact over the course of a year. Without proper treatment up to two thirds of people ill with TB will die.” Ibrahim said.
Dr. Julius B. Gajere, Medical Director, SMOH General Hospital, Kafanchan, one of the beneficiaries of the Chest Clinic in Kaduna State told THISDAY that with aid of the fully equipped Clinic, the hospital has been able to contribute its quota towards reducing TB burden in Nigeria and giving a ray of hope to tuberculosis victims such as Zainab who do not have the resources for treatment.
“Since the inception of the Chest Clinics, we have made over 10,000 visits aimed to screen, diagnose and monitor TB. More than 200 patients have been successfully treated and counting,” he says.
However, he listed challenges facing TB in Nigeria which include stigma, inaccessibility of tests to identify MDRTB gene and few MDRTB treatment centers, a scenario, which often lead to long waiting period for confirmed cases of MDRTB across the country.
Other challenges, according to him, include lack of proper awareness and nonchalant attitude of victims until they present very late. Some are caused by fear of stigmatisation most famous amongst women.
Tobacco use greatly increases the risk of TB disease and death. More than 20 per cent of TB cases worldwide are attributable to smoking.
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