BEREFT of an efficient health care system and a genuine commitment to its eradication, Nigeria has remained stuck among countries with a malignant presence of the deadly tuberculosis infection. Nigeria in 2018 came sixth, behind India, China, Indonesia, Philippines and Pakistan, in the global total of TB, says the World Health Organisation’s Global Tuberculosis Report 2019. Every year, around 245,000 Nigerians die from the disease and about 590,000 new cases occur. Of these, around 140,000 are also HIV-positive. TB accounts for more than 10 per cent of all deaths in Nigeria. Every hour, nearly 30 people die from the disease, despite effective treatment being available.
Already the clear leader in Africa, the country has made very little progress over the years in her avowed bid to end the TB scourge. Rather, owing to the lack of a reliable nationwide survey, cases of TB in Nigeria are believed to be grossly understated.
It should, therefore, not come as a surprise that, with just 10 years away from the WHO 2030 target date for the eradication of the killer disease, there is no reason to be optimistic about the country achieving this goal. Ayodele Awe, the Coordinator of the WHO TB Programme, confirmed this when he said “…this is 2020; the progress we are making is not enough.”
The main obstacle to cutting the numbers has been that of identifying those carrying the disease so that they can be treated and prevented from spreading it. While the country is estimated to have over 400,000 cases of TB infection each year, Nigeria had not been able to identify over 300,000 of such cases. “We have the highest burden in Africa; we are supposed to detect 420,000 cases every year. Last year was the greatest number that has ever been detected … We were able detect to 120,000 cases. Where are the remaining 300,000 cases that are still coughing?” Awe queried.
Nigeria needs to awaken and join the league of countries that have curbed the destructive impact of the disease, which the immediate past Minister of Health, Isaac Adewole, described as an epidemic. As long as the unidentified cases continue to roam freely, they risk infecting between five and 15 other people yearly. To successfully track them, the country needs to invest more resources by closing the funding gap currently put at $157 million.
The global health agency, through its “End TB Strategy” and the “Sustainable Development Goals”, seeks to reduce the TB mortality rate by a massive 90 per cent and the incidence (new cases of infection) by 80 per cent by 2030, compared to the 2015 situation. TB’s high mortality rate of 1.3 million deaths globally in 2016 overtook HIV, the erstwhile leading infectious disease killer, which WHO credited with one million deaths globally. Latest figures indicate that TB mortality rate rose to 1.5 million in 2018.
Tuberculosis is a bacterial infection caused by Mycobacterium Tuberculosis which, most often, affects the lungs. It is characterised by symptoms such as coughing with sputum and sometimes blood, chest pains, night sweat, body weakness, fever and weight loss. Infection from person to person occurs when an infected person sneezes, spits or coughs, emitting the germs into the air. Once a healthy person inhales the germs, he becomes infected.
Although both preventable and curable, 154,000 Nigerians die of the disease each year, figures from TBFACTS.ORG indicate. Describing its destructive power, the website said, “When TB wakes up and gets into the lungs, it eats them from the inside out, slowly diminishing their capacity, causing the chest to fill up with blood and the ‘liquidy’ remains of the lungs.” When liquid replaces the lungs, the patients can no longer get enough oxygen as a result of respiratory failure, resulting in a painful death.
Experts say there is indisputable evidence that TB is a poverty-related disease that concentrates in the most vulnerable, marginalised and hard-to-reach populations. Incidentally, it is not everybody infected that will exhibit the symptoms or become ill. If a person has a strong immune system, the person could live a normal life without coming down with the disease. This however makes it easy for the infection to be spread if the latent pathogens become active in future due to compromised immunity.
The crisis in Nigeria has been made worse by the issues of drug-resistant TB and the HIV/AIDS epidemic. People with HIV are particularly vulnerable. WHO says people living with HIV “are 19 times (on the average) more likely to develop active TB disease than those without HIV.”
In these days of the coronavirus disease, TB has also been identified as an underlying disease, which could result in death in the case of a co-infection. Surviving a coronavirus infection is dependent on a strong immune system, which explains why mortalities have been higher among the elderly and people with underlying illnesses whose immune system have been compromised. Another vulnerable group is children, whose immune system may not be as well developed as those of adults.
To reduce the rate of infection, there is the need for increased awareness among the people about the need to know their status. This can only be done by going for testing. Anybody who is aware of his or her status can then have a good reason to seek treatment. The WHO says that an estimated 58 million lives were saved through diagnosis and treatment between 2000 and 2018. These are people that would not only have died eventually, but would have continued transmitting the disease.
Managing the risk factors would go a long way in reducing mortality, especially among smokers who are quite vulnerable too. Malnutrition is also a risk factor in much the same way as diabetes. Due to the high cost of treatment, the government should create more diagnostic and treatment centres, especially to guarantee access by those in the rural areas.
Eradicating tuberculosis globally presents formidable challenges. The World Economic Forum says closing the funding gap and ending the scourge requires the involvement of more — and more diverse — donors. Government should lead the way with renewed commitment and mobilise the private sector and philanthropists to make direct contributions. It needs to step up all efforts to create the right incentives towards achieving the SDGs target.
In short, eradicating the TB epidemic presupposes efforts to ensure that health-care systems are capable of delivering the right care. And the right care requires rapid development and dissemination of new tools, including quick point-of-care diagnostic tests, safe and fast-acting drugs, and an effective TB vaccine.
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