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Tuberculosis: Early diagnosis, treatment key

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Tuberculosis diagram

As the World Tuberculosis (TB) Day is marked this Saturday, physicians have said the disease affects nine million people and causes death of about 1.5 million globally in a year.

TB is said to be the ninth leading cause of death worldwide and the leading cause from a single infectious agent, ranking above Human Immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS).

Seven countries account for 64 per cent of the total, with India leading, followed by Indonesia, China, Philippines, Pakistan, Nigeria, and South Africa.

To eradicate the disease, the experts advocate that government shows sustained political commitment; escalate availability of drugs and diagnostic facilities, increase health workers’ training, partnership with donor agencies, strengthening of tuberculosis control programme, as well as increase awareness among citizens through appropriate public health campaign.

Like most ailments, they said early diagnosis and treatment is key to prevention. This includes immunisation of children with Bacillus Calmette Guerin (BCG) vaccine and provision of prophylaxis to vulnerable group. Early diagnosis of HIV infection is a co-morbidity and important driver of TB.

There is also need for effective support and motivation to those on treatment to complete therapy, as well as provision of infection control facilities in hospital and personal protective equipment to health care providers to limit spread, teaching of cough etiquettes, stepping up advocacy about TB transmission and treatment, among others. Sufferers need support and removal of barriers and stigma associated with the disease.

A Consultant Respiratory physician with Department of Medicine, Lagos State University College of Medicine Ikeja, Dr. Olayinka Olufunke Adeyeye said this year’s theme: ‘Wanted: Leader for a TB-free World. You can make history and End TB’ is in line with the global journey to eradication of tuberculosis, which is a potentially preventable disease, has come a long way.

She said: “From 1993, when the World Health Organisation (WHO) noted the global burden of this disease and declared a state of emergency on it and adopted Directly Observed Treatments (DOTs) strategy to combat it, different efforts and strategies have emerged to bring about an end to TB, but unfortunately, this is yet to happen. The stop TB strategy was adopted in 2005.

“In 2016, End TB strategy/post TB strategy was adopted, which aimed to reduce deaths by 95 per cent, cut new cases of TB by 90 per cent and ensure no family is burdened with catastrophic expenses due to TB. In this strategy, the vision is a world that is free of TB, zero deaths from TB and zero suffering from TB 2016 to 2035.”

She explained that a TB leader could be any one from the president, head of state, governors, local government chairmen, community leaders to the citizens, or any one at all that will advocate, speak up and engage with the aim to end TB.

“The world needs individuals and non- governmental organisations to show leadership in this regard and not only the political leader to help make the dream of a TB-free society a reality. Relying only on government may not be enough.

There is need for greater call to action by everyone to build capacity for a TB-free world by increasing leadership awareness to end the disease.

This year, activities and commitment are to ensure that leaders, who will increase the awareness needed to ensure TB receive the needed attention at the forthcoming planned United Nations (UN), General Assembly High-Level Meeting on TB, are made.

“Leaders for a TB-free world have roles to play. They need to raise awareness around TB, as people lack adequate information about drive policies that support the poor and marginalised.

There should be no discrimination, no catastrophic cost, and people need to know that treatment is available, that it is free. And they should know where to go for the treatment. Leaders should accelerate the end TB response; ensure implementation of the commitment made by ministers at the meeting in Moscow that this translates into action. It is by raising awareness that people will know for what to hold the government accountable.”

She said there is need to advocate highest level of participation at the UN for TB; request for accelerated increased and sustainable funding for TB care, as well as call for increase in investment for TB researches.

“How can individuals become leaders for a TB-free world? They need to educate themselves about TB; raise awareness about TB; speak to colleagues, employees, family, church and schools, among others. They should stimulate leadership and action by organising activities and campaigns in their surroundings,” she explained.

A Consultant Family physician, Dr. Ademola Olumide Orolu said the commonest cause of tuberculosis is the bacterium mycobacterium tuberculosis. Other causes include mycobacterium bovis, transmitted through ingestion of unpasteurised milk, mycobacterium africanum, mycobacterium canetti, and mycobacterium microti.

He explained that it is important for individuals to note that tuberculosis is a preventable disease.

He said: “The mode of spread is through airborne transmission of droplets of the bacterium from infected patients to others. This is possible through repeated close contact with infected persons who may cough or sneeze.

Such close contact can be seen in households, boarding institutions, open office settings, and any circumstance, which brings people together for a long time.

“A brief contact with a patient, who has tuberculosis is not enough to infect people in most cases. Tuberculosis can also be transmitted through consumption of unpasteurised milk, in which case the disease is transferred from infected cows or dairy animals to man.

“In developing nations, overcrowding is a major risk factor in the transmission of the disease from the patient to other unaffected persons. Hence, community planning and housing needs to be done in such a way as to prevent overcrowding. Conditions, which weaken the immune system, such as cancers, medications to treat cancers, HIV/AIDS, poorly controlled diabetes mellitus, increase the chance of an exposed individual having the active disease.

“Hence, efforts should be made to ensure that individuals have good immune system through regular medical evaluation. It should be noted that tuberculosis causes the patient loss of direct income, loss of days at work, loss of play, as well as the risk of stigmatisation. Therefore, prevention cannot be over emphasised.”

He explained that signs and symptoms of tuberculosis depend on the affected organs. Tuberculosis of the lungs, the commonest form of the disease, manifests as a combination of persistent cough, lasting for at least two to three weeks, fever of more than three weeks, unusual night sweat of three weeks or more and weight loss. Such individuals may appear sick, although those with strong nutrition and immunity may appear well.

“This explains why such apparently well individuals would infect so many people before they report to the hospital for evaluation. Abdominal tuberculosis may manifest as abdominal pain, loss of appetite, weight loss, constipation or diarrhoea, depending on the specific type of abdominal tuberculosis.

“Tuberculosis of the spine manifests as persistent back pain, difficulty with walking, prolonged fever or weight loss. Other parts of the body that can be affected include the genitourinary system, genitourinary tuberculosis, the covering of the central nervous system, tuberculosis meningitis and the covering of the heart pericardial tuberculosis, among others.”

He advised that any individual experiencing the above listed symptoms should consult a medical doctor immediately.

“Proper evaluation would assess the possibility of such complaints being caused by tuberculosis. A few investigations would be requested to confirm the clinical diagnosis of tuberculosis.

“Thereafter, medications are commenced. Just as in some other chronic medical conditions, a combination of medications is used in the treatment of tuberculosis. Irrespective of the type of tuberculosis infection, the medications are used for at least six months.

“DOT is a public health approach in which medical personnel confirm that the patient takes the medication. Appropriate treatment ensures recovery and helps prevent further spread to other individuals. Regular follow-up clinical evaluation is essential to assess if the patient is making progress.

“In terms of individual differences, any other medical condition, which can impair the immunity, is also screened for in the work up of a patient who has tuberculosis. Such conditions are also treated to achieve optimal recovery,” he said.

In addition, other close contacts of every patient with the disease should be screened to rule out the active disease in them. For those who do not have active tuberculosis, Isoniazid therapy for six months is recommended. This has been proved to prevent progression to the active disease. Close contacts with the patient are treated accordingly.

“Beginning from birth, children, especially, in countries with a high burden of the disease, are given the Bacillus BCG vaccine, which helps prevent having the active disease later in life.

“The higher the numbers of people immunised against tuberculosis, the higher the herd immunity, which helps protect the few unimmunised individuals because the disease is rarely present in the community.

Unimmunised migrants from countries, with low prevalence of the disease who desire to visit other countries, where the disease is prevalent should also get immunised prior to entry. Efforts to eradicate poverty and overcrowding are social measures to prevent the disease.”



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