• One Person Dies Of TB Every Five Minute In Nigeria 
• $13b Needed Yearly For Prevention, Dignosis — WHO

As the world marks the World Tuberculosis (TB) Day today, the disease has remained the leading infectious killer disease in the world and among the top 10 causes of death worldwide.

Meanwhile,142 years after the cause was discovered, the whole world is still battling with the scourge of TB, as it is  still ravaging and sending many into extinction. 

Despite being both preventable and curable, about 1.9 billion people, representing one-quarter of the world’s population, are infected with TB, live with the causative organism, in a dormant/inactive state.

Every year, it is estimated that 10 million people develop active TB disease following the re-activation of the dormant organism or from community transmission of active forms of the organism. Of the number , approximately 1.1 million are children and 860,000 people living with Human Immunodeficiency Virus (HIV).

Three million persons miss out on care and treatment yearly, another 500,000 develop a drug-resistant form of TB (DR-TB; not curable with usual TB drugs), with only one in three able to receive the appropriate treatment for DR-TB.

According to World Health Organisation ( WHO), about $13 billion is needed yearly for TB prevention, diagnosis, treatment and care to achieve the global target agreed at the 2018 UN high level-meeting on TB.

In Nigeria, a death certificate is issued every five minutes for a disease that is curable and preventable.  Available statistics from the WHO shows that in Nigeria, one person dies every five minute from TB and Nigeria has the highest TB burden in Africa and sixth in the world, accounting for about 4.6 per cent of the global TB burden

Specifically, about 15 Nigerians die each hour due to TB, equivalent to about 347 deaths daily, 10,417 monthly and 125,000 in a year.

Nigeria’s TB incidence rate is about 219 in a 100,000 population with an estimated total of 467,000 persons who have active TB disease.
According to WHO, about 245,000 Nigerians die from TB , while 590,000 new cases of the disease are recorded every year .

Nigeria has a high triple burden of TB, Drug Resistant TB (DR-TB) and HIV-associated TB, and is one of the 10 countries that contribute the highest number of missing TB cases globally

As the world marks the 2024  Tuberculosis Day , the WHO has said that 10.6 million people fell ill with TB in 2022 while 1.3 million people died of TB in 2022

According to the WHO, about 75 million lives have been saved since 2000 by global efforts to end TB. Consequently, the global health body has called for High-level leadership action to end TB.

With the theme, ‘Yes! We can end TB!’ WHO stated that getting back-on-track to turn the tide against the TB epidemic is possible through high level leadership, increased investments and faster uptake of new WHO recommendations. TB is an air-borne disease caused by a germ known as Mycobacterium Tuberculosis.

According to experts, persistent cough for two or more weeks could be tuberculosis, and it is advised that the only way to get the right diagnosis is by visiting a health facility for test or seeing a qualified health care provider.

In 2021, the National TB, Leprosy and Buruli Ulcer Control Programme (NTBLCP) notified 207,785 having a gap of 56 per cent of the estimated cases unidentified.

In 2021 about 2,975 DR-TB cases were diagnosed out of an estimated 21,000 cases in the country, leaving more than 80 per cent of the resistant cases missing

Though Directly Observed Treatment short course (DOTs) clinics for TB treatment and care are available in up to 50 per cent of health facilities in Nigeria, only nine per cent of these have facilities for laboratory diagnosis of TB infection and disease.

TB Disease is often more severe in children less than 15 years, with higher mortality amongst those less than five years. The notification of children with active disease and latent TB has remained abysmally low, accounting for just six per cent (out of the country’s total of 450,000) of all forms of notified TB cases in 2021.

Only about 11 per cent of children with TB disease out of the estimated country total of 77,000 cases were notified in 2021 by the NTBLCP.
Nigeria has a 69 percent funding gap for TB, of the $373 million needed for TB control in Nigeria in the year 2020, only 31 per cent was available to all the implementers of TB control activities in Nigeria (seven per cent domestic and 24 per cent donor funds), with a 69 per cent funding gap. The seven per cent domestic contribution is mainly for personnel.

To reduce the scourge of TB, global leaders at the United Nations High-Level Meeting (UNHLM) in 2018 set a global target to identify more TB cases and put people on treatment by the year 2025. The target is a road-map to ending TB by the year 2030.

In spite of the fact that that Nigeria accounts for the high burden of the disease, it still has a 70 per cent funding gap in TB with high level of donor dependency and infrastructure deficit which hinder access to essential TB services, including diagnosis and treatment.

To mark the 2024 TB day, Nigeria has adopted a slogan, ‘No gree for TB, Check am o!’. The Acting Executive Secretary of the Country Coordinating Mechanism (CCM) of the Global Fund, Ibrahim Tajudeen told The Guardian that in allocating resources to Countries, the Global Fund uses a combined methodology which primarily consider disease burden and income level adding that the approved allocation USD 153,771,804 to
Tuberculosis for 2024-2026 Implementation period by the Global Fund Board is because of the concerns recognized about Nigeria. 

He said, ‘Due to our economic situation, we are classified as a lower middle-income. Also, Nigeria is of the country that accounted for about two thirds of global cases of Tb in 2022.

The Global Fund has invested about $200 million to support Tuberculosis program in Nigeria including mitigation funds from the COVID-19 Resource Mobilization grant.

He observed that Nigeria government is yet to invest adequately in the TB programme like that of HIV/AIDS,however, some state like Lagos and Kaduna are experiencing increase domestic financing for tuberculosis intervention.

Tajudeen explained that the donors are responsible for the financing of TB program worth over 92% while domestic financing cater for about 8%.
He noted that there are several challenges confronting TB response in Nigeria ranging from poor infrastructure, inadequate medication and consumables, inadequate diagnostics tool like GeneXpert machine, maintenance, and power supply to facilitate ambient environment for the diagnostic tool.

He said, ‘Another major challenge is the inadequate health workers (retirement and staff attrition). The budget required on yearly basis for the TB interventions is about $300 million yearly and this pose threat to the current momentum with country increased case notification to over 300,000 in the year 2023’.

Tajudeen said that Nigeria can actualize the realization of end Tb target by the year 2025 if adequately resourced. Speaking with The Guardian the Acting Board Chair, Stop TB Partnership Nigeria, Queen Ogbuji-Ladipo  said that the world is still battling with tuberculosis 142 years after it was discovered because people that are malnourished, it lowers the immunity so the baterium that causes TB can thrive. 

She said, ‘When a child is born, that child is given BCG to protect that child against the severe form of tuberculosis but when there is malnutrition, diabetes, HIV or any condition that lowers somebody’s immunity, the body is susceptible to tuberculosis and then tuberculosis can occur.

She observed that Tuberculosis continues to be a major public health concern, claiming far too many lives each year, particularly in Nigeria and despite advancements in medicine and healthcare, TB remains a formidable adversary, disproportionately affecting vulnerable populations and underserved communities. 

Some of our young youths that are “japaring” now, the International Office of Migration (IOM) informed us that many of them harbor the infection but they do not have the disease. So you see them looking well but when you do the test you will find out the tuberculosis is hiding there. For such people, just having something that lower their immunity, the disease will come out but they won’t know that they have been harboring it.

That is the good thing with the protection we give children at birth, when we eat well, not stressed and don’t have any other diseases that we call ‘’ comobidity’ then most people are protected’.

Now even when we have somebody that has the disease in the house, we protect the other members of the family with that TB preventive treatment that we call TPT so it protect the whole family so that while you are treating somebody that has the disease, those people are infected because the disease is not showing signs and symptoms will also be protected and won’t come down with the disease’.

On why Nigeria has a a high burden of TB, Ogbuji-Ladipo said, ‘Ngeria has a very high burden of tuberculosis because in Nigeria it is a disease common in men and those that are HIV positive because their immunity is low. Now we are seeing it in children because the children that are malnourished usually come down with tuberculosis because if an adult around them is coughing they can easily catch it even though they are immunized.

‘There are other factors that affects because men don’t usually go to the facility, their health care behavior is poor so they kept on buying cough syrup and won’t go for treatment. More women come out for testing but the few men that come out for testing are more positive than the women that are coming out.

All the people that have a crowded living condition, poverty as a whole is a thriving condition for tuberculosis and that’s one of the reason why it is still high in Nigeria. When we address the issue of stigma, people are more comfortable to come out, more comfortable to let their family members know and they are screened on time and are put on treatment early’. 

According to her, ‘We can end tuberculosis in Nigeria by prompt diagnosis and treatment, protecting the people that are in contact with those that are positive so that they don’t come down with the disease and continue our immunization at birth, continue to improve the standard of the living condition of people’.

‘Once the living standard condition improves, people are less likely to go into crowded living environment. With the condition in our country today, our fear has increased, that’s why we continued to educate people what they can do, how to eat well, the first lady has said that every woman should have a garden’.

In her massage to mark the World TB day, 2024, WHO Regional Director for Africa, Dr Matshidiso Moeti called on countries to prioritize addressing the social determinants of TB, such as poverty, inequality, and limited access to healthcare, to achieve sustainable outcomes.
She stated that the 72nd session of the WHO Regional Committee for Africa in Lomé, Togo, in 2022 ignited a powerful movement toward ending tuberculosis (TB) – that of prioritizing childhood TB. Ministers of Health across the region united to address the needs of this often-overlooked population.

Moeti noted that since then, a 20% increase has been recorded in identified paediatric TB cases compared to the previous year. This signifies a positive step, indicating a more practical approach to recognizing TB in children and a decisive push to end this ancient disease.

She said, ‘TB continues to be the second leading cause of death from a single infectious agent, surpassing the toll of HIV/AIDS. According to the latest report, about 2.5 million individuals contracted TB in 2022 in the region, equating to one person every 13 seconds. Additionally, the number of TB deaths in 2022 reached 424,000, resulting in the loss of one life every minute—even when TB is preventable and treatable. These figures underscore the urgency of our collective action in addressing the ongoing TB epidemic and highlight the need for sustained efforts to end it’.

Moeti observed that between 2015 and 2022, the African region has achieved a remarkable 38% reduction in TB deaths, surpassing the initial End TB Strategy milestone of 35% by 2020.

She noted that from 2015 to 2022, the region also saw a 23% reduction in new TB cases, exceeding the initial End TB Strategy target of 20% by 2020 as a result of effectiveness of implemented strategies and renewed commitment from countries.

Moeti however, pointed out that while the reduction in TB deaths is commendable, it still falls short of the 2025 End TB Strategy target of a 75% reduction.

‘Similarly, the 23% decline in TB incidence mises the mark of the 50% reduction target for 2025. This highlights the need for continued and intensified efforts to meet these ambitious goals’ .

She cautioned that challenges such as delayed diagnosis, limited access to new tools and technologies, and the ongoing threat of multi-drug resistant TB require continued vigilance and sustained efforts. 

She urged Member States to prioritize a multi-faceted approach that addresses the root causes of the disease while bolstering our efforts in prevention, diagnosis, and treatment and appealed to health leaders to intensify their commitment to strengthening health systems, ensuring equitable access to TB care, and scaling up innovative interventions.

‘’ Investing in research and developing new tools, including vaccines and improved diagnostics, is essential to accelerate progress. Stakeholders can join us by providing resources, enhancing community engagement, conducting research, and forming private-sector partnerships. Through this unified action, we can address the challenges of TB in Africa and achieve our goal of its elimination as a public health threat’, she added . 

The National Programme Officer for TB, WHO, Amos Omoniyi,  wondered why anybody should die from a disease that is curable just with 6 months treatment and preventable with 12 doses of medicines, or one month or 6 months doses.

He stressed the need to increase awareness about TB symptoms and treatment options, emphasising the role of communities and individuals in advocating improved healthcare services. Omoniyi warned that TB anywhere, is TB everywhere adding that one person with TB can infect 12-15 other persons annually.

He noted that the commonest symptom of TB is cough and people can contract the disease when the person with TB Coughs, sneezes, sings or talks.
Omoniyi advised any one coughing for 2 weeks to go for TB test.