Screening, treatment can dramatically reduce TB burden


TUBERCULOSIS (TB) is the third biggest killer infectious disease in Tanzania, behind malaria and HIV/AIDS, according to the National Tuberculosis and Leprosy Programme (NTLP).

Every year an average of 62,000 new cases of TB are recorded in the country as the disease mostly ravages the male population aged between 15 to 45 years.

“The average number of TB cases recorded every year is too small compared to the set World Health Organisation target of 160,000 TB new cases which are to be recorded annually,” says Dr Allan Tarimo of the National Tuberculosis and Leprosy Programme in the Ministry of Health, Community Development, Gender Elders and Children.

Dar es Salaam, the country’s commercial capital with its burgeoning population, is notoriously becoming the hotspot for TB because of the higher incidence levels of new cases recorded every year compared to other regions of the country, Dr Tarimo says.

So how has this ancient disease come to pose such a major risk to public health in Tanzania and the world at large? It surprises many people that the disease remains one of the great scourges in human history.

One out of every three people in the world is infected with latent or sub-clinical TB, and scientists predict that 10 per cent of them will manifest the disease as age and other illnesses compromise their immune systems.

TB is a bacterial infection, caused by Mycobacterium tuberculosis, which most often affects the lungs but can attack any part of the body, including the spinal cord and brain.

It is an infectious disease transmitted from person to person via airborne particles, which once inhaled can become the source of a new infection. Contrary to common misunderstanding, TB is not sexually transmissible.

The WHO says around one in three people live with a latent TB infection, where the bacteria reside in the person's body but are not transmissible and do not cause significant damage.

When a person's immune system is compromised—for example, through infection with HIV, during cancer treatment, or in smokers—a latent TB infection can evolve into a full-blown case.

The bacterial infection is a global disease, but the WHO found that South East Asia and the Western Pacific region—which includes China and the countries of Oceania among others—accounted for 56 percent of new cases in 2013.

Africa, however, had the highest rate of new cases per population at 280 cases per 100,000 people. TB epidemiologists say the disease strikes wherever poverty is found. All over the world, TB affects the most marginalised communities, they say.

In Dar es Salaam, for example, social and biological factors combine to make it an ideal breeding ground for the bacterial infection. According to the NTLP surveys, factors which increase the likelihood of developing active TB -- including poor housing and HIV infection -- are more commonplace in Dar es Salaam than elsewhere in the country.

The NTLP strategy to fight TB from the country is directed towards improving screening and follow-up treatment taking into account WHO's Stop TB Strategy, launched in 2006 with the aim to "dramatically reduce the global burden of TB.

Tanzania, like other countries, has a great work to be done in the fight against the disease in terms of creating awareness among the population, especially in rural areas. The most common symptoms of TB are a persistent cough with blood in the sputum, as well as chest pains, general fatigue, fever, weight loss and night sweats.

In Tanzania, NTLP experts advise that patients should see a doctor if they have a cough lasting more than three weeks or if they are coughing up blood. Generally, there are several reasons why TB persists which include lack of knowledge among the populace in understanding the sociology behind it, scientists lacking an effective paradigm to attack it, and the rich and famous no longer die from it.

TB once affected every stratum of society, but it now afflicts the most vulnerable populations. This makes it an ideal meme for artists and activists who focus on social justice.

The incidence of drugresistant TB is on the rise, because the health-care systems of poor countries lack the re sources to screen for TB and to help patients comply with their therapies.

TB is a disease that can destroy the lungs. About 9 million new cases are diagnosed worldwide every year, one-quarter of them in Africa. Africa also has the highest TB death rate per head of population.

Antibiotics can cure TB, but it’s fatal if untreated, and many patients are never diagnosed. This is partly because the 125-year-old microscopebased test used across Tanzania (and in many other cashstrapped countries) picks up only about 60 per cent of cases, a figure that drops as low as 20 per cent for people also infected with HIV.

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