Tuberculosis (TB) remains one of the world’s most major causes of death worldwide says Dr. Wilson Osarogiagbon, a Consultant Pediatric Pulmonologist in a lecture delivered at the Institute of Child Health, University of Benin to celebrate the World Tuberculosis Day on Monday, 25th March, 2013. He said that TB is an air-borne infectious disease caused by the bacilli of the genus Mycobacterium with several species, however, Mycobacterium tuberculosis is the most important cause of tuberculosis disease in humans. Although the disease may affect other parts of the body such as the brain (causing TB meningitis), bones, abdomen, etc it is a disease that primarily affects the lungs. He went on to describe the Mycobacterium organism as obligate aerobes, and that the tubercle bacilli is tough, stubborn as well as being slow to stain, slow to grow (– generation time 10 – 24 hours; incubation period 4 – 6 weeks), slow to infect, slow to spread, and slow to succumb to treatment.
Dr Osarigiagbon stated that M. tuberculosis is almost always acquired by inhalation of droplets (things you can cough out or sneeze out) from an infectious person but M. bovis which is the major cause of tuberculosis in cattle may infect humans when they drink unpasteurised infected milks. Man can also be infected by coming in contact with meat infected with TB. He said that though TB is a major cause of death especially in children; most children infected with TB got the disease from adults with the active disease and he showed a cycle of the disease transmission from the old (adult) to the young (child). He however stated that one of the major ways of preventing the disease transmission is by breaking this transmission cycle.
One third of the world’s population carry the TB bacteria and about 75% of global TB burden are in 22 countries of Africa, Asia and Eastern Europe. These are called the High Burden TB countries and Nigeria ranked 10th among the 22 TB burden countries in the world and 4th in Africa (2011). Dr Osarogiagbon said that more than 9 million people world-wide become sick each year with active TB that can be spread to others and that about 1.7 million people die each year from TB. In every 20 seconds, 1 person dies from TB and that more than 90% of new TB cases and deaths occur in developing countries. He went on to say that in 2009, there were an estimated 9.7 million (range, 8.5–11 million) children who were orphans as a result of losing at least one of their parents to TB (including HIV associated TB). One third of more than 42 million people with TB are also infected with HIV and TB is leading cause of death amongst people living with the virus.
The World Health Organization (WHO) estimated that 210,000 new cases of all forms of TB occurred in Nigeria in 2010, equivalent to 133/100,000 population and there were an estimated 320,000 prevalent cases of TB in 2010, equivalent to 199/100,000 cases. Dr Osarogiagbon told the audience that the main goal of Nigeria’s TB program is to halve the TB prevalence and death rates by 2015 and that the good news is that TB is preventable and treatable. As at the end of 2010, TB death rates had declined from 11% in 2006 to 5% in 2010.
TB is in all states of Nigeria but the most affected states were Lagos, Kano, Oyo, Benue and Kaduna. Edo State being the 20th most affected States in Nigeria in terms of number of TB cases notified in 2010 in Nigeria. The worst age group affected is the 15 to 54 years of age group which constituted the work force age group of the nation.
Before he described to the audience how to know or identify an individual with TB, he discussed a phenomenon called Multi-drug Resistance Tuberculosis (MDR-TB) which he said is TB that is resistant to any of the first-line drugs, specifically Rifampicin and Isoniazid. The lecturer emphasized that the emergence of MDR-TB also posed a threat, which if not effectively addressed, may wipe out the achievements of previous efforts in controlling TB. He said that this type of TB can result from non-compliance to TB medication in individuals who had commenced treatment for TB either by not taking the TB drugs regularly as prescribed or by not completing medication according to the stipulated period of time for treatment. The estimated number of MDR-TB cases among notified TB cases was 2,400. The major problem with MDR-TB is in diagnosis because there are only four reference laboratories providing services for drug resistant TB in Nigeria. Drug treatment also poses a challenge as it requires the second line anti-TB drugs which are more expensive.
Clinical features of TB include chronic cough (cough lasting 3 weeks or more). [Cough may be absent in children]. Other features are blood in sputum, prolonged fever, marked weight loss and weakness, low Packed Cell Volume, failure to thrive in children, abdominal swelling and pain. It could be just swelling around the neck as shown below:
The lecturer went on to discuss the TB control strategies which he divided into three principles as follows: (i). To decrease the population of infector by contact tracing and treatment of infected adult – Directly Observed Treatment strategy; (ii). Prevent natural infection by good housing and vaccination (immunization with Bacille Calmette Guerine (BCG); (iii). The STOP TB partnership, launched in 2006-2015, which setted out the activities that would make an impact on the global burden of TB. This involves reducing the TB incidence by 2015 and halving TB prevalence and deaths compared with 1990 levels
Dr Osarogiagbon highlighted some of the challenges encountered in some of these control programs. These included Poor health infrastructure and facilities; Poor referral systems and lack of effective collaboration between the TB and HIV programs; Poor TB drug procurement and supply management system; and Poor donor coordination locally and internationally. Again Dr Osarogiagbon noted that TB program in Nigeria is donor-dependent with the United State of American Government and Global Fund as the major donors. Support from other development partners included WHO; Leprosy Mission in Nigeria; Netherland Leprosy Relief; German Leprosy and TB Relief Association; Damien Foundation of Belgium; International Union against TB and Lung Disease; Canadian International Development Agency; and UK Department for International Development.
What then is individuals’ role in “stopping TB in their life time?”(This being the theme of this years’ World TB Day). Dr Osarogiagbon re-emphasized that individuals must prevent or avoid TB by avoiding overcrowding and smoking, ensuring adequate nutrition by eating good food to improve personal immunity, ensuring a voluntary counselling and testing for HIV and that HIV positive individuals should be screened and treated for TB; getting TB screening in any individual who had been coughing for more than 3 weeks as well as covering the mouth while coughing.
For health workers, he admonished that they should adopt universal precautions in the management of TB patients. To prevent TB in children every new born must be immunized with BCG. Other activities that would help Stop TB include:
- Encouraging and supporting friends and family who have TB to comply with treatment to avoid MDR-TB.
- Passing the message of TB control to others.
- All individuals must work with the Government and organizations to stop TB by supporting the government by engaging in public enlightenment programs, by being part of Non-governmental Organizations, forming local and professional organizations targeted at controlling TB, and forming clubs or associations in schools for TB control.
In conclusion, he stated that TB still remains a problem in our environment and it is a disease that affects both adults and children. All individuals have roles to play directed to self, to others and to the Government.
Written by Dr Damian, U. NWANERI (Research Fellow I, ICH UNIBEN)
Edited by Dr Mrs Ayebo SADOH (Senior Research Fellow, ICH UNIBEN)