Medics at Fort Portal Regional Referral Hospital in Uganda are still battled by the high rate of tuberculosis (TB) drug defaulters which is stumbling the government’s efforts to fight the disease.
Medics at Fort Portal Regional Referral Hospital in Uganda are still battled by the high rate of tuberculosis (TB) drug defaulters which is stumbling the government’s efforts to fight the disease.
The hospital director, Dr Charles Olara, revealed that health workers are finding the biggest challenge in the fight against TB is the defaulters who stop taking TB drugs before their dose completion.
“The major challenge in the management of TB is the high defaulting rate,; many patients are not completing their treatment. For the last year we have had 167 defaulters,” Olara revealed.
Olara warns that once a person defaults treatment they are more likely to go to second line treatment and run a risk of creating a multidrug resistant TB which is expensive to treat.
“Treating TB may cost about $30 but for multidrug resistant it may take $ 3,000 dollars, Patients become resistant to Isioniazid and Rifampicin, the two most widely available anti-TB drugs, because of a failure to take medication at the right times and also defaulting,” Olara explains.
Olara revealed they are looking forward to having counselors who would also monitor medication through the prescribed period, which could reduce the number of ‘defaulters’ who stop taking their medicine.
Olara also believes taking medicine correctly is a big challenge as there are no supporters to guide patients.
The hospital boasts of a new TB testing machine, which has made it easy for medical staff to detect the disease as it cannot be detected by microscopes.
“We now have a new machine, [GeneXpert] which easily detects TB which cannot not been detected by the Microscope. It is now easy to diagnose the patient, when the microscope proves negative we subject them to GeneXpert” Olara said.
GeneXpert, made by Cepheid, was endorsed by the WHO in 2010 as a “major milestone for TB diagnosis and care” and hailed as revolutionary by experts. It allows diagnoses to be made in around 90 minutes rather than the several weeks needed with sputum smear tests. Its sensitivity is about 98% compared to smear microscopy’s 35-80%, and it requires very little technical training to operate.
However, more attention and seriousness should also be put to TB patients as it is in HIV because they intermarry.
“When you have HIV and TB, what is most likely to kill you is TB, so with every HIV patient they have to be screened of TB first” Olara revealed.
He explains that people are defaulting partly due to education, distance, and transport to health facilities but explains that the government is doing all possible to reach the communities.
“Government is addressing this by offering services nearer to the people, especially all health center IVs. However, some people still think of witchcraft, but sensitization is also one way of helping the defaulters,” Olara said.
He says with HIV, the TB pandemic has increased as people living with HIV are more susceptible to co-infection.
“TB is acquired through the air and is all around us – in taxis, classrooms, offices – and what normally protects you is the high immunity one has. But HIV patients, whose immunity is broke, they [can] easily succumb to it and this poses a big threat to life.
“The best way to prevent and fight TB is through immunization at childhood. To boost one’s immunity early diagnosis, taking the right dosage at the right time and stopping stigma [is what’s needed].”
Due to co-infection with TB and HIV, and the emergence of multidrug-resistant TB, efforts to make quality care accessible to all Ugandans has been hampered.
TB is a major cause of death among people living with HIV and AIDS. In Uganda, 50% of TB patients are infected with HIV and 30% of AIDS-related deaths are attributed to TB. Eliminating TB depends on the development of new drugs and vaccines, and coordinated efforts to fight diseases in an integrated, collaborative way.
What is tuberculosis?
Tuberculosis (TB) is an infectious disease caused by bacteria whose scientific name is Mycobacterium tuberculosis. It was first isolated in 1882 by a German physician named Robert Koch. TB most commonly affects the lungs but also can involve almost any organ of the body. Many years ago, this disease was referred to as “consumption” because without effective treatment, these patients often would waste away. Today, of course, tuberculosis usually can be treated successfully with antibiotics.
How does a person get TB?
A person can become infected with tuberculosis bacteria when he or she inhales minute particles of infected sputum from the air. The bacteria get into the air when someone who has a tuberculosis lung infection coughs, sneezes, shouts, or spits (which is common in some cultures). People who are nearby can then possibly breathe the bacteria into their lungs. You don’t get TB by just touching the clothes or shaking the hands of someone who is infected. Tuberculosis is spread (transmitted) primarily from person to person by breathing infected air during close contact.
There is a form of atypical tuberculosis that is transmitted by drinking unpasteurized milk. Related bacteria, called Mycobacterium bovis cause this form of TB. Previously, this type of bacteria was a major cause of TB in children, but it rarely causes TB now since most milk is pasteurized (undergoes a heating process that kills the bacteria).
Uganda ranks 16th on the list of 22 countries with the highest TB burden in the world. In 2007, the country had almost 102,000 new TB cases, with an estimated incidence rate of 330 cases per 100,000 people.
In Uganda, under an internationally recognised strategy for TB control known as DOTS, TB detection and treatment success rates are 51 and 70% respectively , which is below the World Health Organization’s (WHO) global targets of 70 and 85% respectively. These low rates are mainly due to insufficient case reporting, non adherence to TB treatment, poor access to healthcare services, and a limited number of skilled staff and diagnostic facilities
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