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Devastations of Tuberculosis: Free drugs might not just be enough in reducing this disease

Four years ago, Majek Oscar (not real name) thought the cause of his temporary loss of sight was mere eyes infection. Then in 2018, after initial denial, he experienced series of signs that made him feel all was not well and confirmed the fear of his family and friends that he was not feeling well. He started having fever, coughing persistently, feeling extremely tired and boils developed all over his body.

“It is a very hectic thing,” Mr. Oscar says as he flinched while trying to describe the discomfort he felt. “I was always feeling tired, coughing and having boils all over my body. The nutrients in my body diminished.”

In spite of the pain, He would continue with his daily activities. He said “people would ask what was happening to me, but I would tell them nothing. It was when the pain became unbearable that I had to go to the hospital where some tests were carried out.”

He was diagnosed with Tuberulosis. Mr. Oscar, a young businessman and the breadwinner of his family thought his world had crashed.

The World’s Deadliest Infectious Disease

Tuberculosis (TB) is a disease caused by bacteria that affect the lungs or other parts of the body such as the abdomen, glands, bones and nervous system. It spreads through inhaling tiny droplets from the coughs or sneezes of an infected person. The disease is one of the top 10 causes of death.

The infection manifests in various forms. It can either be primary, latent or active. Primary infection is likely to happen when a person gets in close contact with persons who have active TB. While people with strong immune system are likely to have the inhaled bacteria immediately killed, the body system of some people will keep the bacteria in a dormant state where they would not show any symptoms and the TB is not infectious. This stage is called the latent infection and it can last for several years and even for life. Many experts say it is important for the latent infection to get identified early and treated because it waits for the body to get weak and then attacks. In an active stage, the bacterium has multiplied, symptoms are manifesting and it has become infectious.

Tuberculosis (TB) is a disease caused by bacteria that affect the lungs or other parts of the body such as the abdomen, glands, bones and nervous system. It spreads through inhaling tiny droplets from the coughs or sneezes of an infected person. The disease is one of the top 10 causes of death.

The disease which is often referred to as the disease of the poor becomes the disease anyone, regardless of class and status, can contract if they breathe in contaminated air from an active TB patient who does not get treatment. According to the World Health Organisation (WHO), people with active TB can infect 10 to 15 other people they come into regular contact with in the course of a year.

“It is very infectious,” says Dr. Adeniji Jaykay, a medical practitioner in Lagos. “But the fortunate thing there is that the disease is treatable, provided the right thing is done. If a person coughs for more than three weeks, you are supposed to report to the hospital where series of tests will be done.”

Some examples of poor handling of Tuberculosis cases include when a patient does not take the full course of TB treatment and healthcare providers prescribe the wrong dose or length of time.

Dr. Adam maintained that “with proper medication, one good thing about Tuberculosis is it is hundred percent treatable. The susceptible one is treatable. The multidrug-resistant TB is also treatable. That is the good news about TB.”

Why Tuberculosis Persists in Nigeria?

Tuberculosis treatment in government hospitals in Nigeria is free. While some people say this should ordinarily be enough to reduce the prevalence of the disease, many agree that the damning statistics by the world health body about Tuberculosis in Nigeria reveals that the country needs to overhaul its fight against Tuberculosis.

Data from the World Health Organisation revealed in 2019, that cases of Tuberculosis in Nigeria increased to 429,000 in 2018 from 412,000 in 2017. The report also showed that Nigeria had the sixth position among countries with a high Tuberculosis burden and it is the first in Africa.

Stakeholders in the fight against Tuberculosis in Nigeria who are baffled by the situation, say giving free drugs alone cannot help the country win the disease. They say factors that make infected persons to not seek proper treatments and the reasons some TB patients abandon treatments must be addressed.

Mr. Oscar blames the health facilities for Tuberculosis patients abandoning treatments.

“You know how the Nigerian system is, one will go to the hospital and there are too many people. One will get to the hospital as early as 5am and one is not certain of seeing the doctor as early as one should.

“When I started going for treatment, it was difficult for me to get to the hospital. I could not walk unassisted. I would have to charter a taxi for the entire day at the rate of seven thousand naira because I was not certain of when I would be able to see the doctor.

“It is not easy. Those nurses are not helping matters; they do not treat sick people the way they should. Some of the hospital workers would get techy. If you do not have money, you are likely to wait for a long time on the queue.

“It is true the drugs are free but some healthcare givers are lazy and uncommitted to their jobs. This makes Tuberculosis patients feel discouraged to continue with the treatment,” he submits

The challenges Mr. Oscar observed are some of the few that have bedeviled Nigeria’s health system. Others are corruption, incessant strike actions by medical workers, inadequate infrastructure and brain drain. Some say that right policies and budgetary allocation will resolve many of the challenges.

The 2019 Global TB report showed that Nigeria depends more on international funding to fight Tuberculosis. While 32 percent of Nigeria’s fight against TB was internationally funded, eight percent of it came from domestic source and 60 percent was unfunded. The allocation to the health sector in the proposed 2020 national budget is 427.3 billion naira. Stakeholders in the sector say this allocation falls short of the 15 percent agreed upon in the Abuja Declaration of 2001. The allocation, when broken down, would show that Nigeria budgets two thousand naira for the healthcare of each citizen in 2020.

Dr. Adam said that meagre allocation to health would make the country to move in a vicious cycle of infectious disease and that “there should be more government and private sector funding. Nobody can fight any disease with inadequate funding. Because of the inadequate funding by Government, there are gaps. We should up our budget to health from the less than 5 percent to twenty percent.”

In addition to the poor health system in Nigeria, some people say that other reasons TB patients abandon treatment is because of the long treatment regimen and poverty. Tuberculosis treatment takes at least six months. TB activists say during the treatment period, some patients are weak and cannot fend for themselves. Because their means of livelihood are likely to be impaired, some patients abandon treatments as soon as they feel slightly okay. Not completing treatment gives the bacteria an opportunity to develop resistance.

“Treatment of drug susceptible Tuberculosis takes at least six months. As a community person, let me tell you the problem, before you take any drug, you need to eat, you need proper care. You can imagine taking drugs for a week and no one is giving you food and adequate shelter, you see the challenges you will face, not to talk of taking drugs for over six months.

“So if the government is ensuring that persons undergoing TB treatment get good nutrition and shelter, there will not be issues of not taking drugs and treatment will be 100 percent and it will be sustained,” Dr. Adam explains.

Olayide Akanni, National Coordinator of the TB Network in Nigeria, agrees with Dr. Adam, but she says that “in addition to issues of distance to health facilities and poor support network for TB patients, there is a gender angle to the issue of adhering to treatment.”

Tuberculosis affects both sexes, the 2019 Global Tuberculosis report indicates that globally, men have the highest burden of the disease. While men accounted for 57 percent of all TB cases in 2018, women accounted for just thirty-two percent.

“So the new thing we are learning is that there are gender dimensions to adhering to treatment and also gender dimensions to TB. If you talk to healthcare workers, they tell you women are more likely to adhere to treatment than men. Men find it difficult to go to the hospital until they are totally down. They say they are men, they are okay,” Ms. Akanni says.

Following her conversation with TB patients who are male, she said men abandon treatment because it weakens them especially in the first couple of months and they just want their energy back.

“So imagine a business man who usually goes from pillar to post, then comes down with TB. First of all, he is down. He is not able to generate income. He feels like he cannot do anything. Now, depending on where he lives, he might be ostracised because his family members are thinking Oh! He has TB. It’s a communicable disease.

“Most times, it is poor people who do not have good food to eat and good shelter that are exposed to TB. The fact that you have to take drugs every day is stressful for most people. So when they begin to feel better, they realise they have lost time and money because of the sickness.

“The men I spoke to say they just want to recoup all they had lost as a result of the illness once they feel a little better. They only return to the healthcare facility when they start feeling the pains again.

“Sometimes, people do not even have transport money to go to the facility to collect drugs. So if you do not have money to go and no one is willing to bring it, you might feel like even the stress of going to the facility is enough. I don’t have the resources to go, chances are once I begin to feel better, I may abandon the treatment,” she posits.

Many Tuberculosis infected persons keep their status a secret to avoid being stigmatized. Fear of being ostracized has made many infected persons to be ashamed of seeking treatments that can save their lives. Some people are of the opinion that considering how infectious TB is, it should be given the HIV/AIDS approach where massive awareness campaigns kept the stigmatisation level down. According to global public health report on Tuberculosis and stigmatisation, about 80 percent of at risk individuals reported that TB is stigmatised in their communities.

“We need more sensitization in the public health aspect,” says Kolawola Ekanoye, Executive Director of Advocate for Health and Development Initiative. “The community needs to accept people who are TB positive. If they are not accepted, fear of being ostracized will make them seek improper treatments such as patent medicine stores. Because some people know little about the disease, they go to religious centres for deliverance thinking they had been bewitched.

“An infected person needs to accept that he or she has a condition. Accepting this status will make such a person take all the prescribed drugs for the stipulated period. When people feel bad about themselves, they abandon proper treatment.

“Even if the government is supporting and they are not getting it right at the community level for acceptance, then the fight against TB will be unsuccessful,” He maintains.

Statistics and experiences of persons working with Tuberculosis patients show that the fight to eradicate Tuberculosis does not stop at providing free drugs. Many agree that there should be effort to ensure Tuberculosis cases are reported and less stressful access to treatment is provided. Some say that beyond strengthening the health sector by allocating more funds to it, moves aimed at improving housing quality and ending poverty and undernutrition would help Nigeria eradicate Tuberculosis.

“I am gradually feeling better,” says Mr. Oscar as he balanced his weight on the chair. “I do not know how I got infected. I thank God because my wife stayed and took care of me,” He adds.

♦ The author, Adeola Oladipupo is an Anadach Journalist.

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