Governments of over 163 countries in 2015 promised to end tuberculosis (TB) by 2030; however, as the current rate of TB declines to 1.5 per cent, reports indicate that a remarkable increase of over 10 per cent of funding by 2025 globally would be required if the target is to be met by 2030. This is as the World Health Organisation (WHO) recently ranked Nigeria as the country with highest cases of tuberculosis in Africa. Kehinde Osasona, in this report, asks examines Nigeria’s precarious situation.
Tuberculosis is an infectious disease caused by bacteria and it primarily affects the lungs. Although preventable, one third of the world’s population, two billion people, are reportedly affected by the TB bacteria.
Significantly too, this deadly disease has been identified by the World Health Organisation (WHO) as one infectious killer-disease which claims 1. 5 million people yearly.
While declaring the disease a global emergency in 1993, WHO insisted that TB remained one of the world’s major causes of illness and death, just as another statistics has it that more than 90 per cent of new TB cases and deaths occur in developing countries.
The WHO recently ranked Nigeria as the country with highest cases of tuberculosis in Africa. Not only that, she was also placed 10th in countries with tuberculosis globally.
While reeling out the statistics, during a visit of a delegation of the United Nations Programming Mission to the Nigeria’s Senate in Abuja, WHO representative in Nigeria, Tereza Kasaeva, restated that TB was responsible for over 1.5 million deaths annually.
He called on the Nigerian government to make additional investments in primary health care services through urgent interventions by the National Assembly.
She said, “Additional investments in tuberculosis and non-communicable diseases will be needed from the domestic source. We, from our side as WHO, will use additional advocacy to attract these resources and provide needed technical support for the country.
“It is an old disease but still number one infectious killer disease in the world with 1.5 million deaths annually. Here in Nigeria, you are number one in the Afro-region and among top 10 countries globally.”
Living with TB pandemic
While declaring Nigeria as a high burden TB country in 2019, the Centre for Disease Control and prevention (CDC) explained that most TB cases are cured using the internationally recommended strategy for TB control, known as DOTS (Directly Observed Treatment, Short Course). But in another report, it was estimated that global efforts to combat TB had saved an approximately 58 million lives since the year 2,000 and have reduced the TB mortality rate by 42 per cent.
In the 2016 report, Nigeria was listed alongside India, China, Indonesia, Philippines, Pakistan, Bangladesh and South Africa as part of the 30 high burden TB countries.
However, stakeholders feared that the emergence of drug-resistant TB posed a major health threat and could put at risk the gains made in efforts to end the health challenge.
According to the 2018 Global TB report, Nigeria was still among the 30 high burden countries for TB, TB/HIV and MDR-TB and over 95 per cent of TB deaths occurred in low and middle income countries, especially Africa.
The report also indicated that Nigeria was one of the countries with the high burden of the disease globally.
Efforts to combat TB
As a way of checkmating the scourge stakeholders in the health sector had at different times called for better attention to the infections as efforts to combat TB was being threatened by the emergence of drug-resistant cases.
In curtailing the trend through funding, the United States Agency for International Aid (USAID) had in 2018 engaged the services of funded 12 TB state surveillance officers to enhance TB case notifications in high burden states.
It was done to help facilitate increased TB case notifications from all the health facilities in Lagos, Kano, Kaduna, Rivers, Anambra, Niger, Imo, Bauchi, Oyo, Delta, Benue and Taraba states through the IDSR structure.
At the 2020 pre-world TB Day press conference held in Nigeria recently with the theme: It’s Time to End TB in Nigeria: Check that cough, Time No Dey, Chairman, 2020 World TB Day Planning Committee Dr. Bertrand Odume, who is also country director KNCV noted that each day, nearly 4,500 people lose their lives to TB and close to 30,000 people are infected by the disease.
According to Odume, “Despite significant progress over the last decades, tuberculosis remains the world’s deadliest infectious killer, and require acceleration of efforts to end TB epidemic globally and in Nigeria.
“Each day, nearly 4,500 people lose their lives to TB and close to 30,000 people fall ill with this preventable and curable disease. Global efforts to combat TB have saved an estimated 58 million lives since the year 2000 and reduced the TB mortality rate by 42 percent.
“However, the emergence of drug-resistant TB poses a major health threat and could put at risk the gains made in efforts to end TB.
“In 2018, about 1.4 million people globally died of TB-related causes including over 205,000 children. And over 95 percent of TB deaths occurs in low and middle-income countries especially Africa.
“TB kills 18 Nigerians every hour. Also, 49 Nigerians develop active TB, seven of which are children, every hour. One of the major challenges of TB response in Nigeria is attributed to low TB case findings both in adult and children.
“This is as a result of low TB treatment coverage and poor knowledge about TB that influence the health seeking behaviour of people.
“To accelerate the TB response in countries to reach targets Heads of State including President Muhammadu Buhari came together and made strong commitments to end TB at the first-ever UN High Level Meeting in September 2018.”
In line with this year’s theme: It’s time to end TB in Nigeria, Odume called on all stakeholders to come together and collaboratively work towards ending the TB epidemic in the country.
National Coordinator of the National Tuberculosis and Leprosy Control Programme (NTBLCP), Adebola Lawanson, said: “TB burden is so huge in Nigeria and a lot of efforts have gone underway in the past to see that we fight this disease. The federal government in collaboration with partners provided quality patient-centred prevention treatment care and support that is totally free for the control of TB.
“Specifically, we have increased the number of diagnostic facilities which we call the GeneXpert machine, which has the capacity to diagnose not just the simple TB, but the complicated one which is called the drug-resistant TB.
“Over the years we started with a few numbers and right now we have over 399 scattered all over Nigeria. We know that Nigeria is big so our aspiration is to have one machine per local government.
“Right now we have 40 per cent of our local government covered; however, right now there are efforts by donor organisations and the federal government to increase this number so that we can get to the universal health coverage that is being at articulated by the health sector.
“We have expanded the treatment of TB services to 12,254 healthcare facilities around the country, public and private. In addition TB services have been included in the primary health care minimum Health Care package to ensure achievement of universal health care to ensure access to care.”
According to the National Professional Officer in charge of TB at the World Health Organisation (WHO), Dr Ayodele Awe, “We have the highest burden in Africa, we are suppose to detect 429,000 each year, last year was the greatest number that has ever been detected over the ten years; we were able to detect 120,000 cases.
“Where are the 300,000 cases that are still coughing? Every undetected tuberculosis case can spread the disease to 15 persons in a year. Multiply that with how many we have each year.
“The total number of funds needed for Tuberculosis each year is $278m, we are having only 8 per cent as domestic. There is a huge gap of $157m gap that was supposed to help us for advocacy, for increasing service coverage.”
Overcrowding, poverty factors
Meanwhile, at a recent forum with the corporate sector on Mobilising Domestic Resources to End TB in Nigeria in Lagos, the Lagos state government, StopTB Partnership Nigeria and other stakeholders hinted that Lagos state presently has the highest burden of tuberculosis in Nigeria.
Chairman of the Nigerian Stop TB Partnership, Prof. Lovett Lawson, was quoted as saying “Lagos has the highest burden of tuberculosis in Nigeria, while Nigeria has the 6th highest burden of tuberculosis in the world and the first in Africa.”
According to Lawson, the challenge of TB in Lagos State is associated with large population and poor living conditions of those living in congregate settings with low awareness of TB.
He described TB as the leading cause of death in adults globally irrespective of age, sex, ethnicity, class or religion, asserting that we all breathe the same air.
While calling for increased funding and commitment to reduce the scourge, he called for better enlightenment amongst the populace as well as more committed to fight the war against TB.
Also speaking on the pandemic, the Permanent Secretary, Lagos state Ministry of Health, Dr Titilayo Goncalves, commended some companies who gathered to mobilise resources to end tuberculosis in Lagos state.
Goncalves, who also represented Governor Babajide Sanwo-Olu of Lagos State, said: “We need to take deliberate steps to reduce the spread of tuberculosis to help reduce putting the healthy population at risk.
“As a state, ranking highest in the number of TB patients in Nigeria, there is a need for drastic and urgent action to check the spread otherwise; our 22 million populations may become fertile ground for the pandemic.”
She disclosed that the Lagos state government has been making efforts toward curtailing the spread of TB stating,
“Toward this goal, we have developed strategies for the control, detection and treatment of TB in Lagos state. They include intensifying case finding in public facilities, intensifying case findings in primary facilities, active case finding among TB contacts, Gene Xpert optimisation and enhancing community awareness on TB.
“Within 16 years, the number of TB treatment centres in Lagos state has increased from six to over 1,008.We, however, need to step up our efforts as these facilities are inadequate, given the rate of population growth to stem TB spread in the state,” she said.
Goncalves stressed the urgent need for strategy in partnership with the private sector in order to put an end to the dreaded TB which has estimated to reach an outbreak of four million cases by 2020.
Experts speak
Worried by the situation some medical experts have advocated possible solution to the knotty situation. For the Director, Public Health, Ministry of Health Oyo state, Dr Oyewole Lawal, community sensitisation and engagement should be advocated as an intervention.
According to Oyewole, it was the first time the IDSR framework was being used as an approach to find missing TB cases and it has started yielding results in its first year of implementation.
He said, “The integrated disease surveillance structure through the Local Government Area (LGA) Disease Surveillance Notification Officer (DSNO) is being extended to finding TB cases in the community and it has been very productive.”
While lauding USAID efforts at redoubling attempt to fight the TB scourge through the engagement of community informants in 12 states, the WHO Nigeria Acting Officer in Charge (OIC), Dr Rex Mpazanje, said: “To fight the TB scourge, investments by the government towards care and prevention must be increased. Every health facility in the country down to community drug stores, need to be enlisted into TB case finding.”
He added that, “Efforts must be made to identify and remove the challenges that are slowing down progress, as well as adopt and roll out the most cost-effective policy options and interventions.
“TB services should be among core interventions in minimum services packages being funded from domestic resources in health insurance schemes being setup to support the revitalized Primary Health Care system to take the country to universal health coverage.”
Ending the scourge
While the official the Ministry of Health was yet to react to the disturbing WHO statistics Blueprint Weekend contacted the Chief Press Secretary to the Minister of Health, Mrs Bob-Manuel, on efforts being made by the ministry to curtail the spread of TB in the country.
The minister’s aide, who declined to speak to our correspondent said, “I am not in the position to give you any information regarding the TB question you just asked. As I speak, I am carrying out some tasks for the minister in his office but I will send some people’s number to you who I think will be able to furnish you with needed answers.”
As advanced by the President of the Senate, Ahmad Lawan, it would not be out of place for UN and WHO to lend their support to the Nigerian government towards ensuring the eradication of tuberculosis in the country.
As part of corporate social responsibility (CSR) to support efforts to end needless deaths from a curable disease affecting our dear country, specialists and experts in the field believed that the financial, manufacturing, telecommunications, oil and gas companies also have a critical role to play to make up the deficit in funding.
Or better still, as health educator Dosumu Oluwafunke puts it; if each undetected TB case has the potential of infecting 10-15 persons in a year, then there was need for awareness programmes, improved socioeconomic standards, availability of TB drugs and well equipped DOTs centres with GeneXperts, at least in the 774 local government areas in the country.