TB treatment under focus as coronavirus cases increase

When Hubert Nyagaka, 46, tested positive for tuberculosis (TB), it was a case of him and his family reliving a health nightmare, nine years after his wife was diagnosed with the same disease.

In early 1999, his wife fell sick, but it didn’t take long before the doctors identified what was ailing her.

But this time around in 2008, Mr Nyagaka’s case proved to be a difficult one, as what he thought at the beginning was a cough and flu went on for nearly two months.

“I thought it was flu where I kept going to different private hospitals, getting medication but it wouldn’t just go away.”

However, this finally came to pass after being taken to a private hospital in Kangemi, where X-ray results confirmed it was TB.

“I was referred to Kangemi Health Centre, a public hospital near where I lived, where my sputum sample was taken and tested, and two weeks later, it was confirmed that I had the disease and immediately put on medication,” he says.

His six-month treatment was between August 2008 and early March 2009, after which he was declared TB-free.

Mr Nyagaka and his wife were among the lucky who recovered after suffering from this disease that continues to claim lives, especially in sub-Saharan Africa.

According to the World Health Organisation (WHO), TB is the ninth leading cause of death worldwide and the leading cause from a single infectious agent, ranking above HIV/Aids.

More than 25 percent of TB deaths occur in Africa, Kenya being one of the 30 high-burden countries that account for more than 80 percent of the world’s TB cases.

In 2017, during the marking of results of the World TB Day, the Kenya Ministry of Health released results of the National TB Prevalence Survey. The report showed that 40 percent of TB cases that occur in the country remain undetected and untreated.

The report that represented data collected between 2015 and 2016, revealed that there were more TB cases in Kenya than previously estimated, with a TB prevalence of 558 per 100,000 people.

Dr Enos Masini, regional TB adviser at the World Health Organisation, and who during that time he was serving as the head of the National Tuberculosis, Leprosy and Lung disease programme at the Ministry of Health, says although the number has reduced, there is a lot that needs to be done to tackle this disease in the country.

Dr Masini whose responsibility includes offering technical support on adaptation and implementation of the end of TB strategy, says there is a problem with tuberculosis diagnosis, with one of the reasons being that most people who have it mostly don’t know they have the disease.

“Most people who exhibit symptoms like coughing or generally feeling unwell end up seeking care in health facilities but for one or another reason, they fail to get diagnosed,” he adds.

One of the reasons that contributes to missed diagnosis, he says, is that there are health facilities that use the old microscopy method for diagnosis.

In 2010, the WHO approved the use of GeneXpert diagnosis method to replace microscopy. “This method is better and more accurate than the microscopy apart from being able to diagnose eight out of 10 cases. It tells whether one is suffering from the drug-sensitive TB or the drug-resistant TB (DR-TB), thus getting the necessary treatment,” he adds.

During that 2017 survey, the disease was found to be higher in young men between the ages of 25 and 34 and living in urban settings. Dr Dr Masini says a number of factors make this group to be a high-risk population for this disease.

“In many countries, men are generally affected by TB than women. A case study of Kenya, for instance, showed men in these age brackets are usually expected to move to urban areas, and most of the time end up in informal settlements due to joblessness; these areas are overcrowded, which is one of the biggest contributors of TB. Their nature of work also reduces their chances of accessing healthcare,” he explains.

For the people living with HIV, Dr Masini says they ought to continue taking their ARVs to boost their immunity.

“Though 83 percent of TB cases were HIV negative, HIV is one of the highest risk factors as it lowers immunity and gives chance for TB virus to flare. ARV therapy suppresses the virus, thus reduces chances of getting TB reduces.” Fast to the current Covid-19 pandemic, TB patients are one of the groups that are in more danger.

“People suffering from Covid-19 and TB show similar symptoms such as cough, fever and difficulty in breathing. Both diseases attack primarily the lungs and although both biological agents transmit mainly via close contact, the incubation period from exposure to disease in TB is longer,” he says.

According to Dr Masini, while the cases of Covid-19 infection in TB patients remains limited, it is anticipated that people infected with both may have poorer treatment outcomes, especially if tuberculosis treatment is interrupted.

Measures ought to be in place to limit transmission of TB and Covid-19 in crowded settings and healthcare facilities using the WHO guidelines. “Although modes of transmission of the two diseases are slightly different, administrative and personal protection measures apply to both (for example, basic infection prevention and control, cough etiquette, segregation of people suspected to be infected).”

Dr Masini says health facilities should ensure TB preventive measures are adhered to.

To reduce the chances of contracting the new coronavirus, TB patients should continue with treatment as prescribed, he says, warning that when facilities are overwhelmed with Covid-19 cases in the future, TB cases could get worse in missed diagnosis and missed drug schedules.

“When Ebola struck, people died of malaria and other diseases than Ebola, because emphasis was given to the epidemic, while other health conditions were relegated to the back seat,” he says.

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