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Expensive Drugs, Challenge to Tuberculosis Treatment in Nigeria

08 Nov 2012

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Increase of  Multi- drug Resistant Tuberculosis (MDR-TB) cases and  access to the right drugs in Nigeria currently constitutes a major source of worry,  Chinyere Okoye writes

Mr. Kene Ajulu, a middle age man is one of the regular faces at the Outpatient Tuberculosis Centre of the Lagos University Teaching Hospital (LUTH). He visits the centre every Friday from his downtown apartment just to collect his survival drugs. He has many regrets a tuberculosis patient living in Nigeria.

He says, “My career stopped. As if that was not enough, my wife left with my two children. I had no money to purchase the expensive drugs needed so I have no option than to come from Alapere  Ketu, every friday for Rifampicin and Isoniazid here at the Lagos University Teaching Hospital. My case is worse than ordinary eye can see but I cannot say much.”

Medical experts have warned that the trend should be quickly checked in order to forestall what they described as “imminent and total collapse of the efficacy of the available first-line drugs for TB treatment.”

According to Dr Taiwo Orelope, a medical practitioner, Tuberculosis is a bacterial infection that is curable, but the disease becomes dangerous when the germ resists the two most powerful anti-TB first line drugs (Rifampicin and Isoniazid).   An estimated 14 million people worldwide are infected with active tuberculosis (TB), which is a disease of poverty affecting mainly young adults in their most productive years. In 2009 there were 9.4 million new cases of TB and 1.7 million deaths, including 380,000 deaths from TB among people with HIV. The vast majority of deaths from TB are in the developing world.

According to  an attendant at LUTH, the number of the infectious diseases hospitals responsible for providing TB treatment nationwide are functioning below optimal capacity. This development,  she said may lead to the country settling for the more  expensive  second-line drugs that are  not only less efficient but more toxic. Specifically, when MDR-TB occurs, unlike the normal TB that requires six months to treat, a patient diagnosed of MDR-TB would be on treatment for at least 18 to 24 months.  In the first phase of treatment, the patient must be hospitalized for six months, followed by ambulatory care for the next 18 months.

“TB is very much with us and we must all put our hands on the deck to contain it before it gets out of control,” she said.

Noting that nobody is immune to contracting TB, especially when those with TB are discriminated against in the society, she said:  “patients with TB should not be stigmatised. Driving them away from the public place can make them to stop taking their medicines and that way, they would develop the resistant strain of TB. In fact, a single person with TB can infect between 10 and 15 people per year.”

To be sure, she pointed out that TB treatment was not for seven days, as with some other infectious diseases. “People need to religiously take their medicines for about eight and nine months if they have the ordinary or normal TB and for 24 months in the case of MDR-TB.”

“Even though after about four weeks of treatment by an individual with TB, the appetite and weight might improve, the coughing might have stopped and then the fever subsides. You may think that you are cured. This is not the case. The TB germ is still hidden in the body,” she said.

Dr Sam Igwe, a medical expert with a private hospital in Lagos expressed his concern over the poor management of TB in private hospitals. He said: “We are beginning to see cases of multi-drug resistant (MDR) TB. These are cases that are now resistant to the normal drugs we know to have worked in treating TB. If these cases are allowed to continue to develop and transmit infections, we are going to run into the problem of losing all the drugs that we have for TB and start going for second line drugs”.

He also noted that most of the cases of MDR-TB develop as a result of wrong clinical management. He said drug-resistant TB is caused by inconsistent or partial treatment, when patients do not take all their medicines regularly for the required period or when health workers prescribe the wrong treatment regimens, or because the drug supply is unreliable.

According to him, most TB treatment programmes have not been succeeding because the primary health care and the communities are not receiving attention.

To tackle TB effectively, the World Health Organisation (WHO) recommends that countries must detect at least 75 per cent of active case and attain 85 per cent treatment. In Nigeria only 36 per cent are detected and over 60 per cent cases are not being treated. The implication of this, according to experts, is that anybody can be infected with TB. Igwe said : “Using the recommendations of the WHO, efforts should  be geared towards using advocacy as a strategy to detect existing active cases.”

New data in the WHO Global Tuberculosis Report 2012,  confirm that TB remains a major infectious killer globally.

The findings show a continued decline in the number of people falling ill from TB, but still an enormous global burden of 8.7 million new cases in 2011. Also in 2011; there was an estimated 1.4 million deaths from TB, including half a million women, underlining the disease as one of the world’s top killers of women.

It also shows a persistently slow progress in the MDR-TB response, with only 1 in 5 patients estimated to exist being diagnosed world-wide; the report highlights country successes among them.

Cambodia which has seen a 45 percent drop in TB prevalence between 2002 and 2011 and, in all, it features data from 204 countries and territories and covers all aspects of TB, including multidrug-resistant TB (MDR-TB), TB/HIV, research and development (R&D) and TB financing.

In contrast, Nigeria ranks 10 among the 22 high-burden TB countries in the world. WHO estimates that 210, 000 new cases of all form of TB occurred in the country in 2010, equivalent to 133 people per 100,000 populations.

According to available information, Kano, Lagos and Oyo have the highest TB prevalence rate in the country. Other states are said to have experienced drop in cases notified, resulting in a 4 percent overall decline in 2010, from 11 percent in 2006. Benue state has the highest TB burden in the country, which is attributed to a high HIV prevalence.


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