The recent alarm raised by the World Health Organization (WHO) that Nigeria may not be able to reach its set target of diagnosing and treating over 1.1 million tuberculosis (TB) cases by next year is indeed worrisome. As the global health watchdog, such an alarm by the WHO should not be ignored, especially, against the backdrop of the rising incidence of tuberculosis in Nigeria. The alert should serve as a wake-up call on individuals, private foundations, federal and state governments to give attention to a grueling disease that is taking a huge toll on Nigerians. It is scandalous and unacceptable that with the resources at Nigeria’s disposal, citizens, especially rural dwellers, continue to be afflicted with air-borne and sundry communicable diseases. Worse still, governments at all levels either lack the political will to face up to the real issues or are too bogged down serving selfish interests to care about the people.
Not surprisingly, the WHO alarm came just as the world marked World TB Day 2021 with the theme, “The Clock is Ticking.” That occasion is therefore a wake-up call that provided an opportunity for us as a nation to accelerate TB response to reach the set targets in the 2021-2025 National TB Strategic Plan and to realise the commitments made by President Muhammadu Buhari at the first-ever UN High Level Meeting on TB in 2018. According to WHO, tuberculosis is one of the top 10 causes of death worldwide and the leading cause of death from a single infectious agent (ranking above HIV/AIDS). The WHO said that there are an estimated 10 million people with TB globally in 2019, with Nigeria and seven other countries accounting for two thirds of the global total. The government’s overarching failure to meet its own benchmark targets has helped to compound the TB burden, especially, among thousands of poor sufferers in Nigeria. The time is therefore, ripe for critical stakeholders to rally and confront the scourge.
There is no doubt that TB has become a major public health issue in Nigeria. The disease is now rampant to the extent that at least practically every Nigerian knows someone who died of TB. The situation is such that except something is done to curb the epidemic, more and more Nigerians would fall victim thereby aggravating the poverty scourge. Perhaps, it was on that ground that Health Minister, Dr. Osagie Ehanire, ostensibly worried about the worsening TB epidemic and the helplessness of many patients, disclosed that the first-line test for TB diagnosis is only available in 317 (41%) of the 774 LGAs in the country.
Speaking at the event to commemorate the World TB Day 2021, WHO country representative in Nigeria, Dr. Walter Kazadi Molumbo revealed that Nigeria had made a commitment to diagnose and treat over 1.1 million TB cases and place about 2.2 million patients on TB preventive Therapy (TPT) from 2018 to 2022 at the United Nations High Level meeting (UNHLM) on TB in 2018. However, he regretted that Nigeria is still far away from achieving these targets with less than two years to go. He explained that low TB case detection has remained a major challenge in the TB control efforts in Nigeria with the country only detecting 27% of the estimated TB cases. “The undetected TB cases can further constitute pool of reservoir that fuel ongoing transmission of TB in the community, as one undetected infectious TB case is able to infect between 12 – 15 people per year,” Molumbo noted. He further said TB control budgets in Nigeria has continued to be drastically underfunded, adding that about 70% of the TB budget in 2020 were unfunded which posed a major threat to the country’s efforts in achieving the set targets.
On progress made so far in the control of TB in Nigeria, it is on record that, Nigeria recorded a 15% increase in TB case notifications in 2020 compared with the previous year despite the effect of the Covid-19 pandemic on the TB Control Program. Also, an estimated 71% of TB patients in Nigeria and their household are affected by catastrophic cost due to TB. There is therefore the need for a national TB prevention and treatment strategy underlining a federal government-driven national policy for comprehensive TB treatment in the country. A key component of this strategy should be establishment of a TB center in each of the six geo-political zones, and at least a mobile TB center in each of the 36 states and the Federal Capital Territory (FCT), Abuja. That way, it would be easy for Nigerians to avail themselves of easily accessible screening centers for early detection, which experts say is critical to effective treatment of the disease.
Available global statistics show that the global battle against TB would not be won with treatment alone but by effective preventive measures. This underscores the fact that developing countries are disproportionately affected, with Africa accounting for over 60% of the world’s total cases, worsened by the lack of early detection and access to treatment. It needs to be stressed that TB is treatable depending on when it is diagnosed. The disease presents in many stages. If diagnosed at stage one, it could be handled. The problem is that many sufferers ignore the symptoms, or are not aware that they have the disease until it gets to stage when treatment is most difficult or impossible.
According to the US Centers for Disease Control and Prevention (CDC), TB is a potentially serious infectious disease that mainly affects your lungs. The bacteria that cause tuberculosis are spread from person to person through tiny droplets released into the air via coughs and sneezes. Symptoms of active TB include: coughing that lasts three or more weeks, coughing up blood, chest pain, or pain with breathing or coughing, unintentional weight loss, fatigue, fever, night sweats, chills and loss of appetite. TB can also affect other parts of your body, including your kidneys, spine or brain. When TB occurs outside your lungs, signs and symptoms vary according to the organs involved. For example, tuberculosis of the spine may give you back pain, and tuberculosis in your kidneys might cause blood in your urine. Many strains of TB resist the drugs most used to treat the disease. People with active TB must take several medications for months to eradicate the infection and prevent antibiotic resistance.
Nigerians, therefore, need to be enlightened on possible preventive measures, including regular screening. That, however, presupposes the availability of TB screening facilities, easily accessible at affordable price. Getting TB is not a death sentence if diagnosed early. The media, therefore, have a role to play in terms of constant enlightenment. TB can strike anyone, whether rich or poor, and that there are millions out there who don’t have the facility or money to get the best treatment. Dr. Ehanire listed federal government’s priorities for TB to include; ensuring continuity of TB services through provision of integrated TB and Covid-19 services especially for of awareness creation, contact tracing and diagnosis; scale-up demand creation for TB services through regular airing of TB jingles in radio and television stations. Dr. Ehanire further said the key challenge to the TB control effort has been the slow pace of achieving Universal Health Coverage (UHC) for TB services.
Given that prompt diagnosis and linkage to care are integral components of TB control, the government should make it a priority to expand rapid molecular diagnostic capacity for TB testing as part of its plan to eliminate TB by 2025. However, scale-up of GeneXpert testing capacity and coverage alone does not ensure that all patients who could benefit from GeneXpert are referred for testing. Education and outreach activities to make health providers aware of the need and local testing availabilities are thus necessary to ensure uptake of GeneXpert testing. Dr. Ehanire was quoted as saying TB testing services were only available in 31% of health facilities, adding that the current coverage of GeneXpert machines, the first-line test for TB diagnosis is only available in 317 out of 774 LGAs. Government must, therefore ensure every state has a GeneXpert machine, which costs about N5 million. Private foundations should also help. A greater commitment to combating TB in Nigeria is more than an urgent national imperative.
