Among African nations, Zimbabwe is one of those most heavily affected by TB
Charles Raradza (44) fell seriously ill in 2001, coughing uncontrollably. He went to get tested for tuberculosis (TB) at a hospital in Kadoma, but the bacteria that causes the disease was not detected in his sputum.
Unconvinced, Raradza went to another hospital where a sputum and lung X-ray test revealed that he was indeed TB-infected.
“I was immediately enrolled into the hospital’s directly observed treatment therapy (Dots), and had to take 13 tablets a day. The tablets were very painful. I guess because I love life so much I never defaulted during the six months that I was on the course,” said Raradza.
But after two years, Raradza started coughing uncontrollably again. He went to get tested for TB again.
“At the hospital, it was discovered that I had TB for the second time, so I was given 60 injections and tablets — it was painful, but I stuck through it. I was put on the six-month long Dots programme again,” he said.
In 2005 Raradza went to a voluntary counselling and testing centre to get tested for HIV.
“It was unheard of then for anyone to go and get tested, but I gathered my courage and went to the testing centre. I tested HIV positive, and was enrolled into the anteritroviral programme,” he said.
After noticing his poor response to the Aids drugs, Raradza said that a doctor-friend recommended another TB test. For a third time in his life, Raradza had TB, and he had to go through the treatment regimen of 60 injection and tablets again.
According to Dr Tonderai Murimwa, an official in the Ministry of Health and Child Welfare’s Aids and TB Unit, Raradza’s case of failed detection of TB is not unique and is attributed to changing epidemiological patterns in Zimbabwe.
“Diagnosis of TB is usually straightforward; the best test is sputum microscopy. But HIV changes the way the body reacts to infections.
“That’s why X-ray is now required, but it is very expensive technology and the country cannot afford it at the moment,” said Murimwa.
Murimwa added that the drug distribution in the country had experienced severe challenges over the past decade due to lack of material resources such as transport, fuel and personnel.
TB is a leading cause of illness and death for people living with HIV — about one in five of the world’s 1, 8 million Aids-related deaths in 2009 were associated with TB.
The risk of developing TB is estimated to be between 20-37 times greater in people living with HIV than among those without HIV infection.
Among African nations, Zimbabwe is one of those most heavily affected by TB. The 2009 Global Tuberculosis Control Report from the World Health Organisation (WHO) ranks Zimbabwe 17th among 22 countries worldwide with the highest TB burden.
Zimbabwe had an estimated 71 961 new TB cases in 2007, with an estimated incidence rate of 539 cases per 100,000 people.
For the past 20 years, Zimbabwe has fought TB fairly successfully, providing free access to WHO-recommended treatments.
In the past few years however the disease has re-emerged as a leading killer, especially among people living with HIV, who are often not identified through long-established TB tests.
According to statistics, the success rate of directly observed treatment is just 74%, far below the WHO recommended rate of 85%.
“In Africa, HIV is the potent factor in the progression of latent TB.
“People living with HIV are susceptible to TB infection. TB is the most common serious infection associated with HIV infection. The two diseases go hand in hand. This call for an integrated and collaborative approach in dealing with the two conditions,” said Dr Patrick Hazangwe, a WHO official.
The TB problem is compounded by the fact that patients often fail to complete treatment because they cannot afford the transport costs to and from health centres.
To complicate matters, the brain drain of qualified front-line health care workers from Zimbabwe has resulted in poor healthcare delivery.
Lack of medical practitioners coupled with obsolete machinery has also worsened the problem.
According to Betty Chikava, Member of Parliament for Mt Darwin East, poor financing of the Health ministry is a key hindrance to an effective response to TB and other diseases.
“The Ministry of Health and Child Welfare has received paltry funding — only 7% of its projected Budget; medical personnel in the hospitals and clinics are seriously overworked. The Ministry of Finance needs to be brought into the picture so that they can finance the Health ministry adequately,” she said.
By Masimba Biriwasha