With 574,600 cases or 338 per 100,000 of the 170 million population, Nigeria has the third highest TB burden in the world. Worse even, 22% of the TB patients also carry the HIV virus that causes AIDS.
Of all people living with HIV globally, 9% of them are in Nigeria. These figures are ominous and needs to be addressed urgently. Health officials should be worried that rather than declining as observed elsewhere, these diseases are gaining ground in Nigeria. This raises question as to the efficacy of the prevention and control measures being applied and calls for more dedication and commitment.
In a statement commemorating World TB Day on March 24, the National Agency for AIDS (NACA) noted: “According to the current national statistics on HIV, an estimated 3.5 million persons are HIV positive, while close to one million are on treatment. So far, Nigeria occupies the unenviable global position in terms of the disease burden for both diseases. Nigeria is the second amongst the highest HIV-burdened countries in the world and the third among the highest TB-burdened globally. Added to this burden is the fact that of the number of cases identified with TB, 22 per cent were found to also have HIV as well, thus compounding the existing disease burden.”
According to the World Health Organization (WHO), HIV prevalence is remarkably small (3.2%) compared to other sub-Saharan African countries such as South Africa (19.1%) and Zambia (12.5%), but the size of Nigeria’s population means that there were 3.2 million people living with HIV in 2015. Nigeria, together with South Africa and Uganda, account for almost half of all annual new HIV infections in sub-Saharan Africa. This is despite achieving a 35% reduction in new infections between 2005 and 2013. Approximately 210,000 people died from AIDS-related illnesses in Nigeria in 2015, which is 14% of the global total. Since 2005, there has been no reduction in the number of annual deaths, indicative of the fact that only 20% of people living with HIV in Nigeria are accessing antiretroviral treatment (ART). Unprotected heterosexual sex accounts for about 80% of new HIV infections, with the majority of infections among prostitutes.
The WHO also ranked Nigeria third among the 22 countries with the highest prevalence of TB in the countries that did not meet the Millennium Development Goals’ (MDG) targets of reducing TB incidence, prevalence and mortality rates. This is despite the control efforts of institutions like the Nigeria Institute of Medical Research (NIMR), which is dedicated to the research and treatment of TB in the country. Half of all HIV infections in Nigeria are among prostitutes, their partners and their clients. Although prostitutes, homosexuals and drug addicts make up only 1% of the Nigerian population, they account for around 23% of all new HIV infections because many of them don’t use condoms when they have sex. This is not surprising considering that 19% of male prostitutes and 25% of female prostitutes are living with HIV. This is eight times higher than the general population.
TB is a very deadly and highly infectious disease and not many people are aware of the potential danger they face daily. This should change with all citizens imbibing better hygiene and prevention. WHO-recommended Direct Observed Treatment Short-Course, (DOTS) is the best treatment option of TB globally. According to the National Tuberculosis and Leprosy Control Programme (NTBLCP), the appropriate services are currently provided in about 6000 health facilities in the country with diagnosis in 1,515 microscopy laboratories. The TB program in Nigeria has also adopted new molecular technology known as GeneXpert, an automated diagnostic test that can identify Mycobacterium tuberculosis and resistance to rifampicin in two hours. The program has also commenced community direct TB services to initiate treatment at the community level and this has helped in mopping up backlog of cases, which could not be admitted in hospital due to limited bed space.
TB certainly remains a public health issue in Nigeria, having been ranked as the second cause of death after HIV/AIDS. Unfortunately, the disease could remain latent and undiagnosed in many patients. As a matter of fact, healthy patients don’t manifest symptoms as the immune system builds a “wall off” the bacteria. This is a factor in the spread and rise of TB cases in Nigeria. Besides, there are indications that a growing number of patients have the highly resistant strains of TB that resist conventional treatment and kill rapidly when left untreated. The multi-drug resistant TB reportedly has a mean annual percentage increase exceeding 100 in Nigeria, which is frightening. Given that scenario, any measure that would enhance universal access to treatment and drugs for TB patients should be pursued.
TB is caused by Mycobacterium tuberculosis, which most commonly affects the lungs. It is transmitted through droplets from the throat and lungs of people with active respiratory disease. Before now, TB used to be a big global problem, but the discovery of effective treatment drugs has raised awareness that the disease is curable. Unfortunately, the disease still kills three people every minute. The “Stop TB Partnership”, founded in 2001 in Geneva, Switzerland, is leading the way in the struggle for total eradication of TB. With 1,300 partners worldwide, the Partnership’s mission is to serve every person who is vulnerable to TB and ensure that high-quality treatment is available to all who need it. Incidentally, TB mostly affects HIV/AIDS patients as lack of immunity predisposes them to opportunistic infections like TB.
Here in Nigeria, lack of research, effective treatment and public enlightenment are among the factors that compound the problem. In the past, TB patients were isolated but that has now changed with the availability and advances in treatment methods. Consequently, people should be careful and basic hygiene is crucial to prevention. Nigerians are wide travelers and the borders are porous. There is a need to have infectious disease hospitals across the country. Sadly enough, the only infectious disease hospital in Lagos has been abandoned. It was only remembered for refurbishment in the wake of the Ebola fever outbreak. The government should, therefore, create infectious disease hospitals and not wait until there is a public health crisis like Ebola before appropriate facilities are put in place.
Worrying as AIDS and TB are, because of their high fatality rates, the present situation calls for concerted efforts by health and other authorities to arrest it and stop further spread. It is doubtful whether these measures have been adequately explored to counter the seriousness of the situation. There is need for public enlightenment because poor education is part of the problem as, quite often; carelessness is responsible for people contacting the diseases. Certainly, the nation’s health education and healthcare delivery infrastructure need overhauling to stem the tide of AIDS and tuberculosis.
Source: News Ghana