As 18-year-old Teopista Nalubega left the Tuberculosis (TB) ward at Mulago National Referral Hospital, she tried so hard to control her emotions. However, as she walked towards the hospital's main gate, she could not hold back any more, so she sat down on the pavement and started crying.
Her grief was not because she had lost someone or because she had a patient at the ward. I was rather because her father could not recognise who she was.
Without talking to anyone in particular, Nalubega started sobbing as she said, "I understand that he is very sick because this is not the first time he has been like this. However, I cannot believe that he does not recognise me," she said in anguish.
Nalubega explains that about eight months ago, her father developed a cough.
"My father has always been a smoker so when he started coughing, we thought it was because of the cigarettes. And since it was just a cough, he did not pay that much attention."
The third born in a family of six, Nalubega adds that when the cough persisted for a month, her father decided to go to a nearby clinic.
"They gave him some tablets which he swallowed but I think because he still continued smoking, this made it hard for the cough to cure," she explains with a distant look.
However, when he started losing weight and appetite, one of his older children decided that he needed to go to one of the government hospital in Masaka, where they stayed.
At the hospital, Nalubega's 49-year-old father was diagnosed with Tuberculosis.
Dr Mario Raviglione, the Director, Global TB Programme at the World Health Organisation (WHO) in Geneva says studies show that a smoker has a risk which is two to three times than that of a non-smoker to get infected with TB and get the disease once infected.
"There is a difference between getting infected with TB and getting the actual disease. This means that if someone has tuberculosis and another person has never had it before and never been exposed, if the person with the disease coughs while you are seated in the same room and this happens for a month or two, the healthy person will get infected," Dr Raviglione says in an interview.
He adds, "When this happens, the healthy person's body can contain the infections so you will never have the disease throughout your lifetime."
The doctor, however, explains that in the event that your immunity is impaired by a number of things such as HIV during the course of your life, the risk of you getting TB is increased. "However, if you are a smoker, it increases two to two and a half times."
This therefore means that Nalubega's father was already infected with TB but his continuous usage of tobacco increased his chances of contracting the disease which is caused by a bacterium.
A 2014 study conducted on 5,567 TB patients in Taiwan indicated that of those patients, 1.5 per cent (83 of the participants) developed a recurrent case of TB, with regular tobacco smokers twice as likely to develop recurrent TB compared with former smokers and with individuals who had never smoked tobacco.
According to theunion.org, one of the authors of the research, Dr Chung-Yeh Deng of National Yang-Ming University in Taipei, "More than ever before, we understand how tobacco harms people who have already been successfully treated for TB."
Relationship between tobacco smoke and TB
When asked about the relationship between tobacco usage and TB, Dr Raviglione who was speaking at the 46th Union World Conference on Lung Health in Cape Town in December explained, "Smoking reduces the defences in the lungs so when the bacterium that cause TB gets in the lungs, there is really no defence. So you get infected so easily, you get the transmission so easily and once infected, the bacteria easily finds its way in the lympnodes, the lungs and near the lungs so you will easily react to diseases such as TB.
Additionally, Dr Kamran Siddiqi, a clinical senior lecturer in Epidemiology and Public Health in the Department of Health Science at The University of York says the body has a defence system which prevents the body from getting infections. He adds that one of the defence systems are the cells.
"These cells are impaired when someone smokes. There are also mechanisms within the lungs that remove all the bacteria and foreign agents in the lungs so these too are impaired by the smoke."
He adds, "When there is damage to the lining of the lungs, the airways and cells. This makes the lungs and the body more vulnerable to attacks so this makes it easy for the person who smokes to get TB."
Dr Raviglione further explains that, "It is more about the chemicals in the smoke that inhibit the lymphatic immune system in the lungs that alters the immune system that allows the TB bacteria to penetrate."
More so, Dr Siddiqi says if you already have TB but are still a smoker, your recovery rate is slow because you need a lot of healthy cells in the lungs to get rid of the bacteria but these cells are damaged by smoking so the body's immune is already damaged and this will make it hard for a smoker to recover.
In an earlier interview with Dr Sheila Ndyanabangi, the Tobacco Control focal person and programme manager for mental health at the Ministry of Health, she said tobacco damages the small hairs that are supposed to push out the foreign bodies.
"When you breathe in, the hairs protect you by making sure that the small particles of dust or smoke do not go into the lungs because they will clog the alveoli but tobacco smoke paralyses and damages them. So smokers lose the ability to filter the air that goes into their lungs so all the dirt settles in the lungs and they end up with chronic cough as they try to cough out the particles lodged in the lungs."
TB burden in Uganda
According to Dr Frank Mugabe, the programme manager of the National TB and Leprosy Programme (NTLP), it is estimated that the TB burden in the country stands at 60,000 patients.
In an interview with Dr Mugabe he said 16,000 patients remain undetected due to lack of awareness, poor health seeking behaviour, inadequate diagnosis such as non-functional x-ray machines, limited capacity of health workers and lack of a patient-tracking mechanism.
He added, "Uganda is among the 22 high burden countries of the world. These are countries with the highest number of TB cases."
However, Dr Raviglione says, "If 20 per cent of the TB patients were not smokers, the TB infections and death rates would be reduced."
What should be done
Last years, the Tobacco Control Bill 2014 was passed into law. It highlights issues such 100 per cent smoke-free environments and it does not permit smoking within 50 metres from a public place, a total ban on the display of cigarettes at the point of sale and on advertising, promotion and sponsorship of tobacco and It also put a ban on the sale of cigarettes in public places like cinemas, educational institutions, public transport, health facilities, among others.
However, Dr Siddiqi says the most effective tobacco control measure is to increase taxes on tobacco products. "This is because we have seen in a lot of European countries that when the price of tobacco goes up, smoking prevalence also goes down."
Dr Raviglione also adds that there is need to offer help for cessation to the most vulnerable, that's TB and HIV patients. This can be done by the health providers offering advice to such patients.
He explains, "We have been working with colleagues in tobacco control to have in the same clinic where people go for tobacco cessation to look out for signs such as over coughing in these people. But more importantly, when a person has TB, in such clinics, there is not only the treatment for six months but there is also a reminder that they should stop smoking so that this person does not run the risk of not getting cured and perhaps even dying."
WHO recommends that there is need to control tobacco everywhere, but especially where people are at risk of TB infection.
According to its fact sheet, WHO advises that, "Governments should coordinate national TB and tobacco control programmes, cross-train TB and tobacco control health workers, register TB patients' tobacco use and offer them counseling and treatment, promote and enforce smoke-free policies, particularly where TB services are delivered, integrate brief tobacco interventions into TB control programme activities and implement smoking cessation procedures through PAL practical approach to lung health."
Source: Daily Monitor