The high rate of patients who are defaulting on TB treatment has been highlighted as the major contributor to Botswana’s low success rate in treating and curing tuberculosis. This emerged last week at the commemoration of the world TB day in Francistown.
Reports indicate that over two million people are infected with TB on an annual basis, and in recent years many countries that had previously won the battle against TB are now experiencing a resurgence. This is greatly attributed to defaulting treatment, discontinuing treatment and the high rate of HIV infections, especially in Sub Saharan Africa, including Botswana.
TB is a highly infectious disease caused by airborne bacterium called mycobacterium tuberculosis. It is transmitted by inhaling indoor air contaminated with the bacterium. Research indicates that a third of today’s population has been affected by TB, and new infections occur at the rate of one per second.
However the human immune system usually destroys or seals off the bacterium at the site of infection, such that most of the infections will not develop into full blown disease.Statistics indicate that about 90-95% of TB infections heal without ever being noticed. But sometimes the bacterium is not destroyed, and remains dormant inside the white blood cells for many years where it can be reactivated if the human immune system is impaired.
HIV impairs the human immune system and can cause reactivation of dormant TB bacterium, leading to symptoms like persistent coughs, night sweats, blood tinged sputum, shortness of breath and loss of appetite. Other factors that can compromise the immune system are immunosuppressive drugs and substance abuse.
It is estimated that 3 million people are co-infected with TB and HIV, while 50-82% of those diagnosed with AIDS have TB. With its high HIV prevalence Botswana is no exception.
Botswana‘s situation is also worsened by a significant number of patients who are defaulting on treatment. The 2006 TB report indicates that the treatment success rate for Francistown was 57.9%, which is much lower than the set World Health Organization standard of 85%. The low treatment success rate is greatly attributed to a significant number of patients who default on treatment. Statistics indicate that the 2005 default rate was 7% while that of 2006 increased to 9.1%.TB related deaths currently stand at 11%.
The guest speaker at the TB commemoration, Gift Pelaelo of the Botswana Power Corporation, said that some patients just decide to discontinue treatment. This, he said, can lead to Multi drug resistant TB (MDR TB), which is very difficult to treat and can lead to death, thus increasing Botswana’s TB related deaths. MDR-TB is defined as TB that is resistant at least to isoniazid (INH) and rifampicin (RMP), the two most powerful first-line anti-TB drugs. It mostly develops in the course of the treatment of fully sensitive TB as a result of patients missing doses or failing to complete a course of treatment.
In recent years, Botswana has been experiencing an increase in the MDR-Tb statistics in Botswana. By January 2008, there were over 100 reported cases of MDR-TB. According to the FCC presentations during the day, Francistown currently has 4 reported cases of MDR-TB.
Extensively drug-resistant tuberculosis (XDR-TB) is a form of TB caused by bacteria that is resistant to the most effective anti-TB drugs. It has emerged from the mismanagement of multi-drug-resistant TB (MDR-TB) and once created, can spread from one person to another. By early 2008, Botswana had 2 reported cases of XDR-TB. The FCC maintains that there have never been any reported cases of XDR-TB in Francistown.
Government has put in place initiatives that are meant to address the issue of defaulting treatment. One such initiative is the involvement of the community in TB treatment, which is primarily meant to reduce the number of TB infections in the community, reduce stigma associated with TB and follow up on patients who have discontinued or are defaulting on treatment.
Pelaelo said that all stakeholders, including, teachers, patients, the community and civic and political leaders should make it their personal agenda to assist in the fight against TB, as espoused in this year’s theme: “I am stopping TB”.
“Lately, community TB care has been introduced to increase access to treatment. Volunteers are identified and trained to provide drugs in the community. This initiative is also meant to enhance community involvement in the control of TB,” he said.
For her part, Health Education Officer in the FCC, Kabo Ng’ombe, said that government introduced community TB care as a way of extending TB care beyond the health facilities. She said that research has proven that some patients find it difficult to adhere to treatment because they are either committed to work or too ill to visit health facilities for treatment.
“Community TB care will also reduce congestion at health facilities and encouraged community members to partake in the care of their own, as espoused in this year’s theme,” she said.