As the nation gears up for the World Tuberculosis Day commemoration slated for Francistown next Tuesday (March 24) the disease continues to show no signs of abating. Despite concerted efforts to reduce the spread of tuberculosis (TB) challenges in dealing with the disease continue to undermine efforts made by the Ministry of Health (MoH). Over 7,000 cases of TB were reported across the country in 2013 while 2014 recorded an increased 8,400 cases.
Speaking at a press conference hosted by her ministry at Cresta Lodge on Tuesday March 17, Deputy Permanent Secretary (DPS) in the Ministry of Health Dr Sheenaz El Halabi said the TB burden per capita in Botswana remains among the highest in the world.
“Our estimated rate of new episodes of TB, or incidence in 2014 was as high as 414 cases per 100,000 people,” she said. This, El Halabi said, is more than three times the global equivalent. She said the Multi Drug Resistant (MDR) TB complicates the MoH’s response to TB.
“Each year we confirm close to 100 new cases of Multi Drug Resistant TB across the country. According to the World Health Organization estimates, this is only 50% of all the MDR TB cases estimated in the country. The other 50% are either missed or do not report to the health facilities,” the DPS said. She said the missed cases will either die or continue to spread the disease. “We will be conducting a national Drug resistance survey in the next financial year to get a true picture of the burden of drug resistance in the country.”
She said Botswana has decentralised the management of drug resistant TB to five MDR TB treatment initiation sites throughout the country. “The ministry provides free transport for patients to be seen at these sites.” Thirty clinicians were successfully trained on MDR TB management in 2014 while more than a hundred private practitioners have been trained in TB care through the Public Private Mix framework.
In their efforts to strengthen TB diagnostic capabilities El Halabi said the ministry successfully rolled out across the country Gene Xpert machines that can detect TB in hours instead of weeks or months. She said this enables early initiation of TB treatment which goes a long way in saving lives.
She said the National TB Reference Lab has been nominated by SADC to be a regional lab and its accreditation process is about to be finalized.
El Halabi said in terms of treatment Botswana is among the few countries in the region where TB treatment is free of charge. “All our national TB drug requirements (first and second line) are procured through our own national recurrent budget.” She cited HIV as the main driver behind the increasing number of TB cases. “It is worth noting that as high as 63 percent of our TB patients are co-infected with HIV,” she said. She said the national TB/HIV Policy framework calls for a more integrated TB and HIV service package. She said all HIV patients are regularly screened for TB. “This helps us to catch TB early and initiate treatment promptly which cuts down transmission of the disease.” El Halabi said despite such achievements, documenting case finding for TB, treatment adherence and scaling up infection control practices in all HIV care settings remains a challenge.
“We still need to do more to engage our communities to meaningfully participate in TB control interventions,” the DPS said. “Preliminary findings of an ongoing study conducted in collaboration with partners show that there is ongoing transmission of TB mostly within communities.”
Speaking on behalf of the WHO Country Representative, Boingotlo Gasennelwe said the current global trends in TB are improving as evidenced by the decline in TB deaths and cases. “The Millennium Development Goal of halting and reversing TB incidence has been achieved in all six WHO regions, especially from high burden countries.” She said however that the trends in some countries still remain daunting. Globally TB incidence fell at an average rate of about 1.5% per year between 2000 and 2013 while death rate fell by an estimated 45% between 1990 and 2013.The TB prevalence rate fell by 41% during the same period. “This has given hope that eliminating the global TB epidemic and ending of the economic and social burden of TB is feasible,”Gasennelwe said.
She said in view of these developments, Member States called on WHO at the 65th World Health Assembly (2012), to develop a post-2015 tuberculosis strategy to end the disease. The strategy was then drafted, discussed and adopted in the 67th World Health assembly in 2014.
The theme for this year’s World TB Day commemoration is ‘Reach the three million’ with the main message being ‘Reach, Treat, Cure Everyone’.