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This year’s World Tuberculosis (TB) Day, marked on March 24, 2023, afforded Nigeria and the rest of the world another opportunity to review and highlight efforts to end it. The World TB Day commemorates the day when Professor Robert Koch announced in Berlin in 1882 that he had discovered the microbial cause of TB known as Mycobacterium tuberculosis. The theme for this year’s event was “Yes! We can end TB!”
The infectious disease is transmitted to people through the air. Someone can contract it by breathing in some TB bugs or germs released in the air by a person with TB who coughs or sneezes, spits or breathes out. It usually affects the lungs. Symptoms of the disease include coughing, weight loss and sweat. There is also latent TB wherein a person can become infected but will not be ill.
Globally, the statistics are not salutary. About two billion people are estimated to be infected with TB in the world. Annually, about 10 million people worldwide reportedly fall ill to the disease. About 25 per cent of all TB cases and 25 per cent of all deaths are in Africa. The disease is the leading cause of death for HIV patients and is said to be the world’s most infectious killer disease despite the fact that effective treatment has been available since 1952. In 2021, about 1.6 million people died of the disease. Out of this number, 240,000 were said to be children. Most of these were not diagnosed before death.
Nigeria ranks sixth among the TB High Burden countries in the world and number one in Africa. Every year, about 245,000 people die from the disease in the country. One major problem hindering effective elimination of TB in Nigeria is poor awareness which leads to the stigmatisation of people suffering from the disease. Due to the stigma, a number of patients avoid going for treatment. The advent of COVID-19 pandemic worsened the situation as both TB and COVID-19 present near similar symptoms.
Early diagnosis and treatment of TB is important. This is easier for adults but more complicated for children. This is partly because it is a bit difficult to test and detect the symptoms of the disease in children. Even the chest X-rays that are commonly used, are not readily available especially in rural areas.
One major way of protecting children against TB is through the Bacille Calmette-Guerin (BCG) vaccine which is given in early childhood. In Nigeria, many parents ensure their babies get the vaccination. But there are still some parents who shy away from the important preventive measure either due to superstitious beliefs or outright ignorance. In 2014, the WHO End TB Strategy was adopted. The focus was to achieve universal access to patient-centred prevention and care with a view to eliminating the high cost for households affected by TB by 2030. Nevertheless, funding for diagnosis, prevention and treatment services has not been encouraging. In 2018, there was a global target to treat 40 million people with TB disease between 2018 and 2022. The sum of $1.3billion per year and another sum of $2billion annually for TB research were required to achieve the targets. This was not realised. According to the World Health Organisation (WHO), global spending on TB services fell to $5.3billion while funding for research was $901million in 2020. In Africa, governments have only provided about 22 per cent of the resources needed for TB services. In Nigeria, only 31 per cent of the N150 billion needed for TB control in 2020 was reportedly made available to implementers.
This is why public-private partnership is essential in the efforts to end TB. Private companies, for instance, could provide high-quality diagnostics where the disease is easily diagnosed before treatment. Recently, one of the world’s largest biotech companies, Roche, announced that it had expanded its collaboration with the US Centers for Disease Control and Prevention (CDC) to strengthen laboratory capabilities in countries with high prevalence of HIV and TB epidemics. Roche and the CDC also seek to improve HIV and TB prevention, detection and treatment in some countries in Africa, Central Asia, Eastern Europe, Central America, Latin America and the Caribbean Regions.
The government should also leverage on the support of private companies, development partners and non-governmental organisations. The WHO Deputy Country Representative, Mr. Chimbaru Alexander, said at a National TB conference in Abuja in November 2021, that WHO had supported the government to develop guidelines, Standard Operating Procedures, new strategies, regimen, and interventions in addition to supporting the country in the implementation of the multi-sectoral approach towards ending TB epidemic in Nigeria. We thank the WHO and implore it to do more.
Let the government equip the primary health care centres with the necessary and effective diagnostic tools that can detect the disease early enough. Efficient prevention programmes and public enlightenment are also important. Periodic training for caregivers will keep them abreast of developments in managing the disease.
The wearing of nose mask can reduce the chances of contracting the disease. Let people live in apartments with adequate ventilation. The need to develop more effective vaccines and strategies against TB is necessary now more than ever before.
