Dr Llang Bridget Maama
Stakeholders fear the worst over Tuberculosis
Pascalinah Kabi
IT never rains but pours for Lesotho.
After leapfrogging Botswana into second place in the world on HIV-prevalence, the Kingdom is now ranked first in Tuberculosis (TB) infections, with 852 people in every 100 000 now said to be suffering from the highly infectious disease, according to the World Health Organisation’s 2015 Global TB Report.
Neighbouring South Africa is second with 834 people in every 100 000 also infected with TB, while in HIV, Swaziland leads the pack with a 26-percent prevalence while Lesotho is second at 23 percent.
A highly contagious disease caused by various strains of mycobacteria, TB largely attacks the lungs, but can also affect other parts of the body.
The disease’s transmission through the air when people who have an active TB infection cough, sneeze, or otherwise transmit respiratory fluids, makes it a very unpredictable if not dangerous adversary.
However, the fact that TB can be treated if detected early, is probably the only bright spot in an otherwise dark and malevolent world in which those infected gradually waste away and should they lose hope, die and become yet another sad statistic.
The World Health Organisation (WHO) says the probability of developing TB is much higher among people infected with HIV, leaving Lesotho very vulnerable due to its high HIV-prevalence rate. Third-placed Botswana is at 19 percent, according to WHO figures.
“TB now ranks alongside HIV as a leading cause of death worldwide. HIV’s death toll in 2014 was estimated at 1.2 million, which included the 0.4 million TB deaths among HIV-positive people,” reads the WHO report.
It is against such a bleak background that the Ministry of Health is “seriously” considering advising Prime Minister Pakalitha Mosisili to declare TB a state of emergency.
According to the Ministry of Health’s TB Manager, Dr Llang Maama, the country’s latest Tuberculosis ranking makes for sad reading hence the need to react accordingly. Various non-governmental organisations (NGOs) operating in Lesotho have also urged the government to declare TB a state of emergency and seek more support from the international community.
“Lesotho has now been ranked number one globally in TB prevalence due to the high incidence of 852/100000 and, yes, this is a bad state of affairs to lead the world with an infection which spreads so easily. The country is facing an emergency which requires extra effort to change this picture,” Dr Maama said.
“I strongly agree with the proposed move by NGOs and the ministry is seriously considering it, but more consultations and preparations would need to be done first.”
Lesotho failed to meet its United Nations Millennium Development Goal (MDG) to halve TB infections by 2015, and Dr Maama attributed this to the disease always having been “a huge problem” for the country.
However, Dr Maama pointed out that Lesotho has not failed in its efforts to fight TB, adding the prevalence rate has not necessarily increased.
“It is just that now there has been this quantum leap following some adjustments to reporting systems and new definitions used by TB programmes as well as denominators used to come up with these estimates,” Dr Maama said.
“We have not totally failed, since we are able to diagnose and treat both susceptible TB and Multi-Drug-Resistant tuberculosis (MDR–TB). Our antiretroviral treatment coverage among TB patients who are also HIV-positive, has steadily increased and is at 72 percent, and there are many other areas of improvement in the ministry’s TB response.”
According to Dr Maama, several factors have contributed to the apparent lack of progress, among them patients seeking treatment late.
“For 2015, the coinfection rate was 74 percent. Malnutrition might have been a contributing factor, as well as poor living conditions which facilitate the continuous transmission of TB at household and community level. This is evidenced by high rates of drug-resistant TB among new MDR-TB patients,” Dr Maama said.
Other contributing factors, she reiterated, include the country’s high HIV-prevalence, extreme poverty, and delays in seeking treatment.
Dr Maama further cited limited human resources to cover at least the basic components of TB control at programme level, such as the capacity to diagnose patients.
Inadequate testing facilities for the disease, as well as lack of information among communities, and lack of specialised staff in areas of health promotion and education in order to reach risk groups such as mineworkers, ex-miners, textile factory workers, children and correctional institutions, were also contributing to the problem, she added.
But according to Dr Maama, the affected lives were far more important than statistics.
“It is not even about the ranking because every number stands for a patient whose life is important. The National TB and Leprosy Strategic Plan has been revised to address some of the many challenges faced by the programme and the country at large,” Dr Maama said.
“The declining number of patients will be addressed through the meaningful engagement of Civil Society Organizations (CSOs) which work at community level but are only focusing on HIV. The ministry, through the National TB Programme, will forge a relationship with all these CSOs through their umbrella body and train them on how to include TB in their business.”
Dr Maama further said the programme would conduct a workshop to adopt WHO procedures aimed at guiding the CSOs on how they could contribute to TB control.
“They can assist in finding cases so that all TB patients are on treatment, support those on treatment, refer all cases for treatment and educate patients and the community on TB and the importance of adherence to treatment. We shall embark on a nationwide TB prevalence survey to better understand the burden of the disease other than relying on the mathematical modelling used to make estimates for these impact indicators.”
The ministry would leave no stone unturned in its efforts to eradicate TB and is going to adopt a multi-sectoral approach that includes involving the corporate sector and community at large, Dr Maama added.
She also said Local Government structures would be very instrumental in improving community involvement and participation in TB programmes.
Dr Maama again noted that the government would be urged to pay attention and address the social determinants of TB, HIV and other diseases and ensure families do not face exorbitant charges when seeking care.
“The ministry will continue to strengthen TB/HIV collaborative activities and pursue universal coverage for all eligible PLHIV (People Living with HIV/AIDS) and susceptible TB, and MDR-TB patients.”
Meanwhile, Partners in Health (PIH)—a United States of America-based non-profit healthcare organisation founded in 1987—has called on the Prime Minister to declare TB a state of emergency.
“I am surprised that the country has not declared TB a state of emergency because doing so would allow international partners to come in and help fight the disease,” said PIH Technical Director, Dr David Omotayo.
“Lesotho’s TB programmes are funded by Global Fund and PIH has been commissioned to undertake this project. Since July 2015, we have tested around 18 people every month and we continue to find new infections, and this is disturbing.
“TB is an opportunistic disease and with the country having the second highest HIV prevalence in the world, it needs the international community’s help in fighting this disease.
“We are in a crisis. Only two years ago, in 2014, we were ranked number three and now we have jumped to number one. This is worrying.”
“It is estimated that 82 percent of MDR-TB cases in SADC (Southern African Development Community) are found in South Africa and it is easy to transmit the disease to Lesotho due to migration, especially by the miners.”
Dr Omotayo warned that the country needed to revamp its health system, especially primary healthcare, in order to combat the disease.
“No country can achieve its set targets without primary healthcare and Lesotho needs to invest more money in this department. Mobilising citizens is also very crucial to decrease TB infections,” he said.
Lesotho, Dr Omotayo further said, needs technical assistance from the international community to fight this disease.
“No one is immune to TB as it is contracted through bacteria in the air, so we need to be worried by this continued increase in infections,” Dr Omotayo said.
Pitsong Institute of Implementation Research, an NGO leading the prime minister’s Health Sector Reform, has also said TB should be declared a state of emergency.
“Health has gone wrong and being ranked number one on TB simply indicates that we have stopped pursuing the interests of Basotho but rather, chasing MDGs and Sustainable Development Goals (which succeeded MDGs after their 2015 deadline),” Mr Tšoele said.
“We are a dying nation. Our health system is ailing and issues of HIV, TB and Maternal and Child mortality are all indicators of a dying nation. We need help from the international community especially on issues of TB. We are going to advise the Prime Minister to urgently declare TB a state of emergency so that the international community can send experts to Lesotho to help.”
Mr Tšoele also spoke about the urgent need to invest in primary healthcare as prevention is crucial.
“The disease burden is high because our primary healthcare level doesn’t have adequate resources, thereby neglecting the most important aspect of social mobilisation and prevention.
“Every Mosotho should play his or her part in fighting TB if we are to win the battle against the disease.”
