Total Victory over the TB Epidemic Will Require a United Front-UN Secretary-General Ban Ki-moon

Last year, the United Nations General Assembly adopted the 2030 Agenda for Sustainable Development. Ending the TB epidemic by 2030 is one of the targets of the new Sustainable Development Goals. TB disproportionately affects the poorest and most vulnerable, the socially marginalized and those lacking access to basic services/health services. Therefore, progress in ending TB must go hand in hand with other Sustainable Development Goal efforts to reduce inequalities, eliminate extreme poverty, ensure social protection, achieve universal health coverage and end HIV/AIDS.

Total victory over TB will require a united front. Ending the epidemic requires actions beyond ministries of health alone. As the World Health Organization End TB Strategy emphasizes, departments responsible for labour, justice, social welfare, science and technology, internal affairs and migration can all make a difference. We must also do more to engage affected persons and communities, as well as non-governmental organizations, researchers and the private sector.

The task ahead is daunting. Drug-resistant TB poses a major global health risk. We need new tests to rapidly diagnose people with TB; earlier, safer, easier and shorter treatment for infection and disease; and effective new vaccines. We need to eliminate stigma and ensure all affected people have access to care. And we need to be ready to keep people healthy in the face of complex emergencies and unprecedented movements of refugees and migrants worldwide.

On this World Tuberculosis Day, I call on leaders across Government, civil society and the private sector to unite to end tuberculosis. Together we can win the fight and end the TB epidemic by 2030.

 

Uganda Commemorates World TB Day 2016

The Days’ activities include free HIV and TB testing services, drama performances, exhibition  as well as vaccination of children.

About Tuberculosis:

Tuberculosis (TB) is caused by a type of bacterium called Mycobacterium tuberculosis. The condition is spread when a person with an active TB infection in their lungs coughs or sneezes and someone else inhales the expelled droplets, which contain TB bacteria.

The Uganda picture

•           60,000 people develop TB in the country

•           Every third Ugandan has the germ

•           About 4,500 people die of the disease per year

Symptoms

Although the body may harbor the bacteria that cause tuberculosis, the immune system usually can prevent you from becoming sick. For this reason, doctors make a distinction between:

• Latent TB. In this condition, you have a TB infection, but the bacteria remain in the body in an inactive state and cause no symptoms. Latent TB, also called inactive TB or TB infection, isn’t contagious. It can turn into active TB, so treatment is important for the person with latent TB and to help control the spread of TB. An estimated 2 billion people have latent TB.
• Active TB. This condition makes you sick and can spread to others. It can occur in the first few weeks after infection with the TB bacteria, or it might occur years later.

Signs and symptoms of active TB include:

Early stages: May have no symptoms: no symptoms. As the TB disease develops individuals may experience some or all of the following:

•           Cough, sometimes with sputum (spit) which can be blood stained

•           Fever

•           Sweating, especially at night

•           Loss of appetite

•           Unexplained weight loss

•           Chest pain

•           Shortness of breath

•           Sometimes lumps (swollen lymph nodes) in the neck or armpits

Tuberculosis can also affect other parts of the body, including the kidneys, spine or brain. When TB occurs outside the lungs, signs and symptoms vary according to the organs involved. For example, tuberculosis of the spine may give you back pain, and tuberculosis in the kidneys might cause blood in the urine.

When to see a doctor

See the doctor if you have a fever, unexplained weight loss, drenching night sweats or a persistent cough. These are often signs of TB, but they can also result from other medical problems. The doctor can perform tests to help determine the cause.

The Centers for Disease Control and Prevention recommends that people who have an increased risk of tuberculosis be screened for latent TB infection. This recommendation includes:

• People with HIV/AIDS
• IV drug users
• Those in contact with infected individuals
• Health care workers who treat people with a high risk of TB

 Causes

Tuberculosis is caused by bacteria that spread from person to person through microscopic droplets released into the air. This can happen when someone with the untreated, active form of tuberculosis coughs, speaks, sneezes, spits, laughs or sings.

Although tuberculosis is contagious, it’s not easy to catch. You’re much more likely to get tuberculosis from someone you live with or work with than from a stranger. Most people with active TB who’ve had appropriate drug treatment for at least two weeks are no longer contagious.

HIV and TB

Since the 1980s, the number of cases of tuberculosis has increased dramatically because of the spread of HIV, the virus that causes AIDS. Infection with HIV suppresses the immune system, making it difficult for the body to control TB bacteria. As a result, people with HIV are many times more likely to get TB and to progress from latent to active disease than are people who aren’t HIV positive.

Facts

• TB is the leading cause of illness and death among people living with HIV.
• Without proper treatment, approximately 90% of people living with HIV die within two to three months of contracting TB.
• People living with HIV who have TB disease die sooner than those without TB–even if they are receiving antiretroviral treatment.
• Globally, 12% of all TB deaths occur in people living with HIV.

Drug-resistant TBAnother reason tuberculosis remains a major killer is the increase in drug-resistant strains of the bacterium. Since the first antibiotics were used to fight tuberculosis more than 60 years ago, some TB germs have developed the ability to survive, and that ability gets passed on to their descendants.

Drug-resistant strains of tuberculosis emerge when an antibiotic fails to kill all of the bacteria it targets. The surviving bacteria become resistant to that particular drug and frequently other antibiotics as well. Some TB bacteria have developed resistance to the most commonly used treatments, such as isoniazid and rifampin.

Some strains of TB have also developed resistance to drugs less commonly used in TB treatment, such as the antibiotics known as fluoroquinolones, and injectable medications including amikacin, kanamycin and capreomycin. These medications are often used to treat infections that are resistant to the more commonly used drugs.

Risk factors

Anyone can get tuberculosis, but certain factors can increase the risk of the disease. These factors include:

• Closeness to the patient
• Time spent together with the patient
• Crowding
• Ventilation
• Low immunity of the individual – Immunity in the case of the person contracting the disease.

Weakened immune system

A healthy immune system is often successfully in fighting the TB bacteria, but the body can’t mount an effective defense if the resistance is low. A number of diseases and medications can weaken the immune system, including:

• HIV/AIDS
• Diabetes
• Severe kidney disease
• Certain cancers
• Cancer treatment, such as chemotherapy
• Drugs to prevent rejection of transplanted organs
• Some drugs used to treat rheumatoid arthritis, Crohn’s disease and psoriasis
• Malnutrition
• Very young or advanced age

Prevention and control of TB

Special precautions must be taken to prevent spread of TB by controlling germs from leaving the sick person through doing the following:

• Early diagnosis and treatment
• Cough etiquette
• Patient must be advised to use masks when around other people or public places.
• Keeping the environment clean
• Proper architectural planning of health centres/wards to allow proper ventilation.
• Opening windows, doors including those of public transport like buses and taxis.
• Avoid crowding.
• Using special lights that kill germs.

Treatment

• TB disease can be cured, even in people living with HIV,
• Treatment takes 8 months in Uganda, this will change soon(to 6months)
• Adequate treatment of TB in people living with HIV has been shown to prolong their life by at least two years.
• TB patients may not spread the disease after 2 weeks of initiation on modern drugs/medicines.(starting treatment)
• TB should be diagnosed and treated as soon as possible. This helps to reduce the damage caused and reduce the risk of transmission to others
• Ensure that the contacts of infectious cases can be traced for TB testing and treatment if necessary.
• DOT is the recommended method of treatment – Directly Observed Treatment.
• If TB drugs are not used properly, the TB bacteria can become resistant to the drugs/medicines.

TB services in Kampala and elsewhere

All KCCA health facilities

Division           Facility

Central             Kisenyi health centre,

Kawempe        Komamboga

Kawempe health centre

Nakawa           Kiswa health centre

Sino-Uganda Friendship Hospital (Naguru)

Makindye        Kissigu health centre

Rubaga            Kawaala health centre, Kitebi

Hospitals: Mulago, Butabika, Rubaga, Kibuli, Namunggona and some private facilities

 

About UNHCO: The Uganda National Health Users’/Consumers’ Organization (UNHCO) is a proud member of the Uganda Stop TB Partnership contributing towards increased awareness of TB disease in over 30 communities across Uganda.UNHCO is a membership not-for-profit Ugandan organization established in 1999 by a group of Ugandans drawn from various professional backgrounds to advocate for the realization of the right to health for all Ugandans. UNHCO exists to promote full integration and implementation of the rights based approach in Uganda’s health sector through meaningful citizen-duty bearer engagement in healthcare planning and delivery.  UNHCO facilitates honest and non-confrontational engagement between policy makers, health providers and citizens in health care planning and delivery. Our passion is our strength; mobilizing and rallying health users for information and action, strengthening systems training groups on relevant topics, orientations on health policy frameworks, using existing evidence and spaces to influence policy and practice, using various tools to monitor services.

UNHCO particularly focuses on raising awareness for prevention and management of Communicable and Non Communicable Diseases. We advocate for purposes of ensuring that policies are adjusted to provide for an enabling environment for addressing. UNHCO plans to raise awareness for prevention and management of both Communicable and Non Communicable Diseases. UNHCO advocates for necessary health policy change to provide for an enabling environment for addressing CDs and NCDs.

 

Take home messages for every Ugandan

•           Without proper treatment most TB patients die.

•           Report early to health facilities if you develop signs and symptoms of TB.

•           Avoid excessive alcohol consumption.

•           Avoid smoking.

•           Complete the treatment course as per treatment plan.

•           Follow instructions of taking your medicine as by your health provider (adherence).

•           TB medicines and other services are free at all government facilities.

•           Family/community members should not discriminate TB patients.

•           Early reporting for proper diagnosis by qualified personnel is very important.