Why we must fight tuberculosis at the grassroots

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Tuberculosis (TB) is a communicable disease caused by any of the several species of Mycobacterium referred to as tubercle bacillus. Nigeria is currently ranked third among the 22 highest-burdened countries in the world and the first in Africa. In Nigeria, Lagos State, carries 10% of Nigeria’s TB burden. In this interview with Omolara Akintoye, the supervisor, Tuberculosis and Leprosy Control, Ikeja local government, Lagos, Mr. Oladimeji Joseph, reveals how the council is fighting tuberculosis at the grassroots by focusing on case detection and treatment. Excerpts

WHAT is tuberculosis and how is it contacted?

Tuberculosis is one of the chronic tropical diseases which principally affect the lungs, but with time we’ve discovered that it can also affect any other organs of the body. It’s caused by a particular bacterium called micro bacterium tuberculosis; it has other siblings called micro bacterium Leparee, the one that causes leprosy and micro bacterium lazaree the one that causes ulcer. It is contacted through the air, precisely through droplets. As I’m talking, if I’m sneezing, coughing or singing the bacilli has the tendency of coming out through my nose and the mouth if I’m a TB-infected individual. For prospective individuals also, they inhale it through the air. In Nigeria, for instance, almost everyone are carriers of TB unless you don’t breathe in air. The air we breathe in has tuberculosis bacilli in it. Many of us are not down with TB yet because of our immunity level.

How can we identify someone having tuberculosis?

TB has some significant symptoms that can point to someone having TB. The one that is globally acceptable is a cough of up to two weeks or more, also if someone is losing weight rationally like losing 5kg within two months without any other cause, the person is down with TB. Other symptoms include night sweat when the weather is not hot, loss of appetite, low grade fever for up to two months, among others. For the diagnosis, we have two ways of diagnosing TB: first is taking the sputum sample of the patient that is coughing to the gene expert site for examination. Second, if we are unable to access gene expert as an interim measure, we can do sputum AFB that is acid facile to detect if the person has TB. For children who are unable to produce sputum samples, we can take them to one of our hospitals in Lagos, especially LASUTH where they can manually remove the sputum and they will examine that. In addition to that, we have free chest x-ray for our children from age zero to 15 years. As regards the treatment, we have what is referred to as ‘Stop TB Kit’, which are drugs allotted to patients. The number of packs you see here are the number of patients undergoing treatment at our centres in Ikeja. For TB patients with pulmonary TB, which is TB that affects the lungs, we treat them for six months. They have two months of intensive treatment and four months continuation, but for extra pulmonary tuberculosis, especially that of the brain and the bone, we treat them for a period of 12 months; two months intensive and 10 months of continuation. All other pulmonary TB is also treated for six months. Currently, we have detected that the eye, the semen on men and woman’s breast are not spared from TB; experts have diagnosed TB affecting all these organs. All of them are also to be treated for six months, except for those who now have Multiple Drug Resistant Tuberculosis (MDRT) which means out of the drugs. Test for TB and its treatment is free in Lagos. The only reason why many people are not coming up is as a result of stigmatisation. I can tell you precisely that here in Ikeja alone we have registered well over 200 TB patients this year, with at least nothing less than 40 people in a month.

How can the community be of assistance?

Community can come in in a myriad of ways: if they observe that someone is having persistent cough, weight loss, or the family members discover that he has night sweat, or having persistent fever, and despite treating it the fever is not going, encourage that person to go to the nearest TB Centre. In Ikeja, all our primary health centres currently run DOT (Directly Observed Therapy) services, where we manage TB. In addition to our centres, we also have other private hospitals where people can access screening, test and treatment. Also in a situation whereby a person was diagnosed of TB, it is not a time for people to run away from such a person, rather they should support him/her morally, financially and otherwise it can be completely wiped out from the family. Here, we imbibe the idea of what is called ‘Treatment Supporter” whose job in the community is to supervise the patient taking the drugs daily that if the patient is not able to come to the clinic daily, because we don’t want such patient to miss the drugs. In addition to this, it is also the responsibility of the community if they suspect anyone coughing around them, they can hint the health facility then the facility can spring into action, and ensure that they trace that individual and manage them. Community can also organise enlightenment programme either in the church or mosque, then call us to come and sensitise them. We want everyone to have a clear knowledge of what tuberculosis is because information is power. If they don’t have the information, you can’t blame them if they are not taking the right step.

Is tuberculosis curable?

Yes, it is curable. There were even a handful number of them we’ve treated here that were so bad and we were able to treat them and they are sound. Currently, the cure rate in Ikeja local government as at the last quarter was over 80% and the treatment success rate is 90%, meaning that we are progressing.

What is your advice to people taking antibiotics over-the-counter drugs to treat tuberculosis?

That era of just ingesting antibiotics without going for test is gone. Right now, Lagos State government do it in such a way that every Out-Patient-Department (OPD) case that is brought into their health facility has to be screened for TB and when they are screened, the one that is presumed to have tuberculosis will undergo test after which they are placed on drugs. It is irrational to just place an individual on antibiotics without a clear cause or reason for giving those individual antibiotics. We also advice pharmacy, chemists, patent medicine stores to discourage people from coming to buy antibiotics over the counter. Once they come to purchase antibiotics second or third time, they should advise them to go to health facility within their neighbourhood for screening. Finally, there is a slogan that says tuberculosis anywhere is tuberculosis everywhere because TB is in the air. That is why we are imbibing the idea of “Cough culture”. Courtesy demands that when coughing, you should cover your nose and your mouth with hand or handkerchief; in the absence of that, use your elbow  to cover your nose and your mouth so that you don’t disseminate the’ bacilli’ into the air. Once we are able to do that, then TB will be completely wiped out not only in Ikeja, but in Lagos, Nigeria and globally. Once we are able to harness our resources together, TB will be completely wiped out in the next five years.

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