Monday, May 28, 2018

Where are the missing tuberculosis patients?

 

By Dr Frederick Haraka

A lot of efforts are done by the National Tuberculosis and Leprosy Programme (NTLP) under the ministry of health and other partners to control TB in Tanzania. Yet, TB remains a major problem and Tanzania is among 30 highly burdened countries globally with TB and TB/HIV co-infection.

According to the latest report of NTLP of 2016, a total of 65,902 patients with TB were notified, indicating about 6 per cent increase from the previous year.

However, this is still an underreporting and/or under-diagnosis of TB in the country.

The World Health Organisation estimates the incidence of TB to be about 160,000 cases per year. At this point it’s already crystal clear we still have a lot to do for us to control TB. In other words, with the burden we have in the country, we should strive to diagnose and report close what WHO estimates of the incidence of TB in Tanzania in order to eventually control TB in our country.

It is undoubted that our NTLP programme is well structured, organised and managed through the cascade of screening diagnosis treatment and follow up of patients. This is well illustrated in the report, which shows a very low proportion of TB patients who are lost follow up (2 per cent). What it means, if you are captured by the programme your probability of completing treatment and getting cured is very high and if you are lost to follow up you will be tracked and brought back to treatment.

The big question is where are the missing patients?

Role of community

Indeed, these patients are within the community. TB is a chronic disease, which takes time for a person to develop symptoms.

Studies have shown a person who has been exposed to a TB patient has a risk of developing TB from that exposure up to two years since the index exposure. It doesn’t mean that every person exposed to coughing TB patient must develop TB. The risk profile depends, among other factors such as HIV, malnutrition.

In a nutshell, those infected with TB will remain in the community for a while before they are diagnosed and treated.

Appropriate health seeking behaviour could bring such individuals to treatment earlier and therefore reduce the risk of transmission to others. Any person with prolonged cough should seek appropriate health care immediately and refrain from visiting pharmacies to buy medicines without receiving proper care first.

New strategies

With the leadership of NTLP, it is undoubted that we need new strategies which will increase TB detection at health facilities and the community.

At health facilities, healthcare workers across different sections must put TB at the forefront and ensure those presenting with prolonged cough are screened for TB regardless of other reasons that prompted health seeking.

Every time a patient present at a health facility both private and public is an opportunity to screen. Similarly, community volunteers and community healthcare workers who are already doing a great job must receive training and encouraged to screen for TB.

As we move towards, increasing TB case detection by intensifying screening the following will remain relevant.

First, intensified screening for TB, comes with cost implication particularly community TB screening. The government and partners in TB control will need to increase budgets on intensified TB screening with reflection of long term benefits realised for TB control.

Second, healthcare workers must reflect on who to screen and why vs where maximum yield can be realised.

Third, the research community will need to develop test and customise new innovative screening tools and algorithms which provide acceptable accuracy as per WHO requirements.

In conclusion, intensified TB screening must be looked at as an investment towards TB control. A well implemented intensified screening of TB will significantly contribute to the ambitious global target of ending TB by 2035.

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