Medical experts specialising in the treatment of respiratory conditions have expressed mixed reactions to the efforts and commitment of the Federal Government to ending tuberculosis in Nigeria.
Speaking with PUNCH HealthWise in separate interviews, the pulmonologists disagreed on the strategy of the FG to eradicate tuberculosis in the country.
While one of the experts said the FG should be commended for the Stop TB programme, others expressed reservations about the sincerity of the government in the implementation of the eradication programme.
The experts were speaking with PUNCH HealthWise in commemoration of the 2023 World Tuberculosis Day themed ‘End TB!’.
The World Health Organisation Day for TB is celebrated on March 24 annually to build public awareness about the global epidemic of tuberculosis and efforts to eliminate the disease.
According to a statement released by the WHO in 2022, a total of 1.6 million people died from TB in 2021 (including 187 000 people with HIV). “Worldwide, TB is the 13th leading cause of death and the second leading infectious killer after COVID-19 (above HIV/AIDS).
In 2021, an estimated 10.6 million people fell ill with tuberculosis(TB) worldwide. Six million men, 3.4 million women and 1.2 million children. TB is present in all countries and age groups,” WHO said, adding that yet the health condition is preventable and treatable.
Nigeria with its huge population is the highest TB-burdened country in Africa.
Speaking with PUNCH HealthWise, Consultant Pulmonologist, Federal Medical Centre, Abeokuta, Dr. Olusola Adeyelu, and Senior Lecturer/Honorary Consultant Physician/Pulmonologist, the University of Abuja Teaching Hospital, Dr. Alexander Akor, differed on whether the FG was doing enough to combat the scourge of tuberculosis in the country.
Speaking with our correspondent, Dr. Adeyelu alleged that right from the outset, the FG never invested a dime in the eradication of tuberculosis.
He said, “What you people are seeing are newspaper stories like every other thing like the way they did the second Niger Bridge and the way they have the Nigerian airline. How TB eradication is funded is destroying the lives of our people by hundreds of thousands because there are different variants of TB. Some you can spread to others, and some you cannot spread. If you have TB of the testis and eyes, all these can’t be given to people…but TB that causes the water in the chest, can spread to others. But how is TB control funded is the real issue.”
Dr. Adeyelu alleged that the Nigerian government has not been paying its counterpart funding, noting that the nation basically depends on free drugs from western partners to eradicate TB.
He alleged further that this was responsible for the poor treatment of many people living with TB as treatment had to be reduced to six months.
“They reduce it (treatment) to six months. It’s not that the disease is gone at six months, they expect your body’s immunity to have developed enough to fight it. The previous method was nine months to 12 months. If you have TB of the bone, and the spine and you become crippled, the moment they give you the drug for 12 months, you start standing and playing basketball. But now they have reduced everybody’s treatment to six months because … the Nigerian government is not paying.
“The Nigerian algorithm was drawn by people nobody knows till today. They just gathered some people together and they issued it. How to use a TB drug is supposed to be per weight… If you weigh 70kg and they say 5mg per kg that is the dose you are to take. But everybody takes the same dose in Nigeria. So there is a problem with our funding of TB. If anybody says they are funding TB let him show us how they pay their counterpart funding… The only thing that is still keeping Nigeria going is the generosity of the white man and their support”.
On what the FG can do to end TB, he stressed that proper funding of TB control is the only way to go.
“So the FG is going to put in its money in TB control. Also, train more pulmonologists, train more respiratory nurses – not just nurse the way they call everybody nurses here is no more anywhere in the world. Train those community health workers their job is not to be fighting that they want to be a nurse if they want to be a nurse they should go to a school of nursing,” he said.
The community health workers, he said, can help ensure compliance with environmental sanitation which would help curb the spread of some diseases.
He also urged the government to back the local manufacturing of TB drugs in Nigeria to reduce dependence on importation and dependence on spurious medicines.
“We must manufacture our drugs and before we can manufacture our drugs we must conduct research to know the variant of TB we have here,” he said.
However, while speaking with our correspondent, Dr. Akor said the FG deserves commendation for its efforts to end TB in the country.
He said the FG has made some efforts towards ending the TB, but noted that there is room for improvement.
“I think they have tried… You know this whole thing about TB there are so many aspects to it. Okay sometime in 2020 the FG came up with this multi-sectoral approach called stemming the tide of TB but there is still room for improvement let me just leave it at that,” he said.
Dr. Akor stated that more efforts were needed to be put into tracing people who are at risk and initiating treatment early.
“I think that seems to be where the gap has been though there are other aspects too that are generally part of this Stop TB programme that is being looked at. Let me give you more insight into it. Emphasis has been directed to early diagnosis of TB and initiating prompt treatment. Once treatment starts early, patients don’t shed the bacteria to the community and to those who are susceptible.
“So identifying those groups of individuals and initiating therapy is the key thing but the real issue is again despite the efforts that have been made some parts of the country are not reachable…am sure u also know that the challenges with insecurity have also affected other things including TB control programme. Before now, you have people that have mobile vans or mobile bikes that can pick a sample from some of these places back to sites where they can be analysed but the insecurity and all of that has affected partly some of the control programmes … but there are other aspects of it (TB control) again that need a lot to be done.
“The diagnostic resource that is available to us is accurate and good but the challenge still is that the turnaround time is also an issue so people have been looking at all these commercial forms of point of care kind of a thing but all of this is still at the rudimentary research phases and so on.
“So what I am trying to is that when it comes to stopping TB, I think that in our locality, in our communities, we need to be identifying cases and tracing contacts, and trying to initiate therapy early. But there are other components of it like early diagnosis which may still be an issue, as not all the communities have the basic gin expert machine that will be required in terms of getting a fast turnaround diagnostic time. Some of these samples are collected from sites peripherally and then sent to central sites where there are still being assessed. So, if you have some of these machines being deployed with a little bit of manpower training I think that that will go a long way. But overall, I think that the FG has tried in terms of that. But we can enhance advocacy and commitment from govt in expanding contact tracing, case identification, and so on,” Akor said.
TB Control, Dr. Akor stated further, has to be a multi-sectoral approach, adding that health experts need to do more with the education of the populace using all media platforms to enlighten then citizens on how to prevent the health condition and also encourage people to go for screening.
“The churches, the mosques, could be a huge source of enlightenment. And I think the media has done a lot of good work but maybe translating the messages in the local dialects, and scaling up all the interventions would help,” Dr. Akor said.
According to a study by the Liverpool School of Tropical Medicine, Tuberculosis (TB) has caused more deaths in the last 200 years than any other infectious disease and yet receives only 1/6th of the funding that HIV research does. In 2013, an estimated 9.0 million people developed tuberculosis and 1.5 million died from the disease, 360 000 of whom were HIV-positive.
In yet another study by Science Daily, it revealed that researchers had developed a new technology to help in the early detection of tuberculosis.