Tuberculosis, The Burning Bush, And Northern Nigerian

Posted: August 27, 2013 in Uncategorized

By Prince Charles Dickson

In 1976, writing under the topic “Initial resistance of Mycobacterium tuberculosis in Northern Nigeria”. Both Fawcett IW, Watkins BJ stated that

“of 61 isolates of Mycobacterium tuberculosis form patients in Northern Nigeria denying any previous treatment for tuberculosis 7 (11.5 per cent) yielded resistant cultures. Four (6.6 per cent) were resistant to isoniazid, 2 (3.3 per cent) to PAS (1 also to thiacetazone), and 1 (1.6 per cent) to streptomycin. No mycobacteria other than M. tuberculosis were isolated from these patients. These results suggest that the level of initial drug resistance in Northern Nigeria may be lower than that found in other African countries.

Today it is far different, Nigeria ranks fifth among the world’s high-burden countries, with a number of tuberculosis (TB) cases of 450,000. The TB incidence is at 311/100,000 and the rate of new sputum smear positive disease is approximately 137/100,000. And it is far worse in the North of Nigeria due to the crisis that has ridden this part of the nation.

More than 90% of new TB cases and deaths occur in developing countries. And Nigeria is one, we rank 10th among the 22 high-burden TB countries in the world. WHO estimates that 210,000 new cases of all forms of TB occurred in the country in 2010, equivalent to 133/100,000 population.

There were an estimated 320,000 prevalent cases of TB in 2010, equivalent to 199/100,000 cases. There were 90,447 TB cases notified in 2010 with 41, 416 (58%) cases as new smear positives, and a case detection rate of 40%.

The World Health Organization (WHO) declared Tuberculosis (TB) a global emergency in 1993 and it remains one of the world’s major causes of illness and death.

TB is an air-borne infectious disease caused by bacteria, which primarily affects the lungs, and it is both preventable and curable.

One third of the world’s populations, two billion people, carry the TB bacteria. More than nine million of these become sick each year with active TB that can be spread to others. Latent TB disease cannot be spread.

TB disproportionately affects people in resource-poor settings; particularly in Africa and Asia…Northern part of Nigeria really mirrors such resource-poor settings

TB poses significant challenges to developing economies as it primarily affects people during their most productive years.

The main goal of Nigeria’s TB program is to halve the TB prevalence and death rates by 2015.

Despite this intention, Nigeria has been slow to recognize the gravity of the epidemic and to mobilize the required commitment and resources for a sustainable national response. While progress has been made in policy development and strategic planning at the Federal level, provision of care, treatment, and prevention services remains inadequate and the level of unmet need continues to increase. And conflicts and killings North of the country has become a barrier.

39 years old Ibrahim Sulieman (not real names) was leading a happy normal life with his wife and 3 children. He was working with the Borno state government as a driver in the Ministry of Information in the Bama area when, way back in 1999, he suddenly vomited blood one day. The doctor diagnosed him with pulmonary TB on the basis of a chest X-Ray and put him on a 6 month Anti TB Treatment under DOTS (Directly Observed Treatment, Short-course).

Ibru as his friends call him, was presumably cured and remained okay for a year and a half. Meanwhile he had been transferred from Bama to Jere. There his problem recurred and he vomited blood again.

He was put on treatment once again in this new town, but this time he was not very regular with his medicines and even missed some doses due to his own carelessness, even as he was transferred once again from Jere to the Borno capital Maidugiri. He would stay healthy for some time and then again become sick. He then went to a private doctor and took medicines for 9 months and felt completely cured although financially devastated– he had to spend around N100,000 on his treatment in the private sector.

By 2009 a lot had change, Borno had become the hot bed of Boko Haram activities, no one was safe from the self-acclaimed Islamist group.

Ibru lost one of his daughters in an attack on her school by the group.

Apart from the shock, after remaining healthy for several years, Ibru took ill once again in February 2012. This time because of shortage of drugs and personnel, he was referred to the teaching hospital in Plateau state, an eight hours trip because of bad roads and military checks every few kilometers. He arrived Plateau and went to a treatment Centre in Jos University Teaching Hospital in Jos and was put on medication.

Simultaneously his sputum was sent for culture, the report of which came in April 2012 and devastated Ibru completely. The disease had returned with a vengeance in the form of Multi Drug Resistant TB (MDR-TB).

He clearly remembers the date of 12th April 2012 when the teaching hospital had referred him to National Hospital in Abuja the Nigerian capital. The doctors there sent him to their Pulmonary Medicine and Tuberculosis experts for pre-treatment evaluation and treatment initiation.

Ibru is drained financially, he had sold his farmland for peanuts, nobody buys anything in good price, the Boko Haram terrorists have turn the state’s economy up side down, and his kids are in and out of school for fear of attacks, delays in salaries by his employers have made it all too difficult.

Just last June 2013 when he had come for his three monthly follow-up. He told me excitedly that he has been testing negative from the fourth month of treatment onwards and was now in the continuation phase of treatment. The ordeal of daily injections was over and he was well on the path of recovery.

As a matter of precaution, he had stayed in a local hospital, away from his wife and 3 children, till his sputum culture report tested negative. Now he stays at home and practices all infection control methods.

He has since become a TB advocate and if he comes across persons suffering from persistent cough and fever he urges them to go to a health center for a free checkup and treatment there. His message for other TB patients, “treatment in the Government setup is free and very reliable. This is a plus for poor people like me and we should make use of the government facility if we unfortunately happen to contract the disease. The medicines for TB are very expensive in the private market, although the problem is that all the fighting and killings pose big problems” he said

“I myself spent around N200,00 while seeking treatment in the private sector and yet was not cured—rather I developed a worse form of TB. One must take the medicines regularly, eat nutritious food and stay away from alcohol and cigarettes.” He added.

He equally tells me “it is all too difficult because doctors are leaving Borno and many parts of the North, the drugs are difficult to come by and again because of similarities in terms of loosing weight, most people first think you are HIV positive and even distance themselves from you”.

Ibru is lucky; he has a high school level equivalent education. Many cases of the cases are illiterates, there is a dearth of primary health workers–international aid organizations and their workers see no need to risk their lives and avoid Borno.

Hospitals in Borno, Yobe and other flash points have not been attacked, but several doctors have been killed. Three Korean doctors were killed in February this year in Yobe state. While 9 health workers helping with polio were killed in the Northern city of Kano.

Note: This story is the first in line of a possible series, Tuberculosis, The Burning Bush, and North Of Nigeria

The names of all patients, doctors have been changed to respect their freedom of anonymity, given the huge social and internalized stigma connected with the disease and associated with other factors such as poverty and illiteracy).

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