Over 300 in 100,000 population in Nigeria may be living with tuberculosis; and the disease, though curable, kills more than AIDS when persons living with it fails to present themselves for treatment said Dr Ronke Agbaje, Associate Director for Global Fund (on tuberculosis) at the Institute of Human Virology of Nigeria, IHVN, in this interview with Health Reporter, Marcus Fatunmole. Excerpt:
What is TB?
TB, also known as tuberculosis, is a bacterial infection; caused by an organism called mycobacterium tuberculosis. The way it is commonly spread is through what we call air droplet. The most common form of manifestation is that the patient is coughing. If is the patient has active tuberculosis infection and either coughs, sneezes or does anything that can cause some air exchange and cause air droplet to enter the atmosphere, it can cause droplets to affect other people. There are other forms of manifestation like you have pulmonary tuberculosis. It goes into the chest and causes all these things that have to do with cough and all that. It also causes weight loss because it is a chronic disease, that is, a disease that lasts for long if it is not treated. It could also cause fever of unknown cause; the person will just be having some low-grade fever, feel unwell and then starts losing weight with the cough.
The other forms of manifestation are in people with TB meningitis, which is the TB that affects the brain. You have spinal TB; the organism goes into the spine and affects the bone of the spine. At times, you see people, when they cough, they don’t sit straight up. You have TB osteomyelitis that goes into the other bones of the body etc; that is the general overview of tuberculosis.
How would you differentiate tuberculosis from other forms of cough?
There are many things that cause cough and tuberculosis is one of them. When people are coughing for a very long time, they need to go and check, if they are producing sputum, they need to take the sputum to the laboratory and check if that micro-bacterium is there. Other things can cause it such as people that are asthmatic; it could just be normal viral flu for example. But, once that cough is prolonged, especially the one caused by viral infection actually resolve within two weeks on its own or just with vitamin C. Once it doesn’t respond to those minor treatments, then you need to check if the person has tuberculosis. Of course, there are other things like weight loss or low-fever that come with it.
Is there any group that is vulnerable to it?
For example, as we are in a room, you or I may be coughing. If either of us has tuberculosis and the other inhales, the person who inhales may not necessarily come down with the disease. You could inhale it, if your immune system is strong, that is, you are eating well, you have good immunity, you don’t have any other sickness like HIV or diabetes or cancer; you may not develop the disease. It is just that you can inhale the organism and just lie low, no problem. People that have low immunity like children are prone to having tuberculosis. Pregnant women, because pregnancy causes a state of low immunity, but, those that have low immunity may be affected.
Given your knowledge of the prevalence of this disease in Nigeria, would you say the cases are rising or coming down in the country?
Well, we have unofficial information. Initially, what we learnt from World Health Organization, because the organization is a partner to Nigeria on TB matter; it is part of the group called “Stop TB Partnership” which is a global group that looks into TB. They give what is called annual tuberculosis report. We had thought that our TB prevalence was around 154 per 100,000 people are likely to have TB. However, we carried out what we called national prevalence survey. That means people actually came and scientifically looked at TB in Nigeria. It appears, the reports are not out yet officially, and we may have double or triple of what we had thought. Now, it may be as high as over 300 in a 100000.
So, it is going up higher than what we thought; and we think that things that can be driving it include diseases like HIV, which of course is also on the rise.
Recent HIV report in Nigeria showed a decline in prevalence. Does this also translate to reduction in tuberculosis, since TB is caused by HIV/ AIDS?
Not necessarily because that is not the only cause of tuberculosis. When you say there is prevalence, it means all the people at that point in time that have the disease. There is also what we call incidence; that is the rate of new infection. So, the fact that HIV prevalence has dropped a bit does not mean tuberculosis has gone down. Our population has also grown larger, when you talk about the population as well. For example, when our population was 120 million, for example, and you say the prevalence was 4.3 percent, you expect that about five million people will have HIV in terms of actual number. Now, we are saying we are 160 million; that is the projection. The prevalence now, I think, is 3.4. You have 5.4 million people. You have to relate the prevalence to the real population of actual number of people with the disease.
That is why the whole world is worried about disease burden in Nigeria; whether it is HIV, TB or malaria because we have a huge population. We are as large as ten African countries; there are countries that are like ten million people. If their prevalence is 80 percent, it can’t still be as high as Nigeria because they don’t have a large population.
Is TB curable?
Yes, that is the wonderful thing about TB. If it is straightforward TB, once the patient starts taking what you call ‘anti-tuberculosis drug’ and I think in Nigeria now, for the noncomplicated TB, we use about four drugs. They come in one combination. Unlike before that patients had to swallow four different drugs, maybe like three tablets of each which was so tedious. At a point in time, the patients had to swallow about 16 tablets; now, it just comes in caplet; everything is packaged in one or two tablets that the patients can swallow. So, those anti-tuberculosis drugs are taken for six months. For the first two months, we take about four drugs. Then, for the remaining four months, which is the new regimen, you just continue with two drugs; and you are ok. After six months, you are cured once you take your drug regularly; you are keeping your regimen, you will be ok after six months, if it is straightforward tuberculosis.
There are instances whereby people have attributed tuberculosis to witchcraft. How true is this?
Information is very important; that is why we need to continue to sensitize people, we need to inform people; we need to let people know that it is not caused by witchcraft; it is just an infection, that is transmitted from one person to another; the human body is the vector; that is where the organism stays. It is not witchcraft. That is why enlightenment, sensitization, education come in. We need to tell people that when you are coughing, you go to the nearest treatment centre, and you get your sputum tested. If it is positive for TB, start treatment; the treatment is free. You don’t have to pay for it; it is available free in at least every local government in this country. Adhere to your treatment and you will be ok.
As you are on treatment, if you are not ok, it is possible that what you have is the resistant strain. That is, it is not responding to the usual antibiotic. There are other drugs that they will give you, which are called second line anti-tuberculosis drug that they will give you. That is very key and it is the message we need to pass across.
How do you manage cases of HIV/AIDS patients who live with TB?
The fact that someone is HIV positive does not necessarily mean the person needs to take drug immediately. At least, the normal CD4, that is the cell that protects your body immunity, if they’ve fought to a certain level, then, you need to start taking medication. But, because TB is so dangerous in people that are HIV positive, a lot of them even die of the TB rather than HIV. So, that is an indication for immediate treatment; and the usual step for it is called co-infection because HIV and TB are domiciled in a single individual. The person needs to start treatment immediately.
How long can a TB patient who doesn’t present himself for treatment live? It is difficult to tell. But, most time, within a year or two, it is most – likely that the person will die; depending on how weak the person is.