Kakaire A. Kirunda writing in The Monitor…
While drug susceptible TB can be cured by antibiotics within six to eight months, Multi Drug Resistant tuberculosis (MDR-TB) requires more powerful and expensive drugs taken for more than two years, and often with adverse side effects. Yet only 50 percent of patients who contract MDR-TB get cured
When volunteers become tired of helping tuberculosis patients take their drugs on time and complete the treatment course, there is cause for worry. This is what is happening as recent surveys have indicated in some parts of Uganda. This has led to the misuse of tuberculosis drugs, making them ineffective in treating the disease, leading to the emergence of Multi Drug Resistant tuberculosis (MDR-TB), which is becoming a serious global public health concern.
Ineffectual national control programmes, inadequate drug supply and availability of anti-tuberculosis medications over the counter in several affected countries have also been cited for as a cause of the problem.
“Multi-Drug Resistant TB, is TB which is a man-made disease. This is our fault and patients’ fault as well. All together we made this disease,” Voice Of America in March quoted Dr. Alicja Dziewiecki of the South African based Sizwe Tropical Diseases Hospital.
According to WHO, multi drug-resistant TB is a specific form of drug-resistant TB. It occurs when the TB bacteria are resistant to at least isoniazid and rifampicin, the two most powerful anti-TB drugs.
In Uganda, the latest available data (2005) on TB shows that of all the reported cases reported by then, 0.5 percent was of the Multi Drug Resistant type. None-the-less, three months of repeated efforts to get hold of key officials of the National TB Partnership and the Focal TB person at the Ministry of Health to establish the magnitude of the problem and discuss the implications have proved futile. Yet improving access to TB information is one of the hallmarks of the National Stop TB Strategy.
However, a 2005 report published by the Wellcome Trust on a pilot project at the TB ward in Mulago hospital to determine the extent of MDR TB offers some insight.
With backing from the Wellcome Trust and the Burroughs Wellcome Fund, project leader Jerrold Ellner and his colleagues at the University of Medicine and Dentistry of New Jersey, teamed up with researchers at the London School of Hygiene and Tropical Medicine and scientists in Uganda.
This followed the discovery that some patients receiving treatment for TB were not responding to conventional drugs. At the end of the study initial results suggested that around 12 percent of patients who had previously received treatment had developed multidrug-resistant TB.
Cause for concern
And although this was not as high as in the pilot study, it was still cause for concern.
“These individuals are transmitting multi drug-resistant strains to other patients and health workers within the hospital and often take the disease back to their communities,” Project Coordinator Edward Jones, was quoted as saying.
But with a detection rate of only 49 percent which is far below the required 70 percent as per global standards, the percentage of MDR-TB might even be higher, two years after the last available TB statistics.
And this has not been helped by the reluctance of the stakeholders to start a health education campaign, especially as regards prevention and treatment adherence through the media and other channels as the case has been with HIV/Aids which continues to date.
Without access to TB information, the public may not be able even to know about the availability of services within their localities. Not even the IEC campaign envisaged in the national stop TB strategy will make sense if such information cannot be accessed. Putting up posters, for instance, on health centre walls where not everyone goes may have little or no impact, according to an eastern Uganda based health worker who preferred anonymity.
“The WHO country office early this year called for the declaration of TB a national emergency as a way of getting on top of the situation. Those in charge of TB should have taken up this clue and started education programmes of TB on the many radio stations across the country. People need to be informed on this re-emerging disease,” said the health worker.
Tuberculosis is curable and preventable. And as a result, many countries had stopped looking at it as a priority. However the resurgence and emergence of drug resistant strains has pulled the curtain on complacency. While drug susceptible TB can be cured by antibiotics within six to eight months, Multi Drug Resistant tuberculosis MDR-TB requires more powerful and expensive drugs taken for more than two years, and often with adverse side effects. Yet only 50 percent of patients who contract MDR-TB get cured.
Due to lack of infrastructural capacity to detect drug resistance early enough as a recent visit to two Regional Referral Hospitals in eastern Uganda indicated, patients with drug susceptible TB are being admitted on the same wards as those with MDR TB.
WHO says globally, over 400,000 cases of multi drug-resistant tuberculosis (MDR-TB1) are emerging every year due to under investment in basic TB control, poor management of anti-TB drugs and transmission of drug-resistant strains.
MDR-TB is much more difficult and costly to treat than drug susceptible TB with a single patient requiring between $10,000 – 20,000 as evidenced by cases being handled by the aid agency MSF in neighbouring Kenya.
The above has not been helped by the emergency of Extremely Drug Resistant TB (XDR TB) in 2006. Therefore, as a result, WHO last month came up with the ‘The Global MDR TB and XDR TB Response Plan 2007-08.’
The document lays out what needs to be done between 2007 and 2008 at the global, regional and national levels by WHO, members of the Stop TB Partnership and countries to address the rising problem of anti-TB drug resistance.
Leaving out the technical aspects of the global response, the document instead details the main activities to be conducted at global, regional and country levels in 2007 and 2008 to operationalise the anti-drug resistance component of the Global Plan. It also marks the beginning of the integration of MDR-TB and XDR-TB activities into general TB control activities.
Critical priorities include the gathering of information on the magnitude, distribution, trends, treatment practices and outcomes of XDR-TB; a significant expansion of TB laboratory services; development of sound TB infection control policies and their implementation; advocacy, communication and social mobilisation to sustain political commitment; resource mobilisation and the promotion of research and development for new tools.
And if fully implemented, the Global Response Plan will save the lives of 134,000 people affected by MDR-TB and XDR-TB by the end of 2008.
The writer is a fellow of the Panos Stop TB Media Fellowships 2007.
