Towards a TB-free world, a TB-free Ghana—effort leaders wanted!

By G.D. Zaney, Esq.

Tuberculosis (TB) is an infectious disease usually caused by the bacterium— Mycobacterium tuberculosis (MTB). Even though TB could also affect other parts of the body, the disease generally affects the lungs. Most infections do not have symptoms, in which case it is known as latent tuberculosis.

In 1882, one Dr Robert Koch announced the discovery of the cause of tuberculosis to a small group of scientists at the University of Berlin's Institute of Hygiene. At the time of Koch's announcement in Berlin, TB was raging through Europe and the Americas, causing the death of one out of every seven people.

Koch's discovery opened the way towards the diagnosis and cure for tuberculosis.

Notwithstanding this discovery and the significant progress over the last decades in finding a cure,TB continues to be the top infectious killer worldwide, claiming over 4 500 lives a day—with the emergence of Multi-Drug-Resistant TB (MDR-TB) posing a major health security threat that could risk the gains made in the fight against TB.

In 2012, 8.6 million people fell ill with TB, and 1.3 million died from the disease, mostly in the Third World, according toWorld Health Organization (WHO) statistics.

Last year, WHO reported that 10.4 million people fell ill with TB and that in 2016, 1.8 million TB deaths were recorded, making it the top infectious killer worldwide.

This disease thrives most in populations where human rights and dignity are limited, among people living in poverty and in communities and groups that are marginalized, available information indicates.

These vulnerable populations include migrants, refugees, ethnic minorities, miners and others working and living in risk-prone settings, the elderly and marginalized women and children in many settings.

Other factors that aid vulnerability to TB and access to care are malnutrition, poor housing and sanitation, compounded by other risk factors such as tobacco and alcohol use and diabetes.

Furthermore, this access is often hindered by astronomical costs associated with the illness, seeking and staying in care, and lack of social protection, resulting in a vicious cycle of poverty and ill-health. The transmission of multidrug-resistant TB (MDR-TB) adds great urgency to these concerns.

Early diagnosis and treatment, no doubt, guarantee cure for all forms TB and, indeed, nearly 32 million people have been treated using the ‘Directly Observed Treatment, Short-course’ DOTS strategy since 1993.

DOTS focuses on diagnosis, a standard drug regime, individual monitoring and a secure supply of drugs.

According to the WHO, TB treatment, which is often available, is one of the most cost-effective health actions available. Yet some communities may not be aware while the cost of travelling to clinics to collect drugs or have treatment supervised can be too much for a family to keep up, and some patients may stop taking their drugs early because relatively they feel better.

It has also come to light that the test used to diagnose TB is now more than 120 years old and cannot be used in some places, neither can it detect all cases of TB, including those in people living with HIV.Similarly, the vaccine used to prevent TB—the Bacillus Calmette-Guerin(BCG) vaccine— which  was introduced in the 1920s and is currently used in many LMICs haslimited protective effects against TB; and no new drugs have been introduced for over 30 years.

It is important to note, information available shows that the poorest and most marginalised are unable to complete the full course of treatment, in which caseall the bacteria may be not have been killed, providing the grounds for resistant bacteria to grow and for the disease to resurface and come more deadly than before.
Multidrug-resistant TB (MDR-TB) is a form of TB that fails to respond to standard first line drugs. Extensive drug-resistant TB (XDR-TB) occurs when resistance to second-line drugs develops on top of multidrug-resistant TB. This type of TB is virtually untreatable.

In 2006, there were an estimated half a million cases of multidrug-resistant TB. There are now around 40,000 cases of extensively drug-resistant TB each year. In 2008, WHO reported the highest rates of multidrug-resistant TB.

Resistance to drugs may also be caused by health workers prescribing the wrong treatment, coupled with unreliable drug supplies.

One-third of People Living with HIV and AIDS (PLWHA) across the globe are thought to be infected with TB and, in Africa, the figure reaches two-thirds. In other words, the increase in TB in recent times is directly linked to the HIV epidemic and in countries with high HIV prevalence, the number of new TB cases has tripled in the past 15 years.

People who are HIV-positive and infected with TB bacteria are up to 50 times more likely to develop active TB disease in their lifetime than people who are HIV-negative and infected with TB bacteria.

Since HIV slowly destroys the immune system, people are less resistant to TB while diagnosis is difficult to diagnose in people living with HIV because they don’t produce sputum in the same way as HIV-negative people do.

TB is curable even in a person living with HIV. However, presently, many of the existing diagnostics for TB are unsuitable. Also, treating a drug resistant TB takes longer, involving more costly drugs.

Thus, new tools and diagnostics, more effective, faster and simpler test are, therefore, urgently needed.

A simple once-daily drug treatment— Isoniazid Preventative Treatment (IPT)—can prevent active TB in people living with HIV and a six-month course of IPT can reduce the chances of developing TB by 40-60 per cent  for two years. Yet, even though IPT is very cheap and could make a real difference, the drug is accessible to only 2 per cent of people who need it.

According to the latestWHO Global Tuberculosis Report 2017,TB retains its undesirable status as the leading infectious cause of death globally while global progress in reducing new tuberculosis (TB) cases and deaths is insufficient to meet the global targets for TB and HIV, despite most deaths being preventable with early diagnosis and appropriate treatment of tuberculosis and HIV.

According to the report, in 2016, the risk of developing TB disease among the 37 million people living with HIV was around 21 times higher than the risk in the rest of the world population. The report indicates that there were more than one million TB cases among people living with HIV—10% of all global TB cases in 2016. Furthermore, the report says, PLWHA are much more likely to die from TB disease than HIV-negative people, and that one in five (22 per cent) TB deaths occurs among PLWHA, with 374, 000 TB deaths among people living with HIV In 2016, representing almost 40% of all AIDS-related deaths.

It is, therefore, as part of efforts to provide a cure and/or eliminate the disease that World Tuberculosis Day (WTBD), has been instituted and commemorated annually.
WTBD is one of eight official international public health campaigns marked by the WHO, along with World Health Day, World Blood Donor Day, World Immunization Week, World Malaria Day, World No Tobacco Day, World Hepatitis Day and World AIDS Day.

In 1982, on the one-hundredth anniversary of Robert Koch's announcement, the International Union Against Tuberculosis and Lung Disease (IUATLD) proposed that March 24 be proclaimed an official World TB Day. This was part of a year-long effort by the IUATLD and the WHO under the theme “Defeat TB: Now and Forever.Even so, WTBD was not officially recognized as an annual event by WHO's World Health Assembly(WHA) and the United Nations until over a decade later.

In the fall of 1995, WHO and the Royal Netherlands Tuberculosis Foundation (KNCV) hosted the first WTBD advocacy planning meeting in Den Haag, Netherlands.
 In 1996, WHO, KNCV, the IUATLD and other concerned organizations joined to conduct a wide range of World TB Day activities.

For WTBD 1997, WHO held a news conference in Berlin during which WHO Director-General,Hiroshi Nakajima, declared that “DOTS is the biggest health breakthrough of this decade, according to lives we will be able to save.

WHO's Global TB Programme Director, DrArata Kochi, promised that, "Today the situation of the global TB epidemic is about to change, because we have made a breakthrough. It is the breakthrough of health management systems that make it possible to control TB not only in wealthy countries, but also in all parts of the developing world, where 95 per cent of all TB cases now exist.”

By 1998, nearly 200 organizations conducted public outreach activities on World TB Day. And, during its WTBD 1998 news conference in London, WHO, for the first time identified the top twenty-two countries with the world’s highest TB burden. The next year, over 60 key TB advocates from 18 countries attended the three-day WHO/KNCV planning meeting for WTBD 1999.

Since then, every year,WTBDis commemorated on March 24 to raise public awareness about the devastating health, social and economic consequences of tuberculosis (TB) and to step up efforts to end the global epidemic.

 The date marks the day in 1882 when Dr Robert Koch announced that he had discovered the bacterium that causes TB, which opened the way towards diagnosing and curing this disease.

U.S. President Bill Clinton marked WTBD 2000 by administering the WHO-recommended Directly Observed Therapy, Short-Course (DOTS) treatment to patients at the Mahavir Hospital in Hyderabad, India. According to Clinton, "These are human tragedies, economic calamities, and far more than crises for you, they are crises for the world. The spread of disease is the one global problems for which . . . no nation is immune."

In Canada, the National Collaborating Centre for Determinants of Health noted on WTBD 2014 that 64% of TB cases reported nationally were among foreign-born individuals and 23% among Aboriginal people, highlighting TB as a key area of concern about health equity.

Today the Stop TB Partnership, a network of organizations and countries fighting TB (the IUATLD is a member and WHO houses the Stop TB Partnership secretariat in Geneva), organizes the Day to highlight the scope of the disease and how to prevent and cure it.

The theme of WTBD 2018 —“Wanted: Leaders for a TB-free world”— focuses on building commitment to end TB, not only at the political level with Heads of State and Ministers of Health, but at all levels from Mayors, Governors, Members of Parliament and community leaders to people affected with TB, civil society advocates, health workers, doctors or nurses, NGOs and other partners. All can be leaders of efforts to end TB in their own work or terrain, the theme appears to suggest.

This is a critical theme, given the political importance of the upcoming UN General Assembly high-level meeting on TB this year, which is expected to bring together Heads of State in New York, following on from a very successful Ministerial Conference on Ending TB in Moscow on 16-17 November, 2017 which resulted in high-level commitments from Ministers and other leaders from 120 countries to accelerate progress to end TB.

At the launch of WTBD in Ghana, last week, Mr AffailMonney, presidentof the Ghana Journalists Association (GJA) pledged the GJA’s commitment to joining the crusade and contribute its quota to the fight for a TB-Free Ghana.

Mr Monney reminded the media of its role in informing the public about the prevention, control, treatment and cure for TB, adding that accurate, sensitive and timely information was required to improve understanding on TB, increase access to TB services and dispel the many myths and misconceptions that persist about the disease.

On his part, Dr Frank AddaeBonsu, Programme Manager, National TB Control Programme (NTP), called for multi-sectoral reforms that would help free Ghana’s air of TB bacteria and urged social protection schemes such as the National Health Insurance Scheme (NHIS) to support TB treatment and protract TB patients.

Dr Bonsu also stressed the need to monitor Government’s stewardship an accountability to achieve the United Nations (UN) Sustainable Development Goals (SDG) targets  to end tuberculosis (TB) related deaths, transmission and catastrophic costs by 2030.

The theme for this year’s WTBD is demanding leaders of effortsin their own work or terrain to end TB—and this is to say thatthe contribution and commitment of all stakeholders—politicians, community leaders, people affected with TB, civil society advocates, health workers, doctors or nurses, NGOs and other partners—  is urgently required.

The writer is an officer of the Information Services Department.

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