Since taking up employment as a confidential secretary with a publishing company in Akure, Ondo State two years ago, Miss Niniola Bello, 19, became known as a very hard working and efficient staff. Being attached to the Editor-in-Chief of the company as his personal assistant and secretary, she was known by majority of the company staff, many of whom interacted with her due to her designation. When she presented with cough some time ago, Niniola was promptly noticed by her contemporaries. As the cough persisted into the fourth week, many staff began to express concern about her health and  when it became embarrassing to the management of the company, Niniola was handed a sack letter.

Three months after her sack, the news of her death shocked her former colleagues. a postmortem examination report issued from the teaching hospital where her autopsy was conducted showed that she died from tuberculosis (TB) infection.

Concerned about how a young girl that was hitherto burbling with life could die in an unclear circumstances, Niniola’s close friends launched an investigation, which revealed that staff of the private health facility where she sought health care did not monitor the treatment of her TB to ensure drug adherence and complete therapy. this, coupled with Niniola’s lack of knowledge on the impact of TB on health, warranted her to abandon the treatment half way. Not too long afterwards, she succumbed to the ailment and died. Niniola’s death is a typical example of how TB makes mincemeat of some human beings. 

Tuberculosis or TB (short for tubercles bacillus) is a common and often deadly infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis in humans. Tuberculosis usually attacks the lungs but can also affect other parts of the body. Twenty-two countries harbour the 75 per cent of the global TB burden. Thet are labbelled 22 High-Burden TB countries. Nigeria is number four on that list.  One third of the world’s population is thought to be infected with M. tuberculosis, and new infections occur at a rate of about one per second. The proportion of people who become sick with tuberculosis each year is stable or falling worldwide but, because of population growth, the absolute number of new cases is still increasing. In Nigeria, the total number of TB cases detected and reported in 2010 was 94,000. how to remove Nigeria and other African countries from the list of TB high-burden group is the focus of forthcoming 18th African Regional Conference on TB and Lung Diseases. The conference will take place in Abuja from March 3 to 5 and its theme is: TB, TB/HIV and other Lung Diseases: Challenges to the Attainment of MDGs in Africa.

Over 1,000 Nigerians  will participate in that conference, which will also discuss the problems and solutions of Asthma, Pneumonia, Lung Cancer, among other lung diseases.

Other issues to be focused on at the Abuja meeting are Funding for TB, from developing countries, Public-Private Mix, new preventive, diagnostic and curative methods to fight TB, in addition to getting awareness of new technology in the area of equipment and treatment.

Since the conference will be taking place in Nigeria, a lot of non government organisations (NGOs) working in the area of TB and lung diseases will participate. Similarly, the conference will provide avenue for Nigeria and   experts from other African countries to exchange notes on TB and lung diseases.Highlighting the importance of the conference, the Director (Research) at the  Nigerian Institute of Medical Research (NIMR), Prof. E. Oni Idigbe said, “TB is very much with us. We must put hands together to fight it.” Besides, It spreads through the air when people who have the disease cough, sneeze, or spit. hence, TB infection has potential to spread very quickly.

On what can be done, he said, “The bottom line of TB control is to detect active cases of TB and render them non infectious with adequate treatment,” said Idigbe. why is this so?

He explained: “One active  undetected case of TB in the community has potential to infect a minimum of 10 people within a year.  if one infects ten, each of the 10 will similarly spread to 110 people annually.

In order to tackle TB effectively, the World Health Organisation (WHO) recommended 75 per cent detection of active TB cases in every country every year and treatment of 85 per cent treatment rate. The WHO estimates that as at 2010,  Nigeria has achieved only of 31 per cent TB case detection only.Going by this statistics, Idigbe said the major problem facing the country is that 69 per cent of TB infections in the communities are still not being detected.Using the recommendations of the WHO, efforts will now be geared towards using the Advocacy Communication and Social Mobilisation (ACSM) Strategies to detect existing active cases. The simple reason for this is that people with TB infections are in the communities, he said, adding that relations, friends and neighbours who observe people with symptoms should advise them to seek prompt medical attention  at the nearest primary health care centre (PHC) in the community. .

SymptomsThe classic symptoms are a chronic cough with blood-tinged sputum, fever, night sweats, and weight loss. Idigbe stressed that community members must learn to know the signs of TB. He lamented that most of the TB controlled programmes have not been recording  success because most of the programmes are being implemented at the secondary and tertiary health care facilities, while forgetting  the primary health cares (PHCs) and the communities. Ironically, Idigbe said, “The communities are where we have the TB cases,” adding that this is where knowledge, attitude and behavioural change practices are very low. this will need to be enhanced, he stressed.

The conference will focus on Advocacy Communication and Social Mobilisation (ACSM) of various communities.

He charged, “If somebody is coughing consistently for two to three weeks, he should be advised to go for test in the nearest microscopic centre. The earlier a TB case is detected and the transmission broken, the better for the control of TB,” he said. Unfortunately, Idigbe lamented that many people in the community do not know that persistent cough may be a symptom of TB. “Most of them believe it is invoked,” he said.

Highlighting the importance of using the public private mix in implementing treatments, he said in spite of the use of the Directly Observed Treatment Short Course (DOTs) in the treatment of TB, most private health facilities have been blamed for not closely monitoring patients to ensure drug adherence. DOTs is about having relevant medical staff observe drug treatment. The WHO advises that all TB patients should have at least the first two months of their therapy observed (and preferably the whole of it observed): this means an independent observer watching patients swallow their anti-TB therapy.Irrespective of this flaw, most TB cases are seen in the private health facilities. “The drive now is the public-private mix (PPM) so that the public and the private sector will be able to work as a team.

Considering that the treatment of TB is free, the strategy being pursued is to track most TB infected patients seeking care in private facilities and connect them with public facilities where they will access the TB treatment free.

According to the director of research in NIMR, the area of concern now is that in Nigeria, “We are beginning to see cases of multi-drug resistance (MDR) TB. these are cases that are now getting resistance to the normal drugs we use to treat TB,”He noted that if these cases are allowed to continue to develop and transmit infections, “We are going to run into the problem of loosing all the drugs that we have for TB and start going for second line drugs,” said  Idigbe.

However, Idigbe noted that treatments with second line drugs are very expensive, toxic and takes a long time. Treatments for second line lasts for a minimum of 18 months as against six to eight months for first line drugs. With second line drugs, at a period, the patient must be hospitalised, he said. The director of research said, “We want to do everything in our power so see that we do not get to that stage where we start having many cases of MDR TB.” Among participants expected at the conference are President Goodluck Jonathan, Minister of Health (FMOH), Prof. Onyebuchi Chukwu and the President, African Union for TB and Lung Diseases and National Coordinator, TB and Leprosy Control in the FMOH, Dr. Mansur Kabir.

Others are officials from the WHO Stop TB,  Partnership in Geneva, International Union against TB and Lung Diseases in France and the WHO African Regional Office in Brazzaville. 

He disclosed that the plan in the country is to have at least one DOT Centre in every local government in the country and two microscopic centres in each local government Area.