High cost, ignorance, bane of TB treatment in Nigeria

LIVING with Tuberculosis, TB,     is not an attractive proposition by any standard. No one knows this better than 32-year-old Kunle, one of the hundreds of thousands of TB patients across the length and breadth of the Federation. An encounter with him at the Direct Observation-Therapy, DOTS, Centre of the Lagos University Teaching Hospital, LUTH, showed all was not well with him.
Dressed in a faded T-shirt and jeans with a handkerchief around his nose and mouth, he elicited sympathy. Jobless and abandoned, his bloodshot eyes and lowly disposition painted the picture of a troubled soul. Kunle, in a lamentable tone, related how in his predicament, he unknowingly infected only daughter with TB.
“I am the only male child and my father is late. Early this year, I received a call from my home town about my mother’s sickness. I travelled home and stayed three weeks. Although my mother had a cough but was being treated at home by a native doctor, we did not suspect TB till she eventually gave up to ghost.”
Few weeks after he returned to Lagos, Kunle began to feel strange. Initially he thought it was the cold water he drank frequently, but the feeling persisted and even drugs from the nearby pharmacy did not bring improvement. “Later I began coughing blood. When I sneezed, my chest hurt. It was in the hospital that I was told I had tuberculosis. When they first told me, I was not alarmed. I was given treatment and given a mouth/nose guard that I was instructed to wear at all times.
“But as soon as I my wife heard that I had been diagnosed with TB, her attitude changed. She wanted to leave me on the pretext of visiting her mother. I was suspicious and refused to let her go with my daughter. That was how Kemi remained with me and unfortunately, became infected.
She is now manifesting TB symptoms.” Kunle is having a hard time coping with the treatment of his condition, along with his daughter who he accidentally infected.
Such is the nature of tuberculosis – an infectious disease which spreads from person-to-person through the air by droplets. It is a silent but deadly infection that is often misdiagnosed, under-treated and misunderstood. Its transmission is highest in health care settings providing care for people affected by TB and HIV/AIDS.
Tuberculosis is the leading cause of morbidity and mortality among People Living with HIV/AIDS. Recently, the World Health Organisation ranked TB alongside HIV as a leading cause of death worldwide, being responsible for 4,400 deaths on daily basis with new cases accounting for 9.6 million deaths.
TB was declared a national emergency in June 2006 after which an emergency plan for the control of TB in Nigeria was developed. At that time, Nigeria was ranked 5th among the 22 high TB burden countries in the world and second in the African region.
The 2015 WHO report describes higher global totals for new TB case (9.6 million) than in previous years and more than half of the world’s TB cases (54 percent) occurred in China, India, Indonesia, Nigeria and Pakistan. Nigeria, now with 170,000 deaths annually is still ranked a high TB burden country. Estimates show 3.1 percent of new TB cases are MDR-TB and of the 95 notified cases, 38 were started on treatment
In 2014 alone, TB killed 890,000 men, 480,000 women and 140,000 children which make it ranks alongside HIV as a leading killer worldwide. In 2008, the Department of Public Health of the Federal Ministry of Health had developed National control programmes that called for special attention to TB- infection control particularly in high risk settings such as HIV service delivery centres.
Certainly more effort is required to reduce the burden of TB to produce desired changes.  A public health physician with more than a decade of experience in managing TB patients who spoke on condition of anonymity told Good Health Weekly that presently Nigeria lacks some of the crucial facilities and resources to tackle the disease. Failure to adjust in approach may lead to catastrophe.
He said that the most dangerous aspect of TB now is that the resistant type which requires second line treatment is more prominent with lack of needed facilities for the treatment in the society.
“Many patients are now presenting for the first time in the hospital with resistance organism and it’s very difficult to treat because most of the needed medications and test are not covered under  National Tuberculosis and Leprosy Control Programme, NTBLCP,  and they are very expensive. This huge cost of medication and lack of appropriate facilities contributed to large extent in setback we are witnessing in this country.
“Second line treatment will cost a patient close to a million naira, now imagine a patient that is poor with such complication, he or she will just abandon healthcare centre and start spreading the organism, that was I said we all need to see TB as a collective problem.
“For instance Mainland Hospital provides secondary care for treatment of MDR but they are confronted with limited space. If the place is full and i wanted to place patient what will happened? “The person will stay at home and continue spreading the organism in his or her environment.
There was a case of a patient that supposed to have started treatment for second line but I was told no space that she had to wait till January next year, you could imagine how many people such people would have infected before that time. Hinted further, he explained that there are some drugs that NTBLC programme covers like 4 fixed drug combination (4 FDC), while others are not and they are all expensive.
“In the area of test, aside sputum smean microscopy which was included in the programme all other test like chest x-ray, manton x test, Sputum MCS among others are to be paid for by the patient and once they could not avoid it, they will decided to stay at home and not coming to healthcare centre again and we could all imagine what that means.
“For those who can afford to buy the medication are still confronted with challenges of counterfeit. Aside from government institution that sources their drugs from NTBLCP which are excluded, other sources are confronted with issue of counterfeit.
What WHO says
“According to the recent research carried out by WHO, revealed that as regard to anti-TB drugs that are available in open drug markets with only one exception, others are counterfeit. When I say counterfeit is not that they do not contain active ingredient, but the needed concentration is absent.
“In the cause of treatment some patients may require dietary supplement to enable them react timely to medication, others may need vitamins but all this are lacking and this contributed largely to why we are still battling with the huge burden. Some of our patients lack access to balance diet to help them rebuild the tissues which has been destroyed by the organism.
In the view of the Coordinator, TB/Leprosy Control, Gwagwalada Town Clinic, Abuja, Mr. Umar Bako:   “Extra-pulmonary TB, which is not infectious, affects any part of the body such as the bone, skin and brain, among others, while the pulmonary TB affects mostly the lungs. In fact, a single person with TB can infect between 10 and 15 people per year.
A Public Health Physician, Dr. Olukemi Longe-Peters who described HIV and TB as evil twins said the NTBLCP, of the Federal Ministry of Health needs to initiate the concept of local manufacturing of some of the TB dugs to help reduce the cost.
“They need support from both public and private sector because once TB patient is on treatment he or she has to take time out of work, to visit the centre and take their medication, so if there are some little assistance that would help them offset that cost, and more importantly is the cost of transportation for at least six months every working day.

Check the Vanguard newspaper for the full story.