Exploring the dangers of undiagnosed TB

MATHATISI SEBUSI

MASERU – The fear of a second encounter with tuberculosis (TB) keeps young Thato Ramafu on the edge of her seat every day, making her wary of the environment around her and essentially what goes down her throat.

It never occurred to her that she would one day become a statistic of this deadly disease, especially in her teenage years. Her understanding before she became a victim herself had always been that only heavy smokers and elderly people with a weak immune system were susceptible to contracting TB.

But in 2014 as a second-year student at varsity, Ramafu was diagnosed with TB and put on an immediate six-month treatment.

Before her diagnosis, she neither had symptoms nor any suspicion of having TB. But over a certain period, she started losing weight drastically while also struggling with both dizziness and dehydration.

Her concerned family believed she was either fatigued or stressed by examinations. Although the family tried hard to help her recuperate, her health deteriorated rapidly.

She never coughed or had hot flashes as normally happens with TB patients, but she continued struggling with dizziness and persistent stomach cramps.

For a long time Ramafu managed to put the situation under control by drinking lots and lots of fizzy drinks and taking pain killers while her mother encouraged her to see a doctor.

The doctor’s diagnosis took her aback because she never thought she would contract TB for any reason whatsoever owing to the healthy lifestyle she led.

She actually laughed it off, thinking that her doctor was somehow innocently mistaken.

“I neither looked sick nor had any symptoms of TB, so I thought the doctor was either joking or crazy. After undergoing a scan, I was horrified to learn that my lungs were swimming in a pool of water. This knowledge hit me so hard that it actually took me days to come to terms with it and pull myself together,” she recalls.

The idea of being infected with TB shocked the living daylight out of her not necessarily because of the perception she had before about the disease but because it then sunk into her that she was actually ill and would be on medication for a long time.

When she started taking medication she had mixed feelings owing to the side effects she was having. It almost drove her over the edge to see other TB patients on medication losing their sight, among other health problems.

What aggravated matters for her was the fact the she had no idea where and how she had contracted TB.

“The pain I endured when the pool of water in my lungs was drained out and the chest pains I sustained during treatment were completely unbearable,” Ramafu recalls.

She adds: “The six-month treatment was most challenging as it required consistency and I was warned never to skip medication as that would disrupt the treatment.”

Through all the pain and sadness, she learnt to be more precautious about her health and diet.

The World Health Organisation (WHO) has advised Lesotho, through the health ministry, to conduct a national tuberculosis prevalence survey to ensure that the country is cognisant about its TB prevalence.

Acting WHO representative in Lesotho, Dr Susan Tempo, has commended the ministry of health for launching the TB prevalence survey.

Dr Tempo says TB remains a major public health concern and the world’s leading infectious killer disease even though a lot of ground has been covered to address the problem.

The End TB strategy aims to end the global TB epidemic with targets to reduce TB deaths by 95% and to cut new cases by 90% between 2015 and 2035.

The target is also to ensure that no family is burdened with catastrophic expenses due to TB. It sets interim milestones for 2020, 2025 and 2030.

Tempo says in 2017, at least 10 million people developed tuberculosis and 1.3 million deaths resulted from the disease.

She shows that in Lesotho, TB prevalence is a major concern as Lesotho is among the top 30 global TB high burden countries with an incidence rate of 665/100,000 population, which is second only to South Africa on the 30-country high burden league.

“Treatment coverage stands at 48%, which means that more than half of TB cases are not diagnosed and treated, meaning more people are likely to die from the disease while at the same time spreading it to their family members, friends and communities,” she says.

The situation, she shows, calls for an emergency investment and programmatic coverage action if the country is to make the desired progress towards meeting the sustainable development goals (SDG).

The United Nations Sustainable Development Goals include ending the TB epidemic by 2030 under Goal Three.

Health deputy minister, ’Manthabiseng Phohleli, remarked during the launch of National TB Prevalence Survey in Mats’aneng, Mafeteng recently that the deadly type of TB called the Multi Drug Resistant (MDR) is one of the diseases that have put Basotho under siege.

The most vulnerable are particularly people who delay visiting established health facilities when they have contracted the disease.

Phohleli appealed to members of the community to learn about the symptoms of TB and to report to the nearest health facilities for early treatment, if they discover any symptoms.

According to her, the ministry had to treat TB as a state of emergency in order to fight its proliferation.

According to Partners in Health (PIH)’s fact sheet, certain types of TB like MDR and Extensive Drug Resistant TB (XDR) are the most challenging in terms of treatment as they require specialised interventions that are more expensive.

The fact sheet notes that unlike the normal TB, MDR and XDR are highly resistant to potent TB drugs that are used to treat all patients of TB.

It also shows that patients with XDR TB are left with few treatment options that are less effective.

The fact sheet further states that XDR TB is of special concern for persons with HIV infection or other conditions that weaken the immune system as such persons are more likely to develop XDR TB disease and, once infected, they have a higher mortality rate.

The report also shows that Lesotho is one of the countries with highest TB burden in the world, with an estimated TB incidence rate of 665 per 100 000 people and about 75% of these patients suffer from HIV co-infection.

“The rate of MDRTB is also high in Lesotho with the incidence rate of 49 per 100 000 populations. However only 45% of estimated susceptible TB cases, and 25% of estimated MDRTB cases were diagnosed and enrolled into TB and MDRTB treatment programmes,” reads the fact sheet.

The Partners in Health report notes that efforts to address the MDR TB problem in Lesotho started in 2006 when the Government of Lesotho procured second line anti-TB drugs. In January 2007, the Green Light Committee approved a proposal for the project supported by Partners in Health.

“Over the years PIH has implemented several Global Fund grants to manage MDR TB. In 2018, a three continuation of the MDR TB programme was agreed between PIH and the Government of Lesotho.

“Under this project PIH continues to manage the MDR TB programme by providing treatment to existing and new MDR/XDR patients referred from district hospitals and from other service providers.

The overall goal of this programme is to detect and treat all infectious TB and MDR TB/HIV patients and reduce morbidity and mortality,” reads the report.

It further noted that PIH’s objectives include to ensure prompt treatment of all drug-resistant TB by making drugs available and accessible to all patients. It also seeks to ensure proper drug safety monitoring and management are put in place, while providing early diagnosis and prompt treatment of all persons who have contact with MDR TB patients.

In addition, PIH aims to provide psychological support to MDR TB patients, including educational, emotional and counselling support, and to assess all patients for nutritional status and provide nutritional counselling and support and screen all MDRTB patients for other co-morbidities such as diabetes, hypertension, cardiac illness, mental illness and other occupational lung diseases while providing quality services for co-morbidity management and implementing strict TB infection control measures.

PIH, through the programme, also provides social support in form of food packages and hygiene kits to all patients to enhance adherence.

Temporary accommodation is provided to patients who need it while their treatment supporters undergo training by PIH staff; while also catering for those with special social challenges.

Again, PIH provides transport fares to patients and treatment supporters to enable them to adhere to their monthly follow-up visits at the hospitals and ongoing psychological support that is provided in the form of counselling for patients and their families.

Target population for PIH are all patients who are diagnosed to have MDR TB which are enrolled in the treatment and care of MDR TB programme.

PIH currently cares for at least 240 active MDR TB patients each month. In addition, up to 10 new patients are enrolled each month.