Mistaken identity: Tuberculosis in the time of COVID-19

Today is World TB Day. For years, Nigeria has struggled to contain the disease that is killing 18 Nigerians every hour. In the COVID-19 era, experts fear many may mistake the symptoms of TB for COVID-19 as the country struggles to meet its 2022 target on the disease.

Muni, 40, began to cough persistently in April last year. She said she initially managed it with over-the-counter drugs but when it persisted for weeks, she suspected she had COVID-19.

 

Afraid of being confined in an isolation centre, she refused to go for a test.

 

When self-medication failed, she was rushed to a district hospital in Abuja where she was diagnosed with tuberculosis.

 

“I wouldn’t have suffered so much if I had gone to the hospital early,” she said. “The treatment is even free. Even if it had been COVID-19, I would have still been treated.”

 

It took months but she did recover.

 

Not all TB patients are lucky though. Hassan lost his wife to the disease. For months, she suffered persistent coughs and chest pain which they tried to manage with alternative medicine.

 

“She became emaciated and continued to grow weak. Later, we went to a clinic and the doctor referred her to a hospital in Keffi, Nasarawa State, and some tests were done. However, she died shortly after the test results revealed she had tuberculosis,” Hassan said.

 

A survivor, Francis Ekong, fell ill in 2013, took anti-malarial drugs but did not feel better. He was later taken to the Asokoro District Hospital, Abuja, where he was diagnosed with TB and placed on a six-month treatment.

 

He recalled facing stigma from close relatives, the support of his mother who made sure he followed the treatment regimen helped him recover.

 

Perpetual Ukaegwu, a survivor whose husband was also treated for the disease said they received free treatment, he in Kano, she in Jos.

 

“My advice to Nigerians is that when they begin to cough for more than two weeks, they should go for a TB test. The test is free of charge, treatment is free of charge,” she said.

 

Tuberculosis, which mainly affects the lungs and other parts of the body, is the world’s top killer infectious disease and remains a major public health problem in Nigeria.

 

It is an airborne disease caused by a bacterium called mycobacterium tuberculosis. Symptoms include coughs lasting longer than two weeks, and any current cough in People Living with HIV and AIDS, weight loss, night sweats, and persistent fever.

 

Dr Ezie Patrick, a physician, said tuberculosis is spread when an infected person coughs or sneezes into the atmosphere.

 

He said; “This action releases thousands of mycobacterium into the air, which are easily inhaled by unsuspecting individuals. Hence the spread is more effective in overcrowded areas and tight spaces.”

 

“TB can be found in the vertebral column commonly referred to as hunch back. It has also been found as swellings in the neck, in the ovaries, intestines, and disseminated around the body. However, the TB that affects the lungs is the commonest presentation of the disease,” he said.

 

Nigeria’s burden

The Minister of Health, Dr Osagie Ehanire said Nigeria has the highest TB burden in Africa and ranks 6th globally. He said Nigeria is classified among countries with a high burden for TB, TB/HIV and Multi-Resistant Tuberculosis (MDR-TB).

Undetected cases

WHO Country Representative, Nigeria, Dr Walter Kazadi-Mulombo said low case detections remain a major challenge in the control efforts with the country only detecting 27% of the estimated incidents of TB cases.

He said the un-detected cases could further constitute a reservoir that fuels on-going transmissions. One undetected case could infect between 12 and 15 people per year.

Coughing: TB or COVID-19?

Experts have emphasized the need to test for the disease, especially for those experiencing prolonged cough and might be testing for just COVID-19.

Cough, the experts say, is a symptom of many diseases and it is therefore important to get the right diagnoses by visiting a health facility for a test.

This also informed the slogan for this year’s World TB Day, ‘That cough, e fit be tuberculosis, not COVID-19. Check am o!’

Country Director of the KNCV Tuberculosis Foundation, Dr Bethrand Odume said because of the stigma associated with COVID-19, and the similarities between COVID-19 and TB, many people deny having coughs and shy away from health facilities

Vice-Chair of the Stop TB Partnership Nigeria, Dr Queen Ogbuji said, “So we still have many people who may have TB but are afraid to come out. And that underscores the importance of engaging the communities.”

Director-General of the Nigeria Centre for Disease Control, Dr Chikwe Ihekweazu said it was important for Nigerians to go for tests because a patient may be infected with both COVID-19 and TB.

Ihekweazu, represented by Dr Elsie Ilori, Director, Surveillance and Epidemiology Department of the agency, during the launch of the Unified National TB Campaign and ACSM guidelines yesterday said Nigeria accounted for about 11% of the global gap between TB incidences and the notified cases.

A large number of Nigerians don’t know where to access care and that treatment is free. The National Hospital, Abuja and all the district hospitals in the FCT, have centres for TB treatment.

The National Tuberculosis and Leprosy Control Programme have advised Nigerians to call 3340 for information on TB.

National Coordinator of the programme, Dr Chukwuma Anyaike said, “TB is curable. We have hope if we do the right thing to arrest the menace of TB. But I must warn that TB is not a respecter of any person whether rich or poor because it cuts across all strata of life but is more likely in those with reduced immunity or nutrition and terminal diseases.”

To curb the menace, he said, sensitization to end stigma and discrimination against people suffering from the disease must be ramped up.

The last TB survey in the country was conducted in 2012. Dr Anyaike thinks a new survey is needed to ascertain the actual figures.

For Dr Odume, the 70 % gap in TB funding must be breached to bring the disease under control.

Meeting the 2022 target

Dr Kazadi-Mulombo of WHO said that at the 2018 UN High-Level Meeting (HLM) on TB, Nigeria made a commitment to diagnose and treat over 1.1 million cases and also place about 2.2 million clients on TB Preventive Therapy (TPT) from 2018 to 2022.

The country is far from achieving these targets with less than two years to go.

“About 70% of the TB budget in 2020 were unfunded, this is a major threat to the country’s efforts in achieving the set targets,” he said.

He said 71% of TB patients in Nigeria and their households are affected by catastrophic costs, with many pushed into poverty due to lost income, transport costs and other expenses.

“The theme for World TB Day 2021 [The Clock is Ticking] is, therefore, a wake-up call for us as a nation to accelerate TB responses to reach the set targets in the 2021-2025 National TB Strategic Plan and to realize the commitments made by His Excellency, the President of the Federal Republic of Nigeria at the first-ever UN High-Level Meeting on TB in 2018,” he said.

Dr Ogbuji, mentioned earlier, said this year’s theme sounds the alarm and reminds world leaders that they have until December 2022 to live up to their promise of ending TB or risk losing thousands of lives to the curable and preventable disease.

“The clock is ticking for all stakeholders to unite towards achieving the political declarations on achieving TB targets,” she said.

 

Credit: Daily trust