What began like normal cough progressed to becoming a constant chest – paining cough which has exceeded three weeks and there is no sign that it is stopping despite different self-medications.
Worried about this development, Kunle Ayeni, an avid sports enthusiast who hardly listen or watch any other news story on television, radio or the internet could not understand why he keeps coughing without any sign of abating.
He had actually went to his elder sister’s house for a family ceremony three weeks ago and had to go to a crowded viewing centre to watch a match of the English Premiership.
He has been managing it and has been told to use different medicines and even had to patronize the local herb seller, iya Taju at the bus stop. All to no avail. It was inside the keke he boarded while going to buy fuel to power his i-pass-my neigbour-generator that his ear caught a radio jingle talking about signs and symptoms of Tuberculosis that it occurred to him that he could be suffering from the ailment.
Ayeni silently cursed himself for not listening or watching any other programme except football because he heard from the radio that TB is curable and free!
He also heard the part that anyone with symptoms or suffering from TB should visit the nearest government hospital which he did early the following day.
Currently, Ayeni is receiving treatment and his condition has greatly improved. It was at the hospital that he understood that he contracted the air borne disease at the crowded viewing centre where many where smoking and coughing aside experiencing bad breath, body odour and other smell.
He thanked his stars that it has not gotten worse than that and promised himself to keep to the doctor’s advice and even volunteered to be an advocate spreading information about TB.
This is just one of many examples of incidences of the not-too-talked- about ailment that is as deadly as any other talked about ailment.
Alarmed at the statistics of notified patients of TB, the Institute of Human Virology (IHVN) in collaboration with Breakthrough Action- Nigeria (BA –N)organized a one-day seminar sensitizing media practitioners on the importance of this deadly disease and how to disseminate information on how to deal with this disease. The event tagged; Media Personnel Interactive Workshop on Tuberculosis was an eye opener to a whole lot of ignorant narrative about this disease.
Seasoned practitioners like Adebisi Adetunji, media officer, Breakthrough Nigeria; Dr. Olusola Daniel Sokoya, Deputy Director and Programme Manager, State Tuberculosis, Leprosy and Buruli Ulcer Control Programme, Lagos State Ministry of Health; Dr. Joseph Edor, Senior Programme Officer TB/RCCE USAID Breakthrough Action –Nigeria; Badejo Olusegun; State Health Educator and Director Health Education, Lagos State Ministry of Health; Dr. Babajide Kadiri, Lagos State Team Lead, USAIDIHVN TB LON3 Project, Samuel Esther, Assistant Director, Health Education, LSMOH and Chinedu Asogra Nkechi, Social Brhavioural Change Consultant USAID IHVN TB LON 3Project took turns to lecture on various aspects of TB.
For instance the basic facts about TB goes thus: it is an airborne disease; it is more common in men than women in Nigeria; Tuberculosis of the lung is the most common type, however, it can occur anywhere in the body; four symptoms used to screen patients –cough (2 weeks duration or more, fever, night sweats and unexplained weight loss); an untreated case can infect an average of 10 -15 people in a year.
It is instructive to note that scary data of TB deaths since 2018 in top six TB countries are as follows: India 449,000, Nigeria 157,000, Indonesia 98,000, South Africa, 64,000, DR Congo, 53,000 and Bangladesh 47,000.
Coming home to Lagos state, Alimosho has 447 incident cases; Ajeromi –Ifelodun has 367 cases; and Ikorodu has 366 cases. Due to population density, the three Local Government Areas are at risk. Mushin also recorded 308 cases, Ojo, 292 and Badagry has 278 cases. Lagos accounts for 11 per cent of TB cases in Nigeria with an estimated 54,000 persons projected to be suffering from TB based on the National Incidence Rate of 219 per 100,000 population.
Risk factor in TB include malnutrition (adult and children), HIV, diabetes, close contact with a person with undiagnosed TB and how to diagnose TB is mainly sputum test for pulmonary TB; chest x-ray; stool test in children.
TB treatment: TB is treated with oral medications for minimum of 6 months. A person with constant TB medications for at least 3 weeks is no longer infectious.
Drug resistant: occurs when TB treatment is not well adhered to. It can also occur when someone is infected directly by someone with drug resistant TB.
Research shows that it is only 25 per cent of Nigerians have correct knowledge of TB.
Under the Federal Ministry of Health, there have been strategic interventions which include the following:
-Active Case Search in communities (house to house TB case finding and community outreaches
-Engagement of the Private sector (Private for profit, Faith based, stand-alone laboratories, Patent Medicine Vendors etc)
-Active case finding among vulnerable populations (Nomads, IDP camps)
-Symptomatic screening of all Out Patient Dept attendees for TB
-Symptomatic screening of children at Maternal Neonatal Child Health clinics
-Increase access to diagnostic examinations (GeneXpert, Truenat, TB LAMP) Contact tracing of TB patients
-Placement of qualified contacts on preventive therapy
-Massive awareness creation using the media, national TB hotline and community structures
-Continued Advocacy to stakeholders to garner support for TB control efforts
There are also high political commitment of global and national TB champions by political office holder like the first lady and other first ladies and national assembly members.
Also discussed is the topic of Children who are at risk of getting TB which are those living with adults who have TB; Children who are HIV positive and Children who are malnourished.
Signs and symptoms suggestive of TB children
- Failure to thrive or gain weight
- Persistent fever of two weeks or more
- Cough of two weeks or more
- Close contact with anyone with TB (caregiver, nanny, etc.
What the NTBLCP is doing to control TB in children
- Rapid diagnostic tests for TB in children
- Stool for Xpert, Truenat, TB LAMP, urine Lateral-Flow Lipoarabinomannan assay for PLHIV with advanced disease
- Active TB case finding (e.g. outreaches) in communities across 24 states
- Task shifting for other HCWs to diagnosis child TB in hard to reach areas
- Support for contact investigation (CI) of diagnosed TB cases
- Training of health care workers so they can promptly diagnose TB in children
- Free chest x-ray and transport voucher to support child TB diagnosis
Challenges with Childhood TB Control
- Low childhood TB awareness among the general population
- Poor health-seeking behaviour
- Stigma and discrimination
- Limited media engagement in TB awareness creation
- Low index of suspicion for child TB by healthcare providers
- Low funding for childhood TB Control
TB Prevention and treatment
- Avoid overcrowded areas,
- Maintain good cough etiquette: cough inside the elbow, or into disposable tissue paper or handkerchief, and avoid spitting indiscriminately.
- Early detection and treatment of TB cases.
- All eligible contacts, especially children, must be put on TB Preventive Treatment (TPT)
TB stigma and Discrimination
Stigma is defined as an act that dishonors and that reduces a person completely by ruining or saying bad things about the person. Stigma exists when a person is identified by a label that sets the person apart from others resulting in unfair treatment and discrimination
Discrimination occurs when a person is treated less favorably, on the grounds of their disease, than others are or would be treated in the same or similar circumstances.
What causes stigma
Self-discrimination
- Fear of transmitting TB
- Avoiding gossip
- Potential discrimination.
Discrimination by members of the general public included:
- Fear of a perceived risk of infection
- Perceived links between TB
Impact of Stigma on TB Prevention and Care
Concerns about stigma and discrimination for TB make it more difficult for persons with TB to start or continue with care, because their fears of being identified as being, or having been infected with TB may hinder their access to other health services.
The fear of being identified as a person with TB make it more difficult for people with a cough of 2 weeks or more who suspect they may have TB to seek care. This may lead to; Delaying in seeking care, Developing more serious symptoms; More likely to transmit the disease to more people in the community.
