Southern Africa's TB response needs integrated approach

from Africa Science News

Written by Masimba Biriwasha

Robert Koch, a German physician and scientist, discovered Mycobacterium tuberculosis, the bacterium that causes tuberculosis (TB). Since then, the world has been marking the day as the World's TB Day and a century later today, TB is still posing a challenge, thanks to the “unholy marriage” with the HIV and AIDS

Announcing the discovery, Koch said: "If the importance of a disease for mankind is measured by the number of fatalities it causes, then tuberculosis must be considered much more important than those most feared infectious diseases, plague, cholera and the like."

Today, more than a century later, true to Koch's words, TB is rearing its old, antiquated head at humanity, causing serious fatalities particularly among poor and marginalized populations.

WHO estimates one billion people will be newly infected, 200 million will get sick, and 35 million will die from tuberculosis if controls to fight TB are not urgently strengthened in the next two decades.

In Southern Africa, the disease is already exploding at a rate that threatens to reverse gains made in the fight against diseases such as HIV and AIDS.

A major problem is that governments in the region lack the wherewithal and political will to address TB, including its interaction with HIV and other diseases.

"Southern Africa is ground zero for TB. Our region includes nine out of the 15 countries in the world with the highest estimated TB incidence rates; moreover, five of the world's 22 high-burden TB nations are in the region, according to the World Health Organisation (WHO)," stated an open editorial in South Africa's Pretoria News on the occasion of 38th Union World Conference on Lung Health in South Africa last year.

"Unfortunately, Southern Africa is nowhere near meeting the Stop TB Partnership impact targets of halving the 1990 prevalence and death rates by 2015. Instead, most indicators show movement in the wrong direction," added the open editorial written by Dr Mamphela Ramphele, a medical doctor and health care activist.

A combination of three factors including serious weaknesses in the health care systems, widespread poverty, and HIV has resulted in the rapid spread of TB in Southern Africa.

First, across Southern Africa, public health systems are in a shambolic state, as a result, over eight million lives are being lost annually to diseases because people have little or no access to services.

Despite declarations made by African Heads of State to commit at least 15 percent of national budgets to health in Abuja, Nigeria, 2001, six years later, only two out of 53 Africa Union member countries (Botswana and Seychelles) have clearly met that pledge.

To reduce disease burden and improve overall public health including reducing TB prevalence, governments in Southern Africa need to significantly increase annual per capita expenditure on health.

In addition, governments need to invest in infrastructure, training and retention of medical personnel. Improving health care systems in Africa will also require developed nations to abandon practices of poaching healthcare workers from Africa.

In fact, developed countries have a moral responsibility to promote the training of healthcare workers to improve Africa's health care workforce.

Without health care workers, the fight against TB, which currently relies on effective implementation of the WHO-recommended Directly Observed Treatment, Short-course will be virtually impossible.

Second, TB spreads rapidly in poor areas where there is overcrowding, malnutrition and no health care facilities exist – a scenario characteristic of many parts of Southern Africa. Addressing poverty must remain a key priority in the response to TB.

Third, TB and HIV have become partners, and we cannot fight one in isolation from the other. HIV infection increases the likelihood of active TB more than 50-fold, for example, an estimated one-third of the 24.5 million people living with HIV (PLHIV) in sub-Saharan Africa also have TB.

To make matters worse, current diagnostic tests for TB often fail to detect the disease among PLHIV. In view of this, only an integrated approach underlined by an increase in political willingness is urgently required to ensure that health development aid is holistically targeted at the intertwined problems of HIV, AIDS, TB, reproductive health, child mortality, and malaria.

Overall, governments in Southern Africa need to make the adoption of comprehensive public health strategies a top priority, including the involvement of health care workers and civil society in setting measurable targets of progress to fight TB, AIDS, malaria and other diseases.