Multi-Drug Resistant TB Epidemic Imminent in Nigeria

Published on Thursday 3rd February 2011

An escalating number of Multi-Drug Resistant Tuberculosis (MDR-TB) cases in Nigeria is currently constituting a major source of worry.

Medical experts have warned that the trend should be quickly checked in order to forestall what they describe as "imminent and total collapse of the efficacy of the available first-line drugs for TB treatment."

Findings by Good Health Weekly show that the spectre of resistance is fast overwhelming important anti-TB drugs such as Isoniazid and Rifampicin.

Worse still, a number of the infectious diseases hospitals responsible for providing TB treatment nationwide are functioning below optimal capacity.

This development, which may lead to the country settling for the more expensive second-line drugs that not only less efficient but more toxic.

Specifically, when MDR-TB occurs, unlike the normal TB that requires six months to treat, a patient diagnosed of MDR-TB would be on treatment for at least 18 to 24 months. In the first phase of treatment, the patient must be hospitalised for six months, followed by ambulatory care for the next 18 months.

"TB is very much with us and we must all put all hands on deck to contain it before it gets out of control," says Dr. Oni Idigbe, Director of Research, and former Director-General of the Nigeria Institute of Medical Research (NIMR).

"A TB patient is said to have developed MDR -TB when the patient becomes resistant to the two most important and potent anti - TB drugs. The bottom line of TB control is to detect active cases of TB and render them non-infectious with adequate treatment," he remarked.

Statistics from the National Tuberculosis and Leprosy Control Programme have shown that currently, there are more than 7,000 MDR-TB cases in the country. Globally, there are about 500,000 cases of MDR-TB, of which only 3 per cent get proper treatment.

Idigbe who expressed concern on the poor management of TB in private facilities said: "We are beginning to see cases of multi-drug resistant (MDR) TB. These are cases that are now getting resistant to the normal drugs we use to treat TB. If these cases are allowed to continue to develop and transmit infections, we are going to run into the problem of losing all the drugs that we have for TB and start going for second line drugs".

Pointing out that most of the cases of MDR-TB develop as a result of wrong clinical management, he said drug-resistant TB is caused by inconsistent or partial treatment, when patients do not take all their medicines regularly for the required period or health workers prescribe the wrong treatment regimens, or because the drug supply is unreliable.

Lamenting the development, Idigbe said most TB treatment programmes have not been succeeding because the nation is just operating at the level of secondary and tertiary healthcare forgetting the primary health care and the communities.

"This is where knowledge, attitudes and behavioural practices are very low. They need to be enhanced. The drive now is the public-private mix (PPM) so that the public and the private sector will work together. We need to go to communities and educate them on the signs and symptoms of TB because the earlier you detect a case and break the chain of transmission, the better."

He said using the recommendations of the WHO, efforts will now be geared towards using the Advocacy Communication and Social Mobilisation (ACSM) Strategies to detect existing active cases.

Nigeria ranks 4th out of the 22 countries that have 75 per cent of the global burden of TB. An estimated 450,000 new TB cases occur annually. Just 94,000 were detected last year.

To tackle TB effectively, the World Health Organisation (WHO) recommends that countries must detect at least 75 per cent of active case and attain 85 per cent treatment. In Nigeria only 36 per cent are detected and over 60 per cent cases are not being treated. The implication of this, according to experts, is that anybody can be infected with TB.

Close contact with a TB patient over a period, increases chances of infection even as one active TB case in a community has potential of infecting 10 people. Most cases are usually detected late with very few getting effective treatment. The patients die or develop MDR-TB.

However, a ray of hope may be on the way as the country is set to host the 18th Conference of The Union African Region of the International Union Against Tuberculosis and Lung Disease in Abuja, March 2-5, 2011.

The conference, with the theme: TB, TB/HIV and other Lung Diseases: Challenges to the attainment of MDGs in Africa, has been designed to address problematic areas of TB and lung diseases, particularly, MDR-TB cases and how to delist Nigeria and other African countries from the list of TB high-burden countries.

Participants are expected to deliberate on problems and solutions of lung disorders as well as new preventive, diagnostic and curative methods to fight TB, among others.



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