TB is manageable,treatable and preventable

News: Mbarara finally chases TB 
Jossy Muhangi
The Daily Monitor
22 March 2006
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Uganda - Once a very congested place, the TB ward at Mbarara hospital will soon start handling other medical cases, following a new system where patients are diagnosed and referred to local health centres for treatment

It appears strange yet it is true. Mbarara University Teaching Hospital's Tuberculosis (TB) ward which up to recently has been notorious for over congestion with chronic patients is today virtually empty. According to the director of Health Services for Mbarara district, Dr. Amooti Kaguna, they "have decongested, let alone depopulated the TB ward at the main hospital. The ward will soon be transformed to accommodate other medical cases".

Kaguna attributes this situation to the adoption and implementation of a system/strategy known as Directly Observed Treatment Short Course (DOTS), which involves a downward referral of TB patients who are diagnosed and sent to the local health centres for treatment.

The system entails sending patients to their home locations where they are accessed by health workers from health centres with the TB drugs. In turn, a volunteer, not necessarily a health personnel is selected and assigned to monitor the administration of these TB drugs to the patients at the right times and ensure completion of the eight-month dosage.

This development which is also implemented in neighbouring Kenyan diagnostic and treatment facilities, has led to decongestion of the TB wards where affected cases would lie for several months bearing extra costs of feeding and facing the inadequate space hazards.

Kaguna says that last year, 3,550 cases were detected through health centres which examine sputum and X-ray examinations (specimen) to screen for TB in greater Mbarara which entails the four new districts carved out recently. Of these however, about 2,056 were identified for treatment and management while the rest remained untouched in the communities which represents about 40 percent.

Kaguna however said the prevalence rate has gradually been going down due to consistent intervention and support from the donors particularly the German Association of Leprosy and TB Relief Primary health care Funds and the Global fund contributions.

In 2005, the National TB/Leprosy allocated Mbarara district Shs116m for drugs procurement, the German Leprosy Relief Association gave Shs2.5m for allowances and other programme activities, the Global Fund contributed Shs12m and the Primary Health Care gave Shs700,000, thus a total of 132m for the entire programme.

With this support, the programme has not run short of TB drugs in recent times while Leprosy has become history. Kaguna says only two cases of leprosy were detected last year, one from Kyenjojo district and another in the refugee camp located in newly created Isingiro district.

He adds that the policy of screening HIV patients for TB and vice versa has also contributed to management of Tuberculosis which affects the lungs, bones and other parts of the body.

He however laments that there are limited centres which do counselling and testing for HIV/TB. In fact, it is only at the Aids Information centre (AIC) where HIV suspects are also screened for TB.

In all, the greater Mbarara has only eight counselling and testing centres. Of the 150 health centres including five hospitals and several health centres at constituency, sub-county and parish levels, only 62 centres have integrated services to include diagnosing and treating TB components.

He however said the situation has improved as most of the patients get screened at the main hospital and are sent back to the Community-Based Health DOTS (CBH) for management. All the sub-counties have got the CBH-DOTS facilities, according to Kaguna.

He said of the affected cases, 60 percent are men, 38 percent women and about 5 percent children. He attributed the higher rates in men to their level of predisposition, lifestyles including heavy drinking and working in congested communities among other risk factors. He identified some of the most affected areas as Rwampara, Bukanga and Ibanda counties.

Besides the health centres with integrated services, there are 24 diagnostic centres where TB patients can be examined. However, these are not evenly distributed and are located mostly in urban centres.

Although the anti TB programme boasts of adequate drugs and reduced prevalence rates, it is faced with a number of challenges that slow its pace and desired targets. Kaguna said the programme lacks sufficient trained personnel to monitor and implement the activities. He said there is need for enough clinicians especially at lower levels who take the drugs to the communities and identify volunteers to administer the drugs. And where there are staff, they lack adequate means of transport to traverse their areas of operation including reviewing the patients' situations.

There is also lack of enough equipment and reagents for testing the cases though the drugs are sufficient unless the health workers have not ordered in time. The adherence rate is yet another challenge to health workers as many patients rarely complete the doses according to prescription in the right times and amounts over long periods.  According to Kaguna, the compliance rate has been at 55 percent and defaulting rate at 45 percent.

Defaulting leads to Drug resistance and an infected patient may have to start the dose all over again with stronger medication. Currently, the anti TB drugs are only provided by the government while private hospitals access it from government departments free of charge. Another challenge has been stigma about the disease which is closely associated
with HIV/Aids.

Estimates show that 60 percent of HIV patients have TB (hidden or obvious) while 48 percent of TB patients have HIV. In spite of the intensive sensitisation of the communities that TB is preventable, manageable and curable, a number of the affected do not show up to utilise available opportunities and services.

Yet another problem is that of migratory populations which makes it difficult to follow them up. However, there are regular collaborative meetings through which those moving within neighbouring districts can be tracked, Kaguna explained.

Health workers here have a vision of having at least 100 diagnostic centres in the near future from the current 24, detecting at least 75 percent of the affected cases and treating about 85 percent of them. He said last year, of the 2,056 identified patients, 55 percent completed treatment.  They also wish to intensify the follow up programme, collaboration with neighbouring counterparts and community sensitisation.

Online at: http://www.monitor.co.ug/socpol/socpol03221.php

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