2022 World TB Day: Stigma, poor funding, other factors threaten disease elimination in Nigeria
2022 World TB Day: Stigma, poor funding, other factors threaten disease elimination in Nigeria
On a sunny Tuesday afternoon, patients were seen trooping in and out of Alheri Ifeoluwa clinic, a facility located at Masaka, a suburb in Nasarawa State.
One of the patients, who was coughing profusely, had caught everyone’s attention.
The patient, later identified as Angulu Anti, a resident of Ankara Agwan garaga, across Kogi river, was recently diagnosed with Tuberculosis (TB).
The managing director of the health family, Ogunyebi Veronica, said Ms Anti was diagnosed with TB in early 2021 and placed on treatment immediately.
Ms Veronica said the patient stopped visiting the hospital for treatment after a while and all efforts to reach her and the family failed.
“I stopped going to the hospital because people in my community were distancing themselves from me,” Ms Anti told this reporter as she coughed into her face mask.
Speaking in Gwandara, her local dialect, she said many people in her community started avoiding her, because, according to them, she may infect them with the disease.
Ms Anti, in her early 20s, said she decided to stay indoors, so that nobody sees her visiting the hospital.
She explained that she felt better after some time and concluded there was no longer need going to access treatment.
“I started having headaches and the cough became more serious so my mother rushed me here today,” she said.
What is Tuberculosis?
Tuberculosis is caused by bacterium (Mycobacterium tuberculosis) that often affects the lungs.
It is spread from person to person through the air. When people with TB cough, sneeze or spit, they propel the TB germs into the air. A person needs to inhale only a few of these germs to become infected.
Despite TB being a vaccine-preventable disease, statistics from the World Health Organisation (WHO) show that every year, about 245,000 Nigerians die from the disease, and about 590,000 new cases occur.
The data further shows that around 140,000 of this figure are also HIV-positive.
TB is identified as the number one infectious killer disease in the world and also among the top 10 causes of death worldwide.
One-quarter of the World’s population, approximately 1.9 billion people, is infected with TB.
Nigeria ranks first in Africa and sixth amongst 30 countries globally with the highest burden of the disease. Nigeria also ranks first in Africa with the number of undetected cases.
To reduce the scourge of TB, global leaders at the United Nations High-Level Meeting (UNHLM) in 2018 set a global target to identify more TB cases and put people on treatment by the year 2025. The target is a road-map to ending TB by the year 2030.
Nigeria at this meeting also committed to diagnose and treat over 1.1 million TB cases and place about 2.2 million persons on TB preventive therapy between 2018-2022.
By the first quarter of 2022, not much progress has been made in the fight against TB in Nigeria. The country still accounts for at least 300,000 missing cases every year.
The failure of Nigeria’s government to meet this target may be partly attributed to the COVID-19 pandemic which has been largely blamed for disrupting several health targets globally.
However, factors like stigmatisation which led Ms Anti to derail from her treatment also threatens the country’s response to TB.
As Nigeria joins the rest of the world to commemorate the 2022 World TB Day (WTBD), PREMIUM TIMES with excerpts from health experts analyses some factors that have hindered TB eradication in Nigeria.
The Nigerian government has repeatedly failed to budget a substantial amount for the country’s overburdened health sector.
Health experts mainly attribute the failure to meet the TB target to poor funding and timely release of budgeted funds.
The experts said the federal government has consistently failed to release adequate funding for TB, leaving major contributions to foreign donors.
The acting board chair of the Stop TB Partnership Nigeria, Queen Ogbuji, said of the N150 billion ($373 million) needed for TB control in Nigeria in 2020, only 31 per cent was available to implementers.
Ms Ogbuji said about seven per cent of the money released came from the Nigerian government, while 24 per cent came from donors, leaving behind a funding gap of 70 per cent.
“Globally, of the $15 billion annual funding for TB promised by world leaders at the UNHLM on TB in 2018, less than half has been delivered.
“And in Nigeria, of the $373 million needed for TB control in 2020, only 31 per cent was available to all the implementers of TB control activities; seven per cent domestic and 24 per cent of donor funds,” she said.
She lamented that the country still accounts for a 70 per cent funding gap in TB and the low levels of funding for TB response year after year is no longer acceptable.
Ms Ogbuji said more investment would save millions of lives and accelerate the end of the TB epidemic.
“World leaders including governments at the National and sub-national levels must step up and quadruple TB funding to save lives and end the disease by 2030,” she said.
A public health expert, Bethrand Odume, said improved funding will account for more TB case funding in the country.
Mr Odume said to fight any disease, the country requires a lot of available resources but that unfortunately, for years there have not been adequate resources to tackle TB.
“The point to note is that we have what we call a strategic plan, which indicates what we need to curb TB. If you look at the funding gap, it mirrors the gap in case finding,” he said, adding that; “TB costs more to treat, it is high time we improved from 25 per cent TB funding.”
It is no longer news that the COVID-19 pandemic has disrupted human activities and overshadowed other health issues across the globe, including TB.
A 2021 data released by ‘Stop TB Partnership,’ indicates that global treatment and diagnosis of TB cases witnessed a drastic decline in 2020 due to the COVID-19 pandemic that is still troubling the world.
The report indicates that disruptions in services caused by the pandemic have led to further setbacks in progress already made against the disease.
The pandemic is said to have eliminated 12 years of progress in the global fight against TB.
“Twelve years of impressive gains in the fight against TB, including in reducing the number of people who were missing from TB care, have been tragically reversed by another virulent respiratory infection,” executive director of the Stop TB Partnership, Lucica Ditiu, said in her reaction to the report.
Ms Ditiu said the pandemic put the lives and livelihoods of millions of people in jeopardy.
She said data emerging from India and South Africa shows that people coinfected with TB and COVID-19 have three times higher mortality than people infected with TB alone.
She said this development makes contact tracing, case finding and bi-directional TB and COVID-19 testing essential.
The National Coordinator of National Tuberculosis and Leprosy Control Programme (NTBLCP), Chukwuma Anyaike, said the pandemic has negatively affected all efforts to tame TB in Nigeria.
In Nigeria, over 255,000 cases of COVID-19 have been recorded and over 3,000 persons have died from the virus.
Various studies have shown that the fear of discrimination restricts people with TB symptoms from seeking help, making it much more likely that they will become seriously ill and infect others.
Just like Ms Anti, Precious Muyiwa, a resident of Masaka, said she suffered a lot of discrimination during her treatment of TB.
Ms Muyiwa said although she has completed her treatment, she is yet to recover from the shame of contracting TB.
“As at then, once I start coughing, people around say I should not infect them with the disease, they tell me to stay far away from them,” she said
Mr Anyaike said most people fail to report to the health facility once they start experiencing symptoms of TB, due to fear of condemnation.
He said the way people with TB are treated leads to delay in reporting to the hospital and consequently increases mortality from the disease.
He explained that to make sure those diagnosed are placed and retained on treatments according to national protocol, stigma and discrimination must first be tackled.
He said this will be a sure way of cutting the chain of TB transmission and ending the disease in Nigeria.
“So many people do not want to be identified with TB and when they get cured, because of the stigma attached to it people still think they are very infectious,” he said.
He explained that stigmatisation does not only affect people in the community, it also affects health care workers.
“If you say you are working for TB programmes, they assume you are carrying the disease around and you will infect them,” he said.
Ms Ditiu also confirmed that the disease is mostly associated with stigma, adding that the COVID-19 pandemic has further worsened the situation due to similarities in both diseases.
“If you cough in a gathering, before you know there are lots of empty spaces around you because everyone assumes you have COVID-19,” she said.
Studies have confirmed that the majority of persons especially those in rural communities lack adequate knowledge about TB.
Health experts believe that a lack of knowledge about TB generally is one of the biggest contributors to low case presentation.
The experts also said if awareness level on TB remains low, eradicating the disease will become an uphill task.
Mr Anyaike said there are some existing beliefs and myths about TB even among the educated populace, which he noted restrict people from accessing treatment.
“One of the challenges in eradicating TB is poor awareness level. It is on record that only 27 per cent of Nigerians have true information about TB,” he said.
He said more efforts are needed to raise awareness levels on TB, especially for those in hard-to-reach areas.
He said this will further reduce the unnecessary stigma associated with the disease.
“We as a group are doing our best to increase the awareness level of people on TB, we tell them about the symptoms and importance of seeking medical help immediately,” he said.
Mr Anyaike noted that one case of TB can infect 10-15 people in a day and the disease keeps spreading once the carrier fails to seek help.
Misdiagnosis, unidentified cases
Misdiagnosis and missing TB cases are also major contributors to delay in addressing the killer disease.
Mr Anyaike said early diagnosis is very important in TB “because it is deadly to mix a bad egg with a good one.”
He said TB misdiagnosis is rampant among children, especially those under five years of age.
He noted that despite the availability of Bacille Calmette-Guerin (BCG) vaccines to prevent TB, more children still get sick from the disease because their guardian failed to present them for vaccination.
“BCG vaccination given to babies and young children provides consistent protection up to 80 per cent against severe forms of childhood TB, such as TB meningitis,” he said.
He explained that some mothers have their children outside the health facility, making it difficult to administer the vaccines on them.
On missing TB cases, he said the country identified above 207,000 missing cases.
“When you look at it and compare with what we have been having in this country, that stands out as the highest ever.
“If at the end of the year we have above 300,000 missing cases and one unidentified case has the capacity to infect 15 to 20 people.
“So if you multiply this by 300,000, you will see that there is a huge problem. TB is not sitting somewhere waiting for you, it is a deadly bacterial infection so it continues to spread in the communities, in hard-to-reach areas,” he said.
Mr Anyaike said the earlier the bad ones are separated from the healthy ones, the better for the country’s response against TB.
“And that is why we need to expand our diagnostics platforms.
“We should be able to have at least one effective diagnostic platform in every local government in the country,” he said.
World TB Day
To create awareness about the impact of TB, World TB Day is marked on March 24 every year.
The day is held to raise public awareness about the health, social and economic consequences of TB, and to step up efforts to end the global epidemic.
The theme of World TB Day 2022 is ‘Invest to End TB. Save Lives’ and Nigeria’s localised slogan is ‘Give more, Do more, End TB now.’
The theme conveys the urgent need to invest resources to ramp up the fight against TB and achieve the commitments made by global leaders to end TB.