TB-Free Ethiopia Demands Collaboration, Further Emphasis On DRTB

Despite advancements in research, diagnosis and medication technologies as well as increased attention in the past years, people are still regrettably suffering from the tuberculosis plague, and globally it is among the top 10 killer contagious diseases. It remains a leading cause of morbidity and mortality in developing countries, and a major health concern globally. To its worst, a significant number of cases of drug resistant TB strains are reported each year.

Marking the 2017 World TB Day, WHO said: "TB claims 5000 lives each day. The heaviest burden is carried by communities which already face socio-economic challenges: migrants, refugees, prisoners, ethnic minorities, miners and others working and living in risk-prone settings, and marginalized women, children and older people."

A 2016 World Health Organization (WHO) report on Global TB status shows the existence of an estimated 10.4 million new TB cases worldwide. A related report shows 24,000 people get infected each day and 10.4 million fall ill from TB and 1.8 million die.

Six countries accounted for 60 per cent of the new cases: India, Indonesia, China, Nigeria, Pakistan and South Africa. People living with HIV accounted for 1.2 million (11 per cent) of all new TB cases (WHO 2016).

The good news is that the number of TB deaths and the TB incidence rate continue to fall globally over the past 15 years. The number of TB deaths fell by 22 per cent between 2000 and 2015. This period, TB treatment avoided 49 million deaths globally; important diagnostic and treatment gaps persist, however.

The disappointment is the epidemic has come up with its drug-resistant strains of TB (DR TB), which has rapidly emerged worldwide. WHO reported alarming rise of not only multi-drug-resistant (MDR) TB but also of XDR TB (extreme drug-resistant TB) globally. Both treatment and management of such cases are well beyond the capacity of any developing country- a perplexing puzzle the globe has to ponder about!

Various investigations, including WHO's, reported the same estimate of new cases of multi-drug-resistant TB (MDR-TB). Four hundred Eighty thousand cases and an additional 100, 000 people with rifampicin-resistant TB (RR-TB), were found also newly eligible for MDR-TB treatment. Within this global scenario,then, has Ethiopia's struggle matched the global figure for the decline of deaths? Have local research efforts contributed for the national effort to end TB? Can all the efforts will result a TB free Ethiopia?

Ethiopia is identified as a high TB burden country. According to the 2014 WHO report, the prevalence and incidence of all forms of TB are 211 and 224 per 100,000 population, respectively. In 2013 TB mortality was estimated to be 32 per 100,000 of the population. TB related deaths, in 2015, fell to 26 per 100,000 population.

Notwithstanding the aforementioned numbers, Ethiopia's TB prevention and control through the national health sector development program over the past 20 years has proved promising. Reports, including one from WHO, indicate that Ethiopia has achieved all the three Millennium Development Goals (MDG) set for TB prevention and control. Thus, the national TB incidence rate declined to 224 per 100,000 population in 2013 as compared to 369 in 1990.

Regarding the Ethiopia's attainment, Leslie Reed, United States Agency for International Development (USAID) Mission Director appreciated Ethiopia's success in the past and expressed US would continue supporting Ethiopia's struggle to end TB. Similarly, WHO, Ethiopia representative Dr. Akpaka A. Kalu for his part commended Ethiopia's success in eradicating TB despite the higher incidence of TB in the country.

Moreover, the Ethiopian Health Ministry announced that the target of halving TB prevalence rate by 2015 was met. TB prevalence rate during the period reduced by 50 per cent. TB and Leprosy Programme Coordinator of the Ministry Lelisa Fekadu told The Ethiopian Herald that the TB prevalence rate currently decreased to 192 from 369 per 100,000 population two decades back. He also indicated that TB incidence rate in Ethiopia declined to 48 per cent as compared to the figure 26 years back.

On the recently held 12th TB Research Annual Conference and Commemoration of the 2017 World TB Day, State Minister of Ministry of Health, Dr. Kebede Worku said Ethiopia has shown greater commitment towards ending tuberculosis. He mentioned a plenitude of interventions the nation has employed so far, and hence, the success thereof. "Envisioning to see a TB free Ethiopia, government has placed greater emphasis on researches towards control and prevention of TB with the understanding its decisive role," he said.

Dr. Kebede also indicated his government's success is attributable to the building and expansion of TB diagnosis and treatment centers and supplying the required inputs at high cost. "TB examination and treatment is now offered in about 3000 public and 400 private health institutions," he said. Currently, there are nine TB culture laboratories that are equipped with special and latest technology and equipment and identify drug resistant tuberculosis (DRTB). The government also showed heightened commitment in allocating huge capital to provide diagnosis and treatment centres for drug-resistant tuberculosis (DRTB). And thus, 46 hospitals are currently offering the service nationwide.

On the same event, Dr Taye Tolera Director of the Armauer Hansen Research Institute (AHRI) said TB mortality rate decreased by 63 per cent because of greater efforts of the nation. Communicating the community through health extension service was one of the big tasks accomplished. He also mentioned the contribution of employing gene Xpert machine, which has brought a significant change on TB identification. "Previously diagnosis was microscopic. This takes two days to know the result, but now it is possible to know within 2 hours using gene Xpert," he said.

On the other hand, local research efforts on TB are said to have contributed for the overall national achievements in TB control and prevention. Dr. Getnet Yimer, Chair, National TB Research Consulting Committee noted researches on TB have so far proved successful. "Ethiopian researches to date have identified the major risk factors associated to TB like diabetic, HIV positive, and alcoholic. Our research efforts also identified and avoided the cause of terminating medication, by supplying a tablet composed of 4 tablets." Ethiopia has contributed the world with a finding that helps magnify the visibility of TB bacterium. Further, the nutritional value of nuts for the TB patients is another fruit of the local research, Dr Getnet explained.

By the same token, Dr. Taye Tolera said his institute is conducting research taking into account the national health transformation plan. "We have been doing experiments on vaccine. We are also undertaking experiments to shorten the length of medication, which is 6 months and more. A number of studies on people with HIV are also under way."

Provided that such research trends are strengthened and propagated, gaining proper support, they will in fact contribute not only to policy making but also to giving lasting solutions to the pandemic.

Rewarding as the fruits of collaborative efforts among policy makers researchers and stakeholders, there are several challenges that have to be emphatically addressed. About a third of those thought to have the infection have not gone to health centres, being potential source and agents of the infection. Another encounter is that patients do not take TB medication as prescribed by the physician or they terminate it. Contrariwise, there is lack of proper prescription and follow up of treatment on the part of health professionals. Moreover, drug resistance tuberculosis and HIV burden have posed significant challenge. Last but not least, less level of knowledge, attitude and practice towards TB among the community and lack of interesting means of communication need attention.

The National Health Sector Transformation Plan (HSTP) identifies TB as one of the nation's priority health issues. It has adopted the global End TB Strategy, which aims ending the plague by 2035. Ethiopia also has launched a new four years national plan for TB research in Ethiopia.

Source- Ethiopian Hearald Newspaper