"TUBERCULOSIS IN CAMEROON: THE LINGERING ISSUES".

                          “……Government curative approach has made considerable impact but more

                                    could be achieved with a little more of education………

          “Where knowledge is completely absent ignorant is King”.

                                       Tuberculosis (TB) – a debilitating lung disease is a public health problem in Cameroon.

                                                  Education / sensitization is an effective tool in the fight against TB.

Agbor, a young banker in Limbe Southwest Cameroon said: “I have not seen a tuberculosis patient before now, but from what I have read about the disease, the young man who sat beside me in a vehicle recently has the symptoms. He looked frail, coughing intermittently and spitting reddish mucus into a plastic bag. When I realized this embarrassing nuisance; I covered my nose and mouth with a handkerchief all through our short journey”.

Agbor is an enlightened mind. With little knowledge of Tuberculosis, he suspected a case and took personal cautionary measure, whether effective or not. Like Agbor there are many Cameroonians out there who are confronted with similar or other incidence of tuberculosis but ignorance prevailed on them to take measures.

Tuberculosis (TB) is a communicable lung disease caused by germs known as tubercle bacilli. These germs are usually found in the spit of TB patient. When a patient coughs sneezes or spits carelessly, the TB germs are spread into the air and can be breathed into the lungs of a healthy person who may develop TB sores in the lungs. Some of the known symptoms of TB include persistent cough, body weakness, loss of weight and appetite, chest pains, blood-stained spit, etc.

TB is endemic. Many people have dormant TB germs in their lungs which will not necessarily develop into active TB disease, may be due to strong immune system. Pulmonary TB is the most common form of tuberculosis (common also in Cameroon) – which affects more of the lungs. However other parts of the body can also be affected when the TB germs spread from the lungs by the bloodstream. TB is treatable and varieties of medications mainly antibiotics could handle it. This however has to be taken for at least 6 months or even longer depending on the case. The necessity of hospitalization for a patient depends on the stage of disease – whether earlier detected or at an advanced stage.

“It was a very painful and agonizing experience” Mr. Moka (not real name), a former TB patient said.

“You have both the complexities of the disease itself and the stigmatization to battle with. But graciously my family stood by me and with strict respect of treatment; today I’m completely ok though I do go for check up once in a while”.

For Lucy (not real name) – a young single mother of two, it is a different story. She has been battling with TB for over two years with no actual cure. “Before now, I have always had this negative thought to end it all – wondering why my own case of tuberculosis has refused to go, despite all the drugs I have taken. Not until the Doctor told me it is because of my HIV status”, she said.

  

Tuberculosis remains a serious public health problem in Cameroon as in many other developing countries. In 2010 for instance, there were 24.528 cases of tuberculosis (all forms included), with a prevalence rate of 122 per 100.000 inhabitants. Same year, the number of new sputum positive cases were 14.646. With an estimated HIV prevalence rate of more than 5% in the country, the rate of co-infections was estimated at 33% in new cases of sputum positive pulmonary TB.

There is no doubt that Government has made concerted efforts to curb the menace of this disease. In line with international directives (Directly Observed Treatment Short Term Strategy) and the Global strategy and plan to stop TB; government of Cameroon set up the National Tuberculosis Control Programme (NTCP). Financed by government and her international partners like the Global Fund, NTCP came on board to execute and elaborate on the national policy for the fight against tuberculosis. Among its operational objectives are: to detect at least 70% of positive pulmonary TB cases and also to cure at least 85% of the patient. Overtime, this control programme actually evolved, making better the delivery of tuberculosis care. Specialized TB units/centers were set up at many health facilities following the health system structure in the country made up of Regional and District Hospitals. The Mission hospitals (owned by Churches and Religious organizations) were also not left out. Some of them are strategically located in proximity to the local population and therefore accredited by NTCP.

“Here in the Southwest Region, there are many special centers at the level of the Regional and District hospitals in Limbe, Buea, Tiko, Kumba, etc; even the mission hospital in Mutengene, says Dr. Arrey – Regional Coordinator of the NTCP in the Southwest Region(just retired). According to this public health expert, there are 16 centers created already and lot more interventions have been made by the State via the NTCP. There are free treatments of TB patients for full treatment period at these centers. Patients pay just a token for laboratory diagnostics or texts fixed at 1000 FRS CFA (about 2 USD). Drugs have been made readily available which are also given to patient free of charge. There are also free TB vaccines for children under five years – some which are administered at the point of birth in clinics or as soon as early family contacts or infections are detected.

These efforts of Government and her international partners though commendably, are fraught with inherent challenges. There are lingering issues some of which seem to rubbish the implementation and effectiveness of the TB control initiative. The reality on ground is that the menace of tuberculosis still lingers. As obvious in other low income countries, the World Health Organisation (WHO) recommended Directly Observed Short Term Strategy –DOTS- faced implementation difficulties in Cameroon. It is complex, entangled with numerous barriers and also required huge resources. For this reason, many adaptations came up depending on the context. Instead of “Directly observed” as is the case, what one sees is “partially observed treatment. For instance during the intensive phase of treatment which is usually the first two months, instead of receiving daily observable drug doses, patients received several doses weekly or monthly. The NTCP on the other hand has not achieved desired or expected results. Though there is an appreciable therapeutic success rate (which is about 77%), the cure and detection of tuberculosis in Cameroon are still low. The cure rate is about 65%, 20% short of the NTCP operational objective pegged at 85%. The detection rate (all forms) was last measured at about 50 in 2012 – indication that the 70% mandate of NTCP on it is yet to be reached.

Many public health experts and other local health actors have attributed the shortfall in the cure rate of TB in Cameroon to issues such as HIV prevalence among the population, treatment of drug resistance cases and non compliance of patients to full treatment term or process. Drug resistance cases are usually provoked by non compliance by patients, which on its own is worsening by a lack of communication and interactions between health staff and patients during treatment process.

 “This has been a persistent challenge” says Mr. Wane, a health worker at the Southwest Regional Coordination Unit of NTCP. He stated that couple of months ago, 1,112 cases of pulmonary TB were diagnosed of which 41 began treatment and later stopped.

Not too long ago, experts from WHO and the Ministry of Public Health indicated that there are some 500 cases of multi drug resistance tuberculosis in Cameroon. This observation was made at a meeting in Yaoundé to evaluate short term treatment administered on 200 patients, and also on how to adopt a common approach in tackling TB infection. Drug resistance is more of a risk factor now. Tuberculosis normally takes 6 months or more for a complete cure process, but a patient can possibly feel better long before the full time. Should a patient for instance stop the treatment half way, there is the tendency of relapse – the germ re-activating after mutating to resist the drugs. The negative here is prolonged and expensive treatment which is not even a guarantee for effectiveness; and also high mortality.

Evidently Tuberculosis remains a killer disease in Cameroon – ranked among the top 20 courses of deaths in the country. According to WHO data published in 2011 Tuberculosis deaths in Cameroon reached 3.047 or 1.54% of total deaths. The age adjusted death is 21.89 per 100.000 of population; ranking the country 69 in the world.

 Any hope in combating this disease in Cameroon?

The answer here is in the affirmative. There is always a possibility; with better policy drive and strategic implementation.

Efforts need be intensified to overcome challenges but I also think that efforts here should be directed more to education – counseling or sensitization. Government curative approach has made considerable impact but more effectiveness could be achieved with a little more of education.

A look at the lingering issues in eradicating Tuberculosis hinges mainly on non compliance by patient – which throws up negative trickling effects. During treatment process, health staffs or officials need to be professional enough as to bridge the communication and interaction gaps between them and patients. By so doing they will have the opportunity to counsel patients more on the danger in abandoning treatment even with visible signs of being or feeling well. For this, regular counseling sessions should be greatly encouraged during treatment period. Education or sensitization should take the form of getting the population better informed on the risk factors of tuberculosis. 

“Sensitization on TB must continue. We are not satisfied with the level of sensitization yet”, says Dr. Arrey. She noted that those who are more at risk of contracting tuberculosis are heavy smokers, abusive alcoholics, those living in poorly ventilated homes and also those with HIV/AIDs infection.

Education or sensitization is also imperative in letting the population have basic knowledge of the symptoms of TB. This will help in early detection and effective treatment. It will enable citizens to take possible precautionary measures whenever there is suspicion of TB infection or patient in their immediate environment.

Much as education or sensitization is considered necessary, focus should be in rural areas. They are the least reached in health care inputs in Cameroon, though the bulk of the population lives here. Here also, ignorance reigns and where knowledge is absent, ignorance is king.

                                                                                                               

By: Godycreative

                                                                                                                                     @Godycreative