At the time of Dr. Koch’s announcement in Berlin, Germany, TB was raging through Europe, causing the death of one out of every seven people. This great discovery paved the way towards diagnosing and curing TB.
World Tuberculosis Day can be traced back to 1982, when the International Union Against Tuberculosis and Lung Diseases (IUATLD) commonly called the Union, launched World TB Day for the first time on March 24 that year, to coincide with the 100th anniversary of Dr Koch’s discovery.
In 1996, the World Health Organisation (WHO) joined the union and other concerned organizations to promote World TB Day.
Today, the day is celebrated worldwide with the aim of raising public awareness about TB and the efforts being made to control and finally eliminate the disease.
The Slogan for World TB Day 2014 is: “Reach the Three Million” - A TB Test, Treatment and Cure for All.
The “missed” three million - In its 2013 Global TB Report, WHO highlighted that about three million people are missed every year by health systems worldwide. This means that of the nine million people who get sick with TB a year, a third of them are missed, that is, they are not detected and reported to health authorities.
Therefore, the slogan is putting emphasis on the need for more collective efforts to reach the three million people who are missed, put them on adequate chemotherapy and ensure that all of them are cured or complete their treatments.
In line with the 2014 World TB Day slogan, the National Leprosy/Tuberculosis Control Program (NLTP) under the Ministry of Health and Social Welfare in The Gambia is implementing several intervention strategies to control TB in the country.
These include high quality DOTS expansion and enhancement. DOTS is a broad strategy covering a wide range of components or service delivery areas as follows:
1. Case detection through quality-assured bacteriology – NLTP is pursuing a nationwide DOTS expansion by setting up TB diagnostic and treatment centres (DOTS centres) across the country including some remote or hard-to-reach areas. The number of DOTS centres has increased from a baseline of 11 in 2005 to 36 in 2014. This has significantly increased access to TB service.
In URR for example, the only DOTS centre was in Basse where suspected (presumptive) TB patients were referred to for confirmation. Currently, there are five centres in this region.
2. Supervised treatment with patient support – high-quality anti-TB medications are provided in all the DOTS centres and given to TB patients at no cost to them irrespective of nationality.
In order to make TB treatment accessible even in the remotest community, NLTP has been utilizing the existing primary health care structures in which we have a net work of village health workers who provide TB treatment to patients in their communities.
The Directly Observed Treatment (DOT) provided all over the Gambia is made possible thanks to the village health workers and other family DOT supporters. The high treatment success rate (88%) in the 2012 cohort of TB cases is partly attributed to DOT and patient support in the form of nutritional support to patients.
Therefore, enhancing case detection and treatment has enabled NLTP to reach (find, treat and cure) many people in the Gambia who might have been missed.
To further enhance early diagnosis, NLTP has recently introduced a new molecular technique called Xpert MTB/RIF, which is one of the WHO-approved rapid diagnostics (WRD) for the diagnosis of TB.
This is a much more sensitive tool than smear microscopy and can detect (diagnose) both TB and Rifampicin resistance in a single test within 2 hours. The tool is being used in the Gambia alongside the conventional bacteriology. The plan is to roll out the rapid diagnostic tool to all the hospitals and major health centres by 2017.
Having elaborated on the 2014 World TB Day slogan or theme, and what NLTP is doing in relation to the slogan, it is also important to remind readers that as part of the events marking World TB Day, it is critical to create more awareness about the disease in The Gambia through the media.
What is TB?
Tuberculosis is a bacterial disease caused by a microorganism called mycobacterium tuberculosis. Today, more than a century (132 years to be specific) after Koch’s discovery, the World Health Organisation (WHO) estimates that one-third of the global population is infected with the TB bacilli and about 1.3 million people die from the disease.
There are two forms of TB:
1. Pulmonary TB (i.e. TB in the lungs)
2. Extra-pulmonary TB (EPTB), i.e. TB outside of the lungs. The symptoms of EPTB vary, depending on the organ affected.
Pulmonary TB is the one that can be transmitted from one person to another. Its symptoms include:
•Persistent often productive cough for 2 weeks or more;
• Fever;
• Night sweats;
• Weight loss and
• Coughing up blood.
However, for pulmonary TB, the most important symptom is persistent cough for 2 weeks or more. This is what underpins the definition of a TB suspect (presumptive TB).
Infection and disease:
Usually, people infected with TB harbor the bacteria without developing symptoms. This condition is called “latent TB infection”. In this state, the bacteria are inactive, kept in check by the body’s immune system. The person does not feel sick.
However, the disease may become active in the future which is principally due to weakening of the body’s immune system. Once they develop active TB, these individuals begin to manifest signs and symptoms of TB. People living with HIV (PLHIV) are particularly vulnerable to reactivation of latent TB infection to active TB disease. Similarly, progression of recent infection to active TB is faster among PLHIV. This is because PLHIV have weakened immune system, which opportunistic infections (OIs) such as TB take advantage of. If not detected and treated early, PLHIV usually die from TB. This is one of the reasons why national TB and HIV/AIDS programs plan and implement collaborative TB/HIV activities.
Mode of transmission:
TB is spread from one person to another by airborne transmission. The main source of infection is a person with pulmonary TB smear-positive. When patients with PTB cough or sneeze, they produce aerosol of infectious droplets containing TB bacilli. If people inhale these infectious particles, they become infected too. A smear-positive patient can infect at least 10-15 people per year.
Factors that determine or increase the risk of transmission of TB among people include:
• The concentration of infecting droplets suspended in the air
• The period of time during which the exposed person breathes this contaminated air (the longer the exposure the greater risk of infection transmission)
• Overcrowding, particularly in buildings that are poorly ventilated. This is significant since TB transmission mostly occurs within the household of the patients with pulmonary TB.
Factors that accelerate progression from infection to disease include the following:
• HIV infection
• Malnutrition
• Diabetes
• Cigarettes smoking
Important measures to minimise or prevent TB infection transmission in our community include:
1 Reduction in the number of sources of infection in the community most effectively achieved through early case detection and prompt treatment of infectious cases. Persons coughing for 2 weeks or more are considered ‘presumptive TB cases’ and should go to the nearest TB clinic for diagnosis. Once test results are positive for TB, these patients are promptly put on directly observed treatment (DOT) so that they will be rendered non-infectious within a shorter period. In this way, the chain of infection transmission is broken faster than it would have been if these infectious cases were not detected earlier and immediately treated.
2. Covering of the mouth and nose when coughing and sneezing.
3. Keeping windows open for movement of fresh air in our houses, places of worship, taxis, buses and in places where people are congregated such as in prisons, police and military barracks.
4. Avoiding spitting on the ground, particularly in public places.
5. Adhering to treatment by taking your TB medication regularly until you are cured or complete the treatment.
For further information about TB, please contact the National Leprosy/TB Control Program at the Serrekunda Hospital, Kanifing.
