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TB and efforts to control it

Mar 25, 2015, 11:08 AM

World TB Day was marked yesterday worldwide. This day is always observed on 24 March each year to enhance the campaign and sensitization efforts at fighting to combat the disease by 2035, whilst taking stock of the gains achieved so far in combating it.

Tuberculosis is believed to be one of the world’s top health challenges with nine million new TB cases and the death of nearly 1.5 million people each year.

This year it is being celebrated on the theme: “find, treat and cure all people with TB and accelerate progress towards the bold goal of ending TB by 2035”. 

“In The Gambia the burden of TB is significantly reducing as a recent TB prevalence survey indicated that the prevalence of TB is three times (126/100,000) less than the WHO estimated prevalence,” said the Principal Laboratory Scientist (PLS) at the Gambia’s National Public Health Laboratory.

The PLS added that the laboratory “has always played a critical role” in diagnosing tuberculosis (TB) and monitoring its treatment.

Although laboratory strengthening is beginning to gain higher priority on the TB agenda, as reflected in the new Stop TB Strategy, more efforts are needed to improve access to and utilization of existing diagnostics, as well as to expand into the implementation of new technologies.

Some of the hurdles to be overcome to achieve these targets are culture methods and drug sensitivity testing (DST); human resources; and laboratory safety. 

The use of culture methods for TB diagnosis and of DST are standard practices; however, many low-resource countries including The Gambia are challenged in provide culture methods for urgent public health needs such as drug resistance surveillance (DRESS), diagnosis of extrapulminary and childhood TB, and MDR-TB, according to the Gambia’s National Public Health Laboratory report.

Management of microscopy networks and referral laboratories for culture and DST require highly skilled laboratory scientists. For many countries, particularly in sub-Saharan Africa, harbouring  the highest burden  of the disease, the human resource challenges  is limiting provision of laboratory  services at all levels.

And laboratory safety is a continuing concern for laboratory staff at all levels who work with specimens and cultures containing M. tuberculosis, according to the report.

These risks present a challenge to countries including The Gambia in terms of supporting appropriate facility design and engineering, training and adherence to safety practices, and use and maintenance of biological safety cabinets.

There is also another challenge, in the sense that laboratories are not just technologies, equipment and buildings; they are people and systems that manage the processes and standards required to produce accurate and timely results that can have a positive impact on people’s health.

“Successful implementation of new diagnostic tests will still require functional networks of laboratories with trained and motivated  staff, quality management systems and safe working environments,” the PLS stated.

It has, therefore, been recommended that a new focus on expanding and strengthening laboratory systems for quality-assured services in microscopy, culture methods and DST, “will help achieve the targets for global TB control.”

“The biggest public health challenge is rebuilding health systems. In other words, if you look at cholera or maternal mortality or tuberculosis in Haiti, they’re major problems in Haiti, but the biggest problem is rebuilding systems.”

Paul Farmer