Tuberculosis in Africa: Where do we go?
Paul
JC Nwosu
Department of Surgery, Faculty of Medicine, College of
Medicine, Madonna University, Elele Campus, Rivers
State, Nigeria.
International Journal of Health Research,
March
2009; 2(1):
1-2 (e210p3-4)
Editorial
Tuberculosis (TB) is today the single leading cause of
death from any single infectious agent and has continued
to be a major public health problem all over the world.
Depending on the prevailing social factors such as
socio-economic status, malnutrition, crowded living
conditions, incidence of HIV/AIDS, level of development
of health infrastructures, quality of available control
programmes and degree of drug resistance to
antituberculous agents, the prevalence, patterns of
presentation and mortality from the disease vary from
one country to another and from one region of a country
to another [1]. Despite the various approaches adopted
to stem the disease, including Directly Observed Short
Course and Stop TB programme, TB continues to be a major
public health problem, particularly in developing
countries [2]. Among the different reasons, the
emergence of drug-resistance has added a major dimension
to the associated HIV/AIDS epidemic which is increasing
the
incidence, prevalence and death rates associated with
the disease.
Resistance to anti-TB drugs occurs primarily due to
poorly managed TB care often due to incorrect drug
prescribing practices by providers, poor quality drugs
or erratic supply of drugs, and patient non-adherence,
among others [3].
Multidrug Resistant TB (MDR-TB) is used to describe strains
of tuberculosis that are resistant to at least the two
main first-line TB drugs (isoniazid and rifampicin).
In September 2006,
the World Health Organization (WHO) expressed concern
over the emergence of virulent drug-resistant strains of
TB following research studies showing the extent of
Extensive Drug Resistant TB (XDR-TB), a newly identified
TB threat which leaves patients (including many people
living with HIV) virtually untreatable with available
anti-TB drugs [3]. XDR-TB is MDR-TB that is also
resistant to three or more of the six classes of
second-line drugs (MDR-TB and XDR-TB are together
defined as M/XDR-TB).
Although the data on drug resistance to TB in Africa are
scare, there are indications that the population
prevalence of drug resistant TB appears to be low
compared to Eastern Europe and Asia. The first
explanation for the low prevalence is the presence of
well-functioning control programmes in Africa. A second
explanation is that rifampicin was only recently
introduced in Africa on a large scale and there appears
to have been relatively little time for resistance to
develop [4]. Analysis of data from 39 countries has
revealed that there is no correlation between high MDR
rates and TB incidence, HIV/TB co-infection rates, or
year of introduction of rifampicin but retreatment
failure rate is the likely most predictive indicator for
MDR [4]. Nevertheless, when the underlying HIV epidemic
is considered, drug-resistant TB in Africa could have a
severe impact on the disease burden in the region. It is
in this respect that Health Ministers from 27 Africa
countries, representatives from international health and
aid agencies, as well as non-governmental organization
met agreed on a series of actions to tackle the epidemic
[3,5]. The action plans include:
a)
Movement towards universal access to M/XDR-TB diagnosis
and treatment by 2015;
b)
Removal
of financial barriers to TB care;
c)
Development of comprehensive M/XDR-TB management and
care frame work;
d)
Deployment of sufficient and trained staff;
e)
Strengthening of laboratory system;
f)
Collaboration with all partners;
g)
Development and implementation of air-borne infection
control policies;
h)
Regulation of the supply of sufficient supply of
high-quality anti-TB medi-cines;
i)
Inclusion of advocacy and communi-cation of social
mobilization in policies and plans; and
j)
Development of new tools to combat M/XDR-TB [5].
While effective control of TB depends on
appropriate use of medications, the potential of herbs
and vitamins to combat TB is being investigated by many
researchers. Echinacea spp. (Echinacea),
Tinospora cordifolia (Tamarisk), Inula helenium
(Elecampane), Berberis vulgaris (TB Barberry) and
Rudbeckia subtomentosa (Sweet coneflower) are
some herbs that may be useful in TB [6]. Patients at
risk for vitamin deficiency (malnourished, alcoholics,
elderly, pregnant and nursing mothers) or for nerve
degeneration (those with diabetes, HIV, or chronic
kidney failure) may need vitamin B6. Recent
studies suggest that a diet deficient in certain
nutrients such as proteins, zinc, vitamins B12,
C and D may be linked to poor response to TB, especially
among the elderly, children, alcoholics, the homeless,
and HIV-infected individuals. There are also
preclinical studies that suggest that TB may be more
severe in persons with diets rich in omega-3 essential
fatty acids compared to those rich in omega-6 essential
fatty acids. Omega-3 fatty acids appear to impair the
animals' immune systems, diminishing the ability to kill
certain organisms including M. tuberculosis [6].
References
1. Erah
PO, Ojieabu WA. Success of the Control of Tuberculosis
in Nigeria: A Review. Int J Health Res 2009; 2(1):3-12
2. World
Health
Organisation (WHO). Group at risk. WHO’s Report on the
Tuberculosis Epidemics. The Organisation, Geneva,
1996;42-55p.
3. World
Health Organisation (WHO). Emergence of XDR-TB. The
Organisation, Geneva, 2009. Available from: http://www.who.int/mediacentre/news/notes/20
06/np23/en/index.html. Accessed 3 Mar 2009.
4. Amor
YB, Nemser B, Singh A, Sankin A, Schluger N.
Underreported Threat of Multidrug-Resistant Tuberculosis
in Africa. Emerg Infect Dis. 2008 September; 14(9):
1345–1352. doi: 10.3201/eid14 09.061524.
5. Muanya
C. Health Ministers Unite against Drug-resistant TB. The
Guardian (Nigeria) April 6, 2009; 26(11058):1,4.
6. Alternative
Medicine, 2004. Available from: http://www.healthandage.com/html/res/com/ConsConditions/Tuberculosiscc.html.
Accessed March 2, 2009.
