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Tuberculosis (TB) is a curable and preventable disease yet in 2013, 4,100 Ugandans died from TB infection and 7,200 from TB- HIV co infection. With 60 000 new cases expected to occur annually, there have been on-going efforts both at the national and international level to reduce the incidence and mortality rates of TB infection.
What is TB and why is incidence so high in Uganda?
Tuberculosis is an infection caused by the bacteria Mycobacterium Tuberculosis (M.Tuberculosis). M. Tuberculosis can infect any organ but most commonly infects the lungs. An individual harbouring the bacterium (the host) is highly infectious when M. Tuberculosis is present in the lungs (pulmonary TB) and can spread through the release of air droplets after an infected individual coughs, sneezes or even talks. A person can be infected with TB without symptoms if they possess a competent immune system which is able to effectively destroy the bacteria. However, in immunocompromised people, such as those infected with the Human Immunodeficiency Virus (HIV), M.Tuberculosis readily becomes active and will proliferate and spread throughout the body to cause organ failure by a combination of both host and bacterial destructive pathways.
In 2013 Uganda’s TB incidence was 62 000 as documented in Annex 2 of the World Health Organisation (WHO) Global Tuberculosis Report 2014. The high incidence can be attributed to a multitude of factors including the rise in multidrug resistant Tuberculosis (MDR TB), lack of funding of national TB health programmes, limited health care resources, and unawareness amongst Ugandan communities of TB and its health risks. Moreover, TB infection is greatest in communities living in severe poverty, for instance in congested slums where sanitation is poor. These conditions only heighten the risk of TB spread and infection.
HIV co infection
Those who are HIV positive are at least 20 times more likely to acquire active TB infection compared to those who are HIV negative. This is due to gradual HIV destruction of immune system components, namely T helper, otherwise termed CD4+ cells. An animation of how HIV destroys CD4+ cells is located here. CD4+ cells are vital for the adaptive immune response to infection and their destruction results in a ‘compromised’ immune system. Inability of the immune system to effectively battle against Tuberculosis results, leading to organ failure in the effected individual and death without treatment.
Uganda’s success against TB
In recognition of Uganda’s TB endemic, the initiative ‘Slum Partnerships to Actively Respond to Tuberculosis in Kampala (SPARK TB)’ commenced in October 2011. The programme approached 100 private clinics located within Kampala’s poor urban areas, offering health care training and equipment, and partnership with public health services that enabled access to free TB medication. One clinic approached by the programme would be that of Dr Kasauli Mahmoud Zinda’s, located in Bwaise. Prior to involvement in the programme, Dr Zinda was unable to test for TB though he knew the symptoms and signs of infection when patients arrived at his clinic. At the time, he could only refer patients to government funded public facilities for further testing and care. Within the first year of partnership, Dr Zinda was able to diagnose 21 patients, with this number rising to 45 in 2013. In addition to success in diagnosis and treatment of TB, SPARK TB has been able to raise awareness of how TB is transmitted and its symptoms in local communities. The results from an initial survey in 2011 and follow up survey conducted at the end of the programme in 2014 show knowledge of how TB is caused rose from 0% to 63%, and awareness of symptoms has risen from 37% to 80%.
In recognition of the programme’s success, Uganda’s Ministry of Health decided to take over and expand the SPARK TB programme when it ended in June 2014, once receipt of a grant from the Global Fund to Fight Aids, TB and Malaria has been finalised. It is hoped that similar programmes in 10 additional urban centres will commence at the end 0f 2015.
Final Comments-What still needs to be done?
It is clear that TB is receiving recognition by the Ugandan government hence the action of the Ministry of Health to continue the work of the SPARK TB programme and further develop its own National Tuberculosis and Leprosy Programme (NTLP). Raising awareness of HIV co infection amongst Ugandan communities should still remain an essential component of existing and new programmes which target both TB and HIV. This, alongside continual access to trained health care professionals, sterile medical equipment, and appropriate medicine regimes for both TB and HIV, is key to relieving Uganda of its infectious disease endemic.
Additional note- Patongo Orphan Infants Health Rehabilitation Centre (PAORINHER), Pader District, Uganda
HART began working with partners in Uganda in 2005 during a period of civil unrest known as the ‘Lord Resistance Army Insurgency’. As a result, up to 90% of Northern Uganda’s population lived in camps severely affected by poverty. HART was able to obtain a generous funder that enabled the development of the Patongo Orphan Infants Health Rehabilitation Centre (PAORINHER) in Uganda’s Pader district, which provided residential care to orphaned and vulnerable children. Since the ceasing of this period of civil unrest in 2010, PAORINHER has developed into a HIV paediatric specialist care centre. For more information on PAORINHER and for information and advice on how you can help support the continuation of PAORINHER, please contact the Humanitarian Aid Relief Trust. Thank You!
If you found this blog interesting, you may want to read Talia’s previous blog: ‘Male circumcision confers added protection against HIV infection‘.
Disclaimer: This blog is a space for discussion and personal reflection. Any opinions expressed within the blog are those of the author and are not necessarily held by HART. Individual authors are responsible for the accuracy of statements made within the blog.