Tuberculosis is silently ravaging urban communities, lets collectively fight it

Abel Nkolo

What you need to know:

  • Let’s join hands. When we work together and become each other’s keeper by spreading awareness, identify those who may have TB in our communities and ensure they start treatment, we will be able to eliminate this disease that has a catastrophic impact on the health, social and economic well-being of Ugandans.

Every year, the world commemorates World TB Day on March 24 and Uganda will join the rest of world in commemoration under the theme: ‘It’s time for Uganda to End TB - It starts with Me’.
This is the time for me to reflect on the progress that we have made in reducing the burden of tuberculosis (TB) as a country and if we are on course to end TB by 2030. In the last few years, the World Health Organisation has reported that TB is now the number one killer infectious disease, surpassing HIV/Aids.
TB is an airborne disease caused by a germ and spread from an infected person to another when they cough, talk, sing or laugh and release small droplets that contain the germ. A susceptible person inhales the infected droplets and may develop TB.

In 2018, only 64 per cent of the expected TB cases were found; and 20 people die from TB every day in Uganda. Out of every 10 TB patients, four are undiagnosed; these are people living within communities, with whom we may interact on a daily basis, who have the potential to spread the disease to 15 more people every year!
In September 2018, a TB screening outreach was held in the New Taxi Park in Kampala where 22 cases out of 366 screened for TB were found. I have repeatedly asked myself what would have happened to the 22 patients had we not held that outreach. Certainly, they would have gone undiagnosed and continued to spread TB to other people in taxis, in their homes, offices and communities.

TB is closer to us than we think; we should open our eyes to the possibility of infection as we go about our daily routines. Fortunately, TB is curable, and treatment is freely available at all TB treatment facilities in Uganda.
So, what will it take to End TB? Well, put simply, we must identify all people with TB and minimise its spread; there is an urgent need for individual and collective responsibility. Communities are critical in the identification and referral of individuals with symptoms and for supporting TB patients to adhere to treatment.

To strengthen community systems, the USAID Defeat TB project, where I work, has made a concerted effort to engage community actors to find and support TB patients. The project aims to increase TB case identification and improve treatment outcomes through health system strengthening to end the TB epidemic in Uganda. USAID Defeat TB works with the National TB and Leprosy Programme, Kampala, Wakiso and Mukono districts, 10 civil society organisations (CSOs) and village health teams in these districts to find TB cases and keep them in care.

This system of community actors has identified more TB cases. In 2018, CSOs in the three districts identified 715 TB cases through contact investigation and 960 TB cases through targeted community screening. If CSOs had not been supported to search for these TB cases, a total of 1,675 TB cases would not have been detected, thus continuing to spread TB in the community.
Using geographical information systems and other analytics, we have learned that whereas TB thrives in slums, fishing communities, prisons and schools, other ‘unusual’ areas, such as taxi parks, can have a high TB burden too.

TB screening outreaches are driven by data on reported TB cases from specific communities. The TB screening outreach in the taxi park was conducted after a district TB and leprosy supervisor identified two passengers with whom she shared a taxi, as TB patients; also, a review of records at one facility showed that six of the TB patients on treatment were taxi drivers.
Community vigilance and awareness are critical in the fight against TB.
My message to all communities in the fight against TB is “Be alert and look out for people who may have TB. TB symptoms include coughing for more than 2 weeks, unexplained weight loss, fever, night sweats, or coughing up sputum with blood.

Support these people to go to a health facility for a TB test. If they have TB, they will be started on treatment and can be cured. Support TB patients to complete treatment, even when they start to feel better.
Health workers should screen all contacts of TB patients and treat those found to have TB. Screen all people living with HIV (PHLIV) for TB and treat all those found to have TB. Protect all PLHIV who do not have TB using isoniazid preventive therapy. Engage community actors to support access to TB services in the community.

I urge policy makers and all local leaders to mobilise communities and allocate resources for community education and TB services.
When we work together and become each other’s keeper by spreading awareness, identify those who may have TB in our communities and ensure they start treatment, we will be able to eliminate this disease that has a catastrophic impact on the health, social and economic well-being of Ugandans. ‘It’s time for Uganda to End TB- It starts with Me’

Dr Nkolo is the Chief of Party of USAID Defeat TB project.