Tuberculosis is raging silently in the villages and towns across Uganda but the disease appears to be lacking the attention it deserves from authorities as well as the community and family members.
TB is an airborne disease caused by bacterium called Mycobacterium tuberculosis. It spreads if a person suffering from infectious TB coughs, sneezes or even speaks and shares particles containing particles from a person with active tuberculosis. The infection usually starts from the lungs but can later spread through the blood stream causing TB to affect other parts of the body such as the spinal code.
Statistics about TB in Uganda show that there were 44, 000 new TB cases reported in 2014, but because of very low levels of awareness and poor data gathering methods, the actual figure is estimated at around 60,000 new infections.
The considerably high number of new TB patients in the country, make the disease the second biggest epidemic after HIV/Aids which infected 100,000 last year, according to latest results.
Unlike HIV/Aids which to some like President Yoweri Museveni, is a voluntary disease, meaning that it is mostly acquired with the will of an individual, TB can be acquired involuntarily and easily so through inhaling cough spores of an infected individual.
This renders millions of people in homes, public places such as in taxis and buses, entertainment places, hospitals, schools and restaurants highly vulnerable to catching the disease.
Fortunately perhaps, unlike HIV/AIDS, is the fact that TB is curable and that medication is available and generally free.
Unfortunately still is that the disease remains surrounded with a lot of stigma, superstition and high levels of non-adherence to medication and recurrent drug stock-outs that have conspired to give the TB bug a chance to toughen and be able to withstand the first line of antibiotics used in its treatment.
Judging which of the two diseases is more lethal, can be a hard nut to crack because the two diseases exist in a deadly bond. According to findings, the two diseases tend to go hand in hand.
As Dr. Frank Mugabe, the Program Manager of the National TB and Leprosy Program (NTLP) in the Ministry of Health notes, fifty percent of HIV/Aids patients in Uganda also suffer from TB. In fact, researchers have found that Tuberculosis is the leading cause of death among people infected with HIV in Sub-Saharan Africa.
The United Nations Aids body (UNAIDS) puts the number of deaths due to HIV in Uganda at between 26,000 – 54,000 annually, compared to 4000 deaths that are characterized as TB deaths in Uganda. This is despite the fact that TB is cited as the leading cause of death for HIV positive patients. When an individual who is co-infected by HIV- TB dies, death is characterized as resulting from HIV.
Dr. Mugabe points out that although an estimated 50 percent of Ugandans carry the TB bacteria, for most people, it remains inactive until when his/her immune system weakens, which sets the stage for inactive TB to become active. Active TB causes infection of lungs (Pulmonary Tuberculosis and other parts of the body called as extra pulmonary tuberculosis).
Although the international donor community through the Global Fund for HIV/Aids, TB and Malaria, provides funding to combat the three killer diseases in countries such as Uganda, rampant drug stock-outs have left many TB patients in pain and exposed to the more dangerous and painful risk of having drug-resistant TB.
Take the example of 16 year-old Harriet Kobusingye. She was diagnosed with TB in 2013 while in her senior one. She narrates that she started treatment against the disease that lasted 8 months.
“After the 8 months,” Kobusingye recalls, “The disease intensified and I was put on another dose of 18 months. Still there was no change. This made me to leave school in May up to December in 2015.” What Kobusingye didn’t say is whether she relapsed in her initial treatment which could have caused her TB to toughen.
Speaking to this reporter from her hospital bed at Mulago, Kobusingye says she feels a lot of pain in her left lung and felt as if it was decaying.
Kobusingye is just but one of many Ugandans who have seen their TB situation worsen because of drug stock-outs, stigmatization, low levels of awareness about the disease and lack of sufficient testing kits.
For example, the latest audit report by Global Fund found that 70 percent of the 50 health facilities it visited witnessed stock-outs of at least one critical medicine, with HIV drugs being the most affected of the three diseases. At the same time, the audit found that 54% of the health facilities visited had accumulated expired medicines, partly funded by Global Fund.
The report warned that: “If unaddressed, pervasive stock-outs of key medicines at all levels will result in treatment disruption for patients pervasive stock-outs of medicines risks.”
This revelation renders suspicious the claim made by the Director General of Health Services Dr. Jane Ruth Aceng that treatment of TB is hampered by lack of funds. This is especially after the Global Fund Audit found that only 46% of funds it disbursed to the Ministry of Finance between January 2013 and June 2015 had been spent by the end of 2015.
Poor management of the resources for managing the disease from both tax payer coffers as well as from donor agencies such as the Global Fund is therefore responsible for the endemic nature of Tuberculosis in Uganda.
The consequences of neglect of TB in Uganda has made the country to be categorized as one of the 22 countries in the world with the highest number of TB cases.
The high proportion of undetected TB patients in the country is further attributed to the poor health-seeking behaviour, inadequate diagnosis such as non-functional x-ray machines, limited capacity of health workers and lack of a patient-tracking mechanism.
Experts concur that the fact that TB has a cure means that it is less dangerous than HIV. However the carefree attitude of authorities as well as the general population towards healthcare, has made it a deadly disease, which is contributing to worsening the impact of other diseases such as HIV.