N Coleman: Celebrations of 2009 World TB Day

24 March 2009

Programme director, Councillor G R Kubhayi
The Executive Mayor of Nkomazi Municipality, Councillor Mavuso
The Executive Mayor of Ehlanzeni District Municipality, Councillor C
Mkhonto
Ubukhosi bala ekhaya
The Acting Head of Department of Health, Dr Sibongile Zungu
The CEO of the National Health Laboratory Services, Mr Sagie Pillay
The Executive Manager for Northern Region NHLS, Mr Jones Mofokeng
Management of the department of Health and other departments
Members of the media
Ladies and gentlemen

Today marks a very important day in the world’s calendar of events. It is
important because it offers an opportunity for all of us to once more pause for
a moment, and take stock of our efforts in the fight against the disease that
unfortunately continue to ravage many of our people despite it being both
preventable and curable.

Tuberculosis (TB) is one of the major causes of illness and death in many
countries and is a significant public health challenge worldwide.

South Africa is one of the 22 high burden countries that contribute
approximately 80% of the total global burden of all TB cases. During the past
ten years the incidence of TB has increased, in parallel to the increase in the
estimated prevalence of HIV in the adult population.

This has resulted in the increasing recognition of the problems posed to
public health by TB by many countries. In 2005, the South African Development
Community (SADC) Ministers of Health met in Maputo Mozambique and agreed to
declare TB a crisis in member states, which required urgent intervention. This
intervention requires that more resources, research, human and financial be
invested in the fight against TB.

Our province has not been immune to the TB crisis. In fact until recently,
we have been one of the provinces with a low cure rate. TB is a major health
problem in our province. The number of TB cases (people infected with TB) has
increased from 10 631 in 2004 to 20 021 in 2007. About 70% of patients are in
the age group of 25 to 55 years.

This has adverse effects not only to the health situation of or people, but
also to the economy of our province. Income of families as well as the income
production of the province gets affected when people in this age category dies
due to TB.

The other major challenge is the link between HIV, AIDS and TB. We know that
people who are HIV positive succumbs easier to diseases such as TB. It is
important to know that people with TB can be cured even if they are HIV
positive.

Although we have noted progress in the improvement of TB cure rate from 42%
in 2004 to 56% in 2006 much more work remains. The TB defaulter rate (people
not completing their six months treatment) remains high at 11% as well as the
death rate (people who die as result of TB) at 10%. This situation is an
indication that we have to continue to mobilise all sectors of society to
actively partake in the fight against TB.

We need to aggressively deal all the factors that continue to inhibit many
people to come out and report TB early in health facilities. Many people still
attach stigma to TB patients and this lead to people either reporting late at
health facilities or not reporting at all. Equally important is a need for
paradigm shift or mindset change as society, but more importantly health
workers with regard to diseases that affect our people, because in part
contribute to reluctance and denial by our people.

In its publication called tuberculosis. Our problem, the health system trust
editorial explains some of our distortions with regard to people affected by
TB,

“When I think of tuberculosis, a picture that comes into my mind is of
adults, often elderly men, struggling to take in air, lying in a hospital bed,
perhaps sitting outside in the sun, helpless, undignified, their health and
social, family and community respect and support lost.

Our response as health workers has been to relegate TB patients to separate
clinics, to label them difficult, and to dole out pills in very large numbers,
with little explanation of the disease or the treatment. We seldom have the
inclination nor make the time to ask, listen or to empathise.

We then wonder why patients fail to complete their treatment, and we embark
on research programmes to find out what went wrong! Then the World Health
Organisation (WHO) comes up with the solution DOTS, which could be interpreted
as getting other people, the community, to do the work for us!”

The message in this extract is that we, as health workers need to show more
empathy and relate more with our patients.

Poor adherence to prescribed medication and interruption of TB treatment not
only fails to cure TB but often results in Multi Drug Resistant (MDR) strains
which require long and more complex treatment. MDR-TB is TB that does not
respond to at least two of the first line drugs and the treatment is up to 24
months compared to six months for ordinary TB.

The province currently has three hundred and two (302) TB patients on
treatment of which 99 are in the wards whilst 203 are on community Direct
Observed Treatment (DOT). Recently we have heard of another stroke of TB called
Extreme Drug Resistant (XDR-TB). This is TB that does not respond to first and
second line drugs and the treatment lasts more than 36 months, highly
infectious and is much more expensive to treat.

It is important to note that TB is infectious; hence it is extremely
important for people to present as early as possible to health facilities for
treatment. Once the patient with TB starts on treatment within a very short
period of time they are not infective and they don’t spread TB to other
people.

TB can be transmitted when a person talks, cough, spits or sneezes and the
germ is spread into the air and the others can breathe it in. Symptoms of TB
include amongst others excessive cough over a two week period, loss of weight
and appetite, sweating at night even when is cold, feeling tired and weak, pain
in the chest, shortage of breath and fever.

As mentioned earlier another challenge is for people to complete their six
months treatment. It is very much important and requires family and community
support to people on treatment.

It is once more important to know that TB is preventable and curable. TB
treatment is free at all public health facilities.

Most important prevention methods of TB include the following:

* eating of Healthy foods (vegetable, fruits, milk, amasi, brown bread,
maize meal, locusts, Mopani worms, eggs, meat, fish etc)
* exercise regularly to keep your muscles strong
* alcohol should be avoided because it lowers body resistance
* smoking causes further damage to the lungs and can also cause heart diseases
lung cancer
* encourage friends, family, colleagues and neighbours to keep the windows
open, to allow air to move freely in an out of their houses/workplaces
* always cover your mouth when coughing or sneezing
* immunisation of all babies at the clinic
* visit your nearest clinic once you suspect you have TB
* it is important to complete treatment to be cured

TB can be cured even if you are HIV positive

“Stop TB complete your treatment”

Thank you.

Issued by: Department of Health and Social Development, Mpumalanga
Provincial Government
24 March 2009