In-depth: TB and HIV: Deadly allies
UGANDA: Low awareness hinders TB diagnosis and treatment
Photo: Glenna Gordon/PlusNews
Just one-third of TB patients are successfully cured
Kampala, 24 March 2009 (PlusNews) - About half of Uganda's TB patients do not know that they could be infected, which has led to very low levels of diagnosis and treatment.
"The community is not coming forward because they are not aware; only 51 percent of all cases are diagnosed," said Dr Francis Adatu, manager of the National TB and Leprosy Programme in the Ministry of Health.
According to the ministry, about five percent of Ugandan patients who start TB treatment die, and even though the country has almost 800 centres capable of diagnosing the disease, many of them are not manned by health workers qualified to treat the disease.
The 2009 Global TB Control report
by the UN World Health Organization (WHO) notes that only one-third of Uganda's TB cases are successfully treated, despite following the community-based directly observed treatment short course (DOTS) system, in which patients take their medicine in the presence of an observer.
In 2006 an estimated 13 percent of patients who started TB treatment defaulted, jeopardising the success of the regimen. "The treatment success rate remains low because of the high proportion of patients who die, default from treatment, or for whom the treatment outcome is not evaluated," the report stated.
"People treat the common cough with simple syrups and traditional herbs like ginger; when it is a difficult cough, patients go to health centres, private practitioners and traditional herbalists, which can lead to low diagnosis," said Sophia Apio Kerwegi, a senior researcher at Uganda's Natural Chemotherapeutics Research Laboratory. "Sometimes they come when the TB is in its active stage – the best time for diagnosing is during the latent stage."
Dr Jim Reeves Lutangira, another local TB researcher, commented: "Many come for diagnosis [but] after two weeks' treatment they disappear, when symptoms like coughing go away, they abandon drugs and get drug-resistant TB."
In 2007 there were 485 new cases of multidrug-resistant TB in Uganda, according to WHO, but only seven were diagnosed and received treatment.
The government is trying to strengthen its DOTS system, and adherence to the drug regimen has risen to about 67 percent where community ties are strong, but in other areas such as northern Uganda, where people were displaced by a 20-year war and are now returning to their villages, they live far from each other and from health services, so adherence is low and TB continues to spread. In Gulu district, which was badly affected by the war, cases rose from 1,369 in 2007 to 1,936 in 2008, largely because of poor monitoring of drug regimens.
Uganda recently experienced a shortage of TB medication, which the government blamed on delays in the disbursement of money by the Global Fund to fight AIDS, Tuberculosis and Malaria. The health ministry purchased drugs from neighbouring Kenya as a stop-gap measure, but poor supply chain management has regularly caused shortages of essential drugs.
More than 80,000 new cases of TB are diagnosed in Uganda every year, with 60 percent of patients co-infected with HIV. The country is ranked 15th on WHO's list of 22 high-burden countries.