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TB fight hauled beyond borders

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BANDAWE—We share notes on TB

By Chancy Namadzunda:

The frantic search for greener pastures, particularly within southern Africa, is driving millions of people out of their home countries.

Malawi is not spared from the immigration rush and the country continues losing its productive people to others within the region, mainly South Africa.

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But because most of them are unqualified for white-collar jobs, they end up working as labourers in informal industries such as mines.

The majority of them hail from border districts and often return home after their stints in the mines with mixed fortunes.

Tuberculosis (TB) is the main disease they contract in the dusty mines whose environments are time and again poorly ventilated and conducive to transmission.

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In Mzimba South, for example, out of 141 TB cases registered between January and June this year, a good number of them were in those who either trek to the Rainbow Nation, Zambia or Tanzania to work in the mines.

This is according to Mzimba South District Hospital TB Focal Person Shadrek Mkupila who further discloses that the imported cases are mostly multidrug-resistant TB (MDR-TB).

“We had six MDR-TB patients. Two of them were discharged while the remaining ones are still on treatment within our facilities,” Mkupila says.

MDR-TB is a form of antimicrobial resistance that is difficult and costly to treat. It is caused by TB bacteria that are resistant to at least one of the first-line existing TB medications, resulting in fewer treatment options and increasing mortality rates.

Extensively drug-resistant tuberculosis (XDR-TB) is characterized when a person develops MDR-TB which is resistant to additional drugs.

The World Health Organisation (WHO) lists two reasons why multidrug resistance continues to emerge and spread, namely mismanagement of TB treatment and person-to-person transmission.

“Most people with TB are cured by a strictly followed, six-month drug regimen that is provided to patients with support and supervision.

“Inappropriate or incorrect use of antimicrobial drugs, or use of ineffective formulations of drugs and premature treatment interruption can cause drug resistance, which can then be transmitted, especially in crowded settings,” the United Nations (UN) healthy agency says.

Nkhotakota also registers a significant number of cases among those who migrate to South Africa, Africa’s most industrialised nation, to work in mines.

“These are people who come back home to access medical services because they cannot do so there since they are undocumented,” Nkhotakota District Hospital TB Officer Samuel Lunda says.

While health personnel and other stakeholders are doing all they can to assist the patients, several of them default.

Medical experts state that defaulting on TB treatment remains a challenge to controlling the bacterial infection that is spread through inhaling tiny droplets from the coughs or sneezes of an infected person.

“TB treatment interruption has resulted in delayed sputum conversion, drug resistance and a high mortality rate and a prolonged treatment course, hence leading to economic and psychosocial affliction,” researchers Qudsiah Suliman and four others say.

Their article published early this year in the Nature journal highlights risk factors for early TB treatment interruption among newly diagnosed patients.

In it, the researchers conclude that as one of the social determinants, TB stigma contributes to a detrimental effect on TB control “via the sentiment of disgrace and blame, hence the internalisation of the community’s sceptical judgments that lead to the abandon treatment.”

While, this might not have been explicitly validated in Malawi, there are instances where some patients return to their respective workplaces before concluding their treatment.

“And because they are often undocumented, we have difficulties in tracking them down,” Mzimba South Director of Health and Social Services Ted Bandawe says.

And to arrest the problem, health officials from Tanzania, Zambia, South Africa and Malawi came up with a system that will be simplifying patient tracing in the four countries.

The multipartite efforts aim at finding ways of tracing defaulters to help in controlling a disease which is the 13th leading cause of death and the second leading infectious killer after Covid-19.

WHO designates MDR-TB as a public health crisis and a health security threat.

The UN agency, however, casts some glimmer of hope on controlling the disease most prevalent in low- and middle-income countries such as Malawi that account for 98 percent of reported cases.

In 2020, an estimated 10 million people worldwide fell ill with TB of who 5.6 million were men like those who work in mines, 3.3 million women and 1.1 million children.

“Globally, TB incidence is falling at about two percent per year and between 2015 and 2020 the cumulative reduction was 11 percent,” WHO says.

Still, the battle to control the disease is far from being over, hence efforts by stakeholders to innovate all manner of solutions.

“We are looking at areas where a patient can be referred to a nearest health facility whenever they go back to their workplaces,” Bandawe says about the multination agreement.

He adds that so far, the system is working between Malawi, Zambia and Tanzania with discussions being at an advanced stage with South Africa.

“We have social media platforms through which we share notes on TB. So, once we find out that a patient has defaulted on treatment and sneaked out of the country, we notify each other through these platforms,” Bandawe says.

Apart from the multination approach, Bandawe says, they also make sure that a patient has enough medicine supplies so that they can continue taking them if they return to their places of work beyond the borders.

The same strategy is being practised between Nkhotakota and Mozambique as the lake strip of the Central Region district shares borders with the former Portuguese colony.

All this is made possible with support from the National Tuberculosis and Leprosy Elimination Programme (NTLEP) under the Ministry of Health on the Malawi side.

With $44 million (approximately K45 billion), NTLEP is working on improving Malawi’s capacity to manage TB and leprosy through a project dubbed Southern African Tuberculosis and Health Systems Support.

Southern African TB and Health Support System Project Environmental and Social Safeguards Specialist Yamikani Muronya recently indicated the work is ramping up the fight against the two infectious conditions.

Muronya said there has been capacity building of health workers through the project to manage TB and conduct research on the disease.

Malawi needs to reduce TB cases by 75 percent and mortality rate by 95 percent by the end of this decade.

In 2015 when the 2030 targets were being set, the country had about 18,000 cases. In 2019, the cases were at 16000 while in 2020 they were at 15,000.

According to Ministry of Health data, treatment success rate has been at 88 percent and death rate at around eight percent.

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