• TB kills 4,400, infects 30,000 people daily, says WHO

By JOHN NWOKOCHA, Abuja

The World Health Organisation (WHO) has warned that plans to end the deadly tuberculosis by 2030 are being threated, insisting the disease remains one of the world’s deadliest infectious killers.

Nigeria is among the 14 high burden countries for TB, TB/HIV and Multi Drug Resistant TB and the country is ranked sixth among the 30 high TB burden countries globally and 1st in Africa.

WHO made this remark on the occasion of World TB Day (WTD), today.

WTD is observed yearly on March 24 to raise awareness about TB and efforts to end the global epidemic, marking the day in 1882 when the bacterium causing TB was discovered.

But, WHO Director-General, Dr. Tedros Adhanom Ghebreyesus, said: “TB is preventable, treatable and curable, and yet this ancient scourge that has afflicted humanity for millennia continues to cause suffering and death for millions every year.

“WHO is committed to supporting countries to step up their response, by expanding access to services to prevent, detect and treat TB as part of their journey towards universal health coverage, and to strengthen their defences against epidemics and pandemics?”

In a statement the WHO, said: “Each day, close to 4400 people lose their lives to TB and close to 30,000 people fall ill with this preventable and curable disease. Global efforts to combat TB have saved an estimated 74 million lives since the year 2000. However, the COVID-19 pandemic, coupled with conflicts across Europe, Africa and the Middle East and socioeconomic inequities, have reversed years of progress made in the fight to end TB, and placed an even heavier burden on those affected, especially the most vulnerable. In its latest Global Tuberculosis Report, WHO highlighted that for the first time in over a decade, estimated TB incidence and deaths have increased.”

Speaking during a road show to mark WTD in Abuja, Director in the Federal Ministry of Health’s Tuberculosis and Leprosy Control Programme, Ahmad Muhammad Ozi, said Nigeria has a lot of missing cases of TB, and records about 400, 000 cases of TB yearly.

The WTB 2023 theme is: ‘Yes! We can end TB!’. It aims to inspire hope and encourage high-level leadership, increased investments, faster uptake of new WHO recommendations, adoption of innovations, accelerated action, and multi-sectoral collaboration to combat the TB epidemic.

This year is critical, with opportunities to raise visibility and political commitment at the 2023 UN High Level Meeting on TB.

The spotlight of World TB Day will be on urging countries to ramp up progress in the lead-up to the 2023 UN High-Level Meeting on TB. WHO will also issue a call to action with partners, urging Member States to accelerate the rollout of the new WHO-recommended shorter all-oral treatment regimens for drug-resistant TB.

Ozi continues: “We are thinking of totally eradicating Tuberculosis by the year 2030, but as it is, we still have a long way to go in Nigeria because from what we had last year, we were able to notify over 280, 000 new cases out of about 400, 000 cases. We have covered up to 40 percent of the notification rate, so we still have a long way to go. We will try; as much as we can to get the Tuberculosis response programme to the nearest minimum. From the policies of the Federal Government, we are working to ensure that Tuberculosis is prevented from communities in the country. TB is a curable disease, and we have earmarked some of the policies that can influence TB control in Nigeria. For instance, the diagnosis of Tb in every community in Nigeria is free. The policy also states that the treatment of the disease is also free.”

Speaking also at the occasion, Deputy Project Director of Tuberculosis – Breakthrough Action Nigeria, Bolatito Aiyenigba noted that there is a drive to end tuberculosis globally and urged Nigerians to get tested because it’s free.

Ayenigba said: “We believe we can end the disease because there is a concerted effort globally to put resources into science in a bid to get rid of the disease. With support from partners, the Federal Government has made a great effort to get the new tools and appropriate diagnostic materials and let the people know that these things are there.

“For a long time in Nigeria, testing for TB has been free, but people don’t know, so they are suffering in silence. To address that, the national programme has created a national campaign tagged ‘Check amoo, because who no go, no go know’. The good thing with tuberculosis is that the treatment is available and free, it can be totally cured.”

WHO Regional Director for Africa, Dr. Matshidiso Moeti, who made the call in her massage to mark the 2023 World TB, yesterday lamented the devastating health, social and economic consequences of this preventable disease and called for accelerated action to end it.

According to the WHO, TB occurs in every part of the world. In 2021, the largest number of new TB cases occurred in the WHO South-East Asian Region, with 46 per cent of new cases, followed by the WHO African Region, with 23 per cent of new cases and the WHO Western Pacific with 18 per cent.

It noted: “A total of 1.6 million people died from TB in 2021 (including 187 000 people with Human Immuno-deficiency Virus/HIV). Worldwide, TB is the 13th leading cause of death and the second leading infectious killer after COVID-19 (above HIV/Acquired Immune Deficiency Syndrome/AIDS).

“In 2021, an estimated 10.6 million people fell ill with tuberculosis worldwide (six million men, 3.4 million women and 1.2 million children). TB is present in all countries and age groups. But TB is curable and preventable.

“In 2021, 1.2 million children fell ill with TB globally. Child and adolescent TB are often overlooked by health providers and can be difficult to diagnose and treat.”

It said in 2020, 87 per cent of new TB cases occurred in the 30 high TB burden countries. “Eight countries accounted for more than two thirds of the global total: India, Indonesia, China, the Philippines, Pakistan, Nigeria, Bangladesh and the Democratic Republic of the Congo,” the WHO said.

Also, the WHO, yesterday, announced the expanded scope of the WHO Director-General’s (DG) Flagship Initiative on tuberculosis over the period from 2023 to 2027 to support fast-tracking progress towards ending TB and achieving Universal Health Coverage (UHC) by 2030.

As part of the DG Flagship initiative, a special call to action is being issued by WHO and partners urging Member States to accelerate the rollout of new WHO-recommended shorter all-oral treatment regimens for drug-resistant TB.

Drug-resistant TB continues to be a pressing public health concern, taking a significant toll on individuals affected by TB, communities, and healthcare systems worldwide. In 2021, nearly half a million people fell ill with multidrug- or rifampicin-resistant TB (MDR/RR-TB), only one in three accessed treatment.

New WHO guidelines on drug-resistant TB treatment recommend rapid roll-out of the novel BPaLM/BPaL regimen that has the potential to significantly increase cure rates due to its high effectiveness, offer more extensive access because of its lower cost, and improve patients’ quality of life, as it is an all-oral treatment that is considerably shorter than traditional regimens.

Director of WHO’s Global Tuberculosis Programme, Dr. Tereza Kasaeva, said: “2023 is our chance to push forward the agenda towards ending TB. On World TB Day, WHO is pressing for firm political commitment at the highest level, strong multisectoral collaboration including beyond health, and an effective accountability system. We need everyone—individuals, communities, societies, donors and governments—to do their part to end TB. Together, yes, we can end TB.”

In September 2023, the UN General Assembly will convene three High-Level Meetings focusing on UHC, pandemic preparedness and response and ending TB. There are clear linkages between these agendas and the Heads of State will deliberate to accelerate action, including on the goal to end TB.

Tuberculosis (TB) is caused by bacteria (Mycobacterium tuberculosis) that most often affect the lungs. Tuberculosis is curable and preventable.

TB is spread from person to person through the air. When people with lung TB cough, sneeze or spit, they propel the TB germs into the air. A person needs to inhale only a few of these germs to become infected.

About a quarter of the global population is estimated to have been infected with TB bacteria, but most people will not go on to develop TB disease and some will clear the infection. Those who are infected but not (yet) ill with the disease cannot transmit it.

People infected with TB bacteria have a five–10 per cent lifetime risk of falling ill with TB. Those with compromised immune systems, such as people living with HIV, malnutrition or diabetes, or people who use tobacco, have a higher risk of falling ill.

When a person develops active TB disease, the symptoms (such as cough, fever, night sweats, or weight loss) may be mild for many months. This can lead to delays in seeking care, and results in transmission of the bacteria to others. People with active TB can infect five–15 other people through close contact over the course of a year. Without proper treatment, 45 per cent of HIV-negative people with TB on average and nearly all HIV-positive people with TB will die.

Tuberculosis mostly affects adults in their most productive years. However, all age groups are at risk. Over 80 per cent of cases and deaths are in low- and middle-income countries.

People who are infected with HIV are 16 times more likely to develop active TB (see TB and HIV section below). The risk of active TB is also greater in persons suffering from other conditions that impair the immune system. People with undernutrition are 3 times more at risk. Globally in 2021, there were 2.2 million new TB cases that were attributable to undernutrition.

Alcohol use disorder and tobacco smoking increase the risk of TB. In 2021, 0.74 million new TB cases worldwide were attributable to alcohol use disorder and 0.69 million were attributable to smoking.

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