CISMAT members prepare for an outreach
By Kemo Cham
Anti-Tuberculosis campaigners in Sierra Leone have called for investment to boost the fight against the infectious disease.
The Freetown-based Civil Society Movement Against Tuberculosis (CISMAT-SL) say a rising trend of Multi Drug Resistance (MDR) TB in the country demands an urgent need for funding for research and development. It said inadequate data has hindered the work of the national TB programme, thereby hindering decision making in terms of budgeting and, consequently, access to services.
According to the campaigners, the Sierra Leone government and partners currently rely mostly on assumptions to make decisions, which they say is unhelpful in the effort to eliminate TB.
“For far too long the national TB programme has been challenged with data. For instance, we have not been able to capture the number of the key affected people in vulnerable populations like prisoners, miners and slum dwellers,” Abdullai Sesay, Executive Director of CISMAT, said. Sesay said what little data is available is not disaggregated.
“You must do research to get data, to enable you assess the progress you are making and to know the vulnerable population and prevent them from getting infected,” Sesay added.
CISMAT is a network of health civil society organisations and groups representing the interest of TB Patients. It works closely with the government through the National Leprosy and Tuberculosis Control Programme (NLTCP) in the Ministry of Health and Sanitation (MoHS).
Sierra Leone is ranked among the 30 highest burden TB countries in the world. It is also one of the 10 countries with the highest TB incidence rate, that is, estimated number of new TB cases per capita, according to the World Health Organisation (WHO).
The Ministry of Health says the country records 10, 000 estimated new cases every year. Figures released by the NLTCP last week show that out of 46, 878 persons screened in 2017, 16,142 were diagnosed with the disease.
TB is regarded as the world’s leading cause of death from a single infectious agent. The disease, which usually infects the lungs, is preventable and curable, but early diagnosis is crucial for this to happen.
According to WHO, globally about 40% of the estimated cases is missing and undetected. Identifying these cases is therefore strongly recommended to be at the center of response for every country.
In Sierra Leone stigma and discrimination are said to be two driving forces behind the disease as many patients shy away from treatment centers, and in the process exposing loved ones to the bacteria and themselves to MDR – TB.
MDR – TB is a situation wherein the bacteria is resistant to at least two of the main TB treatment drugs: isoniazid and rifampin, which are the two most potent TB drugs available.
The prevalence rate for MDR-TB in Sierra Leone is 304/100, 000 population, according to the national TB programme office, whose figures show that out of 3, 068 people tested for MDR-TB last year, 700 were positive for microbacterium tuberculosis, that is, presumptive MDR cases.
Of the 700 cases, 234 were found to have Refampeesin Resistance TB, which means they can’t be cured with the first line TB drug treatment. And in this state patients are highly at risk of MDR-TB.
By the end of the year, 90 out of the 234 MDR-TB cases had gone missing, and officials say that could be attributed to either defaulting, death or double recording.
WHO targets the elimination of TB by 2030 and the world health agency, as part of last week’s commemoration, urged governments to scale up access to testing and treatment for TB infection, especially among high risk groups such as children and people living with HIV and those with latent TB infection.
In Sierra Leone about 2, 073 children are said to be infected with TB, while HIV/TB co-infection cases stand at 1, 970, translating to 12% of the total cases.
In spite of the situation, however, campaigners and health authorities say some progress have been registered, especially within the last few years, notably the establishment of the first ever Drug Resistant TB Management Centre, provision of TB/DR-TB diagnosis in ten health facilities across the country, as well as the maintenance of a high TB treatment success rate over the last six years.
The NLTCP figures show that 89% of cases detected last year were successfully treated.
“We have seen great progress in our capacity to manage TB cases with treatment and testing available free of cost,” Dr. Linda Foray, Programme Manager, NLTCP, told journalists at a press conference as part of the commemoration of the World TB Day.
She however warned that in spite of the progress, the disease remained a major public health concern and requiring collective effort to reverse the trend.
“There are still many TB patients who are not diagnosed. This contributes to continuous transmission of the disease and increases the risk of complications for those affected,” she said.
World TB Day, commemorated on March 24 every year, provides a platform to raise awareness on prevention, care and control of the bacterial disease. This year’s edition was observed on the theme: “Wanted: Leaders for a TB-free world. You can make history – end TB”.
As part of the commemoration, CISMAT in partnership with the Health Ministry, has developed a documentary teaser featuring the voices of TB patients and strategic stakeholders like the National TB Programme Manager, WHO country representative and the country’s Chief Medical Officer, which is planned for airing on TV and radio nationwide.
CISMAT is also accelerating its ‘Promoting the People Centered Approach (PCA)’ strategy, which emphasises using people who are living with or affected by TB at the center of the national response efforts to accelerate service delivery. Through this, the civil society has established TB Support Groups across 14 of the 16 districts of the country.
These group members are presented as ‘TB Ambassadors’ in their respective communities, where they complement the work of the TB DOTs [Direct Observed Treatment] providers and Community Health Workers. Through outreach and door to door campaigns, these men and women identify and refer cases to the health facilities. They also help in terms of contact tracing and follow-up visits to TB patient’s homes.