Will Killer TB Dash Future Hopes?

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By Wonder Guchu WINDHOEK The Extensive Drug Resistant TB (XDR-TB) strain that has killed about 99 percent of its victims in the past few months in South Africa, could put efforts of curbing HIV and Aids in Namibia and the whole of southern Africa into disarray. This development is also likely to scupper the World Health Organization’s wish for attaining a TB-free environment in the near future. The XDR-TB strain, discovered by Dr Tony Moll in Eastern KwaZulu Natal early this year, has killed 52 of the 53 patients placed under medical surveillance in 28 hospitals within 25 days. Whilst there are fears that the TB strain could have gone beyond South Africa’s borders because of unrestricted human movement, the Namibian Health Permanent Secretary, Dr Kalumbi Shangula, this week downplayed the issue saying there was no outbreak. “Outbreak is a wrong term. What they have in South Africa is an unusually high number of people suffering from the TB strain,” he said, adding that the country was using the same drugs as in any other country. The latest figures released by the WHO on Namibia’s HIV and Aids prevalence for 2005 also raise concern that in the event of the XDR-TB breaking out in the country, the ministry may be overwhelmed. The report released in July this year shows that out of Namibia’s estimated 2ÃÆ’Æ‘ÀÃ…ÃÆ”šÃ‚ 044ÃÆ’Æ‘ÀÃ…ÃÆ”šÃ‚ 147 people, about 230ÃÆ’Æ‘ÀÃ…ÃÆ”šÃ‚ 000 were living with HIV by last year. Of this number, an estimated 130ÃÆ’Æ‘ÀÃ…ÃÆ”šÃ‚ 000 were women aged between 15 and 49 while 170ÃÆ’Æ‘ÀÃ…ÃÆ”šÃ‚ 000 were children aged from infants up to 15-year-olds, and that 17ÃÆ’Æ‘ÀÃ…ÃÆ”šÃ‚ 000 people were estimated to have died of HIV and Aids by the end of last year. The country’s TB mortality rate is believed to be 85 per every 100ÃÆ’Æ‘ÀÃ…ÃÆ”šÃ‚ 000 people, with the prevalence rate estimated at 586 per every 100ÃÆ’Æ‘ÀÃ…ÃÆ”šÃ‚ 000 people and, of the estimated 717 per 100ÃÆ’Æ‘ÀÃ…ÃÆ”šÃ‚ 000 new TB cases, 1.3 percent of them are in the multi-drug resistant strain category. Multi-drug resistance is when a TB patient becomes resistant to at least two main first-line drugs – isonianid and rifampicin – while Extensive or Extreme Drug Resistance is when a patient becomes resistant to more than three of the second-line drugs. Drug resistance happens when patients fail to finish their medication course, orr when an inferior type of drug is used. This situation can also result from erratic drug supply and patients’ non-adherence to medication. Extreme cases of multi-drug resistance develop into XDR-TB which were first diagnosed in the former Soviet Union states and Asia, with four percent of MDR-TB in the United States of America developing into XDR-TB. The May outbreak of polio in the country should act as a barometer on whether the Health Ministry is prepared for an eventual outbreak of XDR-TB. According to the figures released by the Ministry of Health and Social Services this week, the polio outbreak discovered in May claimed 32 lives and left more than 200 paralyzed. A single case had within a two-week period spawned 34 other infections and claimed seven lives. Yet polio that is widely spread through person-to-person contact or by eating contaminated food and drinking dirty water, is far easier to contain than TB which is contactable through sneezing and coughing. In fact, according to WHO statistics, TB is currently spreading at the rate of one person per second and, given the overcrowdedness and the poor hygienic conditions at public places, containing an outbreak of XDR-TB will not be easy. It is even more difficult considering that diagnosing TB in most parts of Africa is not easy largely because people have to be admitted to hospital before being tested, in which case TB would have spread to many others within their communities. The situation in Namibia would be a bit complicated because of open-food markets where a single infection could lead to several others. According to WHO, XDR-TB can be prevented by strengthening basic TB cure in order to prevent drug-resistance and ensure prompt diagnosis and treatment of any resistant cases. There is also need to invest in laboratory infrastructure to enable better detection and management of resistant cases. Now if South Africa, with its advanced medical technology and availability of drugs, is finding it difficult to cope with XDR-TB, could Namibia – given that the doctors who first came across polio failed to identify it – cope? (Wonder Guchu is a visiting journalist from Zimbabwe on attachment with Nampa)

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