By Anna Ingwafa
There are 254 cases of multi-drug resistant TB under treatment throughout Namibia, a matter of great concern and an indication that it is only a matter of time before extremely drug resistant cases – known as XDR tuberculosis – become widespread.
The alarming upswing in this strain of drug-resistant TB was announced by Councillor Petrus Shigwedha who spoke on behalf of the Minister of Health and Social Services Dr Richard Kamwi at the event to mark World TB Day that was held at Uukwiyuushona in Oshana Region on Friday.
He stated that experts in the Ministry of Health are in the process of reviewing all cases of drug resistance to verify the situation. There is fear however that given the large number of cases, incurable XDR TB may be detected amongst the group.
According to the 2008 Global TB Control Report compiled by the World Health Organization, Namibia is ranked second in the world in terms of TB incidence while Swaziland is first. Last year, a total of 15, 244 cases of TB were reported nationwide.
The figure translates into a tuberculosis case notification rate of 722 cases per 100 000 population. Of this total number of reported cases, 5 114 had infectious form of TB which can be transmitted from one person to another.
In 2006, the cases were 765 cases per 100 000 population.
“While we acknowledge the slight decrease in overall case rates, we cannot neglect the reality that when compared with the global community Namibia still registers the second highest TB rate,” said the Minister of Health in the statement issued by his office.
Hardap, Erongo, Karas, Oshikoto, Caprivi and Khomas are the regions with the highest burden of tuberculosis per 100 000 population, according to Kamwi.
Hardap region with the highest incidence of TB in Namibia last year reported 1 294 cases per 100 000 population.
He said the current TB situation is exacerbated by the challenge of the HIV/Aids epidemic in the country.
“HIV infection is the major known individual risk factor for the development of TB disease. Last year, 8 186 TB patients representing 54 percent of the total notified patients, were tested for HIV and 59 percent were HIV-positive.”
Kamwi noted that the impact of the dual infection of TB with HIV/Aids is a major cause of concern as it affects the Namibian workforce.
“We are experiencing a decline in work productivity. This then results in a decrease in household incomes, which jeopardizes health, nutrition, sanitation, safety, education and care in our nation.
“The effect of the disease on the workforce can essentially stunt the necessary socio-economic growth on our path to Vision 2030. We therefore need to remain proactive, focused, tireless and united in our responses against these two disease epidemics.”
Kamwi said that the ministry has put in place measures to address the tuberculosis epidemic through a national TB Control Programme, which has been established to implement countrywide activities.
TB treatment is provided free of charge in all public health facilities fully supported by the Government, according to the Heath Minister. He said 75 percent of TB cases are treated successfully; 10 percent short of the WHO recommended target.
He added that the national TB response has been expanded to include all stakeholders.
Considerable mutual parties’ support in the fight against TB in Namibia has been forthcoming during the past three years, especially from the US Government, the Global Fund, WHO and Unicef.
Kamwi called on all stakeholders to refocus their attention on the dual epidemic of TB and HIV/Aids. “My emphasis in the fight against TB is that of a multi-sectoral approach. It calls for resolute commitment at all levels – public, private, non-governmental organisations, churches, civil society, community, grassroots and with our development partners.”
He urged the healthcare workers to stay alert, do diagnoses promptly, give appropriate treatment and ensure that patients with HIV infection are counselled and tested for TB.
They should also educate all patients, family members and the community on all aspects of TB and empower them by teaching the signs and symptoms of TB.
Kamwi called upon community members and family relatives to encourage individuals with persistent coughs for more than three weeks to be tested for TB.
He made a call on TB patients and those who lead by example and through communication, to educate others on adherence and completion of TB treatment.
“We know for certain that TB is curable, even in the presence of HIV infection or HIV/Aids. Therefore, we encourage TB patients to know their HIV status and vice versa for those who are HIV-positive.”
He thanked all the development partners in the fight against TB such as the United States Agency for International Development (USAID) which increased support to the national TB programme from US$1.2 million to US$2 million last year, the Global Fund for the sum of US$19 million which it has given in support of the TB programme for the next five years, World Health Organisation and the U.S Center for Disease Control and Prevention for the continued valuable technical support.
Kamwi acknowledged the shortage of health care workers as “this high disease burden has caused our nursing, clinical support staff to be over-worked”, and that there is a need for more skilled health care workers.
He appealed for assistance as the ministry scales up its endeavours in procurement of medicines, in strengthening the hospital infrastructure in terms of medical doctors with expert technical knowledge on TB, enhancing control in TB wards and strengthening grassroots intervention through community counsellors.
A total of 120 volunteer community counsellors from all over Oshana Region received their certificates after they underwent training sponsored by the Global Fund.