No Drugs for Virulent TB Strain

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By Petronella Sibeene

WINDHOEK

Two weeks after the country reported cases of the virulent drug-resistant strains of tuberculosis, Namibia still struggles to procure the much-needed drugs.

The situation has prompted the Central Medical Stores to circulate to three national and two international medical companies requests to supply the much-needed drugs for extreme drug resistant tuberculosis (XDR-TB).

Eight cases of XDR-TB have so far been identified in Namibia but the scarcity of drugs on the international market remains a worry for the Ministry of Health and Social Services.

“Wherever we can get the drugs and at whatever cost, we are willing to take them,” Chief Pharmacist of the Central Medical Stores Gilbert Hadimana told
New Era.

Hadimana said of all the drugs listed on the order form only a few have arrived.

The Indian company from which the medical stores procured other drugs indicated it would only be able to supply the other three medicine types by the end of June, Hadimana said.

“These medicines are hard to get but we are trying,” added Hadimana.

Minister of Health and Social Services Dr Richard Kamwi said, “The funds are there, it’s a question of getting the drugs.”

Five females and three males of the 291 multi-drug resistant (MDR-TB) cases in the country were confirmed to have progressed to XDR-TB. Two cases of XDR-TB were confirmed in Oshakati, two in Walvis Bay, one in Katima Mulilo, one in Okahao, one in Onandjokwe and one in Outapi.

XDR-TB was diagnosed in persons between the ages 29 and 45.

What is TB?
The World Lung Organisation defines TB or tuberculosis, as a disease caused by bacteria called Mycobacterium tuberculosis. The bacteria usually attack the lungs.

How is TB Spread?
TB is spread through the air from one person to another. The bacteria are circulated into the air when a person with TB disease of the lungs or throat coughs or sneezes. Laughing, singing, or playing brass or woodwind instruments can also spread the germs in an enclosed space. People nearby may breathe in these bacteria and become infected.

When a person breathes in TB bacteria, the bacteria can settle in the lungs and begin to grow. From there, they move through the blood to other parts of the body, such as the kidney, spine, and brain.

Symptoms of TB
These depend on where in the body the TB bacteria are growing. TB bacteria usually grow in the lungs. TB in the lungs may cause a bad cough that lasts longer than two weeks, pain in the chest, and coughing up blood or sputum (phlegm from deep inside the lungs).

Other symptoms include weakness or fatigue, loss of weight, loss of appetite, fever and sweating at night.

Statistics In Namibia
Namibia is the second country in the world with high TB cases after Swaziland.

The Ministry of Health and Social Services says there were 15 241 cases last year. In 2006, 15 771 cases of TB were reported. This means about 765 cases per 100 000 people. About 1 000 cases per 100 000 people have been reported in the regions of Erongo, Hardap, Karas and Oshikoto.
Minister Kamwi early this year declared TB in the country a national health emergency.

TB Prevention
The World Health Organization (WHO) estimates that one-third of the world’s population is infected with the bacteria that causes TB. To avoid getting an active TB infection:

– Do not spend long periods of time in stuffy, enclosed rooms with anyone who has active TB until that person has been treated for at least two weeks.

– Use protective measures, such as facemasks, if you work in a facility that cares for people who have untreated TB.

– If you live with someone who has active TB, help and encourage the person to follow treatment instructions. The World Health Organization (WHO) estimates that one-third of the world’s population is infected with the bacteria that causes TB.

What is XDR-TB?
According to the World Health Organisation (WHO) Stop TB Department, MDR-TB (Multi Drug Resistant- TB) describes strains of tuberculosis that are resistant to at least the two main first-line TB drugs – isoniazid and rifampicin.

XDR-TB, or Extensive Drug Resistant TB (also referred to as Extreme Drug Resistance) is MDR-TB that is also resistant to three or more of the six classes of second-line drugs.

The description of XDR-TB was first used earlier in 2006, following a joint survey by WHO and the US Centers for Disease Control and Prevention (CDC).

Resistance to anti-TB drugs in populations is a phenomenon that occurs primarily due to poorly managed TB care. Problems include incorrect drug prescribing practices by providers, poor quality drugs or erratic supply of drugs, and also patient non-adherence.

Scarce drug resistance data available from Africa indicate that while population prevalence of drug resistant TB appears to be low compared to Eastern Europe and Asia, drug resistance in the region is on the rise.

Given the underlying HIV epidemic, drug-resistant TB could have a severe impact on mortality in Africa and requires urgent preventative action.
What action is required to prevent XDR-TB?

XDR-TB poses a grave public health threat, especially in populations with high rates of HIV and where there are few health care resources.

Recommendations outlined in the WHO Guidelines for the Programmatic Management of Drug Resistant Tuberculosis include:

– Strengthening basic TB care to prevent the emergence of drug-resistance;

– Ensuring prompt diagnosis and treatment of drug resistant cases to cure existing cases and prevent further transmission;

– Increasing collaboration between HIV and TB control programmes to provide necessary prevention and care to co-infected patients; and,

– Increasing investment in laboratory infrastructure to enable better detection and management of resistant cases.
(Source: http://www.who.int/mediacentre/news)

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