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HEALTH-ZIMBABWE: Doctors Fear High Risk of Drug-Resistant TB

Stanley Kwenda

HARARE, Mar 2 2009 (IPS) - Zimbabwe’s crumbling health system makes it almost impossible to detect and treat tuberculosis (TB), doctors say. As a result, they suspect the country has large numbers of unidentified cases of multi-drug resistant (MDR) as well as extensively drug resistant (XDR) TB.

International humanitarian relief organisation, Médicins Sans Frontières (MSF), said Zimbabwe has the public health system of a country at war.

HIV and TB

Someone in the world is newly infected with tuberculosis (TB) bacilli every second; overall, one-third of the world's population is currently infected with the TB bacillus.

TB is spread through the air when infectious people cough, sneeze, talk or spit, they propel TB germs, known as bacilli, into the air. A person needs only to inhale a small number of these to be infected.

Left untreated, each person with active TB disease will infect on average between 10 and 15 people every year. But people infected with TB bacilli will not necessarily become sick with the disease. The immune system "walls off" the TB bacilli which, protected by a thick waxy coat, can lie dormant for years.

HIV and TB form a lethal combination, each speeding the other's progress. HIV weakens the immune system; someone who is HIV-positive and infected with TB bacilli is many times more likely to become sick with TB.

TB is a leading cause of death among people who are HIV-positive. In Africa, HIV is the single most important factor contributing to the increase in incidence of TB since 1990.

Information adapted from WHO

“It’s like being asked to have a fist fight in the dark because you don’t know what you are treating,” said Dr Clemence Duri, head of the Harare city council’s two infectious disease hospitals, Beatrice and Wilkins. He says the number of MDR and XDR cases in Zimbabwe is unknown because proper patient health records and statistics are not being kept.

“The truth is that we don’t know the extent of the MDR TB, but it is likely that it is high, and it is also likely that we have many cases of XDR TB,” Duri told IPS. “Most of the TB patients we see at the hospital have been infected at least twice.”

A shortage of financial resources and health workers further exacerbates the situation. Zimbabwe Doctors for Human Rights (ZDHR) estimates 100,000 health professionals have left the country within the last nine years. To make matters worse, many nurses and doctors who have remained in the country are not working, as the strike over pay for health workers that began in August last year is still unresolved.

Many hospitals and clinics have had to close down, as a result, while those still in operation have little medicine available. “Right now, we are poorly resourced. Even if we want to carry out studies, we have no capacity, no computers or even test kits. We have nothing,” Duri explained.

There is also a shortage of drugs to treat TB. As a result, government hospitals have started to refer patients to rural mission hospitals financially supported by international aid organisations.

According to 2007 health department statistics, the country’s TB case detection rate is only 42 percent, a figure falling far short of the World Health Organisation (WHO) target of detecting 70 percent of TB infections. In addition, Zimbabwe’s official treatment success rate is 68 percent, 17 percent lower than the WHO target of 85 percent.

To get the disease under control in the midst of a poorly functioning primary health care infrastructure, doctors have called on the national health department to swiftly implement TB awareness and education programmes. To reach as many people as possible, this needs to involve community members and take place within communities, Duri suggested.

National TB coordinator, Dr Charles Sandy, admitted at a recent National TB Capacity Building and Policy Dialogue Platform conference in Harare that a MDR-TB outbreak could soon surprise Zimbabwe. “The chances that TB is spreading fast in our population is high,” he said.

Anecdotal evidence points to significant drug-resistance problems, Sandy explained: “We have cases of MDR and XDR TB for sure, but we have a challenge because our TB reference laboratory, which is supposed to diagnose the tests, is not (functioning).”

Sandy was referring to the country’s only TB testing lab at Parirenyatwa Hospital in Harare – the country’s only laboratory that can carry out bacterial culture and drug sensitivity tests – which is currently dysfunctional because of outdated and broken diagnostic equipment.

Theoretically, TB can be diagnosed relatively easily through sputum smear tests that are then analysed in a laboratory. But with limited testing services available, many TB cases either go undiagnosed or are treated without accurate diagnosis. As a result, TB treatment in Zimbabwe currently relies on a doctor’s ability to recognise the disease based on symptoms, or on guesswork.

The Zimbabwean health department has blamed international sanctions for its inability to receive donor money that could help to purchase much-needed modern medical equipment. This although Zimbabwe has received a $12 million grant from the Global Fund to Fight AIDS, Tuberculosis and Malaria.

A nurse at Beatrice Infectious Diseases Hospital, who did not want to be named, told IPS that a Detect-TB research study funded by the UK-based Welfare Trust, which had been commenced last year in collaboration with the Biomedical Research Institute in London and the London School of Hygiene and Tropical Medicine has been suspended because of the outbreak of the cholera epidemic, which took up all of hospitals’ capacity.

Since August last year, more than 3,500 Zimbabweans have died of cholera, according to the United Nations.

 
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