HEALTH-ZAMBIA: Fighting Tuberculosis – an Uphill Battle

By IPS Correspondents Reprint | | Print |

Charles Mubambe

LUSAKA, Mar 26 2003 (IPS) - Frederick Tembo, 42, was afflicted by unprecedented bouts of fever, low blood pressure, poor appetite, night sweats and general body weakness. Medical doctors and traditional healers tried to help, but failed to diagnose the illness.That was in Sep 2001.

Between Sep 2001 and June 2002 Tembo submitted to three tuberculosis tests, following difficulties in breathing. The results were all negative. To Tembo’s disappointment, his body weight continued to dwindle from a healthy 74kg to an appalling 50kg.

Then, a colleague at work encouraged him to seek a second opinion. ”That is how I trekked to the University Teaching Hospital in Lusaka (the capital of Zambia). The diagnosis was quick. An x-ray revealed unusual sag on my right lung, an indication of a serious infection – tuberculosis. In no time, I was referred to Mtendere Health Centre for a weekly dose of intensive drugs,” he says.

”Within weeks, the ailment ‘disappeared’. I regained my appetite and chewed voraciously at anything that came my way,” he recalls.

The problem? Before going to the University Teaching Hospital, Tembo was fed on wrong drugs, sometimes on as many as eight different types of medicines per day. The wrong medication was to have unbearable effects on Tembo.

At Mtendere health centre, where Tembo is being treated, frail men, women and children wobbled in for their weekly or monthly supplies of TB drugs, dispensed after being weighed.

Ganizani Banda, aged 35, tips the scales at 50kg – a far cry for a 1.75m tall man who only a year ago was an athletic senior executive weighing around 75kg.

The atmosphere at the TB clinic is occasionally broken by giggles on how much weight one has lost or gained. If one had gained weight, the whole shelter would chorus: ‘Soya, Soya,’ in reference to the high-protein Soya flour supplement dispensed weekly by health centres to TB patients. The flour comes handy in a country where the majority of the population hardly meets their daily nutritional requirements.

In 2000, an astonishing number of 512 per 100,000 people had tuberculosis in Zambia. This figure represents a four-fold increase from the 1985 figure of 124 per 100,000 people.

Zambia’s National HIV/AIDS/TB Intervention Strategic Plan of 2002 says the arrival of the HIV/AIDS pandemic has caused a re-emergence of TB epidemics throughout Southern Africa, where the average tuberculosis case rate between 1964 and 1984 remained constant at 100 per 100,000 people. Since the advent of the HIV/AIDS epidemic, the TB case rate in Zambia increased nearly fivefold to over 500 per 100,000 people in 1996.

”There are now in excess of 40,000 new tuberculosis cases reported every year. This figure is expected to rise by 10 percent annually in the next few years. The tuberculosis co-infection has also resulted in an increased mortality rate of TB patients on treatment by over 15 percent,” says the strategic plan.

Figures obtained from the University Teaching Hospital in Lusaka indicate that at least 68 percent of adult patients with TB are HIV positive.

In May 2002, a national conference held in Lusaka on ”TB control in Zambia: The Challenge” urged government and donors to take an active role in supporting the health of workers in terms of drugs supply, transport and supervision.

The fight against tuberculosis in Zambia is an uphill battle, especially in the absence of limited resources.

To combat the disease, health officials have called on HIV/AIDS/TB support groups to intensify their campaigns.

This is because many people are unwilling to come out in the open to seek treatment – thereby spreading the virus, or bacilli, to other people. The ‘S-factor’ – stigma, shame and silence – leads to discrimination, denial and blaming, thereby delaying action on treatment.

Tembo is grateful to the University Teaching Hospital for diagnosing his illness. ”I am now in my fifth month of treatment, ostensibly healthy and enjoying life positively. I have religiously stuck to my daily intake of drugs and accepted it as part of life. I look to each day to achieve my aspirations,” he says.

TB is a global emergency. Even so, drug resistance and HIV are seriously challenging global TB-control efforts. Some adults carry a latent TB infection, which is suppressed by a healthy immune system. When HIV weakens the system, overt TB disease develops.

Transmission begins when a person shares space with an infectious person. TB is transmitted when a cough puts TB drops in the air. Risk of infection is dependent upon time, proximity and host factors.

Factors such as high population growth, overcrowding, poor housing, poverty and the spread of HIV, and non-compliance to treatment have contributed to the increase in TB cases.

According to the Centre for Disease Control and Prevention in Atlanta, Georgia, U.S., one third of the world’s population is infected. TB kills 5,000 people a day – over two million people each year. More than 100,000 children die of the disease each year.