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HEALTH-MALI: Community Also Has a Role in Preventing TB

Soumaila T. Diarra

BAMAKO, Aug 2 2011 (IPS) - Tuberculosis remains a leading cause of death in Mali despite the availability of free treatment. The resurgence of the illness, linked to poverty and HIV infection, could be reduced by changing behaviour, doctors say.

“I know people who have died of tuberculosis,” Ramata Guindo told IPS.

“In this market, a vendor of kitchen utensils died of it last year. He didn’t go to a health centre in time. When they discovered what was wrong with him, it was too late,” says the vegetable vendor at Bamako’s Lafiabougou market.

This teeming market of hastily-constructed wooden sheds perfectly illustrates the overcrowding that supports the transmission of contagious diseases like TB. Between the merchants’ stalls, shoppers trample muddy soil mixed with spittle. “If you don’t pay attention, you risk being caught full in the face by someone’s spit, because around here, people are used to spitting anywhere, even in public places,” says Guindo.

Dr Faran Sissoko, a lung specialist at the Pape Clinic in Bamako, explained to IPS that this kind of behaviour plays an important role in the prevalence rate of tuberculosis which remains a public health problem in developing countries because it is so highly contagious.

“Tuberculosis continues to be an important cause of mortality in Mali. According to estimates by the World Health Organisation in 2009-2010, the prevalence of this disease in Mali is 142 per 1,000 residents,” says Sissoko.

Some 6,840 cases of tuberculosis, counting all forms of the disease, were recorded in 2009 in Mali, including 5,163 cases of highly contagious pulmonary tuberculosis, according to the medical authorities.

Vaccinations administered to children at birth seem to be failing to prevent the disease. “We’re seeing many cases of tuberculosis, and it’s affecting all age categories. The specialists explain the return of tuberculosis by pointing to HIV and the vulnerable conditions (of poverty) that many people are living in,” said Boubacar Diarra, a nurse in Commune V (the Fifth Commune) of Bamako District.

While the diagnosis of tuberculosis can require sophisticated and costly techniques, there are simple tools within the means of developing countries with which to detect the disease.

In Mali, the community health centres which are found even in the most rural areas can do bacteriological analyses. “To diagnose tuberculosis, one does a bacteriological survey of the sputum of the patient. If the sick person is found to have tuberculosis, they get six months of treatment for free,” Diarra told IPS.

But in the popular imagination in Mali, tuberculosis is a terrifying and incurable illness. People with the illness feel rejected by others.

Salif Traoré, a trader living in Bamako, is living testimony that tuberculosis need not be fatal. “I had heard on the radio or on the television that when a cough lasts more than 15 days, one has to go for a tuberculosis test, so I didn’t hesitate. I think that I owe a lot to the awareness messages,” he told IPS. He tested positive and was treated for six months before his health was restored.

“It is bad when you notice that people are uncomfortable near you. Even after I had recovered, I noticed that people were still afraid to shake my hand,” says Traoré.

The awareness campaigns can help to correct or eliminate dangerous behaviour that can spread the bacillus bacteria that causes the illness.

“If a person who has tuberculosis doesn’t get medical care within a month, they can contaminate ten other people. That’s why in the fight against tuberculosis, it is not only the disease and the doctor who matter. There is also the community that needs to become aware. And to achieve this, strong political will is needed to reinforce national programmes,” says Sissoko.

Mali has adopted this approach to prevention and control, although awareness campaigns were threatened by the suspension of finance from the Global Fund for the Fight Against AIDS, Tuberculosis and Malaria.

The Malian courts are currently investigating a corruption scandal involving misappropriation of money from the previous round of funding. Fourteen people were arrested, including the former health minister, Oumar Ibrahim Touré, charged with involvement in fraud in public procurement with the Global Fund’s grant.

The country’s health authorities will resume popular awareness campaigns thanks to new financing for 2011 and 2012 agreed in June.

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