A doctor examines the x-ray of a TB patient in New Delhi. Credit: Bijoyeta Das/IPS.

By Lyndal Rowlands
UNITED NATIONS, Mar 24 2017 (IPS)

New antibiotics that could treat tuberculosis may rapidly become ineffective, according to new research published by the Lancet ahead of World Tuberculosis Day.

The rise in multi-drug resistant tuberculosis, which affected 480,000 people in 2015, could mean that even newly discovered drugs will soon be useless, the study found.

In total both drug resistant and non-drug resistant Tuberculosis (TB) killed an estimated 1.8 million people in 2015, making it the world’s deadliest infectious disease. The five countries where TB is most predominant are India, Indonesia, China, Nigeria, Pakistan and South Africa.

Multi-drug resistant tuberculosis reflects the meeting of an ancient and under-addressed disease – tuberculosis – with an emerging modern threat – antimicrobial resistance. The inappropriate use of antibiotics, including taking them without prescription or not following doctor’s orders closely is slowly rendering many antibiotics useless.

“Resistance to anti-tuberculosis drugs is a global problem that threatens to derail efforts to eradicate the disease,” said lead author of the Lancet report Professor Keertan Dheda from the University of Cape Town, South Africa.

“Even when the drugs work, TB is difficult to cure and requires months of treatment with a cocktail of drugs. When resistance occurs the treatment can take years and the drugs used have unpleasant and sometimes serious side effects,” said Dheda.

Dheda added that it is important for improved diagnostic tests, which are currently being developed, to be made available in low-income countries “so as to inform treatment decisions and preserve the efficacy of any new antibiotic drugs for TB.”

The report was published in the Lancet Respiratory Medicine on World TB Day – 24 March.

Meanwhile, according to Medecins Sans Frontieres (MSF) Access Campaign fewer than five percent of people with multi-drug resistant Tuberculosis have access to new medicines, four years after these medications were released.

“It’s downright disheartening that, with hundreds of thousands of people living with deadly drug-resistant tuberculosis, only 4,800 people last year received the two new drugs that could dramatically increase the number of lives saved,” said Dr. Isaac Chikwanha, TB advisor for MSF’s Access Campaign.

“Our first major problem is that pharmaceutical corporations are not even registering important new drugs in some of the countries hardest hit by TB; The next major problem is their high price,” said Dr. Chikwanha.

“People with drug resistant TB who don’t have access to the two new drugs continue to be treated with older, more toxic regimens that cure only 50 percent of people treated and cause severe side effects ranging from severe nausea to deafness to psychosis,” said MSF Access.

Dr Margaret Chan, Director General of the World Health Organization recently told IPS at a press conference on antimicrobial resistance that “there is no denying the fact that TB is a top priority for the world.”

She says that there are two high level meetings planned in 2017 and 2018 to “shine a light on TB” and give it “the political attention and the investment in research and development that it deserves.”

However according to both MSF Access and the new Lancet study, research and development alone, though needed, is not enough to address the shortcomings in the global response to TB and Antimicrobial Resistance without a matching political response.

In a comment article published alongside the new Lancet study David W Dowdy from Johns Hopkins Bloomberg School of Public Health said that the difference between “a drug-resistant tuberculosis epidemic of unprecedented global scale” or “an unprecedented reversal of the global drug-resistant tuberculosis burden,” falls largely to whether there is “political will to prioritise a specific response to the disease.”

In Papua New Guinea, most people live in rural areas with poor access to health services, increasing the challenges of fighting infectious diseases, such as tuberculosis. Credit: Catherine Wilson/IPS

By Catherine Wilson
CANBERRA, Australia, Mar 23 2015 (IPS)

Rising multi-drug resistance in patients suffering from tuberculosis, a debilitating infectious lung disease which mainly impacts the developing world, has led to a public health emergency in the southwest Pacific Island state of Papua New Guinea, according to state officials.

While efforts to combat the disease worldwide have produced results, with the global death rate dropping by 45 percent since 1990, the annual number of new cases in Papua New Guinea has risen from 16,000 to 30,000 over the past five years.

“The biggest barrier for the moment is cultural beliefs about the causes of diseases [...]. The first source of help [for many patients] is witchdoctors and local remedies." -- Louis Samiak, chairman of public health at the School of Medicine and Health Services at the University of Papua New Guinea
On World Tuberculosis (TB) Day, observed on Mar. 24, the country’s health experts spoke out about the challenges they face in tackling a disease that thrives in communities struggling against hardship and inadequate access to information and basic services.

“The biggest barrier for the moment is cultural beliefs about the causes of diseases. TB is a disease with long incubation and the first source of help [for many patients] is witchdoctors and local remedies. When patients present late [at health facilities] with advanced disease, it is difficult to treat,” Louis Samiak, chairman of public health at the School of Medicine and Health Services at the University of Papua New Guinea, told IPS.

Disease symptoms include fever, chest pains, fatigue, weight loss and cough, frequently with sputum and blood, which results in the airborne spread of bacteria.

The illness transmits quickly in overcrowded impoverished settlements and in Papua New Guinea, where sanitation coverage is only 19 percent and less than half the population have access to clean water, it is the leading cause of hospital deaths.

In rural villages of Kikori District in the southern Gulf Province the TB incidence rate is an alarming 1,290 per 100,000 people, according to the Papua New Guinea Institute of Medical Research. The national prevalence is 541 cases per 100,000 people, compared to the global average of 126.

The campaign to halt the epidemic in Gulf Province is supported by the international medical non-governmental organisation Doctors Without Borders (MSF). Operating from the main town of Kerema, MSF has since last year diagnosed an average of 50 new TB cases every month, inlcuding patients as young as 10 months.

Adults aged 15-54 years are mainly afflicted, but youth account for about 28 percent of cases in PNG, while pulmonary TB and TB meningitis contribute to malnutrition and mortality in children.

One mother took her ill six-year-old child to Kerema General Hospital in an arduous journey from her mountain village, which took three hours by boat and two by truck.

“In the beginning, the mother did not understand what TB is, why the child needs treatment every day for long periods and why she has to be away from her village. It took two months to gain her acceptance of the treatment and for her to prepare for living away from the village,” a spokesperson for MSF in Papua New Guinea recounted to IPS.

“But the child is now receiving treatment every day with signs of improvement.”

Threatening disease control efforts is increasing resistance in patients to the strong first-line drugs, isoniazid and rifampicin. Common practice of patients stopping medication as soon as they feel better and not fully completing treatment is the main cause of multi-drug resistant TB in the country, Suparat Phuanukoonnon of the Institute of Medical Research told IPS.

When treatment is interrupted, the lower level of medication consumed fails to eradicate all the bacteria, which then develop resistance in the patient’s body.

In 2013, 4.5 percent of diagnosed TB cases in the country were multi-drug resistant, a significant increase from 1.9 percent in 2010. Drug resistant TB is rising in the rural Western and Gulf Provinces and the capital, Port Moresby, where more than half the population live in squatter settlements.

The impact on development is acute, with 75 percent of people with TB worldwide of working age.

“TB can affect all or any part of the human body. It, therefore, affects the whole person and reduces their ability to be productive to society or their community,” University of Papua New Guinea’s Samiak said.

While sufferers face rising healthcare expenses, the inability to work reduces their incomes. Poverty is perpetuated in the next generation when the disease affects both parents, forcing children to withdraw from school in order to care and provide for the family.

Papua New Guinea is the most populous Pacific Island nation with a population of seven million. But there are immense logistical challenges to fighting infectious diseases in the country, with more than 85 percent living in rural areas with poor, if any, access to roads and readily available transport to urban centres and health facilities.

A further hindrance is insufficient healthcare professionals with less than one doctor and 5.3 nurses per 10,000 people and a decline in the country’s health services since 2002, according to a report last year by the National Research Institute.

It found the availability of basic drugs in health clinics has fallen by 10 percent and visits from doctors dropped by 42 percent in the past decade. Despite rapid population growth, the number of patients seeking medical help per day has decreased by 19 percent.

Resources also need to be directed toward public education following a medical research institute survey of 1,034 people in the Central, Madang and Eastern Highlands Provinces, which showed the majority to be unaware of TB, its causes, and treatment.

Phuanukoonnon explained, “Prior to the Global Fund grant for TB [eradication] in PNG in 2007, it was a neglected disease in terms of political commitment and proper funding for the control programme.”

Limited health services are stretched as it is and, while TB information is available at health centres, overworked staff members still have little time for advocacy.

Any educational approach should address “how people receive and process information and believe the information enough to take action”, which requires that “health communication should be relevant to local contexts,” she continued.

Resources to assail the epidemic have been boosted, with the Global Fund announcing last month a further 18 million dollars of funding to fight TB in Papua New Guinea over the next three years.

Samiak said that financial resources could be well spent developing in-country laboratory facilities and staff training, so that TB test results are processed more efficiently and patient follow up and treatment expedited.

Edited by Kanya D’Almeida

Caring for MDR-TB patients at home or even at taking them to hospitals is a challenge for relatives, especially as the disease is uncertain to completely go away after treatment. Credit: Jeffrey Moyo/IPS

By Jeffrey Moyo
HARARE, Jan 25 2015 (IPS)

About eight years ago, 44-year-old Tilda Chihota was struck with tuberculosis which kept her bed-ridden for over six months at her rural home in Zimbabwe’s Mwenezi district, 144 kilometres southwest of Masvingo, the country’s oldest town.

Although Chihota later recovered after receiving treatment at a local district hospital here, early this year, she was once again struck with the same ailment. This time is came with increased severity in the form of multi-drug-resistant tuberculosis (MDR-TB).“MDR-TB cases will continue to increase and worsen as long as the backlog of TB cases keeps increasing." -- Dr. Charles Sandy

MDR-TB occurs when a strain of TB bacteria becomes resistant to two or more “first-line” antibiotic drugs prescribed to combat standard TB.

According to the Ministry of Health and Child Welfare, cases of MDR-TB nearly doubled from 156 in 2011 to 244 cases in 2013. This was despite the fact that notifications for ordinary TB drastically declined from 47,000 in 2010 to 38,367 in 2012.

“I am HIV-positive, but because I defaulted on taking treatment drugs, doctors have diagnosed me with MDR-TB,” Chihota told IPS.

Cases of MDR-TB like Chihota’s are common among people who are living with HIV/AIDS, according to the United Nations AIDS organisation (UNAIDS). Close to 80 percent of TB patients in the care of Doctors Without Borders are co-infected with HIV/AIDS.

“The best way of avoiding MDR-TB is prevention through strict adherence to prescribed treatment by the health provider,” Dr. Charles Sandy, deputy director for the AIDS and TB unit in Zimbabwe’s Health ministry, told IPS.

According to the World Health Organisation (WHO), it takes longer to treat MDR-TB, which can only be cured with the use of very expensive second line drugs that often cause serious side effects.

These include nausea, vomiting and permanent deafness, which often deters patients from finishing their treatment course. On average, patients need to take between 12 and 15 tablets daily for two years, which cost about 5,000 dollars for the entire course.

“The treatment drugs required per each MDR-TB patient are quite expensive and involve the use of quantities of resources enough to treat more than 100 TB patients, which is a strain on government’s public health sector,” Everson Murwira, a local health inspector based in Gweru, a town 222 kilometres west of Harare, the Zimbabwean capital, told IPS.

Medical doctors also point out a litany of many other factors fuelling rising cases of MDR-TB here.

“Food insecurity, large numbers of Zimbabwe’s population living in destitution, lack of balanced diet and crowded and often poorly ventilated homes in both the countryside and high density suburbs in cities leads to TB patients not recovering, but rather further suffering from MDR-TB,” Tinashe Chauke, a private medical doctor often treating TB patients in Masvingo, told IPS.

Chauke added that because most Zimbabweans are poor, “they can hardly afford to visit doctors for regular medical check-ups, resulting in most former TB patients falling prey to MDR-TB.”

But government could be doing more to combat TB.

At last year’s World TB Day commemorations, Health Minister Dr. David Parirenyatwa expressed concern at the number of missed TB cases here, saying that based on WHO projections, Zimbabwe missed 30,000 TB cases in 2013 alone.

“We continue to miss TB cases because of stigma and lack of awareness in the community and limitations in access to health services as well as the quality of health services,” Dr. Parirenyatwa said at the time. World Tuberculosis Day falls on Mar. 24 each year.

Médecins Sans Frontières (MSF or Doctors without Borders in English) says direct observed treatment is the best model to manage MDR-TB.

“Direct observed treatment of MDR-TB patients in their homes by their loved ones is the best option, but in Zimbabwe, only doctors and nurses can inject patients and nobody else, which creates a challenge for patients,” an MSF medical doctor in Harare, speaking on the condition of anonymity, told IPS.

With the help of MSF two years ago, 3,200 patients in Zimbabwe were placed under treatment for TB while 63 patients were treated of MDR-TB.

Government cooperation with MSF, however, has been spotty. In a recent case, an MSF clinic in Beitbridge district near the South African border that treated HIV/AIDS and TB was forced to close after government officials accused the clinic of meddling in politics.

According to MSF, Zimbabwe trails behind other countries in Southern Africa in its response to TB. Diagnostics need improving and treatment needs to be decentralised to community levels, the health agency said in a recent report.

A 2010 UNICEF report revealed that 78 percent of Zimbabwe’s 13 million people were living in ‘absolute poverty’, following which the WHO global tuberculosis report of 2012 placed Zimbabwe’s estimated TB incidence per capita at 603 per 100,000 population.

“Besides inadequate medical facilities, there are also many cases where sick people have needlessly died because they could not access medical attention due to bad or nonexistent roads,” said Edmond Kabarapate, the village head of Kafurambanje Village, said in a recent press interview.

Although Zimbabwe has made significant strides in reducing HIV/AIDS infections to 15.6 percent from 16 percent in 2007, according to the United Nations Development Programme (UNDP), it is still a sad story for this country as it contends with the menace of MDR-TB.

“MDR-TB cases will continue to increase and worsen as long as the backlog of TB cases keeps increasing,” Dr. Sandy told IPS.

Evident of Dr Sandy’s sentiments, the 2009 WHO Global TB Control Report rated Zimbabwe as having the fourth highest incidence of TB in the world. In 2012, the WHO reported that the Southern African nation was amongst 22 countries referred to as the TB “high burden” countries.

Caught up in difficult health situations, especially MDR-TB, many Zimbabweans like Chihota are unsure whether or not they will live after contracting the disease.

“Whether for better or for worse, with the MDR-TB that is wasting me away, taking the complex treatment prescribed to me, I am still very uncertain about what the future holds in as far as my state of health and even my survival is concerned,” Chihota told IPS.

Edited by Lisa Vives

South Africa is battling to reduce its cases of multidrug-resistant TB (MDR-TB) with the success rate for those on treatment at about 40 percent. Miriam Mannak/IPS

By Brendon Bosworth
CAPE TOWN, Mar 12 2014 (IPS)

Despite an increase in diagnosis times, South Africa is facing a growing drug-resistant tuberculosis (TB) burden as nationally there remains a large gap between the number of patients diagnosed with multidrug-resistant TB (MDR-TB) and those who start treatment.

Between 2007 and 2012, recorded cases of MDR-TB, which is resistant to at least two of the primary drugs used to combat standard TB, almost doubled.

South Africa has improved its ability to test for drug-resistant TB by introducing GeneXpert, a rapid testing machine that can diagnose TB in sputum samples in less than two hours.“We have in South Africa one of the only rising epidemics of drug-sensitive TB and drug-resistant TB. And we are not doing very well at detecting it and treating it.” -- Gilles van Cutsem, Médecins Sans Frontières (MSF)

But in 2012, just 42 percent of patients diagnosed with MDR-TB began treatment, according to government figures. The success rate for those on treatment is about 40 percent.

“If we don’t do something about it now, MDR-TB is going to become XDR-TB [extensively drug-resistant TB],” Dr. Jennifer Hughes, a drug-resistant TB doctor with Médecins Sans Frontières (MSF), told IPS. XDR-TB is a strain of TB resistant to at least four of the main TB drugs.

“If we don’t start focusing on how we treat XDR-TB properly as well, we’re just going to drive further and further resistance as we go.”

Treatment Gap

Most of South Africa’s provinces have increased their treatment capacity for MDR-TB patients after the government introduced a 2011 framework for decentralising MDR-TB care. This allows patients to start treatment at sites closer to their homes instead of the country’s few specialised TB hospitals, where a typical stay is six months.

But provision of treatment at primary healthcare level needs to increase, Dr. Norbert Ndjeke, director of the Department of Health’s DR-TB, TB and HIV division, told IPS.

“[Decentralisation] is not moving at the speed we want it to,” admitted Ndjeke. There is no special budget for decentralisation and provincial governments choose how to prioritise their spending, he said.

The number of sites MDR-TB patients can start treatment in the Western Cape, Gauteng, Eastern Cape, and the Free State provinces has quadrupled due to decentralisation. The number of sites in the Western Cape, for instance, went from four to 17, while Gauteng now has five treatment sites instead of one.

Limpopo Province has not added new facilities, while North West and the Northern Cape provinces have doubled available treatment initiation sites, going from one to two, and two to four, respectively.

When properly implemented, decentralisation can cut the treatment gap.

In Khayelitsha, a large semi-informal township on the fringes of Cape Town, a combination of quicker testing and decentralisation has led to the time between diagnosis and treatment for drug-resistant TB dropping from 73 days to just seven days between 2007 and 2013, according to data by MSF. Ninety-one percent of patients diagnosed with MDR-TB in Khayelitsha in 2013 began treatment.

Ndjeke noted that provisional national data for 2013 indicates that 10,095 MDR-TB patients began treatment. Figures are not yet available for the number of patients diagnosed during that period, but in the first nine months of the year 7,271 patients were diagnosed with MDR-TB, possibly indicating a shrinking gap between treatment and diagnosis.

Accurate recording and reporting of patient numbers and outcomes remains a challenge, and the government is working to improve its systems, he said.

Large Burden

South Africa has the world’s third-largest TB burden, after India and China, according to the World Health Organisation. It also reports the world’s most cases of XDR-TB, a virulent form of the disease that is resistant to at least four of the main TB drugs and has a treatment success rate of less than 20 percent. An estimated one percent of the population of about 51 million develops TB every year.

“We have in South Africa one of the only rising epidemics of drug-sensitive TB and drug-resistant TB. And we are not doing very well at detecting it and treating it,” said Gilles van Cutsem, MSF’s medical coordinator for South Africa and Lesotho, at a media briefing.

Doctors are concerned about the rise in transmission of drug-resistant TB.

When drug-resistant TB started emerging it was mainly due to patients not being able to complete their full course of treatment for standard TB, said MSF’s Hughes. But now most drug-resistant TB transmission happens through people breathing it in from others, she said.

New Drugs Offer Hope 

One of the main challenges for treating drug-resistant TB is that the available drugs come with side effects including nausea, vomiting and permanent deafness, which often deters patients from finishing their treatment course.

“The drugs are horrendous – it’s a terrible regime but it’s the best they’ve got,” Hughes told IPS. On average, patients need to take between 12 and 15 tablets daily for two years, she explained.

South Africa is running a clinical access programme for up to 200 XDR-TB – and pre-XDR-TB patients with limited treatment options for a new drug called Bedaquiline, the first drug designed specifically to treat TB in over 50 years.

One of the features of the drug, which is taken along with other drugs, is that patients get better a lot quicker, said Dr. Francesca Conradie, clinical advisor to Sizwe Hospital, a MDR-TB hospital in Gauteng.

“It’s the first in a pipeline of maybe four or five drugs that will revolutionise the way we treat MDR-TB,” said Conradie.

Based on the outcomes of this initial programme, South Africa’s Medicines Control Council will decide whether or not to register Bedaquiline for use for more patients.

A new regime of drugs for drug-resistant TB patients could be ready by 2022 based on the outcomes of existing trials, said van Cutsem.

An elderly TB patient at the Srinagar-based Chest Diseases Hospital in the Indian state of Kashmir. Credit: Athar Parvaiz/IPS

By Athar Parvaiz
SRINAGAR, India, Jul 22 2013 (IPS)

Twenty-three-year-old Haleema (not her real name) was not the first female patient at Srinagar’s Chest Diseases Hospital in the Indian state of Kashmir to try to run away.

While undergoing treatment in the isolation ward reserved for tuberculosis patients, she hatched a plan with her brother to dodge the watchful eyes of the officer in charge, Ali Mohammad, and make a quick escape.

“She told me they wanted to take a stroll,” Mohammad told IPS. “I followed them and managed to get her (Haleema) back to the ward…but not without resistance.”

“I don’t have TB,” a distraught Haleema told IPS from the bed where, for the time being, she is reluctantly continuing her treatment.

Her doctors say she is suffering from all the telltale TB symptoms, including a bad cough that has lasted for over two weeks, evening temperature rises, blood in her sputum and loss of weight and appetite.

Worried that the infection could lead to fibrosis (a thickening of the lung tissues) if left untreated, doctors are administering daily doses of isonicotinylhydrazine (INH), rifampin, ethambutol and pyrazinamide, which they hope to continue for six months.

Far from being grateful for the care she is receiving at the state-run facility, the young woman insists that the hospital staff are putting her future “at risk” by forcing her to stay put.

By way of explaining this unusual claim, Haleema’s brother told IPS: “We won’t be able to find her a husband if she remains in the hospital. The word will spread about her illness and no one will want to marry her.”

Dangerous misconceptions

Haleema’s desperate escape attempt is not an isolated case, but rather a trend in this region of 12 million people, where misconceptions about TB are thwarting doctors’ attempts to stamp out the disease.

Women often bear the brunt of the stigma attached to TB.

Rehana Kausar, a researcher with Kashmir’s health department who presented a study entitled ‘Sex Differences in Key Aspects of Tuberculosis Control’ at a recent conference at the Srinagar-based Sher-i-Kashmir Institute of Medical Sciences (SKIMS), found that 87.6 percent of 240 female respondents said they would deny or hide a TB diagnosis for fear of “spoiling marital life or ruining their marriage prospects.”

“Nearly one-third of married women feared desertion by their husbands and the majority (95.9 percent) of unmarried women said they would not be able to find a match (marriage partner) if their TB diagnosis was revealed.”

According to Mushtaq Ahmad, director of the State Tuberculosis Diagnostic Centre (STDC), misunderstandings about the disease and its impacts pose “a major challenge” to the medical establishment.

He says that some TB patients prefer to visit private doctors rather than check into free, government-run health centers, in the hopes of keeping their health status a secret.

“This is a dangerous trend,” Ahmad told IPS, “because these patients often leave the treatment midway… when they can no longer bear the cost of paying private doctors themselves.”

Experts say incomplete treatment is a serious health hazard for the entire region.

Ghulam Ahmad Wani, Kashmir’s chief tuberculosis officer, told IPS that patients frequently declare themselves infection-free after a month, even though a full course of TB medication typically runs for at least six months.

“Though the symptoms may disappear, this does not mean the disease has been cured,” he stressed, adding that, on the contrary, stopping TB treatment prematurely simply makes the disease harder to treat.

Patients end up developing multidrug-resistant tuberculosis (MDR-TB), a particularly virulent strain of the disease that refuses to respond to isoniazid and rifampin, the two most potent TB drugs, and a host of related medications.

The worst-case scenarios, says Suraiya Farooq, an MD at the Chest Diseases Hospital, include extensively drug-resistant tuberculosis (XDR-TB) and totally drug-resistant tuberculosis (TDR-TB), which are particularly worrisome strains for people living with HIV/AIDS, since the body effectively stops responding to even second-line intravenous drugs, leaving the patient with a severely weakened immune system.

The repercussions of this trend are magnified in India, the country with the highest number of TB patients in the world.

According to the World Health Organisation (WHO), India accounts for one-fifth of global TB cases, with two million people developing TB annually, of which roughly 870,000 are thought to be infectious cases. It is estimated that 300,000 Indians die of TB every year.

Residents of the mountainous state of Jammu and Kashmir, nestled between the Great Himalayas and Pir Panjal mountain range, are highly susceptible to TB, especially those who dwell in traditional mud huts without proper ventilation.

Unhygienic and crowded living conditions also encourage transfer of the disease, according to Suraiya.

In 2012, Kashmir’s Tuberculosis Cell conducted sputum tests of 50,000 people who complained of TB-like symptoms: 5,800 were diagnosed with TB.

In the previous two years, according to officials speaking to IPS under condition of anonymity, more than 15,000 out of roughly 100,000 suspected cases tested positive for TB.

The officials refused to divulge the number of deaths resulting from these cases.

However, Wani said that state hospitals “treated 93 percent of those patients, who recovered fully, while the remaining seven percent left the treatment midway.”

Most experts agree that a lack of awareness about the disease is the main culprit for the high infection rate and for the number of people who either deny their diagnosis or discontinue their treatment.

Quoting figures from her recently published study, Kausar told IPS that 10 percent of women with TB did not know they were living with the condition, while 60 percent of female patients had no knowledge about the disease and how it spreads.

According to her research, few patients were aware that TB is a bacterial infection, caused by inhalation of respiratory fluids emitted by an infected person; in fact, one-fourth of the women surveyed attributed the disease to “tension”, stress, domestic strife and “past sins”, while 21 percent of nearly 250 male respondents believed the disease was caused by smoking.

Ahmad lamented that Kashmir’s health department had yet to create a comprehensive awareness campaign, though he welcomed recent efforts undertaken through the Revised National TB Control Programme (RNTCP), which is being implemented throughout India as part of a nationwide TB eradication initiative.

States are now utilising radio and television stations to advertise that the disease is treatable. “We are also (mobilising) school teachers and preachers from the mosques to help spread the word,” he said.

Suraiya says awareness is crucial not only for ending the stigma but also for urging people, especially residents of the Himalayan foothills, to come for regular check-ups or sound the alarm when a family or community member has been coughing continuously for more than a week.

The Swaziland Migrant and Mineworkers Association secretary general Vama Jele says that many ex-mine workers suffering with TB have died. Credit: Mantoe Phakathi/IPS

By Mantoe Phakathi
MBABANE , Apr 9 2013 (IPS)

For more than a decade after 1992, when Swazi gold miner Benson Maseko, 50, fell ill with chest pains and a nagging cough, he did not seek treatment.

Because of his illness, Maseko was retrenched without benefits from his job at a mine in Johannesburg, South Africa. And when he returned to his home in Mahlangatsha, a small village on the outskirts of Swaziland’s commercial hub, Manzini, he chose to pursue traditional healing for his ailment instead of going to a doctor.

“I only went to hospital in 2005 where I was diagnosed with and treated for tuberculosis (TB),” he told IPS. It was thanks to Médecins Sans Frontières, an international NGO, that Maseko was able to make the monthly trips to hospital. They provided him with the transport fees of about 5.50 dollars and food rations.

But after he ended his six-month treatment, he relapsed twice. “(Then) a year after completing treatment again, I fell sick again,” said Maseko.

The father of five is also HIV-positive, and his recurring TB baffled health workers because he was on antiretroviral therapy. But, he explained, when he told health workers that he used to work in the mines, everything about his illness made sense to them.

“I was then diagnosed with MDR-TB (multidrug-resistant TB),” he said. He has since successfully completed his treatment in January and is scheduled for a check up in April.

According to Dr. Samson Haumba, the executive director at University Research Co., LLC (URC), an NGO working across the globe and in Swaziland where it provides technical support on HIV and TB, MDR-TB is very common among mine workers.

Since the beginning of April, URC, in partnership with the Swaziland Migrant and Mineworkers Association (SWAMMIWA), have begun a nationwide registration of ex-mine workers and their families. In addition, they are also testing them for TB and referring them for treatment.“We used to go underground without any masks," Benson Maseko, 50, who was diagnosed with multidrug-resistant TB.

This southern African nation has no database for mine workers, who first started going to South Africa to work on the mines there in the 1920s. But the Ministry of Labour and Social Security estimates the figure to be around 100,000.

“We want to know where the mineworkers are and how far they are from health facilities,” said Haumba. “If there is a need, we’ll mobilise for resources to strengthen the capacity of health facilities.”

Haumba said that identifying miners in their communities would help them “get the disease” before it spreads further among communities.

“The treatment defaulting rate is also very high because the miners are scared of taking time off to get their medication, as they fear getting fired because they are the breadwinners at home,” he explained.

It is a prevalent issue not only in Swaziland, but also in the entire region. Southern African Development Community (SADC) heads of state signed the SADC Declaration on TB in the Mining Sector in 2012. Swaziland’s King Mswati III was among the signatories.

According to a February World Health Organization report, Africa has overtaken Asia with the highest TB death toll of 600,000 people in 2011. The organisation said that in 2011, 1.5 million people died from TB, and of those cases over 95 percent were from low- and middle-income countries.

Haumba said that a common disease found among miners was silicosis, a respiratory disease resulting from the inhalation of silica dust from gold.

“Silicosis weakens the pulmonary system such that it is easy to get TB,” he said. “That’s why TB is very common among mine workers.” It is also because they work in an enclosed underground area where air circulation is inadequate, Haumba added.

Maseko said that the miners he had worked with did not have masks to protect themselves from the dust.

“We used to go underground without any masks. Besides having to put up with the pungent smell from the gold smelting, the heat was unbearable because there is no circulation of air.”

Many ex-mine workers are suffering with TB as a result, but the only difference between them and Maseko is that they do not live to tell their tale, said SWAMMIWA secretary general Vama Jele.

“Mine workers are suffering from lung diseases because of the dust they inhale (working on) the mines in South Africa,” Jele told IPS.

South African Minister of Health Dr. Aaron Motsoaledi agreed.

On Mar. 21, when health leaders in the region met in Swaziland and renewed their commitment towards the fight against TB and HIV, Motsoaledi said: “If HIV/AIDS and TB were a snake, I can assure you that the head would be in South Africa.”

“Mine workers come from the whole sub-region to our mines to catch TB and HIV and take it back to their families and communities,” he said.

Currently 160 miners and their families from four communities in southern Swaziland, including those who have already succumbed to TB, have been registered with the two-year URC/ SWAMMIWA programme. Only 42 percent of the registered miners are still alive and of these 15 percent are infected with TB, URC nurse coordinator Nokuthula Mdluli told IPS.

“It’s important to register even the deceased because we want to screen their families for TB and refer them for treatment if necessary,” said Mdluli.

Development partners have committed 120 million dollars towards the fight against the co-epidemic in the region, and health leaders are racing against time to at least halve the number of HIV- and TB-related deaths.