Triangle of community awareness, testing accessibility lowers TB case

26Mar 2020
The Guardian
Triangle of community awareness, testing accessibility lowers TB case

AS the world marks World TB Day in a cloud of COVID-19 there is hope that the goal of ending TB is within reach.

Tuberculosis project manager Mwinuka Ereneus (R) and Shdepha+ Valuation and Review Coordinator Rabia Abeid hold placard with a massage saying Protect your lungs against Tuberculosis at the World anniversary of TB held in Kahama in Shinyanga region on Monday. Photo: Correspondent Shaban Njia

The number of identified cases in Tanzania is steadily increasing from 62,180 in 2015 to 75,606 in 218. In 2019 the number of identified cases in Tanzania has reached more than 82,000.

The steady climb brings the hope of ending TB in Tanzania from a realm of dreams into the platform of realities. Ending TB in Tanzania is no longer a wild guess, but a reachable possibility.

A story from Geita, one of the regions in Tanzania whose annual identification of TB cases climbed by 75 percent from 2015 to 2019 brings to life a triangle of actors that exemplify the quality improvement initiatives in the TB programme in Tanzania since 2015.

One sunny morning in the outskirts of Geita town, an evangelical pastor notices a man goes about his morning routine of conducting counseling and prayers to individuals at his home.

People are queuing. The pastor notices one person coughing painfully, repeatedly. He is one of the clients waiting for their turn for counseling and prayers from the popular pastor.

Thanks to an orientation about symptoms of TB the pastor decides to categorize this client as a TB suspect and call the Geita region TB focal person. He continues to pray for his clients.

The TB programme in Tanzania, working with different implementing partners had trained key community persons to ‘suspect’ TB cases in the communities. Traditional healers, pastors, and community health care workers are among them.

Within an hour arrives Juma Babu TB Community volunteer that has also been trained in taking samples from TB suspects. After a hushed conversation with the pastor, the coughing clients are summoned in another hushed conversation. From outside the other faithful hears prayers. When the door opens Babu walks out with his solid box, climbs on his bike and off he goes.

Some of pastor Daudi Masau’s clients have often visited traditional healers to try their luck with their health and psychological issues.

“I am serving God by preaching about God’s will. It is God who brings doctors and other medical professionals for us, even in the Bible you see the Apostle Paul was with Doctor Luke, moving together and healing people,” says pastor Masau with pride in his voice.

This chain works as a triangle stand where each part is critical and removal of one disables the whole arrangement. In Geita region, this collaborative triangle is evident where health professionals, community members, religious leaders (and other people in the community) and former TB patients (working as community volunteers) work closely to bring new TB patients to care.

In 2015 Geita recorded 2,000 TB patients. That number increased to 3,300 in 2017.

Compared with previous years, the number of notified TB patients has climbed, partly because of increased awareness in the community and the contribution of health stakeholders in fighting TB.

Twenty-one regions out of 26 in Tanzania have increased case notifications in 2019 from 2015. Five regions have increased case notification by 50 percent including Geita that increased case notification by 75 percent from 2015 rates.

According to TB programme data between 2015 and 2019 identification of TB cases nationally increased by 32 percent. In the interval TB cases that were confirmed in laboratory increased by 13 percent.

Available case-based childhood TB data show that in 2017 to 2019 majority of pediatric cases were self-referral at 63 percent, followed by community referral at 17 percent. The increase in the number of GeneXpert machine for clinical confirmation of TB cases has facilitated access to testing services.

Based on the WHO policy recommendation, the ministry of health has increased hospital with GeneXpert machines from four in 2012 to 238 by the end of 2019.

The country has maintained a high treatment rate at 90 percent and in 2019, the treatment success rate has reached 91 percent. The death rate among new and relapse cases has decreased from 6 percent to four percent in 2018.

Geita is one of the regions with GeneXpert machines, therefore when the coughing patient showed up at the TB clinic at Geita regional hospital his samples had already been tested. Babu, TB community volunteer brought his specimen the day before.

Tanzania has implemented several initiatives that have contributed to an increasing number of TB patients that are timely identified and linked to treatment. Apart from the community initiative, there are more health facilities equipped with testing equipment and skilled health care workers for laboratory testing.

These initiatives reflect Tanzania’s adoption of the World Health Organisation policy on collaborative TB/HIV activities and community TB activities.

According to WHO, Africa is progressing in ending TB. WHO data shows that in 2018, four out of five (80.2%) people with multidrug-resistant or extremely drug-resistant TB started treatment.

However, there continues to be more new TB cases in the African Region, than in any other WHO region. Only one in two people with TB (56%) across the continent is on treatment. Fewer than one in three children (29%) living with someone with confirmed active TB is on preventive therapy.

TB control budgets are chronically underfunded, and most countries do not have information on families facing catastrophic costs due to TB.

According to WHO regional director for Africa, Dr Matshidiso Moeti it is time for governments to increase domestic investments in TB, and to strengthen regulatory environments to facilitate importation, monitoring, and use of quality products.

“We must engage other ministries, parliamentarians, community leaders, researchers, academic institutions, patient advocacy groups and people affected by TB. Multisectoral action is needed to ensure universal access to services,” said Dr Moeti