Health workers score with TB campaign

A tuberculosis (TB) treatment programme recently introduced in Swaziland is credited with lowering the number of TB patients, at a time when other African nations face a rising number of cases. Dumsile Nxumalo, the first Swazi to participate in the Directly Observed Treatment Short-course (DOTS) TB programme, believes she is alive today because of the initiative. "My mother still had hope when I had given up, which is what I ask all families to do. Do not give up on your family members who have TB, because it makes them believe that there is nothing left for them anymore," Nxumalo testified this week at a health workers conference on DOTS. "I was in very critical condition; I knew I was dying. Then nurses told me I was going to be the first person to be introduced to the DOTS programme for six months. I was very nervous, but I was desperate to live. I took the mediation in the hope that the doctors would not recommend something that would not help me," Nxumalo said. Thandi Hlengetfwa, director of The AIDS Information and Support Organisation (TASC), said, "Swaziland has some reason to celebrate a reasonable degree of success in containing, controlling and curing TB." The strategy being implemented by the health ministry's TB Control Unit includes a community campaign to raise awareness and provide information and education about the basic facts on TB - such as how it is spread, taking precautions, the signs and symptoms of the disease, available treatment - and the DOTS initiative. "DOTS involves a course of anti-TB drugs, taken uninterrupted for six to eight months. DOTS is a community-based treatment because the patient does not have to be hospitalised, but can live with his or her family. It prevents new infections, stops the development of multidrug- resistant strains of TB, extends the lives of HIV and AIDS patients, for whom TB is an opportunistic disease and, most importantly, it cures TB," Hlengetfwa explained. Nxumalo added, "The good thing about this programme is that you are not confined in hospital if you are on the medication; the treatment is taken at home where there is family support." Hlengetfwa's organisation, one of the country's oldest AIDS information NGOs, has become involved in the TB campaign because of its high rate of co-infection with HIV/AIDS. "The TB education campaign is informing communities that being HIV positive is one of the greatest risk factors known to increase the progression of TB infection to a fatal disease," she noted. "And it stresses the importance of all HIV positive people having a regular TB check up." The Raleigh Fitkin Memorial Hospital, the main health facility in Swaziland's most populous town, Manzini, reported a 10 percent decline in TB cases during 2004. TB has historically been Swaziland's 'third disease', behind sexually transmitted diseases (syphilis prior to AIDS) and malaria, as reflected in hospital records that go back to 1929. In that year, TB accounted for only 3.6 percent of cases treated at the hospital, versus 16 percent for malaria, and 66 percent for syphilis. As the country's population expanded after independence in 1968, TB cases proliferated, and the hospital devoted a large donor grant to a TB treatment centre in the 1970s. By the 1990s, the country's main TB centre was included in the Swaziland Mental Health Institute in Manzini. Because of overcrowding, TB patients were sometimes kept in the same dormitories as mental patients, raising concern over the risk of infection. This situation has not changed. Swazi customary beliefs have demonised TB, and the disease has been attributed to witchcraft. Senior health educator for the Ministry of Health and Social Welfare, Africa Magongo, travels the country countering such superstition. "I tell the people it is high time they start believing that TB is a deadly disease, but curable, instead of believing that they are bewitched when infected, which makes it very hard for them to get help," he said. Magongo believes an effective education programme partly accounts for a nationwide drop in TB cases, down by an estimated 15 percent last year according to the health ministry. "People are beginning to go for testing as soon as the early signs and symptoms start," he said. "Community leaders need to disseminate health learning materials, and hold health community talks to teach their constituents about the disease." Families have been the main target of the anti-TB campaign. "Family members are very important, because they are in close contact with their infected relations and can help prevent transmission without isolating them. We encourage them to love the patients, help them take their medicine, and be there for them in every way," Magongo commented. Discrimination against TB patients is similar to the stigmatisation of AIDS patients. Nxumalo recalled, "I used to encounter problems walking publicly, because people used to look at me, and talked about me behind my back. I was isolated in society." After the six-month DOTS treatment, her health improved considerably, and people around her became less nervous. "There was a huge difference," she said. Like other health officials, Magongo feels that TB can continue to be brought under control through a wider application of new medicines, community education and the cooperation of patients' families. "Swaziland still has a long way to go to completely control and eradicate TB, but we are making progress," Hlengetfwa said. TB is primarily an illness of the respiratory system, spread by coughing and sneezing, which kills about two million people across the globe each year. The disease is linked to poverty and now increasingly HIV/AIDS, with Africa accounting for a quarter of all notified TB cases worldwide. The health systems in many African countries are already over-burdened by the AIDS epidemic and often lack the capacity to properly supervise the millions of individuals in need of TB treatment under the DOTS strategy. In too many cases, patients simply stop taking their daily pill as soon as they feel well, giving the disease an opportunity to mutate and eventually return in a multidrug resistant form. International relief agency Medecins Sans Frontieres (MSF) has been campaigning loudly in recent months for a radical rethink of the DOTS strategy that would take into account the impact of HIV and capacity problems of health systems. MSF is also calling for more investment in the research and development of better diagnostic tests, and new drugs that would shorten treatment times and lessen the need for supervision.