Health officials in Ethiopia's capital, Addis Ababa, are concerned about the spread of tuberculosis in the city's crowded public transport networks and tightly packed "DSTV [satellite television] houses" where ardent fans come to watch English and Spanish football.
During big matches, a single "DSTV house" can hold up to 100 people.
"I sometimes open windows to avoid bad smells but on most occasions people say they will catch cold and TB... [they think that the] cold that comes through the window gives them the disease, so the windows and doors remain closed most of the time," said Daru Shifa in Addis's Merkato area.
Health officials say there is an urgent need to address the misconceptions about how TB is spread in order to curb the further spread of the disease in the city, whose population is more than 2.7 million.
"People in buses, taxis, 'DSTV houses' and similar places where there are many youngsters who sit together for a long time, often don't appreciate the need to have their windows opened," said Genet Yosef, TB/HIV Officer at the Addis Ababa Health Bureau. "Without allowing fresh air into these very small, crowded rooms, those inside risk catching infectious TB if there is one person among them with it and that is exactly what is happening across the city."
"The spread of TB has nothing to with cold, though this has been the understanding held by a significant number of people," said Desalegn Gebreyesus, TB/HIV adviser at the Health Ministry. "This is what we are targeting - educating people through the media, dramas, pamphlets and gatherings - so they understand the real way of TB transmission and therefore prefer to have their windows open to avoid it."
The city's TV and radio stations frequently air commercials urging people with coughs lasting more than two weeks to seek TB testing and treatment; a TV spot also highlights the risk of crowded areas such as the DSTV houses. Many public transportation vehicles also carry messages encouraging passengers to keep windows open to reduce risk.
“This year in particular we are working to launch a [song] prepared by a number of artists, and we hope it will appeal to the youth, creating awareness about TB,” said Genet.
|Case detection for TB in Addis Ababa is 63 percent - lower than WHO's target of 70 percent|
According to Desalegn, people in food-insecure areas, children under five and people in crowded spaces are most at risk of TB infection. People whose immunity is compromised, such as those living with HIV, are also at risk. An estimated 300 TB infections occur for every 100,000 Ethiopians annually, according to Ministry of Health statistics.
"Based on WHO's [World Health Organization] latest projections, we expect up to 12,000 new infections to be diagnosed every year [in Addis Ababa] but actually our health facilities had 13,000-14,000 new cases on average over the last three years," said Genet.
Stepping up treatment
Addis Ababa has 35 government health facilities and 40 private health facilities that offer anti-TB treatment. However, case detection for TB in Addis Ababa is 63 percent, lower than the WHO target of 70 percent.
When patients are diagnosed, about 80 percent are successfully treated, mainly through the directly observed treatment short course (DOTS).
"We carefully see whether they have adhered to the regimen or not and counsel them accordingly," said the Addis Ababa Health Bureau's Genet.
The Ministry of Health is keen to avoid the development of drug resistant forms of TB. About 400 multi-drug resistant TB (MDR TB) cases are registered in Addis Ababa, 180 of which are receiving treatment at Addis's St Peter General Specialized Hospital.
The country has more than 5,000 MDR TB cases annually, according to WHO.
"Our effort is to increase our treatment success rate and have the patient cured in the first-line treatment," said Desalegn. "Treatment for MDR TB is costly - our country cannot shoulder [the cost]."
He noted that through WHO's Green Light Committee, the Global Fund to fight AIDS, Tuberculosis and Malaria and other partners, the government was working towards treating at least 1,200 MDR TB patients around the country.
"Among the listed MDR cases you find teachers, even some who teach at nursery schools, and health professionals; these are among informed parts of our society and yet they fail to follow the treatment that could lead to a crisis for our community," Genet said. "We need to improve our attitude towards TB by sending patients to health facilities and follow them until they finish the treatment successfully.
"The responsibility isn't only for oneself, but also for the next generation - that is what we are trying to have the public hear," she added.