Fight against tuberculosis hampered by patients’ failure to complete treatment

Like many Senegalese, Ibou Seck stopped taking his tuberculosis treatment before the course was up, prolonging his illness, risking death, and ultimately reducing the effectiveness of the drugs for other patients. “I didn’t have any support from my family so I stopped my treatment early. I was left alone, isolated in a back room near the chicken house while everyone in the district gossiped about my illness,” explained 36-year-old Seck, who works as a mechanic in the capital, Dakar. Frightened, too, that he would lose his garage business, Seck donned his oily overalls as soon as he was feeling well enough, and discarded his remaining pills. But he fell ill again shortly afterward and it has taken him a year to regain his health. In Senegal, 63 percent of tuberculosis patients are cured, according to figures from the French Dakar-based Research Institute for Development (IRD). But health officials calculate that the success rate could be much higher if all patients took the full course of medication. IRD estimates that 11 percent of TB sufferers in Senegal fail to do so. Patients who do not complete their treatment, which runs for at least six weeks, risk a relapse and the second time around the drugs might not be so effective, according to the World Health Organisation (WHO). And if this bad practice is widespread, new more virulent forms of tuberculosis will develop that existing drugs will not be able to treat, WHO warns. Tuberculosis, or TB, is transmitted much like the common cold -- through the inhalation of bacilli found in the coughs, sneezes or even breath of an infected person. A highly contagious, chronic infection, TB can lie dormant in a carrier’s body for years before the hint of any symptoms, which may include severe coughing, night sweats, malaise or weight loss. TB kills more people in sub-Saharan African than anywhere else in the world. Doctors also lose a lot of patients – between 5 and 30 percent -- before their treatment is up, said Christian Liendhardt, the research institute’s TB programme coordinator at a conference in Dakar earlier this month. Part of the problem is that many tuberculosis sufferers are too poor to pay for treatment. In Senegal, treatment as recommended by WHO costs between 300 and 2,000 francs CFA – between US 60 cents and $4 – IRD doctors say. This represents a significant outlay of cash in a country where, according to the UN, most people live on less than US $2 a day. But even if treatment were free, transport costs and loss of income due to illness or time spent seeking treatments make it practically impossible for many impoverished victims to complete their course of medication. “A poor patient who doesn’t have the means to come every day to collect their treatment, even if that treatment is free, cannot support the indirect costs,” said Liendhardt. In Mali, a vast and largely desert country, health centres may be several days journey away making diagnosis difficult and weeks of treatment practically impossible. “In a large country of 1.2 million sq km, the ill are obliged to travel long distances to get diagnosed and even then they find themselves unable to stay near the health centre to complete their treatment,” said Alimata Naco, coordinator of Mali’s TB programme. Like Seck the mechanic, isolation and rejection by family members can make things even tougher for people diagnosed with TB. But the prejudice doesn’t stop at home. Even nursing staff are reluctant to deal with TB cases, said Ibrahima Seck, a doctor at the Institute for Health and Development at Dakar’s main university. “The treatment of tuberculosis is often used as a disciplinary measure [among medical staff]” said Seck, and as a result, “the tuberculosis sufferer is forever isolated and all too often they end up at the mortuary.”