Poor access to treatment hampers fight against TB

Despite its status as a middle-income country, Namibia has a high incidence of tuberculosis (TB), a poverty-related disease. Poor geographical access to health services has hampered the treatment rate of TB, the country's second biggest killer, said Alfons Babie, an official at the recently created directorate for special diseases in the health ministry. Instead of the international target of 85 percent stipulated by the World Health Organisation (WHO), the TB treatment rate in Namibia is only 64 percent. Moreover, 40 percent of those infected do not continue with their TB medication for the stipulated six-month course, and health authorities have picked up an emerging multidrug-resistant TB epidemic. The lack of an electronic database also made it impossible for the health system to trace patients who did not report for collection of their TB drugs, explained Babie. In 1996 the government introduced WHO's Directly Observed Treatment Short-Course (DOTS) strategy, which includes free medication and treatment at all government hospitals for the six-month course of medication. "If patients stop taking their medication before that they have to start from scratch again, but the TB bacillus has built up a resistance against the medication - it has mutated - so a different drug cocktail must be found for the patient," explained Kerstin van Wyk of Johanniter Hilfswerk, a German NGO working with people infected with TB. "We had cases where patients interrupted [treatment] two or three times and had to be put on different medication each time, as the TB bacillus built up a resistance to the former medication cocktails," she noted. The health ministry noted in its latest annual report for the Khomas region, where the capital, Windhoek, is situated, that many patients defaulted "because they become too sick and too weak to walk to the health facility, and cannot afford taxi money". The San, who live in remote corners of the country are one of the worst affected by the disease. According to WHO, an average of 676 TB cases were recorded for every 100,000 Namibians, putting the country at the top of the world ranking for the disease. Last year Namibia launched its first national strategy to combat TB, which is also the principle cause of death among people infected with HIV or living with AIDS. A recent successful health ministry proposal to the Global Fund to fight AIDS, TB and Malaria stated that about 50 percent of TB patients were also HIV positive. "AIDS is worsening the TB infections," Babie told IRIN. This month the Fund announced the disbursement of US $143,000 to the Namibian authorities to help fight TB, and approved a further $7.2 million over five years for the TB programme. The funds will used to improve access to treatment by setting up community-based DOTS in each of the country's 13 regions, hike its treatment rate to reach the 85 percent target by the end of 2007, and monitor TB drug resistance.