Tuberculosis still killer number one

Tuberculosis (TB), aggravated by HIV/AIDS, remains chief cause of death in Swaziland, which holds the dubious record of having the most TB infections in the world per population.

Cesphina Mabuza, Director of Health Services for the Ministry of Health and Social Welfare, told IRIN there were 186 TB patients per 100,000 people, and "of the 8,500 reported cases in the country, all are on some form of treatment."

However, 60 cases scattered across three of Swaziland's four regions indicate that a strain of TB has developed that is resistant to normal TB medication. These multidrug-resistant tuberculosis (MDR-TB) patients are being kept in isolation for the first phase of possible treatment at government hospitals.

"Ordinarily, TB should respond to treatment within two months. If improvement is not forthcoming, that is evidence of MDR-TB presence," Mabuza said.

"What we call TB first line is the type that could be treated the ordinary way. There is also MDR, which is resistant to treatment but can be curable with stronger drugs. Then there is XDR [extremely drug-resistant], which is difficult to treat," said Themba Dlamini, Programmes Manager at the Ministry of Health.

Dlamini said no cases of XDR had been identified in Swaziland yet, but without the necessary testing facilities available in the country it was impossible to rule out the possibility. Very few countries in Africa have the technology to test for drug-resistant TB and the health ministry is liaising with its counterpart in neighbouring South Africa, where MDR-TB is on the rise, to send specimens from Swazi TB patients to Pretoria, in South Africa, for testing.

MDR-TB is often the result of TB patients failing to finish their 6-month course of drugs, and is particularly dangerous and difficult to treat in people living with HIV. Even more alarming, XDR strains of TB emerged in South Africa's KwaZulu-Natal Province in 2006 and have since spread to other provinces, leaving more than 200 people dead so far, most of them HIV-positive patients.

It is estimated that as many as half of all adults in southern Africa carry a latent form of TB, but people with HIV-compromised immune systems are 50 times more likely to develop active TB. Without sophisticated laboratory facilities, TB patients co-infected with HIV also present a diagnostic challenge.

The degree of prevalence of TB amongst people living with HIV/AIDS is not known and, despite the AIDS crisis, hard data is often lacking.

The correlation between Swaziland's record TB infection rate and its HIV-infection rate - at 36.8 percent of the sexually active population also the highest in the world - has not been lost on health officials.

Of all patients admitted to Swaziland's hospitals and private clinics, 25 percent suffer from TB, and one out of four deaths at these facilities are TB related.

Lack of space at government hospitals has led to the establishment of a TB centre at the National Psychiatric Centre in the eastern commercial town of Manzini, the country's only facility for the mentally ill. The presence of dissimilar patients in the same centre has prompted concern in parliament, increasing the pressure on health ministry officials to open a new TB Hospital in Moneni, east of downtown Manzini.

Health Minister Njabulo Mabuza told members of parliament that the hospital would soon be open, and the first functioning wards would be dedicated to patients with MDR-TB and XDR-TB.

According to recent health ministry statistics, only twelve percent of Swazis know whether they are HIV positive or not. "There is an urgent need to maximise access to knowledge of one's HIV status, and achieving universal access to HIV prevention treatment, care and support," said Rejoice Nkambule, National Coordinator of the health ministry's Health Education Unit.

Stigma against people living with HIV/AIDS remains strong. "People still do not wish to know their status because they fear being ostracised by their families, friends and co-workers. It happens. TB is a good 'cover story' for many people living with HIV and AIDS, because when they fall sick they blame it on the TB and not AIDS," said Noah Fakudze, a voluntary testing counsellor in Manzini.

At a World TB Day celebration at Manzini's public square on 24 March, people co-infected with HIV and TB testified to the crowd that they could live long and productive lives despite these diseases.

"No one should feel ashamed because they fall sick. The good news is that treatments are here. If you live right, and get tested, you might not even need those treatments," said a woman in her twenties named Rose, who said she had been HIV-positive for eight years and was recently cured of TB.

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