12 October 2009

'Not much progress' in TB fight

Not much progress has been made in preventing the spread of tuberculosis, said Deputy Health Minister Molefi Sefularo recently.


"Not much progress" has been made in preventing the spread of tuberculosis, Deputy Health Minister Molefi Sefularo said in Cape Town on Monday.

South Africa's performance in fighting TB was worse than that of its neighbour Mozambique, despite having far better resources, Sefularo told a meeting of Aids and tuberculosis specialists, the Consortium to Respond Effectively to the Aids/TB Epidemic.

"TB prevalence has increase almost threefold in the last 10 years. South Africa is amongst the 10 worst performing countries on TB control. This has left us anxious and concerned."

Number on cause of death
A recent report by Statistics South Africa found that for every 100 deaths in 2006, 13 were from TB. This made the sickness the number one cause of death in South Africa.

The World Health Organisation (WHO) estimates almost 1% or 461,000 South Africans develop TB annually.

Although South Africa's current cure rate of about 65% is significantly better than the 51% it had been in 2004, the country is still way below the WHO recommended cure rate of 85% required to disrupt the country's high levels of infection.

SA may not reach target
Sefularo said the country was in danger of not reaching the goal of halving prevalence and death rates by 2015, compared with their levels in 1990.

"We are in danger of not meeting our Millennium Development Goals as a result of these poor outcomes." Sefularo said the government was well aware it had to "more than double" its efforts.

"We need a change of mind set and more sense of urgency to confront the scourge of TB. Program managers whose responsibility is to implement government programs against TB and our partners, whose daily work is to assist us as a country to deliver better outcomes, should not only be satisfied with drafting crisis plans. "All should work in partnership to ensure that society gets involved in our fight against TB, as we have declared this a priority disease."

TB/HIV combo a great challenge
Sefularo said the onset of both multi-drug resistant TB (MDR-TB) and extremely drug resistant TB (XDR-TB) and their lethal combination with HIV in some areas of the country posed major challenges, "possibly in a manner that this country has never faced before".

"Their management demands more from health workers than what they ordinarily are required to offer, as they have to maintain the delicate balance of respecting patients' human rights and the need to ensure public health safety in view of a fatally contagious ailment.

"The associated problems of compromised psychosocial well-being of infected patients place additional strain, as health workers often have to extend their service into areas that their training may not have adequately prepared them for."

Lapses in institutions
Although there were infection control policies and guidelines with better compliance in drug-resistant treatment units, there were major lapses in many institutions, including general hospitals.

"Smear-positive patients are usually found in open wards, mixed with susceptible patients, including HIV positive, diabetic and elderly patients," Sefularo said.

In response, the department is pushing for more intensive training on infection control in partnership with other institutions, including the CSIR.

"Existing policies and guidelines will be tailored to specific health facilities with individualised action plans." The National Treasury estimates about R1.8 billion is available to fight TB, well below the estimated R4.5 billion needed. - (Sapa, October 2009)


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