Advertisement

Public, private sectors join forces to fight TB in urban slums of Uganda

Saturday March 28 2015
newss04 pix

Tuberculosis patients at Gulu Regional Referral Hospital. A group of volunteers is helping to diagnose, treat and make follow-ups of patients through a public-private partnership innovative programme. PHOTO | RACHEL MABALA

Hethiri Bukenya first developed a persistent cough when he was two-and-a-half years old. Slowly, he started to lose appetite and as his weight declined, he became weak and frail.

By the age of five, he was falling ill regularly. His mother, Sarah Najjuka visited several health facilities including Mulago, Uganda’s national referral hospital, all of which failed to diagnose the problem.

But one evening as a village health team (VHT) member was conducting an awareness programme in Kampala city’s Kawempe Division, Najjuka learnt of the symptoms and signs of tuberculosis.

“The symptoms were similar to those my son had. The next day I visited Pillars Medical Centre, which the VHT recommended for those who had symptoms,” said the 22-year-old single mother.

VHTs are groups of volunteers who mobilise, recommend referrals and inform communities about the availability of services at health units.

At Pillars Medical Centre, which is located in Bwaise, Kawempe division of Kampala, Bukenya tested positive for TB. He was put on a six-month treatment course, which he completed in June last year.

Advertisement

Bukenya and his mother live in a one-roomed house in the sprawling slums of Kawempe.

Slums are ideal breeding grounds for diseases such as TB as most housing in these areas is overcrowded and poorly ventilated, making it easy for air-borne diseases to spread from person to person.

Health officials project that Uganda gets nearly 60,000 new cases of TB every year. However, because of factors such as poverty, lack of knowledge about risk factors and symptoms of TB or limited capacity of the health facilities to correctly diagnose the disease, many people who live in urban slums rarely seek treatment on time, further facilitating the spread of the disease.

Patients like Bukenya can get a diagnosed and receive treatment because of a public-private partnership innovative programme — the Slum Partnership to Respond to TB in Kampala (SPARK-TB), which works with community-based health facilities to aid the diagnosis, treatment and follow-ups on patients.

The programme, initiated by the International Union Against TB and Lung Diseases, commonly known as the Union, helps to fight TB in high burden countries such as Uganda with the help of volunteers.

John Kisembo, a volunteer who works in Bwaise said: “My job involves going around the community and sensitising people about the TB services and where they can get treatment; For those who test positive and start treatment, I must ensure they are taking their medicines as prescribed by the doctor.”

Under the Union programme, patients who are diagnosed with TB in private facilities can receive free medicines provided by the public sector.

“Because the national TB programme remains largely under-funded, innovations like these have made it possible for us to reach a large number of people in diagnosis and treatment,” said Dr Frank Mugabe, head of the TB and Leprosy Programme at Uganda’s Ministry of Health.

Dr Anna Nakanwagi-Mukwaya, the Uganda country director for the Union, said many TB cases, particularly in the slums, remain untreated because of limited resources. 

“The tendency is always to put services in big, government facilities far away from the communities,” said Dr Mukwaya.

Dr Mahmoud Kasawuli, the director of Pillars Medical Centre, said before the clinic started treating TB patients in 2011, those who presented with symptoms were often referred to public facilities. However, with no mechanism for follow-up, many suspected TB patients often returned to their communities without seeking treatment, further spreading the disease.

“Now that the service is within the community, we can follow up the patients in their homes and know if they are defaulting on treatment,” said Dr Kasawuli.

Dr Kasawuli said the presence of a GeneXpert machine at the facility had made it easier for doctors to diagnose and treat TB patients in his community.

With funding from the Stop TB Partnership and Centres for Disease Control and Prevention, the Ugandan government has installed 74 GeneXpert machines in selected public and private health facilities across the country.

The GeneXpert technology allows doctors to correctly diagnose TB in less than two hours. It is especially recommended for testing TB among children who cannot produce sputum and for diagnosing the disease among HIV-positive people or those with multi-drug resistant strains of TB.

Sputum smear

Most countries in the developing world rely on sputum smear microscopy, a diagnostic method that may be cheap, but is unreliable for testing TB among people who are HIV-positive. In Uganda, at least half of all TB patients are co-infected with HIV.

With many undetected cases, Dr Mugabe said that about 10 per cent of patients who are treated become re-infected or the disease recurs.

“Because it is an airborne disease, getting cured of TB does not mean you have been immunised completely. You may get exposure from someone who has not been treated,” he added.

The country detects only about 60 per cent of all TB cases, and successfully treats 77 per cent of these.

The global target is for countries to successfully treat at least 85 per cent of all cases.

“TB would be the simplest disease to manage if it were well funded in terms of contact investigation, diagnosis and treatment,” said Dr Mugabe.

Another challenge to managing TB is failure to complete the required dose of treatment. For many patients, taking antibiotics every day for six months or more is a challenge, and when their health starts to improve after a few weeks of treatment, there is a tendency to abandon the medicines.

That is why the World Health Organisation introduced the Directly Observed Treatment Short Course (DOTS) programme, which requires patients to swallow their medicine in the presence of a health worker or village health team member.

Uganda introduced the DOTS programme in 2004.

“DOTS starts from diagnosis to treatment initiation and support. Ideally, we should be having a component where health workers visit homes to deliver the medicine, but because of underfunding, we rely on volunteers and caretakers,” said Dr Mugabe.

Poor adherence has also resulted in the emergence of drug-resistant strains of TB that the standard antibiotics such as rifampicin cannot treat.

“Drug resistant TB can take more than 20 months to treat, which may also have a social and economic effect on the patient,” said Dr Mugabe.

Currently, it costs about Ush30,000 ($10.08) to treat non-drug resistant TB, with treatment lasting between six and eight months. However, when a person develops a more resistant strain of the disease, treatment costs can go up to $4,000 and it can take as long as two years before a person gets cured.

Dr Mugabe noted that without addressing the growing cases of TB in slums where the disease often spreads faster than in the general population, all other efforts would be in vain.

Advertisement