Lesotho tops the world in TB

Mohloai Mpesi

For over a decade Lesotho has been a country struggling to fight many diseases among them the curable but stubborn lung-drilling Tuberculosis (TB), thus ranked the number one country in the world with the prevalence of TB.    

The TB Prevalence Survey conducted in 2019 that was mandated to understanding the TB burden and identifying ways to improve TB management in the country revealed jaw-dropping records of 581 per 100 000 people infected. Currently the country holds a record of 653 per 100 000 populations.

The survey explains that a total of 39, 902 individuals were listed at the households. Females constituted 22, 069 (55%) of the respondents. Majority of individuals listed were children under the age of 15 years 12, 583 (32%), and 23, 448 (59%) were rural dwellers.

The report divulged the TB treatment history that the overall, 285 (1.31%) participants reported that they were currently on TB treatment during the survey time while 1, 943 (9%) participants reported to have previously been treated for TB. “Leribe had the highest number of participants, 83 (0.38%), who reported being on TB treatment during the survey time, followed by Maseru with 63 (0.29%). Similarly, Maseru 613 (2.82%) and Leribe 268 (1.23%) had the highest number of participants who reported to have been previously treated for TB. On the other hand, Mokhotlong had the smallest number of participants 3 (0.01%) who reported receiving TB treatment at the survey time,” the report read.

“Urban areas have 158 (0.73%) participants who reported being on TB treatment during the survey time, while rural areas and peri-urban areas reported 124 (0.57%) and 3 (0.01%) respectively. In the case of participants who reported to have been previously treated for TB, rural areas had the highest number 996 (4.56%),” the report read.  

The Ministry of Health’s TB Programme Manager, Dr Llang Maama, said the road to victory is nowhere near with the escalating death rate. Last year the country registered 14% of deaths caused by the disease and the targeted 90% of recovery rate seems to be a far goal to reach.  

“We are unable to combat this disease because the death rate keeps on mounting, it is a very high rate,” she said.

“Currently we are standing at 77% of recovery because the rate of death is high and our target is to reach 90%,” she said.      

Besides the fact that Covid-19 contributed immensely to the scourge of the disease, negligence to take medication by the patients added to the factor of the prevalence of the disease.

A feat which brings another issue to the fore, promoting another stubborn TB type known as Drug Resistant TB which repels the medication if a patient does not take the pills well on time or either has stopped taking them.

TB is a disease caused by micro bacterium tuberculosis which affects the lungs most of the times, but other times a small proportion can affect other parts of the body; extra pulmonary TB which affects the bones and spinal cords.

The survey reveals that all the age groups are vulnerable to the disease; 65-year-old people being the more prevalent. The rural and peri-urban as well as the makes are the most vulnerable groups.       

“With this survey, we are able to assess the sustainable development goals that we conduct almost every year to see the prevalence of TB, and the rate is high this year because we currently rank number one in the world with 652 per 100 000 populations.

“We set a target every year and you’d find that we hit the lower number that says there are some infected people loitering around and infecting others. So we have to test all the infected people so that we treat them in order to decrease the rate of the disease. So it is our challenge and we urge all the infected TB suspects to go to the clinics so that they get treatment.

“Covid-19 affected patients with the disease a lot because of lockdowns where a number of people coming to the clinics for pills were reduced. Also, to know if one is infected, we test everyone who came to the health centres, so a few people came to clinics and we could only test a few and our chances of getting infected people were reduced and that only signalled that some people might even have died.

“TB is curable; many people die because they delay to come to the health centres for treatment. But if they could all go for treatment, they will be saved. Even the stubborn ‘Drug Resistant TB which is cured after a long time is treatable. It is worse when one is HIV positive,” she said.

She continued that they have made plans and strategies that would mitigate the plague of TB, among others are a contact tracing which will help to trace the infected people.

“Since this disease affects people at the community, we have developed strategies to fund people at the community level. We have a Centre of Excellence Project where our vision was to stay in the community and screen all the community, we started in Leribe and were about to go to Berea but we were halted by Covid-19. Also our Prevalence Survey taught us that the use of x-rays helps to detect many suspects who we will have to test.

“We were also going to help the Health Workers, to help them build the corporation schemes to eat healthily at all times. So they were going to be paid to according to their good work and that they should also continue to be resilient even when we are gone, and that they should go in the village to search for people infected by the disease.

“The other strategy is contact tracing, where we are going to trace the people who relate to the patient should they have also contracted the disease.  Another that one is that people who are vulnerable to the disease should test and those who do not have it must be given the medication that will be resistant to the disease,” she said.

The money amounting to M166million was announced in the National Assembly’s Parliament as part of the 2021/22 budget by the Minister of Finance, Thabo Sofonia a fortnight ago to fight the TB and Immunisation.

The sum is a part of the money allocated to fight TB, which adds to the financial support from the Global Fund, a capital budget which has been put under Global Fund Support to TB project.

“We also allocate money amounting t0 M482million so that people should have good health especially when we are on the campaign to fight HIV and AIDS. The country is on its toes to fight the TB and has allocated money amounting to M166million to fight Tuberculosis and Immunisation.” Sofonia said.

Maama said the money will help them to, “stretch health facilities to test males; miners, ex miners, male and female prisoners, health workers, factory workers, taxi operators et al, because we have categorised people according to how vulnerable they are to the disease and the 6.9million has been mandated to serve among others, such projects.

“We have two health facilities in Maseru and Mafeteng where the mentioned people are treated, we were helped by the Global Fund although the facility is now under the government’s control, Global Fund continues to help us and the government also injects a certain potion of money to fight the disease, that’s where a part of the allocated sum is used.

“We are now going to make some improvements during our testing process so that we get all those who are infected,” she said adding that last year they were only able to test a few number of people due to lockdown while the positive patients halted their routine of collecting medication at their respective health centres which created an inconvenience since they had already purchased the medication. She said some of the pills are soon going to meet their expiration date. 

“Last year we only treated about 4 634 patients, while in 2019 they were only 7 052 and that was the low number because our estimate was around 15 000. Last year during Covid-19, the numbers declined, this means that the situation is worse. It is true that Covid-19 and flue have similar symptoms of coughing, but Basotho are now hiding behind Covid-19.

“Education about the disease was still shared to the people but was disrupted by Covid-19, so we have to start again. We used to tell the taxi drivers to lower the windows when driving passengers because some might have the disease and they infect the operator.

“When we ask people why they didn’t come to collect their medication, some said they thought the clinics are closed. So that gap they took without medication is very dangerous to them and those around them. So we are still anticipating to experiencing that Drug Resistant TB again since they took long without taking medication.

“We were already prepared for 2020 to stop the disease; the pills that we have bought are going to expire because a few people showed up to the clinics last year because of Covid-19. Our staffs were also reduced because some were taken to work on Covid-19 related issues.

“I urge all to go to the health centres to rest for TB so that if one doesn’t have it, they will be given a pill that will make the body to resist the disease. People should eat healthy, excise, stop the intake of alcohol and drugs.

“The rate of death interrupts us from getting the Treatment Success Rate, where our target is 90% of people we want to have been cured completely. But we are now standing at 77% because the rate of death is high.

“Last year the rate of death was 14%, so it is difficult to get to the 90% that we want when we still experience these rates of people dying. TB is curable and it is not good that people die of this disease when it can be cured. Some disappear, we call them lost follow ups, those are the ones who put us at a devastating position because by the time they return, and the diseases are no longer controllable and will take time to heal. Some we don’t even know where they are at all.”

She continued that, “People with malnutrition problem are vulnerable because their white blood cells are weak and are prone to the disease.