Tuberculosis on earth is not unlike craters on the moon. Deep and dark in certain areas, weak at others but omni-present never-the-less.
Like many other developing countries of the world, Ghana, a country located in west-Africa, can be related to such a crater with high TB Prevalence. Out of a total population of 23,478,000 it is estimated that the number of new TB cases is 47,632. This makes Ghana rank 19th in Africa for the highest estimated number of new cases per year, according to WHO’s Global TB Report 2009. Also, the estimated TB incidence (per 100,000 population) in Ghana is as high as 203 (see table below).
As the above statistics clearly state, TB is a menace in the country. While trying to understand the extent of this threat I came across a very interesting piece of information – ‘Deaths from TB account for 25% of all avoidable deaths in developing countries.’ Evidently, Ghana is no different. In fact, Nine percent of the 7,786 TB patients registered in 2007 died before completing TB treatment. To combat this terror, National TB Control Program (NTCP) was established in the country in 1994. It is based on the internationally acclaimed, DOTS (Directly observed therapy-short course) strategy, and has 100% coverage in the different states and districts. This high level of coverage, though, does not qualify for much as the quality of treatment and facilities is still below expectations. The strategy has not yet been integrated with normal functioning in many districts. Even in the areas where it is being incorporated, the facilities and training are inferior enough to ensure lack of ‘knowledge and care’ distribution to their end customer i.e. the Patient.
Today, TB remains a vital but ignored cause of adult and childhood morbidity and mortality in Ghana. The WHO targets for Case Detection Rate and Treatment Success Rate were 70% and 85% respectively. These, obviously are far from being achieved.
A major cause of this disease becoming fatal in the country is the co-relation between HIV and TB. According to Technical Policy and Guidelines for TB/HIV Collaboration in Ghana, 2007, ‘There is a complex relationship between Human Immunodeficiency Virus (HIV) and Tuberculosis (TB) which fuels both epidemics in a synergistic way.’ HIV is fanning the TB epidemic in Ghana. Some supporting statistical data suggests that out of the total reported cases of TB, about 60% occur in 15-49 years. According to researchers, this same age group is also at the greatest risk of contracting HIV. According to WHO, approximately 15.6 percent of new TB cases are HIV positive. The Government of Ghana has a National AIDs/STI Control Program (NACP) to bring antiretroviral therapy (HAART) to all corners of the country. But as Nelson Mandela had rightly quoted, ‘We cannot win the battle against AIDS if we do not also fight TB. TB is too often a death sentence for people with AIDS’. Hence a collaborative strategy (between the NTCP and NACP) on the district, regional, and national levels is being aimed. It is only after the correct and timely implementation of this strategy that the burns caused by the two monsters, namely, TB and HIV will get soothed.
Apart from the above mentioned collaborative strategy, training of DOTS providers and counselors is also of immense importance. It is through these focal points that any aid or program reaches its intended audience. Hence, the health workers who are in direct contact with the ground realities are the ones who need to be effectively trained and taught how to counsel the patients and their families and also give them the hope and strength to fight Tuberculosis. It is the stigma and low level of awareness which instills fear and as we all know – fear is the key ingredient of destruction.
Hence, to achieve the eventual goal of making Ghana TB free, the need of the hour is to first strategically tame the monster.