Global Fund to Fight AIDS, TB and Malaria’s Active Tuberculosis Case Finding (ACF) approach is helping Nigeria, the country with highest TB burden in Africa, discover and treat more and more cases of active TB
By Adam Alqali
When forty-five-year old Yunusa Saidu, a farmer, started coughing and began having body pains two years ago, he didn’t have the slightest idea of the fact that he was suffering from a disease that is one of the top 10 killers of human beings in the world: Tuberculosis. Other than coughing and having body pain, Saidu began to have night sweat and lose weight.
Tuberculosis (TB) is an infectious disease caused by the bacteria, Mycobacterium tuberculosis, which primarily affects the lung (Pulmonary TB) and can also affect other organs of the body like bones, kidney and brain tissue (Extra Pulmonary TB).
Among others, Active TB’s symptoms include chronic cough, fatigue and weakness, fever, as well as night sweats and weight loss; TB of the lung is airborne and so can be transmitted if TB germs are released into the air when a TB positive person (who is not on treatment) coughs, sneezes, or talks.
Luckily for Saidu, a year later, the Global Fund to Fight AIDS, TB and Malaria’s Active TB Case Finding (ACF) project was launched in Nigeria and his village, Faragai, a remote rural village located around 60kms northeast of Kano city, Nigeria’s second largest city, was one of the selected communities to be covered by the project.
Global Fund’s Active Tuberculosis Case Finding (ACF) project is an innovative program that employs house-to-house search for TB patients, a process that has brought about tremendous increase in detection of TB cases across Nigeria. ACF came about as a result of the failure of Nigeria’s National TB Control Programme to cover people in remote rural communities like Faragai.
With over 600,000 tuberculosis positive persons, Nigeria is the country with the highest TB burden in Africa as well as fourth highest number of TB patients in the world; with India, Indonesia and China leading the pack. Shortly after ACF was launched, a community tuberculosis worker (CTW) in Saidu’s village, who suspected he had TB, advised him to provide his sputum for diagnosis.
“Abubakar [the Community Tuberculosis Worker] collected my sputum and later came back to inform me that I was having TB,” recalled Saidu “I was immediately placed on medication and I ensured I never missed taking my drugs. I am now feeling better; I no longer cough, have fever or body pain. I am grateful to God and all the organizations and health workers who helped got me treated.”
As well as other infectious diseases like HIV/AIDS, there are so many misconceptions about Tuberculosis in Africa, including beliefs that it is being caused by witchcraft, it is hereditary, and that it cannot be cured. Another misconception is that all TB positive persons are also HIV positive. This underscores the importance of the involvement of community leaders in creating awareness about the scourge as well as efforts to combat it in rural communities.
“This system [ACF] has helped us know about a disease we hitherto didn’t know anything about, says Adamu Mohammed, head of Saidu’s village. “All patients discovered in our village are now on treatment and we are urging the health workers to always report defaulting patients who will be dealt with. We are also encouraging our religious leaders to incorporate sensitization on TB in their sermons to further curtail the spread of the disease in our community.”
Doubtlessly, the success recorded by the ACF project in Faragai and other rural communities in Nigeria is as a result of the support of community leaders to the effort to tame TB in the country. Their collective effort entails sensitizing the people on the symptoms and causes of tuberculosis and the need for precautionary measures as well as ensuring defaulting patients are made to continue taking their medication.
“Our major challenge has to do with defaulting patients who abscond from taking their medication but with the support of the community leaders, we are getting them to resume taking medication. In the last 7 months, we have detected around 40 cases in Faragai and neighboring communities, 37 of which are on medication while 3 are fully cured. We are yet to record a case of multi-drug-resistant TB,” says Hamza Muhammad, a TB DOT provider in the community.
Since the launch of Global Fund’s Active Tuberculosis Case Finding project in 22 of Nigeria’s 36 states, almost 2 years ago, more and more TB positive persons are being discovered and placed on treatment. The fact that the treatment is totally free and drugs are delivered to patients at their doorstep makes it even more appealing to rural dwellers who ordinarily cannot afford the treatment.
Bosun Abolarin, a senior monitoring and evaluation officer at the NGO, Civil Society for the Eradication of Tuberculosis in Nigeria (TB Network), believes changing people’s attitude – at the centre of which is the duo of poverty and ignorance – is very important in the campaign against tuberculosis hence the importance of involving community leaders in the campaign.
“As a result of poverty,” he said “in some communities people will ask community tuberculosis workers (CTWs) for incentives like money before they give information. Unlike Malaria, there is lack of awareness about tuberculosis hence 2017 is going to be a year of accelerated active case finding in Nigeria, and since we have one of the highest figures of active TB cases, we will need more DOT centers to be able to reach more people in remote communities.”
Global Fund has engaged 87 community based organizations (CBOs) and 870 trained Community Tuberculosis Workers (CTWs) across the 22 priority Nigerian states for the implementation of the ACF project. And the Global Improvement of Less Privileged Persons Initiative (GIOPINI) is the CBO responsible for the implementation of the project in Faragai and neighboring communities of Albasu local government area of the state of Kano.
“There is a remarkable progress in the house-to-house search of active TB cases as the government and people of the communities are taking ownership of the project,” said Mohammed Mashi, executive director of GIOPINI, “the government is establishing more laboratories for testing across the communities and people are now bringing themselves forward for proper diagnosis.”
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