The making of a social disease: Tuberculosis and the unending campaigns

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Tuberculosis is a highly contagious multi-system disease. This simple fact is as indisputable as it is misleading.

Tuberculosis in 2016 is the foremost killer of mankind linked to a single infectious agent (now surpassing HIV/AIDS) and up to 95% of TB cases and 98%of TB mortalities are in resource-constrained developing countries (WHO, 2018).

Asia, Eastern Europe and Sub-Saharan Africa are the worst hit. No thanks to their favourable weather conditions and teeming population with many a person living in squalor.

Nigeria lamentably sits at position 4 of 22 of the most burdened countries (WHO, 2016). A lamentable reality.

Tuberculosis led to 1.8million deaths globally in 2015 (WHO, 2016). That corresponds to 3 deaths every minute.

Tuberculosis is a social problem in that it affects typically the most economically productive age groups, is a chronic disease that often brings its sufferers to poverty even if they were rich initially; thus has been described as a disease of poverty and is associated with a host of community stigmata.

Regardless of the preponderance of effective anti-TB drugs, TB is not on the decline. On the contrary, if present trends aren’t reversed, the yearly number of new cases arguably could increase from 10.4million in 2016 (WHO, 2018) to about 15million in 2020.

There are many reasons why the WHO End TB campaign is not making as much gains as are the efforts invested therein. One of them, is the poor healthcare seeking behaviour of at risk groups. Health is a fundamental human right, nevertheless, health itself is not completely possible if the people are not seeking the right care at the right place. The patient’s health is primarily his own responsibility, before it is that of third parties or the healthcare system.

How many people in Sub-Saharan Africa engage with healthcare systems is both discouraging and problematic owing largely to misconceptions and delimiting belief systems. For instance, Edginton et al (2002) found that beliefs like breaking a cultural law on abstinence from sex after bereavement and after a woman has spontaneous abortion as an influencing factor for where and how a woman decides to seek care. Nyasulu and colleagues (2016) in Malawi pointed out that many locals still associate TB to “bad air”, tobacco, promiscuous sexual behaviour and sheer uncertainties. This corroborates the findings of Hoa and colleagues (2003) in Vietnam who showed that TB patients retained feelings of guilt and blame because their communities stigmatized them as immoral and many are reluctant to seek care early. Again, these communities strongly correlated TB with witchcraft.

There are those who believe that there are two kinds of TB: One curable by modern medicine and another curable by traditional medicine or by a witch doctor. Several other studies in different Sub-Saharan settings corroborate this (Austine et al, 2004; Boeree et al, 2000; Bara et al, 2007).

Elsewhere, perceptional inconsistencies around men’s bodily strength or the appropriate response they should muster debars them from seeking care early. A man is considered macho and should only seek care not at the slightest notice of a symptom but when the disease has really weighed him down. How people reason!

Tuberculosis healthcare seeking behaviour studies repeatedly indicate that patients do not always choose a formal care pathways, they delay diagnosis and often do not adhere to the long treatment regimen. This reality hinges on a complex of implicit assumptions, perceptions and socioeconomic/sociodemographic contingencies including patient and systems factors.

There are contrasting evidences however, whilst some individuals readily choose formal care systems understanding TB to be a “European Disease” responsive to Western Medicine, the sentiments are different in other Sub-Saharan African communities and even for individuals within the same region, some of whom hold strongly to African mythologies or “hand of God” contagions.

Suffice it to say that one of the commonest diagnosis often mentioned within the ranks of many African locals is usually: ‘ATTACK’… I have myself dealt with countless patient who conceive that their ailment is spiritually sent to them by their enemies. Sadly, even some educated folks think this way regarding any severe or limiting illnesses that befall them or persons they know.

The implication is that TB suspects are likely to take a long time establishing an deciding whether to seek orthodox or traditional care. More often than not, people start consulting traditional healers first, then resort to the formal sector only after traditional remedies have failed.

For the umpteenth time, TB is a biomedical phenomenon — a highly infectious disease…Not a the consequence of the wrath of an offended god, not an attack from perceived or real enemies and not a sexually transmitted disease. One needn’t be HIV positive to develop TB, although both co-exist often. The causal agent, tubercle bacillus or Mycobacterium tuberculosis is a bacterium transmitted from person to person through inhalation of ‘aerosolized’ sputum droplets expelled through coughing and Not Through Sex. TB affects virtually every organ: brain, liver, kidneys, bone, lymphatics, intestines, lungs etc, but occur most often in the lungs.

Cough lasting over 2 weeks, low grade fever, drenching night sweats and progressively losing weight are some of the clinical markers of an active TB…Be proactive about your health, seek care early. Tuberculosis is a curable malady.

G.Mark.

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