The Sunday News
Robin Muchetu, Senior Reporter
MORE than 12 000 Tuberculosis cases were missed in Zimbabwe in 2021, a situation caused by a delay in seeking health attention, limited access to facilities and high staff turnover of specialists in the field.
According to the Ministry of Health and Child Care there was a 26 percent decline in TB notification in 2020 compared to 2019 with a three percent improvement in 2021. There is however, a gap between TB incidence and TB notification with 12 520 cases missed in 2021.
The annual incidence represents the estimated national burden of TB and the notifications are the actual TB patients identified and reported in the national health system. Missed cases are represented by Incidence minus Notifications.
Deputy director Tuberculosis Unit in the Ministry of Health and Child Care Dr Charles Sandy said various challenges have led to this gap.
“TB cases are missed due to poor health seeking behaviour, delays in seeking care, limited access to health services (geographical or financial or both), low presumption index by community health workers and health care workers and under-reporting.
The proportion of coughers screened for TB at facility Out Patients Departments is less than 10 percent versus 100 percent.
This is mainly attributed to low-risk perception by Health Care Workers to presume TB and follow up patients through the diagnostic cascade,” said Dr Sandy.
Brain drain which has affected the country has also been named as a challenge in mopping up all cases of TB in the country.
“This is compounded by a high staff turnover leaving behind inexperienced staff who are also short in numbers. For instance, in the year 2021, 123 421 patients presumed for TB, 94 849 had specimens sent to the laboratory and 86 224 received results.
This just shows the leakages along the diagnostic cascade that results in cases being missed. Contact investigation activities are weak mainly due to lack of motor bikes and fuel in the peripheral facilities,” he said.
Dr Sandy said if TB cases are missed there will be an increase in adverse outcomes among those suffering from TB together with an increase in TB morbidity and mortality.
TB, just like Covid-19, is a communicable disease that can spread through contact with an infectious source. He said undiagnosed TB cases will serve as reservoirs of sustained community transmission.
In a bid to mop up all the missed TB cases, the ministry has however, devised strategies to assist in getting all cases identified such as strengthening community TB care, including a wider involvement of communities in TB knowledge, awareness behaviour change, case finding and treatment support.
The ministry will also conduct targeted active screening for TB at the community level to bridge the geographical and financial access divide and also expansion of the TB diagnostic network through further decentralise diagnostic capacity to high volume primary health facilities with the aim of improving access to highly sensitive and WHO recommended diagnostic tests.
Dr Sandy said the country has 140 GeneXpert machines used in the rapid testing of TB and an additional 20 Truenat machines have been deployed to remote sites that do not have electric power supply.
He said the ministry has also started capacity building and mentorship of health care workers in TB case finding and management among other interventions.
Every year, the world celebrates World TB Day on 24 March, a day set aside to educate the public about the impact of TB around the world.
This year’s commemorations were held under the theme “Invest to End TB. Save Lives”, coming on the backdrop of a surge in the number of people that have died of the disease due to the Covid-19 pandemic.
Zimbabwe Civil Liberties and Drug Network (ZCLDN), an organisation that advocates for the effective strategies for addressing problems associated with use of drugs in Zimbabwe, said there is need to invest resources to ramp up the fight against TB and achieve the commitments to end TB made by global leaders especially among people who use drugs in their diversity.
“We believe with a robust and well-invested TB programme, stigmatising and criminalising of people who use drugs could come to an end.
People who use drugs and substances are more susceptible to TB because their bodies are weak and cannot defend themselves against illnesses such as TB/HIV/Aids and Hepatitis B and C,” they said in a statement.
According to the World Health Organisation’s 2021 Global TB report, in 2020, more people died from TB, with far fewer people being diagnosed and treated or provided with TB preventive treatment compared to 2019, and overall spending on essential TB services falling.
The theme of World TB Day 2022 — “Invest to End TB. Save Lives” — conveys the urgent need to invest resources to ramp up the fight against TB and achieve the commitments to end TB made by global leaders. — @NyembeziMu
