Tuberculosis: Our Impact

 {Photo: MSH staff}Nimeri and his family relocated to Yei when war broke out in Juba. Nimeri was in his sixth month of TB treatment.Photo: MSH staff

Ripenti Nimeri Yotma is a 40-year-old soldier who has lived through war and being displaced. But it was a battle with Tuberculosis (TB) that almost killed him. The father of three children (aged 14, 4, and one and a half), Nimeri presently lives in Logobero Village, Yei Boma. However, his illness started in April 2013 while he was still living in Juba. When his persistent cough eventually led to him coughing up blood-stained mucus, Nimeri’s wife took him to the nearest health center in Juba City, where he was examined.

{Photo credit: MSH staff}Photo credit: MSH staff

Kabul is the largest city in Afghanistan, with a population of over 3 million people. The population density leads to overcrowding and strains health systems and infrastructure. In a country with a high tuberculosis (TB) burden, TB service delivery has been a particular challenge. In 2009, only 22 of the 106 existing public and private health facilities in Kabul provided partial TB services. TB case detection was only 26 percent, and the treatment success rate was 49 percent. All TB indicators for the city consistently fell below national targets.

{Photo credit: Loren Gomes/SIAPS}Photo credit: Loren Gomes/SIAPS

Curbing the spread of tuberculosis (TB) requires that patients have uninterrupted access to a full course of treatment—frequently a difficult task in developing country settings considering that each regimen includes multiple medicines taken over the span of several months. These may need to be customized based on the type of TB being treated and the patient’s reaction to the prescribed combination. The emergence of multidrug-resistant TB (MDRTB) and extensively drug-resistant TB (XDRTB) further complicates the management of TB medicines.

 {Photo credit: Diana Tumuhairwe/MSH}Musingire Annania (right) has successfully battled TB with the help of Paul Sebale (left), his community linkage facilitator.Photo credit: Diana Tumuhairwe/MSH

This is the story of Musingire Anania, a 45-year-old, small-scale laundromat owner from the slums of Mulago in Kampala District, Uganda, who has successfully battled tuberculosis (TB) through the dedicated efforts of his community linkage facilitator, Mr. Paul Sebale, and an example of how community linkages can help a TB patient at the brink of death to start and complete treatment and be fully cured.

 {Photo credit: MSH staff}Mariam Nangobi receives treatment for multidrug-resistant TB (MDR TB) at an MSH-supported health facility in eastern Uganda.Photo credit: MSH staff

Mariam Nangobi was first diagnosed with tuberculosis (TB) in 2010 when she was 12 years old. After completing a full, eight-month course of treatment, she still tested positive for the disease. She was referred to a larger health facility where she stayed for two months, receiving daily injections. Again, after treatment, she continued to test positive for TB and missed a year of school. Health workers eventually diagnosed her with multidrug-resistant TB (MDR TB) -- a strain of TB that cannot be treated with the two most powerful first-line medicines.

 {Photo credit: MSH staff.}A community health worker brings sputum samples she collected during home visits for testing at a laboratory.Photo credit: MSH staff.

Solange Bitondo coughed for a year, but never sought treatment from the Kinkindi health center less than a kilometer from her home. Instead, the 37-year-old mother of three consulted traditional healers, prayed, and self-medicated with herbs and medicines she found in the market. 

{Photo credit: MSH staff}Photo credit: MSH staff

The average Ugandan woman gives birth to 6.2 children—a national fertility rate that is among the five highest in sub-Saharan Africa—increasing the chances of complicated pregnancies and deliveries. If all unmet need for modern contraceptive methods in Uganda were satisfied, it is estimated that maternal mortality would drop by 40 percent, and unplanned births and induced abortions would decline by about 85 percent. 

 {Photo credit: Berhan Teklehaimanot/MSH}HEAL TB has trained 471 district TB focal persons on identification and management of TB in children in the Amhara and Oromia regions of Ethiopia.Photo credit: Berhan Teklehaimanot/MSH

The World Health Organization (WHO) estimates that up to 80,000 children die from tuberculosis (TB) each year and that children account for over half a million new cases annually. Unfortunately, global figures likely underestimate the burden of childhood TB worldwide due to missed diagnosis, causing TB in children to be a ‘’hidden epidemic.”

 {Photo credit:  Diana Sharone Tumuhairwe} MDR-TB patients receiving continuous health education at Lira hospital.Photo credit: Diana Sharone Tumuhairwe

Although the incidence of tuberculosis (TB) in Uganda is declining, multidrug resistant TB (MDR-TB), a strain of TB that cannot be treated with the two most powerful first-line medicines, is a growing concern. This is especially true in Uganda’s Lira district, a commercial hub in the Northern region.

{Photo credit: MSH staff/Afghanistan}Photo credit: MSH staff/Afghanistan

Dr. Mohammad Khakerah Rashidi is Country Representative of Management Sciences for Health (MSH) Afghanistan and Project Director of USAID's Challenge TB in Afghanistan. Rashidi also serves as First Vice Chair of the Country Coordinating Mechanism (CCM) Afghanistan (Global Fund) and is a Senior Lecturer at Zawul Institute of Higher Education. Earlier in his career, Rashidi says he was the “only medical doctor for more than a million people.” He spoke to MSH about its TB work in Afghanistan in the context of a fragile state.

Pages