World TB Day was observed on Tuesday, March 24, 2009. Worldwide, the disease has continued to spread, with developing nations like Uganda affected most by the epidemic, which kills nearly two million people every year.
While the TB crisis is currently escalating, the alarming rise of TB infection worldwide can be reversed by minimizing the factors encouraging the creation of drug-resistant strains and by providing more funding to eradicate the disease.
TB affects the world’s poorest, with 98 percent of deaths from TB occurring in developing countries -- but a recent Scientific American article cautions that “the developed world would be mistaken to consider it safe,” citing the explosive growth of highly resistant strains of tuberculosis that do not respond to drugs.
Uganda’s TB rate is measured at 600 per every 100,000, in stark contrast to a rate of 4.2 per 100,000 in the United States. Efforts to curb the spread of the disease have been slowed by several stumbling blocks. An under funded health care system, low availability of affordable drugs, limited access to basic services like water (34% of Ugandans do not have access to clean water), and widespread government corruption have negatively impacted the health of many communities.
One symptom of Uganda’s failing health system is the reported mass exodus (Monitor, March 23, 2009) of doctors from the country. Doctors who work at government hospitals are paid roughly $450 USD per month, prompting corruption by many who sell donated medicines on the black market.
Although money continues to flow to Uganda from various donors, little progress has been made in curbing TB. The United States, Uganda’s third largest donor, contributed USD $2.2 million in 2008 through USAID specifically for TB. The US also contributes to the Global Fund to fight HIV/AIDS, tuberculosis and malaria, which has approved nearly USD $8 million in grants to Uganda for TB programs, but countrywide, patients have little access to TB drugs.
Lack of treatment and interruptions in treatment prompted by the shortage of drugs in the country are leading contributors to the creation of drug-resistant strains of TB. The conditions of extreme poverty where large populations live in overcrowded, poorly sanitized areas, is also a leading factor in the spread of TB in Uganda.
In northern Uganda, where war-affected communities struggle to rebuild following decades of war, high poverty, low access to clean water and poor sanitation (Gulu District in northern Uganda has one of the lowest levels of latrine coverage) have created an environment ripe for disease transmission.
Health officials report that highly infectious, drug resistant strains of TB are increasingly surfacing in the North, with children making up the largest number of newly reported TB cases.
While the rate of TB is increasing fastest among children, health officials in Northern Uganda reported in January that no medicine for children under 14 had been received for several months.
The spread of TB in northern Uganda has been worsened by the high rate of HIV/AIDS. People with weakened immune systems are easy preys for TB.
The high rate of co-infection (60-70%) calls for a measured, immediate response from health officials -- especially as the national HIV/AIDS rate continues to rise -- reversing the progress made in the early 90s.
Government Excesses, Health Care Neglected
Although there is a shortage country-wide of life-saving drugs and a dire lack of basic services like water and health-care, Ugandans point to the continued excesses of the Ugandan government, which recently authorized the purchase of a new Presidential jet at the tune of USD $55 million, and the renovation of Uganda’s State House, at a whopping USD $100 million.
Clearly, health care has been left behind as a priority. Highlighting the Ugandan government’s lack of concern for critical issues, An Economist article (Feb. 12, 2009) opined that though Uganda’s President Museveni is planning sweeping economic changes in the East African Community, including the introduction of a single-currency, “he is oddly blasé about other challenges” listing the high poverty rate among Ugandans as a neglected concern.
In order to effectively curb the potentially disastrous spread of highly infectious, drug-resistant strains of TB, Uganda’s donors must hold the Ugandan government accountable and ensure that adequate attention and resources are focused on reducing the TB infection rate.
Donors must also ensure that Uganda continues to make progress towards the Millennium Development Goals that it has pledged to achieve. Doing so would ensure that multi-drug resistant strains of tuberculosis, which are more difficult and expensive to treat, do not continue to spread globally.
As the world grows increasingly smaller, and people travel more frequently from place to place, global health must be a priority. The highly infectious nature of TB means a mere cough could be the bearer of a devastating disease.
Improving health care, sanitation and access to clean water are achievable goals. Allowing the growth of infectious TB to continue unchecked will harm us all.
TB in the United States: 12,898 new cases were reported in 2008. The Centers for Disease Control (CDC) reports that the average rate of decline has slowed to 4%, compared with a 7% rate. Four states: California, New York, Florida and Texas reported more than 500 TB cases each in 2008, accounting for nearly 50% of reported cases. Seventeen states reported higher rates of infection in 2008.
More Current Information About Health in Uganda:
Tuberculosis Leading Killer of People with HIV: www.aegis.com/news/nv/2008/nv080215.html
Irish Envoy Irked by HIV Rate: www.newvision.co.ug/pa/8/13/675616