For Iniobong Mkpa, a 53-year-old man in one of the communities with high TB cases, though he has been coughing for more than two weeks, he would rather choose to live with this nagging cough than to provide a sputum for a Tuberculosis (TB) test.
Mkpa, whose surname literally means death, was one of the community members who attended a free healthcare programme carried out by the Akwa Ibom state ministry of health in partnership with some organisations working to eliminate TB in the state TB is deadly and has been the highest killer disease before COVID-19.
“I can’t spit into any container,’’ he said emphatically and he moved away from the health officials who were conducting the screening.
Nigeria ranks 6th among the 30 high burden countries and the first in Africa in terms of numbers of people with TB and every year, around 245,000 Nigerians die from TB and about 590,000 new cases occur, according to the World Health Organisation.
Finding new cases of the disease is important because it will help in bringing them under treatment and reducing the possibility of new infections. To achieve this, many states were given targets to meet.
For instance, Akwa Ibom State had a target of 3085 cases to be found between April and June this year but only 1472 or 47.7percent cases were found, a far cry from the expected target.
“Akwa Ibom State is under-tested; we need people to come out for testing, we are not testing enough to find more cases of TB,” says Bassey Akpan, a medical doctor and the programmes manager, TB and Leprosy Control Programme in the state Ministry of Health.
According to experts, stigmatisation, low microscopy testing for follow up and inadequate funding are some of the challenges hindering the scale up of testing and the finding of new TB cases in addition to “optimisation of sensitisation testing and enrolment of cases during the National Tuberculosis Week marked yearly in March 24.
For Etop Antia, a medical doctor and Public Health specialist, the national TB testing week is an innovation to find missing TB cases which should be fully utilised by all to reduce the disease burden. Antia is the director of public health, Akwa Ibom state ministry of health and has been working round the clock with partners to ensure that missing cases of TB are found.
While more than 35 people were screened at the dilapidated health facility built in the 1940s, with only one community health worker, others volunteered to provide their specimen and stool depending on their ages.
The village head of Ikot Akpan Ntembom in Etinan Local Government Area, Ekerette Jumbo said the health centre built by the community was demolished to make way for the construction of the Etinan Ndon Eyo highway to connect the East West road.
We have sent emissaries to the state government, our women who used to give birth at the health centre before it was demolished are suffering, the state government should come and build our health centre, no compensation was paid when the facility was pulled down,’’ he said.
An investigation showed that the community had a well equipped health centre, additional block for staff quarters and another hall for patients but all were pulled down.
‘We want the state government to come and build our health centre for us,’’ he lamented.
Dropped in a carton at the dispensary, the specimens are usually picked up by riders who collect them to where there are laboratory scientists to do the test and send back the reports to the health facility.
According to investigations, this is usually fraught with delays and errors in the labeling of the documents and accompanying information about the owners of the specimens.
For instance, investigation shows that the container has the specimen, the names of the people are not usually correctly written, no contact information and it is often a big task to locate the owners of the specimens.
Sometimes, the laboratory scientists outrightly reject containers that are not properly indicated and this has worked against concerted efforts being made to find more TB cases.
“I have rejected many samples that were not properly labelled,’’ one lab scientist, who did not want his name in print, said recently.
“Some of them in the communities do not have telephones and so cannot be reached while the space provided is not enough to contain all the necessary information,’’ another lab scientist said.
Though TB treatment is offered in many of the health facilities in the state, only a handful can offer laboratory services with up to date equipment while health centres have to wait for riders for days who collect the samples to turn them in for testing.
This shows the critical role of laboratory scientists in chasing the missing TB numbers as any delay in the delivery of the samples, timely testing and submission of results lead to not achieving the overall goal of reducing the disease burden in the state.
According to Benedict Etuk, a laboratory scientist and quality assurance expert, there is need to improve on universal testing to ascertain the status of persons while emphasising the need for proper documentation and labelling of samples collected for testing.
For Temitope Dayo, a medical doctor and TB specialist, the lack of counterpart funding for the TB control programme has been a major setback adding that there has been no funding for TB testing campaigns for several years from the state government.
The TB testing campaign involving community outreach which took the exercise to Etinan, Uruan and Eket Local Government Areas also had children as the target with over 12 children having been found in one local government to have TB according to Dayo.
She believes more cases of TB could be found if “awareness is created, the challenge of sample collection is addressed and child TB testing is carried out as well as preventive TB in the community.’’
“Let us not miss this golden opportunity by using schools and making use of immunization campaigns and contact tracing so that we can address the issue of resistance to TB treatment,’’ she said.
To maximise the awareness creation campaign and boost demand for TB programming and services, Breakthrough Action Nigeria, a communication based organisation funded by the United States (Agency for International Development (USAID) has been at the forefront of driving the campaign.
It has done so using several social media platforms and providing radio and Tv jingles and announcements including the popular, “check that cough slogan,’’ which it created to raise awareness on TB by urging people to check the cough if it has lasted more than two weeks.
For the missing TB numbers to be found, those infected should be put on treatment and those exposed to it given preventive treatment, people like Mkpa should be willing to be tested by readily providing samples.
It should be a win-win situation if all hands are on deck to find a solution to an illness that is deadly which has ravaged the society for decades, yet treatable and curable.