Zambia: The hidden costs of TB

LUNDAZI, 3 December 2009 (PlusNews) – “When you are poor and you have AIDS, you live with the threat of death above your head. However, when you have tuberculosis (TB), death moves closer and sits on your shoulder,” said Max Ngoma, who used to be a peasant farmer in Lundazi, a rural town in eastern Zambia.

He is now destitute and cannot afford to buy food to take with the drugs to treat TB, nor can he afford the frequent trips to the health centre, about 15km away.

Zambia has the seventh highest TB/HIV co-infection rate in the world: 70 percent of people with TB are also infected with HIV. The estimated HIV prevalence rate of 14.3 percent in the adult population makes TB treatment difficult to contain and treat.

The World Health Organisation (WHO) estimates that the incidence of TB is now about 500 cases per 100,000 people annually, making it one of the leading causes of death in Zambia.

“I could no longer tend to my fields after I fell ill, so I lost my only income. My wife tries to farm but she can only do so much; our children are small so they cannot help. Others in my village are in the same position as me, impoverished because of droughts, floods and sickness.”

Ngoma’s wife has been treating him with a herbal concoction she prepares, but there is little improvement. Musole Musenge, the clinical officer who runs a health centre in Chinyumba village in Lundazi district, said people taking TB drugs need high-protein foods like chicken, rice, milk and eggs, which are beyond the normal diet of most households.

The medication to treat TB is freely available in government health centres and hospitals, but is not always accessible in rural areas. “A patient can wait for anything between two months to a year for diagnosis and treatment,” Musenge noted.

Not all health centres have diagnostic equipment, so specimens have to be sent to the nearest town, which might not have testing facilities; also, the necessary drugs are not consistently available and patients may have to wait.

Most TB patients have usually been too ill to work for some time before diagnosis. After diagnosis, the added costs of transport for routine visits to health facilities and special or extra food, on top of the loss of income, make the whole family suffer, Musenge told IRIN/PlusNews. Not many families are able to muster the resources for treatment and adequate care.

Poverty makes things worse

The Jesuit Centre for Theological Research (JCTR), which monitors the cost of a monthly food basket, estimates that a family of six needs about 2 million Zambian kwacha (US$400) a month to survive. But the unemployment rate is around 70 percent and, according to the World Bank, more than 70 percent of the population live below the poverty datum line.

The desperation of poverty drives many people to areas where the World Food Programme (WFP) or World Vision, an international charity, run feeding programmes. Lundazi is one such area.

”We will not be able to contain TB if people cannot get food – the drugs are too strong”

Ngandu Ngandu told IRIN/PlusNews that his wife heard about the World Vision feeding programme in Lundazi and relocated the family. “Hopefully I will have completed my medication by the time WFP phases out its programme here. I feel sorry for people who cannot access any kind of feeding programme – they cannot go on treatment.”

Michael Gwaba, who works at the Community Initiative for Tuberculosis and Malaria (CITAM), a Zambian organisation providing nutritional supplements to patients on TB drugs, as well as other health services, agreed that food was their biggest challenge. “We will not be able to contain TB if people cannot get food – the drugs are too strong.”

Yet CITAM can only source so much food, and many TB patients fall through the cracks. Gwaba said the government should step in to provide social grants for families affected by TB.

“We have better services for ART [antiretroviral therapy] than for TB, but because the two are intertwined we should include TB; it should be that at every visit to an HIV clinic, people should be routinely screened for TB.”

Minister of health Kapembwa Simbao believes not all the news is bad: Zambia now provides 100 percent of patients in all government health facilities with the standard regimen of isoniazid and rifampin for treating TB.

The Centre for Infectious Disease Research in Zambia (CIDRZ), funded by the United States, is working with the ministry of health to improve the quality of TB screening, and care for TB/HIV co-infected patients, while the Zambia AIDS Related Tuberculosis (ZAMBART) project has piloted an initiative to reduce the risk of TB becoming active in people exposed to the bacteria.

“We are also working with our partners to reduce the treatment period for TB from eight to six months,” Simbao told IRIN/PlusNews. “We acknowledge that people experience many difficulties while on TB treatment, so if we can shorten the period it will encourage patients to continue with their medication.”

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