Cross Boarder Activity Fertile Ground For Multi Drug Resistant TB

FOLLOWING a positive diagnosis of Multi Drug Resistant Tuberculosis (DR TB) in 2010, life for Mr Mthobisi Ndebele (45) from Makokoba, Bulawayo unfolded like a horror movie script in front of his eyes.

By Michael Gwarisa recently in Bulawayo

Having worked as a Malayitsha for the better part of his life (cross boarder transporter) plying the South Africa /Zimbabwe route, he watched his fortunes fade into oblivion as his possessions, family, friends, and not forgetting his health vanish  into an abyss of uncertainty, leaving him broke, jobless and hopeless.

At age 37, circumstances forced Mr Ndebele to go stay with his mother. As if that was not enough, his wife of many years abandoned him, leaving him to fend for his four daughters whom he currently shares a bedroom with.

“I was in the cross boarder association as a Malayitsha transporting goods from South Africa to Zimbabwe. I would say I came full time to Zimbabwe when I fell ill in 2010. I went to the hospital and they told me that I had TB, they first told me about my HIV  since I had also been initiated on Anti Retro Viral Therapy (ART) ON 29 August of 2010.

“I was actually told that having a TB and HIV co-infection was not that much of an issue and TB would only affect me for a short while.  I was instantly put on TB treatment and I had to submit my sputum every month so that they would see how I was responding to the medication,” said Mr Ndebele.

Following his frequent visits to the hospital, the health personnel discovered that his sputum was very thin and had to run tests which came out as MDR TB positive.

“When they told me about MDR TB, they put me on some medication for two years as well as injections for not less than six months.

“I was given strict instructions not to share a room with other people since I would infect the others. I stayed in the hospital for six months, because what happens when you are MDR TB positive, the bacteria infects the next person as MDR TB which is difficult to manage to control.”

Mr Ndebele has since remarried but is struggling to fend for his family as he is failing to secure employment owing to high stigma from his community and potential employers. At some point he attempted vending but no one would buy from him for fear of being infected.

Since he shares a single room with five other occupants (his new wife and four daughters), fears are that should the MDR TB strike again, his family is at high risk of getting infected with MDR TB.

Mr Ndebele’s ordeal is just but a drop in the ocean of the actual catastrophe bedeviling the Matabeleland province with Mat South being the hardest hit.  Matabeleland has the highest TB mortality  rate currently standing at 19 percent owing to failure by patients to get treatment and high HIV/TB co-infection  rate since the province has the highest HIV prevalence rate.

Matabeleland South also has the highest MDR TB prevalence in the country owing to numerous factors chief among them being the cross boarder activities rampart in the province. Majority of people from the province have illegally migrated into neighboring countries and as a result, they cannot access health care services hence they are forced to return home for TB treatment. However, most abandon treatment midway after showing signs of improvement a situation which according to the ministry of health has led to the rise in MDR TB.

According to the World Health Organisation (WHO), the major two reasons why multidrug resistance continues to emerge and spread are mismanagement of TB treatment and person-to-person transmission. Most people with TB are cured by a strictly followed, 6-month drug regimen that is provided to patients with support and supervision. Inappropriate or incorrect use of antimicrobial drugs, or use of ineffective formulations of drugs (such as use of single drugs, poor quality medicines or bad storage conditions), and premature treatment interruption can cause drug resistance, which can then be transmitted, especially in crowded settings such as prisons and hospitals.

The bacteria that causes tuberculosis (TB) can develop resistance to the antimicrobial drugs used to cure the disease. Multidrug-resistant TB (MDR-TB) is TB that does not respond to at least isoniazid and rifampicin, the 2 most powerful anti-TB drugs.

Deputy Director TB and HIV services, Dr Charles Sandy said even though there seem to be a decline in new TB cases, MDR TB cases were on the rise especially in Matabeleland.

“Geographical access to diagnostic and care services for rural communities  is inadequate and villagers have to travel long distances to access health care services.

“There is high cross boarder activity in the province and the lack of inter-country protocols to address cross-border health issues- referrals, care access (SADC TB Focal Point?) is also another issue.”

The Ministry Health and Child Care (MoHCC) provincial Epidemiology and Disease Response shows that Mat South recorded 257  TB notifications in 2018 with Beitbridge and Gwanda reporting the highest TB notifications in while Umzingwane and Bulilima had the lowest notifications in the province.

Presenting on the Mat South Epidemiology and Diseases Response at a World TB Day per-commemoration conference held recently in Bulawayo, Mat South Provincial Medical Director, Dr Rudo Chikodzore said the province has continuously failed to reach a 90 percent Rx success rate due to high mortality (17-19%) over past 3 yrs.

“1872 (76%) cases against a target of 2452 were notified in 2018,  79% of TB cases in 2018 were diagnosed through the Xpert machines, 44 from a target of 66 DRTB cases were diagnosed. 43 have since been initiated on Rx. We did note experience o stock outs of medicines in the previous year.

“93% of TB patients were offered an HIV test. Positivity rate ~ 91%, all clients commenced on ART,” said Dr Chikodzore

A recent survey on  tuberculosis patient cost survey in Zimbabwe  released by the Ministry of Health and Child Care (MoHCC) in partnership with the World Health Organisation (WHO) and other partners, indicates that an estimated 37,000 people developed TB in 2017, of which only 26,401 were diagnosed and reported (30% of people with TB are “missing”).

In some countries, it is becoming increasingly difficult to treat MDR-TB. Treatment options are limited and expensive, recommended medicines are not always available, and patients experience many adverse effects from the drugs. In some cases even more severe drug-resistant TB may develop. Extensively drug-resistant TB, XDR-TB, is a form of multidrug-resistant TB with additional resistance to more anti-TB drugs that therefore responds to even fewer available medicines. It has been reported in 117 countries worldwide.

Drug resistance can be detected using special laboratory tests which test the bacteria for sensitivity to the drugs or detect resistance patterns. These tests can be molecular in type (such as Xpert MTB/RIF) or else culture-based. Molecular techniques can provide results within hours and have been successfully implemented even in low resource settings.






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