AS the Tanzanian government grapples with the challenge of enhancing the health status of its people, one of the goals to which the Fifth Phase government is laying much emphasis , a potential opening in tackling Tuberculosis (TB) would be most delightful.
The opening would be in the form of the government enforcing a recommendation to train over 70,000 Traditional Health Practitioners (THPs) to diagnose suspected TB patients in rural areas. The recommendation comes from a new study published late in March 2018 by the Infectious Disease of Poverty journal conducted by scientists from Ifakara Health Institute (IHI) and Swiss Tropical and Public Health Institute.
TB affects 10 million people and kills nearly 1.7 million every year, making it the leading cause of mortality worldwide from an infectious disease. In Tanzania and elsewhere, the prevalence of TB varies considerably across regions with the presence of other diseases (comorbidities) accounting for different TB treatment outcomes. A research scientist from IHI and one of the principal investigators of the study,
Dr Jerry Hella, said that this could result in continued TB transmission in the community due to delays in TB diagnosis and presentation at health facilities at an advanced stage of the illness, making treatment more complicated to an individual patient. "The observation may guide public health policies which can target, for example, traditional healers aiming to identify TB cases at early stages of the disease or helminth screening and treatment depending on which species predominates a particular setting," he said.
Reacting to the report, the Acting Assistant Director of Traditional and Alternative Medicine in the Ministry of Health, Community Development, Gender, Elderly and Children, Dr Paulo Peter Mhame, exclusively told the ‘Sunday News’ that, if used, THPs would make a difference. Dr Mhame said that the entire country was covered by over 75,000 THPs who are scattered and that an average of 5-8 THPs are available in each village.
"If trained, THPs would know the signsand symptoms which would allow them to refer patients to health facilities for proper diagnosis and later assist in better management of the disease,” he said. He explained that in 1998, most THPs were trained to first think of TB and when they encountered a patient with a cough history of 14 days, to refer them to a health facility. They were given referral forms and used them.
This procedure increased the number of patients to three folds. In his opinion, the same methodology could be used in connection with other diseases, such as diabetes mellitus, high blood pressure, enlarged prostate and uterine fibroids. The rural and urban differences in TB epidemiology and treatment study explored the underlying differences between urban (Temeke) and rural (Ifakara) cases of TB in Tanzania and how these differences could lead to different intervention strategies to effectively control Tuberculosis.
It was seen in the study that patients from rural Tanzania were likely to be older and at a more advanced stage of illness, with lower body mass index and lower CD4 cell counts for patients with HIV co-infections, compared to those from urban Tanzania. Patients from the rural setting had approximately four times higher odds of recurrent TB than their counterparts from the urban setting with an overall 6 per cent increase in the odds of recurrent TB for every one year increase in the life of a TB patient from the two settings.
The proportion of HIV infection and diabetes mellitus were similar in the two settings. On the contrary, the urban setting (Temeke, Dar es Salaam) had higher prevalence of helminth infection primarily driven by a particular type of worm infestation known as Strongyloides stercoralis, whereas in the rural setting of Ifakara in Morogoro, the main culprit was Schistosoma mansoni which was to be expected due to close proximity of the study area with the Kilombero River.
As had been seen in other studies, only about 20 per cent of TB was transmitted within ones household – a feature predominant in the urban setting. Patients in the rural setting were likely to have contact with a TB patient, making active case finding activities more beneficial and cost effective in the rural setting.
These differences in TB epidemiology and co-infections in urban and rural Tanzania underlined the importance of public health interventions that were tailored to a given setting not only in Tanzania but elsewhere in the world, he explained