Tuberculosis infection rates in Uganda have increased due to the HIV/AIDS pandemic in the country, but the scarcity of health centres and over-crowding in camps for the displaced are also to blame, officials said.
The Ugandan health ministry said it had recorded an increase of almost 12 percent between 2001 and 2005, with the country registering up to 80,000 new infections every year. The total number of TB patients was 500,000, according to the study, but only half the cases were being tracked.
“The rise in the infection rate is mainly because of HIV. In many countries with a high prevalence of HIV/AIDS, TB cases have gone up because HIV has attacked and weakened the body’s defence systems, which would keep at bay widespread TB infections,” Joseph Imoko, the World Health Organisation (WHO) national professional officer for TB in Uganda, told IRIN.
He said increased numbers were registered in the early 1990s because reporting of cases had been low but when access to medical services improved, more cases were reported. However, the numbers stabilised in 1995.
“But when the HIV/AIDS pandemic intensified, we noticed a rapid increase in the number of cases. At present an estimated 70 percent of TB patients in the country are also infected with HIV,” Imoko said.
“Poor nutrition among the people has also worked at weakening people’s immune systems, leaving people susceptible to TB infections,” he said.
Imoko said the country had started a three-year, US-funded US$3 million Tuberculosis Control Assistance Programme (TBCAP) that will support the health ministry in a combined fight against TB and HIV. The programme has been launched in 12 districts of central, western, eastern, and southwestern regions out of 70 districts.
There are an estimated 1.2 million cases of HIV/AIDS in the country, while a million people are believed to have died of the syndrome since it was first diagnosed in Uganda in 1982.
Long trek to health centres
Imoko says the main challenge in fighting TB infections - whose main weapon should be effective and immediate treatment - has been the distance people have to cover to reach health centres.
“When a person feels really sick, he or she will struggle to reach a health centre no matter the distance, but when they feel a little better, the distance to cover determines whether they continue with the treatment and most of the time, many patients drop the treatment and in the process they continue infecting others. One person can infect up to 20 people a year and the vicious cycle leads to many infections,” he said.
He said the situation had not been helped by the over-crowding in slum areas and camps for the internally displaced where most infections have been recorded. Hundreds of thousands have been displaced by two decades of conflict in northern Uganda.
Other issues blamed for the high infection rates include poor health infrastructure, lack of awareness among the public and poor sanitation.
Imoko, however, said the Ugandan health ministry had embarked on what he called “community-based dots”, which involves the identification of patients, awareness-raising and giving volunteers the responsibility of ensuring that patients adhere to their treatment regime - eight months for adults and six months for children.
“Government procures these drugs free of charge and distributes them free of charge to patients either through government or non-governmental health centres. Treating patients helps the community to stem the spread of the disease,” the officials added.
Tuberculosis is the leading cause of death among people living with HIV/AIDS. The number of TB patients co-infected with HIV has risen from five to seven in every 10 during the past two years, according to the health ministry. It is estimated that 30 percent of the deaths among AIDS patients are attributable to TB.
TB is a chronic disease caused by a bacterium. The symptoms include a cough lasting more than three weeks, chest pain, evening fever and night sweats.