By Shu’eib Hassen
CAPE TOWN, South Africa
Africa has 28% of the world’s tuberculosis (TB) cases and the highest severe burden relative to population, according to the annual World Health Organization (WHO) Global TB Report released last October. That means 281 cases for every 100,000 people, including 32% of the new HIV-positive cases in Africa in 2014.
The economic burden on the infected as well as African countries’ expenses are often neglected in stories of statistics and numbers. “The monetary impact of TB patients needs to be further explored, as the world often forgets that illness and disease also heavily burden the patient’s ability to provide for their families,” Professor Keertan Dheda, South African National Research Foundation chair in lung infection and immunity, told Anadolu Agency.
A 2012 study by Nigeria’s Ebonyi State University Teaching Hospital concluded that overall estimates of the cost burden on patients are almost impossible due to a lack of consensus on calculation methods by different institutions. Their data indicated, though, that costs are high for TB patients. Extended families’ assistance was usually the only way for TB patients to survive the economic burden.
South Africa
A joint 2015 report by South Africa and Britain gauged a TB-associated episode cost to total 22% of the average per capita income (US $103.12), which is further exacerbated by a 72% income loss during the intensive phase treatment.
The steady growth of Multi-Drug Resistant TB (MDR-TB) requires more costly treatment, as further expenditures are needed when 40% of patients respond poorly to drug treatment.
As over 318,000 people in South Africa are diagnosed with TB each year, there is a considerable economic impact on the country. The Post-2015 Developmental Agenda report by Dr. Anna Vassal, of the London School of Hygiene and Tropical Medicine states that to reduce TB’s death rate to 90%, $422 million in addition to current spending would be required.
Uganda
Up to 50,000 cases of TB are seen every year in Uganda.
Dr. Alphonse Okwera, head of the Tuberculosis unit at Mulago National referral hospital in capital Kampala, told AA, “But also increasingly, we are seeing cases of multiple drug resistance and extensive drug resistance of TB.”
Donors such as the Global Fund and USAID increased funding for the treatment of TB in Uganda in 2012, reducing the cost to the government, said Okwera. “The government would spend $11,858 annually on one MDR patient for 24 months, but now with support from donors, the cost of treatment has gone down to $4,500.”
Kenya
Ranked 4th on the list of high-burden TB countries, with 268 infected out of every 100,000 people, Kenya’s economy is feeling the impact in its agricultural industry. Providing 24% of the country’s GDP and 45% of government revenues, it is a major employer.
But TB has directly affected farm output. The Kenya Medical Research Institute (KEMRI) says that farmers have been forced to leave work due to frequent hospital trips when seeking treatment. Last year the average monthly expenditure per household for TB treatments was $67.
Furthermore, a nationwide shortage of TB vaccine since late December has put the lives of newborn babies at risk, prompting the government to order an emergency batch of 1.3 million doses of TB vaccine.
Marking TB month this March, Kenya’s government is conducting its first nationwide TB survey.
Advancing treatment beyond costs
Africa has by far the largest funding gap, $0.4 billion in 2015, according to the WHO report. It has missed two of its 2015 targets for lowering prevalence and mortality rate. The situation has been exacerbated as MDR-TB increases in the region, stretched wider by having the largest gap in treatment access.
TB treatment costs are having to deal with old problems of poverty that are rampant across African households. Dheda says, “In Africa, it is not one factor but multiple factors that pose the problem. So one needs to innovate and transform healthcare systems in Africa.”
A recent urine test developed by Dheda and his team across Sub-Saharan Africa will not only save more lives but reduce detection costs to $2.66 and provide results in 25 minutes.
“The absolute reduction in mortality was small at 4 percent, but with 300,000 patients with HIV dying from tuberculosis in Africa every year, implementing this low-cost, rapid bedside test could potentially save thousands of lives annually," said Dheda in a statement.
Hopes are being further raised about a new MDR-TB drug to be introduced this April in Ethiopia.
“It is more effective – halves treatment times, eliminates the need for injection, and improves chances of care from 48 to 70 percent. We have completed every necessary preparation,” Dr. Andargachew Kumssa, chief technical advisor to the Ethiopian Health Ministry’s National TB Prevention and Control Program, told Anadolu Agency.
Zambia far from reaching WHO goal
In Zambia, for example, Dr. Aaron Mujajati, head of the Medical Association of Zambia (MAZ), told Anadolu Agency in an interview that there is a need to improve detection in the country.
“Some areas are hard to reach due to the poor road network in rural areas. Inasmuch as we need to find more patients to give them treatment, our effects are inhibited by accessibility,” Dr. Manasseh Phiri.
“The chances that Africa will meet the WHO target of reducing the scourge by 2035 are slim. As for Zambia, this is not likely to happen any time soon.”
According to Phiri, 70% of people with TB in Zambia are also infected with HIV, and the prevalence rate is about 14.3% of the adult population.
Reduced treatment duration and costs will allow for evasion of the medical poverty trap that is trending across Africa. The African Union seeks to end TB by 2030 on the continent.
-- Anadolu Agency correspondents from Uganda (Halima Athumani Asijo), Kenya (Magdalene Mukami), Zambia (Francis Maingaila), and Ethiopia (Seleshi Tessema) contributed to this report.
