Zimbabwe: Communities can lead the fight against TB from the front

Tuberculosis remains one of the leading killer diseases in Zimbabwe.

Pulmonary tuberculosis is caused by a bacteria called Mycobacterium tuberculosis.

This bacteria causes holes in the lung tissues that can lead to further respiratory complications.

TB is not only dangerous for the infected person, but also for the community.

Tuberculosis spreads through airborne droplets.

These droplets can remain airborne for hours, posing a high risk of infection for those who are near someone with TB.

In 2019, there were an estimated 2.5 million TB cases in the African region, accounting for 25 percent of the global burden. Each year, more than 500,000 Africans lose their lives to this disease.

In Zimbabwe, an estimated 29,000 people fell ill with TB in 2019 and about 6,300 of them succumbed to the disease. In 2019, an estimated 1,200 diagnosed TB cases had drug-resistant TB.

Zimbabwe had an estimated TB incidence of 190 per 100,000 population in 2020

The country has made progress in reducing the number of people who have developed tuberculosis (TB) since 2015 from 242 per 100,000 inhabitants in 2015.

The government has produced the National TB Strategic Plan (TB NSP) (2021-2025) to guide the country’s TB response. The main objective of the plan is to promote access to high-quality, patient-centred TB prevention, diagnosis and treatment for all Zimbabweans with all forms of TB, in line with the Universal Health Coverage (UHC) objectives.

As a result of a targeted TB response, Zimbabwe was moved from the top 30 countries severely affected by TB. However, it remains doubly burdened with drug-resistant TB and TB and HIV co-infections.

Although TB ​​treatment and care are free in Zimbabwe, statistics show that more than 80 percent of people who need help face exorbitant costs to access it. The situation was exacerbated by the Covid-19 pandemic, which disrupted access to health facilities due to travel restrictions.

So despite notable milestones in the TB program, the 2021 Global TB Report revealed that between 2015 and 2020, TB deaths increased by 36 percent compared to 2015 and there were 8,010 deaths in 2020 alone, representing one person who dies every hour.

About 30,000 new cases of TB occur each year, which equates to one person per minute. There is evidence that men bear the greatest burden of TB in the country, mainly within the artisanal mining communities and others and the informal sector. These people are usually in hard-to-reach areas and are therefore often missed.

Dr. Munyaradzi Dobbie, chief health director of the Ministry of Health, recently stated that despite the high number of new TB cases, the proportion of new cases diagnosed and treatment initiated fell from 72 percent in 2019 to 54 percent in 2020, leading to continued community-level transfer.

“So there are still programmatic gaps in finding TB cases, including missed opportunities along the screening-diagnosis-care cascade, suboptimal treatment outcomes, compounded by delays in patient seeking care, and lack of adherence support, even though 80 percent of patients experience catastrophic costs,” he said.

Addressing these gaps and challenges effectively and efficiently, Dr Dobbie said active participation and involvement of all sectors contributing to health was needed.

This includes finding the 12,520 missing undiagnosed people with TB who have a multiplier effect of each infecting 10 to 15 people per year.

More worryingly, these 12,520 missing TB cases are within the communities and the longer it takes for them to be identified, the greater the risk of them spreading the disease.

Community involvement is becoming a critical tool in identifying these people and linking them to care.

At the launch of the Zimbabwe Multi-sectoral Accountability Framework for TB this month, Acting Director of the AIDS TB Unit within the Ministry of Health and Child Care, Dr Fungal Kavenga, said communities have played an important role in the fight against TB in Zimbabwe.

He said that in 2020 alone, at least 12 percent of reported TB cases were community-referred for TB services.

The support groups and awareness campaigns conducted in the communities had seen an increase in the number of early referrals of suspected cases, as well as the provision of psychosocial and adherence support to patients in care.

But more needs to be done.

TB spreads in households and communities ranging from rural villages to urban apartment blocks to schools to workplaces and busy places.

Therefore, community-based efforts can both help prevent the spread of TB and support diagnosis and treatment.

Communities need more education about TB and its consequences, while health professionals still need to be educated on how to approach communities, especially mining communities that may be hostile to new ideas.

Knowing how to identify TB symptoms and encouraging those who may show them to visit the health facilities can reduce the burden of the disease in communities and also help reduce the stigma surrounding it.

Below are some facts about TB that people should know:

A person with latent or inactive TB will not have any symptoms. They may still have a TB infection, but the bacteria in the body is not yet causing any damage.

Those with active TB may show symptoms such as a cough that lasts more than three weeks, loss of appetite and unintentional weight loss, fever, chills, and night sweats. They may experience other symptoms related to the function of a specific organ or system that is affected. Coughing up blood or mucus is a sign of pulmonary tuberculosis. Bone pain may mean that the bacteria have entered the bones.

Because such symptoms can also occur with other diseases, it is important that people go to a health center to be tested for TB.

The disease can be diagnosed using a person’s medical history, a physical exam, chest X-rays, and other laboratory tests.