Poverty is one of the major contributory factors to the consistent spread of TB in the Eastern Cape, according to a study by a research group led by two academics based at the Walter Sisulu University (WSU)’s faculty of health science. The research further indicates that of all the nine provinces, the Eastern Cape remains highly susceptible to TB infection, treatment failure and fatality.
World TB Day
The outcome of the study was unveiled to coincide with the World TB Day held by the WSU last month as part of raising awareness about the increasing cases of TB infections and to call for the acceleration of efforts to eliminate it.
The two academics are Dr Lindiwe Faye and Dr Ntandazo Dlathu; the former is currently serving as the laboratory manager at Nelson Mandela academic clinical research unit. Her research, which began in 2018, focused on transmission dynamics and public health impact of TB infections among patients in rural areas. Dr Dlathu who serves in the Cecilia Makiwane Quality Control Office, probed the continuous spread of TB in the impoverished communities in the Eastern Cape.
Poverty is a powerful determinant
Dr Faye said the research shows that there is clear connection between poverty and TB, adding that there is very little understanding of the disease in the rural areas and that as a result it is not well managed. “Poverty in rural areas is a very prevalent and powerful determinant of tuberculosis and constitutes a direct risk factor for tuberculosis transmission. Poverty results in undernutrition which contributes to developing active diseases and weakening the immune system leading to risk of easy infection,” said Faye. She also found that the management of TB was further complicated by high levels of drug resistance particularly Multi-Drug Resistant TB (MDR-TB).
She said one of the biggest challenges concerning TB treatment is what is known as hetero-resistance. This is the co-existence of drug-resistant and drug sensitive TB-causing bacterium strains at the same time in a patient, explained Dr Faye. Said Dr Faye: “In the findings of the study it increased with time. By the third year of the study period, the hetero-resistance rate was almost triple that of the previous year. The impact of hetero-resistance on treatment outcomes remains to be determined further in rural Eastern Cape, hence I am currently investigating the reason behind increase of rate in hetero-resistance.”
Addressing needs of vulnerable communities
Her counterpart, Dr Dlatu, added that TB is also the leading cause of death for patients living with HIV in the O.R Tambo district municipality. Her paper posits integration of TB and HIV patient treatment as one of the ways through which government and healthcare professional can curb the impact of the sicknesses. “TB control and poverty reduction cannot be achieved solely by seeking improvements of target indicators on averages across populations; instead, specific needs of vulnerable communities must be addressed,” said Dr Dlathu. She said in areas where poverty is rife people with TB are stigmatised. This leads to denial and prevent timely diagnosis and treatment.
“This can be addressed by tackling stigma through knowledge dissemination and behavioural change with the support of former TB patients and others,” Dlatu said.
Adopting the WHO’s recommendations
According to the National Institute of Communicable Diseases (NICD), South Africa is among the “high-burden tuberculosis (TB), MDR-TB and HIV-co-infected TB countries, across the world”. However, since 10 years ago, it has made noticeable progress by adopting the WHO’s recommended diagnostic technologies and therapies for both prevention and management to reduce the burden of the disease, said the NICD.
Achieving ‘END TB Strategy’
But South Africa has also reached some milestones such as parallel strengthening of HIV management which have caused a year-on-year decline in TB incidence. This has seen South Africa being one of six countries to achieve the ‘END TB Strategy’ landmarks for 2020, namely a 20% reduction in new TB cases between 2015 and 2020. Another success, according to the institute is that South Africa is one of 18 high-burden countries to achieve a greater than 80% coverage of testing for Rifampicin (a key drug for the treatment of drug susceptibly TB) resistance.