According to the Rwanda Biomedical Centre (RBC), the country has made significant strides in the fight against tuberculosis (TB), recording the lowest TB incidences in East Africa.

Tuberculosis, a serious infectious bacterial disease that mainly affects the lungs, is a communicable disease that is a major cause of morbidity and death, with most of these deaths preventable through early diagnosis and appropriate treatment.

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As Rwanda joins the world to mark World Tuberculosis Day on Friday, March 24, the Rwanda Biomedical Centre reports that TB incidence in the country decreased from 96 patients per 100,000 populations in 2000 to 56 patients per 100,000 populations in 2021, according to the 2022 global TB report.

The government has integrated TB management in all health centers nationwide and initiated preventive measures among household contacts of bacteriologically TB cases above five years.

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In terms of TB notifications during the fiscal year 2021-2022, a total of 5,538 TB cases were diagnosed, including 39 rifampicin-resistant or multi-drug resistant TB. As noted, almost all TB presumptive and TB cases knew their HIV status, and the treatment success rate for susceptible TB Drug Sensitive was 88.8 and 97.5 per cent drug resistant.

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However, despite these achievements, there are still some challenges.

According to the country's 2022 Demographic Health Survey, 60% of people who presented TB suggestive signs or symptoms did not go to any health facility for diagnosis, and only 68% of people interviewed had good knowledge about TB transmission.

According to the World Health Organisation (WHO), TB is among the top 10 causes of death worldwide and the leading cause of death from a single infectious agent. However, most of these deaths could be prevented with early diagnosis and appropriate treatment.

Dr. Byiringiro Rusisiro, the Director of the TB infection control unit at RBC, said the Ministry of Health is organising media tours to educate the public about the threats of TB and how to fight it.

Additionally, almost 60,000 trained community health workers are delivering information and services to TB-infected persons countrywide.

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Medical officials in the country stress the importance of seeking care after developing TB signs and symptoms to receive effective treatment to cut the transmission channel. The goal is to achieve no TB records by 2030.

Who is most at risk?

According to the World Health Organisation, Tuberculosis mostly affects adults in their most productive years. However, all age groups are at risk. Over 80% of cases and deaths are in low- and middle-income countries.

People who are infected with HIV are 16 times more likely to develop active TB and the risk of active TB is also greater in persons suffering from other conditions that impair the immune system. People with undernutrition are 3 times more at risk. Globally in 2021, there were 2.2 million new TB cases that were attributable to undernutrition.

Alcohol use disorder and tobacco smoking increase the risk of TB. In 2021, 0.74 million new TB cases worldwide were attributable to alcohol use disorder and 0.69 million were attributable to smoking.

Symptoms and diagnosis

Common symptoms of active lung TB are cough with sputum and blood at times, chest pains, weakness, weight loss, fever and night sweats. The WHO recommends the use of rapid molecular diagnostic tests as the initial diagnostic test in all persons with signs and symptoms of TB as they have high diagnostic accuracy and will lead to major improvements in the early detection of TB and drug-resistant TB.

Rapid tests recommended by WHO are the Xpert MTB/RIF Ultra and Truenat assays.

Diagnosing multidrug-resistant and other resistant forms of TB as well as HIV-associated TB can be complex and expensive.

Tuberculosis is particularly difficult to diagnose in children.