March 24 every year marks World Tuberculosis Day. And this year’s theme is ‘It’s Time’. In Rwanda, the event was to be held in Rulindo District, in Northern Province. However, this was postponed due to the outbreak of COVID-19, which has seen many meetings and gatherings suspended. Events were to take place in Rulindo District because of the high rate of TB cases there, and most importantly, due to the many mining sites found in the region, officials say. In addition to other respiratory diseases, miners are at high risk of TB because of the nature of their work. Nevertheless, there have been awareness campaigns carried out by the Ministry of Health through the media, and other channels, on TB transmission, prevention and treatment across the country. Dr Vianney Byiringiro Rusisiro, the director of TB Infection Control Unit at Rwanda Biomedical Centre (RBC), says the campaigns, which kicked off in January this year, included sensitising miners from the area within their associations, to be tested in health facilities nearest to their place of work. He says x-ray checks for all miners were carried out, and when found with abnormal signs, what followed was to ask for sputum, which then gave a clear picture of the way forward as far as TB is concerned. Sputum is a mixture of saliva and mucus coughed up from the respiratory tract, typically as a result of infection or other disease and often examined microscopically to aid medical diagnosis. Meanwhile, during the fiscal year 2018/19, the total TB cases diagnosed were 5,949, of which 109 were multi-drug-resistant tuberculosis (MDR-TB) cases. Among them, 91 per cent were new TB cases while 9 per cent were old cases. During the same time, TB bacteriologically confirmed cases were 4,349 (74 per cent) and clinically diagnosed were 1,506 (26 per cent). Whereas, TB detection rate was at 80 per cent as that of missing cases stood at 20 per cent. The TB HIV co-infection was at 21 per cent (1,245), as that of children under 15 years was 7.6 per cent. And the TB cases brought in by Community Health Workers (CHWs) were at 25 per cent. 53 per cent of TB cases were notified among the high-risk groups; people living with HIV /AIDS (PLHIV), prisoners, TB contact, children under 15 and people aged 55 and above, according to RBC. Creating more awareness Despite the postponed TB awareness events, there has been alertness of TB diagnosis, treatment, and prevention though radio talks, TV shows, among other platforms. The preliminary preparations carried out by MoH included conducting TB case active findings by health care providers. This, Rusisiro says, is an activity of trying to identify new TB cases in the community before coming to the hospital. “This includes carrying out an outreach programme in the community, to identify those people suspected to be having TB symptoms, to be examined and if tested positive, treatment commences immediately,” he says. In this particular outreach, he says, there are two mobile x-ray machines that help in consultation of high risk people. During the 2018/19 fiscal year, MDR-TB cases: 107 initiated on treatment, 77 per cent (82) were among new TB cases and 23 per cent among previous cases. Challenges According to Rusisiro, patients displaying symptoms of TB might delay getting the required treatment due to lack of knowledge about the symptoms. He explains that this is where a person could have the symptoms but has not yet been diagnosed, and most of them, he says, mistake these signs for common cold or any other common ailment that they believe will go away on its own. The most worrying part, he says, is that during this time, the transmission is very high among family members and other people. Apart from that, Dr Yves Habimana Mucyo, the director of multidrug resistance at RBC, says the delay can also complicate the disease which is another challenge as far as treatment of TB is concerned. “We encounter situations where TB patients come to health facilities with complicated cases of diseases such as pneumonia and other respiratory diseases,” he says. When this happens, he says, while in the process of testing and diagnosis, the person can lose their life due to the delay. Another challenge, the medic says, is that some patients when diagnosed and put on treatment, shift from one residential place to another. Here, he notes, it’s hard to follow up, therefore, complicating the whole process of treatment. Drug resistance is also another big challenge in the treatment of TB. Mucyo explains that this happens when the treatment given in the first occurrence is not effective, due to the resistance of bacteria within their body. These people, he says, have to take a second line of treatment which can bring about challenges in the whole process of treatment. What you should be aware of Rusisiro says when people stop the medication intentionally, there are many risks, including death. “It’s important for the public to know about the TB, its symptoms, transmission, prevention, and treatment, in order to avoid transmission and further complications,” he says. For diagnosis, Rusisiro says, one should keep in mind that if they are staying with a person showing symptoms, such as a cough that is extended for more than two weeks, they have to ensure the person seeks help from the hospital. “It’s better for such people to be diagnosed to avoid any complications that could follow after the delay. Also, if the person is not diagnosed with it, it’s better because finding out the cause of what exactly they are suffering from is important,” he says. In case one has the disease, to avoid its transmission is mandatory, and covering your mouth while coughing or sneezing can help prevent transmission. “If one happens to have the condition, they should keep in mind that TB is curable, and its treatment is available and free in Rwanda, and, therefore, shouldn’t be stigmatised,” Rusisiro adds.
