Poor diagnosis driving Drug resistant TB deaths  

By Samuel Baker BYANSI.

On a chilly morning in Kanombe, Kigali, I meet a 43 year old neighbour Mugisha (not real name), a former drug-addict.  Doctors had successfully convinced him to stop abusing drugs, which had taken its toll on his health.

“The journey wasn’t cool. I call it no pain no gain, you understand you gaining while in pains. I received a lot of injections between 1995 and 2007,” Mugisha said

It has been two decades since Mugisha quit his job as a night club disco jockey in order to concentrate on his rehab from drugs, mainly marijuana. Initially, he had been Pneumonia.

He was later diagnosed with drug resistant Tuberculosis (TB) and put on medication. After completing his medication, he developed a series of complications.

“My chest, the doctors say, corrupts with fibrosis, I did an echo test, which showed that my heart moved from left to the right side because of the space on the right” Mugisha narrated.

Drug resistances TB is form of tuberculosis caused by bacteria that are resistant to the treatments with at least two of the most powerful first line anti – B Drugs isoniazid and rifampicin.

Patients suffering from this type of TB are put on second line drugs, which are toxic and must be taken on a daily basis for nine month.

According to the world health organization in 2017, 10 million people fell ill with TB and 1.6 million died from the disease including 0.3 million among people with HIV. In the same year, an estimated 1 million of children became ill with TB and 230,000 children died of TB including those with HIV associated TB.

WHO estimates that there were 558 000 new cases with resistance to rifampicin – the most effective first-line drug of which 82 per cent had MDR-TB. The MDR-TB burden largely falls on 3 countries India, China and the Russian Federation which together account for nearly half of the global cases. About 8.5% of MDR-TB cases had extensively drug-resistant TB (XDR-TB) in 2017.

World Health Organisation WHO Director-General Margaret Chan addresses the 66th World Health Assembly at the United Nations European headquarters in Geneva …

Patients with drug resistance TB (DR-TB) incurred $1,412.80 per episode, six times higher the cost than DS-TB which is the TB that is no resistant and was $251.90.

Out of the $1,412.80, medical costs account for 4 per cent which is only $56.512, indirect costs consume $226.048 which is 16 per cent while Non-medical costs consume 80 per cent which equates to $1130.24 of the total cost. The survey further attributes the high cost to nutritional supplements and lost productivity lost during the treatment.

Queen Nyinawase a nurse and a sister to Mugisha, has been closely following his case and understands his journey.

“I feel these are gaps in the amount that the government invests, in research to come out with better less toxic drugs,” Queen said.

According to the TB alliance, XDR-TB is a global health threat. They are accelerating a treatment that provides hope to the hopeless. Nearly 50 per cent of the patients with XDR-TB die within 2 years and nearly 85 percent of patients die in 5 years. 

Cost side is one of the problems to the drug resistance patient comes before even they know what illness they have.

Muteteri Evelyne, a mother of 9 lost her only daughter in 2015 after making runs to different facilities, only later to be diagnosed with drug resistance TB and later developed complications.

“The next day is when the Dr Came with pipes because she was not able to produce spectrums, the Dr really soothed her and played with her finally produced. At 2pm he came and told me the results were out and   that she had MDR – TB. I didn’t even know what MDR- TB was,” said Muteteri, she also believes that a lot must be done to prevent these complications that arise with the treatment.

Dr Gallican Rwibasira says that the complications patience suffers are traceable back to late diagnosis.

“TB attacks any parts of our body. One of the problems is the late diagnosis when it’s located outside the lungs and causes usual known symptoms like cough,” he said

“Mycobacterium Tuberculosis (the bacteria that causes TB) has pretty much cost of a lot of effects on the lungs, where most of the commonest symptoms are manifested.  And it is good sensitive to usual treatment when diagnosed at time.”

Mugisha’s life was changed because of late diagnosis and Muteteri’s daughter lost her life.

The latest evidence on treatment of drug-resistant TB was reviewed by an independent panel of experts convened by WHO. A rapid communication on key changes to recommendations for the treatment of drug-resistant TB has been issued by WHO, to be followed by the release of updated and consolidated WHO policy guidelines later in the year.

Variation in 5- and 50-year projections of drug-resistant tuberculosis

WHO also approved in 2016 a rapid diagnostic test to quickly identify these patients. 62 countries have started using shorter MDR-TB regimens. By the end of 2017, 62 countries reported having introduced bed aquiline and 42 countries reported having introduced delamanid, in an effort to improve the effectiveness of MDR-TB treatment regimens.

An estimated 54 million lives were saved through TB diagnosis and treatment between 2000 and 2017 while Ending the TB epidemic by 2030 is among the health targets of the Sustainable Development Goals.

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Elias Hakizimana

Elias Hakizimana, CEO&Founder of The Inspirer Ltd,(www.rwandainspirer.com) is a professional Rwandan Journalist with Bachelor’s Degree in Journalism and Communication, received from University of Rwanda’s College of Arts and Social Sciences (CASS) in 2014. He served various media houses in Rwanda including Rwanda Broadcasting Agency (RBA) in 2013 and became passionate with English Online and Print Media Publications where he exercised his talent as a Freelance News Reporter for The New Times, The Independent, The Rwanda Focus, Panorama and more before he became a Self-Entrepreneur as the CEO and Founder of The Inspirer Limited in early 2017.

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