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Low diagnosis hinders TB control efforts in Sierra Leone

  • Dr Lynder Foray, Programme Manager, National Leprosy and TB Control Programme

By Kemo Cham
Delay in diagnosis and stigma remain the two major factors hindering efforts to control tuberculosis (TB), medical authorities and campaigners say, amid calls for renewed efforts to mobilise against the deadly bacterial disease.
The Ministry of Health and partners say stigmatisation has forced many TB patients to go underground, and sending suspected cases into hiding and refusing to come forward to seek treatment. Consequently, there is a huge number of missing TB cases out there.
“There are many patients who are afraid to come out because they are afraid to lose their job, they are afraid their families will ostracise them…and that should stop,” warns Cornelia Henning, the TB technical expert for the World Health Organisation (WHO).

TB often infects the lungs and is preventable and curable, but early diagnosis is crucial for this to happen.
According to WHO, Sierra Leone is among the 30 highest burden TB countries in the world. It is also one of the 10 countries with the highest incidence rates, that is, estimated number of new TB cases per capita.   
The National Leprosy and Tuberculosis Control Programme (NLTCP) says that in 2016 the country recorded 14, 114 new cases, all of which were put on treatment. 
The health ministry, in a joint statement with WHO and a TB survivors’ group ahead of World TB Day commemoration on Friday, March 24, called for extensive collaboration, from communities to NGOs, the private sector, religious organisations and policy makers, to break a culture of silence over what many see as a “silent killer”.
WHO estimates that 20,000 people fall sick with the TB disease in the country every year, among them an estimated 2,500 children. These figures, according to the world health agency, suggest that on average four people die of the disease in the country every day. 
TB was ranked among the top 10 causes of death worldwide in 2015, killing more people than HIV and Malaria put together, according to the WHO.
Globally it is estimated that 40 per cent of all TB cases are missing, hence the call for rigour in identifying them.
The statement says at present “there are still many TB patients who are not diagnosed”, adding that this contributes to continued transmission of the disease and an increased risk of complication for those affected.
Minister of Health and Sanitation, Dr Abubakarr Fofanah, laments that despite availability of cure, thousands of people die of the disease. 
“This is unacceptable and it is tragic,” he said in a prepared statement, adding: “We must work together in our communities to encourage people to come forward for test and treatment and fight stigma against those affected, which is one of the major barriers that stop people from seeking care.”
WHO Acting Country Representative, Dr Alexander Chimbaru said that if everyone played their part TB could be ended.
“The impact of TB is devastating, and yet we hear all too little about this silent killer,” he said.
The Civil Society Movement Against Tuberculosis (CISMAT) wants TB survivors to play an active role in efforts to tackle the epidemic.
CISMAT is made up of people who have survived the disease. Its National Executive Director, Abdullai Sesay, said TB survivors could play a vital part in tackling myths and misperceptions that had helped fuel the spread of the disease and frustrate efforts against diagnosis and treatment.
Sesay called for increased investment in anti-TB efforts, citing insufficient DOTS [Directly Observed Treatment, Short Course] centres which contribute to discouraging patients from seeking treatment.

“We must also ensure that communities remain at the centre of the response. If we engage communities, we can curtail the spread of TB, challenge stigma and help protect the rights of patients and their families,” he said.
Sierra Leone is said to have made tremendous progress in terms of access to care and treatment for TB patients. It has notably expanded its DOT centres to 171 nationwide. According to the NLTCP, the country last year recorded an 86.76 % treatment rate. 
Officials also spoke of the introduction of innovative tools and treatment for rapid detection of drug resistant TB, of which there are 420 cases recorded annually.

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