ARTICLE ON HEALTH-A Killer disease has returned
Among the six killer diseases seen
commonly in children, the one which is
viewed with alarm by public health
specialists and responsible governments
around the world is the resurgence of
tuberculosis.
This disease is caused by a tiny bacterium
called mycobacterium. Tuberculosis is
usually contracted by droplet infection
meaning that coughing or sneezing
produces the aerosols in which the
organisms are suspended. This forms its
mode of transmission from one individual
to another. The inhalation of these aerosols
allows the organism into the lungs, where
the bulk of the infection is caused. This
disease also manifests in other forms,
usually as complications by spreading to
some other regions of the body through
the blood stream.
It could spread within a few months to the
kidneys and cause renal tuberculosis or to
the large joints causing tuberculous
arthritis and even to the skin where it
causes chronic ulcers. It can affect the
spine as well causing vertebral and joint
damage and can smoulder for years in that
region with the production of pus known
as cold abscesses. It may also cause
meningitis and could spread around the
body simultaneously causing what is
known as military tuberculosis, which is
similar in terms of description to a
spreading cancer. In this situation, virtually
every organ in the body is invaded at the
same time by the bacterium.
Tuberculosis can also begin in the
abdomen as is seen among those
communities where the consumption of
fresh cow milk is a way of life. The
nomadic Fulanis of the Sahel region and
the Masaai of East Africa are the leading
examples. It can also afflict those
communities who emulate these peoples'
habit of drinking fresh, unpasteurised
milk . It is a disease that has also been
known to attack the testes causing
widespread damage and the inability of
the testes to produce spermatozoa thus
causing male infertility. The range of this
disease is thus very extensive. And only
those who have the lung infection would
exhibit a cough; the others could present
with chronic malaise for a long time before
a practitioner with a high index of
suspicion decides to chase the root cause
of the individual's ill health. Many may
actually appear healthy in virtually every
respect.
Some two decades ago, this disease was
largely confined to the poorest parts of the
globe with countries such as Nigeria, India,
Pakistan, Bangladesh and China being
responsible for some 90 per cent of the
world's total number of cases. However,
starting from about 1985, this disease has
with the advent of the HIV pandemic, the
virus which causes AIDS, begun a renewed
onslaught on even the most prosperous
communities of the world. Anywhere there
has been a rise in the number of HIV/AIDS
cases, tuberculosis has been on the
ascendancy. This has not been the only
reason for new infections, however.
Communities which allowed their level of
surveillance to slacken have seen dramatic
increases in new infections. This has
happened because the old and tested
formula of reporting every new infection
to the public health authorities and the
relentless follow-up of all possible contacts
have been abandoned, and allowed new
infections to occur. While this is largely true
of
the poor developing countries named
above, the causes are more varied in the
advanced countries which have also been
affected by the AIDS pandemic.
In those nations, the common causes of
the increase in incidence are the advent of
drug resistant strains of the organism that
causes the disease and the advent of AIDS,
a disease which weakens the immune
system and thus renders the sufferer
unable to fend off an infection. In the
poorer nations of the world, the people
have to cope with those two reasons in
addition to systemic weaknesses that allow
sufferers to go undetected. Those who are
diagnosed do not have their closest
contacts investigated for the possibility of
also harbouring the disease and the reality
that those who drop out of their treatment
schedules are not followed up and so
remain at liberty to hobnob with everyone
else are additional reasons for the
relentless spread of this disease. The result
is the emerging chaos we are faced with
and as with everything else, those nations
are particularly poorly equipped to deal
with the looming scourge especially those
in sub-Saharan Africa, Pakistan and
Bangladesh.
All of them have one thing in common:
they are resource-poor nations or
resource-mismanaged nations which have
considerable political instability and weak
institutions. The summation of all that is
further public health chaos with attendant
increases in poverty levels as a sizeable
proportion of the annual budgets are
eventually diverted towards the treatment
of this chronic disease.
Worse, the resistant strains of the disease
invariably ensure that more advanced
drug combinations are utilised for its
treatment. The meaning is clear: it is more
expensive to use those drugs. The poor
nations with their scant attention to public
health issues and their teeming masses of
poor peoples are thus in a very weak
position to lift themselves out of the
developing problem. Governments and
health planners in all those nations
therefore need to sit down and itemise
what targets must be met within specific
timelines in order to contain this issue. The
people must be educated about the ills of
half-hearted treatment or of not seeking
treatment at all, and made to realise that
this eminently curable disease should not
be viewed as a social stigma.
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