International public health officials have announced plans to eliminate tuberculosis in more than 30 countries that already have low TB rates. The new goal calls on those nations to prioritize efforts to drive down the infection rate to near zero.
The new framework – driving down the tuberculosis rate to fewer than 10 new cases per million annually by 2035 – was outlined at the weekend in Rome where international public health officials are meeting there to coordinate TB elimination efforts.
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Fewer than 100 TB cases per one million people are reported each year in 33 countries and territories, including Nigeria, the United Arab Emirates, Jordan, Malta, the West Bank and Gaza Strip. Still, that translates to 155,000 new infections and some 10,000 deaths.
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The ultimate goal is eradication of the disease in those countries by 2050. The WHO defines elimination as less than one new case per million people each year.
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“We need an extra coordination of all the areas, all the compartments of this TB control elimination program. And those are eight main areas. “There are several studies showing that the treatment and prevention of tuberculosis is cost-effective. So, that the society costs due to tuberculosis are much higher than the investment needed to prevent them [the disease],” Giovanni Batista Migliori, director, WHO Collaborating Center for Tuberculosis and Lung Diseases said.
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Migliori noted that the eight key interventions include increased funding to screen for active and silent TB infection in high risk groups, such as people with HIV, residents of impoverished communities and migrants from neighboring countries.
He added that governments should invest in research into new tools to rapidly identify and treat tuberculosis, including multi-drug resistant strains. He pointed out that a renewed push to eliminate TB is needed so a resurgence of a preventable and treatable disease does not occur in low-burden countries.
This development comes as TB is a major public health problem in Nigeria, being one of the ten leading causes of hospital admissions and a leading cause of death in adults, especially among the economically productive age group.
Currently, Nigeria ranks tenth in global list of 22 High Burden Countries (HBCs) that account for about 80 percent of the estimated global TB burden. According to the 2011, WHO Global TB report, Nigeria has an incidence rate of 133 per 100,000 populations per year (210,000 cases).
The estimated prevalence for Nigeria in the same report for all forms of TB is 199 per 100,000 populations per year (320,000 cases) and mortality rate for all forms of TB is 21/100,000 population (33,000 deaths per year).
While multi-drug resistant TB (MDR-TB) and extensive drug-resistant TB (XDR-TB) remains major threats to TB control efforts in Nigeria, challenges such as inadequate funding and budgetary provisions for TB care and control services at National, State and LGA levels, poor coordination and lack of synergy of efforts among different players in TB control, and coverage of community TB care programs have experienced limited successes.
Experts believe that this aspect of TB control is very important in addressing the social link between TB and poverty, TB and gender as well as TB and community health system structures. They also identified participation of private health institutions in TB control services as been very minimal with the use of evidence-based data to inform better TB control planning, design, implementation, monitoring and supervision also very weak.
A peep into high burden countries with TB include Afghanistan, Bangladesh, Brazil, Cambodia, China, the Democratic Republic of Congo, Ethiopia, India, Indonesia, Kenya, Mozambique, Myanmar, Nigeria, Pakistan, the Philippines, the Russian Federation, South Africa, Thailand, Uganda, Tanzania, Viet Nam and Zimbabwe.
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While several patients misdiagnosed as a result of inaccurate or incomplete diagnosis of an ailment, the absence of quality assurance which ensures that the final results reported by the laboratory are accurate is fuelling misdiagnosis in the country, a situation which has led to the death of Nigerians, including notable personalities in the country.
As it has become a common feature to see patients administered medicare without laboratory tests been conducted, more often than not, this has led to inaccurate diagnosis with the patient administered a wrong medication that could be injurious to such a patient.
In an interview with SUNDIATA POST , Kehinde Aluko, managing director, Clina-Lancet Laboratories, Nigeria; Aluko said that prompt diagnosis with accurate laboratory test before treatment would eliminate misdiagnosis and improve life expectancy.
Describing quality assurance as overall programme that ensures that the final results reported by the laboratory are accurate, Aluko explained that quality control measures must be put in place in laboratories to ensure that each test is conducted according to set standards.
According to Aluko “The aim of medical tests is to improve the efficacy of diagnostic medicine, compliments the technology deficiency in the tertiary hospitals, avail doctors the opportunity to practice evidence-based medicine (EBM) and bridge the gap between Nigeria and other countries in the area of clinical diagnosis.
“Unfortunately, several laboratories in Nigeria cannot boast of internal quality control which has become the bane of accurate laboratory results. Most laboratories have inadequately trained personnel, poor reagent equipment among others and this has made laboratory results from the country unacceptable abroad. What you see is that lab practice in one part of the country is not the same with another laboratory practice elsewhere, leading to a variance in the outcome of lab results.”
Aluko advocated the need to put in place standard operating procedure that every laboratory in the country must adhere to. She added that regular audits are critical to ensure that standards are maintained and quality control and quality assurance met.
Pamela Ajayi, managing director PathCare, Nigeria noted that when misdiagnosis arises from clinical or technical error, the patient can suffer traumatic consequences because of complications.
While accurate laboratory test before treatment eliminates misdiagnosis and improve life expectancy, Ajayi pointed out that inadequate trained personnel, poor reagent equipment among others affect the quality of laboratory results obtained.
“Laboratory tests are very essential because no drug is absolutely safe. Self diagnosis only treats symptoms and not the problem. There is need for patients to take ownership of their body and object when doctors do not carry out laboratory tests before treating them. To put an end to patient doubts, there is the need for laboratories to be accredited by recognised bodies to ensure that they meet minimum quality management standards. Pathology supervision is also necessary,” Ajayi added.
Idris Durojaiye, medical director, Clina-Lancet Laboratories advocated the need to institutionalise internal and external quality assurance programmes as well as invest in upgrading laboratories to meet world standard in a bid to address growing misdiagnosis and safeguard the health of Nigerians.
A peep into Nigeria’s health sector reveal that the number of medical laboratories is fast catching up with patent medicine stores that can be found everywhere in Nigeria. The increasing demands for sample tests by people seeking answers to ailments have fuelled the increase in laboratories. These clinical laboratories are dotted in attractive diagnostic varieties.
While some labs claim that they have the capacity to test all samples as may be requested by any health facility, some are well branded to offer quality care and others made to suit the environment they are located in.
Laboratories can be set up in any space available like kiosks, shops, room apartment, hospitals or any place as long as there is a roof. With a handful of equipment and reagents, medical laboratory business can hit the ground running. Desperate people seeking solution to health issues are never out of sight.
Sadly, most laboratories in the country cannot boast of internal quality control which has become the bane of accurate laboratory results. The lack of internationally adopted standards that encompass all professionals, accreditation and monitoring system amongst others have continued to plague the system.
In addition, dearth in quality control of clinical laboratory practice, inadequate trained personnel, and poor reagent equipment, among others has made laboratory results from Nigeria unacceptable for diagnosis abroad. Experts believe that for Nigeria to have quality laboratory results and improve the quality of clinical care, there is need to raise the profile of laboratories in the country.