Harmonising TB Control Strategies

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Tuberculosis popularly called TB is an air borne disease caused by a complex family of bacteria described as mycobacterium.

Scientifically, the disease is said to affect all vertebrate animals including man.

According to the 10th Edition of the Merk Veterinary Manual page 621, TB is identified and described as a granulotous disease caused by acid-fast bacilli of the family of mycobacterium.

By way of identification of the chronic antageous disease, therefore, the bacterium that causes TB in human is called mycobacterium tuberculosis, in cattle it is called mycobacterium bovis, the one in goats and sheep is called mycobacterium Capri, in birds mycobacterium avium, while mycobacterium canis describes the condition in dogs.

One thing is clear: TB in any creature be they livestock, birds or humans remains a bacterial disease caused by the complex mycobacterium family.

TB is largely seen to be caused by breathing in of air droplets from cough and sneezing of infected person particularly in the case of pulmonary tuberculosis.

In an interview with the Head of Rivers State Tuberculosis and Leprosy Control Programme, Doctor Kingsley Aleruchi, the National TB Control Programme with the state Ministry of Health classifies tuberculosis into two(2) types; tuberculosis of the lungs which he described as pulmonic TB and the TB that affects other parts of the body called extra pulmonic TB.

Doctor Aleruchi explains pulmonic TB as one that attacks and affects breathing apparatus of man, contending that it is this subtype that is of public health importance in the quest for TB control and paid less attention to TB as zoonotic disease which he said is not as common as pulmonic.

On the other hand, TB is classified as a disease that is transmissible from animal to man and vice vesa, hence it is described as zoonotic deserving of attention too.

The Chairman, Nigeria Veterinary Medical Association, Rivers, State Chapter, Doctor Olutoyin Adetuberu said in an interview that humans can contract TB through the consumption of infected animals and contaminated dairy products and called for thorough inspection of livestock before they are slaughtered for consumption at the various abattoirs.

In her words, “tuberculosis is not peculiar to man alone because the one found in animal are transmissible when man consumes the tubercles in the lungs and visceral of animals.

Evidence abounds that laboratory scientists are strategic in TB diagnosis and treatment in all TB cases whether as a disease condition in humans or livestock.

A Bacteriologist in the Medical Microbiology and Parasitology Department of University of Port Harcourt, Omakwele Godwin Chukwudi confirmed the complex family of mycobacterium as the main causative organism that causes tuberculosis in man and livestock which should not be trivialised. Man in search for food and games contracts diseases from animal too.

Mr Omakwele Godwin Chukwudi who is the TB Laboratory Focal Person in South-South Nigeria also expressed concern over what he called multi-drug resistant cases in the present day TB control effort.

“What is paramount is that TB has progressed beyond the ordinary drug susceptible case. There are now what we call mono, multi-drug and extra drug resistant cases and patients in the drug resistant category take longer time to manage than the 6 – 9 months theraphy in drug susceptible case.

Interestingly, at the 11th Rivers State Council for Health Meeting in May 2013 in Port Harcourt the Commissioner for Health Doctor Sampson Parker disclosed that there was resurgence of TB and also voiced concern over the attitude of some faith-based organisations that prevent children and wards of their members from accepting immunization.

Besides, an international donor organisation, The Global Fund describes TB as a global epidemic; adding that an estimated 14 million people worldwide are infected with active TB.

The Global Fund also reports that in 2009 alone there were 9.4 million new cases of TB and 1.7 million death including 380,000 deaths from TB, among people living with HIV/AIDS while the vast majority of deaths are in the developing world.

It is also on record that TB is listed as the sixth UN Millennium Development Goals (MDG) covering HIV/AIDS, malaria and TB itself.

In this circumstance, TB no doubt has come to stay as a disease of mankind and livestock.

To treat and control TB, therefore, there is the need to mainstream collaboration among all the critical stakeholders in the health sector.

In the view of Omakwele Godwin Chukwudi, a laboratory scientists and TB Laboratory Focal Person in South-South Nigeria cited above, the veterinary

medical doctors, laboratory scientists, human doctors, pharmacists, clinicians and nurses should form a synergy to bring abound holistic control of TB.

The Bacteriologist asserted: “TB as a disease is not only TB transferred from man to man as a reservoir but other animal component in the disease dynamic. There is the need to look into the abattoirs where animals are slaughtered for consumption.

It would be recalled that earlier in August 2013, China banned dairy product from New Zealand in the wake of botulism scare.

In other words, botulism refers to food poisoning, in this case of dairy product infected by bacteria.

A veterinary surgeon and chairman Nigeria Veterinary Medical Association, Doctor Olutoyin Adetuberu corroborated the view of the bacteriologist above, calling Rivers State for the emulation of the One Health approach which deals with collaborative effort of multiple professionals of varied backgrounds in the health sector working locally, nationally and globally to attain optimal health for people, animal and the environment.

Today, increasing international travel and migration, genetically modified food, contact between human and wildlife as well as integration of food production to address food security are global issues begging for attention.

Better still, collaboration among human and veterinary doctors had proved effective in Rivers State when in 2006, the Rivers State Inter-ministerial Committee on the Control of Bird Flu headed by Doctor Godwin Mpi as Chairman and a veterinary doctor, Allwell Emejuru (Secretary) confirmed the case of Bird Flu in the farm of Captain Kanu in Bori Camp, Port Harcourt.

If collaboration worked in the case of Bird Flu, a viral disease, it can also work in the case of TB, a bacteria disease.

More so, at a time when there are reported multi drug resistant cases, the management of TB cannot be left in the hands of one set of professionals because drug resistant case are attributed to abuse and defiance on part of patients, poor quality drugs hasty generalization by human doctors that the specie of mycobarium must be of human reservoir rather than migration from animals as well as poor monitoring of patients on treatment. In these instances, only one group of professional cannot claim to be all-knowing.

As the head of TB and Leprosy Control Programme, Rivers State, Doctor Kingsley put it: Anyone that has regular cough for 2 weeks is a TB suspect.

In this regard, early diagnosis remains the panacea and TB treatment in Rivers State is free.

TB is not a death sentence. The time to act is now.

Baridon Sika is of the  Rivers State Broadcasting Corporation PH.