What Caused Tuberculosis to Regain Its Position as Africa’s Leading Cause of Death? 

Since the beginning of the 20th century, there has been a reliable treatment for tuberculosis (TB). However, tuberculosis continues to be the leading cause of death attributable to a single infectious agent. It ranks higher than HIV and AIDS, as well as other diseases.

This is due, in part, to the impact that HIV co-infection has on tuberculosis patients in regions such as Africa, as well as the emergency of MDR-XDR TB. It is of continuing concern that there is a lack of gender mainstreaming as well as a reduction in stigma, which is demonstrated by insistently lower cases reported among women than among men.

In the past two years, COVID-19 has overtaken TB as a leading cause of death. Since 2005, there has been a declining trend in the number of people who pass away from TB. But as of right now, TB occupies the number one spot. The number of individuals who received treatment for tuberculosis dropped between the years 2019 and 2021, primarily as a result of lockdowns brought on by COVID. The percentage of people diagnosed with tuberculosis who were receiving treatment dropped to 61% in 2021, down from 69% in 2020.

Where Did We Go Wrong?

The process of eradicating tuberculosis was making headway. However, TB control programs all over the world have been set back as a result of the COVID-19 pandemic and the associated lockdowns. More so in Africa. Even though COVID-19 protective measures such as mask-wearing could have deterred TB transmission, as a whole, little focus was paid to retaining the forts of TB detection and treatment as all efforts went toward fighting the COVID-19 pandemic, which disrupted well-functioning programs built over generations of meticulous research and planning. The following are the consequences that this disruption has brought about:

More Cases of Tuberculosis

The number of new active TB cases in the world increased to 10.6 million in 2021, from 9.9 million in the previous year. These rises have been seen in drug-sensitive TB cases as well as TB cases that are resistant to multiple drugs.

 An Increase in TB-related Fatalities

There were an approximated 1.6 million deaths worldwide caused by tuberculosis in 2021, an increase from the 1.5 million deaths caused by the disease in 2020 and the 1.4 million deaths caused by the disease in 2019. This represents a reversal of the decline that had been occurring for many years before the COVID-19 pandemic. The African region, which accounts for approximately 16% of the world’s population, is responsible for 25% of all TB-related fatalities. One of the primary contributing factors is HIV.

A Decrease in Total Global Spending on Tuberculosis Treatment Both During and After the Covid-19 Pandemic

The amount of money spent around the world on essential tuberculosis services is expected to decrease from $6.0 billion in 2019 to $5.4 billion in 2021. This is only a little over a third of what is required. This prolonged decline in tuberculosis prevention and control has been compounded by the conflict in Ukraine.

Before the Russian invasion, there was a significant tuberculosis problem in Ukraine. The war has made the situation significantly worse, as it has resulted in the destruction of health facilities and the displacement of people. The most severely impacted are TB control programs in Africa that are dependent on aid and support from the Global Fund.

How Do We Put a Stop to This?

What must be done should be guided by the first milestones established by the End TB Strategy for reductions in TB disease. This includes a reduction of 20% in the incidence rates of tuberculosis in 2015 and a reduction of 35% in the total number of TB deaths benchmarked in 2015. Kenya (in 2018), Tanzania (in 2019), and Zambia are the three high-burden countries in Africa that have attained or passed the first benchmarks of the End TB Strategy for declines in TB incidence and TB deaths.

Kenya reached this benchmark in 2018, and Tanzania and Zambia both achieved this benchmark in 2019. (in 2021). The majority of the African continent, on the other hand, has witnessed a turnaround in the gains that were made.

To prevent further damage caused by the COVID-19 pandemic and even potentially reverse its effects, it is urgently necessary to step up efforts to secure financial backing. This problem has become even more urgent in light of current conflicts across Africa and other regions of the world, which are likely to exacerbate some of the more general factors that determine the risk of tuberculosis, such as a lack of adequate nutrition. The following should be top priorities when treating TB:

  • Improve existing tuberculosis and tuberculosis/HIV services by allocating more funds and personnel.
  • Create online platforms for education and training in health-related topics
  •  Create data dashboards aimed at the general public for tuberculosis surveillance. Create a system of telemedicine that relies on digital platforms for patient consultations. Reduce the number of missed follow-ups.
  • Services for the treatment of tuberculosis in the community should be improved.
  • Increase the use of virtual care and community monitoring solutions to deliver remote support, such as video-based therapy. Increase the use of text messaging as a means of communication in order to enhance treatment adherence as well as patient-centered care and support.

The following should be prioritized in TB prevention:

  • Targeting high-risk clusters for widespread testing can help communities find the majority, if not all, of their undiagnosed active TB cases.
  • Efforts should be made to improve active case-finding and diagnostic services for tuberculosis in community settings (including in shelters for people who are homeless).
  • Integrate services for tuberculosis, HIV, and COVID-19, such as screening and testing, finding cases, and preventing infection.
  • Boost actions at health facilities aimed at screening patients and locating cases, including those that target populations at high risk
  • A greater emphasis on TB testing in populations at high risk For dual medical tests for tuberculosis and COVID-19, use molecular tests that have a quick turnaround time and a high level of sensitivity and specificity.
  • Increase the use of chest radiography for tuberculosis, either with or without the assistance of computer-assisted detection and improve facility-based screening.
  • Make sure that there is a consistent source of diagnostics and medications by using local manufacturing.
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