Despite increased resources, deadly disease rises

Zinhle Mapumulo

Zinhle Mapumulo

Despite the allocation of more resources and the increase in the budget to fight extreme drug- resistant (XDR) tuberculosis in KwaZulu-Natal, the killer strain continues its rampage unabated.

Since XDR-TB was discovered in KwaZulu-Natal in February 2005, about 352 cases have been identified across the country. Of these, 247 were reported in KwaZulu-Natal in the Tugela Ferry district.

In the past two years, at least 237 people have died from XDR-TB and of the deaths, 221 were reported in KwaZulu-Natal.

Tony Moll, principal medical officer at Church of Scotland Hospital in Tugela Ferry, was the one who first raised the alarm about the killer TB strain in the province.

He detected the strain when most of his patients, who were co-infected with TB and HIV, suddenly no longer responded to the TB treatment.

After several tests, Moll discovered that they had developed resistance to TB drugs.

Moll said the emergence of multi-drug resistant (MDR) and XDR-TB should not be seen as an outbreak, but as a reflection of a failed TB control programme and an indication of poor socio-economic conditions in South Africa.

"It is a fact that TB is associated with poverty, yet we can't dispute that it affects everyone, even the richest. This is why as medical people we blame the TB programme for the emergence of MDR and XDR-TB," Moll said.

"We could have prevented XDR-TB if our TB control programme was adequate.

"But the programme was neglected for many years. As a result we developed the worst strain of tuberculosis without knowing it."

MDR-TB was first discovered in South Africa in 1994. Through the years, scientists have tried to control it by continually improving TB drugs.

Lindiwe Mvusi, manager of the TB control programme, agrees with Moll that the programme was poor.

This led to the development of the drug resistant strains.

"I would be lying if I said the TB programme was adequate. For many years, the programme remained unchecked and no data was collected," Mvusi said.

"We had poor contact and defaulter tracing, and as a result patients would be diagnosed with TB and never come back. Nobody would trace the whereabouts of these people afterwards.

"I believe we have learned from our mistakes. We do understand that we can't reverse the situation, but we can try to find a solution. We are currently running campaigns to create awareness about TB and the dangers of not adhering to the treatment," she added.

Last year, the TB programme established a crisis plan. Initially the plan was to focus on the two worst performing provinces - KwaZulu-Natal and Eastern Cape.

The four worst-affected districts were identified in these two provinces - Mzinyathi, Amatole, eThekwini and Nelson Mandela Metro.

As part of the crisis plan KwaZulu-Natal was recently given a budget of R220million in aid to fight MDR and XDR-TB. The department of health has already started with this project by investing in an MDR clinic at Greytown Hospital.

The hospital will admit MDR and XDR patients referred back from King George V Hospital.

King George V Hospital in Durban, the only TB referral hospital in the province, admits about 780 MDR and XDR-TB patients a month.

Medical manager, Shamin Maharaj, said the hospital could not afford to separate TB patients because of space.

"As much as we would love to keep the XDR-TB patients isolated, it is impossible because we don't have the luxury of space. Already we are crammed in the MDR clinic and we can't admit any more patients," she said.

She said the situation was serious. "We sometimes have to turn back critically ill patients because we don't have beds for them."

The hospital is currently revamping and has promised to increase the number of beds to 400 in the MDR clinic.

It is estimated that KwaZulu-Natal has about 95000 TB patients, 23percent of whom have defaulted on their treatment. This has impacted on the cure rate of the province. Currently the province has the lowest cure rate in the country.

TB expert, Professor Willem Sturm of the University of KwaZulu-Natal, said poverty, the high prevalence of HIV and lack of information about TB and its impact were reasons for such high defaulter and low cure rates.

"Poverty plays a major role. Most TB patients cannot afford to go to clinics every month to collect treatment and, therefore, end up defaulting.

"When patients default, they automatically decrease the cure rate and increase incidents of MDR and XDR-TB.

"The high prevalence of HIV also contributes to the spread of MDR and XDR-TB," Sturm added.

Moll also emphasised that alleviating poverty, educating the community about TB and its dangers, as well as implementing the directly observed treatment therapy would help win the fight against the spread of TB in the country.