The story of Sokoto
The day Binta was diagnosed with tuberculosis (TB) was the day she died. She had the disease for long but didn’t go to hospital until the last moment.
According to the doctors that attended to her, she already had TB of the chest and spine and couldn’t walk when she got to the hospital.
Health officials in Sokoto are expressing concern that despite the availability of TB treatment – free of charge – many, especially in the rural areas, do not go to hospital to seek medical redress for the disease.
TB is an infectious disease with symptoms such as cough that lasts for over two weeks, chest pain, fever, night sweat, fatigue and coughing up blood, among others.
Daily Trust has, however, gathered that of great concern now is the Drug Resistant Tuberculosis (DR-TB).
“We believe that there are a lot of TB/leprosy cases in the communities. The issue is how finding the patients,” said Dr Bello Umar Tambuwal, Control Officer Tuberculosis and Leprosy, Sokoto. “Many of the people in the rural areas have TB but on their own, they don’t come to the hospital, we have to find them.”
He said leaving one case of TB in the community is quite dangerous because “it is estimated that if you have one case of TB in the community, within one year, that can infect at least 15 people. That is how the pattern is; they continue to infect more people until we get them. We create more awareness and get to the cases.”
Dr Bello also said Sokoto is among the best in Nigeria in terms of active case finding of tuberculosis in the country. “The target set for Sokoto last year was over 8,000 and we reported over 6,000,” he said, adding “we reached more than 50 percent of the target which many of the states were not able to achieve. So far only Sokoto, Kano, Bauchi and Lagos have got 50 percent of the expected target.”
According to him, emphasis is on TB because of a type of the disease currently that is very difficult to treat; the Drug Resistant Tuberculosis (DR-TB).
“The conventional drug we use to treat TB cannot be used for DR-TB; it is resistant to the first line drugs. Even the duration of treatment is quite different because if you treat the conventional TB – drug susceptible TB – for six months, DR-TB has to be treated for more than a year. And anybody that gets TB from somebody with Drug Resistant TB, will from the beginning get the resistant strain. So he will start with Drug Resistant TB,” the control officer explained.
He said the DR-TB centre at the Specialist Hospital in Sokoto is the only centre in Sokoto, Kebbi and Zamfara states, adding that they receive many cases from Zamfara, Kebbi as well as about six patients from Katsina being the only centre around the area.
Dr Bello however noted that a centre is being constructed in Zamfara that would complement that of Sokoto.
The medical expert noted: “It is quite common now; we have over 30 patients in the community with Drug Resistant TB and currently we have nine of them at the treatment centre receiving intensive care.
“We had 19 patients, we discharged nine of them before the Sallah because they had been there for four months. After four months we discharge them. They go back to their communities and continue to take their medications.”
On the detection of the resistant strain of TB, Dr Bello explains that DRTB cannot be identified through the conventional ways of x-ray and sputum that TB is detected. “We have special machines that we use. We have six of such machines in Sokoto, they were provided by the Federal Government through the partners.”
However, our correspondent gathered that two of the machines are faulty – the one at Murtala Hospital where many patients in the metropolis visit and that of General Hospital Isa, that takes care of the Sokoto East zone.
On the broken-down machines, the control officer said the state government through the unit had reported and is waiting for them to be fixed. He said they also send samples to Kano because of the reference lab there.
Bello identified lack of compliance to drug as a major cause of DR-TB. That is why DOTS, (Directly Observed Treatment Short) course is practiced. It involves giving patients drugs under direct supervision by health personnel. However, people still have to come from their houses to take the drug and some of them don’t come, said Dr Bello.
He said: “Despite the fact that TB treatment from beginning to end is completely free, we still have to be talking to people on the need to come for it. Some of them take the medication for two months and stop because usually when they take the treatment for two months, the cough will stop, so they think that they are cured.
“Some will just disappear and this is what brings about TB Resistance. The children are at risk because many of them have children who can easily get it.”
As part of effort to tackle DR-TB in the Sokoto State, a dedicated focal person and assistant focal person have been assigned for DR-TB while series of training, routine supervision in all local governments and advocacy regarding DRTB are being embarked upon, says Bello.
He said there are 23 tuberculosis/leprosy supervisors in the state, one for each local council.