TB is not the whole story

Blog 30 Oct 2020

IMPALA researchers shed light on the state of Chronic Lung Diseases (CLDs) in Africa at a special seminar attended by parliamentarians from across the African continent.

The Network of African Parliamentary Committees on Health (NEAPACOH) meets annually to facilitate sharing of lessons and experiences on how parliamentary committees of health can more effectively address health challenges in their countries. The meeting also provides a platform for the committees to develop concrete commitments and actions to champion and address critical health challenges. This year, the committees met virtually between October 28th-29th.

In a special seminar on October 27th organised by Partners in Population Development (PPD-ARO) and The African Institute for Development Policy (AFIDEP), IMPALA researchers were invited to give evidence to parliamentarians based of the findings emerging from their work. At least 44 parliamentarians from more than 20 African countries attended the seminar to listen and actively participate in discussion.

The IMPALA panel comprised of Dr Angela Obasi, Dr Eliya Zulu, Dr Brenda Mungai, Dr Jamilah Meghji, Dr Elizabeth Shayo, and Dr Uzochukwu Egere. Mr Nick Wambugu Kibugi a TB Champion also gave testimony about his lived experiences of being a TB patient.

Dr Obasi opened the session by highlighting that as well as tuberculosis (TB) causing 1.4 million deaths annually worldwide, CLDs like asthma and chronic obstructive pulmonary disease (COPD) account for a further estimated 3.9 million deaths annually. She further highlighted how COVID-19 could exacerbate the existing challenges health systems already face in addressing Lung Health.

Dr Mungai spoke about her PhD work reviewing chest X-rays taken as part of the 2016 Kenya TB prevalence survey. When reviewing these X-rays, the team found many lung abnormalities that were not TB but various presentations of CLD as well as heart abnormalities. Dr Mungai urged parliamentarians to bear in mind that when health care facilities embark on chest X-ray TB screening activities, they need to be aware that other respiratory and non-respiratory problems (such as cardiomegaly) are likely to be as prevalent, if not more so, than active TB. Scaling up CXR for diagnosis therefore can aid in early detection of these preventable and treatable conditions.

Dr Meghji gave an overview of Post-TB lung disease and the issues faced by patients after TB treatment completion in Malawi. Although patients may be given the all clear from TB after a long journey of recovery, Dr Meghji explained that a minority of patients can be left with patterns of lung damage including bronchiectasis, airway obstruction, or destroyed lung tissue that may have long term impacts on their lives and livelihoods. She finished by highlighting the opportunity to leverage the existing TB programme infrastructures to link TB suspects and TB survivors who suffer from CLDs to the right services, and the need to educate patients about how to access these services if they become unwell again after TB.

Dr Shayo followed up by presenting her research about the burden of CLDs in low-and-middle income countries and the socioeconomic impacts of these conditions. She showed attendees her evidence that in Sudan and Tanzania, CLD patients face stigma and social isolation, as well as the financial impact of being unable to work and having to pay for clinic visits and medications. Dr Shayo highlighted the need for increased investment to provide training to community health volunteers and to sensitize communities on these issues to reduce misconceptions and subsequent stigma.

Dr Egere then presented findings about how ready the health systems in Kenya, Sudan and Tanzania are to look after CLD patients. His research showed that currently, health care facilities at all levels of the health system are lacking in human resources, specific CLD treatment guidelines, equipment and medicines. There is a large pool of individuals with chronic cough in the community who do not have TB but have no further pathway for diagnosis or care within the health system. Dr Egere explained that a ‘vicious cycle of CLD neglect’ is currently happening whereby lack of data, diagnostic skills and sensitization, leads to continued under reporting and lack of prioritisation of CLD. Without capturing CLD data, policy makers remain unaware of its true burden and resources are not allocated.  Diagnostic equipment and medicines are not procured and training is not conducted. Without trained healthcare workers  and equipment there is no diagnosis. This perpetuates the cycle of neglect driven by lack of data. Looking for CLD when screening suspected TB patients could help break this cycle.

Mr Wambugu Kibugi gave a powerful patient testimony which illustrated the importance of the findings of IMPALA researchers to the lived experience of patients with lung disease. He told a moving story of surviving TB twice, first becoming sick in 2012 at the age of 18 when he was so unwell he weighed just 35kgs. He was immediately put on TB treatment for 6 months which he completed, but symptoms persisted, and in 2016 he was found to have a collapsed lung that ultimately needed removing. Mr Wambugu talked about the psychological and socioeconomic costs of living with and being treated for TB, and asked parliamentarians to consider a number of interventions which could provide a better experience for TB patients including financial aid, and guidance and counselling.

Overall a strong take home message that emerged during the final discussion was that with relatively little additional investment, serious gains could be made in the treatment of CLD by leveraging existing TB programme infrastructures. Dr Obasi gave the example of asthma, a chronic lung disease whose treatment is relatively cheap and straightforward; inhalers are on many essential drug lists and can be accessed by health care facilities.

In closing, Dr Obasi emphasised that TB is less than one third of the whole story; the data that we already have tells us that more than twice as many people are dying from CLDs as are dying from TB. Dr Obasi therefore urged parliamentarians to bear in mind the other two thirds of the burden of lung disease when decisions are being made about resource allocation and research priorities.

In his closing remarks, Dr Eliya Zulu thanked all the presenters and urged the parliamentarians to take on CLD as a priority issue to be discussed in the main NEAPACOH meeting over the next 2 days.