XDR-TB in Namibia

[Shiloh]

Source: http://www.namibian.com.na/2008/April/national/08F606ADE1.html

Wednesday, April 2, 2008 - Web posted at 6:22:01 GMT

Lethal TB strain now in Namibia
CHRISTOF MALETSKY

HEALTH professionals are quietly treating up to 24 confirmed cases of extensively drug-resistant tuberculosis (XDR-TB) - the worst form of TB with seriously limited treatment options and chances of cure - in Namibian hospitals.

Well-placed health sources have confirmed to The Namibian that the extreme form of TB is currently under control, but expressed fears that the country does not have the capacity to deal with a major outbreak of XDR-TB.

The Namibian had been aware of at least one case being treated at Walvis Bay since December, but health sources said this week that the situation was worse than initially thought.

On Friday, Health Minister Dr Richard Kamwi only expressed fears that Namibia was about to record its first cases of XDR-TB.

TB can usually be treated with a course of four standard, or first-line, anti-TB drugs.

However, if the drugs are misused or mismanaged, multi-drug-resistant TB (MDR-TB) develops and later progresses to extensively drug-resistant TB (XDR-TB).

"There are currently 254 cases of multi-drug-resistant TB under treatment throughout the country.

This is a great concern and is a clear indication that it is only a matter of time before we will have extremely drug-resistant cases, known as XDR Tuberculosis, in Namibia," Kamwi said at the World TB Day event staged at Mariental on Friday.

He said experts in the Ministry of Health were busy reviewing all TB cases with drug resistance to verify the extent of the problem.

"Given the large number of cases, we may well find some incurable XDR-TB amongst this group," Kamwi said.

Kamwi confirmed that Namibia was the country with the second highest TB incidence in the world after Swaziland, with 15 244 cases reported last year alone.

The host region of this year's TB Day event, Hardap, had the highest incidence of TB in Namibia last year, reporting a worrying 1 294 cases per 100 000 people, Kamwi said.

The TB situation is exacerbated by the HIV-AIDS epidemic in the country.

"HIV infection is the major known individual risk factor for the development of TB disease.

Last year 8 186 TB patients representing 54 per cent of the total notified patients were tested for HIV and 59 per cent were HIV positive," Kamwi said.

He said the impact of the dual infection of TB with HIV-AIDS was a major cause for concern, in particular as it affected the Namibian workforce.

"We are experiencing a decline in work productivity; this then results in a decrease in household income, which jeopardises health, nutrition, sanitation, safety, education and care in our nation.

The effect of disease burdens on the workforce can essentially stunt the necessary socio-economic growth on our path toward Vision 2030," the Minister warned.

He called on health workers to be proactive, focused, tireless and united in their responses against the two diseases.

"Clearly, if we are to make an impact in the control of TB, and considering the reported MDR-TB and the concern related to the XDR-TB, we need more skilled healthcare workers," Kamwi said, appealing for more donor assistance to scale up the procurement of medicines, strengthening hospital infrastructure and enhancing control in TB wards.

 

[Shiloh]

Re: XDR-TB in Namibia

Source: http://allafrica.com/stories/200804040323.html

Namibia: Uncertainty Over New TB Strain
4 April 2008
Posted to the web 4 April 2008

Petronella Sibeene
Windhoek

The Minister of Health and Social Services Dr Richard Kamwi says there is no evidence to suggest extreme drug-resistant tuberculosis (XDR) in Namibia.

The minister this week told New Era that although there is concern this type of strain could be found in the country given its proximity to South Africa where it was identified, it remains unknown whether Namibia has this strain type. He disclosed that a South African expert in the field is expected soon to assess the situation in Namibia. The minister said this after a report in The Namibian stating there are 24 confirmed cases at the country's health facilities. Investigations into resistant tuberculosis have started. Namibia is the second highest in the world after Swaziland.

The Karas region has a notification rate of 1 000 and above TB cases for every 100 000 people. It is said that respiratory diseases are common in the region presumably as a result of the dusty environment. The minister early February declared TB a national health emergency in the country. There were 15,771 cases of TB reported in 2006, or about 765 cases per 100,000 people. About 1,000 cases per 100,000 people have been reported in the regions of Erongo, Hardap, Karas and Oshikoto.

Kamwi said the ministry together with the World Health Organisation (WHO) intends to launch a TB education programme on communication for behavioral change. He told New Era that TB cases are too high hence it is urgent to educate people on the disease. The educational programmes will concentrate on raising awareness about TB prevention and encourage people to diagnose and treat the disease early.

According to WHO experts, the country has the capacity to successfully treat 75 percent of cases and not the 85 percent target. HIV/AIDS is a major factor in the spread of TB in Namibia. Health ministry data from 2005 show that 50 percent to 60 percent of HIV-positive people have TB. The country's health annual report 2006 shows that about 67 percent of people with TB tested positive for HIV. The health ministry's policy requires people diagnosed with TB to be offered an HIV test and referred for antiretroviral treatment if necessary.

The ministry says TB co-infection with HIV/AIDS renders it a disease with a burden of alarming proportions. Similarly, WHO says that HIV/TB co-infection, as well as the stigma associated with both diseases and multi-drug resistant TB, are major factors that have contributed to the low success rate of TB control in Namibia.