Rise of drug resistant TB in South Africa a reminder of challenge the country still faces

While the world unites around the FIFA World Cup in South Africa this Friday, tuberculosis continues to pose a significant challenge in a country where the disease remains the leading cause of death.  TB is also the leading cause of death among people infected with HIV/AIDS.

Furthermore, the emergence of new, drug resistant strains of TB, such as multidrug resistant (MDR) and extensively drug resistant (XDR) TB, have exacerbated the situation because these strains cannot be treated with standard drugs.  Instead, they must be treated with drugs that are less effective, more expensive, and have harmful side effects. Worryingly, drug resistant TB is on the rise in South Africa.

Drug resistant TB developed due to inconsistent or incomplete treatment.  This occurs when patients do not complete their treatment because they start to feel better, when patients are prescribed the wrong treatment (because diagnosis of TB that , or when drug supply is unreliable.  Drug resistant TB strains have emerged in every country surveyed by the WHO, seriously threatening TB control efforts.

Voice of America reports how multi-drug resistant tuberculosis is gaining ground in South Africa:

Sister Flora Nsubane shows a group of visitors around the King George Hospital in Kwazulu Natal, a world leader in the treatment of tuberculosis.  They wear masks to protect them from getting infected with multi-drug resistant tuberculosis, or MDR-TB.

“This is a 32-bedded ward…It is always full because it is the only TB ward that we have,” said Nsubane.

Patients who are sick with more virulent strains of MDR-TB and extensively drug-resistant tuberculosis or XDR-TB stay in separate wards.

The children’s ward is spotlessly clean but largely empty because most of the children are at a school run for them by the hospital.  A couple of toddlers are quietly playing on the floor.

A baby girl in a highchair fixes her big dark eyes on Sister Suminthra Sukmandam, the nurse who is feeding her.

“The baby is having a soft diet, which is prepared from the kitchen.  It is pureed butter nut, pureed chicken and also mashed potato,” she said.

Sister Sukmandam says the baby is four months old and was admitted to the hospital two weeks ago.  “She’s got multi-drug resistant TB and she has been the same.  Her appetite is improving,” she added.

Sister Flora says the survival rate for children with MDR-TB is about 80 percent because they are kept in the hospital up to a year where their treatment is closely supervised.  She says adults are admitted for six months and once their sputum is negative they are sent home.

“Then they continue without patient treatment.  And, at home, we have discovered that family members are not good support teams.  Why? If the patient says I am tired of taking eight tablets a day and maybe the family member says no, it is O.K., you can take it tomorrow,” she said.  “And then that increases resistance and they take long to be cured.”

(…)

Thirty-six-year old Samkelisiwe is a single mother of a 17-year old boy.  She says she took treatment for ordinary TB last year. On April 26 she was admitted to the hospital and found to have XDR-TB

Samkelisiwe says that in September, 2009, she went to the clinic because of severe weight loss. She says she was coughing up sputum, which was diagnosed as TB.  She says she did not respond to the TB treatment and later learned she had XDR.

The World Health Organisation also warns ‘urgent investments in infrastructure, diagnostics, and provision of care are essential if the target established for 2015 – the diagnosis and treatment of 80% of the estimated M/XDR-TB cases – is to be reached.’  As the world gathers to celebrate the World Cup for the next month, it is also a key moment to remember that the fight against tuberculosis, both in South Africa and globally, is not over.

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