Poor access to treatment hampers fight against tuberculosis

Tuberculosis has reached alarming proportions in Namibia, as the country is now among the world's top three worst affected countries. The other two countries are Lesotho and Swaziland. In a document sent to the Global Fund to Fight AIDS, Tuberculosis and Malaria, Namibia's Health Ministry revealed that between 650 and 750 cases were registered among every 100.000 people since 2003 - an equivalent to an incidence of about 15.000 patients each year. Tuberculosis affects mainly the poor segment of the society, the majority of whom are HIV positive. The Ministry states in a proposal for funding that tuberculosis had a "steady" increase in the last 10 years as HIV came to the fore and made it a dual epidemic. The proposal expressed the fear that it will take the next 50 years to reduce tuberculosis transmission, morbidity and mortality to such an extent that it will no longer be a public health problem in the country. The proposal further stated tuberculosis was high among the marginalised San people, in the defence force, prisons and among migrant workers. Males were more affected than females, except in the age groups under 24 years.
According to the Ministry of Health tuberculosis programmes in the past 10 years had been hampered by a shortage of well-trained staff in tuberculosis control and patient management, lack of regular supervision and inadequate clinical management. "The multitude of medical doctors from dozens of different nations is not oriented on the Namibian tuberculosis guidelines and often do not provide what the NTCP (Tuberculosis Control Programme) considers 'gold standard clinical practice'," the proposal said. In addition, the frequent rotation of nurses in between health facilities severely eroded efforts to build up a competent tuberculosis workforce at the primary care level. (The Namibia, Windhoek)