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TB Situation in Botswana

Publishing Date : 13 April, 2015

Author :

Dr Boima
HEALTH ESSUES


Red Flag Symptoms to take note of

Cough (with or without blood)
Fever
Night sweats
Weight loss


It is no secret that Botswana is one of the top countries in the world with high Tuberculosis (TB) incidence, despite TB being both preventable and curable. This is partly because of the high HIV prevalence and other factors that help in fuelling the infection.

Currently the TB notification rate is at about 414 per 100,000 people in Botswana. Fortunately, Botswana continues to enjoy the global support from both international Governments and NGO partners in fighting the TB (and HIV) co-pandemics.


Locally, Ministry of Health through the Botswana National TB Programme (BNTP) is dedicated in directing collaborative efforts of fighting TB (and HIV) hence reducing their morbidity and mortality. BNTP is in keep with both national policies and targets and WHO standards;

TB/HIV Policy Framework

guides the integration of TB/HIV treatment

Vision 2016

Emphasises the desire to have a healthy nation by the year 2016 and beyond

Practicing Direct Observation Therapy (DOT)

Most effective for TB treatment as per WHO guidelines

United Nations Millennium Development goals

Botswana was among 147 UN member states that committed to pursuing the MDGs by 2015, among them Goal 6: ‘Combating HIV/AIDS, Malaria and other Diseases including TB’. A tremendous progress has been made so far

Challenges in addressing the fight against TB

Botswana has high HIV prevalence rate which is the main driver of the TB pandemic (About 63% of people diagnosed with TB are co-infected with HIV) which is why efforts are being channelled towards integrating the two conditions in the fight.


Naturally, detection of TB in people living with HIV is difficult (low immune system may not allow HIV patients to be able to mount TB symptoms and signs).

Poor Infection Control – in our health facilities and other community places.


Stigma – the nature of the infection or the misconceptions surrounding the infection (especially in our African communities) play a big role in making people reluctant to get screened for TB, even in cases where people have clear symptoms and signs of TB.


Illiteracy - Inadequate information on TB, HIV and AIDS and preventative measures in Botswana especially at the rural/far-to reach areas (compared to the Western world) continues to make our communities vulnerable to getting infected by TB.


High defaulting Rates and Poor Contact tracing- Batswana are a very mobile population with people having at least three places where they reside seasonally (Home village, city, moraka, masimo), which makes it difficult for health care workers to make thorough follow up on the patients or their contacts.


Drug-drug interactions - Medications for HIV and TB taken at the same time may lower the efficacy of each other or increase the toxicity levels of the drugs in the body.


Drug Resistant TB – Adherence to treatment remains the highest challenge for the country when dealing with TB matters. A combination of reasons, others mentioned above encourages this. Poor adherence almost always leads to the development of drug resistant TB which is very difficult, expensive and long to treat. About 100 new cases of Drug resistant TB are recorded every year in Botswana.

What to do at individual level

There is no doubt that Botswana as a country, is enjoying all the international support it can get (both financial and otherwise) and is trying by all means to keep up with good international standards when dealing with issues of TB.

What is still lacking is commitment from the grassroots, where TB is mainly rampant. Individuals still do not understand the implication of one contracting TB or spreading it, as a major contribution towards the national pandemic. It does not end with that individual! What about their family? Work colleagues? People they travel with on public transport?

TB is a public health concern. So apart from worrying about oneself when it gets to screening for TB, individuals should not be selfish and think about the next person. Failure to honour TB treatment and preventative measures (like wearing masks) can land one in prison (involuntary incarceration) in order to save the public.

Employers should understand this, Bus drivers, teachers at school and all other people in power that may act towards hindering access to health care. We should ‘Doctor’ our family members and encourage them to seek medical help when we can clearly see they are not well. This is not to be used to mock but rather to help that individual and the people around them.

For help email agboima@yahoo.com

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