TB cases likely to top 600 this year
- stakeholders call for expansion of treatment programme
Stabroek News
November 19, 2006

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Close to 554 new cases of tuberculosis were detected this year and it is estimated that an additional 96 cases would be added to the register by year end. But combined this figure does not adequately represent the situation in Guyana given that detection is still limited.

Just around 50 per cent of the population is currently being covered by the Direct Observation Therapy Short course (DOTS) programme. Full coverage is projected for December 2007.

Manager of the National Tuberculosis Programme Dr Jeetendra Mohanlall told participants at the just-concluded Third National Tuberculosis Conference of Guyana held at the Sea Breeze Hotel that full coverage would mean an increased detection rate. He said the World Health Organisation (WHO) estimates that Guyana had close to 800 new cases of tuberculosis annually, but the current figure stands at 650 because of limited DOTS coverage.

Mohanlall said there was an 84.7 per cent detection rate for every 100,000 but pointed out that the WHO estimates this at 115 per cent per 100,000. He noted that DOTS was already in high burden areas such in Regions Four, Three, Six and Ten but was expanding and would soon cover Regions One, Two, Five and Seven.

Currently, close to 120,000 Guyanese are infected with the bacteria germ which causes tuberculosis but only ten percent of this number would actually develop the disease in their lifetime. Those who are smear positive are on treatment to prevent them developing the disease.

"Persons need not be alarmed about getting TB. Those who have the germ are monitored in the health system and many never go on to develop the disease. Persons who develop TB are placed on treatment and through DOTS many successfully make it off the treatment programme," Mohanlall said.

The DOTS programme has had a tremendous impact in treating TB patients, according to Mohanlall but he noted a few weaknesses. He said TB laboratory facilities in Guyana need strengthening, personnel were inadequate and the programme needed to be de-centralised.

He noted too that more social service support needed to be injected into DOTS. In the initial phase of the DOTS, he explained, workers are required to visit patients every day for five days in the first two months. In the continuing four months patients are visited three times a week.

During the two-day conference, participants posed questions as to whether donors were doing enough by simply providing money to a country that has limited human resources and where expertise is not sustained. One doctor said programmes would come and go while TB remained a problem in the health system and questioned what really happened after the donors left and the programmes ended.

The Canadian Society for International Health (CSIH) which has partnered with Guyana for tuberculosis was part of the conference, and two doctors on the visiting team conceded that donor countries were not doing enough. They said collaboration was the key but it must be sustained.

One doctor noted though that the CSIH team will join a coalition of advocates back in Canada to lobby with their government to bump up its donor dollars because the government was planning to reduce it. She said a reduction in the funds coming to Guyana has already been announced.

The CSIH team also urged local TB personnel to document local findings and package them so that donor countries could see exactly what the situation is. They pointed out that this would boost lobbying efforts.

DOTS workers present at the conference also highlighted the need for more incentives in the field, particularly a salary increase. One worker said it was hard to survive on her salary.

The conference also looked at the global TB situation, nutritional intervention in TB management and the vision of a TB lab network in Guyana and setting up TB laboratory in resource limited settings among other areas. It was a collaborative effort between the Guyana Chest Society, the Ministry of Health, Public Health Strengthening Project of Guyana and CSIH.