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Lesotho ranks No. 1 in TB incidence

By Thoboloko Ntšonyane

MASERU – The Ministry of Health (MoH) said it is unduly concerned with the high rate of Tuberculosis (TB) prevalence in the country, making Lesotho rank the highest in the world.

These developments transpired on Friday last week at the Ministry’s headquarters during the pronouncement of the Lesotho TB Mortality study Dissemination.  

Speaking at the event, MoH Principal Secretary (PS) ‘Maneo Ntene said the study was conducted to inform the Ministry of possible factors leading to a high mortality rate in TB patients despite the former being curable.

The PS said they will have to establish the causes of mortalities yet TB is curable.

Ntene added that Lesotho is classified among the “high burden” countries.                                       

“This persistent high mortality makes it impossible for us to reach the desired treatment success rate of 90 percent as per our national target,” she said adding that the study will better inform them to address the identified gaps.

The PS continued: “The findings of this study will be used to design and implement strategies including the multi-sectoral approach to turnaround the current picture of high TB deaths and fast track us towards achieving the set SDGs (Sustainable Development Goals) of reducing TB deaths by 90 percent by 2030 and 95 [percent] by 2035 and as per End TB Strategy.”

Giving an overview of the TB situation in the country, the TB Program Manager, Dr Llang Maama said  Lesotho has the highest TB incident in the world with 650 cases per 100 000 population, a figure she said is high.

The TB Program Manager said: “Tuberculosis remains a major public health concern in Lesotho and globally, as TB is of the top 10 causes of death and the leading cause from a single infectious agent surpassing HIV/AIDS.”

Dr Maama showed that in 2020, an estimated 14 000 people fell ill from TB.  

She said the TB incidence in Lesotho is three times higher than that of the World Health Organisation (WHO) in Africa region and five times higher than the global average.

The TB Program Manager also noted that TB/HIV incidence is 7.3 times higher than WHO in Africa region while 38 times higher than the global average.

The TB/HIV mortality rate in Lesotho is 10.5 times higher than in WHO in Africa region.

She said the WHO Global TB Report, 2021, flagged about 4624 cases in 2020 that were notified accounting to 33 percent, of which four percent were children, a figure which she said was against an estimated 5 – 15 percent by the WHO report.

“In 2020, the Multidrug-Resistant Tuberculosis (MDR-TB) estimated incident cases were 870 (510 – 1 500) which translates to 41 percent … incidence rate. Estimates made from routine drug resistant surveillance revealed that there were 4.9 percent. The treatment coverage among MDR-TB patients remains low at 13 percent,” the TB Program Manager said.

She further highlighted that the country is facing a “massive” challenge of missing TB patients.                                                                                                                                                                                   

According to the study conducted by Partners in Health, some TB patients complain about the distance of health facilities … coupled with long queues at the clinics, which they say are discouraging on their part.

“The patients shared their experiences accessing TB services, noting numerous barriers. Many patients take public transportation; therefore, they need to wake up in the early morning to walk and catch [a] taxi. The taxi rides are long in distance and in time as the taxi will continuously stop and go, picking up passengers along the way. Finally, once the patients arrive at the clinic or hospital, they are greeted by long queues and can expect to wait half a day until they are seen by a clinician,” reads the study.

It continues: “Many patients shared that they hide their symptoms because they want to finish early and go back to their villages. … and, his colleagues found that patients are sometimes screened twice in the same visit, prolonging the time they spend at a facility. Combined, these reasons indicated flaws in the screening process which leads to patients leaving the clinic or hospital undiagnosed with TB.”

Since 2007, the MoH has provided free diagnosis and treatment for MDR-TB patients and its treatment has been decentralised to all 10 districts.

Also, Village Health Workers (VHWs) play a critical role in the communities as they provide home-based care to TB patients, monitor the patients’ recovery, and encourage them to take up their medication.

Dr Llang pointed that the case detection in Lesotho during 2020 was hovering at 33 percent and 67 percent was “missed to care”.

While the treatment success rate is 78 percent, the TB case fatality sitting at 34 percent.

She said at least 50 percent of the patients visit the health facility three times before being diagnosed with TB.

“Current efforts to reduce TB associated mortality [are] not informed by a systemic evaluation. As a result, causes and factors contributing to TB mortality are not well understood in Lesotho,” Dr Maama said, adding that the study was conducted in 2019 aimed at identifying social and clinical characteristics, causes and times to death for TB patients.                                                                                                                                                                                                                                                                                                                                                                     

She said the country had failed to meet the 2020 milestone, adding that 17.5 percent decline in TB incidence from 788 in 2015 to 650 in 2020 shows a gap between incident cases and notified cases.