Tuberculosis | Background

Damien Foundation Nigeria


Multi-drug resistant tuberculosis a serious threat

Hamred is a bus driver. He contracted tuberculosis four years ago and was put on a course of pills. “I felt better pretty quickly, was able to go back to work and stopped the treatment early.” Too early, or so it now appears. The tuberculosis returned, only this time it seems to have stopped responding to the medication

Multi-drug resistant tuberculosis (MDR) is a huge problem. Recent figures suggest that 2.9% of new tuberculosis cases and 25% of relapse cases involve MDR and the patients no longer respond to the two most powerful TB drugs. The therapy for MDR is much longer, more toxic, more expensive and has a lower rate of success.

Damien Foundation began offering MDR therapy in 2010, in association with the university hospital of Ibadan. Today Damien Foundation runs 3 MDR treatment centres in its field of operations, which provide care for more than 700 patients. New diagnostic technologies have been introduced and ten hospitals now offer the treatment. “Our treatment gets better and better”, says Doctor Adekunle, who works for Damien Foundation and specialises in resistant tuberculosis. “A few years ago MDR was a death sentence in fifty percent of the cases. Patients now have a 70% chance of recovery.” But there is still a long way to go: in 2013, 335 of the 554 patients diagnosed with MDR were effectively treated. But, unfortunately, patients can often drop off the radar after a while.

Multi-drug resistant tuberculosis should be earmarked for better treatment, but it should also be prevented. For this reason we need to work on the patients' confidence in their treatment and keep a close eye on them when they are taking their medication. The most effective strategy we have at the present time is DOTS+ (Directly Observed Treatment), where a healthcare worker, volunteer or member of the family makes sure that the patient takes their medicine every day, and does so for a period of twenty months. This is highly labour intensive. Fortunately, the people at Damien Foundation are highly motivated. Atere, who supervises 13-year-old Waris, is so strict that Waris wouldn't dare skip a day. And tailor Papoola has developed strong ties of friendship with Samuel, the carer who came to visit him for months on end.

One potentially grave danger is that of extensively drug-resistant tuberculosis, which is resistant to second line anti-TB drugs. The chances of survival are much lower and treatment is extremely complex. Damien Foundation runs Nigeria's only treatment centre for the extensively drug-resistant form. In 2016 it had three patients. One is still in treatment, the others did not survive.

TEXTS: Wendy Huyghe
PHOTOS: Tim Dirven @T.Dirven for Damien Foundation

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