TUBERCULOSIS (TB) remains a thorn in the flesh for Zimbabwe and needs thinking outside the box if we are to join the world in endeavours to end TB by 2030.
A recent survey taken by The International Union Against Tuberculosis and Lung Disease (The Union), Zimbabwe Country Office, Centre for Operations Research, The Union, Paris, France, AIDS and TB Unit in the Ministry of Health and Child Care, Operational Research Unit, Médecins Sans Frontières, Luxembourg and the Bulawayo City Health Department, Zimbabwe showed that tuberculosis (TB) was fatal in the elderly as compared to other age groups. The high TB incidence was recorded in a resource-limited urban setting in Bulawayo urban in Zimbabwe.
The objectives were to compare treatment outcomes among people initiated on first-line anti-tuberculosis treatment in relation to age and other explanatory factors. This was a retrospective record review of routine programme data.
Elderly affected most
Of 2 209 patients included in the study, 133 (six percent) were children aged 10 years), 132 (six percent) were adolescents (10–19 years), 1782 (81 percent) were adults (20–59 years) and 162 (seven percent) were aged 60 years, defined as elderly.
“The highest proportion of smear-negative pulmonary TB cases was among the elderly (40 percent), the report stated. TB was seen to be fatal in senior citizens.
“Unfavourable outcomes, mainly deaths, increased proportionately with age, and were highest among the elderly (adjusted relative risk),” it noted.
Having previous TB, being human immunodeficiency virus positive and not on anti-retroviral treatment or cotrimoxazole preventive therapy were associated with an increased risk of unfavourable outcomes.
The survey concluded that the elderly had the worst outcomes among all the age groups. The report noted that this may be related to immuno-suppressant comorbidities or other age-related diseases mis-classified as TB, as a significant proportion were smear-negative.
What to do
Older persons need better adapted TB management and more sensitive diagnostic tools, such as Xpert MTB/RIF.
The Xpert MTB/RIF is a cartridge- based nucleic acid. In December 2010, the World Health Organisation (WHO) endorsed the Xpert MTB/RIF for use in TB endemic countries. Zimbabwe is ranked among the world’s 30 high burden countries.
Zimbabwe is one of the eight countries in Africa with a high burden of TB, HIV/TB co-infection and multi drug resistant TB. Latest TB statistics show that per 100 000 people 292 had active TB. Through Challenge TB in Zimbabwe, the country has managed to make TB-HIV services integrated.
“Through our Challenge TB programme through the Ministry of Health and Child Care integrated services around the country, but I believe more can be done to encourage adherence and lessen the pill burden,” said The Union country director, Dr Christopher Zishiri, addressing a Meaningful Involvement of People Living with HIV forum in Kwekwe in June this year.
As noted by the study effective machines are needed to detect TB in senior citizens. If the standard procedure of sputum is used the results are negative. The gains achieved in Zimbabwe in the fight against HIV and TB must not be lost. Leave no one behind as we set to end TB together with the global village by 2030.