Tough TB hits Botswana

Health authorities on Wednesday reported the first known cases of virtually untreatable tuberculosis in Botswana, following fears that the highly contagious strain has spread beyond South Africa.

The health ministry said there were two cases of so-called extremely drug resistant tuberculosis, or XDR-TB, as well as 100 cases of the slightly more manageable multi-drug resistant TB, or MDR-TB.

Although XDR-TB has been reported in other parts of the world, especially former Soviet republics, it is particularly lethal in southern Africa, where Aids incidence is high, because it combines with Aids to kill.

Spreading in southern Africa
For the past few months, health professionals have warned that XDR-TB, although only confirmed in South Africa, had spread to other southern African nations like Swaziland and Lesotho hard hit by the Aids epidemic, but hadn't been diagnosed because of lack of laboratory facilities.

Batatu Tafa, permanent secretary at Botswana's Ministry of Health, urged health workers who develop chronic coughs or other symptoms while managing TB patients, to have check ups. She also appealed to people with HIV to be screened for TB.

The drug resistant forms of TB have developed largely because patients don't stick to their six-month course of treatment.

Nearly 400 cases have been reported so far in South Africa, but there may be more cases. Testing methods are inaccurate and out of date and many patients die before they are diagnosed. Botswana is the only other country in southern Africa with testing facilities.

Government criticised
Groups like Medecins Sans Frontieres have accused the South African health ministry of failing to take the problem seriously enough.

The South African trade union Solidarity on Wednesday appealed to the South African health department to draw up a clear strategy on drug-resistant TB, given the scare after dozens of patients with the disease escaped from two hospitals in the Eastern Cape province just before Christmas, saying they wanted to spend the festive season with their families.

South African police mounted door-to-door searches to compel patients to return to the hospitals, and health authorities said they would get tougher with forcibly confining sufferers. Eight still reportedly remain at large.

Lack of capacity
"South African public hospitals simply do not have the capacity to provide proper care for patients suffering from these highly drug-resistant forms of TB," the trade union Solidarity said. It voiced particular concern about its members in the mining and metal engineering industries who work in stuffy confined spaces where infection easily spreads.

"These are the people who will be at the greatest risk if sufferers are not given the correct treatment," said Solidarity spokesman Jaco Kleynhans.

Several provinces in South Africa have taken legal action to force drug resistant TB patients to stay in hospitals in isolation units surrounded by wire fences and protected by guards. Last year in Cape Town, authorities confined a minibus taxi driver - who was a potential risk to hundreds of people every day - after he insisted he could not afford the loss of wages by committing himself to a hospital.

Although forced confinement of patients violates most medical ethics, authorities say they have no choice but to put the wider public good above individual rights. Confinement for XDR-TB is at least six months, usually much longer.

South African authorities say they do not have the resources to enforce isolation and treatment because the number of patients is far too high. – (Sapa-AP)

Read more:
Tuberculosis Centre
Why quarantine may backfire

January 2008

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