According to the TB Facts Organisation, Tuberculosis (TB) is the single largest contributor to death in South Africa. An estimated 360 000 South Africans became ill with TB in 2019, and an estimated 58,000 people died from TB in the same year.
During TB awareness month and on World TB Day today, Right to Care, an NGO involved in South Africa’s response to TB and Covid-19, highlights that TB is also a killer pandemic and WHO’s statistics give an estimated TB incidence rate in SA of 615 per 100 000 people.
Dr Lucy Connell, TB programme lead at health NGO, Right to Care, explains how Covid-19 has had a negative impact on South Africa’s TB programme.
“TB is curable and South Africa has clear guidance on how to find and manage TB patients, but Covid-19 has had a negative impact on SA’s TB programme and caused major setbacks. We have seen a drastic drop in TB testing and diagnosing,” she explains.
Dr Connell adds that many patients also stopped going to facilities during the hard lockdowns.
“Most TB is curable within six months of treatment, but we now have TB patients who are either undiagnosed or not on treatment and who may become infectious and spread it to others, especially those close to them at home,” she said before explaining how the symptoms of Covid-19 overlap with those of TB.
“Anyone with symptoms suggestive of Covid-19, like a cough, fever and fatigue needs to go for a Covid-19 test and ask for a TB test as well because Covid-19 symptoms overlap with those of TB,” says Dr Connell.
- chest pain,
- loss of weight,
- loss of appetite,
- coughing up blood,
- sweating at night,
- shortness of breath and difficulty breathing.
“If you have these symptoms, please go and test – if you are worried about Covid, then test for Covid and for TB at the same time. If you have TB you must start TB treatment immediately,” she says.
Right to Care has also welcomed the recent release of the National TB Prevalence Survey which sheds light on the nature of the TB epidemic in South Africa.
“This survey revealed that South Africa has a much higher TB burden than we have ever reported to the World Health Organisation before. It identified a higher TB prevalence in men than women, and in individuals aged 35 to 44 and in people over 65,” Dr Connell says.
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“The prevalence survey also points to the high incidence of undiagnosed TB amongst HIV-negative men who are less likely to go to a clinic. Historically, there has been a big focus on HIV-positive people because of the high risk of HIV-TB co-infection, but HIV negative men have been left behind. Women tend to seek healthcare services more easily and routinely than men, and because TB is a major cause of maternal death, pregnant women are now being routinely tested for TB, regardless of whether they have TB symptoms.”
She also adds that SA’s prevalence survey supports numerous studies which show that people can have TB without any of the classic TB symptoms.
"This is true in groups at higher risk for TB. These include people who have had TB in the last two years (you can get TB more than once), close contacts of people with TB, and HIV-positive people," she says.
"People in these groups need to test for TB, even if they don’t have symptoms. If you have TB and have stopped your TB treatment, please return to your healthcare facility and get back onto treatment. Our TB nurses know that if a patient has missed less than two months of treatment and their condition hasn’t worsened, he or she can go back onto treatment and their treatment finishing date will move out. The patient may need to be tested again to establish if they have developed resistance.”