By Emma Kakololo WINDHOEK The Government says ongoing efforts with its development partners to curb tuberculosis are not in vain. Namibia is ranked among the countries that are worst affected by tuberculosis by the Global Fund on Aids. In 2004, Namibia topped the list of the countries worst affected by TB in Africa, but the Government has worked very hard resulting in a drop in its ranking to the number three spot, says the Minister of Health, Richard Kamwi. “What is reported by the Global Fund is very true. TB remains an ongoing factor and Namibia is third, only competing with Swaziland and Lesotho,” he said in an interview with this paper on the report compiled by the Global Fund. The analysis was based on a document the health ministry sent to the Global Fund in which it revealed that between 650 and 750 cases of TB were registered among every 100 000 people in the last three years – an equivalent to an incidence of about 15 000 patients each year. The number of TB cases reported in 2004 stood at 16,156 cases translating into a case notification rate of 822 per 100 000 population, the worst in the world. “The TB burden in Namibia is exacerbated by the HIV/AIDS epidemic. It is mainly affecting the poor segment of our society, who are severely affected by HIV/AIDS, which has resulted in a steady increase of TB case notifications in the past 10 years attributable to the TB/HIV dual epidemic,” explained the minister. In 1998, an HIV-prevalence survey in TB patients showed that 45 percent of tuberculosis patients were HIV positive, ranging from 80 percent in Katima Mulilo to 16 percent in Nankudu. “In 2004, we assumed that this prevalence had risen to 50-60 percent,” he stated. As part of its commitment to fight TB, the health ministry last year launched the TB Medium Term Plan. This strategy has already attracted the attention of the United States Agency for International Development (USAID) that has pledged U$1,2 million for the next two years as specific TB programme support. This is likely to be extended to 2010. More assistance would also come from the Global Fund, in particular, in the introduction of Fixed-Dose Combinations (FDCs) to replace the mono-substance and also assist in increasing TB diagnostic centres at hospitals, health centres, clinics and advocacy. “As a sign of the commitment of Government to TB, all TB medicines have always been reliably procured by the MOHSS (single dose formulations) from its recurrent budget,” he stated, adding that from this year onward, the Government would introduce the Fixed-Dose Combinations as the standard of care. Kamwi said TB is a contagious disease, like a common cold spreading through the air, and only people who are sick with TB in their lungs can be infectious. “When infectious people cough, sneeze, talk or spit, they propel TB germs, known as bacilli, into the air. A person needs only to inhale a small number of these to be infected. Left untreated, each person with active disease will infect on average between 1 to 15 people every year. But people infected with TB bacilli will not necessarily become sick with the disease,” he said. It is important that people should complete their treatment, have a balanced diet and exercise. If not, they would remain contagious to others. He warned that improper treatment might also result in the disease becoming drug-resistant, requiring a person to go for extended chemotherapy that is toxic. “From a public health perspective, poorly supervised or incomplete treatment of TB is worse than no treatment at all. When people fail to complete standard treatment regiments, or are given the wrong treatment regiment, they may remain infectious,” he noted It takes a patient a period of between six to eight months of regularly-supervised treatment through the Direct Observed Treatment Strategy (DOTS) to heal, but at least, the first two months should include direct observation of drug taking, followed by a healthy diet and exercise.