About 23,000 people suffer from tuberculosis (TB) in Sierra Leone, but only 11,513 received treatment as of October 1st, according to data from the Ministry of Health and Sanitation (MoHS). A majority of cases either dropped off of the treatment due to fear of COVID-19 quarantine, or they may be unaware that they suffer from TB.
Tuberculosis (TB) is caused by bacteria that most often affect the lungs. Tuberculosis is contagious, but curable and preventable.
Alhaji Borbor Sesay, from Kamakuwie, Karene District, northwest region, still coughs after completing his six months TB treatment. “It seems like my TB is resistant to the treatment I was taking. But I did not return to the hospital to inform the doctors due to fear of being associated with COVID-19.”
“I heard that people who experienced cough and shortage of breath were quarantined and taken as COVID-19 cases, and that’s the reason I refused to go to the hospital.”
“I am yet to go to the hospital. I am still afraid.”
Alhaji Borbor Sesay’s concerns are echoed by thousands of Sierra Leoneans experiencing TB symptoms but afraid to go to a hospital for fear of being quarantined.
Official MoHS data released exclusively to Premier News shows that the total TB cases registered in the month of April dropped by 47% from March, immediately after the declaration of a state of emergency in Sierra Leone.
There were 4,479 reported cases of TB during the second quarter of 2019 (April-June). That number dropped by 40% in the second quarter of 2020, when health facilities received just 2,693 cases of TB, based on MoHS official data released exclusively to Premier News.
Because of COVID-19 scare, TB patients went “underground”
The President of Sierra Leone, Julius Maada Bio, declared a 12-month state of emergency on March 24, followed by multiple a 72-hour nationwide lockdowns and inter-district travel restrictions. Hundreds of people were quarantined for prolonged time, isolated from food, medicine, water and help. Terrified of these stories, most of the ill preferred keeping quiet than seeking help at a healthcare provider.
“The symptoms of COVID 19 are similar to TB. And because of the rigorous treatment for the COVID-19 patients, some of the TB patients went underground and we lost about 30% of our cases,” said Dr. Alhassan Sesay, Technical Assistant of the National Tuberculosis Control Program (NTCP) for Sierra Leone.
Dr. Sesay explained that there are ways to differentiate between a COVID-19 case and a TB case. If patients experience shortness of breath, difficulty breathing, and headaches, they will be tested for COVID-19, Dr. Sesay said. But if they experience coughing for two weeks in a constant manner as well as loss of weight, they will be tested for TB, as these are indicators of tuberculosis.
“The moment we discovered that the number of people frequenting hospitals for TB treatment were decreasing, we came up with a treatment guideline and a policy paper that all TB cases should report to their respective healthcare center, in order for them to be orientated about the differences between the virus and other diseases, so that they can be at ease in order for them to be receiving treatment,” Dr. Sesay said in an exclusive interview.
The anti-TB team also launched a “village-to-village” campaign to educate people about the differences between the COVID-19 and TB symptoms, and also revised the strategy to provide treatment for a longer term to diagnosed patients, to avoid unnecessary travel.
According to the WHO 2017 Global Tuberculosis Report, Sierra Leone is one of the 30 countries with the highest burden of TB cases.
Dr. Sesay said that the estimated incidence of TB for Sierra Leone is over 23,000 cases. Of these, about 5,000 did not receive treatment in 2019 because they didn’t know they suffer from TB, or because of lack of access to a healthcare. About 3,300 of the estimated cases are children, representing over 14%.
“We have 1,400 health facilities in Sierra Leone, but only 183 of them are providing TB services. This deters thousands of people from accessing TB treatment, especially in the remote areas,” Dr. Sesay said.
The total number of reported TB cases in Sierra Leone between 2014 and 2020. Please note, 2020 is a projected estimate based on data from January to September.
In September, the number of people visiting healthcare centers for TB patients went back up, closer to normal.
Getting the treatment on time is important, not only for the TB sufferers, but also for the health of those around them.
“If you have the disease and have not completed the treatment, you may end up spreading it from village to village, anywhere you live and sleep and cough at night. Your family will end up being infected. These are the challenges if you are not treated well. More people will get infected and it means more challenges,” Dr. Sesay explained.
It is not yet known how many people may have died of TB due to fear of accessing a healthcare facility, but Dr. Sesay estimates that the challenges of TB patients not going for treatment, especially during this COVID-19 situation, could be a major cause for the number of TB death cases.
The risks of losing timely treatment
The drop off of TB treatment during the COVID-19 restrictions will have long term implications. If a TB patient stops the treatment for a few weeks, then that case becomes a complicated one, and much more difficult to cure with regular treatment.
“The challenges of not coming for treatment is that you will lose a whole period, and you will move from being cured to a complicated case, and that means your chance of dying increases.If we don’t see them again, we might end up losing them because they have not completed treatment and we cannot know how many of those who died this period were TB,” Dr. Sesay explained.
Sierra Leone does not have a policy of testing for COVID-19 cases post-mortem, according to official sources.
Dr. Sesay encourages everyone that is experiencing tuberculosis symptoms during this Coronavirus pandemic to not be afraid and come forward and be tested in order to receive life-saving treatment.
By Hasbin Shaw
23/12/2020. ISSUE NO: 7972