Promoting TB drug research in Nigeria

...As world marks day

Tuberculosis (TB) is a major global health problem which has confronted human existence. Little wonder about nine million new cases of TB emerge and close to two million people die from the disease yearly, with the highest number of deaths in the African region.

With nations across the globe not free from this health puzzle, the worrisome situation is that, according to the World Health Organisation (WHO) estimates, the largest number of new TB cases in 2008 occurred in the South-East Asia Region.

The estimated incidence rate in sub-Saharan Africa is nearly twice that of the South-East Asia Region with over 350 cases per 100 000 population.

As Nigeria join the rest of the world to mark World TB Day, a day set aside to raise awareness about the global epidemic of tuberculosis (TB), the scope of the disease and how to prevent and cure it, health experts in the country have called for increased tuberculosis drug research activity in Nigeria which has been low in recent times.

In a recent interview with Folasade Ogunsola, head, Department of Medical Microbiology, College of Medicine, Lagos State University Teaching Hospital (LUTH), he disclosed that Tuberculosis is an infectious bacterial disease caused by Mycobacterium tuberculosis, which, most commonly, affects the lungs.

Ogunsola stated that though transmitted from person to person via droplets from the throat and lungs of people with the active respiratory disease, in healthy people, infection with Mycobacterium tuberculosis often causes no symptoms, since the person's immune system acts to “wall off” the bacteria.

According to her, “TB drug resistance is an issue that threatens the success of directly observed treatment (DOTS), which is WHO-recommended treatment approach for detection and cure of TB. Recently, strains of TB resistant to major anti-TB drugs have emerged due to inadequate capability for diagnosis and treatment of TB.

“A dangerous form of drug-resistant TB, multidrug-resistant TB (MDR-TB), resists the treatment of, at least, isoniazid and rifampicin, the two most powerful anti-TB drugs. The emergence of extensively drug-resistant (XDR) TB occurs particularly in settings where many TB patients are also infected with HIV, and this poses serious threat to TB control. Also, poor-quality drugs or incomplete drug regimens also give resistant TB bacteria time to arise, multiply, and infect others,” Ogunsola added.

For his part, Aderemi Kehinde, Consultant Medical Microbiologist, College of Medicine, University of Ibadan, revealed that Nigeria ranks 4th out of the 22 countries designated by the WHO with the highest burden of TB globally behind India, China and Indonesia.

Kehinde stated that TB research in Nigeria had not been active until recently, due to inadequate facilities arisen from poor funding as research activities were mainly carried by few individual researchers in academic environment.

In his words “TB drug research activity is low in Nigeria. This is as a result of low research funding. Majority of the funds come in form of individual grants from local research institutions, including universities. The recently awarded round 5 Global funds were used to scale-up DOTS expansion with very little funding left for research. Among the challenges include- equipment needed to carry out medical analysis which needs to be strengthened, requisite human capacity of physicians, researchers, lab scientists, nurses etc in TB drug research such as maintaining good clinical practice, good laboratory practice and ethics of research in human subjects among others.

Taking a look at the level of TB drug resistance activity in the country, it is noteworthy to state that the accessed funds from the round 5 Global Fund for AIDS, TB and Malaria were used to equip two National reference laboratories (Nigerian Institute of Medical Research (NIMR) Lagos TB training school, Zaria), one zonal reference laboratory in each of the six geopolitical zones of the country and a nationwide external quality assurance (EQA) system.

This initiative has created awareness and interest among academics to do research on TB. University College Hospital, Ibadan, houses the Southwest TB reference laboratory. It serves six states with population of about 35 million.
Recognising the scale of the problem, global targets for reductions in the burden of disease (measured as incidence, prevalence and mortality) caused by TB have been set within the context of the Millennium Development Goals (MDGs) and by the Stop TB Partnership. The target set within the MDGs is to halt and reverse the incidence of TB by 2015.

In addition, the MDGs included three other indicators for measurement of progress in TB control- prevalence and death rates, and the proportion of cases that are detected and cured in DOTS programmes with the Stop TB strategy aimed at dramatically reducing the global burden of TB by 2015 in line with the Millennium Development Goals.