Each year thousands of South Africans are infected with tuberculosis. March has been declared national TB awareness month to coincide with World TB day on March 24.
TB of the lungs, or pulmonary TB, is the most common form of the disease, but it is not uncommon for people to be infected with TB of the spine, heart, kidneys and other parts of the body. But, only those with TB of the lungs can spread the disease to others.
The disease is spread through the air. When an infected person coughs, sneezes or spits, he or she transmits TB germs, known as bacilli.
There are two forms of the illness: TB infection and active TB. If proper detection and treatment does not take place, each person with active TB can infect 10 to 15 people a year.
But not everyone infected with TB bacilli will become ill. Research indicates that one in 10 people infected with TB in South Africa gets sick with the disease.
A healthy immune system fights off the bacilli by covering them with a thick waxy coating, which can render the bacilli dormant for several years. The danger arises when an infected person’s immune system is weakened, making the possibility of illness much greater.
Immunity can also be weakened by poor nutrition, excessive physical stress, old age or HIV infection. In these cases, as people’s immune systems weaken, TB takes advantage.
The illness can be cured, but is dependent on the patient taking the full course of medication over the stipulated period. With a cocktail of five different pills to be taken over six months, there is the danger that patients will not complete the course if they start feeling better.
“Often patients stop the treatment midway through the stipulated six-month course, because they suddenly feel better,” says Dr Martie van der Walt, head of the Medical Research Council’s tuberculosis epidemiology and intervention research unit.
“This is extremely dangerous and irresponsible, as it gives rise to multidrug resistant TB (MDRTB), which places greater strain on the health system.
“Patients infected with MDRTB are subjected to a more rigorous treatment regime, which lasts for eight months, so it is in their best interest to complete the treatment properly the first time around,” she says.
In this regard the introduction of the direct-observation treatment short (Dots) course in 1996 has gone a long way to ensuring that patients take their medication correctly.
Under the programme, which is the accepted best practice for dealing with the illness internationally, support staff observe patients to ensure they take the correct medication and the correct dosage over the treatment period.
Although there are no official figures available yet for the success rate of the Dots system in South Africa, Van der Walt points out that international studies have shown it to be the most effective way to curb the spread of MDRTB.