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While the City of Cape Town’s tuberculosis caseload has dropped, it’s not necessarily a reason to celebrate ahead of World TB Day. Read more below:

Tuberculosis (TB) remains an epidemic in many parts of the world, resulting in 1,5 million deaths every year – mostly in developing countries. In the run-up to World TB Day on 24 March 2016, the City’s Health Directorate wants to raise awareness about the importance of regular TB tests as a means of reducing the public health burden.

The City of Cape Town urges residents to get tested for tuberculosis if they have been in close contact with someone diagnosed with TB.City Health has recorded a steady decline in the number of people starting TB treatment in the last five years, as illustrated in the graph below:

In 2015, 23 815 patients started treatment, of which 1 539 were children four years and younger. Of these, 45% of patients were co-infected with HIV. A total of 1 021 multidrug-resistant (MDR) patients were diagnosed and commenced treatment. The turnaround time between diagnosis and treatment has been shortened dramatically; HIV tests have become routine for all TB patients; and dual-infected patients will also be started on antiretroviral (ARV) treatment if they are not already on ARVs.

‘Although significant strides have been made in recent years and this has given reason for some optimism, there remain a number of challenges,’ said the City’s Mayoral Committee Member for Health, Councillor Siyabulela Mamkeli.

Some of the challenges facing City Health and its partners in the treatment of TB include:

  • There is no culture of cough hygiene in South Africa
  • Too many cases go undiagnosed or are diagnosed at an advanced stage
  • Some patients are diagnosed, but don’t report for treatment and cannot be traced because they provide false addresses and contact details
  • Drug-resistant TB treatment completion rates are problematic because patients have to be booked off work until sputum results are negative; they have to be at the clinic every day for treatment; and the drugs have severe side effects – which may be a contributing reason for patients to default on their treatment
  • Poor socio-economic conditions can be directly associated with a higher burden of TB in certain areas in the city

‘While our caseload has dropped, these are only the cases we are aware of. Many people develop symptoms of TB but leave it unchecked or try to treat it with cough syrup or antibiotics. We need people to start thinking TB first and get tested, if only to eliminate it as a possibility. Let’s rather be safe than sorry because the longer TB goes undiagnosed, the more those around you are exposed and at risk of developing disease,’ said Councillor Mamkeli.

Close contact with someone who has TB increases the risk of infection. However, while a skin test may come back positive, not everyone who is infected will develop TB. The difficulty is that it is impossible to predict how many of those with positive skin tests will translate into TB cases later.

Currently, the BCG vaccine prevents very young, susceptible children from developing complicated or severe TB disease, but it does not prevent TB. Caregivers can bring children under the age of five to the City’s clinics for a course of prophylactics if they have been exposed to a person with TB. The prophylactics can also be used by HIV-positive persons in the same situation.

‘Ideally we need a vaccine to prevent those breathing in the germs from developing TB, but currently no such vaccine exists. So we have to work with what we have which is education, awareness and regular TB tests. Members of the public also need to familiarise themselves with the symptoms of TB, which include a cough, night sweats and weight loss.

‘Get tested if you notice one or more of these symptoms. It doesn’t matter if the test of positive or negative – knowing your status will put you in a position to take action if required. We encourage residents to adopt safer infection control practices, including getting screened, tested and treated for TB,’ added Councillor Mamkeli.

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