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Analytical summary - Tuberculosis

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The annual burden of all forms of tuberculosis (TB) in the Gambia is estimated to be 4415 (TB incidence of 257 per 100 000 populations), including 1893 (113 per 100 000 population) smear-positive TB cases.[1] In the past 5 years (2005–2010) with the support of a Round 5 grant from the Global Fund to Fight AIDS, Tuberculosis and Malaria (GMB-506-G03-T), the total TB case notification in the Gambia increased by 5%. This is, in part, due to an increase in sensitization through both print and electronic media, with the support of the Global Fund.

The number of diagnostic sites increased countrywide from 11 in 2006 to 31 in 2011. Diagnostic sites also serve as places for TB/HIV surveillance. DOTS, the basic package that underpins the Stop TB Strategy, has been scaled-up through the use of primary health structures comprising networks of village health workers, community health nurses and community volunteers.

The National Leprosy and Tuberculosis Control Programme has established a robust system comprising a taskforce to monitor the emergence of multidrug-resistant TB (MDR-TB) drug sensitivity, carry out sputum culture on all retreatment cases and increase sensitization to raise the index of suspicion. No case of MDR-TB has been detected so far. All TB patients are offered HIV counselling and testing and all HIV-positive patients are screened for TB. The main challenge is how to achieve an integrated service for both diseases for patient convenience. The National Leprosy and Tuberculosis Control Programme has over the years supported the strengthening of TB services country wide.[2][3][4]

Recently, the Practical Approach to Lung Health in South Africa (PALSA) has introduced PALSA PLUS Gambia as a pilot study in two health regions, namely North Bank Region and Lower River Region.

Community involvement and empowerment of people with TB is being implemented through the advocacy, communication and social mobilization strategy, which includes:

  • sensitization of policy-makers and decision-makers at national, regional and community levels
  • training of journalists
  • celebration of World TB Day
  • sensitization of traditional healers
  • open field days
  • radio and TV programmes.

The advocacy, communication and social mobilization component has enabled the general public to understand TB better and this may have contributed to the increase in case detection rate and the reduction in deaths and defaulters over the years. Culture and drug sensitivity test are done in retreatment cases and quality control is carried out in all TB diagnostic centres.

The National Leprosy and Tuberculosis Control Programme in collaboration with the Medical Research Council under a Round 9 grant from the Global Fund will conduct prevalence surveys to determine the true burden of TB in the Gambia.[5] It is hoped that this will provide baseline data that can be used to monitor the impact of control efforts towards achieving the Stop TB Strategy and Millennium Development Goal targets. A countrywide TB prevalence study alongside a TB survey in children is also underway.

References

  1. WHO global surveillance report 2009. Geneva, World Health Organization, 2009
  2. Annual report. National Leprosy and Tuberculosis Control Programme, 2010
  3. Strategic Plan 2008–2012. National Leprosy and Tuberculosis Control Programme
  4. Monitoring and Evaluation Plan 2010–2014. National Leprosy and Tuberculosis Control Programme
  5. National Leprosy and Tuberculosis Control Programme. Round 9 proposal, Global Fund to Fight AIDS, Tuberculosis and Malaria