Analytical summary - Tuberculosis
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One of the priorities of the Ministry of Health and Sanitation is the control of tuberculosis (TB). With an estimated prevalence of 574 cases per 100 000 population and new smear-positive cases of 247 per 100 000 population, the burden of TB is increasing in Sierra Leone.
The number of registered TB cases in the country almost doubled between 2004 and 2007. The case detection rate increased from 42% in 2004 to 52% in 2007 (the WHO target is 75%) (see table).
TB treatment success rate increased from 79% in 2000 to 84% in 2005, and then to 86% in 2009, but reduced to 79% in 2010. Possible reasons for this reduction are:
- poor compliance of TB patients on treatment
- unavailability of drugs for treating TB
- drug resistance, which is a frightening possibility for the nation.
This is further complicated by the recent emergence of multidrug-resistant TB.
In 1990, the German Leprosy and Tuberculosis Relief Association, working with the Ministry, integrated the National Leprosy Control Programme with TB control to form the National Leprosy and Tuberculosis Control Programme (NLTCP), which endorses the objectives set by WHO.
TB/HIV coinfection is also an issue of concern: the prevalence rate of TB/HIV coinfection in Sierra Leone is 10%. TB/HIV collaboration has been strengthened through the development of a TB/HIV collaboration policy and guidelines on intermittent presumptive therapy for people living with HIV/AIDS by the NLTCP and the National AIDS Control Programme.
The main thrusts of the NLTCP are the integration of TB and leprosy services into the primary health care system and the reduction of the TB and leprosy burden by effective diagnosis and treatment until the diseases cease to be public health problems. The Ministry, in collaboration with WHO and other partners, has developed an NLTCP Strategic Plan for 2007–2011. Its main focus includes:
- expansion of DOTS (the basic package that underpins the Stop TB Strategy) implementation and multidrug therapy services;
- drug supply for anti-TB and antileprosy drugs;
- strengthening surveillance, monitoring and evaluation for multidrug-resistant TB;
- strengthening laboratory networks and services and operational research for TB and leprosy control.
The NLTCP's main strategy in the management and control of TB infection is DOTS, which was adopted in Sierra Leone in 1992 and is now used at all levels. DOTS has enabled the programme to scale-up access to diagnosis and management of TB country wide. The NLTCP has also created an opportunity for the empowerment and active involvement of the community in the control and management of TB through:
- the development of guidelines on community DOTS services;
- recruitment by communities and district health management teams of community DOTS providers for early detection and community-based management of TB.
The number of TB diagnostic centres increased from 116 in 2009 to 148 in 2010.
Anti-TB drugs provided by the Global Drug Facility are widely available in sufficient quantities across the country and there is satisfactory drug flow from the German Leprosy and Tuberculosis Relief Association drug stores to the districts. District supervisors provide supportive supervision at all DOTS centres monthly, while the NLTCP and district health management teams jointly carry out quarterly supportive supervision.
Quality laboratory services are a key component in the control and management of TB. Diagnostic and management TB services are carried out in all DOTS centres. Diagnoses and treatment of TB cases is free of charge to patient at all DOTS centres in the country.
The private health sector is actively participating in DOTS services expansion with the development of guidelines for public–private mix and DOTS services, and the establishment of DOTS centres within private clinics.
- ↑ 1.0 1.1 1.2 1.3 National Leprosy and Tuberculosis Control Programme, annual report. Government of Sierra Leone, Ministry of Health and Sanitation, 2010
- ↑ 2.0 2.1 2.2 2.3 Performance report. Government of Sierra Leone, Ministry of Health and Sanitation, 2010
- ↑ 3.0 3.1 WHO Country Cooperation Strategy 2008–2013 Sierra Leone (pdf 943.71kb). Brazzaville, WHO Regional Office for Africa, 2009