Doctors admit to poor knowledge about tuberculosis

At a gathering of about 300 doctors from different private hospitals in Nigeria, Temidayo Giwa, a medical doctor, with Union diagnostics and Clinical Services Plc, Ibadan, says he knows little or nothing about a multidrug resistant tuberculosis (MDR-TB). Dr. Giwa who spoke at this interactive doctor's forum in Lagos organised by PathCare, a laboratory diagnostic service provider, said the modern methods of TB treatment is not only new to him, but to his many colleagues as well.

"I'm happy that Pathcare is organising such an event today, because everything here sounds new to me. And not only myself, last week a senior colleague asked us some questions about multidrug resistant TB and many of my colleagues do not even know anything about it. The challenge is how we can be kept informed and abreast of these interventions."

A study by the Human Development Public Health Initiative also shows that many doctors especially those from private hospitals are not familiar with the correct treatment regimen for TB and they lack diagnosis of and management of various classes of TB. According to the World Health Organisation (WHO), tuberculosis, a bacterial infection is one of the world's leading causes of adult mortality with 9.2 million new cases and 1.7 million deaths in 2006. MDR-TB is a particular strain of tuberculosis that is resistant to two of the most powerful drugs used in the first line treatment of the disease, and it is the biggest problem now in TB management.

Lack of knowledgeable doctors

Folasade Ogunsola, a professor of medical microbiology at the University of Lagos College of Medicine, who presented the topic: "MDR-TB: Averting a Crisis", traced this phenomenon of a lack of accurate knowledge on diagnosing TB on the part of clinicians to why TB is under reported in most private hospitals today.

"In most labs in this country, we can't find TB," she said. "We are not even diagnosing TB per se. What we are doing is presumptive diagnosis." According to her, the case detection rate as at 2007 is 17 per cent as against the 75 per cent detection rate stipulated by the WHO.

"And these cases are found in government hospitals: this is because most of these government hospitals are donor-driven. And we know that a higher percentage of Nigerians seek healthcare from private hospitals." (It is reported globally that 60 per cent of a country's population seek care in private hospitals).

Oni Idigbe, a TB specialist at the Nigeria Institute of Medical Research, Lagos said most people seek private hospitals because of confidentiality. Because of stigma, they prefer to attend private hospitals where they will buy the drugs than to go to government hospitals where they can get it for free. As a result, the doctors prescribe to them to buy off-counter drugs or sell to them expired drugs. You see, most of these doctors are the ones causing treatment failures in TB patients. He added that a lack of training on proper management, diagnosis, lack of psychosocial support such as following up on patients, fuel the MDR-TB. Drug resistance is caused when the treatment chain is broken.

Way out

These factors according to Mrs. Ogunsola, needs to be addressed if any progress is to be made.

"In order to prevent and control MDR-TB, we need case detection through quality assured bacteriology, we need standardised treatment with patient supervision and support. She mentioned that old methods that are not sensitive to the bacteria are reasons why most lab cannot detect the bacteria. She named many newer and sophisticated methods of detecting it, which are currently not available in most Nigerian labs.

Stressing the need for doctors to equip themselves with knowledge, the managing director of PathCare, Pamela Ajayi says TB remains an emergency and that was why the forum was being held.

"The private hospital doctors are too engrossed in making profit that they don't update themselves," she said. "They need to go for refresher courses, read journals and keep themselves abreast of what is happening."

Nigeria ranks fifth among 22 high TB burden countries. In order to address this problem, the Federal Government, through several international donors began a nationwide research on MDR-TB, this month. Currently, MDR-TB can be detected at the National TB reference laboratory at the Nigeria Institute of Medical Research, Yaba and the Ahmadu Bello University, Zaria.