Tuberculosis in SA: The disease that won't go away

Of the 22 countries with the highest burdens of tuberculosis infections, South Africa is ranked number 3  after India and China, according to Dr Mary Edginton in a talk entitled ‘Tuberculosis, the disease that won’t go away’  which took place at the Library Hall in Grahamstown on Monday.

Since 1920, when tuberculosis was largely unheard of in South Africa, the infection rate of TB has gone up four fold. South Africa’s rate of tuberculosis infections is 993 per 100 000 of the population.  That’s almost 1000 per 100 000. This figure is extremely high when compared with India and China which have rates of 181 and 75 respectively.

After going through a brief history of the development of TB around the world and subsequent treatments and drugs that have been developed in response to the epidemic, Dr Edginton highlighted the significance of the development of the GeneXpert diagnostic tool.“This is truly a remarkable achievement which has revolutionised the diagnosis of lung TB” said Edginton. 

The GeneXpert is available in South Africa however concern about the capacity of the country to manage the burden of diagnoses was raised by Edginton.

Another concern raised by Edginton was the development of Multi-Drug Resistant TB (MDR-TB) and Extreme-Drug Resistant TB (XDR-TB). “The resistance to anti-TB drugs is the problem of our time” said Edginton, “We are going into the dark ages of TB in terms of Multi-Drug Resistant TB.” However the pandemic is yet to fully hit South Africa.

MDR-TB develops as a result of taking TB drugs irregularly. “What we call ‘stop-start’ drug taking” says Edginton. The core problem lies with health service failure such as ill-equipped clinics, empty drug stores and unmotivated staff members.  Access to clinics in South Africa is also a problem which can hinder TB infected people from taking their drugs regularly. 

South Africa's relatively recent history with the incidence of TB coupled with the problems currently plaguing our public health system show that South Africa is a ticking time bomb for an MDR-TB epidemic to explode.

However international work is making progress in finding better diagnostic tools, newer drugs and new vaccines to attempt to curb the incidence of TB and combat the scourge of MDR-TB.