By Edoamaowo Udeme
If one shares a living space with people who have been diagnosed with tuberculosis (TB), one has a much higher chance of being infected with the disease. It’s not surprising though that regular test of people known as ‘contact investigation’ is a way of diagnosing more people who are infected with TB.
In Nigeria, USAID’s Challenge TB project has trained over 338 healthcare workers, across 184 local government areas, all of whom are now working as contact investigators, visiting the homes of every person who is diagnosed with TB.
The investigators are taught how to identify people who may have the disease, and how to collect sputum samples that can be sent to testing centers to confirm the diagnosis.
Talatu Dalihu is one of these new contact investigators. She works in the Nasarawa area of Kano State and began her career as a health worker over fifteen years ago. She became interested in fighting TB when she lost a cousin to TB a couple of years ago.
“When I heard about the Challenge TB training, I knew that I had to participate, as I am sure I would not have lost my cousin if she had been diagnosed earlier.” – Talatu Dalihu
Working as a contact investigator has become Talatu’s calling in life, she looks for every opportunity she can to find as many people with TB.
In January 2018, she was at work in Kano General Hospital, when she met Sadiq Dan-Asabe. Sadiq has drug-resistant TB and had just been admitted to the hospital to start his treatment. Talatu seized the moment and introduced herself explaining who she was and why it was important that she visited his home to see if anyone living with him was also infected.
The very next day Talatu visited Sadiq’s family home and found ten people living there, precisely the sort of place where TB thrives, small living spaces, crammed full of people. TB bacteria become airborne when someone with the disease coughs and can remain in unventilated dark rooms for many hours, which puts everyone inside at high-risk of also becoming infected.
Sadiq was living with his two brothers and their wives, his sister Amina and her husband, and four children. Talatu gathered the family together and explained the reason for her visit, and although none of them said they were experiencing any TB symptoms, she still asked them to provide samples for testing because she wanted to be absolutely sure. The children were all put on isoniazid preventive treatment (IPT) to stop them from getting TB, and the samples were tested at a local laboratory using a GeneXpert machine purchased by USAID/Challenge TB.
When the test results came back, they showed that Sadiq’s sister Amina had TB and his two brothers Aliyu and Haruna had a form of TB that is drug-resistant. Talatu informed the family of these results and what it meant. Unlike their brother Sadiq, none of them had any obvious TB symptoms and did not even know they were sick. Thanks to Talatu’s visit all three have now started on the appropriate treatment and are progressing well.
This quick and easy action not only demonstrates how effective contact investigation is but also illustrates its importance. Without a fast diagnosis, his family would have had less chance of being treated successfully and would have continued to infect those around them, adding further to the epidemic of TB in Nigeria.
R-L: Sadiq, Amina, Talatu, 2 sisters-in-law, a niece, and a nephew.
It was not so long ago that Esther began feeling chest pains and developed a terrible cough. The wet season in Markurdi, Nigeria, had just started, and Esther initially thought that her symptoms were caused by the change in the weather. She started self-medicating with drugs she bought at a local pharmacy but her condition did not improve, and she began to lose weight. Before long, she was forced to close her shop as she no longer had the strength to continue working.
Esther behind her sewing machine– Photo: Habiba Bello
Closing her shop meant that she could not provide for her family. As the only breadwinner, her parents and two younger sisters, Elizabeth and Ezra, are dependent on Esther and the income from the shop.
Just when Esther had given up all hope of getting better, hope came in the form of one of her customers told her about the USAID-funded Challenge TB project which provides free TB diagnosis and treatment to people who suffered from similar symptoms.
“This really nice customer encouraged me to visit the Teaching Hospital in Benue State. When I went to the hospital they tested me for free,” Esther explains.
Esther was diagnosed with drug-resistant TB and put on treatment. Her treatment will take up to 20 months, during which she will undergo many painful injections and will have to take many different pills of which some can have nasty side effects.
“The first few weeks of injections were horrible. The needle is very big and painful. I have got used to it now, but at first, I really hated that needle. The pills also made me very nauseous, but thankfully this has passed.”
Three months into her treatment Esther has returned to work in her shop. Her customers are happy she is back to work as she is one of the few good tailors in the area.
“We really missed Esther. It is a bit more expensive to have your clothes tailor-made, but it is definitely worth the extra money,” says one of her customers while Esther takes her measurements.
Business is going well, but Esther realizes that her battle with TB has only just begun. Many people are tempted to stop taking their TB medication once they start feeling better but she knows that taking her medicine every day until her treatment is complete is the only way she will be completely cured.
“I will do everything in my power to beat this terrible disease. My work not only supports myself but my parents and siblings as well. Being able to go back to work is a blessing which I do not take for granted. I just want to thank the Challenge TB project staff for all their help and support during this tough time.”
Bernard, a qualified mason, had left his family behind in Lagos, Nigeria, and moved 750 kilometers east to the city of Makurdi to realize his dream of starting a brickmaking business. What he didn’t know was that soon after finishing school something would happen that would make him have to put his dreams on hold.
“Initially, I thought I had some kind of respiratory illness,” says Bernard, “but then I started suffering from a high fever, and as if that wasn’t bad enough, I began coughing up blood. Foolishly, I spent all my money on drugs at a local pharmacy none of which helped. One day it suddenly it hit me, I might not live to achieve what I had worked so hard for.”
By chance, he saw an announcement on Facebook, which described the same symptoms that he had been experiencing. He called the free number in the advert, and he got through he was asked what symptoms he was suffering from. When the operator heard, they referred him to a hospital which provided TB free testing and treatment through the Challenge TB project.
Bernard was diagnosed with multidrug-resistant TB, which meant that he would have to start a 20-month treatment program consisting of an 8-months of daily injections and many different pills.
“The early days were so difficult I almost gave up. The injections were bearable, but the pills made me nauseous. I found a handy trick that helped me a lot. I would take the injections in the morning, and the pills just before going to bed. This meant I avoided the feelings of nausea, and it allowed me to complete my treatment successfully.”
Now that he has completed his treatment, Bernard has finally been able to start his own business. He is now the proud owner of a brickmaking machine, and his business is starting to grow.
Living far from his family, Bernard had felt very lonely during his treatment, apart from the project staff, there was had been one to support him during this tough period in his life.
“I wish there had been someone to encourage me. One of the most important parts of TB treatment is the support from family and friends,” he says.
Bernard with his brick making machine – Photo: Habiba Bell
To show his gratitude for the help and support he received during his illness and to help others with TB, he now speaks to other patients about his fight with TB and when he has the time he also works as a TB advocate for the Challenge TB project in Benue State.
Contact investigation is just one method Challenge TB is employing to find people with TB who are being missed by routine health services. Nigeria has the seventh highest number of people with TB globally, and the second highest in Africa, this goes to show that there is a desperate need to do everything possible if there is to be any hope of reducing the numbers of people being infected and dying of this easily treatable disease.
Every year, approximately 20,000 people in Nigeria get sick with drug-resistant TB. The USAID-funded Challenge TB project provides a telephone helpline as well as diagnosis, treatment, and support to TB patients across the country. Between October 2017 and June 2018, a total of 777 drug-resistant TB patients were diagnosed, and 79 percent started on treatment.
