Among African nations, Zimbabwe is one of those most heavily affected by tuberculosis (TB). The deadly combination of TB and HIV epidemics is igniting a silent and uncontrollable epidemic of drug resistant TB that will negate previous national health gains.
The 2007 Global Tuberculosis Control Report from the World Health Organization ranks Zimbabwe among 22 countries worldwide with the highest TB burden. While little is currently known about the extent of multi-drug resistant TB (MDR-TB) cases, conditions prevailing in the country point to the high probability of a significant drug resistance problem.
Drug resistance arises when TB treatment and other services do not work as intended and numerous critical factors such as rampant poverty, a crumbling health system, a lack of appropriate laboratory and diagnostic capacities, the movement of people including the brain drain of health workers, and limited TB funding, hamper TB control efforts. The lack of access to TB information, care and drugs, especially among poor communities, and an extensive HIV epidemic, have further driven a resurgence of the disease.
For the past 20 years, Zimbabwe has fought TB fairly successfully, providing free access to WHO-recommended treatments. In the past few years, however, the disease has re-emerged as a leading killer, especially among HIV positive people, who are often not identified though long-established TB tests.
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An estimated two-thirds of Zimbabweans with TB are also infected with HIV. As a consequence, Zimbabwe has a staggering six times more TB cases than it did 20 years ago. According to statistics, the success rate of directly observed treatment is just 54 percent.
Alongside the current TB emergency, Zimbabwe is also suffering its worst-ever economic crisis, with an estimated 80 percent of the population living below the poverty line. Malnutrition, poor sanitation and overcrowding are also helping TB to spread.
TB patients often fail to complete TB treatment because they cannot afford the transport costs to and from health centers. The lack of access to health services in remote or rural parts of the country adds to the likelihood that large numbers of TB infections are going undetected and untreated. The ongoing brain drain of qualified front-line health care workers from Zimbabwe has also not helped.
To make matters worse, the government-led national land reform program has seen many people resettling in areas with little access to medical care in the past seven years, which has disrupted TB care records and patient monitoring efforts.
Hardship and acute need is driving many people to seek opportunities in neighboring countries. Outward migration, including informally into other southern African nations, makes it impossible to effectively monitor TB incidence and prevalence.
The recent outbreak of extensively drug resistant TB (XDR-TB) in South Africa poses a direct threat to the situation in Zimbabwe. South Africa is home to an estimated three million Zimbabweans who frequently travel back and forth between the two countries.
Despite this mounting humanitarian disaster, engagement among vital government, private sector, donor and non-governmental (NGO) stakeholders is inadequate. NGOs involved in HIV-related work are doing little or nothing to address the TB problem.
Zimbabwean media organizations pay scant attention to the issue of TB. As part of a 2006 research project, only one article exploring the relationship between TB and HIV was identified in the print media. According to the Panos Global AIDS Program, which conducted the study, even when journalists cover TB, they usually overlook the links between TB, poverty and other socio-economic factors, and rarely interview people directly affected by the disease.
We need to put TB issues onto the public agenda through awareness-raising in all sectors of Zimbabwean society. This calls for an integrated approach to address the interlinked problems of HIV and TB.
Prevention of MDR-TB is clearly beyond the capacity of the country, and programs need to be put in place to ensure prompt diagnosis and adequate treatment. Funding, laboratory and diagnostic systems and technical support need to be directed towards fighting TB in the country to prevent the problem worsening even further.