Poor geographical access to health services has hampered the treatment rate of TB, the country's second biggest killer, says Alfons Babie, an official at the recently created directorate for special diseases in the Health Ministry.

Instead of the international target of 85 per cent stipulated by the World Health Organisation (WHO), the TB treatment rate in Namibia is only 64 per cent.

Moreover, 40 per cent of those infected do not continue with their TB medication for the stipulated six-month course, and health authorities have picked up an emerging multi drug-resistant TB epidemic.

The lack of an electronic database also made it impossible for the health system to trace patients who did not report for collection of their TB drugs, said Babie.

In 1996, the Government introduced the WHO's Directly Observed Treatment Short-Course (DOTS) strategy, which includes free medication and treatment at all government hospitals for the six-month course of medication.

"If patients stop taking their medication before that they have to start from scratch again, but the TB bacillus has built up a resistance against the medication - it has mutated - so a different drug cocktail must be found for the patient," explained Kerstin van Wyk of Johanniter Hilfswerk, a German NGO working with people infected with TB.

"We had cases where patients interrupted [treatment] two or three times and had to be put on different medication each time, as the TB bacillus built up a resistance to the former medication cocktails," she said.

The Health Ministry notes in its latest annual report for the Khomas Region that many patients defaulted "because they become too sick and too weak to walk to the health facility, and cannot afford taxi money".

The San, who live in remote corners of the country, are one of the groups worst affected by the disease.

According to the WHO, an average of 676 TB cases were recorded for every 100 000 Namibians, putting the country at the top of the world ranking for the disease.

Last year Namibia launched its first national strategy to combat TB, which is also the principal cause of death among people infected with HIV or living with AIDS.

A recent successful Health Ministry proposal to the Global Fund to fight AIDS, TB and Malaria stated that about 50 per cent of TB patients were also HIV positive.

"AIDS is worsening the TB infections," Babie told Irin.

This month the Fund announced the disbursement of US$143 000 (about N$850 000) to the Namibian authorities to help fight TB, and approved a further US$7,2 million (about N$430 million) over five years for the TB programme.

The funds will used to improve access to treatment by setting up community-based DOTS in each of the country's 13 regions, hike its treatment rate to reach the 85 per cent target by the end of 2007, and monitor TB drug resistance.

- Irin News

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