March 2020

{Photo credit: MSH}Photo credit: MSH

by Barbara K. Timmons, PhD

Tuberculosis (TB) is the pandemic that won’t go away. This ancient disease, the leading infectious cause of death in the world, kills more than a million people every year. One-third of the world’s population lives with latent TB infection. Despite being a preventable and curable disease, TB has been difficult to eradicate in part because of the stigma around the infection, preventing people from getting tested and continuing treatment. 

Ethiopia is among the 30 countries with the highest burden of TB in the world. One TB patient in Eastern Ethiopia, a woman from the small city of Dire Dawa, told researchers from Management Sciences for Health (MSH), “My husband’s family stigmatized me a lot. Since they knew that I am a TB patient, they didn’t sleep in our house. They sleep outdoors. They are not also willing to eat with me. . . . Before I was infected with TB, our social life with other people was great. The social life of Dire Dawa community is well known. But after they knew that I am a TB patient, only one of my neighbors sometimes comes to visit me.”

{Doctors visit with patients in Rabia Balkhi Hospital, Kabul, Afghanistan. Photo Credit: Afghan Eyes/Jawad Jalali}Doctors visit with patients in Rabia Balkhi Hospital, Kabul, Afghanistan. Photo Credit: Afghan Eyes/Jawad Jalali

A recent Management Sciences for Health (MSH) study conducted with mental health patients in Afghanistan revealed that people being treated for mental illness were almost 20 times more likely to have tuberculosis (TB) than the general population. 

Years of conflict, poverty, stress, and illicit drug use have led to Afghanistan’s high rates of mental disorders, including depression, anxiety, and post-traumatic stress disorder. Studies have shown depression and anxiety rates as high as 72% and 85%, respectively, among Afghan adults. Afghanistan’s high incidence of TB is similarly linked to high rates of poverty and illegal drug use. Both TB and mental disorders may also be associated with poor nutrition, inadequate housing, and other manifestations of poverty. 

The MSH study, which screened 8,073 patients at six mental health facilities (five public and one private) in Herat, Jalalabad, Kabul, Kandahar, and Mazar-e-Sharif provinces found that 3.4% of patients suffered from TB. The incidence rate among Afghanistan’s general population is 189 per 100,000 people.

{Photo credit: Warren Zelman}Photo credit: Warren Zelman

Originally published by Global Health NOW

COVID-19’s lethal invasion in late 2019 has turned the world inside out. Yet, another disease, tuberculosis, has been plaguing humans since the Upper Paleolithic era, some 20,000 years ago. In fact, many infection-prevention precautions promoted for the coronavirus—coughing etiquette, distancing, and hand washing—originated as TB-control measures in Victorian times. The COVID-19 response can draw on more challenges and lessons from TB programs that emphasize investments in research and rapid uptake of new diagnostic, prevention, and treatment tools for universal health coverage.