The number of cases of tuberculosis diagnosed in Mozambican health units is well below the real number of infections, warned// Health Minister Ivo Garrido on Wednesday.
Speaking in Maputo, at the opening of a national meeting on tuberculosis, Garrido said, "in our country, we only manage to detect about 50 per cent of people suffering from tuberculosis".
In 2006, he noted, 35,492 cases of TB were notified, which was an increase of five per cent on the previous year. But, despite the major efforts made to expand the health network since the end of the war of destabilisation in 1992, it is still inadequate, and so an estimated half of all TB cases go undiagnosed.
There are now about 1,200 health units in Mozambique, but only 250 have the capacity to make laboratory diagnoses.
The key problem, Garrido said, was locating the people who have the disease and are not being treated. "That's our central problem at this meeting", he declared. "We will not improve the situation without deciding how to increase our capacity to diagnose those people who have the disease and are scattered across the country".
The problem is complicated by the relationship between TB and HIV/AIDS. TB is one of the most common opportunist infections that strikes people whose immune systems have been compromised by HIV. Levels of co-infection in Mozambique are extremely high: Garrido cited World Health Organisation (WHO) figures, according to which about half the patients with TB seen in Mozambican health units are also HIV-positive.
"This results in high mortality from tuberculosis", he said.
Currently 13 per cent of TB patients die - leading Garrido to the conclusion that "HIV infection is doubling the number of TB deaths".
The rapid spread of strains of TB that are resistant to all the main drugs used against the disease is an additional concern, and a potentially a serious drain on the Health Ministry's resources.
Garrido said it costs the government ten US dollars to cure a new case of tuberculosis - but 300 dollars to treat a case of multi-resistant TB. "Hence the importance of the correct treatment of all cases diagnosed, to prevent them from becoming cases of multi-resistant TB", he stressed.
"We are aware that we face enormous challenges", said the Minister, "such as increasing the number and quality of staff at all levels, and decentralising and expanding the laboratory network, while guaranteeing its quality".
Garrido announced that this year two new laboratories will open, one in the central city of Beira, and the second in Nampula, in the north of the country. They would be able to grow bacterial cultures, and improve capacity to diagnose cases of tuberculosis with negative baciloscopy, extrapulmonar tuberculosis and multi-resistant TB.
He also stressed the need ensure respect for patients, and combat the stigma that TB still carries. Critical to success would be improve the management of anti-TB drugs, so as to ensure that no patient is forced to abandon treatment because the drugs run out.
Garrido attacked the passive attitude of certain local health officials who took no action when drugs against TB were stolen from health units, and ended up on sale in informal markets.
"As from now our attitude must change", he stressed, "so that the Tuberculosis Control Programme can advance and we can have better results".
Garrido welcomed the cooperation from foreign partners in the fight against TB - but stressed that it is the government, and not well-intentioned outsiders, that determines the country's health policies.
"There are partners who contact the Health Ministry, not to help implement the Ministry's programme, but to try and implement a programme foreign to Mozambique, drawn up we don't know where or by whom", he said, "There was even a case where the partner wanted to give instructions t
o the Ministry".
"The partners must understand that Mozambique is a sovereign country, with a government whose task is to lay down the policies to be followed", he insisted.
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