TUBERCULOSIS in FIJI

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National TB Programme 

Keywords: Tuberculosis, TB-Diabetes Mellitus (DM), Fiji

INTRODUCTION
Tuberculosis (TB) is an infectious disease that is still a major threat to the population  of Fiji. The populations most commonly affected by TB are those with low socioeconomic status, poor housing, and unhealthy lifestyles mainly in semi- urban and densely populated areas. In addition to this, other co-morbid conditions such as TB-HIV and  TB-Diabetes Mellitus (DM) are challenges which  the  National  TB Programme  needs  to address to fully control TB in Fiji.

The most recent data from WHO Global Report 2011 shows that  Fiji has an  incidence rate  of 27/100,000 and a prevalence rate of 40/100,000 population.  In  2010 there  were approximately 191 active TB cases and in 2011 about 213 cases recorded by the national programme. The increase in case detection can be attributed to Advocacy, Communication   and  Social  Mobilization (ACSM) activities, sensitizing medical staff on TB suspect identification, improvement of diagnostic services and other strategic activities supported by the Global Fund. Out of the 213 TB cases in 2011, Central/Eastern division represented 42%, Western  41% and  Northern   17%. TB  affects mostly  the  productive  age group  between  15 and  55 years old who are exposed to  various social and  environmental  determinants.  Males represent  a  higher  number  of  TB cases than females. An estimated 7 to 11% of total TB cases are represented by children under the age of 15 years.

The Treatment Success Rate (TSR) of new smear positive TB cases in 2010 was at a low 67%. Out of the 33% that were not successfully treated, 6% had died, 24% had defaulted and 3 % were transferred out   with  their   outcomes  not   recorded.  The NTP is designing strategies to increase the TSR and especially reduce the number of defaulters through intensive follow up. The NTP continues to  apply the  Stop TB  strategies in  controlling TB in Fiji and eliminating it as a public health problem (1<1 million population). CLINICAL PRESENTATION: SIGNS & SYMPTOMS
Any person with symptoms or signs suggestive of TB should be investigated for tuberculosis.
The most common symptom of pulmonary TB is a productive cough for more than 2 weeks, which may be accompanied by other respiratory symptoms including shortness of breath, chest pains, coughing up blood (haemoptysis) and/or constitutional symptoms including loss of appetite, weight loss, fever, night sweats, and fatigue.

                The diagram below show the steps involved in diagnosing an active TB case. 

                     

 Sputum Collection
AFB  microscopy  of  sputum  smear  is  a  vital procedure  in  diagnosing TB  and  below is the steps to guide in the collection and transportation of sputum samples.

  •  Demonstrate to the patient how a good sputum specimen is produced by taking a deep breath and coughing deeply.
  • Find an outdoor  location, away from others, for the patient to expectorate sputum into the sputum container. For children, the use of nebulizers may help in stimulating the airways in order to obtain a good sputum sample.
  • Ask the  patient  to  screw the  lid  onto  the container before returning it you.
  • Make sure that the lid on the container is firmly close. Place the container inside a plastic bag. Wash your hands.
  • When two specimens have been collected, send both the specimens together with the request form to the laboratory as soon as possible. If it cannot be despatched immediately store in a fridge if one is available or a cool place if there is no fridge.
  • The specimen should be sent to the nearest DOTS  centre  within  two  days.  Otherwise it should be sent to the nearest microscopy centre for fixing and then transfer to the DOTS centre.

 

Referral
TB suspects can be referred to any of the 3 DOTS Centers (Tamavua, Lautoka Hospital-Tagimoucia Ward  and  Labasa Hospital)  using the  Referral Form (Tub1).

Contact Tracing
All care providers for patients with Tuberculosis should ensure that persons (especially if symptoms suggestive of TB, children <5years of age, persons with HIV infection, and contacts to MDR/XDR- TB) who are in close contact with patients who have infectious TB are screened and attended to accordingly.

The key objectives of screening are to assess if the contact:
■    has undiagnosed TB
■    is at high risk of developing TB if infected.
■    is at high risk of having been infected by the index case

                     

 

                                           

TB in HIGH RISK GROUPS
People living with HIV infection who are also infected with TB are at great risk of developing active TB. HIV testing of TB patients is conducted at all 3 DOTS Centers.

People with Diabetes Mellitus (DM) are 3 times more  likely to  get active TB. Type 2 diabetes involving chronic high blood sugar, is associated with altered immune response to TB. This leads to patients with diabetes and TB take longer to respond to anti-TB treatment. Screening for diabetes in TB patients is conducted at all DOTS centers

TREATMENT
NTP now uses Fixed Dose Combination  (anti-TB medicines)  for  intensive  and  continuation phase of treatment.  Regimens are available for adults and children and for new patient and re- treatment cases.

The standard regimen for adults is: 2RHZE/4RH ( 2 months of Rifampicin, Isoniazid, Pyrazinamide, and  Ethambutol;  plus 4 months  of Rifampicin and Isoniazid). For dosage information, refer to the TB Technical Guidelines.

Evaluation   of   treatment    outcome    in   new pulmonary  smear-positive patients is used as a major indicator of programme quality. Outcomes in other patients (retreatment, pulmonary smear- negative, extra¬pulmonary) are analysed in separate cohorts. Each registered patient should have his/her  outcome  recorded  in  the  register as soon as treatment  course is completed. The following treatment  outcome definitions should be used for sputum smear-positive patients.
                     
                                         

 

2 Replies to “TUBERCULOSIS in FIJI”

  1. My daughter and I were in Fiji in 1993 to 1994 and I was staying in Nasese. We were not immunized for TB and because we got so ill a doctor said we had to return to Australia. I was told we had Dengue Fever but my daughter has now got Latent TB. Is Dengue Fever symptoms similar to TB? Thank you

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