World TB Day: Kingdom in the Sky
March 23, 2012 BY Eric Porterfield
Every year hundreds of thousands of children will become sick with tuberculosis and tens of thousands will die. Often, TB goes undetected in children and infants and young children are at special risk of having severe, often fatal forms of TB, such as TB meningitis, which can leave them blind, deaf, paralyzed or mentally disabled.
View photos from Lesotho, Africa, often referred to as “Kingdom in the Sky” which has the second highest rate of TB cases in the world. In Lesotho, village health workers are attempting to track down cases of TB, screen patients, and educate them on prevention as well as ways to lessen their chances of spreading TB to others. So far, the project in the Kingdom in the Sky has identified more than 4,000 cases of TB.
Lesotho, often called the "Kingdom in the sky", is a predominantly mountainous country, with more than 80% of its land at altitudes higher than1,800 metres. Three-quarters of the population live in rural areas. Off the main roads, walking and horse riding are the only transport options.
Lesotho has the second highest rate of new tuberculosis (TB) cases in the world. The lack of healthcare facilities in remote areas makes it hard for people with TB to get tested and treated, so the disease spreads quickly through communities. The epidemic is also fuelled by high levels of HIV infection which makes people more vulnerable to TB. Here: a patient waits for her TB treatment at the district hospital.
Nowesele Phandle, a village health worker and horse rider, has a lead role in the latest effort to track down TB patients who would otherwise have never been treated. Supported by a grant from the Stop TB Partnership's TB REACH initiative, FIND is using horse riders to collect the sputum samples needed to diagnose TB from patients in the most far flung parts of the country.
The horse riders are supported by a team of village health workers, who screen patients for TB and use a novel text message system to track patients' test results. The health workers receive an alert as soon as the results are ready so that patients can be put onto TB treatment immediately. The system, which is based on open source software, has very low operating costs.
Village health worker Mafole Mosolo gives a talk to villagers about TB symptoms and encourages people who think they might have TB to get tested, which is critical for their own health and to prevent the disease spreading. Each person with untreated TB is likely to transmit the infection to 10 or more people.
Malebona Sellonyane (right) has been coughing for more than two weeks and suffering from a fever—common TB symptoms—and agrees to provide sputum samples for testing. The health worker collects three samples to enhance accuracy of the results.
Nowesele Phandle returns to the health centre with the samples collected during the day. The horse riders carry out two to three weekly visits, reaching a total of 120 villages in the two districts where the project operates.
At the Central TB Reference Laboratory in Maseru, laboratory staff examine slides which have been prepared with the patients' sputum samples. The lab workers say that the number of samples they receive has increased since the project began.
A data clerk enters the results from the tests into a laptop. The results are automatically sent back to the health centre nurses via text message. So far, the project has identified suspected 4154 TB cases. More than 300 confirmed cases have been registered using the text message system.
Thanks to the combination of traditional horse riders, village health workers and mobile phone technology, patients can continue their daily lives without fear of spreading TB to their family and friends.
Photo Credit: Sam Nuttall/WHO
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