Lesotho has highest TB prevalence rate in world

MASERU – LESOTHO now has the highest Tuberculosis (TB) incidence rate in the world with 650 cases per every 100 000 people, according to the latest statistics revealed by the Ministry of Health’s TB Manager, Dr Llang Maama.

Dr Maama revealed this at the Lesotho TB mortality 2019 audit study dissemination.

The study was conducted to better inform the ministry on possible factors leading to the increase in mortality in TB patients.

TB is an infectious bacterial disease caused by Mycobacterium tuberculosis (MTB).

The report revealed that in Lesotho, the total TB incidence is three times higher than in the World Health Organization (WHO) African region and five times higher than the global average.

It also shows that TB/HIV incidence is 7.3 times higher than in WHO African region and 38 times higher than the global average.

The TB/HIV mortality is 10.5 times higher than in WHO African region and 58.5 times higher than the global average.

“There is a huge gap between incident cases and notified cases,” she said.

“Lesotho is the 3rd country with the highest relative percent reduction of notification cases between 2019 and 2020 at 35 percent.”

Dr Maama said results from studies conducted in similar settings had shown that patients diagnosed with extra-pulmonary tuberculosis are more likely to die than patients with pulmonary tuberculosis.

“TB/HIV co-infected patients that do not receive antiretrovial therapy (ART) and or co-trimoxazole preventative therapy are also more likely to die.”

She added “history of smoking, previous TB treatment, alcohol and drug abuse are other factors associated with high mortality among TB patients. Studies have also found that comorbidities such as malnutrition, diabetes mellitus, liver cirrhosis and bacterial pneumonia to be among the major causes of death among TB patients.”

In 2020, there were 14 000 TB cases – 8 200 HIV positive incidence, 1 100 HIV negative TB mortality, and 3 400 HIV positive TB mortality.

She said the number of TB cases are attributable to five risk factors, which are diabetes (554 cases), alcohol use disorder (1 388), smoking (1 849), undernourishment (3 114) and HIV (7 539).

She said case detection (treatment coverage) was 33 percent while 67 percent was missed to care.

TB mortality rate in Lesotho remains high at 53 percent and 158 per 100 000 population in HIV negative and people living with HIV.

“Currently, effort to reduce TB associated mortality is not informed by a systematic evaluation. As a result, causes and factors contributing to TB mortality are not well understood in Lesotho,” Dr Maama said.

Similarly, she said the country did not reach the 2020 milestone of 35 percent reduction in absolute number of TB deaths compared to 2015 as the deaths reduced by only 33 percent.

She said although TB is curable, Lesotho has high TB case fatality ratio at 34 percent.

She said in 2020, the TB coverage was 33 percent and 34 percent mortality rate while 19 percent of patients faced catastrophic costs in 2019.

The Ministry of Health’s Principal Secretary, ’Maneo Ntene, said HIV played a negative role on TB treatment outcomes.

“This persistent high mortality makes it impossible for us to reach the desired treatment success rate of 90 percent as per our regional target,” Ntene said.

“The findings will be used to design and implement strategies including multi-sectoral approach to turn around the current picture of high TB deaths and fast track us towards achieving the set SDG goals of TB death reduction,” she said.

“The aim of ending TB by 2030 must be pursued at all costs through partnerships, new and old.”

Dr Tšepang Lekhela, from the Health Director-General’s office, said “the findings will shed light on the causes currently observed among our TB patients and enable stakeholders to find better ways on how to address the identified problems”.

’Mapule Motsopa