Dr. Ameen Noman: “Our goal is to uncover at least 70% of TB cases in Yemen, and try to cure at least 85% of them by the year 2000.” [Archives:1998/13/Interview]
Dr. Ameen Noman is the Director of the National Tuberculosis Control Program (NTCP) at the Ministry of Public Health. Working at the pulmonary diseases department in the Taiz Jumhoori Hospital from 1983 to 1984, Dr. Noman was able to acquire a lot of expertise in combating this dangerous disease. He later became the director of the TB control program in Taiz until 1992 when he took over his current post.
Dr. Salah Haddash, Yemen Times Managing Editor, talked to Dr. Ameen Noman and filed the following interview. Excerpts:
Q: When did the programto control TB in Yemen start?
A: National programs to combat TB started in Yemen in the early 1970s with assistance by the WHO. However, TB control measures were then limited to major towns and cities and to those people who had enough money to get to these cities. This remained the case up to the early 1980s when cooperation with Japan started in this field.
During the first stage of the Yemeni-Japanese cooperation, 1983-1992, three specialized centers to combat TB were opened in Sanaa, Hodeida, and Taiz. These centers are fully equipped with modern medical facilities. Expansion into other governorates started in the mid-1980s.
The adopted principle then was to integrate the TB control facilities with other primary health-care services. Health workers can then be trained in various aspects of the health-care field.
Q: What are the NTCP main goals?
A: The NTCP’s main goal is to uncover at least 70% of the TB cases in Yemen, and try to cure at least 85% of these cases by the beginning of the next century.
Q: How prevalent is TB in Yemen?
A: A national survey was conducted at the end of 1990 and the beginning of 1991 among population samlpes.
The results of the survey showed that the annual infection risk, on a national level, is 0.86% – quite small, compared to other developing countries. But it still represents a problem. A 1% annual infection risk means that 50 new TB cases will occur. So this estimate shows that 7,000 pulmonary TB cases occur every year in Yemen. The same number of the less dangerous extra-pulmonary TB also occurs. This mean that the overall annual TB incidence is around 15,000 cases.
An untreated TB patient is likely to infect 10 to 15 other people every year. The most important thing about treating TB is that a patient must go through the whole course of medication. Incomplete treatment makes that the TB bacilli would become more resistant to medication. So a patient with drug-resistant TB germs is more dangerous than an ordinary patient.
Q: How many TB cases have you uncovered so far?
A: The epidemic, more dangerous pulmonary TB constitutes about 50% of the all TB cases. By the end of 1997, the coverage rate of positive cases was 62%. This means that we are getting nearer to the national and international goal of 70% by the start of the next century.
Q: In which governorates is TB most prevalent?
A: The rate of incidence is rather high in Hodeida, Hajja, Abyan, Lahaj, and Hadhramaut. Overcrowding in homes in these areas is a major factor in the spread of TB. Also, people tend to share the water pipe or the food utensils, a main cause of TB infection.
Q: Could you tell us more about the modern strategy to combat TB?
A: This modern strategy – short-term treatment under direct observation – is recommended by the WHO, and was entirely adopted by Yemen in 1995. We started to gradually implement it in several control areas in Taiz. The effort was expanded to include Aden, Hodeida, and the Capital Sanaa. By 1997, 13 governorates became covered by the new strategy.
This strategy is based on 5 elements:
1- Governmental commitment to providing medicines and medical supplies;
2- Training health workers on all levels of the health-care system;
3- Identifying suspected TB cases
4- More active role by the primary health-care system; and
5- Direct supervision and evaluation on all levels.
Before implementing this strategy, the proportion of the smear test changing from positive to negative following the third month of treatment was less than 50%. This ratio has risen to 88% by the end of the first quarter of 1998. This is a very good indication. The rate of cure also rose from 50% to 72% after implementing the new strategy, while, the rate of relapse fell from 40% to less than 10%.
Q: How active is the media in making people more aware of the dangers of TB?
A: Health media and education are rather inefficient. There is a plan, carried out with donor organizations, to provide direct health education and medical instruction facilities. It is just not enough to have a five- minute weekly public information piece on TV. Direct health education means that the patient must be in direct contact with the doctor or the health worker.
Q: How can people recognize the onset of TB?
A: The main symptoms of TB include continuous coughing, mild fever, loss of appetite, and loss of weight. If discovered early, during the first three weeks of infection, TB can be successfully cured. The important thing is to have a well-balanced and nourishing diet in order to have a healthy immune system.
Q: What organizations are assisting in the efforts to combat TB in Yemen?
A: The major supporter in this field in Yemen is JICA, which has been providing technical and medical assistance since 1983. JICA has provided about $75,000 worth of medicines and other sums for medical equipment and facilities.
Every two years, the WHO provides between $45,000 and $50,000 worth of medicines and medical supplies and training to Yemen. There is also a small pilot project to combat TB and leprosy in Taiz conducted by a German NGO.