The tuberculosis-malnutrition link in Yemen [Archives:2008/1132/Health]
Mahmoud Assamiee
For the Yemen Times
Tuberculosis, commonly called TB, is a contagious bacterial disease usually affecting the lungs; however, it also may affect other parts of the body, such as the brain, lymph nodes and kidneys.
TB is spread by tiny germs floating in the air spread via coughing or sneezing. Those nearby then breathe these TB germs into their lungs and become infected. However, those with latent TB infection – not the active form of the disease – can't infect others.
Studies by the World Health Organization have found that one-third of the world population currently is infected with the TB bacillus, with between five and 10 percent of those carrying latent TB infection, or LTBI, becoming sick sometime during their lifetime.
Those with active TB typically experience symptoms such as a persistent cough or chest pain and, in some cases, cough up blood from the lungs. Those with these types of symptoms are capable of transmitting the infection to others. “The main causes of TB are smoking, especially shisha – the water pipe, dirty and crowded places and bad or malnutrition,” notes Dr. Adel Mahyoub, director of information management at Yemen's Ministry of Public Health and Population.
TB cases increase in Yemen
The increase of TB cases in Yemen has many sources. Besides the smoking of shisha and cigarettes, there's the popular Yemeni trend of using shamma, whereby a small amount of tobacco powder is placed under the tongue or between the lip and gums.
“TB is increasing in Yemen nowadays,” observes Dr. Nashwan Al-Attab, who works in the emergency unit at Al-Thawra Public Hospital. He attributes this increase of TB to the incursion of dirty, crowded areas and the type of lifestyle forced upon Yemenis due to poverty, such as eight or 10 people sleeping in one room.
Al-Attab noted that a primary study by the Health Ministry on the increase of TB in Yemen found 1,700 cases in 2006, whereas the figure increased to 2,300 in 2007. He expects that this figure is even more than what's been recorded, as he's found more than three cases in one unit alone at just one hospital.
“TB is one of Yemen's major problems,” states Dr. Ali Al-Mudhwahi, director-general of family health at the Ministry of Public Health and Population.
“In the past, the Yemeni government gave free monthly portions of foodstuffs such as flour, wheat and sugar to TB patients while they received their daily medication at the TB units,” Mahyoub noted.
Nutrition and TB
Nutrition means eating a diversity of food containing numerous types of vitamins and sufficient proteins, which the body needs for energy. As Al-Mudhwahi says, “Yes, there's a relation between nutrition and TB.
“Those who are poorly nourished are more vulnerable to TB and other diseases than those who are well-nourished with sufficient immunity to face diseases,” he explained.
Likewise, a 2004 study by WHO reaffirmed the relation between malnutrition and TB. In combination, malnutrition and TB present a dangerous menace, as malnourishment makes individuals vulnerable to TB, which aggravates malnutrition. This downward cycle leads to severe physical deterioration and possibly death. One of the poorest countries in the region, Yemen's poverty is exacerbated by near-constant price hikes for even the most basic staples such as wheat and sugar. Nowadays, a major concern is how to get enough food to the poor in order to prevent the spread of diseases like TB.
“TB is the disease of the poor,” notes Al-Attab, who expects daily TB cases in other hospital units such as delivery and exterior clinics.
“Doctors are more vulnerable to TB infection due to direct contact with patients,” he pointed out, citing the case of a colleague so severely infected with TB that the disease paralyzed him.
Tuberculosis is curable
If given enough anti-TB medicines or special antibiotics quickly, TB patients often can get rid of the disease completely. Medicine must be administered to the patient regularly without interruption for six to eight months under a physician's supervision.
However, medicines like these are very expensive for the average rural-dwelling patient. They are available at pharmacies, but ordinary citizens can't afford them.
Although the government sometimes provides TB patients free medicine, the process is sporadic because, as some doctors allege, this medication secretly is sold to those working at public centers that distribute these medicines.
“Patients sometimes go to public centers where free medicine is handed out only to find that there's no more medicine,” Al-Attab stated, noting that this interruption of treatment is dangerous because TB medicine must be given to patients regularly.
Fatima Saleh, 67, came to Sana'a for treatment after obtaining an inaccurate diagnosis in Taiz. “I've suffered with this disease for more than 10 years. My son went with me to several clinics in Taiz, but I found no remedy,” Saleh recounted, “I then was advised to go to Sana'a, where doctors diagnosed me with chronic TB.”
Saleh was given medicine and advised to rest at home. Her son, Abdu Thabit, points out that his mother used to smoke a meda'a, or water pipe, but gave up smoking 15 years ago.
Doctors who treated her at private clinics said smoking was the reason she became infected with the disease. Because Saleh is old and was slow in seeking treatment for her TB, managing her illness will be difficult.
Yemen began combating TB in 1970 through vaccinations, free medicine and awareness campaigns, Al-Mudhwahi noted.
With no independent TB treatment centers, the Yemeni government combats the disease through early vaccination for children and providing free medicine to infected TB patients.
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