Dr. Yusuf Garow

I am sure by now you have heard or read extensive material concerning about TB, so I am not going to bore you with the pathological process of the disease; I rather explore the impact of TB on community level.

Transmission of Mycobacterium tuberculosis occurs due to contact with an infectious individual and several clinical and epidemiological studies of infection or disease after contact with tuberculosis (TB) have been published. Although households are regarded as places of close contact and high risk for transmission of TB, the exact definition of a "household" or "close contact" is not clear and the relative importance of crowding or contact with a TB patient outside the household has not been established. Alcohol, Qad (jad) are regarded as risk factors for developing TB, but it is uncertain whether susceptibility to TB is increased by the alcohol, qad (jad), per se, or by the fact that alcohol, Qad (jad), may be in close contact with untreated TB patients.

The trend of TB in Somaliland according to Authors: Annalena Tonelli, Ahmed Omar Askar, MD, Abdisalaam Jama Ibrahim, MD, at Borama TB Center, clearly indicated reduction between the years 1998 to 2000 (The prevalence of the year 1998 was 58% and the prevalence of the year 1999 was 44% and that prevalence of the year 2000 is 21%), if the study results can be generalizable to the rest of the country, it is something to be proud of. In other words, the authors are sending us a message, which is if we can manage to establish enough TB treatment centers we can actually make a damage on the disease transmission simply because we are treating the index cases to protect the others.

O.K let us take the argument to another level, doctors and other TB medical personnel did a wonderful job treating the patients with the disease to the best of their abilities, and it is about time someone should say: thank so much ladies and gentlemen for the noble job, but as a community are we up for the challenge to tackle the problem as well??? If we would, we need to keep in mind that, this disease is very expensive to treat, not to mention the stigma that attached to it, so prevention is not a bad idea, don’t you think? There are few basic steps we can take to prevent or to reduce the transmission such as:

• Allowing plenty of air in our homes during the day light hours
• If possible reducing the number people sleeping in one room or at least increasing the space between them
• Those who enjoy chewing Qad with friends are the most vulnerable and for sure carry the highest risk of contracting the disease, even though this behavior is difficult to change, be warned that someday a person with this disease is sitting right next to you, and there is good chance that you may develop the disease someday, so please see if you can enjoy your pleasure (if any) in a less crowded place
• Ask your doctor about signs and symptoms of the disease
• If one person in the family has the disease, it usually is good idea to check the other family members, do not assume every one else is safe

Taking these few basic and doable steps, will impact in a significant way about the TB transmission, and the medical community will appreciate in a great deal about the effort.

There is 5.4% rate of multi-drug resistant TB in Somaliland today, we need to realize that this number can only go up, it will never go down, the only logical explanation is the some patients are not complaint with their treatment protocols, and medical providers need to add educational component in the treatment protocol as well, and it is imperative that patients should make every effort to complete the treatment, though at times it can be difficult financially.

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