| Issue 374
and Regional Affairs |
Somaliland successfully treats more
than 90 percent of its TB patients
HARGEYSA, March 24, 2009 – Despite rampant poverty, high levels of
illiteracy and limited international support, the republic of Somaliland
has become an unlikely TB success story.
"We adopted the DOTS (Directly Observed Treatment Short Course) system
for treating TB in 1995, so someone is always present to ensure patients
take their medication," said Dr Ismail Adam Abdillahi, coordinator of
the national TB programme. "As a result, adherence is very high and
treatment success is over 90 percent."
The World Health Organization (WHO) has set a global target of 85
percent treatment success by 2015; Somalia, part of WHO's Eastern
Mediterranean Region, ranks second in the region's 22 countries in terms
of treatment success.
"The majority of the population has access to a health facility with TB
services that have at least one doctor able to treat TB," Ismail said.
"There is no shortage of drugs, which we get from the Global Fund [to
fight AIDS, Tuberculosis and Malaria] through World Vision
Education has ensured that almost all patients have a basic knowledge of
TB, while the establishment of a wide network of TB centers implementing
close supervision and monitoring means TB treatment continues to make
progress. The global target for TB case detection is 70 percent by 2015,
but Somaliland has already achieved a case detection rate of 68 percent.
"In 2008 we diagnosed 4,153 cases; we believe these were most of the
people who contracted the disease," Ismail said. Although the country
does not have the technology to detect multidrug-resistant TB, he noted
that there were very few cases of "chronic" or recurring TB.
This progress has been made despite the fact that Somaliland, which has
not achieved international recognition as a sovereign state, is
extremely poor - a decade-old livestock ban by Saudi Arabia and several
other meat-importing countries in the Middle East has devastated its
main source of income.
Although the country has been relatively peaceful since its formation in
1991, it continues to experience some insecurity, which hampers access
and limits staff movement to certain areas.
Sustaining the response in a difficult environment
"We also have a lot of IDPs [internally displaced persons] and refugees
in Somaliland from the south; when people are in such emergency
situations, personal health is not a priority and people do not seek
treatment," Ismail said.
"The war before 1991 also destroyed our health infrastructure, and we
still need many more health facilities and staff trained to handle TB."
The largest urban centre, Hargeysa city, with a population of more than
500,000, still has only one health centre equipped to treat TB.
"Our regulations are not as strong as they could be, and we do get
unlicensed practitioners treating patients and private pharmacies
selling TB drugs over the counter, which risks patients getting
incorrect information and taking drugs the wrong way," said Dr
Abdirashid Hashi Abdi, the Global Fund HIV/AIDS coordinator for the UN
Children's Fund (UNICEF) in Hargeysa. "There is also no known data for
the level of multi- and extensively drug-resistant TB."
Ismail noted that one of the groups still causing his department some
concern were the nomads, who roamed the countryside, never settling
anywhere long enough for TB education to reach them, and often grazing
their herds far from health facilities with TB services.
"Men who chew khat [a mild stimulant widely used in the Horn of Africa]
in small, poorly ventilated rooms for hours are also particularly at
risk," Ismail said. "This explains the fact that the ratio of men to
women infected with TB in Somaliland is two to one."
Somaliland and Somalia combined have an annual TB incidence of about 324
cases per 100,000 people, with more than half aged between 15 and 34.
The disease is strongly associated with poverty, and many TB patients
also suffer from malnutrition, making treatment more difficult.