World TB Day: Patients Confront Stigma and Treatment Challenges

For Chioma Ifeanyi, a 39-year-old mother of three from Kubwa, Abuja, tuberculosis transcended mere illness; it became a test of endurance against societal stigma.

'People immediately associate tuberculosis with being infectious forever. Some of my neighbors stopped coming around when they learned of my diagnosis,' Chioma shared.

In April of last year, after suffering from persistent fatigue and fever, she initially wrote it off as malaria. 'I had malaria treated three times, yet nothing improved. I continued losing weight and experienced night sweats. Finally, a doctor suggested I get tested for TB.'

The diagnosis was a shock. 'I pondered: Will people avoid me?' she expressed. Despite receiving free treatment at a public hospital, Chioma felt the emotional burden of stigma weighed just as heavily as the physical symptoms.

'Encouragement from my family kept me on my medication during the weak moments. Without that support, I might have given up,' she stated.

Ezeh Daniella, a student, similarly faced stigma that initially delayed her seeking help. 'I kept convincing myself it was merely stress, yet I became extremely frail and weak,' she recounted. Eventually, it took a friend’s persuasion for her to pursue medical care. 'I felt ashamed at first, concerned about my classmates' opinions.'

Fortunately, with treatment and support, Daniella has recovered and is now sharing her story to promote early diagnosis.

These accounts underscore a crucial yet often neglected aspect of tuberculosis in Nigeria: the social isolation experienced by many patients even while undergoing treatment for a curable condition.

In recognition of World TB Day on March 24, survivors, healthcare professionals, and public health advocates are calling for increased awareness, early diagnosis, and ongoing support systems to address both the disease and the stigma it brings.

Bello Tijani, 28, is well-acquainted with the demanding nature of TB treatment. For nearly three months in his Bmuko community near Bwari Road, Abuja, he awoke before dawn to take a handful of bitter pills.

The medication left him feeling nauseous and weak, but he understood that missing a single dose could necessitate starting his treatment anew.

According to the World Health Organization (WHO), Nigeria has the highest tuberculosis burden in Africa, ranking sixth globally, with an estimated 467,000 individuals currently living with active infections.

Reports from Daily Trust indicate that the Federal Ministry of Health and Social Welfare, through the National Tuberculosis and Leprosy Control Programme (NTBLCP), offers free TB testing and treatment nationwide, aiming to eliminate the epidemic by 2030.

Despite these efforts, TB continues to pose a serious threat. The Knowledge Network for Disease Control and Vigilance (KNCV Nigeria) estimates that around 15 Nigerians die every hour from TB, which adds up to approximately 347 deaths daily and 125,000 each year.

Tuberculosis is caused by bacteria that primarily target the lungs, spreading through the air when an infected person coughs, sneezes, or speaks. While preventable and treatable, delays in diagnosis and interruptions in treatment remain significant barriers to controlling the disease.

The treatment journey often presents both physical and emotional challenges for patients. Faruk Nako, a 35-year-old commercial driver, recalls almost giving up on his treatment due to the side effects. 'The medication made me dizzy, and I struggled to eat. At one point, I thought of stopping altogether,' he admitted.

His doctor explained the dangers of discontinuing treatment, warning that it could lead to a stronger recurrence of the disease and even drug resistance.

Drug-resistant tuberculosis has become a pressing global issue, typically arising when bacteria survive incomplete or incorrect treatment, complicating recovery. Nako eventually finished the six-month course, saying, 'I feel strong again now, but it was a difficult journey.' He believes that increased counseling could better aid patients in managing their experiences.

Lawal Hassana, a mother of two, emphasized the vital role her family played in her recovery. 'They reminded me every evening to take my medication,' she said. After months of uncertainty marked by persistent chest pain and a stubborn cough, Hassana was diagnosed and began treatment. 'The doctor assured me that the treatment was available and free,' she explained.

The regimen, however, proved demanding. 'It requires daily medication, even after feeling better, to prevent a resurgence of the disease,' she noted. Today, she actively educates others in her community about the importance of not concealing symptoms, stressing that acting promptly can make a significant difference.

In a conversation with our correspondent, Dr. Ruth Adeniyi, an infectious disease specialist, identified incomplete tuberculosis medication as one of Nigeria's largest obstacles to controlling the disease. 'Beginning treatment does not mean stopping once you feel better. Many patients assume they're cured and stop taking their medication, which is dangerous,' she warned.

According to her, not completing treatment allows bacteria to persist and adapt, resulting in drug-resistant tuberculosis, which is considerably more challenging and costly to treat. 'When TB becomes resistant, treatment duration is extended, drugs are more intense, and the likelihood of recovery diminishes,' she added.

Additionally, failing to finish treatment heightens the risk of community transmission. 'A patient who falters in their treatment can still spread the infection to others, making adherence not just a personal issue but a public health priority,' she emphasized.

Adeniyi also highlighted the crucial need for ongoing investment in diagnostics and treatment infrastructure. Dr. Adamu Gimba, a pulmonologist in a government hospital in Abuja, pointed out that most patients only seek healthcare after the disease has advanced significantly. 'People often dismiss a persistent cough as minor. By the time they reach the hospital, they may have already wasted weeks or months treating other ailments,' he noted.

He stressed the importance of early testing. 'Any cough lasting longer than two weeks should not be ignored. Early detection can simplify treatment and reduce the likelihood of spreading the disease.'

Furthermore, Gimba noted that stigma continues to deter many from seeking timely care.

Dr. Tunji Badmus, a public health expert in TB control, mentioned improved reporting rates from recent awareness campaigns. 'People are becoming more aware that TB is curable. Still, a significant number of undiagnosed cases remain.' He advocated for enhancing community screening. 'Many Nigerians reside in rural areas where access to diagnostic centers is limited. Mobile testing units and community outreach can help bridge this gap,' he proposed.

Badmus emphasized the need for integrating TB services into primary healthcare.

Simultaneously, the WHO has advocated for increased domestic funding and improved case detection to combat tuberculosis in Nigeria. WHO Country Representative Pavel Ursu highlighted the necessity for Nigeria to take greater responsibility for its TB response through sustained local investment.

He pointed out that while the country has made strides in extending diagnostic and treatment options, approximately 175,000 TB cases remain undetected each year, exacerbating transmission risks. He mentioned that an untreated case could potentially infect up to 15 others annually.

'It is crucial to direct domestic resources toward implementing TB initiatives, especially in light of declining support from traditional donors,' he said, noting that around 71 percent of TB patients and their households face catastrophic costs.

Ursu characterized TB as one of the world’s deadliest infectious diseases, with 1.23 million fatalities and 10.7 million infections reported globally in 2024. In Nigeria, he projected around 510,000 cases annually, including 61,000 children.

He assured that WHO will continue assisting Nigeria with innovative diagnostics, training for healthcare workers, and developing a new national TB strategic plan for 2027–2031, while collaborating with partners on vaccine development.

In a significant move, the Federal Government has announced plans to utilize technology and innovation to expedite tuberculosis eradication and address other infectious diseases.

An allocation of $54 million has been sanctioned for the procurement of medications, particularly those for TB and HIV, to ensure an uninterrupted supply of essential medicines.

Dr. Charles Nzelu, Director of Public Health at the Federal Ministry of Health and Social Welfare, stated that the government is making substantial progress in tackling healthcare sector challenges.

Under the leadership of Muhammad Pate, TB has been identified as a major priority within the national health agenda. Nzelu disclosed that the ministry is implementing the National Strategic Plan (2021–2026), leveraging technology to eliminate TB as a public health concern in Nigeria.

'Nigeria is introducing over 1,000 diagnostic devices as part of this initiative,' he remarked. 'However, technology's effectiveness hinges on the supporting systems in place.

'We are currently focused on enhancing our electronic reporting systems to ensure effective data transmission from healthcare facilities to the national dashboard,' he emphasized.