Tuberculosis

Tuberculosis (TB) is one of the most endemic infections in Somalia and thus one of the leading causes of high morbidity and mortality rates. To combat this disease many attempts were made by Mercy USA for Aid & Development, who succeeded to officially open the Mercy TB Centre during the Civil War.

Mercy TB Centre was officially inaugurated in 1996 and funded by Mercy USA for Aid & Development (MUSA).  It is also supported by theWorld Health Organisation (WHO) and the United Nations World Food Programme (WFP) in providing medication and food for patients, respectively. TASS is the implementing agency, which is responsible for the daily running and maintenance of the Centre as per the set strategy.  Currently, the center employs a TB specialist doctor and 9 health workers.

The Centre not only treats patients but also educates them on the best practices of TB prevention using the most effective TB treatment strategy, which is the Directly Observed Treatment Short-courses (DOTS) method.  Mercy TB Centre's cure rate is around 90%, compared to the international care rate average of 85% using the DOTS method.

Considering the WHO recommended strategy to eliminate TB at source using the DOTS method it was decided to consider the following principles:

·     To give priority to smear positive patients.

·     To take only seriously ill cases of smear negative patient and extra pulmonary. (The   successful treatment of patients depends upon them regularly taking medications without interruption for a long period of time).

·     To prevent the defaulters, it was decided to implement health contact signing by the patient and elders or a notable person who will be responsible for patient complaints. The center strictly carried out daily use of DOTS through courses of treatment.

·     The drug distributors strictly insured that every patient has swallowed their medicine in front of them.

How the TB Center functions:

Outpatient Department - this is the entry point of the center which receives all new cases.  Patients are then directed to the relevant practitioner and those suffering of TB symptoms for more than two weeks are referred to the laboratory for examination. The total number of patients visiting the center in 2009 was 2922 patients

Laboratory - Sputum examinations for AFB are carried out in the laboratory. In 2009, 2036 patients were examined with 14% testing positive.

Treatment Unit - TB positive patients are treated here and are provided with follow-up checks until the disease is completely cured. In 2009, 497 patients were treated.

Pharmacy - prescriptions are available at the pharmacy, which is within the center.

The Food Distribution Programme from the United Nations World Food Programme (WFP) is the cornerstone of the TB Center as the majority of patients are poor and unable to afford a nutritious diet.  Following the set goal to reduce high mortality and morbidity rates resulting from malnutrition among a majority of the TB patients in Bosaso, Mercy TB Centre received food donations from the WFP.  A follow-up observation showed marked improvements in patients' health and nutritional status, resulting in overall improvement in physical fitness. Food rations appear to have attracted more people to the Mercy TB Centre, meaning more people are being tested for TB.

Research shows that epidemiologically there is a close link between TB and HIV.  Thus, a TB-HIV co-Management Programme was started in the TB Center in March 2007.  It entails HIV screenings of all TB positive patients.