COVID-19 pandemic had a disruptive effect on the implementation of TB interventions in Zambia


Minister of Health Sylvia T Masebo has said the COVID-19 pandemic had a disruptive effect on the implementation of tuberculosis (TB) interventions in Zambia.

When officiating at the Regional consultation Conference on the management of TB in children and adolescents for the African region,
Ms Masebo said at the peak of the first wave of the corona virus pandemic, the country recorded an 18 per cent reduction in weekly TB notifications.

She said government through the Ministry of Health hastened to mount up a robust response program that extensively put in place mitigation measures.

Ms Masebo further noted that the government has prioritized the attainment of the universal health coverage agenda in the 8th national development plan.

She pointed out that government is investing in human resource for health as evidenced by the recruitment of 11,326 health care workers recently.

“TB remains a disease of public health concern globally, in the African Region, and individual Countries including ours. This supports the narrative that TB anywhere is TB everywhere. In 2021, it was estimated that there were 10 million new cases of TB globally, with at least 1 million cases in Children below the age of 15 years. TB has been a deadly disease and it still remains deadly. In 2021 over 1.5 million deaths were attributed to TB globally, and over 200,000 of these deaths were in children below 15 years. These grim statistics show that we need to do more to reverse this situation which the COVID-19 pandemic has exacerbated.Despite the burden of TB remaining high in Zambia, I wish to share that we have accelerated our TB response in the last two decades. Working collaboratively with our stakeholders, we have reduced the TB incidence from 759 per 100,000 in the year 2000 to 319 per 100,000 in 2020. This represents a 58 % reduction,” Ms. Masebo said.

“Further, Zambia has significantly reduced TB mortality, especially in HIV positive population. Despite the devasting effects of the COVID-19 Pandemic, we made great strides in TB case notifications. In 2021, one of the peak years for COVID-19, we notified 50,825 TB cases, compared with 36, 866 in 2019. Our treatment coverage now stands at 85%, getting close to the global target. We have also made an outstanding performance in increasing TB Preventive Treatment initiations and completion rates in persons living with HIV. TB treatment success rate in patients with drug-sensitive TB has been at least 90% in the last four years. Distinguished guests, ladies and gentlemen, I also wish to inform you of the tremendous progress that Zambia has made on the United Nations High-Level Meeting (UNHLM) targets. By week 35th of 2022, we achieved 98% against the United General Assembly (UNGA) target for Zambia TB notifications. In addition, we have already surpassed the mark for TB Preventive Treatment in people living with HIV. Of concern, are the low TB case detection and TB Preventive Treatment coverage in under five contacts of TB patients. By the end of 2021, we attained 62% of the childhood TB notifications, looking unlikely to achieve the UNHLM targets by the end of 2022. TB Preventive Treatment in the under-five contacts is 35%.”

Ms. Masebo added:”As a country, we will use this meeting to learn the best practices from other countries and experts from WHO and other technical agencies on accelerating TB case finding and prevention in children. To address the issue of low TB case detection in children, we are decentralizing TB screening, diagnosis, treatment and prevention to primary health care levels. This approach involves building the capacity of frontline workers through onsite mentorship and structured technical support supervision. Unfortunately, drug-resistant TB notifications are also way below the target.Distinguished guests, ladies and gentlemen, Reflecting on this meeting and its objectives, I am happy to inform you that the Government of the Republic of Zambia places a premium on the health of children and adolescents. Addressing TB in children and adolescents is a priority for this government. Against this background, I applaud and welcome the WHO recommendations to shorten TB treatment to four months in children and adolescents with non-severe TB.”

Ms. Masebo revealed that the Ministry of Health has consolidated TB guidelines which will be launched soon.

“You will be pleased to note that we have already adopted and included this recommendation in our Consolidated TB guidelines, which I will be launching soon. We continue to be proactive in adopting new molecular and rapid diagnostic tools in our laboratories. We have rolled out Gene-Xpert testing using stool specimens and Urine LAM. These tools have helped us increase TB detection in children, especially those under five years, as reflected in our 2021 performance. In 2019, TB case notifications in children aged 0-14 years stood at 2473 cases. This is before we introduced LAM and related diagnostic interventions. In 2021, after introducing the newer interventions, we notified 3,890 TB cases in the same population, an increment of 57.3%. Distinguished guests, ladies and gentlemen, The UPND led government has placed a premium on the matter of TB. To that effect, we have domesticated the End TB Strategy and other Global Commitments, such as the Sustainable Development Goals. We have translated them into the National Strategic plan, including the current one covering the Period 2022 to 2026. In this National Strategic Plan, we are taking bold and strategic steps to expand the coverage of TB interventions to reach every TB patient within the bounds of the Country. We are taking deliberate steps to ensure we deliver and improve care quality to everyone who accesses health services, including TB,” she said.

‘The Ministry of Health, under my leadership, continues to support research and innovations to inform policy and enhance service delivery across the continuum of care. You may be aware that through the University of Zambia, the Country participated in two landmark studies, the TB SPEED and SHINE studies, that have informed the normative guidance recently published by the World Health Organization. The two studies informed us about newer TB diagnostic approaches and shorter TB treatment regimens in children. We will continue to create an enabling environment for conducting transformative research. You will be pleased to also learn that we just concluded conducting two large studies that have policy implications on TB services; the Out-of-Pocket Expenditure Study and the Drug-Resistant Survey. The first-ever Out of Pocket Expenditure study showed that 42% and 56% of drug-sensitive and drug-resistant TB, respectively, experienced catastrophic costs due to TB treatment. With this critical information, we will adjust the policy frameworks to remove the current barriers TB patients experience when seeking health care. We are already implementing interventions that bring about equity and ease of access to sensitive and rapid TB diagnostic tools. As a demonstration of our intent to eliminate catastrophic costs due to TB, we have deployed mobile TB trucks equipped with Gene-Xpert and Digital chest-Xray machines in seven out of the ten provinces. We have also deployed community-based volunteers supporting robust TB contact investigation and treatment support for TB patients. This includes those with drug-resistant TB. With this approach, we are reaching, on average, 04 contacts per TB patient. We continue to build on these high-impact interventions to expand the TB treatment coverage from 85% to 90%.Distinguished guests, ladies and gentlemen, The COVID-19 pandemic had a disruptive effect on the implementation of TB interventions,” Ms. Masebo said.

“During the peak of the first wave, we saw an 18% reduction in weekly TB notifications. Learning from the Cholera outbreak in 2018, which equally led to the decrease in TB notifications, we quickly mounted a robust response and extensively put in place mitigation measures. Central to our TB response to COVID-19 was the creation of the TB situation room. This situation room is our flagship intervention that has enhanced the use of data for decision-making and action. Using this flagship intervention, we could effectively coordinate case-finding measures, provide strategic guidance, and sustain a stable supply chain for all essential commodities for TB. Distinguished guests, ladies and gentlemen, The Government of the Republic of Zambia, under the leadership and stewardship of His Excellency the Republican President Mr. Hakainde Hichilema, has put the attainment of Universal Health coverage as a critical priority under the 8th National Development Plan. Under this framework, we have prioritized primary health care as a bedrock of our health interventions. In the spirit of integration, we will ensure that TB screening is integrated into Maternal and Child Health services, and diabetic clinics. We are also investing in human resources for health; in the first year of this Government, we have recruited 11,326 health care workers. This additional workforce has contributed to reducing the doctor and nurse-patient ratio. These health care workers will contribute to service delivery regarding childhood and adolescent TB.Distinguished guests, ladies and gentlemen, I will be failing in my duty if I do not highlight areas that need global coalition and urgent actions to support the strategy to end TB by 2030:Additional resources are required to conduct research; this includes building the capacity of our health workforce in research. We need newer child-friendly second-line drugs A newer TB vaccine is needed Migration of paper-based data capturing and reporting to a digital case-based electronic platform.”

Ms. Masebo concluded:”I would like to express our profound appreciation for the support we continue to receive from various funding technical agencies such as; the WHO, USAID, US CDC, Global Fund, and the Stop TB Partnership to mention but a few. I also wish to thank all the distinguished delegates and stakeholders who have made this consultative and transformative meeting a reality. I wish to seize this opportunity and officially launch our TB National Strategic Plan for 2022-2026, the Consolidated National TB Guidelines and the TB Situation Room Dashboard.Finally, it is my singular honour and privilege to declare the Regional Consultative meeting on the Elimination of Childhood and Adolescent TB officially opened.”

Meanwhile, Ministry of Health Zambia Permanent Secretary-Technical Services Lackson Kasonka has said the Zambia National Public Health Institute-ZNPHI working with the Ministry of Health has prioritized public health security for the country as an investment aimed at safeguarding the wellbeing of the citizens.

Speaking in Lusaka, during an official opening of the Zambia Field Epidemiology Training Program-FETP, Professor Kasonka has observed that the program is one of the key strategic roles in assuring health security as has been shown from the FETP involvement in rapid response to disease outbreaks across the country since inception.

He has assured that the high level policy discussions are underway that will create positions for field epidemiologists and motivate graduates in their career progression.

“Keeping the momentum of all FETP gradates can also be attained through alumni networks like this one,” he said.

Professor Kasonka has revealed that government has shown commitment through the allocation of funds in the national budgets to support FETP.

The Permanent Secretary said the ministry will also work closely with ZNPHI to extend disease intelligence structures at provincial and district levels.

“Zambia recognises the need for epidemiological skills at all levels of care,” he adds.

He said the ministry will continue engaging districts and provinces at national level in
training so as to improve health care worker skills through the Frontline and Advanced FETP tiers.

And ZNPHI director general Roma Chilengi says emergency preparedness is key to combating novel diseases.

Professor Chilengi also health advisor to the president is hopeful that the training workshop will moot lasting solutions to public health emergencies and disease surveillance.

World Health Organisation Country Representative to Zambia Dr.Nathan Bakyaita has applauded the FETP role in training health professionals with investigative skills that ensures evidence based data for public health decision making.