Senegal is committed to achieving the ambitious global agenda of ending TB by 2030. To meet this commitment, the country needs to address specific barriers to finding people with TB (missing cases) at different points in the care continuum that continue to impede the response.
World Tuberculosis Day (WTD), celebrated on March 24, is an opportunity for stakeholders in the TB response to raise awareness about the global epidemic and its health and socio-economic consequences. It is also an opportunity to communicate on the challenges and efforts undertaken to prevent, treat and maintain patients in care until cure. For this year again, the fight against tuberculosis continues to suffer the adverse effects due to the pandemic of COVID-19. In addition, there is an upsurge of tuberculosis cases in large cities with a high concentration of people, especially in Kaolack, Diourbel, Thiès and particularly in Dakar and its suburbs, as well as in places of deprivation of liberty.
ENDA Santé's action against tuberculosis
To address this issue, ENDA Santé, through its FEVE IMPULSE and Community Health/St. Louis projects, has been working for years in collaboration with community actors and health districts to stop community transmission of tuberculosis.
The NGO conducts awareness-raising activities with community actors through VADs and talks. The relays, Bajenu Gox (neighborhood godmothers), peer educators, the main animators of these activities, address the theme of tuberculosis, its mode of transmission, its signs, its free and accessible treatment in the nearest health facilities. They also emphasize the importance of testing, especially for those who have been coughing for more than 15 days. Also in its axis of strengthening health structures and personnel, through the FEVE IMPULSE project coordinated by ENDA Santé and implemented in 10 West African countries including Senegal, the Organization has signed partnership agreements with health structures. This is to support them in the screening and medical care of people living with HIV and in particular PLWHA co-infected with tuberculosis. This initiative has led to the signing of several agreements in Dakar, Mbour and Ziguinchor and the monitoring of a cohort of 265 PLHIV.
Increase in TB cases in the district of Keur Massar
The Keur Massar health district is a reference center for the treatment of tuberculosis. Opened since 2010, the District through its PNT service screens, treats and accompanies patients until they are cured in partnership with community-based organizations in the area. The service is always full and the providers are overwhelmed by the number of patients who visit the facility every day. "The National Tuberculosis Control Program has set us a target of 400 cases of tuberculosis per year, i.e. 100 cases per quarter. But, the District exceeds this quota. In 2022, for example, we received 614 cases of tuberculosis patients. This year too, just for the first quarter (January, February and March) we have 157 cases while we were expecting 100 cases, explains Salimata Gaye, in charge of TB treatment in the district of Keur Massar.
Traditional healers and private practitioners involved in case finding
These figures indicate the extent of the disease, but in the opinion of Salimata Gaye, many patients are still missing. Salimata Gaye does not seem surprised by the figures, given the demographic weight of this commune, she thinks that many cases are still missing.
To find these cases hidden in houses, the District of Keur Massar as well as the districts of Yeumbeul, Pikine, Guédiawaye and Mbao are collaborating with 12 community-based organizations including Environment, Community, Health and Safety (ECOSS) which operate in the area.
"First, we worked with Traditional Medicine Providers (TMPs) and Private Pharmacy Counter Agents (PCAs) by training them on how to identify suspected TB patients and refer them to health facilities. We targeted them because we know that they are the first point of contact for suspected TB patients. For each district, 15 PMTs and 15 ACPPs have been trained," explains Mame Ciré Ndiaye, project manager at ECOSS.
Then, explains the project manager, agreements were signed with these actors to carry out a package of activities, including referencing, which is the main activity alongside the VAD and VALT talks.
Ibrahima Ndiaye, a retired agent of the former SOTRAC, is 68 years old and is waiting for his examination to confirm his recovery. For 6 months, he was undergoing treatment for tuberculosis in the District of Keur Massar. We found him at home, confident and grateful to his nurse, Salimata Gaye, who accompanied him during his treatment.
It is a disease like any other that needs to be treated
I was diagnosed with tuberculosis after an examination. At first I was short of breath, lacked appetite and coughed mostly at night. I thought it was a cold, but when I went to the center I was given a sputum test and then a CT scan, which confirmed tuberculosis. I was afraid but the providers reassured me and advised me to follow the prescribed treatment. Now I don't feel anything. I give thanks to God. I encourage people, especially those who have been coughing for more than 15 days, to get tested and treated if they test positive. It's just a disease like any other that needs to be treated.
