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Sharon Kavhu : Correspondent

Sithabile Mpofu is among thousands of people who have experienced a phase of infection by Tuberculosis (TB) while living with diabetes in Southern Africa. The 52-year-old woman from Lobengula, Bulawayo in Zimbabwe’s second largest city has been diabetic for the past decade. She was diagnosed with TB in September last year and underwent eight months treatment.Mpofu completed her TB treatment in May, 2016 and The Herald Features caught up with her recently.

“I was diagnosed of TB last year in September. I contracted TB from my grandchild who is among seven family members that stay at my homestead,” said Mrs Mpofu.

What initially confused Mrs Mpofu is that of all the people that were staying at the homestead, she was the only one who contracted TB, and yet she rarely spent time with her grandchild.

Instead, her daughter, the mother to the boy who had TB, spent more time with him but never got infected.

She added: “At the hospital they told me that TB was an airborne infection, but what surprised me was that of all the seven people that stay at my homestead, I was the only one who contracted it. Family members slept in the same room with the child never contracted any TB.”

Several experts speak on the possible reasons why Mrs Mpofu is vulnerable to TB and unpack the link between diabetes and TB.

City of Harare Director of Health Services, Dr Prosper Chonzi said the initiative is a positive approach towards the two conditions because diabetic people have an immune system that is very amenable to infections.

“What we know is that TB is normally detected in the young and very old. Diabetic people are at high risk because they have a suppressed immune. Their system is very respective to infections,” said Dr Chonzi.

“Previously we were only screening TB among people living with HIV and testing HIV in TB infected people, thus the development is a positive step towards TB response.”

International Union Against Tuberculosis and Lung Disease (The Union) country director, Dr Christopher Zishiri explained the link between the two conditions, some of which have been documented.

“The association between diabetes mellitus (DM) and infectious diseases has been well documented owing to the fact that DM weakens the immune system. TB and DM are two of the world’s leading causes of death and disability,” said Dr Zishiri.

“DM triples the risk of developing TB and diabetes is a common co-morbidity in people with TB.”

Dr Zishiri said the two infections needed to be taken seriously because the combination could be deadly.

He said: “TB patients with DM co-morbidity are at an increased risk of TB relapse, treatment failure and death. DM patients with TB co-morbidity also have challenges in controlling their blood sugar levels thus increasing the likelihood of developing complications from DM.”

“Diabetic patients also experience some gastro paresis which impairs absorption of a number of TB drugs.

“The drug interactions between diabetes and TB medications can also have negative implications. Patients with DM also experience some gastro paresis which impairs absorption of a number of TB drugs.”

He said diabetes is fuelling the spread of TB and this negatively impacts on global efforts to end TB by 2035.

According to The Union, the growing burden of TB – DM is changing the landscape of TB care and prevention. There is now abundant evidence of high rates of diabetes in people with TB and often diabetes is only discovered if actively screened for. The same is true of TB rates among people living with diabetes.

However, there is a general assessment that has shown that the prevalence rates of TB tend to be higher among the older populations and among people living in urban versus rural areas.

Like most developing countries, Zimbabwe has been experiencing an increase in the number of non-communicable disease particularly diabetes.

In addition the country is among the high burden countries that account for more than 80 percent of TB-HIV and MDR-TB cases globally.

Given the close association of these two epidemics there is greater need to provide integrated patient centred care and treatment for both TB and DM.

This can be done by ensuring that patients with TB are screened for DM and conversely patients with DM are screened for TB regularly.

On the other hand, Ministry of Health and Child Care’s Deputy Director HIV, TB unit, Charles Sandy said TB infection may lead to metabolic changes that make management of sugar in a diabetic hard.

“Co-infection may lead to poor outcomes for the patient if both conditions are not well managed e.g. diabetic complications, failure of ant-TB treatment and even death,” said Dr Sandy.

Today, Southern and Eastern Africa are on a pilot programme to have a two – way approach on TB and Diabetes through Zimbabwe and Uganda respectively.

Zimbabwe and Uganda’s pilot programme on TB, diabetes integrated approach is proceeding well although it is too early to get a clear assessment.

This follows the disbursement of $289 974 to the two countries by the Diabetes Foundation (WDF).

To date, 10 health facilities from each country have started the pilot. In Zimbabwe it is currently running at: Mabvuku, Glenview, Budiriro, Mufakose, Kuwadzana, Rujeko, Warren Park, Mbare, Rutsanana and Highfield polyclinics.

In Uganda, the pilot programme is being held at Kiswa Health Centre, Murchison Bay Hospital, Kisugu Health Centre, Nsambya Hospital, Mengo Hospital , Kisenyi Health Centre, Kawaala Health Centre, Kitebi Health Centre and Nahuru Hospital.

TB patients are being offered free blood test for diabetes in order to establish the prevalence of diabetes among TB patients.

The assessment and outcomes of the pilot programme will determine whether or not it should be a policy to screen TB patients for diabetes.