She was admitted at the Ola During Children’s Hospital when she started experiencing illness. After several months of treatment for other diseases, the hospital discovered that she was actually suffering from tuberculosis (TB), and she was transferred to the Lakka hospital where she has been for the past four months.

Twelve-year-old Francess Kargbo (not her real name) developed a swollen stomach and was unable to walk or even eat by herself when she was brought in. She was losing weight and regularly coughing. Once in a while her father would visit her, but Francess said she felt lonely most of the time.

“It’s lonely in here. My father comes once in a while but my mother has never visited me,” she sobbed.
Tuberculosis (TB) is a potentially serious infectious disease that mainly affects the lungs. The bacteria that cause tuberculosis are spread from one person to another through tiny droplets released into the air via coughs and sneezes.

Sierra Leone remains one of the 30 high burden TB countries globally.

According to Dr. Lena Matata, TB Speed Coordinator at Solthis, 17, 169 TB cases were reported in 2018 in Sierra Leone, 14% of which were children.

This statistics was corroborated by the country’s Minister of Health and Sanitation, Dr. Alpha T. Wurie, saying Sierra Leone is considered as one of the high TB burden countries. He revealed that 17,167 patients were treated for sensitive tuberculosis and 125 registered for drug-resistant TB in 2018.

“Every year TB claims the lives of more than 3,000 people in Sierra Leone, but it is preventable and can be cured. We are advocating that the fight against TB is everybody’s business and we have to start educating people about the disease,” he said, adding that the national treatment success rate is 90.8% and meets global target.
At district level only one district scored less than 85% and two districts scored between 85-90% (Kono and Western Area Urban). The Health Minister considers this an improvement from 2017.

According to the Officer in Charge, World Health organization (WHO) in the Africa region, Alexander Chimbaru, TB is a major challenge to development as it causes untold human suffering, and threatens the achievement of the 2030 Agenda for Sustainable Development.

Nevertheless, the 2018 WHO Global Tuberculosis Report indicates that the disease burden caused by TB is falling globally and in most countries, but not fast enough to reach the first milestones of the End TB Strategy in 2020. The decline in TB cases by 4% per year in Africa between 2013 and 2017, placed the region on second ranking among all WHO regions, which is regarded as commendable progress.

In Sierra Leone, there have also been some remarkable progress in the control of the disease since 2013. Between the same period (2013-2017) the deaths due to TB decreased by more than 30%. Moreover, WHO reported great progress in the ability of Sierra Leone to diagnose and manage drug Resistant TB cases.

According to the Health Minister, improvement is also seen in the number of patients that they lose during treatment which has dropped from 9.8 in 2010 to 2.9 in 2018, adding that follow-up of patients is needed in Bonthe, Bombali, and Western Area Urban. Work is on-going in the decentralisation process in two regions, implementation of new regimen and implementation of universal access. To improve on the diagnosis with TB in Sierra Leone, 12 digital xrays have been installed at district/facility levels and capacity building.

However, to sustain these advances, Chimbaru suggested that current levels of investment by national governments and partners towards TB care and prevention must be increased so as to end the epidemic by the end date of the Sustainable Development Goals- 2030. He further noted that it is important that universal health coverage should be strengthened to ensure quality assured preventive, diagnostic, treatment and care services.

“Building on the successes of the recent past and fulfilling the commitments made by our political leaders, national governments, the need to adopt policy and programmatic actions to foster a multi-sectoral response to end the epidemic is critical,” said Chimbaru.

Within the broader context of a revitalized Primary Health Care system, he said these measures should include initiative to look for and effectively treat all existing cases, and scaling up preventive treatment for high-risk populations, especially people living with HIV and child contacts of known TB cases.

“To end the epidemic by 2030, we also need to ensure universal access to the WHO recommended rapid molecular tests as first-line tests for diagnosis for all presumptive TB cases, as well as to adopt the new WHO recommended drugs and drug combinations for treatment of drug-resistant TB,” continued Chimbaru.

At the Lakka Government Hospital conditions are not favourable for patients. Lansana Kalawa Conteh from Biriwa Limba Chiefdom Bombali District has been in the hospital for six months.

“The drugs we are given require us to eat a lot, but we don’t get enough food. Buying extra food in the Lakka community can be difficult because the traders are afraid to sell to us,” explained Lansana.

He said since he came to Freetown, he hasn’t got a single visitation from a family member or friend, and it has been very difficult for him; a concern shared by most of the patients.

According to a TB survivor Augustine Fornah, he started taking the treatment for three months and when he noticed that he has started putting on weight, he abandoned the treatment and returned to his village. His condition worsened and he decided to return to the treatment centre in Freetown.

“Many patients at the Lakka Hospital are constrained,” he said. “Some coming from the provinces have been abandoned by their relatives and friends. Food is provided for patients, but it is not enough. Lack of food is one of the main reasons most patients flee the hospital.”

Moreover, the Executive Director of the Civil Society Movement Against Tuberculosis (CISMAT), Abdulai Abubakarr Sesay, said stigmatization as one of the major problems affecting the treatment of TB because society perceive people experiencing TB symptoms as being bewitched and as a result TB patients are isolated in their communities.

He said when a patient is stigmatized, there is the likelihood for that patient to be missing out of the system and for such patient to transfer the disease to another person faster.

“Currently, we have about 3,400 people that have abandoned their treatment last year (2018). Even TB health workers are stigmatized. TB patients are not as contagious as most people believe; once a patient starts taking treatment for two months he/she is no longer contagious,” he said.

However, people suffering from TB cannot continue their normal employment work or go close to people. But CISMAT is advocating for school going pupils to continue their schooling while undergoing treatment, and for TB health centers to be very close to the patients so that patients will not be spending hugely on transportation to visit the centers.
Meanwhile, Francess said the drugs are helping her a lot.

“Now I feel healthy; my stomach is no longer swollen. I’m now doing almost everything for myself,” she said beaming.
But the Class 5 pupil from Calaba Town had stopped going to school since she got sick and her classmates will be taking the National Primary School Examination (NPSE) first week next month.