‘We have a major problem’ ‘ head of TB programme

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Dr David Mametja has been the Chief Director for TB Control and Management in the national Department of Health since March 2008. He describes TB as a ‘major, major problem’. Quoting estimates by the World Health Organisation (WHO) in 2009, Dr Mametja illustrates how huge the problem of Tuberculosis is in the country.

‘Our incidence rate, which is the number of people that contract TB on an annual basis’¦ the new cases’¦ was actually 1% of the South African population. One percent of the South African population is almost 500 000 people in South Africa contracting TB every year. It’s a massive number of people’, Dr Mametja says.

Over the same period of 2009, working on the assumption that about 500 000 South Africans have active TB, facilities were able to screen, test and diagnose just over 400 000 people. This means that many with infectious TB are walking the streets of towns, villages and other neighbour-hoods not knowing that they are sick.

‘We are under-diagnosing’, Dr Mametja admits. ‘But the good news is that we are seeing improvements in that regard. In 2009 we diagnosed 406 000 cases of TB against a target of about 490 000 in terms of this 1% incidence rate estimate that WHO has given us. It’s still not exactly the 490 000, but it’s much better than the 380 000 that we diagnosed the previous year; and the figures actually get lower and lower as you go back. I acknowledge the point that we are not detecting as many as we should, but we are seeing an upward trend in terms of the numbers that we are able to detect’, he adds.

The WHO recommends that countries should strive to reach the gold standard cure rate of 85% for TB. South Africa has been struggling to reach the target over the years.

‘Our cure rate is about 70% and, then, it varies from province to province. For example, KwaZulu-Natal is under-performing. The cure rates are about 55%, while the Western Cape and Gauteng province are doing very well. They are now at about 80%. So, you can say 70% against 85%… it means we are not doing well. But, then, you have to look at this in a proper context as well. In terms of our strategic plan’¦ because we realised that we can’t just leap to 85% if four – five years ago we had about 50% – 51%. So, we have to move through properly set targets. In fact, our target for this year we’re talking about, which is 2009, was 70% and we have actually reached that target of 70%. So, yes, we are not at 85%, but we are well above the 51% cure rate that we had four – five years ago’.

Because of the huge burden of TB, South Africa is a member of the international Stop TB partnership. To be a member of the partnership is not an accolade. The 22 member countries are responsible for about 75% – 80% of the world’s TB burden.

‘We are ranked number three after China and India. And that ranking is based on the actual number of people in a country with TB. Now, if you are talking China and India, you are talking of countries with very huge populations. For China, the population is about 1.3 ‘ 1.4 billion and for India it’s about 1.2 billion and we are only just under 50 million and we are ranking number three behind those two countries. So, it really demonstrates that we have a major, major TB problem’, says Dr Mametja.

He says South Africa has attained this status as a result of its slow response to TB.

‘It’s an indictment of sorts in terms of the slow response that we had in the beginning and taking the eye off the TB ball, so to speak’, he says. ‘But some people think that there might have been legitimate reasons. And I don’t know whether we are trying to find excuses’¦ one of the reasons being that when HIV hit, the focus actually went to HIV – and correctly so. But while we were looking at HIV in terms of raising awareness, in terms of providing resources, we actually ignored TB, and silently, then, the TB problem actually expanded. But, maybe it doesn’t matter that much anymore because we have recognised that TB is a problem and the (Health) Minister is very much open about acknowledging that we’ve got a TB problem on our hands just as we have an HIV problem on our hands’, concludes Dr Mametja.