So the good news is that the cholera epidemic in Zimbabwe is finally getting under control. Weekly case fatality rates have dropped from over 5% to now about 1%. The bad news is that tuberculosis may soon take its place as a leading cause of death in Zimbabwe. According to the WHO, Zimbabwe has the the fourth highest incidence of TB in the world.
When the government finally admitted four months following the cholera outbreak last year that it did indeed face a spiraling epidemic, the ZANU-PF regime funneled the meager resources it did have toward combating the disease. One of the problems with this vertical health approach, however, is that it redirected resources away from other pressing health issues.
When PHR investigators spoke with physicians at Beatrice Infectious Diseases Hospital in Harare, they reported to us that they could no longer treat their TB patients because government authorities mandated they only treat people infected with cholera.
The current health crisis in Zimbabwe poses other major problems including a dysfunctional national laboratory, a lack of diagnostic capacity and a severe shortage of first-, second- or third-line drugs to treat TB. Do you hear the din of alarm bells? They're sounding the spread of multiple-drug-resistant TB (MDR-TB) and the most severe form, extensively drug-resistant TB (XDR-TB). These highly lethal forms of TB develop and spread rapidly because treatment interruptions allow the bacillus to evolve and evade the antibiotics by various cellular mechanisms.
Drug-resistant variants of TB are arguably more of a threat to southern Africa than the spread of cholera, which is an acute illness that remains both treatable and curable with basic medical services. Drug-resistant TB will pervade in the regions for years and will greatly increase the cost and complexity of treatment and care.
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