Concerns about other diseases falling through the cracks

WHILE South Africa grapples with high Covid-19 infections in the midst of the third wave, recording over 83 000 deaths to date, deaths related to HIV/Aids, diabetes, and tuberculosis, still remain high.

Last year, Gauteng, Free State, Eastern Cape, Western Cape, and Limpopo, altogether, recorded 8 495 tuberculosis (TB)-related deaths and 12 468 HIV/ Aids-related deaths in four of the five provinces, except the Eastern Cape, where precise records of deaths were not available.

The Western was the only province that could submit diabetes-related deaths of 3 699 for the year 2018, citing lack of recent stats due to Covid19. Provincial authorities said most TB and HIV/Aids deaths occurred while patients were on the appropriate treatment. But, with Covid-19 dominating the national discourse, many health activists believe that HIV/Aids, TB, and diabetes have been put on the back-burner, regardless of the fact that they are among the leading causes of deaths in the country.

With diabetes, National Manager for Diabetes SA, Margot McCumisky, said, the disease has been neglected for over 30 years, with the organisation now pushing for more attention and education, to no avail.

“It’s been mostly lip service. Since HIV/Aids reared its ugly head and of course attention was given to that, rightfully so, it wasn’t right that everything else was neglected. We’ve been warning the Department of Health for so long that this neglect was going to cause problems later, putting pressure on the economy, as well as the burden on the health system, among other things,” said McCumisky.

The neglect that most departments do not concede to has caused a severe disruption within society, according to McCumisky, making diabetes the leading cause of death among women in the country and the second leading cause of death overall.

“We are 0.1% behind TB. HIV/Aids has dropped to about the seventh leading cause of death, so when will the same attention be given to diabetes, to make such significant strides.

“With 5 million or more people living with diabetes, we still don’t have accurate statistics on it, since it’s not a recordable disease. It’s very difficult to fight something when you don’t even know what it is, and the fact that people are dying from complications caused by diabetes, we are walking blind,” she said.

Founder of HIV/Aids non-governmental organisation Stru Movement, Lebo Rapetswa, said with 7.7 million people recorded to be living with HIV last year, education on the virus needed to be readjusted and tailor-made to go hand-in-hand with the Covid-19 response and the effects that exist due to it.

“By now, almost everyone knows what HIV/Aids is but we need to review what education means in the Covid-19 era. We have medication defaulters now because of the fear of catching (the) corona(virus) and dying. So the question is, what are we educating on, because in the context of Covid-19, we are failing,” she said.

“Our entire Covid-19 response already compromised those who are immune-compromised. Because, to educate, means to give access, not only to information, but to the supply of food and medication. With social distancing in place, and the required isolation, if a patient is required to show up at the clinic, are there any allocations done to ensure their safety? And that is where we are failing.”

Rapetswa believes that although the country is winning the HIV/Aids fight from the awareness of infection point of view, we are losing it on the familiarity front.

“Because it is treatable, we tend to relax more and put our guard down or ignore all precautions from getting infected. But what we don’t understand, is that, all these infections will weigh heavily on our health system and negatively impact our economy. So, even during Covid-19, we should not relax and instead realign our messaging to suit the pandemic,” she said.

Gauteng Health Department spokesperson Kwara Kekana, said, the department has not neglected education on HIV/Aids and TB, hence, it was continuing with integrated Covid-19 screening, door-to-door campaigns, health talks integrated with Covid-19. This specific sentiment was echoed by other provinces.

“The department, in partnership with the Office of the Premier, has developed the TB hotline, whereby, communities are encouraged to seek information in relation to the disease. TB and HIV patients were decongested to external pick-up points and we utilised ward-based outreach teams (WBOT) to deliver chronic medication,” she said.

Kekana added that deaths in TB and HIV/Aids programmes have not significantly increased due to the Covid-19 pandemic, and the deaths that occurred due to TB and HIV/Aids, were not due to neglect.

Limpopo Health Department spokesperson Neil Shikwambana, said: “The Aids-related death-rate decreased by 0.6% from 2.1% to 1.5% during the Covid-19 pandemic. The contributory factor to this decline, is that, patients on ART, were given multi-month prescriptions to avoid frequent visits to health institutions, thus reducing exposure to Covid-19.”

“The TB death-related rate in the province has increased by 1.5% from 11.1% to 12.6% during the pandemic. The contributory factors to this increase may be that Covid19 also affects the lungs, which may overwhelm the already compromised pulmonary system.”

A similar decline was recorded in the North West that saw a 52% decline in HIV/Aids deaths between 2019 and 2020.

“The decline in deaths may be attributed to the implementation of the Phuthuma project meetings where TB deaths remain a standing agenda item and the analysis thereof,” said Tebogo Lekgethwane, spokesperson for the North West Department of Health.

Lekgethwane said, “Implementing the tracking of early and missed appointment strategy and recalling the patients continues to bear fruit. Also, the implementation of the test-andtreat policy contributes to the decline of HIV/Aids-related deaths.”

In the Eastern Cape, it was noted that Covid-19 impacted negatively on TB programme management, much as the impact cannot of the death-rate is not clear.

“The outcomes of the TB patients who started treatment last year, will reflect in the system after 12 months. The only data that the system shows is the outcomes of the TB patients who started treatment in January 2019 to March, as reflected under 2020. Currently, the death rate related to diabetes is not reported on the District Health Information System, but we are ensuring that all the patients on treatment, adhere to treatment and remain stable,” said Dr Rolene Wagner, the Eastern Cape's head of department.