Reasons for the re-mergence of tuberculosis (TB) (2025)

March 24, 2025, was set aside by the World Health Organisation as World Tuberculosis Day to commemorate the day in 1882 when one of the true giants of early medicine, Dr Robert Koch, announced his discovery of the bacterium that causes the disease.

The first World TB Day was observed in 1982, a full century after Koch’s groundbreaking discovery.

Tuberculosis is notable for causing fever, a persistent cough that produces yellowish sputum, increasing sputum production, which may occasionally be bloody, and weight loss.

This date is marked globally to raise awareness about the devastating health, social, and economic consequences of TB and to accelerate efforts to end the global TB epidemic.

The re-emergence of tuberculosis around the world is a complex issue influenced by a variety of remote and immediate factors.

Understanding these requires examining the underlying social, economic, and biological determinants, as well as more recent events and trends.

In an essay titled, ‘An Old Disease Strikes Back’ published on this page in 2013, we argued that various strains of the disease were re-emerging in different ways, not least due to its close association with people living with HIV/AIDS, but also because, at the time, the country appeared likely to witness a rise in TB cases if the required level of disease surveillance were to weaken.

Well, we have seen how remote causes behind this renewed spread, such as weak healthcare systems across many regions of the world, particularly in low- and middle-income countries, have worsened the problem.

In Nigeria’s case, the steady emigration of all categories of healthcare workers, the rising level of insecurity, especially in the north, and failing, dilapidated infrastructure, particularly concerning electricity supply and the lack of motorable roads, have all contributed to a retreat in basic services, even in areas where the country had previously made some progress.

A steady power supply is indispensable for the proper storage of vaccines, for instance. When this singular factor is absent, entire communities may have their children denied the health benefits of immunisation against tuberculosis.

A fortnight ago, we examined some of the reasons why diphtheria was ravaging the country. Now, the conversation has shifted to tuberculosis. Together, these two infections account for one-third of the six most common killer diseases in infants and young children under the age of five.

To be sure, tuberculosis is the most common infectious disease in the world, and also the most deadly. It is estimated that up to one-quarter of the global population has had this infection. Yet it is a preventable disease, treatable with antibiotics.

TB exists everywhere in the world; no country is exempt. However, the majority of infections occur in the poorest and middle-income nations.

It is no coincidence that these are the very countries plagued by inadequate health services, leading to poor TB diagnosis, treatment, and management. These are also the countries least equipped to mount the levels of disease surveillance and reporting mechanisms required to track and control TB outbreaks effectively.

The disease is caused by bacteria that primarily affect the lungs, and like diphtheria, most infections are spread through coughing and sneezing.

However, other parts of the body can also be affected, depending on how the infection is contracted.

For example, the stomach can be involved if people consume fresh milk from goats, sheep, or cows infected with the animal variant of TB.

In individuals with compromised immune systems, such as those living with HIV/AIDS or chronic illnesses like diabetes, liver disease, or kidney disease, or in cases of severe malnutrition, the infection can spread to other parts of the body, including the kidneys, brain, spine, and reproductive system.

Additionally, rapid urbanisation in developing countries has led to overcrowded living conditions, which further facilitates the spread of TB. Many of these countries are located in sub-Saharan Africa, which remains a massive reservoir for both the bacteria and the disease.

Economic and social inequalities have understandably arisen in many of these countries. Such disparities, caused either by design or circumstance, have further deepened the inequalities in social conditions.

Economic globalisation can worsen these gaps in health investment, as governments often divert much-needed resources to other areas of development, resulting in poor TB control in certain regions.

In Nigeria, as in many other similarly positioned countries both geographically and economically, high levels of poverty limit access to healthcare, proper nutrition, and living conditions conducive to good health.

Worse still, these vulnerable populations are the very same people forced to pay for healthcare out of pocket. There is little to no health insurance, and where any exists, as in the chaotic structure we have, many essential medications are often unavailable.

These vulnerable groups are also more susceptible to infections like TB.

Global travel and migration have further facilitated the spread of TB across borders, as impoverished individuals and ambitious others seeking to climb the socioeconomic ladder travel the globe in search of better opportunities, trade links, and education. The emergence of the HIV epidemic also contributed significantly to TB’s resurgence, as individuals with compromised immune systems became more vulnerable to TB infection.

As if these challenges weren’t already enough, the emergence of multidrug-resistant TB (MDR-TB)—resulting from inadequate treatment regimens and poor adherence to TB therapy—has further complicated control efforts.

Then came the COVID-19 pandemic, which severely disrupted health services worldwide, diverting attention and resources from TB programmes and leading to missed diagnoses, treatment delays, and interruptions.

In many of our traditional communities, TB remains heavily stigmatised, often leading to delays in seeking treatment.

Public awareness campaigns are generally inadequate, perpetuating the cycle of transmission and creating diagnostic challenges. This leads to delayed diagnoses, particularly in remote areas and in communities under siege by gunmen.

In these regions, the lack of awareness about TB symptoms and the limited access to diagnostic tools are especially pronounced. Additional contributing factors, such as malnutrition, poor housing, and substance abuse, previously discussed under the concept of “health poverty”,—further increase susceptibility and facilitate transmission within communities.

Global efforts to combat TB have reportedly saved an estimated 79 million lives since the year 2000.

However, drastic and abrupt cuts to global health funding, particularly under United States President Donald Trump, now threaten to reverse these hard-won gains.

Rising drug resistance, especially across Europe, as well as ongoing conflicts across the Middle East, Africa, and Eastern Europe, are further worsening conditions for the most vulnerable.

The U.S. support for global health may constitute a small portion of its domestic budget, but it accounts for a significant share of international health funding.

In 2023, U.S. global health spending represented just about 0.3 per cent of its federal budget, approximately $20.6bn out of a $6.1tn appropriation.

Yet, that same year, the U.S. was responsible for nearly three-quarters of international development assistance for HIV/AIDS, 40 per cent of global malaria aid, and over one-third of TB funding.

Until recently, the U.S. was also the single largest financier of the World Health Organisation, the biggest provider of vaccines to the COVID-19 multilateral vaccine initiative, and the main driver behind the Pandemic Fund, a World Bank vehicle that invests in low-income countries to prevent infectious disease outbreaks.

Unfortunately, America’s retreat from these initiatives is unlikely to be compensated for by countries like China, which, despite its considerable wealth, has often acted with self-interest, aggressively extracting resources from nearly every corner of the globe.

Questions and answers

Good day, Doctor Sylvester. I have been having this recurring headache over the past few days. The headache is mostly on my forehead. I think it may be related to my broken sleep during the night, around 2 am when I wake up to pray, and the need to wake up early to drive my children to school.

I checked my blood pressure this morning, and it was 138/71 with a pulse of 52. This evening (about 2 minutes ago), the reading was 144/77 with a pulse of 62. I don’t usually have any problems with my blood pressure, but we have this machine at home because of my late brother, who was hypertensive. What could the problem be, and what is the solution?

08064863***

Thank you for your important question. If your body or system is accustomed to a particular sleep pattern, disrupting that, such as waking up in the middle of the night for prayers, can lead to consequences for how you feel when you wake up to carry out your daily chores.

If the timing of your night-time prayers is flexible, you might consider adjusting the timing to around 4 am. This way, once you finish your prayers, you can easily transition into your usual activities. This adjustment may be easier on your body. Unfortunately, you didn’t mention your age, which would be useful in further assessing your situation.

Please, I have been feeling light-headed since yesterday. I thought it might be due to the ongoing fasting, but I also had some body aches when I woke up yesterday, though the body pain is no longer there. However, I still feel light-headed. What should I do about this? Thank you.

08027202***

Good afternoon to you as well. It’s not clear what type of fasting you are doing, but generally, fasting can lead to inadequate fluid intake, especially with the heat we are experiencing. If you’re not drinking enough water, it’s quite common to feel light-headed. Since your only symptoms are headaches and light-headedness, it’s crucial to focus on staying hydrated over the next two days and observe how your body responds. Aim to drink a minimum of 3 litres of water a day.

Dear Dr Sylvester, my mother is 90 years old, and she is constantly scratching her body. It disturbs her at night, and she cannot sleep well. Now, for the past 5 days or so, whenever she scratches her skin, it begins to peel. The problem we have is how to get her to the hospital, as she is almost confined to a wheelchair. What can we do about this skin itching?

08033526***

Thank you for your question. At her age, her skin is likely very dry and thin, which could explain the intense itching she is experiencing. Ideally, a doctor should examine her skin, but in the meantime, you can help by applying a good moisturising cream or lotion that has excellent hydrating properties.

Additionally, a low dose of Piriton tablets, taken twice a day, can help relieve her discomfort and help her sleep. If the itching persists after five to seven days of this treatment, you will need to get her to see a doctor or have one come to examine her at home.

Dear doctor, thank you immensely for how kindly you solve people’s problems. God will bless you abundantly. I have been experiencing infections on and off in my private parts for the past seven weeks.

I am a 46-year-old woman, and I am also struggling with menopause, which was so bad that my doctor had to prescribe a pill that has helped somewhat. This infection is terrible; there is a whitish discharge that is very itchy but has no smell.

I did some tests, and my doctor put me on treatment for 10 days with tablets and injections. These treatments were very expensive, and to now find out that the infection is still there is depressing. It stopped for about two weeks and has now returned. This is very tiring. What is the solution, please?

08054192***

Thank you for your kind words and prayers, madam. The symptoms you’ve described are likely related to menopause. The vaginal dryness that often accompanies menopause makes you more susceptible to infections, particularly fungal ones.

The situation you are experiencing sounds like a recurring fungal infection, which is common during this stage. Unfortunately, there is no quick fix without proper laboratory testing to identify the exact organisms causing the infection.

These tests will help determine which antibiotics or antifungal treatments are most effective. Since the infection returned quickly, it is possible that the treatment you received was inadequate or that a different organism is involved that wasn’t addressed in the original treatment.

Dear doctor, thank you for your previous advice on health issues. My problem is that I had unprotected sex with a man I randomly met, and now my period is one week overdue. This has never happened to me before. I am 31 years old and very worried. What should I do now? Please help me.

+23490472761***

Thank you for your kind words. This is a common concern among young women who may feel anxious after such an experience. The first step is to take a rational approach. Since your period is delayed and you had unprotected sex, you should take a laboratory pregnancy test. The next steps will depend on the result. It may simply be a harmless delay or a missed period, but the best way to find out for sure is to conduct a pregnancy test, preferably a blood test.

Good morning, doctor. I wish to thank you for the free healthcare consultations you render every Sunday in the Punch Newspaper. God Almighty will continue to bless and prosper you and your family in Jesus’ Mighty Name.

Here is my issue: It concerns my 3-year-old son, who has been coughing on and off for almost 2 weeks now. He also has a runny nose. He plays well during the day and hardly even coughs. But at night, we hardly sleep because he starts coughing from the moment he lies down till early in the morning. Why is this? What should we do about it?

08023450***

Thank you very much for your prayers and kind words. This kind of situation often results when a child lies down and the secretions from the nostrils then flow backwards into the throat. There, the secretions, called mucus, irritate the tiny hairs in that area and initiate a cough. For as long as the backflow of mucus goes on, so will the child cough. You should get a doctor to examine him and be sure his chest is not involved in this event. After that, successful treatment with relevant medications should be pretty satisfactory.

Good day to you, doctor.

My granddaughter is just over one year and five months old, but she has been coughing persistently without any improvement since the beginning of February. She has been to the hospital several times — about three times — and each time, after examining her, the doctors prescribe the same medications: Primpex, Vitamin C, and Coflin. The cough has not stopped; there is no improvement at all. What can we do about this? I am very worried, please. 08034441***

Good day to you as well. The fact that the cough is not stopping does not necessarily mean there is a serious problem. Many common episodes of respiratory tract infections like this are most likely caused by a virus. So, if she is not running a fever, continues to play, is feeding well, and is not breathing abnormally fast, there may be no cause for alarm.

However, depending on the type of hospital your granddaughter has been attending, she should be scheduled to see a paediatrician.

The paediatrician may have a different perspective from the doctors who have treated her so far and could make some changes to her prescription that may lead to a more effective outcome. Good luck with that.