World health officials meeting in Brazil this week say more people are dying from tuberculosis than ever before. Nearly half of the countries most affected are in Africa. In Liberia where treatment for tuberculosis is limited by a shortage of funds.
Of the 22 countries responsible for 80 percent of the world's tuberculosis cases, health officials say nine of them are in Africa.
The disease is particularly hard to fight because of the emergence of multi-drug-resistant and extensively-drug-resistant strains that are more expensive to treat. There is a generally lower level of primary health care and less access to that care in rural areas.
Africa is also home to more than 22 million people who have the virus that leads to AIDS, and the World Health Organization says death rates among TB patients with HIV have doubled since 2007, now accounting for at least one in four TB deaths. Tuberculosis kills nearly 5,000 people a day and is the leading cause of death for people living with HIV/AIDS.
In Liberia, the World Health Organization is helping improve laboratory services and train TB caseworkers. But budget constraints mean treatment is limited to about 5,000 patients a year.
"We are gradually reaching our target because of our own budget constraints," says John Ballah, who manages patient data for the country's National Leprosy and TB Control Program.
The number of tuberculosis cases reported in Liberia is on the rise at a time when health officials say nearly 40 percent of cases worldwide are not properly detected and treated.
Deddeh Bah-Keseley manages Liberia's leprosy and TB program. She says caseworkers follow up with patients to ensure they complete their eight-month course of drugs so as not to have a drug-resistant relapse.
Bah-Keseley says one of the reasons why the disease so often goes undetected is because people fear being stigmatized if they are diagnosed with TB.
"There is stigma in the community when it comes to the TB patient, because nobody wants to be around someone who is sick. When they see them coughing, they become afraid," Bah-Keseley said.
She says the government is trying to combat that stigmatism by encouraging patients to return to their communities once they have completed the initial six-week treatment and can no longer spread tuberculosis to others.
"We encourage our TB patients to live in their environment and live in the communities they come from," Bah-Keseley said.
She says the program's public education campaign encourages local communities to embrace TB patients once they are no longer communicable.
While treatment funds are limited, John Ballah says proper diagnosis is crucial to containing the spread of tuberculosis. He is encouraging anyone who feels they may have the disease to visit a clinic for free testing.
"Everybody in their own little way can advise somebody to take the necessary step towards their own cure. So if you feel sick with cough, it is free. Go to the nearby clinic where the TB people are working and do your test," he said.
In Africa, the World Health Organization says what is known as a Directly Observed Treatment Short-Course or DOTS has helped contain TB in a number of countries. The program includes a political commitment with increased and sustained funding for management and training including on-line courses in epidemiology and drug-resistance surveillance.
It strengthens detection through better laboratories and standardizes treatment with community involvement along with requirements for an effective drug supply and management system and proper monitoring and reporting of tuberculosis through global control reports.
Health officials say there must be a better coordinated approach to a disease that annually kills more than 1.5 million people in order to meet the Millennium Development Goal of reversing the spread of tuberculosis within the next six years.
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