GULU, 5 January 2009 (IRIN) - Christopher Odong coughs incessantly in his bed in the tuberculosis ward of a hospital in the northern Ugandan district of Gulu. Diagnosed with TB six months ago, Odong did not complete his initial course of treatment and has developed a resistant form of the disease.

"I stopped taking my drugs three months ago when I got better, but after some time I started coughing blood and was re-admitted at the hospital," he told IRIN/PlusNews. "The drugs I am taking are very strong and I cannot walk when I swallow them; doctors said I will stay admitted [in hospital] for some time until I get better."

Another patient at the hospital, Santa Akello, who lives in a displaced persons camp in the neighbouring district of Amuru, told IRIN/PlusNews that she stopped her treatment because she did not have enough food. "When I take the drugs, I feel very weak and hungry but I don't have enough food," she said.

Health workers in northern Uganda - where a two-decade long war between the government and the rebel Lord's Resistance Army has left residents with poorly developed health infrastructure - say cases of multi-drug resistant TB (MDR-TB) are on the rise in the region due to poor drug adherence and drug shortages.

MDR-TB is a form of the disease that does not respond to standard treatment, usually because of a failure to complete first-line treatment.

A two-year lull in hostilities has led the government to encourage more than two million internally displaced people to leave their camps and return to their places of origin, many of which are long distances from health facilities.

"We are experiencing a problem in managing TB treatment because some of these IDPs do not understand the dangers of skipping treatment," a senior nursing officer at Gulu hospital who preferred anonymity, said. "Some patients miss treatment because the hospital at times runs out of TB drugs."

John Opwonya, Gulu district's senior clinical officer and TB and leprosy supervisor told IRIN/PlusNews that for the past several months, the district had received no TB drugs for children under the age of 14 years.

Opwonya said the district planned to extend TB services to all county-level and district-level health centres in the region in an effort to reach returning IDPs; currently, TB services in Gulu district are only available at two hospitals in Gulu town.

"We have embarked on community-based directly observed treatment short course, where every TB patient should have a volunteer or relative to directly observe and monitor them," he added. "It is a district policy to help patients complete their treatment."

According to local health NGOs, displaced people are among the most vulnerable to TB infection due to overcrowding in camps, unsanitary living conditions and poor access to health facilities.

Statistics obtained from Gulu district's TB control office revealed that up to 1,379 TB patients were registered and put under treatment in 2008. According to Opwonya, an estimated 60 percent of the district's TB patients are co-infected with HIV.

The government has recently embarked on an exercise to survey the extent of drug resistant strains of TB across the country. According to WHO, in 2004 and 2005, Uganda had the highest treatment default rate of any high-burden country, despite the use of community-based TB care.

Uganda ranks 15 on the United Nations World Health Organisation's list of 22 countries with the highest global TB burden.

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