BURAO, 23 September 2010 (IRIN) - The number of tuberculosis patients in Burao, in Somalia's self-declared independent republic of Somaliland, has increased because of khat use as well as rising displacement due to drought and conflict, say officials.

"Currently, Burao General Hospital has 130 male and 30 female patients admitted to the TB ward," Abdijibar Mohamed Abdi, a director of the TB unit at hospital, told IRIN. "One of the reasons for the high rate of infection among men is the chewing of khat, which is done in poorly ventilated rooms for many hours. Such men are also at greater risk due to hunger and sleeplessness as the chewing takes place mostly at night."

Since 2009, Abdi said, the hospital has handled 1,200 TB patients. The hospital provides medication to 250-300 TB patients quarterly under the World Health Organization (WHO) DOTS system - directly observed treatment short course - whereby health workers ensure the patient takes the dose, he added.

Another contributor to the increase, Abdi said, was lack of access to health facilities by nomadic communities.

"Such people do not settle anywhere and may not have enough TB education. As it is difficult to reach them since many often graze their herds far from health facilities, some of them end up spreading TB," he said.

Moreover, he said, many people displaced due to either drought or conflict do not seek treatment. "When people are in such emergency conditions, personal health is not a priority."

Abdi said the hospital recently built two extra TB wards to cope with the rise in patient numbers.

Public health concerns

Hussein Mohumed Hog, a doctor in the Somaliland Ministry of Health, said TB was a "huge" public health problem in the Togdheer region, where Burao is located, and that the management of the disease had been complicated by non-payment of health workers in the past four months.

"Togdheer region [in the east] has one of the highest rates of TB yet the health workers have not received salaries in the transition period since presidential elections in June; this is one of the staff complaints we have received," Hog said. "The ministry is currently processing these payments and is planning to reopen most of the MCH [mother-child health centres] in urban areas in eastern Somaliland to follow up TB cases."

Hog said Togdheer, Mudug and Bay were some of Somaliland's regions with high TB infection rates, according to former Somalia health ministry reports.

Burao General Hospital was constructed in 1945 when the region was a British colony.

Abdi said the local authority in Burao had since renovated the facility, which also receives funding from the Global Fund to Fight AIDS, Tuberculosis and Malaria. This, he said, had given the urban population easy access to a health facility offering TB services.

"There is no shortage of drugs, which we get from the Global Fund through World Vision International and WHO," Abdi said. "The local business community also supports some facilities in the hospital."