Experts worry rising air pollution is driving a spike in TB infections and deaths

When Mary Akorley Kotey started coughing incessantly, it didn’t occur to her that it could be tuberculosis. The 60-year-old trader at the Kaneshie market in Accra had already beaten the scourge, known more commonly as TB, 30 years before.

Last year, after months of sleepless nights with excruciating chest pain that ravaged her body, she finally went to the Kaneshie polyclinic in Accra, where she heard the dreaded diagnosis for the second time.

A hawker serving a client

“I was coughing out phlegm that had blood in it, always feeling sick and extremely tired,” Kotey says. “I became very scared when I started losing weight drastically because that was exactly how my battle with this same deadly disease started in 1993.”

Today, Kotey displays her merchandise very close to the lorry station, a few metres away from the junction of Kaneshie-Mallam streets. It’s a busy area with commercial and private vehicles moving constantly, releasing high levels of toxic pollutants. Health experts say it’s also likely the cause of her reinfection or relapse.

Mary Akorley narrating her story

Accra’s dirty vehicles are the biggest cause of poor health from air pollution. Toxic gases inhaled through the respiratory tract can cause inflammation, and suppressed immune systems, causing or exacerbating conditions such as TB.

“If a person’s immune system is already compromised by factors that could be linked to exposure to air pollution, the individual becomes more susceptible to diseases like TB,” says Dr Daniel Damfo, a specialist at the Kaneshie Polyclinic Chest Unit. “So, I can say air pollution can increase incidences of TB in Ghana if not checked properly.”

TB remains one of the top 10 causes of death worldwide. There were approximately 11 million new cases worldwide in 2022, and 1.3 million people died from the disease according to the World Health Organisation. Approximately 25% of the global population is infected with the bacteria that causes TB. Air pollution can cause the infection to develop into an illness. It is also contagious.

Dr Yaw Adusi-Poku, Manager of the National TB Control Programme of the Ghana Health Service, says he is worried that TB is a growing threat to public health in Ghana. Forty three people a day succumb to TB in Ghana. As air pollution has ticked up so has TB. In 2023, the number of cases jumped 15 per cent from the year before to 19,000.

Dr Adusi-Poku says the surge is worrying and recommends enhanced testing capacity and huge investments to tackle the menace.

A gentleman hawking pastries at the kaneshie traffic light, Accra

“There is the need for massive investment to fight TB in Ghana. We need to invest in equipment, logistics, advocacy, and capacity building for health workers. This is very important because it promotes early detection and effective treatment,” he says.

For more than a year, Akorley battled the disease that ravaged her body, leaving her weak and weary. It was only when she finally started the six-month treatment regime that she started to feel better.

Akorley’s suffering began long before her diagnosis, with months of fatigue and persistent cough that refused to abate. Persisting with a job that exposed her to air pollution would have also made things worse.

Delaying treatment of TB could lead to death, warns Dr Damfo. When the lungs are completely damaged, effective treatment cannot be achieved, leading to death. Treatment costs nothing in Ghana but too many people are not seeking it.

TB has taken a terrible toll on Akorley’s family. She says her son fell severely ill last year. The doctors suspected TB but before the suspicion could be confirmed, “my son passed away leaving behind a void that can never be filled. He was my only child.”

TB is airborne, meaning it can be transmitted between individuals through the air. When a person is infected with TB of the lungs, the disease can spread through the air when the person coughs, sneezes, or speaks. Those in close proximity can inhale the TB bacteria into their lungs. It can also end up in other organs of the body.

“We have treated a person with TB of the cervix in this facility before,” says Dr Damfo. “This disease is dangerous and spreads quickly, so everyone needs to be cautious.”

Dr Damfo’s patients include many hawkers, commercial drivers and market traders. He advises them to take precautionary measures such as wearing a nose mask and avoiding traffic as much as they can.

Many obstacles stop infected people from seeking life-saving treatment. Akosua Saah Nyarko, a hawker at the Kaneshie traffic light area, says she has been feeling unwell for close to a year but continues to rely on over-the-counter medications to tackle her symptoms. She visited the Cocoa Clinic in October last year but has never returned after she was asked to run some laboratory tests which she says she could not afford.

“I experience severe headaches and coughing at night,” Nyarko says. “The days when I spend time navigating through traffic to attract clients I end up feeling dizzy and nauseous.”

James Addy, a public transport driver, says he and his conductor were diagnosed with pulmonary TB six years ago. Addy was treated by a clinic but his conductor refused.

“He feels I infected him with the disease because I told him my doctor asked me to ensure people close to me get tested too,” Addy says. “He got uncomfortable after the results showed he had TB and said he would rather opt for herbal treatment. That was the last time I saw him.”

At the Tema Station, dealers in secondhand clothing also complain about the constant exposure to fumes from vehicles. But they say do not have the option to move to a safer place.

“Most of us here know very well that we are sick but we hardly visit the hospital,” says Bernice Anderson. “As for TB, we know people here who have contracted it many times, some have died, and others survived.”

This story was in collaboration with New Narratives. Funding was provided by the Clean Air Fund. The funder had no say in the content of the story.

BY RAISSA SAMBOU