Maputo, Mozambique ? Mozambican health officials know they are being overwhelmed by tuberculosis – and fear the crisis may be even worse than thought.

But Thursday’s declaration by African health ministers of a tuberculosis emergency on the continent “will certainly help tackle the problem,” Candido Mindu, head TB doctor at Maputo’s busy Machava hospital said Friday.

The ministers attending a World Health Organization regional meeting in Mozambique’s capital also appealed to donor governments to devote more resources to what is regarded as one of the world’s most forgotten diseases.

WHO’s Stop-TB department has asked for $2.2 billion in new funding for TB control in Africa during 2006-2007, saying that tuberculosis expenditure is dwarfed by spending on AIDS.

TB is killing more than half a million people a year on the world’s poorest continent. In Mozambique, 30,000 cases were diagnosed in 2004, but this is likely to be an underestimation because many people in rural areas are unable to seek treatment, said Mozambique’s Deputy National Director of Health Martinho Djedje.

“It’s really a worry for our country,” said Djedje. “We need to check what is happening in the rural areas, but due to problems like poor roads we can’t.”

TB is spread by airborne bacteria that settle in the lungs and cause long-term infection. Many people who are infected do not become ill themselves but can spread the disease.

Cases quadruple since 1990

AIDS orphans line up Friday for food at a kindergarten in Manzini, Swaziland, where they are fed once a day. The annual number of tuberculosis (TB) cases in Africa has quadrupled since 1990, fueled by a lethal mix of poverty, HIV/AIDS, and understaffed health systems. At a World Health Organization meeting in neighboring Mozambique, African health ministers declared TB an African emergency.

The annual number of new TB cases in 18 worst hit countries in Africa has quadrupled since 1990 and continues to rise, fueled by a lethal mix of poverty, HIV/AIDS, which weakens the immune system, and understaffed, crumbling health systems.

“We have frequently gone into denial when faced with unpleasant, unpalatable facts and now we are hearing from governments in Africa that they are not going into denial but that they are facing up to a horrendous situation forthwith,” said Nobel Peace Prize laureate Desmond Tutu, who spent 20 months in hospital as a teenager with TB.

“We call on the international community, which was so tremendous in its fight against another epidemic, apartheid, to show the same commitment to deal with TB and HIV/AIDS,” Tutu said Friday in a telephone conference call from his home in Cape Town, South Africa.

No new reliable test for the disease has been developed in a century and there has been no new treatment for decades.

“Africa is the one region where TB is totally out of control,” said Karin Weyer, a TB expert with South Africa’s Medical Research Council, which forecasts that South Africa will have 300,000 cases and 30,000 deaths from TB this year – a fatality rate of 10 percent compared to a fatality rate of 3 percent to 5 percent before the arrival of HIV, the virus that causes AIDS.

The Maputo declaration “is a good first step but good declarations need to be followed by action,” Weyer said Friday.

Tuberculosis is the most common infection among – and leading killer of – people living with HIV/AIDS. Of the estimated 25 million Africans now living with HIV, about 8 million also harbor the bacillus that causes TB. Each year, 5 percent to 10 percent of these 8 million develop active TB, according to WHO figures.

In the late 1970s and early 1980s, Mozambique, Tanzania, and Malawi were among the first to apply what became the global TB control strategy, a program under which trained workers monitor patients to ensure drugs are taken properly.

The cost of the six-month course of drugs is just $15. And yet, in the past 15 years, TB incidence rates have soared in the region – by fourfold in Malawi and fivefold in Kenya.

“Despite commendable efforts by countries and partners to control tuberculosis, impact on incidence has not been significant and the epidemic has now reached unprecedented proportions,” said WHO Africa director Dr. Luis Gomes Sambo. “Urgent and extraordinary actions must be taken.”