Tuberculosis in focus
10 Key facts
- Tuberculosis (TB) is a top infectious disease killer worldwide.
- In 2014, 9.6 million people fell ill with TB and 1.5 million died from the disease.
- Over 95% of TB deaths occur in low- and middle-income countries, and it is among the top 5 causes of death for women aged 15 to 44.
- In 2014, an estimated 1 million children became ill with TB and 140 000 children died of TB.
- TB is a leading killer of HIV-positive people: in 2015, 1 in 3HIV deaths was due to TB.
- Globally in 2014, an estimated 480 000 people developed multidrug-resistant TB (MDR-TB).
- TB incidence has fallen by an average of 1.5% per year since 2000 and is now 18% lower than the level of 2000.
- The TB death rate dropped 47% between 1990 and 2015.
- An estimated 43 million lives were saved through TB diagnosis and treatment between 2000 and 2014.[extracted from World Health Organisation ]
Zimbabwe: Tuberculosis, HIV - a Deadly 'Marriage'
"The 100-year old TB is now married to the young HIV
and the honeymoon is causing a lot of death and misery," said Chigodora
while presenting a paper titled "Tuberculosis and HIV -- a deadly
'marriage'."
And despite the fact that TB and HIV and AIDS are now the major killers in Zimbabwe and Africa many people on the continent are unaware of their TB or HIV/AIDS status until they fall sick, further complicating an already deadly situation.
The TB bacterium is spread through droplets in the air when an infected person coughs, sneezes or talks and exposure to someone with untreated TB increases the chances of infection.
# Zimbabwe ranking 20th among countries with TB and HIV and AIDS co infections.
Tim France, a medical doctor attached to the Thailand-based Health and Development organisation says: "The point, however, is not to tally up marks for a macabre competition; it is precisely the opposite: We need to stop thinking of the two diseases in separate bodies…”
"Imagine the two diseases in one body. Jolting enough to be told you have TB, then to be called back to hear your HIV test was also positive.
"The doctor is fully aware that TB progresses faster in HIV-infected people, and that TB in those who have HIV is more likely to be fatal. Their task now is to explain to you that the two diseases often cannot be treated at the same time; the two sets of drugs can interfere with one another," says France in an article titled: "The chasm between HIV and TB".
Despite this glaring reality, the paradox in
perceptions on the two diseases persist and is perplexing.
While HIV and Aids have been highly profiled by everyone including
politicians TB advocacy is entirely in the opposite sphere. It is as if the
disease is of little consequence, largely because it is curable, treatable and
preventable while HIV and Aids is incurable but manageable.But breaking the entrenched attitudes has proved difficult, with the responsibility to re-shape public thinking and shift opinion on the serious problems confronting the global fight against these major killer diseases now lying with the media.
"With the emergence of the multi-drug and extreme-drug resistant strains of TB, both of which are far more challenging to treat than conventional TB -- the mandate for the media to advocate greater awareness of the linkages between TB and HIV is even more pronounced," says SAFAIDS. [ extracted from http://www.safaids.net/content/zimbabwe-tuberculosis-hiv-deadly-marriage ]
Stopping the TB contagion
Festus Mogae & Precious MatsosoSuch was the fear around tuberculosis (TB) in the 17th century that author John Bunyan described the deadly disease as “the captain of all these men of death”. TB killed one in seven, causing many to believe it was inherited, witchcraft, or punishment from God.
It was not until 1882 that Robert Koch, following tests on guinea pigs, announced to the Berlin Physiological Society that he had discovered an infectious disease that he called Mycobacterium tuberculosis.
March 24, the world will marked the anniversary of Koch’s findings in what is now known as World TB Day. Koch’s discovery is acclaimed as the most important step taken toward the eliminating the disease.
Recently to complicate matters is the rise in multidrug-resistant TB (MDR-TB), which is TB that is resistant to rifampicin and isoniazid, two of the most effective drugs that are used to treat ordinary TB. The WHO estimates that there are 480 000 cases of MDR-TB every year worldwide, with only a quarter of these actually detected and reported. MDR-TB is harder to treat and more deadly.
It typically takes two years for a patient to recover from MDR-TB, negatively impacting on the patient’s overall health and exponentially raising the cost of treatment. An estimated 190 000 people die every year from MDR-TB.
In what should sound a global alarm, nearly 10 percent of MDR-TB cases are resistant to not only rifampicin and isoniazid, but also several second line treatment options. This form of drug resistant TB is known as extensively-drug resistant TB (XDR-TB) and represents a dangerous moment for the world as we move towards a contagion scenario where all available drugs are ineffective in tackling the disease.
In Zimbabwe, the scenario is concerning and needs action at the international, national and local levels. Every year, the WHO estimates that there are nearly 40 000 cases of TB in Zimbabwe, 25 000 are co-infection cases with HIV, which more than doubles the chance of death. With drug-resistant TB being reported across the country, there is a lot to be done at all levels to reduce the number of cases and deaths, and prevent a drug-resistant TB contagion.
TB and the threat of a drug-resistant contagion emphasise that we need to find new solutions so that access to life-saving medicines, vaccines and diagnostics are accessible and sustainable.
At the local level it is critical that medical staff are trained appropriately on how best to prevent the spread of TB, as well as how to best treat people with the disease. Also, it is critical that medical staff are trained in the different care and treatment needed by those patients with MDR-TB and XDR-TB.
Civil society has a major role to play both in educating the public on how best to prevent and treat TB, and to maintain pressure on industry and governments to ensure that medicines, vaccines and diagnostics for TB are available and accessible for all in need.
Investing in tuberculosis is value for money. A group of 60 economists identified TB as one of the best buys with a return of $43 for each dollar invested in TB diagnosis and treatment. Further research and development will be needed to expand if the world is to win the battle against TB. Last week, for example, a new study in the Lancet highlighted a low-cost, easy to use, urine test that could diagnose TB among patients with HIV and thereby significantly reduce the TB death rate of HIV-positive patients and save thousands of lives every year.
Illegal cross border migrating worsening drug resistant TB
WHEN tuberculosis patient Loyiso Nare decided to cross the border into Botswana
in search of greener pastures, accessing treatment for his ailment was the
least of his worries. His desperate situation made
him blind to the risk that came with leaving home without guarantee of
accessing the crucial drug supply needed to fight TB.
Many Zimbabweans like Nare who illegally cross over to TB high-burden
countries like Botswana and South Africa find themselves stranded with no
medication.
Most of them cannot access healthcare as they have no proper documents. They
are forced to suffer in silence than seek medical attention and risk
deportation or arrest.
Such incidents have fuelled not only the prevalence of TB but that of drug
resistant TB in Zimbabwe, a strand more expensive to cure and more detrimental
to health.
TB has become one of Zimbabwe’s top killer diseases.
“Drug-resistant TB can occur when the
drugs used to treat the disease are misused or mismanaged.
Examples of how this can happen are when people do not complete the full
course of treatment; when health care providers prescribe the wrong treatment,
the wrong dose, or wrong length of time for taking the drugs; when the supply
of drugs is not always available; or when the drugs are of poor quality.
“There is a high prevalence rate of HIV and a significant number of patients
being diagnosed with TB are coming from high risk countries like South Africa
where TB is the top killer.
The Ministry has developed strategies like one stop shops for the management
of TB/HIV and ensuring that all HIV positive patients are being screened for TB
and vice-versa,” says Muleya.
He says the ministry is also rolling out the Isoniacid Preventive Therapy
(IPT) that prevents HIV patients develop TB as well as the cross border
collaboration.
“As Botswana and South Africa are considered high risk countries, it is
natural and of great priority to ensure that health professionals near the borders
are given priority in terms of diagnostics so that they have the capacity to
identify TB cases coming into the country.
Quite a significant population of Zimbabweans stay in South Africa and
Botswana thus the need for integrated interventions,” he said.
Muleya says Zimbabwe recorded 1,968 TB cases which slightly dropped to 1,843
cases in 2015.
A survey in Plumtree town shows that most TB patients who travel to Botswana
rarely adhere to medication and end up being resistant to drugs.
This, says Muleya, presents a risk to the remaining citizens who from to
time interact with their visiting spouses and relatives.
“I am a health professional who attends to about 15 or more deportees on a
daily basis coming from Botswana.
What we have noted is that most TB patients abandon seeking medication as
they fear identifying themselves and being deported for lack of travel
documents.
All we need is to increase awareness campaigns or maybe craft a SADC policy
on TB which will enable anyone from within the region to freely access TB
medication from wherever they are regardless of travel documents or origin,”
says one practitioner who preferred anonymity.
According to CDCD, the most important way to prevent the spread of
drug-resistant TB is to take all TB drugs as exactly prescribed by the health
care provider.
“No doses should be missed and treatment should not be stopped early.
People receiving treatment for TB disease should tell their health care
provider if they are having trouble taking the drugs,” says CDCD.
The statement also says health care providers can help prevent
drug-resistant TB by quickly diagnosing cases, following recommended treatment
guidelines, monitoring patients’ response to treatment, and making sure therapy
is completed.
The International Organisation for Migration, Zimbabwe says poverty and a
poor understanding of TB disease can cause migrants to put off care seeking
altogether.
“When cross-border Zimbabwean migrants live in neighboring countries such as
Botswana and South Africa, they are particularly hard to reach.
This is because of the many challenges they encounter as they try to access
health services.
For instance, irregular migrants often avoid using public health facilities
in host countries out of fear of being intercepted and deported; long
distances between the health facilities and the main road network affects
attendance; negative attitudes of health workers can impact turnout; lack of
time, the cost of travel and health services, and opportunity cost also have a
negative impact,” reads the statement.
What causes Tuberculosis?
Tuberculosis (TB) is caused by bacteria that most often affect the lungs and is curable and preventable.How it spreads
-spread from person to person through the air.-people with lung TB cough, sneeze or spit, they propel the TB germs into the air.
-A person inhale only a few of these germs to become infected.
People infected with TB bacteria have a 10% lifetime risk of falling ill with TB. However, persons with compromised immune systems, such as people living with HIV, malnutrition or diabetes, or people who use tobacco, have a much higher risk of falling ill.
# When a person develops active TB disease, the symptoms (cough, fever, night sweats, weight loss etc.) may be mild for many months which delays seeking care, and results in transmission of the bacteria to others.
Without proper treatment, 45% of HIV-negative people with TB on average and nearly all HIV-positive people with TB will die.
Who is most at risk?
Tuberculosis mostly affects adults in their most productive years but all age groups are at risk. Over 95% of cases and deaths are in developing countries.The risk of active TB is also greater in persons suffering from other conditions that impair the immune system for example people infected with HIV are 20 to 30 times more likely to develop active TB
Tobacco use greatly increases the risk of TB disease and death. More than 20% of TB cases worldwide are attributable to smoking.
Global impact of TB
TB occurs in every part of the world. In 2014, the largest number of new TB cases occurred in the South-East Asia and Western Pacific Regions, accounting for 58% of new cases globally. However, Africa carried the most severe burden, with 281 cases per 100 000 population in 2014 (compared with a global average of 133).In 2014, about 80% of reported TB cases occurred in 22 countries. The 6 countries that stand out as having the largest number of incident cases in 2014 were India, Indo¬nesia, Nigeria, Pakistan, People’s Republic of China and South Africa.
Common Symptoms and diagnosis
Common symptoms of active lung TB are cough with sputum and blood at times, chest pains, weakness, weight loss, fever and night sweats.#Tuberculosis is particularly difficult to diagnose in children.
Treatment
Active, drug-susceptible TB disease is treated with a standard 6 month course of 4 antimicrobial drugs that are provided with information, supervision and support to the patient by a health worker or trained volunteer. Without such support, treatment adherence can be difficult and the disease can spread.Between 2000 and 2014, an estimated 43 million lives were saved through TB diagnosis and treatment.
TB and HIV
At least one-third of people living with HIV worldwide in 2014 were infected with TB bacteria.HIV and TB form a lethal combination, each speeding the other's progress. In 2014 about 0.4 million people died of HIV-associated TB. Approximately one third of deaths among HIV-positive people were due to TB in 2014. In 2014 there were an estimated 1.2 million new cases of TB amongst people who were HIV-positive, 74% of whom were living in Africa.
Multidrug-resistant TB
Multidrug-resistant tuberculosis (MDR-TB) is a form of TB caused by bacteria that do not respond to, at least, isoniazid and rifampicin, the 2 most powerful, first-line (or standard) anti-TB drugs.
A primary cause of MDR-TB is inappropriate treatment. Inappropriate or incorrect use of anti-TB drugs, or use of poor quality medicines, can cause drug resistance.
Disease caused by resistant bacteria fails to respond to conventional, first-line treatment. MDR-TB is treatable and curable by using second-line drugs. However second-line treatment options are limited and recommended medicines may not be always available.
In some cases, more severe drug resistance can develop. Extensively drug-resistant TB, XDR-TB, is a form of multi-drug resistant tuberculosis that responds to even fewer available medicines, including the most effective second-line anti-TB drugs.
About 480 000 people developed MDR-TB in the world in 2014. More than half of these cases were in India, the People’s Republic of China and the Russian Federation. It is estimated that about 9.7% of MDR-TB cases had XDR-TB.
human nature of TB Care
The “human nature” of TB — a debilitating disease that can take months or years to cure, and where the effectiveness of treatment hinges on an individual’s needs, responses and circumstances — demands treatments that take into account more than the purely medical, Williams says. Treatment requires a holistic approach factoring in people’s social, economic and environmental situations and psychological needs. Nurses are often best-placed to address these and to provide the patient support and education so vital to controlling TB.
Yet nurses rarely get rigorous TB training — rarer still training that focuses on the breadth of approaches needed to tackle the disease. Williams and her colleagues at the International Council of Nurses TB Project have therefore created training courses designed and run by nurses, for nurses. These have led to improvements in infection control, made diagnostic processes more robust, and have strengthened relationships between both labs and clinics, and nurses and patients.
Nurses have also been trained to research what techniques work where and how to improve systems, Williams says. This both helps strengthen TB response, and means that nurses can take the lead in shaping interventions to improve the lives and treatment outcomes of millions of people.
publications hard and copy and online
Global tuberculosis report 2015
provides a comprehensive and up-to-date assessment of the TB epidemic and progress in implementing and financing TB prevention, care, control and research at global, regional and country levels. In this 2015 edition, particular attention is given to assessment of whether 2015 global TB targets set in the context of the Millennium Development Goals were achieved worldwide and at regional and country levels.
provides a comprehensive and up-to-date assessment of the TB epidemic and progress in implementing and financing TB prevention, care, control and research at global, regional and country levels. In this 2015 edition, particular attention is given to assessment of whether 2015 global TB targets set in the context of the Millennium Development Goals were achieved worldwide and at regional and country levels.
- WHO guidelines on tuberculosis
- Strategy
- Detection and diagnosis
- Treatment and care
- Preventive care
- Drug resistance
- TB and HIV
TB in children
- Digital health
- Technical support to countries
- Community engagement
- Engaging all care providers
- Monitoring and evaluation
Archived publications
More publications on TB
- WHO regional publications on TB
- WHO Global TB Programme e-newsletter
- Fact sheets on tuberculosis
- World Health Assembly TB resolutions
- Journal articles on TB by WHO auth
[extracted from http://www.who.int/campaigns/tb-day/2016/en/
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