tuberculosis

 {Photo credit: MSH staff.}Dr. Jamie Tonsing, TB CARE I Project Director, preparing to release of balloons with the TB health education messages during 2013 WTD celebrations in Phnom Penh, Cambodia.Photo credit: MSH staff.

MSH staff are commemorating World TB Day through awareness-raising activities around the globe, including in Afghanistan, Cambodia, Ethiopia, Ghana, Indonesia, and Nigeria. Here are photos (some from 2013) with activities this year.

Afghanistan - TB CARE I

During this year’s World Tuberculosis Day (WTD) celebration in Afghanistan, MSH’s TB CARE I project team will reach more than 21,000 individuals with tuberculosis (TB) advocacy and awareness activities. The project staff plans to distribute over 8,530 banners, notebooks, and posters on TB control to politicians, health workers, and community members. Additionally, the TB CARE I Afghanistan team will travel to the 13 project-supported provinces to help field-based staff plan and facilitate WTD celebrations at health centers in their communities. The project staff will also support staff from the National TB Program (NTP) and other stakeholders in planning and participating in WTD celebrations at 26 schools and 600 and communities.

Mildred Fernando shares her story of surviving XDR-TB at a symposium in Japan.

I never thought that being sick with tuberculosis (TB) for a decade would lead me to this purpose: being an advocate to fight and eliminate this disease--not just in my country, the Philippines, but all over the world.

I was recently invited by RESULTS Japan to represent TB patients' perspectives in the call for continuous funding from the Japanese government to the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund). The advocacy activities, led by Results Japan, were in support to the Global Fund Fourth Replenishment which aims to secure financing for the years 2014-2016.

 {Photo provided by Ayyaz Kiani of DEV-NET.}(Left to right): Dr. Khalid Saeed, President of the Pakistan Pharmacists Association; Dr. Sania Nishtar, Founder and President of Heartfile; Dr. Ejaz Qadeer, NTP Manager; Dr. Azhar Hussain, Director of Pharmacy, Hamdad University, Islamabad; and Dr. Gul Majeed Khan, Chairman of the Department of Pharmacy, University Quaide Azam, Islamabad.Photo provided by Ayyaz Kiani of DEV-NET.

A version of this post originally appeared on the SIAPS program blog.

"Health care is not about what doctors and nurses do in hospitals," said Dr. Sania Nishtar. "There are a range of different stakeholders that need to play their parts."

" href="https://twitter.com/SaniaNishtar">Dr. Nishtar, keynote speaker at the "Engaging Pharmacists in TB Care and Control in Pakistan" stakeholders' meeting last week in Islamabad, Pakistan, highlighted the importance of involving all care providers in tuberculosis (TB) diagnosis and treatment. The meeting of key stakeholders included representatives from the Ministry of Health, universities, and pharmaceutical manufacturers, among others.

{Photo credit: KNCV/TB CARE I}Photo credit: KNCV/TB CARE I

TB CARE I Indonesia, The Global Fund to Fight AIDS, Tuberculosis and Malaria, and Indonesia’s National TB Program (NTP) organized a mass-mobilization World TB Day event on March 24, 2013, called "Run 4 TB".

This 5K race drew thousands of runners, bikers, walkers, and observers.

(Photo credits: KNCV/TB CARE I)

Makasi after two months of tuberculosis treatment. {Photo credit: A. Massimba/MSH.}Photo credit: A. Massimba/MSH.

With less than 1000 days until the Millennium Development Goals expire, the process for setting post-2015 goals continues to ramp up.  We take this opportunity to reflect on the current state of community health systems in low- and middle-income countries and consider how the post-2015 agenda could reshape them—perhaps dramatically.

Community health systems today

Integration moves ahead

Poor and rural communities in low- and middle-income countries are leaving behind the “one clinic, one service” approach. So-called vertical programs, which organized resources according to single health conditions, created a patchwork of health services at the community level. You could get HIV care from one provider, but would have to go down the hall, down the street, or often much farther to get maternal health care or malaria care.

Voice of America Interviews Dr. Stephen Macharia: On Tuberculosis in South Sudan (Audio).Voice of America Interviews Dr. Stephen Macharia: On Tuberculosis in South Sudan (Audio).

On the eve of World Tuberculosis Day, Voice of America interviewed Dr. Stephen Macharia, the TB CARE I country director for South Sudan.

During the interview (transcript, PDF), Dr. Macharia discussed the TB epidemic in South Sudan, TB CARE I project achievements, and the way forward for improving funding for TB services and multi-drug resistant TB (MDR-TB) control in fragile states, like South Sudan.

TB CARE I is a USAID-funded project, led by KNCV TB Foundation with partners, including Management Sciences for Health.

Voice of America, the official external broadcast institution of the United States federal government, produces nearly 1,500 hours of news and programs each week for an estimated global audience of 123 million people.

In recent years, commitments from the government and major donors have led to improved tuberculosis (TB) control in Indonesia, with reductions in both prevalence and incidence. The nation’s economic status has also improved; however, this has caused many donors to reduce their contributions to the nation’s health programs.  Compounding this financial challenge is the rising prevalence of drug resistant strains of TB that further tax the health system with the cost of expensive services and medicines needed to care for these patients.

Management Sciences for Health (MSH) under USAID’s TB CARE I project, is assisting the Ministry of Health’s National TB Program (NTP) to develop ways to increase domestic financing for Indonesia’s TB control initiatives. Possible solutions include: increased contributions from national health insurance and government budgets, corporate social responsibility programs, and improvements in cost-effectiveness and efficiency.

 {Photo credit: Stephen Macharia/MSH.}Santo (right) and his father (left) share how Santo was finally diagnosed and treated for TB after being incorrectly treated for malaria for over two months.Photo credit: Stephen Macharia/MSH.

After South Sudan gained independence from Sudan in 2011, disagreements over oil-sharing between the two nations caused fighting and high economic inflation in certain regions. Desperate for security, over 110,000 Sudanese refugees escaped to South Sudan and now reside in camps in Maban County.

Bounj Hospital: Diagnosing and treating residents and refugees

These refugees, and the county’s 40,000 residents, are served by Bounj Hospital, the only TB diagnostic and treatment center in the district. This hospital is currently treating 75 patients for TB, 56 of whom are refugees.

The USAID-funded TB CARE I South Sudan project is helping to build the hospital staff’s capacity in TB treatment and infection control, despite the challenges the health workers face. Led by Management Sciences of Health in partnership with the National TB Program (NTP), the TB CARE I project team has trained over 200 health workers in TB diagnosis and treatment.

TB CARE I also teaches the health workers how to educate their patients about TB infection control and provides the trainees with regular supportive supervision and mentorship.

Mukabaha Ntakwigere (at right) at the General Reference Hospital in Nyangezi, DRC. {Photo credit: MSH staff.}Photo credit: MSH staff.

Tuberculosis (TB) is a leading cause of death in Democratic Republic of the Congo (DRC), partly due to a low case detection rate within the health system, compounded by little knowledge or awareness among patients of the disease’s symptoms. In the province of Sud Kivu, where people have relied on traditional healers for generations, those who were suffering from the persistent, painful coughing that is one symptom of TB were advised by traditional healers that they had been poisoned, and they were not referred to health centers.

In Sud Kivu province, in the health zone of Nyangezi, with a population of roughly 129,000 people, case detection was below 12%, which is the minimum "acceptable" threshold for TB detection.

Medical professionals in Nyangezi realized that they were never going to identify and treat those suffering from TB until they could educate the community about the symptoms and the treatment methods.

Patients wait in a well-ventilated area outside the TB clinic in Homa Bay, Kenya. {Photo credit: A. Kwiecien and A. Salakaia / MSH.}Photo credit: A. Kwiecien and A. Salakaia / MSH.

The state of tuberculosis (TB) is in a tug-of-war as current challenges threaten to undo past successes. One of the primary hurdles currently facing TB prevention and cure is the emergence of strains that are resistant to at least two of the most effective medicines (rifampicin and isoniazid).

So-called drug-resistant (DR)-TB arises when patients are unable to complete a full-course of appropriate, high quality anti-TB medicines. As compared with the 6 month treatment regimen for drug-sensitive (DS)-TB, DR-TB requires 18-24 months of treatment with medicines that are less effective, can cause sometimes severe side effects, and can cost up to 300 times more.

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