tuberculosis

Grace Tsawe owns a prayer camp in Ghana's Lower Manya Krobo District. She recovered from TB, and uses her experience to encourage others to be tested and treated medically for TB. {Photo credit: B. Adusei/MSH.}Photo credit: B. Adusei/MSH.

Tuberculosis (TB) control in Ghana is challenging: detection of TB cases is low, and TB mortality rates high. In many communities, like Lower Manya Krobo District, these challenges are compounded by the popular belief that TB is a spiritual disease. Many Ghanaians who contract TB seek healing in prayer camps and shrines, rather than going to health facilities for testing and treatment. By the time these patients seek medical care, it often is too late to recover and avert death.

Lower Manya Krobo District has over 93,000 residents, and a high incidence of TB (209 cases per 100,000 people in 2011). The district is also home to many of the nation’s mushrooming prayer camps, where local healers provide daily services for ill residents. There are 50 prayer camps in Lower Manya Krobo District---and only 18 health facilities.

Grace Tsawe owns a prayer camp in this district, and she usually sees over 100 patients on her main clinic day.

{Photo credit: Katy Doyle / MSH.}Photo credit: Katy Doyle / MSH.

Stop TB in my lifetime.

This global call to action---the Stop TB Partnership's theme for March 24, World TB Day 2013---is as relevant now as it was over a hundred years ago.

Progress toward reducing the global burden of tuberculosis (TB) has been impressive in recent years: TB mortality has fallen by 41 percent since 1990.

Yet, TB remains one of the world’s leading causes of death, killing more than 1.4 million people per year, including 70,000 children. In 2011, 600,000 people died of TB in Africa alone---including many people with HIV.

Low detection rates, new strains of multidrug resistant TB (MDR-TB), high prevalence of HIV/TB co-infection, and risk of TB among diabetes patients---nearly 10 percent of TB cases are linked to diabetes, add to the challenge of TB control, especially among the poor and most vulnerable.

World TB Day celebration in Ghana (2012). {Photo credit: MSH.}Photo credit: MSH.

Sunday, March 24, 2013, is World TB Day, and MSH staff and partners are promoting global efforts to stop TB throughout the week.

Here are highlights from some of our activities around the world:

The Afghanistan TB CARE I team is working with the national TB program (NTP) to conduct celebration events at 290 health facilities and communities in 13 USAID-supported provinces. TB messages will be aired through local telephone companies to approximately one million people throughout the nation. TB CARE I is also identifying and publicly rewarding high-performing health workers.

The Bangladesh SIAPS TB team will participate in a national rally on March 24 with all TB partners and stakeholders within the NTP network, as well as in a press conference, workshop, and scientific session.

 {Photo Credit: Abel Helebo/MSH.}Silenat with her three-year-old child, her husband Yirga, and Tadele, a TB focal person at the Keraniyo Health Center.Photo Credit: Abel Helebo/MSH.

Silenat Yihune, a 40-year-old woman, mother, and housewife, lives in a remote region of Huletejuenesie District, Ethiopia, which is approximately 20 kilometers from the closest health facility. For nine months Silenat suffered from a cough, chest pain, fever, and weight loss, but was unable to receive treatment. As is common among Ethiopian families, Silenat was economically dependent upon her husband. He refused to pay for her travel to the distant health facility. Several months later, Silenat’s husband, Yirga, started to show similar symptoms and visited the Keraniyo Health Center, where he was diagnosed with tuberculosis (TB).

Keraniyo Health Center is one of the health facilities in Huletejunesie district supported by the PEPFAR-funded, USAID project, Help Ethiopia Address Low TB Performance (HEAL TB), led by Management Sciences for Health (MSH).

Dr. Quick discusses Myanmar’s health system with Dr. Pe Thet Khin, the minister of health. {Photo credit: Myanmar Ministry of Health.}Photo credit: Myanmar Ministry of Health.

In Myanmar, 50 years of military dictatorship left behind a seriously underdeveloped health system, serving barely one in twenty of the country’s 60 million people. You might expect that the first minister of health under civilian rule would be despondent. But on my recent trip I found the opposite: Dr. Pe Thet Khin and his team are aligned around an ambitious vision for building a strong health system for the country.

2012 World AIDS Day event in Port au Prince, Haiti. From left to right: Pamela White, Ambassador of the United States to Haiti; Michel Sidibe, Executive Director of UNAIDS; Sophia Martelly, First Lady of Haiti; Florence Duperval Guillaume, Minister of Public Health and Population; and Guirlaine Raymond, Director General of the Ministry of Public Health and Population. {Photo credit: C.Gilmartin/MSH.}Photo credit: C.Gilmartin/MSH.

In recent years, Haiti has endured some of the greatest misfortunes in its history, including hurricanes, floods, the devastating 2010 earthquake, and the cholera epidemic that followed. These natural disasters and public health crises have added to the harm already caused by the country’s widespread poverty, social and political unrest, and under-resourced health system. Haiti’s fragile population is further plagued by the highest HIV prevalence in the Western Hemisphere at 1.9 percent, which translates to roughly 120,000 HIV-positive individuals and 93,000 children who have lost their parents to AIDS (UNAIDS, 2011).

http://www.youtube.com/watch?feature=player_embedded&v=joX9cq692Wc

Michel Sidibé, Executive Director of UNAIDS, discusses the new UNAIDS World AIDS Day report: Results at a press conference today in Geneva.

 

 

 

Children in Yogyakarta, Indonesia, a community supported by TB CARE I volunteers. {Photo credit: D. Collins/MSH.}Photo credit: D. Collins/MSH.

Each year, as many as 64,000 people die from tuberculosis (TB) in Indonesia. Although the Ministry of Health’s (MOH) National TB Program (NTP) has made great progress over the last few years, the country is still one of twenty-two high TB-burden countries in the world. Indonesia is also one of the twenty-seven countries considered to have a high burden of multi-drug resistant TB (MDR-TB). In 2011, the nation reported 6,100 cases of MDR-TB.

Donor funding has been a major factor in the success of Indonesia’s TB program over the last few years, especially The Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) grants.  Indonesia has, however, progressed economically and is now a relatively low priority for Global Fund grants, which are expected to end or reduce significantly by 2015.

Despite Indonesia’s economic growth, the sustainability of the TB program will be a major challenge without support from this critical donor, especially during the funding transition period.

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

Seven-year-old Makasi, an HIV-positive orphan in Tanzania, was diagnosed with advanced tuberculosis (TB) and started on curative treatment. Clinicians at a local health center used standardized TB guidelines to overcome the difficulty of identifying TB in children co-infected with other diseases. In Afghanistan, sixteen-year-old Hamida provides for her family while trying to complete school. Hamida was visited by a community health worker, who identified her TB symptoms, and helped her access appropriate diagnosis and treatment.

Steady Progress Against Daunting Challenges

Tuberculosis mortality has fallen by a third since 1990. Yet TB is still the second leading cause of death from infectious disease worldwide. The vast majority of new cases (8.8 million in 2010) and deaths (1.1 million in 2010) occur in poorer countries. TB’s effects are often most devastating among people in fragile circumstances. Poverty and conflict push people into crowded, unsanitary conditions without appropriate nutrition and health care.

Even more, TB is fast spreading, easy to misdiagnose, often co-morbid with other diseases, and, increasingly, highly drug-resistant.

Esther manages commodity supplies with meticulous record keeping {Photo credit: Y. Otieno/MSH.}Photo credit: Y. Otieno/MSH.

This is the advice that Esther Wahome, a registered community health nurse in a Kenyan health facility, gives to her clients when they come to the tuberculosis (TB) clinic. Within a short time, Esther dispenses the drugs to the patient, provides health care advice and updates her records.

Esther’s TB clinic clients are usually referred to Kayole II sub-district hospital from Toto Bora and other smaller health care centers. Kayole II, located on the outskirts of Nairobi, provides free health services and receives nearly 300 outpatients each day.

During a routine supervisory visit conducted by the USAID-funded, MSH-led, Health Commodities and Services Management (HCSM) Program, Esther, a mother of two, spoke about her work at the Kayole II TB Clinic, which she has been running for the last three months.

“I like serving in the TB clinic because I get to see patients who are weak regain their strength. Sometimes the patients come in when they are so weak and close to skin and bones that at times I wonder where to inject them. Seeing patients thrive fulfills me and is my joy,” says a smiling Esther.

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