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En Afrique australe, la tuberculose migre avec les mineurs

Patrick Osewe's picture

Il y a quelque temps, je suis parti en mission visiter un nouvel hôpital au Lesotho. Je savais que cet établissement était destiné à accueillir des patients atteints de tuberculose multi-résistante et je sais aussi le lourd tribut que la co-infection VIH-tuberculose fait payer au pays. Je m’attendais donc à ce que les caractéristiques démographiques des patients correspondent à celle du VIH : essentiellement des patients jeunes, et de plus en plus de femmes.

Mais je n’étais pas préparé à voir deux familles entières, jeunes et vieux, hommes, femmes et enfants, confinées ensemble pour un certain temps, sous la surveillance de professionnels de santé veillant à ce que tous prennent bien leurs doses quotidiennes de médicaments.

El desafío de la TB de África meridional emigra con los minero

Patrick Osewe's picture

Hace un tiempo, formé parte de una misión que debía visitar un nuevo hospital en Lesotho. Me advirtieron de antemano que el propósito de estas instalaciones era atender a las personas que sufren de tuberculosis (TB) multirresistente a los medicamentos, y conociendo la inmensa carga de coinfecciones de VIH y TB en el país, esperaba que el perfil demográfico de los pacientes fuera similar al del VIH: en su mayoría jóvenes y cada vez más mujeres.

Para lo que no estaba preparado era para encontrarme con dos familias enteras —jóvenes y viejos, hombres, mujeres y niños— confinados juntos en el futuro inmediato para ser observados por trabajadores de la salud mientras toman sus medicamentos diariamente.

南非的结核病问题随矿工迁移

Patrick Osewe's picture

不久前,我随代表团参观了莱索托的一家新建医院。有人事先提醒说,该医院专门治疗多重抗药性结核病患者,同时我也知道莱索托因艾滋病和结核病合并感染而面临沉重负担,因此我预想结核病患者的构成应该与艾滋病感染者的构成相吻合,即基本为年轻人,而且女性感染者不断增加。

令我毫无准备的是我目睹了两个家庭——无论是老少、男女,还是儿童——整个被集中在一处,由医务人员对其每人服药过程进行监督。今后一段时间内,他们都会呆在这里。

Southern Africa's TB challenge migrates with miners

Patrick Osewe's picture

Also available in: FrançaisEspañol中文

A while ago, I was part of a mission to visit a new hospital in Lesotho. Warned in advance that this facility was intended to treat people with multi-drug resistant tuberculosis (TB)– and knowing the huge burden of HIV-TB co-infection in the country—I was expecting the patients’ demographic to match the profile of HIV: largely young and increasingly female.

What I wasn’t prepared for was the sight of two entire families—young and old, men, women and children—all confined together for the foreseeable future, to be monitored by health workers as they take their daily drugs.

A recipe for good health: safe water and sanitation

Patricio V. Marquez's picture

Also available in: Français中文 Drinking water from a pump in Mali (credit: Curt Carnemark).

On the eve of World Water Day (March 22), there is some good public health news that is unrelated to medical care for the “sick,” but to a critical investment that makes people healthier and more productive, and promises a higher quality of life, particularly among the poor.

The 2012 UNICEF/World Health Organization report, Progress on Drinking Water and Sanitation, says that at the end of 2010, 89% of the world’s population, or 6.1 billion people, had access to improved drinking water. This means that the related Millennium Development Goal (MDG) has been met well ahead of the 2015 deadline. The report also predicts that by 2015, 92% of people will have access to better drinking water.

But, the not-so-good news is that only 63% of the world has improved sanitation access, a figure projected to increase only to 67% by 2015, well below the 75% MDG aim. Currently 2.5 billion people lack improved sanitation.  The report also highlights the fact that the global figures mask big disparities between regions and countries, and within countries (e.g., only 61% of the people in Sub-Saharan Africa have access to safe water).

Filling empty stomachs: when enough food is not enough

Leslie Elder's picture

Children having a bowl of soup (credit: Jamie Martin).

Save the Children’s recent report, A Life Free from Hunger: Tackling Child Malnutrition, reminds us that undernutrition is not a new crisis—and that the crisis will deepen if the global community fails to take serious action. If current trends persist, 11.7 million more children will be stunted in Sub-Saharan Africa by 2025, compared to 2010.

 

What can we do? Food is part of the answer, but it’s about the right food, at the right time—not just starchy staple foods that fill empty stomachs. According to Save the Children, more than half of children in some countries are eating diets of just three items: a staple food, a legume, and a vegetable (usually green leaves).

 

Availability of food and access to food are necessary but insufficient to ensure good nutrition. Insidiously, malnutrition (undernutrition) is not hunger, although malnourished children are often hungry. And undernutrition is frequently invisible, but increases the risk of child death; steals children’s growth; decreases cognitive potential, school performance, and adult productivity; and contributes to the development of non-communicable diseases later in life.

AIDS: translating scientific discoveries into sustainable, affordable programs

David Wilson's picture

Red ribbon for World AIDS Day, Thailand (credit: Trinn Suwannapha).

We’re entering a phase where AIDS is moving from emergency crisis financing to sustainable development financing—which is a major challenge, but one that we’re continuing to tackle, with the goal of stronger national ownership and responsibility.

 

One of the Bank’s international mandates is to support countries to develop better national health plans and budgets. Today, the Bank released an important study, The Fiscal Dimension of HIV/AIDS in Botswana, South Africa, Swaziland, and Uganda, which is a part of this mandate. The study helps countries do the long-range planning that we so desperately need in HIV programs.

 

The Bank has a long-established partnership with ministries of finance and planning, and we understand country systems. We stand ready to help countries integrate HIV into their programs and plan for it in a sustainable way.

 

We’ve seen extraordinary progress in AIDS. Today, we have more antiretroviral drugs to treat HIV than every other virus in history combined. We’ve reduced treatment costs from tens of thousands of dollars to as little as $100. And we’ve expanded our understanding of effective HIV prevention, including the role of male circumcision and the important role that treatment can play in prevention under the right circumstances.

 

Many of us involved in HIV remember the days when 70% of beds in health facilities in Africa were occupied by people with AIDS. Our successes in treatment and prevention have removed this specter and have allowed health systems to focus on other important health priorities.

Les « Maman Lumière » de Djibouti donnent l’exemple pour changer de comportement et améliorer la santé

Marie Chantal Messier's picture

Mothers discuss child rearing in Djibouti (credit: Marie Chantal Messier).

Nous étions assises sur des tapis de sol, dans la chaleur et la poussière du quartier Moustiquaire, le plus pauvre de Djibouti, pour parler des pratiques d’alimentation des enfants. Des voix se sont soudainement élevées dans le groupe. Plusieurs femmes insultaient et montraient du doigt l’une d’entre elles qui baissait honteusement la tête.

Mes homologues djiboutiennes m’ont expliqué que la femme embarrassée était critiquée parce que son fils ne parlait pas encore à 5 ans. Au lieu de donner de l’eau à boire à son nouveau-né comme le veut la tradition, elle avait choisi d’allaiter son dernier enfant au sein exclusivement jusqu’à l’âge de six mois.  Le groupe pensait que ce choix expliquait les problèmes de développement de l’enfant.

Ma première réaction a été de me dire : « la pression du groupe est un véritable obstacle à la promotion des méthodes d’allaitement optimales à Djibouti ! »

Djibouti’s "Shining Mothers": Role models for behavior change, better health

Marie Chantal Messier's picture

Also available in: FrançaisMothers discuss child rearing in Djibouti (credit: Marie Chantal Messier).

We were sitting on floor mats in the hot and dusty Quartier Moustiquaire, the poorest neighborhood of Djibouti City, observing a group of new mothers and their children discussing child feeding practices. All of a sudden, there was an uproar in the group. One woman had her head bent down in shame, and several other women shouted and pointed fingers at her.  

My Djiboutian counterparts told me the embarrassed woman was being criticized because her 5-year-old son still doesn’t speak.  Rather than follow the ancestral tradition of giving water to her newborn, she chose to exclusively breastfeed her last child until he was 6 months old. The group asserted that this choice had led to the child’s developmental problems. 

My immediate reaction to the scene was, “Peer pressure is a true obstacle to promoting optimal breastfeeding in Djibouti!”

Are all medical procedures, drugs good for the patient?

Patricio V. Marquez's picture

Also available in: РусскийPatients waiting at health center in Angola (credit: UN/Evan Schneider).

When healthcare professionals take the Hippocratic Oath, they promise to prescribe patients regimens based on their “ability and judgment” and to “never do harm to anyone”.

Although extraordinary progress in medical knowledge during the last 50 years, coupled with the development of new technologies, drugs and procedures, has improved health conditions and quality of life, it has also created an ever-growing quandary regarding which drugs, medical procedures, tests and treatments work best.

And for policy makers, administrators and health economists, the unrestrained acquisition and use of new medical technologies and procedures (e.g., open heart surgery to replace clogged arteries, ultrasound technology scanners to aid in the detection of heart disease, and life-saving antiretroviral drugs for HIV/AIDS) is increasing health expenditures in an era of fiscal deficits.

In many countries, I’ve see how ensuring value for money in a limited-resources environment is not only difficult but requires careful selection and funding of procedures and drugs. It also comes with serious political, economic and ethical implications—and with new drugs and technologies appearing every day, this challenge isn’t going away. What should countries do?

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