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Tuberculosis

Laboratory accreditation: Critical to quality care

Miriam Schneidman's picture

The quest for an accurate, timely and affordable medical diagnosis remains elusive in many developing countries.  In East Africa, laboratories are often poorly staffed; ill-equipped; and lack quality systems. Obsolete equipment clogs up limited space. Clinicians often resort to presumptive diagnoses rather than requesting lab confirmations. Individuals suffering from infectious diseases, such as tuberculosis, run the risk of going undetected and transmitting the disease to others, or being misdiagnosed, which in turn leads to compromised care and higher health care costs. 

 

Many laboratories are not adequately prepared to respond during public health emergencies, yet their services are critical to detecting new pathogens and containing disease outbreaks. 

 

World Laboratory Accreditation Day, observed recently, offers a good opportunity to draw attention to the critical role of laboratories in health, and the importance of accreditation in promoting quality.  Accurate and reliable laboratory services are critical for conducting clinical diagnosis, guiding treatment, and responding to disease outbreaks.  There’s a growing recognition of the importance of laboratory services, and several important initiatives have been launched, including the WHO-AFRO Stepwise Laboratory Improvement Process towards Accreditation (SLIPTA).

Circumcision and smoking bans: Can policies nudge people toward healthy behaviors?

Patricio V. Marquez's picture

Walking through river. Mali. Photo: © Curt Carnemark / World Bank

The scaling up of voluntary medical male circumcision, particularly in high HIV prevalence settings, is a highly cost-effective intervention to fight the epidemic—randomized controlled trials have found a 60% protective effect against HIV for men who became circumcised.

But, the supply of this medical service is just one part of the picture. Without active involvement from individuals and communities to deal with social and cultural factors that influence service acceptability, the demand for this common surgical procedure will be low.

Indeed, on a recent visit to Botswana, a country with high HIV prevalence and low levels of male circumcision, my World Bank colleagues and I had a good discussion with the National HIV/AIDS Commission about ways to address the low uptake of voluntary, safe male circumcision services in spite of a well-funded program by the government.  It was obvious to all that if the demand for, and uptake of, this service were not strengthened through creative mechanisms that foster acceptance, ownership, and active participation of individuals and community organizations, the program would not help control the spread of HIV through increased funding of facilities, equipment, and staff alone.

So, what do we need to do to ensure that need, demand, utilization, and supply of services are fully aligned to improve health conditions?

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

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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.

Putting Humpty Dumpty back together again

Cristian Baeza's picture

2012 is off to a sobering start for those of us in the global health community, against a backdrop of continuing global financial volatility coupled with complex reforms at the Global Fund to Fight AIDS, Tuberculosis and Malaria. New research from the Institute for Health Metrics and Evaluation (IMHE) shows a slowdown—and perhaps a plateauing—of the historical growth in global health funding to which we have been accustomed during the past decade. This new reality is, rightly, leading to questions about whether substantial—if not radical—changes are needed in the highly fragmented global health ecosystem. And yet, at the same time, there are signs of new initiatives.

I believe the slowdown in global health funding requires adjusting our expectations in the coming years. Last fall, after participating in a number of inspiring discussions during the UN General Assembly, I reflected about each one of the critical global health priorities to which we have all pledged our support in recent years: the Millennium Development Goals (MDGs) for nutrition, child and maternal health, and HIV/AIDS, TB, and malaria, as well as non-communicable diseases. It struck me that while most of these health interventions are destined to help the same mother or child, we have created very separate initiatives and institutions to deliver on each. We have been able to elevate the awareness and commitments for each of these priorities, but now the challenge is, like Humpty Dumpty, how do we now put them all back together again?

The clock is ticking: attaining the HIV/TB MDG targets in the former Soviet Union countries

Patricio V. Marquez's picture

Some countries of the former Soviet Union, the so-called CIS countries, are facing difficult challenges to achieve the HIV/tuberculosis-related Millennium Development Goal (MDG 6) by 2015. The continuing growth of new HIV cases, insufficient access to prevention services and treatment for people living with HIV, combined with the severity of region’s tuberculosis (TB) epidemic (particularly multi-drug resistant TB) are major challenges.

On October 10-12, 2011, the Russian government, along with UNAIDS, the Global Fund, and the World Bank, is hosting in Moscow a high-level forum to discuss these challenges and ways to reach MDG 6 in the CIS. (Click here for a video, a presentation, and more from the forum.)

Unless concerted action is taken, sustained political commitment mobilized, new public/private and civil society partnerships established, and a sharp improvement in the effectiveness of HIV and TB programs realized, MDG 6 risks not being achieved. So, what to do?

Обратный отсчет: достижение целей развития тысячелетия в области борьбы с ВИЧ и туберкулезом в странах бывшего СССР

Patricio V. Marquez's picture

Некоторые бывшие республики Советского Союза, включая страны СНГ, сталкиваются с серьезными трудностями на пути к цели развития тысячелетия в области борьбы с ВИЧ/туберкулезом (ЦРТ-6), которая должна быть достигнута к 2015 году. Основные проблемы – это продолжающийся рост числа новых случаев инфицирования вирусом ВИЧ, недостаточный доступ к профилактическим услугам и лечению для людей, живущих с ВИЧ, а также острота эпидемии туберкулеза в регионе, особенно туберкулеза с множественной лекарственной устойчивостью.