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Unite to End TB

Miriam Schneidman's picture
image courtesy: TB Alliance

On March 24th the global community marks World TB day to commemorate the day in 1882 when Dr. Robert Koch discovered the cause of tuberculosis.  At the time, the tuberculosis (TB) epidemic was raging out of control in Europe and the Americas, and this discovery paved the way for millions to be successfully treated.  Today, TB remains a major public health threat with 4,000 lives lost daily to this highly curable disease.  But this TB day stands out from previous ones. 

The global community has now mobilized to End TB by 2030, bringing an end to this crippling disease that hits predominantly working age adults. But children have not been spared.  The Louder than TB global alliance aims to focus attention on the plight of children, showing how TB continues to steal laughs and rob children of their childhood.

Globally, 9.6 million people fell ill with TB, of which 1 million children, and 1.5 million succumbed to the disease (2014). TB is now the leading cause of death from an infectious disease. The Africa region has roughly 28% of the world’s cases but the most severe burden relative to the population (281 cases for 100,000 people, more than double the global average of 133).

This World TB day I am in Tanzania, one of the high TB burden countries in Africa.  Tanzania has made important strides in TB control but like other countries grappling with the disease increased efforts are needed. Virtually all high TB burden countries in Africa need to improve case detection, strengthen diagnosis and ensure prompt treatment, and follow up defaulters as adherence can be problematic.

When I mention the End TB goal to the head of the TB ward at the Ndanda Hospital, Barbara’s eyes light up and she smiles widely.  I see in her face both a healthy sense of cynicism and a glimmer of hope.  At the faith-based Ndanda Hospital in the Mtwara region of Tanzania, Barbara assists TB patients to complete their six-month drug regimen.  Patients are accompanied by family members who assist in collecting medications, as this requires frequent visits in the first two months and some patients are too frail to travel long distances.

Salma sits quietly in a wheelchair eager to share her story which sounds strikingly familiar.  The 47-year old recounts how she was initially diagnosed with hypertension.  The coughing persisted and within a month she was diagnosed with TB and became physically inactive and economically unproductive.  More bad news followed when she tested HIV positive. Rates of TB/HIV co-infection in Tanzania are over 40% and require facilities to provide holistic care so that patients can receive treatment at the same location.  Salma is among the fortunate patients in Africa, as the Ndanda Hospital receives free anti-TB drugs from government and was able to place her on treatment promptly following diagnosis.  As soon as she completes TB treatment, Salma will receive antiretroviral drugs which are readily available at the hospital.  She is also fortunate to have a supportive family by her side.  “Stigma is no longer a problem,” Salma says proudly, underscoring progress in some settings to tackle the social aspects of the disease.

“Access to quality diagnostic services is pivotal to TB control efforts in Tanzania,” notes Dr. Fausta Moshe, Director of the National Quality Assurance Laboratory and Training Center.  Under the Bank-funded East Africa Public Health Laboratory Networking Project (EAPHLNP) the Ndanda Hospital is among the facilities that benefitted from the roll out of the GeneXpert machine, which is able to accurately diagnose drug resistant TB in hours rather than waiting months for culture results, saving time and money.  The new technology has allowed the laboratory to conduct over 900 tests over the past 18 months with a four-fold increase in monthly tests, demonstrating enhanced capacity.

Compliance with treatment remains an important challenge, particularly for multi-drug resistant TB patients who face lengthy treatment and high risk of side effects.  Operational research supported under the EAPHLNP is providing information to better understand factors that hinder the referral process and treatment completion rates.  At the Bank-supported Musoma Regional Referral Hospital, a study conducted on people with presumptive TB revealed difficulties in paying for transport and problems with long distances.  Another study found significant gaps between specimens for MDR-TB received at the national TB laboratory and cases arriving at Kibong’oto Hospital which served the country for decades as a sanatorium for TB patients, and now functions as the center of excellence for treatment of MDR-TB.  Tracing of patients will provide critical information to understand factors associated with pre-treatment loss of MDR-TB patients.  “It is critical to support facility personnel to conduct on site research to understand the causes of poor adherence, impediments to a well-functioning referral system, and socio-cultural dimensions of effective TB control,” notes Dr. Esther Ngadaya, Principal Research Scientist at the National Institute of Medical Research.

Looking back at my visit to Ndanda Hospital I recall a tiny, frail two-year old girl named Gladness who was recently placed on TB treatment, sitting in the pediatric ward, connected to an oxygen machine unable to join her playmates. Let’s join forces to make the dream of a world free of TB a reality.


Follow the World Bank health team on Twitter:  @WBG_Health


 

Comments

Submitted by Chris Masila on

Indeed Miriam great experience sharing from Tanzania reminding us of the challenges of TB control. The louder than TB initiative is timely since children are suffering from TB and other lung disease and the need to focus on them in terms of better TB care is laudable. This year we saw appropriate Anti-TB drug formulations for children suffering from TB enter the market thank you TB alliance for your mission to avert any more children dying from a preventable and treatable disease and become leaders of tomorrow. Let us unite to end TB is the rallying for World TB day 2016 I fully support this call, having worked under the NTP in Kenya and seen firsthand what successful TB interventions and innovations like GeneXpert like what Miriam highlights translates to ending TB in the 30 high TB burden countries.

Submitted by Dr Enos Masini on

In Kenya we closely identify with the louder than TB campaign especially because we still have limitations in finding all childhood TB cases. We also identify with the challenges faced by Tanzania especially with regards to MDR-TB and increasing acess to quality TB diagnosis. Our World TB Day slogan was Mulika TB Maliza TB. Swahili for- mulika is to focus a spotlight while maliza is to end.
In line with this theme, in the next one year we will focus special interventions in key most at risk populations for TB. For children it will be the roll out of the new peadiatric formulations,for People Living with HIV we plan enrol about 800,000 on IPT with a phased implementation of TB-Diabetes collaborative activities and the phased roll-out of Xpert MTB RIF as the initial diagnostic test for TB.

Submitted by Thomas Alinaitwe on

For Salma and Gladness hope is renewed. The TZ experience shared above proves that thousands more elsewhere in Africa (both adults and children) suffering from TB can get tested and treated and become more productive if given access to the services. A big lesson for just about any African country.

Submitted by Lucy Chesire on

TB continues to be a major public health problem despite the fact that it is curable and treatable. In the light of just having commemorated World TB day,as a Community Advocate and one who has had personal experience with TB, i very well would resonate with the Tanzanian Experience. Kenya is recognized as one of the flag ship TB Control programmes in the region and this can also be noted internationally, this is due to the fact that we have been able to embrace new technologies, encourage innovations in finding pediatric cases and ensuring government commitment in fighting the epidermic . Ending TB for us means finding the missing cases, ensuring that patient centered approaches are at the center of TB Programming , and empowering of TB patients and communities will be very key.

Submitted by Niharika Hanglem on

A few years ago the WB's Development Marketplace awarded a grant to Apopo (www.apopo.org), which used rats to sniff out mines. Apopo has now trained rats to sniff out positive TB samples-- which they can do at a rate of 300 samples/hour-- and with 30% greater accuracy than conventional microscopy! In 2015 alone, these rats screened more than 40,000 sputum samples. They mainly operate in Tanzania-- might be worth checking them out too.

Submitted by Jeremiah Chakaya on

Why is Tuberculosis still such a huge public health problem in 2016? After the discovery of the Mycobacterium tuberculosis as the cause of TB by Robert Koch in 1882, the World lit up with hope that this disease could finally be tamed. But TB furiously raged on. In the 1940's another landmark discovery, that of Streptomycin by Selman Waksman, again led to renewed hope that the TB monster was finally going to be tamed. But it did not, at least not in the developing world. For many years we focused on finding those with the bug and offering them drug treatment and developed strategies around this concept but failed to recognize that the TB war required actions beyond case finding and treatment. We had seen it in the developed world: plummeting TB rates even before drug treatment became available primarily (but not limited to this) as a result of improving social conditions. And that is the reason I love the END TB Strategy. This comprehensive strategy that pushes the TB actions beyond the health sector just does it for me. As a clinician and public health practitioner, I see it every day: the poor urban slum dweller, my usual kind of TB patient, is getting the largest hit today from TB. What if we created a world where there are no poor urban slum dwellers, could we in fact throw TB into the bin where it would remain for ever? I therefore love what is beginning to happen all over the world but more so in my country and my continent where the frontiers of the TB war are expanded beyond the clinic. I love the work that is beginning to happen with the political class. The formation of the African Caucus of Members of Parliament united against TB is unprecedented. The proposed work to make mines in Southern Africa safer and the related advocacy work to improve living conditions of miners is great music to my ears. All this is happening on the background to find persons with TB earlier and placing them on treatment sooner while at the same helping them to cope with the rigors of TB treatment. This is it for me - a multi pronged , multi fronted approach to the TB war which gives me hope that success is very likely. Bravo to the END TB Strategy and to all those in the trenches.

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