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TB News from India: March-April 2006
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Health and Development Initiative-India, (www.healthinitiative.org),
publishes
'TB News from India' once every two months. The objective of newsletter
is to highlight issues related to Tuberculosis and HIV/AIDS control
in India and enlist political, public, professional and administrative
support for its cause. Health and Development Initiative-India is a
not-for-profit organization and the news items have been quoted from
various sources for fair use and in public interest. Reproduction of
the material published is welcome provided a reference is made to the
original source of the news item and TB News from India.
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A
road map for TB control in Southeast Asia
While acknowledging the key achievements of Southeast Asian countries
in implementing DOTS, the new Global Plan to Stop TB (2006-2015) has
laid out a road map for TB control programmes of the region.
The plan calls for continuation of strong political commitment and
a raise in current level of funding in order to continue to improve
access to quality TB services. It cautions that with an estimated 35%
of cases still not being reached through existing DOTS services, significant
and sustained efforts will be needed to continue the current positive
trends.
The Global TB Plan informs that South-East Asian Region is second-hardest
hit by the HIV-epidemic, after sub-Saharan Africa. More than 6 million
people were estimated to be living with HIV in December 2004. The extent
of the epidemic of TB/HIV co-infection in the Region will depend on
the future course of the HIV epidemic, as well as on efforts to control
TB.
Yet another challenge facing the region is low coverage of drug resistance
surveillance mainly because of limited data from Bangladesh, India and
Indonesia, thus making it difficult to assess the regional MDR-TB situation.
Most national TB programmes in the Region do not at present diagnose
and treat MDR-TB patients.
The plan unfolds the priority activities for the region in the next
decade. The first and foremost being sustaining adequate human resource
capabilities to deliver quality DOTS services, a tall order for most
state health departments in India. A number of state governments in
India have embargoed fresh recruitments and replacements for retiring
health providers are a rarity.
The second identified activity is to increase the reach of DOTS,
through scaling up the participation of the large and vibrant private
sector in the Region. The encouraging results from pilot public-private
mix projects have paved the way for expansion this critical participation
In India. The lessons learnt from PPM endeavor in country will help
develop similar initiatives in other countries of the region.
The plan also moots decentralization of TB services so as to involve
health and social workers at the grass-roots level to help reduce barriers
to access for women and children. Understandably, community outreach
activities, as well as education, information and communications campaigns
need to be brought to the fore.
The call for establishing surveillance for HIV amongst TB patients
in new Plan marks a paradigm shift in the policy for integration of
the control programmes for two pandemics. Both the public and private
health sectors in most countries of the region would need to reposition
themselves in order to move ahead in this direction.
The implementation of proposed activities for Southeast Asian countries
pose a formidable challenge. The TB programme now has to emerge from
within the confines of health facilities to embrace a new team. The
players of this new-look team would be general practitioners and corporate
hospitals; community volunteers and opinion leaders; priests and politicians;
medical researchers and social scientists; cured patients and families
of the sick and anybody or everybody willing to extend a helping hand.
The turning point in our crusade against TB would be as to how we address
the issue of HIV amongst TB patients. Southeast Asians cannot afford
to circumvent this query; they have to meet it face-to-face.
Global Plan to Stop TB (2006-2015): http://www.stoptb.org/globalplan/default.asp
TB
cases on the decline: Anbumani Ramadoss
Source: The Hindu (27th February 2006)
The annual increase of tuberculosis in India has shown a downward
trend in the last three years, according to Union Health Minister Dr
Anbumani Ramadoss.
"Three years ago there were about 2 million new cases of TB
annually, which has come down to 1.8 million", he said today after
inaugurating the Golden Jubilee Celebrations of the TB Research Centre
(TRC) here and dedicating to the nation a HIV vaccine trial centre at
the TRC complex.
Stating that the WHO had appreciated the steps taken by the country
to control TB, he attributed the drop in cases to the revised national
TB control programme.
Referring to DOTS (Directly Observed Treatment Short course) programme
initiated in 1993 and scaled up in 1997, he said TRC had to be given
credit for introducing the programme, under which over 5.2 million persons
had benefited, including 1.2 million last year.
The mortality rate of TB cases had dipped from 29 per cent to four
per cent while the success rate stood at 84 per cent, he said.
http://www.hindu.com/thehindu/holnus/004200602261623.htm
Tuberculosis
Research Centre Completes Fifty Golden Years
The prestigious Tuberculosis Research Centre (TRC), Chennai is celebrating
its Golden Jubilee this year. TRC is one of the International Centers
for Excellence in Research, funded by NIAID/NIH U.S.A. The centre recently
established a HIV Vaccine Trial Centre funded by IAVI, New York.
TRC was initially started as Tuberculosis Chemotherapy Centre in
1956 as a 5-year project, under the joint auspices of the Indian Council
of Medical Research (ICMR), the Government of Tamil Nadu, the World
Health Organization (WHO) and the British Medical Research Council (BMRC).
Many of the research findings of the Centre have received worldwide
acknowledgement and, indeed, some of them have had a great impact on
the formulation of tuberculosis control programmes in Asia, Africa,
South America and some parts of Europe. It must be emphasized that although
the main aim of the studies at this Centre is to evolve inexpensive,
effective and practicable methods of treatment for tuberculosis patients
in India, the logical sequence of the investigations undertaken, complemented
by appropriate laboratory investigations, has resulted in invaluable
knowledge of the principles of chemotherapy and of the bacteriology
of tuberculosis.
The first controlled clinical trial, which established unequivocally
the value of out-patient treatment for pulmonary tuberculosis, has received
world-wide acclaim as the classic "Madras Study". The finding
that tuberculosis patients can be effectively treated as outpatients
and continue to live in their homes without added risk to their family
contact has revolutionized the whole concept of the management of tuberculosis.
Later, the Centre evolved supervised intermittent chemotherapy as an
alternative system of treatment, especially for urban areas and large
cities.
United
Kingdom plans to
help fight tuberculosis in India
Source: Web India, January 30, 2006
The United Kingdom plans to spend an additional 41.7 million pounds
to help fight tuberculosis in India. The new funds come in addition
to the UK's recent doubling of its contribution to the Global Fund to
fight AIDS, Tuberculosis, and Malaria, to 100 million pounds per year
for 2006 and 2007. The World Health Organization (WHO) and the Stop
TB Partnership will administer the funds in India.
Urging other donors to similarly increase their support, UK's Secretary
of State for International Development, Hilary Benn said: ''More must
be done to help reach the poor and underserved areas in India, where
more than 1,000 people die from TB every day. Together, we can do even
more to combat this disease that often drives families into poverty.''
This latest DFID funding for India will help procure anti-TB drugs which
will directly benefit over four million TB patients. It will also support
a five year plan to provide technical assistance through the WHO to
the Government of India's revised National TB Control Programme (RNTCP).
WHO is already providing technical support to RNTCP in partnership
with DFID, as well as with the Canadian International Development Agency
(CIDA) and the United States Agency for International Development (USAID).
The Organisation is committed to continuing such support during Phase-II
of RNTCP for the period 2006-2010.
Dr Samlee Plianbangchang, Regional Director, WHO South-East Asia
Region, welcoming this development, said, ''The rapid strides that the
Revised National TB Control Programme in India has made in recent years
is today driving global progress in TB control. I welcome this generous
support from the Department for International Development UK which is
one of our key partners in this Region. I view this as a sound investment
in improving the health of people across the globe.''
According to Dr S J Habayeb, WHO Representative to India, ''India
has made remarkable progress in expanding the internationally recommended
DOTS strategy to 97% of the country. The challenge is to sustain good
quality services, widen the reach through involvement of a wider network
of health care providers, and deal with newer challenges posed by TB/HIV
co-infection and drug resistance.''
http://news.webindia123.com/news/showdetails.asp?id=235185&n_date=20060130&cat=Health
TB
stalks 7,000... & more
Source: Statesman News Service, 13th January 2006
A sizeable portion of the Kolkata population suffers from tuberculosis.
More than 7,000 people, most of whom from slum areas, visited civic
TB treatment centres last year. The number of TB patients in the city
is increasing every year, Dr Deb Dwaipayan Chattopadhyay, Kolkata Municipal
Corporation's chief municipal health officer, said today.
Data available with Kolkata Municipal Corporation health department
shows that the maximum number of patients visit the Manicktola TB clinic,
followed by other centres located at Behala, Manashatola, Alipur and
Tollygunge. Officials said people suffering from TB mostly live in and
around these areas.
The civic body treats TB patients through 10 tuberculosis clinics
located in various parts of the city. Though the disease is a completely
curable one, it persists since most of the patients do not complete
the full course of medication. Under the pan-India DOTS programme, civic
health officials want to keep patients under sustained medication by
providing medicines to them.
City civic health officials said since more patients were coming
to the clinics, the number of patients seems to be increasing. World
Health Organisation has been saying, however, that keeping several factors
in mind, more people must be suffering from the disease.
"Kolkata Municipal Corporation health department has been working
with several NGOs, private hospitals, private laboratories and private
practitioners to help eradicate the disease from the city. The problems
mostly arise when after first dose of medicine, patients stay away from
regular medication. They relapse with further complications. More than
15 per cent cases are being detected at private clinics," said
Dr. Deb.
Tuberculosis, primarily an illness of the respiratory system, spreads
through coughing and sneezing. So there is always fear of the disease
spreading through droplet infection. To root out the disease, patients
need to continue proper treatment, which most poor people cannot afford.
"Free medicine is available from tuberculosis clinics in the
city. Besides this, under the DOTS programme, medicines are being provided
and patients are being treated with special care. If fever continues
for several days, people should immediately contact chest clinics,"
Dr Chattopadhyay added.
Free
from tuberculosis certificates for dhaba workers
Source: The Tribune, 13/1/2006
With a view to prevent the spread of tuberculosis in the southern
Sangrur district of north India state of Punjab, the Deputy Commissioner
on Tuesday asked owners of dhabas (traditional eating joints),
hotels and restaurants to get "free from TB " certificates
for their workers from the health department.
Mr. Husan Lal, Deputy Commissioner, presiding over a meeting of the
district TB Control Society here yesterday, further said
procurement of free from TB certificates would be beneficial for workers
as well as general public because a worker infected with TB could spread
the disease among those persons to whom he served eatables. The meeting
was held to review the progress of RNTCP, aimed at controlling the spread
of TB in district.
Dr. Nirpal Singh Civil Surgeon said TB patients should be motivated
and compelled to complete treatment as an incompletely treated or untreated
patient could infect 10-15 healthy persons every year.
This
TB hospital is in need of intensive care
Source: News Today, Jan 3rd 2006
Some portions of the campus of Thiruvotteeswarar TB hospital
(Tamil Nadu) at Otteri are completely desolated and badly maintained
making one wonder how a health care centre could be reduced to this
state.
The rains, which lashed the city in the past two months, had caused
inundation of low-lying areas within the campus, which has led to breeding
of a large number of mosquitoes causing discomfiture among the patients.
Another blemish is an abandoned building, which is not being utilised
as it is alleged to be infested with snakes.
The hospital is equipped with 222 beds and every day 300-400 patients
visit the outpatient section from different parts of India such as Gujarat,
Andhra Pradesh, Karnataka. There are four patients with TB due to Human
Immuno-deficiency Virus in the hospital and around 30-40 HIV-related
TB patients visit the Hospital every month.
'Due to certain myths about the disease the patients are ostracized
and are left to lead a solitary life', according to Dr Meenakshi , Medical
Superintendent of the hospital. She called upon various social organizations
to chip in and help the patients, 'Social welfare organizations can
send volunteers to the hospital and spend some time with the patients
which will give tremendous psychological strength to them'.
http://newstodaynet.com/03jan/rf4.htm
Free
X-ray facility for suspected TB patients
Source: The Tribune News Service, 21st February 2006
The Punjab Health Systems Corporation (PHSC) has directed all Civil
Surgeons of the state to conduct x-ray of chest, free of cost of all
those suspected TB patients whose all three samples of sputum are found
negative for TB germs i.e. Acid Fast Bacilli (AFB).
Earlier only in the case of a suspected TB patient, whose one sputum
sample, out of three, was found positive for AFB, x-ray of chest was
done free of cost in government hospitals.
http://www.tribuneindia.com/2006/20060222/punjab1.htm#16
Update
from Research Labs
India comes up with TB breakthrough
By: Sanchita Sharma
Hindustan Times, February 4th, 2006
In perhaps the biggest tuberculosis breakthrough in two decades,
Delhi's National Institute of Immunology (NII) has identified five key
genes that enable Mycobacterium tuberculosis to acquire the iron it
needs to grow and promote the infection in humans. Experts say targeting
genes within this cluster would help evolve better drugs to cure TB,
which affects 15.4 million people worldwide.
http://www.hindustantimes.com/news/5922_1617432,0015002500000000.htm
Newly Identified
Mechanism Helps Explain Why People of African Descent Are More Vulnerable
to TB
Source:
UCLA News
A team of scientists has identified a cellular mechanism that may
help explain the puzzle of why people of African descent are more susceptible
to tuberculosis infection and why, once infected, they develop more
severe states of the disease than whites. The team includes researchers
from UCLA and the Harvard School of Public Health
Innate immunity, which has been retained in evolution from fruit
flies to humans, is the rapid immune response of host scavenger cells
to recognition of certain patterns of molecules found on pathogens.
A set of receptors on macrophages in humans called "Toll-like receptors"
contributes to innate immune responses. The researchers describe a novel
pathway used by human macrophages that may be critical to resisting
infection with certain pathogens and that turns out to be critically
dependent on vitamin D.
Scientists have long known that blacks have less vitamin D than whites
and that blacks are more vulnerable to TB. This study helps to resolve
two of the puzzles of tuberculosis, the differences between mice and
human antibacterial mechanisms, and the susceptibility of people of
African and possibly Asian descent to tuberculosis. The researchers
suggest a need for clinical trials to investigate the effect of vitamin
D supplementation.
"Tuberculosis is a devastating disease that strikes vulnerable
populations particularly hard," said immunologist Barry R. Bloom,
dean of the faculty at the Harvard School of Public Health and a co-author
of the paper. "This study provides a new mechanism for innate immunity
in humans and demonstrates how variations in vitamin D synthesis may
make individuals susceptible to TB infection. It is exciting to consider
the possibility that innate immunity to tuberculosis and other infections
in vulnerable populations might be enhanced by providing a simple vitamin
that would cost only pennies a day."
http://www.newsroom.ucla.edu/page.asp?RelNum=6856
Letter
to Editor
TB
Control Programme: A Sacred Mission
I do welcome your Editorial note (Oct-Nov 2005) on the Patients'
Charter of the Tuberculosis Community. TB patients have their rights
and their responsibilities as well.
All health providers summarized as "the Programme workers"
take up full responsibility to, as far as possible, guarantee a cure
for each and every patient under their care. Due to irregular treatment,
we all know too well, the disease may relapse and (multi) drug resistant
mycobacteria may be cultivated and patients' suffering become immeasurable.
TB Control Programme has three main functions: detecting, treating and
curing tuberculosis patients.
Responsibilities of TB Programme workers comprise that all TB patients
be correctly diagnosed. World Health Organization guidelines stipulate
that every year 70% of the prevailing sputum positive cases in a given
area be detected by sputum smear examination. The number of cases detected
however depends on the availability of anti-TB drugs. I wonder what
is the sense of case-detection if the cases found do not receive the
sufficient supply of drugs? And once under treatment, every case must
be cured. Since what is the sense of treatment if it were not for cure?
The Programme workers have to see to it, that all patients
get right drugs, in correct doses under a pre-determined drug regimen.
All Programme workers must be prepared and committed to actually
achieve the targets of a successful TB Programme at all times and whatever
be the conditions. This is the Mission which every Programme worker
has to accomplish. It is a "sacred mission" because
an unaccomplished mission proves to be disastrous for the patient.
Says Sir John Crofton, "TB can be cured, patient's life is in
your hands."
Let's save our patients.
Dr Muherman Harun
Pneumo-phthisiologist
St.Carolus hospital, Jakarta
mhjkt@attglobal.net
Web Call: TB Education
Materials in South Asian Languages
Bureau of Tuberculosis Control, The New York City Department of Health
and Mental Hygiene has produced highly readable educational materials
for public in a number of South Asian languages. The patient brochures
cover a number of topics including, Contact with TB, What you need to
know about TB and Stop TB. The brochures explain the difference between
latent TB infection and TB disease provides information on preventing
the development of TB disease. A brochure also explains what a person
should do if he/she has spent time with someone who has tuberculosis
has also been explained. These easy to easy to download and print brochures
are available in Hindi, Urdu and Bengali.
http://www.nyc.gov/html/doh/html/tb/tb1.shtml
_____________________________________________________________________________
Editorial Team:
Dr. Dinesh Kumar Sharma, dineshkumarsharma@gmail.com
Dr. Jatinder Singh, jatindersingh@vsnl.com
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