Strong tuberculosis (TB) control relevant when social determinants weak

One of the most adversely affected communities is at times least likely to seek care – as demanding care might have a price. "Relevance of strong tuberculosis (TB) control programmes is more when social determinants are weak" said Dr Ernesto Jaramillo from Stop TB Department, WHO at the 41st Union World Conference on Lung Health, Berlin, Germany. Read more

Although it is believed that healthcare services in public sector might be free or cheaper, yet 74% and 96% patients were seeking care in private sector in Bangalore (India) and Yangon (Myanmar) respectively. Clearly more needs to be done to reach the unreached people who might be dealing with conditions like TB and poverty.

A study titled 'Trends in TB incidence and their determinants in 134 countries' concluded that although TB control programmes have averted millions of deaths, their effects on transmission and incidence rates are not yet widely detectable. In many other sessions at the 41st Union World Conference on Lung Health it became evident that a medical response alone is just not enough – and a strong community-led social response to TB care and control can only bring in the desired difference.

There are enough studies done to show that numerous conditions increase the risk to TB manifold – these include HIV infection, malnutrition, diabetes, tobacco use among others.

In an earlier conducted consultative workshop of TB and poverty sub-working group of the Stop TB Partnership it became evident that those people who are the poorest and marginalized due to any of the myriad reasons, are also most at risk of diseases of poverty like TB, and least likely to get timely, proper diagnosis, treatment, care and support. "They are not the ones who are missing rather we are the ones who are missing them" said Dr Ernesto Jaramillo.

Same goes for indigenous communities or aboriginal peoples in many countries. TB rates are disparate for indigenous communities when compared to general population in the same country! If TB rates among indigenous communities in Canada are 4 times than among general population, it is likely that the TB incidence among indigenous communities might be even higher in Asia and Africa, said Dr Anne Fanning, a noted TB expert, former President of the International Union Against Tuberculosis and Lung Disease (The Union) and a recognised global authority on TB and indigenous communities.

The WHO Stop TB strategy calls for partnership with poor and marginalized communities for DOTS expansion, engaging all providers, and steps to deal with TB-HIV co-infection, multi-drug resistant tuberculosis (MDR-TB), among others. Indigenous community is a good place to start, and it is a matter of human rights, said Dr Fanning. The DOTS is essential but clearly not sufficient, said she.

Efforts in TB control are not enough, what we need to do is something about social determinants, said Dr Fanning.

The WHO Stop TB Strategy also advocates strong engagement of affected communities with dignity. The Patients' Charter for TB Care, is a rights and responsibilities based framework that is an integral part of the WHO Stop TB Strategy and should be implemented in all communities, particularly those at higher risk of TB like indigenous communities or aboriginal peoples.

Bobby Ramakant - CNS 

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