National free access to The Cochrane Library in India: Freedom may end at midnight…

Professor (Dr) Prathap Tharyan
(first published online here): The Indian Council of Medical Research (ICMR) created history in February 2007 when India became the first and only low-income country in the world with a national subscription to The Cochrane Library.  This initiative of the ICMR to purchase a national license was widely hailed as an exemplar of responsible leadership in health-research governance, as it gave all people in India with an internet connection free access to the online collection of reliable evidence-based resources to aid health decisions. Easy access to trust-worthy summaries that synthesize all relevant evidence, and that is not influenced by the marketing manipulations of drug companies, is the key step in evidence-informed health care; as it facilitates the working together of public and private health providers and their patients to better understand treatment options.

Children and TB: The struggle continues

Sam Banda Jnr, Malawi 
(First published in The Daily Times, Malawi on 28th March 2013): On Sunday March 24, the world came together to commemorate the World TB Day under the theme Stop TB in My Life Time. The World TB Day was designed to build public awareness about the global epidemic and reporter SAM BANDA JNR takes a closer look at the challenge the disease poses on children. TB is an airborne disease and second leading cause of death among infectious diseases worldwide after HIV and Aids. World Health Organisation (WHO) latest figures indicate that at least 500,000 children become ill with TB each year and that up to 70,000 do not survive.

Time to act now on MDR-TB

Paidamoyo Chipunza, Zimbabwe
(First published in The Herald, Zimbabwe on 26th March 2013): After two grueling years of treatment, Chipo Mhlanga, 48 (not her real name) is one of the first patients in Zimbabwe to be successfully treated of multi-drug resistant tuberculosis (MDR-TB). Speaking from her home in Epworth, Ms Mhlanga said she first showed symptoms of TB in 2006 after caring for four members of her family who had the disease. She said after eight months of treatment, and without screening her to confirm whether the treatment had been successful, she was taken off TB medication by her doctor who declared she was “looking much better.”

The hanging over, let us now find out who organized the attack?

Photo credit: CNS,
Dr Sandeep Pandey
[हिन्दी] (Note: From the case of Liaquat Shah it is amply clear how police, for taking credit, implicate surrendered militants as terrorists. Had it not been for the vocal protest of J&K police and CM Omar Abdullah the country would have believed that Liaquat came to carry out blasts in Delhi during Holi. Now the question is who planted the arms and ammunition in Old Delhi? Some of us believe that Afzal Guru's case was similar to that of Liaquat's. The STF and Special Cell of Delhi Police made him a scapegoat. In this country the police, to hide its incompetency, has been known to implicate innocent people in false cases even in other matters.)

Guidelines for Clinical and Operational Management of Drug-Resistant Tuberculosis

The International Union Against Tuberculosis and Lung Disease (The Union) marked World TB Day 2013 by formulating and publishing the much needed ‘Guidelines for Clinical and Operational Management of Drug-Resistant Tuberculosis’. This new guide offers practical advice on how to manage the estimated 630,000 patients worldwide who have multidrug-resistant TB (MDR-TB). Drug-resistance can develop if basic TB control fails at any of its different stages: when diagnosis and/or treatment are inaccurate, drug supplies are not consistent or the quality of the medicines is poor and/or patients do not adhere to the at least two years long treatment.

More action needed to tackle multi-drug resistant TB in Ghana

Bernard Appiah, Ghana 
(First published in Joy Online, Ghana on 24th March 2013): What appeared to be a routine visit to the hospital in late February 2013 to seek medical treatment for persistent cough with blood turned out to be different for sixty-eight-year old Maame Akua (not the real name). “I was just sick and went to the hospital only to be told later after some tests that I have tuberculosis (TB),” says Akua. “Since then I have been going to the hospital daily to take medications there every morning, and I’ve been advised to do so continuously for two months before I can take other TB medicines at home for four months.”

We can stop TB: With a little bit of love and a pinch of will power...

MDR-TB is curable
Photo credit: Citizen News Service-CNS
MDR-TB is curable
This is the story of Munnawar Khan Pathan, a 49 years auto rickshaw driver of Ahmedabad who has successfully battled multidrug-resistant TB (MDR-TB) through his will power and the loving efforts of his doctor Dr R M Leuva. His is an example of how a caring and committed doctor can help an MDR-TB patient to complete the two years long ordeal of toxic medication and get fully cured. Last month, in February 2013, I was in Ahmedabad, talking to a healthy and beaming Munnawar, little realising that he had been through terrible times before eventually conquering MDR-TB. Although I had spoken to many patients afflicted with this serious form of the disease, this was the first time I was face to face with a cured MDR-TB patient.

President of India commends India's TB programme

The President of India, Mr Pranab Mukherjee, commended India's tuberculosis (TB) programme in his message on the eve of World TB Day, 24th March. He said: "On the occasion of World Tuberculosis Day, I commend the important work that has been undertaken by various stakeholders led by the National TB Programme. Since 1998, due to the successful implementation of the DOTS strategy; more than 14.2 million people across India have accessed treatment."

Catch them early–can we?

Photo Credit: WHO/M.Gzemska
Carolyn Kavita Tauro - CNS
“I will not take all these medicines for two years... they are very strong medicines. I won’t be able to go to school” said 12 year old Abu (name changed) as the doctor explained to him that his sputum was still positive after six months of treatment. Abu was now affected with Multi-Drug Resistant Tuberculosis (MDR-TB) and the person from whom he had contracted it was his 17 years old brother. Abu’s mother sat helpless recalling all the money she had already spent on doctors, medicines and nutritious food for her children.

Breaking the Silence Finally on Child Sexual Abuse

Anjali Singh - CNS
Child Sexual Abuse is a topic few are ready to discuss much less address. Thus it came as a welcome surprise when in May 2012 the Indian Parliament enacted its first law specifically outlawing child sexual abuse. Prior to that the Protection of Children from Sexual Offences Act being notified,  different forms of abuse with children in India was covered by laws not designed to address them. So if a girl suffered non-penetrative sexual abuse it would be classified as “assault with intent to outrage the modesty of woman,” and if a boy suffered abuse it would be classified as per the draconian anti-homosexuality law that criminalized, “carnal intercourse against the order of nature.”

Women and the challenges of lung health

Sam Banda Jnr, Malawi 
The world on March 8 every year celebrates the International Women's Day which, originally, was known as International Working Women's Day. The focus of the day involves general celebration of respect, appreciation and love towards women for women's political and social achievements. In some countries, however, the political and human rights theme designated by the United Nations runs strong and political and social awareness of the struggles of women worldwide are brought out and examined in a hopeful manner.

Advocacy efforts for improving TB services in Tamil Nadu

Civil society organizations, TB forum members, the State NGO Network and Partners working in different districts of Tamil Nadu under Project Axshya and Partnership for TB Care and Control in India met recently in Chennai to discuss the current scenario of Tuberculosis programme in Tamil Nadu and the challenges faced at grass root level for providing services to the TB patients. The meeting was coordinated and facilitated by The International Union Against Tuberculosis and Lung Disease and REACH.

Research findings underscore need for additional HIV prevention options for women

Moses Wasamu, Kenya
Results of recent research findings underscore the need to accelerate development of additional HIV prevention options for women in the area of HIV prevention. The HIV prevention trial was done among women in Uganda, Zimbabwe and South Africa, and its results released at a scientific conference in the US early March. At the same time, the results from a large-scale HIV prevention trial among African women known as VOICE (Vaginal and Oral Interventions to Control the Epidemic), provide an urgent reminder that products must meet the needs of the people using them.

Vote For Health: Women and Lung Health

MARCH 2013
This is a special issue of Vote For Health e-magazine on the theme: Women and Lung Health. Vote For Health e-magazine presents select news articles penned by members of CNS Health Writers' Network from African and Asian countries on specific themes every month. We are grateful to International Union Against Tuberculosis and Lung Disease (The Union) for its support and The Union experts who helped Health Writers tremendously in developing their articles.

Smoke exposure fatal for women

Gugulethu Nyazema, Zimbabwe
(First published in Daily News, Zimbabwe on 13th March 2013): Zimbabwean women are suffering health risks arising from being exposed to indoor smoke. But the problem is not unique to Zimbabwe: nearly three billion people, most living in low-income countries, rely on solid fuel for cooking, lighting and heating. Health experts said the great challenge is that Zimbabweans are unaware of the problem, making them more vulnerable to it. “The diseases that women get from the smoke exposure occur only after many years of and this means that they are unlikely to make the connection between exposure and the disease,” local doctor Manikai Nyandoro said. Nyandoro said that the best way to inform people and engage them for change is to select “change agents” in the community who are affected by the problem.

Lung diseases a major killer of women

Female MDR-TB Ward
KS Roy Hospital, Kolkata
Photo credit: CNS
Moses Wasamu, Kenya
(First published in The Star, Kenya on 8th March 2013): The International Women’s Day is marked all over the world to celebrate the positive developments that have taken place among women. Annually on March 8, thousands of events are held throughout the world to inspire women and celebrate achievements. However, despite the positive developments that have been experienced, women still face many challenges in life. The unfortunate fact is that globally, women's health is worse than that of men. Lung disease is one of the top three causes of death among women worldwide. The World Health Organisation says the leading risk factor is tobacco use, and the sad fact is that it is on the rise among women.

Tuberculosis and women: The case of Swaziland

Alice M Tembe, Swaziland
Tuberculosis, commonly called TB, is caused by microscopic bacteria called Mycobacterium tuberculosis. It can be pulmonary in nature, when it affects the lungs and is highly infectious or extra pulmonary when it affects some part of the body other than the lungs and is less communicable. TB can be latent (meaning the TB bacteria are in the person’s body but are not causing illness) and it can be active whereby the bacteria causes illness. Tuberculosis is transmitted through the air from exposure to bacilli in the sputum by inhalation through the mouth or nose via the trachea leading to the lungs.

What Factors Predispose Women To Lung Cancer?

Okeoghene Oghenekaro, Nigeria
Mrs. Christy Efemena, 59, a mother of four children, had never smoked a cigarette in her life, just as Mrs. Joyce Adefila, 47, a mother of five had never done. Ironically, they were both victims of lung cancer and unfortunately, they were not able to survive the disease in spite of series of treatments, including chemotherapy, at home and abroad. Such cases tend to elicit some thought-provoking questions as to why non-smokers die of lung cancer in spite of the fact that smoking is adjudged to be one of the major causes of the disease.

Heart specialists from India awarded by American College of Cardiologists

Dr Rishi Sethi, Cardiologist, KGMU
Dr Rishi Sethi, Dr Sharad Chandra awarded prestigious FACC
[हिंदी] The Cardiology Department of King George’s Medical University (KGMU) in India added yet another feather to its cap with two of its faculty members being awarded in the same year with the prestigious fellowship of American College of Cardiologists. Dr Rishi Sethi and Dr Sharad Chandra, both Associate Professors in the Cardiology Department at KGMU, were awarded the coveted Fellowship of American College of Cardiologists in its Convocation held in San Francisco on 11th March 2013.

Women need protection from indoor air pollution

Bernard Appiah, Ghana
A rat burrows into a small bushy hill, and makes the hole its abode, supplying food and leafy "clothing" into it. Men or boys, dressed in sweat-drenched shirts bent on having bush meat put fire materials like dry leaves in front of the hole, light a match, resulting in fire and smoke. Then they begin to fan the smoke directly into the hole resulting in the sound "pupupupupupu" while hunting dogs and other interested men anxiously look on. Roughly 10 to 20 minutes later, the smoke forces the unfortunate rat to jump out of its abode into the paths of its enemies who chase it and literally arrest it.

TB: yet another killer of women

Carolyn Kavita Tauro - CNS
According to the WHO In 2011, an estimated 8.7 million people fell ill with tuberculosis and 1.4 million people died from it, including 0.5 million women, making TB one of the top three causes of death for women aged 15 to 44 worldwide. “Although the ratio of males to females affected by TB in the pre-puberty and childhood ages is almost equal, this changes significantly in adulthood, and we find almost 4 men per 1 woman affected with TB,” according to Dr Sarabjit Chadha, Project Director at the International Union Against Tuberculosis and Lung Disease (The Union), India. Dr Chadha attributes this to “access related issues considering that women in the rural settings do not have a similar health seeking behavior as men. Also, issues of poverty and malnutrition are more relevant in case of women because of gender inequality.”

TB care and control under gender lens

Tuberculosis care and control came under gender lens when participants attending Western Regional Consultative Meeting of Partnership for TB Care and Control in India (PTCCI) shared their perspectives on TB and women. This regional consultation was held in Indore, Madhya Pradesh during 5-6 March 2013. If we look at data, number of new TB infections in India was more in men than women. However statistics on male: female ratio in new TB cases is different too in some parts of India.

TB Forum demands GeneXpert in Maharashtra

GeneXpert at Lok Nayak Hospital
Delhi: Photo credit: CNS
Recent advances in TB diagnostics, particularly around GeneXpert, a technology which enables a rapid diagnosis of tuberculosis (TB) and also of Multidrug Resistant TB (MDR-TB) within two hours, has been a breakthrough in the worldwide efforts to curb the spread of the disease. Increased media coverage of this development and the growing incidence of MDR-TB as well as Extensively Drug-Resistant TB (XDR-TB) have stepped up general awareness and knowledge in the community of TB. Patients and families affected by TB are now coming together to demand the latest available technology with the potential to save many lives through an early and accurate diagnosis.

All I Want Is Clean And Safe Air

Breath is life, and yet the importance of lung health is under-recognised, especially in women. No wonder then that lung disease (including respiratory infections, chronic obstructive pulmonary disease (COPD), tuberculosis, lung cancer and asthma) accounts for more than 16% deaths among women worldwide. Exposure to tobacco smoke and indoor air pollution, from using solid fuels for cooking and heating, are the two leading risk factors that impact women’s lung health much more than that of men, especially in low/middle income countries. Each of these pollutants kills over 1.5 million women worldwide every year.

Movie with four friends or dignity for four women in 'those days'?

Do you have US$ 24 or Indian Rupees 1,000 to spare? Now the choice is yours how you would like to spend the money: buy movie tickets and enjoy with friends or sponsor four women for a year to help protect their dignity? With this money these women would get the supply of sanitary napkins for a year. Till 5-6 years back menstruation was a tabooed topic in the Indian society. Activists avoided discussions on this integral part of a woman’s life. Even women felt embarrassed to talk about this biological cycle. The situation was despite the fact that the focal point for all schemes of social uplift always remained women–be it micro finance, self help groups or corporate social responsibility.

VOICE study disappoints: Longer road ahead for additional HIV prevention options for women

PrEP Strategies Remain Valuable Prevention Tool: AVAC
Results from a large-scale HIV prevention trial among African women known as VOICE (Vaginal and Oral Interventions to Control the Epidemic) provide an urgent reminder that products must meet the needs of the people using them. While disappointing, the results lend new urgency and direction to the search for additional safe and effective HIV prevention options for women, AVAC said. Researchers announced on 4th March 2013 that none of three pre-exposure prophylaxis (PrEP) and microbicide interventions tested in VOICE – daily oral tenofovir, daily oral TDF/FTC (Truvada), and daily 1% vaginal tenofovir gel – provided additional protection against HIV in the study, likely because few of the women in the trial used the products as directed.

Another Trial to Help Women Control HIV Infection Ends In Setback

Efforts to get women controlled HIV prevention tools have once again suffered a setback following the release of final results from a 4 year study that that sought to determine the safety and effectiveness of two antiretroviral (ARV)-based HIV prevention approaches in women. Speaking to a select team of journalists in the trial countries of Uganda, Zimbabwe and South Africa via teleconference on Monday afternoon, the lead researchers announced that none of the three products - tenofovir gel, oral tenofovir and oral Truvada proved to be effective among the women enrolled in the VOICE study.

Gender equality is essential across all MDGs

A national level consultation on "Reducing Gender Inequalities: A Possible Framework for Post 2015" was recently held at Nawabganj, Unnao. Organized by the National Mission for Empowerment of Women (NMEW), Government of India, and supported by the UN Women South Asia, it was hosted by the Centre for Advocacy and Research and brought together leading civil society groups, think tank bodies and academicians to deliberate on the strengths and weakness of the Millennium Development Goals (MDGs); to review gaps and suggest remedies  and evolve an inclusive, participatory and sustainable framework to advance the MDG post 2015.