CNS

Summary Report: Lessons from roll-out of MDR-TB services

The summary report on multidrug-resistant tuberculosis (MDR-TB) services was released during the ongoing Lung Week (12-17 November) and the 43rd Union World Conference on Lung Health in Kuala Lumpur, Malaysia. Citizen News Service – CNS, a partner of the Stop TB Partnership, along with other partners such as National Partnership for TB Care and Control in India, Rural Youth Advocate for Health and Development in Nigeria, National Council of People Living with HIV in India (NCPI+), International Treatment Preparedness Coalition (ITPC) India, Global Health Advocates (GHA), Sneha Foundation Varanasi, Asha Parivar, Vote For Health campaign, National Alliance of People's Movements (NAPM) and the Global Stop-TB eForum had hosted the online consultation and key informant interviews on issues related to multidrug-resistant tuberculosis (MDR-TB).

Advocates are calling for greater attention to the promotion and fulfillment of sexual and reproductive health and rights in the ASEAN region. Just released, “Engaging the ‘New’ ASEAN” highlights the urgency for wide collaboration amongst civil society to assist ASEAN member states to fulfill their commitments. Reducing maternal and child mortality and HIV and improving health outcomes for young people will contribute to the social, economic and environmental sustainability across the region.

Lung Week: 12-17 November
As the world marks the Lung Week, Citizen News Service - CNS' Kakaire Ayub Kirunda speaks to the president of the Uganda Thoracic Society Dr Martin Okot-Nwang who recently retired after several years of service at the country’s national referral hospital in Kampala. Dr Okot – Nwang speaks about the state of lung health in Uganda and resource limited settings.

The International Union Against Tuberculosis and Lung Disease (The Union), the World Health Organization (WHO) and the World Diabetes Foundation in association with the Indian government conducted a pilot project this year screening more than 8,000 tuberculosis patients for diabetes, and over 10,000 diabetes patients per quarter for TB. Fasting blood glucose tests for diabetes measured in TB patients at 7 tertiary hospitals and over 60 primary health care centres across the country showed that 13% of them had high blood sugar levels indicating diabetes, with higher rates in the south than in the north. Interim data from the project was presented to India's Revised National TB Control Programme in September 2012 and resulted in a national policy decision to scale up testing of all TB patients for diabetes in the country.

(Hara Mihalea is a noted Public Health and Tuberculosis Consultant. She is a Greek American and trained as a specialist on adolescent reproductive health. She has worked on all aspects of public health and was one of first groups of people in 1985 that were trained as HIV counsellors at CDC. Then in 1995 she moved to Thailand and has since dedicated her life solely to the cause of TB prevention, care and control. This is based on an interview she granted to CNS onsite at the 43rd Union World Conference on Lung Health in Kula Lumpur.)

World Pneumonia Day, 12th November
Lung Week: 12-17 November
Ms Mary Musoke of Kampala in Uganda is expecting to have her third born child in late March or early April 2013, making the delivery timely for the newborn to get its Pneumococcal Conjugate Vaccine (PCV), which debuts in the Uganda public health system for free. Due to the high disease rates of the killer invasive pneumococcal disease (pneumonia, septicaemia and meningitis), a major cause of illness and death, now Government is set to introduce PCV as part of the routine immunization schedule.

[Hindi]Today government delegates from across the world adopted the illicit trade protocol of the global tobacco treaty – the world’s first public health and corporate accountability treaty - but not without a fight from Big Tobacco. In the lead up to the Seoul negotiations, the World Health Organization, which administers the treaty, deemed the tobacco industry’s interference in these negotiations and the implementation of the treaty as the single greatest threat to its success. But, despite continued pressure tactics from the industry, it is commendable that illicit tobacco trade protocol was adopted on the first day of the negotiations.

Kiran,a healthcare worker
attending to a child with pneumonia

Lung Week is 12-17 November
Despite being preventable and curable, pneumonia is the leading killer of children under 5 years old. In 2011 alone, 1.3 million children died from this preventable and treatable illness, accounting for 18% of child mortality. In 2008, there were an estimated 203,000 deaths due to Haemophilus influenzae type b (Hib) and 541,000 deaths due to Streptococcus pneumoniae (pneumococcus) in children under five. Effective vaccine for pneumonia caused by pneumococcus exists - yet children who are likely to be at a high risk of pneumonia are least likely to get the protection.

Lung Week is 12-17 November

According to the International Union Against Tuberculosis and Lung Disease (The Union), child pneumonia remains a major threat to children under 5 years of age despite the great potential of the pneumococcal vaccine. “Pneumococcal vaccine is an important intervention that is already in use and highly effective in resource-rich settings – and it has great potential in high child-mortality settings too. However, tackling childhood pneumonia is a complex issue that requires a more comprehensive approach than a single vaccine”, said Dr Steve Graham of The Union’s Child Lung Health Division.

New Hope For Protecting Infants Against Malaria

The first complete set of results from an on-going pivotal, large-scale Phase III study of a new malaria vaccine candidate--RTS,S-- in children aged 5 to 17 months and combined data for severe malaria in the first 250 cases from those aged 6 weeks to 17 months were published online in the New England Journal of Medicine. The data confirms that this vaccine candidate reduces both clinical and severe malaria by approximately one-third in African infants (aged 6-12 weeks at first vaccination).

(This story is based upon inputs given by Vedavalli’s daughter Radha to CNS via email)

58 years is no age to die. Yet Radha Rangaswamy’s mother Vedavalli died of tuberculosis (TB) in the last week of October 2012 precisely at that age. Her only fault seemed to be her undaunted faith in the public health system of India (the Government DOTS programme) which proved to be her undoing.

Millions of people around the world struggle to breathe, and more than 10 million die each year due to lung diseases, including tuberculosis, asthma, pneumonia, influenza, lung cancer and chronic obstructive pulmonary disease (COPD). Still lung health is less well recognised as a key health indicator as compared to blood pressure or weight. Lung diseases afflict people in every country and every socioeconomic group, but take the heaviest toll on the poor, the old, the weak and the young. There is a critical need to raise awareness of the importance of lung health and bring it to the top of the public health agenda.

November could be dubbed the “lung health month” this year, with advocates organising World Pneumonia Day on 12 November, World chronic obstructive pulmonary disease (COPD) Day on 14 November and the whole month designated by some groups as Lung Cancer Awareness month. Yet people are largely unaware of their lung health, according to Dr Nils E Billo, Executive Director of the International Union Against Tuberculosis and Lung Disease (The Union). “Lung health is as central to health as blood pressure or weight, but most people are unaware of their lungs until something goes wrong”.

At a sprawling field in Jalalpur – on the outskirts of Gwalior district in Madhya Pradesh state-- over 10,000 people raised their hands flashing their first three fingers and vouched their commitment to: always use a toilet; always wash hands before handling food and after going to toilet; take forward the message of sanitation and hygiene to at least three more people. The occasion was the Great WASH (Water Sanitation Hygiene) Fair organized by the on-going Nirmal Bharat Yatra under Nirmal Bharat Abhiyan. Jalalpur was the fourth stop of the Yatra which was flagged off from Vardha (Maharashtra) on October 3 and now moves through villages of Maharashtra, Rajasthan, Madhya Pradesh, Uttar Pradesh and Bihar – the five states recording lowest sanitation coverage (between 14% and 22%).

The growing trend by Asian countries to allow local production of cheap generic drugs got another feather in its cap recently in India. In a landmark victory for patients’ groups fighting against patents to ensure access to medicines, the Intellectual Property Appellate Board (IPAB), while holding that a patients’ group can challenge the validity of granted patents, has revoked a patent granted in India to Roche for pegylated interferon alfa-2a (a medicine used to treat Hepatitis C). This patent, granted to Roche in 2006, was the first product patent on a medicine in India under the new TRIPS-mandated product patent regime for medicines, as part of the country’s obligations under World Trade Organization's (WTO) international trade rules.

A New Promising Tuberculosis Vaccine In The Offing!

With nearly nine million new cases and 1.5 million deaths per year, tuberculosis is a major global health threat, apart from entailing significant financial and economic burdens. The increase and spread of drug resistant TB makes the problem even more dangerous. The only currently available vaccine, BCG, offers limited protection and is not effective enough to stop the TB epidemic. New safer and more effective vaccines are therefore urgently needed.

New Roll Back Malaria report highlights malaria burden in Asia‐Pacific

(This is the story of Payal Bhattacharya—as told by her to CNS over a telephonic interview)

32 years old Payal Bhattacharya of Delhi, is a victim of not only an extremely rare genetic disorder known as Von Hippel-Lindau (VHL) syndrome since the tender age of three, but is also battling with extra pulmonary multiple drug resistant TB (MDR TB) of the bones for almost 3 years now. The VHL syndrome is associated with an abnormal capillary growth in blood-rich organs, (like the pancreas, heart and liver), constantly signalling a lack of oxygen in the blood and resulting in the formation of tumours in many organs which could be benign or malignant. Tumours have already been removed from her thyroid, liver, brain, legs, and forearm in several surgeries during the past 20 years. Lately her vision has started deteriorating and doctors suspect that she has some tumour in her eyes too.

Community Consultation: 2013 WHO Consolidated ARV Guidelines

Context

The global expansion of access to HIV treatment ranks among the great recent achievements in public health. At the end of 2011, an estimated 8 million people in low-and middle-income countries were receiving ART – a 25-fold increase since 2002. Nevertheless, most low- and middle-income countries are yet to achieve ‘Universal Access’ to ART. Reasons for this include lack of awareness of HIV status, high cost of ART, late initiation of ART, human rights issues affecting people living with HIV and key populations and substantial attrition in the ‘test-treat-retain’ continuum. Addressing structural barriers, reducing costs and strengthening the continuum of care is critically important if the full gains of expanded HIV treatment are to be realised.

Tuberculosis (TB) is one of India's oldest and perhaps most neglected public health challenges. It is a disease caused by bacteria that are spread from person to person through the air. Chronic cough (for more than 2 weeks) and fever are the most important symptoms of TB. When a person with TB coughs, TB bacteria get ejected into the air. They can then get inhaled by another person who can become newly infected. TB usually affects the lungs, but it can also affect other parts of the body, such as the brain, lymph nodes, abdomen, or the spine. In most cases, TB is treatable and curable. However, unlike most common infectious diseases that require a few days of antibiotic treatment, TB requires several antibiotics and long-term treatment for cure.

[हिंदी]The just retired Central Information Commissioner Shailesh Gandhi is quite agitated about the recent Supreme Court judgement making it necessary for Chief Information Commissioners to have a judicial background and to conduct all hearings in benches consisting of two Commissioners one of whom will have to be a person from judicial background. He put up a spirited argument why a person of judicial background was not necessary for the Information Commission. The task merely involved either taking a decision of either allowing information to be given or not. Some judicial thinking may be required to consider the cases of exemption from the Act. But such cases are rare. In the 20,000 cases that he disposed of, he said, he just encountered two which required some legal interpretation.

With diabetes largely associated with over-consumption of sugar by many Zimbabweans, it is hardly surprising that its link to tuberculosis (TB) is hardly a public health matter. TB kills more than 3,500 people each day worldwide, leading to approximately 1.4 million deaths every year. One-third of the world's population is currently infected with the causative agent of TB, and 8.8 million new cases of active TB are estimated to occur around the world each year.

The 23rd of October 2012, is the last day of the Hindu festival of Navratra—the nine days’ regimen of fasting and feasting, which is celebrated in its various nuances—Durga Pooja (worshipping goddess Durga); the rhythmic Garba dancing; the night long singing of bhajans (devi jagran); the Ramlila (enactment of life of god Rama), with the celebrations culminating on the tenth day by immersing the statues of the goddess in the river (from dust unto dust) and burning the effigy of the demon king Ravana (triumph of good over evil). However there is one common thread that links all these different forms of festivities—the feeding of the kanya (girl child) on the seventh, eighth and ninth days.

Link between TB and diabetes in Thailand

Duangkamol Donchaum who writes for CNS has produced an audio podcast on the link between tuberculosis (TB) and diabetes in Thailand and also an article in Thai language. To read the Thai language article, click here or to listen to Thai language podcast, click here

Government of India seeks YouTube videos on need for new TB drugs

The Government of India's Council for Scientific and Industrial Research (CSIR), Open Source Drug Discovery (OSDD) and Vigyan Prasar have announced an initiative calling for submissions of YouTube videos on the topic: "The need for new tuberculosis (TB) drugs." According to the Global Alliance for TB Drug Development (TB Alliance), "A shorter [anti-TB] drug regimen would reduce lost work-time and lessen the economic impact of TB on individuals' lives, and in turn help stabilize families, save and enrich the lives of millions of children, and enable a healthier, more productive labor force in many TB-endemic countries."

Citizen News Service (CNS), a partner of the Stop TB Partnership, and the global Stop-TB eForum along with partners are hosting an online consultation to document community perspectives and learn lessons on what worked and what didn’t in rolling out MDR-TB services in different countries/ contexts. These lessons are very important, especially experiences of affected communities, we believe, and must not be missed. These lessons should inform the ongoing and future planned roll-out (and scale up) of MDR-TB services at all levels.
GUIDING QUESTIONS
* Please share your experiences and perspectives of what works and what doesn’t work in your local settings where MDR-TB related services are available?
* What are the key lessons from this experience, that must be taken into account before scaling up the MDR-TB services any further for enhanced public health outcomes?

Top Tuberculosis Scientists Warn of Urgent Need to Develop Effective TB Vaccines

With cases of drug resistant tuberculosis (TB) on the rise globally, top TB researchers at a briefing today in London, called for greater focus on the quest for new vaccines—a crucial cost-effective method for addressing the growing threat. The WHO estimates that 9% cases of multidrug-resistant (MDR) TB in fact have extensively drug-resistant (XDR) TB for which even fewer drugs are effective, and a recent research published in The Lancet in August suggests that levels of drug-resistant TB are higher than previously appreciated and rates of XDR-TB range from 0.8-15.2% of MDR-TB cases at study sites across the world.

With growing strong evidence on the dangerous communion between tuberculosis (TB) and diabetes in India, government health programmes must no longer delay implementing TB-diabetes collaborative activities. “Like the HIV/AIDS epidemic, the diabetes epidemic threatens to cause an escalation in TB incidence. China and India constitute 40% of the world’s diabetes population of 400 million people which is likely to go up to half a billion by 2020. If we do not seriously think about the link between TB diabetes my feeling is that it may begin to derail some of the good advances made in India and China on TB control” said Professor (Dr) Anthony D Harries, Senior Advisor, International Union Against Tuberculosis and Lung Disease (The Union).

Tobacco industry's allied groups lobbied
against global tobacco treaty provisions

Kudos to Justice Amar Saran and Justice Anuraag Kumar of the Allahabad High Court for issuing strong warnings to the Uttar Pradesh government to ban gutkha (paan masala mixed with tobacco), on a public interest litigation filed by the Indian Dental Association, in the light of the provisions of the Food Safety and Standards Act. The Court also expressed its displeasure over the delay and the frequent change in the stand of the state government on this issue. It was only due to the firm stand taken by the Court that the Uttar Pradesh government has agreed to ban the manufacturing, sale and distribution of gutkha in accordance with the Regulation 2.4.3 of the Food Safety and Standards Act 2006 notified for implementation from August 5, 2011 by the Government Of India which states: ‘Tobacco and nicotine shall not be used as ingredients in any food products’. The Supreme Court had clarified that ‘since pan masala, gutkha or supari are eaten for taste and nourishment, they are all food within the meaning of Section 2(v) of the Act.’

The Smokeless Tobacco Association, the All India Kattha Factories Association and the Central Arecanut and Cocoa Marketing and Processing Co-operative Ltd have suddenly assumed the responsibility to inform people about the relative merits of gutkha over cigarettes. Their bold and blatant advertisement splashed in prominent newspapers is part of a country-wide campaign in an apparent retaliation to the ban on gutkha (tobacco laced pan masala), currently effective in 14 states of India. It wickedly accuses the 14 states of treating cigarettes to be beneficial for health and. The advertisement questions if it is just and fair to ban gutkha and not cigarettes, and reads that:--(i) one pouch of gutkha contains 0.2gm of tobacco as opposed to 0.63gm of tobacco in one cigarette; (ii) cigarette has 4000 chemicals while smokeless tobacco has 3000 chemical; (iii) cigarette smoke affects the health of non-smokers while gutkha does not; (iv) ban on gutkha will render lakhs of shopkeepers and farmers without a livelihood.

October 9, 2012—Just one day before this year's World Menatl Health Day, 56 year old Varsha Bhosle, a political columnist and journalist and singer Asha Bhosle's daughter, shoots herself to death in her flat in Mumbai. She had reportedly made two suicide attempts in the past and was currently undergoing treatment for depression. Incidentally, the latest figures peg India's suicide rate the second highest in the world with 187,000 suicides taking place in 2010.

October, 2012--In Bhopal a 13 year old boy hangs himself to death after a minor squabble with his younger brother over watching a particular cartoon channel on TV. August, 2012-- A 13 year old son of a roadside stall owner in Nagpur commits suicide by hanging from the ceiling fan with his mother’s dupatta, after being scolded by her for neglecting his studies.

In 2011 India had 61.3 million people living with diabetes (17% of the global incidence of 366 million) with 983,000 deaths (20% of the global figure of 4.6 million) attributable to the disease. India also accounts for 21% of the global incidence of tuberculosis (TB) with 1.98 million people developing TB and nearly 300,000 dying of it every year. Diabetes Mellitus is a non curable, non communicable metabolic disease that occurs when either the pancreas fail to produce sufficient insulin, (the hormone that regulates blood sugar), or when the body cannot use the insulin it produces effectively. It can be treated and controlled effectively although, over a period of time, it does increase the risk of heart disease and stroke and can cause kidney failure, blindness and nerve damage.

Mohan Das Karamchand Gandhi – affectionately and respectfully called Bapu or Mahatma - who played a key role in the Indian freedom struggle, had once said “Sanitation is more important than independence.” Paying tributes to Gandhiji on his 143rd birth anniversary, the Indian government has decided to take this message forward by starting a Nirmal Bharat Yatra (Clean India March). This 2000 kilo metres long Yatra is being launched on October 3 from Wardha district in Maharashtra. In the next 56 days it proposes to cover five states which, according to the 2011 census have the lowest sanitation coverage in India, namely Maharashtra, Madhya Pradesh, Rajasthan, Uttar Pradesh and lastly Bihar where it would culminate on November 19, which is World Toilet Day.