CNS

World Health Day (7 April): Antimicrobial resistance: no action today, no cure tomorrow

World Health Day – 7 April 2011
With emerging drug resistance gradually making existing array of curative drugs ineffective, treatment options for a range of health conditions is getting severely limited. This year, the World Health Day (7th April) has put this theme in the bull's eye: Combat drug resistance - no action today, no cure tomorrow. According to the World Health Organization (WHO), antimicrobial resistance is not a new problem but one that is becoming more dangerous; urgent and consolidated efforts are needed to avoid regressing to the pre-antibiotic era.

In lead up to this year's World Health Day (7th April), a coalition of health and human rights groups launched a campaign to stop torture in healthcare. This global effort builds on the recent groundswell of civil society activity to protect and advance human rights in health settings. The Campaign seeks to hold governments accountable for the most egregious abuses perpetrated against citizens in the name of health care. Of particular focus for the Campaign are the egregious abuses committed across south-east Asia in compulsory detention centers for people who use drugs.

In lead up to the World Health Day (7th April), interview with the President-elect 2012 of the India's largest association of surgeons has a coherent message: Make hospitals safe in emergencies. "We have been neglecting the safety of health facilities and the readiness of healthcare workers who treat those affected by emergencies. Health centres and staff are critical lifelines for vulnerable people in disasters - treating injuries, preventing illnesses and caring for people's health needs" said Prof (Dr) Rama Kant, President-elect 2012 of Association of Surgeons of India (ASI).

This is not sensational news but in spotlight because CNS recently reported that genital tuberculosis was one of the lead causes of tubal infertility and only 2 per cent women with genital TB delivered live births. It was a very positive news that a woman with genital TB successfully completed anti-TB treatment and then due to in-vitro fertilisation technique, also succeeded in giving births to normal baby (well, two babies in this case!). The Hindustan Times (Lucknow, 25 March 2011) reported that: "Deepti of Rajajipuram, married for eight years, delivered twins (male children) on Wednesday after being treated at the fertility centre of the Queen Mary's Hospital. The in-vitro fertilisation technique helped the woman conceive. Earlier, she was unable to conceive due to genital tuberculosis (TB)."

Jairam Ramesh, Minister of State (Independent Charge) for Environment and Forests, Government of India, has assured the affected communities to visit them in Narmada valley on 10-11 April 2011. Jairam Ramesh has made a mark as Environment minister by taking pro-people stands on many issues. However Jairam's support to the proposed Jaitpur Nuclear Power Plant in Maharashtra, India, has sent a negative signal.

"Nothing for Us without Us" was said by an activist friend from Africa at one of the conferences. Another World TB Day (WTBD) has come and gone and this time Delhi was abuzz with events more than ever before. A media awards function honouring journalists from different parts of the country. An art exhibition on TB, definitely the first; a gathering at the Red fort and a street play by students on multidrug-resistant TB (MDR-TB) accompanying the release of TB 2011 report by WHO (SEARO) and Bill Gates visiting the TB Hospital for a closed door exclusive meeting.

On World TB Day 2011, WHO, the Global Fund to Fight AIDS, Tuberculosis and Malaria and the Stop TB Partnership called upon world leaders to step up their commitment and contributions to meet the goal of diagnosing and treating one million people with multi drug-resistant tuberculosis (MDR-TB) between 2011 and 2015. WHO also released a report, Towards universal access to diagnosis and treatment of MDR-TB and XDR-TB by 2015, which presents progress in the MDR-TB response in the countries with the highest burden of drug-resistant TB. According to this report, China has an estimated 66,000 cases of MDR-TB amongst notified cases, yearly.

A two day convention of rural women leaders, which was held on 24th and 25th March,2011, in the east Uttar Pradesh town of Mau, brought together over 400 women leader delegates from 10 districts of eastern UP, to share their bitter and sweet experiences under the umbrella of the "Empowering Rural Women-ERW" program. Under the banner of this program, over 40,000 women from the marginalized and backward communities of this backward area, (of an already backward state), have formed ‘women collectives’ or Nari Sanghs in 253 Gram Panchayats (village councils), and are working ceaselessly towards claiming their entitlements, with special emphasis on right to food and right to work. They are also demanding their rightful place in the political and social arena.

People need not be afraid of tuberculosis (TB) as it is completely curable. People should be encouraged to go to the government-run free anti-TB treatment centres (providing the WHO recommended Directly Observed Treatment Short course - DOTS), rather than opt for visiting private practitioners as paying for treatment places an additional burden on the TB patient, said Dr Ashok Kumar, Deputy Director General, Central TB Division, Ministry of Health and Family Welfare, Government of India. Dr Ashok Kumar was speaking at the inaugural session of a unique art exhibition, "Chehera - The Human Face of TB", on the eve of World TB Day 2011 in New Delhi.

Non-communicable Diseases (NCDs) - cancer, cardiovascular disease, chronic respiratory disease and diabetes - are no longer diseases of the wealthy. They are responsible for 8 million deaths in the world’s poorest billion, largely composed of children and young adults. These were among some of the key messages from the speakers at a conference co -organized by the NCD Alliance and Partners in Health , in the first week of March in Boston. This conference was an important step in breaking the myths that surround NCDs, and demonstrates that the growing NCD epidemic should clearly be a top priority for developing country governments and development agencies.

Dr Binayak Sen, a medical practitioner and a civil liberties' activist, has been sentenced to life imprisonment in Chhattisgarh. Amnesty International calls him a 'prisoner of conscience' because he never advocated violence and was a champion of human rights causes in the state but was unduly targeted by the state. Probably his stand for human rights exposing gross injustices meted out to tribal population by the state, and a report had irked the government which slapped upon him violation of two draconian laws: Chhattisgarh Special Public Security Act and Unlawful Activities Prevention Act (UAPA).

A promising new diagnostic test will finally help detect more people with drug-resistant tuberculosis (DR-TB), increasing the urgency to solve major problems around the pricing and supply of DR-TB medicines, according to a new report by the International Union Against Tuberculosis and Lung Disease (The Union), and international medical humanitarian organization Médecins Sans Frontières (MSF). DR-TB is on the rise, but less than 7% of 440,000 new cases each year receive treatment, and DR-TB kills 150,000 people annually. The treatment of DR-TB relies on old antibiotics, many of which have severe side effects, ranging from constant nausea to deafness, and must be taken as complex regimens – patients must take up to 17 pills every day for up to two years. However, these are the only drugs that exist today that can tackle DR-TB.

European politicians, tuberculosis (TB) advocates and health advisers are gathering to discuss an innovative financing model that would enable scientific discoveries to be translated into TB vaccines. On the occasion of a World TB Day meeting, Joris Vandeputte of TuBerculosis Vaccine Initiative (TBVI) will present a new funding plan: "Our governments are faced with a difficult question: how to reduce the deficit while maintaining a commitment to invest 3% of gross national income in research and innovation?"

Key questions regarding the new tools and new challenges facing TB control and prevention today are being addressed through an innovative international initiative, TREAT TB. The purpose of TREAT TB, which stands for Technology, Research, Education and Technical Assistance for Tuberculosis, is to conduct field evaluations of new diagnostic tools, clinical trials of priority research questions and operational research benefiting TB control. The initiative is managed by the International Union Against Tuberculosis and Lung Disease (The Union) and funded by the United States Agency for International Development (USAID).

Worldwide concerted efforts are being made, with renewed pledges on World TB Day (24th March), to rid this planet of the scourge of tuberculosis. The World TB Day theme for the year 2011 is Transforming the Fight – Towards Elimination of Tuberculosis. On the national front, as part of the newly-launched Project Axshya - a Global Fund to fight AIDS, TB and Malaria (GFATM) Round 9 project to fight tuberculosis in the States of Jharkhand, Chattisgarh and Madhya Pradesh, CARE India has launched an intensive mass awareness programme. According to CARE India Chief Advocacy Officer Ms Alka Pathak, "Tuberculosis is one of the leading causes of mortality in India- killing two persons every three minute, nearly 1,000 every day."

A Regional Women Leaders' Convention is being held on 24-25 March 2011, in Mau, UP, as part of the Empowering Rural Women (ERW) programme, which has been operating in 253 Gram Panchayats (village councils) of 10 districts of UP, since December 2007. This is a unique programme as its key focus is on developing leadership qualities among rural women, particularly those belonging to the marginalized sections of society. It has an optimistic target of reaching out to 100,000 such women, and collectivizing them for realization of their rights by ensuring entitlements. The intervention is focused on the leadership development of women by providing them a platform in the form of community based organizations (CBOs) for strengthening women's informed participation in local governance and ensuring entitlements related to right to work/livelihood and right to food for the poorest of the poor.

World TB Day is on 24th March 2011
[To read in Hindi language, click here]
Clearly more needs to be done for effective tuberculosis (TB) control by reaching out to the unreached populations who are least likely to access existing TB care services. Project Axshya, aims to do exactly that. Supported by one of the largest grants from the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund), the five-year project got underway last year with a focus on engaging civil society to improve the reach and effectiveness of India's Revised National Tuberculosis Control Programme in 374 districts across 23 Indian states, reaching some 744 million people by 2015.

Water constitutes about three fourths of the earth's surface, but only less than one percent of it can be used by its inhabitants. Most of it is salt water oceans (about 97%) and 2% of it is contained in glaciers. With every country seeking to satisfy its ever increasing water needs from shrinking and limited water resources, there could be a future of conflict. As the UN Secretary General, Ban Ki Moon remarked recently that water scarcity is the potential fuel for wars and conflict. But cooperation, not conflict should guide us in our quest for a solution to this crisis.

Transforming the fight towards elimination: World TB Day

World TB Day, 24 March

According to the Stop TB Partnership, For World TB Day 2011 we enter the second year of a two-year campaign, "On the move against tuberculosis" whose goal is to inspire innovation in TB research and care. This year's campaign challenges us to look at the fight against TB in an entirely new way: that every step we take should be a step towards TB elimination.

Thus spoke Robert Oppenheimer to Harry S. Truman in August 1945 after the atomic bombing on Hiroshima and Nagasaki. A noted physicist, Oppenheimer was the director of the the Manhattan Project where he worked with top notch scientists to develop the atom bomb. But the wide scale destruction caused by the dropping of atom bombs in Japan made him admit at a meeting of the American Philosophical Society: "We have made a thing, a most terrible weapon, that has altered abruptly and profoundly the nature of the world... a thing that by all the standards of the world we grew up in is an evil thing. And by so doing... we have raised again the question of whether science is good for man."

Meaningful community engagement is so central to addressing tuberculosis (TB) of all forms. In preventing, diagnosing and treating genital TB it becomes no less valuable. "For sure the issue of genital TB caused me to flashback on the number of women who have had several miscarriages, and despite the investigations the cause is still unknown! Could this be Genital TB?" said Margaret Namaganda, a noted health advocate. "The magnitude of this problem is enormous, in most cases, genital TB has caused a lot of suffering amongst the population without being noticed, and in most cases blamed on other causes" said Kennedy Kassaza from Uganda.

The Indian Prime Minister and citizens both made a call for scrutiny of India's nuclear plants. Citizens in Lucknow called for a public scrutiny of India's nuclear plants. Padmashree Ranjit Bhargava, Environmentalist, was speaking at a discussion on demanding an end to India's nuclear programme held at PMT College, Hazratganj, Lucknow. Same evening, India's Prime Minister Dr Manmohan Singh called for a re-examination of all nuclear safety systems in the wake of the recent nuclear emergency in Japan.

Recent nuclear emergency in Japan leaves no doubt that this world needs to renounce nuclear power for military and civil/ energy purposes, as soon as possible, to put an end to any further catastrophe in the name of 'energy', 'power' or 'technology'. Humankind has only seen unprecedented and uncontrollable devastation, misery and agony due to nuclear accidents over the past years or atom bomb strikes in Hiroshima and Nagasaki in 1945. Nuclear power is clearly the most dangerous options for civil or military use - and - time is running out before we can act upon nuclear disarmament in the world.

World Sleep Day is held every year on March 18th, with a view to raise awareness about the merits of sleeping well for a healthy life. The theme for this year (2011) is promoting healthy sleep for all ages. Sleep is a basic human need—a crucial component of healthy living, much like breathing, eating and remaining physically fit. Unfortunately, in today’s world it is often compromised by the habits of a whirl wind lifestyle. Very often our waking hours tread with impunity upon the territory of our dreams. Sleep disorders constitute a global epidemic, affecting up to 45% of the world's population. Insomnia, obstructive sleep apnea (OSA), restless legs syndrome (RLS), and sleep deprivation significantly impact physical, mental and emotional health, in addition to affecting work performance and personal relationships.

Starting antiretroviral therapy (ART) in people co-infected with HIV and tuberculosis (TB) save lives. This reinforces already existing body of evidence of beneficial public health outcomes of providing ART along with standard anti-TB treatment to TB and HIV co-infected people. These new study results were presented at the recently concluded 18th Conference on Retroviruses and Opportunistic Infections (CROI 2011). In 2010, Prof Anthony Harries, Senior Adviser, International Union Against Tuberculosis and Lung Disease (The Union) had said in an exclusive interview with CNS: "The most recent WHO advice issued in November 2009, is to give ART to ALL HIV infected TB patients regardless of CD4 count and to give it as soon as possible after the anti-TB treatment."

Surgical Site Infections (SSIs) are infections associated with surgical procedures and are a major source of post-operative illness. "These infections are responsible for approximately one quarter of all nosocomial infections and affect 1.4 million people worldwide at any time. SSIs result in longer hospitalization, increased patient mortality and higher costs for healthcare providers and payers" said Professor (Dr) Rama Kant, who is the national President-elect of Association of Surgeons of India (ASI) 2012 and former Head of Surgery Dept, King George's Medical College (KGMC) and former Chief Medical Superintendent of Gandhi Memorial and Associated Hospitals.

When one hears of farm suicides, Vidharbha in Maharashtra may come to mind immediately. And then perhaps Anantapur in Andhra Pradesh or Kalahandi in Orissa. Of course, if we have been tracking the subject, we may know that Karnataka, Chattisgarh, Kerala, West Bengal, Assam Madhya Pradesh, Rajasthan and Punjab will figure in a list of badly affected states. It is ironical that the last among these was touted to be among the success stories of India's Green Revolution.

Although women get diagnosed for tuberculosis (TB) later than men, treatment outcomes among women are better than men with higher TB treatment success rate and lower default (drop-out) rate in the female patients. Among the unreached people who need TB care, a significant number of them are likely to be poor and probably women. There is a lot more we need to do to bring in the desired change in diagnosing people with TB as early as possible and treating them with standard regimens successfully.

Tuberculosis (TB) treatment outcomes are better among women as compared to those in men, said Dr KS Sachdeva, Chief Medical Officer (CMO), Revised National TB Control Programme (RNTCP) of the Government of India. According to the RNTCP data, among new sputum positive cases of TB registered in 2009, TB treatment success rates were higher in women (89 per cent) than those in men (87 per cent) and less women dropped out of TB treatment than men (4 per cent drop out or default rate for women, and 6 per cent default rate in men). He was speaking at a focussed meeting on TB and women organized in New Delhi by Global Health Advocates (GHA) on 8th March 2011.

Close on the heels of International Women's Day 2011, comes the news of a path breaking research which puts the onus of a healthy generation on women. The research, by scientists from the University of Cambridge, provides important insight into why children born to mothers who consumed an unhealthy diet during pregnancy have an increased risk of health problems later in life. According to this research, poor diet can lead to abnormal development of the pancreatic beta cells which make insulin, the hormone vital for regulating blood sugar levels. This can trigger diabetes in adulthood as the cells "wear out" sooner than usual, said Susan Ozanne of the University of Cambridge, co-leader of the team.

Genital tuberculosis (TB) is a major cause of tubal infertility, said Mamta Jacob of Global Health Advocates (GHA) at a meeting on importance of addressing TB in context of women's health in New Delhi, India, to mark the International Women's Day (8th March). Only two per cent of women with genital TB have live births. It is usually asymptomatic so needs higher degree of suspicion so that proper diagnosis can be made and standard treatment provided as early as possible, said Dr Nerges Mistry, Director, The Foundation for Medical Research, Mumbai, who was another keynote speaker at the above mentioned meet.

It is no coincidence but rather an ill-synergy of a range of factors that increase the risk for a woman to get tuberculosis (TB). In India, sixty per cent women are poor which often means poor living conditions, poor food, long working hours and ignoring health overtime. Fifty five per cent women are anaemic. Anaemia is a cause of TB (as it accelerates progression from latent TB infection to active TB disease) and effect of TB too (once a person develops TB anaemia can set in). Forty eight per cent women are malnourished. Fifty six per cent of India’s total population lives in urban slums (overcrowded, poorly ventilated) out of which women constitute forty seven per cent.

According to the study done by Tuberculosis Research Centre in India alarming numbers of women with tuberculosis (TB) become homeless once diagnosed with TB. At a meeting on importance of addressing TB in context of women’s health organized by Global Health Advocates (GHA) to mark the International Women's Day (8th March), this fact sent shivers down the spine: 100,000 women are abandoned by their husbands due to TB every year in India.