CNS

Preparing the leaders of change for sanitation

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.

More than 3,000 lung health experts and advocates from countries around the world will come together at the 43rd Union World Conference on Lung Health in Kuala Lumpur, Malaysia, to discuss the latest opportunities and challenges in the fight against lung disease. The conference organised by the International Union Against Tuberculosis and Lung Disease (The Union), will be held at the Kuala Lumpur Convention Centre from 13th to 17th November 2012.

In an exclusive interview given to Citizen News Service onsite at the Amrita Endocrinology, Diabetes and Diabetic Foot Conference (AEDFC 2012) held recently at the Amrita Institute of Medical Sciences (AIMS) in Kochi, two renowned and senior stalwarts of the institute’s Department of Endocrinology, Diabetic Lower Limb and Podiatric Surgery, Dr Harish Kumar and Dr Ajit Kumar Varma, shared some of the latest developments that have taken place at AIMS in the field of diabetic foot management.

….So said Dr Mitchell Warren, Executive Director of AVAC: Global Advocacy for HIV Prevention, in an exclusive interview given to CNS onsite at the AIDS Vaccine 2012. Underlining the importance of understanding the complexities of science and community, he emphasized that, “None of the HIV/AIDS prevention methods can be the answer to the problem by themselves. It is not the product but the person who uses it that prevents HIV. A condom will not work if not used. Even if we have the gel or a vaccine unless people think about their risk and go for testing nothing will work. So, one should resist the temptation to fall in love with technology - as all scientific interventions require behavioural changes—not only at the individual level but also at the health system levels.”

The Integrated Child Protection Scheme (ICPS) is a much awaited initiative in Uttar Pradesh. And Rightly so with hopes of both, the government agencies as well as the private NGOs and activists pinned on the scheme for a better, safer and a more organized system of ushering in a protective environment for children in the state. Once implemented the ICPS is being touted as the ultimate accountability apparatus for care and protection as well as an effective juvenile justice system in the state.

Young women, female sex workers, transgender women, women who use drugs and women living with HIV have called on ASEAN to support women and girls living with and affected by HIV. On September 24 and 25, 2012, ASEAN delegates from the ASEAN Task Force on AIDS (ATFOA) and the ASEAN Committee on Women (ACW) gathered together for a “Consultative Meeting on HIV and Key Affected Women and Girls: Reducing Intimate Partner Transmission of HIV in ASEAN” in Luang Prabang, Lao PDR. Civil society and community groups representing key affected women and girls called for scaling up action and resources for policies and programs that address the rights of women and girls in the context of HIV and AIDS.

Charcot neuropathic osteo-arthropathy, commonly referred to as the Charcot Foot, is a condition affecting the bones, joints, and soft tissues of the foot and ankle. The disorder was first brought to the world’s attention in 1983 by Dr Jean Martin Charcot when he referred to the disease process as a complication of syphilis in the knee joint in his patient. Syphilis was believed to be the most common cause of Charcot arthropathy until 1936, when Dr William Jordan linked it to diabetes. Diabetes is now one of the leading causes of Charcot Foot especially in patients with a long history of the disease. In India the incidence is 1%, but detection rates are increasing, perhaps due more awareness.

World Heart Day is on 29th September

Cardiovascular diseases (CVDs) are the world's largest killers, claiming 17.3 million (1 crore 73 lakhs) lives a year. Risk factors for heart disease and stroke include raised blood pressure, cholesterol and glucose levels, smoking, inadequate intake of fruit and vegetables, overweight, obesity and physical inactivity. Heart disease and stroke can be prevented through healthy diet, regular physical activity and avoiding tobacco smoke. Individuals can reduce their risk of CVDs by engaging in regular physical activity, avoiding tobacco use and second-hand tobacco smoke, choosing a diet rich in fruit and vegetables and avoiding foods that are high in fat, sugar and salt, and maintaining a healthy body weight.

A three day Amrita Endocrinology, Diabetes and Diabetic Foot Conference (AEDFC 2012) was recently held in Kochi at the Amrita Institute of Medical Sciences (AIMS). It brought together clinicians, surgeons and researchers from across the country and the world to re energize the grey cells and deliberate upon various problems related to endocrinology and diabetes, with special emphasis on the management of diabetic foot infections, which could so often be life/limb threatening and yet are largely misunderstood and/or ignored by the public as well as medical fraternity.

With over 200,000 diabetic foot related amputations in India every year, it is critically important to do all that is warranted to salvage, and to care for, the feet of the people living with diabetes. Dr Robert Frykberg, Chief of the Podiatry Section, Carl T Hayden VA Medical Center, Phoenix, Arizona, USA, said to Citizen News Service (CNS) at the Amrita Endocrine, Diabetes and Diabetic Foot Conference (AEDFC 2012): "Rate of amputations is probably higher in India with 200,000 amputations per year in India [than in USA]. About 15-20% patients of diabetic foot might end up with amputations."

Foot care for people with diabetes attains a high priority, given the risk they have for developing complications which, if not cared for, might lead to serious outcomes, such as amputation. In the hospital setting, caring for feet of people with diabetes needs a well-coordinated and multi-speciality response that engages different specialist doctors and other healthcare providers. This was a clear message coming out of the Amrita Endocrine, Diabetes and Diabetic Foot Conference (AEDFC 2012) held in Kochi, India.

Microbicides Set To Change The landscape Of HIV Prevention

The concept of microbicides as an HIV prevention tool was first proposed 20 years ago. Microbicide is a product applied topically in the vagina or rectum with the intention of preventing sexually transmitted infections (STIs) including HIV. It can take different forms such as a gel, foam or a ring. The idea to use the ARV-based tenovofir gel was mooted in 2003 but the proof of concept came only in 2010. The microbicide tenofovir gel was found safe and effective in reducing the risk of HIV in women who used it before and after vaginal sex in a study called CAPRISA 004. The CAPRISA 004 study demonstrated an overall 39% reduction in HIV infection, with 54% HIV reduction in women who used tenofovir gel consistently, providing proof of concept that microbicides indeed can prevent sexually transmitted HIV if used consistently.

In the event that control and elimination of HIV is realised in the next few years, maintaining this success is going to be hard without a vaccine. That is how the Director of the US’ National Institutes of Allergy and Infectious Disease Dr Anthony Fauci analysed the situation at the AIDS Vaccine 2012 conference which ended Wednesday (Sept.12) in the American city of Boston. “If you want to have [HIV] control and maintenance of control, elimination and maintenance of elimination, in my mind the science and behaviour will tell me that it will virtually impossible to get to the point of true control and elimination without a vaccine,” said Dr Fauci in a keynote lecture.

Modeling based on a timeline where 80 percent coverage of Voluntary Medical Male Circumcision (VMMC) of men age 15-49 is achieved by 2015 suggests that more than 20 percent of new HIV infections would be averted by 2025, with financial savings of an estimated USD 16.6 billion in future medical costs, said Cindra Feuer, Communications and Policy Advisor, AVAC - Global Advocacy for HIV Prevention at AIDS Vaccine 2012.