CNS

Bold and audacious steps needed for TB control

Diana E Wangari, CNS Special Correspondent

Photo credit: Diana Wangari/CNS

When the Indian Minister of Health and Family Welfare Dr. Harsh Vardhan made a speech at the WHO Global Tuberculosis Symposium held just prior to the 45th Union World Conference on Lung Health in Barcelona, he was greeted with a roaring applause. I could not help but wonder whether it was in recognition for the inspirational speech just delivered or it was an appreciative gesture for a step long overdue.

WHO launches new guidelines on management of latent TB infection

Shobha Shukla, Citizen News Service - CNS

For the first time, the World Health Organization (WHO) has issued guidelines on testing, treating and managing latent TB infection (LTBI) in individuals with high risk of developing the disease. These guidelines were launched today at the Global TB Symposium just before the start of the 45th Union World Conference on Lung Health in Barcelona.

As HIV prevention needs and contexts vary, it is important to expand the range of effective prevention options that people can use. Archbishop Desmond Tutu said in a video link at the first-ever international conference on all HIV-related biomedical prevention research, that “No single method of prevention can end this epidemic on its own." That is why conferences on microbicides and vaccines merged to provide one single global platform to deliberate on a spectrum of biomedical prevention research for HIV. HIV Research for Prevention (HIVR4P) is being held in Cape Town, South Africa.

Owen Nyaka, CNS Correspondent, Malawi
The International Union Against Tuberculosis and Lung Disease (The Union) and the World Diabetes Foundation recently released a report at the 45th Union World Conference on Lung Health in Barcelona calling for international action against the looming co-epidemic of diabetes and TB.

There is a direct and irreconcilable conflict of interest between tobacco industry and public health policy. This conflict of interest is also enshrined in the preamble of the Article 5.3 of the global tobacco treaty (formally called WHO Framework Convention on Tobacco Control). The WHO Director-General Dr Margaret Chan had said at a recent meeting in Moscow: "Giving any tobacco company a place at the negotiation table [of global tobacco treaty] is akin to appointing a committee of foxes to take care of your chickens."

Shobha Shukla, Citizen News Service - CNS
In May 2014, the World Health Assembly approved the WHO's new post-2015 global TB strategy and targets for tuberculosis, which aims to achieve the targets for 2035-- 95% decline in TB deaths and 90% decline in TB incidence rate compared with 2015--less than 10 TB cases per 100, 000 population, and the elimination of catastrophic costs for TB-affected households. It is a 20 years approach but also includes the expectation to have by 2025 new revolutionary tools like shorter and better regimens for TB and MDR-TB.

VIP visits proving catastrophic for this slum

Dr Sandeep Pandey, Magsaysay Awardee and CNS Columnist

[Video of burning slum] Some 160 families live in a slum opposite the ‘Bhavishya Nidhi Bhawan’ office in Vibhuti Khand, Gomti Nagar, Lucknow. The consist of mostly a scheduled caste community which makes stone items and a muslim community which makes traditional Indian percussion instrument ‘dholak’. In 2009 the Governor was supposed to come and inaugurate the Human Rights Commission office located nearby. So that the poor did not come in the way of Governor, the slum was bulldozed by Lucknow Development Authority. When the Governor’s office came to know about this they felt it would be too embarrassing for the Governor to go and inaugurate the Human Rights Commission after such a human rights violation act had taken place. The Governor never came.

Chhatra Karki, CNS Correspondent, Nepal
Are you suffering from an ear-abscess? Be careful if you have not undergone treatment for a long time. Delay in treatment can cause the pus from the abscess to spread all over the head and result in a cerebral abscess. Heart problems can further compound the risks.

The torment of common citizens

Dr Sandeep Pandey, Magsaysay Awardee and CNS Columnist

Shanti devi is a stone cutter belonging to scheduled caste community. She lives in a village called Meerpur Sudihamau of Barabanki district. She was visiting her brother Gabbar in Lucknow in June 2014 with her entire family. Gabbar lives in a slum opposite Bhavishya Nidhi Bhawan and Seema Shashastra Bal campus in Vibhuti Khand, Gomti Nagar, Lucknow. On the night of 3rd-4th June, 2014 at 1 am her husband Vinod went out to urinate by the side of road. A speeding car came and hit him. It dragged his for a while and then fled the scene of accident. Vinod was taken to KGMU Trauma centre but could not be saved.

Transforming Women’s Lives Through Radio and TV

Swapna Majumdar, CNS Special Correspondent

Photo Credit: Swapna Majumdar

In 2008, in De Mugogo, an impoverished village in the Democratic Republic of Congo (DRC), voices of women were heard for the first time on a community radio-- Radio Bubusa FM was the first community radio set up by women in DRC’s South Kivu province. The radio station, exclusively for rural women, shared information on health, violence against women, HIV/AIDS, and food security with a community that had never before listened to a radio.

Photo Credit: Carolyn Kavita

Carolyn Kavita Tauro, CNS Correspondent, India
For those who have been fighting for tobacco control, Wednesday the 15th of October was a step ahead when the Health Minister of India announced that, come 1st April 2015, graphic and text warnings (which reflect the adverse effects of smoking and are meant to act as a deterrent to the buyers) will cover up to 85% of space on both sides of cigarette packs and other tobacco products. 60% space will be devoted to pictorial warnings while 25% will be covered by textual warnings.

Chhatra Karki, CNS Correspondent, Nepal
TB has established its strong foothold as an epidemic, especially in the low and middle income countries, and diabetes is adding fuel to the fire. World Health Organization (WHO) identifies about 8.6 million cases of TB annually. At the same time, around 382 million people in the world live with diabetes. This cannot be good!

[Audio podcast] This the first time ever when global tobacco treaty negotiations are taking place in Russian Federation. While sharing an internal tobacco industry document that is now in public domain, Dr Margaret Chan, Director General of the World Health Organization (WHO) said: “One record shows that there was an internal discussion whether the [tobacco] industry should consider children as part of its market. I remember very well one reply which I would like to quote: ‘they have got lips, we want them’. They [tobacco industries] just want market share, they could not care less whether they are killing children or not.”

Allies of tobacco industry had tried to persuade government delegations before the global tobacco treaty negotiations began in Moscow earlier this week. But governments who have ratified the global tobacco treaty voted for public health and not corporate interests. Dr Margaret Chan, Director General of the World Health Organization (WHO) said at the opening of Sixth Session of the Conference of the Parties to the WHO Framework Convention on Tobacco Control (FCTC): “In a brazen move, the tobacco industry brought its agenda and its voice here to the heart of tobacco control. [On Sunday 12th October,] at the International Tax and Investment Centre, whose board of directors include several tobacco companies, had convened parties and observers to discuss tobacco tax and price policies without fully disclosing their vested interests.”

Alice Tembe, CNS Correspondent, Swaziland
As the world mobilizes for the world’s largest global conference on lung health issues in Barcelona –the 45th Union World Conference on Lung Health organized by The International Union against Tuberculosis and Lung Disease (The Union) from October 28 through November 1, 2014, it is essential to learn from our past as new research evidence surfaces. Since the advent of HIV in the 1980s and 1990s, TB was seen as a number one opportunistic infection accounting for the highest number of deaths among people living with HIV (PLHIV) in Swaziland, noted by the then Executive Director of the National Emergency Response Council on HIV-AIDS, Dr Von Vissel.

Programmatic Management of MDR-TB by Private Health Sector in the Philippines

Nenet Ortega, CNS Correspondent, Philippines

Several Asian countries, including Philippines, come in the bracket of 22 high TB burden countries in the world. The Department of Health of Philippines, implements the National Tuberculosis Control Programme (NTP) through its health offices and units of 81 provinces and 1,634 municipal and city governments. Direct services are provided mainly at the primary health centres that utilize the Directly Observed Treatment Short Course (DOTS) strategy to treat TB.

Will diabetes add the last straw on the burdened back of TB?

Shobha Shukla, Citizen News Service - CNS

According to a new Series about TB and diabetes, published in The Lancet Diabetes and Endocrinology, the rapid increase in rates of type-2 diabetes, especially in low- and middle-income countries where TB is endemic, could thwart global efforts to control and eliminate TB. Currently there are 8.6 million cases of TB annually and the worldwide population of people living with diabetes is 382 million.

Do doctors engage patients? Consumers central to evidence-informed healthcare

Shobha Shukla and Bobby Ramakant, CNS

Dr Kay Dickersin,
Director US Cochrane Center

Who decides the questions health scientists research upon to find reliable answers? Do the patients decide or other consumers, or the doctors, or the policy makers, or other stakeholders make a call? How important is the consumer voice in decision-making on the research tables? "There is one famous example, when doctors and patients of rheumatoid arthritis came together. Doctors had assumed pain to be a major research outcome that patients were interested in. When they engaged the patients in their discussions doctors were very surprised because what was most important to the patients is that they felt tired all the time. It had not occurred to doctors that feeling tired is something they should be studying. It is very important that people interact and we learn a lot about what we have not been measuring because of the assumptions" said Dr Kay Dickersin, Director, Center for Clinical Trials, John Hopkins Bloomberg School of Public Health and Director of the US Cochrane Center.

Evidence shows we can prevent obesity in children: E Waters, Anne Anderson Awardee 2014

Shobha Shukla and Bobby Ramakant, CNS

Prof Elizabeth Waters
Anne Anderson Awardee 2014

Researchers have demonstrated that childhood obesity prevention programmes have a positive health impact on body mass index (BMI - a measure of body fat based upon height and weight). So policies and practices should take this evidence into consideration to nip alarming rates of childhood obesity. Professor Elizabeth Waters, Jack Brockhoff Chair of Public Health in University of Melbourne, did this game-changing systematic review on childhood obesity prevention with her colleagues, which is the most downloaded review in The Cochrane Library. Prof Waters was also awarded the prestigious Anne Anderson Award for 2014 at 22nd Cochrane Colloquium in Hyderabad, India.

Babs Verblackt, CNS Correspondent
Indoor air quality concerns more than just the fumes and smoke in the house. Dampness and mould pose health risks too, especially for people living with asthma. Researchers warn that people's living habits and the new energy efficient technology used to revamp old houses might actually give indoor damp and mould more room to rise. The need for adequate heating, ventilation and home maintenance remains crucial for ones lung health.

Modi's economic policy at loggerheads with Gandhi's vision

Dr Rahul Pandey and Dr Sandeep Pandey, CNS Columnist

Mahatma Gandhi’s birth anniversary is an opportune time to assess Prime Minister (PM) Narendra Modi’s major policy thrusts on the economic front. His policy contrasts both with Gandhi’s vision and with what is needed to develop long term capabilities in India’s workforce and economic infrastructure. In a nutshell Modi’s economic policy is an accelerated version of that of former PM Manmohan Singh and his United Progressive Alliance (UPA) government.

Photo credit: Alina Saba

Shobha Shukla, CNS Columnist
Climate change seems to be the new food for thought for world leaders to chew upon. Recently 122 heads of state gathered in New York City for the UN Climate Summit, organised by UN Secretary General Ban Ki Moon, aimed to mobilize action to prevent looming climate disasters and garner political will for a new climate change treaty by the end of 2015.

Connect researchers and policy makers for maximising evidence-informed public health gains

Bobby Ramakant and Shobha Shukla, CNS

Dr Taryn Young

When scientists produce evidence that a public health intervention works (or not works), why does it takes years of delay to implement these learnings into programmes on the ground? Dr Taryn Young, Director, Centre for Evidence-Based Health Care at Stellenbosch University, South Africa, said to Citizen News Service (CNS) at the 22nd Cochrane Colloquium in Hyderabad, India: "We see a gap between the evidence being ready and actually being implemented. Because whole evidence-informed policy making and practice takes some time as there are many other factors, costing, feasibility, acceptability, politics, etc."

Early diagnosis of female genital TB can reduce morbidity

Dr AG Radhika, CNS Columnist

Photo credit: CNS: citizen-news.org

Tuberculosis (TB) is an important health problem in the low and middle income countries. Pulmonary TB is estimated to have affected about 14 million people in India, most of who are in the reproductive age group. About 12% of women with pulmonary TB also suffer from female genital TB (FGTB). FGTB constitutes almost 9% of extra-pulmonary cases of TB and 13% of gynaecological admissions in India. Infertility is the most frequent clinical presentation of FGTB (43%-74%).

Dr Meenu Singh, co-chair
22nd Cochrane Colloquium

Shobha Shukla, CNS Columnist
Very often the plea for simple and effective healthcare for children gets drowned in the din of voices of vested interests (including those of pharmaceutical companies) that clamour to draw attention to long lasting adult diseases like cardiac, neurological, and diabetes problems, just to name a few. Producing/selling drugs for them is far more profitable than for childhood diseases like diarrohea and pneumonia, which have a short span, and so are nobody’s baby. It is high time we stood up for the cause of evidence based healthcare for children.

Rhythm of the heart

Dr Bobby John, CNS Columnist

A little fluttering in the chest or pounding of the heart is all too familiar and a common phenomenon that we often ignore; rightly so, when it is before a public speech or while we run to catch a bus or train that is leaving the platform. These are normal responses to stressful events. However, when it occurs without any rhyme or reason, then we ought to give it some thought.

Wikipedia and Cochrane collaboration: Big push for evidence-informed public health

Shobha Shukla and Bobby Ramakant, CNS

Dr David Tovey

The Cochrane Collaboration has undoubtedly succeeded in deepening the roots of evidence-based medicine, policy and practice, despite challenges and limitations. How to ensure that healthcare professionals, policy makers, and citizens can have access to this reliable and trustworthy evidence while making decisions is indeed a key challenge. At 22nd Cochrane Colloquium, Wikipedia and Cochrane collaboration attracted huge attention: because it can indeed be a potential game-changer in terms of widening the audience manifold, astronomically!

Knowledge translation into policy is not automatic, it is political: Dr Binayak Sen

Shobha Shukla and Bobby Ramakant, CNS

"Translation of knowledge into policy is not automatic. It is a political process" said Dr Binayak Sen, a recipient of prestigious Jonathan Mann Award for Global Health and Human Rights in 2008. He spoke to Citizen News Service (CNS) at 22nd Cochrane Colloquium in Hyderabad, India, and remarked that "technical advancements in informatics and processing of information and the impulse towards democratization of knowledge structures have come together at this Colloquium. Coming together of these two processes will create an impulse for genuine democratization of medical knowledge. We are looking forward to the day when everybody will be able to access all the medical knowledge in the world. At least there should be no barrier for people who want to access knowledge from medical system."

Medical malpractices: Is there light at the end of the tunnel?

Shobha Shukla and Bobby Ramakant, CNS

Dr Peter Gotzsche

The noblest professional of all-to heal fellow human beings- is certainly witnessing its worst decay. Dr Peter Gotzsche, Director, Nordic Cochrane Centre and Professor in University of Copenhagen, said to Citizen News Service (CNS): "There is a lot that needs to change in healthcare. It is one of the most corrupted sectors in society. In Denmark, for example, we have thousands of doctors who are on industry payrolls - they are consultants, they sit on advisory boards - but in reality it is a soft form of bribery because if you do not behave as expected you will no longer be on the payroll." Dr Gotzsche is one of the sanest voices in medical fraternity striving hard to bring evidence-based medicine, ethics and integrity back in fashion.

Dr Jeremy Grimshaw

Shobha Shukla and Bobby Ramakant, CNS
Till recently, medical schooling curriculum did not include training for searching medical literature, doing systematic reviews or finding credible evidence from time-tested repositories such as The Cochrane Library. But in the last decade or so, medical training has incorporated some of the evidence-based medicine principles in countries such as Canada. Dr Jeremy Grimshaw, Director of Canadian Cochrane Centre and current co-chair of The Cochrane Collaboration globally spoke with Citizen News Service (CNS) on the sidelines of 22nd Cochrane Colloquium in Hyderabad, India.

Prof Lisa Bero
Photo credit: UCSF

Shobha Shukla and Bobby Ramakant, CNS
The World Health Organization (WHO) has accepted the Cochrane Collaboration, the largest repository of systematic reviews that provides reliable and thorough evidence on healthcare, as a non-governmental agency in "official relations with WHO". This collaboration between the two can potentially accelerate the uptake of evidence-based medicine, health policy and practice. Citizen News Service (CNS) interviewed Professor Lisa A Bero, the key leader in the Cochrane Collaboration who helped make this synergistic two-ways linkage happen in 2011.

Hyderabad to Cape Town: Evidence driving medical research and health systems strengthening

Shobha Shukla and Bobby Ramakant, CNS

Prof Jimmy Volmink

"We develop medicines and other therapies which are based on very good research, but then we offer those therapies often in ways that are untested and have never been evaluated. So there is a natural progression from making sure that our treatments are evidence-based, to the next phase of ensuring that the way we offer those treatments to people is also evidence-based” said Professor Jimmy Volmink, Director of South African Cochrane Centre and Dean, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.

Chhatra Karki, CNS Correspondent
Situated at an altitude of 2,400 metres, Toplang, a village in the South West district of Dhading, Nepal, has been successfully maintaining its identity as an 'organic village' of the country. The village is merely an hour's drive along the Chandragiri hill from Kathmandu's Thankot pass.