Category: Berita

Health agencies around the world are working March 24 to raise awareness and action to combat a disease that claims a victim every 18 seconds: tuberculosis.

Just over 8.5 million people a year fall ill with TB, which is exceeded only by HIV/AIDS in the number of lives taken by a disease caused by a single infectious agent, according to the World Health Organization (WHO). About 1.3 million succumbed to the disease in 2012, and it is the leading cause of death for 20 percent of people with HIV/AIDS.

The toll of the disease is high, but it is slowly declining, and WHO reports that the fulfillment of international goals to slow the spread of the disease by 2015 are in sight.

Of the millions who fall ill each year, as many as 3 million are never seen or treated by public health systems because of isolating factors such as poverty, stigma or lack of access to a health facility. Developing better solutions to “reach the 3 million” is the theme of World TB Day 2014, and members of the StopTB Partnership aim to target better TB diagnosis, treatment, prevention and cures to these overlooked patients.

“To reach those most vulnerable, most at risk, those that are poor, weak, scared, stigmatized and alone — for this, you need additional efforts, you need innovative thinking and, beyond anything else, you need to care,” said Dr. Lucica Ditiu, executive secretary of the Stop TB Partnership, in a press release. “I am happy we are having this conversation on reaching, treating and curing everyone with TB at a global level. This is what it is all about.”

The partnership is highlighting the missing patients and is proposing solutions that grass-roots organizations, governments and the global community might adopt to better address the problem.

The U.S. Centers for Disease Control and Prevention (CDC), the U.S. Agency for International Development (USAID) and the National Institutes of Health (NIH) are among the many partners addressing what is considered a global health emergency. The U.S. agencies are helping countries with high TB caseloads to expand their basic control programs, invest in research and development, and reach vulnerable populations.

source: allafrica.com

 

Air pollution kills about 7 million people worldwide every year, with more than half of the fatalities due to fumes from indoor stoves, according to a new report from the World Health Organization published Tuesday.

The agency said air pollution is the cause of about one in eight deaths and has now become the single biggest environmental health risk.

“We all have to breathe, which makes pollution very hard to avoid,” said Frank Kelly, director of the environmental research group at King’s College London, who was not part of the WHO report.

One of the main risks of pollution is that tiny particles can get deep into the lungs, causing irritation. Scientists also suspect air pollution may be to blame for inflammation in the heart, leading to chronic problems or a heart attack.

WHO estimated that there were about 4.3 million deaths in 2012 caused by indoor air pollution, mostly people cooking inside using wood and coal stoves in Asia. WHO said there were about 3.7 million deaths from outdoor air pollution in 2012, of which nearly 90 percent were in developing countries.

The new estimates are more than double previous figures and based mostly on modeling. The increase is partly due to better information about the health effects of pollution and improved detection methods. Last year, WHO’s cancer agency classified air pollution as a carcinogen, linking dirty air to lung and bladder cancer.

WHO’s report noted women had higher levels of exposure than men in developing countries.

“Poor women and children pay a heavy price from indoor air pollution since they spend more time at home breathing in smoke and soot from leaky coal and wood cook stoves,” Flavia Bustreo, WHO Assistant Director-General for family, women and children’s health, said in a statement.

Other experts said more research was needed to identify the deadliest components of pollution in order to target control measures more effectively.

“We don’t know if dust from the Sahara is as bad as diesel fuel or burning coal,” said Majid Ezzati, chair in global environmental health at Imperial College London.

Kelly said it was mostly up to governments to curb pollution levels, through measures like legislation, moving power stations away from big cities and providing cheap alternatives to indoor wood and coal stoves.

He said people could also reduce their individual exposure to choking fumes by avoiding traveling at rush hour or by taking smaller roads. Despite the increasing use of face masks in heavily polluted cities such as Beijing and Tokyo, Kelly said there was little evidence that they work.

“The real problem is that wearing masks sends out the message we can live with polluted air,” he said. “We need to change our way of life entirely to reduce pollution.” (AP)

source: www.sunstar.com.ph

 

Yulinda Santosa was talking enthusiastically to some people in the room. She was eloquent, cheerful and seemed perfectly healthy. It’s hard to believe that until last year she was still suffering from a serious illness that nearly killed her and forced her to put her life on hold for years.

“It started when I just graduated from high school in 2005. I worked in a factory in Bogor, West Java, and befriended someone who told me that he was suffering from tuberculosis. At that time I wasn’t aware that it was highly contagious,” Yulinda said.

Yulinda spent almost every day talking to her friend, trying to encourage him to toughen up and face his illness, not realizing that she has risked her health by having close contact without adequate protection.

In 2008 Yulinda started to develop some symptoms including a persistent cough and high fever, and she even vomited blood.

She went to her health clinic and the doctor diagnosed her with tuberculosis and put her on a course of treatment.

“After three months I stopped taking medicines, I stopped coughing. I felt much better and I gained the weight I lost when I was sick. But that was when the real tragedy started,” Yulinda said.

In 2010 the illness came back, and the symptoms got worse.

Yulinda had developed multiple drug-resistant tuberculosis (MDR-TB), a strain of the disease that can develop if the initial treatment course is not observed for the full duration of six to eight months.

Yulinda was quarantined for three months while waiting for the doctors to formulate the best treatment for her. Eventually they referred her to Persahabatan Hospital in North Jakarta.

“So that was it. I had to quit college and my job, moved away from my family so I would not infect them and stayed alone in a rented room near the hospital,” she said.

Every day for three years she wore a surgical mask and went to the hospital for her treatment, taking 15 pills and enduring severe side effects including nausea and skin rashes.

Her only consolation was developing friendships with other MDR-TB patients in the hospital.

“The treatment was unbearable sometimes. I was once kicked out of my rented room by the landlady when she found out I had tuberculosis. My fellow patients started to die one by one, so of course it was hard,” Yulinda said.

Yulinda was lucky because the drugs and the treatment were paid for by donors and the hospital.

And after a long struggle she was declared free of tuberculosis in February last year.

After contacting some of the other former patients that she met during her treatment, Yulinda formed a group called Peta or Pejuang Tanggung (Tough Fighters).

The group motivates tuberculosis patients to stick to their treatment by giving them encouragement and support.

Massive challenge

It is estimated some 7,000 Indonesians are suffering from MDR-TB.

Tjandra Yoga Aditama, director general of disease control and environmental health at the Health Ministry, said that only 1,000 MDR-TB patients were undergoing treatment currently, and that all medical expenses were paid by the state.

While Indonesia has been lauded internationally for its success in diagnosing and treating tuberculosis patients, the disease remains a serious challenge for the country.

The World Health Organization estimated there are 456,000 new tuberculosis cases in Indonesia annually, meaning that it shoulders the fourth largest new diagnosis-burden in the world after India, China and South Africa.

Indonesia is also home to the seventh largest number of sufferers of MDR-TB.

A patient who develops MDR-TB must undergo a treatment for at least 24 months. The drugs alone cost $4,000.

MDR-TB can develop into extensive drug-resistant tberculosis, or XDR-TB, for which the survival rate is only 15 percent.

The condition can also develop into totally drug-resistant TB (TDR-TB) where the patient does not respond to any drug treatments at all.

Tjandra said currently there are 20 cases of XDR-TB in Indonesia; four have been cured while the rest are still undergoing intensive treatment.

“Tuberculosis is still a serious problem not only for Indonesia, but for the world,” Tjandra said.

The conventional diagnosis tool used to detect the new cases of tuberculosis has been used for more than 100 years and the newest drug currently available is more than 40 years old, Tjandra said.

“We need more updated drugs, the new drugs are underway but they are not yet available on the market,” he said.

The tuberculosis vaccine, Bacillus Calmette-Guerin vaccine (BCG) which is included in Indonesia’s national routine immunization program, is highly unreliable — it has been more than 90 years since the vaccine was invented.

“It has been proven that the BCG vaccine does not have any significant impact in slowing down the tuberculosis epidemic,” Tjandra said.

Double burden

Ibnu Rizal has a slightly different story from Yulinda. He does not have MDR-TB but he is HIV positive and has been diagnosed with tuberculosis, the most common infection for those with the immune deficiency virus.

Rizal, 28, is an inmate at Salemba Penitentiary in Central Jakarta.

He has been in prison for three years for drug abuse and will be released in the near future.

Instead of feeling relieved and happy, Rizal is feeling weary because he will have to return to his family and tell his wife that he has tuberculosis and HIV and may possibly have infected her.

“I just don’t know how I should tell her. This will come as a great shock for her,” he said.

Rizal found out about his HIV status in 2010 but did not start antiretroviral (ARV) therapy until 2013 because he was afraid of not being able to keep up with his treatment.

An interrupted treatment might have resulted in him developing a resistance and needing to switch to the second line of the drugs, which have more side effects.

Rizal was forced to start his treatment when he later found out he no longer responded to the first line of ARV. On top of that he developed tuberculosis after staying in the damp and overcrowded prison.

“Overcrowding in prison is a serious problem that hampers our efforts to manage tuberculosis transmission,” Tjandra said.

The Health Ministry reported that tuberculosis was the most common cause of death in prisons.

Dyah Ayu Ertikawati, the director for tuberculosis control at the Health Ministry, said some 30 percent of Indonesian prisoners have been affected by the disease because most inmates are living in a damp cell, cramped together in a confined space.

Dyah said Indonesia has started a more progressive approach by introducing the tuberculosis control program in 200 out of 420 prisons in the country.

The program focuses on fixing ventilation systems in prisons for better air circulation and setting up booths to collect spit samples for testing.

Tjandra said the Health Ministry has been working closely with the penitentiaries directorate to control tuberculosis from spreading.

“Right now the program is focused on managing the co-infection between tuberculosis and HIV among the inmates.

I am exploring the possibility of solving the poor sanitation problem as well,” he said.

Better access to treatment

“If we want to ensure the patient’s adherence we have to make sure the access to medication is easy and nearby, that’s what we have been trying to achieve,” Tjandra said.

He said patients’ low adherence was the main reason for tuberculosis’s enduring prevalence. He said the Ministry has been developing a system where a patient can access the treatment and the medication at the nearest health clinic instead of coming all the way to a satellite hospital.

Indonesia has also purchased 23 units of Gen-Expert, the most cutting-edge medical device that is able to rapidly diagnose tuberculosis. Indonesia will purchase 49 more devices by the end of 2014.

“For now we only use Gen-Expert to diagnose MDR-TB and the diagnosis is free of charge,” Tjandra said.

Millions of people worldwide have tuberculosis but are yet to be diagnosed. Poor diagnosis rates are often exacerbated by poor socio-economic conditions and stigma.

“Drugs alone cannot beat tuberculosis in the community, the disease is a condition strongly influenced by low nutrition, poverty, social stigma, environment, rapid urbanization, and large population displacement in many countries. And these are factors that result in so many unreported cases,” Dr Poonam Khetrapal Singh, WHO Regional Director for Southeast Asia, said.

“We have made substantial progress in tuberculosis, but unless we address the social, economic and behavioral determinants that impact the disease, our fight will not be over,” she said.

Indonesia is aiming to eradicate tuberculosis by 2030 but it is generally admitted the target is a daunting task. For a country to be able to declare itself rid of tuberculosis, the prevalence of active infections in the general population must not exceed 10 cases per 100,000 people.

The current rate in Indonesia is 185 per 100,000 people and in prisons it is much higher. Indonesia also aims to reduce the mortality rate from the disease by 95 percent by 2035.

source: www.thejakartaglobe.com

 

In Israel, the disease is diagnosed mainly among foreigners or immigrants, but even here, bacteria are becoming more resistant to existing antibiotics.

The World Health Organization warned on Thursday that resistance of tuberculosis strains to antibiotics is growing, threatening the life and health of people around the world who have been diagnosed with the often-fatal infectious disease spread by mycobacteria.

WHO director-general Dr. Margaret Chan said in Geneva before World TB Day on March 24 that almost half a million people fell ill with multidrug-resistant tuberculosis (MDR-TB) in 2012, yet less than 25 percent of these people were diagnosed, mainly due to a lack of access to quality diagnostic services. The disease is diagnosed in Israel, mainly among foreigners or immigrants from countries where TB is endemic, but even here, bacteria are becoming more resistant to existing antibiotics, which are given over a period of months to defeat the mycobacteria.

“Earlier and faster diagnosis of all forms of TB is vital,” said Chan. “It improves the chances of people getting the right treatment and being cured, and it helps stop spread of drug-resistant disease.” An innovative international project in 27 countries is making promising progress in diagnosing MDR-TB, she continued. The project known as EXPAND-TB (Expanding Access to New Diagnostics for TB), financed by UNITAID, helped to triple the number of MDR-TB cases diagnosed in participating countries.

The theme for World TB Day 2014 is “Reach the 3 Million”. One third of the estimated nine million people falling ill with TB each year do not get the care they need. In many countries, it is hard for people to access diagnostic services – particularly for MDR-TB. Some countries have only one central laboratory, which often has limited capacity to diagnose MDR-TB. In some cases, patient samples have to be sent to other countries for testing. Moreover, traditional diagnostic tests can take more than two months to get results. Chan noted that the situation is beginning to change, as new technologies can rapidly diagnose TB and drug-resistant TB in as little as two hours and prices are going down. Between 2009 to 2013, the number of MDR-TB cases diagnosed in the 27 countries tripled, with 36 000 diagnosed in 2013 alone.

“The gap in access to TB diagnostics and care is far from filled, but is narrowing. With the impetus of modern laboratories, we are on the right track finally to handle MDR-TB,” said Dr Mario Raviglione, director of WHO’s Global TB Program.

source: www.jpost.com

 

By Nuraini Razak

An island once suffering from a record number of malaria cases has managed to eradicate all indigenous cases of the disease, which is a leading cause of death among children under age 5.

SABANG, Indonesia, 19 March 2014 – When Adelia’s fever simply did not go down, she was tested for the second-most-common malaria parasite – malaria vivax. That was in 2011. Thanks to immediate and effective treatment, Adelia, who is now 9 years old, managed to recover fully. But many others before her were not so lucky.

“On Sabang island, basically everyone had malaria at one point in their lives. We were so used to it,” Adelia’s mother, Rahmawati, explains. “But when it happens to one of your own children, I must say, I was terribly worried.”

At one point, Batee Shok, the village Adelia and her mother call home in Aceh province, broke all records, with the highest number of malaria cases to be registered in a single village in Sabang.

Eliminating malaria

Adelia was not yet born when the Indian Ocean tsunami hit Aceh province in 2004 and triggered a massive post-disaster response in the region, but the groundwork on implementing the malaria interventions that would one day save her life was soon to begin.

“After the tsunami, there was an increase in malaria cases in Sabang,” recalls Dr. Titik Yuniarti, Head of Communicable Disease Control in the district health office. “In 2008, we started working with UNICEF to eliminate malaria.”

Financial and technical support from UNICEF catalyzed greater government investment in controlling malaria and in enhancing health systems – and budget allocations from the local government have steadily increased. Reporting has improved among hospitals and private physicians, as has more rapid investigation of reported cases.

In addition to political commitment and community engagement, strict malaria surveillance by the local health department was essential. The local health office included each malaria case in a database, providing information on all possible aspects that may have influenced a person’s risk of exposure, including where he or she lived and whether there were habitats of Anopheles mosquito larva nearby.

These efforts have yielded enormous success. “[T]oday we can claim that we no longer have any indigenous cases on the island,” says Dr. Yuniarti.

Indeed, it was Adelia who suffered the last case of indigenous malaria among Sabang’s 30,000 inhabitants.

“No one should die from a mosquito bite”

Community volunteers, trained by UNICEF, play a vital role in preventing spread of the disease. The volunteers go door-to-door to check on the health of residents and ask whether they are using their insecticide-treated bed nets correctly. A first line of defence against malaria, the nets are distributed by the local government with support from the Global Fund to Fight AIDS, Tuberculosis and Malaria.

The volunteers also collect blood samples. Though the task has earned them the nickname “Dracula,” testing for malaria is critical to identify active cases of the disease, initiate timely treatments and prevent its further spread.

“I want malaria to be eliminated from my island,” says volunteer Srikayanti of Sabang. “It’s ridiculous; no one should die from a mosquito bite, especially no child.”

Three years ago, she made daily house calls for Adelia after she was diagnosed with malaria. Srikayanti wanted to make sure that Adelia fully adhered to her treatment – Artemisinin-based combination therapy – so that the malaria parasite could be fully removed from her system.

Saving more lives

Sabang’s significant gains have implications for saving more children like Adelia from this deadly disease.

The lessons learned in Sabang are now being applied in seven more districts in Aceh province – and have become a model for scaling up surveillance in other malaria-endemic regions throughout Indonesia.

source: www.unicef.org