Category: Berita

18 MARCH 2013 | GENEVA – WHO and the Global Fund to Fight AIDS, TB and Malaria said today that strains of tuberculosis with resistance to multiple drugs could spread widely and highlight an annual need of at least US$ 1.6 billion in international funding for treatment and prevention of the disease.

Dr Margaret Chan, Director-General of WHO, and Dr Mark Dybul, Executive Director of the Global Fund, said that the only way to carry out the urgent work of identifying all new cases of tuberculosis, while simultaneously making progress against the most serious existing cases, will be to mobilize significant funding from domestic sources and international donors.

With the overwhelming majority of international funding for tuberculosis coming through the Global Fund, they said, it is imperative that efforts to raise money be effective this year. Growing alarm about the threat of multi-drug resistant TB, also known as MDR-TB, is making that even more pressing.

“We are treading water at a time when we desperately need to scale up our response to MDR-TB,” said Dr Chan. “We have gained a lot of ground in TB control through international collaboration, but it can easily be lost if we do not act now.”

WHO and the Global Fund have identified an anticipated gap of US$ 1.6 billion in annual international support for the fight against tuberculosis in 118 low- and middle-income countries on top of an estimated US$ 3.2 billion that could be provided by the countries themselves. Filling this gap could enable full treatment for 17 million TB and multidrug-resistant TB patients and save 6 million lives between 2014-2016.

“It is critical that we raise the funding that is urgently needed to control this disease,” said Dr Dybul. “If we don’t act now, our costs could skyrocket. It is invest now or pay forever.”

Dr Chan and Dr Dybul spoke to the media in Geneva in advance of World TB Day on 24 March, which commemorates the day in 1882 when Dr Robert Koch discovered the mycobacterium that causes tuberculosis.

While the Millennium Development Goal of turning around the TB epidemic has already been met, the 2% decline in the number of people falling ill with TB each year remains too slow. Two regions – Africa and Europe – are not on track to achieve the global target of halving the TB death rate between 1990 and 2015. In 2011, 1.4 million people died due to TB, with the greatest per capita death rate in Africa. Multidrug-resistant TB (MDR-TB) presents a major threat, with an estimated 630,000 people ill worldwide with this form of TB today.

WHO worked with the Global Fund and the Stop TB Partnership to support selected high TB burden countries in reviewing their priorities for the next three years and estimating available funding and gaps. Estimates have been made for 118 countries eligible for Global Fund support. Of the US$ 1.6 billion gap in donor financing, almost 60% is for WHO’s Africa region.

In the 118 countries, there are four priority areas for domestic and international investment to drive down deaths, alleviate suffering, cut transmission and contain spread of drug resistance.

• For the core areas of expanded diagnosis and effective treatment for drug-susceptible TB (which will prevent MDR-TB), a total of US$ 2.6 billion is needed each year for the 2014-2016 period. For 2011, funding of about US$ 2 billion was available. In low-income countries, especially in Africa, this is the largest area for increased financing.
• Prompt and effective treatment for multidrug-resistant TB requires an estimated total of US$ 1.3 billion per year. This is where the greatest increase in funding is needed in the coming years. For 2011, funding of US$ 0.5 billion was available.
• Uptake of new rapid diagnostics and associated laboratory strengthening, especially for the diagnosis of MDR-TB and for TB diagnosis among people living with HIV, requires US$ 600 million per year.
• Excluding antiretroviral treatment for TB patients living with HIV, which is financed by HIV programmes and their donors, about US$ 330 million is required for HIV-associated TB interventions, such as testing TB patients for HIV, ensuring regular screening for active TB disease among people living with HIV, and providing TB preventive treatment.

In addition to the US$ 1.6 billion annual gap in international financing for the critical implementation interventions above, WHO and partners estimate that there is a US$ 1.3 billion annual gap for TB research and development during the period 2014-2016, including clinical trials for new TB drugs, diagnostics and vaccines.

(source: www.who.int)

Indah Kristina, a working mother with a 5-year-old daughter, is deeply concerned about the string of media reports on sexual abuse of children in Indonesia over the past few months.

“I’m scared to think that it could have been my child. I don’t even want to take my eyes off of her because I noticed many victims were raped or sexually abused by people they knew and trusted,” the 31-year-old event organizer told the Jakarta Globe.

However, as a single mother, Indah must work and leave her daughter in the care of teachers or a nanny from time to time. Indah said she started giving her young daughter lessons about her own body in very simple ways that she could easily understand.

“I can’t watch her 24 hours a day, so I told her that not everybody can touch her private parts. My daughter also knows she’s not allowed to let any man enter her room without supervision,” she said.

In the past few months, Indonesia has been rocked by shocking cases of children being sexually abused.

In January, an 11-year-old girl fell into coma for six days and later died of infection. Doctors confirmed she had been sexually abused and contracted sexually transmitted diseases from her rapist.

It was later learned that the girl was raped several times by her own father.

In late February, the family of a 5-year-old boy filed a report to the police after he was allegedly sodomized by his neighbors, a police officer and a construction worker.

The boy was severely traumatized, and medical examination revealed he had been sexually abused.

Shortly after the case went public, the family had to evacuate after being intimidated by neighbors who did not believe the boy’s claim and thought the family was trying to stir up trouble.

“We have already declared 2013 as a year of national emergency over child sexual abuse. This is totally unacceptable,” said Arist Merdeka Sirait, chairman of the National Commission for Child Protection (Komnas PA), a nongovernmental organization advocating children’s issues.

Arist said there had been a worrying escalation in the number of child sex abuse cases. In 2010, Komnas PA received 2,046 reports of violence against children, 42 percent of which were sexual.

In 2012, the figure had risen to 2,637 cases, 62 percent of them sexual abuse.

“Remember this is just the tip of the iceberg, many more cases go unreported,” Arist added.

Maria Advianti, secretary of the Indonesian Commission on Child Protection (KPAI), said the most worrying part was that most rape or sexual abuses were committed by family members.

“In such cases, the probability of the victim filing a report is even lower.”

Maria said rape committed by family members usually went unreported because the family could not bear the shame if it was publicly known.

“We have heard cases where daughters were raped by their own fathers for years, in such cases where it would be impossible for the mothers to be totally ignorant, she said.

“I believe the mothers knew but were too afraid to say anything out of shame, or because the fathers were the bread-winner, and if the fathers went to jail the family would not have any means to survive.”

Community’s role

“We need to change society’s mindset. People must know that there is nothing private when it comes to rape or domestic violence,” Arist said.

“The neighborhood has a shared responsibility to be aware of what’s happening in their surroundings, and if the neighbor knows something but doesn’t say anything about it because they believe it’s none of their business then they too must be held accountable.”

Gregorius Pandu Setiawan, a prominent psychiatrist and former director of mental health at the Ministry of Health, echoed that sentiment, saying communities must be alert all the time.

“Children are the easiest prey for sexual predators because they are completely powerless against adults, physically and psychologically, not to mention most abuses come with a threat, so terrified children do not say anything. It’s society’s job to notice if something is wrong,” he said.

Pandu said that in urban areas there was a growing trend of people gradually stopping to care about what’s going on in their surroundings.

“It has happened in a densely populated city like Jakarta: with so many stress triggers in their life, people simply do not care about what’s going on,” he said.

Arist said children would continue to be victimized by sexual predators as long as Indonesians did not perceive sex abuse as a serious crime.

“Sadly it has been deeply ingrained in our permissive society that women and children are sex objects, and we need to re-educate our people so that nobody should be subjected to such atrocities. We need to speak up,” he said.

In late 2012, a 14-year-old student in Depok was expelled from her school after she was kidnapped and raped by a man she met online.

The growing use of the Internet and social media in Indonesia has also played a role in the escalating number of cases of sexual abuse against children.

Last week, a 15-year-old junior high school student was raped by several men after she agreed to meet someone she befriended on Facebook.

“In the social media era, even 10-year-olds have started using Facebook or Twitter. Parents must take control before it’s too late,” Arist warned.

“Internet use is inevitable in this age, and we can’t stop our children from using it, but we can teach them how to use the Internet healthily.”

Arist said many children spend excessive amounts of time in front of computers or gadgets because their family was dysfunctional and did not provide them with security or a sense of protection. He said unhappy children would resort to the Internet to seek attention and could easily fall prey to seduction by strangers.

“Many of those children who agreed to meet their captors were loners who did not get the affection they wanted from their family. Strengthening family values and spending more quality time with our children might change this, he added.

Maria proposed that parents monitor what their children were doing on the Internet carefully.

“Don’t give them limited access to the Internet but assist and guide them. Parents must also check what the children have been browsing,” she said.

Tougher laws, or better enforcement?

Arist said the growing prevalence of child sexual abuse indicated a failure in the Indonesian legal system.

“Clearly our current law isn’t working, it doesn’t provide any deterrent for the perpetrator,” he said.

Under the 2002 Law on Child Protection, anyone who has intercourse with a minor can face up to 15 years in prison and a maximum fine of Rp 60 million ($6,200).

“We need to revise the law; the minimum punishment for child sex abuse should be at least 15 years while the maximum sanction should be a life sentence,” Arist said.

“There should be additional punishments if the perpetrators were the parents, teachers, or police officers of the children, and supposed to protect them.”

But Maria said Indonesia did not need to revise the law, just make sure law enforcement was upheld.

“I think the current law is sufficient, it’s the enforcement that concerns me; many times prosecutors only demand seven to eight years for the perpetrators, so they could walk free in a few years,” she said.

University of Indonesia criminologist Erlangga Masdiana said harsher punishments alone would not be enough to reduce the rate of sexual violence in Indonesia.

“The problem is much more complex than that. There’s the demoralization problem and the poverty issue [for example]. The government must address these issues individually, and we need to strengthen our fading spiritual values, be it religion or anything else,” he said.

For victims of sexual abuse, serious counseling sessions are needed to help their psychological recovery.

Maria said there were several counseling or trauma centers run by the government or private organizations that provided assistance to rape victims.

“But the number is nowhere near enough compared to the number of children being victimized by sexual predators, that’s why we need to empower our society so everyone can take part in healing traumatized children,” she said.

Pandu added that victims of sex abuse must be handled very carefully to properly heal their trauma, with the counseling done in a very private and safe environment.

“It really angers me to see children who have been sexually victimized interviewed on TV with their faces covered by a mask, it’s really dangerous for their mental health,” he said.

Pandu said it was very unlikely for victims to forget what happened, but with proper care their pain could be eased.

“The counselors must have the capacity to handle these vulnerable children, and all of society must ensure they can return to a safe environment without any stigma and without any worry that the horrible experience could happen again,” he said.

(source: www.thejakartaglobe.com )

JAKARTA, 15 March 2013 (IRIN) – A new healthcare-for-all programme in Indonesia’s capital, Jakarta, is under scrutiny following the recent death of two patients who allegedly received inadequate hospital care. National officials are monitoring the city’s response and experience ahead of the rollout of a government scheme to provide universal health care by 2019.

Last November the Indonesian capital’s governor, Joko Widodo, launched a healthcare programme that sought to cover all 10 million of Jakarta’s residents by 2014.

Under the initial phase of the programme, called Kartu Jakarta Sehat (Healthy Jakarta Card), 4.7 million people will be eligible for affordable health care in third class hospital wards (the cheapest ward where one room is occupied by three or more patients) in more than 90 of the city’s 147 hospitals this year, said Dien Emawati, head of Jakarta Health Department. The governor has said he wants all public hospitals to join the programme.

“Kartu Jakarta Sehat has some shortcomings, but it’s working and it’s progress compared to the previous programmes,” Emawati told IRIN.

Unlike the healthcare scheme under the previous governor, residents are not required to prove their income status, a lengthy process that often involved bribing officials.

Automatic eligibility has resulted in an increase of up to 70 percent in the number of people treated, Emawati said.

“Some hospitals have been overwhelmed by patients, partly because the programme has prompted underequipped and understaffed ‘puskesmas’ [government-run health clinics] to refer patients directly to hospitals [rather than attempting treatment first],” she said.

When local media reported the death of a premature baby in February after she was denied neonatal intensive care by at least eight hospitals, the public’s attention – and fury – turned on the new healthcare programme.

The Health Ministry said the baby was not refused treatment because of the family’s inability to pay, but rather because a hospital’s neonatal intensive care unit was full, or it did not have such a facility.

In the latest case, a 14-year-old girl died from an intestinal infection on 9 March after hospitals reportedly denied treatment.

Government response

In response to the rising number of patients as well as complaints about inadequate treatment, Emawati said her office is working with the University of Indonesia’s medical school and Cipto Mangunkusomo national hospital in Jakarta to improve health workers’ skills.

The Jakarta administration also seeks to strengthen the role of hospital medical committees to ensure appropriate treatment. The medical committee includes doctors appointed by the Jakarta government to oversee implementation of the citywide health care programme and audit the appropriateness of treatment (including drug dispensation).

Following local protests over the baby’s death, the administration set up “Hotline 119” for people to get information on the availability of class III rooms in hospitals across the capital.

From most to least expensive, the hospital wards are: VVIP, VIP, first class, second class and third class. By law, at least 25 percent of a hospital’s patient wards must be third class.

Governor Widodo has urged hospitals to convert some of their second class wards into third class ones to cope with rising demand for care among the poor, and warned of sanctions if patients were turned away based on income.

When the government rolls out universal health coverage nationwide in 2014, it may face similar problems as Jakarta does now, said Kartono Mohamad, a health care reform proponent and former chairman of the Indonesian Medical Association.

“In the first few months demand will be high [and] hospitals will struggle to cope,” Mohamad said. “Even people with minor complaints will seek treatment. These kinds of things will need to be anticipated, both in terms of infrastructure and resources.”

“Trade-offs are inevitable” in trying to reach efficiency, equity, and sustainability in health care access, concluded research on nine low and middle-income countries’ experiences with national insurance schemes.

Health insurance for all

Indonesia is seeking to provide all Indonesians with health insurance by 2019, as mandated by a 2004 law.

The government has set up an administering body called BPJS Kesehatan, which will begin operating in January 2014 with an initial investment of US$2.6 billion to harmonize existing national and regional health schemes launched in recent years to help the poorest access health care.

Mohamad said in the early phase of its operation, BPJS will take over the role of one of the state insurance companies currently covering 27 million residents, which means it will serve civil servants and salaried employees who already have insurance policies with that company. Both state insurance companies will eventually be disbanded, and their assets taken over by BPJS.

Currently about 60 percent of Indonesia’s 240 million people are covered by health insurance.

A government health waiver for the poor, Jamkesmas, covers 76 million people while state-run insurance companies cover another 45 million.

There is still disagreement within the government about the amount of premiums to be paid to BPJS. The Health Ministry proposes 22,000 rupiah ($2.30) per person monthly, with the government covering this for the poorest, while the People’s Welfare Ministry is seeking a lower premium of $1.50.

For universal health care to work nationwide, Indonesia also needs to regulate the pharmaceutical sector, said Mohamad, adding that “invisible costs” like kickbacks to hospital staff and officials have boosted drug prices multi-fold.

“The absence of a drug policy has prompted pharmaceutical companies to compete to persuade hospitals and doctors to prescribe their products. The practice leads to doctors being bought and as a result, drugs have become increasingly expensive,” he said.

Indonesia has 25 health workers per 10,000 residents on average – which meets the World Health Organization’s minimum of 23 workers per 10,000 residents – but most of this resource is in densely-populated urban centres, leaving parts of the archipelago completely uncovered.

“The idea of universal health coverage as mandated by the law is still far off,” Mohamad concluded.

(source: www.irinnews.org)

Administering early treatment shortly after HIV infection could lead to a so-called functional cure in approximately one out of every 10 patients infected with the virus that causes AIDS, according to a new study published in the journal PLoS Pathogens.

Lead researcher Asier Sáez-Cirión of the Institut Pasteur in Paris and colleagues discovered that 14 patients who were treated within the first two months following infection were eventually able to stop combination antiretroviral therapy without the virus rebounding, explained MedPage Today North American Correspondent Michael Smith.

The 33- to 66-year-old French patients involved in the study, who were identified by BBC News Health and Science Reporter James Gallagher as the Visconti cohort, all started their treatments within ten weeks of being infected.

They remained on the medication, which helps keep the virus at bay but cannot eliminate it, for an average of three years before stopping treatment. Normally, the virus rebounds, but not in the case of the Visconti patients, some of whom have been able to control their HIV levels for a decade, Gallagher said.

While all 14 patients technically still have HIV, in most cases the virus is undetectable without the use of ultrasensitive laboratory equipment, the researchers report. Saez-Cirion told the BBC the treatment will not be able to control the infection in most patients, but that between five and 15 percent of them will be functionally cured. Essentially, that means that the infection will go into a sort of remission.

“The finding follows recent reports that a baby girl born with HIV in Mississippi in the United States has been cured after receiving standard drug therapy,” Sam Marsden of The Telegraph said on Friday.

He added that scientists have said that there are “intriguing parallels” between the new study and the curious case of a Mississippi baby that was said to be functionally cured of the disease at the age of 23 months. However, those experts also warned that the phenomenon “was rare and warned that most people with HIV would develop full-blown AIDS if they stopped taking medication.”

“These individuals reflect what a functional cure may represent because they have been actually controlling the infection for many years now,” Saez-Cirion told the AFP news agency, according to Marsden. “I think this is proof of concept that this may be achieved in individuals. And that this happened thanks to early treatment onset.”

HIV, or human immunodeficiency virus, is a lentivirus that causes acquired immunodeficiency syndrome (AIDS) – a condition in which a person’s immune system begins to fail. AIDS can lead to life-threatening opportunistic infections transferred through bodily fluids, often through unprotected sex, sex, contaminated needles, breast milk, and transmission from an infected mother to her baby at birth.

Blood screens have largely eliminated transmission through blood transfusions and infected blood products in the developed world. Nonetheless, the World Health Organization (WHO) considered HIV infection to be a pandemic. From its discovery in 1981 through 2006, AIDS has killed over 25 million people and has infected approximately 0.6 percent of the world’s population.

(source: www.redorbit.com)

LONDON (Reuters) – A Saudi man infected with a deadly new virus from the same family as SARS has died, becoming the ninth patient in the world to be killed the disease which has so far infected 15, the World Health Organization said on Tuesday.

The 39-year-old developed symptoms of the novel coronavirus (NCoV) on February 24 and died on March 2, several days after being hospitalized, the WHO said in a disease outbreak update.

NCoV is from the same family of viruses as those that cause common colds and the one that caused the deadly outbreak of Severe Acute Respiratory Syndrome (SARS) that first emerged in Asia in 2003. The new virus is not the same as SARS, but similar to it and also to other coronaviruses found in bats.

The WHO first issued an international alert in September after the virus infected a Qatari man in Britain who had recently been in Saudi Arabia.

Symptoms of NCoV include severe respiratory illness, fever, coughing and breathing difficulties.

“Preliminary investigation indicated that the (latest Saudi)patient had no contact with previously reported cases of NCoV infection,” the WHO said. “Other potential exposures are under investigation.”

Nine of the 15 people confirmed to have been infected with NCoV have died. Most cases have been in the Middle East or in patients who had recently traveled there.

Research by scientists in Europe has found that NCoV is well adapted to infecting humans and may be treatable with medicines similar to the ones used for SARS, which killed a tenth of the 8,000 people it infected.

The Geneva-based WHO said it was monitoring the situation closely and urged its member states to continue surveillance for severe acute respiratory infections and to carefully review any unusual patterns.

“WHO is currently working with international experts and countries where cases have been reported to assess the situation and review recommendations for surveillance and monitoring,” it said, adding that national authorities should “promptly assess and notify” it of any new NCoV cases.

(source: news.yahoo.com)