24 March: World TB Day: Can India stop drug-resistant TB too?
This World Tuberculosis (TB) Day (24 March) is another opportunity for people of India to review their TB responses. Drug susceptible TB is treatable, curable and with proper programme interventions, it is possible to believe in the theme of World TB Day: 'I can stop TB'. Can we say the same for drug-resistant TB?
Drug-resistant TB has been recorded in the world at the highest levels ever according to the World Health Organization (WHO) report (Anti-Tuberculosis Drug Resistance in the World, February 2008).
DOTS (directly-observed treatment short-course), is the internationally recommended TB control strategy that includes standardized case detection, treatment and patient support. It requires consistent drug supply and effective monitoring systems. According to WHO, drug resistant TB is a symptom of poor programme performance. If we hope to change the outcome, and decrease the proportion of drug resistant TB, doesn't the DOTS model need to be adapted or its implementation improved? More of the same might only compound the TB drug resistance threat.
The African, South-East Asian and Western pacific regions account for 83% of total TB case notifications according to the Global Tuberculosis Control report of WHO (March 2008). China, India and Indonesia are home to two-in-three of the world's TB cases. The Africa region has the highest TB incidence rate. These countries are expanding coverage of its TB programme at record-breaking speed. In its shadow, drug resistance is also upping the pace.
The proportion of resistance to at least one anti-TB drug (any resistance) was found to be as high as 56.3% in Azerbaijan.
Multi drug-resistant TB (MDR-TB) is defined as TB with resistance to isoniazid and rifampicin, the two most powerful first line anti-TB drugs. MDR-TB patients have significantly poor outcomes than patients with drug susceptible TB.
Global estimates indicate that 4.8% of TB cases were of MDR-TB (about half a million MDR-TB patients). Currently treatment is available only to one out of ten MDR-TB patients and 90% of MDR-TB patients cannot have access to treatment they need today.
About 50% of MDR-TB cases are in India and China because of large population. In Africa, hard-hit by HIV, the proportion of TB drug-resistance is no less alarming. In former Soviet Union, almost half of all TB cases are resistant to at least one anti-TB drug and every fifth case of TB will be of MDR-TB.
Extensively drug-resistant TB (XDR-TB) is virtually untreatable and likely to emerge where second-line anti-TB drugs are widely and inappropriately used. XDR-TB is more expensive and difficult to treat than MDR-TB and outcomes for patients are much worse with mortality rates very high. So far 46 countries have reported XDR-TB with UK reporting the first XDR-TB case last week.
Studies suggest that transmission of TB, especially the drug-resistant strains is more likely to take place where people living with HIV (PLHIV) congregate. Healthcare settings, for example those for anti-retroviral (ARV) delivery, is one such place where improper infection control can put PLHIV at risk of contracting TB. TB is the most common opportunistic infection and leading cause of death for PLHIV. Improving infection control in healthcare settings is clearly vital, doable and potentially life saving.
In many countries insufficient laboratory capacity to test drug-resistance is a serious impediment in scaling up TB programmes. Even the new WHO report on TB drug-resistance had data only from 6 African countries because other countries had no laboratory capacity to provide data on anti-TB drug-resistance. Developing laboratories to provide rapid diagnosis of anti-TB drug-resistance, particularly for PLHIV, is of utmost importance to improve TB responses.
Not only more and better TB drugs and diagnostics in the public sector are urgently needed but also better strategies to make TB control programmes work more effectively for the most vulnerable and hard to reach communities are essential to improving treatment adherence and, as a consequence, reducing drug resistance.
Random Stories
7 Nov 2016 - 9:19pm |
AT News
A close door meet of Sarbananda Sonowal and Rajnath Singh failed to find out a clear cut strategy to avoid the huge controversy over the move to amend the Citizenship Act. The Assam Chief Minister...
6 Aug 2016 - 7:14pm |
AT News
Patriotic People’s Front Assam (PPFA) expresses shock and utter dismay over the unwanted diktat imposed by a section of rebellion elements in Manipur on Irom Sharmila Chanu for her decision to end...
6 Mar 2009 - 8:47pm |
editor
Altogether four persons were killed as suspected DHD(J) militants shot dead the parents of two of thier former colleagues in North Cachar hills district on Friday morning.According to information, a...
26 Jul 2007 - 5:58am |
editor
Silchar : Two elephants went berserk and trampled nine people to death in Hawaithang under Dhalai Police Station in Cachar District. Forest Officials however managed to track the two elephants and...
Other Contents by Author
The smoke-free policies in India were enforced since 2 October 2008 and different states are at varying levels of its implementation, yet the tobacco cessation services are still limited to very few clinics in India.A lead article published in The Economist (7-13 March 2009) says: "tobacco is more addictive than virtually all of them [narcotic drugs]."With tobacco being highly addictive, it is clear that for a successful implementation of the smoke-free policies, the scaling up of high-quality and reliable tobacco cessation services can no longer be ignored."Large areas in central and north-east India have more than 65 per cent tobacco use" said Dr Pratima Murthy, who is the...
On 23 January 2009, the Group of Ministers (GoM) in India will again meet to assuage concerns of tobacco lobby on pictorial warnings, health activists apprehend.This group of ministers (GoM) consists of: Pranab Mukherjee (External Affairs Minister), Kamal Nath (Commerce and Industry Minister), Priyaranjan Dasmunsi (former Information and Broadcasting Minister), S Jaipal Reddy (Urban Development Minister), Dr Anbumani Ramadoss (Health and family welfare Minister), and Oscar Fernandes (labour and employment Minister for state). The pictorial warnings on tobacco products are proven to reduce tobacco consumption. Particularly in countries like India, where literacy rates are alarmingly low, it...
To confront the present war posturing between India and Pakistan, the citizens of both countries are launching a joint signature petition campaign on 9 January 2009, to voice their mandate against terrorism, war posturing and to promote mutual cooperation and peace. This signature petition campaign shall conclude on 8 February 2009, after which these signatures shall be handed over to the heads of both the nations along with other prominent stakeholders. Citizens of both nations can also sign online here or by going to the following URL: http://www.PetitionOnline.com/ indopak/petition.html The petition states that the citizens of Pakistan and India demand that: The Government of Pakistan...
The first patient was successfully treated by the state-of-the-art technology in radiotherapy – linear accelerator, which began functioning last week at RR Cancer Institute and Research Centre, Sri Ram Murti Smarak Institute of Medical Sciences (SRMSIMS), Bareilly in India.A linear accelerator (LINAC) is the device most commonly used for external beam radiation treatments for patients with cancer. The linear accelerator can also be used in stereotactic radiosurgery similar to that achieved using the gamma knife on targets within the brain. The linear accelerator can also be used to treat areas outside of the brain. It delivers a uniform dose of high-energy x-ray to the region of the...
India is reeking under increasing communal polarisation and urgent steps to check it are warranted. Between 24 August and 2 October 2008, more than 300 villages in 14 districts of Orissa state were affected by communal violence. 4,300 houses were burnt and 57 people were killed. 2 women were gang-raped. 149 churches and 13 educational institutions were attacked. In Kartnataka state, 19 churches in 4 districts were attacked and 20 women sustained serious injuries. In other states of India, like in Kerala 3 churches were attacked, in Madhya Pradesh 4 churches were attacked, and one church was attacked in Delhi and Tamil Nadu each. In the state of Uttarakhand, 2 people were killed. In all the...
India has boldly enforced the smoke-free policies banning smoking in public places and private areas with public access from 2 October 2008 – the birth anniversary of the father of nation Mahatma Gandhi.The government of India and countless people who have been advocating the enforcement of public health policies need due credit. It was certainly not so easy, more so because of the financially robust, strategically shrewd tobacco industry that has mastered the art of circumventing public interest policies and promoting a product (tobacco) that kills even when used as intended by the manufacturer.The tobacco industry, and other corporations or associations like ITC ltd, Indian Hotel...
The 3rd edition of the "Global Tobacco Treaty Action Guide 2008: Protecting Against Tobacco Industry Interference" was released earlier this week in many countries including India, during International Week of Resistance (IWR) to tobacco transnationals (22-28 September 2008). The Global Tobacco Treaty Action Guide 2008 is produced by Corporate Accountability International [which is in official relations with the World Health Organization (WHO)], along with the Network for Accountability of Tobacco Transnationals (NATT).The need for IWR was never so acute – when on one hand government of India is resolved to enforce the nation-wide ban on smoking from 2 October 2008, the...
It is a pity that India's robust smoke-free policies have been challenged by those with vested interests neglecting the immense and undisputed proven public health benefits of implementing such policies for people at-large. India is to ban smoking in public places nation-wide from October 2. However the ITC Limited and the Indian Hotel Association are among those who have challenged these public health policies in the court of law. The hearing by the honourable court is due."Secondhand smoke, also know as environmental tobacco smoke (ETS), is a mixture of the smoke given off by the burning end of a cigarette, pipe or cigar and the smoke exhaled from the lungs of smokers. It is...
There is a growing consensus to raise awareness about diabetes in the 50 days leading up to World Diabetes Day on 14 November 2008. The International Diabetes Federation announced that the theme for this year's campaign is "Diabetes in Children and Adolescents."Diabetes is one of the most common chronic diseases to affect children. It can strike children of any age, even toddlers and babies. Every day more than 200 children are diagnosed with type 1 diabetes, requiring them to take multiple daily insulin shots and monitor the glucose levels in their blood. It is increasing at a rate of 3% each year among children and rising even faster in pre-school children at a rate of 5% per year...
All tobacco products will display approved pictorial warnings and nicotine-tar levels from 30 November 2008, as per a notification issued by the Indian Ministry of Health and Family Welfare (dated 27 August 2008), in accordance with the Cigarettes and Other Tobacco Products (Prohibition of advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, 2003. The implementation of pictorial warnings on tobacco products in India was initially planned for February 2007, but got deferred four times thereon.Grim images of diseased lungs will appear on cigarette, bidi and gutkha packets, as per the notification, covering 40 per cent of the surface area of the tobacco...
Add new comment