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The East African : Dec 15th 2014
The EastAfrican OUTLOOK DECEMBER 13-19,2014 Estimated burden of TB in EA Region, 2013 (in thousands) UGANDA 6.6 5 91 200 KENYA 7.5 12 TB Prevalence TB Mortality TANZANIA 140 THE FIGURES In 2012 8.6 million people fell ill with TB 1.3 million people died from TB in 2012 (including 320 000 people with HIV) A total of The trial will also evaluate the revaccination of the BCG vaccine. That is, evaluate the effectiveness of the vaccine when it is given for a second time. According to Dr Sitenei, TB cases are on the increase but prevention is the better option in fighting the disease. The first step in TB prevention is to stop transmission from one adult to another, which is done by identifying people with active TB and then administering the drug treatment. About 56 million TB patients worldwide have been successfully treated since 1995 Upto 22 million lives have been saved since 1995 through DOTS and the Stop TB Strategy “In Kenya, testing and treat- ment of TB is free in all public hospitals,” said Dr Sitenei adding with proper treatment people with active TB will not be infectious and so can no longer spread the disease to others. “Prevention of TB also in- volves stopping people with latent TB from developing active, infectious TB.” He said that anything that in- creases the number of infectious people, such as the presence of TB and HIV infection together, HIV-Positive TB Mortality 4.8 8.2 A doctor prepares a BCG vaccine, which is typically given to infants. Poor healthcare systems have been blamed for the spread of TB in developing countries. Picture: File or which increases the number of people infected by each infectious person, such as ineffective treatment because of drug resistant TB, reduces the overall effect of TB prevention efforts. For TB prevention, WHO rec- ommends the drug isoniazid to be taken daily for at least six months and preferably for nine months. Isoniazid is a cheap drug, but in a similar way to the use of the BCG vaccine, it is mainly used to protect individuals rather than to interrupt transmission between adults. This is because children rarely have infectious TB, and it is hard to administer isoniazid on a large scale to adults who do not exhibit any symptoms. It costs from $100 to $500 to treat normal TB in countries that have the most cases — almost all of them poor countries in Africa and Asia. If TB is eradicated before it can mutate into drug-resistant forms, it is cheaper and easier for all involved, experts say. “Taking isoniazid daily for six months is difficult in respect of adherence, and as a result many individuals who could benefit from the treatment stop taking the drug before the end of the six-month period,” said Dr Sitenei. “This then leads to multidrug resistant TB (MDR-TB).” At a paediatric HIV/Aids conference in Kampala, doctors were unable to agree on whether children infected with HIV should be given isoniazid as preventative treatment for TB. Those arguing for the drug treatment as prevention, claimed that in children co-infected with HIV and TB, up to 50 per cent of exposed children ended up developing the disease. There have also been con- cerns about the possible impact of TB treatment on prevention programmes because of drug resistance. However, a review of scientific evidence has now shown that there is no need for this to be a concern. The benefit of isoniazid preventative therapy for people living with HIV, and who have, or may have had latent TB, has also recently been emphasised. Although the differences be- tween drug-susceptible and drug-resistant TB, as well as HIV status, affect the risk of TB transmission, Dr Sitenei said that people with drug-resistant TB remain infectious for much longer, even if treatment has been started, and this may prolong the risk of transmission in the household. The WHO advocates directly observed therapy (DOTS) under the supervision of health care workers to reduce the emergence of drug resistance. “Every TB patient is supposed 39 to be supervised when taking medication in order to increase adherence and decrease emergence of drug resistance,” said Dr Sitenei. The MDR-TB treatment takes 20-30 months to work depending on the stage and extent of infection. The drugs administered in- clude an injection and five types of tablets to be taken daily. The entire treatment regi- men costs between $18,000 and $36,000. However, Dr Sitenei said that treatment options are limited and expensive; the recommended medicines are not always available and patients experience many adverse side effects from the drugs. In some cases, even more severe drug-resistant tuberculosis can develop. The other challenge to the MDR-TB treatment is the emergence of extensively drug-resistant TB, XDR-TB, a form of multidrug-resistant tuberculosis with additional resistance to more anti-TB drugs that therefore responds to even fewer available medicines. It has been reported in 100 countries worldwide. Kenya has so far reported three cases of XDT-TB and has managed to treat one. Drug resistance can be detect- ed using special laboratory tests that assess the bacterium for sensitivity to the drugs or detect resistance patterns. These tests can be molecular in type (Xpert MTB/RIF) or culture-based. Molecular techniques can provide results within hours and have been successfully implemented even in low resource settings. WHO recommends the use of GeneXpert machine, which provides a two-hour diagnosis. The machine can also detect TB/HIV co-infection as well as drug-resistant strains. Because it is DNA-specific, it only detects the TB bacterium that infects humans only, compared with other tests that also pick up other strains such as bovine TB, which is found in cow’s milk. Kenya, Uganda and Tanza- nia have already adopted the use of the GeneXpert machines to detect TB. Kenya has 100 machines being used in public hospitals and plans to buy more next year. disease inc≥ease by mo≥e than 50pc in poo≥e≥ count≥ies 90pc health risks, such as air pollution, poor nutrition and lax anti-smoking laws, than their counterparts in rich countries, and are more likely to develop a chronic disease. And with limited resources to pay for treatment, those with chronic diseases are much more likely to become disabled and die as a result. In all, about 80 per cent of the deaths and disabilities from chronic diseases in Africa and South Asia involved people under the age of 60, more than double the share in many rich countries, said Thomas J Bollyky, a fellow at the council and one of the report’s authors. In lower-income countries in particular, about 40 per cent of the deaths from chronic diseases occur in people younger than 60, compared with 13 per cent in rich countries. If the trend continues unabated, it could have far-reaching consequences, the report stated, including catastrophic health expendi- tures and impoverishment among low-income populations. At the national level, it would further strain already overburdened health systems and could lead to lower economic productivity. In rich countries, mortality pat- Of children with leukaemia in highincome countries can be cured, but 90 per cent of those with that disease in the world’s 25 poorest countries die from it terns changed slowly, over generations, giving health systems time to adapt. But in poorer countries, the changes are often happening too fast for threadbare health care systems that are still geared toward treating infectious diseases to cope. The report notes that spending on health care in middle- and low-income countries has tripled over the past 20 years but that it is still small: All the governments in sub-Saharan Africa together spend about as much on health care a year as Poland — about $30 billion. Chronic diseases are finding a foothold among much poorer people, who are less able to afford the medicines and treatment that can mitigate their illnesses. In rural Ghana, for example, minimumwage earners with diabetes spend 60 per cent of their incomes on insulin, the report noted. Chronic diseases that are treat- able in developed countries are often death sentences in developing countries, the report notes. For example, 90 per cent of children with leukaemia in high-income countries can be cured, but 90 per cent of those with that disease in the world’s 25 poorest countries die from it. The report, whose contribu- tors include Thomas E Donilon, a former national security adviser in the Obama administration, and Mitch Daniels, a former governor of Indiana and director of the Office of Management and Budget under President George W Bush, called on the United States to make chronic disease a priority in global health funding. The United States spent more than $8 billion on global health aid in 2013, but just $10 million went to fight noncommunicable diseases.
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