Global Issue of TB - Assignment Example

Describe the Global Issue of TB and the Impact It has on The Health System of the Most Affected Region Abstract A third of the world’s population carries latent TB infection, which can appear at any time as symptomatic and at times life threatening disease when the immune systems of the infected persons are compromised. While many will never become ill, those who get are often suffer due to inadequate and incomplete treatment with an undesirable outcome because of their vulnerable and fragile health systems. A major cause of death, TB ranks as the eighth leading cause of death in low and middle income countries. It is third biggest cause of death, after HIV/AIDS and ischemic heart disease in the age group of 15-59 years. There are many undeniable reasons to urgently improve TB control. While millions of people transverse countries and continents every day by crossing borders, global security is at stake. Introduction Tuberculosis (TB) is an airborne, potentially fatal infectious disease, acquiring pandemic proportion affecting almost all countries, is indeed a major global health concern. A third of the world’s population carries latent TB infection, which can appear at any time as symptomatic and at times life threatening disease when the immune systems of the infected persons are compromised. While many will never become ill, those who get are often suffer due to inadequate and incomplete treatment with an undesirable outcome because of their vulnerable and fragile health systems. A major cause of death, TB ranks as the eighth leading cause of death in low and middle income countries. It is third biggest cause of death, after HIV/AIDS and ischemic heart disease in the age group of 15-59 years (Lopez et al. 2006). TB, generally, is a curable disease; people with drug-sensitive type can be cured in six months. However, treatment of multidrug-resistant TB (MDR-TB) that are resistant to isoniazid and rifampicin, the two most important first-line drugs used in treatment of TB, is really challenging. There is around 0.4–0.5 million cases of MDR-TB each year. It requires use of second-line drugs that are costlier with severe side-effects, and treatment has to continue for longer period may be up to two years. Even then prognosis is not always very good for, with success rate of 50% to 70% (WHO 2010). Countries most affected by TB and populations most at risk According to the WHO (2010) each year, there are around 9 million new cases of TB, and about 2 million deaths due to TB infection. Almost every country of the world is affected by the TB, however, most cases (85%) occur in Asia (55%), and Africa (30%) with India and China alone account for 35% of all cases. Of all the world’s TB cases, 80% of the cases are reported from 22 countries (Afghanistan, Bangladesh, Brazil, Cambodia, China, the Democratic Republic of the Congo, Ethiopia, India, Indonesia, Kenya, Mozambique, Myanmar, Nigeria, Pakistan, Philippines, the Russian Federation, South Africa, Thailand, Uganda, the United Republic of Tanzania, Vietnam and Zimbabwe), which are known as high-burden countries (HBCs) and have been given special attention in TB control (WHO 2010). Patients suffering from HIV/AIDS, TB infection is more fatal though such incidence is low, just over 10% of the TB cases that occur each year are among people living with HIV. Africa alone has 80% of such cases. The HIV epidemic caused a major rise in TB cases in Africa during the 1980s and 1990s with highest numbers reached in 2004, and have since begun to decline. There were around 1.3 million deaths from TB among HIV-negative people and around 0.4 million deaths from TB among HIV-positive people in 2009 (WHO 2010). TB is not restricted to low and middle income countries; it has affected the United States as well. According to Centers for Disease Control and Prevention (CDC)’s (2010) report in 2010, a total of 11,181 (a rate of 3.6 cases per 100,000 population) tuberculosis (TB) cases were reported in the United States which was a decline of 3.9% from 2009 cases of 11, 545 TB (a rate of 3.8 cases per 100,000 persons), though, there is a trend of decline in overall cases over the years. There were 544 deaths from TB in 2007 and 644 deaths in 2006. There are many undeniable reasons to urgently improve TB control. While millions of people transverse countries and continents every day by crossing borders, global security is at stake. Majority of the afflicted population is between 15-59 years, the economic burden is unprecedented. The emergence of multidrug-resistant forms of the disease and TB incidence amongst HIV/AIDS patients pose additional challenges. The irony of the disease is that it affects those who cannot afford the treatment and have poor health systems. Chen (2004) calls it “double crisis” of devastating disease and overwhelmingly failing health systems in many low-income countries. Health system utilized by countries most affected In 2000, the UN Millennium Declaration was signed by 189 countries, with eight Millennium Development Goals (MDGs) for development and poverty eradication (UN 2000). Three of the eight MDGs are dedicated to health. The MDG6 is related to TB. These goals are supposed to be achieved by 2015 that led to a series of global health initiatives, including the Global Fund to Fight AIDS, TB and Malaria, Stop TB, Roll Back Malaria, The Presidential Emergency Plan for AIDS Relief, and the Global Alliance for Vaccines and Immunization. All these initiated are intricately linked with concern about the massive health challenges being faced by the world's poorest countries, and many low-income countries are unlikely to achieve the MDG health targets by 2015 (World Bank 2003 and Clemens et al. 2004). Unfortunately those countries away from the targets are the ones for whom all these initiatives were meant. Despite of a number of effective and affordable interventions with international assistance of billion dollar funds there is not much progress and their health systems are really in a bad shape. There is convergence of opinion, evidence based studies and analyses that suggest the biggest obstacles in progress of initiatives and programs to alleviate TB and other diseases is the health systems of the low and middle income countries, the ones most affected by the scourge TB and other diseases. This has led to believe that concerted and coordinated efforts should be made to scale up the health systems of the affected countries. While robust health systems are critical to achieving the health MDGs, there is presently little direct focus on systems strengthening. The motivation to produce results for the MDGs has led many health care providers of the concerned health systems to focus on the disease itself with a notion that through the implementation of specific interventions the system will be automatically strengthened in course of time. The present health systems of the affected countries lack in the key areas such as the health workforce, drug supply, health financing, and information systems. With coordinated endeavors of national governments and international agencies, recently health system strengthening strategies have started that are wider in scope and application. Many innovative initiatives remain at low ebb due many reasons, for example, lack of political will and support, staff indifference, donor interests and inadequate funding. Above all according to some estimates, less than 10% of the world’s biomedical research funds are dedicated to addressing problems that are responsible for 90% of the world’s burden of disease, the so called 90/10 divide. Challenges faced by the Policy Makers These typically include: 1. limited human resources 2. Weak national health governance 3. Slow procurement systems 4. Poor financial management systems 5. No or limited health information 6. Lack of coordination of initiatives Scope and purpose of tuberculosis control regulations According to the WHO’s (2001) Good Practice in Legislation and Regulations for TB Control,” the legislation should provide the legal basis for the implementation of the various measures proven to be of value in combating communicable diseases, and for the continuous and systematic prevention and control of outbreaks. These measures must be: Necessary to prevent the transmission of a disease; Justifiable from a medical point of view, and must not cause needless or unreasonable harm to those affected”. Overall objective of the TB control strategy is to reduce mortality, morbidity and transmission of the disease. The scope and purpose of the regulations is to prevent the transmission of infection. TB Control Regulations shall have the following measures as per the WHO (2001) guidelines: To protect uninfected persons against TB infection To detect cases of infectious TB as early as possible and to initiate treatment To ensure that persons with active TB are given adequate treatment To notify and report cases of TB To perform screening to detect TB infection and disease among close contacts To prevent children from infection and development of the disease by BCG vaccination To prevent the development of the disease by offering prophylactic treatment to high risk population. Plausible strategies to alleviate stress of issue or solve issue The ‘DOTS’ strategy used by the WHO’s Stop TB partnership is evidence based, internationally recommended approach in TB control, It has five components or plausible strategies that have been successfully used all over the world in combating TB. These are as follow: 1. Political commitment: This is the foundation of the strategy for TB control that needs many initiatives, funding and support of regional and national authorities. 2. Early case detection through quality-assured diagnosis: It is crucial to use accurate, reliable, and sensitive diagnostic tests and there has been increasing emphasis on the role of diagnosis based on culture as well as smears, as highlighted by the WHO in the Laboratory strengthening program and goals. 3. Standardized treatment with supervision, and patient support: The highly recommended treatment for drug sensitive TB, is a short-course (six months) of four drugs: isoniazid and rifampicin, the two most effective first-line anti-TB drugs, besides, pyrazinamide and ethambutol. That should cure around 90% of TB cases if a patient has 100 % compliance under supervision for the full course of treatment and drugs are quality-assured. 4. Drug supply and management system: A reliable supply of quality-assured first-line drugs is a requirement for the quality treatment. The WHO’s Stop TB Partnership in 2001 ensures the availability of quality-assured drugs at affordable prices. 5. Monitoring and evaluation: Routine monitoring of the performance of TB control is crucial. The main indicators to monitor DOTS implementation are the number of cases diagnosed and notified, and the percentage of patients who are successfully treated. Conclusion Despite of ambitious goals and initiatives by United Nations, WHO, World Bank, National Governments, host of International bodies and Philanthropic organizations, the progress in alleviating the human population from the scourge of TB is not very heartening. There is huge gap between the goals set and results achieved as many initiative, programs and interventions have not reached a large population yet due to financial and other political reasons. To get rid of the disease completely by 2050 as set in the agenda of the ambitious goals of the WHO and United Nations seem to be a distant dream. The world should unite to Stop TB by coordinated and concerted efforts with adequate funds and right attitude of all the stake holders, otherwise millions of people will lose their lives to this preventable, curable disease that should have been eradicated a long time ago. Reference CDC (2010). Reported tuberculosis in the United States, 2009. Atlanta, GA: US Department of Health and Human Services Chen LC (2004). Harnessing the power of human resources for achieving the MDGs. Geneva: World Health Organization Lopez AD et al. (2006). Global burden of disease and risk factors. New York, Oxford University Press and the World Bank United Nations (2000). Millennium Declaration: A/RES/55/2: resolution adopted by the General Assembly. NY WHO (2001). Good Practice in Legislation and Regulations for TB Control, An Indicator of Political Will. WHO/CDS/TB/290 Geneva, Switzerland WHO (2010). The global plan to stop TB 2011-2015: transforming the fight towards elimination of tuberculosis. Geneva, Switzerland. WHO (2010). Multidrug and extensively drug-resistant TB (M/XDR-TB): 2010 global report on surveillance and response. Geneva, Switzerland World Bank (2003). The Millennium Development Goals for health. Rising to the challenges (draft). Washington Read More