Health and Development Initiative-India, (www.healthinitiative.org), publishes TB News from India' once every two months. The objective of newsletter is to highlight issues related to Tuberculosis and HIV/AIDS control in India and enlist political, public, professional and administrative support for its cause. Health and Development Initiative-India is a not-for-profit organization and the news items have been quoted from various sources for fair use and in public interest. Reproduction of the material published is welcome provided a reference is made to the original source of the news item and TB News from India..

Editorial note:  

Country Coordinating Mechanisms are crucial to success of Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund)

Country Coordinating Mechanisms (CCMs) have been designed as a critical link between the Global Fund and priority community requirements at national level. Their organization and procedures have been intensely deliberated upon at various national and international forums. Owing to the diverse circumstances under which they function, there cannot be a universally applicable prescription. Nevertheless, the CCMs need to be democratic and representative in their character, transparent and communicative in their functioning and accountable both to their local and global communities.

These CCMs, which were expected to pull off a groundbreaking performance, have however encountered bottlenecks at different levels and are finding it tough to deliver. At the Alternative Community Forum held in Bangkok in January this year, participants brainstormed to identify the obstacles that come in the way of civil society participation and involvement in CCMs.

One major barrier recognized was 'lack of communication'. "Information about the CCM process, Global fund application process or its implementation is not disseminated to people living with HIV and civil society in the Asia-Pacific region, which is of major concern” commented the participants. The Forum noted that in majority of the countries, government officials dominate the CCM. The selection of civil society members is merely symbolic and they are meted out a second-class status. The participation of people living with tuberculosis or malaria is negligible or not at all.

Concerns have also been expressed about who should head the CCM- a bureaucrat or a development professional. Even if a consensus eludes this issue there is an agreement that CCMs must never become victims of red tape or inefficiency.

Another useful suggestion made about setting up of sub-national CCMs is worth a serious thought. In large countries like India the CCMs have yet to make their presence felt in all the regions of the country. Sub-national CCMs would be able to elicit added civil society participation and generate proposals that would be of relevance to community needs.

An active civil society participation in CCM activities is a key to its success. Global Network of People Living with HIV is absolutely correct when it says, " Civil society participation per se brings additional skills and knowledge to the table".

We must take note of a candid suggestion from Mr. Mick Matthews, Co-ordinator UK Consortium on AIDS and International Development, "Governments must take this message on board and realize that in effect they are simply an extension of civil society rather than some special entity".

CCMs are crucial to success of the Global Fund. Even in the initial days of their existence, their working is being closely scrutinized. However CCMs cannot complain about it, as the responsibilities they have taken upon themselves are critical to human existence.
 

Poverty, hooch spurt TB amongst tribals in Jharkhand


(Itki, Jharkhand):

Poverty, poor health care and heavy consumption of liquor amongst tribals in the country have led to tuberculosis (TB) taking on epidemic proportions in the region.

The tribal belts of Loherderga, Gumla, Simdega in the highly- backward Jharkhand are the worst affected as 80 percent of the population, mainly males, are suffering from the disease.

Officials at a state-run sanatorium in Itki, 50 km from state capital Ranchi, say that 300 tribals are being treated for TB and 150 more have succumbed to it in the last two years, mainly due to lack of health care in the remote areas.

Doctors cite a near total lack of hygiene and nutrition coupled with the heavy intake of country-made liquor or "hooch", for the spurt of the disease. "Many people cohabit in a single room; they even keep livestock with them. They cook in the same room; children and old people are confined to a single place. The food is not nutritious enough and wide-spread consumption of country- made liquor is only aggravating the situation," said R.P Singh, Chief Physician at the medical centre.

Even in areas close to cities, people either work as daily wage labourers or have their own farming land but in either case the 40-50 rupees (about one US dollar) a day that they make is far from enough.

Studies indicate that although 80 percent of TB patients attend health facilities, few are diagnosed correctly.

Read the complete story at:
http://news.newkerala.com/india-news/index.php?action=fullnews&showcomments=1&id=21592 

Five members of family die of TB in Jharkhand

The Hindu, June 28,2004

Garwah, Jharkhand

Five members of a family, belonging to a primitive tribe, in Tehri village of Jharkhand Garwah district, died of tuberculosis in the past couple of months, according to official reports.

“Jhagoho Korwa and his family, died of the disease in the last couple of months. The isth and last member – 12 year-old Rajju Kurwa is also afflicted with TB,” officials in the district health department said confirming the reports.

When contacted Health Minister Dinesh Sarangi told Press Trust of India on phone “ sufficient medicines have been made available at all health centres but the problem is the patients do not visit these centres. And those who visit, do not complete the six-month treatment, which is compulsory for every TB patient.”

A local initiative in rural Andhra shows the way to community participation in TB control

Contributed by Jyothirmayee Kidambi, E-mail JKPerfect@yahoo.com

The South Indian state of Andhra Pradesh (AP) continues to grapple with a rising number of tuberculosis patients. The rural belt of the state has a less than optimal primary health care system. Thus the achievement of targets set up by Revised National Tuberculosis Control Program (RNTCP) under the DOTS strategy is proving to be a formidable task for AP. However an innovative community participation project being implemented by a community based organization in thirty villages of Bommalaramaram sub-division of Nalgonda District of the state is making an effort to provide a working solution to achieve effective tuberculosis control in such a disadvantaged situation.

Every year more than five thousand new sputum positive tuberculosis (TB) patients are detected in the state. The number of TB patients has risen to 1, 08,180 at the end of March 2003 from 69,622 in March 1997. Various constraints faced by RNTCP in AP include low motivation levels and inadequate training of health workers, little community participation made worse by illiteracy, ignorance and superstitions, technocracy marred by top down decision making and lack of monitoring and evaluation of programme delivery.

The DOTS services were launched in the Nalgonda District in November 2003. Fully aware of the impediments being faced by RNTCP in other areas of AP, Rural Organization for Social Education (ROSE) aided by a Spanish Foundation, ANESVAD decided to launch a project to provide services through Community owned and managed trained health workers, working hand in hand with the existing Government infrastructure and Staff stationed by RNTCP.

As a part of the project ROSE has trained 90 Community Health Workers (CHWs) - 3 villagers from each of the 30 villages in the entire sub-division. The training programme covered various aspects of TB - physical, economical, social and psychological; Health communication, DOTS and Disease Surveillance.

These CHWs have been provided skills to identify suspected TB cases. They motivate such patients to access the services provided by RNTCP for detection and treatment of TB. These workers also take care that the patients adhere to the treatment regimens and other DOTS protocols. In fact these workers act as a 'mediator' between patients and DOTS providers. They also conduct regular awareness programmes to educate the villagers about TB and DOTS services.

The involvement of Community Health Workers, who have taken upon themselves the responsibility of their own villages, has helped TB patients in the villages to begin treatment without delay, and adhere to the regimen as well. Within six months of implementation of the project, ROSE with its trained staff has identified seventy-nine cases of Sputum Smear Positive TB cases in just eight villages of the project. Thirty-seven of these patients have been cured and remaining forty-two are under treatment.

Thus ROSE with its trained CHWs has become a reliable entry as well as enquiry point for the villagers to avail of DOTS services. The CHWs have become a visible local link between RNTCP and their community.

India signs major new AIDS and TB grants

India has signed two new grant agreements with the Global Fund to Fight AIDS, Tuberculosis and Malaria, paving the way for the disbursal of US$ 33 million over the next two years, and totalling US$ 129 million over five years. These vital new grants will help scale up the National HIV/AIDS prevention and control program and expand the national TB control program. These grants were originally approved on January 30, 2003 by the Board of the Global Fund at its second round of grant proposals, at the same time as India signed its first grant agreement with the Global Fund for US$ 5.6 million for TB control as the first phase in a five-year program worth US$ 8.8 million. The Global Fund has subsequently also approved another US$ 15 million for HIV/TB prevention and treatment in its third round of grants. Total commitment from the Global Fund to India now amounts to US$153 million over five years.

More details at:
http://www.theglobalfund.org/en/media_center/press/pr_040210.asp

Kids in North India more susceptible to TB: Study

Toufiq Rashid, Express News Service

A nationwide survey has found that 1 to 2 per cent of children in the 1-9 year age group are at risk of developing tuberculosis in the country annually. It has also found that children in the North zone are at a higher risk of contracting the disease. The sample survey, conducted by National Tuberculosis Institute, Bangalore and the Tuberculosis Research Centre, Chennai from 2000 to 2003, was done in over two years to assess the current situation of TB in the country. The study was conducted in rural and urban clusters in - Haryana, Delhi, Himachal Pradesh, Uttaranchal, Arunachal Pradesh, Sikkim, Nagaland, Manipur, Mizoram, Tripura, Meghalaya and Kerala.

According to the study, children in the North are at a higher risk than in the rest of the country, with an infection prevalence percentage of 10.3 and about 1.9 per cent children at a risk of contracting the disease annually.

Researchers said the prevalence is due to non-immunization. With the BCG scar as the parameter, researchers found that only 45 per cent of children in North zone had been vaccinated.

The survey has come also come up with the fact that a higher proportion of children from urban areas had BCG scars compared to those from rural areas. Despite the above fact, the risk in urban areas was higher than in rural areas due to dense population and polluted environment providing a good condition for TB transmission.

Read the complete story at:
http://indianexpress.com/full_story.php?content_id=41910

Resistance to anti-TB drug found

In another study, the Tuberculosis Research Centre, Chennai and National TB Institute (NTI), Bangalore had undertaken a surveillance of drug resistance in the districts of Hooghly, Jabalpur, Mayurbhanj, North Arcot, Raichur and Wardha to determine the proportion of initial drug resistance among self-reporting new smear positive cases of Pulmonary TB. The results of the surveys show that the prevalence of Multi-Drug Resistant TB (MDR-TB) is 1-3 per cent among previously untreated patients

Read the complete story at:
http://indianexpress.com/full_story.php?content_id=41910

Bovine TB alarms health officials in Dharamsala (Himachal Pradesh)

Increasing cases of bovine tuberculosis in Dharamasala have sent alarm bells ringing as authorities try to contain its spread to humans. Sixty percent of the total 520,000 cattle in the state are partially or fully affected by the disease. Experts say that bovine tuberculosis, which affects the mammary glands, leaves the bacteria of disease in the cattle's milk and the humans get it by consuming this milk. The humans can prevent the disease by taking a preventive vaccine. Keeping the environment hygienic is the only way to protect the animals from the disease.

Read the complete story at:
http://news.newkerala.com/health-news-india/?action=fullnews&id=20964

News from India's neighbours

Bangladesh Government fights losing battle against TB

Sharier Khan, OneWorld South Asia

Despite the government's concerted efforts, pulmonary tuberculosis annually kills over 70,000 people and infects another 300,000 in Bangladesh, with health officials blaming the lack of private sector involvement for the relentless spread of the disease.

They warn that the situation is likely to deteriorate rapidly if the government does not revamp its strategy to fight TB. For over a decade, this country of 140 million people has retained its position as the world's fourth most tuberculosis affected region, after India, China and Indonesia.

The government's free National Tuberculosis Control Program (NTCP), launched in 1993, has been termed a failure. According to estimates, the NTCP has diagnosed only 41 percent of Bangladesh's tuberculosis patients. A majority of the patients remain untreated due to a lack of proper diagnosis, even though there are more than 450 fully equipped laboratories for TB detection close to villages. There are also 44 chest clinics and eight TB segregation hospitals to ensure free treatment.
Yet, the disease seems to be spreading like wildfire across the country. Concedes the program manager of NTCP, Dr Jalaluddin, "We have ignored the private sector and private doctors in the mission of controlling tuberculosis. We have only focused on using government facilities, when a large number of patients actually go to private clinics and doctors. This is one of the major reasons why our efforts have remained far below the target."

Read the complete story at:
http://southasia.oneworld.net/article/view/87201/1/

15 million children in Pakistan suffer from TB every year

Pakistan stands sixth on the WHO list of countries, where tuberculosis has taken the shape of an epidemic. This was stated by Dr SM Afaq of the National Institute of Child Health (NICH) while a talking to journalists. He said that Pakistan receives 0.4 million new cases of TB every year of which 0.15 million are children, below the age of 15 years. Citing statistics he said, in one year, till March 22, 2004, 61 children died of tuberculosis, only in the teaching hospitals of the country. There has been a record increase of TB among children in Pakistan.

In Pakistan, 100 per cent children are susceptible and infected with TB bacilli. Of these 60 per cent are cured, while 40 per cent children have latent tuberculosis. This is the situation when the TB bacilli are present in the body but do not cause disease. Such children suffer from low weight, constant coughing, indigestion and asthma, said Dr Afaq.

Read the complete story at:
http://www.pakistanlink.com/headlines/May04/14/12.html

Web call –The new website for Stoptb.org

Stop TB is a “global movement to accelerate social and political action to stop the unnecessary spread of tuberculosis around the world”. Working under the aegis of WHO and the American lung association, StopTB promotes its activities, achievements and information through its website- www.stoptb.org. The new avatar of the website is based on the uncluttered homepage which has hyperlinks to various news information and resources. There is a facility of viewing a translated version of the page in major South Asian languages. The linked pages however are still from the old website and not updated. The website provides directory of Stop TB partners from various countries including India. It also contains detailed session-wise reports from the Second Stop TB Partners’ Forum held in New Delhi in March this year.

TBNI Editorial Team

Dr. Dinesh Kumar,
dinesh_kumar@vsnl.com 

Dr. Jatinder Singh,
jatindersingh@vsnl.com