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TB News from India: March-April 2002 Issue

(TB News from India is published by Health and Development Initiative-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

SAARC leaders stress the need for evolving a regional strategy to combat HIV/AIDS & TB

SAARC leaders stress the need for evolving a regional strategy to combat HIV/AIDS and TB

Heads of Government of seven South Asian countries, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan and Sri Lanka met at the 11th meeting of South Asian Association for Regional Cooperation (SAARC) in Kathmandu from 4th to 6th January this year. They adopted a SAARC Declaration which lays down the development oriented agenda for the region. The leaders recognized the debilitating and widespread impact of HIV/AIDS, TB and other communicable deadly diseases on the population of South Asia and stressed the need for evolving a regional strategy to combat these diseases. The strategy should include, inter-alia, culturally appropriate preventive measures, an affordable treatment regime and should specially target the vulnerable groups. In this regard, they felt that SAARC should collaborate with international organizations and civil society on those diseases. They also emphasized that the SAARC tuberculosis center in Kathmandu should play a coordinating role in the related areas.

The leaders of one of the most impoverished region of world were on the mark when they identified TB along with HIV/AIDS as principal diseases, which have inflicted enormous socio-economic costs on the people of this region. SAARC region alone accounts for 40 percent of the global TB burden with 1.1 million new smear positive cases and 0.6 million deaths each year. Almost 50 percent of adults of this region have already been infected with TB. 

In terms of individual countries, Bangladesh accounted for 3.6 percent of the TB cases worldwide in 1997. TB kills over 60,000 people in the country every year, branding it as the worst TB-affected country in South Asia and the fourth worst-affected in the world. TB remains a major killer disease in Bangladesh. One person succumbs to TB every 10 minutes while one person get infected every 2 minutes. According to recent estimates, there are 600,000 existing cases of TB; with 1,41000 new sputum smear positive (SS+) cases reported every year in this country ridden with poverty. 

Nepal has 80,000 TB patients, half of them infectious and every year 21500 new (SS+) TB cases occur.

Pakistan has the sixth highest tuberculosis rate globally, and the country accounts for 44 per cent of all TB cases in the Eastern Mediterranean region (of WHO), comprising 23 countries. Pakistan has 1.5 million TB patients. Each year, 250,000 persons tend to develop this illness. Only 24% population of the country has access to DOTS. According to World Health Organization statistics, the incidence of TB infection in Pakistan is 177 per 100,000 people. But the rate in the border areas is more like 450 per 100,000. More than 3 million Afghan refugees reside there, having fled civil unrest, drought and the recent anti-terrorist military conflict. About half of them live in camps along the border. Afghan refugees in Pakistan are suffering from high rates of tuberculosis as an outgrowth of crowded living conditions, poor ventilation and malnutrition, an American Refugee Committee team found during an assessment mission.

India carries a third of global TB burden. An estimated one in two of the adult population are infected with TB bacterium. The TB epidemic continues to grow, every year, two million people develop active tuberculosis (more than any other country in the world). More people now die from tuberculosis than ever before -nearly 4,50000 every year. More than 1000 persons die of the disease each day. Barely 42% population (410 million people) of the country had access to DOTS till December 2001.

The burden of Tuberculosis in the SAARC region is massive. This serious situation will worsen further with Tuberculosis/HIV co-infection (nearly 2 million people are co infected with TB and HIV in South East Asia) and multi-drug resistant Tuberculosis. Regional cooperation is an urgent need for TB control. Pakistan (and Afghanistan) is already dealing with high TB infection rates. Hundreds of thousands of refugees are living in cramped conditions along their common border. In these circumstances there is a real risk that even more people will fall victim to the disease. 
The political will for TB control programme demonstrated by leaders of SAARC countries in the declaration needs to be translated into action. The members of national parliaments and state assemblies or other key opinion leaders who influence the national policies need to be made aware of the magnitude of the TB epidemic in this region. Greater political interest in TB control will in turn reinforce the national TB control programmes.

Global Disease Fund to Be Strict For Better Chance to Get Results - Rejects India's request for free TB drugs twice.

Poor and beset with the world's biggest tuberculosis epidemic, India seemed a perfect candidate for free TB drugs offered through the World Health Organization (WHO). But, over the past year, the WHO has turned down India's request - twice, reports The Wall Street Journal in its issue dated 13th February 2002. Mark Schoofs and Michael M. Phillips Staff Reporters of The Wall Street Journal recount that people familiar with the situation say India couldn't convince the WHO that it had a viable plan to bring more patients under directly observed therapy (DOTS). India isn't the only country that has had trouble making the grade. Of the 25 nations that have applied for free TB drugs, only 16 have so far been approved.

The strict WHO application process "is not there to create barriers to assistance," says Diana Weil, a senior public-health specialist at the World Bank and one of the experts who reviews TB-aid applications. But, "because it's a fund that buys drugs . . . it is particularly important that it fit into a larger strategy." Critics of the free-drug program argue that the U.N. underestimated the effectiveness of India's TB program. But even those critics concede that the U.N. stood firm. "Certainly it's an example of the U.N. saying no to a powerful country," says one veteran TB expert with knowledge of the case.

WHO officials won't discuss India's TB-aid application. They say, however, that with U.N. help, India's TB program has improved enormously, and the country is now on the verge of qualifying for free drugs.

(Break-the-silence discussion forum coordinated by Health and Development Network: BTS discussion archives are available at: http://www.hdnet.org  )

Economics of Health: Editorial in The Tribune Chandigarh

Medical news seldom gets the media and public attention it deserves in this politics-crazy country writes The Tribune published from Chandigarh in an Editorial on 12th February 2002. That is why when Union Health Minister C.P. Thakur announced in Tamilnadu that the country would soon have a new health policy and a separate policy on AIDS and blood transfusion not many took notice. With four million AIDS/HIV cases, the country ranks second in the world after South Africa in the number of AIDS sufferers. Apart from AIDS, the other major causes of avoidable deaths are hepatitis B, malaria, tuberculosis, childhood infectious diseases, maternal and pre-natal conditions and micronutrient deficiencies. The governments (both in the states and the one at the Center) need to spend more on health. The economic benefits of a healthy and disease-free society are not adequately realized laments the article. With a health cover within reach, healthier, even if impoverished, families will have fewer children. They can then spend more on the education and well being of their children, which ultimately would translate into higher incomes and better economic growth. To make this a reality the country needs an awakened political leadership, a responsive bureaucracy and an active involvement of the medical community and the general public the article concludes.

Read the full article at: http://www.tribuneindia.com/2002/20020212/edit.htm#3 

HIV/AIDS high on agenda on Manipur political parties

Politicians in Manipur, a North-eastern Indian State, have a new constituency. HIV-infected and AIDS patients and high-risk groups like drug users and sex workers. And every political party has put HIV/AIDS awareness and control on their "priority lists" and in their manifestos for the State assembly Election held in February 2002.

The lead has been taken by the newly formed Democratic Peoples' Party (DRP) which in its manifesto, promises maximum autonomy to the Manipur AIDS Control Society, subsidizing medicines and allotting more funds to NGOs working in the sector. In fact, the DRP has invited leading NGOs like Manipur Network of Positives. Even parties like the Samta Party and the BJP have made token mentions and say when asked that the "matter is serious".

Human Rights activists and NGOs are enthused with this change and say that, even such lip service was missing earlier. Now no party can ignore this problem. Statistics are alarming, by December 2001, 12,817 out of 82,399 samples (in Manipur) tested were found HIV positive. Of this, 1033 have full blown AIDS. The number of confirmed deaths due to AIDS is officially 193.HIV has entered homes of even common man. And it makes good political sense to address this. But even now the problem has not been addressed systematically.

The wining party or coalition has to move from its manifesto to real time management of AIDS and HIV.

Read the full story at:
http://www.timesofindia.com/articleshow.asp?catkey=-2128936835&art_id=827989735&sType=1  

Government launches TB control project 

The West Bengal government will give maximum emphasis to the national tuberculosis control programme reports Times Of India Network in a story dated January 07, 2002 from Kolkata. 

This was stated by Minister of State for Health Pratyush Mukherjee said while launching the 'Directly Observed Treatment - Short Course Chemotherapy Project' in West Bengal, organized by the Cooperative Assistance for Relief Everywhere (CARE), the state government and Calcutta Municipal Corporation. West Bengal was selected for launching the project because it is prone to various kinds of communicable diseases and cases of TB are quite high. Around 15,000 tuberculosis cases are detected annually.

The state government wants to ensure direct observatory treatment of Tuberculosis patients until they are fully cured. Already 13 districts have been covered by the scheme and another five will soon be brought under it. Dr Subroto Mukherjee from CARE said that they would work as a facilitator to the government in the DOT project for reaching to the lowest level at the districts. This help will be extended in Kolkata, Hoogly, Howrah, Murshidabad, Nadia and Malda. Although the government has a directly observed treatment center in the districts with a population of 100,000 under it for providing service to TB affected patients, it is not possible on its part to keep trace of individual TB cases. CARE will do this job. There are many patients who hesitate to come at the center and would prefer to go to the private practitioner. We will coordinate with these practitioners to ensure that the patient takes the treatment until the disease is fully cured, Mukherjee said.

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