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

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 the 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. 

Talking of individual countries, TB remains a major killer disease in Bangladesh. One in every 10 minutes dies of TB in this country, while one in every 2 minutes get infected. In 1997, Bangladesh accounted for 3.6 percent of the TB cases worldwide. 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. 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 patients 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  )

Article 1

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 Tamil Nadu 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 

Article 2

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 DPP 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  

Article 3

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.

Article 4

Deadly diseases prey on hotel boys

Over 10,000 teenagers form the workforce of Mumbai's booming restaurant business. Part of the organized as well as the unorganized sector, these boys are highly prone to contracting AIDS, tuberculosis and sexually transmitted diseases, reports Sharmistha Chatterjee in Times of India dated January 05, 2002 

Nikute Mishra (13), a cleaning boy in a restaurant in Parel, works 18 hours a day and sleeps on a straw mat in a dingy room, along with nine others. The restaurant owner sent him for a check-up after he coughed blood. He has been diagnosed for tuberculosis.

Atul (15) ran away from his home in Karnataka at the age of nine and now works in a Udipi restaurant at Dadar. A frequenter to the red light areas, he was tested positive for HIV.

"Mumbai has one of the biggest hotel businesses in the country," points out Dr Arvind Shah, senior medical officer at the Mumbai Municipal Corporation's STD Clinic, which caters to a large number of such patients. "And these boys are highly vulnerable to these killer diseases."
Various health organizations in the city have identified them as high-risk groups and working towards spreading the word of awareness. According to Nirja Mattoo, executive member of an NGO called Community AIDS & Sponsorship Programme, which is working with over 1000 such restaurant boys, "the working conditions at most restaurants are not conducive. The boys develop numerous health problems, besides being exposed to homosexual incidents." Part of the large migrant population from interior Maharashtra (in western India) and Karnataka (in South India), eight out of every 10 such hotel workers are initiated into the world of brothels.
Read the full text of story at: http://www.timesofindia.com/articleshow.asp?catkey=1225119221&art_id=1060236898&sType=1 


Article 5

Bihar Government may supply TB drugs through NGOs

TIMES NEWS NETWORK [MONDAY, FEBRUARY 04, 2002 reports that Bihar Minister of state for health Akhilesh Prasad Singh, while inaugurating the third conference of the Bihar Tuberculosis Association (BTA) here on Sunday, said that the state government would consider the proposal for supplying TB medicines through NGOs of repute like the BTA for free distribution among such patients. The minister said this in reply to BTA chairman U N Vidyarthi's welcome address in which he maintained that the elusive target of controlling TB can be achieved only through the concerted efforts of all the components of the health care system, including government departments, private practitioners, NGOs and the media.

Vidyarthi said involvement of the community plays a vital role in successful implementation of the National Tuberculosis Control Programme. NGOs are normally closer to and more trusted by patients. They play an active role in health promotion in the community as they work in such areas where access to medical facilities is limited and as such the NGOs have an important role to play in the government-sponsored programmes.

Referring to the poor management and lack of infrastructure of the government-sponsored Primary Health Centers and sub-canters, he said most of such centers are unable to meet the requirements of patients.

http://www.timesofindia.com/articleshow.asp?catkey=-2128817995&art_id=71685882&sType=1  

Web Call: A visit to www.dantb.org  

The Danish Agency for Development Assistance (DANIDA ) has been sustaining various projects in the health sector in India since the late 1970s through different ventures in areas as diverse as primary health care, control of leprosy (DANLEP) and blindness (DANPCB). Since 1996, it has been supporting the control of tuberculosis through DANTB. Danida's support to RNTCP in the Indian State of Orissa focuses on the most vulnerable and marginalised groups in society. 

The website of DANTB, www.dantb.org  has been designed to provide information on its activities in India. The commitment of DANIDA to help India strengthen the Revised National Tuberculosis Control Programme (RNTCP) and raise the level of community awareness in selected districts of Orissa, have been adequately explained along with the kind of project support being provided by the Agency. The site also goes on to explain details of the disease and the breakthrough achieve in its cure by the use of Directly Observed Treatment, Short Course (DOTS). The core five – point DOTS Strategy formulated by RNTCP and its translation into practice by DANTB has been succinctly explained. The use of IEC, Community participation, Gender initiatives, capacity building, health systems research, monitoring, geographical information systems, infrastructure development and drug distribution have been given in details on separate pages. These links make for very interesting insights into the problems faced in implementing programmes of this nature in developing countries. The Gender Initiative is an unique component of the programme and should provide effective lessons into successfully overcoming the barriers to women seeking treatment for TB.There is a presence of links to various publications of DANTB as well as to other related sites. 

The website is a good showcase of a successful implementation of a TB control programme in an underprivileged society and should be of immense help to health workers involved in designing and carrying out such initiatives. 

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