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TB News from India,
September-October 2005
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:
The Parliamentary Network on the World Bank
The Parliamentary Network on the World Bank (PNoWB), an independent
association of some 800 members of parliament from 110 countries was
established in year 2000. It mobilizes parliamentarians in the fight
against global poverty, promotes transparency and accountability in
international development, and offers a platform for policy dialogue
between the Bank and parliamentarians.
PNoWB, which seeks to be an action-oriented network of parliamentarians,
established a committee on HIV/AIDS, Malaria and Tuberculosis in February
2004. The committee will strive to strengthen the capacity of
parliamentarians for effective legislation, advocacy, resource
mobilisation and oversight over budgetary provisions for HIV/AIDS, Malaria
and Tuberculosis.
The parliamentary network now plans to set up a number of regional
chapters including one in India. The interaction of Indian Members of
Parliament with their counterparts from Africa and Far East will apprise
them of the intensity of the passion and determination with which these
leaders have mobilised their communities to face the epidemic caused by
trine of AIDS, TB and malaria. Leaders like Nelson Mandela, Desmond Tutu
and Thaksin Shiwanatra have not only shaped the response of their
respective regions but have also led the global campaigns.
The response of Indian society to AIDS pandemic is still in its formative
stage and Indian parliamentarians have to make their contribution in such
a way that the pace of newer infections is halted and mechanisms are
developed to provide support and care to victims, their families and
communities. The presence of PNoWB in India would direct the actions of
parliament members in this direction.
Public private mix projects for TB control
Chandigarh scripts a success story
Chandigarh, the capital city of the North Indian States of Punjab and
Haryana is one of the fourteen cities in the country implementing pilot
Public-Private-Mix (PPM) projects initiated by Revised National
Tuberculosis Control Programme (RNTCP). These PPM projects launched in
second half of the year 2003 are located mostly in state capitals or
larger cities.
Dr. Parmod Sridhar, State TB Officer, is enthused by the promising
results of PPM project in Chandigarh. Talking to TBNI he said, “Our
programme caters to one million people. At any given time, we expect to
have at least 900 patients on DOTS. In April 2005, 914 patients were
being provided DOTS in Chandigarh and the contribution of PPM project
was an impressive 314 patients.”
“When we began to sensitize private doctors we realized that it was not
so easy to bring together family physicians, specialists and
super-specialists on one platform for meetings or workshops,” says
Sridhar, reminiscing the early days of PPM project in Chandigarh.
“PPM methodology in India provides a number of options or schemes for a
range of situations. We in Chandigarh opted for schemes I and II which
involve referring chest symptomatic patients (persons with cough for
three weeks or more) to microscopy centers for sputum examination and
working as DOTS providers respectively”, Sridhar explains.
“We were able to associate ninety-five private doctors under the first
scheme. Some of them were physicians from other systems of medicine such
as Ayurveda or Unani. The office bearers of local branch of Indian
Medical Association (IMA), representing allopathic doctors, were
initially reluctant to work with them”, he remembers.
“We explained to them that the thirteen slum colonies of Chandigarh were
a priority area for our project. The number of allopathic doctors doing
practice in such colonies was very low. Therefore, the people in these
localities depended on physicians from other systems of medicine for
health care. These physicians were an appropriate mean of reaching out
to chest symptomatic patients,” says Sridhar. “It took a couple of
meetings and back-up from IMA national headquarters before the local
branch members agreed to work with them”, he notes with a sense of
relief.
Fifty-five physicians (all of them practicing modern system of medicie)
were selected as DOTS providers under the Scheme II. They included
fifteen working in charitable clinics run by voluntary or community
based organizations.
“Chandigarh is considered to be one of best planned cities of the
country but even it has thirteen big slum colonies. We divided these in
four zones. Our aim was that no patient had to travel more than two
kilometers for sputum examination and one kilometer for a DOTS center.
We have been largely successful on this front”, he said while providing
an insight in to the planning process.
“We approached the local Municipal Corporation (MC) for financial help
to appoint 13 Community Health Volunteers (CHV), so as to augment our
presence in these colonies. We were lucky to get funds from MC under the
Union Government’s Swaran Jayanti Shehri Rojgar Yojna (Golden Jubilee
Urban Employment Plan) and now we have one CHV for approximately 30,000
to 40,000 people. They are paid Indian Rupees 1000 (US$ 24
approximately) every month. They are our watchdogs inside these
communities. They help spread the messages of programme, identify newly
arrived outsiders, locate addresses of the patients who leave the city
and treatment midway and contact defaulting patients. No surprise the
defaulter rate in Chandigarh has fallen to 2.5 percent”, he declared
with a sense of satisfaction.
Dr. Sridhar has very ambitious plans for PPM project in Chandigarh, “At
present one third of our patients on DOTS come from private sector, we
want to gradually increase it to fifty percent and finally reach a level
when two third of patients will come from non public health sources”, he
asserts.
Pune Municipal Corporation steps up drive to rope in private
practitioners
Anuradha Mascarenhas , Indian Express, July 25, 2005
Channa has completed a sanitary inspector’s course. He is now totally
dedicated to his job as a Tuberculosis Health Visitor (TBHV). His target
is to cover 200,000 residents of Sahakarnagar and enlist private
practitioners to treat TB patients.
“I travel from 8 am till 8 pm informing community members and
sensitising doctors to get involved in the Revised National Tuberculosis
Control Programme,” he says about his job — one among 14 other health
visitors appointed by the Pune Municipal Corporation (PMC) as part of a
pilot project of the Union government’s TB division and World Health
Organisation (WHO).
Pune is one of the 14 cities in the country that will involve private
practitioners in the revised TB control programme, says Dr Dilip Jagtap,
Secretary of the PMC TB Control Society. The PMC’s health visitors were
chosen for the six TB units of Gadikhana, Bhawani Peth, Sahakarnagar,
Hadapsar, Gandhinagar and Kothrud.
So far, the results are encouraging. At least 377 private practitioners
are involved in the programme. Of these, 177 work on the WHO recommended
Directly Observed Treatment, Short-Course strategy or DOTS.
While the pilot project commenced a few months ago, Jagtap says the PMC
TB control society has been encouraging private practitioners to join
the programme over the last 5 years. Already two medical colleges and 25
NGO’s are involved. Henceforth, Central Government Health Scheme (CGHS)
and Employees State Insurance Scheme (ESIS) will be involved with the
national TB control programme.
In Maharashtra, Mumbai has the highest number of cases due to migrant
population and overcrowding. Due to the involvement of private
practitioners and other players, there has been an increase in the
number of patients diagnosed with tuberculosis. In Pune, the PMC TB
Control Society diagnosed 3,876 cases in 2004.
Read the
complete story
TB is a killer, but Pune is fighting it
Anuradha Mascarenhas , Indian Express , August 24, 2005
After a long wait on the steps of the entrance to the Department of
Chest and Respiratory Diseases at Sassoon General Hospital (SGH), a
listless Nathu has been told at the OPD that he has to be admitted for
treating Multi-Drug Resistant Tuberculosis (MDR-TB). A daily wage
labourer from Bhor (45 km away from Pune), Nathu has been unable to work
for a year. His wife’s salary as a housemaid and from doing jobs fetches
them Rs 400 (US$ 9) a month. Their two children aged four and six, miss
school most days. And Nathu has already spent close to Rs 10,000 (US $
240) for the “right treatment” for curing TB.
Twenty-two-year-old Ramesh from Parli village in Beed district (350 km
from Pune) has not been able to attend classes at the Nehru College for
a year. A TB patient, he underwent the Directly Observed Treatment Short
Course (DOTS) for six months, but he is a likely patient of MDR-TB. He
boards his bus at 9 pm from Parli and reaches Pune at 7 am the next day
to see doctors at Sassoon and KEM Hospital. There are no facilities for
treating him at Parli and now Ramesh needs to be admitted.
Nathu and Ramesh are tell-tale cases of TB patients who have to depend
on the treatment facilities in Pune. In Pune district, there are 5,755
patients receiving DOTS at 1,199 DOT centres and 100 designated
microscopy centres (DMC).
The DOTS programme ensures the patient adheres to the treatment. “Even
if one misses a dose, they are traced and given the dose the next day,’
says Dr S R Karad, Pune District TB Control officer. In fact, DOTS
programme has contributed immensely for the success of the Revised
National Tuberculosis Control Programme (RNTCP) of the Union health
ministry since it keeps a tab on each and every patient under its
regime.
Today, more and more TB patients are being identified. Outlining the
DOTS methodology, Karad said before a patient is put on the anti-TB drug
regimen, his/her address is verified. And if someone misses a dose, they
are called from their homes and referred to the nearest DOT centre where
community workers and senior supervisors ensure the patient takes the
medicine in their presence.
Normally, the tendency is not to come back for treatment as patients
often start feeling better after two months. “But our staff ensures they
are back,” says Karad pointing to Suresh Sarode from Solapur who is now
a “relapse case” who has had to be admitted at Sassoon.
Read the
complete story
TB cases on the rise in Delhi
Bindu Shajan Perappadan, The Hindu, July 12, 2005
India’s TB control programme is cited as the largest and the fastest
expanding public health programme across the world in terms of patient
base. Revised and re-introduced way back in 1977, the Government's
tuberculosis programme, according to experts, may now have slowed down
and not netted enough patients in time.
With the capital showing an ascending graph in terms of indoor patients
admitted due to tuberculosis, a four-year disease surveillance report
compiled by Municipal Corporation of Delhi has come as a shocker.
Pointing fingers at possible flaying of the Directly Observed Treatment
Short-course (DOTS), which places more than 100,000 patients on
treatment every month across the country, experts claim that even the
Capital with its high quality infrastructure is yet to see a 100 per
cent reach or cure for its patients.
In Delhi, besides the conventional programme of patients reporting with
the disease, detection is also carried out by mobile vans in urban slums
and other vulnerable communities. “Aimed at reaching a larger population
base, the vans are fitted with X-ray mzchines and a small laboratory for
sputum examination. Confirmed cases are sent to nearest DOTS centre for
treatment and follow-up examination."
"The Capital registers 210 new tuberculosis patients per 100,000 persons
annually. Congested slum regions and clusters add to the vulnerability
of residents of Delhi. While the incidence of cases is higher compared
with rest of the States, the death rate has slowed down" according to
State TB Control Officer, R P Vashishth
MDR TB cases on the rise in India
Neha Khanna, July 7, 2005 , NDTV
45-year-old Sheela has been undergoing treatment at a TB hospital in
Delhi for the last 10 months. She suffers from multi-drug resistant
Tuberculosis or MDR TB. It's a complication that arises when the
treatment of a TB patient is interrupted for some reason. What makes
Sheela's story particularly poignant is that a couple of years ago, she
lost a 14-year-old daughter to MDR TB. What's more, her elder daughter
is also suffering from the disease.
"Our 14-year-old daughter died of this disease. Our elder daughter
suffers from MDR TB. And my wife has also been at this hospital for so
long. We're very poor and can hardly afford the medical treatment," said
Uday Singh, Sheela's husband.
Health experts believe incidence of MDR TB is on the rise, even though
the government has no data on the scale of the problem.
"There are no exact figures to quantify this. But most of the clinicians
practising in the field of TB will agree that there's a rise of MDR TB.
The significance is of the combination of HIV and MDR TB. Together, they
can spell doom," said Dr J N Banwalikar, In-charge, TB Hospitals,
Municipal Corporation of Delhi.
Though the Government insists that its campaign to fight tuberculosis
has been a big success story, it admits that more needs to be done for
effective implementation.
"Yes, in the very nature of the treatment of regime, there are a certain
percentage of MDR TB cases going up. The medical community has to be
committed to better monitoring. I'll submit that it's not alarming
though it's significant and we should take note of it and provide for
it", said P K Hota, Union Secretary, Health.
The TB programme in India is seen as one of the more successful TB
campaigns in the world. So now questions are being raised why MDR TB
cases going up in India. Perhaps the monitoring mechanisms are not as
efficient as they're made out to be. What's needed is better
implementation and that itself poses the biggest challenge before the
health authorities.
Read the
complete story
TB drug: CSIR on the verge of breakthrough
Shastry V Mallady , The Hindu , July 11, 2005
The Council of Scientific and Industrial Research (CSIR) is developing
an indigenous drug for tuberculosis under `drugs for the poor' programme
that brings together public-private partnership in the pharmaceutical
research. "The TB drug is undergoing first phase of clinical trials at
the CSIR laboratories and a breakthrough is expected soon", says CSIR
Director-General, R.A. Mashelkar.
In an exclusive interview to The Hindu during his visit to the Central
Electrochemical Research Institute at Karaikudi, Dr. Mashelkar said the
country's premier body for scientific research was bringing together
traditional medicine, modern medicine and science for the drug
development programme that had now reached an advanced stage.
He pointed out that a TB drug in the current context became
indispensable since the last time a drug for tuberculosis came out was
in the year 1963. "Our drug means a lot not only to the large number of
Indian patients but also to the entire African region, plagued with TB
in the background of HIV-AIDS," he said.
Stating that the final process of the new drug could be completed in
four years after multiple lab trials, Dr. Mashelkar said he was "very
optimistic" of the end result due to the progress made so far.
According to him, the CSIR's TB drug is expected to be more effective to
patients with regard to time taken for treatment/cure. While normally it
takes eight to ten months to recover despite a heavy daily dosage, "a TB
patient with our drug can feel much better in two months time," he said
and added that a substantial budget allocation was made for the drug.
Several reputed pharmaceutical companies in the country were also
involved in the project going on under the CSIR banner of New Millennium
technology initiative.
Read the
complete story
TBNI International
WHO declares TB an emergency in Africa
The World Health Organization (WHO) Regional Committee for
Africa comprising health ministers from 46 Member States has declared
tuberculosis an emergency in the African region. The continent is in the
midst of an epidemic that has more than quadrupled the annual number of new
TB cases in most African countries since 1990 and is continuing to rise
across the continent, killing more than half a million people every year.
The declaration was made in a resolution adopted at the end of the
Committee's fifty-fifth session in Maputo, Mozambique. The resolution urges
Member States in the African Region to commit more human and financial
resources to strengthen DOTS programmes and scale up collaborative
interventions to fight the co-epidemic of TB and HIV. These and other
measures recommended by the Committee encompass those laid out in a
"blueprint" developed by the global Stop TB Partnership, which calls for US
$2.2 billion in new funding for TB control in Africa during 2006-2007.
In the late 1970s and early 1980s, African countries like Tanzania,
Mozambique and Malawi were among the first to apply what became the global TB
control strategy now known as DOTS. But in the past 15 years, TB incidence
rates have soared in the region - to as high as four-fold in Malawi and
five-fold in Kenya, to cite some typical examples -due largely to the link
with HIV/AIDS, poverty and weak health systems. Although countries have made
efforts to treat the rising tide of TB cases, they are still being outpaced
by the epidemic.
"It is tragic that this disease has not been brought under control, because I
am living proof that TB can be effectively treated and cured," said Nobel
laureate Archbishop Desmond Tutu, who along with former South African
President Nelson Mandela is a survivor of the disease. "The problem is huge
and medical authorities cannot overcome it alone, they need help. A full
course of TB drugs that costs 15 dollars will save the lives of TB patients -
and in the case of people who are co-infected with HIV, extend their lives by
precious years until ARVs become more widely available in Africa."
Among the constraints to fighting the epidemic cited in the Maputo meeting is
the inadequate financial support currently available for TB control. A
majority of African countries that provided financial data to WHO in 2003
reported funding gaps and included eight of the nine countries with the
highest TB burden. Many national TB programmes are relying extensively on
grants from external donor agencies, including the Global Fund to Fight AIDS,
TB and Malaria (GFATM). At the same time, few African countries have included
TB in their poverty alleviation strategies.
Read the
complete story
Web Call
OpenMED@NIC Archive
http://openmed.nic.in
OpenMED@NIC is a discipline based Open Access International Archiving
service launched by National Informatics Centre (NIC). It intends to serve
as an international Archive in Medical and Allied Sciences. It has been
designed to encourage authors to self-archive their publications.
The aim of OpenMED is to provide free service to academics, researchers,
and students working in the area of Medical and Allied Sciences. Currently
there are over 250 users and over 500 items submitted in it and out of
these there are over 200 on Tuberculosis. This useful resource contains a
variety of documents that provide an insight into history of tuberculosis
control in India. Some of the interesting publications available include,
A report on BCG vaccination in India published in 1960; A sociological
inquiry into an urban tuberculosis control programme in India published in
1963; Problems of treatment of tuberculous patients in rural areas
published in 1965; A tuberculosis programme for big cities published in
1975 and Journey of tuberculosis control movement in India: National
Tuberculosis Programme to be revised National Tuberculosis Control
Programme published in 2005. The variety and number of publications
available in the ‘tuberculosis section’ of the web site is likely to
expand in coming years and months. This will prove to be of immense use to
both international and Indian researchers, policy planners, programme
managers and advocates.
TBNI Editorial Team
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