Diseases in Sao Tome and Principe
Sao Tome and Principe is a developing country located on the African west coast. More than two-thirds of the population of this small island state lives on under $3.20 a day and faces the effects of critical disease. However, many organizations are working with the country to fight the war against diseases in Sao Tome and Principe.

Common Diseases in Sao Tome and Principe

Three of the most common diseases in Sao Tome and Principe are tuberculosis (TB), malaria and human immunodeficiency virus (HIV).

TB is an airborne disease caused mainly by air droplets that someone infected with Mycobacterium tuberculosis transmits; it is endemic in Sao Tome and Principe. TB can cause various pulmonary symptoms and affect the lymphatic system, joints and even the central nervous system.

Malaria is a mosquito-borne disease; it is common in the country. Malaria can be very fatal to the victims and cause them to suffer from flu-like symptoms and high fevers.

Finally, HIV is a virus that attacks the immune system and can lead to dangerous acquired immunodeficiency symptoms (AIDS); it is still a significant problem in Sao Tome and Principe.

Key Players in Supporting Sao Tome and Principe

The United Nations Development Programme (UNDP) and the Global Fund have been key players in supporting the fight against diseases in Sao Tome and Principe. Since 2005, the organizations have funded the country in its efforts against HIV, TB and malaria.

Over the years, the organizations have spent $4.5 million for HIV, $3.9 million for TB and $25.4 million for malaria. Through this funding, the UNDP has been able to ally with the National TB Program to develop various treatment and education plans for patients. According to the World Health Organization (WHO), in 2016, there was a 63% decrease in TB mortality since 2000, a 95% detection rate for the disease and a 78% success rate in treating patients.

The UNDP also runs an HIV program; it supports those living with HIV and counsels populations who are at a higher risk for HIV about preventative actions. From 2008 to 2014, the prevalence rate of HIV among 15 to 49-year-olds declined from 1.5% to 0.5%. According to UNDP’s data from 2018, 249,700 people received counseling and HIV testing.

Sao Tome and Principe observed its greatest success in defeating malaria. Mortality rates from malaria have declined from 3.9 to 0.5 cases per 100,000 people. Although the Global Fund is no longer supporting the malaria program, it helped distribute 503,000 bed nets, reaching 100% of the population, and treated 56,800 cases of malaria according to UNDP in 2018. The incidence of malaria morbidity decreased from 65.5 to 11.3 cases per 1,000 people in the time frame between 2012 and 2016. Further, UNDP has granted approximately another $6 million to support the complete eradication of malaria and further control TB and HIV.

Others in the Fight to Eradicate Diseases in Sao Tome and Principe

Although UNDP and the Global Fund have been the major players in supporting the country, there are other groups that have helped toward the goal of eradication of critical diseases in Sao Tome and Principe. In 2015, Brazil spent over $500,000 to build a laboratory that would be focused on diagnosing and treating TB. This laboratory would ensure that the patients would receive quicker lab results and correct diagnoses.

Medical Care Development International, a nonprofit organization, has also taken up a project that will last from 2019-2023. It aims to bolster the ability of the military to provide HIV/AIDs care for its members and population in Gabon and Sao Tome and Principe. The project will increase its capacity to provide care in the military health facilities and laboratories.

A Ray of Hope for Sao Tome and Principe

Despite the dangers of malaria, TB and HIV, the people of Sao Tome and Principe can have hope in the fact that there are many international allies willing to provide support in their fight against these diseases. These common diseases in Sao Tome and Principe may still impose fatal effects on its victims; however, Sao Tome and Principe is not alone in its fight to protect its people.

San Sung Kim
Photo: Flickr

tuberculosis in madagascar
Madagascar, a country off the southeastern coast of Africa, comprises of tuberculosis cases among its citizens of low socioeconomic status. In 2012, 70.7% of the Malagasy population was living below the poverty line and in 2017, the incidence rate for tuberculosis in Madagascar was 233 cases per 100,000 people. Encouraged and perpetuated by poverty, this disease makes Madagascar the perfect candidate for an outbreak.

Tuberculosis, commonly known as TB, is the most infectious fatal disease in the world. Although it is a very treatable illness, it kills more than 1 million people annually across the globe. The vast majority of TB diagnoses and deaths derive from individuals residing in poor, developing nations.

Risk Factors

Lack of quality living conditions, nutrition and healthcare amplify the risk of getting tuberculosis in Madagascar. Limited access to toilets and handwashing facilities for the majority of Malagasy people have left many at risk. According to CIA World Factbook data, sanitation facility accessibility in Madagascar was unimproved for 88% of the total population in 2015. TB is also the leading cause of death for people with HIV. As of 2018, there were roughly 39,000 Malagasy people diagnosed with HIV but only 20,865 known TB cases that also had documented HIV statuses. Without quality systems in place to document HIV and TB rates across the country, solving the epidemic in Madagascar will not be easy.

The Global Fund Support

The added historical stigma surrounding TB makes matters worse. While already struggling financially, patients often fear that exposing their diagnosis will cause them to lose their jobs. This stigma is combated through support systems like The Global Fund, an organization that provides relief for epidemics through fundraising and education for those affected by TB. The fund’s employees act as a support system, thus debunking the shame that infected patients may feel due to their diagnosis.

In 2018, The Global Fund’s donations and work helped cure 33,000 patients with tuberculosis in Madagascar. For 2020-2022, the organization projects that a total of $18,045,448 will go toward tuberculosis management in Madagascar. In 2017, these funds helped increase Madagascar’s TB treatment success rate to 84%.

Biotechnological Solutions

Although TB is preventable and curable, Madagascar lacks the necessary medical tools to diagnose and treat this disease. Not only are there minimal supplies, but there is also a need to expand and strengthen Madagascar’s ability to analyze TB samples according to Niaina Rakotosamimanana, the head of the mycobacteria unit at the Health Institute of Madagascar.

Researchers from the Health Institute of Madagascar, Stony Brook University and Oxford University are also collaborating to find solutions for this issue. These institutions are working together to grant access to a portable and affordable tool, the MinION. The MinION helps to diagnose and efficiently test the resistance of TB strains to antibiotics, while at the same time being a cheap, affordable option that is accessible to Malagasy people.

Tuberculosis is still one of the top 10 leading causes of death in Madagascar, but the country is making significant progress towards the eradication of the disease. The efforts Madagascar is taking in tracking TB are positive steps that contribute to the fight against this epidemic.

Sophia McGrath
Photo: Pixabay

Pott’s DiseaseInfectious diseases are one of the main results of poverty in the developing world. In addition, the prevalence of infectious diseases has long been disparate between developing and developed nations. In a report on environmental risk factors and worldwide disease, the World Health Organization (WHO) affirmed the “total number of healthy life years lost per capita was 15-times higher in developing countries than in developed countries” for infectious diseases. Yet, one disease continues to be the deadliest infectious disease in the world, killing approximately 4,000 people a day: tuberculosis. Tuberculosis is a devastating widespread illness in the developing world, specifically in Asian and sub-Saharan African nations. However, tuberculosis of the spine called Pott’s Disease is a serious concern for the developing world. Read on for five things to know about Pott’s Disease.

5 Things To Know About Pott’s Disease

  1. Pott’s disease gets its name from a British surgeon. Though it is also referred to as spinal tuberculosis, the namesake of Pott’s Disease takes after British surgeon Percivall Pott. Pott originally studied and defined the condition in 1779, and his writings and research are still used today.
  2. Pott’s disease begins when tuberculosis spreads to the spine. Tuberculosis is an airborne infection that begins when an individual inhales mycobacterium tuberculosis, the bacteria that causes the disease. If tuberculosis goes untreated for a long period of time (which it often does in the developing world due to lack of access to healthcare and low-income citizens who cannot afford medication), the disease can spread from the lungs to the spine. Once this happens, an individual experiences a type of “spinal arthritis.” Tuberculosis bacteria invades the spinal cord and, if it infects two neighboring spinal joints, blocks the nutrient supply to that region of the back. Eventually, the spinal discs deteriorate and can cause serious back injury, difficulty standing or walking, nerve damage and, in serious cases, paralysis.
  3. Pott’s disease is visually recognizable and has existed for centuries. Unlike normal tuberculosis, which most commonly affects the lungs, Pott’s disease is easily visually recognizable due to the severe curvature of the mid to lower spine that results from the infection. Specifically, the thoracic spinal region is the most affected, followed closely by the lumbar region. This visual indication from remains traces the disease back to the European Iron Age and Egyptian mummies, making it one of the oldest documented diseases in history.
  4. Spinal tuberculosis only represents a small percentage of all tuberculosis cases. Although it is the most debilitating form of tuberculosis, Pott’s Disease only accounts for 1.02 cases per 100,000 tuberculosis cases in the world. This rate is higher among Africans, where 3.13 per 100,000 cases are attributed to Pott’s Disease. Globally, this means that only 1-2% of all tuberculosis cases are attributed to that disease.
  5. Pott’s disease can be treated through a rigorous medication regimen or surgery. Pott’s Disease is a result of a lack of treatment over a long period of time; conversely, a lengthy period of medication is often needed to fully treat the condition. The time period of treatment ranges from nine months to over a year, depending on individual symptoms and progression. However, medication cannot redeem an affected individual’s deformed spinal structure. Thus, it is often only used to treat the tuberculosis infection after surgery. “Spinal fusion or spinal decompression surgeries” can both repair the warped spine and “prevent further neurological complications.” Physical therapy is also often necessary after receiving spine surgery for Pott’s Disease. Yet, treating Pott’s Disease is highly expensive. Even when tuberculosis medication is free, “patient costs associated with TB treatment can be upwards of 80% per capita income in some regions.” However, multiple organizations exist that provide donations to supply healthcare and surgeries to low-income patients in developing nations. In addition, specific organizations like the Nuvasive Spine Foundation provide life-saving spine surgery in vulnerable regions around the world.

Although Pott’s Disease represents a small percentage of all tuberculosis cases, it is a serious illness. However, through the help of surgeons, medication and awareness, the disease can hopefully be treated across the globe soon.

– Grace Ganz
Photo: Flickr

End Tuberculosis Now Act
Kosovo is a country in southeastern Europe that declared independence from Serbia in February 2008. It is Europe’s youngest nation, but also one of its smallest and poorest. Kosovo ranks 137th in the world for GDP per capita and the country’s overall budget is just above $2 billion. Despite the fact that Tuberculosis (TB) is a completely preventable, treatable and curable airborne infection, the virus continues to spread throughout developing nations—including Kosovo—killing more people per year than any other infectious disease. The End Tuberculosis Now Act seeks to address this silent pandemic by refocusing U.S. efforts towards effective TB prevention and treatment in Kosovo and other developing countries. Neither the House nor Senate has held a vote on the End Tuberculosis Now Act since its introduction in August 2019. Kosovo demonstrates the importance of this act and why Congress needs to address it.

Kosovo’s Tuberculosis Rates

Among its neighbors in southeastern Europe, Kosovo has one of the highest TB infection rates, trailing only Moldova and Romania. From 1999 to 2006, total TB cases in Kosovo were declining. This progress has since stopped, with infection rates plateauing at the rate they were in 2006. A limited budget has severely hampered Kosovo’s efforts to combat and eradicate TB.

Kosovo’s insufficient health system is one reason behind the country’s spread of TB. A majority of Kosovo’s residents are dissatisfied with their health service. In addition, the nation’s top health authority is not responsible for contact tracing, testing, treatment or any other method that people use to combat TB. Instead, non-governmental organizations have received this responsibility, resulting in a lack of central planning. The End Tuberculosis Now Act would refocus USAID efforts on TB prevention and treatment in developing nations like Kosovo, providing a unified example of how to properly stop the spread and financially support affected individuals.

Kosovo and COVID-19

For some of the same reasons it struggles with TB, Kosovo is also struggling to stop the spread of COVID-19. Compared to its neighbors, the country’s pandemic response is falling short. Kosovo is much smaller than Albania, Montenegro and Greece, but has many more COVID-19 cases and deaths than these nations.

The COVID-19 pandemic has further exposed the aforementioned weaknesses in Kosovo’s healthcare system. For example, temporary medical facilities built to increase the nation’s hospital capacity have not been properly set up to prevent COVID-19 transmission between healthcare workers and infected patients.

No matter how valiant Kosovo’s efforts to combat COVID-19 are, the country is ultimately limited by its $2 billion yearly budget. The same is true when it comes to their fight against TB. Kosovo simply lacks the capital to properly test, treat and prevent the spread of both COVID-19 and TB. The End Tuberculosis Now Act will give developing nations like Kosovo a better chance of defeating TB while teaching them how to tackle similar pandemics.

Putting the Tuberculosis Fight on Hold

As the COVID-19 pandemic takes center stage, the fight against TB has been put on hold across the world. Despite this, TB has continued its spread. Approximately 80% of worldwide programs to combat the disease have experienced disruptions in their supply chains since the beginning of the COVID-19 pandemic.

Manufacturers of TB tests have pivoted to developing COVID-19 tests, reducing the overall availability of TB testing. This means massive drops in diagnosing TB. In one year, an infected individual can spread the virus to 15 people, making the diagnostic process extremely important. As testing capacities decrease, TB will continue its spread unabated in developing nations. Kosovo was already struggling to contain TB before the COVID-19 pandemic, but it could now get much worse. The End Tuberculosis Now Act is a critical component in increasing testing capacities in Kosovo to combat the spread of TB.

More Important Than Ever

TB is a preventable and treatable disease, yet it continues to kill more people worldwide than any other infectious disease. The End Tuberculosis Now Act would increase investments in TB prevention and treatment measures while saving countless lives in developing nations like Kosovo.

Furthermore, the bill would ensure that nations and non-governmental organizations receiving aid from USAID would stand by their commitments to eradicate TB. This refocusing of aid would provide the World Health Organization and the Stop TB Partnership with more resources to fulfill their missions.

Moving Forward

Kosovo’s continued fight against TB demonstrates the importance of the End Tuberculosis Now Act. The bill, introduced in August 2019, would save lives in developing nations and help combat a completely preventable and treatable disease. Congress must pass this bill to increase the quality of life for the world’s poor and help eradicate TB in developing nations.

Marcus Lawniczak
Photo: Flickr

Tuberculosis in BangladeshTuberculosis (TB) is an airborne disease; common symptoms include cough with sputum and blood in some cases, chest pains, weakness, weight loss, fever and night sweats. TB can lead to the death of an infected person when left untreated. According to the World Health Organization (WHO), TB has caused about 2 million deaths worldwide, and 95% of deaths were recorded in developing countries. Bangladesh ranked sixth among high TB burden countries. The National Tuberculosis Control Programme (NTP) has attained more than 90% treatment success and more than a 70% case detection rate. Despite these successes, tuberculosis in Bangladesh remains a serious public health problem.

Reasons for Higher Infection of Tuberculosis in Bangladesh

  1.  Delays in the Initiation of Treatment: Patients in Bangladesh often receive late treatment. Delays in treatment increase chances of negative treatment results, death and community transmission of TB. A study on 1,000 patients reported that, on average, there were 61 days of delay in the treatment of women and 53 days of delay in the treatment of men.
  2.  Role of Informal Health Practitioners: Most of the impoverished people in Bangladesh prefer to go to their local practitioners due to the ease of accessibility and low cost. A recent survey showed that approximately 60% of the Bangladesh population prefers to go to these uncertified doctors. However, such doctors typically lack formal training. This may lead difficulties in accurately diagnosing and treating TB.
  3. Lack of Awareness: Directly observed treatment short-course (DOTS) has been recognized as one of the most efficient and cost-effective approaches for treating TB. In 1998, the DOTS program became an integrated part of the Health and Population Sector Programme. The inclusion of the DOTS strategy in the Programme helped TB services transition from TB clinics to primary level health facilities. These health facilities typically incorporate GO-NGO (government-organized non-governmental organization) partnerships, and the NGOs have advocated for work on literacy, social awareness along and health care development. As part of the Health and Population Sector Programme, DOTS is freely available to the public. Unfortunately, many remain unaware of the treatment option.  As a result, detection of new TB cases has stagnated at around 150,000 cases per year since 2006.
  4. Poverty: A large portion of the country is still suffering from poverty. Poverty can often lead to overcrowding and poorly ventilated living and working conditions. People with less income also cannot afford food, leading to higher incidences of malnutrition. The culmination of these factors typically make the impoverished population more vulnerable to contracting TB.

The Effort to Combat TB

Tuberculosis is a major public health problem in Bangladesh. However, continuous efforts by the NTP and various NGO organizations have played an important role in decreasing the spread of the disease. DOTS, for instance, demonstrated a 78% cure rate in 1993. Due to its success, a phase-based treatment plan was implemented in 67 million rural populations in 1996.  Since implementation, the NTP has attained a 90% treatment success rate. Further efforts to combat the disease include development of the FAST program (Find cases Actively, Separate safely and Treat effectively). The program intends to detect active TB cases and decrease spread of the disease in healthcare facilities. However, despite efforts by the NTP and a number of NGOs, significant delays in care-seeking and treatment initiation still exist as major hindrances to the program’s goals. 

Challenges to TB Programs

Tuberculosis in Bangladesh kills more than 75,000 people every year. Despite free services like DOTS and other NTP programs, limited access to quality service, lackluster funding and insufficient screening prevent adequate detection and treatment of the disease. The lowest quartile of the population is still five times more likely to contract TB, potentially due to a lack of awareness of TB-treatment programs among the general public. Adding to the problems for TB programs, private health professionals are typically inactive in national programs. While NTP programs have made progress in addressing the disease, these challenges persist, and tuberculosis remains a major health problem in Bangladesh.

Solutions

To stop the growth of tuberculosis in Bangladesh, community organizations such as the Bangladesh Rural Advancement Committee (BRAC) have shown impressive results in lowering the percentage of those afflicted by TB. Effective treatment of TB includes investment in medicine, local health services and diagnostics. To ensure full recovery, social protection of patients is also required. Multidrug-resistant TB (MDR-TB), for instance, requires two months of drug treatment and a four month continuation period. If treatment programs can satisfy requirements investment and social protection requirements, the chance of curing TB patients reaches 92%. The application of a more successful method will help in curing the most complex TB cases, such as drug-sensitive TB, with improved results. With the implementation of proper and effective treatment strategies, we can eliminate tuberculosis in Bangladesh and the benefit even the poorest members of society.

– Anuja Kumari

Photo: Pixabay

Tuberculosis in Tuvalu
Tuberculosis (TB) is the world’s deadliest infectious disease, yet millions of people remain undiagnosed. TB diagnosis is a challenge for many island communities. In order to be diagnosed, patients usually have to go to the main island. This was the case for tuberculosis in Tuvalu.

Tuvalu is a remote Pacific island with a population of 11,500 and only one hospital. Travel to the hospital is difficult and increases the risk of transmission, especially when it includes a crowded boat full of people. TB rates are high in Tuvalu but are declining with only about 15 new cases each year since 2016 – a great improvement from the rate of 36 new cases each year in the 1980s. The death rate in 2017 was 19 per 100,000 people. Thanks to a couple of developments that have made diagnosis more achievable – namely GeneXpert machine, portable x-ray machines and training for health teams – Tuvalu is actively reducing rates of TB since 2018.

GeneXpert Machine

The United Nations Development Programme (UNDP) and the Global Fund have provided a GeneXpert machine to the government of Tuvalu. This machine reduces the duration of the TB test and allows for diagnosis of the drug-resistant strains, which are increasingly becoming a problem. Using the machine, the test only takes about two hours. Without this technology, the TB test takes at least two-six weeks.

It is a relatively new test that works on a molecular level to identify mycobacterium tuberculosis as well as rifampin resistance in a sputum sample. Another positive is that limited technical training is required to run the GeneXpert tests. These tests are being used around the world and prove to be an incredible feat of science.

Portable X-ray Machines

Because x-ray machines are now portable, more people can be reached and examined, including those on the outer islands. Mobile health teams travel to smaller islands and carry out chest x-rays for those presenting TB symptoms.

Thanks to portable x-ray technology, the number of TB diagnoses is increasing. Dr. Lifuka at the Tuvalu hospital said, “We can now actively find cases in the outer islands where there are no facilities, and we can assess everyone, even those who previously faced difficulties coming to the hospital.”

Training for Health Teams

Of course, none of this would be possible with the technology alone. Trained professionals are needed to help diagnose and treat people with tuberculosis in Tuvalu. They travel to patients’ houses and provide medication. Because of the stigma surrounding TB, patients won’t always get their treatments. This is why Tuvalu Red Cross community-based health promoters and other trained professionals treat patients at home.

Though TB rates remain rather high in Tuvalu, as well as throughout the Pacific, the new technology implemented in 2018 is promising. Technology will not be enough, however; system-wide approaches aimed at reducing poverty and development of infrastructure on the outer islands will also be needed in order to eradicate TB. Furthermore, Tuvalu needs to continue to improve TB surveillance in order to inform public health agencies of the strategies proven to be most effective. Hopefully, the new technology will help spread awareness of TB to all the members of the community. The change is already evident, as cases of tuberculosis in Tuvalu have declined consistently over the past 10 years, and detection has increased. In 2008, they were only able to diagnose eight cases a year. In 2017, there were 23. The new technology and training programs will continue to save lives on this small, isolated island.

Fiona Price
Photo: Flickr

Tuberculosis in Timor-Leste
Tuberculosis, also known as TB, is a bacterial disease that affects one’s lungs. The disease can cause symptoms such as coughing fits, sneezing, as well as troubled breathing; however, some people do not exhibit symptoms. Tuberculosis is an air-borne disease that can be exchanged through interacting with individuals who have tuberculosis, typically by either coughing or speaking.

There are also two different types of tuberculosis: latent TB infection and TB disease. Latent tuberculosis occurs when an individual has the bacteria that causes tuberculosis in their lungs but shows no active symptoms of tuberculosis; therefore, there is no spread of the bacteria. Tuberculosis disease refers to when an individual has the bacteria in their lungs and is showing symptoms due to the growth of the bacteria. The disease is typically treated through a mixture of different antibacterial medications, taken for six months to a year.

Though tuberculosis may not sound dangerous, there are some dangers for those who do not receive proper medical treatment. While TB does directly affect the lungs, the bacteria can also affect other organs such as the brain and kidneys, which can cause more concerning health issues like renal failure. Renal failure causes the kidneys to malfunction, so waste is not properly removed from the body. If not treated, tuberculosis can cause the lungs to be filled with fluid and blood and can ultimately result in death.

Which Countries are Most at Risk?

Timor-Leste, located in Southeast Asia, is one of the countries most affected by tuberculosis. Unfortunately, many people are not diagnosed, causing the disease to go on untreated. Timor-Leste has limited medical resources and supplies. As of 2017, the WHO estimates that for every 100,000 people in Timor-Leste, only 498 people are notified that they have tuberculosis, and 106 are killed annually.

83% of the treatment for tuberculosis in Timor-Leste comes with an enormous fee. Due to this, many are reluctant to be treated or even tested for tuberculosis in Timor-Leste. It is also estimated that in 2017, 46% of individuals living with tuberculosis in Timor-Leste have gone undiagnosed. Therefore, there is a dire need for education about tuberculosis in Timor-Leste. Many do not understand the disease or the medical treatment they are receiving and end up not completing the whole treatment.

What is Being Done to Help Timor-Leste?

According to the World Health Organization (WHO), certain programs have been created across Southeast Asia to teach tuberculosis prevention. Overall, there are thirteen districts, each of which focused on a different campaign. Originally, the program was started to address the missing cases in Timor-Leste. The WHO has also implemented more test screenings and treatment. It hopes to execute the “TB Free Core Package” in which there will be more TB prevention, detection, treatment, and protection. This package would be focused on helping low-income families who cannot afford the hefty price tag that comes with TB treatment. As the WHO programs have reached thousands of individuals, there is hope to decrease the number of TB cases and better educate the Timor-Leste public on tuberculosis prevention.

The International Organization of Migration and UN Migration Agency are working with Timor-Leste’s health ministry to help fund more test screenings. Supporting the National Tuberculosis Program will allow screenings to become more available to the public; as of 2018, more than 6,000 individuals have had a screen test. Programs such as this pave the way for more partake in reducing the cases of tuberculosis in Timor-Leste.

Olivia Eaker
Photo: Flickr

Tuberculosis in BotswanaBotswana is a southern African country with just over 2 million residents living inside its borders. Every Batswana lives with the threat of tuberculosis, an infectious disease that remains one of the top 10 causes of death on the African continent. Tuberculosis has a 50% global death rate for all confirmed cases. Investing in tuberculosis treatments and prevention programs is essential. Botswana has one of the highest tuberculosis infection rates in the world with an estimated 300 confirmed cases per 100,000 people, according to the CDC. Preventative and community-based treatment shows promise in combating tuberculosis in Botswana.

Treating Tuberculosis in Botswana

Tuberculosis treatment cures patients by eliminating the presence of infectious bacteria in the lungs. The first phase of treatment lasts two months. It requires at least four separate drugs to eliminate the majority of the bacteria. Health workers administer a second, shorter phase of treatment to minimize the possibility of remaining bacteria in the lungs.

Early identification of tuberculosis is a crucial step in the treatment process and significantly reduces the risk of patient death, according to the Ministry of Health. Preventative treatment methods are vital because they inhibit the development of tuberculosis infection. They also reduce the risk of patient death significantly.

Health workers detect tuberculosis with a bacteriological examination in a medical laboratory. The U.S. National Institutes of Health estimate that a single treatment costs $258 in countries like Botswana.

Involving the Community

Botswana’s Ministry of Health established the National Tuberculosis Programme (BNTP) in 1975 to fight tuberculosis transmission. The BNTP is currently carrying out this mission through a community-based care approach that goes beyond the hospital setting. Although 85% of Batswana live within three miles of a health facility, it is increasingly difficult for patients to travel for daily tuberculosis treatment. This is due to the lack of transportation options in much of the country.

Involving the community requires the training and ongoing coordination of volunteers in communities throughout the country to provide tuberculosis treatment support. Community-based care also improves treatment adherence and outcome through affordable and feasible treatment.

The implementation of strategies such as community care combats tuberculosis. For example, it mobilizes members of the community to provide treatment for tuberculosis patients. The participation of community members also provides an unintended but helpful consequence. For example, community participation helps to reduce the stigmas surrounding the disease and reveals the alarming prevalence of tuberculosis in Botswana.

A Second Threat

In addition to the tuberculosis disease, the HIV epidemic in Africa has had a major impact on the Botswana population, with 20.3% of adults currently living with the virus. Patients with HIV are at high risk to develop tuberculosis due to a significant decrease in body cell immunity.

The prevalence of HIV contributes to the high rates of the disease. The level of HIV co-infection with tuberculosis in Botswana is approximately 61%. African Comprehensive HIV/AIDS Partnerships (ACHAP), a nonprofit health development organization, provides TB/HIV care and prevention programs in 16 of the 17 districts across the country in its effort to eradicate the disease.

Fighting Tuberculosis on a Global Scale

The World Health Organization (WHO) hopes to significantly reduce the global percentage of tuberculosis death and incident rates through The End TB Strategy adopted in 2014. The effort focuses on preventative treatment, poverty alleviation and research to tackle tuberculosis in Botswana, aiming to reduce the infection rate by 90% in 2035. The WHO plans to reduce the economic burden of tuberculosis and increase access to health care services. In addition, it plans to combat other health risks associated with poverty. Low-income populations are at greater risk for tuberculosis transmission for several reasons including:

  • Poor ventilation
  • Undernutrition
  • Inadequate working conditions
  • Indoor air pollution
  • Lack of sanitation

The WHO emphasizes the significance of global support in its report on The End TB Strategy stating that, “Global coordination is…essential for mobilizing resources for tuberculosis care and prevention from diverse multilateral, bilateral and domestic sources.”

– Madeline Zuzevich
Photo: Flickr

Tuberculosis in South Africa
Tuberculosis (TB), a bacterial disease, is contracted through airborne respiratory droplets from an infected individual. TB is also contractible from unpasteurized milk containing Mycobacterium Bovis, or Bovine Tuberculosis. Pulmonary TB primarily affects the lungs, but more than 90% of individuals with TB have a latent form known as drug-resistant TB (DR-TB). With tuberculosis as the leading cause of death in South Africa, the government and other organizations are working to help those with the illness. The South African government, with aid from the international community, is slowing the spread of TB through treatment, premature diagnosing, proper medical training and accessible testing. Here is what you need to know about tuberculosis in South Africa.

Tuberculosis: the Leading Cause of Death in South Africa

Tuberculosis is a major public health threat in South Africa, causing more than 89,000 deaths annually. Even so, the government is making strides toward eradicating TB in South Africa. Medical professionals in South Africa encourage early intensive action by screening all patients attending a primary medical provider. While premature screening is an important measure, it is also critical that the South African government encourages and helps individuals receive testing and remain on the treatment.

Treatment Availability and Effectiveness

Most individuals with TB are curable with a series of medicines. There are currently four recognized medicines that can treat TB: Isoniazid (INH), Rifampin (RMP), Pyrazinamide (PZA) and Ethambutol (EMB). After patients take the drugs for three to nine months and depending on the dosage, their bodies can successfully be rid of the bacteria. However, there is a handful of cases that are multi-drug resistant (MDR-TB). Around 1.8% of the new cases in South Africa are MDR.

For those with DR-TB, the efforts of medical professionals and the government are poor. Treatments become inaccessible for many South Africans. Many local clinics run out of medication for MDR patients, or the wait times to receive prescriptions are several hours long. As a result, patients must go to hospitals also with long wait times and crowded waiting rooms. For individuals who lack the time, money and resources to wait, there are few alternatives. This discourages those with an MDR-TB diagnosis from finishing their treatment plans. If a patient skips one dose of the six-month long medication regime, TB can resurface in the individual and come back much stronger. It is crucial that the government of South Africa, with help from other countries and organizations, provide better accessibility to testing, medicine and capable medical staff to its citizens.

Other Obstacles to Overcome

Much of the spread of TB is the result of unknowingly transmitting the disease or total neglect to seek testing because of inaccessibility or social stigmas. The stigma surrounding a TB diagnosis is a real problem. In 2014, the South African Stigma Survey reported that teasing and mockery affect more than a third of individuals who have TB.

Poverty is also an important dimension. On average, treating a regular case of TB would cost 2,500 rand (about $144.05), which is a steep cost for families in a country with a poverty rate of nearly 50%. To reduce TB deaths in South Africa by 90% would cost the government five billion rand per year, or more than $288 million. However, with help from other countries and organizations, eradicating tuberculosis is possible.

HIV, COVID-19 and TB

HIV comorbidity with tuberculosis has been a fatal combination for decades. More than 6 million South Africans live with HIV, yet only one million were screened for TB in 2013. In 2014, only 34,000 of the millions of people eligible for testing received a test.

Now, according to studies from June 2020, researchers believe citizens with active TB are 2.58 times more likely to die after contracting the coronavirus. Still, TB and HIV pale in comparison to other major risk factors for COVID-19 like diabetes or old age.

The skills medical professionals have gained from treating patients with HIV and TB will hopefully help in handling the novel virus. Being familiar with protective gear, tracking diseases and reducing the spread of illness are all important ways in which TB has prepared South Africa for the pandemic.

Organizations in the Fight against Tuberculosis

The South African government could take several actions to mitigate cases of tuberculosis in South Africa. One potential preventative action is active case finding, where health professionals search communities for individuals with TB. Another action is contact tracing, the method of finding patients who have TB and testing those with whom they have been in contact. Many NGOs and campaigns are stepping up to help the government fight TB.

In 2015, the World Health Organization (WHO) adopted a new plan to tackle the epidemic of tuberculosis in South Africa entitled the End TB Strategy. In collaboration with the National TB Programme, the WHO encourages South Africa to research, use new innovative medicines and tools, collaborate across all sectors of government and properly assess the threat of TB in influenced areas. In addition, The TB Alliance helps to end the spread of tuberculosis by funding clinical drug trials for MDR-TB in South Africa.

 

When considering what the “ideal clinic” is, only 10% of the clinics in South Africa make the cut. These clinics have ample supplies, educated staff and fair policies. It is critical that the South African government receives enough funding to help more clinics reach this status and stay on track to significantly diminish TB by 2035.

– Danielle Kuzel
Photo: Flickr

mass incarcerations in Colombia
Colombia is a country in South America with a population of nearly 50 million as of 2018. It is the second largest country located in South America, with the 38th largest economy in the world. The Colombian Justice System is structured similarly to that of the United States, where defendants have the right to a fair and speedy trial and are sentenced by judges.

Colombian prisons have a problem with mass incarceration. They have an overall capacity of 80,928 people; however, their actual capacity is at 112,864 people as of May 2020. The majority of people are incarcerated for non-violent crimes, such as drug-related offenses. Mass incarcerations in Colombia are also an issue because they lead to other health issues, such as the transmission of HIV and tuberculosis. Here are four more important things to know about mass incarcerations in Colombia.

Mass Incarcerations in Colombia: 4 Things to Know

  1. Capacity Rates: There are 132 prisons in Colombia with a total maximum capacity of just over 80,000 people. Despite this capacity, Colombian prisons have an occupancy level of 139.5%, or just over 112,000 people. Women make up approximately 6.9% of this number, or about 7,700 women. There are no children actively incarcerated in Colombian prisons. The country’s congress has regularly fought against the release of prisoners, instead choosing to keep the prisons full.
  2. Effects of COVID-19: Prison riots are becoming increasingly common in Latin America with the spread of the coronavirus. Mass incarcerations in Colombia have created panic amongst the prisoners, who have demanded more attention to their conditions. The Colombian Minister of Justice, Margarita Cabello, has not outwardly acknowledged the prison riots as demands for better care against COVID-19. Instead, she has stated that the riots were an attempt to thwart security and escape from prison. Furthermore, because of the scarcity in the number of doctors, many prisoners have contracted and/or died from COVID-19. In one particular prison in central Colombia, over 30% of staffers and prisoners have become infected with the virus.
  3. Infectious Diseases: Beside COVID-19, mass incarcerations in Colombia have allowed for the spread of other infectious diseases, such as HIV and tuberculosis. Colombian prisons have designated cell blocks for those who contract HIV, as it is common for prisoners to engage in sexual relationships with guards. Healthcare facilities are not readily available in prisons, and condoms are in scarce supply. Active cases of tuberculosis (TB) also correlate with mass incarcerations in Colombia. Approximately 1,000 prisoners per 100,000 were found to have active cases of TB with little to no access to affordable care.
  4. Possible Solutions: Local citizens Mario Salazar and Tatiana Arango created the Salazar Arango Foundation for Colombian prisoners. Salazar conceived the idea after being imprisoned in 2012 on fraud charges and seeking ways to make serving his sentence more tolerable. The Salazar and Arango Foundation provides workshops for prisoners in the city of La Picota and puts on plays for fellow inmates. Prisoners have found the organization to be impactful to their self-esteem and their push for lower sentences.

Mass incarcerations have had major impacts on the Colombian prison system. Issues such as food shortages and violence have given way to poverty-like conditions with little action. Despite these conditions, organizations such as the Salazar Arango Foundation look to make mass incarcerations in Colombia more tolerable for those behind bars. Hopefully, with time, mass incarcerations in Colombia can eventually be eliminated.

– Alondra Belford
Photo: Unsplash