tuberculosis in PeruCOVID-19 has ravaged populations and economies alike. It has also exacerbated the impacts of previous conditions that threaten the developing world. In particular, the lung-damaging disease known as tuberculosis has seen an alarming resurgence. The World Health Organization (WHO) has classified tuberculosis as one of the 10 leading causes of death worldwide as recently as 2019. Furthermore, the Stop TB Partnership asserts that in just one year, the novel coronavirus and its wide-reaching implications have delayed progress on the eradication of tuberculosis by 12 years. The problem is especially grave in Peru where both COVID-19 and a tuberculosis resurgence are impacting healthcare resources. Cases of both viruses have only multiplied the threat of each, calling for swift solutions.

The History of Tuberculosis in Peru

Tuberculosis in Peru was a pressing issue long before the emergence of COVID-19. Peru reports the second-highest rate of tuberculosis in the Americas and WHO has classified Peru as one of the countries with the most cases of multidrug-resistant tuberculosis (MDR-TB) worldwide. Peru’s economic landscape makes it the perfect hotbed for highly contagious diseases such as COVID-19 and tuberculosis. Roughly 27% of Peru’s population lives in poverty, with a lack of proper housing confining many to dense slums in urban centers. When combined with restricted access to healthcare, these circumstances worsen the spread of disease.

In recent years, Peru has made strides in combating the spread of tuberculosis. For example, the Peruvian government has revamped its tuberculosis control program by establishing multiple committees to guide tuberculosis containment. It has also increased funding for tuberculosis efforts. However, COVID-19 has become a serious roadblock to this mission.

The Impact of Two Pandemics

Upon the outbreak of the novel coronavirus in Peru in early 2020, nearly all the country’s healthcare equipment and resources went toward its treatment and containment. Peru’s healthcare system lacked the capacity to continue fighting tuberculosis as it had, thus, COVID-19 and tuberculosis cases rose simultaneously. Lockdown has also limited the availability of tuberculosis testing, making it harder for doctors to track the disease’s spread. Doctors fear inadequate access to proper medical care and resources will contribute to the development of new strands of MDR-TB.

Continuing to Fight Tuberculosis

The COVID-19 pandemic will undoubtedly continue to impact how Peru addresses tuberculosis. However, efforts have occurred at every level of society to keep combating the latter’s rise. For example, the government is continuing the TB Móvil program which it established in 2019 to increase access to tuberculosis testing by mobilizing vans across the country. The program will provide wide-reaching tuberculosis diagnosis and treatment options.

Non-governmental organizations are working on the ground in Peru as well. Socios en Salud (Partners in Health), which has been active in Peru since the mid-1990s, created its own programs and tools to increase access to tuberculosis treatments. The tools include Mochila TB, individual backpack machines that are useful for tuberculosis testing. The portable and compact machines “[take] testing directly to patients.” One device can test as many as 80 people per day. Solutions like Mochila TB make healthcare more accessible to the rural population. The devices can therefore greatly reduce the impact of tuberculosis in Peru.

Descriptions have determined that Mochila TB is a combination of “digital radiology, artificial intelligence and molecular biology” and has already made a significant impact. Since early March 2021, Mochila TB has reached 3,491 people in the most remote communities of Peru. The mobile testing capability eases the strain on healthcare systems to accommodate for COVID-19 care.

Paving the Way Forward

Healthcare professionals have identified another key step in mitigating COVID-19’s effect on the spread of tuberculosis in Peru: using the healthcare system to combat both diseases simultaneously. Given the diseases’ many similarities in infection, containment and spread, using the same strategies and principles for COVID-19 and tuberculosis in Peru can help stop the spread of both. Through innovations and strategizing, Peru should be able to successfully combat both pandemics.

Nathan Mo
Photo: Flickr

Tuberculosis in AfghanistanEvery year in Afghanistan, more than 60,000 citizens contract tuberculosis. A bacteria called mycobacterium tuberculosis causes the disease and spreads from one infected person to another through the air. Individuals recover from tuberculosis with antibiotics; however, some people struggle to recover with regular medicine. Multi-drug resistant tuberculosis (MDR-TB) occurs when individuals develop resistance to the antibiotics isoniazid and rifampicin. The United Nations Development Programme (UNDP), Medecins San Frontieres (MSF) and the Oriental Consultants Global Co., Ltd. (OC Global) work toward diagnosing, treating and improving tuberculosis in Afghanistan.

Medecins San Frontieres

MSF came to Afghanistan in 1980 and strives to serve individuals with critical medical conditions, children and pregnant women. More specifically, MSF started its MDR-TB program in 2017 to improve the quality of life of individuals with MDR-TB. Since the program’s inception, MSF identified over 40 patients with multi-drug resistant tuberculosis in Afghanistan and many of them received treatment that lasted nine months, as opposed to the standard 20 months. The short treatment time helped eliminate the negative symptoms the patients endured with regular treatment. During their treatment, MDR-TB patients received one of the two antibiotics called bedaquiline and delamanid.

Some patients reside at the association’s clinic in Kandahar to receive antibiotics every day. During their stay, individuals affected with MDR-TB consume nutritious food to help them recover faster. Also, the patients receive counseling and learn how to stop the transmission of tuberculosis to their loved ones.

United Nations Development Programme

The Government of Afghanistan provides universal healthcare to all its citizens. However, many Afghani citizens with MDR-TB do not receive treatment due to the inability to travel to medical centers in the city. The United Nations Development Programme (UNDP) noticed the struggle that individuals endured to get medical care and constructed four treatment centers in Kabul, Nangarhar, Herat and Balkh. The UNDP came to Afghanistan over half a century ago and strives to get rid of destitution, establish systemic change and teach citizens to be adaptable. More specifically, UNDP works towards providing better medical treatment for citizens affected with MDR-TB.

With the help of donations from the Global Fund, each treatment center bought over 20 beds and built enough space to manage 200 patients. Next, over 1,000 health care workers learned how to better identify and manage the disease. Lastly, programs teach Afghani citizens about the disease to decrease judgment towards MDR-TB patients.

Oriental Consultants Global Co., Ltd.

OC Global began helping Afghanistan in 2009 and aims to construct innovative projects all over the world. In Afghanistan, the corporation helped build a new hospital in Kabul that aims to reduce the number of MDR-TB cases.

Inside the hospital, a laboratory allows medical professionals to draw blood from patients to diagnose them more efficiently and swiftly. Next, the corporation bought all the necessary equipment needed to provide better medical treatment. Lastly, with the data collected from the patients, the hospital learns more about the disease and spreads this knowledge to others.

Looking Forward

All in all, MSF, UNDP and OC Global assist in lowering the cases of multi-drug resistant tuberculosis in Afghanistan. These organizations strive to provide easy access to medical care, better quality treatment and a quick diagnosis. As more citizens become aware of the services provided by these three entities, complete management of MDR-TB appears achievable.

– Samantha Rodriguez-Silva
Photo: Flickr

Tuberculosis in UkraineThe tuberculosis epidemic in Ukraine is characterized by drug-resistant tuberculosis strands. Among new tuberculosis cases in 2019, 27% involved drug-resistant tuberculosis and thousands of other cases were classified as multidrug-resistant tuberculosis (MDR-TB). Ukraine suffers from close to the highest rate of MDR-TB in the world. Tuberculosis in Ukraine is only successfully treated at a rate of 76% for various reasons, including patients stopping treatment prematurely, further complications, the high prevalence of MDR-TB and receiving treatment too late.

Current Efforts

In an effort to reduce the burden of tuberculosis in Ukraine, USAID is working with U.S. government agencies and other partners on various projects. Many programs have been introduced in recent years to strengthen the fight against tuberculosis in Ukraine. For example, the Management Sciences for Health (MSH) implemented the Safe, Affordable and Effective Medicines for Ukrainians (SAFEMed) project to ensure transparency and cost-efficiency within the Ukrainian health system. The programs work to increase public access to medicines and commodities essential to treating tuberculosis. Moreover, PATH, a global nonprofit working to improve public health, began the USAID-supported Serving Life Project to reduce the spread of tuberculosis and other diseases by improved detection. Serving Life specifically aims to increase the care and treatment of people living with tuberculosis in pre-trial detention centers, prisons and post-prison settings.

The Transportation Problem

Affordable medication and proper detection are the first steps in the fight against tuberculosis as “timely access to diagnosis and treatment make a difference in tuberculosis care.” However, many parts of Ukraine suffer from lacking specimen transportation systems. With inefficient or even nonexistent systems, the fight against tuberculosis in Ukraine becomes more difficult as these systems delay access to tuberculosis testing and treatment.

The failures in specimen transportation have potentially increased the already high rates of multidrug-resistant tuberculosis, a tuberculosis strand much more challenging to treat. This is because multidrug-resistant tuberculosis arises from the incomplete treatment of tuberculosis, occurring when public health systems are unable to deliver reliable and consistent tuberculosis treatment to patients. Strains on the healthcare system only exacerbate these inefficiencies as the system becomes overloaded. For example, when COVID-19 reached Ukraine, COVID-19 treatment received priority. As a result, many tuberculosis patients were forced to resort to their own methods of specimen transport.

USAID Introduces New Transportation Plan

When USAID’s Support TB Control Efforts in Ukraine activity began in October 2019, Ukraine’s lacking specimen transportation system was identified as one of the weakest links in the fight against tuberculosis in Ukraine. USAID then began a functional transportation system in the Cherkasy Oblast of Ukraine in June 2020. The program uses USAID-provided coolers to preserve specimens in transport and works to plan more flexible and adaptable transportation routes. As a result, transport vehicles are now able to do rounds four times a week while also ensuring weekly delivery to and from each primary healthcare facility. While the program began in Cherkasy, it has expanded to seven other oblasts in Ukraine within less than a year of the program’s inception.

With efforts from organizations to address the tuberculosis epidemic in Ukraine, it is hopeful that Ukraine will see its case numbers dropping.

Kendall Carll
Photo: Flickr

HIV/AIDS in Mozambique
The East African country of Mozambique has struggled to control the spread of the human immunodeficiency virus (HIV) and the acquired immunodeficiency syndrome (AIDS). Since its introduction to southern Africa in the late 1980s, the adult prevalence of HIV/AIDS in Mozambique is around 12.10% – the seventh-highest rate in the world. However, there is good news. Infection rates and deaths that relate to AIDS are decreasing and the country is feeling a surge of international support. Here are three ways in which Mozambique is currently fighting against the epidemic.

Grants

In February 2021, the Government of Mozambique, the Global Fund and other medical partners launched six new grants to expand treatment and service options for HIV, TB and malaria. Actions like this are causing HIV/AIDS in Mozambique to experience a downward trend in cases and deaths.

With greater funds, HIV treatment will become more available. In fact, one can attribute greater access to treatment to the “29% decrease in the number of AIDS-related deaths” from 2006 to 2019. These particular grants are significant because they are worth $773,913,131, a figure that is 49% larger than the previous allocation amount.

The financial assistance aims to reach vulnerable populations, especially adolescent girls, and to make testing widespread. Mozambique is working towards creating strong, sustainable health systems. Health officials are hopeful that these grants will put the country on the path to self-sufficiency where external help is no longer necessary.

Medicine

There have also been recent developments in the world of pharmaceuticals. Mozambique launched a new preventative drug for tuberculosis (TB) on March 24, 2021, which is World Tuberculosis Day. Although this drug does not specifically treat people with HIV/AIDS in Mozambique, the two ailments inextricably connect. HIV greatly weakens the body’s immune system and puts people at high risk for diseases like TB.

The Mozambique Health Minister, Armindo Tiago, explicitly stated, “this programme is aimed at people living with HIV/AIDS.” The new system reduces pill intake from nine to three pills a week and the treatment duration from up to 36 months to just three months. According to Unitaid, “up to 3 million patients are expected to be made available for eligible countries this year.” These countries include Mozambique, Ethiopia, Ghana, Kenya and Zimbabwe.

This shorter, less invasive treatment intends to attract more people seeking medical therapy. If proven successful, it is likely that the number of HIV-related deaths will drop. As a result, Mozambique should gain the upper hand in the fight against communicable diseases.

Clinics

The U.S. NGO, the Elizabeth Glaser Pediatric AIDS Foundation, is helping combat HIV/AIDS in Mozambique. This organization focuses on preventing pediatric HIV and ending pediatric AIDS all over the world. On March 15, 2021, the NGO donated two mobile clinics that will serve the cities of Maputo, Matola and the district of Marracuene.

The organization intends to provide primary care as well as sexual and reproductive health services to 3,000 young people. It chose the areas of Matola, the district of Marracuene and Maputo because of the high number of teenagers who need “more accurate information” about sexual health and sexually transmitted diseases. The mobile clinics have services for HIV/AIDS testing, tuberculosis, cancer screening, counseling and more.

Implementing these three forms of aid furthers the country’s efforts to make healthcare more accessible for those who need it most. Mozambique is a demonstration of how people across the world are still passionately fighting against HIV/AIDS.

– Lucy Gentry
Photo: Flickr

Leading Cause of Death
The World Health Organization (WHO) estimates that one-third of the global population has latent tuberculosis. Though a vaccine exists for this fast-spreading virus, tuberculosis is a leading cause of death in the world.

While some may think of tuberculosis, formerly known as consumption, as a virus of the past, it has begun to reemerge and create public health crises in multiple countries. The evasive nature of the virus has resulted in its continued spread. Additionally, many underlying factors contribute to the continuation of this illness.

Immigration and Movement of People Between Countries

Despite the efforts of many countries, the complete eradication of tuberculosis is near impossible due to the influx of immigrants leaving and entering endemic countries. The CDC claims that without proper treatment and health services for all immigrants, this disease will continue to spread. Containing and quarantining the infected would be of little use since only 10% of tuberculosis carriers present outward signs.

How it Compliments Other Epidemics

The destructive manner in which tuberculosis attacks the respiratory system creates an even deadlier combination when paired with another disease. For example, the United States experienced a spike in both tuberculosis and HIV cases around the same time, due to the nature of both diseases. With a weakened immune system, HIV patients struggled to fight the disease on their own, leading to the re-emergence of tuberculosis.

Poor Government Structures and Funding to Facilitate Care

As the COVID-19 pandemic made evident, many governments are poorly equipped to facilitate proper care to combat TB epidemics. However, movements to eradicate it have resulted in mandatory testing for nearly all hospitals and universities. While developed countries have made large strides in the positive direction, the lack of governmental structure and resources in poverty-stricken countries allows tuberculosis as a leading cause of death.

Vaccine Resistant Strains

As with any virus, TB has evolved to include many vaccine-resistant strains. These strains stand in the way of eradication. Furthermore, the CDC has discussed the threat this strain poses if used as a bioweapon. WHO has set a goal of wiping out tuberculosis by 2035, but without a method of controlling or stopping vaccine-resistant strains, this goal is challenging.

NGOs Working to Address Tuberculosis

The Global Fund, WHO and USAID are all working to address tuberculosis, the leading cause of death, through new health technologies. These organizations use technologies to monitor antibiotic administration, side effects and maintain patient charts on a virtual platform. This virtual platform allows healthcare workers to navigate data conveniently. Some platforms use safety precautions to eliminate issues of miscommunication and over-administration of medications.

– Venus Wang
Photo: Flickr

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

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