Tuberculosis in sub-Saharan Africa
As tuberculosis (TB) kills more than a million people each year, a new strategy to detect the disease has emerged: using rats to identify TB positive samples. TB remains the world’s deadliest disease, infecting 10 million and killing 1.5 million people in 2018. Tuberculosis in sub-Saharan Africa is also the main cause of death for people living with HIV.

In Mozambique, where 13.2% of the population has HIV, more than half of the people with TB also have HIV. Along with malnutrition and other diseases, HIV reduces resistance to TB, so people living in poverty are especially susceptible to TB. Those experiencing poverty are also more likely to have fewer healthcare options and spend most of their lives in overcrowded conditions and poorly ventilated buildings where TB can easily spread. However, TB is treatable; it just needs to be caught in time. APOPO, a Belgian NGO, works to detect tuberculosis in sub-Saharan Africa by training rats to sniff it out.

How Can Rats Detect Tuberculosis?

For nine months, African giant pouched rats are trained to sniff out TB from samples of sputum — the mucus produced from coughs. Much like the Pavlov’s dog theory, trainers condition rats to associate the sound of a click with a reward; the rats only hear a click and receive a reward when they interact with TB positive samples. The rats have to hold their snouts over the sample for two to three seconds to indicate the positive sample. To “graduate” and become heroRATS — the official name for APOPOs rats — the rats go through a testing process where they have to detect every TB positive sample among rows of sputum.

Since 2007, APOPO has partnered with local clinics that send potential TB samples for the rats to check. Health clinics perform smear microscopy tests that often come up negative when they are actually positive. The heroRATS help to correct this problem by accurately identifying the TB positive samples. Their detection rats can check up to 100 TB samples in 20 minutes while the same task might take a lab technician up to four days. After the APOPO lab confirms the TB samples tested by the rats (using WHO methods), they alert the clinic about the results. So far, the rats have screened 580,534 TB samples and prevented 126,375 potential TB infections, raising TB detection rates of partner clinics by 40%.

The Relationship Between TB and Poverty

When medical professionals are unable to detect tuberculosis and treat it in time, the disease can augment poverty rates, making living conditions even worse for people who have it. Because TB is highly contagious, those with the disease are not allowed to go to work or school, leading to a loss of income and education. The stigma surrounding TB is also detrimental; people are often excluded from the community, so they can no longer rely on support from previous outlets. APOPO’s work to increase the TB test’s accuracy and speed helps those infected to know their correct results and then seek more immediate treatment.

Progress Detecting Tuberculosis in sub-Saharan Africa

The three main countries APOPO operates in  — Tanzania, Mozambique and Ethiopia —  are all considered high burden TB countries.

  • Tanzania: Tanzania has one of the highest TB burdens in the world at approximately 295 TB cases per 10,000 adults. With a poverty rate of 49.1%, almost half of Tanzanians are susceptible to TB’s spread. To help alleviate the effects of this disease, APOPO began in Tanzania in 2007 and has since expanded to 74 collaborating clinics across the country. A new testing facility in Dar es Salaam opened in 2016 and delivers results to clinics in 24 hours. Along with increasing accuracy, the APOPO facilities and rats boost the TB detection rate to around 35%.

  • Mozambique: After its success in Tanzania, in 2012 APOPO developed programs in Mozambique, where approximately 62.9% of the population lives in poverty. In partnership with Eduardo Mondlane University, APOPO built a new testing facility on the university’s grounds in Maputo. This center works with 20 local healthcare clinics and delivers results in 24 hours, which increases the probability of the patient starting treatment because it reduces the time and effort it takes to track down a patient to inform them of the results. Due to this partnership, the TB detection rate has increased by 53%.

  • Ethiopia: With a 30.8% poverty rate, Ethiopia ranks 10th for the highest TB burden in the world. To help identify these cases, APOPO is currently building a detection facility with the Armauer Hansen Research Institute. Additionally, this center will not only partner with clinics in Addis Ababa to test for TB, but will also screen up to 52,000 prison inmates and staff located in 35 prisons across Ethiopia. At the clinics, the goal is to increase identified TB cases by 35% while developing its program to create a long term impact in Ethiopia.

Armed with its innovative thinking — and its heroRATS — APOPO is making progress in detecting tuberculosis in sub-Saharan Africa and limiting its spread.

Zoë Padelopoulos
Photo: Flickr

Tuberculosis in Lesotho
On May 13, 2020, Lesotho confirmed its first case of COVID-19, making it the last country in Africa to contract the virus. The country now has to make a difficult decision on how to take charge of the situation. In short, the government has its work cut out for it.

But COVID-19 is not the first disease that the country has had to fight off. For years, Lesotho has been at war with tuberculosis, an incredibly infectious disease that acts similarly to COVID-19. Although Lesotho’s fight with TB may not be over, it has certainly made great strides towards ending the epidemic its citizens are living in.

Tuberculosis in Lesotho

Lesotho is a country in Africa that South Africa surrounds on all sides. It is a developing country home to approximately 2.11 million people. Currently, Lesotho ranks second in the world for people with tuberculosis, with an estimated 724 cases per 100,000 people—about 15,276 people in total. In Lesotho, tuberculosis is particularly harmful to those with HIV, as 73% of people who contract tuberculosis also have HIV.

Tuberculosis is the leading fatal infectious disease in the world, and it kills more than 1.6 million people worldwide each year. TB is an airborne disease: it transfers when a person breathes contaminated air droplets from an actively sick person. If untreated, active TB can be lethal. However, 90-95% of infected people do not actually show symptoms. Most tuberculosis is treatable, as the success rate of treatment in Lesotho is around 77%, but the country has seen a rise in MDR-TB or multidrug-resistant tuberculosis. As the name suggests, multidrug-resistant tuberculosis is immune to the common medications for TB. According to the National Center for Infectious Diseases, MDR-TB affects about 10% of people with smear-positive TB or around 1,000 people. The stronger strain of the bacteria requires that doctors develop more creative treatment options.

Treating Tuberculosis

Although the tuberculosis epidemic has significantly impacted life in Lesotho, the country has not stopped its ongoing war with it. Trained community health workers treat and supervise several patients from the patients’ homes. These workers give injections as well as monitor the side effects of treatments. Patients who become dangerously ill go to Botshabelo Hospital, a place that specializes in MDR-TB in the capital of Maseru.

The CDC also partnered with Lesotho in 2007 to help fight the infection. Since then, it has been working diligently to bring peace. The CDC helps the Ministry of Health and Social Welfare’s efforts towards HIV and TB treatment by improving health information systems, preventing transmission of HIV between mother and child, increasing the capacity in laboratories and giving counseling and testing for those HIV has affected. It also works with the ministry on diagnosis and treatment of the many variations of TB infecting the country. Altogether, the CDC has lowered the TB mortality rate to just 46 deaths per 100,000 infected.

Global Resilience

As a whole, the world has made phenomenal progress in its fight against tuberculosis. Global efforts have saved more than 50 million lives since 2000. Furthermore, global aid is actually is one of the best investments in the public health industry, as each dollar that goes towards TB relief yields $43 back.

Even though Lesotho is facing much loss, including those from its new COVID-19 cases, the country has stayed resilient amid hardship. Lesotho continues its ongoing war with TB, and it will not stop until there is no disease left to fight. The people of Lesotho show the world each day what true bravery looks like as they work towards a new, tuberculosis-free era.

John Pacheco
Photo: Flickr

tuberculosis in ZambiaThe South African country of Zambia has a population of around 17 million. Over the last 30 years, it has experienced a rise in tuberculosis cases, an infectious bacterial disease in the lungs. Estimates show the mortality of the disease as approximately 30 deaths due to tuberculosis per 100,000 people. Below are seven important facts about tuberculosis in Zambia.

7 Facts About Tuberculosis in Zambia

  1. Co-infection: HIV patients have a high risk of contracting tuberculosis. In Zambia, 59% of tuberculosis patients have also tested positive for HIV. Though there are healthcare systems for the prevention and treatment of tuberculosis among patients with HIV, overpopulation, poverty, cultural beliefs and sanitation conditions can make a diagnosis of both HIV and tuberculosis a challenge.
  2. Limited Access to Treatment: There is a greater prevalence of tuberculosis mortality in rural areas of Zambia. The commute to a clinic is often greater than a two-hour walk for a person living in a rural home, which puts a strain on those with the disease and on the family or friends who need to take time off of work to travel with their loved one.
  3. Economic Burden: Tuberculosis is extremely costly for individuals and for Zambia as a nation. Medications and other services like x-rays can be expensive for individual families. Furthermore, the overall loss of a workforce can impact the greater economy. This can be seen in mining communities, where tuberculosis is especially prevalent. Because the mining industry plays an important role in Zambia’s economy, there have been negative economic impacts in losing a percentage of the workforce due to tuberculosis. A 2016 study on tuberculosis in Zambian mines advocates for greater regulatory legislation for mining conditions and better health systems to create a healthier population and a more stable economy.
  4. Improving the Cure Rate: Tuberculosis is a serious disease and can be fatal. The Ministry of Health finds that 62,000 Zambians contract tuberculosis and 16,000 people die each year from the disease. Though there are still many fatalities, there has been great progress in treating the disease. Today, around 88% of people treated are cured, exceeding the WHO recommended cure rate of 85%, and the pooled cure rate of between 55% and 73% for Africa.
  5. Better Management: World Tuberculosis Day, observed each year on March 24, commemorates the discovery of the bacteria that causes tuberculosis in 1882. During the 2019 World Tuberculosis Day, the Ministry of Health Announced the new guidelines for “Management of Latent Tuberculosis Infection.” This was the launch of greater efforts towards the elimination of tuberculosis and emphasizes early detection.
  6. Improved Surveillance: Though tuberculosis is a severe health issue, there have been limited health surveys to find an accurate prevalence of the disease. In 2013, the Government of the Republic of Zambia (GRZ) through the Ministry of Health (MoH) and USAID conducted a survey on the tuberculosis rate in Zambian regions. The surveys showed a higher prevalence of tuberculosis than estimated. They also revealed improved techniques for tuberculosis detection. For example, the use of digital systems and the integration of HIV testing in tuberculosis surveys (HIV is common comorbidity) can help estimate the rate of incidence and help improve the efficiency of tuberculosis healthcare.
  7. More Accurate Diagnoses: Founded in 2006, the Center For Infectious Disease Research in Zambia (CIDRZ) has provided many services for combating tuberculosis in Zambia including research on diagnostic techniques. CIDRZ tested some novel techniques of tuberculosis diagnosis such as LED fluorescence microscopes and computer-assisted digital x-ray interpretation technology. CIDRZ helps mobilize these techniques and train community members in the identification of tuberculosis.

These facts show that the health crisis of tuberculosis in Zambia exposes a dire need for increased accessibility of healthcare and better methods of diagnosis and treatment. The recent efforts in management and care of tuberculosis show promise of effective tuberculosis management and an overall healthier population.

– Jennifer Long
Photo: Flickr

Tuberculosis in PakistanPakistan is ranked as the fifth-highest nation contracting Tuberculosis (TB) daily in the world. It has an “estimated 510,000 new TB cases emerging each year,” accounting for 61% of TB in the eastern Mediterranean region. According to the Stop TB Partnership, there are 1,540 developing cases and 121 deaths from tuberculosis in Pakistan every day. Pakistan also experiences the fourth-highest rate of multidrug-resistant TB (MDR-TB) globally. The abundance of MDR-TB cases largely results from delays in diagnosis, inadequate drug treatment and non-compliance of some patients.

Economic Background and Effects

The average monthly cost to treat Tuberculosis in Pakistan is between 1,500 and 1,800 Pakistani rupees, which equals around $9 to $11 per month. In Pakistan, this is a huge financial burden considering the average monthly income of less than $35, with many TB patients earning even less than that. One study reported 96.7% of Pakastani TB patients were already struggling financially prior to their diagnosis.

After diagnosis, changes in employment status are common for many patients. Roughly 75% of TB patients are unemployed after diagnosis. Those who do not lose their jobs often face cuts in work hours. These economic constraints inadvertently encourage non-compliance and refusal of treatment, which ultimately contributes to the spread of TB in Pakistan.

Stigmatization of Tuberculosis

Beyond employment consequences, tuberculosis in Pakistan is heavily stigmatized by the public. More than three-quarters of Pakistanis believe TB patients should be kept in hospitals or sanitariums during treatment. Some even admit that they would not marry an individual who has had TB. Out of a fear of being ostracized, most TB patients in Pakistan hide their disease and refuse treatment—behavior that contributes to the high rates of MDR-TB in the country.

The stigmatization of TB in Pakistan is mainly a result of a lack of public knowledge and misconceptions about the disease. Recent studies point toward insufficient TB awareness among the public and even patients in Pakistan. One study found that 88.7% of patients questioned did not know the risk factors of TB or the protective measures people with the disease should take. Moreover, less than half of the respondents could accurately identify TB symptoms.

The National TB Control Program (NTP)

Despite the high rates of tuberculosis in Pakistan, the country has made strides in decreasing its numbers. Organizations such as the National TB Control Program (NTP) are actively working to achieve a TB-free Pakistan. NTP re-launched in 2001 after TB became a national emergency in Pakistan. Since then, the organization has worked alongside the National Institute of Health to fight TB in the country. The main objective of NTP is to cut the number of TB cases present in 2012 in half by the year 2025.

The organization has brought more attention to the issue and improved its detection of cases from 11,050 cases in 2000 to 248,115 in 2008. The NTP hopes to increase that number to 420,000 by the end of 2020. Furthermore, the organization was able to bring the treatment success rate up to 91% by 2007 and has been working to maintain that level since.

COVID-19 Impact

The recent outbreak of COVID-19 across the globe has posed a major threat to the state of tuberculosis in Pakistan. With social distancing regulations, it has become difficult for individuals to be diagnosed and treated for the disease. Despite these new challenges, Pakistan and the NTP have remained committed to controlling the TB situation. The National Manager of NTP, for example, announced that follow-up appointments following treatment are to be conducted over the phone. Furthermore, the NTP outlined plans to use methods like the Pakistan Postal Service and Uber to deliver ongoing treatment to patients across the country.

The NTP has also started an online TB case notification pilot program where patients can register and receive treatment notifications and additional assistance from healthcare workers via text. This program will provide the NTP with greater information on TB cases in Pakistan as well as encourage patient compliance with treatment plans.

– Mary Kate Langan
Photo: Flickr

Life Expectancy in Timor-Leste
Timor-Leste, also known as East Timor, is a nation that occupies the eastern half of the island of Timor in Southeast Asia. With a population of 1.26 million people, Timor-Leste is one of the least populated countries in Asia. The Portuguese originally colonized the country in 1520. After declaring independence in 1975, Indonesia invaded the nation, which occupies the western half of the island. The Indonesian invasion brought violence, famine and disease to Timor-Leste, resulting in a large loss in population. After a majority of the Timorese population voted to become independent in 1999, Indonesia relinquished control and Timor-Leste moved under the supervision of the United Nations. The nation officially became independent in 2002, making it one of the newest nations in the world. These 10 facts about life expectancy in Timor-Leste outline the rapid improvement the country has made since Indonesian occupation and the issues it still needs to overcome.

10 Facts About Life Expectancy in Timor-Leste

  1. Life expectancy in Timor-Leste increased from 32.6 years in 1978 to 69.26 years in 2018, matching that of South Asia. The consistent improvement in life expectancy in the past decade is primarily due to the Ministry of Health’s public health interventions. Such interventions include the reconstruction of health facilities, expansion of community-based health programs and an increase in medical graduates in the workforce.
  2. Life expectancy in Timor-Leste increased despite a drop in GDP, which decreased from $6.67 billion in 2012 to $2.6 billion in 2018. However, Timor-Leste’s GDP rose by 2.8% from 2017 to 2018. Continued improvement in GDP and economic progress in the nation will only serve to increase life expectancy by providing more opportunities for employment, education and improved quality of life.
  3. Tuberculosis was the highest cause of death in 2014, causing 14.68% of deaths. In 2014, estimates determined that Timor-Leste had the highest prevalence of tuberculosis in Southeast Asia, and 46% of people with tuberculosis did not receive a diagnosis in 2017. Maluk Timor, an Australian and Timorese nonprofit committed to advancing primary health care, provides a service through which team members visit Timorese households to locate undiagnosed patients and raise awareness about the severity of tuberculosis in the community. The organization collaborates with the National TB Program and aims to eliminate suffering and deaths in Timor-Leste due to diseases that Australia, which is only one hour away, had already eliminated.
  4. Communicable diseases caused 60% of deaths in 2006 but decreased to causing 45.6% of deaths in 2016. While diseases such as tuberculosis and dengue fever remain a public health challenge, the incidence of malaria drastically declined from over 200,000 cases in 2006 to no cases in 2018 due to early diagnoses, quality surveillance, funding from The Global Fund to Fight AIDS, Tuberculosis and Malaria and support from the World Health Organization.
  5. The adult mortality rate decreased from 672.2 deaths per 1,000 people in 1977 to 168.9 deaths per 1,000 people in 2018. Additionally, the infant mortality rate decreased from 56.6 infant deaths per 1,000 live births in 2008 to 39.3 infant deaths per 1,000 live births in 2018. While public health interventions and disease prevention contributed to the decrease in the adult mortality rate, Timor-Leste needs to expand access to maternal health services in rural areas to continue to improve the infant mortality rate.
  6. Maternal mortality decreased from 796 deaths per 100,000 live births in 1998 to 142 deaths per 100,000 live births in 2017. The leading cause of the high maternal mortality rate is poor access to reproductive health services, as only 43% of women had access to prenatal care in 2006. While the Ministry of Health continues to expand access to maternal health care through mobile health clinics that reach over 400 rural villages, only 30% of Timorese women gave birth with a health attendant present in 2013. Even as access increases, challenges such as family planning services, immunization, treatment for pneumonia and vitamin A supplementation remain for mothers in rural communities.
  7. The violent crisis for independence in 1999 destroyed more than 80% of health facilities. Despite rehabilitation efforts to rebuild the health system, many facilities at the district level either have limited or no access to water. However, the number of physicians per 1,000 people improved from 0.1 in 2004 to 0.7 in 2017. The capacity of the health care system is also improving, as UNICEF supports the Ministry of Health in providing increased training for health care workers in maternal and newborn issues and in striving to improve evidence-based public health interventions.
  8. Timor-Leste has one of the highest malnutrition rates in the world. At least 50% of children suffered from malnutrition in 2013. Additionally, in 2018, 27% of the population experienced food deprivation. USAID activated both the Reinforce Basic Health Services Activity and Avansa Agrikultura Project from 2015-2020 to address the capacity of health workers to provide reproductive health care and the productivity of horticulture chains to stimulate economic growth in poor rural areas. Both projects aim to combat malnutrition by addressing prenatal health and encouraging a plant-based lifestyle that fuels the economy.
  9. Motherhood at young ages and education levels are key contributors to malnutrition, as 18% of women began bearing children by the age of 19 in 2017. Teenage girls are far more likely to experience malnourishment than older women in Timor-Leste, contributing to malnutrition in the child and therefore lowering life expectancy for both mother and child. As a result of malnutrition, 58% of children under 5 suffered from stunting in 2018. Additionally, findings determined that stunting levels depended on the wealth and education level of mothers. In fact, 63% of children whose mothers did not receive any formal education experienced stunting, while the number dropped to 53% in children whose mothers received a formal education.
  10. Education enrollment rates are increasing, as the net enrollment rate in secondary education increased from 40.5% in 2010 to 62.7% in 2018. Completion of secondary education links to higher life expectancy, especially in rural areas. Since 2010, Timor-Leste has increased spending on education. Additionally, local nonprofit Ba Futuru is working to train teachers to promote quality learning environments in high-need schools. After Ba Futuru worked with schools for nine months, students reported less physical punishment and an increase in innovative and engaging teaching methods in their classrooms. The organization serves over 10,000 students and provides scholarships for school supplies for hundreds of students. With more programs dedicated to increasing enrollment and the classroom environment, students are more likely to complete secondary education and increase both their quality of life and life expectancy.

These 10 facts about life expectancy in Timor-Leste indicate an optimistic trend. Although malnutrition, disease and adequate access to health care remain prevalent issues in Timor-Leste, the nation’s life expectancy has rapidly increased since Indonesian occupation and has steadily improved its education and health care systems since its founding in 2002. To continue to improve life expectancy, Timor-Leste should continue to focus its efforts on improving public health access and community awareness in poor rural areas, and particularly to emphasize maternal health services to reduce both maternal and infant mortality rates. Despite being one of the newest nations in the world, Timor-Leste shows promise and progress.

Melina Stavropoulos
Photo: Flickr

Tuberculosis in DjiboutiTuberculosis (TB) is an infection caused by Mycobacterium tuberculosis. In addition to airborne spread, TB can be transmitted through unpasteurized milk contaminated with Mycobacterium bovis. This infection attacks the respiratory system, but in extreme cases, it can impact the central nervous system, bones, joints, lymphatic system and urogenital area. It’s a disease that is endemic in Djibouti, a country in eastern Africa. 

Infection Rates and Spending Levels

From 2000 to 2018, there were two peak levels of tuberculosis in Djibouti — one in 2001, and the other in 2010. In these years, Djibouti hit 716 cases of TB per 100,000 people and 621 cases per 100,000 people, respectively. As of 2018, TB rates were the lowest they had been in since 2000, at only 260 cases per 100,000 people. That being said, TB has remained the number four cause of death in Djibouti since 2007.

Despite the fact that deaths have increased, health data analyzers seem optimistic that the incidence of TB will decline as more funding goes toward health in Djibouti. In 2016, only $66 was spent per person on health. By 2050, experts predict that spending will rise to $87 per person. This increase will largely come from expanded development assistance and a rise in government spending on health — predicted to jump from $35 per person in 2016 to $48 in 2050. With more money being put into the health of citizens, it will be easier to get and keep people healthy. If someone does contract TB, there will be more money allotted for their treatment. Increased health funding will also allow for more community outreach and education around the spread and treatment of TB. If someone contracts TB and cannot get to a medical facility, they will at least have tools to keep themselves healthy and ensure that their case doesn’t spread. 

Refugees and Tuberculosis in Djibouti

Refugees account for nearly 3% of Djibouti’s population. Most refugees come from neighboring countries raging with war. Djibouti’s refugee camps are small, cramped and perfect breeding grounds for TB. While things may seem bleak, there is hope. The government in Djibouti is working with multiple NGOs to bring awareness and treatment to TB in refugee camps. UNDP has partnered with UNHCR and the Global Fund to address tuberculosis in Djibouti. So far, they have provided treatment for 850,000 TB patients, as well as 19,139 patients with drug-resistant TB. The work of NGOs has allowed families to stay with the sick during treatment, without fear of contracting the infection.

The goal of this partnership is to end TB in Djibouti by 2030 — an ambitious goal, but one that is potentially attainable as support and funding help to educate, treat and provide support for the people who need it. While treatment is important, however, these NGOs have also shown that community outreach programs aimed at teaching people how to avoid TB are just as vital in stopping the spread of the disease.

The tuberculosis crisis in Djibouti has been a lasting one. Thanks to recent investments by the government, new technologies to combat TB and organizations helping contain the refugee TB crisis, there is hope for the future of this country and its citizens.

Maya Buebel
Photo: Flickr

tuberculosis in KiribatiKiribati is one of the world’s smallest countries, located in the middle of the Pacific Ocean. The 30 plus islands that together form Kiribati may be small and house a population of a little more than 100,000 people, but Kiribati is modernizing every day. The country only became fully independent in 1979 after a history of colonialism, and it joined the U.N. in 1999. Today, one of the biggest threats it faces is tuberculosis (TB). Of all the neighboring pacific island countries, Kiribati has the highest incidence of tuberculosis with a report of 349 incidents per 100,000 in 2018. While tuberculosis is endemic in Kiribati, the situation is far from hopeless. New scientific approaches to diagnosing and treating tuberculosis are making it possible to eradicate the disease in the future.

Tuberculosis and Overcrowding

Tuberculosis is directly related to overcrowding. While there are 33 total islands of Kiribati, only 20 of these islands are inhabited. Moreover, almost all of these islands are very sparsely inhabited, with around 64,000 inhabitants living on the main atoll, Tarawa. Though the nation does not boast a large overall population, the population density of the country is one of the highest in the world. Tarawa has a population density on par with major cities, like Tokyo and Hong Kong. This high population density means that most households in Kiribati are vastly overcrowded, creating a greater likelihood of spreading tuberculosis. Oftentimes, the housing lacks proper construction or proper ventilation, which also impacts the spread of TB. On average, households in Tarawa have between eight and nine people in them.

Tuberculosis and Diabetes

Tuberculosis and diabetes are often co-morbid illnesses causing major concern in Kiribati, which has one of the top 10 highest rates of diabetes in the world. In Kiribati, between one fourth and one-third of adults have diabetes, so the likelihood of having tuberculosis and diabetes is quite high. In fact, one-third of citizens with tuberculosis are also diagnosed with diabetes. This is so prevalent because diabetes can impact the treatment of tuberculosis. As a result, most of the citizens with both diabetes and TB have the infectious form of TB. This means that they pose a greater risk of spreading the illness to other members of the community.

New Methods for Catching and Eliminating TB

While tuberculosis is a serious concern to citizens of Kiribati, there are groundbreaking efforts to speedily diagnose and treat tuberculosis. Addressing TB is one of the country’s top priorities. In conjunction with organizations like the Global Fund to Fight Aids, Tuberculosis and Malaria, Kiribati has managed to acquire modern diagnostic tools like portable X-ray machines. In recent years, another strategy that targets specific “hotspot” areas has proved incredibly useful in diagnosing TB in the early stages. This process focuses on areas known to have the greatest likelihood of TB by using patterns from past years to locate the most at-risk communities. After locating these communities, citizens of the area participate in screening for TB. In 2019, during a hotspot case study, healthcare workers screened 3,891 people for tuberculosis in less than two weeks. Over the course of the 11 days, they diagnosed seven new cases.

A More Positive Future

In the past few years, the general fear of tuberculosis in Kiribati has greatly diminished. With the new systems in place to screen, diagnose and treat TB, citizens have become more aware of how to prevent the spread of disease. The new systems also allow more citizens who may be living in poverty or isolated areas to access treatment. Healthcare workers go directly into the villages within each hotspot, allowing citizens to easily walk to clinics for screening. At these clinics, they receive prevention tips, pamphlets and a better understanding of how to care for themselves and those around them.

Despite overcrowding and comorbidity with diabetes, the future of tuberculosis in Kiribati is looking up. With only 323 cases in 2018 after 745 new cases in 2007, the numbers are slowly decreasing. With increased awareness and prevention tactics, along with modern technology and hotspot screening, it is hoped that this trend will continue.

– Lucia Kenig-Ziesler
Photo: Flickr

tuberculosis in Eastern Europe
One of the oldest diseases, tuberculosis is still prevalent in hundreds of countries and nearly every continent. Although many countries have been able to reduce their number of cases through medical intervention and policies, Eastern Europe remains affected by the disease. Despite the rising cases of tuberculosis in Eastern Europe, European and other governments are coming up with new solutions to better treat individuals with TB and potentially eradicate the disease. Here are five facts about tuberculosis in Eastern Europe.

5 Facts About Tuberculosis in Eastern Europe

  1. Most of Europe’s tuberculosis cases are in Eastern Europe. According to the World Health Organization (WHO), Europe has the lowest incidence of tuberculosis in the world. However, the cases that do exist concentrate in Eastern Europe. The WHO found that 18 countries in Eastern Europe bear 85% of the tuberculosis burden for the continent. Over the past decade, cases of tuberculosis have halved throughout Europe. Despite this decrease, however, the number of cases in Eastern Europe is almost eight times higher than that of Central and Western Europe.
  2. Eastern Europe has the highest rates of drug-resistant tuberculosis. Multidrug-Resistant Tuberculosis (MDR tuberculosis) is currently the most prevalent form of TB in Eastern Europe. MDR tuberculosis occurs when the bacteria that causes tuberculosis becomes resistant to at least isoniazid and rifampin, the two most common drugs doctors use to treat tuberculosis patients. Typically, this resistance occurs when patients do not finish their antibiotics or when tuberculosis infects a person more than once. In all of Europe, 99% of MDR tuberculosis cases occur in Eastern Europe. As a result, scientists need to develop new antibiotics or treatments for patients in that region.
  3. Tuberculosis outbreaks are more common in poorer regions. In general, researchers tend to find tuberculosis in poorer and developing countries. Similarly, the levels of TB in Eastern Europe could connect to the overall poverty rates in the region. The poverty rates in Central and Western European countries such as the Czech Republic are as low as 10%. However, in Eastern European countries, such as Romania, the poverty rates are as high as 25%. In poorer countries, access to medical treatment and preventative care decreases. Thus, in Eastern Europe, a common struggle for individuals with tuberculosis is finding health care that is effective and affordable.
  4. Problems with tuberculosis are worsening due to COVID-19. The COVID-19 pandemic has led countries to implement social distancing and stay-at-home policies. As a result, the circumstances for individuals with tuberculosis in Eastern Europe may worsen. A recent modeling study looked at the rate of incidence of tuberculosis and the tuberculosis mortality rate during the lockdown. The study predicted that both the number of cases and the number of deaths will rise as people remain in close quarters. For example, imagine the lockdown in a high-risk country such as Ukraine lasting for 3 months with a 10 month recovery period. The rate of incidence would increase by 10.7% and the mortality rate would increase by 16%. One reason for this increase is the lack of medical care available during the pandemic. As more supplies and medical officials go towards fighting COVID-19, other diseases such as tuberculosis could go unchecked during the lockdown.
  5. Better diagnostic services are currently in progress. This year, in 2020, the European Lab Initiative (ELI) on tuberculosis, HIV and Viral Hepatitis, a regional center that has dedicated itself to the treatment of those three diseases, released its goals for 2020 and 2021. These goals, which include improved drug treatments and better tracking algorithms, hope to allow doctors in Eastern Europe to diagnose patients with tuberculosis faster. By diagnosing people earlier, the transmission of tuberculosis will slow, and those who test positive for tuberculosis will have a higher chance of recovery.

Although the rates of TB continue to drop in Western and Central Europe, wealth inequality and the COVID-19 pandemic are keeping the number of cases up in Eastern Europe. However, if progress on better diagnostic services continues, the occurrence of tuberculosis there will decrease.

– Sarah Licht 
Photo: Flickr

8 Facts About Tuberculosis in Russia With COVID-19 emerging as a global pandemic, attention has centered on alleviating its effects. However, this has posed challenges to combating other respiratory illnesses, like tuberculosis, due to the lack of control efforts. Russia has been particularly hit by this, where it has a higher sensitivity to respiratory issues. To better understand this and the solutions that might be used to fight both COVID-19 and tuberculosis, here are eight facts about tuberculosis in Russia.

8 Facts About Tuberculosis in Russia

  1. Tuberculosis (TB) is endemic, or regularly found, in Russia. In fact, Russia has the world’s 11th highest burden of TB. Compounding its status as a major public health problem is a rising incidence of multidrug-resistant TB (MDR-TB). This means that TB does not respond to many of the antibiotics that are most commonly used to treat the disease. Russia has the third highest number of MDR-TB in the world.
  2. The severity of Russia’s TB epidemic stems from historical, social and economic factors. When the Soviet Union collapsed, health infrastructure and the economy declined dramatically. Poverty and crime rates increased, leading to higher incarceration rates. As TB is airborne, it spreads best in cramped and crowded conditions, just like those in prisons. These factors contributed to the rapid spread of both TB and MDR-TB. The Fall of the Iron Curtain also led to unstable living conditions, increased mass migration and exacerbated the TB epidemic with a 7.5 percent annual increase in new cases from 1991 to 1999.
  3. There is a close synergy between the TB and HIV/AIDS epidemics in Russia. The TB notification rate of individuals living with HIV infection is approximately 1,700 per 100,000 HIV-infected. Because HIV attacks the immune system, HIV infection leaves patients more vulnerable to infection with all sorts of pathogens, including TB.
  4. In the early to mid-2000s, the Russian government increased its budget allocation for tuberculosis control. Russia also received a $150 million World Bank loan, two thirds of which was designated for tuberculosis. Additionally, it received a $91 million grant from the Global Fund To Fight AIDS, Tuberculosis and Malaria.
  5. In recent years, there have been some improvements in TB infection rates in Russia. Cases of TB in Russia decreased by 9.4 percent to a rate of 48.3 per 100,000 people in 2017. In the same vein, Russia has recently experienced a steady decline in TB morbidity and mortality. Since 2012, morbidity or disability due to TB has decreased by more than 30 percent, and mortality has decreased by more than 48 percent.
  6. The COVID-19 pandemic is interfering with TB diagnosis, prevention, treatment and control efforts worldwide. It is grimly clear that Russia will not be exempt. A recent report based on analyses of several countries, including neighboring Ukraine, predicts an additional 6.3 million cases of tuberculosis by 2025 as a result of COVID-19’s disruption of TB control efforts. Progress in the fight against TB could be set back by five to eight years. Russia is facing its TB epidemic in a world where TB kills 1.5 million people a year, more than any other infectious disease. Five years ago, world leaders pledged to end the TB epidemic by 2030. In addition, in 2018, they pledged to double TB funding by 2022. However, the COVID-19 pandemic’s diversion of attention, funding, and resources makes the realization of these TB goals unlikely.
  7. Partners in Health, a nongovernmental organization, treats TB and uses a comprehensive model of ambulatory care. They treat every patient free of charge and provide care as it is most convenient to patients, bringing medication to each patient individually twice a day. Their close relationship with patients in this community based model gives their patients up to a 90 percent cure rate. Particularly, Partners in Health established The Sputnik Initiative, where it provided social and clinical support for poor MDR-TB patients in Tomsk, Russia. This initiative allowed Partners in Health to treat 70 percent of its total 129 participants who would otherwise not receive adequate medical care.
  8. Partners in Health has success in curbing TB by integrating TB treatment with the provision of other medical care. They have established TB clinics within HIV treatment centers, which is strategic as the HIV and TB co-infection rate among the patients they treat is five percent. Additionally, they have incorporated mental health and drug addiction services into their TB treatment program in Russia. A similar integrative model could conceivably be deployed for COVID-19 once a treatment becomes available.

Tuberculosis and COVID-19 pandemics present unique challenges both individually and as they co-occur. However, existing community based treatment models for tuberculosis in Russia may contain useful lessons as we learn to treat COVID-19.

– Isabelle Breier

Photo: Flickr

Leading Diseases in Sri Lanka
A 6-year-old boy cried from pain from a small room in an overcrowded ward. The small child had a fever and rash and pointed to the different parts of his body that hurt. Hannah Mendelsohn, a medical volunteer from Haifa, Israel, tried to distract the boy with games of tic-tac-toe and peekaboo.

The child displayed classic symptoms of dengue fever. Doctors diagnosed him with the virus at Karapitiya Teaching Hospital in Galle, Sri Lanka during the summer of 2015. “[The boy] had luckily gotten to the hospital when he was still in an earlier stage of the disease,” Mendelsohn told The Borgen Project. “There were a few times I heard doctors tell patients with dengue that there were no options for life-saving care.”

While non-communicable diseases are the main causes of death in Sri Lanka, many still consider certain infectious diseases, including dengue fever, threats to public health. Here are five leading diseases in Sri Lanka.

5 Leading Diseases in Sri Lanka

  1. Dengue Fever: Dengue is a mosquito-borne virus that is endemic to Sri Lanka. A person can contract dengue any time of year. However, the risk elevates during the monsoon season. This is the time of year when dengue-bearing mosquitos are most common, and severe storms often inhibit travel for care. The year 2019 saw double the cases when compared to the previous year with over 99,000 reported cases and 90 deaths. The World Health Organization (WHO) is currently working with Sri Lanka’s Ministry of Health, Nutrition and Indigenous Medicine to control the spread of dengue fever by enhancing dengue surveillance and training health care workers dengue case management and prevention. Among the suggested prevention strategies, WHO advises keeping neighborhoods clean and using mosquito netting and repellents to prevent bites.
  2. Acute Lower Respiratory Infections: Acute lower respiratory infections (ALRI) are leading causes of childhood mortality and morbidity in Sri Lanka; they are responsible for 9 percent of deaths of children under age 5. Poor access to health care, food shortages, lack of safe water and poor sanitation elevate the risk and disease burden. Fortunately, the political prioritization of public health has led to increased administration of vaccinations. This has reduced the impact of contracted ALRI. In 2014, Sri Lanka’s government enacted a national immunization policy which guarantees every citizen the right to vaccination. A separate line in the national budget aims to ensure the continuous availability of immunizations.
  3. Typhoid Fever: Typhoid is a bacterial infection that has a high mortality rate when a person does not receive treatment. Between 2005 and 2015, Sri Lank had 12,823 confirmed cases of typhoid fever. The risk of typhoid is related to overcrowding, food shortages and poor water quality. Sri Lanka’s prevention strategy has largely focused on disease surveillance and health education. Every medical practitioner has to notify the government of any typhoid fever diagnosis. Health education has involved the promotion of proper sanitation and immunization campaigns.
  4. Meningitis: Meningitis, a bacterial disease, was the 20th leading cause of premature death in Sri Lanka in 2010. Malnutrition, poor access to health care and poor sanitation are risk factors for infection and disease severity. Since 1990, the annual number of deaths due to meningitis in Sri Lanka has decreased. It was formerly the 16th leading cause of premature death. Experts largely attribute this to the growing accessibility of the Haemophilus Influenzae B vaccine.
  5. Tuberculosis: Tuberculosis was the 21st leading cause of premature death in Sri Lanka in 2010. The estimated number of cases has progressively increased from 10,535 in 1990 to 11,676 in 2007. The National Strategic Plan for Tuberculosis Control 2015-2020 states that Sri Lanka has successfully maintained a high treatment rate for tuberculosis. Because tuberculosis transmits from person-to-person, a high treatment rate reduces the risk of transmitting further infections. Additionally, Sri Lanka has received funding from the Global Fund for AIDS, Tuberculosis and Malaria. The funds are for raising awareness and increasing access to medication.

Non-communicable diseases currently represent a larger health burden. However, the continued incidence of infectious diseases ­­in Sri Lanka highlights the burden of poverty. For many of these five leading diseases in Sri Lanka, vaccinations are widely available and accessible in developed countries. Yet, reports of cases and fatalities in Sri Lanka still occur.

Still, for infectious diseases where vaccines remain elusive, poverty is a prominent risk factor for infection and severity of illness. Poverty affects the ability to receive adequate nutrition, sanitary housing, health care and more.

“Around the clock, patients died from diseases that are definitely preventable,” Mendelsohn said. “Coming from a developed country where medical care is among the best in the world, it was hard for me to accept that, just a continent away, people were still dying of infectious diseases to which the cures had already been found.”

– Kayleigh Rubin
Photo: Pixabay