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

How HeroRATS Are Saving LivesThere is a new solution to saving lives in countries with high rates of tuberculosis and the presence of landmines: rats. A nonprofit organization called APOPO is training these so-called HeroRATs to use their sense of smell and detect both landmines and tuberculosis. These African giant pouched rats receive training in Tanzania and Mozambique and then deploy across sub-Saharan Africa. The question is: why rats? HeroRATs are saving lives for a variety of reasons:

  • A strong sense of smell
  • Easily trainable and very intelligent
  • Impervious to most tropical diseases
  • Do not have the weight to cause landmines to go off
  • Cost-efficient to take care of
  • A lifespan of 6-8 years

Tuberculosis Detection

Tuberculosis is the world’s deadliest infectious disease. In many developing countries, the diagnosis method of smear microscopy is only 20-60% accurate, meaning that about half of the people with TB go undiagnosed. While the GeneXpert test is more accurate, it costs $17,000 for each device. HeroRATs are saving lives by rechecking human tested sputum samples. APOPO’s lab then rechecks the samples that the rats identify as positive.

APOPO says that these brave rodents increase clinic detection rates by 40%. A rat can go through 50 samples in just eight minutes. Incredibly, a rat can evaluate more samples in 10 minutes than a lab technician can in a whole day. This is all thanks to their intensive, nine-month training that utilizes operative conditioning; the rats learn to associate the smell of TB with a reward.

Landmine Detection

Not only do HeroRATs save lives by smelling tuberculosis in sputum, but they also receive the training to clear hazardous fields by sniffing dangerous explosives underground. Hidden landmines and bombs still endanger lives in 59 countries. The rats undergo training to associate the smell of the explosives with the sound of a click and a reward. Rather than metal detectors which detect scrap metal as well, HeroRATs can identify the actual scent of the explosives, leading to fewer false detections.

Since the landmines are “antipersonnel,” they target people through direct pressure or a wire. Fortunately, rats are too light to set these off. Since APOPO’s launch in 2006, the rats have cleared over 6 million square meters in Mozambique and uncovered 2,406 landmines and 992 bombs. It would take them only 30 minutes to check the area of a tennis court. In contrast, it would take a human deminer with a metal detector four days to do the same work.

Though rats may be unpopular, they are brilliant little heroes. Not only do landmines endanger lives, but they also hinder economic development in war-torn countries. Villages cannot access basic necessities like water and travel routes and cannot use the fertile land for farming. HeroRATs are saving lives, but they are improving livelihood as well.

It is possible they could be saving a different kind of life as well: that of pangolins. Pangolins are one of the world’s most poached animals. In Tanzania, HeroRATs are training to detect the scent of pangolin scales that smugglers transport into Asia. In the future, HeroRATs could also help limit smuggling and trafficking. These little heroes prove that innovation is not synonymous with technology; sometimes, even a rodent can save lives.

Fiona Price
Photo: Flickr

What You Need to Know about Tuberculosis in Guinea-Bissau
West Africa is a region that has experienced exposure to many different diseases and illnesses. This is the result of poor health care and poor quality of living conditions. Examples of some diseases and illnesses are malaria, yellow fever, cholera and typhoid. When it comes to the West African country of Guinea-Bissau, a specific infectious disease has plagued its people for a long time. This disease is tuberculosis (TB). Many prevalent risk factors of the country are the leading causes of this disease, which has made it difficult to slow down the progression of tuberculosis in Guinea-Bissau. Tuberculosis is the sixth highest cause of death in the country.

Tuberculosis Risk Factors

A major reason for the rise and continuance of tuberculosis in Guinea-Bissau and in many African countries is the Human Immunodeficiency Virus (HIV). According to the World Health Organization (WHO), people who have HIV are 19 times more likely to develop active TB. A survey by the United States Library of Medicine National Institutes of Health found a TB prevalence rate of 134 out of 100,000 people.

Suboptimal living conditions and poor immune systems as a result of having HIV have made it very difficult to combat tuberculosis in Guinea-Bissau. According to the Center for Disease Control and Prevention (CDC), people with HIV infection, the elderly and young children are at risk of contracting TB. Poor medical facilities, poor access to health care, mistreatment and not having the supplies to correctly cure the disease can certainly lead to people spreading and dying from tuberculosis.

Mortality Demographic

The mortality rate of the disease among children under the age of 5 in Guinea Bissau gives a major indication of just how significant of a problem tuberculosis is for the country. The Bandim Health Project (BHP) conducted a study of children under the age of 5 living with an adult with TB. The study compared the mortality rate of those children with the mortality of children in the general population. Children under 5 years of age who experienced exposure to an adult with TB had a 66% higher mortality than unexposed children. Once exposed to the disease, there was a high risk of death six months after exposure. Children 3 or 4 years of age were highest at risk for death.

Treatment and Widespread Vaccination

It is possible to cure tuberculosis with proper treatment. The End Tuberculosis Strategy that the WHO implemented has a vision of ending the global tuberculosis epidemic. The vision involves providing the right care, supplies and medical professionals to regions where people are most at risk. The BHP has also directly involved itself in helping the country stop the spread of TB. In addition, the project is introducing and testing the Bacillus Calmette-Guerin vaccine (BCG). The BCG is a vaccine that can attack tuberculosis in the body.

BHP researched children who received the vaccine at birth and compared them to those who did not. The result showed a reduction in a third of child deaths from any disease. A barrier to getting more people in Guinea-Bissau vaccinated is the accessibility of BCG to families. The more vaccine coverage that BHP can provide to children and people who both have and do not have tuberculosis, should drastically limit risk factors toward stopping tuberculosis in Guinea-Bissau.

Dorian Ducre
Photo: Flickr

As of 2018, Gabon had the third-highest rate of tuberculosis among African countries, with a yearly occurrence of 428 cases per 100,000 people. Tuberculosis is so prevalent in Gabon, in part, because it often goes undiagnosed and is poorly treated. In addition, the rates of local transmission and drug resistance are high, leading to a tuberculosis crisis in Gabon.

Limited Laboratory Access

Effective diagnosis and treatment of tuberculosis in a laboratory setting is crucial to the prevention and treatment of the disease. Limited access to laboratory diagnosis is one of the main contributing factors to the tuberculosis crisis in Gabon. CERMEL, a not-for-profit center for research in Lambaréné, is the country’s foremost resource for tuberculosis research. In the past decade, CERMEL has held events regarding the treatment and diagnosis of tuberculosis, through which doctors share research and information. Though the center was established over 30 years ago, CERMEL has devoted considerable resources to tuberculosis only in recent years. Gabon has also received support from the Global Fund, an international financing and partnership organization. Before 2015, however, the country was receiving no outside financial support to deal with the tuberculosis crisis.

Tuberculosis and HIV Co-Infection

Another issue Gabon faces is the simultaneous prevalence of tuberculosis and HIV. In 2012 and 2013, the co-infection rate of these diseases was 42% in adults and 16% in children. The mortality rate for those infected by both TB and HIV was 25%.

Cultural and Social Obstacles to Professional Healthcare

Cultural and socioeconomic factors contribute to Gabon’s high infection rates and low treatment success rates. When it comes to TB, patients often do not follow “doctor’s orders.” This is largely due to patients’ belief that they can be healed by visiting a spiritual doctor, rather than by going to the hospital. Additionally, high transportation costs and improper diagnosis and treatment prevent patients from taking healthcare professionals’ advice seriously.

Multidrug-Resistant Tuberculosis

The prevalence of multidrug-resistant tuberculosis, or MDR-TB, is yet another concern. Like many countries in sub-Saharan Africa, Gabon has limited access to the second line of drugs used to treat tuberculosis in drug-resistant cases. The first MDR-TB treatment center was opened in Gabon in 2015, in Lambaréné, with the laboratory support of CERMEL. The German Ministry of Health provided funding for a trial study of second-line drug treatment for patients in Gabon, which showed positive effects — 63% of patients were cured. However, the drugs used in second-line treatment are harsh and often cause adverse effects, such as gastrointestinal problems.

Expanding laboratory infrastructure will be invaluable in stopping the tuberculosis crisis in Gabon. As it stands, CERMEL is one of the only research laboratories in the country and newer data on TB is not available. CERMEL has helped get the ball rolling for research on the disease, but further laboratory spaces and doctors are necessary. Additionally, to quell the tuberculosis crisis in Gabon, healthcare professionals will have to engage the population in ways that account for prevailing cultural beliefs and socioeconomic realities.

Elise Ghitman
Photo: Flickr

tuberculosis in SomaliaTuberculosis is a disease caused by bacteria that spreads through the air. While it can also be spread through the consumption of unpasteurized milk contaminated with the bacteria, the most prevalent form of the TB infection is pulmonary TB. In rare cases, TB can also affect the lymphatic system, central nervous system, urogenital region, joints and bones.

In Somalia, one of the world’s most poverty-stricken nations, less than half of estimated cases of TB are detected. Not all tuberculosis strains are equal, making diagnosis and treatment more difficult. While antibiotics typically treat TB, studies have shown that the prevalence of drug-resistant TB has increased. Somalia has a recent history of a tumultuous political climate, exacerbating obstacles that might prevent the delivery of efficient healthcare, like fund allocation and accessibility.

Diagnosis

In a cultural profile of Somalia conducted in 2006, many believed the disease was spread through airborne particles resulting from coughing or sneezing. These same people often believed that the contraction of TB also comes from a variety of things including it being inherited or the result of a loss of faith, creating stigmas around the disease.

Many people distinguished TB from other ailments with respiratory symptoms through weight loss and the presence of blood in the mucus. Until these symptoms are found in addition to an existing cough, it is assumed to be a chest infection. In cases when a fever is apparent, some confuse TB with malaria.

While the primary symptoms (cough, weight loss and bloody mucus) follow the same way the west symptomatically views TB, Somalians understand the progression of symptoms and the disease a little differently. For example, they separate coughing as a symptom into different phases based on the nature of the cough. They focus on whether or not chest pains accompany a cough, or how it sounds. Based on what phase the symptom is in, it might dictate different treatment plans.

Drug-Resistant Tuberculosis

As of 2011, 5% of first-time infected tuberculosis patients had a drug-resistant strain of TB. In comparison, 41% of previously infected patients had this more robust form of TB. These strains are resistant to several drugs used in the treatment of TB. This resulted in the highest recorded instances of multidrug-resistant TB in Africa at the time.

World Vision

World Vision is a global poverty mitigating initiative with boots-on-the-ground efforts. The organization provides healthcare resources, clean water and education to impoverished communities around the world.

Partnering with the Global Fund to Fight AIDS, Tuberculosis and Malaria, the organization has created 33 tuberculosis grants valued at a total of $160.6 million. World Vision has been the primary recipient of tuberculosis grants in Somalia.

In Somalia, World Vision works to fight the frequency of tuberculosis and its drug resistance. With the help of the Global Fund, the organization has treated more than 115,000 people. Additionally, it has trained 132 health professionals in DOTS, the directly observed treatment, short course, as recommended by the WHO. The organization has also helped 30 laboratories with TB microscopy, which resulted in the national health authority documenting 6,505 cases. World Vision continues to strive to strengthen resources within Somalia so that the government and community have a better capacity in which to deal with TB.

– Catherine Lin 
Photo: Flickr

Tuberculosis in Impoverished CountriesThe largest infectious cause of death in the world is Tuberculosis (TB), resulting in over 4,000 deaths a day. Many factors make people living in poverty more susceptible to undiagnosed and untreated active TB, notably its interaction with HIV/AIDS. A lack of information and adequate healthcare systems also make Tuburculosis in impoverished countries a major threat, requiring a rapid response from the global community.

10 Facts About Tuberculosis in Impoverished Countries

  1. Tuberculosis is more common in impoverished countries. People in severe poverty often live and work in crowded areas with poor ventilation, which are the optimal conditions for the spread of TB.  They’re also more susceptible to conditions that lower their immune systems such as malnutrition or other infectious diseases. These factors make them more likely to catch and spread TB, as well as less likely to be able to fight it.
  2. COVID-19 is expected to increase TB. Two large effects of the COVID-19 pandemic are economic crises and quarantining. For people living in poverty, quarantining can increase the transmission of TB as households may be more crowded with less ventilation. Losing one’s job can increase undernutrition or malnutrition which lowers your resistance to TB.
  3. The cure rate is low in developing countries. The cure rate for TB in many developing countries is less than 50%. This is a result of many factors, but it is mainly because of a combination of the fear and stigma around TB in impoverished countries. It leads to delayed treatment or refusal to seek treatment, and inadequate healthcare systems in place that are tasked with treating the disease.
  4. TB often spreads because of delayed treatment or refusal to seek treatment. A person with active TB can spread it to 10-14 people a year, which may not seem like a lot, but allows cases to multiply in places that are suffering from other lethal infectious diseases as well. This makes tuberculosis in impoverished countries more deadly and harder to treat.
  5. TB interacts with HIV. HIV patients develop active TB at a much higher rate. The progression of TB and HIV is sped up when a person has both diseases, which usually leaves little room for treatment in countries that are struggling to provide adequate healthcare. Almost 70% of HIV-positive people live in sub-Saharan Africa, where 41% of people live in poverty. The risk of getting TB increases 19-fold when a patient also has HIV because of their weakened immune systems and their environment. Of reported TB cases, 56% have been among those who are also HIV-positive. This leads to at-risk individuals contracting both of these diseases which are much more difficult to treat together.
  6. Drug-resistant TB is on the rise. A strain of the TB that is resistant to the traditional course of antibiotics is starting to spread. It is particularly dangerous for people with TB in impoverished countries because many may not have adequate resources or information to follow their TB treatment methods. This results in infectious, drug-resistant strains that are harder to treat. When a drug-resistant strain of TB appeared in the U.S. during the 90s, the quick government response helped to decrease cases by 67% over five years. A similar approach would help to quell the current spread of TB in impoverished countries by providing resources that lead to better diagnoses and tracking of new infections.
  7. TB is curable and preventable. The reason people in developed countries don’t hear a lot about TB is because developed countries have better-funded healthcare systems. These systems can monitor for the disease effectively and have access to drugs that can treat it quickly. More than 95% of all TB cases and deaths happen in developing countries where healthcare systems often don’t have the same reach or resources.
  8. USAID is helping in the fight against TB. USAID focuses on providing locally generated solutions to fight TB. By training healthcare workers, USAID is able to improve the detection of TB, as well as the treatment and overall treatment success rate. In 2018 the organization was able to train 40,000 healthcare workers in key areas to fight TB in impoverished countries and saw a 14% increase in case notifications. USAID also set the tremendous goal of having another 40 million people diagnosed and enrolled in treatment, and another 30 million people enrolled in preventative therapy by 2022.
  9. Poverty and TB connect. TB cases would fall by more than 80% by eliminating extreme poverty. There is a strong link between extreme poverty and TB. If combined, programs directly targeting TB and programs targeting the eradication of poverty can help slow the transmission and increase the response rate by improving healthcare services and raising the quality of life.
  10. The TB Alliance is working to affect change. The TB Alliance is researching affordable treatment for those in need. By forging partnerships in many different sectors, this non-profit is chasing the goal of ending TB deaths. The organization is developing faster-acting drugs that can be circulated to both treat and prevent TB. This development has already transformed how TB is approached in the medical research field and could help millions of patients struggling to access affordable and fast treatment options.

Although TB poses a threat to impoverished countries, there is a lot being done to prevent TB deaths. The Global Fund is ensuring that grants are provided for countries combating the dual-threat of COVID-19 and existing diseases like TB, HIV and malaria. With effective treatment regimens already on the market and faster-acting versions in development, increased U.S. foreign aid and funding for aid programs could expedite the end of TB in impoverished countries.

– Eleanor Williams

Photo: Flickr