tuberculosis in North KoreaTuberculosis (TB) is a bacterial infection that mainly attacks the lungs, and can prove fatal without treatment. Tuberculosis spreads through the air via coughing or talking. It causes people to become sick because the immune system cannot prevent the bacteria from growing. The lengthy and specific nature of the treatment for TB means developing nations can struggle with treating tuberculosis epidemics. One of these nations is the Democratic People’s Republic of Korea (DPRK), which labels TB as one of its most serious health problems. Here are eight facts about tuberculosis in North Korea.

8 Facts About Tuberculosis in North Korea

  1. Though the data on tuberculosis in North Korea is sparse, the rate of instances is estimated to be 442 out of 100,000 people. Furthermore, the WHO estimates that in 2017, the estimated mortality of TB per 100,000 people was 63%. While it had been slowly decreasing since the year 2000 (161%), estimated mortality has risen since 2015 (42%).
  2. North Korea is a poor country, which limits access to healthcare. According to a report by Amnesty International, the healthcare system has been collapsing, with barely-functioning hospitals devoid of medicine. Though the country claims to provide healthcare for all, estimates indicate it is spending under $1 per capita, less than any other nation in the world. Because it is unlikely that the regime will increase healthcare funding, TB patients often do not receive appropriate care.
  3. The inadequately funded healthcare system also means doctors are improperly trained. This results in maladaptive treatment strategies which are expensive and are prone to hijacking by the black market. Hence, many people turn to self-medicating and are unable to access crucial TB drugs. There have been efforts to train doctors through a program in the late 1990s. However, there have not been any in recent years, either from the government or from NGOs.
  4. The lack of documentation and data on tuberculosis in North Korea also causes more serious strains of TB such as multidrug-resistant (MDR)-TB to spread unchecked. Experts estimate that MDR-TB is an already growing problem. Disinformation surrounding TB in North Korea is so widespread. Many people regard TB as so common as to not require a trip to the doctors. Hence, education about the disease is critical. While there have been efforts to educate people about TB, only NGOs (rather than government-sponsored programs), like the Eugene Bell Foundation, have started initiatives to educate patients, though not the general public.
  5. North Korea’s poor track record on human rights also exacerbates its TB and MDR-TB crisis. According to the Health and Human Rights Journal, North Korea’s prison camps and migration across the China-Korea border heighten the risk of citizens contracting TB. Additionally, those migrating or detained are more likely than the average North Korean to receive little or no treatment.
  6. North Korea’s standing as an international pariah aggravates its struggle with tuberculosis. The regime’s totalitarian nature, cold war-era cult of personality, nuclear ambitions and disregard for human rights causes it to face sanctions, political antagonisms and limited medical exchange. International sanctions ban the export of minerals, agricultural products, technology, aviation fuel, metals and more. This results in limited resources, making testing and treatment nearly impossible.
  7. In 1998, the North Korean government began implementing a TB treatment system. Despite North Korea’s reluctance to accept international aid, the government did begin a TB treatment system in cooperation with the WHO. The TB treatment was named DOTS (Directly Observed Treatment, Short-Course). Though it reached the entire country in 2003, DOTS had problems. For example, hospitals turned patients away due to insufficient medicine. Additionally, some medication ended up on the black market.
  8. The only NGO to earn the trust of the North Korean government has been the Eugene Bell Foundation. The Eugene Bell Foundation has been offering support to treat cases of TB since 1996. Focusing on MDR-TB in particular, EBF is the only large scale provider of treatment in the country. Additionally, it has a unique 20-year relationship with the North Korean Ministry of Public Health. The foundation’s program cures an estimated 70% of patients in North Korea. However, despite EBF’s successes in opening clinics, bringing in medication and medical equipment and training doctors, a recent uptick in estimated mortality suggests that North Korea is still a long way away from effectively treating its tuberculosis epidemic.

In conclusion, North Korea faces structural and international challenges that prevent it from being able to treat its tuberculosis and multidrug-resistant tuberculosis epidemic. The regime’s neglect of the healthcare system and disregard for human rights has led to numerous international sanctions, causing it to rely on NGOs and the WHO to treat TB patients. For the situation to improve, wholesale reform of the country’s institutions is likely necessary, though international preventative measures could also help improve the situation.

– Mathilde Venet 
Photo: Flickr

Tuberculosis In Cambodia To the nearly 17 million people living in Cambodia, tuberculosis is no stranger. In 2007, it was the seventh leading cause of death in the country. In 2012, it caused nearly 8.6 million Cambodians to fall ill. Today, despite the ongoing threat of tuberculosis in Cambodia, eradication efforts continue to prove that solutions to complex health problems can oftentimes start with the simplest of interventions—take, perhaps, a new washing machine.

A Clean, New Discovery

For the staff at the Khmer Soviet Friendship Hospital in Cambodia’s capital, such a realization came around because of Nhib Chhom. Nhib Chhom, the Deputy Infection Control Coordinator, asked nurse educator Kareeen Dunlop to test the bacterial residue of hospital linens. She discovered an extremely minor reduction in the amount of bacteria on washed laundry. This was a surprising finding no doubt, but to the hospital’s many employees, less than so.

“Staff have been pleading with me in regards to their laundering,” describes Dunlop in a 2019 report. “Nhib Chhom again said how the washing was coming back from the laundry dirtier than it went.”

Seeing as the hospital specializes in the treatment of infectious diseases, the nurses’ frustration is particularly understandable. Without the proper means to sanitize linens, curbing disease transmission is made unnecessarily more difficult. Furthermore, the lack of sanitization unnecessarily ignites yet another outbreak of tuberculosis in Cambodia.

What to Know About Tuberculosis in Cambodia

Globally, the WHO approximates that 1.8 billion people have TB. Cambodia in particular is still home to one of the largest TB infection rates in the world. Cambodia has approximately 13,000 TB-related deaths per year. Cases of tuberculosis in Cambodia have decreased by 45% between 2002 and 2011. Despite this decrease, however, Cambodia continues to remain among the world’s 22 high-burden tuberculosis countries. The Pasteur Institute in Cambodia estimates a TB prevalence of 36,000 cases out of a population of 16 million in 2015 alone. Coupled with an estimated 40% TB under-diagnosis rate according to research at the National University in Singapore, the TB threat in Cambodia is certainly far from passed.

Thankfully, however, such staggering numbers have not gone unchecked. In fact, together the national TB program and international partners have achieved an 85% TB treatment success rate. They continue to address eradication efforts. In the case of the Khmer Soviet Friendship Hospital’s laundry problem, the officials involved were Michael and Jodie Flowers. Michael and Jodie Flowers, managers of Commercial Laundry Solutions LTD., who volunteered to install four washing machines and donate a drier to the hospital. Aided by $6,000 worth of spare parts from Electrolux, the Flowers spent three weeks refurbishing their washing appliances. They ultimately granted nurses the ability to deliver sparkling clean laundry for the first time.

How the Cambodian Health Committee is Combatting Tuberculosis in Cambodia

Many others works to empower healthcare providers with the materials necessary to deter global health threats. A nonprofit NGO, the Cambodian Health Committee (CHC), has also been working long hours to eradicate tuberculosis in Cambodia. Additionally, they also strive to eradicate HIV/AIDS from Svay Rieng, Kompot and Kandal, three of Cambodia’s poorest and most war-affected provinces.

Founded by research immunologist Dr. Anne Goldfeld, in collaboration with healthcare professional Dr. Sok Thim, the CHC has treated more than 32,000 people with tuberculosis in Cambodia since its founding in 1994. The CHC has also screened over 2,000 people for drug-resistant TB infection. With an integrated emphasis on healthcare, clinical research and education, the CHC implements a community-based healthcare model to provide direct TB care, in addition to investigating the effectiveness of new innovations.

For example, the CHC designed a research study regarding the effects of treatment timing in outcomes for TB and HIV-infected patients. The study, CAMELIA, found that beginning TB drug therapy two weeks prior to administering AIDS medications decreases mortality by 34%.

The Borgen Project recently spoke with Dr. Sarin Chan, a clinical investigator for CAMELIA. According to Dr. Chan, the study has since progressed out of the experimental phase and into the clinical one. The study is involved with early ARV treatment for co TB and HIV-infected patients now recognized in the national guidelines for clinical care of HIV patients. The National Center for Tuberculosis and Leprosy Control’s development of a TB prevention strategy is similarly a promising step forward in the fight against tuberculosis in Cambodia, says Chan.

Looking Ahead

At the end of the washing cycle, much good can be said about the progress against tuberculosis in Cambodia. Despite the country’s high TB infection rate, increased access to community-based healthcare as provided by the CHC and improvement of hospital sanitation practices all point towards a brighter future.

– Petra Dujmic 
Photo: Flickr

tuberculosis in Côte d'IvoireTuberculosis (TB) is a bacterial illness spread through breathing contaminated air droplets from an infected individual. TB is also transferable by drinking unpasteurized milk containing Mycobacterium bovis, or Bovine Tuberculosis. The bacterium primarily affects the lungs, which is known as pulmonary TB. More than 90% of individuals with TB have a latent form and do not experience overwhelming symptoms. With tuberculosis being one of the leading causes of death in Côte d’Ivoire, the government is making numerous efforts to help those with the illness. The health agencies in Côte d’Ivoire, using assistance from the government and other countries, are mitigating the spread of TB through medicine, proper healthcare and bringing awareness to the communities. Here are five facts about the rising issue of tuberculosis in Côte d’Ivoire.

5 Facts About Tuberculosis in Côte d’Ivoire

  1. More than 8,000 people died from tuberculosis in Côte d’Ivoire in 2018. In addition, there were 36,000 reported cases of TB. While active efforts are being made to try and control the spread of TB, the citizens of Côte d’Ivoire struggle to afford treatment, healthcare and testing. With over 46% of the population living in poverty, it is difficult for most of them to find access to hospitals and testing centers. TB is highly endemic in Côte d’Ivoire, meaning it is extremely prevalent within many of the impoverished Ivorian communities. For every 100,000 citizens, 23 of them will die from tuberculosis. Among those 100,000 citizens, more than 148 of them will be diagnosed with a form of TB. It is increasingly important that a global effort is made to bring awareness to this illness and help the citizens of Côte d’Ivoire receive proper medical treatment. Thankfully, the transmission of TB has been on the decline within the past few years. In 2000, 367 people per 100,000 citizens of Côte d’Ivoire were diagnosed with TB. This contrasts 2018 in which less than half the number of citizens were diagnosed (only 142 per 100,000 individuals).
  2. There are multiple factors that lead to the spread of tuberculosis. TB can be spread through Côte d’Ivoire by living in poverty, existing in a post-war environment and having HIV/AIDS. Ivorian citizens living in impoverished circumstances suffer from malnutrition and weakened immune systems. This makes contracting TB far easier for those with an inferior healthcare system and little access to basic resources. Living in poverty also means less access to tests for TB, which makes it hard to know who is infected. The war-torn climate of the country weakens the healthcare system. This causes a wider outbreak of TB with fewer people being treated. Political unrest and violence also force citizens to escape to other parts of the country. The emigration of families moving from northern cities to rural settlements in the south of Côte d’Ivoire increases the spread of TB while limiting immediate access to healthcare. Abidjan is one major city that faces overwhelming cases of tuberculosis. HIV/AIDS renders immune systems weak and increases individuals’ susceptibility to TB. The comorbidity between HIV and TB in Côte d’Ivoire is extremely high. In 2018, more than 7,000 of the 36,000 citizens with TB were also treated for HIV/AIDS. The Ivorian Ministry of Health (MOH) works with organizations like Measure Evaluation to track the spread of diseases like HIV and TB and increase testing in high-risk areas. The efforts have so far been successful.
  3. There are currently four treatments for tuberculosis. As of 2020, there are four recognized medicinal treatments for TB: Isoniazid (INH), Rifampin (RMP), Pyrazinamide (PZA) and Ethambutol (EMB). These medicines must be taken for three to nine months as directed by a medical professional. This ensures that the bacterium is killed. Skipping a dose, because of inaccessibility to a prescription or otherwise, causes a tuberculosis infection to come back stronger. While most forms of TB are curable with medicine, Côte d’Ivoire is plagued with strains of drug-resistant tuberculosis. In 2018, there were more than 2,000 individuals with a drug-resistant type of tuberculosis (DR-TB). These individuals are harder to treat since any known medicine is ineffective against the strain of TB. Luckily, 82% of people who are treated for tuberculosis in Côte d’Ivoire recover successfully. With the help of well-trained medical professionals and funding from other countries, the government of Côte d’Ivoire can better treat and identify those with TB.
  4. Tuberculosis is primarily observed in young men. Men ages 20-40 years old experience TB more frequently than any other demographic. Most of these men are working-class and have little education. Because men are also frequently diagnosed with HIV/AIDS in Côte d’Ivoire, they are at a greater risk for contracting TB. As the rates of HIV/AIDS increase in the male population (a 3:1 sex ratio), the tuberculosis infection rates have also increased.
  5. World organizations and other countries have greatly aided in treating and ending the spread of tuberculosis in Côte d’Ivoire. With help from NGOs and world health outreach programs, TB in Côte d’Ivoire has decreased. In 2007, TB was the 7th leading cause of death, however, a decade later in 2017, TB has dropped to the 8th leading cause of death in Côte d’Ivoire.

One important organization is The Stop TB Partnership. By pairing government agencies with other foundations, research agencies and private sector resources, this organization aims to create a TB-free world. In 2014, various partners met with specialists from the Programme National de Lutte contre la Tuberculose to design a national committee tasked with controlling and treating tuberculosis in Côte d’Ivoire. The members of these groups were responsible for designing a plan for infection control, allocating monetary and human resources and outlining the structure of the new committee. Through this workshop, the anti-TB program in Côte d’Ivoire established clear strategies for tackling the problem of tuberculosis. Stop TB developed oversight committees, regulations for how resources are spent and a plan for reducing the spread of TB.

According to the United Nations, Côte d’Ivoire is on the way to reaching various Sustainable Development Goals (SDGs). The U.N. is actively helping Côte d’Ivoire eradicate illnesses like HIV, malaria and TB by the year 2030 through free doctor visits and accessible medicine.

It is crucial that the citizens of Côte d’Ivoire receive the proper treatment and financial assistance to help them overcome the tuberculosis endemic. It is imperative that those diagnosed with this illness are immediately identified and properly treated. With strategic planning, proper funding and extensive training for medical professionals, the infection rate of tuberculosis in Côte d’Ivoire is expected to decrease in the coming years.

– Danielle Kuzel
Photo: Flickr

Tuberculosis in Liberia
As COVID-19 spreads across the world, it is still not the leading cause of death from a single infectious agent. According to the CDC, that title belongs to tuberculosis, a respiratory illness that the bacteria species Mycobacterium tuberculosis causes. It usually targets the lungs but can attack any part of the body. Tuberculosis in Liberia, among other impoverished countries, remains a predominant issue that the country needs to address.

While tuberculosis is largely curable, it can be lethal if left untreated. The disease still affects populations of developing nations due to their lower capacity health care systems. According to the CDC, tuberculosis is the eighth leading cause of death in Liberia. The disease infects over 300 people per 100,000 Liberians.

Poverty in Liberia

 An article in the Lancet explains that tuberculosis is the “archetypal disease of poverty,” remaining prevalent largely in developing nations such as Liberia. Over 90% of the Liberian population lives under the international poverty line of $5.50 per day. Poverty not only makes treatment costs excessively burdensome for many people, but it also contributes to risk factors that further the spread of the infection.

According to Dr. Saurabh Mehta, Associate Professor of Global Health, Epidemiology and Nutrition at Cornell University, conditions that weaken the immune system are risk factors for tuberculosis transmission. These conditions include HIV infection, diabetes and malnutrition, all of which correlate with a lower socioeconomic status.

Dr. Mehta explains that overcrowding is another risk factor that facilitates TB transmission. In a crowded setting, a person infected with tuberculosis has a higher potential to interact with susceptible people.

Both malnutrition and overcrowding could contribute to the impact of tuberculosis in Liberia. One in three Liberian children experience stunting due to malnutrition, and over half of Liberia’s urban population lives in slums. The World Food Program is working to alleviate hunger in Liberia by providing meals in schools, supporting refugees through direct food aid and creating food reserves in food-insecure communities. The World Food Program provided over 66,000 pounds of rice as an initial reserve, which community members can access at a low-interest rate.

Rebuilding Health Care System Capacity

In order to treat tuberculosis in Liberia, the Liberian government needs a robust health system. However, civil war and outbreaks of other illnesses, such as Ebola, have weakened Liberia’s health system leaving fewer than four physicians per 100,000 people.

From 1989 to 2003, a civil war wreaked havoc throughout the nation, killing more than 250,000 people. Because many either died or fled, the number of trained doctors in Liberia declined from 237 to less than 20 by the end of the war.

While training programs that the country established after the war helped increase the number of nurses, Liberia only had a few dozen of its own doctors at the outset of the 2013-2016 Ebola outbreak. Ebola killed 4,809 people and further damaged Liberia’s health systems, among other West African countries. In a few years, the disease killed at least 600 health care workers across Liberia, Sierra Leone and Guinea.

To expand and safeguard its health care system’s capacity, Liberia collaborated with the WHO and other organizations to invest in Ebola treatment units as well as training for over 21,000 health workers.

Multidrug-resistant Tuberculosis Treatment

Drug-resistant pathogens are a serious public health concern globally. As existing medications become less effective, previously treatable illnesses become more deadly.

Over 2.5% of people with tuberculosis in Liberia have a multidrug-resistant form of the illness, making their condition higher risk and their treatment more expensive. Additionally, according to Mehta, treatment for multidrug-resistant tuberculosis is less effective and takes two to four times as long to complete as the treatment for tuberculosis that is not drug-resistant.

Taking an incomplete course of tuberculosis treatment increases the risk that someone could develop multidrug-resistant tuberculosis. This risk would decrease, however, if patients had more affordable treatment options.

The Liberian National Leprosy and Tuberculosis Control Program has worked to expand access to the international standard of care for tuberculosis, DOTS (Directly Observed Treatment Short courses). Although the treatment success rate for those who received treatment was at 80%, less than half of people with tuberculosis obtain treatment.

Tuberculosis Comorbidity with HIV/AIDs

The World Health Organization reports that 53 out of every 100,000 people in Liberia have a particularly lethal combination of tuberculosis and HIV/AIDs. People who have both diseases face a higher risk of their tuberculosis becoming active rather than remaining latent/asymptomatic. This is because HIV/AIDS weakens the immune system. As a result, tuberculosis causes 40% of deaths in HIV/AIDS patients.

While treatment to prevent tuberculosis for HIV/AIDs patients exists, only 21% of HIV positive patients receive such treatment. Expanding access to preventative treatment has the potential to significantly reduce mortality for people with tuberculosis in Liberia who also have HIV/AIDs.

Tamara Kamis
Photo: Flickr

Tuberculosis in Madagascar
Tuberculosis, commonly known as TB, is the most infectious fatal disease in the world. Despite the fact that it is treatable, TB kills more than 1 million people annually across the globe. The wide majority of diagnoses and deaths occur in poor, developing nations. Here is some information about tuberculosis in Madagascar.

Tuberculosis in Madagascar

Tuberculosis cases plague Madagascar, a country off the southeastern coast of Africa, especially among the citizens of low socioeconomic status. As of 2012, 70.7% of the Malagasy population lived below the poverty line. As a result, in 2017, the tuberculosis incidence rate in Madagascar was 233 cases per 100,000 people. TB is a disease that poverty perpetuates, making Madagascar a likely candidate for an outbreak.

Lack of quality living conditions, nutrition and health care all amplify the risk of tuberculosis infection in Madagascar. Proper toilets and handwashing facilities are scarce for the majority of Malagasy people. According to CIA World Factbook data, as of 2015, sanitation facility access in Madagascar remained unimproved for 88% of the total population. As for health care, not only is TB deadly in itself if it does not receive treatment, but it is the leading cause of death for people who suffer from HIV. As of 2018, there are 39,000 Malagasy people who receive a diagnosis of HIV, however, only 20,865 TB patients also had documentation of their HIV status. Without quality systems in place to document HIV and TB status, solving the epidemic in Madagascar will not succeed.

The Global Fund’s Support

The added historical stigma surrounding TB makes matters worse. While already struggling monetarily, patients are often fearful that, if their diagnosis is public, they will risk losing their jobs. However, various groups are making progress in reducing this stigma while aiding those with TB. The Global Fund, an organization that assists in funding relief for epidemics, is hiring employees to administer medication and encourage TB patients in Madagascar to stay on track with their antibiotics. These employees act as a support system as well and are working to debunk the shame that patients may feel surrounding their diagnosis.

The Global Fund is continuing to make huge strides in combating this disease. In 2018, the organization funded the cure of 33,000 patients in Madagascar. For 2020-2022, there is a projected $18,045,448 that will contribute to tuberculosis health care in Madagascar. These huge sums of money should significantly diminish the problem. As of 2017, based on the recorded percentage of new cases of TB, the treatment success rate was 84%.

Biotechnological Solutions

Although the disease is incredibly preventable and curable, there is a lack of medical tools in Madagascar necessary to diagnose and treat TB. Not only are there minimal supplies, but the head of the mycobacteria unit at the Health Institute of Madagascar, Niaina Rakotosamimanana, said that “we have a collection of [TB] strains at the Pasteur Institute… about 9,000 strains. We have been thinking about expanding and strengthening our ability to analyze those samples.”

Researchers from the Health Institute of Madagascar, Stony Brook University and Oxford University are collaborating to help grant greater access to a portable and affordable tool, the MinION. The MinION helps to diagnose and efficiently test the resistance of TB strains to antibiotics. It is a cheap, affordable option that is accessible to Malagasy people. While developed countries have the technology to create complex, expensive tools to prevent the spread of TB, low-income countries, where the disease is affecting more people, have considerably less information. Because developing nations often cannot support Western medical technology, tools like the MinION are incredibly beneficial.

Tuberculosis in Madagascar is still one of the top 10 leading causes of death in the country, but Madagascar is making significant progress towards the elimination of the disease. The efforts Madagascar is taking in tracking TB are positive steps contributing to the mitigation of the epidemic.

Sophia McGrath
Photo: Flickr

Tuberculosis in the Congo
At the beginning of the 1990s through the early 2000s, the contraction and subsequent testing for HIV increased significantly in Africa. Within this time period, the World Health Organization (WHO) discovered that nearly 85% of Africans were HIV-positive. More recently, HIV numbers in Africa have reduced with a 38% drop in eastern and southern Africa since 2010. While Africa is getting a handle on HIV, tuberculosis is prevalent. It affects the entire African continent, but cases of tuberculosis in the Congo are the most significant.

Tuberculosis hit African nations forcefully, debilitating the economy, altering sociality and increasing mortality rates. In 2016, estimates determined that 417,000 Africans died due to the disease. This number constituted 25% of all tuberculosis cases present in the world at the time. Of the African deaths in 2016, 321 of them occurred in the DRC, which had one of the highest rates of TB in all of Africa during that time.

Although many have worked to combat TB and HIV within the DRC, the country is still suffering from preventable diseases. With internet access alone, individuals may support groups and companies who are already battling tuberculosis in the Congo and globally.

Important Organizations

The Global Fund is a group that has combated drug-resistant TB through “antimicrobial-resistant superbugs.”  Over the last 20 years, funding to find a cure for this type of tuberculosis has treated and saved 5 million people. Yet, its founder stated that “with more funding triple that number could have been saved.” He advised all to support The Global Fund by donating to its research on drug-resistant TB and by signing petitions to raise awareness.

Starting in 2011, the Management Sciences for Health (MSH) and USAID funded the Democratic Republic of Congo-Integrated Health Project (DRC – CIH) to educate people about the symptoms of tuberculosis in the Congo. This program also prepared healthcare professionals in ways to quickly identify and treat TB. Because of the efforts of this program, the detection rate for TB has raised from 12% to 86%. This program still needs support today, as funding is low and publicity has been scarce. Raising one’s voice in support of such a cause will only benefit the program and save more lives. Ciza Silva Mukabaha, a supporter of the MSH and the DRC – CIH called this program a “starting point” for change. He stated that, with more support from others, change is inevitable.

How to End Tuberculosis in the Congo

The End Tuberculosis Now Act recently entered Congress. Individuals in the United States can email or call their representatives and advocate to provide U.S.-government aid to combat multidrug-resistant TB and “support the fight to end tuberculosis” everywhere.

People can also aid the situation by staying informed and supporting local groups who are raising funds to combat TB. In 2018, healthcare worker Virginia Benhard started a personal fundraiser to fight tuberculosis in the Congo. She told The Borgen Project that the cause originally attracted her because of her visit to the Congo as a healthcare worker. She realized that community members consuming contaminated milk and meat caused them to contract tuberculosis. Since TB is an airborne illness, those who had tuberculosis would process the meats and then sell them, causing the infection rates to increase dramatically. Virginia “saw a need and responded,” and through local support she was able to raise over $1,000. She donated the proceeds for the building of a milk pasteurization factory in Kinshasa as well as a meat processing factory.

While this disease still rages on, there is much that individuals can do to help. One can sign a petition, donate, speak out for those who cannot speak for themselves and help those who cannot help themselves. Through small and simple acts, tuberculosis in the Congo should decrease.

Alexis LeBaron
Photo: Flickr

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