Public Health Challenge: Combating the Top Diseases in Estonia
A member of the European Union since 2004, Estonia is among the wealthiest nations in the Baltic region. Likewise, the country has a modern health system that can reasonably support its population of 1.3 million.

Almost all Estonians are covered by health insurance, and the greatest menaces to public health, like heart disease and cancer, are characteristic of a developed country.

Nonetheless, more than one in five Estonians live below the poverty line and are especially at risk for certain health problems that are prevalent in the country. Here are some of the top diseases in Estonia and what is being done to combat them.

HIV/AIDS

While the death toll from AIDS is dwarfed by that of heart disease and cancer in Estonia, the country has the highest prevalence of HIV in all of Europe. Around 1.3% of the population carries HIV, comparable to rates in Sierra Leone or Mali.

The first case of HIV was diagnosed in 1988, and the rate of incidence remained minuscule until the turn of the century. According to a report by the World Health Organization (WHO), the disease exploded in 2000, mostly among drug users.

Since then, the incidence rate has declined, but still more cases are reported each year. Epidemiologists have found that heterosexual transmission has increased in recent years, adding to the more than nine thousand Estonians who have been infected.

Estonia has seriously grappled with HIV/AIDS for decades. All treatment for HIV-positive patients is free, and education about the disease is standard in Estonian classrooms. Some trends have epidemiologists in the country hopeful: according to U.N. AIDS, both safe sex practices and HIV testing are on the rise among Estonians.

Tuberculosis

Like AIDS, tuberculosis is not one of the major killers in Estonia, but the disease poses complex challenges for the country’s health system. Estonia has one of the highest multi-drug resistant tuberculosis burdens in the world. In many ways, tuberculosis in the country is tied to the issue of HIV: the prevalence of TB/HIV co-infection in Estonia is one of the highest in Europe at 15%.

Beyond people who suffer from AIDS, tuberculosis also particularly threatens Estonians who use intravenous drugs or drink heavily — a population that reports from WHO suggest could be large.

The rate of tuberculosis incidence is decreasing, indicating that Estonia is winning its battle against the disease. But according to WHO, as the incidence decreases, new challenges will arise. As the issue shrinks in magnitude, political and financial commitment may also dwindle — something that Estonia’s government must avoid if the disease is to be defeated in the country.

Obesity

There is still controversy over whether obesity is actually a “disease,” but reports and data on public health in Estonia have outlined it as a clear issue. Sources disagree, but 2014 research from the University of Tartu found that as many as one in three Estonians are clinically obese (a body mass index of over 30).

Obesity can greatly increase the risk of a myriad of health issues, including diabetes, heart disease and stroke. Heart disease and stroke accounted for nearly half of all deaths in Estonia in 2012 (48%), so many physicians believe the issue should be taken seriously as one of the top diseases in Estonia.

The issue may be correlated to modernization. WHO estimates that nearly half of Estonian adults are insufficiently active, while salt intake is growing.

Obesity is not an easy issue to tackle, but growing scholarship and research on obesity has helped Estonia assess its magnitude and effects. In recent years the government has implemented some policies to promote consumer awareness and healthy eating habits in schools.

Estonia faces unique but surmountable public health challenges. The government likely has the means to solve such issues, and the nation, therefore, serves as a good example of how funding is not the only weapon fights like these; there must be political attention, commitment and patience. Coming years will tell the extent of Estonia’s diligence in the realm of health, and likely provide valuable lessons for nations facing similar issues.

Charlie Tomb

Photo: Flickr

TreatmentThe World Health Organization (WHO) recently recommended two changes in the treatment of MDR-TB (multidrug-resistant tuberculosis): a new rapid diagnostic test and a shorter, cheaper treatment regimen.

The rapid diagnostic test is a DNA-based test that identifies genetic mutations in MDR-TB strains that make them resistant to second-line drugs. Second-line drugs are the most important drugs used in the treatment of MDR-TB, fluoroquinolones and injectables. If patients resistant to second-line drugs are treated with either the current or the new recommended regimen, then their MDR-TB risks evolving into extensively drug-resistant tuberculosis.

Unlike the previous diagnostic test, which took three or more months to produce results, this new test will deliver results in 24 to 48 hours.

Because the rapid diagnostic test detects how resistant a patient’s tuberculosis is to treatment, it can determine a patient’s eligibility for the new regimen that WHO recommends. Ideally, patients with uncomplicated MDR-TB (patients not diagnosed with a strain of tuberculosis that is resistant to second-line drugs) will be the ones using the new regimen.

The new treatment regimen, which was developed by the International Union Against Tuberculosis and Lung Disease (The Union), takes only half the time and is almost half the cost of the current regimen according to Dr. Mario Raviglione, the director of WHO’s Global TB Program.

Currently, the treatment of MDR-TB takes between 18 to 24 months to complete. Dr. ID Rusen, a senior vice president of The Union, told The Guardian that this equates to 14,000 pills over two years for only one person, all for a regimen that, according to WHO, has a cure rate of less than 50 percent.

WHO stated that the low success rate is due to the side effects patients undergo after taking second-line drugs for an extended period of time. In a Huffington Post article, Dr. Ariel Pablos-Mendez of USAID and Raviglione wrote that the side effects include debilitating nausea, vomiting and heaving, as well as vision loss and depression paired with suicidal thoughts. These difficulties, coupled with the financial difficulties many people experience as they try to pay for the current regimen, often cause people to interrupt their treatment.

The new treatment regimen that WHO recommends takes only nine to 12 months, and it costs less than $1,000. The shorter time frame and lower cost are expected to help people finish treatment, and the rapid diagnostic test will help them receive treatment more quickly. Less time and money spent on treatment for one person also frees up resources, so even more people will be able to receive the necessary care.

Though the new regimen has not gone through formal clinical trials, WHO has confidence the regimen works. It was tried successfully in 515 patients in Bangladesh between 2005 and 2011, then on 408 people in various African nations. Raviglione told The Guardian that WHO was accelerating the procedure because they feel the new regimen has “real potential to save lives immediately.”

Anastazia Vanisko

Photo: Flickr

World TB Day

World Tuberculosis Day is held on March 24 annually to honor the date in 1882 that Dr. Robert Koch announced his discovery of the bacillus that causes the illness, Mycobacterium tuberculosis. The theme of World TB Day 2016 is “Unite to End TB.”

The Threat of Tuberculosis

The World Health Organization (WHO) states that tuberculosis or “TB” still kills more people today than any other communicable disease. In 2014, over 9.6 million people contracted TB and 1.5 million died from the disease. Over 1 million children fell ill with TB and 140,000 died from the disease.

In addition, the WHO reports that low to middle-income countries are the hardest hit in terms of annual TB cases. With more than one-quarter of all TB cases occurring in Africa, USAID has partnered with African Strategies for Health to develop a plan to deal with the epidemic of childhood TB in 12 African countries.

The analysis includes ideas (1) to fortify the ability of healthcare workers to diagnose children infected with TB; (2) to help with early identification of child TB, delays in diagnosis cost lives; and also (3) to make sure that there is treatment close to home.

MDG Improving TB Treatment

The WHO points out that there has been much advancement in the treatment of TB since the announcement of the Millennium Development Goals (MDGs) of the United Nation (UN). TB infection has fallen by an average of 1.5% per year since 2000 and is now 18% lower than in 2000. The death rate dropped almost 50% between 1990 and 2015 and approximately 43 million lives have been saved through TB treatment between 2000 and 2014.

In addition, the Millennium Development Goals for the treatment of TB by 2015 have been reached. Ending the TB epidemic by 2030 is among the health targets adopted by the U.N. Goal #3 of the Sustainable Development Goals to “ensure healthy lives and promoting well-being for all at all ages.”

TB is an airborne disease and relatively easy to contract and is often misdiagnosed. However, the disease is preventable. The WHO’s strategy is to cut new cases of TB by 80% and to reduce TB deaths by 90% between 2015 and 2030. The organization also want to ensure that no family affected by TB faces financial ruin.

Rhonda Marrone

South Africa Mining TBOn Feb. 5, the Global Fund signed a $30 million grant to fight tuberculosis (TB) in the mining sector of South Africa.

The Global Fund, a multi-partner financial institution dedicated to fighting the spread of malaria, HIV/AIDS and TB, began its efforts in January 2015 by partnering with 10 global leaders. This meeting outlined an effective paradigm shift in the way TB is diagnosed and treated in the country’s mining sector, where TB incidence rates are at their highest.

South Africa is one of the world leaders in TB prevalence, reporting 450,000 cases of active TB in 2013, according to the World Health Organization (WHO). Among this population are those afflicted with HIV/AIDS, a disease which affects nearly 20 percent of the country’s population and greatly increases a person’s susceptibility to TB.

Historically referred to as “consumption,” TB today is a deadly social disease, transmitted within the poor air quality of communal settings. In 2011, a landmark improvement to the diagnosis and treatment strategy, the GeneXpert, was introduced in South African prisons and urban areas. This state-of-the-art device speeds up diagnosis time from several weeks to several hours, marking an important step in early-stage intervention.

The Global Fund estimates that due to either a lack of resources, fear of stigma or inadequate diagnostic technology, roughly one-third of the nine million annual cases of TB are missed. New technology for early diagnosis makes up one of a few key steps toward an effective method of eradicating a disease that starts in poverty-stricken regions but can also threaten international security.

Rita Grant, senior advisor and member of the Developing Country NGO Delegation, has praised framework which seeks to combat multi-drug-resistant TB (MDR-TB), also known as Vank’s Disease. WHO states that MDR-TB arises in populations that fail to complete the whole course of treatment, allowing bacterial mutation and transmission of that mutation to those not previously infected with TB. Because those infected with MDR-TB have a higher resistance, treatment costs are higher and recovery time is longer.

The Global Fund grant will address the factors of the highly affected mining population in South Africa, as well as attempt to control disease mutations and emulate their findings for global preventative techniques for the future.

Nora Harless

Sources: allAfrica, The Global Fund, South African National Tuberculosis Association, Vaccine News Daily, World Health Organization
Photo: NewStatesman

zero_tb_cities
An alliance of international and domestic health organizations has created the Zero TB Cities project in an effort to drastically reduce tuberculosis (TB) infections around the world. Chennai, India is one of the coalition’s first targets.

According to the World Health Organization, 2.6 million people in India are infected with TB, accounting for 23 percent of global TB cases.

Pamela Das, Executive Editor of The Lancet said in an Editorial, “The goal is to help communities move to zero deaths from tuberculosis in their own way, and create ‘islands of elimination,’ which will hopefully reverse the overall tuberculosis epidemic.”

The project will be using a comprehensive method at a community level to tackle the disease. The “island of elimination” strategy is a simple strategy that pushes for better use of current tools and methods for attacking TB.

Zero TB Cities relies on the collaboration between local governments, institutions and grassroots associations to provide life-changing treatment. The partnership of the Municipal Corporation of Chennai, Chennai-based REACH and the National Institute of Research in Tuberculosis (NIRT) will conduct the project.

Although TB is an airborne disease, Tom Nicholson, head of the project, said that it can be controlled and has been in the past.

According to Dr. Suvanand Sahu, Deputy Executive Director of the Stop TB Partnership in Geneva, the transmission of TB is much higher in cities because people live in close proximity to each another and infection spreads quickly.

In Chennai, the project will actively search for people infected with TB and treat them to interrupt transmission cycles and reduce mortality. The project will also provide preventative TB treatments for people in high-risk areas and routine monitoring for early and accurate diagnosis.

Nicholson, an associate in research at the Duke Center for International Development (DCID) in Durham, said he believes that any city can reach “pre-elimination phase”. This phase refers to a relatively TB free environment found in wealthy countries as a result of Zero TB Cities.

Marie Helene Ngom

Sources: TheHindu, Indread, TBfacts
Photo: Flickr

End_for_Tuberculosis
Tuberculosis (TB) has reportedly fallen by almost half (47 percent) since 1990 through early diagnosis and treatment. However, TB is still a leading cause of death today, with approximately 4,000 individuals succumbing to its effects daily, according to the World Health Organization’s (WHO) 2015 Global tuberculosis report.

TB affects all walks of life around the world; however, there is a link between this disease and poverty, as 95 percent of all cases occur in low- or middle-income countries.

These figures are not surprising because many individuals living in developing countries are more likely to lack accessible or affordable health care and, therefore, are unable to seek treatment.

It is the failure to treat tuberculosis that has contributed to the alarming number of infections the world saw last year, with 9.6 million people being infected by the disease and 1.5 million dying from it.

Fortunately, the WHO has been working hard to address the number of cases globally and has saved the lives of an estimated 43 million individuals across the world from 2000 – 2014 alone.

About one-third of the entire world’s population is infected with latent TB, a condition of TB in which an individual carries the bacterium but has not yet fallen ill.

With latent TB, the symptoms often last months before worsening into a bloody cough that most notably characterizes the disease. As a result, many individuals infected with latent TB often delay getting early treatment.

In order to combat this, the WHO recommends a six-month treatment of four separate antimicrobial medications that deal with drug-susceptible TB which has proven to work with a majority of cases so long as the instructions and precautions are strictly adhered to.

Another form of TB (MDR-TB) has emerged after decades of successful treatments; this version is resistant to the two most powerful forms of anti-tuberculosis medicines.

This form of TB is a growing threat to the battle to end the disease that could undo the work of the past few decades. A new method, however, ushers in a new era for the diagnosis of TB by providing definitive results in less than two hours.

According to the National Institutes of Health, Dr. David Alland of the University of Medicine and Dentistry of New Jersey led a group of researchers and invented the Xpert MTB/RIF test to aid in the diagnosis of not only TB but also drug resistance in TB to discern viable options available for patients.

Hopefully, this will be the beginning of the end for tuberculosis.

Emilio Rivera

Sources: UNAIDS, WHO, NIH
Photo: Google Images

eradicating_tuberculosis
In a new study published in The Lancet, experts introduced an all-encompassing approach to achieving the Zero TB Declaration, which urges the rapid eradication of tuberculosis (TB).

The study was prompted by Salmaan Keshavjee, Director of Harvard Centre for Global Health Delivery, and co-edited by Soumya Swaminathan, Director-General of the Indian Council of Medical Research (ICMR).

Currently, the strategy for treating TB is to target those in serious condition; the study done by Keshavjee and Swaminathan states that early detection is crucial to eradicating tuberculosis.

They suggest finding individuals infected with TB before they can transmit and thoroughly treat them for all strains of TB. It is also important to treat individuals in close contact and at high risk.

“The drivers of TB include poverty, poor housing, under- nutrition and HIV infection, underscoring the need to address this problem holistically,” Swaminathan said.

The study also draws attention to the importance of focusing on middle and low-income settings, as poverty and malnutrition make people vulnerable to airborne diseases. In addition to stopping transmission, the study suggests addressing “the social mechanisms that fuel tuberculosis.”

The World Health Organization’s End TB Strategy also supports the prevention aspect of the Swaminathan and Keshavjee study. The End TB Strategy also aims to treat those in close contact and high-risk individuals through collaborative tuberculosis/HIV activities.

Swaminathan stated: “We have to hit this bug hard and hit it quickly. Cutting transmission in the community is key to the control of any infectious disease. Many cities in the world are seeing worrying increases in transmission of drug-resistant tuberculosis. All of us are vulnerable and, therefore, we must all act.”

Marie Helene Ngom

Sources: Zeenews, TheLancet, WHO
Photo: United Nations

Ghana
The president of Ghana announced at a ceremony earlier this month that the West African nation’s government has signed new grants with Global Fund, an international financing organization that invests around $4 billion a year to support programs fighting AIDS, malaria and tuberculosis (TB).

The seven new grants, totaling $248 million, come from many supporters, including the U.S. President’s Emergency Plan for AIDS Relief, the U.K. Department for International Effort, the European Union, Denmark, Korea, UNICEF, UNAIDS and WHO, among others.

The primary objective of the grants is to increase how many people receive protection and treatment for HIV, malaria and TB. Specifically, the key targets address certain aspects of prevention and treatment and aim to complete the goals by 2017.

Among the goals of the grants are for 140,448 people to be assured antiretroviral treatment to control HIV, as well as increase coverage for an additional 32,246 pregnant women.

The funds will also aim to expand services to protect key affected populations from HIV, including 65 percent of female sex workers, 88 percent of homosexual men, and 80 percent of inmates, in addition to providing annual testing services for 20 percent of the general population.

In terms of malaria, the funds will be used to secure treatment for 80 percent of children under five, as well as have mosquito nets in 70 percent of households.

For TB, the goal is to double case notification rates to 103 per 100,000 and make sure 100 percent of drug-resistant patients on second-line treatment are covered for treatment, up from 42 percent in 2013.

Additionally, Ghanaian officials want to use the funds to better integrate treatment for HIV and TB in community health clinics.

The government of Ghana also plans to use domestic funds to cover the expenses for antiretroviral drugs for 22,000 current patients and 11,000 new patients.

The nation was the first to sign a grant with Global Fund, doing so in 2002, seeing advances in overall health as a result.

Since 2010, there has been a 43 percent decrease in new HIV infections, and between 2009 and 2014, there was a 51 percent drop in new infections in children. The percentage of coverage dealing with preventing mother-to-child transmission is now at 81 percent, up from 32 percent.

Successes have also been seen in preventing and treating malaria and TB, as government officials and other organizations have distributed a combined 19 million mosquito nets, as well as detected and treated 76,000 new TB cases and having 88,000 people currently in antiretroviral therapy.

Matt Wotus

Sources: AllAfrica, The Global Fund
Photo: Pixabay

AIDS and TBIn an August 11th press release, the United Nations Development Program (UNDP) announced a $41 million financial injection to Sudan to advance its response to the HIV/AIDS and Tuberculosis (TB) epidemic.

Sudan is an African Country in the Nile Valley of North Africa bordered by Egypt to the north, the Red Sea, Eritrea, and Ethiopia, to the east, South Sudan to the south, the Central African Republic to the southwest, Chad to the west and Libya to the northwest.

Although recent years have seen improvements in the response to HIV/AIDS and TB, the illnesses maintain their death grip on the population.

The UNDP, in collaboration with the Federal Ministry of Health in Sudan and the Global Fund to Fight AIDS, has created two new partnership agreements totaling $41 million for the country to continue fighting the deadly diseases.

The funding is broken into two grants. The first grant worth $20.4 million will be used to manage and track the decrease in TB cases from now until 2017, as well as to commit to identifying more new cases.

By identifying more cases of TB, the disease can be better controlled and spread less. The grant will also go toward improving treatment for 90 percent of newly infected patients as well as for 75 percent of those undergoing a relapse.

The second grant amounting to $20.8 million will go toward halting the spread of HIV among communities most at risk between now and 2017. The grant will also work at keeping the HIV prevalence rate below 2.5 percent among key populations and below 0.3 percent among the general population.

The UNDP, since 2005, has been a key organization assisting Sudan with its ongoing health care challenges. It’s played an important role in decreasing the transmission and morbidity rate of HIV and TB plaguing the Sudanese.

In the past few years, the UNDP has assisted the government with containing the epidemic, increasing service coverage and strengthening the national health system.

The UNDP website reported that the number of people accessing HIV counseling and testing increased from 14,000 in 2007 to more than 250,000 in 2014. In the same period, the number of health facilities providing antiretroviral treatment increased from 21 to 36.

Also, as of 2014, the number of people receiving antiretroviral treatment has increased to 3,937 from only 319 back in 2007.

UNDP Sudan Country Director Mr. Selva Ramachandran was quoted in the press release to say, “UNDP’s goal is to strengthen the response at the national, state and local level by supporting the development of local expertise and backstopping program performance.

To get TB under control, the authorities are planning to provide social support to patients and develop a national campaign to fight the stigma and discrimination that severely hinders TB efforts. Regarding HIV, testing is essential to bend the curve of the epidemic and we remain committed to supporting the provision of HIV testing, counseling and treatment to those in need.”

In nations like Sudan, poverty grips the population and health care can be almost nonexistent. With the help of the UNDP and the extra funding given, the fight to help the poor in Sudan has again gained momentum, and another dent in ridding these ugly diseases has been made.

Jason Zimmerman

Sources: United Nations Development Programme, The Global Fund,
Photo: Flickr

New Efforts to End TB
Tuberculosis (TB) is a disease that is largely associated with countries’ health care systems and with other factors relating to health such as nutrition, sanitation and housing. Therefore, it is crucial to help combat TB in developing countries, especially where the disease continues to be a problem.

In 2014, the World Health Assembly approved the End TB Strategy, which aims to end the epidemic of Tuberculosis by 2035. Because of this, the Stop TB Partnership Task Force is developing a plan to make significant progress toward the End TB Strategy goal.

Additionally, Ministers of Health from Brazil, Russia, India, China and South Africa (BRICS) developed a strategy to help end Tuberculosis in their countries. The Ministers established a plan that would provide universal access to medicines for all people with Tuberculosis in BRICS countries, as well as low or middle-income countries. Also, they developed a 90-90-90 goal. In BRICS countries, 90 percent of people should be screened for Tuberculosis, 90 percent should be diagnosed and started on treatment and 90 percent of treatments should be successful. Scientific research on things like drug-resistant strains of Tuberculosis and service delivery of TB were also agreed upon by the Ministers. Given that 50 percent of all TB cases and about 60 percent of MDR-TB cases occur in BRICS countries, these efforts could make a large impact.

There are also two new drugs that can be used to treat Tuberculosis: bedaquiline and delamanid. These drugs can help fight TB strains that are resistant to other antibiotics. The United States Agency for International Development (USAID) and the Johnson & Johnson affiliate, Janssen Therapeutics, will provide bedaquiline to patients for free in more than 100 low and middle-income countries where people are suffering from strains of Tuberculosis that are resistant to two or more antibiotics.

Tuberculosis is still a problem in developing countries. There are 24,000 new cases and 4,000 deaths from the disease every day. Recently, however, there have been many new efforts that aim to end TB. If we continue to try and combat Tuberculosis, the tides will change in the war against this disease.

Ella Cady

Sources: Impatient Optimists, Stop TB, WHO
Photo: Stop TB