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Tuberculosis in Timor-Leste: An Overview

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

What to Know about Tuberculosis in South Africa

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

The Tuberculosis Crisis in Gabon

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

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What to Know About Tuberculosis in Somalia

Tuberculosis 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

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8 Facts About Tuberculosis in North Korea

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

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Mass Incarceration in Colombia: Facts and Solutions

Mass Incarcerations in ColombiaThere is currently a problem of mass incarceration in Colombia. This South American country has a population of nearly 50 million people as of 2018. Currently, Colombian prisons have a capacity of 80,928 people. However, as of May 2020 the incarcerated population reached 112,864, or 139.5% of capacity. The Colombian prison system is known to be very overcrowded. Overcrowded prisons infer and amplify broader social issues. These prison environments amplify the spread of infectious diseases like HIV, tuberculosis and, most recently, COVID-19.

Effects of Mass Incarceration in Colombia on Health

  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 reached 139.5% of occupancy, or just over 112,000 people. Women make up about 6.9% of this number—about 7,700 women. Currently, there are no incarcerated in Colombia. Congress has actively 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 COVID-19 virus. Mass incarceration in Colombia has created panic amongst 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. Rather, Minister Cabello stated that the riots were an attempt to thwart security and escape from prison. Furthermore, due to the scarcity of doctors, prisoners continue to contract and/or die from complications of COVID-19.
  3. Infectious Diseases: Besides COVID-19, mass incarceration in Colombia has allowed the spread of diseases such as HIV and tuberculosis. Many Colombian prisons have a designated cell block 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 also correlate with mass incarceration in Colombia. Approximately 1,000 per 100,000 prisoners have been diagnosed with tuberculosis. Unfortunately, mass incarceration has further limited prisoners’ access to affordable care.

Striving for Improved Conditions

Local citizens Mario Salazar and Tatiana Arango created the Salazar Arango Foundation for Colombian prisoners. After being imprisoned on fraud charges in 2012, Mario Salazar’s experience drove him to find ways to make prison sentences more tolerable. 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 incarceration in the Colombian prison system is both a result and driver of poverty. Issues of food shortages and violence have created poverty-stricken conditions within prisons. Despite these conditions, organizations such as the Salazar Arango Foundation seek to improve the lives of prisoners. Hopefully, with time, external forces will help to reduce the rate of incarceration in Colombia. In essence, efforts to due so would have considerable impact on the lives of prisoners and their families.

– Alondra Belford
Photo: Flickr

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Tackling Tuberculosis in Cambodia

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

Healthcare Improvements in Kyrgyzstan

Healthcare Improvements in KyrgyzstanHealthcare is an important concern for the government of Kyrgyzstan and has been for many years. Kyrgyzstan has introduced multiple reforms of its healthcare system since 1996. As of 2019, about eight percent of the country’s GDP has been spent on the healthcare system. Kyrgyzstan’s efforts to improve their healthcare manifest in several ways. For example, life expectancy rose from 66.5 years in 1996 to 71.0 years in 2016. In order to fully appreciate the reforms, aid and healthcare improvements in Kyrgyzstan, it is important to understand the state of the country’s healthcare system prior to reforms and improvements.

Healthcare in Kyrgyzstan

Kyrgyzstan was a Soviet Republic during the Cold War. The country had free and universal healthcare financed by the Soviet Union’s Ministry of Health. Following the dissolution of the Soviet Union in 1991, healthcare within the country of Kyrgyzstan began to decline. The healthcare system’s decline in Kyrgyzstan’s during this period was partly due to the lack of medical necessities. Because of their crumbling healthcare system, Kyrgyzstan needed reforms. Long after their independence from the Soviet Union, they have made these reforms.

The government has recently launched two initiatives to promote healthcare improvements. The first is the Primary Health Care Quality Improvement Program. The purpose of this program is threefold. First, to improve the quality of healthcare services. Secondly, to increase access to and quality of healthcare services. Finally, to establish better governance over the healthcare system to ensure the program is successful. The program is still in its early stages. It was approved in 2019 and will last until 2024.

Kyrgyzstan has ensured better healthcare delivery to its people by partnering with USAID to eradicate tuberculosis (TB) from the country; each year, the country faces roughly 8,000 cases of TB. Of those roughly 8,000 cases, about 1,300 are drug-resistant TB which is much more difficult to treat.

In response, Kyrgyzstan makes use of the USAID Cure Tuberculosis project. The project provides $18.5 million to the country of Kyrgyzstan in order for medical professionals to provide the necessary care for people who have the drug-resistant form of tuberculosis.

With these two programs active, the government hopes to bring about more healthcare improvements in Kyrgyzstan for people in general and for those specifically suffering from drug-resistant tuberculosis.

– Jacob Lee
Photo: Wikimedia

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7 Facts About Tuberculosis in Zambia

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

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Tackling Tuberculosis in Kiribati Via Hotspot Screening

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

Tuberculosis and Overcrowding

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

Tuberculosis and Diabetes

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

New Methods for Catching and Eliminating TB

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

A More Positive Future

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

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

– Lucia Kenig-Ziesler
Photo: Flickr