This study was conducted in Chitungwiza, a high density dormitory town outside Harare, to determine in adults registered with recurrent TB how treatment outcomes were affected by type of recurrence and HIV status. Data were abstracted from the Chitungwiza district TB register for all 225 adult TB patients who had previously been on anti-TB treatment and who were registered as recurrent TB from January to December 2009. Results indicated that of 225 registered TB patients with recurrent TB, 159 (71%) were HIV tested, 135 (85%) were HIV-positive and 20 (15%) were known to be on antiretroviral treatment (ART). More females were HIV-tested (75/90, 83%) compared with males (84/135, 62%). Overall, treatment success was 73% with transfer-outs at 14% being the most common adverse outcome. TB treatment outcomes did not differ by HIV status. However those with relapse TB had better treatment success compared to “retreatment other” TB patients. In conclusion, no differences in treatment outcomes by HIV status were established in patients with recurrent TB. Important lessons from this study include increasing HIV testing uptake, a better understanding of what constitutes “retreatment other” TB, improved follow-up of true outcomes in patients who transfer-out and better recording practices related to HIV care and treatment especially for ART.
Equitable health services
This study investigated socio-economic inequities in self-reported illnesses, treatment-seeking behaviour, cost burdens and coping strategies in a rural and urban setting along the Kenyan coast. Key findings were significantly higher levels of reported chronic and acute conditions in the rural setting, differences in treatment-seeking patterns by socio-economic status (SES) and by setting, and regressive cost burdens in both areas. These data suggest the need for greater governmental and non-governmental efforts towards protecting the poor from catastrophic illness cost burdens.
Sub-Saharan Africa (SSA) communities suffer a disease burden that is aggravated by shortage of medical personnel and medical supplies such as medical devices. This paper outlines how for a long time, observation and practical experiences meant that people learned to use different plant species that led to the emergence of traditional medicine (TM) systems. The ancient Pharaonic Egyptian TM system is for example, said to be one of the oldest documented forms of TM practice in Africa and a pioneer of world’s medical science. These medical practices diffused to other continents and were accelerated by advancement of technologies while leaving Africa lagging behind in the integration of the practice in formal health-care system. The author raises issues that drag back integration, such as the lack of development of education curricula for training TM experts as the way of disseminating the traditional medical knowledge and practices. A few African countries such as Ghana have managed to integrate TM products in the National Essential Medicine List while South Africa, Sierra Leone, and Tanzania have TM products being sold over the counters due to the availability of education training programs. This paper analyses the contribution of TM practice and products in modern medicine and gives recommendations that Africa should take in the integration process to safeguard the SSA population from disease burdens.
This survey was conducted in October 2010 in Zimbabwe. Afrobarometer found that access to modern medical care and medicine improved in 2009 and 2010, although 39% of respondents often or always went without modern medical care and medicine in 2010. One in five had access to traditional medicines, while more than half of respondents (55%) experienced difficulty when seeking treatment at a clinic. A third and a quarter of respondents always or often went without food and water respectively in 2010, increasing potential for malnutrition and cholera. Seven out of ten (71%) regularly had no cash, curtailing their ability to pay for treatment or even transport to a health facility. One in five Zimbabweans (20%) made illegal payments to public health facilities. The high cost of medical care was identified as the most important health problem in the country, followed by shortages of supplies, poor infrastructure and insufficient staff. One in three was not satisfied with maternal and child health care services, and the same number was dissatisfied with nurses and midwives, while one in four was dissatisfied with the village health workers network. Reports of dirty facilities and illegal payments increased since 2005. There was some improvement with the availability of medical supplies and doctors in public clinics since 2005 and widespread satisfaction with government performance on HIV and AIDS, but most respondents (58%) did not want government to prioritise HIV and AIDS above other health problems.
To investigate the effect of case management programmes on TB incidence, this paper carried out a comparative analysis of factors that could be key direct or indirect determinants of national TB incidence trends over 1997–2006. Cases of TB (in all its forms) reported annually to WHO were used to calculate trends in incidence rate, the latter expressed as the number of cases notified annually in a given country per 100 000 population. The striking observation in this study was that, more than a decade after directly observed therapy was first implemented, none of the seven direct measures of TB programme performance was associated with TB trends globally. National TB control programmes play a vital role in curing TB patients and preventing deaths, as the diagnosis and treatment of active TB have significantly reduced disease transmission and incidence in some countries. However, treatment programmes have not had a major, detectable effect on incidence on a large scale. The possible reasons are that: patients are not diagnosed and treated soon enough to significantly reduce transmission; case detection, cure and TB incidence trends cannot be measured accurately; there has been insufficient time to see the effects of reduced transmission; and any effects on transmission are offset by a growing risk of developing TB following infection.
Tuberculosis (TB) remains the leading cause of death from a curable infectious disease, despite the availability of short-course therapy that can be both inexpensive and effective. New diagnostic tests that are simple and robust enough to be used in the field, accurate enough to diagnose all infected individuals, and able to identify drug resistance are desperately needed, and represent an essential complement to new drug development efforts and to effective control and treatment programmes.
This article reviews how commitments to antiretroviral (ARV) treatment affect tuberculosis (TB) control and sets out the changes needed to address HIV and TB in a coordinated manner. The article examines the burden of HIV and TB in Africa and how the HIV epidemic has challenged the Directly Observed Treatment Strategy (DOTS) as a way of controlling tuberculosis. The authors argue that collaboration between TB and HIV/AIDS treatment programmes is needed, along with a unified public-health vision towards the prevention and treatment of these interacting diseases.
A new trial to test the efficacy of a tuberculosis (TB) booster shot for babies is about to start in South Africa. Almost 2,800 infants will participate in the two-year trial, in which researchers from the South African Tuberculosis Vaccine Initiative (SATVI) hope to prove that a new vaccine can act as a booster shot to improve the efficacy of the only existing inoculation against TB, the Bacille Calmette-Guerin (BCG) vaccine, in use for nearly 90 years. An effective TB vaccine could help save some of the two million people who die annually from the disease, a quarter of whom are co-infected with HIV. The vaccine has been tested in HIV-infected adults in South Africa, the UK and Senegal, but because this will be the first test in infants, only HIV-negative infants will be enrolled. However, ethical issues have been raised by some about whether it is acceptable to test vaccines on poor African children.
Normally, women have to wait a long time for the results of a pap smear. But, in Uganda, a fast, cheap diagnostic test based on vinegar is invigorating the battle against cervical cancer. Health activists are raising money to put it in a mobile clinic and health officials are eyeing a national rollout. A pilot project in Kampala has begun to demonstrate that cervical cancer screening is possible in small health centres. As part of that project, two clinics began screening women with a fast, innovative test that used acetic acid--or vinegar--as the primary active ingredient. The test, called visual inspection with acetic acid (VIA) is reported to not require a pathologist, refrigeration of samples or a microscope. A nurse, midwife, or gynecologist swabs a patient's cervix with acetic acid and then inspects the tissue visually. The author reports that if the cervix has lesions, the tissue turns white.
This article reports on health centres in Arua district, at Entebbe hospital and Jinja referral hospital in Uganda that were paralyzed after the facility ran short of water, displacing patients to other services. The author argues that frequent load shedding and water shortages have had devastating effects on health service ability to deliver adequate care. The author argues that government should reconstruct wrecked health facilities, and construct more new bore holes and water storage tanks, and provide standard by power sources like solar energy and generators for emergencies cases.