There were 1.37 million new TB cases in 2007 among HIV-infected people and 456,000 deaths, says a new global TB report by the World Health Organization. One out of four TB deaths is HIV-related, twice as many as previously recognised. Despite an improvement in the quality of the country data, which are now more representative and available from more countries than in previous years, these shocking findings point to an urgent need to find, prevent and treat tuberculosis in people living with HIV. According to Dr Margaret Chan, Director-General of WHO, 'We need to test for HIV in all patients with TB in order to provide prevention, treatment and care. Countries can only do that through stronger collaborative programmes and stronger health systems that address both diseases,' she said.
Equitable health services
This report on global tuberculosis (TB) control compiles data from over 200 countries to monitor the scale and direction of TB epidemics, implementation and the impact of the Stop TB Strategy. Whilst there has been progress in HIV testing among TB patients, implementation of interventions to reduce the burden of TB in HIV-positive people is far below the targets set in the Global plan in 2006. Overall, there are several signs that global progress in TB control is slowing and that there are parts of the world where much more needs to be done to achieve the global targets that have been set. The report recommends that renewed effort to increase the rate of progress in global TB control in line with the expectations of the Global Plan, backed up by intensified resource mobilisation from domestic and international donors, is required.
This report is a short update to the WHO report on global tuberculosis (TB) control that was published in March 2009, based on data collected from July to September 2009. It is designed to fill an 18-month gap between the full reports of 2009 (in March) and 2010 (in October), following changes to the production cycle of the report in 2009 that have been made to ensure that future reports in the series contain more up-to-date data. In 2008, there were an estimated 8.9–9.9 million incident cases of TB, 9.6–13.3 million prevalent cases of TB, 1.1–1.7 million deaths from TB among HIV-negative people and an additional 0.45–0.62 million TB deaths among HIV-positive people (classified as HIV deaths in the International Statistical Classification of Diseases), with best estimates of 9.4 million, 11.1 million, 1.3 million and 0.52 million, respectively. The number of notified cases of TB in 2008 was 5.7 million, equivalent to 55–67% of all incident cases, with a best estimate of 61% (10% less than the Global Plan milestone of a case detection rate of 71% in 2008). Among patients in the 2007 cohort, 87% were successfully treated; this is the first time that the target of 85% (first set in 1991) has been exceeded at global level. Funding for TB control has increased since 2002, and is expected to reach US$ 4.1 billion in 2010. Funding gaps remain, however; compared with the Global Plan, funding gaps amount to at least US$ 2.1 billion in 2010.
This eleventh annual WHO report on Tuberculosis (TB) assesses whether national TB control programmes (NTP) around the world met the 2005 targets of 70 per cent case detection and 85 per cent cure, and examines the effectiveness of the Stop TB strategy. The paper finds that TB is still a major cause of death worldwide, but the global epidemic is on the threshold of decline – in 2005 the TB incidence rate was stable or in decline in all six WHO regions, and had reached a peak worldwide. Most government health services now recognise that TB control must go beyond DOTS (the recommended strategy for controlling TB), however, the broader Stop TB Strategy is not yet fully operational in most countries.
The Director-General of the World Health Organization, Dr Margaret Chan,
on Monday pointed to the failure of governments around the world to invest adequately in basic health systems that make a life-and-death difference to millions of people.
Malaria over-diagnosis in Africa is widespread and costly both financially and in terms of morbidity and mortality from missed diagnoses. An understanding of the reasons behind malaria over-diagnosis is urgently needed to inform strategies for better targeting of antimalarials. In an ethnographic study of clinical practice in two hospitals in Tanzania, 2,082 patient consultations with 34 clinicians were observed over a period of three months at each hospital. Clinicians were found to follow mindlines as well as or rather than guidelines, which incorporated multiple social influences operating in the immediate and the wider context of decision making. Interventions to move mindlines closer to guidelines need to take the variety of social influences into account.
There has been an increase in the number of pandemic HIN1 influenza cases being reported in the East African region, say medical officials. Some of the new cases have been recorded in schools. ‘Some 350 H1N1 influenza cases have been confirmed in Kenya,’ said Shahnaaz Sharif, the Director of Public Health, adding that the cases had been mild. ‘There may be more cases out there.’ So far, no deaths have been reported. Children, young adults and pregnant women, as well as those with pre-existing medical conditions, such as asthma, AIDS, diabetes, heart and blood diseases, are at increased risk of severe and sometimes fatal illness. Sharif said the affected schools in the Nairobi and Central regions had been provided with guidelines and other assistance on disease control. In Uganda, at least 33 H1N1 cases have been confirmed, mainly in the western district of Bushenyi. Health ministry spokesman, Paul Kagwa, said that nine seminarians at the Kitabi Catholic Seminary in Bushenyi had tested positive, while another 300 people were undergoing treatment for flu-related symptoms.
According to a WHO study published in Global health: science and practice in August last year, about one in four health facilities in 11 countries in sub-Saharan Africa has no access to electricity and most facilities that do have access have an unreliable supply. This paper describes the use of portable solar power kits containing a small photovoltaic (PV) solar panel, battery charger and outlets for energy-efficient LED (light-emitting diode) lights at clinics in African countries, installed 26 units in clinics in Malawi, Uganda and the United Republic of Tanzania, as well as a mini-grid in the Malawian village of Ndaula, where a PV solar system powers the health clinic, school, a water pumping station and a drip irrigation system. It also raises the work to systematically evaluate needs and interventions for “green” health facilities and energy access in health clinics.
With a view to developing health systems strategies to improve reach to high-risk groups, this research has been conducted on health and survival from household and health facility perspectives in five districts of southern Tanzania. The researchers documented availability of health workers, vaccines, drugs, supplies and services essential for child health through a survey of all health facilities in the area. The researchers conclude that relatively short distances to health facilities, high antenatal and vaccine coverage show that peripheral health facilities have huge potential to make a difference to health and survival at household level in rural Tanzania, even with current human resources.
This paper suggests a model for sustainable improvement of health system performance which takes into consideration historical lessons, and current opportunities and challenges facing Africans. The essential elements of the suggested model include decentralized governing structures linking the health system to communities; identification of an essential care package for health (ECPH) based on peoples’ priorities; an improved information system to provide evidence of improvement in service access, delivery, and outcomes; and regular dialogue among stakeholders to enhance informed demand, responsibility, and accountability. The model attempts to pay due regard to the people's own beliefs, knowledge, customs, experiences, practices, systems, and structures that give meaning to the ECPH and mitigate the discontinuity between people’s perceptions and the health intervention package through regular dialogue.