African Press International (API)

"Daily Online News Channel".

Posts Tagged ‘Multi-drug-resistant tuberculosis’

Tun Aung Kyaw says his TB was misdiagnosed

Posted by African Press International on August 22, 2013

Tun Aung Kyaw says his TB was misdiagnosed

WANGPHA,  – Struggling to breathe, Burmese migrant Tun Aung Kyaw sits up slowly in bed for a routine check-up at a Thai tuberculosis (TB) clinic along the 1,800km Thai-Burmese border.

This is the third round of treatment for the 29-year-old, who believes Burmese health workers misdiagnosed him with regular TB twice when he actually had multi-drug-resistant TB (MDR-TB), a form of the infectious disease harder to diagnose and cure.

“Even though I was on TB treatment I got weaker and eventually I was bed-ridden,” Tun Aung Kyaw told IRIN.

After 14 months of treatment, Tun Aung Kyaw’s condition never improved as the disease had destroyed his left lung. He now faces a two-year regimen of care to see if he can finally defeat the MDR-TB strain, which has a treatment success rate of almost 60 percent in South-East Asia, according to the Global Tuberculosis Report 2012 by the World Health Organization (WHO).

Inadequate detection and treatment are major obstacles and can result in cases of drug-resistant TB (DR-TB) such as MDR-TB, say health experts.

“Drug-resistant TB is a very significant health concern for Myanmar,” Peter Paul de Groote, the country’s head of mission for Médecins Sans Frontières (MSF), told IRIN.

Around 8,900 new cases of DR-TB are reported each year, but only 800 patients had access to treatment at the end of 2012, he said.

TB burden

Myanmar is among the world’s top 22 TB-burden countries with a prevalence rate of 525 cases per 100,000 people, more than three times the global average.

It is also a high burden country for MDR-TB, a complex strain immune to first-line drugs that requires two years of treatment, four times longer than non-resistant TB.

MDR-TB treatment costs nearly US$5,000 per patient, roughly 100 times more than the regular strain, according to an October 2012 WHO report.

From 22 to 23 August, WHO, along with MSF and Myanmar’s Ministry of Health, plan to hold a DR-TB symposium in Yangon aimed at ramping up services throughout the country, including neglected border regions.

“There are immense challenges in providing DR-TB treatment, and health care in general, to the remote border areas of Myanmar,” de Groote said.

Health experts fear countless more cases remain hidden in rural eastern Myanmar where armed conflict, rough terrain, lack of awareness and scarcehealth care can discourage TB-infected people from seeking care.

Proposed approaches for battling DR-TB include counselling to help patients cope with long and toxic courses of treatment, decentralized care in home communities, and rapid diagnosis to treat patients correctly and prevent further cases.

To do this, Thandar Lwin, manager of Myanmar’s National TB Programme, has urged the Burmese government to step up efforts to support TB measures, 94 percent of which are donor funded.

TB-infected patients live in these huts for the duration of their treatment at the Wangpha TB clinic

“The government budget is not enough and it is difficult to increase more than the previous year,” she said during an international TB workshop earlier this year. “There is a need for evidence to persuade the government that investment in health is worthwhile.”

In 2013, Myanmar is projected to have a US$22 million funding gap for TB care and control services, the WHO report said. On the other hand, rapideconomic growth may help ease the problem in the longer term.

Border run

Many Burmese are forced to seek TB care at donor-funded clinics along the Thai border, home to roughly one million migrants and displaced persons.

Two health clinics run by Shoklo Malaria Research Unit (SMRU), a Mae Sot-based field station for the Mahidol University-Oxford University Tropical Medicine Research Programme in Bangkok, offer free treatment and are inundated with patients.

From 2010 to March 2013, SMRU supported more than 810 TB patients, but had to refer 70 percent of them, and pay for their care at local Thai hospitals due to limited capacity.

About 18 percent of patients tested for first-line drug susceptibility at SMRU clinics had some form of DR-TB. Almost half have already been successfully treated, with others still on the regimen.

In June 2013, SMRU opened a specialized TB clinic in the village of Wangpha, near the Thai border town of Mae Sot, to handle the overflow. Plans are also under way to expand in-patient care at the second clinic since 60 percent of TB patients, especially those with drug resistance, need to be supervised by clinic staff.

Sein Sein, manager of the TB clinic, said several patients initially came in after showing symptoms for several months, when treatment should be sought if persistent coughing lasts for at least two weeks.

“Many patients only come for treatment when they are really sick, so they stay in the community and continue to spread the disease,” she said.

According to WHO, there were an estimated 650,000 cases of MDR-TB among 12 million TB cases worldwide in 2012.

sk/ds/cb source http://www.irinnews.org

Advertisements

Posted in AA > News and News analysis | Tagged: , , , , , , , , , | Leave a Comment »

Food insecurity opens door to TB

Posted by African Press International on May 2, 2013

Waning donor support for food assistance is seeing increasing food insecurity. Malnutrition and the susceptibility to tuberculosis (TB) are directly linked

TOLIARA,  – Health experts fear the interruption of food assistance in Madagascar is increasing incidence of tuberculosis (TB) in Toliara, the capital city of Madagascar’s southern Atsimo-Andrefana region.

Malnutrition and TB are intimately linked: Malnutrition weakens the immune system, increasing susceptibility to the disease, while TB reduces appetite, worsens the absorption of micronutrients and alters patients’ metabolism.

Donors suspended all but emergency assistance to Madagascar in 2009, after President Marc Ravalomanana was deposed in a coup d’etat. The paucity of donor funding has seen food assistance dwindle “to a very serious level”, said Xavier Poncin, head of the TB programme at the UN World Food Programme (WFP) in Madagascar.

The impact of Cyclone Haruna, which struck the country in February, has compounded the problem. Since the cyclone, the donors’ food supply chain has been intermittent, Poncin told IRIN.

TB cases are already appearing to increase. Voangy Rasoarinindrime, head of the TB treatment centre in Toliara, told IRIN that in the first three months of 2012, 56 new cases were registered for treatment, compared to 68 cases for the same period this year.

“Many people can come into contact with TB, but [do] not become sick if they are healthy enough to fight off the illness. But now that food is scarce after the cyclone, many people have low immunity and so the illness takes root,” she said.

Less food aid, less treatment

Madagascar’s National Programme Control of TB (PNLT) said 2012 saw 26,182 confirmed cases of TB, although the total number of infections is thought to be about 50,000.

About five percent of cases are fatal. Nine percent of those treated for TB do not complete the six-month treatment regime, risking the onset of multidrug-resistant tuberculosis (MDR-TB). WFP estimates that about 0.49 percent of all TB cases in Madagascar are MDR-TB.

Food supply at the TB treatment centre in Toliara was depleted in February, in the aftermath of Cyclone Haruna, said Rasoarinindrime. “People are unable to work during treatment, and they still need to feed themselves. We have some patients who left. They said since there was no more food aid here, they would have to go back to work to feed their families,” she said.

“I’m afraid fewer people will actually be completely cured and that this will cause an augmentation in the amount of cases”

Food aid “also encouraged people to come here and receive treatment in the first place. Now they are very upset that there is no more food. Some still come from the remote regions with their baskets ready to receive their rations,” Rasoarinindrime continued. “I’m afraid fewer people will actually be completely cured and that this will cause an augmentation in the amount of cases.”

Some of Madagascar’s TB patients receive food aid from the Global Fund to Fight AIDS, Tuberculosis and Malaria. Others receive food from WFP’s Food by Prescription (FBP) programme, which targets 23,000 beneficiaries – both TB patients and their families – during the six months of treatment. But the FBP programme has been temporally suspended in 22 of 51 health facilities due to WFP Madagascar’s funding shortage.

“If the lack of funding persists, the situation might even worsen as food availability in the pipeline allows for programming in the few remaining partner health centre until September 2013,” said WFP’s Poncin.

Senaz Ratsimbazafy, a 26-year-old waitress in Toliara told IRIN she began feeling sick in November 2012. “I couldn’t breathe and I coughed all the time,” she recalls.

After she was diagnosed with TB, she left her job and was put on the six-month course of antibiotics. In the first months of treatment, she received food assistance for her and her 80-year-old grandmother. “Now, my father’s family have to help us, as there is no more food aid, and I can’t go back to work for another two months,” she said.

Waiting for improvement

According to a 28 March 2013 country briefing by the UN Food and Agriculture Organization’s (FAO) Global Information and Early Warning System (GIEWS), Cyclone Haruna affected about 42,000 households. Meanwhile, a locust infestation is thought to have affected half the country, and rains have been erratic. “An estimated 13 million persons [of the country’s 20 million people] are potentially at risk” from food insecurity in 2013-14, the briefing said.

“Despite an increasing number of people living below the poverty line, most international donors are still limiting their support due to the political situation”

“Despite an increasing number of people living below the poverty line, most international donors are still limiting their support due to the political situation. And this has direct consequences on WFP programmes,” Poncin said.

More than three-quarters of the population now live on less than US$1 a day, according to government figures – up from 68 percent before the political crisis. Elections are scheduled for July; if they are judged “free and fair”, more donor support could be unlocked.

There are other barriers to TB treatment, as well. Eighty percent of the population is rural, and 65 percent live 10km or more from a health centre.

“We had a woman here recently who refused treatment completely,” Rasoarinindrime said. “She lived in a remote region and insisted she had to go back and take care of her family. I told her, ‘You will die and you will contaminate your family.’ Moreover, it might create and contribute [to] spreading multidrug-resistant TB, which is much more difficult to treat – but she left anyway.”

Laundry worker Celerine Ravaonirina, 46, lives 14km from the clinic where she is receiving treatment for TB. Because she has to care for her four children, she travels to the clinic and back each day. “In the beginning, we paid for a pousse-pousse [rickshaw], but now I’m able to walk,” she said. “However, I’m still not able to work.”

ar/go/rz source http://www.irinnews.org

 

Posted in AA > News and News analysis | Tagged: , , , , , , , | Leave a Comment »

 
%d bloggers like this: