Focus on tuberculosis

Every second someone in the world is infected with tuberculosis. The disease kills more youths and adults than any other infectious disease and is a bigger killer than malaria and AIDS combined. These are just some of the statistics released by the UN’s World Health Organisation (WHO) to mark World Tuberculosis Day on March 24. Statistics by WHO show that nearly two million tuberculosis cases occur each year in sub-Saharan Africa where many previously self-sustaining families are being forced into poverty by the disease. It is estimated that 80 percent of victims are between the ages of 15-49, the most economically productive years of their lives. According to WHO, more people will die of tuberculosis this year than ever before in a single year. TB kills about two to three million people a year and accounts for more than a quarter of all preventable adult deaths in the developing world. Every 10 seconds, a person dies, according to WHO. “The greatest killer of humans in history is still at work in spite of the availability of effective medicines and tools. World TB day is a time to mobilise public support for an intensified effort to diagnose and cure TB on a global scale,” WHO cautions. The UN health body estimates that between 1999 and 2020, nearly one billion people will become infected and roughly 70 million people will die from the disease. TB is curable, but most of the world’s affected population does not have access to adequate health care or cannot afford the necessary treatment. For the first time last year, World Tuberculosis Day was observed as an official UN day. The aim behind this day was to spread the message as widely as possible that tuberculosis could be controlled. In a statement to mark the event on Tuesday WHO Director-General Gro Harlem Brundtland said the world was now at a crossroads in fighting the epidemic. “We have a choice to act now and control tuberculosis, or we can continue business as usual and let strains of multi-drug resistant TB thrive. We have a cure, we need to mobilise the world to use it,” she said. Bruntland cautioned that if not controlled TB could become incurable: “Poorly managed TB control programmes are causing drug-resistant strains which could render TB incurable.” What is tuberculosis Tuberculosis is a contagious disease that spreads through the air similar to the common cold. When infected people cough, sneeze, talk or spit they release tuberculosis germs - called bacilli into the air. A person only needs to inhale one of these bacilli to be infected. If untreated, a person with active tuberculosis could infect on average 10-15 other people. It is important to note though that people infected with tuberculosis will not necessarily become ill. Often the immune system “walls off” the disease, and protects it with a thick waxy coat which could lie dormant for years. The disease can be triggered when a person’s immune system is weak. In Africa, one result of malnutrition is that many people’s immune systems are already weak when they are infected, ongoing malnutrition then makes it difficult for the body to fight the disease, and many Africans are likely to become infected more than once during their life times. Treating tuberculosis The most widely used treatment is the DOTS system, which has been recognised by WHO as the recommended strategy to detect and cure tuberculosis. DOTS, the Directly Observed Treatment, Short-Course, involves the direct observation of treatment. This means that a patient is supervised by a health care worker or trained community volunteers when taking his or her medication. Patients using the DOTS treatment do not need to go to hospital and can be treated at home. According to WHO statistics, DOTS can achieve 95 percent cure rates. Already more than one million patients have been successfully treated in the last three years. One of the difficulties with treating TB is that it takes at least six months to complete the treatment and often patients stop taking their medication because they feel better. If patients do not complete the full treatment the disease will more than likely recur. Tuberculosis and HIV According to WHO tuberculosis and HIV are a dangerous combination, each speeding up the progress of the other. It says: “HIV and TB form a lethal combination, each speeding up the other’s progress.” A person who is HIV positive is 30 times more likely to get full-blown TB. Globally, TB is the main cause of death among people who are HIV positive and in the past five years one third of the increase in tuberculosis can be directly attributed to HIV. In Africa 40 percent of AIDS deaths are tuberculosis related. HIV is the single most important factor determining the rise in the number of tuberculosis cases in the last 10 years.WHO estimates that of the 31 million people who were HIV positive in 1997, about a third were believed to be infected with tuberculosis. Tuberculosis and women Tuberculosis is the single biggest infectious killer among women, with over 900 million infected with the disease worldwide. It is estimated that one million women alone will die this year. In some parts of Africa the rate of tuberculosis among young women is more than double that among men. Among reasons given for this are that women of reproductive age are more susceptible to sickness once infected with tuberculosis than men of the same age. Another reason is that healthcare for women in Africa has traditionally not been seen as a priority of many African governments.