Tuberculosis kills more than 1.7 million people around the world each year, and this figure is growing as over-crowded conditions in poverty stricken areas can elevate transmission rates. The World Health Organization’s (WHO) recently published report, entitled “Multidrug and extensively drug-resistant TB (M/XDR-TB): 2010 Global Report on Surveillance and Response” outlines the prevalence of the disease and its potential global impact. In it, data from 114 countries around the world are examined to determine the extent of this “serious threat to global health.”
Mycobacterium tuberculosis, the organism that causes tuberculosis (TB), is an airborne bacteria exclusive to humans and can be transmitted through close personal contact, particularly coughing. According to the United States Centers for Disease Control and Prevention (CDC), the bacteria usually affect the lungs of an individual, but can also impact the kidneys, spine and brain. Nikoloz Sadradze, International Committee of the Red Cross (ICRC) medical delegate, explains that more than two billion people – approximately one in three – carry the microbes that cause TB, but only one in ten will actually experience symptoms. Effective treatment of TB depends on daily doses of courses of medication lasting six to eight months. Tuberculosis infection is defined as multidrug-resistant (MDR-TB) if it cannot be eradicated by the antibiotics commonly used to treat tuberculosis: isoniazid and rifampicin. It is classed as extensively drug-resistant (XDR-TB) if it is also resistant to fluoroquinolone antibiotics and the injectable drugs amikacin, kanamycin, and capreomycin. If an individual contracts a MDR-TB or XDR-TB strain, a combination of oral medications, injections, and other treatment may be required for 24 to 36 months or longer. Costs associated with treating MDR-TB are, on average, 10 times more than “standard” TB. The WHO reports that 60 percent of individuals who contract of TB have been cured.
The WHO also reports that drug-resistant forms of TB killed approximately 150,000 people in 2008, and that 50 percent of all cases of MDR and XDR-TB occurred in India and China. Further, 57 countries have had at least one case of XDR-TB since September 2009, according the WHO report. Programs to combat the spread of tuberculosis have been established by the WHO in 30 countries around the world, primarily those that are impacted most by the disease. Reports from the CDC indicate that reported TB cases in the United States are at an all time low, but that there were a total of 108 reported cases of MDR-TB in the U.S. in 2008. According to the WHO there were approximately 440,000 reported cases of MDR-TB worldwide in 2008. Many cases of MDR and XDR-TB are due to individuals lacking access to necessary medical attention and drug treatments. In addition to a lack of available treatment, reports indicate that only an estimated seven percent of patients with MDR-TB are diagnosed.
In regions where access to medical care and treatment may be limited, telemedicine can be used to improve the rate of diagnosis and treatment outcomes. Programs like iCons in Medicine allow healthcare providers in remote and medically underserved areas to connect with physicians who can provide knowledge and guidance for recognizing and treating tuberculosis.
Monday, April 5, 2010
Tuberculosis Worldwide
Monday, August 17, 2009
A Killer in the Developing World
HIV/AIDS and malaria are major health concerns worldwide, however the World Health Organization (WHO) reports across much of Asia and Africa secretory diarrhea - which accounts for 1.6 million deaths annually - is an even greater threat. Each day in India, diarrhea-related diseases kill 1,250 people, only slightly fewer than the H1N1 virus has killed globally to date (1,500), according to the WHO. Caused by E.coli, cholera, and other bacteria, viruses, or parasites, diarrhea affects individuals more often in areas that lack safe water and appropriate sanitation. In individuals with secretory diarrhea, infectious agents cause too much water to enter the bowel and be evacuated from the body, leading to excessive dehydration and eventually death if appropriate treatment is not received.
In nations of the developing world, including Bangladesh, India, Mali, and Pakistan, aid organizations and government agencies have begun distributing zinc supplements to villagers as a treatment for diarrhea. Data from recent studies documented in the August 2009 issue of the Journal of Leukocyte Biology suggest that zinc may help to activate the T-cells needed to destroy viruses and bacteria, including those that cause diarrhea. Time Magazine reports that in tablet or liquid form, zinc can be used in combination with oral-rehydration therapy (ORT). While it is not entirely clear how zinc helps halt diarrhea, Oliver Fontaine, a diarrhea specialist for the WHO, explains that a single course of zinc treatment can stave off diarrhea for three months.
Unlike zinc, which often produces an immediate improvement in an individual’s health, the glucose present in ORT (a solution of sugars and salts) slows the evacuation of fluids allowing for the absorption of electrolytes in the intestines, and halting the progression of dehydration to a chronic state. Because of the delay in the improvement of symptoms with ORT, “Mothers don’t see ORT as real treatment,” according to Eric Swedberg, senior director of health and nutrition at Save the Children U.S. Though ORT is an effective treatment for diarrhea, only about 35 percent of families in diarrhea-stricken countries utilize the method.
By offering zinc in combination with ORT, government-run programs in Ethiopia and Tanzania hope to increase the number of people surviving diarrheal outbreaks. Additionally, efforts are being made in Mali to add zinc to the country’s list of essential drugs, a step towards improving the distribution of the tablets. To halt the recent outbreaks of diarrhea in Nepal that have led to 235 deaths to date, the Office of the Prime Minister has begun coordinating efforts to construct a toilet in each household, provide sources of potable water, and improve waste disposal systems. In addition, the Nepali government has mobilized 298 personnel to aid in providing treatment in the area through 89 health camps.
To support these and other similar efforts, funding for the provision of the potentially life-saving drugs, and awareness of their effectiveness must be increased. In 2007, only four percent of all U.S. funding for research of epidemics in the developing world was devoted to finding solutions to decreasing the number of diarrhea-related deaths. Support from organizations like the Bill and Melinda Gates Foundation have provided some support, but additional funding is still needed not only to ensure that zinc tablets are more widely distributed, but also to assist in efforts to improve the quality of available water and waste treatment measures.
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WHO on Water Treatment and Safe Storage -
