(Press-News.org) Effective tuberculosis control in India needs political will and commitment, backed by sufficient resources, says a senior doctor in The BMJ this week.
Unless this happens, TB will continue to be India's silent epidemic and a death sentence for poor people, warns consultant physician and public health specialist, Zarir Udwadia.
Twenty years ago it was widely believed that India was successfully on its way to controlling its alarming tuberculosis (TB) epidemic. Yet, each year, India has 2.2 million new cases, more than 300,000 deaths, and economic losses of $23bn (£14.9bn; €20.3bn) from TB, making it India's biggest health crisis.
At the heart of this crisis is the failure of India's Revised National Tuberculosis Control Program (RNTCP) to engage and monitor the country's large and unregulated private sector, argues Dr Udwadia.
He explains that patients with TB in India "typically flit between an unsympathetic public sector and an exploitative private sector until they are too sick or impoverished to do so, all the while continuing to transmit and spread tuberculosis in crowded home and work environments."
In December 2011, following reported cases of totally drug resistant TB, the RNTCP revisited its approach to TB control at the national and city level, which led to several policy initiatives.
But despite these positive developments, the general perception remains that India's TB programme has failed to control disease and to reach out to poor and marginalised people who need its help most, he argues.
"India needs to do much more if it seriously wants to control its TB epidemic," he warns. India must work at providing every TB patient with free and accurate diagnosis and the right treatment, whether in the public or the private sector. When TB is diagnosed, patients and their families must receive counselling, nutrition, and economic support.
And India desperately needs new drugs for the growing population of patients with more extreme forms of drug resistant TB, who have nearly exhausted the available first and second line drugs, he concludes.
In an accompanying Personal View article, Yogesh Jain, a public health physician and paediatrician says India should screen all tuberculosis patients for drug resistant disease at diagnosis.
He argues that inadequate screening for drug resistance, together with inappropriate treatment regimes, is fuelling the development of drug resistant tuberculosis (MDR TB). This is exacerbated by a political economy of poor resources for poor people, coupled with poor programme implementation, he adds.
He believes that India "should align its TB regimens with the latest guidelines to prevent the development of MDR TB." Most importantly, "we need an attitude that escapes the construct of scarcity and demands equitable and holistic solutions for people with TB," he concludes.
A second Personal View article calls for an end to stigmatizing language in tuberculosis research and practice.
TB Activists, Mike Frick, Dalene von Delft, and Blessina Kumar, say terms that invoke metaphors of transgression and punishment rather than of dignity and cure cause harm.
They argue that labels like "treatment defaulter" and "non-compliant" assign blame and mask the underlying structural reasons for interrupting or ceasing treatment.
They also point out that the social and economic impact of stigma can affect peoples' willingness to undergo tuberculosis screening and treatment - and has clouded the vision of research and programs.
"Changing community norms about tuberculosis is not easy, but a change in the language used by the scientific and medical communities is a necessary step in the right direction," they conclude.
INFORMATION:
Conscientious children are less likely to smoke in later life and the personality trait could help explain health inequalities, indicates a study published in the Journal of Epidemiology & Community Health.
It is well known that people belonging to lower socio-economic groups have lower life expectancy and more health problems than those who are in higher groups, and certain health behaviours, such as smoking, follow a similar pattern, suggesting they could be partly responsible for health inequalities.
Recently, certain personality traits have been found to be associated ...
At least 30 dogs in England have been killed in less than 18 months by an unknown disease which causes skin lesions and kidney failure, reveals research published in Veterinary Record.
The disease is believed to be Alabama rot (cutaneous and renal glomerular vasculopathy), a condition which has been seen in the USA in greyhounds for almost 30 years.
While there have been occasional reports of the disease in individual dogs outside of the USA, this is the first report of a series of cases occurring in England. None of the 30 dogs in this English series of cases were greyhounds ...
On May 19, 2014, the 67th World Health Assembly (WHA) adopted WHO's "Global strategy and targets for tuberculosis prevention, care and control after 2015". This post-2015 global tuberculosis strategy, labelled the End TB Strategy, was shaped during the past 2 years. A wide range of stakeholders--from ministries of health and national tuberculosis programmes to technical and scientific institutions, financial and development partners, civil society and health activists, non-governmental organisations, and the private sector--contributed to its development. The strategy has ...
Microbiological confirmation of childhood tuberculosis is rare because of the difficulty of collection of specimens, low sensitivity of smear microscopy, and poor access to culture. This study, led by Dr Anne Detjen, from the International Union Against Tuberculosis and Lung Disease, aimed to establish summary estimates for sensitivity and specificity of the Xpert MTB/RIF assay compared with microscopy in the diagnosis of pulmonary tuberculosis in children. The researchers found that compared with microscopy, Xpert offers better sensitivity for the diagnosis of pulmonary ...
1. Task Force finds insufficient evidence to recommend routine screening for thyroid dysfunction
The U.S. Preventive Services Task Force (USPSTF) concludes that the current evidence is insufficient to recommend for or against screening for thyroid dysfunction in nonpregnant, asymptomatic adults. The recommendations are published in Annals of Internal Medicine.
Thyroid gland disorders are among the most common endocrine conditions evaluated and treated by clinicians and may be asymptomatic. If left untreated, thyroid dysfunction could lead to fractures, cancer, or cardiovascular ...
Archaeologists working in Guatemala have unearthed new information about the Maya civilization's transition from a mobile, hunter-gatherer lifestyle to a sedentary way of life.
Led by University of Arizona archaeologists Takeshi Inomata and Daniela Triadan, the team's excavations of the ancient Maya lowlands site of Ceibal suggest that as the society transitioned from a heavy reliance on foraging to farming, mobile communities and settled groups co-existed and may have come together to collaborate on construction projects and participate in public ceremonies.
The findings, ...
CLEMSON, S.C. -- Researchers have long believed that supercomputers give universities a competitive edge in scientific research, but now they have some hard data showing it's true.
A Clemson University team found that universities with locally available supercomputers were more efficient in producing research in critical fields than universities that lacked supercomputers.
A supercomputer that can do 551 trillion calculations per second is housed at Clemson's Information Technology Center.
A supercomputer that can do 551 trillion calculations per second is housed at ...
DALLAS, March 23, 2015 -- Kids exposed to their parents' smoking may have a higher risk of developing heart disease in adulthood than those whose parents didn't smoke, according to research in the American Heart Association journal Circulation.
The study's results add to the growing evidence that exposure to smoking from parents has a lasting effect on children's cardiovascular health in adulthood.
Researchers tracked participants in the Cardiovascular Risk in Young Finns Study, which included childhood exposure to parental smoking in 1980 and 1983. They collected carotid ...
A blood test that measures the number of cells shed from prostate tumours into the bloodstream can act as an early warning sign that treatment is not working, a major new study shows.
Researchers showed that measuring the numbers of circulating tumour cells in the blood predicted which men were benefitting least from a prostate cancer drug after as little as 12 weeks of treatment.
They hope their work will allow doctors to switch patients to alternative treatments earlier than is currently possible, if these results are confirmed by further studies. The research could ...
Insulin resistance is a risk factor for developing both type 2 diabetes and cardiovascular disease. Almost one third of the U.S. population has some degree of insulin resistance, though it is undiagnosed in many of these individuals. Obesity is associated with reduced insulin sensitivity and the development of insulin resistance. However, recent large-scale genetic studies have indicated that insulin resistance is heritable. A new study in the Journal of Clinical Investigation identifies a gene that is strongly associated with the presence of many features of insulin resistance. ...
