Drug-resistant TB: Our Impact

 {Photo credit: Francis Hajong/MSH}Anika and her mother.Photo credit: Francis Hajong/MSH

Anika was a 22-month-old baby girl living in Belai Chandi Kuthipara in the northern part of Bangladesh when she became sick with fever, cough, and weight loss. She was admitted to the LAMB’s Missionary Hospital in Parbotipur, run by one of the many NGOs where the US Agency for International Development (USAID)-funded Challenge TB project, led by Management Sciences for health (MSH) in Bangladesh, is funding active tuberculosis (TB) case finding among high-risk groups such as children, people living with HIV, and diabetics.

{Photo credit: Loren Gomes/SIAPS}Photo credit: Loren Gomes/SIAPS

Curbing the spread of tuberculosis (TB) requires that patients have uninterrupted access to a full course of treatment—frequently a difficult task in developing country settings considering that each regimen includes multiple medicines taken over the span of several months. These may need to be customized based on the type of TB being treated and the patient’s reaction to the prescribed combination. The emergence of multidrug-resistant TB (MDRTB) and extensively drug-resistant TB (XDRTB) further complicates the management of TB medicines.

 {Photo credit: MSH staff}Mariam Nangobi receives treatment for multidrug-resistant TB (MDR TB) at an MSH-supported health facility in eastern Uganda.Photo credit: MSH staff

Mariam Nangobi was first diagnosed with tuberculosis (TB) in 2010 when she was 12 years old. After completing a full, eight-month course of treatment, she still tested positive for the disease. She was referred to a larger health facility where she stayed for two months, receiving daily injections. Again, after treatment, she continued to test positive for TB and missed a year of school. Health workers eventually diagnosed her with multidrug-resistant TB (MDR TB) -- a strain of TB that cannot be treated with the two most powerful first-line medicines.

 {Photo credit: Berhan Teklehaimanot/MSH}HEAL TB has trained 471 district TB focal persons on identification and management of TB in children in the Amhara and Oromia regions of Ethiopia.Photo credit: Berhan Teklehaimanot/MSH

The World Health Organization (WHO) estimates that up to 80,000 children die from tuberculosis (TB) each year and that children account for over half a million new cases annually. Unfortunately, global figures likely underestimate the burden of childhood TB worldwide due to missed diagnosis, causing TB in children to be a ‘’hidden epidemic.”

 {Photo credit:  Diana Sharone Tumuhairwe} MDR-TB patients receiving continuous health education at Lira hospital.Photo credit: Diana Sharone Tumuhairwe

Although the incidence of tuberculosis (TB) in Uganda is declining, multidrug resistant TB (MDR-TB), a strain of TB that cannot be treated with the two most powerful first-line medicines, is a growing concern. This is especially true in Uganda’s Lira district, a commercial hub in the Northern region.

 {Photo credit: MSH}Tshoeu, skeptical at first, now encourages others to access health care.Photo credit: MSH

The role of community leaders in the response to tuberculosis (TB) in South Africa cannot be overrated. Approximately 500,000 of the country’s residents acquire active TB every year. South Africa also faces treatment adherence challenges, partially due to the stigma associated with TB in communities: nearly one in five patients with multiple‐drug resistant TB do not complete their course of medication.

The online research section of the Bulletin of the World Health Organization (WHO) published the results of a cross-sectional survey aiming to document the prevalence of multidrug resistance among people newly diagnosed with, and those retreated for, tuberculosis (TB) in Malawi.

 {Photo credit: Giang Hoai Nguyen/MSH, Vietnam.}TB CARE I conducts on-site training to teach laboratory staff at Hanoi Lung Hospital how to safely package TB samples before shipping them to the national laboratory.Photo credit: Giang Hoai Nguyen/MSH, Vietnam.

Vietnam is one of 27 countries with the highest burden of multi-drug resistant tuberculosis (MDR-TB), a form of TB that is hard to treat and cannot be cured by at least two of the primary treatment drugs. Unfortunately, the country has just two national laboratories equipped for MDR-TB diagnosis. Until recently, health facility staff had to deliver patient specimens to the laboratories themselves—often requiring laboratory technicians to travel long distances over poor roads.

Homa Bay TB team, MSF, and SIAPS collaboration. (Photo credit: MSH)Successful treatment of tuberculosis (TB) is one of the key indicators of a TB Control Program’s performance and essential to containing the emergence of anti-TB drug resistance. Multi-drug resistant TB (MDR-TB) treatment requires medicines that are expensive, involve longer treatment regimens, are toxic, and can cause patients to have severe side effects.

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