Tuberculosis: Our Impact

 {Photo credit: MSH staff}Kasifa Mugala, 34, started feeling ill while she was pregnant, and started ART after referral for prevention of mother-to-child transmission of HIV. “I am very happy. I gave birth to a healthy baby who is now turning one year old,” she said. “I did not know that I would ever be fine. I am grateful to our village health team.”Photo credit: MSH staff

Esther Nyende, 45, is a member of her village health team and a community leader in Uganda’s eastern Pallisa District. Nyende alone has referred 20 clients who are now receiving antiretroviral therapy (ART).

{Photo Credit: MSH Staff}Photo Credit: MSH Staff

Management Sciences for Health has been working closely in collaboration with the Global Alliance for TB Drug Development (TB Alliance) on the introduction of the new dispersible pediatric fixed-dose combination. Through MSH’s projects across identified high-burden countries, we have been providing assistance on updating treatment guidelines and essential medicines lists, registration of the reformulated product, financing and reprogramming grants, quantification, and training healthcare providers on the medicine and its use. 

 {Photo: HEAL TB Ethiopia}Aster Gemede and her daughter, Lemlem, at a TB clinic in Borena.Photo: HEAL TB Ethiopia

Aster Gemede lost her husband to tuberculosis (TB) meningitis early in 2012. Struck with grief, Gemede did not notice her own deteriorating health in the months after his death. Cough, fever, chest pain, and loss of appetite became part of her everyday life. She hardly noticed she was losing weight. When Gemede got to the point where she was unable to look after her two children, she was forced to walk eight hours from her home in rural Borena zone, Oromia, Ethiopia, to the nearest health facility.  

 {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: Tadeo Atuhura/MSH}Flora Mugisa receives incentives (porridge and milk) from the hospital team during a home visit.Photo credit: Tadeo Atuhura/MSH

As is the norm in the extended family support system in Uganda, Flora Mugisa helped care for her sister who was suffering from multidrug-resistant tuberculosis (MDR-TB). A year later, Flora also fell sick. She lost her appetite, grew thin, and complained of a heavy chest with severe pain. “I could not sleep at all,” said Mugisa, 70. “I would cough throughout the night. My grandson knew that I would die anytime.”

 {Photo: MSH staff}Nimeri and his family relocated to Yei when war broke out in Juba. Nimeri was in his sixth month of TB treatment.Photo: MSH staff

Ripenti Nimeri Yotma is a 40-year-old soldier who has lived through war and being displaced. But it was a battle with Tuberculosis (TB) that almost killed him. The father of three children (aged 14, 4, and one and a half), Nimeri presently lives in Logobero Village, Yei Boma. However, his illness started in April 2013 while he was still living in Juba. When his persistent cough eventually led to him coughing up blood-stained mucus, Nimeri’s wife took him to the nearest health center in Juba City, where he was examined.

{Photo credit: MSH staff}Photo credit: MSH staff

Kabul is the largest city in Afghanistan, with a population of over 3 million people. The population density leads to overcrowding and strains health systems and infrastructure. In a country with a high tuberculosis (TB) burden, TB service delivery has been a particular challenge. In 2009, only 22 of the 106 existing public and private health facilities in Kabul provided partial TB services. TB case detection was only 26 percent, and the treatment success rate was 49 percent. All TB indicators for the city consistently fell below national targets.

{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: Diana Tumuhairwe/MSH}Musingire Annania (right) has successfully battled TB with the help of Paul Sebale (left), his community linkage facilitator.Photo credit: Diana Tumuhairwe/MSH

This is the story of Musingire Anania, a 45-year-old, small-scale laundromat owner from the slums of Mulago in Kampala District, Uganda, who has successfully battled tuberculosis (TB) through the dedicated efforts of his community linkage facilitator, Mr. Paul Sebale, and an example of how community linkages can help a TB patient at the brink of death to start and complete treatment and be fully cured.

 {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.

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