#HowtoStopTB

Mildred shares her story of surviving XDR-TB at an event honoring "TB Champions" in DC; Ambassador Goosby listens. {Photo: E. Delmotte/MSH.}Photo: E. Delmotte/MSH.

Mildred Fernando lives and works in the Philippines for the USAID-funded, MSH-led, Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program. Mildred spoke at several World TB Day events in Washington, DC, including at a senate briefing and an event honoring TB survivors and advocates (watch video). The interview below first appeared on the SIAPS blog.

It all began in November 2001 for Mildred Fernando when she was diagnosed with tuberculosis (TB), a preventable and curable disease which caused the death of 1.4 million people in 2011. She was only 19 years old, working on completing her last semester in college when she contracted TB from her father who sadly succumbed to it two years later.

 {Photo credit: Stephen Macharia/MSH.}Santo (right) and his father (left) share how Santo was finally diagnosed and treated for TB after being incorrectly treated for malaria for over two months.Photo credit: Stephen Macharia/MSH.

After South Sudan gained independence from Sudan in 2011, disagreements over oil-sharing between the two nations caused fighting and high economic inflation in certain regions. Desperate for security, over 110,000 Sudanese refugees escaped to South Sudan and now reside in camps in Maban County.

Bounj Hospital: Diagnosing and treating residents and refugees

These refugees, and the county’s 40,000 residents, are served by Bounj Hospital, the only TB diagnostic and treatment center in the district. This hospital is currently treating 75 patients for TB, 56 of whom are refugees.

The USAID-funded TB CARE I South Sudan project is helping to build the hospital staff’s capacity in TB treatment and infection control, despite the challenges the health workers face. Led by Management Sciences of Health in partnership with the National TB Program (NTP), the TB CARE I project team has trained over 200 health workers in TB diagnosis and treatment.

TB CARE I also teaches the health workers how to educate their patients about TB infection control and provides the trainees with regular supportive supervision and mentorship.

Mukabaha Ntakwigere (at right) at the General Reference Hospital in Nyangezi, DRC. {Photo credit: MSH staff.}Photo credit: MSH staff.

Tuberculosis (TB) is a leading cause of death in Democratic Republic of the Congo (DRC), partly due to a low case detection rate within the health system, compounded by little knowledge or awareness among patients of the disease’s symptoms. In the province of Sud Kivu, where people have relied on traditional healers for generations, those who were suffering from the persistent, painful coughing that is one symptom of TB were advised by traditional healers that they had been poisoned, and they were not referred to health centers.

In Sud Kivu province, in the health zone of Nyangezi, with a population of roughly 129,000 people, case detection was below 12%, which is the minimum "acceptable" threshold for TB detection.

Medical professionals in Nyangezi realized that they were never going to identify and treat those suffering from TB until they could educate the community about the symptoms and the treatment methods.

Patients wait in a well-ventilated area outside the TB clinic in Homa Bay, Kenya. {Photo credit: A. Kwiecien and A. Salakaia / MSH.}Photo credit: A. Kwiecien and A. Salakaia / MSH.

The state of tuberculosis (TB) is in a tug-of-war as current challenges threaten to undo past successes. One of the primary hurdles currently facing TB prevention and cure is the emergence of strains that are resistant to at least two of the most effective medicines (rifampicin and isoniazid).

So-called drug-resistant (DR)-TB arises when patients are unable to complete a full-course of appropriate, high quality anti-TB medicines. As compared with the 6 month treatment regimen for drug-sensitive (DS)-TB, DR-TB requires 18-24 months of treatment with medicines that are less effective, can cause sometimes severe side effects, and can cost up to 300 times more.

Grace Tsawe owns a prayer camp in Ghana's Lower Manya Krobo District. She recovered from TB, and uses her experience to encourage others to be tested and treated medically for TB. {Photo credit: B. Adusei/MSH.}Photo credit: B. Adusei/MSH.

Tuberculosis (TB) control in Ghana is challenging: detection of TB cases is low, and TB mortality rates high. In many communities, like Lower Manya Krobo District, these challenges are compounded by the popular belief that TB is a spiritual disease. Many Ghanaians who contract TB seek healing in prayer camps and shrines, rather than going to health facilities for testing and treatment. By the time these patients seek medical care, it often is too late to recover and avert death.

Lower Manya Krobo District has over 93,000 residents, and a high incidence of TB (209 cases per 100,000 people in 2011). The district is also home to many of the nation’s mushrooming prayer camps, where local healers provide daily services for ill residents. There are 50 prayer camps in Lower Manya Krobo District---and only 18 health facilities.

Grace Tsawe owns a prayer camp in this district, and she usually sees over 100 patients on her main clinic day.

{Photo credit: Katy Doyle / MSH.}Photo credit: Katy Doyle / MSH.

Stop TB in my lifetime.

This global call to action---the Stop TB Partnership's theme for March 24, World TB Day 2013---is as relevant now as it was over a hundred years ago.

Progress toward reducing the global burden of tuberculosis (TB) has been impressive in recent years: TB mortality has fallen by 41 percent since 1990.

Yet, TB remains one of the world’s leading causes of death, killing more than 1.4 million people per year, including 70,000 children. In 2011, 600,000 people died of TB in Africa alone---including many people with HIV.

Low detection rates, new strains of multidrug resistant TB (MDR-TB), high prevalence of HIV/TB co-infection, and risk of TB among diabetes patients---nearly 10 percent of TB cases are linked to diabetes, add to the challenge of TB control, especially among the poor and most vulnerable.

World TB Day celebration in Ghana (2012). {Photo credit: MSH.}Photo credit: MSH.

Sunday, March 24, 2013, is World TB Day, and MSH staff and partners are promoting global efforts to stop TB throughout the week.

Here are highlights from some of our activities around the world:

The Afghanistan TB CARE I team is working with the national TB program (NTP) to conduct celebration events at 290 health facilities and communities in 13 USAID-supported provinces. TB messages will be aired through local telephone companies to approximately one million people throughout the nation. TB CARE I is also identifying and publicly rewarding high-performing health workers.

The Bangladesh SIAPS TB team will participate in a national rally on March 24 with all TB partners and stakeholders within the NTP network, as well as in a press conference, workshop, and scientific session.

 {Photo Credit: Abel Helebo/MSH.}Silenat with her three-year-old child, her husband Yirga, and Tadele, a TB focal person at the Keraniyo Health Center.Photo Credit: Abel Helebo/MSH.

Silenat Yihune, a 40-year-old woman, mother, and housewife, lives in a remote region of Huletejuenesie District, Ethiopia, which is approximately 20 kilometers from the closest health facility. For nine months Silenat suffered from a cough, chest pain, fever, and weight loss, but was unable to receive treatment. As is common among Ethiopian families, Silenat was economically dependent upon her husband. He refused to pay for her travel to the distant health facility. Several months later, Silenat’s husband, Yirga, started to show similar symptoms and visited the Keraniyo Health Center, where he was diagnosed with tuberculosis (TB).

Keraniyo Health Center is one of the health facilities in Huletejunesie district supported by the PEPFAR-funded, USAID project, Help Ethiopia Address Low TB Performance (HEAL TB), led by Management Sciences for Health (MSH).

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