CNS: February 2012

Polio eradication has a lesson for TB control

A week back the door bell rang and two ladies stood with vaccine boxes at my doorstep asking if there were children five years and below in the house as they wanted to give polio drops. Hearing a 'no' from me they went to the next door and then continued knocking on doors. India just completed a year without a single case of Polio and this is a great achievement indeed. World over India's Polio control is being quoted as a huge success story and rightly so.

TB has been with us since times immemorial. In ancient India it was called Rajrog or the King’s Disease. A benevolent king would dole out gold coins to the poor, which raised their economic status, leading to improvement in their nutritional standards. This lead to a decrease in the number of new infections of TB, and better recovery of those already infected. If he was uncaring towards his people, the undernourished poor would find it difficult to avoid the curse of TB and inadvertently become victims of it. So, rightly or wrongly, it was thought that the king controlled the disease. However, one thing is crystal clear—it has always been an accepted fact that an undernourished body is an open invitation to the germs of tuberculosis, as well as other diseases.

Children are innocent victims of tuberculosis (which in Hindi is called Kshaya Rog—a disease which wastes away the body). According to the WHO over 250,000 children fall prey to the disease and 100,000 of them die every year from TB, for no fault of theirs. They can only blame their infected parents and elders, who inadvertently pass on the germs of TB to them. Adults infected with TB become potential transmitters of the disease to children. It is a one way transmission of the disease from adults to children, as children with TB usually do not infect the adults.

(CLICK HERE TO COMMENT!)
The theme II of the time-limited online consultation on childhood tuberculosis (TB) in lead up to the World TB Day is: "Getting to zero TB deaths in children by 2015." Have your say before 11th March 2012 - share with us - how to correctly diagnose and treat TB in children and achieve 'zero TB deaths' in children by 2015, in your local settings. Your perspectives, opinions and voices are important for us and we do look forward to them.

A SUMMARY REPORT on preventing tuberculosis (TB) in children was released by Citizen News Service (CNS, www.citizen-news.org) and other partners who are conducting online consultation and key informant interviews on childhood TB in lead up to the World TB Day (24 March). The theme of World TB Day 2012 is childhood TB. This summary report is based upon online consultations and key informant interviews with noted experts and more importantly – parents and guardians of children with TB.

The SUMMARY REPORT has been released on 26th February 2012 of theme 1 online consultation on childhood tuberculosis (TB) in lead up to the World TB Day on: "Getting to zero new TB infections in children by 2015." The summary report can be downloaded or read online here.

Whither Our Human Morality?

It was a sad day indeed when the additional solicitor general (ASG) Mr Malhotra, recently came out strongly against homosexuality, while arguing on behalf of the Ministry of Home affairs, in the Supreme Court hearing challenging the Delhi High Court order of 2009 decriminalising consensual sex among gay adults. He junked homosexuality as immoral saying that it is against the order of nature and spreads HIV. He was of the view that, "Laws can't run separately from society and the morals of the time."

Dr Muherman Harun (Indonesia) raises key challenges related to diagnosing TB in children

The Citizen News Service (CNS) is conducting an online consultation on childhood tuberculosis (TB) in lead up to the 2012 World TB Day. I will like to share our views on the ‘essentials’ of the diagnosis of TB in Children. The main means of diagnosing TB in children is undoubtedly, chest X-ray.

A regional consultation, organized jointly by South Asian Association for Regional Co-operation in Law (SAARCLAW), UNAIDS Technical Support Facility for South Asia (TSF-SA) and Maitri, was held recently in New Delhi. It was part of the UNDP funded project ‘Support to the development of enabling environment by scanning of laws that impede effective HIV and AIDS responses in India,’ which aims to develop a comprehensive study on the issue, informed by engagement with the affected communities and other stakeholders during the consultations.

The South Asian Association for Regional Cooperation in Law (SAARCLAW), UNAIDS Technical Support Facility for South Asia (TSF-SA) and Maitri, together hosted a one day meeting on Thursday, 16 February 2012 in New Delhi, to discuss strategies for overcoming legal barriers to HIV prevention and treatment efforts. This meeting was one of the four regional consultations being held as part of the UNDP funded project ‘Support to the development of enabling environment by scanning of laws that impede effective HIV and AIDS responses in India.’

Will improving efficiency and efficacy of TB control programmes within the healthcare facilities help the world meet the 2015 TB-related targets set by the Millennium Development Goals, the Global Plan to Stop TB, and the country programmes, or do we need a paradigm shift in the basic principles we do TB control upon? Experts have repeatedly emphasized that unless we control adulthood TB, children will continue to get TB. And unless we the change the way we do TB control, adulthood TB is unlikely to be controlled. The TB programme is still very medical despite advocacy, investment and the gold standard Patients' Charter for TB Care - which is sadly not implemented to the extent it should have been by the countries.

Hara Mihalea, PATH

(Written by Hara Mihalea, PATH)

I like to start by sharing a real story which I experienced in one of my visits in the field last year. I'm sure many of you working in the field have similar stories to tell. During a monitoring visit for our PPM program I came across a referral slip made out by a pharmacy staff referring a 36 year old woman to the DOTS health center. Looking at the symptoms circled on the slip one could tell that this was certainly a pulmonary TB case; weight loss, fatigue, chest pain, fever, and cough with blood. We traced the referral to one of the district health centers where we found out that the woman had indeed gone for further evaluation, she was checked, diagnosed, given medication and sent home.

(CLICK HERE TO COMMENT!)
The theme 1 of the time-limited online consultation on childhood tuberculosis (TB) in lead up to the World TB Day is: "Getting to zero new TB infections in children by 2015." Have your say before 25th February 2012 - share with us what should be done more (or less of) to prevent new TB infections in children in your local settings. Your perspectives, opinions, voices are important for us and we do look forward to them.

CNS Podcasts: The Gender Agenda - Making HIV Responses Work for Key Affected Women and Girls

Thai version:

English version:

Do not trade away human lives in the "European Union-India Free Trade Agreement"

As India and the European Union meet for a Summit in Delhi on 10th February 2012, to iron out the differences over a Free Trade Agreement (FTA), more than 2,000 people living with HIV will march alongside farmers and traders, from Mandi House to Jantar Mantar in New Delhi, in protest against the EU-India FTA, which will negatively impact access to affordable medicines produced in India, for millions living in the developing world, and on livelihood and the right to food in India.

Women In The Forefront Of The Fight Against HIV/AIDS

The United Nations Economic and Social Commission for Asia and the Pacific (UN-ESCAP) Inter governmental meeting on HIV/AIDS and Millennium Development Goals was held in Bangkok from 6th to 8th February, 2012. During the meeting, an event “The Gender Agenda: Making HIV Responses Work for Key Affected Women and Girls”, focusing on the female face of HIV was also held, during which women delegates spoke on the challenges and gaps in the existing programmes.

HAVE YOUR SAY by joining the online consultation. Send an email to:
stop-tb-subscribe@yahoogroups.com

The Citizen News Service (CNS), a partner of the Stop TB Partnership, is facilitating a time-limited online consultation in lead up to the World TB Day, on issues around childhood TB.

"It would have been an honour to receive Basava award in the name of revolutionary saint poet, philosopher Shri Basaveshwara of 12th century who promoted social change, reform and communal harmony. However, collective opinion of movements I am associated with suggests that Karnataka Government has not been able to deal with the mining scam and other scandals" said Medha Patkar, one of the most respected social activists in India. Medha leads the National Alliance of People's Movements (NAPM).

(Based on an interview given to CNS by Dr Soumya Swaminathan, at Chennai ART Symposium, 2012)

A significant proportion - about 15% to 20% - of all tuberculosis (TB) occurs in children in India, where paediatric TB is a serious, but under-recognized and neglected public health problem. "The reason is that, unlike in adults, children get forms of TB that are not infectious. Therefore less public health priority and importance is given to it. TB spreads through the air borne route. So children get it from adults through cough etc. The most important risk factors in children are malnutrition, poverty, environmental pollution, poor housing, overcrowding, indoor air pollution, passive smoking, and to a much smaller extent HIV infection also" said Dr Soumya Swaminathan, National Institute for Research in Tuberculosis, Chennai.

The United Nations Economic and Social Commission for Asia and the Pacific (UN-ESCAP) Inter governmental meeting on HIV/AIDS and Millennium Development Goals is being held in Bangkok from 6th to 8th February, 2012. During the meeting, a side event “The Gender Agenda: Making HIV Responses Work for Key Affected Women and Girls” will be held on 7th February, by the Inter Agency Task Team on Gender and HIV/AIDS. At this event, a briefing paper, published by Asia Pacific Coalition of AIDS Service Organizations (APCASO) in collaboration with the Asia Pacific Alliance for Sexual and Reproductive Health and Rights (APA), will be distributed. The paper titled “Women and Girls: The 2011 Political Declaration on HIV/AIDS, Civil Society Perspectives on the 2011 HIV/AIDS High Level Meeting” looks at the 2011 Political Declaration made at the United Nations General Assembly High Level Meeting (HLM) on HIV/AIDS held in New York in 2011, and it is important here to reiterate its significant points.

[हिंदी] How gender based discrimination impacts lives of men and women on daily basis and how unethical and misleading corporate marketing of products such as tobacco, alcohol, fast food, among others, is influencing and changing lifestyles of young people which puts them at heightened risk of biggest killer diseases in India, were the issues discussed at Sherwood College of Engineering, Research and Technology, Faizabad Road, Barabanki to mark World Cancer Day.

Minister of State for Trade and Development, Joe Costello TD addressed the delegates of the Irish Forum for Global Health Conference in the Royal College of Surgeons in Ireland (RCSI). The two day international conference addresses one of the greatest challenges facing global health - the critical shortage of skilled health personnel, especially in poorer countries and populations and in remote areas of the world.

Ireland is, in percentage terms, among the biggest recruiters of foreign trained nurses and doctors among OECD countries. According to Professor Brugha of Royal College of Surgeons of Ireland (RCSI), at the Irish Forum for Global Health's Conference on the Global Health Workforce, by 2008 a two-fold higher percentage of foreign trained nurses were registered in Ireland compared to the OECD country ranked second. While ranked second in 2008 for recruiting foreign trained doctors, the rapid upward trend between 2000 and 2010, along with Ireland's recent recruitment drive in India and Pakistan, mean that Ireland is likely to now rank first for recruiting foreign-trained doctors.

The Irish Forum for Global Health's (IFGH) two days conference, which opened in Dublin on 2nd February, 2012, focuses on the theme of the Global Health Workforce Crisis, recognising that one of the greatest challenges facing global health today is the critical shortage of skilled health personnel, especially in remote areas of the world. Its aim is to synthesise, build upon and propose further actions on how to train, retain and get maximum benefits from a motivated workforce.

According to new research from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, more than 1.2 million people died from malaria worldwide in 2010. Malaria is killing more people worldwide than previously thought, but the number of deaths has fallen rapidly as efforts to combat the disease have ramped up. IHME researchers say that perhaps deaths from malaria have been missed by previous studies because of the assumption that the disease mainly kills children below 5 years of age. IHME found that more than 78,000 children aged 5 to 14 years, and more than 445,000 people above the age of 15 years died from malaria in 2010, thereby suggesting that 37% of all malaria deaths were in people aged 15 years and older. 37,000 deaths occurred in India alone of persons above 15 years of age. However, the chances of someone dying from malaria in India have fallen rapidly since 1980.

The clinical course and opportunistic infections of HIV vary from patient to patient and country to country. In India TB is a major opportunistic infection in people living with HIV (PLHIV), with over 35% PLHIV co-infected with TB-HIV. There is an estimated 3.52% faster progression to death if a PLHIV suffers from TB also. Even today in India, two deaths occur every three minutes from TB. Major challenges to control TB in India include poor primary health-care infrastructure especially in rural areas; unregulated private health care leading to widespread irrational use of first-line and second-line anti-TB drugs, poverty, social stigma and lack of political will.

Aeras, a Rockville, Md.-based non profit organization focused on developing vaccines and other products to prevent TB, announced on January 31, 2012 that the National Institute of Allergy and Infectious Diseases (NIAID), part of the United States National Institutes of Health (NIH), has joined as a partner for a Phase II proof-of-concept clinical trial testing the safety and effectiveness of an investigational booster TB vaccine candidate jointly developed by Aeras, and Dutch biopharmaceutical company Crucell.

The YRG Centre for AIDS Research and Education, Chennai, recently organized with partners the Chennai ART Symposium (CART 2012), and The International Science Symposium on HIV and Infectious Diseases, to deliberate upon a wide range of aspects related to HIV infection and provide latest clinical updates on the management of the disease, which has been plaguing the Indian populace for over 25 years.