HEALTH: Tuberculosis Not Beaten Yet

By Gustavo Capdevila Reprint | | Print |

Gustavo Capdevila

GENEVA, Feb 17 1998 (IPS) - Tuberculosis, which appeared to be beaten, has killed more people this year than in any other year in history.

Concerned by this perspective, the World Health Organisation (WHO) launched a warning to the international community Tuesday for them to apply the new therapies against the modern epidemic with greater rigour.

The current expansion of the illness echoes the spread of the human immunodeficiency virus (HIV) which causes AIDS, errors in tuberculosis treatment rendering the disease incurable and the increase in population movement.

The world map of tuberculosis shows new outbreaks in Eastern Europe, where deaths from the illness have started to rise again after nearly 40 years of falling figures, reaching 250,000 cases per year.

But the greatest number of cases are found in Southeast Asia, where there are three million. Meanwhile, in Subsaharan Africa, there are two million new cases each year.

Of all the infectious diseases, tuberculosis is at present the most lethal for children and adults alike. It’s death toll of between two and three million people per year mean it outranks AIDS and malaria together.

The WHO stressed that at present, more women die each year from tuberculosis than from all other causes of maternal mortality. The illness has taken the lives of 100,000 children in the same period.

HIV takes a third of the blame for rising tuberculosis rates in the last five years. It is estimated that by the year 2000 around 15 percent of tuberculosis cases will be due to the AIDS virus.

Tuberculosis is the main cause of death amongst HIV positive patients world-wide, killing a third of all HIV sufferers.

In Africa, 40 percent of AIDS deaths occur as a result of tuberculosis. The percentage is similar in Asia.

Out of some 31 million HIV positive people registered in 1997, around a third were infected with tuberculosis.

The outlook for medical treatment of tuberculosis improved fifty years ago with the appearance of drugs which could cure it. But in recent years varieties have emerged which are resistent to one type of medicine or a combination of drugs.

The WHO estimated that at present some 50 million people are at risk of infection with the drug-resistent strains, especially those immune to isoniazid and rifamicin – the main anti- tuberculosis drugs.

The multidrug-resistant (MDR) strains have arisen following the application of irregular or partial treatments, when the patients do not take their medicines regularly once they begin to feel better.

This also occurs when the doctors or their assistants prescribe the wrong medicines or when the supplies fail.

The WHO stated that incomplete or badly supervised anti- tuberculosis treatment is worse, from the healthcare point of view, than a total lack of treatment.

Patients who do not complete the treatment or who receive the wrong medicines remain infected. The bacilli in their lungs become resistent to the antituberculosis drugs.

MDR tuberculosis is more difficult and expensive to treat and there is a great possibility the disease will prove fatal.

The tuberculosis treatment costs some 2,000 dollars per patient in the industrialised countries. But when this is a resistent strain, the cost increases to 250,000 dollars per patient.

The WHO also blamed the spread of tuberculosis on the increasing mobility of the world’s population. Since 1960, international trade has increased sixfold and the number of people travelling by air, 17 times.

In many industrialised countries, said the WHO, at least half the tuberculosis cases appear in people born abroad. In the United States, this is so in a third of all cases.

Untreated tuberculosis is also spreading rapidly in the refugee camps, and around half the refugees world-wide could be infected with the disease, the organisation added.

In 1995, nearly 30 percent of the homeless of San Francisco, the United States, were found to have tuberculosis. This index stood at 25 percent for the same sector in London.

The WHO stressed the recommended way to cure tuberculosis is the Directly Observed Treatment, Short-course (DOTS) method.

This therapy includes a political health commitment, the offer of microscope services, the supply of drugs, monitoring systems and direct observation of the treatment.

The DOTS system cures more than 95 percent of patients, even in the poorest countries. The therapy prevents new infections from appearing and works against the emergence of the MDR-TB strain.

Drugs are supplied to a patient over a six month period, at a cost of only 11 dollars.

Hence, the World Bank classed DOTS as one of the “most cost- effective of all health interventions.”