HEALTH-JAMAICA: TB Care on Target Despite Challenges-Officials

By Zadie Neufville Reprint | | Print |

Zadie Neufville

KINGSTON, Mar 27 2002 (IPS) - The World Health Organisation (WHO) says lack of money is endangering a commitment to cut the rate of tuberculosis in the Third World, but Jamaican health authorities say the disease is under control here.

Tuberculosis (TB), a contagious and possibly fatal disease has been making a comeback world-wide, driven by increasing rates of HIV/AIDS. But Jamaican officials say doctors can cure those infected if they are diagnosed early.

Good hygiene, detection and monitoring and a high level of immunisation has kept Jamaica’s infection rates constant over the past 15 years, says the island’s TB co-ordinator in the ministry of health, Sydney Erwing.

TB affects mainly the lung but can attack other parts of the body including the brain, joints and kidneys. It is spread in the air, by coughing, sneezing, or laughing, among other ways.

According to Erwing, about 114 Jamaicans fall ill with the disease every year, and 80 per cent are cured, despite heavy caseloads, mis-information on the part of infected people and the failure of some patients to take their medication. Less than 10 per cent of those who get the disease in Jamaica die.

But there is concern that increased tourist traffic and the continued presence and resurgence of TB among people with HIV/AIDS in countries like the United States and South Africa could become a problem here.

TB rates among HIV/AIDS patients in Jamaica fluctuates between 4 and 12 per cent but officials say effective monitoring will ensure that the disease remain under control, even among high risk groups.

The United Nations Millennium Summit in September 2000 committed to cut TB mortality by half in 10 years. The disease kills more that two million people world-wide each year and infects another eight million.

The World Health Assembly has adopted global TB control goals for 2005 that include detecting 70 percent of infectious cases and successfully treating at least 85 percent of them. But the Geneva-based WHO reports that the programme needs 300 million U.S. dollars if targets are to be reached. If current trends continue, TB targets set for 2005 will not be reached until 2013, it says.

The WHO estimates that a person with TB will lose 20 to 30 percent of his or her annual income, and that the families where TB has caused a death “lose an average of 15 years of earnings”.

The organisation’s new treatment strategy DOTS, a strategy of brief treatment under direct observation, is used by developed nations and is proven to cure most people with TB. But with cost of drugs ranging between 10 and 15 dollars per patient, it is proving prohibitive for many developing countries.

DOTS was officially launched in Jamaica last year in an effort to further reduce the number of TB cases and achieve the 70 per cent detection and 85 per cent cure rate by the 2005 target date.

Local authorities say Jamaica’s rate of detection and 80 per cent cure rate is above the regional average of about 70 per cent, an average that jeopardises the Pan American Health Organisation (PAHO) commitment to push recovery rates to 85 per cent in the region.

According to PAHO, tuberculosis continues to be a serious health problem in Latin America and the Caribbean region with some 250,000 cases and nearly 20,000 deaths annually. The highest rates are in the poorest countries and are linked to poverty and an increase in the rates of HIV/AIDS among the poor.

While infection rates are in single figures in most of the smaller countries like Barbados and the Bahamas, Guyana has recorded an average of 347 infections since 1994 and Haiti an average of 8,712 infections since 1996.

TB affects mainly those who have poor nutrition, live in over crowded conditions or those with medical conditions that lower the body’s immune system. Also at risk are alcoholic or drug abusers and people working in long-term care facilities like prisons and nursing homes.

Men are also twice as likely to get the disease than women, possibly because of their lifestyles.

Director of PAHO George Alleyne, says TB is a serious public health challenge, not only because of its perennial toll of death and disease, but also because of its clear linkage with poverty. The disease, he says “threatens aspirations of equity and health for all”.

PAHO will focus its fight against TB on the DOTS strategy, adds Alleyne.