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WORLD HEALTH DAY-SOUTH AFRICA: An Outbreak Kept From Breaking Out

Moyiga Nduru

JOHANNESBURG, Apr 6 2007 (IPS) - South Africa seems to have succeeded in preventing an outbreak of Extreme Drug Resistant Tuberculosis (XDR-TB) from spiralling out of control and spreading beyond its borders, at least for now.

XDR-TB is a more serious form of Multidrug Resistant TB (MDR-TB). While various strains of MDR-TB can resist treatment by certain “first-line drugs” – drugs used as the first line of defence against the disease – XDR-TB is also resistant to various second-line drugs.

The outbreak took place last year in the south-eastern KwaZulu-Natal province.

“Of the 54 people infected with the new strain, 53 died,” Lihle Dlamini, coordinator in KwaZulu Natal for the Treatment Action Campaign (TAC), told IPS. The TAC is a pressure group based in the coastal city of Cape Town that seeks access to treatment for people living with HIV/AIDS.

Persons who have contracted the HI virus are particularly vulnerable to TB, while XDR-TB can prove deadly. According to the Joint United Nations Programme on HIV/AIDS (UNAIDS), adult HIV prevalence in South Africa is put at 18.8 percent.

On the eve of World Health Day (Apr. 7), these developments are significant. The theme for this year’s day is “Invest in health, build a safer future”. It was chosen to highlight the fact that health threats increasingly stretch across borders, and that global co-operation is needed to counter them.

Had XDR-TB gained a hold beyond KwaZulu-Natal, it would have posed a threat not only to South Africa, but the region as a whole – considered the epicentre of the global AIDS pandemic. UNAIDS estimates indicate that one in three people who have contracted HIV lives in Southern Africa.

“In an age of widespread global trade and travel, new and existing diseases can cross national borders and threaten our collective security,” writes Margaret Chan, director-general of the World Health Organisation (WHO), in her message for World Health Day 2007.

“Only through strong collaboration among developed and developing countries, together with an increased focus on information sharing and the strengthening of public health systems and surveillance, can we contain their spread.”

In South Africa, an XDR-TB epidemic would also have proved very costly, no small matter in a country where there are many needs to be addressed.

“Government spends at least 400 rand (about 55 dollars) per patient for treating ordinary TB. For multidrug resistant TB, the cost of treatment dramatically increases to 24,000 rand (3,288 dollars) per patient” Jeff Radebe, acting health minister, said in a speech on World Tuberculosis Day, Mar. 24.

“In addition to the resources available in provinces, we have allocated an extra 3.6 million rand (about 494 million dollars) to complement infection control renovation projects that are underway in various provinces,” he added.

Efforts to step up the fight against TB are focussed on a variety of areas.

“Infection control measures are aimed at reducing direct or indirect contact transmission by isolating patients, creating adequate bed floor space and improving ventilation in wards,” Radebe noted.

“These hospitals are being fitted with extractor fans and ultraviolet light filters which remove and kill the bacteria circulating in the air, thereby preventing cross infection in health facilities. For extra protection, respirator masks are given to health workers, and visitors in the hospital and patients are provided with surgical masks,” he added.

“Drug-resistant TB units are also being improved countrywide to deal with infection control.”

Several factors cause TB to develop resistance to drugs, including patients’ failure to complete courses of TB medication. Incorrect prescription of drugs and the use of poor quality drugs are also to blame.

Much remains to be done in the fight against the various strains of TB, such as tackling traditions that undermine effective treatment.

“For cultural reasons and stigma attached to the disease, some TB patients prefer to go to the witchdoctor first. And when they are too sick they come to the hospital,” said Dlamini. “By then, they are already too weak and some of them can’t even walk.”

XDR-TB also remains a threat.

“Even now we have 200 cases in the province (KwaZulu-Natal). The number could be more, but we are not sure because not everybody comes for testing,” Dlamini noted. “The majority of our people live in rural areas where the nearest clinic may be five or six kilometres away. However, there’s a specific team focusing on TB in the province.”

There is also a pressing need for new drugs to cope with XDR-TB.

“Research into these new agents has only recently been revitalised and despite promising drugs in the pipeline, these will not be available for at least five years. Further investment in new drug research and development will be necessary to ensure an adequate number of effective drugs,” noted a statement by WHO TB experts and others who gathered in the South African commercial centre of Johannesburg last September. Their meeting discussed strategies for dealing with TB resistance.

 
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