Stop TB Partnership and MSF launch Out of Step Report showing urgent need for updated National TB Policies

By Stop TB Partnership

The Stop TB Partnership and Médecins Sans Frontières (MSF) today released Out of Step 2015 report, a 24-country survey of policies and practices used to guide the diagnosis and treatment of tuberculosis (TB). If countries are to meet Sustainable Development Goals target to End TB by 2030, aggressive efforts must start now to adopt and implement the 14 key policies and practices identified in the report, which are currently recommended by World Health Organization (WHO).

In 2014 only one in four (26%) of the 480,000 people estimated to have developed multidrug-resistant TB (MDR-TB) was diagnosed, with 111,000 people (23%) started on treatment and less than half of them successfully treated. Yet of the 24 countries surveyed for Out of Step, only about 30% of countries (8 out of 24) have put in place policies to ensure that rapid molecular tests for detection of TB and drug resistance are used as the initial test for everyone being evaluated for TB.

"To meet the 90-(90)-90 targets in the Stop TB Partnership’s Global Plan to End TB 2016-2020 and the longer-term goals outlined in WHO’s End TB Strategy, country programmes need to urgently bring their national policies and practices in step with international recommendations for optimal diagnosis and treatment of TB", said Dr Lucica Ditiu, Executive Director of the Stop TB Partnership

"We recognise that the adoption of TB policies to national and local situations can take time, but many countries are leading the way. Just one year after new paediatric guidelines were released, the report found that 30% of countries surveyed have already adopted the new guidelines, which benefits all children with TB. We hope the Out of Step report will bring a renewed focus on the importance of TB policies and serve as a tool to help countries create the paradigm called for in the Global Plan to End TB 2016-2020", said Dr Ditiu.

The report recommends that countries should consider expanding access to rapid molecular diagnostics in order to ensure early diagnosis and early treatment initiation; reduce the chain of transmission; reduce cost implications in the long run; and reduce the emergence of drug-resistant TB cases and the overall global burden of TB.

"Outdated policies for TB treatment that put people at risk of increased suffering and death should be banished, including re-treatment regimens that potentially increase drug resistance, and mandatory hospitalisation during treatment," said Dr. Grania Brigden, MSF Access Campaign TB Advisor. "The use of rapid molecular tests that can effectively diagnose drug resistance hasn’t yet reached the broad coverage needed. We won’t be able to close the huge gaps in TB diagnosis and treatment unless the policies and practices known to reduce illness, death and transmission are fully adopted and implemented in every country, including the best use of every effective tool available today."

Almost 60% of countries surveyed (14 out of 24) continue to offer the ‘Category II’ re-treatment regimen, which has poor outcomes in countries with high rates of MDR-TB and HIV/TB co-infection. Once countries upgrade their diagnostic protocols to rapid molecular testing for all TB patients, this treatment should be phased out completely in line with WHO recommendations. The survey also highlighted that nine countries still require DR-TB patients to be hospitalised for all or part of their illness.

"In MSF projects and beyond, we’ve shown that hospitalising people with drug-resistant TB is not necessary, and that people can receive treatment while living at home, even in resource-limited settings," said Dr Vivian Cox, Deputy Medical Field Coordinator, MSF South Africa. "Decentralised drug-resistant TB care is cost-effective for treatment programmes and as medically effective as centralised care, and is much, much better for patients, their families and their communities. We also know it’s critical for clinicians to have access to the full toolbox of new and existing TB drugs so they can give people the best chance to survive drug-resistant TB. When access to needed TB drugs is blocked, the results are too often deadly."

Only about 12% of countries surveyed are confirmed to have all of the existing drugs used to treat drug-resistant TB on their national essential medicine lists. While 65% of countries surveyed do have a process in place to access the newest TB drugs for patients who have run out of other treatment options, it is vital that drug companies submit their drugs for registration in the countries that need them the most, so that use of new and re-purposed drugs in treating drug-resistant forms of TB can be scaled up.

"As a first step, all countries with a high TB burden should implement rapid diagnostics, phase out the obsolete re-treatment regimen within a year, and do away with compulsory hospitalisation," said Dr. Brigden. "We need all countries to upgrade their national policies and practices to fully meet WHO recommendations within the next three years to really address TB illness and death head-on."

Notes to editors:

The Stop TB Partnership’s Global Plan to End TB 2016-2020 aims to reach the following 90-(90)-90 targets: 1. Find at least 90% of all TB people with TB in the population that require treatment and place them on appropriate therapy (first line, second line as well as preventive therapy); 2. As a part of the effort to reach 90% of all people with TB, make a special effort to reach at least 90% of the key population groups - the most vulnerable, underserved, at risk populations in countries; and 3. Reach at least 90% treatment success through affordable treatment services, promoting adherence and social support.

Category II re-treatment regimen: The Category II re-treatment regimen has traditionally been recommended for all patients with a prior history of TB treatment. One drug, streptomycin, is added to standard first-line drugs and the regimen is extended to eight months. According to the latest WHO guidelines, the re-treatment regimen with first-line drugs is ineffective in MDR-TB and should only be considered in areas at low risk for MDR-TB. It is therefore critical to detect MDR-TB promptly so that an effective regimen can be started.

Source: Stop TB Partnership.

For more information: Out of Step 2015 report.

Tuberculosis mortality nearly halved since 1990

But TB ranks alongside HIV as a leading cause of death worldwide

By WHO

The fight against tuberculosis is paying off, with this year’s death rate nearly half of what it was in 1990. Nevertheless, 1.5 million people died from TB in 2014. Most of these deaths could have been prevented, according to WHO’s Global tuberculosis report 2015, which was released today in Washington.

To reduce TB’s overall burden, detection and treatment gaps need to be closed, funding shortfalls filled and new diagnostics, drugs and vaccines developed, according to the report.

A child receiving Tuberculosis medicine in South Sudan under
a programme supported by the Global Fund to Fight AIDS,
Tuberculosis and Malaria and UNDP.
Photo: UNDP South Sudan/Brian Sokol.

Most of the improvement has come since 2000, the year the Millennium Development Goals (MDGs) were established. In all, effective diagnosis and treatment saved 43 million lives between 2000 and 2015, according to the report, the 20th in a series of annual evaluations produced by WHO.

“The report shows that TB control has had a tremendous impact in terms of lives saved and patients cured,” said WHO Director-General Margaret Chan. “These advances are heartening, but if the world is to end this epidemic, it needs to scale up services and, critically, invest in research.”

Those advances include the achievement of the MDG that called for halting and reversing TB incidence by 2015. The goal was reached globally and in 16 of the 22 high-burden countries that collectively account for 80% of cases.

Worldwide, TB incidence has fallen 1.5% per year since 2000, for a total reduction of 18%.

“Despite the gains, the progress made against TB is far from sufficient,” according to Dr Mario Raviglione, Director of WHO’s Global TB Programme. “We are still facing a burden of 4 400 people dying every day, which is unacceptable in an era when you can diagnose and cure nearly every person with TB.”

In 2014, TB killed 890 000 men, 480 000 women and 140 000 children. The disease ranks alongside HIV as a leading killer worldwide. Of the 1.5 million people killed by TB in 2014, 400 000 were HIV-positive. HIV’s total death toll in 2014 was estimated at 1.2 million, which included the 400 000 TB deaths among HIV-positive people.

This year’s report describes higher global totals for new TB cases (9.6. million) than in previous years. However, these figures reflect increased and improved national data and in-depth studies rather than any increase in the spread of the disease. More than half of the world’s TB cases (54%) occurred in China, India, Indonesia, Nigeria and Pakistan. Among new cases, an estimated 3.3% have multidrug-resistant TB (MDR-TB), a level that has remained unchanged in recent years.

Action needed to close diagnostic and treatment gaps

The report highlights the need to close detection and treatment gaps, fill funding shortfalls, and develop new diagnostics, drugs and vaccines.

The detection gap is significant. Of the 9.6 million people who fell ill with TB in 2014, 6 million (62.5%) were reported to national authorities. That means that, worldwide, more than a third (37.5%) of the cases went undiagnosed or were not reported to national authorities. The quality of care for people in the latter category is unknown.

Detection and treatment gaps are especially serious among people with MDR-TB, which remains a public health crisis. Of the 480 000 cases estimated to have occurred in 2014, only about a quarter – 123 000 – were detected and reported to national authorities. The 3 countries with the largest numbers of cases are China, India and the Russian Federation.

Treatment initiation for those diagnosed with MDR-TB substantially increased and almost all cases detected in 2014 started treatment. Forty-three countries reported cure rates for MDR-TB patients of more than 75%. Nevertheless, globally, data shows an average cure rate of only 50% for treated MDR-TB patients.

Treatment is improving, with 77% of patients known to be co-infected with HIV and TB getting antiretroviral medicines in 2014.

The number of people living with HIV who were given TB preventive therapy was nearly 1 million in 2014, an increase of about 60% compared with 2013. More than half (59%) of these people were in South Africa.

Financing shortfalls stand in way of accelerated progress

“A primary reason for detection and treatment gaps is a major shortfall in funding,” said Dr Winnie Mpanju-Shumbusho, WHO Assistant Director-General for HIV, TB, Malaria and Neglected Tropical Diseases. This shortfall amounted this year to US$ 1.4 billion of the US$ 8 billion needed to fully implement interventions. In addition, an annual funding gap of at least US$ 1.3 billion must be filled for research that would include the development of new diagnostics, drugs and vaccines.

From 2016, the global goal will shift from controlling TB to ending the global TB epidemic. The End TB Strategy, adopted by all WHO Member States, serves as a blueprint for countries to reduce TB incidence by 80% and TB deaths by 90% and to eliminate catastrophic costs for TB-affected households by 2030.

“Ending the TB epidemic is now part of the Sustainable Development Goal agenda” said Dr Eric Goosby, UN Special Envoy on Tuberculosis. “If we want to achieve it, we’ll need far more investment – at a level befitting such a global threat. We’ll also need progress on universal health coverage and poverty alleviation. We want the most vulnerable communities worldwide to gain first, not last, in our efforts.”

Source: WHO.

For more information: Global tuberculosis report 2015. 

Uma em cada cinco pessoas com tuberculose não sabe que tem a doença nas Américas

Belford Roxo, Baixada Fluminense.

Foto: Agência Brasil

Por ONU Brasil

Cerca de 220 mil casos foram notificados em 2012, mas estima-se que outras 60 mil pessoas não foram diagnosticadas, a maioria em cidades.

Uma em cada cinco pessoas afetadas com tuberculose na região das Américas desconhece ter a doença, por não possuir acesso a serviços de saúde ou pelo fato de a doença não ter sido detectada corretamente, de acordo com estimativas da Organização Pan-Americana da Saúde (OPAS/OMS).

Quase 220 mil casos foram notificados em 2012 e estima-se que tenham ocorrido cerca de 19 mil mortes por tuberculose nas Américas. Estima-se que, para além disso, cerca de 60 mil pessoas não foram diagnosticados a tempo. Isto não só coloca em risco a vida das pessoas com a doença, mas também perpetua a transmissão da tuberculose, gerando problemas sócio-econômicos para as pessoas atingidas e suas comunidades.

“Chegar ao diagnóstico e tratamento para todos só pode ser alcançado se todos os prestadores de cuidados de saúde, organizações comunitárias, parceiros e países unirem esforços para detectar e tratar essas 60 mil pessoas”, disse a diretora da OPAS, Carissa F. Etienne, marcando o Dia Mundial da Tuberculose.

“O acesso universal aos serviços de saúde de qualidade através de sistemas de saúde baseados em cuidados primários vai ajudar a reduzir a carga de tuberculose e garantir uma vida longa e produtiva para as pessoas que vivem nas Américas”, acrescentou.

O fardo da tuberculose varia por país e está concentrado principalmente nas populações mais vulneráveis que vivem nas grandes cidades – geralmente em favelas, onde as condições de vida levam a superlotação, acesso limitado a água potável e saneamento e acesso limitado a serviços de saúde.

Segundo a OMS, cerca de 80% da população da América Latina e do Caribe vive em cidades e uma em cada quatro pessoas vive na pobreza.

No mundo, três milhões sem tratamento

“Ao cuidar dos 3 milhões de pessoas que não têm o tratamento que necessitam, vamos promover um futuro melhor para toda a humanidade”, disse o secretário-geral da ONU, Ban Ki-moon , em sua mensagem para o Dia: “Todos com tuberculose devem ter acesso aos serviços de que necessitam para o diagnóstico rápido, tratamento e cura. Esta é uma questão de justiça social.”

Mesmo quando há o dignóstico, destacou Ban, muitos não têm acesso a um tratamento eficaz.

“Para acelerar os resultados, é preciso aumentar o acesso aos serviços de saúde e mobilizar as comunidades, hospitais e prestadores para atingir mais pessoas e tratá-las mais rapidamente. Devemos também investir mais em pesquisa para encontrar ferramentas de diagnóstico, medicamentos e vacinas”, disse o chefe da ONU.

A diretora-geral da OMS, Margaret Chan, realizou uma coletiva de imprensa em Genebra sobre o estado dos esforços globais para tratar a tuberculose, a segunda doença infecciosa mais mortal do mundo entre os adultos, depois do HIV/aids.

Todos os anos, a tuberculose mata 1,3 milhão de pessoas pelo mundo e atinge outras 9 milhões.

A tuberculose, transmitida pelo Mycobacterium tuberculosis, o bacilo de Koch, é provavelmente a doença infecto-contagiosa que mais mortes ocasiona no Brasil. Estima-se, ainda, que mais ou menos 30% da população mundial estejam infectados, embora nem todos venham a desenvolver a doença. Proximidade com pessoas infectadas, assim como os ambientes fechados e pouco ventilados favorecem o contágio.

UNAIDS pede acesso precoce aos serviços de testagem e tratamento de HIV e tuberculose

O Programa Conjunto das Nações Unidas sobre HIV/Aids (UNAIDS) fez um apelo urgente a fim de intensificar esforços globais para assegurar testagem e tratamento precoce de tuberculose e HIV.

A tuberculose continua a ser principal causa de morte entre pessoas que vivem com HIV. Em 2012, estima-se que 1,1 milhão de novos casos de tuberculose ocorrerão em pessoas vivendo com HIV – com 75% dos novos casos ocorrendo na África.

O impacto conjunto dessas doenças é devastador para milhões de pessoas e suas famílias, segunda a agência da ONU. “Isto é inaceitável, pois a tuberculose possui cura e pode ser prevenida. Ao expandir o acesso à prevenção básica de tuberculose para pessoas que vivem com HIV, o objetivo de reduzir em 50% o número de mortes pode ser alcançado até 2015.”

Estudos mostram que o diagnóstico e o acesso precoce ao tratamento de HIV podem reduzir em 65% o risco de infecção por tuberculose. Quando o tratamento de tuberculose é combinado com terapia antirretroviral (TARV), o risco da doença pode ser reduzido cerca de 90%.

Pessoas com maior vulnerabilidade devem ter a oportunidade de conhecer seu status e iniciar o tratamento mais cedo para prevenir a tuberculose ativa. Se pessoas vivendo com HIV desenvolvem tuberculose ativa, o tratamento imediato de TARV pode reduzir a chance de morte em cerca de 50%.

Infelizmente, apesar do conhecimento da importância do diagnóstico e tratamento precoce de HIV e tuberculose, milhões de pessoas muitas vezes descobrem tarde demais que estão infectadas.

Fonte: ONU Brasil.

Tuberculosis In Blacks

By CDC

Tuberculosis (TB) is a disease caused by a bacterium called Mycobacterium tuberculosis. The disease is spread from person to person through the air. The bacteria usually attack the lungs, but TB bacteria can attack any part of the body such as the kidney, spine, and brain. If not treated properly, TB disease can be fatal.

TB disease was once a leading cause of death in the United States, but since 1993 the rates of TB in the country have declined in all groups. In 2011, a total of 10,528 TB cases were reported in the United States; however, blacks continue to have a disproportionate share of TB. The percentage of TB cases in blacks is higher than expected based on the percentage of blacks in the U.S. population. If looking at only people born in the United States, the proportion of TB in blacks is even greater. Although rates of TB in blacks have declined substantially over the past decade, the disparity remains. Addressing the TB disparity among blacks is an important priority; prevention and control efforts should be targeted to this population.

The Numbers

In 2011, TB disease was reported in 1533 non-Hispanic blacks in the United States, accounting for 23% of all people reported with TB nationally.

• Among U.S.-born people reported with TB disease, 39% were non-Hispanic blacks.
• The rate of TB disease was 6.3 cases per 100,000 population, which is over seven times higher than the rate of TB disease in white, non-Hispanic people (0.8 cases per 100,000 population).

Prevention Challenges

TB is a challenging disease to diagnose, treat, and control. Dwindling resources and loss of public health capacity, including access to care and maintaining clinical and public health expertise add to the challenge. It is critical to reach those at highest risk for TB, and to identify and implement innovative strategies to improve testing and treatment.

TB rates are higher for some racial and ethnic groups. This relates to a greater proportion of people in these groups who have other risk factors for TB. Like other communities, blacks face a number of challenges that contribute to higher rates of TB. Challenges include:

• The duration of treatment for latent TB infection and TB disease is lengthy. Patients are often unable or reluctant to take medication for several months. For people with TB disease, inadequate treatment can lead to treatment failure, relapse, ongoing transmission, and development of drug resistance. For people with latent TB infection, medication for a condition with no symptoms of illness is often not a priority.
• Socioeconomic factors impact health outcomes and are associated with poverty, including limited access to quality health care, unemployment, housing, and transportation. These factors can directly or indirectly increase the risk for TB disease and present barriers to treatment of this disease.
• Language and cultural barriers, including health knowledge, stigma associated with the disease, values, and beliefs may also place certain populations at higher risk. Stigma may deter people from seeking medical care or follow up care.
• TB remains a serious threat, especially for people who are infected with human immunodeficiency virus (HIV). People infected with HIV are more likely than uninfected people to get sick with other infections and diseases, including TB.
  • Blacks have the most severe burden of HIV of all racial/ethnic groups in the United States. Compared with other races and ethnicities, Blacks account for a higher proportion of HIV infections at all stages of disease—from new infections to deaths.
  • Blacks accounted for an estimated 44% of all new HIV infections among adults and adolescents (aged 13 years or older) in 2010, despite representing only 12% to 14% of the U.S. population.
  • Without treatment, as with other opportunistic infections, HIV and TB can work together to shorten the life of the person infected.
• In addition to HIV, other underlying medical conditions may increase the risk that latent TB infection will progress to TB disease. For example, the risk is higher in people with diabetes, substance abuse (including injection of illegal drugs), silicosis, or those undergoing medical treatments with corticosteroids.
• Delayed detection and diagnosis of TB disease, as well as delayed reporting of TB disease remains a challenge in TB prevention and treatment. Because the number of TB cases in the United States is declining, there is decreased awareness of TB signs and symptoms among health care providers and at-risk populations. Patients may be less likely to seek medical care and health care providers may be less likely to consider TB as the cause.

What CDC is Doing

To achieve TB elimination, ongoing efforts are needed to address the persistent disparities that exist among racial and ethnic minorities in the United States.

CDC is working on projects designed to educate and raise awareness about TB in black communities. In one project, representatives from ten sites where disproportionate cases of TB disease are reported in blacks received training to enhance skills for engaging communities, develop strategies, and sustain partnerships for reducing TB rates.

Other CDC activities include a study to identify the socio-cultural, racial, and health system barriers specifically for blacks with or at risk for TB. The study’s goals include the development and testing of interventions to eliminate racial and ethnic disparities in TB rates in blacks; and to make improvements in health-seeking behavior, contact investigations, culturally sensitive case management, and completion of treatment among black TB patients.

Data from a national sample of U.S.-born blacks also will be reviewed to quantify the time to diagnose and treat TB; examine the roles of the patient, provider, laboratories, and TB programs that affect timeliness of diagnosis and treatment of blacks; and evaluate the effect that time of exposure has on transmission. The findings will be used to propose performance goals and indicators for TB programs in an effort to encourage faster diagnosis and treatment in this population.

Source: Centers for Disease Control and Prevention.

For more information:

2013: Tuberculosis in Blacks.

Screening diabetes patients for TB proves effective at community health level in China

By The Union

The Union has been providing technical support to the United States Agency for International Development (USAID) Control and Prevention-Tuberculosis (CAP-TB) project in China, a five-year project designed to improve case detection and treatment for multidrug-resistant TB (MDR-TB) in the Greater Mekong Sub-Region of China, Myanmar and Thailand. One of the components of the project, which began in 2011, has been to detect TB earlier in high-risk groups, such as people with diabetes mellitus.

An earlier Union study in China and India demonstrated that bidirectional screening of patients for TB and DM in a hospital setting was both feasible and effective. The goal of this new project, in addition to detecting cases, was to determine if the same screening model would work well in community health settings.

In partnership with USAID’s implementing partner, FHI 360, and Yunnan Provincial Anti-TB Association, 10 community health centres in urban and rural areas of the Xishan District of Yunnan Province were selected and the staff trained to conduct the TB screening.  During the project period (June 2013-April 2014), 2,942 patients with diabetes visited these clinics. Of them, two were already known to have TB, and 278 (9.5 percent) proved to have positive TB symptoms and were sent for further treatment. One person was diagnosed with active TB and started on anti-TB treatment. Although this number is small, the rate of diagnosis is nearly three times higher than that found in the general population in Yunnan.

This study, which was based on the WHO-Union Collaborative Framework for the Care and Control of TB and Diabetes (2011), is significant because China has the second largest number of TB cases in the world – with close to 900,000 cases reported to the World Health Organization in 2012 – and an estimated 113.9 million adults with diabetes.  With research showing that people with diabetes mellitus are more than three times more likely to develop active TB than people without diabetes, effective cross-screening of these populations is essential to reducing the impact of both diseases.

Funding for the CAP-TB project was provided by USAID. Results of the TB-diabetes study have been accepted for publication in Tropical Medicine and International Health.

Source: The Union.

For more information: 

2011: Collaborative framework for care and control of tuberculosis and diabetes.

New UN report shows mixed results for reaching MDG health targets by end of 2015

By UN

The United Nations health agency today reported that by the end of 2015, the world will have met the Millennium Development Goals (MDGs) for turning around the epidemics of HIV, malaria and tuberculosis, and boosting access to drinking water, but will likely fall short of reaching other health-related goals in areas such as child and maternal deaths and basic sanitation.

“The MDGs have been good for public health. They have focused political attention and generated badly needed funds for many important public health challenges,” Dr. Margaret Chan, Director-General of the World Health Organization (WHO) said on the release of this year’s World Health Statistics. While progress has been very encouraging, there are still wide gaps between and within countries, she added.

“Today’s report underscores the need to sustain efforts to ensure the world’s most vulnerable people have access to health services,” Dr. Chan said.

Health workers carrying out a spraying operation to eradicate 
infected Anopheles mosquitoes which spread malaria. Photo: WHO.

The report’s release comes four months before countries are to decide on new and ambitious global post-MDG targets for the period through 2030, during the annual high-level opening of the UN General Assembly in September.

Summarizing today’s report, which assesses progress towards the health-related goals in each of the 194 countries for which data are available, WHO noted that “results are mixed” for reaching the landmark MDG’s set by governments 15 years ago to guide global efforts to end poverty.

Noting that by the end of the year the world would likely have met targets on turning back pandemics and maternal and child deaths, and increasing access to basic sanitation, the report shows that “progress in child survival worldwide is one of the greatest success stories of international development.”

“Since 1990, child deaths have almost halved – falling from an estimated 90 deaths per 1000 live births to 46 deaths per 1000 live births in 2013,” according to the report.

“Despite great advances, this is not enough to reach the goal of reducing the death rate by two-thirds,” it said. “Less than one third of all countries have achieved or are on track to meet this target by the end of this year.”

The top killers of children aged less than 5 years are: preterm birth complications, pneumonia, birth asphyxia and diarrhoea.

The report also reveals that the number of women who die due to complications during pregnancy and childbirth has almost halved between 1990 and 2013, but “the rate of decrease won’t be enough to achieve the targeted reduction of 75 per cent by the end of this year.”

“In the WHO African Region, one in four women who wants to prevent or delay childbearing does not have access to contraceptives, and only one in two women gives birth with the support of a skilled birth attendant,” it said. ”Less than two-thirds (64 per cent) of women worldwide receive the recommended minimum of four antenatal care visits during pregnancy.”

On a positive note, according to the report, the world has begun to reverse the spread of HIV, with new infections reported in 2013 of 2.1 million people, down from 3.4 million in 2001.

“At current trends, the world will exceed the target of placing 15 million people in low- and middle-income countries on antiretroviral therapy (ARTs) in 2015,” it said.

While the global target for increasing access to safe drinking water was met in 2010, the report noted that “the world is unlikely to meet the MDG target on access to basic sanitation.”

“Around 1 billion people have no access to basic sanitation and are forced to defecate in open spaces such as fields and near water sources,” it said. “Lack of sanitation facilities puts these people at high risk of diarrhoeal diseases (including cholera), trachoma and hepatitis.”

WHO also drew attention to the following 10 facts from the report:

1.Life expectancy at birth has increased six years for both men and women since 1990.

2.Two-thirds of deaths worldwide are due to non-communicable diseases.

3.In some countries, more than one-third of births are delivered by caesarean section.

4.In low- and middle-income countries, only two-thirds of pregnant women with HIV receive antiretrovirals to prevent transmission to their baby.

5.Over one-third of adult men smoke tobacco.

6.Only one in three African children with suspected pneumonia receives antibiotics.

7.15 per cent of women worldwide are obese.

8.The median age of people living in low-income countries is 20 years, while it is 40 years in high-income countries.

9.One quarter of men have raised blood pressure.

10.In some countries, less than five per cent of total government expenditure is on health.

Source: United Nations.

For more information:

2015: World health statistics 2015.

WHO calls on the world to “Gear up to End TB”

By ONU

Photo: IRIN/David Gough.

GENEVA - As countries mark World Tuberculosis Day on March 24, WHO is calling for “global solidarity and action” to support a new 20-year strategy, which aims to end the global tuberculosis epidemic.

Recent years have seen tremendous progress in the fight against TB, with over 37 million lives saved, but much more needs to be done. In 2013, 9 million people fell ill with TB, almost half a million of whom have a multi-drug resistant disease which is far harder to treat. An estimated 1.5 million people still die of tuberculosis each year.

The disease frequently has devastating economic consequences for affected families, reducing their annual income by an average of 50%, and aggravating existing inequalities.

“This is a matter of social justice, fundamental to our goal of universal health coverage. Each and every man, woman or child with TB should have equal, unhindered access to the innovative tools and services they need for rapid diagnosis, treatment and care,” says Dr Margaret Chan, WHO Director-General.

New strategy sets ambitious targets

WHO’s End TB Strategy, adopted by governments at the World Health Assembly last year, is designed to drive action in three key areas: integrated patient-centred TB care and prevention for all in need, including children; bold policies and supportive systems; and intensified research and innovation.

The strategy sets ambitious targets of a 95% reduction in TB deaths and a 90% reduction in cases of TB by 2035. An important milestone to be reached within the next five years (2020) is the elimination of catastrophic costs for TB patients and their families. Eliminating catastrophic costs is feasible through making care more accessible and through financial protection schemes to minimize medical and non-medical costs as well as income loss.

2015 is seen as a critical year for action to adapt and roll out the strategy in diverse country settings. Achieving success for the strategy will require the TB community around the world to work together to leverage alliances and resources.

“The progress that has been made in combating TB has been hard won and must be intensified if we are to wipe out the TB epidemic,” says Dr Eric Goosby, who was appointed UN Special Envoy on TB in January this year. “The End TB Strategy offers new hope to the millions of people suffering and losing their lives to TB each year. It is time to join forces to create a world free of TB.”

The strategy addresses tuberculosis among vulnerable groups, including people living with HIV who develop TB. In 2013 there were an estimated 1.1 million people co-infected with HIV and TB, 360 000 of whom died.

Mobilization needed to fund gaps and end TB

Persistent funding gaps in the TB response also need to be filled to drive progress towards ending the global epidemic. It is vital that resource gaps of USD 2 billion per year for TB interventions and USD 1.39 billion per year for TB research be filled. Accelerating research and innovation in basic science, new diagnostics, drugs and vaccines and their rapid uptake, will be critical to break the trajectory of the epidemic and reach the global targets.

“This World TB Day should serve to alert and mobilize as many people as possible to end the epidemic,” says Dr Mario Raviglione, Director of the WHO Global TB Programme. “We must work with innovators in health, development, civil society and the private sector to end the burden of this preventable disease.”

Gearing up to adapt and implement the End TB strategy has already begun. A new action framework targeting the elimination of TB for low-incidence countries was launched last year. Regions are working on plans to support countries, and ministries of health are updating their national plans in line with the strategy and its milestones.

Source: WHO.

For more information:

2015: Gear up to End TB

2015: Towards tuberculosis elimination: an actionframework for low-incidence countries