By Carrie Loewenthal Massey
In Islamabad, U.S. Deputy Chief of Mission Stephen Engelken and Pakistan Minister of Health Makhdoom Shahabuddin helped announce a new tuberculosis survey.Pakistan long has been listed among the 22 nations with the highest rates of tuberculosis (TB). But precisely how high? The United States is partnering with Pakistan’s Ministry of Health and others to get the clearest answer to that question in decades.
With U.S. support, researchers are conducting the first comprehensive survey of TB in Pakistan since the 1980s and will generate data crucial to the Pakistani government’s ability to make informed decisions about public health.
“Having this information will allow both the public and private health service delivery sectors to be more responsive to the TB needs of the country,” said Dr. Sardar Talat Mahmud, senior health adviser with the U.S. Agency for International Development (USAID), via e-mail from Pakistan.
“An accurate understanding of the disease burden of a country is a critical component for planning and resource allocation by policy makers, managers and health practitioners,” he added.
The U.S. Embassy in Islamabad announced a $4.5 million grant from USAID in December to support the survey. The Dutch Tuberculosis Foundation is facilitating the research, and other partners include the World Health Organization (WHO); Paris-based nonprofit International Union against Tuberculosis and Lung Disease; and Management Sciences for Health, a U.S.-based international nonprofit organization.
“This survey is going to provide us with evidence to understand the magnitude of tuberculosis in Pakistan so we can plan effectively control of the disease,” Pakistani Minister for Health Makhdoom Shahabuddin said at the December 2010 announcement.
The United States and Pakistan are working on several joint health projects as part of the U.S.-Pakistan Strategic Dialogue, which also includes partnerships in energy, agriculture, defense, education, water and communications, among others.
“Our commitment to partner with Pakistani health officials and work together in areas they identify is part of America’s comprehensive commitment to improve the well-being of ordinary Pakistanis in tangible ways,” U.S. Deputy Chief of Mission Stephen Engelken said at the December 2010 grant announcement.
Already at work in the field, Talat and his colleagues started the survey in December 2010 and expect to complete it within 12 months. Using a short questionnaire and a chest X-ray, they will screen for TB symptoms in more than 150,000 adults — people over 15 years old — in 95 locations throughout Pakistan. The survey is one of the largest of its kind ever conducted, according to an embassy press release.
The survey results will replace outdated estimates of Pakistan’s TB burden, provide a more precise picture of the TB burden within the adult population and help Pakistan’s health sector better assess the annual risk of TB infection. Current TB incidence rates in Pakistan are based on computer modeling and a survey conducted in 1987; that makes it difficult for the Pakistani government to accurately measure its progress in the fight against TB, Talat said.
The survey is off to a productive start. According to preliminary reports Talat has received, “field work has been going very well and the community response has been very encouraging.”
While the data will support long-term public health decisions, the effort also has an immediate positive effect on the population’s well-being.
“Everyone who tests positive for TB is then referred to the nearest health facility for appropriate follow up and treatment,” Talat said.
TUBERCULOSIS IN PAKISTAN
With more than 413,000 new TB cases reported each year, Pakistan ranks eighth among the world’s 22 most highly TB-burdened countries, according to WHO. TB kills an estimated 48,000 Pakistanis each year.
Compounding the issue, multidrug-resistant TB struck Pakistan 13,000 times in 2009. (Multidrug resistant TB is a deadlier form of the disease where the majority of available TB drugs are ineffective.) WHO ranks Pakistan sixth of 27 countries battling multidrug-resistant TB.
The U.S. government has worked with Pakistan for many years to help control the spread of infection. USAID began supporting Pakistan’s effort to combat TB in 2003, primarily by providing assistance to the Pakistani government’s National Tuberculosis Control Programme, Talat said.
Pakistan also receives approximately $202 million in additional TB resources from the Global Fund to Fight AIDS, Tuberculosis and Malaria, to which the United States is the largest contributor.
A DEVASTATING GLOBAL HEALTH CRISIS
TB infects an estimated one-third of the global population, and approximately 1.7 million people worldwide died from the disease in 2009, according to Talat. It spreads easily through the air, and a contagious person can infect 10 to 15 people every year. People living in close quarters with others become especially vulnerable.
Several agencies within the U.S. government work to fight TB. In 2008, the National Institutes of Health (NIH) spent about $160 million on TB research, and ongoing NIH efforts complement those by the Centers for Disease Control and Prevention, the National Institute for Allergy and Infectious Diseases, and USAID.
“USAID has provided approximately $953 million through direct programs to improve TB services and prevent the spread of TB and multidrug-resistant TB in over 40 countries,” Talat said.
http://www.america.gov/st/develop-english/2011/January/20110106161915eirrac0.5755884.html?CP.rss=true
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