TUBERCULOSIS: World: Drug resistance hampers fight against tuberculosis

 Mar 17 2011: Kate Kelland : (Editing by Douglas Hamilton)
LONDON (Reuters) - Rising rates of multi-drug resistant tuberculosis (TB) are hampering world health programs aimed at tackling TB and threaten to wipe out progress made against the disease, scientists said on Friday.
Experts from the World Health Organization and the European Center for Disease Prevention and Control (ECDC) said they were concerned about spreading multidrug-resistant TB, known as MDR TB, in Europe, and the persistence of TB among children.
A second report, in The Lancet medical journal, said sub-Saharan Africa was disproportionately affected and accounted for four of every five cases of tuberculosis linked to HIV, the human immunodeficiency virus that causes AIDS.
"Increasing rates of drug-resistant TB in eastern Europe, Asia, and sub-Saharan Africa now threaten to undermine the gains made by worldwide tuberculosis control programs," said researchers in The Lancet.
TB kills an estimated 1.7 million people each year and the worldwide number of new cases -- more than 9 million -- is higher than at any other time in history, they said.
According to data from the WHO's European office, reported rates of TB have been falling in Europe since 2005 with a regional average of 36.8 notifications per 100,000 population in 2009. But notification rates of newly detected and relapsed TB cases in 18 high-priority countries remain almost eight times higher than in the rest of the region, the WHO data show.
"Vulnerable populations, including children, still do not have ready access to quality and timely diagnosis and treatment," the WHO-ECDC report said. "This remains a matter of urgency given the high prevalence of multi- and extensively drug-resistant TB in the region.
Up to a third of people worldwide are infected with the bacterium that causes TB, but only a small percentage ever develop the disease. Studies show that people with substance abuse problems, those who are poor and those who live in hard-to-reach communities are more prone to the disease.
The AIDS epidemic drove up the number of TB cases across the world in the late 1980s and 1990s because the immune suppression caused by HIV can make a person far more susceptible to TB.
People can get drug-resistant forms of TB either as a result of catching such a strain from another person or because of inappropriate or incomplete treatment.
In The Lancet report, Alimuddin Zumla of University College London Medical School and Stephen Lawn of the University of Cape Town said rising global rates of diabetes and high rates of smoking in low and middle-income countries were now increasingly important drivers of the TB epidemic.
Diabetes raises the risk of developing TB three-fold and smoking increases it two-fold, they said.
The experts concluded that progress toward controlling TB worldwide was being hampered by an absence of a quick and cheap diagnostic test, the long duration of treatment, the lack of an effective vaccine, rising rates of drug-resistant TB and weak health systems in developing countries.
http://uk.reuters.com/article/2011/03/18/health-us-tuberculosis-resistance-idUKTRE72H31B20110318

MDG's: Next Millennium Development Goals 'should be more holistic'

Mićo Tatalović

16 September 2010
Goals focused on wellbeing might have been more effective, argues the report

The Millennium Development Goals (MDGs) were conceived with an outdated, fragmented approach to international development, and a new way forward will be needed after their due date in 2015, according to a report.
"Patchy" progress towards achieving the eight goals reflects fundamental problems with the way they were set up, says the report, launched ahead of the international summit on the goals in New York next week (20 September).

In particular, they were not designed to interact and support each other, says the London International Development Centre (LIDC) and the Lancet, which have set up the Lancet–LIDC Commission, producer of the report launched this week (13 September).
The eight United Nations MDGs were agreed in 2000 and are due to be met by 2015. A UN report published in June showed that countries have made only partial progress. But a draft declaration, expected to be formally adopted at next week's summit, maintains that the goals are achievable despite setbacks caused by the global financial and economic crises.
"MDGs do address many but not all key development challenges," said Andy Haines, director of the London School of Hygiene and Tropical Medicine. "This report for the first time really casts an interdisciplinary spotlight on the MDGs, what they will have achieved and where we need to go afterwards."
"The broad picture of MDGs is patchy progress, and not at a pace capable of achieving the goals by 2015," said Jeff Waage, director of the LIDC, who added: "Is this just a matter of effort or are there fundamental problems with the MDGs themselves that will hamper their achievement?"
The commission's report identifies a number of common features across the goals that have limited their implementation, he said.
First, the goals were put forward as separate, unconnected targets by the relevant communities working in those sectors, and each community had its pre-existing aspirations. Secondly, the goals were brought together without broader analysis of what was needed for them to work as a set, or how the different targets might interact, according to Waage.
As a result "there are considerable gaps between goals that undermine their capacity to achieve some interaction and synergy in development".
For example, the focus on children's early years in the education goal has meant it could not support one of the aims of the health goal, to build the workforce of health professionals in higher education.
The report also highlights the plight of those not targeted by the goals — such as those living on just over US$1 a day.
Another key problem has been ownership, according to Elaine Unterhalter, professor of education and international development at the Institute of Education in the United Kingdom.
"Certain MDGs have powerful advocates at international level or in certain ministries in individual countries, but the other MDGs do not," she said.
The commission has concluded that future goals should be centred on 'wellbeing', which has human, social and environmental components.
"We propose a conceptualisation of development as a dynamic process operating at multiple scales and with multiple agents, involving sustainable and equitable access to improved wellbeing ," said Andrew Dorward, professor of development economics at the School of Oriental and African Studies in the United Kingdom.
But Anthony Costello, head of the Centre for International Health and Development at University College London, said the term 'wellbeing', was vague and might be difficult to define and measure.
He said there was a need to engage stakeholders in developing countries in any post-2015 plans.
And Viroj Tangcharoensathien, from the International Health Policy Program, Thailand, a country that has already achieved all of the goals, said it was crucial for all countries to achieve them before considering further, more ambitious action.



Link to 'The Millennium Development Goals: a cross-sectoral analysis and principles for goal setting after 2015'[2.23MB]


http://www.scidev.net/en/news/next-millennium-development-goals-should-be-more-holistic-.html