Tuberculosis

The Initiative for Sub-district Support (ISDS) approached the Centre for Health Systems Research & Development to assist in conducting a situation analysis regarding the control of TB in Tshepo. The research was conducted in March 2000.

South Africa has one of the highest TB rates in the world, and the incidence is increasing, Parliament's Health Portfolio Committee was told. South Africa's current rate is 419 per 100 000 people, which is more than double that in other developing countries. TB rates have doubled in most provinces in the past five years' with projections of a five-fold increase by 2005 to 600 000 cases a year. Dr Karin Weyer, of the Medical Research Council, estimates that South Africa had 273 365 cases last year, of whom 46,7% were HIV-positive. Dr Refiloe Matji, the Department of Health's director of TB control programmes, said South Africa's cure rate of 62 % fell short of the World Health Organisation's standard of 85 %. Also, on Tuesday this week, the South African National Tuberculosis Association appealed to Parliament's health portfolio committee for more funds to combat the increasing tuberculosis rate. Santa said the high HIV/AIDS rate was fuelling the increase of the tuberculosis rate and urged government to implement a strategy that would combat the HIV/AIDS fight along with the tuberculosis epidemic. Staying with news on tuberculosis, World TB Day, which falls on the 24th of March 2001, has adopted the theme DOTS: TB cure for all, which calls for equitable access to TB services for anyone who has TB, free from discrimination - rich or poor, man or woman, adult or child, imprisoned or free, and including other vulnerable groups such as people with HIV or drug resistant TB. TB cure for all contributes to the fulfilment of everyone’s right to the enjoyment of the highest attainable standard of health. (Source: Brian Stuart: The Citizen, 21 March 2001; and SAPA, 20 March 2001)

South Africa will join the rest of the world in celebrating World TB Day on March 24 and highlighting problems about multi-drug resistance. According to World Health Organisation (WHO) representative in South Africa Mrs Greer van Zyl all activities will take place under the theme: Dots: TB cure for all. The marking of the day aims to raise awareness about an available cure for TB and the right to access TB treatment and complete the treatment without stigma. This would contribute to the fulfilment of a constitutional right to enjoy the highest attainable standard of health. Van Zyl says that the theme reflects the important role of governments and the private sector in providing TB drugs and services and points to the need for health services to be patient- centred and non-discriminatory. She said that Dots providers are challenged to continue outreach and adapt Dots to the needs of TB patients. Dots workers play a crucial role in the community to ensure the right to health for patients. Among factors that influence the incidence of TB are malnutrition, stress and unemployment. (Source: Sowetan, 15 March 2001)

The Global Alliance (GA) for TB Drug Development, which is carrying out research into the development of a more effective yet affordable cure for tuberculosis, officially opened its office in Cape Town on Monday.

SA's Medical Research Council is to lead an international team, which it is hoped will produce efficient drug treatment for tuberculosis. Council president Malegapuru Makgoba said at a healthcare conference yesterday that SA scientists would conduct research as part of a $500m effort spread over 10 years and in three countries. The council had also set up three units around the country to take advantage of developments in the unravelling of the human gene and other similar research. Makgoba said after the meeting that the recently formed Global Alliance of TB Drug Development had been formed with the financial backing of the Bill and Melinda Gates Foundation, the Wellcome Trust, the Rockefeller Foundation and the World Health Organisation, and the council. He said that of the three centres in which it would operate, the council would be the only research site. Brussels would be the advocacy centre and New York would provide the governance venue and would deal with funding issues. The initiative was to be launched in Cape Town next week.

Tuberculosis remains the most important communicable disease in the world. In South Africa it accounts for over 80% of all notifiable diseases. The combination of a bacterium which presents special problems in treatment and the tissue destruction that results from the host response have made it a dangerous and life threatening disease since very early human civilization.

The process of developing and implementing the district's TB Control Programme (published jointly with the Department of Health)

When I think of tuberculosis, a picture that comes into my mind is of adults, often elderly men, struggling to take in air, lying in a hospital bed, perhaps sitting outside in the sun, helpless, undignified, their health and social, family and community respect and support lost. Our response as health workers has been to relegate TB patients to separate clinics, to label them difficult, and to dole out pills in very large numbers, with little explanation of the disease or the treatment. We seldom have the inclination nor make the time to ask, listen or to empathise. We then wonder why patients fail to complete their treatment, and we embark on research programmes to find out what went wrong! Then the WHO comes up with the solution - DOTS, which could be interpreted as getting other people, the community, to do the work for us!