 |
| About Bioline | All Journals | Testimonials | Membership | News |
|
||||||
|
||||||
Indian Journal of Medical Science Vol. 58 No. 4, April 2004 , pp. 166-173 Practitioners Section NEWS Code Number: ms04030 Drug resistant tuberculosis levels ten times higher in Eastern Europe and Central Asia GENEVA — Tuberculosis patients in parts of Eastern Europe and Central Asia are 10 times more likely to have multidrug-resistant TB (MDR-TB) than in the rest of the world, according to a World Health Organization (WHO) report into the deadly infectious disease. China, Ecuador, Israel and South Africa are also identified as key areas. New data released today confirm geographical concentrations of TB drug resistance across the Commonwealth of Independent States. Six out of the top ten global hotspots are: Estonia, Kazakhstan, Latvia, Lithuania, parts of the Russian Federation and Uzbekistan, with drug resistance in new patients as high as 14%. "TB drug resistance is an urgent public health issue for countries from the former Soviet Union," said Dr Mario Raviglione, Director of WHO's Stop TB Department. "It is in the interest of every country to support rapid scale-up of TB control if we are to overcome MDR-TB. Passport control will not halt drug resistance; investment in global TB prevention will." WHO's leading infectious disease experts estimate there are 300 000 new cases per year of MDR-TB worldwide. There is also new evidence proving drug resistant strains are becoming more resistant, and unresponsive to current treatments. 79% of MDR-TB cases are now "super strains", resistant to at least three of the four main drugs used to cure TB. MDR-TB is TB that is resistant to the two medicines most commonly used to treat it, Isoniazid and Rifampicin. Without the correct drugs MDR-TB is untreatable and in most cases fatal. Though curing `normal' TB is cheap and effective - a six month course of medicines costs US$ 10 - treating drug resistant TB is a hundred times more expensive. Even then a cure is not guaranteed. With no effective vaccine, everyone is vulnerable to infection simply by breathing in a droplet carrying a virulent drug resistant strain. Highest prevalence of MDR-TB coincides with one of the world's fastest growing HIV infection rates in Eastern Europe and Central Asia. Recently the United Nations Development Programme reported more than 1.5 million people living with the virus in the region, compared to just 30 000 in 1995. People whose immune systems are compromised with HIV are many times more susceptible to contracting all forms of TB. "With people's immune systems compromised, MDR-TB has a perfect opportunity to spread rapidly and kill," said WHO Assistant Director-General of HIV/AIDS, TB and Malaria, Dr Jack Chow. "As a priority to prevent the spread of all forms of TB, we need more investment in resources, programmes and health workers." New surveys in China, where HIV is also increasing, have also mapped MDR-TB areas of concern. Two provinces revealed around one in every ten new patients tested positive with MDR-TB. The report's authors fear similar high levels of resistance could exist elsewhere, since only six of the country's 23 provinces were represented in the study. Some successes have been achieved since the last study four years ago - most notably in Cuba, Hong Kong and the United States. Rates in those countries have decreased, as a result of strong and well-maintained TB strategies. According to the report "the most effective strategy to prevent the emergence of drug resistance is through implementation of the DOTS." DOTS is the internationally agreed treatment strategy, and is designed to ensure patients take their medicines properly. It has proven effective in preventing drug resistance. The report also notes TB control strategies used in Eastern Europe and the Russian Federation have recently begun to improve with the introduction of the DOTS strategy. In worst affected areas innovative "DOTS Plus" schemes which diagnose and treat effectively drug resistant TB, are being introduced. Patient access to MDR-TB drugs is key to the success of the DOTS Plus strategy. The cost of supplying these medicines has fallen dramatically through initiatives backed by the WHO, namely the Green Light Committee, which engages pharmaceutical companies to fully support the fight to eradicate drug resistant TB. Research and development into new TB drugs is also urgently required to shorten the length of treatment and to treat drug resistant strains. After a 40 year standstill in TB drug development, R&D investments are critical now to expand treatment options and overcome resistant strains. The Global Alliance for TB Drug Development, a WHO partner, is building a pipeline of promising new drugs and uniting public and private researchers in the search for a faster cure. "Anti-Tuberculosis Drug Resistance in the World - Third Global Report" presents data from the examination of 67 657 TB patients in 77 countries and regions. "The more we survey, the more MDR-TB we find," said the report's leading author Dr Mohamed Aziz. "MDR TB has now been identified in every region and almost every country surveyed in what is the largest drug resistance surveillance project of its kind. Yet the true burden is unknown and may well be higher in unsurveyed areas, stressing the need for full expansion of drug resistance surveillance." Source: http://www.who.int/mediacentre/releases/2004/pr17/en/ Far more pregnant women getting antenatal care The number of pregnant women in developing countries receiving antenatal care during pregnancy has increased significantly since 1990, signalling that an untapped opportunity exists to reach poor women with a whole package of life-saving health services, according to a joint report issued by UNICEF and the World Health Organization. The number of women receiving antenatal care has increased by 20% since 1990, with the greatest progress in Asia (31%) and the least improvement in sub-Saharan Africa (4%). "The advantages of receiving regular antenatal care cannot be stressed enough," said Carol Bellamy, Executive Director of UNICEF. "If a woman comes for antenatal care early in her pregnancy, there is time for early diagnosis and treatment of infections in the mother, and an opportunity to prevent low birth weight and other conditions in the newborn. These findings have enormous significance for maternal health and child survival." The study highlights nations that have begun to see antenatal care visits as a unique opportunity to provide the pregnant woman with a vaccination to prevent tetanus, an insecticide-treated bednet to prevent malaria, screenings for anaemia, and enrolling women in Prevention of Mother to Child Transmission of HIV, counselling for a safe delivery all factors that help ensure that the mother remains healthy through childbirth and gives her child the best start in life. Antenatal care also increases the likelihood of a skilled attendant being present at the birth. A skilled attendant is a doctor, midwife, nurse, or other health care provider with equivalent skills, who can detect and manage complications at birth. This can often mean the difference between life and death for both mother and baby. "The most dangerous time for a pregnant woman is the critical period around labour and delivery, which is when most women die," said Joy Phumaphi, Assistant Director-General for Family and Community Health at WHO. "Giving care and information during pregnancy can help reduce the number of women who die giving birth." More than half of women in the developing world are getting at least four antenatal visits during their pregnancy, which is in line with the WHO recommendation that antenatal care for normal pregnancies should be a minimum of four visits. Notable exceptions, however, include Bangladesh, Ethiopia, Morocco, Nepal and Yemen, all of which have relatively high percentages of women who have only one antenatal care visit. South Asia, overall, had the lowest levels of antenatal care with only 50% of women getting even one visit. Wealth and education tell The study finds that antenatal care is heavily influenced by such factors as wealth and education. In poor households, women are far less likely to use antenatal care than women in well-off households. And the report notes that women with secondary schooling are two to three times more likely to have antenatal care than women with no education. "This demonstrates, yet again, the undeniably powerful link between education and improving the lives of women and their children," Bellamy said. Opportunity to save lives Antenatal health care visits can be a critical opportunity for women to get access to other healthcare services, and the report concludes that this opportunity is not being maximized in most instances. "Improving antenatal care is vital to achieving several of the Millennium Development Goals," says WHO's Phumaphi. "Reducing child mortality, malaria and TB prevalence and mortality, and reducing HIV transmission, depend to a large extent on reaching women during pregnancy with interventions we know work." The authors of the report point out that greater efforts need to be directed toward:
Source: http://www.who.int/mediacentre/releases/2004/pr22/en/ WHO leads drive for international coordination of clinical research The World Health Organization (WHO) and Current Controlled Trials (CCT) have announced that all randomized controlled trials approved by the WHO ethics review board will be assigned an International Standard Randomised Controlled Trial Number (ISRCTN).1 As a result, the scientific community should now find it easier to keep up-to-date with current research. Randomised controlled trials are considered the best way to compare - in an unbiased manner - the effects of particular interventions on people or populations either for health promotion, prevention, treatment or for rehabilitation. They are one of the main sources of medical knowledge, yet information about these trials is difficult to find. This is because several trials may have the same title, one trial may be reported in several places under different titles, and many trials are never reported at all. Information is even more difficult to find about neglected diseases that disproportionately affect poor and marginalized populations. WHO supports and funds much of the research in this area. However so far, there has been no mechanism to make the information generated from this research easily available to researchers, particularly those in developing countries whom it affects most. By providing free access on the internet, ISRCTNs offer a way to keep the international community informed about these clinical trials. Supporting systematic trial registration is consistent with WHO's commitment to increase knowledge sharing, access and utilization in low and middle income countries. According to Dr. Tikki Pang, Director of the Department of Research Policy and Cooperation, who is leading the effort in trial registration, "The ISRCTN Register is an important first step within a wider context of the new emphasis on the need to increase international access to and utilization of health-related knowledge". In the first phase, all trials included in the HRP (UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction) trials register have now been included in the ISRCTN Register. "Our trials register has been operational for two years and we welcome this opportunity to make our research programme in sexual and reproductive health more accessible to the wider community," says Dr Paul Van Look, Director of Reproductive Health and Research at WHO. Randomised trials in the other major research areas that the WHO supports - infectious diseases, childhood diseases, vaccines and others will be added shortly to the ISRCTN Register. The ISRCTN Register also tackles the problem of publication bias - trials that are not published either because of negative findings, or language barriers, or inaccessibility of the researcher to journals. By registering clinical trials at the start of the research, the ISRCTN Register will ensure that this information is now more easily available. "Although trial registration is an important step on its own, it should not be seen as an end in itself," says Dr. Timothy Evans, Assistant Director-General of the Evidence and Information for Policy cluster of the WHO. "Only when these registers are efficiently used can they serve the purpose they are set up for. As an international agency with a mandate to set standards and norms, WHO will take steps to encourage its Member States to support the publication of research conducted within their countries and encourage the use of such registers." Working across 192 countries, one of the major challenges for WHO is coordinating national research activity in the global effort to reduce maternal mortality and stem pandemics like HIV, re-emergence of tuberculosis and malaria, and eradication of polio. "We are delighted that the WHO are taking a lead in the registration of trials with an ISRCTN," says CCT's Managing Director Anne Greenwood. "The ISRCTN scheme was conceived to address the confusion experienced by the research community. For controlled trials to be useful on a global scale, it is critical that research be coordinated. ISRCTNs offer a way to do exactly that." The ISRCTN Register represents the first online service that provides unique numbers to randomised controlled trials in all areas of health care and from all countries around the world. Access to the ISRCTN Register is completely free and open to the public. Since its launch in May 2003, the Register has assigned ISRCTNs to over 1800 trials, and is growing fast. The ISRCTN Register has been developed by Current Controlled Trials Ltd, part of the Current Science Group of companies. The Group has its headquarters in London, UK and also has offices in Philadelphia and Tokyo. 1This is a unique number that provides a means of identifying and unambiguously tracking a trial throughout its life cycle. Information about trials that have received this number can be obtained from an online register maintained by Current Controlled Trials®. Access to this Register is free of charge. Source: http://www.who.int/mediacentre/releases/2004/pr23/en/ World Health Day: Road safety is no accident! Road crashes are the second leading cause of death globally among young people aged five to 29 and the third leading cause of death among people aged 30 to 44 years. Road crashes kill 1.2 million people every year and injure or disable as many as 50 million more. Without immediate action to improve road safety, it is estimated that road traffic deaths will increase by 80% in low- and middle-income countries by 2020. A joint report launched by the World Health Organization (WHO) and the World Bank today demonstrates that much can be done to reduce the toll of deaths and injuries and that "Road Safety is no Accident". "Thousands of people die on the world's roads everyday. We are not talking about random events or `accidents'. We are talking about road crashes. The risks can be understood and therefore can be prevented," said Dr LEE Jong-wook, Director-General, World Health Organization. "Road safety is no accident. We have the knowledge to act now. It is a question of political will," he added. The magnitude of this growing global public health crisis, the risk factors that lead to road traffic deaths and injuries and effective ways to prevent them are detailed in the World report on road traffic injury prevention. The report provides governments and other policy-makers, industry, nongovernmental organizations, international agencies and individuals with concrete recommendations to improve road safety. Unlike in high-income countries where those most at risk of injury or death are drivers and passengers in cars, the people who are most at risk of being involved in a road traffic crash in low- and middle-income countries are pedestrians, cyclists, motorcyclists and users of informal modes of public transport. Human and Economic cost The human suffering caused by road crashes is huge for every victim of a crash, there are family members, friends, and communities who must cope with the physical, psychological and economic consequences of the death, injury or disability of a loved one. Crash survivors and their families must cope with the painful and often long-term consequences of injury, disability and rehabilitation. In many cases, the cost of care, the loss of the primary breadwinner, funeral expenses, or the loss of income due to disability can drive a family into poverty. The human suffering is in itself a reason to act now, but the economic impact is also significant. In low- and middle-income countries, the cost of road traffic injuries is estimated at US$ 65 billion, exceeding the total amount these countries receive in development assistance. Road traffic injuries cost countries between 1% and 2% of gross national product, amounting to US$ 518 billion every year. Taking action makes a difference However, many countries have already demonstrated that actions to improve road safety will protect people. Recent gains have been achieved in nations such as Colombia, Costa Rica, Ghana and Thailand. In past decades tens of thousands of lives have been saved in Australia, Canada, New Zealand, the United States of America and others countries in Western Europe. This success is attributed to improving the design of vehicles and roads and focusing on legislation, enforcement and sharing of information about the use of seat-belts, helmets, and child restraints and about the dangers of speed and drink-driving. Among the report's recommendations are the appointment of a lead agency in every country to coordinate multisectoral efforts, the preparation of national road safety strategies and plans of action with clear roles and objectives for each sector, and the implementation of proven interventions to prevent crashes and minimize injuries and their consequences. The report notes that road safety is a shared responsibility, and calls on the expertise of people across many sectors and disciplines, including public health professionals, health care providers, road and motor vehicle engineers, law enforcement officials and educators. Source: http://www.who.int/mediacentre/releases/2004/pr24/en/ More than 600 million people urgently need effective malaria treatment to prevent unacceptably high death rates More than 600 million people, most of them children living in sub-Saharan Africa, face the daily threat of death from malaria because new, effective treatments are not available where they live. Existing, cheaper medicines, which have been used for many years, are no longer effective in most places because the malaria parasite has developed resistance to them. "At least one million children die every year in Africa from malaria. Several million more become seriously ill. In many places, they are still given medicines whose effectiveness is very low and decreasing," said Dr LEE Jong-wook, Director-General of the World Health Organization (WHO). "Better treatment is available and must be delivered urgently to the people who need it most." Artemisinin-based combination therapies (ACTs) provide a highly effective new medicine to treat malaria for the first time in more than 20 years. But despite some progress, the new treatment has not become available as widely or as quickly as it needs to. Since April 2001, WHO has strongly recommended that countries where there is resistance to conventional treatments should switch to ACTs. However, at around US$ 2 for an adult dose, ACTs cost 10-20 times as much as the old monotherapies such as chloroquine. For most countries in Africa, external funding will be required. In 2002, the Global Fund to Fight AIDS, TB and Malaria started to make significant funds available to countries in need. Since then, six countries in Africa have started using ACTs: Burundi, Mozambique, Senegal, South Africa, Zambia, and Zanzibar. In the past 12 months, an additional nine countries in Africa have adopted ACTs in their antimalarial treatment policies: Benin, Cameroon, Comoros, Gabon, Ghana, Equatorial Guinea, Kenya, Sao Tome and Principe, and the United Republic of Tanzania. Others are likely to follow suit this year. Outside Africa, 14 malaria endemic countries have adopted an ACT policy. Throughout this process, WHO has provided technical advice and support to ministries of health on all aspects of national treatment policy change, including monitoring the therapeutic efficacy of medicines, as well as implementation. "We will continue to strongly advocate for rapid scale-up of ACTs," said Dr Jack Chow, Assistant Director-General for HIV/AIDS, Tuberculosis and Malaria at WHO. "Some countries are still reluctant to adopt ACT treatment policies because it is much more expensive than conventional therapies. Countries feel insecure about the sustainability of donor support as they switch to more costly treatment regimes. However, the progress we have witnessed over the last 12 months is remarkable in terms of its speed and the number of countries changing their policies." WHO estimates that the global demand for ACTs will soar from about 20 million per year currently to between 130-220 million adult treatments in 2005. In the following years and at the current price, about US$ 1 billion per year will be required to provide 60% of the population in need with ACTs. Much of this money will have to come from donor countries and funding institutions such as the Global Fund. Together with Roll Back Malaria (RBM) partners, WHO works for lower prices to reduce the cost of making quality ACT products available to the poor. "While private-public cooperation can be instrumental, we have learnt that it is wrong to wait for the prices to go down," said Dr Fatoumata Nafo-Traoré, Director of WHO's Roll Back Malaria Department. "Increased demand is the main factor that will drive down prices." WHO's renewed call for a more rapid change to ACTs comes as the world commemorates Africa Malaria Day. This year's theme is "children for children to roll back malaria". Young children under five are the main victims of malaria. They have a right to be protected, but in reality they do not have access to life-saving treatment because their parents are poor. Increased access to effective medicines, together with the improved use of technology to prevent malaria transmission, could enable much better progress towards the RBM targets, set by African leaders in 2000 . In the area of prevention, WHO also notes important technological progress since 1998, despite inadequate funding. According to the Africa Malaria Report 2003, about 15% of African children slept under mosquito nets and 2% under insecticide-treated nets, which are known to be highly effective. Although these rates are far from satisfactory, the adoption of mosquito nets throughout Africa reflects a profound, even if incipient, change in behaviour and attitude. Such practice was unknown to most rural African populations until the late 1990s. "This is a significant improvement," says Dr Nafo-Traoré. "However, we are still far from reaching our reduction targets, because the fight against malaria has been so dreadfully under- funded." The situation has improved considerably since the emergence of the Global Fund, but not enough. Until and unless most people can afford to buy their own bednets and pay for their own treatment, substantial public funding will continue to be needed." 1Four years ago, 44 Heads of State and Government from the 50 malaria-affected countries in Africa came together in Abuja, Nigeria, to set ambitious targets to reduce the malaria burden by the end of 2005. They committed themselves to work to improve access to affordable and appropriate treatment for at least 60% of those suffering from malaria. In the area of prevention, they agreed that at least 60% of those at risk of malaria should be protected by insecticide-treated mosquito nets and other community preventive measures, and that at least 60% of pregnant women should have access to intermittent preventive treatment. Source: http://www.who.int/mediacentre/releases/2004/pr29/en/ Copyright by The Indian Journal of Medical Sciences |
| |||||||||
