MDR-TB Crisis Highlights Gaps in Health Systems

By Chief K.Masimba Biriwasha | Global Editor-At-Large

Despite existing since antiquity, TB is the second biggest killer globally today – and there are more and more cases of TB resistant to first-line drugs normally used to treat it.

In fact, the scope of multidrug-resistant tuberculosis (MDR-TB) is much more vast than previously estimated, requiring a concerted international effort to combat this deadlier form of the disease, according to a statement by the medical humanitarian organisation Médecins Sans Frontières (MSF).

Alarming new data suggests that a concerted international effort is required to combat this deadlier form of the disease.Multidrug-resistant TB (MDR-TB) is a form of TB that does not respond to standard treatments using first-line drugs, MSF said. The deadly TB strain may develops due to insufficient medication or because patients miss some of their treatments.  It is difficult and takes much longer to treat – around two years, with highly toxic drugs.

Drug-resistant tuberculosis (DR-TB) develops during the treatment of drug-sensitive TB, when patients fail to complete their full course of treatment, drug supply interruptions, or when healthcare workers provide improper drug doses or improper, expired, or poor-quality medicine; and is now transmitting from person to person in its own right.

Other factors known to have major impact on treatment adherence include social and economic factors, as well as weaknesses in the health care system itself. In most countries where there are high TB rates, health care systems are often in a shambolic state. This means that even ‘compliant’ patients are at a high risk of TB recurrence, as well as developing and transmitting drug resistant strains.

According to MSF, the global MDR-TB crisis coincides with a huge gap in access to diagnosis and treatment with nearly nine-five percent of TB patients lacking proper diagnosis.

“Existing diagnostic tools and medicines are outdated and hugely expensive, and inadequate funding threatens the further spread of the disease. Worldwide, less than five percent of TB patients have access to proper diagnosis of drug resistance, and only 10 percent of MDR-TB patients are estimated to have access to treatment – far less in low-resource settings where prevalence is highest,” MSF said in the statement.

MSF President Dr. Unni Karunakara added that current knowledge about the extent of MDR-TB did not adequate capture the scope of the problem.

Wherever we look for drug resistant TB we are finding it in alarming numbers, suggesting current statistics may only be scratching the surface of the problem,” he said.

With 95 percent of TB patients worldwide lacking access to proper diagnosis, efforts to scale-up detection of MDR-TB are being severely undermined by a retreat in donor funding – precisely when increased funding is needed most.”

The cancellation of an entire round of funding from the Global Fund to Fight AIDS, Tuberculosis and Malaria threatens to seriously undermine a five-year plan to reach a further 10,000 people living with MDR-TB in Myanmar, along with scale-up plans in many other countries.

According to MSF, the global crisis is exacerbated by a perfect storm of lengthy treatment regimens (around two years) with highly toxic drugs, most of which were developed mid-last century and have unpleasant side effects.

Reduced funds—notably recent Global Fund cuts—and a small market with few manufacturers, have kept the costs of some of the drugs prohibitively expensive. Furthermore, expanded use of a new rapid diagnostic tool with the potential to massively increase early detection of drug-resistant TB in low-resource settings is inhibited by affordability.  It is exactly in those places where the ability to detect TB within hours—as opposed to days or weeks—is most needed to save lives.

MSF urged governments, international donors, and drug companies to fight the spread of drug-resistant TB with new financing and new efforts to develop effective and affordable diagnostic tools and drugs.

Far shorter and less toxic drug regimens are needed, along with currently non-existent formulations for children, and a point-of-care diagnostics test.  Regulatory measures need to be enforced to prevent further spread of the disease due to mismanagement by practitioners.

We need new drugs, new research, new programmes, and a new commitment from international donors and governments to tackle this deadly disease,” said Dr. Karunakara.

Only then, will more people be tested, treated and cured. The world can no longer sit back and ignore the threat of MDR-TB. We must act now.”

Pregnancy complications claim eight women daily in Zimbabwe

By Chief K.Masimba Biriwasha

Harare, Zimbabwe – Between 1 300 and 2 800 women and girls die each year due to pregnancy-related complications in Zimbabwe. This translates to eight women dying every day of the year.

According to the Zimbabwe Maternal and Perinatal Mortality Survey (ZMPMS) conducted in 2007, 725 women die per every 100 000 live births, a figure which is far higher than the Millennium Development Goals (MDG) target of 75 per 100 000 live births.

Additionally, another 26 000 to 84 000 women and girls suffer from disabilities caused by complications during pregnancy and childbirth each year.

Given such shocking statistics, it is quite laudable that the government, in partnership with international donor agencies, the private sector, civil society and individuals, is making efforts to redress the unwarranted deaths of pregnant women in the country.

As in most countries in Africa, maternal and neo-natal health services in Zimbabwe face severe resource shortages from both the public and private sector that hamper the expansion of services.

This is despite the fact that the consequences of maternal mortality are felt not only by women but also by their families and communities.

Loss of women during their most productive years also means a loss of resources for the entire society.

Yet giving birth is such an important activity in our nation that every effort must be taken to guard against the loss of life.

In fact, 50% of the deaths are due to factors which can be prevented, such as delays in seeking care and lack of effective treatment.

Pregnancy-induced hypertension, commonly known as blood pressure, bleeding after birth, and puerperal sepsis (a serious medical condition that affects a woman during or shortly after childbirth, miscarriage or abortion) also contribute to the death of pregnant women.

Conditions such as anaemia, diabetes, malaria, sexually transmitted infections, and others can also increase a woman’s risk of complications during pregnancy and childbirth, and are thus indirect causes of maternal mortality and morbidity.

In addition, Aids accounts for 25% of the deaths among pregnant women.

According to the ZMPMS, 34% of pregnant women in the country tested positive for HIV in 2007, but only 1,8% were taking ARVs with dire consequences for their own lives and their unborn babies.

The survival chances of a baby whose mother dies or is HIV-infected and not on ARV treatment are severely reduced.

Undoubtedly, the political, economic and social crisis of the past decade has had a terrible impact on the public health delivery system, significantly reducing the quality of services provided to pregnant women.

Shortages in personnel, equipment and supplies continue to plague Zimbabwe’s healthcare infrastructure, putting the lives of pregnant women at risk.

Furthermore, many women, particularly in rural areas, cannot afford the transport costs required to make frequent travels to health centres during and after pregnancy.

Most women cannot raise the fees required to consult health personnel and hence go through a pregnancy ignorant of potential life-threatening complications.

Instead, they opt to deliver at home which significantly increases chances that a pregnant woman will die, especially when the delivery requires surgical intervention, or is carried out by non-skilled persons.

Other causal factors for high maternal mortality include gender inequality and lack of women’s rights and poor sexuality education.

Like Zimbabwe, many countries in Africa will not attain the MDGs unless urgent action, political will and commitment is strengthened.

Approximately one in every sixteen women in Africa faces the risk of dying in childbirth, while thousands more face delivery-related complications and illness.

In an effort to influence African states to act on maternal and child mortality, the African Union launched the Campaign on Accelerated Reduction of Maternal Mortality in Africa in 2009.

The purpose of the campaign is to mobilise political will and action that will save the lives of pregnant women and newborn babies.

As part of the campaign, the government of Zimbabwe is partnering with international donor agencies, private companies and individual to raise funding and awareness to reduce maternal mortality in the country.

What needs to happen immediately is a thorough revamp of the public health system otherwise efforts to reach women that die from pregnancy complications will remain in vain.

Healthcare programmes to improve maternal health must be supported by strong policies, adequate training of healthcare providers, and logistical services that facilitate the provision of those programmes.

Ensuring that all women and girls have equal access to the full range of services will be key to success.
More importantly, the government needs to implement policies that promote the liberation of women from traditional, economic, legal and cultural fetters.

Female education and empowerment are critical determinants of fertility, and providing girls with access to education is likely to increase their knowledge about how to prevent pregnancy complications.

Simply put, there must be a commitment to make access to services that improve the status of women as much a part of national life as breathing air.

TB/HIV poses challenges for Zimbabwe

By Chief K.Masimba Biriwasha

Harare, Zimbabwe – Charles Raradza, 44, fell seriously ill in 2001, coughing uncontrollably. He went to get tested for tuberculosis (TB) at a nearby hospital but the bacteria was not detected in his sputum.

Unconvinced, Raradza went to another hospital where a sputum and lung X-ray test revealed that he was indeed TB-infected.

“I was immediately enrolled into the hospital’s directly observed treatment therapy (DOTS), and had to take 13 tablets a day. The tablets were very painful. I guess because I love life so much I never defaulted during the six months that I was on the course,” said Raradza.

After two years, Raradza started coughing again. He went to get tested for TB again.

“At the hospital, it was discovered that I had TB, so I was given 60 injections and tablets – its was painful but I stuck through it. I was put on the 6-month long DOTS programme again,” he said.

In 2005 Raradza said he went to a Voluntary Counseling and Testing centre to get tested for HIV.

“It was unheard of then for anyone to go and get tested but I gathered my courage and went to the testing centre. I tested HIV positive, and was enrolled into the anteritroviral programme,” he said.

After noticing Raradza’s poor response to the AIDS drugs, Raradza said that a doctor-friend of his recommended another TB test. For a third time in his life, Raradza had TB, and he had to go through the treatment regimen of 60 injection and tablets.

According to Dr Tonderai Murimwa, an official in the Ministry of Health and Child Welfare’s AIDS and TB Unit, Raradza’s case of failed detection of TB is not unique and is attributed to changing epidemiological patterns in Zimbabwe.

“Diagnosis of TB is usually straightforward, the best test is sputum microscopy. But HIV changes the way the body reacts to infections. That’s why X-ray is now required but it is very expensive technology and the country cannot afford it at the moment,” said Dr Tonderai Murimwa, an official in the Ministry of Health and Child Welfare’s AIDS and TB unit.

Murimwa added that the drug distribution in the country had experienced severe challenges over the past decade due to lack of material resources such as transport, fuel and personnel.me

TB is a leading cause of illness and death for people living with HIV—about one in five of the world’s 1.8 million AIDS-related deaths in 2009 was associated with TB. The majority of people living with HIV and TB are in sub-Saharan Africa. The risk of developing tuberculosis (TB) is estimated to be between 20-37 times greater in people living with HIV than among those without HIV infection.

According to UNAIDS, TB places a heavy burden on people living with HIV including significant illness that requires at a minimum six months of treatment, with the associated economic costs to the individual, his or her family and the health-care system.

Among African nations, Zimbabwe is one of those most heavily affected by tuberculosis (TB). The deadly combination of TB and HIV epidemics is igniting a silent and uncontrollable epidemic of drug resistant TB that will negate previous national health gains.

The 2009 Global Tuberculosis Control Report from the World Health Organization (WHO) ranks Zimbabwe 17th among 22 countries worldwide with the highest TB burden. Zimbabwe had an estimated 71,961 new TB cases in 2007, with an estimated incidence rate of 539 cases per 100,000 population.

For the past 20 years, Zimbabwe has fought TB fairly successfully, providing free access to WHO-recommended treatments. In the past few years, however, the disease has re-emerged as a leading killer, especially among HIV positive people, who are often not identified though long-established TB tests.

An estimated two-thirds of Zimbabweans with TB are also infected with HIV. As a consequence, Zimbabwe has a staggering six times more TB cases than it did 20 years ago. According to statistics, the success rate of directly observed treatment is just 74 percent, far below the WHO recommended rate of 85 percent.

“In Africa, HIV is the potent factor in the progression of latent TB. People living with HIV are susceptible to TB infection. TB is the most common serious infection associated with HIV infection. The two diseases go hand in hand. This call for an integrated and collaborative approach in dealing with the two conditions,” said Dr. Patrick Hazangwe, a WHO official.

In Zimbabwe, the TB problem is compounded by the fact that patients often fail to complete treatment because they cannot afford the transport costs to and from health centers. The lack of access to health services in remote or rural parts of the country adds to the likelihood that large numbers of TB infections are going undetected and untreated.

To complicate matters, the brain drain of qualified front-line health care workers from Zimbabwe has resulted in poor healthcare delivery. Leck of medical practitioners coupled with obsolete machinery has also worsened the problem.

According to Betty Chikava, Member of Parliament for Mt Darwin East, poor financing of the health ministry is a key hindrance to an effective response to TB and other diseases.

“The Ministry of Health and Child Welfare has received paltry funding – only 7 percent of its projected budget; medical personnel in the hospitals and clinics are seriously overworked. The Ministry of Finance needs to be brought into the picture so that they can finance the health ministry adequately,” she said.

Zimbabwe Fails Its Young People

By Chief K.Masimba Biriwasha| AfroFutures.com Global Editor-At-Large| Harare

ZIMBABWE’s acrimonious political system marked by a bitter rivalry between ZANU PF and MDC political parties combined with a decade-long economic collapse has sidelined the social and economic rights of young people, according to a recently published study.

The new study, which surveyed 1500 urban-based youths  in Harare, Bulawayo, Gweru, Mutare and Chitungwiza, revealed that most young people, that is, 76 percent of the respondents had a basic understanding of their socio-economic rights. Most of the young people felt that promoting such rights through human rights education is required.

In addition, 58 percent of the youth respondents said the government has the primary responsibility for providing socio-economic rights

The study, which was conducted by Youth Initiative for Democracy in Zimbabwe (YIDEZ), aimed to investigate young people’s views on social and economic rights, focusing on awareness, availability and accessibility of such rights.

Many youths in Zimbabwe – approximately 65 percent of the total population – are currently trapped in poverty and unemployment, with their voices largely curtailed in nation building endeavours such as the constitution making process. The study, titled, “Socio-Economic Rights: Youths Know Your Rights,” revealed that the current constitution does not have a provision for economic and social rights of young people. This is despite the fact that over the years the government has ratified various international human rights instruments which it has failed to incorporate into domestic law. According to Sydney Chisi, director of YIDEZ, the ongoing constitution making process had been a missed opportunity to address the issue of young people’s economic and social rights.

“The motivation of the study was the context of socio-economic rights within the framework on the ongoing discussion on the constitution. One of the missing links is that the discussion has been largely political and there has been very little focus on issues of socio-economic rights. If you look at the political discourse in post independent Zimbabwe, you’ll see that we have been moving away from issues of social and economic rights,” said Sydney Chisi, director of  YIDEZ.

To reduce unemployment rates and increase access to jobs, most of the young people surveyed said that Zimbabwe needs major legislative and policy reforms and external assistance for economic development. Sixty-two percent felt that an effective land audit should be conducted by the government to repossess all unproductive land and redistribute it to productive farmers.

The survey found that 32 percent of young people felt that title deeds should be issued to farmers to ensure security of tenure and boost confidence in the farming sector, while 6 percent felt that government must mobilize and distribute farm inputs before the beginning of each season.

“It is all about bread and butter issues. It about access to health, education and responsible local governance. It is difficult to talk about politics and democracy without taking it consideration fundamental human rights. The absence of access to fundamental social and economic rights will exacerbate the abuse of young people. Politicians have a way to come and promise services to young people. So we want young people to know about their basic social and economic rights  as a way for them to demand accountability from their local and national governance structures without necessarily being partisan,” said Chisi.

In the study,  72 percent of the respondents, said that despite slight improvement in the provision of health care following the formation of the inclusive government, young people were still facing a plethora of challenges to access affordable and quality healthcare. In addition, the respondents felt that decrease in public financing of the education sector, exorbitant fees and shortage of teachers is hindering young people from accessing quality education.

According to the study, the sidelining of social and economic rights can be a powder keg that if left unaddressed can hinder the country’s development.

“Zimbabwe has become a nation that is marked by oppressive political arrangements that favour particular segments of society and marginalize the basic survival rights of the average masses. It is saddening to note that social and economic rights have taken second or no place at all in the country priorities,” says the study.

In Zimbabwe, Women Face Baby Pressures

By Masimba Biriwasha| AfroFutures.com Global Editor-At-Large

When Maidei Tavaziva (30) consciously chose not to conceive for approximately five years after getting married, she experienced a barrage of salient remarks from her relatives suggesting that time was up for her to reproduce.

“My aunts, my grandmother and my other relatives started telling me that I needed to have a baby. I suspect that my husband’s relatives were also talking behind my back. My grandmother would say that she now wanted a grandchild. I’m definitely convinced that in Zimbabwe, there is social pressure to produce a baby once you enter into marriage,” said Taziva.

Tavaziva added that though some of the comments appeared innocuous on the surface, the intent was clearly to influence her to get pregnant.

“Of course, I knew that what my relatives wanted was for me to get pregnant and deliver a healthy infant, preferably a boy, so that I could secure my relationship with my husband, and increase my status,” she said.

Unlike most women, Taziva said that she did not bow down to the pressure; she stuck to her guts not to have a child early in marriage because she needed to first complete her educational studies without the pressure of having to look after a baby.

According to traditional norms in Zimbabwe, a woman has a responsibility to expand the clan of her husband once she is married. Babies are often regarded as sealers of marriage – but not just any baby – women are generally expected to give birth to a baby boy who will carry the family name and inheritance.

“A woman who has a first-born child who is a girl is not as revered as one with a boy. So women are under pressure to produce baby boys,” said Betty Makoni, Global Advocate for CNN for protecting the powerless and CEO of Girl Child Network Worldwide.

However, a woman who has a child outside of a recognized and socially sanctioned sexual union faces the risk of being ostracized by family, the community and religious organizations to which she belongs.

“Girls who fall pregnant force themselves into marriage or are forced into marriage. Many women are married because they’ve fallen pregnant,” said Makoni.

For most newly married women in the country, the desire to fulfill social expectations to conceive immediately after marriage supersedes efforts to engage in proper family planning.

“I have friends whom after marriage have experienced pregnancy check-ups from their relatives. They will start to check the skin tone, whether you have nausea and at family gatherings they expect to see you with a bump. Society still expects women to follow the conventional trajectory of dating, marriage, and then children,” said Buhle Makamanzi, a development sector consultant and mother of three.

“This is not to say that motherhood is a bad thing; for me, there is nothing in this world as fulfilling as being a mother – your heart certainly grows bigger.”

According to a Women and Law in Southern Africa Research and Educational Trust (WLSA) study titled “Pregnancy and childhood: Joy or despair?” women’s sexual lives are mediated by those of men.

“Women must conform to male strictures or so they believe. Thus, if their sexuality is perceived as a reproductive resource by males and is controlled by male norms and values, women who are dependent on males will seek to conform to those norms and values,” states the study.

But as Tavaziva revealed the pressure on her came mainly from her female relatives, and that may have been no coincidence.  According to the WLSA report, women often use their reproductive capacity to support their entitlement to benefit from resources held by men.

“This reliance on reproductive roles means that women are obliged to fill that role and produce children to secure their membership in their marital families and build up status that secures their entitlements in that family in their later years,” says the study.

The study also noted that women’s sexual integrity may be demanded and enforced by their natal families to maximize their opportunities for successful marriages.

Makamanzi commented that as women become more independent-minded due to increased access to educational opportunities, social expectations about the timing of pregnancy within marriage are beginning to shift, albeit, slowly.

“One major factor is whether the husband succumbs to pressure, if he does, then as a woman, you’re forced to try for a baby even if it wasn’t your plan. With the buzz on women’s empowerment, some women are beginning to think outside this box. However, pregnancy borne out of societal and family pressure is still rampant even among the so-called career women,” said Makamanzi.


Diabetes in Zimbabwe: It’s Not All About Sugar

GROWING up in Zimbabwe, diabetes (a polygenic disease characterized by abnormally high glucose levels in the blood) was something that the old people always talked about, and the fear of the disease grew over me like a giant baobab.

To describe a person with diabetes, the old people would say in local parlance “Ane shuga”, which literally means: “He/she has sugar”. Essentially, it meant that the affected person has a disease associated with sugar.

To my childhood fancy, I thought that the people who were affected with the diabetes ate a lot of sugar only to discover later it was the common understanding.

Most people in Zimbabwe associate diabetes with a high intake of sugar, particularly in tea.

Little to no other foods are associated with the onset of this condition. Put simply, very few people know that eating too much of carbohydrates, fats, proteins can increase the incidence of diabetes.

I discovered later that diabetes mellitus occurs when the pancreas does not make enough or any of the hormone insulin, or when the insulin produced doesn’t work effectively. In diabetes, this causes the level of glucose in the blood to be too high.

According to experts, the number of people with diabetes in Zimbabwe is growing. In 2003, Zimbabwe recorded more than 90 000 cases of diabetes, an increased of 3 000 from the 1997 figure.

The Diabetic Association of Zimbabwe estimates that around 400 000 people in the country have the disease but many are unaware on their condition.

“About 50 percent of Zimbabweans are diabetic but are not aware of the condition, so many people are suffering from diabetes but do not have any knowledge about it,” a Zimbabwe Diabetes Association official was quoted in The Herald newspaper.

“It is sad that a lot of people have died because of this disease without knowing it, and only relatives will know about it after a post-mortem has been conducted,” added the official. Continue reading

The Great Vasectomy Fear

For most men, the idea of vasectomy, a surgical procedure to cut and close off the tubes that deliver sperm from the testicles, is a complete no-can-do associated with being sexually dysfunctional in the male psyche.

According to the latest issue of Population Reports, titled “Vasectomy: Reaching Out to New Users,” published by the Johns Hopkins Bloomberg School of Public Health, vasectomy is simpler and more cost effective than female sterilization and offers men a way to share responsibility for family planning.

“The most entrenched and powerful rumors concern manhood, masculinity, and sexual performance. Many men confuse vasectomy with castration and fear, incorrectly, that vasectomy will make them impotent,” says the report.  But in fact, “Castration involves removal of the testicles. In contrast, vasectomy leaves the testicles intact, and they continue to produce male hormones.”

The procedure which typically takes from 15-30 minutes and usually causes few complications and no change in sexual function is one of the most reliable forms of contraception. Though it does not offer protection against sexually transmitted infections or HIV, for couples it is a way for men to be directly involved in family planning. Family planning has been largely seen as the responsibility of women but vasectomies allow men to play a part.

The report states that the largest number of vasectomized men are in China, where almost 7% of women in relationships — or more than 17 million couples — rely on vasectomy for birth control. Continue reading