US$120 million required to fight TB among children.

By Masimba Biriwasha | Op-Ed | @ChiefKMasimba | January 09, 2014

According to an ambitious plan launched last year by leaders in the TB field, a total of  US$120 million is required to stem the TB among children.

The plan titled, The Roadmap for Childhood TB: Toward Zero Death, outlines three priority areas that require attention in order to turn the tide in the fight again TB including: a sense of urgency beyond the TB community, improvement in research, policy development and clinical practices as well as increased funding. Continue reading

TB in Children: Why Zimbabwe Must Act Now

By Chief K.Masimba Biriwasha | iZiviso Editor-in-Chief

Harare, Zimbabwe – Tuberculosis (TB) is a major public health problem in Zimbabwe yet very little is known about the impact of the disease on children. Without a functional health-care system and research into pediatric TB, Zimbabwe is likely to continue losing its children to this hidden epidemic.Image

Among African nations, Zimbabwe is one of those most heavily affected by TB. The 2009 Global Tuberculosis Control Report from the World Health Organisation (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 people. While, Zimbabwe has fought TB fairly successfully since attaining statehood in 1980, in the past few years the disease has re-emerged as a leading killer, especially among people living with HIV, who are often not identified through long-established TB tests. Put simply, the TB control programme has been adversely affected by a lack of adequate financial, human and material resources.

As it is, there’s very little epidemiological data on the extent of TB among children in the country. Experts say that child TB is widely under-reported and can represent as much as 40% of the TB caseload in some TB high burden settings such as Zimbabwe. Children are at high risk of TB, are prone to disseminated disease and the diagnosis of paediatric TB may be difficult, since complaints often are unspecific and contacts may not been known.

To make matters worse, the HIV epidemic has affected TB in children enormously, as it has adults. It has increased the risk that infants and young children will be exposed to TB, since many adults with TB-HIV are young parents.

HIV-infected children have a 20-fold risk of developing TB compared to HIV-uninfected children. It also makes diagnosis and treatment more complicated and increases the risk of TB-related death about 5-fold.  The HIV epidemic has also orphaned many children (with or without TB-HIV themselves).

Unfortunately, Zimbabwe’s national tuberculosis programme has historically not given child TB high priority because of diagnostic challenges (e.g., children under 10 have difficulty producing enough sputum for microscopy and the majority are smear-negative); children are not a major source of the spread of the disease; resources are limited; recording and reporting forms did not include boxes for recording ages 0–4 and 5–14 until 2006.

“Our ability to even assess the magnitude of the problem is severely hampered by the lack of diagnostics in children. The problem is that diagnostic tools, both current and in development, do not adequately take into account the special requirements for assessing children,” said Dr Steve Graham, chair of Stop TB’s Child TB Subgroup of the DOTS Expansion Working Group.

Once infected with TB, infants and young children are at greater risk than adults for developing active TB disease, as well as of having the TB disseminate throughout the body, including to the brain, where it causes meningitis. This type of TB is often fatal or leaves the child with major disability.

Many health workers regard the management of a child with suspected TB as ‘difficult cases’, especially with regard to diagnosis. Children are thought of as needing specialised care.

Against this background, TB case-finding efforts should target children under 5 years of age living in a household with a sputum-smear positive adult. If the children are well, they should receive isoniazid preventive treatment (IPT) to help prevent their developing active TB disease.  If they are not well, TB treatment should be considered and a clinical examination is recommended.

Suggestions for national tuberculosis programmes include:

  • Establish a dedicated child TB working group that includes National Tuberculosis Control Programme (NTP) staff and national child TB experts.
  • Use the working group to set practical priorities and goals, develop guidelines, implement activities for child TB, support health workers managing child TB and raise awareness through advocacy and health education.
  • Include the needs of child TB in routine NTP activities, such as training, drug procurement, strategic plans and recording and reporting.

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.

Help Me Raise A Voice For Africa’s Pregnant Women

pregnant_womanWHILE governments in sub-Saharan Africa continue to dole out money on military hardware, teargas canisters and baton sticks etc., pregnant women in the region are dying in droves due to lack of proper healthcare. Paradoxically, women and girls are the main caregivers for the sick in the absence of proper health systems. Yet when they need care the most during pregnancy it is not available, a scenario made worse by gender inequities that put the lives of women and girls at risk.

The statistics are downright shocking. In sub Saharan Africa, 1 in 16 women is likely to die as a consequence of pregnancy and childbirth, according to a recently published report titled “Measure of Commitment: Women’s Sexual and Reproductive Risk Index for Sub-Saharan Africa”.

For many women in the region, particularly in underserved remote and rural areas, getting pregnant is akin to a death sentence.

“Pregnancy is dangerous business in Sub Saharan Africa where a woman is 100 times more likely to die from pregnancy related complication than in a developed country,” states the report. Continue reading

Young Zimbabweans Face HIV Risk As Hard Times Hit

Like many young people growing up in Zimbabwe today, Linda Kuterera (not her real name) was forced to drop out of school because her mother could no longer afford the spiraling school fees.

Soon after she stopped going to school, Linda’s mother fell sick and had to be hospitalized.

“They told me to pay for my mother’s medication, and being the eldest in the family the responsibility fell on me. I hate what I am doing but I am forced to sleep with men so that I can raise money to pay for the hospital bills,” said Linda choking back tears.

Poverty has left many young girls and women with little choice but to sell their bodies in order to cope with the economic struggles and food shortages.

According to the Zimbabwe 2008 National Youth Shadow report, girls as young as 12 are being forced to sell their bodies to raise money for sustenance or just to get a day’s meals. Unfortunately, young Zimbabweans are often likely to be left out of HIV and AIDS programmes, adds report.

The report, which seeks to measure the country’s progress on the 2001 UNGASS Declaration on HIV and AIDS states that young people continue to be overlooked in the implementation of programmes. Continue reading

AIDS home-based care in Zimbabwe in dire need of support

Girls

Girls

The HIV epidemic is shaking up Zimbabwe, like many countries in sub-Saharan Africa, and the shock is being reflected in the collapse of the public health-care system.

According to the World Health Organization’s (WHO) 2006 World Health Report, the African continent bears 24% of the global burden of disease but has only 3% of the global health-care workforce and 1% of the world’s financial resources.

The report identifies 57 countries that cannot meet a widely accepted basic standard for health-care coverage by physicians, nurses and midwives; 36 of these ‘critical countries’ are in sub-Saharan Africa.

The WHO estimates that it will take an additional 2.4 million physicians, nurses and midwives to meet current needs, along with an additional 1.9 million pharmacists, health aides, technicians and other auxiliary personnel.

In simple terms, the public health-care system can no longer accommodate the millions of ill people who require medical attention, care and support. Ironically, the money that is flowing into Zimbabwe to combat HIV has done little to resolve the problems of the poor and weakened public health systems – problems made worse by the ‘brain drain’ of qualified medical personnel.

Critically ill people, it seems, are being offloaded from the public health system onto the community. Increasingly, the burden of HIV care is being borne at the community level, particularly at the household level, where much of the care work and support costs for people living with HIV (PLHIV) are now being taken on. Continue reading

It’s so sad, as her death was avoidable

By Godsway Shumba

Guest Blogger

 

“Lord! Give me another chance. I want to live and look after my children. They are still very young.”

 

Vimbayi (not her real name) repeated this prayer for several nights during her last days. In spite of her desperate prayers, she died at the age of 28, leaving behind two children.

 

Perhaps the saddest part is that her death was avoidable if she had had the correct information and people to support her.

 

A relative of Vimbayi, I finally got a chance to see her five months after hearing of her failing health. By that time, she was very weak. I asked her husband whether she had been tested for tuberculosis. He handed me her medical records.

 

At first, I thought that this was a breach of confidentiality. Later, I realised time was running out and we needed to do our best from an informed position. In my community, before HIV/Aids, people easily shared medical records.

 

But the Aids stigma changed the way people share information about their health.

 

The records confirmed that two sputum tests for TB had produced negative results. Unlike her husband, I also realised that Vimbayi had tested positive for HIV. As someone who was working in the HIV/Aids field, I knew the meaning of phrases such as “patient referred to OI (Opportunistic Infection) Clinic” and “post-test counselling done and positive living discussed”.

 

Prophylaxis treatment had been prescribed but I could not see any signs of it. She told me she stopped taking it two months previously because there had been no improvement.

Continue reading