World
TB Day 2003
DOTS*
cured me it will cure you too!
*DOTS: internationally recommended strategy for
TB control
FACT SHEET 1
The TB
challenge
More people die from tuberculosis (TB) than from any other
curable infectious disease in the world. Every day, more than 20000 people develop active TB and
5000 die from the disease. One-third of the worlds population is infected with
the TB bacillus.
TB is caused by the bacillus Myobacterium tuberculosis and is spread through the
air like the common cold. If left untreated, one person with active TB will
infect on average between 10 and 15 people every year.
TB infects people in every country of the world, both rich
and poor alike. However, 22 countries account for 80% of the global TB burden.
Many of these high-burden countries are particularly hard hit by poverty and
the resulting malnutrition, poor sanitation and overcrowding that contribute to
spread of the disease.
The global TB epidemic continues to increase by 3% every
year and by 10% annually in sub-Saharan Africa, fuelled mainly by the HIV/AIDS
epidemic affecting many African countries. HIV co-infection greatly increases
the risk of progressing from latent to active TB by weakening the immune
system.
TB patients who start, but do not complete, their course of
drug treatment can develop multidrug-resistant TB (MDR-TB), which is much more
difficult and costly to treat.
Drug-resistant strains of TB are spreading because of the
greater mobility of populations resulting from increased air travel and
immigration. MDR-TB has been increasing over the past 20 years, highlighted by
deadly outbreaks in North America and Europe in the late 1980s and early 1990s.
DOTS the cure for TB
TB is curable. DOTS the internationally
recommended strategy for TB control cures patients, saves lives, prevents the
development and spread of drug resistance, and reduces disease transmission.
Widespread use of DOTS could save millions of lives.
With DOTS, TB patients receive free drugs and are observed
taking every single dose for the first two months of their six- to eight-month
treatment regimens. This ensures that TB patients take all their drugs, and it
also means that many can be treated at home instead of in clinics or hospitals.
In 1993, the World Bank hailed DOTS as "one of the
most cost-effective of all existing health interventions", yet only 30% of
people with TB are currently being treated under DOTS.
Access to DOTS for TB patients is limited by a lack of
political will, insufficient resources, inadequate health care infrastructure,
unreliable drug supplies, poor management, remote locations and challenging
geography, homelessness, and social stigmas that prevent people particularly
women from seeking treatment.
The Global Plan to Stop TB eliminating TB as a public
health problem
1. The Stop TB Partnership is a global movement with more
than 250 members, including governments, scientists, nongovernmental
organizations, donors and other TB advocates, who work together in coordinating
action and resources to control TB.
2. Over the next five years, TB partners around the world
will continue to:
expand DOTS treatment
services so that all those with TB have access to effective diagnosis and
treatment;
adapt DOTS to meet the
emerging challenges of HIV and TB drug resistance;
support research to develop
better methods for diagnosis, new drugs and a new TB vaccine;
strengthen the Stop TB
Partnership to accelerate progress and mobilize resources so that proven TB
control strategies are effectively applied.
3. Global targets:
by end-2005, to detect 70% of all
infectious TB cases in the world and cure 85% of those detected;
by 2010, to reduce TB prevalence and
deaths by 50%;
by 2020, to avert 25 million deaths
from TB and prevent 50 million TB cases;
by 2050, to eliminate TB as a public
health problem.
FACT SHEET 2
DOTS cured me
it will cure you too!
The theme for World TB Day 2003 is People with TB and the
slogan is DOTS cured me it will cure you too! This highlights the need to
involve people with TB as advocates and active participants in TB control.
Planned activities for 2003 will emphasize mobilizing TB patients and people
who have been cured of TB as well as those in the health sector to advocate
for government action, educate communities, and put a human face on TB to
reduce social stigmas associated with the disease.
People with TB
People infected with TB can bring about positive change! By
combining their voices, they can form a powerful lobby to call for stronger TB
control programmes with DOTS expansion, and better access to diagnosis and
treatment. Peru was once on the list of countries with the highest global TB
burden. Thanks in part to a street demonstration in the early 1990s by TB
patients protesting the lack of access to effective TB drugs, the Peruvian
government responded with commitment, resources and action. Today, Peru is off
the list of high-burden countries and has one of the best TB control programmes
in the world.
It is important that people with TB be visible in their
communities, not hidden away. Neighbours and family members must learn that TB
is not a death sentence when patients have access to DOTS. In some parts of the
world, there is such a stigma associated with having TB that people do not seek
treatment. This is especially true for women. Helping TB patients to get
involved in advocacy could mean the difference between life and death for
others suffering from TB.
People cured of TB
Former patients make the best ambassadors for TB control.
Those who have suffered from TB and are now cured are living proof of the
effectiveness of the DOTS treatment strategy. They are also well educated about
TB symptoms, treatment and prevention, and therefore extremely valuable in
spreading that information throughout their communities and identifying people
who should be tested for TB. In 2001, the Damien Foundation in Bangladesh
detected 11 641 cases of TB, more than 25% of whom were sent for testing by
former TB patients. Case detection is critical for TB control, and encouraging
people with suspected TB to go to a clinic is a vital service provided by those
who recognize the symptoms.
Former patients have personal experience with TB, so they
are highly motivated. They are often willing to volunteer their time to trace
treatment defaulters and to become DOTS partners. Some Nelson Mandela, for
example are highly influential at the national and international level and
can have a huge impact in reducing the stigma associated with TB. Other VIP
patients, such as political figures or community leaders, may be influential
at the local or regional level. Building on this available pool of educated TB
advocates provides communities with a sustainable resource for TB control.
health care providers
The Stop TB Partnership is working at the global level to
coordinate and accelerate TB control worldwide. However, it is at the local and
regional levels that TB control actually occurs, with health care
professionals, pharmacy staff and DOTS partners putting into action all the
plans that are made nationally and internationally.
DOTS
treatment works one patient at a time. Doctors, nurses, clinic staff and
volunteers these are the faces that a TB patient first encounters when
seeking diagnosis and treatment. In a clinic or hospital setting, some patients
may be intimidated, frightened or unconvinced of the importance of completing
the course of treatment. This is why those in the health care sector play such
an important role, beyond just providing treatment. Every interaction between
TB patients and their health care providers can serve to educate and reinforce
the importance of continuing with the full course of TB drugs, even after
patients start to feel better.
FACT SHEET 3
Advocacy planning
You can use World TB Day 2003 as a focal point for
awareness-building and attracting media attention to TB. You can also use it as
a springboard for continuous education throughout the year.
Get your message out by:
gathering statistics on TB
generally and on your country and region in particular;
identifying your key
messages and packaging them appropriately for your audience;
contacting the media with
press releases, information packages and invitations to any TB-related events
you have planned.
Ideas bank
You can find a wealth of information on what TB
partners around the world did last year in the World TB Day 2002 Highlights
Report.
If you do not have a copy,
you can find it at:
www.stoptb.org/events/world_tb_day/2002/Final_Highlights_Report_2002.pdf
or you can request a
printed copy from:
WHO Communicable Diseases Information Resource Centre at:
cdsdoc@who.int
You will find many ideas to inspire your planning for World
TB Day 2003.
Who to contact for more information
in your region
African Region (AFRO)
Dr Eugene
Nyarko
TB Regional
Adviser
Tel: +(1) 321
733 9020 Fax: 263 491 32 6040 E-mail: nyarkoe@whoafr.org
Americas Region (AMRO)
Dr Rodolfo
Rodriguez Cruz
TB Regional
Adviser
Tel: +(1) 202
974 3494 Fax: +(1) 202 974 3642 E-mail: rodrigro@paho.org
Eastern Mediterranean Region (EMRO)
Dr Akihiro
Seita
TB Regional
Adviser
Tel: 202 276
5258 Fax: 202 670 2492/4 E-mail: seitaa@emro.who.int
European Region (EURO)
Dr Richard Zaleskis
TB Regional Adviser
Tel: +(45) 39 17 13 35 Fax: +(45) 39 17 18 51 E-mail: rza@who.dk
South-East Asia Region (SEARO)
Dr Jai P. Narain
TB Regional Adviser
Tel: +(91) 11 337 0804 Fax: +(91) 11 337 8412 E-mail: narainj@whosea.org
Western Pacific Region (WPRO)
Dr Dong Il Ahn
TB Regional Adviser
Tel: +(63) 2 528 9704 Fax: +(63) 2 5211036 E-mail: ahnd@who.org.ph
WHERE
TO LOOK
The following web sites
provide data on TB control. You may wish to visit these sites for more ideas
and information:
World TB Day 2003 > /events/world_tb_day/2003/default.asp
World Health Organization
TB portal >
http://www.who.int/health_topics/tuberculosis/en/
The Stop TB Partnership > http://www.stoptb.org/
World Health Organization
TB Strategy & Operations, Monitoring & Evaluation > http://www.who.int/gtb/
WHO Regional Office for
Africa >
http://www.whoafro.org/tb/index.html
WHO Regional Office for the
Americas >
http://www.paho.org/English/HCP/HCT/TUB/tuberculosis.htm
WHO Regional Office for
South-East Asia >
http://w3.whosea.org/tb/index.htm
WHO Regional Office for
Europe >
http://www.who.dk/eprise/main/WHO/Progs/TUB/Home
WHO Regional Office for the
Eastern Mediterranean > http://208.48.48.190/STB/
WHO Regional Office for the
Western Pacific >
http://stoptb.wpro.who.int/
International
Union Against Tuberculosis and Lung Disease >
http://www.iuatld.org/
FACT SHEET 4
The 22 high-burden countries accounting for 80% of all global TB
cases*
Country Number
Incidence
of
cases rate
India 1
820 369 178
China 1
447 947 113
Indonesia 581
847 271
Bangladesh 327
754 233
Nigeria 274
972 235
Pakistan 247
416 171
South Africa 243
306 556
Philippines 232
266 301
Russian Federation 193 363 134
Ethiopia 188
097 292
Kenya 161
085 515
Democratic Republic of
the Congo 158 734 302
Viet Nam 143
412 181
United Republic of
Tanzania 123 717 344
Brazil 110
511 64
Thailand 85
870 135
Zimbabwe 80
733 628
Cambodia 78
564 585
Myanmar 78
473 162
Uganda 77
853 324
Afghanistan 70
531 314
Mozambique 49
342 265
Total
22 HBCs 6
776 162 177
Total world 8
474 305 138
* World Health Organization, 2001 data