Drug resistant tuberculosis can be controlled, says WHO
BMJ 2000; 320 doi: https://doi.org/10.1136/bmj.320.7238.821 (Published 25 March 2000) Cite this as: BMJ 2000;320:821All rapid responses
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Being a primary health care practioner and having wasted my time
attending conferences related to TB over the last month (an yearly "WHO"
planned let's scare them out of their wits and offer them a solution which
is impossible to implement). Please will someone coming up with these
fancy theories help device a method which is more practical.
Approximately
90% of the practioners in Pakistan do not know how to write a prescription
for any form of TB. The Goverment does not want to spend money on this
disease, they don't have a budget or the resourses. And with a population
well over 140 million how can one expect chasing this disease. DOTS might
be very effective at a small scale but to implement it in a country like
Pakistan is impossible unless some money is poured into the health sector.
Dr.M.N.Ansari
mnansar@cyberaccess.com.pk
Competing interests: No competing interests
The Philippines is one of the countries who have a high incidence of
TB. Our recent studies show Tb incidence is slowly rising. More alarmingly
resistance rates have dramatically increased back in the 70's hospital
based surveys showed only less than 10% of cases were resistant to at
least 2 drugs. Now it has risen 37%. However in community based studies,
the rates are pegged at 6.5%. That I think is just an underestimation.DOTS
which has recently been implemented may make a difference but
unfortunately this program is not yet a government policy. Also we are
plaqued by insufficient funding for medications. Can you help us in some
way. Thank you.
Competing interests: No competing interests
I have no medical experiance but after a recent visit to India last
year where I visited one of the a teberculous hospitals. The suggestion by
WHO seams somewhat of a joke.
What I experienced was less a problem with having a supply of drugs more
a problem of how the patients were being treated for the disease.
Conditions in Indian hospitals are appalling and unbelievable.
Apparently during strikes hospitals patients were put out onto the street
no mattar what their condition. Many patients from what I was told, and
witnessed were treated until the disease was no longer infections and then
released from the hospital. They were given very little or no information
about taking further medication to be fully cured. This often meant that
the patients became infected with a new resistant strain of TB and ended
back in the hospital within a couple of months. Support for patients once
they leave hospital is virtually non-existent.
The way patients are treated for TB in India does not look likely to
change quickly as it involves huge social change when considering the
caste system and Indian culture in general it will take a very long time.
Competing interests: No competing interests
It is gratifying to read authoritative statements on tuberculosis
'resistance' and of the nature of occurrences of resistant strains, but
for my historical-research purposes I find it difficult to properly assess
the tuberculosis, especially the resistant strain, situations in Timor
(East and West), Papua New Guinea and Indonesia from the point of view of
the populations concerned.
Generalized statements suggest that multiple problems are present, that TB
is rife, that there is not sufficient finance available to medical workers
to buy antibacterial drugs, yet there is little firm data in the public
arena.
How much of the comments coming out of those countries are cries for real,
assessed help, or how much crossed into a mythical zone is quite
impossible for people at a distance to know.
This area is an important human focus from where 'microbes' can
travel and I suggest that information---such as is available, and that
would be primarily from Australian Health authorities---may be of great
value in creating a true world view of the increase in resistant strains
of tuberculosis.
Lois Baglin
Competing interests: No competing interests
Drug resistant Tuberculosis cannot be controlled in India
Drug resistant tuberculosis cannot be controlled in India as there is
currently no cure affordable for some multidrug-resistant strains. Inspite
of the World Health Organization declaration in 1993 of TB as a global
emergency and the increase from 10 to over 100 countries implementing the
DOTS strategy, progress against TB is stalled by slow progress in many of
the 22 countries including India that account for 80% of the world’s TB
burden.
Currently only 17% of the world’s TB cases are covered by DOTS.
Progress in TB control is constrained by several factors, the foremost of
which is lack of potential will and commitment to TB control at both
global and national levels.
In India more than 70% of TB cases are being treated by Private
Practitioners including quacks. India with a high burden of TB cases will
not be able to reach the targets of TB control by 2000 as established by
World Health Assembly. World-wide up to 50 million people may be infected
with drug-resistant tuberculosis. These facts are a sobering reminder of
the urgency with which we need to confront the challenge posed by this
ancient threat to our society.
Competing interests: No competing interests