Access to new test for drug-resistant TB must be improved: WHO expert

A World Health Organization expert called for greater access to a new diagnostic tool for multidrug-resistant tuberculosis (MDR-TB) in the Western Pacific and southeast Asia.  The new diagnostic tool reduces the time needed to detect MDR-TB from eight weeks to two hours.

Drug-resistant TB emerges when patients fail to follow treatment regimens, take substandard drugs or stop treatment too early.  Patients with MDR-TB can then transmit the disease to others.

According to the WHO, there are 120,000 new cases of MDR-TB in the Western Pacific each year, which makes up 28 percent of the global caseload.  Combined with cases in southeast Asia, all MDR-TB cases in Asia make up 58 percent of the global caseload.

Number of drug-resistant TB cases, 2007

• India – 131,000
• China – 112,000
• Russia – 43,000
• Bangladesh – 15,000
• South Africa – 16,000

TB killed 1.8 million people across the world in 2008, or a person every 20 seconds. It is not only a scourge in poor countries but also in the West, where it has flared anew in the last 20 years because of AIDS, which weakens the immune system.

UN Report: Efforts to boost maternal and child health falling short

From the UN Daily News:

An annual assessment report released today by the United Nations shows that while significant declines have been recorded by many countries in reducing maternal and child mortality, greater progress must be made to meet the global targets contained in the Millennium Development Goals (MDGs).

According to the MDG Report 2010, launched by Secretary-General Ban Ki-moon in New York, the number of deaths among children under the age of five has dropped from 12.6 million in 1990 to an estimated 8.8 million in 2008.

The greatest advances were made in Northern Africa, Eastern Asia, Western Asia, Latin America and the Caribbean, and the countries of the Confederation of Independent States (CIS).  But most striking is the progress that has been made in some of the world’s poorest countries. Bangladesh, Bolivia, Eritrea, Laos, Malawi, Mongolia and Nepal have all reduced their under-five mortality rates by 4.5 per cent annually or more.

“Despite these achievements, and the fact that most child deaths are preventable or treatable, many countries still have unacceptably high levels of child mortality and have made little or no progress in recent years,” stated the report.  The highest rates of child mortality continue to be found in sub-Saharan Africa, which accounted for half of the 8.8 million deaths in children under five worldwide in 2008.

The publication pointed out that child deaths are not falling quickly enough to reach Goal 4, namely a two-thirds reduction in childhood mortality rates between 1990 and 2015, and millions of children continue to die each year at a tragically young age.

First agreed at the UN Millennium Summit in September 2000, the eight MDGs set worldwide objectives for reducing extreme poverty and hunger, improving health and education, empowering women and ensuring environmental sustainability by 2015.

Progress in Health: a WHO report on health-related MDGs

The World Health Organization recently released a progress report towards the achievement of the health-related Millennium Development Goals.  Highlights of progress (all goals and targets are measured in terms of progress since 1990) include:

• Fewer children are dying. Annual global deaths of children under five years of age fell to 8.8 million in 2008 – down by 30% since 1990.
• Fewer children are underweight. The percentage of underweight children under five years old is estimated to have dropped from 25% in 1990 to 16% in 2010.
• More women get skilled help during childbirth. The proportion of births attended by a skilled health worker has increased globally, however, in the WHO Africa and South-East Asia regions fewer than 50% of all births were attended.
• Fewer people are contracting HIV. New HIV infections have declined by 16% globally from 2001–2008.
• Tuberculosis treatment is more successful. Existing cases of TB are declining, along with deaths among HIV-negative TB cases.
• More people have safe drinking-water, but not enough have toilets. The world is on track to achieve the MDG target on access to safe drinking-water but more needs to be done to achieve the sanitation target.

WHO report: drug resistant TB at record levels

Drug-resistant tuberculosis (TB) is now at record levels with Asia bearing the brunt of the epidemic, says the United Nations World Health Organization (WHO) in a recent report.

In some parts of the world, one in four people with TB becomes ill with a form of the disease that can no longer be treated with standard drugs, according to WHO’s Multidrug and Extensively Drug-Resistant Tuberculosis: 2010 Global Report on Surveillance and Response.

Nearly one-third of the 440,000 people with multidrug-resistant form of the disease (MDR-TB) in 2008 died, the report stated.

Almost half of the MDR-TB cases occurred in China, where the first nationwide drug resistance survey was conducted, and India. In Africa, estimates show 69,000 cases emerged, the vast majority of which went undiagnosed.

Even in the presence of severe epidemics, governments and partners can turn around MDR-TB by strengthening efforts to control the disease and implementing WHO recommendations, the report noted.

Counterfeit medicines in China

An interesting article from the Canadian Medical Association Journal about the production and dangers of counterfeit medicines, with a specific focus on China.

China’s booming counterfeit medicine trade

It was a cringe-worthy moment for China when 600 000 counterfeit antimalarial tablets were intercepted by the Nigerian government in June. Produced and shipped from China, they bore an unexpected label — ”Made in India.” Even the fakes were being faked. It was a new low.

Many things are faked here — from cheap Gucci sunglasses to iPhones. Drugs are no exception. Medicine counterfeiters in China have the dubious honor of being among the worst offenders in the counterfeit drug trade. Often stuffed with chalk, flour or pollen, the pills are passed off as genuine medications. The drug counterfeiters are so skilled that even the holograms on the packages are copied and faked. It’s a trade which preys upon poorer countries, such as Nigeria, that lack the funds to set up strict regulation and the ability to purchase higher quality drugs.

“China, along with India, is responsible for the vast majority of the fakes making it to the international market,” says Roger Bate, an economist who researches health policy and author of Making a Killing: The Deadly Implications of the Counterfeit Drug Trade.

Malaria parasite’s resistance to top drug grows

The World Health Organisation last week warned that the parasite which causes malaria is increasingly resistant to artemisinin, the best drug around, and failure to contain this trend would bring serious consequences.

“This (Asia Pacific) region has traditionally been the focus of resistance to antimalarial drugs and now we have artemisinin resistance primarily on the Thai-Cambodian border,” said John Ehrenberg, WHO regional adviser on malaria and other vectorborne and parasitic diseases.

From WHO's World Malaria Report, 2008

Artemisinin, derived from the sweet wormwood shrub, is the best drug available but misuse and over-prescription have led to the parasite becoming resistant to it.

The best way to prolong the use of the drug would be to use it in combination with other antimalarial drugs. Nearly all the Asia Pacific region countries that suffer most from the disease pledged on Wednesday to do that.

The 10 countries are Cambodia, China, Laos, Malaysia, Papua New Guinea, the Philippines, South Korea, Solomon Islands, Vanuatu and Vietnam. In 2008, these 10 states reported 248,141 confirmed cases of malaria and 1,005 deaths.

Under the agreement, the use of artemisinin alone for treating malaria must be banned by 2015.  All 10 states will also help fight counterfeit antimalarial drugs, again a major cause of deaths.

In recent years, parts of Asia have been awash with fake antimalarial drugs. They contain little or no active ingredient that would fight the disease and many people have died because of that. Some of the fakes have been traced back to illegal factories in China, according to experts.

Although malaria is preventable and treatable, there were still between 189 million to 327 million cases in 2006, resulting in between 610,000 to 1.2 million deaths.

“If it is not contained, it can have global implications and the most serious one would be in Africa which has a high disease burden and the highest mortality rates,”  said Ehrenbergh on the sidelines of a regional meeting of the WHO in Hong Kong.

Half the world’s population is at risk, particularly the poor and those living in remote areas with limited healthcare access. A child dies from malaria every 30 seconds.

UN report on HIV transmission in Asia: more than 90% of HIV+ women in Asia were infected by husbands or long-term partners

A new UN report estimates that more than 90 per cent of the 1.7 million women living with HIV in Asia became infected from their husbands or partners while in long-term relationships.  A further 50 million women in Asia, who are either married or in long-term relationships with men who engage in high-risk sexual behaviours, are predicted to be at risk of becoming infected with HIV from their partners.

The report, HIV Transmission in Intimate Partner Relationships in Asia, was produced by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and its partners.

In Cambodia, India and Thailand, the largest number of new HIV infections occur among married women.  The evidence from almost all the countries in Asia indicates that women are acquiring HIV not because of their own sexual behaviours but because of the unsafe behaviours that their partners engage in. The intimate partners of men who have sex with men, injecting drug users or clients of sex workers constitute the largest vulnerable population in Asia.

The UNAIDS report recommends four main strategies that should be implemented in addition to increased services for key populations:

1. HIV prevention interventions must be scaled-up for men who have sex with men, injecting drug users, and clients of female sex workers and should emphasize the importance of protecting their regular female partners.
2. Structural interventions should be initiated to address the needs of vulnerable women and their male sexual partners. This includes expanding reproductive health programmes to include services for male sexual health.
3. HIV prevention interventions among mobile populations and migrants must be scaled-up and include components to protect intimate partners.
4. Priority should be given to operations research to develop a better understanding of the dynamics of HIV transmission in intimate partner relationships.