Children, tuberculosis and socio-economic development

RESULTS Sydney City group member, Tima Sannah Brewah, reflects on the barriers to adequate prevention and treatment for TB and HIV, particularly for children. 

Image courtesy ACTION. From the report Childhood TB: From neglect to Action

Developing countries are defined by their varying poverty levels and low socio-economic development. Most lack efficient and effective health systems to ensure much needed health services are available to their population. Tuberculosis is one such disease that places enormous constraints on health systems. Children account for approximately 11% of the global burden of TB according to 2010 estimates however because of the increasing number of under-diagnosed cases, this figure may be higher. More worrisome is TB co-infection in HIV-infected children. Most countries are presently striving to increase BCG vaccination coverage, but the BCG vaccine does not protect children and adults from the most common form of TB. Additionally, maintenance of an efficient cold chain mechanism is often challenging, especially in hard to reach areas as such the effectiveness of the vaccine at the time of administration may be low. Underlying socio-economic issues such as poverty, food security, overcrowding, poor road infrastructure, illiteracy further increases the risk of acquiring TB infections and delays care- seeking and response to therapy. DOTS has proven successful in improving patient compliance to TB drug therapy, however for children the unavailability of fixed-dose combinations of anti-TB drugs results in inaccurate dosage regimens for children, poor compliance to therapy and high administrative costs. In addition, most developing countries lack adequate number of skilled health professionals and health infrastructure to cater for the needs of children infected with TB. Laboratories services are often slow; with inefficient health information systems and cases may often be missed or misdiagnosed. 

The Global Fund to Fight AIDS, TB and Malaria has provided a platform for the integration of TB and HIV programming for the most-at –risk children. However, despite the high burden of these diseases and their inter-relatedness, in most developing countries, TB prevention, treatment and diagnostic services are not part of current child health services and there is poor coordination among the National Programmes for Malaria, TB and HIV.  

In order to ensure aid effectiveness, key international aid donors need to prioritize the funding of research and development of new TB vaccines, diagnostics and treatment that are more effective for children, and those people living with HIV. A comprehensive assessment of current national, regional and global maternal and child survival policies is required to ensure well-coordinated TB response mechanisms for children. If countries are to make progress socio-economically and otherwise, the next generation of leaders, policy makers and workers, need to be much better protected from these diseases of poverty. 

 Our guest blogger Tima Sannah Brewah

Every disabled and able child has the right to go to school

Image credit: CBM (Courtesy of UNICEF Australia)

LIVING with a disability in the developed world can be a struggle. Living with a disability in poverty can be an unimaginable struggle.

International Day of People with Disability was on Monday, December 3.

The day aims to promote an understanding of people with disability and encourage support for their dignity, rights and well-being.

Disability is a growing issue in our region and extreme poverty can cause disability through poor nutrition, inadequate working conditions and a lack of access to clean water, sanitation and health care.

According to AusAID, children with disability are less likely than their peers to start and to complete school.

In fact, in low income countries only 46 per cent of males with disability and 33 per cent of females with disability have completed primary school, compared with 56 per cent of males and 42 per cent of females without disabilities respectively.

“A child who has to struggle with a disability and poverty should be totally unacceptable and non-existent in today’s world,” Ms Maree Nutt, National Manager of RESULTS, said.

RESULTS’ Education for All Report released earlier this year recommends mainstreaming disability into education by adapting buildings and classrooms appropriately so that students can attend and that teachers and support staff are adequately trained in adaptive curricular and resources, i.e. braille.

“There needs to be better monitoring of disability plans in developing countries education programs,” Ms Nutt continued. 

As a leading donor on education, Australia should use its influence at the World Bank and the Asian Development Bank to push for greater measures so that disabled children can go to school.

“Every child, disabled and able, has the right to go to school,” Ms Nutt affirmed.

World AIDS Day 2012

Saturday was International World AIDS Day (WAD). Observed worldwide on the 1^st of December every year since 1988, WAD raises awareness of the pandemic of AIDS caused by the spread of HIV, through the organisation of events around the globe, speeches by country leaders and major fundraising efforts, such as the famous red ribbon collection. Each year has a theme, and since 2011 and until 2015, the theme will remain Getting to Zero, representing a powerful push towards the eradication of HIV/AIDS in the lead-up to the end of the Millennium Development Goal era.

In Australia this year, WAD is in part being marked by the opening of the Access to Life exhibition at the Powerhouse museum in Ultimo, to coincide with the 30 years since the first case of HIV was diagnosed in Sydney. The exhibition, which has toured Rome, Madrid, Oslo, New York, Oakland, Tokyo and Seoul since opening in 2008, is a collection of case study photographs of people affected by HIV/AIDS taken by some of the world’s leading photographers from the Magnum photographic agency, and has been organised in partnership between the Global Fund to Fight AIDS, Tuberculosis and Malaria and Magnum Photos. The Global Fund is a public/private partnership and international financing institution that supports large-scale prevention and treatment against the three major diseases of poverty. In the Asia Pacific region alone, half a million people have received life-saving HIV/AIDS treatment due to the Global Fund. 

Members of RESULTS Australia, along with a number of key people involved in the fight against HIV/AIDS, attended the opening of the exhibition in Sydney this week. The evening included speeches by the chair of the Global Fund, Simon Bland and the Governor General of Australia and patron of the Global Fund, Quentin Bryce. There were also two joint musical performances by Australian and Papua New Guinean artists. Local David Bridie performed with PNG singer George Mamua Telek, and members of the Australian band the Jezebels performed with the PNG-born singer Ngaiire. Ngaiire’s powerful performance was heightened by her positioning on a raised, red velvet-draped podium in the centre of the Powerhouse museum, backed by a rotating show of moving photographs projected onto the wall behind her. The images were taken from the series of photographs from Papua New Guinea, a new part of the exhibition unveiled for the first time in Sydney on this opening night. 

Click on the links below to find out more about the exhibition.

Exhibition

Video

World Aids Day

Union Conference

Members of RESULTS International (Australia) have just returned from the 43rd World Conference of the International Union Against Tuberculosis and Lung Disease (the Union), hosted in Kuala Lumpur, Malaysia. It was an action packed week filled with technical briefings, planning for the future fight against TB, collaborative meetings and advocacy workshops. The resounding message from the week, looking forward to the post-Millennium Development Goal era, was for bold policies and ambitious targets.

The Union conference, held annually, is the peak global event for people working in lung health and tuberculosis (TB), and brings together hundreds of participants from more than 120 countries. Participants range from academics and researchers, civil society advocates and affected community representatives to members of governments, NGOs and policy makers.

The heart of advocacy activities at the conference was the Advocacy Corner, jointly hosted by Action.org, the Stop TB Partnership and TB Alert. The Corner provided a space for civil society advocates to meet, share ideas and knowledge, and to strategize and coordinate actions. Additionally, the Advocacy Corner was the location of a number of workshops and presentations, such as an Action hosted workshop aimed at researchers, providing information on how they can utilise advocacy in and alongside their work.

The outstanding event of the conference was the first ever civil society protest to occur at a Union conference. Frustrated by the unambitious targets for reducing TB, lack of commitment for funding targets, and with the stigmatising language frequently used in reference to persons with TB, more than 100 activists marched through the Kuala Lumpur Convention Centre, landing at the opening ceremony. 

The group carried signs of protest, such as ‘50% won’t cut it’, condemning the current aim to cut TB deaths by 50% by 2025, noting that this target will result in more than 600 000 people still dying each year, and ‘nothing for us without us’, in reference to the need to more effectively engage civil society in discussions and planning. Other signs included words crossed out in red, like ‘suspect’ and ‘defaulter’, condemning the language commonly used to describe persons thought to have TB and persons with TB who don’t finish the full regimen of treatment, respectively. Throughout the crowd were signs of ‘zero’, calling for an ambitious target to stop entirely this curable disease.

The crowd of activists, made up of people from dozens of countries from around the world `chanted, sang, stomped their feet and danced, and brought a much needed energy to the conference, revitalising the conversation at a crucial time, when planning is under way for the targets that will replace the MDGs in 2015. 

The week of activities culminated in the presentation at the closing ceremony of the first ever civil society Declaration on TB. The Kuala Lumpur Declaration on Tuberculosis spells out the aspirations that informed the week’s advocacy activities and the principles and demands that will guide TB advocacy efforts into the future. 

To read the declaration, click here: 

To add your signature to the declaration email KLZerodeclaration@gmail.com with your name, organizational affiliation (if any), city and country of residence and email address.

Tuberculosis: Child killer

TUBERCULOSIS kills 64,000 children each year.  

TB preys on the most vulnerable young people – the orphaned, the malnourished, even those living with HIV. It causes an almost unimaginable burden to victims and their families and what makes this situation more abhorrent, TB is entirely preventable and curable.

This week international global health advocacy partnership, ACTION, of which RESULTS Australia is a part, released its Children and TB report, Children & TB:From Neglect to Action, which highlights the lack of awareness that remains around childhood TB.

Alarmingly, children are still misdiagnosed, unaccounted for, and lack access to appropriate lifesaving drugs.

The report makes a number of recommendations to countries that have donated funds to child survival initiatives and for high burden countries affected by TB to do more to stem the scourge of TB.

ACTION believes more funding for programs that address childhood TB should be made available to The Global Fund to Fight AIDS, TB & Malaria.

ACTION also recommends that countries that are affected by TB should improve their National TB programs by appropriately collecting and reporting on childhood TB data.

More importantly, they also suggest that Governments should increase funding for their own TB programs, including training and supporting health workers.

“This report goes a long way in identifying the problems that we have in trying to combat tuberculosis,” RESULTS Chief Executive Officer Maree Nutt said.

“The solutions are right there in black and white. What’s required from us is the public and poltical will to act on these recommendations,” Ms Nutt continued.

The report also notes that the lack of awareness of the child-killing disease by developed countries remains a persistent and significant barrier from defeating it.  "200 children are dying of TB every day. Most people do not know this," Archbishop Desmond Tutu said.
 
RESULTS is committed in increasing the awareness of this deadly disease.

"Whether you live in the developed or developing world, TB can end a child’s life so unexpectedly wherever you may live,” Ms Nutt added.

“John F. Kennedy once said that children are the world’s most valuable resource and its best hope for the future. 

“If tuberculosis continues to kill young people, then our future looks bleak,”Ms Nutt said.

Malaria

by Marita Jones, RESULTS member, Tasmania

Being a Hobartian by birth it is easy to believe that diseases like malaria should be no more relevant to me then remembering to take anti-malarials when I go on my summer holidays. But this disease, that still affects 200 million people around the world every year and causes major mortality, especially in the vulnerable, is more relevant to us than we realise.

Marita Jones - RESULTS member, junior doctor and guest blogger.

I work as a junior doctor in the local emergency department and recently a woman came in very sick with fevers and hallucinations. She had been travelling to Bangladesh where her young child fell sick, so she had to spend 5 days with him in the local hospital. She was exposed to every possible disease, as she did not want to be separated from her sick child. We found out a few days later when results came back that she had been exposed to malaria and typhoid fever. During her 6 hours in the department numerous staff members, children and elderly people were put at risk.

Communicable diseases such as malaria, typhoid and TB do not respect borders and disease outbreaks in regions close to Australia, particularly drug resistant strains, pose a real threat to us all. 42,000 people in the Asia-Pacific region died from malaria in 2010. An increase in malaria cases in Australia, where we would be slow to diagnose, as it is uncommon, could be disastrous especially for children under 5 years old, who are most vulnerable to dying.

Malaria is not only deadly, but it also means lost income for parents and lost ability to go to school for children. Other than direct health impact the disease burden in the Asia-Pacific region affects Australia in many other ways. For example, as a trade and tourism partner and as an inhibitor for countries in the region to become self-sufficient and less reliant on Australian aid. Many Australian citizens are from countries with rampant malaria and their families still suffer.

The good news is malaria deaths have been cut by 26% since 2000. This is largely due to treatment and prevention programmes run by governments and funded through the Global Fund to Fight AIDS, TB and Malaria.

There is much that can be done:

• Appropriate diagnosis and treatment of malaria with artemisinin, the affordable most effective drug
• Widespread use of insecticide treated bed nets
• Education about the early signs of malaria so families can seek medical care
• Education about prevention such as covering open water sources or avoiding water collections after rain where the mosquitoes breed 

Tasmanian researchers from the Menzies Research Institute are playing their part, doing very special work to find new treatments strategies to fight malaria and genetic susceptibility to disease and resistance^[1].

I am proud that AusAID hosted Malaria 2012 in Sydney recently, and applaud the announcement of an additional $100 million of funding to scale up the response to the disease in the region.

Malaria is a great example of an international disease with local relevance and we can all be a part of the target to reduce malaria cases and deaths in the Asia-Pacific by 75% by 2015. 

Well done Australia.

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^[1] http://www.menzies.utas.edu.au/information.php?Doo=ViewData&type=Disease&ID=21

Malaria Control - Staying Focused on Local Communities

As I consider what impact the upcoming Malaria 2012: Saving lives in the Asia-Pacific will have on communities within our region, I am in the process of organizing a month’s worth of anti-malarial drugs for an upcoming trip, one of the few luxuries afforded to me that I would not consider going without. 

Malaria is one of the world’s oldest diseases yet continues to be a major global disease burden with enormous impact on the health and development of almost half the world’s population. Though in general, cases result in uncomplicated disease with a low case fatality rate, it can lead to severe complications, particularly for pregnant women and children. Demonstratively, across the Asia-Pacific there are 36 million cases of malaria every year, with 42,000 fatalities. Despite this significant impact on morbidity and mortality, the real tragedy of malaria is the burden placed on families and the economic growth of developing countries through losses in productivity, education, and the associated health care costs. 

RESULTS' Aldo King (left) and Maree Nutt (right) with the "African Princess" and Roll Back Malaria Ambassador Yvonne Chaka Chaka in Parliament House, Canberra to meet with MPs and Senators on Malaria and other issues.

This is a disease of poverty, mostly affecting countries with limited infrastructure and resources available for malaria control. In endemic countries malaria is a part of everyday life, you do not have to look far to discover the constant impact it has on communities. Some families can spend over a quarter of their income on malaria prevention and treatment. Therefore, aside from the modest goal of saving lives, a real benefit of controlling and eliminating malaria will be a significant improvement to the livelihoods of hundreds of millions of people. 

The good news is that malaria could be controlled for less than one-tenth of the economic losses suffered as a result of death and illness. Malaria control, costing between US $2-24 per disability adjusted life year (DALY) saved, is one of the most cost-effective health interventions. It is also considered one of the most effective strategies for reducing poverty and childhood mortality. So… if malaria is easily treatable and preventable, why does it continue to be a leading cause of morbidity and mortality across the majority world?
Infectious diseases do not respect borders, therefore, a regional approach must be a collaborative long term commitment. Developing countries have by far the largest global disease burden, but also both the lowest incomes and global health expenditure, tackling malaria has to be a responsibility for the entire international community. In the past a combination of political factors and shifting global priorities has meant we have failed to deliver a sustained and collaborative commitment.  Unless we see programs through to the end with necessary scope and coverage, the disease will resurge and all our efforts thus far will be waisted or worse, deadly, demonstrated by the emergence of increasing drug resistance. 

What we often neglect in the struggle to identify global priorities is what malaria control means at the local community level. The reality is that for many communities living in poverty, malaria prevention might not be the highest priority when faced with daily struggles to survive. Reflecting upon my own experiences in malaria endemic regions, and the fact that often effective and readily available interventions such as bed nets can be underutilized, we need to ensure that our efforts within the region combine resources and support with adequate education and awareness activities. 

Malaria 2012 therefore, brings me cautious hope. The increasing priority placed on malaria control globally is very exciting, and for our neighbours in the Asia-Pacific this could mean great things for both their health and economic development. It is pleasing to see Australia take leadership and place importance on this significant disease. At the same time, we need to ensure that recent and ongoing efforts to tackle malaria are sustained and comprehensive, staying focused on the very communities we hope to impact. The goal of saving lives by controlling and eliminating malaria will ultimately benefit us all. 

by Sandra Opoku, RESULTS Melbourne Group

The global TB situation

The newest Global Tuberculosis Report, which was released on 17 October 2012 and is the seventeenth report on tuberculosis (TB), reveals both bright and dark sides of the global TB situation. It is clearly great that we are on track and likely to reach the Millennium Development Goal (MDG) of reducing by half the TB epidemic by 2015. 

Yet the numbers of people infected by TB are still high. Last year 8.7 million people worldwide became ill with TB, and 1.4 million people died because of the disease. The highest numbers of TB cases are found in the South East Asia and Western Pacific regions, where about 60 % of the world's TB cases are located. Additionally, although the numbers globally are going down, seen regionally Africa and Europe are not on track to reach the MDG before its set date of 2015.

AIDS, TB and malaria are the three most deadly infectious diseases in the world today. However, funding for TB is lacking behind compared to the other two diseases. Consequently, the epidemic is becoming increasingly resistant to the few medicines available to fight the disease. 

This critical lack of sufficient funding for TB care and control, is one reason for the high numbers of TB cases, when there are not enough medicines or vaccines provided to the people in need. Also, research and development are held back because of insufficient funding, although there has been progress in developing new medicines and vaccines. 

The Global Fund is a major sponsor of fighting TB, malaria and AIDS, and 90 % of global funding for TB comes from this financing institution, which is one of RESULTS International's partner organisations. 

The annually Global Tuberculosis Report gives a comprehensive and up-to-date assessment of the TB epidemic, and analyses the progress in implementing and financing TB prevention, care and control at global, regional and national levels. This report is helpful for the future work on TB, and important in our struggle to reach the MDGs globally, regionally as well as nationally.