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Washington, D.C., World Bank, Human Development Network, Health, Nutrition and Population Team, 2007 Aug. 51 p. (Policy Research Working Paper No. 4295)Tuberculosis is the most important infectious cause of adult deaths after HIV/AIDS in low- and middle-income countries. This paper evaluates the economic benefits of extending the World Health Organization's DOTS Strategy (a multi-component approach that includes directly observed treatment, short course chemotherapy and several other components) as proposed in the Global Plan to Stop TB, 2006-2015. The authors use a model-based approach that combines epidemiological projections of averted mortality and economic benefits measured using value of statistical life for the Sub-Saharan Africa region and the 22 high-burden, tuberculosis-endemic countries in the world. The analysis finds that the economic benefits between 2006 and 2015 of sustaining DOTS at current levels relative to having no DOTS coverage are significantly greater than the costs in the 22 high-burden, tuberculosis-endemic countries and the Africa region. The marginal benefits of implementing the Global Plan to Stop TB relative to a no-DOTS scenario exceed the marginal costs by a factor of 15 in the 22 high-burden endemic countries, a factor of 9 (95% CI, 8-9) in the Africa region, and a factor of 9 (95% CI, 9-10) in the nine high-burden African countries. Uncertainty analysis shows that benefit-cost ratios of the Global Plan strategy relative to sustained DOTS were unambiguously greater than one in all nine high-burden countries in Africa and in Afghanistan, Pakistan, and Russia. Although HIV curtails the effect of the tuberculosis programs by lowering the life expectancy of those receiving treatment, the benefits of the Global Plan are greatest in African countries with high levels of HIV. (author's)
Global Fund-supported programmes' contribution to international targets and the Millennium Development Goals: An initial analysis.
Bulletin of the World Health Organization. 2007 Oct; 85(10):805-811.The Global Fund to Fight AIDS, Tuberculosis and Malaria is one of the largest funders to fight these diseases. This paper discusses the programmatic contribution of Global Fund-supported programmes towards achieving international targets and Millennium Development Goals, using data from Global Fund grants. Results until June 2006 of 333 grants supported by the Global Fund in 127 countries were aggregated and compared against international targets for HIV/AIDS, tuberculosis and malaria. Progress reports to the Global Fund secretariat were used as a basis to calculate results. Service delivery indicators for antiretrovirals (ARV) for HIV/AIDS, case detection under the DOTS strategy for tuberculosis (DOTS) and insecticide-treated nets (ITNs) for malaria prevention were selected to estimate programmatic contributions to international targets for the three diseases. Targets of Global Fund-supported programmes were projected based on proposals for Rounds 1 to 4 and compared to international targets for 2009. Results for Global Fund-supported programmes total 544 000 people on ARV, 1.4 million on DOTS and 11.3 million for ITNs by June 2006. Global Fund-supported programmes contributed 18% of international ARV targets, 29% of DOTS targets and 9% of ITNs in sub-Saharan Africa by mid-2006. Existing Global Fund-supported programmes have agreed targets that are projected to account for 19% of the international target for ARV delivery expected for 2009, 28% of the international target for DOTS and 84% of ITN targets in sub-Saharan Africa. Global Fund-supported programmes have already contributed substantially to international targets by mid-2006, but there is a still significant gap. Considerably greater financial support is needed, particularly for HIV, in order to achieve international targets for 2009. (author's)
Bulletin of the World Health Organization. 2007 Aug; 85(8):631-636.Following the destruction of Cambodia's health infrastructure during the Khmer Rouge period (1975-1979) and the subsequent decade of United Nations sanctions, international development assistance has focused on reconstructing the country's health system. The recognition of Cambodia's heavy burden of tuberculosis (TB) and the lapse of TB control strategies during the transition to democracy prompted the national tuberculosis programme's relaunch in the mid-1990s as WHO-backed health sector reforms were introduced. This paper examines the conflicts that arose between health reforms and TB control programmes due to their different operating paradigms. It also discusses how these tensions were resolved during introduction of the DOTS strategy for TB treatment. (author's)
Bulletin of the World Health Organization. 2007 May; 85(5):325-420.In 1991, the 44th World Health Assembly set two key targets for global tuberculosis (TB) control to be reached by 2000: 70% case detection of acid-fast bacilli smear-positive TB patients under the DOTS strategy recommended by WHO and 85% treatment success of those detected. This paper describes how TB control was scaled up to achieve these targets; it also considers the barriers encountered in reaching the targets, with a particular focus on how HIV infection affects TB control. Strong TB control will be facilitated by scaling-up WHO-recommended TB/HIV collaborative activities and by improving coordination between HIV and TB control programmes; in particular, to ensure control of drug-resistant TB. Required activities include more HIV counselling and testing of TB patients, greater use and acceptance of isoniazid as a preventive treatment in HIV-infected individuals, screening for active TB in HIV-care settings, and provision of universal access to antiretroviral treatment for all HIV-infected individuals eligible for such treatment. Integration of TB and HIV services in all facilities (i.e. in HIV-care settings and in TB clinics), especially at the periphery, is needed to effectively treat those infected with both diseases, to prolong their survival and to maximize limited human resources. Global TB targets can be met, particularly if there is renewed attention to TB/HIV collaborative activities combined with tremendous political commitment and will. (author's)
Bulletin of the World Health Organization. 2007 May; 85(5):325-420.The development and expansion of WHO's DOTS strategy was successful, with 83% of the world's population living in countries or parts of countries covered by this strategy by the end of 2004. Treatment success in the 2003 DOTS cohort of 1.7 million patients was 82% on average, close to the 85% target. Treatment success was below average in the African Region (72%), which can be partly attributed to occurrence of HIV co-infection, and in the European Region (75%), partly due to drug resistance. Drug resistance, specifically multidrug resistance and extensive drug resistance, is a serious threat to public health in all countries, especially in the Russian Federation, where the highest rates of multidrug resistance are presently accompanied by a rapid increase in HIV infection. Based on the experience of the first projects approved by the Green Light Committee, the treatment success of patients with multidrug-resistant tuberculosis (MDR-TB) is lower than that of drug-susceptible cases, but nevertheless reaches 70%. The collaborative effort of different organizations, professionals and communities is needed to address the development and spread of multidrug resistance and extensive drug resistance, which combined with the epidemic of HIV infection is one of the barriers to dealing effectively with TB. This effort should be directed towards facilitating the diagnosis and treatment of TB patients, in particular by improving access to drug susceptibility testing and strengthening treatment delivery by rigorous adherence to DOTS as outlined by the Stop TB Partnership. (author's)
Bulletin of the World Health Organization. 2007 May; 85(5):325-420.Laboratories and laboratory networks are a fundamental component of tuberculosis (TB) control, providing testing for diagnosis, surveillance and treatment monitoring at every level of the health-care system. New initiatives and resources to strengthen laboratory capacity and implement rapid and new diagnostic tests for TB will require recognition that laboratories are systems that require quality standards, appropriate human resources, and attention to safety in addition to supplies and equipment. To prepare the laboratory networks for new diagnostics and expanded capacity, we need to focus efforts on strengthening quality management systems (QMS) through additional resources for external quality assessment programmes for microscopy, culture, drug susceptibility testing (DST) and molecular diagnostics. QMS should also promote development of accreditation programmes to ensure adherence to standards to improve both the quality and credibility of the laboratory system within TB programmes. Corresponding attention must be given to addressing human resources at every level of the laboratory, with special consideration being given to new programmes for laboratory management and leadership skills. Strengthening laboratory networks will also involve setting up partnerships between TB programmes and those seeking to control other diseases in order to pool resources and to promote advocacy for quality standards, to develop strategies to integrate laboratories' functions and to extend control programme activities to the private sector. Improving the laboratory system will assure that increased resources, in the form of supplies, equipment and facilities, will be invested in networks that are capable of providing effective testing to meet the goals of the Global Plan to Stop TB. (author's)
Bulletin of the World Health Organization. 2007 May; 85(5):325-420.The Global Plan to Stop TB 2006-2015 is a road map for policy-makers and managers of national programmes. It sets out the key actions needed to achieve the targets of the Millennium Development Goals relating to tuberculosis (TB): to halve the prevalence and deaths by 2015 relative to 1990 levels and to save 14 million lives. Developed by a broad coalition of partners, the plan presents a model approach combining interventions that can feasibly be supplied on the ground. The main areas of activity set out in the plan are: scaling up interventions to control tuberculosis; promoting the research and development of improved diagnostics, drugs and vaccines; and engaging in related activities for advocacy, communications and social mobilization. Scenarios for the planning process were developed; these looked at issues both globally and in seven epidemiological regions. The scenarios made ambitious but realistic assumptions about the pace of scale-up and implementation coverage of the activities. A mathematical model was used to estimate the impact of scaling up current interventions based on data from studies of tuberculosis biology and from experience with tuberculosis control in diverse settings. The estimated costs of the activities set out in the Global Plan were based on implementing interventions and researching and developing drugs, diagnostics and vaccines; these costs were US$ 56 billion over 10 years. When translated into cost per disability adjusted life year averted, these costs compare favourably with those of other public health interventions. This approach to planning for global tuberculosis control is a valuable example of developing plans to improve global health that has relevance for other health issues. (author's)
Geneva, Switzerland, World Health Organization [WHO], 2006. 93 p. (WHO/HTM/STB/2006.37)A significant scaling up of advocacy, communication and social mobilization (ACSM) will be needed to achieve the global targets for tuberculosis control as detailed in the Global Plan to Stop TB 2006--2015. In 2005, the ACSM Working Group (ACSM WG) was established as the seventh working group of the Stop TB Partnership to mobilize political, social and financial resources; to sustain and expand the global movement to eliminate TB; and to foster the development of more effective ACSM programming at country level in support of TB control. It succeeded an earlier Partnership Task Force on Advocacy and Communications. This work-plan focuses on those areas where ACSM has most to offer and where ACSM strategies can be most effectively concentrated to help address four key challenges to TB control at country level: Improving case detection and treatment adherence; Combating stigma and discrimination; Empowering people affected by TB; Mobilizing political commitment and resources for TB. (excerpt)
Strategic approach for the strengthening of laboratory services for tuberculosis control, 2006-2009.
Geneva, Switzerland, World Health Organization [WHO], 2006.  p. (WHO/HTM/TB/2006.364)Bacteriology is one of the fundamental aspects of national tuberculosis (TB) control programmes (NTPs) and a key component of the DOTS strategy. However, TB laboratory services are often neglected components of these programmes. Given existing constraints, it will be difficult for many countries to achieve the global targets of 70% detection of infectious cases and 85% cure of these incidents by the year 2005. Although the global success rate under DOTS has reached 82%, the detection rate of the estimated prevalence has increased at a far slower rate (53% in 2004). In order to improve the case-detection rate, a global strategy for the development and strengthening of TB laboratory networks needs to be implemented urgently. In addition to improving sputum smear microscopy, the strategy recognizes the need to upgrade existing laboratory services and to strengthen/build capacity to perform culture and drug susceptibility testing (DST) in areas experiencing a high burden of acid-fast bacilli (AFB) smear-negative TB associated with human immunodeficiency virus (HIV) infection and to support DOTS-Plus projects. (excerpt)
Geneva, Switzerland, World Health Organization [WHO], 2006 Apr. 20 p. (WHO/HTM/TB/2003.328 Rev.2)The IDA Foundation is a non-profit organization supporting health care in low- and middle-income countries by providing high-quality drugs and medical supplies at the lowest possible price. In addition, IDA provides procurement agency services and offers consultancy and training on topics related to the various aspects of pharmaceutical supply management. IDA is based in the Netherlands and is ISO 9002-2000 and GDP certified. The quality of IDA products is verified in IDA's GcLP-approved laboratories. GLC is a subgroup of the Stop TB Working Group on DOTS-Plus for MDR-TB. GLC has been established to review applications from potential DOTS-Plus pilot projects and determine whether they are in compliance with WHO's Guidelines for establishing DOTSPlus pilot projects for the management of MDR-TB. Projects that are approved will benefit from second-line anti-TB drugs at concessional prices and from technical assistance from the GLC. (excerpt)
Geneva, Switzerland, World Health Organization [WHO], Stop TB Department, 2006.  p. (WHO/HTM/TB/2006.361)The emergence of resistance to drugs used to treat tuberculosis (TB), and particularly multidrug-resistant TB (MDR-TB), has become a significant public health problem in a number of countries and an obstacle to effective global TB control. In many other countries, the extent of drug resistance is unknown and the management of patients with MDR-TB is inadequate. In countries where drug resistance has been identified, specific measures need to be taken within TB control programmes to address the problem through appropriate management of patients and adoption of strategies to prevent the propagation and dissemination of drug-resistant TB, including MDR-TB. These guidelines offer updated recommendations for TB control programmes and medical workers in middle- and low-income countries faced with drug-resistant forms of TB, especially MDR-TB. They replace two previous publications by the World Health Organization (WHO) on drug-resistant TB. Taking account of important developments in recent years, the new guidelines aim to disseminate consistent, up-to-date recommendations for national TB control programmes and medical practitioners on the diagnosis and management of drug-resistant TB in a variety of geographical, political, economic and social settings. The guidelines can be adapted to suit diverse local circumstances because they are structured around a flexible framework approach, combining a consistent core of principles and requirements with various alternatives that can be tailored to the specific local situation. (excerpt)
Engaging all health care providers in TB control. Guidance on implementing public-private mix approaches.
Geneva, Switzerland, World Health Organization [WHO], Stop TB Department, 2006. 52 p. (WHO/HTM/TB/2006.360)A great deal of progress has been made in global tuberculosis control in recent years through the large-scale implementation of DOTS. It has been acknowledged though that TB control efforts worldwide, although impressive, are not sufficient. The global TB targets -- detecting 70% of TB cases and successfully treating 85% of them, and halving the prevalence and mortality of the disease by 2015 as part of the Millennium Development Goals (MDGs) -- are likely to be met only if current efforts are intensified. Among the important interventions required to reach these goals would be a systematic involvement of all relevant health care providers in delivering effective TB services to all segments of the population. Therefore, engaging all health care providers in TB control is an essential component of WHO's new Stop TB strategy¹ and the Stop TB Partnership's Global Plan to Stop TB 2006-2015. (excerpt)
The Stop TB Strategy: building on and enhancing DOTS to meet the TB-related Millennium Development Goals.
Geneva, Switzerland, World Health Organization [WHO], 2006. 22 p. (WHO/HTM/STB/2006.37)Since the development of the DOTS strategy, WHO and partners have worked on complementary policies and strategies to address the remaining major constraints to achievement of global TB control targets. These include expanding access to diagnosis and treatment through community TB care, and public--private mix (PPM) approaches aimed at engaging all care providers -- state and non-state -- in DOTS implementation. Innovative mechanisms such as the Global Drug Facility and the Green Light Committee have been developed to improve access to quality-assured and affordable drugs in resource-poor settings. The collaborative activities that need to be implemented by TB and HIV/AIDS control programmes have been defined, and strategies for managing multidrug-resistant TB (MDR-TB) have been developed and tested. Impact assessment is being pursued as a means of evaluating progress towards the MDGs. New partnerships and academic research initiatives for development of new tools are beginning to produce results and several new diagnostics, drugs and candidate vaccines are in the pipeline. (excerpt)
Tuberculosis control in Bolivia, Chile, Colombia and Peru: Why does incidence vary so much between neighbors?
International Journal of Tuberculosis and Lung Disease. 2006 Nov; 10(11):1292-1295.In 2003, Peru and Bolivia reported the highest annual tuberculosis (TB) incidence rates in the Americas. Neighboring Colombia and Chile had lower annual incidence rates despite their proximity. The objective was to determine what factors contribute to differences in TB incidence rates among Chile, Colombia, Bolivia and Peru. Multiple sources of literature dating between 1990 and 2005 were used and World Health Organization TB control guidelines were consulted for policy level comparisons. Comprehensive implementation of the DOTS strategy is the main factor explaining the differences in TB incidence rates, even after considering socio-economic factors. Cross-national comparisons suggest ways to improve regional DOTS implementation. (author's)
International Journal of Tuberculosis and Lung Disease. 2006 Oct; 10(10):1166-1171.The setting used was a tuberculosis control programme, southern region of Ethiopia. The objective was to assess the impact of the expansion of the DOTS strategy on tuberculosis (TB) case finding and treatment outcome. Reports of TB patients treated since the introduction of DOTS in the region were reviewed. Patients were diagnosed and treated according to World Health Organization (WHO) recommendations. Case notification and treatment outcome reports were compiled quarterly at district level and submitted to the regional programme. Of 136 572 cases registered between 1995 and 2004, 47% were smear-positive, 25% were smear-negative and 28% had extra-pulmonary tuberculosis (EPTB). In 2004, 94% of the health institutions were covered by DOTS. Between 1995 and 2004, the smear-positive case notification rate increased from 45 to 143 per 100 000 population, the case detection rate from 22% to 45%, and the treatment success rate from 53% to 85%. The default and failure rates decreased from 26% to 6% and from 7% to 1%, respectively. There was a steady increase in the treatment success rate with the decentralisation of DOTS. Although 94% coverage was achieved after 10 years, the stepwise scale-up was important in securing resources and dealing with challenges. The programme achieved 85% treatment success; however, with the current low case detection rate (45%), the 70% WHO target seems unachievable in the absence of alternative case-finding mechanisms. (author's)
Arlington, Virginia, Management Sciences for Health [MSH], Rational Pharmaceutical Management Plus, 2005 Oct. 13 p. (USAID Development Experience Clearinghouse DocID / Order No: PD-ACH-075; USAID Cooperative Agreement No. HRN-A-00-00-00016-00)USAID, through its SO5 TB global objective, promotes TB pharmaceutical management activities through the RPM Plus program. The global activities support the DOTS scheme, a WHO initiative, documented to break the transmission of TB when implemented correctly by national TB programs (NTP). One of the five primary elements of the DOTS scheme is an uninterrupted supply of TB drugs. RPM Plus provides technical assistance to the following WHO/Stop TB organizations: The Global TB Drug Facility (GDF): established in 2001 to provide free grants of TB medicines to countries unable to satisfy their medicine needs and to serve as a source of good quality TB drugs for those countries having their own funds; The Green Light Committee (GLC): technical support group for the DOTS Plus program. Initiated by the WHO and its partners to promote the correct treatment of multi-drug resistant (MDR) TB. The GLC makes medicines available to countries at affordable prices. As part of the global support RPM Plus also provides training in Pharmaceutical Management for TB at various World Health Organization consultant-training courses promoted by the Stop TB Department. (excerpt)
Rational Pharmaceutical Management Plus. Workshops on TB pharmaceutical management: trip report, Sondalo, Italy and Tbilisi, Georgia, July 6-17, 2005.
Arlington, Virginia, Management Sciences for Health [MSH], Rational Pharmaceutical Management Plus, 2005 Jul 31.  p. (USAID Development Experience Clearinghouse DocID / Order No: PD-ACH-073; USAID Cooperative Agreement No. HRN-A-00-00-00016-00)A regular supply of TB medicines is one of the main components of the DOTS and DOTS Plus schemes. RPM Plus contributes to these schemes through facilitation of training workshops in collaboration with other TB partners. In July 2005 RPM Plus participated in two training activities for pharmaceutical management of tuberculosis in Sondalo, Italy in collaboration with World Health Organization and in Tbilisi, Georgia in collaboration with GOPA/German Development Agency. There were 12 participants in the Sondalo workshop and 9 participants in the Tbilisi workshop representing the entire Caucasus region. (author's)
Bulletin of the World Health Organization. 2006 Sep; 84(9):688.Tuberculosis (TB) has been a major killer disease for several thousand years. Despite intensive efforts to combat the disease over the past twenty years, TB remains one of the leading causes of morbidity and mortality in many settings, particularly in the world's poorest countries. TB is primarily a disease of poverty, but is a significant public health problem also in wealthier countries where pockets of poverty and marginalized population groups exist. It is estimated that around 1.7 million people die each year from TB; and in 2004 figures indicate that approximately 8.9 million people developed the disease. (excerpt)
Lancet. 2005 Apr 2; 365:1206-1209.WHO’s strategy for DOTS is the main weapon against the global tuberculosis epidemic. DOTS was originally an acronym to emphasise directly-observed treatment and short-course chemotherapy with combinations of first-line drugs. It is now better thought of as the brand name of a broader public-health strategy, including diagnosis by sputum-smear microscopy, mechanisms for supporting patients over 6–8 months of treatment, systems for the maintenance of drug supplies, and for recording and reporting. There is abundant evidence that, when all the recommended procedures are in place, chemotherapy under DOTS can achieve cure rates of 90% or more, and prevent the emergence of resistance to first-line drugs. However, it is equally clear that, in populations where resistance has already spread because therapy has been inadequate in the past, first-line drug regimens are associated with higher rates of treatment failure and death. (excerpt)
Anti-tuberculosis drug resistance in the world. Third global report. The WHO / IUATLD Global Project on Anti-Tuberculosis Drug Resistance Surveillance, 1999-2002.
[Geneva, Switzerland], World Health Organization [WHO], WHO / IUATLD Global Project on Anti-Tuberculosis Drug Resistance Surveillance, . 129 p.This is the third report of the WHO/IUATLD Global Project on Anti-Tuberculosis Drug Resistance Surveillance. The two previous reports were published in 1997 and 2001 and included data from 35 and 58 settings respectively. The main conclusions of the two previous reports were that drug-resistant tuberculosis (TB) was present in all settings surveyed, multi-drug resistance (MDR) was identified in most settings, and that good TB control practices were associated with lower or decreasing levels of resistance. The goal of the third report is to expand knowledge of the prevalent patterns of resistance globally and explore trends in resistance over time. This report includes new data from 77 settings or countries collected in the third phase of the project, between 1999 and 2002, representing 20% of the global total of new smear-positive TB cases. It includes 39 settings not previously included in the Global Project and reports trends for 46 settings. Data were included if they adhered to the following principles: (1) the sample was representative of all TB cases in the setting under evaluation; (2) new patients were clearly distinguished from those with previous treatment; and (3) optimal laboratory performance was assured and maintained through links with a supranational reference laboratory (SRL). Data were obtained through routine or continuous surveillance of all TB cases (38 settings) or from specific surveys of sampled patients, as outlined in approved protocols (39 settings). Data were reported on a standard reporting form, either annually or at the completion of the survey. (excerpt)
Lancet. 2004 Nov; 4:653.WHO is not doing enough to control rising levels of tuberculosis, according to researchers at Harvard University, MA, USA. Despite almost 10 years of Directly Observed Treatment, Shortcourse (DOTS), WHO’s main strategy for treating active tuberculosis infections and reducing its prevalence, most of the world remains no closer to controlling this disease. The DOTS programme detects tuberculosis by sputum-smear microscopy then administers standard shortcourse chemotherapy under a directly observed therapy approach. WHO’s goal is to identify 70% of patients with positive smears, and to cure 85% of them by the end of 2005. But this tactic, says author Timothy Brewer, is likely to have only a modest effect on population-based tuberculosis control. (excerpt)
Global HealthLink. 2001 Mar-Apr; (108):4, 20.A new report jointly issued by six United Nations agencies claims that worsening AIDS, TB and malaria epidemics are not inevitable; the strategies that developing countries have deployed to turn back these diseases and prevent the deaths they cause have been successful. The targets for reducing the toll of these illnesses, set by the world’s leaders at successive summits over the last year, are feasible. What is needed are the funds and systems that will enable widespread implementation of actions that have shown to be effective, the report says. In a joint report issued in December – “Health, a Key to Prosperity: Success Stories in Developing Countries” – the World Health Organization (WHO), the United Nations Children’s Fund (UNICEF), the United Nations Educational, Scientific and Cultural Organization (UNESCO), the United Nations Joint Programme on AIDS (UNAIDS), the United Nations Population Fund (UNFPA) and the World Bank outline key factors for combating AIDS, tuberculosis, malaria, childhood diseases and maternal and perinatal conditions, even in resource-poor settings. (excerpt)
Journal of the Pakistan Medical Association. 2004 Apr; 54(4):175-181.Objectives: There are two objectives: (a) to clearly articulate the Millennium Development Goals (MDGs) adopted by the United Nations in 2000 and their implications for developing countries like Pakistan; and (b) to critically review the challenges faced by Pakistan in achieving the health-related MDGs. Methods: A critical review of secondary data and information generated primarily by multilateral agencies and United Nations organizations. Results: The MDGs represent a global consensus on the broad goals of development to be achieved by 2015. Of the eight Millennium Development Goals, three are specifically health related - reducing infant (under-5) and maternal mortality; and combating HIV/AIDS, tuberculosis, malaria and other significant communicable diseases. According to various studies, many developing countries will not achieve the MDGs without concerted efforts and commitment of additional resources. Like many other developing countries, Pakistan is also faced with an enormous challenge in reaching the Millennium Development Goals and targets set by the United Nations. For Pakistan, perhaps the most challenging MDG is that of reducing "by three-quarters the maternal mortality ratio." Maternal mortality is so intertwined with other "social" factors - including the status of women - that a comprehensive holistic approach is required. Conclusion: In order to achieve the MDGs, Pakistan would require a fundamental shift in its policy and strategic directions. Along with allocation of significant additional resources for health, it needs to review and reprioritize the use of existing resources, focusing more on primary health care. Pakistan must also adopt a holistic integrated approach that views health, education, and other social sector development as intrinsically interrelated and interwoven. Without such an integrated approach, achieving the health-related MDGs is likely to remain illusive for Pakistan. There is a critical need to foster a healthy debate on the health-related Millennium Development Goals in Pakistan so as to inform and, hopefully influence, public policy. (author's)
Lancet. 2004 Apr 3; 363(9415):1122.With just 20 months to go before the World Health Assembly’s (WHA) tuberculosis (TB) treatment target is due to be met, it is clear that the deadline will not be reached. In May, 2000, the WHA pledged to combat TB— which infects 9 million people each year and kills 2 million—by setting goals that demand detection of 70% of cases of infectious TB, and treatment of 85% of these by December, 2005. But, new data announced at the second meeting of Stop TB Partners’ Forum (March 24–25, 2004; New Delhi, India), where WHO’s 2004 Global Tuberculosis Report was also released, confirmed fears that TB is still far from under control. Treatment is now successful in 82% of cases, just 3% shy of the cure target. But smear-positive case detection remains low at 37%—just over half the goal of 70%. (excerpt)
BMJ. British Medical Journal. 2003 Oct 11; 327:822-823.The likelihood of successful treatment of tuberculosis depends on the extent to which patients complete the prescribed treatment regimen (usually called compliance with, or adherence to, treatment). Interrupted treatment of tuberculosis results in ongoing transmission of disease. Without support throughout the full course of treatment, many patients with tuberculosis adhere to treatment until symptoms have resolved and then stop, since patients may equate disease and therefore the need to continue treatment with illness (symptoms). The consequent risks of failure of treatment, relapse, death, and drug resistance, threaten not only patients but also communities. Recognition in the 1950s of the importance of providing intensive support to patients with tuberculosis to promote adherence to treatment paved the way for later promotion of directly observed therapy (DOT) for adherence to treatment. (excerpt)