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International Journal of Tuberculosis and Lung Disease. 2008 Jan; 12(1):108-110.The information provided in the guidelines of the World Health Organization and the International Union Against Tuberculosis and Lung Disease for Ziehl-Neelsen staining is not practical on a number of points. The advice given here is meant to supplement the guidelines. It is based on experiments on and field experience of basic fuchsin stain and staining solutions.
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)
Bulletin of the World Health Organization. 2007 Aug; 85(8):586-592.WHO's new Global Plan to Stop TB 2006-2015 advises countries with a high burden of tuberculosis (TB) to expand case-finding in the private sector as well as services for patients with HIV and multidrug-resistant TB (MDR-TB). The objective of this study was to evaluate these strategies in Thailand using data from the Thailand TB Active Surveillance Network, a demonstration project begun in 2004. In October 2004, we began contacting public and private health-care facilities monthly to record data about people diagnosed with TB, assist with patient care, provide HIV counselling and testing, and obtain sputum samples for culture and susceptibility testing. The catchment area included 3.6 million people in four provinces. We compared results from October 2004-September 2005 (referred to as 2005) to baseline data from October 2002-September 2003 (referred to as 2003). In 2005, we ascertained 5841 TB cases (164/100 000), including 2320 new smear-positive cases (65/100 000). Compared with routine passive surveillance in 2003, active surveillance increased reporting of all TB cases by 19% and of new smear-positive cases by 13%. Private facilities diagnosed 634 (11%) of all TB cases. In 2005, 1392 (24%) cases were known to be HIV positive. The proportion of cases with an unknown HIV status decreased from 66% (3226/4904) in 2003 to 23% (1329/5841) in 2005 (P< 0.01). Of 4656 pulmonary cases, mycobacterial culture was performed in 3024 (65%) and MDR-TB diagnosed in 60 (1%). In Thailand, piloting the new WHO strategy increased case-finding and collaboration with the private sector, and improved HIV services for TB patients and the diagnosis of MDR-TB. Further analysis of treatment outcomes and costs is needed to assess this programme's impact and cost effectiveness. (author's)
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)
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)
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)
Geneva, Switzerland, WHO, 2005.  p. (WHO/HTM/TB/2005.349)The goal of this series of annual reports is to chart progress in global TB control and, in particular, to evaluate progress in implementing the DOTS strategy. The first targets set for global TB control were ratified in 1991 by WHO’s World Health Assembly. They are to detect 70% of new smearpositive TB cases, and to successfully treat 85% of these cases. Since these targets were not reached by the end of year 2000 as originally planned, the target year was deferred to 2005.4 In 2000, the United Nations created a new framework for monitoring progress in human development, the MDGs. Among 18 MDG targets, the eighth is to “have halted by 2015 and begun to reverse the incidence of malaria and other major diseases”. Although the objective is expressed in terms of incidence, the MDGs also specify that progress should be measured in terms of the reduction in TB prevalence and deaths. The target for these two indicators, based on a resolution passed at the 2000 Okinawa (Japan) summit of G8 industrialized nations, and now adopted by the Stop TB Partnership, is to halve TB prevalence and death rates (all forms of TB) between 1990 and 2015. All three measures of impact (incidence, prevalence and death rates) have been added to the two traditional measures of DOTS implementation (case detection and treatment success), so that the MDG framework includes five principal indicators of progress in TB control. All five MDG indicators will, from now on, be evaluated by WHO’s Global TB Surveillance, Planning and Financing Project. The focus is on the performance of NTPs in 22 HBCs, and in priority countries in WHO’s six regions. (excerpt)
[Washington, D.C.], Massive Effort Campaign, 2005.  p.Tuberculosis was last year's most overlooked tragedy. TB killed more people than all wars, earthquakes, floods, tsunamis, airline accidents, terrorist acts and murders worldwide the past year, and with much less fanfare. The deaths of these 1.8 million people were arguably all the more tragic as almost every one of them could have been prevented if they had been properly treated with highly-effective anti-TB medicines. This report asks, "Who is succeeding in preventing these tragic deaths?" In examining the most recent data that countries have provided to the World Health Organization, this independent report finds that some countries - even among the poorest such as Cambodia and the Democratic Republic of Congo - are doing quite a lot. Indeed, over one million people with infectious TB worldwide were completely cured the past year thru the DOTS TB treatment strategy. The TB control efforts of just six countries - China, India, Indonesia, Philippines, South Africa and Viet Nam - cured nearly half of these cases. Hundreds of thousands of lives have been spared this past year because of these efforts. This report also asks, "Who is failing to prevent deaths from TB?" (excerpt)
Bulletin of the World Health Organization. 2006 Apr; 84(4):265-266.Nearly a decade after starting work with the Russian Federation to stem a tuberculosis (TB) epidemic, WHO is reporting slow but steady progress. The WHO-recommended DOTS treatment strategy is gradually taking hold across world's largest country, but its vast network of prisons and labour camps remains a hotbed of the disease. (excerpt)
Indian Journal of Tuberculosis. 2005; 52:121-131.Drug resistant tuberculosis has been reported since the early days of the introduction of chemotherapy, but recently multi-drug resistant tuberculosis (MDR-TB) has been an area of growing concern and is posing a threat to control of tuberculosis. A review of 63 surveys conducted between 1985 and 1994 suggested that primary and acquired MDR-TB was between 0-10.8% and 0-48% respectively. However, the qualities of these studies were variable due to the lack of proper representativeness and size of population sampled, as well as lack of standardized laboratory methods in some of them. In 1994, WHO-IUATLD carried out a surveillance which concluded that the problem is global; the median prevalence of primary and acquired multi drug resistance was 1.4% (0-14.4%) and 13% (0-54.4%) respectively. A second WHO-IUATLD global project on drug surveillance carried out in 1996-1999 in 58 countries, found that the median prevalence of primary and acquired multi-drug resistance was 1% (0-14%) and 9% (0 - 48%) respectively. Current estimates report, the prevalence of primary and acquired multidrug resistance in India as 3.4% and 25% respectively. It must be emphasized that optimal treatment of MDR-TB alone will not curb the epidemic. Efforts must be focused on the effective use of first line drugs in every new patient so as to prevent the ultimate emergence of multidrug resistance. The use of reserve drugs to cure multi-drug resistant tuberculosis and to reduce further transmission should be considered, but only as part of well structured programmes of tuberculosis control. (author's)
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)
[Multiple drug resistance: a threat for tuberculosis control] La resistencia a múltiples fármacos: una amenaza para el control de la tuberculosis.
Revista Panamericana de Salud Pública / Pan American Journal of Public Health. 2004; 16(1):68-73.Drug-resistant tuberculosis (TB) was reported soon after the introduction of streptomycin, although it did not receive major attention until recently. It was not considered a major issue in the industrialized world until outbreaks of multidrug-resistant TB (MDR-TB) were reported among HIV infected people. Administration of standard shortcourse chemotherapy (SSCC) with first-line drugs under directly observed therapy (DOT) is the cornerstone of modern TB control. Unfortunately, data available on the treatment outcome of MDR-TB cases under routine programmatic conditions suggest that patients with MDR-TB respond poorly to SSCC with first-line drugs. Since 1994, the World Health Organization and the International Union Against Tuberculosis and Lung Disease (IUATLD) have conducted anti-TB drug resistance surveys through a network of subregional laboratories and researchers. Drug resistance was present in almost all settings surveyed, and prevalence varied widely across regions. High prevalence of MDR-TB is widespread in the Russian Federation and areas of the former Soviet Union (Estonia, Kazakhstan, Latvia, and Lithuania) as well as Israel, Liaoning and Henan Provinces in China, and Ecuador. The Global Project has surveyed areas representing over one third of notified TB cases. However, enormous gaps still exist in the most crucial areas. The most effective strategy to prevent the emergence of drug resistance is through implementation of the directly observed treatment short (DOTS) strategy. Effective implementation of the DOTS strategy saves lives through decreased TB transmission, decreased risk of emergence of drugresistance, and decreased risk for individual TB patients of treatment failure, TB relapse, and death. The World Bank recognizes the DOTS strategy as one of the most cost-effective health interventions, and recommends that effective TB treatment be a part of the essential clinical services package available in primary health care settings. Governments are responsible for ensuring the provision of effective TB control through the DOTS strategy. WHO and its international partners have formed the DOTS-Plus Working Group, which is attempting to determine the best possible strategy to manage MDR-TB. One of the goals of DOTS-Plus is to increase access to expensive second-line anti-TB drugs for WHO-approved TB control programmes in low- and middle-income countries. (author's)
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)
Bulletin of the World Health Organization. 2004 Sep; 82(9):716.A decade after introducing the WHO recommended tuberculosis (TB) control strategy across half of China, a recent study showed that prevalence of the deadly bacterial disease that affects the lungs has fallen by about one-third. WHO and the Chinese Ministry of Health published a joint report in the Lancet on 30 July based on the findings of a survey conducted in 2000 among 376 000 people in all 31 provinces, autonomous regions and municipalities on the Chinese mainland. In the report, researchers compared TB prevalence in regions where the DOTS control strategy had been implemented with those in the rest of the country. Researchers concluded that — as a direct result of the project — there were 382 000 fewer cases of TB in 2000 than 10 years earlier, a 30% decline in prevalence, taking into consideration a larger and more aged population. WHO said TB remains a significant public health problem in China with 1.4 million new cases each year, where the most recent WHO data suggests that only four or five cases out of every 10 receive treatment through the DOTS programme. (excerpt)
Tuberculosis control in resource-poor countries: have we reached the limits of the universal paradigm?
Tropical Medicine and International Health. 2004 Jul; 9(7):833-841.The aim of TB control is to break the cycle of transmission by treating TB cases as early and efficiently as possible. In its efforts to promote a model of worldwide TB control, WHO defined specific targets and launched the ‘Directly Observed Therapy, Short-course’ (DOTS) strategy as the main tool to reach them. However, the diversity of patients’ attitudes towards the disease and the extreme variability of access to care, especially in resource-poor countries, are amongst the many factors of social context that profoundly affect the ability of control programmes to implement this policy effectively. There are multiple reports of TB control programmes using various types of intervention to promote adherence and enhance case-holding, but most of these interventions depend on external funding, which bring into question their long-term sustainability. In this paper, we address the problems related to operational variabilities in the implementation of the DOTS strategy in resource-poor countries and question the appropriateness of a universal paradigm for global TB control. This analysis is of particular importance as programmers consider using this model in the delivery of anti-retroviral therapies for the treatment of HIV in resource-limited settings. (author's)
Journal of the Indian Medical Association. 2003 Mar; 101(3):157.The introduction of rifampicin, pyrazinamide and ethambutol ushered in the era of “short course chemotherapy”. Multidrug resistance TB (MDR-TB) is threatening to destabilise the best efforts of TB control. Treatment of MDR-TB is difficult, expensive and toxic and is often unsuccessful. DOTS is an interventional strategy designed to effectively diagnose and treat TB. The fundamental principles in the DOTS strategy are : Polititical will, diagnosis by sputum microscopy, directly observed standardised short-course treatment, adequate supply of good quality drugs, systematic monitoring and accountability. Patients with HIV infection and TB disease respond well to antituberculosis treatment if they are given short-course chemotherapy in the programme of DOTS. (excerpt)
Journal of the Indian Medical Association. 2003 Mar; 101(3):142-143.The TB problem in India was first recognised through a resolution passed in the All India Sanitary Conference, held at Madras in 1912. The TB picture started becoming clear with the introduction of tuberculin testing. The Bhore committee report issued in 1946 estimated that about 2.5 million patients required treatment in the country with only 6,000 beds available. The first open air institution for isolation and treatment of TB patients was started in 1906 in Tilaunia near Ajmer and Almora in the Himalayas in 1908. The anti-TB movement in the country gained momentum with the TB Association of India was established in 1939. WHO and UNICEF took keen interest in providing assistance for introducing mass BCG vaccination with low cost in 1951. In the 1940s streptomycin and PAS were introduced in the west followed by thiocetazone and INH is 1950s. National Tuberculosis Control Programme (NTP) was formulated in 1962 which was implemented in phased manner. The deficiency in NTP was identified in 1963 and Revised National TB Control Programme (RNTCP) was developed. There is a commitment for Government of India to expand RNTCP to cover the entire country by 2005. (excerpt)
MRC News. 2001 Feb; 32(1):.Tuberculosis, or TB as it's commonly known, is a rampant, infectious disease with estimates putting worldwide infection rates at 1 in every 3 people. Especially in countries where the rate of HIV infection is high, TB infection rates soar, with HIV and TB forming a deadly duo. An even greater problem is that of drug-resistant TB - when the illness is not cured by the use of first-line drugs. This is commonly thought to be caused only by poor compliance of patients not adhering to treatment strategies. Prof. Paul van Helden, Director of the MRC's Centre for Molecular and Cellular Biology, and his team of scientists hold a different view. (excerpt)
InterDependent. 2002 Fall; 28(2):15-16.To date, the Global Fund has received multi-year pledges of $2.1 billion from governments, corporations, foundations, non-profit organizations, and private individuals- a level that has remained stagnant for several months. However, as of October 10, the Fund has received only $483 million. Of the 31 countries that made pledges, only Ireland has made a complete payment, while 23 countries have made no payments at all. Feachem warned, "We need an additional $2 billion in 2003 and an additional $4.6 billion in 2004, in addition to the $2.1 billion that [has] already [been] pledged." He said these "very substantial short-term resource requirements" were needed by the Fund "pretty quickly." (excerpt)
FRONT LINES. 1991 Nov; 16.Indonesia's success in reaching World Health Organization (WHO) universal immunization coverage standards is described as the result of a strong national program with timely, targeted donor support. USAID/Indonesia's Expanded Program for Immunization (EPI) and other USAID bilateral cooperation helped the government of Indonesia in its goal to immunize children against diphtheria, pertussis, tetanus, polio, tuberculosis, and measles by age 1. The initial project was to identify target areas and deliver vaccines against the diseases, strengthen the national immunization organization and infrastructure, and develop the Ministry of Health's capacity to conduct studies and development activities. This EPI project spanned the period 1979-90, and set the stage for continued expansion of Indonesia's immunization program to comply with the full international schedule and range of immunizations of 3 DPT, 3 polio, 1 BCG, and 1 measles inoculation. The number of immunization sites has increased from 55 to include over 5,000 health centers in all provinces, with additional services provided by visiting vaccinators and nurses in most of the 215,000 community-supported integrated health posts. While other contributory factors were at play, program success is at least partially responsible for the 1990 infant mortality rate of 58/1,000 live births compared to 72/1,000 in 1985. Strong national leadership, dedicated health workers and volunteers, and cooperation and funding from UNICEF, the World Bank, Rotary International, and WHO also played crucially positive roles in improving immunization practice in Indonesia.