The rise of diabetes coupled with the fact that it makes people more prone to catching TB is causing some health experts to become increasingly concerned. From NPR:
“Diabetes is fueling the spread of TB,” declares a white paper on the looming “co-epidemic” released at the 45th Union World Conference on Lung Health in Barcelona on Wednesday.
“Having diabetes increases the risk that a person will become sick with TB,” the report says. “Diabetes is also more difficult to manage in people who have TB. And a person sick with both diseases is likely to have complications that do not typically exist when either is present on its own.”
Dr. Anthony Harries, a coauthor of the report, tells Goats and Soda there’s a new urgency to head off the dual epidemic in countries with high levels of TB, such as Brazil, China, India, Indonesia and the Russian Federation.
Harries, who spent years in Malawi as the HIV/TB epidemic unfolded, doesn’t want to repeat history. “Looking back, we were a bit late in our response to the HIV/TB epidemic. It took a while to wake up to the fact that HIV was driving that.”
Warnings about the deadly interaction of HIV and TB were sounded in the early 1990s, but no global strategy was developed until 2004. The AIDS virus kills off CD4 cells in the immune system, which are necessary to fight TB infection.
The TB/diabetes double-whammy has at least two important differences from the TB/HIV co-epidemic:
- It involves the interaction of an infectious disease (TB is the world’s second-deadliest, next to HIV/AIDS) and a non-communicable chronic disease, rather than two infections.
- It has potentially more global impact. The TB/HIV co-epidemic was concentrated in sub-Saharan Africa, where 18 countries saw TB rates quadruple because of HIV. Many more countries have high rates of TB and, increasingly, of diabetes.
Spotlight on PSI
IntraHealth International reports on the recent trip by PSI ambassador Mandy Moore and Mom Bloggers for Social Good founder Jennifer James to Tanzania, with PSI. An excerpt:
At an IntraHealth-run site in Shinyanga, Mandy and Jennifer saw firsthand the inner workings of a rural, mobile HIV facility, where HIV testing, counseling, and voluntary medical male circumcision take place.
During IntraHealth’s three-week campaigns when the site is up and running, health workers from clinics and hospitals across the region take time away from their regular duties to staff the outreach facility. Men and boys flock to them, standing in long lines or in groups in the shade as they wait for services.
Mandy and Jennifer talked with clients and health workers, watched nurses and counselors at work, and even followed one client through the entire process of HIV testing, counseling, and voluntary medical male circumcision.
“I was passing nearby and heard there was a tent and asked what was being done,” said 24-year-old Amos Emmanuel Kakere. “I was anxious to get the service.” (Read more about Amos in Jennifer’s Huffington Post article.)
IntraHealth has provided voluntary medical male circumcisions to 315,904 men and boys in three regions of Tanzania. We’ve also helped provide HIV testing and counseling to more than 1.1 million Tanzanians and trained 3,000 health workers to provide HIV services.
During the same week, Mandy and Jennifer also visited PSI facilities in Dar es Salaam, Tanzania. There, they met frontline health workers, including family planning providers, and visited two dispensaries that are part of the PSI Tanzania-supported Familia health franchise network.
Global Health and Development Beat
Doctors Without Borders urged caution over claims of a slowdown in infections in Ebola-hit Liberia, saying the apparent drop could be due to poor management of the sick.
Preliminary data indicate a shorter, less painful treatment regimen for people with TB is just as effective as current treatment that lasts one to two years.
Speaking in Kenya on Thursday, UN Secretary-General Ban called female genital mutilation a brutal practice that must be stopped to increase the health, human rights and empowerment of women and girls.
Brothel closures in Indonesian cities could put sex workers in danger and hamper HIV prevention efforts, say health experts and outreach workers.
The international humanitarian organization Action Against Hunger USA warns the Ebola emergency has left a shortage of manpower for food production and a spike in food costs for the three main countries hit hardest by the Ebola outbreak—Guinea, Liberia and Sierra Leone.
Violence in Central African Republic has taken a heavy toll on food security. A new U.N. assessment says crops, livestock and fishing have all been affected.
Liberia is making some progress in containing the Ebola outbreak while the crisis in Sierra Leone is going to get worse, the top anti-Ebola officials in the two countries said.
The World Bank said Thursday it was immediately providing $100 million to support the deployment of more health workers to Ebola-stricken West Africa.
Buzzing in the Blogs
Jina Moore, who has been doing excellent reporting on Ebola from Liberia, reflects on what the US can learn from Liberia about quarantines. She writes in BuzzFeed:
In the face of all that human need, quarantines can do more harm than good. The approach “pushes people underground, and they basically will lose trust in the system, in those people that are trying to help them,” he said.
Archie C. Gbessay, who runs the case investigation team in West Point that’s in charge of actively finding Ebola patients, said that’s just what happened. “The quarantine of West Point hurt in some sense. It built… more disbelief [of the disease], more distrust by of people of government,” he said. “If you leave the community like that, closed up in the area, you create the idea that you’re going just to let everybody die.”
The biggest problem with quarantines may be people’s desire to resist them. Hickox, who still shows no symptoms of Ebola and has had two negative Ebola tests, has vowed to disobey quarantine orders in Maine, attracting press attention this morning when she went for a bike ride. President Barack Obama on Wednesday echoed concerns that mandatory quarantines could discourage health workers from volunteering in West Africa.
Human psychology and behavior, even more than human movement, may be the key to stopping the disease. Sick patients need to go to hospitals when they have symptoms that may be Ebola — just like Dr. Craig Spencer did in New York, and just like dozens of Liberians here do every week. And prevention measures need to adapt to what people will, and won’t, actually do.
“This is about people, and people are complex things,” said Ian Bray, a senior spokesperson for Oxfam, “Working with what the community wants to do is really important. We all know in our own communities what the public does with health warnings on drinking or smoking. It’s a universal issue, how to communicate health messages.”
None of this surprises Brown, who is the only official in Liberia — other than the president who issued the order — authorized to speak on the highly sensitive issue.
“People don’t want to be quarantined,” Brown said. “It’s a natural instinct. We don’t want to be caged.”
11:00 AM – Cultural Adaptation and Translation in Autism Research: Global Perspectives – Elliot School
By Mark Leon Goldberg and Tom Murphy
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Disclaimer: Opinions presented in this email do not necessarily reflect the views of PSI.