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Tuberculosis now a global threat

Thursday, 23 March 2000: UNICEF today called tuberculosis "one of the most seriously neglected and underestimated health, human rights and poverty problems of our era" and said only a concerted effort could conquer a disease that accounts for 2 million deaths a year, including over 250,000 children.

"TB is the globe's leading infectious killer of youth and adults and a leading killer of women," UNICEF Executive Director Carol Bellamy said. "In a globalizing world, we need a quick, global solution."

UNICEF Deputy Executive Director Andre Roberfroid will underline the agency's concern in an address tomorrow to the Ministerial Conference on TB and Sustainable Development, being held now in Amsterdam. The meeting brings representatives from high-incidence countries together with health and humanitarian officials to map out a tuberculosis strategy for the new millennium.

Tomorrow has been designated World TB Day 2000 to highlight the widespread commitment to a "Stop TB" initiative. Among the major objectives of that initiative are a significant expansion of the use of what is called DOTS (Directly Observed Treatment Short-Course") -- a six-to-nine-month regimen to combat TB. Effectively addressing the complementary relationship between TB and HIV/AIDS is also a primary objective.

"The cost of inaction is high," Mr. Roberfroid says. "If we accept the proliferation of inadequate TB treatment services and incorrect self-treatment -- a real possibility in Asia -- we face a rise in the incidence of multi-drug resistant TB (MDR-TB). That would be a humanitarian and epidemiological disaster."

MDR-TB develops when TB patients begin but do not complete a full course of treatment with drugs. When this occurs, the disease becomes much harder to treat -- and far more costly.

Every year, an estimated 2 million people die of TB around the world. There are 8 million new cases annually. Asia accounts for approximately 70 per cent of all TB cases. Ten Asian countries -- Bangladesh, Cambodia, China, India, Indonesia, Myanmar, Pakistan, Philippines, Thailand and Viet Nam -- are among the 22 countries in the world with the highest number of cases.

Although some 2 billion people are infected with TB, only a relatively small percentage ever develop the disease. But because TB is an opportunistic disease, people whose immune systems have been weakened by HIV/AIDS are 30 times more likely to develop the disease. As reported by WHO, there has been a quadrupling of TB cases in several African countries over the past 10 years as a direct result of HIV.

This is why approximately 40 per cent of people with HIV/AIDS also develop TB and why, in many countries, TB is the leading cause of death for HIV/AIDS-infected people.

In Bangkok, UNICEF Deputy Executive Director Kul Gautam noted that TB is the single biggest killer of young women in the world, taking the lives of 750,000 each year.

"In addition to being a deadly killer, the stigma of TB often results in women being ostracized by their families and communities, which in turn has a devastating impact on the well-being of their children," Mr. Gautam said. "The result is that many thousands of upwardly mobile families are driven back into poverty, while those families that were already impoverished must struggle even harder just to survive."

Children are especially vulnerable to the effects of TB, which is often difficult to diagnose in young children and therefore difficult to treat effectively. Children also suffer serious social consequences when someone in their family has TB. In India, for example, over 300,000 children are withdrawn from school each year either to go to work to help their families bear the costs of TB care or due to the stigmatizing effects of the disease.

"But TB can be prevented and cured," Mr. Gautam said. "Several countries in Asia, including poorer countries such as Cambodia and Vietnam, have developed model responses and are well on their way to effectively controlling the disease. The medical solutions are within our reach. The remaining challenge is to mobilize sufficient political will to attack TB and to build a social partnership that includes governments, the business and private sector, concerned institutions, NGOs, and communities and families."

"DOTS has achieved cure rates of 80 per cent at a cost of between $10 and $20 per patient. Untreated, a person with infectious TB can infect as many as 15 persons in a year," Ms. Bellamy said. "Our concern is to ensure that women and children receive the medical care and attention that they need as the number of cases continues to increase, especially in sub-Saharan Africa, as a result of AIDS"

She expressed strong approval of the TB Initiative goal of increasing DOTS coverage to reach World Health Organization goals: a 70 per cent detection rate and an 85 per cent cure rate.

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