Adieu Dr Govil!
Shobha Shukla - CNS
----------------

To read the original CNS article online, go to:
http://www.citizen-news.org/2012/01/adieu-dr-govil.html
----------------

The hands, which healed, bringing back thousands of kids to life from near
death, are no more. The voice that inspired hope in the hopeless is silenced. We
lost Professor (Dr) Yogesh C Govil, Professor of Paediatrics, Chhatrapati
Shahuji Maharaj Medical University, (erstwhile King George's Medical College),
Lucknow, to the cruel hands of fate. He, who was like God to many of his
patients, was snatched away by God in a fatal car accident on Sunday, the 8th of
January, 2012. An excellent and sensitive doctor, who touched many lives with
his humility and gentleness, Dr Govil will be fondly and tearfully remembered by
his colleagues and numerous patients who virtually idolized him. We at CNS are
proud of our long association with Dr Govil. Despite his very busy schedule, he
always found time to enlighten us about various childhood diseases.

Reproduced below are some of his golden words, as told to CNS, on a range of
topics related to paediatric health:--

On the importance of mother's milk---"Bottle feeds and formula milk certainly
cannot be a replacement for breast milk, because no human endeavour can put
those factors which the Almighty has done. They may be sufficient in terms of
nutritive value to some extent, but there are many other benefits of mother's
milk which the formula food cannot meet. Maternal and infant bonding cannot be
provided by these foods. A lot of research has ultimately proved that breast
milk is the best milk. A child should be exclusively breastfed during the first
6 months, and then weaned away gradually by starting complementary food like
cereals, mashed papaya, banana etc. As the child grows, all types of household
diets must be added with some butter and ghee also, so that dense calories can
be provided."

On good nutrition--- "One cannot define nutrition in variant degrees-- if it is
not good it will certainly be bad. Bad nutrition is such that either it leads
the child to become overweight or underweight. Bad nutrition is one extreme for
affluent families, where kids are fond of junk food, which overfill them with
calories; and at the other extreme are families with poor socio-economic status
who are forced to dilute milk and other food, which deprives them of the
nutrient values."

On public awareness of childhood dieases---"The biggest intervention that can be
done is education. No measure is better than awareness, and for that people need
to be educated about the havoc which tobacco and fuel smoke can wreak on
innocent infants and children, exposing them to several diseases, like
pneumonia, and  related complications (which may even be fatal) for no fault of
theirs."

On the misuse of antibiotics---"Development of antibiotic resistance among
common pathogens is a global concern. Unfortunately, nowadays a lot of
antibiotic misuse is happening in our country and the reason is that many a
times patients are been treated by unqualified practitioners of medicine,
especially in rural areas. I think more than 20%-30% of patients initially go to
unqualified practitioners, who are in the habit of advising lots of broad
spectrum antibiotics in the beginning. Even in viral infections, where
antibiotics are not usually indicated, antibiotics are prescribed. This is
prevalent in the urban setup as well. Very often patients try to self medicate
also, as antibiotics are easily available over the counter. This develops a
resistance against normal (narrow spectrum) antibiotics, thus making them
ineffective. Before the first wonder drug penicillin was discovered in the
1930s, men used to die like flies, and if this trend (overuse of antibiotics)
continues that era would return."

We at CNS join thousands others in paying homage to this departed soul. May we
continue his legacy of dedication and selfless service to one and all,
irrespective of social status, caste and creed.

Shobha Shukla - CNS
(The author is the Managing Editor of Citizen News Service (CNS). She is a J2J
Fellow of National Press Foundation (NPF) USA. She has worked earlier with State
Planning Institute, UP and taught physics at India's prestigious Loreto Convent.
She also co-authored a book (translated in three languages) "Voices from the
field on childhood pneumonia" and a report on Hepatitis C and HIV treatment
access issues in 2011. Email: shobha@..., website:
http://www.citizen-news.org)
----------------

To read the original CNS article online, go to:
http://www.citizen-news.org/2012/01/adieu-dr-govil.html
----------------

CNS: Biggest threat to citizens lurks within our borders
Bobby Ramakant - CNS
*************************

Online at:
http://www.citizen-news.org/2012/01/biggest-threat-to-citizens-lurks-within.html

(CNS): Newspapers in India today feature a news (
http://timesofindia.indiatimes.com/india/Nuclear-weapons-only-for-strategic-dete\
rrence-Army-chief/articleshow/11502906.cms )prominently where the Army Chief has
said that nuclear weapons are not for war-fighting (because it will finish the
world) but have a deterrent value. Also the news highlights that Pakistan has
slightly more nuclear warheads than India - further fueling the ongoing arms
race in the Indian sub-continent. Firstly, we believe that the nuclear weapons
have zero deterrent value. If nuclear weapons had a deterrent value then nuclear
powers would not have been attacked by countries that have no nuclear weapon,
and nuclear powers would not have to lose a war. Secondly, where should India
invest a significant portion of its budget - in strengthening military/ army or
systems that help fight the 'enemies' that are real threat to its citizens on
daily basis?

Which is the biggest killer of our citizens in India? And what is the biggest
threat to us Indians? Is it the enemy across the border or is it the conditions
in which our people live on day-to-day basis that puts them at risk of premature
death? Should not this decide where the public money is invested in so that our
citizens are healthy, safe and secure?  Non-communicable diseases (NCDs) account
for about two-third of deaths, and lead conditions include heart diseases,
stroke, diabetes, cancer, among others.

According to a news published in The Times of India
(http://timesofindia.indiatimes.com/india/Superpower-230-million-Indians-go-hung\
ry-daily/articleshow/11494502.cms ), 21% of India's population is
undernourished, nearly 44% under-5 children are underweight and 7% of them are
dying before they reach five years. India is firmly established among the
world's most hunger-ridden countries (Source: International Food Policy Research
Institute - IFPRI which combines the above three indicators to give us a Global
Hunger Index (GHI) according to which India is 67th among the worst 80 countries
in terms of malnourishment.)

In India, diarrhoea continues to be a significant cause of mortality. Childhood
pneumonia is the biggest cause of death for under-five children. How can one
justify when our people are dying of preventable, and even worse, curable,
causes such as pneumonia, diarrhoea, tuberculosis, or hunger?

The above-mentioned news further adds: the proportion of hungry in the
population has actually gone up. Today India has 213 million hungry and
malnourished people by GHI estimates although the UN agency Food and Agriculture
Organization (FAO) puts the figure at around 230 million. The National Family
and Health Survey (NFHS), last carried out in 2004-05, had shown that 23% of
married men, 52% of married women and a chilling 72% of infants were anemic - a
sure sign that a shockingly large number of families were caught in a downward
spiral of slow starvation (Source: TOI news).

Where is the biggest threat to majority of our citizens - across the borders or
within our country? Should we invest huge amounts of money in weapons and
military or should we strengthen our health systems?

Citizens have to seriously ponder of the utility (or futility) of investing
significant amounts of limited public money India has in nuclear weapons and
other arms and ammunition. Where should our money (public money) be invested? In
bombs or in providing basic human amenities to every citizen? Should not
governments provide social security to every citizen instead of so-called false
sense of security that comes from nuclear weapons and other forms of weapons?

Time for citizens to think rationally and make a choice.

Bobby Ramakant - CNS

Online at:
http://www.citizen-news.org/2012/01/biggest-threat-to-citizens-lurks-within.html

Childhood Tuberculosis: Act before it is too late
SHOBHA SHUKLA – CNS
**********************
ONLINE AT:
http://www.citizen-news.org/2012/02/tuberculosis-in-children-act-before-it.html

(Based on an interview given to CNS by Dr Soumya Swaminathan, at Chennai ART
Symposium, 2012)

(CNS): A significant proportion - about 15% to 20% - of all tuberculosis (TB)
occurs in children in India, where paediatric TB is a serious, but
under-recognized and neglected public health problem. "The reason is that,
unlike in adults, children get forms of TB that are not infectious. Therefore
less public health priority and importance is given to it. TB spreads through
the air borne route. So children get it from adults through cough etc. The most
important risk factors in children are malnutrition, poverty,  environmental
pollution, poor housing, overcrowding, indoor air pollution, passive smoking,
and to a much smaller extent HIV infection also" said Dr Soumya Swaminathan,
National Institute for Research in Tuberculosis, Chennai.

Dr Swaminathan was speaking to Citizen News Service (CNS) at the recently
concluded Chennai ART Symposium (CART 2012). She has been working at the
National Institute for Research in Tuberculosis, Chennai since 1992. She has
been involved with clinical trials for new TB regimens, both for adults and
children, has focused on HIV infected adults and children, especially its
interaction with TB.

According to Dr Swaminathan, the two main challenges in dealing with childhood
TB are by way of diagnosis and treatment. Timely and correct diagnosis is a
challenge due to two reasons:
(i) young children cannot produce sputum whose examination is the cornerstone of
TB diagnosis and
(ii) TB in children is pauci-bacilliary: there is more of tissue damage, but
less of bacteria. Hence it is more difficult to isolate and examine those
bacteria. Another reason is the shortage of laboratory facilities in India to do
TB cultures. Many states still do not have reference labs for this purpose. So,
diagnosis has to rely on clinical evidence and X- Rays which can often lead to a
lot of confusion. So now work is being done on diagnostic criteria which will be
very well laid out and can be followed internationally by researchers as well as
clinicians.

The symptoms of the common form of TB of lungs (pulmonary TB), are fever and
cough, which overlap with the symptoms of many other common infections in
children - viral, bacterial and upper respiratory tract infections, asthma and
wheezing. So there is often confusion in the mind of the parent as well as the
doctor as to what type of fever and cough it is. Most often, parents bring the
child to the doctor for repeated and persistent fever/ cough, or if the child is
not gaining weight and not having a good appetite. The other common form of TB
in children is the lymph node TB, in which case there may be an enlarged
swelling in the neck or the armpit. Then there are serious forms of TB like TB
meningitis, in young children specially. They may just be lethargic and have low
grade fever, followed by headache and vomiting. But there is a lot of overlap
with symptoms of other diseases.

Treatment depends upon correct diagnosis, so once correct diagnosis is made,
half the challenge is over. As TB can very often mimic pneumonia,
bacterial/viral infections, it is very important to follow a correct procedure
for diagnosis. Once TB is suspected we need to do a chest X- Ray, and wherever
possible try to make a bacteriological diagnosis—either by obtaining sputum in
case of an older child, or by obtaining respiratory secretions in younger ones
like a gastric lavage or induced sputum. If the X- Ray is suggestive of TB, then
one should give a course of antibiotics, and watch the child for about 10 to 14
days. Most of the other bacterial infections, including pneumonia, will improve
in this time. If the child still does not improve, only then can one consider TB
as a likely diagnosis. Many doctors skip this step. They may, find a lesion in
the X- Ray and start TB treatment. This is responsible for a lot of misdiagnosis
and may also be dangerous for the child in the long.

There are treatment adherence and compliance problems in children with TB,
especially because of the long duration of treatment (6 to 9 months) and also
because they have to depend on others to take the drugs. They may refuse to take
medicine or spit it out. Even in older children and adolescents, we can get
issues of noncompliance, especially if we do not have child friendly
formulations—the taste may be bad or the pills too big to swallow. It depends a
lot on the parents and caregivers, to ensure that treatment is completed.
Unfortunately we have very few quality assured child friendly formulations. So,
very often one ends up using adult formulations with reduced dosage. The Revised
National TB Control Program now has pediatric boxes which are made keeping in
mind different age and weight bands in children. Luckily, side effects in TB
drugs for children are very less as compared to those in adults.

Childhood TB is difficult to control, because the infection is air borne, and
the only way to prevent is to tackle adult TB more seriously. All family members
of a TB patient, especially children, should be tested, and started on
chemoprophylaxis. This way the burden of pediatric TB can be reduced. There are
social and economic issues too, as most of the TB affected children come from
poor socio economic background.

As for HIV-TB co infection in children, it is not too much in terms of overall
population prevalence, but for the HIV infected child, TB is a huge problem, and
very often difficult to diagnose. HIV- TB co infected children have very bad
outcomes, if they are not properly diagnosed and treated in a good centre. In
HIV positive children infected with TB, the challenges are bigger, because many
of them are orphans, living either with grandparents or extended families or
living in orphanages. Treatment compliance in these children is much worse, as
there is no dedicated caregiver, and children are left to themselves to take
their medicine.

Children are innocent victims of the TB epidemic. They have to deal with the
disease as well as the stigma associated with it. The general awareness level
about TB is very poor, even amongst educated people. They do not know how it
spreads, how it can be diagnosed and treated and what can they do to reduce the
burden of TB. As it is an air borne infection, anybody can get it, but poor
nutrition makes one more susceptible to it. We must incorporate nutrition and
education program in the primary health care system, as primary care is very
critical for overall health of the child. We also need to use community
volunteers, social mobilization, and self-help groups to motivate patients to
complete TB treatment and not leave it in between.

As someone has rightly said - Many things can wait, but a child cannot. To her
we cannot say tomorrow, for her name is today. (CNS)

Shobha Shukla - CNS
(The author is the Managing Editor of Citizen News Service (CNS). She is a J2J
Fellow of National Press Foundation (NPF) USA. She has worked earlier with State
Planning Institute, UP and taught physics at India's prestigious Loreto Convent.
She also co-authored a book (translated in three languages) "Voices from the
field on childhood pneumonia" and a report on Hepatitis C and HIV treatment
access issues in 2011. Email: shobha@..., website:
http://www.citizen-news.org)

ONLINE AT:
http://www.citizen-news.org/2012/02/tuberculosis-in-children-act-before-it.html

How to Get To Zero childhood TB infections and deaths by 2015?
Citizen News Service (CNS)
******************************

[Mods note: HAVE YOUR SAY by joining the online consultation. Send an email to:
stop-tb-subscribe@yahoogroups.com . Online at:
http://www.citizen-news.org/2012/02/online-consultation-how-to-get-to-zero.html
]
******************************

The Citizen News Service (CNS, www.citizen-news.org), a partner of the Stop TB
Partnership, is facilitating a time-limited online consultation in lead up to
the World TB Day, on issues around childhood TB.

This online consultation will be around two themes:
THEME 1: How to 'get to zero new TB infections' in children by 2015?
THEME 2: How to correctly diagnose and treat TB in children and achieve 'zero TB
deaths' in children by 2015?

We will like you to speak your world and share your experiences of addressing TB
in children in your local contexts.

HOW CAN YOU HAVE YOUR SAY?
- Join the new Stop-TB eForum by sending an email to:
stop-tb-subscribe@yahoogroups.com and have your say!
- Be a PARTNER of this online consultation - to be a partner organization, send
an email to: bobby@...
- Email us your comments, perspectives and experiences at:
stopTB@...
- Go online at CNS blog: www.citizen-news.org and publish your comments real
time!
- Skype us and we will record your statement (skype id: bobbyramakant ). To
schedule skype appointment, email: bobby@...
- Tweet us! use #tag: #childhoodTB
- Have your say on our CNS Facebook page!
- Call us and record your statement! (+91-98390-73355)

TIMELINE
The online consultation is open for five weeks (Monday, 13th February to
Saturday, 17th March 2012), after which a summary report will be published by
CNS and released on World TB Day, 24th March 2012.

REFERENCE DOCUMENTS:
Call for Action for Childhood TB launched in Stockholm in March 2011:
http://www.stoptb.org/getinvolved/ctb_cta.asp
Stop TB Strategy: http://www.who.int/entity/tb/strategy/en/
Global Plan to Stop TB: 2011-2015: http://stoptb.org/global/plan/ World TB Day
website: http://stoptb.org/events/world_tb_day/2012/
Global Tuberculosis Control Report 2011:
http://www.who.int/tb/publications/global_report/en/
Whole Is Greater Than Sum Of Its Parts: CNS report 2011:
http://www.scribd.com/doc/70768912/Stop-TB-Online-Consultation-Summary-Report-Li\
lle-2011

Looking forward to a meaningful dialogue,

Citizen News Service (CNS): www.citizen-news.org
Email: stopTB@...

Theme 1 (e-consultation): Getting to zero new TB infections in children by 2015
Citizen News Service (CNS) and partners
*******************************************

[Mods note: To sign up for the e-consultation, send an email to:
stop-tb-subscribe@yahoogroups.com . The Theme 1 announcement is online at:
http://www.citizen-news.org/2012/02/theme-1-e-consultation-how-to-get-to.html .
Thanks]
*******************************************

The theme 1 of the time-limited online consultation on childhood tuberculosis
(TB) in lead up to the World TB Day is: "Getting to zero new TB infections in
children by 2015."

Have your say before 25th February 2012 - share with us what should be done more
(or less of) to prevent new TB infections in children in your local settings.
Your perspectives, opinions, voices are important for us and we do look forward
to them.

GUIDING QUESTION
---------
- What can be done more (or less of) at the family, community or your country
level to prevent new TB infections in children?

This e-consultation on childhood TB is being facilitated by the Citizen News
Service (CNS), a partner of the Stop TB Partnership, along with many other
organizations and networks that have endorsed this initiative and joined as a
partner (see the list below).

HOW CAN YOU HAVE YOUR SAY?
---------
- Join the new Stop-TB eForum by sending an email to:
stop-tb-subscribe@yahoogroups.com and have your say by sending your comments to
stop-tb@yahoogroups.com
- Be a partner of this online consultation - to be a partner organization, send
an email to: bobby@...
- Email us your comments, perspectives and experiences at:
stopTB@...
- Go online at CNS blog: www.citizen-news.org and publish your comments real
time!
- Skype us and we will record your statement (skype id: bobbyramakant ). To
schedule skype appointment, email: bobby@...
- Tweet us! use #tag: #childhoodTB
- Have your say on our CNS Facebook page!
- Call us and record your statement! (+91-98390-73355)

TIMELINE for THEME 1
---------
Responses to theme 1 are welcome till 25th February 2012, after which a summary
report of Theme 1, will be compiled and released to mark World TB Day.

REFERENCE DOCUMENTS:
---------
- Call for Action for Childhood TB launched in Stockholm in March 2011:
http://www.stoptb.org/getinvolved/ctb_cta.asp
- Stop TB Strategy: http://www.who.int/entity/tb/strategy/en/
- Global Plan to Stop TB: 2011-2015: http://stoptb.org/global/plan/ World TB Day
website: http://stoptb.org/events/world_tb_day/2012/
- Global Tuberculosis Control Report 2011:
http://www.who.int/tb/publications/global_report/en/
- Whole Is Greater Than Sum Of Its Parts: CNS report 2011:
http://www.scribd.com/doc/70768912/Stop-TB-Online-Consultation-Summary-Report-Li\
lle-2011
- Tuberculosis and children: Exposing the hidden epidemic - ACTION brief
http://c1280352.r52.cf0.rackcdn.com/childrens_tb_0811v2.pdf

PARTNERS
---------
McGill TB Research Group
Treatment Action Group
Asian Harm Reduction Network (AHRN)
PATH
Cambodian Health Committee (CHC)
Positive Muslim Group, Myanmar
Life Foundation, Pakistan
The Good Neighbour Nigeria
TB Alert
University of Nairobi, Kenya
Medical Care Development Inputs (MCDI) Kenya
Kenya Consortium to Fight TB, Malaria and AIDS (KECOFATUMA)
Partnership for TB Care and Control, India
PCI India
MAMTA
SNEHA
Institut Pasteur de Madagascar
Institute for Plantation Agricultural And Rural Workers (IPARW)
Rural Youth Advocate for Health and Development in Nigeria (RYAN)
Citizens for Healthy Lucknow (CHL) initiative
Abhinav Bharat Foundation (ABF)
Asha Parivar
Samadhan
National Alliance of People's Movements (NAPM)
PRAYAS Health Group
Indian Society Against Smoking (ISAS)

Looking forward to a meaningful dialogue,

Citizen News Service (CNS)
Email: stopTB@...

POST YOUR COMMENT online at:
http://www.citizen-news.org/2012/02/theme-1-e-consultation-how-to-get-to.html

Spotlight: Zero children dying from tuberculosis by 2015 is possible, if...
Hara Mihalea, PATH
**********************

[Mods note: To join the e-consultation on childhood TB, send an email to:
stop-TB-subscribe@yahoogroups.com . The below CNS article written by Hara
Mihalea, PATH, Thailand, is available online at:
http://www.citizen-news.org/2012/02/0-children-dying-from-tb-by-2015-is.html .
Comments are welcome. Thanks]
**********************

I like to start by sharing a real story which I experienced in one of my visits
in the field last year. I'm sure many of you working in the field have similar
stories to tell. During a monitoring visit for our PPM program I came across a
referral slip made out by a pharmacy staff referring a 36 year old woman to the
DOTS health center.

Looking at the symptoms circled on the slip one could tell that this was
certainly a pulmonary TB case; weight loss, fatigue, chest pain, fever, and
cough with blood. We traced the referral to one of the district health centers
where we found out that the woman had indeed gone for further evaluation, she
was checked, diagnosed, given medication and sent home. We were told by the
health center staff that since the first visit she came back twice, each time
sicker than before, and was again send home, no TB. We decided to visit her at
home where she lived with her husband, her in-laws, two small children and one
baby. We asked the district TB officer to join us so he could be able to
follow-up later on.

When we arrived in her small house we were taken up in her room, she was sitting
on a straw mat on the floor, baby on the breast, glassy eyes, face flushed with
fever. She repeated the same story that the health staff told us. She told us
how disappointed, sad, and scared she felt, she said she was getting worse by
the minute and no one could help her. She said she wanted to go back to the
health center but they didn't have any more money and no transportation. Each
time she coughed she hit on her chest to show us where it hurts. I will never
forget the pain on her face, the shortness of her breath when she tried to tell
us her story. I will never forget the fear I felt for the baby on her breast and
her other two children and thinking that this woman unless treated immediately
will soon die and leave these children orphans. The end of the story is that the
woman did have TB and the last we heard was that the district officer was trying
to get the children tested.

So what went wrong? why did this woman sought care three times and still was
send home with a bag of  antibiotics and vitamins? This is a very common story
and it's happening every day, many times a day around the world, especially in
high TB burden developing countries.

I shared this story with you because I truly believe that once again we might
not be able to reach our goal to Zero the numbers of children dying of TB in our
lifetime, left alone by the year 2015, if we don't take some drastic steps to
address the real problems that are preventing us from doing a good job. We can
have the guidelines and country operational plans for TB in children, we can
have the treatment algorithms however I strongly feel that these will not help
much, especially in limited resource setting where stories such as this are real
unless we start by:

(1) Holding governments accountable for the health and well-being of their
populations, especially the children; health is a right not a luxury and not
only for the few. Advocate governments for resource allocation that will
increase the salaries of the health staff and will motivate them to perform
their tasks in an appropriate manner; health staff in developing countries often
do not get their salary for 3-6 months.

(2) Strengthening the DOTS program. If we had a quality DOTS program the health
staff would have been able to accurately diagnose and successfully treat the mom
in the story.  They would have being able to prevent TB and the needless
suffering in her children.

(3) Integrating TB into the primary health care and sensitizing all health care
providers on TB.  Once sensitized health staff be able to screen children and
moms during immunization sessions, postnatal visits, reproductive health (RH)
visits or other consultations.

(4) Most importantly recognizing the symptoms of TB in children, creating
linkages and partnerships between communities, private providers and TB services

(5) Intensifying case finding and contact tracing when TB is suspected to all
family members, most importantly to children. The majority of the children get
TB from a family member.

(6) TB is a poverty disease, half of the children in the developing countries go
without meals, they are malnutrition which makes them even more vulnerable to
TB. Addressing the nutrition needs is of out-most importance.

(7) TB in a child that is already living with HIV is a double heartbreak and so
much more difficult to diagnose and treat.

I might sound to you pessimistic, I am a little bit because TB is very political
and things are moving very slowly; we cannot afford to move slowly anymore, we
should not allow it. We need to step up and step up very fast. What we should
all see at the end of 2015 is not just the numbers, the statistics showing fewer
deaths, we should see children, happy and smiley faces, children free of TB.
Where there is a will there is a way and collective voices will find the way.

Hara Mihalea CHE, MPH
PATH, Thailand

Online at:
http://www.citizen-news.org/2012/02/0-children-dying-from-tb-by-2015-is.html
**************************************************

[MODS NOTE: Join the e-consultation by sending an email to:
stop-tb-subscribe@yahoogroups.com . The guiding question (Theme 1) of the
time-limited online consultation on childhood tuberculosis (TB) in lead up to
the World TB Day is: "What can be done more (or less of) at the family,
community or your country level to prevent new TB infections in children?"

Have your say before 25th February 2012:
http://www.citizen-news.org/2012/02/theme-1-e-consultation-how-to-get-to.html .
Thanks]
**************************************************

Spotlight: Patients' Charter for TB Care, and childhood TB
Bobby Ramakant - CNS
**********************

[MODS NOTE: Join the e-consultation on childhood TB by sending an email to:
stop-tb-subscribe@yahoogroups.com . The below CNS article is online at:
http://www.citizen-news.org/2012/02/patients-charter-for-tb-care-and.html .
Comments are welcome. Thanks]
**********************

(CNS): Will improving efficiency and efficacy of TB control programmes within
the healthcare facilities help the world meet the 2015 TB-related targets set by
the Millennium Development Goals, the Global Plan to Stop TB, and the country
programmes, or do we need a paradigm shift in the basic principles we do TB
control upon? Experts have repeatedly emphasized that unless we control
adulthood TB, children will continue to get TB. And unless we the change the way
we do TB control, adulthood TB is unlikely to be controlled. The TB programme is
still very medical despite advocacy, investment and the gold standard Patients'
Charter for TB Care - which is sadly not implemented to the extent it should
have been by the countries.

PATIENTS' CHARTER FOR TB CARE
--------------
According to the World Health Organization (WHO),
http://www.who.int/tb/people_and_communities/patients_charter/en/index.html the
Patients' Charter for Tuberculosis (TB) Care, outlines the rights and
responsibilities of people with TB. It empowers people with the disease and
their communities through this knowledge. Initiated and developed by patients
from around the world, the Patients' Charter makes the relationship with
healthcare providers a mutually beneficial one (download the patients' charter
here http://www.who.int/entity/tb/publications/2006/patients_charter.pdf ).

UNLESS WE TREAT ADULT TB, CHILDHOOD TB WILL CONTINUE TO RISE
--------------
In an interview given recently to Shobha Shukla - CNS, Dr Somya Swaminathan, MD
in Paediatric TB, and a Scientist at the National Institute for research in
Tuberculosis (Indian Council of Medical Research - ICMR), said that: "Pediatric
TB is difficult to control, because the infection spreads through the air borne
route, and children get it from adults. So the only way to prevent childhood TB
is to tackle adult TB more seriously. Contact to contact TB testing must be
done. All family members of a TB patient, especially children, should be tested,
and started on chemo-prophylaxis. That way we can reduce the burden of
paediatric TB. The general awareness level about TB is very poor, even amongst
educated people. They do not know how it spreads, how it can be diagnosed and
treated and what they can do to reduce the burden of TB. As it is an air borne
infection, anybody can get it. The most important risk factor in children is
malnutrition, as poor nutrition makes one more susceptible to it. Other social
or environmental causes could be poor housing, overcrowded indoors, indoor air
pollution, passive smoking, and to a much smaller extent HIV infection also, as
in India HIV prevalence is fairly low."

President of Indian Chest Society (North Zone) and Professor and Head,
Department of Pulmonary Medicine, King George's Medical College (now renamed as
CSM Medical University) Dr Surya Kant said: "Another important risk factor is
that we have a large number of adult TB infections that can potentially be
transmitted to children. First and foremost measure that can control childhood
TB is to early diagnose and successfully treat the adult TB. So all adult TB
cases must be treated effectively and priority should be given to those whose
sputum is positive for AFB. If we can intervene in early diagnosing and
successfully treating adult TB then a secondary outcome will be to effectively
control childhood TB."

Dr Surya Kant emphasized: "More effectively we cure the adult TB more
effectively we will prevent the childhood TB. Studies show that children with TB
usually don't infect the adults rather adults with TB infect children. It is
only one way transmission of TB from adults to children."

PATIENTS' CHARTER CAN BE THE GAME-CHANGER
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Unless people who are experiencing the disease (TB) or have successfully
completed the treatment are engaged as EQUAL PARTNERS WITH DIGNITY, we will
continue to see TB control dominated by the medical experts who are undoubtedly
doing a great contribution to TB control, but that's clearly not enough.
Engaging people who know the best can be the game changer. People who have
completed TB treatment are best "community experts" to share with us the
challenges they faced on daily basis when on TB treatment. These are the
challenges which are the potential barriers for many people in benefiting from
existing TB control services and should be addressed by the programme. The
realities of their lives, on day-to-day basis, that continues to put them and
their family members at risk of preventable infections such as TB, needs to be
brought in, to increase the impact of TB programmes. The challenges people face
in getting a proper confirmed TB diagnosis and tolerating the anti-TB treatment,
must be recorded and documented - without which the programme will continue to
miss a very important piece of the puzzle - and is unlikely to reach the ZERO
mark by 2015 in terms of zero new TB infections and deaths.

Unless we implement the Patients' Charter optimally adulthood TB will continue
to challenge us, and so will childhood TB.

As experts said if we can control adulthood TB, childhood TB will automatically
taper off. Implementing the Patients' Charter, empowering communities,
especially those who have completed TB treatment, to get engaged as equal
partners with dignity in TB control, and ensuring the programme addresses the
needs felt by the people can help us reach the unreached TB patients - adults
and children both.

The Citizen News Service (CNS) along with more than 50 partners from around the
world is hosting an e-consultation and conducting key informant interviews on
childhood TB. To have your say, go to:
http://www.citizen-news.org/2012/02/theme-1-e-consultation-how-to-get-to.html

Bobby Ramakant - CNS
Email: bobby@...

Online at:
http://www.citizen-news.org/2012/02/patients-charter-for-tb-care-and.html
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[MODS NOTE: Join the e-consultation by sending an email to:
stop-tb-subscribe@yahoogroups.com . The guiding question (Theme 1) of the
time-limited online consultation on childhood tuberculosis (TB) in lead up to
the World TB Day is: "What can be done more (or less of) at the family,
community or your country level to prevent new TB infections in children?"

Have your say before 25th February 2012:
http://www.citizen-news.org/2012/02/theme-1-e-consultation-how-to-get-to.html .
Thanks]
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