Spotlight: Tuberculosis Is A Women's Issue Too
Chief K Masimba Biriwasha, CNS
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email to: stop-tb-subscribe@yahoogroups.com . The below CNS article is online
at: http://www.citizen-news.org/2012/03/tuberculosis-is-womens-issue-too.html .
Comments are welcome. Thanks]
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Today is March 8, and across the world the International Women's Day is being
commemorated. Coincidentally, March is the global tubercolusosis (TB) awareness
month. The disease, which is caused by a mycrobatrium, has a major impact on
women's sexual reproductive health and that of their children. For pregnant
women living in areas with high TB infection rates, there are increased chances
of transmission of TB to a child before, during delivery or after birth. The
disease, especially if associated with HIV, also accounts for a high incidence
of maternal and infant mortality. Unfortunately, there is little to no attention
to women's vulnerability in the current discussion and media blitz of a
resurgent TB internationally, and in particular, sub-Saharan Africa.

In sub-Saharan Africa, TB is threatening to unravel public health developments
gains around increased HIV awareness yet the solutions are not easy,
particularly where they concern the well-being of women.

There is need for huge financial, human, research and technological investments
to fight the problem, but such investments will work only if they radically put
women's health needs at the core.

More importantly is the need to align TB services and sexual reproductive health
services, so that men and women know about the implications of the disease to
their sexual lives and households.

In sub-Saharan Africa, however, there are pervasive systemic factors driving TB
and drug resistance which cannot be ignored in the search of an effective
solution to the problem.

A myriad of social and economic factors, as well as weaknesses in the health
care system, inadequate laboratories combined with high HIV infection rates are
fuelling the resurgence of the TB in the region. Food insecurity, poor
sanitation and overcrowding also contribute to the easy spread of the disease.

According to WHO, although Africa has only 11% of the world's population, it
accounts for more than a quarter of the global TB burden with an estimated 2.4
million TB cases and 540,000 TB deaths annually.

Governments in the region are grappling with inadequate infrastructure and the
increasing threat of drug-resistant strains and co-infection with HIV.

HIV infection increases the likelihood of active TB more than 50-fold. An
estimated one-third of the 24.5 million people living with HIV (PLHIV) in
sub-Saharan Africa also have TB.

For women in the region, the prospect of a growing TB epidemic is harrowing, but
discussion about the disease rarely sheds light nor seeks to address women's
specific needs.

Given the high rates of HIV infection among women in the region – the majority
of people living with HIV in sub-Saharan Africa (61% or 13,1 million) are women
– it is clear that they are the largest group at threat to develop active TB,
and more likely drug resistance.

Even with the availability of TB drugs women's socio-economic status and gender
roles including child-bearing and caring puts them at high risk of both HIV and
TB infection.

For many women in the region, the costs required to access health care centers
for TB treatment are usually out of reach due to poverty and undermined
socio-economic positions.

The social stigma associated with a TB diagnosis and its association with HIV
forces both men and women to delay going to get tested for the disease. In some
cases, when men in marital relationships test positive for TB, they are likely
to withhold the information, thereby increasing the likelihood to spread the
disease to both their partner and children.

Moreover, women in the region are largely responsible for the upkeep of the
family, including looking after children, which may also affect consistent
uptake of TB drugs. When a woman is infected with TB, the likelihood of
spreading the disease to young children is very high.

An additional concern for women is that the uptake of TB drugs interferes with
contraceptive use, pregnancy, and fertility.

According to researchers, Rimfampicin, a key component of TB treatment can
reduce the effectiveness of oral contraceptive pills and possibly other hormonal
methods, such as implants, injectables and emergency contraception.

TB in pregnant women not only increases the rate of maternal mortality, but is
also a major factor contributing to the risk of mother-to-child transmission of
the disease.

A study conducted in South Africa revealed mother-to child-transmission of TB in
15% of infants born to a study cohort of pregnant women in which 77% were
HIV-infected. Maternal HIV/TB coinfection also increases the risk of mother-to
child transmission of HIV.

Screening and treatment for TB in pregnant women at antenatal clinics must
therefore be a major public health priority in the region. Information about TB
needs to be an integral component of sexual reproductive health services.

To be precise, women infected with TB need to be empowered so that they can take
control of their own care and lives. (CNS)

Chief K Masimba Biriwasha
Citizen News Service - CNS
Email: masimba@...

(The author, born in Zimbabwe, is a children's writer, poet, playwright,
journalist, social activist and publisher. He has extensively written on health.
His first published book, 'The Dream Of Stones', was awarded the Zimbabwe
National Award for Outstanding Children's Book for 2004)

Online at:
http://www.citizen-news.org/2012/03/tuberculosis-is-womens-issue-too.html

Spotlight: Control Infection To Prevent TB In Children
Shobha Shukla - CNS
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[Mods note: To join the online dialogue on TB, send email to:
stop-tb-subscribe@yahoogroups.com . The below CNS article is online at:
http://www.citizen-news.org/2012/03/control-infection-to-prevent-tb-in.html .
Comments are welcome. Thanks]
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(CNS): At the inaugural lecture of the 42nd Union World Conference on Lung
Health, organised by the International Union Against Tuberculosis And Lung
Disease (The Union), in October 2011,  Mikkel Vestergaard Frandsen, showed a
poignant video clip of a 14 year old girl who had suffered and died of TB in her
poor, smoke ridden home in a Kenyan village last year. The video was a telling
but true commentary on the polluted and unhygienic environments that exist in
most houses of urban slums and villages of the developing world, making them
fertile grounds for TB germs, and exposing their children to this life
threatening disease.

Children living in poor circumstances, in very crowded houses with bad
ventilation and increased indoor air pollution, due to tobacco and cook stove
smoke, become easy targets for the TB bacterium. A congested neighbourhood with
poor refuse management and improper drainage only adds to their vulnerability. 
Medical experts, as well as community advocates, from across the globe almost
unanimously agree that practising basic infection control measures at all
levels, including home, community and hospitals, would go a long way in saving
our children from unnecessary exposure to TB infections.

Overcrowding in houses with poor ventilation, lack of basic hygiene and
proximity to an index adult case, are like an open invitation to the TB
bacteria. According to Professor Surya Kant, Head of the Pulmonary Medicine
Department, Chhatrapati Shahuji Maharaj Medical University, "Usually one TB
patient spreads TB to 10-15 other people in a year. But if the patient is living
in an overcrowded environment then the spread of TB is more rampant. Children
living in urban slums where dwellings house a large number of people in small
space can be at higher risk of TB."

Dr Manoon Leechawengwong, of the Drug-Resistant Tuberculosis Research Fund,
Thailand, advises that adults in the family with active TB should practice
infection control by wearing masks as long as they continue to cough and must
try to stay away from kids in the family.

A large number of rural/urban slum households still use biomass fuels for
cooking, and exposure of children to this cook-stove smoke can increase their
risk for developing active TB. These fuels should be replaced by other energy
options which are not detrimental for one's health. Second hand smoke arising
out of elders smoking cigarettes/bidis is another demon to be watched. Children
inhaling this smoke can become easy victims of a host of diseases including TB.
Improper ventilation increases the risk as, it not only prevents the smoke from
escaping out, but also prevents adequate sunlight from entering the house. Dr
Surya Kant mentions that a five minutes exposure to sunlight kills even the drug
resistant forms of Mycobacterium tuberculosis bacilli.

Even doctors agree that hospitals are a store house of infections which must be
reduced to rein in TB. Proper ventilation of wards to circulate of fresh air and
admit enough sunlight is very important. Inefficient disposal of hospital waste
and patients' sputum increase the chances of patients contracting the disease,
instead of getting cured. Cough hygiene is very important, especially for those
who are AFB sputum positive. They should be counselled to cover their mouth with
cotton or mask while talking or coughing. Proper and timely disinfection and
management of excreta from known tuberculosis patients is important. Also,
spitting on the roads and defecating in the open is very common in India and 
helps in the spread of the tuberculosis germs.

In India it is a common practice for children to unnecessarily accompany their
parents on hospital visits. All hospitals should be instructed to convey to
their patients that whenever they visit the hospital children should not
accompany them unless needed – because hospitals are a hot bed of infections.

One of the fallouts of urbanization is construction of flats or apartments which
often lack proper ventilation and block sunlight from entering the rooms, thus
encouraging the spread of air borne diseases like tuberculosis. City planners,
private builders, as well as the housing policy of the government, need to keep
these critical issues in mind for construction of residential/official complexes
and pay adequate attention to allow for proper air flow and natural light in
houses.

Getting to Zero new TB infection in children by 2015 may be like moving a
mountain, which requires more than just faith. Challenges are vast and resources
are inadequate. It would need the combined efforts of the community, healthcare
personnel and supportive government policies to curb the onslaught of TB. As Dr
Vijay Kumar Edward of World Vision India, so succinctly sums up, "We should not
be found in a situation where we are pouring all our efforts and funds into
diagnostics, research, treatment and care, while ignoring the silent spread of
TB through fine droplets in closed rooms where the poor of this world huddle
together." (CNS)

Shobha Shukla
Citizen News Service - CNS
Email: shobha@...

Online at:
http://www.citizen-news.org/2012/03/control-infection-to-prevent-tb-in.html

Lives before profits: India issues first compulsory license
Citizen News Service (CNS)
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stop-tb-subscribe@yahoogroups.com. The below article is online at:
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Comments are welcome. Thanks]
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GROUNDBREAKING MOVE SETS PRECEDENT FOR OVERCOMING DRUG PRICE BARRIERS

In a landmark case, the Indian Patent Office has issued the first-ever
compulsory license in India to a generic drug manufacturer. This effectively
ends German pharmaceutical company Bayer's monopoly in India on the drug
sorafenib tosylate used to treat kidney and liver cancer. The Patent Office
acted on the basis that not only had Bayer failed to price the drug at a level
that made it accessible and affordable, it also was unable to ensure that the
medicine was available in sufficient and sustainable quantities within India.

"We have been following this case closely because newer drugs to treat HIV are
patented in India, and as a result are priced out of reach," said Dr Tido von
Schoen-Angerer, Director of the Médecins Sans Frontières (MSF) Access Campaign.
"But this decision marks a precedent that offers hope: it shows that new drugs
under patent can also be produced by generic makers at a fraction of the price,
while royalties are paid to the patent holder. This compensates patent holders
while at the same time ensuring that competition can bring down prices."

Competition from the generic version will bring the price of the drug in India
down dramatically, from over US$5,500 per month to close to $175 per month – a
price reduction of nearly 97 per cent.

"This decision serves as a warning that when drug companies are price gouging
and limiting availability, there is a consequence: the Patent Office can and
will end monopoly powers to ensure access to important medicines," said Michelle
Childs, Director of Policy/Advocacy at the MSF Access Campaign. "If this
precedent is applied to other drugs and expanded to include exports, it would
have a direct impact on affordability of medicines used by MSF and give a real
boost to accessing the drugs that are critically needed in countries where we
work."

Under the World Trade Organization's TRIPS Agreement which governs trade and
intellectual property rules, compulsory licenses are a legally recognised means
to overcome barriers in accessing affordable medicines. The Indian decision in
fact mirrors similar moves made in other countries, including the US. In
February 2011, the US Patent Office decided not to prevent a "generic" medical
device used for skin grafts from being sold, but rather insisted that its
manufacturer pay royalties to the patent holder.
"Behind this action is the idea that the public has a right to access innovative
health products and they should not be blocked from benefiting from new products
by excessive prices," said Michelle Childs. "If more compulsory licences are
granted in this vein, the answer to the question of how to ensure affordable
access to new medicines could radically shift."

Today's system is one where new medicines are patented, and drug companies
aggressively defend their monopolies, at the expense of patients who can't
afford the high prices charged. Instead, we could move to a more equitable
system where new medicines have multiple producers, who each pay royalties to
the patent holder, helping them not only to recoup their development costs but
ensuring that people in developing countries have access.

This move marks the first time India's patent law has been used to allow generic
production when a drug is unaffordable.

"More generic companies should now come forward to apply for compulsory
licences, including on HIV medicines, if they can't get appropriate voluntary
licences," said Dr Tido von Schoen-Angerer.

The compulsory licence has been granted by India's Controller of Patents (the
highest authority of the Indian Patent Office) to the generic company Natco for
the eight years sorafenib tosylate will remain patented in India (until 2020),
and against the payment of a  royalty rate fixed at 6%. The order of the
compulsory licence can be found online at:
http://www.ipindia.nic.in/ipoNew/compulsory_License_12032012.pdf (CNS)

Citizen News Service - CNS

Online at:
http://www.citizen-news.org/2012/03/people-before-profits-india-issues.html

Spotlight: TB - The ugly face of an innocent childhood
Shobha Shukla - CNS
*******************

[Mods note: To join the online dialogue on tuberculosis, send an email to:
Stop-TB-subscribe@yahoogroups.com . The below CNS article is available online
at: http://www.citizen-news.org/2012/03/tb-ugly-face-of-innocent-childhood.html
. Be welcome to share on social media or websites. Comments are welcome. Thanks]
*******************

LOCATION: a typical urban semi slum area (in as much as the houses are not
makeshift but permanent brick structures) of Lucknow, the capital of Uttar
Pradesh, which boasts of the state of art medical facilities.

PLACE: A brick walled house in a very narrow by lane, carefully protected from
the prying rays of the sun, and just broad enough to let a two wheeler pass
through. There is a small open verandah, leading to two dark, dingy and damp
rooms, with no access to sunlight, and hardly any ventilation. One of the rooms
doubles up as a kitchen, which has a mud stove run on wood fuel. The smoke from
the chulha and from the bidis smoked in the house, linger in the closed
environment for long.

OCCUPANTS: Shiv Prasad, a daily wage earner and  the sole bread winner of the
family, (who is also an ex TB patient) and dutifully follows the patriarchal
tradition of spending a large part of his meagre earnings on drinking liquor and
smoking bidis and thrashing his wife every day; his father; his four
children—three sons and one daughter—aged 14 to 3 years; Ramdulari the charming,
but uneducated, hapless wife, who blames it all on her fate and kismet, waiting
silently for some miracle to happen to blow her misfortunes away.  She has
resigned herself to a life where each day's survival is an ordeal, and where
hope has given way to mute resignation. She no longer resents being beaten/ill
treated by her alcoholic husband every day. Though convinced of the merits of a
small family, she is scared of undergoing tubectomy, but is very sure that she
will not beget another child.

THE GROUND REALITY: Ramdulari has a long tale of woe to narrate and pours out
her heart to my eager ears. This is what she had to say—"My 6 year old third
son, Jugal Kishore, has been diagnosed with pulmonary TB and has been undergoing
free anti tuberculosis treatment (ATT) since the last one month, at a nearby
DOTS centre. I never had any institutional delivery, and like my other kids,
Jugal Kishore too was born at home. It was a normal delivery, but he was under
weight. I could only partly breast feed him, as I was not lactating enough. He
has never been a healthy child, falling sick off and on. When he was 1 month old
he got the BCG vaccination in the hospital, but there was no swelling. So after
9 months an anganwadi (community) worker gave the vaccine a second time. Then
also there was hardly any swelling.

He started coughing when he was two years old, which worsened over a period of
time. The cough would be particularly bad at night, and often make him
breathless. I could do nothing more than massage his back to give him some
relief. We would take him to a government hospital for treatment frequently, but
the medicines did not improve his condition. The doctors would ask us to buy
medicines from outside, which we could not afford. He was eventually diagnosed
with TB in the summer of 2011 on the basis of an X Ray. The doctor prescribed
medicines most of which were to be bought from the private market. We could not
afford that, so treatment was discontinued. Some medicines were given from the
hospital.  After sometime, he was very sick again, so he was admitted in the
hospital for 10 days. Another X-Ray was taken, and he was also given the BCG
vaccine for a third time. Then he was put on ATT about a month ago. Only when I
told the doctors repeatedly that we cannot afford to buy medicines, did they
prescribe free medicines which we now get from the DOTS centre. Doctors have
said that the medication will continue for 6 months.

My husband earns around Rs 100 to Rs 150 ($2 or 3) per day, in which I have to
run a family of seven. There is never enough to eat in the house, let alone milk
or any other nutritive food for the children. We give him plain daal roti to eat
as we cannot afford anything better. Sometimes he complains of headache,
otherwise he is okay. Another X Ray has been taken recently, but we have not got
the report. My husband had TB about 7 years ago. He had taken treatment for 6
months from a government hospital and was cured. But of late he has been
coughing a lot, perhaps because of his smoking. He has not gone to the doctor,
as he feels he has already completed the treatment of TB once, so he will not
have it again.

I do not know anything about TB, or how it is spread. I did not know that we get
free medicine for TB. The doctors did not tell us anything about cough hygiene,
or about cleanliness, or how to protect others from infection. No other member
of the family has been tested for TB, and no doctor has asked us to do so. The
child sleeps with me on the same bed along with my other kids. The cough
increases at night and/or when he cries. When he was admitted in the hospital,
he had improved. Sometimes he complains of headache, but otherwise he is okay.
(When I met the child, he had had a severe bout of cough, and he was coughing
very close to his 3 year old sister). We were not counselled about any infection
control measures at the DOTS centre."

If this is the situation in a metro city, one can well imagine what the
situation would be in rural and remote areas. It may sound politically correct
to cry hoarse in unison that we want a TB Free World by 2015, but merely
chanting slogans are not going to make any difference in the lives of people
like Ramdulari and her kids. One has to see what can be improved in the existing
setup. Only if the much publicised maternal and child health programmes of the
government could reach these unreached populations; only if women could be made
aware and counselled about family planning, exclusive breast feeding and basic
health/hygiene measures; only if the healthcare services were more receptive to
the needs of the common people; only if there was prompt diagnosis of TB and
better contact tracing; only if. . . . The list may seem endless, yet it is
achievable without any extra resources. Only if there is more competency and
accountability in our work, instead of a 'couldn't care less attitude', a lot
can be achieved in the field of controlling TB. (CNS)

Shobha Shukla
Citizen News Service - CNS
Email: shobha@...

Online at:
http://www.citizen-news.org/2012/03/tb-ugly-face-of-innocent-childhood.html

Spotlight: Blaming poverty and malnutrition for TB is no excuse for complacency
Dr Muherman Harun, Indonesia
(Source: Citizen News Service - CNS)
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Stop-TB-subscribe@yahoogroups.com . The below CNS article is available online
at:
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. Comments are welcome. Thanks]
********************************

All of us know that there is a pool where TB bacilli that can flourish and can
cause TB infection in children. We are the ones who together with our knowledge
and experience aim to eliminate the pool, so that no more infections can occur.

How does infection take place? Infection is caused by a TB patient excreting
Acid Fast Bacilli (AFB) in sputum. While coughing he will disseminate sputum
into the air. The smallest particles called the droplet nuclei will remain
floating and when inhaled, can pass the mouth/nose/bronchi and bronchioli to end
up at the alveoli of the healthy person. The bigger sputum particles will reach
the ground and cannot cause infection (unable to form floating droplet nuclei).

In the developing and poor countries there are several risk factors which could
make the children prone to TB infection and could accelerate infection into
disease  Examples:

Children become prone to infection in over-crowded homes, where large number of
people live in a small space and be at higher risk of TB. In the proximity to an
index adult case, where ventilation and illumination are poor or absent.

In the developing and poor countries there are factors accelerating TB infection
towards TB disease. Examples are malnutrition, pollution (cigarette smoke),
biomass fuels, unhygienic condition, co-existing infectious disease: viral
disease (measles, pertussis, smallpox, HIV etc), anemia, malignancy, diabetes

The question is, can we do something about those circumstances which are
basically caused by poverty, poor nutrition and ignorance?

It is not the task of the TB control centers or advocates to change this sad
situation inherent to a poor socio-economic community.

What can we do? The answer is: Detect, treat and cure all infectious cases we
encounter in the community, so that no longer they can spread the infectious
bacilli to others (children).

Once the infectious sources are identified and treated, all, each and every
earlier mentioned risk factors will become irrelevant. Even under the most
miserable socio-economic conditions where poverty and poor nutrition prevailed,
TB can still be stopped successfully, even on an ambulatory basis as was
reported from Madras.

The Madras study (1966) showed that home-treatment is not less effective than
sanatorium-treatment. That even poor nutritional status and hardships, like
continued working under harsh conditions, do not reduce the success of
treatment. And that the spread of TB is halted as soon as chemotherapy was
started.  This fact was later also shown by Riley R.L. with his experimental
guinea pigs and by Prof Jacques Grosset in his laboratory.

Then Dr Karl Styblo developed the DOTS strategy since the 19-eighties  as the
world's most effective means of controlling the tuberculosis epidemic. And this
was considered to be among the most cost -effective system of all interventions
in fighting sickness and disease in the Third World. Implemented by WHO in 1995,
the DOTS strategy has shown to be successful even in the lesser developing
countries. Let's not blame poverty or poor nutrition for the spread of
tuberculosis.

Instead of waiting for socio-economic situation to improve, let's now
concentrate on stopping the spread of TB.  The surest way to instantly stop
infection is to immediately treat the infectious sources.

Finally, lest we forget. The TB bacilli contained in sputum droplet nuclei,
floating in the air are the very ones that can penetrate the bronchi and
bronchioli. While landing on the alveolus, the droplet cum bacillus can cause
infection when inhaled. The poor and undernourished people are the preferential
targets of TB. Notwithstanding, according to West European records, there were
various kings and many world famous artists, who also were victimized by TB.

Technically speaking, TB infection is not caused by poor disinfection or poor
management of excreta from infectious tuberculosis patients.

Also, spitting on the roads and defecating in the open, are indicative of poor
hygiene but for sure, these acts cannot help in the spread of tuberculosis
germs.

Consequently, bed linen, pillow cases, blankets, handkerchiefs, and personal
clothing from untreated infectious TB patients are contaminated, but not
contagious (observation from the Netherlands before the invention of anti-TB
drugs!).

EPILOGUE: For almost thirty years by now, our service providers in 5 outpost
clinics of Jakarta, used to sit within reach or next to each TB patient. They
(the providers) wear no mask, don't take preventive medicines, daily vitamins or
food supplements. Yet, no one of our workers got the disease. Praise the Lord!

Dr Muherman Harun
St.Carolus TB Program,
Jakarta, Indonesia
Email: muhermanharun@...

Online at:
http://www.citizen-news.org/2012/03/blaming-poverty-and-malnutrition-for-tb.html
********************************

[Mods note: To join the online dialogue on tuberculosis, send an email to:
Stop-TB-subscribe@yahoogroups.com . The above CNS article is available online
at:
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. Comments are welcome. Thanks]
********************************

Spotlight: Children and TB: A Hidden Epidemic
Masimba Biriwasha, CNS, Zimbabwe
*****************************

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*****************************

(CNS): Tuberculosis (TB) among children is rarely discussed. Because children,
more often than not cannot speak for themselves, not much about how they're
affected by the disease ever hits the headlines. This is despite the fact that
TB remains among the top ten killers of children worldwide. In spite of this,
virtually no public or political attention is paid to TB as a children's health
issue. The World Health Organization (WHO) estimates that approximately 176,000
children died, but the consensus among researchers says that actual figures are
higher. In 2009 alone, at least 1 million children became sick with TB.

A report titled "Children and Tuberculosis: Exposing A Hidden Epidemic," states
that TB preys on the most vulnerable children - the orphaned, the malnourished,
those living with HIV - and it causes an almost unimaginable burden to children
and their families.

According to Dr. Jeffrey Starke, a leading TB specialist at Texas Children's
Hospital, childhood TB "is a fundamentally different disease from adult
tuberculosis. Its proper diagnosis, treatment, and prevention require specific
planning and resources. We must consider the unique nature of childhood TB if
we're to successfully eliminate TB anywhere in the world."

"Approximately 9 million people become sick with TB each year.2 At least 10-15
percent of these cases are in children under 15 — but the percentage is probably
much higher, because childhood TB is under-reported," states the report.

Most children have a type of TB classified as sputum smear-negative TB which
makes them less likely to spread the disease to others — but it's still deadly
if left untreated. Because on average children are less contagious than adults,
they've been overlooked by national TB programs.

"While adults most often get TB in their lungs, in children the disease often
spreads to other parts of the body. Children are therefore more likely than
adults to develop severe forms of TB, including TB meningitis. TB meningitis
occurs when the bacteria spread to the central nervous system, including the
brain. The bacteria inflame the tissue that protects the brain, causing it to
swell. TB meningitis is most common in children under two years old, and the
disease is almost always fatal without treatment. TB can attack virtually any
part of a child's body in similar fashion," states the report.

It is more cost effective to prevent disease than it is to treat it. The most
effective way to prevent childhood TB is to stop the disease from spreading in
the wider community.

"Even with the limited tools currently available, better organization of
services and aggressively identifying recently exposed and infected children
would prevent tens of thousands of tuberculosis cases in children every year,"
said Dr. Starke. (CNS)

Chief K.Masimba Biriwasha
Citizen News Service (CNS)
Email: masimba@...

Online at:
http://www.citizen-news.org/2012/03/children-and-tb-hidden-epidemic.html
******************************************

[Mods note: To join the online dialogue on TB, send an email to:
Stop-TB-subscribe@yahoogroups.com . The above CNS article is online at:
http://www.citizen-news.org/2012/03/children-and-tb-hidden-epidemic.html . Be
welcome to share it on social media and comment, thanks]
******************************************

CNS Video: Reality Check on Childhood tuberculosis (part 1)
Citizen News Service (CNS)
*********************

[Mods note: To join the online dialogue on tuberculosis, send an email to:
Stop-TB-subscribe@yahoogroups.com . The CNS Video (see below) is online at:
http://www.citizen-news.org/2012/03/cns-video-reality-check-on-childhood.html .
Thanks]
*********************

Dear Stop-TB members,

The new CNS video documenting voices of families and caretakers of children with
TB, (Hindi and English languages, 12 minutes, Part I) is online now at:
http://www.citizen-news.org/2012/03/cns-video-reality-check-on-childhood.html

Please be welcome to view it, comment and SHARE IT ON SOCIAL MEDIA OR YOUR
WEBSITES in lead up to and during World TB Day.

This video raises key issues such as contact tracing, quality counseling on
infection control, health and treatment literacy, BCG vaccination, risk factors
for TB such as exposure to secondhand smoke, cook stove smoke of biomass fuel,
malnutrition, among others. This is Part 1. The Part 2 is focused on diagnostics
and treatment issues.

Thanks

Bobby Ramakant
Citizen News Service (CNS)
Email: bobby@...
*********************

[Mods note: To join the online dialogue on tuberculosis, send an email to:
Stop-TB-subscribe@yahoogroups.com . The CNS Video is online at:
http://www.citizen-news.org/2012/03/cns-video-reality-check-on-childhood.html .
Thanks]
*********************

Spotlight: A woman's courageous journey through TB treatment
Masimba Biriwasha - CNS
************************

[Mods note: Join the online dialogue on tuberculosis (send an email to:
Stop-TB-subscribe@yahoogroups.com . This CNS article is available online at:
http://www.citizen-news.org/2012/03/womans-courageous-journey-through-tb.html .
Thanks]
************************

"I REMEMBER THERE IS ONE TIME I WAS ADMITTED TO HOSPITAL AND THE
SISTER-IN-CHARGE TOLD THE NURSES NOT TO WASTE THEIR TIME ON ME BECAUSE I WAS
GOOD AS DEAD. THAT GAVE ME STRENGTH TO FIGHT FOR MY LIFE"

(CNS): In 2005, Tariro Jack, 27, fell ill with Tuberculosis (TB) during her
first year at college. She said that she struggled to cope not only with her own
health but also managing people's perceptions. TB is an infectious disease that
spreads through the air. The disease mostly affects young adults in their most
productive years and 95% of TB deaths are in the developing world. Estimated TB
incidence rates are highest in sub-Saharan Africa with over 350 cases per
100,000 population. Among African nations, Zimbabwe is one of those most heavily
affected by TB. The deadly combination of TB and HIV epidemics is igniting a
silent and uncontrollable epidemic of drug resistant TB that will negate
previous national health gains.

"I had TB at 21 in my first year at college and I know people thought that I was
dying; I struggled a lot," Jack said, adding that when she was put on the World
Health Organisation (WHO) -recommended Directly Observed Treatment Shortcourse
(DOTS), matters only got worse as her health further deteriorated.

"My skin was very smooth. When I started taking pills, I developed a rash and my
legs became sore to the extent that I couldn't walk," she said.

"Every time that I took the pills I would feel more sick that before and after,
I used to throw up a lot. I used to go to the toilet frequently because the
pills upset my whole system."

To complicate matters, her doctor at the time told her that she was not
responding well to the medication and recommened that she go and see a
specialist. Other health officials did not help the situation by predicting
Jack's demise.

"I remember there is one time I was admitted to hospital and the
sister-in-charge told the nurses not to waste their time on me because I was
good as dead. That gave me strength to fight for my life," she said.

Due to the close association between TB and HIV, Jack said that she had to
contend with another struggle, that of being suspected to be HIV-positive. TB is
a leading cause of illness and death for people living with HIV - about one in
five of the world's 1.8 million AIDS-related deaths in 2009 was associated with
TB. The majority of people living with HIV and TB are in sub-Saharan Africa. In
spite of this close association, it is not automatic that when one has TB,
they're also HIV positive. Stigma around this association is portent though and
can lead affected to shun seeking medical attention.

"When I had TB, everyone seemed to think I was HIV positive. I went for
countless HIV tests and everytime they came out negative. This was to prove a
point but I later realised I didn't live for people but for myself," Jack said.

"I finally got better as I followed the treatment course until I was fine and I
thank God because people who did not know me at the time cannot in any way tell
that I once had TB."

She said that the negative attitude that she received from some of the health
personnel is still like a fresh scar in her memory.

"To people with TB, whether you're HIV-negative or living with HIV, what you've
to know is that TB is curable. You should just believe in yourself and have a
thick skin because people will always talk but I thank God because He gave me
strength and now I can tell everyone of my experience. TB does not kill. Don't
let anyone lie to you," she said. (CNS)

Chief K.Masimba Biriwasha - CNS
Harare, Zimbabwe
Email: masimba@...

Online at:
http://www.citizen-news.org/2012/03/womans-courageous-journey-through-tb.html

Spotlight: Plan to develop new vaccines could help stop TB in our children's
lifetimes
Dr Lucica Ditiu, Executive Secretary
Stop TB Partnership
************************

[Mods note: To join the online dialogue on tuberculosis, send an email to:
Stop-TB-subscribe@yahoogroups.com . The below blog post by Dr Lucica Ditiu was
first published on Science Speaks. It is available online at: Online at:
http://www.citizen-news.org/2012/03/plan-to-develop-new-vaccines-could-help.html
. Thanks]
************************

The following is a guest blog post by Dr Lucica Ditiu, executive secretary of
the Stop TB Partnership, and was published on the Science Speaks Blog (online
at: http://sciencespeaksblog.org/2012/03/20/blueprint-toward-a-tb-free-future/ )
on occasion of the newly released document "Tuberculosis Vaccines: A Strategic
Blueprint for the Next Decade" (online at:
http://www.stoptb.org/wg/new_vaccines/assets/documents/TB%20Vaccine%20Blueprint%\
202012.pdf ). The new strategy reflects the consensus of members of the TB
vaccine research and development community to develop new vaccines that could
help stop TB in our children's lifetimes.

10 MILLION CHILDREN HAVE BEEN ORPHANED BY THE DEATH OF A PARENT FROM TB
Some 10 million children have been orphaned by the death of a parent from
tuberculosis (TB). That number is shocking, but it does not begin to account for
the children who must quit school to care for sick parents, or go to work to
keep the family fed, or those who catch TB from a parent or another relative, or
those who die from TB without ever accessing proper treatment.

IT IS UNCONSCIONABLE THAT IN THE 21ST CENTURY ANY CHILD SHOULD DIE FROM TB – A
CURABLE ILLNESS
It is unconscionable that in the 21st century any child should die from TB – a
curable illness. This year's World TB Day theme, Stop TB in my lifetime, draws
attention to TB's devastating impact on children and also the vision that
today's youngsters will live to see a world free of TB.

WORLD NEEDS A VACCINE THAT IS SAFE AND EFFECTIVE FOR ALL CHILDREN AND ADULTS
To achieve this goal the world needs a vaccine that is safe and effective for
all children and adults. The new vaccine must go way beyond what the only
existing TB vaccine –BacilleCalmette-Guérin (BCG) – can do. BCG is used broadly
across the world and has considerable value because it protects children against
some forms of severe tuberculosis. But it is not safe for children with HIV, and
it doesn't work against pulmonary tuberculosis – the most common and most
infectious form of the disease – or in protecting adults.

This month, the TB vaccine research field took a leap forward. Members of the TB
vaccine research and development community have come to consensus in a new
document titled Tuberculosis Vaccines: A Strategic Blueprint for the Next Decade
to coordinate and guide their efforts over the next 10 years. This valuable
resource outlines the five key questions that need to be addressed, and provides
a basic framework around which both advocates and researchers can organize and
rally.

The Blueprint appears in a special edition of the journal Tuberculosis and was
produced under the auspices of the Stop TB Partnership's Working Group on New
Vaccines. Co-edited by Dr. Michael Brennan and Dr. Jelle Thole of Aeras and the
Tuberculosis Vaccine Initiative (TBVI) respectively – which are two of the
leading TB vaccine research and development organizations globally – the
Blueprint is a bold and pragmatic scientific plan that highlights how
researchers and advocates can create stronger partnerships to work together to
develop a fully effective TB vaccine.

TB remains grossly overlooked by global decision makers whose support we need to
help drive greater action. According to a report by the Treatment Action Group,
the $78 million TB vaccine investment for 2010 was $302 million short of the
$380 million the Stop TB Partnership indicated as needed in their Global Plan to
Stop TB. We need more doctors, vaccine researchers, and people living with or
affected by TB to raise awareness about the impact of the disease and to demand
support for new tools.

When we think about the desperate need for a TB vaccine, we need to stay focused
on people – the babies, children, women and men who are vulnerable to getting
sick from and dying of TB. Without a new vaccine, TB will continue to wreak
havoc on the lives of millions. It is high time we answered the scientific
questions that remain roadblocks to developing new TB vaccines.

I encourage advocates to use Tuberculosis Vaccines: A Strategic Blueprint for
the Next Decade as a resource to show global leaders that we can, and will,
bring new vaccines to fruition if this effort is prioritized. Researchers and
advocates need to coordinate their efforts. This is the only way we will realize
the vision in the Blueprint.

Over the past decade, tremendous progress has been made toward developing better
TB vaccines. We went from having zero new vaccine candidates to 12 vaccine
candidates in clinical trials globally. With the Blueprint, we will be able to
make even more progress in the decade to come. A global meeting of TB vaccine
researchers and advocates – the Third Global Forum on TB Vaccines – is scheduled
for March 24, 2013 in Cape Town, South Africa. This World TB Day, let's resolve
to make that conference the deadline for each of us to begin to play our part in
increasing local, national and global support for TB vaccine development.

Dr Lucica Ditiu
(The author is the Executive Secretary of the Stop TB Partnership,
www.stoptb.org)

Online at:
http://www.citizen-news.org/2012/03/plan-to-develop-new-vaccines-could-help.html

Spotlight: TB in Children: Why Zimbabwe Must Act Now
Chief Masimba Biriwasha – CNS
*******************************

[Mods note: To join the online dialogue on tuberculosis, send an email to:
Stop-TB-subscribe@yahoogroups.com. The below CNS article is online at:
http://www.citizen-news.org/2012/03/tb-in-children-why-zimbabwe-must-act.html .
Comments are welcome. Thanks]
*******************************

Harare, Zimbabwe: Tuberculosis (TB) is a major public health problem in Zimbabwe
yet very little is known about the impact of the disease on children. Without a
functional healthcare system and research into paediatric TB, Zimbabwe is likely
to continue losing its children to this hidden public health problem. Among
African nations, Zimbabwe is one of those most heavily affected by TB. The
Global Tuberculosis Control Report from the World Health Organisation (WHO)
ranks Zimbabwe 17th among 22 countries worldwide with the highest TB burden.

Zimbabwe had an estimated 71,961 new TB cases in 2007, with an estimated
incidence rate of 539 cases per 100,000 people. While, Zimbabwe has fought TB
fairly successfully since attaining statehood in 1980, in the past few years the
disease has re-emerged as a leading killer, especially among people living with
HIV, who are often not identified through long-established TB tests. Put simply,
the TB control programme has been adversely affected by a lack of adequate
financial, human and material resources.

LITTLE DATA ON CHILDREN WITH TB
As it is, there's very little epidemiological data on the extent of TB among
children in the country. Experts say that child TB is widely under-reported and
can represent as much as 40% of the TB caseload in some TB high burden settings
such as Zimbabwe. Children are at high risk of TB, are prone to disseminated
disease and the diagnosis of paediatric TB may be difficult, since complaints
often are unspecific and contacts may not been known.

To make matters worse, the HIV epidemic has affected TB in children enormously,
as it has adults. It has increased the risk that infants and young children will
be exposed to TB, since many adults with TB-HIV are young parents.

HIV-infected children have a 20-fold risk of developing TB compared to
HIV-uninfected children. It also makes diagnosis and treatment more complicated
and increases the risk of TB-related death about 5-fold.  The HIV epidemic has
also orphaned many children (with or without TB-HIV themselves).

DIAGNOSTIC CHALLENGES
Unfortunately, Zimbabwe's national tuberculosis programme has historically not
given child TB high priority because of diagnostic challenges (e.g., children
under 10 have difficulty producing enough sputum for microscopy and the majority
are smear-negative); children are not a major source of the spread of the
disease; resources are limited; recording and reporting forms did not include
boxes for recording ages 0–4 and 5–14 until 2006.

"Our ability to even assess the magnitude of the problem is severely hampered by
the lack of diagnostics in children. The problem is that diagnostic tools, both
current and in development, do not adequately take into account the special
requirements for assessing children," said Dr Steve Graham, chair of Stop TB's
Child TB Subgroup of the DOTS Expansion Working Group.

Once infected with TB, infants and young children are at greater risk than
adults for developing active TB disease, as well as of having the TB disseminate
throughout the body, including to the brain, where it causes meningitis. This
type of TB is often fatal or leaves the child with major disability.

Many health workers regard the management of a child with suspected TB as
`difficult cases', especially with regard to diagnosis. Children are thought of
as needing specialised care.

Against this background, TB case-finding efforts should target children under 5
years of age living in a household with a sputum-smear positive adult. If the
children are well, they should receive isoniazid preventive treatment (IPT) to
help prevent their developing active TB disease.  If they are not well, TB
treatment should be considered and a clinical examination is recommended.

SUGGESTIONS FOR NATIONAL TUBERCULOSIS PROGRAMMES INCLUDE:
- Establish a dedicated child TB working group that includes National
Tuberculosis Control Programme (NTP) staff and national child TB experts.
- Use the working group to set practical priorities and goals, develop
guidelines, implement activities for child TB, support health workers managing
child TB and raise awareness through advocacy and health education.
- Include the needs of child TB in routine NTP activities, such as training,
drug procurement, strategic plans and recording and reporting.

Chief K.Masimba Biriwasha
Citizen News Service - CNS
Email: masimba@...

*******************************
[Mods note: To join the online dialogue on tuberculosis, send an email to:
Stop-TB-subscribe@yahoogroups.com. The above CNS article is online at:
http://www.citizen-news.org/2012/03/tb-in-children-why-zimbabwe-must-act.html .
Comments are welcome. Thanks] *******************************

CNS Video: Reality Check on Childhood TB (parts 1 and II)
Citizen News Service (CNS)
*********************

[Mods note: To join the online dialogue on tuberculosis, send an email to:
Stop-TB-subscribe@yahoogroups.com . Thanks]
*********************

Dear Stop-TB members,

Both the parts I and II of the CNS video "REALITY CHECK ON CHILDHOOD TB" (37
minutes, Hindi and English) documenting voices of families and caretakers of
children with TB, are now online.

Part I:
http://www.citizen-news.org/2012/03/cns-video-reality-check-on-childhood.html
Part II:
http://www.citizen-news.org/2012/03/cns-video-reality-check-on-childhood_22.html

Please be welcome to view it, comment and SHARE IT ON SOCIAL MEDIA OR YOUR
WEBSITES in lead up to and during World TB Day.

You are most welcome to screen the video at your World TB Day event.

This video raises key issues such as contact tracing, quality counseling on
infection control, health and treatment literacy, BCG vaccination, risk factors
for TB such as exposure to secondhand smoke, cook stove smoke of biomass fuel,
malnutrition, diagnostics and treatment challenges, tubercular empyema in
children, diabetes and TB, TB and HIV co-infection, among others.

Thanks

Bobby Ramakant
Citizen News Service (CNS)
Email: bobby@...
*********************

[Mods note: To join the online dialogue on tuberculosis, send an email to:
Stop-TB-subscribe@yahoogroups.com . Thanks]
*********************

Report: Hearing the unheard voices - saving children from TB
Citizen News Service (CNS)
***********************

Dear friends,

Please be welcome to share the report released on World TB Day, 24 March 2012,
in Lucknow, India and Chiang Mai, Thailand, by CNS summarizing the content from
the online consultation and key informant interviews on childhood TB conducted
by CNS along with support from more than 50 partner organizations and networks
globally.

The Scribd (pdf) version of this report is online at: 
http://www.scribd.com/doc/86723326/Hearing-the-unheard-voices-saving-children-fr\
om-TB

The e-paper version of this report is online at:
http://issuu.com/bobbyramakant-cns/docs/childhood_tb_e-consultation_and_key_info\
rmant_inte

Please share this report with your team members, partners and be welcome to use
it for your advocacy as appropriate. All comments are welcome.

Be welcome to share the links of this report on social media platforms your team
members and partners use.

We will be grateful if this report can be published on your websites as well.

Warm regards

Bobby Ramakant
Citizen News Service (CNS)
Email: bobby@...

**********************************
To join online consultation on tuberculosis, send an email to:
stop-tb-subscribe@yahoogroups.com
**********************************

Spotlight: Tuberculosis: Ugly scar on beautiful childhood
Shobha Shukla – CNS
********************

[Mods note: To join the online dialogue on issues around tuberculosis, send an
email to: Stop-TB-subscribe@yahoogroups.com . Have your say! Thanks]
********************

(CNS): Jugalkishore is a six year old boy whose impish smile hides the ugly
germs of TB that are ravaging his health. He is the third child of Ramdulari -
the charming, but uneducated, hapless wife of daily wage earner Shivprasad, who
uses excessive alcohol and tobacco, and is also a former TB patient who
successfully completed TB treatment.  Jugalkishore, has recently been diagnosed
with pulmonary TB and put on a 6 months course of free anti-tuberculosis
treatment (ATT) since the last one month, at a DOTS centre. He is just one of
the estimated one million children under 14 years of age who will need treatment
for tuberculosis this year (approx. 10–15% of 9 million cases estimated by the
WHO Global TB Control Report 2011).

Some experts believe that childhood TB is widely under-reported and can
represent as much as 40% of the TB caseload in some TB high burden settings.
Childhood TB ranks high on the public health priority list because TB is an
important cause of child (and maternal) morbidity and mortality, and also
because TB infected children are at greater risk than adults for developing
active TB disease, as well as of having the TB disseminate throughout the body,
including to the brain, where it causes meningitis. This type of TB is often
fatal or leaves the child with major disability.

The International Union Against Tuberculosis and Lung Disease (The Union)
strongly believes that, "TB case-finding efforts should target children under 5
years of age living in a household with a sputum-smear positive adult. If the
children are well, they should receive isoniazid preventive treatment (IPT) to
help prevent their developing active TB disease.  If they are not well, TB
treatment should be considered and a clinical examination is recommended."

But the likes of Ramdulari are ignorant about the seriousness of the disease.
She only knows that he son had started coughing when he was two years old, which
worsened over a period of time. The cough would be particularly bad at night,
and often make him breathless. The parents would take him to a government
hospital for treatment, but the medicines did not improve his condition. The
doctors would ask them to buy medicines from outside, which they could not
afford. He was eventually diagnosed with TB in the summer of 2011 on the basis
of an X Ray. The doctor prescribed medicines most of which were to be bought
from the private market. As they could not afford that, treatment was
discontinued. After sometime, he was very sick again, so he was admitted in the
hospital for 10 days. Another X-Ray was taken, and he was also given the BCG
vaccine for a third time. Only when the doctors were repeatedly told that they
were too poor to buy medicines, did they prescribe free medicines from the DOTS
centre.

The family has no knowledge about TB, or how it is spread. They did not even
know that one gets free medicine for TB. They were not counselled about any
infection control measures at the DOTS centre. The doctors did not tell them
anything about cough hygiene, or about cleanliness, or how to protect others
from infection. (When I met the child, he had had a severe bout of cough, and he
was coughing very close to his 3 year old sister). No other family member has
been asked by the doctors to get tested for TB, although the child's father has
been on ATT a few years ago and is coughing again. The child sleeps with the
mother on the same bed along with his siblings.

Dr Anne Detjen, Child TB specialist working with The Union's TREAT TB
initiative, emphasizes that, "Contact tracing and preventive therapy are the
most important measures to prevent the development of TB in children. Children
in close contact to TB cases have the highest risk of becoming infected and
developing disease, often severe disease, if they don't receive preventive
therapy. Not tracing down those children and treating them is a missed
opportunity. Early detection of TB in adults and the interruption of
transmission is another important step, to prevent TB in children. This requires
advocacy at the community level as well as easy access to diagnosis and
treatment."

The family of Ramdulari lives in a typical urban semi slum area (in as much as
the houses are not makeshift but permanent brick structures) of Lucknow, the
capital of Uttar Pradesh, which boasts of the state of art medical facilities.
They reside in a brick walled house in a very narrow by lane, carefully
protected from the prying rays of the sun. There is a small open verandah,
leading to two dark, dingy and damp rooms, with no access to sunlight, and
hardly any ventilation. One of the rooms doubles up as a kitchen, which has a
mud stove run on wood fuel. The smoke from the chulha, and from the bidis smoked
in the house, linger in the closed environment for long.

However according to Dr Penny Enarson, Head of the Child Lung Health Division, 
The Union, "Improving  the detection rate/treatment in adults by the national TB
Programmes and improving housing to reduce the conditions that increase
transmission, especially over-crowding, would affect the incidence in TB in
children drastically."

Ramdulari has 4 children, but she never had any institutional delivery.  Like
her other kids, Jugal Kishore too was born at home. He was an underweight infant
and could be only partially breast fed due to the poor health of his mother.
There is never enough to eat in the house, let alone milk or any other nutritive
food for the children. Ramdulari has to manage a family of seven on the meagre
earnings of around Rs 100 to Rs 150 ($2 or 3) per day, a major part of which is
spent on the liquor and bidis of his husband, who has been coughing a lot of
late. But he has not gone to the doctor, as he feels he has already completed
the treatment of TB once, so he will not have it again.

The case of Jugalkishore is not an isolated one. There are innumerable tales of
neglect and apathy, which dampen the success stories of the government
programmes. But if this is the situation in a metro city, one can well imagine
what the situation would be in rural and remote areas. It may sound politically
correct to cry hoarse in unison that we want a TB Free World by 2015, but merely
chanting slogans are not going to make any difference in the lives of people
like Ramdulari and her kids. One has to see what can be improved in the existing
setup. Only if there was prompt diagnosis of TB and better contact tracing; only
if the much publicised maternal and child health programmes of the government
could reach these unreached populations; only if women could be made aware and
counselled about family planning, exclusive breast feeding and basic
health/hygiene measures; only if the healthcare services were more receptive to
the needs of the poor people. The list may seem endless, yet it is achievable
without any extra resources. A little more competency and accountability in our
work, instead of a 'couldn't care less attitude', will go a long way in
controlling childhood TB.

Dr Steve Graham, Child Lung Health division,  The Union, and Chair, Child TB
Subgroup of the DOTS Expansion Working Group of Stop TB Partnership, rightly
insists that, "Improved case finding and increased use of preventive therapy,
are the two most important, yet simple, interventions in resource limited
settings which can bring down the incidence of childhood TB. Both of these are
the target of routine screening of close contacts of TB cases and are currently
available. Of course, also improved vaccine and improved accuracy of diagnostic
tools (which could be simple but are not yet available)."

For more than a decade, The Union has been providing a major forum for
clinicians, researchers and advocates in child TB through its annual World
Conference. It has also provided important resources, including courses on child
lung health; technical guides, such as the Desk-guide on diagnosis and
management of TB in children; and research published in the monthly
International Journal of Tuberculosis and Lung Disease. It also supports
National Tuberculosis Programmes in high-burden countries through technical
assistance and training and also by providing input into the research agenda,
including the work on new diagnostics that is so critical for addressing child
TB. (CNS)

Shobha Shukla - CNS
Email: shobha@...

Online at:
http://www.citizen-news.org/2012/03/tuberculosisugly-scar-on-beautiful.html

Action: 43rd Union World Conference - online submission of abstracts
International Union Against Tuberculosis and Lung Disease (The Union)
***********************************************

[Mods note: For continued information exchange and online dialogue on
tuberculosis, join the new Stop-TB eForum! Send an email to:
Stop-TB-subscribe@yahoogroups.com . Thanks]
***********************************************

The online submission of abstracts for presentation at the 43rd Union World
Conference on Lung Health to be held in Kuala Lumpur, Malaysia from 13-17
November 2012 is open.

The theme of the conference is "Driving sustainability through mutual
responsibility". Click here for more information on the theme of the conference.
We are particularly interested in attracting abstracts on the following broad
topics: tuberculosis, asthma, pneumonia, HIV/AIDS, tobacco-related and all other
lung diseases, as well as the health consequences of air pollution.

Updated information will be posted on the conference website:
http://www.worldlunghealth.org

If you are experiencing any difficulties submitting your abstract, or have any
questions, please write to: scientific2012@...

Yours sincerely,

Dr Nils BILLO, MD, MPH
Executive Director
International Union Against Tuberculosis and Lung Disease (The Union)

Ms Rajita BHAVARAJU, MPH, CHES
Chair, Coordinating Committee of Scientific Activities

Perspectives From The Frontlines: Drug-resistant TB and HIV
Citizen News Service (CNS)
**************************

[Mods Note: : For continued information exchange and online dialogue on
tuberculosis, join the new Stop-TB eForum! Send an email to:
Stop-TB-subscribe@yahoogroups.com . Thanks]
**************************

Dear friends,

The Citizen News Service (CNS) is sharing a series of case studies of people
living with HIV who are also dealing with drug-resistant TB in Mumbai, India. We
thank the Medicins Sans Frontieres (MSF) or Doctors Without Borders with helping
with these interviews with people on the frontlines.

1. A Caring Treatment Conquers All Odds: Story of Shanti
Online at:
http://www.citizen-news.org/2012/03/caring-treatment-conquers-all-odds.html

2. Chandrika's Fight Against The Deadly Virus-Bacteria Duo
Online at:
http://www.citizen-news.org/2012/04/chandrikas-fight-against-deadly-virus.html

3. A Commoner's Fight Against HIV and Drug Resistant TB
Online at:
http://www.citizen-news.org/2012/04/sukhrams-fight-against-deadly-duo-of.html

Please be welcome to share the above perspectives from the frontlines widely
with your team members and partners or other channels such as websites, eForums,
social media platforms, among others.

Kind regards

Bobby Ramakant
Citizen News Service (CNS)
Email: bobby@...

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