TUBERCULOSIS: THE LINKS WITH POVERTY Anthony D Harries The Union, Paris, France.
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Transcript of TUBERCULOSIS: THE LINKS WITH POVERTY Anthony D Harries The Union, Paris, France.
TUBERCULOSIS:
THE LINKS WITH POVERTY
Anthony D HarriesThe Union, Paris, France
Poverty
MalnutritionImmune deficiency
Tuberculosis
Malnutrition and low body weight
Immune deficiency and low CD4 cell count
Tuberculosis
In the TB patient:
• Wasting
• Lack of vitamins
• Lack of trace elements
• Low levels of protein
These deficiencies are worse in those with the lowest body mass index (BMI)
Nutrition - clinical outcomes
• study in Malawi -1181 patients
• risk factors for early death =
age >35, HIV, low BMI
In first 4 weeks of TB therapy:
• BMI<17 = 11% death
• BMI >17 = 6.5% death
Zachariah et al, 2002
BUT……
No evidence that nutritional supplementation on its own can improve
TB treatment outcomes
Poverty and TB…
• The poor are at greater risk for TB– Poor housing, poor diet, poor education, risky behaviours
• The poor face barriers to accessing care:-– Financial – user fees, diagnostic tests, transport
– Geographic - distance to health services
– Cultural – stigma, poor education, traditional
– Health system – no choice, poor treated worse than the rich
UK Malawi
Population 60M 13M
Health expenditure $2,500 $15
Physicians 135,000 270
Nurses 700,000 7,300
PLHIV 70,000 950,000
Annual TB cases 6,700 26,000
Household characteristics of 770 smear-positive Pulmonary TB patients in Malawi
• Live in mud-built houses 36%• No piped water in house 75%• No electricity in house 92%
• Household income (<$10/m) 45%
Claessens et al, IJTLD, 2002
Thyolo district, Malawi: 550,000
A patient’s journey with TB
Patient Access to Health Facilities
Long distances
Lack of faith in allopathic sectorBelief in traditional healers
Traditional Healers in Malawi
Health care provision at District Hosptial clinics
Undermanned
Busy, especially in central and district hospitals
New disease such as TB can be overlooked
Mangochi District Hospital ART Clinic: 4,500 patients on ART
TB of the abdomen
Some forms of TB difficult to diagnose in RLS
Disseminated TB
Submitting sputum specimens for AFB
This may be a long process
Laboratories where TB is diagnosed are over-burdened and under staffed
It may be a long time to get results
Standardised TB Treatment“Short course” [6 months]
New Cases:
2RHZE/ 4RH is standard first line treatment
WHO recommended regimens - 2009
TB Programmes like their treatment given by direct observation
The main road to Chitipa District Hospital
Poor urban settings – same problems
Make it easier for TB suspects and TB patients
• Better education about TB and how it is transmitted (air-borne disease)
• Diagnostic services closer to homes
• Treatment services closer to homes
• Shorter treatment for Tuberculosis