Medicine Cabinet
Reiner W. Gloor
CONTROLLING and managing the spread of tuberculosis (TB) more effectively in a country such as the Philippines may require new strategies such as a “biosocial” approach hand-in-hand with biomedical solutions.
The long decades of focusing mainly on biomedical solutions to deal with TB may need to be reviewed by many countries for it has “not worked,” according to researchers at the Harvard T.H. Chan School of Public Health.
“Unless there is a major shift in the way the world fights tuberculosis, from a reliance on biomedical solutions to an approach that combines biomedical interventions with social actions, the epidemic and drug resistance will worsen,” the researchers at Harvard T.H. Chan School of Public Health revealed in a new study, the results of which were initially released on Oct. 26.
Prof. Rifat Atun, professor of global health systems and senior author of the TB study, and his team are calling for a biosocial approach that incorporates interventions in areas such as nutrition, urban planning, occupational health, addiction recovery, and mental health services.
“Despite increased funding for tuberculosis programs over the past 15 years, progress has been woefully slow,” Atun said. “We strongly argue that more of the same will not stop tuberculosis. The time has come for comprehensive actions to confront the root causes of tuberculosis, which lie in poverty and deprivation.”
In the Philippines, the World Health Organization (WHO) has described TB as “a major health problem” in the country, as it is the sixth leading cause of death and illness.
The WHO estimated in 2011 that there were 260,000 TB incident cases in the country, with 28,000 deaths from it every year. It is estimated that 10,600 patients have multi-drug resistant TB in 2011.
The WHO noted that TB prevalence is high among the high-risk groups such as the urban poor, elderly, smokers, and those with compromised immune systems, such as people living with HIV, malnutrition, and diabetes.
The prevailing situation of TB in the Philippines is causing substantial socioeconomic losses in the country. Because of these huge socioeconomic losses, under the National TB Control Program, the country aims to detect 85% of TB patients and to successfully treat at least 90% of them.
The 2010-2016 Philippine Plan of Action to Control TB provides the road map to achieve the goal of halving the TB mortality and prevalence by 2015.
Persons with signs and symptoms of TB can access free diagnostic test using sputum microscopy and anti-TB drugs from different “directly observed treatment, short-course” facilities, such as rural health units, health centers, private clinics, some hospitals, prison clinics, and other facilities.
To ensure compliance, a patient is assigned a “treatment partner.”
Despite aggressive government efforts, however, an estimated 65,000 TB cases remain undetected and untreated, the WHO reported. These are called the “missing” TB cases.
Although it has been curable and preventable since the 1950s, tuberculosis still kills more than 1.5 million people worldwide each year and drug resistant strains are an increasing threat, the Harvard T.H. Chan School researchers on TB said.
Social conditions including malnutrition and overcrowded housing, HIV and diabetes, smoking and excessive consumption of alcohol continue to drive the epidemic, they noted.
Biomedical approaches alone have not achieved substantial decreases in tuberculosis burden, the authors of the TB study argued. In developing countries, the benefits of improved diagnostics and treatment are offset by susceptibility to tuberculosis in at-risk populations.
“A biosocial approach to stopping tuberculosis will not only reduce morbidity and mortality from disease but would also alleviate poverty and help sustainable development,” Atun said.
“It will meet present needs for the poor and provide them and subsequent generations with an opportunity for a better future,” the professor added.
Other Harvard T.H. Chan School authors included Katrina Ortblad, Joshua Salomon, and Till Bärnighausen.
(The Harvard T.H. Chan School of Public Health study on TB was published online Oct. 26 in The Lancet as part of a special series led by Salmaan Keshavjee, Harvard Medical School associate professor of global health and social medicine. The series, which includes five papers detailing a comprehensive plan to stop TB deaths, along with three commentaries that place the epidemic in context, will also be published as a book. The strategies outlined in the papers will ultimately be put into action through the Zero TB Cities Project, an initiative aimed at creating “islands of elimination” of the disease.)
Log on to www.phap.org.ph and www.phapcares.org.ph.
E-mail the author at reiner.gloor@gmail.com.
