Common Health Problems, Millenium Development Goals and Evidence Based Interventions

Sources of Evidence and Guidelines

Malnutrition and MDG 1

Children and MDG 4

Maternal Health and MDG 5

HIV/AIDS and MDG 6

Malaria and MDG 6

Tuberculosis and MDG 6

Disability

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TUBERCULOSIS

 

• Millenium Development Goal 6 
• The illness, diagnosis and treatment
• Tuberculosis in high risk groups
• Advice for healthcare workers and travellers

 

Millenium Development Goal 6

• Reducing the incidence of tuberculosis is part of Millennium Development Goal 6 with collaborative action by international alliances.

• MDG Target 6C : Is to have halted by 2015 and begun to reverse the incidence of malaria and other major diseases. TB is one of the "other major diseases".

• New cases and deaths globally from are falling with progress towards current targets
• However, here are 8 - 10 million cases globally each year, and one and a half million deaths.

• Tuberculosis is strongly linked to poverty so programmes to reduce poverty are important
• Tuberculosis has increased greatly in communities with high HIV infection rates, and almost half the deaths occur in people with HIV.

• Early diagnosis of active cases, and directly observed treatment short-course (DOTS), giving drug combinations for six months, are key control measures.
• Finding cases among contacts and preventing cross-infection to healthcare workers and other patients is important.

• Drug resistance has developed which is a risk to effective control.
• Research priorities are for the development of new techniques for diagnosis, new drugs, and a more effective vaccine against tuberculosis.

 

FURTHER INFORMATION Stop TB Partnership supports social and political action to address tuberculosis. It provides factsheets, reviews and guidelines. WHO tuberculosis country profiles for epidemiology and strategy, drug resistance and financing  Underlying issues for reducing TB, including health systems and programmes The Global Fund to Fight AIDS, Tuberculosis and Malaria funds prevention, treatment and care programmes.

 

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The illness, its diagnosis and treatment

The Illness 

• Tuberculosis is a bacterial infection caused by Mycobacterium tuberculosis, transmitted by droplets from people with active respiratory infection.
• initial infection is often without symptoms Usually it becomes latent, but it causes illness in 5 - 10% over a lifetime. Half of these are affected in the first 2 years after infection.
• most commonly affects the lungs presenting with coughing, sputum sometimes with blood, chest pains, weakness, weight loss, fever, or night sweats.
• can affect most organ systems or be diffuse with skeletal, gastrointestinal, cardiac, neurological, or genitourinary symptoms.

Diagnosis

• Identification of Mycobacterium tuberculosis on microscopy and culture 
• Rapid diagnostic tests are planned.for the future

Treatment

• Effective treatment uses several drugs with presumed sensitivity for at least six months and there needs to be high compliance.
• Specific regimes are recommended by WHO, and in national plans, for first line treatment, re-treatment, and drug resistance, with different regimes for children, and people with HIV/AIDS.
• Finding close contacts of cases for preventative treatment is part of tuberculosis control, with priority for treating children under five years, and finding contacts for drug resistant tuberculosis and people with HIV/AIDS.

 

GUIDANCE/INFORMATION WHO Tuberculosis Treatment Guidelines Clinical guides and resources for tuberculosis management WHO guidelines for management of drug-resistant tuberculosis  Maps of anti-tuberculosis drug resistance

  

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Tuberculosis in high risk groups

Those at higher risk include

• Children

• Newborn BCG vaccination is given in high prevalence countries to reduce deaths.
• Adverse effects of treatment are more common in children and specific drug regimes are recommended.

• People with HIV/AIDS or lower immunity

• People with HIV/AIDS are more likely to be ill after initial infection, to have reactivation of latent infection, and to relapse following treatment.
• For people with HIV infection, preventative anti-tuberculosis therapy is recommended for latent tuberculosis to reduce reactivation, and antibacterial prophylaxis for people with active tuberculosis. Intensified case finding and infection control are also priorities.
• Co-infection with HIV and tuberculosis is common in high prevalence countries requiring a coordinated approach to diagnosis and management of both conditions.

 

GUIDANCE WHO position paper on BCG vaccination  WHO advice on treatment of TB in children WHO policy for collaborative TB/HIV activities - key recommendations WHO TB case finding and preventive treatment for people living with HIV WHO diagnosis and management of smear-negative pulmonary and extra-pulmonary TB in high HIV prevalent and resource constrained settings - clinical guidelines and algorithms  WHO TB / HIV clinical manual. Comprehensive clinical guide

 

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Advice for healthcare workers and travellers

• Prolonged and close exposure with someone with active pulmonary tuberculosis is usually required for transmission, and brief contact carries little risk.
• BCG vaccination is recommended for healthcare workers under 35 years working in high prevalence areas.
• Personal protective equipment and barrier nursing should be used when caring for people infected with tuberculosis, according to local protocols.

 

GUIDANCE Travel advice for tuberculosis

 

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