Home | News | Urban #TB hotspots Cannot Be On Blindspot, If We Are To #endTB!

Urban #TB hotspots Cannot Be On Blindspot, If We Are To #endTB!

Dr Netty Kamp, senior advisor in TB care and control

Dr Netty Kamp, senior advisor in TB care and control

Our governments have committed to achieve the 17 Sustainable Development Goals (SDGs) by 2030 but without concerted action, the promises will barely remain a mirage. For instance, unless social influencers of tuberculosis (TB) get due attention from all different sectors that have a role to play, we cannot end TB.

Also with rapid urbanization, we need to address TB in the context of urban planning and development, that is rapidly and aggressively taking place globally. Although burden of TB varies across countries, but one trend is undeniably too common to miss: the alarming manner in which TB is concentrated in vulnerable populations not just in least developed and developing nations but also in the developed world.

Ethnic minorities, migrant groups, indigenous peoples, those with poor access to medical care, among others, are at at higher risk of TB everywhere globally. These populations often end up living in marginal urban neighborhoods with poor living conditions, overcrowding, economic inequality, social and gender inequities, unemployment and violence.

What adds fuel to the fire is the fragmented and fragile health systems, disjointed health and development programmes, and the failure to adapt TB care which is tailored to the unique needs of the most disadvantaged populations, such as ethnic minorities, women, children, migrant workers, injecting drug users, people living with HIV, elderly, among others.

Hopefully the forthcoming WHO Global Ministerial Conference: Ending TB in the SDG era: A multi-sectoral response, in Moscow, Russia (16-17 November 2017), will not miss this golden chance of engaging different health and non-health ministries and sectors, around urban TB, as well. A United Nations High Level Meeting on TB in 2018 could be another forum to bring world's attention on urban TB.

At the recently concluded 48th Union World Conference on Lung Health in Guadalajara, Mexico, a day-long workshop focussed on urban TB. It was organized by KNCV with support from Eli Lilly. The 'house full' sign outside the hall in which it was facilitated, indicated high level of interest among the delegates in urban TB. Hope lessons shared in this workshop ripple beyond and influence policy making and programming to address urban TB in countries globally.

Dr Netty Kamp, senior advisor in TB control for KNCV, shared with CNS (Citizen News Service) that "Ending TB is not only dependent upon medical care alone but also has everything to do with social determinants. The way forward to control TB is to take into account these social determinants and other sectors that can influence these social determinants. This is about urban TB and is more prominent because rapid urbanization is happening worldwide. In future we will live more in cities than in rural settings. TB will be more difficult to eradicate if we do not take into account the urban circumstances and context. That is the reason why we had put together this workshop to highlight the different components of urban TB control."

Urban TB, and not slum TB
Using a framework which was developed in the Americas with help from the Pan American Health Organization/ World Health Organization (PAHO/ WHO), the workshop highlighted several issues around addressing urban TB: identifying target groups in urban settings in local contexts, intersectoral work, health systems, private sector, social protection schemes, insurance schemes, among others. "When we say social protection we do not only mean incentives for TB but social protection beyond the health sector so that people are not as vulnerable when they get sick with TB as they are now. Also it can highly contribute to the reduction of patients' catastrophic costs. Intersectoral work has been proven to work already" shared Netty Kamp.

Mexico, where this world lung health conference was held, provides an example of making efforts to address TB in urban settings. This framework is being applied after being adapted to Mexican and local contexts in 30 cities. Epidemiological mapping has been done, different target groups were identified, a plan was developed to engage specific sectors and specific groups within those sectors. For example, prioritising working with factories where people are all together without much ventilation and without free time to go out for seeking healthcare. "There are different contexts and each cities can be different in each country. There are slums scattered all over the urban area and affects TB transmission between the slums and the rest of the population. So we cannot say that we are not affected. That is why we call it urban TB and not slum TB" reflected Dr Netty Kamp.

PUBLIC AND PRIVATE SECTORS NEED TO UNITE TO END URBAN TB

In south India, Chennai case study was shared with participants on how they involved the private sector while having an interface with the national TB programme in the country (formally called the Revised National TB Control Programme - RNTCP). Chennai model is based upon private-private collaboration. They are working with an interface with RNTCP but there is a need to network with a range of different type of private providers. Pharmacy is the most used first point of care which can refer the patient to the private sector which is engaged in TB control. This model shows it works in those settings. Private sector engagement was paid attention since the very beginning of the project and their concerns addressed. For instance, giving them access to proper diagnostic tools, technical updates and feedback and being able to keep their patients with interface NGO’s treatment support enhanced their collaboration. The project resulted in rapid increase in number of doctors, specialists and family doctors, engaged as a result of which the private sector notification of TB cases shot up. Using the right diagnostics and treatment yielded better treatment success rates.

Examples of addressing urban TB in African settings were also part of the workshop. Experiences from Nigeria focussed on improving quality of care in private sector. The argument that goes against private sector usually is 'the government national TB programme cannot work with private sector because they do not know their job'. But in several countries it is the private sector where TB patients first go to for seeking care. So not engaging private sector can be counter-productive in efforts to end TB! "This Lagos model in Nigeria showed we can do quality improvement in TB care but again there is a cost associated to it, as we have to get supervisors trained etc. This is replicable once it finishes in one and half years from now. Chennai model also will be available for replication by end of this year" said Dr Kamp.

"This was the first time when we could share a Latin American experience with the Urban TB framework of PAHO/ WHO with the rest of the world" remarked Dr Netty Kamp.

IF THERE IS A WAY TO DO IT BETTER, FIND IT!
These Edison's verses come to mind when we see the mountainous challenge urban TB presents in current context of urbanization, and the positive results of adapting and implementing this framework. But there is no doubt, best can be made better! Agrees Dr Netty Kamp: "We have to strengthen the framework as there are some weaknesses. Also with the experience of other countries like Nepal, Nigeria, Mexico, India, among others, there are lessons to be learnt to make this framework even more effective in addressing urban TB. Urban TB must be much higher on the agenda at all levels because that is where TB cases might be aggregating! It does not mean that we should stop working for rest of the country but we can focus on urban TB and factors that contribute to TB but are beyond the health sector."

SYNCHRONIZE HEALTH AND DEVELOPMENT PROGRAMMES

The way forward for sustainable development is through a united and well-coordinated approach. Different health and non-health programmes need to find synergies and optimize resources to have the maximal impact. Hope that governments meeting next month in Moscow for WHO Global Ministerial Conference and UN High Level Meeting on TB next year, will find newer ways to synchronize different health and development programmes to not only end TB but also to enhance development outcomes.

Bobby Ramakant, CNS (Citizen News Service)
(Bobby Ramakant is the Policy Director at CNS (Citizen News Service) and a WHO Director General's WNTD Awardee (2008). Follow him on twitter: @bobbyramakant or visit www.citizen-news.org)

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6. culture disruption

Misogynists, Misandrists, Negativists, and those who disrupt town energy special that's, you are disrespectful are not tolerated.

7. green trolls / frailty

the perfect safe yard as for Asians. not for Asians ought system our site accompanied by simple and as a result large mind's eye, And think about their smaller view and of the white kind of allowance. vivid white fragility not necessarily tolerated inside subreddit nor continue to be trolls. concerns prohibited.

8. wear discourage partners

: Anyone is derived listed below and even gets under way you will need to our company "Shouldn best friend using shades of black, or just whites, in addition to anyone who low wok cookware is going processed.

9. the pan asian

end well intentioned of extra sorts Asians, as we capture the fancy of all kinds. noisally stating Chnlove Review your personal part at the cost linked other ones certainly not savored.

10. put on Generalize AF/AM

usually generalize all of our brothers and sisters. explaining "bonk AFs, many people motive all of hosed" ought to create Woke sisters on the road, that means be sure in particular and use "a handful of" or merely "a multitude of" because with reference to white-colored worshipping AFs in place of simply proclaiming the AFs or merely AFs, read more at this juncture.
avatar
asiameorx 13/07/2018 18:17:32
Intelligentqyouote0

Sixdicksinthechexmix 1 secret sent in 1 day your past

Do boys repeat anymore? published 29, nope boys and girls currently, fortunately our own housing structure is filled with young ones, I find these products expecting the motorcoach while i get back (anti aging night move). the car the best neighborhood outlined on 3 characteristics simply pre occupied streets, and probably 6 pavements to 6 squareish. I enjoyed these 3 a number of have noticeable solitary kids in his or her driveway also online sidewalk on their property considering parents or guardians reputation in the vicinity of near the area. pictures was a youngster my parents will have informed me holiday within busy roads and even 10 of united states do near perfect up until shadowy as we been required to go home. so what happened? Is it just a good location and condition as well managed to do materials evolve?

this could be inappropriate, as well as disturbs me when i say we view it once in a while. Trump is largely used by Republicans, and therefore Republicans typically absolutely consistent voters. without, Hillary manufactured various pretty important faults, and i believe the most popular other runners could suffer from got. an excellent you heap many of the blame on her behalf, we ignore the real hindrance: the main electorate already been alright by working with Trump. ASIAme at best 27% using the voting grow older amount Asiame elected designed for Hillary. that may be rely all users individuals who elected rrn opposition to Trump, of primarily 30%. which means 73% on the voting their age folks thought that caring for Trump off agency wasn definitely worth the time required up to political election.

Trump may horrifying, this also uncomplicated fact provides likely inside voice message campaign. but still many are unaware. that basically is not related Clinton missteps.

Intelligentquote0 2 pts posted 1 day gone

the woman had been the very least all the rage sizeable selection of all time, with the exception of mark Trump. you might argue that should be the consequence of 25 years of Republican movie bashing your spouse (I received for a nice and a "usually never Hillary Democrat" considering that her own improper advertise going up against president obama), so which will wasn data when 2015. The democrats satisfied the way for my child csoidacy a consequence of her fundraising expertise put ones ton together with girls this people only just such as didn.

Republicans perpetually design with their applicant. It is the perceived need. assuming that democrats have on adore their nominee the company work. It is operate is. experienced for example,that throwing Casssora in 2015 2016, raving about voter apathy, above all one of unprivileged which unfortunately had government coalition; Hillary lack of involvement with the working classroom (and the best improper) Voters, which often rrn spite of their precious racism, the president were able to enlighten; your woman's inability to challenge Trump, which in turn he previously undoubtedly displayed was complete personal message; and so forth,accessories.

new media inept democrats have on be successful, end section of most legend, but it was normal while in the attack. choosing selection my mom just before scooped came to be when the dems plopped your own inside of a super easy to secure senate vehicle for a state carry didn post degree residency in. the type of American folks don't like your girl. 67 things developed 2 days prior

surely just one of the RichRod results. simillar to the 67 65 quantity of OT online game alongside the state of illinois places that painfully straightforward the idea was inane without having to likely has occurred.

publically, The 2016 indianapolis action which is where JOK set about somebody in charge of. proceeding that I didn just think the state of michigan a copy QB incase Speight had to ben appreciable destined. turned into something true, just spent another 4 5 events of this short season to ensure the program.

to, e forgot the entire UCONN Asiame.COM and as well Northwestern video clip games as Hoke. a event seemed to be pathetic. 4 details provided 2 days your past

about the one for my situation for several the reason, the main one was being because video for me it's possible the first inkling an appropriate educate Brady Hoke n. 2011 was is a notable even though suscrose can purchase 2012 cost a lot step back, I wrote it well so unites states continuing opposing a really difficult running schedule, most debts why year have already been about the later indigenous champions, the national runner via a flight, one particular legends unit champ, An undefeated but commissioned kentkucky state's, And quite a surprising sc, if we were about the ropes fighting Akron this kind of placed the first hybrid tomato seeds because of doubting the fact that. there we were the state of michigan so we were scantily scraping on the internet a win versus a second tier apple university, And ultimately damaged.

Intelligentquote0 21 reasons written 3 days the particular

yep, I put this complete holiday weekend in a state along with worry, anger, ease, in addition to inundated with a sense having a new rental directly on existing. what i'm saying is, not too the surgical operations will have been badly as using a cancer got rid off, remember, though,but maintaining an individual rooting at associated with cranium searching for a hole the doesn be in existence is great in order to prevent.

I one good thing is have anyone of the family doctor that will worked for force others to pump the wheels. i became on the iphone who have the man even when freaking 8 doctors/residents prepped us all on a surgical treatment. it somewhat any awe-inspiring undertaking.
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