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TUBERCULOSIS:
THE LINKS WITH POVERTY
Anthony D Harries
The Union, Paris, France
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Poverty
MalnutritionImmune deficiency
Tuberculosis
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Malnutrition and low body weight
Immune deficiency and low CD4 cell count
Tuberculosis
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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)
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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:
BMI17 = 6.5% death
Zachariah et al, 2002
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BUT
No evidence that nutritional
supplementation on its own can improve
TB treatment outcomes
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Poverty andTB
The poor are at greater risk forTB
Poor housing, poor diet, poor education, risky behaviours
The poor face barriers to accessing care:-
Financial user fees, diagnostic tests, transport
G
eograph
ic - distance to health services Cultural stigma, poor education, traditional
Health system no choice, poor treated worse than the rich
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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 8,500 26,000
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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 (
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Thyolo district, Malawi: 550,000
A patients journey with TB
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Patient Access to Health Facilities
Long distances
Lack of faith in allopathic sector
Belief in traditional healers
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Traditional Healers in Malawi
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Health care provision at District Hospital clinics
Undermanned
Busy, especiallyin central anddistrict hospitals
New diseasesuch as TB canbe overlooked
Mangochi District Hospital ART Clinic: 4,500 patients on ART
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TB of the abdomen
Some forms of TB difficult to diagnose in RLS
Disseminated TB
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Submitting sputum
specimens for AFB
This may be a long
process
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Laboratories
where TB is
diagnosed areover-burdened and
under staffed
It may be a long
time to get results
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Z-N stain: AFB on the slide = smear-positive PTB
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Standardised TB Treatment
Short course [6 months]
New Cases:
2RHZE/ 4RH is standard first line treatment
WHOrecommended regimens - 2009
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TB Programmes like their treatment given by direct observation
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The main road to Chitipa District Hospital
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Over-crowded hospitals may be a risk for contracting TB
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Three women to a hospital bed!
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Make it easier for TB suspects and
TB patients
Better education about TB and how it is
transmitted (air-borne disease)
Diagnostic services easier and closer to homes
Treatment services closer to homes
Shorter treatment forTuberculosis
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