Agir plus vite avec les populations locales

 Le Burkina Faso a commémoré le dimanche 28 mars dernier, la journée mondiale de lutte contre la tuberculose (JMT) à Koudougou. La cérémonie officielle a connu la participation de 3 ministres à savoir celui de la santé, des sports ainsi que celui du travail et de la sécurité sociale. Plusieurs représentants d’organisations internationales et inter africaines ont suivi avec intérêt la cérémonie aux côtés d’une population fortement mobilisée.

Environ 850 personnes ont pris part à la cérémonie commémorative de la JMT à Koudougou. Cette localité située à 100kms de la capitale Ouagadougou a été choisie en raison de son faible taux de détection et de guérison de la tuberculose. En 2009, sur les 1222 nouveaux cas TPM+ attendus, 187 ont été détectés avec un taux de succès de 77%. La célébration de la JMT dans cette zone a été une occasion de sensibiliser les populations locales, d’encourager les malades à poursuivre leur traitement et d’encourager les agents de santé afin qu’ils s’investissent mieux dans leur travail.

La cérémonie officielle a démarré par une course cycliste dénommée un coup de pédale contre la tuberculose. 54 coureurs ont parcouru 124kms pour montrer leur engagement en faveur de la lutte contre la tuberculose. Dans toutes les localités traversées par la course cycliste, des messages sur la tuberculose ont été diffusés. Cela constitue une innovation majeure dans les activités de cette année, a rappelé Seydou Bouda, ministre de la Santé tout en insistant sur les efforts communs à fournir pour agir plus vite contre la tuberculose. La  représentante de l’Organisation de la Santé, Djamila Cabral estime que l’effort doit être fournit non seulement par les communautés mais également par les chercheurs et les partenaires techniques et financiers. A cinq années de la date butoir pour l’atteinte des objectifs du millénaire pour le développement, il est urgent d’intensifier les recherches, de rendre plus exactes les méthodes de diagnostic de la tuberculose et de garantir l’accès au traitement pour les malades.

Au cours de la cérémonie de Koudougou, les meilleurs acteurs de 2009 en matière de lutte contre la tuberculose ont été récompensés. Il s’agit de 3 districts sanitaires (Sig noghin, Batié et Dafra) et de l’association Yaam Wekré pour leurs efforts dans la détection et la prise en charge des malades tuberculeux.

Le thème de la journée mondiale tuberculose est bien mis en exergue au Burkina Faso. L’innovation consiste à :

- Amener les agents de santé à s’investir plus dans leur travail pour la détection et le traitement plus rapide des malades.

- Amener les agents de santé à être plus vigilants aux cas contacts. Dans l’entourage d’un malade tuberculeux, il s’agit de rechercher d’autres cas de tuberculose et de sensibiliser la famille pour un soutien au malade pendant tout son traitement.

- Utiliser des techniques de diagnostic plus performantes avec les microscopes à fluorescence

- Réaliser la culture du bacille en milieu solide et liquide

- Sensibiliser et rechercher des cas de tuberculose au sein des populations à risque vivant dans les quartiers périphériques ou travaillant sur des sites d’orpaillage, de granit, les PVVIH, les populations carcérales.

- Amener les anciens malades de tuberculose à mieux s’investir dans les activités de sensibilisation.

Activités réalisées dans le cadre de la JMT au Burkina Faso

Au niveau des mass médias :

- réalisation d’une annonce radio, télé et presse écrite

- réalisation de 16 émissions radio et télé

- diffusion de bandes défilantes de message au bas de l’écran télé

Au niveau des prisons

Réalisation d’une journée d’informations sur la tuberculose dans la prison centrale de Ouagadougou avec la participation de plus de 100 prisonniers

Au niveau des régions

- Réalisation d’une tournée de théâtre forum dans les quartiers périphériques

- Réalisation d’une course cycliste « un coup de pédale contre la tuberculose »

- Célébration officielle de la JMT présidée par le ministre de la Santé

Les supports de sensibilisation réalisés

- 30 banderoles

- 1000 affiches

- 1000 pochettes

- 1000 brochures

- 1000 dépliants

- 1600 T shirts

2010 WORLD TB DAY

A CALL TO STOP TB IN KADUNA STATE

BY MR. ISAH DANSSALLAH, PRESIDENT/CEO DESTINY RESOURCE CENTER/FOCAL PERSON,  KADUNA STATE CBOs FORUM ON TB/HIV COLLABORATION

World TB Day is a worldwide call to action and a means to mobilize political and social Commitment. This once-a-year event offers an unparalleled opportunity for stakeholders to raise awareness about the burden of TB in the society. It also bring  all people involved in national tuberculosis control programmes, civil society groups engaged in fighting TB, TB-affected communities and any other groups working to stop TB engage in World TB Day activities.

 This year’s slogan -On the move against tuberculosis: Innovate to accelerate action- offers stakeholders the opportunity to showcase the successes of people in their communities.

 The year 2010 marks the halfway point for the Global Plan to Stop TB (2006-2015). We can meet these goals, but only if we see this as a multi-sectoral problem that affects our work-force, economic, and put in place innovative approaches and work together in new and different ways.

 Nigeria has the highest TB burden in Africa and is 4^th among the 22 countries with high TB burden globally. Estimated incidence for all cases is 311per 100,000 pop (460,000) and estimated incidence for smear positive (SM+) cases is 131 per 100,000 pop (195,000).

It has an estimated TB prevalence of 521/100,000 (772,000) and estimated Mortality rate of  93/100,000 (138,000). The estimated prevalence of MDR-TB among new TB cases is 1.8% and  9.4% among previously treated TB with a prevalence of HIV in adult TB patients (15-49yrs) 27%.

Lagos, Kano, and Kaduna have the highest burden in the country because of the over population.  Kaduna state ranks the third list of high-burden TB state in Nigeria.   

Kaduna State TBLCP Number of total TB cases (all forms) reported under DOTS in 2009 is 4341. This simply indicates that there is the need for DOTS expansion for more case detection.

 Some key challenges:

Due to past patterns of donor involvement, states in the north still have far fewer

TB services than those in the south.

 There is no active participation of the civil society in campaigns to increase community- and patient-driven demands for improved TB and integrated TB/HIV services.

 The State TB and Leprosy Control program have not been funded by the state for over two years due to lack of release of the counterpart funds by the state ministry of health. 

 The State TB and Leprosy Control Program solely depend on the Netherlands Leprosy Relief (NLR)  with little or no plan to sustain the program by the state government  

 I therefore urge the Donors, the NTBLCP, and regional and state officials to devote particular attention to expanding TB control activities in the northern states. In

addition, states must develop targeted services to address the higher concentrations of TB among vulnerable groups, including the urban poor, people living in remote areas, prisoners, migrant laborers, and people living with HIV.

 CSOs, NGOs, and CBOs and the health care facilities needs to integrate TB program into their activities in order to promote TB/HIV collaboration

CSOs, NGOs, and CBOs needs to embark on effective TB campaign/awareness in order to increase new TB case detection in the state and Nigeria at large.

 The general public is therefore encourage to access the available TB services in the state (any cough that lasted for 2 weeks, please go to the nearest DOTS Center).   NGOs should be empowered to sensitize and mobilize reporters and editors of print, electronic and broadcast media about the impact of TB in the society for effective reporting.

 Though, I acknowledge Kaduna state government effort on health matters but there is the need to develop plans to sustain the current TB services rendered by development partners.

 Lastly, the Kaduna state government needs to demonstrate more political will and commitment through increases funding and releases to support DOTS expansion in the state.

 Long live Kaduna state!! Long live Nigeria!!

Figure 1: Trends of Tuberculosis case notification in Adamawa State: 2004 – 2009.

Continuous DOTS expansion and strengthening over the years have not translated into improved case finding; rather, a high sputum conversion (85%0, cure rate (82%) and treatment success rate (89%) was recorded.

Figure 2: Tuberculosis treatment and diagnostic center expansion in Adamawa State: 2002 – 2009

There are 120 TB treatment centers with an average of 5 in each LGA and 34 treatment centers providing TB control services in the State (figure 2). These 2 trends imply that although expansion of services did not lead to the desired increase in case finding, improved access to TB control services contributed to better case holding.

The World TB Day (WTBD) provides an opportunity to reflect on programme performance and raise awareness on TB in Adamawa State with the hope of reaching policy makers and community members. With support from Implementing Partners (IPs) working in the area of HIV and TB in Adamawa State, activities to commemorate the 2010 WTBD were planned and implemented on the 24^th March 2010.

The Event:

The plan was developed and presented by the STBLCO to all IPs in Adamawa State at the 1^st Quarter TB/HIV Working Group Meeting which took place at the SACA office on 20^th March 2010. Contributions were solicited by the STBLCO from all IPs towards staging a successful WTBD at the meeting; the table below summarizes the contributions of our IPs for the 2010 WTBD:

The State Ministry of Health was earlier briefed by the STBLCO on the planned event, the Director Disease Control would have been part of the activities, unfortunately, he was off to Abuja on an official assignment. Early on the 24^th March, banners were fixed at strategic points in Jimeta metropolis.

The event started with a brief address by the STBLCO at the control office around 1:00pm which was followed by an initial press interview and refreshment.

The WTBD motorcade drove out of the Specialist Hospital premises. Starting with the main market street, then the bank street and finally reaching our 1^st stop at the Federal College of Education Yola.

The rally team interacted with students for 30minutes before continuing on its course.

The school authorities wanted the rally team to stage an interaction with FCE students on TB at the convocation square. However, this was not part of the plan. The STBLCO explained to the authorities that such event could be arranged specially for the school in the 1^st or 2^nd quarter of 2010.

The next stop for the rally was the State Ministry of health where the Permanent Secretary and the Deputy Permanent Secretary received the team on behalf of the Honourable Commissioner of health.

The Permanent secretary welcomed the Team. He emphasized the need to design and implement targeted interventions like awareness creation for the WTBD in order to improve case detection of TB in Adamawa State. He also reiterated Government’s commitment towards provision of counterpart funds to the State TBL programme which he said will move the programme forward in the State.

The rally continued on its course towards other densely populated areas of Jimeta metropolis and ended at the control office.

The events of the 2010 WTBD came to a close at 4:30pm.

National Capital District, PNG commemorate World TB Day in a walkathon

24 March 2010 – Abuja – Nigeria commemorated the 2010 World Stop TB Day on Tuesday 24th March 2010; this year’s theme is “innovation” and the slogan is “on move against TB, innovate to accelerate action”.  The theme was chosen against the background of the fact that tuberculosis is still taking the lives of some 4500 people every day, despite massive efforts across the world to control it.  The aim is to focus on individuals around the world who have found new ways to stop TB and can serve as an inspiration to others. The idea is to recognize people who have introduced a variety of innovations in a variety of settings. 

At a press conference to mark the occasion, the Permanent Secretary Federal Ministry of Health (PSH), Mr Linus Awute mni, said that TB is still a major public health problem in Nigeria, with the country ranking 4th among the 22 high TB burden countries which collectively bear 80% of the global burden of TB. He revealed that the number of TB cases notified in the country increased from 31,164 in 2002 to 96,000 in 2009, representing a case detection rate of 31% and treatment success rate of 82%.

Guests at the occasion include Federal Government Officials, representatives of partners (WHO, USAID and other USG partners, ILEP, CDC, ARFH, and TBCAP), the Nigeria stop TB partnership, the network of persons affected by TB, and non-governmental organizations working in TB.

According to the PSH, The TB burden is further compounded by high HIV prevalence of 4.6%; the national prevalence of HIV among TB patients is currently estimated to be 27%.  In addition, the emergence of resistant TB (MDR-TB) resulting mostly from poor management and poor adherence to TB treatment also poses major threat for TB control efforts in Nigeria. Though the burden of MDR-TB in Nigeria is estimated to be 1.9% among new cases and 9.3% among re-treatment cases, the programme is at the moment conducting a drug resistance survey to determine the actual burden of MDR-TB in Nigeria. Preliminary report of the survey has confirmed the presence of MDR TB in Nigeria.

Mr. Awute then assured the gathering that the Federal Government of Nigeria is fully committed towards reducing the TB burden in the country as demonstrated by the creation of the National Tuberculosis and Leprosy Control Programme (NTBLCP) in 1989.  By 1993, the programme had adopted the WHO recommended DOTS strategy for TB control and by 2006, the revised Stop TB strategy TB control.  NTBLCP is currently providing TB diagnostic and treatment services free of charge nationwide in about 1025 Laboratories and 3459   DOTS treatment centers. 

The WHO Country Representative, Dr Peter Eriki, represented by Dr Klint Nyamuryekunge, delivered the WHO Regional Director’s (RD) message at the occasion.  He stated that although the region represents only approximately 12% of the world’s population, it accounts for 22% of new TB cases every year making it to have the highest TB notification rate per 100 000 population.  However, only 47% of the estimated new TB cases in the population are identified and of these, only 79% complete their treatment.  In addition, about 35% of all TB patients in the region are also infected with HIV and 33 countries in the Region have reported at least one case of MDR-TB and eight of them have reported at least one case of XDR-TB.

The Regional Director, Dr Louis Gomes Sambo, then called on national authorities to mobilize additional resources for TB control from government, the private sector and other partners. This could be facilitated through the establishment of national Stop TB Partnerships.  Governments, nongovernmental organisations, community-based organisations, prison and military services, and other partners should all collaborate to ensure uninterrupted availability of quality-assured first and second line anti-TB medicines. They should also facilitate testing of all TB patients for HIV and linking of all HIV co-infected patients to HIV/AIDS care services especially for antiretroviral treatment and co-trimoxazole preventive treatment in line with WHO guidelines. All HIV care providers should facilitate screening of their patients for TB to ensure that those who are infected receive the benefit of early diagnosis and treatment.  It is also essential for all countries to establish and scale up management of drug-resistant TB as part of basic TB control programme activities.  He also stressed the importance of engaging communities and civil society in the fight against TB.

Dr Sambo observed that although there are only five years to go before the MDG target year, the region could still “make TB cease to be a public health problem” if all stakeholders will join hands in the renewed fight against TB.  “Together, let us all use greater Innovation to move against TB this year”, he concluded.

The WHO Representative in Nigeria a/i, Dr Klint Nyamuryekunge (standing) delivering a goodwill message on behalf of WHO during a press conference to mark 2010 World TB Day in Abuja, Nigeria.  Sitting next right is Mr Linus Awute, mni, Permanent Secretary, Federal Ministry of Health, Abuja, Nigeria. 

27 March 2010 – Abuja – A panel discussion in the Federal Radio Co-orporation of Nigeria (FRCN)’s famous programme Radio Link took place for an hour.  The topic was Tuberculosis control in Nigeria and 4 discussants were drawn from the National TB programme (NTP), World Health Organisation (WHO), Tuberculosis Control Assistance Programme (TBCAP) and the affected community.

30 March 2010 – Abuja – The Nigerian Television Authority (NTA) played host to a team of four TB experts in its well watched Tuesday Night Live programme.  The experts were drawn from the NTP, WHO, Family Health International (FHI) and the affected community.  Discussions were held on the progress, challenges and prospects for TB control efforts in Nigeria.

 31 March 2010 – Abuja – TB articles have been published in 3 major dailies to create awareness and provide information on the current TB control efforts in Nigeria.

26th of March, the Yomiuri, the in japan, we have translated all the materials issued by WHO into japanese and emailed to about 100 key stakeholders: Diet members, MOFA, MOF, MHLW, mass media, STBJ members, etc.
at the day, in front of the building of japan anti-tubeculosis association(JATA) in tokyo, despite of unfortunate cold rainy weather, STBJ and RJ have distributed the leaflets to people on the street(please see the attached). this time we have focused on TB for the aged in japan in addition to global TB control, so that many passers-by seemed interested in it.

26th of march, the Yomiuri, the japanese newspaper, the world nunber one in circulation of 10 million, recognized by the Guinnes book record has featured TB with mr. Naruse, 35 years of age, who is former MDR-TB patient and has come out recently and works at JATA to promote TB advocacy.
I think that a lot of concerns are sure to lead to stop TB even by oneself.
HIs message is very impressive, and we will learn his experience on the World TB Day on the article. Japanese newspaper, the world nunber one in circulation of 10 million, recognized by the Guinnes book record has featured TB with mr. Naruse, 35 years of age, who is former MDR-TB patient and has come out recently and works at JATA to promote TB advocacy.
I think that a lot of concerns are sure to lead to stop TB even by oneself.
HIs message is very impressive, and we will learn his experience on the World TB Day on the article.