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TUBERCULOSIS: THE LINKS WITH POVERTY Anthony D Harries The Union, Paris, France

TUBERCULOSIS: THE LINKS WITH POVERTY Anthony D Harries The Union, Paris, France. Poverty. Malnutrition. Immune deficiency. Tuberculosis. Malnutrition and low body weight. Immune deficiency and low CD4 cell count. Tuberculosis. In the TB patient: Wasting Lack of vitamins

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TUBERCULOSIS: THE LINKS WITH POVERTY Anthony D Harries The Union, Paris, France

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  1. TUBERCULOSIS:THE LINKS WITH POVERTYAnthony D HarriesThe Union, Paris, France

  2. Poverty Malnutrition Immune deficiency Tuberculosis

  3. Malnutrition and low body weight Immune deficiency and low CD4 cell count Tuberculosis

  4. 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)

  5. 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: • BMI<17 = 11% death • BMI >17 = 6.5% death • Zachariah et al, 2002

  6. BUT…… No evidence that nutritional supplementation on its own can improve TB treatment outcomes

  7. Poverty and TB… • The poor are at greater risk for TB • Poor housing, poor diet, poor education, risky behaviours • The poor face barriers to accessing care:- • Financial – user fees, diagnostic tests, transport • Geographic - distance to health services • Cultural – stigma, poor education, traditional • Health system – no choice, poor treated worse than the rich

  8. UKMalawi 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 6,700 26,000

  9. 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 (<$10/m) 45% Claessens et al, IJTLD, 2002

  10. Thyolo district, Malawi: 550,000 A patient’s journey with TB

  11. Patient Access to Health Facilities • Long distances • Lack of faith in allopathic sector • Belief in traditional healers

  12. Traditional Healers in Malawi

  13. Health care provision at District Hosptial clinics Mangochi District Hospital ART Clinic: 4,500 patients on ART Undermanned Busy, especially in central and district hospitals New disease such as TB can be overlooked

  14. Some forms of TB difficult to diagnose in RLS TB of the abdomen Disseminated TB

  15. Submitting sputum specimens for AFB This may be a long process

  16. Laboratories where TB is diagnosed are over-burdened and under staffed It may be a long time to get results

  17. Standardised TB Treatment“Short course” [6 months] New Cases: 2RHZE/ 4RH is standard first line treatment WHO recommended regimens - 2009

  18. TB Programmes like their treatment given by direct observation

  19. The main road to Chitipa District Hospital

  20. Poor urban settings – same problems

  21. Make it easier for TB suspects and TB patients • Better education about TB and how it is transmitted (air-borne disease) • Diagnostic services closer to homes • Treatment services closer to homes • Shorter treatment for Tuberculosis

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