And so I wondered in which country I'd find You.
I've heard that many people in Africa have TB. How so ... after all there’s so much ultraviolet on the African continent! In Belarus, it rains and snows often, there’s very little warm weather. It is hard to grasp it - the sun and bacillus Kochii... What else do I not know?
There are different diagnostic capacities in different countries: there are areas where it’s not possible to conduct 2nd line DST (drug susceptibility test to the 2nd line TB medicines), and there are, I'm afraid, some where even DST 1 is not always available. Gradually, of course, the diagnostics capacities are improving. One can talk confidently about the levels of drug resistance (that is the focus of my attention) about those countries where quality diagnostics are available. On the other hand, in some countries in Africa, the problem of drug resistance is not so acute, because antibiotics have not been used so widely, and people simply did not have the medicines to get resistant to.
The solution is unequivocal: to sort this out.
Basis: Annex to the WHO World Tuberculosis Report 2016, which provides statistics for 2015.
Purpose: to identify the countries with the highest rate of DR TB incidence.
Course of action: I plot data from the aforementioned Appendix on a free map.
* Marked in yellow are countries where the number of registered cases of DR TB exceeds 20 persons per 100,000 = 1 case per 5,000 persons.
** Marked in red are the countries where the number of registered cases of DR TB exceeds 35 persons per 100,000 = 1 case for 2,860 persons.
Is it a lot or is it little? How often is someone hit by a car? I think that it is little, but I would not like to be in this group. What chance do I have to get infected again (please note, I do not mean a relapse). It’s high (the same as for every healthy person). Why? Many more people are infected than detected. The most common opinion is that 80% of people are infected. Ahchoo! Sorry. So, 80%, in other words, 80,000 out of 100,000. So, there is a much deeper meaning behind the numbers 20 and 35 on the map. How many unfamiliar people do you communicate with every new day? And with familiar ones? Are you sure about them? And if you got TB whom of them would you tell about your trouble? Every other person you communicate with has either been treated or infected (whether he knows about it or not). There are cars on the roads, everyone understands that it is necessary to be cautious. But who sees the infection? I do not see it, I do not know about the ways of its transmission and in most cases I do not want to know!
I dive in the metro where there is no sun and there is constant wind (remember the 13th post) BREATH, I eat in cafes and canteens where they don’t always disinfect dishes and wash fruits and vegetables well enough STOMACH, relax in a bath-house with a bunch of birch twigs MUCOUS MEMBRANES, and I don’t care a damn BLOOD.
I see a child and I think: "He certainly is not contagious," and then he is taken to see a doctor...
The map for detailed viewing can be downloaded here.
So, what do we see:
1) ** Three most affected by DR TB territories in the world:
- Former USSR countries (219 million people)
- South of Africa (60 million people)
- The Republic of Kiribati (an islands and atolls state in the western and central Pacific Ocean) (<1 million people)
2) ** The lowest success rate of DR TB treatment:
- Ukraine, Russia
- South Africa
- couldn’t find information on the Republic of Kiribati.
Note: Angola, for example, without international assistance and with a lack of domestic funding, is managing on its own to reach a good level of success rate in the DR TB treatment. Such a good job! I wonder what it depends on?
3) TB programmes financing (domestic, international, unfunded):
- Ukraine – n/a, Russia 100% domestic
- South Africa 87% domestic, 8% international, 5% unfunded.
- couldn’t find information on the Republic of Kiribati.
Note: Bangladesh, for example, receives 87% of international funding for 6 registered cases of DR TB per 100,000 persons. And they also have a good success rate. How is the country chosen for financing?
I gave the examples of Angola and Bangladesh because they have the same treatment success rate with different initial data.
The source of funding for TB drugs and the procedure for countries to purchase them has a direct impact on the quality of the medicines, especially considering the varying stringency of national medicines regulatory authorities across countries. Furthermore, there is no harmonisation even within countries in terms of the different purchase and mixed funding mechanisms for TB medicines. (MSF’s Out Of Step report 2015, p.36).
A few years ago, Russia moved to the status of donor countries, which, of course, is very unfortunate. As I already said at the 3rd month of treatment, in January 2017, I learned that in December 2016 the Global Fund stopped sponsoring Belarus. Apparently, a similar process is going on with Belarus, that’s sad. Donor is the one who gives. Would you like someone who is gravely ill to be a donor? Who let this country to become one..?
Michael Iseman, Professor of Medicine at School of Medicine of the University of Colorado in Denver, warned ten years ago that the double epidemics of AIDS and tuberculosis in Africa, China and India would lead to so many deaths that it would change the very social structure of these societies.
Isn’t it grandiose? The first time I heard about it! It's the third part of the Earth!
Imagine, the third part of your apartment has been flooded, and you are sitting on the couch: "Ah, well, okay." So why do so few people know about the GLOBAL THREAT?