Tuberculosis: health problem and social ill

Published: 25 March 2002 0:00 CET

John Sparrow in Budapest

From Russia to Romania, from the Baltic to Bulgaria, the message of World Tuberculosis Day, March 24, was unequivocal. Tuberculosis (TB), reported Red Cross Societies, was not only a medical problem. It was also a reflection of social and economic challenges that impact on the poor, the unemployed, the homeless and other vulnerable people, as well as on under-resourced health-care systems.

The point was abundantly clear in Romania where all Red Cross branches mobilized for a public awareness campaign on prevention, diagnosis and treatment. They had reason to. Romania faces a TB crisis. In 2001, its number of chronically sick doubled, and the mortality rate reached ten deaths per 100,000. The incidence has been climbing steadily. From 12,677 reported cases in 1985, the number grew to 25,758 in 1998, 26,107 in 1999, and 27,470 in 2000, among a population of 22.5 million.

The true figure today may be considerably higher. TB here, as elsewhere, is particularly prevalent among disadvantaged communities. Red Cross health education programmes are providing them with information but a disturbing discovery has been that many infected people are not reporting the disease. Treatment is free but with high unemployment, and a low level of medical insurance, the fear persists that detection will mean a bill to pay. People in jobs, meanwhile, are afraid they will lose them if they reveal their infection.

Early detection of active cases is essential if TB is to be contained and, globally, transmission continues because many patients are never diagnosed or are diagnosed late. Red Cross awareness programmes assume ever greater importance as a consequence, and over recent years the Romanian Red Cross has reactivated a campaign it ran for five decades from the 1920s. In the light of the latest figures, it is redoubling preventive efforts and March 24 provided one more opportunity. Some 75,000 leaflets were distributed around the country as branches targeted particularly the young and communities with a high TB incidence. They also provided food, clothes and hygiene parcels to the poor and sick, and to institutions treating and caring for TB victims.

A significant growth in tuberculosis is also reported from Bulgaria, where the Red Cross again used March 24 to spread awareness messages. New TB cases per 100,000 people have grown from 25.9 in 1990 to 41 in 2000 and a preliminary 46 in 2001. They are part of the global pandemic but the Bulgarian Red Cross believes the economic crisis of the past decade has been an undoubted factor, impacting badly on health care. Moreover, it says, poverty, chronic unemployment, poor living and working conditions, and malnutrition have all helped spread the disease among those most vulnerable to it.

With the Hellenic Red Cross, the National Society has been running treatment programmes since 1998, coordinated with the Ministry of Health. Now its attention has turned to preventive efforts in high-incidence regions, raising awareness and knowledge of TB among patients, their families, and the general public. With the Ministry, it plans a nationwide information campaign distributing leaflets through the 28 Bulgarian Red Cross branches, as well as continued support of treatment.

Tuberculosis also remains one of the most worrisome health issues in Central Asia, particularly in Kazakhstan, with a rapid growth in the number of cases. Last year, the rate of increase was especially high among teenagers. Most of them got infected from contacts with sick family members and because of an insufficient knowledge about basic hygiene. In response, the Red Crescent and Red Cross of Kazakhstan has embarked on an extensive public awareness campaign, with its main focus on youngsters from 14 to 18 years old.

In Russia last month, health officials reported that new tuberculosis cases are dropping for the first time in many years. "This is related to the general stabilisation of living conditions in the country," explains Dr Perelman, head of the tuberculosis unit in the Russian Health Ministry, who adds that the greater availability of anti-tuberculosis drugs also impacted on the statistics. This is welcome news, since the number of new tuberculosis cases has more than doubled in the last ten years in the Russian Federation. Health authorities reported some 342,000 active TB cases, including about 133,000 new ones in the country in 2001. Approximately 30,000 people die from tuberculosis each year in Russia.

The last four years have shown that tuberculosis control in Russia has proved to be very successful with a coordinated and cooperative approach to tackle the problem. In Russia, international organisations, such as Médecins Sans Frontières, Merlin (UK), the Open Society Institute (Soros Foundation), Partners in Health and the UN's International Organisation for Migration, are working in collaboration with the Russian Red Cross and the International Federation.

So efforts are paying off. Where the National Societies have run programmes, the incidence of new cases is falling. The other message of March 24 would seem to be that TB can be controlled, with long-term commitment and coordination of partners.