Tuberculosis: The Links With Poverty (Dr. Anthony Harries)

8/7/2019 Tuberculosis: The Links With Poverty (Dr. Anthony Harries)

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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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Tuberculosis: The Links With Poverty (Dr. Anthony Harries)

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