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World: WHO Releases Report On Tuberculosis Problem

Prague, 24 March 1999 (RFE/RL) -- The U.N.'s World Health Organization says countries around the world must at least triple their efforts to find and treat tuberculosis. Without the extra measures, WHO officials say many cases of TB will soon become untreatable.

WHO officials made the warning yesterday in Washington when they released their third-annual report on global tuberculosis control. The report monitors how well so-called "high-burden" countries are able to find and treat TB using methods recommended by the WHO.

Tuberculosis is an infection that usually destroys tissue in the lungs. Without treatment, up to 60 percent of patients die. Until about a decade ago, TB was on the decline. But in 1993, the WHO said TB was increasing and declared a global emergency. It's now estimated that eight million people get tuberculosis every year.

The WHO has recommended that all countries use a treatment known as Directly Observed Short Course, or DOTS. The program involves giving patients a standard drug treatment that lasts for six months. The patients usually take the treatment at home and are monitored by visiting health care workers.

The WHO said yesterday that health care workers have made some progress in finding and treating the disease. It said 10 to 20 percent more patients have received the WHO treatment every year since it declared an emergency in 1993. But that still means that less than one-fifth of the world's TB patients are getting proper care.

Chris Dye is a specialist on epidemics who helped write the WHO report. He says governments must ensure at least 85 percent of patients receive DOTS by 2005. He says if they don't, patients risk developing a form of TB that cannot be cured with drugs.

"Of the ones that are not being found by DOTS programs, many of them will be treated, but they will be treated ineffectively and ineffective treatment leads to drug resistance. And the consequence of that is that TB control -- whilst quite cheap at the moment -- will become ever more expensive, and in some developing countries it will simply become unaffordable."

The WHO report says governments in Africa, Asia and Eastern Europe must be especially aggressive in trying to increase the number of patients who get DOTS treatment. In Africa, the number of TB cases is increasing by 10 percent a year. The increase is mostly related to the high number of HIV and AIDS patients, who are more susceptible to TB.

The number of cases in many countries in Central Asia and Eastern Europe is also growing by 10 percent a year. The WHO estimates nearly 160,000 people in Russia alone have TB. The entire area is already considered a "hot zone" for the dangerous, drug-resistant form of tuberculosis.

The growth in TB in the former Eastern bloc started in the early 1990s amid the disruptions accompanying the fall of communism. Dye says that today, many governments in the region can no longer afford TB programs. He adds that what money is spent often goes for old-style treatments, such as X-rays and surgery. Those treatments are far more expensive than new methods, which involve giving patients the drug treatment at home instead of keeping them in the hospital.

"It's probably true that more money in total could and should be spent on TB control, but what funds are being spent at the moment are being ineffectively distributed. So rather than spending a lot of money on X-ray diagnosis in one area, it would be much better to disperse that money on more effective methods of diagnosis across the country as a whole."

Studies show the WHO-recommended TB treatment is just as effective as old-style cures. And it costs only about $50 to $100 per patient. But the WHO report released today found that former communist countries, such as Russia, have done little to implement the DOTS program.

Dye says doctors often oppose the new treatments and that governments lack the will to force through changes. He adds that the longer it takes to muster the political will, the longer it will take to begin to control the world's TB epidemic

(First of two features on WHO efforts to fight tuberculosis.)