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Joint Venture

Regional experts discuss cross-border initiatives in tackling HIV/AIDS, tuberculosis, malaria and kala-azar at a conference in Kathmandu

By AKSHAY SHARMA

A four day SAARC-WHO meeting on "Cross border initiatives in HIV, AIDS, TB, malaria and kala-azar was organized last week by the SAARC Tuberculosis Center, Kathmandu and the World Health Organization (WHO).

More than a hundred years have passed since Robert Knock identified tuberculosis in 1882. Moreover, nearly 50 years have passed since drugs for TB were developed. "Disease, information, diagnostic method, drugs have been available for a long time now, but they have not managed to control this dreadful disease," said Dr KK Jha of the National Tuberculosis Center (NTC) in Thimi, Bhaktapur.

"Discussions from eminent experts in tuberculosis, HIV/AIDS, malaria and kala-azar from Bangladesh, Bhutan, India, Nepal, WHO Headquarters (Geneva) South East Asia Regional Office New Delhi, UNICEF, UNDP and SAARC nations provides us with fruitful incentives," said Dr. D.S. Bam, director of SAARC Tuberculosis Center.

Delegates from other pioneer institutions from the SAARC region also took part in the conference. The burden of TB/HIV in the 21st century will certainly be bigger than in the 1950s if proper interventions are not applied, according to the participants.

"The objectives of the meeting were to review cross-border issues related to HIV/AIDS, TB, malaria and kala-azar in the participating countries, and to exchange experiences and lessons learned on interventions to reduce the spread of these diseases across the border and to prepare a plan of action," Dr Bam said.

"Every TB patient has the human right to get free treatment. The government and the community have given their full commitment."

Dr Jha said integration and decentralization are vital for cooperation and coordination in the battle against these diseases. "Today, in this changing demographic situation, no country can remain aloof."

Dr Shanta Bahadur Pande of the NTC said: "The private practitioners welcome the National Tuberculosis Program (NTP) to develop links between the private and the public sector. Private practitioners are willing to provide TB patients quality care and service that is easily accessible. The referral from the private sector was 10 percent in the first year and has increased to 18 percent in the second year."

Dr. B.Shrestha of the NTC observed: "The problem of drug resistance has been a challenge to the revised National Tuberculosis Program (NTP) and DOTS (Directly Observed Treatment Short Course) strategy all over the world. High prevalence of drug resistance may lead to the failure of the DOTS strategy."

The NTC and the German-Nepal TB Project carried out drug resistance surveillance all over the country in 1999.

Dr Shrestha added: "This was the first nationwide survey on TB drug resistance in Nepal. In 1996, initial sentinel site surveillance was carried out. The reports are not alarming but they cannot be ignored. NTP should try to decrease the trend of drug resistance by properly implementing the DOTS strategy. Every effort must be made toward the prevention of the drug-resistance problem."

Dr. P. Malla, director of NTP, said: "In Patan, more than 90 percent of the treatment for TB cases has been achieved. The number of TB-related cases in private nursing homes has increased and the patients are getting better quality of service. The longer opening hours of these healthcare institutions has been convenient to the patients. The experience we have learnt from Patan should encourage us to involve the private sector. The private sector is willing to provide free services to TB patients if the public sector is willing to provide recognition and guidance."

Experts emphasized that these diseases are preventable through better hygiene, food habits and proper sanitation facilities.