PAPUA NEW GUINEA: MDR-TB an emerging "health emergency"
"Eighty percent is what Papua New Guinea presented," said Marcela Rojo, spokeswoman for the Global Fund to Fight AIDS, Tuberculosis and Malaria. "In comparison with other countries ... coverage of treatment in PNG [Papua New Guinea] is lagging behind."
With the highest tuberculosis (TB) prevalence rate in the Pacific, there are 16,000 new recorded cases a year and someone dies from TB every two hours in PNG, according to the National Department of Health.
But with unregistered cases and data that indicates multiple drug resistant tuberculosis (MDR-TB) [ http://whqlibdoc.who.int/publications/2010/9789241599191_eng.pdf ] is on the rise, fighting a troubling TB caseload has proven difficult.
MDR-TB develops when patients do not finish their medication or take inappropriate drugs; first-line more affordable treatments are then rendered ineffective.
Health officials are blaming several obstacles, including the country's disorganized, ill-equipped health system. "Unless the national government provides funding and resources to deal with this issue, we are faced with a serious health problem," head of the National TB Task Force, Paul Aia, told IRIN.
In 2007, the Global Fund granted PNG's Health Department $19,193,202, of which some $8 million has been disbursed.
When asked if the grant is enough to fight MDR-TB in an endemic country of 6.9 million people, Rojo explained that countries request funds according to their assessed need.
"Some countries have more ambitious plans or different economic, political and social contexts, or other impediments that might prevent them from presenting more ambitious proposals," she said.
For some, the obstacles to containing MDR-TB are numerous. "The job is not easy given the difficult geography of the country combined with the problems we have in the public health system and also the lack of knowledge of the disease among the people," said Clement Totavun, technical adviser with Jane Thompson Association International (JTAI), an NGO.
PNG's 80 percent coverage goal by the end of 2012 excludes 21 of the country's remote and sparsely populated districts, according to its Global Fund proposal
.This places it behind other high TB burden countries, such as Vietnam and the Philippines, which reached 100 percent of their respective populations in 2000 and 2003, using the directly observed treatment strategy (DOTS), viewed by health experts around the world as the most effective means of treating TB.
To date, the Global Fund has paid out $15 and $53 for every 100 people in Vietnam and Philippines, respectively, against $118 in PNG.
According to WHO's 2010 global report on MDR-TB, 1.9 percent of newly diagnosed TB cases are drug resistant in PNG, compared with 2.7 percent in Vietnam and 4 percent in the Philippines.
But physicians say assessing the scope of MDR-TB has been problematic for PNG.
"The magnitude of the MDR-TB problem in PNG has been estimated only through modelling by World Health Organization [WHO]. Most countries of the region have conducted Drug Resistance Surveillance to estimate this problem," said Egil Sorensen, WHO representative in PNG.
The lack of diagnostics further complicates both timely recordkeeping and disease control. PNG labs are not equipped to test MDR-TB strains. Suspected specimens are sent to Australia, a process that can take months, leaving unsuspecting MDR-TB patients at risk of infecting others.
Both Sorensen and Aia have characterized MDR-TB as an emerging "health emergency" in PNG.
Aia blames drug resistance not only on patients who do not keep to their treatment regimes, but also on drug shortages.
PNG's latest Global Fund grant performance report, dated 25 October 2010, not yet public, states that more than half of the facilities covered by the Stop TB Strategy lacked medicines for more than one week from January to March 2010, the most recently monitored period.
"The situation is so bad, even our health workers fear for their lives," Aia said.
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