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Nearly 70% of tuberculosis cases remain undetected
Newsdesk Nearly 70% of tuberculosis cases remain undetected In its 6th annual report on global tuberculosis control, the WHO has warned that although countries implementing DOTS (directly observed therapy short course) increased to 148 in 2000 from 127 in 1999, only 27% of the world’s tuberculosis cases were detected under this strategy. The “rate of progress in case finding between 1999 and 2000 was no faster than the average since 1994”, stated the report. Among the 22 high burden countries (HBC) which account for 80% of the world’s tuberculosis burden, India and China have, partly because of external funding, made “great strides” in tuberculosis control over the past decade; whereas Indonesia, Nigeria, Pakistan, Russia, Brazil, and
Afghanistan, all with less than 20% case-detection rates, have the “weakest” tuberculosis control measures in place. “The main obstacle is not, by and large, getting countries to agree in principle that the DOTS strategy is fundamentally the best approach. Rather it is proving difficult to scale up DOTS in the large tuberculosis endemic countries”, notes Christopher Dye of the WHO’s tuberculosis control programme. Obstacles to DOTS expansion include: non conformity of the private sector with DOTS standards (Indonesia, India), poor access to health service (Ethiopia, Mozambique), acceptance of DOTS restricted to local rather than national level (Russia), poor collaboration
between tuberculosis and HIV/AIDS services in many African countries, and war (Afghanistan). To achieve targets for global tuberculosis control by 2005 required an additional $300 million per year, WHO said. If the current trends continued, targets might only be reached by 2013, it warned (see p 374). Richard Chaisson (Johns Hopkins University, Baltimore, MD, USA) commented that patients treated under DOTS remain very much “the minority”. “It is more important to stress the numbers of patients treated under DOTS, which is disappointingly low, than to stress the widespread uptake of DOTS”, he noted. Khabir Ahmad
South Africa tests traditional medicines anxiety, reports Nigel Gericke, director of manufacturer Phyto Nova. However, although L-canavanine is found in several legumes, notably alfafa sprouts, critics have questioned the safety of long-term L-canavanine ingestion.
Nigel Gericke
The South African Medical Research Council (MRC) has launched a “clinical platform” for testing the safety and efficacy of indigenous medicinal plants, with the report of a “test case”—the first vervet monkey safety study of an indigenous plant. “In China and India, as well as in many countries in Africa, traditional methods are now being used for the treatment of HIV infection”, explains Xiaorui Zhang of WHO’s traditional medicine section. Such herbs can be used to develop affordable medicines that help alleviate the symptoms of HIV infection with fewer side effects than currently used antiretroviral therapy. But, she stresses that further research on safety and efficacy of known remedies is vital, as emphasised by WHO’s new strategy for traditional medicine. One such remedy, Sutherlandia frutescens subspecies microphylla (kankerbos) contains L-canavanine, which has antiretroviral, antimicrobial, and anticancer activity, the antidiabetic agent pinitol, and GAMMA-aminobutyric acid. Since sutherlandia has been available in supplement form, anecdotal reports suggest benefits for HIV/AIDS patients on overall well-being and function, appetite and weight, plus mood and
Sutherlandia frutescens
In April, Gilbert Matsabisa (MRC) and colleagues reported “no single indication of toxicity was found after feeding the vervet monkeys with dried sutherlandia leaf powder for three months”, even at nine times the equivalent human dose (http://www.sahealthinfo.org/). South Africa has lagged behind other nations in using indigenous plants for HIV/AIDS. Gerry Bodeker, (GIFTS of Health, Oxford University, UK) notes that Nigerian and Kenyan researchers are investigating medicinal plants for activity against HIV and
THE LANCET Infectious Diseases Vol 2 June 2002
http://infection.thelancet.com
other pathogens, while positive clinical trials in Uganda and Zimbabwe have indicated promise for such remedies in people with HIV/AIDS. Zhang points out that WHO has so far supported clinical studies in Burkina Faso, the Democratic Republic of Congo, and Zimbabwe. Relevant legislation on indigenous healthcare has been passed in Ghana and Nigeria. Within the decade that the Organisation of African Unity has dedicated to the development of traditional African medicine, greater recognition of traditional medicine seems likely, and not only in Africa. The forthcoming WHO strategy, expected at the time of going to press, is “a response to the favoured position [traditional medicine] holds in developing countries”, explains Zhang. The strategy’s objectives include increasing access especially to essential herbal medicines, promoting “therapeutically sound use” of traditional medicine by practitioners and consumers, and policy aimed at integration of traditional medicine with national health systems. In addition, WHO intends to develop information sources and guidelines to enhance safety, quality, and efficacy of traditional medicines. Kelly Morris
319
For personal use. Only reproduce with permission from The Lancet Publishing Group.
Afghanistan, all with less than 20% case-detection rates, have the “weakest” tuberculosis control measures in place. “The main obstacle is not, by and large, getting countries to agree in principle that the DOTS strategy is fundamentally the best approach. Rather it is proving difficult to scale up DOTS in the large tuberculosis endemic countries”, notes Christopher Dye of the WHO’s tuberculosis control programme. Obstacles to DOTS expansion include: non conformity of the private sector with DOTS standards (Indonesia, India), poor access to health service (Ethiopia, Mozambique), acceptance of DOTS restricted to local rather than national level (Russia), poor collaboration
between tuberculosis and HIV/AIDS services in many African countries, and war (Afghanistan). To achieve targets for global tuberculosis control by 2005 required an additional $300 million per year, WHO said. If the current trends continued, targets might only be reached by 2013, it warned (see p 374). Richard Chaisson (Johns Hopkins University, Baltimore, MD, USA) commented that patients treated under DOTS remain very much “the minority”. “It is more important to stress the numbers of patients treated under DOTS, which is disappointingly low, than to stress the widespread uptake of DOTS”, he noted. Khabir Ahmad
South Africa tests traditional medicines anxiety, reports Nigel Gericke, director of manufacturer Phyto Nova. However, although L-canavanine is found in several legumes, notably alfafa sprouts, critics have questioned the safety of long-term L-canavanine ingestion.
Nigel Gericke
The South African Medical Research Council (MRC) has launched a “clinical platform” for testing the safety and efficacy of indigenous medicinal plants, with the report of a “test case”—the first vervet monkey safety study of an indigenous plant. “In China and India, as well as in many countries in Africa, traditional methods are now being used for the treatment of HIV infection”, explains Xiaorui Zhang of WHO’s traditional medicine section. Such herbs can be used to develop affordable medicines that help alleviate the symptoms of HIV infection with fewer side effects than currently used antiretroviral therapy. But, she stresses that further research on safety and efficacy of known remedies is vital, as emphasised by WHO’s new strategy for traditional medicine. One such remedy, Sutherlandia frutescens subspecies microphylla (kankerbos) contains L-canavanine, which has antiretroviral, antimicrobial, and anticancer activity, the antidiabetic agent pinitol, and GAMMA-aminobutyric acid. Since sutherlandia has been available in supplement form, anecdotal reports suggest benefits for HIV/AIDS patients on overall well-being and function, appetite and weight, plus mood and
Sutherlandia frutescens
In April, Gilbert Matsabisa (MRC) and colleagues reported “no single indication of toxicity was found after feeding the vervet monkeys with dried sutherlandia leaf powder for three months”, even at nine times the equivalent human dose (http://www.sahealthinfo.org/). South Africa has lagged behind other nations in using indigenous plants for HIV/AIDS. Gerry Bodeker, (GIFTS of Health, Oxford University, UK) notes that Nigerian and Kenyan researchers are investigating medicinal plants for activity against HIV and
THE LANCET Infectious Diseases Vol 2 June 2002
http://infection.thelancet.com
other pathogens, while positive clinical trials in Uganda and Zimbabwe have indicated promise for such remedies in people with HIV/AIDS. Zhang points out that WHO has so far supported clinical studies in Burkina Faso, the Democratic Republic of Congo, and Zimbabwe. Relevant legislation on indigenous healthcare has been passed in Ghana and Nigeria. Within the decade that the Organisation of African Unity has dedicated to the development of traditional African medicine, greater recognition of traditional medicine seems likely, and not only in Africa. The forthcoming WHO strategy, expected at the time of going to press, is “a response to the favoured position [traditional medicine] holds in developing countries”, explains Zhang. The strategy’s objectives include increasing access especially to essential herbal medicines, promoting “therapeutically sound use” of traditional medicine by practitioners and consumers, and policy aimed at integration of traditional medicine with national health systems. In addition, WHO intends to develop information sources and guidelines to enhance safety, quality, and efficacy of traditional medicines. Kelly Morris
319
For personal use. Only reproduce with permission from The Lancet Publishing Group.