Published Date: 2005-06-13 23:50:00
Subject: PRO/EDR> Tuberculosis - Iraq (Missan)
Archive Number: 20050613.1652
TUBERCULOSIS - IRAQ (MISSAN)
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
Date: Mon 13 Jun 2005
From: Mary Marshall <email@example.com>
Source: UN Integrated Regional Information Networks, IRIN [edited]
Iraq: Increase in TB cases worrying, doctors say
Iraqi doctors say they are concerned over an increase in tuberculosis (TB)
cases in the southeastern city of Amarah, fueled by a shortage of medicine
and poor living conditions. The disease, which has been under control in
the area for more than 50 years, has been rising steadily since the
conflict in 2003.
A survey on living conditions, released by the UN and the Iraqi government
in May 2005, stressed that standards had seriously deteriorated over the
past 2 years, with poor access to clean water and adequate healthcare.
Health experts are now concerned about a rapid increase in cases over the
past 4 months. The number of cases in the city [population about 330 000 -
Mod.LL], located in Missan governorate, some 360 km south of the capital,
Baghdad, has reached 400.
"The spread of TB after more than 50 years is something worrying. The total
of 400 cases is a huge number in relation to the population of Amarah, and
the number is increasing daily," director of the chest diseases hospital in
Amarah, Dr. Hameed Jassim, said.
TB is treated through DOTS [directly observed therapy strategy, see more
below - Mod.LL], which involves a course of a variety of powerful
anti-tuberculosis drugs taken uninterrupted for 6 to 8 months. This
treatment also stops the development of multidrug-resistant strains of TB.
Some 20 years ago, the disease afflicted nearly 20 percent of Iraq's
population, but efforts by the country's Ministry of Health (MoH) and WHO
bought that figure down to 2 percent. Jassim said cases in Iraq could not
be cured through treatment alone.
"Poverty, high population, dust, unpaved streets and absence of health
awareness expands the circle of the disease," he explained. Most patients
will not admit they have the disease, especially those from rural
conservative societies, as they feel embarrassed. This is due to
misconceptions about the way in which TB is caught, relating to close
contact between men and women.
"I did not tell my family that I have TB; I told them something else, and
they believed me because they are simple people. If I tell them, they won't
speak to me. I cannot work now to support my family, and I sent my wife and
son to her parents home afraid that they will catch the disease," said a
construction worker,as he lay in his bed.
Local pharmacy owner, Dr. Hadi Hassan, said most patients in need of drugs
were from poor suburbs in the area, adding that the normal course of
treatment costs at least USD 500, which most families could not afford.
According to Hassan, the medicines most requested were rifampicin [also
referred to as rifampin - Mod.LL], ethambutol and pyrazinamide, but they
are not found easily.
WHO officials for Iraq said a special health team would be sent to the area
to supply drugs and assist in controlling the spread of the disease. But
they added that poor hygiene in many areas in the south was opening doors
for the spread of diseases previously under control during the rule of
[Good overall health and adequate living conditions without crowding are
the 2 most important historical parameters in decreasing the amount of
tuberculosis in a community. This is best shown by the decrease in
_Mycobacterium tuberculosis_ infections in the USA starting at the
beginning of the 20th century, 4 decades before the 1st anti-tuberculosis
drugs were utilized.
is a newer arrival on the anti-TB scene and utilizes directly supervised
therapy to assure that the affected individual is actually taking his/her
medications and requires the availability of medications and political and
economic commitments for effectiveness. In numerous studies in quite
difficult areas to treat tuberculosis (including refugee camps in Asia and
USA inner cities), DOTS produces a higher cure rate, lower incidence of
relapse and, should relapse occur, less development of drug resistance. All
of these results contribute directly to the overall public health. - Mod.LL]