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Regional Director's message (Arabic)
Message from
DR HUSSEIN A. GEZAIRY
REGIONAL DIRECTOR
WHO EASTERN MEDITERRANEAN REGION
on the occasion of
WORLD TUBERCULOSIS DAY
24 March 2004
In
the Name of God, the Compassionate, the Merciful
Dear Colleagues and Friends,
In 1993, the World Health Organization declared the
worldwide tuberculosis epidemic to be a global
emergency and since 1996 has propagated a new
strategy, called DOTS, to combat the epidemic
rapidly and in the most cost-effective way.
Countries in the Eastern Mediterranean Region led by
the ministries of health and supported by national
and international partners, have succeeded
remarkably in the implementation of DOTS. By the end
of 2003, 18 countries in the Region had introduced
the DOTS strategy throughout the health services of
their ministries of health, thereby achieving DOTS
ALL OVER. The treatment success rate in DOTS areas
is, on average, 81%, and the global target of 85%
has almost been achieved. In our Region, the DOTS
strategy has already saved the precious lives of at
least 350 000 people, and benefited at least 1.5
million family members during the period from 1997
to 2001. ‘Every breath counts’ is the theme of this
year’s World Tuberculosis Day, and the combined
efforts of the national tuberculosis programmes in
our Region have proved dramatically how an effective
treatment strategy can make hundreds of thousands of
patients breathe normally again and return to
productive lives.
But our past success should not lead us to
complacency. In addition to achieving an 85% cure
rate among treated cases, all WHO Member States are
committed to detecting at least 70% of all
tuberculosis cases occurring in the general
population. Despite expanding coverage of DOTS
activities and the achievement of impressive
treatment success rates, the DOTS case detection
rate in the Region has remained comparatively low at
28% in 2003. However, we are now seeing encouraging
signs that indicate a more rapid increase in case
detection levels in the near future. During recent
years, slow expansion of DOTS coverage in two
countries with a high burden of tuberculosis,
Afghanistan and Pakistan, has been the main reason
for the low DOTS case detection rate in the Region.
In both countries, continuing technical support and
increasing financial assistance have laid the
groundwork for a faster expansion of the DOTS
strategy. Most recent reports from Pakistan indicate
that the country will achieve full DOTS coverage by
the end of 2004, which will add substantially to the
regional case detection level.
Further increasing case detection in countries that
have already achieved full coverage is our second
priority. The strategic options were discussed
extensively during recent intercountry meetings of
the national managers of tuberculosis control
programmes and of the Strategic and Technical
Advisory Group for Tuberculosis Control in the
Region (STAG). During 2003, we took important steps
towards putting the recommendations resulting from
the various meetings into action.
There are two major directions for action with
regard to improving case notification. One is to
improve the quality of DOTS activities. This implies
improvement of the laboratory network and its
activities, and improvement of surveillance
activities for tuberculosis control. During 2003,
the mycobacteriology laboratory services in several
countries of the Region were reviewed with regard to
standardization of work, quality and access, and
country-specific plans and guidelines for
strengthening these services were developed. Through
the EMRO quarterly ‘DOTS Fax’, we now have a
surveillance system that will ensure the collection,
analysis and feedback of accurate, complete and
timely information on case detection and treatment
outcome for all countries in the region. Some
countries have also implemented innovative
approaches such as nominal case reporting and
reporting of cases by nationality.
The second strategy to increase case detection is to
widen the comprehensiveness of DOTS activities by
involving a variety of health care providers in DOTS
activities. At present, DOTS is in place throughout
the services of the ministries of health in many
countries. However, other health care providers,
such as ministries of higher education, interior and
defence and the social insurance and private health
sectors, are not yet fully involved in DOTS
activities. Depending on the specific situation in
the various countries of the Region, the number of
tuberculosis patients attending these providers can
be very important, and their inclusion in a
comprehensive DOTS programme can increase the
reported case detection levels substantially. EMRO
has assisted nine countries in the Region in the
preparation of proposals for funding of a variety of
activities to explore methods for collaboration
between various health care providers. Four
countries have already received funding for these
important activities. The detailed reports from
countries with various pilot projects will serve as
a basis for developing a comprehensive regional
strategy.
The reported case detection rates are based on
estimates of incidence which have been made for each
country in the Region by using epidemiological
modelling and all available epidemiological
information. The estimated incidences are generally
reliable, but in some countries the validity of
estimates has been doubted because case detection
rates have remained low while there are good DOTS
activities and coverage. For some countries with
full DOTS coverage of high quality, EMRO has started
a review exercise.
Another important area is operational research. The
Regional Office has promoted operational research
activities in order to address obstacles to DOTS
expansion and strengthen the implementation of
tuberculosis services. This has been done primarily
through the WHO/TDR/RBM Small Grants Scheme for
communicable disease control at the Regional Office.
In the past three years, 25 operational research
projects on tuberculosis control have been funded
through the Scheme. It is important to continue and
further strengthen the use of operational research
to address the issues relating to low case detection
rates.
An important component of tuberculosis research in
the Region will be surveillance of the level of
multidrug-resistant tuberculosis. Care for patients
suffering from multidrug-resistant tuberculosis is
extremely difficult and costly. The best way to
prevent multidrug-resistance is to ensure
appropriate care for tuberculosis patients through
DOTS activities, and regular information on the
level of drug resistance is thus an important
monitoring tool to assess the quality of DOTS
implementation. The countries of the Gulf
Cooperation Council have completed national
anti-tuberculosis drug resistance surveys with a
view to establishing a surveillance system for this
purpose, especially in Oman. Egypt has completed the
survey, however, Lebanon is still in the phase of
analysing the collected data. Other countries such
as Jordan, Syrian Arab Republic and Yemen are in the
process of implementing the survey and Sudan is
planning to conduct the multi-drug resistance
survey.
Dear Colleagues,
Tuberculosis has long been considered incurable and
associated with social stigma. Today, the situation
is different. We have an effective public health
intervention, namely DOTS, that can cure
tuberculosis patients. Public support for
tuberculosis control has improved dramatically.
Various new funding sources have opened up. The lack
of funds can no longer be cited as a reason for poor
programme performance. Our challenge now is to make
the most effective use of the available means. All
WHO Member States have committed themselves to the
global targets for tuberculosis control by 2005. A
window of opportunity has now opened and our task
has been summarized in the theme for this year’s
global Stop TB Partnership forum: keeping the
pledge.
Thank you.
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