Free treatment gives hope for a TB-free country

Free treatment gives hope for a TB-free country

Tantri Yuliandini, The Jakarta Post, Jakarta

One can imagine that in her youth, Nihaya was very beautiful. At
57 years of age, this petite woman looks like she is in the best
of health. Her eyes twinkle, her skin glows and laugh lines are
barely visible around her rosebud mouth.

Nihaya, however, is one of the hundreds of thousands of people
in the country who have contracted tuberculosis (TB).

According to the World Health Organization (WHO), the rate of
TB in the country in 2002 was 271 per 100,000 people, making it
number three after China and India in terms of the number of
patients.

The way in which Nihaya talks about her illness is down to
earth. She breezes over her experiences in much the same way as
one might relate their grandson's school achievements, or the
pengajian (reading the Koran) gathering at a neighbor's house.

"When I have a relapse -- it usually happens in the morning
you see -- I sweat profusely, my whole body gets all wet, and I
cough a lot -- expectorated coughing -- and my nose runs
horribly. It usually happens in the morning -- by noon it would
have gone away," Nihaya explained.

She has been attending the free tuberculosis clinic on Jl.
Baladewa 34, Tanah Tinggi, Central Jakarta, for five weeks now.
The entire treatment program runs for six months.

"They prepare for you your whole six-month treatment package
immediately after you register, did you know? And you don't have
to pay anything except for the Rp 35,000 (about US$4)
registration fee and first course of Roentgen (X-ray
examination)," Nihaya said.

The tuberculosis clinic on Jl. Baladewa -- officially called
Poliklinik Pemberantasan Penyakit Paru (Polyclinic for the
eradication of lung diseases) -- was established in 1978 by the
Indonesian Tuberculosis Association (PPTI).

Since then, the non-governmental organization has set up
similar clinics on Jl. Sultan Iskandar Muda 66A in South Jakarta
and on Jl. Dermaga I, Kompleks Nelayan in Muara Angke, North
Jakarta, as well as five other clinics in North Sumatra, Jambi,
South Sulawesi, Central Java, and Yogyakarta.

The clinic on Jl. Baladewa treated more than 14,000 patients
between 1978 and 2003, with a cure rate of more than 90 percent,
the clinic's medical supervisor Halim Danusantoso said in a
journalists forum on International Tuberculosis Day last week.

The treatment strategy endorsed by the clinics is the Directly
Observed Treatment Short-course, or DOTS, as recommended by WHO.

According to WHO, DOTS produces cure rates of up to 95 percent
in even the poorest countries, and prevents new infections, at a
cost of as little as US$10 per patient in some parts of the
world.

DOTS is comprised of five key components; political commitment
to sustained TB control activities, case detection by sputum
smear microscopy, a standardized treatment regimen for six to
eight months, the regular and uninterrupted supply of all
essential anti-TB drugs, and a standardized recording and
reporting system that allows for the assessment of treatment
results.

Once patients with infectious TB have been identified using
microscopy services, health and community workers and trained
volunteers observe patients taking the full course of the correct
dosage of anti-TB medicines.

In conforming with this, and to make use of the free
medication, every patient admitted to the Baladewa clinic has to
sign a letter of agreement. This must be acknowledged by the
local administration and a third party, who commits to ensuring
that the medication is taken correctly.

The letter, or contract, states that the patient has
voluntarily promised to take the full course of medicine. They
also agree to bring the empty plastic medicine packets with them
to the clinic once a week, when they come for more medicine.

Should a patient fail to comply with the expressed procedure,
he or she would be bound to repay the cost of the medicine that
had been taken so far.

"This very rarely happens though. We have a compliance rate of
more than 95 percent," Maria Heru Gunadi, vice president of PPTI,
said.

The need for the contract stems from the fact that it is
tempting for patients to stop taking their medication halfway
through the course. Often they feel much better a few weeks into
the treatment and mistakenly believe that they have been cured.
Other times, the reason is simply that the patient is
absent-minded or forgetful.

If the course is interrupted, or the dose of medicine is
incorrect, the TB bacteria could become drug resistant. Treating
a patient with multi-drug resistant TB (MDR-TB) is far more
difficult.

"My son's mother-in-law has agreed to ensure that I take my
medicine properly," Nihaya said.

Similar TB-treatment programs are available in 99 percent of
the 7,240 public health clinics across Indonesia, Minister of
Health Achmad Sujudi said, but this does not mean that the
disease is under control, as people still have a low awareness of
TB.

"DOTS only managed to reach 41.3 percent of all TB patients in
2003," he said, explaining that with the "more aggressive"
dissemination of information the government expected the number
to increase by 70 percent by 2005.

As for Nihaya, she did not always have such confidence in
doctors and used to go to a dukun (shaman) for treatment.

"It didn't always made sense of course. I mean, what does
rubbing a lemon up and down your arm has to do with curing chest
pain, I ask you?" Nihaya said.

But after a variety of traditional treatments failed to bring
about results, Nihaya decided to give the clinic a go.

"I don't really mind, you know, whether I get better or not,
that's up to God, but at least I am doing my part in trying to
get better," she said cheerfully.

2. CIRCUM -- 1 x 35

Circumcision may block HIV infection

LONDON: Circumcised men are less likely to be infected with the
virus that causes AIDS because of biological reasons and not less
risky behavior, scientists said on Friday.

Studies have shown that men whose foreskin has been removed
are six to eight times less likely to become HIV positive but
there has been some debate about the reason for the lower
infection rate.

Researchers at Johns Hopkins University Medical School in
Baltimore, Maryland, found that circumcision had a protective
effect against HIV, but not against other sexually transmitted
infections (STIs) such as syphilis or gonorrhea.

"The specificity of this relation suggests a biological rather
than behavioral explanation for the protective effect of male
circumcision against HIV," Dr. Robert Bollinger said in a report
in The Lancet medical journal.

Although male circumcision is common in the United States, the
practice varies throughout the world and is influenced by
cultural and religious attitudes.

Bollinger and his team studied men in India, where
circumcision is not common, between 1993 and 2000. All of the
2,298 men were attending one of three sexually transmitted
disease clinics and were HIV negative at the start of the study.
Their HIV status and risk behavior were assessed regularly.

Because circumcision did not prevent the men from infection
with other STIs, Bollinger believes the study supports the
hypothesis that protection is due to the removal of the foreskin,
which contains cells that have HIV receptors which scientists
suspect are the primary entry point for the virus into the penis.

"Our results suggest that the foreskin has an important role
in the biology of sexual transmission of HIV," he said.

Some researchers have recommended male circumcision as a means
to prevent the spread of HIV. Bollinger and his team called for
clinical trials, where culturally acceptable, to assess the
safety and effectiveness of male circumcision as a toll against
AIDS.

They also stressed the need for new compounds to block the
entry of the virus into the cell. -- Reuters

3. CHILD -- 1 x 35

Dairy foods reduce risk of obesity

Daniel Q. Haney
Associated Press
San Fransisco

Youngsters who skimp on milk and other dairy food to avoid
calories actually appear to substantially increase their risk of
becoming overweight, a study found.

Several reports in recent years have shown health benefits of
dairy products, despite their fat content. The latest research
shows an unusually striking effect on weight as children go
through their teens.

Pediatricians in the United States say too much weight is now
the most common medical condition of childhood. The problem has
doubled over the past two decades, and about 15 percent are now
considered overweight or obese.

While the overall cause is too much food and too little
exercise, many studies are attempting to tease apart the precise
changes in habits that are driving this health hazard. Several
were reported at a meeting in San Francisco of the American Heart
Association.

Lynn Moore, an epidemiologist at Boston University School of
Medicine, found that just two servings of dairy food a day are
linked to a substantial reduction in adolescent fatness.

Childhood dairy intake has been failing for the last 20 years,
in part as youngsters' preferences have switched from milk to
soft drinks. During this time, soda consumption has risen by 300
percent.

Another factor, though, has been fat phobia. Youngsters
"consume less and less as they get older," Moore said.
"Adolescent girls in particular are concerned about eating dairy
because they think it will make them fat."

However, her research, based on the Framingham Children's
Study, found just the opposite is true. The analysis was financed
largely by the National Health, Lung and Blood Institute with
additional funding from the National Dairy Council.

Several studies -- including Moore's -- have shown that
children and adults who consume adequate amounts of dairy foods
have lower blood pressure. Some researchers have put adults on
diets with increased dairy and found, to their surprise, that
they also seem to lose weight.

In the latest study, the researchers did frequent dietary
surveys on 106 families with children and followed them an
average of 12 years. They judged body fat by measuring the skin
thickness on four parts of their bodies.

They found that those who consumed less than two servings a
day averaged about an extra inch (2.5 centimeters) of fat in a
fold of skin, a surprisingly large amount. The children's average
skin fold thickness was 75 millimeters, while those who ate
little dairy were 25 millimeters greater.

Dr. Stephen Daniels, associate chairman of the heart center at
Cincinnati Children's Hospital, noted that the benefit was seen
with a relatively modest amount of dairy food, and overdoing it
could mean large amounts of extra fat calories.

"You shouldn't take home from this that you need to eat as
much dairy as you can, but it should be part of an overall
healthy diet," he said.

He also noted that no study has yet shown that adding milk to
youngsters' diet actually helps them control weight. He said
those who get regular dairy foods may weight less because they
eat more home-cooked meals or have breakfast each morning.

Among other findings of Moore's study:
* Youngsters who ate moderate amounts of fat -- between 30
percent and 35 percent of total calories -- weighed less than
those who ate either more or less.
* Increased consumption of fruits and vegetables was also
associated with lower weight.
* Contrary to one popular theory, the glycemic index of
children's diet -- the amount of fast-burning carbohydrates --
had no bearing on their eventual weight gain.

Just how dairy food might moderate weight gain is a mystery.
Moore speculated that calcium or some other nutrient in milk
might help influence the way the body stores energy in fat cells.
Or perhaps dairy foods simply make children feel less hungry.

Moore noted some parents who cannot eat dairy foods also
withhold milk from their children, although lactose intolerance
is usually not a problem among the young.

Another study at the conference, presented by Dr. Nicolas
Stettler of Children's Hospital of Philadelphia, suggests the
important of early infancy weight gain. He followed 1,850 pairs
of full-term siblings to help sort out the effects of household
and genetic factors.

Six percent of those who gained between 3.6 and 4.5 kilograms
during their first four months of life were obese by the time
they reached age six, compared with 3 percent of those who put on
between 2.7 and 3.6 kilograms during this critical early period.

He said the work suggests that breast-feeding, which leads to
less quick weight gain than formula feeding, may help prevent
later obesity.

4. CANCER -- 1 x 52

U.S. FDA finds cancer-risk acrylamides in more food

Maggie Fox
Reuters
Washington, D.C.

Acrylamide, a cancer-causing substance that caused scares when it
was found in fried potatoes and other popular foods, is also
found in olives, prune juice and teething biscuits, U.S.
regulators said on Thursday.

The U.S. Food and Drug Administration released figures on a
new batch of food it tested and confirmed earlier findings that
suggest cooked and especially fried snacks contain the highest
levels -- potato chips (crisps), pretzels and popcorn.

To their relief, officials found no acrylamides in infant
formula but said they would continue looking as it is a sole
source of food for so many babies.

Scientists stress that they have no idea what any of this
means, yet, for human health.

Acrylamide is naturally formed in some starchy foods when they
are fried, baked, or roasted at high temperatures. No one
suspected it was so pervasive in food until Swedish scientists
announced they had found it in 2002.

"To date, acrylamide is known to cause cancer and reproductive
problems in animals at high doses and is a neurotoxin in humans
at high doses," the FDA said in a statement.

"Although initial reports of acrylamide's presence in some
foods raised concerns because of possible links with increased
risk of cancer in some laboratory animals, it was largely unknown
how pervasive it was in the food supply, and its true public
health significance for humans," the FDA added.

"Based on the current understanding of the science, FDA
continues to advise consumers to eat a balanced diet, choosing a
variety of foods that are low in trans-and saturated fat and rich
in high fiber grains, fruits and vegetables."

Trans-fats are created when fat is processed and clog the
arteries like cholesterol does.

To find out how much acrylamide people might be eating, the
FDA has been testing popular food products. For its latest sample
the FDA bought 750 different foods from bread to pancake syrup.

It found no acrylamide in the processed cheeses, milk and ice
cream tested. Relatively high levels were found in arrowroot
cookies -- commonly given to small children -- teething biscuits,
sweet potatoes and lower levels in some prepared meals such as
turkey and vegetable dinners.

Other childhood favorites such as peanut butter and chocolate
chip cookies were also sources.

Home-cooked meats seemed acrylamide-free but fried chicken and
fast-food chicken nuggets contained the compounds.

Fresh fruits and vegetables seemed clear but bottled prune
juice and black olives had relatively high levels of acrylamides.
The FDA says it plans more studies on just how toxic acrylamides
may be.

In June a team at the City of Hope National Medical Center in
Duarte, California, found that acrylamides can mutate DNA.
Experts say the best way to find out if acrylamide causes cancer
in people is to do epidemiological studies -- studies of
populations to see if people who eat more foods containing
acrylamides have higher rates of cancer.

One such study, published by U.S. and Swedish researchers in
January 2003, found no link between acrylamide consumption and
the risk of bladder or kidney cancer.

But a consumer group, the Center for Science in the Public
Interest, is lobbying for limits on acrylamide in food.
Rhona Applebaum, Executive Vice President of the National Food
Processors Association, argued this would not be necessary.

"FDA's research on acrylamide levels in various foods is
neither a warning to consumers nor a finding of risk associated
with any particular foods or individual brands," she said in a
statement.

More FDA data can be found on the Internet at
http://www.cfsan.fda.gov/~lrd/pestadd.html#acrylamide.

REUTERS

GetRTR 3.00 -- MAR 26, 2004 02:44:58