1. Tuberculosis epidemic in ukraine
By Olha Litvina and Mohammed Al-Dury
2016

2. What is it?
Tuberculosis is a serious infectious disease that mainly targets the lungs, but can also target other parts of the body. The bacteria that cause tuberculosis (Mycobacterium tuberculosis) are contagiously spread from person to person through little droplets released into the air when coughing and sneezing. Many strains of tuberculosis are drug- resistant and hence they pose a significant danger to inadequate medical systems.

3. Prevalence
Particularly prevalent in Africa, TB causes 1.45 million deaths around the world each year. It is estimated that a third of humanity had been infected by the TB bacteria, although not all of those progressed into tuberculosis.

4. Ukraine is particularly suspect to TB due to widespread multi-drug resistance. Kiev has the lowest incidences and Kherson has the highest in the country.

5. What causes it?
Simple droplet transmittance between two people is all that is required to pass on the disease. As mentioned before, it’s caused by the Mycobacterium tuberculosis bacteria.
Sneezing, coughing, spitting, speaking or singing can all spread infectious aerosol droplets.
Inhaling fewer than 10 bacteria is sufficient to cause infection.
Risk factors play a larger role in infection than the bacteria itself, as other diseases such as HIV have resulted in higher rates of TB.

6. Overcrowding and poverty also contribute as risk factors to the spread of TB
Poverty is a factor especially in the poorer regions of Ukraine, as there is a correlation between TB rates and the poorer provinces such as Chernivtsi and Ternopil.

7. Types of tuberculosis TB can be both latent and active
Latent TB is a situation in which one is infected, but the bacteria lay dormant in the body, causing no symptoms.
Active TB is simply the activated form which makes you ill. Latent TB can become active eventually, taking between a few weeks to years later.
Types of tuberculosis

8. Symptoms Signs and symptoms of active TB include:
Coughing that lasts three or more weeks
Coughing up blood
Chest pain, or pain with breathing or coughing
Unintentional weight loss
Fatigue
Fever
Night sweats
Chills
Loss of appetite
Symptoms

9. Tb effect on other organs Extrapulmonary TB
TB can also affect other parts of the human body, for example kidneys, brain or spine. Consequently other symptoms, different from the classic TB signs, may occur, e.g. pain in the spine or blood in the urine.
When it spreads to the bones, it is also known as "osseous tuberculosis”, a form of osteomyelitis.
Tb effect on other organs Extrapulmonary TB

10. The Mantoux (Mendel-Mantoux) test
The Mantoux (Mendel-Mantoux) test. It is one of the major tuberculin skin tests used around the world.
Vaccination. The only available vaccine as of is Bacillus Calmette-Guérin (BCG). In children it decreases the risk of getting the infection by 20% and the risk of infection turning into disease by nearly 60%. It is the most widely used vaccine worldwide, with more than 90% of all children being vaccinated. The immunity it induces decreases after about ten years.
Prevention

11. Treatment
It is important to take antibiotics for at least six to nine months. The exact drugs and length of treatment depend on your age, overall health, possible drug resistance, the form of TB (latent or active) and the infection's location in the body.
If you have latent tuberculosis, you may need to take just one type of TB drug. Active tuberculosis, particularly if it's a drug-resistant strain, will require several drugs at once. Most common medications:
Isoniazid
Rifampin (Rifadin, Rimactane)
Ethambutol (Myambutol)
Pyrazinamide
Serious side effects of TB drugs aren't common but can be dangerous when they do occur. All tuberculosis medications can be highly toxic to the liver.

12. According to WHO, if the number of infected people is higher that 0,5% of the population of the country, it is considered to be an epidemic of TB in Ukraine, regarding the statistics.
The death toll has risen in 2,9 times for the last 15 years in Ukraine.
The spread of the disease depends mainly on 2 factors:
how fast HIV is spread
high level of drug-resistant forms of the virus
High level of patients that do not complete the treatment ( %)
Situation in Ukraine

13. Problems in healthcare system
Not enough financial support of hospitals, governmental programmes, import and supplying of medication.
Poor nutrition of the patients, especially in poorer regions of the country.
Lack of medical staff.
Rising levels of infection even among the medical personnel.
Poor conditions of living in the TB health centres.
Difficulty in obtaining necessary diagnostic tests (cost, transportation, and difficulty accessing multiple sites)
Problems in healthcare system

14. Management in Ukraine
DOTS (directly observed treatment, short-course) is the internationally recommended TB control strategy. It is composed of five elements:
- political commitment to sustained TB control
- a regular supply of anti-TB drugs
- sputum smear diagnostic microscopy services
- individual patient monitoring systems
- standardized treatment regimes with direct observation of therapy (DOT).
If administered accurately, DOTS can treat TB with a success rate of nearly 99% and can help to avoid the development of MDR- TB.

15. References https://en.wikipedia.org/wiki/Tuberculosis
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