Meet Angela Day – GHO Program Manager

March 10, 2020 Kayti Baur Leave a Comment

By: Kayti Baur, MSc Candidate in Community Health and Epidemiology

The Global Health Office has a new team member – Angela Day! Angela is taking over as our Program Manager for our Education Programs and will be working to strengthen initiatives around global health education.

Angela has a breadth of knowledge and expertise in global and environmental health. Having completed her Masters in International Development here at Dalhousie, she is currently a PhD Candidate in the University of Toronto’s Department of Geography, where she specializes in environment and health. Her research has a distinct focus on health equity, and this is a lens Angela is able to bring from her academic work.

This is not Angela’s first time working in the Global Health Office – several years ago she worked on the first iteration of our online pre-departure program before leaving Halifax for her studies at the University of Toronto. While studying in Toronto she also worked with Toronto’s Centre for Addiction and Mental Health and since being back in Halifax, has been a part-time faculty member at Saint Mary’s University.

Angela sees her role at the GHO as bringing a strong theoretical lens and interdisciplinary pedagogical approach to our education programs. Our education programs currently include a number of initiatives, such as international electives and placements for students across the Faculties of Medicine and Health, and online learning. Angela manages the current programs and aims to increase our offerings and supports for trainings, to round out our educational offerings in this area.

Angela says some of her goals here are to convene an active advisory committee for Global Health Education to strengthen education programs and international partnerships, as well as updating online education opportunities and pre departure trainings. She is excited about the diversity of activities that happen through the GHO since her previous tenure here, and is interested in learning more about our PLANS and indigenous health initiatives under the framework of global health education. Finally, Angela is excited about working with students and exploring innovative ways of teaching and learning – both in person and online – to address global health inequities.

Welcome back Angela!

Welcome our new PLANS Manager, Sarah Upshaw!

November 4, 2019 Kayti Baur Leave a Comment

By: Kayti Baur, MSc Candidate in Community Health and Epidemiology

The Global Health Office (GHO) in happy to introduce Sarah Upshaw as the new Program Manager for the Promoting Leadership in health for African Nova Scotians (PLANS) Program! Sarah brings a robust skill set to the position, having worked as a mental health nurse for many before moving on to Recreation Therapy here at Dalhousie, and finally her Master of Counseling at Acadia University. At Acadia, Sarah was part of an Africentric cohort aimed at increasing the number of African Nova Scotians in the counseling field. She went on to work in public health as a Youth Health Centre Coordinator before coming to join us here at the GHO. Having such a diverse background of both study and work, Sarah became keenly aware of the lack of representation of diversity within health professions, and could clearly see the impact on the populations that were being under served.

Sarah is passionate about the PLANS goals of helping create interest and guide youth through the process of making the transition to post-secondary education and eventually attending school in any medical field. The most common ways this is done is through youth summer camps, mentorship and support opportunities, and financial help through bursaries for entrance exams and conference attendance. Sarah has a personal interest in finding ways to better reach youth living outside HRM, especially in rural areas, to better introduce them to what the PLANS program can offer.

Sarah currently works out of the Global Health Office all week, as well as providing drop-in based mentorship out of the Black Student Advisory Center on Thursdays from 9am-noon. One of Sarah’s goals for the upcoming year is to expand this drop-in time in a virtual way, hoping to make it easier for youth and young adults to contact her from across the province.

Welcome Sarah!

PLANS seeks to increase representation of African Nova Scotians in the health professions through recruitment and retention, community collaborations and partnerships to improve health outcomes within the African Nova Scotian community. PLANS offers programming, resources, and attends community and school events to provide health career support and preparation. Learn more here!

Global Health: Three Issues to Watch During Summer 2016

April 28, 2016 Maria Wilson Leave a Comment

By: Maria Wilson

Global Health Office Outreach Assistant

Another academic year is coming to an end. Thousands of Dalhousie University students are heading home for the summer months, but that doesn’t mean the global health learning has to end! We hope you continue your interest in global health, and to make things easier, we have compiled a list of three global health issues that we think will be “hot topics” during the summer heat. Look out for these issues in the media, in your travels, and even in your own back yard.

Zika virus

Zika virus has dominated global health news in 2016, and its coverage in the media will only grow with the Rio Olympics taking place in the country at the center of the outbreak – Brazil. This event, to be held in August 2016, will draw hundreds of thousands of visitors from around the world – from athletes, to coaches, to spectators. Although mosquito control efforts in Brazil have been scaled up enormously in recent months, the risk of infection still exists [1]. Whether, and to what extent, Zika virus will spread to other countries through infected travelers remains to be seen.

Eradicating polio

Poliomyelitis, often referred to as polio, is a distant memory in most of the world. Since 1988, when the Global Polio Eradication Initiative was formed, polio case numbers have decreased by more than 99%. A cost-effective, oral polio vaccine (OPV) exists, and the Global Polio Eradication Initiative is on a mission to ensure that every child, worldwide, is immunized. There are currently only two countries where polio transmission has not been stopped: Afghanistan and Pakistan. With only 98 cases reported in 2015, eradicating polio in the near future is a very real possibility. Expect eradication efforts to go into overdrive this summer, in what will hopefully be the final push to make this disease history [2].

Mental health

Global health has its origins in targeting infectious disease threats, such as TB, HIV and malaria. However, the field of global health has grown to encompass so much more: from health systems, to non-communicable diseases. Expect mental health to receive increased attention in the months, and years, to come. One in four people in the world will be affected by a mental or neurological disorder during their lifetime, and 450 million people are currently suffering from such conditions [3]. The United Nations has recognized the importance of mental health by including it in the new set of 2030 Sustainable Development Goals (SDGs) [4]. The World Health Organization and the World Bank presented to ministers of finance and development agencies on the expected economic, health and social returns from investing in mental health services in Washington DC earlier this month [5]. Important discussions are happening on this topic, let’s hope that policy action begins to take shape this summer.

The Health Association of African Canadians – Student Organization (HAAC-SO)

April 27, 2016 Maria Wilson Leave a Comment

Founders of HAAC-SO, from left to right: Akila Whiley, Michelle Patrick, Leah Jones.

The Health Association of African Canadians – Student Organization (HAAC-SO) was formed by Michelle Patrick, Akila Whiley and Leah Jones in the summer of 2015. Patrick is the Promoting Leadership in Health for African Nova Scotians (PLANS) coordinator at Dalhousie, while Whiley and Jones are both students at Dalhousie Medical School. Throughout the 2015-2016 academic year, this group has been involved in raising awareness of African Canadian health issues. We recently interviewed Jones and Whiley to learn more about HAAC-SO.

Who are the members of HAAC-SO exec?

Kristine Yarney – Secretary (Pharmacy)

Celeste Williams – Faculty of Dentistry Rep (Dentistry)

Cinera States – Faculty of Medicine Rep (Medicine)

Tiffany Richards – Member at Large (Nutrition)

Korede Akindoju – Faculty of Health Professions Rep (Physiotherapy)

Leah Jones – Co-Chair (Medicine)

Akila Whiley – Co-Chair (Medicine)

Michelle Patrick – Liaison to Health Association of African Canadians (Promoting Leadership in Health for African Nova Scotians)

What are the goals of HAAC-SO?

The Health Association of African Canadians – Student Organization (HAAC-SO) is a sub group of the Health Association of African Canadians (HAAC), which addresses African Canadian health issues and the systemic inequities affecting health. The goal of the student society is to bring students together from Dalhousie University, and beyond, to create a community of learning centered on Black health issues, career development and community engagement.

What events has HAAC-SO been involved with during the 2015-2016 academic year?

Since the start of the school year, HAAC-SO has been involved in a variety of events of awareness events, both at Dalhousie University and in the community. Some of these are listed below:

September 2015 – HAAC-SO Kickoff Social, Dalhousie Society and Volunteer Expo (recruiting new members)

October 2015 – Living Library (contributed a human “book” to educate attendees on ANS Health)

November 2015 – Pathways to Education (participated in a Health Education and Nutrition workshop with local youth)

January 2016 – Poverty Inc. screening and discussion at Dalhousie Medical School

February 2016 – Elephant in the Room speaker series, Talk About Health

March 2016 – Screening of Black Mother Daughter at Dalhousie Medical school featuring spoken word from Verena Rizg and Monique Thomas

April 2016 – End of year potluck

In your experiences with HAAC-SO, how have partnerships helped you to achieve your goals?

Throughout the year we have made many partnerships; from the Global Health Office, Human Rights Equity and Harassment Prevention Office and many local activists. This has made it possible to host successful events, by event promotion through their networks and financial support. We are thrilled to have had the opportunity to form these valuable partnerships as we are a new organization just getting off the ground!

Over the course of one year, HAAC-SO has managed to make a significant impact on Dalhousie campus. The Global Health Office can’t wait to see what this hard-working group has planned for next year!

From IMU to Dal, and Beyond: An Interview with Randy Aung

April 19, 2016 Maria Wilson 1 Comment

Dr. Randy Aung, second year MSc. Community Health & Epidemiology student at Dalhousie University.

Dr. Randy Aung, originally from Yangon in Myanmar, is a second year student in the MSc. Community Health and Epidemiology program at Dalhousie University. He is also a member of the Dalhousie Medical School Class of 2014, and began his medical education at the International Medical University (IMU) in Malaysia. During his time as a student at Dalhousie, Randy participated in the Global Health Office Link Program, and acted as an intern at the World Health Organization (WHO). We recently sat down with Randy to learn more about his Dalhousie experience.

What did your internship at WHO this past summer entail, and how did you discover this opportunity?

I was talking to Shawna O’Hearn (the director of the Global Health Office) and she mentioned that there is an opportunity each year for a few Dalhousie students to undertake an internship with WHO. I was interested in building my resume, and she connected me with the organizers. It was an unpaid internship, and although Geneva can be expensive, I think the experience was well worth it. You get to meet so many people from different countries, and also travel on the weekends.

I worked on two main projects with the SAGE (Strategic Advisory Group of Experts) secretariat at the Department of Immunization, Vaccines and Biologicals. The first project involved working with the Wikipedia Medical Director to incorporate all the WHO vaccine recommendations into their respective Wikipedia pages. The other project involved revising the 2015 guideline document for WHO vaccine position papers. For each vaccine-preventable disease, there is a ~30 page position paper where WHO recommendations are published. If a working group needs to prepare a position paper, they have to refer to the guidelines. The whole internship lasted for two and a half months.

Randy and the other 2015 WHO interns in Geneva.

How would you describe your experience at Dalhousie and in Halifax?

Halifax is a cool city. Before I moved, I had only lived in big cities like Singapore and Kuala Lumpur. When I was Googling it, Halifax seemed to be pretty small…but when I arrived here, I found that there are so many things to do. I really love the snow in the winter, as ridiculous as it may sound! Before I moved I had never seen snow.

The people here are really friendly, especially at Dal. When I was in medical school, everyone was very willing to help and reach out so you can succeed in your career and academic goals. For medical school, Halifax was a big change from Malaysia where I did the first part of my medical school. Malaysia has a completely different healthcare system compared to Canada. During my first clinical rotation, it took a while to get used to these changes. Once I got into my second rotation though, I was more familiar with how things worked in the hospital. I decided to do a Master’s in Community Health & Epidemiology (CH&E) because I didn’t have any undergraduate degree before medical school and I had no previous research experience. Evidence-based medicine is very important. Research studies come out so fast, and there are so many of them. You have to be able to critically appraise which studies are of good quality, and which ones are relevant to the patients you are seeing. CH&E really helped me out with that, and taught me how to appreciate good research.

What are your next steps, now that you are graduating from your Master’s?

I’m moving to New York. I’ll be doing my residency at Bronx Lebanon Hospital Center, which is affiliated with Albert Einstein College of Medicine. My residency in general pediatrics will last 3 years. I haven’t made up my mind on which sub-specialty I want to go into. I may end up staying with general pediatrics, but I am considering pediatric hematology/oncology or pediatric infectious diseases for my fellowship.

What type of research are you conducting for your CH&E Master’s thesis?

I’m working with Dr. Joanne Langley at the Canadian Center for Vaccinology. We are conducting a retrospective cohort study, looking at the incidence and clinical burden of lower respiratory tract infections in immunocompromised children. This involves a retrospective chart review.

Why are you interested in pediatrics?

First of all, I love kids and I love working with kids. You get to work and play at the same time, which is a great career! I find that kids are very resilient, and they really tend to improve after seeing doctors. This is different from some other specialties. Take older adults who present at an Emergency Department with heart failure or COPD. They get treated, but it can often be a cycle [in older patients], where it is difficult to see improvement. But for kids, they often get better, and that’s one of the main things that I love about pediatrics. You can make a very visible difference.

Could you tell us a bit about the Link program, and how it helped you to transition into your clerkship?

The Link program lasts about 3 months (15 weeks) and is designed by the Global Health Office for IMU students. We study for two and half years in Malaysia, then we transfer for third and fourth year at Dalhousie Medical School. The curriculum at IMU versus Dal are a bit different. There are some aspects that are not covered in Malaysia, such as psychiatry and pediatrics. We also didn’t have a lot of clinical experience in our first two years at IMU, whereas at Dalhousie during these years they have clinical experience weekly. The Link program is basically a transition period, where topics like psychiatry and pediatrics are covered, and we get to experience a four-week hospital rotation. We shadow doctors, like Dalhousie students do in the first two years of their medical education. It was a good transition, I couldn’t imagine myself going straight into third year without the Link program. I wouldn’t know what to do! The program also included an introduction to the Canadian healthcare system.

Do you have any advice for incoming IMU students?

One important thing to note is that there is only one province where you can do your residency in Canada after this program – Newfoundland. I would advise IMU students to take the United States Medical Licensing Examination (USMLE) before coming to Dalhousie if you’re interested in doing residency in the US. Clerkship can be busy, and you might not have as much time to study for, and take that exam during this time.

Note: Randy took a break between graduating from medical school and residency, and wrote the exam while studying for his Master’s degree.

Try to be outgoing, and enjoy what Halifax has to offer. The university culture is a bit different. In Malaysia, you don’t usually ask questions when you are face to face with your staff physicians. In Halifax, you are encouraged to talk and ask questions. Even if you don’t know all the answers, don’t be afraid to try and put yourself out there. It will help you grow and learn.

To learn more about the IMU partnership, please watch the Faculty of Medicine’s latest Youtube video (which features Randy at 3:27)!

Randy and friends during summer travels in Interlaken.

What is Global Health? Towards an Updated, Universal Definition

April 5, 2016 Maria Wilson Leave a Comment

By: Maria Wilson

Global Health Office Outreach Assistant

Global Health is an attractive and high profile field. We encounter global health issues on a daily basis, often without even realizing. In 2014, the West African Ebola outbreak was sensationalized in the media for months, featured heavily on every major Canadian media outlet. Several of the world’s largest charitable organizations – which you may work with, donate to, or benefit from – target global health issues. Poverty and health inequities continue to affect both our local and global communities. Students are being encouraged more and more to engage in international experiences in order to become well-rounded “global citizens.” Global health is all around us.

But what does “global health” really mean? If we asked five experts in the field to define global health, chances are each would provide a different response. Why? Because global health has grown over the years to encompass a variety of ideas and notions, including interdisciplinary cooperation, infectious and non-infectious disease, international development, social justice, food security, maternal and newborn child health, and environmental issues…and the list goes on. Global health is broad in scope, and each one of us may approach our work in slightly different way.

Academics have tried to define global health in past. Perhaps the most well-known and widely accepted definition of global health is that of Koplan et al. from 2009:

“Global health is an area for study, research and practice that places a priority on improving health and achieving equity in health for all people worldwide” [1].

While this definition touches on many important aspects of global health like equity, and a worldwide reach, it fails to address the “how.” We can study, research and practice global health, but what are the best ways to engage in our work? How do we find common ground?

I must admit, I don’t have the answers to these complex questions (yet), but I’m hoping that in the near future the global health community comes together to arrive at a solution. Until then, these are questions we should all be cognizant of when we approach our work in global health. Just like Koplan et al. called for the adoption of a common definition in global health in 2009, I am calling for an updated, universal definition of global health in 2016.

Why is it important to come to a consensus on what global health means? As global health continues to grow and become a part of our everyday lives, we must come together to determine a more clear purpose, and path for the future. With everyone working with a common framework in mind, towards shared goals, we will achieve the best outcomes moving forward.

Health Care Teams Addressing Poverty and Determinants of Health

March 16, 2016 Maria Wilson Leave a Comment

The Dalhousie Global Health Office, in collaboration with the Healthy Populations Institute, The National Collaborating Centre for Determinants of Health and Upstream, hosted the “Health Care Teams Addressing Poverty and Determinants of Health” event on March 3^rd. This event featured three speakers, who shared stories of addressing the social determinants of health in their work, and participated in a panel discussion.

Dr. Hamilton-Hinch, Dr. Forbes and Dr, Meili, our panel for the Healthcare Teams Addressing Poverty and Determinants of Health event.

Dr. Ryan Meili, the Executive Director of Upstream and a family doctor in Saskatoon, shared his experience as both a doctor treating patients in inner city Saskatoon affected by poverty, and as an advocate for health equity. Dr. Cindy Forbes talked about her experiences in advocating for health equity as the President of the Canadian Medical Association. Dr. Barb Hamilton-Hinch provided local context to this global issue, by discussing the barriers to healthcare faced by the African Nova Scotian population. All three speakers had common themes in their work: the need for policy change, the importance of story sharing to drive impact, and of course, the priority of addressing the social determinants of health in healthcare.

Dr. Meili speaking at the Healthcare Teams Addressing Poverty and Determinants of Health event.

Dr. Meili sharing stories from his work with Upstream at the Healthcare Teams Addressing Poverty and Determinants of Health event.

Dr. Meili shared the story of one of his HIV-positive Aboriginal patients who was facing several barriers to proper healthcare access. “She’s not sick with HIV,” Dr. Meili said after introducing us to her story, which was initially puzzling. However, if you take a moment to ponder this statement, it makes a lot of sense. By listening to her story, we learned that his patient has been sick with poverty, historic marginalization, poor living conditions, low education and addictions throughout her life. These factors have contributed to her HIV infection, and subsequent difficulty accessing care. This way of thinking is the fundamental to addressing the social determinants of health, and to the upstream approach. For a refresher on the social determinants of health in Canada, see our blog post from January. To learn about the upstream approach, check out this video created by Upstream, where Dr. Meili acts as the Executive Director. Upstream thinking requires us to reframe the public discourse around addressing the social determinants of health. We should be focusing more resources on the things that have the greatest influence on our health, including income, education, housing and nutrition, rather than pouring our resources into the healthcare system down the line.

Dr. Cindy Forbes, President of the Canadian Medical Association, at the Healthcare Teams Addressing Poverty and Determinants of Health event.

Building a body of evidence, and sharing these findings are both important pieces to guiding policy change. But as Dr. Forbes noted “evidence doesn’t make people feel empathy.” Upstream also aims to share stories through a variety of media in order to creatively engage citizens, showing them they have a personal stake in the social determinants of health. Citizen engagement can lead to a political push for evidence-based, forward-looking policy innovations to address these determinants so people can live longer, fuller and healthier lives.

Dr. Hamilton-Hinch highlighted the importance of not only addressing policy change, but ensuring that power dynamics shift to reflect the diverse makeup of our Canadian population. Dr. Hamilton-Hinch is involved with PLANS (Promoting Leadership in Health for African Nova Scotians) at Dalhousie. PLANS seeks to improve health outcomes within the African Nova Scotian community (about 2.3% of the NS population), while creating mentoring and outreach opportunities. In order to facilitate access to healthcare for African Nova Scotians, Dr. Hamilton-Hinch discussed the need for change in our healthcare system. Change to the way healthcare professionals are educated by challenging curriculum, change to the way healthcare professionals practice in order to reflect cultural proficiency, and most importantly, change in the disparity between the small numbers of African Nova Scotian healthcare professionals and the much larger population they serve.

Dr. Barb Hamilton-Hinch of Dalhousie University, discussing the health of African Nova Scotians at the Healthcare Teams Addressing Poverty and Determinants of Health event.

The Global Health Office would like to thank Dr. Meili, Dr. Forbes and Dr. Hamilton-Hinch for sharing their stories with over 80 attendees. The stories you have shared will go on to impact the way that we approach our learning, practice and advocacy.

World Tuberculosis Day Part III – Treatment & Drug Resistance

March 8, 2016 Maria Wilson Leave a Comment

The World Health Organization (WHO) has declared March 24, 2016 as World Tuberculosis (TB) Day [1]. Over the month of March, the Global Health Office will be publishing a series of blog posts about TB in hopes of raising awareness of its worldwide impact. WHO’s “End TB Strategy” has a goal of ending the TB epidemic by 2030, by targeting poverty, improving testing and treatment, ending stigma and discrimination, and driving research and innovation. Put simply, TB is not yet a disease of the past, but if we unite and focus our efforts, we can make TB history.

Last week we talked about diagnosing TB, and the importance of determining an appropriate treatment course along with that diagnosis. But how is TB treated, and why is drug resistance an issue with TB in particular?

Although those with latent TB infection do not present symptoms, and cannot spread TB bacteria to others, treatment can still be provided to stop them from developing TB disease. This step is important in eliminating and controlling TB around the world, but should only be initiated once the possibility of TB disease has been excluded. In the United States, four treatment regimens are approved, using combinations of isoniazid, rifampicin and rifapentine. Treatment for latent TB can last anywhere from 3 months to 9 months, necessitating between 12 and 270 doses (minimum) of anti-TB drugs [2].

Treating those with active TB disease is a much more pressing matter, as they have the potential to spread the disease to others. Treatment regimens for active TB disease can last between 6 and 30 months depending on resistance, a process which burdens patients and treatment providers alike [3]. With a treatment course this long, some patients inevitably fail to complete the full regimen, for many reasons including finances, social pressures and inadequate access to proper treatment. To provide a glimpse at the financial burden of TB, each case in Canada cost the healthcare system $47,290 [4]. This can lead to acquired drug resistance, which can then be passed on to others when the infected person, coughs, sneezes or spits, releasing TB bacteria into the air [5].

There are two types of drug-resistant TB: multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB). MDR-TB bacteria does not respond to (at least) the two most widely used and powerful first line TB drugs: isoniazid and rifampicin [6]. XDR-TB involves resistance to isoniazid and rifampicin, in addition to resistance to any of the fluoroquinolones (ofloxacin, etc.), and to at least one of three injectable second-line drugs (amikacin, capreomycin or kanamycin) [7]. Both MDR-TB and XDR-TB take longer than regular TB to treat (at least 18 months) and have lower treatment success rates. Furthermore, patients often experience more harsh side effects from treatment, leading to increased hospitalization [8]. In order to maximize the potential for positive treatment outcomes, it is important that further tests are undertaken after initial diagnosis to determine whether bacteria is drug-resistant, and provide appropriate treatment [7].

According to the WHO Global TB Report, in 2014 an estimated 3.3% of new TB cases and 20% of previously treated cases had MDR-TB. More than half of these cases occur in India, China and the Russian Federation. Additionally, an estimated 190,000 people died of MDR-TB in 2014. As of 2015, XDR-TB had been reported in 105 countries. The map below shows the number of patients in these countries with laboratory-confirmed XDR-TB who started treatment in 2014 [9].

Map of the world, showing the number of laboratory-confirmed cases of XDR-TB receiving treatment by country, 2014. (Source: World Health Organization).

In response to treatment non-adherence, and to combat the spread of drug-resistant TB, the directly observed therapy, short-course (DOTS) strategy was developed by WHO in 1994. Health workers meet with patients regularly to help with treatment, adherence, and to provide support and education. This strategy also advocates for increased allocation of domestic and international funding and resources to combat TB [10]. Tuberculosis is also highlighted in two recent worldwide strategies, the WHO End TB Strategy, and the UN Sustainable Development Goals (SDGs), which will be discussed in our next post.

World Tuberculosis Day Part II – Tuberculosis Testing and Diagnosis

March 2, 2016 Maria Wilson Leave a Comment

Mycobacterium tuberculosis scanning electron micrograph. Mag 15549X. Source: CDC.

Now that you have an idea of how TB is spread, its symptoms and its worldwide burden, let’s talk about how TB is diagnosed.

When a patient presents with the symptoms discussed in the last blog post (coughing up blood, cough lasting longer than 3 weeks, unexplained weight loss, etc.), a medical history is taken to determine whether TB infection is probable. Questions that are asked include whether they have been in close contact with someone with TB, if they have a previous history of TB infection, and whether they have an immunocompromising condition (such as HIV) that could increase the risk of latent TB infection progressing to TB disease [2].

There are two primary types of tests that are used to determine if a patient has been infected with TB bacteria: the tuberculin skin test and TB blood tests. The tuberculin skin test (also called the Mantoux tuberculin skin test) involves injecting a small amount of fluid (tuberculin) into the skin of the lower arm. After 48-72 hours have passed, a trained health care worker will look for a raised, hard area or swelling, to determine whether infection is present. TB blood tests (interferon-gamma release assays or IGRAs) measure how a person’s immune system reacts to TB bacteria by testing a blood sample in the laboratory. Blood tests are preferred for those who have had a TB disease vaccine, or who would have difficulty returning for a second appointment. Testing positive on either of these tests does not differentiate between latent TB infection and TB disease, it simply means the person’s body is infected with TB bacteria [3].

Diagnosing active TB involves a series of other tests. Chest X-rays can be used to check for lung abnormalities, but X-rays alone cannot provide a definitive TB disease diagnosis. Sputum Smear Microscopy (SSM) is one of the techniques used to diagnose active TB. Sputum is examined under a microscope for Mycobacterium tuberculosis. SSM can provide results in 24 hours, but it cannot always distinguish between TB and other infections. Polymerase Chain Reaction (PCR) testing can be used to detect genetic material specific to TB in bacteria; however, this test is complicated and can be much more expensive than SSM. Diagnosing TB outside of the lungs can include tests such as a biopsy, lumbar puncture, urine culture or CT scan [4].

Culture techniques, where TB bacteria can be grown in a laboratory from a variety of specimens, are also used to diagnose active TB, though it can take 1-6 weeks to obtain results. Culture techniques are particularly useful in determining an antibiotic treatment course, an important step in combatting TB. One of the largest issues in TB treatment is properly identifying and targeting drug resistance in order to provide appropriate treatment, a topic that will be discussed in our next post [5].

World Tuberculosis Day Part I – What is TB?

March 1, 2016 Maria Wilson Leave a Comment

Tuberculosis (TB), caused by the bacillus Mycobacterium tuberculosis, is an airborne disease that primarily affects the lungs (pulmonary TB) [2]. This means that when people with pulmonary TB cough, sneeze or spit, TB bacteria are propelled into the air, giving them the potential to spread from person to person via inhalation. TB can affect other sites as well, including the brain, the kidneys and the bones [3]. An ancient disease, TB has affected humans for over 4,000 years [2].

In many cases, the immune system will fight off the TB bacteria, and no infection occurs. If the immune system is not able to completely fight off the bacteria, some inactive bacteria may stay in the body, leading to latent TB infection (no symptoms). If the immune system does not respond sufficiently, active TB infection occurs (TB disease), and symptoms begin to manifest [4]. People with latent TB infection cannot spread TB bacteria to others, but can go on to develop active TB over time. WHO estimates that about one-third of the world’s population is infected with latent TB [5]. Symptoms of TB disease include a persistent cough of 3 weeks or longer, pain in the chest, coughing up blood or sputum, weakness or fatigue, weight loss, loss of appetite, chills, fever and night sweats [6].

The burden of TB is mainly concentrated in low and middle income countries, where 95% of TB deaths occur. In 2014, there were 1.5 million TB deaths, and 9.6 million people developed TB disease [5]. TB is one of the leading causes of deaths from infectious diseases worldwide [7]. The map below, produced by WHO, shows estimated TB incidence rates, by country, in 2014.

Map of the world showing estimated TB incidence rates, by country, in 2014 (Source: World Health Organization).

This map provides a visual representation of the worldwide burden of TB, with the lowest rates in Western Europe, Canada, the United States of America, Australia and New Zealand. This has led to a common misperception in higher income countries that TB is a disease of the past. However, in many countries, including Lesotho, South Africa, Swaziland and Mozambique, rates are still above 500 cases per 100,000 population [7].

Keep reading our series of blog posts on TB to learn more about risk factors, diagnosis, treatment and much more.

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By: Kayti Baur, MSc Candidate in Community Health and Epidemiology

By: Kayti Baur, MSc Candidate in Community Health and Epidemiology