USAID Impact Photo Credit: USAID and Partners

Archives for Global Health

Better Diagnostics Critical to the Fight against Typhoid

During the month of May, IMPACT will be highlighting USAID’s work in Global Health. From May 1-10, we will be featuring the role that Science, Technology & Innovation plays in Global Health.

The lack of a robust, sensitive, and easy-to-use diagnostic test is one of the most serious barriers to the control and prevention of typhoid fever.

Typhoid fever is a severe bacterial infection spread through water or food that has been contaminated with human waste. The disease causes high fever, flu-like symptoms, abdominal pain, and systemic illness that can result in severe morbidity or death.

An estimated 21 million people fall ill due to typhoid each year, and unfortunately, the burden of disease is greatest among the most vulnerable: school- and pre-school-age children. These children primarily live in poverty throughout Asia and Africa, typically in crowded and unsanitary conditions without access to safe water or basic sanitation.

Women and children in Bihar state, India. Photo credit: Esther Havens

When they fall ill with typhoid, recovery is no guarantee. WHO estimates at least 216,000 people die from typhoid each year. The disease can be treated with antibiotics, but resistance to common drugs is widespread and increasing.

The lack of effective diagnostics means it is more difficult to identify patients, provide effective treatment and prevent the disease from spreading, especially for drug resistant typhoid. It also hinders our ability to conduct surveillance and to identify high-burden and at-risk populations. For policymakers, ministries of health, and others, this lack of diagnostics obscures the true impact of the disease, and reduces the sense of urgency that is required to address it.

There are vaccines available to prevent typhoid; however, they have limitations. Existing vaccines are only moderately effective and provide limited protection to young children. But without a more trusted method for identifying patients, it is also more difficult to conduct efficacy trials of next generation vaccines and clinical therapies. The lack of a sensitive diagnostic test increases the number of patients that must be recruited for these trials and, as a result, dramatically increases the associated costs and time. As a result, in the past few decades, the field has moved forward only with public sector investment.

We don’t have to wait for next generation diagnostics to make a strong case that international organizations and national governments should invest in the control and prevention of typhoid. Timely case identification and management with antibiotics has dramatically reduced case fatality rates, and access to clean water and basic sanitation will provide the best long-term solution.

But at the same time, we know that next generation vaccines providing high levels of lasting protection as early as infancy and effective clinical care may not become available to the children that would benefit most because the cost of needed trials is too high. And when children’s lives are at stake, we need to move quickly.  That’s why we need to rise to the challenge of developing better typhoid diagnostics, and soon.

Learn more about typhoid fever and how to get involved at www.coalitionagainsttyphoid.org.

Follow USAID for Global Health (@USAIDGH) on Twitter and use #GHMatters to join in the conversation.

Embracing Innovation and Discovery to Accelerate Global Health Progress

Ariel Pablos-Mendez, PhD, serves as assistant administrator for Global Health

During the month of May, IMPACT will be highlighting USAID’s work in Global Health. From May 1-10, we will be featuring the role that Science, Technology & Innovation plays in Global Health.

Improving women’s and children’s health is critical to the development of successful economies and stable communities. It not only saves lives, but it helps communities move themselves out of poverty. Yet every year, 6.9 million children die of preventable causes and more than 287,000 women die from complications of pregnancy and childbirth.

In his State of the Union Address earlier this year, President Obama set forth a vision to, within the next two decades, achieve some of the greatest contributions to human progress in history– eliminate extreme poverty, ensure an AIDS-free generation, and end preventable child and maternal deaths.

To many, these goals seem impossible. They seem like nothing more than a catchy statement, in a political speech. But in reality, these goals are achievable, and we’ve already begun to see tremendous progress.   For example, we’ve supported the scale up of a simplified newborn resuscitation program, “Helping Babies Breathe” through a public-private partnership. The partnership has trained and equipped 100,000 health providers in 50 countries in the last two years. This past year, USAID reached more than 84 million women with family planning information and services. By enabling women to delay and space pregnancy, this helped to prevent 15,000 maternal deaths and save the lives of more than 230,000 infants. These are just a couple examples of the recent advancements we’ve made.

But while we have tools and knowledge that can save and improve lives today, we must also look toward the future. Millions around the globe still do not have adequate access to reproductive, maternal and child health services. There is no guarantee that today’s tools will meet tomorrow’s challenges. We must not become complacent.

USAID and the broader global health community invest in innovation, science & technology to find game-changing solutions. Solutions that will help accelerate the goal of ending preventable child and maternal deaths, and creating an AIDS-free generation.

Through the Grand Challenges for Development, Development Innovation Ventures, and the Higher Education Solutions Network, USAID is helping to drive breakthroughs in science and technology that can transform development challenges. Recently, we launched the Center for Accelerating Innovation and Impact in Global Health to help promote and discover innovative, business-minded approaches to address key bottlenecks in the development, introduction and scale-up of global health technologies and interventions.

And since 2011, Saving Lives at Birth has supported 39 exciting and potentially transformational solutions to women’s and newborns’ health. The innovative ideas include an instrument-free, low-cost, rapid point-of-care CD4 test; a postpartum intrauterine device simulation training model; a counterfeit and substandard drug detector device for use in the developing world; and a low-cost, sustainable health cooperative.

At USAID, we are committed to finding innovative solutions to global health  problems (PDF) and if the global health community can harness science, technology and innovation for the poorest communities in the world, we can leave an unparalleled legacy in global health in this next decade. Over the next few days, we will be blogging about some of the latest cutting-edge solutions that are changing the global health arena. By working together to discover and build new solutions, we can maximize our impact and expand what is possible in development.

Follow USAID for Global Health (@USAIDGH) on Twitter and use #GHMatters to join in the conversation.

Religious Leaders “Noisy About Malaria” in Mozambique

Each year, World Malaria Day (April 25) commemorates the global fight toward zero malaria deaths and mobilizes action to combat malaria. This year’s theme is “Invest in the Future: Defeat Malaria.”

Anglican Bishop Dinis Sengulane’s message isn’t exactly what one might expect from a typical religious leader. Then again, Bishop Sengulane, who has presided over Mozambique’s Lebombo Diocese since 1976, is not a typical leader, religious or otherwise. The large cross that hangs from a chain around his neck is fashioned from components of disassembled weapons surrendered by combatants after the Mozambique civil war, a prolonged conflict that he and other religious leaders played an integral role in bringing to an end in the mid-1990s.

Bishop Dinis Sengulane addresses the crowd at Coca Missava village about the importance of net retreament and malaria prevention. Photo credit: Bita Rodrigues/USAID

Today, Bishop Sengulane is fighting to bring an end to another destructive force in his nation: Malaria. The disease steals 650,000 lives around the world each year, devastating entire communities and undermining opportunities for prosperity and growth — and disproportionately affecting the African continent.

At a gathering hosted by USAID last month in Washington, DC Bishop Sengulane was joined by Rear Admiral Tim Ziemer of the President’s Malaria Initiative (PMI), leadership from USAID’s Global Health Bureau and representatives from a number of faith-based and community organizations, including Christian and Muslim groups. The Bishop’s message was simple and clear: “[Mozambique] reached peace 20 years ago. But 10 years ago we said there is something else that is killing day and night. Its name is Malaria. Let’s stop it. Let’s start working on that as communities of faith because we know this is not God’s will.”

In 2006 the Bishop helped launch a nationwide campaign to end malaria called PIRCOM (Programa Inter Religioso Contra a Malaria) alongside leaders from Christian, Muslim and Baha’i faith backgrounds. Their ambitious goal: train thousands of religious leaders across the country with basic malariaprevention and control messages, equipping them with the resources and tools needed to bring these messages to their communities. 

“People in Mozambique know that I often say ‘Let’s be noisy about malaria’. That’s actually how PIRCOM started… people heard us saying could we give them a platform to address even more people on their concerns about malaria.”

To date PIRCOM has trained over 27,000 religious leaders and reached nearly 2 million congregants with basic malaria education, made possible through funding from the President’s Malaria Initiative. The PIRCOM network now extends to 36 district councils and six provincial councils across Mozambique where efforts are coordinated. Reflecting on the unique role faith communities can play in saving lives through simple public awareness raising, Bishop Sengulane observed: “If a doctor talks about how important it is for you to have your home sprayed, of course he will talk about those things in those terms, because it is how he will get his salary. But when a leader of a mosque starts talking about health issues, about malaria, then people are ready to listen. [Religious leaders] have got a good audience.”

Echoing this theme, Rear Admiral Tim Ziemer added, “No matter what the cause, if you don’t have political, or community, or civil leadership behind, it isn’t going to go anywhere… these leaders represent a ‘flag pole’ for the cause.”

Still, there is much work to be done, especially in preventing deaths of children under five. Concluding his remarks, the Bishop acknowledged, “At the present moment we continue to have too many children dying of malaria. It’s very important that we ensure that with the under-fives, pregnant women and similar vulnerable groups, that we go back and do the very urgent work of providing them with whatever is needed so that malaria doesn’t kill, as we see happening too often.”

PIRCOM’s example reminds us that effective global development not only requires sound public policy and results-oriented programming, it is also a fundamental expression of our values, both as individuals and as a nation.

On this, World Malaria Day, let’s resolve to be noisy about malaria.

Malaria is a Marathon, Not a 50-yard Dash

Each year, World Malaria Day (April 25) commemorates the global fight toward zero malaria deaths and mobilizes action to combat malaria. This year’s theme is “Invest in the Future: Defeat Malaria.”

I used to call them “disease du jour” bills. As a staffer on the U.S. Senate committee with jurisdiction over public health issues, every time a Senator’s nephew or cousin or college roommate’s daughter got a terrible diagnosis, it was my job to explain why passing a one-time bill wasn’t the answer for every disease. Washington’s attention span tends to wane after the galas end, the celebrities leave town, and the surge of early funding and enthusiasm dries up.  Without unglamorous vigilance, the disease remains after the politicians and paparazzi move on to the next disease du jour. Global health was no different.  After working on malaria policy for several years, I noticed the buzz starting to shift to tuberculosis. Malaria control was just so… 2006.

For children under five, malaria mortality rates have fallen dramatically with scale-up of malaria control efforts. Photo credit: USAID

Surely the private sector wouldn’t be so fickle, right? I joined MosquitoZone International, a U.S.-based firm that offers malaria prevention services to companies with operations in endemic areas. How exciting to work with clients who were absolutely committed to keeping their workers and communities safe from malaria! It turns out, of course, that companies can sometimes be a lot like governments. They invest in controlling malaria and they make so much progress that pressure builds to redirect scarce resources into one of the other health and safety threats facing their workers and their bottom line. But malaria doesn’t go quietly into the night.

One of our clients started off doing everything right. They committed to eliminating malaria at a sub-Saharan African project site. They hired us to run a comprehensive vector control program and we don’t play around. Our entomologists knew every mosquito on that jobsite by name and killed it. By 2011, our client had zero new cases among non-immune expatriate workers and zero complicated cases among semi-immune local workers. They bragged about their success on the company web site. Problem solved.

Inevitably, the urgency of the need for investment in sophisticated entomology was questioned. After all, there were plenty of other problems clamoring for their health and safety resources. Unfortunately, when you stop putting experienced entomological eyeballs on surveillance data, the bugs get the upper hand. After we left, the company failed to respond to entomological data suggesting a major spike in the mosquito population that should have prompted a five-alarm investigation. The company recognized the problem, recommitted to entomological excellence and their success continues with MosquitoZone’s entomologists driving their prevention program today.

Time and again, we see the same predictable cycle in public and private sector programs all over the world. Success turns the volume down on the alarm bells that drive the investments that produced that success in the first place, and when that happens, only failure raises the alarm again. But failure isn’t just a technical abstraction about budget line-items or resistance data. Failure means babies dying, workers downed, and human productivity and potential plummeting.

When it comes to the wily mosquito, every day has to be World Malaria Day.

Katy French is the Vice President for Corporate Affairs at MosquitoZone International.

Photo of the Week: Invest in the Future: Defeat Malaria

Malaria kills more than 650,000 people each year; the majority of those deaths occurring on the African continent. Each year, World Malaria Day (April 25) commemorates the global fight toward zero malaria deaths and mobilizes action to combat malaria. This year’s theme is “Invest in the Future: Defeat Malaria.” On this occasion, the President’s Malaria Initiative (PMI), led by the U.S. Agency for International Development and implemented together with the U.S. Centers for Disease Control and Prevention (CDC), will release its Seventh Annual Report to Congress, which describes the U.S. Government’s contributions to the global fight against malaria. Photo is from Jaclyn Wong, CDC.

USAID’s Global Health Bureau is working with United States Africa Command and partners all day on April 25 for a Twitter relay.  Join @USAfricaCommand from 6 – 10 a.m. EDT, then join @USAIDGH and partners starting at 9:30 a.m. EDT.  Medical experts and malaria prevention specialists will be standing by live to answer your questions. Additionally, Admiral Timothy Ziemer, U.S. Global Malaria Coordinator and leader of the U.S. President’s Malaria Initiative (PMI), will join the chat from 9:30 – 10 a.m. EDT. View the full schedule.

Join the conversation with #malariabuzz on Twitter.

Learn more about World Malaria Day.

 

Non-hormonal Methods of Contraception Meet Need in DRC

More than 26 percent of married women in the Democratic Republic of the Congo (DRC) want to avoid pregnancy but aren’t using a modern method of family planning. Furthermore, meeting this demand for family planning is not an easy task in the DRC, where deep-seated traditional and religious views exist around family size, gender roles and the use of contraception.

USAID programs have worked to meet the needs of women in the DRC by expanding access to a wide range of family planning choices from short term to long acting reversible contraceptives and permanent methods. USAID has also identified the need to increase access to non-hormonal methods to increase options for women and couples. Since 2003, USAID and its partners have worked to incorporate fertility awareness-based methods into the DRC context, in particular, the Standard Days Method “SDM” (PDF), developed by the Institute for Reproductive Health with funding from USAID. Using SDM, women track their menstrual cycles with CycleBeads in order to avoid unprotected intercourse during their fertile days and by doing so can prevent pregnancy. Based on World Health Organization analyses (PDF), with perfect use, the SDM is effective 95% of the time, and 88% of the time with average use.

Christopher Hook with members of Maman An’Sar. Photo credit: USAID

CycleBeads have a particularly strong acceptance in the DRC’s religious communities. I recently visited the capital city of Kinshasa and was lucky enough to attend a community training of young women on use of CycleBeads. A local Catholic organization, La Conduite de la Fecondité, conducts these trainings twice per week in thirteen integrated maternal and child health clinics all across Kinshasa. It was a moving experience for me as a development professional (even though I did not speak a word of Lingale!). The training incorporated singing, dancing and call-and-response, which created a fun atmosphere where learning could happen.

Later that day I also met with representatives from Maman An’Sar, a Muslim organization who advocates to local Imams to incorporate family planning messages (PDF) into their weekly sermons. Following a sermon, Maman sends out teams of community health workers who follow up with individuals and couples from the congregations to talk about what they heard. Faith-based organizations like Maman and religious leaders have significant potential to influence positive behavior change within communities and disseminate reproductive health messages.

The use of CycleBeads continues to grow in the DRC. Today, SDM has been scaled-up in 278 of 515 health zones, and CycleBeads are available in more than 1800 sites with trained providers ready to assist potential users. Moreover, SDM has been included in all Ministry of Health norms and protocol documents, ensuring long-term host government support of fertility awareness-based contraception as a key component of the contraceptive method mix.

Access to family planning information and services is only one health challenge in the DRC, but it’s an important one. The DRC has one of the highest rates of child mortality in the world, and enabling couples to determine whether, when and how often to have children is vital to safe motherhood and child survival. Research has shown improving access to family planning and reproductive health services could prevent up to 40 percent of maternal deaths across the world, and save the lives of 1.6 million children (PDF) under the age of five annually. Increasing access not only to hormonal methods of family planning, but also to fertility awareness methods is one way in which USAID and its partners are seeking to meet unmet need in the DRC and across the world.

If you or someone else you know may be interested in using the SDM, please follow this link for the web-based service, and this for the iCycleBead smartphone app.

The Final 1,000 Days of the MDGs: Accelerating Progress and Working to End Extreme Poverty

Today we  mark an important milestone: 1,000 days left until the end date of the Millennium Development Goals (MDGs). The MDGs, agreed to at the UN in 2000, constitute the world’s first global development agenda. Together, world leaders committed to tangible, ambitious targets for reducing poverty and hunger, expanding primary education, ensuring gender equality, improving the health of mothers and children, halting the spread of infectious diseases, promoting environmental sustainability, and coming together in partnership to achieve these important goals.

The MDGs and the broader development agenda are a work in progress, for sure—but it’s important to recognize what they have achieved so far, and remember these critical commitments we made.

The United States is committed to the MDGs and, broadly, to improving wellbeing, promoting prosperity, and tackling some of the world’s gravest challenges, like poverty, hunger, morbidity, and inequality. In 2010, President Obama announced the U.S. Global Development Policy, the first of its kind by any administration. The policy outlined key development objectives—broad-based economic growth, democratic governance, game-changing innovations, and sustainable systems for meeting basic human needs—that feed directly into the MDGs. This year, in his State of the Union address, President Obama reiterated the U.S.’s commitment to a core tenet of the MDGs: poverty reduction. We are now in a position, the President said, to eradicate extreme poverty within a generation. USAID and its partners are working towards this important end—by connecting people to the global economy, empowering women, saving children from preventable death, ending the scourge of AIDS, and helping communities to feed, power, and educate themselves.

Joytara, one of the women whose life has been changed for the better through Bangladesh’s “Jita” Rural Sales Programme, which generates income and employment opportunities for the rural poor. The program is one of the ways USAID is meeting MDG 1 to end extreme poverty and hunger. Photo credit: Kathryn Richards, CARE

Working together, we have made substantial progress (PDF) since the Millennium Declaration was signed 13 years ago. For the first time since we’ve measured world poverty, the number of people living on less than $1.25/day is falling in every developing region—including sub-Saharan Africa. In 1990, more than 43% of people in developing countries lived in extreme poverty; as of 2008, this proportion had dropped to 23%. Estimates suggest that the MDG 1 target to halve extreme poverty was met in 2010. During this period, more than 600 million people have risen above the $1.25/day line.

We have made important gains on other MDGs, as well. The enrollment ratio of girls to boys in primary school rose, from 91% in 1990 to 97% by 2010—that’s within the margin of error of complete parity, the target for MDG 3. The incidence of tuberculosis has fallen since 2002, and, since 2006, this decline has outpaced global population growth—achieving part of the MDG 6 target to reverse the spread of infectious disease. And more than 200 million people living in urban slums gained access to improved water sources, sanitation facilities, and housing, more than doubling the MDG 7 target.

Elsewhere, though, we have more work to do. Today, 1.2 billion people still live in extreme poverty, and 870 million people suffer from hunger—we expect the proportion of undernourished to drop to 12.5% by 2015. This, however, falls short of MDG 1 target of 11.6% (half of the 1990 level). Globally, primary enrollment is at 90%, up from 82% in 1999. But that remains below the MDG 2 target for universal primary education. While we’re within the margin of error for gender parity in primary schools, progress on secondary education has been slower. Although we cut under-five mortality by more than a third, we are still only halfway to the MDG 4 target of a two-thirds reduction. And although maternal mortality has been halved since 1990, this is far from the MDG 5 target of a three-quarters reduction. The number of AIDS-related deaths fell to 1.7 million in 2011, a decline of 24% from the peak in 2005—but this lower mortality also means that, today, more people than ever are living with HIV/AIDS.

The MDGs touch on issues across the development spectrum. USAID’s programs reflect this broad array of efforts—and others as well, like promoting human rights and democratic governance, managing and mitigating conflict, investing in renewable energy and infrastructure, building resilience to recurrent crisis, combating climate change, and more. USAID Forward (for which the 2013 Progress Report, PDF, was just released) and the USAID Policy Framework (2011 – 2015) (PDF) outline this comprehensive approach to development.

In recent years, USAID and its partners have made substantial contributions towards MDG achievements. In these final 1,000 days, though, there is much more we can accomplish—and USAID is looking to accelerate progress as we near the finish line. Through Feed the Future and the New Alliance for Food Security and Nutrition, for instance, we are catalyzing private sector investment and expanding our reach to smallholder farmers, to help them increase productivity, adopt modern technologies, connect to wider markets, and access financial services and products. Together, these initiatives can help lift 50 million people out of poverty in the next 10 years. And in cooperation with UNICEF and the governments of India and Ethiopia, we are spearheading a global effort to reduce under-five mortality to less than 20/1,000 births in every country by 2035.

USAID is also looking towards the future of development—and towards finding new ways to address some of our most intractable challenges, such as helping fragile states realize peace, stability, and long-term prosperity. We also recently released policies and strategies to address some of the most pressing issues we face, like building resilience to recurrent crisis (PDF), the development response to violent extremism and insurgency (PDF), promoting gender equality and female empowerment (PDF), engaging and empowering youth in development (PDF), and adapting to and mitigating climate change (PDF).

The global community has also begun a discussion about “post-2015″.  What will the next set of MDGs look like?  USAID has been deeply involved in this dialogue. The UN Secretary General’s High-level Panel and the Open Working Group on Sustainable Development Goals, for instance, will both issue recommendations in the coming months. We are grateful for the leadership of these two bodies and the many contributions from a diversity of voices around the world—and are looking forward to continuing the conversation.

While we work to accelerate progress in these final 1,000 days, we also hope these interlinked and collaborative efforts will produce a new development agenda, for beyond 2015, that builds on the impressive and historic successes of the MDGs.

Learn more about how USAID is working towards achieving the MDGs.

FrontLines Releases March/April 2013 Issue

Read the latest edition of USAID’s FrontLines to learn how the Agency is working to provide safe water to the millions who live without this vital resource, and how unique approaches to wipe out neglected tropical diseases are faring. Some highlights:

Three young boys having some fun while they use a public standpipe in Bauchi town, Nigeria. This is one of the sites where town residents retrieve water since few have water taps at their homes. In December 2011, USAID’s Sustainable Water and Sanitation in Africa project signed an agreement with town officials to help them expand and improve services to residents. Photo credit: Emily Mutai, SUWASA

  • When a family of 12 fled violence in Syria, the Jordanian relative who took them in was not too concerned about providing everyone with adequate water – a scarce resource in this region of the world – thanks to a USAID project that helped build cisterns to harvest and store rainwater.
  • water ATM? Similar technology that meters public water sources is a welcome development for some urban Kenyans who would otherwise face the high cost and inconvenience of procuring water for cooking, washing, cleaning and everything else.
  • Cambodia is enlisting a variety of players – including school children – on its mission to wipe out snail fever, an infection that can lead to debilitating illness, and, in children, malnutrition and cognitive difficulties.
  • Delivering medications efficiently could stomp out two debilitating diseases endemic to Haiti; wearing new sneakers kicks up that protection even more by creating a barrier between parasites and kids’ feet.
If you want an e-mail reminder in your inbox when the latest issue of FrontLines has been posted online, subscribe here.

Video of the Week: Help a Child Reach 5

For the first time in history, we have the available knowledge and technologies to reach the world’s most marginalized children with life-saving interventions. Now is a time for action, to deliver on our long-standing commitment to end preventable child deaths. By working together with renewed determination, we can accelerate declines in child and maternal mortality, enabling more countries to achieve Millennium Development Goals (MDGs) 4 and 5 by 2015 and sustaining the momentum well into the future. Learn about A Promise Renewed.

Latin America’s Slums and TB

In the slums of Latin America, 117 million people live in poverty. The region’s megacities, including Mexico City, Sao Paulo, Bogota, Rio de Janeiro, and Lima, generate over-crowded living conditions without access to clean water or electricity, poor nutritional status, and often lack of basic health services.  These marginalized populations are made up of the poor, the homeless, and vulnerable indigenous groups that have migrated to the city in search of a better life; they are the urban poor of Latin America.

The combination of these social determinants generates a breeding ground for tuberculosis (TB).

A woman and child receive TB treatment. Photo credit: USAID

Around the world, tuberculosis rates are often high in urban areas and in the Americas it is no exception. Twenty-five percent of Peru’s urban poor live in Lima-Callao, which reports 60% of the tuberculosis cases for the entire country and 85% of drug-resistant tuberculosis cases which is difficult and costly to treat.

As populations continue to explode throughout the region, health conditions will continue to worsen if they are not addressed, particularly in slums.  In 2011, 30,000 people died of tuberculosis in the Americas and there were 268,000 new reported cases. Worldwide, 1.4 million lost their fight against the disease. Tuberculosis, once thought an old disease, is the new emerging problem for the most vulnerable.

Tuberculosis has been used as a prime example of a “social disease” because it finds its nest among the poor and marginalized. The control of tuberculosis in cities requires social, economic, and environmental interventions to improve living conditions and increase access to health services. USAID has funded the Pan American Health Organization (PAHO) to tackle this concentrated epidemic in key cities across the Americas.

PAHO currently works with municipalities in Sao Paulo, Brazil; Bogota, Colombia; and Lima, Peru to improve their tuberculosis programs that service the urban poor. The successes from these cities will be shared with Mexico City, Guayaquil, and other megacities in Latin America and around the world.

As urbanization rates continue to increase, so are the chances of tuberculosis among the urban poor. Tuberculosis is contagious but also curable; acting now while the epidemic is concentrated will help avoid astronomical costs for treatment and keep the region healthy.

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