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Africa COR P OR AT E

Issue 61 Vol 2 Number 888 2015

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PARTNERSHIPS FOR PREVENTION AND CARE

Creating Innovative Health Response Systems Garance Upham The African Federation for Emergency Medicine Conference Report Using Technology to Fight Ebola Fabienne Ostermeyer


CONTENTS 4 .....

The struggle against antibiotic-resistent epidemics: Garance Upham discusses lessons learnt from Ebola

8 .....

2014 African Federation for Emergency Medicine Conference, report by Tsegaye Girma

12 ...

The Union’s Private-Public Partnership introduces a new treatment for Multidrug-Resistant TB

16 ...

Weapons against Ebola: interview with VISIONMED GROUP’s Fabienne Ostermeyer

Published By Times Publications Group Ltd Publisher - James Norris Editor - Shan Bertelli ASSISTANT Editor - Tsegaye Girma Proof Reader- Alison Walters Coordinator - Aisha Aingal Media Executives - Aster Mengesha, Ashenafi Molla, Milkyas Getachew, Helene Suana Special Project Director - Jian Ping Sun Production - Robert Ellerbeck Publication Partners - Nepad Council, NASME Nigeria, CNBC Africa, BRICS Summit Group. Partnerships for Prevention and Care Africa Health Report is published quarterly. Subscription details can be obtained from Times Publications Group Ltd. at principal commercial offices: 30-32 Tabard Street, London SE1 4JU; Tel: +44 (0) 20 7089 8830 or Fax: +44 (0) 20 7089 8831. Email administration@ times-publications.com or visit our website at www.corporate-africa.com. © Times Publications Group Ltd. 2013 — all rights reserved. First Published in 2013. Distributors in Africa: Shama PLC Tel: +251 11 554 5290, MCS/Caxton International PressTel: +27 11 807 9599, Print Excellence Ltd.Tel: +233 243 213 881, Dominion Bookshop, +233 240 695 791, Publisher’s Distribution Services Tel: +254 20 3222 901, PDS Accountant Tel: +254 20 3222 903, Newsstand Nigeria Tel: +234 802 3382788. Corporate Africa

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Creating Innovative, Responsive Health Systems Applying the lessons from Ebola in the struggle against antibiotic-resistant epidemics. By Garance Upham, Safe Observer International.

Lack of Infection Prevention and Control (IPC) has been a weak link in facing Ebola “My main task in Guinea was to head several teams

fact that the health systems in the three worst-affected

of grave diggers to bury Ebola victims who are more

West African nations have further deteriorated. Health

contagious when they are dead. The problems are many;

professionals are insufficient and overwhelmed, giving

people don’t trust their government, the social fabric is

serious cause for concern if Ebola or another epidemic

coming apart, and the health systems are very different

were to return.

for urban and rural populations, and for rich and poor. The Ebola crisis brings these problems to the fore.”

As is often the case during an epidemic, people with

Elhadj As Sy, General Secretary, Federation of the Red

ailments other than Ebola have died or are suffering

Cross and Red Crescent Societies.

unduly, unable to reach healthcare systems which are burdened by Ebola under worsening social and economic

The Ebola Outbreak

conditions.

Estimates of 21,000 cases and 8,000 deaths from

4

Ebola in Guinea, Liberia, and Sierra Leone, have led

The WHO’s future

to pessimistic conclusions. However, the good news

The crucial question about the WHO’s global responsibility

is that the Center for Disease Control (CDC) Bulletin

might now be taken more seriously along with the

epidemiologists’ mathematical model predicting that

decision to build strong health systems. The WHO’s

Ebola could reach 1.4 million cases by the end of

34-member-Executive Board (EB) held an all-day Special

January, 2015, and the World Health Organization’s

Session on Ebola on January 25, 2015. It was only the

(WHO) forecast of 10,000 new cases weekly were both

third time in the organization’s 60-year history that the

proven wrong. As of January 2015, there are only a

EB has held a Special Session. High-level representatives

dozen new cases of Ebola appearing each week, and

were in attendance and ground-breaking decisions on the

the trend appears to be falling. Less encouraging is the

future of disease management and issues surrounding

Corporate Africa


the WHO’s operational capacities and global initiatives

Beyond Ebola: threat of civil unrest

were made.

In addition to Ebola, a food crisis is growing in the three Ebola-hit countries, and destabilization has jeopardized

Military-like Preparedness

industrial production in a region where the threat of

According to Laurie Garrett, from the Council on Foreign

terror from Boko Haram looms. In Guinea, the Ministry

Relations Health Expert, China was able to contain the

of Health explained how they thought the epidemic

Severe Acute Respiratory Syndrome (SARS) epidemic

had been brought under control and considered closing

within two months by building a first-class hospital

treatment centers, only for a few Ebola contact cases to

within 10 days and repeating the pattern in every region

escape, leading to new outbreaks and hunger through

affected by the disease. Check-points for fever and

loss of employment. It is a situation from which political

quarantines were also set up. This is a good example

instability could arise.

to follow in the case of African epidemics, but would be difficult to implement for many reasons, including lack of

Dr. Remco Van de Pas of the Antwerp Tropical Medicine

finance, skills capacity and cultural beliefs or practices.

Institute, who is carrying out Ebola research in Guinea, reported his shock at the lack of healthcare facilities in the disease’s epicenters, and points to the link with palm

If African healthcare systems were “amplifiers” of Ebola, it is because they are weak and, in some countries, barely existent.

oil productions where workers come into contact with contagious animals, further adding to the risk. A major problem is the tendency to think that Ebola in another country is not one’s concern. In the wake of Ebola, large epidemics of antibiotic-resistant bacterial infections are growing and it is dangerous to think that problems in Africa are not problems for the US or Europe.

In the wake of the first Macroeconomic and Health

When he discovered the NDM-1 gene (which confers

Summit held in Geneva in 2003, former WHO Director

resistance to the latest class of antibiotics) in the New

General (DG), Dr. Lee Jong-wook, said that he advised

Delhi water system, Dr. Timothy Walsh rang alarm bells

China to learn from SARS and rebuild public health

and called for investment banks to pay attention to

structures to enable the building of a strong public

the need for safe water systems in India. Dame Sally

health system to control epidemics. He also said that

Davies, England’s Chief Medical Office at the WHO, stated

it was unwise of macroeconomic institutions to force

that NDM-1 had travelled to 18 other countries in the

entrenchment of health personnel in Africa because

13 months since Dr. Walsh’s declaration. She said that

vertical disease programs cannot work without solid

antimicrobial resistance is as urgent a matter as climate

horizontal foundations, with strong and well-staffed

change.

health systems. We have entered the “Post-Antibiotic Era,” Margaret Chan Macroeconomic institutions still reason that poor countries

stated at the joint WHO-WTO-WIPO meeting in 2013.

could manage epidemics with outside, case-by-case

Responses to Ebola and the threat of antibiotic-resistant

funding and without public health systems. However,

bacterial diseases, notably the imminent threat of enteric

Dr. Margaret Chan, the WHO’s current DG, says that it

diseases, are similar in many ways. They all demand

is doubtful if Official Development Assistance (ODA) and

strong, clean, universal healthcare systems with clean

private philanthropy alone is enough to achieve this,

water, and sanitized infrastructure.

especially in the “post-antibiotic era.” IPC in Healthcare Systems If African healthcare systems were “amplifiers” of Ebola,

Lack of infection control has been the weak link in Ebola

it is because they are weak and, in some countries, barely

according to Dr. Babacar N’Doye. The CDC study, “Cluster

existent. Both national authorities and macroeconomic

of Ebola Cases among Liberian and US Healthcare

institutions have neglected the need for good public

Workers in an Ebola Treatment Unit 2014,” admitted to

health. Poor levels of public health, weak infection

the “amplification” of Ebola by unsafe healthcare settings.

control, and insanitary environments could result in

There is general agreement on the need for Infection

major pandemics.

Prevention and Control (IPC) but very little action.

Corporate Africa

5


Responses to Ebola tends to lean too much on the side of

There has been much talk about the development of

medicines and too little on the preventative side. Africa’s

treatments and vaccines for Ebola, with promises of

big problem is IPC. The rate of nosocomial (disease care)

multimillion dollars and special protection equipment.

infections is far too high and efforts should be made in

Yet, insufficient attention is paid to the reinforcement of

this decade for better infection control. A person with the

health systems and how and what types are required.

flu comes into a health system and catches pneumonia;

It is the weaknesses of these systems in Liberia, Sierra

another with pneumonia comes in and gets Ebola, or HIV.

Leone, and Guinea that has given rise to the Ebola

This is unacceptable according to Dr. Abdulsalami Nasidi,

crisis according to Dr. Marie-Paule Kieny, WHO Assistant

Project Director, CDC Nigeria.

DG (for Health Systems and Innovations). She also stated that there is a need for emphasis on strong

In the study “Lessons from nosocomial viral hemorrhagic

health systems and infection prevention if collapses of

fever outbreaks,” Dr. Susan Fisher-Hoch arrived at a

health systems are to be averted and the Millennium

similar conclusion. Poor people, she said, are uneducated,

Development Goals achieved.

not stupid: even in remote communities they quickly grasp that the hospital are where people become infected with VHFs, so they shun them and hide the sick from medical personnel. This is a major reason why case finding can prove difficult. With the knowledge of this and consequences of poor practices in Africa, and some parts of Asia, she concluded that transmission of blood-borne

Responses to Ebola tend to lean too much on the side of medicines and too little on the preventative side.

viruses in medical facilities is probably common within the endemic care of hemorrhagic fever viruses. Hope for an Ebola-free Africa rests with the general public

Africa could leapfrog into a new era of healthcare

in West African communities who are mounting a great

systems if the necessary resources are put in place.

effort to contain Ebola and medical staff who deserve our

Mobile health delivery systems which can access patients

highest regard for their determination and courage.

in remote areas. Mobile surgery, laboratories, and diagnostics and procedures such as endoscopies at a

From

Ebola

to

antibiotic-resistant

enteric

distance should become an integral part of African health

diseases

systems. Robotics, mobile health delivery systems, and

Very advanced and very old technologies and methods

the internet are a vital in order to achieve this.

need to be used for comprehensive IPC, which is returning as a priority in the Post-Antibiotic Era. Dr.

Healthcare systems characterized by mobility should

Precious Matsoso, Director of the South African Health

become the norm. There is a real need to create

Services, spoke at the Norwegian Institute of Public

blueprints with contribution from public representatives,

Health meeting last year. She said that, in order to

innovation companies, engineers, universities, and field-

prevent the spread of antibiotic-resistant infections

based NGOs. Such new systems would combine primary

in health systems, we need to place emphasis on IPC

community-based

globally because it is central to Health as a Human

technologies. This is feasible, is in everyone’s interest,

Right.

and offers the best protection in line with a well-

care

with

very

advanced

mobile

resourced WHO. Members of other delegations from Africa at the same meeting firmly believed that an Africa-wide effort is long-

Garance Upham is an economist with 30 years’ experience

overdue to fight infection control. Some countries were

in public health, HIV, TB and infection control. She

keen to undertake such an initiative.

is the President of Safe Observer International and a founding member of the World Alliance Against Antibiotic

Strong health systems with adequate resources

Resistance (WAAAR) and “Patients for Patient Safety,” a

Health personnel need to be trained rapidly by the

branch of the World Health Organization Patient Safety

hundreds of thousands and be provided with decent

Program (2004 – Jan, 2014). The views expressed above

wages.

are entirely her own and have not been reviewed by the NGOs mentioned. ■

6

Corporate Africa


Weak Healthcare Systems Causes Epidemics Corporate Africa Correspondent Tsegaye Girma reports from Addis Ababa on the African Federation for Emergency Medicine meeting, and the importance of effective healthcare systems in the prevention of epdemics. Liberia’s post-war healthcare situation share similar features with Sierra Leone. When the country emerged from its 14-year-long civil war, 242 of the 293 public health facilities in operation before the war were rendered

Professor Lee Wallis, President of the African Federation for Emergency Medicine

T

non-functional according to a study published by the WHO in 2010. The study included a survey of health facilities in Nimba County in the north and 43 of the 49 surveyed health facilities did not provide all the basic

he African Federation for Emergency Medicine

services and equipment required, ranging from malaria

(AFEM) held its second annual conference last

treatment to emergency obstetric care. The situation was

November in Addis Ababa, Ethiopia. Challenges

the same for the rest of the country.

and recommendations to proffer effective emergency healthcare across Africa were high on the agenda.

Emergency care in a well-functioning healthcare system enables healthcare workers to isolate initial cases

Due to the prevalence of Ebola, broader issues of

of disease and alert health networks. None of those

emergency

agenda.

deeply-affected countries actually has any emergency

Delegates agreed that poorly-trained healthcare workers,

care systems that allow for isolation, according to Dr

lack of basic supplies, and the absence of responsive

Emilie Calvello, a clinical instructor in the Department

healthcare systems led to Ebola placing a heavy burden

of Emergency Medicine at Tawam Hospital. Her research

on affected countries.

highlighted the need for appropriate leadership, allocation

care

topped

the

conference’s

of adequate financing, and training of healthcare workers As is the case in much of sub-Saharan Africa, healthcare

at all levels of the healthcare system to enable delivery of

systems in Guinea, Liberia, and Sierra Leone fall short

adequate and effective emergency care across countries

of effective and adequate healthcare provisions for their

of sub-Saharan Africa.

citizens. The latter two in particular have healthcare infrastructure severely affected by recent civil wars.

The Ebola outbreak has taken a severe toll on fragile healthcare systems and courageous healthcare workers,

Even before the outbreak, Sierra Leone’s system was

many of whom were exposed to very high risk of infection

reeling from the effects of a decade-old war that

and death. More than 240 have succumbed to the virus.

ended in 2002. The war took its toll on the country’s

They are what Dr Bradley Dreifuss, Assistant Professor

healthcare system as health facilities were demolished

of Emergency Medicine at the University of Arizona, calls

and healthcare workers fled rural areas which were under

“the second burden of disease.”

the control of rebels. Lack of funding for the health sector

8

also made access to health services very difficult for

Hysteria surrounding Ebola, has led to absences of

the majority populace who live under the threshold of

healthcare workers causing patients with other urgent

extreme poverty.

care needs to go untreated, creating a second burden

Corporate Africa


effective surveillance systems. It has put emergency care on the agenda, offering a real opportunity to do things well, to invest well, train people well, and acquire good infrastructure and appropriate systems. The Conference declaration emphasized that building effective healthcare systems is key to containing outbreaks like Ebola and dealing with such pandemics in a timely and adequate manner. Stakeholders, including GOs, NGOs, multilateral and bilateral agencies, and the private and public sectors, were encouraged to act accordingly to ensure rapid development and strengthening of acute care systems. of disease. “Under-five-year-old mortality from malaria is going through the roof right now because there is no

International aid has been flowing to Ebola-affected

one willing to treat them because of fears over Ebola,”

countries, and the virus’s reach has been greatly reduced.

said Dr Dreifuss.

However, the need still exists to step up support to the region to make all the affected nations Ebola-free.

The current Ebola outbreak seems to have two effects on

Governments and the donor community are required to

the healthcare situation. On one hand, the outbreak has

work together to rebuild the healthcare systems of the

diverted attention from other acute care needs with high

affected countries and equip them with the resources

mortality rates such as malaria and respiratory conditions.

needed to contain epidemics. This will ensure that,

On the other hand, it has highlighted the need to put

emergency care systems and syndromic surveillance can

robust healthcare systems in regions likely to experience

be integrated to contain outbreaks at an early stage in

future outbreaks into place at an early stage through

rebuilding healthcare systems. ■

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All-oral Treatment Option for Multidrug-resistant TB A Private Public Partnership headed by the International Union Against Tuberculosis and Lung Disease recently rolled out a new treatment for multidrug-resistant tuberculosis. By Katia Yezli, The Union.

I. D. Russen, Senior Vice President for Research and Development, The Union

T

Against

Two regimens to be tested in the study include an all-oral,

Tuberculosis and Lung Disease) announced plans

nine-month regimen and a six-month regimen, which

he

Union

(the

International

Union

for new clinical research that would evaluate

will both include bedaquiline (a new anti-TB medicine

the effectiveness of two new treatment regimes for

developed by Janssen Research & Development, LLC).

multidrug-resistant tuberculosis (MDR-TB) last November.

The Union and the main trial partner, the UK Medical

If successful, the study will provide robust new evidence

Research Council, will enroll participants in the study

on the effectiveness of both all-oral and a six-month

from 2015 up until the first quarter of 2018. Results of

regimen for MDR-TB.

the study are expected in 2020.

The current standard treatment regime for MDR-TB lasts

The evaluation of these new regimens comprises the

up to 24 months and requires frequent injections, which

second stage of a larger ongoing clinical trial called

pose a significant burden on patients and health systems

“STREAM,” which is testing the effectiveness of shortened

tasked with administering treatment. Permanent hearing

treatment regiments for MDR-TB. The second stage of

loss is a serious and tragic side effect of the injected

STREAM is the result of innovative partnerships between

medicines used to treat MDR–TB.

the United States Agency for International Development (USAID), The Union, and Janssen. Such public-private

“If these new regimens are demonstrated to be effective,

partnerships are relatively rare in clinical research and

this research will help make MDR-TB substantially less

are essential to developing new treatments for MDR-TB.

burdensome for everyone involved,” said I.D. Rusen, Senior Vice President for Research and Development.

“USAID is committed to supporting research that will lead to better treatment outcomes for MDR-TB patients,” said

Undergoing treatment for multidrug-resistant TB currently is one of the most grueling experiences that a person affected by disease can face. It is also challenging for health workers to administer, and requires much greater investment of resources from the public health system compared with most other diseases. “The complexity and costs associated with treating MDRTB have a lot to do with why so few people with MDR-TB today receive successful treatment. MDR-TB patients shouldn’t have to choose between deafness and death,” said I. D. Rusen.

10

Corporate Africa

Dr Ariel Pablos-Mendez, USAID Assistant Administrator


Development (DIFD) and is testing a separate nine-month treatment regime, with results expected in 2017. About MDR-TB According to the World Health Organization (WHO), an estimated 480,000 people developed MDR-TB and an estimated 210,000 died from the disease in 2013. MDR-TB is defined as tuberculosis that is resistant to at least isoniazid and rifampicin, two of the most important first-line drugs typically used to treat TB. About the Union for Global Health. “Today, treatment for MDR-TB can be

For nearly 100 years, The Union has drawn from the

long, grueling and toxic. With an injection-free, more

best scientific evidence and the skills, expertise, and

tolerable, and shorter regiment, we can reduce the

reach of its staff, consultants, and membership in order

suffering associated with MDR-TB treatment and save

to advance solutions to the most pressing public health

lives. This collaboration with the Union and Janssen

challenges affecting people living in poverty around the

allows us to continue the important work of the STREAM

world. With nearly 17,000 members and subscribers

study.”

from 156 countries, The Union has headquarters in Latin America, North America, and South-East Asia.

The first stage of STREAM is primarily funded by USAID

The Union’s scientific departments focus on tuberculosis

with additional funding and support from the UK Medical

and HIV, lung health, and non-communicable diseases,

Research Council and the UK Department for International

tobacco control, and operational research. ■

Corporate Africa

11


ThermoFlash Equip Doctors to Fight Ebola Global Health Consultant Therese Lethu speaks with Fabienne Ostermeyer, Director of VISIOMED, about the features of ThermoFlash technology and its benefits.

The VISIOMED GROUP is working with the United Nations, local health authorities, and companies with large numbers of employees in Africa to battle Ebola ThermoFlash is the first clinical, contactless infrared

temperature of large populations. We are working with the

thermometer. Launched in 2007, it has revolutionized

United Nations, local health authorities, and companies

the monitoring of body temperature. ThermoFlash uses

with large numbers of employees in Africa. The product

infrared technology to remotely capture the invisible

has been referenced by NATO and widely used in the fight

waves emitted by the temporal artery which is directly

against H1N1.

connected to the heart. This wave is analyzed by an algorithm for an accurate reading of the body’s

How has your team managed to meet the growing

temperature.

needs of stakeholders and requirements of medical institutions or organizations in the fight against

Infrared radiation is an electromagnetic wave frequency

the pandemic?

lower than visible red light. In medical applications, it enables the identification of local temperature anomalies

We started to follow the Ebola outbreak in the late

(such as tendinitis or superficial inflammation). Since its

spring of 2014 when the first orders from the World

release, the VISIOMED GROUP has steadily continued to

Health Organization (WHO) and various NGOs arrived.

improve ThermoFlash’s quality and reliability.

Personally, I read everything available on the subject to know how best to help and answer questions from

Why is ThermoFlash particularly well-suited to

doctors.

monitor the Ebola virus? Since the start of beginning last November, we have faced

12

Fever is the first symptom in the contraction of Ebola

an increasing number of requests. Clients become more

and ThermoFlash is very suitable

anxious every day as fears increase and the pandemic

Corporate Africa

for monitoring the


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becomes overwhelming. It takes a calm attitude and

unfortunately attracts unproven equipment and that

a lot of organization to deal with the constant calls.

there are thermometers on the market which are the

Orders, once placed, are usually shipped within 24

same shape as ThermoFlash models but sold at lower

hours to any destination, but it should be able to go

prices. They may even be expensive but do not contain

faster and a continuous link between the VISIOMED

effective technology. It is so easy to deceive customers

GROUP and Africa should be established. Other potential

by putting an official brand on a cheaper product.

clients come directly to the office and place orders. We are facing a kind of fragmentation of demand, with each

This is why I keep knocking on doors to explain the

person buying for their own community.

beneficial qualities of ThermoFlash for use in clinics and hospitals. We reviewed all of our training materials

What

are

ThermoFlash’s

latest

technological

developments?

to improve the use of ThermoFlash and answer any questions asked. Being a leader in France with a solid reputation, attracts increasing numbers of African

Our latest generation of ThermoFlash incorporates a

medical societies who desire our listening capacity,

sensor which is capable of measuring the quality of

professionalism, and the reliability of our products.

the ambient air as a wave does not act the same in a Parisian hospital at 20°C as it would in West Africa with

The instantaneous transmission of information

100 per cent humidity in 30°C weather.

is essential to prevent the spread of the virus. How has the VISIOMED GROUP responded to this need?

Our new patented technology reinforces the reliability of the device since it includes a medical probe capable of measuring the quality of ambient air in real time.

Immediate transmission of information is a condition for the success of any monitoring program. That is why we have developed a concept of health monitoring based on new technologies. Bewell Control. Thermometers connect via Bluetooth to tablet computers and a central server. This allows real-time monitoring of temperature measurements and the possible centralization of all this data; allocation of resources where needed; and

Our last world patent, “Microsecondflash Technology,”

sending vital information and procedures via tablets.

provides a very accurate record of body temperature, even at extreme temperatures. This new patented

With this range of connected health products, our group

technology reinforces the reliability of the device since

had become the first electronic medical laboratory to

it includes a medical probe capable of measuring the

enter the market with a very high potential to be part

quality of the ambient air in real time. It takes clinical

of the Internet of Things (IoT – the interconnection

data into account and improves the accuracy of the

of uniquely identifiable embedded computing devices

measurement when it is very high or low.

within the existing internet infrastructure).

What is the optimal way to use the ThermoFlash?

BewellControl brings health professionals and public authorities a homogenous screening procedure, and

In TV reports, I am surprised by the number of people

instant epidemiological surveillance and monitoring of

pointing ThermoFlash equipment at the centre of a

communities and contacts. This new concept of health

person’s forehead or at their hands. We know that using

monitoring is, therefore, particularly well-suited to

it outside the temporal area of the forehead (where

African countries in response to their increasing need

the vein protrudes) may give completely erroneous

for epidemiological monitoring.

results. I get discouraged when I read that people complain about low-quality equipment, particularly in

Based in Paris, VISIOMED GROUP relies on a team of

the Washington post.

77 employees including health professionals. In 2013, the group achieved a turnover of € 11 million (US$

14

In speaking with doctors and other players in the field

12.65 million). VISIOMED Group has been called an

of medical equipment, it is notable that any crisis

“Innovative Company” by OSEO Innovation. ■

Corporate Africa


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The TheBD BDMGIT MGIT™ ™(Mycobacteria (MycobacteriaGrowth GrowthIndicator Indicator Tube) Tube)system systemcan canshorten shortenthe therecovery recoveryofofTB TBinin culture culturefrom from42 42days daystotoasaslittle littleasas10-14 10-14days. days. This Thiscan cancontribute contributetotothe thereduction reductionininspread spread and andmortality mortalityofofTB, TB,particularly particularlyininHIV-infected HIV-infected individuals, individuals,where whereititisisespecially especiallydifficult difficulttotodiagnose. diagnose. Named Namedone oneofofthe theWorld’s World’sMost MostAdmired Admired wellasasone oneofofthe theWorld’s World’sMost Most Companies Companies®2®2asaswell , BD , BDprovides providesadvanced advanced Ethical EthicalCompanies Companies®3®3 medical medicaltechnology technologytotoserve servethe theglobal global community’s community’sgreatest greatestneeds. needs. BD BD––Helping Helpingall allpeople peoplelive livehealthy healthylives. lives.

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Health supplement Africa issue 61  
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