Most deaths occur in the underdeveloped countries, most specifically sub-Saharan Africa.  TB kills more young people and adults than any other infectious disease and is the world's biggest killer of women; although the disease can be cured, there are no modern methods of detection, and no advanced and rapid methods of treatment.  Add to this mixture the age old problems of shortage of money and the lack of cheaper, readily available pharmaceuticals and the result is a pandemic of massive proportions.

Even in the United States, where in the 1900s TB was one of the leading causes of death, there is still a significant national health problem.  In 2003 some 14,000 cases were reported (that's 5.1 cases per 100,000 population per year) and today there remains a disease reservoir of approximately 15 million infected people. 

Mycobacterium tuberculosis (TB) is a disease caused by bacteria that attack, usually, the lungs, but can also pinpoint the kidney, spine and brain.  If left untreated, it can kill.  It is an airborne infection so when infectious people cough, sneeze, talk or spit, they release TB germs knows as TB bacilli into the air which can be ingested by others.

Not everyone infected will develop the full blown disease and will not necessarily exhibit the normal symptoms:- a long lasting bad cough, pain in the chest, coughing up phlegm or blood from deep in the lungs, weakness, fatigue, weight loss, lack of appetite, chills, fever and sweating at night.  Those with latent TB cannot spread the disease to others, and sometimes never go on to develop active TB.  The immune systems kept the TB at bay, but the bacilli, protected by a thick, waxy, mucus-like protective layer can lie dormant for years.  If the immune system is weakened for any reason, the chances of developing active TB increase.

Angola
These pictures were taken in a Medecins Sans Frontieres (MSF) health centre in Kuito, the capital of the central province of Bie in Angola, where medical workers are becoming increasingly alarmed at the growing prevalence of tuberculosis in the country.  This tented medical facility looks after over 400 TB patients, and is one of the many funded by the Belgium based NGO (non governmental organisation).

Three decades of civil war in Angola has displaced 35% of the population and destroyed 70% of the country's health facilities.  It was estimated, in 2002, that there were over 44 thousand cases of TB out of a population of 13 million, but this figure is growing daily.  Of the clinics that survived conflict, only a fifth have laboratory facilities, and the drugs to fight TB, although available in the capital  Luanda, are in irregular supply for the rest of the country.  Bie Province was in the heart of the fighting so the country's transportation network has been decimated over the years, and with many roads still heavily mined, large areas of the interior remain inaccessible.  Civil war breeds refugees, which in itself is a major problem in countries like Angola - poor nutrition and health, plus overcrowding in refugee camps and shelters allows an untreated disease to spread quickly.  Not only is it difficult to treat a mobile population, this mobility leads to discrepancies in population figures; the government figures put that of Bie province at some 2.8 million whereas United Nations estimates are jut over one millions doctors can only guess at the scale of the problem.

Detection
Despite WHO (World Health Organization) reports to the contrary, medical workers in the field will attest to the fact that a main failure in coping and containing such a widespread disease is the lack of a positive screening programme to detect infected people at an early stage.  So far, only people who turn up at the health posts complaining of feeling ill will be tested.  For such a virulent and prevalent disease, it is a travesty that the only tool with which to diagnose it, was invented in 1882 and hasn't been modified since.  This is a sputum test, which basically means taking phlegm that has been coughed up from deep within the lungs, and then testing under a microscope to identify the bacilli.  In ideal conditions, ie. sterile environment, and in the absence of any other infections such as HIV, the sputum test will  detect 75% of pulmonary TB, but for young children, who are most at risk from the disease, people with extra-pulmonary TB (bacteria elsewhere in the body other than the lungs) and the majority of HIV patients with TB, the test is virtually useless.  One offshoot of extra-pulmonary TB is ganglions or lumps in the neck, back or abdomen.  While not normally painful, these lumps can cause discomfort and attack the vertebrae in the back, leading, in serious cases, to paralysis.  Indications from a passive screening programme administered by MSF in Bie Province show that the rate of prevalence of the disease is four times the normal rate.
.
This child's little body has been so wasted by the disease that the doctors are finding it difficult to find a vein in which to insert a needle for a saline drip, to re-hydrate him.  He died two hours after this picture was taken.  He was two and a half years old.

Treatment
Until 50 years ago, there were no medicines to cure TB, and now, like the diagnostic tests, the medication used to treat TB is from another era.  The drugs, which were invented three to five decades ago, are only available in the main towns and there is no distribution system to get them to outlying areas.  The tablets have to be taken under controlled conditions for long periods of time - 4 to 6 pills every day for up to eight months, requiring a long term stay in a health centre or sanitorium.

In addition, TB tablets have to be taken under the supervision of an observer - this last to make sure that any development of multi-drug resistance is caught quickly because as yet there is no other drug available to treat TB.  Patients who develop multi-drug resistant TB have to endure up to two years of hospitalized treatments with expensive drugs whose severe side effects can cause acute psychosis.