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[PARIS] Effective control of tuberculosis, which has had a dramatic resurgence in the last 20 years, requires the active involvement of a better-informed civil society.

This is the common conclusion of five reports released by a US-based policy institute at the 37th World Congress on Lung Health, held this week in Paris, France.

In 2005, more people died of tuberculosis (TB) — 1.7 million — than in any other year in history.

The rebound has been attributed in part to the spread of HIV in many countries, but these reports also identify a lack of awareness about TB as a major contributing factor.

This ignorance, say the reports by the Open Society Institute's Public Health Watch initiative, stems from the failure of governments, media and civil society organisations to communicate the issues to the public and to high-risk groups such as the HIV-positive, including the fact that it can be cured.

"There is an unhealthy silence around TB," said Olayide Akanni, one of the reports' authors and a senior programme officer with Journalists Against AIDS in Nigeria.

"People know the signs and symptoms of HIV/AIDS, but that's not the case with TB, even though it's a major killer."

The reports looked at national TB policy in Bangladesh, Brazil, Nigeria, Tanzania, and Thailand, and were put together with substantial input from communities most affected by TB.

They identified successful local approaches to improve TB treatment uptake.

Examples include a programme in Bangladesh that refunds patients a deposit when they have completed a full course of treatment. This is now being emulated in Afghanistan and some African countries.

Ignorance about TB transmission and treatment can lead to stigma and discrimination, the reports show. This negatively impacts adherence to treatment and increases mortality and drug-resistance.

Poverty can further compound these problems because treatment may contain hidden costs, such as travel to clinics, which further reduce the chances of completing a full course of treatment.

The reports call for government officials and civil society to join efforts to increase awareness about the symptoms of TB, available treatment, and the high risk of co-infection with HIV/AIDS.

"There is a kind of closed circuit between governments, the World Health Organization, and professionals and bureaucrats," investor and philanthropist George Soros, founder and chairman of the Open Society Institute, told SciDev.Net.

"People and communities have the right to demand more effective action from their governments and from global leaders," he said.

Link to full reports