Indonesia was the patron for the recent Bali summit on TB and diabetes organised by The Union and World Diabetes Foundation, as a country deeply impacted by this looming co-epidemic. It ranks fifth in terms of TB incidence globally, but there are approximately 9.1 million adults with diabetes – an enormous pool of people who have a three times higher risk of developing active TB.
The Union has assessed that the Indonesian provinces that overlap in terms of the highest DM and TB prevalence rates include Aceh and North Sumatera, most of Kalimantan and parts of Sulawesi.
Despite the challenges of accessibility and availability of healthcare services in some of these provinces, piloting dual strategies with a multi-level approach could be a good step to controlling the epidemic. While community engagement is vital at the primary healthcare level, routine bi-directional screening for TB among people with diabetes and vice versa at the tertiary or hospital level for testing is important too. This is in line with the Collaborative Framework for Care and Control of Tuberculosis and Diabetes, jointly developed by the Union and the World Health Organization.
Says Dr Anthony D Harries, The Union’s Senior Advisor and Director of Research, “There are likely to be challenges such as disseminating protocols throughout Indonesia’s vast healthcare system. Collaborative initiatives should be gaining momentum as the TB-DM co-epidemic becomes a serious health concern. We do have an opportunity to implement recommendations on a short- and long-term basis.”
With the signing of the Bali Declaration at the conclusion of the summit, Indonesia and other countries have committed themselves to taking the actions needed to address these linked diseases.
For further information, see also: The Looming Co-epidemic of TB and Diabetes (The Union/World Diabetes Foundation, 2014).