To mark world TB day, 24 March 2003, the World Health Organization
(WHO) has published the seventh annual report on global tuberculosis (TB)
control. This report aims to share information from national TB control programmes,
and includes data on case notifications and treatment outcomes. It also provides
analysis of plans, finances and constraints on DOTS (directly observed treatment-short
course) expansion for the 22 high burden countries in order to assess progress
toward global targets for case detection (70%) and treatment success (85%).
According to this report, there were an estimated 8.4 million new cases
of tuberculosis in 2001. Total notifications in Europe represent 10% of
global notifications in 2001, with case detection over 70% in 35 of the
51 countries in the WHO European region, according to revised estimates.
The tuberculosis epidemic is still growing by approximately 0.4%/year, but
much faster in sub-Saharan Africa and in countries of the former Soviet
Union (1). The TB epidemic is closely linked to HIV and poverty in sub-Saharan
Africa, and is exacerbated by disruption to public health services in many
countries of the former Soviet Union (2). In some sub-Saharan African countries
with high HIV prevalence, TB rates have quadrupled since the mid 1980s,
threatening to overwhelm well established TB control programmes. AntiTB
drug resistance, an increasingly recognised effect of inappropriate TB control
will be dealt with in a specific report expected to be published by the
end of 2003.
The number of countries implementing DOTS has increased, bringing the total
to 155 out of 210 countries. By the end of 2001, 61% of the world's population
lived in DOTS areas.
Two thirds (67%) of the additional smear-positive cases reported under
DOTS in 2001 (compared with 2000) were found in India alone. There were
smaller but marked improvements in case detection in Myanmar, the Philippines,
and Thailand. Other high burden countries made minor gains in case detection,
though Pakistan and Brazil reported significant increases in the geographical
coverage of DOTS.
Treatment success under DOTS for the 2000 cohort was 82% on average, and
has moved closer to the 85% target as the patient population has grown in
size. In the African region, treatment success was only 72%.
In the WHO European region, DOTS coverage exceeded 90% of the population
in 14 of the 22 countries (five in the West, five in the Centre, and four
in the East) in 1999 (3). As DOTS programmes have expanded geographically,
the proportion of estimated cases found within DOTS areas has remained constant
at 40-50%. If the 70% target is to be met, DOTS programmes must improve
case finding within designated DOTS areas. The constraints on DOTS expansion
most often identified were lack of qualified staff, insufficient preparation
for decentralisation, non-compliance of the private sector with DOTS, inadequate
health infrastructure, and weak political commitment.
The EuroTB annual report 2000 (http://www.eurotb.org/)
includes data on treatment outcome for TB cases notified in 1999 in 30 of
the 51 countries of the WHO European Region.