Wetmore TB Foundation
TB Education
Professional HotLine
International Perspectives - GROUPS AT RISK
WHO Report on Tuberculosis 2002 - Executive Summary
WHO
Report 2002
WHO/CDS/TB/2002.295
Global
Tuberculosis Control
Surveillance, Planning, Financing
Background and aims
1. This is the 6th annual report on global TB control. It includes data on case notifications and treatment outcomes from all national control programmes that have reported to WHO, together with an analysis of plans, finances, and constraints on DOTS expansion for 22 high-burden countries (HBC). Seven consecutive years of data are now available to assess progress towards the 2005 global targets for case detection (70%) and treatment success (85%).
Methods
2. During 2001, a standard form for reporting surveillance data was sent to 210 countries via WHO regional offices. The form requests information about policy and practice in TB control, the number and types of TB cases notified in 2000, and the outcomes of treatment and retreatment for smear-positive cases registered in 1999.
3. NTP managers in the 22 HBC were asked to identify the major constraints to DOTS expansion, and to present 3-5 year plans and budgets to overcome these constraints as they move towards target case detection and cure rates.
Main findings
4. The number of
countries implementing the DOTS strategy increased by 21
during 2000, bringing the total to 148 (out of 210). By
the end of year 2000, over half (55%) the world’s
population lived in parts of countries providing DOTS.
DOTS programmes notified almost two million new TB cases,
more than one million of which were smear-positive.
Back to
top
5. However, the 1.02 million smear-positive cases notified under DOTS represent only one quarter (27%) of the estimated total, and the rate of progress in case finding between 1999 and 2000 was no faster than the average since 1994, a mean annual increment of 133 000 smear-positive cases. Globally, DOTS programmes must recruit an extra 330 000 smear-positive patients each year to reach 70% case detection by 2005.
6. Over half of the additional smear-positive cases reported under DOTS in 2000 (as compared with 1999) were found in just five countries - India (28%), the Philippines (19%), Ethiopia (6%), South Africa (5%) and Myanmar (4%). Only India, the Philippines, and Myanmar significantly increased the proportion of all new cases detected.
7. DOTS programmes
successfully treated 80% of all registered new
smear-positive patients in 1999, but only 19% of all new
smear-positive cases estimated to have arisen that year.
Back to
top
8. Following the departure of Peru from the list of HBC, Viet Nam was the only high-burden country to have reached targets for case detection and cure by the end of year 2000.
9. The constraints on DOTS expansion most commonly identified were: lack of qualified staff and management skills, shortage of laboratory equipment, absence of collaboration between TB and HIV programmes, an unregulated private sector, and decentralization of health services. Other constraints restricted to a subset of HBC include poor access to health services (e.g. Ethiopia, Mozambique), and war (Afghanistan, DR Congo).
10. All 22 HBC have prepared a plan for DOTS expansion, with the collaboration of international technical partners; 11 have established National Interagency Coordination Committees (NICC); 19 have budgets for one or more years 2002-5; six were assisted by the Global Drug Facility (GDF).
11. The budgets
developed by the 22 HBC, which usually focus on costs
specific to TB control only, currently total
US$ 436-486 million per year for the period 2002-5.
At least 17% of this total is not yet funded. The largest
anticipated shortfalls are in Afghanistan, DR Congo,
Indonesia, Myanmar, Uganda and Pakistan, where 29-100% of
the budget is not yet funded. When the costs not covered
in these budgets are added, the total public investment
required in TB control in the 22 HBC is estimated at
around US$ 1 billion per year, with a funding gap of
up to US$ 300 million per year.
back to top
Conclusion
12. Between 1999 and 2000, global TB control continued along the steady but slow path traced since 1994. At this rate of progress, the target of 70% case detection under DOTS will not be reached until 2013.
13. 2001 was a year for the preparation of plans and identification of funding gaps; the emphasis in 2002 will be on implementing these plans for DOTS expansion.
14. Funds permitting, the biggest advances during 2002 are expected in Cambodia, China, India, Myanmar, Pakistan, the Philippines, and Uganda. The challenge will be to show that DOTS expansion in these and other countries can significantly accelerate case finding while high cure rates are maintained.
Reprinted from Global Tuberculosis Control
Global Tuberculosis Programme, World Health Organization, 20 Avenue Appia CH-1211 Geneva 27 Switzerland
Get more information on fighting TB throughout the world!
Global Tuberculosis Programme
World Health Organization
GTB is dedicated to fighting the TB problem and we need your help. If you are interested in what we do and how you can aid in disseminating information about TB, please follow the easy instructions below.
In your correspondence, please reply to any of the following questions:
Send your
request! Please send the following information:
Name / Position
Organization
Full Address Country
Phone / Fax
E-mail
For WHO TB documents, please contact the:
CDS Information
Resource Centre
World Health Organization
20 avenue Appia
1211 Geneva 27
Switzerland
Tel: +41 22
791 3504
Fax: +41 22 791 4285
Email: CDSDOC@who.int
Disclaimer: The material on the LSU-Wetmore TB website and subsequent e-mail correspondence in respone to your queries is for general information only. It is not meant to constitute a patient-physician relationship and whereas confidentiality will be maintained, it cannot be guaranteed. If you have any further questions, you should consult your personal physician or qualified health care provider in your area for specific advice and follow-up.
Copyright 1997-2003 LSUHSC Wetmore TB Info