Major Concerns
Although the incidence of tuberculosis is falling, the
rate of decline is slow, at less than 1% per year. An estimated 37% of
cases of smear-positive TB are not being treated in DOTS programs; more
than 90% of new cases of MDR -TB are not being diagnosed and treated
according to international guidelines; the majority of HIV-positive TB
cases do not know their HIV status, and those who know, are not yet
accessing anti-retroviral therapy.
Box: Status Report for Tuberculosis and its Control
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Globally, an estimated 9.27 million new cases (15% amongst HIV +ve) occurred in 2007; mostly in Asia (55%)
and Africa (31%).
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Globally, an estimated 9.27 million new cases (15% amongst HIV +ve) occurred in 2007; mostly in Asia (55%)
and Africa (31%).
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The maximum number of cases occurred in India (2.0 million), China (1.3 million), Indonesia (0.53 million),
Nigeria (0.46 million) and South Africa (0.46 million).
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There were about 1.75 million TB deaths; over 25% occurred in HIV-positive persons.
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The incidence decreased marginally from 142 per 100 000 in 2004 to 139 per 100 000 population in 2007;
prevalence and mortality rates also falling globally in all six WHO regions.
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TB was the most common cause of death among people living with HIV/AIDS in 2007. HIV-positive people are
about 20-37 times more likely to develop TB.
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There were an estimated 0.5 million cases of multi-drug resistant TB (MDR -TB) in 2007 with maximum number
from India (131 000).
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Extensively drug resistant TB (XDR -TB) has been reported from 55 countries.
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In 2007, 5.5 million TB cases (2.6 million smear-positive) were notified by DOTS programs (99% of total case
notifications). The case detection rate of new smear-positive cases under DOTS was 63 percent; 7 percent short
of the target of 70% or more for 2005.
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Globally, the rate of treatment success for new smear-positive cases treated in DOTS programs in 2006
reached the target of 85%.
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In 2009, a total of US$ 3.0 billion is available for TB control in 94 countries which account for 93% of the world’s
TB cases as against the requirement of US$ 4.2 billion. Most of the extra funding required is for MDR -TB diagnosis
and treatment in India and China, and for DOTS and collaborative TB/HIV activities in Africa.
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Indian scenario: A lot needs to be done
There is a huge burden of TB in India including the MDR
and XDR cases. All government health facilities in India were providing
DOTS services by 2006, and there are ongoing initiatives to collaborate
with the private sector, non-governmental organizations and medical
colleges. This collaboration has helped to achieve a case detection rate
of 68% (2007) and a treatment success rate of 86% (2006). Services to
control MDR-TB are now available in six states, with culture and drug
susceptibility testing facilities in five state-level laboratories(1).
According to current data, India and South East Asia region are well on
target to achieve goals by 2015, the overall performance on the ground
leaves scope for improvement.
Every year more cases are being detected and put on
treatment than in the previous year under DOTS strategy. While this is
projected as success of the program, in that its detecting efficiency is
increasing, in reality it witnesses the failure of 45 years of attempted
TB control. Besides this, many cases are being treated, often
irrationally, outside the government facilities. Ensuring the rational use
of anti-TB drugs outside the Revised National TB Control Program is
crucial. Government should now re-design primary health care in rural and
urban communities in order to combine quality and equity in TB care. The
control of TB offers India a unique opportunity to construct a model of
primary health care linked to public health(2).
There is an urgent need to develop reliable and
accurate diagnostic tools, new drugs and an effective vaccine(3).
Additionally, efforts to control tuberculosis should engage communities to
reduce stigma, support care and develop local solutions.
1. Global Tuberculosis Control Report 2009. Available
from: URL: http://www.who.int/tb/publications/global_report/2009/pdf/full_
report.pdf. Accessed April 4, 2009.
2. John TJ. Tuberculosis control: detect and treat
infection in children. Indian Pediatr 2008; 45: 261-264.
3. Smith R. Eradication of tuberculosis by 2050 impossible without new
vaccine. BMJ 2009; 338: b1291.
