Assessment of worldwide tuberculosis control

doi:10.1016/S0140-6736(97)04146-9

The Lancet

Volume 350, Issue 9078, 30 August 1997, Pages 624-629

https://doi.org/10.1016/S0140-6736(97)04146-9 Get rights and content

Summary

Background

Because worldwide tuberculosis (TB) control had never been assessed, WHO set up a surveillance and monitoring project in 1995. The objectives were to assess the performance of national TB programmes; to assess the extent of implementation of the WHO strategy of TB control; and to attempt a comparison between regions that had adopted the WHO strategy and those that had not.

Methods

In June, 1996, we sent data-collection forms requesting information on national TB programmes' control policies, 1995 case notifications, and 1994 treatment results to 216 countries, areas, and territories. We assessed the performance of national TB programmes by comparing case notifications with estimated incidence and by outcome of treatment in cohorts of patients. We also investigated worldwide treatment success and case detection among sputumsmear-positive patients.

Findings

180 (83%) of the 216 countries, areas, and territories surveyed replied to WHO (98% of the worldwide population). In 1995, the WHO control strategy had been implemented in 75 countries, and in 39 of these implementation was countrywide. Up to 23% of the worldwide population lived in regions where the strategy was available. In 1995, 3 297 688 cases of TB (all types) were reported, of which 1 161 411 (35%) were sputum-smear positive. 54% of all reported cases in countries that used the WHO strategy were sputumsmear positive, compared with 30% in other countries. The worldwide case-detection rate of new sputum-smearpositive cases was 35%. 92% of cases registered for treatment in 1994 in regions that used WHO strategy were assessed for outcome and 76% were treated successfully, compared with 54% and 42%, respectively, in regions that had not implemented the WHO strategy. Among cases reported worldwide in 1994, the documented treatment-success rate was 43%

Interpretation

National TB programmes that have adopted the WHO TB control strategy achieve higher cure rates, but their impact on TB is modest on a worldwide scale. Wider continuous coverage with the WHO strateg is needed for effective worldwide TB control.

Introduction

Tuberculosis (TB) has been neglected as a publichealth issue for many years by many countries and remains the major cause of death from a single infectious agent among adults in developing countries. There has been a resurgence of TB in industrialised countries.¹: Several factors, most notably a lack of resources and government commitment, have prevented adequate implementation of control measures. In many countries of Africa and southeast Asia, infection with HIV has further increased TB morbidity and mortality.2, 3, 4 In several formerly socialist countries, TB morbidity and mortality continue to rise because of the deterioration of public-health systems.⁵ Finally, in many industrialised countries the recent increase of TB, which is due largely to cases among immigrants from other countries,6, 7, 8 is the direct consequence of worldwide neglect. In 1993, WHO declared TB to be a global emergency.¹ The exact burden of disease, however, is not known and the worldwide achievements of national TB control programmes in terms of diagnosis and treatment results have not been analysed.

The key to controlling TB is rapid detection and cure of infectious cases by TB control programmes. In 1991, the World Health Assembly recommended that national TB programmes should work towards two objectives by the year 2000: to treat successfully 85% and to detect 70% of smear-positive cases⁹ by the introduction of an effective approach to TB control. The WHO TB control strategy (directly observed treatment, short course) is defined by five elements: government commitment to TB control; case detection focusing on patients with symptoms self-reporting to health services and use of sputum-smear microscopy; administration of short-course chemotherapy in a standard way throughout the country with direct observation of treatment during, at least, the first 2 months of treatment; a regular supply of all essential antituberculosis drugs; and a standard recording and reporting system that allows assessment of treatment results.¹⁰

To assess the achievements of TB control, WHO set up a worldwide surveillance and monitoring project in 1995. We present the first results, focusing on the extent of implementation of the WHO strategy and the

performance of national TB programmes, and attempt to compare areas that have and have not adopted the WHO strategy.

Section snippets

Methods

In early 1996, we developed two data-collection forms requesting information on TB-control policy, cases reported for 1995, and treatment outcomes among patients registered during 1994. The first form asked questions in the standard format proposed by WHO¹⁰ for countries or areas within countries where the WHO strategy was implemented. The second form was designed for countries and areas where the WHO strategy had not been implemented and did not request certain data-for example, re-treatment

Results

By 1 July, 1997, WHO had received data from 180 countries, areas, and territories (83% of the 216 surveyed, 98% of the worldwide population). Of these, 84 (47%) areas had not yet accepted the WHO strategy, 75 (42%) had implemented the strategy (39 in >90% of the population), and 21 (12%) had a casenotification rate of less than ten per 100 000 population (table 1). 2% of the worldwide population lived in countries that did not report to WHO, 27% in countries where the WHO strategy was not

Discussion

The main purposes of this study were to assess the extent of implementation of the WHO strategy worldwide, the achievements of national TB programmes, and the progress towards the achievements of the two WHO targets set by the World Health Assembly in 1991.⁹ Of the 216 countries, areas, and territories surveyed, 83% replied to WHO.

By the end of 1995, the WHO strategy had been accepted in 75 countries (35%) of the 216 surveyed), but only 39 countries had implemented the strategy countrywide. The

References (22)

JP Narain et al.
HIV-associated tuberculosis in developing countries: epidemiology and strategies for prevention
Tuberc Lung Dis
(1992)
MC Raviglione et al.
Tuberculosis trends in Eastern Europe and the former USSR
Tuberc Lung Dis
(1994)
VH Springett
Ten-year results during the introduction of chemotherapy for tuberculosis
Tubercle
(1971)
MW Uplekar et al.
Private doctors and tuberculosis control in India
Tuberc Lung Dis
(1993)
AD Harries et al.
Tuberculosis programme changes and treatment outcomes in patients with smear-positive pulmonary tuberculosis in Blantyre, Malawi
Lancet
(1996)
MC Raviglione et al.
Global epidemiology of tuberculosis: morbidity and mortality of a worldwide epidemic
JAMA
(1995)
KM De Cock et al.
Tuberculosis and HIV infection in sub-Saharan Africa
JAMA
(1992)
H Yanai et al.
Rapid increase in HIV-related tuberculosis, Chiang Rai, Thailand, 1990–1994
AIDS
(1996)
MF Cantwell et al.
Epidemiology of tuberculosis in the United States, 1985 through 1992
JAMA
(1994)
MT McKenna et al.
The epidemiology of tuberculosis among foreign-born persons in the United States, 1986 to 1993
N Engl J Med
(1995)

MC Raviglione et al.

Secular trends of tuberculosis in Western Europe

Bull World Health Organ

(1993)

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ArticlesAssessment of worldwide tuberculosis control

Summary

Background

Methods

Findings

Interpretation

Introduction

Section snippets

Methods

Results

Discussion

Tuberc Lung Dis

Tuberc Lung Dis

Tubercle

Tuberc Lung Dis

Lancet

Global epidemiology of tuberculosis: morbidity and mortality of a worldwide epidemic

JAMA

Tuberculosis and HIV infection in sub-Saharan Africa

JAMA

Rapid increase in HIV-related tuberculosis, Chiang Rai, Thailand, 1990–1994

AIDS

Epidemiology of tuberculosis in the United States, 1985 through 1992

JAMA

The epidemiology of tuberculosis among foreign-born persons in the United States, 1986 to 1993

N Engl J Med

Secular trends of tuberculosis in Western Europe

Bull World Health Organ

Articles
Assessment of worldwide tuberculosis control