World TB Day 2000 Global Situation

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World TB Day 2000 Global Situation

• Edward A. Nardell, MD
• Associate Professor of Medicine,
• Harvard Medical School
• Tuberculosis Control Officer,
• Massachusetts Department of Public Health

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Thanks, for use of slides...

• Ian Smith, MD, WHO
• Christopher Dye, PhD, WHO

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TB and Development
Combating ill health
Combating ill health
450-1000
22,000-31,100
GNP per capita (1995)
Source J. Sachs (Harvard)
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Source Global Tuberculosis Control WHO Report
2000
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Source Global Tuberculosis Control WHO Report
2000
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Poverty Disease Facts

• 1.3 billion people live in absolute poverty on
  less than US 1 per day
• Nearly 50 of people live on less than 2 a day
• Poverty and disease in poor and non-poor
• Adult mortality 2.2 x higher in males, 4.3 x
  higher in females
• Under 5 mortality males 4.3 x higher, females
  4.8 x higher
• Maternal mortality 1 in 12 (1 in 4,000 in
  Europe)
• Risk of tuberculosis 2.6 times higher

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Poverty Communicable Disease

• Communicable diseases cause 25 of disease burden
  in poor countries, and 2.5 in rich countries
• TB, malaria and HIV make up 10 of global disease
  burden

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Poverty TB

• Poor 2.6 times as likely to get TB than non-poor
• Poor less likely to seek and receive care, more
  likely to self medicate
• Non-treatment costs higher than treatment costs
• Largest indirect cost loss of work, 3-4 months
  per patient (20-30 annual household income)
• Premature death means loss of about 15 years
  income

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• Government commitment
• Passive case finding
• Diagnosis by sputum microscopy
• Directly observed Rx, short-course
• Standardized regimens
• Continuous supply of effective drugs
• Cohort analysis of outcome

DOTS
S
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Cost Effectiveness of DOTS

• Drug costs fallen from US 40-50 in 1990 to US
  10-20 in 2000
• DOTS costs US 3-7 per DALY saved
• US1 invested by government now saves up to 50
  for community over next 20 years

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Global Progress with DOTS
Total number of countries
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The Progress...
Indicator
1991
1997
No. countries adopting DOTS strategy Global TB
patients treated under DOTS system Average cost
of Anti-TB drug regimen, per patient External aid
for TB control in developing countries (excluding
WHO) WHOs budget for TB-related activities
10
110
lt1
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US40-60
US10-20
Approx. US100m
US16m
US2m
US25m
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1998 Steady progress..but....

• 45 of estimated global TB cases notified
• All 22 high burden countries adopted DOTS
• 43 global population has access to DOTS (double
  1995)
• 78 treatment success with DOTS

• Only 21 of infectious patients were treated in
  DOTS programmes
• Only two high burden countries have met the
  global targets
• Only 62 treatment success in Africa
• MDR TB and HIV pose serious threats

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Source Global Tuberculosis Control WHO Report
2000
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TB incidence and HIV seroprevalence in AFRO
Source WHO/CDS
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TB and HIV

• Profound impact on TB epidemic in sub Saharan
  Africa and parts of South East Asia
• Nearly 11 million people co-infected with TB and
  HIV
• About 8 of TB cases were associated with HIV
  infection in 1997
• Increased TB case fatality rates (23 on average)

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• "Without Koch's discovery, the socioeconomic
  character of tuberculosis would have been
  clearer, and a demand for redistribution of the
  wealth of the community would have become a much
  more important issue."
• Waaler

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Global Expenditure on TB
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National wealth and debt
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Conclusion

• Poor people get TB, TB makes people poor
• Poor countries get TB, TB makes countries poor
• It is obscene that 2 million people - 98 in
  poorest countries - die every year from a
  preventable disease
• TB follows the 95 - 5 rule
• Addressing the TB pandemic means addressing
  issues of poverty, equity and debt

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• The growing tuberculosis epidemic is no longer
  an emergency only for those who care about
  health, but for those who care about justice
• World Health Organization. TB - A global
  emergency. Geneva WHO 1994

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Stop TB

• An expanded global partnership across all sectors
  of society to
• Ensure that every TB patient has access to TB
  treatment and cure. This is a human right.
• Protect vulnerable populations, especially
  children, from TB and multi-drug resistant TB
• Reduce the social and economic toll that TB
  exerts on families and communities

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