An Overview of TB in SAARC Countries and

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An Overview of TB in SAARC Countries and Role of
SAARC TB Centrein TB Control Dr Paras K
Pokharel, Associate Professor Dept. of Community
Medicine, BPKIHS Dr Dirgha S Bam Director
SAARC TB Centre
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Global TB Burden
50 of Global TB Burden occurs in 5 countries of
South East Asia India, Indonesia, Bangladesh,
Thailand, Myanmar
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TB is the leading single infectious cause of
death in South-East Asia
Deaths from infectious agents in South-East Asia
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Prevalence of TB in poor and non poor populations
in developing countries

• TB is a
• disease of
• vulnerable
• populations,
• eg
• poor
• women
• refugees
• prisoners

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TB is a Leading Killer of Women
Deaths among women
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Tuberculosis and SAARC
TB a Major Public Health Problem in South Asian
Countries with 38 total Global TB Burden
SAARC Global

• New TB Cases 2.5 million/year 8
  million/year
• Deaths due to 0.6 million/year 2
  million/year
• TB

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Tuberculosis and SAARC
TB a Major Public Health Problem in South
Asian Countries with 38 total Global TB Burden

• Population 1,300 million
• Prevalence of Tuberculosis 6 million
• New Cases of TB per year 2.5 million
• Death per year 0.6 million

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Estimated TB Incidence
New TB Cases Countries in
Million
Bangladesh 0.30 Bhutan Maldives 0.01 India
1.80 Nepal 0.05 Pakistan 0.26 Sri
Lanka 0.04
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22 countries 80 global TB burden
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TB in South Asia
All countries
India
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Global HIV Epidemic

• 33.6 million people living with HIV
• 5.6 million new infections and 2.6 million deaths
  in 2000
• 10 of new cases under 15 years
• 40 of cases in women
• 16.3 million deaths since beginning of epidemic

WHO/UNAIDS AIDS Epidemic Update December 2000
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Estimated No. of Adults and Children living with
HIV/AIDS as of end 2000
Western Europe 520 000
North America 920 000
Eastern Europe Central Asia 360 000
East Asia Pacific 530 000
North Africa Middle East 220 000
South South-East Asia 6 million
Caribbean 360 000
Latin America 1.3 million
Sub- Saharan Africa 23.3 million
Australia New Zealand 12 000
Total 33.6 million
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Western Europe 30 000
North America 44 000
Eastern Europe Central Asia 95000
East Asia Pacific 120000
Caribbean 57 000
North Africa Middle East 19000
South South-East Asia 1.3 million
Latin America 150 000
Australia New Zealand 500
Sub- Saharan Africa 3.8 million
Total 5.6 million
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Current HIV Situation

• High HIV prevalence India, Myanmar and
  Thailand
• Low HIV prevalence in women in antenatal clinics
  but relatively high among IDU Nepal
• Low HIV prevalence Bangladesh, Bhutan,
  Indonesia, Maldives and Sri Lanka
• No reported HIV DPR Korea

HIV now declining
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To Summarize...

• Majority of new HIV infections are now in
  developing world
• Epidemic in the SAARC Region is dynamic and
  still evolving
• Epidemic started in many countries among IDU now
  predominantly heterosexual spread
• Intensity of risk behavior and vulnerability
  determine HIV spread

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HIV in South Asia
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Tuberculosis and HIV- the Deadly Duo
TB is the most common life threatening condition
associated with HIV infection
With the rise in HIV infection, Tuberculosis is
also increasing as in Africa. The same is likely
to happen in Asia as well
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TB and HIV/AIDS Allianceis the most serious
threat to TB Control
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HIV and TB Dual Infection

• 17 of global burden of dual infection
• HIV seroprevalence in TB patients, Mumbai
• 1988 2
• 1992/3 9
• gt 50 of AIDS patients have TB

• Bangladesh 9,761
• Bhutan 37
• India 1,795,532
• Maldives 32
• Nepal 11,973
• Pakistan 24,451
• Sri Lanka 1,644
• Total 1,843,430

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TB and HIV in South Asia The Context

• High levels of stigma of vulnerable groups and of
  people with HIV
• Rapid political, cultural, economic and social
  transitions
• Low status of women
• Poverty
• Limited political commitment and recognition of
  epidemic
• Lack of trust between government and civil
  society
• Increasing mobility of population
• Most health care provided by private sector
• Widespread and indiscriminate availability of TB
  medicines

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Consequences of HIV Infection on NTPs of SAARC
Member Countries

• Increased Case Load
• Over diagnosis of sputum smear negative
  pulmonary TB
• Under diagnosis of TB because of atypical
  X-ray presentations
• Low cure rates
• High case fatality rates during treatment
• High default rates because of adverse drug
  reactions
• Increased emergence of drug resistance