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Challenges and Progress in TB Epidemiology in Africa

Explore the magnitude of the TB problem in the African region, including new cases, deaths, and the impact of HIV. Review global and regional targets set for TB control and observe trends in TB rates, DOTS strategy coverage, and case detection and treatment success rates.

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Challenges and Progress in TB Epidemiology in Africa

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  1. Overview of TB Epidemiology in the African Region TUB/AFRO Meeting on TB Surveillance and Epidemiology, Harare August 2003

  2. Magnitude of the TB Problem • Approx. 1.6 million new cases estimated to occur per year • Approximately 600,000 deaths estimated to occur per year • With only 10% of world population AFRO contributes 20-24% of TB cases0yr. • Approx. 30-50% of new TB cases in Southern and Eastern Africa is HIV+ • Approx. 40% of AIDS deaths due to TB

  3. Global and Regional Targets. Where are we ? Context: Global targets adopted by WHA in 1993 & 1999: By 2005, to attain: • Case detection rate of 70% • Treatment success rate of 85%2: By 2015: • To reduce incidence and mortality by 50%

  4. REPORTED POPULATION COVERAGE WITH DOTS STRATEGY BY COUNTRY. 2000

  5. TREND OF TB RATES IN SELECTED MEDIUM TO HIGH HIV PREVALENCE COUNTRIES: 1990-1998

  6. TB IN SELECTED LOW HIV PREVALENCE COUNTRIES: 1990-1998

  7. NOTIFIED NEW SMEAR POSITVE CASES BY AGE GROUP AND SEX: JAN-DEC 2000

  8. MAJOR OBSERVATIONS • Severe and worsening TB epidemic: Case notifications and case notification rates of all cases and smear positive cases have progressively risen in many countries in the Region, especially those in the epicenter of the dual TB/HIV epidemic • Apparent higher TB “incidence” among females aged <25 years compared to male counterparts • Overall, slow but steady progress in expanding “DOTS”: 41 of 46 countries adopted TB DOTS Strategy and 20 already attained population wide coverage • Very slow though increasing progress towards attaining global targets for case detection: In-spite of increasing notifications and notification rates, case detection rates still fall below the global target of 70% of expected new smear positive cases. • Still below global targets for treatment success rate even though fair and steady progress being made

  9. MAJOR OBSERVATIONS • Regional average treatment success rate still below global target: Even though the averagetreatment success rate for the region has been increasing steadily since the mid nineties, current levels are still below the Global and Regional targets • Completeness and frequency of reporting by country varies violently from year to year. Since 1997, only a maximum of 38 countries have submitted complete annual TB reports to WHO (range 29-38)

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