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An Overview of TB in SAARC Countries and Role of SAARC TB Centre in TB Control Dr Paras K Pokharel, Associate Professor

An Overview of TB in SAARC Countries and Role of SAARC TB Centre in TB Control Dr Paras K Pokharel, Associate Professor Dept. of Community Medicine, BPKIHS & Dr Dirgha S Bam Director SAARC TB Centre. Global TB Burden. 50% of Global TB Burden occurs in 5 countries of South East Asia:

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An Overview of TB in SAARC Countries and Role of SAARC TB Centre in TB Control Dr Paras K Pokharel, Associate Professor

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  1. 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

  2. Global TB Burden 50% of Global TB Burden occurs in 5 countries of South East Asia: India, Indonesia, Bangladesh, Thailand, Myanmar

  3. TB is the leading single infectious cause of death in South-East Asia Deaths from infectious agents in South-East Asia

  4. Prevalence of TB in poor and non poor populations in developing countries TB is a disease of vulnerable populations, eg: • poor • women • refugees • prisoners

  5. TB is a Leading Killer of Women Deaths among women

  6. 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

  7. 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

  8. 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

  9. 22 countries: 80% global TB burden

  10. TB in South Asia All countries India

  11. 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

  12. 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

  13. 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

  14. Current HIV Situation • High HIV prevalence: India, MyanmarandThailand* • 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

  15. 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

  16. Country Reported AIDS cases Estimated HIV infections Routine Surveillance Bangladesh 17 13,000  Bhutan 1 <100  India 12,239 3,500,000  Maldives 5 <100  Nepal 383 33,000  Pakistan 147 64,000  Sri Lanka 117 7,3 00  Total 12,809 3,617,500 HIV in South Asia

  17. 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

  18. TB and HIV/AIDS Allianceis the most serious threat to TB Control

  19. 17% of global burden of dual infection HIV seroprevalence in TB patients, Mumbai: 1988 2% 1992/3 9% > 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 HIV and TB Dual Infection

  20. 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

  21. 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

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