Burden of TB in SAARC

BURDEN OF TUBERCULOSIS IN SAARC REGION

SAARC Regional Strategy for Control / Elimination of Tuberculosis

SAARC has adopted WHO’s Global Stop TB Partnership strategy which envisions a TB-free world and elimination of TB by 2050.

Guiding Principles & SAARC TB Control Strategy

The strategic directions for TB Control are grounded in six principles, which will guide achievements of the strategic goals as follows:

Inclusiveness

Working in partnership with all stakeholders will be at the core of the TB Control Strategies in the SAARC Region. The stakeholders would include governments, private sector, non-governmental organization and civil society, researchers, academia, policymakers, professional bodies, national and international development agencies.

Equitable access to effective interventions

The TB Control strategy would endeavor to ensure equity in access, availability and utilization of the quality TB Control services for all sections of the population including poor and marginalized, special populations such tribal, people living in slums, and distant and inaccessible rural areas and terrains.

Flexibility

 All the SAARC Member States have their National Tuberculosis Programs and follow a general framework of DOTS and STOP TB partnership. However, each country may have specific and peculiar circumstances that would require adaptation of broad strategies to their own.

Quality

Commitment to high quality DOTS that would provide diagnostic services and treatment with effective anti-tubercular drugs will be an integral part of the strategy.

High Impact Interventions

High priority to research and innovation that have the greatest potential to improve and enhance performance and impact in reducing inequities, high cure rates, and contribute to achieving the Millennium Development Goals (MDGs) in the Region.

Ethics and Human Rights

Strategy would be based on the core values of equity, fairness and integrity, and promoting the utilization of scientific evidence and respect for gender and human rights.

Targets for SAARC Region

SAARC Region Targets for the scale-up of interventions for TB care and control set in line with the Global Plan to Stop TB 2011–2015.

  • By 2015: Reduce prevalence and death rates by 50%, compared with their levels in 1990.
  • By 2050: Reduce the global incidence of active TB cases to <1 case per 1 million population per year

SAARC Epidemiology

The SAARC region, with an estimated annual incidence of 3.7 million TB cases equivalent to 215 cases per 100 000 (1.41 million females and 2.29 million males), carries 36% of the global burden of TB incidence. Three of eight Member States in the SAARC Region are high TB and MDR-TB burden countries among 30 high burden countries. India accounting for 26% of the world’s TB Cases. An estimated 0.5 million (31 cases per 100 000) TB deaths in the region, however, India accounted 31 % of Global TB deaths.

Estimates of the burden of diseases caused by TB in the SAARC Region 2016

Country Population (‘000) Incidence Mortality (Excluding HIV)
Number (‘000) Rate * Number (‘000) Rate *
Afghanistan 35000 65 189 11 33 (19-49)
Bangladesh 163000 360 221 66 40 (26-58)
Bhutan 802 1.4 178 0.16 20 (13-28)
India 1324000 2790 211 423 32 (24-40)
Maldives 379 0.21 49 0.017 3.9 (3.1-4.9)
Nepal 29000 45 154 6.5 22 (16-30)
Pakistan 193000 518 268 44 23 (19-29)
Sri Lanka 21000 13 65 1.2 6 (4.3-8.0)
Total 1766181 3793 215 552 31

 

Source:, WHO Global Tuberculosis report-2017

* Rates are per 100 000 Population

 Notifications and Treatment Success

A total 2.6 million TB cases were notified in 2016 in the SAARC region. it shows, 77 % treatment success rate among 2.4 million total new and relapse cases.

 

 

 

 

 

TB Case notifications (2016) and Treatment Success Rate (2015 Cohort) in SAARC Region

Country Population (‘000) Total Case notified Total (New and relapse cases) Treatment Success (%)
Afghanistan 35000 43046 41954 88
Bangladesh 163000 223921 222248 93
Bhutan 802 1145 1139 92
India 1324000 1936158 1763876 72
Maldives 379 169 169 83
Nepal 29000 32056 31371 92
Pakistan 193000 366061 356390 93
Sri Lanka 21000 8886 8664 85
Total 1766181 2611442 2425811 77

Source: WHO Global Tuberculosis Report 2017

 

A remarkable progress has been made for DOTS since its inception in 1993 in the SAARC Region. By 1997 all Member States started DOTS strategy for TB control. DOTS coverage within the SAARC region has steadily increased since 2000. Population coverage in 1997 was 11%, since then it has increased and reached 99% in 2006 and since 2007 it is 100% . Regarding treatment success, the WHO target was achieved in 2005. The treatment success rate for new smear positive cases were 77% (2015 cohort) in the SAARC Region.

 

Progress in TB Control in SAARC Region, (2000-2016)

Source: WHO Global TB Report-2017, SAARC Epidemiological Response on Tuberculosis-2016

Drug Resistance TB

In the year 2016, the SAARC region has 106918 total number of an estimated MDR/RR-TB cases among notified pulmonary TB cases. In the Region, laboratory confirmed cases in the same year were 43243 MDR/RR-TB cases and 3003 XDR-TB cases. However, 37322 MDR/RR-TB and 2576 XDR-TB patients started on treatment .

Estimates of Drug-resistant TB care in the SAARC Region, 2016

Country Estimated MDR/RR-TB cases among notified pulmonary TB cases (Total Number)*** % of TB cases with MDR-TB Laboratory confirmed cases Patients started on treatment****
New Previously Treated
MDR/RR-TB XDR-TB MDR/RR-TB XDR-TB
Afghanistan 1600 4.1 16 1472 1 149 (10%) 0
Bangladesh 5300 1.6 29 969 9 918( 95%) 8 (89%)
Bhutan 70 11 18 55 0 55 (100%) 0
India 84000 2.8 12 37258 2464 32914 (88%) 2475
Maldives 1 1.7 0 1 0 2 0
Nepal 900 2.5 15 134 403 386 17 (4%)
Pakistan 15000 4.2 16 3331 126 2881 (86%) 76 (60%)
Sri Lanka 47 0.54 3.1 23 0 17 (74%) 0
Regional 106918 43243 3003 37322 (86%) 2576 (86%)

*** Includes cases with unknown previous TB Treatment history

****Includes patients diagnosed before 2016 and patients who were not laboratory- confirmed

Source: WHO Global Tuberculosis Report-2017

TB/HIV Co-infection

In 2016, the region has 40255 TB Patients with known HIV status, among them 39506 (98%) were on Antiretroviral Therapy.  India accounts 39815 TB patients with known HIV status, 98% patients were on ART, however, Afghanistan and Maldives had provided 100% ART to TB patients with Known HIV status in the region. In the SAARC region 29% Children (age <5) house hold contacts of bacteriologically-confirmed TB cases on Isoniazid treatment .

 

Estimates of TB/HIV case in new and relapse TB patients, 2016

Country Patients with known HIV status who are HIV positive patients on Antiretroviral Therapy (ART) Children (age <5) house hold contacts of bacteriologically-confirmed TB cases on preventive treatment
Number % Number % %
Afghanistan 8 <1 8 100 79
Bangladesh 87 2 69 79 17
Bhutan 6 <1 3 50 6.3
India 39815 3 39123 98 1.9
Maldives 1 100 1 100 100
Nepal 255 4 227 89 na
Pakistan 71 <1 68 96 na
Sri Lanka 12 <1 7 58 27
Regional 40255 39506 98 29

Source: WHO Global TB Report, 2017

 

The estimated Population of SAARC region in year 2016 was 1.76 billion which 24% of global Population. In 2016, there were 3.7 million estimated incidences of TB cases, which carries 36% of global burden of TB diseases. There is an estimated deaths due to TB in the region was 0.5 million, which is 31% of global deaths due to TB in year 2016 (Table 07).

 

Global vs. SAARC Region on TB Indicators, 2016

TB Control Indicators Global SAARC % of Global
Estimated Population 7.4 billion 1.76 billion 24
Estimated Incidence 10.4 million 3.7 million 36
(140 cases/100 000) (215 cases/100 000)
Estimated Deaths Due to TB 1.3 million 0.5 million 31
(17 cases/100 000) (31 cases/100 000)
Total cases notified 6.6 million 2.6 million 39
New and relapse notified cases 6.3 million 2.4 million 38
Treatment Success Rate (2015 cohort) 83% 77%
Estimated MDR/RR- TB cases among notified pulmonary TB cases 0.34 million 0.1 million 29
Patients with Known HIV Status who are HIV Positive 0.47 million 0.04 million 8.5
Patients with Known HIV Status who are HIV Positive on ART 0.4 Million (85%) 0.039 million (98%) 10

 Source: WHO Global TB Report- 2017

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