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:
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.
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.
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
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 *|
|Sri Lanka||21000||13||65||1.2||6 (4.3-8.0)|
Source:, WHO Global Tuberculosis report-2017
* Rates are per 100 000 Population
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 (%)|
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
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****|
|Bangladesh||5300||1.6||29||969||9||918( 95%)||8 (89%)|
|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
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|
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