Burden of TB in SAARC

 

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

BURDEN OF TUBERCULOSIS IN SAARC REGION

SAARC Epidemiology

The SAARC region, with an estimated annual incidence of 3.7 million TB cases equivalent to 203 cases per 100 000, accounted for 37% of the global burden of TB incidence in the year 2019. Three of eight Member States in the SAARC Region are High TB and High MDR-TB burden countries among 30 High burden countries. India accounted for 26%, Pakistan 5.7% and Bangladesh 3.6% of the world’s TB Cases. An estimated 0.5 million (30 cases per 100 000) TB deaths occurred in the region in 2019.

Table 01: Estimates of TB Incidence in the SAARC Region 2019

Country Population (‘000) Number Rate*
Best Estimate Uncertainty Interval (Range) Best Estimate Uncertainty Interval (Range)
Afghanistan 38000 72000 46000-103000 189 122-270
Bangladesh 163000 361000 262000-474000 221 161-291
Bhutan 760 1300 960-1600 165 126-208
India 1366000 2640000 1800000-3630000 193 132-266
Maldives 530 190 150-240 36 28-46
Nepal 29000 68000 40000-103000 238 141-359
Pakistan 217000 570000 404000-764000 263 187-353
Sri Lanka 21000 14000 10000-18000 64 47-83
Total 1835290 3726490 203

Source: WHO Global Tuberculosis Report 2020, * Rates are per 100 000 population

 

Table 02: Estimates of the TB Mortality in the SAARC Region 2019

Country Population (‘000) HIV -Negative TB Mortality HIV-Positive TB Mortality Total TB Mortality
Number Rate * Number Rate * Number Rate *
Afghanistan 38000 9800 26 120 0.32 9920 26
Bangladesh 163000 38000 24 150 0.09 38150 23
Bhutan 760 140 18 1 0.10 141 19
India 1366000 436000 32 9500 0.69 445500 33
Maldives 530 11 2 0 0.00 11 2
Nepal 29000 17000 58 220 0.77 17220 59
Pakistan 217000 42000 19 1900 0.90 43900 20
Sri Lanka 21000 770 3.6 4 0.02 774 4
Total 1835290 543721 30 11895 0.65 555616 30

Source: WHO Global Tuberculosis Report 2020, * Rates are per 100 000 population

 

 

In 2019, the SAARC region had 0.4 million estimated TB burden in children (0-14). Among them 0.24 million were males and 0.22 million were females. The region has 46% Children (age <5) house hold contacts of bacteriologically-confirmed TB cases on Isoniazid treatment (Table 03).

 

Table 03: Estimates of TB Burden in children (0-14) by age and sex in the SAARC Region, 2019

Country Male Female Total Children (age <5) house hold contacts of bacteriologically -confirmed TB cases on preventative treatment (%)
Afghanistan 7800 7300 15100 93
Bangladesh 17000 16000 33000 51
Bhutan 32 30 62 28
India 174000 160000 334000 33
Maldives 1 2 3 70
Nepal 2700 2400 5100 37
Pakistan 40000 36000 76000 5.6
Sri Lanka 410 370 780 51
Regional 241943 222102 464045 46

Source: https://www.who.int/teams/global-tuberculosis-programme/data

3.2 Notifications and Treatment Success

A total 3.1 million TB cases were notified in 2019 in the SAARC region (Table 04). An increasing trend of total case notification has been shown in figure 01. The treatment success rate for new smear positive cases was 85% (2018 cohort) in the SAARC Region (Figure 02).

Table 04: TB Case notifications (2019) and Treatment Success Rate (2018 Cohort) in SAARC Region

Country Population (‘000) Total Case notified Total (New and relapse cases) Treatment Success (%)
Afghanistan 38000 52770 52438 91
Bangladesh 163000 292942 291595 94
Bhutan 760 1016 1005 95
India 1366000 2404815 2162323 82
Maldives 530 154 154 64
Nepal 29000 32043 31495 91
Pakistan 217000 334754 328312 93
Sri Lanka 21000 8434 8204 85
Total 1835290 3126928 2875526 85

Source: WHO Global Tuberculosis Report 2020

 

 

 

Figure 01: Trend of total case notified in the SAARC Region (2010-2018)

 

 

Source: WHO Global Tuberculosis Report-2020, SAARC Epidemiological response on Tubreculosis-2019

Figure 02: Trend of Treatment success rate for new smear positive and relapse cases (2000-2018)

Source: WHO Global TB Report-2020, SAARC Epidemiological Response on Tuberculosis-2019

3.3 Drug Resistant TB

In the year 2019, the SAARC region had 157119 estimated MDR/RR-TB cases of among notified pulmonary TB cases. However, laboratory confirmed cases were 72677 MDR/RR-TB cases and 2625 XDR-TB cases. However, 61682 MDR/RR-TB and 1979 XDR-TB patients were started on treatment (Table 05).

Table 05: TB care services for Drug-resistant TB in the SAARC Region, 2019

Country Estimated MDR/RR-TB Incidence** Laboratory Confirmed Cases** Patients Started On Treatment MDR/RR-TB Cases Tested For Resistance To Any Fluoroquinolone
MDR/RR-TB XDR-TB MDR/RR-TB XDR-TB
Afghanistan 2400 486 5 396 6 43
Bangladesh 3300 1373 7 1243 7 1248
Bhutan 190 87 1 70 0 65
India 124000 66255 2523 56569 1918 36748
Maldives 2 1 0 1 0 1
Nepal 2200 635 29 378 14 417
Pakistan 25000 3820 60 3004 34 2512
Sri Lanka 27 20 0 21 0
Regional 157119 72677 2625 61682 1979 41034

** Includes cases with unknown previous TB Treatment history

Source: WHO Global Tuberculosis Report 2020, *https://www.who.int/tb/country/data/download/en/

 

3.4 TB/HIV Co-infection

In 2019, the region had 47664 TB Patients with known HIV status, among them 45298 (95%) were on Antiretroviral Therapy.  India accounts for 46741 TB patients with known HIV status, 95% patients were on ART, however, Bhutan and Sri Lanka had provided 100% ART to TB patients with Known HIV status in the region. (Table 06)

Table 06: TB/HIV care in new and relapse TB patients, 2019

Country Patients with known HIV status who are HIV positive patients on Antiretroviral Therapy (ART)
Number % Number %
Afghanistan 11 0.036 7 64
Bangladesh 120 1.2 116 97
Bhutan 3 0.31 3 100
India 46741 2.7 44517 95
Maldives 0 0 0
Nepal 159 0.72 155 97
Pakistan 624 0.48 494 79
Sri Lanka 6 0.078 6 100
Regional 47664 45298 95

Source: WHO Global tuberculosis report 2020

The estimated Population of SAARC region in year 2019 was 1.83 billion which 24% of Global Population is. Table 07 shows the comparison between TB indicators for Global and SAARC Region respectively for the year 2019.

Table 07: Global vs. SAARC Region on TB Indicators, 2019

TB Control Indicators Global SAARC % of Global
Estimated Population 7.69 billion 1.83 billion 24
Estimated Incidence 10 million 3.7 million 37
(130 cases/100 000) (203 cases/100 000)
Estimated Deaths Due to TB 1.4 million 0.5 million 45
Total cases notified 7.5 million 3.1 million 41
New and relapse notified cases 7.1 million 2.8 million 39
Treatment Success Rate (2018 cohort) 85% 85%
Estimated MDR/RR- TB incidence 0.46 million 0.15 million 32
Patients with Known HIV Status who are HIV Positive 0.45 Million (9.5%) 0.047 Million (5.52%) 10
Patients with Known HIV Status who are HIV Positive on ART 0.39 Million (88%) 0.045 Million (95%) 12

Source: www.who.int/tb data/TB country, regional and global profiles (downloaded on 27 Jan 2021)

 

 

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