TB and poverty agenda in WPR WHO/WPRO Stop TB

World Health Organization Percentage of population living below US$1 a day

World Health Organization TB and poverty 98% of 1.8 million TB deaths per year in developing countries. TB mortality rate 3 X higher in rural poor China than in more developed urban areas. ARI in the Philippines 2.5 times higher among urban poor than urban non-poor. Mexico and South Africa: no difference in socio- economic status between TB patients and non TB patients living in the same community

TB incidence weakly related to social and economic variables: infant mortality Infant mortality rate 1991 (log-transformed) estimated TB incidence (log-transformed) AF AS CA EE SA US WP ME WE Series10

World Health Organization TB prevalence among poor and non-poor, Philippines Source: Philippines NTP, 2000

World Health Organization S(+) prevalence rates: China Source: World Bank, 2000

World Health Organization TB and poverty in China (1990)

World Health Organization Prevalence of s(+) TB by ethnic group in China in 2000 Source: Ministry of Health of China, 2000

World Health Organization Poverty and TB Vulnerability to severe disease and death from TB Delaying access to care Inhibiting treatment adherence Overcrowding associated with infection and outbreaks of TB TB burden higher where poverty is higher

World Health Organization S(+) TB notification rates versus income in Vietnam provinces Source: Ministry of Health of Vietnam, 2003

World Health Organization TB notification rates and ethnic groups in Vietnam provinces Source: Ministry of Health of Vietnam, 2003

World Health Organization TB notification rates and poverty in Cambodian provinces Source: Ministry of Health of Cambodia, 2002

World Health Organization TB notification and poverty TB notification is lower where poverty is higher in Vietnam TB notification is at a similar level between poorer and less poor areas in Cambodia

World Health Organization Poverty and TB Case Detection Rate Poor compared to non-poor communities: Higher TB prevalence Lower or similar case notification rates  Lower TB Case Detection Rate in poorer areas

World Health Organization Expansion may not be enough ‘The Missing Cases’ Detection Coverage

World Health Organization Progress in 2004 Objective 1: Reaching the 70/85/100 targets Targets * DOTS Coverage (target: 100%) 77%90%94% Case Detection (target: 70%) 40%52%63% Cure Rate (target: 85%) >85% *2004 figures are for high burden countries which account for 90% of the TB burden

World Health Organization Impact of scenarios D 70 and D increased on prevalence Decline in prevalence rate per 100,000 D70 Dincreased

World Health Organization Impact of scenarios D 70 and D increased on mortality

World Health Organization Thank you!