1. What is “burden”? DALY = YLL (death) + YLD (disability)
For TB ~ 90% DALYs due to death
death is why TB is among top 10 in “burden” league table

2. LOSS OF HEALTHY LIFE DUE TO TB

3. Decline in TB, Alaska 1950-73 Incidence or death rate/10K/year 6 5 4 3
cases 13%/yr 5 t
= 5 yr
1/2 4 3
Incidence or death rate/10K/year 2 1
deaths 30%/yr -1 t
= 2.3 yr
1/2 -2
1950
1955
1960
1965
1970
1975
source: Grzybowski Tubercle 1976

4. Impact of TB control on cases and deaths Netherlands 1950-94 6 5 4
incidence 7.0%/yr 3
CFR 15% 2 1
CFR 1.5% -1 -2
deaths 12.3%/yr -3 50 55 60 65 70 75 80 85 90 95
year

5. TB cases and deaths Uruguay, 1945-1995
GTB, 1997

6. Trends in TB death registrations
1200
Former Soviet Union
1000
Central Europe
Industrialized
800
Latin America
Geometric mean number of deaths
600
400
200
1985
1990
1995
2000

7. Impact of improved TB control: deaths reduced in Peru
20000
other
defaulted
DOTS 1991
15000
untreated
Estimated number of deaths
10000
5000 87 88 89 90 91 92 93 94 95 96 97 98 99