1. THE GLOBAL EPIDEMIOLOGY OF TUBERCULOSIS WORLD HEALTH ORGANIZATION
CHRIS DYE
WORLD HEALTH ORGANIZATION
GENEVA

2. Most TB cases are in India and China
< 1 000
1 000 to 9 999 to to
or more
No Estimate
The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.
© WHO 2002

3. Highest TB rates per capita are in Africa
25 to 49
50 to 99
100 to 299
< 10
10 to 24
300 or more
No Estimate
per population
The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.
© WHO 2002

4. 22 high-burden countries: 80% of all new cases
10000
1000
Estimated new TB cases ('000s)
100 10
India
China
Nigeria
Kenya
Brazil
Indonesia
Pakistan
Ethiopia
Thailand
Uganda
Philippines
DR Congo
Viet Nam
Myanmar
Bangladesh
Zimbabwe
Cambodia
South Africa
UR Tanzania
Afghanistan
Mozambique
Russian Federation

5. Tuberculosis in the world, 2001
New TB cases m (137/100K)
New ss+ TB cases m
Change incidence rate %/yr
Prevalence HIV in new cases %
Prevalence MDR in new case %
Deaths from TB m (29/100K)
TB deaths attributable to HIV 12%

6. Tuberculosis in the African Region, 2001 estimates
New TB cases , 857,000 (290)
New ss+ TB cases ,000 (185)
Change incidence rate 3.9%/yr
Prevalence HIV in new cases 38%
Prevalence MDR in new cases 1.8%
Deaths from TB ,000 (75)
TB deaths attributable to HIV %

9. Millennium Development Goals Goal 6
Millennium Development Goals Goal 6. Combat AIDS, malaria and other diseases
Target 8. Have halted by 2015, and begun to reverse, the incidence of malaria and other major diseases
Indicators
23. Prevalence and death rates associated with TB
24. Proportion of TB cases detected and cured under DOTS

10. Global targets for TB control  internationally agreed
By 2005: “Going to scale” : 85% cure, 70% case detection (WHO)
By 2010: Having an impact: 50% reduction in TB prevalence and deaths (G8)

11. Sources of data ordered by ease of measurement
Cure: 6-month follow-up in DOTS cohorts (surveillance/monitoring)
Case detection: DOTS case notifications (surveillance, surveys)
Prevalence: number of existing sm+ cases (surveys)
Deaths: number of deaths all forms of TB (surveys, vital registration)

16. Progress towards 70% case detection in DOTS areas?
Asia

17. Progress towards 70% case detection in DOTS areas?
Africa

24. Dynamics of pulmonary TB in Peru 1980-2000
220
DOTS 1990
200
case finding
180
Pulmonary TB cases/100,000
160
140
120
PTB falling at 6%/yr
100
1980
1985
1990
1995
2000

28. 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

29. This workshop will review:
TB burden and trends by country
Methods to assess TB morbidity and mortality; application of methods to national populations and to sub-populations
Methods to assess case detection and cure rates; methods of analysing data to explain the results
Progress towards the targets of 70% case detection and 85% cure, and the utility of these and other indicators
(Some) methods to evaluate impact: incidence, prevalence, deaths

30. Day 1: data review by country
Summary of available data describing TB burden and trends
Summary of estimates of case detection rates, nationally and for sub-populations of special interest (e.g. by region, ethnic group, age, sex)
Summary of treatment outcomes, nationally and for specific sub-populations
Summary of impact of TB control (incidence, prevalence, deaths)
Overview of outstanding analytical problems (from perspective of the NTP)

31. Day 2: surveys and estimates
AM: Surveys of TB infection and disease
PM: Methods for making estimates of TB incidence (prevalence, deaths)
Day 3: analyses of surveillance data
AM: Examples from EMR and elsewhere, based on standard and other indicators
PM: Presentations of results by country