The burden of TB

V GANESAN

The burden of tuberculosis (TB) remains enormous despite the world having achieved the Millennium Development Goal of halting and reversing the TB epidemic by 2015, according to Global Tuberculosis Report 2012 of the World Health Organisation. In 2011, there were an estimated 8.7 million new cases of TB, of which 13 per cent were co-infected with the human immunodeficiency virus (HIV), and 1.4 million people died of TB. Geographically, the burden of TB is the highest in Asia and Africa, with India and China accounting for almost 40 per cent and Africa accounting for about a quarter of global TB cases. Africa has the highest rates of cases and deaths per capita. Despite the above, the report says the TB mortality rate has decreased by 41 per cent since 1990, and that the world is on track to achieve the global target of a 50 per cent reduction by 2015.

Significantly, the worldwide response to multi-drug-resistant TB (MDR-TB) remains slow. Worldwide, 3.7 per cent of new cases and 20 per cent of previously treated cases are estimated to have MDR-TB. The number of cases in MDR-TB notified in the 27 high MDR-TB burden countries is increasing and had reached almost 60,000 worldwide in 2011. This, according to the report, is only 20 per cent of the notified TB patients estimated to have MDR-TB. In China and India, which have the largest number of MDR-TB cases, the identified cases are, in fact, only one in 10. India, China, Brazil, the Russian Federation and South Africa, the BRICS countries, have almost 60 per cent of the worlds cases of MDR-TB. Extensively drug-resistant TB (XDR-TB) has been reported in 84 countries, with the ratio of XDR-TB cases to the total number of MDR-TB cases being about 9 per cent.

There is a huge funding gap to the tune of about $3 billion of the $8 billion a year required globally for TB care and control up to 2015. For scaled-up diagnosis and treatment of MDR-TB in BRICS countries in particular, national contributions, which provide the bulk of financing in BRICS countries, need to be supplemented with international funding, the report has pointed out.