Press Release WHO/30
19 March 1998
PROGRESS AGAINST TB STALLED IN KEY COUNTRIES
WHO Identifies 16 Countries Struggling to Control TB
Global Control is Jeopardized by TB 'Trouble Spots'
LONDON - Lack of progress by 16 key countries is threatening global TB control efforts, according to a new World Health Organization report released today.
WHO identified the world's most worrisome TB trouble spots according to new data released at a meeting of health experts in London. WHO also announced that global TB control targets for the year 2000 would not be met as the 16 key countries have moved too slowly in using DOTS, a strategy proven to be effective in controlling TB. The countries are the source of over half the world's seven million annual TB cases.
"Some governments did not take WHO's declaration of a global TB emergency seriously," said Dr Arata Kochi, Director of WHO's Global Tuberculosis Programme. "Countries that did -- such as Bangladesh, Viet Nam and Peru -- are making excellent progress toward controlling TB."
Half of the trouble spots are middle or upper-middle income countries Brazil, Indonesia, Iran, Mexico, Philippines, Russian Federation, South Africa and Thailand. These countries have the financial means to tackle TB, but some have delayed too long in pressing for the successful implementation or expansion of DOTS.
The other eight countries are low-income economies Afghanistan, Ethiopia, India, Myanmar, Nigeria, Pakistan, Sudan and Uganda. These countries also delayed the adoption or the expanded use of the DOTS strategy so that too little progress has been made. In at least four of them, there has been a deterioration in their efforts to control TB, as shown by worsening treatment success rates. Most of these countries will need financial assistance to fully adopt and quickly expand their TB control efforts.
WHO warned that no country is safe from TB as long as the epidemic is allowed to thrive in parts of the world. A study released at the end of last year documented the extent of often-incurable multidrug-resistant forms of TB which gives new urgency to the situation.
"TB is certain to spread wherever it is ignored," said Dr Carlyle Guerra de Macedo, former director of the Pan American Health Organization. "If we allow TB to prosper and multiply in any corner of the world, we do so at our own peril." Dr Macedo chairs the committee of leading international public health and TB experts convened by WHO to assess how to assist countries where little progress is being made.
According to WHO, the TB epidemic will become more difficult to contain the longer extensive control efforts are delayed. A lethal combination of HIV and TB is leading to sharp increases in the TB epidemic, particularly in Africa. Poorly managed TB programmes are causing drug-resistant strains of TB to emerge which could render TB incurable. Asia shoulders almost two thirds of the burden of the epidemic, accounting for 64 percent of the world's notified TB cases. Without more effective action, 70 million people will die from TB between now and 2020.
"If we seem impatient in again calling for global action, it is because we have an effective solution to a disease which is needlessly claiming millions of lives," said Dr Kochi. "The use of DOTS has expanded nearly ten-fold in the past five years, cure rates have nearly doubled and drug-resistance is lower in places where DOTS has been used. But as impressive as this progress may seem, it is simply not enough when compared with the scale of the global epidemic."
In contrast to the 16 countries, TB control is succeeding in many parts of the world, such as Armenia, Cambodia, Cuba, Kenya, Malawi, Mongolia, Morocco, Nicaragua, Oman and Slovenia, to name a few. It has become clear that the DOTS strategy can achieve high cure rates and steady expansion in any country which is determined to control TB. DOTS is being used extensively in large countries such as Bangladesh and in half of China, as well as in small countries such as Equatorial Guinea, Maldives and Seychelles.
There is hope that many trouble spots can soon become TB control success stories, as 10 of the 16 countries have just begun using the DOTS strategy. Afghanistan, Iran, Mexico, Myanmar, Philippines, Russian Federation, South Africa, Sudan, Thailand and Uganda all have begun to implement DOTS since 1996, and the treatment outcome data from these initial efforts will be available for analysis late this year.
Worldwide, few health initiatives have expanded as quickly and as successfully as the DOTS strategy. Globally, use of the DOTS strategy rose from 704,920 recorded patients in 1995 to 887,731 patients in 1996, an increase of 26 percent. According to Global Tuberculosis Control 1998, 96 countries have begun to use the DOTS strategy, compared with only 19 in 1993. The treatment success rate of cases in DOTS areas was 78 percent, compared with 45 percent in non-DOTS areas.
Note to editors
- The WHO-recommended treatment strategy DOTS combines five elements: political commitment, case detection through sputum smear microscopy, directly observed short-course treatment, regular drug supplies and monitoring systems. Once infectious cases have been detected using microscopy services, health and community workers and trained volunteers observe and record patients swallowing the correct dosage of anti-TB medicines, and document that the patient has been cured. The most common anti-TB drugs are isoniazid, rifampicin, pyrazinamide, streptomycin and ethambutol.
- World TB Day (24 March) commemorates the day in 1882 when Dr Robert Koch announced his discovery of the TB bacillus that hailed the treatment, cure and potential elimination of the disease.
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