Press Release WHO/40
26 May 1998
TB IS SINGLE BIGGEST KILLER
OF YOUNG WOMEN
Gothenburg, Sweden/Geneva, Switzerland Tuberculosis is now the single biggest infectious killer of women in the world, according to an international research meeting on TB and gender in Sweden.
Data presented by the World Health Organization at the meeting showed unprecedented levels of infection and deaths among women and girls: over 900 million are infected with TB worldwide, one million will die and 2.5 million will get sick this year from the disease mainly between the ages of 15 and 44. This makes TB the single leading cause of deaths among women of reproductive age.
"Wives, mothers and wage earners are being cut down in their prime and the world isn't noticing," said Dr Paul Dolin of WHO's Global Tuberculosis Programme. "Yet the ripple effect on families, communities and economies will be felt long after a woman has died."
This counters perceptions in wealthy countries where the disease is most commonly found in elderly men. In industrialised countries, one quarter of all TB cases occur in the over-65s, compared with only ten per cent in developing countries of Africa, Asia and Latin America. In the developing world, TB is predominantly a disease of young adults: 60 per cent of all cases are young men and women of reproductive age.
TB accounts for 9 per cent of deaths worldwide among women aged between 15 and 44, compared with war which accounts for 4 per cent, HIV 3 per cent and heart disease 3 per cent. Women of reproductive age are more susceptible to fall sick once infected with TB than men of the same age. Women in this age group are also at greater risk from HIV infection. As a result, in parts of Africa, young women with TB outnumber young men with TB.
"Among leading threats to women's health, TB may be the most affordably controlled," said Professor Vinod Diwan of the Nordic School of Public Health, where the meeting was held. "Enormous losses to this disease have prompted a search for factors such as gender that may help us to better understand and better control the epidemic."
The meeting (24 26 May 1998) was organized by the Nordic School of Public Health, Umea University and Karolinska Institute in Sweden, and co-sponsored by the Swedish International Development Cooperation Agency (SIDA) and WHO. SIDA's Department for Research Cooperation (SAREC) supports TB and gender research. This is the first major international meeting to be held on TB and gender.
TB and gender experts met to draw up an agenda for research into biological, epidemiological, social and cultural differences in the occurrence of TB in men and women, and their access to the TB treatment strategy DOTS, recommended by WHO. Specific areas of research will be TB and pregnancy, diagnosis of TB in women, adherence to treatment, and patient education.
"Improved access to DOTS could prevent many needless deaths among women and children and improve our control of this infectious killer," said Dr Dolin of WHO. "Outreach services, flexible opening hours for clinics, and health workers trained to respond to women's needs could make DOTS more user-friendly for this risk group."
"We need to ensure that our health systems are delivering DOTS in ways that remove rather than reinforce inequities," added Professor Diwan of the Nordic School of Public Health. "Our interventions must protect this already vulnerable group."
DOTS combines five elements: political commitment, case detection through sputum smear microscopy, directly observed short-course treatment, regular drug supplies and monitoring systems with evaluation of treatment outcome for each and every patient. 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.
A 1996 study by the World Bank, WHO and Harvard University shows TB as a leading cause of 'healthy years lost' among women of reproductive age. 8.7 million 'disability adjusted life years' (DALYs) were lost as a result of TB compared with 8.5 million due to sexually transmitted diseases, 3.6 million due to HIV, 2.3 million due to diarrhoeal diseases and 2 million due to malaria.
For more information, copies of photographs and broadcast quality footage, please contact Becky Owens at the World Health Organization in Geneva on +41 22 791 2630 (cell phone +41 79 217 3404), or Richard Nyström at SIDA in Stockholm on +46 8 698 5550 (cell phone +46 70 341 9699).
All WHO Press Releases, Fact Sheets and Features as well as other information on this subject can be obtained on Internet on the WHO home page http://www.who.ch/