Global Tuberculosis Report -- 2012.pdf

FIGURE 2.13 Trends in TB mortality rates in Eastern European countries, 1990–2011. The solid orange line shows the bestestimate of the TB mortality rate and the orange band represents the uncertainty related to this estimate. a Uncertaintyis due to adjustments made to the mortality data from vital registration systems that were reported by countries (thereported data are represented by the “x” symbol). Reported data were adjusted to account for incomplete coverage (deathswith no reported cause) and ill-defi ned causes, and the uncertainty range does not account for miscoding of causes ofdeaths (such as HIV deaths miscoded as TB deaths); further explanation of methods is provided in Annex 1.ArmeniaAzerbaijanBelarusBulgaria1086425201510510866543GeorgiaKazakhstanKyrgyzstanLatviaTB mortality rate per 100 000 population per year987654313121110987Lithuania4030201015105Republic of Moldova25201510121086Romania1210864201510Russian Federation252015105Tajikistan40353025201510Turkmenistan25201510Ukraine201510Uzbekistan1990 1995 2000 2005 20111990 1995 2000 2005 2011 1990 1995 2000 2005 2011 1990 1995 2000 2005 2011aThe width of an uncertainty band narrows as the quality and completeness of the vital registration data improves.FIGURE 2.14 Changes in TB mortality and gross nationalincome (GNI) per capita in Latvia, 1990–2011. The vertical dashed line shows the GNI percapita in 1990, prior to the economic crisis. Theeconomy shrank during the early 1990s and thelevel of 1990 was only recovered in 1999.TB mortality rate per 100 000 population per year1997 199819961999121995200019942001108619931992199119902002200320046000 8000 10000 12000 14000 16000GNI per capita (US$)2005200620102007200920082.5.1 Strengthening surveillanceIn 2008, the Task Force defined a conceptual frameworkto assess surveillance data as a basis for updatingestimates of the burden of disease caused by TB and fordefining recommendations for how surveillance needs tobe improved to reach the ultimate goal of direct measurementof TB cases and deaths from notification and VRdata (Figure 2.2). Tools to implement the framework werealso developed, and used in the 96 country consultationsillustrated in Figure 2.1. Major challenges in current estimatesof TB incidence include reliance on expert opinionabout the number of cases that are diagnosed but notreported to national surveillance systems and the numberof cases that are not diagnosed at all. Major challenges inestimating TB mortality include the lack of VR systems ofsufficient coverage and quality in many countries, notablyin Africa and parts of Asia (Figure 2.11).Since 2011, the Task Force’s three priorities have been:● developing and applying standards and benchmarksfor TB surveillance;● preparing a guide on inventory studies to measure TBunder-reporting;22 GLOBAL TUBERCULOSIS REPORT 2012