Global Tuberculosis Report -- 2012.pdf

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FIGURE 2.16 Progress in global coverage of data on drug resistance, 1994–2011Year of most recentrepresentative dataon anti-TB drugsurveillance1995–19992000–20042005–20092010–2011Ongoing 2012No dataSubnational data onlyNot applicablecorrective actions need to be identified and implemented.Inventory studies have been implemented in very fewcountries to date. Examples include the UK, the Netherlandsand several countries in the Eastern MediterraneanRegion (Egypt, Iraq, Yemen and, most recently, Pakistan).To facilitate and encourage inventory studies in morecountries, WHO and its partners (notably the Centers forDisease Control and Prevention in the USA and the UK’sHealth Protection Agency) initiated the development of aguide on how to design, implement, analyse and reporton inventory studies in 2011. As this report went to press,the guide was due to be published before the end of 2012.Electronic recording and reporting of dataAssessment of various aspects of data quality is the firstand most basic of the three major components of theTask Force’s framework for assessing surveillance data(Figure 2.2) and several of the standards in the TB surveillancechecklist are about data quality. In all of theregional and country workshops held between 2009 and2012, it was evident that it is much easier to assess thequality of TB surveillance data in countries with casebasedelectronic recording and reporting. In 2011, WHOand its partners produced a guide on electronic recordingand reporting for TB care and control, which was widelydisseminated in April 2012 (Box 2.5).2.5.2 Surveys of the prevalence of TB diseaseNationwide population-based surveys of the prevalenceof TB disease provide a direct measurement of the numberof TB cases; repeat surveys conducted several yearsapart can allow direct measurement of trends in diseaseburden. Surveys are most relevant in countries where theburden of TB is high (otherwise sample sizes and associatedcosts and logistics become prohibitive) and surveillancesystems are thought (or known) to miss a largefraction of cases.Before 2007, few countries had implemented prevalencesurveys (Figure 2.9, Figure 2.17). In the 1990s,national surveys were confined to China, Myanmar, thePhilippines and the Republic of Korea. Before 2009 andwith the exception of Eritrea in 2005, the last nationalsurveys in the African Region were undertaken between1957 and 1961. From 2002 to 2008, there was typicallyone survey per year. In 2007, WHO’s Global Task Forceon TB Impact Measurement identified 53 countries thatmet epidemiological and other criteria for implementing asurvey. A set of 22 global focus countries were selected toreceive particular support in the years leading up to 2015.Following five years of substantial efforts by countries,supported by the Task Force (Box 2.6), enormousprogress has been achieved (Figure 2.17). If surveys areimplemented according to schedule, around 20 surveyswill be implemented during 2011–2013, with a majorpeak in activity in 2012 and 2013. The number of surveysbeing implemented at the same time in 2012, at five,GLOBAL TUBERCULOSIS REPORT 2012 25
BOX 2.5New guidance on electronic recording and reporting for TB care and controlSurveillance systems depend on countries keeping good records of all TB cases notifi ed to national TB control programmes (NTPs) and ofTB treatment outcomes. This is a data-intensive activity that is increasingly moving away from paper-based to electronic recording andreporting (ERR).Advantages of ERR include:■ Better management of individual patients, for example by providing fast access to laboratory results;■ Better programme and resource management, by encouraging staff to use and act upon live data. This may help to prevent defaultingfrom treatment and assist with management of drug supplies (including avoidance of stockouts);■ Improved surveillance by making it easier for facilities not traditionally linked to the NTP, suchas hospitals, prisons and the private sector, to report TB cases, and by reducing the burden ofcompiling and submitting data through paper-based quarterly reports;■ Greater analysis and use of data, since data can be readily imported into statistical packages,results are available to decision-makers more quickly and it is possible to detect outbreakspromptly;■ Higher quality data, since automated data quality checks can be used and duplicate ormisclassifi ed notifi cations can be identifi ed and removed (which is very diffi cult or impossible to donationally with paper-based systems). It is also easier to introduce new data items.WHO coordinated the development of a guide on how to design and implement ERR according to bestpracticestandards in 2011. The guide was widely disseminated in April 2012 and is available atwww.who.int/tb/publications/electronic_recording_reportingFIGURE 2.17 Global progress in implementing national surveys of the prevalence of TB disease, actual (2002–2012)and expected (2013–2017)Number of surveys11109876543210Asia – GFC Africa – GFC OtherGlobal focuscountries (GFC) selected byWHO Global Task Force onTB Impact MeasurementViet NamCambodia Malaysia Indonesia Eritrea Thailand Philippines Bangladesh Myanmar China Ethiopia UR Tanzania Indonesia Bangladesh2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014–2017Lao PDRPakistanCambodiaRwandaThailandNigeriaGambiaSudanDPR KoreaNepalMongoliaSouth AfricaZambiaKenyaMalawiUgandaGhanaPhilippinesMyanmarViet Nam26 GLOBAL TUBERCULOSIS REPORT 2012
Page 2 and 3: GLOBALTUBERCULOSISREPORT2012
Page 4 and 5: ContentsAbbreviationsivAcknowledgem
Page 6 and 7: AcknowledgementsThis report on glob
Page 8 and 9: WHO Western Pacific RegionShalala A
Page 10 and 11: Executive SummaryThe World Health O
Page 12 and 13: CHAPTER 1IntroductionBOX 1.1Basic f
Page 14 and 15: TABLE 1.1 Targets for the scale-up
Page 16 and 17: TABLE 1.2 Reporting of data in the
Page 18 and 19: BOX 2.1Uncertainty in estimates of
Page 20 and 21: TABLE 2.2 Estimated burden of disea
Page 22 and 23: FIGURE 2.5 Estimated TB incidence r
Page 24 and 25: FIGURE B2.2.1Reporting of notificat
Page 26 and 27: FIGURE 2.8Estimated TB incidence ra
Page 28 and 29: FIGURE 2.11 Countries (in blue) for
Page 30 and 31: FIGURE 2.12 Trends in estimated TB
Page 32 and 33: ● producing and widely disseminat
Page 36 and 37: BOX 2.6Efforts by the Task Force to
Page 38 and 39: CHAPTER 3TB case notificationsand t
Page 40 and 41: BOX 3.1 1Definitions of TB casesDef
Page 42 and 43: TABLE 3.3 Contribution of public-pr
Page 44 and 45: BOX 3.4Integrating community-based
Page 46 and 47: TABLE 3.4 Estimates of the case det
Page 48 and 49: TABLE 3.5 Treatment success for new
Page 50 and 51: CHAPTER 4Drug-resistant TBKEY FACTS
Page 52 and 53: FIGURE 4.2 Percentage of new TB cas
Page 54 and 55: BOX 4.1Frequencies of resistance to
Page 56 and 57: FIGURE 4.6 Number of MDR-TB cases e
Page 58 and 59: FIGURE 4.7Notified cases of MDR-TB
Page 60 and 61: egimens globally, providing more su
Page 62 and 63: 5.1 Funding for TB care and control
Page 64 and 65: TABLE 5.2 NTP budgets, available fu
Page 66 and 67: FIGURE 5.5Trends in domestic and do
Page 68 and 69: FIGURE 5.6Domestic funding as a per
Page 70 and 71: FIGURE 5.8Cost per TB patient succe
Page 72 and 73: FIGURE 5.10 Total cost and unit cos
Page 74 and 75: ● The 14 countries not included i
Page 76 and 77: on public health by an external Exp
Page 78 and 79: evised as a result of the introduct
Page 80 and 81: TABLE 6.2 Incorporation of WHO poli
Page 82 and 83: FIGURE 6.3The Supranational Referen
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of TB disease by 65%, irrespective
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FIGURE 7.3Percentage of TB patients
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BOX 7.1Accelerating progress in pro
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TABLE 7.2 Assumptions used to estim
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FIGURE 8.1 The development pipeline
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sputum specimens and TB isolates fr
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cal trial sites and building labora
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new TB vaccine candidate. A Phase I
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This annex explains the methods tha
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2011. On average, 15 data points we
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may suffer from biases. These biase
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TABLE A1.3Parameter estimates used
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5. Estimates of TB prevalence, 1990
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the Republic of Moldova, Romania, t
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AFGHANISTANPopulation 2011 32 milli
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BRAZILPopulation 2011 197 millionHI
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CHINAPopulation 2011 1 348 millionH
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ETHIOPIAPopulation 2011 85 millionH
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INDONESIAPopulation 2011 242 millio
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MOZAMBIQUEPopulation 2011 24 millio
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NIGERIAPopulation 2011 162 millionH
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PHILIPPINESPopulation 2011 95 milli
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SOUTH AFRICAPopulation 2011 50 mill
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UGANDAPopulation 2011 35 millionHIG
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VIET NAMPopulation 2011 89 millionH
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ANNEX 3Regional profiles
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WHO REGION OF THE AMERICASPopulatio
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WHO EUROPEAN REGIONPopulation 2011
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WHO WESTERN PACIFIC REGIONPopulatio
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SUMMARY BY WHO REGIONTable A4.1 Est
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MORTALITY (EXCLUDING HIV) PREVALENC
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NEW AND RELAPSENOTIFICATION RATE aY
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-% OF TB PATIENTS WITHKNOWN HIV STA
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AFRICAN REGIONTable A4.1 Estimates
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INCIDENCE (INCLUDING HIV) INCIDENCE
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NEW AND RELAPSENOTIFICATION RATE aY
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NEW AND RELAPSENOTIFICATION RATE a1
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TREATMENT SUCCESS (%) a1995-2010YEA
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YEARTOTALCONFIRMEDCASES OFMDR-TB aE
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MALEYEAR 0-14 15-24 25-34 35-44 45-
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REGION OF THE AMERICASTable A4.1 Es
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% OF COHORTTREATMENT SUCCESS (%) a1
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MALEFEMALEYEAR 0-14 15-24 25-34 35-
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EASTERN MEDITERRANEAN REGIONTable A
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EUROPEAN REGIONTable A4.1 Estimates
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SOUTH-EAST ASIA REGIONTable A4.1 Es
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SMEAR LABS % OF SMEARPER 100K LABS
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Estimates of mortality, prevalence
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YEARPOPULATION(MILLIONS)MORTALITY (
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YEARPOPULATION(MILLIONS)INCIDENCE (
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YEARPOPULATION(MILLIONS)INCIDENCE (
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Page 281 and 282:
SMEAR LABS % OF SMEARPER 100K LABS
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