TUBERCULOSIS

:: FIG. 3.9
Countries (in red) for which TB mortality in HIV-negative people is estimated using measurements from vital
registration systems and/or a mortality survey
Not applicable
mortality rate (per 100 000 population) fell by 34% between
2000 and 2015 (Fig. 3.6), and by 2.7% between
2014 and 2015. Rates have also been falling in all six of
the WHO regions (Fig. 3.13). Since 2010, the fastest average
rates of decline in the mortality rate have been in the
WHO Eastern Mediterranean and European regions (6.5%
and 6.2% per year, respectively) and slowest in the WHO
African Region (2.2% per year). Trends in mortality rates in
the 30 high TB burden countries vary markedly (Fig. 3.14),
ranging from substantial reductions since 2000 (e.g.
China, Ethiopia, Myanmar, Pakistan the Philippines and the
Russian Federation) to increases in Congo and the Democratic
People’s Republic of Korea.
3.2.4 The case fatality ratio and across-country
equity
The CFR is the proportion of people with TB who die from
the disease; it can be approximated as the number of TB
deaths divided by TB incidence in the same year. The CFR
allows assessment of variation in equity in terms of access
to TB diagnosis and treatment among countries because, if
everyone with TB had access to timely diagnosis and highquality
treatment, the CFR would be low in all countries. To
achieve the milestones for reductions in TB deaths set for
2020 and 2025 in the End TB Strategy, the global CFR needs
to fall to 10% by 2020 and to 6% by 2025 (Chapter 2).
In 2015, the global CFR (calculated as the combined
number of TB deaths in HIV-negative people and HIV-
positive people divided by the total number of incident cases
in both HIV-negative and HIV-positive people) 1 was 17%
and varied widely among countries (Fig. 3.15), from under
5% in a few countries to more than 20% in most countries
in the WHO African Region. Intensified efforts are required
to reduce the CFR to 10% globally by 2020.
1
The CFR was calculated based on the combined total of deaths in
HIV-negative and HIV-positive people for the purpose of crosscountry
comparisons, in particular to illustrate the high CFRs in
African countries that could be reduced by effective detection and
care programmes. CFRs restricted to HIV-negative TB deaths and
cases can also be calculated but are not shown. At the subnational
level, CFRs can also be restricted to HIV-negative TB deaths,
depending on the country and its HIV burden.
32 :: GLOBAL TUBERCULOSIS REPORT 2016