A flare-up of tuberculosis due to war in Congo Brazzaville

Congo Brazzaville, a country with a population of 3 million, experienced a period of war from 1997 to 1999. Before this time the annual increase in numbers of tuberculosis cases was on average 20%; in 2000 it was 84%. This situation had a considerable impact on the activities of the National Tuberculosis Programme. Before the war the diagnostic and treatment centres had notified nearly 100% of new cases of tuberculosis; in 2000 this had dropped to 76.19%, whereas the number of tuberculosis patients had almost doubled, from 5125 in 1999 to 9436 in 2000. New cases of smear-positive pulmonary tuberculosis represent 45% of cases, in comparison with an average of 55% before the war, and extrapulmonary tuberculosis 30% versus 21% before the war. The relapse rate has not changed significantly, by approximately 2%, while the default rate has risen significantly, from 20% to about 26%. The rates of new smear-positive tuberculosis cases who are cured or have completed treatment remain unchanged (70%), while the mortality rate dropped after the war from 6% to 1.23%. The war led to an increase in rates of tuberculosis, particularly in the two main cities, Brazzaville and Pointe-Noire, to which refugees had fled from the rural areas. This resulted in an excessive workload for the health workers. Sustained financial support is needed to reduce tuberculosis transmission in the Congo population.