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The TB epidemic from 1992 to 2002.
1Tuberculosis Strategy & Operations, Stop TB Department, World Health Organization, 20 Avenue Appia, CH 1211 Geneva 27, Switzerland. raviglionem@who.int
Tuberculosis (Edinburgh, Scotland)
|May 22, 2003
Summary
Tuberculosis (TB) re-emerged globally in the 1990s, prompting the World Health Organization to declare it an emergency. The Directly Observed Treatment Short-course (DOTS) strategy was adopted by many countries, but challenges remain in case detection and addressing TB/HIV and multidrug-resistant TB (MDR-TB).
Area of Science:
- Global Health
- Infectious Diseases
- Public Health Policy
Background:
- Tuberculosis (TB) resurged as a major global health issue in the 1990s after decades of neglect, with rising incidence in industrialized nations and developing countries, particularly sub-Saharan Africa and the former USSR.
- An estimated 7-8 million new cases and 2-3 million deaths occurred annually, highlighting the urgent need for effective control strategies.
- Multidrug-resistant TB (MDR-TB) outbreaks and the growing TB/HIV co-infection crisis exacerbated the global TB burden.
Purpose of the Study:
- To analyze the global TB control landscape in the early 2000s and assess the progress and challenges of implementing the Directly Observed Treatment Short-course (DOTS) strategy.
- To establish global targets for TB control, including achieving 85% cure rates and 70% case detection among infectious cases.
- To identify key constraints hindering TB control and advocate for expanded DOTS implementation and innovative approaches.
Main Methods:
- The study reviews global TB trends, policy declarations by the World Health Assembly, and the adoption rates of the DOTS strategy by member countries.
- It analyzes the effectiveness of DOTS in case detection and cure rates, identifying geographical coverage gaps and notification capacity limitations.
- The research also considers the impact of TB/HIV co-infection and MDR-TB on control efforts.
Main Results:
- The World Health Assembly set global TB control targets in 1991, and the WHO declared TB a global emergency in 1993.
- The DOTS strategy, launched in 1994-1995, was adopted by 148 countries by 2000, including all 22 highest burden countries.
- Despite widespread adoption, progress in case detection remained slow due to incomplete coverage and the need for innovative detection schemes.
Conclusions:
- Expanding DOTS rapidly remains the top priority, requiring new approaches to enhance case detection and notification while maintaining high cure rates.
- Addressing TB/HIV co-infection and MDR-TB is crucial for effective global TB control.
- Collaboration with the private sector and communities, alongside strengthening primary healthcare services, is essential for overcoming TB control constraints.