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Analytical summary - Tuberculosis

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Up to 30% of the global tuberculosis (TB) disease burden occurs in Africa, with incidence doubling between 1990 and 2007. Death rates also doubled during this period. At present rates of progress, most countries are unlikely to reach the Millennium Development Goal target, despite significant progress in expanding DOTS (the basic package that underpins the Stop TB Strategy) coverage since 1990.

Tuberculosis death rate per 100 000 population per year in the WHO African Region, 2000 and 2007

Health system weaknesses are considered mainly responsible for slower than desirable improvement in TB identification and care. Limited local-level diagnostic capacity, poor patient follow-up and shortages in drug supplies are contributing factors. Multidrug-resistant and extensively drug-resistant forms of TB, are emerging concerns attributed mainly to poor DOTS performance.

The true extent of multidrug-resistant and extensively drug-resistant TB in the WHO African Region is not known with accuracy. Problems are compounded by the irregular supply and high cost of second-line anti-TB medications. Training courses are being organized to build core capacity in addressing multidrug-resistant TB.

TB cannot be adequately controlled where:

  • health systems remain weak, insufficiently decentralized, staffed or funded;
  • there is inadequate laboratory back-up;
  • drug supplies are uncertain.

These systemic problems need to be rectified. At the same time, it is imperative to engage strongly in partnership with all levels of health care providers, as well as with individuals and communities to contribute to health systems strengthening. As TB is a disease of the poor, and treatment costs are protracted, links with national anti-poverty mechanisms should be made both to reduce the costs to individuals and to address the upstream economic losses suffered by all countries with high TB disease burdens.