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Country Summary

Zimbabwe

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This analytical profile on tuberculosis is structured as follows:

4.2.1 Analytical summary
4.2.2 Disease burden
4.2.3 DOTS expansion and enhancement
4.2.4 MDR, TB/HIV and other challenges
4.2.5 Contributing to health systems strengthening
4.2.6 Engaging all care providers
4.2.7 Empowering people with TB, and communities
4.2.8 State of surveillance
4.2.9 Enabling and promoting research

Niger

O conteúdo em Portugês estará disponível em breve.

This analytical profile on tuberculosis is structured as follows:

4.2.1 Analytical summary
4.2.2 Disease burden
4.2.3 DOTS expansion and enhancement
4.2.4 MDR, TB/HIV and other challenges
4.2.5 Contributing to health systems strengthening
4.2.6 Engaging all care providers
4.2.7 Empowering people with TB, and communities
4.2.8 State of surveillance
4.2.9 Enabling and promoting research

Namibia

O conteúdo em Portugês estará disponível em breve.

This analytical profile on tuberculosis is structured as follows:

4.2.1 Analytical summary
4.2.2 Disease burden
4.2.3 DOTS expansion and enhancement
4.2.4 MDR, TB/HIV and other challenges
4.2.5 Contributing to health systems strengthening
4.2.6 Engaging all care providers
4.2.7 Empowering people with TB, and communities
4.2.8 State of surveillance
4.2.9 Enabling and promoting research

Mozambique

Moçambique consta como o 14º (em 2009 era 16º) na lista de 22 países com a mais alta carga de tuberculose (TB) em 2010. De acordo com o Relatório Mundial sobre TB da OMS de 2011, em 2010 foram diagnosticados mais de 110.000 casos novos de TB no país contra 92.000 em 2009. Em termos de incidência, esta aumentou de 432 para 500 por cada 100.000 pessoas. (OMS 2011) Prevê-se que número de casos de TB aumente nos próximos anos devido à alta prevalência de HIV. A infecção por HIV continua a ser o principal fator de risco para a tuberculose em Moçambique. Aproximadamente 65% dos pacientes novos de TB são co-infectados com HIV.

A TB multi-droga resistente surgiu como um novo desafio em Moçambique. Em 2003 foram notificados 77 casos e este número cresceu até 181 em 2008. Um declínio na notificação dos casos de TB-MDR verificado entre 2008 e 2009 coincide com a suspensão da cultura e TSD de TB no Laboratório Nacional de Referência de TB em Maputo devido à reabilitação em curso. Em 2007 foi confirmado o primeiro caso de TB resistente a extensivos drogas (TB-RED).

Mauritania

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This analytical profile on tuberculosis is structured as follows:

4.2.1 Analytical summary
4.2.2 Disease burden
4.2.3 DOTS expansion and enhancement
4.2.4 MDR, TB/HIV and other challenges
4.2.5 Contributing to health systems strengthening
4.2.6 Engaging all care providers
4.2.7 Empowering people with TB, and communities
4.2.8 State of surveillance
4.2.9 Enabling and promoting research

Mali

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This analytical profile on tuberculosis is structured as follows:

4.2.1 Analytical summary
4.2.2 Disease burden
4.2.3 DOTS expansion and enhancement
4.2.4 MDR, TB/HIV and other challenges
4.2.5 Contributing to health systems strengthening
4.2.6 Engaging all care providers
4.2.7 Empowering people with TB, and communities
4.2.8 State of surveillance
4.2.9 Enabling and promoting research

Sierra_Leone

O conteúdo em Portugês estará disponível em breve.

This analytical profile on tuberculosis is structured as follows:

4.2.1 Analytical summary
4.2.2 Disease burden
4.2.3 DOTS expansion and enhancement
4.2.4 MDR, TB/HIV and other challenges
4.2.5 Contributing to health systems strengthening
4.2.6 Engaging all care providers
4.2.7 Empowering people with TB, and communities
4.2.8 State of surveillance
4.2.9 Enabling and promoting research

Guinea-Bissau

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Taux d’incidence de la tuberculose pour 100.000 habitants par année en Guinée-Bissau et dans les pays limitrophes, 2008 et 2000
Taux d’incidence de la tuberculose pour 100.000 habitants par année en Guinée-Bissau et dans les pays limitrophes, 2008 et 2000.JPG

...: Données indisponibles

Kenya

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Tuberculosis incidence rate per 100,000 population per year in Kenya and neighboring countries, 2008 et 2000
Tuberculosis incidence rate per 100,000 population per year in Kenya and neighboring countries, 2008 et 2000.JPG

Guinea

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Taux d’incidence de la tuberculose pour 100.000 habitants par année en Guinée et dans les pays limitrophes, 2008 et 2000
Taux d’incidence de la tuberculose pour 100.000 habitants par année en Guinée et dans les pays limitrophes, 2008 et 2000.JPG

Ghana

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Tuberculosis incidence rate per 100,000 population per year in Ghana and neighboring countries, 2008 et 2000
Tuberculosis incidence rate per 100,000 population per year in Ghana and neighboring countries, 2008 et 2000.JPG

Nigeria

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This analytical profile on tuberculosis is structured as follows:

4.2.1 Analytical summary
4.2.2 Disease burden
4.2.3 DOTS expansion and enhancement
4.2.4 MDR, TB/HIV and other challenges
4.2.5 Contributing to health systems strengthening
4.2.6 Engaging all care providers
4.2.7 Empowering people with TB, and communities
4.2.8 State of surveillance
4.2.9 Enabling and promoting research

Seychelles

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This analytical profile on tuberculosis is structured as follows:

4.2.1 Analytical summary
4.2.2 Disease burden
4.2.3 DOTS expansion and enhancement
4.2.4 MDR, TB/HIV and other challenges
4.2.5 Contributing to health systems strengthening
4.2.6 Engaging all care providers
4.2.7 Empowering people with TB, and communities
4.2.8 State of surveillance
4.2.9 Enabling and promoting research

Zambia

O conteúdo em Portugês estará disponível em breve.


This analytical profile on tuberculosis is structured as follows:

4.2.1 Analytical summary
4.2.2 Disease burden
4.2.3 DOTS expansion and enhancement
4.2.4 MDR, TB/HIV and other challenges
4.2.5 Contributing to health systems strengthening
4.2.6 Engaging all care providers
4.2.7 Empowering people with TB, and communities
4.2.8 State of surveillance
4.2.9 Enabling and promoting research

Uganda

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This analytical profile on tuberculosis is structured as follows:

4.2.1 Analytical summary
4.2.2 Disease burden
4.2.3 DOTS expansion and enhancement
4.2.4 MDR, TB/HIV and other challenges
4.2.5 Contributing to health systems strengthening
4.2.6 Engaging all care providers
4.2.7 Empowering people with TB, and communities
4.2.8 State of surveillance
4.2.9 Enabling and promoting research

Togo

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This analytical profile on tuberculosis is structured as follows:

4.2.1 Analytical summary
4.2.2 Disease burden
4.2.3 DOTS expansion and enhancement
4.2.4 MDR, TB/HIV and other challenges
4.2.5 Contributing to health systems strengthening
4.2.6 Engaging all care providers
4.2.7 Empowering people with TB, and communities
4.2.8 State of surveillance
4.2.9 Enabling and promoting research

Tanzania

O conteúdo em Portugês estará disponível em breve.


This analytical profile on tuberculosis is structured as follows:

4.2.1 Analytical summary
4.2.2 Disease burden
4.2.3 DOTS expansion and enhancement
4.2.4 MDR, TB/HIV and other challenges
4.2.5 Contributing to health systems strengthening
4.2.6 Engaging all care providers
4.2.7 Empowering people with TB, and communities
4.2.8 State of surveillance
4.2.9 Enabling and promoting research

Swaziland

O conteúdo em Portugês estará disponível em breve.


This analytical profile on tuberculosis is structured as follows:

4.2.1 Analytical summary
4.2.2 Disease burden
4.2.3 DOTS expansion and enhancement
4.2.4 MDR, TB/HIV and other challenges
4.2.5 Contributing to health systems strengthening
4.2.6 Engaging all care providers
4.2.7 Empowering people with TB, and communities
4.2.8 State of surveillance
4.2.9 Enabling and promoting research

South_Sudan

O conteúdo em Portugês estará disponível em breve.


This analytical profile on tuberculosis is structured as follows:

4.2.1 Analytical summary
4.2.2 Disease burden
4.2.3 DOTS expansion and enhancement
4.2.4 MDR, TB/HIV and other challenges
4.2.5 Contributing to health systems strengthening
4.2.6 Engaging all care providers
4.2.7 Empowering people with TB, and communities
4.2.8 State of surveillance
4.2.9 Enabling and promoting research

South_Africa

O conteúdo em Portugês estará disponível em breve.


This analytical profile on tuberculosis is structured as follows:

4.2.1 Analytical summary
4.2.2 Disease burden
4.2.3 DOTS expansion and enhancement
4.2.4 MDR, TB/HIV and other challenges
4.2.5 Contributing to health systems strengthening
4.2.6 Engaging all care providers
4.2.7 Empowering people with TB, and communities
4.2.8 State of surveillance
4.2.9 Enabling and promoting research

Senegal

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This analytical profile on tuberculosis is structured as follows:

4.2.1 Analytical summary
4.2.2 Disease burden
4.2.3 DOTS expansion and enhancement
4.2.4 MDR, TB/HIV and other challenges
4.2.5 Contributing to health systems strengthening
4.2.6 Engaging all care providers
4.2.7 Empowering people with TB, and communities
4.2.8 State of surveillance
4.2.9 Enabling and promoting research

Rwanda

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This analytical profile on tuberculosis is structured as follows:

4.2.1 Analytical summary
4.2.2 Disease burden
4.2.3 DOTS expansion and enhancement
4.2.4 MDR, TB/HIV and other challenges
4.2.5 Contributing to health systems strengthening
4.2.6 Engaging all care providers
4.2.7 Empowering people with TB, and communities
4.2.8 State of surveillance
4.2.9 Enabling and promoting research

Sao_Tome_and_Principe

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Taux d’incidence de la tuberculose pour 100.000 habitants par année au Sao Tomé-et-principe et dans les pays limitrophes, 2008 et 2000
Taux dincidence de la tuberculose pour 100000 habitants par annee au Sao Tome-et-principe et dans les pays limitrophes 2008 et 2000.JPG

Gabon

Esta seção do perfil do sistema de saúde está estruturado da seguinte forma:

Résumé analytique

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La tuberculose demeure un problème majeur de santé publique au Gabon. Le nombre de cas notifiés de tuberculose est en croissance continue d’année en année, et les indicateurs clés montrent une faible performance de la lutte contre la maladie par rapport aux objectifs du partenariat Halte à la Tuberculose, des Objectifs du Millénaire pour le Développement(OMD) et de l’Organisation Mondiale de la Santé (OMS).

Parmi les déterminants de cette situation, il y a la propagation du VIH/SIDA, la pauvreté des populations, les ruptures fréquentes des stocks de médicaments antituberculeux, de nombreuses insuffisances du système national de santé, lale non implication effective des communautés, un partenariat très limité et l’apparition de nouveaux défis tels que la tuberculose à bacilles multi résistants et ultra résistants. Ces dernières années, l’Etat gabonais s’est engagé à augmenter progressivement la part national du budget alloué à l’achat des médicaments antituberculeux pour limiter la dépendance de leur acquisition au financement extérieur.


Charge de morbidité

Extension et amélioration de la stratégie DOTS

Tuberculose MR, Tuberculose/HIV et autres défis

Contribution au renforcement du système de santé

Engager les dispensateurs des soins de santé

Favoriser l'autonomisation des personnes atteintes de tuberculose et des communautés

Etat de la surveillance

Promouvoir et développer la recherche

Notes de fin: sources, méthodes, abréviations, etc.

Congo

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Au Congo, la tuberculose reste un problème majeur de santé publique avec une prévalence estimée de tous les cas à 449 pour 100 000 habitants. L’incidence estimée des nouveaux cas TPM+ est de 158 pour 100 000 habitants et 367 cas pour 100.000 habitants TB toutes formes. Le taux de mortalité spécifique est de 69 pour 100.000 habitants et la séroprévalence VIH parmi les tuberculeux de 25% en 2005 [1].

Le Programme National de Lutte contre la Tuberculose (PNLT) a démarré la stratégie DOTS depuis 1992 avec les objectifs chiffrés OMS/UICTMR de 70% le taux de détection et 85% le taux de succès de traitement pour les TPM+ [2]. Le DOTS est établie dans les 12 départements et 41 CSS . En 2005, le taux de détection des TPM+ était de 57%, Pour la cohorte enregistrée en 2004, le succès thérapeutique des TPM+ était de 63 %, le taux des perdus de vue de 29%, le taux de décès de 13%.

Gambia

Esta seção do perfil do sistema de saúde está estruturado da seguinte forma:

Analytical summary

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The annual burden of all forms of tuberculosis (TB) in the Gambia is estimated to be 4415 (TB incidence of 257 per 100 000 populations), including 1893 (113 per 100 000 population) smear-positive TB cases.[1] In the past 5 years (2005–2010) with the support of a Round 5 grant from the Global Fund to Fight AIDS, Tuberculosis and Malaria (GMB-506-G03-T), the total TB case notification in the Gambia increased by 5%. This is, in part, due to an increase in sensitization through both print and electronic media, with the support of the Global Fund.

The number of diagnostic sites increased countrywide from 11 in 2006 to 31 in 2011. Diagnostic sites also serve as places for TB/HIV surveillance. DOTS, the basic package that underpins the Stop TB Strategy, has been scaled-up through the use of primary health structures comprising networks of village health workers, community health nurses and community volunteers.


Disease burden

DOTS expansion and enhancement

MDR, TB/HIV and other challenges

Contributing to health systems strengthening

Engaging all care providers

Empowering people with TB, and communities

State of surveillance

Enabling and promoting research

Endnotes: sources, methods, abbreviations, etc.

References

  1. WHO global surveillance report 2009. Geneva, World Health Organization, 2009

Algeria

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Tuberculosis incidence rate per 100,000 population per year in Algeria and neighboring countries, 2008 et 2000
Tuberculosis incidence rate per 100000 population per year in Algeria and neighboring countries 2008 et 2000.JPG

Benin

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Le Ministère de la Santé du Bénin dispose d’un Programme National de Lutte Contre la Tuberculose (PNT) dont le but est de réduire la transmission des bacilles au sein des populations à un niveau tel que la tuberculose cesse d’être un problème de santé au Bénin. Dans le cadre du suivi de ses activités, le Programme National contre la Tuberculose(PNT) organise de façon régulière et systématique la supervision des Centres de Diagnostic et de Traitement (CDT) de la tuberculose et le contrôle de qualité de son réseau de laboratoires. Cette supervision, à caractère formatif permet entre autres de valider et de collecter les données statistiques (voir graphique2). Ces données permettent le suivi trimestriel des indicateurs du programme et l’élaboration du rapport annuel du PNT.[1]. Les évaluations externes annuelles de l’Union Internationale Contre la Tuberculose et les Maladies Respiratoires (UICT-MR) sont régulièrement faites chaque année et permettent aux acteurs du PNT de bénéficier des avis des partenaires externes. Des revues générales sont parfois effectuées, conjointement par l’OMS et l’UICT-MR, en collaboration avec les cadres nationauxdu PNT. Ces deux types d’évaluation contribuent au suivi et à l’évaluation des activités programmées dans le plan stratégique du PNT.

Botswana

Esta seção do perfil do sistema de saúde está estruturado da seguinte forma:

Analytical summary

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Botswana has one of the world’s highest burdens of tuberculosis (TB) per capita, with a notification rate of 470 per 100 000 population (see table). TB is one of the most common opportunistic infections in those infected with HIV, with 75% of TB patients being HIV positive. TB rates started rising with increasing prevalence of HIV/AIDS in the 1990s, with an increase of 200 cases per 100 000 population in 1990 to 620 cases per 100 000 in 2002. Botswana’s response to TB has been influenced by both national commitment and regional and international resolutions and targets for controlling TB. The country has also had strong support from development partners. The development of the current strategic plan document was also informed by the global Stop TB Partnership strategy that empowers people living with TB and their communities and devolves responsibility to them. The TB control guidelines provide a framework for guiding implementation of the TB control strategy and define responsibilities of the different players.


Disease burden

DOTS expansion and enhancement

MDR, TB/HIV and other challenges

Contributing to health systems strengthening

Engaging all care providers

Empowering people with TB, and communities

State of surveillance

Enabling and promoting resarch

Endnotes: sources, methods, abbreviations, etc.

Angola

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Tuberculosis incidence rate per 100,000 population per year in Angola and neighboring countries, 2008 et 2000
Tuberculosis incidence rate per 100000 population per year in Angola and neighboring countries 2008 et 2000.JPG

Malawi

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This analytical profile on tuberculosis is structured as follows:

4.2.1 Analytical summary
4.2.2 Disease burden
4.2.3 DOTS expansion and enhancement
4.2.4 MDR, TB/HIV and other challenges
4.2.5 Contributing to health systems strengthening
4.2.6 Engaging all care providers
4.2.7 Empowering people with TB, and communities
4.2.8 State of surveillance
4.2.9 Enabling and promoting research

Madagascar

O conteúdo em Portugês estará disponível em breve.

This analytical profile on tuberculosis is structured as follows:

4.2.1 Analytical summary
4.2.2 Disease burden
4.2.3 DOTS expansion and enhancement
4.2.4 MDR, TB/HIV and other challenges
4.2.5 Contributing to health systems strengthening
4.2.6 Engaging all care providers
4.2.7 Empowering people with TB, and communities
4.2.8 State of surveillance
4.2.9 Enabling and promoting research

Liberia

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Liberia's National Leprosy and TB Control Programme was established in 1989 to organize and coordinate all leprosy and tuberculosis (TB) control activities nationwide.

The interruption of leprosy and TB service delivery during the civil war has contributed to the increased burden of leprosy and TB. In a bid to address this increase, Liberia endorsed and adopted the global Stop TB Strategy and DOTS, the basic package that underpins the Strategy and developed a 5-year National TB Strategic Plan (2007–2012) aimed at reducing the national burden of TB.

Lesotho

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This analytical profile on tuberculosis is structured as follows:

4.2.1 Analytical summary
4.2.2 Disease burden
4.2.3 DOTS expansion and enhancement
4.2.4 MDR, TB/HIV and other challenges
4.2.5 Contributing to health systems strengthening
4.2.6 Engaging all care providers
4.2.7 Empowering people with TB, and communities
4.2.8 State of surveillance
4.2.9 Enabling and promoting research

AFRO

Esta seção do perfil do sistema de saúde está estruturado da seguinte forma:

Analytical summary

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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.

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.


Disease burden

Tuberculosis incidence rate per 100 000 population per year in the WHO African Region, 2000 and 2009

Africa is home to approximately 12% of the world population, but is estimated to carry up to 30% of the global burden of tuberculosis (TB).[2]

The most recent estimate of TB incidence in Africa, carried out by WHO in 2007, reported a doubling of figures since 1990 (see figure), with a population ratio of 351:100 000.[2] Prevalence has also greatly increased, with rates standing at 473:100 000 in 2008. Mortality figures have risen, more than doubling between 1990 and 2007.

While estimated TB incidence has been seen to decline since 2005, intensified action in all African countries is needed to maintain progress. At present rates, most countries will not attain the Millennium Development Goal target (see figure).

Tuberculosis prevalence per 100,000 population per year in the African Region, 2000 and 2009


Expanding directly observed treatment short course (DOTS)

Significant progress in expanding DOTS coverage has been made since the beginning of the 1990s. An average coverage rate of 93% had been achieved throughout the WHO African Region by the end of 2008. By then, nine countries of the Region had reached the global target of a 70% case detection rate, compared with seven countries in 2007.

DOTS expansion and enhancement

Significant progress in expanding directly observed treatment short course (DOTS) coverage has been made since the beginning of the 1990s. An average coverage rate of 93% had been achieved throughout the WHO African Region by the end of 2008. By then, nine countries of the Region had reached the global target of a 70% case detection rate, compared with seven countries in 2007.

Case detection, treatment success and key challenges

The slow improvement in case detection is attributable to health system challenges. Chief among these are:

  • limited human resources
  • weak decentralization of diagnostic and clinical services to the periphery
  • low levels of community engagement in identification and treatment of suspected cases.

While there has, in general, been an improvement in the quality of TB care in the Region, the treatment success rate has reached only 79%. This represents a marginal increase from 72% in the year 2000. Fifteen countries (Algeria, Benin, Burundi, Comoros, Democratic Republic of Congo, Eritrea, Kenya, Malawi, Mauritius, Rwanda, Sao Tome and Principe, Seychelles, Sierra Leone, United Republic of Tanzania, Zambia) attained the treatment success rate target of 85% in 2008, compared with only nine countries in 2007. Failure to meet the designated success rate is attributed mainly to high treatment default rates, transfers out, and death rates in several countries.

The principal challenge to DOTS implementation remains the weakness of national health systems. Typical shortfalls include:

  • limited diagnostic capacity at community level
  • inadequate mechanisms for patient follow-up during treatment
  • high default and transfer out rates
  • high death rates
  • challenges in drug storage and distribution
  • weak monitoring and evaluation systems.

MDR, TB/HIV and other challenges

Multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant TB (XDR-TB) are emerging concerns in the WHO African Region. The commonest cause is poor basic performance of the DOTS (the basic package that underpins the Stop TB Strategy) programme. MDR-TB is defined as TB caused by organisms resistant to isoniazid and rifampicin, the two most potent first-line anti-TB medicines. XDR-TB is defined as MDR-TB cases that are also resistant to at least two of the key second-line anti-TB drug families (fluoroquinolones and second-line injectable agents). Both these forms of resistance bring a new dimension to the threat of the TB epidemic, and draw attention to the need for adequate resources to combat inadequacies in diagnosis, treatment and infection control in health institutions and communities.

The true extent of drug-resistant TB in Africa is not known. However, between January 2007 and December 2009, a total of 22 032 new MDR-TB cases had been reported in 33 countries. During the same period, 1501 new XDR-TB cases were reported in eight countries (Botswana, Burkina Faso, Kenya, Mozambique, Namibia, South Africa, Swaziland).

These figures may in fact represent only a fraction of the real total, since the Region has limited capacity to identify and monitor the treatment of drug-resistant TB strains. Thirteen countries do not have the local laboratory capacity to identify MDR-TB cases (Burundi, Cape Verde, Chad, Comoros, Congo, Eritrea, Gabon, Guinea-Bissau, Liberia, Mali, Niger, Sao Tome and Principe, Zimbabwe) , while only two (Algeria, South Africa) have the technical capacity to identify XDR-TB cases.

A further complication is the lack of second-line anti-TB medicines. This is partly due to the high cost and short shelf-life of some of these medicines. Of the 33 countries that have reported MDR-TB cases since 2007, only 20 are known to have a structured MDR-TB treatment programme, despite the existence of a WHO facility (the Green Light Committee mechanism) to ensure access to quality-assured second-line anti-TB medicines at concessionary prices. Four regional MDR-TB case management courses, two in the English language (organized with WHO headquarters) and two in French (organized with the International Union against TB and Lung Diseases), have been conducted to build core capacity for managing MDR-TB cases.

The HIV/AIDS epidemic has become the most important risk factor for TB incidence and death in the Region. Sub-Saharan Africa remains the most affected region, accounting in 2008 for over two thirds (67%) of all people living with HIV and nearly three quarters (72%) of AIDS-related deaths globally.[3]

On average, 35% of new TB patients in the Region are coinfected with HIV, compared with 8% globally. TB-related death rates in countries with high HIV prevalence have risen to as much as 20% during the past 10 years.[2] Coinfection increasingly causes TB to occur in younger, and hence more economically productive members of society, especially girls and young women aged between 15 and 24 years.

In 2006, 22% of TB patients were tested for HIV infection. By 2007, this had risen to 37%. The proportion in whom HIV infection was diagnosed and who started treatment with cotrimoxazol reached 66% in 2007, while 33% started antiretroviral therapy.[2]

Contributing to health systems strengthening

Without a functioning health system, effective TB control interventions cannot be successfully implemented. Health system weaknesses have been identified in most Member States of the WHO African Region. Efforts to strengthen them focus mainly on:

  • human resource development
  • strengthening laboratory capacity
  • bolstering procurement and supply management systems
  • improving health information systems.

The Fifty-ninth session of the WHO Regional Committee for Africa, held in 2009, adopted Resolution AFR/RC59/R2 entitled "Drug resistance related to AIDS, tuberculosis and malaria: issues, challenges and the way forward".[4] This Resolution called on Member States to strengthen national and subnational health laboratory networks, including human resources capacity, and to implement administrative, environmental, personal protection, and integrated infection control measures, particularly for multidrug-resistant TB and extensively drug-resistant TB.

WHO continues to provide assistance to Member States in implementing the provisions of this Resolution.

Engaging all care providers

The WHO Stop TB Strategy recognizes the need to engage with all health care providers, utilizing the public–private mix approach in implementing DOTS. Currently, most African countries have public–private mix DOTS initiatives in place, primarily involving organized private care providers and industry-related health services.

However, a significant proportion of countries are still not including informal health care providers in their DOTS activities. Mechanisms established with countries to further DOTS outreach should ensure that all levels of health care providers are engaged, thereby increasing outreach for the identification, referral, diagnosis and treatment of suspected TB cases. Existing experience in some countries has shown that informal sector providers can successfully support the DOTS approach.

Empowering people with TB, and communities

Tuberculosis (TB) is a disease of the poor. An infected individual becomes poorer due to the costs of a protracted process of diagnosis and treatment. A 2004 joint report by the African Union and the Economic Commission for Africa estimated an annual economic loss of 4–7% of gross domestic product in countries with a high TB disease burden.[5]

Economic loss on this scale underscores the need for well-defined linkages between TB control and national antipoverty initiatives geared to reaching poor and vulnerable populations. These include the Poverty Reduction Strategy Papers, Medium Term Expenditure Frameworks, Poverty Reduction Support Credits, and other broad planning mechanisms such as the Sector-wide Approach. Formal linkages of this nature will help ensure sustainability of commitment to TB control. The WHO Regional Office for Africa will assist this process by systematically promoting the incorporation of pro-poor approaches in the formulation of national TB control strategies.

The Regional Office has provided technical support to countries through provision of guidance for community TB care, based on results of the project ‘Community TB Care in Africa’, and lessons from other disease control programmes.[6] These successful patient-centred and community-based initiatives have shown the importance of building a partnership between patients, communities and the formal health system. They have demonstrated that this partnership is feasible, cost effective and acceptable. Moreover, the sociocultural traditions of African communities offer a sound departure point to enhance the involvement of patients and communities in measures to address the scourge of TB and other killer diseases.

State of surveillance

Recording and reporting of tuberculosis cases is systematically carried out by countries and reported annually to WHO. Disease measurement through prevalence surveys has been identified as a priority need in the 2010/2011 reporting period. Surveys will take place in 11 African countries this year. These are currently at different stages of preparation and implementation, but the outputs are expected to improve present estimates of the tuberculosis disease burden throughout the continent.

Enabling and promoting research

The WHO Regional Office for Africa supports countries in the development and implementation of programme-based operational research, and the documentation of best practices within the WHO African Region. However, this area requires significant further human and financial resourcing to become more effective.

Endnotes: sources, methods, abbreviations, etc.

References

  1. Rapport annuel PNT 2010. 1,2Mo
  2. 2.0 2.1 2.2 2.3 WHO global tuberculosis control: a short update to the 2009 report. Geneva, World Health Organization, 2009 (WHO/HTM/TB/2009.426)
  3. AIDS epidemic update 2009 (pdf 2.9Mb). Geneva, Joint United Nations Programme on HIV/AIDS and World Health Organization 2009
  4. Drug resistance related to AIDS, tuberculosis and malaria: issues. Challenges and the way forward (pdf 28.53kb). Resolution AFR/RC59/R2 http://www.afro.who.int/index.php?option=com_docman&task=doc_download&gid=3852
  5. Scoring African leadership for better health. Addis Ababa, Economic Commission for Africa, 2004 http://www.uneca.org/eca_resources/Publications/Scoring/index.htm
  6. Draft guidelines for implementing community TB care programmes. Brazzaville, World Health Organization Regional Office for Africa, 2004

Title

Tuberculose

Burkina_Faso

O conteúdo em Portugês estará disponível em breve.

La lutte contre la tuberculose est organisée au Burkina Faso autour d’un Programme National mis en place depuis 1995.

15. rubrique Tuberculose.JPG

Depuis sa création, le PNT du Burkina Faso est basé sur la stratégie DOTS (de l'anglais, directly observed treatment, short-course) proposée par l’OMS aux Etats pour contrôler la tuberculose. Les composantes de cette stratégie sont les suivantes :

Burundi

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La tuberculose est un problème de santé publique car elle est la cinquième cause de mortalité selon les données EPISTAT de 2010. La tranche d’âge la plus touchée est celle de 15-54 ans (86,6%) avec une prédominance masculine (64,4%)[1]. Certains indicateurs relatifs à la lutte contre la tuberculose restent faibles. Selon le rapport 2010 du PNLT, les taux de notification des cas contagieux (TPM+) et de toutes les formes de tuberculose (TTF) sont respectivement de 54 et 91 cas pour 100 000 habitants en 2010 contre 47 et 87 cas pour 100 000 habitants en 2009. Le nombre de TPM+ nouveaux cas déclarés et mis sous traitement a évolué de 2004 à 2010 en passant de 3087 à 4590 TPM+NC.

Les activités de prise en charge font recours à la stratégie DOTS avec un régime court de six mois pour tous les nouveaux cas de tuberculose : 2 mois de traitement par la Rifampicine, Isoniazide, Ethambutol, Pyrazinamide suivis de 4 mois de Rifampicine et Isoniazide 2RHZE/ 4(RH). En cas d’échec aux précédents régimes thérapeutiques, le traitement des cas de multi résistance en vigueur en deux phases (première phase de trois mois (forme orale) suivie d’une deuxième phase de 12 mois (forme injectable) La mise en place d’un DOTS communautaire est à sa phase d’extension dans 6 provinces.

Ethiopia

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Ethiopia ranks third in Africa and eighth among the 22 highest tuberculosis (TB) burdened countries in the world. The prevalence of all forms of TB is estimated at 261 per 100 000 population, leading to an annual mortality rate of 64 per 100 000 population. The incidence rate of all forms of TB is estimated at 359 per 100 000 population, while the incidence rate of smear-positive TB is 108 per 100 000 population. The TB case detection rate, treatment success rate and TB cure rate are 74%, 82.5% and 67%, respectively (see figure).[2]

Multidrug-resistant TB (MDR-TB) is a challenge. A countrywide survey between 2003 and 2006 showed that the prevalence of MDR-TB was 1.6% in new TB cases and 11.8% in retreatment cases. In addition, there was a high TB/HIV coinfection rate, with 25% of registered TB cases also testing positive for HIV.[3]

Eritrea

O conteúdo em Portugês estará disponível em breve.

Tuberculosis incidence rate per 100,000 population per year in Eritrea and neighboring countries, 2008 et 2000
Tuberculosis incidence rate per 100,000 population per year in Eritrea and neighboring countries, 2008 et 2000.JPG

Equatorial_Guinea

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L’Organisation de la lutte contre la tuberculose en Guinée Equatoriale

La lutte contre la tuberculose est organisée suivant les trois niveaux de la pyramide sanitaire.

  • 1. Le niveau central: constitué par la Direction Nationale de programme à laquelle est attaché le centre national de référence base à Bata. La direction centrale du programme dépend hiérarchiquement de la Direction General de Sante Publique et de la Planification Sanitaire.
  • 2. Le niveau intermédiaire : la coordination régionale de Bata.
  • 3. Le niveau périphérique : il est constitue par les Centre de diagnostic et traitement de la tuberculose, bases au niveau de districts.

Democratic_Republic_of_the_Congo

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Taux d’incidence de la tuberculose pour 100.000 habitants par année en R. D. Congo et dans les pays limitrophes, 2008 et 2000
Taux d’incidence de la tuberculose pour 100.000 habitants par année en R. D. Congo et dans les pays limitrophes, 2008 et 2000.JPG

Côte_d'Ivoire

Esta seção do perfil do sistema de saúde está estruturado da seguinte forma:

Résumé analytique

O conteúdo em Portugês estará disponível em breve.

Selon l’OMS en 2006, le nombre total de cas estimé de tuberculose en Côte d’Ivoire était de 70 220, soit une incidence de 393 cas pour 100 000 habitants. L’incidence de la forme à microscopie positive était de 169 cas pour 100 000 habitants. Depuis l’avènement de l’infection à VIH, on note une progression de 10% des cas de tuberculose chaque année. La tuberculose représente chez les PVVIH 36% des infections opportunistes et est responsable de 32% des cas de décès. La co-infectioncoïnfection tuberculose - VIH/Sida pose un problème de santé publique. En 2007[4], cette co-infectioncoïnfection était d'environ 39% et l'incidence de la tuberculose multi-résistante était estimée à 2,5%.

Comoros

Esta seção do perfil do sistema de saúde está estruturado da seguinte forma:

Résumé analytique

O conteúdo em Portugês estará disponível em breve.

La tuberculose est connue aux Comores depuis de longues dates et est considérée par une partie de la population comme une maladie honteuse et inguérissable. Dès 1980, cette maladie a été classée comme problème de santé publique majeur.

Journée tuberculose - WR et le MdS

A cet effet, le Programme National de Lutte Contre la Tuberculose (PNLT) a été créé et une politique de prise en charge mise en place avec l’appui des partenaires dont l’OMS et Action Damien.

Pour apprécier l’ampleur de la maladie au niveau national, une enquête épidémiologique basée sur le test tuberculinique (la seule enquête effectuée aux Comores et qui est à la base de toutes les statistiques de cette maladie jusqu’à nos jours) a été effectuée au milieu des années 1980. Les résultats de cette enquête ont donné une prévalence de la tuberculose évaluée à 60 cas pour 100.000 hab. Le Pays dispose d’un Plan Stratégique conte la tuberculose 2011-2015.


Charge de morbidité

Extension et amélioration de la stratégie DOTS

Tuberculose MR, Tuberculose/HIV et autres défis

Contribution au renforcement du système de santé

Engager les dispensateurs des soins de santé

Favoriser l'autonomisation des personnes atteintes de tuberculose et des communautés

Etat de la surveillance

Promouvoir et développer la recherche

Notes de fin: sources, méthodes, abréviations, etc.

Cape_Verde

Esta seção do perfil do sistema de saúde está estruturado da seguinte forma:

Resumo analítico - Tuberculose

Cerca de duzentos e setenta casos novos de tuberculose, todas as formas, são notificados anualmente em Cabo Verde, desde 2003.

Raio-X do peito de um paciente com tuberculose pulmonar avançada

Nesse ano a incidência foi de 65,51 casos por 100.000 habitantes e em 2005 de 57,93. Tendo em conta o consenso publicado pela OMS em 1999 em que o risco anual de infecção tuberculosa em Cabo verde é estimado em 1,5%, espera-se em Cabo Verde uma média anual variando entre 600 e 700 casos, de modo que que a taxa de detecção continua baixa, à volta de um terço dos casos.

Não estão disponíveis dados que nos permitam analisar, com rigor, a evolução da incidência da tuberculose nos concelhos, no entanto pode-se constatar, nos últimos anos, a incidência tem sido elevada na Praia, Santa Cruz e Tarrafal, que ultrapassam a média nacional. Na Boavista, Mosteiros e Porto Novo desenha-se uma melhoria da situação e nos restantes concelhos mantém-se um patamar endémico perto da média nacional[5].

Fardo de doença

Em 2010 foram registados a nível mundial 8,8 milhões de casos de Tuberculose, o que causou 1,1 milhões de mortes em pessoas com TB associadas a HIV negativas e outras 0,35 milhões de mortes a pessoas com TB associadas a HIV[6].

Em Cabo Verde, de modo geral a mortalidade por Tuberculose tem vindo a diminuir paulatinamente nos últimos dez anos em todos os concelhos. O número de óbitos por Tuberculose foi, em média, de 31 de 1992 a 1998 e de 15 de 1999 a 2005, mostrando uma tendência para redução na ordem dos 50%.

Segundo os últimos dados, foram registados em 2010 o total 365 casos, destes, 186 novos casos TP +, 98 Casos Novos TP-, 54 TB Extra Pulmonar, 18 recaídas, 2 re tratamento/fracasso e 7 casos de tratamento. O total de óbitos foi de 21, para uma taxa de incidência de 68,7/100.000, prevalência de 74,2/100.000 e uma taxa de mortalidade de 4,3/100.000, (Tabela 4.2.2.1).

Tabela 4 2 2 1 Tuberculose Incidencia prevalencia e mortalidade 2006 2010.png


Expansão e melhoramento da DOTS

Segundo os dados disponíveis, a nível de tratamento dos novos casos de Tuberculose Pulmonar (BK+) em 2009, a taxa de sucesso nos tratamentos foi de 74%, 54,4% dos casos foram curados, 19% dos doente fez tratamento completo, tratamento de fracasso foi registado em 1,5% dos casos, a taxa de mortalidade foi de 0,6% apenas taxa de abandono foi de 13,4%, taxa de transferidos foi de 5,6%[7], não estando disponíveis os dados referentes a 2010 (Tabela 4.2.3.1).

Tabela 4 2 3 1 Resultado de Tratamento de Casos Novos de Tuberculose.png


MDR, TB / VIH e outros desafios

Contribuição para o reforço dos sistemas de saúde

A vacinação com BCG, o diagnóstico e o tratamento são garantidos gratuitamente pelo Governo.

Em 2004 a candidatura de Cabo Verde ao fornecimento de medicamentos antituberculosos por GDF (Global Drug Facility - ramo de Stop TB) foi aceite e a partir de 2005 os medicamentos passaram a ser fornecidos ao programa com regularidade por essa organização, gratuitamente por um período de três anos, mediante avaliação anual.

No fim dos três anos o Governo passou a comprar os medicamentos antituberculosos através de GDF, por preço muito inferior ao do mercado normal.

Desde 2004, no âmbito do enquadramento da Tuberculose como infecção oportunista o PNLT tem contado com a parceria do Programa de Luta contra a Sida[8].


Envolver todos os prestadores de cuidados

O PNLT está integrado no Serviço das Doenças Transmissíveis e Meio Ambiente, dependente da Direcção Geral da Saúde. É a unidade central que coordena a luta antituberculosa em todo o país, responsável pela planificação, a implementação e a avaliação das actividades do plano nacional.

A coordenação nacional do PNLT é garantida por um Director e conta com a colaboração do Serviço de Vigilância Epidemiológica, do Programa de Luta contra a SIDA, da Rede Nacional de Laboratórios e do Centro Nacional de Desenvolvimento Sanitário entre outros departamentos do Ministério da Saúde[9].

A nível concelhio o Delegado de Saúde é o responsável pela luta antituberculosa. A este título, deve organizar:

  • as actividades de formação do pessoal da saúde;
  • o abastecimento em medicamentos antituberculosos e em reagentes de laboratório;
  • a recolha e a análise dos dados sobre a despistagem os resultados do tratamento; e
  • assegurar a supervisão e a gestão do programa no concelho.


Normalmente existe em cada Delegacia de Saúde um médico que é o ponto focal e que coordena directamente a execução do programa. A esse nível, as actividades de luta antituberculosa estão integradas nas actividades de rotina dos serviços de saúde de base: centros de saúde e postos sanitários. O diagnóstico e o atendimento dos casos de tuberculose, constituem partes integrantes do pacote mínimo de actividades (PMA) das delegacias de saúde.

Os hospitais regionais e centrais, enquanto estruturas de referência, participam também nas actividades de despistagem, tratamento e hospitalização dos casos graves de tuberculose.

A articulação com o sector privado é fraca, o que acarreta um diagnóstico tardio e atraso no início da terapêutica.


Capacitar as pessoas com TB, e as comunidades

As actividades de educação e sensibilização são feitas junto dos doentes e seus familiares deforma rotineira pelo pessoal de saúde durante as consultas.

Anualmente por ocasião da comemoração do dia mundial da tuberculose, são realizadas campanhas dirigidas à população em geral, quer nas estruturas da saúde pela distribuição de folhetos e afixação de cartazes, quer ao nível dos meios de comunicação social – rádio, televisão e imprensa escrita.

No entanto estas actividades devem ser contínuas ao longo do ano[10].


Estado da vigilância

Tendo em atenção o recrudescimento da tuberculose a nível mundial e o conhecimento da situação em Cabo Verde que regista ainda uma prevalência elevada.

Preconizam-se as seguintes directrizes específicas, com vista a:

  • controlar a doença e a inversão da tendência actual na frequência da doença, nomeadamente a organização, em todas as estruturas do primeiro contacto, do diagnóstico precoce e sistemático da tuberculose e seu tratamento imediato no nível municipal com a estratégia DOTS, e dum sistema de referência para o nível regional que dê confiança e estimule os doentes na observância das regras do tratamento regular;
  • investigação rápida dos níveis epidemiológicos da tuberculose e consequente programação de medidas de controlo, diagnóstico e tratamento precoces;
  • envolvimento multisectorial na divulgação sistematizada de medidas de promoção e prevenção contra a tuberculose e suas múltiplas causas, nomeadamente socio-económicas, enquadradas no combate à pobreza.


Possibilitar e promover a investigação

A nível de investigação nesta área não há dados disponíveis, existindo apenas a recolha dos dados epidemiológicos e de gestão do programa feita através de formulários próprios que são enviados trimestralmente do nível local para o central.

Nestes estão incluídos:

  • o formulário do relatório trimestral dos casos detectados;
  • o formulário do resultado do tratamento dos doentes com Tuberculose Pulmonar com baciloscopia positiva (TP BK+) registados 12 meses antes; e
  • o formulário da requisição de medicamentos que é feita de acordo com o número de casos notificados.


Notas de fim: fontes, métodos, abreviaturas, etc.

Bibliografia

  1. 1. Plano Estratégico Nacional de luta contra a Tuberculose, 2007-2011; GS, MS, 2007
  2. 2. Relatório Estatístico da Saúde, 2010.Ministério da Saúde, 2011
  3. 3. Global Tuberculosis Control, WHO, 2011
  4. 4. Política Nacional da Saúde, MS, 2007

Abreviaturas

  • PNLT – Plano Nacional de Luta contra a Tuberculose
  • PMA – Pacote Mínimo de Actividades
  • GDF – Global Drug Facility
  • DOTS – Cobertura do tratamento directamente observado


Referências

  1. Rapport PNLT 2010
  2. Health Sector Development Programme IV. Annual performance report. Addis Ababa, Government of Ethiopia, Ministry of Health, 2011
  3. Global tuberculosis control 2009. Epidemiology strategy financing (pdf 6.95Mb). Geneva, World Health Organization, 2009
  4. Rapport annuel PNLT 2007
  5. Plano Estratégico Nacional de luta contra a Tuberculose, 2007-2011; GS, MS, 2007
  6. Relatório Estatístico da Saúde, 2010.Ministério da Saúde, 2011
  7. Global Tuberculosis Control, WHO, 2011
  8. Plano Estratégico Nacional de luta contra a Tuberculose, 2007-2011; GS, MS, 2007
  9. Plano Estratégico Nacional de luta contra a Tuberculose, 2007-2011; GS, MS, 2007
  10. Plano Estratégico Nacional de luta contra a Tuberculose, 2007-2011; GS, MS, 2007

Chad

O conteúdo em Portugês estará disponível em breve.

Taux d’incidence de la tuberculose pour 100.000 habitants par année au Tchad et dans les pays limitrophes, 2008 et 2000
Taux d’incidence de la tuberculose pour 100.000 habitants par année au Tchad et dans les pays limitrophes, 2008 et 2000.JPG

Central_African_Republic

O conteúdo em Portugês estará disponível em breve.

Taux d’incidence de la tuberculose pour 100.000 habitants par année en République Centrafricaine et dans les pays limitrophes, 2008 et 2000
Taux d’incidence de la tuberculose pour 100.000 habitants par année en République Centrafricaine et dans les pays limitrophes, 2008 et 2000.JPG

Cameroon

O conteúdo em Portugês estará disponível em breve.

Taux d’incidence de la tuberculose pour 100.000 habitants par année au Cameroun et dans les pays limitrophes, 2008 et 2000
Taux d’incidence de la tuberculose pour 100.000 habitants par année au Cameroun et dans les pays limitrophes, 2008 et 2000.JPG

...: Données indisponibles