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An Overview of TB in SAARC Countries and Role of SAARC TB Centre in TB Control
Dr Paras K Pokharel, Associate ProfessorDept. of Community Medicine, BPKIHS&Dr Dirgha S Bam Director SAARC TB Centre
Global TB Burden50% of Global TB Burden occurs in 5 countries of South East Asia: India, Indonesia, Bangladesh, Thailand, Myanmar
TB is the leading single infectious cause of death in South-East AsiaDeaths from infectiousagents in South-East Asia
TB - A priority in South-East Asia
One third of the population is infected!TB kills 2000 people everyday ;750 000 every year Is the commonest infectious cause of death in adultsMore women die of TB than all causes of maternal mortalityUrgency due to:close association with HIV/AIDSemergence of drug resistance
South-East Asia accounts for nearly40% of all tuberculosis cases
TB is a disease of vulnerable populations, eg:poorwomenrefugeesprisonersPrevalence of TB in poor and non poor populations in developing countries
TB is a Leading Killer of WomenDeaths among women
Tuberculosis and SAARCTB a Major Public Health Problem in South Asian Countries with 38% total Global TB Burden SAARC GlobalNew TB Cases 2.5 million/year 8 million/yearDeaths due to 0.6 million/year 2 million/year TB
Tuberculosis and SAARCTB a Major Public Health Problem in South AsianCountries with 38% total Global TB Burden Population 1,300 million Prevalence of Tuberculosis6 million New Cases of TB per year2.5 million Death per year0.6 million
Estimated TB Incidence New TB Cases Countries in MillionBangladesh0.30Bhutan & Maldives0.01India1.80Nepal0.05Pakistan0.26Sri Lanka0.04
22 countries: 80% global TB burden
TB in South AsiaAll countriesIndia
Chart1
7695401146154
9230951309081
10750981254324
11093101254154
11688041329130
12795361482680
14031221636103
14572881704797
15105001745413
15191821742728
15553531822004
11211201159554
10812791228708
11143741185762
12199231316792
13009351398605
11359831231473
11300381324519
769 540
Total
Sheet1
SAARC Case finding
Country198119821983198419851986198719881989199019911992199319941995199619971998
Bangladesh426444987052961456794180245599453554428045191486735605231400540014827656437634716342072256
Bhutan265772010179041073158260811261525115499614010811591299127112111292
India7695409230951075098110931011688041279536140312214572881510500151918215553531121120108127911143741219923130093511359831130038
Maldives112111143123911111158520315212392175249231212173175
Nepal3371459700190522521012160311003101428983131611557219804229702415824135
Pakistan324576326492117739915721114191490041794801943231705621567591943237317513142430789599
Sri Lanka628873346666637658896596641160926429666661746802680961325956543965287024
Total114615413090811254324125415413291301482680163610317047971745413174272818220041159554122870811857621316792139860512314731324519
Sheet1
19811146154
19821309081
19831254324
19841254154
19851329130
19861482680
19871636103
19881704797
19891745413
19901742728
19911822004
19921159554
19931228708
19941185762
19951316792
19961398605
19971231473
19981324519
Sheet2
Sheet3
Global HIV Epidemic 33.6 million people living with HIV5.6 million new infections and 2.6 million deaths in 200010% of new cases under 15 years40% of cases in women16.3 million deaths since beginning of epidemicWHO/UNAIDS: AIDS Epidemic Update December 2000
Estimated No. of Adults and Children living with HIV/AIDS as of end 2000Australia & New Zealand 12 000 Sub- Saharan Africa 23.3 millionLatin America 1.3 millionCaribbean 360 000 North America 920 000North Africa& Middle East 220 000Western Europe 520 000Eastern Europe &Central Asia 360 000East Asia & Pacific 530 000South & South-East Asia 6 millionTotal: 33.6 million
Australia & New Zealand 500Sub- Saharan Africa3.8 millionLatin America 150 000Caribbean 57 000 North America 44 000North Africa & Middle East 19000Western Europe 30 000Eastern Europe &Central Asia 95000East Asia & Pacific 120000South & South-East Asia 1.3 millionTotal: 5.6 million
Current HIV SituationHigh HIV prevalence:India, Myanmar and Thailand*Low HIV prevalence in women in antenatal clinics but relatively high among IDU:NepalLow HIV prevalence:Bangladesh, Bhutan, Indonesia, Maldives and Sri LankaNo reported HIV:DPR Korea
* HIV now declining
To Summarize...Majority of new HIV infections are now in developing worldEpidemic in the SAARC Region is dynamic and still evolvingEpidemic started in many countries among IDU; now predominantly heterosexual spreadIntensity of risk behavior and vulnerability determine HIV spread
HIV in South Asia
Tuberculosis and HIV- the Deadly DuoTB is the most common life threatening condition associated with HIV infectionWith the rise in HIV infection, Tuberculosis is also increasing as in Africa. The same is likely to happen in Asia as well
TB and HIV/AIDS Allianceis the most serious threat to TB Control
HIV and TB Dual Infection17% of global burden of dual infectionHIV seroprevalence in TB patients, Mumbai:1988 2% 1992/3 9%> 50% of AIDS patients have TB
Bangladesh 9,761Bhutan 37India 1,795,532Maldives 32Nepal 11,973Pakistan 24,451Sri Lanka 1,644Total 1,843,430
TB and HIV in South Asia: The ContextHigh levels of stigma of vulnerable groups and of people with HIVRapid political, cultural, economic and social transitionsLow status of womenPovertyLimited political commitment and recognition of epidemicLack of trust between government and civil societyIncreasing mobility of populationMost health care provided by private sectorWidespread and indiscriminate availability of TB medicines
Consequences of HIV Infection on NTPs of SAARC Member Countries Increased Case Load Over diagnosis of sputum smear negative pulmonary TB Under diagnosis of TB because of atypical X-ray presentations Low cure rates High case fatality rates during treatment High default rates because of adverse drug reactions Increased emergence of drug resistance
Source: WHO Global Tuberculosis Control Report 2000
Estimated No. of Adults and Children newly infected with HIV during 2000
Source: UNAIDS/WHO Epidemiological fact sheets June 2000, and SEARO AIDS Watch (Vol.5.No.1), (updated if information available)