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)