Progress in global tuberculosis control 1995-1996, with emphasis on 22 high-incidence countries. Global Monitoring and Surveillance Project.
OBJECTIVE
To review global tuberculosis case notifications and treatment outcomes, and to assess progress in TB control 1995-1996, especially in the 22 countries that carry 80% of all incident cases.


METHODS
Compilation of case notifications; cohort analysis of treatment outcomes in DOTS and non-DOTS programmes.


RESULTS
The 181 of 212 countries (85%) that reported data to WHO in 1997 covered 97% of the global population. They reported 3.81 million cases of tuberculosis, of which 1.29 million were smear-positive, representing case detection rates of approximately 39% and 51%, respectively. DOTS programmes diagnosed 67% of new pulmonary cases to be smear-positive (65% expected), compared with 30% in other control programmes. They evaluated a higher fraction of registered cases (94% vs 55%), achieved higher treatment success rates (78% vs 45%), and a higher fraction of patients was shown to be cured by smear conversion (72% vs 23%). Despite the apparent advantages of DOTS, only 12% of all estimated cases, and only 15% of smear-positive cases, were treated in such programmes.


CONCLUSIONS
With the exceptions of Vietnam, Peru and Tanzania, none of the 22 highest-incidence countries achieved WHO targets for TB control. The slow progress is of greatest concern in 16 countries, including India, Indonesia, Nigeria and Pakistan.
Netto
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Communicable Diseases, World Health Organization, Geneva, Switzerland.
Dye
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Raviglione
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D000995:Antitubercular Agents / Q000008:administration & dosage*; D003140:Communicable Disease Control / Q000639:trends; D018563:Disease Notification; D004359:Drug Therapy, Combination; D014943:Global Health; D006801:Humans; D015994:Incidence; D009313:National Health Programs; D019370:Observation / Q000379:methods; D017063:Outcome Assessment, Health Care; D011159:Population Surveillance; D015397:Program Evaluation; D014397:Tuberculosis, Pulmonary / Q000453:epidemiology / Q000517:prevention & control*; D014944:World Health Organization
D000995:Antitubercular Agents