title: Trends of Zambia's tuberculosis burden over the past two decades.
abstract: OBJECTIVE
  To study trends in Zambia's TB notification rates between 1990 and 2010 and to ascertain progress made towards TB control.
  
  
  METHODS
  Retrospective review of TB notification returns and TB programme reports for the period from 1990 to 2010.
  
  
  RESULTS
  Two distinct TB trend periods were identified: a period of rising trends up to a peak between 1990 and 2004 and a period of moderately declining trends between 2004 and 2010. Treatment outcomes improved over the two decades. Data on trends in paediatric TB, TB in prisoners and TB in pregnant women remain scanty and unreliable owing to poor diagnostic capability. There were no data available on trends on drug-resistant TB because of the lack of laboratory services to perform drug sensitivity testing.
  
  
  CONCLUSIONS
  The period of increasing TB between 1990 and 2000 coincided with an increase in HIV/AIDS. The period of slightly decreasing TB between 2004 and 2010 can be attributed to improved TB care, sustained DOTS implementation and improvement in TB diagnostic services. Newer diagnostics technologies for the rapid diagnosis of active TB cases and for drug-resistant testing, recently endorsed by the WHO, need to be implemented into the national TB programmes to detect more cases and to provide epidemiological and surveillance data from which to obtain an evidence base for guided investments for TB control. Alignment of TB and HIV services is required to achieve improved management outcomes.
authors.affiliation: National TB and Leprosy Control Program, Ministry of Health, Lusaka, Zambia. nkapata@gmail.com
authors.forename: Nathan
authors.initials: N
authors.lastname: Kapata
authors.forename: Pascalina
authors.initials: P
authors.lastname: Chanda-Kapata
authors.forename: Justin
authors.initials: J
authors.lastname: O'Grady
authors.forename: Samana
authors.initials: S
authors.lastname: Schwank
authors.forename: Mathew
authors.initials: M
authors.lastname: Bates
authors.forename: Victor
authors.initials: V
authors.lastname: Mukonka
authors.forename: Alimuddin
authors.initials: A
authors.lastname: Zumla
authors.forename: Peter
authors.initials: P
authors.lastname: Mwaba
mesh_terms: D000995:Antitubercular Agents / Q000627:therapeutic use*; D023801:Directly Observed Therapy; D005260:Female; D006801:Humans; D008297:Male; D011159:Population Surveillance / Q000379:methods; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*; D012189:Retrospective Studies; D014376:Tuberculosis / Q000188:drug therapy / Q000453:epidemiology*; D014944:World Health Organization; D015024:Zambia / Q000453:epidemiology
chemical_list: D000995:Antitubercular Agents