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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 Professor
Dept. of Community Medicine, BPKIHS
&
Dr Dirgha S Bam
Director SAARC TB Centre
Global TB Burden
Rest of the
world
20%
50% of Global TB
Burden occurs in 5
countries of South
East Asia:
India, Indonesia,
Bangladesh,
Thailand,
Myanmar
22 High
burden
countries
80%
TB is the leading single infectious
cause of death in South-East Asia
800
700
600
Deaths from infectious
agents in South-East Asia
500
400
300
200
100
0
Tuberculosis
HIV
Measles
STD
Malaria
Tropical
Diseases
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 adults
• More women die of TB than
all causes of maternal
mortality
• Urgency due to:
– close association with HIV/AIDS
– emergence of drug resistance
South-East Asia accounts for nearly
40% of all tuberculosis cases
AF R
WP R
AMR
EMR
EUR
SEAR
Prevalence of TB in poor and non poor
populations in developing countries
TB is a
disease of
vulnerable
populations,
eg:
• poor
• women
• refugees
• prisoners
700
600
598
500
400
300
230
200
100
0
Poor
Non Poor
TB is a Leading Killer of Women
605,000
Deaths among
women
493,000
538,000
101,000
48,000
Tropical
Diseases
STD
Maternal
Mortality
Malariya
TB
Tuberculosis and SAARC
TB a Major Public Health Problem in South Asian
Countries with 38% total Global TB Burden
SAARC
Global
•New TB Cases 2.5 million/year 8 million/year
•Deaths due to 0.6 million/year 2 million/year
TB
Tuberculosis and SAARC
TB a Major Public Health Problem in South Asian
Countries with 38% total Global TB Burden




Population
Prevalence of Tuberculosis
New Cases of TB per year
Death per year
1,300 million
6 million
2.5 million
0.6 million
Estimated TB Incidence
New TB Cases
Countries
Bangladesh
Bhutan & Maldives
India
Nepal
Pakistan
Sri Lanka
in Million
0.30
0.01
1.80
0.05
0.26
0.04
22 countries:
80% global TB burden
TB in South Asia
2,000,000
1,800,000
1,600,000
All countries
1,400,000
1,200,000
India
1,000,000
800,000
600,000
400,000
200,000
0
1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998
Global HIV Epidemic
• 33.6 million people living with HIV
• 5.6 million new infections and 2.6 million
deaths in 2000
• 10% of new cases under 15 years
• 40% of cases in women
• 16.3 million deaths since beginning of
epidemic
WHO/UNAIDS: AIDS Epidemic Update December 2000
Western Europe
520 000
North America
920 000
Caribbean
360 000
Eastern Europe &
Central Asia 360 000
North Africa& Middle
East 220 000
East Asia & Pacific
530 000
South & South-East Asia
6 million
Latin America
1.3 million
Sub- Saharan Africa
23.3 million
Total: 33.6 million
Australia & New Zealand
12 000
North America
44 000
Western Europe
30 000 Eastern Europe &
Central Asia 95000
East Asia & Pacific
120000
Caribbean
57 000
North Africa &
Middle East
19000
Latin America
150 000
Sub- Saharan
Africa
3.8 million
Total: 5.6 million
South & South-East
Asia 1.3 million
Australia &
New Zealand
500
Current HIV Situation
• High HIV prevalence:
India, Myanmar and Thailand*
• Low HIV prevalence in women in antenatal
clinics but relatively high among IDU:
Nepal
• Low HIV prevalence:
Bangladesh, Bhutan, Indonesia, Maldives and
Sri Lanka
• No reported HIV:
DPR Korea
* HIV now declining
To Summarize...
• Majority of new HIV infections are now in
developing world
• Epidemic in the SAARC Region is dynamic
and still evolving
• Epidemic started in many countries among
IDU; now predominantly heterosexual spread
• Intensity of risk behavior and vulnerability
determine HIV spread
HIV in South Asia
Country
Reported AIDS
cases
Estimated HIV
infections
Routine
Surveillance
17
13,000

1
<100

12,239
3,500,000

5
<100

Nepal
383
33,000

Pakistan
147
64,000

Sri Lanka
117
7,3 00

12,809
3,617,500
Bangladesh
Bhutan
India
Maldives
Total
Tuberculosis and HIVthe Deadly Duo
TB is the most
common life
threatening
condition
associated with
HIV infection
With 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 Alliance
is the most serious threat to
TB Control
HIV and TB Dual Infection
17% of global burden of
dual infection
HIV seroprevalence in
TB patients, Mumbai:
1988
1992/3
2%
9%
> 50% of AIDS patients
have TB
Bangladesh
Bhutan
India
Maldives
Nepal
Pakistan
Sri Lanka
9,761
37
1,795,532
32
11,973
24,451
1,644
Total
1,843,430
TB and HIV in South Asia: The Context
High levels of stigma of vulnerable groups and of
people with HIV
Rapid political, cultural, economic and social
transitions
Low status of women
Poverty
Limited political commitment and recognition of
epidemic
Lack of trust between government and civil society
Increasing mobility of population
Most health care provided by private sector
Widespread 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