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Opportunities
Shift in Perspective for Infectious Disease
Control
(Porter et al 1999 Health Policy and Planning 14: 322-328)
From:
• Disease specificity and
verticality
To:
• Integrated/ Horizontal
linkages
• Standardised
interventions
• Flexibility/context
sensitivity
• Short term orientation
• Longer term
objectives/sustainability
• Emphasis on
product/targets
• Emphasis on process
Shift in Perspective for Infectious Disease
Control
(Porter et al 1999 Health Policy and Planning 14: 322-328)
From:
• Limited to health sector
To:
• Linking multiple sectors
• Focus on individual ‘risk’
• Understanding social
vulnerability: risk in the
context of everyday life
• Operating without
reference to global
processes
• Taking globalization as
referent and context
• Working on behalf of
populations
• Working in partnership with
communities
Tuberculosis Control as an
example
Historical decline of TB, 1840-1960
Standardised notification rate
400
Phase 1
Koch’s
discovery
200
0
Antibiotic
era
Segregation of poor
consumptives in enlarged and
improved workhouses infirmaries
300
100
Phase 4
Phase 3
Phase 2
Systematic
segregation
of consumptives,
rich and poor,
In hospitals and
sanatoria
Initial effect of
segregation of poor
consumptives in
work house
1840
1860
1880
1900
1920
1940
Year
Source: data derived from various sources including T. McKewon. The modern rise of population, London: Edward Arnold 1976.
1960
TB & Poverty overlap
Source: World Economic Forum, 2005
Risk factors for TB
Risk factor
Relative risk
for active TB
disease
(range)
Weighted
prevalence,
total population
Population
Attributable
Fraction (Range)
HIV infection
8.3 (6.1-10.8)
1.1%
7.3% (5.2-9.6)
Malnutrition
4.0 (2.0-6.0)
17.2%
34.1% (14.7-46.3)
Diabetes
3.0 (1.5-7.8)
3.4%
6.3% (1.6-18.6)
Alcohol
2.9 (1.9-4.6)
3.2%
5.7% (2.8-10.3)
Active smoking
2.6 (1.6-4.3)
18.2%
22.7% (9.9-37.4)
Indoor pollution
1.5 (1.2-3.2)
71.1%
26.2% (12.4-61.0)
From Lonnroth K et Al. Global epidemiology of tuberculosis. Seminars in Respiratory and
Critical Care Medicine, 3 March 2008
WHO-recommended Global Strategy to Stop TB
and reach the targets for 2015
1.
Pursuing quality DOTS expansion and enhancement
•
•
•
•
•
Political commitment
Case detection through bacteriology
Standardised treatment, with supervision and patient support
Effective drug supply system
Monitoring system and impact evaluation
Additional components
2
Addressing TB/HIV and MDR-TB
3.
Contributing to health system strengthening
4.
Engaging all care providers
5.
Empowering patients and communities
6.
Enabling and promoting research
Stop TB Department
Global TB Control Targets: the theory
• 2015: 50% reduction in TB prevalence and deaths
• 2050: elimination (<1 case per million population)
• 5-10% declining incidence per year:
– 70% detection rate
– 85% successful treatment
Global TB Control Targets: the reality
Case detection rate
• 61% globally in 2006
• 46% in Africa
• 52% in European/Eastern Mediterranean regions
• 2/3 of missing cases are in China, India, Africa
Treatment success rate
• 84.6% globally
• 70% in Eastern Europe
• 76% in Africa