World TB day- Poverty is the root cause of Tuberculosis
Tuberculosis caused 1.4 million deaths in 2019
Tuberculosis (TB) is the leading adult infectious killer in the world. The
high rates of HIV infection and social deprivation, i.e. crowded, poor quality
housing; air pollution, poverty combine to fuel TB disease rates.
TB diagnosis in primary care can be challenging. Patients are often
unwell for prolonged periods and may attend the health centre multiple times.
The existing tests for TB are either not accurate enough, too slow and require
centralised laboratory infrastructure, or too expensive for widespread implementation.
Tuberculosis (TB) caused 1.4 million deaths globally in 2019, according
to the WHO report 2020. Nearly 10 million new cases reported in 2019 including
1.2 million children. Tuberculosis continues to cause significant morbidity and
mortality, especially in the low and middle income countries) identified by the
World Health Organization (WHO) as the 22 “high burden” nations.
While TB incidence has declined in most regions of the world, the slow
pace of progress has prompted a search for new targets for interventions
Recent work suggests that, on a national level, TB trends track more closely
with social and economic indicators than with measures of TB control
activities . These data imply that the targeting of interventions to the
most vulnerable groups may be necessary to speed progress toward elimination of
this scourge.
There is substantial evidence that poverty is a determinant of TB, both
at the macro-scale and in individual and hierarchical analyses. Some researchers
documented a linear association between per capita GDP and TB incidence. And some researchers found that the country
level human development index was a strong predictor of changes in TB incidence
over time.
With the recognition of poverty as a root cause of TB, the need to
intervene not only on economic status, but also on the proximal risk factors
that put the poor at risk is increasingly clear.
According to the latest WHO data;
A total of 1.4 million people died from TB in 2019
(including 208 000 people with HIV). Worldwide, TB is one of the top 10 causes
of death and the leading cause from a single infectious agent (above HIV/AIDS).
In 2019, an estimated 10 million people fell ill with
tuberculosis (TB) worldwide. 5.6 million men, 3.2 million women and 1.2 million
children. TB is present in all countries and age groups. But TB is curable and
preventable.
In 2019, 1.2 million children fell ill with TB globally.
Child and adolescent TB is often overlooked by health providers and can be
difficult to diagnose and treat.
In 2019, the 30 high TB burden countries accounted for
87% of new TB cases. Eight countries account for two thirds of the total, with
India leading the count, followed by Indonesia, China, the Philippines,
Pakistan, Nigeria, Bangladesh and South Africa.
Globally, TB incidence is falling at about 2% per year
and between 2015 and 2019 the cumulative reduction was 9%. This was less than
half way to the End TB Strategy milestone of 20% reduction between 2015 and
2020.
An estimated 60 million lives were saved through TB
diagnosis and treatment between 2000 and 2019.
Ending the TB epidemic by 2030 is among the health
targets of the United Nations Sustainable Development Goals (SDGs).
Policies
widely adopted in response to the ongoing pandemic of Covid-19, particularly
lockdowns and reassignments of health personnel and equipment, are having an
impact on the performance of global TB detection and care programmes.
A global TB
case detection decrease by an average 25% over a period of 3 months, (as
compared to the level of detection before the pandemic) will lead to a
predicted additional 190,000 TB deaths. This will bring the total predicted
deaths from TB in 2020 to 1.66.million deaths. This is near the global level of
TB mortality of 2015. This would be a serious setback in the progress towards ending
TB.
Most of
these deaths could have been prevented with earlier diagnosis and appropriate
treatment.
On 26
September 2018, the United Nations (UN) held its first- ever high-level meeting
on TB, elevating discussion about the status of the TB epidemic and how to end
it to the level of heads of state and government. It followed the first global
ministerial conference on TB hosted by WHO and the Russian government in
November 2017. The outcome was a political declaration agreed by all UN Member
States, in which existing commitments to the SDGs and WHO’s End TB Strategy
were reaffirmed, and new ones added.
SDG Target 3.3 includes ending the TB epidemic by 2030. The End TB Strategy defines milestones (for 2020 and 2025) and targets (for 2030 and 2035) for reductions in TB cases and deaths. The targets for 2030 are a 90% reduction in the number of TB deaths and an 80% reduction in the TB incidence rate (new cases per 100 000 population per year) compared with levels in 2015.
The political declaration of the UN high-level meeting included four new global targets:
Treat 40 million people for TB disease in the 5-year period
2018–2022;
Reach at least 30 million people with TB preventive treatment
for a latent TB infection in the 5-year period 2018–2022;
Mobilise at least US$ 13 billion annually for universal
access to TB diagnosis, treatment and care by 2022;
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