Controlling Tuberculosis in China

Controlling Tuberculosis in China

ABSTRACT

Geographic area: China

Health condition: Tuberculosis is the leading cause of death from infectious disease among adults in China. Every year, one point four million people develop active tuberculosis. In nineteen ninety, three hundred sixty thousand people in China died from the disease.

Global importance of the health condition today: Tuberculosis currently ranks as the third leading cause of death and disability among adults in the world, and nearly one third of the world's population is infected with the tuberculosis bacillus. Of these cases, more than nine million people become sick with tuberculosis when their immune system is weakened, and one point seven six million die each year.

Intervention or program: In nineteen ninety-one, China revitalized its ineffective tuberculosis program and launched the ten-year Infectious and Endemic Disease Control project to curb its tuberculosis epidemic in thirteen of its thirty-one mainland provinces. The program adopted the World Health Organization-recommended tuberculosis control strategy, directly observed treatment shortcourse, through which trained health workers watched patients take their treatment at local tuberculosis county dispensaries. Information on each treatment was sent to the county tuberculosis dispensary, and treatment outcomes were sent in quarterly reports to the National Tuberculosis Project Office.

Cost and cost-effectiveness: The program cost one hundred thirty million dollars in total. The World Bank and the World Health Organization estimated that successful treatment was achieved at less than one hundred dollars per person. One healthy life was saved for an estimated fifteen to twenty dollars, with an economic rate of return of sixty dollars for each dollar invested. The World Bank ranks directly observed treatment shortcourse as one of the most cost-effective of all health interventions.

Impact: China achieved a ninety-five percent cure rate for new cases within two years of adopting directly observed treatment shortcourse, and a cure rate of ninety percent for those who had previously undergone unsuccessful treatment. The number of people with tuberculosis declined by over thirty-seven percent in project areas between nineteen ninety and two thousand, and thirty thousand tuberculosis deaths have been prevented each year. More than one point five million patients have been treated, leading to the elimination of eight hundred thirty-six thousand cases of pulmonary tuberculosis.

At any given time, nearly one third of the world's population is infected with tuberculosis bacillus, and every second a new person becomes infected. Of those ill in two thousand four, an estimated nine million people became sick with tuberculosis disease. Although Asia accounts for over half of all tuberculosis patients, the highest rates of tuberculosis occur in sub-Saharan Africa. Tuberculosis kills an estimated one point seven million people each year and ranks as the third leading cause of death and disease burden among adults aged fifteen to fifty-nine. And there are few signs that the epidemic is subsiding: The global incidence of tuberculosis is growing at approximately zero point six percent per year and at much faster rates in sub-Saharan Africa, where as much as four percent growth in incidence has followed rising HIV rates.

Over the last decade, China, one of the countries most profoundly affected by tuberculosis, has demonstrated the potential for large-scale deployment of directly observed treatment shortcourse, the World Health Organization-recommended tuberculosis control strategy. Directly observed treatment shortcourse is a public health approach focused on the early detection of tuberculosis patients via smear microscopy and with a standardized directly observed six-month treatment in dispensaries or in the community until cure. This strategy was developed primarily to prevent the early dropout from treatment, which can result in the development of bacteria that are resistant to available drugs. China has shown how a combination of adequate funding, leadership, and a sound technical approach, delivered through a relatively strong health system, can dramatically reduce tuberculosis over a short period. In the process, China has averted hundreds of thousands of deaths and paved the way for future wins in the battle against tuberculosis.

HOW TB KILLS

Tuberculosis is caused by the bacteria Mycobacterium tuberculosis and is contracted by inhaling infected air droplets spread by active tuberculosis carriers when they cough, sneeze, or talk. The majority of the people who come into contact with the bacteria can fight the progression of the disease, and the bacteria then lie dormant in the body without the development of any symptoms. Carriers of latent tuberculosis cannot spread the infection to others but are still at risk of developing the disease at some point in their lives if their immune system becomes depressed.

Between five percent and ten percent of those infected with tuberculosis will fall ill. Tuberculosis occurs when a weakened immune system allows the bacteria to multiply and active disease to develop. Tuberculosis in the lungs, or pulmonary tuberculosis, is the most common form, although the bacilli can cause the disease in any part of the body. The main symptom of pulmonary tuberculosis is a persistent worsening cough. If left untreated, night sweats, malaise, weight loss, blood in sputum, and shortness of breath take hold as the lungs are slowly destroyed.

HIV and tuberculosis are a particularly deadly combination. Because HIV weakens the immune system, it raises the likelihood of latent tuberculosis becoming active. Consequently, tuberculosis is the leading cause of death among HIV-infected persons and accounts for approximately eleven percent of all AIDS deaths worldwide. As the number of people infected with HIV has increased so has the number of active tuberculosis cases. Unfortunately, the diagnostic tools, which were developed some one hundred years ago, often fail to accurately detect tuberculosis in HIV-positive individuals.

The spread of HIV has fueled the tuberculosis epidemic, but it is not the only reason tuberculosis persists as a major global health problem. Tuberculosis is both a cause and consequence of poverty. Untreated tuberculosis spreads quickly in dense populations, and urbanization and migration accelerate its transmission. Refugees and displaced persons are at an especially high risk because they are usually in crowded refugee camps or shelters and frequently relocate, making compliance with a six-month treatment regimen extremely difficult. The tuberculosis epidemic also is closely associated with the breakdown of financing and infrastructure for public health systems, particularly in the former Soviet Union and in Africa, where access to effective detection and treatment services is limited.