Progress in global tuberculosis control 1995-1996, with emphasis on 22 high-incidence countries

OBJECTIVE: To review global tuberculosis case notifications and treatment o utcomes, and to assess progress in TB control 1995-1996, especially in the 22 countries that carry 80% of all incident cases. DESIGN: Compilation of case notifications; cohort analysis of treatment out comes in DOTS and non-DOTS programmes. RESULTS: The 181 of 212 countries (85%) that reported data to WHO in 1997 c overed 97% of the global population. They reported 3.81 million cases of tu berculosis, of which 1.29 million were smear-positive, representing case de tection rates of approximately 39% and 51%, respectively. DOTS programmes d iagnosed 67% of new pulmonary cases to be smear-positive (65% expected), co mpared with 30% in other control programmes. They evaluated a higher fracti on of registered cases (94% vs 55%), achieved higher treatment success rate s (78% vs 45%), and a higher fraction of patients was shown to he cured by smear conversion (72% vs 23%). Despite the apparent advantages of DOTS, onl y 12% of all estimated cases, and only 15% of smear-positive cases, were tr eated in such programmes. CONCLUSION: With the exceptions of Vietnam, Peru and Tanzania, none of the 22 highest-incidence countries achieved WHO targets for Tn control. The slo w progress is of greatest concern in 16 countries, including India, Indones ia, Nigeria and Pakistan.