ASSESSMENT OF WORLDWIDE TUBERCULOSIS-CONTROL

Background Because worldwide tuberculosis (TB) control had never been assessed, WHO set up a surveillance and monitoring project in 1995. Th e objectives were to assess the performance of national TB programmes; to assess the extent of implementation of the WHO strategy of TB cont rol; and to attempt a comparison between regions that had adopted the WHO strategy and those that had not. Methods In June, 1996, we sent da ta-collection forms requesting information on national TB programmes' control policies, 1995 case treatment results to 216 territories. We a ssessed the performance of national TB programmes by comparing case no tifications with estimated incidence and by outcome of treatment in co horts of patients. We also investigated worldwide treatment success an d case detection among sputum-smear-positive patients. Findings 180 (8 3%) of the 216 countries, areas, and replied to WHO (98% of the In 199 5, the WHO control strategy had been implemented in 75 countries, and in 39 of these implementation was countrywide. Up to 23% of the worldw ide population lived in regions where the strategy was available. In 1 995, 3 297 688 cases of TB (all types) were reported, of which 1 161 4 11 (35%) were sputum-smear positive. 54% of all reported cases in coun tries that used the WHO strategy were sputum-smear positive, compared with 30% in other countries. The worldwide case-detection rate of new sputum-smear-positive cases was 35%. 92% of cases registered for treat ment in 1994 in regions that used WHO strategy were assessed for outco me and 76% were treated successfully, compared with 54% and 42%, respe ctively, in regions that had not implemented the WHO strategy. Among c ases reported worldwide in 1994, the documented treatment-success rate was 43%. Interpretation National TB programmes that have control adop ted the WHO TB strategy achieve higher cure rates, but their impact on TB is modest on a worldwide scale. Wider continuous coverage with the WHO strategy is needed for effective worldwide TB control.