TB and poverty agenda in WPR WHO/WPRO Stop TB. World Health Organization Percentage of population living below US$1 a day.

TB and poverty agenda in WPR

WHO/WPRO

Stop TB

World Health Organization

Percentage of population living below US$1 a day

0

5

10

15

20

25

30

China Lao PDR Viet Nam Malaysia Mongolia Philippines

Per

cent

age

of P

opul

atio

n

World Health Organization

TB and poverty

98% of 1.8 million TB deaths per year in developing countries.

TB mortality rate 3 X higher in rural poor China than in more developed urban areas.

ARI in the Philippines 2.5 times higher among urban poor than urban non-poor.

Mexico and South Africa: no difference in socio-economic status between TB patients and non TB patients living in the same community

TB incidence weakly related to social and economic variables: infant mortality

1.5

2.0

2.5

3.0

3.5

4.0

4.5

5.0

5.5

6.0

6.5

1.5 2.0 2.5 3.0 3.5 4.0 4.5 5.0 5.5

Infant mortality rate 1991 (log-transformed)

esti

mat

ed T

B in

cid

ence

(lo

g-t

ran

sfo

rmed

)

AF

AS

CA

EE

SA

US

WP

ME

WE

Series10

World Health Organization

TB prevalence among poor and non-poor, Philippines

0

1

2

3

4

5

6

S(+) TB rate per

1000

National Urban non-poor

Urban poor

Source: Philippines NTP, 2000

World Health Organization

S(+) prevalence rates: China

0

20

40

60

80

100

120

140

160

Village Township City

s(+) rate per 100k

Source: World Bank, 2000

World Health Organization

TB and poverty in China (1990)

ShanghaiBeijing

Tianjin

Guizhou

HainanNeimeng

ZhejiangGuangdong

2

2.5

3

3.5

4

4.5

5

5.5

6

45 65 85 105 125 145 165 185

provincial GDP per capita (square root)

s(+)

cas

e n

oti

fica

tio

n r

ate

per

10

0K (

nat

ura

l lo

gar

ith

m)

World Health Organization

Prevalence of s(+) TB by ethnic group in China in 2000

0

50

100

150

200

250

300

Source: Ministry of Health of China, 2000

World Health Organization

Poverty and TB

Vulnerability to severe disease and death from TB Delaying access to care Inhibiting treatment adherence

Overcrowding associated with infection and outbreaks of TB

TB burden higher where poverty is higher

World Health Organization

S(+) TB notification rates versus income in Vietnam provinces

Source: Ministry of Health of Vietnam, 2003

World Health Organization

TB notification rates and ethnic groups in Vietnam provinces

Source: Ministry of Health of Vietnam, 2003

World Health Organization

TB notification rates and poverty in Cambodian provinces

Source: Ministry of Health of Cambodia, 2002

World Health Organization

TB notification and poverty

TB notification is lower where poverty is higher in Vietnam

TB notification is at a similar level between poorer and less poor areas in Cambodia

World Health Organization

Poverty and TB Case Detection Rate

Poor compared to non-poor communities: Higher TB prevalence Lower or similar case

notification rates

Lower TB Case Detection Rate in poorer areas

World Health Organization

Expansion may not be enoughExpansion may not be enough

‘The Missing Cases’

Detection

Coverage

World Health Organization

Progress in 2004Objective 1: Reaching the 70/85/100 targets

Targets 2002 2003 2004*

DOTS Coverage (target: 100%)

77% 90% 94%

Case Detection (target: 70%)

40% 52% 63%

Cure Rate (target: 85%)

>85% >85% >85%

*2004 figures are for high burden countries which account for 90% of the TB burden

World Health Organization

Impact of scenariosD70 and Dincreased on prevalence

Decline in prevalence

0

50

100

150

200

250

300

1990 1995 2000 2005 2010 2015 2020

rate

pe

r 1

00

,00

0

D70

Dincreased

World Health Organization

Impact of scenariosD70 and Dincreased on mortality

Decline in mortality

0

10

20

30

40

50

60

1990 1995 2000 2005 2010 2015 2020

rate

pe

r 1

00

,00

0

D70

Dincreased

World Health Organization

Thank you!