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.

Among the social, environmental and biological determinants of TB, many are more prevalent among the poor than in wealthier groups and these determinants likely contribute to a complex web of poverty-based risk factors that is difficult to tease apart.

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.

Multidrug-resistant TB (MDR-TB) remains a public health crisis and a health security threat. A global total of 206 030 people with multidrug- or rifampicin-resistant TB (MDR/RR-TB) were detected and notified in 2019, a 10% increase from 186 883 in 2018.

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. 

 In 2019 an estimated 194,000 HIV negative children died from TB as well as an estimated 36,000 HIV positive children. So it is estimated that in total 230,000 children died from TB. This is greater than the number of children who died in 2018.

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 milestones for 2020 are a 35% reduction in the number of TB deaths and a 20% reduction in the TB incidence rate. The strategy also includes a 2020 milestone that no TB patients and their households face catastrophic costs as a result of TB disease.

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;

Mobilise at least US$ 2 billion annually for TB research.                                                             

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