13.2  Global and regional burden of TB disease

TB is a major public health problem throughout the world. According to the World Health Organization’s (WHO) Global Report 2009, one-third of the world’s population is estimated to be infected with TB bacteria and at risk of developing the active form of the disease. In 2009, the annual incidence of TB (the number of new cases) across the world was about nine million people. The annual number of deaths due to TB was 1.7 million, including 195,000 patients infected with HIV. In developing countries, TB comprises 25% of all avoidable adult deaths. The disease affects both sexes equally and most TB cases are found among the age group 15–54 years. Since this group constitutes the majority of the working population, their deaths can be a major blow to the economy of any country.

Thirty percent (30%) of the estimated total TB cases in the world in 2008 occurred in Africa. Among African countries, South Africa has the highest estimated number of cases (0.38-0.57 million), followed by Nigeria (0.37-0.55 million), and Ethiopia is third with 0.24-0.36 million. Throughout the world, almost 30,000 cases of multidrug resistant-TB (MDR-TB), a form of TB that does not respond to the standard treatments using the drugs most commonly used against TB, were reported in 2008.

The main reasons for the increasing burden of TB globally include:

• Poverty.
• Neglect of the disease (inadequate case finding, diagnosis and cure).
• Collapse of the health system in countries experiencing severe economic crisis or civil unrest.
• Effect of the HIV pandemic.

TB is a disease of poverty because most cases occur among poor peoples of the world, often living in very poor conditions and hard-to-reach communities. Because of their circumstances, poor people do not have easy access to health care services, including diagnosis and treatment for TB. This is why your role as a Health Extension Practitioner is crucial, because you can bring TB diagnosis and treatment within reach of the rural community dwellers.