13.2.1 Tuberculosis burden in Ethiopia
According to the Ethiopian Federal Ministry of Health’s hospital data, tuberculosis is the leading cause of morbidity (sickness), the third cause of hospital admission, and the second cause of death in Ethiopia, after malaria.
Sputum is jelly-like mucus coughed up from the lungs. TB bacilli can be seen in sputum smeared thinly onto a glass microscope slide and stained with special dye.
Ethiopia ranks seventh among the 22 countries with high TB burden, and third only to South Africa and Nigeria in Africa, with an estimated incidence of all forms of TB at 378/100,000 in 2009. This means that among every 100,000 Ethiopians, 378 new cases of TB were estimated to have occurred in 2009. The estimated incidence of smear-positive (a form of TB in which TB bacteria are seen when a sputum smear is stained and examined under the microscope) is 163 per 100,000 population. If the population of Ethiopia is assumed to be 80,000,000, then 302,400 new cases of all forms of TB and 130,400 new smear-positive TB cases were expected to have occurred in the country in 2009. However, of the estimated figures, only 145,924 (48%) of all forms of TB cases and 44,593 (34%) of estimated new smear-positive TB cases were actually detected. This suggests that the number of TB cases detected in Ethiopia in 2009 is far below the expected numbers.
For all forms of TB the expected cases calculation is 80,000,000 divided by 100,000 = 800, then 800 x 378 = 302,400 cases. For smear-positive cases it is 80,000,000 divided by 100,000 = 800, then 800 x 163 = 130,400 cases.
The global target for TB control is to detect at least 70% of the smear-positive cases and cure at least 85% of the detected cases. If we do not detect TB cases as they occur in the communities, it means that people who are sick with active TB will continue to spread the disease among the healthy population and many people will continue to suffer and/or die in our communities.
As a Health Extension Practitioner, you have an important role to play in the community to prevent and control TB.
The HIV epidemic (which you will learn more about in Communicable Diseases, Part 3) has made the TB situation significantly worse by accelerating the progression of TB infection to active TB disease, thus increasing the number of new TB cases. Another challenge to TB control in Ethiopia is the emergence of MDR-TB, with 5,979 estimated cases in 2007.