TB in the SEA Region. Review Plans and Progress. Dr Md Khurshid Alam Hyder Medical Officer TB SEARO/WHO

Transcription

1 TB in the SEA Region Review Plans and Progress Dr Md Khurshid Alam Hyder Medical Officer TB SEARO/WHO

2 The SEA Region: 25% of the world s people, but >33% of TB patients Eastern M editerranean Region 5% Americas 4% African Region 28% European Region 4% South-East Asia Region 34% 4.8 million cases 538,000 deaths/year Western Pacific Region 25% Global Burden: 13.7 million TB cases; 2 million TB deaths

3 The numbers: All forms of TB Estimated number of cases 4.88 million Number on treatment as reported by NTPs in 2008 >2.2 million Multidrug-resistant TB (MDR-TB) > 150,000/yr ~ 1000 Extensively drugresistant TB (XDR-TB) NA <10 HIV-associated TB ~ 120, 000/yr ~ 6000 on ATT+ CPT +ART Adapted from a slide provided by Dr. Paul Nunn, WHO Geneva

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8 Source: Annual Reports on TB control, National TB Programmes, SEAR Member Countries, December 2008 Case detection and treatment success rates, SEAR countries, 1997 to Treatment success rate (%) 50 CDR: 69%; TSR: 87% Target zone Case detection rate (%)

9 20 280, Established Market Economies Central Europe Eastern Europe Latin America Eastern Mediterranean Region Africa low HIV incidence Africa high HIV incidence South-east Asia Western Pacific Region MDR-TB % MDR-TB number MDR TB Burden Among All Cases by Regions % of MDR-TB Number of MDR-TB 28% of the global burden of MDR-TB 260, , , , , , , , ,000 80,000 60,000 40,000 20,000 0

10 Review of country plans and progress made since last workshop in 2006

11 Bangladesh-Planned 2006 Surveillance Survey Improve recording and reporting system and compilation of data To establish a baseline survey by 2009

12 Bangladesh-Progress made Case notification rates increased steadily until 1997 From 1998 till 2001, a flat or even falling pattern, while increase after 2001 Increases due to improved case finding attributable to geographic expansion and intensified collaboration with NGOs. The observed variations are due to changes in case finding and not a true rise in incidence Soft ware for data collection and analysis developed Population based survey initiated in 2007 and preliminary results available

13 Bhutan-Planned 2006 Surveillance Survey To refine TB information system by revising the current recording and reporting system by 2007 ARTI survey by the end of 2007

14 Bhutan-Progress made High notification of extra pulmonary TB Low number of smear negative TB Revision of recording and reporting system undertaken

15 DPR Korea-Planned 2006 Surveillance Survey Revision of recording and reporting forms and computerization at central, provincial and county levels gradually ARTI surveys in three province by

16 DPR Korea-Progress made Recording and reporting forms revised Soft ware developed at the central level and functional ARTI surveys conducted in three provinces in 2007; ARTI represents 3.1%

17 India-Planned 2006 Surveillance Survey National roll-out of EPIENTER to be completed by mid 2008; Enhancing data management capabilities at district/state/central levels; Training of trainers and planned roll-out of training; Electronic patient based information for DOTS-Plus cases Prevalence surveys in six sites to be completed by 2010; Tuberculin testing baseline data information available by 2010

18 India-Progress made Revised R&R and Windows based EpiCentre introduced late 2008 / DOS-based system to be phased out by end 2009 On-going MIFA (Managing Information For Action) training of trainers course to enhance data management capabilities at district/state/ central levels since 2008 Electronic patient based information for DOTS-Plus being developed Disease prevalence surveys on-going in seven sites, where screening is done through X-ray and symptom elicitation in 3 sites and with symptom elicitation alone in 4 sites, followed by smear and culture field enrollment expected to be completed by end nd National ARTI survey on-going in 4 zones, field enrollment expected to be completed by March 2010 W1

19 Slide 18 W1 As decided upon by a National level Expert Committee. Also the Committee produced an estimate of the disease prevalence for the country for the year Waresf,

20 Indonesia-Planned 2006 Surveillance Survey Improvement of electronic TB software Inclusion of surveillance data, update provincial profiles and upload TB website Tuberculin survey in 3 epidemiological zones; TB mortality study in 6 provinces; TB/HIV sero-prevalence study in 6 provinces; Repeat national TB prevalence study in 2010

21 Indonesia-Progress made 2004 TB Prevalence Survey show that the prevalence and incidence rates for Indonesia are 119 per 100,000 and 110 per 100,000 respectively National Institute for Health Research and Development (NIHRD- MOH) carried-out mortality survey in ten sub districts located in three main project sites representing metropolitan areas (Jakarta), urban areas (Surakarta) and rural areas (Pekalongan district), covering a total population of about 1 million, estimated to yield about 7000 deaths annually. The one year mortality data (2006) in Pekalongan district shows that TB was ranked as the sixth highest (6%) contributor for leading causes of death

22 Indonesia-Progress made HIV prevalence survey among TB patients in 5 provinces (Jakarta, West Java, East Java, Bali and Papua) Tuberculin Surveys in South Kalimantan and North Sulawesi Provinces of Indonesia to Estimate the Annual Risk of Tuberculosis Infection (ARTI), being implemented by University of Indonesia in collaboration with WHO Drug Resistance Survey in East Java Province is the second DRS in Indonesia using the same method with the first one in Central Java province done in 2006 is being conducted by NTP with support from KNCV, IMVS Australia and WHO

23 Maldives-Planned 2006 Surveillance Survey Set up of uniform excel format in the central office by 2008 Measure the duration of disease for better assessment of the prevalance

24 Maldives-Progress made Overall trend consistently downward across all age groups Rate of decline has decreased from 10% per year earlier to 1-2% currently Central uniform excel format in the process of development

25 Myanmar-Planned 2006 Surveillance Survey Computerized recording and reporting system using STAR by ; Establish mortality data base system linked with existing vital registration by first quarter 2007 Continuation of point prevalence survey in remaining parts of the country by 2008 and repeat in

26 Myanmar-Progress made Routine sentential surveillance among new TB patients are in place Results of TB prevalence survey in Yangon Division in 2006 showed incidence of TB 2.26 times higher than the current WHO estimates DHIS software were introduced in central, state and divisional levels Staff trained on data management

27 Nepal-Planned 2006 Surveillance Survey Strengthening of data management system using EPICENTER by middle of 2007 Mortality from observation on patient cohorts by 2008

28 Nepal-Progress made Case notifications are rather flat following the period of DOTS expansion, which may signify that case finding is good but the incidence is apparently not decreasing Tuberculin survey was conducted, ARTI 0.6% indicating decrease in transmission or over estimation of previous estimates Sentinel surveys of HIV among TB patients conducted in show a prevalence of 2.4%

29 Sri Lanka-Planned 2006 Surveillance Survey Developing software on supervision, on going meetings, cross recording and reporting in TB/HIV Tuberculin survey by 2007 Drug resistant survey by

30 Sri Lanka-Progress made Minimal change in over all case notification rates However, increase in the age group years, particularly among males ARTI is on going and the preliminary results available by the end of July 2009

31 Thailand-Planned 2006 Surveillance Survey Epidemiological situation analysis; Electronic recording and reporting system; Strengthening supervision, monitoring and evaluation in large hospitals by 2008 Not planned

32 Thailand-Progress made Epidemiological situation analysis done Electronic recording and reporting introduced in central level Supervision and monitoring strengthened in large hospitals

33 Timor Leste-Planned 2006 Surveillance Survey Develop regional supervision and monitoring plan; Introduction of training on monitoring and evaluation; Quarterly reporting and follow up of new smear positive TB cases registered under DOTS successfully treated; Quality control by 2008 Not planned

34 Timor-Leste-Progress made In May 2008 based on analysis of national data and other evidence from Indonesia and in particular from province that includes West Timor, and active case finding data from one Sub-district in TLS revised range for incidence of NSP in the country 115 to 175 per 100,000 population An updated excel format has been designed with assistance from WHO to recording national data at central level NTP data organized into uniform excel format, retrospectively, prospective formats designed till 2012 This allows internal consistency checks, auto generates a quarterly and annual performance report on key indicators, auto-generates relevant graphs, trend analysis Staff at NTP has been trained in the use of this new system

35 Thank you