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WHO report: SA monthly TB notifications below 50%

South Africa is one of the countries that will pay a heavy price as a result of COVID-19, not only due to the economic losses the country has experienced, but also because the leading killer disease tuberculosis is set to worsen due to neglect during the lockdown.

The Times reports that this is according to the Global TB Report 2020, released by the World Health Organisation (WHO) which found, South Africa’s monthly TB notifications dropped below 50% by June – meaning that thousands of TB carriers could be transmitting the bug in their communities.

Authors noted that the pandemic threatens to reverse progress made to reduce the global burden of TB. The report warns that if action and investments are not made urgently, global targets for prevention and treatment will likely be missed.

The report has put South Africa in the top eight countries carrying the world’s TB burden and which account for two thirds of the global total cases. The countries are India (26%), Indonesia (8.5%), China (8.4%), the Philippines (6%), Pakistan (5.7%), Nigeria (4.4%), Bangladesh (3.6%) and South Africa (3.6%).

Apart from the non-testing of TB at health centres, the authors of the WHO TB report have also warned that the loss of income could increase the percentage of people with TB as unemployment and undernutrition are key drivers of TB.

The report says South Africa, India, Indonesia and the Philippines, which account for 44% of the global TB cases, experienced the largest drops in the reported number of people diagnosed with TB between January and June.

 

The WHO estimates that around 360,000 people fell ill with TB in South Africa in 2019. As with previous estimates, however, there is significant uncertainty with a 95% chance that the real number is in the range 250,000 to 489,000. Spotlight reports that the higher number seen in the new report is likely not because of an actual increase in TB cases, but rather due to better data being available.

The report says the new WHO numbers take into account findings from South Africa’s first National TB Prevalence Survey – the findings of which have not yet been published by the Health Department. Spotlight has requested access to the survey findings in terms of the Protection of Access to Information Act.

Around 210,000 (58%) of the estimated 360,000 people with TB in 2019 were diagnosed. This suggests that around 150,000 people fell ill with TB, but they were never diagnosed. Given that the 360,000 estimate is quite uncertain, the estimate of this treatment gap is also uncertain. Either way, these new figures will raise questions about South Africa’s TB case detection strategy.

South Africa had the eighth highest absolute number of TB cases in 2019, but ranked second on cases per 100,000. Only Lesotho with an estimated 654 cases per 100,000 had more cases than South Africa with 615 per 100,000.

Around 14,000 people fell ill with drug-resistant TB in South Africa 2019 (range 8 500 to 20,000). While more people are falling ill with TB than previously thought, the good news is that fewer people are dying of TB.

The WHO estimates that around 58,000 people died of TB in South Africa in 2019 (range 35,000 to 91,000). Around 36,000 of the 58,000 people thought to have died of TB were also HIV positive. Last year’s report estimated that there were 63 000 TB deaths in the country in 2018.

Preventive therapy (pills taken to prevent people from falling ill with TB) are considered a critical part of TB prevention efforts, especially for people living with HIV who are at an increased risk of developing TB. A total of 69% of people newly started on HIV treatment in South Africa in 2019, received TB preventive therapy. This number was a bit lower, at 56%, for children younger than five years living in households where someone has TB.

The WHO estimates that around 10m people fell ill with TB in 2019 (range 8.9 to 11m).

An estimated 1.4m people died of TB in 2019 (including people co-infected with HIV). This means that in 2019, TB killed more people than any other single infectious agent, including HIV.

“Despite increases in TB notifications, there was still a large gap (2.9m) between the number of people newly diagnosed and reported and the 10m people estimated to have developed TB in 2019,” the WHO report reads. “This gap is due to a combination of underreporting of people diagnosed with TB and under-diagnosis (if people with TB cannot access health care or are not diagnosed when they do).”

 

[link url="https://www.timeslive.co.za/news/sci-tech/2020-10-15-tb-reporting-plummets-in-sa-and-country-will-likely-pay-a-heavy-price/"]Full report in The Times[/link]

 

[link url="https://covid19.who.int/"]WHO report[/link]

 

[link url="https://www.spotlightnsp.co.za/2020/10/14/who-estimates-20-more-tb-cases-in-sa-than-previously-thought"]Spotlight report[/link]

 

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