Objective: To review global tuberculosis case notifications and treatment outcomes, and to assess progress in TB control 1995-1996, especially in the 22 countries that carry 80% of all incident cases.
Design: Compilation of case notifications; cohort analysis of treatment outcomes in DOTS and non-DOTS programmes.
Results: The 181 of 212 countries (85%) that reported data to WHO in 1997 covered 97% of the global population. They reported 3.81 million cases of tuberculosis, of which 1.29 million were smear-positive, representing case detection rates of approximately 39% and 51%, respectively. DOTS programmes diagnosed 67% of new pulmonary cases to be smear-positive (65% expected), compared with 30% in other control programmes. They evaluated a higher fraction of registered cases (94% vs 55%), achieved higher treatment success rates (78% vs 45%), and a higher fraction of patients was shown to be cured by smear conversion (72% vs 23%). Despite the apparent advantages of DOTS, only 12% of all estimated cases, and only 15% of smear-positive cases, were treated in such programmes.
Conclusion: With the exceptions of Vietnam, Peru and Tanzania, none of the 22 highest-incidence countries achieved WHO targets for TB control. The slow progress is of greatest concern in 16 countries, including India, Indonesia, Nigeria and Pakistan.