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A walk in the Park

This blog is dedicated to everyone who has struggled with Community Medicine. Through my posts I hope to simplify and demystify community medicine. The emphasis will be on clarifying concepts rather than providing ready-made answers to exam questions.

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A single example may not be able to explain 100% of a given topic, so multiple examples may be provided to explain different parts of a single concept.

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I hope that my exertions will make your experience with community medicine seem like a “Walk in the Park”

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Global Tuberculosis Report 2019 Released (17 October 2019)

The World Health Organization (WHO) has released the Global Tuberculosis Report 2019.

Background Information:

Tuberculosis (TB) is a contagious and airborne disease.

TB was one of the top 10 causes of death worldwide in 2018. It is also the leading killer of people with HIV and a major cause of deaths related to antimicrobial resistance.

Global TB Report 2019 Top causes of mortality in 2017 2019-10-20 16_11_56-9789241565714-eng.pdf - Opera

Key Messages:

Burden of TB:

In 2018, there were an estimated 10 (9.0—11.1) million new (incident) TB cases worldwide:

  • Men: 5.7 million were men,
  • Women: 3.2 million, and
  • Children: 1.1 million.

People living with HIV accounted for 9% of the total.

Global TB Report 2019 Incidence Map for 2018 2019-10-20 16_08_07-9789241565714-eng.pdf - Opera

Eight countries accounted for 66% of the new cases:

  1. India,
  2. China,
  3. Indonesia,
  4. the Philippines,
  5. Pakistan,
  6. Nigeria,
  7. Bangladesh, and
  8. South Africa.

In 2018, 1.5 (1.4—1.6) million people died from TB, including 251 000 (223 000—281 000) people with HIV.

Global TB Report 2019 TB-HIV deaths in 2018 2019-10-20 16_13_09-9789241565714-eng.pdf - Opera

Globally, the TB mortality rate fell by 42% between 2000 and 2018.

TB Care and Prevention

TB treatment saved 58 (53—64) million lives globally between 2000 and 2018.

In 2018, 7 million new TB cases were notified to national authorities and reported to WHO. This reflects a gap of 3 million between incident and notified cases. Ten countries accounted for about 80% of the gap, with India, Nigeria, Indonesia and the Philippines accounting for more than half of the total.

Global TB Report 2019 Countries with largest gaps 2019-10-20 16_22_35-9789241565714-eng.pdf - Opera

The global treatment success rate for people newly diagnosed with TB was 85% in 2017.

Drug-Resistant TB:

Globally in 2018, 484 000 (417 000—556 000) people developed TB that was resistant to rifampicin-resistant (RR-TB), the most effective first-line drug, and of these, 78% had multidrug-resistant TB (MDR-TB).

Global TB Report 2019 MDR.RR-TB 2019-10-20 16_16_55-9789241565714-eng.pdf - Opera

187 000 cases of MDR/RR-TB were detected and notified in 2018. Of these, a total of 156 000 were enrolled and started on treatment with a second-line regimen.

Global TB Report 2019 Largest gaps MDR TB 2019-10-20 16_24_03-9789241565714-eng.pdf - Opera

Treatment success rate at 56%, remains low globally.

Among cases of MDR-TB in 2018, 6.2% were estimated to have extensively drug-resistant TB (XDR-TB).

Global TB Report 2019 Gaps in Care 2019-10-20 17_06_04-GraphicExecutiveSummary.pdf - Opera

Co-Epidemics of TB and HIV:

In 2018, there were 477 000 reported cases of TB among people living with HIV, of whom
86% were on antiretroviral therapy.

Most of the gaps in detection and treatment were in the WHO African Region, where the burden of HIV-associated TB is highest.

Preventive Treatment for TB:

WHO recommends preventive treatment for people living with HIV and all contacts living in households with TB.

A total of 748 000 people who were newly enrolled in HIV care were started on TB preventive treatment in 2018 (only 49% of people newly enrolled in HIV care).

Global TB Report 2019 TB Preventive Rx 2019-10-20 17_05_05-GraphicExecutiveSummary.pdf - Opera

In addition, the number of children aged under 5 years who were started on TB preventive treatment reached 349 000 in 2018 – a four-fold increase from 2015 but much less than the 4 million estimated to be eligible.

Global TB Report 2019 Household child contact preventive Rx 2019-10-20 16_41_33-9789241565714-eng.pdf - Opera

Uptake of Diagnostics, New Drugs and Regimens: 

The WHO-recommended rapid diagnostic test (WRD) for detection of TB and rifampicin resistance currently available is the Xpert MTB/RIF® assay. Of the 48 countries in at least one of the lists of high burden countries, 37 had adopted national algorithms positioning the WRD as the initial diagnostic test for all people suspected of having pulmonary TB by the end of 2018.

Global TB Report 2019 2019-10-20 16_04_57-9789241565714-eng.pdf - Opera

Global TB Report 2019 Testing with WRD 2019-10-20 16_21_01-9789241565714-eng.pdf - Opera

By the end of 2018, 90 countries reported having imported or started using bedaquiline, and 57 countries had used delamanid.

Research and Development:

There is still no single rapid, accurate and robust TB diagnostic test suitable for use at the point of care.

Fourteen vaccine candidates are in clinical trials: three in Phase I, eight in Phase II and three in Phase III. They include candidates to prevent the development of latent TB infection and TB disease, and candidates to help improve the outcomes of treatment for TB disease.

There are 23 drugs and several combination treatment regimens in clinical trials.

Global TB Report 2019 New anti TB Drugs 2019-10-20 16_36_08-9789241565714-eng.pdf - Opera

Funding for TB research and development has increased and reached a peak of US$ 772 million in 2017. However, this is only 39% of the estimated requirement of US$ 2 billion per year.

TB Financing:

The funding required for a full response to the global TB epidemic in low- and
middle-income countries is estimated at US$ 10.1 billion in 2019, excluding research and development.

US$ 6.8 billion was available for TB prevention, diagnosis and treatment in 2018, leaving a funding gap of almost US$ 3.3 billion.

87% of the funding available in 2019 is from domestic sources. However, this global aggregate figure is strongly influenced by BRICS countries.

International donor funding accounts for 38% of the funding available in the 25 high TB burden countries outside BRICS and 49% of funding available in low-income countries.

International donor funding led by the Global Fund and US Government remains critical, especially in these countries.

For research and development, at least an extra US$ 1.2 billion per year is needed to accelerate the development of new tools.

Global TB Report 2019 Progress towards End TB Strategy 2019-10-20 17_08_17-GraphicExecutiveSummary.pdf - Opera

TB and Universal Health Coverage:

All of the 30 high TB burden countries need to increase service coverage and reduce
levels of catastrophic expenditures to reach Universal Health Coverage, consistent with
findings from surveys of costs faced by TB patients and their households.

Global TB Report 2019 Catastrophic health expenditure 2019-10-20 16_30_40-9789241565714-eng.pdf - Opera

Global TB Report 2019 Rx Cost drug susceptible TB 2019-10-20 16_38_29-9789241565714-eng.pdf - Opera

The Global TB Report features a TB-SDG monitoring framework that focuses attention
on 14 indicators that are associated with TB incidence. Monitoring of these indicators
can be used to identify key influences on the TB epidemic at national level and inform
the multisectoral actions required to end it.

Many new cases of TB are attributable to undernourishment, HIV infection, smoking, diabetes and alcohol use.

Global TB Report TB Attributable Factors 2019-10-20 17_04_02-GraphicExecutiveSummary.pdf - Opera

Useful Links:

Link to related WHO news release:


Link to Global Tuberculosis Report 2019: