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GLOBAL: Too few MDR-TB cases diagnosed
Less than a quarter of countries globally have continuous surveillance systems in place
NAIROBI, 19 March 2010 (IRIN) - The diagnosis of drug-resistant tuberculosis is still extremely low despite as many as half a million cases and 150,000 deaths from multidrug-resistant TB (MDR-TB) in 2008 globally, according to the World Health Organization (WHO).
"In 2008, there were 29,423 MDR-TB cases reported throughout the world by 127 countries. These cases only represent about seven percent of the MDR-TB cases estimated to have emerged that year," WHO noted in a new report
, Multidrug and Extensively Drug-Resistant Tuberculosis: 2010 Global Report on Surveillance and Response.
In the 27 countries with a high MDR-TB burden, only one percent of new TB cases, and three percent of previously treated TB cases, were tested for drug susceptibility.
"This points to the urgent need for improvements in laboratory facilities, access to rapid diagnosis, and treatment with more effective drugs and regimens shorter than the current two years," the report said.
Less than a quarter of the world's countries have continuous surveillance systems in place. In Africa, which experienced an estimated 69,000 cases of MDR-TB in 2008, only South Africa has continuous drug resistance surveillance in place.
"Given that African countries have the highest incidence of TB per population in the world, even at low levels of drug resistance the caseload of MDR-TB patients becomes very high," the study commented.
"As a result, the rates of MDR-TB cases arising per 100,000 population in some southern African countries are five to six times higher than those of China and India."
Kenya has diagnosed 551 cases of MDR-TB, but a shortage of laboratories means the government is unable to diagnose most patients. "We have one main lab to diagnose MDR-TB and three coming up, but our capacity is still very low," Joseph Sitienei, head of the National Leprosy and TB Control Programme in the Ministry of Health, told IRIN/PlusNews.
WHO and its partners have started the EXPAND-TB Project, a multi-country initiative to scale up and accelerate access to diagnostic technologies for MDR-TB, after a pilot programme in Ethiopia found that a rapid scale-up of laboratory services for MDR-TB diagnosis was feasible, even at regional level, in resource-constrained settings.
Treatment a hurdle
Treating MDR-TB can cost between 50 and 200 times more than first-line treatment for non-resistant TB, an outlay that developing countries often cannot afford.
Each MDR-TB case cost the Kenyan government an estimated US$21,000, compared with $80 for first-line TB treatment. "We have only managed to put 110 people on MDR-TB treatment," Sitienei said.
Uganda, one of the EXPAND-TB countries, regularly experiences drug shortages due to funding and supply chain issues; shortages could lead to treatment interruption, which raised the risk of resistance.
The WHO report concluded: "While information available is growing, and more and more countries are taking measures to combat MDR-TB, urgent investments in infrastructure, diagnostics, and provision of care are essential if the target established for 2015 – the diagnosis and treatment of 80 percent of the estimated M/XDR-TB cases – is to be reached."