versão impressa ISSN 0042-9686
Bull World Health Organ vol.82 no.9 Genebra Set. 2004
TB prevalence down 30% in China after DOTS
A decade after introducing the WHO-recommended tuberculosis (TB) control strategy across half of China, a recent study showed that prevalence of the deadly bacterial disease that affects the lungs has fallen by about one-third.
WHO and the Chinese Ministry of Health published a joint report in the Lancet on 30 July based on the findings of a survey conducted in 2000 among 376 000 people in all 31 provinces, autonomous regions and municipalities on the Chinese mainland.
In the report, researchers compared TB prevalence in regions where the DOTS control strategy had been implemented with those in the rest of the country.
Researchers concluded that as a direct result of the project there were 382 000 fewer cases of TB in 2000 than 10 years earlier, a 30% decline in prevalence, taking into consideration a larger and more aged population.
WHO said TB remains a significant public health problem in China with 1.4 million new cases each year, where the most recent WHO data suggests that only four or five cases out of every 10 receive treatment through the DOTS programme.
Routinely collected data show that in 2000 only 30% of new TB cases had been referred to TB dispensaries known as DOTS clinics. The remaining cases were treated in general hospitals, by private practitioners or received no treatment at all, WHO said.
"These people should be referred to DOTS clinics, but it doesn't always happen," said Catherine Watt, an epidemiologist from WHO's Stop TB department.
"In order to improve the detection rate China needs to improve access to DOTS, improve referral from hospitals and ensure that people know where to go for free diagnosis and treatment," she said.
WHO officials said they hoped the study would spur China to honour its commitment to implement DOTS across parts of the country that have not yet adopted the control strategy.
Some experts argued that DOTS was introduced in Chinese regions with the best health infrastructure. Dr Watt said that whether this was the case or not, the study demonstrated that DOTS had a clear impact on TB in China and added that funding played a vital role in making the programme effective.
"It is clear that DOTS will only be as effective in the rest of the country if it is properly implemented and properly funded," Dr Watt said.
DOTS relies on a regular supply of essential anti-TB drugs as well as sustained political commitment to fighting TB, a diagnosis method known as "smear microscopy", standardized treatment practices and a standardized recording and reporting system.