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Tuberculosis in China
Medecins Sans Frontieres: Fact Sheet Date: 27/03/2008
In 2006 China had 4.5 million cases of TB with the annual number of new cases estimated to be 1.3 million, according to the WHO report on Global TB control. As elsewhere, TB hits the poor hardest and in particular in China, the millions of migrants who move from rural to urban areas where their access to health care is limited.
Since the introduction of the programme, the detection of TB cases in China has improved and free treatment is available in specialised TB centres. However despite the government's efforts, the challenges remain numerous.
Challenges of poor detection rates and the rise of drug resistance
Globally, the WHO has estimated that for every five cases of the disease that are detected, four further cases go undetected. This lack of case detection is a major concern for TB control in China and has lead to a continued spread of the epidemic. And the spread of multi drug resistant (MDR) TB in China is of even bigger concern.
Poverty is driving the epidemic
Poor detection rates and poor adherence to treatment means that the disease is spreading in China. Poverty is the underlying reason for this - for instance although TB drugs are free in government programmes, China's poor cannot pay for the multiple tests and X-rays required to diagnose the disease.
Poverty also leads to poor drug adherence to the first list treatment because the TB treatment centres are often far away from the places where people live and work and they cannot travel to get their treatment easily if at all. And if people are on the move, migrating from one area to another, this too throws up obstacles to treatment adherence and is more likely to lead to the creation of drug resistance.
HIV co-infection multiplies the difficulties of diagnosis
Further challenges include the lack of modern diagnostic tools for TB. Diagnosis of TB with the current medical tools is particularly difficult in people infected with HIV. In MSF's HIV/AIDS project in Nanning,10% of the HIV-infected patients develop active TB infections a year. Yet of these infections only 23.5% were easily diagnosed (smear positive tests) whilst another 45% were diagnosed with a significant delay (smear negative tests).
"Delays in diagnosis may lead to delay of treatment which usually means loss of lives in late-stage HIV infection" says Dr. Peter Saranchuk, Medical Advisor of MSF's Nanning project.
To curb the TB epidemic in China, improved adherence, improvements in the health system, better diagnostic tools and access to second line anti-TB drugs are urgently needed.
Source: Medecins Sans Frontieres Hong Kong. © Medecins Sans Frontieres Hong Kong