EPIDEMIOLOGICAL REVIEW OF
TUBERCULOSIS
IN THE WESTERN PACIFIC REGION
1991-1992
Western Pacific Regional Office
MANILA 1993 'Wnn,wrpn LrBnAl8 )4(),n.,;!,n
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Acknowledgements
The WHO Regional Office for the Western Pacific (WPRO), Manila, would like to acknowledge the contribution of the Research Institute of Tuberculosis, Tokyo, in preparing this document. MaincontributorsareDrT. Yoshiyama,DrN. Yamada, MsJ. Nakamura, Dr S. Tokeshi, Ms K. Sato and Dr N. Ishikawa.
This document does not necessarily represent the official view of WHO-WPRO. The authors are responsible for the selection and review of data in this report. The user's additional information, corrections and comments are most welcome.
TABLE OF CONTENTS PART I EPIDEMIOLOGICAL REVIEW OF TUBERCULOSIS IN THE WESTERN PACIFIC REGION General indicators Tuberculosis epidemiological indicators Age distribution of tuberculosis cases Patterns of age specific incidence rate in the Western Pacific Region Data collection TABLES FIGURES PART II TUBERCULOSIS DATA FOR EACH COUNTRY AND AREA IN THE WESTERN PACIFIC REGION Abbreviations American Samoa Australia Brunei Darussalam Cambodia China· Cook Islands Fiji French Polynesia Guam Hong Kong Japan Kiribati Lao People's Democratic Republic Macao Malaysia Nauru New Caledonia New Zealand
2 4 6 II
12 14 19 34
57 58 59 62 65 68 72
76 79 82 85 88 92 96 100 103 106 110 112 115
Niue Papua New Guinea Philippines Republic of Korea Western Samoa Singapore Solomon Islands Tokelau Tonga Mariana Islands Micronesia, Federated States of Marshall Islands Palau Tuvalu Vanuatu VietNam Wallis and Futuna
118 120 124 128 132 136 139 143 146 149 152 156 159 162 165 169 173
PART I The Western Pacific Region, with 35 countries and areas and a population of approximately 1400 million, accounts for nearly half the tuberculosis problem in Asia. However, the current situation of tuberculosis in the region has not yet been systematically reviewed, although reports and statistics have been available from several countries. This study reviews the current tuberculosis situation with reference to the national tuberculosis control programme of each countJy in the region. The objectives are to collect the epidemiological data of tuberculosis and national tuberculosis control programmes from each countJy and area in the Western Pacific Region, to evaluate these collected data and make comparative analyses within and among the countries, and to explore the possibility of developing a simple international tuberculosis information system based on the data base which is prepared in the above processes. This report consists of two parts; Part I, an overall epidemiological review of tuberculosis in the the Western Pacific Region (revision of the 1990 report) and Part II, tuberculosis data for each countJy and area in the region with reference to its national tuberculosis control programme.
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EPIDEMIOLOGICAL REVIEW OF TUBERCULOSIS IN THE WESTERN PACIFIC REGION The Western Pacific Region covers 35 countries and areas as shown in Table 1 (page 19). Geographically, the countries and areas in this region are also scattered very widely, in the northern, western and southern Pacific. The total land area is approximately 19.9 million square kilometers. The total estimated population is about 1.4 billion. China with 9.6 million square kilometers in land area and 1.1 billion in population, covers almost half of all land area and three fourths of the total population in the region. The latest population and some basic information for each country and area are inel uded in Table 2 (pages 20-22). Figure 2 (page 35) shows the population by country from the largest to smallest. This region is a mixture of macro and micro countries and areas; seven countries have a population of more than 10 million, headed by China. Six countries have a population between I and 10 million. Twenty-two countries and areas have a population of less than I million and their total population is only 3.7 million; most are Pacific islands countries. Twelve countries and areas have a population ofless than 100 000. For the purposes of this study, the following information has been collected from each country: General indicators: population, infant mortality rate (IMR), GNP per capita, national health budget per capita. Tuberculosis epidemiological indicators: incidence (number of new cases and rates) and prevalence of all forms, pulmonary and smear positive (and/or bacillary confirmed) tuberculosis, mortality of tuberculosis (number of deaths and the rates), estimated annual risk of infection and age distribution of cases. National tuberculosis control programme information: organization structure and programme for case finding, treatment, regimen, laboratory, BCG or others, and achievement in case finding, treatment and BCG vaccination.
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Data were collected mainly from the official reports from each country,
and partially from other published or unpublished reports. The main sources were the Country Health Information Profile (CHIP), Data Bank on Socioeconomic and Health Indicators by the WHO Regional Office for the Western Pacific (1990), Demographic Yearbook (1990), United Nations, World Tables (1991), World Bank, World Development Report (1991), World Bank, Key Indicators of Developing Asian and Pacific Countries (1990), Asian Development Bank and the State of the World's Children (1991), UNICEF. Some data were collected from official rePorts such as the annual report of the Ministry of Health of each country and area. Data on tuberculosis indicators obtained from each country used the following main sources:
OffICially published reports (domestic and international) Domestically, annual tuberculosis reports are published by countries such as Hong Kong, Japan, Macao, Malaysia, Papua New Guinea, Philippines, the Republic of Korea and Singapore. Although these reports are highly useful, they sometimes pose difficulties for international comparison. They are also not easily available because of difficulty of communication. Official enquiries through the embassies or consulates are effective for some countries. Internationally, the World Health Statistics Annual (WHO) also provides information. Documents in the WHO Regional Officeforthe Western Pacific Though not published openly, a document as Data Bank is compiled periodically in the WHO Regional Office for the Western Pacific (WPRO). The assignment reports to WPRO on tuberculosis in various countries are highly useful, especially for the countries and areas of the Pacific islands. TheExpandedProgramme on Immunization (EPI)ofWPRO has developed the Computerized EPI Information System (CEIS) which includes some tuberculosis data. These data are not directly transferable to this study due to differences in definition.
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Reports and articles in medical journals (international and domestic) These are often of great use and sometimes the only source of data for some countries. The authors of papers on tuberculosis epidemiology especially in international journals are as yet limited in afew countries such as China, Hong Kong, Japan, Philippines and the Republic of Korea.
Unpublished reports and personal communications These are sometimes the only means of obtaining information. Unpublished data collected at the Research Institute of Tuberculosis (RIT) in Tokyo have been used. The international human network established through international anti-tuberculosis activities, including the international training courses at the RlT has also been very helpful. The present status of data availability for each indicator is shown in Table 3 (page 23).
General indicators General indicators, i.e. population, GNP per capita, infant mortality rate (IMR), health budget per capita, are shown in Table 2.
Population The size of population is listed in Figure 2 (page 35) for each COllntry and area. Figure 3 (page 36) shows the proportion of population of the five largest countries (China, Japan, Viet Nam, Philippines and the Repubiic of Korea) to the total population in the region. China occupies almost three fourths of the total population in WPR, with the other four countries comprising almost 95% of the total population. The remaining 30 countries and areas occupy less than 5% of the total population of the region. China has such an enormous population and area that it might be better dealt with in several sub-countries (or provinces) for the purpose of this analysis.
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GNP per capita The GNP per capita for each country and area is mainly collected from the latest World Tables by the World Bank. For several countries and areas, GNP per capita is collected through CIDPs by WPRO, reports from each country and area and other publications. Figure 4 (page 37) shows the GNP per capita for 32 countries and areas from the largest to the smallest. These countries and areas are divided into four groups of economies according to World Bank criteria; High-income (GNP per capita US$6000), upper-middle-income (US$2200-6000),lower-middleincome (US$545-2200), and low-income (US$545). In the Western Pacific Region, 20 out of 32 countries and areas (62%) have lower-middle or low income economies. If, in addition, population is considered, China with US$360 per capita GNP occupies about 75% of the total population of the Western Pacific Region, and Viet Nam with US$215 (or 105 with other data) per capita GNP occupies about 5% of the total population.,This means that approximately 80%ofthe total population in the region beloilgs to low-income countries.
Infant Mortality Rate (IMR) Though recently 'under 5 mortality rate (U5MR)' has often been preferred for several reasons, infant mortality rate (IMR) is selected as an indicator of health, because it is still easily available. The figures for IMR are avaJlable from 31 countries and areas, while U 5MR from only 13. Figure 5 (page 38) shows the IMR from the lowest to highest. In the Western Pacific Region, the IMR in 14 countries and areas out oD 2 is higher than 25 per 1000 live births.
Health budget per capita The health budget per capita is available from 25 countries. It is often difficult to interpret and the figures shown in Table 2 may reflect only a limited part of the medical expenditures. The health budget and TB budget have not been analyzed in this report. According to the general indicators reviewed above, it can be summarized that the countries and areas in the region vary greatly in population size, and economic and health status.
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Tuberculosis epidemiological indicators Officially reported numbers of new cases and their rates, numbers of deaths and mortality rates, prevalence rates, estimated annual risk of infection and age-distribution of the new cases have been collected and analyzed. The number and rate of new cases ofthree types oftuberculosis have been collected and reviewed., namely all forms (often described as all cases), pulmonary and smear positive. For some countries, bacillary (i.e. smear and! or culture positive) tuberculosis is used instead of smear positive tuberculosis. Table 4 (page 24) shows the latest reported number of new cases of tuberculosis and their rates (per 100 000) of all forms for 31 countries and areas in the region. No data have been available from Cambodia, Nauru, Niue, and Wallis & Futuna. Only estimated numbers were available for Laos. According to these reported figures, the total number of new cases of all forms of tuberculosis in the region amounts to approximately 0.79 million.
Number of new cases The latest number of new cases varies among the countries and areas in the Western Pacific Region. It is more than 10 000 in 6 countries (China, Philippines, the Republic of Korea, Viet Nam, Japan and Malaysia) and in 4 countries between 1000 and 10000. In the remaining countries and areas, it is less than 1000, and 13 countries have less than 100. Figure 6 shows that the five largest countries in tuberculosis incidence (China, Philippines, the Republic of Korea, Viet Nam and Japan) make up 97% of all reported new cases in the region. China accounts for 47% of all new cases. The total number of all reported new cases in the Western Pacific Region amounts to about 794 000. This is about 30% of the total number of annual new cases in the region i.e. 2 557 000 estimated by the Tuberculosis Unit of WHO, Geneva in 1990. In some countries such as China and the Republic of Korea, the reported number oftuberculosis cases might be only ofpulmonary tuberculosis from the context of the information, but in this analysis it is regarded as that ofall forms.
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Incidence rate Figure 7 (page 40) shows the latest incidence rate per 100 000 for each country from the largest to smallest. For some countries and areas, the incidence rate has been calculated simply by dividing the reported number of new cases by the population because the reported incidence was not available. The rate varies among the countries and areas in the region. It is higher than 100 (per 100 000) in 9 (29%) of 31 countries and areas, and in 5 of them (Kiribati, Tuvalu, Philippines, the Republic of Korea and Solomon Islands), it is higher than 150. It is lower than 10 in 2 countries (Australia and New Zealand).
Time trend of number of new cases Figure 8 (page 41) and Table 5 (page 25) show the trend of the actual number of new cases for the same countries. In 7 out ofJO countries (Brunei, Hong Kong, Japan, Macao, the Republic of Korea, Singapore, Tonga), the numbers show a decline. In the Republic of Korea, the number increased till 1984 but has been decreasing since then. In some countries (Australia, Fiji, Vanuatu),. it showed a decrease but recently seems to be increasing. In other countries, it shows no practical decline or increase (China, Philippines). In some small countries and areas, the number fluctuates yearly mainly due to small numbers. Against the general decline in the rate (except for Chiua), the actual number of new cases has not been decreasing remarkably in the region. Attention must be paid to China and the Philippines where the numbers ofnew cases are the largest two in the region. The recent increase of incidence of tuberculosis in Australia and other countries must be carefully monitored. Though in Australia and New Zealand the immigrant population at present seems to be contributing more to the recent increase in tuberculosis, the potential impact ofHlV infection on tuberculosis should be taken into consideration, as has been observed in sub-Saharan countries where the number and the rate of new tuberculosis cases is increasing due to the AIDS epidemic. HlV infection in the region is still in the early stages and epidemiologically no substantial influence on tuberculosis has yet been observed. However in the not so distant future, it might become a major threat to tuberculosis epidemiology in the region as well.
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Time trend of incidence rate Figures 9 (page 42) and Table 6 (page 26) show "the time trend of incidence rate of all cases over 10-15 years for 29 countries and areas. In 7 countries and areas (Brunei, Hong Kong, Japan, Macao, Malaysia, Singapore, Tonga), the incidence rate has been decreasing steadily though the reduction rate varies by country and time. In French Polynesia it has decreased remarkably in the 1970s but only slightly in the 1980s. In the Republic ofKorea it increased until 1984 but has been decreasing since then. Some countries and areas (Australia, Fiji, Guam, Vanuatu, New Zealand and Mariana Islands), showed a tendency to decrease, but recently they show a plateau or even an increase. Other countries and areas (New Caledonia, Papua New Guinea, Micronesia, Palau, Tuvalu and Viet Nam), show no practical reduction. In some small countries (American Samoa, Cook Islands, Kiribati and Marshall Islands), the incidence rate fluctuates by year. In China and the Philippines, the incidence rate as well as the number has been increasing recently, most probably due to the improvement of service coverage. In China, the prevalence surveys show an overall declining trend. In the Philippines, the programme has been intensified since 1987. Table 2 shows the latest number of new cases and incidence rate of pulmonary tuberculosis for 23 countries and areas. The time trends of the number and the rate for each country and area are shown in Part 2. They are mostly parallel with those for all forms. No data are available on pulmonary tuberculosis for the remaining countries and areas. Table 2 shows the latest number of new cases and incidence rate of smear positive (or bacillary) tuberculosis for 24 countries and areas. For Australia, Malaysia and the Republic of Korea, the incidence rate of bacillary tuberculosis, including culture positive cases, is used instead of smear positive tuberculosis. As shown in Table 3, other countries have data about bacillary cases, but it is not clear whether these numbers include culture positive or not. In some tables and figures, they are often presented under the name of smear positive. The highest rate is 175 per 100 000 in the Philippines (1990) and the lowest is 2 in New Zealand (1988). The variation of incidence of smear positive tuberculosis among countries and areas is smaller than that of all forms of tuberculosis.
Time trencl of incidence rate (smear positive or bacillary) Figure 10 (page 43) and Table 7 (page 27) show the time trend of incidence rate of smear positive (or bacillary) cases for countries and areas. The incidence rate has been decreasing steadily in 4 countries and areas (Fiji,
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Solomon Islands, French Polynesia and Tonga). In the Republic of Korea, it increased until 1984 and has been decreasing since then. There has been no decline in Japan or Kiribati. In recent years, there was a declining trend but it is now slightly increasing in Australia, Malaysia, Singapore, New Zealand and Vanuatu. An increasing trend is being observed in China and the Philippines. Most of these trends are similar to those of all cases.
Time trend of ",umber of new cases (smear positive or bacillary) Figure 11 (page 44) and Table 8 (page 28) show the time trend of the actual number of new smear positive (or bacillary) cases for countries and areas. In most of these countries, the trend is similar to that of the incidence rate of smear positive cases except for Malaysia, where the incidence rate is decreasing but the number is almost stable.
Proportion of smear positive to all forms Table 9 (page 29) and Figure 12 (page 45) show the incidence rates of all forms and smear positive (bacillary) cases with ratios for countries and areas. This ratio does not necessarily represent the true proportion of smear positive (or bacillary) tuberculosis to all forms, because in some countries, smear examination is not made for all tuberculosis cases, and among smear negative (or non-bacillary) cases, comments such as "examination not done" or "result unknown" may be included. On the whole, the distribution of the incidence rate of smear positive (bacillary) cases is not proportional to that of all forms. The figure in Kiribati, for example, is lower than that of Viet Nam in smear positive incidence rate, while the incidence rate of all forms in the former is much higher than that of the latter. The ratio of smear positive to all forms varies by country and area from 10% to 70%. It is reasonable that the ratio in 3 countries (the Republic of Korea, Malaysia and Australia) is higher as their figures include culture positives as well. The marked discrepancy in the ratio indicates the great difference in diagnostic criteria and procedures for tuberculosis or the reporting system in each country and area, and international comparison of reported figures is not easy.
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Mortality of tuberculosis The figures for mortality of tuberculosis are available from 26 countries and areas in the region. The latest number of tuberculosis deaths, mortality rate (per 100 000) is shown in Table 2. Figure 13 (page 46) shows the mortality rates from the highest to the lowest. According to these data, at least 40 000 tuberculosis deaths are reported in one year in the regiol}. International comparison is not easy because in most countries and areas the reporting system of death has not yet been established and the quality of figures is limited. Among countries with a population over 1 million, the rate in the Philippines has been fairly high, over 40. Figure 14 (page 47) and Table 10 show the time trend of the actual number of tuberculosis deaths. In the Philippines and Viet Nam it shows no substantial decline. Table 11 and Figure 15 (page 48) show the time trends of mortality rates for 17 countries and areas. In the majority, except Viet Nam, themortality rate has been substantially decreasing, though the reduction rale varies by country and time.
Prevalence of tuberculosis Data for the prevalence of tuberculosis are .available only from 5 countries. For China, the Philippines and the Republic of Korea, data are collected from their national prevalence surveys. For other countries (Japan and Papua New Guinea), data are collected from tuberculosis registry. Table 12 (page 32) shows the latest prevalence of tuberculosis (per 100000) for 3 countries by type of disease and year. International comparison of the indices of prevalenCe such as radiologically active pulmonary tuberculosis or smear positive tuberculosis is difficult due to the difference in criteria or diagnostic procedures; as discussed previously for incidence. Compared to previous surveys, the prevalence rate is decreasing steadily in China, the Republic of Korea and Japan: The decline in the prevalence rate In China gives a clue to the improvement of notificatioA (or tuberculosis service) as tIie nu.r of new cases has been increasing in the country.
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Though ARI is regarded as the only one universal and comparable indicator for the epidemiological situation of tuberculosis in the region, it has been reported only from 6 countries as in Table 13: (page 32) China, the RepublicofKorea and the Philippines (national tuberculin surveys), Viet Nam . (unpublished report), Fiji (tuberculin survey) and Japan (report by Mori). in most countries in the region, ARI is estimated to be between O.S%and 1.6%. For China and the Republic of Korea. the time trend of ARI is also available, and for Japan, it has also been estimated. ARI has been declining in China and the Republic of Korea by about 7% annually, and in Japan by about 10% annually.
Age distribution of tuberculosis cases The age distributions of tuberculosis cases (new and/or dead cases) available for 24 countries and areas. As they represent the proportion of cases of each age group to all caSes, their value nuiy be limitefi compared to the age specific rates of incidence or mortality which are not available from many countries. However they are still useful and can give some idea about the epidemiological stage of tuberculosis invasion and the socioeconomic burden of tubercl,llosis in the country as well. The pattern ·of age distribution is classified. into 4 types (A to 0) according to the age group with the highest mode of distribution; i.e. higher figures in younger age groups under or around 20 years and much lower in the older age group (A), highest in the 20s or 305, while gradual decline with fairly higher figures in the older age groups as well (B), higher in the middle-aged with decline in the older age groups (C), and a fairly low figure in the younger age groups and highest in the older age group over 60 (0). Table 14 (page 33) shows the countries and areas in the region grouped according to the pattern of the age distribution classified as above. Not all countries and areas are typical of each type, but sometimes fall between the two types. (-» or is given after the country when the type is closer to the next type.
are
«-)
It can be said hypothetically that in accordance with the decline of ARI, the age distribution of tuberculosis cases would shift to older ages (A ->B ->C ->0). Table 14 indicates that tuberculosis in many countries and areas in the region may be in the intermediate epidemiological stage ofinvasion (B and C).
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It should also be emphasized that tuberculosis is still causing socioeconomic loss in these countries and areas as almost 50 to 70% of tuberculosis cases are in the productive ages. As to tuberculosis death, 7 countries belong to types CandD.
Pattern of age specific incidence (new case) rate in the Western Pacific Region In addition to the age distribution oftuberculosis cases in the 1991 report, the age specific incidence rate (exactly new case rate) was analyzed. The age specific tuberculosis incidence rate ofthe region shows a pattern of 'lower in younger age group and higher in older age group'. This is significantly different from that of many African countries, where the younger group still has a higher incidence rate. The pattern is classified as follows: (I) Pattern for Australia and New Zealand (Fig. 18.1): The incidence rates in these countries are as low as in many European countries. The rate becomes higher in proportion to age, but the absolute rate is fairly low even among the old. The pattern reflects that tuberculosis has been under control for a long-time. (2) Pattern for Japan, Malaysia and Singapore (Fig. 18.2): The rate becomes higher in proportion to age but is still fairly high for the old age group, while it is lower for the young age group. This pattern reflects that tuberculosis has been under control but not for as long a time as seen in pattern I. (3) Pattern for Cook Islands, Tonga and Marshall Islands (Fig. 18.3): The rate becomes higher in proportion to age and is still higher in the young age group. The pattern reflects that tuberculosis is still prevalent in all age groups for which some intensified programme may be required.
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(4) Pattern for the Philippines and CNMI (Fig. 18.4)
In the Philippines and the Commonwealth of the Northern Mariana Islands, the absolute values of the rate are considerably higher. The pattern reflects that tuberculosis is still prevalent in all age groups for which some intensified programme may be required. (5) Pattern for Hong Kong and Brunei (Fig. 18.5): The rate becomes higher in proportion to ageand at the same time there is a peak in the group of.20-30 year olds. The pattern indicates that new infection is increasing in this age group. The peak in the younger age group is observed in Mrican countries where tuberculosis has been highly prevalent in recent years. Immigrant population and/or HIV infection may be a contributing factor. Further analysis is required. (6) Pattern for Kiribati (Fig. 18.5):
The rate has been fairly high and stable for all age groups in the 1980s. This may be due to the special epidemiological background of this country or inadequate criteria for diagnosis. Further analysis is required.
In the Western Pacific Region, at least 0.79 million tuberculosis cases (all forms) are reported annually. Nearly half are in China, and 97% of them are in 5 larger countries, namely China, the Philippines, the Republic ofKorea, Viet Nam and Japan. In approximately one third of all countries and areas, the number of annually reported new cases (all forms) is less than 100, and in approximately two thirds of the countries and areas, it is less than 1000. The latest incidence rate of all forms varies much among countries and
areas, but it is higher than 150 per 100 000 in 5 countries (the Philippines, Tuvalu, Kiribati, the Republic of Korea and Solomon Islands), and it is lower than 10 per 100 000 in 2 countries and areas (New Zealand and Australia).
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On the whole, tuberculosis problems in the region are concentrated in only a few countries, both in quantity and quality, especially in China, the Philippines, the Republic of Korea and Viet Nam. Looking at the time trend, though many countries and areas show a gradual decline in rates, more than half show no practical decline and sometimes even an increase in number of new cases over the past 10 - 15 years. The tendency is not uncommon among economically more developed countries in the region. Attention must be paid to this recent increasing tendency in some countries such as Australia, New Zealand or Guam both in the number and rate of new cases. Evaluating the age distribution of new cases in many countries and areas in the region, it is to be noted that tuberculosis still develops to a great extent in young productive age groups. In conclusion, tuberculosis is still a big health problem in most of the countries and areas in the region.
Data collection Tuberculosis data is a key to the scientific and feasible planning and evaluationof the national and international tuberculosis control programme, and the quantity and quality of the information is crucial. At the same time, the nature of the information itself can be an Indicator of the level attained by the tuberculosis control programme.
A vailability of tuberculosis information One ofthe rnajorCQJlStraints ofthis study was the availability ofdata from each country and area. As there is so far no system in the region of collecting tuberculosis information routinely (except for the number of all TB cases and deaths), basic data had to be collected from various sources as described in the methodology. The successful data collection rate was 86% (30/35) for the incidence rate ofall forms, 71 % (25/3 5) for the incidence rate of smear positive cases, 66% (23/35) for mortality, 14% (5/35) for the prevalence rate, 17% (6/ 35) for ARl, 68% (24/35) for age distribution of new cases and 23% (8/35) for that of deaths.
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The availability of the number of new smear positive cases is rather low, and considering its significance in the National Tuberculosis Control Programme, more effort must be made to collect this indicator. Though basic data may exist in most ofthe countries and areas, they may be not reported officially or unavailable. Each country should be encouraged to repOrt basic indicators including the incidence of smear positive tuberculosis and AR1 to make it available internationally. .
. Quality of information The second major constraint of this study is the quality of information. Various comparisons and analyses made iii this study are mainly based on officially reported data and on the assumption that the data are more or less reliable and fet1ect the actual epidemiological condition. However, it is unlikely that all these data represent real conditions. The reported data, except for prevalence and the tuberculin survey, are influenced markedly by the coverage and quality of the on-going services and so reflect case finding activities and the registration system. Further, theillirerence in diagnostic criteria and procedures surely affects the reported number of cases as discussed before. The discrepancy seen in distribution of the incidence rate between all forms and smear positive is a good example. However, the aim of this study is to provide the current overall status of information as well as opportunity for further discussions. . Sometimes the problem of data quality can be overcome by comparing them among countries or by analyzing them in combination with other indicators.
National and international information system As discussed above, the indicators for tuberculosis epidemiology are not as yet universally defined. There is an urgent need to select and define the indicators which could be used nationally and internationally. In addition, the informaiio)l system needS to be strengthened fot periodic data reporting! collection and for their appraisal nationally and internationally. All personnel dealing with the data from centra) to peripheral levels need to be oriented to . understand the whole information system and the importance of the role of data.
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Based on the above results and discussions, future activities for the continued collection and analysis of quality data may be: To develop a manual of tuberculosis information gathering for domestic and international use which include a list and definition of indicators, model tables/graphs for reporting, simple evaluating criteria such as smear positivity, treatment completion rate. To periodically organize a national and/or international workshop to exchange inforrnationand expand the information network. The importance of some basic indicators such as the number of new smear positive cases or ARI may be stressed there. A manual can be prepared and disseminated through the workshop. To identify a national tuberculosis information unit for each country and area so that network activities can be strengthened. At the same time, an international tuberculosis information unit should be developed for the region for the future development of international tuberculosis surveillance activity in the region. China should be given highest priority in tuberculosis control in the region because of the enormity of the tuberculosis problem in that country. The Republic of Korea, the Philippines and Viet Nam should also be given higher priorities because of their high prevalence both in number and rate. For some countries and areas, particularly where tuberculosis information is not easily available, it would be advisable to send a temporary adviser to collect and evaluate the data.
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The 1992 report on tuberculosis epidemiology and information in the Western Pacific Region has built on data published in May 1992 and has been incorporated into the present report. As far as information has been made available, the latest epidemiological data have been revised for 12 countries in the Western Pacific Region. It is these data which are included in the country .descriptions on tuberculosis frequency and treatment. The pattqn of age specific incidence in the Western Pacific Region has also been included on pages 53 to 55. The latest epidemiological data oftuberculosis for each country is shown in Tables 2-1, 2-2, and 2-3 (pages 20 - 22). Updated data have been provided for 13 countries (China, Cambodia, French Polynesia, Hong Kong, Japan, Kiribati, Macao, New Zealand, Papua New Guinea, Philippines, the Republic of Korea, Solomon Islands and Viet Nam) and corrections were made for others. The rates such as incidence are taken from the report by each country, but for some countries, the calculated figures (underlined in Table 1) were shown by using the number of cases and population. When the latest population figure was not available, the rate for the previous year was used. The number and rate of new cases increased from the previous year in three countries, namely New Zealand, Papua New Guinea and Viet Nam, while it decreased in 10 other countries. It should be noted that those for China decreased in 1991 while they had been increasing in previous years. The number of sputum smear positive increased in the Philippines. The number and rate of tuberculosis deaths increased in Hong Kong and Kiribati. The database has been updated after a critical review of the information obtained during the previous year. The routes of data collection were: Direct communication with countries and areas concerned Letters with 1991 data from the 1991 report were mailed to possible units concerned in most of the countries and areas of the region for corrections and further information. Replies were received from various countries.
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Hot line with the WHO Regional Office for the Western Pacific New information was sought according to the list of assignment reports to WPRO and copies of the relevant documents were obtained and reviewed. Communication with other sources In addition to the above, personal contact was made for additional information. Published papers and reports were investigated. Field visits Visits were made selectively to Laos and Kiribati, as their tuberculosis information was scarce. Information from visits to other countries by other programmes was also utilized. The International Tuberculosis Information System (lTIS) operated with a simple computer system which was developed at the Research Institute of Tuberculosis (RlT) for updating the database.
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Ta.b1e
1
LIST OF COUNTRIES AND AREAS IN WPR (35) 1
AMS AUS CON
AMERICAN SAMOA AUSTRALIA CIDNA
2 4
3 BRU BRUNEI DARUSSALAM .............................................................................................................................................................................................. ......................._•••• _•••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••....••••••••••••••••••••••......•.•••••••••••••••••••••••••••••••••o.
COK COOK ISLANDS 6 CAM CAMBODIA ............................................................................................................................................................................................... 5
7 FU FIJI ...............................................................................................................................................................................................
8
FRP GUM
FRENCH POLYNESIA GUAM
10 HOK HONG KONG ............................................................................................................................................................................................... 11 JPN JAPAN ............................................................................................................................................................................................... 12 KIRIBATI KIR 13 LAO LAO PEOPLE'S DEMOCRATIC REPUBLIC ............................ ................................................................................................................................................................ .
-
14 MAC MACAO .................................................................................................................. _........................................................................... 15 MAA MALAYSIA ............................................................................................................................................................................................... 16 NAU NAURU 17 NEC NEW ............................................................ -...........CALEDONIA _ .................................................................................................................... 18 NEZ NEW ZEALAND ..._ .......................................................................................................................................................................................... 19 NW NIUE ...............................................................................................................................................................................................
20
PNG
PAPUA NEW GUINEA
21 PIlL - .-....................... PHILIPPINES .................................................... _............................................................................................................. 22 KOR REPUBLIC OF KOREA ........................- ................................................................................................................................................................... .. 23 SMA WESI'ERN SAMOA SIN SINGAPORE .......__24 ............................................................. _..................................................................................................................... 2S SOL SOLOMON ISLANDS TOK TOKELAU 27 TON TONGA .............................................................................................................................................................................................. 28 COM. OF NORTHERN MARIANA ISLANDS (CNMI) . .......................... ..........MAl _ ........_............ _..._ ... _.................................. _..... _ ........................................................................... MIC FEDERAL SfATES OF MICRONESIA (FSM) _..... _._29 ........ _.... .................................. .................-..................... -..................................... _ ................................................. . ~
30 31
MLI BLA
REPUBLIC OF MARSHALL ISLANDS REPUBLIC OF BELAU
32 TUV TUVALU ............................................................................................................................................................................................... VAN VANUATU ...........33 _...-........ ..... _... _ ............._ ......................... _ ... _ ........ _............................................................................................... 34 35 VTN WAF VIET NAM WALLIS AND FUTUNA
19
CouIItry J.-
Ll!ES'l' DATA OF EAa\ OOUI'l'IlY 1IOIIBIR OF IIBW ClSES Ail PuI.caary SIIear( +)
IIICIDEIICE RlTE(/100000) ill PulJDIary SIIear (+) TB Deaths
18
Death
R
/100000
POP (ill)
GlP/e ($)
DIR 11000
H-Bud/e 18-Bud/e ($) ($) (1988) 937 (1987) 479 (1987)
Allerican
------------------------------------------------------------------------------------------------------------------------------------------------------------10.4 305 1750 s-. 5 5 3 13 13 8 1 3 0.039 (1989) (1989) 831 (1985) (1987) (610) (1989) (1989) 8 (1989) 52.2 (1988) 345000 (90000)
(1989) 5.2 (1985)
(1987) (3.6) (1989)
(1987) 57 (1991) 8 (1988)
(1987) 0.3
(1990) 17.3 (1991) 0.249 (1989) 1120 (1989) 0.021 (1989)
(1985) 14440 (1989) 13910 (1988) 360
(1987) 7.1 (1991) 9 (1990) 30
lustralia
1351 (1989) 126 (1988) 345000
(1989) 3.3 (1988) 5.7 (1990)
Brunei
China
(1991) Cook Islands
(1991)
(1991)
30 (1991) 5.0 (1990)
30
(1991)
(7.8) (1991)
(1989) 980 (1987) 160 (1990) 1640
(1990) 15 (1990) 186.6
1 (1990) 10903 (1991) 218 (1989) 49
(1988)
~
r.aoobndia
8507 (1991) 129 (1988) 56
77.4 (1990) 30
61.1 (1990) 18 (1988) 10 (1989) 22.3 (1989) 50 (1989) 101.9 (1991) 37.7 (1991) 138 (1986) 47.2 (1991) 12.3 (1991) 23
8.4 (1990) 0 (1989) 0 (1991) 4 (1988) 409
120 (1990) 26 34
I-' $ ~
~ I ~
~
Fiji
76 (1989) 34
(1989) 25
0.0 (1989) 0 (1991) 3.1 (1988) 7.1 (1991)
0.738 (1989) 0.193 (1989) 0.121 (1989) 5.8 (1991)
(1989) 8250 (1986) 9175 (1986) 14102 (1991) 23810 (1989) 700 (1989)
(1990) 18.4 (1986) 7.9 (1988) 6.5 (1991) 5 (1990) 58
(1986) 29.9 (1987) 100 (1983) 223
Freucb PoIJll8Sia
(1991) Guam
(1988) 66
(1991) (13) (1987) 2714 (1991) 15285 (1991) 14 (1983)
(1991) 57 (1989) 109.2 (1991) 40.8 (1991) 177.9 (1989)
75 (1989) 6283 (1991) 50612 (1991) 68
(1989) 5866
IIcmg Koog
(1991) 46809 (1991)
(1991) 3659 (1990) 14 (1990)
(1991)
7.2 (1991)
Japan
3 124.043 (1990) (1991) 8.8 (1989) 0.068 (1989)
llrihati
(1990)
89 (1986)
(1983)
(1990)
19.5 (1986)
Cowrt.ry . . . Laos
I..l'lES'l' DAn or DCB COOII!IlY IIIIBIIl or DIiI CISIS ill PalKmry SI&Ir(+)
IlICIDIIICI RUI(/l00000) TIl Death R ill PalKmry s.&r(+) TIl Deaths /1rxxm
PCP
m/c ($) 170 (1989) (3813) (1989) 2l6O (1989)
DR
H-Bud/C 'l'B-Bud/c ($) ($)
(lIil)
/lrm 104 (1990) 10.2 (1989) 14.4 (1987)
------------------------------------------------------------------------------------------------------------------------------------------------------------3.972 (1989) 329 438
JIacao
(1991) lta1aysia
(1979) 10816 (1990)
(140) (1991) (6714) (1990)
92 (1991) 61.2 (1989) 57.7 (1989) (38.8) (1990)
18 (1991) 288
5 (1991) 2.7 (1989)
0.457 (1990) 17.371 (1989) 0.009 (1989)
85.3 (1989) 29
11702 (1990)
(1990)
(1989)
IIauru
IIev CaledcD1a
130 (1989) 335 (1991)
122 (1983) 250
39 (1989) 62 (1988)
110 (1983) 9.9 (1991)
78 (1983) 7.4 (1991)
24 (1989) 1.9
0.16 (1989) 12 (1991) 0.4 (1991 ) 3A
5242 (1984) 11800
16.8 (1983) 8.4 (1990) 40
103
68
(1987) 704 (1988) 188 (1982) 18.71 (1988) 5.6 (1989) 28.34 (1989) 20.3 (1987) 84.5 (1988) 1.44 (1990)
t-.)
IIev ZealaDd
(1991)
(1988)
(1991) 0.004 (1989)
(1989)
I
!oJ
~
lIiue
(1986) 890 (1989) 760 (1990) 5440 56
N I N
Papua IIev Guima
3401 (1991) 201371
2402 (1991)
489
(1991) 109664 (1991)
90.9 (1991) 278.8 (1987) 156.8 (1989) 23.3 (1984) 53
64.2 (1991)
13.1 (1991) 174 (1990)
210 (199O} 28697
5.6 (1990) 42.9 (1989) 12.7 (1989) 3.1 (1984) 3.7 (1990)
3.7 (1990)
(1990) 51.5 (1989) 12.5 (1988) 46
PbllippiDes
(1991) Republic of Itoraa
(1987) 4382
60.1 (1989) 42.38 (1989) 0.163 (1989) 2.69 (1989)
57864 (1991) 44 (1990)
57864 (1991) 30 (1984) 1450 (1990)
(28790) (1991) 20 (1984) 493 (1990)
156.8 (1989) 18.9 (1984) 48
(80.2) (1989) 12.6 (1984) 17.9 (1989)
(1989) 1
(1990) 720 (1989) 10450
WesterrJ
s...
(1990) 110 (1990)
(1990) 6.6 (1989)
sinQllpate
1591 (1990)
(1990)
(1990)
(1989)
Country Name SoIOOlOll Islands
LlTEST DATA OF EACH COUHTRY IlUMBER OF 1m! CASES ill Pulmooary SIEar( +)
DlCIDERCE RlTE(/lOO000) ill PulJIoDIIrJ SIEar(+) 94
TB Death R TB Deaths 2 (1986) 0 (1988) /100000 8 (1990)
pop (1Ii1)
GIlP/C ($)
llIR
/1000 30 (1990) 14.8 (1986) 11.1 (1987) 19 (1987) 23 (1990) 23 (1990) 23
H-Bud/C TB-Bud/C ($) ($) 33
----------------------------------------------'------~- -------------------------------------------------------------------------------------------------------
309
(1991) T<Jkelau
184 (1991)
88 (1991)
56
Z1
(1991)
(1991)
(1991)
,0.33 (1991) 0.002 (1988)
570 (1989) 1560 (1987) 910 (1989) 2163 (1987) 1300 (1983) 1300 (1984) Z177 (1987) 402
(1991) 65 (1988) 43.3 (1989) 442
1 (1990) 20
Tonga
(1990) Mariana IsllIIIds
12 (1988) 24 (1989) 64 (1989) 7 (1989) 3 (1989) 20
7 (1988) 22
15 (1988) 68
12.5 (1988) 58
7 (1988) 24 (1986) 18 (1987) 10 (1986) 28 (1987) 20
2
(1988) 1 (1984) 4
2.1 (1988)
0.098 (1989) 0.041 (1990)
28 (1989) 68 (1989) 7 (1989) 3 (1989) 23 (1990) 144 (1989) 59784 (1991)
(1987) 18 (1987) 4 (1986) 4 (1987) 7 (1990) 39 (1989) 35855 (1991)
(1989) 65 (1989) 16 (1989) 21 (1989) 260
(1989) 64
(1985) 100 (1986) 115 (1985)
8 ID
Micronesia
(1989) 16 (1989) 21 (1989) 230 (1990) 70 (1989) 65.7 (1991)
(1990) 2
4 (1990) 5.1 (1986) 21.1 (1987) 20
0.108 (1990) 0.044 (1990) 0.014 (1990) 0.009 (1990) 0.155 (1989) 66.2 (1990) 0.012 (1989)
~ I-' ~
t-.> t-.>
Marshall IslIIIIds
(1986) 3 (1987) 2
Belau
(1990) 34
I IN 35.5 (1988) 22
Tuvalu
(1990) 100 (1989) 44118 (1991)
(1990) 101 (1989) 89 (1991)
(1990) 29
(1990) 15 (1989) 1287 (1990)
(1990) 10.5 (1989) 2 (1990)
(1988) 860 (1989) (215) (1989)
(1990) 69 (1990) 49 (1990)
Vanuatu
(1989) 53.4 (1991)
(1989)
Viet
!lam
\/allis and Futuna
Ta.b~e
3
AVAILABILITY OF CURRENT DATA (1992) Incidence
Country or Area Am. Samoa
AD X
Puhnonary Smear( + )
Bac(+)
Mortality
PreYaIeoce
X
X*
X
Australia
X X
X X X
X
X
Brunei China Cook Islands
X X X
X** X
Cambodia
X
X
Fiji X X X X _ .............................................................. - ............................................................................... - ................................................... . ~:..~~~.....................~..................................................~ ....................... ~ ...................... ~..................................... Guam X X X X ..................................................................................................................................................................................................... ~~~.. ~~.~.........................~.......................~ .......................~ ................................................. ~..................................... !.~....................._ .............~......................~.......................~......................~........ _. _ ..........?5........_. _ ........................
Kiribati
X
X
X
X
Laos Macao X X X ....................................................................................................................................................................................................... ~~!~.~ ..............................~.......................~.................................................~......................~..................................... Nauru ...................................................................................................................................................................................................... New Caledonia X X X X ............................................. _ ..................................................................................................................................................... . New Zealand
X
X
X
X
N'ue ~G X X X X ..................................................................................................................................................................................................... ~.~!p.~...........................~.................................................. ~................................................ ~......................~........... ~~~ ..~!..~~~................~~.~....................~ .................................................. ~...................... ~.......................~...........
Western Samoa X X X X ...................................................................................................................................................................................................... Siogapore X X X X X ...................................... ........................... ........................... ........................... .................... .......................... .......................... Solomon Is. X X X X ... _................ _................ .......................... .._....................... ........................... .......................... ...................-..... .......................... Tokdau X X ........................................ ............. _........-. ........_................ ... _...................... .......................... .......................... ......................... ~.....
!.~~....................................~.......................~ ......................~.~................................................~.................................... MariaDaIs. Micronesia
X X
X X X
X
X* X*
X
ManbaIl Is. . . 0& . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _
X
X
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0& . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
BeIau X X X* X ................................................................................................ ,..................................................................................................... . Thvw X X X X ..........................................................................................................................................................................- .......................... Vanuatu Wallis & Futuna
X
X
X
X
X
VietNam X X X X X ...........__._................................................................................................................................................................................ .
Proportion
31/35
24/35
23/35
10/35
27/35
4/35
X : Data available x* : Smear( + ) or bac( + ) x** : Equals to pulmonary TB (extra-pulmonary TB not counted) 23
INCIDENCE OF ALL FORMS OF TB IN WPR CASES AMS AUS BRU CHN COl CAM FI J FRP GUM HOK JPN KIR LAO MAC MAA NAU NEC NEZ NIU PMG PHL KOR SMA SIN '24 25 ' SOL 26 TOK 27 TON 28 MAl 29 MIC 30 MLI 31 BLA 32 TUV 33 VAN 3(, VTM 35 WAF TOTAL 1 '
RATE
Reference
~
2: 3' : 4: 5: 6: 7: 8 ' 9: 10 11 12 : 13 : 14: 15 : 16 17 : 18 , 19 : 20 ' 21 : 22 23 '
/100.000 5 13 Paci fie Morbidi ty and Mortal i ty Monthly(USA) 1351 8 Annual report (including relapse) ", 126 5 2. 2 THE REPORT 1988. MINISTRY OF HEALTH 345000 30 'Informat ion from Dr. Farrugia (WHO) 1 5 Information from Dr. Farrugia (WHO) 10903 French Red Cross 218 29. 5 Mission report by Dr. Umemura(WHO) Information from Dr.Drollet (MOH) 58 41 75 57 Pacific Morbidity and Mortality Monthly(USA) 6283 109. 2 ANNUAL REPORT 1991 50612 40.8 ANNUAL REPORT 1992 Register book information 68 329 11702 130 303 3401 207371 5786( U
(YEAR) RATE 89 89 88 91 81 91 89 89 89 91 91 90 91 90 89 89 91 91 91 90 90 91 88 fo3
92 61. 2 81 9. 2 91
RELATORIO ANUAL 1991 LAPORAN TOHANAN 1990 Information from Dr.Lee(WHO) NEW ZEALAND HEALTH STATISTICS Summary of Provincial Report ANNUAL REPORT 1991 NATIONAL TB CONTROL PROGRAMME OF KOREA. KIT 1992 Mission Report by WHO Dr Jittinandana SINGAPORE TUBERCULOSIS STATISTICS Information from Kenneth Konare (TB officer) Annual report on health services 1987-1988 Information by Dr Farrugia (WHO) Pacific Morbidity_ and Mortality Monthly(USA) Pacific Morbidity and Mortality Monthly(USA) Pacific Morbidity and Mortality Monthly(USA) Pacific Morbidity and Mortality Monthly(USA) I nfonat ion from Dr, Salesa (Senior Med i cal Off i eer) Information from Dr. George F. Bule(Direetor of health) Infonation from Dr. Houng (National Institute of TB and Lung Dis) ,
, 1-1 ~
~
1591 309 1 22 28 68 7 3 23 144 59784 751824
53 94
50 68 65 16 21 260 101 89
90 89 89 89 89 90 89 91 .~
Time Trend of the Number of New Cases by Country and Area (All form T8) ICOUNTRY IAm.5amOa Australia Brunei China Cook Islands Cambodia FIJI French Polynesia Guam Hong Kong Japan
1975 12 1347
1976 12 1387 336
1977 7 1251
1978 8 1292 230
1979 2 1542 216 30
1980 2 1457 196 37
1981 6 1386 285 10 180 58 41 7729 ~7
268
259
257
187
D:
Kiribati 187 Laos 442 1101 671 274 Macao 1383 585 455 571 420 389 320 343 329 Malaysia 11692 11098 10264 10441 11094 11218 10970 11944 11834 10577 10569 10735 11068 10944 10686 11702 Nauru (8) New Caledonia 128 111 161 144 130 108 104 New Zealand 303 437 402 663 611 608 595 542 474 448 415 359 320 296 295 348 335 Niue Papua New Guinea 2212 2446 2232 2525 2418 2742 2954 3505 3678 2877 3235 4261 3396 2497 3401 Philippines 133537 148057 107108 118587 108813 112307 116821 104715 108300 151883 151028 153129 163740 217272 317008 207371. Rep. of Korea 81910 89803 98532 100878 91572 85669 87169 88789 87419 74460 70012 83904 57864 Western Samoa 37 37 51 79 36 59 68 59 49 43 41 29 29 44 Singapore 3097 2813 2780 2964 2800 2710 2425 2179 2065 2143 1952 1760 1616 1666 1617 1591 455 3091 324 337 Solomon Islands 261 307 355 411 266 313 302 377 292 334 372 488 382 1 Tokelau 1 0 0 2 9 I Tonga 67 79 89 71 64 49 45 35 54 90 50 49 24 14 20 . Mariana Islands 26 75 74 58 16 28 64 56 27 Micronesia 67 68 60 77 73 75 66 96 12 Marshall Islands 17 8 6 4 6 7 15 12 15 37 11 7 32 5 7 9 3 17 Belau 20 14 17 10 14 20 26 13 38 17 Tuvalu 7 9 32 27 24 25 16 12 33 18 23 22 23 214 Vanuatu 150 214 131 184 92 173 196 188 124 131 118 144 178 90 VIetNam 43506 51206 43185 43875 46941 47557 55505 52483 52270 50203 59784 ~al/ls& Futuna
67 64 49 46 8192 7928 7191 6623 108088 97924 89245 80629 97 40 279 278
210 73 71 55 7903 8065 76455 70916 94 146
205
1982 1983 1984 1985 1986 1987 1986 1969 1990 1991 8 5 6 8 12 5 9 13 1270 1219 1299 1088 1041 1165 1351 686 245 189 276 256 238 212 126 98654 117557 151564 226899 265095 251600 304839 310607 375481 345000 1 19 20 17 16 1 29 36 8158 7572 10241 10145 10325 9106 10691 7906 6501 10903 173 163 185 165 230 199 162 218 48 66 73 75 79 64 58 49 63 49 48 54 75 37 49 34 41 7527 7301 7843 7545 7432 7269 7021 6704 6510 6283 63940 62021 61521 58567 56690 56496 54357 53112 51821 50612 193 127 111 121 129 110 103 208 68
~
~ 1-1 GI
U1
Time Trend of Incidence Rate of New Cases by Country and Area (All form TB) (per 100 000) COUNTRY Am. samoa Australia Brunei China Cook Islands Cambodia FIJI French Polynesia Guam Hong Kong Ja~
1975 41 9.7
1976 40 9.9
1977 23 8.8
1978 26 9
1979 6 10.8 120.7 166.7
1980 6 9.9 105.9 205.6 33 48 51.7 159.3 80.7 251
1981 18 9.3 147.7 55.6 27 37 37.6 149.1 55.9 315
1982 18 8.4 122.5 111.8 123.6 25 29.7 43.9 143 53.9 320
Kiribati Laos
47 110 51.5 183.6 96.6 528
44 87 47.2 175.5 88.6 508
43 78 67.2 156.9 78.2 171
30 62 62.7 141.9 70 125
33 56 68 180.4 85.8 184
1983 24 7.9 132.7 11.6 161.1 111.4 27 39.6 42 136.6 51.9 207 122.1 78.9 110 13 93 204.5 229.2 25.9 83 121 52 416 86 43 106 280 151 75.2
1984 34 8.3 118.5 14.8 117.6 144.2 24 43 46.1 145.3 51.2 178 171.6 70
1985 14 6.9 106.1 21.9 211.8 139 32 43.1 30.8 138.3 48.4 162 140 68.2
1986 22 6.5 106.8 25.4 100.0 139.5 27 44.2 39.8 134.5 46.6 200
1987 24 4.2 79.4 25.2 94.1 118.3 23 34.4 26.7 130.3 46.2 164.2 89.5 67
1988 35 7.1 52.2 29.1 88.2 135.3 22 34.1 31.7 124.8 44.3 310.4 72.2 64.7
1989 13 8 28.9 5.0 97.6 30 30.1 57 117.9 43.1 177.9 60 61.2
1990
1991'
n.4 25 114.1 41.9 109.2 40.8
29.7 5.0
30
Macao ~ Malaysia Nauru New Caledonia New Zealand Niue Papua New Guinea PhiliPPInes Rep. or Korea Western Samoa Singapore Solomon Islands Tokelau Tonga Mariana Islands Micronesia Marshall Islands Belau Tuvalu Vanuatu VIetNam IWalllS Ii FUluna
98.3
88.8
80.2
79.7
82.8
83
80.6
86
99.2 66.6
75
92
8
~ j-l
. 21.3
19.4
19.3 78
19 85 280.5 37.9 127 195 94
17.4 76 233.6 217.8 36.7 119 208 74
15.1 84 232.4 236.6 29.9 113 118 85
14.2 79 235.8 254.5 31.3 99 135 50 154 22 81 240 77 79.2 -
76 13.8
12.5 107 285.5 211.1 23.3 85 131 56
11
9 84.1 267 212.8 68 102 37 76 63 95 79 320 99 78.7
9 93.5 278.8 207 62 113 25 141 101 81 268 260 66 89.9
8.9 119 177.4
9.2 93 156.8 60 154
10.3 67
9.9 90.9
ID (J\
314.1 33.9 138 138 90
338.4 52 124 156 74
238 23.4 120 175 67
88 206.2 256.5 27.3 88 135 45 435
273.3 211.5 76 137 50 314 72 40 193 390 91 78.1 ....
63 121 15 67 77 26 121 280 85 83.2
53 120
94
85.4
29.6
21.4
14.3
220
220 -- - - -
150 -------
130
,
160
16 140 450 150
81 36 134 180 140 91.2 ----
295 85 33 151 120 143 74.7
68 65 16 21 280 101 81.2
260 76.34 89
Time Trend of the Number of New Cases by Country and Area (Smear Positive TB) ICOUNTRY lAm. samoa Australla* Brunei China Cook Islands Cambodia FIJI French Polynesia Guam· [tiong Kong Japan Kiribati
1975 1026
1976 1002
1977 881
1978 741
1979 807
1980 0
765
1981 6 723
1982 3 690
1983 6 598
1984 9 834
1985 2 583
1986 5 574
1987 3 584
1988 613
1989 610
1990
1991
19833 26256 39841 128 122 145 101 114 111 52 28 97 39 5801 98 32 5316 79 5507 82 52
54639 62953 59674 76837 77505 94321 5235 99 48 8715 86 49
90000
7173 8246 5842 5132 8507 78 75 65 44 43 34 48 45 47 51 13 3109 3084 3046 2977 2863 2799 2714 13703 13360 13373 13198 12806 12291 12214 12649 13010 13277 13808 13745 14405 14592 14710 15498 15285 17 21 10 34 14 31 23 22 4 8717 8609 6050
Laos Macao· MalavsIa* Nauru New Caledonia New Zealand Niue IPaDua New Guinea Philippines Rep. of Korea* Western Samoa Singapore Solomon Islands Tokelau Tonga Mariana Islands Mia-onesla Marshall Islands Belau Tuvalu Vanuatu VIetNam wallis III futuna
6313
8622
8819
8786
7533 34
7251 80
6860
8682 69
8653
6924 55
8718 62
133 6711 39
124 8774
140
~
!j
66
I-' ~
~
852
903
133 26
187 22
182 29
606 1273 951 611 489 867 942 870 1061 870 839 967 17275 19006 20678 18857 21291 39571 50624 72150 63655 97070 106928 109664 34633 38211 43888 48735 45688 42561 48515 49063 45068 39040 33988 30700 28790 32 25 20 30 445 482 493 178 101 115 137 149 117 88 174 184 153 174 130 155 155
883
..,J
41
28
32 5 10 23 59
18 0 4 5 10 34 33243
82
67
57
52
52
23 25 23 18 7 25 12 5 11 28 3 4 22 10 11 18 32 14 18 7 8 8 8 4 0 4 0 2 8 4 3 2 7 3 5 7 7 5 7 3 39 55 51 36 26 48 49 55 33014 32612 30426 34217 30381 34530 39488 35095 30143 35855
Data Including cunure positive
Time Trend of Incidence Rate by Country and Area (Smear Positive T8) (per 100 000) COUNTRY Am. Samoa Australia* Brunei China Cook Islands Cambodia Fiji French Polynesia Guam* Hong Kong Japan Kiribati Laos Macao* Malaysla* Nauru New Caledonia New Zealand Niue Papua New Guinea Philippines Rep. of Korea* Western Samoa Sil'lg8pore* Solomon Islands Tokelau Tonga Mariana Islands Micronesia Marshall Islands Belau Tuvalu Vanuatu VietNam Wallis II< t" utuna 1975 7.4 1976 7.1 1977 6.2 1978 5.2 1979 5.6 1980 0 5.2 1981 18 4.8 1982 9 4.5 2.7 87.9 15 19.8 1983 18 3.9 2.6 78.2 12 28.8 1984 26 4.1 3.9 77.6 12 30.6 1985 6 3.7 5.3 71.7 14 27.6 57 11.4 1986 14 3.6 6 117.8 12 27.4 55.8 11.3 1987 8 3.6 6.3 93.2 10 24.6 54.6 11.8 1988 3.7 7.4 104.4 9 23.4 52.9 11.9 7.2 72.1 10 22.3 50.4 11.9 7.8 61.1 7.8 1989 1990 1991
22 56
21 38
24 35
16 28
18 30
17 34.2
15 24.8
12.2 59
11.8 42
11.7 39
11.5 7
11 37
10.5 17
10.4 57
10.7 28
10.9 23
11
49.1 12.5
47.2 12.3
56.4
52.9
47.9
48.2
49.4
50.7
49.7
54.4 23
49.2 41
44.1
43.1
41.3
41.9
39.7
38.4 24
38.8
~
N
00
2.2 30 31 30 92.1 63 60 56 59 32 100.2 53 68
2 16.1 117.6 32.4 35 19 24 11 10 0 80 27 50.3
1.7 19 122.9 106.7 28.3 39 13 18 28 80 19 55.9
1.9 20.5 105.9 93 30 41 7 24.1 161.5 80.2 30.6 47 16.3 174 13.1
.... ID
~
28 113.3 20.5 44 75 18 0 12 40 40 28 60.5
30 118.8 19.1 40 73 25 64 13 18 16 140 40 58.8
27 114.4 15.8 34 52 24 17 38 17 46 90 45 56.8
32 104.9 12.6 39 60 26 143 20 19 0 40 42 51.8
26 117.7 37.1 56 24 20 15 21 30 60 38 57
00
a:; 26 24 31 43
51 85 2~
28 37
27
33
I 16 83 310 50
90
70 ---
60 --
50
50
20 33 62.6
80 29 54.5
20 45.8 53.4
*: Data Including c:ulture pOlltlve
Table
9
Incidence Rate of All Forms and Smear(+) Cases in WPR (per 100 (00)
······Sei"au············································· ··········268··· ·············2if· ························1·0:"4%·1······················.... ···········1·987"····· ······Kirlbatr··································..... ·..·······207··· ··············23·· ························1""f·1"%·I···············..···..···· ..·········1"983······ ··. ··TuvaIu. ····. ·····..···. ···..···....·····....· ···········1"iif· ··············56·· ··············. ·..· ..·3·f3%·I···..···············..··.. ···········1·991""····· ·..···Marlan·a·"isiand"s···..············ ···········1"56··· ·············61""" ····. ···....···..···..·39:3%"1""························ ··········"1"987"····· ....··Rep·:·of""i<orea······················· ·····..····1"4ff" ..···..···..·72·· ························48·:0%T(sAc:j:)"""·· ···········1990··..· ·····Ho·ng··Kong·····..········....···..···..· ..···..····1"09··· .............."47". ························43·:2%"1""···....·....············ ···....·. ·1·991"""···· ···. Vanuatu····························..······· ····..·····1"01"""· .............2"9.. ························28:·7%r························ ··········"1"989······ ·..···Micronesia······························ ..· ..·....1"01"""· ·..·····....·. 1"if ····..·······..········Ti:8%·I·························· ···········1·987"····· ······MarshaiHsiand"s..·············· ·······..·····95·· ············..1"0·· ························1"0:5%"1""···..·······....········ ···········1·986······ ······So"iomon·"isi"and"s··············· ..............9"4...............,2."7". ························28:7%"1""·······....············· ···········1"991"""···· ······Pa·pua·New··Gu·in·ea········ ··············9f· ········. ·. ·1·3·· . ······················1·"4:"4%·(······················· ···········1·991""····· ······viefNam·······························. · ······..·....·89··· ··············53·· ························6(iO%{························ ···. ·····"1"99"1""····· ······N·ew·Cai"edonia··..·············.. ··············8f· ··············24·· ························30:0%"1""························ ···········1·989······ ······CambOdia································ ............."7"1". ··············61·. ·. ···········. ········78:9%"1"························· ···········1·990······ ······Macao·········································· ····· . ·. ····75··· ········....·27"· ························36:2%;r·················..····· ····....···1"990······ ······MaTaysla···································· ··············6f· ·············38·· ···················...··62:7%T(sAc:j:)"""·· ···········1"989······
Country Philippines
All 365
SPTB 176
Proportion 48.2%i
Year 1990
::::::1~~~P.?:f.~:::::::::::::::::::::::::::::::: ::::::::::::::~~:: :::::::::::::::~l ::::::::::::::::::::::::~~~~~r:::::::::::::::::::::::: :::::::::::~:~~~:::::: ······French··Poiynesi"a..··..··· . ·· ..··. ········36·· ·············22·· ························7"4:"1"%·1·..··..···..···....······· ···········1"989······ . ····Fijr..·····..·..····································... ··············3(:;-· ············..1"0.. ····....···..···········33:3%{························ ···········1·989······ ······china············································ ··..···..···..30·. ··..···..·····..·8·· ························26:0%{························ ···········1·991""····· ······G·uam····..····..···..···..·········. ···..···.. ········. ····27"· ··············1·0·· ························3S·:2%T(sAc·:j:r·· ···········1"987"····· ·. ···AiTie·iican·samoa············· ···········..·2"4·· ·················8·· ························33·:3%r························ ···········1·987"·····
::::::~~~!.~:f.~:~~~~:::::::::::::::: ::::::::::::::?~:: :::::::::::::::!:~:: ::::::::::::::::::::::::~~;:!:~r:::::::::::::::::::::::: :::::::::::~:~~:::::: · . ··New·Zeaiand"························ ·················9··· ·············....2.. ··. ····· . ·..··..··....2T:3%·r-·....·················· ···········1"988······ ······Austra:lia:·······..·························.. ···....········..~f ·····..········..~r ························45:0%·~·{BAC+r·· ··········"1"988····.. Tonga 15 7 46.7%i 1988
All: All Forms SPTB: Smear Positive Case BAC+:Baciliary Positive (including culture positive) Proportion: SPTB(or BAC+)! ALL
29
Time Trend of the Number of TB Deaths by Country and Area COUNTRY Am. samoa Australia Brunei China Cook Islands cambodia Fill French Polynesia Guam Hong Kong ~
1975 128
1976 125
19n 108
1978 108
1979 67 13
1980 0
65 28
1981 1 81 11
1982 3 63 20
1983 1 54
16
1984 1 58 15
1985 1 51 19
1986 1 61 11
1987 1 54
1988 54 8
1989 56
1990 63
1991 57
4 14668
32 846 10567 23 158 568 532
Kiribati
9578 15 140
8803
15 124
420 8261 3 71
523 6738 8 113
4 551 6439 14 109 934 27
6 489 5698 8 99 856
5 454 5343
3 92 839 22
1 446 5329 8 94
3 420 4950 7 58
8 3 409
4692 15 44 514 22
7 2 407 4170 10 34 528 16
12 5 405 4022 27 531 10
5 4 368 3872 10 24 637 8 249 4676 5 164 0 2 10 5 12 1992
0 4 403 3527 6 14 469 10 238 4382 132 1 110 382 3659 14 30 288 11 210
0 409
3325 18
Laos Macao Malaysia Nauru New Caledonia New Zealand Niue Papua New Guinea Philippines Rep. of Korea Western Samoa Singapore Solomon Islands Tokelau Tonga Mariana Islands Micronesia Marshall Islands Belau Tuvalu Vanuatu VietNam IWaliis & t'utuna
~
'" o
74
62
71
59
34
25
13
25
12
I-' m I-'
~
254 285 169 191 274 213 252 222 308 29438 31386 31805 28398 28221 28798 27317 28309 25580 27320 31650 30604 28897 5212 6865 7106 6n2 6274 5872 5321 21 11 6 6 11 5 5 5 9 10 1n 1n 420 359 340 240 221 207 224 177 318 309 163 11 3 2 1 0 0 0 0 8 4 11 5 9 5 6 5 2 1 1 1 0 11 8 0 2 2 2 1 3 1 1 1 2 2 2 0 3 1 0 1 1 1 0 1 1 4 5 5 4 6 2 4 0 16 22 18 21 27 1705 2040 1315 1816 1847 1805 2053
o
6 3 15 1908
4 2 1287 2
Time Trend of Mortality Rate of TB by Country and Area (?er lUU UUU) COUNTRY Am. samoa Australia Brunei China Cook Islands Cambodia Fiji French Polynesia Guam Hong Kong Japan Kiribati Laos Macao Malaysia Nauru New Caledonia New Zealand Niue Papua New Guinea Philippines Rep. of Korea Western Samoa Singapore Solomon Islands Tokelau Tonga Mariana Islands Mia-onesia Marshall Islands Belau Tuvalu Vanuatu VietNam Wallis & Futuna
1975 0.9
1978 0.9
19n
1978 0.8
1979 0.5 7.3
0.8
1980 0 0.4 15.1
1981 3 0.5 5.7
1982 9 0.4 10
1983 3 0.4 7.7
1984 3 0.4 6.9
1985 3 0.3 8.5
1988 3 0.4 4.9 9.3
1987 3 0.3 1.7 10.2
1988 0.3 3.3 8.9
1989 0.3 7.6
1990
1991
5.7
5.2 14.5 9.5 43.5 12.6 8.5 27.4 11.8 7.8 28.5 9 7.2 5.3 10.8 5.8 14 5.8 2.4 89.2 6 18.7 2 71.7 13.8 15.7 2.3 70.7 72 14.7 1.9 82.4 6.4 13.6 1.1 7.4 60.6 3.8 13.3 3.8 10.9 5.5 24 41 5.6 0.9 9.1 59.6 3.7 10 11.2 7.8 7.4 3.6 3.5 9.7 0 50
5.5 9.4 4.9 13.5 33
4.5 8.8 4.5 5 29
0.9 8.3 4.5 13 27 4.4 0.4 8 55 32 9 1.2 8.3 2.9 7.7 50
2.8 7.8 4.1 11.2 14 4.5 0.8 9.4 52.6 17.4 3.1 8.4 0.4 5.2 5.5 7.6 0 17.9 3.1
4.8 2.5 7.5 3.9 23.8 10 3.1 0.7 8.5 57.9 17.7 6.9 5.1 0 14.8 50
3.9 1.8 7.4 3.4 15.5 8 3.1 0.5 4.9 54.6 17.1 8.8 0.7 8.5 12.2 5.1 0 60 15.8 3'
8.5 3.9 7.3 3.3 6.2 3.1 0.3 5.5 52.1 15.9 6.8 4.2 8.6 21.1 60
2.7 3.1 6.9 3.2 14.9 5.4 3.3 0.2 7 51.4 13.7 8.2 2.1 10.4 60 8.6 3.2
2.1 7.1 2.9 8.8 3 2.7 0.3 6.5 42.9 12.7 4.9 6.7 3 6.5
0 7.1 2.7
1-3 5 5.1 0.8 8.2 55.1 7 9 9.1 6.2 8.1 80
5 0.7 7.1 55.7 3.2 8.4 4.6 5 3 7.9 30 3.6
.... ....
I-' ~ 0.3 5.8 0.4 joI joI
~
3.7
6.1 30 10.5 3
4 20
22.2
3.1
12.9 2.3
13.9 3.1
19.9 3.3
2
Tab1.e
12
Prevalence Rate by National Survey Country China Year X-ray Active Bac(+) Smear(+) Reference 1979 717 187 1st National Survey 1984 550 205 156 2nd National Survey 1990 523 177 134 3rd National Survey 1983 860 2900 _~O l!'!atlon~1 ::survey 1965 5100 940 690 1st National Survey 1970 4200 740 560 2nd National Survey 1975 3300 760 480 3rd National Survey 1980 540 2500 310 4th National Survey 1985 2200 440 240 5th National Survey 1990 1800 240 150 6th National Survey
IPhilippines Rep. of Korea
Tab1.e
13
Annual Risk of Infection (Tuberculin Survey) country China Year ARI(O/O) Relerence 1979 1.1 1st National Survey 1984 0.6 2nd National Survey 1 3rd National Survey 1990 1979 0.9 J uberc~n~urvey 1983 2.5 National Survey 1989 2.08 Tuberculin Survey 1965 5.3 1st National Surv~ 1970 3.9 2nd National Survey 1975 2.3 3rd National Survey_ 1980 1.8 4th National Surv~ 1985 1.2 5th National Surv~ 1.1 6th National Survey 1990 1986 2.8 Ho Chi Minh CJ!y Survey 1988 1.5 Unpublished 1987-88 0.26 Hanoi City survey 1985 0.00 It:.stlmatlon
IFiJI Philippines Rep. of Korea
Viet Nam .'
IJapan
32
Tab1.e
14
PATTERN OF AGE DISTRIBUTION OF TUBERCULOSIS CASES BY COUNTRY AND AREA IN WPR
PATTERN OF AGE DISTRIBUTION I
i
i
A NEW CASES SOL KIR VAN(-+) MIC
I I
B
i I
i i
I
C MAA PHL TUV NEZ(PTB) FRP. VTN GUM (-+) lOR
I
i I
D SIN(+-) JPN Ails
I
COK. FIJ HOK. MAC ! SKA. BRU NEC. BLA i KLI ! TON (-+) i I
I I
i
! I
I I I I
I I I
DEAD CASES
I I
FRP I I
I I I
I I I I
pitL
I
I I
!
! I
GUM (+- ), AUS CHN (+- ). HOK JPN
I
33
Fig-ure
:1.
'
NTRIES IN WESTERN
AND
AREAS J
35 GOU
-
PACI _ _ _ _ __
FIG REGION
,
.... . ".,
~
IFRP
I
•
.
~ •
34
F.i..gure
2
Population by Country and Area In WPR
China Japan VietNam Philippines Rep. of Korea Malaysia Australia Cambodia Hong Kong Laos Papua New Guinea New Zealand Singapore All Macao Solomon Islands Brunei French Polynesia Western Samoa New Caledonia Vanuatu Guam Micronesia Tonga KlrlbaU Marshall Islands Mariana Islands
0.74 0.46 0.33 0.25 0.19 0.16 0.16 0.16 0.12 0.11 0.098 0.068 0.044 0.041 0.039 0.021 0.014 0.012 0.009 0.009 0.004 0.002 0 20 40 60 80 100 Population (MIllion)
Am. Samoa Cook Islands Belau Wallis & Futuna Tuvalu Nauru Niue Tokelau
120
140
3S
Fig'Ure
:3
Rep. of Korea(43mll) others (66 mil) Philippines (61 mil)
Japan (124 mil)
111111~c:h:lna
(1120
mil)
36
Figu.:re
4.
Japan Australia Hong Kong Brunei New Zealand Singapore Guam French Polynesia Rep. of Korea New Caledonia Macao Belau Malaysia Mariana Islands RII Am. Samoa Tokelau MarshaUlslands Micronesia Vanuatu Tonga Cook Islands Papua New Guinea Western Samoa Philippines Kiribati Solomon Islands Tuvalu China VietNam Laos
;
:
.: :
::.,,", :
", ," ~: : l ~i j
·.·.····.··25890
13910 11800 10450 9175 8250 5400
215 170 160 0 5000
Cambodia
10000
15000 US$
20000
25000
30000
37
F.i.gu.:re
5
Cambodia Laos Vanuatu Kiribati Papua New Guinea VietNam Philippines Western Samoa Niue Solomon Islands China Tuvalu FIJI Belau Marshall Islands Micronesia Mariana Islands French Polynesia New Caledonia Cook Islands Tokelau Malaysia Rep. of Korea Tonga Am.Samoa Macao Brunei New Zealand Guam Australia Singapore Hong Kong Japan 0 20
40 60 80 IMR (per 1 000 live birth) 38
100
120
Figu
re
6
Number o
f New Ca ses o
f A ll Form s of T
B by
J a p a n (5 0612)
o th e rs (3
7207)
Rep_ o f K o re a (57864)
~2
V ie t N a m
(59784) C h in a (3 45000)
P h il ip p in
(207371)
e.
39
Figu.:re
7
Latest Incidence Rate of All Form of TB In
Philippines Tuvalu KIribati Rep. of Korea New Caledonia Hong Kong Vanuatu Solomon Islands Macao Papua New Guinea VietNam Mariana Islands Micronesia Malaysia Guam Singapore Brunei Japan RII French Polynesia Western Samoa Belau Marshal,l Islands Tonga Am. Samoa New Zealand Australia Cook Islands 0
178
50
100 40
150 Per 100 000
200
250
300
Time Trend of the Number of New Cases by Cou and Area (All form of TB) Incidence 1000000 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
•
China II
---D---- Philippine. • VietNam
II
II
100000
--<>----- Rap. of Korea • Japan
-----fr--- Malaysia -~ • . - - Cambodia
~
Hong Kong
--x-- Papua New Guinea - - ) 1 ( - - Singapore
- - t - - Australia - - - - New Zealand ----Macao -~._-
Solomon Island.
100 1975 1980 1985 1990 41
Year
Figu.:re
9
Trend of Incidence Rate of New Cases by Country and Area (All form of TB) 1000 Incidence - - - - - - -Rate - - - - (per - - - -100 - - - 000) ---------------------------- - - - .--- - - --. - -.- - - ---- - --- - - - - --- .--- -- -----_.- --- - - - - -.- - --- .---- _.- - --- --. ---- - - -- - --- -- - -- - - - - -- - ---- - - ---- - --- - .-- - - - -- - - -- - - .-. - - - - -- - -- -- - - ---- - ---- -- - - - - -. - - - .-- ---------------------------------------- . ----
--------------------------------------------
•
Philippine.
- 0 - - Rep. of Korea • Hong Kong
----<>---- Papua New Guinn • V1etNem
----f'r-- Cambodia - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - -:;K;";:")K"~::K-::K
~-:K' -- 1 1- -
•
Malaysia
+-- -- ---- --- -- --- -;- ---------------'-+
---0--- Singapore --X--Japan
10
y-+"+ =- - =- = - - - - ==- - == =- = === ======~ ,- -1- - -; -=+?":'~+ ------------.-_.-
"
+---+-----t__.., )C
--::K-- China
--+--
New Zealand
- - - - Australia
1 1975 1980
1985
1990
Year
42
Figure
.10
Trend of the Number of New Cases by Country and Area ( Smear Positive TB) IncIdence 1000000 --.--. ---. - ---- ----- - ---- - ---- - -.--. - ---. - ----- --- - - -. -- ---. - -- .. - --. - - - - _.- - -----.- - - -- - - - - -.-- - --- - - -- - - - - - - - - - -- - -------------------------------------------_. ----.- -- - - --- - .---- - ---. - -.- - - - -- _.- --- -_. -----------------------------------------.
-----------------:...-----------------------. -----------------------------------------
---------------------------------------100000
•
Phlllppin..
-O--Chlna • VietNam
10000
----<>--- Rap. of Korea • Japan
- - I ' : r - - Cambodia
-------------------------~
---4._-
Malayala
- - 0 - Hong Kong
- - ; 1 ( - - Singapore
- - - \ - - - Papua New Guinea NewZaaland
100
---------------------------------::::::::: .... - .. --_ .... --_ ...... -_ .... --_ .... -_ .. -_ .. --======================
= = = ~= == == =• =
10
1975
1980 Year
1985 43
1990
F:i.gu.:re
11
me Trend of Incidence Rate of New Cases Country and Area (Smear Positive New "CI~:n::~1 Incidence Rate (per 100 000) 1000 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
•
Phlllppin ••
--0---- Rep. o. Korea
100
-----+-- Cambodia ---<>---- Viet Nam .. Hong Konll - - - { s - - Malaysia
•
Singapore
- - 0 - - Solomon Islands - - X - - French Polynesia
- - ) : - - Papua New Guinea Japan
---FIJI
10 ----China • Australia
--D---- New Zealand
-- ---
-
- - - - - - - - - - - - - - - - - - - - -~ - - - - - --
1
1975
1980 Year
1985 44
1990
Figure
12
Incidence Rate of Smear(+) and Smear(-) ca!~esl by Country and Area in WPR
Australla* Hew Zealand Tonga Western Samoa American Samoa Guam* China FIll French Polynesia Japan Singapore Malaysla* Macao Cambodia New Caledonia VietNam Papua New Guinea Solomon Islands Marshall Islands MIcronesia Vanuatu Hong Kong Rep. of Korea* Mariana Islands Tuvalu KlrlbaU Belau Philippines ,_ Smear(+)
IZl Smear (-) or Unknown
I I
0
50
100
150
200
2SO
300
350
400
: Smear( +) bar Includes culture positive
Incidence Rate (/100000) 45
Figu.:re
13
Philippines Tuvalu Belau Rep. of Korea Vanuatu Kiribati Hong Kong China -Papua New Guinea
FIJI Marshall Islands Macao Micronesia Singapore Brunei Western Samoa Guam Am.Samoa Malaysia Japan Tonga French Polynesia VietNam Solomon Islands New Zaaland Australia
o
5
10
15
20 25 par 100000 46
30
35
40
45
Figure
14
me Trend of the Number of TB Deaths by Country and Area Mortality 100000
10000
•
Philippines
~Chlna
• ----<)--
Rep. of Korea Japan VJetNam
1000
:: :: :: :: :: :: :: :: :: :: ::~:: :: :: :: :: :: :::: :: :: :: :: :: :: :: :: :: :: :: :: :: ::
..
-f:r----- Hong Kong
•
Malaysia
- - { ) - Papua New Guinea
100
- - x - - Singapore --)K--
Australia Macao Brunei
- - - - Solomon Islands
10
1
1975
1980
1985
1990 47
Vear
F.:I..qu.:re
1S
II Trend of Mortality Rate of TB by Country and Area Mortality Rate (per 100 000) 100 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - --
•
Philippines
- - 0 - - - Rep. of Korea
•
Hong Kong
--<>---- China ... Papua New GUinea ~Macao
10
--..~-
Singapore Brunei
-0---
--X--Japan --~--
Malaysia
--+-- Viet Nam - - - - Solomon Islands - - - - New Zealand • 1
Australia
0.1 1975 1980 1985 1990
Year 48
F.i.gu.:re
16
!Estlmated Annual Risk of Infection In WPRI ARI(%) 2.5 2 1.5 1 0.5 0 1970 1975
• • China -----0----- Rep. of Korea
• • 1980 Year
Philippines
--<>---- Fill VietNam
1985
1990
49
PATTERN OF AGE DISTRIBUTION OF NEW CASES BY COUNTRY AND AREA IN WPR
ALL FORMS OF TB
r- ----- ----- ------1---- " SOLOHQfI ISLANDS ( 1,.1 J I
I
r-----------------r--------------------------------------------------I PATTERN A 1
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ------1 1984 , MARSHALL ISLoUIDS C 1960 1965 ) SAHOA
PATTERN B
COOk ISLA,NOS I
t
Ull -
U14 )
)
•
! I I
I..
•
a.. ................................
a.1
..
I • :
»
:
• ................................
I..
"
,.
I ~
I
:.. 1 I. I H I~I'
"....... . ... ........ ...
. ",.
""...,.
110-,.
...
.....
....
~.
....
I.....
...
......
~
I I I I
I I
kl~l.lTI
( 1,'6 )
! I .. I
I I
,r HONG KONG FlJ [ I .... TOIl","
I /Jj I u.
~~
I................................. .... o Ut
•................................ ..
•
:.......................................................:. :: I
..
11
I : I I I I VANUATU ( I'll - 1,., )
I.. I .. ................ ......
" II
II
"
U
I~
1-.1 I I I I 101
I.' "4
I.. .... I"". a-.. ...... ....
I' I
I
8iWtf£1 (
,,,. )
HACAU I
UII9 )
8ELAU ( 1910 - '7 )
I I I
L ____ ---__________ ___________________________________ --___________ _ ~
F.:1.gu.:re
17-2
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I
I
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1 1
1_ I" : on :
1 I 1
1 I I
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I
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~
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1~ ~ ~
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I
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I I I I I I I
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I 1 1
~-I--------------------------------------------------J I I
I
I
I
I I I I I
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I ~ :: .. :?:
I
I I I I
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I I I 1 I
II:?: I~ 1II
I
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I I I U I : 1 I:: I
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la I!C
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r ~
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51
rl--------------------------------------, . . . ' ~
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I I I I
. :: ~ ~ ~
· :: ~
~
•
.. ~ ~ ~
0
.'" ~
:a z
'" ... '" z ... o
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... .. I 1 I I 1
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w '" ...
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" v
~ r-T---------------------------------------------------~ l;j
... I W I :!l I i;l
I I I I I
•
~ I ~ I ~ I -
I I
I I I
EI EI ~ I ~ I .. III
5
I;:: II ~ I: u
· . ~
Q I ~ I
I ~
~ E ~
~
I I I
I
I I 1
I:: I .
.,. .. .,. .
.' .
I I
~-1--------~------------------------------------------l I I
I I
I I
I m
II:;;
I~ : I~ J:: ... I ~ .. .. I " I~ I:
I :: I-
I I
i
w
I I I I I I I I I I
I
I I I L _______________________________________ I 52
1
I
~
Figu.r-
18-1
(per 100 000)
Age specific incidence rate of all tuberculosis
20 18 16 14 12 10 8 6 4 2
- - . - - Australia 1985 - - - 0 - - New Zealand 1983
OL-----~----~----~------~----~----~------~----~
o
10
20
30
40
50
60
70
80
age
Figu.reo
18-2
Age specific incidence rate of all tuberculosis (per 100 000) 300 250 200 150 100 - - American Samoa 1980-87
- 0 - - Japan 1991 • Malaysia 1987
- - 0 - - Samoa 1987-90 ---,4k---
Singapore 1990
10
20
30
40 age
50
60
70
80
53
Figure
18-3
(per 100 000)
Age Specific Incidence Rate of All TuberculoSis 1979·87
300 250 200 150 100
---1.1--- Cook Islands
- - 0 - - Tonga 1988 --< • ..---
Marshall Islands 1987
5:~~~==---~_~ o 10 20
30
40
50
60
70
80
age
Figure
18-4
Age Specific Incidence Rate of All Tuberculosis (per 100 000) 1800 1600 1400 1200 1000 800 600 400 ----1.1--- Philippines 1989 - - - 0 - CNMI1988
2~~~~~~~~~~==~ o 10 20
30
____ ____ ____ ______ ____ ~ ~ ~ ~ 40 50 60 70 age 54
~ 80
Figu..re
18-5
Age specific incidence rate of all tuberculosis (per 100000) 400
- - - Hong Kong - 1988
350 300 250 200 150
--D----- Kiribati 1980-86
- + - Brunei -1988
100 50 0~=4~~~~--~~~----~--~----~--~--~ o 10 20 50 30 40 60 70 80 90 age
55
PART II
TUBERCULOSIS DATA FOR EACH COUNTRY AND AREA IN THE WESTERN PACIFIC REGION (Revised 1992 figures)
57
ABBREVIATIONS EpidemiologylProgram
ARI CHIP EPI GNP HC
IMR MMR NTP RIT SCC WHO WPRO Name of drugs S H
Annual Risk of Tuberculosis Infection Country Health Information Profile Expanded Programme on Immunization Gross National Product Health Center Infant Mortality Rate (per 1000 live births) Mass Miniature X-ray National Tuberculosis control Program Research Institute of Tuberculosis (Japan) Short Course Chemotherapy World Health Organization Western Pacific Regional Office of WHO
R E Z T Tables and f.gures
Streptomycin (SM) INH Rifampicine (RFP) Ethambutol (EB) Pyrazinamide Thiacetazone
All Pul Smear(+) NC
PTB SPTB INCR GNP/C IMR Pop H-Bud/C TB-Bud/C
All forms of tuberculosis Pulmonary tuberculosis Smear positive tuberculosis (bacillary in some countries) Number of New Cases Pulmonary Tuberculosis Smear Positive Tuberculosis Incidence rate Gross National Product per Capita Infant Mortality Rate Population Health Budget per Capita TB Budget per Capita
58
AMERICAN SAMOA Population: Epidemiology: 39000 in 1990 The number of newly reported cases has been about 10 and has been almost stable for the last 15 years. The number of bacteriologically confirmed cases has been between 5 and 10.
Programme: Case finding: Treatment: All tuberculosis suspects are referred to the Lyndon Baines Johnson Hospital. Sputum positive patients are admitted to the hospital for initial intensive phase treatment After discharge, the patients are administered drugs every 1-3 months from the hospital (Unsupervised domiciliary chemotherapy). Almost all symptornatics are examined with sputum smear and culture examinations. Partly 2SHRZI4HR since 1986, but some cases are not treated with SCC in 1988.
Laboratory: Regimen: BCG: Achievement: Treatment Outcome:
Completed; 46%, died; 18%, lost; 28% (1980-87).
References: 1.
2. 3. 4.
VSA; Pacific Morbidity and Mortality Monthly v 3 n 2 (Febrnary, 1990). Fu, Q. Y. (WHO); Report on a field visit to American Samoa May, 1988. Fu, Q. Y. (WHO); Report on a field visit to American Samoa, August, 1987. CHIP 1986.
59
American Samoa
American Samoa
INUMBER OF NEW CASESI
--·1 1---+- - - _",mon.,., - - - -A - - -
1-.
aU
smear( + )
Ii.
· ·,
•
,
.. 1990
1975
1980 YEAR
•
1985
ilNCIDENCE RATEI (per 100,000)
45
40 35 30 25 20 15 10 5
--1_"'--
all
- ..... _. pulmonary - - - -A - _.
smear( + )
o
L-~~~~~~~~~_~~~~~~~
1975
1980 YEAR
1985
1990
60
American Samoa TRENDS OF TUBERCULOSIS & OTHER INDICES NUMBER OF NEW CASES All Pulmon~ Smear(+) 12 12 7 8 2 2 2 0 6 3 6 9 2 5 3 INCIDENCE RATElL100,000] All Pulmon~ Smear(+) 41 40 23 26 6
American Samoa
MORTALITY Number Rate
YEAR 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991
6 18 18 24
0 18 9 18 26 6 14 11 29 13 8
0 1 3 1 1 1 1 1
6 6 8 12 5 8 9 13 5
6 5 8 12 5
0 3 9 3 3 3 3 3
34 14 22 24 35 13
6 8 11 5
Population
GNP/C [USS)
IMR [/1,000)
Budget/C[USS) for Health forTB
YEAR 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991
[Mil]
0.032 0.032 0.033 0.034 0.034 0.035 0.036 0.036 0.036 0.037 0.038 0.039 10.4 305 1750 5.8 14.7
61
AUSTRALIA Population: Epidemiology: 17 million in 1989 There were 13S1 new (including relapse) cases in 1989. The number decreased until 1987 but has been increasing since then. The immigrant population seems to be a major cause ofthe increase. Culture positive cases in 1988 were 613. The number of Tuberculosis deaths is about SO and has stabilized in the 1980s.
Programme: Case finding: Laboratory: Regimen: The sensitivity test is made at either of the five State Tuberculosis Reference Laboratories. The standard regimen for smear positive cases is 3HRS (or E) + 6-9HR for patients born in Australia. For Asian immigrants, HREZ for the first 2 months, and after that, according to the result of sensitivity test.
BCG: Achievement: Treatment outcome:
References:
1. 2. 3.
Information from Dr. 1. Christeusen (Statistical service section, Department of Community Services and Health, March, 1991). Communicable Diseases InteIligence 89/21 (1989). Treatment of Tuberculosis in Australia (Medical J. of Australia v.143 1985).
4. S. 6. 7.
Public Health Department (Western Australia); Annual Report. Commonwealth Department of Health; Annual Report 1986. Commonwealth Department of Health; Annual Report 1983. CHIP 1990.
62
Australia
Australia
/NUMBER OF NEW CASES' (number)
1600 1400 1200 1000 800 600 400 200 • all - - -.- -. pulmonary - - - -4 - - - bac( + )
o
L-~~~~~~~_~~~~~~~~
II
1975
1980 YEAR
1985
1990
II i i
IINCIDENCE RATEI (per 100,000)
12 10 8 6 4 2
•
all
- - ... - _. pulmonary
----Al---
bac(+}
o
L-~~~~~~~~~~~~~~~
1975
1980 YEAR
1985
1990
63
Australia TRENDS OF TUBERCULOSIS & OTHER INDICES NUMBER OF NEW CASES Bac(+) Pulmonary A" 1026 1126 1347 1002 1142 1387 881 1010 1251 1292 1542 1457 1386 1270 1219 1299 1088 1041 686 1165 1351 1042 1275 1197 1127 1009 902 921 831 741 807 765 723 690 596 634 583 574 584 613 610 INCIDENCE RA.TE{{l 00,0061 All 9.7 9.9 8.8 9 10.6 9.9 9.3 8.4 7.9 8.3 6.9 6.5 4.2 7.1 8 Pulmonary 8.3 8.2 7.1 7.3 8.8 8.1 7.6 6.7 5.9 5.9 5.2 r
Australia
YEAR 1975 1976 19n 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990
Bac(+) 7.4 7.1 6.2 5.2 5.6 5.2 4.8 4.5 3.9 4.1 3.7 3.6 3.6 3.7 3.6 II
MORTALITY Rate Number 128 125 108 108 67 65 81 0.9 0.9 0.8 0.8 0.5 0.4 0.5 0.4 0.4 0.4 0.3 0.4 0.3 0.3 0.3
63 54 58 51 61
54 54 56 63 57
1991
Population
GNP/C rUSS]
IMR
YEAR 1975 1976 19n 1976 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991
[Mil] 13.9 14 14.2 14.4 14.5 14.7 14.9 15.2 15.4 15.6 15.8 16 16.1 16.5 16.8 17 17.3
Ul,Ooo]
6360 7410 7630 8090 8820 9730 11020 11610 11520 12020 11700 11330 11250 12330 14440 10.3 9.6 9.2 10 8.8 8.7 8.7 8 8.2 7.1
Budget/C[USS] for Health forTS 561 592 601 640
n8 767 912 957 906 963 901 905 937
64
BRUNEI DARUSSALAM Population: Epidemiology: 249000 in 1989 The number of all newly registered cases has been decreasing in the last 15 years and was 126 in 1988. The number of Tuberculosis deaths has also decreased and was 8 in 1988.
Programme: Case finding: Laboratory: Regimen: BCG: Achievement: Programme since 1970 Both passive and active (by MMR)
References: 1. 2. 3. 4.
5.
Ministry of Health; The report 1988. The experience in Brunei Darussalam 1990. CHIP 1990. SEAMIC; SEAMlC Health Statistics. CHIP 1984.
65
Brunei
Brunei
INUMBER OF NEW CASESI (number)
350 300 250 200 150 100 50
• • all
- - -+- - - pulmonary - - - -A - - -
smear( + I
o
L-~~~~~~~~~~~~~~~
1975
1980 YEAR
1985
1990
IINCIDENCE RATEI (per 100,000)
160.0 140.0 120.0 100.0 80.0 60.0 40.0. 20.0 0.0 L-~~~~~~~~~~~~~~~ 1990 1980 1985 1975 YEAR
f - - t . I - - all - - -+- _. pulmonary - - - -A - - -
smear( + I
66
Brunei TRENDS OF TUBERCULOSIS & OTHER INDICES NUMBER OF NEW CASES YEAR All Pulmonary Smear(+} INCIDENCE RATE 1100,000) All Pulmonary Smear(+)
Brunei
MORTALITY Number Rate
1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991
336 230 216 196 285 245 276 256 238 212 189 126 120.7 105.9 147.7 122.5 132.7 118.5 106.1 106.8 79.4 52.2 13 28 11 20 16 15 19 11 4 8 7.3 15.1 5.7 10 7.7 6.9 8.5 4.9 1.7 3.3
Population YEAR 1975 [Mil) 0.16
GNP/C [US$l
IMR [/l,OOO~
Budget/C[US$) for Health forTB
1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 0.179 0.19 0.192 0.2 0.21 0.216 0.224 0.226 0.234 0.241 0.249 12756 12244 13910 12.7 12.1 10 10 7 9.2 9 352 443 504
20 21.4 17.5 77.7
479
67
CAMBODIA Population: Epidemiology: 8.4 millions in 1990 The ARI in 1966-68 was estimated to be 2-3% and the prevalence rate in 1967-68 (in some provinces) was 2.1% (all) or 0.3% (smear positive). In the 19805 the prevalence rate of smear positive cases was about 0.24%. The number of cases treated at various hospitals was IO 903 in 1991 (among these, 8507 cases were smear positive) and these numbers.have been almost stable since 1982. Since 1981, a 5-year tuberculosis control programme has been in operation. (The third program is underway for 1991-1995). National level; National anti-tuberculosis institute (Institut national d'anti-tuberculeux), Provincial level; 8 Province hospitals among 20 with admission facilities, district level; 83 district hospitals out of 150 districts with Tuberculosis centers and microscopists, Commune level; nurses for referral and supervision, Village level: health workers for education. Passive by sputum microscopy. (In provincial hospitals, X-rayexaminationsarerarelydone). Microscopy only. Supervision is expected but seems to be rarely made. In the. central hospital, about half of the cases are hospitalized. Mean duration of stay is about 3 months. 3SHV9S2H2, 3SHRZJ9SH for failure cases. UnderEPI. The central hospital is expected to make a supervisol)' visit to provincial hospitals 2-4 times per year.
Programme:
Organization:
Case finding: Laboratory: Hospitalization:
llegimen: BCG: Supenision:
68
Achievement: Treatment outcome: Cohort analysis is not routinely done. A small sample (622 cases in 1991) analysis shows: cured; 400/0, died: 4%, defaulted: 32%, T/O; 16%. In some hospitals, the completion rate is very low due to lack of drugs. Laboratory: Supervision: There were 600 microscopists in 1990. Supervisory visits made to the areas near Phnom Penh. Recording and reporting from district to province and from province to central are routinely done. 30 microscopists and 25 programme supervisors are trained every year. Most drugs are supplied from foreign aid but not regularly. Drugs including RFP can be bought commercially at market stores.
Training: Drug supply: Private sector:
References: 1. 2. 3. Information from Dr Kong Kim San (National Anti-tuberculosis Institute, 1991). French Red Cross; Anti-Tuberculosis Programme in Cambodia, 1991. Information from Dr Morl (RIn 1992.
69
Cambodia
Cambodia
I NUMBER (number)
OF NEW CASESI
12000 10000 8000 6000 4000 2000 --il.I---
all
- - .... - _. pulmonary - - - -& - - -
smear! + ,
o
L-~~~~~~~~~~~~~~~
1975
1980 YEAR
1985
1990
IINCIDENCE RATEI (per 100.000)
160.0 140.0 120.0 100.0 80.0 60.0 40.0 20.0 0.0 L-~~~~~~~~~~~~~~~ 1990 1975 1980 1985 YEAR --1.1--- all
... ...-_.
.'1Il
. .
- - .... - _. pulmonary - - - -& - - -
smear! + ,
70
Cambodia TRENDS OF TUBERCULOSIS & OTHER INDICES NUMBER OF NEW CASES Pulmonary Smear(+) All INCIDENCE RATE[!100,000] All Pulmonary Smear(+)
Cambodia
YEAR 1975 1976 19n 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991
MORTALITY Number Rate
8158 7572 10241 10145 10325 9106 10691 7906 6501 10903
5801 5316 5507 5235 8715 7173
123.6 111.4 144.2 139.0 139.5 118.3 135.3 97.6
87.9 78.2 n.6 71.7 117.8 93.2 104.4 72.1 61.1
8246 5842 5132 8507
n.4
Population YEAR [Mil) 1975 1976 19n 6.8 1978 6.6 1979 6.5 1980 6.4 6.5 1981 1982 6.6 1983 6.8 7.1 1984 1985 1986 1987 1988 1989 1990 1991 7.3 7.4 7.7 7.9 8.1 8.4
GNP/C rUSS]
IMR [11,000]
Budget/C[US$] for Health forTB
160
160
127 133 120
71
CHINA Population: Epidemiology: 1.1 billion in 1989 Three nationwide surveys were done in 1979, 1984/85 and 1990. In 1990 the prevalence rate was 523 per 100 000 for all tuberculosis cases, and i34 per 100 000 smear positive cases. The ARI is estimated to be 0.55% in 1984-85 with a 6.3% annual reduction rate (1979-84). Two kinds of incidence rate are available: one is from the registration of selected areas (the population size was only 27 million) in 1986-88; the incidence rate was about 50 per 100 OOp for all cases and 9 per 100 000 for smear positive cases: the other is from the registration for the whole country. The total· number of newly registered cases was 375 481 in 1990 (incidence rate: 34 per 100 000) and 345 000 in 1991 (incidence rate: 30 per 100000). The increase up to 1990 is probably due to theimprovementofprogramme coverage. The number of newly registered smear positive cases was about 90 000 in 1991 (incidence rate: about 8 per 100 000). Since 1978, integrated into general health system. Responsible units are: Bureau of Epidemic Prevention in the Ministry of Public Health, 29 Provincial Tuberculosis Dispensaries, County tuberculosis dispensaries, Multi-purpose primmy health care workers at the community level. Usually sputum smear microscopy for symptomatic cases and X-ray if necessary. Both sec and conventional regimen without RFP are used in many provinces. Until 1988, the commonly used regimen was ISHII I S2H2.
Programme: Organization:
Case finding: Laboratory: Regimen:
72
Supenision: BCG:
Widelydone(differentfromplacetoplace). In some areas, supervised ambulatory treatment. Programme since 1950. Primaryvaccination for infants and revaccination for schoolchildren.
Achievement: Treatment Outcome: Cured; 59.6%, Failed; 15.8%, Dead; 14.5%, Lost; 10.1%(1979). Fromasrnallsamp\(iof 3000, regularity rate was 90% (1986-1990) and in Beijing, the cure rate of smear positive cases was about 90% (1985-1989). The coverage in 1986 was estimated to be 67% (in Shanghai, 96%).
BCG:
References: 1. 2. 3. 4. 5. 6. 7. 8. 9. Information from Duan-Mu Hong Jin (National Tuberculosis Control and Research Center Beijing, October, 1991). National Tuberculosis Control Center in Beijing; 1986-88 National Tuberculosis Surveillance Programme (:i:IJ!I~;f1£~ii~I-I1') Ministry of Public Health; Nationwide Random Survey for the Epidemiology of Tuberculosis in 1984/85. Kan G. (Beijing Tuberculosis Center); Tuberculosis Control in Beijing. Styblo K. (WHO); Assignment report 7-25 October 1987. Li-Xing Z.; Case Finding of Tuberculosis in China. Information from Dr Farrugia dated 9 July 1992. LXZhang (Beijing TB Center) et. al.; TB control programme in Beijing Tubercle and Lung Disease 73, 162-166 (1992). Tubercle (1989) Vol. 70, pp. 293-296, TB in China.
73
China
China
INUMBER OF NEW CASESI (number)
400000 350000 300000 250000 200000 150000 100000 50000 "- , --41.'--- all - ..... _. pulmonary •.••.., ••• bac( +)
.A'~'.'A L-~~~~~~~.~~~~~~~~
o
A'-
-'" • A'
.A· .....
1975
1980 YEAR
1985
1990
IINCIDENCE RATEI (per 100,000)
30.0 25.0 20.0 15.0 10.0 5.0 0.0 1975 1980 YEAR ..... .--- all
- ..... _. pulmonary
L-~~~~~~~~~~~~~~~
........ .. A-'" '
- - - ..., - - - bac( + ) A··A·-A- •
1985
1990
74
China TRENDS OF TUBERCULOSIS & OTHER INDICES NUMBER OF NEW CASES INCIDENCE RATE[l100,OOO] All Pulmonary
China
MORTALITY Number Rate
YEAR 1975 1976
All
Pulmonary
Bac(+)
Bac(+)
19n 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1986 1989 1990 1991 98654 117557 151564 98654 117557 151564 226899 265095 251600 19833 26256 39641 54639 62953 59674 76837 77505 94321 90000 13.3 11.6 14.6 21.9 25.4 25.2 29.1 28.9 29.7 13.3 11.6 14.8 21.9 25.4 25.2 29.1 28.9 29.7 2.7 2.6 3.9 5.3 6 6.3 7.4 7.2 7.8 7.8 9.3 10.2 8.9 7.6 5.7
226899 265095 251600 304639 310607 375481 345000
304639 310607 375481 345000
30
30
Population
GNP/C [US$] 180 170 190 220 280 300 320 320 330 330 330 310 310 340 360
IMA [11,000] 44.2 40 41
BudgeVC[US$] for Health forTB
YEAR 1975 1976
[Mil] 942 952 962 963.584 996.135 1008.547 1020.839 1033.249 1046.078 1059.522 1073.37 1088.57 1103.963
19n 1978 1979 1980 1981 1982
39 42.8 37.3 34.7 41.4 38.4 37.4 37.1 ~.8
1983 1984 1985 1986 1987 1988 1989 1990 1991
31 31
1120
30
7S
COOK ISLANDS Population: Epidemiology: 18 000 in 1980 The number of new cases has been fluctuating between 10 and 40. There is a decreasing tendency mainly in Rarotonga Island (main island), but in other islands it is almost stable. The number of smear or culture positive cases is not available.
Programme: Case finding: Laboratory: Regimen: BeG:
In Ralotonga Island, almost all cases are examined by the sputum exarninationsince 1985. SCC is recommended but the coverage is not known. Primary vaccination for infants and revaccination at school.
Achievement: Treatment outcome: BCG:
Completed; 70%, Transferred; 23% (RaIotonga Island). Primary vaccination coverage; 70%. The coverage of revaccination for schoolchildren is nearly 100%. (Both on Rarotonga Island).
References: 1. 2. 3.
Fu, Q. Y. (WHO); Notes on field visit, March, 1988. Fu, Q. Y. (WHO); Notes on field visit, March, 1986. CHIP 1990.
76
Cook Islands
Cook Islands
INUMBER OF NEW CASESI (number)
40 35 30 --1.1---
all
25 . 20 15 10 5
- . -.. _. pulmonary •..." . .. smear! + )
o
L-~~~~~~~~~~~ ,
1975
1980 YEAR
1985
1990
IINCIDENCE RATEI (per l00,OOO)
250.0 200.0 • all
150.0 100.0 50.0 0.0 '--~~~~~~~~~~~~--==--~ 1975 1980 1985 1990 YEAR
- . -.. _. pulmonary ..• ·A • ••
smear! + )
77
Cook Islands
Cook Islands
TRENDS OF TUBERCULOSIS & OTHER INDICES NUMBER OF NEW CASES Pulmonary Smear(+) All INCIDENCE RATEU100,OOO) Pulmonary Smear(+) All MORTALITY Number Rate
YEAR 1975 1976 19n 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1986 1989 1990 1991
30 37 10 19 29 20
166.7 205.6 55.6 111.8 161.1 117.6 211.8 100.0 94.1 86.2 5.0 5.0
36 17 16 1 1
Population [Mil) YEAR 1975 1976 19n 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 0.018 0.018 0.018 0.018 0.018 0.018 0.018 0.017 0.017 0.017 0.017 0.017 0.021
GNP/C [US$)
IMR
Budget/C[USS) for Health forTB
Ul,OOO)
16.4
980
21.6 38.7 37.1 22 15
184.6 186.6
1991
78
FIJI Populatiou: Epidemiology: 738 000 in 1990 TbenumberofnewcaseshasfluctuatedaroWid 200 in the last 15 years and the incidence rate has decreased to 30/100 000 in 1989. All cases and suspects are hospitalized at either the Tarnavua tuberculosis hospital or the Lautoka hospital for 2 months for initial phase treatment; then semi-supervised chemotherapy is given at OPD. Passive. MMR is done only for some groups such as army and police recruits. Smear and culture examination is routinely done.
Programme:
Case finding: Laboratory: Regimen: Achievement: Treatment Outcome:
2S (or E)HRZ + 7HRE(or7HR).
Completed; 90%, lost; 5%, dead; 5% (1988-89). Coverage for infants is over 90%.
BCG:
References: I. 2. 3. 4. Umemura N. (WHO); Assignment report October-November 1990. Ministry of Health; Tuberculosis situation in Fiji 1989. Ministry of Health; Annual report 1985·86. Fu, Q.Y. (WHO); Notes on field visit, July, 1986.
79
Fiji
Fiji
INUMBER OF NEW CASE' (number)
300 250 200 150 100 --1.1'---
all
l
I
- ..... - . pulmonary ....••.• smear! + I
50
o
L-~~~~~~~~~~~~~~~~
1975
1980 YEAR
1985
1990
(INCIDENCE RATEI (per 100,000)
50 45
40 35 30 25 20 . '.' 15 10 5
'..
,,
, ,,4· "4. A '4' '4.
. "A, "A'
--I.It--
all
, ~, ,. ~ .~,A. -A."
- , ... - - . pulmonary • , - - -A ' - -
smear( + I
4- -4' ..
o
L-.~~~~~~~~~~~~~~~~
1975
1980 YEAR
1985
1990
80
Fiji TRENDS OF TUBERCULOSIS & OTHER INDICES NUMBER OF NEW CASES INCIDENCE RATElL1oo,000~ All Pulmo~ Smear..i+L 47 22 21 44 24 43 30 16 18 17 15 15 12 19 24 20 12 14 12 10 9 10 0
Fiji
YEAR 1975 1976 19n 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991
All
PulmonlID' Smeart+) 268 128 122 259 145 257 187 205 210 180 163 185 165 133 173 146 151 129 101 114 111 97 98 79 82 99 86 75 65 76
MORTALITY Number Rate
32
5.2
33 33 27 25 27 24 32 27 23 22 30
230 199 173 162 218
20 18
0.0
Population
YEAR 1975 1976 19n 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991
[Mill 0.573 0.59 0.602 0.614 0.627 0.639 0.65 0.663 0.6n 0.691 0.702 0.715 0.741 0.74 0.738
GNP/C [US$] 1030 1190 1290 1340 1580 1750 2000 1870 1700 1770 1640 1760 1590 1500 1640
IMR [11,000] 41.4 36.8 31.9 28.9 28.7 32.8 28.8 26.6
Bu<!9.et/C[US~
for Health
forTS
22 22.5 17.4 19.8 19.7 26 26
30
35 34
81
FRENCH POLYNESIA Population: Epidemiology: 193 000 in 1989 The number of newly registered cases fluctuates around 60. The incidence rate decreased remarkably in the 1970s and only a little in the 1980s (30/100 000 in 1989). There was only 1 case of meningitis tuberculosis between 1983-87. From the tuberculin survey, ARI was estimated to be 0.4% in 1979. The tuberculosis service is mainly provided by the Institute MaIarde. Both Passive (63%) and Active (37%). Sputum smear examination is made for almost all cases. 90% ofpulmonary TB cases are confirmed with culture or pathological examinations.
P",gramme: Case finding: Laboratory:
Regimen:
BCG: Achievement:
Primary fornewbom babies and revaccination for school age children.
References: 1. 2. 3. 4. Sante publique; rappon annuel d'activites. Polynesie, direction de la sante, 1988. Sante publique; rappon annuel d'activites. Polynesie, direction de la sante, 1986. Information from Sante publique 1986. Information from Jacque Drollet (Ministere de la Sante et de I'Environnement, 26 October 1990).
82
French Polynesia
French Polynesia
INUMBER OF NEW CASESI
--t·~-all
•
- - -+- _. pulmonary - - - -j, - - -
smear( + )
1980 YEAR
1985
1990
/INCIDENCE RATEI (per 100.0001
120 100 80 60 --t·~-all
- - -+- _. pulmonary • - - -j, - - -
40 20
smear( + )
• ~~~~~~~~~-~~~~~~~
o
1975
1980 YEAR
1985
1990
83
French Polynesia TRENDS OF TUBERCULOSIS & OTHER INDICES NUMBER OF NEW CASES Pulmonary Smear(+) All INCIDENCE RATEU100,OOO] All Pulmonary Smear(+)
French Polynesia
YEAR 1975 1976 19n
MORTALITY Number Rate
1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991
110 87 78 62 56
56
73 56
48 66 73 75 79 63 64
56
58 49
52 39 32 48 52 48 49 45 44 43 34
48 37 29.7 39.6 43 43.1 44.2 34.4 34.1 30.1 25
38 35 28 30 34.2 24.8 19.8 28.8 30.6 27.6 27.4 24.6 23.4 22.3
8 7 12 5
4 0
4.6 3.9 6.5 2.7 2.1 0
Population
GNP/C [USS]
IMR U1,OOO)
YEAR 1975 1976 19n
[Mil]
Budget/C[US$) forT8 for Health
1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991
0.148 0.149 0.15 0.154 0.157 0.16 0.163 0.167 0.188 0.189 0.193
18.5 8250 18.4 29.9
84
GUAM Population: Epidemiology: 121 000 in 1989 The number of new cases has fluctuated between 40 and 70 in the last 15 years and the incidence rate was 62/100 000 in 1989. Basically follows the programme of USA. Passive. Active for immigrants( 13% of patients were migrants in 1981). Microscopy and culture (class 2 in CDC classification). Sensitivity test and identification test are done in USA (CDC). Treatment is given by private practitioners at Guam Memorial Hospital. SCC (as in USA).
Programme: Case finding: Laboratory:
Treatment: Regimen: BCG: Achievement: Treatment Outcome:
References: 1. 2. 3. 4. 5. 6. USA; Pacific Morbidity and Mortality Monthly, vol 3, no 2 (February, 1990). CDC, USA; Tuberculosis Statistics in the US 1987. Guam; Annual Summary of Notifiable Diseases 1980-88. Department of Public Health and Social Services; Statistical Report 1988. Eng (WHO); Assigrunent report, September, 1981. CHIP 1989.
85
Guam
Guam
[NUMBER OF NEW CASESI (number'
80 70 60 ..... ·t---all
50 40 30 20
- ..... _. pulmonary
••.••.. - bacl +)
10
o
~~~~~~~~~~~----~~~~
1975
1980 YEAR
1985
1990
[INCIDENCE RATEI (par 100,000)
70 60
50 40
-
...... t--- all
- - ... - _. pulmonary
30 20
- ...• - .. bacl +)
10
o
L-~~~~~~~~~~~~~~~~
1975
1980 YEAR
1985
1990
86
Guam TRENDS OF TUBERCULOSIS & OTHER INDICES NUMBER OF NEW CASES Pulmonary Bac(+) All 49 46 39 46 57 67 64 61 51 61 47 71 55 49 28 41 34 47 49 48 38 54 50 37 37 49 39 27 34 13 41 35 75 86 INCIDENCE RATEr/1oo,0001 Bac(+) Pulmonary All 51.5 48.3 47.2 38 57.2 67.2 59.8 62.7 58.4 68 44.2 51.7 29.4 37.6 36.7 43.9 42 33.1 42.7 46.1 30.8 30.8 31.7 39.8 21.2 26.7 31.7 27.2 50 57
Guam
YEAR 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991
MORTALITY Number Rate
4 6 5 1 3 3 2 5 4
3.8 5.5 4.5 0.9 2.6 2.5 1.6 3.9 3.1
YEAR 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991
Population (Mil] 0.076 0.079 0.082 0.084 0.104 0.107 0.11 0.111 0.116 0.12 0.114 0.124 0.126 0.119 0.121
GNP/C (US$]
IMR 1/1,000)
Budget/CIUS$I forTB for Health
9.1
100
9175
9.7 7.9
87
HONG KONG Population: Epidemiology:. 5.8 million in 1990 Tuberculosis mortality rate decreased to 6.81 100 000 in 1988, and has nearly halved over the last 15 years. The incidence rate of all cases has steadily decreased to 123/100 000 in 1988, though the number of new cases showed only a small decline after 1984 and was 6704 in 1989.
Programme: Case finding: Treatment: Regimen: Chemopropbylaxis: Passive and active (including MMR) and contacts survey. Duration; 6 months. Initially admitted to hospital for 2 months (there are 1181 TB beds). SCC Applicants migrating to Australia, Canada and other countries must have preventive chemotherapy to fulfill the migration criteria when they have stable radiographic shadows. Primary directly to new born babies before 6 weeks or tuberculin negative infants over 6 weeks old. Revaccination for tuberculin negative school entrants. Contacts under 5 years of age with negative tuberculin are given BCG. For refugees under 14 years ofage, directBCG is given.
BCG:
Acbievement: Case finding: Both passive and active (MMR and contact examination) Contact examination: In 1988, 14433 contactsof7 433 casesweretraced,amongwbom 166 pulmonary and 3 extrapulmonary tuberculosis cases were detected.
88
Laboratory:
The laboratories made 90 000 direct smears, 80 000 cultures and 9000 sensitivity tests mainly against SM, INH and RFP in 1988, by which about 7000 cases were detected. Coverage of the first vaccination: 98.4% in 1988.
BCG:
References: 1. 2. 3. 4. Director of medical and health services; departmental report 1988-89. Director of medical and health services; Annual Report 1988. CHIP 1990. Director of medical and health services; Annual Report 1980.
89
Hong Kong
Hong Kong
INUMBER OF NEW CASESI (number)
9000
SOOO 7000 6000 5000 • all
- ..... _. pulmonary •••••••• smear( +) j. . . . .
4000 3000 2000 1000
*
. j .. . . . . .
.'.'" 19.90
o
L-~~~~~~~~_~~~~~~__
1975
1980 YEAR
1985
IINCIDENCE RATEI (per 100,000)
200 180 160 140 120 100 80 60 40 20
-
..... 1--- all
- ..... - . pulmonary . . • ••. •. smear( +) j. . . . . . . . ~ • • -- ' j .•• j. ••j.
o
L-~~~~~~~~~~~~~~~
1975
1980 YEAR
1985
1990
90
Hong Kong TRENDS OF TUBERCULOSI$ & OTHER-INDICES NUMBER OF NEW CASES INCIDENCE RATEU100,OOO] All 183.6 175.5 156.9 141.9 160.4 159.3 149.1 143 136.6 145.3 3109 138.3 134.5 130.3 124.8 117.9 114.1 109.2 Pulmonary 179.2 170.5 151.5 133.8 151.8 150.5 141.7 134.9 128.5 136.4 131 126 122.3 117 109.9 106.5 101.9 57 55.S 54.6 52.9 50.4 49.1 47.2 Smear(+)
Hong Kong
MORTALITY Number Rate 14.5 12.6 11.6 9 10.6 10.9 9.4 8.6 8.3 7.8 7.5 7.4 7.3 6.9 7.1 6.7 7.1
YEAR 1975 1976
All 8192 7928 7191 6623 7903
Pulmonary Smear(+) 7995
noa 6944 6246 7481 7620 7347 7101 6866 7365 7146 6963
646 568 532 420
19n 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991
523 551 489 454 446 420
8065 n29 7527 7301 7843 7545 7432 7269 7021 6704 6510 6283
409 407 405
6826 6581 6249 8076
3084 3046 29n 2863 2799 2714
388 403 382 409
5866
Population
GNP/C rUSS] 1353 1708 1949 2242 2797 3463 4075 4523
IMR
BudQet/C[USS] forTB 1.2 1.4 1.5 1.4 1.6 1.8 2.2 2.7 2.8 3.2 3.4 4 3 3.3 4.6 5.9 7.2
YEAR 1975 1976
[Mil] 4.5 4.5 4.6 4.7 4.9 5.1 5.2 5.3 5.3 5.4 5.5 5.5 5.6 5.6 5.7 5.7 5.8
[11,000] for Health 15 25 14.3 13.9 11.8 13.3 11.8 9.7 9.9 10.1 9.1 7.6 7.7 7.5 7.6 6.9 5.9 6.5 32 36
19n 1978 1979 1980 1981 1982 1983 1984 1985 1988 1987 1988 1989 1990 1991
43 42 65 73 84 75
4946 5889 6134 6927 8445 9879 11254 12493 14102
n 89 104 116 129 137 175 223
91
JAPAN Population: Epidemiology: 123.6 million in 1990 Though the number and incidence rate of all new cases have been decreasing steadily, the reduction rate has slowed down since 1977. The number and incidence rate were 51 821 and 41.9/100 000 respectively in 1990. The number of bacillary positive cases is about 18000 and almost the same for the last 15 years; the number of smear positive cases increased slightly in the 1980s and was 15 498 in 1990. Ha!fofthecasesareover60yearsold. The tuberculosis prevention law has been legislated since 1919 and revised in 1951. NTP is fully integrated with general health services with full coverage by the health insurance system. Patients are diagnosed and treated both at private and public clinics and hospitals. Registration is made at governmentalHealth Centerswbich covers about 100 000 people and is responsible for the public health programme of the area. The law covers the expenditures necessary for tuberculosis treatment together with health insurance. The public health nurses of the Health Center visit patients regularly, take action against defaulters and make the contact tracing. The computerized surveillance system has been maintained since 1987. Passive (about 80%) + Active (20%; MMR and contact tracing). About 95%ofcasesare exarninedwith sputum smear or culture. Sensitivity test and Niacin test are routinely done. 6HRS (orE) + 3HRforthe smear positive new cases. Six HR for X-ray active cases.
Programme:
Case finding: Laboratory:
Regimen:
92
Preventive chemotherapy:
Tuberculin strongly positive children (particularlycontacts) are given cbemoprophylaxis with 6 months of INH. Primary vaccination for tuberculin negative infants. Revaccination for tuberculin negative primary and secondary school entrants (at the ages of6 and 13 years).
BCG:
Achievement: Total Delay: 66 % of TB cases start treatment within 2 month of duration of SYmptoms. The coverage is 88%.
BCG:
References: 1. 2. Ministry of Health and Social Welfare; Statistical Year Book of Tuberculosis. Ministry of Health and Social Welfare; Health and Welfare Service in Japan 1991.
93
Japan
Japan
INUMBER OF NEW CASESI (numberl
120000 100000
-004."-- all - - ~- _. pulmonary - - - -& - - -
80000
60000 40000 20000
smear( +)
o
-* -&- * -&- -&- .. -&- * -&- -&- .. -&- * -&- -&-. ~~~~~~~~~~~~~~~
1975
1980 YEAR
1985
1990
IINCIDENCE RATEI (per 100,0001
100 90 80 70 60 50 40 30 20 10
... ...
..........
• .
all
..........
............... 1985 YEAR
- - ~- _. pulmonary ----&--- smear(+)
-~-*-
o
.. -~-&-~-*- .. -~-&-~-~-*-~-&-~ 1980 1990
L-~~~~~~~~~~~~~~~
1975
94
Japan TRENDS OF TUBERCULOSIS & OTHER INDICES NUMBER OF NEW CASES Pulmonary . Smear{+) All INCIDENCE RATEU100,OOOl All Pulmonarv Smear{+)
Japan
MORTALITY Number Rate
YEAR 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991
108088 97924 89245 80629 76455 70916 65867 63940 62021 61521 58567 56690
56496 54357 53112 51821 50612
96872 87670 79350 71995 68367 63195 56881 57550 55884 55629 53287 51870 52077 50014 48827 47774 46809
13703 13360 13373 13198 12806 12291 12214 12649 13010 13277 13808 13745 14405 14592 14710 15498 15285
96.6 86.6 78.2 70 65.8
60.7 55.9 53.9 51.9 51.2 48.4 46.6 46.2 44.3 43.1 41.9 40.8
86.5 77.5 69.5 62.5 58.8 54.1 49.9 48.5 46.8 46.3 44 42.6 42.6 40.7 39.6 38.6 37.7
12.2 11.8 11.7 11.5 11 10.5 10.4 10.7 10.9 11 11.4 11.3 11.8 11.9 11.9 12.5 12.3
10567 9578 8803 8261 6738 6439
5698 5343 5329 4950 4692 4170 4022 3872 3527 3659
9.5 8.5 7.8 7.2 5.8 5.5 4.9 4.5 4.5 4.1 3.9 3.4 3.3 3.2 2.9 3
Population [Mil] YEAR
GNP/C
IMR
Budaet/C(US$I forTS
1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991
111.573 112.775 113.872 114.913 115.89 117.06 117.648 118.449 119.259 120.305 121.049 121.672 122.264 122.46 123.116 123.611 124.043
[US$] .4490 4970 5690 7020 8620 9870 10390 10280 10320 10560 11240 12840 15800 20960 23810
U1,OOO] for Health 10 9.3 8.9 8.4 7.9 7.5 7.1 6.6 6.2 6 5.5 5.2 5 4.8 5 5
9S
KIRIBATI Population: Epidemiology:. 68000 in 1989 The number of new cases has fluctuated between 100-300 in these last 15 years. The incidence rate fluctuates between 100-4001 100 000 and sometimes it was the highest in WPR. The proportion of smear positive cases to all cases was about 10% in the early 1980s. Under the public health section, with a central registry. Passive. Most of the symptomatic cases are referred to a hospital in the main island (Tarawa Island) and both sputum and X-ray examinations are done. In other islands, the sputum examinations of symptomatic cases are made either locally by medical assistants or by sending the smear slides to the main island. X-ray is available in the main island only. Sputum smear examination by trained microscopists can be done on the main island. There is no quality control. On other islands, microscopes are available in the health centres but examinations are not practically carried out. On Tarawa Island, culture examination was started in 1991, but the quality needs to be improved. On Tarawa island, the regimen used in the hospital is 2SHRZI4HR. On other islands, both SCC and regimen without RFP are used. Infants only (revaccination was previously done but was recently stopped). Medical assistants must report to the statistical officer every month on the numbers of cases diagnosed, under treatment, and out of treatment. There is no specific registration form. Cohort analysis is not done.
Programme: Case finding:
Laboratory:
Regimen:
BCG: Registration:
96
Achievement: Treatment outcome: 38.80/0, Dead; 8.1 %, Lost; Completed: 17.10/0, Transferred; 36% in 1986-1988. In 1991-92, according to a small sample study on Tarawa Island, over half of the cases dropped out. Coverage is nearly 100% probably due to overreporting.
BeG:
References: 1. 2. 3. Fu, Q.Y. (WHO); Notes on field visit in July, 1987. CHIP 1989. Observation by Dr Yoshiyama (RIT) in November, 1992.
97
Kiribati
Kiribati
INUMBER OF NEW CASESI (number)
300 250 200 150 100 • all
•
- ..... -. pulmonary ......... smear( + I
1975
1980 YEAR
1985
1990
I INCIDENCE (per 100,000)
RATEI
6()()
500 400 300 ......... smear( + I --t.t--- all
- ..... _. pulmonary
200 100
o·I ' , • ,"" 1975
".
~ '--" .-.... . .•..•
.
..
"
1980 YEAR
1985
1990
98
Kiribati TRENDS OF TUBERCULOSIS & OTHER INDICES NUMBER OF NEW CASES Pulmonary Smear(+) All 279 278 97 40 210 190 83 31 23 22 4 21 10 34 17 14 INCIDENCE RATPI100,OOO] Pulmonary Smear(+) All 528
Kiribati
YEAR 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991
MORTALITY Number Rate 23 15 15 3 8 14 8 3 8 7 15 10 10 6 14 43.5 27.4 26.5 5.3 14 24 1.3.5 5 13 11.2 23.6 15.5 14.9 8.8
508 171 125 164 251 315 320 207 178 162 200 164.2 310.4 177.9
397 347 146 105 127 163 211 177 135 168 137 138
59 42 39 7 37 17 57 28 23
59 73
94 146 187 193 127 111 103 129 110 208 121
95 125 107 83 105 87 89
68
.Population
YEAR 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988
[Mil] 0.053 0.055 0.057 0.056 0.057 0.058 0.059 0.06 0.061 0.062 0.063 0.065 0.067 0.067 0.068
GNP/C [US$]
IMR
[11,000]
Budget/C[US$] for Health forTB
87
898 889 300 27.2
324
82 19.5
1989 1990 1991
650 700
62 58
99
LAO PEOPLE'S DEMOCRATIC REPUBLIC Population: Epidemiology: 4.0 millions in 1989 There are no data on tuberculosis prevalence and incidence. It is roughly estimated that the prevalence rate is 2%for all cases and O. 5% for smear positive cases, and the number of newly registered cases is 8000. NTP was started in 1986 after a national seminar. Since then, several regional seminars have been held every year. In July 1992, the first nationwide seminar was held and 15 of 17 provinces participated. National level; National TB Center (NTC). Intermediate level; Provincial office. (In some provinces the provincial TB office exists in the provincial hospital). Peripheral level; ? Passive only Microscopy only. Microscopes are equipped at NTC, most provincial hospitals and some district hospitals. Until July 1992, some provincial hospitals could not provide sputum AFB smear services due to the lack of reagents and training. (Microscopes are used for malaria and other examinations). Technicians are trained in a 3 year basic course. The standard regimen is without RFP. Thiacetazone was previously used but was recently discontinued due to side effects. The most popular regimen is 2 drugs ofSH (daily for the first 2 months and intermittently after that). In some provincial hospitals patients are given only prescriptions and advised to purchase drugs in the market. Only in the NTC, RFP containing regimen is given (2SHRZ/4HR, 2EHRZ/4HR, 2SHRZI6HE, 2HRZE/6HE).
Programme:
Case finding: Laboratory:
Regimen:
100
BCG:
Since 1981, BCG has been given in EPI under the responsibility of the Institute of Hygiene and Epidemiology.
Achievement: Case finding: The number of cases reported in 1991 from 8 provinces was 1951 and 562 were smear positive. Treatment completion rate is about 30% for the cases treated with RFP containing regimen; (Dr Jittinandana). BCG coverage is about 30% and improving.
Case holding:
BCG:
References:
1. 2. 3.
Information from Dr Houmdaophet (National Tuberculosis Center, April, 1991). Nagasaki, D.R. (WHO); Assignment report 1989. flCA; Observational Report on Infectious Diseases in Lao People's Democratic Republic 1990.
4. 5. 6.
CHIP. Dr A. Jittinandana (WHO); Mission report 1992. Dr Yoshiyama (WHO) Report, 1992.
101
laos TRENDS OF TUBERCULOSIS & OTHER INDICES NUMBER OF NEW CASES All PulmOlllll}' Smearl"tl INCIDENCE RATEWOO,OOO~ All Pulmo~ Smeal'{+)
Laos
YEAR 1975 1976 19n
MORTALITY Number Rate
1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991
I
!
Population [Mil] YEAR
GNP/C rUSS]
Budget/C[US$] forTB JL1,0~ for Health
IMR
1975 1976 19n
1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991
3.5 3.6 3.6 3.2 3.3 3.3 3.3 3.4 3.5 3.6 3.7 3.9 3.972
118 202 180 170
110 106 104
102
MACAO Population: Epidemiology:. 448 000 in 1989 The number of new cases and deaths have decreased in the last 15 years (343 cases and 30 deaths in 1990). The incidence rate has declined most remarkably in WPR (171 to 30 per 100 000 between 1984 and 89).
Programme: Case finding: Regimen: BCG: Achievement: Treatment outcome: Cured; 64%, Abandoned; 25% Both active (including MMR) and passive. SCC (6-9 . month several choices for regimens). Primary to infants. given. Revaccination is also
References:
1. 2.
3.
Government of Macao; Relatorio Annual 1990. Government of Macao; Relatorio Annual 1989. CInP 1986.
103
Macao TRENDS OF TUBERCULOSIS & OTHER INDICES NUMBER OF NEW CASES YEAR 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 455 671 571 420 389 320 274 343 329 133 124 140 122.1 171.6 140 99.2 89.5 72.2 60 75 92 442 1101 585 438 All 1383 Pulmonary INCIDENCE RATEU100,000] Pulmonary Bac(+) All
Macao
MORTALITY Number 158 140 124 71 113 109 99 92 41 33 29 27 14 10 8 6.2 5.4 3 6.5 5 Rate
Bac(+)
94 58 44 34 27 24 14 30 18
Population YEAR 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1988 1987 1988 1989 1990 1991 0.268 0.298 0.322 0.343 0.391 0.408 0.417 0.429 0.444 0.448 0.457 [Mil]
GNP/C [US$]
IMR U1,000]
Budget/C[US$] for Health forTB
18.2 9.7 1500 13.9 14.1 12
3700 3700 (3813
6.9 9.3 10.2
66.5 78.8 85.3
104
Macao
Macao
iNUMBER OF NEW CASESI (number)
1400. 1200 1000 800 600 400 200 • all pulmonary
- . -+. -.
........ - bact + I
o
.a.- .. - ... L-~~~~~~~~~~~~~~~
1975
1980
1985
1990
YEAR
ilNCIDENCE RATEI (per 100,000)
180.0 160.0 140.0 120.0 100.0 80.0 60.0 40.0 20.0 0.0 L-~~~~~~~~~~~~~~~ 1990 1980 1985 1975 YEAR
-
... ·I---all
- . -+- - . pulmonary - - - -A • - -
bact + I
lOS
MALAYSIA Population: Epidemiology:. 17 million in 1990 The number of new cases and smear positive cases have been almost stable around 10 000 and 7 000 respectively for the last 15 years. The incidence rate of all cases decreased until 1985, but has been almost stable since then (67{100 000 in 1990). TheARIwasestimated to be 0.6% in 1989. A national tuberculosis control programme (NTCP) was started in 1961. National level; the National Tuberculosis Centerwith 276 beds is the headquartersoftheTB Division under MOH and the head is the director ofNTCP. State level; State Tuberculosis Control Centers with chest clinics in general hospitals. Passive and contact tracing. MMR was abolished in 1968. Culture examination is routinely done. 6 Month SCC.. [(2HRZJ4HR(SM or EB may be added)]. Primatyforinfantsand revaccination at school. Both directly. Quality control is made. Centralized training in the National TB Center and regular visits for spot training.
Programme: Organization:
Case finding: Laboratory: Regimen: BCG: Training and supenision: Achievement: Treatment Outcome: BCG:
Completed; 84% in 1987. The coverage is 90%.
106
Refet"ellUS: 1. 2. 3. Pusat tibi negara (MOil); Laporan Tahunan,Rancangau kawaJan tibi kebaugsaan 1989. Pusat tibi negara (MOil); Laporan Tahunan,Rancangan kawalan tibi kebaugsaan 1988. Pusat tibi negara (MOil); Perpustakaan 1987.
107
Malaysia
Malaysia
INUMBER OF NEW CASESI Inumber)
12000 10000 8000 6000 4000 2000 ---..,,-t.~-
all
-..
'.'.
•......... .: ,A,A. ....-... -.......... -'* ....
- - .... _. pulmonary .. - -. - - - bac( + )
o
L-~~~~~~~~~~~~~~~~
1975
1980 YEAR
1985
1990
IINCIDENCE Iper 100,000)
RATE) --1.1--- all
100 90 80 70 60 50 40 30 20 10
'.
........... - ........"
&.
.&. •
.. ..... -... .......•. ,*-"" 1985 1990
- ..... _. pulmonary . . . .• . .. bac( + I
o
~~~~~~~~~~~~~~~~~~
1975
1980 YEAR
108
Malaysia TRENDS OF TUBERCULOSIS & OTHER INDICES NUMBER OF NEW CASES Pulmonary Bac(+) All 11692 11098 10264 10441 11094 11218 10970 11944 11634 10577 10569 10735 11068 10944 10686 11702 10953 10360 9471 9712 10307 10411 10141 10824 10632 9544 9397 9756 6717 6609 6050 6313 6622 6819 6766 7533 7251 6660 6682 6653 6924 6718 6711 6774 INCIDENCE RATE r /100,000] Pulmonary Bac(+) All 98.3 88.8 80.2 79.7 82.8 83 80.6
Malaysia
MORTALITY Number Rate
YEAR 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991
92 82.9 74 74.2 76.9 75.7 71.9 74.6 78.4 62.5 59.9 60.6 60.5 56.2 57.7
56.4 52.9 47.9 48.2 49.4 50.7 49.7 54.4 49.2 44.1 43.1 41.3 41.9 39.7 38.4 38.8 514 528 531 637 469 288 934 856 839 5.8 5.6 5.1 5 4.4 4.5 3.1 3.1 3.1 3.3 2.7
86 78.9 70 68.2 66.6 67 64.7 61.2
9992 9518 9676 10816
Population YEAR 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 (Mil] 11.9 12.5 12.8 13.1 13.4 13.75 14.1 14.5 14.89 15.27 15.68 16.11 16.525 16.921 17.377
GNP/C (US$] 820 920 1000 1140 1400 1680 1890 1910 1900 2040 1970 1850 1830 1930 2160
IMR (/1,000]
BudlJet/CrUS$] forTB for Health 14 19 20 23 26 30 31 29 30 29 29 27 27 29
33.2
24 19.7 19.3 20.3 17.5 17 15.5 14.4
109
NAURU Population: 9000 in 1989 No data is available on the epidemiology and control programme of tuberculosis.
References: 1. 2.
Kiki Thoma (Director of medical service) et a1; Nauruan mortality 1976-1981. CHIP 1989.
110
Nauru TRENDS OF TUBERCULOSIS & OTHER INDICES NUMBER OF NEW CASES Pulmonary Smear(+) All INCIDENCE RATE[J100,OOO] Pulmonary Smear(+) All
Nauru
MORTALITY Number Rate
YEAR 1975 1976 1977 1978 1979 1980 1981 1982 (8) 1983 1984 1985 1986 1987 1988 1989 1990 1991
YEAR 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991
Population [Mil]
GNP/C [US$]
IMR [/1,000)
BudgetlC[uS$) forTS for Health
0.007 0.008 0.008 0.008 0.007 0.008 0.008 0.008 0.008 0.009 0.009 0.009 (10000)
111
NEW CALEDONIA Population: Epidemiology:. 160 000 in 1989 Though there was a slight peak in 1983, the number and rate of new cases has been stable. The numbers of new cases and smear positive cases were 130 and 39 respectively in 1989. The incidence rates were 81.3/100 000 and 24.4/100 000 respectively in 1989. There is a central registration system.
Programme: Case finding: Laboratory:
Smear and culture examinations are routinely done. Thirty-five of75 specimens were positive in culture examination in 1989.
Regimen: Preventive chemotherapy: Achievement: Preventive chemotherapy is given.
Referent:eS:
I. 2. 3. 4.
Information from Dr Lee (WHO, November, 1990). Ecole nationale de la sante; lasante en nouvelle caledonieet dependances 1987. Service de sante; I' activite du service de sante 1983. ClDP 1990.
112
New Caledonia
New Caledonia
INUMBER OF NEW CASESI (number)
180
160 140
120 100 80 60 40
• • ~: L-~~~~~~~~~~~~~~~
--t.I--- aI/
- ...... -. pulmonary •••••••• smear( + I
20
o
1975
1980 YEAR
1985
1990
IINCIDENCE RA (per
TEl .... ·I---all
100,000)
120.0 100.0 80.0 60.0 40.0 /
.
. ...
- ...... _. pulmonary . ..••... smear( + I
20.0 0.0 L-~~~~~~~~~~~~~~~
1975
1980 YEAR
1985
1990
113
New Caledonia
New Caledonia
TRENDS OF TUBERCULOSIS & OTHER INDICES NUMBER OF NEW CASES INCIDENCE RATEU100,OOO] All Pulmonary Smear(+) MORTALITY Number Rate
YEAR 1975 1976 1977 1976 1979 1980 1981 1962 1983 1984 1985 1986 1987 1988 1989 1990 1991
All
Pulmonary Smear(+)
108 128 111 161 144 104
78 76 122
34 60
76 110
48 78
23 41
130
39
24
Population [Mil] YEAR 1975 1976 1977 1978 1979 1980 1981 1962 1983 1984 1985 1986 1987 1988 1989 0.137 0.139 0.143 0.144 0.145 0.148 0.151 0.148 0.156 0.16 0.16
GNP/C rUSS)
IMR
Budg~C[US$)
U1,OOO.l
for Health
forTB
67 5379 5242 16.6
68
1990 1991
114
NEW ZEALAND Population: Epidemiology:. 3.4 million in 1990 Though the number and rate of new cases had been steadily decreasing, the decline has stagnated since 1987. The incidence rate of all cases and mortality rate were 9/100 000 and 0.3/100 000 respectively in 1989. The incidence rate of all cases was 40.5/100 000 for the Maori and Polynesians in contrast to '}j 100 000 for tJle population of European descent. Refugees consisted of 14.5% of the notifications in 1989. A small proportion of new cases had mv infection.
Programme: Case finding: Laboratory: Regimen:
BCG: Cbemopropbylaxis: Acbievement:
Given not routinely but only in some areas and to high risk children. Chemoprophylaxis is given.
References:
l. 2. 3. 4. 5. 6.
Information from Dr 1. Stehr-Green (Epidemiology unit CDC) November, 1990. Department of Statistics; Key statistics November, 1990. Department of Health; Pbblic Health Report 1982. Department of Health; Morbidity and Demographic Data 1987. CIDP 1990. Information from Dr J.Stehr-Green (Epidemiology unit CDC) October, 1990.
115
New Zealand
New Zealand '
INUMBER OF NEW CASESI (nurn""r)
700 600 500 400 --t---all
300 200 100
\,
., _..... .... ... ..... .... ...'.... . 1985 YEAR
- .... _. pulmonary ••••,6 •••
smear( + I
o
~~~~~~~~~~~~~~~~~
1975
1980
1990
IINCIDENCE RATEI (per 100,000)
25
20 all
15 10 5
............. .....
o 1975
_ ........ .................. ........... 1985 1990
- .... _. pulmonary • • - -,6 - - -
smear( + I
1980
116
New Zealand TRENDS OF TUBERCULOSIS & OTHER INDICES NUMBER OF NEW CASES Pulmonary Smear(+) All 663 611 556 503 531 513 INCIDENCE RATE[f100,OOO) Pulmonary Smear(+) All 21.3 17.9 19.4 19.3 19 17.4 15.1 14.2 13.8 13 12.5 69 11 9 9 8.9 9.2 10.3 9.9 16 17.2 16.5 11.2 9.8 8.5 8.9 7.3 7.9 6.4 6 5.4 5.9 6.3 7.3 7.4 I
New Zealand
MORTALITY Number 74 62 71 59 34 27 25 22 13 25 22 16 10 8 10 11 12 Rate 2.4 2 2.3 1.9 1.1 0.9 0.8 0.7 0.4 0.8 0.7 0.5 0.3 0.2 0.3 0.3 0.4
YEAR 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1969 1990 1991
608 595 542 474 448 437 415 402 359 320 296 295 303 348 335
348 309 268 280 234 254 209 196 177 195 212 249 250
i 2.2 2 1.7 1.9 1
66 55
62
Population [Mil] YEAR 3.1 1975 3.1 19761 3.1 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 3.1 3.1 3.1 3.1 3.2 3.2 3.2 3.2 3.3
GNP/C [US$] 4380 4280 4300
IMR [/1,000]
for Health
BudgetlC(US$] forTB 110 113 112 115
4600 5580 6520 7280 7320 7010 12.9 11.8 12 12.9 11.7 10.9 11.4 10.1 10.8 10.2 8.4
372 307
6580 6790 6700 8140 9660 11800
363 478
3.3 3.3 3.3 3.4 3.4
834 704
117
NIUE Population: Epidemiology:. 3 000 in 1980s In 1980, there were only 2 doctors. There were only 9 tuberculosis cases between 1975-84 and the average annual incidence rate was 26/100 000. Among them, only one was sputum positive. The case finding and treatment is centralized in the general hospital in Aloti. Passive. There is only one technician. Culture specimens are sent to New Zealand. SM, INH and RFP are used. Primary vaccination to newborn babies. Revaccination at school.
Programme:
ease finding: Laboratory: Regimen: BeG:
Achievement: Duration of treatment: Most of the cases drop out within a year though the recommended duration is 18 months. The coverage of primary vaccination is 100"10 because almost all babies are delivered in the only hospital. Revaccination coverage was 62% in 1984.
BeG:
References: 1. 2. 3. Fu, Q.Y.(WHO); Notes on a field visit to Niue June-July 1985. Statistics Unit in Administrative Department; Niue censns ofpopulation and dwellings 1986. CHIP 1989.
118
Niue TRENDS OF TUBERCULOSIS & OTHER INDICES NUMBER OF NEW CASES INCIDENCE RATEU100,OOO] All Pulmonary Smear(+)
Niue
MORTALITY Number Rate
YEAR 1975 1976 19n 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991
All
Pulmonary Smear(+)
Population [Mil). YEAR 1975 1976
GNP/C
IMR [ll,OOOJ 30 0 10 10
rUSS)
Budget/C(US$] forHeaJth forTB
19n 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 0.003 0.003 0.003 0.003 0.003 0.003 0.003 0.003 0,002 0.004
98
0
36 0 0 188
40
c'
119
PAPUA NEW GUINEA Population: Epidemiology:. 3.7 million in 1990 The number of newly registered cases fluctuated between 2 500 and 4 000 in the last 15 years and was 2497 in 1990. The incidence rate has been between 80-100/100 000. The number of TB deaths has been fluctuating around 250. The proportion of pulmonary tuberculosis to all cases is about 70% and that of sputum positive cases to pulmonary cases is about 40 %. Since 1978, NTP has been decentralized. At the provincial level, the provincial TB Officer runs the vertical programme, but the integration into PHC has been gradually taking place through district health officers. The cases are supervised in health centers, health subcenters, and local aid posts. Passive. . Sputum smear microscopy is widely used in the periphery (health center or provincial hospital). Cross check is done in the Central Public Health Laboratory. No data is available on culture examination. Most treatment is given on an ambulatory basis. Both 6 Month SCC and conventional standard chemotherapy. Until 1986, standard regimen was 2SHT (in hospital) + 16SH (intermittent and ambulatory). Primary vaccination to infants and revaccination at school. In-service training is given. The aid post orderly or nurse keeps the treatment card and administers the treatment.
Programme: Organization:
Case finding: Laboratory:
Treatment: Regimen:
BCG: Training and Supervision: Rerording and reporting:
120
Monthly report from the post to the health center, from He to province, and from provincetoMOH. Achievement: Treatment outcome: Regimem: BeG: Among the see cases: completed; about 740/0, lost; 20%.
see is given in 40%ofhealth centers in 1989. Coverage ofprimary vaccination was :;0-60"10 in 1986, and that of revaccination was small.
References: I. 2. 3.
4. 5. 6. 7.
Nagpaul, D.R (WHO); Assignment report September. 1989. Fu, Q.Y. (WHO); Notes on a field visit December, 1986. Department of Health, Division of PHS; Handbook Health Statistics PNG 1988. Tuberculosis Annual Summary 1989. Information from Dr Pahum (Office of the Secretary fur Health, April, 1991). Department of Health; National Health Plan 1986-90. Nagpaul, D.R (WHO); Assignment report August, 1990.
121
Papua New Guinea
Papua New Guinea
!NUMBER OF NEW CASESI (number)
4500 4000 3500 3000 2500 2000 1500 1000 500
--I.t--- all
- . -+. _. pulmonary . • • .• • •• smear( + I
o
~~~~~~~~~~~~~~~~~
1975
1980 YEAR
1985
1990
(per 1 00,000)
120.0 100.0
so.o 60.0 40.0 20.0 0.0 '--~~~~~~~~~~~~~~~ 1975 1980 1985 1990 YEAR
--I.t--- all
...........................
..
',.
, '-/
- . -+. _. pulmonary
I
•
. . . .• . .. smear( + I
122
Papua New Guinea
Papua New Guinea
TRENDS OF TUBERCULOSIS & OTHER INDICES NUMBER OF NEW CASES INCIDENCE RATEU100;OOO] All Pulmonary Smear(+) MORTALITY Number Rate
YEAR 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991
All
Pulmonary
Smear(+)
2212 2446 2232 2525 2418 2742 2954 3505 3678 2877 3235 4261 33~
1638 1773 1695 1801 1749 1876 1997 2435 2356 1931 2168 2984
852 903 883 967 867 942 870 1061 870 606
78 85 76 84 79 88 93 107 84.1 93.5 119 93 67 90.9
58 62 58
30
31 30
60 57 60
63 74 56.7 44.6 83.3 64.7 46.9 64.2
32 28 30 27 32 26
2497 3401
2491 1756 2402
839 1273 951 611 469
16.1 19 20.5 24.1 16.3 13.1
213 274 252 222 254 308 285 169 191 249 238 210
7.4 9.1 8.2 7.1 8 9.4 8.5 4.9 5.5 7 6.5 5.6
Population
GNP/C [US$]
IMR
YEAR 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1988 1987 1988 1989 1990 1991
[Mil]
U1,OOO]
Budget/ClUS$] for Health forTS
530 530
2.8 2.9 2.9 3 3.1 3.2 3.2 3.3 3.3 3.4 3.7 3.8 3.6 3.7
550 650 710 760 810 790
730 710 690 690
23.8 26.6 25 22.7 22.4 21.1 23.6 72 57
730 790 890
18.77
58
56
123
PHILIPPINES Population: Epidemiology:. 60 million in 1989 The number of new cases has been increasing and the incidence rate has been almost stable since 1978. The number and incidence rate of smear positive or cavitary cases were 13 5 ()()() and 233/100 ()()() respectively in 1989. With a further 65 ()()() non cavitary X-ray positive cases, about 200 000 cases were newly put on treatment in 1989. The average incidence rate in the late 1980s is the highest in WPR. The mortality rate has been decreasing and was 42.9in 1989. Theprevalenceratesofbacillary positive and smear positive cases were 8601 100 000 and 6601100 000 respectively in the 1980-1983 prevalence survey. The tuberculosis control programme is fully integrated into the general health system. The Tuberculosis Control Service in the Department of Health supervises the national programme. Regional, Provincial and District Tuberculosis Coordinators supervise the programme at each level. The case i1nding, treatment and registration are basically made at Barangay Health Centers under the supervision of Rural Health Units at the peripheral level. Passive by direct sputum smear and X-ray. If a symptomatic case is sputum smear negative twice and the symptom persists after symptomatic treatment, then a chest X -ray is taken. Itinerant teams are sent into various regions for strengthening case finding. SCC (2HRZJ4HR) to smear positive or cavitary case; SM + INHfor 12 months to other X-ray positive.
Programme: Organization:
Case fmding:
Regimen:
124
Achievement: Casef"mding: The number of new cases increased to about 200 000 in the late 19805, which is probably due to the improvement of case finding activities. About half are sputum smear positive.
Laboratory: Treatment outcome:
The sputum microscopy service covers 94%of the whole country. Completed; 88.9"/.., dead; 1.6%, lost; 2.7% (In another assessment, the completion rate i~ about 75% in the project area. 10».
References:
I. 2. 3. 4. 5.
6. 7. 8. 9. 10
Health Intelligence Service, MOH; Philippines Health Statistics 1986. Department of Health; Annual report 1988. Tripathy, S.P.(WHO); Assignment report June-July 1989. Department of Health; Tuberculosis Control Service Annual report 1989. Valeza, F.S.(Department of Health); Report in Sturbridge meeting 1990. CHIP 1990. Italian Assistance to the National TB Control Programme; Plan of Action. Tripathy, S.P.(WHO); Assignment report May, 1991. Department of Health; NTP Annual report 1990. Persoual communication with Italian project team.
125
Philppines
Philippines
INUMBER OF NEW CASESI (number) I
!
350000 300000 • all
II I I
250000 200000 150000 100000 50000
I~.... ... -
-..&.
~
... ...
- • -.. _. pulmonary • •••Jt.. "
smearl +)
~ . . . . .... •Jt..~' "--,---,~~~~
..... ....
........ ...
o
1975
1980 YEAR
1985
1990
IINCIDENCE RATEI (per 100,000)
350 300 250 200 ... ·~-all
- ..... _. pulmonary
150 100
... .... L-~~~~~~~~~~~~~~~
- - - -Jt. - - -
smearl + )
50
o
1975
1980 YEAR
1985
1990
126
Philippines TRENDS OF TUBERCULOSIS & OTHER INDICES NUMBER OF NEW CASES Pulmonary Smear(+) All 133537 148057 107108 118587 108813 112307 116821 104715 106300 151863 151028 153129 163740 217272 317008 207371 17275 19006 20676 18657 21291 39571 50624 72150 63655 97070 106928 109664 INCIDENCE RATEU100,OOO] Pulmonary Smear(+) All 314.1 338.4 238 260.5 233.6 232.4 235.8 206.2 204.5 285.5 273.3 267 278.8 122.9 105.9 161.5 174
Philippines
MORTALITY Number 29436 31386 31805 28398 28221 28798 27317 28309 25580 27320 31650 Rate 69.2 71.7 70.7 62.4 60.6 59.6 55.1 55.7 55 52.6 57.9 54.6 52.1 51.4 42.9
YEAR 1975 1976
19n 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991
30604 28697
YEAR
Population [Mil] 1975 42.52 1976 43.75 45.01 19n 1978 1979 45.53 46.58 46.1 49.53 50.78 52.06 53.35 54.67
GNP/C [US$] 360
IMR
Ul,OOO]
Budget/CIUS$] forHeaJth forTS 2.9 3.2 2.6 3.4 3.8 4.4 4.9 4.3 2.6 3.1 3.1
420 450 500 590 680 63.2
1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991
no 800 740 830 570
57.36 58.72 60.1 60.1
560 590 830 54.1 51.5
700 760
3.5 4.5 5.6
127
REPUBLIC OF KOREA Population: Epidemiology:. 42.4 millions in 1989 The number and rate of new cases has decreased in the last 4 years and was 52710 and 124/100 000 respectively in 1991. The number of bacillary positive cases detected annually has also decreased in the last years and was 20 007 in 1991. Cases treated at private clinics are not registered. According to the 6th prevalence survey in 1990, the prevalence rate was 1800/100000 (for all), 240/100 000 (for bacteriologically confirmed), 150/100 000 (for smear positive), and the ARI was estimated to be 0.76% with a 6.4% annual reduction rate. Of culture positive cases, 23.4% are resistant to at least one drug (20% were resistant to INH), and it was 30.8% in 1985 and 48% in 1980. NTP was developed in 1962. NTP covers pulmonary cases only. At the central level, Chronic Disease Division, Ministry of Health and Social Affairs is responsibleforthe programme. Attheprovinciallevel, each city or provincial government has a supervisory medical officer. Patients are basically detected, treated and registered at Health Centers staffed with a microscopist and TB worker, or at health subcenters staffed with TB aids, under the supervision of a cityl province TB supervisory team. Patients receive medicine and follow-up from HCs or health subcenters (TB workers and TB aids). Sputum and X-ray examination for symptomatic cases, contacts. Active case finding with MMR is also made for high risk groups. Sputum examination is done at HCs. Suspected cases by X-ray are examined with culture examination at the 12 provincial TB
Programme: Organization:
Case finding:
Laboratory:
128
centers (branches ofKNTA)., The sensitivity test is made at the National Institute of Health in Seoul. Regimen: Since 1990, 2HREZJ4HRE or 2HRSZl4HRor 9HREor6HRS/3HR(for smear positive cases); 2HREZJ4HRE or 6HRE or 2HRS+ 10HE (for smear negative cases). Retreatment cases are treated at provincial hospitals on the basis of the sensitivity test result. Primary to preschool children: revaccination direcdyfor 1st year primary schoolchildren without BCG scars, and 6th year primary schoolchildren with negative tuberculin, National Institute of Health and Korean Tuberculosis Association trains TB service per-
BCG:
Training and supervision:
sonneL Achievement: Treatment outcome: Completed, transferred, dropped-out, migrnted and died were 86,2%, 5.2%, 2.9%, 2.8% and 1.3% respectively in 1989. 74 763 X-ray positive and 8845 sputum positivecasesweredetected in 1991 by 1154 257 X-ray and 355307 sputum examinations. Case-finding ratio in passive case finding was 8.2% in X-ray and 3.7% in sp.utum examination. The ratio in active case finding was I. 9"10 in X-ray and 1.0% in sputum examination.
Case finding:
References: 1. 2. 3. 4. I<:orean Institute oITuberculosis (KIT); National Tuberculosis Control Programme of Korea, 1990, 1991. KIT; Manual National Tuberculosis Control Programme of Korea 1990. KIT; Report on the 5th Tuberculosis Prevalence Survey 1986. Ministry of Health and Social Affairs, Republic of Korea, National Tuberculosis Programmeme, 1992.
129
Republic of Korea
Republic of Korea
I NUMBER (number)
OF NEW CASESI
120000 100000 80000 60000
--1.""-- all - - .... - -. pulmonary - - - -A - - - bac( + I
40000 20000
o
L-~~~~~~~~~~~~~~~
1975
1980 YEAR
1985
1990
IINCIDENCE RATEI (per 100,000)
300.0 250.0 200.0 150.0 100.0 50.0 0.0
--1.""-- all
.".. - .- -.. . .... &...
- ...... -" pulmonary ....- ..
-
~
-
t 1980 YEAR
.. ". 1990
.. - -A .. " bac( + I
'---"~~~~~~~~~~--'--~~~~
1975
1985
130
Republic of Korea
Republic of Korea
TRENDS OF TUBERCULOSIS & OTHER INDICES NUMBER OF NEW CASES Pulmonary All Bac(+) INCIDENCE RATE[/100,OOO] All Pulmonary MORTALITY Number Rate
YEAR 1975 1976
Bac(+)
19n 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991
81910 89803 98532 100878 91572 85669 87169 88789 87419 74460 70012 63904 57864
81910 89803 98532 100878 91572 85669 87169 88789 87419 74460 70012 63904 57864
34633 38211 43868 46735 45688 42561 48515 49083 45066 39040 33968 30700 28790
217.8 236.6 254.5 256.5 229.2 211.1 211.5 212.8 207
217.8 236.6 254.5 256.5 229.2 211.1 211.5 212.8 207 1n.4 156.8
92.1 100.2 113.3 118.8 114.4 104.9 117.7 117.6 106.7 93 80.2 5212 6865 7106
1n.4 156.8
6n2 6274 5872 5321 4676 4382
17.4 17.7 17.1 15.9 13.7 12.7
Population
YEAR 1975 1976 19n 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991
IMil} 35.28 35.86 36.44 37.02 37.61 38.12 38.72 39.33 39.96 40.58 41.21 41.72 42.23 41.98 42.38
GNP/C [US$] 580 750 910 1190 1510 1630 1830 1930 2100 2230 2310 2550 2920 3550 4400 5440
IMR 111,000]
Budget/C[US$) for Health forTB 0.707 0.147 1.5 0.198 2.8 3.8 3.1 3.4 3.9 4.9 5.8 5.3 5.4 0.245 0.256 0.304 0.467 0.745 0.666 0.707 0.637 0.659 0.706 0.879 1.19 1.37 1.44
39.5 38.5 37.6 36.8 35 34.2
31.8 12.4 12.5
6.4 11.7 14.3 28.34
131
WESTERN SAMOA Population: Epidemiology:. 163000 in 1989 The ARI was estimated to be 0.7% (1988 Dr Lin). The number and incidence rate of new cases decreased to 37 and 23/100 000 respectivelyin 1984. Since 1987, the number of new cases increased from 29 in 1987 to 44 in 1990. Among 139 cases between 1987 and 1990, 123 cases were of pulmonary tuberculosis and 48 of these were smear positive. No case of meningitis or miliary tuberculosis was reported in the 19705 or 1980s. There is a staff of 11 in the TBlLeprosy Control Section at the central level. No full time staff for TB works at district hospitals, health centers, or subcenters. All symptomatic persons suggestive of TB and leprosy are referred to the National Hospital. Passive and semi-active. 'Sputum smear examinations are done in the National Hospital and Tuasivi District Hospital. Most sputum specimens are sent to the National Hospital (about 100 specimens per month) with only 1 technician. There is no quality control. Culture examination is currently not carried out though it was done until 1987. Since 1983, RFP has been used. (2-4HRE/9IIH2R2). Initial 2-4 months in hospital (national hospital) and 9-11 months in ambulatory (OPD of national hospital or district hospitals).
Programme:
Case finding: Laboratory:
Regimen:
132
BeG:
Primary vaccination to newborn babies under EPI and revaccination is also done.
Achievement:
ease finding:
Since 1982, case-finding activities are practically centralized to the Chest Clinic and the National Hospital in Apia. In 1983-85, those who were detected in district hospitals and health centers were 12% of all and those detected in private clinics were also 12%. Cured; 95% abandoned; 5% in 1987-90 (smear positive). The sputum examination of the patients treated in the district hospital is incompletely done. Coverage of primary vaccination is 90%.
Treatment outcome:
BeG:
References: I. 2. 3. 4.
Fu, Q.Y.(WHO); Notes on field visit February, 1985. Monthly report of notifiable diseases December, 1988. CHIP 1989. Dr A. Jittinandana (WHO); Mission report (7 July - 2 August 1991).
133
Western Samoa
Western Samoa
INUMBER OF NEW CASESI (number)
80 70 60
--1.1--- all
50 40 30 20
- ..... -. pulmonary ......... smear( + I
10
o
L-~~~~~~~~~~~~~~~~
1975
1980 YEAR
1985
1990
IINCIDENCE RATEI (per 100.000)
60
50 40 30 20 --1.1--- all
- ..... _. pulmonary
........•. ... 1980 YEAR
10
o
L-~~~~.~~~~~~~~~~~~
'.
. . . .... .. smear( + I
1975
1985
1990
134
Western Samoa TRENDS OF TUBERCULOSIS & OTHER INDICES NUMBER OF NEW CASES INCIDENCE RATE [11 00,0(0) All 33.9 52 23.4 37.9 36.7 41 Pulmonary Smear(+)
Western Samoa
MORTALITY Number 9 21 11 10 6 6 11 5 5 5 Rate 6 13.8 7.2 6.4 3.8 3.7 7 3.2 3.2 3.1
YEAR 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991
All 51 79 36 59
Pulmonary Smear(+)
58 59 49 43 41 37
32 30 25 20
29.9 31.3 27.3 25.9 23.3
26.2 27.3 24 18.9
20.5 19.1 15.8 12.6
43 38 30
29 29 37 44 5 1
Population
GNP/C [US$]
YEAR 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991
IMill 0.15 0.152 0.154 0.156 0.158 0.161 0.156 0.157 0.158 0.159 0.163 0.165 0.161 0.159 0.163
IMR [11,0(0) 30 23 14 8.8 17.6
Budget/C[US$] forTB for Health 24.3 28 33.6 33.6 33.9 32.2 34.8
680 620 560 560 610 720
24 24 33 50 46
25.8 17.1 15.9 18.3 20.3
135
SINGAPORE Population: Epidemiology: . 2.69 million in 1989 The number and rate of new cases have been steadily decreasing and were 1617 and 60/ 100 000 respectively in 1989.
Programme: Case finding: Laboratory: Regimen: Treatment: BCG: Both passive and active including contact tracing. Sputum smear microscopy, culture examination and sensitivity test are routinely done. SCC. Chemoprophylaxis is done Primary vaccination for infants. Revaccination for school entrants without BCG scars and for primary and secondary school leavers with negative tuberculin «lOmm).
Achievement: Hospital: Most of the registered cases are treated at governmental institutions; Tan Tock Sen Hospital (about 70%), other government hospitals (10-20%), Singapore Anti-Tuberculosis Association (10%), Private clinics (4%).
References
1. 2. 3. 4.
Tan Tock Sen Hospital, Ministry of Health; Singapore Tuberculosis Statistics, 1988, 1989. Ministry of Health; Annual report 1989. National Registration Department; Singapore Demographic Bulletin 1990. CHIP 1990.
136
Singapore
Singapore
INUMBER OF NEW CASES (number)
I • all
3500 3000
2500 - - -.- - . pulmonary - - - -4 - - - smear( + )
1500 1000 500
o
4-" -. L-~~~~~~~~~~~~~~~~
1975
1980 YEAR
1985
1990
I INCIDENCE (per 100.000)
RA
TEl --1.1--- all
140 120 100 80 60
- - -.- _. pulmonary - - - -4 - - -
smear( + )
40 20 4- -4 ~~~~~~~~~-~~-~~~~~~
o
1975
1980 YEAR
1985
1990
137
Singapore TRENDS OF TUBERCULOSIS & OTHER INDICES NUMBER OF NEW CASES INCIDENCE RATE[I100,OOO) Pulmonary Smear(+) All
Singapore
MORTALllY Number Rate
YEAR 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1988 1987 1988 1989 1990 1991
All
Pulmonary
Smear(+)
3097 2813 2760 2964 2800 2710 2425 2179 2065 2143 1952 1760 1616 1686 1617 1591
2973 2684 2628 2795 2637 2562 2269 2029 1927 1987 1781 1570 1499 1543 1492 1450 445 482 493
138 124 120 127 119 113 99 88
132 118 111 117 109 105 91 81 75 77 70 61 57
420 359 340 318 309 240 221 207 224 163 177 177 177 164 132 110
18.7 15.7 14.7 13.6 13.3 10 9 8.4 9 6.4 6.9 6.8 6.8 6.2 4.9 3.7
83 85 76 68 62 63 60
58 56 48
16.8 17.9
53
Population [Mil) YEAR 2.26 1975
GNP/C [US$) 2540 2760
1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 2.41 2.4 2.5 2.5 2.53 2.56 2.59 2.61 2.65 2.69
2940 3310
Budget/C[US$] forTS [11,000) for Health 25.8 13.9 25.9 11.6 27.9 12.4 33.4 12.6
IMR
3880 4550 5450 6160 6930 7730 7610 7450 8010 9100 10450
13.2 11.7 10.7 10.7 9.4 8.8 9.3 9.4 7.4 6.9 6.6
38.6 44.8 53 60.7 85.8 72.2 ·88.6 85.9 74.5 84.5
138
SOLOMON ISLANDS Population: Epidemiology: . 314000 in 1989 The number of newly registered cases has fluctuated between 300-400 for the last 15 years. The proportion of pulmonary TB to all is about 75%. The number of sputum positive cases decreased from 180 in the late 1970s to 110 in the late 1980s. The tuberculosis and leprosy unit in the MinistJy ofHealth and Medical Services is responsible for the national TB control progranune with a central registration system. A TB and leprosy coordinator is assigned at each province. The activity of case finding and case holding is integrated into the general health unit (Health Clinic run by a nurse) at periphery. Passive and contact examination. Smear (at hospitals) and culture (at central laboratory) examinations are done. Cross check of slides is rarely done.
Programme:
Case finding: Laboratory:
Regimen: Hospitalization: Achievement: Treatment outcome:
SCC (2HRSZ17SH or 2HRSzJ7hz). Most cases are admitted to the hospital for 2 months.
Completed; around 60%, Defaulted; 40-50%
(The cure rate is unknown because smear examinations are rarely made during treatment).
BCG:
Coverage is 83% (1991).
139
References: 1. 2.
3. 4. 5.
6.
Ishikawa, N. (WHO); Assignmeot report, August 1989. Fu, Q. Y. (WHO); Notes on a field trip to Solomon Islands, November 1985. Ministry ofHealth and Medical Services; National Health Plan 19861989. CHIP 1990. SCC for Tuberculosis in South Pacific (from Papers for Workshop 00 MDT for Leprosy 6-10 March 1989). Guideline on Short course Chemotherapy for Tuberculosis andMultidrug Therapy for Leprosy (fB and Leprosy Unit, Ministry of Health and Medical Services).
140
Solomon Ialands
Solomon Islands
I NUMBER (number)
OF NEW CASESI
500 450 400 350 300 , 250 •.•' . 200 ' . . . . . . . . . 4, \. / ..... , ......... « .... 150 < ,. ' .' .... "_.k· ';a. 100 50
•
all
- • ~. _. pulmonary \
'.,
•
• ••••••• smear(+)
o
-
• ...
L-~~~~~~~~~~~~~~~
1975
1980 YEAR
1985
1990
IINCIDENCE RATEI (per 100,000)
250 200 150 100 50 0 1975
•••
,.' ...
•
all
\ \ ~'
........ .......... ' ' , .,r '
.-....... ... ....... . . ... " '",.
.
\
.'\
...,...
- • ~. -, pulmonary
, :It • • • "'....... "'. ''''
..
........ smear(+)
1980 YEAR
1985
1990
141
Solomon Islands TRENDS OF TUBERCULOSIS & OTHER INDICES NUMBER OF NEW CASES All Pulmonary Smear(+) 261 182 133 307 355 411 455 266 313 324 302 337 228 242 289 334 183 239 249 216 256 276 207 242 282 358 257 184 187 182 174 184 153 174 176 130 155 155 101 115 137 149 117 88 INCIDENCE RATE'/100,OOO] All Pulmonary Smear(+) 138 96 156 113 119 175 195 208 118 135 135 121 131 137 102 113 121 154 120 94 136 153 81 103 104 87 100 100 72 82 92 113 81 83 85 68 75 73
Solomon Islands
MORTALITY Number Rate
YEAR 1975 1976 19n 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991
11 3 1 2
4.6 1.2 0.4 4 3 4 10 8
3n 292 334 372 488 382 309
56
52 60 56 35 39 41 47 37 27
Population YEAR [Mil] 1975 1976 19n 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 0.21 0.218 0.225 0.233 0.24 0.249 0.257 0.275 0.285 0.295 0.306 0.317 0.318 0.33
GNP/C [US$] 290 280 300 320 440 410 510 570 550 590 500 580 600 630 570
IMR [/1,000]
BudgetlC[US$] forTS for Health
11 14.5
46 46 44 43 30
18.3 8.3 16.4 10.5 14.2 16.2 . 24.5 33
142
TOKELAU Population: 2000 in 1989 There are 3 hospitals on the 3 main islands and 4 doctors in the country. Epidemiology: . Programme: There were 9 cases in 1987 and 1 case in 1988; there were no TB deaths in 1987 and 1988.
BeG:
Given under EPI.
References: 1. Government of New Zealand; Report of Administration of Tokelau. CHIP 1990. Tokelau; Annual Health Report 1985. Annual Report on Health Services 1987 and 1988.
2. 3. 4.
143
Tokelau
Tokelau
I NUMBER (number)
OF NEW CASES ~
I • all
9 8 7
6 5 4 3
- - -+- - - pulmonary - - - -. - - - smear( + )
~ L-~~~~~~'-~~'-~~~~~~.~ 1975 1980 YEAR
1985
1990
I INCIDENCE (per 100,000)
RATEI
1.0
0.9 0.8 0.7 0.6 0.5 0.4
--1.1--- all
- - -+- - - pulmonary - - - -. - - - smear( + )
0.3 0.2 0.1
0.0 L-~~~~~~~~~~~~~~~ 1985 1990 1975 1980 YEAR
144
Tokelau TRENDS OF TUBERCULOSIS & OTHER INDICES NUMBER OF NEW CASES INCIDENCE RATE(/1 00,000] All Pulmonary Smear(+)
Tokelau
MORTALITY Number Rate
YEAR 1975 1976
All
Pulmonary
Smear(+)
19n 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991
.
0 0
.
0 0 0 0 0
2 9 1 1
Population
GNP/C rUSS]
IMR
Budget/C[US$] for Health forTB
YEAR 1975 1976
[Mil]
U1,OOO]
19n 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 0.002 0.002 0.002 0.002 0.002 0.002 0.002 0.002 0.002 0.002
58.5
14.8 1560 56
65
145
TONGA PopuiatiOll: EpidemioIOl)':. 98000 in 1989 The number of new cases, sputum positive cases and TB deaths is steadily decreasing and was 14,7 and 2 respectively in 1989.
Programme: Case finding: Laboratory: Passive The central laboratory in the Valiola hospital is equipped with 2 microscopes and 3 technicians. The slide check system has not been established. Six months SCC in Tongatapu (Capital city).
Regimen: Achievement: Treatment outcome:
Completed; about 80%, dead; 130/0, lost 5% in 1981-1988. About 90% of children are vaccinated. The numbers ofsmear examinations and smear positive cases is decreasing (7/388 in 1988).
BeG: Laboratory:
References: 1. 2. 3. 4. Kwon, D. W. (WHO); Assignment report August, 1989. Fu, Q. Y. (WHO); Notes on a field visit March, 1986. . MOR; Report of the ministry of health for the year 1987. CHIP 1990.
146
Tonga
Tonga
INUMBER OF NEW CASESI (number'
90 80 70 60
I
.t- \ .
•
all
50 40 30 20
'. ...i ' -,,:
10
o
~~~~~~~~~~~~--~~~~
". '... . ................ '" .......... -.. -.. , ,
.
..
'.
.', . 1980
........,_.--
- • ~. - . pulmonary
.\-.
, -.-.'. .....
.......... smear( +)
• 1990
1975
1985 YEAR
IINCIDENCE RATEl (per 100,000'
100
90 80 70 60
--1.1--- all
50 40 30 20 ..• ' ,.... \ , .A . - . - . -......
- • ~. _. pulmonary
•
"~
·· ..... ···smear(+) '.
. ' . ' ........ , .... J["
10
o
L-~~~~~~~~~~~~~~~~
1975
1980 YEAR
1985
1990
147
Tonga TRENDS OF TUBERCULOSIS & OTHER INDICES NUMBER OF NEW CASES INCIDENCE RATE[1100,000] All '. 90 74 67 94 74 65 50 45 52 56 Pulmonary Smear( +) 75 61 52 80 I. "
Tonga
MORTALITY Number Rate
YEAR 1975 1976
All 90 67 79
Pulmonary Smear( +) : 75 55 48 76 26 22 29 41 28 32 18 25 23 25 23 1B 12 7
26 24 31 43 29 33 1B 25 24 26 24 19 13 11 11.2 9.1
19n 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991
89 71 64 49 45 50 54
58 54
60 55 37 35
36 35 32 33 39 30 18 12
33 34 40
9 5 6 5 5 8 4
5 6.3 5.2 5.1 8.5 4.2 2.1
49 35 24 14 20
50 37 25 15
12.5
7
2
Population
GNP/C [US$]
IMR
YEAR 1975 1976
[Mil]
19n 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991
0.093 0.095 0.096 0.098 0.099 0.1 0.096 0.097 0.097 0.097 0.098 0.096 0.098
no 780 730 740 750 800 910
[/1,000] 14 17.4 13.7 16 11.5 29.7 21.7 22.4 9.7 11.1 9.8 8.B 11.1
BudgeVC[US$] for Health forTB 5.9 9.7 10.4 11.3 13.7 15.1 22.1 25.1 36.6 38.3 42 41.6 40.1 43.3
148
COMMONWEALTH· OF MARIANA ISLANDS Population: Epidemiology: . 41000 in 1989 including 18 000 migrant workers) The number of all cases and sputum positive cases fluctuated very much between 25-75 and 3-30 respectively in the last 10 years. Most of the cases are pulmonary tuberculosis. Thirty percent of all cases are migrant workers who are diagnosed at the conventional alliance physical examination at the time of s+.arting their job.
Programme: Case finding: Both passive (60%) and active. Active case finding includes contact tracing (6%) and conventional alliance physical examination of migrant workers(34%). Until 1985, over half of the TB patients were not examined with sputum smear microscopy. But the situation bas much improved since 1986. Cross-check was not done in 1986. In 1988, the regimen was not standardized. SCC was recommended by WHO.
Laboratory:
Regimen: Achievement: Treatment outcome:
Completed; 56%, lost; 30% in 1986-87. (12 month completion rate was 75%).
References:
1. 2. 3. 4. 5. 6.
Department of State, USA; Pacific morbidity and mortality monthly vol 3 no 2 Feb 1991. Department of State, USA; TTPI annual report 1986. Fu, Q.Y. (WHO); Report on a field visit to CNMI July-August, 1988. Fu, Q.Y. (WHO); Notes on a field visit to CNMI October, 1986. Department of Health and Environmental Services; Monthly morbidity summary 1988. CHIP 1989.
149
Mariana Islands
Mariana Islands
INUMBER (number.
OF NEW CASESI !
80 70 60 50 40 30 20 10
I
• - - - -4 - - -
all
I - - .... - ' pulmonary smear( + I
.. . . .•. 4 '~
o
L-~~~~~~~~~~~~_ _~~~
~ • fl.
. 1990
1975
1980 YEAR
1985
IINCIDENCE RATEI (pe, 100.000.
450.0 400.0 350.0 300.0 250.0 200.0 150.0 100.0 50.0 0.0
-
... •.....-all
- - .... _. pulmonary _. - -., - - - smear( + I
L-~~~~""",,,,,,,,,,,......:J:~~~~~~~~
1975
1980 YEAR
1985
1990
150
Mariana Islands TRENDS OF TUBERCULOSIS & OTHER INDICES NUMBER OF NEW CASES Pulmonary Smear(+) All INCIDENCE RATE(f100,OOO] Pulmonary Smear(+) All
Mariana Islands
YEAR 1976 1976
MORTALITY Rate Number
19n 1978 197~
1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 26 75 74 58 64 16 56 27 28 24 69 66
2 0 11 3 28 4 5 22 154 435 416 295 314 76 141 67 66
0
64 17 143 20 24 54 58
1 1 0 1
53
60 14 55 22 24
YEAR 1975 1976
Population [Mil] 0.013 0.014 0.014 0.015 0.015 0.016 0.017 0.017 0.018 0.02 0.028 0.033 0.036 0.04 0.04 0.041
GNP/C [US$)
IMR [/1,000] 25.8 19.2 34.8 14.2 39.5 26.1 12.9 25.1 15.6 23.8 20.1
BudgeVC[US$] for Health forTB
19n 1978 1979 1980 1981 1982 1983 I 1984 1985 1986 1987 1988 1989 1990 1991
I
442
2163
19
151
FEDERATED STATES OF MICRONESIA Population: Epidemiology:. II 000 in 1989 The numbers of all cases and smear positive cases flucturate between 60-80 and 10-20 rspectively. The reporting on some islands is poor. The number of cases under 5 years old is about 13 % of all and the incidence rate among them is 68/100 000. Ten meningitis cases were reported between 1986-90.
Programme: Case finding: Laboratory: Passive (Valeza 1991). The microscopic examination is given high priority, but only a few technicians are trained for AFB smear (Valeza). The culture examination is carried out only for failure cases. 2HRZJ4HR. (Both smear positive and negative cases). SM or EB is added for retreatment cases.
Regimen:
BCG: Registration: Achievement: Laboratory:
Only to infants. Record keeping needs improvement (Valeza).
Less than halfofthecases were examined with sputum examination (Fu 1988; Valeza 1991). The number of sputum examinations done in 1988-90 was 495 and 39 of these (7.9%) were smear positive. The estimated coverage is over 80%.
BCG: Case finding:
In 1979-87, 67% of all cases were detected by symptoms, and 30% by contact examination. Among 367 cases detected in 1988-90, only 39 cases were smear positive, 163 cases were detected by X-ray examination and 165 cases by clinical examination and PPD testing.
152
Case holding: References:
No data are available.
1. 2. 3. 4. 5. 6. 7.
Infonnation from Dr Sally Jo Manea II December 1990. Department of State,USA; Pacific Morbidity and Mortality Monthly vol 3 no 2 Feb. 1991. Department of State,USA; TIPI Annual Report 1986. Fu, Q.Y. (WHO); Report on a field visit 1986. Department ofHurnan Resources; National proposal for tuberculosis control 1988. CHIP 1990. Valeza,F.S. (WHO); MissionReport(l October -7 November 1991).
153
Micronesia
Micronesia
INUMBER OF NEW CASES, (number)
100
90 80 70 60 50 40
-
.... ·I---all II
- ...... _. pulmonary ......... smear( +)
30
20 10
o
L-~~~~~~~~~~~~~~~
1975
1980 YEAR
1985
1990
I'NC'DENCE RATE' (per 100,000)
120.0 100.0
80.0 60.0 40.0 20.0
•
all
- ...... _. pulmonary
". L~~~~-,--~~~~~~~~
......... smear( +)
0.0
1975
1980 YEAR
1985
1990
154
Micronesia TRENDS OF TUBERCULOSIS & OTHER INDICES NUMBER OF NEW CASES YEAR 1975 1976 All Pulmonary Smear(+) INCIDENCE RATE /100,000] Pulmonary Smear(+) All
Micronesia
MORTALITY Number Rate
19n 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1986 1989 1990 1991 67 73 75
66 60 98
53 59 59 58 50 94 72
11 32 18 14 10 18
81 86 85 72 63 101
64 69 67
13 38
20 15 11 18 11 8 10 6 4 12.2 8.6 10.4 6.1
63 53 97 72
n 68
n 65
64
64
4
Population YEAR [Mil) 1975 1976
GNP/C [US$)
IMR U1,000]
BudgetJC[US$] for Health forTB
19n 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 0.082 0.085 0.088 0.091 0.095 0.098 0.1 0.104 0.108 18.9 100
1300 17.9 86.5
23 23
155
REPUBLIC OF MARSHALL ISLANDS Population: Epidemiology: . 44 000 in 1990 The number of new cases has fluctuated between 6 and 32 in the last 10 years. The number of sputum positive cases is less than to and the number of TB deaths ~s around 2 every year.
Programme: Case finding: Regimen: BCG: Both passive (70"10) and contacts tracing (30"10). Not standardized in 1986. SCC (2EHRI7HR)
was recommended by WHO. Started in 1986.
Acbievement: Treatment outcome: Laboratory: Completed; 33%, lost; 47% in 1986 and 87. Over halfof the cases were not given a sputum examination between 1986-1988.
References 1. 2. 3. 4. 5. 6 Fu, Q.Y. (WHO); Report of a field visit July, 1988. Department of State, USA; Pacific morbidity and mortality monthly vol 3 no 2 Feb 1991. Department of State, USA; TI'PI annual report 1986. Fu, Q.Y. (WHO); Report of a field visit October, 1986. Ministry of Health Services; Health & vital statistics quarterly 1989, 1990. CHIP 1989.
156
Marshall Islands
Marshall Islands
INUMBER OF NEW CASESI (number)
40
35
30 25
--t·'--all - ..... - . pulmonary • . . •• . .• smear( +)
20
15 10 5
o
L-~~~~~~~~~~~~~~~~
1975
1980 YEAR
1985
1990
IINCIDENCE RATEI (per 100,000)
100.0 90.0 80.0 70.0 60.0
--t.t--- all - ..... - . pulmonary ....•... smear(+)
50.0 40.0 30.0 20.0
10.0 0.0 L-~~~~~~~~~~~~~~~
1975
1980 YEAR
1985
1990
157
Marshall Islands TRENDS OF TUBERCULOSIS & OTHER INDICES NUMBER OF NEW CASES All Pulmonary Smear(+) 17 8 6 4 6 7 12 15 12 15 37 32 11 7 8 7 5 3 5 5 9 10 9 13 28 32 11 7 5 4 6 6 7 8 4 INCIDENCE RATEf/100,000] Pulmonary Smearj+) All 65.4 29.6 21.4 14.3 16 22 30.8 25.9 17.9 10.7 13 18 32 16 12 18 17
Marshall Islands
YEAR 1975 1976
MORTALITY Number Rate 2 2 1 1 3 2 1 1 2 0 2 7:6 7.4 3.6 3.5 9.7 6.2 3 2.9 5.5 0 5.1
19n 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991
36 43 33 40 95 81 26 16
36 25
19 21 10
34 71 81 26 16
Population YEAR [Mil] 1975 1976 0.026 19n 0.027 1978 0.028 1979 0.028 1980 0.031 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 0.032 0.033 0.035 0.036 0.038 0.039 0.04 0.043 0.043 0.044
GNP/C . [US$]
IMR [/1 ,000]
BudgeVC[US$] forTB for Health
58 87 69 70 105 126 147 153 1300 33 30 115
23 23
158
PALAU (BELAU) Population: Epidemiology:. 14000 in 1989 The number of new cases has fluctuated between 3 and 38 in the last 15 years and that of sputum positive cases is less than 10.
Programme:
ease finding: Regimen:
Both passive (85%) and contact tracing (8%).
sec (9 month) since 1987. Not done in 1988.
BeG: Achievement: Treatment outcome: Laboratory:
Completed; about 80%, transferred out; 110/0, dead; 6%,(1983-86). Ninety per cent of cases are examined with sputum microscopy.
References:
I. 2.
3. 4.
Fu, Q. Y. (WHO); Report on a field visit October, 1988. Department of State, USA; Pacific morbidity and mortality monthly vol 3 no 2 Feb 1991. Department of State, USA; TIPI annual report 1986. Bureau of Health Services; Annual statistics report 1987.
159
--.
Belau
Belau
INUMBER OF NEW CASESI (number)
40
35 30 25 20 15 10
-"'.1--- all - - -+. - . pulmonary • - - -A - - -
smear( + )
5
o
L-~~~~~~~~~'r'~~~~~~_
1975
1980 YEAR
1985
1990
IINCIDENCE RATEI (per 100,0001
1300.0) 1250.0) (200.01 1150.01 (100.01 (50.01 (0.01
•
all
- - -+- - . pulmonary .- - -4' - - smear(+)
.. jl'
.A 1985 YEAR
L...~~~~~~~Ii:-'--II~~~~~
1975
1980
1990
160
Belau TRENDS OF TUBERCULOSIS & OTHER INDICES NUMBER OF NEW CASES All Pulmonary Smear(+) INCIDENCE RATErt100,OOO) All Pulmonary Smear(+)
Belau
MORTALITY Number Rate
YEAR 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1
20 5 7 14 9 17 10 17 14 20 26 13 38 17 3
18 4 5 12 8 15 7 10 12 13 23 11 35 17 3 10 5 2 6 0 4 140 81 134 108 151 193 79 268 121 21 250 121 21 83 40 16 1 1
a a 1 1 1 1 2
a 8.1 7.9 7.7 7.6 14.8
46
a 30
a 4
a 28
a 3
a 21.1
1991
Population
GNP/C [USS)
IMR U1,OOO) 55 22 25 32
YEAR 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991
[Mill 0.013 0.013 0.014 0.014 0.014 0.015 0.015 0.016 0.017 0.017 0.013 0.014 0.014 0.014 0.014 0.014
BudQet/C(USS) for Health forTB
2777
44 27 14 22 23 33 24 25.9 9.3 26 23 23
161
TUVALU Population: 9000 in 1990
On the main island, the Princess Margaret Hospital has four doctors. On the other islands, dispensaries were under construction in 1988. Epidemiology: . The numbers of new cases and sputum positive cases have been stable around 25 and 5 respectively for the last 10 years. Registration is compulsory (at onset). Passive by X-ray and sputum smear. Sputum smear examination is routinely done in the Princess Margaret Hospital. Both Sputum positive and X-ray positive cases are hospitalized. SHRZ/SHR.. Primary vaccination at birth and revaccination for school entrants.
Programme: Case finding: Laboratory: Hospitalization: Regimen:
BCG: Achievement: Treatment outcome:
Completed; 100%. Coverage is almost 100%. In 1988, 116 specimens were examined (5 positives).
BCG: Laboratory:
References I. 2. 3. 4. 5. Information from Dr Salesa (Senior Medical Officer, June, 1991). Information from Dr Salesa (February, 1991). Chaulet, P. (WHO); Assignment report May, 1988. Health Division, Ministry of Social Services; Annual report 1990. Health Division, Ministry of Social Services; Annual report 1987.
162
Tuvalu
Tuvalu
I NUMBER (number)
OF NEW CASESI
35 30 25 - ..... _. pulmonary • a/l
20 15 10 5 ,
..•••••• smearl +)
o
~~~~~~~~~~~~--~~~~
"
. 1985 1990
1975
1980 YEAR
IINCIDENCE RATEI (per 100,000)
450.0 400.0 350.0 300.0 250,0 200.0 150.0 100.0 50.0 0.0 A." " ,If'·'·' '-----~~~~~~~~~~~~~~~
-
.... ....-- a/l
- ..... _. pulmonary ..•••... smearl +)
'&
'.&
1975
1980 YEAR
1985
1990
163
Tuvalu TRENDS OF TUBERCULOSIS & OTHER INDICES NUMBER OF NEW CASES All Pulmonary Smear(+) INCIDENCE RATEV100,000] All Pulmonary Smear(+) I
Tuvalu
MORTALITY Number Rate
YEAR 1975 1976
19n 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1986 1989 1990 1991
7
5
33 18 12 23 9 32
33 15 8 18 7 25 21 14 18 19
23 10 3 7 3 3 5 7 7 2 7
450 240 160 280 120 390 320 260 280 280 260
450 200 100 240 90 300 250 260 210 210 230
310 40 140 90 40
4 6 2 4 0 4 5 5 5 3 2
50 80 30
50 0
27 22 24 25 23
60 60 60 20 80 20
50 60 60 60 30 20
20
Population
GNP/C [USS)
IMR
YEAR 1975 1976
[Mil)
V1,OOO)
Budget/C[USS) for Health forTB
19n 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1986 1989 1990 1991 0.007 0.007 0.007 0.008 0.007 0.007 0.008 0.008 0.008 0.009 0.009 0.009 334
388
37.5 28.6 20.3 45.6 54.4 56.3 89.6 35.2 37.6 34
38
39 35 35.5
402
164
VANUATU Population: Epidemiology:. 155000 in 1989 The numbers of new cases and sputum positive cases fluctuated (between 100-200 and 30'{;0 respectively) and bas increased slightly in the last 3 years. On the whole they have decline over the last 15 years. The incidence rate shows a similar tendency( 10 11100 000 for all cases in 1989).
Programme: Organization: The District Health Officer is in charge of hospitals, health centers and dispensaries. Sputum is collected both at health centers and dispensaries. Passive. Cross check of smear slides is done. Culture examination is rnadefor smear negative symptomatic cases. Conventional standard regimen (2 or 3SHTI 9HT). In 1988, SCC' was not yet introduced.
Case finding: Laboratory:
Regimen: Hospitalization: BCG:
All cases ruehospitalizedforthefirst2 months. Primary for infants and revaccination for schoolchildren.
Achievement: Treatment outcome: BCG: Coverage is 80%. 70% ofthe cases were treated with the conventional standard regimen in 1988. Smear examination was done on 90% of the pulmonary cases.
Regimen: Laboratory:
165
References
1. 2. 3. 4. 5. 6.
Information from Dr George F Blue (Director of Health. 1990). Fu, Q.Y. (WHO); Report on a field visit June, 1988. Fu, Q. Y. (WHO); Report on a field visit April, 1986. Epidemiological Unit, MOH; Statistical and epidemiological report 1988. Epidemiological Unit, MOH; Statistical and epidemiological report 1986. TB Control Team (WHO); Assignment report October-December 1982.
166
Vanuatu
Vanuatu
jNUMBER OF NEW CASESI (number)
250 200 150 100 ·A.
-
.... ·t---all
- - ~- - . pulmonary - - - -A - - -
smear( + )
50
·A· ·A· .. ·....
.... a
Ir ....- ·A· ·A.
.. '.. 'A' a.
... 1990
o 1975 1980 YEAR
1985
jlNCIDENCE RATEl (per 100,000)
250
200 • all
150 100 • &. • &.
- - ~- _. pulmonary - - - -A - - -
smear( + )
50
.... 'A- -A,
,."A' -A- ·A--A. _. • •• 'A'
.A-'A
o
'--~~~~~~~~~~~~~~~~-
1975
1980 YEAR
1985
1990
167
Vanuatu TRENDS OF TUBERCULOSIS & OTHER INDICES NUMBER OF NEW CASES INCIDENCE AATE'/100,OOO) All 220 220 150 130 160 150 77 140 151 143 91 107 134 139 67 111 127 128 Pulmonary Smear{+) 90 70
Vanuatu
YEAR 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991
All 214 214 150 131 184 178 92 173 196 188 124 131 90 118 144
Pulmonary Smear{+)
MORTALITY Number Rate
109 151 159
82 67 57 52 52 59
80 137 162 163 105 113 79 94 100
34 49 55 55 51 3e 26 46 39
99 BB 85 101
80 84 58 68
70
60 50 50 50 28 40 45 42 38 27 19 33 29
16 22 18 21 27 12 15
12.9 17.9 13.9 15.8 19.9 8.6 10.5
Population
GNP/C (US$}
IMR
Budget/C[US$) forHeaJlh forT8
YEAR 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991
[Mil] 0.095 0.097 0.099 0.102 0.113 0.114 0.12 0.124 0.128 0.128 0.131 0.14 0.145 0.147 0.155
JL1,OOO]
44 47 33 26 30 30 31 920 890 770 820
69 101 56 69
30 30 26 28 22
860
168
VIETNAM Population: Epidemiology:. 65.8 million in 1989 The numbers of new all cases and sputum positive cases increased slightly in the 1980s and wre 52 270 and 35 095 respectively in 1989. (About one-third of the new bacillary cases are estimated undetected( 1». Incidence rates ofall cases and smear positive cases have been stable around 80 and 50 per 100 000 respectively. Several tuberculin surveys were conducted in the 1980sand ARI was estimated to be l%in the north, 1.5% in the central area, and 2.5% in the south (3.2% in Ho Chi Minh City and less than 2% in rural areas). The primary drug resistance rate (at least to 1 drug) is 42.5% (Ho Chi Minh City, 1991). Since 1986, a new NTP has been implemented. 1 National Institute, 2 Central TB Hospitals, "4 Provincial TB Hospital workers. NTP is fully integrated in the PHC system. 3SHZ/6SH (smear positive cases), 3HRE1 6HRE (relapse cases), 3 SHl9H (smear negative cases) since 1988. Recently,2HRZJ6HE . (or 2HRZJ6HT) has been used for smear positive cases. Chemoprophylaxis is not given. Primary to infants since 1985 under EPI. Laboratories have been strengthened. Cross check for the district microscopist is made in the provincial laboratory. Sensitivity test can be done in the National Institute of Tuberculosis and Respiratory Diseases in Hanoi. Training is given in the National Institute for bacteriologists and physicians and in the province for microscopists and assistant physicians. National supervising teams visit for monitoring every year.
Programme: Organization:
Regimen:
BCG: Laboratory:
Training and Supervision:
169
Achievement:
Treatment outcome:
22.5% abandoned treatment in 1981-85. Cured: 65%, failure: 60/0, completed without [mal examination; 10%absconded; 120/0, died; 40/0, transferred; 4%, for standard 9 month regimen in 1989. Cured; 70-80"/0, failure; 8-9"/0, completed; 50/0, defaulted; 3-8% for SCC regimen in 1988-90.
BCG:
Coverage is about 80% for the newborn in 1986-1988. 85% ofdistricts had sputum smear facilities in 1986; 772 microscopists worked allover the country in 1989. About 70% of smear positive cases are. given SCC (1991).
Laboratory:
Regimen:
References: 1. 2. 3. 4. 5. 6. 7. 8. Information from Dr N.D. Huong (National Institute of Tuberculosis and Respiratory Diseases) July, 1990. Huong, N.D.; National Tuberculosis Control Programme in VietNam, 1990. Huong, N.D.; New National Control Programme In the 16 Provinces Of Southern Viet Nam. Linh, Pham Duy (pham Ngoc Thach Tuberculosis and Lung Center); short course on chemotherapy in 6 districts ofHo Chi Minh City. Linh, Pham Duy; Current tuberculosis control programme in Ho Chi Minh City. Chaulet. P. (WHO); Assignment report May, 1988. Information from Dr Morl (RIT) on his visit to Viet Nam ill December, 1991. Chaulet, P. (WHO): Mission report. 20 October - 6 November 1991.
170
Viet Nam
Viet Nam
INUMBER OF NEW CASESI (numberl
60000 50000 40000 --1.1---
all
30000 20000 10000
.-*-&. .•- .&.- Ii
- - -+- - . pulmonary - - - -A - - -
smear( + )
o
L-~~~~~~~~. __~~~~~~
1975
1980 YEAR
1985
1990
IINCIDENCE RATEI (per 100,0001
100.0 90.0 80.0 70.0 60.0 50.0 40.0
•
all pulmonary smear(+)
- - -+. _. ••• 'A- _.
30.0 20:0 10.0 0.0 L-~~~~~~~~~~~~~~~~ 1990 1980 1985 1975 YEAR
171
Viet Nam TRENDS OF TUBERCULOSIS & OTHER INDICES NUMBER OF NEW CASES INCIDENCE RATE[/100,000] All Pulmon~ Smear(+)
Viet Nam
YEAR 1975 1976
All
Pulmonary Smear(+)
MORTALITY Number Rate
19n 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991
43506 51206 43185 43875 46941 47557 55505 52463 52270 50203 59784
33243 33014 32612 30426 34217 30381 34530 39486 35095 30143 35855
79.2 91.2 75.2 74.7 78.1 78.7 89.9 83.2 81.2 76.3 89
60.5 58.8 56.8 51.8 57 50.3 55.9 62.6 54.5 45.8 53.4
1705
3.1 3.6 2.3 3.1 3.1 3 3.3 3.2 3 2
2040 1315 1816 1847 1805 2053 1992 1908 1287
37310 44118
56.74 65.7
Population YEAR 1975 1976 19n 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 [Mil]
GNP/C
IMR
Budget/C[US$] forTB
[US$]
[11,000] for Health 32.6 34.2 34.2 36.4 36 34.7
52.521 53.701 54.912 56.154 57.426 58.728
60.06 61.42 82.808 64.228 64.412 66.2 109 (215] 105 36.6
63 61 49
172
WALLIS AND FUTUNA Population: 12000 in 1989 No data are available on the epidemiology and the national programme of tuberculosis. Four doctors worked in 1982.
References: 1. ClllP 1990.
173
Wallis and Futuna
Wallis and Futuna
TRENDS OF TUBERCULOSIS & OTHER INDICES NUMBER OF NEW CASES Pulmonary Smear(+) All INCIDENCE AATEU100,000] Pulmonary Smear(+) All MORTALITY Number Rate
YEAR 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991
(3) (19)
Population [Mil] YEAR
GNP/C [US$]
IMR
Budget/C[US$] for Health forTB
U1,OOO]
1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991
0.009
0.01
0.014 0.012 0.012
174