Tuberculosis prevalence rates in China fall 30 % after introduction of the 'dots' strategy
An analysis of a decade-long tuberculosis (TB) programme in China has revealed that prevalence rates of the disease have fallen substantially since the introduction of the TB control strategy known as 'DOTS'* to half of the country's population. The results not only demonstrate the effectiveness of DOTS, but also provide a powerful argument for the need to expand the strategy across the entire country.
Today, the Chinese TB Control Collaboration, which includes the Ministry of Health of China and the World Health Organization, published a report in The Lancet on the impact of the World Bank funded project. The project was initiated in 1991, one year after a national TB survey, and introduced DOTS to half the Chinese population.
A repeat survey**, carried out ten years later in 2000, provided the opportunity to assess the health benefits of DOTS. The report's authors concluded that prevalence of TB fell by an estimated 30%, or 382 000 cases, as a result of the DOTS project - a substantial decline.
Still, there are major challenges that must be met if China is to reach the United Nations Millennium Development Goal (MDG)*** of halving TB prevalence by 2015. TB remains a significant public health problem in China. With 1.4 million new cases a year, China is second only to India when it comes to incidence of the disease. Given the proven success of DOTS so far it is important that the strategy be further expanded across the country.
"By building on the successes of the past decade, and by providing all of its more than one billion people with access to high-quality treatment, China could make a major contribution to the global control of tuberculosis," said Dr Christopher Dye, WHO's lead investigator in the recent analysis.
"We commend China for its stated commitment to tackling tuberculosis," said Dr Shigeru Omi, Regional Director of WHO's Western Pacific Region. "Still, several obstacles remain, and these should, and can, be surmounted."
Despite the progress made, there are some provinces where up to 20% or more of the population do not have access to DOTS. At the time of the 2000 survey, only one third of estimated TB cases were detected in China. At the present time, the case detection rate remains very low, at only four out of ten cases. "When one takes these realities into account, and then views the encouraging results of the DOTS strategy that has already been implemented, it's clear that China needs to rapidly expand DOTS and increase its case detection rates for tuberculosis," said Dr Omi.
The Government of China's National Tuberculosis Plan provides for DOTS to be expanded to 100% of the country by 2005. "WHO is pleased to support China in its efforts," said Dr Dye, "and looks forward to seeing the country reach - and surpass - its Millennium Development Goal for slashing TB prevalence in the years ahead."
* DOTS is the internationally recommended strategy to control TB combining five elements: political commitment; microscopy services; drug supplies; surveillance and monitoring systems; and the use of highly efficacious treatment regimes with direct observation of treatment.
** The 2000 survey included 376 000 people at 257 investigation points from all 31 provinces, autonomous regions, and municipalities on the Chinese mainland.
*** The Millennium Development Goals (MDGs), set by world leaders at the United Nations Millennium Summit, define clear targets for reducing disease and other obstacles to human and social development.
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