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South African Medical Journal

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The relentless spread of tuberculosis in Zambia - trends over the past 37 years (1964- 2000)

P Mwaba, M Maboshe, C Chintu, B Squire, S Nyirenda, R Sunkutu, A Zumla

Abstract


Objective. To review trends in the rates of tuberculosis (TB) case notifications over a 37-year period.
Design. A retrospective study of Ministry of Health records on TB notifications between 1 January 1964 and 31 December 2000.
Setting. Zambia, sub-Saharan Africa.
Methods. Retrospective analysis of case-notification data for TB of the Zambia Ministry of Health annual returns.
Outcome measures. Annual TB case-notification rates and trends over the past 37 years.
Results. TB case-notification data from 1964 to 2000 show a 12-fold increase over the past two decades, and apparent gains in controlling TB seen in the 1960s and 1970s have been reversed over the past two decades. A stable situation during the period 1964 - 1984 (case-notification rate remained around 100 per 100 000 population) was followed by an exponential increase since the mid-1980s. The absolute number of new TB
cases increased from 8 246 in 1985 (124/100 000) to 38 863 (409/100 000) in 1996 and 52 000 (512/100 000) in 2000. Comparison of case-notification rates over the past 2 decades with neighbouring countries (Zimbabwe, Malawi and Tanzania) show that Zambia has one of the highest case notification rates in the region.
Conclusions. Zambia, like many countries in Africa, is in the midst of a serious TB epidemic and there are no signs that it is abating. This increase was most likely due to the impact of the HIV / AIDS epidemic and subsequent breakdown of TB services. Concerted donor-government efforts should invest appropriately in long-term plans for TB control.



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