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Building On Sucess: Scope For Further Expansion Of Tuberculosis Control In China
July 28, 2004The results of an initiative to reduce tuberculosis in China-supported by the World Bank and WHO-are reported in this week's issue of THE LANCET. Disease prevalence has been reduced by around 30% in areas where a treatment programme was introduced a decade ago; authors of the study comment that expansion of the programme to all areas of China will further improve national and global tuberculosis control.
China has 1"Ē4 million new cases of tuberculosis every year-more than any country except India. A tuberculosis control project based on short-course chemotherapy using anti-tuberculosis drugs within the internationally recommended DOTS strategy was introduced in half the country in 1991, after a national survey of tuberculosis prevalence in 1990. Another survey was done in 2000 to re-evaluate the national tuberculosis burden, providing the opportunity to assess the effect of the control project.
More than a third of a million people were surveyed in the year 2000 at 257 investigation points chosen from all 31 mainland provinces in China. The survey showed a decrease in tuberculosis prevalence of around a third compared with the original survey done in 1990.
Lead author Chris Dye of WHO comments on behalf of the China TB Control Collaboration: "In 2001, the Chinese government issued the 10-year National Tuberculosis Control Plan (2001-10). The plan commits the government to expanding the programme to at least 90% of the country by 2005 and 95% by 2010. By building on the successes of the past decade, and by providing more than a billion people with access to high-quality tuberculosis treatment, China should be able to reach the UN Millennium Development Goal of halving TB prevalence between 2000 and 2015, and thereby make a further, major contribution to the global control of tuberculosis".
In an accompanying commentary (p 391), S Bertel Squire (Liverpool School of Tropical Medicine, UK) concludes: "The paper by Dye and colleagues gives strong support to expanded implementation of the DOTS strategy, both in China and worldwide. It is important, however, that wider implementation comes with careful and critical appraisal of what is needed to make DOTS work, especially where people, health infrastructures, and human resources are poor. Also, we need better measures of socioeconomic development than the crude proxies of geography and urbanisation that have been used in Dye and co-workers report. Once we have such measures we should look carefully at the way in which they influence the success, or otherwise, of DOTS".
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