The World Health Organisation (WHO) estimates that 20% more people are falling ill with TB in South Africa than previously thought.
This emerged from new estimates contained in this year’s WHO World TB Report launched on Wednesday and published its website.
The WHO estimates that about 360 000 people fell ill with TB in South Africa last year.
As with previous estimates, however, there is significant uncertainty with a 95% chance that the real number is between 250 000 and 489 000.
In last year’s report, the WHO estimated that 301 000 people in the country fell ill with TB in 2018.
The higher number seen in the new report is likely not because of an actual increase in TB cases, but rather due to better data being available.
The new WHO numbers take into account findings from South Africa’s first national TB prevalence survey – the findings of which have not yet been published by the department of health.
Spotlight has requested access to the survey findings under the Protection of Access to Information Act.
About 210 000 (58%) of the estimated 360 000 people with TB last year were diagnosed.
This suggests that around 150 000 people fell ill with TB, but were never diagnosed.
Given that the 360 000 is quite uncertain, the estimate of this treatment gap is also uncertain. Either way, these new figures will raise questions about the country’s TB case detection strategy.
South Africa had the eighth highest absolute number of TB cases last year, but ranked second on cases per 100 000.
Only Lesotho, with an estimated 654 cases per 100 000, had more cases than South Africa’s 615 per 100 000.
At least 14 000 people fell ill with drug-resistant TB in South Africa last year (range from 8 500 to 20 000).
Fewer TB deaths
While more people are falling ill with TB than previously thought, the good news is that fewer people are dying of TB.
The WHO estimates that 58 000 people died of TB in South Africa last year (range from 35 000 to 91 000). About 36 000 of the 58 000 people thought to have died of TB were also HIV positive.
Last year’s report estimated that there were 63 000 TB deaths in the country in 2018.
Preventive therapy – pills taken to prevent people from falling ill with TB – are considered a critical part of TB prevention efforts, especially for people living with HIV who are at an increased risk of developing TB.
At least 69% of people newly started on HIV treatment in South Africa last year also received TB preventive therapy.
This number was a bit lower, at 56%, for children younger than five years living in households where someone has TB.
The global picture
The WHO estimates that around 10 million people fell ill with TB last year (range 8.9 million to 11 million).
An estimated 1.4 million people died of TB last year, including people co-infected with HIV.
This means that last year, TB killed more people than any other single infectious agent, including HIV.
“Despite increases in TB notifications, there was still a large gap – 2.9 million – between the number of people newly diagnosed and reported and the 10 million people estimated to have developed TB last year,” the WHO report reads.
“This gap is due to a combination of underreporting of people diagnosed with TB and underdiagnosed (if people with TB cannot access health care or are not diagnosed when they do).”
*This article was produced by Spotlight – health journalism in the public interest.