54. ¿Cuáles son los objetivos mundiales para el control de la tuberculosis y en qué se ha basado su definición?

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    ABSTRACT: Background WHO advocates the use of directly observed treatment with a short-course drug regimen as part of the DOTS strategy, but the potential effect of this strategy worldwide has not been investigated. Methods We developed an age-structured mathematical model to explore the characteristics of tuberculosis control under DOTS, and to forecast the effect of improved case finding and cure on tuberculosis epidemics for each of the six WHO regions. Findings In countries where the incidence of tuberculosis is stable and HIV-1 absent, a control programme that reaches the WHO targets of 70% case detection and 85% cure would reduce the incidence rate by 11% (range 8-12) per year and the death rate by 12% (9-13) per year. If tuberculosis has been in decline for some years, the same case detection and cure rates would have a smaller effect on incidence. DOTS saves a greater proportion of deaths than cases, and this difference is bigger in the presence of HIV-1. HIV-1 epidemics cause an increase in tuberculosis incidence, but do not substantially reduce the preventable proportion of cases and deaths. Without greater effort to control tuberculosis, the annual incidence of the disease is expected to increase by 41% (21-61) between 1998 and 2020 (from 7.4 million to 10.6 million cases per year). Achievement of WHO targets by 2010 would prevent 23% (15-30) or 48 million cases by 2020. Interpretation The potential effect of chemotherapy (delivered as DOTS) on tuberculosis is greater in many developing countries now than it was in developed countries 50 years ago. To exploit this potential, case detection and cure rates urgently need to be improved in the main endemic areas.
    The Lancet 12/1998; 352(9144):1886-1891. DOI:10.1016/S0140-6736(98)03199-7 · 45.22 Impact Factor
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    ABSTRACT: In 39 randomly selected villages and towns in Tumkur District, South India, approximately 2000 persons, tuberculosis cases and matched controls, were interviewed in order to determine how many had symptoms suggestive of tuberculosis. Approximately 70% of the bacteriologically confirmed cases and over half the radiologically active or probably active cases had at least one major symptom. The authors discuss these findings in the light of the results of certain other studies they have carried out-for example, on present action-taking among tuberculosis sufferers. They conclude that under present circumstances in India, it is epidemiologically and economically justified to base tuberculosis control programmes on the persons who seek assistance because of worry over symptoms. Only when services satisfying the needs of the already worried tuberculosis sufferers are well developed, may mass case-finding be considered as an additional measure.
    Bulletin of the World Health Organisation 01/1963; 29:665-83. · 5.11 Impact Factor


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