The 22 tuberculosis (TB) disease burdened countries (TB countries) in the world, in 2014, were home to a combined population of nearly 4.6 billion people.
Nine of those 22 TB countries are in Africa and in 2014 those nine African countries were home to a combined population of 580 million people. The nine African TB countries included: Uganda, Kenya, Tanzania, Democratic Republic of Congo (DR Congo), Ethiopia, Mozambique, Nigeria, South Africa, and Zimbabwe.
The majority of the 22 TB countries, 11 of them, are located in Asia and in 2014 the 11 Asian TB countries were home to over 3.6 billion people. Among the 11 Asian countries are the two densely populated countries of China, with a population of about 1.4 billion people; and India, with a population of about 1.3 billion people. The other nine TB countries in Asia are: Afghanistan, Bangladesh, Cambodia, Indonesia, Myanmar, Pakistan, Philippines, Thailand and Vietnam.
The remaining two of the 22 TB countries are: Russia which is located in Eurasia and, in 2014, had a population of 143 million people; and Brazil, which is located in South America and, in 2014, had a population of 206 million people. None of the 22 TB countries of 2014 are of North America and of Europe.
The 22 TB countries, in 2014, had combined TB prevalence of over 10.2 million cases. The majority of those TB cases, nearly 7.8 million, were from the 11 Asian TB countries. Of those cases from the 11 Asian TB countries, the majority were from India – 2.5 million; Indonesia – 1.6 million; and China – 1.2 million.
The nine African TB countries, in 2014, had TB prevalence of over 2.2 million cases; of which the highest numbers were from Nigeria – 590 thousand, DR Congo – 400 thousand and South Africa – 380 thousand. Brazil had TB prevalence of 110 thousand and Russia of 160 thousand.
Practitioners, such as Andreas Wulf, in his article: “Systematic failure”, that was published in “Development and Cooperation (Vol.41.2014:1:17-18)”, have concluded that TB sustains in ‘richer’ countries, such as Russia, India and South Africa, not because of insufficient TB budget allocations per se, but because of income inequality and marginalisation in service provision.
Whereas, national TB budgets may be well provided for, it is how these budgets are distributed within a country and a region that matters. If, as it is the case in Uganda, for example, in some cases TB diagnostic facilities and treatments are located great distances away from where the patients reside, then the challenges of accessing diagnosis and treatment become a factor in determining TB prevalence.
Patients already weakened by the disease may not seek medical care on grounds of incapacitation – distance too long to walk, ride a bike or afford taxi/bus fare; or a child’s school fees is needed urgently. Even patients not yet adversely weakened by the disease may delay testing on similar grounds; sadly perpetuating the cycle. This is because, when they do decide to get tested they may already be adversely weakened and with permanent damage to their internal organs.
By Norah Owaraga, CPAR Uganda Managing Director, Cultural Anthropologist researching Tuberculosis in Uganda.