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World TB deaths shoot up - on paper

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You might be forgiven for thinking we are losing ground in the battle against tuberculosis after reading a recent statement from the medical humanitarian organisation Doctors Without Borders .

"The World Health Organization’s annual look at the global state of tuberculosis this year makes for a shockingly bad report card," the statement began. It then noted: "WHO’s report reveals that more people are dying of TB and more people are left undiagnosed and untreated than last year, creating a cycle of TB transmission and death."

We went to the WHO tuberculosis report to see if more people are dying of TB and if so, does that amount to shockingly bad news.

1.8 million deaths due to TB in 2015

A man suffering from tuberculosis (TB) holds his medication after receiving it from a Nairobi clinic run by Doctors without Medecins Sans Frontieres in March 2015. Photo: AFP/TONY KARUMBA
A man suffering from tuberculosis (TB) holds his medication after receiving it from a Nairobi clinic run by Doctors without Borders in March 2015. Photo: AFP/TONY KARUMBA" />

In 2015, the WHO estimated that tuberculosis killed 1.4 million people directly and was the proximate cause of death for an additional 400,000 people infected with HIV. Together, the death toll was 1.8 million.

In 2014, WHO estimated the total number of deaths at 1.5 million, with about 1.1 million who died exclusively from tuberculosis and another 400,000 who were HIV-positive.

So that’s pretty clear. The total death toll rose by about 300,000.

But as the authors of the latest report spell out, the change stems from better counting, not in the growing reach of the disease.

"The TB epidemic is larger than previously estimated, reflecting new surveillance and survey data from India," the report said.

India home to over a quarter of TB cases

WHO spokeswoman Prudence Smith explained that between 2013 and 2015, India shifted from a paper-based reporting system to one that lives on the internet.

"In addition," Smith said, "the country has made case notification legally mandatory."

In the world of tuberculosis, India is a huge deal. It is home to more than 25% of all TB cases and deaths worldwide.

Nigeria had the second most deaths due to TB in 2015, with four other African countries ranking in this top 10. 

With better raw data in hand, the estimated death toll in India more than doubled between 2014 and 2015. While that might seem shocking, what really happened is that the earlier estimates low-balled deaths by a huge amount.

So, has the situation deteriorated?

Not really.

There are two ways to measure progress. You can estimate deaths and from that, you can estimate the TB death rate within the population. The same WHO report said both deaths and the death rate are down dramatically since 2000.

We looked at estimates from another respected source, the Institute for Health Metrics and Evaluation at the University of Washington. In an October 2016 Lancet article, the institute looked at the trend between 2005 and 2015. Over this period, both the total number of deaths and the death rate per 100,000 people dropped.

Numbers can be confusing

Director of global health and HIV policy at the Kaiser Family Foundation, Jennifer Kates, told us the numbers can seem confusing. Kates said there’s been a strong effort to increase the accuracy of tracking TB for some time, and she doesn’t find the latest figures surprising.

"Newer methods, better data, and so on yield better estimates and that sometimes makes understanding the trends and messaging about them much harder," Kates said.

Doctors Without Borders spokeswoman Brienne Prusak said the latest figures paint a dire picture, though. Prusak noted that the report shows that TB deaths topped those by HIV/AIDS.

Kates, WHO and Doctors Without Borders applaud the improved TB monitoring. They also all say that funding to combat the disease falls well short of what’s needed. The WHO said the global effort ought to be in the neighbourhood of US$8.3 billion. Current spending is about US$2 billion shy of that.

The 2015 estimate from the WHO has a special significance. It is the starting point in a 20-year plan to not just stop tuberculosis, but to end it.

Conclusion: Rise in reported TB deaths is mainly result of better reporting, not surge in TB

The group Doctors Without Borders called the latest WHO report on TB shockingly bad and said that more people are dying from the disease. That statement is accurate only if we add an important qualification.

Estimated deaths rose by about 300,000 people. But much of that increase has more to do with better reporting and more complete data than an actual increase in deaths. As the WHO report noted, experts came to believe that earlier estimates were too low.

Looking back 10 years, the trends in the number of deaths and the TB death rate show steady improvement. We therefore rate the claim that more and more people are dying of TB as misleading.

Politifact rated the claim “half true”. See how it appeared there.


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