South Africa: WHO Estimates 20 Percent More TB Cases in SA Than Previously Thought

Globally, the TB incidence rate is falling, but not fast enough to reach the 2020 milestone of a 20% reduction between 2015 and 2020.

14 October 2020

Around 20% more people are falling ill with tuberculosis (TB) in South Africa than previously thought. This emerged from new estimates contained in the 2020 WHO World TB Report launched today and published on the World Health Organization (WHO) website.

The WHO estimates that around 360 000 people fell ill with TB in South Africa in 2019. As with previous estimates, however, there is significant uncertainty with a 95% chance that the real number is in the range 250 000 to 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 in terms of the Protection of Access to Information Act.

Around 210 000 (58%) of the estimated 360 000 people with TB in 2019 were diagnosed. This suggests that around 150 000 people fell ill with TB, but they were never diagnosed. Given that the 360 000 estimate is quite uncertain, the estimate of this treatment gap is also uncertain. Either way, these new figures will raise questions about South Africa's TB case detection strategy.

South Africa had the eighth highest absolute number of TB cases in 2019, but ranked second on cases per 100 000. Only Lesotho with an estimated 654 cases per 100 000 had more cases than South Africa with 615 per 100 000.

Around 14 000 people fell ill with drug-resistant TB in South Africa 2019 (range 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 around 58 000 people died of TB in South Africa in 2019 (range 35 000 to 91 000). Around 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. A total of 69% of people newly started on HIV treatment in South Africa in 2019, 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 in 2019 (range 8.9 to 11 million).

An estimated 1.4 million people died of TB in 2019 (including people co-infected with HIV). This means that in 2019, 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 in 2019," the WHO report reads. "This gap is due to a combination of underreporting of people diagnosed with TB and under-diagnosis (if people with TB cannot access health care or are not diagnosed when they do)."

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