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Background: TB in Africa

Background

TB in Africa

Of the more than nine million new cases of active TB that occur worldwide each year, a disease that is both curable and preventable, approximately 30% of them are in Africa.

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This translates into 363 per 100,000 persons in Africa each year being newly infected with TB. Twenty-two countries designated as having a high-burden of TB by the World Health Organization account for 80% of the world’s TB cases; nine are in Africa (Democratic Republic of Congo, Ethiopia, Kenya, Mozambique, Nigeria, South Africa, Tanzania, Uganda, and Zimbabwe).

The most TB-affected part of Africa is Southern Africa, with the disease also cutting a deadly swath through East and Central Africa. A few West African countries also bear a large TB burden while most North African countries are relatively less affected. In most cases, a heavy TB burden goes hand-in-hand with a high HIV prevalence. In Africa, TB is often the first manifestation of HIV infection, and it is the leading cause of death among HIV-infected individuals.

TB Incidence and HIV Prevalence Classification
COUNTRY HIV Prevalence Classification* TB Incidence
Classification**
Angola low low
Benin low low
Botswana high high
Burkina Faso low low
Burundi high high
Cameroon high low
Cape Verde low low
Central African Republic high high
Chad low low
Comoros low low
Congo, Dem. Rep. high high
Congo, Rep. high high
Côte d’Ivoire high high
Equatorial Guinea low low
Eritrea low low
Ethiopia high high
Gabon high high
Gambia low low
Ghana low low
Guinea low low
Guinea-Bissau low low
Kenya high high
Lesotho high high
Liberia low high
Madagascar low low
Malawi high high
Mali low low
Mauritania low high
Mauritius low low
Mozambique high high
Namibia high high
Niger low low
Nigeria high high
Rwanda high high
Sao Tome and Principe low low
Senegal low low
Sierra Leone low high
Somalia low
South Africa high high
Sudan low
Swaziland high high
Tanzania high high
Togo low high
Uganda high high
Zambia high high
Zimbabwe high high
* The high HIV prevalence subregion includes countries with an estimated adult HIV prevalence rate equal to or greater than 4%;
** The high TB incidence classification is given to countries with an estimated TB incidence rate (new cases per/100,000 people) greater than 300.

These dual epidemics translate into Africa also bearing the biggest burden of TB/HIV co-infection on a per capita basis.

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Also of growing and alarming concern are the continued increase of Multidrug-resistant TB (MDR-TB) and the emergence of Extensively drug-resistant TB (XDR-TB). MDR-TB is a form of TB which is resistant to at least two of the most commonly used anti-TB drugs while XDR-TB is a virtually untreatable form of the disease. When an XDR-TB outbreak occurs, it can be extremely lethal. In one outbreak in South Africa, the mortality rate was 98%.

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