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TB Statistics for South Africa – National & provincial

National TB statistics for South Africa

TB incidence and prevalence

South Africa is one of the countries with the highest burden of TB, with the World Health Organisation (WHO) statistics giving an estimated incidence of 450,000 cases of active TB in 2013. So about 1% of the population of about 50 million develop active TB disease each year. This is worldwide the third highest incidence of any country after India and China, and the incidence has increased by 400% over the past 15 years.

Out of the 450,000 incident cases in South Africa it is estimated by WHO that about 270,000 (60%) people have both HIV and TB infection. The latest figure from the South African Department of Health is that 73% of TB patients are HIV positive.1“Annual Performance Plan 2012/13 – 2014/15”, Department of Health, South Africa 2012 App2012-2014.pdf When figures are provided by both WHO and the South African government, and the figures are different, this can be because the WHO is always providing estimated figures, whereas the South African government is providing actual figures.

WHO give a prevalence figure for active TB of 390,000 people in South Africa in 2011.

Words used in TB statistics

With TB statistics the words TB incidence and TB prevalence will often be used. The TB incidence for any country is the number of new cases, usually of active TB disease that have occurred in the country during a certain time period which is usually a year. TB prevalence for a country is the number of people who are living with a specific condition, usually active TB, and is usually but not always given as a percentage.2“Mortality and causes of death in South Africa, 2010: Findings from death notification”, Statistics South Africa 2013 www.statssa.gov.za

Latent TB

It is estimated that about 80% of the population of South Africa is infected with TB bacteria, the vast majority of whom have latent TB rather than active TB disease. The highest prevalence of latent TB, estimated at 88% has been found among people in the age group 30-39 years old living in townships and informal settlements.

Mortality

TB continues to be the leading cause of death in South Africa. WHO gives a figure of 25,000 deaths from TB in South Africa in 2011 but this excludes those people who had both TB and HIV infection when they died. These people are internationally considered to have died of HIV.

The South African causes of death from death notifications, gives a figure of 62,827 for 2010 which is 11.6% of the number of people who have died, and this includes people who also had HIV infection as well as TB. This compares with a figure of 69,791 in 2009 and 75,281 in 2008.3“National Tuberculosis Management Guidelines 2009”, Department of Health, South Africa 2009 http://familymedicine.ukzn.ac.za/Libraries/Guidelines_Protocols/TB_Guidelines_2009.sflb.ashx

Statistics for TB cases notified and incidence rate of TB cases

TB cases notified and incidence rate of all forms of TB in South Africa in 2002 – 2010
2002 2003 2004 2005 2006 2007 2008 2009 2010
TB Cases Notified 224,420 255,420 279,260 302,460 341,160 353,870 388,880 406,080 410,040
TB Incidence Rate 493.7 550.1 599.4 645.1 719.9 739.5 798.7 823.4 802.2

The incidence rate is the incidence per 100,000 population.

During this same period the number of new smear positive cases has remained stable.

For 2011 the WHO gives an estimated total TB cases notified in South Africa of 389,974 and an incidence rate of 993. The incidence rate for people with TB and HIV co-infection is given by WHO as 650.

The latest published statistics for TB notifications in South Africa by province are for 2006 as shown below.4“National Tuberculosis Management Guidelines 2009”, Department of Health, South Africa 2009 http://familymedicine.ukzn.ac.za/Libraries/Guidelines_Protocols/TB_Guidelines_2009.sflb.ashx

TB case finding by South African province 2006
Province All TB cases PTB cases New smear positive PTB cases Re treatment smear positive PTB cases Smear negative PTB cases Children 0 – 7 years EPTB cases Inc. all TB cases per 100,000 Inc. PTB cases per 100,000
Eastern Cape 48,512 41,558 19,527 8,473 3,615 2,805 6,954 687 589
Free State 23,374 19,058 9,553 2,840 2,479 2,295 4,316 789 643
Gauteng 46,093 34,290 20,609 4,188 2,915 4,155 11,803 501 372
KZN 104,705 88,271 32,855 9,527 20,547 8,593 16,434 1,076 907
Limpopo 17,301 14,118 7,574 1,323 1,305 1,069 3,183 305 249
Mpumalanga 15,035 13,496 7,216 1,081 859 755 1,539 463 416
North West 28,421 24,519 12,539 2,954 1,764 2,156 3,902 738 637
Northern Cape 8,631 7,951 3,583 1,482 901 1,018 680 950 875
Western Cape 49,093 43,296 17,644 8,563 8,366 6,955 5,797 1,033 911
Total 341,165 286,557 131,100 40,431 42,751 29,801 54,608 720 605

In addition, for 72,276 patients there was no result given for a smear test. This ranged from 1,986 patients in the Northern Cape to 25,342 cases in KZN.

Statistics for treatment outcomes of new TB cases

Treatment outcomes of new TB cases in South Africa 2001 – 2009
2001 2002 2003 2004 2005 2006 2007 2008 2009
TB cure rate (%) 49.7 50.0 50.9 50.8 57.6 62.9 70.8 67.5 71.1
TB success rate (%) 60.5 63 65.5 62.9 70.8 73.8 73.9 76.4 77.1
TB mortality rate (%) 6.7 7.5 7.5 7.1 7.3 7.3 7.8 7.8 7.2
TB defaulter rate (%) 11.1 11.9 11.2 10.3 10.4 9.1 8.5 7.5 7.1

These figures come from the National Strategic on HIV, STIs and TB 2012 – 2016 and show how the TB cure rate has improved over the years reaching 71.1% in 2009. The corresponding TB treatment success rate of new infectious TB cases was 77.1 in 2009, but still below the global target of >85%.

The cure rate is the number of cases per 100,000 population where the patient has finished the course of treatment, and there is bacteriological evidence that this has been successful. The treatment success rate is the combination of the cure rate, added to the rate of completion where the course of TB drugs has been completed but there isn’t bacteriological evidence of success. In other words both “success” and “cure” is when the course of drugs has been completed, and for “cure” there in addition has to be bacteriological evidence.

Some further statistics as shown below, together with targets for future years, come from the Annual Performance Plan, 2012/13 – 2014/2015, as part of the strategic objective to reduce the burden of TB.

TB strategic objectives with audited figures and targets
Audited performance 2008/09 Audited performance 2009/10 Audited performance 2010/11 Estimated performance 2011/12 Medium term target 2012/13 Medium term target 2013/14 Medium term target 2014/15
TB cure rate (%) 60 68 72.5 75 80 85 90
TB treatment defaulter rate (%) 8.5 7.9 6.8 6 5 5 >5

The latest published statistics for TB treatment outcomes in South Africa by province are for 2005 as shown below.

New smear positive treatment outcomes for TB in South Africa by province 2005
Province Registered Cured (%) Completed (%) Treatment success (%) Died (%) Failed (%) Default (%) Not evaluated (%)
Eastern Cape 20,551 54.7 20 74.7 7 1.2 9 4.5
Free State 9,731 67.5 9.3 76.9 10.1 2 5.9 0.3
Gauteng 23,921 66.7 5 71.7 9.6 1.5 6.9 2.2
KZN 36,511 45.2 19.1 64.2 6.1 1.2 14.7 7.9
Limpopo 6,807 60.8 9.2 70.0 9.5 2 7.4 2.5
Mpumalanga 7,642 51.8 13.9 65.7 9 1 10.8 9.2
North West 13,771 57.6 12.3 70 7.3 2.9 9.5 3.8
Northern Cape 3,888 50.1 21.3 71.4 6.8 3.2 13.1 2.6
Western Cape 18,845 71.9 7.8 79.7 3.7 1.9 11.1 0.4
Total 141,667 57.7 13.3 71.1 7.2 1.7 10.4 4.2

Statistics for TB Treatment outcomes in South Africa, retreatment cases

Treatment outcomes of TB retreatment cases 2008 – 2010
Number notified Size of cohort Cohort as % notified % of cohort cured % of cohort completed % of cohort died % of cohort failed % of cohort defaulted % of cohort not evaluated
2008 64,470 38,754 60 53 11 11 3 13 9
2009 65,916 34,122 52 53 8 10 3 12 15
2010 60,580 60,580 100 31 4 5 2 7 52

Statistics for TB and HIV co-infection in South Africa

TB and HIV Co-infection 2011

TB patients with known HIV status 323,440 (83%)

HIV positive TB patients 211,800 (65%)

HIV positive TB patients on co-trimoxazole preventative therapy (CPT) 161,298 (76%)

HIV positive TB patients on antiretroviral therapy (ART) 92,376 (44%)

HIV positive people screened for TB 1,256,212

HIV positive people provided with IPT 372,994

TB and HIV co-infection with audited figures and targets
Audited performance 2008/09 Audited performance 2009/10 Audited performance 2010/11 Estimated performance 2011/12 Medium term target 2012/13 Medium term target 2013/14 Medium term target 2014/15
Percentage of HIV positive patients screened for TB 48 58 71 85 85 90 90
Percentage of TB patients tested for HIV 76 77 68 85 90 90 90
Percentage of eligible TB/HIV co-infected patients started on CPT 77 78 71 80 80 85 90

Of those people with HIV who were screened for the symptoms of TB, and were found not to have active TB, some 38% were initiated on IPT.

Statistics for TB deaths in South Africa by province 2010

TB deaths for each province, and the districts within the province where deaths from TB are the highest percentage of all deaths in that district.5“Mortality and causes of death in South Africa, 2010: Findings from death notification”, Statistics South Africa 2013 www.statssa.gov.za

TB deaths by province and district
Province Deaths from TB TB % of all deaths in Province District Municipality TB % of all deaths in District District Municipality TB % of all deaths in District
Western Cape 3,573 7.8 West Coast 10.5 Central Karoo 8.4
Eastern Cape 10,205 12.7 Buffalo City Metro 15.2 Nelson Mandela Bay Metro 14.9
Northern Cape 1,396 9.2 Frances Baard 10.6 Pixley ka Seme 10.3
Free State 5,440 12.1 Mangaung Metro 12.1 Lejweleputawa 12.0
KwaZulu-Natal 18,205 15.7 Zululand 19.9 Sisonke 18.8
North West 4,942 12.3 Dr Kenneth Kaunda 14.1 Ngaka Modiri Molema 14.0
Gauteng 9,247 8.8 Ekurhuleni Metro 10.2 West Rand 9.5
Mpumalanga 5,595 13.4 Ehlanzeni 16.5 Ger Sibande 11.7
Limpopo 5,984 12.0 Waterburg 9.8 Capricon 8.9

Overall there are only 10 districts out of 52 where TB is not the leading cause of death.

Drug resistant TB 2010

In 2010 there were 7,386 laboratory confirmed cases of MDR TB and 741 confirmed cases of extensively drug resistant TB (XDR TB).

Major sources for TB statistics for South Africa

National Strategic Plan on HIV, STIs and TB 2012-2016, South African National AIDS Council, 2011 www.gov.za/documents/national-strategic-plan-hiv-stis-and-tb-2012-2016

Global Tuberculosis Control 2014, WHO, Geneva, 2014 www.who.int/tb/publications/global_report/

References

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1. “Annual Performance Plan 2012/13 – 2014/15”, Department of Health, South Africa 2012 App2012-2014.pdf
2. “Mortality and causes of death in South Africa, 2010: Findings from death notification”, Statistics South Africa 2013 www.statssa.gov.za
3. “National Tuberculosis Management Guidelines 2009”, Department of Health, South Africa 2009 http://familymedicine.ukzn.ac.za/Libraries/Guidelines_Protocols/TB_Guidelines_2009.sflb.ashx
4. “National Tuberculosis Management Guidelines 2009”, Department of Health, South Africa 2009 http://familymedicine.ukzn.ac.za/Libraries/Guidelines_Protocols/TB_Guidelines_2009.sflb.ashx
5. “Mortality and causes of death in South Africa, 2010: Findings from death notification”, Statistics South Africa 2013 www.statssa.gov.za