Which are the TB high burden countries?
The "high burden" TB countries are those countries that are given the highest priority at global level. The "high burden" country list was first created in 1998.
High Burden TB Countries - 2021 Adjustments
China is a country that appears in all three high burden TB lists
In June 2021 the World Health Organisation (WHO) announced updated global lists of high burden countries for tuberculosis (TB), HIV-associated TB and multidrug-resistant TB (MDR/RR-TB). The new lists are for 2021-2025 and replace those previously used between 2016 and 2020.
The main changes compared with the previous lists for 2016-2020 are:
The 30 high TB burden countries: Cambodia, the Russian Federation and Zimbabwe have transitioned out of the list, Gabon, Mongolia and Uganda have joined the list.
The 30 high TB/HIV burden countries: Angola, Chad, Ghana and Papua New Guinea have transitioned out of the list, Gabon, Guinea, Philippines and the Russian Federation have joined the list.
The 30 high MDR/RR_TB burden countries: Ethiopia, Kenya and Thailand have transitioned out of the list, Mongolia, Nepal and Zambia have joined the list.
A country’s burden of TB
How much a country is affected by TB is generally referred to as a country’s burden of TB. Countries often singled out are the high burden countries that have a particularly high burden of TB. Also, low burden countries who have a particularly low burden of TB.
A country’s burden of TB can be described by saying how many people with TB they have in a year. It can also be described by saying how many people in the country die of TB each year. A third way of describing it is to say how many cases of TB there are at any given point in time. The burden of TB is also sometimes related to the population size.
The TB statistics page gives the TB incidence for all high burden countries.
TB low burden countries
The number of incident TB cases relative to the population size of a country varies greatly among countries. The lowest rates, that is the countries least affected by TB are found mostly in high income countries, including most countries in Western Europe. Canada, the United States of America, Australia & New Zealand also have among the lowest rates. In these countries the incident rate is less than 10 cases per 100,000 population per year.
Countries with a very low incident rate tend to have different aims with regard to TB, compared to the high incidence countries. For example, in the United States of America, the aim is the eradication of TB. However, it is realised that there is a need for high income low incidence countries to help other countries particularly low income countries, where there is a much higher burden of TB.
Initial 1998 lists of high burden countries
In 1998 the initial list of 22 high burden countries was defined based on the burden of TB in absolute terms. At this time TB was barely on the global health agenda. The aim in creating the list was to highlight the scale of the global TB epidemic, by focusing on a small number of countries responsible for 80% of the total number of TB cases worldwide. The 22 high burden countries were defined as those countries with the highest absolute burden of TB in respect of the estimated number of incident cases. Subsequently Peru was removed from the list and replaced by Mozambique.
Then in 2004 the WHO issued its first guidance on the implementation of 12 collaborative TB/HIV activities. The aim was to jointly address the co-epidemics of TB and HIV. Subsequently in 2005 a list of 41 TB/HIV high burden countries was agreed. The countries in the list made up 97% of the estimated global burden of TB among people living with HIV. This list was then used to promote the scaling up of TB and HIV activities and to help advocate for Global Fund support for these activities. The list was updated each year until 2009.
In 2008 it was decided that a list of high MDR-TB burden countries was important. After some debate the criteria was agreed. The list would consist of countries that collectively accounted for 85% of the estimated global total. Every country in the list was also required to either have more than 4,000 estimated TB cases a year and/or greater than or equal to 10% of new TB cases needed to be of MDR-TB. The list was used in advocating for Global Fund support for MDR-TB activities. This was especially the case for middle income countries with a high MDR-TB burden in central Asia and Eastern Europe. These were countries that would not otherwise be eligible for support. There were 27 countries in the list.
Revising the three high burden country lists
By 2015 it has been realised that there were advantages but also disadvantages to the lists. One particular disadvantage is that the main high burden country list was based on absolute burden, so countries with very high rates per head of population were not included. So it was decided in 2015 that the lists would be revised. After a period of consultation it was decided that there would still be three lists for the next five years.
It was also decided that each list would contain 30 countries using a “20 + 10” approach. This meant that the countries would be the top 20 in terms of absolute numbers of incident cases, plus the ten countries with the most severe burden in relative terms that did not already appear in the top 20. There would also be a threshold of a minimum number of 10,000 cases per year for TB and 1,000 per year for TB/HIV and MDR-TB. This would avoid any of the lists including countries with a very small number of cases.
With several countries appearing in more than one list, in total the three lists include 48 countries.
Revised high burden country lists
In 2020 the three lists were as follows and have been used between 2016 and 2020.
The 30 TB high burden countries
Top 20 by estimated absolute number (in alphabetical order)
Angola, Bangladesh, Brazil, China, DPR Korea, DR Congo, Ethiopia, India, Indonesia, Kenya, Mozambique, Myanmar, Nigeria, Pakistan, Philippines, Russian Federation, South Africa, Thailand, UR Tanzania, Viet Nam
Additional 10 by estimated incidence rate (in alphabetical order)
Cambodia, Central African Republic, Congo, Lesotho, Liberia, Namibia, Papua New Guinea, Sierra Leone, Zambia, Zimbabwe
The TB statistics page has the estimated TB incidence for each of these countries. There is also more about TB in India, TB in China, TB in Nigeria & TB in South Africa.
The 30 high TB/HIV burden countries
Top 20 by estimated absolute number (in alphabetical order)
Angola, Brazil, Cameroon, China, DR Congo, Ethiopia, India, Indonesia, Kenya, Lesotho, Malawi, Mozambique, Myanmar, Nigeria, South Africa, Thailand, Uganda, UR Tanzania, Zambia, Zimbabwe
Additional 10 by estimated incidence rate (in alphabetical order)
Botswana, Central African Republic, Chad, Congo, Ghana, Guinea-Bissau, Liberia, Namibia, Papua New Guinea, Swaziland
The 30 high MDR-TB burden countries
Top 20 by estimated absolute number (in alphabetical order)
Bangladesh, China, DPR Korea, DR Congo, Ethiopia, India, Indonesia, Kazakhstan, Kenya, Mozambique, Myanmar, Nigeria, Pakistan, Philippines, Russian Federation, South Africa, Thailand, Ukraine, Uzbekistan, Viet Nam
Additional 10 by estimated incidence rate (in alphabetical order)
Angola, Azerbaijan, Belarus, Kyrgyzstan, Papua New Guinea, Peru, Republic of Moldova, Somalia, Tajikistan, Zimbabwe
Page Updating
This page was last updated in June 2022
Author Annabel Kanabus
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