Is TB common in Pakistan?
It is estimated that in 2018 562,000 people in Pakistan developed TB. This is the estimated number of HIV negative people. In addition there were an estimated 3,800 HIV positive people that developed TB.1Global TB Report, WHO, 2019, https://www.who.int/tb/publications/global_report/en/
A doctor working in a TB clinic in Pakistan © WHO
Pakistan has the sixth largest population in the world and has the fifth greatest burden of TB. With an estimated 27,000 drug resistant TB cases each year Pakistan also ranks 6th for drug resistant TB among the 30 high burden countries.
A total of 369,548 people were notified as having TB in 2018. This means that there is a large gap of approximately two hundred thousand people between the number of people notified and the number of people estimated as having TB. These people will not be receiving treatment. They will also be infectious, and whilst they are ill they could be passing TB on to other people.
Of the 369,548 cases notified:
- % tested with rapid diagnostics at time of diagnosis 22%;
- % with known HIV status 20%
- % pulmonary TB 80%
- % bacteriologically confirmed 48%
- % children aged 0-14 years 13%
- % women 42%
- % men 45%
Deaths from TB
An estimated 44,000 HIV negative people die from TB disease in Pakistan each year and an estimated 1,300 HIV positive people also die. It is difficult to appreciated what it means for 45,300 people to be dying each year from TB. So it can be helpful to read the page on dying from TB.
Provincial and Territorial TB Statistics Pakistan 2National TB Data, 2018, https://ntp.gov.pk/national-tb-data/
There are four provinces in Pakistan. They are Balochhistan, Khyber Pakhtunkhwa (KP), Punjab and Sindh. There are also four territories. The territory of Azad Jammu and Kashmir (AJK), the territory of Giligit-Baltistan (GB), the Islamabad Capital Territory (ICT) and the Federally Administered Tribal Areas (FATA).
| Province/Territory | DOTS Population | Total people notified | Bacteriologically Positive New Patients | Bacteriologically Positive Previously Treated Patients | Total Bacteriologically Positive Patients | Clinically Diagnosed Bacteriologically Negative New Patients | Clinically Diagnosed Bacteriology Negative Previously Treated Patients | Total Bacteriologically Negative Patients |
|---|---|---|---|---|---|---|---|---|
| AJK | 4,109,272 | 5,215 | 1,830 | 218 | 2,048 | 1,741 | 88 | 1,829 |
| Balochistan | 12,344,408 | 10,331 | 3,743 | 247 | 3,990 | 3,634 | 63 | 3,697 |
| FATA | 5,001,676 | 4,753 | 1,083 | 222 | 1,305 | 1,959 | 72 | 2,031 |
| GB | 1,408,498 | 2,918 | 329 | 18 | 347 | 1,856 | 76 | 1,932 |
| KP | 24,742,592 | 43,598 | 12,418 | 1,416 | 13,834 | 13,825 | 23 | 13,848 |
| Punjab | 110,012,442 | 220,775 | 78,214 | 8,134 | 86,348 | 98,173 | 856 | 99,029 |
| Sindh | 46,757,728 | 80,061 | 29,887 | 5,781 | 35,668 | 28,846 | 1,701 | 30,547 |
| ICT | 2,001,579 | 1,897 | 497 | 84 | 581 | 505 | 25 | 530 |
| Pakistan Total | 206,378,195 | 369,548 | 128,001 | 16,120 | 144,121 | 150,636 | 2,807 | 153,443 |
Childhood TB in Pakistan
Childhood TB is a major public health problem in Pakistan. Approximately 20% of the TB patients detected every year are children under the age of 15.3Subregional workshop on childhood tuberculosis (TB), 2013, http://www.emro.who.int/pak/pakistan-events/sub-regional-workshop-on-childhood-tb.html
The World Health Organisation has identified a number of areas, which if improved, could prevent serious illness and death from TB in thousands of children each year. These include:
- Increasing case detection of TB in children within the community;
- improve the diagnosis and management of children with all forms of TB;
- increase implementation of child contact screening and preventive therapy (with a special focus on high-risk groups);
- increase child TB cases reporting from the private sector.
TB in the Public & Private Sectors in Pakistan
All TB patients should be reported to the National Tuberculosis Program (NTP) which provides free TB diagnostic and treatment services. These are available in more than 1700 public and private sector facilities across Pakistan.
The private health sector in Pakistan is very large and in general unregulated. Eighty five percent of patients choose to seek care in the private sector. Despite the large share of the health sector that they occupy, less than one per cent of private providers report TB cases to the NTP.4Razia Fatima, Delivering Patient-Centred Care in a Fragile State, Journal of Infectious Diseases, 2017, https://academic.oup.com/jid/article/216/suppl_7/S733/4595552
National TB Control Program
TB control in Pakistan was very limited until the National TB Control Program (NTP) was revived in 2001. At this time TB was declared a national emergency through the "Islamabad declaration". Following this a 5 year plan was devised leading to universal DOTS coverage in the public sector by 2005. 5P Metzger, Tuberculosis control in Pakistan: reviewing a decade of success and challenges, Eastern Mediterranean Health Journal, 2010, http://www.emro.who.int/emhj-volume-16-2010/volume-16-supplement/article-06.html After achieving countrywide DOTS coverage in 2005, the NTP expanded the scope of its activities to include multidrug resistant tuberculosis (MDR-TB).
The National TB Control Program has as its goal to reduce by 50% the prevalence of TB in the general population by 2025 as compared with 2012. The Government of Pakistan has also set the ambitious goal of zero deaths due to TB and universal access to TB care by 2020. It is now clear that these targets are not going to be met.6National TB Control Program, https://ntp.gov.pk
National END TB Strategic Plan 2017 -2020
In 2016 the development took place of the National Strategic Plan for 2017 - 2020. 7National END TB Strategic Plan 2017 - 20, https://secureservercdn.net/104.238.71.109/9aa.913.myftpupload.com/wp-content/uploads/2020/07/nets.pdf This is a very comprehensive plan setting out three groups of objectives under the headings of:
- Innovative Care
- Bold Policies and Supportive Systems
- Intensified Research and Innovation
Ten Monitoring and Evaluation Indicators were also set which include the following:
| Indicator | 2015 Baseline | Target 2019 | Actual 2019 | Target 2020 |
|---|---|---|---|---|
| TB Treatment Coverage of Drug Susceptible TB (DS-TB) | 63% | 88% | 90% | |
| TB Treatment Coverage of Drug Resistant TB (DR-TB) | 20% | 50% | 60% | |
| TB Treatment Success Rate DS-TB | 93% | 93% | 93% | |
| TB Treatment Success Rate DR-TB | 69% | 74% | 75% | |
| % of new and relapse TB patients tested using WRD | 50% | 60% | ||
| Drug Susceptibility Testing (DST) Coverage for TB Patients (new cases) | 1% | 35% | 50% | |
| DST Coverage for TB Patients (previously treated) | 84% | 90% | 90% | |
| Treatment Coverage New TB Drugs | 40% | 80% | ||
| Documentation of HIV Status among TB Patients | 4% | 40% | 60% | |
| Case Fatality Ratio (CFR) | 9% | <5% | <5% |
It is difficult to know which of the targets have been met for 2019. This is because the National TB Control Program does not seem to have published an annual report for several years.
Page Updating
This page was last updated in August 2020.
Author Annabel Kanabus
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