The relentless spread of tuberculosis in Zambia - trends over the past 37 years (1964-2000)

Objective. To review trends in the rates of tuberculosis (TB) case notifications over a 37-year period. Design. A retrospective study of Ministry of Health records on TB notifications between I January 1964 and 31 December 2000. Setting. Zambia, sub-Saharan Africa. Methods. Retrospective analysis of case-notification data for TB of the Zambia Ministry of Health annual returns. Outcome measures. Annual TB case-notification rates and trends over the past 37 years. Results. TB case-notification data from 1964 to 2000 show a 12-fold increase over the past two decades, and apparent gains in controlling TB seen in the 1960s and 1970s have been reversed over the past two decades. A stable situation during the period 1964-1984 (case-notification rate remained around 100 per 100 000 population) was followed by an exponential increase since the mid-1980s. The absolute number of new TB cases increased from 8 246 in 1985 (124/100 000) to 38 863 (409/100 000) in 1996 and 52 000 (512/100 000) in 2000. Comparison of case-notification rates over the past 2 decades with neighbouring countries (Zimbabwe, Malawi and Tanzania) show that Zambia has one of the highest case-notification rates in the region. Conclusions. Zambia, like many countries in Africa, is in the midst of a serious TB epidemic and there are no signs that it is abating. This increase was most likely due to the impact of the HIV/AIDS epidemic and subsequent breakdown of TB services. Concerted donor-government efforts should invest appropriately in long-term plans for TB control.