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. 2000 Jan;55(1):39–45. doi: 10.1136/thorax.55.1.39

Towards elimination of tuberculosis in a low income country: the experience of Cuba, 1962-97

A Marrero 1, J Caminero 1, R Rodriguez 1, N Billo 1
PMCID: PMC1745596  PMID: 10607800

Abstract

BACKGROUND—This study describes the epidemiological trends of tuberculosis in Cuba and the performance of the tuberculosis control programme. The circumstances that caused an increase in the incidence of new cases of tuberculosis between 1991 and 1994 had been analysed and were corrected in 1995-7.
METHODS—A descriptive study of the incidence rates of new cases of tuberculosis notified from 1962 to 1997 was made, with special emphasis on the total change between 1965 and 1991 and the increase thereafter.
RESULTS—The case notification rate of 14.7 per 100 000 in 1994 was almost three times the rate found in 1991 (4.8 per 100 000) and reversed the mean annual decrease of 5% observed since 1965. This increase was almost twofold in the rate of smear positive new cases (4.4 per 100 000 in 1991 and 8.3 in 1994). From 1971 onwards the programme had achieved a cure rate of 90% throughout the country with only 2% absconding by applying directly observed treatment. The main factors associated with the increasing trends were: (1) a probable underdetection of cases for the 1988-92 period that generated contagious sources in the community; (2) improved case finding from 1993 onwards and the introduction of an expanded case definition in 1994; (3) a considerable increase in the diagnostic delay from initial medical consultation to beginning of antituberculosis treatment (56.9 days in 1993); and (4) operational changes in the tuberculosis control programme due to the economic crisis in Cuba. In 1995, 1996 and 1997 it has been possible to reverse this trend, achieving rates of 14.1, 13.5, and 12.2 per 100 000, respectively (7.6, 7.6, and 6.9 for smear positive cases) as a result of effective intervention correcting the problems identified. Reducing the diagnostic delay attributable to shortcomings in the health care system and the study of contacts were of particular importance for re-establishing the tuberculosis programme as a priority.
CONCLUSIONS—Cuba represents a good example of how it is possible to fight against tuberculosis effectively, even in a low income country, by applying control strategies advocated by the World Health Organisation and the International Union Against Tuberculosis and Lung Disease and by giving adequate support to the programme through political commitment.



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Selected References

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  1. Bienia R. A., VanDerDecker J. D., Bienia B. H. Cuban refugee health care: response of the American health care system to the unexpected arrival of 125,000 immigrants. Am J Public Health. 1982 Jun;72(6):594–596. doi: 10.2105/ajph.72.6.594. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Cantwell M. F., Snider D. E., Jr, Cauthen G. M., Onorato I. M. Epidemiology of tuberculosis in the United States, 1985 through 1992. JAMA. 1994 Aug 17;272(7):535–539. [PubMed] [Google Scholar]
  3. Chum H. J. The Tanzania National Tuberculosis/Leprosy Programme in the face of HIV infection. Bull Int Union Tuberc Lung Dis. 1990;66 (Suppl):53–55. [PubMed] [Google Scholar]
  4. Clancy L., Rieder H. L., Enarson D. A., Spinaci S. Tuberculosis elimination in the countries of Europe and other industrialized countries. Eur Respir J. 1991 Nov;4(10):1288–1295. [PubMed] [Google Scholar]
  5. De Cock K. M., Soro B., Coulibaly I. M., Lucas S. B. Tuberculosis and HIV infection in sub-Saharan Africa. JAMA. 1992 Sep 23;268(12):1581–1587. doi: 10.1001/jama.268.12.1581. [DOI] [PubMed] [Google Scholar]
  6. Enarson D. A. Principles of IUATLD collaborative tuberculosis progammes. Bull Int Union Tuberc Lung Dis. 1991 Dec;66(4):195–200. [PubMed] [Google Scholar]
  7. Frieden T. R., Fujiwara P. I., Washko R. M., Hamburg M. A. Tuberculosis in New York City--turning the tide. N Engl J Med. 1995 Jul 27;333(4):229–233. doi: 10.1056/NEJM199507273330406. [DOI] [PubMed] [Google Scholar]
  8. Gharabli A. E. La lutte contre la tuberculose en REpublique Arabe D'Egypte. Bull Int Union Tuberc. 1974;49(1):118–128. [PubMed] [Google Scholar]
  9. González Ochoa E., Armas Pérez L., Machín Gelaber A. Tendencias por provincias de la tuberculosis en Cuba: 1979-1993. Bol Oficina Sanit Panam. 1995 Nov;119(5):396–404. [PubMed] [Google Scholar]
  10. González Ochoa E., García Pérez M. M., Armas Pérez L. Recuento de las etapas de evolución histórica de la lucha antituberculosa en Cuba. Rev Cubana Med Trop. 1993;45(1):49–54. [PubMed] [Google Scholar]
  11. Grundy P. H., Budetti P. P. The distribution and supply of Cuban medical personnel in Third World countries. Am J Public Health. 1980 Jul;70(7):717–719. doi: 10.2105/ajph.70.7.717. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Grzybowski S., Styblo K., Dorken E. Tuberculosis in Eskimos. Tubercle. 1976 Dec;57(4 Suppl):S1–58. doi: 10.1016/0041-3879(76)90059-3. [DOI] [PubMed] [Google Scholar]
  13. Heldal E., Cruz J. R., Arnadottir T., Tardencilla A., Enarson D. A. Successful management of a national tuberculosis programme under conditions of war. Int J Tuberc Lung Dis. 1997 Feb;1(1):16–24. [PubMed] [Google Scholar]
  14. McKenna M. T., McCray E., Onorato I. The epidemiology of tuberculosis among foreign-born persons in the United States, 1986 to 1993. N Engl J Med. 1995 Apr 20;332(16):1071–1076. doi: 10.1056/NEJM199504203321606. [DOI] [PubMed] [Google Scholar]
  15. Murray C. J., DeJonghe E., Chum H. J., Nyangulu D. S., Salomao A., Styblo K. Cost effectiveness of chemotherapy for pulmonary tuberculosis in three sub-Saharan African countries. Lancet. 1991 Nov 23;338(8778):1305–1308. doi: 10.1016/0140-6736(91)92600-7. [DOI] [PubMed] [Google Scholar]
  16. Murray J. F. An emerging global programme against tuberculosis: agenda for research, including the impact of HIV infection. Bull Int Union Tuberc Lung Dis. 1991 Dec;66(4):207–209. [PubMed] [Google Scholar]
  17. Narain J. P., Raviglione M. C., Kochi A. HIV-associated tuberculosis in developing countries: epidemiology and strategies for prevention. Tuber Lung Dis. 1992 Dec;73(6):311–321. doi: 10.1016/0962-8479(92)90033-G. [DOI] [PubMed] [Google Scholar]
  18. Pérez-Stable E. J., Pedraza R. O. Tuberculosis in Cuba. Am Rev Respir Dis. 1984 Sep;130(3):520–523. doi: 10.1164/arrd.1984.130.3.520. [DOI] [PubMed] [Google Scholar]
  19. Raviglione M. C., Dye C., Schmidt S., Kochi A. Assessment of worldwide tuberculosis control. WHO Global Surveillance and Monitoring Project. Lancet. 1997 Aug 30;350(9078):624–629. doi: 10.1016/s0140-6736(97)04146-9. [DOI] [PubMed] [Google Scholar]
  20. Raviglione M. C., Rieder H. L., Styblo K., Khomenko A. G., Esteves K., Kochi A. Tuberculosis trends in eastern Europe and the former USSR. Tuber Lung Dis. 1994 Dec;75(6):400–416. doi: 10.1016/0962-8479(94)90113-9. [DOI] [PubMed] [Google Scholar]
  21. Raviglione M. C., Snider D. E., Jr, Kochi A. Global epidemiology of tuberculosis. Morbidity and mortality of a worldwide epidemic. JAMA. 1995 Jan 18;273(3):220–226. [PubMed] [Google Scholar]
  22. Raviglione M. C., Sudre P., Rieder H. L., Spinaci S., Kochi A. Secular trends of tuberculosis in western Europe. Bull World Health Organ. 1993;71(3-4):297–306. [PMC free article] [PubMed] [Google Scholar]
  23. Rieder H. L., Cauthen G. M., Comstock G. W., Snider D. E., Jr Epidemiology of tuberculosis in the United States. Epidemiol Rev. 1989;11:79–98. doi: 10.1093/oxfordjournals.epirev.a036046. [DOI] [PubMed] [Google Scholar]
  24. Rieder H. L. Misbehaviour of a dying epidemic: a call for less speculation and better surveillance. Tuber Lung Dis. 1992 Aug;73(4):181–183. doi: 10.1016/0962-8479(92)90082-U. [DOI] [PubMed] [Google Scholar]
  25. Styblo K. The impact of HIV infection on the global epidemiology of tuberculosis. Bull Int Union Tuberc Lung Dis. 1991 Mar;66(1):27–32. [PubMed] [Google Scholar]
  26. Sutherland I. Epidémiologie de la tuberculose. Vaut-il mieux prévenir que guérir. Bull Int Union Tuberc. 1981 Sep-Dec;56(3-4):139–146. [PubMed] [Google Scholar]
  27. Torres Peña R., Joanes Fiol J., Carreras Corzo L., Pérez Avila J., Hernández Gutiérrez O., Marrero Figueroa A., Gil Suárez R., Santín Peña M. La infección por el virus de la inmunodeficiencia humana y la tuberculosis en Cuba. Bol Oficina Sanit Panam. 1995 Jul;119(1):66–73. [PubMed] [Google Scholar]
  28. Valdivia Alvarez J. A., Jiménez Misas C. A., Ferrá Salazar C., Mederos Cuervo L., Echemendía Font M., Mazón Zamora D. El Laboratorio Nacional de Referencia de Mycobacteria y Tuberculosis dentro de la lucha antituberculosis en Cuba. Rev Cubana Med Trop. 1988 May-Aug;40(2):51–66. [PubMed] [Google Scholar]
  29. Yanai H., Uthaivoravit W., Panich V., Sawanpanyalert P., Chaimanee B., Akarasewi P., Limpakarnjanarat K., Nieburg P., Mastro T. D. Rapid increase in HIV-related tuberculosis, Chiang Rai, Thailand, 1990-1994. AIDS. 1996 May;10(5):527–531. doi: 10.1097/00002030-199605000-00012. [DOI] [PubMed] [Google Scholar]
  30. Yankauer A. Y. What do you want from WHO? Am J Public Health. 1980 Jul;70(7):681–682. doi: 10.2105/ajph.70.7.681. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. de Kantor I. N., Ritacco V. Bovine tuberculosis in Latin America and the Caribbean: current status, control and eradication programs. Vet Microbiol. 1994 May;40(1-2):5–14. doi: 10.1016/0378-1135(94)90042-6. [DOI] [PubMed] [Google Scholar]

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