Communicable disease control in China: From Mao to now

Hipgrave, David

TB is probably the most important communicable disease that China has struggled to control. China has the world' s second highest number of cases of TB (after India) and accounts for 16% of the world' s disease burden. It is estimated that around 45% of the population are infected with Mycobacterium tuberculosis, with rates of infection and active disease much higher in rural and western areas; cases number around 1.5 million per year, and deaths around 160 000. Again, TB has been the focus of several large externally-funded projects in China over the last two decades, focusing especially on the introduction and expansion of the five-component Directly Observed Treatment (Short-Course) or DOTS strategy promoted by the World Health Organisation. These were effective in treating patients identified and appropriately referred to dedicated TB facilities, but relatively ineffective in improving case-detection and suffered from many of the same problems as the immunization and schistosomiasis programs. Several reports concluded that there were socio-economic barriers to careseeking, failure or delay in referring patients for available free treatment (due to loss of income by referring clinicians), weak coordination between hospitals and public health authorities and weak local political and financial prioritization of TB case detection and management (that is, weak co-funding), particularly in poorer counties (52, 53) . The nature of TB as a disease affecting the poor, the itinerant and those least able to pay for treatment applies in China as elsewhere; absolute case numbers have increased with the population and the problem of multi-drug resistance, currently around 8% of cases, is rising.