Trends of Zambia's tuberculosis burden over the past two decadesTendances de la charge de la tuberculose en Zambie au cours des deux dernieres decenniesTendencias en la carga de tuberculosis en las ultimas dos decadas en Zambia

Objectives To study trends in Zambia's TB notification rates between 1990 and 2010 and to ascertain progress made towards TB control. Methods Retrospective review of TB notification returns and TB programme reports for the period from 1990 to 2010. Results Two distinct TB trend periods were identified: a period of rising trends up to a peak between 1990 and 2004 and a period of moderately declining trends between 2004 and 2010. Treatment outcomes improved over the two decades. Data on trends in paediatric TB, TB in prisoners and TB in pregnant women remain scanty and unreliable owing to poor diagnostic capability. There were no data available on trends on drug-resistant TB because of the lack of laboratory services to perform drug sensitivity testing. Conclusions The period of increasing TB between 1990 and 2000 coincided with an increase in HIV/AIDS. The period of slightly decreasing TB between 2004 and 2010 can be attributed to improved TB care, sustained DOTS implementation and improvement in TB diagnostic services. Newer diagnostics technologies for the rapid diagnosis of active TB cases and for drug-resistant testing, recently endorsed by the WHO, need to be implemented into the national TB programmes to detect more cases and to provide epidemiological and surveillance data from which to obtain an evidence base for guided investments for TB control. Alignment of TB and HIV services is required to achieve improved management outcomes.Original Abstract: Objectifs: Etudier les tendances des taux de notification de la tuberculose (TB) en Zambie entre 1990 et 2010 et evaluer les progres accomplis vers la lutte antituberculeuse. Methodes: Revue retrospective des notifications de la TB et des rapports du programme TB pour la periode allant de 1990 a 2010. Resultats: Deux periodes distinctes de tendance de la TB ont ete identifiees: une periode de tendance a la hausse avec un pic entre 1990 et 2004 et une periode de tendance a la baisse moderee entre 2004 et 2010. Les resultats du traitement se sont ameliores au cours des deux dernieres decennies. Les donnees sur les tendances de la TB infantile, la TB chez les detenus et la TB chez les femmes enceintes restent rares et peu fiables en raison des possibilites de diagnostic faibles. Il n'y avait pas de donnees disponibles sur les tendances de la TB resistante aux medicaments en raison du manque de services de laboratoire pour effectuer les tests de sensibilite aux medicaments. Conclusions: La periode d'augmenta