Burden of Tuberculosis: Serbian Perspectives

Abstract:

Tuberculosis still remains the largest single infectious cause of death among young persons and adults, and continues to be a major public health problem in many parts of the world. TB incidence in Serbia, very high in the 1950s (about 350/100,000 population), significantly decreased in subsequent years and fell below 50/100,000 in the last decade of the twentieth century. As a result of deteriorating social and economic conditions during the 1990s, TB incidence leveled off at an annual average of 34.6/100,000 in the period 1992–2002. During the same period childhood tuberculosis incidence rates in Serbia tended to fall, which could be explained by the decreasing trend in overall tuberculosis incidence and the good control program including chemoprophylaxis of young household contacts. TB mortality in Serbia showed a significant decreasing trend from the 1950s, even in the period 1992–2002 in which the average annual mortality rate was 4.1/100,000. The decrease in DALY caused by TB in Serbia, from 1992 to 2002, was the result of a lower death rate. This means that, in addition to the improvement of primary prevention, which is very important, the improvement of secondary prevention, consisting of early diagnosis and adequate treatment, is needed to prevent premature death. The good organization and efficient work of anti-tuberculosis dispensaries in Serbia, the low frequency of HIV/AIDS, the low frequency of Mycobacterium tuberculosis resistant strains and the implementation of the DOTS strategy explain how in the 1990s, during a period of social and economic crisis, TB incidence did not increase and TB mortality continued to drop. Thanks to the intensification of health care activities regarding TB control from 1998, the epidemiological situation of TB in Serbia is not expected to deteriorate in the future despite the anticipated inevitable increase of HIV/AIDS.