Tuberculosis in DPR Korea           

With a population of nearly 24 million, the Democratic People’s Republic of Korea (DPR Korea) has an annual incidence and prevalence of all forms of TB of, respectively, 345 and 423 per 100,000 populations. The expected incidence was revised upwards significantly in 2007 following a national ARTI survey. The notification rate of all forms of TB and new smear-positive cases in 2010 were respectively 408 and 132, showing a steady increase compared with previous years.

Given the significant gap between the estimated incidence and actual case notifications, intensified and active case-finding in the community was adopted as a supplementary method for case-finding. The more active case-finding campaign and integration of previously non-DOTS sectors such as health facilities under the ministries of the military, security and railways has led to an increase in case notifications. The treatment success rate for the cohort of patients registered in 2009 was 90%.

National response to DR-TB has been limited due to resource constraints. A national reference laboratory for culture and DST has been established at the Central TB Institute in Pyongyang. Guidelines for MDR-TB Management have been developed and Programmatic Management of DR-TB is expected to be initiated in early 2012. There is no reliable data on the extent of MDR-TB in the country. However, re-treatment cases comprised 14% of all notified cases during 2010. A drug resistance survey is planned to be initiated in early 2012. The protocol for the DRS is being developed and support of national and international partners is being mobilised

A strategic plan has been developed for 2008–2015, in line with the Global Plan to Stop TB and the Regional Plan for TB Control 2008–2015. The government provides for over half of the programmes’ funding requirements in terms of staffing, infrastructure, drugs and surveillance. WHO continues to provide support to the programme in terms of technical assistance, training health staff, strengthening laboratory services, upgrading infrastructure, and monitoring and evaluation.

Regular supplies of anti-TB drugs have been ensured through the GDF grant mechanism from 2003- 2009 and WHO-SEARO secured funds on an exceptional basis to provide up to 90% of funding to cover the needs of 2010. Supplementary support is also received through the Eugene Bell Foundation and the Christian Friends of Korea. From 2011, the main support for adult anti-TB drugs are coming though Global Fund Round 8 grant. UNICEF, DPR Korea is the Principal Recipient of this Global Fund grant and WHO, Country Office is sub-recipient.

Major achievements:

·        DOTS is firmly in place with service delivery extending to even the most peripheral level.

·        A national TB reference laboratory for culture and DST has been established.

·        M&E and supervision of DOTS implementation has been strengthened.

·        Logistic management system for drug supply and management strengthened.

·         TB estimates revised on the basis of ARTI survey.

·        Health facilities in other sectors involved in TB control and management.

·        Involvement of household doctors in DOTS institutionalized.

·        Standardized laboratory kits introduced.

·        Patient-wise kits introduced.

·        Global Fund-supported project initiated.

 

Major challenges:

·        Sustaining funding to implement basic DOTS, shortages of laboratory reagents and first-line drugs being a consequence.

·        Low level of documentation of DOTS by household doctors.

·        Inadequate laboratory capacity for undertaking laboratory QA.

·        Diagnosis of TB in children is not widely undertaken.

·        Lack of adequate information on pattern of MDR-TB in the country and non-availability of drugs for MDR-TB.

 

 

 

 


 

Estimates and notification rates for 2010

DPR Korea

Number of population

24 345 000

Estimated TB incidence(All forms)

82 000 (70000-96000)

Estimated TB incidence rate
(All form
s, per 100,000 population %)

345 (293-400)

Estimated TB Prevalence(All forms)

100 000(30 000~180 000)

Estimated prevalence rate
(All form
s, per 100,000 population %)

423 (126-736)

Estimated NSP Patients

40 656

Estimated NSP rate %

167

Estimated TB Mortality(All forms)

5 900

Estimated TB mortality rate
(All form
s, per 100,000population %)

25

 

 

 

Source: National Tuberculosis Recording and Reporting System

  Global Tuberculosis control 2010, WHO

 

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