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Improving the health of the population in Romania by increasing TB control

Project financed by the Norwegian Grants 2009 - 2014, within the RO 19 - Public Health Initiative.

Tuberculosis (TB) is a contagious disease which is spread by air. O person with active TB may eliminate TB bacilli in air while coughing, sneezing, laughing and even singing. The people around the ill persons can inhale infectious TB bacilli. If not treated, each person with active TB can infect, in average, between 10 and 15 persons every year.

More than 2 billion people, which means a third of the world population, are infected with TB bacilli. One in 10 of those persons will become ill of TB during their lifetime.

Sensitive tuberculosis is a disease which can be cured if it is early diagnosed and treated appropriately, with drug correctly administered and healthy life-style and nutrition.

More severe forms of tuberculosis are multidrug resistant tuberculosis (MDR TB) and extensive resistant (TB XDR). These forms do not respond to standard antibiotics, need a long period of treatment (up to 2 years), with expensive drugs and much more difficult to procure and with serious adverse reactions.

Anybody can become ill with tuberculosis, disregarding the social or professional status, but the most vulnerable to the disease are the persons with a weakened immune system, poor people living in difficult conditions. 

Tuberculosis, in figures*

  • At global level, in 2013, 9 million people became ill with tuberculosis. The figure indicate an increase of the number of ill persons comparing with 2012, when 8.6 million new TB cases were registered, out of which 80% in only 22 countries
  • 550.000 children in the world became sick with TB in 2013
  • A total number of 1.5 million people died of tuberculosis in the world, in 2013 (including 360.000 persons with HIV), meaning around 4109 death per day. One in 4 deaths among the HIV persons is caused by TB
  • MDR TB and XDR TB are forms extremely difficult to treat, often causing the death of patients. The cost of the treatment for XDR TB is higher than the GDP per capita
  • At global level, in 2013, it is estimated that 480.000 persons developed multidrug resistant tuberculosis.
  • 37 million lives were saved in the world, due to early diagnostic and treatment, between 2000 and 2013. 86% of the people who became ill with TB and were put under treatment in 2012 and were successfully treated.
  • Romania* remains one of the world countries most affected by TB, and the EU member state with the highest number of cases. About 20% of the TB cases in the EU come from Romania.
  • In Romania, each year, 1100 persons die of TB and another 16,000 are diagnosed, most of them among the young and active population.
  • The fight against tuberculosis, at global level and in Romania, is affected by an important funding gap, with a deficit of more than 2 billion USD per year (in the world) and over 15 million in Romania.

(*According to the World Health Organization – October 2014 and the National TB Control Program)


Tuberculosis in Romania

The major challenge in TB control in Romania is due to the chronic funding gap of the National TB Control Program, which led to:

Problems in ensuring a rapid and complete, especially for MDR/XDR TB.

The World Health Organization (WHO) estimates that in Romania should be diagnosed, each year, between 800 and 1000 new MDR TB cases. In reality, because of the lack of necessary equipment, Romania identifies each year only 600 cases of resistant and extensive resistant TB.

At present, at global level, there are rapid diagnostic methods which decrease the diagnostic period from 6 months to 2 hours, but in Romania the access to rapid diagnostic methods is available only through projects with international funding, for a limited number of patients.

Gaps in ensuring complete, continuous and correctly administered treatment

According to the WHO missions to evaluate the National TB Control Program, for the tuberculosis resistant to treatment (MDR/XDR TB) only one part of the drugs are available in Romania.

If the treatment regiment is not administered correctly and completely, the cure of the patients is NOT possible. Basically, the patients are condemned to death, and for the population they represent an infection outbreak.

In the last years, Romania registered one of the lowest curing rate in the world of the MDR TB patients, meaning 20% (a rate equal to the spontaneous curing rate, which is without treatment). As such, in Romania, the pool with infectious patients is continuously increasing.

Lack of capacity to ensure treatment adherence

The default rate of the treatment varies between 6% for new cases and respectively over 25% for the patients with resistant tuberculosis. One of the causes of default is the lack of existence of medical-psycho-social assistance to help the patient during the entire course of treatment, in order to manage the extremely severe adverse reactions of the drugs, lack of material means to ensure daily transportation to the doctor, lack of proper food absolutely necessary for curing (at least 4,000 calories/day), lack of material means to procure ancillary drugs for the treatment of adverse reactions.

According to the studies (Raportul de cartografiere a nevoilor pacientilor cu TB din Romania – June 2014), during the period of drugs administration, the patients with tuberculosis need medical, psychological and social support, to successfully finish treatment.