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Free Content The decline of tuberculosis epidemics under chemotherapy: a case study in Morocco

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BACKGROUND: Tuberculosis (TB) case notifications per capita fell by only 3–4% per year in Morocco between 1996 and 2005, despite implementation of the World Health Organization (WHO) DOTS strategy since the early 1990s. At the current pace of epidemic decline, there will be more than 10 000 new cases in 2050, the target year for global elimination.

METHODS: Analysis of cases reported by the National TB Control Programme, disaggregated by age, sex, clinical form of TB and region, for years 1996–2005. The validity of observed patterns was judged using four criteria: statistical validity, precision of measurement, biological plausibility and the consistency and strength of different lines of evidence.

RESULTS: TB incidence (case numbers and rates) is higher in urban than in rural areas and higher in adult men than in women. The most infectious (smear-positive) form of the disease is more frequent in men with TB than women. Men aged 15–44 years accounted for half of all smear-positive cases in 2005. TB incidence has fallen more slowly than average among men, but the decline was also unexpectedly slow among women.

CONCLUSIONS: In Morocco, men living in cities should be a focus for prevention and control. Globally, routine surveillance data should be more fully exploited to guide TB control activities.

Keywords: DOTS strategy; Millennium Development Goals; Morocco; pulmonary tuberculosis; sputum smear-positive tuberculosis

Document Type: Regular Paper

Affiliations: 1: World Health Organization, Geneva, Switzerland 2: National Tuberculosis Control Programme, Direction de l'Epidémiologie et de Lutte Contre les Maladies, Division des Maladies Transmissibles Services des Maladies Respiratoires, Rabat, Morocco

Publication date: November 1, 2007

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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