Statistical Analysis of TUBERCULOSIS

Data

PROJECT REPORT
Submitted in the summer research program of the
INSPIRE Scholarship for higher education
Session: May2013-July2013

Supervisor Submitted by
Dr. Sanjeev Kumar Abhigyan Pandey
Assistant Professor B.Sc.(Hons.) iv Sem.
Dept. of statistics, faculty of science faculty of science
Banaras Hindu University, Varanasi Banaras Hindu University, Varanasi


INSPIRE SHE Reg. no.-4053/2011
CERTIFICATE
This is to certify that the project report entitled as Statistical analysis of Tuberculosis data
has been successfully conducted and completed under my supervision and guidance.

The data used in this project report was collected, analyzed and submitted by Abhigyan Pandey.
B.Sc.(Hons.) IV sem. During the session 11 May 2013-10 July 2013.

Dated: Dr. Sanjeev Kumar
Assistant Professor
Dept. of Statistics
Banaras Hindu University
Varanasi-221005

ACKNOWLEDGEMENT

On the very outset of this report, I would like to extend my sincere and heartfelt obligation towards all the
personages who have helped me in this endeavor. Without their active guidance, help, cooperation and
encouragement I would not have made headway in the project.

Especially, I take this opportunity to express my profound gratitude and deep regards to my supervisor Dr. Sanjeev
Kumar for his exemplary guidance, monitoring and constant encouragement throughout the course of this project
work. The blessing help and guidance given by him time to time shall carry me a long way in the journey of life on
which I am about to embark .

I extend my gratitude to Dept. of STATISTICS, BANARAS HINDU UNIVERSITY and INSPIRE SHE Scheme for giving me
this opportunity.

Lastly, I thank almighty, my parents, brother, sister and friends for their constant encouragement without which
this project work would not be possible.



Dated: Abhigyan Pandey
B.Sc.(Hons.) IV-sem.
Faculty of science, BHU
Varanasi-221005






CONTENTS:
1. Introduction
2. Global TB disease burden
2.1 Tables
2.2 Graphs
2.3 Interpretations
3. India TB disease burden
3.1 Tables
3.2 Graphs
3.3 Interpretations
4. TB-HIV Co infection
5. Conclusion
6. References & Abbreviations

Introduction
Tuberculosis, or in short TB, is caused by the bacterium Mycobacterium tuberculosis,
which can be present as either latent infection or active disease. Latent TB infection
means that TB bacteria are living in the body but not causing any symptoms. People
with latent TB infection are not sick, do not have symptoms, and cannot spread the
disease. TB disease means that the bacteria are multiplying and are destroying body
tissues, if not diagnosed and treated properly, it can be fatal. People with TB disease are
sick do have symptoms, and can spread the disease. Only TB disease is infectious latent
TB infection is not. TB disease of the lungs or airways can be spread from person to
person through the air when a person with TB disease coughs, sneezes, speaks.
TB infection can be detected by a skin test or a blood test, if the test is positive,
additional tests such as sputum tests and x-rays are needed to determine whether the
infection has progressed to TB disease.
The symptoms of active TB of the lung are coughing, sometimes with sputum or blood,
chest pains, weakness, weight loss fever and night sweats. Tuberculosis is treatable with
a six-month course of antibiotics. The drugs that are taken for the treatment of TB, have
the aim of killing all the TB bacteria in the persons body. However, TB bacteria die very
slowly, and so the drugs have to be taken for quite a few months. Even when a patients
starts to feel better they can still have bacteria alive in their body, and so the person
needs to keep taking the medicine until all the bacteria are dead. All the drugs must be
taken for the entire period of treatment. If only one or two drugs are taken then the
bacteria may not all be killed and they can become resistant to the drugs which then
dont work. If the person becomes sick again then different drugs may be needed.


TB Treatments the aims:-
The aims of TB treatments are-
To cure the patients and restore quality of life and productivity.
To prevent relapse of TB.
To reduce the transmission of TB to others.
To prevent the development and transmission of drug resistant TB.

Relapse, failure and recurrence:-
A patient is said to relapse if they improve whilst on TB treatment, but become ill again after
finishing their TB treatment. Patients who experience only a transient improvement whilst on
TB drug treatment, or who never respond to treatment, are said to have failed their TB
treatment.
Recurrence of active TB is usually used to refer to the situation when a persons first TB
treatment appears to have been successful, and there has then been a significant time interval
before active develops again. This may either be because of reactivation of the persons
have been reinfected. In any of these situations it must be considered a real possibility that the
person has drug resistant TB and their TB drug treatment program must be decided taking this
into account.








Tabulation and analysis
of Global TB burden

Tables
Graphs and charts
Interpretations
Global TB disease burden
As per the WHO Global TB Report2011, there were an estimated 8.8 million
incident cases of TB(range,8.5million-9.2million) among HIV-negative cases of TB
and an additional 0.35 million deaths(range,0.32million-0.39million) among
people who were HIV positive in 2009, there were an estimated
9.7million(range,8.5-11million) children who were orphans as a result of parental
deaths caused by Tuberculosis.Globally,the absolute number of incident TB cases
per year has been falling since 2006 and the incidence rate(per 1000000
population) has been falling by 1.3%per year since 2002. If these trends are
sustained, the MDG target that TB incidence should be falling by 2015 will be
achieved.
Pie diagram1:-
The following pie diagram shows the incidence of TB patients throughout the
world continents wise-




2300000
260000
660000
380000
3500000
1700000
Incidence of TB
Africa
Americas
Eastern Mediterranean
Europe
Asia
Western pacific
Table1:-The following table shows the total number of incidence and deaths
cases due to TB in various continents.

Continents Deaths due to TB Incidence of TB

Africa 220000 2300000

Americas 21000 260000


Eastern
Mediterranean

99000 660000

Europe 45000 380000

Asia 480000 3500000


Western pacific 130000 1700000

Source- "Global Tuberculosis Control 2012, WHO, Geneva

Bar Diagram1:-
The bar diagram1 shows the deaths and incidence of TB patients in various
continents.



0 1000000 2000000 3000000 4000000
Africa
Americas
Eastern
Mediterranean
Europe
Asia
Western pacific
Incidence of TB
Deaths due to TB




Interpretations of TB incidence and deaths in continents:-
There are 35,00,000 estimated incidence cases of TB in Asia which
is highest as compared to other continents.

There are 2300000 estimated incidence cases of TB in Africa.


American continents are in good condition.

Europe and other continents are in satisfactory condition.

In Asia India has the maximum number of TB patients, whereas
China is the second.

Medical facilities in Asia are in very poor condition almost 48%
deaths in Asia out of incidence cases.




TB Statistics for high burden countries:-
Of all the countries that report their TB statistics to WHO. There are 20 countries
that are sometimes referred to as the TB high burden countries, and they have
been prioritized at a global level since 2000. There are 20 of these countries and
between them they accounted for 81% of all estimated cases of TB worldwide in
2011.
Table2:- Data for high burden countries
Country Incidence


Deaths

Population
Afghanistan 61000

13000

32,358,000
Bangladesh 340,000

68000

150,494,000
Brazil 83,000

5600

196,655,000
Cambodia 61,000

9100

14,305,000
China 1,000,000

47000

1,347,565,000
DR Congo 220,000

36000

67,758,000
Ethiopia 220,000

15000

84,734,000
India 2,200,000

300000

1,241,492,000
Mozambique 130,000

11000

23,930,000
Myanmar 180,000

23000

48,337,000
Nigeria 190,000

27000

162,471,000
Pakistan 410,000

59000

176,745,000
Philippines 260,000

28000

94,852,000
Russian Federation 140,000

22000

142,836,000
South Africa 500,000

25000

50,460,000
Thailand 86,000

9800

69,519,000
Uganda 67,000

5000

34,509,000
UR Tanzania 78,000

6400

46,218,000
Viet Nam 180,000

38000

88,792,000
Zimbabwe 77,000

6000

12,574,000

Source:- "Global Tuberculosis Control 2012, WHO, Geneva


Bar Diagram2:-
The following bar diagram shows the fraction of died people over incidence TB
cases in high burden countries in year 2011.





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Fraction of death over incidence TB cases
Interpretations of bar diagram2:-
In high burden countries Afghanistan has highest fraction
of deaths over incidence TB cases due to poor medical
facilities and insufficient supports from the governments.

China has the largest proportion of population but fraction
for deaths over incidence TB cases is very less because TB
control has been a part of Chinas public health program
since the 1950s.


Vietnam, Russian federation, India and Pakistan are also
have high fraction of deaths over incidence TB cases.








Bar Diagram3:
The following bar diagram shows the proportion of incidence TB case and
proportion of deaths in high burden countries in year 2011.







0 0.1 0.2 0.3 0.4 0.5
Afghanistan
Bangladesh
Brazil
Cambodia
China
DR Congo
Ethiopia
India
Mozambique
Myanmar
Nigeria
Pakistan
Philippines
Russian Federation
South Africa
Thailand
Uganda
UR Tanzania
Viet Nam
Zimbabwe
Proportion of Deaths
Proportion of Incidence
Bar Diagram4:-
The following bar diagram shows the proportion of incidence and population
proportion in high burden countries in year 2011.







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0.2
0.25
0.3
0.35
0.4
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Countries
Proportion of Incidence
population proportion
Interpretations of Bar diagrams 3 and 4:-
In Zimbabwe, UR Tanzania, Uganda, South Africa, Philippines, Mozambique,
Ethiopia, China and Brazil proportion of deaths low with respect to
proportion of incidence. So by this we draw a conclusion that in these
countries medical facilities are good with respect to other high burden
countries.

Afghanistan, Bangladesh, DR Congo, India, Pakistan and Vietnam are in very
poor condition due to low social level and insufficient medical facilities.

In Thailand proportion of deaths and proportion of incidence both are
almost equal.

Afghanistan, Bangladesh, DR Congo, Ethiopia, India, Mozambique,
Myanmar, Pakistan, Philippines, Thailand, and Zimbabwe have higher
proportion of incidence with respect to population proportion.

South Africa is in very bad condition. It has very low population proportion
among high burden countries but it has very high proportion of incidence
because South Africa has the highest TB-HIV coinfection in the world,TB is a
leading cause of death for people living with HIV.

China is in very good condition. It has very low proportion of incidence with
respect to population proportion.


Interpretations of Global TB disease burden:-
There were an estimated 8.7 million incident cases of TB in 2011.

The Africa and Asia continents are in bad condition.


There are 20 of these countries and between them they accounted for 81%
of all estimated cases of TB worldwide in 2011.

There were an estimated 1.42 million deaths. Of these 990,000 were
among HIV negative people and there were a further 430,000 deaths
among HIV positive people.


Medical facilities are in poor condition in Indian subcontinent, Africa, and
Vietnam

In high burden country china is in the good condition.

.





Tabulation and analysis
of India TB burden

Tables
Graphs and charts
Interpretations



TB Burden in India
Though India is the second-most populous country in the world, India has more
new TB cases annually than any other country. In 2009,out of the estimated
global annual incidence of 9.4million TB cases, 2million were estimated to have
occurred in india, thus contributing to a fifth of the global burden of TB. It is
estimated that about 40% of Indian population is infected with TB bacillus.
Bar Diagram5:-
The following bar diagram shows the comparison of India with some other
country.





0 100 200 300 400 500 600 700
swaziland
Camodia
Bangaladesh
INDIA
Pakistan
China
Russia
Japan
USA
TB patients per lakhs population of year 2011
Table3:- The following table shows the TB cases notified in India from year
2005-2011.


Year Tb cases notified
2005
1,294,550

2006
1,400,340

2007
1,474,605

2008
1,517,363

2009
1,533,309

2010
1,522,147

2011
1,515,872


Source- TB India 2012 annual report

Interpretation:-
TB is prevalent even in developed countries. But it is a more serious
problem in the developing and populous countries.







Bar Diagram6:-
The following bar diagram shows the total number of TB cases notified
during years 2005-2011.






1,294,550
1,400,340
1,474,605
1,517,363
1,533,309
1,522,147
1,515,872
1,150,000
1,200,000
1,250,000
1,300,000
1,350,000
1,400,000
1,450,000
1,500,000
1,550,000
1,600,000
2005 2006 2007 2008 2009 2010 2011
Total TB cases notified
Total TB cases notified


Bar Diagram7:-
The following bar diagram shows the death due to TB in India in the year
2011.






300,000
1515872
0
200,000
400,000
600,000
800,000
1,000,000
1,200,000
1,400,000
1,600,000
People died from TB in INDIA People infected from Tb
P
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a
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n

Table4:-
The following table shows the number of TB patients in a year and new TB
cases notified in that year


Year
Total TB case
notified
New TB case
notified

2005 1294550 507089

2006 1400340 554914

2007 1474605 592262

2008
1517363 616027



2009 1533309 624617

2010 1522147 630165

2011 1515872 642321

Source- Revised national TB control program
Interpretations:-
TB patients were increased in a regular manner from the year 2005
to 2009 and slightly decreased in the year 2010 and 2011.
The new TB cases were increased in a regular manner from 2005 to
2011.


Bar Diagram8:-
The following bar diagram shows the comparison of total TB case notified
versus new TB case notified in India.







0
200000
400000
600000
800000
1000000
1200000
1400000
1600000
1800000
2005 2006 2007 2008 2009 2010 2011
P
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Years
Comparison of total TB case notified versus
new TB case notified in india
Total TB case notified
New TB case notified

Table5:-
TB retreatment outcome statistics for India



Year Treatmen
t relapse
retreatme
nt success
Treatment
relapse
retreatment
death,
failure or
default
Treatment
failure
retreatment
success
Treatment
failure
retreatment
death,failure
or default
Treatmen
t default
retreatme
nt success
Treatment
default
retreatment
death,failure
or default
2005 73% 26% 59% 40% 67% 32%
2006

73% 26% 58% 41% 66% 31%
2007 74% 23% 60% 38% 68% 30%
2008 75% 24% 59% 39% 68% 29%
2009 75% 24% 58% 41% 68% 29%
2010 75% 24% 57% 41% 68% 30%

Table6:- The following table consists the number of patients and population of every state
in India.

States patients population
Andaman & Nicobar 908 400000
Andhra Pradesh
111915 84700000



Arunachal Pradesh 2311 1400000



Assam 37841 31200000
Bihar 76484 103800000
Chandigarh 2537 1100000
Chhattisgarh 27118 25500000
Dadar & Nagar haveli 419 300000
Daman & Diu 313 200000
Delhi 51645 16800000



Goa 1982 1500000
Gujrat 74867 60400000
Haryana 37913 25400000
Himachal Pradesh 13501 6900000
Jammu & Kashmir 13473 12500000
Jharkhand
38574 33000000

Table6 continued
Karnataka

70595

61100000
Kerala

26126

33400000




Lakshadweep

17

100000
Madhya Pradesh

90764

72600000
Maharashtra

135281

112400000
Manipur

3080

2700000
Meghalaya

5079

3000000
Mizoram

2304

1100000
Nagaland

3722

2000000
Orissa

48970

41900000
Puducherry

1568

1200000
Punjab

39206

27700000
Rajasthan

112504

68600000
Sikkim

1631

600000
Tamil Nadu

79830

72100000
Tripura

2798

3700000




Uttar Pradesh

285884

199600000
Uttarakhand

14883

10100000
West Bengal

99829

91300000

Source:- Revised national TB control program

Bar diagram9:-
The following bar diagram shows the TB patients proportion and population proportion of the
states which have the TB patients proportion less than 0.003.





Lakshadweep
Daman & Diu
Dadar & Nagar haveli
Andaman & Nicobar
Puducherry
Sikkim
Goa
Mizoram
Arunachal Pradesh
Chandigarh
Tripura
Manipur
Nagaland
Population proportion
TB patients proportion

Bar diagram10:-
The following bar diagram shows the TB patients proportion and population proportion of the
states which have the TB patients proportion greater than 0.003 but less than 0.03.







0 0.005 0.01 0.015 0.02 0.025 0.03
Meghalaya
Jammu & Kashmir
Himachal Pradesh
Uttarakhand
Kerala
Chhattisgarh
Assam
Haryana
Jharkhand
Punjab
Population proportion
TB patients proportion

Bar diagram11:-
The following bar diagram shows the TB patients proportion and population proportion of the
states which have the TB patients proportion greater than 0.03.




0 0.05 0.1 0.15 0.2
Orissa
Delhi
Karnataka
Gujrat
Bihar
Tamil Nadu
Madhya Pradesh
West Bengal
Andhra Pradesh
Rajasthan
Maharashtra
Uttar Pradesh
Population proportion
TB patients proportion


Interpretations of bar diagrams 9, 10 and 11:-
Nagaland, Chandigarh, Arunachal Pradesh, Mizoram, Sikkim, Haryana,
Himachal Pradesh, Rajasthan and Delhi are in very poor condition.
These states have TB patients proportion much higher than the
population proportion.

Tripura, Kerala, Lakshadweep and Bihar are in satisfactory condition.



Madhya Pradesh and Gujrat have same population proportion and TB
patients proportion.
















Table7:- Year wise budget for the 11
th
five year plan for Revised
national TB control program

Year Allocation as per
Planning
commission(in crore)
Actual allocation by
the MOHFW*(in
crore)
2007-08 267.00 267.00
2008-09 275.00 275.00
2009-10 285.00 312.25
2010-11 300.00 350.00
2011-12 320.00 400.00

Bar diagrams12:-



1440000
1450000
1460000
1470000
1480000
1490000
1500000
1510000
1520000
1530000
1540000
2
0
0
7
2
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0
8
2
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9
2
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1
0
2
0
1
1
Total TB case notified
Total TB case
notified
0
100
200
300
400
500
2
0
0
7
2
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8
2
0
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9
2
0
1
0
2
0
1
1
Allocation of
rupees(in crores) for
RNTCP
Allocation of
rupees(in
crores) for
RNTCP


Interpretations:-
The allocations of rupees for the RNTCP by the ministry of health and
family welfare are increased in a regular manner every year but the total
number of notified cases of TB patients in India is increased from 2007 to
2009 and then slightly decreased.


Table8:- Population attributable fraction- risk factors for progression to disease


Factors Weighted prevalence Population
attributable fraction
HIV infection 0.8% 16%
Malnutrition 16.7% 27%
Diabetes 5.4% 10%
Alcohol use 8.1% 13%
Active smoking 26% 21%
Indoor air Pollution 71.2% 22%

Source- TB India 2012 annual report





Fitting of curve for the total number of patients in India in
various years:-

Equation of Regression curve
y=4.935257841+0.142348x+0.02585976x
2




Interpretations:-
From the curve estimated number of patients for the year 2012 is
1508883.
Number of patients for the year 2013 is 1516772
Number of patients for the year 2014 is 1525177
1250000
1300000
1350000
1400000
1450000
1500000
1550000
2004 2006 2008 2010 2012 2014 2016
p
a
t
i
e
n
t
s

Years



TB and HIV Co-infection

TB and HIV co-infection is when people have both HIV infection, and also either
latent or active TB disease. In 2011, there are total 430,000 people are estimated
to have died of TB and HIV co-infection, in addition to the 990,000 people who
died from TB alone. Those people, who have HIV infection as well as TB when
they die, are internationally reported as having died of HIV infection. In total an
estimated 1.7 million people died of HIV infection in 2011. So this means that the
deaths from TB and HIV are:
Deaths* from HIV and TB coinfection:430,000
Deaths* from TB alone:990,000
Deaths* from HIV alone:1,270,000

*in the year2011

So with an estimated 1.42 million people having active TB when they died, of
these 30% also had HIV infection. The World health organisation(WHO)
reported that in 2010 350,000 people died who had active TB and HIV infection,
meaning an increase between 2010 and 2011. Yet despite this in November
2012 UNAIDS reported that there had been a 13% reduction in TB associated
HIV deaths in the last two years.







CONCLUSION
Tuberculosis was declared a global health emergency in 1993 but it has been
growing unchecked. Today, TB is causing millions of deaths every year globally.
Like any infectious disease, TB is prevalent even in developed countries. But it is
a more serious problem in the developing and populous countries. According to
the WHO report, the detection rate for new and relapse cases is almost the same in
1995 and 2011, 58 in 1995 and 59 in 2011. But it was 71 per cent in 2011 among
new sputum positive patients alone. But among the populous countries china is in
good condition because of the 37 notifiable diseases in china, TB ranks no. 1. The
concept of acceptance of the problem, identifying its requirements and the political
will of TB eradication has set China on a progressive path. From the above
analysis, there are following main points which is
In 2011 total 430,000 people are estimated to have died of TB and HIV co-
infection There are 35,00,000 estimated incidence cases of TB in Asia which is
highest as compared to other continents.
TB patients were increased in a regular manner from the year 2005 to 2009 and
slightly decreased in the year 2010 and 2011.
The new TB cases were increased in a regular manner from 2005 to 2011.
The estimated number of patients for the year2014, is 1525177.




Abbreviations:-
Abbreviations used in this project are-
WHO- World Health organization
RNTCP- Revised national TB control program
TB- Tuberculosis
MOHFW- Ministry of health and family welfare

References:-
My major references are-
Global Tuberculosis Control 2012, report WHO, Geneva
TB India 2012 report
Revised national TB control program
The Hindu
Wikipedia.org
Tbfacts.org