Health and health care in South Africa — 20 years after Mandela

South Africa has one of the worst tuberculosis epidemics in the world. Driven in recent decades by the spread of HIV infection, the incidence of tuberculosis increased from 300 per 100,000 people in the early 1990s to more than 600 per 100,000 in the early 2000s and to more than 950 per 100,000 in 2012. Despite notable progress in improving treatment outcomes for new smear-positive tuberculosis cases, the tuberculosis burden remains enormous. Multidrug-resistant (MDR) tuberculosis accounts for 1.8% of all new cases of tuberculosis (95% confidence interval [CI], 1.4 to 2.3) and 6.7% of retreatment cases (95% CI, 5.4 to 8.2). Since a study involving patients with extensively drug-resistant (XDR) tuberculosis in rural South Africa made international headlines, South Africa reports the most XDR tuberculosis cases in the world. Annual notifications increased from 298 in 2005 to 1545 in 2012. Approximately 10% of MDR tuberculosis cases reported in South Africa are XDR tuberculosis cases.

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Source: NEJM