World health statistics report. Rapport de statistiques sanitaires mondiales最新文献

The most important problem facing phthisiologists in the past was how to ensure a sufficient number of sanatorium beds for the management of tuberculosis patients, their rehabilitation and the prevention of transmission of infection by isolating them. There is considerable evidence today, however, that the results obtained with ambulatory treatment are as good as those following in-patient treatment. The latter is now considered unnecessary as it serves merely to prolong duration of the patient's incapacity and to increase the cost of treatment. The presentation of the available information on the trend of beds designated for tuberculosis aims at stimulating the new approach to efficient control of the disease so as to prevent the misuse of available resources. During the period 1960-1965 there were more than 870000 tuberculosis beds reported in the world. Between 1970 and 1975, the number of tuberculosis beds was reduced to 609000. The average percentage of tuberculosis beds to the existing total bed complement was 8.4 in 1960-1uberculosis bed density"--was 3.9 and 3.1 respectively, for the two periods. Owing to the very large variety of reporting systems and sometimes to their defective patterns, international comparisons are hazardous. In general, there is a considerable declining trend in the tuberculosis bed density, in countries with a high initial level, whereas in other countries an upwards trend is sometimes to be found. The analysis of the particular patterns of tuberculosis bed density is difficult, as in many countries the still existing high bed density is actually a combined tuberculosis and respiratory diseases bed density. In countries with a well developed network of institutional units, treatment costs account for approximately half the total cost of the tuberculosis control programme. In a broad public health sense bed strategy is becoming increasingly important since apart from the substantial capital cost of institutional facilities, it also influences both the pattern of service rendered and the use of resources available.

The main objective of gathering available world-wide information on tuberculosis is to present an overall picture of how tuberculosis infection, morbidity and mortality, can be reflected today and to suggest the necessity to improve international epidemiological statistical intelligence. The highest levels of tuberculosis infection in the world (i.e. 60-80% in children 14 years old) may be found in eastern Asia, Oceania and in several areas in Africa. Considerable differences still do exist between the highest and lowest prevalence level within each continent. The ratio between the highest and lowest prevalence level of infection is varying from 1 to 2 in the Americas, to 1 to 10 in Europe. While, in general, in developed countries the annual infection rate reached 0.5% (1969-1972), in developing countries, annual infection rates of 2% or more were reported. The decrease of the annual infection rate in developed countries is, in general, 10% each year, whereas in the developing part of the world the fall in the rates has been slower or the level even remained constant for the last ten years. The information concerning tuberculosis morbidity is sometimes incomplete or inconsistent because of the lack of standard criteria for diagnosing and reporting tuberculosis. Although the bacteriological confirmation of tuberculosis cases has an important bearing on the recording system, official reports are particularly deficient in this respect. Estimating the total number of newly registered tuberculosis cases, one may say that more than 3.8 million, and approximately 4 million cases could have occurred 1967 and 1971 respectively. The prevalence of tuberculosis cases can be estimated to be around 6-8 in 1967 and 8 million cases in 1971. The highest incidence rates reported in 1971 were in Asia, Oceania and in some African countries (i.e. 250-523 per 100000 population). In Europe and America, tuberculosis incidence did not exceed a level of 200 per 100000 population. The average tuberculosis incidence rate for 1971 in the world may be estimated to be 111.5 per 100000 population (111.4 in 1967).

Mortality rates for Hodgkin's disease calculated by WHO since 1957 are analyzed. In spite of a rather limited variability of the age-adjusted rates, important differences are found in age-specific rates. The mortality curve has 3 main peaks: one in childhood, one in young adults and one in older adults. Only the latter is observed uniformly in all populations. The international variability in the first 2 peaks suggests the effect of host factors in determining the age of onset and the clinical and pathological characteristics of the disease. The last peak is more in line with the usual shape of mortality curves of neoplastic diseases. A slight drop in mortality rates in recent years is reported from some countries.