Intended for healthcare professionals

Rapid response to:


WHO annual report finds world at a crossroad on tuberculosis

BMJ 2012; 345 doi: (Published 19 October 2012) Cite this as: BMJ 2012;345:e7051

Rapid Response:

Re: WHO annual report finds world at a crossroad on tuberculosis

Tuberculosis is one of the major public health problems in China. According to WHO’s report, China has the world’s second largest group of tuberculosis patients, behind India, with 1.3 million new cases of tuberculosis every year. 1 Tuberculosis has already been the number one cause of death from infectious disease among Chinese people. Within the 39 notifiable communicable diseases in China, tuberculosis ranks first with respect to notified cases and deaths. 2 About 130,000 Chinese people died from tuberculosis per year.3

In recent years, China has been making much effort against tuberculosis. The central government increased funding for tuberculosis control from RMB 40 million in 2001 to RMB 580 million in 2010. 4 A new five-year initiative program (from 2011 to 2015), was announced in 2011, with objectives to use innovative technologies to improve the detection and treatment of tuberculosis. And the Ministry of Health has revised the law on the prevention and control of tuberculosis, with the aims to provide instructions to tackle tuberculosis outbreaks.

However, tuberculosis control is still an enormous challenge in China. Across the country, the number of people infected with tuberculosis bacteria is about 500 million, which accounts for 45% of the total population. 5 The low rate of public awareness on tuberculosis, including lack of knowledge on tuberculosis among Chinese people is becoming a major handicap for tuberculosis prevention and control. On the basis of the result from the 5th National tuberculosis epidemiology survey in 2011, the rate of public awareness on general knowledge about tuberculosis was as low as 57%. Among tuberculosis patients, only 47% have sought treatment. And only 59% of patients took their medicines as directed. 6 Moreover, there are some other serious problems relevant to the low public awareness on tuberculosis.

First, in China, there is significant disparity in the epidemic situation among different regions, tuberculosis morbidity rate in west area is 1.7 times the morbidity rate of middle area, and 2.4 times the rate of east area, and the morbidity rate in rural areas is 1.6 times the rate of urban areas. Overall, 80% tuberculosis patients are from rural areas in China. Second, there are significant gaps in the awareness of tuberculosis among different groups of people. Rural people and rural-urban migrants are two groups with lowest awareness of tuberculosis. 7 In 2011, a murder of exterminating a family in Gansu indicated the ignorance and misunderstanding about tuberculosis especially in Chinese rural areas. A man killed his wife and three children; because he thought they all were infected with tuberculosis - an incurable disease. 8 Third, the situation with respect to multi-drug resistant tuberculosis (MDR-TB) in China is severe. The multi-drug resistance rate among tuberculosis patients is as high as 8.32%, which resulted from the shortage of knowledge on tuberculosis diagnosis and treatment, such as unreasonable treatment programmes, and interrupted treatment by patients due to shortage of awareness on tuberculosis.6

Public education plays a key role in tuberculosis prevention and control, and prevention is one of the main factors that lead to limit tuberculosis transmission. Future programmes of tuberculosis prevention and control in China should publicly emphasise general knowledge of tuberculosis, which includes tuberculosis symptoms, tuberculosis dispensaries, knowledge about tuberculosis transmission (cough and sneeze) and risk factors, knowledge about tuberculosis diagnosis and treatment, knowledge about tuberculosis prevention, and its free tuberculosis detection/treatment policy to increase public tuberculosis awareness. Moreover, the education could target different groups of people, especially should include rural people, rural-urban migrants, tuberculosis patients, and students who account for 30% of the total population. The education can be carried out by distribution of pamphlets and materials, lectures and seminars, health training, blackboard newspapers and bulletin boards. Besides, the level of education about tuberculosis for medical staff should also be improved.

The media, including electronic and print media, should be encouraged to communicate accurate scientific information about tuberculosis.


1 WHO. Global tuberculosis control. WHO Report. WHO/HTM/TB/2006.362. Geneva: World Health Organization, 2006.

2 Ministry of Health Public in China. Ministry of Health report on status of national notifiable diseases in Jan 2013. (accessed Feb 22, 2013)

3 Around 130,000 Chinese people died from tuberculosis every year. (accessed Feb 22, 2013)

4 Jia Z, Cheng S, Wang L. Tuberculosis control in China: striving for sustainability. Lancet 2012; 379 (9832): 2149.

5 The survey shows that 500 million infected with tuberculosis bacteria in China. (accessed Feb 22, 2013)

6 The Ministry of Health in China issues the tuberculosis morbidity rate across the country. (accessed Feb 24, 2013)

7 Hu X. Cook S. & Salazar M. A. Internal migration and health in China. The Lancet 2012; 372 (9651):1717-1719.

8 The murder of exterminating a family is a result of ignorance. (accessed Feb, 24, 2013)

Competing interests: No competing interests

23 May 2013
Yan Li
Associate Professor
School of Philosophy and Social Development, Shandong University, China
27 Shanda Nanlu, Jinan City, Shandong, China