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TB continuum of care
Step 1: People not accessing the health system


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This dashboard presents indicators relevant for the first step of the continuum of TB care and prevention

People with TB infection, high risk of disease

B.1. Risk factors

B.1.1 HIV prevalence among adults aged 15-49 years (%)

B.1.2 Alcohol use disorders (15+), 12 month prevalence (%), YEAR

B.1.3 Diabetes prevalence among adults aged ≥18 years (%)

B.1.4 Estimate of current tobacco smoking prevalence (%) (age-standardized rate)

B.1.5 BCG immunization coverage among 1-year-olds (%)

B.1.6 Probability of dying by age 5 per 1000 live birth

B.1.7 Underweight prevalence among children under 5 years of age (% weight-for-age <-2 SD), survey-based estimates

B.1.8 Prevalence of thinness among children and adolescents, BMI <-2 standard deviations below the median (crude estimate) (%)

B.1.9 Prevalence of underweight among adults, BMI <18.5 (crude estimate) (%)

B.2. Screening

B.2.1 Percentage of household contacts (or all close contacts) evaluated for TB

B.2.2 Percentage of people newly diagnosed with HIV who were screened for TB, 2023

B.2.3 Percentage of people living with HIV who were screened for TB, 2023

B.2.4 Percentage of people in prison who are screened for TB, 2023

B.2.5 Percentage of miners exposed to silica dust who were screened for TB, 2023

B.2.6 Percentage of districts in which chest X-ray is used regularly for TB screening, 2023

B.3. Social protection

B.3.1 Population covered by at least one social protection benefit

B.3.2 Public social protection expenditure (% of GDP), YEAR

B.3.3 Population with household spending on health greater than 10% of total household budget

B.3.4 Population with household spending on health greater than 25% of total household budget

B.3.5 Prevalence of moderate or severe food insecurity in the population

B.4. Socioeconomic

B.4.1 GDP per capita (constant LCU)

B.4.2 GDP per capita (current LCU)

B.4.3 GDP per capita, PPP (constant 2021 international $)

B.4.4 Health expenditure per capita, PPP (current international $)

B.4.5 Poverty headcount ratio (national): Percentage of population living below the national poverty line, YEAR

B.4.6 Percentage of population living below international poverty line

B.4.7 Percentage of population with access to clean fuels and technologies for cooking

B.4.9 Percentage of urban population living in slums

Asymptomatic disease, not seeking care

B.5. Detection

B.5.1 Rate ratio of estimated incident to notified TB cases, 2023

B.5.2 Rate ratio of prevalent to notified TB cases by sex, YEAR

B.5.3 Rate ratio of prevalent to notified TB cases by age group, YEAR

B.5.4 Percentage of survey participants with radiological abnormalities (screen positive) from the field reading, YEAR

B.5.5 Percentage of people diagnosed with bacteriologically confirmed TB during the survey who did not report screening symptoms, YEAR

Symptomatic disease, not seeking care

B.6. Health seeking behaviour

B.6.1 Percentage of national TB prevalence survey participants with symptoms suggestive of pulmonary TB, YEAR

B.6.2 Percentage of symptom-screen positive national TB prevalence survey participants who did not seek care, YEAR

B.6.3 Percentage of symptom-screen positive national TB prevalence survey participants who sought care by health facility type, YEAR

B.6.4 Children aged <5 years with pneumonia symptoms taken to a health facility by area type (%)

B.6.5 UHC service coverage index

Metadata

Glossary and definitions

HIV prevalence among adults aged 15-49 years (%)

The estimated number of adults aged 15-49 years with HIV infection, whether or not they have developed symptoms of AIDS, expressed as per cent of total population in that age group.

Alcohol use disorder (15+), 12 month prevalence (%)

Adults (15+ years) who suffer from disorders attributable to the consumption of alcohol (according to ICD-10: F10.1 Harmful use of alcohol; F10.2 Alcohol dependence) during a given calendar year. Numerator: Number of adults (15+ years) with a diagnosis of F10.1, F10.2 during a calendar year. Denominator: Midyear resident population (15+ years) over the same calendar year. UN World Population Prospects, medium variant.

Diabetes prevalence among adults aged ≥18 years (%)

Proportion of population aged  ≥18 years with raised fasting blood glucose (≥7.0 mmol/L) or on medication.

Estimate of current tobacco smoking prevalence (%)

Current smoking of any tobacco product prevalence estimates, resulting from the latest adult tobacco use survey (or survey which asks tobacco use questions), which have been adjusted according to the WHO regression method for standardising that attempts to enable comparisons between countries.  "Tobacco smoking" includes cigarettes, cigars, pipes or any other smoked tobacco products. “Current smoking” includes both daily and non-daily or occasional smoking.

BCG immunization coverage among 1-year-old (%)

The percentage of live births who have received one dose of bacille Calmette-Guérin (BCG) vaccine in a given year. 

Probability of dying by age 5 per 1000 live birth

The probability of a child born in a specific year or period dying before reaching the age of five, if subject to age-specific mortality rates of that period. Under-five mortality rate as defined here is strictly speaking not a rate (i.e. the number of deaths divided by the number of population at risk during a certain period of time) but a probability of death derived from a life table and expressed as rate per 1000 live births.

Underweight prevalence among children under 5 year of age (% weight-for-age <-2 SD), survey-based estimates

 Prevalence of underweight children is the percentage of children under age 5 whose weight for age is more than two standard deviations below the median for the international reference population ages 0-59 months. The data are based on the WHO's 2006 Child Growth Standards.

Prevalence of thinness among children and adolescents, BMI <-2 SD below the median (crude estimate) (%)

Percentage of defined population with a body mass index (BMI) less than 2 standard deviations below the median, according to the WHO references for school-age children and adolescents.

Prevalence of underweight among adults, BMI <18.5 (%)

Percentage of adults aged 18 years and over with a body mass index (BMI) less than 18.5 kg/m2.

Household contact

A person who has shared the same enclosed living space as the index case for one or more nights or for frequent or extended daytime periods in the 3 months before TB disease was identified in the index case.

Contact investigation (or evaluation)

A systematic process for identifying previously undiagnosed people with TB among the contacts of an index case. Contact investigation consists of identification, prioritization and clinical evaluation. It may also include testing for TB infection to identify candidates for TB preventive treatment. Recommendations on how to evaluate contacts can be found in WHO guidance on prevention and screening, however, approaches used to implement those methods vary according to country settings.

Population covered by at least one social protection benefit

Proportion of population covered by at least one social protection benefit. The indicator reflects the proportion of persons effectively covered by a social protection system, including social protection floors. It also reflects the main components of social protection: child and maternity benefits, support for persons without a job, persons with disabilities, victims of work injuries and older persons. 

Public social protection expenditure (% GDP)

Social protection expenditure refers to total programme expenditure expressed as percentage of GDP. It includes spending on benefits and administrative costs; it also captures both recurrent and capital programme budget. The indicator is constructed based on administrative program records. Social spending includes, among others, the following areas: health, old age, incapacity-related benefits, family, active labor market programmes, unemployment, and housing.

Population with household spending on health greater than 10% of total household budget

The proportion of the population with household expenditure on health exceeding 10% of total household expenditure or income.

Population with household spending on health greater than 25% of total household budget

The proportion of the population with household expenditure on health exceeding 25% of total household expenditure or income.

Prevalence of moderate or severe food insecurity in the population

The percentage of people in the population who live in households classified as moderately or severely food insecure. A household is classified as moderately or severely food insecure when at least one adult in the household has reported to have been exposed, at times during the year, to low quality diets and might have been forced to also reduce the quantity of food they would normally eat because of a lack of money or other resource.

GDP per capita (constant LCU)

GDP per capita is gross domestic product divided by midyear population. GDP at purchaser's prices is the sum of gross value added by all resident producers in the economy plus any product taxes and minus any subsidies not included in the value of the products. It is calculated without making deductions for depreciation of fabricated assets or for depletion and degradation of natural resources. Data are in constant local currency.

GDP per capita (current LCU)

GDP per capita is gross domestic product divided by midyear population. GDP is the sum of gross value added by all resident producers in the economy plus any product taxes and minus any subsidies not included in the value of the products. It is calculated without making deductions for depreciation of fabricated assets or for depletion and degradation of natural resources. Data are in current local currency.

GDP per capita, PPP (constant 2021 international $)

GDP per capita based on purchasing power parity (PPP). PPP GDP is gross domestic product converted to international dollars using purchasing power parity rates. An international dollar has the same purchasing power over GDP as the U.S. dollar has in the United States. GDP at purchaser's prices is the sum of gross value added by all resident producers in the country plus any product taxes and minus any subsidies not included in the value of the products. It is calculated without making deductions for depreciation of fabricated assets or for depletion and degradation of natural resources. Data are in constant 2021 international dollars.

Health expenditure per capita, PPP (current international $)Per capita current expenditures on health expressed in respective currency - international Purchasing Power Parity (PPP) dollar.
Poverty headcount ratio (national): Percentage of population living below the national poverty line

National poverty headcount ratio is the percentage of the population living below the national poverty line(s). National estimates are based on population-weighted subgroup estimates from household surveys.

Percentage of population living below international poverty line

The indicator proportion of population below the international poverty line is defined as the percentage of the population living on less than $2.15 a day at 2017 international prices. The 'international poverty line' is currently set at $2.15 a day at 2017 international prices.

Percentage of population with access to clean fuel and technologies for cooking

Access to clean fuels and technologies for cooking is the proportion of total population primarily using clean cooking fuels (gaseous fuels, electricity, as well as an aggregation of any other clean fuels like alcohol) and technologies for cooking. Under WHO guidelines, kerosene is excluded from clean cooking fuels.

GINI index

The Gini index measures the extent to which the distribution of income or consumption among individuals or households within an economy deviates from a perfectly equal distribution. A Gini index of 0 represents perfect equality, while an index of 100 implies perfect inequality.

Percentage of urban population living in slums

Population living in slums is the proportion of the urban population living in slum households. A slum household is defined as a group of individuals living under the same roof lacking one or more of the following conditions: access to improved water, access to improved sanitation, sufficient living area, housing durability, and security of tenure, as adopted in the Millennium Development Goal Target 7.D. The successor, the Sustainable Development Goal 11.1.1, considers inadequate housing (housing affordability) to complement the above definition of slums/informal settlements.

Prevalence to notification ratio

TB prevalence measured in the survey divided by the notification rate for bacteriologically confirmed TB among those aged ≥15 years in the main year of the survey

Percentage of survey participants diagnosed with TB during the survey who did not report screening symptoms 

Percentage of survey participants diagnosed with TB during the survey who did not report screening symptoms. The main screening criterion for the prevalence survey is a chronic cough. However, screening criteria might vary by country, by broadening criteria, including combination of cough of any duration, loss of body weight, shortness of breath, loss of appetite, weight loss, fever, hemoptysis, chest pain, night sweats, fever and history of TB.

Radiological abnormality

Any lung (including pleura) abnormality detected on interpretation by the medical officer (e.g. opacities, cavitation, fibrosis, pleural effusion, calcification(s), any unexplained or suspicious shadow, etc). Congenital abnormalities, normal variants, and bony abnormalities like fractures are excluded by definitions as are findings like increased heart size, and other heart-related abnormalities. 

Symptoms suggested for pulmonary TB

Symptoms suggestive for TB may vary by survey. The main symptom screening criterion is a chronic cough (i.e. ≥2 weeks in most surveys). Other symptoms might include chest pain, night sweats, shortness of breath, loss of appetite, weight loss, fever or haemoptysis or combination of symptoms.

Percentage of symptom-screen positive participants who did not seek care

Percentage of symptom-screen positive survey participants eligible for sputum examination, reporting having not sought medical advice. 

Percentage of symptom-screen positive participants who sought care by health facility type

Percentage of symptom-screen positive survey participants, reporting having sought medical advice by the type of facility among all participants who sought care. 

Children aged <5 years with pneumonia symptoms taken to a health facility

Proportion of children aged 0–59 months who had ‘presumed pneumonia’ (ARI) in the previous 2 weeks and were taken to an appropriate health-care provider. Strictly speaking, ‘ARI’ stands for ‘acute respiratory infection’. During the UNICEF/WHO Meeting on Child Survival Survey-based Indicators, held in New York, 17–18 June 2004, it was recommended that ARI be described as ‘presumed pneumonia’ to better reflect probable cause and the recommended interventions. The definition of ARI used in the Demographic and Health Surveys (DHS) and in the Multiple Indicator Cluster Surveys (MICS) was chosen by the group and is based on mothers’ perceptions of a child who has a cough, is breathing faster than usual with short, quick breaths or is having difficulty breathing, excluding children that had only a blocked nose. The definition of ‘appropriate’ care provider varies between countries.

UNC service coverage indexCoverage index for essential health services (based on tracer interventions that include reproductive, maternal, newborn and child health, infectious diseases, noncommunicable diseases and service capacity and access). It is presented on a scale of 0 to 100.

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