CHAPTER ONE

INTRODUCTION

1.1          Background of the study     

Tuberculosis (TB) is one of the most common worldwide infectious diseases and one of the single largest causes of death in the world (World Health Organization, 2015). TB has been declared as "global emergency" by the World Health Organization. Despite the downward trend in the incidence and prevalence of TB, every continent still reports new cases, especially Africa and South-East Asia. In 2009, U.S. Global Health policy in Global Tuberculosis Epidemic, declared that about one-third of the world's population or two billion people, carried the TB bacteria, and more than 9 million of who become sick each year with “active” TB, which could be spread to others (WHO, 2013). There is a close link between TB and HIV. It has to been noted that TB may be the first indicator of HIV infection tuberculosis (TB) for people with both latent tuberculosis infection (LTBI).

TB is caused by Mycobacterium tuberculosis (M. tuberculosis), a microorganism whose principal reservoir is humans. M. tuberculosis is spread by patients with pulmonary tuberculosis, especially those with positive sputum smears (Murray, Styblo, and Rouillon, 2014). Of those becoming infected, 10–12% will develop tuberculosis disease after a period ranging from weeks to decades (Vynnycky E and Fine P.E, 2012).

Pulmonary tuberculosis (TB) is a contagious bacterial infection that involves the lungs. It may spread to other organs.

Co-infection with tuberculosis (TB) and Human Immunodeficiency Virus (HIV) poses a tremendous challenge to TB control and management, particularly in developing countries (WHO, 2018). Among the estimated 9.3 million new patients with TB in 2007, just over 1.3 million (14.8%) were estimated to be HIV positive. In 2007, there were an estimated 456,000 deaths from HIV-associated TB. Among patients with active TB, patients with HIV co-infection have greater risk of relapse, raising concerns about the optimum duration of TB treatment (WHO, 2015). It was estimated that 8.8 million new TB cases occurred in 2003, of which 1.87 million were fatal due to late diagnosis or non-compliance with treatment (WHO, 2015). Though TB prevalence is declining in many countries, it is estimated that by 2020, there will be over 1 billion new TB infection and, 200 million people will succumb to clinical disease and about 35 million will die if TB control is not further strengthened (WHO, 2015).

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