The impact of corruption on multidrug-resistant tuberculosis: a quantitative assessment: Figure 1–

Abstract

To the Editors: Multidrug-resistant tuberculosis (MDR-TB) is among the most preoccupying aspects of the pandemic of antimicrobial resistance. In 2008, an estimated 440,000 cases of MDR-TB emerged globally and caused 150,000 deaths [1]. MDR-TB is globally distributed, but significant variations in prevalence have been observed in different geographical regions. The emergence of antimicrobial resistance is a complex problem driven by numerous interconnected factors, many of which are linked to the use of antimicrobials [2]. According to Caminero [3], at a community level four main groups of potential factors associated with the selection of resistance and the generation of MDR-TB under epidemic conditions exist: 1) non-implementation of DOTS (Directly Observed Treatment Short course) and DOTS expansion strategies; 2) inadequate supply or poor quality of drugs; 3) patients’ inadequate drug intake; and 4) other factors such as the magnitude of HIV infection. Corruption is a complex problem which threatens the impact of public investments, healthcare access and services, equity and outcomes [4]. There is mounting evidence on the negative effects of corruption on the health and welfare of citizens and on the consequences of corruption in multiple health areas or processes, especially in the regulation of product quality and the distribution and use of drugs. More globally, corruption was shown to affect all domains of life from education to economic performance [5] and it could also impact on health outcomes. Due to a strong overlap between corruption consequences and potential MDR-TB drivers, it was argued in the literature …