ABSTRACT
Background There are limited measures of the impact of the COVID-19 pandemic on tuberculosis (TB) control in high-burden countries like Indonesia. Methods We analysed district-level data of reported TB cases, treatment and deaths, COVID-19 incidence and mortality, health care capacity, economic status, education level, and public health development index from all 514 districts in Indonesia. We compared data before (2016-2019) and during (2020-2021) the pandemic. Findings Compared to the preceding year (2019), in the first pandemic year (2020) the TB case notification declined by 31% (from median 172 [IQR 129-244] in 2019 to 119 [IQR 87-170] in 2020 per 100,000 population; 565,669 vs 393,323 cases, respectively); mortality increased by 8% (from median 4.2 [IQR 2.0-7.4] to 5.0 (IQR 3.1-7.5) per 100,000 population; 13,059 vs 14,148 deaths, respectively); and the overall proportion of cases who started treatment declined by 7% (from 98% to 91%). The second pandemic year (2021) saw a partial recovery of case notifications (median 142 [IQR 99-204]; 473,006) and deaths (4.1 [IQR 2.5-6.8]; 12,016), but a persistently reduced treatment coverage (84%). Reductions in TB notifications between districts were associated with higher COVID-19 incidence and fewer per capita GeneXpert machines for TB diagnosis. Likewise, reduced TB treatment coverage was associated with fewer per capita doctors, and increased reported TB deaths was associated with fewer per capita primary health centres, lower per capita domestic expenditure and higher education. Interpretation The COVID-19 pandemic significantly, yet unevenly, impacted the national TB control programme across Indonesia, with the greatest impacts in districts with the least resilient health systems.
Subject(s)
COVID-19 , Tuberculosis , DeathABSTRACT
The Delta variant of SARS-CoV-2 has dominated the COVID-19 pandemic in 2021. Here we report the Delta variant among paediatric cases in North Sumatra, Indonesia, from June-July 2021. Whole-genome sequences (WGS) from 18 new COVID-19 paediatric patients showed that 6 were B.1.459 and 6 were B.1.466.2, known variants in Indonesia in Clade 20A. Six were the Delta variant B.1.617.2 of Clade 21A, with 5 on one branch, and one on a distant branch consistent with that patient’s geographic separation, suggesting at least two introductions to the region. Variants tended to be spatially clustered, and four children with Delta variant had an adult infected household member, all of whom had lower real-time polymerase chain reaction (RT-PCR) cycle threshold (Ct) values compared to the child. No temporal trends were observed for Ct. These data support a paradigm shift with children being highly susceptible to the Delta variant and a priority for vaccination.Funding Information: We would like to thank the Wellcome Trust for support of whole-genome sequencing of SARS-CoV-2 in the Asia and Africa Regions.Declaration of Interests: The authors have no conflict of interest to declare.Ethics Approval Statement: "The study protocol was approved by The Ethics Committee of the Faculty of Medicine, University of Indonesia – Cipto Mangunkusumo Hospital KET-725/UN.2.F1/ETIK/PPM.00.02/2021 (Protocol No. 21-05-0535)."