Historical research into tuberculosis control strategies and the implications of mortality trends in Taiwan

[[abstract]]SETTING: Taiwan. OBJECTIVE: To analyse mortality trends to determine whether government organisation structuring and activities of disease control programmes affect outcomes. DESIGN: We conducted a Joinpoint regression analysis to identify changes in TB mortality trends from 1971 to 2008 in Taiwan. The annual percentage change (APC) was calculated for the time segments on either side of the Joinpoints. Mortality data were extracted from the cause-of-death registry database of the Taiwanese Department of Health. RESULTS: Between 1971 and 1987, the TB mortality rate dropped from 51 per 100 000 population to 13.4/100 000; during the period 1987–2000, it dropped from 13.4 to 7/100 000, with a lower APC; and from 2000 to 2008, it fell more rapidly, from 7 to 2.2/100 000, than during the previous two stages. These turning points are associated with organisational structure changes from the Joinpoint regression analysis. CONCLUSION: We found that organisational structure and availability of resources play an important role in TB control. We recommend that other countries consider these vital factors to enhance the effectiveness of their TB control programmes