Under the Radar
Preliminary data from a recent survey in Myanmar shows a large proportion of TB cases are going undetected.
In 2010, the World Health Organization (WHO) - working from 2009 estimates not yet confirmed by the latest survey data - estimated 300,000 tuberculosis (TB) cases out of a total population of 53 million, but that only 64 % of new cases were being detected.
The latest survey by the government’s national TB programme of 51,367 people in 70 geographical areas confirmed the 2009 estimates.
Of the estimated 597 in every 100,000 people nationwide who have TB (316,410 out of 53 million), most are male living in urban areas. The number infected in urban areas is twice as high as in rural areas, as has been the case for years.
“Of the found TB cases in the [2009-2010] national prevalence survey, the majority had not sought health care for TB,” said Eva Nathanson, the TB technical officer in Myanmar’s WHO office.
It may be that patients are ignoring symptoms of their illness, are unaware about TB, live far from health care facilities, are not having their TB detected by health workers, or are being misdiagnosed, she added.
Of those who do start treatment, many abandon it before completion, making them candidates for multi-drug resistant TB, said a government clinic doctor in Magway Division in central Myanmar who spoke on condition of anonymity.
“Many patients do not understand their TB could be resistant if they do not take drugs regularly. It is hard to convince them to take their drugs on a regular basis. Some patients stop taking their drugs when their health is getting better. They just come back [for treatment] when their health is bad again.”
The 2009-2010 survey did not examine multi-drug resistant TB (MDR-TB) - when patients no longer respond to the first line of TB treatment because they are infected with a drug-resistant form of the disease, or they did not follow through with the entire course of treatment, thereby rendering treatment ineffective.
Based on earlier surveys, health experts estimated there were 9,000 people with this more difficult-to-treat form of TB in Myanmar in 2008.
The next nationwide drug resistance survey is expected to be conducted in 2011. TB results in an estimated 1.7 million deaths each year, with the global number of new cases in 2009 (more than nine million, with 55 % occurring in Asia) higher than at any other time in history, according to WHO.
In a study published in the British medical journal, the Lancet, for World TB Day on March 24, the authors concluded: “Increasing rates of drug-resistant TB in eastern Europe, Asia, and sub-Saharan Africa now threaten to undermine the gains made by worldwide tuberculosis control programmes.”
Classified by WHO as a high-burden TB country, Myanmar has one of the world’s highest TB prevalence rates.
This post was originally published in IRIN in March 2011.