There is not a word in this piece on multi drug resistant TB or tuberculosis in Yangon about the new WHO recommended short course TB treatment.
https://apps.who.int/iris/bitstream/handle/10665/311389/9789241550529-eng.pdf
Jamie
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Efforts to fight TB in Yangon
Aung Phay Kyi Soe
Myanmar Times
28 October 2019
For the past three months Daw Khaing Mar Wai from No. 7 ward of Shwe Pyi Tha Township has been taking medication for her multi-drug-resistant tuberculosis (MDR-TB).
She is a regular patient at the MDR-TB treatment centre in the Aung San TB Specialty Hospital in Insein Township, where she receives treatment to combat the drug resistant form of the disease.
The regular treatment for MDR-TB usually lasts for 11 to 20 months. Daw Khaing Mar Wai decided to choose the 11-month course of injections and pills as she wanted to be cured as quickly as possible so she can properly care of her four month-old daughter again.
Her husband U Kyaw San Win takes care of the whole faamily’s home duties, preparing the meals, going shopping and helping their eldest daughter with her studies. All of this takes time away from his taxi driving work.
Before his wife became sick he earned more than K600,000 per month, but now he’s decided to rent their car to a friend at a rate of K15,000 a day.
There is a strong stigma around the disease, for obvious reasons, but this can often prevent people from seeking timely medical advice. Daw Khaing Mar Wai believes she caught the disease from a person in the neighbourhood who was unaware that she was sick.
“When I was first diagnosed my siblings didn’t want to visit, even though they were happy to see me before. It’s a bit depressing that I have to take these pills for such a long time, but I have to take them – if that’s what it takes to get better again, then so be it,” Daw Khaing Mar Wai, aged 29, told Metro.
According to data from the 2018 National Tuberculosis Programme in Myanmar, out of a total of 180,000 TB patients some 140,000 are cured with treatment. But around 40,000 patients are left needing further medical treatment, with one-tenth of them living in the Yangon Region.
“TB is a curable disease. If we detect it early and the medication is taken properly, the patient can be cured and the risk of infecting others will be dramatically reduced. So, if anyone is suspected of having the disease, they should visit the township health department immediately,” Senior Consultant (TB) Dr. Zaw Myint, who is in charge of the National TB Programme, said.
Dr Thandar Lwin, Deputy Director General from the Public Health Department (Disease Control) warned that, “if infected people don’t get treated, they can spread the disease to 10 or more people very quickly.”
This is a particular problem in high-density urban areas, where people often share cramped living quarters and transportation.
Incidence rates for TB in Myanmar stood at 338 per 100,000 people in 2018, according to the World Health Organisation’s (WHO) figures. There are 180,000 new TB cases reported each year, according to the same data.
According to a nation-wide national TB survey, there were 361 new cases of the disease per 100,000 people in 2016; that number dropped slightly to 338 per 100,000 in 2018.
“There are more tuberculosis patients in the Yangon Region than other regions and states. So we have to carry a heavier burden when looking after them,” said Dr Zaw Myint from the Yangon’s National Tuberculosis Programme.
Several years ago the problem was more serious on the border, but as medical experts were able to treat and educate people there, the problem has resurfaced in the city.
Health care services in the Yangon Region are ill-equipped to reach out to TB patients, who are likely to be from low socioeconomic neighbourhoods with little knowledge of the disease. Many may have also recently arrived in the city, and are unaware of programs to combat the spread of TB.
Some patients may also suffer from HIV, which makes treating TB particularly difficult.
Medical facilities in Yangon face staff shortages; and many patients do not want to be treated once diagnosed with the disease. Nurses and health care workers may also find it difficult to relocate patients when they leave the hospital, leaving them in danger of infecting others in the community.
It is also very difficult to organise squatters and part-time factory and construction workers to attend check-ups, said the Minister of Social Affairs of Yangon Region, U Naing Ngan Lin.
“They have to work every day, so they don’t want to take time off to visit the clinic – that means missing out on examinations. What’s needed is a coordinated approach from the related departments, so that we can prepare examinations for many workers at the same time,” he said.
U Tun Myint, Yangon Regional Health Department head and deputy director general, underscored the need for patients to voluntarily undergo treatment to achieve “great results”.
Treatment for TB
A TB treatment plan for the non-resistant strain of TB requires six to eight months of medication, whereas the drug resistant TB requires an 11- to 20-month regime. If TB is found in other family members, the doctor will prescribe the drug Isoniazid for six months as a precautionary measure.
The drug resistant TB develops when patients don’t follow the treatment plan or take poor quality medication. As the TB bacteria repopulates, it develops a resistance to the conventional drugs.
Every day 70 to 100 people are tested for TB at outpatient department of the Aung San TB Specialty Hospital in Insein Township, Yangon Region. About two-thirds of the patients are diagnosed with the disease. At present, there are 50-70 patients who are receiving treatment at the MDR-TB treatment centre.
Similarly, door-to-door TB treatments are being provided by the medical staff in 330 townships across the country.
Most of the patients experience vomiting, dizziness, or hearing impairment after they take TB injections or medicines, patients say.
Dr Zaw Myint, the superintendent of Aung San TB Specialty Hospital, Insein Township, said the new medicines have greatly improved and approved by the international health organizations.
But he encouraged patients to report to medical staff about any side effects they experience while taking the medicines.
“Whether it’s the non-drug-resistant or drug-resistant strains, side effects from the medications are often unavoidable – but they can be managed,” said Dr. Zaw Myint.
Regional plans to reduce TB cases
The Yangon Region’s Department of Public Health has started drafting a sub-national TB Operational Plan for 2020-2021, expected to be released to the public in January 2020.
A multi-sector steering committee was formed in September this year, with the aim of reducing TB rates in Yangon and across the country.
It is comprises 17 members who are officials and members of civil society organisations. The committee is led by four health patrons including Yangon Region Minister of Social Affairs U Naing Ngan Lin.
In Yangon the following townships recorded the highest rates of TB: Hlaing Tharyar, Shwe Pyi Thar, Insein, Mingaladon and Mayangone. Gene Xpert is a new machine to diagnose TB, and the government plan to use it in these townships first.
“We provide diagnosis of TB for all patients from the five townships. Now we also diagnose drug-resistant TB,” said Dr Zaw Myint.
Daw Khine Mar Wai who takes medication for Multi-drug-resistant tuberculosis in Shwe Pyi Thar Township said she wants to be cured as soon as possible. She believes she was infected from a person with the drug-resistant strain.
“I want all patients to take their treatment. This disease can be cured, and I don’t want other people to suffer the same fate as me,” she said. – Translated
https://www.mmtimes.com/news/efforts-fight-tb-yangon.html
