Burma on Track to Reach Tuberculosis Targets: WHO

By Samantha Michaels 25 October 2013

RANGOON — Burma, with one of the highest tuberculosis prevalence rates in the world, is on track to reach global targets in reductions to its incidence, prevalence and mortality rates for the disease by 2015, the World Health Organization (WHO) said Wednesday.

But significant challenges remain, the UN health agency warned, as a large proportion of TB cases in the country go unreported or undiagnosed, while the number of laboratories to test for drug-resistant strains are far below recommendations and medical officials warn that medication supplies are running low.

Burma is one of 22 countries identified by the WHO for having the world’s highest disease burdens for TB, with 489 people infected last year per 100,000 in the population, compared to the global average of 169.

In its “Global Tuberculosis Report 2013,” the WHO estimated that worldwide, 1.3 million people died last year out of 8.6 million who became infected with TB, an airborne disease that affects the lungs and can easily spread from person to person. “The number of TB deaths is unacceptably large, given that most are preventable,” it said.

Burma was one of four high-burden countries (HBCs) on track to meet the Millennium Development Goal (MDG) targets for TB by 2015. These targets include a falling incidence rate, or the number of people infected annually per 100,000 in the population; as well as a halving of the disease’s prevalence rate, or the proportion of people infected in the population at a given time, compared to 1990 levels; and a halving of the disease’s mortality rate.

Burma, Ethiopia, India and Thailand are on track to meet all three goals, the WHO said. Burma has already met the targets for incidence rate and mortality rate, which stood at nearly 30,000 deaths from TB last year. It is expected to meet the target for prevalence rate by 2015, the WHO said.

Seven HBCs—Brazil, Cambodia, China, the Philippines, Uganda, Vietnam and Tanzania—have already achieved all three goals, while 11 other HBCs are not expected to meet them by the deadline. Globally the goal for falling incidence rates has been met and the targeted reduction in mortality rates is expected to be achieved by 2015, but the targeted reduction in prevalence rates appears out of reach by the deadline, the WHO said.

Despite Burma’s progress, the Southeast Asian nation faces significant challenges and is far below standards for detecting cases of the disease. Globally, about 3 million of all new cases of TB went undiagnosed or unreported in 2012, and Burma was among 12 countries responsible for 75 percent of those “missing” cases. An estimated 35 percent of Burma’s new cases were not detected, about the same percentage as in 2009.

“Finding the ‘missed cases’ is one of the biggest challenges in TB care and control today,” the WHO said in a supplement to its report. It called on Burma and other countries with high disease burdens to increase the number of health facilities with diagnostic capacity, expand service coverage through NGOs, and step up engagement with community workers and volunteers.

Burma has only two laboratories in the entire country that are equipped to test for drug-resistant TB and two laboratories equipped for bacterial culture testing, or about 0.2 laboratories of each type per 5 million people, the WHO said. The UN agency recommends five times that many laboratories for the same population.

The laboratories for drug-resistant TB are in Rangoon and Mandalay, the country’s two biggest cities, and they require a 24-hour supply of electricity that currently would not be possible in underdeveloped rural areas.

The WHO also called on Burma to improve its testing for HIV, as patients with HIV have weakened immune systems and are particularly at risk of contracting TB. Only 13 percent of tuberculosis patients in the country knew their HIV status last year, far below the target rate of 100 percent, it said, although most of those who were diagnosed with both diseases were receiving antiretroviral therapy (ART).

“Concerted efforts are required to increase HIV testing while also ensuring access to ART for HIV-positive TB patients,” it said.

Burma’s health care system was chronically underfunded for decades by the former military regime, and even today, under the quasi-civilian government that took power in 2011, only about 3 percent of the national budget goes to health.

Last month the country received four state-of-the-art machines to detect drug-resistant TB. The machines were donated by a health assistance consortium formed by the governments of Brazil, Chile, France, Norway and Britain.

Also in September, the Ministry of Health reportedly announced that it would expand its TB program to double the number of drug-resistant TB patients under treatment. Ministry officials said they would expand their care and treatment services this year to reach 500 more patients at centers in 38 townships, The Myanmar Times newspaper reported.

The ministry aims to treat some 10,000 cases in 100 townships by 2015.

However, last month medical officials in Rangoon warned that important TB medications were running low across the country and could even run out before the year’s end.

The WHO also cautioned in its report on Wednesday that a funding shortfall would remain a challenge. It said that while Burma’s national tuberculosis control program reported a budget of US$36 million, available funding was only about $14 million.