Report on national TB prevalence survey 2009-10, Myanmar

The National TB Prevalence Survey for Myanmar was concluded by the National Tuberculosis Programme in April 2010. In this survey, 57 607 eligible adults aged 15 or older were recruited, of whom 51 367 (89.2%) participated, in 70 clusters. The average number of participants per cluster was 728 (ranging from 621 to 850). Females showed higher a participation rate (91.8%) than males (86%), and rural clusters had a slightly higher participation rate (90%) than urban clusters (86.3%). Among the 70 clusters, only four had a participation rate of less than 80%. There was no significant difference in participation rate among age groups.

The methodology was to first conduct symptom screening by face-to-face interview, followed by chest X-ray screening for all participants except pregnant women and those who refused. For participants with any TB-suspect symptom or any lesion showing in the chest X-ray, sputum microscopy for acid-fast bacillus (AFB) and culture were performed at TB reference laboratories in Yangon and Mandalay.

The survey identified 123 smear-positive cases and 188 culture-positive cases, totalling 311 bacteriologically confirmed pulmonary TB cases. Smear-positive TB prevalence was calculated as 242.3 (186.1-315.3)/100 000 population aged 15 years and above, whereas bacteriologically confirmed TB prevalence was 612.8 (502.2-747.6)/100 000 population 15 years and above. With the assumption that 0.7% of bacteriologically positive TB prevalent cases are children, smear-positive and bacteriologically confirmed TB prevalence became 172 (132-225)/100 000 population and 437 (358-533)/100 000 population, respectively. The smear-positive TB prevalence was higher in states than in regions (369 vs 191.6/100 000 population 15 years and above), higher in urban than in rural areas (330.7 vs 216.1/100 000 population 15 years and above), and higher in males than in females (397.8 vs 122.2/100 000 population 15 years and above) participants with TB-suspect symptoms were 3.3% of the survey sample (1691/51 367), and those with any TB symptom were 37.2% of participants. Only 34.1% (42/123) of survey-detected smear-positive TB patients had a cough for more than three weeks, and 78.9% (97/123) had any TB symptom. Among 762 active TB cases detected by chest X-ray, only 164 were bacteriologically positive. On the other hand, among 298 bacteriologically confirmed TB patients, 80 did not have active TB and were diagnosed as having healed TB or other diseases.

The survey found 79 patients currently on treatment and 1 463 previously treated. Of the previously treated patients, 66% had sought treatment in the public sector and 32% in the private sector, while among patients currently in treatment, 80% were being treated in the public sector and 18% in the private. Among patients with chronic cough, 10% and 29% first visited public centres and medical facilities, respectively, while 26% went to pharmacies as their first action. Assessing risk factors, smoking and drinking seemed to be associated with bacteriologically positive TB by crude analysis; however when adjusted by other factors such as age and sex, there was no significant relationship.

It may be concluded from the survey that the vast majority of TB cases remain undetected. The gap between the TB prevalence found in the survey and the notification rate of 2009 may be due to a slow decline of TB incidence or to the limitations of the current case-finding strategy. Regarding health-seeking behaviour, visits to public and medical facilities as a first action was not common. There is a need to accelerate case-finding activities in Myanmar though improved access to diagnostic services, improved TB screening tools and algorithms, and to expand partnerships for TB control.

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