TB control in Myanmar and Yunnan, China: Programme analysis

Lead organisation: CDPRG, LSHTM

LSHTM staff : Prof Richard Coker , Dr.Samantha Watson , Dr. Mishal Khan

Collaborating organisations: National University Singapore (NUS), University of Public Health, Myanmar, FHI

Support by: USAID 

Project Summary:

Tuberculosis (TB) is an infectious disease caused by the bacteria Mycobacterium tuberculosis. It most commonly affects the lungs. It is transmitted from person to person via droplets from the throat and lungs of people with the active respiratory disease. In 2012 (the latest year for which figures are available), an estimated 8.6 million people were diagnosed with TB, and an estimated 1.3 million people died from it. TB occurs throughout the world, though over 95% of TB deaths occur in low- and middle-income countries. Drug-resistant strains of the disease have been documented in every country surveyed, and are a growing public health concern in many countries.

Both China and Myanmar are classified as “high tuberculosis (TB) burden” countries[1] in which supporting TB control is an acknowledged global public health priority. It is estimated that there are a million new cases of tuberculosis in China each year, more than any country except India. Of these, an estimated 63,000 are multidrug-resistant tuberculosis (MDR-TB). In Myanmar, the 2010 National TB Prevalence Survey revealed that TB prevalence is three times higher than previously thought. The World Health Organization (WHO 2012) estimates that 9,000 multidrug-resistant tuberculosis (MDR-TB) cases occur in Myanmar each year, with the MDR-TB rate among new cases the highest in South-East Asia. Extensively Drug-Resistant TB (XDR-TB) is a growing problem, and a pressing concern, in both Myanmar and China. The research will provide timely analysis to assist the NTP, donors, and NGO’s in the design and implementation of control measures in the two study countries.

This project involves a three-pronged, inter-disciplinary and mixed methods programme of research to analyse the operation and effectiveness of TB/MDRTB programmes in Myanmar and Yunnan province, China, which includes: 

1. Macro-economic analysis. An evaluation of the most efficient allocation of funding to ensure TB control, control of MDRTB prevalent cases, prevention of new cases of MDRTB, and control of HIV-associated TB. A focus on public health outcomes (changes in incidence of TB, changes in incidence of MDRTB, mortality, HIV-associated TB, DALYs; and costs based on aggregate allocations to prevention, detection, treatment elements).

2. Case control study: Analysis of the risk factors associated with MDRTB in previously treated patients and those never treated.

3. Gender analysis of incentives/disincentives at patient, provider and health system level. A mixed method analysis of gender impacts on disease susceptibility and diagnosis, health (and related) outcomes, and incentives.

The programme of research has been scheduled to last for two years.

Please visit the Knowledge Gateway here,www.cap-tb.org

[1] Two of the 22 countries which together account for 80% of TB cases worldwide  

  Project Collaborators include: