Risk factors that may be driving the emergence of drug resistance in TB patients treated in Yangon, Myanmar
Abstract
Background
The majority of new
tuberculosis cases emerging every year occur in low and
middle-income countries where public health systems are often
characterised by weak infrastructure and inadequate resources.
This study investigates healthcare seeking behaviour, knowledge
and treatment of tuberculosis patients in Myanmar—which is
facing an acute drug-resistant tuberculosis epidemic—and
identifies factors that may increase the risk of emergence of
drug-resistant tuberculosis.
Methods
We randomly selected adult
smear-positive pulmonary tuberculosis patients diagnosed between
September 2014 and March 2015 at ten public township health
centres in Yangon, the largest city in Myanmar. Data on
patients’ healthcare seeking behaviour, treatment at the
township health centres, co-morbidities and knowledge was
collected through patient interviews and extraction from
hospital records. A retrospective descriptive cross-sectional
analysis was conducted.
Results
Of 404 TB patients selected
to participate in the study, 11 had died since diagnosis,
resulting in 393 patients being included in the final analysis.
Results indicate that a high proportion of patients (16%; 95% CI
= 13–20) did not have a treatment supporter assigned to
improve adherence to medication, with men being more likely to
have no treatment supporter assigned. Use of private healthcare
providers was very common; 59% (54–64) and 30.3%
(25.9–35.0) of patients reported first seeking care at
private clinics and pharmacies respectively. We found that 8%
(6–11) of tuberculosis patients had confirmed diabetes.
Most patients had some knowledge about tuberculosis transmission
and the consequences of missing treatment. However, 5%
(3–8) stated that they miss taking tuberculosis medicines
at least weekly, and patients with no knowledge of consequences
of missing treatment were more likely to miss doses.
Conclusions
This study analysed
healthcare seeking behaviour and treatment related practices of
tuberculosis patients being managed under operational conditions
in a fragile health system. Findings indicate that ensuring that
treatment adherence support is arranged for all patients,
monitoring of response to treatment among the high proportion of
tuberculosis patients with diabetes and engagement with private
healthcare providers could be strategies addressed to reduce the
risk of emergence of drug-resistant tuberculosis.
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Source:
PLOS ONE
