Spatiotemporal Distribution and Trend of Childhood Tuberculosis in Myanmar (2008-2013)

Nyi Nyi Zayar, Rassamee Sangthong, Saw Saw,Si Thu Aung & Virasakdi Chongsuvivatwong

Special Issue May 2020

-

In 2015, it was estimated that there were 1 million childhood tuberculosis (TB) cases which is 10% among 10.4 million overall new TB cases worldwide.¹ The percentage of cases occurring in children in low-income countries is approximately 15% of all TB cases.¹ In Myanmar, over 36,000 cases of childhood TB were found in 2014. The percentage of childhood TB to all TB cases was one-fourth (26%) in 2014.

Although TB is a priority concern among major communicable diseases, childhood TB was considered as low public health priority because of misperception that it would be disappeared by containing adult tuberculosis.² However, childhood TB case represents the recent infections and reflects the overall incidence of tuberculosis in current situation. The spatial distribution and trends of childhood TB incidence provide information about high-risk areas of tuberculosis. The study aimed to find out the spatial distribution and trend of childhood tuberculosis incidence in Myanmar from the year 2008-2013.

The study setting was 315 townships from 15 states and regions in Myanmar. Study design was a retrospective study with secondary data analysis using aggregated data of childhood TB case finding, extracted from routine surveillance report of National Tuberculosis Program from 2008-2013 (with 3 different types of TB; pulmonary TB, hilar lymphadenopathy and TB meningitis). Hilar lymphadenopathy is the most common radiologic features of primary tuberculosis.

Data management and analysis was done by using R software.³ Descriptive statistics including mapping and trend analysis were used to identify spatiotemporal distribution and hot spot areas of childhood TB in Myanmar.

The mean incidence of childhood TB over the year 2008 to 2013 was 250/100,000 population with 283/100,000 in under 5 year old and 192/100,000 in 5 to 14 years old. The trend of incidence was almost steady over these years. The average incidence of pulmonary TB was 181/100,000, hilar lymphadenopathy 65/100,000 and TB meningitis was 5/100,000. Among 15 states and regions in Myanmar, pulmonary TB was the most common among three types of TB except in Kachin where hilar lymphadenopathy was significantly higher than pulmonary TB from the year 2008 to 2011.

Figure 1 shows the incidence of childhood TB in all states and regions in Myanmar over the years 2008 to 2013. In the figure, the highest incidence including all types of TB was found in Kachin, Taninthayi, Mon and Chin with more than 350/100,000 and lowest in Naypyitaw (105/100,000 population). In terms of pulmonary TB, Taninthayi and Mon had highest incidence with more than 300/100,000 followed by Kayah, Chin and Kayin. The rate of hilar lymphadenopathy, (354/100,000) in Kachin state was significantly higher than the average of whole country which was 65/100,000. The lowest incidence was found in Bago region with 5/100,000. For TB meningitis, Ayeyawady hold the highest incidence with 17/100,000 and lowest in Mon and Sagaing with around 1 case per 100,000 population.

The areas with highest childhood TB incidence were found to be the border areas of Myanmar including Kachin (northern border area), Chin (west border area), Kayah and Kayin (middle east border areas) and Taninthayi (southern border area).

According to World Health Organization report, cross-border population is recognizeas a vulnerable group of TB who are low-income minorities living near a border and working in the neighbouring country, involving continuous movement across borders.⁴ WHO also reported that the undocumented migrants are the largest public health concern, as many do not have access to health services, have increased morbidity and present a number of public health risks, such as low immunization rates. A study in US-Mexico border found that low socioeconomic status, crowded living conditions, and limited access to health care increase the risk for TB transmission on both sides of the border.⁵ Moreover, the health system review in Myanmar indicated the existence of dis-parities in access to and utilization of health services in rural and border areas of the country. Therefore, high incidence of childhood TB among border areas of Myanmar might be associated with increased gap to access health care including immunization services in children, low socio-economic condition and migrant population moving around these border areas. The limitation of the study is that the secondary data was aggregated data for the township level and lack of data to identify the associated factors related to childhood TB.

In conclusion, allocating more resources and health care facilities related to TB with improving case finding and health awareness of people living in border areas should be done to reduce the incidence of childhood TB in Myanmar.

-

-

The authors declare that they have no competing interests.

1. World Health Organization. Global Tuber-culosis Report 2016. Geneva, WHO, 2016. WHO/HTM/TB/2016.13.[Internet]. Available from:https://apps.who.int/medicinedocs/ documents/ s23098en/s 23098en. pdf
2. World Health Organization. Roadmap for Childhood TB: Toward Zero Deaths. Geneva,  WHO,2013.WHO/HTM/TB/2013.12. [Internet]. Available from: https://www. who. int/tb/areas-of-work/children/roadmap/en/
3. R Project Organization. The R Project for Statistical Computing.[Internet]. [cited 2020 Jan 21] Available from: https://www.r-project.org/
4. Figueroa-Munoza F & Ramon-Pardo P. Tuberculosis control in vulnerable groups.Bulletin of the World Health Organization 2008; 86(9): 733-735. [doi: 10.2471/BLT.06.038737]
5. United States-Mexico Border Health Commission (BHC). Border Lives: Health Status in the United States-Mexico Border Region. National Latino, Border Health Research, 2010. [Internet]. Available from:https://www.ruralhealthinfo.org/assets/940-3105/health-status-in-the-united-states-mexico-border-region.pdf