Delay in treatment initiation and treatment outcomes among adult patients with multidrug-resistant tuberculosis at Yangon Regional Tuberculosis Centre, Myanmar: A retrospective study

Abstract

BackgroundMyanmar faces a health security threat, with an increasing number of multidrug-resistant tuberculosis (MDR-TB) cases. Long delays in the initiation of treatment are a barrier to MDR-TB control.ObjectivesThe main objectives of this study were (1) to identify the determinants of delay in treatment initiation after MDR-TB diagnosis, and (2) to explore the effects of treatment delay on disease infectivity, severity, treatment adherence, and treatment outcomes.MethodsThis retrospective study reviewed 330 MDR-TB treatment cards for patients enrolled for treatment at Yangon Regional Tuberculosis Centre, in 2014.ResultsMedian treatment delay was 105 days, interquartile range (IQR) 106 (61–167) days; (51.5%) of patients experienced a long treatment delay (≥ 105 days). Regarding the determinants of treatment delay, this study identified important patient-healthcare system interaction factors. Significant risk factors of long treatment delay included female sex, age > 30 years, and prior contact with patients with MDR-TB. Patients with long treatment delays were significantly different from those with short delays, in terms of having high sputum smear grade, resistance to more than two main drugs (isoniazid and rifampicin), and long culture conversion time. In this study, delay in the initiation of treatment was associated with poor treatment outcome, but this was not statistically significant after adjusting for other risk factors. Median treatment-delay times were longer among patients with poor outcomes (144 days) than those with successful outcomes (102 days).ConclusionsPost-diagnosis delays in the initiation of treatment among MDR-TB patients were significantly long. The study results showed that inadequate MDR-TB treatment initiation center, centralization of treatment initiation, limitation of human resources, were health-system factors delaying timely treatment initiation and implementation of an effective TB-control program. Our findings highlight the need for immediate interventions to reduce treatment delay and improve treatment outcomes, including scaling up diagnostic capacity with Xpert MTB/RIF at township level, expansion of decentralized MDR-TB treatment initiation centers, ensuring a productive health workforce comprising trained health personnel, and providing health education and treatment-adherence counseling to patients and family members.

Level of Infectiousness and Associated Factors Among Bacteriologically Confirmed Pulmonary Drug-resistant Tuberculosis Patients Registered for Treatment in Ethiopia: A Seven-year Data

“…As the evidence showed that those smear-positive patients were more infectious and their probability of infectiousness increases with increased sputum smear grading [12]. High sputum smear grading was established as a result of long treatment delay which will also directly linked to extensive transmission to the communities because of large MTB load and prolonged contacts [13]. Study results from Ethiopia, China, Vietnam, and India evidenced that high smear grading was also associated with delayed smear and culture conversion, longer isolation period, more intensive treatment, and poor interim and nal treatment outcomes [14][15][16][17].…”

Impact of nucleic acid amplification test on pulmonary tuberculosis notifications and treatments in Taiwan: a 7-year single-center cohort study

“…Delayed diagnosis and treatment of TB led to severe clinical disease and drug resistance [21, 22]. A time-period of > 60 days from the onset of TB symptoms to start of anti-TB treatment is associated with unfavorable treatment outcomes, including treatment failure and mortality in Ethiopia [23].…”

Facts and Fiction: The Myth of Suvaṇṇabhūmi Through the Thai and Burmese Looking Glass

“…Given these requirements, it is not surprising that later Pali commentaries and recensions, as recorded for instance in the ‘Extended Mahāvaṃsa ’, 18 specify that in fact each Asokan mission consisted of a leader and four other associates in order to form a minimum chapter of five monks 19 . Modern Mon-Burmese chronicles even provide the names of the three additional missionary monks travelling together with Soṇa and Uttara, namely “Aniruddha, Tissakutta and Somarasa who arrived in Sudhammavatī [Thaton]” (Tun Aung Chain 2010: 13) 20 . Conversely, a recent Thai chronicle or tamnan composed in the twentieth century assigns them different names of “Phra Chaniya, Phra Phuriya and Phra Muniya” (Thammathatto and Pho Na Pramuanmark 1989: 55, 69) 21 .…”

“…On the one hand, the Mon-Burmese, basing their arguments mainly on later chronicles (e.g. Bode 1897: 10–11; Tun Aung Chain 2010) and strong local and oral traditions, generally locate it in lower Burma. It seems fair to say from the Kalyāṇī inscriptions that the myth of Suvaṇṇabhūmi there actually dates to at least about the middle of the second millennium AD.…”

“… 12 For such an example in Burma, see Leider (2009), Pranke (2004: 131, 136–138, 158–159), Stadtner (2011: 190–197), and Tun Aung Chain (2010: 1–11). For the case of northern Thailand, see Lagirarde (2007).…”