Myanmar's dual public health challenge: TB and Diabetes

Lwin Lwin Thant, CNS Correspondent, Myanmar
Photo credit: CNS:
Diabetes Mellitus (DM), a chronic disease, is not only increasing globally but is also associated with higher risks of TB and adversely impacts the outcomes of TB treatment. Like other developing countries, Myanmar too faces the double burden of communicable and non-communicable diseases, due to the socio-economic transition that occurred in recent times.

In a webinar hosted by Citizen News Service (CNS), Paul Jensen, a Senior Advisor (Policy) from International Union Against Tuberculosis and Lung Disease (The Union), rightly said that, “TB-diabetes is an example of a public health challenge that will become more serious unless action is taken now to prevent it. This is relevant for the post-2015 sustainable development goals, because the goals aim to end the TB epidemic by 2030. The TB epidemic will not be eliminated in the absence of a response to TB-diabetes.”

According to the International Diabetes Federation (IDF) Atlas 2014 the estimated diabetes prevalence in Myanmar is 5.7%. However a survey conducted during 2003-2004, showed the overall prevalence of adult diabetes in Yangon, the capital city of Myanmar, to be as high as 11.8 %. The 2009 National Survey record listed several associated risk factors for diabetes, with smoking being on the top (33.6% in males, and 6.1% in females), followed by hypertension (31% in males and 29.3% in females), overweight (21.85% in males and 23.07% in females), and drinking alcohol (31.17% in males and 1.47% in females).

Even though the prevalence of diabetes is high, there is very limited information sharing and health education on choosing proper treatment options and/or making life style changes.  Many people living with diabetes in Myanmar have to cope with financial challenges regarding monitoring their body glucose level, insulin therapy, etc. These constraints often make diabetes patients rely on traditional medicines (like some varieties of herbs and plants), which play a vital role in the overall health system of the country. Thus, there is an urgent need to raise awareness about diabetes and to improve the existing diabetes care system.

Due to late diagnosis of diabetes, a lot of people need to undergo operations and some even become amputees. U Saw, a person living with diabetes in Monywa Town said very sadly, “We believe that diabetes is a genetic disease. As my parents and grandparents had not suffered from diabetes, I never ever thought that I could get diabetes just because of my faulty lifestyle and diet. I only learnt that I had diabetes when my condition had become very serious-- so much so that surgeons had to amputate my left leg”.

Paul Jensen shared that people with diabetes are two to three times more likely to develop TB than people who do not have diabetes.  TB patients who also have diabetes are more likely to die from TB as compared to those TB patients who do not have diabetes.

It is thus not enough to merely receive comprehensive care and treatment on diabetes, but also on TB associated with diabetes. According to researchers, it is estimated that more than 80% of diabetes related deaths occurs in low and middle- income countries. World Health Organization has recommended that all countries should establish joint diabetes and TB care and control programmes in accordance with their local contexts at regional/district levels; conduct TB screening among diabetes patients; and provide quality TB treatment to people with or without diabetes.

Under the guidance of the WHO, a pivoted collaborative programme for TB and diabetes has been undertaken in Mandalay city of Myanmar. A Diabetes Mellitus clinic has recently been established in Mandalay General Hospital, that provides TB screening to all the diabetes patients who come to the clinic. Such collaborative activities need to be replicated in other parts of the country to fulfill the needs of all people across the region.

Lwin Lwin Thant, Citizen News Service - CNS
August 13, 2015