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September 17, 2019

Human population on this Earth is infected with TB! Innovations are indicated to Mycobacterium infection

Myanmar is one of the world’s 22 high-TB-burden countries. So also is one of the 27 high-Multi-Drug-Resistant-TB (MRD-TB) – burden – countries. TB prevalence rate in Myanmar is 3 times higher than global average and one of the highest TB prevalent countries in Asia. Annual Risk of Infection (ARI) was 1.5 percent in 2009. An estimated 9000 cases of multi drug TB occur each year. Extensively drug resistant TB (XDR-TB) has been reported since 2007. Nearly 20,000 new cases of TB/HIV co-existence is recorded, the source says. TB is one of the top three priority diseases in the National Health Plan, Myanmar.
As TB Control in Myanmar, National Tuberculosis Program (NTP), is implementing a National Strategic Plan for TB control 2011-2015 and in line with WHO’s Stop TB Strategy. Such noble objectives as to reduce ill health and deaths due to TB and to erase TB from a public health problem, to prevent drug resistance TB, to promote sputum tests, to sustain the implementation of Directly Observed Treatment Short-course therapy (DOTS) and so forth are included.
NTP has been established since 1966 and running with 14 Regional and State TB Centers with 101 TB teams at district and township levels in 2009. NTP implemented DOTS strategy for the treatment of TB since 1997 and 100% DOTS coverage has been achieved since 2003, according to Annual Report 2011 of NTP. NTP is usually doing passive case findings in all DOTS townships and also started active case finding activities using mobile teams based in Yangon and Mandalay.  Diagnosis is mainly done by sputum smear microscopy. Case finding activities are strengthened by radiological examination. Culture and Drug Susceptibility Testing (DST) are carried out at National TB Reference Laboratory (Aung San) and Upper Myanmar TB laboratory (Mandalay). Line probe assay, liquid culture and DST using Mycobacterial Growth Indicator (MIGIT) were introduced in both TB laboratories in 2010.
Around the world steps to stop tuberculosis (TB) are having an impact. Today, the epidemic is continuing its decline. But the rate of decline is far too slow, and TB still takes a life every 20 seconds. Millions of people are benefiting from treatment through coordinated national efforts, but millions more are still missing out. Unless we accelerate action, the numbers of those falling ill will continue to expand.
Together, we need to help prevent infection, find all people who are ill far earlier and provide treatment for all. WHO has a Stop TB Strategy that can do this and a Global Plan to Stop TB that sets the course, but some efforts are falling short.
We must redouble our efforts to fight multidrug-resistance (MDR-TB) and extensively drug-resistant (XDR-TB) forms of TB. We must also continue to fight the TB/HIV co-existence.
The commitment of governments, multilateral organizations, non-governmental organizations, foundations and members of the corporate, academic and research communities working to halt and reverse the spread of the disease should be welcomed and encouraged and stay on track to achieve the goal.
We must protect investments in global health, particularly to protect investments in global health, particularly to protect the most vulnerable. Global cooperation in fighting tuberculosis, and all other challenges must be essential to our future task.
Looking forward, we need to build and expand our partnerships to deliver the solutions we know work today.
To save lives, enable the communities to thrive, and prevent spread of deadly Tuberculosis, health personnel, for sure, need innovations. Wide-spread scientific researches all over the world, decision making findings, exchange and collaborations among global partners, intergovernmental and institutional cooperation are the means to promote global health problems, including Tuberculosis control, indeed.
Department of Medical Research (Lover Myanma), of course, is the key department responsible for undertaking health researches in collaboration with programme managers. Bio medical TB Research is mainly directed towards the areas which help is the case-detection, rapid and improved diagnostic methods for TB and MDR-TB, rates and patterns of anti-TB drug resistance, prompt and effective treatment and understanding of molecular epidemiology. Molecular methods help diagnosing conventionally those difficult to diagnose patients who transmit infection to the community. So also, molecular methods help early detection of TB-HIV co-infections and extra-pulmonary TB. (Extra-pulmonary means TB occurring in organs of the body other than lungs, such as, brain-coverings, lymph glands, abdominal organs, reproductive organs, urinary system, including kidney, bladder etc). Amplification techniques such as Polymerase Chain Reaction (PCR) also plays an important role of rapid diagnosis. PCT diagnose TB in-negative HIV/TB cases and inconclusive chest X-rays. Accuracy of Loop-medicated isothermal amplification (LAMP), diagnostic method was discussed during Myanmar Health Research Congress 2012. Histopathological examination (HPE) was considered as a gold standard. LAMP diagnosed 57 (79%) tuberculous lymph adenitis (enlargement of nodes at arm-pit, neck, abdomen, groins etc) due to inflammation, as a natural defence-mechanism to block the spread of infection and 15 (21%) non tuberculous lymphadenitis cases.
Moreover, DNA-based innovated methods are needed for epidemiological purposes, it is learnt. Outbreak of investigations, epidemiological links, laboratory cross contaminations, distinction between pre-infection and reactivation, analysis of transmission between sub populations etc involve Molecular Strain Typing of M. tuberculosis by DNA banding based method.
Collaboration with USA, Australia, UK and other EU nations, Japan, Republic of Korea and other eastern countries, ASEAN co-members is beneficial for DMR, NTP, Universities of Medicine and others domestic institutes and organizations. Modest KOICA – assisted infectious diseases scrutinizing laboratory research building in DMR-LM premises is one of the symbolic evidence of Myanmar-Republic of Korea collaboration.
In controlling tuberculosis, media inclusion is crucial, I believe. Health education is simple digestive domestic languages in one of the cornerstones to get rid of TB from the list of public health problems. Community participation, of course, is necessary, as World TB Day falls on 24 March.


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