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Cablegate: Burma: Tracking Tb Cases in the Delta

VZCZCXRO8005
RR RUEHAST RUEHCHI RUEHDT RUEHHM RUEHLN RUEHMA RUEHNH RUEHPB RUEHPOD
RUEHTM
DE RUEHGO #0531/01 1840932
ZNR UUUUU ZZH
R 020932Z JUL 08
FM AMEMBASSY RANGOON
TO RUEHC/SECSTATE WASHDC 7869
RUCNASE/ASEAN MEMBER COLLECTIVE
RUEHZN/ENVIRONMENT SCIENCE AND TECHNOLOGY COLLECTIVE
RUEHBJ/AMEMBASSY BEIJING 1922
RUEHBY/AMEMBASSY CANBERRA 1327
RUEHKA/AMEMBASSY DHAKA 4915
RUEHLO/AMEMBASSY LONDON 2038
RUEHNE/AMEMBASSY NEW DELHI 4859
RUEHUL/AMEMBASSY SEOUL 8415
RUEHTC/AMEMBASSY THE HAGUE 0685
RUEHKO/AMEMBASSY TOKYO 5977
RUEHRO/AMEMBASSY ROME 0169
RUEHFR/AMEMBASSY PARIS 0588
RUEHCN/AMCONSUL CHENGDU 1509
RUEHCHI/AMCONSUL CHIANG MAI 1690
RUEHCI/AMCONSUL KOLKATA 0360
RUEAUSA/DEPT OF HHS WASHDC
RHHMUNA/CDR USPACOM HONOLULU HI
RUEHPH/CDC ATLANTA GA
RUCLRFA/USDA WASHDC
RUEHRC/USDA FAS WASHDC
RHEHNSC/NSC WASHDC
RUCNDT/USMISSION USUN NEW YORK 1830
RUEKJCS/SECDEF WASHDC
RUEHBS/USEU BRUSSELS
RUEKJCS/JOINT STAFF WASHDC

UNCLAS SECTION 01 OF 03 RANGOON 000531

SENSITIVE
SIPDIS

DEPT FOR EAP/EX; EAP/MLS; EAP/EP; EAP/PD
DEPT FOR OES/STC/MGOLDBERG AND PBATES; OES/PCI/ASTEWART;
OES/IHA/DSINGER AND NCOMELLA
DEPT FOR CA/OCS/ACS/EAP
DEPT PASS TO USAID/ANE/CLEMENTS AND GH/CARROLL
CDC ATLANTA FOR COGH SDOWELL and NCID/IB AMOEN
USDA FOR OSEC AND APHIS
USDA FOR FAS/DLP/HWETZEL AND FAS/ICD/LAIDIG
USDA/FAS FOR FAA/YOUNG, MOLSTAD, ICD/PETTRIE, ROSENBLUM
DOD FOR OSD/ISA/AP FOR LEW STERN
PARIS FOR FAS/AG MINISTER COUNSELOR/OIE
ROME FOR FAO
BANGKOK FOR REO OFFICE, USAID/RDMA, USAID/OFDA
PACOM FOR FPA

E.O. 12958:N/A
TAGS: ECON TBIO EAID SOCI PGOV AMED BM
SUBJECT: BURMA: TRACKING TB CASES IN THE DELTA

REF: A) RANGOON 282 B) RANGOON 278

RANGOON 00000531 001.2 OF 003


1. (SBU) Summary. Cyclone Nargis, which struck Burma May 2-3,
destroyed much of the Irrawaddy Delta, including more than 125 many
public and private health facilities. Consequently, many
tuberculosis (TB) patients living in the delta lost access to their
medications and stopped treatment. Officials from the World Health
Organization (WHO) and the Ministry of Health (MOH), concerned that
prolonged lack of access to TB medications could cause patients to
develop multi-drug resistant TB (MDR-TB), traveled June 11-18 to
three cyclone-affected townships - Laputta, Bogalay, and Ngapudaw -
to track down TB patients. TB officials, after identifying 162 TB
patients registered with the National TB Program who had defaulted
on their treatment protocol, successfully traced all but 48
patients. Three patients refused to continue their treatment and
could develop MDR-TB. Population Services International (PSI),
which runs 71 private clinics in Irrawaddy Division, confirmed that
all but four of its 345 TB patients in the three affected townships
had access to medicines immediately after the storm. These four
patients have since resumed taking their medications. WHO, MOH, and
NGO staff continue to trace missing TB patients in Irrawaddy and
Rangoon Divisions. End Summary.

TB: A Priority Disease
----------------------

2. (SBU) The World Health Organization (WHO) considers Burma to be
one of 22 tuberculosis (TB) high-burden countries in the world. The
Ministry of Health (MOH) reported more than 130,000 new TB cases
last year, up from 107,991 cases in 2006 (Ref B). Burma's rate of
multi-drug resistant TB (MDR-TB) is the highest in Southeast Asia.
While a 2003 WHO study showed that 4 percent of new TB cases and
15.5 percent of previously treated TB cases were multi-drug
resistant, a 2006 study of MDR-TB in Rangoon showed the rates to be
higher, at 4.2 percent of new cases and 18.8 percent among
previously treated cases (Ref A). The true burden of TB and thus of
MDR-TB in Burma is unknown, but the rates are likely to be three
times higher than previous estimates, WHO TB Medical Officer Dr.
Hans Kluge told us.

3. (SBU) The MOH's National Tuberculosis Program (NTP), which is
active in all 324 townships, monitors and treats TB cases throughout
Burma, running the country's DOTS program. NGOs and private clinics
also provide DOTS services to patients, PSI Deputy Country Director
Dr. Nyo Nyo Minn explained. Some TB patients prefer to seek
treatment at private clinics rather than NTP sites because the
service is more personalized and the quality of care is higher. PSI
alone treats more than 10 percent of Burma's TB cases, she noted.

TB in the Delta

RANGOON 00000531 002.3 OF 003


---------------

4. (SBU) TB is prevalent in the Irrawaddy Delta, particularly in
Labutta, Bogalay, and Ngapudaw, WHO TB Officer Dr. Osman Eltayeb
declared. (Note: official estimates on the number of TB cases in
the delta remain unavailable. End Note.) In the weeks after the
cyclone, MOH staff assessed the damage to medical clinics in the
delta, verifying that 17 rural health centers and 120 sub-rural
health centers were destroyed and 186 rural health centers and 588
sub-rural health centers were partially destroyed. NTP staff also
confirmed whether registered TB patients had access their TB
medicines. While exact figures are unavailable, Dr. Eltayeb
estimated that 20 percent of TB patients lacked access to medicines
after the cyclone. Concerned that the TB patients would default on
their treatment (defaulting occurs after two months of with no
medicines) and could potentially develop MDR-TB, staff from the WHO
and NTP conducted a joint trip to Labutta, Bogalay, and Ngapudaw
June 11-18 to trace missing TB patients.

5. (SBU) NTP data showed that 723 TB patients had sought treatment
at NTP facilities in three townships, Dr. Eltayeb explained. The
teams determined that the destruction of local TB clinics and
supplies of TB drugs caused the interruption of treatment for 162 of
these patients. During the week in the delta, the teams searched
for the missing patients, using registration data to track down
patients or family members. They traced 106 of the patients: 56
continued their treatment, 54 had died, and 3 refused to continue
their treatment, arguing that they had other issues to worry about.
NTP continues to search for the missing 48 patients, despite lack of
information about their location. Assuming that NTP cannot find
these patients, a total of 51 TB patients in the three townships
will be classified as defaulters. The probability that they will
develop MDR-TB is high, Dr. Kluge admitted. However, there is no
mechanism under Burmese law to force TB patients to take their
medicines. Thus, all that NTP staff can do is try to track them
down, conduct new sputum tests to determine their TB status, and
provide them with drugs. Whether or not the TB patients take the
medications is up to them, he stated.

--------------------------------------------- -------
Missing TB Patients in Three Delta
Townships after Cyclone Nargis
As of June 27, 2008
--------------------------------------------- -------
Township Registered Interrupt No. No. Still
Patients Treatment Traced Missing
--------------------------------------------- -------
Labutta 245 100 68 32
Bogalay 280 38 25 13
Ngapudaw 198 24 20 3

RANGOON 00000531 003.2 OF 003


--------------------------------------------- -------
Total 723 162 113 48
--------------------------------------------- -------
Source: World Health Organization

6. (SBU) PSI, the largest private provider of DOTS in Burma,
successfully traced all of its TB patients from the delta after the
storm, Dr. Nyo Nyo Minn confirmed. (Note: TB patients who seek care
in private clinics are not included in the NTP figures above. End
Note.) While the cyclone destroyed six of the Sun Clinics that
provided DOTS, only four of the 345 TB patients stopped their
treatment due to lack of access to medicines. Immediately after the
storm, PSI sent TB drugs through its Sun Clinic networks to the
affected areas, ensuring that the four patients could resume
treatment within days. Sun Clinic doctors in the delta continue to
treat TB patients, and have diagnosed several new TB cases in the
past month, Dr. Nyo Nyo Minn stated.

Comment
-------

7. (SBU) Burma already has the highest rate of MDR-TB in Southeast
Asia; disruptions in TB treatment will only exacerbate the
situation. Ministry of Health and NTP officials are cognizant of
this fact, resulting in strong efforts to track down missing TB
patients living in the delta before they defaulted on their
treatment. Despite GOB efforts, whether a TB patient decides to
continue his or her treatment remains a personal decision, one based
on an understanding of the consequences of the disease. That three
patients opted to forgo TB drugs can be explained in part by the
disaster they experienced, but it also indicates a need for more
rigorous efforts by health officials to explain the potential
dangers of TB. While the NTP remains committed to combating the
spread of TB, the GOB needs to develop efforts to ensure TB patients
complete DOTS treatment. A strong DOTS program, and a strong
commitment on the part of both the NTP and the patient, will help
prevent the spread of MDR-TB in Burma.

VILLAROSA

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