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
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RUEHLO/AMEMBASSY LONDON 2038
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RUEHRO/AMEMBASSY ROME 0169
RUEHFR/AMEMBASSY PARIS 0588
RUEHCN/AMCONSUL CHENGDU 1509
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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
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RUEHBS/USEU BRUSSELS
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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