Tuberculosis mortality rates and trends in Bangladesh: secondary analysis of mortality data

Overview

While Bangladesh is making remarkable progress in achieving population health outcomes, tuberculosis (TB)persists as one of the major public health issues with high rates of incidence, prevalence, and death. Under the National Tuberculosis Control Program (NTP), and with partnership and support from BRAC, icddr,b and other non-government organisations which are implementing the DOTS programme, there has been considerable development in terms of an increase in the case notification rate from 31 in 100,000 in 1993 to 71 in 100,000 in 2006. Despite such improvements, the absolute number of (reported) TB cases has risen from 85,410 in 2004 to 190,893 in 2013. In 2013, the estimated prevalence of people with TB was 639 (95% CI 330-1000), incidence 350 (95% CI 310-400) and mortality rate 80 (95% CI 51-110) per 100,000 population.

The information currently available on TB mortality in Bangladesh, as provided by different sources, is fragmented. Thus, there is a need for uniformity in using the standard tools and proceduresin determining TB related deaths. Further, the quality of available data has always been a question, which limits effective use and interpretation of findings derived from the existing databases.

Therefore, assessment of available data sets, identification of gaps,and triangulation has become critically important. Furthermore, there is a need for appropriate statistical analyses of available data sets and synthesis of evidence base to provide a national, close-to-exact picture on TB mortality. This would also help to determine the progress made so far and guide informed policy decisions for TB prevention and control in Bangladesh.

With the funding support from The Global Fund to Fight AIDS, Tuberculosis and Malaria(GFATM), the James P Grant School of Public Health, BRAC University(JPGSPH), in collaboration with BRAC, icddr,b and National TB Program, is currently conducting a study onTB mortality in Bangladesh. The study seeks to determine the tuberculosis mortality situation in Bangladesh.

Specific objectives of the study:
• To estimate the TB mortality rate using the databases currently available.
• To determine the age, sex and geographic distribution of TB mortality.
• To determine the gaps in the currently available data, such as the use of standard procedures. for data collection, definition, validation, and data management.
• To assess the TB mortality trends over the past 10 years.

Activities

This research study has been designed and divided into two phases: in phase I, analyses of secondary data related to tuberculosis (TB) mortality in Bangladesh will be conducted;inphase II,the primary TB mortality data collection was conducted using verbal autopsy. In phase I, the following databases were reviewed:
• Health & Demographic Surveillance Systems (HDSS) (icddr,b)
• Death related data reported by National Tuberculosis Program (NTP)
• Bangladesh Demographic & Health Survey (BDHS) (NIPORT)
• Sample Vital Registration System (SVRS) (BBS)
• Bangladesh Maternal Mortality and Health Care Survey (BMMS) (NIPORT)
• National AIDS/STD Programme (NASP)
• National Institute of Chest Diseases and Hospital (NIDCH) (DGHS, MoHFW)
• Health Management Information System (DGHS, MoHFW)

Activities completed and the current status of phase I:
• The different datasets as indicated above have now been obtained and are being cleaned for a range of analyses.
• Thorough analyses of the data collection procedure took place in each datasets, resulting in the identification of the strengths and the gaps.
• A draft reporting is under progress, and the final report is expected to be completed by February 2016.

Activities completed and the current status of phase II:
• Preparatory works for phase II of the study are underway.
• A range of available verbal autopsy (VA) tools have been reviewed.
• A workshop on tuberculosis mortality was held on 28 December 2015 with participation from TB experts. The workshop focused on preparing and adopting VA tools for phase II of the TB mortality study.

Partners/donors

Funding support: The Global Fund to Fight AIDS, Tuberculosis and Malaria
Strategic partners: BRAC, icddr,b, and National Tuberculosis Program

Treatment-seeking pathway(s) of patients diagnosed with Drug Resistant TB (DR TB) in selective areas of Bangladesh and associated stigma among health care providers: a Mixed Method Study

Overview
Bangladesh has an estimate of 1.4 per cent Multi Drug Resistant(MDR) tuberculosis (TB) cases in newly diagnosed pulmonary patients and 29 per cent estimate of MDR cases from previously treated TB cases. There have been studies which indicate the risk factors regarding MDR TB in Bangladesh, showing that previous treatment history and TB contact history were the main factors to be noted as a potential risk for MDR TB.

The objective of this research, conducted from October – December 2015,was to find out the treatment-seeking pathways undertaken by drug resistant tuberculosis (DR TB) patients who are currently under treatment, simultaneously examining the role of associated stigma among the providers and whether and how this affects the patients who seek treatment.

The specific objectives of the research study are:

  • To study the treatment seeking pathway for the DR TB patients under treatment at the time of data collection.
  • To understand the attitude of health care providers toward MDR TB patients and associated stigma.
  • To study whether the providers who bear stigma associated with MDR TB has any role in treatment-seeking by the patients.

Activities
The health seeking pathway of MDR TB patients was studied through both quantitative and qualitative approaches; the attitude and stigma of health providers was explored through qualitative interviews of both patients and providers. Three government hospitals - Chest Disease Hospitals in Dhaka, Chittagong and Sylhet - were the study sites. DR-TB patients aged 18 years and above and who had already been diagnosed and were admitted for treatment at the selected three Chest Disease Hospitals were the target group of the study. The health care providers who were responsible for the treatment and management of these patients were also included in the study.

Partners/donor

Donor: GFATM-TB Research

Tuberculosis co-morbidity with diabetes mellitus in Bangladesh: prevalence and treatment outcomes in urban and rural settings

Overview
In 2012, the World Health Organization ranked Bangladesh as the 6th highest tuberculosis (TB) burdened country in the world. As a highly contagious disease, tuberculosis poses a significant public health challenge to Bangladesh’s TB control especially when comorbid with Diabetes Mellitus (DM), a disease which suppresses the immune system in humans. The rise in DM means a growing percentage of the population face an increased risk of reactivation of latent TB infections. Moreover, underlying DM may adversely affect the success of TB treatment in patients, and vice versa. Before taking corrective action, a thorough analysis of TB-DM prevalence, distribution, and baseline treatment outcomes is needed. There is a large gap in the literature regarding prevalence of DM in TB patients in rural and urban areas. In addition, there is little information regarding treatment outcomes of TB in patients with DM in Bangladesh. Therefore, this study aimed to fill the existing gap in literature and help build stronger policies regarding tuberculosis control, and in turn improve the services provided by TB control programmes in Bangladesh.

Activities

• The study conducted oral glucose tolerance test (OGTT) of 1,910 TB patients in 16 districts of Bangladesh to gather information about their DM status.
• While undergoing the OGTT, the patients were also interviewed using a structured questionnaire, and their height and weight were measured to calculate their body mass index (BMI).
• The study also followed up with 750 patients after they had completed their treatment regimen to collect information about the outcome of their treatment.

Partners/donor

Donor: Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM)

Highlights

• A manuscript was submitted to the journal ‘The International Journal of Tuberculosis and Lung Disease’ on prevalence and risk factors of DM on TB patients. The paper is currently under review.
• A second manuscript on the influence of DM on the treatment outcome of TB patients was submitted to the journal ‘Journal of Tropical medicine and International Health’, which is also currently under review.