Khan M S, Khine T M, Hutchison C, Coker R J, Hane K M, Innes A L, Aung S
Communicable Diseases Policy Research Group, London School of Hygiene and Tropical Medicine, Satharanauskwisit Building, 420/1 Rajwithi Road, Bangkok, 10400, Thailand.
Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
BMC Infect Dis. 2016 Mar 3;16:110. doi: 10.1186/s12879-016-1429-y.
Although there is a large increase in investment for tuberculosis control in Myanmar, there are few operational analyses to inform policies. Only 34% of nationally reported cases are from women. In this study, we investigate sex differences in tuberculosis diagnoses in Myanmar in order to identify potential health systems barriers that may be driving lower tuberculosis case finding among women.
From October 2014 to March 2015, we systematically collected data on all new adult smear positive tuberculosis cases in ten township health centres across Yangon, the largest city in Myanmar, to produce an electronic tuberculosis database. We conducted a descriptive cross-sectional analysis of sex differences in tuberculosis diagnoses at the township health centres. We also analysed national prevalence survey data to calculate additional case finding in men and women by using sputum culture when smear microscopy was negative, and estimated the sex-specific impact of using a more sensitive diagnostic tool at township health centres.
Overall, only 514 (30%) out of 1371 new smear positive tuberculosis patients diagnosed at the township health centres were female. The proportion of female patients varied by township (from 21% to 37%, p = 0.0172), month of diagnosis (37% in February 2015 and 23% in March 2015 p = 0.0004) and age group (26% in 25-64 years and 49% in 18-25 years, p < 0.0001). Smear microscopy grading of sputum specimens was not substantially different between sexes. The prevalence survey analysis indicated that the use of a more sensitive diagnostic tool could result in the proportion of females diagnosed at township health centres increasing to 36% from 30%.
Our study, which is the first to systematically compile and analyse routine operational data from tuberculosis diagnostic centres in Myanmar, found that substantially fewer women than men were diagnosed in all study townships. The sex ratio of newly diagnosed cases varied by age group, month of diagnosis and township of diagnosis. Low sensitivity of tuberculosis diagnosis may lead to a potential under-diagnosis of tuberculosis among women.
尽管缅甸对结核病控制的投资大幅增加，但用于政策制定的业务分析却很少。全国报告的病例中只有34%来自女性。在本研究中，我们调查了缅甸结核病诊断中的性别差异，以确定可能导致女性结核病病例发现率较低的潜在卫生系统障碍。
2014年10月至2015年3月，我们系统收集了缅甸最大城市仰光10个乡镇卫生中心所有新的成人涂片阳性结核病病例的数据，以建立一个电子结核病数据库。我们对乡镇卫生中心结核病诊断中的性别差异进行了描述性横断面分析。我们还分析了全国患病率调查数据，以计算涂片镜检阴性时使用痰培养法在男性和女性中额外发现的病例数，并估计在乡镇卫生中心使用更敏感诊断工具对性别的影响。
总体而言，在乡镇卫生中心诊断的1371例新涂片阳性结核病患者中，只有514例（30%）为女性。女性患者的比例因乡镇而异（从21%到37%，p = 0.0172）、诊断月份（2015年2月为37%，2015年3月为23%，p = 0.0004）和年龄组（25 - 64岁为26%，18 - 25岁为49%，p < 0.0001）。痰标本的涂片镜检分级在性别之间没有实质性差异。患病率调查分析表明，使用更敏感的诊断工具可能会使乡镇卫生中心诊断出的女性比例从30%增加到36%。
我们的研究首次系统地汇编和分析了缅甸结核病诊断中心的常规业务数据，发现所有研究乡镇中诊断出的女性比男性少得多。新诊断病例的性别比例因年龄组、诊断月份和诊断乡镇而异。结核病诊断的低敏感性可能导致女性结核病潜在诊断不足。
