Only 29 percent of people who test positive for tuberculosis infection actually go to a healthcare provider to seek help for treatment, while just 19 percent of those who have hemoptysis – coughing for two weeks or more – seek care for their condition.

These are the findings of the 2018 National Tuberculosis Prevalence Survey that likely contribute to the increasing rate of TB prevalence in the Philippines.

Further, there is no evidence that says there was a decline in prevalence from the results of the 2007 survey.

Based on the study, the TB prevalence rate in 2016 is 1,159 per 100,000, which when extrapolated by the World Health Organization translates to about a million Filipinos projected to have pulmonary TB in 2017.

A sobering message

According to Dr Mary Ann Lansang, principal investigator of the Foundation for Advancement of Clinical Epidemiology, Inc. that conducted the survey, “This is a low percentage of people seeking care from a healthcare provider and [it] is a sobering message for us.”

The results should serve as a signal for health authorities to encourage eople to seek care much more quickly ad receive proper care, Dr Lansang stressed.

The infectious disease expert explained that the objectives of the NTSP 2016 was to determine the magnitude of the TB burden in the country from age 15 and above, and to study the trend of TB incidence and prevalence compared to the 2007 survey results.

The nationwide probe involved 46,689 participants aged 15 and older, and was done in 106 clusters from the “tip of northern Luzon to the southernmost part” of the country.

New features were introduced in the process, among them the use of a digital x-ray that made images available on site. The equipment used further allowed for more mobility, making it easier to go around different clusters.

Three tests

The first stage was symptom screening to find out who among the participants had hemoptysis, which is suggestive of TB. If symptoms were present, and x-ray images showed suspicions for the pulmonary disease, sputum was collected.

The principal investigator explained they used three tests for quality assuredness. The first is through smear microscopy, using LED fluorescent which is more sensitive. The second is through solid culture, the usual gold standard for TB mycobacterium, and finally is the rapid accurate test (Xpert MTB/RIF). The last test is able to amplify the DNA of the mycobacterial organism and results are available within two hours.

From the initial screening, only 6 percent admitted to having cough for two weeks or more. And sputum was mostly collected from individuals who had undergone chest x-rays and were found suspicious for TB, but only accounted for 26 percent of the cohort.

Significant findings

Among the findings that Dr Lansang and her team found remarkable was that the prevalence of TB among males was very high – 1,173 per 100,000 – compared to only 627 for females.

Still, the infectious disease expert cautioned that a prevalence of 627 for one gender is “not low.” “It is still very high because the total incidence previously was only 322.”

Furthermore, the survey found certain factors associated with higher risk for TB, in particular smoking.

Males who smoked – especially for more than 5 years – had three times more the risk of TB while female smokers had twice the risk of contracting the pulmonary disease. An individual who has previously been treated for TB also had 2.3 times the risk of getting TB, and those in the older age bracket increased their risk by two or three times.

Diabetes was likewise a risk factors, as is low socioeconomic with proxy indicators, such as enrolment in the 4Ps programme or other social protection programmes. People in urban dwellings and persons without insurance coverage likewise had a higher risk.

The Department of Health now intends to include chest x-rays in its TSEKUP package where it hopes to target 50 percent of Filipinos at risk of TB. Moreover, it will integrate TB control with HIV/AIDS management and other health programmes.

DOH hopes that in the next 6 years, at least three million TB cases will be detected through x-ray screening. And the number of new cases per 100,000 would be reduced from the 554 reported in 2016.

As money is often a factor that leads to discontinued treatment or non-compliance in TB therapy, government will be expanding the health insurance and social insurance coverage for all TB patients. The aim is to reduce to less than 10 percent the proportion of patients suffering from catastrophic costs due to tuberculosis. MIMS

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