TB in Myanmar: “I must fight this disease for my daughter’s sake.”

With support from Community Partners International, the Myanmar Anti-TB Association is helping push back tuberculosis (TB) in Yangon’s low-income communities. We talk to health care providers and a TB patient about preventing and treating this potentially life-threatening disease.

“In December, I coughed up blood”

In October 2023, Nandar*, 39, started coughing. “It was worse in the evening and during the night,” she recalls. “I lost weight and felt exhausted. Then, in December, I coughed up blood.”

Nandar lives in Dala Township on the southern bank of the Yangon River in Myanmar’s Yangon Region. She is married and has a ten-year-old daughter. Her mother and sister also live with her.

Although Dala Township is just a short boat ride from Myanmar’s commercial capital, Yangon, it is mainly rural, and poverty is widespread. It is a popular destination for rural migrants seeking work in the city and contains many informal migrant settlements. Crowded living conditions, poor sanitation, and the lack of affordable health services help diseases like TB spread.

Like many households in Dala, Nandar and her family struggle to earn enough income. “My husband used to run a small motorcycle repair shop,” she explains, “but he had to close it because of high equipment costs. After that, he began trading beans and other crops, but we struggle to make ends meet. It seems that everyone worries about money nowadays. People are prioritizing work over health.”

Concerned about her health, Nandar visited a clinic run by the Myanmar Anti-TB Association (MATA), a local organization supported by Community Partners International (CPI) through the USAID HIV/AIDS Agency, Information and Services (AIS) Activity. “I had been to this clinic before when my neighbor had TB,” Nandar explains. “So, I knew what services they provided. They referred me for a chest X-ray and did a sputum test. The next day, the doctor told me that I had TB.”

When Nandar received her TB diagnosis, her first thought was for others. “I worried about my daughter and mother because we live together,” she confirms. “The clinic helped them get a test, and, luckily, they were negative. I used to think TB only spreads when you cough, but the doctor explained that it can also spread through the air when you talk, laugh, or sneeze. I’ve taken precautions to protect them. I use separate eating utensils and don’t sleep beside my daughter anymore. It is painful hearing her cry because she’s used to sleeping with me, but I know it’s for the best.”

Myanmar is one of 30 countries identified by the World Health Organization (WHO) as having a high burden of TB, HIV-associated TB, and TB drug resistance. The WHO estimates that 257,000 people had TB in Myanmar in 2022, and nearly 50,000 people died of the disease. According to the National TB Prevalence Survey (2018), the Yangon Region has the highest TB burden nationally. The conflict and instability that have plagued Myanmar in recent years have worsened the economic situation and made it more difficult for people to access affordable health care.

“We focus on people who can’t access health care due to poverty.”

”Overcrowding, malnutrition, and a lack of awareness are all factors that drive TB infections here,” confirms Dr. Ye Htut Win, MATA’s Clinic Medical Officer in Dala. “It’s most common in men, children under five, and the elderly. We focus on people who can’t access health care due to poverty.”

“At the clinic, we screen patients for TB and refer them for chest X-rays, sputum tests, and, if necessary, polymerase chain reaction (PCR) tests,” explains Dr. Ye Htut Win. “If results indicate TB, we help them get treatment through the National TB Program. They can collect their TB medication supplied by the National TB Program from our clinic. We also monitor TB patients, treat side effects from the TB drugs, and offer nutrition support.”

MATA supports a network of community-based volunteers who help educate communities about TB and conduct TB case-finding. “We have trained eight volunteers in Dala,” Dr. Ye Htut Win reveals. “They find suspected TB cases and refer them to our clinic. Their role is essential for our community-based care model of TB services. Without them, our community outreach would be much weaker.”

TB is treated with a standard six-month course of four TB drugs. Adhering to the full course of treatment is important to cure TB and prevent drug resistance. However, these drugs can have side effects for some patients, and encouraging them to complete the course is challenging.

The lack of TB awareness and the stigma and anxiety around diagnosis are barriers that MATA faces. Thiri, a MATA community volunteer, is familiar with these hurdles. “I live in an area where the population density is high,” she explains. “Poor ventilation and sanitation, and crowded living spaces, increase the risk of TB infection. Many people lack awareness of how to stay healthy. They think if they get TB, they’ll have to stop working, and it’ll make their situation worse. Some can’t afford the transport costs to get to our clinic.”

The MATA volunteers help break down the barriers and connect suspected TB patients to free care. “I distribute pamphlets about TB and ask people to contact me if they have symptoms,” Thiri confirms. “I keep an eye out for people with possible symptoms. If I come across them, I refer them to the MATA clinic for further evaluation and trace close contacts. I also provide information to the patient and their family about how to manage TB effectively.”

“I encourage them to stay strong and fight the disease.”

Thiri supports patients throughout the treatment period. “When I visit, I check if they’ve missed any doses of their medication. I follow up regularly, scheduling sputum examinations in the second, fifth, and sixth months of treatment. I call them to ask how they’re feeling and check side effects. This allows me to monitor their progress, address concerns, and adjust their treatment plan if needed.”

MATA provides home-based directly observed treatment (DOT) for certain patients. During DOT, a trained community volunteer or designated person watches the patient swallow each prescribed TB drug dose to ensure adherence.

“We provide DOT for TB patients who live alone or have no family members and for those who have health complications due to the side effects of the treatment,” confirms Dr. Ye Htut Win. “We provide these services through our volunteers.”

MATA volunteer Thiri supports a few of her patients with DOT services. “I visit them daily for the first two months to administer TB drugs,” she explains. “After that, I go every two days according to the medication schedule. Currently, I’m providing DOT services to a patient who has cancer and TB. I encourage them to stay strong and fight the disease.”

Through MATA’s efforts, 92% of patients enrolled in their TB program in Dala Township adhered to the full course of treatment in 2023.

TB patient Nandar is working hard on her recovery and is glad she can count on MATA and her family for support. “After I started treatment, I lost my appetite and started getting skin rashes. Thankfully, my family is taking good care of me. I must fight this disease for my daughter’s sake. My family has been incredibly supportive and encouraging. I feel lucky to have them by my side. I take my medication at 6 am, and they always remind me.”

“MATA’s support is invaluable,” she continues. “They communicate well. The staff is kind and compassionate and provides comfort. The volunteer checks on me frequently on visits and by phone. The treatment is free of charge, and they helped cover the cost of diagnosis. I go to the clinic every two weeks to collect the drugs, and they have helped me manage the symptoms caused by the side effects.”

“These services are crucial for our community,” Nandar adds. “When I was diagnosed with TB, I was upset and concerned about stigma. But I haven’t faced any discrimination. After two months of treatment, I started looking for a job to support our livelihood and my daughter’s education. The doctor assured me that I was no longer infectious. I’m happy to share that I’ve found a job in Yangon.”

*Name changed to protect privacy

The USAID HIV/TB Agency, Information and Services (AIS) Activity aims to achieve HIV epidemic control by ensuring 95 percent of people living with HIV in Burma are aware of their status, 95 percent of those identified as positive are on antiretroviral treatment, and 95 percent of those on treatment are virally suppressed. It also aims to achieve a Burma free from TB by reaching every person with TB, curing those needing treatment, and preventing the spread of disease and new infections. It is funded by PEPFAR and the Global Accelerator to End TB through USAID.