Tuberculosis in Southeast Asia

The incidence of tuberculosis (TB) in ASEAN declined from 2002 to 2017. Six out of ten ASEAN countries—Cambodia, Myanmar, Indonesia, Vietnam, Laos, and Thailand—showed a continuous decrease in TB cases. The Philippines experienced an initial decline in TB incidence until 2007, followed by an increasing trend. Meanwhile, Malaysia, Singapore, and Brunei exhibited fluctuations in TB case trends, with Malaysia showing a rising trend from 2009 onward. Regarding health-related expenditures, Singapore had the highest per capita spending at US$1,550.42, followed by Brunei at US$716.15. These two countries also reported the lowest mean number of TB cases. In contrast, Myanmar had the second-highest mean number of TB cases while spending the least per capita on health compared to other ASEAN nations.[1] See also: https://tbreadingnotes.blogspot.com/2024/08/achieving-universal-social-protection.html

TB loss to follow-up (LTFU) refers to patients who begin tuberculosis treatment but fail to complete it or attend follow-up appointments. According to the WHO, TB LTFU includes patients who discontinue treatment for more than eight consecutive weeks after undergoing at least four weeks of therapy. Several socioeconomic factors contribute to TB LTFU, including low education levels, short-term migration—particularly across provinces—and limited access to healthcare services. Additionally, individuals from lower-income backgrounds and those who are unemployed face a higher risk of discontinuing treatment, especially when healthcare services are not easily accessible.[2] See also: https://tbreadingnotes.blogspot.com/2024/08/cost-effectiveness-and-budget-impact-of.html

Behavioral and community-related factors also play a significant role in TB LTFU. Alcohol consumption and smoking have been linked to an increased likelihood of treatment default, with alcohol impairing judgment, disrupting adherence to treatment schedules, and reducing the effectiveness of TB medications through drug interactions. Similarly, smoking may exacerbate pulmonary symptoms, complicating the treatment process and potentially diminishing TB medication efficacy. Furthermore, household economic conditions influence treatment adherence, with self-employed household heads being more likely to default on treatment compared to government employees. In contrast, having health insurance and access to travel support significantly reduces the risk of LTFU by alleviating financial and logistical burdens associated with treatment.[2]

Migrants face unique challenges that heighten their risk of TB LTFU, including unstable housing, irregular employment, and difficulties accessing consistent healthcare services. Their transient nature often results in treatment interruptions due to relocation and barriers to continuity of care. Financial constraints further exacerbate treatment adherence issues, as out-of-pocket payments may deter individuals from continuing TB therapy. Conversely, individuals with health insurance are more likely to adhere to TB treatment protocols, underscoring the crucial role of financial stability in ensuring treatment completion and reducing LTFU rates.[2]

References:

1. Shanmuham, V., Shetty, J.K. and Naik, V.R., 2022. Incidence of tuberculosis in the association of South-East Asia Nation (ASEAN) countries and its relation with health expenditure: a secondary data analysis. Manipal Journal of Nursing and Health Sciences, 8(1), p.7.

2. Rani, A.Y.A., Ismail, N., Zakaria, Y. and Isa, M.R., 2024. A scoping review on socioeconomic factors affecting tuberculosis loss to follow-up in Southeast Asia. Med J Malaysia, 79(4), pp.470-476.