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Ikushi Onozaki MD, MPH Chiba Anti-TB Association/JATA

National TB Prevalence Survey Cambodia, 2002. 8 years after introduction of DOTS. Ikushi Onozaki MD, MPH Chiba Anti-TB Association/JATA Chiba Foundation for Health Promotion and Disease Prevention. How much TB in Cambodia? Estimates for 2001. estimate number rate/100,000

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Ikushi Onozaki MD, MPH Chiba Anti-TB Association/JATA

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  1. National TB Prevalence Survey Cambodia, 2002 8 years after introduction of DOTS Ikushi OnozakiMD, MPH Chiba Anti-TBAssociation/JATA Chiba Foundation for Health Promotion and Disease Prevention

  2. How much TB in Cambodia? Estimates for 2001 estimate number rate/100,000 incidence (all) 75,000 573 incidence HIV+ 9,200 70 incidence (ss+) 34,000 256 prevalence (all) 178,000 1356 prevalence (ss+) 72,000 548 deaths 16,000 121 From Chris Dye

  3. National TB Prevalence Survey1st Systematic, National Representative and Comprehensive TB Survey in Cambodia • First population based survey under a typical DOTS program • 42 clusters of 31,000 people across the country • 30,000, 97%, participated • 22,164, 96%, Age 10 or more Age <15 y : Tuberculin Age 10 or more: X-ray Preparation Meeting with Local People

  4. Lao Thailand Viet Nam Survey Cluster:★

  5. Basic Operation Schedule: Cluster/Week Sunday: Arrival & Basic Preparation Monday: Census/ Informed Consent Arrival of Technical Team Tuesday/Wednesday: Interview, X-ray, Tu-test, Sputum collection Thursday: Interview, X-ray, Sputum collection, Sputum transfer to CENAT Friday: Sputum collection, Tu-reading Saturday: Tu-reading (morning only) , Departure

  6. Census: Confirming eligible population and asking for participationPeople who basically stay in a defined area more than a month are eligible population regardless the possession of their house and their availability on the survey day Proper informed consent to avoid creating fears

  7. Survey Days Collaboration with local community is essential

  8. Family by family interview by a physician from CENAT • TB related symptoms • Duration of sickness • TB history • Possible treatment • Consultation Places 1,699 (7.7%) participants who met the TB suspect criteria such as cough more than 3 weeks were asked to submit sputum regardless X-ray findings

  9. Age 10ys or more: Taking X-ray • 22,012 X-ray exams • 2,432 who showed any kind of abnormality were asked to submit sputum JICA team is monitoring and ensuring the safety of the survey

  10. Developing Film on the SpotQuality Direct X-ray is Available in Villages that contributed to high participation rates and 100% sputum collection from suspects

  11. 84 showed smear positive slide(s) 81 Smear Positive TB 1 MOTT 2 contamination susp. 81 S(+) TB :(71 New) New: 66 on Treatment: 5 New, 2 Ret Previously treated: 8 202 S(-)C(+) 190 S(-)C(+) TB Cases 12 contamination susp 190 Cases New: 174 on Treatment: 3 New, 1 Ret Previously treated: 13

  12. Number of S(+) cases actually detected and Prevalence Rate

  13. Prevalence of Bac(+) Pulmonary TBNational TB Survey 2002

  14. Relations between prevalence and notificationsmear positive TB Ａｇｅ

  15. Limitation of Symptom Screening by Interviews to Detect Cases

  16. DOTS in all MPA Health Centers, primary care level per 10,000 population, by 2005

  17. Prevalence of TB and Distance to DOTS Service( /100,000 age 10 or more)

  18. Point Estimates of ARI, 2002 National SurveyChildren with No BCG Scar (RT23:2TU)

  19. Estimation of Incidence of New S(+) DOTS CDR=52%, Private Tx=10%, TB/HIV: 15%

  20. Conclusions and Research Questions Yes, Cambodia has very high TB burden, however, • S(+) Prevalence, 270, a half of WHO estimate • No more among 22 HBC???, dropping from 18th to 24th? A large pool of latent infection may be a major source of new cases: Continuous efforts are essential 30/81 S(+) were judged as no-TB suspects by interviews: Limitation of a survey without X-ray and/or CF strategy S(+) occupied only 30% of Bac (+) Less in groups with better access to DOTS: A transitional phenomenon of short history of DOTS? Or Need of new model? Bac (+) prevalence of 902: Total TB burden is probably more than the WHO estimate that may make Cambodia still within 22 HBC, even 16th or 17th ?

  21. Efforts on DOTS Expansion, establishing better access to DOTS, are paying off in case detection

  22. Yes, DOTS is working to reduce S(+) prevalence in Cambodia even with TB/HIV impact. However: S(+) Prevalence: 50-60% of the WHO estimate and/ or the era before DOTS Incidence: 80-85% level of those Detecting S(+) only: Is it enough in community with such a high prevalence, where one out of 11 “grandfathers” is C(+)? : Need to assess unknown impact of chronic S(-)C(+) with a large number of close contacts in a large family in Asia Incidence of S(-)C(+) may be much higher than the WHO estimate with current model. However, majority of them might not come to health facility to seek treatment because many of them are not so sick.

  23. Now, we’ve got a clear view

  24. Challenge: The next round in 2008? CENAT/JICA National TB Control ProjectCambodia Thanks for your collaboration in advance!

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