The USAID TB CARE II project, Bangladesh has been supporting Diabetic Association of Bangladesh (DAB) to increase access to TB services for diabetes patients by improving prevention, early case detection and quality of care, thereby contributing to reduction in mortality and morbidity rates due to TB-diabetes by integrating TB services into diabetes delivery services.
The key activities include early detection of TB in diabetes patients through active screening of diabetes patients and quality of care for patients with TB-DM. As a result, total case notification of all forms of TB among diabetes patients increased manifold - from 337 cases notified during April-December in 2013 to 1119 cases in January - December 2014.
Moreover, DAB (i) oriented 811 health professionals from BIRDEM and affiliated hospitals on screening and management of TB among diabetes patients; (ii) developed a National guideline on management of TB-DM co- morbidities; (iii) provided regular counseling to diabetes patients to sensitize them about increased risks of TB infection and early care seeking for TB services.
Malaysia
Another study presented by Dr Abdul Razak Muttalif of Institute of Respiratory Medicine, Kuala Lumpur Hospital, Malaysia, compared treatment outcomes among TB patients in four states (Penang, Sabah, Sarawak and Selangor) with and without diabetes. The study results showed that:
- 24.4% of the TB patients had diabetes also, which was twice as high as reported by a previous study.
- A very high percentage of TB-DM patients had poorer treatment success rate with the odd ratio for treatment success rate among them being 0.63 with 95% confidence interval.
- TB-DM patients were found to be at 8% increased risk for TB treatment failure.
- Treatment non-compliance rate and death rate (at 5.8% each) was also high in this group.
Thus diabetes has a strong influence on treatment success rate and hence is a contributing risk factor for mortality among TB patients. Even though Malaysia is a moderate TB burden country, the increasing level of diabetes enhances the chances of an escalating number of TB patients in future. It is because of this reason that all TB patients in Malaysia are screened for diabetes.
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