Childhood TB in Myanmar: trends in notification, profile and treatment outcomes in the private sector

SETTING

Myanmar National Tuberculosis (TB) programme (NTP).

OBJECTIVE

To describe 1) the trends in childhood TB (aged ⩾ 14 years) notification from 2014 to 2017 and quantify the private sector contribution to this notification; and 2) the profile and treatment outcomes of childhood TB managed in the private sector in 2016.

STUDY DESIGN

This was an observational study involving the review of routine records and reports of the NTP public-private mix (PPM) projects managed by the Myanmar Medical Association and Population Service International.

RESULTS

The total number of childhood TB notified has declined from 36 314 in 2014 to 28 723 in 2017 (average annual decline = 2607 cases per year). The private sector contribution to the notification remained between 17% and 19%. Of the 5616 childhood TB cases diagnosed and treated under the two PPM projects in 2016, 99% were clinically diagnosed and 5459 (97.7%) had successful treatment outcomes. Children aged ⩾10 years, males, those with bacteriologically confirmed TB, those treated in the regions or states of Mandalay, Chin and Shan had a higher risk of an unfavourable outcome (lost to follow-up, death, move to second-line treatment and not evaluated).

CONCLUSION

Childhood TB notification is showing a declining trend. One of five notified childhood TB cases was diagnosed and treated in the private sector, where the successful treatment rate was high.

Dimensional growth of the rabbit eye

The rabbit eye has been used experimentally in research in vision and ophthalmology. However, there is little information about postnatal growth. The purpose of this study was to determine growth patterns of the rabbit globe from birth to young adult status focusing in particular on the fibrous outer tunic of the globe, the sclera. Eyes of both sexes of New Zealand White rabbits were examined on postnatal days 1, 7, 14, 28, 42 and 56. Axial length, equatorial diameter and corneal diameter were measured using a digital caliper. Plastic-embedded tissue was used to quantify scleral thickness and cellular density at anterior, equatorial and posterior sites. Axial length increased 230% between postnatal days 1 and 56. The rate of growth was not linear and revealed two peaks. The first peak occurred between postnatal days 1-7, and the second between days 14-28. Eye opening occurred on days 9-11. Sex differences were seen, with the male eye being larger (p = 0.00001). Surface area measurements of sclera and cornea revealed that the sclera occupies approximately 5/6 of the outer surface of the globe and the cornea 1/6. Scleral thickness increased from day 1 to day 42 (70-155 microm at the equator) while fibroblast density was found to decrease (0.32 to 0.05 cells/microm(2)). The results suggested that eye opening precedes a unique increase in the rate of eye growth and visual processes may be playing a role in modulating the growth pattern between days 14 and 28.