Social and behavioral factors predicting beliefs about the use of traditional Chinese medicine for tuberculosis treatment in Myanmar and Yunnan, China. Public

Abstract

Tuberculosis (TB) is a major public health issue in both Myanmar and China; two countries listed as one of the 14 countries with high burden of TB, TB/HIV and MDR-TB. In low resource countries, where the ratio of patient to healthcare provider may not be enough to meet the healthcare needs of the country, traditional medicine is often a widely used alternative, including for suspected and active tuberculosis. However, using traditional medicine as a substitute for standard therapy can prevent initiation of effective treatment regimens and treatment non-adherence, resulting in increased opportunities for onward transmission. Using a validated questionnaire examining socio-demographic and knowledge about TB, 1473 participants were convenience sampled in Yunnan Province, China, and various regions in Myanmar. Of these 1473 participants, 1250 subjects (288 Chinese, 962 Burmese) were examined to investigate which factors predict whether a subject believed that traditional Chinese medicine (TCM) could cure TB. Multivariable logistic regression analysis was used to construct predictive models for each cohort. Comparing the Chinese and Burmese models highlighted the predictive power of education levels, knowing where to get tested, location of treatment for previous illness, and perception of time taken to cure TB. Marital status influenced predictive power only in the Chinese model, while being a manual laborer, believing that TB can be transmitted genetically and geographic area influenced predictive power in the Burmese model. These differences can potentially be attributed to regional variations in cultures, socioeconomic factors and attitudes towards TB. These findings provide potential targeting strategies for intervention development in order to increase efficacy in preventing TB transmission and mortality as a result of continued TCM use. Considering these types of variables may help to identify the community and presumptive patients/families who are most likely to believe that traditional medicine can cure TB. Educating these communities may improve uptake of TB treatment.

Table of Contents

1. Introduction 1

2. Materials & Methods 6

2.1 Study Subjects & Data Collection 6

2.2 Variable Selection 6

2.3 Variable Coding 7

2.4 Statistical Analysis 8

3. Results 10

3.1 Univariate Analysis 10

3.2 Bivariate analysis of predictor variables with outcome 10

3.3 Multivariable Analysis 12

3.3.1 Chinese Cohort 12

3.3.2 Burmese Cohort 13

4. Discussion 15

5. Conclusion 23

6. Tables 24

7. References 30

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Global Epidemiology - MPH & MSPH
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Mot-clé	Tuberculosis China Traditional Medicine Myanmar Predictive Modeling Traditional Chinese Medicine
Committee Chair / Thesis Advisor	Janssens, A Cecile, Emory University Innes, Anh, FHI 360
Partnering Agencies	International Non-governmental organization (e.g., CARE, Inc.)

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