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Han KT, Wai KT, Oo T, Thi A, Han Z, Aye DKH, Win AYN, Sattabongkot J. Correction: Access to primaquine in the last mile: challenges at the service delivery points in pre-elimination era, Myanmar. Trop Med Health 2023; 51:6. [PMID: 36732863 PMCID: PMC9896819 DOI: 10.1186/s41182-023-00499-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- Kay Thwe Han
- grid.10223.320000 0004 1937 0490Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Nakhon Pathom, Thailand ,grid.415741.2Parasitology Research Division, Department of Medical Research (DMR), No. 5 Ziwaka Road, Yangon, 11191 Myanmar
| | | | - Tin Oo
- grid.415741.2Parasitology Research Division, Department of Medical Research (DMR), No. 5 Ziwaka Road, Yangon, 11191 Myanmar
| | - Aung Thi
- Department of Public Health (DoPH), National Malaria Control Program, Yangon, Myanmar
| | - Zayar Han
- Parasitology Research Division, DMR, Yangon, Myanmar
| | | | | | - Jetsumon Sattabongkot
- grid.10223.320000 0004 1937 0490Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Nakhon Pathom, Thailand
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Win AYN, Wai KT, Harries AD, Kyaw NTT, Oo T, Than WP, Lin HH, Lin Z. The burden of Japanese encephalitis, the catch-up vaccination campaign, and health service providers' perceptions in Myanmar: 2012-2017. Trop Med Health 2020; 48:13. [PMID: 32161512 PMCID: PMC7059723 DOI: 10.1186/s41182-020-00200-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 02/27/2020] [Indexed: 01/28/2023] Open
Abstract
Background Myanmar is endemic for Japanese encephalitis (JE) and has experienced several outbreaks in recent years. The vector-borne disease control (VBDC) program has collected hospital-based surveillance data since 1974. There is an urgent need to collate, analyze, and interpret the most recent information. The study aimed to describe (i) hospital-based JE cases and deaths between 2012 and 2017, (ii) a catch-up vaccination campaign in children in 2017, and (iii) health service provider perceptions about JE in one township in 2018. Methods This was a cross-sectional study of cases, deaths, and catch-up childhood vaccinations using secondary data from program records and a survey database of health service provider perceptions. Results Between 2012 and 2017, there were 872 JE cases and 79 deaths with a case fatality rate of 91 per 1000; 2016 was the year with most cases and deaths. Most cases (n = 324) and deaths (n = 37) occurred in children aged 5–9 years. Large case numbers were reported in delta and lowland regions (n = 550) and during the wet season (n = 580). The highest case fatality rates were observed in the hills and coastal regions (120 and 112 per 1000, respectively). Nationwide coverage of the catch-up JE vaccination campaign among 13.7 million eligible children was 92%, with coverage lower in the hills and coastal regions (84%) compared with delta and lowland regions and plains (94%). More vaccinations (65%) occurred through school-based campaigns with the remainder (35%) vaccinated through community-based campaigns. Structured interviews in one township showed that service providers (n = 47) had good perceptions about various aspects of JE, although perceived benefits of specific vector control measures were poor: spraying/fumigation (38%), garbage removal (36%), larvicide use (36%), and drainage of standing/stagnant water (32%). Conclusion The catch-up vaccination campaign was a successful response to high JE case numbers and deaths in children. However, ongoing surveillance for JE needs to continue and be strengthened to ensure comprehensive reporting of all cases, more knowledge is needed on disability in JE survivors, and all attempts must be made to ensure high percentage coverage of vaccination through routine and catch-up campaigns.
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Affiliation(s)
- Aung Ye Naung Win
- 1Epidemiology Research Division, Department of Medical Research, Ministry of Health and Sports, No. 5, Ziwaka Road, Dagon Township, Yangon, 11191 Myanmar
| | - Khin Thet Wai
- 1Epidemiology Research Division, Department of Medical Research, Ministry of Health and Sports, No. 5, Ziwaka Road, Dagon Township, Yangon, 11191 Myanmar
| | - Anthony D Harries
- 2International Union against Tuberculosis and Lung Disease, Paris, France.,3London School of Hygiene and Tropical Medicine, London, UK
| | - Nang Thu Thu Kyaw
- 2International Union against Tuberculosis and Lung Disease, Paris, France
| | - Tin Oo
- 1Epidemiology Research Division, Department of Medical Research, Ministry of Health and Sports, No. 5, Ziwaka Road, Dagon Township, Yangon, 11191 Myanmar
| | - Wint Phyo Than
- 4Vector Borne Disease Control Program, Ministry of Health and Sports, Naypyitaw, Myanmar
| | - Htar Htar Lin
- 5Expanded Program on Immunization, Ministry of Health and Sports, Naypyitaw, Myanmar
| | - Zaw Lin
- 6WHO South East Asia Regional Office, New Delhi, India
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Han KT, Wai KT, Oo T, Thi A, Han Z, Aye DKH, Win AYN, Prachumsri J. Access to primaquine in the last mile: challenges at the service delivery points in pre-elimination era, Myanmar. Trop Med Health 2018; 46:32. [PMID: 30250397 PMCID: PMC6145114 DOI: 10.1186/s41182-018-0115-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 09/10/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Alongside monitoring of the disease burden, the successful move towards malaria elimination relies on the readiness of the health care delivery system. However, there is a lack of evidence in the gap of existing National Guidelines and access to low dose primaquine in real practice under varying degrees of antimalarial resistance in the pre-elimination phase in Myanmar. Therefore, this study addressed the essential information from the service delivery points (SDPs) of public and private sectors on the availability and the use of primaquine in both supply and demand side. Concomitantly, the study aimed to underscore challenges in health system infrastructure to promote the sustained flow in rolling out primaquine in line with National Guidelines for malaria elimination. METHODS A cross-sectional study conducted from September 2017 to February 2018 included six townships of three states/regions. The team used an observation checklist for documenting primaquine supplies at SDPs. Semi-structured interviews, key informant, and in-depth interviews focused both public and private sectors including staff from the Vector-Borne Diseases Control (VBDC) teams in each state/region and rural health centers (n = 25), those from the non-governmental organizations (NGOs), general practitioners and drug sellers (n = 11), and recently infected malaria patients (n = 11). Triangulation of quantitative and qualitative data provided meaningful interpretations. RESULTS Public sector staff reported an adequate stock of primaquine, but it was unavailable at the general practitioners' clinics without any connection to NGOs and also at the unlicensed drug shops. Health care providers of the public sector experienced challenges in poor compliance of malaria patients to primaquine treatment in conjunction with an artemisinin-based combination therapy, loss-to-follow-ups especially in conflict areas, and delays in timely substitution of new batches of primaquine. Respondents from the private sector demanded for the refresher training course on updated antimalarial treatment guidelines. CONCLUSION Monitoring compliance and safety of primaquine treatment was found as a barrier especially among mobile migrant workers and those who were in conflict areas. An alternative strategy by the NMCP could enable to prevent the underutilization of primaquine in vivax malaria to reach the malaria elimination targets.
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Affiliation(s)
- Kay Thwe Han
- grid.415741.2Parasitology Research Division, Department of Medical Research (DMR), No. 5 Ziwaka Road, Yangon, 11191 Myanmar
| | | | | | - Aung Thi
- National Malaria Control Program, Department of Public Health (DoPH), Yangon, Myanmar
| | - Zayar Han
- Parasitology Research Division, DMR, Yangon, Myanmar
| | | | | | - Jetsumon Prachumsri
- 0000 0004 1937 0490grid.10223.32Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Nakhon Pathom, Thailand
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Win AYN, Maung TM, Wai KT, Oo T, Thi A, Tipmontree R, Soonthornworasiri N, Kengganpanich M, Kaewkungwal J. Understanding malaria treatment-seeking preferences within the public sector amongst mobile/migrant workers in a malaria elimination scenario: a mixed-methods study. Malar J 2017; 16:462. [PMID: 29132373 PMCID: PMC5683526 DOI: 10.1186/s12936-017-2113-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 11/08/2017] [Indexed: 11/25/2022] Open
Abstract
Background Migration flows and the emerging resistance to artemisinin-based combination therapy in the Greater Mekong Sub-region (GMS) create programmatic challenges to meeting the AD 2030 malaria elimination target in Myanmar. The National Malaria Control Programme (NMCP) targeted migrant workers based mainly on the stability of their worksites (categories 1: permanent work-setting; categories 2 and 3: less stable work-settings). This study aims to assess the migration patterns, malaria treatment-seeking preferences, and challenges encountered by mobile/migrant workers at remote sites in a malaria-elimination setting. Methods A mixed-methods explanatory sequential study retrospectively analysed the secondary data acquired through migrant mapping surveys (2013–2015) in six endemic regions (n = 9603). A multivariate logistic regression model was used to ascertain the contributing factors. A qualitative strand (2016–2017) was added by conducting five focus-group discussions (n = 50) and five in-depth interviews with migrant workers from less stable worksites in Shwegyin Township, Bago Region. The contiguous approach was used to integrate quantitative and qualitative findings. Results Among others, migrant workers from Bago Region were significantly more likely to report the duration of stay ≥ 12 months (63% vs. 49%) and high seasonal mobility (40% vs. 35%). Particularly in less stable settings, a very low proportion of migrant workers (17%) preferred to seek malaria treatment from the public sector and was significantly influenced by the worksite stability (adjusted OR = 1.4 and 2.3, respectively for categories 2 and 1); longer duration of stay (adjusted OR = 3.5); and adjusted OR < 2 for received malaria messages, knowledge of malaria symptoms and awareness of means of malaria diagnosis. Qualitative data further elucidated their preference for the informal healthcare sector, due to convenience, trust and good relations, and put migrant workers at risk of substandard care. Moreover, the availability of cheap anti-malarial in unregistered small groceries encouraged self-medication. Infrequent or no contact with rural health centres and voluntary health workers worsened the situation. Conclusions Mitigating key drivers that favour poor utilization of public-sector services among highly mobile migrant workers in less stable work-settings should be given priority in a malaria-elimination setting. These issues are challenging for the NMCP in Myanmar and might be generalized to other countries in the GMS to achieve malaria-elimination goals. Further innovative out-reach programmes designed and implemented specific to the nature of mobile/migrant workers is crucial. Electronic supplementary material The online version of this article (10.1186/s12936-017-2113-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Aung Ye Naung Win
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Epidemiology Research Division, Department of Medical Research, No. 5 Ziwaka Road, Yangon, Myanmar
| | - Thae Maung Maung
- Medical Statistics Division, Department of Medical Research, No. 5 Ziwaka Road, Yangon, Myanmar
| | - Khin Thet Wai
- Department of Medical Research, No. 5 Ziwaka Road, Yangon, Myanmar
| | - Tin Oo
- Department of Medical Research, No. 5 Ziwaka Road, Yangon, Myanmar
| | - Aung Thi
- National Malaria Control Programme, Department of Public Health, NayPyiTaw, Myanmar
| | - Rungrawee Tipmontree
- Bureau of Vector Borne Diseases, Department of Disease Control, Ministry of Public Health, Bangkok, Thailand
| | | | - Mondha Kengganpanich
- Department of Health Education and Behavior Sciences, Faculty of Public Health, Mahidol University, Bangkok, Thailand
| | - Jaranit Kaewkungwal
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
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Soe TN, Wu Y, Tun MW, Xu X, Hu Y, Ruan Y, Win AYN, Nyunt MH, Mon NCN, Han KT, Aye KM, Morris J, Su P, Yang Z, Kyaw MP, Cui L. Genetic diversity of Plasmodium falciparum populations in southeast and western Myanmar. Parasit Vectors 2017; 10:322. [PMID: 28676097 PMCID: PMC5496439 DOI: 10.1186/s13071-017-2254-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 06/19/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The genetic diversity of malaria parasites reflects the complexity and size of the parasite populations. This study was designed to explore the genetic diversity of Plasmodium falciparum populations collected from two southeastern areas (Shwekyin and Myawaddy bordering Thailand) and one western area (Kyauktaw bordering Bangladesh) of Myanmar. METHODS A total of 267 blood samples collected from patients with acute P. falciparum infections during 2009 and 2010 were used for genotyping at the merozoite surface protein 1 (Msp1), Msp2 and glutamate-rich protein (Glurp) loci. RESULTS One hundred and eighty four samples were successfully genotyped at three genes. The allelic distributions of the three genes were all significantly different among three areas. MAD20 and 3D7 were the most prevalent alleles in three areas for Msp1 and Msp2, respectively. The Glurp allele with a bin size of 700-750 bp was the most prevalent both in Shwekyin and Myawaddy, whereas two alleles with bin sizes of 800-850 bp and 900-1000 bp were the most prevalent in the western site Kyauktaw. Overall, 73.91% of samples contained multiclonal infections, resulting in a mean multiplicity of infection (MOI) of 1.94. Interestingly, the MOI level presented a rising trend with the order of Myawaddy, Kyauktaw and Shwekyin, which also paralleled with the increasing frequencies of Msp1 RO33 and Msp2 FC27 200-250 bp alleles. Msp1 and Msp2 genes displayed higher levels of diversity and higher MOI rates than Glurp. PCR revealed four samples (two from Shwekyin and two from Myawaddy) with mixed infections of P. falciparum and P. vivax. CONCLUSIONS This study genotyped parasite clinical samples from two southeast regions and one western state of Myanmar at the Msp1, Msp2 and Glurp loci, which revealed high levels of genetic diversity and mixed-strain infections of P. falciparum populations at these sites. The results indicated that malaria transmission intensity in these regions remained high and more strengthened control efforts are needed. The genotypic data provided baseline information for monitoring the impacts of malaria elimination efforts in the region.
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Affiliation(s)
- Than Naing Soe
- Department of Public Health, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Yanrui Wu
- Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, China.,Department of Cell Biology & Genetics, Kunming Medical University, Kunming, China
| | - Myo Win Tun
- Department of Medical Research, Yangon city, Myanmar
| | - Xin Xu
- Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, China
| | - Yue Hu
- Department of Pathology, Kunming Medical University, Kunming, China
| | - Yonghua Ruan
- Department of Pathology, Kunming Medical University, Kunming, China
| | | | | | | | - Kay Thwe Han
- Department of Medical Research, Yangon city, Myanmar
| | - Khin Myo Aye
- Department of Medical Research, Yangon city, Myanmar
| | - James Morris
- Department of Genetics and Biochemistry, Eukaryotic Pathogens Innovation Center, Clemson University, Clemson, SC, USA
| | - Pincan Su
- Transfusion Medicine Research Department, Yunnan Kunming Blood Center, Kunming, China
| | - Zhaoqing Yang
- Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, China.
| | - Myat Phone Kyaw
- Department of Medical Research, Yangon city, Myanmar. .,Myanmar Medical Association, Yangon, Myanmar.
| | - Liwang Cui
- Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, China. .,Department of Entomology, Pennsylvania State University, University Park city, PA, 16802, USA.
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