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Han KT, Han ZY, Aye KH, Wai KT, Thi A, Cui L, Sattabongkot J. Correction: G6PD deficiency among malaria-infected national groups at the western part of Myanmar with implications for primaquine use in malaria elimination. Trop Med Health 2023; 51:8. [PMID: 36740714 PMCID: PMC9900901 DOI: 10.1186/s41182-023-00498-9] [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: 02/07/2023] Open
Affiliation(s)
- Kay Thwe Han
- grid.415741.2Parasitology Research Division, Department of Medical Research (DMR), No. 5 Ziwaka Road, Yangon, 11191 Myanmar ,DMR, No. 5 Ziwaka Road, Yangon, 11191 Myanmar
| | - Zay Yar Han
- grid.511992.7Department of Public Health (DoPH), National Malaria Control Program, Naypyitaw, Myanmar
| | | | - Khin Thet Wai
- grid.511992.7Department of Public Health (DoPH), National Malaria Control Program, Naypyitaw, Myanmar
| | - Aung Thi
- grid.170693.a0000 0001 2353 285XDepartment of Internal Medicine, University of South Florida, Tampa, USA
| | - Liwang Cui
- grid.10223.320000 0004 1937 0490Mahidol Vivax Research Unit (MVRU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Jetsumon Sattabongkot
- grid.415741.2Parasitology Research Division, Department of Medical Research (DMR), No. 5 Ziwaka Road, Yangon, 11191 Myanmar
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2
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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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3
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Aung E, Han KT, Gordon CA, Hlaing NN, Aye MM, Htun MW, Wai KT, Myat SM, Thwe TL, Tun A, Wangdi K, Li Y, Williams GM, Clements ACA, Vaz Nery S, McManus DP, Gray DJ. High prevalence of soil-transmitted helminth infections in Myanmar schoolchildren. Infect Dis Poverty 2022; 11:28. [PMID: 35272701 PMCID: PMC8908594 DOI: 10.1186/s40249-022-00952-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 11/15/2021] [Accepted: 02/21/2022] [Indexed: 11/23/2022] Open
Abstract
Background Achieving the elimination of soil-transmitted helminth (STH) infections requires a sufficient understanding of the current epidemiological status of STH endemicity. We aimed to examine the status of STH in Myanmar – a country with the eighth highest STH prevalence in the world, 10 years after instigation of the national deworming programme. Methods In August 2016 we screened for STH infections using Kato Katz (KK) microscopy and real-time PCR (qPCR) in schoolchildren from the Bago Region township of Phyu, a STH sentinel site in Myanmar. Ten schools were randomly selected, and one stool sample each from a total of 264 students was examined. Prevalence and intensity of infection were calculated for each STH. Results High prevalence of STH was identified in the study area with 78.8% of the schoolchildren infected with at least one STH by qPCR, and 33.3% by KK. The most prevalent STH was Trichuris trichiura, diagnosed by both KK (26.1%) and qPCR (67.1%), followed by Ascaris lumbricoides (15.5% KK; 54.9% qPCR). No hookworm infections were identified by KK; however, the qPCR analysis showed a high prevalence of Ancylostoma sp. infection (29.6%) with few Necator americanus (1.1%) infections. Conclusions Despite bi-annual deworming of schoolchildren in the fourth-grade and below, STH prevalence remains stubbornly high. These results informed the expansion of the Myanmar National STH control programme to include all school-aged children by the Ministry of Health and Sports in 2017, however further expansion to the whole community should be considered along with improving sanitation and hygiene measures. This would be augmented by rigorous monitoring and evaluation, including national prevalence surveys.
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Affiliation(s)
- Eindra Aung
- Department of Global Health, Research School of Population Health, Australian National University, Canberra, ACT, Australia.,St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Kay Thwe Han
- Parasitology Research Division, Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
| | - Catherine A Gordon
- Infectious Diseases Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | | | - Moe Moe Aye
- Department of Zoology, University of Yangon, Yangon, Myanmar
| | - Myo Win Htun
- Parasitology Research Division, Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
| | - Khin Thet Wai
- Parasitology Research Division, Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
| | - Su Mon Myat
- Department of Public Health, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Thida Lay Thwe
- Department of Zoology, University of Yangon, Yangon, Myanmar
| | - Aung Tun
- Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Kinley Wangdi
- Department of Global Health, Research School of Population Health, Australian National University, Canberra, ACT, Australia
| | - Yuesheng Li
- Infectious Diseases Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.,Hunan Institute of Parasitic Diseases, World Health Organization Collaborating Centre for Research and Control On Schistosomiasis in Lake Region, Yueyang, China
| | - Gail M Williams
- School of Public Health, University of Queensland, Brisbane, QLD, Australia
| | - Archie C A Clements
- Department of Global Health, Research School of Population Health, Australian National University, Canberra, ACT, Australia.,Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Susana Vaz Nery
- Department of Global Health, Research School of Population Health, Australian National University, Canberra, ACT, Australia.,The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Donald P McManus
- Infectious Diseases Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Darren J Gray
- Department of Global Health, Research School of Population Health, Australian National University, Canberra, ACT, Australia.
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Han KT, Han ZY, Aye KH, Wai KT, Thi A, Cui L, Sattabongkot J. G6PD deficiency among malaria-infected national groups at the western part of Myanmar with implications for primaquine use in malaria elimination. Trop Med Health 2021; 49:47. [PMID: 34108049 PMCID: PMC8191138 DOI: 10.1186/s41182-021-00339-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 05/31/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Glucose 6-phosphate dehydrogenase deficiency (G6PDd) plays a central role in readiness assessment for malaria elimination in Myanmar by 2030 that includes primaquine (PQ) use. The risk of hemolysis in G6PDd individuals hampers the widespread use of primaquine safely in malaria-infected patients. In the pre-elimination era, it is important to screen initially for asymptomatic malaria in combination with G6PD deficiency by applying more sensitive diagnostic tools. Therefore, this study examined the proportion of G6PDd and the distribution of G6PD genotypes among malaria-infected national groups in Myanmar before initiation of malaria elimination strategies. METHODS A cross-sectional study in one township each with high malaria burden from two states in the western part of Myanmar, was conducted during 2016-2018, and 320 participants (164 Rakhine and 156 Chin National groups) were recruited. We used RDT and ultrasensitive polymerase chain reaction (us PCR) method to confirm malaria infection, and a G6PD RDT(CareStart) to detect G6PDd and PCR/restriction fragment length polymorphism (RFLP) method to confirm the variant of G6PDd for genotyping. G6PD enzyme activity was measured by G6PD Biosensor (CareStart). RESULTS Malaria positivity rates detected by RDT were lower than those detected by us PCR in the combined samples [13% (42/320) vs. 21% (67/320)] as well as in the Rakhine samples [17% (28/164) vs. 25% (41/164)] and in Chin samples [9% (14/156) vs. 17% (26/156)]. G6PD deficiency rates were approximately 10% in both the combined samples and specific national groups. For G6PD enzyme activity in the combined samples, G6PDd (defined as < 30% of adjusted male median) was 10% (31/320) and severe G6PDd (< 10% of AMM) was 3% (9/320). Among malaria-infected patients with positive by both RDT and usPCR, G6PDd was less than 20% in each national group. G6PD genotyping showed that the G6PD Mahidol (G487A) was the major variant. CONCLUSIONS The varying degree of G6PDd detected among malaria-infected national groups by advanced diagnostic tools, strongly support the recommend G6PD testing by the National Malaria Control Program and the subsequent safe treatment of P. vivax by primaquine for radical cure. Establishing a field monitoring system to achieve timely malaria elimination is mandatory to observe the safety of patients after PQ treatment.
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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
| | - Zay Yar Han
- DMR, No. 5 Ziwaka Road, Yangon, 11191 Myanmar
| | - Kyin Hla Aye
- 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), Naypyitaw, Myanmar
| | - Liwang Cui
- grid.170693.a0000 0001 2353 285XDepartment of Internal Medicine, University of South Florida, Tampa, USA
| | - Jetsumon Sattabongkot
- grid.10223.320000 0004 1937 0490Mahidol Vivax Research Unit (MVRU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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5
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Pwint KH, Min KS, Tao W, Shewade HD, Wai KT, Kyi HA, Shakya S, Thapa B, Zachariah R, Htun ZT. Decreasing Trends in Antibiotic Consumption in Public Hospitals from 2014 to 2017 Following the Decentralization of Drug Procurement in Myanmar. Trop Med Infect Dis 2021; 6:57. [PMID: 33924003 PMCID: PMC8167548 DOI: 10.3390/tropicalmed6020057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/31/2021] [Accepted: 04/02/2021] [Indexed: 11/16/2022] Open
Abstract
(1) Background: In 2014, drug procurement for public hospitals in Myanmar was decentralized to a pull system. This might lead to increasing trends in the consumption of broad-spectrum and last-resort antibiotics. For fiscal years 2014-2017, we assessed annual antibiotic consumption trends and patterns in total defined daily doses (DDDs). (2) Methods: We followed World Health Organization (WHO) methodology for surveillance of antimicrobial consumption based on hospital antibiotic procurement records (as a proxy). (3) Results: In 32% of all public hospitals where data were retrieved, total antibiotic consumption reduced by 19% between 2014 (7,122,852 DDD) and 2017 (5,794,904 DDD). Consumption per 1000 inhabitants per day (<200 bed hospitals) also reduced from 0.6 to 0.3. Over 60% of procurement was for beta-lactam antibiotics and quinolones; quinolones decreased over time. Consumption of first-line antibiotics increased (42% in 2014 to 54% in 2017), whereas broad-spectrum antibiotics decreased (46% in 2014 to 38% in 2017). Linezolid was the only last-resort antibiotic procured. There was a progressive reduction in per capita government current health expenditure from approximately 9.2 US$ in 2014 to 8.3 US$ in 2017. (4) Conclusions: Antibiotic consumption decreased over time in public hospitals. This first study provides a baseline for developing an antibiotic consumption surveillance system in Myanmar.
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Affiliation(s)
- Khin Hnin Pwint
- Department of Medical Research, Ministry of Health and Sports, Yangon 11191, Myanmar; (K.T.W.); (Z.T.H.)
| | - Kyaw Soe Min
- Department of Medical Services, Ministry of Health and Sports, Naypyidaw 15015, Myanmar; (K.S.M.); (H.A.K.)
| | - Wenjing Tao
- Unit for Antibiotics and Infection Control, Public Health Agency of Sweden, 171 65 Stockholm, Sweden;
| | - Hemant Deepak Shewade
- International Union Against TB and Lungs Disease (The Union), 75000 Paris, France;
- The Union South East Asia, New Delhi 110001, India
| | - Khin Thet Wai
- Department of Medical Research, Ministry of Health and Sports, Yangon 11191, Myanmar; (K.T.W.); (Z.T.H.)
| | - Hnin Aye Kyi
- Department of Medical Services, Ministry of Health and Sports, Naypyidaw 15015, Myanmar; (K.S.M.); (H.A.K.)
| | - Sushma Shakya
- World Health Organization, Lalitpur 44700, Kathmandu, Nepal;
| | - Badri Thapa
- World Health Organization, 403 (A1), Bahan Township, Yangon 11201, Myanmar;
| | - Rony Zachariah
- Special Program for Research and Training in Tropical Disease (TDR), 20 Avenue Appia, 1211 Geneva 27, Switzerland;
| | - Zaw Than Htun
- Department of Medical Research, Ministry of Health and Sports, Yangon 11191, Myanmar; (K.T.W.); (Z.T.H.)
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Lum N, Wai KT, Thar AMC, Show KL, Harries AD, Wann NMA, Hone S, Oo HN. HIV testing and ART initiation in people who inject drugs and are placed on methadone in Kachin State, Myanmar. Public Health Action 2020; 10:27-32. [PMID: 32368521 DOI: 10.5588/pha.19.0063] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 01/07/2020] [Indexed: 11/10/2022] Open
Abstract
Setting People who inject drugs (PWID) enrolled for methadone maintenance therapy (MMT) and never previously tested for human immunodeficiency virus (HIV) in Myitkyina Drug Dependency Treatment Hospital, Myitkyina, Kachin State, Myanmar. Objectives To compare before (2016) and after (2018) adoption of 'Test and Treat' guidelines for antiretroviral therapy (ART): 1) the demographic profile of PWID, 2) HIV testing uptake and ART initiation in those diagnosed HIV-positive, and 3) time taken for events. Design This was a cohort study using secondary programme data. Results In 2016 and 2018, there were respectively 141 and 146 PWID: all were male except for one female and age distribution between the 2 years was similar. In 2018, significantly more PWID were HIV-tested than in 2016 (85% vs. 45%; P ≤ 0.001). Among those tested, the proportions who were HIV-positive were similar (37% in 2016 and 38% in 2018). In 2018, significantly fewer HIV-positive PWID were started on ART than in 2016 (19% vs. 48%; P = 0.01). Median times between enrolment on MMT and HIV testing (2 vs. 1 day) and between being diagnosed HIV-positive and started on ART (31 vs. 17 days) for 2016 and 2018 were not significantly different. Conclusion ART uptake decreased in 2018 compared with 2016, and ways to rectify this are urgently needed.
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Affiliation(s)
- N Lum
- National AIDS Programme, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - K T Wai
- Department of Medical Research, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - A M C Thar
- Expanded Programme on Immunization, Department of Public Health, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - K L Show
- Department of Medical Research, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France.,London School of Hygiene & Tropical Medicine, London, UK
| | - N M A Wann
- Department of Medical Services, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - S Hone
- National AIDS Programme, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - H N Oo
- National AIDS Programme, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
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7
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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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Hein ZNM, Maung TM, Aung PP, Mon NO, Han WW, Oo T, Linn NYY, Thi A, Wai KT. Do we need to go further to train healthcare providers in the targeted regions for malaria elimination in Myanmar? A mixed-methods study. Trop Med Health 2020; 48:11. [PMID: 32123518 PMCID: PMC7035698 DOI: 10.1186/s41182-020-00196-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 07/05/2019] [Accepted: 02/10/2020] [Indexed: 01/04/2023] Open
Abstract
Background The National Malaria Control Programme (NMCP) in Myanmar trained health staff at the township level starting in mid-2016 in order to achieve the Plasmodium falciparum malaria elimination target by 2020. This study aimed to evaluate the knowledge and perception of Basic Health Staff (BHS) and Vector-borne Diseases Control (VBDC) teams exposed to a short training course on malaria elimination in six targeted townships which included two conflict-affected townships between 2016 and 2017. Methods This was a cross-sectional mixed-methods study using quantitative and qualitative data extracted from one survey database conducted between October 2018 and March 2019. Modified Poisson regression analysis was performed to ascertain the determinants of low knowledge scores after the training programme. Results Altogether, 544 trained frontline health workers involved in malaria elimination at the time of the survey were recruited and 56% (302/544) were stationed at sub-Rural Health Centers. More than half of the respondents had correct knowledge of malaria case categories although relapse and recrudescent cases (39% and 37% respectively) were less well known. Over two-thirds of respondents could mention those eligible for malaria testing. Less than 30% knew the foci classification. The overall knowledge scores ranged from 10 to 31. The significant predictors of low level of knowledge [the cut-off point was set at the median value of 21 (IQR 12-30)] in multivariate analysis were the younger age group (18-29 years) and health staff who had attended malaria elimination training in 2017, [(APR = 1.6, 95% CI 1.2-2.2)]; and (APR = 1.5, 95%CI 1.2-1.8)]. Qualitative data from 10 key informants identified perceived challenges in conflict-affected areas as well as in areas of high population mobility with further implications for case surveillance. In addition, the low level of education of community members was noted as one of the barriers that hampered public readiness in the elimination scenario. Conclusion A significant impact on knowledge improvement after the training programme was not visible especially for correct notification of malaria cases and treatment according to National Malaria Elimination Guidelines. Regular monitoring and continuing guidance by the higher level management is critical to support the field staff.
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Affiliation(s)
- Zar Ni Min Hein
- 1Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
| | - Thae Maung Maung
- 1Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
| | - Poe Poe Aung
- Duke Global Health Institute Myanmar Program, Yangon, Myanmar
| | - Nwe Oo Mon
- 1Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
| | - Wai Wai Han
- 1Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
| | - Tin Oo
- 1Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
| | - Nay Yi Yi Linn
- 3National Malaria Control Program, Department of Public Health, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Aung Thi
- 3National Malaria Control Program, Department of Public Health, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Khin Thet Wai
- 1Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
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9
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Show KL, Shewade HD, Kyaw KWY, Wai KT, Hone S, Oo HN. HIV Testing among General Population with Sexually Transmitted Infection: Findings from Myanmar Demographic and Health Survey (2015-16). J Epidemiol Glob Health 2020; 10:82-85. [PMID: 32175714 PMCID: PMC7310811 DOI: 10.2991/jegh.k.191206.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 12/03/2019] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Human Immunodeficiency Virus (HIV) testing and counseling is recommended for people with Sexually Transmitted Infections (STIs). In Myanmar, HIV testing and its predictors among those with STI in general population is unknown. METHODS This is a cross-sectional study using secondary data from Myanmar demographic and health survey 2015-16. We included all women and men aged 15-49 years that reported having STI in the past 12 months. Self-reported HIV testing and its predictors were assessed (using modified Poisson regression with robust variance estimates). We have provided weighted estimates as the analyses were weighted for the multistage sampling design. RESULTS Of 998 self-reported STIs, 96 [9.6%, 95% confidence interval (CI): 7.5, 12.1] had been tested for HIV in the past 12 months. Respondents who were residing in hilly regions [adjusted prevalence ratio (aPR): 2.28, 95% CI: 1.29, 4.04] were more likely to have taken the HIV test. However, people in the poorest quintile (aPR: 0.34, 95% CI: 0.12, 0.96) and those who were staying at the current residence for more than 12 months (aPR: 0.45, 95% CI: 0.25, 0.79) were less likely to have taken HIV test. CONCLUSION There is a necessity to promote HIV literacy and HIV testing among those with STI with focus on the poorest populations.
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Affiliation(s)
- Kyaw Lwin Show
- Department of Medical Research, Ministry of Health and Sports, Yangon 11191, Myanmar
| | - Hemant Deepak Shewade
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris 75006, France
- Department of Operational Research, The Union South-East Asia, New Delhi 110016, India
| | - Khine Wut Yee Kyaw
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris 75006, France
- Department of Operational Research, The Union Myanmar Country Office, Mandalay 05021, Myanmar
| | - Khin Thet Wai
- Department of Medical Research, Ministry of Health and Sports, Yangon 11191, Myanmar
| | - San Hone
- National AIDS Programme, Department of Public Health, Ministry of Health and Sports, Nay Pyi Taw 15011, Myanmar
| | - Htun Nyunt Oo
- National AIDS Programme, Department of Public Health, Ministry of Health and Sports, Nay Pyi Taw 15011, Myanmar
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10
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Aung PP, Thein ZW, Hein ZNM, Aung KT, Mon NO, Linn NYY, Thi A, Wai KT, Maung TM. Challenges in early phase of implementing the 1-3-7 surveillance and response approach in malaria elimination setting: A field study from Myanmar. Infect Dis Poverty 2020; 9:18. [PMID: 32036792 PMCID: PMC7008564 DOI: 10.1186/s40249-020-0632-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 10/26/2019] [Accepted: 01/21/2020] [Indexed: 11/25/2022] Open
Abstract
Background The National Plan for Malaria Elimination (NPME) in Myanmar (2016–2030) aims to eliminate indigenous Plasmodium falciparum malaria in six states/regions of low endemicity by 2020 and countrywide by 2030. To achieve this goal, in 2016 the National Malaria Control Program (NMCP) implemented the “1-3-7” surveillance and response strategy. This study aims to identify the barriers to successful implementation of the NPME which emerged during the early phase of the “1-3-7” approach deployment. Methods A mixed-methods study was conducted with basic health staff (BHS) and Vector Born Disease Control Program (VBDC) staff between 2017 and 2018 in six townships of six states/regions targeted for sub-national elimination by 2020. A self-administered questionnaire, designed to assess the knowledge required to implement the “1-3-7” approach, was completed by 544 respondents. Bivariate analysis was performed for quantitative findings and thematic analysis was conducted for qualitative findings using Atals.ti software. Results Although 83% of participants reported performing the key activities in the “1-3-7” surveillance and response approach, less than half could report performing those activities within 3 days and 7 days (40 and 43%, respectively). Low proportion of BHS correctly identified six categories of malaria cases and three types of foci (22 and 26%, respectively). In contrast, nearly 80% of respondents correctly named three types of case detection methods. Most cited challenges included ‘low community knowledge on health’ (43%), ‘inadequate supplies’ (22%), and ‘transportation difficulty’ (21%). Qualitative data identified poor knowledge of key surveillance activities, delays in reporting, and differences in reporting systems as the primary challenges. The dominant perceived barrier to success was inability to control the influx of migrant workers into target jurisdictions especially in hard-to-reach areas. Interviews with township medical officers and the NMCP team leaders further highlighted the necessity of refresher training for every step in the “1-3-7” surveillance and response approach. Conclusions The performance of the “1-3-7” surveillance and response approach in Myanmar delivers promising results. However, numerous challenges are likely to slow down malaria elimination progress in accordance with the NPME. Multi-stakeholder engagement and health system readiness is critical for malaria elimination at the sub-national level.
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Affiliation(s)
- Poe Poe Aung
- Duke Global Health Institute Myanmar Program, Yangon, Myanmar.
| | - Zaw Win Thein
- Duke Global Health Institute Myanmar Program, Yangon, Myanmar
| | - Zar Ni Min Hein
- Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
| | - Kyaw Thet Aung
- Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
| | - Nwe Oo Mon
- Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
| | - Nay Yi Yi Linn
- National Malaria Control Program, Department of Public Health, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Aung Thi
- National Malaria Control Program, Department of Public Health, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Khin Thet Wai
- Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
| | - Thae Maung Maung
- Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
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Thar AMC, Wai KT, Harries AD, Show KL, Mon LL, Lin HH. Reported measles cases, measles-related deaths and measles vaccination coverage in Myanmar from 2014 to 2018. Trop Med Health 2020; 48:4. [PMID: 32047360 PMCID: PMC7006084 DOI: 10.1186/s41182-020-0191-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 01/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is a global resurgence of measles, consequent upon worldwide stagnating measles vaccination coverage. The study aim was to document trends and characteristics of reported cases of measles, measles-related deaths, and measles vaccination coverage (MCV1-first dose of measles-containing vaccine and MCV2-second dose of measles-containing vaccine) at national and sub-national level in Myanmar over a five year period between 2014 and 2018. METHODS This was a descriptive study using routine data collected and submitted to the Expanded Programme on Immunization. RESULTS Between 2014 and 2018, there were 2673 measles cases of which 2272 (85%) occurred in 2017 and 2018. Five adjacent regions in lower Myanmar were the most affected: in 2017 and 2018, these regions reported 1647 (73%) of the 2272 measles cases in the country. Overall, 73% of measles cases were laboratory confirmed, 21% were epidemiologically linked, and 6% were clinically compatible (clinical diagnosis only), with more laboratory confirmed cases in recent years. Annual measles-related deaths were either zero or one except in 2016 when there were 21 deaths, all occurring in one remote village. In the recent years, the most commonly affected age groups were 0-8 months, 9 months to 4 years, and ≥ 15 years. Among 1907 measles cases with known vaccination status, only 22% had been vaccinated and 70% of those had only received one dose of vaccine. Annual MCV1 coverage nationally varied from 83 to 93% while annual MCV2 coverage nationally varied from 78 to 87%, with no clear trends over the years. Between 2014 and 2018, a high proportion of the 330 townships had MCV coverage < 95%. Over 80% of measles cases were reported from townships that had MCV coverage < 95%. CONCLUSION There have been a large number of measles cases in recent years associated with sub-optimal measles vaccine coverage. Myanmar has already conducted supplemental immunization activities in October and November, 2019. Myanmar also needs to improve routine immunization services and targeted responses to measles outbreaks.
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Affiliation(s)
- Aye Mya Chan Thar
- The Expanded Programme on Immunization, Department of Public Health, Ministry of Health and Sports, Naypyitaw, Myanmar
| | - Khin Thet Wai
- Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
| | - Anthony D. Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France
- London School of Hygiene and Tropical Medicine, London, UK
| | - Kyaw Lwin Show
- Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
| | | | - Htar Htar Lin
- The Expanded Programme on Immunization, Department of Public Health, Ministry of Health and Sports, Naypyitaw, Myanmar
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Leonardo L, Bergquist R, Li SZ, Lv S, Khieu V, Sayasone S, Xu J, Olveda R, Utzinger J, Sripa B, Satrija F, Tangkawattana S, Ullyartha H, Wai KT, Nguyen H, Zhou XN. Multi-disciplinary integration of networking through the RNAS +: Research on other target diseases. Adv Parasitol 2019; 105:95-110. [PMID: 31530397 DOI: 10.1016/bs.apar.2019.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
In 2005, the network decided to increase its number of target diseases to include other helminthic zoonoses such as fascioliasis, clonorchiasis, opisthorchiasis, paragonimiasis and cysticercosis and in the process expanding membership to include South Korea, Vietnam, Thailand and Japan. NTDs were eventually included as awareness is heightened on these diseases affecting poor and developing countries. Researches on clonorchiasis and opisthorchiasis unravel the mechanism by which these diseases eventually predispose to cholangiocarcinoma. The liver cancer associated with these liver fluke infections necessitate the need to clarify the global burden of disease of these infections. The magnitude of these liver fluke diseases in endemic countries like China, Vietnam, Laos, Cambodia and Thailand is described. Success in elimination of lymphatic filariasis in PR China and Cambodia is highlighted to show how intensified multisectoral collaboration and strong political become strong ingredients in elimination of parasitic diseases like LF. New advances are presented that clarify species and strain differences in Fasciola spp., Paragonimus spp., Taenia spp. and Echinococcocus spp. Conventional diagnostic techniques are compared with new serologic techniques that are being developed. New control strategies such as the Lawa model are presented.
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Affiliation(s)
- Lydia Leonardo
- Institute of Biology, College of Science, University of the Philippines Diliman and University of the East Ramon Magsaysay Graduate School, Quezon City, Philippines.
| | | | - Shi-Zhu Li
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, China; Chinese Center for Tropical Diseases Research, Shanghai, China; WHO Collaborating Centre for Tropical Diseases, Shanghai, China; National Center for International Research on Tropical Diseases, Shanghai, China; Key Laboratory of Parasite and Vector Biology, Ministry of Health, Shanghai, China
| | - Shan Lv
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, China; Chinese Center for Tropical Diseases Research, Shanghai, China; WHO Collaborating Centre for Tropical Diseases, Shanghai, China; National Center for International Research on Tropical Diseases, Shanghai, China; Key Laboratory of Parasite and Vector Biology, Ministry of Health, Shanghai, China
| | - Virak Khieu
- National Helminth Control Program, National Center for Parasitology, Entomology and Malaria Control, Ministry of Health, Phnom Penh, Cambodia
| | - Somphou Sayasone
- Lao Tropical and Public Health Institute, Vientianne, Lao People's Democratic Republic
| | - Jing Xu
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, China; Chinese Center for Tropical Diseases Research, Shanghai, China; WHO Collaborating Centre for Tropical Diseases, Shanghai, China; National Center for International Research on Tropical Diseases, Shanghai, China; Key Laboratory of Parasite and Vector Biology, Ministry of Health, Shanghai, China
| | - Remigio Olveda
- Asian Tropical Foundation, Filinvest Corporate City, Research Institute for Tropical Medicine Compound, Muntinlupa, Philippines
| | - Juerg Utzinger
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Banchob Sripa
- Department of Pathology, Khon Kaen University, Khon Kaen, Thailand
| | - Fadjar Satrija
- Bogor Agricultural University (IPB), JL. Agatis, Kampus IPB, Bogor, Indonesia
| | | | | | - Khin Thet Wai
- Department of Medical Research, Ministry of Health & Sports, Yangon, Myanmar
| | - Hung Nguyen
- Department of Parasitology, Institute of Ecology and Biological Resources, Vietnam Academy of Science and Technology, Hanoi, Vietnam
| | - Xiao-Nong Zhou
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, China; Chinese Center for Tropical Diseases Research, Shanghai, China; WHO Collaborating Centre for Tropical Diseases, Shanghai, China; National Center for International Research on Tropical Diseases, Shanghai, China; Key Laboratory of Parasite and Vector Biology, Ministry of Health, Shanghai, China
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Theingi P, Harries AD, Wai KT, Shewade HD, Saw S, Win T, Thein S, Kyi MS, Nyunt Oo H, Aung ST. National scale-up of tuberculosis-human immunodeficiency virus collaborative activities in Myanmar from 2005 to 2016 and tuberculosis treatment outcomes for patients with human immunodeficiency virus-positive tuberculosis in the Mandalay Region in 2015. Trans R Soc Trop Med Hyg 2019; 111:402-409. [PMID: 29361150 DOI: 10.1093/trstmh/trx073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 11/16/2017] [Indexed: 11/15/2022] Open
Abstract
Background HIV-associated TB is a serious public health problem in Myanmar. Study objectives were to describe national scale-up of collaborative activities to reduce the double burden of TB and HIV from 2005 to 2016 and to describe TB treatment outcomes of individuals registered with HIV-associated TB in 2015 in the Mandalay Region. Methods Secondary analysis of national aggregate data and, for treatment outcomes, a cohort study of patients with HIV-associated TB in the Mandalay Region. Results The number of townships implementing collaborative activities increased from 7 to 330 by 2016. The number of registered TB patients increased from 1577 to 139 625 in 2016, with the number of individuals tested for HIV increasing from 432 to 114 180 (82%) in 2016: 10 971 (10%) were diagnosed as HIV positive. Uptake of co-trimoxazole preventive therapy (CPT) and antiretroviral therapy (ART) nationally in 2016 was 77% and 52%, respectively. In the Mandalay Region, treatment success was 77% and mortality was 18% in 815 HIV-associated TB patients. Risk factors for unfavourable outcomes and death were older age (≥45 years) and not taking CPT and/or ART. Conclusion Myanmar is making good progress with reducing the HIV burden in TB patients, but better implementation is needed to reach 100% HIV testing and 100% CPT and ART uptake in TB-HIV co-infected patients.
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Affiliation(s)
- Phyo Theingi
- National Tuberculosis Programme, Department of Public Health, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Anthony D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France
- Faculty of Infectious Diseases and Tropical Medicine, London School of Hygiene and Tropical Medicine, London, UK
| | - Khin Thet Wai
- Department of Medical Research, Ministry of Health and Sports, Myanmar
| | - Hemant D Shewade
- International Union Against Tuberculosis and Lung Disease, Paris, France
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India
| | - Saw Saw
- Department of Medical Research, Ministry of Health and Sports, Myanmar
| | - Than Win
- National AIDS Programme, Department of Public Health, Ministry of Health and Sports, Myanmar
| | - Saw Thein
- National Tuberculosis Programme, Department of Public Health, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Myo Su Kyi
- National Tuberculosis Programme, Department of Public Health, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Htun Nyunt Oo
- National AIDS Programme, Department of Public Health, Ministry of Health and Sports, Myanmar
| | - Si Thu Aung
- National Tuberculosis Programme, Department of Public Health, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
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Show KL, Le Win L, Saw S, Myint CK, Than KM, Oo YTN, Wai KT. Knowledge of potential risk of blood-borne viral infections and tattooing practice among adults in Mandalay Region, Myanmar. PLoS One 2019; 14:e0209853. [PMID: 30629615 PMCID: PMC6328096 DOI: 10.1371/journal.pone.0209853] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 12/12/2018] [Indexed: 11/19/2022] Open
Abstract
Introduction Tattooing especially gains popularity among both men and women in adulthood from the wide range of socioeconomic groups and is noted as a risk taking behaviour in adults. Especially when tattooing does not perform to the highest standards, it can potentially be the hazardous practice. Myanmar has a paucity of evidence-based information on the estimated prevalence of tattoos and awareness of potential disease transmission from tattooing under insanitary conditions as well as the infection risk. The present research was undertaken to help identify the self-reported prevalence of tattooing among adults (18–35 years) and their knowledge of transmission risk of blood-borne infections and its determinants. Methods A community-based cross-sectional study focused on residents aged 18–35 years was carried out in two urban and two rural areas in Mandalay district, Mandalay Region during 2015. Trained interviewers used a pre-tested structured questionnaire for face-to-face interviews with one eligible participant per selected household (n = 401). Bivariate analysis and multivariable analysis using binary logistic regression were done to ascertain the relevant explanatory variables. Results The overall self-reported prevalence of tattooing was 19.5% (78/401) (95% CI = 16–24). Nearly 80% of participants (318/401) knew at least one blood-borne viral infection that could be transmitted from tattooing. The persons who had high formal education, manual laborers and those who lived with their families were significantly more likely to cite at least one blood-borne viral infection. Their perceived possibility to remove tattoo independently influenced the practice of tattooing (aOR = 1.91, 95% CI = 1.06–3.45; p = 0.03) compared with participants who reported no perceived possibility. Tattooing was more common in male (aOR = 13.07, 95% CI = 6.25–27.33; p<0.001) compared to female which was independently significant. Conclusions This study ascertained the tattoo prevalence as two in ten adults of working age especially among male in central part of Myanmar in the context of lack of registration system for tattoo parlours and the issuance of safety guidelines. Findings have suggested the target groups and risk factors to be included in future health promotion programs. Future research directions should focus on perspectives of tattooists to create and sustain the sanitary practices to reduce the chance of transmission of blood-borne viral infections.
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Affiliation(s)
- Kyaw Lwin Show
- Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
- * E-mail:
| | - Le Le Win
- Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
| | - Saw Saw
- Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
| | | | - Kyi Maw Than
- Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
| | - Yin Thet Nu Oo
- Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
| | - Khin Thet Wai
- Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
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Han KT, Wai KT, Aye KH, Kyaw KW, Maung WP, Oo T. Emerging neglected helminthiasis and determinants of multiple helminth infections in flood-prone township in Myanmar. Trop Med Health 2019; 47:1. [PMID: 30787669 PMCID: PMC6318856 DOI: 10.1186/s41182-018-0133-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 12/25/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Myanmar has similar agro-based ecology and environmental risks as others in the Greater Mekong sub-region leading to the broad array of helminthic infections. Basic health staff (BHS) from the public sector forms a key stakeholder group in deworming interventions. The study aimed to ascertain the prevalence and determinants of multiple species helminth infections to promote township-level integrated interventions. METHODS A cross-sectional implementation research study in 2017 covered randomly selected 240 households in four villages of Shwegyin Township. Trained interviewers administered the pre-tested structured questionnaire to either the household head or the assigned person concerning their knowledge, perceptions, practices, food habits, and deworming experience. Concomitantly, the research team collected a single stool sample from each of 698 participants (age range of 8 months to 87 years) from 93% (224/240) of eligible households and examined by Kato-Katz smear microscopy. Eventually, 16 BHS joined the interactive dialogue session based on research evidence and knowledge translated for further validation. RESULTS The estimated prevalence of at least one helminth infection was 24% [168/698; 95% CI 21.0-27.0]. Apart from the soil-transmitted helminths (14%), zoonotic helminths especially Taenia spp. (0.7%) and Schistosoma spp. (3%) were detected. Almost half of the seasonally mobile gold panning workers (12/25; 48%) and 46% of pre-school-age children had helminth infections. Community risk groups at riverside villages had significantly higher multiple species helminth infection than those from inland villages (AOR = 10.9; 95% CI 4.9-24.2). Gold panning workers had higher infection rates than other categories (AOR = 2.5; 95% CI 0.6-9.5) but not significant. In flood-prone areas, householders failed to follow the guidelines to construct/re-construct specific type of sanitary latrines and challenges remained in disseminating health messages for community engagement. The innovative ideas recapitulated by BHS included the integration of health talks during the sessions for small agricultural loans and to harness advocacy with water, sanitation, and hygiene interventions. CONCLUSIONS The emerging evidence of neglected zoonotic helminths required attention to introduce the periodic mopping-up and the "selective deworming plan" for vulnerable groups to cover the missed targets. Further multidisciplinary research to confirm the intermediate hosts and vectors of zoonotic helminths in the environment is essential for surveillance and response.
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Affiliation(s)
- Kay Thwe Han
- Parasitology Research Division, Department of Medical Research (DMR), No. 5 Ziwaka Road, Yangon, 11191 Myanmar
| | - Khin Thet Wai
- Parasitology Research Division, Department of Medical Research (DMR), No. 5 Ziwaka Road, Yangon, 11191 Myanmar
| | - Kyin Hla Aye
- Parasitology Research Division, Department of Medical Research (DMR), No. 5 Ziwaka Road, Yangon, 11191 Myanmar
| | - Khine Wah Kyaw
- Parasitology Research Division, Department of Medical Research (DMR), No. 5 Ziwaka Road, Yangon, 11191 Myanmar
| | - Wai Phyo Maung
- Parasitology Research Division, Department of Medical Research (DMR), No. 5 Ziwaka Road, Yangon, 11191 Myanmar
| | - Tin Oo
- Parasitology Research Division, Department of Medical Research (DMR), No. 5 Ziwaka Road, Yangon, 11191 Myanmar
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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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Maung TM, Tripathy JP, Oo T, Oo SM, Soe TN, Thi A, Wai KT. Household ownership and utilization of insecticide-treated nets under the Regional Artemisinin Resistance Initiative in Myanmar. Trop Med Health 2018; 46:27. [PMID: 30083078 PMCID: PMC6069854 DOI: 10.1186/s41182-018-0111-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 04/26/2018] [Accepted: 07/18/2018] [Indexed: 12/22/2022] Open
Abstract
Background Malaria is a major public health problem in Myanmar with reported artemisinin resistance. Myanmar promotes the use of insecticide-treated nets (ITNs) through the free delivery of long-lasting insecticide nets (LLINs) with target coverage of at least 80% in moderate and high-risk areas by 2014. Migrant people are at greater risk of malaria. They have significant barriers to health care services for febrile illness and malaria. Thus, a community-based survey was conducted among the migrant population to assess the ownership and utilization of bed nets (ITN/LLINs) for malaria. Methods The study analyzed secondary data from a community-based malaria survey conducted in 2014 among migrant population in 30 randomly selected townships out of 52 Regional Artemisinin Resistance Initiative (RAI) townships. In each township, five migrant sites were randomly selected (total of 150 migrant sites). A total of 3933 households (approximately 125 households from each township) were selected. Results Of 3923 households assessed, 97% had access to at least one bed net (any type), but only half had access to ITN/LLINs. Only 24% of households had adequate ITN/LLIN access (at least one ITN/LLIN per two persons). In terms of household utilization, 94.3% slept under a bed net (any type) the previous night. Only 43.4% slept under an ITN/LLIN. ITN/LLIN utilization in children under 5 years and pregnant women (high-malaria risk groups) was 45.3 and 46.6%, respectively. Of all nets, 31.3% had holes or had already undergone repairs. In terms of insecticide treatment status, 52.9% of bed nets were untreated and 35.9% of ITNs had not been treated with insecticide for more than a year. Conclusion This study highlights poor access and high utilization of ITN/LLINs among migrant population, particularly among children and pregnant women. It highlights the need for improving bed net coverage and access to ITN/LLINs through bed net distributions and/or social marketing with the focus on migrant population and targeting of households with children and pregnant women.
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Affiliation(s)
- Thae Maung Maung
- 1Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
| | - Jaya Prasad Tripathy
- 2International Union Against Tuberculosis and Lung Disease, The Union South East Asia Office, New Delhi, India.,3International Union Against Tuberculosis and Lung Disease, Paris, France
| | - Tin Oo
- 1Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
| | - Swai Mon Oo
- Population Services International, Yangon, Myanmar
| | - Than Naing Soe
- National Malaria Control Program, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Aung Thi
- National Malaria Control Program, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Khin Thet Wai
- 1Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
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Maung TM, Oo T, Wai KT, Hlaing T, Owiti P, Kumar B, Shewade HD, Zachariah R, Thi A. Assessment of household ownership of bed nets in areas with and without artemisinin resistance containment measures in Myanmar. Infect Dis Poverty 2018; 7:19. [PMID: 29571301 PMCID: PMC5865351 DOI: 10.1186/s40249-018-0399-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 05/31/2017] [Accepted: 03/06/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Myanmar lies in the Greater Mekong Subregion where there is artemisinin-resistant Plasmodium falciparum malaria. As the artemisinin compound is the pillar of effective antimalarial therapies, containing the spread of artemisinin resistance is a national and global priority. The use of insecticide-treated bed nets/long-lasting insecticidal nets (ITNs/LLINs) is the key intervention for ensuring the reduction of malaria transmission and the spread of resistant strains, and for eventually eliminating malaria. This study aimed at assessing household ownership of, access to, and utilization of bed nets in areas of Myanmar with and without artemisinin resistance containment measures. METHODS Secondary data from a nationwide community-based malaria survey conducted by the National Malaria Control Program in 2014 were analyzed. Based on evidence of artemisinin resistance, Myanmar was divided into tiers 1, 2, and 3: townships in tiers 1 and 2 were aggregated as the Myanmar Artemisinin Resistance Containment (MARC) areas and were compared with tier 3 townships, which were defined as non-MARC areas. The chi-square test was used to compare groups, and the level of significance was set at P ≤ 0.05. RESULTS Of the 6328 households assessed, 97.2% in both MARC and non-MARC areas had at least one bed net (any type), but only 63% of households had ITNs/LLINs. Only 44% of households in MARC areas and 24% in non-MARC areas had adequate numbers of ITNs/LLINs (one ITN/LLIN per two persons, P < 0.001). Nearly 44% of household members had access to ITNs/LLINs. Regarding the utilization of ITNs/LLINs, 45% of household members used them in MARC areas and 36% used them in non-MARC areas (P < 0.001, desired target = 100%). Utilization of ITNs/LLINs among children aged below five years and pregnant women (high malaria risk groups) was low, at 44% and 42%, respectively. CONCLUSIONS This study highlights the nationwide shortfalls in the ownership of, access to, and utilization of ITNs/LLINs in Myanmar, which is of particular concern in terms of containing the spread of artemisinin resistance. It highlights the need for priority attention to be paid and mobilization of resources in order to improve bed net coverage and utilization through bed net distribution and/or social marketing, information dissemination, and awareness-raising.
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Affiliation(s)
- Thae Maung Maung
- Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar.
| | - Tin Oo
- Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
| | - Khin Thet Wai
- Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
| | - Thaung Hlaing
- Department of Public Health, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Philip Owiti
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Binay Kumar
- Gavi, the Vaccine Alliance, Geneva, Switzerland
| | - Hemant Deepak Shewade
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Regional Office, New Delhi, India
| | - Rony Zachariah
- Médecins Sans Frontières, Brussels Operational Centre, Luxembourg city, Luxembourg
| | - Aung Thi
- National Malaria Control Program, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
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Naing PA, Maung TM, Tripathy JP, Oo T, Wai KT, Thi A. Awareness of malaria and treatment-seeking behaviour among persons with acute undifferentiated fever in the endemic regions of Myanmar. Trop Med Health 2017; 45:31. [PMID: 29213208 PMCID: PMC5713003 DOI: 10.1186/s41182-017-0070-9] [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: 07/01/2017] [Accepted: 09/28/2017] [Indexed: 12/02/2022] Open
Abstract
Background Myanmar has a high burden of malaria with two-third of the population at risk of malaria. One of the basic elements of the Roll Back Malaria Initiative to fight against malaria is early diagnosis and treatment within 24 h of fever. Public awareness about malaria is a key factor in malaria prevention and control and in improving treatment-seeking behaviour. Methods A large community-based survey was carried out in 27 townships of malaria endemic regions in Myanmar in 2015 which reported on the knowledge, behaviour and practices around malaria in the general population. We used the data already collected in this survey to assess (i) general public awareness of malaria and (ii) treatment-seeking behaviour and associated factors among persons with acute undifferentiated fever. Results A total of 6597 respondents from 6625 households were interviewed (response rate of 99.5%). About 85% of the respondents were aware that mosquito bite was the mode of transmission of malaria and 90% mentioned that malaria was preventable. However, only 16% of the respondents knew about anti-malaria drug resistance. There were certain misconceptions about the transmission of malaria such as dirty water, same blood group, sharing shelter, sleeping/eating together and poor hygiene. Health facility staff were the most common source of information about malaria (80%). Nearly one-fourth (23%) of the respondents with fever resorted to self-medication. Around 28% of the respondents with fever underwent blood testing, less than half of whom (44%) were tested within 24 h. Elderly age group, females, those with poor knowledge about malaria and those residing in non-Regional Artemisinin Resistance Initiative townships were associated with poor treatment-seeking behaviour in case of fever. Conclusion Although there is fair knowledge on mosquito bite as a mode of transmission and prevention of malaria, there are some misconceptions about transmission of malaria. Those having poor knowledge about malaria have poor treatment-seeking behaviour. A considerable number of respondents seek care from informal care providers and seek care late. Thus, there is a need to promote awareness about the role of early diagnosis and appropriate treatment and address misconceptions about transmission of malaria.
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Affiliation(s)
- Phyo Aung Naing
- Department of Medical Research, Ministry of Health and Sports, No. 5, Ziwaka Road Dagon Township, Yangon, 11191 Myanmar
| | - Thae Maung Maung
- Department of Medical Research, Ministry of Health and Sports, No. 5, Ziwaka Road Dagon Township, Yangon, 11191 Myanmar
| | - Jaya Prasad Tripathy
- International Union Against Tuberculosis and Lung Disease, The Union South-East Asia Regional Office, New Delhi, India
| | - Tin Oo
- Department of Medical Research, Ministry of Health and Sports, No. 5, Ziwaka Road Dagon Township, Yangon, 11191 Myanmar
| | - Khin Thet Wai
- Department of Medical Research, Ministry of Health and Sports, No. 5, Ziwaka Road Dagon Township, Yangon, 11191 Myanmar
| | - Aung Thi
- National Malaria Control Program, Ministry of Health and Sports, Naypyitaw, Myanmar
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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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Oo PM, Wai KT, Harries AD, Shewade HD, Oo T, Thi A, Lin Z. The burden of dengue, source reduction measures, and serotype patterns in Myanmar, 2011 to 2015-R2. Trop Med Health 2017; 45:35. [PMID: 29118655 PMCID: PMC5667489 DOI: 10.1186/s41182-017-0074-5] [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: 06/06/2017] [Accepted: 10/18/2017] [Indexed: 12/24/2022] Open
Abstract
Background Myanmar is currently classified as a high burden dengue country in the Asian Pacific region. The Myanmar vector-borne diseases control (VBDC) program has collected data on dengue and source reduction measures since 1970, and there is a pressing need to collate, analyze, and interpret this information. The aim of this study was to describe the burden of hospital-based dengue disease, dengue control measures, and serotype patterns in Myanmar between 2011 and 2015. Methods This was a cross-sectional study using annual records from the Dengue Fever/Dengue Hemorrhagic Fever Prevention and Control Project in Myanmar. Results Between 2011 and 2015, there were a total of 89,832 cases and 393 deaths in hospitals, with 97% of cases being in children. In 2013 and 2015, there was an increased number of cases, respectively at 21,942 and 42,913, while during the other 3 years, numbers ranged from 4738 to 13,806. The distribution of dengue deaths each year mirrored the distribution of cases. Most cases (84%) occurred in the wet season and 54% occurred in the delta/lowlands. Case fatality rate (CFR) was highest in 2014 at 7 per 1000 dengue cases, while in the other years, it ranged from 3 to 5 per 1000 cases. High CFR per 1000 were also observed in infants < 1 year (CFR = 8), adults ≥ 15 years (CFR = 7), those with disease severity grade IV (CFR = 17), and those residing in hilly regions (CFR = 9). Implementation and coverage of dengue source reduction measures, including larval control, space spraying, and health education, all increased between 2012 and 2015, although there was low coverage of these interventions in households and schools and for water containers. In the 2013 outbreak, dengue virus serotype 1 predominated, while in the 2015 outbreak, serotypes 1, 2, and 4 were those mainly in circulation. Conclusion Dengue is a serious public health disease burden in Myanmar. More attention is needed to improve monitoring, recording, and reporting of cases, deaths, and vector control activities, and more investment is needed for programmatic research.
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Affiliation(s)
- Pwint Mon Oo
- Central Vector Borne Disease Control Programme, Department of Public Health, Ministry of Health and Sport, Nay Pyi Taw, Myanmar
| | | | - Anthony D Harries
- International Union against Tuberculosis and Lung Disease, Paris, France.,London School of Hygiene and Tropical Medicine, London, UK
| | - Hemant Deepak Shewade
- International Union against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India
| | - Tin Oo
- Department of Medical Research, Yangon, Myanmar
| | - Aung Thi
- Central Vector Borne Disease Control Programme, Department of Public Health, Ministry of Health and Sport, Nay Pyi Taw, Myanmar
| | - Zaw Lin
- Central Vector Borne Disease Control Programme, Department of Public Health, Ministry of Health and Sport, Nay Pyi Taw, Myanmar
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Phyo Than W, Oo T, Wai KT, Thi A, Owiti P, Kumar B, Deepak Shewade H, Zachariah R. Knowledge, access and utilization of bed-nets among stable and seasonal migrants in an artemisinin resistance containment area of Myanmar. Infect Dis Poverty 2017; 6:138. [PMID: 28903759 PMCID: PMC5598078 DOI: 10.1186/s40249-017-0353-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 10/22/2016] [Accepted: 08/19/2017] [Indexed: 11/10/2022] Open
Abstract
Background Myanmar lies in the Greater Mekong sub-region of South-East Asia faced with the challenge of emerging resistance to artemisinin combination therapies (ACT). Migrant populations are more likely than others to spread ACT resistance. A vital intervention to reduce malaria transmission, resistance spread and eliminate malaria is the use of bed nets. Among seasonal and stable migrants in an artemisinin resistance containment region of Myanmar, we compared a) their household characteristics, b) contact with health workers and information material, and c) household knowledge, access and utilization of bed nets. Methods Secondary data from community-based surveys on 2484 migrant workers (2013 and 2014, Bago Region) were analyzed of which 37% were seasonal migrants. Bed net access and utilization were assessed using a) availability of at least one bed net per household, and b) one bed net per two persons, and c) proportion of household members who slept under abed net during the previous night (Indicator targets = 100%). Results Over 70% of all migrants were from unstable work settings with short transitory stays. Average household size was five (range 1–25) and almost half of all households had children under-five years. Roughly 10 % of migrants were night-time workers. Less than 40% of households had contact with health workers and less than 30% had exposure to information education and communication (IEC) materials, the latter being significantly lower among seasonal migrants. About 70% of households were aware of the importance of insecticide-treated bed-nets/long-lasting insecticidal nets (ITNs/LLINs), but knowledge on insecticide impregnation and retreatment of ITNs was poor (< 10%). Although over 95% of households had access to at least one bed net, the number with one bed net per two persons was grossly inadequate (13% for stable migrants and 9% for seasonal migrants, P = 0.001). About half of all household members slept under a bed net during the previous night. Conclusions This study reveals important short-falls in knowledge, access and utilization of bed nets among migrants in Myanmar. Possible ways forward include frequent distribution campaigns to compensate for short transitory stays, matching household distributions to household size, enhanced information campaigns and introducing legislation to make mosquito repellents available for night-time workers at plantations and farms. Better understanding through qualitative research is also merited. Electronic supplementary material The online version of this article (doi:10.1186/s40249-017-0353-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Wint Phyo Than
- Regional Public Health Department, Ministry of Health, Bago, Myanmar.
| | - Tin Oo
- Department of Medical Research, Ministry of Health, Yangon, Myanmar
| | - Khin Thet Wai
- Department of Medical Research, Ministry of Health, Yangon, Myanmar
| | - Aung Thi
- National Malaria Control Program, Ministry of Health, Naypyitaw, Myanmar
| | - Philip Owiti
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Binay Kumar
- GAVI the Vaccine Alliance, Geneva, Switzerland
| | - Hemant Deepak Shewade
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Regional Office, New Delhi, India
| | - Rony Zachariah
- Médecins Sans Frontieres, Operational Research Unit (LuxOR), Luxembourg City, Luxembourg
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Nwe TW, Oo T, Wai KT, Zhou S, van Griensven J, Chinnakali P, Shah S, Thi A. Malaria profiles and challenges in artemisinin resistance containment in Myanmar. Infect Dis Poverty 2017; 6:76. [PMID: 28438194 PMCID: PMC5404679 DOI: 10.1186/s40249-017-0292-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 10/07/2016] [Accepted: 03/21/2017] [Indexed: 11/11/2022] Open
Abstract
Background This study examined evolving malaria profiles from January, 2010 to December, 2014 to evaluate achievements and challenges of implementing measures to prevent and control spread of artemisinin resistance in Myanmar. Methods Using National Malaria Control Programme (NMCP) data, a cross-sectional descriptive study of 52 townships in artemisinin-resistant containment areas in Myanmar was conducted. Annual program data were analysed, and trends over time are graphically presented. Results In the 52 study townships populated by 8.7 million inhabitants, malaria incidence showed a decreasing trend from 10.54 per 1 000 population in 2010 to 2.53 in 2014, and malaria mortalities also decreased from 1.83 per 100 000 population in 2010 to 0.17 in 2014. The proportion of confirmed to total tested malaria cases also decreased from 6 to 1%, while identification of cases improved. All cases from all parasites species, including Plasmodium falciparum, decreased. Coverage of LLIN (long-lasting insecticidal net)/ITN (insecticide-treated mosquito nets) and indoor residual spraying (IRS) was high in targeted areas with at-risk persons, even though the total population was not covered. In addition to passive case detection (PCD), active case detection (ACD) was conducted in hard-to-reach areas and worksites where mobile migrant populations were present. ACD improved in most areas from 2012 to 2014, but continues to need to be strengthened. Conclusions The findings provide useful data on the malaria situation in artemisinin-resistant initiative areas, which may be useful for the NMCP to meet its elimination goal. These profiles could contribute to better planning, implementation, and evaluation of intervention activities. Electronic supplementary material The online version of this article (doi:10.1186/s40249-017-0292-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Thet Wai Nwe
- National Malaria Control Programme, Department of Public Health, Ministry of Health, Zabukyetthayay Road, Nay Pyi Taw, Myanmar.
| | - Tin Oo
- Department of Medical Research, Ministry of Health, Nay Pyi Taw, Myanmar
| | - Khin Thet Wai
- Department of Medical Research, Ministry of Health, Nay Pyi Taw, Myanmar
| | - Shuisen Zhou
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Beijing, China
| | | | - Palanivel Chinnakali
- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Safieh Shah
- Operational Research Unit (LuxOR), Médecins Sans Frontières - Operational Centre Brussels, Luxembourg City, Luxembourg
| | - Aung Thi
- National Malaria Control Programme, Department of Public Health, Ministry of Health, Zabukyetthayay Road, Nay Pyi Taw, Myanmar
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Nyunt MH, Aye KM, Kyaw KT, Han SS, Aye TT, Wai KT, Kyaw MP. Challenges encountered by local health volunteers in early diagnosis and prompt treatment of malaria in Myanmar artemisinin resistance containment zones. Malar J 2016; 15:308. [PMID: 27267877 PMCID: PMC4895800 DOI: 10.1186/s12936-016-1368-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 02/09/2016] [Accepted: 06/02/2016] [Indexed: 11/25/2022] Open
Abstract
Background After artemisinin resistance was reported, the Myanmar artemisinin resistance containment (MARC) project was initiated in 2011. One of the activities of MARC is to train volunteers for early diagnosis and prompt treatment by providing rapid diagnostic tests (RDT) and artemisinin combination therapy. This study aimed to fulfil the gap of information on the challenges faced by malaria volunteers in artemisinin-containment areas. Methods A cross-sectional, descriptive study was conducted in 11 townships in MARC areas to assess the challenges in early diagnosis of malaria and treatment by malaria volunteers using qualitative and quantitative approaches. Results Altogether 405 volunteers participated in the study. Although 97.5 % of volunteers can interpret a positive result for malaria, only 41.2 % correctly stated the persistence of a positive result in recently infected cases. Over 80 % knew the effects of temperature and humidity on performance of the malaria RDT. Unexpectedly, 15.1 % perceived that expired RDTs can still be useful for diagnosis although 98.3 % of respondents cited that the overall results of RDTs were reliable. Although most of them knew the treatment for malaria based on RDT results, some could not give the correct answer, while a few (2 %) mentioned artesunate monotherapy for RDT-negative cases. Training received by volunteers was also varied in study sites and 92.1 % believed that it was not sufficient. A certain portion of them faced the problem of regular supply of RDTs (9.9 %) and drugs (47.5 %), interpretation of result of RDTs (30 %), and performing blood test (20 %). The median RDT tested per month (25th, 75th percentile) was 6.0 (2.0, 15.0) indicating the need for prioritization based on endemicity. Regular reporting, supervision, monitoring system, and proper refresher training using uniform content of guideline to correct misconception of the volunteers, were needed to be strengthened. Moreover, the reliable and regular supply of materials and exchange system for expired RDTs and anti-malarials was important in the effectiveness of volunteers in MARC zones. Conclusions Adequate refresher training, monitoring, supervision, and regular reliable supply of RDTs and anti-malarials were needed for capacity strengthening of volunteers in MARC zones.
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Affiliation(s)
- Myat Htut Nyunt
- Department of Medical Research, Yangon, Republic of the Union of Myanmar.
| | - Khin Myo Aye
- Department of Medical Research, Yangon, Republic of the Union of Myanmar
| | - Khin Thiri Kyaw
- Department of Medical Research, Yangon, Republic of the Union of Myanmar
| | - Soe Soe Han
- Department of Medical Research, Yangon, Republic of the Union of Myanmar
| | - Thin Thin Aye
- Department of Medical Research, Yangon, Republic of the Union of Myanmar
| | - Khin Thet Wai
- Department of Medical Research, Yangon, Republic of the Union of Myanmar
| | - Myat Phone Kyaw
- Department of Medical Research, Yangon, Republic of the Union of Myanmar
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Nyunt MH, Aye KM, Kyaw MP, Wai KT, Oo T, Than A, Oo HW, Phway HP, Han SS, Htun T, San KK. Evaluation of the behaviour change communication and community mobilization activities in Myanmar artemisinin resistance containment zones. Malar J 2015; 14:522. [PMID: 26697850 PMCID: PMC4690302 DOI: 10.1186/s12936-015-1047-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 12/11/2015] [Indexed: 11/10/2022] Open
Abstract
Background Behaviour change communication (BCC) can improve malaria prevention and treatment behaviour. As a one of the activities under Myanmar Artemisinin Resistance Containment (MARC) programme, BCC have been conducting. This study aimed to evaluate the effectiveness of the behaviour change communication and community mobilization activities in MARC zones in Myanmar. Methods A cross sectional descriptive survey was conducted in randomly selected 16 townships in Tier I and II areas of MARC zones by quantitative and qualitative approaches. Results In 832 households resided by 4664 people, there were 3797 bed nets. Around 54 % were untreated while 45.6 % were insecticide-treated nets (ITN) and 36.2 % were long-lasting insecticide-treated nets (LLINs). Proportion of households with at least one ITN was 625 (75.12 %), proportion of households with at least one ITN for every two peoples was 487 (58.53 %), and proportion of existing ITNs used in previous night was 1225 (70.65 %) respectively. Nearly 23 % of households had old nets while 52 % had new and unused extra bed nets reflecting the adequacy. Interestingly, 38 % could not mention the benefit of the use of ITN/LLINs. Although 88.2 % knew the disease “malaria”, 11.9 % could not be able to mention the symptoms. More than 80 % provided correct responses that mosquito bite can cause malaria while only 36.9 % could mention the blood test for malaria diagnosis. Only 36.6 % received malaria information within previous year but nearly 15 % could not recognize it. Mostly, 80 % of fever episodes were treated at rural health centers (38.24 %) followed by drug shops (17.65 %) and private clinics (16.18 %) respectively. Conclusions Efforts should focus on correcting misconceptions about malaria transmission, prevention and universal use of ITN/LLINs. Although BCC activities have been documented, it is still necessary to intensify community mobilization through all accessible multiple channels in MARC areas.
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Affiliation(s)
- Myat Htut Nyunt
- Department of Medical Research, Yangon, Republic of the Union of Myanmar.
| | - Khin Myo Aye
- Department of Medical Research, Yangon, Republic of the Union of Myanmar.
| | - Myat Phone Kyaw
- Department of Medical Research, Yangon, Republic of the Union of Myanmar.
| | - Khin Thet Wai
- Department of Medical Research, Yangon, Republic of the Union of Myanmar.
| | - Tin Oo
- Department of Medical Research, Yangon, Republic of the Union of Myanmar.
| | - Aye Than
- Department of Medical Research, Yangon, Republic of the Union of Myanmar.
| | - Htet Wai Oo
- Department of Medical Research, Yangon, Republic of the Union of Myanmar.
| | - Hnin Phyu Phway
- Department of Medical Research, Yangon, Republic of the Union of Myanmar.
| | - Soe Soe Han
- Department of Medical Research, Yangon, Republic of the Union of Myanmar.
| | - Thurein Htun
- Department of Medical Research, Yangon, Republic of the Union of Myanmar.
| | - Kyaw Kyaw San
- Department of Medical Research, Yangon, Republic of the Union of Myanmar.
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Hlaing T, Wai KT, Oo T, Sint N, Min T, Myar S, Lon KN, Naing MM, Tun TT, Maung NLY, Galappaththy GNL, Thimarsan K, Wai TT, Thaung LNN. Mobility dynamics of migrant workers and their socio-behavioral parameters related to malaria in Tier II, Artemisinin Resistance Containment Zone, Myanmar. BMC Public Health 2015; 15:886. [PMID: 26370297 PMCID: PMC4570258 DOI: 10.1186/s12889-015-2241-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Accepted: 09/07/2015] [Indexed: 11/29/2022] Open
Abstract
Background Areas with dynamic population movements are likely to be associated with higher levels of drug-resistant malaria. Myanmar Artemisinin Resistance Containment (MARC) Project has been launching since 2012. One of its components includes enhancing strategic approaches for mobile/migrant populations. We aimed to ascertain the estimated population of mobile migrant workers and their families in terms of stability in work setting in townships classified as tier II (areas with significant inflows of people from areas with credible evidence of artemisinin resistance) for Artemisinin resistance; to identify knowledge, attitudes and practices related to prevention and control of malaria and to recommend cost-effective strategies in planning for prevention and control of malaria. Methods A prospective cross-sectional study conducted between June to December 2013 that covered 1,899 migrant groups from 16 tier II townships of Bago Region, and Kayin and Kayah States. Trained data collectors used a pre-tested and subsequently modified questionnaire and interviewed 2,381 respondents. Data of migrant groups were analyzed and compared by category depending upon the stability of their work setting. Results The estimated population of the 1,899 migrant groups categorized into three on the nature of their work setting was 56,030. Bago region was the commonest reported source of origin of migrant groups as well as their transit. Malaria volunteers were mostly within the reach of category 1 migrant groups (43/66, 65.2 %). Less stable migrant groups in category 3 had limited access to malaria information (14.7 %) and malaria care providers (22.1 %), low level of awareness and use of long-lasting insecticide-treated nets (46.6 and 38.8 %). Also, they had poor knowledge on malaria prevention on confirming suspected malaria and on using artemisinin combined therapy (ACT). Within two weeks prior to the survey, only 16.5 % of respondents in all categories combined reported acute undifferentiated fever. Discussion and Conclusions Mobility dynamics of migrant groups was complex and increased their vulnerability to malaria. This phenomenon was accentuated in less stable areas. Even though migrant workers were familiar with rapid diagnostic tests for malaria, ACT still needed wide recognition to improve practices supportive of MARC including the use of appropriate personal protection. High mobility calls for re-designation of tier II townships to optimize ACT resistance containment. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-2241-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Khin Thet Wai
- Department of Medical Research, No. 5 Ziwaka Road, Dagon Township, Yangon, 11191, Myanmar.
| | - Tin Oo
- Department of Medical Research, No. 5 Ziwaka Road, Dagon Township, Yangon, 11191, Myanmar.
| | - Nyan Sint
- Department of Public Health, Naypyitaw, Myanmar.
| | - Tun Min
- Department of Public Health, Naypyitaw, Myanmar.
| | - Shwe Myar
- Department of Public Health, Naypyitaw, Myanmar.
| | - Khin Nan Lon
- Department of Public Health, Naypyitaw, Myanmar.
| | | | - Tet Toe Tun
- Malaria Unit, WHO Country Office, Yangon, Myanmar.
| | | | | | | | - Tin Tin Wai
- Department of Medical Research, No. 5 Ziwaka Road, Dagon Township, Yangon, 11191, Myanmar.
| | - Lwin Ni Ni Thaung
- Department of Medical Research, No. 5 Ziwaka Road, Dagon Township, Yangon, 11191, Myanmar.
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Vogel JP, Bohren MA, Tunçalp Ö, Oladapo OT, Adanu RM, Baldé MD, Maung TM, Fawole B, Adu-Bonsaffoh K, Dako-Gyeke P, Maya ET, Camara MC, Diallo AB, Diallo S, Wai KT, Myint T, Olutayo L, Titiloye M, Alu F, Idris H, Gülmezoglu MA. How women are treated during facility-based childbirth: development and validation of measurement tools in four countries - phase 1 formative research study protocol. Reprod Health 2015; 12:60. [PMID: 26198988 PMCID: PMC4510886 DOI: 10.1186/s12978-015-0047-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 06/07/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Every woman has the right to dignified, respectful care during childbirth. Recent evidence has demonstrated that globally many women experience mistreatment during labour and childbirth in health facilities, which can pose a significant barrier to women attending facilities for delivery and can contribute to poor birth experiences and adverse outcomes for women and newborns. However there is no clear consensus on how mistreatment of women during childbirth in facilities is defined and measured. We propose using a two-phased, mixed-methods study design in four countries to address these research gaps. This protocol describes the Phase 1 qualitative research activities. METHODS/DESIGN We will employ qualitative research methodologies among women, healthcare providers and administrators in the facility catchment areas of two health facilities in each country: Ghana, Guinea, Myanmar and Nigeria. In-depth interviews (IDIs) and focus group discussions (FGDs) will be conducted among women of reproductive age (15-49 years) to explore their perceptions and experiences of facility-based childbirth care, focused on how they were treated by healthcare workers and perceived factors affecting how they were treated. IDIs will also be conducted with healthcare providers of different cadres (e.g.: nurses, midwives, medical officers, specialist obstetricians) and facility administrators working in the selected facilities to explore healthcare providers' perceptions and experiences of facility-based childbirth care and how staff are treated, colleagues and supervisors. Audio recordings will be transcribed and translated to English. Textual data will be analysed using a thematic framework approach and will consist of two levels of analysis: (1) conduct of local analysis workshops with the research assistants in each country; and (2) line-by-line coding to develop a thematic framework and coding scheme. DISCUSSION This study serves several roles. It will provide an in-depth understanding of how women are treated during childbirth in four countries and perceived factors associated with this mistreatment. It will also provide data on where and how an intervention could be developed to reduce mistreatment and promote respectful care. The findings from this study will contribute to the development of tools to measure the prevalence of mistreatment of women during facility-based childbirth.
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Affiliation(s)
- Joshua P Vogel
- Department of Reproductive Health and Research, including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Avenue Appia 20, 1201, Geneva, Switzerland.
| | - Meghan A Bohren
- Department of Reproductive Health and Research, including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Avenue Appia 20, 1201, Geneva, Switzerland.
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, USA.
| | - Özge Tunçalp
- Department of Reproductive Health and Research, including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Avenue Appia 20, 1201, Geneva, Switzerland.
| | - Olufemi T Oladapo
- Department of Reproductive Health and Research, including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Avenue Appia 20, 1201, Geneva, Switzerland.
| | | | - Mamadou Diouldé Baldé
- Cellule de Recherche en Santé de la Reproduction en Guinée (CERREGUI), Enceinte Hôpital National Donka, Conakry, Guinea.
| | | | | | - Kwame Adu-Bonsaffoh
- Department of Obstetrics and Gynecology, Korle Bu Teaching Hospital, Korle Bu, Accra, Ghana.
| | | | | | | | - Alfa Boubacar Diallo
- Service de Gynécologie-Obstétrique, Hôpital national universitaire de Conakry, Conakry, Guinea.
| | - Safiatou Diallo
- Cellule de Recherche en Santé de la Reproduction en Guinée (CERREGUI), Enceinte Hôpital National Donka, Conakry, Guinea.
| | | | - Theingi Myint
- Maternal and Reproductive Health Division, Department of Public Health, Naypyitaw, Myanmar.
| | - Lanre Olutayo
- Department of Sociology, Faculty of The Social Sciences, University of Ibadan, Ibadan, Nigeria.
| | - Musibau Titiloye
- Department of Health Promotion and Education, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria.
| | - Frank Alu
- Department of Obstetrics & Gynaecology, Maitama District Hospital, Abuja, Nigeria.
| | - Hadiza Idris
- Department of Obstetrics & Gynaecology, Nyanya General Hospital, Abuja, Nigeria.
| | - Metin A Gülmezoglu
- Department of Reproductive Health and Research, including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Avenue Appia 20, 1201, Geneva, Switzerland.
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Myint SLT, Myint T, Aung WW, Wai KT. Prevalence of household drinking-water contamination and of acute diarrhoeal illness in a periurban community in Myanmar. WHO South East Asia J Public Health 2015; 4:62-68. [PMID: 28607276 DOI: 10.4103/2224-3151.206623] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND A major health consequence of rapid population growth in urban areas is the increased pressure on existing overstretched water and sanitation services. This study of an expanding periurban neighbourhood of Yangon Region, Myanmar, aimed to ascertain the prevalence of acute diarrhoea in children under 5 years; to identify household sources of drinking-water; to describe purification and storage practices; and to assess drinking-water contamination at point-of-use. METHODS A survey of the prevalence of acute diarrhoea in children under 5 years was done in 211 households in February 2013; demographic data were also collected, along with data and details of sources of drinking water, water purification, storage practices and waste disposal. During March-August, a subset of 112 households was revisited to collect drinking water samples. The samples were analysed by the multiple tube fermentation method to count thermotolerant (faecal) coliforms and there was a qualitative determination of the presence of Escherichia coli. RESULTS Acute diarrhoea in children under 5 years was reported in 4.74% (10/211, 95% CI: 3.0-9.0) of households within the past two weeks. More than half of the households used insanitary pit latrines and 36% disposed of their waste into nearby streams and ponds. Improved sources of drinking water were used, mainly the unchlorinated ward reservoir, a chlorinated tube well or purified bottled water. Nearly a quarter of households never used any method for drinking-water purification. Ninety-four per cent (105/112) of water samples were contaminated with thermotolerant (faecal) coliforms, ranging from 2.2 colony-forming units (CFU)/100 mL (21.4%) to more than 1000 CFU/100 mL (60.7%). Of faecal (thermotolerant)-coliform-positive water samples, 70% (47/68) grew E. coli. CONCLUSION The prevalence of acute diarrhoea reported for children under 5 years was high and a high level of drinking-water contamination was detected, though it was unclear whether this was due to contamination at source or at point-of-use. Maintenance of drinking-water quality in study households is complex. Further research is crucial to prove the cost effectiveness in quality improvement of drinking water at point-of-use in resource-limited settings. In addition, empowerment of householders to use measures of treating water by boiling, filtration or chlorination, and safe storage with proper handling is essential.
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Wai KT, Kyaw MP, Oo T, Zaw P, Nyunt MH, Thida M, Kyaw TT. Spatial distribution, work patterns, and perception towards malaria interventions among temporary mobile/migrant workers in artemisinin resistance containment zone. BMC Public Health 2014; 14:463. [PMID: 24884534 PMCID: PMC4032392 DOI: 10.1186/1471-2458-14-463] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 05/12/2014] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Mobile populations are at a high risk of malaria infection and suspected to carry and spread resistant parasites. The Myanmar National Malaria Control Programme focuses on preventive interventions and vector control measures for the temporary mobile/migrant workers in Myanmar Artemisinin Resistance Containment Zones. METHODS A prospective cross-sectional study was conducted in 2012 in Kawthaung and Bokepyin townships of Tanintharyi Region, Myanmar, covering 192 mobile/migrant aggregates. The objectives were to identify the spatial distribution of the mobile/migrant populations, and to assess knowledge, attitudes, perceptions, and practices concerning malaria prevention and control, and their preferred methods of interventions. The structure of the 192 migrant aggregates was investigated using a migrant mapping tool. Individual and household information was collected by structured interviews of 408 respondents from 39 aggregates, supplemented by 12 in-depth interviews of health care providers, authorities, volunteers, and employers. Data were analyzed by triangulating quantitative and qualitative data. RESULTS The primary reasons for the limitation in access to formal health services for suspected malaria within 24 hours were identified to be scattered distribution of migrant aggregates, variable working hours and the lack of transportation. Only 19.6% of respondents reported working at night from dusk to dawn. Among study populations, 73% reported a perceived risk of contracting malaria and 60% reported to know how to confirm a suspected case of malaria. Moreover, only 15% was able to cite correct antimalarial drugs, and less than 10% believed that non-compliance with antimalarial treatment may be related to the risk of drug resistance. About 50% of study population reported to seeking health care from the public sector, and to sleep under ITNs/LLINs the night before the survey. There was a gap in willingness to buy ITNs/LLINs and affordability (88.5% vs. 60.2%) which may affect their sustained and consistent use. Only 32.4% across all aggregates realized the importance of community participation in effective malaria prevention and control. CONCLUSIONS Community-based innovative approaches through strong collaboration and coordination of multi-stakeholders are desirable for relaying information on ITNs/LLINs, rapid diagnostic test, and artemisinin combination therapy and drug resistance successfully across the social and economic diversity of mobile/migrant aggregates in Myanmar.
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Affiliation(s)
- Khin Thet Wai
- Department of Medical Research (Lower Myanmar), No. 5 Ziwaka Road, 11191 Yangon, Myanmar
| | - Myat Phone Kyaw
- Department of Medical Research (Lower Myanmar), No. 5 Ziwaka Road, 11191 Yangon, Myanmar
| | - Tin Oo
- Department of Medical Research (Lower Myanmar), No. 5 Ziwaka Road, 11191 Yangon, Myanmar
| | - PeThet Zaw
- Department of Medical Research (Lower Myanmar), No. 5 Ziwaka Road, 11191 Yangon, Myanmar
| | - Myat Htut Nyunt
- Department of Medical Research (Lower Myanmar), No. 5 Ziwaka Road, 11191 Yangon, Myanmar
| | - Moe Thida
- Department of Medical Research (Lower Myanmar), No. 5 Ziwaka Road, 11191 Yangon, Myanmar
| | - Thar Tun Kyaw
- Department of Health, National Malaria Control Programme, Nay Pyi Taw, Myanmar
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Wai KT, Htun PT, Oo T, Myint H, Lin Z, Kroeger A, Sommerfeld J, Petzold M. Community-centred eco-bio-social approach to control dengue vectors: an intervention study from Myanmar. Pathog Glob Health 2013; 106:461-8. [PMID: 23318238 PMCID: PMC3541898 DOI: 10.1179/2047773212y.0000000057] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objectives To build up and analyse the feasibility, process, and effectiveness of a partnership-driven ecosystem management intervention in reducing dengue vector breeding and constructing sustainable partnerships among multiple stakeholders. Methods A community-based intervention study was conducted from May 2009 to January 2010 in Yangon city. Six high-risk and six low-risk clusters were randomized and allocated as intervention and routine service areas, respectively. For each cluster, 100 households were covered. Bi-monthly entomological evaluations (i.e. larval and pupal surveys) and household acceptability surveys at the end of 6-month intervention period were conducted, supplemented by qualitative evaluations. Intervention description The strategies included eco-friendly multi-stakeholder partner groups (Thingaha) and ward-based volunteers, informed decision-making of householders, followed by integrated vector management approach. Findings Pupae per person index (PPI) decreased at the last evaluation by 5.7% (0.35–0.33) in high-risk clusters. But in low-risk clusters, PPI remarkably decreased by 63.6% (0.33–0.12). In routine service area, PPI also decreased due to availability of Temephos after Cyclone Nargis. As for total number of pupae in all containers, when compared to evaluation 1, there was a reduction of 18.6% in evaluation 2 and 44.1% in evaluation 3 in intervention area. However, in routine service area, more reduction was observed. All intervention tools were found as acceptable, being feasible to implement by multi-stakeholder partner groups. Conclusions The efficacy of community-controlled partnership-driven interventions was found to be superior to the vertical approach in terms of sustainability and community empowerment.
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Wai KT, Arunachalam N, Tana S, Espino F, Kittayapong P, Abeyewickreme W, Hapangama D, Tyagi BK, Htun PT, Koyadun S, Kroeger A, Sommerfeld J, Petzold M. Estimating dengue vector abundance in the wet and dry season: implications for targeted vector control in urban and peri-urban Asia. Pathog Glob Health 2013; 106:436-45. [PMID: 23318235 PMCID: PMC3541889 DOI: 10.1179/2047773212y.0000000063] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background Research has shown that the classical Stegomyia indices (or “larval indices”) of the dengue vector Aedes aegypti reflect the absence or presence of the vector but do not provide accurate measures of adult mosquito density. In contrast, pupal indices as collected in pupal productivity surveys are a much better proxy indicator for adult vector abundance. However, it is unknown when it is most optimal to conduct pupal productivity surveys, in the wet or in the dry season or in both, to inform control services about the most productive water container types and if this pattern varies among different ecological settings. Methods A multi-country study in randomly selected twelve to twenty urban and peri-urban neighborhoods (“clusters”) of six Asian countries, in which all water holding containers were examined for larvae and pupae of Aedes aegypti during the dry season and the wet season and their productivity was characterized by water container types. In addition, meteorological data and information on reported dengue cases were collected. Findings The study reconfirmed the association between rainfall and dengue cases (“dengue season”) and underlined the importance of determining through pupal productivity surveys the “most productive containers types”, responsible for the majority (>70%) of adult dengue vectors. The variety of productive container types was greater during the wet than during the dry season, but included practically all container types productive in the dry season. Container types producing pupae were usually different from those infested by larvae indicating that containers with larval infestations do not necessarily foster pupal development and thus the production of adult Aedes mosquitoes. Conclusion Pupal productivity surveys conducted during the wet season will identify almost all of the most productive container types for both the dry and wet seasons and will therefore facilitate cost-effective targeted interventions.
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Affiliation(s)
- Khin Thet Wai
- Department of Medical Research (Lower Myanmar), Yangon, Myanmar
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Aung WW, Thant M, Wai KT, Aye MM, Ei PW, Myint T, Thidar M. Sexually transmitted infections among male highway coach drivers in Myanmar. Southeast Asian J Trop Med Public Health 2013; 44:436-447. [PMID: 24050075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
A cross sectional descriptive study was conducted from February 2008 to December 2009 at the largest Highway Terminal, Yangon, Myanmar to determine the prevalence of curable STIs (syphilis, gonorrhea, chlamydial infections, and trichomoniasis), to find out the associated factors for STIs, and to determine the antibiotic susceptibility pattern of gonococcal infection among highway drivers. Urine and blood specimens were collected from 601 male highway coach drivers after an interview about their behavior. Standard laboratory tests were carried out to detect STIs. Multivariate analysis was used to ascertain potential risk factors for STIs. The prevalence rates of syphilis, gonorrhea, chlamydial infections, and trichomoniasis were 4.8, 4.3, 5.7, and 9.8%, respectively. One hundred and two (17.0%) were infected with at least one of the tested four STIs, and 34 (5.7%) had STI co-infections (2STIs). Those who had multiple sexual contacts were likely to be infected with at least one STI, and those who had a history of inconsistent condom use within past two weeks and multiple sexual contacts were more likely to have STI co-infections (p < 0.05). Antimicrobial susceptibility of 21 Neisseria gonorrhoeae isolates showed that 85.7% were susceptible to azithromycin, 80.9% to spectinomycin, 66.7% to cefixime, 61.9% to ceftriaxone, and 38.1% to ciprofloxacin. The high prevalence of STIs in this study and the decreased susceptibility of Neisseria gonorrhoeae to cephalosporin and fluoroquinolone highlighted the role of periodic screening in early diagnosis and effective treatment of STIs among high-risk populations.
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Affiliation(s)
- Wah Wah Aung
- Bacteriology Research Division, Department of Medical Research (Lower Myanmar), Ministry of Health, Myanmar.
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Arunachalam N, Tana S, Espino F, Kittayapong P, Abeyewickreme W, Wai KT, Tyagi BK, Kroeger A, Sommerfeld J, Petzold M. Eco-bio-social determinants of dengue vector breeding: a multicountry study in urban and periurban Asia. Bull World Health Organ 2010; 88:173-84. [PMID: 20428384 DOI: 10.2471/blt.09.067892] [Citation(s) in RCA: 143] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2009] [Revised: 11/29/2009] [Accepted: 11/30/2009] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To study dengue vector breeding patterns under a variety of conditions in public and private spaces; to explore the ecological, biological and social (eco-bio-social) factors involved in vector breeding and viral transmission, and to define the main implications for vector control. METHODS In each of six Asian cities or periurban areas, a team randomly selected urban clusters for conducting standardized household surveys, neighbourhood background surveys and entomological surveys. They collected information on vector breeding sites, people's knowledge, attitudes and practices surrounding dengue, and the characteristics of the study areas. All premises were inspected; larval indices were used to quantify vector breeding sites, and pupal counts were used to identify productive water container types and as a proxy measure for adult vector abundance. FINDINGS The most productive vector breeding sites were outdoor water containers, particularly if uncovered, beneath shrubbery and unused for at least one week. Peridomestic and intradomestic areas were much more important for pupal production than commercial and public spaces other than schools and religious facilities. A complex but non-significant association was found between water supply and pupal counts, and lack of waste disposal services was associated with higher vector abundance in only one site. Greater knowledge about dengue and its transmission was associated with lower mosquito breeding and production. Vector control measures (mainly larviciding in one site) substantially reduced larval and pupal counts and "pushed" mosquito breeding to alternative containers. CONCLUSION Vector breeding and the production of adult Aedes aegypti are influenced by a complex interplay of factors. Thus, to achieve effective vector management, a public health response beyond routine larviciding or focal spraying is essential.
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Affiliation(s)
- Natarajan Arunachalam
- Centre for Research in Medical Entomology, Indian Council of Medical Research, Madurai, TN, India.
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Oo KN, Yin NN, Han TT, Wai KT, Myint K, Gyi MM. Serological response to chemoprophylaxis in extended contacts in leprosy-a randomized controlled trial. ACTA ACUST UNITED AC 2008; 77:3-10. [DOI: 10.5025/hansen.77.3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Tin TT, Thida M, Maung MM, Wai KT. Maternal influences on low birth weight. Malays J Reprod Health 1994; 12:32-7. [PMID: 12320337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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Thike KB, Wai KT, Oo N, Yi KH. Contraceptive practice before female sterilization. Asia Oceania J Obstet Gynaecol 1993; 19:241-8. [PMID: 8250756 DOI: 10.1111/j.1447-0756.1993.tb00380.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The reproductive profile and contraceptive practice of 402 women undergoing female sterilization at the Central Women's Hospital are presented. Most (89%) of the interviewees were urban-dwellers and housewives with primary school education. Fifty-two percent were between 30 and 34 years with a mean of 4.2 living children. Sixty-nine percent were past contraceptive users, of them; 29.9% had used more than one method. A considerable gap between knowledge and practice of different methods was found. Education level and employment had a significant effect on contraceptive practice (p < 0.01 and p < 0.5). The majority knew and used combined oral contraceptive pills and injectable progestogens, whereas rhythm, withdrawal and barrier contraception were lesser known methods. Contraceptive use was primarily for child-spacing whereas the main reasons for female sterilization were socioeconomic and achievement of desired family size.
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Affiliation(s)
- K B Thike
- Department of Obstetrics and Gynaecology, Institute of Medicine, Yangon, Myanmar
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