Catastrophic expenditure for health care in Myanmar.

Protecting households from the catastrophic health care expenditure is important for every health system because it can prevent some people from seeking care and result in impoverishment. Therefore, this cross-sectional study was done in 2014 to determine the magnitude of the catastrophic health care expenditure and its relationship with income, expenditure, residence, and receiving an in-patient care. Altogether 437 households from both urban and rural areas of 1 State and 5 Regions including Nay-Pyi-Taw territory were included in the study. Two thresholds that cover the 10% of total expenditure and 40% of non-food expenditure were used to estimate the catastrophic health care expenditure for one year period in randomly selected households. The estimates of catastrophic health care expenditure were 37.1% and 32.9% for thresholds of 10% of total annual expenditure and 40% of annual non-food expenditure, respectively. The catastrophic health care expenditure was significantly related to both annual household income (p = 0.012) and expenditure (p = 0.009). The estimate of catastrophic expenditure for health care was highest in households of lowest income (quintile) group (42.3%) whereas this estimate was lowest in households with highest income (21.2%), (p = 0.008). The similar trend was detected in the expenditure quintile groups (p = 0.013). The catastrophic expenditure for health care was significantly higher among households residing in the rural area compared to those of urban area (p = 0.001). Similarly, households experiencing hospitalization of any of its members was more likely to have the catastrophic expenditure than those who did not (p = 0.001). This study highlighted the urgent need to promote health, strengthen the strategic approach to universal health care coverage and also to seek ways to improve household income, especially for the rural poor. The establishment of nationwide health insurance system should also be considered.

Rectus sheath haematoma after laparotomy.

Case (1) - A 32 years old, P2+1 lady was referred to Central Women's Hospital (CWH), Yangon with shock for 18 hours following laparotomy for ruptured ectopic pregnancy at Tike Gyi Hospital. Resuscitated measures were carried out. The urgent re-laparotomy was done with the diagnosis of intra-abdominal bleeding. The operative findings were rectus sheath haematoma (about 100ml), haemoperitoneum (about 300 ml) and intact left tubal ligation stump. The source of bleeding was from inferior epigastric vessels. The bleeding point was secured and abdominal and sub-rectus sheath drains were inserted. At post operative period, her condition deteriorated and she had acute renal failure (ARF) and disseminated intravascular coagulopathy (DIC). She was referred to renal medical unit on post-operative day 2 for peritoneal dialysis. However, she expired on the next day. Case (2) - A 28years old, G2 P1+0 lady was admitted to CWH, Yangon for previous one scar with twins pregnancy at 37 week gestation. Elective Caesarean Section was done at 38 week gestation with the indication of previous one scar with twins pregnancy. At 4 hours after operation, she had shock with clinical features of intra-abdominal bleeding and abdominal wound haematoma. Urgent laparotomy was undertaken and the operative findings revealed the 9x10 cm right sub-rectus sheath haematoma with active bleeding from right inferior epigastric vessels and 1000 ml of haemoperitoneum. Her post-operative period was uneventful and she was discharged on post-operative day 10.