Scenario of the twins with suspected congenital rubella syndrome (CRS) in Yangon, Myanmar

Rubella is a common cause of childhood rash and fever. Congenital rubella syndrome (CRS) can lead to deafness, heart disease, cataracts, and a variety of other permanent manifestations. In order to identify the disease burden of rubella infection, CRS surveillance among infants in Yangon was conducted for two consecutive years from December 2000 to December 2002, as a WHO-funded study. Among the 13 participating hospitals, the Special Care Baby Unit of the Central Women‘s Hospital in Yangon reported 17 infants with suspected CRS. Interestingly, three sets of twins with suspected CRS were reported. One ml of blood was collected from each infant after obtaining informed consent, then tested for the presence of rubella antibody (Immunoglobulin M and G) by the ELISA method, and for the presence of rubella viral RNA by the RT-PCR method. Furthermore, nucleotide sequencing and genotype identification of samples from two cases with positive rubella RNA were performed. All 3 sets of twins were IgM negative. However, rubella RNA was detected by RT-PCR in twin 1A who showed no obvious clinical signs, and in twin 2B who had patent ductus arteriosus, splenomegaly and hepatomegaly. Nucleotide sequences of PCR positive cases revealed genotype Ia sequences. Twin 2B was identified as having deafness of the left ear on audiometry assessment conducted at 5 years and 4 months of age. Both twins of twin set-2 were IgG positive at age 12 days, but turned out to be negative by the age of 9 months. Both twins of twin set-3 presented with splenomegaly and died before 2 months of age, probably due to other infections. Our findings revealed the different scenario of twins with suspected CRS. It is expected to serve as a valuable addition to the medical literature as there were very few reports on twins with CRS.

Evaluation of tuberculin response after BCG vaccination:by gestation and by age at immunization

Tuberculin response following BCG vaccination was evaluated in 3 groups of babies. One hundred and sixteen full term babies (Group I) were vaccinated with BCG at birth; 89 full term babies (Group II) received BCG at the end of third month of life and Group III was made up of 48 preterm babies (32-36 weeks) given BCG vaccination at birth. The sizes of PPD induration area [mm] (6.3+/-3.1 Vs 2.5+/-3.0; P< 0.00001) and BCG scar diameter (3.7+/-1.5 Vs 2.7+/-1.3; P< 0.0001) were significantly larger in full term than preterm babies all of whom were vaccinated at birth, whereas no significant difference was observed between full term babies who were vaccinated at different age. The complications of BCG vaccine were not observed in all study groups. This study suggests that tuberculin responses are equivalent at birth and at third month of age in full term babies. Although immune response is not fully developed in preterm babies (32 to 36 weeks of gestation), they can be safely immunized with BCG at birth.

Screening for and utilization of contraceptive methods among clients at family planning clinic of Central Women's Hospital, Yangon

One thousand one hundred and thirty two clients attending the family planning clinic of Central Women's Hospital, Yangon during a 16-months period, begining in May 1995 were screened according to a set of eligibility criteria, counselled on suitable method(s) among the 4 methods, viz. combined oral contraceptive pills (COC). depot-medroxyprogesterone acetate (DMPA), intra-uterine contraceptive device (IUCD) and condoms, and offered the method of informed choice. Among the clients, 904 (79.85 per cent) were fit for COC. Of these, 9.4 per cent chose COCs whereas 58.9 per cent chose DMPA, Of these, 55.33 per cent chose DMPAs, whereas 30.69 per cent chose IUCDs, 9.1 per cent COCs and 4.9 per cent condoms. Of these 44 clients who were unfit for DMPA, 59.1 per cent had been past users. Likewise, 942 (83.2 per cent) were fit for IUCD. Of these, 36.2 per cent chose IUCDs, whereas 50.8 per cent chose DMPAs, 7.6 per cent COCs and 5.3 per cent condoms. Of those 190 who were unfit for IUCK, 1.6 per cent had been past users. Those who were unfit were reassessed to fulfil the wishes of users. In all, DMPA was the most utilized method (54.2 per cent), followed by IUCD (31.3 per cent), COC (9.0 per cent) and condoms (5.5 per cent). The utilization of IUCK was increased 6 times higher than that in 1990 before provision of contraceptive services by public sector. Tthe creation of such services in the country will definitely improve the optimum contraceptive mix required for a family planning programme.

Task analysis of Midwives (Part 2)

This paper is presented in recognition of work contributed by midwives, the category of health worker who exists as the front-line worker at the periphery of the health care delivery system. It attempts to describe the current situation of midwives in thecontext of their socio-demographic, economic and task profiles. The study subjects were midwives currently employed by the Ministry of Health. Different research methods were used, notably the mailed questionnaire survey for all midwives, the Shadow Observation method for midwives stationed in one township in Yangon Division and the Self-Dntry Diary for midwives of one township representing each of the fourteen States and Divisions.s For additional in-depth information pertaining to their training needs, work conditions, job satisfaction, career ladder and continuing education requirements, a Focus Group Discussion was conducted at the Institute of Nursing (ION). The study subjects for this discussion comprised of midwives from all States and Divisions attending a Lady Health Visitor (LHV) course. The research instruments for each method was devised based upon an existing list of job descriptions of midwives that had been established by the Department of Health. All methods yield a fairly consistent priority listing of tasks performed. Albeit the vast array of additional tasks imposed upon them by the global and local changing health paradigms, Maternal and Child Health remains the dominant function of midwives across rural and urban as well as geographical regions. The benefit that can be derived from this finding is the possibility of skill improvement in this area of service which could be conducive towards the enhancement of the quality of life of mothers and children.

Clinical trial of low-dose aspirin in treatment of pre-eclampsia

The effectiveness of low-dose aspirin in treatment of pre-eclampsia was studied by a prospective randomized double-blind control trial. A total fifty primigravidae with pre-eclampsia (blood pressure of 160/110 mmHg or more and proteinuria of one pllus or more) were selected. They were randomly assigned to receive either 75 mg Buspro (or) placebo. Conventional treatment was given to both groups. These patients were admitted to the C.W.H up to the fifth day of puerperium. The following variable were noted blood pressure, proteinurea, blood uric acid, platelet count and bleeding time. Mode of delivery, duration of labour, neonatal outcomes and estimated blood loss due to delivery were noted. Low-dose aspirin was associated with better control of blood pressure, lower uric acid level, improved gestational age and less number of abdominal delivery, instrumental delivery (p < 0.05). Neonatal outcomes were better with improved gestational age and heavier birth weight (p < 0.05). There was no clinical evidence of abnormal bleeding in mothers and babies. changes in severity of proteinuria was not different in both groups. (p > 0.05)