Aspirations and attitudes towards medical professionalism and awareness of medical ethics among Final Part 2 MBBS students in Myanmar Medical Universities.

The cross-sectional descriptive study being conducted in 2012 explored the aspirations and attitudes of the Final Part 2 MBBS students towards medical professionalism and their awareness of medical ethics. A total of 920 students from four Medical Universities in Myanmar responded to the self-administered questionnaire. Less than 65% of their parents were graduates and nearly half (48.5%) of them earned their living by own business. Sixty five percent of students admitted their career ambition during high school period as becoming a medical doctor. They had attended the Medical University due to family influence (22.1%), high scores in Basic Education High School examination (22.8%) and their desire for monetary gains (23.5%). Almost all (90%)accepted medical profession as noble and 65.7% of respondents cited that they were fond of giving care to patients. Regarding their attitudes toward medical professionalism, more than 90% of the respondents agreed towards principles of fair distribution of finite resources, honesty with patients, a necessity to improve quality of care, ability to manage conflict of interest and professional self regulation. Only 5.5% of students disagreed that periodic recertification was desirable. Nearly half (45.8%) of them disagreed on improving an access to care regardless of patient’s ability to pay,and also on increasing scientific knowledge by encouraging their patients to participate in clinical trials (63%). For future aspiration, 40.4% of respondents intended to join the government service, of whom 71.6% expected to become clinicians. Eighty seven percent of the students agreed to teach Medical ethics as a separate subject and they preferred group discussions. So, to review and revise the existing curriculum for medical ethics is necessary to improve the professional skills of students.

Role of guardians in adolescents'reproductive health behaviors in rural area

A cross-sectional community-based study was undertaken in Taikkyi Township during July 1997, to explore the guardians' attitudes and practices relating to adolescents' reproductive health behavior. Altogether 102 guardians who have adolescents between 10 to 19 years of age involved in the study. Majority of the guardians did not favor their adolescents on choosing their fiancees by themselves and having more than one fiancee. While 52 per cent thought adolescents should know about contraceptives before their marriage, 38.2 per cent thought they should not. Most of the guardians approved that dissemination of messages about sex education for the adolescents through mass media was an appropriate way. It was found that most did not allow their teens to discuss such things either in front of them or with others. But some of them (36.3 per cent) said they would respond about those things willingly if or when they were asked. By knowing sex education and reproductive health, about 48 per cent (46.2 per cent of the mothers and 53.6 per cent of the fathers) said adolescents will gain benefits. Regarding information on Reproductive Health, this study highlights the needs for proper education and counselling for guardians, especially on adolescents.

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.

Acceptability of condoms among family planning clinic attenders in Waybagi, North Okkalapa

A hundred currently married women of 20-49 years were interviewed to assess the knowledge, attitude and practice of male condoms among family planning clinic attenders of Waybagi in North Okkalapa Township and to identify their acceptance and perception towards male condoms. The majority of wives were 30 to 34 years ole and primary school level whereas the majority of husbands were between 35 to 39 years of age, educated up to high school level. Most wives (75 per cent) were dependents whereas majority of husbands (38 per cent) were semi-skilled workers. although 75 per cent have heard of condoms only 36 per cent had actually seen one. Most knew that condoms were meant for contraception (86.7 per cent). Sixty-eight per cent knew condoms could prevent transmission of sexually transmissible diseases; 8 per cent thought condoms were meant for extra-marital sex; 77.3 per cent knew that condoms were meant for single use only. Over half thought condom is important for family planning and prevention of STD, less than half thought it was good for sexual relationship, that every adult male should use it, that it was good for male use, and that it would not create any problem between husband and wife. as regards statements with negative view, more than half disagreed with statements that condoms could disturb sexual relationship and that it could not be used for monogamous marriage. Overall, the respondents seemed to regard condoms positively rather than negatively. Only 5 per cent had ever used condoms out of which only one liked it whereas one disliked it due to condom rupture. None were currently using condoms. It indicated that proper counselling and appropriate training is essential to promote condom acceptability.

Male participation in birth spacing

A cross-sectional, descriptive, community-based survey using pre-tested pre-formed questionnaire was carried out on 100 randomly selected husbands of 1000 currently married women of age 15-49 years residing in rural area of Taikkyi Township where 24.2 percent of the married women were current users of contraceptives. Major portion (89 percent) had heard of contraception and 85 percent knew one or more method(s) of spacing birth. Only 1 percent knew what safe period meant although 75.3 percent claimed to have knowledge of the method. The majority desired three children per family. As regards attitudinal responses, 80 percent thought contraception should be the wife's responsibility, 72 percent thought it should be theirs, 23 percent thought contraception should begin at the start of married life, 71 percent preferred male method, 51 percent agreed that contraception should not be practiced, 48 percent disliked methods requiring medical examination and 78 percent thought contraception should be used during lactation. As for effect on health, 70 percent considered it good for the child. Contraception was negatively reviewed by some as to be against religion (22 percent), against culture (18 percent) and against nature (17 percent).

Objective assessment of meconium content in amniotic fluid

In the first part, a sample set of meconium and amniotic fluid solutions with concentrations of 15 percent, 10 percent, 7.5 percent, 5 percent, 3 percent and 1.5 percent was prepared by mixing fresh meconium with clear amniotic fluid. After centrifugation, meconiumcrit values were measured similar to haematocrit measurement. A graph was constructed from meconium concentration and respective meconiumcrit values. A linear relationship was found. In the second part meconiumcrit readings were measured from meconium-stained amniotic fluid obtained from women in labour. fetal and neonatal morbidity were increased significantly in cases where meconium level reached >10 percent. The cut-off level requiring tracheal intubation was found to be 15 percent. High meconiumcrit levels could alert the obstetrician to the possibility of neonatal morbidity and the need for intensive resuscitative measures.

Prescribing practices on contraception among general practitioners and basic health services staff in Taikkyi Township

Sixty-eight health service providers including 14 Medical Doctors (7 Full-time General Practitioners (GPs) and 7 Government Medical Officers), 4 Health Assistants (HAs), 11 Public Health Supervisors (PHS I & II), 5 Lady Health Visitors (LHVs) and 34 Midwives (MWS) practising in Taikkyi Township, were interviewed using a self administered structured questionnaire, to assess their level of knowledge and prescribing practices for contraception. All of the service providers with the exception of some PHS have prescribed some form of contraception during their practice. Among the contraceptives stated to be most prescribed by them, oral contraceptives came first with 94 percent, followed by injections with 92 percent, rhythm method in 37 percent, intra-uterine device in 30 percent, female sterilization in 21 percent, and condoms were prescribed only by 16 percent of them. The real and perceived side effects experienced with various methods are also discussed. The findings suggest that health care providers need to be trained or given refresher courses on contraceptive technology and proper counselling and use of the available methods, appropriate choice of methods suitable for the individual, the real and perceived side effects from various methods and their management. Development of appropriate health education and counselling package for use in birth spacing programmes is also indicated.

Morbidity and mortality pattern of hospitalized elderly patients in YGH (1985-1987)

A record analysis of all elderly patients admitted to YGH during 1985 to 1987 was done to determine the morbidity pattern of hospitalized elderly patients, aged 55 years and above. There was an average admission rate of 7000 patients per year constituting approximately 18 percent of all admissions. The mean duration of stay in hospital for each hospitalized person was approximately 19 to 21 days. The most common morbidity condition for admission to hospital according to International Classification of Diseases (ICD) grouping is neoplasms in 18.9 percent of admissions, followed by diseases of the circulatory system in 18.7 percent and injuries or poisonings in 16.9 percent, digestive system diseases 12.8 percent, and other ill defined causes led to be 21.8 percent. The case fatality for hospitalized elderly is 12.8 percent for the three years. Implications of the study in planning for geriatric services are discussed.

Nutritional status and intestinal parasitosis in school-enrolled and non-enrolled school-age children in Yangon

In Myanmar, over 38 percent of children in the age-group 5-9 years were never enrolled in school in 1990. Also, there is a lack of information on the comparative prevalence of malnutrition and intestinal parasitosis among school-enrolled and non-enrolled school-age children in Myanmar. We, therefore, undertook a cross-sectional survey comprising 3325 school children from 13 primary schools and 164 non-enrolled school-age children from neighbouring quarters in Tharkayta and Mingaladon townships of Yangon during December 1993. Height and weight of the children were measured and a total of 944 stool samples, including 148 non-enrolled children, were examined for the presence of intestinal parasites. Expressing the nutritional status as standard deviation scores for weight-for-height, the prevalence of wasting among 5-10 years non-enrolled school-age children was 19.8 percent, while that for school children of similar age was 13.9 percent. In addition, non-enrolled school-age children had higher infection rates than school children regarding Ascaris Lumbricoides (66.9 percent vs 50.1 percent), Trichuris trichiura (38.5 percent vs 23.9 percent), and Giardia lamblia (5.4 percent vs 2.7 percent). The policy implication of this study is that health and nutritional status of non-enrolled school-age children needs to be promoted and this should be partly solved by the provision of regular and periodic mass chemotherapy against major intestinal parasitoses influencing nutritional status.

Study of KAP on HIV infection/AIDS among medical doctors in Yangon

HIV infection/AIDS related knowledge, attitudes and precautionary practices were studied among medical doctors in various health institutions, which included general hospitals, specialist hospitals, township health centers and GP clinics in Yangon, between June and August of 1991. The main objective of the study is to provide necessary information that may promote the appropriate use of health education services for the prevention of HIV infection/AIDS in health workers, particularly those at high risk. A total of 425 questionnaires were delivered and 378 (99.9 percent) returned. The survey results indicated that (99 percent) of the respondents had ever heard of AIDS and only (74 percent) knew the difference between AIDS and HIV infection. Knowledge concerning aetiology, transmission, diagnosis, control and prevention of the disease were revealed to provide the necessary information for effective management. Positive and negative attitudes towards HIV infected person were assessed and practices towards prevention of HIV infection/AIDS in health care settings were discussed in detail.

Access to family planning services through general practitioners

In Myanmar, private medicine now plays a significant role in delivery of health care as well as the provision of family planning services. Thirty nine general practitioners, practicing in Sangyaung township, Yangon Division were inquired to determine the present situation of the family planning services provided by them. The majority (94.9 Percent) realised the importance of the family planning services and believed that, they could help people for birth spacing. The findings will be helpful for the future planning of Family Planning Services in Myanmar.

A knowledge-attitudes-practices study on AIDS/HIV infection in intravenous drug users at Yangon Drug Dependency Treatment and Research Unit

A Standardized questionnaire was administered to 198 new and 112 recurrent cases of intravenous drug users enrolled at the Drug Dependency Treatment and Research Unit in Yangon to elicit knowledge about, attitudes towards and practices on AIDS/HIV infection. The respondents were all males, with the mean age of 26 years among new and 28 years among recurrent cases. Over 90 Percent of both groups resided in Yangon City. Recurrent users had higher level of knowledge abot correct mode of transmission of HIV infection than new cases. For instance, over 73 Percent of recurrent and about 50 Percent of new cases knew that HIV infection could not be transmitted via air or drinking water. 93-97 Percent of recurrent patients believed that transmission of HIV infection was possible through blood, sexual contact or IV drug use against 85-92 Percent of new cases. Concerning drug suing and sexual behaviours, recurrent cases took more frequent injections per day, prefered to be alone during drug use, did not take more care in cleansing syringes and needles, but had lesser contact with sex workers than new ones. The findings are compared with those of similar studies in other risk groups. The implications of the study are discussed.

Epidemiology of sports injury in Myanmar athletes

An epidemiological study of sports injury was conducted in early part of 1990. Records of five different federations, namely track and field, foot ball, volley ball, boxing and weight lifting from outpatients department of the Aung San Stadium, were collected for 1985, 1986, and 1987. An interview study was also carried out in 116 Myanmar selected athletes from the above five federations, to determine the possible causal factors of sports injury. Three year average incidence rate of sports injury in five federations was 5.5 per 100 athletes. Common sites of injury, major types of injury, type of treatment, health seeking pattern, causes of sports injury were described, and discussed.

Emergence and spread of Non A, Non B hepatitis in Burma; (An epidemiologic evaluation)

A Hospital based study of acute viral hepatitis was conducted in different regions of Burma during 1985, to evaluate the emergence and spread of Non-A, Non-B hepatitis. Inpatient records of acute viral hepatitis for 5-year (1980-1984) were obtained from the hospitals of Prome, Bassein and Moulmein. Records of 10 years 1975 to 1984 were also collected from hospitals in Mandalay and Taunggyi. Data were analysed to show age distribution, age shift and seasonality by each hospital. Interpretation was done to see whether there is any evidence of Non-A, Non-B hepatitis occurrence during the study period in some regions occurrence during the study period in some regions of the country. By age and seasonality, conclusion may be drawn that Non-A, Non-B hepatitis has been emerged in plain areas like Prome and Bassein since 1980. Validation of past occurrence of Non-A, Non-B hepatitis was also done in Mandalay and Moulmein and it seems that Non-A, Non-B hepatitis has been emerged before 1975. There was no evidence of Non-A Non-B hepatitis in Taunggyi during the study periods. It is recommended that such studies should be conducted in other parts of the country.