Medulloblastoblastoma with excessive nodularity: Typical imaging appearance

Medulloblastoma is the most common form of childhood primary brain tumour arising from the cerebellar vermis. It is classified as WHO grade IV embryonal tumours and currently at least four histological variants have been established. Only few case reports been published on the imaging features of the medulloblastoma with excessive nodularity variant. We report the MRI features of a rare case of medulloblastoma with excessive nodularity in a child which is confirmed by histopathology.

Alcohol consumption among adult males in urban area of Thanlyin Township, Yangon Region, Myanmar.

Background: Alcohol consumption is a major cause of morbidity and mortality worldwide. It is frequently related to health and behavioural problems as well as socio-economic hardship. Therefore, this study was conducted to determine the prevalence and risk factors of alcohol consumption among adult males residing in urban area of Thanlyin Township, Yangon Region. Methods: A cross-sectional study was conducted among 380 adult males. Multi-stage random sampling was applied. Data entry and analysis was done using Stata 11.0 statistical package. Results: The prevalence of current alcohol drinking, ex-drinking and never drinking were 20.5%, 9.0% and 70.5%, respectively. There was a significant decreasing trend of alcohol consumption across the levels of age-group. Age, education status and practicing other health-risk behaviours such as smoking and betel chewing were detected as significant risk factors of alcohol consumption. Ever smokers and ever betel chewers were about 4 times more likely to be ever alcohol user compared to their counterparts even if age and education level were adjusted. By controlling smoking and betel chewing habits, 79.2% and 76.6% of existing prevalence of alcohol consumption among respondents would be reduced, respectively. Conclusions: There is an urgent need to curb the habit of alcohol consumption among adult males living in urban area, especially young adults. Alcohol and tobacco control policies in Myanmar should be strengthened or reinforced. Tobacco control program also needs to be intensified. Health education and health promotion activities should be enhanced in order to reduce alcohol consumption in the country.

Health literacy - is it useful in prevention of behavioral risk factors of NCDs.

Background: Health literacy means cognitive and social skills of a person that determine his or her ability to access, understand and use health information to maintain and promote health. People need to understand and use health information in order to choose a healthy lifestyle or to take advantage of preventive measures. The occurrence and consequences of NCDs are related to unhealthy life styles. Insight into the relationship between health literacy and modifiable behavioral risk factors of NCDs may support the prevention and control of these diseases. Methods: A cross-sectional study was conducted among 1367 adults. Multi-stage random sampling was used. Data entry and analysis was done using Stata 11.0 statistical package. Multiple logistic regression analysis was applied to assess the association between health literacy and behavioral risk factors. Results: The proportion of participants who reported ever smoking, ever alcohol drinking and not-practicing daily-exercise was 19.8%, 16.2% and 85.2%, respectively. The prevalence of satisfactory level of health literacy was 31.5%. Health literacy was significantly related to behavioral risk factors even if age, sex, education status and monthly household’s expenditure were adjusted. By improving the health literacy status of adults up to satisfactory level, the prevalence of ever smoking, ever drinking and not-practicing daily exercise among them would be reduced by 34%, 32.1% and 38.9%, respectively. Conclusions: Health literacy status of community should be assessed, monitored and improved. Health literacy may be an effective tool in prevention and control of NCDs because of its preventive effect on modifiable behavioral risk factors.

Underweight prevalence among young adults from rural areas, Salin Towinship, Magwe Region.

Maintaining a normal body mass index (BMI) throughout the life-span of a person may reduce occurrence as well as the burden of non-communicable diseases (NCDs), in terms of years lived with disability and premature death. Lifestyle and socioeconomic factors like physical activity and availability of healthy or unhealthy food may contribute to both extremes of BMI, namely underweight and overweight/obesity. The aim of the present cross-sectional study was to estimate the prevalence of underweight and overweight/obesity and selected lifestyle factors in a cluster randomized sample of 335 young adults aged 18-35 years from rural communities residing at SalinTownship, Magwe Region. In addition, it also aims to investigate the association between selected socioeconomic and lifestyle factors with underweight. Data were collected by carrying out face to face interviews with the individuals selected in the sample in 2011 using semi-structured questionnaires and measuring of their weight and height. SPSS version 16 and STATA version 11 were used for data entry and analysis respectively. Based on WHO criteria, participants were classified according to their BMI into underweight (BMI < 18.5); normal weight (BMI 18.5 - 24.99); and overweight/obese (BMI > 25). Individuals with normal BMI was found in 72% (95% confi dence interval (CI): 67.1 - 77.0) and the prevalence of underweight was found in 28% (23.0 - 32.9). The majorities of respondents were illiterates, of monastic and primary schooling, and working as farmers and manual workers. Nearly 84% of the respondents were able to have 3 meals per day, and the same proportion consumed vegetables daily. The prevalence of current smokers was 11% and all were found to be males. Seventy-two percent were physically active on a daily basis. Out of these respondents, three-fourths of them were physically active at least two hours per day. A total of 64% reported to sleep during the day and 71% reported less than 8 hours of sleeping during the night. Logistical regression analysis showed that underweight was significantly associated with lower age as compared to higher age (OR = 0.54: CI 0.32 - 0.92). There was no significant association between sex, education, occupation and lifestyle factors.

Knowledge and perception towards Ebola virus disease among nursing students in University of Nursing, Yangon.

An analytical cross-sectional study of knowledge and perception towards Ebola Virus Disease (EVD) among nursing students was conducted in University of Nursing (UON), Yangon in October 2014. A total of 170 nursing students were interviewed. Subjects were selected by simple random sampling method and the survey was conducted using self-administered questionnaire.The general objective of the study was to find out the knowledge and perception towards Ebola Virus Disease among nursing students. The study showed that the nursing students have received general information about EVD via TV, radio, internet news and peer groups. The minimum knowledge score was 7 while maximum score was 40. It was observed that 54.7% of the respondents had good knowledge about Ebola disease and 45.3% had poor knowledge (Mean ± SD = 28.51 ± 5.144). Regarding perception about the disease, the minimum perception score was 32 while the maximum score was 48. Similar to what was found regarding knowledge about the disease, 55.3% had favorable perception and 44.7% had unfavorable perception towards EVD (Mean ± SD = 43.73 ± 3.645). The academic year was found to be associated with the knowledge level (p < 0.001) and also with the perception level (p = 0.033) of the respondents. Total years of service in the government sector was also found to be associated with a higher knowledge level of EVD (p = 0.040). A signifi cant association was also observed between knowledge level and perception level (p = 0.019). The study showed that there is an urgent need to improve knowledge and perception levels of the nurses regarding the epidemiology of EVD and prevention activities.

Knowledge, attitude and practice on safety measures against occupational hazards among constructional workers at Bayint Naung Bridge construction site in Yangon Region.

A cross sectional analytic study was carried out to assess the knowledge, attitude and practice on safety measures against occupational hazards and their inter-relationships, among Bayint Naung New Bridge Construction workers during 2014. Altogether 184 workers were selected by simple random sampling. Face to face interview method was used to collect the necessary data. Among respondents, only 4.3% (95% CI = 2%, 8.1%) had good knowledge, but all respondents had favorable attitude and 77.7% (95% CI = 71.3%, 83.3%) had good practice. There were statistically significant associations between age (P = 0.040), educational status (P = 0.001), type of work (P = 0.013), type of worker (P = 0.016), attending skill training (P = 0.002) and knowledge. However, no statistically significant associations were found between knowledge and attitude, knowledge and practice, attitude and practice of respondents on safety measures against occupational hazards. Although attitude and practice among workers are satisfactory, knowledge of respondents needs to be improved. The information gained from this study may be helpful in prevention against occupational hazards.

Hand washing and occurrence of diarrhoea and acute respiratory tract infection.

This cross-sectional study done in 2014 explored the hand-washing practice and its relation with the occurrence of acute diarrhoea and acute respiratory tract infection (ARI) among grades 9 and 10 students from No.1 Basic Education High School, North Okkalapa Township, Yangon Region. Altogether 380 students were selected: inclusive of 190 students from ninth grade and the same number of students from tenth grade by using multistage sampling procedure. Anonymous self-administered questionnaires were used in data collection. Results indicated that only 19.7% (95% CI = 15.9%, 24.1%) of students reported proper handwashing practices. The occurrence of acute diarrhoea and ARI among students within last three months were reported as 40.8% (95% CI = 35.9%, 45.8%) and 98.2% (95% CI = 96.2%, 99.2%), respectively. There were statistically significant associations between age (p = 0.002), gender (p =0.002), grade (p = 0.001), socio-economic status (p = 0.05) and practice of hand-washing. Moreover,proper hand-washing practice significantly influenced the occurrence of acute diarrhoea (p =0.001) and occurrence of ARI (p = 0.004) among students. Therefore, the enabling environment for hand-washing should be created for children at school as well as in their home settings. This may lead the children to adopt and sustain proper hand washing-practice in regular manner.

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.

Health hazards, job satisfaction and quality of life of health professionals working at government hospitals in Mandalay City, Myanmar.

Health professionals play a vital role in improving and restoring health status of the community. Quality of care, patient safety and patient satisfaction depend on their performance. Job dissatisfaction, poor quality of life and they themselves being unhealthy have signifi cant impact on performance and commitment of health professionals. Therefore a cross-sectional study was conducted to determine health hazard, job satisfaction and quality of life of Myanmar health professionals during the period of February and March, 2014. Altogether 142 subjects (97 medical doctors and 45 nurses) working in government hospitals situated in Mandalay City were recruited after getting informed consent. This study found out that overall, very few health professionals were regular smokers (2.1%) and betel chewers (1.4%). There were no regular alcohol drinkers. However, among the male medical doctors12% and 8% were found to be regular smokers and betel nut chewers, respectively. Reading (58.5%) and watching movie (43.9%) are the most common recreational activities. About half (45.8%) of the subjects reported to have encountered injury either during an operation or while giving injections to patients. Such injury was reported in spite of 92.8% of all the respondents reporting to have followed universal safety precaution measures. In addition 67.6% reported that they did not have enough income and 21.1% reported not to be having adequate sleeping hours. In general 53% did not have job satisfaction. The reasons given for this were low salary (66.7%) and overwork (61.3%). However, most of the subjects (about 80%) fell into average levels of compassion satisfaction, burnout and secondary traumatic stress. Only 1% of the respondents were at low level of compassion satisfaction and high level of secondary traumatic stress. No respondent was at high level of burnout scale. Insuffi cient income was found to be major determinant of job satisfaction and quality of life of Myanmar health professionals (p < 0.01). There was significant relationship between job satisfaction and quality of life, especially burnout (p = 0.008). There is urgent need to address the problem of lacking job satisfaction through giving enough income and increasing manpower to reduce workload in hospitals. Strict adherence to universal precaution by health professionals should be reviewed and reinforced.

Infection control measures among interns / house surgeons in teaching hospitals under University of Medicine (1), Yangon.

Health care workers are responsible for prevention and control of communicable diseases in the hospital environment. This study aimed to focus on infection control measures among house officers. A cross-sectional descriptive study was conducted in 2010 at three teaching hospitals in Yangon City by introducing anonymous self-administered questionnaires to randomly selected 150 respondents. SPSS version 16.0 was used for analysis. Over half of the respondents had high knowledge and perception but the practice was poor. Infection control messages acquired through health talks, seminars and media were infl uencing factors on knowledge while training programs signifi cantly infl uenced both knowledge and perception. Senior house offi cers had significantly higher mean perception scores than their juniors (p=0.005). Their hand washing practice was signifi cantly infl uenced by newspapers and magazines (p=0.003) and poster and pamphlet(p=0.056). Compliance on utilization of surgical mask as a precautionary measure for airborne transmission was associated with knowledge (0.020), adequate supply in wards (p=0.001) and donation from medical product company (p=0.042). They bought gloves for handling infectious materials (p=0.000), and needle recapping practice before discarding was related to knowledge (p=0.05). Knowledge, perception and practice of house offi cers were interrelated to each other. Further education and training of house surgeons, resource allocation and continuous monitoringwere necessary for proper infection control and safe hospital environment.

Proper hand washing practice among mothers and occurrence of diarrhoea among family members.

A cross-sectional analytic study was done to determine the self-reported prevalence of proper hand washing practice among mothers and its relationship with the occurrence of diarrhoea among family members in Mandalay during 2011. Altogether 829 mothers (one from each household) from Chan-Aye-Tharzan and Mahar-Aung-Myay townships were selected by using systematic random sampling procedure. Face to face interview method was used to collect the necessary data. The prevalence of proper hand washing practice as reported among mothers was almost 80% (95% CI = 76.6%, 82.1%) but the occurrence of diarrhoea reported among her family members including herself within past one year was 18.2% (95% CI = 15.7%, 20.9%). Family income (p = 0.006) and education status (p = 0.048) were found to have significant effects on reported practices of proper hand washing. Moreover, proper hand washing practice by mothers was found to have significant effect on the occurrence of diarrhoea among all family members including herself (p < 0.001). It was apparent that if the mother washed her hands properly, the annual occurrence of diarrhoea would be reduced among the whole family (48% of current occurrence), among other family members (53%) and herself (50%). Although proper hand washing practice among mothers is satisfactory, habit of this hygienic behavior should be promoted in the whole country to prevent episodes of diarrhoea especially giving priority to low income households and mothers with low education status.

Selected health-risk behaviors among middle and high school students in Chan-Aye-Tharzan township of Mandalay city and their determinants.

A cross-sectional study was done during 2010 to determine the self-reported prevalence of health-risk behaviors such as smoking, alcohol drinking and betel chewing among young students in Mandalay and examine their determinants. Six hundred students from grade six to eleven from a randomly selected Basic Education High School were recruited into the study by systematic random sampling. Data were collected by anonymous self-administered questionnaire and were analyzed by SPSS version 17.0 software. The prevalence of current smoking, alcohol drinking and betel chewing habits among middle and high school students were 2.3%, 1.2% and 6.7% respectively. Those who reported ever smoking, drinking and betel chewing were 5.7%, 3% and 10.3% respectively. The mean ages of initiating smoking, alcohol drinking and betel chewing were 13.1, 14.3 and 13.2 years respectively. These health-risk behaviors were significantly associated not only with students’ characteristics such as age (p < 0.001), sex (p < 0.001) and education level or grade (p < 0.001) but also among each other (p < 0.001). The students whose fathers smoked were more likely to report smoking (p = 0.052). Similarly, drinking (p = 0.004) and betel chewing (p = 0.005) habits of students were significantly associated with similar behaviors of their fathers. This study created the composite variable reflecting the concurrent multiple health-risk behaviors based on the smoking, drinking and betel chewing habits of fathers. The greater the number of risk behaviors of fathers, the more likely the students to become smokers (p < 0.001), drinkers (p = 0.024), and betel chewers (p = 0.002). If their fathers were currently unemployed, school children were more likely to be smokers (p = 0.002) and betel chewers (p = 0.012). Although the prevalence of smoking and drinking among high school students in Chan-Aye-Tharzan township, Mandalay were lower than that of neighboring countries, the existing tobacco and alcohol control programs require intensification to reduce the extent of health-risk behaviors. Fathers seemed to play a vital role in controlling these health-risk behaviors of students that posed threat to their health. Therefore, fathers should be encouraged to join the effective risk reduction program of high school students to avoid smoking, alcohol drinking and betel chewing.

Promoting antenatal care services for early detection of pre-eclampsia.

A prospective, quasi-experimental study was carried out in 2009 at urban health centres (UHCs) of five townships of Mandalay, Myanmar, to improve the skill of midwives (MWs) in diagnosis and referral of pre-eclampsia (PE) from UHC to the Central Women’s Hospital (CWH) and to enhance the supervision of midwives by lady health visitors (LHVs). The intervention was training on quality antenatal care focusing on PE using an updated training manual. Altogether, 75 health care providers (MWs & LHVs) participated. In this study, data were extracted from patient registers and monthly reports of UHCs and CWH. Interviewers were trained regarding the conduct of semi-structured questionnaires to elicit knowledge and to use checklists in observation of skills in screening of PE, measuring blood pressure and urine protein (dipstick test). A guide for LHVs was also used to obtain data, and data was collected six months prior to and after the intervention. Significant improvements from baseline to endline survey occurred in the knowledge (p<0.001) and skill levels (p<0.001) including skills for screening, measuring blood pressure and urine protein. At CWH, there was an increase in referred cases of PE after the intervention, from 1.25% to 2.56% (p<0.001). In conclusion, this study highlights the early detection of pre-eclampsia by widespread use of quality antenatal care, education and training of health-care providers to improve their performance and increase human resources for health care, in order to enable women in our society to have healthy pregnancies and healthy babies.

Effect of Azadirachta indica neem seed kernel extracts on Anopheles dirus mosquitoes

Neem oil (seed kernel extract) produced a strong repellent action on An. dirus mosquitoes (the major vector of malaria) in Myanmar even at concentrations as low as 0.5 and 1.0 percent. At a concentration of 2 percent no anopheles biting and the protection provided was 100 percent during 10-12 hrs periods. The larvicidal effects of neem oil on An. dirus (larvae) were determined by using 3rd instar and above. The LC90 and LC50 were found to be one percent and 0.45-0.5 percent respectively, The residual effect of neem oil under laboratory condition with 2 and 4 percent persisted ca 72+/-5 hrs. Moreover, under laboratory condition with 2 and 4 percent, the ovicidal effect was found to be 100 percent control.

Enteric bacterial contamination and chemical composition of Oral Rehydration salts packets in Yangon

In acute diarrhoea except bacillary dysentery and cholera WHO recommends fluid therapy other than antibiotics to replace dehydration. there is no information on the enteric bacterial contamination and chemical composition of ORS (oral rehydration salts) packets which are available in Yangon and thus this study was carried out. It was conducted in Yangon from December 1996 to July 1997. The packets were bought from markets, drug shops and general practitioner clinics. Each packet was dissolved in water which was first boiled and then cooled. Faecal coliform count (FCC) was determined on those solution by multiple tube method at 0,6 and 24 hour. Isolation of enteric bacterial pathogen was done by standard procedures. pH values, glucose, sodium and potassium concentrations were determined by standard methods. FCC was increased with longer duration of storage time. the enteric bacterial pathogens were not isolated from all types. pH value was acidic in solutions of "Royal D" and "Servidrat". Glucose concentration was higher and potassium concentration was lower in "Royal D" than ORS packets from Myanmar Pharmaceutical factory.

Serum calcium in normal and preeclamptic pregnant Myanmar women

To study the changes during normal pregnancy and in preeclampsia, serum calcium concentration was measured in 26 apparently healthy pregnant Myanmar women and in 15 preeclamptic patients. They were 20-40 years of age. In healthy pregnant women, serum total calcium levels measured at 24th week, 28th week, 32nd week and 36th week of gestation were 2.45 + or - 0.30 mmol/1, 2.47 + or - 0.29 mmol/1, 2.41 + or - 0.29 mmol/1 and 2.46 + or - 0.29 mmol/1 respectively and ionized calcium levels at these periods were 1.24 + or - 0.15 mmol/1, 1.23 + or - 0.14 mmol/1, and 1.20 + or - 0.16 mmol/1 respectively. In preeclamptic patients, the mean serum total calcium level (2.26 + or - 0.24 mmol/1) was significantly lower than that (2.52 + or - 0.23 mmol/1) of 0.27 mmol/1) and ionized calcium level (1.23 + or - 0.14 mmol/1) of preeclamptic patients were not significantly different from those (2.43 + or - 0.24 mmol/1 and 1.24 + or - 0.13 mmol/1 respectively) of control.

Antibacterial properties of essential oils from six medicinal plants

The essential oils obtained from six medicinal plants namely Vitex sp. (Kyaung-ban), Zingiber officinale (gyin), Cymbopogon citratus (sabalin), Curcuma longa (nanwin), Piper nigrum (ngayokekoung) and Coleus aromaticus (ziyarywethtu) were tested on 20 strains of bacteria. The bacteria comprised of 9 strains of Escherichia coli, 8 strains of Salmonella, and one strain each of Proteus morganii, Staphylococcus aureus, and Shigella sonnei. It was observed that Cymbopogon citratus and Coleus aromaticus were active on most bacteria tested.

The anti-ulcerogenic activity of Plantago major Linn.

Plantago major Linn. (Ahkyaw-baung-tahtaung; Mann-sote ywet; Htaung-Khaung-pwa; Sai-Kyaw-gyi; Phar-Kyaw-ywet) has long been used in official folk medicine for various purposes. Ethnobotanic field survey in Russia has shown that P. major (Plantaginaceae) can be used in the treatment of acid-peptic gastritis. So the plant was investigated for the anti-peptic ulcer activity by the previously standardized method using cimetidine. The aqueous extract of air-dried leaves of the plant was found to have a significant anti-ulcerogenic activity against aspirin-induced ulceration in in-vivo rat model (p < 0.005). The reduced ulcer severity was seen by the ulcer index of 8.4 + 1.0 in the treated group when compared to the ulcer index of 20.6 + 3.5 in the untreated group, showing a 59 percent healing activity of the ulcers.