Epidemiology of measles and rubella in Myanmar.

The measles virus is one of the most infectious agents that cause disease in human. The virus is an exclusive human pathogen and has no animal reservoirs or vectors. During the prevaccination periods in Myanmar, more than 90% of individuals were infected with measles virus by the age of 10 years. Majority of the cases were symptomatic but some of them had severe complications that lead to deaths especially in young children. In 1987, Myanmar introduced measles immunization which greatly reduced the number of cases and deaths. In addition, Mass Measles Campaign was conducted in selected townships in the country in 1995. Mass Measles Campaigns were conducted to cover the children in an age group that is beyond the age for routine measles immunization. The aim of the supplementary immunization activity is to cover children that were missed (left out) by routine immunization. In addition, it is also intended for those children who did not develop immunity or who did not sero-convert. The measles vaccines given in these mass campaigns were regarded as a supplementary dose and it was a second opportunity for the children to be vaccinated against measles.Myanmar made efforts towards the goal of mortality reduction due to measles by routine measles first dose immunization and the provision of second opportunity in supplementary immunization activities (SIA) implemented in 2002 - 2004 and in 2007 nationwide. Second dose of measles vaccination was introduced officially in 2010 although the coverage of both the first and second doses never reached the effective level of 95% coverage in the townships where measles immunization was introduced. Regional measles consultation in 2009 concluded that Myanmar has reached the goal of measles mortality reduction by 90% compared to the year 2000 estimate.

Prognostic indicators in patients with snakebite: Analysis of two-year data from a township hospital in central Myanmar.

Background: Rural people seek medical treatment for snakebite at peripheral health care facilities. Hence, identification of the characteristics, which can be used at peripheral levels of health care as reliable predictors of mortality, are required. Methods: Hospital records of 101 patients (70 males and 31 females) with age ranging from 3 to 80 years, admitted to Nahtogyi township hospital in central Myanmar during January 2005 to December 2006 were reviewed retrospectively. Binary logistic regression was used for estimating odds ratio (OR) and 95% Confidence Interval (CI) for various prognostic indicators of mortality. Results: Almost all snakebites were on extremities; more in legs (62%) than hands (37%). Most (52.5%) bites occurred in the morning (4 am to noon). Mean (SD) time for bite-to-hospital and bite-to-injection of anti-snake venom (ASV) was 134.6 (78.6) and 167 (187.8) minutes respectively. Eleven cases (10.9%) had died. Case fatality ratio (CFR) was significantly higher in 39 patients with un-clotted blood as compared to 62 patients with clotted blood (25.6% vs 1.6%, p <0.0005). Significantly higher CFR was observed in 49 patients who received ASV in >2 hours after the bite compared to 52 cases who received ASV within two hours (9.9% vs 0.9%, p <0.0001). Odds ratio of fatality were higher among those who had urine output of <400 ml in the first 24 hours (OR 26.4; 95% CI 2.4 to 288.3), un-clotted blood (OR 4.6; 95% CI 0.3 to 66.7), bite-to-injection time of >2 hours (OR 4; 95% CI 0.1 to 219.8) bite-to-hospital time of >2 hours (OR 3.1; 95%CI 0.1 to 136.3) and bites in the morning (OR 2; 95% CI 0.3 to 16.0). Conclusions: Clinical parameters could be used by healthcare providers to identify snakebite patients for referral, who may have fatal outcome.

Comparison of two health education methods (Talk & Pamphlet study)

Two health education methods, "talk" and "pamphlet" study, were studied in order to plan health educational activities regarding rheumatic fever in school children in Mandalay Division. The two health education methods, Talk and Pamphlet study, were studied in two groups of school children. Eighty students from V standard and 80 students from IX standard, randomly selected from 4 randomly selected schools: one school from each of the 4 townships of Mandalay City. Each group of 80 students from the V and IX standards were subdivided into two groups using random numbers one group being assigned to the health education talk and the other to the pamphlet study. Pre-test and post-test scores were obtained from the 160 students involved in the study. Analysis of the data using appropriate statistical tests was done. The mean health education level achieved (post-test scores) after health education talk was found to be significantly better than that after the pamphlet study.

Morbidity pattern of patients treated at Station Hospital Letyetma, Myaing Township

A retrospective study of cases admitted to station hospital Letyetma- Myaing, during the period June 1978 to August 1980 has been made with an attempt to define the health status of Burmese village community in Dry Zone, Upper Burma. Leading causes of morbidity and mortality, surgical morbidity and local health problems were presented. Hookworm infestations problems were briefly discussed. Prevalence of malignant diseases in that locality was mentioned.