Polymorphisms of pvcrt-o and pvmdr1 genes of 48 Plasmodium vivax isolates from the China-Myanmar border / 中国热带医学

@#Abstract: Objective To detect the polymorphisms of drug resistance-related genes pvcrt-o and pvmdr1 of Plasmodium vivax in lazan city in the China-Myanmar border, in order to guide the treatment plan of Plasmodium vivax. Methods A total of 48 Plasmodium vivax samples were collected from Lazan in the China-Myanmar border in 2007, and fragments of pvcrt-o and pvmdr1 genes were amplified by PCR and sequenced. The sequences were aligned with the Salvador I (Sal-I) strain reference genome sequences to determine the presence of SNPs. Results The target fragments of pvcrt-o gene were amplified from 39 Plasmodium vivax samples, while pvmdr1 genes were amplified from 40 samples. Amongst them, 25 samples had AAG insertion before the 10th amino acid (K10 insertion) of pvcrt-o gene, accounting for 64.1%. Non-synonymous mutations were detected at three loci of pvmdr1 gene (T958M, Y976F, and F1076L), the mutation rates were 100%, 22.5%, and 55.0%, respectively. There were three haplotypes of pvmdr1 gene, of which the triple mutant 958M/976F/1076L accounted for 22.5% (9/40), the double mutant 958M/Y976/1076L accounted for 32.5% (13/40), and the single mutant 958M/Y976/F1076 accounted for 45.0% (18/40). The proportion of strains with pvcrt-o and pvmdr1 gene mutation is 63.16%, which is significantly different from those only with pvmdr1 mutation. Conclusions The proportion of pvcrt-o and pvmdr1 gene mutation of 48 Plasmodium vivax isolates is high in the China-Myanmar border, and there is a certain degree of correlation between the two gene mutations. To assess changes in Plasmodium vivax drug resistance in this region, it is required to improve the surveillance of these two molecular markers.

Malaria control knowledge and behaviors and their influencing factors among residents in Banlao Township, Cangyuan County, Yunnan Province / 中国血吸虫病防治杂志

Objective To investigate the awareness of malaria-related knowledge, the use of mosquito nets and their influencing factors among residents in Banlao Township, Cangyuan County, Yunnan Province.. Methods In August 2020, 19 settlement sites in Banlao Township, Cangyuan County, Lincang City, Yunnan Province were selected as study areas, and permanent residents at ages of 10 years and older were enrolled for a questionnaire survey, including residents’ demographics, family economic status, malaria control knowledge and use of mosquito nets. In addition, the factors affecting the use of mosquito nets in the night prior to the survey were identified using multivariate logistic regression analysis. Results A total of 320 questionnaires were allocated, and all were recovered (a 100% recovery rate). There were 316 valid questionnaires, with an effective recovery rate of 98.75%. The 316 respondents included 152 men and 164 women and 250 Chinese respondents and 66 foreign respondents. The awareness of clinical syndromes of malaria was significantly higher among Chinese residents (71.60%) than among foreign residents (50.00%) (χ2 = 11.03, P < 0.01), and the proportions of Chinese and foreign residents sleeping under mosquito nets were 46.00% and 69.70% on the night prior to the survey, respectively (χ2 = 11.73, P < 0.01). Multivariate logistic regression analysis identified ethnicity group and type of residence as factors affecting the use of mosquito nets in the night prior to the survey. Conclusions The awareness of malaria control knowledge, the coverage and the use of mosquito nets were low among residents in Banlao Township, Cangyuan County, Yunnan Province. Targeted health education is recommended to improve the awareness of malaria control knowledge and self-protection ability. In addition, improving the allocation of long-lasting mosquito nets and health education pertaining to their uses and increasing the proportion of using mosquito nets correctly is needed to prevent re-establishment of imported malaria.

Challenges of maintaining malaria elimination in China: Cross-border malaria / 中国血吸虫病防治杂志

China was certificated malaria-free by WHO in 2021 and has continued to maintain malaria elimination. However, there are still huge challenges in malaria control in the border regions between Yunnan Province, China and Myanmar due to lack of geographic barriers and frequent cross-border travel. Hereby, we review the direction contributions of the Global Fund Malaria Program implemented by Health Poverty Action (HPA), an international non-governmental organization (NGO), to malaria elimination in China, and analyze the challenges of malaria control caused by external environmental factors, such as COVID-19, in regions where the Global Fund Malaria Program is implemented. In addition, some suggestions are proposed for cross-border collaboration on malaria control.

Association of Self-reported Figural Scales With Body Mass Index Among Adults With Hypertension in a Resource-limited Setting

@#Introduction: This study examined the performance of perceived body size in predicting measured body mass index (BMI) among adults with hypertension in Myanmar and to determine the perceived body size cutoffs for obesity. Methods: This cross-sectional study was conducted among 410 hypertensive patients attending public health centers in Myitkyina Township, Kachin State, Myanmar. Perceived body size was measured using the Stunkard’s silhouettes and was compared to a measured BMI. The performance of perceived body size was analyzed by sex-specific receiver operating characteristic curves (ROC) and the optimal perceived body size cutoffs for overweight/obesity (BMI ≥25) were determined. Results: With good correlation coefficients between perceived body size and BMI (0.78 and 0.70 in men and women respectively), perceived body size had the high area under curve (AUC) for overweight/ obesity (0.896 (95%CI=0.835-0.956) for men and 0.828 (0.761-0.895) for women). The optimal figural scales for identifying overweight/obese individuals with a correct detection rate were sixth in men and women. Linear regression analyses supported the fact that the self-reported silhouette rankings in detecting the social patterning of body size was similar with measured BMI. Conclusion: This study supports the idea that figural drawing scales are a potentially useful indicator to assess the overweight/obesity of adults in resource limit settings when self-reported and measured BMI are not available. Further studies are required to re-examine our findings and its effectiveness using a larger population.

Accuracy and cost-effectiveness of the Diabetic Foot Screen Proforma in detection of Diabetic Peripheral Neuropathy in Myanmar / Journal of the ASEAN Federation of Endocrine Societies

Objective@#Proper foot assessment is important for early detection and treatment of diabetic peripheral neuropathy (DPN), the main cause of diabetic foot ulcers (DFUs). This study aimed to determine the accuracy and cost-effectiveness of the locally developed Diabetic Foot Screen (DFS) proforma in detecting DPN among diabetic patients at 10 selected clinics in Yangon, Myanmar@*Methodology@#The study included 625 type 2 diabetics from 10 primary care clinics who participated in the diagnostic accuracy and cost-effectiveness analysis. They were assessed with DFS proforma and biothesiometry by two examiners independently. The cost-effectiveness analysis was conducted based on available data in the local primary care setting.@*Results@#The overall accuracy of the DFS proforma assessment was 74.76% (95% CI: 70.46%- 79.06%). The optimal cut-off DFS score was ≥1.5 (sensitivity 62%; specificity 76%) in detecting DPN. Compared to biothesiometry, the cost-effectiveness of DFS proforma assessment in DPN detection was 41.79 USD per DPN case detected.@*Conclusion@#This study supported the use of DFS proforma for DPN detection in primary care clinics. It also provided new information on the estimated costs per patient with DPN detected in Myanmar.

Detection and factors associated with tuberculosis and rifampicin resistance among presumptive patients at the Thailand-Myanmar border

@#Tuberculosis (TB) continues to be a major public health problem in Thailand and many countries. Endemic TB and outbreaks of TB drug resistance in the borderlands are particularly important. The Thailand-Myanmar border has extensive cross-border travel that may accelerate TB’s spread. This cross-sectional study aimed to determine the frequency and factors associated with TB, and rifampicinresistant TB (RR-TB) among presumptive tuberculosis patients in Mae Sot Hospital. Sputum was processed by microscopic examination and Xpert MTB/RIF assay. Laboratory results and socio-demographic characteristics were collected and analyzed. Univariate and multivariate analyses were performed to assess the association of the risk factors with TB and RR-TB. The significant variables at p-values < 0.05 in univariate analysis were selected for multivariate analysis. Of 365 presumptive patients enrolled, 244 (66.85%) were males and 199 (54.52%) were Burmese. Of these, 314 (86.03%) were registered as new cases and 183 (50.14%) worked as laborers. Sputum microscopy was positive in 132 (36.16%) cases. Based on Xpert MTB/RIF, the frequency of TB was 136 (37.26%) and RR-TB was 15 (11.03%). TB was more common in males than females. The majority of the cases belonged to the 26-50-year-old age group and migrant workers. In RR-TB detection, the rpoB mutations covered by probe E were the most frequently observed. Sequencing showed that the most highly mutated codon was codon 531 and Ser531Thr was the most common mutation. For risk factor analysis, working as laborers was significantly (p-value < 0.05) associated with TB (aOR 2.83; 95% CI 1.43-5.63) and previously treated cases were significantly associated with RR-TB (aOR 12.33; 95% CI 2.29-66.49). The high frequency of TB and RR-TB in migrants highlights the problem and factors associated with TB at the border and the need for efforts in TB control programs in this setting.

Public health status of Myanmar refugees in South East Asia: A Malaysian case study

@#The United Nations High Commissioner for Refugees (UNHCR) reports over 80 million people are displaced worldwide with approximately 26.3 million categorized as refugees and over a million residing temporarily in South East Asia. Despite the lack of national legislative framework in place for refugees and asylum seekers (RAS), Malaysia hosts approximately 178,140 as registered with UNHCR and the majority originate from Myanmar. In this review, we examine refugees from South East Asia, particularly from Myanmar that have contributed to the largest influx of refugees to this region with a focus on their health status. The present study traces barriers to the health care of refugees in the country of asylum and also the challenges faced by these communities in accessing health services.

Factors Associated With Food Safety Knowledge And Practice Among Street Food Vendors In Taunggyi Township, Myanmar: A Cross-Sectional Study

@#Food safety is a growing public health concern worldwide. Street foods are an integral part of many cultures and offer at affordable prices. However, it is associated with food safety issues, especially in developing countries. Therefore, it is essential that street food vendors understand and implement food safety practices to prevent outbreaks of food-borne illnesses. This cross-sectional study investigated the food safety knowledge and practices as well as their associated factors among street food vendors in Taunggyi Township, Myanmar. Validated structured questionnaires were used to interview 158 street food vendors, and a set of observational checklists was used to inspect the sanitary conditions of vending sites and vendors’ food hygiene practices. The association between food safety knowledge and practices was assessed using a chi-squared test. Our results revealed that most vendors had a high level of food safety knowledge and that 58.9% scored equal to or lower than the median value in food safety practices, whereas 41.1% scored higher than the median value (median=15). Sex and education level were significantly associated with participants’ food safety knowledge (p < 0.001). Similarly, education, race and monthly income were significantly associated with their food safety practices (p < 0.001), whereas food safety training attendance had no association. Additionally, participants with better knowledge scores were more likely to have better practice scores. Food safety training given to vendors should be more detailed and comply with standard guidelines, especially with regard to street food safety practices.

Seroprevalence And Associated Factors Of Helicobacter Pylori Among Myanmar Children From The Peri-Urban Community Of Yangon

@#Helicobacter pylori infects 50% of children aged 5 years in developing countries. The infection is associated with socio-economic background and family composition. The aim of this study was to determine the seroprevalence and associated factors of Helicobacter pylori infection among Myanmar children in Insein Township, which is a peri-urban community situated in the northern region of Yangon. A cross-sectional study was carried out in Insein Township on 193 children, aged 2 to 13 years, who were tested for H. pylori antibody by enzyme-linked immunosorbent assay (ELISA) test. Parents were interviewed using a questionnaire. Statistical analyses were done using chi-square test and two-sample t-test. The prevalence of H. pylori infections was 67.36%. The mean age of the participants was 7.6 +/- 3.85 years. Those positive for H. pylori antibody were significantly older (8.18+/-3.8) than those with negative results (6.41+/-3.7). There is no gender preponderance. The sero- positive rate was higher among low socio-economic group. The children who tested positive for H. pylori antibody had a mean family member of 5.97+/-2.22 and those who tested negative had 6.06+/-2.17. Thus, there was no association between H. pylori infection and number of family members. There was no association between H. pylori infection and overcrowding, type of drinking water, type of latrine used and type of housing.Our findings suggest that the prevalence of H. pylori infection among Myanmar children is common, as it is in other developing countries, and also highlight its association with socioeconomic status. Over time, the prevalence of H. pylori infections in children is expected to decline worldwide in parallel with the improvement in socioeconomic status of the nations. There is a need to intensify efforts of improving sanitation and living conditions in order to protect children against H. pylori infection.

Bio-efficacy of Long Lasting Insecticidal Mosquito Nets (LLINs) on Malaria Vector Anopheles Mosquitoes in Malaria-Endemic Areas of Myanmar

Sixty used Long Lasting Insecticidal Nets (LLINs) from six malaria endemicareas of States and Regions of Myanmar were assessed for their bio-efficacy againstAnopheles mosquitoes. Total ten nets were collected from the randomly selectedhousehold of each area. Insecticide susceptibility and bio-efficacy test were doneaccording to WHO testing method. Results revealed that a total of 4470 mosquitoes of 12Anopheles species including main vector and secondary vectors were collected in highdensity in Beelin, Taungoo, Pyin Oo Lwin, Kamamaung and Hpa-an. All collectedmosquitoes were found susceptible to insecticides as recommended by the WHO. Bioefficacy of PermaNet 2.0, DAWA TANA, Yorkool, BASF, Net protect and Yahe LLINs netswere 12(100%), 11/12(91.67%), 4(100%), 8(100%), 5(100%) and 19(100%)respectively. The DAWA TANA net had 20% sensitivity after repetitive washing. Thesensitivity of LLINs nets was higher for all selected areas of States and Regions inMyanmar. The study suggested that there is need to distribute a large number of effectiveLLINs nets in malaria endemic areas as well as the replacement of expired, less effectiveand very old LLINs nets with a new one is also necessary. LLINs nets are very effectiveAnopheles mosquitoes control tools and it can reduce the human-vector contact effectively.Moreover, research on bio-efficacy evaluations of the LLINs nets is required regularly tomaintain and control the transmission of malaria through Anopheles mosquitoes.

Dietary Diversity, Social Support and Stunting among Children Aged 6–59 Months in an Internally Displaced Persons Camp in Kayin State, Myanmar

Children living in the internally displaced person (IDP) camp are at higher risk of stunting. This cross-sectional study aimed to assess the prevalence and to identify the associated factors of stunting among children aged 6–59 months at Myaing-Gyi-Ngu IDP camp in Kayin State, Myanmar. According to the World Health Organization Child Growth Standards, children with a height-for-age Z-scores below −2 standard deviation of the reference median (HAZ ≤ −2) were classified as stunted. Multiple logistic regression analysis was performed to identify the strong predictors. Prevalence of stunting has been found very high (59.4%). Adjusted model revealed that children living with illiterate mothers (odds ratio [OR], 1.86; 95% confidence interval [CI], 1.07–3.24), being third/later-birth child (OR, 1.88; 95% CI, 1.13–3.14), consuming less than 4 food groups (OR, 4.22; 95% CI, 1.94–9.16), and older age of child (OR, 6.36 for 13–24 months; 95% CI, 2.74–14.74, 7.45 for 25–36 months; 95% CI, 3.21–17.25 and 12.75 for 37–59 months; 95% CI, 5.51–29.52) had higher odds of becoming stunted. The levels of support availability, presumed support and support received of mothers were generally low, but no significant associations were observed. In conclusion, this study showed high prevalence of stunting, but low dietary diversity and social support in the IDP camp. Due to the significant association of dietary diversity scores with stunting, interventions aiming at improving dietary diversity should be taken to reduce the stunting among children in the IDPs camp.

Factors associated with the choices of home deliveries in Myanmar: A secondary data analysis of the Demographic Health Survey in Myanmar in 2015-2016 / 国際保健医療

Objectives  Maternal and neonatal mortality remains high in Myanmar. Whilst the proportion of deliveries assisted by a skilled birth attendant (SBA) is moderate, the proportion of institutional deliveries is low in Myanmar. Home births have life-threatening risks for mothers and their newborn due to the limited emergency care available at home. This study explores the socio-cultural and maternal health factors, which were associated with mothers’ place of delivery using secondary data.Methods  This study used nationally representative data from the Myanmar Demographic Health Survey (DHS) conducted in 2015-16. The data was obtained from mothers aged 15-49 years with their most recent births in five years preceding the survey (n=3856). A multivariable logistic regression analysis was undertaken, and the adjusted Odds Ratio (aOR) and 95% Confidence Interval (CI) of home deliveries were provided. Results  The study shows that 62% of women in Myanmar delivered at home. The aOR of home deliveries was 6.18 (95% CI: 4.17-9.16) for women with no antenatal care (ANC) compared to those with four or more ANC visits, 4.46 (3.19-6.22) for the lowest wealth quintile in comparison with the highest wealth quintile, and 2.94 (2.28-3.80) for women having four or five children relative to women with only one child. The place of residence, women’s educational attainment, women’s and their husbands’ occupations were also associated with the place of delivery. On the other hand, maternal age, husbands’ education levels, women’s media exposure levels and women’s decision-making power were not associated with home deliveries. Conclusion  This study has identified populations which service providers should target to attend for institutional deliveries in Myanmar. It appears necessary to improve accessibility of health services, including ANC, to promote institutional deliveries and have better health outcomes among mothers and their newborn.

Seroprevalence of Toxoplasma gondii among School Children in Pyin Oo Lwin and Naung Cho, Upper Myanmar

Toxoplasma gondii is an apicomplexan parasite that can cause toxoplasmosis in a wide range of warm-blooded animals including humans. In this study, we analyzed seroprevalence of T. gondii among 467 school children living in the rural areas of Pyin Oo Lwin and Naung Cho, Myanmar. The overall seroprevalence of T. gondii among school children was 23.5%; 22.5% of children were positive for T. gondii IgG, 0.4% of children were positive for T. gondii IgM, and 0.6% of children were positive for both T. gondii IgG and IgM. Geographical factors did not significantly affect the seroprevalence frequency between Pyin Oo Lwin and Naung Cho, Myanmar. No significant difference was found between males (22.2%) and females (25.0%). The overall seroprevalence among school children differed by ages (10 years old [13.6%], 11–12 years old [19.8%], 13–14 years old [24.6%], and 15–16 years old [28.0%]), however, the result was not significant. Polymerase chain reaction analysis for T. gondii B1 gene for IgG-positive and IgM-positive blood samples were negative, indicating no direct evidence of active infection. These results collectively suggest that T. gondii infection among school children in Myanmar was relatively high. Integrated and improved strategies including reinforced education on toxoplasmosis should be implemented to prevent and control T. gondii infection among school children in Myanmar.

Indirect estimation of infant mortality in small areas* / Estimação indireta da mortalidade infantil em pequenas áreas / Estimación indirecta de la mortalidad infantil en pequeñas áreas

The Brass-type indirect methods of early-age mortality estimation have been used for more than four decades, providing very robust estimates for countries without reliable vital registration systems. However, when estimation areas become smaller, the number of dead children could be very small, especially among those born to young women, who provide essential information to estimate recent mortality. In these cases, estimates could be affected by random errors and unexpected annual fluctuations. At the same time, although it is very unlikely that demographic trends in a small area would follow patterns very different from those prevailing in the broader environment they belong to, it is possible that some local events may become relevant to small areas, causing some deviations from the assumptions that may hold true to the larger area. The objective of this paper is to propose an adaptation of the indirect estimation approach, which would allow obtaining infant and child mortality estimates for small areas. As such, this proposal belongs to the realm of indirect estimation methods, sharing the limitations and advantages that characterize this type of estimation procedures. The method is illustrated with data from the 2014 Population and Housing Census of Myanmar. The results indicate that the method proposed here provides reliable and consistent infant mortality estimates, compared to the original Brass' method, even in very small areas.

Métodos indiretos do tipo Brass para estimar a mortalidade nas primeiras idades da vida têm sido usados por mais de quatro décadas, fornecendo estimativas muito robustas para países que não possuem sistemas confiáveis de estatísticas vitais. No entanto, quando as áreas de estimativa são pequenas, o número de crianças mortas pode ser muito baixo, especialmente entre os nascidos de mulheres jovens, que fornecem informações essenciais para estimar a mortalidade recente. Nestes casos, as estimativas podem ser afetadas por erros aleatórios e flutuações anuais inesperadas. Ao mesmo tempo, embora seja muito improvável que as tendências demográficas em uma área pequena sigam padrões muito diferentes daqueles prevalecentes no ambiente mais amplo ao qual pertencem, é possível que certos eventos locais se tornem relevantes em pequenas áreas, causando alguns desvios de padrões que na área maior são válidos. O objetivo deste trabalho é propor uma adaptação da abordagem de estimativa indireta, que permita obter estimativas de mortalidade infantil e das crianças em pequenas áreas. Dessa forma, tal proposta pertence ao escopo dos métodos de estimativa indireta, compartilhando as limitações e vantagens que caracterizam essa metodologia de estimativa. O método é ilustrado com dados do Censo de População e Habitação de Myanmar, 2014. Os resultados indicam que o método proposto aqui fornece estimativas confiáveis e consistentes de mortalidade infantil, em comparação com os resultados do método original de Brass, mesmo em áreas muito pequenas.

Los métodos indirectos del tipo Brass para estimar la mortalidad en las edades tempranas se han utilizado durante más de cuatro décadas y han proporcionado estimaciones muy robustas para países que no cuentan con sistemas de estadísticas vitales fiables. Sin embargo, cuando las áreas de estimación son pequeñas, el número de niños muertos podría ser muy reducido, especialmente entre los nacidos de mujeres jóvenes, quienes proporcionan información esencial para estimar la mortalidad reciente. En estos casos, las estimaciones podrían verse afectadas por errores aleatorios y fluctuaciones anuales inesperadas. Al mismo tiempo, aunque es muy poco probable que las tendencias demográficas en un área pequeña sigan patrones muy diferentes de los que prevalecen en el entorno más amplio al cual pertenecen, es posible que ciertos eventos locales se tornen relevantes en áreas pequeñas, causando algunas desviaciones de los supuestos que para el área más grande pueden ser válidos. El objetivo de este trabajo es proponer una adaptación del enfoque de estimación indirecta que permita obtener estimaciones de mortalidad infantil y en la niñez para áreas pequeñas. Como tal, esta propuesta pertenece al ámbito de los métodos de estimación indirecta, por lo que comparte las limitaciones y ventajas que caracterizan a esta metodología de estimación. El método se ilustra con datos del censo de población y vivienda de Myanmar de 2014. Los resultados obtenidos indican que el método aquí propuesto brinda estimaciones de mortalidad infantil confiables y consistentes, en comparación con los resultados del método original de Brass, incluso en áreas muy pequeñas.

Perceived role and its enhancing factors among the village health volunteers regarding malaria control in rural myanmar

Background: Village health volunteers (VHVs) are key agents for malaria control in community. The Myanmar Medical Association-Malaria (MMA-Malaria) Project has promoted effective malaria control in endemic and high-risk townships by supporting roles of VHVs. Objectives: To assess the roles of VHVs on malaria control and factors enhancing their roles in rural Myanmar. Methods: A cross-sectional study was conducted in five townships where the MMA-Malaria Project has been implemented. One hundred and fifty VHVs were sampled from five townships by simple random sampling. Data were collected by trained interviewers using structured questionnaires, which covered sociodemographic, supportive, motivational factors, and roles of malaria control. Studied variables were described by proportions, means, and standard deviations and were analyzed for their association by odds ratio with 95% confidence interval and Chi-square tests. Results: Most of VHVs (96%) expected to demonstrate good roles on malaria control, but only 44.0% exhibited current roles at a good level. Factors enhancing their roles were female (P = 0.037), family income ?50,001 kyat/month (P < 0.015), time serving as a volunteer 1�years (P = 0.006), good knowledge of malaria control (P < 0.001), good family support (P < 0.001), good community support (P < 0.001), and good motivational factors (P = 0.002). Conclusion: VHVs are key agents for malaria control in community. Most of VHVs expected to demonstrate good roles on malaria control, but less than half of them exhibited current roles at a good level. The systems and program for improving VHVs� knowledge, encouraging family and community support, and promoting motivation are essential for their better roles.

Herbal Medicines Used by Tuberculosis Patients in Myanmar

Aims: This study attempted to explore the natural products commonly used by the TB patients in a selected township of Myanmar. Study Design: Secondary data analysis of qualitative data. Methodology: This is a secondary data analysis of qualitative data focusing on the herbal plants used by the tuberculosis patients in Myanmar. A checklist was used for data analysis to explore the herbs used by TB patients and related information. The researcher also searched the literature using the both vernacular & botanical names of the herbs. Results: Four herbal plants namely Lauk Thay (Desmodium triquetrum), Owe Pote (Melastoma malabathricum), Mu Yargyi (Justicia adhatoda) and Mee Quin Gamone (Rhoeo discolor) were identified in this study. There are two methods of administration of the herbal leaves. In several instances, the TB patients first make use of the herbs before seeking proper anti-TB treatment. Also, the patients and traditional healers alike accepted that the medicines provided by DOTS programme could cure the disease. Conclusion: This study revealed that self-medication with herbs is a common practice among TB patients. As the herbal plants identified were well known medicinal plants in different parts of the world, their therapeutic value and efficacy should be further explored in the light of developing effective complimentary medicines for TB.

The movements of the government and development partners after democratization in Myanmar: A perspective on development aid for universal health coverage / 国際保健医療

Objective  Donor countries either suspended or restricted development aid for Myanmar during the period of the military regime. However, the democratic movement, which began in 2011, gradually resolved this situation. The government of Myanmar organized a “Myanmar Development Cooperation Forum” in 2013, where the government demonstrated a path for the country’s future development to development partners, including donor countries, international organizations, and international funds. Furthermore, the government has increased the budget for the health sector and upheld universal health coverage (UHC), a target of Social Development Goals, as a goal for the future. To achieve that goal, the “National Health Plan 2017-2021” was recently formulated. This research attempts to identify issues that need to be considered by development partners in this changing environment.Methods  The research was conducted through field studies and literature reviews to investigate the movements of both the government of Myanmar and development partners. It identified issues that need to be considered to achieve UHC, as well as those that development partners should consider when providing aid.Results and conclusion  During the era of the Millennium Development Goals, development partners tended to focus their development aid on maternal and child health, control of specific diseases, and strengthening health services for those specific health problems. However, in order to extend health and medical services to all people, without financial risks on the part of patients under the goal of UHC, it is necessary for the government to formulate and execute comprehensive health policies based on an analysis of Myanmar’s health and medical problems. Aligning with this change, development partners need to concretize their support in response to Myanmar’s health policy issues.

Genetic and Morphologic Identification of Spirometra ranarum in Myanmar

In the present study, we identified a Spirometra species of Myanmar origin (plerocercoid) by molecular analysis using mitochondrial cox1 and nad1 genes, as well as by morphological observations of an adult tapeworm. Spargana specimens were collected from a paddy-field in Taik Kyi Township Tarkwa Village, Yangon, Myanmar in December 2017. A total of 5 spargana were obtained from 20 frogs Hoplobatrachus rugulosus; syn: Rana rugulosa (Wiegmann, 1834) or R. tigrina (Steindachner, 1867). The plerocercoids were used for experimental infection of a dog. After 4 weeks of infection, an adult tapeworm was recovered from the intestine of the dog. Morphologically, the distinct features of Spirometra sp. (Myanmar origin) relative to S. erinaceieuropaei and S. decipiens include a uterine morphology comprising posterior uterine coils that larger than the terminal uterine ball and coiling of the uteri diagonally (swirling) rather than spirally. The cox1 sequences (1,566 bp) of the Myanmar-origin Spirometra species showed 97.9% similarity to a reference sequence of S. decipiens (GenBank no. KJ599679) and 90.5% similarity to a reference sequence of S. erinaceieuropaei (GenBank no. KJ599680). Phylogenetic tree topologies were identical and presented high confidence level of values for the 3 major branches of the 3 Spirometra species in cox1 and nad1 genes. These results indicated that Myanmar-origin Spirometra species coincided with those of S. ranarum and may be considered as a valid species.

Characterizing Helicobacter pylori cagA in Myanmar

BACKGROUND/AIMS: Differences in the Helicobacter pylori infection rate are not sufficient to clarify the dissimilarity of gastric cancer incidence between Myanmar and its neighboring countries. To better understand this trend, the H. pylori virulence gene cagA was characterized in Myanmar. METHODS: Glutamate-proline-isoleucine-tyrosine-alanine (EPIYA) patterns and CagA multimerization (CM) motifs of cagA genotypes were examined by performing polymerase chain reactions and DNA sequencing. RESULTS: Of 69 tested H. pylori strains, cagA-positive patients had significantly more severe histological scores in their antrum than cagA-negative patients. Sequence analysis revealed that 94.1% of strains had Western-type cagA containing an EPIYA motif (92.6%) or EPIYT motif (6.4%). The intestinal metaplasia scores in the antral of patients infected with the ABC and ABCC types of cagA were significantly higher than those of patients with AB-type cagA. Interestingly, in patients infected with H. pylori, 46.3% of strains with three EPIYA motifs contained two identical Western-typical CM motifs, and these patients showed significantly higher antrum inflammation scores than patients infected with two identical nontypical-CM motif strains (p=0.02). CONCLUSIONS: In Myanmarese strains, Western-type cagA was predominant. The presence of CM motifs and the proportion of multiple EPIYA-C segments might partially explain the intermediate gastric cancer risk found in Myanmar.

The movements of the government and development partners after democratization in Myanmar: A perspective on development aid for universal health coverage / 国際保健医療

Objective  Donor countries either suspended or restricted development aid for Myanmar during the period of the military regime. However, the democratic movement, which began in 2011, gradually resolved this situation. The government of Myanmar organized a “Myanmar Development Cooperation Forum” in 2013, where the government demonstrated a path for the country’s future development to development partners, including donor countries, international organizations, and international funds. Furthermore, the government has increased the budget for the health sector and upheld universal health coverage (UHC), a target of Social Development Goals, as a goal for the future. To achieve that goal, the “National Health Plan 2017-2021” was recently formulated. This research attempts to identify issues that need to be considered by development partners in this changing environment.Methods  The research was conducted through field studies and literature reviews to investigate the movements of both the government of Myanmar and development partners. It identified issues that need to be considered to achieve UHC, as well as those that development partners should consider when providing aid.Results and conclusion  During the era of the Millennium Development Goals, development partners tended to focus their development aid on maternal and child health, control of specific diseases, and strengthening health services for those specific health problems. However, in order to extend health and medical services to all people, without financial risks on the part of patients under the goal of UHC, it is necessary for the government to formulate and execute comprehensive health policies based on an analysis of Myanmar’s health and medical problems. Aligning with this change, development partners need to concretize their support in response to Myanmar’s health policy issues.