Effectiveness, safety and acceptability of the method of visual inspection with acetic acid (VIA) and cryotherapy based single-visit approach to cervical cancer prevention (CCP) in Kungyangon Township, Yangon Region, Myanmar.

Cervical cancer is the second most frequent cancer occurring among the women in Myanmar. Being a preventable cancer, it is crucial to have an organized screening program in place that uses simple, practical and cost effective technology so as to ensure that the screening services have a wide coverage and it is universally accessible. The aim of this study is to fi nd out the effectiveness, safety and acceptability of the method of visual inspection with acetic acid (VIA) and cryotherapy based single-visit approach for use in cervical cancer prevention (CCP) programmes in Myanmar. The study is a descriptive community-based study conducted from July 2013 to October 2014. A well trained central CCP mobile team from Central Women’s Hospital (CWH) of the University of Medicine 1 visited Kungyangon Township fortnightly during the weekends to carry out the study. During the 6 visits undertaken by the team, 1,617 married women between the ages of 30 - 49 years were screened for cervical cancer using VIA method. The screening coverage achieved was 8.97%. The VIA tests were positive in 121 women and the screening positive rate was 7.5%. Cryotherapy was given to 119 eligible women after proper counseling. The treatment rate was 98.35%. Two women needed loop electrosurgical excision procedure (LEEP) surgery. Another two women had invasive cancer on screening. Watery vaginal discharge for 2 to 3 weeks after cryotherapy was the only symptoms reported at the time of one month follow-up. At the time of 1 year follow-up visit, the defaulter rate was 13.45% and 3 women had persistent VIA positive lesions. The overall cure rate was 97.09%. Twenty local basic health staff (BHS) were trained during screening visits of the Central CCP team. A local CCP team was also formed to sustain the screening program at the community level. All women that participated in the study were happy with the single-visit approach and they have been supported by their husbands in their efforts to obtain treatment. In addition, it was found that the women undergoing cryotherapy successfully adhered to home-care instructions prescribed by the CCP team. The study has shown that the screen and treat single-visit approach can be successfully implemented and expanded to other areas so that a universal coverage can be obtained to control cervical cancer in Myanmar.

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.

Humoral immune response to falciparum malaria during pregnany

Humoral immune respone against Plasmodium Falciparum was studied ontwo hundred and thirty seven pregnant and non pregnant women in Tha-hton township during premonsoon season of 1998. Slide positivity rate among pregnant women was 7.3

(10/137), fifty percent of which were primigravide. Eighty percent of infection occured druing second trimester. Antimalarial antibiodies were determined by both Indirect Fluorescent Antibody Test (IFAT) and Enzyme Linked Immunosorbent Assay (ELISA). IFAT seropositivity rate was 63.33

(n=33) in primigravidae and 83.63

(n=11) in non pregnant healthy women. In the convalescent sera, the rates were 77.14

(n=7) and 87.33

(n=15) respectively. These IFAT results were also comparable with those of ELISA. Lower seropositivity rate and mean antibodytitre were observed in pregnant women compared with non-pregnants. These findings inply that there is suppression of antimalarial immunity druing pregnancy

Prevalence of syphilis, gonorrhoea and chlamydial infections in women attending Maternal and Child Health Care Centres in Hlaing Tharyar Township

A total of 105 subjects comprising 74 pregnant women, 26 STD patients and 5 commercial sex workers were randomly selected to detect the prevalence of syphilis, gonorrhoea and chlamydial infections. Syphilis was most prevalent among MCH clinic attendants with overall seroprevalence of 15.2 per cent; 10.8 per cent of antenatal cases, 19.2 per cent of STD patients and 60 per cent of CSWs were observed to be either TPHA reactive or both VDRL and TPHA positive. Gonorrhoea was detected in 6.7 per cent of total tested group. Gonococcal infection was not observed in antenatal cases. Neisseria gonorrhoeae isolated were found to be less sensitive to Penicillin, susceptible to Ciprofloxacin and Ceftriaxone. Beta lactamase producing strains and Tetracycline resistant N. gonorrhoeae were not observed. Chlamydial antigen detected by ELISA was observed in 4.8 per cent of total tested group. 5.4 per cent of antenatal cases (4/74) and 3.8 per cent of STD patients (1/26) were positive for chlamydial antigen. 22.9 per cent of clinic attendants were found to be infected with one or more sexually transmitted diseases.

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.

A preliminary study on the use of preoperative antibiotic in hysterectomy

A study was done on the u

Maternal influences on low birth weight

A total of 2613 babies delivered in North Okkalapa General Hospital (N.O.G.H) during 9 months period from January 1990 to September 1990 were studied with the view to determine maternal influences on low birth weight. Maternal variables assessed and recorded were completed age, parity, height, education, smoking, last birth interval. Fetal variables assessed and recorded were birth weight and gestational age in weeks. The incidence of L.B.W in N.O.G.H during the study period was 21.0 percent, 18.1 percent due to intrauterine growth retardation and 2.9 percent due to preterm. The highest proportion of L.B.W was found in the < 20 years age group, parity one, last birth interval > 3-4 years, maternal height < = 145cm., maternal education 1-4 years and in smoking group. Increased risk and significant association with L.B.W was found among teenage (< 20 years) pregnancies, primiparity, maternal height < = 145 cm, smokers and maternal education < = 8 years. Odds ratio > 1 but no significant association with L.B.W was found among maternal age > 35 years, last birth interval< = 1 year and > 3 years, and parity 5 + groups.