Gaps and challenges to integrating diabetes care in Myanmar

In common with other low-income countries, diabetes is a growing challenge forMyanmar. Gaps and challenges exist in political commitment, policy development,the health system, treatment-seeking behaviour and the role of traditional medicine.National policies aimed at prevention – such as to promote healthy food, createa healthy environment conducive to increased physical activity, restrict marketingof unhealthy food, and initiate mass awareness-raising programmes – need to bestrengthened. Moreover, existing initiatives for prevention of noncommunicabledisease (NCD) are channelled vertically rather than being horizontally integrated.Primary health care is traditionally orientated more towards prevention of infectiousdiseases and staff often lack training in prevention and control of NCDs. Capacitybuilding activities have been modest to date, and retaining trained health workers indiabetes-oriented activities is a challenge. The World Health Organization Packageof Essential Noncommunicable (PEN) disease interventions for primary healthcare in low-resource settings has been piloted in Yangon Region and countrywide expansion awaits ministerial approval. Recently, the Myanmar Diabetes CareModel was proposed by the Myanmar Diabetes Association, with the aims of bothbridging the gap in diabetes care between rural and urban areas and strengtheningcare at the secondary and tertiary levels. However, implementation will requirepolicy development for essential drugs and equipment, capacity-strengthening ofhealth-care workers, and an appropriate referral and health-information system.

Metabolic Syndrome in obese and normal weight Myanmar children / Journal of the ASEAN Federation of Endocrine Societies

Objectives@#To estimate the frequency of Metabolic Syndrome (MS in Myanmar obese children and to determine the risk factors associated with MS in obese children comparing with normal weight children. @*Methodology@#A cross-sectional study was conducted to compare the risk factors for metabolic syndrome between normal and obese children by using the pediatric definition for metabolic syndrome [International Diabetes Federation (IDF), 2007]. Twenty-three obese children (BMI, ≥ 97th percentile) and 23 normal weight children (BMI, < 85th percentile) aged 5-12 years were included in the study. Blood pressure, body weight, height, waist circumference (WC), fasting triglycerides, HDL-cholesterol, total cholesterol and glucose concentrations were determined. @*Results@#Based on the IDF pediatric criteria, 9 obese children (39.1%) had metabolic syndrome while no normal weight child had metabolic syndrome. Ten (43.5%) normal weight children and 3 (13.0%) obese children had at least one risk factor for the metabolic syndrome. Central obesity (WC ³ 90th percentile for age and sex), the most common risk factor, was observed in 25 children (54.4% of the total population). @*Conclusion@#This study highlights the need for early recognition of risk factors for metabolic syndrome in all children to halt the progression of type 2 diabetes and cardiovascular diseases (CVD) in later life.

Dissemination of reproductive health knowledge by questions and answers through telephone hotline: a feasibility study in Myanmar.

This study was conducted to determine the feasibility of disseminating reproductive health (RH) information to the general public of Myanmar in a confidential, anonymous and interactive way through a telephone hotline. We carried out a cross-sectional study using a short questionnaire interview with the RH hotline callers and analyzing sample audio recordings of conversations. The hotline was advertised in print media. It was answered by trained hotline responders (medical doctors) of Department of Madical Research (Lower Myanmar) (DMR-LM). There were 743 calls during six months, from all 14 States and Divisions. Most of the calls were from Yangon, Mandalay and Bago Division. Both male (48%) and female (52%) callers used the hotline. The majority of callers (74%) were between 25 and 45 years old; 21% were young people (15-25 years old). Married people (81%) used the hotline more than singles (19%). Most of the callers (91%) had a high school to graduate education level. The most frequently asked topics were infertility (23%), birth spacing (22%), sexual problems (13%) and adolescent health, including reproductive function (12%). The anonymity of the callers, the non-judgmental attitudes of the responders and the use of media for publicity appeared to facilitate the use of the hotline by the public. More linkages with service entry points, enhancement of communication skills, sexual counselling training and use of media can improve topic coverage and utilization of the reproductive health hotline.

Prevalence of hypertension and its associated factors in the adult population in Yangon Division, Myanmar.

A study was performed among 4616 people aged 20 years and above in Yangon Division in 2003 to determine the prevalence of hypertension and its associated factors. The prevalence of hypertension (systolic blood pressure ≥140 mm Hg, diastolic blood pressure ≥90 mm Hg, or use of antihypertensive drugs) was 33.8% (95% confidence interval [CI] = 32.1%-35.6%). The prevalence of prehypertension (systolic blood pressure = 120 to 139 mm Hg or diastolic blood pressure = 80 to 89 mm Hg) was 29% (95% CI = 27.2%-30.8%). The multiple logistic regression showed that age, low physical activity, high intake of alcohol, obesity, high level of total cholesterol, and diabetes mellitus were associated with hypertension. Among the hypertensive participants, 53% were aware of their hypertension, and 32% were currently taking antihypertensive medication, but only 11% had their hypertension controlled. The study highlights the low level of control despite the high level of hypertension prevalence in Yangon Division.

Sexual and reproductive health needs of vulnerable youth in Myanmar.

A cross-sectional survey of 56 youth, using participatory research methods, was conducted with the objective to identify the sexual and reproductive health needs among vulnerable youth in Pyin Oo Lwin town in terms of their livelihoods, perceptions about health and health risks, sex practices, perceived health information needs and preferred channels for health information, and visions for their future generation. The results indicated that a majority of young people of both sexes were deficient in knowledge of the locations and functions of reproductive organs. The majority of respondents of both sexes said that their main health concern was AIDS. Pre-marital sex among youth, 16-20 years of age, was identified in our study. Malaria and AIDS were mentioned as information needed by young people. TV and magazines/journals were prioritized as preferred channels of disseminating health messages. Almost all reported that education was the one thing that they wanted for their own children.

Household income, health and education in a rural area of Myanmar.

This study was to determine the relationship between a commonly used social stratification indicator, net equivalent income, and self-rated health, long-term disability, visual acuity status, death rate, birth rate, unsafe delivery and school enrollment in a rural area of Myanmar. Data were collected from 3,558 respondents in 805 households of all ages. Data analysis for various items was based on different age groups. The results from two income groups (highest and lowest) are as follows: the percent of those who self-rated their health as very good were 17.8% and 10.4% in the highest and lowest income groups, respectively (adjusted coefficient = 0.30, 95% Cl 0.11-0.50); those with an acute medical condition were found in 16.3% and 20.8% in the highest and lowest income groups, respectively (adjusted OR = 1.35, 95% Cl 1.08-1.68); those with long-term disability were found in 15.3% and 21.2% in the highest and lowest income groups, respectively (adjusted OR = 1.39, 95% Cl 1.05-1.84); and those with poor visual acuity at a distance of 13 feet were found in 8.1% and 13.5% in the highest and lowest income groups, respectively (adjusted OR = 1.64, 95% Cl 1.18-2.30). The birth rate ratio was 1.3, the death rate ratio was 1.2, and school enrollment was found in 92.8% and 83.2% in the highest and lowest income groups, respectively (adjusted OR = 0.34, 95% Cl 0.1-0.8). These results indicate that there is an urgent need to strengthen the health care infrastructure and educational system, targeting the poor in rural areas.