Co-occurrence of behavioural risk factors for non-communicable diseases among 40-year and above aged community members in three regions of Myanmar.

Background: Risky behaviours such as smoking, alcohol consumption, physical inactivity and inadequate consumption of fruits and vegetables are known contributing factors for non-communicable diseases (NCDs) which account for 74% of global mortality. Such behavioural risk factors co-occur frequently resulting in synergistic action for developing NCD related morbidity and mortality. This study aims to assess the existence of multiple risk behaviours and determine the socio-economic and demographic factors associated with co-occurrence of behavioural risks among Myanmar adult population. Method: Data were collected, in the context of the SUNI-SEA project (Scaling Up NCD interventions in Southeast Asia), from 660 community members aged 40 years and above of both sexes, residing in selected urban and rural areas from Ayeyawaddy, Yangon and Mandalay regions of Myanmar. The co-occurrence of behavioural risk factors was presented as percentage with 95% CI and its determinants were identified by multinomial logistic regression. Results: The co-occurrence of two risk behaviours and three or four risk behaviours were found in 40% (95% CI: 36.2%, 43.9%) and 10.8% (95% CI: 8.5%, 13.4%) respectively. Urban residents, men, participants without formal schooling and unemployed persons were more likely to exhibit co-occurrence of two risk behaviors and three or four risk behaviours. Conclusion: The current study shows high prevalence of co-occurrence of behavioural risk factors among Myanmar adults in the study area. NCD prevention and control programs emphasizing management of behavioural risks should be intensively promoted, particularly directed towards multiple behavioural risk factors, and not focused on individual factors only.

Risky behaviours such as smoking, alcohol consumption, physical inactivity and inadequate consumption of fruits and vegetables are known contributing factors for non-communicable diseases (NCDs) which account for 74% of global mortality. Such behavioural risk factors co-occur frequently resulting in synergistic action for developing NCD related morbidity and mortality. This study aims to assess the existence of multiple risk behaviours and determine the socio-economic and demographic factors associated with co-occurrence of behavioural risks among the Myanmar adult population. Data were collected from 660 community members aged 40 years and above of both sexes, residing in selected urban and rural areas from Ayeyawaddy, Yangon and Mandalay Regions of Myanmar. The current study shows substantial proportion of study adults had co-occurrence of behavioural risk factors (at least two risk factors), contributing to 50.8%. Urban residents, men, participants without formal schooling and unemployed persons were more likely to present co-occurrence of two risk behaviors and three or four risk behaviours, compared with their counterparts. Based on the study findings, the research team highly recommends that NCD prevention and control programs emphasizing management of behavioural risks should be intensively promoted, particularly directed towards multiple behavioural risk factors, and not focused on single risk factor only.

Caring for persons with drug use disorders in the Yangon Region, Myanmar: Socioeconomic and psychological burden, coping strategies and barriers to coping.

Drug use disorder (DUD) is a serious health condition that imposes a heavy burden on the persons who have a drug addiction experience and their families, especially in countries, such as Myanmar, where few formal support mechanisms are in place and repressive drug laws exacerbate the situation. Yet, in Myanmar, little is known about how informal caregivers are affected. This qualitative study aims at exploring the socioeconomic and psychological burden that informal caregivers in Myanmar encounter, coping strategies they employ, as well as barriers to coping they face. Thirty primary informal caregivers were chosen purposively from a mental health hospital in Yangon for in-depth interviews. The recorded interviews were transcribed and the data were analysed using framework analysis. The results revealed that financial constraint, income loss, social limitation and negative impact on family cohesion are important dimensions of socioeconomic burden, whereas sadness, anger, helplessness, worry, fear and guilt are the main psychological distress factors encountered by caregivers of persons with DUD. Key coping strategies employed by caregivers include religious coping, financial coping, acceptance and planning. Moreover, perceived stigma towards persons with DUD and their caregivers was very high and caregivers received hardly any social support, inter alia because of the country's drug law which reinforces stigma and discrimination. Neither the government nor any other organization in Myanmar provided financial support to the caregivers. The results of this study showed that caring for persons with DUD has devastating effects on caregivers and their families. While the 2018 National Drug Control Policy can potentially help alleviate the burden on substance users and their families, further amendments of the existing drug law are urgently needed. Moreover, strengthening prevention and harm reduction approaches, improving treatment and rehabilitation services, as well as stigma-reducing educational campaigns should be considered a priority.

Wounds, Antimicrobial Resistance and Challenges of Implementing a Surveillance System in Myanmar: A Mixed-Methods Study.

Wound infections with drug-resistant bacteria lead to higher mortality and morbidity and increased healthcare costs. We aimed to describe the spectrum of bacterial pathogens, isolated from wound cultures in Yangon General Hospital in 2018, and their antimicrobial resistance (AMR) patterns and to understand the challenges in implementing an AMR surveillance system in Myanmar. We conducted a concurrent mixed-methods study involving analysis of surveillance data and in-depth interviews with nine key personnel involved in AMR surveillance. Of 1418 wound specimens processed, 822 (58%) were culture-positive. The most common Gram-positive bacteria were coagulase-negative staphylococci (23.3%) and Staphylococcus aureus (15.1%). Among Gram-negative bacteria, Escherichia coli (12.5%) and Pseudomonas aeruginosa (10.1%) were common. Staphylococcus aureus isolates were resistant to penicillin (98%), oxacillin (70%) and tetracycline (66%). Escherichia coli showed resistance to ampicillin (98%). Lack of dedicated and trained staff (microbiologist, technician, data entry operator), lack of computers at sentinel sites and non-uniform and non-standardized data capture formats were the major challenges in implementing AMR surveillance. These challenges need to be addressed urgently. We also recommend periodic analysis and sharing of antibiograms at every hospital to inform the treatment regimens used in wound management.