Threat of HIV/AIDS in children: social, education and health consequences among HIV orphans and vulnerable children in Myanmar

Background: There is very limited information available on HIV related orphansand vulnerable children (HIV-OVC) in Myanmar. Hence, the objective of this studywas to identify and compare the social, education and health consequencesamong HIV‑OVC and children from the families not related to HIV in the sameneighbourhoods (neighbouring children).Materials and Methods: A cross‑sectional, comparative survey was carried out inthree geographical locations. Face‑to‑face interviews were conducted with guardiansand children using a pretested structured questionnaire including Strength andDifficulties Questionnaire (SDQ) for behavioural problems. Outcome measureswere compared using Chi‑squared test or ‘t’ test or ‘Rank‑sum’ test.Results: A total of 300 HIV-OVC and 300 neighbouring children were included. Agreater number of HIV-OVC than their neighbouring children have experienced familydisplacement from their original homes (27% and 1%), child/sibling displacement(20%and 2.7%) and family dispersion (20.3% and 1.3%) (P < 0.001). More guardians ofHIV‑OVC reported that the disease affected their children’s education (28.2% and16.3%; P < 0.05). Fifteen per cent of HIV‑OVC and 10.5% of neighbouring childrenhad to work for their families (P < 0.05). Psychological condition was assessedon emotional, conduct, hyperactivity/inattention, peer relationship and prosocialbehaviour. A greater number of HIV‑OVC were noted in the abnormal category withregard to hyperactivity and prosocial behaviours (P < 0.05).Conclusions: Higher incidence of social and psychological consequences amongHIV‑OVC call for more community support programmes and creation of jobopportunities to minimize social impact in the affected families. Future programmesshould focus on counselling of HIV‑OVC and providing psychological support.

Challenges faced by skilled birth attendants in providing antenatal and intrapartum care in selected rural areas of Myanmar

Background: In Myanmar a large proportion of antenatal and intrapartum care in rural areasis provided by skilled birth attendants (SBAs), this study assessed the coverage by these healthworkers of all births, their adherence to service guidelines, and community opinion on the antenataland delivery care they give in two rural health centres in Pathein Township, Ayeyarwaddy Regionto identify the challenges and improve antenatal and intrapartum service delivery provided by theSBAs.Method: A structured questionnaire was used to interview 304 women who had infants under oneyear of age, and in-depth interviews were held with 12 SBAs and 10 community members.Results: Of the 304 pregnancies, 93% had received antenatal care (ANC); 97% of these werecovered by SBAs at an average 15 weeks’ gestation. The average frequency of ANC visits was 9.Rates of home and hospital deliveries were 84.5% and 13.8% respectively. Among home deliveries,use rate of SBA was 51.4%, while for postnatal care, 31.3% was given by unskilled providers(traditional birth attendants (TBAs) 17.5%, auxiliary midwives (AMWs),13.8%). Multivariate analysisshowed that interviewees aged 30 years and below (OR=0.468, P=0.046), with an education atprimary level and below that of husband (OR=0.391, P=0.007) or not residing in the village of therural/station health centre (OR=0.457, P=0.011) were significantly less likely to use SBAs. Thecategories of supervision, referral, and health education activities of SBAs were not in line withservice guidelines. The main reasons were lack of access and community acceptance of TBAs.Conclusion: Heavy workload, geographical location, transportation and financial concerns weremajor challenges for SBAs, along with community compliance and mutual coordination. Goodcommunication and service management skills were important to overcome these challenges.

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.

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.