Multi-level partnerships to promote health services among internally displaced in eastern Burma.

Ethnic populations in eastern Burma are the target of military policies that result in forced labour, destruction of food supplies, and massive forced displacement. Despite international assistance to Burmese refugees along the Thai-Burma border, traditional humanitarian models have failed to reach these internally displaced persons (IDPs) within Burma. Nevertheless, through the cultivation of a model (cross border local-global partnerships) 300,000 IDPs in eastern Burma now receive critical health services where, otherwise, there would be none. We describe key elements of the partnership model's genesis in eastern Burma. The role of the local partner, Backpack Health Worker Team (BPHWT), is highlighted for its indigenous access to the IDP populations and its maintenance of programmatic autonomy. These local elements are potentiated by international support for technical assistance, training, resources, and advocacy. International policy and investment should prioritize support of locally-driven health initiatives that utilize local-global partnerships to reach not only IDPs but also other war-torn or traditionally inaccessible populations worldwide.

HIV/AIDS knowledge, attitudes, and practices among Burmese migrant factory workers in Tak Province, Thailand.

Little information is known regarding the level of knowledge among Burmese migrant workers along the Thai/Burma border concerning risk factors, prevention or transmission of HIV. The Burma Medical Association (BMA) and National Health and Education Committee (NHEC) collected data on knowledge, attitudes and practices among 725 factory workers in Tak Province, Thailand during July 2000. We present results from a secondary analysis of these data. Responses were grouped into prevention, transmission and risk categories, and percentages answered correctly were recorded. Men consistently scored higher than women, with significant gender differences in the prevention and transmission questions. Forty-one per cent of the women understood that contraceptive pills do not prevent infection and 15% of females reported ever seeing a condom. Twelve per cent of men and 1.4% of women reported ever using a condom (OR = 8.57, p < 0.0001). Previously, virtually no access has been extended to persons trying to document health status among Burmese migrant workers in factories. The survey reveals a significant lack of knowledge about HIV among factory workers and indicates that a sub-population of Burmese people appears to lack the most basic information about the epidemic.

Clinical diagnosis of malaria on the Thai-Myanmar border.

BACKGROUND: To evaluate the prevailing practice of presumptively diagnosing malaria in all cases of febrile illness in a clinic serving a refugee population on the Thai-Myanmar border METHODS: A retrospective review of 3,506 patient charts from December 1993 through June 1994 at the MaeSot medical clinic to compare clinical signs of malaria to blood smear findings. Patients presenting without fever were assumed not to have malaria; the remaining 2,111 patients presenting with fever had blood smears examined for malaria infection. RESULTS: Fever alone sufferedfrom poorpositive predictive value (54.7 percent) and specificity (59.3 percent). When fever was combined with hepatosplenomegaly and anemia, the positive predictive value and specificity improved (84.5 percent and 98.5 percent, respectively). However, this combination also resulted in an unacceptably poor sensitivity (16.5 percent) and false negative error rate (835/1,000). CONCLUSIONS. In this nonimmune refugee population, severe complications of falciparum malaria occur quickly and commonly; aggressive chemotherapy is necessary to reduce morbidity and mortality. Until laboratory facilities are made available, all cases offever should continue to be treated presumptively as malaria.