An update in the pharmacological management of axial spondyloarthritis.

INTRODUCTION: Significant progress has been made in the diagnosis and management of axial spondyloarthritis (AxSpA) over recent decades. A greater understanding of the immunopathogenesis of the disease has paved the way for the development of targeted treatments. Their efficacy has been demonstrated in randomized controlled trials, meta-analyses and one head-to-head study of biologic DMARDs. Treatment decisions in AxSpA are currently influenced by patient choice, co-morbidity, clinician familiarity and cost. AREAS COVERED: We review the clinical trials that underpin the evidence base for treatments in AxSpA. We also cover the meta-analyses and head-to-head data that seek to support clinicians in personalizing treatment decisions. Further, we discuss the recent international guidelines that provide clinicians with treatment pathways and guidance. EXPERT OPINION: We conclude that treatment decisions in managing both radiographic and non-radiographic AxSpA should be based on shared decision-making with patients, the clinical effectiveness of drug class, co-morbidity and cost. At present, we have limited head-to-head data to prioritize one drug class over another for first-line treatment but can recommend tumor necrosis factor (TNF), interleukin 17 (IL17) and JAK inhibition as being comparable in terms of clinical, structural and patient-reported outcome measures. Further real-world data may guide treatment decision-making in individual patients.

Exploring the determinants of risk behavior for transfusion transmissible infections among first-time blood donors in Mandalay General Hospital, Myanmar.

INTRODUCTION: Blood donation is vital to healthcare, but it must be kept safe by mitigating the risk of transfusion transmissible infections (TTIs). The objective of this study was to investigate the factors that influence risk behavior for transfusion transmissible infections among first-time blood donors at Mandalay General Hospital, Myanmar. METHODS: This study utilized a cross-sectional study design using secondary data. Mandalay city and Mandalay Blood Bank in Mandalay General Hospital were purposely selected and a total of 406 first-time blood donors participated. A structured questionnaire administered by an interviewer was used. The questionnaire contained background characteristics, knowledge on TTIs, attitude toward TTIs, and TTIs risk behaviors. To examine the determinants (background characteristics, knowledge, and attitude) that affect risk behavior, inferential statistics techniques that included the chi-squared test, bivariable logistic regression, and multivariable logistic regression were applied. A p-value of less than 0.05 signified statistical significance. RESULTS: Among 406 first-time blood donors, 52.9% were under 20 years old, and 53.7% were male. Most had undergraduate education (77.6%), were married (84.2%), and were students (55.7%). Additionally, 76.8% hadn't received the hepatitis B vaccine. Blood groups were distributed as follows: B (40.0%), O (33.8%), A (23.4%), AB (8.9%). About 15.8% showed high knowledge level, and 63.6% had high attitude. Notably, 29.3% exhibited high-risk behavior for TTIs. Age was associated with lower risk behavior (OR = 1.54, 95% CI: 0.99, 2.38, p = 0.049), but lost significance in multivariable regression (p = 0.214). Knowledge on TTIs didn't show significance. However, high attitudes were significantly associated with lower risk behavior (OR = 11.4, 95% CI: 1.25, 103.83, p = 0.017, retained in multivariable regression, p = 0.012). CONCLUSION: Findings of this study contribute in the development of programs that ensure a safe and reliable blood supply chain. To improve blood safety standards among first-time blood donors, this study highlights the value of targeted education and screening processes, placing particular emphasis on acquiring knowledge and positive attitude toward blood donation and risk behavior.

Atrio-Ventricular Block by Legionella Disease.

Although Legionnaires' disease mainly affects the lungs, it can also present with other systemic involvement, including rare cardiac manifestations. Recognised presentations are endocarditis, myocarditis, pericarditis, and pericardial effusion. A 72-year-old British man presented with a six-day history of dry cough and a four-day history of fever during the peak of the COVID-19 pandemic. His electrocardiogram showed Mobitz type II atrio-ventricular block. Although all the cultures were negative, the chest X-ray demonstrated COVID-19 infection-like features. With high clinical suspicions and chest X-ray features, the polymerase chain reaction of the COVID tests was repeated three times and all were negative. He had a positive urinary Legionella antigen, and his bradycardia and heart block improved after treatment with amoxicillin/clavulanic acid, and clarithromycin. As the electrocardiogram showed Mobitz type II, a permanent pacemaker was implanted. The follow-up pacemaker check showed that he still required active pacing.

Perceptions of livestock value chain actors (VCAs) on the risk of acquiring zoonotic diseases from their livestock in the central dry zone of Myanmar.

OBJECTIVES: The Central Dry Zone (CDZ) is one of the most important livestock production areas of Myanmar. However, there is an eminent lack of information on the attitudes and traditional beliefs of local farmers and livestock supply chain actors in CDZ of Myanmar on the public health implications. A modified data collection instrument of the Health Belief model was developed to investigate attitudes, beliefs and barriers to the application of recommended zoonotic disease prevention. STUDY DESIGN: Cross-sectional study. METHOD: Data analyses were conducted considering a two-phase multilevel mixed effect binomial generalized linear models modelling approach. RESULTS: The availability of information about zoonosis to supply chain actors influenced their confidence to implement preventive actions (OR = 1.5, p = 0.045 for cattle diseases; OR = 1.5, p = 0.022 for village chicken diseases). Supply chain actors were more likely aware of zoonosis transmitted by cattle compared to livestock farmers (OR = 0.3, p = 0.005 for cattle farmers), while people not rearing or trading small ruminants and/or poultry were less likely to be aware of the zoonotic risk associated with these animals (p < 0.005). Information on zoonosis transmitted from small ruminants was mainly promoted through farmers (p = 0.032), while information on zoonotic diseases that can be obtained from chickens was disseminated through farmers, local authorities and the media. Nevertheless, appropriate hand hygiene measures (i.e. cleaning of hands after touching, cutting, cooking meat) (OR = 7.7, p < 0.001 for zoonotic small ruminant diseases; OR = 1.6, p = 0.073 for zoonotic village chicken diseases) and treating of sick animals (OR = 7.3, p < 0.001 for small ruminant zoonotic diseases; OR = 2.2, p = 0.031 for village chicken zoonotic diseases) increased the confidence of small ruminant and village chicken owners to prevent these zoonotic infections. CONCLUSIONS: The findings from this study indicate that while gender and the availability of information on zoonotic risks play an important role on the perceived threat of zoonoses, the practice of prevention methods influenced the confidence of value chain actors (VCAs) on zoonoses prevention.

Discerning risk and uncertainty with "better insurance" - How animal health interventions for village chickens influence farmers' perceptions on the prevention of poultry diseases.

High mortality in young chicks and deaths from Newcastle disease (ND) are the two major constraints to village chicken production in low-and middle-income countries. A 12-month intervention study was conducted across 174 households in two townships of Central Myanmar, to reduce these chicken mortalities. Interventions included ND vaccinations of village chickens and improved chick management. Following the Health Belief Model (HBM) framework, 81 village chicken farmers involved in the intervention study were repeatedly surveyed before and after the interventions to determine the level of change in farmers' knowledge about ND, perceptions about susceptibility and severity of ND virus infection, perceptions about benefits and barriers of ND vaccination, as well as farmers' actions to improve the health status of their birds and to improve biosecurity and ND control measures. Marginal homogeneity tests were used to compare the level of change in farmers' matched responses to individual survey questions before and after the interventions. In addition, confirmatory factor analysis and structural equation modelling was used to create latent variables describing farmers' perceptions about susceptibility and severity of ND in their birds, farmers' perceptions about the barriers and benefits of conducting ND vaccination as well as farmers' cues to action and self-efficacy before and after the interventions. Interventions resulted in 33% more chicks surviving, which resulted in increased sales of birds after they had reached a market age of 7 months. After the interventions, farmers acknowledged the value of protecting birds from ND to increase their income (p = 0.0002). Farmers were also more willing to overcome barriers to vaccination (i.e., 'catching' birds for ND vaccinations) after the interventions (p = 0.0388). Interestingly, after the interventions, fewer farmers were concerned about the risk of their birds becoming infected with ND virus through cock fights and non-confinement (p = 0.0008 and p = 0.00022, respectively), and farmers were more uncertain about the susceptibility of their birds to ND virus infection after the interventions. Surprisingly, farmers became 'less active' in ensuring good biosecurity practices after the interventions: fewer farmers were willing to observe disease signs in village chickens (p < 0.001) and fewer farmers buried dead birds (p < 0.001). Perceived susceptibility was the only HBM component that was significantly reduced (p = 0.014) after the interventions: thus, less farmers were concerned about ND even when using management practices associated with high risk of ND transmission (e.g., cook fights, no confinement). Our results highlight the importance of information campaigns and extension work to ensure farmers maintain a high level of biosecurity when animal health interventions are implemented.

How can we compare multispecies livestock rearing households? - an analysis of the impact of health and production parameters on multispecies livestock rearing outcomes.

BACKGROUND: The Central Dry Zone (CDZ) of Myanmar is a critical region of livestock production. This region supports 10 million people whose livelihoods depend on small-scale, dry-land agriculture, but it is also one of the poorest regions of Myanmar. Little is known about the constraints to animal health in multi-species livestock farms in this region or the relationships between husbandry practices and measures of the success of livestock rearing such as income, and successful health management. RESULTS: In this study, we describe associations between husbandry practices and animal health problems affecting different body systems. We also develop a biosecurity and livestock disease prevention index by taking account of different activities (i.e. treatment, vaccination, reducing disease transmission practice, sanitation) that can be compared between livestock species, estimate the income generated from livestock production, and identify factors influencing these parameters. Cross-sectional study was used to collect data on livestock production and health from cattle (N = 382), sheep, goat (N = 303) and village chicken (N = 327) farmers in 40 villages of the CDZ. Survey-design based techniques and F-statistics, ordinal, and binomial regression were used for data analysis. Our results indicate that a significant proportion of farmers' income in the CDZ comes from crop production (43.2%) and livestock production (23.1%) and the rest of the farmers' income is derived from trading, supported by other relatives and employment. Our results indicate that animal health management practices, herd/flock size, and experience of farmers contributed significantly to the presence of animal health problems, in particular related to the physical, respiratory and digestive systems. Animal health management was usually conducted in traditional ways. Among different livestock species farms, cattle farms (cattle median BDPI: 45; IQR: 35-55) practised better biosecurity than other livestock species farms (i.e. small ruminant and village chicken farms) (small ruminant and village chicken BDPI: 10; IQR: 0-20). Interestingly, the ownership groups (i.e. rearing singly or multispecies) did not show any impact on biosecurity and disease prevention index of the farms. CONCLUSIONS: This study identified good practice households and these findings will be useful for designing intervention trials to improve the production and health outcomes evaluated in this study.

What drives small-scale farmers to vaccinate their multiple livestock species animals against common infectious diseases in Myanmar?

Livestock rearing is an important income source for small-scale farmers in Myanmar, but Foot and Mouth Disease (FMD) and Newcastle disease (ND) are major constraints to livestock production. A study was conducted to identify perceptions of farmers about FMD and ND disease risks and perceptions about vaccination practices by using the modified health belief model. The majority of livestock farmers (>70%) reported that they were aware of the risk and impact of FMD and ND and were willing to vaccinate their livestock (>60%). Focusing on three main livestock farmer groups, about 17.0% of cattle, 15.4% of village chicken, but only 2.3% of small ruminant owners, indicated that the non-availability of vaccinations in the villages was the major constraint to vaccinations (p<0.001), while in contrast twice as many small ruminant farmers compared to cattle and village chicken farmers indicated they had no knowledge about vaccinations and no funds to conduct vaccinations. Limited accessibility to vaccines and vaccinators was related to size of villages (p = 0.001 for cattle; p = 0.027 for small ruminants; p = 0.005 for village chicken). Willingness to vaccinate small ruminants against FMD was associated with the perceived impact of the disease on sales and accessibility of information about vaccination. Accessibility to information about ND vaccination influenced the willingness of village chicken farmers to conduct vaccinations. In addition, beliefs in the effectiveness of vaccinations played a major role in the willingness to carry out vaccinations on both, cattle (ß = 0.3, p = 0.018) and village chicken farms (ß = 0.5, p<0.001). Our study highlights that policies that increase the accessibility of vaccines and the dissemination of information about disease prevention and vaccination practices in villages of all sizes, have the potential to increase FMD and ND vaccination rates and thereby reduce outbreak occurrence in Myanmar. On the other hand, indirect factors, such as village size strongly influenced the availability of vaccinations.

Molecular Breeding for Improving Productivity of Oryza sativa L. cv. Pusa 44 under Reproductive Stage Drought Stress through Introgression of a Major QTL, qDTY12.1.

Increasing rice production is quintessential to the task of sustaining global food security, as a majority of the global population is dependent on rice as its staple dietary cereal. Among the various constraints affecting rice production, reproductive stage drought stress (RSDS) is a major challenge, due to its direct impact on grain yield. Several quantitative trait loci (QTLs) conferring RSDS tolerance have been identified in rice, and qDTY12.1 is one of the major QTLs reported. We report the successful introgression of qDTY12.1 into Pusa 44, a drought sensitive mega rice variety of the northwestern Indian plains. Marker-assisted backcross breeding (MABB) was adopted to transfer qDTY12.1 into Pusa 44 in three backcrosses followed by four generations of pedigree selection, leading to development of improved near isogenic lines (NILs). Having a recurrent parent genome (RPG) recovery ranging from 94.7-98.7%, the improved NILs performed 6.5 times better than Pusa 44 under RSDS, coupled with high yield under normal irrigated conditions. The MABB program has been modified so as to defer background selection until BC3F4 to accelerate generational advancements. Deploying phenotypic selection alone in the early backcross generations could help in the successful recovery of RPG. In addition, the grain quality could be recovered in the improved NILs, leading to superior selections. Owing to their improved adaptation to drought, the release of improved NILs for regions prone to intermittent drought can help enhance rice productivity and production.

Characteristics of Livestock Husbandry and Management Practice in the Central Dry Zone of Myanmar.

The central dry zone of Myanmar is the area with the highest density of small-scale livestock farmers under harsh environmental condition. In this study, we describe and quantify ownership patterns for various livestock species and characterised management and husbandry practices of small-scale farmers. In addition, we identify the husbandry factors associated with selected outcome indicators, 'herd or flock size' and 'purpose of rearing'. A total of 613 livestock farmers in 40 villages were interviewed. Multispecies rearing was common with 51.7% of farmers rearing more than one livestock species. Rearing animals to be sold as adults for slaughter (meat production) was more common for small ruminants (98.1%) and chickens (99.8%) compared to cattle (69.8%). Larger cattle herds were more likely to practice grazing (p < 0.001) and to employ labour from outside the household to manage cattle than medium or small herds (p = 0.03). Patterns of grazing differed significantly between seasons (p < 0.01) for cattle, but not for small ruminants and village chicken. Overall, multispecies rearing and species-specific husbandry practices are used to raise livestock under harsh environmental conditions. Our results reveal that herd/flock size and purpose of rearing across different livestock species were significantly associated with feeding and housing practices and experience of farmers.

Using longitudinal syndromic surveillance to describe small ruminant health in village production systems in Myanmar.

A novel syndromic surveillance approach was used to describe small ruminant health in Myanmar, to help overcome limitations in disease diagnosis common in many parts of the world, especially in low and middle income countries (LMICs). Observations were made from July 2015 to June 2016 of ten clinical syndromes in 12 goat herds and sheep flocks owned by smallholders in the Central Dry Zone. Strengths and weaknesses to using syndromic surveillance in a village setting were identified using a formal surveillance evaluation framework, 'SERVAL'. Larger reporting teams made disproportionately more reports than smaller ones (86% compared to 14% of all reports, with a reporting rate ratio of 4.3 95% CI 3.5-5.4), which may have affected surveillance sensitivity. The benefits of the syndromic surveillance included its relatively low cost and ability to produce quantitative disease estimates that could be used to prioritise further disease investigation and extension activities. In particular, significant mortality was observed, with monthly mortality of 3.0% (95% CI 2.5-3.7%) and 0.28% (0.15-0.53%) in young and adult animals, respectively, and a population attributable fraction of mortality for young animals of 82% (68-91%). Mortality was associated with ill-thrift in young animals but had not previously been considered an important production-limiting condition in Myanmar. This information contributes to an understanding of the prevalence of excessive mortality in smallholder goat and sheep production systems. It is a practical example of the use of syndromic surveillance in a LMIC livestock production system, the results of which can direct future disease research, treatment and prevention to improve the health and productivity of small ruminants in Myanmar.

Suppressed translation as a mechanism of initiation of CASP8 (caspase 8)-dependent apoptosis in autophagy-deficient NSCLC cells under nutrient limitation.

Macroautophagy/autophagy inhibition under stress conditions is often associated with increased cell death. We found that under nutrient limitation, activation of CASP8/caspase-8 was significantly increased in autophagy-deficient lung cancer cells, which precedes mitochondria outer membrane permeabilization (MOMP), CYCS/cytochrome c release, and activation of CASP9/caspase-9, indicating that under such conditions the activation of CASP8 is a primary event in the initiation of apoptosis as well as essential to reduce clonogenic survival of autophagy-deficient cells. Starvation leads to suppression of CFLAR proteosynthesis and accumulation of CASP8 in SQSTM1 puncta. Overexpression of CFLARs reduces CASP8 activation and apoptosis during starvation, while its silencing promotes efficient activation of CASP8 and apoptosis in autophagy-deficient U1810 lung cancer cells even under nutrient-rich conditions. Similar to starvation, inhibition of protein translation leads to efficient activation of CASP8 and cell death in autophagy-deficient lung cancer cells. Thus, here for the first time we report that suppressed translation leads to activation of CASP8-dependent apoptosis in autophagy-deficient NSCLC cells under conditions of nutrient limitation. Our data suggest that targeting translational machinery can be beneficial for elimination of autophagy-deficient cells via the CASP8-dependent apoptotic pathway.

Three distinct 3-methylcytidine (m3C) methyltransferases modify tRNA and mRNA in mice and humans.

Chemical RNA modifications are central features of epitranscriptomics, highlighted by the discovery of modified ribonucleosides in mRNA and exemplified by the critical roles of RNA modifications in normal physiology and disease. Despite a resurgent interest in these modifications, the biochemistry of 3-methylcytidine (m3C) formation in mammalian RNAs is still poorly understood. However, the recent discovery of trm141 as the second gene responsible for m3C presence in RNA in fission yeast raises the possibility that multiple enzymes are involved in m3C formation in mammals as well. Here, we report the discovery and characterization of three distinct m3C-contributing enzymes in mice and humans. We found that methyltransferase-like (METTL) 2 and 6 contribute m3C in specific tRNAs and that METTL8 only contributes m3C to mRNA. MS analysis revealed that there is an ∼30-40% and ∼10-15% reduction, respectively, in METTL2 and -6 null-mutant cells, of m3C in total tRNA, and primer extension analysis located METTL2-modified m3C at position 32 of tRNAThr isoacceptors and tRNAArg(CCU) We also noted that METTL6 interacts with seryl-tRNA synthetase in an RNA-dependent manner, suggesting a role for METTL6 in modifying serine tRNA isoacceptors. METTL8, however, modified only mRNA, as determined by biochemical and genetic analyses in Mettl8 null-mutant mice and two human METTL8 mutant cell lines. Our findings provide the first evidence of the existence of m3C modification in mRNA, and the discovery of METTL8 as an mRNA m3C writer enzyme opens the door to future studies of other m3C epitranscriptomic reader and eraser functions.

Prevalence and Antimicrobial Resistance of Salmonella Isolates from Chicken Carcasses in Retail Markets in Yangon, Myanmar.

A cross-sectional investigation was conducted concerning prevalence, antimicrobial resistance, multidrug resistance patterns, and serovar diversity of Salmonella in chicken meat sold at retail in Yangon, Myanmar. The 141 chicken meat samples were collected at 141 retail markets in the Yangon Region, Myanmar, 1 November 2014 to 31 March 2015. Information on hygienic practices (potential risk factors) was retrieved via checklists. Salmonella was isolated and identified according to International Organization for Standardization methods (ISO 6579:2002) with minor modifications. Twelve antimicrobial agents belonging to eight pharmacological groups were used for antimicrobial susceptibility testing (disk diffusion method). Salmonella was recovered from 138 (97.9%) of the 141 samples. The isolates were most frequently resistant to trimethoprim-sulfamethoxazole (70.3% of isolates), tetracycline (54.3%), streptomycin (49.3%), and ampicillin (47.1%). Resistance was also found to chloramphenicol (29.7%), amoxicillin-clavulanic acid (17.4%), ciprofloxacin (9.4%), tobramycin (8.7%), gentamicin (8%), cefazolin (7.2%), lincomycin-spectinomycin (5.8%), and norfloxacin (0.7%). Among the 138 Salmonella isolates, 72 (52.2%) were resistant to three or more antimicrobial agents. Twenty-four serovars were identified among the 138 Salmonella-positive samples; serovars Albany, Kentucky, Braenderup, and Indiana were found in 38, 11, 10, and 8% of samples, respectively. None of the potential risk factors were significantly related to Salmonella contamination of chicken carcasses. This study provides new information regarding prevalence and antimicrobial resistance and Salmonella serovar diversity in retail markets in Yangon, Myanmar.

Influenza A(H9N2) Virus, Myanmar, 2014-2015.

Routine surveillance of influenza A virus was conducted in Myanmar during 2014-2015. Influenza A(H9N2) virus was isolated in Shan State, upper Myanmar. Whole-genome sequencing showed that H9N2 virus from Myanmar was closely related to H9N2 virus of clade 4.2.5 from China.

Suppressed translation and ULK1 degradation as potential mechanisms of autophagy limitation under prolonged starvation.

Macroautophagy/autophagy is a well-organized process of intracellular degradation, which is rapidly activated under starvation conditions. Recent data demonstrate a transcriptional upregulation of several autophagy genes as a mechanism that controls autophagy in response to starvation. Here we report that despite the significant upregulation of mRNA of the essential autophagy initiation gene ULK1, its protein level is rapidly reduced under starvation. Although both autophagic and proteasomal systems contribute to the degradation of ULK1, under prolonged nitrogen deprivation, its level was still reduced in ATG7 knockout cells, and only initially stabilized in cells treated with the lysosomal or proteasomal inhibitors. We demonstrate that under starvation, protein translation is rapidly diminished and, similar to treatments with the proteosynthesis inhibitors cycloheximide or anisomycin, is associated with a significant reduction of ULK1. Furthermore, it was found that inhibition of the mitochondrial respiratory complexes or the mitochondrial ATP synthase function that could also take place in the absence of substrates, promote upregulation of ULK1 mRNA and protein expression in an AMPK-dependent manner in U1810 lung cancer cells growing in complete culture medium. These inhibitors could also drastically increase the ULK1 protein in U1810 cells with knockout of ATG13, where the ULK1 expression is significantly diminished. However, such upregulation of ULK1 protein is negligible under starvation conditions, further signifying the contribution of translation and suggesting that transcriptional upregulation of ULK1 protein will be diminished under such conditions. Thus, we propose a model where inhibition of protein translation, together with the degradation systems, limit autophagy during starvation.

Challenges in universal coverage and utilization of insecticide-treated bed nets in migrant plantation workers in Myanmar.

BACKGROUND: High coverage of the bed nets can reduce mortality and morbidity of mosquito-borne diseases including malaria. Although the migrant workers are at high risk of malaria, there are many hidden challenges in universal coverage and utilization of the insecticide-treated nets (ITNs) in this populations. METHODS: Cross sectional study was conducted in 170 migrant workers in palm oil plantation sites in Tanintharyi Region and 175 in rubber plantation sites in Mon State. A multistage stratified cluster sampling was applied to select the participants. During household visit, face-to-face interviews using structured pre-coded, pre tested questionnaires and direct observation on installation of the bed nets was conducted. Two focus group discussions in each site were done by sample stratified purposive sampling method mainly focused on effective utilization of bed nets. RESULTS: Among them, 332 (96.2%) had a bed net and 284 (82.3%) had an ITN, while 204 (59.1%) had unused extranets. Among the ITNs users, 28.9% reported problems including insecticide smell (56.9%), dizziness (20.2%), headache (12.8%) and itchiness (9.2%). More than 75% received ITNs from health authorities and NGOs free-of-charge. More than 70% wanted to buy a net but they were unaffordable for 64% of them. On observation, only five families could show no bed net, but 80% showed 1-3 ITNs. Consistent utilization in all seasons was noted in 189 (53.1%), that was higher in palm oil plantation than rubber plantation workers (p = 0.0001) due to the nature of the work at night. Perceived malaria risk was also significantly higher ITNs consistent users than non-users (p = 0.0004) and better willingness to buy an ITN by themselves (p = 0.0005). They said that effectiveness of the ITNs was reduced after 6 months and 2-3 times washing. They wished to receive more durable smooth nets with small holes in lace. Misuses of the ITNs such as use the nets for animals and fishing, were also noted. CONCLUSION: There should be efforts to improve effective utilization of ITNs by continuous mass free distribution, durability monitoring, surveillance of insecticide resistance of the vector and behaviour change interventions in migrant plantation workers.

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 areas is provided by skilled birth attendants (SBAs), this study assessed the coverage by these health workers of all births, their adherence to service guidelines, and community opinion on the antenatal and delivery care they give in two rural health centres in Pathein Township, Ayeyarwaddy Region to identify the challenges and improve antenatal and intrapartum service delivery provided by the SBAs. METHOD: A structured questionnaire was used to interview 304 women who had infants under one year 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 were covered 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 analysis showed that interviewees aged 30 years and below (OR=0.468, P=0.046), with an education at primary level and below that of husband (OR=0.391, P=0.007) or not residing in the village of the rural/station health centre (OR=0.457, P=0.011) were significantly less likely to use SBAs. The categories of supervision, referral, and health education activities of SBAs were not in line with service guidelines. The main reasons were lack of access and community acceptance of TBAs. CONCLUSION: Heavy workload, geographical location, transportation and financial concerns were major challenges for SBAs, along with community compliance and mutual coordination. Good communication and service management skills were important to overcome these challenges.

First hominoid from the Late Miocene of the Irrawaddy Formation (Myanmar).

For over a century, a Neogene fossil mammal fauna has been known in the Irrawaddy Formation in central Myanmar. Unfortunately, the lack of accurately located fossiliferous sites and the absence of hominoid fossils have impeded paleontological studies. Here we describe the first hominoid found in Myanmar together with a Hipparion (s.l.) associated mammal fauna from Irrawaddy Formation deposits dated between 10.4 and 8.8 Ma by biochronology and magnetostratigraphy. This hominoid documents a new species of Khoratpithecus, increasing thereby the Miocene diversity of southern Asian hominoids. The composition of the associated fauna as well as stable isotope data on Hipparion (s.l.) indicate that it inhabited an evergreen forest in a C3-plant environment. Our results enlighten that late Miocene hominoids were more regionally diversified than other large mammals, pointing towards regionally-bounded evolution of the representatives of this group in Southeast Asia. The Irrawaddy Formation, with its extensive outcrops and long temporal range, has a great potential for improving our knowledge of hominoid evolution in Asia.