Educational inequalities and self-reported health among men and women aged 18-49 years in Yangon Region, Myanmar: analysis of a population-based, cross-sectional study.

OBJECTIVES: To estimate the prevalence of good self-reported health (SRH) in subpopulations based on the social determinants of health and to investigate the association between education (measured in years of schooling) and good SRH among men and women aged 18-49 years in Yangon Region, Myanmar. DESIGN: Analysis of data from a population-based, cross-sectional study conducted in Yangon, Myanmar, from October to November 2016. A multistage sampling procedure was employed, and structured face-to-face interviews were conducted with standardised questions adapted from the Myanmar Demographic and Health Survey. Prevalence ratios (PRs) with 95% CIs were estimated using Poisson regression analyses by sex. SETTING: Urban and rural areas of Yangon Region, Myanmar. PARTICIPANTS: The sample included 2,506 participants (91.8% response rate) aged 18-49 years and excluded nuns, monks, soldiers, institutionalised people and individuals deemed too ill physically and/or mentally to participate. RESULTS: The prevalence of good SRH was 61.2% (95% CI 59.3 to 63.1), with higher rates among men (72.0%, 95% CI 69.3 to 74.5), younger individuals (69.2%, 95% CI 66.2 to 72.1), urban residents (63.6%, 95% CI 60.8 to 66.3), extended family dwellers (66.6%, 95% CI 63.7 to 69.4) and those with a higher level of education (66.0%, 95% CI 61.3 to 70.5). After adjusting for confounders (age and area of residence), the association between years of schooling and SRH (PR) was 1.01 (95% CI 1.01 to 1.02, p=0.002) in men and 1.01 (95% CI 0.99 to 1.02, p=0.415) in women. CONCLUSIONS: Good SRH was more prevalent among men than among women. Additionally, a 1-year increase in education was associated with a 1% increase in the prevalence of good SRH among men, whereas the association was not statistically significant among women. In order to enhance the educational benefits of health in Myanmar, we recommend a higher focus on the length of education and addressing gender inequalities in wage return from education.

Prevalence and social determinants of depression: A cross-sectional survey of Myanmar migrant workers in Chiang Mai, Northern Thailand.

BACKGROUND: Depression is a common mental disorder and the sixth leading cause of disability in Thailand. Chiang Mai has historically been a city of attraction for labour migration for Shan migrants from the adjacent Southern Shan State of Myanmar. Currently, only infectious diseases are screened during the pre-employment period. Prevention and early detection of noncommunicable diseases can improve a healthy workforce and reduce the healthcare burden on the host country. Therefore, we aimed to determine the prevalence of depression and associated factors. METHODS: A cross-sectional survey was done among Myanmar migrant adults legally working in Chiang Mai, Thailand. RESULTS: The final analysis included 360 participants and the prevalence of depression was 14.4%. Being female, duration of stay in Thailand of more than 10 years, co-residence with co-workers, and marginalisation pattern of acculturation were significant associated factors affecting depression in a multivariate regression analysis model. CONCLUSION: Although the culture and dialect were not different between the host and country of origin, Myanmar migrant workers of Shan ethnicity suffered from depression. Our findings highlighted the importance of social determinants beyond common predictors of depression among migrants and the need for public health measures to promote migrants' integration into the host culture.

Socioeconomic inequalities in skilled attendance at birth and caesarean section rates in Myanmar 2015-2016: a cross-sectional study.

OBJECTIVES: This study aims to assess inequalities in skilled birth attendance and utilisation of caesarean section (CS) in Myanmar. STUDY DESIGN: Cross-sectional study design. SETTING AND POPULATION: We used secondary data from the Myanmar Demographic and Health Survey (2015-2016). Our outcome measures of skilled birth attendance and utilisation of CS were taken from the most recent birth of interviewed women. Absolute and relative inequalities across several sociodemographic characteristics were assessed and evaluated by calculating rate differences, rate ratio and concentration indexes. RESULTS: More than one-third (36%, 95% CI 32.5% to 39.4%) of women gave birth without a skilled birth attendant present at their most recent birth. 40.7% (95% CI 37.8% to 43.7%) gave birth in healthcare facilities, and the CS rate was 19.7% (95% CI 17.9% to 21.8%) for their most recent birth. The highest proportion of birth without a skilled provider was found in the hilly regions and rural residents, poorest and less educated women, and those with less than four antenatal care visits. Inequalities in birth without a skilled provider were observed across regions, place of residence, wealth quintile, education level and number of antenatal care taken. The highest rate of CS was found among plain regions and urban residents, richest women, more than secondary education, those with more than four antenatal care visits and in private health facilities. Inequalities in CS utilisation were observed across place of residence, wealth quintiles, education level, number of antenatal care taken and type of health facilities. CONCLUSION: This study provides evidence regarding inequalities in maternal health service utilisation in Myanmar. Increasing maternal health service availability and accessibility, promoting quality of care and health education campaigns to increase maternal health services utilisation are recommended.

Socioeconomic, behavioral, and psychological factors related to oral health in Myanmar: A cross-sectional study.

OBJECTIVES: This study aims to evaluate the effects of socioeconomic, behavioral, and psychological factors on oral health status and oral health-related quality of life in Myanmar adults. METHODS: Data were from a convenience sample of Myanmar adults who are from a township health center in Yangon city. Face-to-face interviews using a paper-based questionnaire in the Myanmar language and clinical oral examinations were performed at the health center. Mann-Whitney U test and linear regressions were used to assess the association of socio-demographic, behavioral, and psychological variables with oral health outcomes. RESULTS: In socio-demographic variables, significant associations were observed in individual income with periodontal pocket and OHIP-14, and history of COVID-19 infection with OHIP-14. However, there were no associations between behavioral factors and oral health outcomes. After adjustment for sex, age, educational level, and individual income, the depression subscale was statistically significant with the number of present teeth, decayed teeth, decayed, missing, and filled teeth, and OHIP-14. The anxiety subscale remained significant with periodontal pocket, but no stress subscale was associated with oral health outcomes. CONCLUSION: The experiences of oral health status were high, and the oral health-related quality of life was unfavorable in Myanmar adults. A large proportion of them suffers from psychological distress. Additionally, individuals with lower income and who experienced a history of COVID-19 infection were susceptible to poor oral health-related quality of life. Psychological distress indicates a higher risk for oral health problems in Myanmar adults.

The assessment of geriatric malnutrition, geriatric depression and associated co-morbidities among forcibly displaced Myanmar nationals in Bangladesh.

OBJECTIVE: To assess the nutritional status and depression of the elderly forcibly displaced Myanmar nationals (FDMN) in Bangladesh and determine the associated factors of geriatric depression (GD). DESIGN: This was a community-based, cross-sectional study among elderly FDMN. The Mini Nutritional Assessment Short-Form (MNA@-SF) and Geriatric Depression Scale Short-Form (GDS-15 SF) were used to determine malnutrition and GD, respectively. SETTING: The study was conducted between November 2021 and March 2022 in Kutupalong Refugee Camp, Cox's Bazar, Bangladesh. PARTICIPANTS: The study participants were elderly FDMN aged ≥ 60 years (n 430). RESULTS: The mean age and BMI were 71·7(±7·8) years and 21·94(±2·6) kg/m2, respectively. There was a high prevalence of self-reported diabetes mellitus (32·1 %), hypertension (26·7 %), hypotension (20 %), skin diseases (28·4 %) and chronic obstructive pulmonary disease (16·5 %). The prevalence of malnutrition was 25·3 %, and another 29·1 % were at risk. The prevalence of GD was 57·9 %, and co-occurrences of GD and malnutrition were seen in 17·5 % of participants. GD was significantly higher among elderly people with malnutrition (adjusted OR, AOR = 1·71, 95 % CI: 1·01, 2·89). FDMN aged ≥ 80 years were at higher risk of GD (AOR = 1·84, 95 % CI: 1·01, 3·37), and having fewer than five members in the household was an independent predictor of GD. Diabetes mellitus (AOR = 1·95, 95 % CI: 1·24, 3·08) and hypotension (AOR = 2·17, 95 % CI: 1·25, 2·78) were also significantly associated with an increased risk of GD. CONCLUSION: A high prevalence of GD and malnutrition was observed among elderly FDMN in Bangladesh. The agencies working in Cox's Bazar should focus on geriatric malnutrition and GD for the improvement of the health situation of FDMN in Bangladesh.

Socio-economic and agricultural factors associated with stunting of under 5-year children: findings from surveys in mountains, dry zone and delta regions of rural Myanmar (2016-2017).

OBJECTIVE: The study's objective was to investigate multiple underlying social, economic and agricultural determinants of stunting among under-five children in three distinct ecological areas in rural Myanmar. DESIGN: Repeated cross-sectional surveys in three states of Myanmar. SETTING: Rural households in Chin (mountainous), Magway (plains) and Ayeyarwady (delta). PARTICIPANTS: From two purposively selected adjacent townships in each state, we randomly selected twenty villages and, in each village, thirty households with under-five children. Households in the first survey in 2016 were revisited in late 2017 to capture seasonal variations. RESULTS: Stunting increased from 40·4 % to 42·0 %, with the highest stunting prevalence in Chin state (62·4%). Univariate Poisson regression showed factors contributing to child stunting varied across the regions. Adjusted Poisson regression models showed that child's age and short maternal stature (aRR = 1·14 for Chin, aRR = 1·89 for Magway and aRR = 1·86 for Ayeyarwady) were consistently associated with child stunting across three areas. For Chin, village-level indicators such as crop consumption (aRR = 1·18), crop diversity (aRR = 0·82) and land ownership (aRR = 0·89) were significantly associated with stunting. In Magway, the number of household members (aRR = 1·92), wealth status (aRR = 0·46), food security status (aRR = 1·14), land ownership (aRR = 0·85) and in Ayeyarwady, women's decision-making (aRR = 0·67) and indicators related to hygiene (aRR = 1·13) and sanitation (aRR = 1·45) were associated with stunting. CONCLUSIONS: Area-specific factors were associated with stunting. Maternal short stature and child age were consistent determinants of stunting. A multi-sectoral local approach, including improvements in transport, is needed to address the intergenerational malnutrition problem.

Associations between socioeconomic status and adherence to hypertension treatment among older adults in urban and rural areas in Myanmar: a cross-sectional study using baseline data from the JAGES in Myanmar prospective cohort study.

OBJECTIVES: This study aims to investigate whether there is a differential association between socioeconomic status (SES) and adherence to hypertension medication among older adults in rural and urban areas in Myanmar and assess what type of SES is associated with a difference. DESIGN: Cross-sectional study using baseline data from the Japan Gerontological Evaluation Study in Myanmar prospective cohort study. A multistage random sampling method was applied in each region. SETTING: An urban and a rural area in Myanmar. PARTICIPANTS: A total of 1200 older adults over 60 years old in Myanmar were randomly selected in 2018 (600 each from rural and urban areas). Of them, 573 had hypertension and were eligible for the analysis (urban: 317, rural: 256). OUTCOME: Adherence to hypertension medication (yes/no) is the outcome of interest. Three types of SES (wealth, education and current employment status) were the independent variables. RESULTS: We found that 21.5% of urban residents and 48.4% of rural residents were non-adherent in the study population. Poisson regression modelling stratified by area was performed to estimate the prevalence ratios (PRs) of not following treatment instructions. Demographic information and complications of hypertension were adjusted for in all models as possible confounders. In terms of SES, middle level of wealth compared with low level was significantly associated with poor adherence (PR 2.68, 95% CI 1.28 to 5.59) in the urban area, but education and employment status did not show similar associations. Lower education compared with middle/high school or higher was significantly associated with poor adherence in the rural area (no school: PR 3.22, 1.37-7.58; monastic: 3.42, 1.16-5.07; primary school: 2.41, 1.18-4.95), but wealth and income did not show similar associations. CONCLUSIONS: SES and adherence to hypertension medication were differently associated among older adults in rural and urban areas in Myanmar. To ensure healthcare access to hypertension treatment for every citizen, the differential association between SES and adherence in urban/rural areas needs to be recognised.

The Lived Experience of COVID-19 Survivors During the Third Wave of the Pandemic and the Political Crisis in Myanmar: A Qualitative Study.

When the third wave of the COVID-19 epidemic broke out, the double burden of the pandemic and political instability meant that people in Myanmar did not have access to adequate hospital care. The aim of this study was to explore the lived experience of COVID-19 survivors in the community. A qualitative, descriptive, phenomenological approach was used, and participants were selected through purposive sampling. Fifteen individuals described their experiences using four themes and 17 categories. The main themes were the aggressive natures of the pandemic, suffering from the disease, receiving vital support for survival, and the hardships due to political pressure. The pandemic and subsequent waves of different variants should not be underestimated, and people's health should take priority over economic development and political crisis. Knowledge and practices of family members and society should be promoted by providing timely and comprehensive information regarding pandemic diseases.

Treatment success among Myanmar migrants with TB in Thailand.

SETTING: Two facilities, one providing clinic-based care and another providing residential care to Myanmar migrants with TB, in a Thailand-Myanmar border area.OBJECTIVE: To determine the effects of health insurance, total delay and the model of care on treatment success of TB.METHODS: A prospective study was conducted among adult Myanmar migrants under treatment for newly diagnosed TB. Effects of health insurance, total delay and model of care on treatment success at completion of 6-month treatment were analysed using multiple logistic regression models.RESULTS: Of 191 Myanmar migrants with TB, 167 (87.4%) had treatment success. Median time delays from symptom onset to treatment initiation among migrants with health insurance receiving clinic-based care were significantly shorter than those without health insurance. Those who received residential care had higher odds of treatment success than those under clinic-based care (aOR 6.0, 95% CI 1.5-23.3); having health insurance (aOR 1.0, 95% CI 0.3-2.9) and total delay (aOR 1.7, 95% CI 0.7-4.2) were not significantly associated with treatment success.CONCLUSIONS: A high treatment success rate was associated with receiving residential care among Myanmar migrants with TB on the Thai-Myanmar border. The residential care model, implemented under a non-governmental organisation, was feasible and effective for the migrant population.

Economic burden on people living with HIV who attend self-help groups in Yangon, Myanmar.

This study aims to determine economic burden or cost of human immunodeficiency virus (HIV) and its consequences from patient perspective and to examine factors influencing the cost. This is a prevalence-based cost-of-illness (COI) study. A cross-sectional survey was carried out in Yangon, Myanmar during March and April 2018. Face-to-face structured interview was conducted among 264 people living with HIV (PLHIV) who were members of the selected four self-help groups (SHGs) that provided HIV peer support. Micro-costing approach was adopted for the cost calculation. Direct medical cost, direct non-medical cost and indirect cost were considered. Cost of HIV per patient in the year 2017 was estimated at 228.2 international dollar (Int$). Direct medical cost was only small portion of the total cost (5.6%). Indirect cost or cost of time loss was the largest contributor among the cost components, accounted for 61.2% of the total cost. First year of the antiretroviral therapy (ART) initiation and second line drug regimen have positive effect on the costs. HIV resulted in substantial economic burden for the patients. Effective interventions aim at reducing the economic burden on patients by providing compensation on transportation cost and providing job opportunity are essential. Further researchers examining cost from provider and societal perspectives are warranted to provide complete picture of the economic burden of HIV in Myanmar.

How Economic Analysis Increases the Awareness of Clinical Services: A Case of Diabetes Mellitus at a Teaching Hospital in Myanmar.

OBJECTIVES: Myanmar faces a growing epidemic of type 2 diabetes mellitus, which has significant impact on the individual health and health service system; nevertheless, reliable cost estimate for treating diabetes is still unknown. Therefore, this study aimed to explore the treatment cost of hospitalization by type 2 diabetes mellitus and the association of complications and comorbidities with the treatment cost. METHODS: The retrospective incidence-based cost of illness analysis was performed at the diabetes ward of 800-bed teaching hospital in Yangon, Myanmar. The data were retrieved from hospital financial reports and patient's medical records for the fiscal year 2017 to 2018. Data was analyzed by using descriptive statistics and multivariate statistics. One-way sensitivity analysis was used to assess the uncertainty of input parameters. RESULTS: This study involved 87 inpatients with type 2 diabetes mellitus with an average length of stay of 16.1 ± 12.6 days. Of the study sample, 67% had complications whereas 74% had comorbidities. The average treatment cost per admission was $718.7 (equal to 58% of gross domestic product - GDP per capita) at 2018 prices. Based on the multiple regression analysis, cost savings per admission were $276.5, $307.3, and $319.5 from preventing foot ulcer, nephropathy, and retinopathy, respectively. CONCLUSIONS: This study found that the treatment of diabetes is costly because of its preventable health consequences. Better disease management to prevent complications results in considerable cost savings. This quantitative evidence would increase awareness in health service system.

Cost estimates of COVID-19 clinical management in Myanmar.

OBJECTIVE: This study aims to estimate the cost of clinical management of COVID-19 infected patients based on their severity by exploring the resources used in health care provision in Myanmar. METHODS: A multicenter retrospective cost analysis of COVID-19 patients was performed using the micro-costing approach from the perspective of the health system. It covered two cost components, namely direct and indirect cost of treating a patient. Input data and their quantities were obtained from COVID-19 Standard Treatment Guidelines of Ministry of Health and Sports, and administrative and financial records of resource utilization of three designated health facilities in Yangon Region. Valuation of these resources was based on the price list from the Procurement Section of the Ministry. RESULTS: This study estimated the unit cost of clinical management of COVID-19 infected patients with no symptom to be 953,552 MMK(717 USD), with mild-moderate symptoms to be 1,155,222 MMK(869 USD) and with severe-critically ill conditions to be 5,705,052 MMK(4290 USD). Average cost for a patient par day was 86,687 MMK(65 USD) for asymptomatic patients, 105,020 MMK(79 USD) for mild-moderate patients and 283,252 MMK(214 USD) for severe-critically ill patients. Since the first case detected till December 31, 2020, COVID-19 clinical management cost was accounted for 139 Billion MMK (104 Million USD) for total 124,630 confirmed cases. CONCLUSIONS: COVID-19 pandemic has caused health systems to incur the significant health care expenses. Timely implementation of the sustainable, affordable and efficient policy for COVID-19 responses is of utmost important for every nation especially in the face of a pandemic. This study provides the fundamental inputs for strategic planning, for future economic evaluations of different policy interventions, and policy recommendations for health systems to remain resilient during and after the COVID-19 pandemic in Myanmar.

Transdisciplinary Online Health Assessment of an Artisanal and Small-Scale Gold Mining Community during the COVID-19 Pandemic in the Mandalay Region of Myanmar.

Artisanal and small-scale gold mining (ASGM) has a known negative effect on the community's health; therefore, assessment to monitor community health is essential to detect any issues and enable early treatment. Because ASGM-related health issues are complex and cannot be addressed effectively with a traditional one-time health assessment alone, both long-term and regular health assessments using a transdisciplinary approach should be considered. In response to this need, we designed an online health assessment tool as a reference for a future long-term health assessment system. An online video interview was conducted with 54 respondents living in the ASGM area of Chaung Gyi Village, Thabeikkyin Township, Mandalay Region, Myanmar, via a social networking service application. The tool was used to evaluate community health during the coronavirus 2019 pandemic, including mercury intoxication symptoms, mining-related diseases, and other diseases. Results show that persons working in mining versus non-mining occupations had a greater prevalence of pulmonary diseases, such as pulmonary tuberculosis, silicosis, and bronchial asthma, in addition to malaria. Based on these findings, online health assessment using a transdisciplinary approach can be recommended as an effective tool for sustainable and long-term health assessment of ASGM-related disease and should be performed regularly following physical health surveys.

Related health risk assessment of exposure to arsenic and some heavy metals in gold mines in Banmauk Township, Myanmar.

Exposure to heavy metals in mining activities is a health issue among miners. This study was carried out at three small-scale gold mining sites situated in Banmauk Township, Myanmar and aims to assess the occupational health risks of small-scale gold miners who are exposed to arsenic (As), cadmium (Cd), mercury (Hg) and lead (Pb) in the soil through the dermal route. Soil samples were analyzed through atomic absorption spectroscopy (AAS). The concentrations of the heavy metals in soils found As, ranged 1.04 mg/kg to 22.17 mg/kg, 0.13 mg/kg to 3.07 mg/kg for Cd, 0.15 mg/kg to 77.44 mg/kg for Hg, and 7.67 mg/kg to 210.00 mg/kg for Pb. In this study, 79% of the participants did not use any form of personal protective equipment (PPE) while working in gold mining processes. Regarding noncancer risk assessment, the results found all hazard quotient were lower than acceptable level (HQ < 1). In addition, all hazard index (HI) was lover than 1, the highest HI was found as 5.66 × 10-1 in the amalgamation process. On the other hand, the result found cancer risk ranged from 8.02 × 10-8 to 1.75 × 10-6, and the estimated cancer risks for 9 years ranged from 4.78 × 10-7 to 1.04 × 10-5. Therefore, the cancer risks of the miners were greater than the United State Environmental Protection Agency (U.S. EPA) acceptable cancer risk level, 1 × 10-6, and the miners may be at risk of developing carcinogenic diseases. The suggestion is to educate miners about the health risks of heavy metals and to encourage the use of proper PPE all the time while working in gold mine.

Internal Migration as a Social Determinant of Occupational Health and WASH Access in Myanmar.

Background: Migration is at an all-time high worldwide, and despite increased focus on international migrants, there is little evidence about internal migrants' exposures to socioeconomic, occupational, and environmental risk factors in low-and middle-income countries. Objective: The aim of this study was to examine differences in occupational health and access to water, sanitation, and hygiene (WASH) between internal migrants and non-migrants. Methods: A face-to-face survey (n = 937) was conducted in Mandalay, Myanmar. Bivariate and multivariate analysis included traditional social determinants such as education, income, occupation, gender, age, and location in addition to internal migration status. Findings: The majority of internal migrants (23% of the total sample) were labor migrants (67.3%), and while common social determinants (e.g., household income, education, and gender) were not statistically different between migrants and non-migrants, these groups reported different occupational profiles (p < 0.001). Migrants had higher odds of being street vendors (AOR = 2.26; 95% CI 1.33-3.85; p = 0.003) and were less likely to work labor jobs such as in factories or construction (AOR = 0.44; 95% CI 0.19-1.00; p = 0.051) when controlling for age, gender, education, and location. Internal migrants had significantly greater probabilities of experiencing some injuries and illness symptoms, such as cuts, vomiting, coughing, heatstroke, and diarrhea at work (p < 0.001). Compared to non-migrants, migrants' households were approximately three times more likely (AOR = 3.45; 95% CI 2.17-5.62; p < 0.001) to have an unimproved source of drinking water and twice as likely (AOR = 1.98; 95% CI 1.10-3.58; p < 0.05) to have unimproved sanitation facilities in their homes. Conclusions: The results underscore the importance of considering internal migration as an aspect of social determinants analyses, and the need for targeting appropriate WASH interventions to address inequities.

Health problems and utilization of health services among Forcibly Displaced Myanmar Nationals in Bangladesh.

BACKGROUND: Access to and utilization of health services have remained major challenges for people living in low- and middle-income countries, especially for those living in impaired public health environment such as refugee camps and temporary settlements. This study presents health problems and utilization of health services among Forcibly Displaced Myanmar Nationals (FDMNs) living in the southern part of Bangladesh. METHODS: A mixed-method (quantitative and qualitative) approach was used. Altogether 999 household surveys were conducted among the FDMNs living in makeshift/temporary settlements and host communities. We used a grounded theory approach involving in-depth interviews (IDIs), focus group discussions (FGDs), and key informant interviews (KIIs) including 24 IDIs, 10 FGDs, and 9 KIIs. The quantitative data were analysed with STATA. RESULTS: The common health problems among the women were pregnancy and childbirth-related complications and violence against women. Among the children, fever, diarrhoea, common cold and malaria were frequently observed health problems. Poor general health, HIV/AIDS, insecurity, discrimination, and lack of employment opportunity were common problems for men. Further, 61.2% women received two or more antenatal care (ANC) visits during their last pregnancy, while 28.9% did not receive any ANC visit. The majority of the last births took place at home (85.2%) assisted by traditional birth attendants (78.9%), a third (29.3%) of whom suffered pregnancy- and childbirth-related complications. The clinics run by the non-governmental organizations (NGOs) (76.9%) and private health facilities (86.0%) were the most accessible places for seeking healthcare for the FDMNs living in the makeshift settlements. All participants heard about HIV/AIDS. 78.0% of them were unaware about the means of HIV transmission, and family planning methods were poorly used (45.2%). CONCLUSIONS: Overall, the health of FDMNs living in the southern part of Bangladesh is poor and they have inadequate access to and utilization of health services to address the health problems and associated factors. Existing essential health and nutrition support programs need to be culturally appropriate and adopt an integrated approach to encourage men's participation to improve utilization of health and family planning services, address issues of gender inequity, gender-based violence, and improve women empowerment and overall health outcomes.

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.

Role of the Global Fund in national HIV/AIDS response in Myanmar: a qualitative study.

BACKGROUND: The Global Fund has been a major funding source for HIV/AIDS programs in Myanmar. In this qualitative study, we aim to understand the impact of Global Fund on national HIV/AIDS response in Myanmar during the era of Millennium Development Goals (MDGs). METHODS: We conducted individual in-depth interviews by recruiting key informants through purposive snowball sampling. The respondents were engaged in the national/subnational response to HIV/AIDS in Myanmar and worked for the United Nations agencies, non-governmental organizations (NGOs), and civil society. Interview questions were organized around the role of Global Fund in strengthening national response to HIV/AIDS in the six building blocks of the Myanmar's health system. Transcripts from the key informants were synthesized into specific themes through a deductive approach. RESULTS: We found that the Global Fund has provided substantial support to (1) finance the national HIV/AIDS response in Myanmar, and (2) strengthen leadership and governance at the central level through improving coordination and collaboration, including more stakeholders (e.g. civil society, NGOs) in decision making process, and catalyzing policy changes on scaling-up key interventions. Yet, its role remains limited in addressing new demands at the township level in terms of capacity building, staffing, and medical supply resulting from rapid scale-up of HIV interventions and decentralization of service delivery in the public sector. CONCLUSION: There was a missed opportunity for Myanmar to capitalize on the use of the Global Fund's funding to strengthen the health system. Deliberate planning is required to optimize the use of those scarce resources to provide universal coverage for HIV/AIDS.

Case Study of Tobacco Use among Myanmar Migrant Factory Workers in the Seafood Industry in Thailand.

Migrant workers commonly face many health disparities when they relocate to a foreign work environment. Many workers migrating to Thailand are young unskilled workers from Myanmar. In this study, we examine factors associated with Myanmar migrant workers' smoking status and characterized smoking-related knowledge, attitudes, and behavior in one seafood factory in Thailand. This descriptive study utilized person-to-person interviews among 300 Myanmar migrants in one seafood factory in Thailand, of which 94.3% were young males between 18 and 39 years of age. Results demonstrated that 90% were current daily smokers, over 90% smoked 30-60 times per month, and 95% spent less than 500 baht (US $16) per month on smoking. About 70% of current smokers had 6-10 friends who smoked, compared with 40% of non-smokers (chi-square, p-value ≤ 0.07). Among this sample of mainly male migrant workers, smoking is very common, in part driven through social contact, but levels of dependence appear relatively low. The results suggest potential intervention approaches to reduce high smoking prevalence among this population, such as targeting young males and addressing their concerns about negative attitudes by peers to tobacco use and the unhealthful exposures of women and children in their families and the larger community.