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.

Understanding Barriers and Facilitators of Maternal Health Care Utilization in Central Myanmar.

The study objective was to examine barriers and facilitators of maternal health services utilization in Myanmar with the highest maternal mortality ratio in Southeast Asia. Data for 258 mothers with children under five were extracted from a community health survey administered between 2016 and 2017 in Mandalay, the largest city in central Myanmar, and analyzed for associations between determinants of maternal health care choices and related outcomes. The study showed that late antenatal care was underutilized (41.7%), and antenatal care attendance was significantly associated with geographical setting, household income, education, and access to transportation (p ≤ 0.05). Less than one-third of women gave birth at home and 18.5% of them did so without the assistance of traditional birth attendants. Household education level was a significant predictor for home delivery (p < 0.01). Utilization of postnatal care services was irregular (47.9%-70.9%) and strongly associated with women's places of delivery (p < 0.01). Efforts geared towards improving maternal health outcomes should focus on supporting traditional birth attendants in their role of facilitating high-quality care and helping women reach traditional health facilities, as well as on maternal health literacy based on culturally appropriate communication.

The relationship between age and the manifestations of and mortality associated with severe malaria.

BACKGROUND: The reported case-fatality rate associated with severe malaria varies widely. Whether age is an independent risk factor is uncertain. METHODS: In a large, multicenter treatment trial conducted in Asia, the presenting manifestations and outcome of severe malaria were analyzed in relation to age. RESULTS: Among 1050 patients with severe malaria, the mortality increased stepwise, from 6.1% in children (age, <10 years) to 36.5% in patients aged >50 years (P<0.001). Compared with adults aged 21-50 years, the decreased risk of death among children (adjusted odds ratio, 0.06; 95% confidence interval, 0.01-0.23; P<0.001) and the increased risk of death among patients aged >50 years (adjusted odds ratio, 1.88; 95% confidence interval, 1.01-3.52; P<0.001) was independent of the variation in presenting manifestations. The incidence of anemia and convulsions decreased with age, whereas the incidence of hyperparasitemia, jaundice, and renal insufficiency increased with age. Coma and metabolic acidosis did not vary with age and were the strongest predictors of a fatal outcome. The number of severity signs at hospital admission also had a strong prognostic value. CONCLUSION: Presenting syndromes in severe malaria depend on age, although the incidence and the strong prognostic significance of coma and acidosis are similar at all ages. Age is an independent risk factor for a fatal outcome of the disease.