ABSTRACT
Prosocial behavior is a distinguishing characteristic of human nature. Although prosocial behaviors emerge early in development, contextual factors play an important role in how these behaviors are manifested over development. A large body of research focuses on the trajectory of prosocial development across diverse cultures and investigating contexts that foster it. Against this backdrop of developmental research endeavoring to understand and enhance the cooperative side of humanity, is the catastrophic impact of profoundly negative forces on social-emotional development for children forced to flee from violent conflict. Close to half a million Rohingya children, whose families were forced to flee genocide in Myanmar, now live in the largest refugee camp in the world. To examine the resilience of human prosociality in the face of extreme adversity, we documented initial levels of prosociality in Rohingya refugee children living in a mega-camp (Cox's Bazar, Bangladesh) and the extent to which those levels were improved following a multifaceted intervention designed to foster prosociality. The research was a partnership between Rohingya community members with lived experience, humanitarian practitioners, and developmental researchers. A sample of 152 Rohingya children (5-12 years) participated in pre- and postintervention assessments of prosocial behaviors and related cognitive-affective processes. The 10-day collaboration-based intervention was implemented between November 2021 and January 2022 by Rohingya researchers. Birthplace was used as a proxy measure of trauma level. Children born in Myanmar (N = 88) directly experienced relatively higher levels of trauma (genocide, forced migration) than children who were born in the camp after their families fled from Myanmar (N = 64). Children were individually tested pre- and postintervention with a task battery, including a helping (Origami) and two sharing tasks (Dictator Game [DG], Forced Choice sharing) measuring prosocial behavior. Assessments of related cognitive-affective processes included measures of empathic responding and emotion perspective-taking in story tasks (Imagine, Judgment) and executive function (EF) skills (Younger: Hearts & Flowers; Older: Dimensional Change Card Sorting). Small group intervention sessions conducted over 10 days targeted these prosocial behaviors and cognitive-affective processes and were based on collaborative activities, emotion perspective taking and EF skills training with the same partner throughout the intervention phase. We used latent change modeling to examine initial levels (preintervention) and intervention-related changes in these measures from pre- to postintervention. Prosocial responding was found across all measures (preintervention) and improvements (pre- to postintervention change) were apparent across most measures. Age and birthplace variables were significant predictors of initial levels and intervention-related change. Initial levels: Regarding age, older children (9-12 years) showed higher levels than younger children (5-8 years) of sharing in the Forced Choice task but lower levels in the DG. Older children also showed higher levels of empathic responding when asked to report how they would feel and respond to another person's misfortune in the Imagine task. Regarding birthplace, prior to the intervention camp-born children showed higher levels than Myanmar-born children of helping in the Origami task and reported more behavioral responses indicating how they would respond to misfortune in the Imagine task. In contrast, Myanmar-born children had higher levels of sharing in the DG and consistently chose equality over inequality in the Forced Choice sharing task, even when their partner would receive more, indicating a pattern of generosity in these children. Myanmar-born children had lower levels than camp-born children on EF measures. Intervention-related change: Regarding age, older but not younger children were more likely to increase choices for equality over inequality on the Forced Choice sharing task following the intervention. Regarding birthplace and helping, camp-born children increased behaviors that helped their partner make origami shapes themselves ("how-to" helping), whereas Myanmar-born children increased behavior that took over folding for their partner ("do-for" helping). For sharing tasks, Myanmar-born but not camp-born children increased sharing in the DG and showed an increased pattern of generosity in Forced Choice sharing task. In the Imagine story task, children born in Myanmar were more likely than those born in camp to increase empathic responding (i.e., imagining how they would feel). Children born in Myanmar showed less improvement on EF measures than children born in the camp. Taken together, these findings provide evidence that in a context of extreme adversity, Rohingya children exhibited prosociality and benefitted from a multifaceted intervention. Our research adds credence to the view that human prosociality is a fundamental characteristic of humanity that not only survives but can be enhanced in even the most adverse of childhood environments. Our multifaceted intervention, which was implemented within a collaborative social context and targeted prosocial behaviors and related cognitive-affective processes, was designed to be easily implemented within existing psychosocial support programs in refugee contexts. As the numbers of children affected by violent conflict and forced migration rise alarmingly worldwide, there is a critical need to expand research partnerships that aim to improve developmental outcomes for these millions of children.
Subject(s)
Refugees , Humans , Refugees/psychology , Child , Child, Preschool , Female , Male , Myanmar/ethnology , Bangladesh/ethnology , Social Behavior , Child Behavior , Refugee Camps , Child DevelopmentABSTRACT
BACKGROUND: Although nutrition is an essential contributor to the quality of pregnancy outcomes, little is known about the experiences and influences affecting dietary behaviors during pregnancy among migrant women, particularly those from Myanmar, the largest immigrant population in Thailand. To fill this gap, we conducted a descriptive qualitative study to explore Myanmar immigrant women's perceptions, beliefs, and information-seeking behaviors concerning nutrition and food practices during pregnancy. METHODS: We conducted focus group discussions (FGDs) with fifty Myanmar immigrant pregnant women aged 18-45 years across all trimesters, who were recruited using purposive sampling from a public tertiary hospital. The FGDs were conducted in Thai or Myanmar using semi-structured guides that probed women's pregnancy perceptions and experiences about nutrition and food patterns during pregnancy. The FGDs were audio-recorded, translated, and transcribed. Direct content analysis was used to guide the analysis through an ecological perspective framework. RESULTS: The seven FGDs with fifty women revealed four major themes involving perceptions, beliefs, and information-seeking behaviors. The qualitative results consisted of (1) a positive attitude toward better changes under difficult conditions (setting goals for infant health; uncertainty about changes); (2) beliefs about eating patterns and dietary practices during pregnancy (taboos aimed at protecting women's health and ensuring safe childbirth; taboos aimed at guaranteeing infant safety); (3) limited access to appropriate information about nutrition (unclear dietary information from healthcare providers; ease of learning from experiences in informal social networks); and (4) difficult living conditions in a non-native setting (work-related influences on dietary behaviors; lack of comprehensible language to gain food literacy). In addition, the results were highlighted across four levels of ecological perspectives. CONCLUSIONS: Immigrant pregnant women are a vulnerable population that should be treated with equity to ensure quality of life through optimal nutrition throughout pregnancy. Respectful care requires that healthcare providers develop culturally sensitive nutrition interventions to increase nutrition literacy, accessibility, and pregnancy outcomes.
Subject(s)
Emigrants and Immigrants , Focus Groups , Health Knowledge, Attitudes, Practice , Information Seeking Behavior , Qualitative Research , Humans , Female , Pregnancy , Thailand , Adult , Myanmar/ethnology , Emigrants and Immigrants/psychology , Young Adult , Adolescent , Middle Aged , Pregnant Women/psychology , Pregnant Women/ethnology , Perception , Feeding Behavior/psychology , Diet/psychology , Diet/standards , Nutritional StatusABSTRACT
BACKGROUND: Typically mobile and vulnerable, migrants face significant barriers to access to routine malaria prevention, diagnostics and treatment, which leads to unchecked malaria transmission, particularly in border regions with a high population displacement. This study aimed to investigate the demographic and socioeconomic obstacles to access to malaria services among Myanmar migrants residing in the Thailand-Myanmar border areas. METHODS: A cross-sectional study was conducted in early 2024 across three districts near the Thailand-Myanmar border. Quantitative data were collected from Myanmar migrants using standardized questionnaires through structured surveys. Data analysis included descriptive statistics and simple and multiple logistic regression models. RESULTS: Out of 300 participants, approximately a quarter (27.3%) reported adequate access to comprehensive malaria services, including prevention, diagnostics, treatment and malaria-related health information. In multiple logistic regression models, factors associated with inadequate access included Myanmar migrants aged over 60 years (aOR: 7.63, 95% CI 1.74-20.58), accompanied by one to three family members (aOR: 3.33, 95% CI 1.06-8.45), earning monthly incomes below 3000 THB (aOR: 5.13, 95% CI 1.38-19.09) and 3000 to 6000 THB (aOR: 3.64, 95% CI 1.06-12.51), belonging to the Karen ethnicity (aOR: 2.13, 95% CI 1.02-3.84), with poor perception toward malaria (aOR: 2.03, 95% CI 1.03-4.01) and with poor preventive and health-seeking practices (aOR: 5.83, 95% CI 2.71-9.55). CONCLUSIONS: A significant proportion of Myanmar migrants encounter demographic and socioeconomic barriers to access to routine malaria services in Thailand. Tailored interventions are required to expand such access, including the recruitment of worksite health volunteers, strengthening the role of ethnic health organizations across the border and collaboration with private sector stakeholders (e.g. farm/company owners) to distribute preventive tools and ensure timely referral of suspected malaria cases to health facilities.
Subject(s)
Health Services Accessibility , Malaria , Transients and Migrants , Myanmar , Thailand , Health Services Accessibility/statistics & numerical data , Cross-Sectional Studies , Malaria/prevention & control , Transients and Migrants/statistics & numerical data , Male , Female , Adult , Humans , Middle Aged , Young Adult , Socioeconomic Factors , Adolescent , AgedABSTRACT
OBJECTIVES: To understand and describe attitudes toward general health checkups, breast health knowledge, cultural beliefs, and health-promoting behaviors among Myanmar American immigrant women in the United States. SAMPLE & SETTING: 267 women participated in the study. 10 women were excluded because of missing data, so the total sample size was 257 participants. METHODS & VARIABLES: A descriptive, cross-sectional survey design was used to describe and investigate breast health perceptions and behaviors. RESULTS: Nearly 75% of the study sample reported having negative attitudes toward general health checkups and were found to have less accurate breast health knowledge and more fatalistic views about breast cancer. Only 29% of older women adhered to mammogram recommendations. Younger women reported more barriers to mammograms, and older women reported fewer barriers to mammograms. IMPLICATIONS FOR NURSING: This study demonstrated the need for additional research focusing on unique perspectives when investigating breast health practices among Myanmar American immigrant women. The findings highlight the essential need to build a strong partnership with stakeholders to combat breast health disparities and address the complex nature of acculturation.
Subject(s)
Breast Neoplasms , Emigrants and Immigrants , Health Knowledge, Attitudes, Practice , Mammography , Humans , Female , Adult , Middle Aged , Emigrants and Immigrants/psychology , Emigrants and Immigrants/statistics & numerical data , Cross-Sectional Studies , Breast Neoplasms/ethnology , Breast Neoplasms/psychology , United States , Myanmar/ethnology , Mammography/statistics & numerical data , Mammography/psychology , Aged , Health Knowledge, Attitudes, Practice/ethnology , Early Detection of Cancer/statistics & numerical data , Early Detection of Cancer/psychology , Asian/psychology , Asian/statistics & numerical data , Surveys and Questionnaires , Young Adult , Health Behavior/ethnology , Mass Screening/statistics & numerical data , Mass Screening/psychologyABSTRACT
An improved understanding of the Plasmodium vivax populations in the Great Mekong Subregion (GMS) is needed to monitor the progress of malaria elimination. This study aimed to use a P. vivax single nucleotide polymorphism (SNP) barcode to evaluate the population dynamics and explore the gene flow among P. vivax parasite populations in the western GMS (China, Myanmar and Thailand). A total of 315 P. vivax patient samples collected in 2011 and 2018 from four regions of the western GMS were genotyped for 42 SNPs using the high-throughput MassARRAY SNP genotyping technology. Population genetic analysis was conducted to estimate the genetic diversity, effective population size, and population structure among the P. vivax populations. Overall, 291 samples were successfully genotyped at 39 SNPs. A significant difference was observed in the proportion of polyclonal infections among the five P. vivax populations (P = 0.0012, Pearson Chi-square test, χ2 = 18.1), with western Myanmar having the highest proportion (96.2%, 50/52) in 2018. Likewise, the average complexity of infection was also highest in western Myanmar (1.31) and lowest in northeast Myanmar (1.01) in 2018. The older samples from western China in 2011 had the highest pairwise nucleotide diversity (π, 0.388 ± 0.046), expected heterozygosity (He, 0.363 ± 0.02), and the largest effective population size. In comparison, in the neighboring northeast Myanmar, the more recent samples in 2018 showed the lowest values (π, 0.224 ± 0.036; He, 0.220 ± 0.026). Furthermore, the 2018 northeast Myanmar parasites showed high and moderate genetic differentiation from other populations with FST values of 0.162-0.252, whereas genetic differentiation among other populations was relatively low (FST ≤ 0.059). Principal component analysis, phylogeny, and STRUCTURE analysis showed that the P. vivax population in northeast Myanmar in 2018 substantially diverged from other populations. Although the 42 SNP barcode is a valuable tool for tracking parasite origins of worldwide parasite populations, a more extended barcode with additional SNPs is needed to distinguish the more related parasite populations in the western GMS.
Subject(s)
DNA Barcoding, Taxonomic , Malaria, Vivax , Plasmodium vivax , Polymorphism, Single Nucleotide , Plasmodium vivax/genetics , Plasmodium vivax/classification , Humans , Malaria, Vivax/parasitology , Malaria, Vivax/epidemiology , Myanmar/epidemiology , Thailand/epidemiology , Genotype , China/epidemiology , Genetic Variation , Gene FlowABSTRACT
Foot-and-mouth disease (FMD) is an important endemic disease in livestock in Southeast Asia. Transboundary movement of animals may result in the transnational disease spread. A major cattle market is located at the Thailand-Myanmar border, where most cattle imported from Myanmar are traded. In this study, we built a stochastic susceptible-exposed-infectious-recovered (SEIR) model to investigate the effectiveness of a private animal quarantine service center in preventing FMDV from entering the major cattle market. We computed with different parameters and found that, with 50â¯% vaccine effectiveness, the risk of releasing infected cattle to the market per batch was generally low during the quarantine period of 21 and 28 days, with the risk ranging from 0.071 to 0.078 and 0.032 to 0.036, respectively. Despite the best scenario, the zero-risk state is difficult to attain. The sensitivity analysis highlights that the percentage of immune animals before entering the quarantine centers and the vaccine effectiveness are important factors. In conclusion, the 21-day quarantine period mitigates the risk of FMDV introduction into the cattle market. This control measure should be rigorously maintained to sustainably prevent FMDV outbreaks through transboundary animal movements, especially among countries in FMD-endemic regions.
Subject(s)
Cattle Diseases , Foot-and-Mouth Disease , Quarantine , Stochastic Processes , Animals , Cattle , Foot-and-Mouth Disease/prevention & control , Foot-and-Mouth Disease/epidemiology , Thailand/epidemiology , Cattle Diseases/prevention & control , Cattle Diseases/epidemiology , Cattle Diseases/virology , Quarantine/veterinary , Myanmar/epidemiology , Foot-and-Mouth Disease Virus/immunology , CommerceABSTRACT
Background: Despite established vaccination programs, vaccine-preventable diseases persist among about 900,000 Forcibly Displaced Myanmar Nationals (FDMN)/Rohingya refugees in the world's largest refugee settlement in Bangladesh. Health service providers (HSPs) play a key role in the delivery of childhood vaccination programs. This study explored their views on individual and context barriers and drivers to childhood vaccination in this setting. Methods: Informed by the theoretical framework of the Capability-Opportunity-Motivation-Behavior (COM-B) model for behavior change, this qualitative study collected data through eight focus group discussions (FGDs) with community health workers (CHWs) and vaccinators in selected camps with high or low vaccination coverage rates, and through 11 in-depth interviews (IDIs) with key informants working in strategic, management, and administrative roles. Findings: Barriers and drivers were evident across all COM factors for HSPs and caregivers. Among HSPs, knowledge around vaccination acted both as a barrier and driver, while communication skills and confidence in vaccination served as drivers. Caregivers' lack of awareness of vaccination, concerns and mistrust were described as main barriers. Context barriers included information system deficiencies, family dynamics, HSPs' working conditions, and vaccination site accessibility. Context drivers included effective communication, mobilization, and incentives. Differences between high and low coverage camps in Cox's Bazar included variations in HSPs' knowledge, communication strategies, incentive use, and stakeholder collaboration. Discussion: For better vaccination coverage in the camps, context-related changes regarding collaboration, health workforce and the use of incentives seem necessary. Caregivers' mistrust toward vaccination needs to be considered under the social and historical background of the Rohingya community, and further addressed with targeted communication and campaigning.
Subject(s)
Focus Groups , Qualitative Research , Refugees , Vaccination , Humans , Bangladesh , Refugees/psychology , Refugees/statistics & numerical data , Myanmar , Female , Male , Adult , Vaccination/psychology , Vaccination/statistics & numerical data , Health Personnel/psychology , Health Personnel/statistics & numerical data , Middle Aged , Health Knowledge, Attitudes, Practice , MotivationSubject(s)
Hepatitis C , Refugees , Humans , Refugees/statistics & numerical data , Hepatitis C/epidemiology , Myanmar/epidemiology , Myanmar/ethnology , Public Health , Epidemics , Male , FemaleABSTRACT
OBJECTIVE: The study aimed to explore the determinants of prenatal breastfeeding knowledge, attitudes and self-efficacy among Burmese migrant pregnant mothers in Samut Sakhon Province, Thailand. DESIGN: The data were collected as part of a baseline survey of a randomised controlled trial. SETTING AND PARTICIPANTS: A total of 198 Burmese migrant mothers between 28th and 34th weeks of gestation were recruited from the antenatal care clinic of Samut Sakhon Hospital. PRIMARY OUTCOME MEASURES: Breastfeeding knowledge, attitudes and self-efficacy RESULTS: The prevalence of good breastfeeding knowledge was 65.7% (n=130), positive attitudes towards breast feeding were 55.1% (n=109) and high breastfeeding self-efficacy was 70.7% (n=140). Multivariate logistic regression models revealed that mothers aged above 25 years (adjusted OR, AOR 3.1, 95% CI 1.2 to 7.9), being Bamar (AOR 2.3, 95% CI 1.2 to 4.4), having support from husband (AOR 2.3, 95% CI 1.2 to 4.6) and having previous childbirth experience (AOR 2.5, 95% CI 1.3 to 4.8) were the main determinants of good breastfeeding knowledge. Similarly, being Bamar (AOR 2.8, 95% CI 1.5 to 5.3), having high school education (AOR 4.3, 95% CI 1.8 to 10.1) and having access to workplace breastfeeding support (AOR 5.3, 95% CI 1.4 to 20.1) were found to be significant predictors of positive attitudes towards breast feeding. Moreover, mothers aged above 25 years (AOR 2.9, 95% CI 1.1 to 7.8), being Bamar (AOR 2.4, 95% CI 1.2 to 5.1), being unemployed (AOR 7.8, 95% CI 1.9 to 31.9), having support of husband (AOR 3.2, 95% CI 1.5 to 7.0), having previous breastfeeding experience for 6 months or more (AOR 5.0, 95% CI 2.1 to 11.7) and having intention to exclusively breastfeed (AOR 2.7, 95% CI 1.3 to 5.8) had significant associations with high breastfeeding self-efficacy. CONCLUSION: The prenatal breastfeeding knowledge, attitudes and self-efficacy among Burmese migrant mothers were influenced by many factors. A comprehensive understanding of these factors will enable policy-makers and healthcare providers to develop context-specific interventions for the promotion of exclusive breast feeding among Burmese migrant mothers in Thailand. TRIAL REGISTRATION NUMBER: TCTR20230310004.
Subject(s)
Breast Feeding , Health Knowledge, Attitudes, Practice , Self Efficacy , Transients and Migrants , Humans , Female , Breast Feeding/psychology , Breast Feeding/statistics & numerical data , Thailand , Adult , Cross-Sectional Studies , Pregnancy , Transients and Migrants/psychology , Transients and Migrants/statistics & numerical data , Myanmar/ethnology , Young Adult , Mothers/psychology , Prenatal Care/psychology , Logistic Models , Southeast Asian PeopleABSTRACT
BACKGROUND: Dengue disease is caused by dengue virus, which is transmitted by Aedes mosquitoes in tropical and subtropical regions worldwide. Although most infected individuals have benign febrile illness or no apparent symptoms, a small percentage develop severe dengue, a potentially fatal condition that occurs after a febrile stage. Many studies have identified factors predicting dengue severity among different populations and time courses. To help find practical approaches applicable in remote settings, we focused on the investigation of early factors associated with severe dengue in Thai-Myanmar cross-border region. METHODS: This retrospective case-control study was performed to determine factors contributing to severe dengue in the pediatric population. We reviewed the hospital records of patients with dengue infection aged 0-19 years who were admitted to Maesot General Hospital, situated near the Thai-Myanmar cross-border region, between 2017 and 2022. Medical data during the first 5 days of illness and outcomes were collected and analyzed. RESULTS: This study included 144 patients with a serologically confirmed diagnosis of dengue infection, with 43 severe and 101 non-severe cases. Among biological factors, being an infant and belonging to an ethnic group in Myanmar showed a significant association with severe dengue in the univariable analysis. Multivariable logistic regression revealed that the presence of mucosal bleeding (adjusted OR 5.39, 95% CI 1.06-27.52, P = 0.043), a change in hematocrit ≥ 10% (adjusted OR 3.68, 95% CI 1.15-11.74, P = 0.028), and serum albumin < 35 g/L (adjusted OR 8.10, 95% CI 2.55-25.72, P < 0.001) during the first 5 days of illness were significantly associated with developing severe dengue. CONCLUSIONS: This study supports the use of certain WHO warning signs and hematocrit change during febrile phase to predict pediatric severe dengue in low-resource settings. Potential factors such as very young age and ethnic groups warrant further exploration to identify risks contributing to severe dengue infection.
Subject(s)
Severe Dengue , Humans , Myanmar/epidemiology , Myanmar/ethnology , Retrospective Studies , Thailand/epidemiology , Infant , Male , Female , Child , Adolescent , Child, Preschool , Severe Dengue/epidemiology , Severe Dengue/diagnosis , Case-Control Studies , Risk Factors , Infant, Newborn , Young Adult , Severity of Illness Index , Southeast Asian PeopleABSTRACT
Burmese amber preserves a diverse assemblage of Cretaceous arachnids, and among pseudoscorpions (Arachnida: Pseudoscorpiones), ten species in five families have already been named. Here, we describe a new fossil species from Burmese amber in the pseudoscorpion family Hyidae, providing detailed measurements, photographs and 3D-models from synchrotron scanning. Based on morphology, the new fossil, Hya fynni sp. nov. is placed in the genus Hya, and is nearly identical to extant species in the genus, except for the position of trichobothrium est on the pedipalpal chela, thereby indicating extreme morphological stasis in this invertebrate lineage over the last 99 million years. Hya fynni represents the first described fossil species in Hyidae, and the third described Burmese fossil in the superfamily Neobisioidea. It also joins the garypinid, Amblyolpium burmiticum, in representing the oldest fossil records for extant pseudoscorpion genera. Considering proposed divergence dates, the newly described fossil species bolsters a Gondwanan origin for Hyidae, and provides evidence for the "Late Jurassic Rifting" hypothesis for the Burma Terrane, in which this landmass rifted from Gondwana in the Late Jurassic and collided with Eurasia by the Cretaceous/Eocene. Like Hya species today, H. fynni likely inhabited humicolous microhabitats in tropical forests on the Burma Terrane, supporting ecological niche stasis for this family since the Mesozoic.
Subject(s)
Amber , Arachnida , Fossils , Animals , Arachnida/classification , Arachnida/anatomy & histology , Biological Evolution , Myanmar , PhylogenyABSTRACT
Although enacted and internalized stigma is a continuing problem for people living with HIV (PLWH) in Southeast Asia, there is little understanding of how PLWH cope with discrimination, exclusion, and other negative outcomes caused by HIV-related stigmatization. This article aims to bridge this gap by analyzing the lived experiences of HIV-related stigmatization and coping strategies among 30 people with HIV in Myanmar, a country heavily influenced by religion, especially Buddhism. Among the 30 study participants, 20 were female and 10 were male, with ages ranging from 18 to 50 years. Through the lens of Bourdieu's concepts of habitus, field, and capital, this article first elucidates the various forms of stigmatization in family, work, social, and other settings as symbolic violence on people with HIV. The present article shows that spirituality serves as a perceptual and action framework for people with HIV to generate reflexivity toward their HIV infection and related stigmatization and to further engage in agentic responses. More importantly, this article demonstrates how people with HIV draw on spirituality to support peers in reclaiming control over their lives and how they are perceived by society. The findings indicate that the local context, especially cultural and religious resources, should be considered when developing interventions to mitigate HIV-related stigmatization in Southeast Asia.
Subject(s)
Adaptation, Psychological , HIV Infections , Social Stigma , Spirituality , Humans , Myanmar , Male , HIV Infections/psychology , Female , Adult , Middle Aged , Adolescent , Young Adult , Stereotyping , Social Support , Qualitative Research , Interviews as Topic , Coping SkillsABSTRACT
BACKGROUND: After the military coup in Myanmar in February 2021, the health system began to disintegrate when staff who called for the restoration of the democratic government resigned and fled to states controlled by ethnic minorities. The military retaliated by blocking the shipment of humanitarian aid, including vaccines, and attacked the ethnic states. After two years without vaccines for their children, parents urged a nurse-led civil society organization in an ethnic state to find a way to resume vaccination. The nurses developed a vaccination program, which we evaluated. METHODS: A retrospective cohort study and participatory evaluation were conducted. We interviewed the healthcare workers about vaccine acquisition, transportation, and administration and assessed compliance with WHO-recommended practices. We analyzed the participating children's characteristics. We calculated the proportion of children vaccinated before and after the program. We calculated the probability children would become up-to-date after the program using inverse survival. RESULTS: Since United Nations agencies could not assist, private donations were raised to purchase, smuggle into Myanmar, and administer five vaccines. Cold chain standards were maintained. Compliance with other WHO-recommended vaccination practices was 74%. Of the 184 participating children, 145 (79%, median age five months [IQR 6.5]) were previously unvaccinated, and 71 (41%) were internally displaced. During five monthly sessions, the probability that age-eligible zero-dose children would receive the recommended number of doses of MMR was 92% (95% confidence interval [CI] 83-100%), Penta 87% (95% CI 80%-94%); BCG 76% (95% CI 69%-83%); and OPV 68% (95% CI 59%-78%). Migration of internally displaced children and stockouts of vaccines were the primary factors responsible for decreased coverage. CONCLUSIONS: This is the first study to describe the situation, barriers, and outcomes of a childhood vaccination program in one of the many conflict-affected states since the coup in Myanmar. Even though the proportion of previously unvaccinated children was large, the program was successful. While the target population was necessarily small, the program's success led to a donor-funded expansion to 2,000 children. Without renewed efforts, the proportion of unvaccinated children in other parts of Myanmar will approach 100%.
Subject(s)
Immunization Programs , Humans , Myanmar , Retrospective Studies , Male , Pilot Projects , Female , Child, Preschool , Infant , Vaccination/statistics & numerical data , Child , Program Evaluation , Refugees/statistics & numerical data , WarfareABSTRACT
As part of a randomized controlled trial conducted in Myanmar between 2016 and 2019, we explore the performance of a maternal cash transfer program across villages assigned to different models of delivery (by government health workers vs loan agents of a non-governmental organization) and identify key factors of success. Measures include enrolment inclusion and exclusion errors, failures in payment delivery to enrolled beneficiaries (whether beneficiaries received any transfer, fraction of benefits received and whether there were delays and underpayment of benefit amounts) and whether beneficiaries remained in the program beyond eligibility. We find that women in villages where government health workers delivered cash transfers received on average two additional monthly transfers, were 19.7% more likely to receive payments on time and in-full and were 14.6% less likely to stay in the program beyond eligibility. With respect to the primary health objective of the program-child nutrition-we find that children whose mother received cash by government health workers were less likely to be chronically malnourished compared to those whose mother received cash by loan agents. Overall, the delivery of cash transfers to mothers of young children by government health workers outperforms the delivery by loan agents in rural Myanmar. Qualitative evidence suggests two key factors of success: (1) trusted presence and past interactions with targeted beneficiaries and complementarities between government health workers' expertise and the program; and (2) performance incentives based on specific health objectives along with top-down monitoring. We cannot exclude that other incentives or intrinsic motivation also played a role.
Subject(s)
Rural Population , Humans , Myanmar , Female , Adult , Mothers , Maternal Health Services/economics , Maternal Health Services/statistics & numerical dataABSTRACT
OBJECTIVES: Inequitable pregnancy care experiences and outcomes disproportionately affect refugee background women in Australia. Culturally safe care is essential for achieving health equity, however, cultural safety can only be determined by the person receiving care. To our knowledge, women of refugee background in Australia are yet to be asked what culturally safe pregnancy care is to them. Specifically, this study aimed to explore what culturally safe pregnancy care is to Karen women (from Burma) of refugee background. DESIGN: A photovoice study founded on community-based participatory research principles was undertaken with a Karen community of refugee background living in Victoria, Australia. A community advisory group was established, guiding study design and conduct. Five S'gaw Karen-speaking women with experience of pregnancy care in Australia were invited to take photos within their community. Participants shared their photos and stories with each other in four online discussion groups. RESULTS: Reflexive thematic analysis guided by a critical constructionist lens developed three themes: Building foundations for belonging; cultivating reciprocal curiosity; and storytelling as an expression of self and shared power. These themes sit within the overarching theme When I can be my whole authentic self, I feel safe and know that I belong. CONCLUSION: When Karen women can embrace their cultural and spiritual identity without fear of discrimination, including racism, culturally safe pregnancy care is possible. This study contributes to the design and delivery of maternity services by providing insights that can enhance equitable and culturally safe pregnancy care for Karen women of refugee background.
Subject(s)
Community-Based Participatory Research , Photography , Refugees , Humans , Female , Refugees/psychology , Pregnancy , Adult , Victoria , Myanmar/ethnology , Prenatal Care , Culturally Competent Care , Cultural CompetencyABSTRACT
Background: The vascular endothelial growth factor (VEGF) polymorphism is associated with preeclampsia since its abnormal expression plays an important role in vasculogenesis in placenta formation. Thus, this study is aimed at analyzing the association between VEGF +936C/T polymorphism and the risk of preeclampsia. Methods: To assess the causal relationship, a hospital-based cross-sectional analytical study was carried out among 204 Myanmar pregnant women during the period of January 2018-September 2020. For data collection, a pretested, structured questionnaire was used. Blood samples were collected after obtaining consent, and then we studied the extracted gene by using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). The Statistical Package for Social Sciences version 18.0 was used for data management and analysis. Results: The genotype CT variant among preeclamptic women was more than that of non-preeclamptic women (26.5% vs. 18.6%), but not significant (p = 0.180). The risk of preeclampsia among women with CT genotypes was 1.57 times higher than that of women with CC genotypes (OR (95%CI) = 1.57 (0.81, 3.06), p = 0.180). The minor allele frequency of the T allele was 15.2% in preeclamptic women and 9.3% in normal pregnant women. The risk of preeclampsia among T allele carriers is 1.49 times (95%CI = 0.80, 2.77) more than that of C allele carriers (p = 0.211). Among the preeclamptic pregnant women, the frequency of the CT genotype was 26.3% in the severe preeclamptic group and 26.9% in the mild preeclamptic group, while the frequency of the T allele was 13.2% and 13.5%, respectively. The frequency of either CT genotype or T allele was more or less the same in both groups, and there was no association between VEGF C/T polymorphism and the severity of preeclampsia. After logistic regression analysis on VEGF genotype and clinical parameters such as age, maternal body mass index (BMI), and neonatal birth weight, the risk of preeclampsia was 2.1 times higher in pregnant women with CT genotype compared to CC genotype (adjusted OR, 2.1; 95% CI, 0.9-4.5, p value -0.057). Conclusion: There was no significant association between VEGF +936C/T polymorphism (rs3025039) and preeclampsia among Myanmar pregnant women. However, the findings of this study highlighted that individuals carrying either the CT genotype or the T allele are at a heightened risk of developing preeclampsia. Furthermore, it suggests a potential impact of the gene on the occurrence of preeclampsia, yet the data lacks sufficient evidence to establish statistical significance.
Subject(s)
Polymorphism, Single Nucleotide , Pre-Eclampsia , Vascular Endothelial Growth Factor A , Humans , Female , Pre-Eclampsia/genetics , Pre-Eclampsia/epidemiology , Pregnancy , Myanmar , Adult , Vascular Endothelial Growth Factor A/genetics , Cross-Sectional Studies , Genotype , Genetic Predisposition to Disease , Young Adult , Gene FrequencyABSTRACT
The coordination of development efforts and ecological conservation in China's border regions is a significant challenge due to the overlap of biodiversity hotspots, ecologically fragile zones, and impoverished areas. Achieving the harmonious integration of ecological preservation and economic development relies on the fundamental assessment of ecological security (ES). However, comprehensive assessments of ES in border regions remain limited. This study introduces a new index, the multivariate ecological security index (MESI), which integrates ecosystem vigor, organization, elasticity, services and risk. Here, the MESI was utilized to assess the temporal and spatial changes in ES and its associated impact factors in the China-Myanmar border region (CMBR) from 2000 to 2020. The MESI provides a clear representation of the actual ES status in the CMBR, exhibiting a significant correlation with the eco-environmental quality index (EEQI; p < 0.01). The ES status exhibited notable spatial heterogeneity in the CMBR, consisting primarily of both relatively safe and safe levels, which accounted for approximately 85% of the total area. From 2000 to 2020, the CMBR experienced a gradual improvement in ES status, with the area experiencing an increase in the ES level accounting for 23.41% of the total area, which exceeded the proportion of the area experiencing a decrease in the ES level (4.71%). The combined impact of multiple factors exerted a greater influence on ES than did individual factors alone. Notably, human factors increasingly influenced the ES status during the study period. The results of this study provide valuable insights for ecological preservation and sustainable management in the CMBR, and the MESI can be extended to assess the ES of other regions.
Subject(s)
Biodiversity , Conservation of Natural Resources , Ecosystem , China , Myanmar , EcologyABSTRACT
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.
Subject(s)
Educational Status , Self Report , Humans , Myanmar/epidemiology , Male , Female , Cross-Sectional Studies , Adult , Adolescent , Young Adult , Middle Aged , Social Determinants of Health , Rural Population/statistics & numerical data , Health Status Disparities , Socioeconomic Factors , Health Surveys , Health Status , Urban Population/statistics & numerical data , PrevalenceABSTRACT
BACKGROUND: The Ayeyarwady Basin in Myanmar, a critical economic zone, faces severe ecological degradation due to unsustainable agricultural practices. These practices pose significant threats to human health and marine biodiversity. Environmental threats persist despite the Myanmar government's efforts to implement biodiversity protection policies. This research explores the limited compliance with environmental protection policies among farmers in the Ayeyarwady Basin and its implications for sustainable agricultural practices and ecological conservation. METHODS: This research employs an exploratory phenomenological approach, utilizing semi-structured, in-depth interviews with government officials and farmers (N = 30). The data collected were subjected to thematic analysis using Atlas 23. RESULTS: Preliminary findings reveal a gap in farmers' awareness and understanding of these policies, hindered by insufficient financing, poor communication infrastructure, and uncoordinated policy monitoring. These factors and existing unrest contribute to a top-down policy approach that neglects frontline stakeholders. The study suggests the need for clear stakeholder roles, adequate policy financing, and diverse communication strategies to effectively implement environmental policies and protect human and marine life. CONCLUSIONS: Environmental policy shortcomings in Myanmar are attributable to governmental oversight and insufficient stakeholder engagement. To mitigate pollution and safeguard river basin ecosystems, the government must delineate stakeholder responsibilities, allocate appropriate policy funding, and adopt varied communication approaches with farmers.