Arsenic and heavy metal contents in white rice samples from rainfed paddy fields in Yangon division, Myanmar-Natural background levels?

The presence of potentially toxic metal(loid)s (As, Pb, Cd, Cr, Mn, Fe, Zn, Cu, Ni, Mo and Co) in 120 white (polished) rice grains (Oryza sativa; 2017 or earlier crop) purchased from farmers in the five most agriculturally active townships near Yangon in the eastern edge on Ayeyarwady Delta was determined by triple quadrupole inductively coupled plasma mass spectrometry (ICP-QQQ). Their total-As and Ni concentrations (0.16 mg/kg, 0.39 mg/kg) were around the worldwide average literature values from a heavy metal non-contaminated area of intermediate to acidic (non-mafic) composition. Their Pb, Cd, and Cr mean concentrations (0.010, 0.0056, and 0.056 mg/kg, respectively) were lower than the maximum allowable levels by over one magnitude, reaching the concentration ranges comparable to the lowest level in the literature values. This study's natural background levels were explained by a negligible influence of human, mining and industrial activities in this area, and probably genotype effect, which remains to be examined by the associated paddy soil analysis. Health risks associated with rice consumption (ca. 0.5 kg/day) by the inhabitants were estimated, assuming that inorganic arsenic was 30% of the total. Arsenic was the main contributor (30%) to the total value of the non-cancer risk (HI) of each element, which was 4.5 times the reference value (< 1), followed by Mn, Zn, Cu, Mo, Co and Ni (15-7%) and Pb, Cd, Cr and Fe (below 4%). The total cancer risk (TCR) for each element was around 17 times higher than the upper limit of cancer risk for an environmental carcinogen (< 0.0001): Nickel accounts for two-thirds of the contribution (66%), followed by Cd (16%) and As (13%). This study suggests that consumers of Yangon rice from paddy fields without groundwater irrigation may need to be concerned about the potential risk of Ni intake besides arsenic.

Evolution of the health sector response to HIV in Myanmar: progress, challenges and the way forward.

Critical building blocks for the response to HIV were made until 2012 despite a series of political, social and financial challenges. A rapid increase of HIV service coverage was observed from 2012 to 2015 through collaborative efforts of government and non-governmental organisations (NGOs). Government facilities, in particular, demonstrated their capacity to expand services for antiretroviral therapy (ART), prevention of mother-to-child transmission (PMTCT) of HIV, tuberculosis and HIV co-infection and methadone-maintenance therapy (MMT). After nearly three decades into the response to HIV, Myanmar has adopted strategies to provide the right interventions to the right people in the right places to maximise impact and cost efficiency. In particular, the country is now using strategic information to classify areas into high-, medium- and low-HIV burden and risk of new infections for geographical prioritisation - as HIV remains concentrated among key population (KP) groups in specific geographical areas. Ways forward include: •Addressing structural barriers for KP to access services, and identifying and targeting KPs at higher risk;•Strengthening the network of public facilities, NGOs and general practitioners and introducing a case management approach to assist KPs and other clients with unknown HIV status, HIV-negative clients and newly diagnosed clients to access the health services across the continuum to increase the number of people testing for HIV and to reduce loss to follow-up in both prevention and treatment;•Increasing the availability of HIV testing and counselling services for KPs, clients of female sex workers (FSW), and other populations at risk, and raising the demand for timely testing including expansion of outreach and client-initiated voluntary counselling and testing (VCT) services;•Monitoring and maximising retention from HIV diagnosis to ART initiation and expanding quality HIV laboratory services, especially viral load;•Prioritising integration of HIV and related services in high-burden areas;•Increasing the proportion of PLHIV receiving testing and treatment at public facilities by improving human resources and increasing public facilities providing these services to ensure sustainability;•Obtaining intelligence and tailoring services in hard-to-reach/under-served areas;•Strengthening planning, monitoring, and coordination capacity especially at regional levels.