RESUMO
Snakebite is a neglected public health issue, with many scientific and medical issues to be solved. Cobras are among the most common venomous snakes in Myanmar and are responsible for a considerable number of severe snakebite envenoming. There are three species of cobra (Naja kaouthia, Naja mandalayensis and Ophiophagus hannah) in Myanmar. The study aims to characterize the N. kaouthia and N. mandalayensis venoms and to investigate the efficacy of anti-cobra antivenom (BPI) against the two venoms. Protein components and fibrinogenolytic activity were determined by SDS-PAGE. Enzymatic activities for PLA2, protease and acetylcholinesterase were determined by spectrophotometric method. Anticoagulant activity was determined by recalcification time of citrated human plasma. Myotoxicity, necrotizing activity, median lethal dose (LD50) and median effective dose (ED50) were determined by WHO recommended methods. The SDS-PAGE displayed the proteins and enzymes containing in two venoms were different. N. kaouthia venom exhibited more in PLA2, acetylcholinesterase, anticoagulant, fibrinogenolytic and necrotizing activities than N. mandalayensis venom. N. mandalayensis venom had more protease activity and myotoxicity than N. kaouthia venom. The median lethal dose (LD50) of N. kaouthia and N. mandalayensis venom was 4.33 µg/mouse and 5.04 µg/mouse respectively. Both venoms induced fibrinogen Aα chain degradation in 30 min (N. kaouthia) and in 6 h (N. mandalayensis). The same median effective dose (ED50) (19.56 µg/mouse) showed that anti-NK antivenom can neutralize against lethal effect of N. mandalayensis venom. It can also neutralize the protease activity, anticoagulant activity and fibrinogenolytic activity of both venoms. Immunodiffusion and immunoblotting studies showed that the antivenom recognized its homologous venom (N. kaouthia) and cross-reacted against the heterologous venom (N. mandalayensis). The anti-NK antivenom is suitable to use for N. mandalayensis bite if monospecific antivenom is not available.
RESUMO
Childhood undernutrition is a major public health challenge in Myanmar. To reduce the prevalence of childhood undernutrition in Myanmar, it is important to understand the social determinants of under-5 undernutrition. This review aimed to identify the social determinants of undernutrition in under-5 children in rural areas of Myanmar. A systematic search strategy was conducted through databases- Medline (Ovid), PubMed, SCOPUS, ProQuest Central, Web of science, and POPLINE. The grey literatures from relevant websites were also searched. Keywords were identified and used to search the literature published from 2007 to 2020 in English. Thematic analysis was performed. Twenty-five publications met the selection criteria and were reviewed. Five major themes were identified as important social determinants of under-5 undernutrition in Myanmar-food insecurity, poverty, maternal factors, an unhealthy environment, and low access to health services. This review highlights the need for a systematic and multisectoral approach to address under-5 undernutrition in Myanmar. Investment in agriculture and rural infrastructure development, and women's education and empowerment may be major contributors to improving the nutritional status of children in rural Myanmar. Findings from this study can be used to develop nutrition-related policies and programs to reduce childhood undernutrition and improve nutrition outcomes in rural Myanmar.