A cost-effectiveness analysis of the 13-valent pneumococcal conjugated vaccine and the 23-valent pneumococcal polysaccharide vaccine among Thai older adult.

Introduction: This study aims to assess the economic impact of introducing the 13-valent pneumococcal conjugate vaccine (PCV13) and 23-valent pneumococcal polysaccharide vaccine (PPSV23) to Thai older adult aged ≥ 65 years who are healthy or with chronic health conditions and immunocompromised conditions from a societal perspective in order to introduce the vaccine to Thailand's National Immunization Program for the older adult. Methods: A Markov model was adopted to simulate the natural history and economic outcomes of invasive pneumococcal diseases using updated published sources and Thai databases. We reported analyses as incremental cost-effectiveness ratios (ICER) in USD per quality-adjusted life year (QALY) gained. In addition, sensitivity analyses and budget impact analyses were conducted. Results: The base-case analysis of all interventions (no vaccinations [current standard of care in Thailand], PPSV23, and PCV13) showed that PPSV23 was extendedly dominated by PCV13. Among healthy individuals or those with chronic health conditions, ICER for PCV13 was 233.63 USD/QALY; meanwhile, among individuals with immunocompromised conditions, ICER for PCV13 was 627.24 USD/QALY. PCV13 are economical vaccine for all older adult Thai individuals when compared to all interventions. Conclusions: In the context of Thailand, PCV13 is recommended as the best buy and should be primarily prioritized when both costs and benefits are considered. Also, this model will be beneficial to the two-next generation pneumococcal vaccines implementation in Thailand.

Prevalence of G6PD deficiency and diagnostic accuracy of a G6PD point-of-care test among a population at risk of malaria in Myanmar.

BACKGROUND: Over the past decade, the incidence of malaria has steadily declined in Myanmar, with Plasmodium vivax becoming predominant. The resilience of P. vivax to malaria control is attributed to the parasite's ability to form hypnozoites in the host's liver, which can cause relapse. Primaquine is used to eliminate hypnozoites but can cause haemolysis in glucose-6-phosphate dehydrogenase (G6PD)-deficient individuals. It is thus necessary to estimate the frequency and variant types of G6PD deficiency in areas where primaquine will be widely used for P. vivax elimination. METHODS: In this study, a descriptive cross-sectional survey was conducted to determine the prevalence of G6PD deficiency in a population residing in Nay Pyi Taw, Myanmar, using a standard spectrophotometric assay, a rapid diagnostic test (RDT), Biosensor, and by genotyping G6PD variants. RESULTS: G6PD enzyme activity was determined from 772 leukocyte-depleted samples, with an adjusted male median G6PD activity value of 6.3 U/g haemoglobin. Using a cut-off value of 30% enzyme activity, the overall prevalence of G6PD deficiency was 10.8%. Genotyping of G6PD variants was performed for 536 samples, of which 131 contained mutations. The Mahidol variant comprised the majority, and males with the Mahidol variant showed lower G6PD enzyme activity. The G6PD Andalus variant, which has not been reported in Myanmar before, was also identified in this study. CONCLUSION: This study provides a G6PD enzyme activity reference value for the Myanmar population and further information on the prevalence and variants of G6PD deficiency among the Myanmar population; it also evaluates the feasibility of G6PD deficiency tests.

Projecting malaria elimination in Thailand using Bayesian hierarchical spatiotemporal models.

Thailand has set a goal of eliminating malaria by 2024 in its national strategic plan. In this study, we used the Thailand malaria surveillance database to develop hierarchical spatiotemporal models to analyze retrospective patterns and predict Plasmodium falciparum and Plasmodium vivax malaria incidences at the provincial level. We first describe the available data, explain the hierarchical spatiotemporal framework underlying the analysis, and then display the results of fitting various space-time formulations to the malaria data with the different model selection metrics. The Bayesian model selection process assessed the sensitivity of different specifications to obtain the optimal models. To assess whether malaria could be eliminated by 2024 per Thailand's National Malaria Elimination Strategy, 2017-2026, we used the best-fitted model to project the estimated cases for 2022-2028. The study results based on the models revealed different predicted estimates between both species. The model for P. falciparum suggested that zero P. falciparum cases might be possible by 2024, in contrast to the model for P. vivax, wherein zero P. vivax cases might not be reached. Innovative approaches in the P. vivax-specific control and elimination plans must be implemented to reach zero P. vivax and consequently declare Thailand as a malaria-free country.

Pneumococcal carriage among high-risk adults in a country with nonmandatory pneumococcal vaccination during the coronavirus disease 2019 pandemic.

BACKGROUND: Streptococcus pneumoniae carriage is a prerequisite for clinical infections and is used to make public health decisions on vaccine licensure. Pneumococcal carriage data among high-risk Thai adults are needed before national vaccine program introduction. The association between coronavirus disease 2019 (COVID-19) and pneumococcal carriage were also investigated. METHODS: During the COVID-19 pandemic, a multi-center cross-sectional study was conducted among high-risk Thai adults from September 2021 to November 2022. Pneumococcal carriage and serotypes were investigated using both conventional and molecular methods. Demographics and co-morbidities were determined for carriage while accounting for case clustering from various study sites. RESULTS: A total of 370 individuals were enrolled. The prevalence of pneumococcal carriage, as determined by the molecular method, was 30.8 % (95 % confidence interval (CI): 26.1-35.8), while after excluding non-typeable pneumococci from the oropharyngeal sample, the carriage prevalence was 20.8 % (95 % CI: 16.79-25.31). The serotype coverage rates by pneumococcal vaccine were 12.3 %, 13.1 %, and 16.4 % for PCV13, PCV15 or PCV20, and PPSV23, respectively, while the non-vaccine type was the majority (45.1 %). The most common serotype was 19B/C (35.5 %), followed by 6 A/B/C/D (10.7 %). The age group under 65 years was associated with a higher pneumococcal carriage rate than the age group 85 and older (odds ratio (OR): 5.01, 95 % CI: 1.75-14.36). There was no significant difference between SARS-CoV-2 and carriage status. CONCLUSIONS: The prevalence of pneumococcal carriage in Thais was high. The majority of serotypes were not covered by the vaccine. Further studies on the link between carriage serotypes and disease are required. The magnitude and serotype distribution of carriage were comparable in the SARS-CoV-2 positive and negative groups.

Multidisciplinary Investigations of Sustained Malaria Transmission in the Greater Mekong Subregion.

In the course of malaria elimination in the Greater Mekong Subregion (GMS), malaria epidemiology has experienced drastic spatiotemporal changes with residual transmission concentrated along international borders and the rising predominance of Plasmodium vivax. The emergence of Plasmodium falciparum parasites resistant to artemisinin and partner drugs renders artemisinin-based combination therapies less effective while the potential spread of multidrug-resistant parasites elicits concern. Vector behavioral changes and insecticide resistance have reduced the effectiveness of core vector control measures. In recognition of these problems, the Southeast Asian International Center of Excellence for Malaria Research (ICEMR) has been conducting multidisciplinary research to determine how human migration, antimalarial drug resistance, vector behavior, and insecticide resistance sustain malaria transmission at international borders. These efforts allow us to comprehensively understand the ecology of border malaria transmission and develop population genomics tools to identify and track parasite introduction. In addition to employing in vivo, in vitro, and molecular approaches to monitor the emergence and spread of drug-resistant parasites, we also use genomic and genetic methods to reveal novel mechanisms of antimalarial drug resistance of parasites. We also use omics and population genetics approaches to study insecticide resistance in malaria vectors and identify changes in mosquito community structure, vectorial potential, and seasonal dynamics. Collectively, the scientific findings from the ICEMR research activities offer a systematic view of the factors sustaining residual malaria transmission and identify potential solutions to these problems to accelerate malaria elimination in the GMS.

Malaria Research for Tailored Control and Elimination Strategies in the Greater Mekong Subregion.

The malaria landscape in the Greater Mekong Subregion has experienced drastic changes with the ramp-up of the control efforts, revealing formidable challenges that slowed down the progress toward malaria elimination. Problems such as border malaria and cross-border malaria introduction, multidrug resistance in Plasmodium falciparum, the persistence of Plasmodium vivax, the asymptomatic parasite reservoirs, and insecticide resistance in primary vectors require integrated strategies tailored for individual nations in the region. In recognition of these challenges and the need for research, the Southeast Asian International Center of Excellence for Malaria Research has established a network of researchers and stakeholders and conducted basic and translational research to identify existing and emerging problems and develop new countermeasures. The installation of a comprehensive disease and vector surveillance system at sentinel sites in border areas with the implementation of passive/active case detection and cross-sectional surveys allowed timely detection and management of malaria cases, provided updated knowledge for effective vector control measures, and facilitated the efficacy studies of antimalarials. Incorporating sensitive molecular diagnosis to expose the significance of asymptomatic parasite reservoirs for sustaining transmission helped establish the necessary evidence to guide targeted control to eliminate residual transmission. In addition, this program has developed point-of-care diagnostics to monitor the quality of artemisinin combination therapies, delivering the needed information to the drug regulatory authorities to take measures against falsified and substandard antimalarials. To accelerate malaria elimination, this program has actively engaged with stakeholders of all levels, fostered vertical and horizontal collaborations, and enabled the effective dissemination of research findings.

Cross-platform mobile app development for disseminating public health information to travelers in Thailand: development and usability.

BACKGROUND: The risk of disease is a key factor that travelers have identified when planning to travel abroad, as many people are concerned about getting sick. Mobile devices can be an effective means for travelers to access information regarding disease prevalence in their planned destinations, potentially reducing the risk of exposure. METHODS: We developed a mobile app, ThaiEpidemics, using cross-platform technology to provide information about disease prevalence and status for travelers to Thailand. We aimed to assess the app's usability in terms of engagement, search logs, and effectiveness among target users. The app was developed using the principle of mobile application development life cycle, for both iOS and Android. As its data source, the app used weekly data from national disease-surveillance reports. We conduced our study among visitors to the Travel Clinic in the Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. The participants were informed that the app would collect usage and search logs related to their queries. After the second log-in, the app prompted participants to complete an e-survey regarding their opinions and preferences related to their awareness of disease prevalence and status. RESULTS: We based our prototype of ThaiEpidemics on a conceptualized framework for visualizing the distribution of 14 major diseases of concern to tourists in Southeast Asia. The app provided users with functions and features to search for and visualize disease prevalence and status in Thailand. The participants could access information for their current location and elsewhere in the country. In all, 83 people installed the app, and 52 responded to the e-survey. Regardless of age, education, and continent of origin, almost all e-survey respondents believed the app had raised their awareness of disease prevalence and status when travelling. Most participants searched for information for all 14 diseases; some searched for information specifically about dengue and malaria. CONCLUSIONS: ThaiEpidemics is evidently potentially useful for travelers. Should the app be adopted for use by travelers to Thailand, it could have an impact on wider knowledge distribution, which might result in decreased exposure, increased prophylaxis, and therefore a potential decreased burden on the healthcare system. For app developers who are developing/implementing this kind of app, it is important to address standardization of the data source and users' concerns about the confidentiality and safety of their mobile devices.

Evaluation of the use of GeneXpert MTB/RIF in a zone with high burden of tuberculosis in Thailand.

GeneXpert MTB/RIF is a reliable molecular diagnostic tool capable of detecting Mycobacterium tuberculosis (MTB) and identifying genetic determinants of rifampicin (RIF) resistance. This study aimed to assess physicians' diagnostic decision-making processes for TB based on GeneXpert MTB/RIF results and how this affected the initiation of multidrug resistance (MDR) treatment. This study employed a mixed method: data were collected retrospectively from the medical records of TB patients and in-depth interviews were conducted with healthcare workers in areas with a high TB burden in Thailand. A total of 2,030 complete TB records from 2 patient groups were reviewed, including 1443 suspected cases with negative smear results and 587 with high risk of MDR-TB. GeneXpert MTB/RIF was routinely used to assist the physicians in their decision-making for the diagnosis of pulmonary tuberculosis (PTB) and the initiation of MDR-TB treatment. The physicians used it as a "rule-in test" for all patients with negative chest X-rays (CXR) and smear results, to ensure timely treatment. Approximately one-fourth of the patients with negative CXR/smear and GeneXpert MTB/RIF results were diagnosed with PTB by the physicians, who based their decisions on other evidence, such as clinical symptoms, and did not use GeneXpert MTB/RIF as a "rule-out test." GeneXpert MTB/RIF proved effective in early detection within a day, thereby radically shortening the time required to initiate second-line drug treatment. Despite its high sensitivity for detecting PTB and MDR-TB, GeneXpert MTB/RIF had contradictory results (false positive and/or false negative) for 21.8% of cases among patients with negative smear results and 41.1% of cases among patients with high risk of MDR-TB. Therefore, physicians still used the results of other conventional tests in their decision-making process. It is recommended that GeneXpert MTB/RIF should be established at all points of care and be used as the initial test for PTB and MDR-TB diagnosis.

Application of Spatial Risk Assessment Integrated With a Mobile App in Fighting Against the Introduction of African Swine Fever in Pig Farms in Thailand: Development Study.

BACKGROUND: African swine fever (ASF), a highly contagious disease affecting both domestic and wild pigs, has been having a serious impact on the swine industry worldwide. This important transboundary animal disease can be spread by animals and ticks via direct transmission and by contaminated feed and fomites via indirect transmission because of the high environmental resistance of the ASF virus. Thus, the prevention of the introduction of ASF to areas free of ASF is essential. After an outbreak was reported in China, intensive import policies and biosecurity measures were implemented to prevent the introduction of ASF to pig farms in Thailand. OBJECTIVE: Enhancing prevention and control, this study aims to identify the potential areas for ASF introduction and transmission in Thailand, develop a tool for farm assessment of ASF risk introduction focusing on smallholders, and develop a spatial analysis tool that is easily used by local officers for disease prevention and control planning. METHODS: We applied a multi-criteria decision analysis approach with spatial and farm assessment and integrated the outputs with the necessary spatial layers to develop a spatial analysis on a web-based platform. RESULTS: The map that referred to potential areas for ASF introduction and transmission was derived from 6 spatial risk factors; namely, the distance to the port, which had the highest relative importance, followed by the distance to the border, the number of pig farms using swill feeding, the density of small pig farms (<50 heads), the number of pigs moving in the area, and the distance to the slaughterhouse. The possible transmission areas were divided into 5 levels (very low, low, medium, high, and very high) at the subdistrict level, with 27 subdistricts in 10 provinces having very high suitability and 560 subdistricts in 34 provinces having high suitability. At the farm level, 17 biosecurity practices considered as useful and practical for smallholders were selected and developed on a mobile app platform. The outputs from the previous steps integrated with necessary geographic information system layers were added to a spatial analysis web-based platform. CONCLUSIONS: The tools developed in this study have been complemented with other strategies to fight against the introduction of ASF to pig farms in the country. The areas showing high and very high risk for disease introduction and transmission were applied for spatial information planning, for example, intensive surveillance, strict animal movement, and public awareness. In addition, farms with low biosecurity were improved in these areas, and the risk assessment developed on a mobile app in this study helped enhance this matter. The spatial analysis on a web-based platform helped facilitate disease prevention planning for the authorities.

Knowledge, Attitudes, and Practices regarding Soil-Transmitted Helminthiasis among Village Health Volunteers in Nakhon Si Thammarat Province, Thailand: A Cross-Sectional Study.

Soil-transmitted helminth infections are most prevalent in rural populations. Village health volunteers (VHVs) are the key individuals for Thai primary healthcare. Therefore, this study aimed to investigate the knowledge, attitudes, and practices regarding soil-transmitted helminthiasis in VHVs. A questionnaire survey was conducted among 552 VHVs randomly selected from four subdistricts in a southern province of Thailand. Sociodemographic variables and information regarding the knowledge, attitudes, and practices related to soil-transmitted helminthiasis were collected using a structured questionnaire. The results demonstrated that VHVs had poor knowledge (70.47%) and practices (66.49%); however, 69.57% had good attitudes. Most VHVs had inadequate knowledge and practices regarding soil-transmitted helminthiasis. VHVs who had been trained in parasitic infection control measures were 2.18 times more likely to have good knowledge. VHVs with a monthly family income of more than 307 USD were 1.58 times more likely to have a good attitude. VHVs with good knowledge were more likely to have good practices. In conclusion, the development of training programs and health promotion should be considered to enhance the knowledge, attitudes, and practices related to soil-transmitted helminthiasis in VHVs, who are the key individuals for providing health education to community members.

Confronting and Coping with Multidrug-Resistant Tuberculosis: Life Experiences in Thailand.

In this article, we aimed to understand the life experiences of Thai persons diagnosed with multi-drug-resistant tuberculosis (MDR-TB). A qualitative study using a face-to-face in-depth interview was conducted at a hospital in Thailand which has the highest prevalence of MDR-TB in the country between January and February 2019. Twenty persons living with MDR-TB in Thailand were purposively selected to represent a variety of experiences based on different gender, ages, and treatment phases. Qualitative data were transcribed and thematic analysis was applied to identify common themes and sub-themes. The results indicated that all participants faced emotional difficulties, such as fear of death, fear of stigmatization, confusion, and sadness when first knowing of their diagnosis. Family and social support were the main ways that the patients coped with difficult situations. Suicidal ideas were more prevalent among patients with poor family support. Screening for mental health problems should be routinely performed in MDR-TB patients. Proper health education should be provided to patients and families to reduce emotional difficulties and stigmatization.

RV144 vaccine imprinting constrained HIV-1 evolution following breakthrough infection.

The scale of the HIV-1 epidemic underscores the need for a vaccine. The multitude of circulating HIV-1 strains together with HIV-1's high evolvability hints that HIV-1 could adapt to a future vaccine. Here, we wanted to investigate the effect of vaccination on the evolution of the virus post-breakthrough infection. We analyzed 2,635 HIV-1 env sequences sampled up to a year post-diagnosis from 110 vaccine and placebo participants who became infected in the RV144 vaccine efficacy trial. We showed that the Env signature sites that were previously identified to distinguish vaccine and placebo participants were maintained over time. In addition, fewer sites were under diversifying selection in the vaccine group than in the placebo group. These results indicate that HIV-1 would possibly adapt to a vaccine upon its roll-out.

Multidimensional Effects of Solid and Hinged Ankle-Foot Orthosis in Children With Cerebral Palsy.

PURPOSE: To compare the effect of solid (SAFO) and hinged (HAFO) ankle-foot orthoses in children with cerebral palsy spastic diplegia and true equinus and jump gait. METHODS: Participants were 26 children (13 wore SAFO and 13 wore HAFO) aged 4 to 14 years classified as Gross Motor Function Classification System levels I to III. Children were tested on standardized measures of body structure and function, activity, and participation. RESULTS: Children wearing HAFO reached further in standing than those wearing SAFO. Among children who walked without an assistive device, children wearing HAFO had greater stride length and faster velocity. Mean Gross Motor Function Measure and Pediatric Evaluation of Disability Inventory mobility scores did not differ between groups. The cost-to-benefit ratios showed parents preferred HAFO. CONCLUSIONS: Among children with true equinus and jump gait, the effects of HAFO were greater in children who walked without an assistive mobility device.

Etiology, Clinical Course, and Outcomes of Pneumonia in the Elderly: A Retrospective and Prospective Cohort Study in Thailand.

Pneumonia is a leading cause of hospitalization and death among elderly adults. We performed a retrospective and prospective observational study to describe the etiology, clinical course, and outcomes of pneumonia for patients 60 years and older in Thailand. We enrolled 490 patients; 440 patients were included in the retrospective study and 50 patients were included in the prospective study. The CURB-65 score and a modified SMART-COP score (SMART-CO score) were used to assess disease severity. The median patient age was 80 years (interquartile range, 70-87 years); 51.2% were men. Klebsiella pneumoniae (20.4%) and Pseudomonas aeruginosa (15.5%) were the most common causative agents of pneumonia. A significant minority (23%) of patients were admitted to the intensive care unit (ICU), and mortality among this subset of patients was 45%. Most patients (80.8%) survived and were discharged from the hospital. The median duration of hospitalization was 8 days (interquartile range, 4-16 days). In contrast, 17.6% of patients died while undergoing care and 30-day mortality was 14%. Factors significantly associated with mortality were advanced age (P = 0.004), male sex (P = 0.005), multiple bacterial infections (P = 0.007; relative risk [RR], 1.88; 95% confidence interval [CI], 1.19-2.79), infection with multi-drug-resistant/extended-spectrum B-lactamase-producing organisms (P < 0.001; RR, 2.82; 95% CI, 1.83-4.85), ICU admission (P < 0.001; RR, 1.8; 95% CI, 1.4-2.3), and complications of pneumonia (P < 0.001; RR, 2.5; 95% CI, 1.8-3.4). Patients with higher SMART-CO and CURB-65 scores had higher rates of ICU admission and higher 30-day mortality rates (P < 0.001). These results emphasize the importance of Gram-negative bacteria, particularly K. pneumoniae and P. aeruginosa, as major causes of pneumonia among the elderly in contrast to other reports, Streptococcus pneumoniae is a common cause of pneumonia among elderly individuals worldwide. The SMART-COP and CURB-65 scores were developed to assess pneumonia severity and predict mortality of young adults with pneumonia. Few studies have examined the appropriateness of these scores for elderly patients with multiple comorbidities. A limited number of studies have used modified versions of these scores among elderly individuals. We found that Gram-negative bacteria has a major role in the etiology of pneumonia among elderly individuals in Southeast Asia. A significant proportion of elderly individuals with low CURB-65 scores were admitted to the hospital, indicating that hospital admission may reflect fragility among elderly individuals with low CURB-65 scores. The modified SMART-COP score (SMART-CO score) sufficiently predicted intensive care unit admission and the need for intensive vasopressor or respiratory support. A SMART-CO score ≥ 7 accurately predicted 30-day mortality.

Effects of COVID-19 government travel restrictions on mobility in a rural border area of Northern Thailand: A mobile phone tracking study.

BACKGROUND: Thailand is among the top five countries with effective COVID-19 transmission control. This study examines how news of presence of COVID-19 in Thailand, as well as varying levels of government restriction on movement, affected human mobility in a rural Thai population along the border with Myanmar. METHODS: This study makes use of mobility data collected using a smartphone app. Between November 2019 and June 2020, four major events concerning information dissemination or government intervention give rise to five time intervals of analysis. Radius of gyration is used to analyze movement in each interval, and movement during government-imposed curfew. Human mobility network visualization is used to identify changes in travel patterns between main geographic locations of activity. Cross-border mobility analysis highlights potential for intervillage and intercountry disease transmission. RESULTS: Inter-village and cross-border movement was common in the pre-COVID-19 period. Radius of gyration and cross-border trips decreased following news of the first imported cases. During the government lockdown period, radius of gyration was reduced by more than 90% and cross-border movement was mostly limited to short-distance trips. Human mobility was nearly back to normal after relaxation of the lockdown. CONCLUSIONS: This study provides insight into the impact of the government lockdown policy on an area with extremely low socio-economic status, poor healthcare resources, and highly active cross-border movement. The lockdown had a great impact on reducing individual mobility, including cross-border movement. The quick return to normal mobility after relaxation of the lockdown implies that close monitoring of disease should be continued to prevent a second wave.

Evaluation of the multidimensional effects of adaptive seating interventions for young children with non-ambulatory cerebral palsy.

PURPOSE: To investigate the short-term effectiveness of the first adaptive seating system received by children with non-ambulatory cerebral palsy (CP) who are classified as level IV or V according to the Gross Motor Function Classification System. MATERIALS AND METHODS: A trained clinical assessor examined 20 children with non-ambulatory CP (mean age: 4.5 years) for their trunk control ability in static, active, and reactive tasks using the Segmental Assessment of Trunk Control. Their primary caregivers were also interviewed about their child's activity and participation using the Paediatric Evaluation of Disability Inventory Computer - Adaptive Test in daily activity and social/cognitive domains and Family Impact of Assistive Technology Scale for Adaptive Seating in child and family functioning domains. Data for each measure were collected 3 times: at baseline (pre-intervention) and then 6 weeks and 3 months after children received their first adaptive seating system. RESULTS AND CONCLUSION: The static and active trunk control scores between baseline and 6 weeks, and baseline and 3 months significantly improved. Daily activity scaled scores significantly improved between baseline and 3 months, and 6 weeks and 3 months. Significant, large gains in child and family functioning overall were detected between baseline and 6 weeks, and baseline and 3 months. These findings provide emerging evidence of multidimensional effects associated with the introduction of a first adaptive seating system into the lives of young children with non-ambulatory CPIMPLICATIONS FOR REHABILITATIONThe introduction of an adaptive seating system into the wheelchair of children with non-ambulatory cerebral palsy may be associated with short-term gains in body function, activities, participation and aspects of the child's environment.

User Acceptance of Electronic Medical Record System: Implementation at Marie Stopes International, Myanmar.

OBJECTIVE: This study assessed the technical feasibility and aimed to determine the factors influencing intention to use Electronic Medical Records (EMRs) at Marie Stopes International, Myanmar (MSI-M). METHODS: A cross-sectional survey was conducted among 112 participants who were working at the clinics and head office of MSI-M. Demographic information, type of office, technical feasibility, information communication technology knowledge, computer usage, and user acceptance towards the proposed system were obtained from the participants. RESULTS: The results indicated low health information technology usage and network availability at MSI-M clinics. Positive perception of EMRs was found among the staff members of MSI-M, which was reflected by positive responses regarding perceived usefulness (average score of 4.15), perceived ease of use (average score of 4.03), and intention to use (average score of 4.10) on a 5-point Likert scale. Statistically, staff from the head office expressed less desire to implement an EMR system (odds ratio = 0.07; 95% confidence interval, 0.01-0.97), especially when they do not perceive the usefulness of the system (odds ratio = 5.05; 95% confidence interval, 2.39-10.69). CONCLUSION: Since health information technology usage and network availability were low in MSI-M, it is important to strengthen the information and communication technology infrastructure and introduce a policy for capacity building at MSI-M. Adequate training and strong leadership support are recommended for the successful initial implementation and sustainability of an EMR system at MSI-M.

Health Literacy Toward Zoonotic Diseases Among Livestock Farmers in Vietnam.

BACKGROUND: Zoonoses are an increasing concern worldwide, particularly in low- and middle-income countries. People with close contact with animals are at high risk for contracting and transmitting the zoonotic diseases. OBJECTIVES: To determine health literacy of livestock farmers toward biosecurity to prevent zoonotic diseases. METHODS: This cross-sectional mixed-methods study was conducted in Thai Nguyen Province, Vietnam, where livestock and farming are the main occupation. The questionnaire survey was submitted to 218 farmers who have close contact with livestock. In addition, 8 farmers were invited to an in-depth interview to further explore the health literacy. RESULTS: Half of the participants were men. The average age (standard deviation) of the participants was 49.3(11.5) years. The median years with experience in farming was 15 years. The majority (82.0%) of the participants had moderate health literacy level regarding zoonoses. Improper use of antibiotics was referred by 58.0% of participants, including antibiotic use as feeding supplements (34.0%) and the use of human antibiotics to treat sick animals (24.0%). Many participants were unaware of zoonotic prevention measures and due to this had practices such as not wearing protective equipment (60.0%), an absence of acaricides to prevent vector infestations (52.0%), an absence of disinfection measures (42.0%), low rate of rabies vaccination (54.0%), and do not quarantining sick animals (38.0%). In-depth interviews revealed great concern among farmers about a collective lack of participation from local veterinarians, health workers, and government authorities in zoonoses-prevention efforts. Statistical models showed that farm scale, ethnic groups, and perceived income were associated with the overall health literacy about zoonoses. CONCLUSION: Comprehensive health education related to zoonotic diseases is recommended to improve overall knowledge, including routes of transmission, symptoms and consequences of diseases, and antibiotic usage. In addition, guidance should be provided to farmers on how to treat sick animals, the appropriate use of antibiotics, and waste management. Local veterinarians and health workers are important contact points and should work closely with the farmers to prevent zoonotic diseases.

Malaria Risk Map Using Spatial Multi-Criteria Decision Analysis along Yunnan Border During the Pre-elimination Period.

In moving toward malaria elimination, finer scale malaria risk maps are required to identify hotspots for implementing surveillance-response activities, allocating resources, and preparing health facilities based on the needs and necessities at each specific area. This study aimed to demonstrate the use of multi-criteria decision analysis (MCDA) in conjunction with geographic information systems (GISs) to create a spatial model and risk maps by integrating satellite remote-sensing and malaria surveillance data from 18 counties of Yunnan Province along the China-Myanmar border. The MCDA composite and annual models and risk maps were created from the consensus among the experts who have been working and know situations in the study areas. The experts identified and provided relative factor weights for nine socioeconomic and disease ecology factors as a weighted linear combination model of the following: ([Forest coverage × 0.041] + [Cropland × 0.086] + [Water body × 0.175] + [Elevation × 0.297] + [Human population density × 0.043] + [Imported case × 0.258] + [Distance to road × 0.030] + [Distance to health facility × 0.033] + [Urbanization × 0.036]). The expert-based model had a good prediction capacity with a high area under curve. The study has demonstrated the novel integrated use of spatial MCDA which combines multiple environmental factors in estimating disease risk by using decision rules derived from existing knowledge or hypothesized understanding of the risk factors via diverse quantitative and qualitative criteria using both data-driven and qualitative indicators from the experts. The model and fine MCDA risk map developed in this study could assist in focusing the elimination efforts in the specifically identified locations with high risks.

Spatiotemporal Trends of Malaria in Relation to Economic Development and Cross-Border Movement along the China-Myanmar Border in Yunnan Province.

The heterogeneity and complexity of malaria involves political and natural environments, socioeconomic development, cross-border movement, and vector biology; factors that cannot be changed in a short time. This study aimed to assess the impact of economic growth and cross-border movement, toward elimination of malaria in Yunnan Province during its pre-elimination phase. Malaria data during 2011-2016 were extracted from 18 counties of Yunnan and from 7 villages, 11 displaced person camps of the Kachin Special Region II of Myanmar. Data of per-capita gross domestic product (GDP) were obtained from Yunnan Bureau of Statistics. Data were analyzed and mapped to determine spatiotemporal heterogeneity at county and village levels. There were a total 2,117 malaria cases with 85.2% imported cases; most imported cases came from Myanmar (78.5%). Along the demarcation line, malaria incidence rates in villages/camps in Myanmar were significantly higher than those of the neighboring villages in China. The spatial and temporal trends suggested that increasing per-capita GDP may have an indirect effect on the reduction of malaria cases when observed at macro level; however, malaria persists owing to complex, multi-faceted factors including poverty at individual level and cross-border movement of the workforce. In moving toward malaria elimination, despite economic growth, cooperative efforts with neighboring countries are critical to interrupt local transmission and prevent reintroduction of malaria via imported cases. Cross-border workers should be educated in preventive measures through effective behavior change communication, and investment is needed in active surveillance systems and novel diagnostic and treatment services during the elimination phase.