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1.
Infect Dis Poverty ; 9(1): 18, 2020 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-32036792

RESUMO

BACKGROUND: The National Plan for Malaria Elimination (NPME) in Myanmar (2016-2030) aims to eliminate indigenous Plasmodium falciparum malaria in six states/regions of low endemicity by 2020 and countrywide by 2030. To achieve this goal, in 2016 the National Malaria Control Program (NMCP) implemented the "1-3-7" surveillance and response strategy. This study aims to identify the barriers to successful implementation of the NPME which emerged during the early phase of the "1-3-7" approach deployment. METHODS: A mixed-methods study was conducted with basic health staff (BHS) and Vector Born Disease Control Program (VBDC) staff between 2017 and 2018 in six townships of six states/regions targeted for sub-national elimination by 2020. A self-administered questionnaire, designed to assess the knowledge required to implement the "1-3-7" approach, was completed by 544 respondents. Bivariate analysis was performed for quantitative findings and thematic analysis was conducted for qualitative findings using Atals.ti software. RESULTS: Although 83% of participants reported performing the key activities in the "1-3-7" surveillance and response approach, less than half could report performing those activities within 3 days and 7 days (40 and 43%, respectively). Low proportion of BHS correctly identified six categories of malaria cases and three types of foci (22 and 26%, respectively). In contrast, nearly 80% of respondents correctly named three types of case detection methods. Most cited challenges included 'low community knowledge on health' (43%), 'inadequate supplies' (22%), and 'transportation difficulty' (21%). Qualitative data identified poor knowledge of key surveillance activities, delays in reporting, and differences in reporting systems as the primary challenges. The dominant perceived barrier to success was inability to control the influx of migrant workers into target jurisdictions especially in hard-to-reach areas. Interviews with township medical officers and the NMCP team leaders further highlighted the necessity of refresher training for every step in the "1-3-7" surveillance and response approach. CONCLUSIONS: The performance of the "1-3-7" surveillance and response approach in Myanmar delivers promising results. However, numerous challenges are likely to slow down malaria elimination progress in accordance with the NPME. Multi-stakeholder engagement and health system readiness is critical for malaria elimination at the sub-national level.


Assuntos
Antimaláricos/uso terapêutico , Agentes Comunitários de Saúde/psicologia , Malária Falciparum/epidemiologia , Malária Falciparum/prevenção & controle , Vigilância de Evento Sentinela , Atitude do Pessoal de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Mianmar/epidemiologia , Plasmodium falciparum , Inquéritos e Questionários , Migrantes
2.
Acta Trop ; 201: 105221, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31654901

RESUMO

Opisthorchiasis-associated cholangiocarcinoma (OV-CCA) is a major public health problem in Greater Mekong Subregion (GMS) Countries, the poorest region in Asia. People in this region have similar traditions or respect the same religion. There is no difference in lifestyle and food culture. Excluding Thailand, publications on risk factors for OV-CCA from the GMS Countries are few, especially data on behavioral risk factors for OV-CCA. Therefore, this study aimed to assess the behavior-related risk factors and to compare the risk of OV-CCA among rural people living along the Mekong River in five GMS countries. It was a cross-sectional analytic study during June and October 2017. All participants with informed consent completed the questionnaires. Descriptive statistics were used to describe the prevalence of risk factors. Odds ratio with 95% confidence intervals were used to compare the risk of OV-CCA. It was found that there were more drinkers than non-drinkers in all areas, except in Vietnam. The highest history of liver fluke infection was found in Cambodia. Praziquantel use and consumption of raw freshwater fish dishes were mostly found in Lao PDR. The highest consumption of nitrosamine-contaminated foodstuffs was found in Ubon Ratchathani, Thailand. The spatial comparison of OV-CCA risk showed that Lao PDR and Ubon Ratchathani were two risk areas when compared to Tachileik, Myanmar (a reference area). This study provided the behavior-related risk factors for OV-CCA among people in five GMS Countries which would be a major jigsaw puzzle leading to proactive surveillance for OV-CCA prevention in the future.


Assuntos
Ductos Biliares Intra-Hepáticos/patologia , Colangiocarcinoma/epidemiologia , Opistorquíase/epidemiologia , Assunção de Riscos , População Rural/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Neoplasias dos Ductos Biliares/epidemiologia , Camboja/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mianmar/epidemiologia , Prevalência , Fatores de Risco , Inquéritos e Questionários , Tailândia/epidemiologia , Vietnã/epidemiologia
3.
Int J Occup Environ Med ; 10(4): 159-173, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31586381

RESUMO

BACKGROUND: The palm oil industry is the largest contributor to global production of oils and fats. Indonesia and Malaysia are the largest producers of palm oil. More than a million workers are employed in this industry, yet there is a lack of information on their occupational health and safety. OBJECTIVE: To identify and summarize occupational hazards among oil palm plantation workers. METHODS: A search was carried out in June 2018 in PubMed, Web of Science, Scopus, and Ovid. Relevant publications were identified by a systematic search of four databases and relevant journals. Publications were included if they examined occupational hazards in oil palm plantation workers. RESULTS: 941 publications were identified; of these, 25 studies were found eligible to be included in the final review. Of the 25 studies examined, 19 were conducted in Malaysia, 2 in Costa Rica, and one each in Ghana, Indonesia, Myanmar, Papua New Guinea, and Cameroon. Oil palm plantation workers were found to be at risk of musculoskeletal conditions, injuries, psychosocial disorders, and infectious diseases such as malaria and leptospirosis. In addition, they have potential exposure to paraquat and other pesticides. CONCLUSION: In light of the potential of palm oil for use as a biofuel, this is an industry with strong growth potential. The workers are exposed to various occupational hazards. Further research and interventions are necessary to improve the working conditions of this already vast and growing workforce.


Assuntos
Indústria Alimentícia , Exposição Ocupacional , Saúde do Trabalhador , Óleo de Palmeira , Doenças dos Trabalhadores Agrícolas/epidemiologia , Camarões/epidemiologia , Comorbidade , Costa Rica/epidemiologia , Indústria Alimentícia/normas , Indústria Alimentícia/estatística & dados numéricos , Inocuidade dos Alimentos , Gana/epidemiologia , Humanos , Indonésia/epidemiologia , Malásia/epidemiologia , Mianmar/epidemiologia , Exposição Ocupacional/efeitos adversos , Exposição Ocupacional/estatística & dados numéricos , Saúde do Trabalhador/estatística & dados numéricos , Óleo de Palmeira/efeitos adversos , Papua Nova Guiné/epidemiologia , Praguicidas/toxicidade , Óleos Vegetais/efeitos adversos
4.
Artigo em Inglês | MEDLINE | ID: mdl-31540348

RESUMO

Myanmar is currently facing the burden of non-communicable diseases due to changes in lifestyle and dietary patterns linked to socio-economic development. However, evidence is scarce about changes in the prevalence of diabetes mellitus (DM) over time. We aimed to investigate changes in the prevalence, awareness, treatment and control of DM from 2004 to 2014, among adults aged 25-74 years, in the Yangon region. Two cross-sectional household-based studies, according to World Health Organization STEPwise approach to surveillance (WHO STEPS) methodology, were conducted in 2004 (n = 4448) and 2014 (n = 1372). The overall age-standardized prevalence of DM was 8.3% (95% CI 6.5-10.6) in 2004 and 10.2% (7.6-13.6) in 2014 (p = 0.296). The DM prevalence increased between the study years among elderly participants only, from 14.6% (11.7-18.1) to 31.9% (21.1-45.0) (p = 0.009). Awareness of having DM increased from 44.3% (39.2, 49.6) to 69.4% (62.9-75.2) (p < 0.001). Among participants who were aware of having DM, the proportion under treatment increased from 55.1% (46.8-63.1) to 68.6% (61.5-74.8) (p = 0.015). There was no change in proportion with controlled DM. Adjusted for age, sex and education, mean fasting plasma glucose levels in 2014 were 0.56 mmol/L (0.26-0.84) higher than in 2004. Preventive measures to halt future increases in DM prevalence and to increase the detection of undiagnosed DM cases are needed.


Assuntos
Conscientização , Diabetes Mellitus , Conhecimentos, Atitudes e Prática em Saúde , Adulto , Idoso , Estudos Transversais , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/prevenção & controle , Diabetes Mellitus/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mianmar/epidemiologia , Prevalência
5.
Malar J ; 18(1): 309, 2019 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-31514740

RESUMO

BACKGROUND: Intensive malaria transmission along international borders is a significant impediment to malaria elimination in the Greater Mekong Subregion (GMS) of Southeast Asia. Passive case detection (PCD) was used to study the dynamics and trends of malaria transmission at the China-Myanmar border to provide epidemiologic information for improved malaria control. METHODS: PCD was conducted in one hospital and 12 clinics near the Laiza town in northeast Myanmar from 2011 to 2016. Clinical malaria was diagnosed by microscopy and demographic information was captured using a structured questionnaire at the time of the patient's presentation for care. RESULTS: Over the study period, 6175 (19.7%) malaria cases were confirmed by microscopy from 31,326 suspected cases. The four human malaria parasite species were all identified, with Plasmodium vivax and Plasmodium falciparum accounting for 5607 (90.8%) and 481 (7.8%) of the confirmed cases, respectively. In contrast to the steady decline of malaria in the general GMS, the study site had an upward trend of malaria incidence with vivax malaria outbreaks in 2013 and 2016. Adult males, children under the age of 15, and those with occupations such as farming, being a soldier or student, had significantly higher risks of clinical malaria compared to having fevers from other aetiologies. A self-reported history of clinical malaria was also associated with a higher risk of confirmed malaria. CONCLUSIONS: The China-Myanmar border area has experienced an overall upward trend of malaria incidence in recent years with P. vivax becoming the predominant species. Evidence-based control strategies need to focus on high-risk populations.


Assuntos
Malária/epidemiologia , Plasmodium/isolamento & purificação , Fatores Socioeconômicos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Malária/diagnóstico , Masculino , Pessoa de Meia-Idade , Mianmar/epidemiologia , Plasmodium/classificação , Adulto Jovem
6.
Asia Pac J Ophthalmol (Phila) ; 8(4): 330-334, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31385820

RESUMO

BACKGROUND: A near vision game has been developed for the autostereoscopic screen of the Nintendo 3DS console. Ease of use and time for testing by non-English-speaking patients was not known. METHODS: Adult and pediatric patients in a remote Burma clinic were compared with US military staff with each performing conventional near acuity, Stereo Fly, and Ishihara color in addition to PDI Check game, so results could be correlated and timed. RESULTS: Seventeen Burma adults (aged 19-58), 20 Burma children (aged 7-15), and 14 US military staff (aged 21-36) completed the testing. Conventional testing correlated with PDI Check for stereo (P < 0.001), acuity oculo dexter (P < 0.01), acuity oculo sinister (P < 0.01). For visual acuity and stereopsis, the intraclass coefficient was 0.55 [95% confidence interval (CI) 0.28-0.72] and 0.62 (95% CI 0.41-0.77) respectively, but with few color deficient cases color was 0.30 (95% CI -0.05 to 0.60). The time in seconds to complete near vision testing with PDI Check (172 ±â€Š27, overall; 198 ±â€Š34, Burma; 99 ±â€Š20, military) was significantly (25% ±â€Š18%) briefer than conventional testing (226 ±â€Š31, overall; 270 ±â€Š34, Burma; 126 ±â€Š20, military). The Burma patients took significantly longer than the military staff (234 ±â€Š25 vs 112 ±â€Š14, P < 0.01). Time for Burma children did not differ from Burma adults for PDI (109 ±â€Š47 vs 217 ±â€Š54, P = 0.42) and for conventional testing (266 ±â€Š51 vs 275 ±â€Š52, P = 0.80). CONCLUSIONS: Non-English-speaking Burma children and adults were able to reliably perform 3 types of near vision testing with a Nintendo 3DS game 25% quicker than the 2 to 3 minutes for conventional methods. They were slower than experienced US military staff adults.


Assuntos
Percepção de Profundidade/fisiologia , Jogos de Vídeo , Transtornos da Visão/diagnóstico , Seleção Visual/instrumentação , Acuidade Visual , Adolescente , Adulto , Criança , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mianmar/epidemiologia , Prevalência , Estudos Prospectivos , Reprodutibilidade dos Testes , Transtornos da Visão/epidemiologia , Adulto Jovem
7.
Korean J Parasitol ; 57(3): 303-308, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31284355

RESUMO

Toxoplasma gondii is an apicomplexan parasite that can cause toxoplasmosis in a wide range of warm-blooded animals including humans. In this study, we analyzed seroprevalence of T. gondii among 467 school children living in the rural areas of Pyin Oo Lwin and Naung Cho, Myanmar. The overall seroprevalence of T. gondii among school children was 23.5%; 22.5% of children were positive for T. gondii IgG, 0.4% of children were positive for T. gondii IgM, and 0.6% of children were positive for both T. gondii IgG and IgM. Geographical factors did not significantly affect the seroprevalence frequency between Pyin Oo Lwin and Naung Cho, Myanmar. No significant difference was found between males (22.2%) and females (25.0%). The overall seroprevalence among school children differed by ages (10 years old [13.6%], 11-12 years old [19.8%], 13-14 years old [24.6%], and 15-16 years old [28.0%]), however, the result was not significant. Polymerase chain reaction analysis for T. gondii B1 gene for IgG-positive and IgM-positive blood samples were negative, indicating no direct evidence of active infection. These results collectively suggest that T. gondii infection among school children in Myanmar was relatively high. Integrated and improved strategies including reinforced education on toxoplasmosis should be implemented to prevent and control T. gondii infection among school children in Myanmar.


Assuntos
Toxoplasma/isolamento & purificação , Toxoplasmose/sangue , Toxoplasmose/epidemiologia , Adolescente , Anticorpos Antiprotozoários/sangue , Criança , Feminino , Humanos , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Masculino , Mianmar/epidemiologia , Estudos Soroepidemiológicos , Estudantes/estatística & dados numéricos , Toxoplasma/genética , Toxoplasma/imunologia , Toxoplasmose/parasitologia
8.
BMC Vet Res ; 15(1): 261, 2019 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-31345206

RESUMO

BACKGROUND: In Southeast Asian countries, including Myanmar, poultry farming is a major industry. In order to manage and maintain stable productivity, it is important to establish policies for biosecurity. Infectious respiratory diseases are a major threat to poultry farming. Avian influenza and Newcastle disease have been reported in Myanmar, but no scientific information is available for other respiratory pathogens, such as mycoplasmas and infectious bronchitis virus (IBV). Identifying the genotypes and serotypes of IBVs is especially important to inform vaccination programs. In this study, we detected Mycoplasma gallisepticum (MG), M. synoviae (MS), and IBV in several poultry farms in Myanmar. RESULTS: Samples were collected from 20 farms in three major poultry farming areas in Myanmar, and MG, MS, and IBV were detected on two, four, and eight farms, respectively, by polymerase chain reaction. Phylogenetic analysis revealed that the observed MG and MS isolates were not identical to vaccine strains. Three different genotypes of IBV were detected, but none was an unknown variant. CONCLUSIONS: Mycoplasmas and IBV were detected on poultry farms in Myanmar. Periodic surveillance is required to establish the distribution of each pathogen, and to institute better vaccine protocols.


Assuntos
Vírus da Bronquite Infecciosa/isolamento & purificação , Mycoplasma gallisepticum/isolamento & purificação , Mycoplasma synoviae/isolamento & purificação , Doenças das Aves Domésticas/epidemiologia , Animais , Galinhas , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/veterinária , Genótipo , Humanos , Vírus da Bronquite Infecciosa/genética , Mianmar/epidemiologia , Infecções por Mycoplasma/epidemiologia , Infecções por Mycoplasma/veterinária , Mycoplasma gallisepticum/genética , Mycoplasma synoviae/genética , Filogenia , Doenças das Aves Domésticas/microbiologia , Doenças das Aves Domésticas/virologia
9.
Parasite ; 26: 46, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31343971

RESUMO

Blastocystis is one of the most common intestinal parasites in humans worldwide. To understand its prevalence and to explore the risk factors for Blastocystis in humans in developing countries, a molecular epidemiological investigation of Blastocystis was conducted in ethnic minority groups on both sides of the China-Myanmar border. A total of 461 fecal specimens were collected from 289 Yao people in China and 172 Wa people in Myanmar, together with a questionnaire for each participant. Based on sequence analysis of the partial small subunit of ribosomal RNA (SSU rRNA) gene (barcode region or 260 bp region), an average prevalence of 6.29% (29/461) was observed, with 4.50% (13/289) in Yao people and 9.30% (16/172) in Wa people. Twenty-two Blastocystis isolates were successfully subtyped by sequence analysis of the barcode region. Three subtypes were identified: ST1 (n = 7), ST3 (n = 13) and ST4 (n = 2). A statistical difference in the prevalence of Blastocystis was only observed between children (12.37%, 12/97) and adults (4.95%, 16/323), and between not washing hands (11.02%, 14/127) and washing hands (4.76%, 15/315) after using toilets, emphasizing the importance and necessity of health education in people in the investigated areas, especially in children.


Assuntos
Infecções por Blastocystis/etnologia , Infecções por Blastocystis/epidemiologia , Blastocystis/genética , Enteropatias Parasitárias/etnologia , Enteropatias Parasitárias/epidemiologia , Adolescente , Adulto , Blastocystis/classificação , Criança , China/epidemiologia , DNA de Protozoário/genética , DNA Ribossômico/genética , Grupos Étnicos , Fezes/parasitologia , Feminino , Variação Genética , Humanos , Masculino , Mianmar/epidemiologia , Filogenia , Prevalência , Fatores de Risco , Inquéritos e Questionários , Adulto Jovem
10.
Acta Trop ; 198: 105104, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31336059

RESUMO

Transmission-blocking vaccines (TBVs) target the sexual stages of malarial parasites to interrupt or reduce the transmission cycle have been one of approaches to control malaria. Pvs25 and Pvs28 are the leading candidate antigens of TBVs against vivax malaria. In this study, genetic diversity and natural selection of the two TBV candidate genes in Plasmodium vivax Myanmar isolates were analyzed. The 62 Myanmar P. vivax isolates showed 9 and 19 different haplotypes for Pvs25 and Pvs28, respectively. The nucleotide diversity of Pvs28 was slightly higher than Pvs25, but not significant. Most amino acid substitutions observed in Myanmar Pvs25 and Pvs28 were concentrated at the EGF-2 and EGF-3 like domains. Major amino acid changes found in Myanmar Pvs25 and Pvs28 were similar to those reported in the global population, but novel amino acid substitutions were also identified. Negative selection was predicted in Myanmar Pvs25, whereas Pvs28 was under positive selection. Comparative analysis of global Pvs25 and Pvs28 suggests a substantial geographical difference between the Asian and American/African Pvs25 and Pvs28. The geographical genetic differentiation and the evidence for natural selection in global Pvs25 and Pvs28 suggest that the functional consequences of the observed polymorphism need to be considered for the development of effective TBVs based on the antigens.


Assuntos
Antígenos de Protozoários/genética , Vacinas Antimaláricas/imunologia , Malária Vivax/prevenção & controle , Plasmodium vivax/genética , Proteínas de Protozoários/genética , Seleção Genética , Substituição de Aminoácidos , Antígenos de Protozoários/imunologia , Antígenos de Superfície , DNA de Protozoário/genética , Haplótipos , Humanos , Malária Vivax/epidemiologia , Malária Vivax/parasitologia , Mianmar/epidemiologia , Polimorfismo Genético
11.
Emerg Infect Dis ; 25(7): 1435-1437, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31211941

RESUMO

We performed an epidemiologic survey of opisthorchiasis in Yangon, Myanmar. The fecal egg-positive rate of residents was 0.7%, and we recovered an adult fluke after chemotherapy and purging of an egg-positive resident. We detected Opisthorchis viverrini metacercariae in freshwater fish. We found the Yangon area to have low-grade endemicity of opisthorchiasis.


Assuntos
Doenças dos Peixes/epidemiologia , Doenças dos Peixes/parasitologia , Opistorquíase/veterinária , Opisthorchis , Animais , Humanos , Mianmar/epidemiologia , Opisthorchis/classificação , Opisthorchis/genética , Vigilância da População
12.
PLoS Negl Trop Dis ; 13(6): e0007498, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31247022

RESUMO

Sustainable dengue intervention requires the participation of communities. Therefore, understanding the health beliefs, knowledge and perceptions of dengue among the local people can help to design locally appropriate strategies for effective interventions. A combination of qualitative semi-structured in-depth interviews (SDIs) and quantitative household questionnaire surveys (HHSs) was used to investigate the beliefs, knowledge and perceptions of dengue among the Shan people in Eastern Shan Special Region IV (ESSR4), Myanmar. The SDI was administered to 18 key informants, and the HHS was administered to 259 respondents. Only 14.7% (95% CI: 10.6-19.6%) of the HHS respondents could confirm that mosquitoes transmit dengue; 14.3% (95% CI: 10.3-19.1%) knew that piebald or Aedes mosquitoes transmit dengue; and 24.3% (95% CI: 19.2-30.0%) believed that dengue-transmitting mosquitoes mainly lived in small ponds. Merely ten (0.4%) of the 259 respondents of the HHS thought that dengue-transmitting mosquitoes bite in the day time. The people in the villages where there were outbreaks of dengue had more knowledge about dengue. This study demonstrates that the health beliefs of the Shan people were closely associated with their lifestyles, social and natural environments. To stay healthy, the Shan people clean their houses and surroundings regularly. However, their knowledge about dengue was not adequate for effective dengue control because it was mostly learned from previous dengue experiences and in a context that lacks systematic health education. Thus, in this setting, with a weak public health structure, more international support should be provided to promote the knowledge of the Shan people about dengue and to increase their sensitive awareness to dengue, which might be beneficial for social mobilization and community participation during future dengue prevention.


Assuntos
Dengue/epidemiologia , Dengue/prevenção & controle , Transmissão de Doença Infecciosa/prevenção & controle , Grupos Étnicos , Conhecimentos, Atitudes e Prática em Saúde , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mianmar/epidemiologia , Inquéritos e Questionários , Adulto Jovem
13.
PLoS One ; 14(6): e0218450, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31206558

RESUMO

BACKGROUND: Population Services International (PSI) Myanmar's social franchise network of general practitioners, known as Sun Quality Health Clinics (SQHC), provided tuberculosis (TB) diagnosis and treatment with Direct Observed Treatment Short course (DOTs) across Myanmar since 2004, with a total of 898 clinics across the country. People who sought TB treatment from these SQHC by themselves were regarded as walk-in patients. To augment TB case notification, PSI Myanmar developed two treatment seeking channels: Community Health Services Providers (CHSP) and Interpersonal Communicators (IPC). They actively sought people who were suspected to have TB and referred them to SQH clinics. In this study, we compared the loss to follow-up rates of TB patients across three treatment seeking channels; and investigated risk-factors for loss to follow-up. METHODS AND FINDINGS: A retrospective cohort design was applied using TB client records between 2012 and 2016. Outcome was defined as loss to follow-up in comparison to successful TB treatment (completed or cured). Multivariate Poisson regression was conducted to estimate incidence rate ratio of loss to follow-up. Of the 62,664 TB patients registered at the SQHC, around 10% each were actively screened by the CHSP and the IPC, and 78.9% were walk-in patients. Overall cumulative incidence for loss to follow-up rate was significantly higher in the IPC channel (14.2%, 95% CI 13.4-15.1%) than walk-in patients (8.9%, 95% CI 8.6-9.1%) and the CHSP channel (5.5%, 95% CI 5.0-6.1%) (p<0.001). The median time after which patients were lost to follow-up from treatment was 4.04 months. We found that patients with older age, male sex, patients residing in hilly region, unknown smear status, retreated cases, HIV co-infection, and unknown HIV status were risk-factors for loss to follow-up in the continuation phase of treatment; whereas patients with higher initial body weight, patients who received travel support and patients taking treatment in older providers were less likely to be lost to follow-up. CONCLUSIONS: Based on these findings, we recommend that implementation strategies for improving case notification and treatment seeking should carefully consider retention strategies in parallel, and the identified influencing factors for loss to follow-up should be taken account for such consideration.


Assuntos
Perda de Seguimento , Tuberculose/epidemiologia , Adulto , Idoso , Bases de Dados Factuais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Mianmar/epidemiologia , Estudos Retrospectivos , Fatores de Risco
14.
Malar J ; 18(1): 172, 2019 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-31088451

RESUMO

BACKGROUND: Sleeping under insecticide-treated mosquito nets/long-lasting insecticidal nets (ITNs/LLINs henceforth referred to as ITNs) is one of the core interventions recommended by the World Health Organization to reduce malaria transmission and prevent malaria in high-risk communities, such as migrants, by preventing mosquito bites. The malaria burden among the migrant population is a big challenge for malaria elimination in Myanmar. In this context, this study aimed to assess the ownership and utilization of ITNs and to understand the barriers to distribution and utilization of ITNs among the high-risk migrant communities in the Regional Artemisinin Resistance Initiative (RAI) project areas of Myanmar. METHODS: A sequential mixed methods study (quantitative component: cross-sectional study involving analysis of secondary data available from a survey conducted among migrant households in the RAI project areas of Myanmar in 2016 followed by a descriptive qualitative component in 2018). A total of 17 focus group discussions (involving 121 participants) with different groups of migrants and 17 key-informant interviews with key programme stakeholders were conducted in 4 selected townships of RAI project areas. RESULTS: Of 3230 migrant households, 63.3% had at least one ITN while 36% had sufficient ITNs (i.e., 1 ITN per 2 persons). Regarding ITN utilization, about 52% of household members reported sleeping under an ITN the previous night, which is similar among under-fives and pregnant women. Over half of all bed nets were ITNs, with nearly one-third having holes or already undergone repairs. The qualitative findings revealed that the key challenges for ITN utilization were insufficient ITNs in households and dislike of ITNs. The barriers to ITN distribution were incomplete migrant mapping due to resource constraints (time, money, manpower) and difficulties in transportation and carrying ITNs. CONCLUSION: This study highlights poor ownership and utilization of ITNs among migrants in the RAI project areas of Myanmar and barriers to their ownership and utilization. To achieve universal coverage and utilization, more programmatic support by the programme is needed to carry out complete migrant mapping and continuous ITN distribution in remote locations.


Assuntos
Mosquiteiros Tratados com Inseticida/estatística & dados numéricos , Malária/prevenção & controle , Controle de Mosquitos/instrumentação , Migrantes , Adolescente , Adulto , Idoso , Pré-Escolar , Estudos Transversais , Características da Família , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Mosquiteiros Tratados com Inseticida/economia , Malária/epidemiologia , Masculino , Pessoa de Meia-Idade , Mianmar/epidemiologia , Propriedade , Inquéritos e Questionários , Cobertura Universal do Seguro de Saúde , Adulto Jovem
15.
Environ Health Prev Med ; 24(1): 23, 2019 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-31014238

RESUMO

BACKGROUND: More than 140 million people drink arsenic-contaminated groundwater. It is unknown how much arsenic exposure is necessary to cause neurological impairment. Here, we evaluate the relationship between neurological impairments and the arsenic concentration in drinking water (ACDW). PARTICIPANTS AND METHODS: A cross-sectional study design was employed. We performed medical examinations of 1867 residents in seven villages in the Thabaung township in Myanmar. Medical examinations consisted of interviews regarding subjective neurological symptoms and objective neurological examinations of sensory disturbances. For subjective neurological symptoms, we ascertained the presence or absence of defects in smell, vision, taste, and hearing; the feeling of weakness; and chronic numbness or pain. For objective sensory disturbances, we examined defects in pain sensation, vibration sensation, and two-point discrimination. We analyzed the relationship between the subjective symptoms, objective sensory disturbances, and ACDW. RESULTS: Residents with ACDW ≥ 10 parts per billion (ppb) had experienced a "feeling of weakness" and "chronic numbness or pain" significantly more often than those with ACDW < 10 ppb. Residents with ACDW ≥ 50 ppb had three types of sensory disturbances significantly more often than those with ACDW < 50 ppb. In children, there was no significant association between symptoms or signs and ACDW. CONCLUSION: Subjective symptoms, probably due to peripheral neuropathy, occurred at very low ACDW (around 10 ppb). Objective peripheral nerve disturbances of both small and large fibers occurred at low ACDW (> 50 ppb). These data suggest a threshold for the occurrence of peripheral neuropathy due to arsenic exposure, and indicate that the arsenic concentration in drinking water should be less than 10 ppb to ensure human health.


Assuntos
Arsênico/toxicidade , Exposição Dietética/efeitos adversos , Água Potável/efeitos adversos , Água Potável/química , Doenças do Sistema Nervoso Periférico/induzido quimicamente , Poluentes Químicos da Água/toxicidade , Adolescente , Adulto , Arsênico/análise , Estudos Transversais , Relação Dose-Resposta a Droga , Feminino , Água Subterrânea/química , Humanos , Masculino , Pessoa de Meia-Idade , Mianmar/epidemiologia , Doenças do Sistema Nervoso Periférico/epidemiologia , Doenças do Sistema Nervoso Periférico/fisiopatologia , Transtornos das Sensações/induzido quimicamente , Transtornos das Sensações/epidemiologia , Transtornos das Sensações/fisiopatologia , Poluentes Químicos da Água/análise , Adulto Jovem
16.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(4): 412-416, 2019 Apr 10.
Artigo em Chinês | MEDLINE | ID: mdl-31006200

RESUMO

Objective: To understand the epidemiological characteristics of imported acute infectious diseases between 2008 and 2017 in the border areas of Yunnan province. Methods: All the cases occurred between January 2008 and December 2017 and related information was from the Chinese CDC infectious disease report information management system, according to definition of imported cases diagnosed by clinicians. Epidemiological characteristics of the imported cases of related information were gathered. Results: A total of 13 157 imported acute infectious diseases were reported from the border areas of Yunnan province, which accounted for 6.03% (13 157/218 284) of the total number of acute infectious diseases in the same areas from 2008 to 2017. Malaria, dengue fever and hand-foot-mouth disease were accounted for 56.05% (7 374/13 157), 21.82% (2 871/13 157) and 4.62% (608/13 157), of all the case, respectively. The number of imported malaria cases decreased annually. However, dengue fever showed a sharp increase. Peaks of the epidemics appeared as: May for malaria and October for dengue fever. Male patients were accounting for the majority (73.22%, 9 634/13 157), so as the patients with Chinese nationality (54.91%, 7 225/13 157). The age distribution appeared as: 67.12% (8 829/13 157) for the 15-44 year olds and 19.26% (2 535/13 157) were children below 14 years of age. Proportions of occupation appeared as: farmers (45.23%, 5 596/13 157), migrant workers (21.30%, 2 802/13 157) and children living at home (11.12%, 1 463/13 157). Most of the imported cases were coming from Myanmar and appearing in the following three counties: Ruili city, Tengchong city, and Yingjiang of Yunnan province. Cities/counties that with number of imported cases more than 10% of the local reported cases, would include Ruili city, Tengchong city, Zhenkang county and Mangshi of Yunnan province. Conclusions: Imported acute infectious disease was a serious public health problem in Yunnan province, 2008-2017. The main imported acute infectious diseases were malaria, dengue fever and hand-foot-mouth disease. The majority imported cases were accounting for Chinese, male, young adults and farmers. It is also important for immigration workers to carry out surveillance, prevention and control programs on infectious diseases when working in neighboring countries.


Assuntos
Dengue/epidemiologia , Malária/epidemiologia , Migrantes/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , China/epidemiologia , Cidades , Feminino , Humanos , Masculino , Mianmar/epidemiologia , Adulto Jovem
17.
Artigo em Inglês | MEDLINE | ID: mdl-30965618

RESUMO

The study aimed to estimate independent and combined associations of sedentary behaviour and physical activity with anxiety and depression among chronic disease patients in Myanmar and Vietnam. The cross-sectional sample included 3201 chronic disease patients (median age 51 years, interquartile range 25) systematically recruited from primary care facilities in 2015. Sedentary time and physical activity were assessed with the General Physical Activity Questionnaire (GPAQ). Overall, the prevalence of sedentary time per day was 51.3% < 4 h, 31.2% between 4 and 8 h, and 17.5% 8 or more hours a day), and 30.7% engaged in low physical activity, 50.0% moderate, and 23.6% high physical activity. The prevalence of anxiety and depression was 12.7% and 19.9%, respectively. In the final logistic regression model, adjusted for relevant confounders, higher sedentary time (≥8 h) did not increase the odds for anxiety or depression, but moderate to high physical activity decreased the odds for anxiety and depression. Combined regression analysis found that participants with both less than eight hours of sedentary time and moderate or high physical activity had significantly lower odds of having anxiety and depression. Findings suggest an independent and combined association between moderate or high physical activity and low sedentary time with anxiety and/or depression among chronic disease patients in Myanmar and Vietnam.


Assuntos
Ansiedade/epidemiologia , Depressão/epidemiologia , Exercício , Comportamento Sedentário , Adulto , Idoso , Doença Crônica , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Mianmar/epidemiologia , Prevalência , Saúde da População Rural , Inquéritos e Questionários , Saúde da População Urbana , Vietnã/epidemiologia
18.
J Pregnancy ; 2019: 8435019, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30931155

RESUMO

Objectives: Hepatitis B virus (HBV) was believed to have minimal impact on pregnancy outcomes apart from the risk of perinatal transmission. In more recent years, there have been reports of adverse associations, most consistently preterm birth (PTB), but this is in the context of high rates of caesarean section. The aim of this study was to explore the association of HBV on pregnancy outcomes in marginalized, low-income populations on the Myanmar-Thailand border. Methods: HBsAg positive (+) point of care rapid detection tests results were confirmed by immunoassays. Women with a confirmed HBsAg status, HIV- and syphilis-negative at first antenatal care screening, singleton fetus and known pregnancy outcome (Aug-2012 to Dec-2016) were included. Logistic regression analysis was used to evaluate associations between HBV group (controls HBsAg negative, HBsAg+/HBeAg-, or HBsAg+/HBeAg+) and pregnancy outcome and comorbidity. Results: Most women were tested, 15,046/15,114 (99.6%) for HBV. The inclusion criteria were not met for 4,089/15,046 (27.2%) women due mainly to unavailability of pregnancy outcome and nonconfirmation of HBsAg+. In evaluable women 687/11,025 (6.2%) were HBsAg+, with 476/11,025 (4.3%) HBsAg+/HBeAg- and 211/11,025 (1.9%) were HBsAg+/HBeAg+. The caesarean section rate was low at 522/8,963 (5.8%). No significant associations were observed between pregnancy comorbidities or adverse pregnancy outcomes and HBV status. Conclusions: The results highlight the disease burden of HBV in women on the Myanmar-Thailand border and support original reports of a lack of significant associations with HBsAg+ irrespective of HBeAg status, for comorbidity, and pregnancy outcomes in deliveries supervised by skilled birth attendants.


Assuntos
Efeitos Psicossociais da Doença , Hepatite B/epidemiologia , Pobreza/estatística & dados numéricos , Complicações Infecciosas na Gravidez/epidemiologia , Resultado da Gravidez , Biomarcadores/sangue , Estudos de Coortes , Comorbidade , Feminino , Hepatite B/diagnóstico , Antígenos de Superfície da Hepatite B/sangue , Humanos , Modelos Logísticos , Mianmar/epidemiologia , Gravidez , Estudos Retrospectivos , Tailândia/epidemiologia
19.
J Forensic Leg Med ; 63: 52-55, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30870725

RESUMO

Clinical and pathological case files of lethal snakebites were reviewed from the Magway Region General Hospital, Magway, Myanmar, over a five-year period (January 2013 December 2017). A total of 2069 postmortem examinations were performed which included 84 cases of lethal snake bite (4.1%). The annual numbers ranged from 10 out of a total of 268 autopsies in 2013 (3.7%), to 31 out of a total of 501 autopsies in 2016 (6.2%). There were 54 males (64%) and 30 females (36%) (M:F = 1.9:1; age range 5-75yrs, mean 33yrs). The most common time for lethal envenomation was August (16/84-19%), the middle of the monsoon season. 45/84 (54%) had acute renal failure, 27/84 (32%) were shocked, and the remaining 12/84 (14%) had disseminated intravascular coagulation. Twenty cases (24%) died within 24 h after envenomation. Fang marks were identified on the legs (either right or left) in 73/84 cases (87%) and on the arms in five cases (6%). The predominant findings at autopsy were of acute renal injury (82/84-98%), pituitary haemorrhage/necrosis (36/84-43%), and adrenal gland haemorrhage (30/84-36%). Despite the reduction in fatalities over the years snakebite from Russell's viper in particular remains an important contributor to mortality in central Myanmar despite the availability of antivenom.


Assuntos
Mordeduras de Serpentes/mortalidade , Venenos de Serpentes/envenenamento , Lesão Renal Aguda/induzido quimicamente , Lesão Renal Aguda/mortalidade , Adolescente , Doenças das Glândulas Suprarrenais/induzido quimicamente , Doenças das Glândulas Suprarrenais/mortalidade , Adulto , Distribuição por Idade , Idoso , Animais , Criança , Pré-Escolar , Coagulação Intravascular Disseminada/induzido quimicamente , Coagulação Intravascular Disseminada/mortalidade , Feminino , Hemorragia/induzido quimicamente , Hemorragia/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Mianmar/epidemiologia , Necrose , Doenças da Hipófise/induzido quimicamente , Doenças da Hipófise/mortalidade , Hipófise/patologia , Estudos Retrospectivos , Distribuição por Sexo , Choque/induzido quimicamente , Choque/mortalidade , Adulto Jovem
20.
Int J Tuberc Lung Dis ; 23(3): 322-330, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30871663

RESUMO

SETTING: Myanmar, a country with a high human immunodeficiency virus-tuberculosis (HIV-TB) burden, where the tuberculin skin test or interferon-gamma release assays are not routinely available for the diagnosis of latent tuberculous infection. OBJECTIVE: To assess the effect of isoniazid (INH) preventive therapy (IPT) on the risk of TB disease and mortality among people living with HIV (PLHIV). DESIGN: A retrospective cohort study of routinely collected data on PLHIV enrolled into care between 2009 and 2014. RESULTS: Of 7177 patients (median age 36 years, interquartile range 31-42; 53% male) included in the study, 1278 (18%) patients received IPT. Among patients receiving IPT, 855 (67%) completed 6 or 9 months of INH. Patients who completed IPT had a significantly lower risk of incident TB than those who never received IPT (adjusted hazard ratio [aHR] 0.21, 95%CI 0.12-0.34) after controlling for potential confounders. PLHIV who received IPT had a significantly lower risk of death than those who never received IPT (PLHIV who completed IPT, aHR 0.25, 95%CI 0.16-0.37; those who received but did not complete IPT, aHR 0.55, 95%CI 0.37-0.82). CONCLUSION: Among PLHIV in Myanmar, completing a course of IPT significantly reduced the risk of TB disease, and receiving IPT significantly reduced the risk of death.


Assuntos
Antituberculosos/administração & dosagem , Infecções por HIV/epidemiologia , Isoniazida/administração & dosagem , Tuberculose/prevenção & controle , Adolescente , Adulto , Estudos de Coortes , Feminino , Infecções por HIV/mortalidade , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Mianmar/epidemiologia , Estudos Retrospectivos , Tuberculose/epidemiologia , Tuberculose/mortalidade , Adulto Jovem
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