Infection prevention and control status at public hospitals and factors associated with COVID-19 infection among healthcare workers in Myanmar: A cross-sectional study.

BACKGROUND: Hospitals should prepare for emerging diseases and protect healthcare workers (HCWs) from work-related infection. This study aims to assess public hospital preparedness for the coronavirus disease 2019 (COVID-19) a year after the Myanmar government began implementing COVID-19 prevention measures, and to identify factors associated with work-related COVID-19 infection among HCWs in Myanmar. METHODS: In January 2021, data were collected from 101 hospitals and 706 HCWs who had COVID-19 in Myanmar in 2020. Data from the hospitals included basic information, the status of infection prevention and control (IPC), the preparedness for COVID-19 (guidelines, checklists, fever screening, patient pathway, and training), handwashing facilities, and availability of personal protective equipment (PPE). Data of COVID-19 infected HCWs included age, occupation, workplace, severity and source of COVID-19 infection, knowledge and practice of handwashing, and working environment. Chi-square test was performed to compare the preparedness for COVID-19 among three hospital levels (primary, secondary and tertiary levels). Logistic regression analysis was performed to identify the associated factors of work-related infection of HCWs. RESULTS: The total number of beds, HCWs, and COVID-19 patients in 2020 at the 101 hospitals was 12,888, 14,421, and 19,835, respectively. The availability of PPE was high in hospitals at all levels. Approximately 80% of hospitals had functional status of IPC, set up fever screening and patient pathway, and provided training on IPC and COVID-19. However, only 39.6% of hospitals had developed COVID-19 guidelines and 55.4% had developed checklists. The percentage of hospitals that prepared each measurement was lowest at the primary level. The factors associated with work-related COVID-19 among HCWs were being 30-39 years old, working as a doctor, working at isolation wards, having disinfection technique training, and having enough PPE at the workplace. CONCLUSION: The preparedness for COVID-19 at public hospitals in Myanmar in January 2021 was insufficient, especially in the availability of the guidelines and checklists and at primary hospitals. A support system for hospital pandemic preparedness and monitoring of IPC implementation is needed. The government should prepare for emerging diseases and provide appropriate and adequate PPE and additional training to all HCWs, especially HCWs who work for isolation wards.

Geographic distribution and utilisation of CT and MRI services at public hospitals in Myanmar.

BACKGROUND: Diagnosis by computed tomography (CT) and magnetic resonance imaging (MRI) is important for patient care. However, the geographic distribution and utilisation of these machines in countries with limited resources, such as Myanmar, have not been sufficiently studied. Therefore, this study aims to identify the geographic distribution and utilisation of CT and MRI services at public hospitals in Myanmar. METHODS: This nationwide, cross-sectional study was conducted at 43 public hospitals in Myanmar. Data were collected retrospectively using a prepared form from 1st January 2015 to 31st December 2017 at public hospitals in Myanmar. A descriptive analysis was performed to calculate the number of CT and MRI units per million population in each state and region of Myanmar. The distribution of CT and MRI units was assessed using the Lorenz curve and Gini coefficient, which are indicators of inequality in distribution. RESULTS: In total, 45 CT and 14 MRI units had been installed in public hospitals in Myanmar by 2017. In total, 205,570 CT examinations and 18,981 MRI examinations have been performed within the study period. CT units per million population in 2017 varied from 0.30 in Rakhine State to 3.22 in Kayah State. However, MRI units were available only in public hospitals in five states/regions. The Gini coefficient for CT and MRI was 0.35 and 0.69, respectively. An upward trend in the utilisation rate of CT and MRI was also observed during the study period, especially among patients aged between 36 and 65 years. CONCLUSIONS: Throughout Myanmar, CT units were more equally distributed than MRI units. CT and MRI units were mostly concentrated in the Yangon and Mandalay Regions, where the population density is higher. The geographic distribution and utilisation rate of CT and MRI units varied among states, regions, and patients' age group. However, the utilisation rates of CT and MRI increased annually in all states and regions during the review period. The Ministry of Health and Sports in Myanmar should consider the utilisation and population coverage of CT and MRI as an important factor when there will be procurement of those medical equipment in the future.

Mapping of QTLs conferring high grain length-breadth relative expansion during cooking in rice cultivar Paw San Hmwe.

Paw San Hmwe (PSH) is a high-quality rice cultivar from Myanmar. PSH has short and broad grains, but the grains become slender after cooking. This desirable feature can be described as a high value of grain length-breadth relative expansion index (GREI). To understand the genetic basis of high GREI in PSH, we crossed PSH with Guang 8B (G8B), a rice cultivar from China with low GREI, to develop an F2 population and a subsequent F2:3 population. Based on the phenotypes of these two populations measured in two years and using the method of sequencing-based bulked segregant analysis followed by verification with conventional linkage-based QTL mapping method, we mapped three QTLs for GREI. The three QTLs were located on chromosomes 3, 5 and 12, respectively, with the trait-increasing alleles all from PSH, and could explain a total of 62.5% of the phenotypic variance and 84.1% of the additive genetic variance. The results suggest that the three QTLs would be useful for the genetic improvement of GREI in rice, and the linked markers will facilitate the selection of the favorable alleles from PSH in breeding.

Unit cost of healthcare services at 200-bed public hospitals in Myanmar: what plays an important role of hospital budgeting?

BACKGROUND: Cost information is important for efficient allocation of healthcare expenditure, estimating future budget allocation, and setting user fees to start new financing systems. Myanmar is in political transition, and trying to achieve universal health coverage by 2030. This study assessed the unit cost of healthcare services at two public hospitals in the country from the provider perspective. The study also analyzed the cost structure of the hospitals to allocate and manage the budgets appropriately. METHODS: A hospital-based cross-sectional study was conducted at 200-bed Magway Teaching Hospital (MTH) and Pyinmanar General Hospital (PMN GH), in Myanmar, for the financial year 2015-2016. The step-down costing method was applied to calculate unit cost per inpatient day and per outpatient visit. The costs were calculated by using Microsoft Excel 2010. RESULTS: The unit costs per inpatient day varied largely from unit to unit in both hospitals. At PMN GH, unit cost per inpatient day was 28,374 Kyats (27.60 USD) for pediatric unit and 1,961,806 Kyats (1908.37 USD) for ear, nose, and throat unit. At MTH, the unit costs per inpatient day were 19,704 Kyats (19.17 USD) for medicine unit and 168,835 Kyats (164.24 USD) for eye unit. The unit cost of outpatient visit was 14,882 Kyats (14.48 USD) at PMN GH, while 23,059 Kyats (22.43 USD) at MTH. Regarding cost structure, medicines and medical supplies was the largest component at MTH, and the equipment was the largest component at PMN GH. The surgery unit of MTH and the eye unit of PMN GH consumed most of the total cost of the hospitals. CONCLUSION: The unit costs were influenced by the utilization of hospital services by the patients, the efficiency of available resources, type of medical services provided, and medical practice of the physicians. The cost structures variation was also found between MTH and PMN GH. The findings provided the basic information regarding the healthcare cost of public hospitals which can apply the efficient utilization of the available resources.

Medical facility statistics in Japan.

Medical facility statistics provide essential information to policymakers, administrators, academics, and practitioners in the field of health services. In Japan, the Health Statistics Office of the Director-General for Statistics and Information Policy at the Ministry of Health, Labour and Welfare is generating these statistics. Although the statistics are widely available in both Japanese and English, the methodology described in the technical reports are primarily in Japanese, and are not fully described in English. This article aimed to describe these processes for readers in the English-speaking world. The Health Statistics Office routinely conduct two surveys called the Hospital Report and the Survey of Medical Institutions. The subjects of the former are all the hospitals and clinics with long-term care beds in Japan. It comprises a Patient Questionnaire focusing on the numbers of inpatients, admissions, discharges, and outpatients in one month, and an Employee Questionnaire, which asks about the number of employees as of October 1. The Survey of Medical Institutions consists of the Dynamic Survey, which focuses on the opening and closing of facilities every month, and the Static Survey, which focuses on staff, facilities, and services as of October 1, as well as the number of inpatients as of September 30 and the total number of outpatients during September. All hospitals, clinics, and dental clinics are requested to submit the Static Survey questionnaire every three years. These surveys are useful tools for collecting essential information, as well as providing occasions to implicitly inform facilities of the movements of government policy.

Characterization and organelle genome sequencing of Pyropia species from Myanmar.

Pyropia is a genus comprising red algae of the Bangiaceae family that is commonly found in intertidal zones worldwide. However, understanding of Pyropia species that are prone to tropical regions remains limited despite recent breakthroughs in genomic research. Within the realm of Pyropia species thriving in tropical regions, P. vietnamensis stands out as a widely recognized species. In this study, we aimed to investigate Pyropia species in the southwest coast of Myanmar using physiological and molecular approaches, culture-based analyses, chloroplast rbcL and nuclear SSU gene sequencing, and whole chloroplast and mitochondrial genome sequencing. Physiological analysis showed that the Myanmar samples were more heat-tolerant than their Japanese counterparts, including those of subtropical origin. Additionally, molecular characterization revealed that the Myanmar samples were closely related to P. vietnamensis from India. This study is the first to sequence the chloroplast and mitochondrial genomes of Pyropia species from tropical regions. A unique deletion event was observed within a ribosomal RNA gene cluster in the chloroplast genome of the studied Pyropia species, which is a deviation from the usual characteristics of most Pyropia species. This study improves current understanding of the physiological and molecular characteristics of this comparatively understudied Pyropia species that grows in tropical regions.

Urbanization, economic development, and environmental changes in transitional economies in the global south: a case of Yangon.

Background: Transitional economies in Southeast Asia-a distinct group of developing countries-have experienced rapid urbanization in the past several decades due to the economic transition that fundamentally changed the function of their economies, societies and the environment. Myanmar, one of the least developed transitional economies in Southeast Asia, increased urbanization substantially from 25% in 1990 to 31% in 2019. However, major knowledge gaps exist in understanding the changes in urban land use and land cover and environment and their drivers in its cities. Methods: We studied Yangon, the largest city in Myanmar, for the urbanization, environmental changes, and the underlying driving forces in a radically transitioned economy in the developing world. Based on satellite imagery and historic land use maps, we quantified the expansion of urban built-up land and constructed the land conversion matrix from 1990 through 2020. We also used three air pollutants to illustrate the changes in environmental conditions. We analyzed the coupled dynamics among urbanization, economic development, and environmental changes. Through conducting a workshop with 20 local experts, we further analyzed the influence of human systems and natural systems on Yangon's urbanization and sustainability. Results: The city of Yangon expanded urban built-up land rapidly from 1990 to 2000, slowed down from 2000 to 2010, but gained momentum again from 2010 to 2020, with most newly added urban built-up land appearing to be converted from farmland and green land in both 1990-2000 and 2010-2020. Furthermore, the air pollutant concentration of CO decreased, but that of NO2 and PM2.5 increased in recent years. A positive correlation exists between population and economic development and the concentration of PM2.5 is highly associated with population, the economy, and the number of vehicles. Finally, the expert panel also identified other potential drivers for urbanization, including the extreme climate event of Cyclone Nargis, capital relocation, and globalization. Conclusions: Our research highlights the dramatic expansion of urban land and degradation of urban environment measured by air pollutants and interdependent changes between urbanization, economic development, and environmental changes.

Prevalence and risk factors of anxiety and depression among the community-dwelling elderly in Nay Pyi Taw Union Territory, Myanmar.

Providing elderly mental healthcare in Myanmar is challenging due to the growing elderly population and limited health resources. To understand common mental health problems among Myanmar elderly, this study explored the prevalence and risk factors of anxiety and depression among the elderly in the Nay Pyi Taw Union Territory, Myanmar. A cross-sectional study was conducted among 655 elderly by face-to-face interviews with a pretested questionnaire. Descriptive analysis and multiple logistic regression analyses were performed. The prevalence of anxiety and depression were 39.4% (33.5% for males and 42.4% for females) and 35.6% (33.0% for males and 36.9% for females), respectively. The adjusted odds ratio of having anxiety was significant for having low education level, having comorbidity, having BMI < 21.3, poor dental health, no social participation, and having no one to consult regarding personal problems, while that of having depression was significant for having comorbidity, having BMI < 21.3, poor vision, and having no one to consult regarding personal problems. The reported prevalence of anxiety and depression indicate the demand for mental healthcare services among Myanmar elderly. Myanmar needs to improve its elderly care, mental healthcare, and social security system to reflect the actual needs of its increasing elderly population. Screening for anxiety and depression among elderly with comorbidities should be promoted. Raising community awareness of mental health, encouraging social participation, and supportive counselling are also essential in combating anxiety and depression among Myanmar elderly.

Rotavirus infection among children under five years of age hospitalized with acute gastroenteritis in Myanmar during 2018-2020 - Multicentre surveillance before rotavirus vaccine introduction.

BACKGROUND: Rotavirus gastroenteritis (RVGE) is a leading cause of severe diarrhea in children under-five worldwide, with the majority of mortality in lower -income countries. This study aimed to provide baseline information on epidemiology of rotavirus and circulating strains before rotavirus vaccine introduction in Myanmar. METHODS: Hospital-based, prospective surveillance was conducted from May 2018 to January 2020 at four sentinel sites; two hospitals in Lower Myanmar, one hospital each in Middle Myanmar and East Myanmar. Children under five years of age hospitalized for acute gastroenteritis were enrolled; demographic and clinical data were collected. Stool samples were screened by ELISA (ProSpecT™ Rotavirus, OXOID-UK) for rotavirus antigen and a subset of ELISA positive samples were genotyped by reverse transcription polymerase chain reaction. RESULTS: Rotavirus was detected in 45.7% (799/1750) of cases enrolled at three sites in May 2018-April 2019 and 42.5% (521/1227) at four sites in May 2019-January 2020. RVGE cases were predominantly male (58.7%; 775/1320) and 92.6% (1223/1320) of RVGE cases occurred in <2 years old. Rotavirus detection was higher in the cold and dry season (November-April). RVGE compared to non-RVGE cases had more frequent vomiting (78.3% Vs 68.1%, p < 0.01), fever (65.8% Vs 61.3%, p = 0.01), severe dehydration (3.6% Vs 2.1%, p < 0.01) and requirement of treatment by IV fluid (58.3% Vs 53.1%, p < 0.01). The most prevalent genotypes identified were G1P[6] (113/359, 31.5%), G1P[8] (94/359, 26.2%) and G2P[4] (33/359, 9.2%). CONCLUSIONS: This study confirms the persistent high prevalence of RVGE among children under-five admitted to hospitals in different parts of Myanmar and the diversity of rotavirus strains over time prior to vaccine introduction. The rotavirus vaccine was introduced nationwide in February 2020 in Myanmar and these data will be important baseline data for post-vaccination monitoring of vaccine impact and circulating strains.

Cognitive impairment and its risk factors among Myanmar elderly using the Revised Hasegawa's Dementia Scale: A cross-sectional study in Nay Pyi Taw, Myanmar.

BACKGROUND: Globally, elderly population with impaired cognitive function, such as dementia, has been accelerating, and Myanmar is no exception. However, cognitive function among elderly in Myanmar has rarely been assessed. This study aimed to identify the rate of cognitive impairment and its risk factors among the elderly in Myanmar. METHODS: This cross-sectional study was conducted at rural health centers in Nay Pyi Taw Union Territory, Myanmar, from December 2018 to January 2019. In total, 757 elderly individuals aged 60 years or over (males: 246 [32.5%], females: 511 [67.5%]) were interviewed using a face-to-face method with a pre-tested questionnaire. Descriptive statistics and multivariable logistic regression analyses were performed. RESULTS: The rate of impaired cognitive function among participants was 29.9% (males: 23.6%; females: 32.9%). The following participants were more likely to present cognitive impairment: those aged 70-79 years (adjusted odds ratio [AOR] = 1.8; 95% confidence interval [CI]: 1.19-2.70) and 80 years or older (AOR = 3.9; 95% CI: 2.25-6.76); those who were illiterate (AOR = 9.1; 95% CI: 3.82-21.51); and those dependent on family members (AOR = 1.6; 95% CI: 1.04-2.44). The elderly livening with their families and those who reported having good health (AOR = 0.7; 95% CI: 0.44-0.99) were less likely to have cognitive impairment. CONCLUSION: Using the HDS-R Myanmar version, this study reported that there out of five elderly participants had cognitive impairment, and its risk factors, altering policy makers that Myanmar needs to prepare for adequate healthcare services and social support for elderly with cognitive impairment. Future research should be performed not only to detect general cognitive impairment but also to differentiate specific cognitive domains impairments among Myanmar elderly. Longitudinal studies are needed to observe the causal and protective factors associated with cognitive impairments in Myanmar.

Cross-sectional study on tobacco advertising, promotion and sponsorship (TAPS) and violations of tobacco sale regulations in Myanmar: do these factors affect current tobacco use among Myanmar high school students?

OBJECTIVES: To examine the associations of current tobacco use with tobacco advertising, promotion and sponsorship (TAPS), and illicit tobacco sales exposures among Myanmar high school students. DESIGN: A quantitative, cross-sectional study. SETTING: Seven high schools from both urban and rural areas of four states and regions in Myanmar. PARTICIPANTS: In total, 1174 high school students (482 males and 692 females) were interviewed using a self-administered questionnaire. MAIN OUTCOME MEASURE: Current tobacco use of participants, defined as using any kind of smoked or smokeless tobacco product at least one occasion within the past 30 days. RESULTS: The prevalence of TAPS exposure was 90.9% among high school students in Myanmar. Current tobacco use was positively associated with being over 14 years old (adjusted OR (AOR) 9.81; 95% CI 4.54 to 21.19), being male (AOR 28.06; 95% CI 13.29 to 59.25), exposure to any kind of TAPS (AOR 6.59; 95% CI 2.33 to 18.64), having seen any smoked tobacco product for sale inside or within 100 feet of the school premises (AOR 4.17; 95% CI 1.65 to 10.58), having seen the sale or gifting of any smoked tobacco product to minors (AOR 6.46; 95% CI 2.18 to 19.12) and having seen the sale or distribution of any smoked tobacco product by minors (AOR 2.42; 95% CI 1.42 to 4.10). Having ever received health education about tobacco use (AOR 0.45; 95% CI 0.27 to 0.78), or having a higher perception score of tobacco use (AOR 0.17; 95% CI 0.10 to 0.30) were negatively associated with current tobacco use. CONCLUSIONS: There was an alarming prevalence of TAPS exposure among Myanmar high school students. TAPS exposure and violations of tobacco sale regulations were strong risk factors for current tobacco use among Myanmar high school students, while health education about tobacco products was reported as an effective protective factor. Specific smokeless tobacco sale regulations for minors are needed immediately in Myanmar.

Adverse Drug Reactions in Selected Wards of the Yangon General Hospital and Yangon Specialty Hospital During the First Quarter of 2019: An Active Pharmacovigilance Study in Myanmar.

BACKGROUND: Previous studies in Europe and the USA have reported a high prevalence of adverse drug reactions (ADRs), but data on local ADRs in Myanmar are sparse. OBJECTIVE: Our objective was to study ADRs in patients admitted to selected wards of Yangon General Hospital (YGH) and Yangon Specialty Hospital (YSH), Myanmar. METHODS: This was a prospective observational study in three hospital wards during the first quarter of 2019. Suspected ADRs were carefully investigated in a face-to-face interview with each patient and via review of clinical records. Patients transferred to other wards or discharged were followed-up by the researchers until day 28 after admission. ADRs were divided into those that (1) led to the admission and (2) occurred during the hospital stay or after discharge (up to day 28 after admission). RESULTS: A total of 65 ADRs were identified, with 47 (29.4%) of 160 patients experiencing at least one ADR. Among these, 16 (24.6%) had led to hospital admission and 49 (75.4%) occurred in 31 patients during their hospital stay. Of 160 patients, 21 had taken at least one herbal remedy and six of these developed an ADR. Five ADR-drug associations (hypokalaemia with methylprednisolone, increased transaminase levels with standard antituberculosis drugs, upper gastrointestinal bleeding with nonsteroidal anti-inflammatory drugs, constipation with tramadol, and increased transaminase levels with herbal remedies) represented 18 (27.7%) of the 65 ADRs in this study. According to the Schumock and Thornton preventability scale, more than half of these ADRs (35 [53.9%]) were preventable. CONCLUSION: The present study highlights the existence of ADRs among patients attending these hospitals. The implementation of active pharmacovigilance in hospitals could be a helpful first step to improving the awareness of unwanted effects of medicines and patient safety, as well as a way to strengthen the national pharmacovigilance system in countries such as Myanmar.

Knowledge, attitude, and usage pattern of tobacco among high school students in Nay Pyi Taw, Myanmar.

In Myanmar, although the law prohibits the sale of tobacco products to and by those aged less than 18 years, the use of smoking and smokeless tobacco among high school students is a social problem. There has been no previous study on tobacco use or knowledge of tobacco law among students in Nay Pyi Taw. A survey was conducted to assess the knowledge, attitude, and usage pattern of tobacco among high school students in Nay Pyi Taw, Myanmar. The data were collected in three high schools, from 300 students of Grade 10 and 11, in September 2015, using anonymous self-administered questionnaires which included characteristics of students, knowledge, attitude, and usage pattern of tobacco. Of the 300 students, 104 (34.7%) were smokers and 85 (28.3%) were users of smokeless tobacco. The average age of first use of tobacco was 14 years. Although most students knew about the ill effects of tobacco, only 25% knew about the Tobacco Product Law. The most common source of tobacco was friends and male family members were main smokers in families. Most students had seen male teachers and headmasters smoking in schools. The usage of tobacco and smokeless tobacco was associated with sex and the students' attitude towards tobacco. This study indicated that the high school students knew about the ill effects of tobacco, but not about the Tobacco Product Law. Schools need to educate students and teachers about tobacco and the Tobacco Product Law and the enforcement of the law is also needed.

Survival rate and mortality risk factors among TB-HIV co-infected patients at an HIV-specialist hospital in Myanmar: A 12-year retrospective follow-up study.

BACKGROUND: Myanmar is listed as one of the countries with the highest burden of tuberculosis and HIV infections (TB-HIV) in the world. However, the survival rate and risk factors for mortality among TB-HIV co-infected patients in the country remain unstudied. Therefore, the purpose of this study was to examine these factors. METHODS: A 12-year retrospective follow-up study was conducted among 3598 TB-HIV co-infected patients (2452 male and 1146 female) aged 15 years and above, enrolled on antiretroviral therapy (ART) from July 1, 2005 to December 31, 2016. Hazard ratios (HR) were estimated using the Cox proportional hazards model. Survival rates at the beginning of ART were calculated using the Kaplan-Meier method. RESULTS: A total of 494 (13.7%) patients died during this period. The survival rate of TB-HIV co-infected patients was 82.0% at 5 years and 58.1% at 10 years. The risk factors for mortality were being bedridden (adjusted hazard ratio (aHR) 2.70, 95% confidence interval (CI) 2.13-3.42), having a low baseline CD4 count (aHR 1.53, 95% CI 1.25-1.87), and being on a second-line ART regimen (aHR 8.12, 95% CI 3.56-18.54). CONCLUSIONS: Two out of five TB-HIV patients died within 10 years after ART initiation. Current HIV prevention and treatment programs should focus more on bedridden patients, those on second-line ART, and those with low baseline CD4 counts.

Myanmar's human resources for health: current situation and its challenges.

BACKGROUND: Human resources for health (HRH) are the cornerstone of health systems, enabling the improvement of health service coverage. The systematic fortification of healthcare in Myanmar has accelerated since a new ruling party took office. Since 2006, Myanmar has been listed as one of the 57 crisis countries facing critical health workforce shortages. Therefore, this study aimed to assess the current situation of HRH in the public health sector where major healthcare services are provided to the people of Myanmar. METHODS: A cross-sectional study was conducted from January to May 2017 by collecting secondary data from the official statistic of the Ministry of Health and Sports (MoHS), official reports, press-releases, and presentations of Government officials. The data were collected using a formatted excel spreadsheet. A descriptive analysis was applied and the density ratio per 1,000 population for medical doctors and health workers was calculated. FINDINGS: In total, 16,292 medical doctors and 36,054 nurses working at 1,134 hospitals were under the management of MoHS in 2016. The finding revealed that 13 out of 15 States and Regions were below the WHO recommended minimum number of 1 per 1,000 population for medical doctor. The distribution of medical doctors per 1,000 population in the public sector showed a gradually decreasing trend since 2006. Urban and rural medical doctor ratios observed wide disparities. INTERPRETATION: The HRH shortage occurred in almost all State and Regions of Myanmar, including major cities. Wide disparities of HRH were found in urban and rural areas. The Myanmar government needs to consider the proper cost-effective HRH supply-chain management systems and retention strategies. The projection of health workforce, distribution of workforce by equity, effective management, and health information systems should be strengthened.

Corrigendum to "Myanmar's human resources for health: current situation and its challenges" [Heliyon 5 (3), (March 2019), e01390].

[This corrects the article DOI: 10.1016/j.heliyon.2019.e01390.].

Barriers between mothers and their adolescent daughters with regards to sexual and reproductive health communication in Taunggyi Township, Myanmar: What factors play important roles?

BACKGROUND: Parents play critical roles in adolescents' sexual and reproductive health (SRH) and discussions between parents and adolescents on this topic are fundamental in reducing adolescents' risky sexual behaviors. However, SRH communication is a challenging issue in Myanmar due to socio-cultural taboos. This study assessed the communication barriers towards SRH issues among mothers and their adolescent girls. METHODS: A community-based, cross-sectional study was conducted from January to December 2017 in Taunggyi Township, Southern Shan State, Myanmar. In total, 112 pairs of mothers and adolescent daughters were recruited using a face-to-face interview method with semi-structured questionnaires. Logistic regression analysis was applied to examine communication barriers on SRH issues between mothers and their adolescent girls. RESULTS: More than half of both mother and adolescent girls had negative perceptions of communication on SRH issues. Only 2.7% of girls discussed SRH issues with their mothers more than four times in the last six months. The factors found to create SRH communication barriers were higher family incomes (adjusted odd ration [AOR] 2.5, 95% confidence interval [CI] 1.0, 6.2), good knowledge of puberty (AOR 4.5, 95% CI 1.6, 12.5), good knowledge of sexual and reproductive health issues (AOR 4.5, 95% CI 1.8, 11.5), and positive perception of communication (AOR 6.7, 95% CI 2.5, 17.9) among mothers, and good knowledge of contraception (AOR 5.7, 95% CI 1.5, 21.4) and good knowledge of sexually transmitted infections (AOR 2.5, 95% CI 1.0, 6.4) among adolescent girls. CONCLUSION: Mothers and adolescent girls communicated on SRHs was narrow, occurring infrequently and late, with only limited topics discussed. Having higher levels of SRH knowledge were more likely to create communication barriers among mother and adolescent girls. Policy makers need to consider targeted sexual and reproductive health education programs that can be implemented at the school and community levels to increase parent-adolescent communication.

Myanmar language version of the Revised Hasegawa's Dementia Scale.

Reduced cognitive function among the elderly is an important issue not only in developed countries, but also in developing countries. As a test to measure cognitive function, the Revised Hasegawa's Dementia Scale (HDS-R) has been used in Asian countries including Japan, Korea, and China. Since there was no HDS-R version in Myanmar language, a questionnaire and manual for the HDS-R were developed. The translation from English to Myanmar language was done by two Myanmar researchers. Back-translation was conducted to confirm the accuracy of the translation by two other Myanmar researchers. Back-translated English was compared to the original by two Japanese researchers, and inconsistencies were discussed by all six researchers to reach consensus. Five Myanmar researchers independently read the questionnaire and manual to verify the expressions are familiar in Myanmar language. The modified points were as follows. 1) The date order in Question 2 is day/month/year. 2) The words to be memorized in Questions 4 and 7 are padauk tree, cat, and bullock cart for the first set, and tamarind tree, dog, and car for the second set. 3) The objects to be memorized in Question 8 are shown with pictures, not actual objects. 4) Like the Lao version, we introduced two new rules; a clear time definition for no reply (10 seconds), and repeating questions twice for those with hearing problems. The revised version of the HDS-R has been prepared to be an applicable standard questionnaire for use on assessment of cognitive function in suspected dementia cases in Myanmar, both in the clinical and public healthcare setting.

Autoimmune Hepatitis: Diagnostic Dilemma When It Is Disguised as Iron Overload Syndrome.

Elevated serum ferritin level is a common finding in iron overload syndrome, autoimmune and viral hepatitis, alcoholic and nonalcoholic fatty liver diseases. High transferrin saturation is not a common finding in above diseases except for iron overload syndrome. We encountered a challenging case of 73-year-old female who presented with yellowish discoloration of skin, dark color urine and dull abdominal pain. Initial laboratory tests reported mild anemia; elevated bilirubin, liver enzymes, and transferrin saturation. We came to the final diagnosis of autoimmune hepatitis after extensive workups. Autoimmune hepatitis is a rare disease, and the diagnosis can be further complicated by a similar presentation of iron overload syndrome. Markedly elevated transferrin saturation can simulate iron overload syndrome, but a liver biopsy can guide physicians to navigate the diagnosis.