Menstrual symptoms and risk of preterm birth: A population-based longitudinal study.

OBJECTIVES: To examine the prospective association between menstrual symptoms before pregnancy and preterm birth. METHODS: Secondary analysis of data from 14 247 young Australian women born between 1973 and 1978 who participated in a longitudinal, population-based cohort study between 1996 and 2015. Women were first surveyed at 18-23 years, and seven waves of data were collected at roughly three-yearly intervals. At each survey, women were asked about "severe period pain," "heavy periods," and "irregular periods" within the last 12 months. From 2009 onward, information on their children was collected, including birth dates and preterm birth (<37 weeks). Logistic regression using generalized estimating equations was used to examine prospective associations between self-reported menstrual symptoms before pregnancy and risk of preterm birth. RESULTS: Data from 6615 mothers who had 12 337 live singleton births were available for analysis. Among all births, women reporting severe period pain (adjusted odds ratio [aOR] 1.34 [95% CI 1.10-1.62]) or heavy periods (1.25 [1.02-1.53]) before pregnancy had higher odds of preterm birth. However, in analyses stratified by birth order, only severe period pain (2.05 [1.41-2.99]), heavy periods (1.77 [1.23-2.55]), or irregular periods (1.58 [1.10-2.28]) before a second or subsequent birth were associated with an increased risk of preterm birth. CONCLUSIONS: Severe period pain, heavy periods, and irregular periods before a second or subsequent birth may be associated with preterm birth.

Stunting: an overlooked problem in Myanmar - an economic evaluation.

OBJECTIVES: Stunting increases a child's susceptibility to diseases, increases mortality, and is associated over long term with reduced cognitive abilities, educational achievement, and productivity. We aimed to assess the most effective public health nutritional intervention to reduce stunting in Myanmar. METHODS: We searched the literature and developed a conceptual framework for interventions known to reduce stunting. We focused on the highest impact and most feasible interventions to reduce stunting in Myanmar, described policies to implement them, and compared their costs and projected effect on stunting using data-based decision trees. We estimated costs from the government perspective and calculated total projected cases of stunting prevented and cost per case prevented (cost-effectiveness). All interventions were compared to projected cases of stunting resulting from the current situation (e.g., no additional interventions). RESULTS: Three new policy options were identified. Operational feasibility for all three options ranged from medium to high. Compared to the current situation, two were similarly cost-effective, at an additional USD 598 and USD 667 per case of stunting averted. The third option was much less cost-effective, at an additional USD 27,741 per case averted. However, if donor agencies were to expand their support in option three to the entire country, the prevalence of 22.5 percent would be reached by 2025 at an additional USD 667 per case averted. CONCLUSIONS: A policy option involving immediate expansion of the current implementation of proven nutrition-specific interventions is feasible. It would have the highest impact on stunting and would approach the WHO 2025 target.

Awareness and Perceptions on Health Warning Labels on Cigarette Packs among Smokers: A Cross-Sectional Study.

BACKGROUNDS: Tobacco use is the leading preventable cause of premature deaths. Tobacco control remains a top priority, and health warning labels (HWLs) are one of the recommended methods. This study is aimed at examining the awareness and perceptions of HWLs on cigarette packs among smokers. METHODS: A cross-sectional study was conducted among 240 smokers who were randomly recruited from three townships in Mandalay in 2018. A face-to-face interview was done using a questionnaire. Multivariate logistic regression was used to analyse the data. RESULTS: About half were 18-40 years old; the majority were males (96.3%) and smokers (93.4%). Nearly all respondents noticed both pictorial warning and text messages, and about half could identify the current size of HWLs. Most of the smokers generally had positive perceptions and opinions on HWLS, and they strongly supported it. About 75% intended to reduce the number of cigarettes, and 18% were willing to quit within 6 months. Those who desired to reduce the number of cigarettes were more likely to quit within 6 months (aOR = 7.6, 95% CI 1.6-35.9 and aOR = 19.6, 95% CI 13.0-294.7 for those who had a little and strong desire, respectively). CONCLUSION: Awareness status and perceptions of the respondents were acceptable, and HWLs have motivated smokers to quit smoking. The Tobacco Control Program needs to strengthen the tobacco control law that prohibits selling loosies in order to maximize the benefits of HWLs.

Multimorbidity and health seeking behaviours among older people in Myanmar: A community survey.

BACKGROUND: The world population is aging very rapidly and the impact is more severe in developing countries because of insufficient resources and low awareness of the challenges faced by older people. This study aimed to explore multimorbidity of older people in Myanmar and their health seeking behaviours. METHODS: A community-based cross-sectional study was conducted in both urban and rural areas of Bago Region and Mon State during October 2016. A multistage sampling method was used to select 4,859 people aged 60 years and older. Participants were interviewed face-to-face using a questionnaire. Multinominal logistic regression was used to analyse data. RESULTS: More than half of the study participants (57.9%) reported at least one chronic condition in the last year and 33.2% reported two or more conditions (multimorbidity). The common conditions were hypertension (67.3%), arthritis (24.7%), arrhythmia (14.7%), coronary heart disease (13.8%) and diabetes (13.7%). A majority (61.7%) of participants with a chronic condition took western medicine. Older people usually saw a doctor (60.2%) or health assistant (21.9%) at a nearby clinic or rural health center; 1.6% reported seeing uncredentialed medical persons. Factors associated with multimorbidity were being female (adjusted Prevalence Ratio (aPR) = 2.14, 95% confidence interval (CI) 1.63-2.82) and having fair (aPR = 2.20, 95% CI 1.59-3.04) or poor self-reported health (aPR = 3.93, 95% CI 2.79-5.52). Those with less than middle school education (aPR = 0.50, 95% CI 0.25-0.99) and those living in rural areas (aPR = 0.78, 95% CI 0.62-0.98) were less likely to have multimorbidity. Older people in rural areas had less access to health care than their urban counterparts. CONCLUSION: Chronic conditions are common among older people in Myanmar, with higher prevalence in women and in urban areas. The lower prevalence of chronic conditions in those who live in rural areas may be related to living a more traditional lifestyle.