DR. An Na has just returned to Beijing from a medical assistance program in Pakistan, and her warm smile and passion are infec- tious at first sight. An, a Chinese gynecologist, began working with her program, which i...DR. An Na has just returned to Beijing from a medical assistance program in Pakistan, and her warm smile and passion are infec- tious at first sight. An, a Chinese gynecologist, began working with her program, which is affiliated with Medecins Sans Frontieres （MSF - also called Doctors Without Borders） in Sierra Leone in 2011. But she is not the only Chinese physician working with the international medical and humanitarian non-governmental or- ganization （NGO）. In recent years, an increasing number of Chi- nese doctors have partnered with MSF to provide medical aid to the world＇s most in need.展开更多
Background:This study examined evolving malaria profiles from January,2010 to December,2014 to evaluate achievements and challenges of implementing measures to prevent and control spread of artemisinin resistance in M...Background:This study examined evolving malaria profiles from January,2010 to December,2014 to evaluate achievements and challenges of implementing measures to prevent and control spread of artemisinin resistance in Myanmar.Methods:Using National Malaria Control Programme(NMCP)data,a cross-sectional descriptive study of 52 townships in artemisinin-resistant containment areas in Myanmar was conducted.Annual program data were analysed,and trends over time are graphically presented.Results:In the 52 study townships populated by 8.7 million inhabitants,malaria incidence showed a decreasing trend from 10.54 per 1000 population in 2010 to 2.53 in 2014,and malaria mortalities also decreased from 1.83 per 100000 population in 2010 to 0.17 in 2014.The proportion of confirmed to total tested malaria cases also decreased from 6 to 1%,while identification of cases improved.All cases from all parasites species,including Plasmodium falciparum,decreased.Coverage of LLIN(long-lasting insecticidal net)/ITN(insecticide-treated mosquito nets)and indoor residual spraying(IRS)was high in targeted areas with at-risk persons,even though the total population was not covered.In addition to passive case detection(PCD),active case detection(ACD)was conducted in hard-to-reach areas and worksites where mobile migrant populations were present.ACD improved in most areas from 2012 to 2014,but continues to need to be strengthened.Conclusions:The findings provide useful data on the malaria situation in artemisinin-resistant initiative areas,which may be useful for the NMCP to meet its elimination goal.These profiles could contribute to better planning,implementation,and evaluation of intervention activities.展开更多
Background:Myanmar lies in the Greater Mekong Subregion where there is artemisinin-resistant Plasmodium falciparum malaria.As the artemisinin compound is the pillar of effective antimalarial therapies,containing the s...Background:Myanmar lies in the Greater Mekong Subregion where there is artemisinin-resistant Plasmodium falciparum malaria.As the artemisinin compound is the pillar of effective antimalarial therapies,containing the spread of artemisinin resistance is a national and global priority.The use of insecticide-treated bed nets/long-lasting insecticidal nets(ITNs/LLINs)is the key intervention for ensuring the reduction of malaria transmission and the spread of resistant strains,and for eventually eliminating malaria.This study aimed at assessing household ownership of,access to,and utilization of bed nets in areas of Myanmar with and without artemisinin resistance containment measures.Methods:Secondary data from a nationwide community-based malaria survey conducted by the National Malaria Control Program in 2014 were analyzed.Based on evidence of artemisinin resistance,Myanmar was divided into tiers 1,2,and 3:townships in tiers 1 and 2 were aggregated as the Myanmar Artemisinin Resistance Containment(MARC)areas and were compared with tier 3 townships,which were defined as non-MARC areas.The chi-square test was used to compare groups,and the level of significance was set at P≤0.05.Results:Of the 6328 households assessed,97.2%in both MARC and non-MARC areas had at least one bed net(any type),but only 63%of households had ITNs/LLINs.Only 44%of households in MARC areas and 24%in non-MARC areas had adequate numbers of ITNs/LLINs(one ITN/LLIN per two persons,P<0.001).Nearly 44%of household members had access to ITNs/LLINs.Regarding the utilization of ITNs/LLINs,45%of household members used them in MARC areas and 36%used them in non-MARC areas(P<0.001,desired target=100%).Utilization of ITNs/LLINs among children aged below five years and pregnant women(high malaria risk groups)was low,at 44%and 42%,respectively.Conclusions:This study highlights the nationwide shortfalls in the ownership of,access to,and utilization of ITNs/LLINs in Myanmar,which is of particular concern in terms of containing the spread of artemisinin resistance.It highlights the need for priority attention to be paid and mobilization of resources in order to improve bed net coverage and utilization through bed net distribution and/or social marketing,information dissemination,and awareness-raising.展开更多
Background:Myanmar lies in the Greater Mekong sub-region of South-East Asia faced with the challenge of emerging resistance to artemisinin combination therapies(ACT).Migrant populations are more likely than others to ...Background:Myanmar lies in the Greater Mekong sub-region of South-East Asia faced with the challenge of emerging resistance to artemisinin combination therapies(ACT).Migrant populations are more likely than others to spread ACT resistance.A vital intervention to reduce malaria transmission,resistance spread and eliminate malaria is the use of bed nets.Among seasonal and stable migrants in an artemisinin resistance containment region of Myanmar,we compared a)their household characteristics,b)contact with health workers and information material,and c)household knowledge,access and utilization of bed nets.Methods:Secondary data from community-based surveys on 2484 migrant workers(2013 and 2014,Bago Region)were analyzed of which 37%were seasonal migrants.Bed net access and utilization were assessed using a)availability of at least one bed net per household,and b)one bed net per two persons,and c)proportion of household members who slept under abed net during the previous night(Indicator targets=100%).Results:Over 70%of all migrants were from unstable work settings with short transitory stays.Average household size was five(range 1-25)and almost half of all households had children under-five years.Roughly 10%of migrants were night-time workers.Less than 40%of households had contact with health workers and less than 30%had exposure to information education and communication(IEC)materials,the latter being significantly lower among seasonal migrants.About 70%of households were aware of the importance of insecticide-treated bed-nets/long-lasting insecticidal nets(ITNs/LLINs),but knowledge on insecticide impregnation and retreatment of ITNs was poor(<10%).Although over 95%of households had access to at least one bed net,the number with one bed net per two persons was grossly inadequate(13%for stable migrants and 9%for seasonal migrants,P=0.001).About half of all household members slept under a bed net during the previous night.Conclusions:This study reveals important short-falls in knowledge,access and utilization of bed nets among migrants in Myanmar.Possible ways forward include frequent distribution campaigns to compensate for short transitory stays,matching household distributions to household size,enhanced information campaigns and introducing legislation to make mosquito repellents available for night-time workers at plantations and farms.Better understanding through qualitative research is also merited.展开更多
Background:It is estimated that the standard,passive case finding(PCF)strategy for detecting cases of tuberculosis(TB)in Myanmar has not been successful:26%of cases are missing.Therefore,alternative strategies,such as...Background:It is estimated that the standard,passive case finding(PCF)strategy for detecting cases of tuberculosis(TB)in Myanmar has not been successful:26%of cases are missing.Therefore,alternative strategies,such as active case finding(ACF)by community volunteers,have been initiated since 2011.This study aimed to assess the contribution of a Community Based TB Care Programme(CBTC)by local non-government organizations(NGOs)to TB case finding in Myanmar over 4 years.Methods:This was a descriptive study using routine,monitoring data.Original data from the NGOs were sent to a central registry within the National TB Programme and data for this study were extracted from that database.Data from all 84 project townships in five regions and three states in Myanmar were used.The project was launched in 2011.Results:Over time,the number of presumptive TB cases that were referred decreased,except in the Yangon Region,although in some areas,the numbers fluctuated.At the same time,there was a trend for the proportion of cases treated,compared to those referred,that decreased over time(P=0.051).Overall,among 84 townships,the contribution of CBTC to total case detection deceased from 6%to 4%over time(P<0.001).Conclusions:Contrary to expectations and evidence from previous studies in other countries,a concerning reduction in TB case finding by local NGO volunteer networks in several areas in Myanmar was recorded over 4 years.This suggests that measures to support the volunteer network and improve its performance are needed.They may include discussion with local NGOs human resources personnel,incentives for the volunteers,closer supervision of volunteers and improved monitoring and evaluation tools.展开更多
Background:Since 2005,the Myanmar National Tuberculosis Programme(NTP)has been implementing active case finding(ACF)activities involving mobile teams in hard-to-reach areas.This study revealed the contribution of mobi...Background:Since 2005,the Myanmar National Tuberculosis Programme(NTP)has been implementing active case finding(ACF)activities involving mobile teams in hard-to-reach areas.This study revealed the contribution of mobile team activities to total tuberculosis(TB)case detection,characteristics of TB patients detected by mobile teams and their treatment outcomes.Methods:This was a descriptive study using routine programme data between October 2014 and December 2014.Mobile team activities were a one-stop service and included portable digital chest radiography(CXR)and microscopy of two sputum samples.The algorithm of the case detection included screening patients by symptoms,then by CXR followed by sputum microscopy for confirmation.Diagnosed patients were started on treatment and followed until a final outcome was ascertained.Results:A total of 9349 people with symptoms suggestive of TB were screened by CXR,with an uptake of 96.6%.Of those who were meant to undergo sputum smear microscopy,51.4%had sputum examinations.Finally,504 TB patients were identified by the mobile teams and the overall contribution to total TB case detection in the respective townships was 25.3%.Among total cases examined by microscopy,6.4%were sputum smear positive TB.Treatment success rate was high as 91.8%in study townships compared to national rate 85%(2014 cohort).Conclusions:This study confirmed the feasibility and acceptability of ACF by mobile teams in hard-to-reach contexts,especially when equipped with portable,digital CXR machines that provided immediate results.However,the follow-up process of sputum examination created a significant barrier to confirmation of the diagnosis.In order to optimize the ACF through mobile team activity,future ACF activities were needed to be strengthened one stop service including molecular diagnostics or provision of sputum cups to all presumptive TB cases prior to CXR and testing if CXR suggestive of TB.展开更多
Background:National tuberculosis(TB)programs increasingly engage with international non-governmental organizations(INGOs),especially to provide TB care in complex settings where community involvement might be required...Background:National tuberculosis(TB)programs increasingly engage with international non-governmental organizations(INGOs),especially to provide TB care in complex settings where community involvement might be required.In Myanmar,however,there is limited data on how such INGO community-based programs are organized and how effective they are.In this study,we describe four INGO strategies for providing community-based TB care to hard-to-reach populations in Myanmar,and assess their contribution to TB case detection.Methods:We conducted a descriptive study using program data from four INGOs and the National TB Program(NTP)in 2013-2014.For each INGO,we extracted information on its approach and key activities,the number of presumptive TB cases referred and undergoing TB testing,and the number of patients diagnosed with TB and their treatment outcomes.The contribution of INGOs to TB diagnosis in their selected townships was calculated as the proportion of INGO-diagnosed new TB cases out of the total NTP-diagnosed new TB cases in the same townships.Results:All four INGOs implemented community-based TB care in challenging contexts,targeting migrants,post-conflict areas,the urban poor,and other vulnerable populations.Two recruited community volunteers via existing community health volunteers or health structures,one via existing community leaderships,and one directly involved TB infected/affected individuals.Two INGOs compensated volunteers via performance-based financing,and two provided financial and in-kind initiatives.All relied on NTP laboratories for diagnosis and TB drugs,but provided direct observation treatment support and treatment follow-up.A total of 21995 presumptive TB cases were referred for TB diagnosis,with 7383(34%)new TB cases diagnosed and almost all(98%)successfully treated.The four INGOs contributed to the detection of,on average,36%(7383/20663)of the total new TB cases in their respective townships(range:15-52%).Conclusion:Community-based TB care supported by INGOs successfully achieved TB case detection in hard-toreach and vulnerable populations.This is vital to achieving the World Health Organization End TB Strategy targets.Strategies to ensure sustainability of the programs should be explored,including the need for longer-term commitment of INGOs.展开更多
基金The Thyolo district HIV/AIDS programme is supported by Medecins sans Frontieres. EuropeAidla Direction Generale de la Cooperation au Developpement(Belgium Government)+6 种基金the Childrens Investment Fund FoundationELMA Foundationthe Global Fundthe International Union Against Tuberculosis and Lung DiseaseParisand the World Health Organization for their continuing support for HIV/AIDS activities in Malawi
文摘DR. An Na has just returned to Beijing from a medical assistance program in Pakistan, and her warm smile and passion are infec- tious at first sight. An, a Chinese gynecologist, began working with her program, which is affiliated with Medecins Sans Frontieres （MSF - also called Doctors Without Borders） in Sierra Leone in 2011. But she is not the only Chinese physician working with the international medical and humanitarian non-governmental or- ganization （NGO）. In recent years, an increasing number of Chi- nese doctors have partnered with MSF to provide medical aid to the world＇s most in need.
基金The program was funded by the WHO/TDR Impact grant to two TDR alumni from DMRThe funders had no role in study design,data collection and analysis,decision to publish,or preparation of the manuscript.
文摘Background:This study examined evolving malaria profiles from January,2010 to December,2014 to evaluate achievements and challenges of implementing measures to prevent and control spread of artemisinin resistance in Myanmar.Methods:Using National Malaria Control Programme(NMCP)data,a cross-sectional descriptive study of 52 townships in artemisinin-resistant containment areas in Myanmar was conducted.Annual program data were analysed,and trends over time are graphically presented.Results:In the 52 study townships populated by 8.7 million inhabitants,malaria incidence showed a decreasing trend from 10.54 per 1000 population in 2010 to 2.53 in 2014,and malaria mortalities also decreased from 1.83 per 100000 population in 2010 to 0.17 in 2014.The proportion of confirmed to total tested malaria cases also decreased from 6 to 1%,while identification of cases improved.All cases from all parasites species,including Plasmodium falciparum,decreased.Coverage of LLIN(long-lasting insecticidal net)/ITN(insecticide-treated mosquito nets)and indoor residual spraying(IRS)was high in targeted areas with at-risk persons,even though the total population was not covered.In addition to passive case detection(PCD),active case detection(ACD)was conducted in hard-to-reach areas and worksites where mobile migrant populations were present.ACD improved in most areas from 2012 to 2014,but continues to need to be strengthened.Conclusions:The findings provide useful data on the malaria situation in artemisinin-resistant initiative areas,which may be useful for the NMCP to meet its elimination goal.These profiles could contribute to better planning,implementation,and evaluation of intervention activities.
基金The program was funded by the World Health Organization/Special Programme for Research and Training in Tropical Diseases(WHO/TDR)Impact grant to two TDR alumni from the DMRThe funders had no role in study design,data collection and analysis,decision to publish,or preparation of the paper.
文摘Background:Myanmar lies in the Greater Mekong Subregion where there is artemisinin-resistant Plasmodium falciparum malaria.As the artemisinin compound is the pillar of effective antimalarial therapies,containing the spread of artemisinin resistance is a national and global priority.The use of insecticide-treated bed nets/long-lasting insecticidal nets(ITNs/LLINs)is the key intervention for ensuring the reduction of malaria transmission and the spread of resistant strains,and for eventually eliminating malaria.This study aimed at assessing household ownership of,access to,and utilization of bed nets in areas of Myanmar with and without artemisinin resistance containment measures.Methods:Secondary data from a nationwide community-based malaria survey conducted by the National Malaria Control Program in 2014 were analyzed.Based on evidence of artemisinin resistance,Myanmar was divided into tiers 1,2,and 3:townships in tiers 1 and 2 were aggregated as the Myanmar Artemisinin Resistance Containment(MARC)areas and were compared with tier 3 townships,which were defined as non-MARC areas.The chi-square test was used to compare groups,and the level of significance was set at P≤0.05.Results:Of the 6328 households assessed,97.2%in both MARC and non-MARC areas had at least one bed net(any type),but only 63%of households had ITNs/LLINs.Only 44%of households in MARC areas and 24%in non-MARC areas had adequate numbers of ITNs/LLINs(one ITN/LLIN per two persons,P<0.001).Nearly 44%of household members had access to ITNs/LLINs.Regarding the utilization of ITNs/LLINs,45%of household members used them in MARC areas and 36%used them in non-MARC areas(P<0.001,desired target=100%).Utilization of ITNs/LLINs among children aged below five years and pregnant women(high malaria risk groups)was low,at 44%and 42%,respectively.Conclusions:This study highlights the nationwide shortfalls in the ownership of,access to,and utilization of ITNs/LLINs in Myanmar,which is of particular concern in terms of containing the spread of artemisinin resistance.It highlights the need for priority attention to be paid and mobilization of resources in order to improve bed net coverage and utilization through bed net distribution and/or social marketing,information dissemination,and awareness-raising.
基金The program was funded by WHO/TDR Impact grant to two TDR alumni from DMR.The funders had no role in study design,data collection and analysis,decision to publish,or preparation of the manuscript.
文摘Background:Myanmar lies in the Greater Mekong sub-region of South-East Asia faced with the challenge of emerging resistance to artemisinin combination therapies(ACT).Migrant populations are more likely than others to spread ACT resistance.A vital intervention to reduce malaria transmission,resistance spread and eliminate malaria is the use of bed nets.Among seasonal and stable migrants in an artemisinin resistance containment region of Myanmar,we compared a)their household characteristics,b)contact with health workers and information material,and c)household knowledge,access and utilization of bed nets.Methods:Secondary data from community-based surveys on 2484 migrant workers(2013 and 2014,Bago Region)were analyzed of which 37%were seasonal migrants.Bed net access and utilization were assessed using a)availability of at least one bed net per household,and b)one bed net per two persons,and c)proportion of household members who slept under abed net during the previous night(Indicator targets=100%).Results:Over 70%of all migrants were from unstable work settings with short transitory stays.Average household size was five(range 1-25)and almost half of all households had children under-five years.Roughly 10%of migrants were night-time workers.Less than 40%of households had contact with health workers and less than 30%had exposure to information education and communication(IEC)materials,the latter being significantly lower among seasonal migrants.About 70%of households were aware of the importance of insecticide-treated bed-nets/long-lasting insecticidal nets(ITNs/LLINs),but knowledge on insecticide impregnation and retreatment of ITNs was poor(<10%).Although over 95%of households had access to at least one bed net,the number with one bed net per two persons was grossly inadequate(13%for stable migrants and 9%for seasonal migrants,P=0.001).About half of all household members slept under a bed net during the previous night.Conclusions:This study reveals important short-falls in knowledge,access and utilization of bed nets among migrants in Myanmar.Possible ways forward include frequent distribution campaigns to compensate for short transitory stays,matching household distributions to household size,enhanced information campaigns and introducing legislation to make mosquito repellents available for night-time workers at plantations and farms.Better understanding through qualitative research is also merited.
基金The program was funded by WHO/TDR Impact grant to two TDR alumni from DMR.The funders had no role in study design,data collection and analysis,decision to publish,or preparation of the manuscript。
文摘Background:It is estimated that the standard,passive case finding(PCF)strategy for detecting cases of tuberculosis(TB)in Myanmar has not been successful:26%of cases are missing.Therefore,alternative strategies,such as active case finding(ACF)by community volunteers,have been initiated since 2011.This study aimed to assess the contribution of a Community Based TB Care Programme(CBTC)by local non-government organizations(NGOs)to TB case finding in Myanmar over 4 years.Methods:This was a descriptive study using routine,monitoring data.Original data from the NGOs were sent to a central registry within the National TB Programme and data for this study were extracted from that database.Data from all 84 project townships in five regions and three states in Myanmar were used.The project was launched in 2011.Results:Over time,the number of presumptive TB cases that were referred decreased,except in the Yangon Region,although in some areas,the numbers fluctuated.At the same time,there was a trend for the proportion of cases treated,compared to those referred,that decreased over time(P=0.051).Overall,among 84 townships,the contribution of CBTC to total case detection deceased from 6%to 4%over time(P<0.001).Conclusions:Contrary to expectations and evidence from previous studies in other countries,a concerning reduction in TB case finding by local NGO volunteer networks in several areas in Myanmar was recorded over 4 years.This suggests that measures to support the volunteer network and improve its performance are needed.They may include discussion with local NGOs human resources personnel,incentives for the volunteers,closer supervision of volunteers and improved monitoring and evaluation tools.
基金The program was funded by WHO/TDR Impact grant to two TDR alumni from DMRThe funders had no role in study design,data collection and analysis,decision to publish,or preparation of the manuscript。
文摘Background:Since 2005,the Myanmar National Tuberculosis Programme(NTP)has been implementing active case finding(ACF)activities involving mobile teams in hard-to-reach areas.This study revealed the contribution of mobile team activities to total tuberculosis(TB)case detection,characteristics of TB patients detected by mobile teams and their treatment outcomes.Methods:This was a descriptive study using routine programme data between October 2014 and December 2014.Mobile team activities were a one-stop service and included portable digital chest radiography(CXR)and microscopy of two sputum samples.The algorithm of the case detection included screening patients by symptoms,then by CXR followed by sputum microscopy for confirmation.Diagnosed patients were started on treatment and followed until a final outcome was ascertained.Results:A total of 9349 people with symptoms suggestive of TB were screened by CXR,with an uptake of 96.6%.Of those who were meant to undergo sputum smear microscopy,51.4%had sputum examinations.Finally,504 TB patients were identified by the mobile teams and the overall contribution to total TB case detection in the respective townships was 25.3%.Among total cases examined by microscopy,6.4%were sputum smear positive TB.Treatment success rate was high as 91.8%in study townships compared to national rate 85%(2014 cohort).Conclusions:This study confirmed the feasibility and acceptability of ACF by mobile teams in hard-to-reach contexts,especially when equipped with portable,digital CXR machines that provided immediate results.However,the follow-up process of sputum examination created a significant barrier to confirmation of the diagnosis.In order to optimize the ACF through mobile team activity,future ACF activities were needed to be strengthened one stop service including molecular diagnostics or provision of sputum cups to all presumptive TB cases prior to CXR and testing if CXR suggestive of TB.
基金This study was funded by the Special Program for Research and Training in Tropical Diseases at the World Health Organization(WHO/TDR)Impact Grant given to two TDR alumni from the DMRThe funders had no role in the study design,data collection and analysis,decision to publish,or preparation of the paper.
文摘Background:National tuberculosis(TB)programs increasingly engage with international non-governmental organizations(INGOs),especially to provide TB care in complex settings where community involvement might be required.In Myanmar,however,there is limited data on how such INGO community-based programs are organized and how effective they are.In this study,we describe four INGO strategies for providing community-based TB care to hard-to-reach populations in Myanmar,and assess their contribution to TB case detection.Methods:We conducted a descriptive study using program data from four INGOs and the National TB Program(NTP)in 2013-2014.For each INGO,we extracted information on its approach and key activities,the number of presumptive TB cases referred and undergoing TB testing,and the number of patients diagnosed with TB and their treatment outcomes.The contribution of INGOs to TB diagnosis in their selected townships was calculated as the proportion of INGO-diagnosed new TB cases out of the total NTP-diagnosed new TB cases in the same townships.Results:All four INGOs implemented community-based TB care in challenging contexts,targeting migrants,post-conflict areas,the urban poor,and other vulnerable populations.Two recruited community volunteers via existing community health volunteers or health structures,one via existing community leaderships,and one directly involved TB infected/affected individuals.Two INGOs compensated volunteers via performance-based financing,and two provided financial and in-kind initiatives.All relied on NTP laboratories for diagnosis and TB drugs,but provided direct observation treatment support and treatment follow-up.A total of 21995 presumptive TB cases were referred for TB diagnosis,with 7383(34%)new TB cases diagnosed and almost all(98%)successfully treated.The four INGOs contributed to the detection of,on average,36%(7383/20663)of the total new TB cases in their respective townships(range:15-52%).Conclusion:Community-based TB care supported by INGOs successfully achieved TB case detection in hard-toreach and vulnerable populations.This is vital to achieving the World Health Organization End TB Strategy targets.Strategies to ensure sustainability of the programs should be explored,including the need for longer-term commitment of INGOs.
