Salt Consumption Patterns and Iodine Nutrition Status of Pregnant Women in Coastal Region

Background: Maternal Iodine Deficiency Disorder can result in inevitable cretinism as well as miscarriages, stillbirth and low birth-weight babies. Objective: There is a need to find out contributing factors towards urinary iodine concentrations of pregnant women. Methods: Therefore, the cross-sectional, descriptive study was conducted to assess the patterns of salt utilization and iodine status of pregnant women living in coastal areas of Mon State in January and May, 2013. Result: A total of 144 pregnant women from Pa-Nga village and Kalokepi village in Thanbyuzayat township were asked by using structured questionnaires including age, parity, socioeconomic status and patterns of salt and iodine-rich foods (seaweed, fish, prawn) consumption. Casual urine samples were collected from each pregnant woman and urinary iodine concentrations were measured. Three samples each of the iodized salt and non-iodized salt from local markets were collected for determination of iodine content by the iodometric titration method. Only 83.3% of the study population consumed iodized salt and the remaining (16.7%) consumed non-iodized salt. The median urinary iodine concentration of the study population was 105 μg/L. The mean urinary iodine level of pregnant women who consumed iodized salt and that of pregnant women who consumed non-iodizes salt were 110.47 ± 67.34 μg/L and 95.83 ± 70.13 μg/L (P = 0.336). Iodine content of the iodized salt and non-iodized salt was 20.6 ± 9.2 ppm and 5.1 ± 1.2 ppm respectively. In conclusion, the median iodine level of pregnant women was lower than that of the optimal iodine nutrition for pregnant women, i.e., 150 - 250 μg/L and the mean iodine content of salt samples was lower than the permissible level of iodine in iodized salt, i.e., 30 - 40 ppm. Conclusion: Our findings indicate that iodine nutritional status of pregnant women in this area is insufficient and salt iodization needs to be monitored for the optimal iodine content in iodized salt.

Dual Burden of Malnutrition among Primary School Children in Myanmar

Background: The distribution of childhood nutritional diseases is shifting from a predominance of under nutrition to a dual burden of under-and over nutrition in low and middle income countries. Rapid economic development and urbanization lead to an increase in overweight and obesity and diet-related chronic diseases. The co-existence of under-and over nutrition is double burden and this is a public health challenge for community. Objective: To find out the nutritional status of primary school children. Method: The study was school based descriptive study and conducted during November 2014 to February 2015 in basic primary schools, basic middle schools and basic high schools in urban and rural area of Yangon, Mandalay, Taungyi and Mawlamyaing. A total of (2937) Grade IV and Grade V students were measured for weight, height and 592 students were measured for haemoglobin by standard equipment and standard procedure. Results: The overall prevalences of stunting, wasting, overweight, obesity and anaemia were 8.8%, 15%, 4.6% and 3.1% and 36.1% respectively. The prevalences of stunting, over weight and obesity were more prevalent in boys and wasting and anaemia were more prevalent in girls. The result showed that the stunting was more prevalent in rural than in urban (7.5% in urban and 12.0% in rural). The prevalences of overweight and obesity were higher in urban than rural area (overweight 5.3% in urban and 2.8% in rural, obesity 3.8% in urban and 0.9% in rural). Children residing in urban area had higher anthropometric parameter than rural children. Conclusion: The present study observed the coexistence of obesity, overweight and undernourishment (wasting and stunting) among Myanmar School children.The findings highlighted the need for continued health promotion efforts to improve nutritional status of primary school children.

Identification of <i>JAK2</i>(V617F) Mutation in Myeloproliferative Neoplasms by Using Allele Specific Polymerase Chain Reaction (AS-PCR)

Myeloproliferative neoplasms (MPNs) are a group of clonal haematopoietic stem cell disorders characterized by the proliferation of one or more myeloid cell lineages. According to WHO classification, the Janus associated kinase 2 (JAK2) V617F mutation is one of the major diagnostic criteria in BCR-ABL1 negative myeloproliferative neoplasms. The aim of this study is to detect the JAK2 (V617F) mutation in patients with myeloproliferative neoplasms to get accurate diagnosis and proper management. A total of 90 clinically diagnosed MPN patients attending to Department of Clinical Haematology, Yangon General Hospital were enrolled in this study. The mean age was 53.4 ± 14 years which ranged from 16 to 81 years old and male and female ratio was 2.4:1. The identification of JAK2 (V617F) point mutation was found to be positive in 44/90 MPN patients (48.9%). According to MPN subtypes, the JAK2 mutation positivity was found in 19 out of 46 polycythemia vera patients (41.3%), 17 out of 25 essential thrombocythemia patients (68%), 8 out of 15 primary myelofibrosis patients (53.3%), 0 of 4 others myeloproliferative neoplasms (0%). Confirmation of each of nine JAK2 mutation positive and negative samples was done by Sanger sequencing. The arterial or venous thrombotic attack was found in 32/44 JAK2 mutation positive cases (72.7%) and 12/44 JAK2 mutation negative cases (27.3%). The association between thrombotic attack and presence of JAK2 mutation was statistically significance with p = 0.000. The diagnosis of myeloproliferative neoplasms mainly relies on the molecular genetics according to WHO classification. The Allele specific PCR reaction is sensitive, simple test and relatively cost-effective. Therefore, the identification of JAK2 (V617F) somatic point mutation by AS-PCR should be implemented as a routine diagnosis procedure for patients with chronic and suspected myeloproliferative neoplasms.

Assessment of household ownership of bed nets in areas with and without artemisinin resistance containment measures in Myanmar

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.

Mapping and modelling the impact of mass drug adminstration on filariasis prevalence in Myanmar

Background:Lymphatic filariasis(LF)is endemic in Myanmar and targeted for elimination.To highlight the National Programme to Eliminate Lymphatic Filariasis(NPELF)progress between 2000 and 2014,this paper describes the geographical distribution of LF,the scale-up and impact of mass drug administration(MDA)implementation,and the first evidence of the decline in transmission in five districts.Methods:The LF distribution was determined by mapping historical and baseline prevalence data collected by NPELF.Data on the MDA implementation,reported coverage rates and sentinel site surveillance were summarized.A statistical model was developed from the available prevalence data to predict prevalence at township level by year of measurement.Transmission assessment survey(TAS)methods,measuring antigenemia(Ag)prevalence in children,were used to determine whether prevalence was below a level where recrudescence is unlikely to occur.Results:The highest baseline LF prevalence was found in the Central Valley region.The MDA implementation activities scaled up to cover 45 districts,representing the majority of the endemic population,with drug coverage rates ranging from 60.0%to 98.5%.Challenges related to drug supply and local conflict were reported,and interrupted MDA in some districts.Overall,significant reductions in LF prevalence were found,especially after the first 2 to 3 rounds of MDA,which was supported by the corresponding model.The TAS activities in five districts found only two Ag positive children,resulting in all districts passing the critical threshold.Conclusion:Overall,the Myanmar NPELF has made positive steps forward in the elimination of LF despite several challenges,however,it needs to maintain momentum,drawing on international stakeholder support,to aim towards the national and global goals of elimination.

Different challenges,different approaches and related expenditures of communitybased tuberculosis activities by international non-governmental organizations in Myanmar

Background:International non-governmental organizations(INGOs)have been implementing community-based tuberculosis(TB)care(CBTBC)in Myanmar since 2011.Although the National TB Programme(NTP)ultimately plans to take over CBTBC,there have been no evaluations of the models of care or of the costs of providing CBTBC in Myanmar by INGOs.Methods:This was a descriptive study using routinely-collected programmatic and financial data from four INGOs during 2013 and 2014,adjusted for inflation.Data analysis was performed from the provider perspective.Costs for sputum examination were not included as it was provided free of charge by NTP.We calculated the average cost per year of each programme and cost per patient completing treatment.Results:Four INGOs assisted the NTP by providing CBTBC in areas where access to TB services was challenging.Each INGO faced different issues in their contexts and responded with a diversity of strategies.The total costs ranged from US$140754 to US$550221 during the study period.The cost per patient completing treatment ranged from US$215 to US$1076 for new cases and US$354 to US$1215 for retreatment cases,depending on the targeted area and the package of services offered.One INGO appeared less costly,more sustainable and patient oriented than others.Conclusions:This study revealed a wide variety of models of care and associated costs for implementing CBTBC in diverse and challenging populations and contexts in Myanmar.Consequently,we recommend a more comprehensive evaluation,including development of a cost model,to estimate the costs of scaling up CBTBC country-wide,and cost-effectiveness studies,to best inform the NTP as it prepares to takeover CBTBC activities from INGOs.While awaiting evidence from these studies,model of CBTBC that have higher sustainability potential and allocate more resources to patient-centered care should be given priority support.

From control to elimination:a spatial-temporal analysis of malaria along the China-Myanmar border

Background: Malaria cases have declined significantly along the China-Myanmar border in the past 10 years and this region is going through a process from control to elimination.The aim of this study is to investigate the epidemiology of malaria along the border,will identify challenges in the progress from control to elimination.Methods:: National reported malaria cases from China and Myanmar,along with the data of 18 Chinese border counties and 23 townships in Myanmar were obtained from a web-based diseases information reporting system in China and the national malaria control program of Myanmar,respectively.Epidemiological data was analyzed,including the number of reported cases,annual parasite index and proportion of vivax infection.Spatial mapping of the annual parasite index(API)at county or township level in 2014 and 2018 was performed by ArcGIS.The relationship of malaria endemicity on both sides of the border was evaluated by regression analysis.Results: The number of reported malaria cases and API declined in the border counties or townships.In 2014,392 malaria cases were reported from 18 Chinese border counties,including 8.4%indigenous cases and 91.6%imported cases,while the highest API(0.11)was occurred in Yingjiang County.There have been no indigenous cases reported since 2017,but 164 imported cases were reported in 2018 and 97.6%were imported from Myanmar.The average API in 2014 in 23 Myanmar townships was significantly greater than that of 18 Chinese counties(P<0.01).However,the API decreased significantly in Myanmar side from 2014 to 2018(P<0.01).The number of townships with an API between 0 and 1 increased to 15 in 2018,compared to only five in 2014,while still four townships had API>10.Plasmodium vivax was the predominant species along the border.The number of reported malaria cases and the proportion of vivax infection in the 18 Chinese counties were strongly correlated with those of the 23 Myanmar townships(P<0.05).Conclusions: Malaria elimination is approaching along the China-Myanmar border.However,in order to achieve the malaria elimination in this region and prevent the re-establishment of malaria in China after elimination,continued political,financial and scientific commitment is required.

The contribution of a non-governmental organisation’s Community Based Tuberculosis Care Programme to case finding in Myanmar:trend over time

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.

Predictors of malaria rapid diagnostic test positivity in a high burden area of Paletwa Township, Chin State in Western Myanmar

Background:Despite major reductions in malaria burden across Myanmar,clusters of the disease continue to persist in specific subregions.This study aimed to assess the predictors of test positivity among people living in Paletwa Township of Chin State,an area of persistently high malaria burden.Methods:Four villages with the highest malaria incidence from Paletwa Town ship were purposively selected.The characteristics of 1045 subjects seeking malaria diagnosis from the four assigned village health volunteers from January to December,2018 were retrospectively analyzed.Their household conditions and surroundings were also recorded using a checklist.Descriptive statistics and logistic regression models were applied to investigate potential associations between individual and household characteristics and malaria diagnosis.Results:In 2017,the Paletwa township presented 20.9%positivity and an annual parasite index of 46.9 cases per 1000 people.Plasmodium falciparum was the predominant species and accounted for more than 80.0%of all infections.Among 1045 people presenting at a clinic with malaria symptoms,31.1% were diagnosed with malaria.Predictors for test positivity included living in a hut[adjusted odds ratios(aOR):2.3,95%confidence intervals(CI ):1.2-4.6],owning farm animals(aOR:1.7,95% CI:1.1-3.6),using non-septic type of toilets(aOR:1.9,95%CI:1.1-8.4),presenting with fever(aOR:1.9,95%CI:1.1-3.0),having a malaria episode within the last year(aOR:2.9,95%CI:1.45.8),traveling outside the village in the previous 14 days (aOR:4.5,95%CI:1.5-13.4),and not using bed nets(aOR:3.4,95%CI:2.3-5.1).There were no statistically significant differences by age or gender in this present analysis.Conclusions:The results from this study,including a high proportion of P.falciparum infections,little difference in age,sex,or occupation,suggest that malaria is a major burden for these study villages.Targeted health education campaigns should be introduced to strengthen synchronous diagnosis-seeking behaviors,tighten treatment adheren ce,receiving a diagnosis after traveling to endemic regi ons,and using bed nets properly.We suggest in creased surveillance,early diagnosis,and treatment efforts to control the disease and then to consider the local elimination.