Com
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maternal/ch
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Mon
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Wednesda
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2014 Room H
H2.41, Caulfiield Campus,, Monash Un
niversity Workkshop Absstracts
A Training Intervention involving Traditional Birth Attendants and Maternal Health
Outcomes in Magway Region
Dr. Aye Aye Oo
Public Health Field Training Center, Hlegu, Yangon, Myanmar
According to WHO (2008), maternal health refers to health of women during
pregnancy, childbirth and the post-partum period. Pregnancy and child birth and their
consequences are still the leading causes of death among reproductive women. Between
11% and 17% of maternal deaths happen during childbirth itself and between 50% and 71%
in the postpartum period. Women die from a wide range of complications in pregnancy,
childbirth or the postpartum period; however, the four major killers are: severe bleeding
(mostly bleeding postpartum), infections (also mostly soon after delivery), hypertensive
disorders in pregnancy and obstructed labor.
Myanmar is one of the South-East Asia countries and total population in 2011-2012
is estimated at 60.38 million with the growth rate of 1.01 percent. More than 70 percent of
the population lives in rural areas and over 60% of the total population constitutes mother
and children who are the most vulnerable group. Approximately 1.3 million women give
birth each year in Myanmar and according to the “Nationwide Cause-Specific Maternal
Mortality Survey” carried out by Department of Health in 2004-2005, maternal mortality
ratio was estimated at 200 per 100,000 live births at national level. Eighty nine percent of all
maternal deaths were reported from the rural areas and the complications during antenatal
and delivery periods were the causes of maternal mortality and morbidity; and 80% of
maternal deaths were mostly at home. The rate of deliveries attended by doctors, nurses and
midwives (skilled birth attendants) is 57%. Thirty nine percent of deliveries are attended by
traditional birth attendants, but this is higher in rural areas, where TBA attended births
account for 45.3 percent of deliveries.
Magway Region in central Myanmar and population in that Region is estimated at
4.4 million in 2013. There are 25 townships and 1696 wards and village tracts in Magway
Region. According to National Mortality Survey (1999), the maternal mortality ratio in
Magway Region was 286 per 100,000 live births that stood the eighth among the States and
Regions in Myanmar. Most deliveries take place at home especially in rural areas.
The WHO defines traditional birth attendant as a person who assists the mother
during childbirth and who initially acquired her skills by delivering babies herself or through
an apprenticeship to other TBAs. Traditional Birth Attendants lack of formal training and
governments and other organizations have conducted training programs to improve their
skills. Their role may include, in addition to birth attendance, bathing and massage,
domestic chores, and provision of care during the later post partum.
Since the 1970s the training of TBAs has been one of the primary single
interventions encouraged by World Health Organization to address maternal mortality.
However, since the 1990s international funding for TBAs has been reduced and the
emphasis has shifted to providing skilled birth attendants for all births due to evidence that
the maternal mortality ratio in developing countries has not reduced.
The study design of this program will be a randomized, controlled trial. Since the
intervention will include the training of traditional birth attendant. In the intervention
clusters, a team of obstetricians, medical officers, township health nurses, lady health
visitors and midwives trained traditional birth attendants. The training will be lasted five
days and involved the use of picture cards containing advice on antepartum, intrapartum and
postpartum care; how to conduct a clean delivery; use of disposable clean delivery kit; when
to refer women for emergency obstetrical care; and care of the newborn.
The primary outcomes of this program will be peri-natal mortality (still-births and
live-born babies who died within 28 days after birth) and maternal mortality (deaths during
pregnancy and up to 6 weeks post partum, excluding those known to have been due to injury
or accident) from any cause, including deaths after spontaneous abortion. The secondary
outcomes will be major complications of pregnancy (hemorrhage, obstructed labor,
puerperial sepsis, eclampsi, and abortion), referral by the traditional birth attendant for
emergency obstetrical care, type and place of delivery, and delivery attendant. Lady Health
Visitors who will record outcomes could not be blinded to the intervention status of the
women but will not be made aware of the main study objective or the outcome measures for
the planned comparison.
This program will reveal the significance of TBA training in rural areas and
highlight the significance of community awareness that will accompany TBA training and
make recommendations in order to enhance training outcomes.
A study on Predictors and Prediction Modeling of HIV incidence among men who have
sex with men and transgender in Yangon and Mandalay, Myanmar
Dr Aye Myat Soe
Burnet Institute, Myanmar
The HIV epidemics in Myanmar are said to be concentrated and are largely driven by key
populations, particularly female sex workers, men who have sex with men (MSM) and
people who inject drugs. As stated in the National Strategic Plan, the HIV epidemics are in
the declining phase, however, it still has one of the highest HIV incidence and caseloads in
Asia. The estimated number of people living with HIV would be approximately 182,252
with the prevalence of 0.45 in 2014. The overall new HIV infection is estimated to be 6,570.
Out of them, the male to male sex transmission would be 16%. According to the projection,
the incidence among MSM estimated was around 1,000 since 2010.
The estimation report described that infections among MSM remain relatively high
and the decrease is slower. Implementation of prevention activities on (MSM) in Myanmar
has been in progress but there is a large gap. Out of 240,000 estimated number of MSM,
only 68,067 were reached by prevention programs as of December 2012. The number of
MSM received HIV test were 12,694. The prevalence of MSM was (8.1%) shown in the
HIV sentinel surveillance survey 2012. Integrated behavioral survey on MSM was done in
2009, unfortunately, it is not published.
Unfortunately, there is uncertainty about the direction of prevalence among MSM
and transgender given limited data. Besides, there is no HIV incidence survey conducted,
but only the prevalence data is available. Thus, HIV incidence estimates are crucial in
understanding and predicting the HIV/AIDS epidemic and identifying sub-populations and
regions most at risk for the epidemic.
In the light of this, the identification of predictors and modeling of HIV
seroconversion among three main categories of MSM; open (apwint), closed (apone) and
young men (tha nge) and transgender will assist in estimation and improve the prevention
activities for MSM community.
The prospective cohort study will be conducted in Yangon and Mandalay
metropolitan areas where by many organizations are implementing the intervention
prevention program. The peer to peer recruitment process will be done. Baseline data of
knowledge, attitude and practice (KAP), sexually transmitted infection and their serostatus
will be recorded. All HIV seronegative MSMs will be followed from 2015 to 2016.
Interviews are conducted at the semiannual and end of the year and serostatus will be tested.
The predictors of HIV incidence among MSM and transgender will also be identified
and be understood the reasons for epidemics. Behavioral change communication and uptake
of HIV testing must be intensified. Decision making and the public health priority must set
for the MSM and transgender community with the aim of achieving “Three Zeros” – zero
new HIV infections, zero AIDS related deaths and zero stigma and discrimination.
Promotion of Knowledge and Perception on HIV/AIDS among Rural Female
Population of Reproductive Age in Magway Region through Effective HIV/AIDS
Related Health Education Program
Dr. Aye Sandar Mon
University of Community Health, Magway
HIV/AIDS has become a serious problem in Myanmar with an increasing trend in low risk
female population (infected female to male ratio was 1:8 in 1993, 1:1.9 in 2009 and
projected 1:1.6 by 2015). These women are largely the sexual partners of current and former
clients of female sex workers (FSW), intravenous drug users (IVDU) and men sex with men
(MSM). HIV epidemic is currently spreading from urban to rural areas, and from high risk
groups to the general population according to the UNAIDS report. Correct information is
essential for raising awareness and giving people the tools to protect them from infection.
That’s why the research, “Awareness of HIV/AIDS among Rural Females of Reproductive
Age in Yenangyaung Township, Magway Region”, was conducted at 2012. From that
research, it was found out that proportion of participants having comprehensive knowledge
on HIV among rural females was 23.3%. Moreover the findings indicated presence of
misconceptions was strongly related to discrimination towards PLHIV. Misconceptions
about HIV are common and can confuse the people and deter the prevention efforts. Since
the accurate knowledge of how HIV is transmitted and ways of preventing transmission is
one of the indispensable components for reducing the rate of HIV infection, the effective
HIV/AIDS related health education program will be provided for that area through health
staff at the grass root level such as midwives, public health supervisors and voluntary health
workers like auxiliary midwives (AMW). After two months of education program, the
operational research will be conducted for program evaluation applying pre-test and posttest study design. The results from operational research will reflect the effectiveness of the
program which will be measured by proportion of participants having comprehensive
knowledge and proportion of those having discrimination towards PLHIV.
Strengthening Capacity of MCH Workforce in Myanmar
Cho Thet Khaing
University of Public Health, Yangon
The population of Myanmar in 2011-2012 is estimated at 60.38 million of which about 60
percent are women and children. According to the Ministry of Health's data, maternal
mortality ratio and under-five mortality rates are high at 1.42 and 34.91 per 1,000 live births
respectively and significantly higher in the rural areas. In Myanmar health system, township
health system is the backbone and Township Health Department provides the primary and
secondary health care services down to the grassroots level. Under the Township Health
Department, there are Urban Health Center, School Health Team, Maternal and Child
Health Team, one to three Station Health Units and four to five Rural Health Centers
(RHCs) which are providing maternal and child health services. Under the guidance of
Township Medical Officers (TMO), basic health personnel are not only providing public
health, disease control and curative health services but also responsible for administrative
and managerial functions. However pre service training for them does not include full skills
and knowledge to address all competencies. Therefore one of the national strategies to
improve health status of mothers and children was strengthening capacity of basic health
staff through in-service training.
The aim of the program is continuing education of key management personnel in the
field (TMO and MCH medical officers, etc.) by certificate courses to update healthcare
knowledge and skills needed to work as leaders in MCH workforce. The course will be
designed to acquire skills for addressing particular MCH problems and customizing the
services to meet the diverse needs of local community. The trainees will be encouraged to
disseminate the knowledge and skills they gained when they return to their unit. This
program will support activities of maternal, neonatal and child health care in Myanmar.
Assessment on Effective service uptake through strengthening the linkages between
HIV prevention and MCH services in rural areas of Myanmar
Ei Ei Tin
Marie Stopes International, Myanmar
A comparative cross sectional descriptive study will be conducted to assess on effective
service uptake through strengthening of linkages between Human Immunodeficiency Virus
(HIV) prevention and Maternal and Child health (MCH) services in rural areas of Myanmar.
The importance of developing links between sexual and reproductive health and HIV
services is widely recognized. The international community agrees that the Millennium
Development Goals will not be achieved without ensuring access to Sexual and
Reproductive Health (SRH) services and an effective global response to the HIV epidemic.
There are wide range of HIV and Reproductive Health (RH) services and the linkages need
addressing to different levels not only to health sector but also to structural and social
determinants affecting RH and HIV. Integration is thought to increase access to and uptake
of health services and improves the efficiency and cost-effectiveness of services through
better use of available resources.
To reach the 2015 targets of reducing maternal mortality ratio and the infant
mortality rate in Myanmar, there is an urgent need for substantial investments to strengthen
both health systems and health human resources to deliver quality reproductive health
services including prevention and treatment of HIV/AIDS. In Myanmar, 70% of the
populations are in rural areas and those populations have to access a series of MCH and HIV
services from different service points. Therefore, despite the gradual progress made to
achieve MDG, the achievements for reproductive health indicators are still low compared to
the targets in 2015. The maternal mortality ratio is 200 per 100,000 live births with antenatal
coverage for one or more visits of 74.8% (2012). Contraceptive prevalence rate is 38.4% for
modern methods and unmet need for family planning services is 18%. Proportion of
pregnant women who undergo voluntary counseling and testing and receive results for HIV
is 59.3% and estimated proportion of pregnant women living with HIV receiving
antiretroviral prophylaxis during pregnancy is 69%.
Most of HIV infections in women are diagnosed during pregnancy and family
planning reduces maternal mortality and provides opportunity for testing and sexual risk
reduction counseling for HIV and sexually transmitted infections (STI). If the RH services
for safe motherhood and HIV prevention services are provided in one place, this single point
of care approach will lead to cost efficient use of limited human and financial resources and
will be more clients centered. Although many international agencies have called for stronger
linkages of RH and HIV services, the evidence for such linkages has not been rigorously
assessed. As there is very limited information on effectiveness in linkages of RH and HIV
services in Myanmar, this assessment on effective service uptake through linkages of RH
and HIV services will be conducted to fill the gap for evidence for increased uptake of RH
and HIV services in one stop service provision setting at rural areas.
In this assessment, RH services refer to antenatal care, post natal care, post abortion
care, family planning services, STI screening and treatment and HIV services refer to HIV
counseling and testing and education for HIV prevention including condom distribution.
Social Norms, Social Networks, and HIV Risk Behavior Among Injection Drug Users
in Myanmar
Dr. Kay Khine Linn
University of Public Health, Yangon, Myanmar
The severity of HIV/AIDS pandemic linked to injecting drug use is one of the most
worrying medical and social problems throughout the world in recent years. The HIV
epidemic in Myanmar also becomes one of the most serious faced in Asia. Although opium
cultivation has decreased significantly in recent years, Myanmar remains the second largest
producer of illicit opium in Asia, after Afghanistan and illegal drug use is rampant along
with the practice of injecting drug use. Heroin abuse predominates in the Kachin State, in
the Northern Shan State, and in the large cities – with an estimated 60,000 to 90,000
injecting drug users (IDUs) nationwide. The emergence of the HIV epidemic in Myanmar is
thought to be linked closely to injecting drug use. Indeed, HIV infection among IDUs in
Myanmar remains one of the highest in the world. HIV prevalence among IDUs peaked at
an alarmingly high 74% in 1993. Though IDUs prevalence declined sharply between 2001
and 2004, there was a gradual increase in the following years and it stabilized at around 40%
in 2005 and 2006. Gradual decrease can be seen 2007 onwards. Findings from the 2012 HIV
Sentinel Sero-surveillance Survey show that overall HIV prevalence among IDUs was 18%,
however this figure varies greatly depending on geographical distribution. The prevalence in
Yangon was 16.3%, Myitkyana (capital of Kachin state) was 29%, Tachileik was 17.8%
whereas it is 22% in Lashio. Given the concentrated nature of the epidemic, this proposal is
developed that puts focus on IDUs in high prevalence townships where the magnitude and
trajectory of the epidemic has the greatest potential for spread. There is a growing consensus
on the need for HIV prevention efforts to focus on structural factors that perpetuate risk and
impede harm reduction. There is a long-standing recognition of the role that social networks
and social norms have a strong influence on numerous health behaviors in the transmission
of HIV and other infectious diseases among IDUs. Social network structure and norms are
linked to HIV risk behavior. However little is known about the gradient of norm of HIV risk
that exists among social networks. In order to address these problems, this proposal intends
to examine the association between injection risk network structure and two HIV risk
behaviors: unprotected sex and needle-sharing behaviors. Hypothesis is that IDUs who
engage in riskier injection behavior with their network members would also endorse both
high-risk injection norms and high-risk sex norms, as compared to IDUs who reported being
in less riskier networks. It will be further sought to explore gender differences in these
associations. It will be a cross sectional analytical study. This study probably will offer
evidence that social norms of both sex and injection risks are relevant to IDUs in certain risk
network structures. These networks are important targets for interventions and the results
have several public health implications. These networks, however, may be resistant to the
larger normative influence of risk reduction and require greater intervention focus.
Understanding their relationship to sociometric network structure is important for both
blood-borne disease transmission and developing appropriate community-based
interventions. The findings will also suggest that networks are an important venue for
understanding social norms and potentially developing interventions to change network
norms.
Efficacy of mobile phone text messaging for promoting adherence to antiretroviral
therapy in patients with HIV infection in Myanmar: A case study of Meikhtilar
National AIDS Programme
Khin Moe Aye
United Nations World Food Program, Magway, Myanmar
HIV pandemic is a major health burden in Myanmar where an estimated 216,000 people are
living with HIV/AIDS. (NAP,2012). According to official data and records, approximately
half of the affected persons are currently receiving antiretroviral therapy (ART). While
regular checkup among HIV patients and adherence to ART are crucial for the treatment
success of HIV/AIDS, viral load control and risk reduction related to the pandemic, they
remain to be a challenge as in other parts of the world.
The use of mobile phone in HIV healthcare has been researched and proven the
positive outcomes in Kenya, Cameroon, Canada, China and many other countries. The
major advantages of mobile use in ART treatment include its capacity to serve a larger and
geographically diverse population as well as its ability for being customized if required. In
addition to that, the patients under study had expressed their appreciation on mobile service
as a form of the care from the health service providers. However, applicability of the mobile
technology for HIV-control in Myanmar context has not been explored until recently.
Especially, the price of mobile sim cards plummeted in Myanmar since the early 2013 and
mobile usage and coverage have been increasing so fast throughout the country. One
research company estimates Myanmar will grow up to 6 million smartphone users by 2017.
This dramatic increase of mobile phone usage and wider network coverage could be
effectively utilized in improving HIV/AIDS pandemic control.
The study intends to conduct a randomized controlled trial among some 2000
HIV/AIDS patients who are enrolled and getting treatment at the National AIDS Programme
in Meikhtilar, one of the HIV hotspots in Myanmar. Health messages and reminders for
drug-taking time will be provided by a health worker on regular basis and its effectiveness
will be explored in both qualitative and quantitative ways. Should the research proves the
positive outcomes on the adherence by using mobile technology, it will be disseminated to
the various stakeholders, thereby paving the way for future technology-friendly HIV/AIDS
control projects.
Quote: “Controlling the HIV pandemic is the managing of our future” (Aung San Suu Kyi,
Nobel Laureate and UNAIDS Goodwill Ambassador)
Workplace-based HIV program to out of school young and early adult people
Khine Khine Saw
Youth Development program, Myanmar Medical Association
In Myanmar, young people represents about 30 percent of the total
population and they are also a large population group, with widely varying
risk behaviours and vulnerabilities to reproductive health problems and
HIV/AIDS. They also include high risk population such as mobile
population and sex workers and their clients. Furthermore they have
limited access to reproductive health information and services which they
require or have to know. The most striking barrier is the cultural
sensitivity on talking about issues related to sexual and reproductive
system. Among young people, out of school young people early engage in
working places to earn money to support their families although they have
less education and low skill. Therefore many out of school young and
early adult people are increasingly on the move for social and economic
reasons to the commercial hub city, Yangon. The work places they engage
are in tea shops, garment factories, jetty, shoes factories and betel fruit
factories and in other low skill labour work places. In this context,
Yangon population is increasing and the city is now very congested.
According to the data from central statistical organization, population in
Yangon is 2.513 million in 1983 and 5.998 million in 2010. We expect
over 7 million in 2014 after the population census. More low skill labour
work places develop in Yangon, more out of school youth occupy in these
workplaces. In Behavioral Surveillance Survey 2008: Out of School
Youth, less than half (47.5%) of out-of-school youth aged 15-24 had
comprehensive knowledge about HIV – that is, were able to both correctly
identify ways of preventing the sexual transmission of HIV and reject
major misconceptions about HIV transmission. Progress report 2012,
National AIDS Program stated that young people out of school youth (1524) reached with HIV prevention programme in Yangon is 26,477 (% of
total reached nationally is 16.5%). The program coverage is not vigorous
and quite low because employers especially small business owners do not
have sound knowledge on the important of employee health status and
even they know it, they do not interest in workplace-based health
education program and can’t arrange the suitable time for peer health educators to
disseminate HIV/STI knowledge and information to their employee. Besides, almost all of
small businesses do not even offer health insurance. Therefore peer to peer workplacebased HIV/STI health education program is the best way to increase the knowledge about
HIV/STI among out of school young people and early adult group. This program aims to
reach more out of school young people and early adult group to HIV program and promotes
their health knowledge and health care seeking behavior to protect by themselves. This
program links them with service providers for HIV testing, STI services and other health
related services.
Improving access to family planning and maternal health care services in rural areas
by promoting the role of Auxiliary Midwives
Kyu Kyu Thinn
University of Community Health, Magway
Myanmar is a country with diverse socioeconomic backgrounds and over 130 ethnic groups
using different dialects resided in various geographic areas. So delivery of health services to
the whole country is quite a challenging issue for Myanmar health system. Maternal and
child health (MCH) is regarded as priority area and many efforts have been exerted to
improve maternal and child health status. According to the existing data, Myanmar is now
on track to achieve the Millennium development goals 4 and 5 but providing quality
reproductive health (RH) and MCH service to remote and hard to reach areas remain
challenging Myanmar health system due to some socioeconomic, cultural and geographic
barriers and limited resources for health sector. Most of the health care expenditure (more
than 80%) constitutes out of pocket payment and most people do not get health care at
affordable cost. Shortage of health manpower also contributes to poor health system
performance. In most rural and remote areas, midwife (MW) is the only available health
worker who is responsible for provision of various health services, maternal and child
health, disease control, environmental sanitation and other health programs in their areas. In
order to address this problem, some community members are recruited and trained as
auxiliary midwife (AMW) for assisting MW. AMWs share the same environment with their
community, so they are more familiar with local culture, customs, and traditional beliefs and
have more knowledge about the community and; are better than others for getting
community involvement. But they are volunteers and do not get regular payment or any
other form of assistance except those working in some project areas. So shifting some tasks
of MW to AMW and provision of some financial or material resources to AMW would
contribute to reduction of workload of MW and promotion of role of community health
workers to some extent.
This study aims to assess the utilization of family planning services and antenatal
care services in the study area before and after the intervention. The study will be conducted
in the remote rural areas with low health services utilization rate, insufficient number of
health workers and presence of AMW in the community. Family planning commodities
(condoms and oral and injection contraceptives) will be distributed to AMWs at subsidized
rate and medical equipments (weighing machine, sphygmomanometer, and stethoscope, etc)
will also be provided. Family planning and antenatal services will be given by AMW and
then the pregnant mother will be referred to skilled birth attendants (MW, nurses or doctors)
to get safe delivery and proper post natal care and child care. The expected benefit of this
study is improving access to RH and MCH services through increasing availability of
resources, providing services at affordable cost and creating user friendly environment.
Receiving family planning and antenatal care services from AMW would facilitate as an
entry point for safe motherhood and continuum of care in delivering quality health care
services.
Integrating the nutrition education into HIV/AIDS management
Dr. Moh Moh Hlaing
Department of Medical Research, Ministry of Health, Myanmar
The HIV/AIDS epidemic continues to have a devastating impact on health, nutrition, food
security and overall socioeconomic development in the countries that have been greatly
affected by the disease. Nutrition plays a critical role in comprehensive care, support and
treatment of HIV infected people( PLHIV) . HIV progressively weakens the immune system
and leads to malnutrition. Malnutrition worsens the effects of HIV and contributes to more
rapid progression to AIDS. When nutrition interventions, especially nutrition education and
counseling are integrated into HIV/AIDS programs, PLHIV’s nutrition knowledge,
attitudes and feeding practices of care givers are improved. An improved/good nutritional
status increases the opportunities for PLHIV to slow down progression of HIV to AIDS and
their ability to fight the disease and reduces their vulnerability to opportunistic infections.
Through improved KAP, PLHIV can ably plan to utilise the limited resources and modify
diets to boost their immunity, better manage the disease and improve response to ART and
other treatment. Myanmar is still need to do incorporate nutrition into care, support and
treatment for HIV-infected persons. Therefore, this study aims to integrate nutrition as an
essential component of the HIV/AIDS management. The general objective of the study is
to improve nutrition knowledge and dietary practice of HIV infected patients by nutrition
education. The study will be done with phase I (2014-2015) and phase II (2015-2016).In
phase I, nutrition knowledge and dietary practices of HIV infected patients (PLHIV) will be
assessed. Nutrition education guidebook for PLHIV will be also developed. In phase II,
PLHIV will get nutrition education with developed nutrition education guidebook. Nutrition
education guidebook will be also provided to caregivers and health staffs from AIDS/STD
prevention and control team. After 3 months of nutrition education, understanding, the
strengths and weakness of dietary guideline used in the nutrition education guide book
among HIV infected patients , care givers and health staffs from AIDS/STD prevention and
control team will be assessed. The results obtained from this project will provide data on
diet and nutritional status of PLWHA in Myanmar . Based on the findings, practical
recommendations for the nutritional care and support to the patients / care givers could be
given and can give the necessary information on nutritional aspects of PLWHA to health
care providers.
Factors influencing sustainable use of chlorine products to treat drinking water at
point-of-use in peri-urban households, Yangon Region
Dr. Su Latt Tun Myint
Epidemiology Research Division,
Department of Medical Research (Lower Myanmar)
Globally, 768 million people relied on unimproved drinking-water sources including
unprotected dug well, spring, cart with small tank/drum, surface water, and bottled water in
2011. Lack of access to safe water is having a disastrous impact on children across the world
because of shortage of water, poverty, and lack of education about the impact of drinking
unpurified water. Nearly, 2.2 million children die annually from water borne diseases.
Worldwide, the estimated 2.5 billion cases of diarrheal diseases are annually reported and
major contributors being unsafe drinking water, poor sanitation and unsatisfactory hygienic
conditions that can ultimately lead to 1.5 million deaths mostly among children under five
years of age. Treating household drinking water at the point-of-use (POU) could prevent
many of the infants and child deaths attributable to waterborne illness in developing
countries. Improvements in drinking water quality through household water treatment can
lead to a reduction of diarrheal episodes by 39%. The UNICEF-WHO 7 point strategy also
highlighted the role of households in safe water storage and treatment to reduce diarrhea in
children under-five years. Total population of 14,396,000 in Myanmar has lack of access to
improved water supply in 2008. Recently completed study in North Dagon Township,
Yangon found that integrated water, sanitation and hygiene strategies are likely to reduce
acute diarrhea and acute respiratory infections among under-five children. Expansion of
access to safe drinking water and sanitation by integrating interventions of household water
treatment and safe storage (HWTS), multiple health benefits and economic advantages can
be gained from broad public health approach. Apart from water storage, evidences are
required for existing water treatment practices at POU at households such as boiling,
filtration, flocculation/coagulation and chlorination within the differentials of water
infrastructure. Reported challenges by promoters of household water treatment included lack
of correct, consistent and sustained use. High adherence to water quality intervention is
essential for realizing potential health gains from household water treatment. Preliminary
analysis of most recently completed study in North Dagon Township revealed minimum
practice of household water treatment. Therefore, the proposed solution to this problem
involves promotion of use of low cost and effective sodium dichloroisocyanurate tablets
(AQUA TAB) which requires no electricity. Besides being sustainable, it is environmentally
friendly and easily implemented. The system eliminates bacteria, removes turbidity, has
strong potentials to remove other common surface and groundwater pollutants, requires no
extra equipment to store pure water and its application can be tailored to regional social and
cultural factors. Findings can be applied to formulate strategies for household compliance to
cost-effective POU water purification products and improved understanding of the
preferences for under-five children and challenges to overcome in unsatisfactory
environmental conditions.
Knowledge, Attitude and Practice of Family Planning By Rural Women and the
impact on family nutrition in Magway
Nan San Thidar Ohn
United Nations World Food Program, Magway, Myanmar
Individual family planning decision has impact on education and women empowerment that
can have strong intergenerational effects, demographic trends, social, economic and cultural
landscapes and family nutritional status.
There are 75% of total populations live in rural areas in Myanmar. By making research on
the family planning in the rural area would be the highlights for some underlying causes of
delayed development for family, society, institutions and state level.
Poor socio-economic and failure of family planning put women to unsafe abortion and/or
big families’ members where resources are scarce. There is no enough land for all of them to
grow the food their families need and limited resources for new generation, as most of the
rural areas depends on agricultural income. This situation creates poor consumption, poor
diet and poor nutrition. Women and children are most vulnerable during in food insecurity
situation. There is a linkage between lack of family planning and undernutrition, as children
nutrition status could affected by short birth spacing interval (less than two years), multiple
child birth in a family, and financial status and family members. This study will measure the
extent of the affect on children nutritional status by lack of family planning among rural
families in Magway region.
In Myanmar, Contraceptive prevalence rate (%) was 39.5 and unmet need for family
planning (%) was 24.2 in 2010 in Myanmar (Source: FRHS, MICS, IHLCA- Health in
Myanmar). In Magway region, wasting prevalence was 10.4% and stunting was 36% in
2009-2010, according to Government of Myanmar and UNICEF, 2011 MICS survey.
The target groups for the research are married women of reproductive age (age
within 18 years to 45 years), children under 2 year, midwives and traditional birth
attendants. This research paper aims to be able to identify the knowledge, attitude and
practice of family planning, to explore relationship between the utilization of family
planning and undernutrition. This research will support the information to the organizations
and health providers to promote access to family planning and effective use of contraceptive
methods in rural area which will contribute to family food security and nutritional status of
children in the country.
Treatment adherence of the people living with HIV who are receiving ART in Yangon
Region: Mixed methodology
Ni Ni Aung
Military Institute of Nursing and Paramedical Sciences
Treatment adherence is an essential issue especially for the patients who need long term
treatment. Poor adherence on prescribed therapy leads the patients to face with drug
resistant, disease complications and decreased life expectancy. Moreover, poor adherence
enhances disease burden not only to the individual and family but also to the community,
and health care system. In developed countries, adherence to long-term therapies in the
general population is around 50% and is much lower in developing countries (WHO, 2003).
Patients receiving ART with poor support for full adherence are likely to develop
treatment failure and ARV resistance virus. Strict adherence to ART is fundamental issue
for sustained HIV suppression, decreased risk of drug resistance, improve quality of life and
survival (WHO, 2003; Chesney, 2006) as well as reduced risk of HIV transmission (Cohen,
Chen, McCauley, et.al, 2011). This is also a potentially major threat of disease related
socioeconomic problems to patient, family and society. Although the retention rates are
initially high among the people who start ART, later those rates gradually decline. Among
23 countries with cohorts of at least 2000 people on ART indicate that the average retention
rates decrease from about 86% at 12 months to 82% at 24 months and 72% at 60 months
(Fatti, Grimwood & Bock, 2010). This finding pointed out the need of appropriate
intervention for poor treatment adherence on ART.
To provide effective treatment for the people living with HIV, the effective
adherence support mechanisms should be intensified. Thus, factors affection treatment
adherence of the people living with HIV on ART should be identified first. There are many
factors influencing on treatment adherence of the people living with HIV such as treatment
related hunger, the burden of out-of-pocket expenses, side effects of medication, long
waiting times at the treatment centres, and fear of stigma and discrimination in the
workplace, the community as well as their families (Hardon, Davey, Gerrits, Hodgkin,
Irunde, Kgatlwance, & et.al., 2006). These factors may be varied from one country to
another and also different between the cultural contexts.
Aiming to provide patient centred care and effective support for the people living
with HIV, factors affecting treatment adherence of ART and their feeling experiences on
receiving ART should be disclosed from both the patients and care provider perspectives. In
Myanmar, there is no study on addressing the factors affecting the treatment adherence of
ART despite of proving health care services for those people. Thus, the proposed study aims
to identify the factors affecting treatment adherence of the people living with HIV who
receiving ART in Myanmar.
Promoting Awareness of Safe Motherhood among Pregnant Women by Community
volunteers in rural area of Myanmar
Dr Soe Ohnmar Khin
University of Medicine, Yangon
In Myanmar, crude birth rate was 16.6 per 1,000 populations and maternal mortality ratio
(per 1000 live births) was 1.54 in 2010 in rural area. Antenatal care coverage (at least once),
proportion of births attended by skilled health personnel and basic health staff were 74%,
67.1% and 51% in 2011 (DHP, 2013). But, the second leading cause of morbidity was other
complications of pregnancy and delivery in 2011 (MOH, 2013). Most of the maternal deaths
are preventable. Lack of information and cultural practices are the contributing factors that
prevent pregnant women from receiving or seeking care during pregnancy, child birth and
postnatal period. Currently, midwives are providing (MCH) service for rural community
with support of auxiliary midwives. With current demands of health care programs, midwife
has other responsibilities such as immunization, disease control, nutrition promotion, water
and environmental sanitation, etc, exploiting some of their time allotted for attending births.
In order to institute an effective safe motherhood program at the grass root level, Myanmar
has recommended the ratio of one midwife to every 5,000 population but in some areas a
midwife practically covers more than 15,000 to 20,000 populations (DOH/ UNICEF, 2005).
Inadequate health work force at different levels and over workload of BHS especially
midwives are challenges to provide effective MCH services in Myanmar particularly in rural
area. Consequently, they may have less chance of giving enough health education about safe
motherhood to the attending pregnant women during ANC visit. Community volunteer like
maternal and child health promoters were developed to overcome the challenge that limited
access of the people to MCH services and information especially in rural and remote areas
(MOH, 2013). But, there is little coverage. Maternal health services need to be focused on
rural women and women with little or no education by further intensification of information,
education and communication activities on “safe motherhood” (Kyi Kyi Sein, 2012).
Therefore, a community based intervention study on promoting awareness of safe
motherhood among pregnant women is needed to conduct in rural area to assess the
effectiveness of community based health education. The trained community volunteers will
be used because they have long social relationship, social convenience, same cultural
background and language. Having awareness about safe motherhood would motivate
pregnant women to take regular AN visit, deliver by skilled birth attendant, PN care, birth
spacing and then can prevent both maternal and newborn deaths.
Feminist perspectives of Kayin married women towards their sexuality and
reproduction
Aye Su Su Win
Military University of Nursing and Paramilitary Sciences, Yangon, Myanmar
As a unique individual, every woman needs to make decisions over her own body to become
a fully empowered participant in society. Control over women’s sexuality and reproduction
is also the neglected violation of human rights. It can affect women’s sexual and
reproductive health in some ways. Interim Country Partnership Strategy in Myanmar, 20122014, stated that women in Myanmar enjoy equal rights in inheritance laws and equal
marital property rights in the case of divorce. However, patriarchal cultural values related to
women’s roles and responsibilities still shape familial relationships, contribute to the
gendered division of labour and limit women’s participation in decision making at all levels.
High maternal mortality ratio and insufficient access to reproductive and basic health
services, low levels of women’s participation in public decision making and in the labour
market, increasing HIV among women are described as key issues of concern for that
strategy. In Myanmar, MMR was 240/100,000 live births in 2008 (Ministry of Health, 2011)
and 5% of all pregnancies ended in abortion (UNFPA, 2007). Moreover, women comprise
50% of people living with HIV in Myanmar (WHO, 2013) and 35% of people living with
HIV between 15 to 49 years of age was female in 2009 (UNAIDS & WHO, 2009). In
Myanmar, contraceptives can be provided only in 109 out of 324 townships of the country
with international support (Ministry of Health, 2008). These data highlighted the importance
of the reproductive rights and reproductive health of women in Myanmar and it is also
necessary to have qualitative information like feelings and experiences of women regarding
the reproductive rights that would be effective in planning the need-based implementation to
ensure the reproductive health of women. Gender disparities are more marked in rural areas
and among some ethnic groups (Interim country partnership strategy: 2012-2014 Myanmar,
n.d.). Feminism provides a framework by which differences such as gender and culture may
be incorporated into the design of nursing research. Therefore, it is proposed to conduct
feminist research on women from Kayin ethnic group to understand their voices upon their
sexuality and reproduction. Data will be collected using individual interviews and focus
group discussions to gain deeper understanding and hence to produce social change in such
a group of women. The more women’s voices are heard, the more their status in society can
be enhanced approaching to enjoy gender equality and leaving gender disparity in
reproductive rights followed by reducing MMR, decreasing number of women living with
HIV, reducing adolescent fertility rate, and increasing use of contraceptives.
Effectiveness of HIV prevention training among high school students in Yangon
Dr Wai Hnin Aye
Department of Preventative and Social Medicine,
University of Medicine, Yangon, Myanmar.
Myanmar is experiencing a rapid increase in HIV/AIDS infections .Young people are at the
centre of this epidemic. Estimated HIV prevalence of age 15-49 was 0.6% from ‘Report on
the Global AIDS Epidemic” UNAIDS (2010). In addition to HIV/AIDS, youth are faced
with many challenges including other sexually transmitted infections; alcohol, tobacco and
other drug use. So young people are needed to be protected from these issues.HIV/AIDS and
sexual health curriculum developed by the School based Healthy Living and HIV/AIDS
Prevention Education Project (SHAPE) was published in March 2000 for reversing of above
issues. Programs on HIV prevention in schools have been conducted by the School and
Youth Health Project in collaboration with National AIDS Programme. It has now practiced
in nationwide. The data from United Nations Educational, Scientific, and Cultural
Organization Institute for Statistics, Youth (ages 15-24 years) literacy rate was 95.82 % for
2010. So high literacy rate can be apply for target of HIV prevention area of school youth.
Schools become appropriate environments for undertaking of activities which can promote
HIV-related risk reduction among the students.
However some difficulties that encountered in SHAPE activities are high rates of
teacher absenteeism, existing curriculum overload. Also the teachers have lack of
motivation and skills to persuade of a participatory approach. Poor distribution of SHAPE
materials and cost of teaching materials are also factors for reluctant. The major thing is
unwillingness of the teachers to talk about sex in the classroom context. With more freedom
and independence than the present cultural norms, many young people may explore their
reproductive knowledge .Such behaviours are so important in the process of changing to
adult and can also reduce their potential risk for HIV.However, health education is non-core
subject that is not graded or examined. In some schools, despite the policy, they may not be
taught at all. So exploring the knowledge and attitude of high school students about HIV
prevention may give their protective sense for it.
After getting agreement of the school principal, school based multistage sampling
method with pre-test post-test quasi experimental study will be used. The questionnaires
consist of socio-demographic character, knowledge and attitude on transmission and
prevention of AIDS. Based on the finding, gap of knowledge and attitude in pre-test
questionaries will be noted. Educational session of AIDS will be led by the investigator or
trained teacher for two hours per month.After intervention their knowledge and attitude
status will be tested and compared with pretest.
For focusing the students, teacher and parent’s engagement in adolescent
reproductive health, three groups of in-depth interview will be done, one group with 9th
standard students, one group with adolescents’ parents and another group with teacher who
give training.The IDIs covered three main topics: the respondents’ perceptive about
adolescent reproductive health, the responsible person for adolescent reproductive health
and respondents’ suggestion for effective implementation of this service.
By doing this study, it will expect that SHAPE will be empowering strategy to health
promotion and prevention of adolescent to protect HIV.
Knowledge, Attitude and Risk Behaviour of HIV/AIDS Among Adolescents Within
Myanmar Population at Muse Urban Area
Dr. Win Aye Hlaing
University of Public Health, Yangon, Myanmar
In Myanmar, the first HIV positive case was detected in 1988 and the first AIDS case in
1991. Total HIV positive cases among adolescent age group from 1988 to June 2006 were
2374 cases. Among them, 1049 cases were male and 1325 cases were female. Acquired
immunodeficiency syndrome was still remaining the first single leading causes of mortality
(6.3%) in 2011. Globally, the people living with HIV were about 35.3 million in 2012.
There was (33%) decline in the number of new infections from 3.4 million in 2001 to 2.3
million in 2012. At the same time, the number of deaths by AIDS was also decreasing from
2.3 million in 2005 to 1.6 million in 2012.
In 2012, about 2.1 million of adolescents were living with HIV in low and middleincome countries. Data on young adolescents was very limited, resulting in little information
on progress toward preventing new infections or averting deaths for the adolescent age
group. In Myanmar, specific data among adolescent age group is still needed for
comprehensive knowledge, attitude and risk behavior about HIV/AIDS. There is the cultural
barrier on reproductive health among Myanmar adolescent population. This age group did
not get the adequate knowledge on reproductive health before and during their adolescent
age. Therefore, they need to know of risk behavior of HIV/AIDS. In recent years, political
transition and open market trade occurred in Myanmar. It favors the interchanging social
network between different countries and Myanmar leading to reproductive health problems.
Reproductive health program had just been beginning in our country but there is still needed
to analyze the achievement of the program. It can highlight the situation of the reproductive
health problem and can contribute evaluation of this program. In order to address these
problems, this proposal intends to determine the level of knowledge, attitude and risk
behavior of HIV/AIDS and association between these factors among adolescent age group at
Muse urban area. A community based cross-sectional descriptive and analytic study will be
done on the assessment of knowledge, attitude and risk behavior of HIV/AIDS among
adolescents within Myanmar population at Muse urban area in 2014. From the study, the
expected outcomes are to promote the awareness and perception of HIV/AIDS among
adolescent age group which can cause the behavioral change and get the healthy lifestyle, to
reduce the transmission of HIV/AIDS and to promote the level of health knowledge and
attitude of adolescent population on HIV/AIDS in this area more than this.
Effectiveness of food support to HIV infected patients who are on ART in Yangon
region and Shan state, Myanmar
Dr. Suu Hlaing Aye
United Nations World Food Programme, Myanmar
As a developing country, access to adequate and nutritionally-balanced food in Myanmar
remains a major challenge for the poorest and most vulnerable people, especially in rural
border areas. According to the IHLCA 2011, twenty-six percent of the population live below
the poverty line and close to three million people are considered “food poor”. This figure
remains considerable disparities between geographic areas and between socio-economic
groups though.
According to the Global AIDS Response Progress Report - 2012, it is estimated that
around 216,000 people were living with HIV in Myanmar in 2011. Similar to most Asian
countries in the region, the HIV epidemic in Myanmar is characterized by high HIV
prevalence rates in most at risk groups: injecting drug users, men who have sex with men,
and sex workers and their clients. In combination with the food insecurity and HIV
infection, many people living with HIV might suffer malnutrition in Myanmar.
Globally, United Nations World Food Programme (WFP) is the convening agency
for food and nutrition in the UNAIDS division of labour since 2004, to make sure that food
and nutrition support are integrated into national plans and programmes for PLHIV. WFP
Myanmar has been providing the food assistance to PLHIV on anti-retroviral therapy (ART)
to access the treatment and improve treatment outcomes since 2010. In 2013, 8796 ART
clients received nutritional food supplement and five percent increase in ART adherence rate
in 2013 with compare to 2012. Although the result of adherence rate is quite satisfactory, the
effectiveness of the programme still need to be reviewed to assess the improvement of the
nutritional and health outcomes of the HIV infected people. This study will assess how this
programme benefits nutritionally on the ART patients. The objectives of this study will be:
 To study the effectiveness of the food support programme to HIV infected
patients in Yangon region and Shan state
 To measure the improvement of the nutritional status of the PLHIV on ART after
6 months duration of food support
 To compare the nutritional knowledge of PLHIV after the interventions of
nutrition education and counselling
The study will be interventional study by using both quantitative and qualitative
research methods.
It is believed that the results come out from this study will be used as the evidence in
the policy or decision making at country level, to review the current project outcomes and
will gain the better knowledge for the design & implementation of the future programmes.
Sexual and Reproductive Health related Quality of Life among HIV infected
Adolescents in Myanmar
Dr. Thida Kyaw
Marie Stopes International, Myanmar
HIV/AIDS is a chronic infection that transcends the biological domain and affects social
relations, mental health, financial aspects and quality of life.Myanmar Annual HIV/AIDS
progress report 2012 mentioned that 0.71% of young people are infected HIV infection
(HSS 2012). A total of US$ 263,884 was spent on this programme, which was far less than
the amount spent in 2011 (US$ 1,886,310). Expenditure per unit decreased dramatically
from US$ 29 to US$ 2 .While adolescents are sexually active they will face to social and
health problems such as, stigma , discrimination, limited information and quality SRH(
Sexual and reproductive health) services accessibility. Unmet needs on Sexual and
Reproductive issues are still struggling in Myanmar. Comprehensive SRH services for
PLWH( People Living With HIV) is including addressing preventing unintended
pregnancies, planning for safe and desire pregnancies. Many CSOs( Civil Society
Organizations) works SRH awareness raising activities to different targeted and risk group
including youth .Lack of appropriate words in the indigenous language about Sexuality,
Gender are potentially contributes to knowledge gap on sexuality education of the
community. Living with HIV is likely to be particularly difficult in terms of negotiating
relationships and sexual situations, as well as concerns regarding future pregnancy; thus, this
may be an important focus for caregivers in clinical settings or important facets of Health
Related Quality Of Life to assess in outcome . Worldwide, Sexual and Reproductive Health
problems remain the leading cause of ill health and death for women of child bearing age.
To date, published data on health care transition, behavior studies for HIV-positive youth
are limited.
This proposed study will be explored to assess the perception of SRH related Quality
Of Life in youth PLWH and to know the effectiveness of current HIV /AIDS Self Help
Groups social activities involved in National HIV/AIDS intervention programs which
concern on adolescent reproductive life. A cross sectional descriptive study will be
conducted in HIV positive adolescents and adolescents who do not know their HIV status
(age 18 to 24 years) of Mon state in Myanmar.
Governments of nations have goals to make their country more developed and their
citizens more healthy and happy. The Ministry of Health in Myanmar has objectives “to
enable every citizen to attain full life expectancy and enjoy longevity” and “to ensure that
every citizen is free from disease”. To fulfill these objectives, and in accordance with the
National Health Policy, the government is giving priority to the implementation of
programmes to improve reproductive health and well-being of citizens. Orphan Vulnerable
Children are now growing up to adolescent age and their SRH status should be considered.
This study will fill up the gap in community initiatives activities in HIV prevention
programs. Moreover that will advocate to policy makers to integrate social and behavior
science knowledge in capacity enhancing of health care service providers in terms of
addressing the Adolescent Reproductive Health of HIV infected youths in Health policy
reform.