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Control of trachoma and prevention of blindness in rural communities in Burma.

Trachoma was identified as the single most important cause of blindness in central Burma in a study carried out in 1961-1962. Control measures started in 1964 considerably reduced the degree of endemicity and severity of the disease in the areas treated. According to recent simplified criteria of evaluation, the prevalence of active trachoma has been reduced by more than 60% and that of active inflammatory disease of moderate and severe intensity from 7.4% to 1.8% of the active cases. A reduction in the risk of becoming infected is evident from changes that have occurred among the younger age groups.The experience acquired by the trachoma control project in central Burma-covering a population of more than 4 million in 8000 villages-emphasizes the importance of the active participation of the community and the role of local auxiliary personnel. Most of the activities, including surgical repair of trichiasis, are the responsibility of health assistants; their training includes, in addition to the recognition and treatment of patients requiring topical application of antibiotics or surgical repair of trichiasis, the screening and referral to the general practitioner or to the eye specialist of those needing more specialized attention.The results already obtained have made possible a gradual replacement of control activities by a surveillance programme, and their integration into the basic health services. The objectives of the trachoma control programme have been expanded to include the prevention and management of other causes of preventable or curable blindness, with special emphasis on eye injuries and glaucoma.

Adolescent↗

Veterinary experiences as a Japanese prisoner of war and ex-POW along the Burma railroad from 1942 to January 1946.

As a prisoner of war the writer was working for nearly three years in different POW camps, and outside them, along the Burma railway from Thanbyuyzat in southern Burma up to Kanchanabury in Thiland. In the army of the Netherlands-Indian archipelago (KNIL) he had the military rank of reserve horse-doctor. In civilian life he was attached to the Veterinary Institute in Buitenzorg(now Bogor) as a veterinary bacteriologist. His task as a POW became that of meathygienist and supervisor of the living animals in the camps. In this function he diagnosed swine fever in growing pigs which had mainly been fed on the offal of the Japanese kitchen. The acute course and the pathological alterations observed during the post-mortem examinations were identical with those of the Southern-African type of the disease. In slaughter cattle the author diagnosed some cases of lung tuberculosis, one of anthrax, several of rinderpest, some of rhinal granulomatosis and one of foot and mouth disease. In chickens he found NCD (pseudo-fowlpest) and in ducklings a mortal disease which the author then called 'keeling disease' but which he many years later, recognized as virus hepatitis. As assistant bacteriologist and ex-POW he joined the British regimental hospital in Bangkok. Here he had the apportunity to assist the bacteriologist pathologist, Maj. C. R. Peck IMS/IAMC in diagnosing the first case of melioidosis in an ex-POW of the KNIL who died from the sub-acute infection, notwithstanding treatment in the hospital with sulfa-drugs and penicillin.

Concentration Camps↗

A study on the aetiology of endemic goitre in lowland Burma.

The prevalence and aetiology of lowland endemic goitre was studied in Bawlle Village, Htan-ta-bin Township, Rangoon Division. The total goitre rate was found to be 40.9 per cent. Low urinary iodine excretion and high 24-h uptake of 131I by the thyroids of the subjects indicated iodine deficiency which was further confirmed by direct chemical analysis of diet samples. The serum thiocyanate level of non-smokers from this area was found to be low, which indicates that dietary goitrogens do not appear to play a role in the aetiology of endemic goitre in this area. The iodine content of water was also very low and the iodine content of soil was also about 10 times lower than soil samples from urban Rangoon. Thus, the present study indicates that the aetiology of endemic goitre in lowland Burma is due to environmental iodine deficiency, the same aetiological factor as in hilly regions of Burma.

Adolescent↗

Differences in the severity of physical signs in the right and left eyes of patients with trachoma in Syria and Burma.

A field record card to permit the recording of physical signs separately in the two eyes, in cases of trachoma was produced by WHO in 1967. The card was used to record clinical examinations in a controlled trial in Syria in 1967 and in the running assessment of a trachoma control programme in Burma in 1968-69.Differences in physical signs in the two eyes were observed in over 20% of cases in Syria and over 35% of cases in Burma. Even when limited to the same stage of infection, differences between the two eyes in the same individual are in the order of 10%. Limiting the examination to one eye underestimates prevalence and severity and overestimates changes in the disease pattern with time; a combined reading for both eyes should give a more accurate picture of infection. A computer could be used in special studies to free the observer from the need to make subjective judgements concerning the more severely affected eye.

Child↗

Endemic goitre in lowland Burma.

The problem of endemic goitre in Burma was thought to be confined to hilly regions and therefore goitre control programme has been focussed on these areas only. However, sporadic evidences accrued that there might also be pockets of endemic goitre in low-lying areas of the country. Goitre surveys and indepth study were carried out to determine the magnitude and nature of endemic goitre in lowland Burma. The overall goitre rate was 67% and the male:female ratio was 1:1.2. The findings of the study indicate that the problem of endemic goitre is also of public health significance in the lowland areas of the country. It is recommended that effective and appropriate intervention programmes be extended to these areas.

Adolescent↗

Pre-exposure prophylaxis of humans against rabies: I. Studies on personnel at the Burma Pharmaceutical Industry.

This is the first time in Burma where personnel at risk against rabies have been pre-immunized and the effectiveness of such a procedure has been studied for nearly two years. The first batch of lyophilized, Semple-type, beta propiolactone inactivated anti rabies vaccine produced by the Burma Pharmaceutical Industry (B.P.I.) was used to immunize 55 B.P.I. workers previously unexposed to rabies and with no history of rabies vaccination. Three doses of 0.25 ml of the vaccine were given intradermally at one week intervals. Booster doses were given on the 98th, 392nd and 592nd day after the first dose. Blood samples were taken and serum neutralization tests were performed at varying time intervals after basic immunization and booster doses. Satisfactory antibody responses were obtained. The course of immunological response is presented and discussed.

Adult↗

Risk factors of breast cancer in Burma.

A hospital-based case-control study of breast cancer was undertaken in Rangoon. The age-standardized incidence rate, 25.1 per 100,000 woman-years and the shape of the age-incidence curve show that Rangoon women have an intermediate level of breast cancer risk compared to women of other countries in the world. The analysis is based on 193 cases and 400 controls. Breast cancer risk was found to be directly related to educational attainment. There was an increased risk associated with early menarche and late menopause. The most striking finding was the strong inverse relationship between risk and parity; women who had six or more children have only one-third the breast cancer risk of married women who had less than four children. This association is not confounded by case-control differences in age at birth of first child. The association of breast cancer risk with age at first birth was not striking; only women with a first birth after age 30 were at increased risk. Breast cancer risk was unrelated to lactation. Overall, the epidemiology of breast cancer in Burma is similar to that in most other countries. However, the possibility of an unusual relationship of risk to parity and age at first parturition warrants further exploration.

Adult↗

Male cross-gender behavior in Myanmar (Burma): a description of the acault.

Cross-gender behavior in Myanmar (formerly Burma) is reported. Western concepts of transsexualism, gynemimesis, transvestism, and homosexuality are not distinct categories by the Burmese. Males with cross-gender behavior are referred to as acaults. Although Myanmar is a profoundly Buddhist society, the people still have strong animistic beliefs with an elaborate system of 37 nats (spirit gods). One of these nats is a female named Manguedon who may take possession of males and impart femininity on them. The cross-gender status of the acaults is sanctioned by their spiritual marriage to Manguedon. The acaults, while not envied, are respected for their roles as shamans and seers.

Adult↗

Contribution of focal haemorrhage and microvascular fibrin deposition to fatal envenoming by Russell's viper (Vipera russelli siamensis) in Burma.

In Burma, clinicopathological studies were carried out in three young farmers who died 15, 52 and 36 h after being bitten by Russell's vipers. Clinical features included local swelling, spontaneous systemic bleeding, defibrination, shock, cardiac arrhythmia, hypoglycaemia, coma and oliguria. On admission to hospital, 15, 48 and 21 h after the bites, serum venom antigen concentrations ranged from 50 to 130 ng/ml. Autopsies revealed widespread congestion and bleeding in the lungs, gastrointestinal and renal tracts, adrenals, heart, brain and anterior pituitary. There was histopathological evidence of focal haemorrhage and fibrin deposition at the site of the bite and in the pituitary, lungs and kidneys and acute tubular necrosis. Deposition of fibrin microthrombi results from the action of venom procoagulants. Shock was attributed to increased capillary permeability, revealed clinically by conjunctival oedema. Acute pituitary/adrenal failure in one case was explained by fibrin deposition and haemorrhage in the anterior pituitary--resembling Sheehan's syndrome. Acute tubular necrosis resulted from ischaemia caused by fibrin deposition and to prerenal factors. An intractable cardiac tachyarrhythmia may have been caused by subendocardial and myocardial haemorrhages.

Adolescent↗

Epidemiology and transmission dynamics of Ascaris lumbricoides in Okpo village, rural Burma.

A horizontal study of the prevalence of Ascaris infection was carried out on the total population of Okpo village near Rangoon, Burma, where a similar study had been conducted 13 years earlier. Ascaris eggs in faeces were counted after treatment with levamisole on a random sample of 50% of the infected population to give information to the numbers of epg of stool, the mean worm burden per host and the distribution of worms in the community. The information on prevalence is compared with that of the previous survey. Various population parameters of Ascaris were calculated to estimate the transmission dynamics of A. lumbricoides. In addition, chemotherapeutic regimes, assessed on the proportion of the human population to be treated and the time interval between treatments, are proposed to reduce transmission below a critical threshold. The findings are compared with those of other studies and the probable mode of occurrence and maintenance of Ascaris infection in Okpo village are discussed.

Adolescent↗

Oral rehydration therapy in the home by village mothers in Burma.

Acceptability and effectiveness of oral rehydration therapy (ORT) when given by mothers in the home under village conditions was investigated in six (two control and four test) communities at Htauk-kyant near Rangoon, Burma. The control and test village communities had populations of 2085 and 4278 respectively, of which 218 and 623 were children under five. In the test villages, Oral Rehydration Salts (ORS) were made constantly available by providing each household with one packet of ORS, which was replenished whenever a used packet was returned to the field workers during their daily surveillance rounds. In control villages ORS packets were not provided. Daily diarrhoea surveillance was made for one year, including daily weighing of each child with diarrhoea, and across-episode weight changes were calculated. Monthly mass anthropometric measurements (weight and height) were carried out on over 90% of all children in test and control villages. Stool samples were investigated for bacterial aetiological agents. In test villages 327 children developed diarrhoea (52% of all children) with a total of 639 episodes and an incidence of 1.3 episodes per child per year. 314 diarrhoea episodes (49% of all) occurred in 67 children who had three or more episodes each. ORS was readily accepted and administered by mothers in 96% of the diarrhoea episodes. The impact of ORS on mortality and morbidity could not be demonstrated as there was no death, nor necessity for admission to hospital for diarrhoea in either test or control village populations.(ABSTRACT TRUNCATED AT 250 WORDS)

Body Height↗

Composition and contamination of oral rehydration solutions prepared with well water by village mothers in Burma.

A field study was carried out at Htaukkyant village in Burma to assess whether village mothers could use condensed milk tins to measure one litre of water with reasonable accuracy for the preparation of oral rehydration solutions (ORS) and whether the extent of bacterial contamination of well water was serious and if this affected the bicarbonate content of the ORS solution. Empty condensed milk tins have a fairly uniform volume around 330 ml and using three condensed milk tins full of water mothers made up one litre quite consistently. Mothers also proved capable of preparing ORS solution by dissolving one packet of oral rehydration salt (ORS) in three condensed milk tins full of water to obtain solutions which contained acceptable and safe concentrations of sodium and potassium. Contamination of well water with faecal coliforms was present. Both storing water in domestic vessels and boiling water reduced the coliform count. Storing could be a good way of reducing the risk of infection if repeated contamination from dipping in to the water could be avoided. The counts on coliforms and faecal coliforms in ORS both increased by about 1 log per day over the first and second 24 hours after the preparation with contaminated well water. Despite this the bicarbonate content of ORS remained stable. In the absence of boiled water, ORS solution can be made using the cleanest available water and using it within 24 hours.

Bicarbonates↗

Double-blind trial to find dose range using a fixed combination of mefloquine, sulfadoxine and pyrimethamine in falciparum malaria: a field study on adults in Burma.

In a field study conducted in Burma, 60 semi-immune adults were randomly assigned to 2 treatment groups. The first (mean parasite count, 12717/mm3) received a single dose of a fixed combination of 500 mg mefloquine base, 1000 mg sulfadoxine and 50 mg pyrimethamine (2 tablets of 'Fansimef') plus 1 tablet placebo. The second group (mean parasite count, 11 863/mm3) were given 3 tablets of the same medication. The study was double-blind. Parasite count was checked daily for the first week and weekly for a further 3 weeks. Average times for parasite clearance were 1.47 d in patients receiving 2 tablets, and 1.87 d in those given 3 tablets. Asexual parasites reappeared on day 28 in one patient in each group, although they had been free of parasites during the previous 4 weeks; this could be due to reinfection. The drugs were generally well tolerated, though mild and transient giddiness was seen in 80% of patients in the first group and 96% in the second. Nausea was reported by 33% and 43% of patients respectively. No vomiting occurred in the first group but 8 patients vomited in the second (P less than 0.01). In conclusion it seems possible to treat falciparum malaria in semi-immune adults, weighing less than 60 kg, with a single dose of 500 mg mefloquine base, 1000 mg sulfadoxine and 50 mg pyrimethamine (2 tablets), instead of the higher dose (3 tablets) currently recommended. This reduces treatment cost and improves tolerance of the drugs.

Adolescent↗

Epidemiology and aetiology of acute childhood diarrhoea in Burma: a rural community survey.

Identical epidemiological and microbiological surveys were carried out in a rural community at Intakaw, Burma, in 2 months, one in the hot wet and the other in the cool dry season. The incidence of diarrhoea was highest in children under 3 years old and in the hot wet month when enterotoxigenic Escherichia coli was the predominant pathogen. Rotavirus was the commonest pathogen in the cool dry month but was absent in the hot wet month. Shigellae, salmonellae and campylobacter were isolated in both seasons, but were not significantly commoner in patients than in controls. Vibrios and Yersinia enterocolitica were sought but not found in any specimen.

Animals↗

The epidemiology and control of hookworm infection in the Burma Valley area of Zimbabwe.

An integrated hookworm control programme, involving mass chemotherapy and improvements in public health, was conducted in the Burma Valley and Vumba areas of Zimbabwe between 1985 and 1990. Three sequential annual mass chemotherapy programmes were implemented. Infection status was monitored annually throughout. Initial observations indicated asymptotic age prevalence and intensity profiles, with peak infection levels in adults. Mass chemotherapy was shown to have immediate and medium term benefits for community health. Reinfection was slow to develop, and average intensity had not returned to pre-intervention levels 39 months after the cessation of chemotherapy. The results support the existence of age-dependency in reinfection. Despite a marked increase in the number of sanitation units, no relationship was found between latrine availability and reinfection intensity on individual farms. This result is consistent with observations that the effect of sanitation is slow to develop, and indicates that repeated anthelmintic intervention should be maintained until sanitation has an impact on transmission.

Adolescent↗

Bites by Russell's viper (Vipera russelli siamensis) in Burma: haemostatic, vascular, and renal disturbances and response to treatment.

Of 123 patients with proved Russell's viper bite, 28% showed no evidence of envenoming, 28% had local swelling alone, but 44% had systemic envenoming manifested by incoagulable blood (100% of those admitted before treatment), thrombocytopenia (26%), spontaneous systemic bleeding (20%), hypotension (35%), evidence of increased capillary permeability (24%), and oliguria (44%). Patients with systemic envenoming usually had more local swelling than those without, but 5 had no local signs. Snake length correlated with the amount of local swelling, but snakes causing systemic envenoming were no longer than those causing local or no envenoming. Burma Pharmaceutical Industry monospecific antivenom was rapidly effective in restoring blood coagulability but did not prevent the development of renal failure even when given within 4 h of the bite. Hypotension responded to volume expanders (11/19 cases) and dopamine (6/7 cases) but not to naloxone (0/3) or high-dose methylprednisolone (0/5). The 10 deaths (8%) were attributed to hypotension, pituitary haemorrhage, and renal failure.

Adolescent↗

Death and injury caused by land mines in Burma.

One hundred and eighty-eight Burmese refugees in Thailand were interviewed. One hundred and five of those interviewed had knowledge of a total of 313 persons who had been exposed to land mine explosions. Twenty-three of the interviewed were land mine survivors. They were all male, aged between eight and 68 years, and all except one had been injured between 1986 and 1997. Fifteen of the 23 were civilians, eight were guerilla soldiers who were injured either in battle or while deploying or disarming land mines. Those who had stepped on land mines were all crus or femur amputated and had several scars on the lower limbs, abdomen and some also on the forearms. Those who had handled a land mine had lost either fingers or hands and one also lost both eyes. This study shows that the frequency of land mine accidents in Burma has been underestimated and that the mortality is high. The study also supports the general impression that many victims are civilians.

Adolescent↗

The susceptibility of Bandicota bengalensis from Rangoon, Burma to several anticoagulant rodenticides.

The baseline susceptibility of the lesser bandicoot rat, Bandicota bengalensis, from Rangoon, Burma, to five anticoagulant rodenticides was established with no-choice feeding in the laboratory. The susceptibility of lesser bandicoots to the several poisons (brodifacoum, difenacoum, diphacinone, coumatetralyl, and warfarin) was such that they were offered at a 0.001% concentration. B. bengalensis was most susceptible to brodifacoum, and in descending order, difenacoum, coumatetralyl, diphacinone and warfarin. In comparison with Rattus norvegicus on warfarin at 0.005%, B. bengalensis proved more susceptible. Feeding tests at 0.005% concentration indicated that a 1-day feeding on brodifacoum and difenacoum would result in complete mortality, whereas coumatetralyl and warfarin would require 4 days feeding to a 100% kill. Brodifacoum and difenacoum are recommended at 0.002-0.005% bait concentrations and coumatetralyl at 0.005--0.01% concentrations for the control of B. bengalensis in the field in Rangoon. The use of any anticoagulant material in rat control should be alternated with acute toxicants to retard the possible development of anticoagulant resistance.

4-Hydroxycoumarins↗