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Spinal injuries in Burma as a result of a fall from height, especially from trees, in young male adults in low socio-economic classes; road traffic accidents are the second commonest cause; deep vein thrombosis and pulmonary embolism is very rare during the period of immobilisation. There are still some social problems of getting back to work and living conditions. We are trying our best to help the patients with spinal injuries.
During the past 30 years three major programmes of research have been carried out in Myanmar (Burma) and India on the ecology and control of Culex quinquefasciatus. To differing degrees the programmes have employed environmental, chemical, biological and genetic control strategies, but none has been an unqualified success. Results have been good when well-trained staff with substantial resources were employed, but much poorer when less-well-equipped general health workers took over the programmes. Overall, it would seem most cost-effective for health workers to concentrate their efforts on the elimination of the limited number of larval habitat categories which commonly contribute a large fraction of the adult population. Insecticides and biological control agents should serve as supplements, not as alternatives, to environmental management. Genetic control strategies have currently no place in C. quinquefasciatus programmes.
A case-control study was carried out on 311 tuberculous children under 5 years of age and 1536 non-tuberculous controls, matched for age, sex and the sector of residence, to evaluate the effectiveness of BCG vaccination of newborns in Rangoon, Burma. BCG vaccination status of both the cases and their matched controls was recorded. BCG vaccination in the newborn conferred 38% protection against the sum total of all forms of tuberculosis. The protective efficacy varied with the different forms of tuberculosis. It was only 20% for primary complex and 52% and 80% for tuberculous meningitis and disseminated tuberculosis, respectively. The protective effect of BCG vaccination was highest during the first 3 years after vaccination and then waned during the subsequent years. Although the protective efficacy seemed to be low, the impact of a BCG vaccination programme on the preventable deaths, neurological sequelae and the health services expenses is considerable.
Studies on the treatment and prevention of iron deficiency anemia, in pregnant and nonpregnant women and in men, were conducted in Thailand and Burma. The effects of the dose of Fe, duration of Fe administration, additional supplementation with folate, mode of supplement delivery (either supervised or unsupervised), and the presence of Hb(AE) were studied. The frequency and severity of side effects were also recorded. Fe administration resulted in an increase in hemoglobin concentration in all anemic individuals but approximately 20% failed to reach normality. The length of administration and the dose influenced the results. Frequency and severity of side effects increased with the dose of Fe administered. Folate supplementation did not affect the results. It appears possible to integrate a program of prevention and treatment of Fe deficiency anemia in a primary health-care system but the constraints and limitations of achievable results should be recognized.
Iron-deficiency anemia (IDA) in refugees is reported to be among the major medical problems worldwide. Because food rations are typically inadequate in iron, long-term reliance is a key predictor of anemia among displaced people. Comprehensive nutritional assessments of refugee children from Burma have not previously been completed. Refugee children aged 6-59 mo were studied to determine 1) the prevalences of anemia, iron deficiency (ID) and IDA and 2) the factors associated with anemia and ID. Cluster sampling in three camps and convenience sampling in two additional camps were used. Hemoglobin (Hb) levels were measured and micro mol zinc protoporphyrin/mol heme were determined in 975 children. Logistic regression analyses (95% CI) determined predictors of anemia and ID. The prevalences of IDA, anemia and ID in these refugee children were 64.9, 72.0 and 85.4%, respectively. Predictors of anemia included young age (P < 0.001), food ration lasting <1 mo (P = 0.001), daily consumption of dietary iron inhibitors (P < 0.05), weight-for-height Z-score of <-2 (P < 0.05), male gender (P < 0.05) and uneducated father (P < 0.001). Predictors of ID were young age (P < 0.001) and recently reported illness (P < 0.05). Laboratory tests confirmed that anemia and ID are major health problems among these refugee children and that ID is the leading cause of anemia. A comprehensive nutrition and public health-focused approach to combating anemia and ID is essential. Following the presentation of results to policy makers, the improvement of the micronutrient content of rations has been initiated.
Participation of the author in the Interdepartmental Committee on Nutrition for National Defense sponsored nutrition surveys of Burma and northeast Brazil is described. These surveys not only collected important data on nutritional status but also guided the subsequent research interests of the author. The Brazil survey results contributed to the creation of legislation that mandated the addition of water-dispersible vitamin A to skimmed-milk powder products. This additive has greatly diminished the likelihood of vitamin A deficiency syndrome occurring in children after famine relief efforts.
PURPOSE: This article describes the development of, and outputs from, a program in which trained refugee health workers provided spherical lenses to adult refugees along the Thailand-Burma border. METHODS: Between 1998 and 2001, the International Rescue Committee trained 48 refugee health workers in basic refraction courses. Once trained, these health workers conduct weekly eye clinics in several refugee camps and one migrant community covering a total population of 142,000. We supplied spherical lenses in 11 powers from +1.00 to +4.00 in 0.50-D steps and from -1.00 to -2.50 in 0.50-D steps. We collected output data from these clinics for the year 2001. RESULTS: In 2001, these clinics provided a total of 7219 eyeglasses. Approximately 84% of all lenses given were for presbyopia, approximately 10% for myopia, and approximately 6% for hyperopia. Our spectacle provision rates per 100,000 persons were 4284 for presbyopia, 482 for myopia, and 317 for hyperopia. Our target provision rates, which would allow the average wearer to get a new pair every 3 to 4 years, was met for presbyopia, but not met for myopia or hyperopia. Few corrections for high errors were needed and only 92 people were found to need powers higher than we provided. In 2001, the cost per eyeglass recipient was approximately $7.00. CONCLUSIONS: Training refugee health workers has allowed for sustainable, low-cost spectacle provision to a large population over an extensive geographic area in a challenging environment.
AIM: To prove that topical antifungal and antibiotic prophylaxis distributed by grass roots village health workers (VHWs) in Burma is an effective public health intervention for the prevention of post-traumatic microbial keratitis in a population where the majority of ulcers are fungal. METHODS: Three villages in Bago District with a combined population of 16,987 were selected for the study. This defined population was followed prospectively for 12 months by 15 VHWs who were trained to identify post-traumatic corneal abrasions with fluorescein dye and a blue torch and to administer 1% chloramphenicol and 1% clotrimazole ointment three times a day for 3 days to the eyes of individuals who fulfilled the eligibility criteria. RESULTS: During the 12 month period 273 individuals reported to VHWs with an ocular injury and 126 were found to have a corneal abrasion. All 126 were treated with 1% chloramphenicol and 1% clotrimazole ointment three times a day for 3 days, and all healed without sequelae. CONCLUSIONS: Both fungal and bacterial ulcers that occur following traumatic corneal abrasions can be effectively prevented in a village setting by using relatively simple measures that local volunteer public health workers can easily be taught to employ.
The problem of trachoma in Burma is presented. For its major sight-threatening complication of trichiasis a surgical procedure is described which is simple, effective, economical, and without any cosmetic blemish. With this procedure 1861 cases of different grades of trichiasis were operated upon at the Eye, ENT Hospital, Rangoon, with 528 cases followed up at 1 year. The results are entirely satisfactory when the operations are performed for first and second degree trichiasis, and for trichiasis of our third degree grading the success rate is 95%.
Giemsa and Hoechst staining of neuroblast chromosomes were used to identify two strains of the Anopheles balabacensis complex from Burma. The laboratory colony of Kwan-ka-thaung (KKT) strain is shown to correspond to A. dirus A, while the laboratory colony of Taikkyi (TKK) strain corresponds to A. dirus C as defined by earlier studies on material from Thailand.
Contrary to earlier reports from Asia, trisomy 21 is common in Burma and other chromosome abnormalities are found. A variety of dominant, recessive and X-linked genetic disorders occur. Twins are found in 1% of births and MZ and DZ twins are equally common. Thalassaemia and meningomyelocele are relatively common while congenital dislocation of the hip and phenylketonuria are very rare. The intensity of inbreeding had been measured by survey and found to be F = 0.0005 in Rangoon and F = 0.0015 in villages around Hlegu.
"A comparison of the 1973 and 1983 censuses provides ample evidence of a decline in fertility in Burma [Myanmar]. The proportion of children in the population fell substantially in the ten-year period accompanied by a significant increase in the mean age at marriage as indicated by the higher female...mean age at marriage. An analysis of the regional variations in population density indicates inter-regional movement of population. While there is marked success in the literacy programmes as indicated by the sharp reduction in the prevalence of illiteracy, especially among the females, changes in the industrial and occupational structure of the labour force suggest worsening economic conditions. Under these circumstances, it is surmised that the fall in fertility, without any concerted government policy for inducing such a decline, may be a first-level and benign response of a more literate and hence more informed population to rising aspirations and the inability of the economy to accommodate these aspirations."
A sporozoite-induced infection of Plasmodium falciparum (Burma-Thau. strain) was established in splenectomized Aotus trivirgatus which received prior treatment with dlmethionine as a dietary supplement. This is the first recorded instance of infection of an Aotus monkey with falciparum sporozoites of human origin.
Otomycosis of the auditory canal is common in Burma. Of 346 cases of otitis externa seen in a hospital outpatient clinic during two consecutive rainy seasons, 189 were due to fungus infection. Aspergillus species were the fungi isolated most frequently. Infection was most commonly due to self-manipulation. Itching and tinnitus were common complaints. Treatment by local cleansing and application of antifungal agents was effective, 10% 5-fluorocytosine ointment being most successful.
Burma faces what could become one of Asia's most devastation AIDS epidemics. Faced with a growing number of heroin addicts, and of Burmese women being sold into prostitution in Thailand and coming back infected with HIV, Burmese officials now admit that more than 5000 people have tested positive for the AIDS virus. WHO's office estimates the number of HIV-infected people in the country to be at least 100,000 and climbing.
Delayed hypersensitivity that can be demonstrated with either a strong dose of tuberculin or a conventional dose of a sensitin prepared from certain nonmammalian mycobacteria (mycobacteria of Runyon Groups II and III, e.g., Mycobacterium avium), is known to be highly prevalent in most tropical and many subtropical areas and rare in many temperate zones. Whether such sensitivity interacts significantly with tuberculosis or with leprosy is not known.A study of reactions to tuberculin (PPD-S) and to a sensitin prepared from M. intracellulare (PPD-B) was carried out in villages close to an area in which a clinical trial of the preventive effect of BCG against leprosy was being conducted. The population had not been vaccinated with BCG. Some of the villages were in river valleys that become flooded every year for a long period during the rainy season; others were on slopes above the area subject to floods. The findings showed that sensitivity to the nonmammalian sensitin was prevalent in the area, and thus confirmed previous findings of low-grade tuberculin sensitivity in Burma and neighbouring countries. No difference in this prevalence was found between flooded and nonflooded villages.
In attempting to evaluate a brief course on care of the mentally ill given to health personnel in Burma, experience suggested: (a) that post-course questionnaires asking participants to rate usefulness of the educational experience are useless in evaluation; (b) Assessments of clinical knowledge before and after the course were useful in guiding the teachers and assessing improvement in knowledge; (c) Data on treatment prescriptions given to patients by health personnel before and after the course might be a simple and inexpensive way of assessing impact on health care. Direct measurement of changes in attitudes and improvement of skills in health personnel and of the clinical outcome of patients they treat cannot be done economically and efficiently.
An outbreak of plague occurred in Hlegu Town, Burma in February and March 1977. Altogether 14 bubonic plague cases, with 2 deaths were reported, mostly children under 15 years of age. Twice as many males as females were affected. A retrospective investigation showed that a rat fall took place in the last week of January. Only 9.5% of the rodents which died in the epizootic were found to be infected with Y. pestis; this apparent low infection rate probably resulted from the inclusion in the survey of some dead rats which died of other causes. 14.5% out of 48 trapped rodents were found to be serologically positive. The general flea and cheopis indices were rather high, perhaps because fleas were found to be partially resistant to DDT and also because spraying of insecticide did not effect fleas on the hosts. The cheopis index in Hlegu Town was 1.17, and less than 0.5 in Hlegu suburb (Yankin-Yat) where no epizootic was reported. An active case search revealed 76 suspected plague cases out of which 11 were found to have bubonic plague. A field trial showed that plague vaccination during the outbreak did not result in a rise of detectable antibodies in persons inoculated.