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PubMed1995

Serotype distribution and antimicrobial susceptibility of Shigellae isolated from diarrhoeal patients in Yangon, Myanmar.

In Myanmar there is a changing pattern in the prevalence of Shigella strains with an increasing antimicrobial resistance, and, thus the serotype prevalence and antibiotic sensitivity pattern of Shigellae were studied in 1993. Dysenteric stool samples were collected from the laboratory of Infectious Diseases Hospital, Yangon during January-June 1993. The Shigella isolates were identified by the standard bacteriologic procedures. Four hundred and sixty stool samples containing blood and mucous were collected in this study, and Shigella spp. were isolated from the 108 (23.5%) samples. The increasing antimicrobial resistance of shigellosis from 1980 to 1993 in this community was also discussed.

Adolescent↗
PubMed1995

Hyperendemic malaria in a forested, hilly Myanmar village.

A 1-year longitudinal study of hyperendemic malaria was carried out at Tha-bye-wa village, Oktwin township, situated in the forested Bago mountain range in south-central Myanmar. Mosquito infectivity was assayed using specific, sporozoite enzyme-linked immunosorbent assays. Anopheles dirus was the predominant vector in the postmonsoon season (October); during the cool-dry season (January), both An. dirus and Anopheles minimus were vectors. Members of the Anopheles culicifacies complex were caught in the hot-dry season (April) but none was infective. The entomological inoculation rate was estimated to be at least 13.7 infective bites/person/year. Infective An. dirus were caught feeding on cattle as well as on humans. Three of the 4 positive An. dirus and both positive An. minimus were caught biting humans indoors in the second quarter of the night when most people were sleeping. This suggests that use of insecticide-impregnated bednets in this area could interrupt transmission.

Animals↗
PubMed1995

Genetic red cell disorders and severity of falciparum malaria in Myanmar.

A hospital-based survey was undertaken to investigate the relationship between the incidence and severity of malaria infection and various red cell disorders in Myanmar. The mean parasitaemia levels of patients with alpha- or beta-thalassaemia trait or with severe glucose-6-phosphate dehydrogenase (G6PD) deficiency were lower than those of individuals with normal haemoglobin AA or with heterozygous haemoglobin E. The double genetic defect of thalassaemia trait and severe G6PD deficiency appeared to confer some degree of protection against malaria.

Adult↗
PubMed1997

The ICT Malaria Pf: a simple, rapid dipstick test for the diagnosis of Plasmodium falciparum malaria at the Thai-Myanmar border.

The ICT Malaria Pf test for the detection of Plasmodium falciparum infection was evaluated in the diagnosis of 305 patients with fever who were admitted to a hospital located on the Thai-Myanmar border. All patients were admitted for at least one week to exclude reinfection. The test was performed using admission blood samples collected into ethylenediaminetetraacetic acid. The sensitivity, specificity and accuracy of the test were 92.7%, 95.1% and 94.7% respectively, compared to standard microscopic diagnosis. The ICT Malaria Pf test is an accurate method for the diagnosis of P. falciparum infection. Its simplicity and rapidity make it particularly appropriate for use in remote areas where microscopic examination of blood films is unavailable.

Animals↗
PubMed1998

Influence of blister packaging on the efficacy of artesunate + mefloquine over artesunate alone in community-based treatment of non-severe falciparum malaria in Myanmar.

Three studies were carried out to determine the need, acceptability, and efficacy of adding mefloquine to artemisinin derivatives (AD) for the first-line treatment of uncomplicated falciparum malaria. The first was a retrospective study of 255 basic health workers which showed that their recommendation of AD to patients depended on their level of training. None of the paramedics/midwives and only 9% of 129 doctors had prescribed AD, and no one had recommended AD in combination with mefloquine; 72% of patients used courses that were too short for parasitological cure. To promote the addition of mefloquine to AD regimens we conducted intervention workshops with health care providers and subsidized the cost of mefloquine to patients. In the second study, we interviewed 200 patients before and after the intervention to evaluate drug compliance with full doses of AD and use of subsidized mefloquine. After the intervention, we found that only 3.6% had used mefloquine and 62% had taken non-curative doses of AD. In the third study, we provided blister packs of medication in daily doses and compared the intake of AD + placebo (158 patients) with that of AD + mefloquine (222 patients) for 5 days. The compliance with both regimens was 99%. Blood smears for parasites on day 28 showed one positive in the AD + mefloquine group and 7 positive in the AD group. We conclude that provision of blister packs of daily doses is a very effective way to improve compliance with short courses and drug combinations, but the efficacy of the combination in Myanmar in this particular study was only marginally higher than that of AD alone.

Adolescent↗
PubMedDate not supplied

Renal ischaemia, transient glomerular leak and acute renal tubular damage in patients envenomed by Russell's vipers (Daboia russelii siamensis) in Myanmar.

Fifty-two patients who had been bitten by Russell's vipers in Myanmar developed acute renal failure (serum creatinine exceeding 1.3 mg/dL). Thirty-four of them (65%) became oliguric, but the other 18 (35%) maintained a urine output of more than 400 mL/24 h. In oliguric patients, gastrointestinal haemorrhages, renal angle tenderness and conjunctival oedema occurred more commonly, and peak serum creatinine, blood urea nitrogen and the fractional excretion of sodium were significantly higher (P < 0.01) than in non-oliguric patients, indicating a greater degree of renal damage. Urinary concentrations of beta 2 microglobulin and retinol binding protein were raised in most of the patients indicating failure of proximal tubular reabsorption of these proteins, while high urinary N-acetyl glucosaminidase concentrations were consistent with renal tubular damage. Plasma concentrations of active renin were very high, suggesting that renal ischaemia, associated with activation of the renin-angiotensin system, was involved in the development of renal dysfunction.

Acute Kidney Injury↗
PubMed2004

Myanmar dengue outbreak associated with displacement of serotypes 2, 3, and 4 by dengue 1.

In 2001, Myanmar (Burma) had its largest outbreak of dengue-15,361 reported cases of dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS), including 192 deaths. That year, 95% of dengue viruses isolated from patients were serotype 1 viruses belonging to two lineages that had diverged from an earlier, now extinct, lineage sometime before 1998. The ratio of DHF to DSS cases in 2001 was not significantly different from that in 2000, when 1,816 cases of DHF/DSS were reported and dengue 1 also was the most frequently isolated serotype. However, the 2001 ratio was significantly higher than that in 1998 (also an outbreak year) and in 1999, when all four serotypes were detected and serotypes 1, 2, and 3 were recovered in similar numbers. The large number of clinical cases in 2001 may have been due, in part, to a preponderance of infections with dengue 1 viruses.

Australia↗
PubMed2004

Typhoid fever outbreak in Madaya Township, Mandalay Division, Myanmar, September 2000.

In September 2000, an outbreak of typhoid fever was reported in a rural village of Central Myanmar. The authors investigated the outbreak in the affected village. A suspected case was a person suffering from fever with either constipation, abdominal pain, diarrhoea/bloody diarrhoea. A probable case was a suspected case who had positive result on the diazo urine test or widal test. Based on probable cases, the authors conducted a case-control study comparing history of contact with the cases, water source, and personal hygiene. Control was a person living in the village was not ill and having a negative result for diazo urine test. Among 49 suspected cases, 33 were probable. Attack rate was 1.2%. Three cases had a positive culture for Salmonella typhi and were not drug resistant. The following risk factors were identified: drinking unboiled river water (adjusted OR 12.5, 95%CI 2.8-75.3), history of contact with other patients before the illness (adjusted OR 22, 95%CI 3.5-76.2), no hand washing with soap after defecation (adjusted OR 0.15, 95% CI 0.03-0.81). Environmental investigation result showed that most of the households had unsanitary latrine and some latrines were constructed near the edge of a river. The outbreak subsided quickly after intervention.

Adolescent↗
PubMed2004

Malaria infection among the migrant population along the Thai-Myanmar border area.

A population based case-control study was performed to determine factors associated with malaria infection among the migrant population, foreign nationals aged 15 years or over. Data were obtained from 217 malaria and 217 non-malaria patients attending the Vector-Borne Disease Control Units 6-9 (Thong Pha Phum and Sangkhla Buri districts) in Kanchanaburi Province and at the Vector-Borne Disease Control Units 1,9 (Mae Fa Luang and Mae Sai districts) in Chiang Rai Province, between June and December 2002. All study subjects were interviewed by trained interviewers using a structured interview form. The statistical analysis was carried out by the chi-square test and multivariate logistic regression: a p-value of less than 0.05 was considered to be statistically significant. The results showed that the study subjects were predominantly Thai-Yai and Myanmar. Plasmodium falciparum was the major type of the malaria (60.8%). Logistic regression analysis, controlling for possible confounding factors, revealed that residence located in the forest increased the risk of malaria infection by a factor of 6.29 (OR = 6.29, 95% CI = 1.56-25.42); outdoor stay < 7 and > 7 days prior to the blood examination also increased the risk by a factor of 4.34 and 4.13 respectively (OR = 4.34, 95% CI = 1.05-17.99; OR = 4.13, 95% CI = 1.29-13.13).

Adolescent↗
PubMed2004

Reliability and validity of two oral health related quality of life measures in Myanmar adolescents.

OBJECTIVE: To assess two Oral Health Related Quality of Life (OHQoL) measures and the levels of oral impacts among 14-year-old students in Yangon Division, Myanmar. DESIGN: Cross-sectional validation study. Setting High schools in Yangon Division. PARTICIPANTS: A multi-stage stratified random cluster sample of 543 students. OUTCOME MEASURES: Prevalence, extent (number of impacts) and total score as recorded using the Oral Impacts on Daily Performance (OIDP) and the short form of the Oral Heath Impact Profile (OHIP-14). Psychometric measures of validity and reliability. RESULTS: 15.8% and 53.0% of participants had an impact using OIDP and OHIP-14 respectively. The extents and total scores were low among those with impacts. Both measures had good reliability (Cronbach's alpha 0.72 for OIDP and 0.86 for OHIP-14). The presence of dental caries was associated with summary measures of OHIP-14 but not with OIDP. The most frequent cause of impact was dental caries. CONCLUSIONS: Both OIDP and OHIP-14 had reasonable reliability but OHIP-14 had superior construct validity. OHIP-14 appears to be more useful as an instrument to discriminate between groups with and without impacts in population surveys.

Adolescent↗
PubMed2004

Malaria infection and life-style factors among hilltribes along the Thai-Myanmar border area, northern Thailand.

A cross sectional study was conducted between January, 2001 and June, 2002 to determine the life-style factors associated with malaria infection among hilltribes in the Chiang Rai Province, Mae Fah Luang district located along the Thai-Myanmar border, northern Thailand. The data collected were a thick blood film examination and a face-to-face interview using a local language interviewer at a mobile clinic or a home visit. The chi-square test, odds ratio, 95% confidence interval and multiple logistic regression were used as data analysis. P. vivax (61.3%) was detected more than P falciparum (38.2%). Parasitic infection was seen in 45.8% of a total of 417 blood examinations. The study area was in a valley covered with forests and small streams, which was ideal for a malaria epidemic. The communities were distributed along different ethnic groups. There were 12 ethnic groups, dominated by the Muser, Eko, and Akha tribes (60-70%). The risk factors included living or working in the forest, accompanying their family during movement through the forest, age < or =14 years (40.9%), poor knowledge of how to protect against malaria (75-80%), and unavailability of protection against malaria via long sleeved clothes, topical repellents, and insecticide treated nets (use and carry), which resulted in an increased exposure to malaria and risk for malaria infection.

Adolescent↗
PubMed1991

Bites by the king cobra (Ophiophagus hannah) in Myanmar: successful treatment of severe neurotoxic envenoming.

Three patients bitten by the world's largest species of venomous snake, the king cobra (Ophiophagus hannah), were observed in Myanmar (Burma). All three were involved in the famous snake dance in Yangon (Rangoon) Zoological Gardens. One patient showed no signs of envenoming despite a sustained bite, another developed only signs of local envenoming, but in a third there was severe neurotoxic envenoming requiring mechanical ventilation for 64 1/2 hours, episodes of hypotension and massive swelling of the bitten limb. This patient showed some signs of recovery before delayed treatment with specific antivenom. It is possible that all three patients had some immunity to king cobra venom resulting from traditional 'immunization' achieved by scratching venom into the skin. The literature on king cobra bites is reviewed and recommendations given for antivenom and ancillary treatments.

Adult↗
PubMed1991

Bacteriologic studies of food and water consumed by children in Myanmar: 1. The nature of contamination.

To isolate major bacterial pathogens from children's food and drinking water, a 3-month study was conducted in a suburban community in Yangon, Myanmar. From the morning meals and stored drinking water of 208 randomly selected children, 775 food and 113 water samples were collected and were cultured using standard methods. Escherichia coli, Vibrio cholerae non-01, and Salmonella were isolated from 505, 28 and 6 food samples respectively, and E. coli and V. cholerae non-01 were isolated from 29 and 5 water samples respectively. Among the E. coli isolates, 8 produced heat-stable toxin (ST) and 3 were enteroinvasive. Nine V. cholerae non-01 produced cholera-like toxin. Of the 29 E. coli isolates from the samples of drinking water, 3 produced ST. All water samples were negative for Salmonella. The study underscores the importance of bacterial contamination of children's food and drinking water and stresses the need to improve environmental sanitation.

Bacterial Toxins↗
PubMed1991

Bacteriologic studies of food and water consumed by children in Myanmar: 2 Lack of association between diarrhoea and contamination of food and water.

The association between contamination of morning samples of food and water of 208 children aged 6-29 months and the incidence of diarrhoea was investigated for 3 months in Yangon, Myanmar. Contamination of the samples was determined by isolation of faecal coliforms (FC) by standard methods. The children were divided into three groups, high, medium and low, according to the proportion of food and water samples found to be contaminated. The incidence of diarrhoea was recorded by weekly recall. Of the 779 food samples, 504 (65%), and of the 860 drinking water samples, 187 (22%) were positive for FC. The association between food and water contamination and the incidence of diarrhoea was assessed by comparing the cumulative incidences in the high and medium groups with that in the low group which served as reference. Diarrhoea risk ratios (RR) for children in the medium and high contamination groups (food, RR = 1.04 in medium and 0.78 in high vs 1 in low; water, RR = 0.73 and 0.73 vs 1) were not significantly different from those who were in the low-contamination group even after controlling for the confounding variables.

Child, Preschool↗
PubMed2005

Drug sensitivity of Plasmodium falciparum along the Thai-Myanmar border using the new field-deployable HRP2 in vitro assay.

Drug resistance in Plasmodium falciparum has turned into a major problem throughout the malaria endemic regions of the world. Surveillance of antimalarial drug resistance is therefore essential for early changes in drug policies. In the course of this first major application of the new field-deployable histidine-rich protein 2 (HRP2) in vitro drug sensitivity assay, we investigated the current status of drug sensitivity to the standard antimalarial drugs dihydroartemisinin, mefloquine, quinine, and chloroquine in an area with an exceptionally high level of multidrug resistance in Thailand. The geometric mean of 50 and 90% inhibitory concentrations determined for 44 successfully tested samples by the HRP2 assay were comparable to earlier published results from the same area suggesting relatively little change in the local drug resistance pattern during the past years. The HRP2 field test was found to be highly sensitive and simple enough to be entirely performed in the field.

Animals↗