Annual Report 2013

DEPARTMENT OF MEDICAL RESEARCH

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ision of the Department of Medical Research (Lower Myanmar)

♦ Achieving a healthier nation through application of research findings

ims of the Department of Medical Research (Lower Myanmar)

1. To undertake research that contributes to the improvement of the health of the people of Myanmar

2. To conduct research utilizing new scientific knowledge and technologies in solving health problems of Myanmar

3. To improve scientific knowledge in the country by capacity building of resources, introducing new technologies, providing research training and by promoting research culture in academic institutions

4. To contribute towards socioeconomic development of the country through appropriate medical research

ission Statement of the Department of Medical Research (Lower Myanmar)

♦ To develop and promote solutions to the major health problems of Myanmar

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issions of the Department of Medical Research (Lower Myanmar)

Mission Number 1 To investigate communicable diseases with emphasis on emerging and re-emerging diseases affecting health of the people

Mission Number 2 To investigate non-communicable diseases affecting National Health

Mission Number 3 To investigate nutritional factors and life style changes affecting health

Mission Number 4 To strengthen research capacity through development of infrastructure and human resources, necessary for medical research

Mission Number 5 To carry out health systems research highlighting effective and efficient health delivery systems including reproductive health

Mission Number 6 To promote research on accidental, occupational, environmental and climatic factors affecting human health

Mission Number 7 To carry out research on traditional medicine for safe and effective utilization within the existing health care system

Mission Number 8 To promote research culture at medical and related health institutions and to provide academic and technical training for post graduate students

Mission Number 9 To enhance technology development and analytical services applicable in the diagnosis, management and control of common diseases or conditions

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FOREWORD

The Annual Report of the Department’s research accomplishments, achievements and advancement covers the period of January to December 2013. During the year under report, 50 th Anniversary celebration of the Department was held on 10 th June 2013 and a total of 11 publications were issued in commemoration of Golden Jubilee. These are; Golden Jubilee Commemorative Volume (1963-2013), DMR-LM Profile (1987 to 2011), Golden Jubilee Magazine, Research projects carried out by DMR (LM) for Rural Health Development (2000-2010), Further development of medical research in Myanmar (1987-2011), Bibliography of Research Findings on Gastrointestinal Diseases in Myanmar, Index of Research Papers Presented at Health Research Congresses (1965-2011), Dimensions of malaria research: A Collection of abstracts (2001-2011), Profile of pesticides registered in Myanmar (2012), Annotated bibliography of traditional medicine research carried out at DMR (LM) during 1965-2011 and Myanmar Traditional Medicine Formulary (2013). This report shared the extensive research works carried out by various research divisions and clinical research units. It is interesting to note that there has been a wide range of research topics that covered several priority health problems. In the communicable diseases category, the report highlighted different entities of top priorities listings such as HIV/AIDS, Malaria and Tuberculosis amongst many others. In the non-communicable diseases category, cancer, nutrition research and toxicology are in the forefront. Also included are essential entities such as Health Systems Research, Traditional Medicine, Environmental Health and Technology Development. The scientists of DMR (LM) support the services and collaboration to the postgraduate students from the various universities. More than 50 master degree and doctoral degree candidates are officially listed and worked together with DMR scientists in various disciplines of research for partial fulfillment of their postgraduate degree courses. It is anticipated that all people of Myanmar can become healthier and can reach their full potential through the application of new knowledge based on research findings. I wish you all the best for the coming year in the completion of the research projects to reflect the motto of “Fostering health and longevity through research”. Lastly, I would like to extend my best wishes for the future filled with many successes in the form of innovative and bright ideas leading to comprehensive research projects resulting in research findings with positive impact for the healthier nation.

Dr. Kyaw Zin Thant Director-General

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BOARD OF DIRECTORS

Dr. Kyaw Zin Thant - Chairperson Dr. Myat Phone Kyaw - Member Dr. Win Aung - Member Dr. Hlaing Myat Thu - Member Dr. Khin Saw Aye - Member Dr. Khin Thet Wai - Member Annual Report 2013 Dr. Theingi Thwin - Member Department of Medical Research Dr. Zaw Myint - Secretary (Lower Myanmar)

Published by Department of Medical Research (Lower Myanmar) No.5, Ziwaka Road, Dagon P.O. Yangon 11191

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CONTENTS

Highlights of Research Findings xi Organization Profile xv Department of Medical Research (Lower Myanmar) Layout Plan xvii Organizational Structure xix Board of Directors xxi Division Activities and Research Findings Bacteriology Research Division 1 Biochemistry Research Division 6 Biological Toxicology Research Division 9 Blood Programming Division 11 Blood Research Division 13 Chemical Toxicology Research Division 16 Clinical Research Division 18 Epidemiology Research Division 22 Experimental Medicine Research Division 30 Health Systems Research Division 33 Immunology Research Division 40 Medical Entomology Research Division 45 Medical Statistics Division 50 Nuclear Medicine Research Division 57 Nutrition Research Division 59 Parasitology Research Division 64 Pathology Research Division 71 Pharmaceutical Toxicology Research Division 74 Pharmacology Research Division 83 Physiology Research Division 89 Quality Assurance Division 91 Quality Control Division 93 Radiation Toxicology Research Division 95 Technology Development Division 98 Virology Research Division 100 Clinical Research Unit Activities and Research Findings Clinical Research Unit (Cerebral & Complicated Malaria - NOGH) 10 7 Clinical Research Unit (Haematology) 109 Clinical Research Unit (HIV/ AIDS) 111 Clinical Research Unit (Malaria – Defence Services General Hospital, Mingaladon) 113 Clinical Research Unit (Malaria – No. 2, Military Hospital (500 bedded) Yangon) 116 Clinical Research Unit (Oncology) 118 Clinical Research Unit (Oral Medicine) 119 Clinical Research Unit (Snake Bite) 120 Clinical Research Unit (Toxicology) 122 Clinical Research Unit (Traditional Medicine) 124 Clinical Resear ch Unit (Un iversity of Medicine 2) 12 6

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Supporting Divisions Central Biomedical Library 12 9 Computer Division 132 Instrumentation Division 134 Laboratory Animal Services Division 136 Publication Division 140 Administrative Department 143 General Administrative Division 143 Budget and Accounts Division 14 5 Procurement Stores and Distribution Division 145 Research Students 146 Consultants/Advisors to DMR (Lower Myanmar) 154 International Seminars/Workshops/Short Training Courses 157 International Fellowships 161 Local Seminars/Workshops/Short Training Courses 163 List of Publications 173 Golden Jubilee Publications 177 List of Papers Presented 178 Academic activities of the Executive Board 186 Institutional Ethical Review Committee 193 DMR External Grant Review Committee 193 Academic Committee 194 Scientific Talks 194 Protocols reviewed by Protocol and Ethical Review Committee 195 Scientific Groups 198 Scientific Group on Malaria Research 19 8 Scientific Group on Traditional Medicine Research 198 Scientific Group on Snakebite Research 198 Scientific Group on HIV/ AIDS and Sexually Transmitted Diseases Research 198 Scientific Group on Liver and Gastroenterology Research 199 Scientific Group on Growth and Nutrition Research 199 Scientific Group on Arboviral Diseases Research 199 Scientific Group on Nuclear Medicine Research 19 9 Scientific Group on Health and Social Medical Research 199 Scientific Group on Tuberculosis and Respiratory Diseases Research 200 Scientific Group on Poison Research 200 Scientific Group on Blood Research 200 Scientific Group on Cancer Research 200 Scientific Group on Information and Technology 200 Myanmar Health Sciences Research Journal Editorial Board 201 DMR (LM) Bulletin Editorial Board 201 DMR (LM) E Newsletter Editorial Board 201

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HIGHLIGHTS OF RESEARCH FINDINGS

In the year 2013, DMR (LM) conducted the research projects concerning with communicable diseases such as HIV/AIDS, malaria, tuberculosis, diarrhoea dysentery, dengue, viral hepatitis and non-communicable diseases and health problems like cancer, nutrition, toxicology, traditional medicine, health research systems, environmental health and technology development.

HIV/AIDS A cross-sectional study conducted in 10 townships highlighted the importance to provide capacity building training for new generations of both youth and community volunteers to improve their communication skills as well as to improve their knowledge on reproductive health and HIV/AIDS to mitigate attritions.

MALARIA An experimental study in Taikkyi township under laboratory conditions revealed that PermaNet ®2.0, Power Net, and K-O-Tab 123 and K-O-Tab only nets retained good insecticidal efficacy for up to 20 washed cycles producing 86.67-100% mortality against main vectors An. dirus and An. minimus . Pilot studies of the molecular epidemiology of drug- resistant malaria conducted in four study sites (Shwe Kyin, Muse, Kawthaung, and Buthidaung) recommended applying whole genome amplification (WGA) before SNP CHIP hybridization for those samples with low parasitaemia. A cross-sectional study on availability and dispensing practices of providers from 120 drug outlets in 71 villages within Tier 1 and Tier 2 zones concluded that there was an urgent need for an intervention directed towards private drug outlets for artemisinin resistance containment. One cross-sectional study conducted in March, 2013 in two townships of Tanintharyi coastal region covered 210 households of resident villagers and 202 migrant households and concluded that especially for hard-to-reach populations, alternative strategies for public-private partnership involving social entrepreneurs might enhance accessibility, coverage, and affordability to changing malaria containment scenario. Evaluation of the effective behavior change communication and community mobilization activities in 16 townships from Bago Region of Myanmar Artemisinin Resistance Containment (MARC) Zone revealed that efforts should focus on correcting misconceptions about malaria transmission, prevention and universal ITN/LLINs utilization through the available multi-channel approaches.

TUBERCULOSIS Molecular based detection of genitourinary tuberculosis from 35 clinically suspected cases in renal surgical ward of New Yangon General Hospital proved that GUTB can be detected in urine AFB negative cases and those without organ impairment by using IS 6110 PCR method. Molecular strain typing methods established for Mycobacterium tuberculosis in Myanmar highlighted the high prevalence of anti-TB drug resistance among new pulmonary TB cases and provided the preliminary information on gene mutation patterns of drug resistant M.tuberculosis strains from Myanmar. A double-blind, placebo-controlled randomized clinical study concluded that a combination of traditional medicine has a potential to use in retreatment of tuberculosis for prevention of treatment failure in CAT II regime. One study that determined pharmacokinetic parameters of oral isoniazid in Cat I failure and relapse pulmonary TB patients revealed that failure to treatment or changed to multi-drug resistant tuberculosis was not due to variability in pharmacokinetic of isoniazid. One study elucidated

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Annual Report 2013 the pharmacokinetics of rifampicin between tuberculosis patients with and without type 2 diabetes mellitus (DM) and concluded that an integrated approach is needed for effective control and efficient treatment for TB with DM to overcome the possible treatment failure and drug resistance.One cost analysis study emphasized TB patient Self Help Groups (SHG) as an alternative strategy for tuberculosis control due to immediate improvement in capacity for TB prevention and control, increased number of members and implementation of fund raising activities for sustainability. One qualitative study suggested for introduction of intervention by provision of TB education messages through FM radio in local language for longer duration and better programming in line with community preferences and feasibility from FM radio station. A cross-sectional study on management of tuberculosis in hard-to- reach area, Laukkai Township, Northern Shan State, Myanmar among 37 General Practitioners concluded that existing management of TB by GPs in hard-to-reach area was not in line with NTP guidelines. One study in randomly selected 5 DOTs-plus townships in Yangon Region recommended to plan regular check-up program for health staff who are in close contact with patients, to strengthen administrative measures including the TB infection control plan at the TB clinics apart from administrative support and regular training of high risk health workers and adequate provision with N95 masks.

DIARRHOEA/DYSENTERY A cross-sectional study carried out in 250 children under 12 years of age with acute diarrhoea attending four tertiary hospitals in Yangon highlighted the detection of thirteen multiple drug resistant V. cholerae isolates and further molecular characterization in local Myanmar strains of V. cholera e O1 exhibited pulsotype Y10. Surveillance of rotavirus diarrhoea in Yangon Children Hospital (2013) reported that the distribution of G and P genotype provided the important and valuable information for the development and production of rotavirus vaccines. Drinking water quality assessed in an expanding peri-urban neighborhood, Yangon Region highlighted the urgent need to promote portable field laboratory systems and test kits for water quality monitoring, reporting and surveillance of acute diarrhoea.

DENGUE Bioassay with crude ethanol extract of Garlic bulb ( Allium sativum ) revealed larvicidal activities against the DHF mosquito Ae. Aegypti 3rd and 4 th stage larvae and larvae of Cx. Quinquefasciatus. One study highlighted the risk of acute kidney injury in younger children ≤ 5 years with dengue haemorrhagic fever in a tertiary care centre although all cases resumed normal renal function within one or two days. Dengue virus serotypes were studied among 1,133 serum samples of dengue haemorrhagic fever patients in Yangon Children Hospital and concluded that the currently circulating Myanmar DENV-1 belonged to Genotype I (Asian Genotype) and had close relationship to viruses isolated from Thailand from the year 2006. One study focused the diversity of dengue virus strains and dynamics of viraemia in children with dengue infections and identified the range of nucleotide mutations. One study in Hlaing Tharyar Township provided an evidence that GIS based dengue vector surveillance system should be developed to the regional level to aid in the prompt identification of local dengue hot spots to strengthen appropriate planning, prevention and control strategies.

VIRAL HEPATITIS AND CHRONIC LIVER DISEASES One study on 75 hepatitis C positive patients indicated a diminished response to plasma derived HB vaccine delivered at a standard dose and schedule compared to its response in

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CANCER One study successfully established the reverse transcriptase polymerase chain reaction of PML-RAR αgene transcript for diagnosis of adult acute promyelocytic leukemia leading to decision for specific treatment. One study recruited 100 female presenting with different sizes of breast lump from surgical units of Yangon General Hospital and Thingangyun Sanpya Hospital and concluded that immune-expression of hormonal marker (ER alpha) was the good indicator for prognosis and treatment of breast cancer whereas epigenetic marker (HER2/neu) was not the sensitive bio-marker for early diagnosis of breast cancer. A cross- sectional study directed towards 203 women who came for breast cancer screening (mammogram) at Central Women Hospital (CWH) showed favorable perception towards mammogram and most of them were willing to do the test in the future. A study on histological grading and immunological markers in 48 gastric cancer tissue specimens reported that HER 2 marker should be used for therapeutic prediction in gastric adenocarcinoma and COX 2 marker would be used for prognostic marker that is involved in the growth of gastric carcinoma. A study on effect of nutrition status on induction remission in children with acute leukemia in Yangon Children Hospital elucidated that early detection of malnutrition and optimal nutritional support should be considered to reduce mortality of newly diagnosed leukemia. An evaluation study reported that trace elements such as copper and zinc have a role to play in pathogenesis as well as in management of betel quid associated oral sub mucus fibrosis and oral squamous cell carcinoma.

NUTRITION The cross-sectional study identified factors contributing towards urinary iodine levels of 144 pregnant women living in coastal area of Mon State and pointed out the necessity to increase the iodine intake and the importance of improving salt iodization programme and continuous monitoring of iodine content at different levels. The collaborative research study on betel quid chewing in Dagon (East) township ascertained its relationship to oral pre-cancerous lesions in 542 adults and highlighted the growing importance of betel quid chewing and smokeless tobacco use as a public health problem that warranted for intensive prevention activities.

TOXICOLOGY Clinical profile of acute poison cases admitted to Poison Treatment Centre, New Yangon General Hospital identified the magnitude of poisoning and the need of research on poison identification analysis, clinical and laboratory indicators for prognosis, outcome of treatment including supportive interventions and antidotal therapies to prevent unnecessary mortality and morbidity.

TRADITIONAL MEDICINE One experimental study suggested that aqueous extract of leaves of Ocimum gratissimum Linn. (Taw Pin Sein) possessed an anti-diarrhoeal effect in castor oil induced diarrhoeal mice model. Antioxidant properties were proved in peel and pulp of red dragon fruits, aqueous and

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Annual Report 2013 ethanolic extract of the leaves of Centella asiatica Linn. (jrif;cGm) but less effective than standard ascorbic acid. For maintenance of the substantial antioxidant properties of noni fruit, fresh expressed juice rather than fermented juice and boiled juice was recommended. Hepatoprotective effect of Amaranthus spinosus ([if;EkEG,fql;ayguf) against CCl 4 induced hepatotoxicity in albino rats was proved according to liver enzyme levels and histopathological results.

HEALTH SYSTEMS RESEARCH Evidence-based information attained from the health facility assessment survey in Myanmar focusing on maternal, newborn and child health at 25 public health facilities called for the nation-wide study to gain deeper insights into the current situation and community perspectives towards MNCH services provided not only by public health facilities but also by the private sector. One qualitative study elucidated the underlying reasons for limited use of health research results by National Progammes and suggested to develop and strengthen existing mechanisms for further enhancement in utilization. A cross-sectional study in peri-urban households with under-five children concluded that apart from improved sanitary facilities and personal hygiene, drinking water purification systems in low income households required strengthening by intensive community engagement through both private and public sectors so as to contribute towards prevention of acute diarrhoea. Two cross-sectional studies using mixed methods approach emphasized the requirement of timely dissemination of minimum and essential information about preparedness and strengthening after flood rehabilitative program and pointed out the need for further research to underscore community barriers that prevent translation of knowledge to action. One qualitative study pointed out the crucial role of village health committee in community-based emergency referral mechanism for maternal, newborn and child health problems in middle island, Nga-Pu-Daw Township and identified common barriers such as variations for defining emergency, over-demand or unnecessary demand of community to refer to get meal cost at hospital and attitude of BHS. A cross- sectional study pointed out that the best rural retention strategies for health staff appeared to be combined financial and non-financial incentives. A systematic, specific and sustainable rural retention policy and plan should be developed in order to avoid failures such as being temporary motivation and lack of transparency.

ENVIRONMENTAL HEALTH

Mushroom Poisoning Diagnostic Laboratory at the National Poison Control Centre has been established and four out of (30) samples from Shan State contained deadly amanitin toxin. Elemental concentrations in water, soil, ambient air and plants were ascertained from two industrial zones by applying Energy Dispersive X-ray Fluorescence 600 (EDXRF) technique and found that the levels of iron, copper, zinc, and manganese were higher than the maximum permissible level in water samples of both study sites.

TECHNOLOGY DEVELOPMENT

Modified WST8/1 methoxy PMS method has been established to detect Glucose-6-Phosphate dehydrogenase enzyme deficiency in pregnant women and found to be applicable in mass screening. Development and validation of test kits for screening of transfusion transmitted infections in donor blood has been completed in collaboration with Olipro Biotechnology Sdn. Bhd., Malaysia prior to field and laboratory evaluation.

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PROFILE

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Department of Medical Research (Lower Myanmar)

Layout Plan

1. Administrative Office and Socio-Medical Research Centre 2. Central Biomedical Library and Auditorium 3. Biomedical Research Centre 4. Clinical Research Centre 5. National Blood Research Centre, National Poison Control Centre & Vaccine Research Centre 6. Stores and Procurement Division 7. Laboratory Animal Services Division 8. Staff Quarters 9. Director-General’s Residence 10. Hepatitis-B Vaccine Clinic and Cervical Cancer Screening Clinic 11. Power Station 12. Medical Entomology Research Division 13. Advanced Molecular Research Centre

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Centre Centre Vaccine Director Research Snake Bite Bite Snake MH) (2 Malaria

- - Quality Control Div. Control Quality Assurance Quality Div. Technology Div. Development Res. Biochemistry Div. Div. Publication Animal Laboratory Div. Services Research Clinical Units Clinic Vaccine

Centre Centre National Director Poison Control Control Poison Toxicology Toxicology Malaria(DSGH) (NOGH) Malaria

- - - Parasitology Div. Res. Pharmaceutical Div. Res. Toxicology Toxicology Chemical Div. Res. Toxicology Biological Div. Res. Toxicology Radiation Div. Res. Clinical Research Units

Centre Centre

National Director

Blood Research Research Blood Traditional Medicine Traditional Haematology Haematology Oral Medicine Cancer Cervical Clinic Screening

- - - - Immunology Div. Res. Programming Blood Div. Div. Res. Blood Pharmacology Div. Res. Clinical Research Units

Centre Centre Research Research Director Biomedical HIV HIV

- Director-General Bacteriology Div. Res. Pathology Div. Res. Virology Div. Res. Medical Entomology Div. Res. Research Clinical Unit

Deputy Director-General Deputy

OrganizationalStructure

Centre Centre Clinical Research Research Director Oncology Oncology UM(2)

- - Clinical Res. Div. Res. Clinical Experimental Medicine Div. Res. Physiology Div. Res. Nutrition Div. Res. Nuclear Medicine Div. Res. Research Clinical Units

Medical - Centre Centre Research Research Director

Socio Epidemiology Div. Res. Health Systems Div. Res. Medical Statistics Div. Res. Central Biomedical Library Computer Div.

= Division = & Support Support Director

Administration General Administration & Budget Account Store & Procurement Div. Distribution Instrumentation Div. Div. Div. Res. Division Research =

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DEPARTMENT OF MEDICAL RESEARCH (LOWER MYANMAR) BOARD OF DIRECTORS (2013)

Dr. Kyaw Zin Thant HGP, MBBS, DTM, PhD (Japan) FACTM, Dip in R&D (Japan), FRCP (Edin) Director-General

Dr. Myat Phone Kyaw MBBS, MMedSc (Biochemistry) PhD (Malariology), FACTM, FRSTM&H, MASTM&H Deputy Director-General

Dr. Hlaing Myat Thu Dr. Win Aung MBBS, MMedSc (Microbiology) MBBS, MMedSc (Biochemistry) MACTM, PhD (Molecular Virology) FACTM, FRCP (Glasg) Director (Research) Director (Research)

Dr. Zaw Myint MBBS, PhD (Japan) Director (Admin )

Dr. Khin Saw Aye MBBS, MMedSc, Dr. Theingi Thwin PhD (Pathology) MBBS, MMedSc (Biochemistry), Director (Research) Dr. Khin Thet Wai PhD (Biochemistry) MBBS, MMedSc (Public Health) Director (Research) MA (Population & Family Planning Research) Director (Research)

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CTIVITIES & RESEARCH FINDINGS

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BACTERIOLOGY RESEARCH DIVISION

Deputy Director & Head … Dr. Wah Wah Aung MBBS, MMedSc, PhD(Microbiology) (UM 1) Research Scientist … Dr. Mya Mya Aye MBBS, MMedSc(Microbiology) (UM 1) Research Officer … Daw Thuzar Myint BSc (Zoology)(YU), DPMS(Yangon) … Dr. Phyu Win Ei MBBS(UM 2), MMedSc(Microbiology) (UM 1) … Dr. Nan Aye Thidar Oo MBBS(UM 2) … Daw Than Mya BSc(Hons), MSc(Zoology) (YU) Research Assistant (2) … Daw Aye Aye Maw BSc(Mathematics)(YU) … Daw Mi Mi Htwe BSc(Zoology), MSc(Zoology) (YU) Research Assistant (3) … Daw Aye Yin Shwe BA(Geography) (DU) … Daw Hay Mar Win BA(History) (EYU) Research Assistant (4) ... Daw Su Mon Win BSc(Engineering Biotechnology) MSc, MRES(YU) Laboratory Attendant ... Daw Saw Nan Wai

The Bacteriology Research Division was engaged in the following research activities on mycobacterial, reproductive tract, acute respiratory and enteric infections; bacteriological aspects on therapeutics and environmental health. Research with direct implication for effective control of diseases was being focused. One of the main areas was detection of emergence of drug resistant organisms. Monitoring of the aetiological agents and drug sensitivity pattern of diarrhoeal and sexually transmitted infections were also performed.

RESEARCH PROJECTS 1. COMMUNICABLE DISEASES 1.1. TUBERCULOSIS 1.1.1. Molecular based detection of genitourinary tuberculosis from clinically suspected cases in renal surgical ward of New Yangon General Hospital Genitourinary tuberculosis (GUTB), the second most common extrapulmonary tuberculosis, has nonspecific presentation, which results in delay diagnosis and management of the disease. Urine acid-fast bacilli (AFB) microscopy is not specific and TB culture is not sensitive for diagnosis of GUTB, nucleic-acid amplification techniques have been investigated extensively for the rapid detection of Mycobacterium tuberculosis in clinical specimens. A descriptive study was carried out from October 2012 to October 2013 at Bacteriology Research Division, DMR (Lower Myanmar) to detect Mycobacterium tuberculosis DNA directly from urine specimens of clinically suspected GUTB cases attending the Urology Department of New Yangon General Hospital by using the insertion segment 6110 polymerase chain reaction (IS 6110 PCR). PCR results were compared with urine AFB microscopy, radiologic findings and clinical symptoms. Among 35 suspected GUTB cases, 13 (37.14%) cases were confirmed by PCR. Among those confirmed cases, 7 (53.84%) were urine AFB positive. When compare with imaging findings, 8 out of 13 (61.53%) showed renal impairment (hydronephrosis and/or hydroureter) and 4 (30.77%) patients had renal stone. Regarding clinical symptoms, 8 out of 13 (61.53%) had dysuria, 9 (69.23%) had frequency, 7 (53.84%) had loin pain, 6 (46.15%) had haematuria and 6 (46.15%) had suprapubic pain. The results showed GUTB can be detected in urine AFB

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Annual Report 2013 negative cases and those without organ impairment by using IS 6110 PCR method. Thus, IS 6110 PCR plays an important role for early detection of genitourinary tuberculosis.

1.1.2 Establishment of molecular strain typing methods for Mycobacterium tuberculosis in Myanmar The aim of this study was to establish molecular strain typing methods for Mycobacterium tuberculosis in Myanmar. Sputum specimens from new smear positive TB patients at Yangon and Mandalay Regional TB Centers, Culture and drug susceptibility testing (DST) were carried out in National TB Reference Laboratory, Aung San and Upper Myanmar TB Laboratory, National TB program, Myanmar. Of 250 sputum samples subjected for culture and DST, 191 isolates of M. tuberculosis were obtained consisting 142 strains from Yangon Region and 49 isolates from Mandalay Region. Some isolates were tested for genotypic drug susceptibility testing by Hain Test, Restriction Fragment Length Polymorphism (RFLP) and Mycobacterial Interspersed Repetitive Units-Variable Number Tandem Repeat (MIRU-VNTR typing in Korea. Phenotypic analysis showed polyresistant strains (resistant to two or more drug) were 21.5% (41/191) including 18.3% (35/191) of multidrug resistant TB (MDR-TB, resistant to at least rifampicin (RIF) and isoniazid (INH) and 2.6% (5/191) of monoresistant strains (resistant to one drug). Genotypic assay showed 17.3% (33/191) of MDR-TB, 0.5% (1/191) of RIF monoresistance and 5.8% (11/191) of INH monoresistance. The genotypic results were 91.1% concordant with the phenotypic susceptibility. Common mutations in the rpoB gene, katG gene and inhA gene conferring resistance to RIF and INH among drug resistant isolates were determined. Among RIF resistant isolates, S531L mutation was the most common mutation, with 62.5% (20/32) of MDR strains and 100% (1/1) of one RIF mono-resistant strain. H526Y mutation was the second most common accounting for 28.1% (9/32) of MDR strains. Of all INH resistant strains, 93.02% (40/43) (31MDR strains and 9 of INH-mono-resistant strains) had a mutation in the S315T1 region of katG gene, and only 4.7% (3/43) (1 MDR strain and 2 INH-mono- resistant strains) had a mutation in the C15T region of inhA gene. This study highlighted the high prevalence of anti-TB drug resistance among new pulmonary TB cases and provided the preliminary information on gene mutation patterns of drug resistant M. tuberculosis strains from Myanmar.

1.2. DIARRHOEA/ DYSENTERY 1.2.1 Bacteriological profile and antimicrobial susceptibility pattern of childhood diarrhoea Diarrhoeal diseases constitute a leading cause of morbidity and mortality in children particularly in developing countries. A cross-sectional descriptive study was carried out on 250 children under 12 years of age with acute diarrhea attending Yangon Children Hospital, Yankin Children Hospital, Thingangyun Sanpya Hospital, Insein General Hospital and North Okkalapa General Hospital during the period of January to September 2013. The rectal swab samples were collected and isolation of Vibrio cholerae was carried out by standard culture methods at Bacteriology Research Division, Department of Medical Research (Lower Myanmar). Suspected colonies were confirmed by biochemical tests and slide agglutination tests using specific antisera. Antibiotic sensitivity was determined by disc diffusion method and Epsilon meter gradient test (E test). Bacterial pathogen were isolated from 60.8% of rectal swabs and Escherichia coli (63.8%) were the most predominant followed by Vibrio cholerae (14%), Shigella dysentriae (7.2%) and S almonella spp. (6%). Among 97 isolates of Escherichia coli , Enteropathogenic Escherichia coli contributes 63.8% (31/97), Enterotoxigenic Escherichia coli 14.5% (14/97) and Enteroinvasive Escherichia coli was 10.3% (10/97) and untypable Escherichia coli was 43.3% (42/97). All V. cholerae isolates 2

Annual Report 2013 were V. cholerae O1 Ogawa serotype and El Tor biotype. Isolated V.cholerae were resistant to cotrimoxazole and naildixic acid (100% each), doxycycline (20%) and amikacin (14%) respectively. They were sensitive to chloramphenicol and cefotaxime (100% each), norfloxacin (94.4%), ciprofloxacin (85.7%), azithromycin (82.8%) and doxycycline (62.8%), respectively. Thirteen multiple drug resistant V.cholerae isolates were detected. Minimum inhibitory concentration (MIC) of susceptible strains of ciprofloxacin revealed 0.125 to 0.5 µg/ml. High level azithromycin resistance MIC = 32 µg/ml was seen in one case. The present study highlighted the occurrence of cholera among the paediatric acute diarrhea cases and determined the drug sensitivity profile of common antibiotics which are currently used for treatment of childhood cholera.

1.3. CHOLERA 1.3.1. Molecular characterization of Vibrio cholerae in Myanmar This study was the collaborative research project of Bacteriology Research Division and Osaka University, Japan. V. cholerae harbours a virulence regulon consisting of genes involved in colonization, toxin production and bacterial survival within the host. The distribution of virulence associated genes and their sequences will provide detail information regarding virulence associated genes among different serogroups of local Myanmar strains. This study was carried out to characterize Vibrio cholerae strains isolated in Myanmar by molecular analysis. Rectal swab specimens were continuously collected from suspected cholera cases and/or severe diarrhea cases from four hospitals in Yangon, New Yangon General Hospital, North Okkalapa General Hospital, Thingangyun Sanpya Hospital and Yankin Children Hospital during 2012 and 2013. Of 312 specimens, V. cholerae O1 were isolated from 72 cases (23.1%). The 50 out of 72 isolates of V. cholerae O1 were involved in this study. All isolates were serotype Ogawa, tetracycline resistance, and carried tcpA (encoding the structural subunit of the toxin- coregulated pilus) and rstR (repressor gene in CTX phage) of El Tor biotype. While, the all sequences of cholera toxin B subunit gene were classical type ( ctxB Cla). V. cholerae O1 isolates carrying Haitian variant cholera toxin gene and MS6 strain which we previously found as a new genetic line in Thai-Myanmar border area . Current Myanmar isolates were atypical El Tor, which carried ctxB Cla and rstR El. Yangon isolates exhibited a total of 10 patterns of Pulsed Field Gel Electrophoresis (PFGE). Between February and April, 2012, the majority of patients were adults and 9 variations of PFGE pattern were observed. Whereas, since May to August, most patients infected with V. cholerae O1 were children less than 5 years old and almost exhibited pulsotype Y10. This pulsotype was predominantly found in 54% isolates (27/50). All isolates of Y10 were tested for multilocus variable-number tandem-repeat analysis and revealed that five MLVA types were shown and they were closely related.

1.4. ENTERIC INFECTION 1.4.1. Characterization of Helicobacter pylori isolates from gastric biopsy specimens from patients with chronic dyspepsia The objectives of this study were to isolate the H. pylori from chronic dyspepsia patients, to determine the genotypic pattern of H. pylori by polymerase chain reaction (PCR) and also to determine the drug sensitivity profile of isolated H. pylori by Epsilon meter gradient test (E test). Two hundred gastric biopsy specimens were taken from dyspeptic patients comprising 100 gastritis cases and 40 duodenal ulcer cases and 60 gastric ulcer patients. The specimens taken from the patients were cultured and 30 samples (15%) were positive for Helicobacter pylori by urease test as well as culture. Of the 30 isolates of H.pylori, resistance to metronidazole (100%) and clarithromycin (63.6%) were found.

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Annual Report 2013

However, all isolates were sensitive to amoxicillin and levofloxacin (100%). Cytotoxin associated gene ( cag- A) and Vacuolating cytotoxin gene ( vac-A s1 ) genotypes were detected in all isolates (100%) by PCR. Among 30 vacA s1 strains, 20 strains were vacA s1a subtype (66.6%) and 10 strains were vacA s1c subtype (33.3%) but there was no detection of vacA s1b subtypes. For the vacA middle region ( m) status, m1subtype was detected in all 30 strains of H.pylori (100%) but there was no detection of m2 subtype. Data from this research were expected to provide the necessary information to select the drug of choice for eradication of H. pylori and also in the management of gastritis and peptic ulcer, and ultimately, to prevent cancer of the stomach.

1.4.2. Virulence gene pattern of Helicobacter pylori among gastric cancer patients One hundred gastric biopsy specimens were taken from suspected gastric cancer cases. The specimens taken from the patients were cultured and 52 samples (52%) were positive for Helicobacter pylori by urease test as well as culture. Cytotoxin associated gene (cag- A) and Vacuolating cytotoxin gene ( vac-A s1 ) genotypes were detected in all isolates (100%) by PCR. Among 52 vacA s1 strains, 40 strains were vacA s1a subtype (76.9%) and 12 strains were vacA s1c subtype (23.1%) but there was no detection of vacA s1b subtypes. For the vacA middle region ( m) status, m1subtype was detected in all 52 strains of H.pylori (100%) but there was no detection of m2 subtype. This study highlighted the prevailing genotypes of H. pylori and their association among gastric cancer patients.

2. ENVIRONMENTAL HEALTH 2.1 WATER SAFETY 2.1.1 Analysis of microbiological quality of household drinking water in a periurban community 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. A cross-sectional descriptive study was carried out in two selected wards which include households with reported fairly high attack rate of acute diarrhoeal disease in North Dagon Township, Yangon from December 2012 to August 2013, to determine the bacteriological quality of household drinking water. One sample of drinking water was collected from currently using drinking water containers of each study household. It was found that most of the study households used water from common water tanks for drinking. Bacteriological parameters including total coliform and faecal coliform counts were detected by Multiple Tube Method at Bacteriology Research Division, Department of Medical Research (Lower Myanmar). Of 137 water sample tested, coliforms were detected in 94.9% (130/137) and faecal coliforms were detected in 93.4% (128/137), ranging from a Most Probable Number (MPN) of 2.2 cfu/100ml to indeterminate. Escherichia coli was isolated from 45.3% (58/128) of faecal coliform positive water samples. The results indicated that the majority of the tested drinking water samples were contaminated with bacteria of faecal origin. Potential risk factors for drinking water contamination might include existing patterns of drinking water storage, methods used for treating drinking water, waste disposal and insanitary latrines that required further confirmation. The present study highlighted the poor bacteriological quality of drinking water and unhygienic sanitation practices in the study households. The results may assist in developing intervention programs for household drinking water treatment and safe storage (HWTS) strategies in the vulnerable communities.

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Annual Report 2013

SERVICES PROVIDED ACADEMIC

Sr. Name Course Responsibility No. 1. Dr. Wah Wah Aung PhD (Microbiology) Thesis Supervision MMedSc (Microbiology) Teaching, Thesis Supervision, Third Year MBBS External Examiner (Microbiology) MSc (Medical Technology) Teaching 2. Dr. Mya Mya Aye MMedSc (Microbiology) Teaching 3. Dr. Phyu Win Ei MMedSc (Microbiology) Teaching 4. Daw Thuzar Myint MSc (Medical Technology) Teaching

LABORATORY

Sr. Name of tests Total Number Tested No. 1. Determination of TB IgG antibody by ELISA 22

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Annual Report 2013

BIOCHEMISTRY RESEARCH DIVISION

Deputy Director & Head .. . Dr. Nwe Nwe Oo MBBS(IM 1), MMedSc(Biochemistry) (IMM) Research Scientist ... Dr. Moe Thida Kyaw MBBS(IM 1), MMedSc(Biochemistry) (IM 2) Research Officers ... Daw Mie Mie Nwe BSc(Botany), DFT (YU) ... Dr. Khin Than Yee MBBS, MMedSc(Biochemistry) (UM 1) Laboratory Incharge … U Aung Myat Kyaw BA(Economics), DFT, PDCSc (YU) Research Assistant (2) ... U Tin Ko Ko Oo BA (Economics) (WC ) ... Daw Lwin Zar Maw BSc(Chemistry)(UDE), DFT (YU) Research Assistant (3) ... Daw May Thu Kyaw BA(Economics) (UDE) Research Assistant (4) ... Daw Nwe Ni Aung BSc(Biotechnology) (DU) Laboratory Attendant ... Daw Yi Yi Sein

The Biochemistry Research Division is actively involved in research activities of Malaria, Tuberculosis, Non-alcoholic fatty liver diseases, Snake bite and others.

RESEARCH PROJECTS 1. COMMUNICABLE DISAESES 1.1 TUBERCULOSIS 1.1.1 C-reactive protein (CRP) levels in pulmonary tuberculosis patients undergoing DOTS regime CRP protein is an acute phase reactant which increases in bacterial infection. This study aimed to analyze the pattern of CRP changes during the course of the anti-TB treatment and to find out the association of changes of CRP and prognostic parameters. Prospective single cohort study with repeated measures was conducted on 30 newly diagnosed pulmonary TB patients, attending to National Tuberculosis Control Programme and getting DOTS regime. The patients were interviewed and their medical records including chest-X rays and sputum smear for acid fast bacilli were documented. Blood CRP levels were determined by using Photometric-turbidimetric test. Among 30 patients, 11 patients were sputum positive and 19 patients were sputum negative at baseline. All patients became sputum negative after 6 months treatment and there was drug resistance case at the end of the study. CRP levels (mean ± SE) at pre treatment (baseline), 2 months after and 6 months after treatment were (43.20 ± 8.64 mg/dl), (61.26 ± 19.37 mg/dl) and (51.84 ± 14.36 mg/dl), respectively. Normal value of CRP in adult is 0.5 mg/dl. This study showed CRP values of tuberculosis patients were much higher than that of normal level up to 6 months. Therefore, CRP level cannot be used as the predicted value in treatment of tuberculosis.

2. NON-COMMUNICABLE DISEASES 2.1 LIVER DISEASES 2.1.1 Correlation of cardiovascular risk and non-invasive fibrosis score in non-alcoholic fatty liver disease (NAFLD) patients in 2013 Patients with ultrasound proven NAFLD, attending the Out Patient Department (OPD) at Yangon General Hospital (YGH) were studied to find out the correlation between different lipid ratios and fibrosis scores in these patients. NAFLD fibrosis score (risk score)

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Annual Report 2013 consisting of 6 variables which were routinely measured and readily available clinical and laboratory data were used. NAFLD fibrosis score was expressed by using the formula of (-1.675 + 0.037 x age (years) + 0.094 x BMI (kg/m 2) + 1.13 x IFG/diabetes (yes = 1, no = 0) + 0.99 x AST/ALT ratio – 0.013 x platelet (x10 9/l) – 0.66 x albumin (g/dl). A total of 35 patients had an average age of 50.1 ± 10.7 years with female predominance (65%). Mean BMI was 28.2 ± 5.6 kg/m 2. Ten (28.5%) patients suffered from hyperglycemia. The mean values of measured plasma lipids were total cholesterol (TC) (205.36 ± 38.43 mg/dl), HDL- cholesterol (HDL-C) (34.61 ± 6.77 mg/dl), LDL-cholesterol (LDL-C) (126.59 ± 21.56 mg/dl) and triglycerides (TG) (195.41 ± 51.09 mg/dl), respectively. In this study, liver biopsy and histological examination could not be done on these patients.

3. TRADITIONAL MEDICINE 3.1 OXIDANT AND ANTIOXIDANT 3.1.1 Detection of antioxidant activity in Hylocereus polyrhizus (နဂါးေမာက်သီးအနီ) fruits Hylocereus polyrhizus (နဂါးေမာက်သီးအနီ) is a rich source of nutrients and minerals, it is also rich in pytoalbumins which are highly valued for their antioxidant properties. Dragon fruits, like many other tropical fruits and vegetables, are believed to be rich in antioxidant levels and properties in its pulps and peels are still lacking. The aim of the study was determine and compare the antioxidant activity of peel and pulp of Hylocereus polyrhizus (နဂါးေမာက်သီးအနီ). The antioxidant activities of peel and pulp of these fruits was evaluated by DPPH (1-1 diphenyl -2-picryhydrazyl) method. Determination of radical scavenging activity of DPPH method is based on the change in absorbance value measured in 517 nm of spectrophotometer. Free radical scavenging activity is usually express in term of percent inhibition and ascorbic acid as standard antioxidant. These activity were detected in 95% ethanol extract of peel and pulp juice in white fruits. The yield percent of red dragon peel was 1.8% and pulp was 7.6%. The concentration of the standard ascorbic acid, peel, and pulp of the Hylocereus polyrhizus were 0.5 µg/ml, 1 µg/ml, 2 µg/ml, 3 µg/ml and 4 µg/ml. The mean percent inhibition of ascorbic acid (standard) was 67.8%, 80%, 85%, 94.9% and 98.3%. The mean percent inhibition of red dragon peel and pulp were 57.3%, 58.6%, 59.5%, 61.5%, 64.0% and 56.4%, 59.1%, 62%, 62.2%, 63.8%, respectively. These above study showed that the peel and pulp of red dragon fruits have anti-oxidant activity.

4. ACADEMIC AND TECHNOLOGY DEVELOPMENT 4.1 TECHNOLOGY DEVELOPMENT 4.1.1 Establishment of modified WST8/1 methoxy PMS method in detection of Glucose -6- Phosphate dehydrogenase enzyme deficiency Glucose -6-phosphate dehydrogenase (G6PD) enzyme deficiency is the most common hereditary disorder. G6PD deficiency may cause acute haemolytic anaemia after taking certain oxidative drugs, eating of fava beans and infections especially in malaria infection. The oxidant drug primaquine causes haemolysis in G6PD deficient person. In Myanmar, many researchers tried to diagnose G6PD enzyme deficiency with different methods. All of these tests are tedious and time consuming and unsuitable for mass screening. The aim of this research project was establish the new method for mass screening of G6PD enzyme deficiency. The blood samples were collected from Out Patient Department of Central Women Hospital. G6PD enzyme deficiency was detected by modified WST8/1 methoxy PMS method. It is a semiquantitative method. The results of this method compared to the results of agarose gelelectrophoresis method, which was also the semiquantitative method

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Annual Report 2013 and this method was used for WHO classification since 1995. Six hundred and six pregnant women and 317 husbands were recruited. Among these subjects, 5.61% of females were deficient and 10.73% of males were found as deficient.

SERVICES PROVIDED ACADEMIC Sr. Name Course Responsibility No. 1. Dr. Nwe Nwe Oo 2nd year MBBS(UM 2) & External Examiner 1st year MMedSc(Biochemistry)

2. Dr. Nwe Nwe Oo Thesis examination of 2 nd year MMedSc Co-Examiners Dr. Moe Thida Kyaw (Biochemistry), DSMA

3. Dr. Nwe Nwe Oo Research Methodology and Bioethics Facilitator s Dr. Moe Thida Kyaw Workshop 2013

4. Dr. Nwe Nwe Oo 1st year MMedSc(Biochemistry), Teaching and Dr. Moe Thida Kyaw 1st year MMedSc(Physiology) Demonstration Dr. Khin Than Yee 1st year MMedSc(Pharmacology) from Demonstration Daw Lwin Zar Maw UM 1, UM 2, UMM, UM (Magway) & DSMA. 1st year M.Pharm from University of Pharmacy 1st year M.MedTech from University of Medical Technology

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Annual Report 2013

BIOLOGICAL TOXICOLOGY RESEARCH DIVISION

Deputy Director & Head … Dr. Thaung Hla MBBS, MMedSc(Pathology) (IM 1) Research Scientist … Dr. Thet Thet Mar BSc(Hons), MSc, Ph.D(Chemistry)(YU) Research Officer … Dr. Lai Lai San MBBS, MMedSc(Microbiology) (UM 2) … Daw Thin Thin Wah MSc (Zoology) (YU) Research Assistant (2) … Daw Tin Tin Htwe BSc(Zoology) (YU) … Daw May Than Htay MSc(Zoology) (YU) … Daw Zin Mi Thein BSc(Mathematics) (YU) Research Assistant (3) … Daw Nilar BSc(Zoology) (YU) … Daw Wai Lwin Oo … Daw Myo Myo Kyaw BSc(Chemistry) (YU) Research Assistant (4) … U Kyaw Kyaw San BSc (Zoology) (YU)

Under the National Poison Control Centre (NPCC), Biological Toxicology Research Division is mainly involved in conducting research on toxins produced by the living organisms. During 2013, projects relating to food safety were undertaken. In order to upgrade the division in the field of determination and identification of toxins, initiation of the establishment of mushroom poisoning diagnostic laboratory in NPCC was commenced at the begining of 2013 and was partly completed. The Division is arranging to expand its capacity year by year.

RESEARCH PROJECTS 1. ENVIRONMENTAL HEALTH 1.1 Establishment of Mushroom Poisoning Diagnostic Laboratory in National Poison Control Centre (WHO APW 2012-2013) Mushroom samples sent from Shan state and Kayin State were analysed chemically. Photo-documentation of the mushrooms were also done. Some mushroom samples were made dry and kept in the division for reference and teaching purposes. A total of (98) mushroom samples were received during this study period. Thirty samples from Shan State, 40 samples from Kayin State, 20 samples from Mon State and 8 samples from Yangon Division, respectively. The following tests were applied as necessary to identify specific toxin for each and every sample. They were agaricus test (Both for bases and Aniline oil), Ammonia (ammonium hydroxide) test, Chlorophyllum test, Ferric chloride test, Ferrous sulfate test (Green vitriol test), Guaiacol test, Hydrochloric acid test, Iodine test, Melzer’s Iodine test, Nitric Acid test, Orellanine presumptive test, Phenol test, Potassium hydroxide test, Schaeffer Reaction and Sulfuric Acid test. Toxin analysis revealed that out of (30) samples from Shan State, (4) samples contain deadly amanitin toxin. The amanitin positive samples were originated from Tone-tar village tract of Kyaing-Tone and Kya-ku-lone village tract of Maing-Tone townships of the Shan State, respectively. Samples from Kayin State, Mon State and Yangon Region do not reveal amanitin. The other types of toxins detected in the samples received from Kayin State are mentioned in the table below.

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Annual Report 2013

Positive Poison Shan Kayin Mon Yangon Amanitin 4 Orellanine 1 Ibotenic acid Hydrazines Muscarine 2 Corpine Psilocin & Psilocybin 1

It is needed to keep in mind that Amanitin is deadly Toxin. But, careful and drastic supportive management can save the lives of the poisonous victims.

1.2 Bacteriological profile of public access points in selected places A total of 100 samples were taken from some public access points that were always crowded with consumers. It includes Elevator/Lift control knobs of pagodas, shopping Centers (25 samples), computer mouse and keyboards of internet cafes (25 samples each) and shopping mall cart handles (25 samples), respectively. Standard bacteriological culture methods were applied for the whole process starting from sample taking to identification of the bacteria. Out of 100 samples, Staphylococcus aureus was isolated from 52 samples, Bacillus species from 16 samples, Escherichia hermanii from 1 sample, Hafnia alvei from 4 samples, Pseudomonas species from 6 samples, Escherichia vulnesis from 2 samples and Neisseria from 1 sample. These figures indicated that decontamination procedures are needed to increase in that places and the public consuming these facilities should aware personal cleanliness after touching them.

SERVICES PROVIDED ACADEMIC Sr. Name Course Responsibility No. 1. Dr. Thaung Hla Research Methodology & Bioethics Lecturer Workshop 2012 2. Dr. Thaung Hla Biological Toxins and its analytical methods Training and Dr. Thet Thet Mar M.Sc (Med: Tech ) Students Practical Dr. Lai Lai San Demonstration Daw Thin Thin Wah 3. Dr. Thaung Hla Symposium on Recent Advances in Speaker Environmental Health 42 nd Myanmar Health Research Congress

POISON INFORMATION SERVICE Biological Toxicology Research Division is actively involved in poison information service to provide appropriate informative answers to the clinicians and the public throughout the country. It includes diagnostic strategies and therapeutic suggestions concerned with biological toxins. The answers are given by Telephone -01379480 and 0973155342. Telephone 379480 can be used during office hours and mobile phone for out of office hours.

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Annual Report 2013

BLOOD PROGRAMMING DIVISION

Deputy Director & Acting Head … Dr. Yi Yi Kyaw MBBS, MMedSc(Micro) (IM 1) Research Officer … Dr. Khin Lapyae Tun MBBS(UM I) Research Assistant (2) … Daw Nwe Nwe Soe BSc(Chemistry) (YU) Research Assistant (3) … Daw Phyu Phyu San BA(History) (DU, Yangon) … U Zaw Min Latt BSc(Chemistry) (YU) … Daw Hla Hla Win BA(History) (DU, Yangon) … U Kyaw Thu Myat Research Assistant (4) … Daw Aye Thandar Oo BSc(Physics) (DU)

Blood Programming Division is primarily involved in providing services on blood safety and blood donor recruitment. Regarding blood safety, surveillance of the prevalence of transfusion transmitted infections in blood donors, promotion of voluntary non-remunerated blood donors’ recruitment by use of Blood Mobile, and research work on viral hepatitis infection and blood borne viral diseases have been carried out.

RESEARCH PROJECTS 1. COMMUNICABLE DISEASES 1.1. VIRAL HEPATITIS 1.1.1. Detection of anti-HBc and HBV DNA in blood donors negative for HBs Ag The safety of blood products is one of the major issues in the area of transfusion medicine. Antibodies to hepatitis B core (HBc) antigen are marker of acute, chronic, or resolved HBV infection and remain detectable for life. Anti-HBc was therefore, detected in anyone who had been infected with HBV. Since anti-HBc detection is not mandatory for transfusion service in Myanmar. We would study whether anti-HBc detection could be adopted as a screening assay for safety of donated blood. One hundred HBsAg negative, first time blood donors would be recruited. A total of 20 blood samples were already collected for detection of hepatitis markers and HBV DNA.

2. HEALTH SYSTEMS RESEARCH 2.1. BLOOD SAFETY 2.1.1. Study on deferral patterns of voluntary blood donors in community (2013) Both safety and adequacy of blood supply for transfusion are major concerns for a Blood Bank. Not all attending voluntary blood donors are entitled for safe blood donation and transfusion therapy. Deferral patterns of voluntary blood donors in community need to be explored. During the year under report, a total of 2,414 persons attended to the blood mobile in community for voluntary blood donation. However, only 1,644 persons (72.7%) were entitled for safe blood donation and 704 persons (29.5%) were deferred from donation of blood due to unacceptable weight, hemoglobin concentration and blood pressure and not eligible for responding to the questionnaires regarding safe blood donation. There was an apparent decrease in deferral rate of blood donors in 2013 (704, 29.5%) compared to 2011 and 2012 (1719, 32.5%).

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Annual Report 2013

2.1.2. Annual seropositivity rate of transfusion transmitted infections among blood donors in Yangon (2013) Blood Safety is essential for transfusion therapy. Annual prevalence rates of major blood-borne diseases: hepatitis B (HBV), hepatitis C (HCV), Human immunodeficiency virus (HIV) and syphilis need to be studied in blood donors for safe blood transfusion. Surveillance study of transfusion transmitted infections among blood donors was done in collaboration with National Health Laboratory, Department of Health. During the year under report, total blood donors in blood banks of hospitals in Yangon City were found to be 6772 and the annual prevalence rates of HBsAg, anti-HCV, anti-HIV and anti-syphilis among these blood donors were found to be 290 (3.18%), 34 (0.51%), 23 (0.34%) and 97 (1.4%), respectively. The seropositivity rates of HBs Ag, HCV and HIV were slightly decreased which compared to previous year. The prevalence rate of syphilis antibody was not apparently changed in blood donors.

SERVICES PROVIDED DONOR RECRUITMENT Effective donor recruitment and collection of safe blood in the community by using blood mobile (2013) Safe blood is mostly obtained from non-remunerated voluntary blood donors. Therefore, effective donor recruitment and collection of safe blood were carried out in community by using a blood mobile. During the year under report, in collaboration with National Blood Centre, Yangon, a total of 3 visits to Mingalar Byuhar religious centre was carried out, collecting 1644 units of blood.

ACADEMIC

Sr. Name Course Responsibility No. 1. Dr. Yi Yi Kyaw Overview of Hepatitis Problem Speaker in Myanmar (8-11-2013) 2. Dr. Yi Yi Kyaw External Examiner UM(1) 3rd Year M.B, B,S

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Annual Report 2013

BLOOD RESEARCH DIVISION

Deputy Director & Head … Dr. Win Pa Pa Naing MBBS(IM 1), MMedSc(IM 2), PhD (Pathology) (UM 2) Research Scientist … Dr. San San Htwe MBBS, MMedSc(Pathology) (UM 1) … Dr. Zin Zin Thu MBBS, MMedSc, PhD(Pathology) (UM 1) Research Officer … Dr. Thweni Nyan Tun MBBS(UM 2) … Daw Aye Mya Khine BSc(Maths) (UDE) Research Assistant (2) … Daw Win Win Mar BSc(Chemistry) (YU) … Daw Aye Myint Oo BA(Economic) (YU) Daw Ni Ni Win BA(History) (UDE) Research Assistant (3) … Daw Aye Thandar Khine BA(Geography) (UDE) … Daw Aye Thidar Saing BSc(Botany) (UM) … Daw Moe Thuzar Min BSc(Zoology) (UDE)

Blood Research Division is primarily involved in research studies on red cell disorders, diagnosis as well as management of common haematological malignancies, haemostasis and coagulation disorders to identify and solve the health problems related to hematological diseases and disorders. The clinical arm is further supported by the Clinical Research Unit on Haematology at the Yangon Children's Hospital.

RESEARCH PROJECTS 1. NON-COMMUNICABLE DISEASES 1.1. CARDIOVASCULAR DISEASE 1.1.1. Usefulness of fibrinogen level in acute ischemic stroke patients at Yangon General Hospital This study was aimed to find out to determine the clinical significance of plasma fibrinogen level in ischemic stroke patients. In this study, 67 acute ischemic stroke patients (Male, 42 and Female, 25) were studied for their demographic data, initial neurological status (levels of Glasgow Coma Scale, GCS), site and size of infarcts, clinical outcomes after two weeks and plasma fibrinogen level. Two ml of venous blood were collected from each patient with sodium citrate tube, within 24 hours from the onset of stroke. All blood samples were detected for fibrinogen level by using automated blood coagulation analyzer - CA 50. Regarding the association between infarct size and fibrinogen levels among the study patients, 34 patients (34/67, 51.8%) had small to median size and 23 (23/34, 67.6%) of them had normal fibrinogen level. Large size of infarct was found in 33 patients (33/67, 49.2%) and 20 (20/33, 60.6%) patients of them showed high fibrinogen level (P value 0.03). GCS level more than 12 were found in 42 patients (42/67, 62.7%) and GCS level less than 12 were observed in 25 patients (25/67, 37.3%). Total of 30 patients (30/42, 83.3%) with good GCS level were investigated with normal fibrinogen level and 19 (19/25, 61.3%) patients with low GCS level had high fibrinogen level (P value 0.001). This study observed that high fibrinogen level (more than 300 mg/dl) is significantly association with large size of infarct and low GCS level. We also found out that 4 patients expired during 2 weeks of hospitalization and interestingly 75% (3/4) of them had high fibrinogen level. Therefore, fibrinogen level in ischemic stroke patients may serve as an important biomarker for the management of these patients.

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Annual Report 2013

1.2. CANCER 1.2.1. Establishment of reverse transcriptase polymerase chain reaction of PML-RAR α gene transcript for diagnosis of adult acute promyelocytic leukemia Acute myeloid leukemia is a complex and heterogeneous disease. Acute promyelocytic leukemia is a distinct subtype of acute myeloid leukemia and it is constantly associated with translocation (15;17) generating PML-RAR α gene transcript. With All-trans- retinoic acid (ATRA), the survival of acute promyeloctic leukemia has been dramatically improved. Diagnosis of PML-RAR α gene becomes an essential part to get the effective gene treatment. The study aimed to detect the PML-RAR α fusion gene by conventional reverse transcriptase Polymerase Chain Reaction. A total of 29 samples (16 males and 13 females) were collected from Clinical Department of Hematology, Yangon General Hospital. The median age was 27.5 years (range from 14 to 65 years). Their mean haemoglobin concentration, total white cell count and platelet count were 5.76 x 10 9 mg/dl, 49.8 x 10 9/l and 42.1 x 10 9 mg/dl, respectively. According to the FAB classification, 2, 13, 6, 6 and 2 cases were diagnosed as acute myeloblastic leukemia without maturation (M1), acute myeloblastic leukemia with maturation (M2), acute promyelocytic leukemia (M3), acute myelomonocytic leukemia (M4) and acute monocytic leukemia (M5), respectively. PML-RAR α transcript was detected in all cases of acute promyolocytic leukemia (M3) cases. It is suggested to detect PML-RAR α gene transcript in morphology suspected M3 cases to get specific treatment.

1.2.2. Hepatitis C infection in patients with different histological subtypes of lymphoma Hepatitis C virus (HCV) is a hepatotropic and lymphotropic RNA virus. It has been postulated that HCV may be cofactor in the pathogenesis of non-Hodgkin's lymphoma. The association of HCV infection and non-Hodgkin’s lymphoma varies with geographical difference, strong association reported in HCV high prevalent area but lack of association in low prevalent HCV area. In our country, gradual rising trend of lymphoma has been observed. The study aimed to find out the number of anti-HCV antibody positivity in patients with lymphoma and to assess the correlation between HCV infection and histological subtypes of lymphoma. One hundred and thirteen lymphoma patients (60 males and 53 females) with the age of 7 month to 67 years were included in the study. Only 3 (2.6%) cases were Hodgkin lymphoma and the histological type of non-Hodgkin lymphoma was diffuse large cell lymphoma in 73 (64.6%), diffuse small cell lymphoma in 22 (19.4%), follicular lymphocytic lymphoma in 13 (11.5%), Burkitt’s lymphoma in 1 (0.8%) and lymphoplasmacytoid lymphoma in 1 (0.8%). The seropositivity of anti-HCV in lymphoma patient was 4/113 (3.5%) and these four anti-HCV positive cases: 5.4% (4/73) were diffuse large cell lymphoma. International Lymphoma Epidemiology Consortium study on hepatitis C and non-Hodgkin lymphoma confirmed the association between HCV infection and specific B-NHL subtypes (diffuse large B-cell lymphoma, 5.09% and marginal zone lymphoma, 4.44%).

1.3. HAEMOGLOBINOPATHY 1.3.1. Quality of life among multi-transfused thalassemia children at Thalassemia Day Care Unit, Yangon Children’s Hospital Thalassemia is a chronic, inherited haemoglobin disorder. In the past, thalassemia could be fatal but survival of those patients has been improved with the advanced treatment like iron chelating therapy and ultimately stem cell transplantation. Therefore, quality of life assessment has become the important issue. The aim of the study was to assess the quality of life (physical and psychosocial health) of thalassaemia patients and to find out the factors

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Annual Report 2013 related to quality of life. It was conducted Day Care Center of Yangon Children Hospital. A total of 80 multi-transfused (>10 unit of blood transfusion) thalassemia patients were recruited for the study. Quality of life (QoL) was assessed using the PedsQL 4.0 Generic Core Scale which consists of 23 items; Physical Functioning (8 items), Emotional Functioning (5 items), Social Functioning (5 items) and school Functioning (5 items). Most of them were Bamar (42, 52.5%) and Kayin (26, 32.5%). Patients were diagnosed as β thalassemia (42, 52.5%) and E β thalassemia (38, 47.5%). The mean (SD) of the total summary score was 74.68 (12.3) while psychosocial functioning was 77.27 (10.95). The physical function subscale score is the lowest, with a mean of 66.9 (SD=20.3). Regarding the correlation between quality of life and patient characteristics, no statistically significant difference were found with age (children and adolescent), gender, income, type of thalassemia, splenectomy, age at first blood transfusion while high serum ferritin level (>2000 ng/ml) was associated with quality of life (p=0.01). Our finding is not consistent with the other studies reported psychological subscale score is much lower than the other subscale scored. This may be due to understanding, caring and support of their parents, school teachers, environment of our society to those chronic patients.

SERVICE PROVIDED ACEDEMIC Sr. Name Course Responsibility No. 1. Dr. Win Pa Pa Naing MMedSc (Pathology) Teaching MPSC (Medical Technology) Teaching Knowledge about leukemia in Skynet TV Presenter media 2. Dr. San San Htwe MMedSc (Pathology) Teaching MPSC (Medical Technology) Teaching Research Methodology and Bioethic Facilitator Workshop 3. Dr. Zin Zin Thu MMedSc (Pathology) Teaching MPSC (Medical Technology) Teaching Research Methodology and Bioethic Facilitator Workshop

LABORATORY Sr. Name of test Total number tested No. 1. Paraprotein testing by serum protein electrophoresis 58

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Annual Report 2013

CHEMICAL TOXICOLOGY RESEARCH DIVISION

Deputy Director & Head … Dr. Kyaw Soe MBBS (IM 1), PhD(Medical Science) (Nagasaki) Research Scientist … Daw Khine Thin Naing BSc(Chemistry) (YU), MSc(Analytical Chemistry) (YU) Research Officer … Dr. Ye Hein Htet MBBS(UM 2) … Dr. Tin Sandar Win MBBS(UM 2) Research Assistant (2) … Daw Tin Nwe Htwe BSc(Chemistry) (YU), DFT (YU) … Daw Khin Moe Latt BA(Myanmarsar) (YU) … Daw Tin Tin Han BSc(Zoology) (YU) Research Assistant (3) … Daw Ohnmar Win BA(Eco) (YU) … Daw Tin Tin Htike BA (Eco) (YU) … Daw Theingi Khin BA(Eco) (YU) Research Assistant (4) … Daw Aye Thidar Tun BSc(Chemistry) (YU) … Daw Thet Htet Aung BSc(Maths) AGTI (EP) Laboratory Attendant … Daw Thandar Wint Wint Aung

The Chemical Toxicology Research Division is engaged in Poison Information Services and Research concerned with environmental health. Chemical Toxicology laboratory provides the information regarding sample analysis and chemical poisoning. Currently, research related to environmental health including safe drinking water and mercury contamination in river water are being conducted in collaborating with other organizations and departments.

RESEARCH PROJECTS 1. ENVIRONMENTAL HEALTH 1.1. Determination of Volatile Organic Compounds in River Water Volatile organic compounds (VOCs) refer to organic chemical compounds which have significant vapor pressures and which can affect the environment and human health. VOCs like benzene, toluene, and xylene have the potential to induce asthma, aplastic anaemia and leukemia. HlaingTharYar industrial zone has many factories which might produce VOCs. Therefore, the aim of this study was to determine volatile organic compounds in river water near it. A total of 9 water samples, 3 from ditches of industrial waste, one sample each from 2 outlets of industrial wastes to Pan Hlaing river, 2 from middle of Pan Hlaing river and 2 from Hlaing river were collected. By using Gas Chromatograph (Shimadzu 17A) equipped with Flame Ionization Detector (GC-FID) attached Headspace sampler, benzene, toluene and 3 isomers of xylene were analyzed within 3 hours (because half life of VOCs has four and a half hours). Benzene and xylene were not detected in all samples. Toluene was detected in one sample from one of the ditches. Detected level of toluene was 0.46 mg/L which is lower than 0.7 mg/L (WHO guideline values for chemicals from industrial sources and human dwellings that are of health significance in drinking water). Therefore, water from Pan Hlaing river and Hlaing river at that time was free from above mentioned VOCs probably due to proper industrial waste treatment system.

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Annual Report 2013

1.2. Preliminary Study on Mercury Content in River Water around Gold Reclamation Site Long term, low level exposure of mercury has resulted in broad-ranging functional disturbance, including irritability, excitability, excessive shyness and insomnia. In Shwe Kyin, gold panning has been carried out for many years. Mercury might be used to extract gold particles by Amalgam technology for the accelerated growth of gold production. Therefore, the aim of this study was to determine the mercury content in river water around Shwe Kyin gold reclamation site by using Inductively Coupled Plasma Optical Emission Spectrometer (ICP-OES). A total of 7 water samples, 2 water samples from mouth of the Sittaung river, 3 water samples from its tributaries where gold panning was carried out and 2 water samples from gold extraction sites were purposely collected. Mercury content in 5 samples was varied between 0.009 and 0.112 ppb and mercury was not detected in 2 samples (1 from Sittaung river and 1 from its tributaries). According to this study, river water in Shwe Kyin was not harmful because the results were lower than 6 ppb (WHO Guideline values for chemicals from industrial sources and human dwellings that are of health significance in drinking water).

1.3. Knowledge, Attitude, Risk Perceptions and Practices of Safety Measures on Pesticides among Agricultural Workers in Kyaungone Township Farm workers in our country have to deal with pesticides and they can have health hazards due to the nature of their work. Accidental exposure or over exposure to pesticides can have serious health implication. So, safe use of pesticides is very important to reduce harmful effects on agricultural workers. Poisoning can be prevented if pesticides are used safety and proper precautions are taken. Therefore, the aim of this study was to determine the knowledge, attitude, risk perceptions and practices of safety measures on pesticides among agricultural workers. The protocol was approved by the Protocol Review Committee and Ethical Review Committee, Department of Medical Research (Lower Myanmar). The structured questionnaires consistes of 4 components: section A- social and demographic characteristic (5 items); section B- knowledge of pesticide brand, route of entry, health hazards, precautions (35 items); section C- attitude and risk perception toward pesticides (9 items) and section D- practices and reported symptoms of pesticide poisoning (18 items). The questionnaires were pretested. The project is in progress.

SERVICES PROVIDED

LABORATORY Sr. Name of test Total number tested No. 1. Methanol in urine 12 2. Organophosphate in urine 3

Poison Information Service The Poison Information regarding chemical poisonings, chemicals used in the commercial products and chemical safety in the residential and the working environment was given by telephone using Poison Information Monograph, International Programme on Chemical Safety (IPCS) and Micromedex.

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Annual Report 2013

CLINICAL RESEARCH DIVISION

Deputy Director & Head … Dr . Han Win MBBS(UM 1) , MMedSc (Int Med) (UM 2) Research Scientist … Dr. Than Than Aye MBBS, MMedSc(Med Onco) (UM 1) Research Officer … Dr. Win Lai May MBBS, MMedSc(Paediatrics) (UM 1) … Daw Than Than Lwin BSc(Zoology) (YU) … Daw Sandar Kyi BSc(Chemistry) (YU), Dip in Japanese (UFL) Laboratory Incharge … U Aye Thar BSc(Mathematics) (UDE) Research Assistant (2) … Dr. Aung Aung Maw BSc (Hons) , MSc , MRES (DU) , PhD(Zoology) (YU) … Daw Kyu Kyu San BA(Geography) (DU) … Daw Ni Ni Aye BSc(Botany) (East YU) … U Win Lwin BA(Economics) (DU) Research Assistant (3) … Daw Tin Htar Lwin BSc(Chemistry) (DU) … Daw Aye Hnin Phyu BSc(Botany) (DU) … Daw Khin Thet Mon BA (Geography) (DU) … Daw Dam Lian Pau BA(Psychology) (West YU), Diploma in Social Work … Daw Kaung Ba Hlwar BSc (Botany) (MU) , Diploma in English (YU) … Daw Phyu Hnin Wai BA(Economics) (DU) Laboratory Attendant … Daw Zin Mar … Daw San Thwin Oo

Clinical Research Division is primarily involved in research activities of the following programme areas: communicable diseases such as dengue hemorrhagic fever, and non- communicable diseases with emphasis on cancer, diabetes mellitus and chronic respiratory diseases.

RESEARCH PROJECTS 1. COMMUNICABLE DISEASES 1.1. DENGUE HEMORRHAGIC FEVER 1.1.1. Acute kidney injury in children with dengue haemorrhagic fever in a tertiary care centre This study aimed to evaluate the proportion of acute kidney injury (AKI), to categorize its severity using pRIFLE (paediatric Risk, Injury, Failure, Loss of kidney function, End stage renal disease) criteria, and to identify the risk factors for the development of AKI in children with dengue haemorrhagic fever (DHF) in Yangon Children’s Hospital (YCH). It was a cross-sectional descriptive study and conducted at medical wards of YCH. Daily urine output was observed and serum creatinine was tested within 24 hours after admission and daily if the parents gave informed consent before hospital discharge. Ninety- four children, 46 boys (48.9%) and 48 girls (51.1%) have been recruited. Their age ranged from 2 to 14 years and mean age was 7.34± 2.88 years. Twelve out of 94 patients (12.76%) were classified as having AKI, in which 10 patients was in Risk group and 2 patients was in Injury group according to pRIFLE criteria. Mean lowest GFR was 59.27± 9.32 ml/min/1.73m 2 in children with AKI and 119.85 ± 35.21 ml/min/1.73m 2 in children with non- AKI (p<0.0001). All 12 cases were children with secondary dengue infection identified by

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Annual Report 2013 positive Dengue IgG antibody. AKI is more common in children ≤ 5 years compared to > 5 years age group (p= 0.001). The most common presentations in children with AKI were lethargy (83.3%), abdominal pain (66.7%) and nausea/vomiting (58.3%). Children with AKI had longer hospital stay than those with non-AKI (3.50± 0.67 days vs. 2.77± 0.77 days, p= 0.01). All the cases had returned to normal renal function within one to two days. This study highlighted that risk of AKI should be considered in paediatric dengue patients especially in younger children.

2. NON-COMMUNICABLE DISEASES 2.1. CANCER 2.1.1. Assessment of osteoporosis in female breast cancer patients attending Medical Oncology Ward, Yangon General Hospital A cross-sectional descriptive study was carried out in Medical Oncology ward, Yangon General Hospital during 2012 to explore osteoporosis status among female breast cancer patients. A total of 95 histologically proven female breast cancer patients were interviewed using semi-structured questionnaire and medical records were also reviewed. Their osteoporosis status were assessed by measuring bone mineral density (BMD) with Quantitative Heel Ultrasound (Sonost 3000 Bone Densitometer) and measured BMD were classified into normal (T score > -1.0), osteopenia (T score: between -1.0 and -2.5) and osteoporosis (T score < -2.5 ) by using WHO criteria for Osteoporosis in Women. Their ages ranged from 31 years to 74 years and mean age was 50.5 ± 9.7 years. Their mean body mass index (BMI) was 23.5± 3.6 and only 31% completed high school and above educational levels. Over 60% of the subjects were postmenopausal women. At the time of initial diagnosis, 63% presented as advanced disease and majority (93%) was ductal type. All of the respondents have received treatment with either surgery alone (8%) or combined therapy (92%). Regarding clinical manifestations, 62% did not show any symptom of osteoporosis and the commonest symptoms among symptomatic patients were numbness (21%) and back pain (17%). Out of 95 studied subjects, 66 (70%) was found to have osteoporosis, 26 (27%) osteopenia and only 3(3%) were normal. Moreover, osteoporosis was more common in older age group ( ≥50 years; p = 0.026), postmenopausal group (p = 0.029) and lower educational group (below high school; p = 0.001)

2.1.2. Knowledge, attitude, and prevention practice about breast cancer among female nursing students in University of Nursing (Yangon) This study was carried out at University of Nursing (Yangon) to determine knowledge, attitude and prevention practice regarding breast cancer among female nursing students. Two hundred and forty-eight female nursing students (122 first year students and 126 final year students) were recruited and data collection was done by using semi-structured questionnaire. Their ages ranged from 16 to 22 years and mean age was 18.33 ± 1.7 years. Majority was Bamar (80%) and their mean age of menarche was 13 ±1.2 years. Forty-two (17%) students had family history of malignancy and more than half (52%) of them happened in their grandparents and the commonest malignancy were breast cancer (17%) and lung cancer (14%). Only 8(3%) female students had past history of breast lumps. Regarding knowledge, 149 (60%) students knew that breast cancer can occur only in women and ageing (34%), obesity (36%), nulliparous (57%) and late bearing of first child (>30 years old)(50%) were known as risk factors. About 50 % of subjects knew the symptoms of breast cancer and 48%, 37% and 49%, respectively were aware of correct timing, frequency and method of breast self examination. However, only 30% of students had the correct knowledge

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Annual Report 2013 concerning with clinical breast examination and only 11% knew the age at which mammogram should be started. Although majority of studied subjects had positive attitude towards the early detection of breast cancer, 116 (47%) practiced breast self examination (BSE). Of those who practiced BSE, only minority performed regularly (44, 38%) and with correct frequency (22, 50%). This study highlighted that there is still need for promoting nursing education programme about breast cancer and its screening practice among nursing students.

2.2. DIABETES MELLITUS 2.2.1. Self-efficacy, self-care behaviors and glycaemic control among type-2 diabetes patients This study aimed to determine self-efficacy and self-care behaviours, to estimate the prevalence of effective glycaemic control, and to find out the association between self- efficacy, self-care behaviors and effective glycaemic control among type-2 diabetes patients. A cross-sectional descriptive study was carried out on type-2 diabetes patients attending the Diabetic Clinic at North Okkalapa General Hospital. Data on socio-demographic, clinical, self-efficacy (using 18 modified questions from the Diabetes Mellitus Self Efficacy Scale) and self-care practices (using 15 questions from the Summary of Diabetes Self Care Activities) were collected. Blood samples were taken for measurement of HbA 1C for glycaemic control. Of 100 patients recruited, 68% were female. Mean age of study population was 58.8±9.8 years, 76% were married, and 32% had a BMI within normal range (18.5 to 24.9). Median duration of diabetes since confirmed diagnosis was 5.7 years (range, 1-20 years). History of diabetes in family members was reported by 24%. Regarding diabetes- related complications, 60% had none; common complications were neuropathy (20%), nephropathy (14%), diabetic foot (14%) and retinopathy (7%). The prevalence of good glycaemic control (HbA 1C ≤ 7%) was 44%. Seventy-two percent of the patients had a high self-efficacy level, and 40% had good self-care behavior. Patients with high self-efficacy level and good self-care behavior were 3 times more likely to have better glycaemic control.

Glycaemic control (%) Crude odds Variable Total 95% CI Yes No ratio Self-efficacy (score) Fair/poor (18-71) 28 25.0 75.0 1.00 High (72-90) 72 51.4 48.6 3.17 1.20- 8.38 Self-care behaviors (score) Fair/poor (18-82) 60 33.3 66.7 1.00 Good (83-105) 40 60.0 40.0 3.00 1.30- 6.87

2.3. CHRONIC RESPIRATORY DISEASES 2.3.1. KAP study on Chronic Respiratory Diseases (CRD) in selected townships in Yangon (Collaboration with CRD Project, Department of Health) A community-based, cross-sectional descriptive study was conducted to assess the knowledge, attitude, and practice (KAP) of the community on Chronic Respiratory Diseases (especially COPD and asthma) in Insein, Kyimyintine and North Okkalapa Townships in Yangon. A total of 480 subjects (153 males and 327 females) aged between 20 and 74 years, with a mean age of 46.3± 14.2 years, were interviewed. Ninety-seven percent were literate and 47% had attained the minimum high school education level. Median family income per month was 150,000 kyats. Awareness of COPD among respondents was quite low (60%)

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Annual Report 2013 compared to awareness of asthma (96%) which is a more common disease. There was a deficient knowledge on risk factors for COPD as well as for asthma. Only 20% spontaneously mentioned smoking as a risk factor for COPD, and even less for other risk factors such as passive smoking (6%) and indoor air pollution (7%). Knowledge of the symptoms was also poor. Regarding the disease nature, about half knew that COPD was preventable, but about one-third wrongly perceived COPD as contagious and hereditary disease. Despite deficient knowledge, majority had correct attitudes towards COPD, 90% reported that smoking was a major cause of COPD while 87% agreed that COPD was a preventable disease. Of 480 respondents, 78 (16%) were current smokers (43% among males and 4% among females) and 41 (8.5%) were ex-smokers. Among the current smokers, 70% were willing to quit smoking. Forty-six percent live with the family members who smoke (median: 1 smoker, range: 1-5). Practices such as use of smoke-forming fuels for cooking, use of mosquito coils and scent stick which caused indoor air pollution were identified in the study areas. About 70% used wood/coal alone or together with electric and/or gas for cooking purpose. Use of mosquito coils and scent stick was reported by 54% and 62% of respondents respectively. The study highlighted a need to improve knowledge and practice of the community on CRD by proper health education.

SERVICES PROVIDED ACADEMIC Sr. Name Course Responsibility No. 1. Dr. Han Win Workshop on Research Methodology Facilitator and Bioethics 2013

2. Dr. Than Than Aye Workshop on Research Methodology Facilitator and Bioethics 2013

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Annual Report 2013

EPIDEMIOLOGY RESEARCH DIVISION

Deputy Director & Head ... Dr. Ohnmar MBBS(IM 1) , MSc (Epidemiology), PhD(Epidemiology)(Prince of Songkla University, Thailand) Research Scientist ... Dr. Myo Myo Mon MBBS(IM 1), MMedSc(Public Health) (IM 2), MSc(Epidemiology) (Prince of Songkla University, Thailand) Research Officer ... Daw Moe Thida BSc (Zoology)(RASU) ... Dr. Thae Maung Maung MBBS(UM 1), MSc(International Health) (Charité Universitats Medizin, Berlin) ... Dr. Su Latt Tun Myint MBBS (IM 1) , MPH (UOPH) ... Dr. Pe Thet Zaw MBBS(UM 2) Research Assistant (2) ... Daw Khin Thet Thet BSc(Physics)(YU) ... Daw Kyi Kyi Mar BSc(Mathematics) (YU) ... Daw Wai Wai Myint BA(Eco)(Workers’ College YU) Diploma in Social Work (YU) ... Daw Tin Tin Wai BSc(Mathematics)(YU) Research Assistant (3) ... U Aung Soe Min ... Daw Zin Mar Aye BSc(Botany)(YUDE) ... Daw Lwin Lwin Ni BSc(Mathematics)(DU) Research Assistant (4) ... Daw Phyu Thi BSc(Botany)(DU) (Diploma in Computer Science) (YUCS) ... Daw Lwin Ni Ni Thaung BA(L LB)(YUDE) ... Daw Ni Ni Htay Aung BA(Geography)(YUDE)

Epidemiology Research Division mainly focuses research activities on HIV/AIDS, malaria, tuberculosis, diarrhoea, dengue haemorrhagic fever, non-communicable diseases, maternal and newborn health, and water and sanitation.

RESEARCH PROJECTS 1. COMMUNICABLE DISEASES 1.1 HIV/AIDS 1.1.1 Situation analysis of orphans and vulnerable children infected and affected by HIV/AIDS in Myanmar A nation-wide cross-sectional study was conducted among children who were either affected and/or infected by HIV/AIDS. It is a collaborative study between Department of Medical Research (Lower Myanmar) and National AIDS Program funded by UNICEF. The study was planned to conduct in 30 townships from 13 States and Regions to determine the socio-economic situation, health and nutritional status, and accessibility to social and health care services. Currently, data collection was completed in 22 townships and data analysis was done for 15 townships. Parents/guardians of 753 children affected by HIV/AIDS (CABA) and parents/guardians of 751 children from non-HIV related families were included. Age of the children ranged from 1 month to 17 years (mean age 9.1 ±4.1 years). Mean age of the guardians from both groups was not different (39.3 ± 10.7 years and 37.7 ± 9.5 years) and

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Annual Report 2013 many of them were mothers (64.5% and 78.7%). Around one-third of the guardians were dependents (30.4% and 39.1%) and primary school passed (30.4% and 31.8%). Among 753 CABA, 32.2% were paternal orphans, 6% were maternal orphans and 12.1% were double orphans. Nearly 78% of fathers and 85% of mothers were HIV positive. Regarding social consequences, significant differences were detected for displacement from original house, family dispersion and child displacement. In particular, higher proportions of families of CABA have displaced from original house than that of control group (29% vs. 12%, P=0.0001) either within the same township or to other township or State/Region. Similarly, higher percentages of CABA families were dispersed in comparing to control families (12.4% vs. 5.1%, P=0.001). Moreover, child displacement among CABA was more than that of control families (11.4% vs. 4.1%, P=0.001). Among under five years old children, 15.9% (n=665) of CABA did not possess birth register which was significantly higher than that of control group (5.4%) (n=664) (P=0.001). Among 298 children over 10 years old, nearly 74% of CABA did not have national registration card. Among 300 CABA between 10 to 14 years old, 15.3% were out of school at the time of survey which was higher than that of control children (7.9%) (P=0.003). A quarter of CABA (25%) were HIV positive. Among them, 79.3% have already started ART.

1.1.2 Assessment of communication skills among youth and community volunteers regarding behavior change communication on reproductive health and HIV A community-based cross-sectional study was conducted in 10 townships from 7 States and Regions to identify the communication skills of youth volunteers and community volunteers regarding reproductive health (RH) and HIV. A total of 859 community support group (CSG) members or community volunteers and a total of 121 youth volunteers were included in the study. Community volunteers: Mean age of the respondents was 40.9±11.7 years and ranged from 16 to 79 years. About one-third (32.0%) had attended high school level of education and another one-third (30.6%) had completed middle school level. Over one-third (37.3%) were farmers while 22.4% were unemployed. Knowledge of community volunteers regarding safe motherhood was assessed including antenatal, delivery, postnatal, abortion, contraception, HIV and Sexually Transmitted Infections (STI). Nearly half (47.4%) of volunteers have low knowledge on safe motherhood. In addition, 46.1% of community volunteers have poor communication skill. Sex and education level of respondents were significantly associated with their communication skills. Male volunteers had good communication skill than female volunteers (60.6% vs. 51.5%, P=0.01). Higher educated volunteers had good communication skills (63.6% vs. 50.2% vs. 44.4%, P=0.001) compared to those with low level of education. Moreover, volunteers with high knowledge level had good communication skill compared to those with low knowledge level (61.9% vs. 45.0%; P=0.001). Youth volunteers: Of 121 youth volunteers, over half (52.1%) were female. Mean age was 21.4± 3.6 years and ranged from 14 to 31 years. Nearly half (46.3%) had attended high school level of education and another one-fourth (25.6%) had completed middle school level. About 42% of youth volunteers had low knowledge on HIV/STI. Similarly, 47.9% had low knowledge on adolescent reproductive health (ARH). Over half (50.4%) of them had poor communication skill. No association was detected between sex of the youth volunteers and the communications skills. Those with high ARH knowledge level were more likely to be good communicators (62.1% vs. 38.1%, P=0.008). Similarly, those who had high knowledge on HIV had good communication skill (59.2%vs. 36.0%, P=0.012). Capacity building training should be provided for both youth and community volunteers to improve their communication skills as well as to improve their knowledge.

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New generation of both CSG and youth volunteers should be trained since attritions were noted during the field survey.

1.2 MALARIA 1.2.1 Human behavioural practices on prevention of malaria in Mudon Township, Mon State A cross-sectional survey was conducted in 141 households in Mudon Township in 2011 to find out the locally appropriate personal protective measures. Nearly 72% of heads of households worked in rubber plantations, 72.8% worked throughout the year, 22% started their work before 6 am and 31.2% usually worked beyond 5 pm. Some 98.6% slept before 11 pm and less than 5% slept before 7 pm. Some 91% knew mosquito bite as a cause of malaria. The commonest methods known to prevent mosquito bites were mosquito coils (73%) and mosquito repellent (47%). Nearly 100% slept under the mosquito net and 92.9% used insecticide treated nets (ITN). Common measures used to prevent mosquito bite from dusk to dawn while staying outside or working were mosquito coils (57.6%) and mosquito repellent (49.6%). Mosquito coils (55%) and mosquito repellents (49%) were the most preferred methods for prevention before sleep. Ninety five percent preferred the use of mosquito nets while sleeping and 92% of respondents were willing to impregnate their own clothes. Long sleeved shirts (78%), trousers (65%) and longyi (60%) were the preferred materials to be impregnated for men while the proportions of acceptability to impregnate the materials were low (less than 25%) for women. Some 41% of household members who stayed outside the house after 5 pm reported chatting in groups followed by playing (10.8%). Strategies for prevention activities in malaria endemic areas with rubber plantation workers should be in line with the outdoor staying behaviors of the targeted population.

1.2.2 Community based survey on knowledge and prevention of malaria in Myanmar While the National Malaria Control Programme has been scaling up the distribution of long tasting insecticide treated nets (LLINs), a community-based survey was carried out in 2012 (Aug-Dec) to assess knowledge and prevention practices on malaria. In total, 5,342 household respondents in 144 villages (23 townships of all States and Regions) were interviewed using a structured questionnaire. Of all, 89% knew mosquito bites as a cause of malaria. Reported methods to prevent malaria included a mosquito net (80.7%) and insecticide treated net (46.7%). Awareness on the benefit of LLINs included prevention of mosquito bites (86%), preventing malaria (36%) and killing insects (32%). Of 25,898 household members, 89.2% slept under any net and 65.2% slept under ITN (from 63.4% to 68.7% for different age groups). Sleeping under ITN was low in Rakhine State (21.8%), Kayin State (55.1%) and Shan State (59.0%). Of 14,871 mosquito nets, the proportions were nets with no holes (87%), LLIN (37.2%), never treated nets (32%) and nets washed frequently in less than 3 months (56.7%). Of ever treated nets, half were treated within the last six months. Although hand-washing (86%), and the use of soap powder (88%), were common, 17% used stick in washing nets. Scaling up of the distribution and the use of LLIN in the community is recommended.

1.2.3 Community based survey on prevalence of fever and treatment seeking for malaria in Myanmar A community-based survey was carried out in 2012 in 144 villages (23 townships of all States and Regions) to assess treatment seeking practice on malaria. A structured interview questionnaire and of 25,898 household members in 5,342 households, prevalence

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Annual Report 2013 of fever in the last two weeks was 6.9% and it differed by age group (12.0% in less than five years, 9.5% in 5 to 15 years, 5.4% in 15 to 59 years, 4.2% in 60 years and above). Self- medication (27.6%), rural health centre or sub-centre (21.6%) and village health worker (13.6%) were common as the first treatment. Self-medication was common in all age groups (22.7% in under five years, 22.7% in 5 to 15 years, 30.3% in 15 to 59 years, 44.9% in 60 years and above). Taking blood test among those history of fever was 32.1% (25.1% in under five years, 33.5% in 5 to 15 years, 34.3% in 15 to 59 years, 26.8% in 60 years and above) and 37.6% were test positive. The proportion of receiving blood test within 24 hours was 28.4% and less than two-fifths in all age groups (27.0% in less than five years, 30.2% in 5 to 15 years, 26.3% in 15 to 59 years, 40.0% in 60 years and above). Health education on malaria should include not to practice on self medication but to seek for the immediate blood test. The coverage of the use of blood test as the first treatment should be improved.

1.2.4 Availability and dispensing practices of anti-malarial drugs in private drug outlets of Myanmar The occurrence of artemisinin resistance due to irrational use of anti-malarial drugs in Greater Mekong Subregion countries is a great problem in the world. Although private drug outlets are established as the main first contact point for malaria treatment, their knowledge and dispensing practice were still doubtful. This cross-sectional descriptive study was conducted in 71 villages within tier 1 and 2 malaria areas in 2012. Providers from 120 drug outlets were assessed using a face to face interview with a structured questionnaire and observation checklists. About 42% of drug outlets did not have a license and 45% of drug outlets were general stores or shops. More than half of the providers did not have an appropriate training. Although the knowledge about malaria signs and symptoms was sufficient, only 16% of the respondents could correctly identify the recommended drug for uncomplicated P falciparum malaria. Availability of artemisinin combination treatment (ACT) including Coartem was extremely low. Most dispended anti-malarial drugs were artesunate tablets, chloroquine and artemether. Irrational dispensing practices such as selling partial package (55.2%) and cocktail treatment (25%), found in 80% of drug outlets. About 20% of drug outlets sold malaria tests mainly rapid diagnostic tests (RDT) and Paracheck was mostly used. Customer demand (67%) was found as a main reason for setting anti-malarial drugs. Respondents' background education and experiences in malaria training workshops was significantly associated with correct knowledge and dispensing practices of the recommended anti-malarial drug. Intervention for private drug outlets is urgently needed for artemisinin resistance containment.

1.3 TUBERCULOSIS 1.3.1 Assessment of general practitioners’ participation on tuberculosis management and treatment outcome in PPM DOTS in Myanmar: patients’ perspectives This study assessed general practitioners' participation on tuberculosis management and treatment outcome in PPM DOTS activities from patients' perspectives in 6 MMA PPM Scheme III implementation townships in Myanmar in 2012. All forms of TB patients aged 15 years and above, registered and treated within 4 th Quarter 2010 to 3 rd Quarter 2011 were interviewed. Of 297 patients, 91.9% were new cases. Treatment outcomes included cured (45.5%), completed (52.9%), treatment failure (0.7%), defaulter (0.7%) and dead (0.3%). Proxy respondents were 13.1%. Of 297, 93.3% knew sputum examination is required for diagnosis. Some 96% considered convenient about clinic opening hours. Median (IQR) waiting time at the clinic was 15 (5 to 30) minutes. Nearly 58% did not need to spend money for cost for visiting the clinic. Around 66% had to pay for transportation to have chest X-ray 25

Annual Report 2013 and for sputum examination. 36% reported financial problem to receive treatment. Borrowing money from others (64.2%), selling out properties (17%) and support from others (18.9%) were common ways to solve financial problems. Some 66% of respondents reported receiving information about tuberculosis from general practitioners. All stated that they received anti-TB drugs free of charge. The proportion of patients who received different kinds of support from the general practitioners included sputum cups (81.5%), pamphlets (81.1%) and nutritional support (78.8%), vitamins (11.8%), the cost for chest X ray (7.7%), transportation cost (2%), and psychological support (94%). The results showed that despite free of charge treatment, patients had to spend money for the cost for diagnosis and travel.

1.4 DIARRHOEA 1.4.1 Household drinking water quality surveillance to prevent potential outbreaks of acute diarrhea in an expanding peri-urban neighborhood, Yangon Region, Myanmar, 2013 Epidemiological surveillance of household drinking water quality plays a pivotal role to minimize health risks due to contamination from the insanitary environment. This cross- sectional survey has been conducted in an expanding peri-urban neighborhood of Yangon Region during February-March, 2013 (early part of hot season). We have sampled 211 out of 575 households with under-five children enlisted during the first survey at the end of rainy season in 2012. Subsequently, collection of water samples from water in a serving cup was done between March to August, 2013 from sub-set of households (n=112). We used multiple tube fermentation method for analyzing water samples to detect total and fecal coliforms and Escherichia coli. We aimed to ascertain the reported cases of acute diarrhea in under five children, identify the sources of drinking water, water purification and storage practices, and assess the bacteriological contamination of drinking water at point-of-use. Nearly half of the households were made of bamboo, 53% had insanitary pit latrines and nearly 36% disposed their waste into nearby water bodies. Acute diarrhea in under-five children was reported from 4.7% (95% CI- 3.0 – 9.0) of households within past two weeks. Their reported source of drinking water was from the tap (39.3%), bottled purified water (37.4%) and from tube wells (26.5%). Nearly a quarter of households never used any method for drinking water purification and 82% (131/159) reported the straining of drinking water by cloth filter easily subjected to contamination. When analyzing water samples obtained from serving cups, 93.75% (105/112) were contaminated with fecal coliforms varied from 2.2 CFU/100 ml (low risk) to very high risk (over >1000 CFU/100 ml). Of fecal coliform positive water samples, 50.48% (53/105) grew E. coli . Drinking water samples were highly contaminated and unfit to drink with limited or none in point-of-use purification technologies. There is an urgent need to promote portable field laboratory systems and test kits for water quality monitoring, reporting and surveillance of acute diarrhea which is a challenging task for resource limited settings. Further research is crucial to capture the composite index of water quality risks at vulnerable sites as a signal for outbreaks.

1.5 DENGUE HAEMORRHAGIC FEVER 1.5.1 Feasibility of advocacy as a risk communication tool in prevention of dengue transmission Intervention strategies based on community participation through advocacy in controlling dengue transmission has been successfully reported in Myanmar. However, public accountability is limited and evidences are required to prove advocacy as the best possible strategy for dengue risk communication. This cross-sectional descriptive study carried out in 2013 in Mawlamyaing and Paung Townships, Mon State, Myanmar explored the current

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Annual Report 2013 advocacy activities of stakeholders in prevention of dengue transmission in vulnerable communities and the favorable and unfavorable conditions for implementation of advocacy as a risk communication tool. Altogether 60 basic health staff and 63 respondents from other multi-stakeholder groups such as Township Administrative Department, Township Maternal and Child Welfare Association and related organizations participated in semi-structured interviews. For dengue vector management, most of them realized that integration of advocacy, community participation and rules and regulations were essential (71/123; 58%).Three commonest activities cited as the requirement for advocacy were discussions on rules and regulations concerning with ways to manage used tires and waste disposal (97/123; 78.9%), information dissemination (94/123; 76.4%) and selection and training of ward-based volunteers (92/123; 74.8%). Approximately, 81% of respondents felt that good organizing skill as mostly required advocacy skill and almost everyone accepted that they required proper training to improve their advocacy skills. Respondents perceived most favorable conditions as attention from regional and ward authorities to hold regular advocacy. By doing advocacy, mostly perceived strengths were smoothness in performing preventive activities and allocation of responsibility between health and health related stakeholder groups and partner organizations. On the other hand, commonest weakness revealed insufficient time for planning and holding advocacy meetings prior to dengue transmission season. Stakeholders concerned for dengue prevention inclusive of local governance required deeper understanding of advocacy than at present to improve health system performance even though they realized the importance, strengths and weaknesses.

2. NONCOMMUNICABLE DISEASES 2.1 CANCER 2.1.1 Awareness, perception, and satisfaction of women towards mammogram for breast cancer screening A cross-sectional study was carried out among women who came for breast cancer screening (mammogram) at Central Women Hospital (CWH) during the trial project in December 2013 to determine the awareness, perception and satisfaction of women towards mammogram. A total of 203 women aged between 40 to 60 years who came for mammogram at CWH during trial period included in current assessment. Mean age of the respondents was 47.9 ± 5.5years and mean BMI was 25.6 ± 4. Among 154 married women, 9.1% have never got pregnant and 11.7% have never delivered a baby. Nearly one-third (31.3%) had history of breast cancer among their relatives. Only very few respondents (5.4%) had history of mammography within 2 years and 23.6% perceived breast cancer as non-curable disease. Almost all (98%) agreed that all women should do breast cancer screening. However, 41.9% thought that it is difficult for women to have access to mammogram and 38.9% thought that it is very costly to have breast cancer screening. More than half (59.1%) of women considered that mammography prevents the risk of contracting breast cancer. After receiving the test, 90.6% said that they have experienced of tolerable pain during the test. Almost all (98%) were willing to take mammogram in the future and 92.6% were willing to pay for the test. Among them, 96.3% responded that they could pay between 20,000 to 30,000 Kyats, only 37.8% could pay between 30,001 to 40,000 Kyats. Very few respondents (19.7%) said that they could pay between 40,001 to 50,000 Kyats. In conclusion, majority of the women showed favorable perception towards mammogram and most of them were willing to do the test in the future.

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Annual Report 2013

3. HEALTH SYSTEMS RESEARCH 3.1 MATERNAL, NEWBORN AND CHILD HEALTH 3.1.1 Improvement in knowledge, perception and practice of men in maternal and child health at South Dagon Township An assessment was conducted at South Dagon Township in 2013 after one year implementation of intervention which was jointly carried out by Burnet Institute and Department of Health for improving male participation in maternal and newborn health. The study was a pre-test, post-test design applying quantitative and qualitative methods. Men who have at least a child under one year old were interviewed using a pre-tested structured questionnaire. Chi-square test was applied to compare between baseline and end-line. A total of 214 men included in the quantitative survey. Mean age of the respondents was 33.6 ± 7.8 years. Higher proportion of participants from end-line were aware of danger signs during antenatal (AN) period (59% vs.80.4%, P<0.001), aware of indication for hospital delivery (50.8% vs.93.0%, P<0.001), knew danger signs during delivery (58.1% vs.72.9%, P<0.05), and aware danger signs of newborn (65.7% vs. 84.6%, P<0.01). Respondents' perception of husbands' responsibilities were providing financial support (71.5%), doing household chores (67.3%), accompanying wife to AN care (37.4%), and giving psychological support (30.8%). Regarding practice, more respondents from the end-line accompanied their wives in seeking AN care (82.0% vs.91.4%), received HIV testing together with their pregnant wives (22.0% vs. 32.0%). Common tasks done by husbands during delivery of their wives were "waiting outside of delivery room" (86.1%) and "doing household chores" (37.4%). The responsible health authority revealed that aim of the project is achieved to a certain extent. Particularly, awareness, knowledge and practice of men regarding maternal and child health was improved.

3.2 WATER AND SANITATION 3.2.1. Drinking water purification system: implications for translating knowledge into action peri-urban households with under-five children Household-based water treatment and safe storage was associated with 35%reduction in diarrheal diseases according to WHO and UNICEF. This cross-sectional study focused all vulnerable households with 262 under-five children selected from the existing sampling frame of North Dagon Township in March 2013. Altogether 36 men and 175 women (mean age 37.5 ± 12.6 years) participated in structured interviews. Nine percent of households reported acute diarrhea in under-five children within one month. Nearly 53% of households were huts with insanitary Pit latrines. Their major source of drinking water was from municipal pipe-water supply (39.3%) and from artesian-well (26.5%). Approximately 41% of respondents did not aware of features of acceptable drinking water good for health. Among others, chlorine tablets and liquid chlorine for drinking water purification were least known. Even though 54.5% of respondents accepted boiling as the purification method, only 33.5% put into practice. Over 70% of respondents perceived that water from ponds, pipe water, and artesian-well were unsafe to drink without any purification. However, 25% of households never used any method for drinking water purification. Nearly 62% reported the use of cloth fitter only for drinking water purification. Almost 80% did not know the available sources for chlorine disinfectants. During drinking water storage, less than four percent prepared chlorine disinfectant for purification. Apart from improved sanitary facilities and personal hygiene, drinking water purification systems in low income households required strengthening by intensive community engagement through both private and public sectors so as to contribute towards prevention of acute diarrhoea.

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Annual Report 2013

SERVICES PROVIDED

ACADEMIC Sr. Name Course Responsibility No. 1. Dr. Ohnmar Research Methodology for Ph.D Course (2013), Teaching University of Medicine 1, Yangon Thesis examination, MPH, University of Public External Health examiner

2. Dr. Myo Myo Mon Research Methodology for Ph.D Course (2013), Teaching University of Medicine 1, Yangon Final examination, Final Part 1, University of External Medicine (2) examiner

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Annual Report 2013

EXPERIMENTAL MEDICINE RESEARCH DIVISION

Deputy Director & Head ... Dr. Yi Yi Kyaw MBBS, MMedSc (Microbiology) (IM 1) Research Scientist ... Dr. Aye Aye Lwin MBBS, PhD(Okayama University, Japan) ... Dr. Aye Aye Win MBBS, MMedSc(Pathology) (IM 1) Research Officer ... Dr. Myat Tin Htwe Kyaw MBBS, MMedSc(Microbiology) (UM 1) ... Daw Ohmar Lwin BSc(Zoology) (YU), Dip in Korean (UFL) ... Daw Haymar Hpoo BSc (Chemistry) ( YU ) ... Dr. Hnin Ohnmar Soe MBBS(UM1) Research Assistant (2) ... Daw Baby Hla BSc(Chemistry) (YU) ... Daw Zin Mar Soe BSc (Chemistry) (YU) Research Assistant (3) ... Daw Wai Myat Thwe BSc(Botany) (UDE) ... Daw Pyae Pyae Phyo BA(Archaeology) (YU) ... Daw Mya Yee Nyo BSc(Zoology) (DU) Nurse ... Daw San N we Research Assistant (4) ... U Hla Win Aung BSc(Biotechnology) (DU) ... Daw Thiri Kyaw BSc, MSc, PhD(Zoology) (YU) Laboratory Attendant ... Daw Win Win Khine

The Experimental Medicine Research Division is primarily involved in research on hepatic and gastro-intestinal diseases. The division is investigating the prevalence of hepatitis B and hepatitis C infections in different geographical areas and population groups and the associated factors with the aim of determining the burden of hepatitis B and hepatitis C infections and to identify ways of controlling it. The division is also concerned with the diagnosis and management of hepatitis B and hepatitis C carriers who are attending the Hepatitis Carrier Clinic.

RESEARCH PROJECTS 1. COMMUNICABLE DISEASES 1.1. VIRAL HEPATITIS 1.1.1. Hepatitis B infection 1.1.1.1 Hepatitis B vaccination response in person with hepatitis C infection The objective of the study was to detect immune response of chronic hepatitis C patients to DMR plasma derived hepatitis B vaccine because decreased in efficacy of hepatitis B vaccine is associated with chronic diseases. A total 75 hepatitis C positive patients screened for presence of antiHBs first and exclude for other viral markers and associated complications. Sixteen anti-HCV positive person patients were included in the study. Their mean age was 45 ± 12.95 years and male: female was 6:10. Those who were vaccinated with three doses of plasma derived HB-DMR vaccine at 0, 1, 2 months schedule by intramascular route. Antibody to HB surface antigen was measured after completion of second dose and two months after completion of third dose of vaccination by quantitative ELISA method. Positive anti-HBs with protective level of more than 10 IU/L was only detected in 1/16 (6.25%) of study group. Hepatitis B vaccine response in patients with hepatitis C infection indicated a diminished response to plasma derived HB vaccine delivered at a standard dose and schedule compared to its response in person without HCV infection (98%).

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Annual Report 2013

1.1.1.2 Hepatitis B virus genotype distribution among HBsAg Positive women of reproductive age This study was carried out in collaboration with International Tuberculosis Research Center and Pusan National University, Republic of Korea. A total of 150 reproductive age group women who have positive for HBs Antigen were recruited. Ninty-Six samples were selected for detection of viral DNA and genotyping was carried out. Only 59 samples were successfully sequence and analyzed on core gene of HBV genome. Of those 59 samples (84.7%) were genotypes E, five (8.4%) were genotype C and four (6.7%) were genotype A.

2 NON-COMMUNICABLE DISEASES

2.1 CANCER

2.1.1 Establishment of advanced laboratory technique for screening, diagnosis and monitoring of hepatocellular carcinoma The general objective of this study was to establish advanced laboratory techniques for screening, diagnosis and monitoring of common malignancies in Myanmar and specific objectives are to collect blood samples from chronic hepatitis and cirrhotic patients to make application of serum markers for hepatocellular carcinoma, both Alpha fetoprotein and L3- alpha fetoprotein for early detection and monitoring of liver cancer patients. Total 100 patients (74 chronic hepatitis patients and 26 cirrhotic patients) were included in study. Determination of alphafetoprotein level carried out by ELISA method and showed that (6/100) 6% of the chronic hepatitis patients had AFP level greater than 20 ng/ml, with a highest level of 236 ng/ml in the absence of hepatocellular carcinoma(HCC). Thirty-seven hepatocellular carcinoma cases those who were higher alphafetoprotein level were determined Alphafetoprotein L3 level by ELISA method. Only two patients had higher alphafetoprotein L3 level and optimization of method is still being needed.

SERVICES PROVIDED

Hepatitis Carrier Clinic Viral hepatitis B or C infected patients were given consultation with regular check up at the hepatitis carrier clinic. There were 501 patients with hepatitis B infection and 103 patients with hepatitis C infection attended this year. A total of 2162 patients of old and new hepatitis B or C patients were consulted at the Hepatitis Carrier Clinic.

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Annual Report 2013

ACADEMIC Sr. Name Course Responsibility No. 1. Dr. Yi Yi Kyaw Overview of Hepatitis Problem in Speaker Myanmar (8.11.2013) External Examiner 3rd Year M.B, B,S UM(1) MMedSc ( Microbiology) Thesis Co -Supervisor 2. Dr. Aye Aye Lwin Research Methodology Course Facilitator Health Talk about Hepatitis Carrier Clinic Speaker Broadcast from Skynet TV Channel Myanmar- Korea Symposium on TB, Speaker Malaria and Hepatitis Health Talk about Cervical Cancer Speaker Screening Clinic Broadcast from Skynet TV Channel

LABORATORY Sr. Laboratory Tests No. of tests No. 1. HBsAg ELISA 102 2. HBeAg - 3. Anti-HBe - 4. Anti-HCV 1208 5. Liver function test 15 6. ALT, AST 976 7. AFP test 739 8. HBV markers (Combo test) 582

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Annual Report 2013

HEALTH SYSTEMS RESEARCH DIVISION

Deputy Director & Head ... Dr. Le Le Win BEcon(Statistics), MEcon(Statistics) (IE), PhD (University of Queensland) Research Scientist ... Dr.Yin Thet Nu Oo MBBS(UM 1), MIRB (Monash University, Australia) Research Officer ... Daw Khin Sandar Oo BCom (IE) Research Assistant (2) ... Daw Cho Cho Myint BA(Economics) (WC) (Diploma in Social Work) (UY) Research Assistant (3) ... Daw Thandar Min BSc(Maths) (University of Mawlamyaing) ... Daw Aye Win Khine BA(History) (YUDE) Research Assistant (4) ... U Soe Moe Myat BA(History) (YUDE) ... Daw Hla Thida Tun BA(Economics) (YUDE) ... Daw Kyi Kyi Htay LLB(Law) (YUDE) Laboratory Attendant ... U Saw Ba Than

Health Systems Research Division focuses research on tuberculosis, leprosy, health policy, health facility assessment, climate change and cancer in areas of social science.

RESEARCH PROJECTS

1. COMMUNICABLE DISEASES

1.1 TUBERCULOSIS

1.1.1 Infection control measures in public TB centres in Myanmar: Focus on health facility, health care provider and patients This study was conducted in collaboration with National TB Programme. Prevention of infection acquired in the health care setting remains a major goal for all health care personnel. Increasing problem of MDR TB is the eminent threat to TB control. Those untreated MDR TB cases are the sources of drug resistant TB in the community. The objective of the study was to found out the situation of TB infection control measures in selected health centers in Yangon, perception and practice of health staff working on MDR TB management, and the knowledge and practice of TB among MDR TB patients. A cross- sectional descriptive study was carried out in randomly selected 5 DOTS-plus townships in Yangon Region in 2013. Study population consisted of health facilities, midwives and TB teams staff of selected townships and MDR TB patients living in study townships. Observations, face to face interviews and in-depth interviews were done. Ninety four MDR TB patients participated in the face to face interview and male constituted 64.9%. Only one fourth were working for income. It is a positive finding that the majority (94.7%) of MDR TB patients know that the disease is airborne transmission. Regarding knowledge on TB prevention, most of them mentioned covering mouth and nose when another person coughs, however only 11% answered eating nutritious food. Very few knew that children, elderly and PLHIV are at risk of TB. Very few mentioned the risk of transmission to health staff. They assume high risk on the family contacts since most of the MDR TB patients cannot work due to health status and mostly stay at home with family members. Only 68% could mention wearing the mask as a preventive measure. There is gap in knowledge and practice on wearing mask, covering mouth/nose while sneezing/coughing and disposing off the sputum. TB patients usually wear mask when they go to the Aung San TB centre, and when the

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Annual Report 2013 midwife visits their house to provide TB treatment, however, it seems that it is not practical for them to wear the mask all the time in public places or at home. Most of the staffs in this study are aware that they are at high risk of TB transmission. Some heath staff has to meet with MDR TB patients as many as 10 times a day especially when they have many MDR TB patients in their ward. It may increase their awareness since they are working in DOTs plus townships. Self protection measures during the sputum processing and sputum examination are weak among the technicians according to the qualitative findings. Therefore, protection measures for lab technicians in routine sputum checkups need to be strengthened and also for TB workers who are in contact with patients. However, midwives practice personal protection measures strongly. Almost all the midwives use self protection whenever they see the MDR patients for daily treatment. Based on the findings, it is recommended to plan regular check-up program for those health staff who are in close contact with TB patients and MDR TB patients, to strengthen administrative measures including the TB infection control plan at the TB clinics. Administrative support and regular training of high risk health staffs is also recommended. BHS taking care of MDR patients should be provided with adequate N95 masks to prevention from getting transmitted. Public awareness on MDR TB should be promoted through appropriate IEC channels.

1.1.2 Awareness and attitudes of public staff towards involvement of General Practitioners (GPs) in TB control in selected townships, Yangon Region A cross sectional study was conducted between NTP and DMR (LM). General objective was to explore the awareness and attitude of public staff towards involvement of General Practitioners (GPs) in TB control in selected townships, Yangon region. The specific objectives were to find out the awareness of public staff on involvement of GPs in TB control, to identify the attitude of public staff towards GPs in TB control and to provide information to NTP for scaling up of PPM DOTS activities. With the aim of exploring awareness and attitude of public staff towards involvement of GPs in TB control, a cross- sectional descriptive study was carried out in five townships (Kyauktan, Hlaingtharyar, Tharkayta, Dala and Pazundaung), Yangon Region. This study was conducted from January to December 2012. Face-to-face interviews with 160 Basic Health Staff (BHS), and 11 in-depth interviews with medical officers and TB coordinators were conducted. BHS defined Public Private Mix DOTS (PPM-DOTS) as referring of TB patients (90.6%), disseminating health education (62.5%), treating TB patients (25.6%) and diagnosing TB patients (27.5%). When asking their opinion of magnitude of GPs that would collaborate with Township Health Department (THD), 11% of BHS thought all GPs would collaborate, 24% thought half of GPs would include and 4% said none of the GPs would involve in PPM. Majority (98%) of BHS stated that role of GPs in PPM-DOTS is important. In-depth interviews with Township Medical Officers and TB coordinators also revealed that most of the BHS understood PPM – DOTS as referral of TB Patients, which is scheme I. Only a few BHS mentioned about scheme II and III. Therefore, most of the BHS had low awareness of PPM DOTS. Findings indicated that advocacy meeting on PPM-DOTS should be done for BHS to enhance their cooperation with GPs in TB control program.

1.1.3 Effect of providing health education message on TB in local language through FM radio in Southern Shan State Please Refer to Annual Report of Medical Statistics Division

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Annual Report 2013

1.2 LEPROSY 1.2.1 Study on stakeholders' perspective for developing strategy for Self Help Groups (SHG) in two leprosy communities This study was collaborated with Leprosy Control Programm and Department of Medical Research (Lower Myanmar) and was funded by National Center for Global Health and Medicine (NCGM). In Myanmar, leprosy had been eliminated at the National level in January 2003 (prevalence rate below 1 / 10,000 population). Political commitment, full support from local authorities and community by integrated services had also been obtained to some extent. Public awareness and partnership building are strengthened in Myanmar. Socio-economic Rehabilitation (SER) program for the PAL had been initiated in Myanmar, however, there is still a gap between needs and demand because SER has not widely launched to every area. Thus this study was attempted to assess the SER launched in two PAL communities so that the success and failure of the SER will be known. A cross-sectional study design using focus group discussion (FGD) and pile sorting methods were applied in two study areas, Mayanchaung, Yangon Division and Nathermyaing, Mandalay Division. Health care providers, village authority, authority concerned from Mission, NGO, volunteer and community members were included. After getting consent, a total of 8 FGD sessions using pretested guideline, 4 in each study area were conducted among 69 persons, (27 male and 42 female) and pile sorting with community members were carried out. Majority of the participants had not heard about self-help group (SHG). Some participants from Mayanchaung, and Nathermyaing who had attended workshop knew that what SHG was. But they confused with social support group like free funeral and welfare service formed in the community. The awareness on SHG was mainly observed among educated staff both in Nathermyaing and Mayanchaung. They discussed that self relying group formed by themselves was SHG. They expressed that the group was formed by a group of people with the capability of community with or without support from others. The SHG must perform with their own effort for the benefit of community. The meaning of SHG was more vivid when pile sorting was done by the villagers mentioning that SHG should be formed by those who shared a similar experience or situation; who had a sense of ownership of the group. Rendering voluntary service without profit to the community was meant for SHG. Various ideas were explored but one of the key issues was leprosy cases should be membership so that they would like to help each other. They thought that PAL should lead the group and members will be PAL’s family. Health care providers, village authorities, village elders who had kind heart should also be included in that organization. Respectable persons in village and those who wanted to work for the community must be selected. For leadership someone who had ability to guide the villagers, who was knowledgeable, trustful, and experienced, should be chosen. They considered the village authority must lead the organization and health staff, village elders and active young people should be included. Arguments were observed in management of SHG. Most of stakeholders did not get proper training on SHG. Perspectives of stake holders in two leprosy communities approved to establish SHG in their localities but they have not been well informed about ways and means for formation and sharing responsibilities among themselves. Proper training to all stakeholders in two leprosy communities needs to be considered.

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Annual Report 2013

2. NON COMMUNICABLE DISEASE 2.1 CANCER 2.1.1 Knowledge, attitude, perception and practice regarding breast cancer prevention among female school teachers in Yangon Region Carcinoma of breast is one of the most common female cancers in Myanmar. School health program focus on the student population only and teacher population may be missed out regarding the early diagnosis of diseases, and especially of cancer. A cross –sectional descriptive study was carried out in 2013 among 405 female school teachers in 8 high schools in East Yangon Region to assess the knowledge, attitude, perception and practice on prevention of breast cancer. Pretested self-administered questionnaire was used. Demonstration of breast self- examination practice and Health Education using poster and pamphlet on breast cancer was given to participants after data collection. Mean age of the teachers was 47 years ± 8.48 and mean age of menarche was 13 years ±1.65. About 45% of respondents were single. Among the married respondents, mean number of children was 1.85(SD 0.84) and most teachers had practised breast feeding. Around 28% had family history of cancer and 34.2% reported family history of breast cancer. Mostly reported potential risk factors were breast lump (67%), family history of breast cancer (63.4%) and hormone drug users (58%). Mostly reported symptoms were breast lump (90%), lumps in arm pit (67%), and change in breast size and shape (58%). Eighty seven percent reported breast self-examination (BSE) as the way for early diagnosis. The study showed moderate to low knowledge of breast cancer prevention among teachers. Most of them had positive attitude towards early diagnosis and BSE. Only 39.6% perceived that they were at risk of breast cancer. Sixty two percent reported to have performed breast self-examination. Twelve percent had been examined by a doctor. Most common reasons for examining with a doctor were breast lump and concern for cancer. Proper breast self examination should be promoted among school teachers for early detection of breast cancer.

3. HEALTH SYSTEMS RESEARCH 3.1 HEALTH POLICY 3.1.1 Health Facility Assessment Survey, Myanmar: focusing on maternal, newborn and child health This study was conducted in collaborative with Department of Health Planning and Department of Health and funded by WHO / COIA. The study aimed to assess the situation of public health facilities regarding maternal, newborn and child health (MNCH). A cross- sectional study was conducted during 2013 at Nay Pyi Taw, Yangon and Bago Regions and Mon State. Altogether, 25 health facilities from State/Regional level to sub-health centres, involved in this study. After getting the written consent, the responsible persons for MNCH services from the selected health facilities were interviewed by trained medical persons using modified service availability and readiness assessment (SARA) questionnaire from WHO. Observations of medical store and service provided areas/places were also done. Hospitals had full strength of specialists, but there were shortages in general medical doctors, nurses, technicians and supporting staff. Nearly all rural health centres (RHCs) and sub centres had full strength of midwives. Almost all MNCH services were available at hospitals. A good infrastructure in terms of communication, power supply and privacy for patient consultation, water sources and latrine system was observed only at hospitals. Some items of basic equipment like micro nebulizer, IV infusion kits, pulse oximeter, oxygen concentrator and cylinder were not found at most OPDs. While most hospitals had depended on the respective

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Annual Report 2013 city development committee for collecting the hospital wastes, some hospitals had incinerators. Rural health centres had kept them in a protected area before disposing. For birth spacing/ family planning services, combined oral contraceptive pills, combined injectable contraceptives, progestin only injectable contraceptives and male condoms were prescribed by majority of health facilities. Progestin-only contraceptive pills, female condoms and cycle beads for standard days were the least mentioned methods. Male sterilization was not provided at all study facilities. Except in Yangon General Hospital, antenatal care (AN), prevention from mother-to-child transmission (PMTCT), obstetric and new born care, caesarean section and child immunization were provided at all facilities. HIV counselling to HIV positive pregnant women and RDT for HIV was done mostly at hospitals. Majority of health facilities particularly at tertiary hospitals, HIV test and blood drawing in their facility were feasible. On the other hand, sub centres did not have such services. Surgical service was provided at nearly all facilities. Incision and drainage of abscess, wound debridement, acute burn management and suturing were offered at all facilities. Medical instruments were sterilized at their facility for re- use, with water at rural health centres and with chlorine bleach at hospitals. Blood transfusion service was found at nearly all hospitals where they had only few blood interruptions, and able to access to other sources for obtaining blood and performance of blood screening. Laboratory diagnosis was done at majority of health facilities, particularly at hospitals. Nearly all health facilities had stored vaccines and medicines for general, infectious diseases, non communicable diseases, reproductive health, maternal health, child health and communicable diseases. Of which, medicines for infectious diseases, maternal health, TB were observed at almost all facilities. In conclusion, this study could only determine the situation of a limited number of health facilities in terms of quantitative information, which requires further nation-wide study exploring the explanations for the current situation of the facilities and community perspectives towards MNCH services provided by public health facilities.

3.1.2 Study on use of health research results by National Progammes This was a collaborative study among Department of Medical Research (Lower Myanmar), People’s Health Foundation, Myanmar and Department of Medical Research (Upper Myanmar). The study was a health policy research using qualitative approach to explore and analyze the utilization of research results by Disease Control Programmes, National AIDS Programme (NAP), National TB Programme (NTP), National Malaria Control Programme (NMCP), reproductive health – RH, maternal and child health (MCH) and woman and child health development (WCHD), senior managers of Department of Health Planning, under the Ministry of Health, covering the period from 2000 to 2012. The policy makers and Disease Control Programmes managers responsible for above-mentioned programmes under the Ministry of Health were selected and key informant interviews and in- depth interviews were conducted anonymously to enquire policy making regarding the planning, implementation, monitoring and evaluation related to research utilization. The interviewees had not only vast amount of more than 10 years experiences in their specific area, also the busiest, highly responsible and authorized person of the Ministry of Health. Research findings obtained from the operational research, programme evaluation and collaborative research based on research problems of the programmes were utilized, especially in disease control activities and health systems development. A number of reasons for not utilizing some research findings by the programme, particularly for nutrition, tobacco and some RH, were explored. Non utilization was due to weakness in communication, coordination and collaboration between the researchers and the users, not receiving the results timely, unavailable research reports done by some INGOs and post-graduate students, invalid and unreliable research results, and inaccessibility to research results. However, the expressions and opinions on utilization of research results by policy makers and program 37

Annual Report 2013 managers emerged from this study would support the development of a mechanism enhancing the utilization of research findings.

3.2 CLIMATE CHANGE 3.2.1 Communication network for disaster preparedness towards protecting human health from climate change among community members and service providers in disaster prone and non-disaster prone townships of Myanmar This study was conducted in collaboration with Department of Health. A cross- sectional study was conducted to assess the communication network regarding flood-related- health care for the people affected by flood in Kyaung-kone (KK) and Kun-chan-kone (KCK) Townships during 2013. These townships were selected purposively because while KK had been facing with flood every year, KCK had experienced with cyclone Nargis in 2008 and did not have any flood afterwards. Face-to-face-interviews were done with 200 adult community members, who had been living in the selected townships for at least 5 years consecutively (100 each per township) and in-depth interviews (IDI) were done with 41 committee members from Township/Village Disaster Preparedness Committees. Interviews were conducted with consent using pretested research tools during 2013. Majority of the respondents (63% from KK and 71% from KCK) were within 25 to 55 years (mean ± SD of 42.21 ± 15.04 for KK and 43.96 ± 14.35 for KCK), female, married and completed at least higher level education. Most of the respondents involved in fishing business. Members from various types of organization participated in IDI and majority were male and as old as 60 years. Nearly all had completed at least higher level education and some were graduates. Since people from KK were accustomed to flood nearly every year, they neither had proper plan for disaster preparation nor took seriously to report about the storm and flood to the authority concerned. People believed that there would be a heavy flood if the year had the month of wa hta’ *** (0gxyf) or intercalary month, and 2012 was that kind of intercalary year. Township and village level disaster preparedness committees were formed only in years of heavy rain. On the other hand, due to bad experience of Nargis, people from KCK Township were well prepared for predicted cyclone Mahasen at the time of study. Roles and responsibilities of the committees at both levels were similar. In both townships, four types of organization/groups had worked for flood victims, namely self-organized groups and group organized by village administrator, NGO and INGO. Of these, groups organized by community and village administrators were actively involved in the activities (about 40% and 50% in each township). Most health activities were done particularly when the rainy season was getting closer and one month after water level rose up. Health personnel took the main role as they initiated and communicated other people and worked together for the people to get health care in time particularly during flood period. Despite of receiving ample information, few respondents could not follow the instructions, did not understand and/or remember like names of medicines to keep. Additionally, some barriers slowed down for timely communication like poor transportation, insufficient life-saving routes and shelters. In conclusion, with some limitations, a good communication network, i.e., two-way communication between higher level and community through health staff and village level committee was observed in both townships. With the contribution of local residents and local responsible persons, health personnel took the main role as they initiated and communicated other people and worked together for the flood victims to get the timely health care. These resulted in achieving some benefits for the community as well as for the responsible person. The findings indicated the requirement of dissemination of minimum and essential information about preparedness and strengthening of after flood rehabilitative program. This study was funded by WHO / APW.

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Annual Report 2013

SERVICES PROVIDED

ACADEMIC Sr. Responsibility Name Course No. Teaching/Training 1. Dr. Le Le Win Hospital Management Course, Teaching Biostatistics, University of Public Health MPH, Biostatistics at University of Examiner Public Health Research Methodology for PhD 2013, Teaching (Problem Identification) UM1,Yangon Workshop on Research Methodology, Lecturer DMR (LM) Workshop on Warning against Dangers Training of Tobacco: Packaging and labelling, MPH University of Public Health Applied Statistics at University of Teaching Public Health Workshop on field Research Resource person Methodology Training. (12-14 August 2013) DMR (LM) 2. Dr. Yin Thet Nu Oo Research Methodology for PhD 2013, Resource person (Research Ethics) UM 1,Yangon Teaching Workshop on Research Methodology, Lecturer DMR (LM) Capacity Building Workshop for Resource person members of Ethics Review Committees Teaching (ERCs) in health institutions in Myanmar. (8th to 10th July, 2013) DMR (LM) Workshop on field Research Resource person Methodology Training. (12-14 August 2013) DMR (LM)

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Annual Report 2013

IMMUNOLOGY RESEARCH DIVISION

Deputy Director & Head … Dr. Moh Moh Htun MBBS , MMedSc (Pathology) , PhD(UM1) Research Scientist … Dr. Aye Aye Myint BSc, MSc(Zoology), PhD(Zoology)(YU) Research Officer … Dr. Min Min Win MBBS(UM2), MMedSc(Pathology)(UM1) … Daw Kyi May Htwe BSc(Chemistry) (YU) … Dr. Min Thein MBBS(UM1), MMedSc(Pathology) (UM2) Research Assistant (2) … Daw Khin Than Maw BSc (Chemistry) (UDE) … Daw Thazin Myint BSc(Zoology) (UDE) … Daw Khine Zar Win BA(Myanmar) (UDE) Research Assist ant (3) … Daw San Kalaya Htwe BSc (Chemistry) (UDE) … U Myat Min Oo BA(English) (UDE) … Daw Ei Ei Mon BSc(Zoology) (Dagon University) Research Assistant (4) … Daw Kay Khine Soe BSc(Zoology) (Dagon University) … Daw Chu Pwint Phyu BSc(Chemistry) (Dagon University) Laboratory Attendant … Daw Le Le Win

During the year under report, the Immunology Research Division was involved in five main research areas, namely malaria, tuberculosis, dengue haemorrhagic fever, cancer cervix, and snake bite. The research projects are exploratory study of Plasmodium knowlesi in Myanmar, loop mediated isothermal amplification (LAMP assay) and polymerase chain reaction (PCR) for the diagnosis of pulmonary and extrapulmonary tubeculosis, human genetic variation and dengue infection in Myanmar, cervical cytology screening and scale up production of Avian Russell’s viper antivenom.

RESEARCH PROJECTS 1. COMMUNICABLE DISEASES 1.1. MALARIA 1.1.1. Exploratory study on Plasmodium knowlesi In Myanmar Human malaria has been known to be caused by 4 Plasmodium species, with Plasmodium falciparum causing the most-severe disease. Recently, numerous reports have described human malaria caused by a fifth Plasmodium species, Plasmodium knowlesi which is similarly to P. falciparum can cause severe and even fatal cases of disease that are more severe than those caused by the other Plasmodium species. Polymerase chain reaction is valuable for diagnosis because P. knowlesi infection which is easily misdiagnosed as less dangerous Plasmodium malariae infection with conventional microscopy. A total of 400 blood sample were collected from clinically suspected malaria infection in Rakhine state. Nested and multiplex polymerase chain reaction (PCR) for identification of 5 malaria species of Plasmodium falciparum, Plasmodium vivax, Plasmopdium ovalae, Plasmodium malariae and Plasmodium knowlesi were performed. Among 400 samples tested, Plasmodium falciparum was detected in 64 samples (16%), Plasmodium vivax in 40 samples (10%) and mixed Plasmodium falciparum and Plasmodium vivax were detected in 24 samples (6%). Human Plasmodium knowlesi infection was not detected in Rakhine state. Although human Plasmodium knowlesi infection was not detected in Rakhine state, Myanmar, this should be determined in other malaria endemic areas of Myanmar.

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1.2. TUBERCULOSIS 1.2.1. Role of TB ICT, Loop mediated Isothermal Amplification (LAMP assay) and PCR in diagnosis of pulmonary TB Myanmar is one of 22 high burden TB and 27 high MDR-TB burden countries in the world. Early case detection, prompt treatment and household contact investigation are crucial role in TB control program. The polymerase chain reaction (PCR) is quick method for the detection of M. tuberculosis in clinical specimens and the loop-mediated isothermal amplification (LAMP) test is an amino acid amplification method without PCR machine. Immune-based ICT tests are potentially suitable for the point of care without laboratory equipment. Therefore, the aim of the study was to explore the role of TB ICT, LAMP assay and PCR in diagnosis of pulmonary TB.

1.2.2. Role of Polymerase Chain Reaction in the diagnosis of tuberculous pleural effusion To reach a definitive diagnosis of tuberculous pleural effusion (TPE) is still a challenge because of its non specific clinical presentations and inefficiency of conventional laboratory methods. The aim of this study was to identify the role polymerase chain reaction (PCR) method in the diagnosis of TPE. A total of 47 patients with clinically suspected TPE was subjected for pleural aspiration and closed pleural biopsy. Pleural fluid routine examination, cytological and PCR analysis mycobacterium in pleural fluid were performed. Histopathological examination of pleural biopsy tissue was also done. Pleural fluid AFB staining and cytology showed no definitive diagnosis of TPE in all cases. Twenty-four cases (51.5%) reached the definitive diagnosis of tuberculosis by histopathology of pleural tissue while the remaining 23 cases (48.9%) described chronic nonspecific pleuritis. PCR analysis of pleural fluid stated that 33 cases (70.2%) were positive and 14 cases (29.8%) were negative for tuberculosis. According to Receiver Operating Characteristic (ROC) curve, protein concentration and lymphocyte count at the levels of 5100 mg/dl and 85% are the best cut-off values where the sensitivities and specificities of TPE were 81.8%, 71.4%.and 75.8%, 71.4%, respectively. Association and 95% confident interval between histopathology and PCR analysis showed sensitivity (69.7%) specificity 92.9%, positive predictive value 95.8% and negative predictive value 56.5%. PCR analysis of pleural fluid has a gain over conventional methods. This study pointed out that, pleural tissue histopathology in combination with total protein concentration and lymphocyte count can be a useful tool in suggestion of TPE.

1.3. DENGUE HEMORRHAGIC FEVER 1.3.1. Human genetic variation and dengue infection in Myanmar Dengue virus (DENV) has become endemic in more than 100 countries in South-east Asia, the Americas, the Eastern Mediterranean, Africa, and the Western Pacific. DENV is the leading cause of childhood death in many countries. To assess genetic variants associated with dengue hemorrhagic fever (DHF), the Dengue Population Genetics Program (DPGP) will compare genetic variants in cases of DHF and dengue fever (DF) using a case-control design. Candidate genes include CD209 (DC-SIGN), VDR, Fc γ receptor II, TNF-α, IL-10, HLA-A, HLA-B, TAP1, TAP2, and CTLA-4 all of which have had alleles shown to be associated with DHF or DF. The study group will conduct an overall multi-country comparison of cases to controls for the three sets of phenotype comparisons specified above. As well, the group will test candidate gene associations with the same phenotypes as described in the original population. The study will be characterized the functional importance of candidate immune response genetic variants with associations that replicate.

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A total of 1011 serologically confirmed dengue serum samples by Immuno-chromatographic tests (SD BIOLINE Dengue Duo NS1 Ag and IgG/IgM test) were collected from children aged 1month to 14 years admitted to Yangon Children’s Hospital (YCH) during January to December, 2013. Thorough history taking and physical examination were performed in those dengue cases. Among those cases, IgG positive were 300 cases (29.7%), IgM positive (245/24.2%), IgG/IgM positive (445/44.0%), NS1 positive (12/1.2%), NS1with IgG (1/0.1%), NS1 with IgM (7/0.7%), and NS1 with IgM & IgG (1/0.1%). Those serologically confirmed dengue cases were classified into dengue fever (DF), dengue haemorrhagic fever (DHF) and dengue shock syndrome (DSS) according to Dengue Population Genetics Program (DPGP) classification. Out of 1011 cases, 495 (49%) cases were DF, 355 (35%) were DHF and 161 (16%) were DSS (Table 1). The most common age groups having dengue infection were above 5 year to 10 year age group (490/48%) followed by 1 month to 5 years (393/39%) and above 10 years to 14 years (128/13%) (Table2). Most of the dengue cases were male patients comprising 514 (51%) followed by females (497/49%) (Table3). The blood and buccal smear will be tested Candidate genes include CD209 (DC-SIGN), VDR, Fc γ receptor II, TNF-α, IL-10, HLA-A, HLA-B, TAP1, TAP2, and CTLA-4. DV RNA will be demonstrated by RT-PCR.

Table (1) Proportion of Dengue Cases attending Yangon Children’s Hospital, 2013 Dengue No . Percentage Dengue Fever 495 49.0% Dengue Haemorrhagic Fever 355 35.1% Dengue Shock Syndrome 161 15.9% Total 1011 100%

Table (2) Proportion of Age of Dengue Cases attending Yangon Children’s Hospital, 2013 Age No Percentage 1 month to 5 years 393 38.8% Above 5 year to 10 years 490 48.5% Above 10 years to 14 years 128 12.7% Total 1011 100%

Table (3) Proportion of Sex of Dengue Cases attending Yangon Children’s Hospital, 2013 Sex No Percentage Male 514 50.8% Female 497 49.2% Total 1011 100%

2. NON COMMUNICABLE DISEASES 2.1. CANCER 2.1.1. Screening of the cervical cytology in women attending Cervical Cancer Screening Clinic, DMR (LM), 2013 Women attending to Cervical Cancer Screening Clinic (DMR-LM) were taken Pap smear for conventional cytology. In 2013 (January to December), a total of 952 women were screened. Age distributions of women attending the CCSC were 27.2 % (259/ 952) in 15 to 35 yrs age group, 64.3% (612/952) in 36 to 55 yrs age group and 8.5% (81/ 952) in 56 and above age group. The most frequent age distribution was between the age of 36 and 55 yrs. Among them, 55.5% (528/952) were normal, 39.3% (374/ 952) were inflammatory cervix

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Annual Report 2013 and 3.7 % (35/952) were due to atypical squamous lesions. Precancerous lesions are 1.6% (15/952). Of which, mild dyskaryosis was 0.7% (7/952), koilocytosis 0.3% (3/952), moderate dyskaryosis 0.4% (4/952), and severe dyskaryosis 0.1% (1/952). No cancer cases were detected. All precancer cases were referred to nearby hospitals of patients.

Table (1) Proportion of different cervical cytology of women attending Cervical Cancer Screening Clinic, 2013 Cytology No. Percentage Normal smear 528 55.5% Inflammatory smear 374 39.3% Atypical squamous lesions 35 3.7 % Mild dyskaryosis 7 0.7% Koilocytosis 3 0.3 % Moderate dyskaryosis 4 0.4% Severe dyskaryosis 1 0.1% Total 952 100%

3. ACADEMIC AND TECHNOLOGY DEVELOPMENT 3.1. SNAKE BITE 3.1.1. Scale up production of avian Russell’s viper antivenom, 2013 A total of 48 sixteen weeks old ISA Brown (Local name CP Brown) hens were immunized with 0.5 ml LD 50 of Russell’s viper ( Daboia siamensis ) venom in complete Freund’s adjuvant on day 0 subcutaneously at multiple sites. Subsequent doses were carried out a dose greater than 1.0 ml LD 50 of same venom emulisified in incomplete Freund’s adjuvant (IFA) at 4 weeks interval. This study was carried out in Kyaunggone village of Htantabin Township, Yangon Division from 2012 August to 2013 December. Daily collection of eggs began 2 weeks after the first immunization. Eggs were labeled and stored at 4ºC until analyzed. Chicken immunoglobulin IgY were extracted according to the method of Frank et al. The pool IgY were concentrated by Tangential Flow diafiltration. The final concentration of chicken IgY (Avian Russell’s viper antivenom) was aimed at 1 ml of antivenom neutralizes 1.5 mg of Russell’s viper venom and vialing was carried out under sterile condition. The abnormal toxicity, pyrogen and sterility were carried out. A total of 3224 vials i.e., 1500 vials in April, 1100 vials in August and 624 vials in September, containing 10 ml antivenom in each vial, were obtained during the study period. It is sterile, non pyrogenic and free of abnormal toxicity.

SERVICES PROVIDED ACADEMIC Sr. Name Course Responsibility No. 1. Dr. Min Thein MMedSc (Pathology), MMedSc(Microbiology) Teaching, Training BPSC (Medical Technology), MMed Tech and Demonstration (Medical Laboratory Technology)

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LABORATORY Sr. Laboratory tests Tested Samples No. 1. Blood sugar 13 2. Lipid profile 43 3. Cholesterol 18 4. Uric acid 56 5. ALT( Alanine aminotransferase) 40 6. AST (Aspertate aminotransferase) 38 7. ASO (Anti-streptolysin O) 47 8. RA (Rheumatoid arthritis) 18 9. Urea 37 10. Creatinine 41

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MEDICAL ENTOMOLOGY RESEARCH DIVISION

Deputy Director & Acting Head … Dr. Thaung Hla MBBS, MMedSc(Pathology) (IM 1) Research Scientist … Dr. Yan Naung Maung Maung MBBS(Ygn), MMedSc (Public Health) (IM 1) Research Officer … Dr . Maung Maung Mya MSc(Zoology) (YU ), PhD(BioMedical Engg) (India) … U Sein Thaung BSc(Zoology) (YU) … Dr . Sai Zaw Min Oo MBBS (Ygn) (UM 2 ) Research Assistant (2) … Daw Khin Myo Aye BSc(Botany) (YU) … Daw Yee Yee Myint BSc(Zoology) (YU) … Daw Chit Thet Nwe BA(History) (YU) Research Assistant (3) … Daw Thuzar Nyein Mu BA(Economics) (YU) … Daw Thandar Aung BSc(Mathematics) (YU) Research Assistant (4) … Daw Zar Zar Aung BDevS, YU Laboratory Attendant … U Thi Ha

The Division undertook research projects on vectors of malaria and Dengue Haemorrhagic Fever (DHF). Insecticide susceptibility status of vectors and suspected vectors of malaria were continued at the selected study sites in Yangon Region. The identification of vectors and suspected vectors of malaria from the field study sites were also carried out during the reporting period. A project on vector bionomics and insecticide efficacy in malaria endemic areas was continued in collaboration with Than Byu Zayat Township, Mon State Health Department and Vector Borne Disease Control program. Two research projects were initiated on Dengue Haemorrhagic Fever (DHF) control in Yangon Region. Establishment of Anopheles mosquito colonies were continued with An. dirus mosquitoes from Mudon and Than Byu Zayat Township, and now they are in F 24 generation. Ae. aegypti and Culex quinquefasciatus mosquitoes from Yangon Region have also been colonized in the insectary.

RESEARCH PROJECTS 1. COMMUNICABLE DISEASE 1.1 MALARIA 1.1.1 Assessment of the insecticide susceptibility status of Anopheles mosquitoes in Myanmar (2013) Monitoring of insecticide susceptibility status in some Anophelines were conducted in Than Byu Zayat Township, Mon State using WHO test kits. Batches of Anopheline were exposed to standard impregnated papers using the standard exposure time of one hour. These studies were conducted to monitor the susceptibility of Anopheles mosquito to various insecticides in selected areas of Myanmar. There was no insecticide resistance detected in the area as follows.

Township Anopheles species No. Tested Insecticides Remark An.dirus 28 Than Byu An.sundaicus 63 DDT 4%, Zayat An. philippinensis 66 Deltamethrin 0.05%, Susceptible Township, An. annularis 133 Permethrin 0.75% and (Mon State) An. maculatus 67 Cyfluthrin 0.15% An.vagus 35 45

Annual Report 2013

1.1.2 Incrimination of suspected anopheline vectors using sporozoite ELISA and cytogenetic methods Suspected Anopheline vectors of malaria were collected from Than Byu Zayat Township, Mon State and identified morphologically using standard methods. A total of 326 Anopheles mosquitoes comprising 28 An. dirus , 63 An. sundaicus , 66 An. philippinensis, 133 An.annularis, 67 An.maculatus and 35 An.vagus were identified. All these mosquitoes were tested with sporozoite ELISA test kit in the laboratory and no mosquito was found positive with malaria parasite. There were no parasite positive results from both manual dissection and ELISA tests. Therefore no new suspected vector was incriminated during the reporting period.

1.1.3 Bio-efficacy and wash resistance of K-O-tab treated bed nets and PermaNet 2.0 on vector mosquitoes under laboratory condition Bio-efficacy and wash resistance of insecticide treated nets (ITNs) and long lasting insecticidal net (LLIN) on malaria vector mosquitoes under laboratory condition were tested. Repeatedly hand washed (7days interval) deltamethrin treated long lasting insecticide nets (LLINs) such as PermaNet ®2.0, PowerNet, and K-O-Tab 123+binder net and K-O-Tab only treated net against malaria vectors were evaluated. The study was conducted in the laboratory of Medical Entomology Research Division and in the field at Taikkyi Township, Yangon Region from June 2012 to May 2013. Laboratory strain of An.dirus was used to evaluate for susceptibility to selected insecticides used in malaria control. The standard bioassay cone technique following WHO guidelines was used to identify the regeneration time and wash resistance. The LC50 and LC90 values were calculated following Probit analysis. The regeneration study by three days continuous bioassay showed that the efficacy was fully recovered by 24 hours after one and three washes. Wash resistance in terms of 100% knockdown and 100% mortality persisted for 20 washes for wild caught F 1 generation of An.dirus from Mudon and also for An.minimus from Laikkyi village but for K-O-Tab only treated net, wash resistance persisted for 15washes against An.minimus . The LC 50 and LC 90 values of deltamethrin as determined for An .dirus and An.minimus were 8 µg/l, 36.7 µg/l (x 2=3.3883, p=0.05) and 9 µg/l, 37.2 µg/l (x 2=0.8897, p=0.05), respectively. PermaNet ®2.0, PowerNet, and K-O-Tab 123 and K-O-Tab only nets retained good insecticidal efficacy for up to 20 washed cycles producing 86.67-100% mortality against main vectors An. dirus and An. minimus .

1.1.4 Novel approach to determine geographical and genomic barriers to gene flow in a major malaria vector A new methodology that uses a network analysis approach was developed to detect sets of SNPs in high linkage disequilibrium with each other. This enables the detection of chromosomal inversions directly from population genomic data without the need for the laborious preparation of polytene chromosomes. The above methodology was applied to ~200 individual Anopheles baimaii mosquitoes from which Restriction-site Associated DNA (RAD) data was generated for ~3000 loci. Five chromosomal inversions were detected and their geographical distribution mapped across Myanmar and northeast India. Broadly speaking, all the inversions are polymorphic in northeast India and show north-south clines in frequency. The high geographical structuring of the inversions indicates their involvement in local adaptation. Genetic analysis of the RAD data indicated that the inversions provided substantial barriers to gene flow. A linkage map of An. baimaii was generated using RAD markers and F2 crosses of parents from two locations in Myanmar. The 410 markers on this genetic map enables >95% of the newly released An. dirus genome to be assembled into the

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Annual Report 2013 three linkage groups. Use of the genetic map and integrated genome assembly revealed that one inversion maps to each chromosome arm and enables us to identify the loci within the inversions. We provided four population pools of An. baimaii to the Broad Institute for whole genome resequencing (to provide SNP data to the 13 Anopheles genome sequence initiative). Our analysis of this data revealed high divergence across the inversion confirming their role as substantial genomic barriers to gene flow. Some more specific sites of high genomic divergence were also identified that warrant further investigation. A landscape genomics analysis was carried out using ~3000 RAD loci from ~200 individuals; 6 microsatellite loci from ~500 individuals; and 7 nuclear genes from ~200 individuals (>1550 sequences) from across northeast India and Myanmar. Separate analyses of RAD and nuclear loci based on their genomic position i.e. inside/outside inversions enabled us to differentiate the effects of inversions from the effects of landscape on gene flow. Non-inversion loci revealed there are two major population groups with a major geographical barrier to gene flow in western Myanmar.

1.2 DENGUE HAEMORRHAGIC FEVER 1.2.1 Integration of mapping and spatial analysis model in surveillance and control of Dengue Hemorrhagic Fever (WHO/APW 2012-13) During the study period, household surveys were conducted at (1) DHF positive houses and surrounding houses 4 (n=5) at 20 wards in Hlaing Thar Yar Township. DHF positive households were confirmed by the Township Medical Office. Entomological surveys were conducted at the selected DHF positive houses and surrounding houses simultaneously with the KAP surveys. Data from the GPS receiver were downloaded using Map Source software, viewed in Google Earth and image registration was processed using ERDAS imaging software. Databases were generated and linked to the ‘Arc View 3.2’ software for data joining and for developing visual maps. Immature stages of Aedes aegypti mosquitoes were sampled for calculation of appropriate larval and pupal indices. All water containers were examined and larvae and pupae were collected using standard methods. A total of 468 containers from 75 households for 2011 and a total of 1208 containers from 155 households for 2012 were examined. Moderate levels of vector infestation were evident based on House Index (HI) 29.33, 22.58, Container Index (CI) 6.41, 5.13, Breteau Index (BI) 40, 40 and Pupae per Person Index (PPI) 0.28 and 0.53 for 2011 and 2012, respectively. Majority of the containers were found to be cement tank/drum, ceramic jar, religious flower vases and spiritual worshiping bowls with some plants. Entomological parameters for DHF survey from 9 wards for 2011 and 17 wards for 2012 were computed. There was not much difference in the condition of the houses. Most of the houses were situated in 20 x 40 feet compound. As residents were from the low income group, majority of the structures were made of brick, wooden and thatch materials. In addition, most of the household heads’ education were from primary to high school level, operating in small scale trading and day to day odd jobs. Regarding the knowledge, attitude and practice of the household heads, the majority knew the cause of DHF transmission (87 and 95 %), importance of man-made containers (96 and 99%), about (75+155), 220 respondents larvae (96 and 99%) and practiced control measures with available means (91 and 94%). In conclusion, based on this study, it is evident that GIS based dengue vector surveillance system should be developed to the regional level to aid in the prompt identification of local dengue hot spots. Therefore, appropriate planning, prevention control strategies can be strengthened and monitored in these particularly DHF high risk locations.

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1.2.2 Improved Dengue Haemorrhagic Fever (DHF) control at schools using an integrated vector management (IVM) approach with community participation (WHO/APW 2012-13) Entomological survey and vector control activities were conducted at 12 schools geo- referenced by using a hand-held GPS receiver to recognize the neighborhoods in Hlaing Tharyar Township. Aedes mosquito larva survey was carried out by using the cotton net sweeper by standard procedure at 12 schools after the preliminary survey. All larvae and pupae were counted and noted down from each respective container. Aedes mosquito larva control activities based on Integrated Vector Management (IVM) was carried out after larva survey activity. In this study, Township Medical Officer, nurses and Township Educational Officer were also participated. During the intervention activities, teachers and students from all schools participated together with entomology survey team. The survey team gave health education messages regarding the Aedes mosquito bionomics and the usefulness of control tools. The use of mechanical control by net sweeper, chemical larvicide (Abate) and usefulness of biological control by mechanical were also demonstrated and the tools were donated to every school. Total of 27,076 students were attending in 12 schools during rainy season and primary, middle and high school students. A total of 285 water holding containers Barrel, cement tank, cement drum, earth port, bucket, flower vases, spiritual bowl, discarded container, overhead tank and small cement container in toilet in campus of study schools were seen. Of 285 containers, 52 larva and pupae positive containers (18.25%) were found in the Pre-intervention study. At Pre-intervention study, container index (CI), positive school index and breteau index (BI) were 19.3, 58.3 and 458.3, respectively. In Post-intervention study, CI, positive school index and BI were 4.6, 33.3 and 108.3, respectively. Among these various types of containers, key container in Schools was cement drum (kyaut si) which was placed in the school campus everywhere for school children without any cover. There were estimated 5000 larva and 300 pupae in 25% of cement drum (kyaut si) containers. After the intervention study, positive larva and pupae containers were reduced and only 13 containers remained positive. It concluded that under the motto of “ Aedes free school”, there are larva inspection teams in some school but all of the teams are based on teachers. However, teachers are small ratio for student population in every school, therefore teachers couldn’t carry out extra duty properly. Thus, students should also participate in dengue vector activities for the better healthy school and environment.

1.2.3 Larvicidal effect of Garlic bulb ( Allium sativum ) MuufoGefjzKK on larvae of Ae.aegypti and Cx.quinquefasciatus under laboratory Bioassay with crude ethanol extract of Garlic bulb ( Allium sativum ) was evaluated for larvicidal activities against the DHF mosquito Ae. aegypti 3rd and 4 th stage larvae. The larval mortality was observed after 24 hour treatment. The result revealed that larvae of Ae. aegypti was more susceptible to Garlic bulb extract. It was found 90-100% mortality at 600 ppm of Garlic bulb crude extract in tap water and rain water bred Aedes aegypti . The evaluation for larvicidal activities against the filarial mosquito Cx. quinquefasciatus 3rd and 4 th instar larvae from Dagon (North) Township was found 2400 ppm is effective dose for 100% mortality. Although 1200 ppm of Garlic bulb crud extract was also found to be 84-100% effective mortality against Culex quinquefasciatus bred in different resources water as 84%, 95.65%, 96% and 100% mortality in septic tank, earthen gutter, pond, and tube well water bred Cx. Quinquefasciatus , respectively.

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SERVICES PROVIDED ACADEMIC Sr. Name Course Responsibility No. 1. Dr. Yan Naung Maung Maung MMedSc Microbiology Teaching Research Methodology Facilitator Workshop (2013)

2. Dr . Maung Maung Mya MMedSc Microbiology Teaching Research Methodology Facilitator Workshop (2013)

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MEDICAL STATISTICS DIVISION

Deputy Director & Head ... Dr. Saw Saw MBBS (UM 1) , PhD (University of Melbourne, Australia) Research Officer ... Dr. Kyi Maw Than MBBS(UM 1) ... Dr. Wai Wai Han MBBS(UM 2) , MSc (Interna tional Health) (University of Heidelberg, Germany) Research Assistant (2) ... Daw San San Aye BA(History) (YU) ... Daw Yee Yee Win BA(Myanmarsar) (DU) Research Assistant (3) ... Daw Pyone Thuzar Nge BSc(Maths) (YUDE) Research Assistant (4) ... U Kyaw Myo Htut Laboratory Attendant ... Daw Aye Su Maw BBA(MeIE)

Medical Statistics Division has been actively engaged in conducting research projects in area of reproductive health, HIV and TB. Statistical consultation, statistical analysis services, training on research methodology, teaching of biostatistics and epidemiology are also provided to various researchers and post-graduate students.

RESEARCH PROJECTS 1. COMMUNICABLE DISEASES 1.1. TUBERCULOSIS 1.1.1 Tuberculosis Mortality in Pa-Daung Township and Kawkareik Township This cross-sectional survey was a collaborative research by National Tuberculosis Programme and Department of Medical Research (Lower Myanmar) to determine adult tuberculosis mortality in Padaung Township in Bago Region and in Kawkareik Township in Kayin State. Six clusters (6 catchment populations covered by 6 health facilities) were selected in Padaung Township and six clusters (6 catchment populations covered by 6 health facilities) were also selected in Kawkareik Township according to probability proportionate to population size (PPS). Verbal autopsy interviews of relatives or main care givers of the deceased whose death occurred during the period from 1 st January to 31 st December of 2012 were done by trained interviewers in May 2013. The 2012 WHO Verbal Autopsy (Form 3) questionnaire for death of a person aged 15 years and above was used. Interviewers included local basic health staff, local NTP staff and research assistants from Department of Medical Research (Lower Myanmar). Verbal autopsy questionnaires were reviewed independently by 2 physicians to assign cause of death and the causes of deaths according to Verbal Autopsy Code as mentioned in 2012 WHO Verbal Autopsy Instrument. For discrepancies in diagnoses between these two physicians, the 3 rd physician gave the final decision. Causes of death were described separately by the study township and aggregately for both study townships using the 2012 Cause of Death List for Verbal Autopsy. Four hundred and forty-eight persons aged 15 years and above died between January and December 2012 in the study areas of Kawtkereik and Padaung Townships: 238 persons 15 years and above died in selected wards and villages of Kawtkereik Township and 210 persons 15 years and above died in selected wards and villages of Padaung Township. The women comprised 61% of all deceased persons in two study townships. The age of the 448 deceased persons ranged from 15 to 99 years with the mean age of 83 years (Standard Deviation=19). About two-fifths of deaths occurred in people under 60 years. Most deceased persons were ever married. Most deaths occurred at home. The five leading causes of adult deaths were stroke (20.3%), liver cirrhosis (7.4%), pulmonary tuberculosis (6.9%), digestive neoplasms (6.3%) and cardiac diseases

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(5.8%) in Kawtkereik and Padaung Townships. A total of 31 deaths due to pulmonary tuberculosis occurred between Jan and Dec 2012 in the study areas of Kawtkereik and Padaung Townships. Nearly two-fifths of these TB deaths occurred in persons under 60 years. Sixty-one percent of TB deaths happened to male persons. Overall tuberculosis mortality in Kawtkareik and Padaung Townships combined in 2012 was 51 per 100,000 population (95% confidence interval= 34 to 72 per 100,000). Pulmonary tuberculosis mortality was higher in older age groups than younger age groups and male persons than female persons. The study indicated that pulmonary tuberculosis stands high in the leading causes of adult deaths, especially over 60-year male deaths. This implied that control activities at the community level to reduce deaths due to tuberculosis need to be strengthened. At the same time, surveillance for TB mortality both at facility level and community level should be stressed. TB mortality survey of wider scope, preferably a national scale, should be conducted to capture regional variation in disease burden due to TB mortality in reasonably reliable terms and that would be a useful input for planning, monitoring and evaluation of national tuberculosis program.

1.1.2 Cost analysis of alternative strategy for tuberculosis control in Hlaingtharyar Township: focusing on TB patient Self Help Groups Tuberculosis is still a major public health problem in Myanmar and the prevalence of smear positive for all ages was 174/100000 in 2010. Not only passive but also active case detection is essential. So community awareness and participation plays a key role in TB control. Therefore, information on the cost of establishing self help groups (SHGs) is necessary when this strategy will be replicated in other townships or areas. The cross- sectional study was conducted to calculate the cost of establishing four TB patient SHGs in Hlaingtharyar Township and explored financial management of those groups. These groups has been established and functioning with the aim of helping TB patients and their families to complete treatment, be cured from TB and lead the community response towards TB. The study was carried out from 2012 to 2013. Cost data were obtained by reviewing records and conducting interviews using tool to categorize cost. Five focus group discussions, nine key informant interviews and ten coins technique were performed to assess financial management of SHGs. The amount of cost spent for the SHGs for two years ranges from more than two to six million kyats depending on the developmental stages. The average cost per SHG for TB control activities such as referral, health education, providing DOT and nutrition for one year is approximately 250,000 kyats. On average, one SHG referred 72 patients and provided DOT for 64 patients per year. Most of the groups cannot perform financial management systematically. This study found out that implementing SHGs is worthy because of the immediate outcomes such as improving capacity of members for TB prevention and control, increasing in number of members and implementing fund raising activities for sustainability.

1.1.3. Effect of providing health education message on TB in local language through FM Radio in Southern Shan State This is a collaborative study among Department of Medical Research (Lower Myanmar), Department of Medical Research (Upper Myanmar), Central Health Education Bureau (CHEB) and National TB Programme (NTP). An intervention study (before and after design) was conducted in two villages in Hopone Township, Southern Shan State using broadcasting health education messages on TB through Cherry FM Radio as an intervention. It was aimed to assess the effect of providing health education message in local language through FM radio in Hopone Township in Southern Shan State. Total of 400 face-to-face interviews, four focus group discussions, five key informant interviews and six in depth

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Annual Report 2013 interviews were conducted. Development of audio script for health messages on TB was done in collaboration with NTP, CHEB and responsible persons from Cherry FM. Baseline assessment was conducted in April 2013 before broadcasting health messages on TB through Cherry FM. Cherry FM broadcasted health messages on TB daily, twice a day (afternoon and evening) for two months both in Myanmar and Pa-Oh languages. Endline assessment was carried out in August 2013. More than half of the respondents used Pa-Oh language in the community and about 30% used Shan language. According to qualitative findings, although there were Shan in the study area, most of them could speak Pa-Oh language. Nearly 50% can speak Myanmar language fluently. Possession of radio for individual use was 47.3% in baseline and 52.3% in endline. However, 81% in baseline and 84% in endline listened to FM radio. About 55.2% in the baseline and 52.4% in the endline listened to the radio in the morning. Qualitative findings showed that young people listened to FM radio more than old people. Some stated that they brought portable radio into the farm and listened while working. About 59% in baseline and 71% in endline had heard about TB. Source of information on TB from radio was increased from 37% in baseline to 53.9% in endline. There was an increase in number of respondents who had heard about DOTS from 25.2% in baseline to 38% in endline. Total knowledge scores on TB was improved from 18.4% in baseline to 26.4% in endline (p=0.056). There is an association between listening to FM radio and having high knowledge scores (p=0.001 in baseline and p=0.004 in endline). Initial action of treatment seeking when getting TB symptoms from public health centre was also improved from 33% in baseline to 70% in endline. About 60% of respondents suggested FM radio as an effective way of delivering health messages and most respondents preferred story type of health message because it was easier to understand and be memorized. Some respondents commented that duration of current health education programme through Cherry FM was too short and not enough to capture the key messages. However, everyone had positive views towards broadcasting in their language which was understandable to both old and young people. Most respondents suggested broadcasting health messages not only for TB but also for other health problems. It should be mainly in the form of story type in both local and Myanmar languages and broadcasted it twice a day for at least 3 to 4 months through FM radio. Using FM radio as one of the Advocacy, Communication and Social Mobilization (ACSM) strategies is an effective way for delivering health messages. It is necessary to consider further development of this intervention for longer duration and better programming according to the preference of community and feasibility from FM radio.

1.1.4 Management of tuberculosis in hard-to-reach area, Laukkai Township, Northern Shan State, Myanmar This is a collaborative study among Department of Medical Research (Lower Myanmar), Department of Medical Research (Upper Myanmar) and National TB Programme. A cross-sectional descriptive study was conducted to explore the management of tuberculosis (TB) in Laukkai Township, hard-to-reach area. Fifty-one face-to-face interviews and 12 in- depth interviews were conducted with 37 General Practitioners (GPs) including two in- service GPs and three medical officers from Asian Harm Reduction Network (AHRN), and 14 Basic Health Staff (BHSs) during 2013. All GPs had laboratory, nursing or medical training from three to seven years and 67.6% were Chinese who were trained from China. Compared to BHSs (30±6.5), total mean knowledge score on TB management was significantly low among GPs (14±10.2). About 64% of BHSs and 11% of GPs had exposure on TB training given by National Tuberculosis Programme (NTP) previously. AHRN was providing TB management in line with NTP guideline. Forty percent of GPs were providing anti-TB treatment and diagnosis was made from clinical and Chest X-Ray (CXR) findings. According to qualitative findings, about 100 to 150 TB patients were taking treatment mainly 52

Annual Report 2013 at four GP kings yearly. Anti-TB drugs given by GPs were loose tablets or capsules originated from China. Treatment duration ranged from six months to two years depending on the severity of the disease and follow-up CXR findings. Interval for follow-up examination depended on the severity of the disease and affordability of the patients. No sputum recheck was requested during follow-up examination except CXR. Existing management of TB by GPs in hard-to-reach area was not in line with NTP guidelines. Therefore, organizing them to involve in TB control under guidance of NTP is essential.

2. NON-COMMUNICABLE DISEASES 2.1 LIFE STYLE 2.1.1 Assessment of school physical activities and healthy eating practices among students in Basic Education Primary Schools of Mingalardon Township, Yangon This is a collaborative study between DMR (LM) and University of Public Health. This study aimed to assess healthy eating practices and physical activities of Basic Education Primary Schools of Mingalardon Township . A cross-sectional descriptive study was conducted in Mingalardon Township, Yangon in June 2013. A total of 220 primary school students from 5 Basic Education Primary Schools were interviewed with pre-tested structured questionnaire. Five key informant interviews and six in-depth interviews were conducted with headmistresses and primary school teachers. About 138 students (62.7%) could mention three main food groups. About 40% of students knew that the lack of physical activity can cause impaired lungs functions and weight gain. About half of the students said that their teachers taught benefits of physical exercise. In their school canteen, the shop keepers use to sell ready–made packets. So, the students had the habit of eating ready-made food. Teachers mentioned that they had to teach all the subjects in time. Therefore, they could not give attention on life skill curriculum. There was no enough space or play ground. Only one school had physical training teacher. Most teachers were very willing to teach healthy eating practice to the students. It is necessary to provide enabling environment such as play grounds and facilities for promoting school physical activities. Training for primary school teachers to improve healthy eating practice and school physical activities of primary school children is essential.

3. HEALTH SYSTEMS RESEARCH 3.1 REPRODUCTIVE HEALTH PROBLEMS/ WOMEN AND CHILD HEALTH 3.1.1. A study of linking RTI/STI services to RH services at primary care level (WHO/HRP) (Project No: A65588) The study aimed to determine if training and management support for linking RTI/STI services to routine RH services at primary care level can improve provision and quality of RTI/STI services at primary care settings. The study was a quasi-experimental design with non-equivalent control group. The effect of training of midwives on linking RTI/STI care and RH services, provision of RTI/STI supplies, and supportive supervision and monitoring for RTI/STI linkages were assessed by comparing the level and change in provision and quality of RTI/STI services in the intervention township (Daik-Oo) and control township (Tha-Nat- Pin). At baseline and end-line, 100 RH clients-provider interactions were assessed by using observation and exit interview of clients both in intervention township (Daik-Oo) and control township and then compared between 2 townships. The endline assessment will be done one year after completion of the training of providers. The advocacy Meeting was held at the Meeting Hall of Bago General Hospital on Friday, 25th of March, 2011. A total of 56 persons

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Annual Report 2013 including health staff from Bago Regional Health Department and Daik-Oo Township and Tha-nat-pin Township Health Department attended the advocacy meeting. The questionnaire for the baseline assessment was pretested on 13 rd June 2011 at a Rural Health Center at South Dagon Township in Yangon Division. From 14 th to 19 th June 2011 the baseline assessment was done . In Daik-Oo township (the intervention area), 118 women (22 for birth spacing services, 64 for antenatal care and 32 for postnatal care) were observed while the midwives were providing routine reproductive care at 4 Rural Health Centers (RHC). In Tha-Nat-Pin township (the comparison area), 144 women (30 for birth spacing services, 89 for antenatal care and 25 for postnatal care) were observed while the midwives were providing routine reproductive care at 4 Rural Health Centers (RHC). These women were also interviewed at exit. A few RH clients (1.7% in Daik-Oo Township and 2.8% in Tha-Nat-Pin Township) were screened for STI/RTI symptoms. No RH clients were assessed for STI/RTI risk behaviors in both townships. A few RH clients (1.7% in Daik-Oo Township and 0.7% in Tha- Nat-Pin Township) were given information on STI/RTI symptoms. Training on STI/RTI management was given to 56 health staff including 53 basic health staff from 26-9-2011 to 31-9-2011. Rapid diagnostic test (SD test kits and the medicines for main RTI/STI syndromes were supplied to health facilities after the training. Review meeting and one-day short training was done 4 times in April 2012 and October 2102, September 2013, December 2013 during which refresher training on risk assessment, health communication, case management and referral concerning STI/RTI was given to basic health staff and STD test kits were delivered to health centers. The endline evaluation is planned to be conducted in April 2014.

3.1.2 Role of Village Health Committee in Community-Based Emergency Referral Mechanism for Maternal, Newborn and Child Health problems in Middle Island, Nga- Pu-Daw Township, Myanmar This cross-sectional study was conducted in collaboration with Department of Medical Research (Lower Myanmar); Maternal and Child Health Section, Department of Health; and Save the Children. It aimed to describe roles of Village Health Committees (VHCs) in community-based emergency referral mechanism for maternal and child health care services in Middle Island, Nga-Pu-Daw Township in Ayeyarwaddy Region. The study was conducted in six villages of Middle Island. Informal group discussion and social mapping in each village, six focus group discussions (FGDs) with women of reproductive age group, three FGDs with VHC members of functioning VHCs, 12 in-depth interviews (IDIs) with mother who had experienced of emergency referral for Emergency Obstetric Care (EmOC) or Emergency Child Care (ECC) within six months were conducted. Eighteen key informant interviews (KIIs), with public health staff, key persons from VHCs, volunteers and Save the Children staff were done. Record review of referral records from 125 villages for 3 years (2010-2012) was also carried out. Although there were three different funding mechanisms to facilitate and support VHCs in previous years, existing funding was from Joint Initiative on Maternal, Newborn and Child Health (JI-MNCH) project. Almost all community were aware about VHCs and its’ main function for supporting emergency referral for MNCH. Most respondents highlighted that health knowledge and access to health services were much better after formation of VHCs in their villages. Strong linkage and coordination among VHCs, Basic Health Staff (BHS) and Save the Children was observed as one of the main strengths of JI-MNCH project. JI-MNCH also supports for health system strengthening. Identifying emergency was based on knowledge and skill of referred person and initial treatment obtained before the referral. Although decision maker to identify emergency was mid wife (MW), for villages which were not easily accessible to sub-centre, AMW or CHW could decide. Most common barriers for the emergency referral mechanism were variations for defining emergency, over-demand or unnecessary demand of community to refer to get 54

Annual Report 2013 meal cost at hospital and attitude of BHS. As there were three main players in community- based emergency referral mechanism—VHCs, BHS and Save the Children—it was crucial that three parties were harmonized and well coordinated. Well functioning health systems plays pivotal role to gear up this community-based emergency referral pathway. Monitoring and stewardship of VHC activities by BHS was also essential to make VHC involve more in health activities apart from providing travel cost. The original concept of revolving fund to provide some portion to emergency health fund became unclear when JIMNCH made replenishment for emergency health fund. For the sustainability and obtaining ownership of the community, contribution of the community for VHC fund was suggested by most key informants. VHC eventually engaged in the emergency referral mechanism for MNCH. However, challenges of capacity building, monitoring, logistics, accountability and strengthening health systems needed to be addressed by the implementing partner and the public health sector. The study recommended maintaining strong linkage with the public health sector and VHC, to strengthen health system at Station Hospitals and sub-RHCs, to build up capacities of VHCs for leadership and management; and capacities of BHS for community mobilization and development concept and to promote contribution of community for funding of VHC to obtain sense of ownership and sustainability. The findings from this study were taken up by Department of Health and Save the Children for future planning of MNCH activities.

3.2 CLIMATE CHANGE 3.2.1 Assessing community awareness and preparedness on hazards from storms and floods in Kyaung-Kone and Kun-Chan-Kone Townships, Myanmar The cross-sectional study was conducted in Kyaung-Kone and Kun-Chan-Kone Townships in 2013. A total of 40 men and 60 women in Kyaung-Kone Township and 25 men and 75 women in Kun-Chan-Kone Township involved in this study. Mean age in both townships were 43.65±13.803 and 46.88±13.417 years, respectively. Forty-two percent of respondents from both townships had completed primary school and were engaged in odd jobs. About 51% of respondents from Kyaung-Kone and 98% of respondents from Kun- Chan-Kone Townships recognized that their areas were at risk of storms. All respondents in Kyaung-Kone and 96% in Kun-Chan-Kone reported that their townships were prone to flood. Almost a quarter of respondents in Kyaung-Kone and 30% in Kun-Chan-Kone knew how to mitigate hazards from natural disasters such as flood and storms. Among them 54.2% and 70%, respectively admitted that the standard shelter construction could reduce the risk of disasters. Fifty-eight percent in Kyaung-Kone and 41% in Kun-Chan-Kone had preparations before the natural disasters. Sixty percent in Kyaung-Kone and 59% in Kun-Chan-Kone had preparations during natural disasters. Thirty-seven percent of respondents in Kyaung-Kone and 33% in Kun-Chan-Kone reported that there were emergency response preparations in their villages for flood. Nearly 100% of respondents in both townships got weather reports from different sources especially via the radio and understood well enough to explain to others. Three percent of respondents from Kyaung-Kone and 4% from Kun-Chan-Kone had completed disaster risk reduction training courses provided by governmental, non- governmental and international organizations. Eight percent from Kyaung-Kone and 4% from Kun-Chan-Kone had completed first aid assessment training course. Thirty-one percent from Kyaung-Kone had chosen monastery as safest place while 16% from Kun-Chan-Kone had preferred to go to township zone to avoid flood and storms. Thirty-nine percent from Kyaung-Kone and 47% from Kun-Chan-Kone had chosen higher ground as the place free from the risk of flood. In this study, the community awareness on preparations to prevent consequences of storms and flood in both townships was excellent but the preparations were

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Annual Report 2013 not up to satisfactory level. Moreover authorities should encourage more than at present for community participation to reduce hazards from natural disasters focusing disaster-prone townships in collaboration with local and international non-governmental organizations and United Nations Agencies. Further research is essential to underscore the community barriers that prevent translation of knowledge to action.

3.3 HEALTH POLICY 3.3.1 Policy mapping and analysis on rural retention policies in Myanmar This was a collaborative study between Department of Medical Research (Lower Myanmar) and Department of Health. The cross-sectional study was conducted in order to better understand the content, process and outcome of various existing government policy interventions on retaining health workforces in underserved areas in Myanmar. Documentary reviews, key informant interviews with key persons and policy-makers, and focus group discussions (FGDs) with key players such as Township Medical Officers and Basic Health Staff were conducted in six townships. A total of 100 policy documents were reviewed, 8% were central government policies and notifications, 67% resolutions from the National Health Committee meetings, 18% MOH directives and 7% departmental directives and regulations. Out of this a chronological inventory for improving rural retentions of health workers with reference to the sixteen recommendations made by WHO was made and 34 documents were found complying to the recommendations. Interest and knowledge of health professionals on rural retention as per policy formulation, contents, implementation and outcome was found to be very low even though they realized they were the beneficiaries/sufferers from policy changes. Both from the desk review and interview found the importance of rural retention policies to be reviewed and revised as needed with proper monitoring and assessment of outputs and outcomes. It is also crucial to include the voices of implementers in policy making as evidence and once a policy is set, it has to make known to the direct beneficiaries were suggested. The best retention strategies appear to be those that combine financial and non-financial incentives. A systematic, specific and sustainable rural retention policy and plan should be developed in order to avoid failures such as being temporary motivation and lack of transparency. Dissemination of research findings was conducted on 26 July 2013.

SERVICE PROVIDED ACEMEDIC Sr. Name Course Responsibility No. 1. Dr . Saw Saw Research Methodology for PhD course (2013) Lecturer at University of Medicine 1, Yangon Field Research Methodology training at Lecturer DMR (LM) Workshop on Research Methodology & Lecturer Bioethics at DMR (LM) Protocol Review of MPH students (12/2013) Reviewer at University of Public Health Viva examination of MPH students (12/2013) Examiner at University of Public Health

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Annual Report 2013

NUCLEAR MEDICINE RESEARCH DIVISION

Research Scientist & Head … Dr. Aye Aye Yee MBBS, DipMedSc (Nuclear Medicine) (UM 1) Research Officer … Daw Yin Yin Win BSc(Chemistry) (YU), DCSc (University of Computer Science) … Daw Aye Aye Maw BSc(Chemistry) (YU) Research Assistant (2) … Daw Thandar Myint BSc(Chemistry) (YU) … Daw Khin Thida Wai BA (Psyco logy) (YU ) Research Assistant (3) … Dr. Sandar Aung BSc , MSc, MRes, PhD(Zoology)YU Research Assistant (4) … Daw Naw Myat Su Mon BSc (Chemistry) (Pathein University) Laboratory Attendant … Daw Ma Gyi

The Nuclear Medicine Research Division has been actively involved in research studies on non-communicable disease.

RESEARCH PROJECTS 1. NON-COMMUNICABLE DISEASES 1.1 OBESITY 1.1.1 Assessment of body composition in children by using stable isotope method Adiposity is estimated through many body composition methods, such as under water weighing, deuterium oxide dilution method and bioelectrical impedance analysis (BIA). Therefore the aim of the study is to determine the body composition by stable isotope using deuterium dilution method in children residing in Yangon. The percentage of body fat was calculated from total body water (TBW) which was measured with deuterium enrich method in the Fourier Transform Infrared Spectrometry (FTIR). The study population consisted of 48 children (36 boys and 12 girls) with 8 to 10 years. Anthropometric measurements (body weight and height) and collection of three saliva samples (pre dose and two post dose) were carried out. The mean weight and height of 38 boys and 12 girls were 24.46 + 3.72 vs 21.38 + 2.53 kg, and 126.6 + 8.10 vs 123.48+5.33 cm, respectively. Mean fat percentage of boys calculated from BMI and skin fold measurements were 14.99 (95%CI- 14.36, 15.6) and 16.46 (95%CI- 15.68, 17.25), respectively. Mean fat percentage of girls calculated from BMI and skin fold measurements were 13.48 (95%CI- 12.72, 14.25) and 18.56 (95%CI- 17.43, 19.68) respectively. Measurement of body fat by Fourier Transform Infrared Spectrometry (FTIR) is still in processing.

1.2. CANCER 1.2.1. Thyroid hormone profile and thyroglobulin in carcinoma thyroid patients six months after radioiodine therapy A total of 20 patients (2 males and 18 females) with mean age of 46.4 + 10 years, attending the Out Patient Clinic of Department of Nuclear Medicine, Yangon General Hospital were recruited in this study. Twelve patients were diagnosed as papillary carcinoma thyroid and eight patients were diagnosed as follicular thyroid carcinoma. Six months after the completion of radio iodine therapy, 3 milliliters of venous blood were collected from each patient. Sera samples were tested for thyroglobulin levels by using high sensitivity ELISA kit from RSR limited, United Kingdom. The determination of thyroid stimulating hormone

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(TSH) levels was carried out by using Human TSH ELISA kit, Germany. The maximum thyroglobulin level of the patients was 1299.2 ng/ml and minimum level was 0.4 ng/ml in six months after the therapy. The maximum TSH level of the patients was 30.7 mIU/L and minimum level was 0.8 mIU/L in six months after the therapy. The reference value of TSH ranges from 0.3 to 6.2 mIU/L.Thyroglobulin levels were increased in 1 of 12 among papillary carcinoma thyroid cases but within normal range in eight follicular thyroid carcinoma cases. One of papillary thyroid carcinoma cases had increased thyroglobulin level (1299.2 ng/ml) after radioiodine therapy which indicated that the prognosis is poor.

SERVICES PROVIDED ACADEMIC Sr. Name Course Responsibility No. 1. Dr. Aye Aye Yee 1st year, M.Med.Sc (Biochemistry) Teaching UM (1), UM (2), University of Medicine Mandalay 1st year, M.Med.Sc (Physiology) UM (1), UM (2) 2. Daw Yin Yin Win 1st year, M.Med.Sc (Biochemistry) Demonstration of UM (1), UM (2), University of Enzyme Immunoassay Medicine Mandalay 1st year, M.Med.Sc (Physiology) UM (1), UM (2) 3. Daw Aye Aye Maw 1st year, M.Med.Sc (Biochemistry) Demonstration on UM (1), UM (2), University of stable isotope method Medicine Mandalay 1st year, M.Med.Sc (Physiology) UM (1), UM (2)

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NUTRITION RESEARCH DIVISION

Deputy Director & Head … Dr. Ko Ko Zaw MBB S, MPH (Epidemiology & Biostatistics) (Boston University) Research Scientist … Dr. Moh Moh Hlaing MBBS, MMedSc (Public Health)(IM 2) Research Officer … Dr. Mya Ohnmar MBBS , MPH (UOPH) … Daw Sandar Tun BSc Hons(Zoology) (YU) … Dr. Thuzar Aye MBBS (IM 1) … U Maung Maung Myint BSc(Zoology) (YU) Laboratory Incharge … Daw Myat Myat Thu BA(Eco) (YU) Research Assistant (2) … Daw Thidar Khine BSc(Chemistry) (Mawlamyine University) … Daw Lei Lei Myint BSc(Chemistry) (Dagon University) … Daw Wah Wah Win BA(Geography) (YU) Research Assistant (3) … Daw Su Su Hlaing BSc(Chemistry), Diploma in Food Technology (YU) … Daw Khin Hnin Wint Phyu BSc (Chemistry) (YU) … Daw Yin Yin Aye BA(Eco) (Dagon University) … Daw Hla Phyo Lin BSc(Chemistry) (Dagon Unive rsity ) … Daw Nyein Nyein Win BA (History) (Dagon University) Laboratory Attendant … Daw Khin Sabai Hlaing

The Nutrition Research Division is primarily involved in research activities of the following areas: micro-nutrient deficiencies, protein energy malnutrition, malnutrition in communicable diseases, tobacco and cardiovascular diseases.

RESEARCH PROJECTS

1. NON-COMMUNICABLE DISEASES 1.1. MALNUTRITION 1.1.1. Nutritional status and dietary intake of children living in foster monasteries in Yangon Increasing numbers of foster schools shows some socio-economic problems in child rearing practices. Nutritional status of these children with institutional life style may differ from that of other school children with families support. Therefore, cross-sectional descriptive study was conducted to find out the nutritional status and dietary intake of children living in two foster monasteries in Yangon Region. One hundred and twenty students, 5 to 13 years of age living in Mayangone and South Okkalapa foster monasteries were participated in this study. Mean and standard deviation of height and weight were 129.7 ± 13.1 cm and 28.0 ± 7.8 kg, respectively. Haemoglobin (Hb) concentration was determined by Cyanmethemoglobin method and serum albumin level was detected by photometric colorimeter. Sixty-three children (52.5%) were anaemic and 44 (36.7%) children had albumin lower than the normal. BMI for age and sex was used to assess nutritional status, 111 (92.5%) of students were within normal BMI-for-age and sex, 4 (3.3 %) were underweight and 5 (4.2%) were overweight. Mean calorie, protein, fat and carbohydrate intake of children from Mayangone foster monastery were 2145.3 ± 0.98 calories, 57.0 ± 0.07 g, 91.1± 0.04 g and 266.7 ± 0.09, respectively and that of children from South Okkalapa foster monastery were 2045.8 ± 64.09 calories, 56.1±1.7 g,76.6± 1.6 g and 279.8 ± 10.9, respectively.

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1.2. MICRONUTRIENT DEFICIENCIES 1.2.1. Factors contributing towards urinary iodine levels of pregnant women living in coastal area of Mon State The cross-sectional study was conducted to assess the patterns of salt utilization and iodine status of pregnant women living in coastal areas of Mon State in January and May, 2013. A total of 144 pregnant women from Pa-Nga village and Kalokepi village in Tanbyuzayat township were interviewed by using structured questionnaires including age, parity, socioeconomic status and patterns of salt and iodine rich food (seaweed, fish, prawn) consumption. Casual urine samples were collected from each pregnant woman and urinary iodine concentrations were measured. Three samples each of iodized salt and non-iodized salt from local markets were collected for determination of iodine content by the iodometric titration method. Only 83.3% of the study population consumed iodized salt and the remaining (16.7%) consumed non-iodized salt. The median urinary iodine concentration of the study population was 105 µg/L. The median iodine level of pregnant women was lower than that of the optimal iodine nutrition for pregnant women, i.e., 150-250 µg/L. The mean urinary iodine level of pregnant women who consumed iodized salt and that of pregnant women who consumed non-iodized salt were 110.47±67.34 µg/L and 95.83±70.13 µg/L (P = 0.336). Iodine content of iodized salt and non-iodized salt were 20.6±9.2ppm and 5.1±1.2 ppm, respectively. The mean iodine content of salt samples was lower than the permissible level of iodine in iodized salt, i.e., 30-40 ppm. In conclusion, our findings indicated that iodine intake of pregnant women in this area should be increased and it was needed to improve the current status of salt iodization programme and continue monitoring of iodine content in salt at factories, retail shop and household levels. Monitoring of the urinary iodine concentration among vulnerable groups such as children, pregnant women and lactating mothers should be done. Nationwide surveillance of the iodine nutritional status of these vulnerable groups should be done.

1.3 TOBACCO 1.3.1. Betel quid chewing in Dagon (East) township This study was a collaborative research by Nutrition Research Division of Department of Medical Research (Lower Myanmar) and University of Dental Medicine (Yangon). The study aimed to assess betel quid chewing practice and its relation to oral pre cancerous lesions in adult population in Dagon (East) Township. The study used a cross-sectional design conducted with a representative sample of 542 adults aged 18 years and above in the township in April 2013. The trained interviewers collected data using a pretested structured questionnaire. On-site oral examination was done on every respondent by a dental surgeon and Toluidine blue staining and oral brush biopsy were done on the respondents with visible oral lesions. When these oral lesions were positive by Toluidine blue stain and/or oral brush biopsy, these oral lesions were regarded as potentially malignant. The mean age of the respondents was 45 years and 59% were women. Fifty-two percent of the respondents were currently in the habit of chewing betel quids (72% of men and 39% of women). The 24-44 years age group have the highest prevalence of current betel quid chewing (81.5%) among male respondents while the 45-64 years age group have the highest prevalence of current betel quid chewing (46.4%) among female respondents. Among 284 current betel quid chewers, 240 (85%) chew betel quid together with tobacco. The commonest kind of tobacco added among current chewers was untreated tobacco leaves (62.9%) followed by “92” brand (30.8%), “92” brand (30.8%), hnat-say (tenderized tobacco leaves) (19.6%) and “Parijet” brand (15.4%). Among current chewers, half started chewing betel quids at 25 years or

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Annual Report 2013 earlier, half chewed betel quid for 10 years or longer and half chewed 8 betel quids or more per days. Most of current betel quid chewers (88.7%) spitted out betel quid juice but about one in ten of them swallowed it sometimes or always. The commonest way of discarding used betel quid among the betel chewers was spitting out it onto the ground or building corner or whatever place available at the time (68.8%). The main reasons given for chewing betel quids is ‘to ease an sour sensation in the mouth’ (35%) and ‘addiction to chewing betel quids’ (34.4%). Out of 284 current betel quid chewers, 24 (8.5%) were found to have oral potentially malignant disorders; out of 258 betel quid non-chewers, only 1 (0.4%) were found to have oral potentially malignant disorders. The prevalence of potentially malignant oral lesions rose from non-chewers (0.4%) through chewers without tobacco (2.3%) to chewers with tobacco (9.6%). The prevalence of potentially malignant oral lesions was similar between non-smokers (4.6%) and smokers (4.7%). The prevalence of potentially malignant oral lesions was significantly higher in alcohol drinkers (8.8%) than in non-drinkers (3.8%). Multiple logistic regression showed that betel hewers were 5.7 times more likely to have oral potentially malignant lesions than non-chewers and that risk increased to 28.6 times with addition of smokeless tobacco to betel quid. Drinkers were 1.6 times more likely to have oral potentially malignant lesions than non-drinkers. This study highlighted the growing importance of betel quid chewing and smokeless tobacco use as public health problem and an anti-betel quid chewing programme and smokeless tobacco control activities is warranted.

2. HEALTH SYSTEMS RESEARCH 2.1. Evidence-based policy and technical support 2.1.1. Past, present and future situation analysis on direction of research activities in Department of Medical Research (Lower Myanmar) This study aimed to analyze research activities, priorities and directions of the department reflecting the country health policies by desk reviewing annual reports, Myanmar Health Sciences Research Journals and annotated bibliography of research findings on various disease and areas and consulting key stakeholders in the research department and selected researchers. When both infectious and non-infectious diseases are taken together- malaria, tuberculosis, hypertension, diabetes, diarrhea and dysentery are the six highest ranking diseases among the top 15 priority diseases in which research is undertaken by DMR- LM. Research on traditional medicine (as alternative medicine) concerning these six commonest infectious and non-infectious diseases is also given higher priority. To promote clinical research, Clinical Research Units (CRU) were stationed together with the researchers and technicians from DMR (LM) in the hospital wards, thus enabling the clinicians to conduct clinical research. Altogether 10 CRUs were stationed in 8 specialist hospitals and in the University of Medicine (2) to promote research activities of these institutions with each CRU specializing in one priority disease. There is also a special research fund known as external research grant for the health personnel outside DMR-LM who need funding for their research projects. Although it is a small scale funding, the Department was supporting 2 to 3 projects yearly for the past two decades. The facilities and laboratories of the Department were also made available for post graduate students of the Universities of Medicine to conduct experiments for their research theses so as to promote medical research. The major research areas of DMR-LM were Viral Hepatitis and Hepatitis B vaccine, Human Reproductive Health/ Maternal, Newborn and Child Health, HIV, Malaria, Tuberculosis, Dengue infection and Leprosy, Diarrhoea, Dysentery, Cholera, Typhoid, Snake-bite, Traditional Medicine, and NCDs. Many research projects were laboratory-based, many other research projects were community-based and some were multidisciplinary. Almost all the new recruits to the department got the proper research training after recruitment. This started

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Annual Report 2013 as on-the-job, hands-on training and through in-house training courses and gradually advanced later to further training abroad. The new technicians and officers joining the department were given laboratory safety courses, medical and research equipment handling courses and basic statistics courses. Research methodology workshops were also conducted yearly which were compulsory for attendance by newly recruited officers. The current policy of the DMR (LM) concerning capacity building is to encourage young scientists to attend postgraduate Master degree courses locally or abroad and then pursue higher degrees and special courses at the universities locally or abroad. Yearly, about 100 research papers and poster presentations were made at the annual research congress which are usually held in January. In past 10 years, 1097 papers have been published by scientists from DMR-LM, including 120 papers on social science studies, 187 clinical studies and 526 papers on biomedical studies. Utilization of research findings by practitioners, service providers and program managers was weak. There are two possible explanations to this situation: findings may not by easily accessible by the busy program implementers and policy makers since there is weak research information system, and another possible answer is that they were not consulted before the research were planned, so there is gap between what is priority and what is studied. A well functioning research information system, mainly in the form of research information data base to which the researchers, policy makers and users can easily access will help to solve the underutilization problem to some extent. Ii is recommended to establish strong networking and reporting mechanism among researchers and policy makers and to develop a user friendly research information data base. The rationale and relevance of research activities reflect to the broad categories of NHP priorities to a considerable extent. However, it was found out that some areas of research were planned to meet the requirements of the funding agency. Funding limitation is one important factor which limits the dissemination of research findings to wider audience in terms of international publications and presentations at scientific conferences. Though operational level research was varied and large in number for all diseases/health problems, there are only a few strategic level research activities that influenced national health policy except for malaria, viral hepatitis and snake bite and more strategic research should be done and when the need and opportunity arises for example, research for universal health coverage is much needed. Health professionals give more emphasis on operational and translational research on the major priority diseases and health problems, which can be prevented and controlled by the current proven cost-effected interventions. But they should be done selected biomedical research on some diseases/problems which are not avertable/avoidable at all with the current interventions. But because these biomedical research activities are costly, they would better make more partnership with scientific institutions abroad, to import technology and develop the capacity to absorb such technology.

2.2 Cardiovasular survey in Myanmar: Knowledge, attitude, risk factors and morbidities This survey was a collaborative research by Cardiovascular Disease Project and Nutrition Research Division of Department of Medical Research (Lower Myanmar). The cross-sectional household survey was conducted in 2013 with 600 people aged 40 years and above in 4 townships (Kyauk-Tan, Mawlamyaing, Pathein and Pyay) to assess knowledge, attitude, risk factors and morbidities of selected cardiovascular diseases (CVDs) The survey included face-to-face interview with questionnaire, physical measurement of height, weight, waist circumference and blood pressure and measurement of random blood glucose and lipids. Age of the study population ranged from 40 to 99 years with the mean age of 56 years. Seventy-one percent of the study population were women. Only the small segment of the study population (not more than 35%) knew the risk factors and preventive behaviours of cardiovascular diseases. High proportion of the respondents (66%) perceived that they were 62

Annual Report 2013 personally at high risk of having cardiovascular diseases and at the same time most of the respondents (78%) felt that they can do many things to prevent cardiovascular diseases. Family history of premature premature coronary event or stroke in first-degree relatives (parents, or siblings or offspring) was present in 19% of the study population. Only the tiny portion of the study population (1.3%) consumed the daily standard of 5 servings and above of fruit and vegetable. Only 23% of the study population were physically active enough (150 minutes per week) for health. Prevalence of current smoking was 17% (38% in males and 11% in females) and that of current smokeless tobacco use was 20% (37% in males and 13% in females). Prevalence of hypertension and obesity was 51% and 21%. Prevalence of diabetes and raised total blood cholesterol (>190 mg/dl) was 13% and 61%. Nine percent of the study population had suffered from angina in their life time according to Rose Angina Questionnaire. Lifetime prevalence of possible heart attack, stroke and heart failure was 8.7%, 6.7% and 6.5%. The low level of cardiovascular knowledge in the community indicates the need for health education programs for the public. Community-based interventions should also be in place to give simple and effective preventive and curative care to the people at the grass-root level for sustainable improvement in cardiovascular health in the public.

SERVICES PROVIDED ACADEMIC Sr. Name Course Responsibility No. 1. Nutrition Research Workshop on upgrading food based Co-organizer Division dietary guideline for Myanmar People (Collaboration with Nutrition Centre, Department of Health) 2. Dr. Ko Ko Zaw MPH Epidemiology lectures for Lecturer (2012/2013) Master of Public Health (MPH) Training Epidemiology lectures for (2012/2013) Lecturer Diploma in Hospital Administration courses. Field Research Methodology Lecturer Workshop on Research Methodology Lecturer 3. Dr. Moh Moh MPH External Examiner/ Hlaing Supervisor Workshop on Research Methodology Lecturer Field Research Methodology Facilitator 1st Year M.MdSc (Physiology) Teaching 4. Dr. Mya Ohnmar Workshop on Research Methodology Facilitator Field Research Methodology Facilitator 1st Year M.MdSc (Physiology) Teaching 5. Daw Thidar Khine Demonstration of sample preparation Demonstrator and macronutrient analysis of egg to staffs from Nutrition Unit, Department of Health.

LABORATORY 1. Study visit of five Staffs from Nutrition Unit, Department of Health from 30-9-2013 to 4-10-2013. 63

Annual Report 2013

PARASITOLOGY RESEARCH DIVISION

Research Scientist & Head ... Dr. Kay Thwe Han MBBS, MMedSc(Microbiology) (UM 1) Research Officer ... Daw Aye Than BSc(Zoology)(YU) ... Daw Kyin Hla Aye BSc (Chemistry) (YU) ... Dr. Khin Myo Aye MBBS, MMedSc(Microbiology) (UM 1) ... Dr. Nan Cho Nwe Mon MBBS(IM 1) ... Dr. Myat Htut Nyunt MBBS(IM 2)(Ygn), MMedSc (Microbiology) (UM 1), DAP&E (IMR) (Malaysia) Research Assistant (2) ... Daw Soe Soe Han BSc(Biotechnology), Diploma in Global English (YU) ... Daw Ni Ni Zaw BA(Myanmarsar) (DU) Research Assistant (3) ... U Phyo Zaw Aung BA (Eco) (YU) ... Daw Ne Chi Aung San BA(Geography) (DU) ... Daw Thin Thin Aye BSc(Chemistry) (YU) ... Daw Cho Cho BSc(Hons) (Zoology) (YU) Research Assistant (4) ... U Hein Min Soe BA(Geography) (DU) ... U Thurein Tun Laboratory Attandent ... Daw Nilar Shwe

Parasitology Research Division has been linked with National Malaria Control Program to fulfill the research needs to solve the priority disease problem of National Health Plan, mainly on anti-malarial drug resistant studies. Parasitology Research Division is part of the research divisions under WHO Collaborating Centre for Research and Training on Malaria and it is also one of the Quality Control sample collection and lot testing sites of World Health Organization/Foundation for Innovative New Diagnostic (WHO/FIND). Parasitology Research Division is the only place for testing of in vitro sensitivity of antimalarial in the field and molecular analysis for detecting resistant malaria.

RESEARCH PROJECTS / SERVICES PROVIDED 1. COMMUNICABLE DISEASES 1.1 MALARIA 1.1.1 DRUG RESISTANT MALARIA 1.1.1.1 Monitoring of in vitro sensitivity of P.falciparum to different antimalarials Monitoring sensitivity of currently used antimalarials is a drug resistant malaria surveillance tool. The study was conducted to determine the sensitivity of P. falciparum to antimalarial drugs namely Mefloquine (MFQ) and Dihydroartemisinin (DHA) by using in vitro sensitivity test, World Health Organization (WHO, Mark III). The field-based analytical study was done on 548 clinically suspected malaria patients in Shwe Kyin Township, Bago Region from May to August, 2013. A total of 548 clinically suspected malaria cases were screened for malaria parasite by Rapid Diagnostic Test (RDT) and Giemsa microscopy. Forty criteria matched samples were subjected to in vitro drug susceptibility testing. Out of 40 samples, 24 P. falciparum isolates (60%) showed successful growth in culture after 48 hours incubation at 37°C. Malaria parasite positivity rate was 14.96% (82 cases out of 548 subjects). Cut-off Minimum Inhibitory Concentration (MIC) value for MFQ was applied as

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320 nM according to WHO Mark III. MFQ in vitro resistance rate was 45.8% (11 out of 24 isolates). For DHA, cut-off MIC value was applied as 300 nM according WHO Mark III, and DHA in vitro resistance rate was 20.83% (5 out of 24 isolates). Applying WHO Calculus Software Programme, the Geometric mean effective concentration 50 (GM EC 50 ) of MFQ was 83.91nM (61.26-114.94), EC 90 was 290.63 nM (177.91-474.74), EC 95 was 413.30 nM (233.22-732.46), respectively. MFQ EC 50 of this study was found to be higher than that of Kawthaung and Buthidaung studies conducted in 2005-06. The GM EC 50 of DHA was 14.12nM (7.70-25.90), EC 90 was 223.86 nM (79.94-626.85), EC 95 was 489.91 nM (144.92- 1656.09). The EC value of DHA was found comparable with that of Kawthaung study conducted in 2005-2006. Findings of the study reported the in vitro sensitivity status of P. falciparum to MFQ and DHA. The findings highlighted that there is some degree of drug resistant malaria problem in Shwe Kyin.

1.1.1.2 Detection of drug resistant malaria by molecular techniques in sentinel sites 2013 Out of a total of 36 falciparum infected samples collected from TRAC study (Shwe Kyin 2011-12), were genotyped for MAL 10 and Mal 13 mutations by PCR-RFLP method. DNA from filter paper samples were extracted using the Qiagen mini DNA extraction kit. Out of 38 samples, 36 samples for MAL 10 and 34 samples for MAL 13 were successfully genotyped. MAL 10 mutation was detected in 27.7% (10 out of 36) and MAL 13 mutation was detected in 2.9% (1 out of 34). In order to have a representative sample size, its plan to recruit more samples in the transmission season of 2014.

1.1.1.3 Pilot studies of the molecular epidemiology of drug-resistant malaria in Myanmar (2013-2014) The study was proposed to conduct in 4 study sites (Shwe Kyin, Muse, Kawthaung, and Buthidaung). During 2013, 57 samples of falciparum infected patients from Buthidaung and 37 samples from Shwe Kyin were collected. Duplicates of Buthidaung samples were analyzed during the project related training in Maryland University. DNA from samples was extracted by Qiagen kit and half amount of the extracted DNA underwent whole genome amplification (WGA) using Qiagen RepliG mini-kit. Twenty-four samples turned out to be eligible for SNP CHIP hybridization. SNPs were called using Heuristic algorithm. The accuracy of SNP call was compared between WGA samples and non-WGA samples, against parasitaemia level. Accuracy was found to be similar (99.7% vs. 99.8%) between WGA and non-WGA in samples with parasitaemia >100,000/ul. However, accuracy was better in WGA than non-WGA samples (96.2% vs. 94%) among samples with low parasitaemia (1000/ul). The findings recommended to apply WGA before SNP CHIP hybridization for those samples with low parasitaemia.

1.1.1.4 Establishment of monitoring system for drug resistant malaria: Identification of genetic markers in drug resistant falciparum and vivax malaria (2013) A therapeutic efficacy study (TES) on Chloroquine (CQ) coupled with molecular epidemiology of P. vivax applying available drug resistant molecular markers was conducted on 61 vivax malaria cases in Shwe Kyin during 2013. Applying WHO guidelines for TES, CQ 10 mg/kg/day on Day 0 and Day 1, and 5 mg/kg/day on day 2 was given to patients. There was no case of parasite positive on day 3 after treatment. Adequate clinical and parasitological response was observed as 100% on day 28 after treatment. Molecular analysis of collected samples were performed in Kangwon National University, Republic of Korea, during projected related training period. As regards to CQ resistant gene, pvmdr Y967F mutation was detected in (24.14%) 14/58 and pvmdr F1076L mutation was found in

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(53.45%) 31/58. Double mutant rate was 22.4% (13/58). Any of the sample did not have multiple copy of pvmdr1 gene. Insertion type of mutation in pvcrt-o was found in 74.14 % (43/58). Quadruple mutant pvdhfr 57-58-61-117 was found in 73.1% and triple mutant pvdhps 3832-382-553 was 30%. The findings of the study reported the preliminary information on molecular epidemiology of drug resistant P.vivax and its susceptibility to CQ.

1.1.2 FIELD RESEARCH ON MALARIA 1.1.2.1 Efficacy and safety of artemether-lumefantrine , dihydroartemisinin-piperaquine, and artesunate-mefloquine for the treatment of uncomplicated Plasmodium falciparum malaria in sentinel sites (2013) Kawthaung from Taninitharyi Region, Shwe Kyin from Bago Region, and Thanbyuzayat from Mon State were selected as sentinel sites for the evaluation of therapeutic efficacy and safety of Artemisinin Combinations Therapies (ACTs). The follow-up period for efficacy trial was 28 days for artemether-lumefantrine, 42 days for artesunate-mefloquine group and dihydroartemisinin-piperaquine. The study started on 7 August 2012 at Kawthaung, Tanintharyi Division with trial for artemether-lumefantrine combination. The study completed on 17 February 2013, actually planned to stop on 5-1-13 but two cases have been found on follow up, therefore the last 59 th case has been recruited on 19-1-13. One case had been resulted by External Validator as mixed infection that a total of 58 has been finished. There was no treatment failure case during 28days follow-up, but seven cases had persistence of parasitaemia on day 3 (12.1%). Artesunate-mefloquine efficacy was studied at Kawthaung this year. The recruitment period was between 7-7-13 and 24-10-13, and then followed up to 42 days. A total of 46 cases were recruited, in which one case recurred and four cases (8.7%) had persistent parasitaemia on day 3. Another study team organized by two Medical Officers had been started to study efficacy of artemether-lumefantrine at Ye on 9-8- 12. Team 1 had been based at Kyaung Ywar Station Hospital and then moved to Lamine Hospital on 17-8-12 after screening at villages under cover of Kyaung Ywar station. There was no criteria matched patients in Kyaung Ywar and Lamine station. Then the team moved to Thanbyuzayat on 25-8-12. Two cases were recruited after the screening of villages covered. Therefore, this team 2 moved to Myawaddy on 13-9-12. The team 2 had been based at Ye town proper and screened at villages covered. This team can recruit 3 cases on 15-8-12, 24-8-12 and 26-8-12 during 5 weeks period. A total of 56 cases were recruited up to 21-12-12 (13 weeks) and then followed up for 28 days, ended at 18-1-13. In which two cases recurred on day 14 and 8 cases had day 3 persistent parasitaemia (13.6%). The efficacy study of dihydroartemisinin-piperaquine was carried out on 5-5-13, finished to recruit on 6-6-13 and then followed up to 42 days. A total of 68 patients had been completed, in which 3 were treatment failure cases and 4 (5.9%) had day 3 persistent parasitaemia. The study was initiated on 20 September 2012 at Shwe Kyin, Bago Division (East). Medical Officer and technicians attended National workshop on monitoring therapeutic efficacy of anti-malarial drugs and National Training workshop on malaria microscopy on 8 April 2013. Therefore, the recruitment was stopped on 5 April 2013, after the recruitment of 43 rd patient. Then, the study restarted on 12 April. A total of 51 patients had been recruited for artemether- lumefantrine trial at the end of April. There were two treatment failure cases during 28 days follow-up period and two cases had persistence of parasitaemia on day 3 (3.9%). The efficacy study of dihydroartemisinin-piperaquine started on 1-5-13 and finished on 21-11-13. A total of 46 patients had been recruited to study, in which one treatment failure and persistence of parasitaemia was 5 (10.8 %).

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1.1.2.2 Laboratory-based quality control testing of malaria rapid diagnostic test (2012-2013) Quality Control (QC) samples have been collected from Myawaddy Township, Myanmar-Thai border areas. The first survey for preparation of the QC samples was carried out during 3-6-2013 to 7-6-2013. Another second survey was performed in 31-10-13 to 6-11-13. A total of 2 falciparum and 2 vivax cases were included for QC sample preparation. A total of 730 cryo-tubes of the 200 parasites per ul and 400 cryo-tubes of the 2000 parasites per ul of the P. falciparum and 796 cryo-tubes of the 200 parasites per ul and 246 cryo-tubes of the 2000 parasites per ul of the P. vivax . All of the QC samples collected were stored in -80°C deep freezer and the temperature has been monitoring daily to ensure the freezing. Evaluation of the malaria Rapid Diagnostic Tests (RDTs), was done in the RDTs already distributed in various State/Region of the country by using Qualified Quality Control blood samples and all of the batches were QC passed.

1.1.2.3 Efficacy and safety of Artemether-Lumefantrine for the treatment of uncomplicated Plasmodium falciparum malaria in children under five year of age in sentinel sites (3 year project) This study is conducting in Magway Region starting from January, 2013. All of the uncomplicated falciparum malaria who met the inclusion criteria recruited, treated with artemether-lumefantrine combination by direct observed method. A total of 90 falciparum malaria cases were successfully recruited and observed up to 28 days follow-up. So far, as there was no case of treatment failure, Adequate clinical and Parasitological Response (ACPR) was observed as 100% on day 28 after treatment. The study is on-going.

1.1.2.4 Sentinel surveillance of Day 3 parasite positivity rate of artemisinin based combination therapy (ACT) in MARC programme areas (Tier 2&3): Ayeyarwaddy Region, Chin and Kayin States The study was conducted in three sites namely, Paletwa, Chin State, Kyeikdon, Kyar Inn Seikkyi Township, Kayin State and YeKyi-Kyaunggon, Ayeyarwady Region. The study was conducted in 30 villages of Paletwa Township. Active case detection surveys were performed by the research team during August - September 2013. A total of 821 cases of clinically suspected malaria were screened for malaria parasite in their blood by Rapid Diagnostic Test (RDT), Pf/Pv kit. In which 205 patients were positive for Plasmodium falciparum , five were P.vivax and seven cases were mixed infection. Slide validation by experienced microscopists was performed in Department of Medical Research (Lower Myanmar). Plasmodium vivax infected patients were treated with chloroquine followed by primaquine. Seventy falciparum malaria cases were recruited to treat with Artemether-lumifantrine combination and another 70 were treated with Dihydroartemisin-piperaquine followed up to day3 of the treatment. The remaining P. falciparum positive cases were treated with Artemether-lumefantrine. After slide validation, out of screened 70 cases were recruited for Artemether-lumefantrine, 49 cases were P. falciparum positive and the others were negative (true positive rate 70%), for whom recruited for dihydroartemisinin-piperaquine 60 cases (85.7%) were true positive. The overall malaria prevalence rate was 21.2% (174/821). Among malaria positive cases, Plasmodium falciparum was detected in 174 patients (93.5%), P. vivax was detected in five patients (2.7%), and mixed infection ( P. falciparum & P. vivax ) was detected in seven patients (3.8%). After data cleaning, 109 enrolled patients were entitled for analysis. No patients out of 109 enrolled cases showed parasite positive on day 3. The other site was in Kyeikdon, Kyar Inn Seikkyi townships. A total of 940 patients were screened from 56 villages. RDT positive for P. falciparum was 66 and 65.2% was true positive by microscopy.

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Forty three cases (4.5%) were Plasmodium falciparum , among them parasite was still present in 11 (23.9%) patients on third day. The study was conducted in Kyaunggon and Ye Kyi township of Ayeyarwady Region, during 16.9.2013 to 17.10.2013. Despite 100 febrile cases, out of total 1200 screened patients in two townships, only 9 RDT confirmed malaria cases were enrolled. Out of nine cases, there were six cases of Plasmodium falciparum, two cases of Plasmodium vivax and one case of Plasmodium malariae malaria. There were no day 3 parasite positive cases. Vivax infected cases were treated with chloroquine followed by primaquine.

1.1.2.5 The role of merozoite surface protein (MSP) malaria antibody in treatment response of uncomplicated malaria in Myanmar Several antigens have been deemed importance in inducing antibodies against malaria but their action in vivo remains unclear. A longitudinal cohort study was conducted in 80 uncomplicated malaria patients from Tanintharyi Region, Mon and Kayin States from August 2012 to January 2013 to assess the role of malaria merozoite surface protein antibody (Ab) in treatment response of uncomplicated malaria. A total of 80, 41(51.3%) from Kawthaung, 32(40.0%) from Myawaddy and 7(8.8%) from Thanbyuzayat were collected respectively by blood film examination for parasitaemia and antibody detection by immunochromatographic assay kit. On Day 0, 34(42.5%) had Ab positive and 46(57.5%) had Ab negative. Among D0 Ab positive patients, parasites were found in 28(35%) on D1, 8(10%) on D2 and 6(8%) on D3 while among D0 Ab negative patients, parasites were noted in 37(46%) on D1, 12(15%) on D2, 8(10%) on D3. Seventy seven (96%) patients had an adequate clinical and parasitological response (ACPR) in which 34(43%) were Ab positive and 43(54%) were Ab negative. There were 3(4%) treatment failure cases in which Ab was not detected on Day 0. The parasite count on D0 parasite count was directly correlated to the D0 band intensity of the Ab assay (R 2 = 0.235, p = 0.004). The sensitivity for MSP Ab on D0 was 43%. All of the treatment failure cases had no antibody on D0, but all antibody negative cases were not treatment failure. These findings provided useful baseline information for clinical trials that MSP Ab confers protection from malaria, and are valuable for supporting merozoite antigens as targets of protective immunity.

1.1.2.6 Enhancing bed-net delivery mechanisms and early diagnosis and prompt treatment for malaria among resident and migrant households in Tanintharyi Coastal Region, Myanmar Process monitoring is essential to uncover limitations for strengthening malaria interventions. This cross-sectional study conducted in March, 2013 in 16 villages of two townships of the selected coastal region covered 210 households of resident villagers and 202 migrant households. During structured interviews, migrants reported night time work and suspected malaria within past 6 months significantly higher than resident villagers (58.9% vs. 31.4% and 111 persons vs. 74 persons). Potential risks contributed towards malaria in migrants may include significantly lower rate of treated bed-net ownership (51.5% vs. 97.1%), receiving health messages (18.8% vs . 48.6%), and less positive attitudes towards sleeping under the treated nets to prevent malaria (76.2% vs . 84.8%) compared to resident village. Among total bed nets observed, the proportion of factory treated nets was lower in migrant households than resident villagers (49% vs . 72%). Concomitantly, in both groups the awareness level for facilities/personnel providing early diagnosis and prompt treatment of malaria was not high. Similarly, they had poor knowledge for the requirement of antimalarials only after the confirmation of suspected fever and also for the preference of combined therapy over monotherapy. However, around 67% of migrants and 71% of resident

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Annual Report 2013 villagers knew to confirm with the rapid diagnostic test prior to antimalarials. Less than 50% in both groups could cite the recurrence of fever and persistent infection due to non- compliance of full course of antimalarials. Therefore, especially for hard to reach populations, alternative strategies for public-private partnership involving social entrepreneurs might enhance accessibility, coverage, and affordability to changing malaria containment scenario.

1.1.2.7 Evaluation of the effective behavior change communication and community mobilization activities in Myanmar Artemisinin Resistance Containment Tier 1 and 2 A cross-sectional descriptive study was conducted in 832 households from 16 townships from Bago Region, Tanintharyi Region, Mon and Kayin States from November to December, 2013. A total of 16 focus group discussions and 10 key informal interviews were also conducted. A total of 4,664 household members were listed and most of the respondents were females, and had primary and middle school education level. Half of them were Myanmar/Burmese and more than 30% were Kayin. The RHCs and sub-centers were major nearest health facility for them while a few of them cited the quack and drug sellers as their health facility. More than half of them had the assets for media such as radio, television and DVD player. A total of 3,797 bed nets were listed in their households and ITN/LLINs comprised 45.6% and 54.4% were untreated bed nets and 36.2% were LLINs. The mean ownership ratio for any type of the bed nets were 0.83, for ITN/LLINs 0.38 and for untreated nets 0.45. Based on this ratio, bed net coverage was just adequate but for LLINs coverage, it was just below the target. Ratio of the bed net utilization in last night was 1.64 in this study. Nearly 23% of them had the old nets and 52% had new unused extra bed nets in their families. Among them, 38% were unable to mention the benefit of the ITN/LLINs. More than 90% of the persons, who used to travelling to the forest, carried the bed nets and more than half were ITN/LLINs. In this study, only 88.2% of the respondents knew the disease "Malaria". But 11.9% of them would not mention the sign and symptoms. Only 36.9% could mention the blood test for diagnostic measure. More than 80% of respondents, correctly answered that mosquito bite caused malaria. Only 36.6% got the information on malaria within last year and among them, nearly 15% cannot recognize what information they had received. Most of them (>40%) could mention the drugs "artesunate" and "artemether" as antimalarial. More than 80% of the fever episode within 2 weeks took treatment outside of their home and their first place for treatment was RHC/Sub Centre (38.24%), drug shops (17.65%) and private clinics (16.18%) respectively. Only 19.27% of fever cases received the blood test. These findings highlighted that efforts should focus on correcting misconceptions about malaria transmission, prevention and universal ITN/LLINs utilization. It is still necessary to emphasize the behaviour change communication and community mobilization through the available multi-channel approaches in MARC areas in Myanmar.

1.2 PARASITIC DISEASES 1.2.1 Prevalence of soil-transmitted helminthes infection in children living under impoverished condition Soil-transmitted helminthes (STH) infections and malnutrition are major public health problems in school-age children in developing countries. This study was conducted on 250 schoolchildren in Kyee-myin-daing Township, Yangon Region starting from June, 2013. As baseline information, the prevalence of helminthic infestation, weight, height and mid-arm circumference of the school children were measured. School-based intervention study was conbined with a longitudinal follow-up at two months and six months after treatment with anthelminthic drug, Albendazole. Baseline prevalence rate of Ascaris lumbricoides , Trichuris 69

Annual Report 2013 trichiura and hookworm spp. infections were 71.48%, 44.14% and 1.56%, respectively before treatment. Two months later after treatment, Ascaris lumbricoides infection was 40.1%, Trichuris trichiura infection was 28.34% and hookworm spp; infection was 1.6%. After 6 months, Ascaris lumbricoides infection was 72.1%, Trichuris trichiura infection was 48.13% and hookworm spp; infection was 2.14%. STH infections are still prevalent and cause a matter of public health poor condition in Yangon region. Sustainable deworming programme at school and community levels among these populations will help to improve their health and nutritional status.

SERVICES PROVIDED ACADEMIC Sr. Name Course Responsibility No. 1. Dr. Kay Thwe Han M.Med.Sc (Microbiology) Teaching and Thesis Supervision 2. Daw Aye Than M.Med.Sc (Microbiology) Demonstration 3. Daw Kyin Hla Aye M.Med.Sc (Microbiology) Demonstration 4. Dr. Khin Myo Aye M.Med.Sc (Microbiology) Teaching 5. Dr. Myat Htut Nyunt M.Med.Sc (Microbiology) Teaching

LABORATORY Sr. Subject Tested Samples No. 1. Microscopic diagnosis of malaria 15

2. Routine and special examination of stools samples 195

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PATHOLOGY RESEARCH DIVISION

Deputy Director & Head … Dr. Moh Moh Htun MBBS, MMedSc(Pathology) (IM 1), PhD (Pathology) (UM 1), PGDE (YU) Research Scientist … Dr. Yin Min Htun MBBS, MMedSc(Pathology) (UM 1) Research Officer … Daw Myat Mon Oo BSc(Chemistry) (YU), DA (MSA), PGDE (YU) Laboratory Incharge … Daw Than Than Swe BSc(Chemistry) (YU) Research Assistant (2) … Daw Khin Myo Set BA(Myanmarsar) (UDE) … Daw Hnin Nu Htwe BA(History) (UDE) Research Assistant (3) … Daw Mya Thandar Win BSc(Botany) (UDE), PGDE (YU) … Daw Kay Thwe Win BSc(Zoology) (UDE) Research Assistant (4) … Daw Khin Zarchi Aung

The Pathology Research Division is actively engaged in screening of haemoglobinopathies, alpha and beta thalassaemia in healthy adults and research on coagulation profile in Type 2 Diabetes Mellitus. Carcinogenetic and epigenetic process of liver, gastric, breast and oral tissues were studied by immunohistochemical (IHC) method, apoptosis (TUNEL) method, insitu-hybridization, DNA methylation and molecular method (polymerase chain reaction PCR). The division has involved in genotypic identification of human papilloma virus in oral cancer tissues by using Restriction Fragment Length Polymorphism Polymerase Chain Reaction.

RESEARCH PROJECTS 1. NON-COMMUNICABLE DISEASES 1.1. DIABETES MELLITUS 1.1.1 Coagulation profile in Type-2 Diabetes Mellitus patients attending at diabetic clinic, Yangon General Hospital Diabetes mellitus is a chronic disease that causes serious health complications including renal failure, heart disease, stroke and blindness. In Myanmar, the overall prevalence of diabetes mellitus was 12.6% of female and 11.5% of male in Yangon Region in 2003. Type 2 Diabetes Mellitus patients had been known to have a hypercoagulable state and hypofibrinolysis. The coagulation profile, glycosylated hemoglobin (HbA1c) were determined in 187 patients with Type 2 Diabetes Mellitus (44 males, 143 females, mean age 55 ± 11 years) attending at diabetic clinic of outpatient department of Yangon General Hospital (YGH). In these patients, prothrombin time (PT) (12.2 ± 1.4 sec), activated partial thromboplastin time (APTT) (32.2 ± 4.7 sec), thrombin time (TT) (18.1 ± 2.6 sec) were within normal ranges. One hundred and two (55%) patients were increased in fibrinogen concentration (4.2 ± 1.3 g/l) just exceeded the upper limit (2-4 g/l). Fibrinogen concentration was significantly higher in female (4.4 ± 1.2 g/l) than male (4.0 ± 1.3 g/l) (P<0.001). Mean fibrinogen concentration and TT were significantly increased in diabetic patients with HbA1c level more than 6.4% (4.4 ± 1.3 g/l and 18.9 ± 2.7 sec, respectively). Plasminogen activator inhibitor-1(PAI-1) was measured in 77 diabetic patients with increased fibrinogen levels by using Human PAI-1 ELISA Kit. PAI-1 level was more than references unit 50 ng/ml in 49/77 (64%) of these diabetic patients. PAI-1 level had positive correlation (r=0.29) with fibrinogen concentration in Type 2 Diabetes Mellitus patients. The findings on coagulation status and fibrinolytic activity of Type 2 Diabetes Mellitus patients would be beneficial for management of diabetic patients with thrombotic complications.

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1.2. CANCERS 1.2.1. Breast cancer 1.2.1.1 Significance of two prognostic markers in histological proven breast cancer tissue samples A total of (100) females between the age of (30-75) years who were presenting with different sizes of breast lump from surgical units of Yangon General Hospital and Thingangyun Sanpya Hospital. The mean age of patients with breast lump was 43±4.5 years. Among these cases, 32% of breast lump were fibroadenoma (benign tumor of breast) and 23% were fibroadenosis (fibrocystic disease of breast) by observation of histopathological findings. Breast cancer was found in 45% of breast lump tissues by using histological grading and differentiation of cell types in breast cancer according to Bloom and Richardson Classification, (45) cases were invasive ductal carcinoma, (10) cases were well differentiated invasive ductal carcinoma, (23) cases were moderately differentiated invasive duct carcinoma and (12) cases were poorly differentiated invasive duct carcinoma by observation of two pathologists with microscopic examination under Haematoxylin and Eosin staining with 96% agreement. Human Epidermal Growth Factor Receptor-2 neu oncogene (HER2/neu) expression was detected in 16 cases (34%) of breast cancer cases including 10 cases (22%) of poorly differentiated type, 4 cases (8%) of moderately differentiated type and 2 cases (4%) of well differentiated type of invasive ductal carcinoma breast (IVDC). Estrogen Hormone Receptor alpha (ER α) expression was identified in 29 cases (66%) of IVDC including 9 cases (20%) of well differentiated type,18 cases (40%) of moderately differentiated type and 2 cases (6%) of poorly differentiated type of IVDC in this study. The highest expression of HER2/neu (genetic marker) was identified in 22% of moderately differentiated IVDC breast and the lowest expression in 4% of well differentiated type of breast cancer. The highest ER α hormone receptor (prognostic marker) expression was found in 40% of moderately differentiated IVDC breast cancer and the lowest expression in 6% of poorly differentiated type of breast cancer in this study. Therefore, immune-expression of hormonal marker (ER alpha) is good indicator for prognosis and treatment of breast cancer whereas epigenetic marker (HER2/neu) is not the sensitive bio-marker for early diagnosis of breast cancer in this study.

1.2.2. Gastric cancer 1.2.2.1 Histological grading and immunological markers in gastric cancer tissue specimens A total of (48) gastric biopsy tissues were tested. Haematoxylin and eosin staining was done to find out different histological types and immunoexpression of HER 2 and COX 2 were done by immunohistochemistry method. There were (5) well differentiated type, (20) moderately differentiated type and (23) poorly differentiated type of gastric cancer. Of 48 cases, Immunoexpression of HER 2 and COX 2 were done on 30 gastric cancer tissue samples. Of 30 cases, positive Her 2 expression was found in (7) cases and COX 2 in (10) cases. According to the staining pattern of Her 2, 1+ (faint membrane staining in >10% of tumor cells) in 2 cases, 2+(weak to moderate staining in >10 % of tumor cells in 2 cases and 3+(Strong complete membrane staining in >10% of invasive tumor cells) in 3 cases. In COX 2 immunoexpression, 2+ in 3 cases and 3+ in 7 cases. According to histological types, (1) positive expression for well differentiated type (3) for moderately differentiated type and (3) for poorly differentiated type in HER 2 and (5) positive expression for moderately differentiated type and (5) for poorly differentiated type accordingly. HER 2 marker should be used for therapeutic prediction in gastric adenocarcinoma and COX 2 marker would be used for prognostic marker that is involved in the growth of gastric carcinoma.

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1.2.3 Oral cancer 1.2.3.1 Molecular typing of human papilloma virus in oral mucosa lesions of potentially malignant and malignant cases Oral cancer is the second commonest cause of death in developing countries and the prevalence of oral cancer is higher among men than women. It is the eighth most common cancer in the world. The common causes of oral cancer are tobacco smoking, excessive alcohol drinking, unhealthy diet and Human papilloma virus (HPV) type 16 and 18. A cross- sectional laboratory based descriptive study was performed in (55) pre-malignant and malignant oral cancer patients out of (75) cases attending in Clinical Research Unit, University of Dental Medicine, Yangon. Oral mucosal samples were collected from mucosal lesions of potentially malignant and malignant oral cancer patients by using sterile oral brush and collected in plastic sterile tubes containing 0.05M phosphate buffer saline for DNA extraction and detection of HPV virus genotypes by using RFLP-PCR method. Internal control h beta actin gene was identified in 44 cases (84.6%) at 297 bp by using PCR with A1 and A2 primers. HPV malignant types including HPV-16, 18, 31, 33, 35, 52b was detected in 13 samples (39.4%) including (5) premalignant and (8) malignant oral lesions, out of beta actin positive (33) cases. Positive control template for malignant HPV was also indentified in 63 bp by using two primers (pU -1M and pU-2R) for HPV-TM and Positive control template for benign was not identified in 61 bp by using two primers (pU31B and pU-2R) for HPV-TB (Takara, Japan). In this study, thermocycler programme will be changed to reduce the time 0.5-1 min at annealing step (55°C) for detection of benign positive control template. Genotyping of malignant and benign HPV will be carried out in Miyazarki University, Japan by using different restriction enzymes. This study will provide identification of common HPV genotypes in premalignant and malignant oral cancer lesions and to analyze the association between genotypes of HPV and histological conditions of oral mucosal lesions.

SERVICES PROVIDED ACADEMIC Sr. Name Course Responsibility No. 1. Dr. Moh Moh Htun M.Med.Sc(Pathology), (Forensic) Teaching M.Med.Sc(Paramedical) 3rd M.B.,B.S External examiner 2. Dr. Yin Min Htun M.Med.Sc(Pathology), (Forensic) Teaching M.Med.Sc(Paramedical) 3. Daw Myat Mon Oo M.Med.Sc(Pathology), (Forensic) Teaching M.Med.Sc(Paramedical)

LABORATORY Sr. Name Tested sample No. 1. Blood for CP 98 2. Blood for ESR 10 3. Haemoglobin screening test 18 4. Acute and subacute toxicity test 111 mice =37 (8 organs per mice)

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PHARMACEUTICAL TOXICOLOGY RESEARCH DIVISION

Deputy Director & Head … Dr. Khin Chit MBBS (UM 1), MMedSc(Pharmacology) (UM 1), PhD (UM 2) Research Scientist … Dr. Min Wun MBBS(UM 1), MMedSc(Pharmacology) (UM 2) Research Officer … Dr. Khin Hnin Pwint MBBS, MMedSc(Pharmacology) (UM 2) … Dr. Nyi Nyi Win MBBS, MMedSc(Pharmacology) (UM 1) … Daw Moe Moe Aye BSc(Chemistry)(YU) Research Assistant (2) … Daw Kyi Kyi Myint BA(Geography)(YU) … Daw Thiri Aung BPharm(UOP) … Daw Ph yu Phyu Aye BSc (Zoology) (DU) Research Assistant (3) … Daw Mya Mya Moe BSc(Chemistry) (DU) … Daw Swe Swe Aung BSc(Marine Science) (MU) … Daw Win Phyu Phyu Zaw Research Assistant (4) … Daw Thin Thin Hlaing BSc(Zoology)(DU) … Daw Thinzar Myo BSc(Zoology) (EU) … Daw Ohnmar Than BSc(Botany) (BU)

The Pharmaceutical Toxicology Research Division, established under NPCC, involves 3 major area activities. To (1) conduct research projects on drug-related poisoning and toxicity, (2) provide information and analytical services to the health sector on prevention, control and management of drug poisoning, and (3) conduct education and training to health personnel concerning poisoning and toxicology. Provision of services includes drug screening and identification in cases of unknown poisoning, quantification of drug levels to support treatment in cases of acute poisoning and provision of poison information to doctors and health care professionals in selected major hospitals for poison control and management.

RESEARCH PROJECTS 1. COMMUNICABLE DISEASES

1.1. TUBERCULOSIS 1.1.1 Evaluation of complementary effect of traditional medicine to Cat II regime in tuberculosis patients The aim of this study was to evaluate the efficacy and safety of four Myanmar medicinal plants on tuberculosis patients, both in terms of therapeutics (sputum conversion and chest X-ray improvement, etc.) as well as on adverse events, as assessed by standard instruments. A double-blind, placebo controlled, randomized, clinical study was carried out on 60 Category II pulmonary tuberculosis patients, 30 in each arm. Group 1: Subjects (30) received drugs for CAT II therapy with 2 capsules of trial drug (Plant extract) and Group 2: Subjects (30) received CAT II therapy with placebo. All preparation of trial drugs were carried out according to WHO guideline for standardization and Quality Control of Herbal drug (2007). Potential subjects were recruited from the Outpatient Departments of Mingalardon, North Okkalapa, South Okkalapa, North Dagon, South Dagon, Insein, Thingangyun and Tharkayta townships under supervision of National Tuberculosis Program (NTP). Baseline demographic, clinical and laboratory investigations were done at the start of patient recruitment and were recorded in all visits (7 visits). All subjects received study

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Annual Report 2013 treatments for a total period of 3 months. Participants were dispensed monthly supply of trial medication at visits 1, 2, 3, 4, 5, 6 and 7 for total duration of 3 months. They were instructed to consume 2 capsules once a day. A total of 100 TB patients were screened to recruit subjects who met the selection criteria. Screening tests included blood for CP, ESR, Liver Function tests, Renal Function tests, Total and differential proteins, Hepatitis B, Hepatitis C, HIV antibody, Gene expert for sputum, chest X-ray, ECG and random blood sugar level. A total of 40 patients either failed to meet the selection criteria or did not provide consent, left the study. From the remaining 60 participants, 30 were given placebo drugs and the rest the trial drugs. Drugs to be given were determined by block randomization and drawing lots. Six patients were allocated in each block with 3 receiving placebo and 3 trial drugs. At present, 30 patients have completed the 3 months trial period and assessment of the remaining half is under process. Patient’s recovery is assessed by sputum smear, Chest X-ray improvement and body weight. Compiling the results so far, out of 15 trial drugs recipients, 11 showed clear negative sputum and significant radiological improvement after 1 month. Among the remaining 4, 2 patients presented in sputum smear from being a 3+ before the trial to 1+ after 3 months. Further improvement will be expected with continuation of the drugs. Nevertheless, 2 patients showed no changes in sputum AFB remaining 3+ consistently throughout the programme. Among of 15 patients of the placebo control group, 7 patients showed improvement in sputum smears ( sputum negativity) within 2 months after treatment whilst other patients showed no sputum conversion after 3 month of study. In this group, 7 patients got radiological improvement and the others showed radiological no improvement. All patients showed no adverse events in all trial period. In this study, combination of traditional medicine has a potential to use in retreatment of tuberculosis for prevention of treatment failure in CAT II regime.

1.1.2. Study on Comparison of Pharmacokinetic of isoniazid in Category I Treatment Failure and Relapse Cases of Pulmonary Tuberculosis Patients The aim of this study was to determine the pharmacokinetic parameters of oral isoniazid in Cat I failure and relapse pulmonary TB patients by clinic based analytical and comparative study. In this study, 30 patients taking Cat II anti-tuberculosis regimens were selected. Out of 30, 15 patients were treatment failure of Cat I and 15 were relapse of Cat I treatment. Baseline laboratory investigations and clinical examination were assessed. For pharmacokinetic analysis, the participants were at least two hours fasted and FDC tablets were given orally according to their body weights. Blood samples were collected at 0, 0.5, 1, 1.5,2, 4 and 6 hours, respectively. Serum INH concentrations were measured by a spectrofluorometric technique. Baseline clinical and laboratory parameters (blood sugar, bilirubin, SGOT, SGPT, urea, creatinine, total protein, albumin, globulin) of all participants are within normal limits. Mean C max , T max , for relapse patients were 4.70±2.16 µg/mL and 1.69±0.95 hr and for Cat I failure patients were 4.63±2.08 µg/mL, 1.70±1.08 hr. Mean T 1/2ab , -1 Kab for relapse patients were 0.57±0.38 hr, 1.76±1.23 hr and mean T 1/2ab , K ab for Cat I -1 failure patients were 0.51±0.35 hr, 1.66±10.80 hr . Mean Vd and AUC (0-∞) for relapse patients were 38.64±14.40 L, 33.53±24.74 µg/mL.hr. Mean Vd and AUC (0-∞) for Cat I failure patients were 39.29±13 L, 37.27±27.12 µg/mL.hr. AUC in Cat I failure patients was higher than relapse patients (37.27±27.12 µg/mL vs 33.53±24.74 µg/mL). Their difference is not statistically significant (p>0.05). Serum isoniazid levels are within therapeutic concentration range in both groups. In this study, failure to treatment or changed to Multi-drug resistance tuberculosis is not due to variability in pharmacokinetic of isoniazid.

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1.1.3 Study of pharmacokinetics of rifampicin between tuberculosis Patients with types 2 diabetes mellitus and tuberculosis patients without type 2 diabetes mellitus Tuberculosis is a major cause of illness worldwide. Diabetes mellitus (DM) acts as a risk factor for tuberculosis. With the convergence of the TB and DM epidemics, co-affliction with the two diseases is on the rise. The main objective of the present study was to compare the pharmacokinetic of rifampicin in tuberculosis patients with or without type 2 diabetes mellitus. A total of 18 tuberculosis patients – 9 having DM and 9 without DM were recruited for the socio-demographic study and pharmacokinetic. Methodology involved determination of social demographic factors and secondly pharmacokinetic analysis on key drug of anti-TB treatment – rifampicin among tuberculosis patients with or without diabetes mellitus. Pharmacokinetic study showed that the tuberculosis patients with DM had significantly lower area under curve (12.2585 ± 7.6103 µg/mL,h) and mean C max (2.6350 ± 0.9245 µg/mL) compared to those of TB patients without DM (26.4407 ± 11.8237 µg/mL respectively). Other parameters were not significantly different in both groups. It was concluded that four regimes currently used for treatment of tuberculosis guided by WHO are safe and effective. Determination of the pharmacokinetic of rifampicin was to support the appropriateness of the regime, or to detect the drug level to correlate with the efficacy, safety or the treatment failure. This study also highlighted that integrated approach is needed for effective control and efficient treatment for TB with DM to overcome the possible treatment failure and drug resistance.

2. ENVIRONMENTAL HEALTH

2.1 PHARMACO-EPIDEMIOLOGY OF POISONING 2.1.1 Monitoring of poisoning cases at New Yangon General Hospital (2013) Epidemiological studies on poisoning were done with the aim to increase the awareness, understand the potential public health impact, establish causal links between exposure and disease and preparedness of laboratory diagnostic methods and clinical management schemes. Registry from the Department of Hospital Records and Poison Treatment Center, New Yangon General Hospital, diagnosed and treated as poison cases, categorized under ICD-10, T36 to T65, basic codes 284 and 285 were collected and analyzed. Out of a total of 7727 admissions in the year 2013, 820 cases (11%) were identified as poisoning which is (37%) higher than the last two years. Acute poisoning is mainly seen in the young adults (18-25 years) 371(45%) followed by (26-40 years) age group 217(26%), both of which were working age group and it is the same trend for 3 consecutive years. The same as in the last two years there is more prevalent in females 520(63.4%) than in males 300(36.6%). This year 570(70%) of the patients were discharged from the hospital with less than 3 days of hospital stay and 213(26%) has to stay in hospital for 4-7 days whereas only 17% patients had to stay in hospital for that long in 2011 and 2012. Although most patients 721(87.9%) recovered and were discharged without undue consequences, 26(3.2%) expired in spite of treatment. Although there was increased in number of expired cases where only 16 and 18 cases expired in 2011 and 2012, respectively, the percentage of expired case is the same (3%). Main causes of poison mortality were seen with insecticide poisoning 14(54%). The trend of poisoning cases was shown in the table below.

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2011 2012 2013 Total Admission to NYGH 6120 6736 7727 Tot al Admission to Poison Treatment Centre 511 597 820 Drug Poison Analgesic (Paracetamol, Aspirin) 60 70 93 Antihistamine (Chlorpheneramine maleate, Citrizine) 93 96 147 CNS drug (Diazepam, Trypta, Artane) 67 117 61 Traditional Medicine 11 13 10 Unknown 37 46 96 Others (Antibiotics, Antihypertensive) 48 16 17 Chemical Poison Pesticide 50 37 94 Rodenticide 33 26 85 Other Chemical 99 145 Corrosive 22 Alcohol derivative 51 Petroleum derivative 11 Household Chemical 47 Gas 8

2.2 ENVIRONMENTAL TOXICOLOGY 2.2.1 Determination of pesticide residues in Brassica oleracea (Cauliflower) and Brassica italica (Broccoli) by advanced methods Pesticides are chemicals used in agriculture to protect crops against destructive pests and thereby increase food supply. There are many different pesticide classes but the major ones are Organochlorine, Organophosphate and Pyrethroids which are used in Myanmar for agricultural purposes. Use of pesticides in agriculture often leads to residues of these chemicals in foods and thereby posing hazards to human health. The aim of the study was to assess the desirable safety waiting period between the last application of pesticides and release of the broccoli to the consumer and to determine pesticide residues in brassica vegetables (cauliflower and broccoli) from market samples, so as to inform and educate consumers and farmers. Laboratory based analytical study involved firstly, field broccoli samples ( Brassica italica ) from Hlegu agricultural university were sprayed by using chlorpyrifos 40% EC (emulsifiable concentrate) and samples were collected from treated and untreated plots at specified intervals (0, 5, 9, 15, 23) days. Collected samples were extracted by using Association of analytical chemistry liquid-liquid extraction method. And then qualitative and quantitative determination of chlorpyrifos from these field samples (20 samples) was done by GC with Flame photometric detector. Secondly, the rate of breakdown of chlorpyrifos pesticide in the plant foliage was also determined by half-life. Stability of extract samples were analyzed by GC-MS after storage at -20°C and room temperature (25°C). Finally, cauliflower and broccoli samples from local markets (10 samples) were analyzed for pesticide levels by GC-FPD, GC-MS and FTIR. The average initial deposit of 14.12 mg/kg was observed after last application of chlorpyrifos at the recommended dosage of 35 cc /gallon. The residue in broccoli dissipated below its MRL value after 7 days. The half- life period of chlorpyrifos in broccoli foliage was observed to be 2.4 days. The decrease of 50% concentration was observed at -20°C after 2 weeks for chlorpyrifos in broccoli extracts. And then degradation of chlorpyrifos was noticed after 28 days at 27°C. Cauliflower and broccoli samples purchased from three different markets in Yangon region were analyzed for

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Annual Report 2013 residue of organophosphate pesticides. Among market samples, three samples contained Organophosphate pesticide residues seems to be chlorpyrifos in qualitative analysis by GC- MS. For quantitative analysis by SIM mode of GC-MS, one sample was found to be contaminated with chlorpyrifos residue about1.2 ppm. Maximum residue limit of chlorpyrifos on broccoli is 2 ppm adopted by Codex. Therefore, all detectable samples were acceptable limit and safe for consumers. In this study, the findings informed us that amount of chlorpyrifos residue was dissipated below Maximum residue limit by volatilization after ~7 days of application. Market samples were observed to be treated with pesticides and pesticide levels may be decline below legal limits by the time food reaches to consumers. But, market samples still needed to analyze over the country.

3. OTHERS 3.1 CLINICAL PHARMACOLOGY 3.1.1 Improvement of patient safety through adverse drug reaction (ADR) monitoring among general practitioners (GP) in Yangon Region. Adverse reactions to drugs are very common in everyday medical practice accounting for 2-6% of all hospital admissions. About half the cases of drug-related injury are from the potentially avoidable adverse drug reactions. Present study targeted the general practitioners as they play a major role in health care system since a large proportion of population prefer going to General Practitioners than hospitals for minor ailments. The two days training course on ADR, ADR reporting system and ADR report forms was held on 17 th and 18 th of March 2013. The knowledge of the participants in relation to ADR and ADR reporting system was assessed with self-administered questionnaires. The results showed improvement of their knowledge after the training course with the score (18-61) to (35-91). After training course, ADR report forms were distributed to the participants that can be used to report ADR they encounter during their practice following 6 months. During these 6 months, the investigators visited at least 3 times to each participant for collection of ADR reports and follow-up assessment. 48% (12/25) of the participants claimed that there was no ADR during 6 months period. Thirty-nine reports were received from the rest 52% (13/25). The reports were analyzed using Naranjo’s algorithm. As there is no reintroducing or re-challenging of the suspected drug and no qualitative and quantitative analysis of the suspected drug in biological fluid were done, all of them turned out to be possible adverse drug reactions as they score only 3-4 points. 46% (18/39) of reported ADR were due to antibiotics and 23% (9/39) were due to analgesics. Most of the ADR were relieved by stopping the treatment with symptomatic treatment where 15% (6/39) cases required hospitalization due to Steven- Johnson syndrome, malena and drug induced hepatitis. There were 5 incidents of hypoglycemia like symptoms following intramuscular injection of diclofenac sodium, which was frequently used by almost all general practitioners. It is relieved by glucose drink or glucose infusion but blood sugar level was not checked. Most of the participants first misunderstood as only the drug allergies are ADR. Some of the non-responder in this study actually experienced some minor side effects in their practice during study period, but they did not report them as they are not drug allergy. Some of the participants thought minor and known side effects are not serious enough to report as ADR. They all agree that there should be a proper system for them to report the ADRs and they all want information about common adverse drug reactions distributed to them regularly.

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3.1.2 Pharmacokinetics study of Cefuroxime axetil in Myanmar Healthy Volunteer and patients with lower respiratory tract infection. Antibiotics are commonly prescribed in respiratory tract infections. In many instance, pharmacokinetics of a drug in actual clinical situation (e.g., disease state) are different from that seen in healthy volunteers. Cefuroxime axetil is used in lower respiratory tract infection as empirical therapy but pharmacokinetic data of this drug have not been established yet in Myanmar. The aim of this study was to determine the pharmacokinetic parameters of oral cefuroxime axetil in Myanmar people and patients with lower respiratory tract infection by hospital based comparative analytical study. Comparison of pharmacokinetic parameters between healthy volunteers and patients were done to understand whether pharmacokinetics of cefuroxime axetil would alter in disease states or not and does it achieve target therapeutic concentration. In this study, a total of 20 subjects, (10 healthy volunteers and 10 patients) with confirmed cases of lower respiratory tract infection were participated. Among these ten patients, two cases were community acquired pneumonia and eight cases were acute exacerbation of chronic obstructive pulmonary disease. Patients were recruited from Defence Services General Hospital (1/1000), Mingaladone. Blood sample were collected from healthy volunteers and patients at times 0, 0.5, 1, 1.5, 2, 3, 5 and 8 hr after taking 250 mg of cefuroxime axetil tablet (Zinnat 250 mg tablet) immediately after same calories of breakfast. Cefuroxime concentration in serum samples was analyzed by fluorescence spectrophotometer. Mean C max of healthy volunteers and patients were 4.76 ± 0.71 µg/mL and (5.09 ± 0.72 µg/mL), respectively and not statistically significant different (p = 0.32). Mean T max were 2.10 ± 0.52 hr in healthy volunteers and 1.95 ± 0.60 hr in patients, which were not statistically significant different (p = 0.56). Mean T1/2a and kab of healthy volunteers were 1.43 ± 0.37 hr and 0.52 ± 0.14 hr 1while patients were 1.28 ± 0.32 hr and 0.57 ± 0.12 hr -1, respectively. Therefore mean T 1/2a and k ab were also not significant different (p = 0.35 and 0.4). In this study, pharmacokinetic parameter between healthy volunteer and patients was not different.

3.1.3 Evaluation of pharmacokinetics and pharmacodynamics of levofloxacin in patients with acute exacerbation of chronic obstruction pulmonary disease Certain antimicrobial therapy should target not only clinical success but prevention of resistance in future. In modern antimicrobial therapy, in addition to a measure of the potency of the drug for the pathogen (MIC), a measure of drug exposure of the individual patient (pharmacokinetic data) becomes essential component in rational dosage regime. The aim of the study was to assess the efficacy or pharmacokinetic/ pharmcodynamic (PK/PD) adequacy of levofloxacin in the treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Hospital-based analytical study was done in 20 patients with AECOPD admitted to 3 major teaching hospitals. Serial blood collection was done to determine pharmacokinetic of oral and intravenous infusion levofloxacin in these patients. Culture and sensitivity of infecting pathogens was done and PK/PD indices were calculated by integrating pharmacokinetic data with microbiological data. Pharmacokinetic parameters were not significantly different between different routes indication interchangeability of the route of administration of levofloxacin. Pathogens isolated were Klebsiella sp. (20%), Escherichia coil (10%), Haemophilus influenza (10%), Staphylococcus aureus (5%), Streptococcus pneumoniae (5%) and Pseudomonas sp. (5%). Although the resulted PK/PD indices were found to be low to achieve the targeted PK/PD values (Cmax/MIC of ≥8-10 and AUC/MIC of ≥87) in most patients, 90% (18-20) achieved clinical cure. The results indicated that although patients got clinical cure, microbiological eradication was uncertain and risk of emergence of resistance was high. This study highlighted the need of efficacy indices for

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3.1.4 Comparison of pharmaceutical quality and bioavailability of newly formulated cetirizine oral liquid preparation with a market sample Allergies are escalating to epidemic proportion and becoming more severe and complex, and the heaviest burden is on children and young adults. Allergy interacts with many other environmental factors such as pollutants, infections, lifestyle and diet that increase the impact on chronic disease. Antihistamines play a critical role to control this condition. Among those antihistamines, cetirizine is one of the effective drugs in the treatment of allergy and liquid preparation is most suitable for paediatric. Therefore, it is necessary to manufacture the oral liquid preparation of cetirizine locally and it may be comparable with imported one. In present study, three formulations of cetirizine paediatric oral solution (F1, F2, F3) containing cetirizine 5 mg/5 mL were prepared. The quality of cetirizine powder and excipients were analysed before formulation. The quality (wt/mL, pH, assay content) of three formulations of cetirizine paediatric solution were compared with market sample (Trizin) and cetirizine content in the preparations were determined by UV-Vis spectrophotometric method. All the results of active pharmaceutical ingredient (API) and finished products (solution) were complied with BP specifications. The accelerated stability testing of three formulations and market sample (Trizin) were carried out as variable temperatures 40°C, 50°C and 60°C with 75% relative humidity. The shelf-life estimation was also predicted by using Arrhenius equation. It was observed that shelf-life of this newly formulated cetirizine paediatric solutions (F1, F2 and F3) and market sample were 2.2, 2.7, 2.1 and 2 years, respectively. Antimicrobial contamination test for F1, F2, F3 and market sample was also carried out by direct inoculation method. All preparations were satisfactory with the criteria of acceptance. After optimization of the pharmaceutical quality, comparison of bioavailability were made for two formulation, F2 (most stable formulation) and market sample (Trizin). The pharmacokinetic parameters of two formulations were experimented with seven healthy volunteers of both sex. The study was based on the assessment of serum drug concentration in relation with time. For the quantitation of two formulations in serum, mean C max , T max , AUC (0-last) of F2 and M (Trizin) were (162.17 ± 12.20 ng/mL and 155.99 ± 14.21 ng/mL), (0.5 hr) and (122.1168 ± 10.95 ng/mL.hr and 123.6989 ± 15.82 ng/mL.hr) respectively. Although pharmacokinetics data of the two preparations showed slight difference but not statistically significant. Estimated costs for formulated cetirizine oral solution (5 mg/ 5 mL) containing 60 mL in amber glass bottle was 200 kyats. That was less expensive than market sample, Trizin (600 kyats). Thus, the study provided a more stable formulation of cetirizine oral solution (F2) which was more economical than imported preparations.

3.2 ANALYTICAL PHARMACOLOGY 3.2.1 Pharmaceutical equivalence and quality assurance of different types of quinolone antimicrobial available in Myanmar Antibiotics are the most frequently prescribed medications in modern medicine. Along with increase usage, antimicrobial resistance has become a serious problem that strikes at the core of infectious disease control and has been recognized as an emerging public health problem having serious implications. Drug identification and quantification is a major area of activity of the Pharmaceutical Toxicology Research Division. Quinolone antibiotics such as ciprofloxacin, norfloxacin, levofloxacin and ofloxacin have been widely used in Myanmar, both in hospitals and in general practice. A laboratory based study of (47) antimicrobials,

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Annual Report 2013 different brands of quinolones, including ciprofloxacin(18), norfloxacin(16), levofloxacin(8) and ofloxacin (5) brands were done. They were purchased by mystery clients from New Bogyoke market and Shwe Pyae Sone market in Yangon. All were coded and standard quality assurance tests were done according to USP (United States Pharmacopeia) & BP (British Pharmacopeia). Results indicated pharmaceutical equivalence in uniformity of weight and disintegration in all brands of levofloxacin, ofloxacin and ciprofloxacin are satisfactory and only 7 brands of norfloxacin (12.5%) failed. Regarding dissolution results all brands of levofloxacin, norfloxacin and ofloxacin are satisfactory and only 1 brand of ciprofloxacin (5.5%) failed. Fourier Transform Infra-red spectrum (FTIR) results in all brands of levofloxacin and ofloxacin are satisfactory but 2 brands of ciprofloxacin (11.1%) and 3 brands of norfloxacin (18.8%) were unsatisfactory. Quantitative analysis in assay of contents showed 7 brands of norfloxacin (43.75%), 5 brands of Ciprofloxacin (27.7%), 3 brands of levofloxacin (37.5%) and 1brand of ofloxacin (20%) failed. The finding indicated the existence of substandard drugs in markets and it was likely to be due to incomplete packaging, improper transport and storage conditions such as temperature and humidity. The results of this study will provide valuable data on the quality assurance of quinolone antibiotics, frequently and widely used in Myanmar, and may help in prevention of emergence of drug resistance.

3.3 EXPERIMENTAL TOXICOLOGY 3.3.1 Toxicological study of ( wyifwdkifjreef; ) Vitis repens plant reputed for anticancer activity Toxicological study is the study of harmful actions of chemicals (there may be various chemicals or drugs) on living organisms. To know the harmful effect of a new chemical or compound, toxicity tests must be done. The principle purpose for conducting toxicity tests on animals is to evaluate the nature and degree of harmful effects and the quantities of chemicals or compound necessary to produce such effects. Two indigenous species of Vitis locally known as ( wyifwdkifjreef; ) are growing wild in Shan State, especially in Kalaw and Mogoke. These two species identified as Vitis repens (Waighy & Arn., 1834) and Vitis discolour (Dalziel., 1830) are belong to Vitis Genus and Vitaceae Family of Vitales Order. Vitis species have long been reputed in treating various forms of cancer for several hundred years in Myanmar culture and Myanmar Traditional Medicine Practitioners. There is no scientific report of toxicity studies of rhizome extract of V. repens species. Therefore, the present study was to investigate acute and subacute toxicities of alcoholic extract of rhizome of V. repens for support of the safety use in people. Acute and subacute toxicities of alcoholic extract of V. repens rhizome were done on in vivo mice and rat model according to OECD guidelines. In the acute toxicity study, there was no lethality with 300 mg/kg dose but all mice were found dead with 2000 mg/kg dose. According to OECD guideline, its LD50 cut- off value is 500 mg/kg. In repeated dose study for 90 days, concerning the haematological and biochemical parameters, there were no significant changes in haematological parameters and biochemical parameters between the groups of rats given with 250 mg/kg, 150 mg/kg and 100 mg/kg dose of ethanolic extract of vitis repens rhizome and the control group. The histopathological studies of tissue samples taken from selected organs of the rats treated with rhizome extract and the control group of rats showed no pathological lesions. The results indicated that the oral administration of the ethanolic extract of rhizome of vitis repens to the rats daily for 90 days showed no toxic effects to internal organs of rats.

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SERVICES PROVIDED ACADEMIC Sr. Name Course Responsibility No. 1. Dr. Khin Chit Post -graduate students (MMedSc, Examiner/ Supervisor/ MPharm and PhD) Co-supervisor / Teaching 1st year MMedSc (Pharmacology) Teaching, Training 1st year MPharm Teaching, Training 1st year MMedSc (Forensic) Teaching 1st year MMed Tech Teaching 4th year BPharm (University of Teaching Pharmacy) 2. Dr. Min Wun 1st year MMedSc (Pharmacology) Teaching, Training 1st year MPharm 3. Dr. Khin Hnin Pwint 1st year MMedSc (Pharmacology) Teaching, Training 1st year MPharm 4. Dr. Nyi Nyi Win 1st year MMedSc (Pharmacology) Teaching, Training 1st year MPharm 5. Daw Moe Moe Aye 1st year MMedSc (Pharmacology) Teaching, Training 1st year MPharm

LABORATORY 2.1. Screening and analysis of drugs and other poisons from biological and non-biological samples in acute poisoning Respond to 420 requests on screening and analysis of drug and poison has been provided to hospitals including unknown poisoning 219 (52%) and drug analysis 201(48%). Requests for screening and identification were mainly from the Poison Treatment Centre, NYGH (77%), Medical Wards, YGH (10%), Yangon Children’s Hospital (8%) and others include No. 2 Military Hospital, North Okkalapa Hospital and Thingangyun Sanpya Hospital (5%).

INFORMATION SERVICES Information and advice were given to general hospitals, 24 hours a day, 7 days a week, under direct supervision of Deputy Director/Head of Division. Respond to 330 requests on drug and poison information has been provided to the public, hospitals and the media and includes drug poisoning (57.6%), pesticide poisoning (27%) and others (15.4%).

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PHARMACOLOGY RESEARCH DIVISION

Deputy Director & Head ... Dr. May Aye Than MBBS (IM 1), MMedSc(Pharmacology) (IM 2) Research Scientist ... Dr. Khine Khine Lwin MBBS(IM 1), MMedSc(Pharmacology) (IMM) ... Daw Mu Mu Sein Myint BSc, MSc(Zoology) (YU) Research Officer ... Dr . Khin Tar Yar Myint MSc, MRes (MU) , PhD(Chemistry) (YU) ... Dr.Ohnmar Kyaw MBBS(UM 1) ... Daw Win Win Maw BSc(Physics) (YU) ... Dr. Zaw Myo Tint MBBS(UM 2) Research Assistant (2) ... Daw Mar Mar Myint BA(Geography) (UDE) ... Daw Myint Myint Khine ... Daw Phyu Phyu Win BSc(Botany) (WC) ... Daw San San Myint BA(Myanmar) (UDE) Research Assistant (3) ... Daw Nu Nu Win BSc MSc(Botany) (DU) ... Daw Ei Ei Soe BSc(Zoology) (EYU) Research Assistant (4) ... Daw Mi Aye Aye Mon BSc MSc(Botany) (DU) ... Daw Mie Mie Thaw BA(Geography)(UDE)

The research activities of the division mainly involve traditional and herbal medicine research. Research concerning traditional medicines includes study in basic research and clinical research on medicinal plants. Both basic research such as botanical identification, phytochemical investigation, experimental pharmacology and toxicity test on selected medicinal plants as well as clinical research including clinical trial are conducted to test the therapeutic potential of reputed medicinal plants. Additional activities include toxicological, physico-chemical, phytochemical and pharmacological assessment of locally available traditional medicines.

RESEARCH PROJECTS/ SERVICES PROVIDED 1. COMMUNICABLE DISEASES 1.1 MALARIA 1.1.1 In vitro anti-malarial activity of ethanol fraction of Ocimum sanctum Linn. leaf on Plasmodium falciparum The aim of this study was to evaluate the in vitro anti-malarial activity of ethanol fraction of Ocimum sanctum Linn. leaf. The protocol and ethical reviews were completed. O. sanctum leaves were collected from Kan Daw Gyi Medicinal Plant Garden and were air- dried. Ethanol fraction of dried leaves was in the process of preparation. In vitro anti-malarial activity of ethanol fraction of O. sanctum leaves were carried out after the preparation of ethanol fraction.

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1.2 DIARRHOEA 1.2.1 Anti-diarrhoeal effect of some medicinal plants on animal model The antidiarrhoeal effect of Ocimum gratissimum Linn.(Taw-pinsein) on experimental animals The aim of this study was to investigate scientifically the antidiarrhoeal effect of leaves of Ocimum gratissimum Linn. on castor oil induced diarrhea in mice model. The dried powder of leaves of Ocimum gratissimum Linn. was extracted with distilled water. The phytochemical analysis showed that flavonoids, polyphenol, glycoside, carbohydrate, steroid, saponin, tannin, reducing sugar were detected but amino acid, cyanogenic glycosides and alkaloids were not detected in dried leaves of Ocimum gratissimum Linn.. In acute toxicity study, according to OECD Guideline 420, there was no lethality of the mice with maximum permissible dose 5 g/kg body weight of the aqueous extract. Therefore, the medium lethal dose LD 50 was expected to be more than 5 gm/kg body weight. Anti-diarrhoeal effect was determined according to castor oil induced diarrhoel test, castor oil induced enteropooling test and castor oil induced small intestinal transit test. In in vivo experiment, dose dependent decreases in frequency (p<0.05-p<0.00005) and intestinal transit (p<0.0005-p<0.0001) showed antimotility action. Dose dependent decrease in weight and volume of intestinal content [(p<0.0005-p<0.000005) and (p<0.005-p<0.00001)] showed anti-secretary action at the doses of 1 gm/kg body weight, 2 gm/kg body weight and 4 gm/kg body weight. The ED 50 of the extract with its confidence limit was 1.4 g/kg (0.7035-2.786) g/kg. In i n vitro experiment on isolated rabbit intestine was done to find out the possible mechanism of action of aqueous extract of leaves of Ocimum gratissimum Linn. There was no direct smooth muscle relaxation on isolated rabbit intestine. But the extract 450 µg/ml totally blocked acetycholine and histamine induced contraction. So, Ocimum gratissimum Linn. had non-specific anti-diarrhoeal action. These findings suggested that aqueous extract of leaves of Ocimum gratissimum Linn. possessed anti-diarrhoeal effect in castor oil induced diarrhoeal mice model.

2. NON-COMMUNICABLE DISEASES 2.1 HYPERTENSION 2.1.1 Phase I Clinical study of antihypertensive effect of Allium sativum Linn (MuufoGefNzL ) bulbs on Stage I hypertensive patients This study was to determine the antihypertensive effect of dried bulb powder tablets of Allium sativum Linn. (Garlic) on Stage 1 hypertensive patients attending the Outpatient Department of Traditional Medicine Hospital, Yangon. Ethical approval for this study was obtained from DMR (Lower Myanmar).Garlic bulbs were collected from the market in Yangon. The bulbs were air-dried under shade. Then, the air-dried bulbs were made into powder by using grinding machine and the dried bulb powder was made into tablets of 400 mg each. Phytochemical studies of the dried bulb powder tablet showed the presence of alkaloids, flavonoids, polyphenol, glycosides, steroids, terpene, saponins, tannins, resin and amino acid. Cyanogenic glycoside was not detected. Stage 1 hypertensive patients are selected according to the criteria sets. At present, 4 Stage 1 hypertensive patients (with the blood pressure of 140/90 mmHg) were selected. Any previous antihypertensive therapy was stopped and wash out period for (3) days was done before entry into the trial study. On the first day of the trial study, blood pressures were measured before giving the trial drug. Then, the trial drug (dried garlic bulb powder tablet) (400 mg) single dose were given orally to the patients and the blood pressures were monitored at 30 min and hourly up to 6 hours after taking the trial drug. Vital signs such as heart rate, pulse rate, respiratory rate were also

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Annual Report 2013 monitored. There were no changes of blood pressure from baseline levels. So, on the second day, the trial drug, 800 mg single dose was given to the patients. Reductions of blood pressure from baseline levels were found. Therefore, the dose of the trial drug (800 mg) was chosen for the clinical study up to 4 weeks. These patients were given the trial drug 800 mg two times per day daily for 4 weeks. Follow up was done weekly up to 4 weeks. Side effects were monitored on each patient follow-up. Investigations of biochemical and hematological parameters (blood for complete picture, random blood sugar, Liver Function Test, Renal Function Test) were done before and at the end of the study. At present, 3 out of 4 patients completed in this study. It was found that the reduction of the mean supine blood pressure from baseline level was from 1 hr to 3 hr after the first dose of the trial drug. At the end of the trial, the reductions in the mean supine systolic and diastolic blood pressures were found from 140 mmHg (baseline) to 130 mmHg and 93.33 mmHg (base line) to 80 mmHg respectively. The results of laboratory investigations were within the reference normal ranges. No side effects were observed.

2.2 DIABETES MELLITUS 2.2.1. Antihyperglycemic activity of 70 % ethanolic extract of Danyin thee ( 'nif;oD;) on animal model The aim of this study was to determine the antihyperglycemic effect of 70% ethanolic extract of seeds of Danyin. The 70% ethanol extract was extracted from the air-dried seeds. Acute toxicity test of 70% ethanol extract of dried seeds were done in mice according to Litchfield and Wilcoxon method. No toxic effect was found at the maximum permissible dose 16 gm/kg body weight. Therefore the median lethal dose (LD 50 ) of 70% ethanol extract was more than 16 gm/kg. The antihyperglycemic effect of 70% ethanol extract at the doses of (1.5, 3 and 6 gm/kg body weight) was determined on adrenaline-induced hyperglycemic rat model. The mean blood glucose levels of the control rats were 181.0 ± 11.29 mg% at 1 hr, 231.17 ± 9.36 mg% at 2 hr, 242.0 ± 11.39 mg% at 3 hr and 244.5 ± 8.57 mg% at 4 hr. The mean blood glucose levels of test extract (1.5 g/kg body weight) were 203.67 ± 6.32 mg% at 1 hr, 227.0 ± 8.86 mg% at 2 hr, 224.17 ± 11.2 mg% at 3 hr and 206.0 ± 8.57 mg% at 4 hr after oral administration. It was found that 1.5 gm/kg body weight showed significant lowering the blood glucose level at 4 hr (p<0.05). The mean blood glucose levels of test extract (3 gm/kg body weight) were 186.67 ± 8.86 mg% at 1 hr, 217.17 ± 9.49 mg% at 2 hr, 194.5 ± 9.66 mg% at 3 hr and 176.83 ± 6.32 mg% at 4 hr after oral administration. It was found that 3 gm/kg body weight showed significant lowering the blood glucose level at 3 hr (p<0.005) and 4 hr (p<0.005). The mean blood glucose levels of test extract (6 gm/kg body weight) were 225.67 ± 9.36 mg% at 1 hr, 242.17 ± 10.59 mg% at 2 hr, 208.5 ± 11.69 mg% at 3 hr and 159.17 ± 9.75 mg% at 4 hr after oral administration. It was found that 6 gm/kg body weight showed the significant lowering effect on the blood glucose level at 1 hr (p<0.05), 3 hr (p<0.005) and 4 hr (p<0.0005), respectively. Thus, it was concluded that the 70% ethanolic extract of seeds of Pithecellobium bigeminum Benth. (Danyin) possess antihyperglycemic activity on adrenaline-induced hyperglycemic albino rats.

3. TRADITIONAL MEDICINE 3.1 ANTIOXIDANTS 3.1.1 Antioxidant activity of Centella asiatica Linn. ( jrif;cGm ) leaves The aim of this study was to determine the antioxidant activity of aqueous and ethanolic extract of Centella asiatica Linn. ( jrif;cGm ) leaves. Antioxidant activity of extracts of

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Annual Report 2013 the leaves of Centella asiatica Linn. were studied using free radical scavenging activity by DPPH (1,1-diphenyl-2-picryl-hydrazl) assay. The aqueous, ethanolic extract and standard ascorbic acid were tested. The percentage inhibition of free radical formation of ascorbic acid, aqueous extract and ethanolic extract at 0.5, 1, 2, 3, 4 ug/ml were (54.27%, 57.69%, 67.52%, 74.36%, 84.62%), (52.14%, 55.56%, 56.41%, 57.26%, 58.97%) and (52.27%, 55.56%, 58.12%, 59.4%, 74.36%), respectively. The IC 50 (50% Inhibitory concentration) of ascorbic acid, aqueous and ethanolic extract were 0.022 µg/ml, 0.049 µg/ml, 0.013 µg/ml respectively. Therefore, it was concluded that the aqueous and ethanolic extract of the leaves of Centella asiatica Linn. (jrif;cGm) possessed antioxidant activity but less effective than standard ascorbic acid.

3.1.2 Antioxidant activity, total phenol content and ascorbic acid content of three different preparations of noni fruit juice (&J,dk) Noni ( Morinda citrifolia L.) is among the traditional medicinal plants used as remedies in Myanmar. Nowadays, noni manufacturers produce various form of noni fruit juice from ripe noni fruits as dietary supplements and herbal drug in market. These studies were determined to evaluate the in vitro antioxidant activity, total phenol content, ascorbic acid content and acute toxicity test of three different preparations of noni fruit juices: fresh expressed juice (EJ), fermented juice (FJ) and boiled juice (BJ). Three different preparation of noni fruit juices 4 ug/ml possess antioxidant activity and results of percent inhibition were 83.8 % (EJ), 72.3% (FJ) and 66.04% (BJ), respectively compare with standard ascorbic acid by DPPH method using UV spectrophotometer (UV-1601). The total phenol content and ascorbic acid content in three types of noni fruit juices were determined by spectrophotometer (UV-1601). Expressed juice possessed highest amount of total phenol content and ascorbic acid content 4.1 ± 0.1 (mg/ml quercetin equavalent) and 1.12 ± 0.1(mg/ml ascorbic acid equivalent). Boiled juice have lowest amount of total phenol content and ascorbic acid content 2.23 ± 0.2 (mg/ml) and 0.48 ± 0.1 (mg/ml) . During fermentation process of fermented juice there was 32.5% decrease in total phenol content, 31.3% decrease in ascorbic acid content and antioxidant activity decrease by 13.7% when compared with expressed juice. In boiled juice, there was 45.6% and 57.1% decrease in total phenol concentration and ascorbic acid concentration and antioxidant activity decrease by 21.3% when compare with expressed juice. Fresh expressed juice of noni fruit contains high amounts of total phenol and ascorbic acid content with strong antioxidant activity. Three different preparation of noni fruit juice showed no lethal effect when tested for acute toxicity with the maximum dose of 67 ml/kg body weight on mice model. The reduction of antioxidant activity of fermented juice and boiled juice was due to lower content of total phenol and ascorbic acid content. The lowering of these contents was due to the effect of temperature and sunlight during the processing method of fruit juice. For maintenance of the substantial antioxidant properties of noni fruit, fresh expressed juice rather than fermented juice and boiled juice is recommended.

3.2 HEPATOPROTECTIVE

3.2.1 Hepatoprotective effect of Amaranthus spinosus ([if;EkEG,fql;ayguf) against CCl 4 induced hepatotoxicity in albino rats The purpose of this study was to find out scientifically on the hepatoprotective effect of whole plant of Amaranthus spinous Linn. (Hin-nu-nwe-subauk) on carbontetrachloride- induced hepatotoxicity in albino rat model. The phytochemical analysis of Amaraanthus spinosus Linn. showed the presence of steroid and terpenes, flavonoids, polyphenol, tannins,

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Annual Report 2013 sapnins, amino acids, glycosides, reducing sugar and carbohydrate. Physicochemical analysis of whole plants of Amaranthus spinosus Linn. showed swelling index (0.7cm), foaming index (<100) and moisture content (9.0%). Extract values were watery extract (7.6%), ethanolic extract (2.6%), chloroform extract (0.9%) and pet-ether extract (0.05%). In acute toxicity study, there was no lethality of the mice up to 16g/kg body weight of 70% ethalonic extract of whole plants of Amaranthus spinosus Linn. according to Litchfield and Wilcoxons method. The hepatoprotective effect of 70% ethanolic extract of whole plants of Amaranthus spinosus Linn. was investigated on carbon tetrachloride-induced hepatotoxicity in albino rats. Thirty-six albino rats of both sexes were divided into six groups (each group contaning six rats). Group I served as normal control group which received distilled water only up to 14 th day. Group II kept as positive control group which received distilled water followed by single th dose of 1 mL/kg body weight of CCl 4 orally on 12 day. Group III, Group IV and Group V were tested groups received 1 g/kg, 2 g/kg and 4 g/kg body weight of extract of whole plants of Amaranthus spinosus Linn., respectively for 14 days and then followed by single does of th CCl 4 1 ml/kg body weight on 12 day of experiment. Group VI received silymarin 25 mg/kg th th body weight for up to 14 day followed by single dose of CCl 4 1 mL/kg body weight on 12 th days. After 48 hours of CCl 4 administration (14 day of experiment) blood sample of all animals were collected from cardiac puncture for liver function tests. The liver samples were also excised from all sacrificed animals for histopathological examination. Mean ALT and AST values were significantly increased in group II (distilled water followed by CCL 4), (ALT 722 ± 187.38 IU/L and AST 660.67 ± 151.79 IU/L) when compared with group I (distilled water only received group), (ALT 81.7 ± 18.32 IU/L and AST 148.73 ± 43.79 IU/L). The mean ALT value of group IV (extract 2g/kg followed by CCl 4) was 303.23 ± 168.21 IU/L and the mean ALT and AST values of group V (extract 4g/kg followed by CCl 4), (ALT 225.32 ± 96.33 IU/L and AST 310.5 ± 71.99 IU/L) showed significantly lower than group II. The mean ALT and AST values of group V were lower than group VI (silymarin 25 mg/kg followed by CCl 4), (ALT 303.83 ± 42.78 IU/L and AST 330.81 ± 80.81IU/L). Therefore, ethanolic extract of Amaranthus spinosus Linn. showed dose-related effect in hepato-protective activity. In histological examination, the control group (group I) showed the normal architecture. In group II, there were significantly increased in scoring of degeneration and necrosis in comparing with group I. The 70% ethanolic extract of whole plants of Amaranthus spinosus Linn.in the dose of 4 g/kg body weight showed significant decrease in degenerative and necrotic changes in comparing with group II. The results also showed that the hepatoprotective activity of 70% ethanolic extract of Amaranthus spinosus Linn. on histopathological changes is in dose-dependent relationship. Therefore, this study showed that 70% ethanolic extract of whole plants of Amaranthus spinosus Linn. have some extent of hepatoprotective effect according to liver enzyme levels and histopathological results.

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SERVICES PROVIDED ACADEMIC Sr. Responsibility Name Course No. 1. Dr. May Aye Than PhD (Botany), PhD ( Chemistry) Co -supervisor MMedSc (Pharmacology) & PhD (Physiology) M.MedSc(Pharmacology) External Examiner 2. Dr. May Aye Than 1st year MMedSc (Pharmacology) Teaching, training Dr. Khine Khine Lwin students from UM (1), UM (2), UMM, demonstration Daw Mu Mu Sein Myint Defence Services Academy and Dr. Khin Tar Yar Myint M Pharm, from University of Pharmacy, Military Institute of Nursing and Paramedical Sciences.

LITERATURE SEACRH 1. Literature search and compilation for achievements of Pharmacology Research Division for Golden Jubilee Publication (Golden Jubilee Commemorative Volume, 1963-2013) DMR (Lower Myanmar) 2. Literature search and compilation for upgrading and publication of Myanmar Traditional Medicine Formulary (1989) are being conducted.

INTERVIEW 1. Interview was done by Sky Net for the information on achievement of Pharmacology Research Division DMR (Lower Myanmar)

LABORATORY

Sr. Subject Tested samples No. 1. Determination of antioxidant activity of Citrus decumana Linn. 3 kinds of fruits (uRJaumoD;) , GUAVA fruits ( rmvumoD; ), Hylocereus fruit (e*g;armufoD;) by UV spectrophotometer (UV-1601) 2. Determination of organic compounds from Yangon University by 5 samples Fourier Transform Infra- Red spectrophotometer (FT-IR 8400) 3. Determination of protein concentration in Avian Antivenom by UV spectrophotometer (UV-1601) from Immunology Research Division DMR (LM)

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PHYSIOLOGY RESEARCH DIVISION

Deputy Director & Head … Dr. Saw Saw MBBS, PhD (Melbourne) Research Scientist … Dr. Moe Thida Kyaw MBBS(UM 1), MMedSc (Biochemistry) (UM 2) … Dr. Khin Mi Mi Lay MBBS (UM 1), MMedSc (Physiology) (UM 1) Research Officer … Dr. Kyaw Zeya MBBS (UM 1) … Dr. Wah Wah Swe MBBS (UM 2) … Dr. Nway Htike Maw MBBS (UM 2) … Daw Kyi Kyi Win Zaw BA (Myanmarsar) (University of Distance Education) Research Assistant (2) … Daw Sandar Win BA (Psychology) (University of Distance Education) … Daw Khin San Lwin BA (Psychology) (University of Distance Education) Daw Htike Htike Soe BSc (Botany) (Workers’ University, Yangon) Research Assistant (3) … Daw Htet Htet Lwin BA (Myanmarsar) (University of Distance Education) … Daw Yi Yi Mon BA (Myanmarsar) (University of Distance Education) … Daw Le' Le' Win Hlaing BA (Eco) (University of Distance Education) … Daw Phyo Phyo Wai BA (Eco) (University of Distance Education) Laboratory Attendant … Daw Kyi Kyi Htwe

The division has involved in research projects on sports physiology, non communicable diseases, academic and technology development. The division provides academic services such as teaching of undergraduate and post graduate students attending Universities of Medicine.

RESEARCH PROJECTS 1. NON-COMMUNICABLE DISEASES 1.1. SPORT PHYSIOLOGY 1.1.1. Effectiveness of aerobic and anaerobic component dominant sports discipline on ventilatory function of adolescent athletes To determine the effect of aerobic training and anaerobic training on ventilatory function of adolescent athletes, a Quasi-experimental study was conducted in (85) adolescent athletes from Institute of Sports and Physical Education, Yangon. A pre-assessment study was done and age, height, weight, FVC (Forced Vital Capacity), FEV 1 (Forced Expiratory Volume in 1 Second), FEV 1/FVC %, and PEFR (Peak Expiratory Flow Rate) were measured in (44) adolescent athletes from aerobic dominant sport disciplines (football, cycling, distance) and (41) adolescent athletes from anaerobic dominant sport disciplines (weight lifting, javelin, shot put, discus, sprint, high jump, long jump). Mean age, height and weight in athletes of aerobic dominant sport disciplines were (14.89±0.93) years, (163.20±4.87) cm,

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(51.38±5.16) kg and (15.31±0.95) years, (165.26±5.01) cm and (57.83±7.06) kg, respectively in athletes of anaerobic dominant sport disciplines. Mean FVC, FEV 1, FEV 1/FVC%, PEFR in aerobic and anaerobic athletes were (3.45±0.52) L, (3.09±0.38) L, (93.29±5.23)%, (6.37±1.23) L/sec and (3.49±0.71) L, (3.27±0.61) L, (93.75±5.36)% and (6.86±1.47) L/sec, respectively.

1.2. OBESITY 1.2.1. Relationship between serum and erythrocyte magnesium with insulin sensitivity and beta cell function in adult male The burden of diabetes is increasing globally, particularly in developing countries. Magnesium (Mg) has an important role in insulin action and insulin also stimulates magnesium uptake in insulin-sensitive tissues. A poor intracelllular magnesium concentration may result in a defective tyrosine-kinase activity at the insulin receptor level and exaggerated intracellular calcium concentration which inhibits insulin receptor dephosphorylation in adipocyte. Both events are responsible for the impairment in insulin action and worsening of insulin resistance. Insulin resistance is a key etiological factor for type 2 diabetes mellitus. Insulin resistance and diabetes are strongly associated with obesity as insulin sensitivity declined with increasing body mass index (BMI). The cross-sectional analytical study was explored among (103) male subjects between 18-60 years of age residing in North Okkalapa Township. Mean age, body mass index and waist circumference were (34.85 ±13.17) years, 2 (23.54 ±3.59) kg/m and (80.92 ±10.18) cm respectively. Serum and erythrocyte magnesium concentration were determined by using Calmagite method. Mean serum magnesium and erythrocyte magnesium level were (5.18 ±0.65)mg/dl and (1.64 ±0.22)mg/dl, respectively.

SERVICES PROVIDED ACADEMIC Sr. Name Course Responsibility No. 1. Dr. Moe Thida Kyaw Research Methodology Facilitator Workshop, DMR (LM) 2. Dr. Wah Wah Swe 1st year MMedSc (Physiology) Demonstration of Universities of Medicine Instruments UM(2) Demonstration and support of skin fold caliper 3. Daw Yi Yi Mon DSMA Demonstration and support of Handgrip Dynamometer

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QUALITY ASSURANCE DIVISION

Research Scientist& Head … Daw Khin Khin Aye BSc (Chemistry) ( RASU ), Dip. Statistics(YU) Research Assistant (3) … Daw Myo Myo Aye BSc(Chemistry) (DU) Research Assistant (4) … U Kyaw Kyaw Khaing BA(History) (YU) … Daw Nay Yee Tun BCom(YIEco) Laboratory Attendant … Daw Swe Swe Zin

The Division is responsible for research and quality assurance of vaccines, biological products and diagnostic test devices at each and every step of production processes and quality control testing to ensure that products are consistently produced and controlled to the quality standards. Under the Vaccine Research Centre, Quality Assurance Division is involved in quality management system of: production, in-process quality control, quality assurance and distribution of plasma-derived hepatitis B vaccine (DMR-HB vaccine). The small scale production of plasma-derived hepatitis B vaccine was carried out in collaboration with Technology Development Division and Quality Control Division under the Vaccine Research Centre.

RESEARCH PROJECTS 1. ACADEMIC AND TECHNOLOGY DEVELOPMENT 1.1 VIRAL HEPATITIS 1.1.1 Preliminary cultivation and fermentation of recombinant hepatitis B surface antigen expressed Hansenula polymorpha yeast cells in the locally prepared master cell bank (lyophilized form) Master Cell Bank (MCB) containing HBsAg expressed Hansenula polymorpha yeast cells were provided by CJ Pharmaceutical Corporation, Republic of Korea in 2003. In 2005, further MCB was locally prepared from original MCB by lyophilization process at the Hepatitis B Vaccine Plant, Department of Medical Research (Lower Myanmar). Previous study showed there were actively growing viable yeast cells at different stages of cell divisions with specific characteristics. These cells also showed an increase in growth during cultivation with normal pattern of growth curve and free from any contamination. Therefore, these locally prepared MCB (L-MCB) was found to be viable, stable and safe and thus being entitled for further processes of recombinant HB vaccine production. The aim of the present study was to develop the laboratory scale production of yeast-derived recombinant hepatitis B vaccine in near future. For achieving this aim, preliminary cultivation and fermentation was done on recombinant hepatitis B surface antigen expressed Hansenula polymorpha yeast cells in (L-MCB-2005 Batch, lyophilized form). Working cell banks (WCB) was prepared from cultivation of L-MCB.Cell cultivation was started from WCB. Cell cultivation on glucose (Phase 1) steps (seed 1, 2, 3) was performed in shaking flasks under non-optimized conditions. Leading produce to high cell biomass and increased antigen protein. It was found that colonial morphology of MCB and L-MCB showed similar characteristic of H. polymorpha yeast cells and pure growth were seen.

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2. OTHERS 2.1 Establishment of the Simple Extraction of Collagen from Some Fishes in Myanmar and Evaluation of Effectiveness in Wound Healing This study was carried out in collaboration with Department of Chemistry, Dagon University. Collagen is the major component of connective tissue found in the body. Collagen has a wide range of application in cosmetic, biomedical and pharmaceutical industrial fields. Fishery production in Myanmar is growing with a huge amount of by- product released. It can be used for collagen extraction. The aim of this study was to extract collagen from fish skins by using simple extraction method and investigate the some properties of the extracted fish collagen for the application. Collagen was extracted from the skin of Ngamyitchin (Labeo rohita ) and Ngaphe ( Notopterus notopterus ) by using common salt (NaCl). The yields of collagen for Ngamyitchin and Ngaphe were 7.65 and 6.45%, respectively. The effect of pH and salting out on the sample were determined. The maximum solubility of collagen of Ngamyitchin and Ngaphe was observed at pH 2 and 3, respectively. No changes in solubility were observed in the presence of NaCl up to 3% (w/v). However, a sharp decrease in solubility was found above 3% NaCl. Fourier transform infrared (FT IR) spectra of both samples showed the presence of N-H, O-H, C=O, -CH 2, and -CH 3 groups in the samples. FT IR spectra of the collagen sample from both fishes showed to coincide with typical protein spectra. In this study, in vivo study was carried out for the determination of wound healing in 24 Wistar rats. Wound was induced under anesthesia in every rat and treated with collagen 1 mg/kg dressing for 18 days. Histological results showed that extracted collagens from Ngamyitchin and Ngaphe were found to be effective in wound healing of skin lesion compared to that of Cicatrine powder.

SERVICES PROVIDED 1. VACCINE PRODUCTION 1.1 Production and in-process quality assessment of the DMR plasma- derived hepatitis B vaccine (2013) The laboratory scale production of plasma-derived hepatitis B vaccine was carried out in collaboration with Technology Development Division and Quality Control Division. During the year under report, 659 units of blood with HBsAg positivity were collected from various hospitals in Yangon areas and 26.8 liters of HBsAg positive plasma were separated and kept at -20 oC. Only seven times for formulation of purified bulk of lot no 02/10, followed by vialing, labeling and packaging were performed. All batches of vaccine passed the specifications of quality control tests recommended by WHO. To date, (8,110) 5 ml vials (81, 100 child doses) were produced and (5,789) 5 ml vials (57,890) child doses were provided to the Vaccine & Diagnostic Clinic, DMR (LM). The lot number of P 01/12 of HB vaccine, purification process was started in middle of November, 2012. The production site was renovated in April to September, 2013, and the purification processes of Lot no 01/12 were stopped. The processes were restarted in October, 2013and completed in middle of November 2013.

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QUALITY CONTROL DIVISION

Research Officer … Dr. Aung Zaw Latt MBBS (UM 2), MMedSc(Microbiology) (UM 1) … Daw Kay Khine Soe BSc, MSc(Zoology) (YU) Research Assistant (2) … Daw Yamin Ko Ko BPharm, MPharm. (University of Pharmacy, Yangon) Research Assistant (3) … Daw San Yu Hlaing BSc(Botany) (UDE) Research Assistant (4) … U Nyunt Naing B.Sc(Chemistry) (DU) Laboratory Assistant … Daw Me Me Khine

During the year under report, the Quality Control Division was involved in quality control testing of plasma derived hepatitis B vaccine and Avian Russell’s viper antivenom, and vaccine preventable arbovirology research on Japanese encephalitis. Quality control testing was done starting from raw materials to final product to get safe and effective vaccine. The research projects were mostly involved in disease surveillance of viral infections for timely prevention of disease outbreaks. Some of the studies aimed to monitor the emergence of new viral strains or subtypes to provide base-line data for the formulation of effective candidate vaccines and for elucidating the contribution of viral genetics to the changing patterns of disease.

RESEARCH PROJECTS 1. COMMUNICABLE DISEASES 1.1 VIRAL HEPATITIS 1.1.1 Quality control testing of plasma derived hepatitis B vaccine (2013) During 2013, a total of 783 units of blood samples were checked for hepatitis B surface antigen (HBsAg) by countercurrent-immunoelectrophoresis (CIEP) and 113 units of blood were with high HBsAg titer. These 113 units of blood were again checked by anti- HCV and anti-HIV 1 & 2 ELISA and syphilis antibody test. A total of 32 blood samples were infected i.e. HCV 25.7% (29/113), HIV 0.9% (1/113) and syphilis 1.8% (2/113). Eighty-two out of 113 units of blood were free of the above diseases and were used for Hepatitis B vaccine production. CIEP test was done not only for HBs antigen determination in raw blood units, but also used for in-process control of HBsAg in vaccine production (76 tests). Other important tests for vaccine preparations such as pyrogen test (4 tests), Lowry’s protein test (61 tests), mouse potency test (1 test), general safety (abnormal toxicity test) (12 tests), sterility tests (19 tests), immunogenicity test (1 test) and one test for extraneous viruses were also done.

1.2. JAPANESE ENCEPHALITIS 1.2.1. Detection of Japanese encephalitis virus infections among hospitalized encephalitis patients in selected hospitals in Yangon (2013) Japanese encephalitis (JE) is one of the vaccine preventable diseases, but is also one of the most important causes of epidemic encephalitis worldwide. Disease surveillance is important to get timely intervention before outbreaks. A total of fifty-five (n=55) sera samples, five (5) from Yangon General Hospital and fifty (50) from Yangon Children’s Hospital were collected from the patients who were admitted with sign and symptoms of encephalitis. The presenting clinical sign and symptoms of these patients were (100%) fever,

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(60.0%) confusion, (54.6%) headache, (14.6%) nausea, (20.0%) vomiting, neck (23.6%) stiffness, (16.4%) myalgia, (32.7%) seizures, (32.7%) generalized weakness and (21.8%) tonic-clonic movement of limbs. Fifty-five sera samples were obtained from January to December 2013. These samples were tested with JE IgM/ antibody rapid test kits (Standard Diagnostics, Korea). Among the sera tested, one sample (1.8%) was JE IgM positive. The JE positive patient was 6 years old girl, from Hpa-an, Kayin State admitted with sign and symptoms of fever, seizures, confusion, neck stiffness, nausea, generalized weakness and tonic-clonic movement of limbs. JE prevalence among encephalitis patients was higher in previous years i.e. 8.8% and 7.7% in the year 2011 and 2012, respectively.

SERVICES PROVIDED LABORATORY Sr. Laboratory Tests No. of tests No. 1. Anti-HBs 1856

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RADIATION TOXICOLOGY RESEARCH DIVISION

Deputy Director & Head … Dr. Tin Oo BSc(YU), MPHM(Mahidol University), Ph.D (University of Queensland, Australia) Research Scientist … Daw Win Thaw Tar Lwin BSc(Physics), MSc(YU) Diploma in Radiation Safety (Malaysia) Research Officer … Dr. Moe Moe Han BSc(Hons), MSc, MRes, PhD(Physics) Diploma in Global English (YU) Research Assistant (2) … Daw Htet Nandar Aung BA(Home Economics) (UDE) … Daw Su Mon BA(Economics) (UDE) … Daw Ni Ni Than BSc(Chemistry) (YU) Research Assistant (3) … U Si Thu Soe Naing BA(History) (UDE) … Daw Ni Ni Maw BSc(Physics) (DU) Diploma in Applied Physics(YU) … Daw Naw Esther BA(Geography) (UDE)

The division has been mainly involved in radiation safety measures with the aim of preventing nuclear related accidents and promoting high standard of protection and research on environmental health. During 2013, services such as regular monitoring for safety of personnel, area monitoring for safety of work place and radioactive waste storage and disposal were carried out.

RESEARCH PROJECTS 1. ENVIROMENTAL HEALTH 1.1 X-RAY 1.1.1 Detection of ionizing radiation among radiographers and their risk perceptions and opinions towards radiation safety at public health care facilities (Estimates of diagnostic imaging procedures at Yangon Children Hospital) Ionizing radiation exposure can be measured indirectly by number of diagnostic imaging procedures carried out. A proxy measure for radiation safety at public health care facilities focusing Yangon Children Hospital was explored through desk-review of secondary data on diagnostic imaging analyzed by specific age-group. Secondary data revealed the annual numbers of diagnostic imaging at Yangon Children Hospital across five years (2009 - 2013) as 10,798, 11,357, 11,312, 14,834 and 9,660 respectively. The data indicated an increased exposure to low dose ionizing radiation from 2009 to 2012 and there was a decrease in exposure in 2013. Most common conditions that required diagnostic imaging included respiratory tract infections, haematological disorders and malignancies, prematurity and low birth weight, intestinal and renal disorders and trauma. Among others, chest X-ray and ultrasonogram were more frequent in 2012 and 2013. For Computed Tomography (CT), cases were referred to Yangon General Hospital and New Yangon General Hospital or to private health care facilities. Mostly, children were exposed to radiation of 60-80 KV. Compared to newborn, chest x ray exposure was highest among infants in both 2012 and 2013. Ultra sound was done mostly in 5-12 years age group in both years. Children exposed to low dose ionizing radiation through conventional X ray were higher than those who required ultra-sound.

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Specific age groups Type of Newborn Infants 1-4 years 5 – 12 years Total diagnostic (n = 1056) (n = 2508) (n = 2994) (n = 3066) (n = 9564) imaging No. % No. % No. % No. % No. % Conventional X ray (2012) Chest 594 56.3 2022 80.6 2412 80.6 2364 78.6 7392 77.3 Abdomen 258 24.4 114 4.5 108 3.6 168 5.6 648 6.8 Other sites 204 19.3 372 14.8 474 15.8 474 15.8 1524 15.9

Conventional X ray (2013) (n = 1200) (n = 1796) (n = 3603) (n = 3061) (n = 9660) Chest 966 80.5 1449 80.7 2898 80.4 2415 78.9 7728 79.9 Abdomen 98 8.2 28 1.6 78 2.2 77 2.5 281 2.9 Skull x ray 29 2.4 20 1.1 38 1.1 28 0.9 115 1.2 Spine x ray 10 0.8 10 0.6 19 0.5 58 1.9 97 1.0 Other sites 97 8.1 289 16.1 570 15.8 483 15.8 1439 14.9

Ultrasound 2012 756 14.4 1081 20.5 1384 26.3 2049 38.9 5270 100 2013 761 15.0 1014 20.0 1522 30.0 1775 35.0 5072 100

1.1.2 Exploring knowledge, attitudes, risk perceptions and opinion towards paediatric imaging The WHO Global Initiative (GI) on Radiation Safety in Health Care Settings focuses on public health aspects of risk and benefits of the use of diagnostic imaging and radiation safety in children. This study aimed to find out the magnitude of knowledge, attitudes, risk perceptions and opinions towards paediatric imaging at two Children Hospitals in Yangon (Yangon Children Hospital and Yankin Children Hospital). Pretested structured interview questionnaire has been introduced by four trained interviewers. They collected data from 24 paediatricians, 50 medical officers, 60 house surgeons (interns), 4 radiologists, 4 radiographers, and 12 senior nursing staff. As might be expected, knowledge on radiation safety for children in general was higher in paediatricians, medical officers and radiologists (>75%) compared to the remaining categories (45%-62%). However, over 94% of radiologists and radiographers could tell correct radiation safety measures in detail especially shielding of genitals, thyroid, eyes, optimum dose and duration of exposure and appropriate distance. All categories except house surgeons (interns) and nursing staff realized that the risk of cancer in children was high in repeated exposure to ionizing radiation. Most of the respondents perceived that life time cancer risk was associated with exposure to chest-x ray but <30% recognized life time risk of cancer due to exposure to computed tomography (CT). Over 90% of respondents expressed their willingness to learn more of radiation safety through regular seminars. Around 73% of respondents felt that parents/care-takers should be explained well about risks and benefits of the imaging technique used. In conclusion, in resource limited settings, awareness raising activities are essential for paediatric imaging techniques not only for the health care providers but also for the target beneficiaries. Findings were supportive to recommend best practices for risk management in children exposed to low dose ionizing radiation.

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1.2 Determination of radon concentration in environment Radon is naturally occurring radioactive gas found our environment and requires special elements to detect its presence. It comes from the natural decay of uranium that is found in nearly all soils. When radon is present in the ground the gas may seed into the buildings. When uranium decays, it produces radium, which in turn decays to produce radon. In this study, the radon concentration in five kinds of building materials (brick, concrete, color cement, lime paint, plastic paint and tile) samples from building material shops in Yangon and three different floors (cement floor, tile floor, color cement floor of ground and 1st floor of newly construction building) were tested by using ‘Can Technique’ which was employing alpha sensitive LR 115 type 2 Solid State Nuclear Track Detector. The plastic cans, each enclosing LR 115 type 2 detector (1cmx1cm) which was fixed at the inner button of the can, were attached on each tested samples. Total of 170 samples were prepared along standard method for testing and detected. The alpha track density in 36 block samples of concrete mixture type (cement: lime: sand) 1:0:4 and 1:2:4, 2 brick samples, 6 background samples and 126 (42 samples from each building) samples from 3 selected building in Yangon city (each building from Mingalar Taung Nyunt Township, Tamwe Township and Kyee Myin Daing Township ) were recorded. It was found that the alpha track density measured in 2 background samples were 0.1 ± 0.04 track / cm 2 day, 2 brick samples were 0.3 ± 0.08 track / cm 2 day, 10 bare concrete samples (1:0:4) were 63.05 ± 0.07 track / cm 2 day, 2 lime-painted block samples were 59.14 ± 0.02 track / cm 2 day, 2 plastic-painted block samples were 58.59 ± 0.01 track / cm 2 day and 2 tile-coated block samples were 30.16 ± 0.04track/cm 2day, 10 bare concrete samples (1:2:4) were 59.79 ± 0.09 track / cm 2 day , 2 lime-painted block samples were 57.14 ± 0.02 track / cm 2 day, 2 plastic-painted block samples were 55.59 ± 0.01 track/ cm 2day and 2 tile-coated block samples were 29.76 ± 0.12 track / cm 2 day. For ground floors, the alpha track density in bare floors were 75.05 ± 0.03 track/cm² day, in color cement-coated floors were 74.18 ± 0.05 track/cm² day and tile- coated floors were 35.15 ± 0.01 track/cm² day. For 1 st floor, the alpha track density in bare floors concrete were 70.05±0.01 track/cm² day, color cement-coated floors were 69.15 ± 0.03 track/cm² day and tile-coated floors were 34.11 ± 0.02 track / cm² day. This study point out the alpha track density in bare floors was greater than that in tile-coated floors.

SERVICES PROVIDED Services are planned for radiation emergencies under following circumstances: fire, explosion, radioactive materials in air and/or water, injured or deceased persons contaminated with radioactive materials. The scope of radiation emergency plan covers both external and internal emergencies. External emergencies include local or regional nuclear accidents, national nuclear accidents/ disasters and international nuclear accidents/ disasters. International emergencies include minor spills, major spills, accidents involving radioactive dusts, mists, fumes, organic vapors and gases, injuries to personal tasks involving radiation hazards, sealed radiation source ruptures and fire involving radioactive materials.

ACADEMIC Sr. Name Course Responsibility No. 1. Dr. Tin Oo Research Methodology for PhD Course (2013) Teaching University of Medicine 1, Yangon (17.2.13) 2. Dr. Tin Oo Qualitative Research Methods , Gender and Teaching Health, University of Public Health (21.3.13)

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TECHNOLOGY DEVELOPMENT DIVISION

Deputy Director & Head ... Dr. Win Maw Tun MBBS , MMedSc , PhD (Microbiology) (UM 1) Research Officer ... Daw Sandar Nyunt BSc(Zoology) (YU) Research Assistant (2) ... Daw Nu Nu Lwin BSc(Botany) (YUDE) Research Assistant (3) ... U Phyoe Wai Aung BSc (Physics) (YUDE) ... Daw Htwe Htwe Nyunt BA(Economics) (YUDE) Research Assiatant (4) ... Daw Wai Mon Lin BSc(Chemistry) (DU) ... Daw May Zon Myint BA(Economics) (YUDE) ... Daw Yu Paing Thet BSc(Chemistry) (Taungoo University) Laboratory Attendant ... Daw Thiri Tun

Technology Development Division was established under Vaccine Research Center in April, 2012. Currently, the main work is purification of hepatitis B surface antigen (HBsAg) from plasma for hepatitis B vaccine production. It also involves in development of new diagnostic test kits and test methods, vaccine immunogenicity studies and research on viral hepatitis infections.

RESEARCH PROJECTS 1 COMMUNICABLE DISEASES 1.1 VIRAL HEPATITIS 1.1.1 Laboratory scale production of plasma-derived hepatitis B vaccine (2013) Plasma-derived hepatitis B vaccine was produced as laboratory scale by purification of hepatitis B surface antigen (HBsAg) from plasma. HBsAg positive blood was collected from blood banks of East Yangon General Hospital, Central Women Hospital, North Okkalapa General Hospital, Insein General Hospital and Central National Blood Bank. In 2013, after 47 visits of blood collection, 659 units of HBsAg positive blood were attained. Among them, 124 units of blood obtained for vaccine production after infection screening and after assessing with CEP test for high HBsAg titre. Percentage of infections in the collected HBsAg positive blood units were 1.8% for syphilis, 25.7% for hepatitis C and 0.9% for HIV. There were 26.867 liters of plasma acquired after plasma separation. One batch (P01/12) of HBsAg purification was performed from December, 2012 to October, 2013 and 225 mL of purified bulk (pre-dialyzed) with protein content of 11.39 mg/mL was achieved and stored at 4ºC for dialysis, heat-inactivation, formulation and vialing. There were nine formulation and vialing procedures performed in 2013 and 8,110 of plasma-derived hepatitis B vaccine 5 mL vials produced. There were 5,789 vials of hepatitis B vaccine (5 mL/vial) issued to Vaccine Clinic, DMR(LM).

2. ACADEMIC AND TECHNOLOGY DEVELOPMENT 2.1 DEVELOPMENT OF TEST KIT FOR INFECTION SCREENING OF DONOR BLOOD 2.1.1. Development of test kits for screening of transfusion transmitted infections in donor blood This was the collaboration between Olipro Biotechnology Sdn. Bhd., Malaysia and Department of Medical Research (Lower Myanmar): Technology Development Division and Experimental Medicine Research Division. Two types of test kit, BLOODCHEK Biochip and

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BLOODCHEK LF Dipstick for screening of transfusion transmitted infections (Human Immunodeficiency Virus HIV 1 & 2, Hepatitis B Virus HBV, Hepatitis C Virus HCV, syphilis and malaria) were to be developed. The BLOODCHEK Biochip is the protein-chip. It needs scanner and computer for reading of result and is intended for the blood banks with electricity supply. The BLOODCHEK LF Dipstick, the lateral flow immune- chromatographic test, is simple rapid test and is intended for rural health centers with irregular electricity supply. The optimization of test kits was done at Olipro Biotechnology Laboratory. Infection positive blood samples (one milliliter of 50 samples each for HBV, HCV, HIV, malaria and syphilis) and 50 normal blood samples (free from above infections) were collected by DMR (LM) for validation of test kits in Olipro Biotechnology Sdn. Bhd., Malaysia. Validation of test kits was completed by Olipro Biotechnology and they prepared for registration at Malaysia. Field and laboratory evaluation in Myanmar is planned for next year.

ACADEMIC Sr. Name Course Responsibility No. 1. Dr. Win Maw Tun MMedSc (Microbiology), UM (2) External Examiner PhD (Microbiology), UM (1) Supervisor Research Methodology and bioethics, Lecturer DMR (LM) (August, 2013)

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VIROLOGY RESEARCH DIVISION

Deputy Director & Head … Dr. Mo Mo Win MBBS, MMedSc(Microbiology) (IM 1) Research Scientist … Dr. Theingi Win Myat MBBS (IM 2), MMedSc (Microbiology) (UM 1) … Dr. Mu Mu Shwe MBBS(IM 2), MMedSc (Pathology) (IM 2) Research Officer … Dr. Htin Lin MBBS(IM 1), MMedSc(Microbiology)(UM 1) … Dr. Nilar Zaw MBBS (UM 1), MMedSc(Microbiology)(UM 2) … Daw Kay Thi Aye BSc(Botany) (YU), DPMS (Medical Technology) (Institute of Paramedical Science) … Daw Khin Mar Aye BSc (Zoology) , MSc (Zoology) (YU) Research Assistant (2) … Daw Thin Thin Shwe BA(Myanmarsar) (YU) … Daw Win Mar BSc(Mathematic) (YU) Research Assistant (3) … Daw Hla Myo Thu LLB(YUDE) … Daw Khin Sandar Aye BA(History) (YUDE) … Daw Khin Khin Oo BSc(Zoology) (YUDE) … Daw Thida Kyaw BSc(Zoology), MSc (Biotechnology) Research Assistant (4) … U Khine Moe Aung BSc (Zoology) (YUDE) … U Aung Hlaing Phyo

During the period under report the Virology Research Division was involved in four main research areas, namely arbovirology, viral diarrhea and viruses causing cervical cancer and acute respiratory infections. The research projects were mostly involved in disease surveillance of viral infections for timely prevention of disease outbreaks. Also, some of the studies were aimed to monitor the emergence of new viral strains or subtypes to provide base-line data for the formulation of effective candidate vaccines and for elucidating the contribution of viral genetics to the changing patterns of disease.

RESEARCH PROJECTS 1. COMMUNICABLE DISEASES 1.1. DIARRHOEA/ DYSENTERY 1.1.1. ROTAVIRUS 1.1.1.1 Surveillance of rotavirus diarrhoea in Yangon Children’s Hospital (2013) The study involved collection of stool specimens from children less than 5 years of age admitted to the three medical wards of the Yangon Children’s Hospital, Yangon, Myanmar. Stool samples not less than 5 ml were collected from diarrheic children as soon as possible after hospital admission. The stool samples were transported daily to the laboratory in the Virology Research Division. A total of 282 stool samples were collected and clinical features were recorded from January to December 2013. All the samples collected were tested for the presence of rotavirus antigen by a commercial enzyme immunoassay kit (ProSpect T TM Rotavirus from OXOID, UK). Rotavirus was detected in 156 (55%) of 282 stool samples tested. Rotavirus diarrhoea was most prevalent in the 6–11 months age group and during the cooler, drier months of the year (January and February). A total of 58 Rotavirus positive samples were analyzed by RT-PCR for genotyping. Among 58 samples

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Annual Report 2013 analyzed, 16 (27.6%) was found to be G2 genotype, 14 (24.2%) was found to be of G9 genotype, 10 (17.3%) found to be G2+10 genotype, 5 (8.6%%) was G12 genotype, 3 (5.2%) was G2+9 genotype, 2 sample each (3.4%) was G1 genotype and G3 genotype, 1 sample each (1.7%) was G8 and G2+12 genotype and 4 (6.9%) was untypable. As for P typing, 22 (38%) was P[4], 11 (19%) was P[8], 3 (5.2%) was P[6], 2 (3.4%) was P[6]+[8], 1 sample each (1.7%) was P[9], P[4]+[6] and P[4]+[8] and 17 (29.3%) was untypable. The most common combination was G2P [4] and G2+10P[4] followed by G9P[4] and G9P[8]. The distribution of G and P genotype provides the important and valuable information for the development and production of rotavirus vaccines, the most effective strategy for the prevention of severe rotavirus diarrhea.

Percent Distribution of percentage of G genotypes by year (2008-2013) G1 G2 G3 G9 G8 G12 G1+ G2+ G9+ G2+ G2+ Untypable G12 G9 G12 G10 G12 2008 42 28 4 0 0 20 4 0 0 0 0 2 2009 42 2 10 0 0 40 0 0 0 0 0 6 2010 7 9 0 0 0 77 0 0 0 1 0 6 2011 5 3 0 1 0 87 2 0 0 0 0 2 2012 24 13 1 7 0 42 1 0 0 0 0 10 2013 2 16 2 14 1 5 0 3 0 10 1 4

Percent Distribution of percentage of P genotypes by year (2008-2013) P[4] P[6] P[8] P[9] P[4]+P[6] P[4]+P[8] P[6]+P[8] P[9]+P[8] Untypable 2008 16 34 38 0 0 4 2 0 6 2009 2 12 68 0 0 4 10 0 4 2010 9 8 72 0 0 3 0 0 8 2011 3 22 64 0 0 0 2 0 9 2012 13 15 53 1 0 0 5 1 12 2013 22 3 11 1 1 1 2 0 17

1.1.1.2 Hospital-based surveillance of intussusception among children in Yangon (2013) Surveillance for intussusception among children less than 2 years of age admitted to the Yangon Children’s Hospital was conducted with the aim to provide base-line data for investigators and programmers in making decisions concerning future use of rotavirus vaccines. However, in 2013, the intussusception cases to be operated were referred to Yankin Children’s Hospital because the operation theatre of YCH was repaired. So data were collected from the Yankin Children’s Hospital. A total of 75 children less than 2 years of age diagnosed as intussusceptions were admitted to the surgical wards of Yankin Children’s Hospital from January to December 2013. Among them 46 cases were male and 29 cases were female. Age range of patients was from 3 to 10 months.

1.2. DENGUE HAEMORRHAGIC FEVER 1.2.1. Dengue virus serotypes among dengue haemorrhagic fever patients in Yangon Children’s Hospital (2013) Serum samples were collected from patients with clinical diagnosis of dengue/DHF attending the medical wards of Yangon Children’s Hospital between January to December 2013. Among a total of 1133 serum samples collected, 868 samples were acute phase sera

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Annual Report 2013 and 265 were paired sera. Acute phase serum samples were tested by Immuno- chromatographic tests (Panbio Dengue Duo Cassette and SD BIOLINE Dengue Duo NS1 Ag and IgG/IgM test) and paired sera by dengue IgM/IgG capture Enzyme Linked Immunosorbent Assay (ELISA) (Panbio, Australia) for confirmation of dengue infection. Of 1133 samples tested, 727 (64%) showed seropositive results, comprising 212 (29%) primary dengue infection and 515 (71%) secondary dengue infection. The most common affected age group was 5-8 years. Male and female ratio for dengue positive as well as negative cases was 1.2:1. The peak admission was found in June. DHF grade I was the most common clinical grade in both primary and secondary dengue infections. From 727 serologically confirmed samples, 158 acute phase sera were subjected to virus isolation by tissue culture in C6/36 mosquito cell lines and further typed with serotype specific monoclonal antibodies to the four dengue viruses by using Indirect Immunofluorescent Antibody Technique (IFA). A total of 36 viruses were isolated and among them 34 (94%) were DENV-1 and the rest 2 (6%) were DENV- 4. To further analyze these DENV-1 isolates, RNA was extracted from 23 DENV-1 isolates and the envelope (E) protein gene was amplified by using the reverse transcriptase polymerase chain reaction (RT- PCR) and then subjected to DNA sequencing. The currently circulating Myanmar DENV-1 belonged to Genotype I (Asian Genotype) and had close relationship to viruses isolated from Thailand from the year 2006.

1.2.2. Sentinel surveillance of dengue viruses in endemic regions of Myanmar (2013) This project was implemented in collaboration with the WHO collaborating centre for Arbovirus Reference and Research, Brisbane, Australia. Material for sera collections and dengue rapid test kits were distributed to all sentinel sites (Mandalay, Mawlamyaing and Sittwe). These samples were tested with PANBIO Dengue IgM and IgG rapid test kit from Australia. The sera which was sent from Mandalay hospital was from 84 patients, of which 50 patients (59.5%) were confirmed to have dengue infection. Among them, 19 patients (38%) were positive for anti-DENV IgM which denotes primary dengue infection and 31 patients (62%) were positive for anti-DENV IgG or both anti-DENV IgM and IgG which denotes secondary dengue infection. The trends of prevalence of dengue virus infection and dengue serotypes in sentinel sites provide an important and valuable information for Dengue Decision Support System which includes hospital management, vector control programmes, consideration of refresher course and hospital capacity and community capacity.

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Trend of prevalence of dengue infection and dengue serotypes by sentinel sites (2008-2013) Sentinel 2008 2009 2010 2011 2012 2013 Sites Positive 79 70.8 58 63.2 - 59.5 Primary 24.4 41.2 18.3 100 - 38 Mandalay Secondary 75.6 58.8 80.7 0 - 62 DEN1 Serotype DEN3 - DEN4 - - - DEN1+4 Positive 82.1 100 46 - 51.1 - Primary 28 66.7 19 - 37.7 - Sittwe Secondary 72 33.3 81 - 62.3 - DEN1 - Serotype - - - - DEN2 Positive 78.6 90.0 42.5 - 42.3 - Mawla- Primary 27.3 0 17.6 - 25.6 - myaing Secondary 72.7 100 82.4 - 74.4 - DEN2 - Serotype - - - - DEN4 Positive 96 55.6 - - - - Primary 36 40 - - - - Lashio Secondary 64 60 - - - - DEN1 - Serotype - - - - DEN4 Positive 72 (Bago)76.9 - 21.4 - - North Primary 15.3 20 - 33.3 - - Okkalapa Secondary 84.7 80 - 66.7 - - DEN2 - Serotype DEN3 - - - DEN3 Positive - (Hinthada)77.8 79.6 - - - Primary - 14.2 4.5 - - - Pathein Secondary - 85.8 95.5 - - - DEN2 - Serotype - DEN2 DEN4 - - DEN2+4

1.2.3. Diversity of dengue virus strains and dynamics of viraemia in children with dengue infections This project was done in collaboration with the Institute of Health and Biomedical Innovation, QUT, Australia. The aim of this project was to study the genetic changes (mutations/polymorphisms) of dengue virus populations during the acute viraemic phase of dengue infection in a single host. The acute serum sample from children admitted to the Yangon Children’s Hospital (YCH) with dengue infection was tested by SD BIOLINE Dengue Duo Rapid cassette test (Dengue NS1 Ag + IgG/IgM) on the first day of sample collection. If the test showed Dengue NS1 Ag positive or Dengue IgM positive or both Dengue NS1 Ag and IgM positive, a drop of blood (approximately 40 µl) from a finger prick

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Annual Report 2013 was collected on to a FTA elute card for another 3 to 5 consecutive days. RNA extraction and RT-PCR was done and the samples with sufficient RNA were further subjected to cloning and sequencing. Twenty to 22 clones from sera of each day from each patient was sequenced. A total of 241 clones of DENV-1 E genes sequenced from four patients were analyzed by phylogenetic analysis. Mutations occurred in 25 (1.7%) to 125 (8.4%) sites of the 1485 nucleotides sequenced. The proportions of nucleotide mutated clones as well as amino acid mutated clones were observed to be higher in early acute phase of viremia (Day 1 and Day 2). The proportion of nonsynonymous mutations ranged from 7% to 26%. The dN/dS ratio ranged from 0.02 to 0.1 (all were <1). The percentage of nucleotide mutation(number of nucleotide changes /number of nucleotide sequenced) ranged from 0.06% to 0.5% (mean 0.26%) in DHF grade III patient and 0.15% to 0.32% (mean 0.22%) in DHF I patient.Significant association of the percentage of nucleotide mutation and clinical severity was not found.

1.3. CHIKUNGUNYA VIRUS 1.3.1. Molecular characterization of Chikungunya virus in Myanmar Acute serum samples were collected from patients admitted to the medical wards of YGH and YCH who were clinically suspected of having Chikungunya virus infection. During November 2009 to November 2012, 200 serum samples were collected. After analyzing the fever days and clinical symptoms, 100 samples were eligible for detection by RT-PCR. Six out of one-hundred samples were RT-PCR positive. Two RT-PCR positive samples were done first purification, cycle sequencing and second purification steps. These two purified cycle sequencing products were sequenced by using ABI-3130 genetic analyzer. Then BLAST program was used to identify the genotype of the sample and then phylogenetic tree was constructed by using Mega software version 5.3. After phylogenetic analysis, it was found that the resulting genotype was ECSA (East/ Central/South Africa) genotype which was similar to chikungunya virus genotype causing the major outbreak in Reunion Island of India in 2006. There is no vaccine available currently, and this study was the first genotyping of chikungunya virus isolate representing the original samples from Department of Medical Research (Lower Myanmar), as the base line data contributed towards vaccine development.

1.4. SEXUALLY TRANSMITTED INFECTIONS 1.4.1. HUMAN PAPILLOMAVIRUS 1.4.1.1. Human Papillomavirus (HPV) related anogenital cancers in men and women A causal role for human papillomavirus (HPV) in anogenital cancers is supported by evidence from molecular and epidemiologic investigations. This study detected the oncogenic HPV genotypes in anogenital cancers among men and women by a cross-sectional descriptive study in 2013. A total of 100 paraffin embedded biopsy tissues of histologically confirmed anogenital cancers within past five years during 2008 and 2012 were studied. Those were 30 penile cancers and 9 anal cancers from Yangon General Hospital and 61 vulva cancers from Central Women Hospital, Yangon. HPV-DNA testing and genotyping were performed by polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP). Overall, 34% of anogenital cancers cases were positive for HPV; of which 64.7% was vulva cancer, 23.5% penile cancer and 11.8.5 anal cancer. Analysis of each anogenital cancer showed that HPV were identified in 44.4% of anal cancer (4/9), 36.1% of vulva cancer (22/61), and 26.7% of penile cancer (8/30). Among anal cancer, the most frequent genotypes were HPV-16 (75%) and HPV-18(25%). In vulva cancer, HPV-33 was the most common genotype (40.9%) followed by HPV-16 (31.8%), HPV-31 (22.7%), and HPV-18 (4.6%). 104

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In penile cancer, HPV-16 (62.5%) was the most common genotype followed by HPV- 33(25%) and HPV-18(12.5%). This study was the first report of evidence based oncogenic HPV genotypes in anogenital cancers among men and women in Myanmar. This research provides valuable information in understanding the burden of HPV associated cancers of the anus, penile and vulva and the consideration of the effectiveness of prophylactic HPV vaccination.

1.5. ACUTE RESPIRATORY INFECTIONS 1.5.1. RUBELLA VIRUS 1.5.1.1 Identification of rubella in children with fever and rash admitted to Yangon Children’s Hospital Rubella is a worldwide common viral infection characterized by fever, rash, lymphadenopathy and joint pain. It can also cause serious complications like otitis media and mental retardation. The aim of this study was to identify rubella infection in children with fever and rash admitted to medical wards of Yangon Children’s Hospital during 2012. Ninety serum samples were collected from children with fever and rash. The samples were collected within 7 days of illness to detect IgM. The age range was from 5 months to 12 years. Rubella IgG/IgM immunochromatographic test (ICT) (SD, Korea) and Anti rubella IgM ELISA (DRG, Germany) were used to detect rubella IgM. Of 90 samples tested, 5 samples (5.5%) were positive for IgM which denoted recent rubella infection. The age of 5 IgM positive children were 7 months, 2 years, 4 years and 9 years, respectively and all of them presented with rhinorrhoea, cough, fever and rash. Thirty-four samples (37.8%) revealed positive for IgG and those cases were regarded as past rubella infection. This study contributed as the baseline data for implementation of rubella control strategies.

1.5.1.2 Assessment of immunity to polio, measles and rubella through antibody testing in serum and oral fluid in Myanmar This study was carried out in collaboration with World Health Organization and Center for Disease Control and prevention, Atlanta. The aim of this study was to determine the immunity to polio, measles and rubella from serum and oral fluid in the population residing in Yangon Region, Kayin and Chin States in Myanmar during 2011-2013. Serum and oral fluid samples were collected from 1260 children residing in Alone and Hlaing Thar Yar townships of Yangon Region, Hpaan and Hlaingbwe townships of Kayin State and Mindat and Matupi townships of Chin State. Their age range was from under 5 years to 15 years. In addition, 756 mothers of those children were also recruited for testing immunity against rubella. They were within the reproductive age (15-45 years). Rubella IgG was tested from serum samples of children and mothers and measles IgG was tested from serum and oral fluid samples of children. All the tests were done by ELISA method (Siemens, Germany for serum and Microimmune, UK for oral fluid). For testing of Polio, the serum samples were sent to National Health Laboratory and will be shipped to Centers for Disease Control and prevention (CDC). Laboratory testing for measles and rubella was completed.

1.5.2. INFLUENZA VIRUS 1.5.2.1 Molecular characterization of influenza viruses among children attending Yangon Children’s Hospital (2013) Determining the prevalence of types of influenza virus helps estimation of outbreak of particular type of influenza virus. The aim of this study was to determine the most prevalent

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Annual Report 2013 subtype of influenza virus circulating among children attending Yangon Children’s Hospital. A total of 100 children with influenza-like illness were recruited at Out Patient Department of the hospital from June to October 2013. Nasal swabs were taken from the children, placed into the tubes containing viral transport media and transported to the laboratory of Virology Research Division. Virus RNA was extracted from specimens by using one step RNA extraction kit (QIAmp® Viral RNA Mini Assay). Influenza virus was detected in specimens by conventional polymerase chain reaction (PCR) using the primers of matrix gene of influenza virus type A and that of type B. Of 100 cases, 6 cases (6%) showed influenza virus- A positive. Among them, 4 cases were male and 2 cases were female. Age ranged from 6 months to 44 months (mean= 22.7 months, SD=12.7). There was no case of influenza-B virus. Influenza-A virus positive samples were subjected to subtyping. Subtyping of influenza-A virus was done by conventional multiplex PCR using the primers of haemagglutinin (HA) genes of pathogenic subtypes of influenza virus type A (pandemic H1, seasonal H1, seasonal H3 and avian H5). Five out of six influenza cases revealed HA gene of seasonal H3 subtypes and one case revealed that of pandemic H1 subtype. There was no case of seasonal H1 subtype or avian H5 subtype. All influenza positive cases presented with cough, fever and rhinorrhoea. Other symptoms like vomiting, diarrhea or febrile convulsion was not seen in the influenza cases. In conclusion, the predominant subtype of influenza virus-type A among children attending Yangon Children’s Hospital in 2013 was found to be seasonal H3 subtype which differed from the finding in 2010-2011 in which predominant subtype was pandemic H1 subtype. The information highlighted that circulating influenza viruses should be characterized continuously to estimate the outbreak of influenza and to notify appearance of a new strain of influenza virus timely.

SERVICES PROVIDED ACADEMIC Sr. Name Course Responsibility No. 1. Dr. Mo Mo Win MMedSc(Microbiology) Teaching MPH Teaching BPMS(Medical Technology) Teaching 2. Dr. Theingi Win Myat MMedSc(Microbiology) Teaching 3. Dr. Mu Mu Shwe MMedSc(Microbiology) Teaching 4. Dr. Htin Lin MMedSc(Microbiology) Teaching 5. Daw Kay Thi Aye MMedSc(Microbiology) Teaching 6. Daw Khin Mar Aye MMedSc(Microbiology) Teaching

LABORATORY Sr. Subject Tested samples No. 1. Performing platelet counts for patients admitted to YCH with 980 suspected DHF and other bleeding disorders. 2. Performing Western Blot tests for confirmation of HIV 95

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CLINICAL RESEARCH UNIT (CEREBRAL AND COMPLICATED MALARIA, NOGH)

Head of Unit ... Professor Chit Soe MBBS(UM 1) (Ygn) MMedSc(Internal Medicine)(UM 2) (Ygn), DrMedSc(General Medicine)(UM 2) (Ygn), MRCP (UK), FRCP(Edin), Dip Med Edu Research Members ... Professor Mar Mar Kyi MBBS(UM 2) (Ygn), MMedSc (Internal Medicine)(UM 2) (Ygn), MRCP (UK), FRCP(Edin) ... Dr. Tint Tint Kyi MBBS(UM 1) (Ygn), MMedSc(Internal Medicine)(UM 1) (Ygn) ... Dr. Swe Swe Thit MBBS(UM 1) (Ygn), MMedSc(Internal Medicine)(UM 1) (Ygn), MRCP ... Dr. Aung Kyaw Thu MBBS(UM 2) (Ygn), MMedSc (Internal Medicine)(UM 1) (Ygn) ... Dr. Kyi Mya Htoo MBBS(UM 1) (Ygn), MMedSc(Internal Medicine)(UM 1) (Ygn), MRCP ... Dr. Nay Myo Aung MBBS(UM 2) (Ygn), MMedSc (Internal Medicine)(UM 2) (Ygn) ... Dr. Thinzar Cho Oo MBBS(UM 1) (Ygn), MMedSc (Internal Medicine)(UM 1) (Ygn) ... Dr. Mi Mi Khine MBBS(UM 1) (Ygn), MMedSc (Internal Medicine)(UM 1) (Ygn) ... Dr. Nay Lin Tun MBBS(UM 2) (Ygn), MMedSc(Internal Medicine)(UM 2) (Ygn) ... Dr. Myo Lin Aung MBBS(UM 2) (Ygn), MMedSc (Internal Medicine)(UM 2) (Ygn) Coordinator ... Dr. Myat Htut Nyunt MBBS(UM 2) (Ygn), MMedSc (Microbiology)(UM 1) (Ygn), DAP&E (Malaysia)

RESEARCH PROJECTS 1. COMMUNICABLE DISEASES 1.1 MALARIA 1.1.1 Clinical profile of severe and complicated malaria patients (2013) The clinical profiles of severe and complicated malaria cases admitted to IGH were thoroughly assessed from 1 January to 31 December 2013. It was reported that a total of 51 clinical suspected malaria cases were admitted. Cerebral malaria occurred in 11 patients (21.56%). Renal involvement comprised 35 patients (68.62%) of the severe malaria patient. Total 9 patients expired (17.64%). The patients came with systemic dysfunction was 1.8% (n=1) (septicemia type). Multi-organ dysfunction (two or more organ involvement) occurred in only one patient and expired. All patients contacted malaria from different endemic areas. Mortality rate was 5.3% of all malaria cases. Thorough assessment of the patients, proper and intensive management for complications in severe and complicated malaria patients is essential to reduce mortality.

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Table(1). Summary of the profile of the malaria cases in past six years

Description 2008 2009 2010 2011 2012 2013 Total malaria patient admitted 146 90 63 81 56 51 Severe and complicated 68 49 27 47 26 51 Uncomplicated malaria 38 35 36 34 30 0 Cerebral Malaria 30 22 9 23 21 11 Malaria Hepatitis 2 8 8 6 4 9 Multi organ dysfunction 5 4 5 5 1 7 Case fatality (%) 7.53 7.5 11.1 7.4 5.3 17.64

1.1.2 Renal involvement in Severe Malaria (Insein General Hospital, 2013-2014) Malaria remains the fourth leading cause of mortality in Myanmar. Previously cerebral malaria constitutes highest number of mortality. There are increasing trend in malaria renal failure cases. A prospective analytical study was carried out in IGH from October 2012 to September 2013 to know the renal involvement in severe malaria patients and their outcome. A total of 48 patients were included (47 Males: 7 Females). Confirmed severe malaria patients (MP slides or RDT positive) for P.f, P.v and mixed ( P.f+P.v ) patients were included. Blood creatinine level of >120 umol/L were identified as renal involvement. Renal involvement comprises (17/48) (35.42%) of the severe malaria patient, (14/48) (29.15%) of the severe malaria patients had cerebral involvement. 6 patients (12.5%) of the severe malaria patients were expired. 5/6 expired patient (82%) had renal involvement and 4/6 expired (66%) had cerebral involvement. Renal involvement in severe malaria indicated serious complication and increase fatality. Early referral to hospital and awareness raising among patients as well as clinician will be urgently needed.

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CLINICAL RESEARCH UNIT (HAEMATOLOGY)

Head of Unit … Prof. Dr . Ye Myint Kyaw MBBS, MMedSc (Paed), MRCP(UK), MRCPCH(UK), DCH(Glasgow), DrMedSc(Paed), FRCP(Edin), Dip.Med.ED Research Members … Prof. Dr . Htun Lwin Nyein MBBS, MMedSc(Int. Med ), DrMedSc(Int. Med), MRCP, FRCP(UK) … Prof. Dr. Aye Aye Gyi MBBS, MMedSc, DrMedSc(IntMed), MRCP, FRCP(UK) … Prof. Dr. Htay Htay Tin MBBS, MMedSc(Pathology), PhD (Pathology) … Dr. Aye Aye Khaing MBBS, MMedSc(Paediatric), MRCPCH (UK) … Dr. Sein Win MBBS, MMedSc(IntMed), DrMedSc(IntMed) … Dr . Tint Myo Hnin MBBS, MMedSc(Paediatric) Coordinator … Dr. Win Pa Pa Naing MBBS, MMedSc(Pathology), PhD(Pathology)

RESEARCH PROJECTS 1. NON-COMMUNICABLE DISEASES 1.1 CANCER 1.1.1 A study of serum ferritin level and usage of oral iron chelation therapy in multi- transfused thalassemic patients at Yangon Children Hospital

Thalassemia is an inherited hemoglobin disorder that is becoming a major health problem in the world, especially in Mediterranean region, the Middle East, the Indian subcontinent, Southeast Asia. Recurrent transfusions lead to iron-overload manifested by increased serum ferritin levels, for which chelation therapy is required. In this study, multi- transfused thalassemic patients were studied their socio-demographic variables, use of oral iron chelation therapy and serum ferritin level. Serum ferritin was measured by using Enzyme linked Immunosorbant Assay (ELISA) method. Of the sixty-four patients included in the study, 30(46.9%) were males while 34(53.1%) were females. The mean age was 95.06 months with the dominant age group 28(43.8%) being 61 to 120 months. The mean age of onset of diagnostic was 21.65 months with the dominant age group 31(48.4%) from 13 to 36 months. The mean serum ferritin levels in our study were 2448.4ng/ml and 61(95.31%) was high serum ferritin levels. Among them, only 26(40.6%) patients used oral chelation therapy. It was used by patients in 12(18.8%) regular, 9(14%) slightly irregular and 5(7.9%) irregularly irregular taking drugs. The main reason for not taking regular drugs were due to unable to afford and unable to access drugs. Our finding showed 35(59.4%) patients not receiving iron chelation therapy at all. Provision of free iron chelation therapy is needed and regular use of these drugs can reduce the risk of iron-overload related complications leading to a better quality of life and improving survival in YCH multi-transfused thalassemic patients.

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1.1.2 Effect of nutrition status on induction remission in children with acute leukemia in Yangon Children’s Hospital This prospective study was aimed to assess the effect of nutritional status on induction remission in childhood acute leukemia: both acute lymphoblastic leukemia (ALL) and acute myeloblastic leukemia (AML). The study was carried out in the Pediatric Haemato-Oncology unit, Yangon Children’s Hospital from January 2013 to December 2013. Nutritional status was assessed using anthropometric measurements, biochemical parameters. There were 50 ALL patients and 30 AML patients, age ranged from 1 month to 14 years. Male preponderance was found in both ALL and AML patients.The most common age group was under 5-year age and which represented about 50% of study population. At the initial state, 26 ALL patients (52%) were well-nourished and 24 patients (48%) were mal-nourished. Only 37 ALL patients completed induction chemotherapy, 5 patients died and 8 patients absconded during induction chemotherapy. In the rest 37 ALL patients, 21 patients (56.8%) were well- nourished and 16 patients (43.2%) were mal-nourished. Among well-nourished ALL patients, 18 patients (85.7%) had complete remission, 2 patients (9.5%) had partial remission and 1 patient (4.8%) had no remission. Among the mal-nourished ALL patients, 14 patients (87.5%) had complete remission, 1 patient (6.3%) had partial remission and 1 patient (6.3%) had no remission. Out of expired cases, 4 patients (16.7%) were mal-nourished and 1 patient (3.8%) were well-nourished. At the initial state, 11 AML patients (36.7%) were well– nourished and 19 patients (63.3%) were mal-nourished. Only 18 AML patients completed induction chemotherapy, 8 patients died and 4 patients absconded during induction chemotherapy. In the rest 18 AMLpatients, 9 patients (50%) were well-nourished and 9 patients (50 %) were mal-nourished. Among the well-nourished AML patients, 6 patients (66.7%) had complete remission, 2 patients (22.2%) had partial remission and 1 patient (11.1%) had no remission. Among the mal-nourished AML patients, 4 patients (44.4%) had complete remission, 2 patients (22.2%) had partial remission and 3 patients (33.3%) had no remission. All expired patients weremal-nourished (n=8, 42.1%). There is no much significant difference between nutritional status and their remission outcome in both ALL (p=0.923) and AML (p=0.497). There are significant changes in weight and height before and after induction chemotherapy (p=<0.001) and (p= <0.001) respectively. This study found out about 50-60% of newly diagnosed leukemia was mal-nourished. Treating clinicians should aware of comorbidity when starting the chemotherapy. Although leukemia remissionoutcome is not significantly related to nutritional status, mortality rate is significantly high in malnourished patients with leukemia. Early detection of malnutrition and optimal nutritional support should be considered to reduce mortality of newly diagnosed leukemia.

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CLINICAL RESEARCH UNIT (HIV/AIDS)

Advisor … Prof. Rai Mra MBBS(Ygn)(UM 1), MRCP, FRCP (Edin) Head of Unit … Dr. Htin Aung Saw MBBS(Ygn)(UM 1), MMedSc (Internal Medicine) (Ygn)(UM 2), FRCP (Edin) Research … Dr. Sabai Phyu MBBS(Ygn)(UM 2) Members MMedSc(Internal Medicine)(Ygn)(UM 1) Dip. in HIV Medicine (University no.VI, Paris) … Dr. Wynn Naing MBBS (Ygn) (UM 2), DTM&H (Mahidol University), Dip. In Dermatology (Institute of Dermatology) (BKK) … Dr. Aung San MBBS (Ygn) (UM 2), MMedSc (Internal Medicine) (UM 2), Dip. in HIV Medicine (University no. VI, Pairs) … Dr. Kyaw Swar Linn MBBS (Ygn) (UM Mandalay), MMedSc (Internal Medicine) (UM 2), Dip. in HIV Medicine (University no. VI, Pairs), MRCP (UK) Coordinator … Dr. Kay Thwe Han MBBS (Ygn)(UM 1) MMedSc (Microbiology)(Ygn)(UM 1)

RESEARCH PROJECTS 1. COMMUNICABLE DISEASES

1.1 PATTERN OF OPPORTUNISTIC INFECTION AMONG HIV-INFECTED PATIENTS IN THE POST-ART ERA Management of opportunistic infection is main stay of the care of HIV-infected patients. Pattern of OI may change as ART and other antibiotic prophylaxis are widely available. In order to evaluate the pattern of different OI with the major goal to update the Anti-HIV treatment guideline, a prospective study (2012-2013) has been conducted at the Tharketa Specialist Hospital Yangon. A cross-sectional descriptive study was conducted among HIV seropositive diarrhoea patients admitted to or attending to out-patient department of Tharketa specialist hospital from January to August 2013. Total of 113 subjects were recruited in the study. Pro-forma was used to collect socio demographic data of patients and clinical information including CD4 count. Stool samples were examined by direct microscopy with saline and iodine and special stain (modified Ziehl-Neelsen stain) was used to detect coccidia. Among 113 patients, 68% were males and 32% were females. The most common age group was between 31-40 years (44.25%). The prevalence of intestinal parasites was 83.18%. Among them, Cryptosporidium (72.6%), Microsporidia (27.4%), Cyclospora and Isospora (2.7%), Entamoeba histolytica (8%) and helminthic infestation (7.1%) were detected. Cryptosporidium was the most common parasite among diarrhoea patients and it was followed by Microsporidia. The positivity rate of Cyclospora and Isospora were low. In relation to host immune status in terms of CD4 count, the lower the CD4 count, the more frequent occurrence of chronic diarrhoea which was statistically significant (p=0.006). Cryptosporidium and Microsporidia were found to be significantly associated with chronic diarrhoea (p<0.05). Cryptosporidium and Microsporidia were also more prevalent among patients with CD4 count <50/ µl but it was not statistically significant (p>0.05). In relation to antiretroviral treatment and parasitic infestation , Cryptosporidium and Microsporidium were more commonly detected in patients who did not take ART. And also

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Annual Report 2013 chronic diarrhoea was more common in patients without taking ART but that association was not statistically significant (p=0.5). The findings highlighted that opportunistic intestinal parasitic infections are more prevalent of among HIV patients with lower immunity and lower prevalence was noted among HIV patients with ART in this study population. Therefore, early diagnosis of HIV, timely ART, early detection and treatment of opportunistic intestinal parasitic infections are recommended to reduce morbidity and mortality of HIV patients.

SERVICE PROVIDED ACADEMIC Sr. Name Course Responsibility No. 1. Prof. Rai Mra Medical Forum on Clinical Care of HIV in Speaker Myanmar, 22 October 2013 2. Dr. Htin Aaung Saw Medical Forum on Clinical Care of HIV in Moderator Myanmar, 22 October 2013 Lecture on “ Problems and perspectives in Speaker HIV clinical care” Thayarwady Continuous Medical Education Programme, 12 th June 2013 Symposium on “Optimizing ART 2013” Speaker Taungoo, Medical Conference Bago Region MMA (13-14December 2013) 3. Dr. Sabai Phyu Lecture on “ Problems and perspectives in Speaker HIV clinical care” Thayarwady Continuous Medical Education Programme, 12 th June 2013 4. Dr. Wynn Naing Symposium on “ Acne and Beauty” Taungoo, Medical Conference Bago Speaker Region MMA (13-14 December 2013)

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CLINICAL RESEARCH UNIT (MALARIA-DSGH, MINGALADON)

Advisor … Brig . General / Colonel Tin Maung Hlaing MBBS, MMedSc (Prev & Trop Med), FACTM (Australia), MPHM (Mahidol Univ Thailand), DrPH (Epidemiology)(UP Manila), MA (Defence Studies), MACE(USA), FACP (USA), FRSPH(UK), FFPH(UK) , FRCP (Edinburgh) Defence Services Medical Research Centre (DSMRC) Head of Unit … Col. / Lt. Col. Khin Phyu Pyar M.B.,B.S (Ygn), MMedSc (Int. Med), MRCP (U.K), MRCPI (Ireland), DTM&H (London), Dip Med Edu (DSMA), FRCPG (Glasg), FRCP(Ireland) Research Members … Lt. Col, Khin Maung Aye MBBS (Mdy), DTM&H , Advisor- Directorate of Medical Services … Col./ Lt. Col. Tin Moe Mya MBBS (Ygn), M.Med.Sc (Pathology), PhD (Pathology), Dip Med Edu Consultant Pathologist / Head of Disease Control Unit, Dept.of Pathology DSGH, DSMRC. … Lt. Col. Khin San San MBBS (Ygn), M.Med.Sc (Microbiology), PhD (Microbiology), (Advisor- Directorate of Medical Services) … Maj. Sai Aik Hla M.B.,B.S (Mdy), M.Med.Sc (Int.Med) Physician, DSGH Mingaladon Laboratory worker … WO II Ye Myint … Cpl. Zin Myo Oo Coordinator … Dr. Myat Phone Kyaw MBBS (Mdy), MMedSc (Biochem), FACTM. Ph.D (Colombo)

RESEARCH PROJECTS 1 COMMUNICABLE DISEASES 1.1 MALARIA 1.1.1 Clinical study on efficacy and safety of Coartem (Artemether-Lumefantrine) in uncomplicated falciparum malaria in adults in Bamaw National Malaria Programme recommended a three-day artemisinin-based combination for microscopy or dipstick confirmed cases of uncomplicated P. falciparum malaria. The results of monitoring the therapeutic efficacy of first-line antimalarials in six countries of the Greater Mekong Sub-region (GMS) from 2008 to 2010 revealed that artemether-lumefantrine remained highly efficacious in Lao PDR and Myanmar. Coartem is the artemether-lumefantrine co-formulated tablets and has been distributed to sub-centre level since 2006 in our country. As its efficacy needs to be monitored continuously, one-arm in vivo therapeutic efficacy study using 42-day WHO standard protocol was done at No. 11 MB, Bamaw to evaluate the clinical and parasitological responses of uncomplicated P. falciparum infections. A total of 52 acute adult uncomplicated falciparum malaria patients were enrolled according to pre-determined criteria from August 2011 to August 2012. The patients were administered usual adult dose 4 tabs twice daily for three days. The patients were monitored clinically and parasitologically for 42 days. Mean age was 30 + 8.5 year. Mean height and weight were 165.1 + 4.75 cm and 55.67+ 4.5 kg, respectively. Initial temperature was 38.5 + 0.78 ºC. Initial parasitaemia was 20552.2 + 37895.49 per µL. Fever clearance time was 43 ± 7.3 hours and parasite clearance time was 44.94 ± 18.41 hours respectively. There was one

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Annual Report 2013 late treatment failure. Therefore, adequate clinical and parasitological response was 97.83%. Day 3 parasitaemia was 4%. There were no serious side effects. Coartem® is still safe and effective for the treatment of uncomplicated falciparum malaria in adults.

1.1.2 Efficacy of Chloroquine for the treatment of Plasmodium vivax malaria in Bamaw Chloroquine three day therapy is still recommended by the World Health Organization to treat Vivax malaria. A considerable level of chloroquine resistant vivax malaria has been reported from some countries. The study aimed to assess the therapeutic efficacy of chloroquine. An oral three day dose of chloroquine was administered to adult uncomplicated vivax malaria patients. Observations of fever, parasite clearance and reappearance, and other clinical manifestations were made on Days 0, 1, 2, 3, 7, 14, 21 and 28. Thirty adult vivax positive cases, with fever or history of fever within the previous 24 h, were included in the final evaluation of the study. Mean age was 32 ± 8 years. Mean weight and height were 59 ± 4 kg and 167 ± 5.8 cm, respectively. Mean fever clearance time and parasite clearance time were 19.71±10.22 hr and 49.62 ±17.0 hr, respectively. Initial temperature was 38 ± 0.5 ºC. Adequate clinical and parasitological response was achieved in 30 cases, the rate being 100%. Chloroquine is still effective for the treatment of uncomplicated P.vivax malaria.

1.1.3 Efficacy of Chloroquine for the treatment of Plasmodium vivax malaria in Loikaw Chloroquine three day therapy is still recommended by the World Health Organization to treat Vivax malaria. A considerable level of chloroquine resistant vivax malaria has been reported from some countries. The study aimed to assess the therapeutic efficacy of chloroquine. An oral three day dose of chloroquine was administered to adult uncomplicated vivax malaria patients. Observations of fever, parasite clearance and reappearance, and other clinical manifestations were made on Days 0, 1, 2, 3, 7, 14, 21 and 28. Thirty adult vivax positive cases, with fever or history of fever within the previous 24 h, were included in the final evaluation of the study. Mean age was 32 ± 8 years. Mean weight and height were 59 ± 4 kg and 167 ± 5.8 cm, respectively. Mean fever clearance time and parasite clearance time were 19.71±10.22 hr and 49.62 ±17.0 hr, respectively. Initial temperature was 38 ± 0.5 ºC. Adequate clinical and parasitological response was achieved in 30 cases, the rate being 100%. Chloroquine is still effective for the treatment of uncomplicated P.vivax malaria.

SERVICES PROVIDED ACADEMIC Sr. Name Course Responsibility No. 1. Brig. Gen./ Col. Tin Maung Hlaing Ph.D.(Microbiology) Reader/Supervisor M Med Sc (Int Med) 2. Col./Lt. Colonel Khin Phyu Pyar M Med Sc (Int Med) Reader/Supervisor 3. Major Sai Aik Hla M Med Sc (Int Med) Reader/Supervisor

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LABORATORY 1. Peripheral Blood films for Malaria Parasites 2422

TRAINING 1. Training Course on Good Clinical Practice - January 2014, Naypyitaw 2. Training Course on research Ethics. Protecting Human research Participants October 2013, Naypyitaw

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CLINICAL RESEARCH UNIT (No. 2, MILITARY HOSPITAL (500 BEDDED), YANGON)

Advisor … Professor Colonel Ye Thwe MBBS (IMM), MRCP (UK), FRCP, FRCPE, FACTM, DrMedSc (General Medicine) … Professor Colonel Daw Yin Yin Htun MBBS, MMedSc (Int Med), FRCP (Edin) Head of Unit ... Professor Colonel Kyaw Thet Htun MBBS, MMedSc(Int Med), MRCP(UK) Research Members ... Professor Lt . Col Kyaw Soe Tun MBBS (UM 1), MMedSc(Int Med), DrMedSc (Hepatology) ... Professor Col. Daw Nwe Nwe Win MBBS, MMedSc (Int Med), MRCP (UK), FRCP (London), Dip in Med (Edu) ... Lt. Col. Daw Aye Min Soe MBBS, MMedSc (Int Med) MRCP (UK) ... Maj. Daw Theingi Kyaw MBBS, MMedSc (Int Med), DrMedSc (Endo & Metabolic Diseases) ... Maj. Win Myint MBBS, MMedSc (Int Med), DrMedSc(Neurology) ... Maj. Nay Myo Win MBBS, MMedSc (Int Med), DrMedSc(Respiratory Medicine) Coordinator ... Dr. Moe Thida Kyaw MBBS(IM 1), MMedSc(Biochemistry) (UM 2)

RESEARCH PROJECTS 1. NON-COMMUNICABLE DISEASES 1.1 OSTEOPOROSIS 1.1.1 Clinical Utility of Osteoporosis self-assessment tool for Asians (OSTA) by using Quantitative Ultrasonometry (QUS) in Post-menopausal women This study was a hospital-based, cross-sectional, descriptive study at the No. (2), Military Hospital (500 bedded), Yangon between October 2011 and August 2013. In this study, the mean age of the postmenopausal women was 56.34 ± 6.43 years, the youngest was 48 years old and the oldest was 84 years. The mean menopausal age was 48.62 ± 1.97 and duration was 7.66 ± 6.17 years. The mean BMI was 24.58 kg/m 2 (SD 4.43, range 16.21 to 38.54 kg/m 2). The OSTA index was -0.34 ± 2.21 (range -5 to 9.8) and the mean Bone Mineral Density (BMD) (T score) was -1.27 ± 1.44 (range -4.4 to 2.4). The OSTA index classification showed that 66.9% of postmenopausal women presented low risk, 33.1% medium risk and 1.9% high risk of osteoporosis, while QUS classified 36.8% for normal and osteopenia and 26.4% for osteoporosis. Base on the World Health Organization’s criteria for BMD, QUS detected that 26.4% of the postmenopausal women were at high risk of osteoporosis. The rest were normal and osteopenia 36.8% of each. For OSTA index, statistically significant results were found in relation to analyses of age (p=0.000), BMI (p= 0.000), and years since menopause. QUS showed significant differences with regard to the variable age (p= 0.017), years since menopause (p=0.045), but not in BMI (p= 0.219). Considering the QUS and OSTA index results together, it was seen that 29.25% of the women were classified as low risk, 15.09% as medium risk and 1.89% as high risk by both OSTA index and QUS. OSTA index demonstrated sensitivity of 40.29% and specificity of

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79.48% for identifying patients at medium and high risk of osteoporosis. The positive predictive value, which indicates the likelihood that medium and high-risk patients as assessed by OSTA are really medium and high-risk using QUS, was 77.14%. The negative predictive value, which indicates the likelihood that low-risk patients as assessed by OSTA are really low-risk using QUS, was 43.66%. Assessing the results, we noted that OSTA index presented a false negative rate of 59.71%, in comparison with QUS. According to our study, among the 67 (63.2%) women of high risk of osteoporosis using BMD, only 27 women were identified moderate to high risk by OSTA risk index. It means 56% women of high risk of osteoporosis will be neglected if they were assessed only by OSTA index. This represented a limitation to the use of this clinical tool, because such patients would fail to be diagnosed, since they would be erroneously considered to be at low risk. The present findings suggested that the application of the OSTA index for identifying postmenopausal women at an increase risk of osteopenia and osteoporosis in a younger age group has low sensitivity.

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CLINCAL RESEARCH UNIT (ONCOLOGY)

Advisor … Pro fessor Dr. Soe Aung MBBS, MMedSc(Int Med)(IM 2), MRCP (UK), FRCP(Edin), IT(Cambridge) Head of Unit … Dr. Khin Thinn Mu MBBS , MMedSc(Med Oncology)(IM 1) Research Members … Dr. Hlaing Hlaing Maw MBBS , MMedSc(Med Oncology) (IM 1) … Dr. Thazin Win MBBS , MMedSc(Med Oncology) (IM 1) … Dr.Theint Theint Win MBBS( IM 2), MMedSc(Med Oncology)(IM 1) … Dr. Thet Khine Zan MBBS , MMedSc(Med Oncology) (UM 1) … Dr. Zun Thynn MBBS( IM 1), MMedSc(Med Oncology) (UM 1) … Dr. San Yee Myint MBBS( IM 2), MMedSc(Med Oncology) (UM 1) Co ordinator … Dr.Than Than Aye MBBS( IM 1 ), MMedSc( Med Onco logy) (UM 1 )

RESEARCH PROJECTS 1. NONCOMMUNICABLE DISEASES 1.1 CANCER 1.1.1 Clinical response of Pamidronate in patients with metastatic bone diseases A hospital-based, quasi-experimental study was carried out in Medical Oncological Ward, Yangon General Hospital from May 2011 to December 2012 to determine clinical presentations of metastatic bone disease and to evaluate treatment response and side effects of Pamidronate on cancer patients with metastatic bone disease. A total of 25 metastatic bone disease patients were enrolled and treated with intravenous infusion Pamidronate sodium 60 mg in normal saline 1 liter for 4 hour (one cycle) for every 3 week. Their short term and long term effects were assessed after each cycle and six cycles of Pamidronate therapy respectively. Their ages ranged from 19 years to 79 years with male to female ration of 1:1.78 and peak incidence was seen in ≥60 years age group (11 cases, 44%). The most common primary cancer were breast cancer (12 cases, 48%) and lung cancer (8 cases, 32%). Out of 25, 20 patients (80%) presented with bone pain, 3 patients (12%) came for spinal cord compression and 2 patients (8%) presented with bone fracture. Before taking treatment, more than half of the patients (14 cases, 56%) had ECOG (Eastern Cooperative Oncology Group) performance status one with 11 patients (44%) suffered severe pain (Visual Analogue Scale(VAS) score ≥ 7).Their skeletal survey revealed that 72% (18 cases) had multiple metastasis and 16% (4 cases) had hypercalcaemia on laboratory tests. Short term assessment resulted that performance status improved in 20% of cases, 60% remained unchanged and 36% became worsen. VAS improved in 36% of patients, 52% remained unchanged, 12% became worsen. All patients with hypercalcaemia responded well to Pamidronate even with single infusion. Moreover, performance status (PS) (30% vs 20%) and VAS score (50% vs 36%) found to be more improved in long term than short term. According to WHO criteria of Radiological response, only 15% had partial response (PR), 60% no change (NC), 25% progressive disease (PD). Pamidronate was well tolerated and no severe side effect apart from hypocalcemia, bone pain and fever, malaise and weakness in a small percentage of patients. Thus, Pamidronate therapy on metastatic bone disease patients had improvement in symptoms (PS and VAS) but no significant changes in skeletal survey.

SERVICES PROVIDED ACADEMIC Sr.No. Name Course Responsibility 1. Dr. Khin Thinn Mu M.Med.Sc. (Medical Oncology) and Course chairman post-graduate students from various disciplines & specialties training

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CLINCAL RESEARCH UNIT (ORAL MEDICINE)

Head of unit … Prof. Dr . Swe Swe Win BDS, MDSc, DrDSc (Oral Medicine) (Ygn), FICCDE, FICD, FIAOO Research Members … Associate Prof. Dr. Sein Shwe BDS, MDSc, FICD, FICCDE, Dip.Med. Ed (Ygn) … Dr. Moe Thida Htwe BDS, MDSc, DrDSc (Oral Medicine)(Ygn), FICCDE … Dr. Win Pa Pa Aung BDS, MDSc (Ygn) … Dr. Kumudra Kyaw BDS , MDSc (Ygn) … Dr. Su Mon Than BDS (Mdy) … Dr. Kyi Pyar Lwin BDS (Ygn) Coordinator … Dr. Moh Moh Htun MBBS, MMedSc, PhD(Pathology) UM 1

RESEARCH PROJECTS 1. NON-COMMUNICABLE DISEASES 1.1 CANCER 1.1.1 ORAL CANCER 1.1.1.1 Evaluation of serum copper and zinc levels in betel quid associated oral submucous fibrosis and oral squamous cell carcinoma patients Oral submucous fibrosis (OSMF) is a well-recognized potentially malignant disease of the oral mucosa and oral squamous cell carcinoma (OSCC) is the most important and common malignant neoplasm. Many authors observed the direct association between trace elements such as copper and zinc and etiopathogenesis of oral premalignancies and the cancer mortality. Measurements of copper and zinc levels in the serum of OSMF and OSCC patients may be helpful in understanding the pathogenesis and rendering effective treatment. The purpose of the study was to evaluate serum copper and zinc in OSMF and OSCC patients with betel quid chewing habit. A cross-sectional descriptive study was conducted on clinically diagnosed 30 OSMF patients and histologically proven 30 OSCC patients. The serum concentration of copper and zinc were measured by atomic absorption spectrometry. Mean serum copper levels for OSMF was 1.39± 0.247ppm and OSCC was 1.33±0.295 ppm (P = 0.000) and mean serum zinc levels for OSMF was 0.825± 0.373 ppm and OSCC was 1.25± 0.687 ppm ( P = <0.05). Although there was no significantly difference between serum copper level of OSMF and OSCC patients, serum zinc level was significantly difference between OSMF and OSCC patients ( P = < 0.05). According to clinical stages OSMF, serum copper levels were gradually increased as the disease become progressive from Stage I to Stage III. As for histological grades of OSCC, moderately-differentiated OSCC had the highest serum copper and the lowest serum zinc levels. These findings indicated that trace elements copper and zinc have a role to play in pathogenesis as well as management of OSMF and OSCC.

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CLINICAL RESEARCH UNIT (SNAKE BITE)

Head of Unit … Professor Khin Maung Htay MBBS , MMedSc (Int Med) , MRCP (UK), DrMedSc(Medicine) Research Members … Professor Khin Thida Thwin MBBS, MMedSc (Int Med), MRCP (UK), DrMedSc(Medicine) … Dr. Win Win Hlaing MBBS, DipMedSc (Renal), MMedSc (Int Med), DrMedSc(Medicine) … Dr. Su Le Htay MBBS, MMedSc (Pathology) Coordinator … Dr. Han Win MBBS, MMedSc (Int Med)

RESEARCH PROJECTS 1. NON-COMMUNICABLE DISEASES 1.1 SNAKE BITE 1.1.1 Role of platelet rich plasma in acute kidney injury due to Russell’s viper bite cases Significant numbers of Russell's viper bite patients are complicated by acute kidney injury (AKI) and thrombocytopenia resulting in great morbidity and mortality. The supportive role of platelet rich plasma in the management of thrombocytopenia in Russell's viper bite induced ARF patients is still yet to know. Platelet rich plasma (PRP) is sometimes used to correct thrombocytopenia and coagulopathy in this situation. On the other hand, PRP or blood products may worsen the situation by inducing more intravascular coagulation and its consequences. There is no previous study of PRP infusion on outcomes of Russell's viper bite induced AKI with thrombocytopenia. In this study, 46 patients of Russell's viper bite presented within 24-96 hours with AKI and moderate thrombocytopenia, in Department of Nephrology, Yangon General Hospital were randomly and equally assigned into two groups as PRP treatment group and control group. In treatment group, 2 units of platelet rich plasma per day for three days were given. In this study, more patients (17 patients, 81.0%) in PRP treatment group needed dialysis compared to control group (13 patients, 56.5%) significantly. So also duration of AKI in PRP treatment group (21.3 days) was significantly longer than control group (9.5 days). Other parameters such as changes in platelet count, severity of AKI and survival rate were found to be worse in PRP treatment group compared to control group although it was not statistically significant. According to this study, platelet rich plasma should not be used in Russell's viper bite induced AKI with moderate thrombocytopenia without major bleeding. But, this study included only 46 patients and there may be some confounding factors such as time of bite, seasonal variation, amount of venom entered the body, timing and dose of antivenom, hypotensive episodes and septicaemia. Therefore, it is difficult to draw conclusion on platelet rich plasma usage in Russell's viper bite induced AKI with moderate thrombocytopenia without major bleeding.

1.1.2 Effect of different first aid methods on outcome of snake bite patients in Myanmar Snake bite is the common occupational hazard in Myanmar. Farmers, plantation workers and forest workers are vulnerable persons. Snake bite causes the great social and economic impact not only in those families but also in country. All snake bite patients have used different first aid methods to prevent the spread of venom in the body. Those first aid methods have been done in fields or in their local areas. Depending on the methods of first aid, morbidity as well as mortality of snake bite may be different. In addition, it sometimes gives severe disability like needing skin grafts. This study had been done on 203 Russell’s

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Annual Report 2013 viper bite cases admitted to Renal Medical Department of Thingangyun Sanpya Hospital from January 2012 to December 2013. Among them, 72% of patients used different first aid methods and 28% did not use any methods. Different first aid methods were (1) applied tight tourniquet above the site of bite (111 patients– 54.7%), (2) incision by knife or sharp materials (6 patients– 3%), (3) needle puncture (10 patients– 4.9%), (4) more than one method e.g. tourniquet and incision, incision and needle puncture etc (18 patients– 8.8%) and (5) other methods including applying herbal leaf, electric shock, burns etc (1 patient– 0.5%). To analyze the effect of those different first aid methods on their outcome, all patients were grouped as A- who used tourniquet, B- who used methods other than tourniquet, and C- who had never used any first aid method. Regarding the need for split skin graft, there was no significant difference among those three study groups. Similarly, there was also no significant difference in their length of hospital stay. Concerning with in-hospital mortality, it was higher in group C than group A (27% vs. 14.4%, p=0.04). However, there was no difference between group C and group B. It was difficult to draw a conclusion because factors influencing the outcome of Russell’s viper bite had many confounding factors like amount of venom injected, bite to needle time, amount and type of ASV, development of DIC and its severity. Therefore, in future a large study with proper design should be done to have better results.

1.1.3 Prevalence of microangiopathic haemolytic anaemia in Russell’s viper envenomation Russell’s viper envenomation causes a venom-induced consumption coagulopathy (VICC). A proportion of cases could go on to develop thrombotic microangiopathy characterized by thrombocytopenia, microangiopathic haemolytic anaemia (MAHA) and acute renal failure. Pilot study had been done in Renal Medical Department of Thingangyun Sanpya Hospital from January 2012 to December 2013. Total number of patients who had thrombocytopenia were 86, among them 72 (84%) were males and 14 (16%) were females. According to age distribution, 10 (12%) was 12- 20 years age group, 35 (40%) was 21- 30 years, 18 (21%) was 31- 40 years, 10 (12%) was 41- 50 years, 10 (12%) was 51- 60 years and 3 (3%) was 61- 70 years. Total amount of ASV used in them were 20- 100 ml in 57% of patients, 101- 200 ml in 28% of patients, 201- 300 ml in 9% of patients and 301- 400 ml in 6% of patients, respectively. Regarding bite to needle time, 17 (20%) patients had ASV within 30 minutes to 1 ½ hour, 16 (19%) had between 1 ½ hour to 3 hours, 24 (28%) had >3 hours to 6 hours, 18 (21%) had >6 hours to 12 hours and 11 (12%) had > 12 hours. According to the level of thrombocytopenia by WHO, 13 (15%) of patients had severe thrombocytopenia (platelet count < 20,000/µl), 35 (41%) had moderate thrombocytopenia (platelet count 20,000 - 50,000/µl), 31 (36%) had mild thrombocytopenia (platelet count 50,000 -150,000/µl) and remaining 7 (8%) had normal platelet count > 150,000/µl. Concerning blood transfusion, 1 (1%) had > 6 units of blood, 63 (73%) had 1- 6 units of blood including PRP, FFP, FWB and remaining 22 (26%) did not need any blood transfusion. Regarding the hospital stay, majority (70%) had hospital stay ≤ 2 weeks and remaining 30% had > 2 weeks. Short term in-hospital mortality was 30%. As this study was a pilot study, it was needed to do proper study with blood film examination, assessing parameters for diagnosis of DIC, standard replacement therapy like FFP in future.

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CLINICAL RESEARCH UNIT (TOXICOLOGY)

Head of Unit ... Professor Dr. Zaw Lynn Aung MBBS, MMedSc (Int Med), DipMedu, MRCP (UK), FRCP (Edin), FRCP (Glasgow) Research Members ... Dr. Ye Myint MBBS(Mdy), DipMedSc (IM 1), MMedSc (Int Med) (IM 1) ... Dr. Soe Nyunt MBBS(IM 2), MMedSc (Anaes) (UM 1) ... Dr. Hein Yazar Aung MBBS(IM 1), MMedSc (Int Med) (UM 1), MRCP(UK), DrMedSc(Gen Med) (UM1) ... Dr. Saw Aung Moe Aye MBBS (IM 1), MMedSc (Int Med) (UM 1) ... Dr. Win Win Myint MBBS (UM1), MMedSc (Int Med) (UM 1) Coordinator ... Dr. Min Wun MBBS(IM 1), MMedSc (Pharmacology) (UM 2)

The Clinical Research Unit (Toxicology) was established under the National Poison Control Centre, with the main objective of conducting evidence-based clinical studies concerning prevention, diagnosis and management of poisoning. The output of these studies will provide a clearer direction in the management procedures including formulation of guidelines, support appropriate patient care and ensure efficient use of available resources including antidotes. Additional collaborators include professionals from departments under the Ministry of Health, selected major hospitals, and postgraduate students.

RESEARCH PROJECT 1. ENVIRONMENTAL HEALTH 1.1 EPIDEMIOLOGY OF POISONING 1.1.1 Clinical profile of acute poison cases admitted to Poison Treatment Centre, New Yangon General Hospital (2013). Acute poisoning remains one of the commonest medical emergencies inflicting a substantial burden on health care system and patient family, as well as contributing significantly to cost of hospitalization and patient care. A clinical profile of poison cases was done to explore the trend of acute poisoning and outcome of management so as to upgrade guidelines for management and prevention of poisoning. The study conducted from January to December 2013, indicated 820 (11%) of total admissions at NYGH, to be acute poisoning , which is (37%) more than last two years (2011 and 2012) which were 511 (8%) and 597 (9%), respectively. There was more prevalence of female (520/820; 63.4%) over males (300/820; 36.6%) as last two years. Although drug poisoning stood the highest, (424/820; 51.7%) it was less than the last two years which were more than 60% of total admission. It was followed by chemical poisoning (318/820; 38.8%) which was increasing as they were less than 35% in 2011 and 2012. In drug poisoning, antihistamine (Chlorpheneramine maleate, Citrizine) is highest (147/424; 35%) followed by Paracetamol and analgesic poisoning (93/424; 22%) and CNS drug (diazepam, artane, trypta) (61/424; 14%). In 2011 antihistamine stood highest with 29% followed by CNS drug 21% and analgesic 19% but in 2012 it was CNS drug that stood highest with 33% followed by antihistamine 27% and analgesic 20%. There were increasing cases where the responsible drug cannot be identified as 12%, 13% and 23% for 2011, 2012 and 2013, respectively. In chemical poisoning, pesticide poisoning was the highest (94/318; 30%) (27% in 2011 and 18% in 2012) followed by rodenticide (85/318; 27%) (18% in 2011 and 13% in 2012) and alcohol derivatives (51/318; 16%). There is also increase in household product (thinner, detergent) poisoning

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Annual Report 2013 cases (47/318; 15%) which was only 1% of the acute poisoning cases last year. Most of the patients (570/820; 69.5%) has to stay in hospital for (1-3) days, (213/820; 26%) has to stay (4-7) days where only 17% of the patients needed longer hospital stay last year. Most patients (721/820; 87.9%) recovered but (26/820; 3.2%) expired in spite of treatment as the last two years. Main causes of mortality was insecticide poisoning (14/26; 54%). The study highlighted the magnitude of poisoning and the need of research on poison identification analysis, clinical and laboratory indicators for prognosis, outcome of treatment including supportive interventions and antidotal therapies to prevent unnecessary mortality and morbidity.

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CLINICAL RESEARCH UNIT (TRADITIONAL MEDICINE)

Head of Unit ... Dr. Tun Myint Aye MBBS (IM , Mandalay ), DIA(India) Research Members ... Daw Mya Mya Win BSc (Zoology)(UDE), DTM (ITM) ... Daw May May Kyi DTM (ITM) ... U Tint Lwin BSc (Maths) (UDE), DTM (ITM) ... Daw Khin Saw Win BA (History, DTM) (ITM) Coordinator ... Dr. May Aye Than MBBS(IM 1), MMedSc (Pharmacology) (IM 2)

During the year under report the clinical study was conducted on effectiveness of traditional medicine therapy in post stroke patients.

RESEARCH PROJECTS 1. NON-COMMUNICABLE DISEASES 1.1 STROKE 1.1.1 Effectiveness of Shirodhara therapy in post stroke patients This study was aimed to find out the effectiveness of Shirodhara therapy in Post Stroke patients. In this study, the functional abilities of the post stroke patients before Shirodhara therapy and the functional abilities of the post stroke patients after Shirodhara therapy were identified. The study was conducted at the General Medical Unit, Yangon Traditional Medicine Hospital. The hospital based open label clinical study of pretest posttest design was carried out on 14 post stroke patients admitted to Yangon Traditional Medicine Hospital. Stroke patients of both sexes with age between 30 and 65 years (50.86 ±11.35 year) diagnosed as first time and suffering from one to six months duration were selected. The European Stroke Scale, Barthel Index, Motricity Index and trunk control test were measured before starting the therapy. The vital signs were monitored. Then, the Shirodhara therapy was started. Firstly, the patient was massaged with luke warm medicated oil (temperature 40°±1ºC) over the whole body and asked to lie on the Shirodhara table in supine position. Then, the eyes and ears were covered with the cotton pad and lightly bandaged with the cloth. Shirodhara pot was hung to the stand and the nozzle of the pot was 7.5 to 10 cm above the forehead of the patient. Then luke warm medicated oil (temperature 40º±1ºC) was poured into the forehead of the patient. Dhara pot was moved by the traditional medicine practitioner in an oscillating manner. The duration for Shirodhara therapy was about half an hour for each time. After completion, the head was washed with warm water and cleaned with towel. Shirodhara therapy was given to the patient daily for four weeks. The vital signs and side effects were monitored during the therapy. Data were collected by interviewing the patients with preformed questionnaires as well as by examining with the assessment tools. These assessments were measured at 0, 2 and 4 weeks of therapy. Only one out of 14 (7.14%) showed no improvements and the rest (92.86%) showed improvements in the functional abilities. The mean score differences of the European Stroke Scale, Barthel Index, Motricity Index and trunk control test between week 0 (base line) and week 2 were (+10.86), (+12.86), (+15.86) and (+15.79), respectively. Differences in mean score were statistically significant. The mean score differences of the European Stroke Scale, Barthel Index, Motricity Index and trunk control test between week 0 (base line) and week 4 (end of study) were (+20), (+24.65), (+28.43) and (+38.29), respectively. Differences in mean score were statistically significant (Table 1). The results of this study have shown scientifically that Shirodhara therapy is effective to improve the functional abilities of the post stroke patients with no side effects.

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Table 1. Mean Score Differences (The European Stroke Scale, Barthel Index, Motricity Index and trunk control test) from Week 0 to Week 4 after Shirodhara therapy in Post Stroke Patients

Week 0 Week 2 Week 4 Score Difference Score Difference at n=14 N=14 n=14 at Week 2 Week 4 Variable Mean Mean Mean Mean Mean P value P value (SD) (SD) (SD) (SD) (SD) The European 46 56.86 66 +10.86 +20 0.000 0.001 Stroke Scale (15.89) (14.51) (18.52) (1.38) (2.63) Barthel 32.14 45 56.79 +12.86 +24.65 0.020 0.000 Index (26.44) (21.93) (23.10) (4.51) (3.34) Motricity 16.07 31.93 44.50 +15.86 +28.43 0.000 0.000 Index (22.90) (20.05) (23.42) (2.85) (0.52) Trunk control 25.07 40.86 63.36 +15.79 +38.29 0.010 0.000 test (27.74) (32.20) (32.40) (4.46) (4.66)

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CLINICAL RESEARCH UNIT (UNIVERSITY OF MEDICINE 2)

Head of Unit … Professor Dr. Khin Nyo Thein MBBS, MMedSc(Paed) (IM 1), MRCPCH(UK) Research Members … Prof. Kyaw Zin Wai MBBS, MMedSc(Paed)(IM 1), MRCPCH … Dr. Khin Win Myint MBBS, MMedSc(Paed)(IM 1), MRCPCH … Dr. Ei Phyu Lwin MBBS, MMedSc(Paed)(IM 1), MRCPCH … Dr. Thein Tun MBBS, MMedSc(Paed)(IM 1) … Dr. Phyu Phyu Oo MBBS, MMedSc(Paed)(IM 1) … Dr. Cho Cho Win MBBS, MMedSc(Paed)(IM 1) Coordinator … Dr. Win Lai May MBBS, MMedSc(Paed)(UM 1)

RESEARCH PROJECTS 1. COMMUNICABLE DISEASES 1.1 DIARRHOEA 1.1.1 Clinical Profile of Acute diarrhea diseases in children aged 2 month to 5 year with positive bacterial culture results and negative bacterial culture results Diarrhoeal disease and its complications remain a major cause of morbidity and mortality in children, especially in developing countries. This study was conducted to study the clinical profile of acute diarrhoeal diseases in children aged 2 months to 5 years with positive and negative bacterial culture results. It was a hospital-based, cross-sectional descriptive study done on 100 patients (aged 2 months - 5 years) admitted to Yankin Children Hospital with acute diarrhoeal diseases during March 2012 to February 2013. Rectal swab cultures were taken from all cases. Bacterial pathogens were isolated in 45% of cases and isolated bacterial pathogens were V. cholerae 21%, EPEC 11%, EIEC 6%, Klebsiella 5% and Shigella spp. 2%. Dehydration was seen in 74% of cases, fever in 70%, vomiting in 76%, shock in 6%, tenesmus in 4 % and paralytic ileus in 2%. Among acute diarrhoeal cases with positive bacterial culture results, severe dehydration was seen in 15.6% of cases, some dehydration in 62.2% and no dehydration in 22.2%. In children with negative bacterial culture results, severe dehydration was seen in 9%, some dehydration in 61% and no dehydration in 30%. High fever was seen in 8 cases, 50% were bacterial culture positive and 50% were bacterial culture negative. Vomiting was noted in 76% of cases. Among them, 55% were bacterial culture negative and 45% were bacterial culture positive. Isolated pathogens were found to be resistant to the commonly used antibiotics in daily clinical practice. The clinical features of diarrhoeal illness are not distinctive enough to allow confident diagnosis of the causal organisms, and routine laboratory studies are of limited value. Hence, more conclusive laboratory tests are needed and monitoring of the antibiotic resistance pattern should be continued to define the shifting antibiotic sensitivity pattern.

1.2 CHOLERA 1.2.1 Different clinical signs and symptoms among children with diarrhea due to cholera and non-cholera causes Myanmar is one of the cholera endemic countries and it is important to recognize the cholera suspected cases in order to isolate and give antibiotic apart from rehydration. This study was hospital-based, cross-sectional, descriptive study conducted in teaching hospitals of University of Medicine 2, Yangon from January 2013 to December 2013. Children under 12 years with acute watery diarrhoea were included in this study. Out of 250 cases, cholera

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Annual Report 2013 was isolated in 18 children (7.2%). Among cholera cases, severe dehydration was found in 2 cases (11.11%), some dehydration in 8 cases (44.44%) and no signs of dehydration in 8 cases (44.44%), fever in 13 cases (72.22%) and vomiting in 12 cases (66.66%). Among non- cholera cases, severe dehydration was found in 3 cases (1.29%), some dehydration in 76 cases (32.75%) and no signs of dehydration in 153 cases (65.94%), fever in 192 cases (82.7%) and vomiting in 159 cases (68.5%). Rice watery stool was found in 3 cases and all are cholera cases. Shock was found in 3 cases and 2 were cholera and 1 was non cholera case. Rice watery stool and shock are highly suggestive of cholera. Cholera was also found in no dehydration cases (4.9%) and no sign of dehydration cannot exclude cholera.

1.3 MENINGITIS 1.3.1 Clinical profile and bacterial etiology of acute pyogenic meningitis in children Acute pyogenic meningitis (APM) is a medical emergency, which warrants early diagnosis and aggressive therapy. The purpose of this study was to study clinical profile and bacterial etiology of acute pyogenic meningitis in children . This study was a hospital-based, cross-sectional, descriptive study conducted in teaching hospitals of University of Medicine 2, Yangon from January 2013 to December 2013. Children under 12 years with pyrexia less than 1 week who were clinically suspected as acute pyogenic meningitis by experienced pediatricians were selected at first and lumber puncture was done. Cases with abnormal cerebrospinal fluid (CSF) examination (CSF pleocytosis, reduced CSF glucose concentration < 40 mg/dL and increased CSF protein concentration > 45 mg/dL) were included in the study. Among them, acute pyogenic meningitis was confirmed by 1 or more of the following – 1. Organisms grown from CSF, 2. Gram positive and Gram negative organisms identified in CSF, 3. Organisms grown from blood and 4. Meningeal exudates at autopsy. Out of 103 total cases, 44 (42.7%) cases had abnormalities of cerebrospinal fluid (CSF). Among them, 12 (27.2%) cases were confirmed by acute pyogenic meningitis by detecting bacteria in blood or CSF culture. Among 44 cases, the commonest age group was between 2 months and 5 years (31.8%) and male: female was 1.09:1. The commonest presentations were fever (68.1%), convulsion (38.6%), headache (20.4%) and impaired conscious level (18.1%). Complications were found in 5 cases (11.3%), and 4 cases (9%) were expired. There were 3 cases of Staphylococcus aureus and 1 case of Escherichia coli in blood culture. There were 2 cases of Neisseria meningitidis , 1 case of Staphylococcus aureus, 1 case of Streptococcus pneumonia , 1 case of Streptococcus faeclis and 1 case of Escherichia coli in CSF culture . There were 1 case of Streptococcus viridan and 1 case of Listeria monocytogenes in both blood and CSF culture. No bacterium was detected in Gram’s stain. One of the expired cases, 51 days old infant, had Escherichia coli in CSF culture and another 3 expired cases had negative culture in both blood and CSF. All Staphylococcus aureus was sensitive to Ceftazidine, Cefoperazone + Sulbactum, Amikacin and Ciprofloxacin. All of Neisseria meningitidis was sensitive to Ceftazidine, Cefoperazone + Sulbactum, Ciprofloxacin and Chloramphenicol and all of Escherichia coli was sensitive to Ceftazidine. Majority of bacteria causing pyogenic meningitis was resistant to currently using antibiotic (Cefotaxime and Ceftriaxone) in this study.

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SERVICES PROVIDED ACADEMIC Sr. Name Course Responsibility No. 1. Prof. Khin Nyo Thein - Undergraduates Final Part I and II Chairman, examiner training - House-officer internship training Chairman - M.Med.Sc (Paed) 1 st to 3 rd year Chairman, examiner training - Diploma in Family Medicine (D.F.M) Examiner, Lecturer - MRCPCH training (Part I and II) Facilitator - Dr.Med.Sc (Paed) 1 st to 3 rd year Chairman, examiner training

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CENTRAL BIOMEDICAL LIBRARY

Research Officer & Head ... Daw Ch o Mar Oo BA (Economics), DipLibSc (YU) Research Officer ... U Khin Soe BSc(Maths) (Workers’ College, Yangon) ... Daw Wah Wah Hla Phyu MSc(Zoology) (YU), DCSc (UC) ... U Nyo Aung BSc(Zoology) (RASU) Library Assistant (2) ... Daw Mu Mu Myint BSc(Botany) (YU), DLIS (YU) ... Daw Cho Cho Aung BA(Myanmarsar) (Workers’ College, Yangon) ... Daw Naw Than Than BA (Myanmarsar) (UDE) Library Assistant (3) ... Daw Wai Wai Hlaing Thu BSc(Physics) (UDE) ... Daw Phyo Phyo Ei BSc(Zoology) (UDE) ... Daw Khin Nan Pyone BSc(Botany) (UDE), DLIS (YU) Library Assistant (4) ... Daw Aye Mya Oo BA(History) (UDE) ... Daw Kyi Kyi Htay LLB(Law) (UDE) Library Worker ... Daw Aye Aye Mu

Central Biomedical Library (CBL) is a major research library in the field of health and biomedical sciences. The library primarily serves the staff of the Department of Medical Research (Lower Myanmar) (DMR-LM). It also caters the needs of health information to the researchers, scientists, postgraduate students and health personnel under the Ministry of Health and researchers from other ministries. It also provides health literature and related information with online access to local as well as global. CBL is the National Focal Point Library for Health Literature Library and Information Services (HELLIS) Network being established by World Health Organization/South East Asia Regional Office (WHO/SEARO).

SERVICES PROVIDED 1. RESEARCH CAPACITY STRENGTHENING 1.1. ROUTINE SERVICES 1. 1.1 Acquisition Service The library collection consists of mainly materials on Health and Biomedical Sciences. It emphasizes the collection of current medical literature in the form of periodicals, journals and bibliographic sources in printed and microforms, journals and other periodicals acquire through subscription and as gifts. During the year under report, CBL subscribed 3 weekly publications and 3 monthly publications in hard copy and totally received 135 copies and 29 CD-ROMs. A total of 396 books and 349 journals in loose issues were collected and the total collection of books at CBL was 18,328 and the total collection of bound journals at CBL was 24,722.

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Acquisition / Collections Sr. Subscribe Grand Description Gift Total No. / Buy Total 1. Journal Title - International 72 187 259 - National 65 25 90 24,722 2. Books (Including Theses and Dissertation) 6 390 396 18,328 3. CD-ROM (Including - 29 29 358 Theses and Dissertation) 4. WHO-Publications - Serials 27 27 - - Non Serials (Monographs) 45 45 3,556 5. Fugitive Literature 1 95 96 1,575 6. Newspaper Clippings on Health - News - - 36 1,473 - Articles - - 102 900 - Editorials - - 31 589

1.1.2 Circulation Service During the reported year, 457 books and 300 journals were loaned out, of which 309 books and 134 journals were borrowed by non-DMR-LM staff. A total of 413 readers used the library, of which 253 readers were non-DMR-LM staff. If necessary, interlibrary loan facility was also provided with other medical libraries.

1.1.3 Literature Search Services Internet, CD-ROMs and online bibliographic search services are available in CBL. Library users are allowed to use computer for self searching. Library databases (holding list of books, periodical, theses, index of medical journal articles and research papers etc.) are provided through Computerized Documentation Service/Integrated Set of Information Systems (CDS/ISIS). CD-ROMs bibliographic search services such as: Medical Online (MEDLINE), and Population Online (POPLINE) are also provided. WHO Health Inter Network Access to Research Initiative (HINARI) website can be accessed from the internet, and provides to the full text of articles from medical journals with 230 titles. Total number of searches were 150 internet (including HINARI) and 200 ISIS.

1.1.4 WHO Depository Library Service CBL served as the WHO Depository Library for Myanmar since 1995. During 2013, the library received as gift of 45 non-serials and 27 serial copies of WHO publications. Loan and bibliographic search of WHO publications (manual and web page access to WHOLIS; SEALIS, etc.) is provided.

1.1.5 Reprographic Service Photocopy and computer printout services were provided. Four computers were used for the assigned service. Articles from journals and books can be copied. Computer printout from CDs and searches from Internet are available.

1.1.6 Newspaper Clip Compilation Service During the reported year, newspaper clip compilation service was provided. All news and articles related to health and medicine in Myanmar were clipped and compiled into three

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groups, as news, articles and editorials. Three Myanmar newspapers (one in English language and two in Myanmar language) in pdf format have been compiled since June 2009.

1.2 SPECIAL SERVICES 1.2.1 HELLIS Network Service a. Reprint Request Service and Document Delivery Reprint request service for full text journal articles not available in Myanmar was provided by HELLIS Resource Centre of the WHO/SEARO Library. b. Collection of Fugitive Literature in Myanmar Fugitive literature, such as documents and reports of Government departments and institutions, were also collected and total number of collection was found to be 96 during year 2013.

1.2.2 Updating and Indexing Periodicals a. Periodicals Database Updating the database on periodicals holding list of CBL is done in progress. b. Theses Database Updating of database on theses of health and allied sciences in Myanmar is on going process.

1.2.3 Internet Server Services Provision of internet server services including installation, maintenance, Troubleshooting and wifi was made. Anti-virus programme was updated as required.

1.2.4 Training The two months practical training course were given to Daw Ei Ei Myo Kyaw, Daw Ei Ei Nyein Chan, Daw Khin Hnin Yee and Daw Kyein Lywan Nyan from Department of Library and Information Studies, University of Yangon, from August to September 2013.

1.2.5 Development of Health Research Information System Health Research Information System development has been initiated since March, 2013 supported by Korea International Cooperation Agency (KOICA). Components included the upgrading of barcode system and online membership, E-Library section of CBL, creating online CBL web page domain. During the reporting year, online literature search for local health research information. Such as articles from DMR-LM Bulletin and Myanmar Military Medical Journal can be accessible through http://www.dmrlmlibrary.org. Data transfer for repository is in progress including Myanmar Health Sciences Research Journal (1989-2013), Myanmar Medical Journals, Theses, Research Papers and Fugitive Literature.

SERVICES PROVIDED ACADEMIC

Sr. No. Name Course Responsibility 1. Daw Cho Mar Oo Field Research Methodology Training Lecturer

Workshop on Research Methodology Lecturer

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COMPUTER DIVISION

Research Officer & Head ... U Tin Maung Maung BEcon(Statistics) (IE, Yangon ) Research Officer ... Daw Nilar Khin BSc(Chemistry) (RASU), DAC (UCC) Research Assistant (2) ... Daw Phyu Phyu Htun BSc(Chemistry) (YU) ... Daw Win Win Mar BA(Economics) (UDE), PGDCA(YU) Research Assistant (3) ... Daw Nwe Nwe Khine BA(Myanmarsar) (Mawlamyaing University) Research Assistant (4) ... Daw Zin Mar Khin Nyo BA(Economics)(UDE) Laboratory Worker ... Daw Khine Khine Win

Computer division mainly focuses in dissemination of newly updated information technology related to computer system. Services on computer hardware and software installation, trouble shooting computer problems, recording and storing of research findings and information from Myanmar Health Research Congress are mainly provided. The division also provides services such as data management, power point presentation, word processing and desk top publication as requested by other research divisions. Moreover, the division managed basic computer application courses for DMR (LM) staff. The division also assists to seek for information relating to research works by using internet efficiently.

SERVICES PROVIDED 1. RESEARCH CAPACITY STRENGTHENING 1.1 ROUTINE SERVICES 1.1.1 Data management and statistical analysis Data management and statistical analysis with software such as STATA, SPSS, MS Excel and EPI INFO were performed for 6 requested jobs using 68 machine-hours and 71 man-hours.

1.1.2 Graphic design and Power Point preparation The division provided technical skills in preparing power point presentation for meetings, workshops, seminars, symposia and conferences held at DMR (LM) and other institutions. The division was also involved in creating graphic presentation for research papers, reports and posters. The staff of the division utilized 31 machine-hours and 41 man- hours for 8 requested jobs.

1.1.3 Word processing and secretarial services Word processing was conducted for dissemination of health related topics such as journals, reports, news and articles. Word processing service was provided for 48 various research projects and adhoc reports using 475 machine-hours and 478 man-hours.

1.1.4 System maintenance and software installation, trouble shooting (1) Detecting and cleaning computer virus, spy ware and computer worm with updated antivirus software. (2) Myanmar Unicode fonts version 2, 3 and Classie were installed for research divisions as required.

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(3) Hardware maintenance and reinstallation of Operating System (Windows XP, Windows 7 with MS office etc.) due to computer viruses.

1.1.5 Reconstruction of DMR (LM) Manpower Database and updating profiles Existing Manpower Database of DMR (LM) was reconstructed by entering the CV data using Myanmar Unicode version 2 according to Ministry of Health format.

1.1.6 Documentation and application of computer facilities at Myanmar Health Research Congress (MHRC), Workshops, Symposia and other academic sessions As a documentation of Myanmar Health Research Congress, programs, abstracts, photos and power point presentations were compiled yearly. Abstracts of 97 research papers and 34 posters included in Programme and Abstract book of 42 nd Myanmar Health Research Congress were formatted. The staff assisted in power point slides preparation for (8) Symposia and (1) Scientific talk being held during 42 nd MHRC. The staff assisted in power point slides preparation for (5) Workshops and (11) Scientific talks at DMR (LM). The division is responsible for computer aided projector shows during protocol reviews, scientific talks, seminars, conferences and in-house training conducted by DMR (LM) and other institutions.

1.1.7 Information technology dissemination Updated programs (e.g. NOD32 anti-virus, research related Power point files and acrobat utility etc.) are available by downloading from Internet.

1.2 SPECIAL SERVICES 1.2.1 COMUPTER TRAINING COURSE Basic Computer Application Course for researchers and research assistants was conducted from 15-8-2013 to 22-11-2013. The training course covered background knowledge of hardware and software applications. Windows XP Operating System and MS- Office application software such as MS Word 2007, MS Excel 2007 and MS Power Point 2007 were included in the course of (19) trainees from various research divisions, (16) trainees completed the course (84%). Time allocated for lectures given were (8) hours for Basic Computer, (8) hours for Windows Operating System, (70) hours for MS-Office application software, (36) hours for utility applications and (5) hours for examination. The trainees attended lectures as well as hand-on sessions during the course.

1.2.2 INFORMATION & COMMUNICATION TECHNOLOGY Strengthen ICT-based services and resources for research on Communicable Diseases by collaborating with KOICA. Basic Computer Application Course will be upgraded by computers of advanced models.

1.2.3 Others Documentation of Golden Jubilee Commemorative Volume (1963-2013) book with CD was prepared. The division took part in desktop publishing of the Commemorative Book and audio-visual aids for seminars and experience talks presented in 50 th Anniversary Ceremony of DMR (LM).

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INSTRUMENTATION DIVISION

Research Scientist & Head … U Maung Maung Gyi B.Sc(Physics), D.A.P (Electronics) (RASU) Research Scientist … U Than Win BSc, Diploma in Applied Physics(YU) Research Officer … U Po Htwe B.Sc(Mathematics)(YDE), ETEC(Electrical) … U Kyaw Min Oo B.Sc(Chemistry)(WC) … Dr. Cho Thanda Tun B.Sc(Hons;), M.Sc, M.Res, PhD(Physics)(YU) … Daw Aye Nwe Soe B.Sc (Q), M.Sc, M.Res(Physics)(YU) … Daw Yin Ei Kyaw B.Sc(Hons;), M.Sc, M.Res(Physics)(DU) … U Khine Win B.Sc(Zoology), D.C.S(YU) Electrical & Mechanical Technician (2) … U Htain Lin B.A(History) (UDE) … U Kyaw Moe Swe B.A(History)(UDE) … U Myint Zaw B.A (Geography)(DU), AGTI(Electrical) … U Phyo Minn Oo B.A(Business Management)(DU) … U Tin Ko Kyi B.A(History)(UDE) … U Saw Ba Win B.Sc(Physics)(DU) , Diploma in Applied Physics; M.Sc Engineering Physics(YU) … Daw Yu Yu Maw B.A(History)(UDE) Electrical & Mechanical Technician (3) … U Thet Paing Soe B.Sc(Physics)(DU), AGTI(IT) Electrical & Mechanical Technician (4) … U Phyo Wai Kyaw … U Myo Min Aung … U Thet Myint Oo … U Sint Than

The responsibility of the Instrumentation division is to technically support DMR in its research activities. It has four main labs such as, (1) Electronics, (2) Electrical, (3) Mechanical, and (4) Optical lab with specialized expertise in each respective field to provide effective and reliable service in installation, repair and maintenance of various types of laboratory equipment and utilities for the whole department.

SERVICES PROVIDED 1. RESEARCH CAPACITY STRENGTHENING 1.1 ROUTINE SERVICES A total of (336) work requests were received from the division of DMR (LM) in the year 2013, and the services provided were classified as follow:

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Assigned Completed Remaining Sr. Work Job Description workshop/ jobs jobs Remarks No. received Lab (Qty) (Qty) 1. Medical labora- 27 Electronics 27 Nil tory equipment 2. Air-conditioners & 116 Mechanical 116 Nil refrigerators 3. Electrical wiring & 193 Electrical 193 Nil installation Total 336 336 Nil

1.2 MAINTENANCE SCHEDULE Equipment registry for all the laboratories in the DMR (LM) has been updated and the maintenance schedule has also been revised accordingly. Every first Friday of the month is the designated Equipment Day to perform user maintenance on all medical laboratory equipment in every research division to improve efficiency, to prolong the life of instruments and to acquire precise data and results.

1.3 IMPLEMENTATION OF SERVICE RECORD DATABASE The service record database system is now in use and all the work requests and jobs done by the Instrumentation Division can be traced easily and systematically for effective work execution and management.

1.4 IMPLEMENTATION OF STOCK RECORD DATABASE The stock record database system is designed to keep record as well as to monitor the appropriate use of issued items and to keep track of the remaining balance of those in order to ensure timely replenishment so that maintenance could be done without delay and on schedule.

1.5 ACADEMIC 1.5.1 International

Sr. Name Course Responsibility No. 1. U Po Htwe Advanced Course on Healthcare Technologies Training (Bio-Medical Equipment and Medical Informatics), Centre For Development of Advanced Computing, Mohali (Punjab), India

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LABORATORY ANIMAL SERVICES DIVISION

Research Officer & Head … Dr. Aye Win Oo BVS (IAHVS, Yezin), MVMedSc (Rep. of Korea) Research Officer … Daw Mu Mu Win BSc(Zoology) (RASU) Research Assistant (2) … Daw Than Myat Htay BA (Philosophy) (WC) … Daw Khin Hnin Yi BSc(Zoology) (WC) … Daw Mya Mya Sein BA(Psychology) (UDE) Research Assistant (3) … Daw Thandar Win BA(Geography) (UDE) … U Aung Kyaw Zaw BA(Myanmar) (UDE) … Daw Hnin Ohnma Oo BSc(Physics) (YU) Research Assistant (4) … U Myint Oo … U Tint Zaw Maung Laboratory Attendant ... U Mahazan ... U Myat Htun Aung ... Daw Hla Hla Win ... Daw San San Myint ... Daw San ... U Myo Htat ... U Tint Zaw Maung ... U Wanna Htun ... U Aung Myat BA(Gerography) (UDE) ... Daw Yi Yi Win

The responsibilities of the Laboratory Animal Services Division are: to produce and maintain good quality laboratory animals, to maintain and build up research facilities for experimental animal models, and to provide various strains of laboratory animals to various divisions from Department of Medical Research (Lower Myanmar) and other Institutes for their research purposes and to conduct research works on experimental animals.

SERVICE PROVIDED 1. RESEARCH CAPACITY STRENGTHENING 1.1 ROUTINE SERVICES 1.1.1 Breeding, Supply and Care of Laboratory Animals These services are major responsibilities of the division.

1.1.1.1 Breeding of Laboratory Animal Routine breeding of the following experimental animals were carried out during the period under report.

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In Out Total Types of Animal Previous Born Issued Dead/Disposed (Balance) Rabbit 41 35 21 15 40 Guinea pig 91 8 4 16 79 Rat 814 198 253 510 261 Mouse (icr) 1010 518 515 227 786 Mouse (ddy) 886 397 935 11 337 Mouse (AKR) 203 95 - 4 294 Mouse (BALB/c) - Japan 109 48 8 - 149 Mouse (BALB/c) - Thai 496 90 72 105 409

1.1.1.2 Routine Supply of Laboratory Animals During the period under report, the following types and numbers of experimental animals were issued to the various divisions of DMR (LM) and other institutions.

Name of Divisions Types & numbers of animals supplied No and Institutions Rabbits Guinea pigs Rats Mice 1. DMR(LM) 1.1. Biological Toxicology - - 5 9 1.2. Entomology - - - 253 1.3. Immunology - - - 10 1.4. Pharmacology - - 32 385 1.5. Vaccine Quality Control 2 - - 97 1.6. Virology - - - 235 2. DMR (Upper Myanmar ) - - 6 35 3. University of Medicine (1) - - 3 - 4. University of Medicine (2) 4 - - - 5. Myanmar Pharmaceutical 11 - - - Factory (Pyin Oo Lwin) 6. Hepatitis B Vaccine Plant 4 - - 50 7. Others - 4 207 456 Total 21 4 253 1530

1.1.1.3 Care of Laboratory Animals Regular works of division were carried out according to the following schedules. Monday - change of bedding Tuesday - corridors and building cleaning Wednesday - making of animal pellet food Thursday - cleaning the animal cages, water bottles and utensils Friday - room cleaning and check the conditions of animals

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1.1.2 Incineration of the Waste Disposal The division is responsible for incineration of the waste disposals such as blood bags, infectious syringes and needles, dead animals' bodies and other biological products by using the incinerator. During the time under report, a total of (24) incineration works were performed.

1.2 SPECIAL SERVICES

1.2.1 Disinfection and Prevention of Animal Diseases in Laboratory Animal Services Division, DMR-LM (WHO-S&E, 2012-13) Good laboratory practices (GLP) for animal facilities is necessary to assure quality and safety of animals used in the animal laboratory during conducting biomedical and behavioural research and testing of products. The vertical autoclave for moist heat sterilization of infectious organisms was installed.

1.2.2 Care of Experimental Laboratory Animals from Other Research Divisions of DMR (LM) Laboratory Animal Services division is taking care of two goats from Experimental Medicine Research division and five geese from Virology Research Division for their research purposes.

1.2.3 Breeding and Maintenance of Balb/C Strain of Mice from Thailand BALB/c strain inbred mice (2 males and 3 females) were imported from National Laboratory Animal Centre, Mahidol University, Thailand in 1999 and have been bred in special mice house. There are 409 numbers of BALB/c strain mice in the division now.

1.2.4 Breeding and Maintenance of ICR Strain from Republic of Korea Mice of icr strain (20 males and 60 females) were imported from CJ Co., Republic of Korea in 2006 and have been kept under special care. To date, a total of 786 icr strain mice have been bred in the Division.

RESEARCH PROJECTS 1. ENVIRONMENTAL HEALTH 1.1 Study of Different Type of Noisy Sounds Effect on Growth and Reproductive Performance of Male and Female Wistar Strain Rats The Guide for the Care and Use of Laboratory Animals notes that researchers and personnel should take noise into consideration when creating and maintaining an environment for laboratory animals. It has been recognized that noise effect is an important factor for laboratory animals’ husbandry. In this study, it was intended to find out the effect of the different kind of noisy sounds on reproduction, growth and breeding performance of Wistar strain rats at DMR (LM). Ten males and thirty females of laboratory rats, Wistar strain, from DMR (LM) (mean body weight of male = 265+15 g, female = 235+15 g) were selected. Wistar rats were housed in animal cage set (430 mm X 2700 mm X 150 mm) TARSONS Pvt. Ltd, INDIA with the mating ratio of one male and three females. The experimental devices for sound such as cassette player, amplifier and speakers were set up in the experimental room. In the mating time, it was switched on songs such as the noisy Rock

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Mating No. of Pregnancy No. of Group Litter size (No. of suckling) Ratio (Pregnant female) Delivery 1 1:3 2 2 23 2 1:3 3 3 36 3 1:3 3 3 39 Total 8 8 98 (88.88%) (88.88%) (Avg: 12.25 ss / one mother)

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PUBLICATION DIVISION

Research Scientist & Head … Dr . Ni Thet Oo BVS (IAHVS) , HGP , Dip ELTM (IOE) Research Officer … U Ye Thway BSc(Physics) (YU) … Daw Win Win San BA(History) (YU), Dip LibSc (YU) … Daw Nilar Soe BA(Myanmarsar) (UDE) , Dip Japanese Language (YUFL), Dip LibSc (YU) Printing Technician (2) … U Htun Htun BA(History) (YU) … Daw Cho Cho Lwin BA(History), Dip Global English (YU) ... Daw Pwint Phyu Khaing BSc(Zoology)(YU), PGDCA(YU) Dip Korea Language (YUFL) Printing Technician (3) … Daw Ei Zin Mar BA(Geography) (YU) … Daw Win Shwe Aye BA(Geography) (YU) Printing Technician (4) … Daw Naw Eh Sel Hti BA(History) (YU) Printing Worker … Daw Htoo Htoo Aung

The Publication Division has provided the research capacity strengthening and research knowledgement in DMR (LM) by performing the following services: publication, dissemination, photography and health education.

SERVICES PROVIDED 1. RESEARCH CAPACITY STRENGTHENING 1.1 PUBLICATION SERVICE 1.1.1 Myanmar Health Sciences Research Journal (MHSR J) The MHSR Journal publishes review articles, long articles, short reports, review articles and correspondences in the field of biomedical and health sciences. The Journal, printed in 500 copies per issue, is published every 4 th month (i.e., April, August and December) in a year. From January to December 2013, the MHSR Journal Vol. 25, No. 1 (April, 2013) and Vol. 25, No. 2 (August, 2013) and Vol. 25, No. 3 (December, 2013) were published. The whole series of volume 25 has been published as special issues of the Golden Jubilee mark of Department of Medical Research (Lower Myanmar). Fifteen articles have been accepted for Vol. 26, No. 1. During the 41 st Myanmar Health Research Congress held in January, 2013, the research papers presented at the paper reading session and displayed as posters were requested to the respective authors for publications. During the year under report, a total of 38 research papers (28 from DMR (LM) & others, 10) were received for publication in the MHSR Journal. The annual meeting of the MHSR Editorial Committee was held on 29 September, 2013 and the new committee which consists of 21 members (ten from DMR (LM) and eleven from Medical Universities) was formed. Dr. Catherine DeAngelis, Professor of Pediatric, Deputy Dean, Johns Hopkins School of Medicine, Emeritus Editor-in-Chief, JAMA discussed with the editorial members for upgrading the Myanmar Health Sciences Research Journal. After the meeting, Professor Catherine De Angelis gave a scientific talk on "Conflict of Interest in Medical Research and Medical Journalism".

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1.1.2 DMR (LM) Bulletin DMR (LM) Bulletin, monthly-issued, covers international and local news about medicine & health, highlights on useful research findings applicable to health and abstracts of research papers published or read abroad by DMR (LM) scientists. In addition, advertisements on Hepatitis B Vaccine Clinic, Cervical Cancer Screening Clinic, Reproductive Health Hot-line, Poison information Centre and recently available research books at DMR (LM) through Central Biomedical Library are mentioned in the Bulletin. The Bulletins were published monthly under the guidance of the Editorial Committee. The Bulletin Review Committee thoroughly reviews the articles sent by various divisions and scientific groups of DMR (LM). Fourteen abstracts of awarded and final-list papers of the 41 st Myanmar Health Research Congress and 55 out of 200 International News about Medicine and Health articles sent by DMR (LM) scientists were published from January to December, 2013.

1.1.3 DMR (LM) E newsletter During the year under report, DMR (LM) E newsletter Vol. 2, No. 3, Vol. 3, No.1, the supplementary issue of Vol. 3, No.1 as the special one to mark the 50 th Anniversary of Department of Medical Research (Lower Myanmar) and Vol. 3, No.2 were circulated to a total of 173 email addresses of current and retired staff of the DMR (LM) through On-line service.

1.1.4 Special Publications As the Golden Jubilee Publications, a variety of following books were published during the year under report. 1. Index of Research Papers Presented at Health Research Congresses (1965-2011) 2. Annotated Bibliography of Traditional Medicine Research carried out at DMR (LM) during 1965-2011 3. Research for Rural Health Development (2000-2010) conducted by Department of Medical Research (Lower Myanmar) 4. Bibliography of Research Findings on Gastrointestinal Diseases in Myanmar 5. Further Development of Medical Research in Myanmar (1987 to 2011) 6. aq;okawoeOD;pD;Xme(atmufNrefrmNynf)a&T&wkr*¾Zif; (1963-2013)

In addition, Annual Reports (2012) and Lecture Guide on Research Methodology (8 th edition), Department of Medical Research (Lower Myanmar) were published.

1.2 DISSEMINATION SERVICE 1.2.1 Mailing Delivery The mailing lists of the MHSR Journal and the DMR (LM) Bulletin were updated according to the guidance of the Editorial Committee. The MHSR Journals are delivered to the health institutions (up to the district hospitals) as well as some international organizations. The Bulletins are delivered all over the country (i.e., up to township hospitals) by postal services. The delivery list to the MHSR Journal and the Bulletin is as follows.

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No. Name of Place MHSR J Bulletin 1. Yangon Region (Departments, Medical Universities, 114 167 Hospitals) 2. Nay Pyi Taw (Ministerial Office, Departments, Hospital) 71 79 3. Other States & Regions 98 397 4. DMR (LM) [All divisions & retired staff] 112 107 5. Authors & Reviewers 36 - 6. Foreign Institutions 10 - Total no. 441 750

1.2.2 DMR (LM) Intranet Website To disseminate health information effectively through Information Communication Technology and to optimize information distribution among divisions, the publications of DMR (LM): MHSR Journals, Bulletins, E Newsletter and Annual reports have been regularly updated at the intranet website.

1.3 PHOTOGRAPHIC SERVICE Photographic works have been carried out for documentations of various academic and social activities held in DMR (LM) including Myanmar Health Research Congress, workshops, seminars, scientific talks, symposia, meetings and laboratory specimens and tests, at research divisions. During the period under the report, the photographic service was carried out for 127 occasions of various activities held in DMR (LM).

2. RESEARCH KNOWLEDGE MANAGEMENT As one of the Research Knowledge Management Programmes, the up-to-date research findings and health related information of DMR (LM) are timely released to the public through the media including journals, newspapers and TV channels (MRTV, Myawadi, MRTV4, SkyNet & Myanmar International) at the Department of Medical Research (Lower Myanmar). During the year under the report, 29 health education programs related to medical research were successfully broadcast through SkyNet channel. Publication Division has provided necessary services to the Research Knowledge Management, e.g, arrangements on press release at Myanmar Health Research Congress, health research review articles to be appeared in the Sunday Kyaemon newspaper, as well as recording and keeping of health education talks and interviews, etc.

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ADMINISTRATIVE DEPARTMENT Director (Admin) Dr. Zaw Myint MBBS, PhD (Biochemistry) (Fukui Medical University, Japan) Deputy Director (Admin) Dr. Tin Oo BSc(YU), MPHM (Mahidol University), PhD (University of Queensland)

GENERAL ADMINISTRATIVE DIVISION Assistant Director (Administration) U Aye Kyaw BA (Geography)

Personnel Administration Section Staff Officer Daw Aye Aye Shein BA (History) Office Superintendent Daw Khin Maw BA(Philosophy) Branch Clerk Daw Aye Myat Ko BSc(Mathamethics), Diploma in English, Diploma in Computer Application Senior Clerk Daw Aye Aye Mar BA(Geography) Daw Saw San Dar Pa Pa Win BA(Economics), Diploma in English Junior Clerk Daw Thi Thi Aye BA(Myanmar) Stenographer Daw Than Than Myint Junior Typist Daw San San Htay Daw Than Than Aye Daw Aye Aye Moe Daw Nwe Kaythi Win Peon U Kyi Lwin

General Administration Section Staff Officer Daw Thein Thein Yin BA (History) Office Superintendent U Tin Shein BSc (Physics) Branch Clerk Daw Cho Cho Win BA(History) Senior Clerk Daw Ami Kyaw BA (Myanmarsar) U Aung Kyaw Htoo Daw Ngu War BA(Law) Junior Clerk Daw Me Me Maung BA(Geography) U Shine Ko Ko Typist Daw May Thet Aung Telephone Operator (4) U Htay Aung Daw Soe Soe Aung Record Keeper U Ko Ko Gyi Duplicating Machine Operator U Myint Oo Security (3) U Myint Aung Jamadar U Kyaw Soe Moe Daw Khin Myint Maw U San Tun Aung Peon Daw Thi Lwin Oo Daw Nay Chi Oo (MOH) Daw Nyein Nyein Ei Daw Khin Thet Swe U Aung Thaung Htwe Daw Pan Ei Ei Phyu Daw Tin Htet Htet Aung

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Security Staff U Phone Kyaw U Aung Ko Latt U Thaung Oo U Aung Taza U San Htwe U Hla Phyo Thu U Moe Zaw Lwin Oo U Zayar Lwin U Kyaw Thu U Mya Win U Naing Lin Tun Cleaning Staff Daw Naw Zinbar Daw Hla Hla Than Daw Than Aye(1) Daw Than Aye(2) Daw Aye Aye Po Daw Khin Mar San Daw Naw Htar Htar New Daw Thet Mar Daw Myat Thandar Daw Thandar Oo Daw Htwe Hla Daw Moe Pwint Phyu Daw Khin Hinn Thet Daw Phyu Phyu Win Daw Yin Htay Gardeners U Kyaw Min Daw Sandar Win U San Maung Daw Than Hla Daw May Htwe Daw Tin Myint Driver (3) U Htay Win Driver (4) Vaccant Driver (5) U Tun Tun U Aung Min U Tin Htay U Yan Aung U Tun Wai U Thet Naing U Aung Myat Oo U Aung Myo Oo U Khin Maung Zaw U Myint Shwe U Kyaw Kyaw Naing

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Foreign Relations Section Staff Officer Vaccant Office Superintendent Daw Tin Latt Latt BA(Myanmar) Branch Clerk Daw Tin Aye Mu BA(Philosophy) Senior Clerk Daw Yin Yin Nu BA(Eco) Junior Clerk Daw Yu Yu Lwin BSc(Botany) Typist Daw Khin Htay Nwe Daw Hlaing Mar Peon Daw Kay Thi Zaw

BUDGET AND ACCOUNTS DIVISION Assistant Director (Administration) U Tin Maung Tun LLB Staff Officer Daw Khin Khin Myint BSc(Physics) Accountant Grade 1 Daw Malar Swe Accountant Grade 2 Daw Hla Myat Mon Daw Nwet Nwet Yi BSc(Zoology) Senior Clerk Daw Aye Aye Lwin Daw Hnin Shwe BA(Law) Daw Nilar Aung BA(Geography) Junior Clerk Daw Htay Htay Win BA(BM) Daw Aye Aye Thwe Daw Zarchi Thein Naing BA(Public Policy) Typist Daw Tin Tin Htike U Thet Khine Peon Daw Hnin Yadanar Oo

PROCUREMENT, STORE AND DISTRIBUTION DIVISION Staff Officer & Head Daw Khin Myat Mon BSc(Physics)(RASU) Staff Officer Daw Thida Moe BSc (Bot)(YU)

Procurement Section & Clearacne Section Office Superintendent U Aung Tun Branch Clerk Daw Myint Kay Thwe BA(Myanmar) Stenographer Daw Aye Aye Khaing Senior Clerk Daw Moe Moe Khine BA(Geography) Daw Le Le Myint BA (Eco) U Pyae Sone Htoo L.L.B Junior Clerk Daw Nan Thin Thin Htwe BA(Myanmar) Daw Nwe Mie Aung Peon Daw Ei Ei Mon

Store and Distribution Section Store Keeper 1 Daw Thi Thi Aye BSc (Zoology) Store Keeper 2 Daw Aye Aye Maw BA(Myanmar) Senior Clerk Daw Aye Aye Mon BA(History) Junior Clerk Daw Khin Zar Chi Tun BA(Myanmar) Store Attendent U Nay Tun

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RESEARCH STUDENTS

AUNG MYO THEIN Host: Pharmacology Research Division Degree: MMedSc (Pharmacology), Defense Services Medical Academy, Yangon Title: Lipid lowering effect and antioxidant activity of Hibiscus rosa sinensis Linn. (Khaungyan) on trition WR 1339-induced hyperlipidemia in albino rats Co-supervisor: Dr. May Aye Than

AYE AYE MYINT Host: Immunology Research Division Degree: DrMedSc (Paediatrics), University of Medicine (1) Title: The role of NS-1 Antigen in early diagnosis of Dengue Hemorrhagic Fever in Yangon Children’s Hospital Co-supervisor: Dr. Khin Saw Aye

AYE PWINT PHYU Host: Pharmaceutical Toxicology Research Division, DMR (LM) Degree: MMedSc (Pharmacology), University of Medicine (1) Title: Effect of diclofenac and ibuprofen on pharmacokinetic of ciprofloxacin in Myanmar healthy volunteers Supervisor Daw Khin Thein Oo Co-supervisor: Dr. Khin Chit

CHO LWIN THEIN TAN Host: Virology Research Division Degree: MMedSc (Microbiology), University of Medicine (2) Title: Dengue serotypes in children with dengue haemorrhagic fever at Yankin Children’s Hospital and Thingangyun Sanpya General Hospital Supervisor: Dr. Mo Mo Win

CHO MG MG MYINT Host: Pharmacology Research Division Degree: MMedSc (Pharmacology), Defense Services Medical Academy, Yangon Title: Hepatoprotective effect of leaves of Cleome viscosa Linn. (Hin-ga-lar- yaing) on carbon tetrachloride-induced hepatotoxicity in albino rats Co-supervisor: Dr. May Aye Than

EI EI MAUNG Host: Epidemiology Research Division Degree: M.P.H, University of Public Health Title: Knowledge, perception and practice among migrant adolescents in Dakthina Thiri Township Supervisor: Dr. Myo Myo Mon

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EI PHYU WIN Host: Health Systems Research Division Degree: MMedSc (OG) (UM2) Title: Study of still births in North Okkalapa General Hospital Supervisor: Dr. Le Le Win

GENNA JERARD (Oversea student from University of Maryland) Host: Parasitology Research Division, Degree: First-year medical student at the University of Maryland, School of Medicine Title: Molecular Markers for Artemisinin-Resistant Falciparum Malaria Mentor: Dr. Ye Htut

HTET WAI MOE Host: Pharmacology Research Division Degree: MMedSc (Pharmacology), Defense Services Medical Academy, Yangon Title: In vitro antimicrobial activity of leaves of Butea monosperma Lam. (Pauk) Co-supervisor: Dr. May Aye Than

KAUNG KHANT Host: Parasitology Research Division Degree: MMedSc (Microbiology), Defence Services Medical Academy, Yangon Title: Diagnostic of Giadia infection among children from selective primary school in Kyee Myin Daing Township by three different diagnostic methods Co-supervisor: Dr. Kay Thwe Han

KHAING ZAR HAN Host: Pharmacology Research Division Degree: PhD (Botany), Yangon University Title: Pharmacognostic study on Hibicus sabdariffa L. Co-supervisor: Dr. May Aye Than

KHIN SANDAR AUNG Host: Epidemiology Research Division Degree: M.P.H, University of Public Health Title: Knowledge and perception regarding HIV counseling and testing service for PMCT among pregnant women attending antenatal clinic at Central Women’s Hospital, Yangon Supervisor: Dr. Myo Myo Mon

KHINE LAY MON Host: Nutrition Research Division, DMR (LM) Degree: PhD (Public Health), (UOPH) Title: Predictors for mortality among HIV infected children on antiretroviral therapy. Co-Supervisor: Dr. Ko Ko Zaw

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KYAW KYAW MYINT Host: Biochemistry Research Division Degree: PhD (Oral Biological Science), University of Dental Medicine Title: Comparison of salivary catalase, glutathione peroxidase and superoxidase dismutase enzymes levels in betel quid chewers and non-betel quid chewers of healthy adult Co-Supervisor: Dr. Nwe Nwe Oo

LAI WIN AUNG Host: Pharmacology Research Division Degree: PhD (Botany), Yangon University Title: Pharmacognostic study on Tabernaemontana divaricata L. Co-supervisor: Dr. May Aye Than

LIN LIN TUN Host: Quality Assurance Division, DMR (LM) & Dagon University Degree: PhD (Chemistry), Dagon University Title: Extraction, Characterization and Application of Collagen from Fish Skins of Ngamyitchin ( Labeo robita ) and Ngaphe (Notopterus notopterus ) Co-supervisor: Khin Khin Aye

LIN LIN TUN Host: Blood Research Division, DMR (LM) Degree: MMedSc (Pathology) UM (1) Title: Plasma fibrinogen level in acute cerebral infarct at YGH Co-Supervisor: Dr. Zin Zin Thu

LWIN LWIN AYE Host: Nutrition Research Division, DMR (LM) Degree: MPH (UOPH) Title: Dietary habits and nutritional status of the elderly in Insein Township, Yangon Region Supervisor: Dr. Moh Moh Hlaing

MIN NANDAR HTUN Host: Pharmacology Research Division Degree: MMedSc (Pharmacology), Defense Services Medical Academy, Yangon Title: The hepatoprotective effect of Amaranthus spinosus Linn. (Hin-nu-nwe- subauk) on experimental animals Co-supervisor: Dr. May Aye Than

MOE THIDA HTWE Host: Immunology Research Division Degree: DrMedSc, University of Dental Medicine Title: Detection of Human Papillomavirus (HPV) infection in oral cancer Co-supervisor: Dr. Khin Saw Aye

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MYA MYA AYE Host: Bacteriology Research Division Degree: PhD (Microbiology), University of Medicine (1) Title: Distribution of Helicobacter pylori virulence genes among gastric cancer and non-cancer dyspeptic patients Co-supervisor: Dr. Wah Wah Aung

MYAT KYAW THU Host: Health Systems Research Division Degree: MPH, University of Public Health Title: Knowledge on TB & treatment seeking behaviour of new TB patients attending Mandalay TB Centre. Supervisor: Dr. Yin Thet Nu Oo

MYAT TIN HTWE KYAW Host: Experimental Medicine Research Division Degree: MMedSc (Microbiology), University of Medicine (1) Title: Seroprevalence of Hepatitis B and Hepatitis C among pregnant women at South Okkalapa Women and Children Hospital Co-Supervisor: Dr. Ye Ye Kyaw

MYINT NAING Host: Medical Statistics Research Division Degree: PhD (Public Health), Defence Services Medical Academy, Yangon Title: The treatment failure cases of pulmonary tuberculosis in Mandalay District in 2012 Supervisor: Dr. Saw Saw

NAN AYE THIDAR OO Host: Bacteriology Research Division Degree: MMedSc (Microbiology), University of Medicine (1) Title: Vibrio cholerae isolated from children with acute diarrhea in Yangon Co-supervisor: Dr. Wah Wah Aung

NANG OMG KHAM Host: Pharmacology Research Division Degree: MMedSc (Pharmacology), Defense Services Medical Academy, Yangon Title: Lipid lowering effects of ethanolic and watery extracts of Cymbopogan citrates Stap f. (Lemongrass) in triton-induced hyperlipidemic rats Co-supervisor: Dr. May Aye Than

NWE NWE SOE Host: Pharmacolgy Research Division Degree: PhD (Botany), Yangon University Title: Pharmacognostic study on Averrhoa carambola L. Co-supervisor: Dr. May Aye Than

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NYEIN CHAN AUNG Host: Pharmacology Research Division Degree: MMedSc (Pharmacology), Defense Services Medical Academy, Yangon Title: Nephroprotective effect of seeds of Carica papaya Linn (Thin-baw) on carbon tetrachloride-induced nephrotoxicity in albino mice Co-supervisor: Dr. May Aye Than

OHNMAR AUNG Host: Experimental Medicine Research Division Degree: PhD (Microbiology), University of Medicine (1) Title: Hepatitis C virus infection in household contacts of HCV infected patients Supervisor: Dr. Win Maw Tun

OHNMAR MYINT Host: Nutrition Research Division, DMR (LM) Degree: MPH (UOPH) Title: Assessment of the referral status for presumptive TB among medicine sellers in Hlaing Township, Yangon Region, 2013 Supervisor: Dr. Ko Ko Zaw

PA PA SOE Host: Medical Statistics Research Division Degree: PhD (Public Health), University of Public Health Title: Health care financing and preferred means and mechanism of payment for emergency obstetric care Supervisor: Dr. Saw Saw

PHYO KYAW TUN Host: Pharmacology Research Division Degree: MMedSc (Pharmacology), Defense Services Medical Academy, Yangon Title: Lipid lowering and antioxidant activities of extract of Aloe vera Linn. (Shar-zaung-let-pat) on hypercholesterolemic albino rats Co-supervisor: Dr. May Aye Than

SA BAI MYINT Host: Bacteriology Research Division Degree: PhD (Microbiology), University of Medicine (1) Title: Extended spectrum beta lactamase production in gram-negative bacilli isolated from clinical specimens in Yangon General Hospital Co-supervisor: Dr. Wah Wah Aung

SOE SANDA Host: Pathology Research Division and Pathology Department, University of Medicine (1) Degree: PhD (Pathology), University of Medicine (1) Title: A study of Her 2 neu (Erb 2) in gastric adenocarcinoma Co-supervisor: Dr. Moh Moh Htun

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SU MON CHELL Host: Health Systems Research Division Degree: MPH, University of Public Health Title: Tobacco use among working age group of Leymyethna Township, Ayeyarwaddy Region Supervisor: Dr. Le Le Win

SU MON WIN Host: Bacteriology Research Division Degree: PhD (Zoology), Yangon University Title: Effects of bacterial inoculants, lime and chlorine on the decontamination of bacteria in pond water Co-supervisor: Dr. Wah Wah Aung

SU SU WIN Host: Pharmaceutical Toxicology Research Division, DMR (LM) & Pharmacology Department, University of Pharmacy, Yangon Degree: M.Pharm, University of Pharmacy, Yangon Title: Pharmaceutical equivalence and oral bioavailability study of ciprofloxacin tablets locally manufacture and imported sample Supervisor: Dr. Khin Chit

THADA OO HLAING Host: Pharmaceutical Toxicology Research Division, DMR (LM) & Pharmacology Department, Defense Services Medical Academy, Yangon Degree: MMedSc (Pharmacology), University of Medicine (1) Title: Pharmacokinetic study of oral cephalaxin in Myanmar healthy volunteers versus patients with impaired renal function Supervisor Sr. Yin Moe Thwe Co-supervisor: Dr. Khin Chit

THANDAR AYE SHEIN Host Pharmacology Research Division Degree MMedSc (Pharmacology) Title Antimicrobial activities of different extracts of leaves of Murraya koenigii Linn. (Pyin-daw-thein) Co-supervisor Dr. May Aye Than

THEINGI WIN MYAT Host: Virology Research Division Degree: PhD (Microbiology), University of Medicine (2) Title: Interhost and Intrahost genetic diversity of dengue virus strains in children with dengue infection Supervisor: Dr. Hlaing Myat Thu

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THET WAI NWE Host: Medical Statistics Research Division & University of Public Health Degree: MSc (Public Health), University of Public Health Title: Antiretroviral therapy adherence among people living with HIV/AIDS in public and NGO centers, Yangon Supervisor: Dr. Saw Saw

THET ZAW TUN Host: Parasitology Research Division Degree: MMedSc (Microbiology), Defence Services Medical Academy, Yangon Title: In vitro susceptibility of Plasmodium falciparum against antimalarial drugs (Mefloquine and Dihydroartemisinin) Co-supervisor: Dr. Kay Thwe Han

THIDA KYAW Host: Virology Research Division Degree: PhD (Zoology), Yangon University Title: Dengue virus antigen production for the diagnosis of Dengue Haemorrhagic Fever by haemagglutination inhibition reaction Co-supervisor: Dr. Hlaing Myat Thu

THURA MAUNG MAUNG Host: Pharmacology Research Division Degree: MMedSc (Pharmacology), Defense Services Medical Academy, Yangon Title: Antihypertensive activity of Punica granatum Linn. (Tha-le) on L-name induced hypertension in Wistar rats Co-supervisor: Dr. May Aye Than

TOE SANDAR Host: Bacteriology Research Division Degree: PhD (Microbiology), University of Medicine (1) Title: Characterization of Vibrio cholerae isolated from acute diarrhoeal cases in Yangon Co-supervisor: Dr. Wah Wah Aung

WIN NAING Host: Health Systems Research Division Degree: PhD (Public Health), Defence Services Medical Academy, Yangon Title: Effect of health promotion activities on maternal and child health assessed by modified indicators of multiple indicator cluster survey in Mingaladon Township Supervisor: Dr. Le Le Win

YE MAHN HEIN Host: Pharmacology Research Division Degree: MMedSc (Pharmacology), Defense Services Medical Academy, Yangon Title: In vitro antimicrobial activity of Mimosa pudica Linn (Hti-ka-roan) on some bacteria Co-supervisor: Dr. May Aye Than

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YI YI MYINT Host: Parasitology Research Division Degree: MMedSc (Microbiology), University of Medicine (2) Title: Opportunistic intestinal parasitic infestations in adult HIV seropositive patients with diarrhoea at Thaketa Specialist Hospital Co-supervisor: Dr. Kay Thwe Han

YIN MOE THWE Host: Immunology Research Division Degree: PhD (Pharmacology), University of Medicine (1) Title: Effect of CYP1 A2 ID gene polymorphism on Pharmacokinetics of the ophylline in healthy Myanmar volunteers Co-supervisor: Dr. Khin Saw Aye

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Consultants/Advisors to Department of Medical Research (Lower Myanmar) during 2013

Sr. Name/Institute Description Duration 1. Professor Chang Chulhum Establishment of laboratory for research 7 days Pusan National University on communicable diseases Republic of Korea 2. Dr. Jong Seok Lee Establishment of laboratory for research 7 days International Tuberculosis on communicable diseases Research Center 3. Dr. Kenji Yokota Collaborative research project – 1 day Okayama University, Japan Characterization of H. pylori in Myanmar 4. Associate Professor Dr. Lay Discussion on baterial, viral and 5 days Myint Yoshida atypical pathogens associated with acute Department of Clinical respiratory infections and their clinical Medicine, Nagasaki characteristics among children admitted University, Japan to Yangon Children’s Hospital 5. Professor John Aaskov Discussion on collaborating projects on 3 days Institute of Health and dengue Biomedical Innovation, Queensland University of Technology, Brisbane, Australia 6. Professor Claude P Muller Discussion on fever and rash study 2 days Institute of Immunology, Luxenbourg 7. Dr. Antony Black Discussion on fever and rash study 2 days Institute of Immunology, Luxenbourg 8. Professor Gagandeep Kang Discussion on Rotavirus sentinel 2 days The Wellcome Trust Research surveillance Laboratory, CMC Vellore 9. Dr. Pushpa Ranjan Wijesinghe Discussion on Rotavirus sentinel 2 days The Wellcome Trust Research surveillance Laboratory, CMC Vellore 10. Prof. Takehiko Koji and group, Wet Lab on Histo endonuclease-linked 2 days Nagasaki Graduate Science, detection of methylation sites of DNA Sakamoto, Nagasaki, Japan (HELMET) (8.1.2013 - 9.1.2013) 11. Prof. Takehiko Koji and group 50 th Anniversary Golden Jubliee 3 days Nagasaki Graduate Science Ceremony (9.6. 2013 - 11.6.2013) Sakamoto, Nagasaki, Japan 12. Prof. Yoshitaka Hishikawa and Meeting (23 .4.2013 - 28.4.2013) 6 days group Miyazaki University Japan 13. Dr. Goshi Fujimoto Kameda (29 Jul - 8 Aug 2013 ) 10 days Medical Center, Hagashi-cho Kamogawa City, Japan 14. Associate Professor, Nagasaki University, Japan, 9 days Dr. Hitoshi Kawada (26 Sep - 5 Oct 2013)

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Sr. Name/Institute Description Duration 15. Prof: Yasuhiko Suzuki Scientific visit for TB research 3 days Hokkaido University, Japan (twice) Asso: Prof: Nakajima Scientific visit for TB research 3 days Hokkaido University, Japan (twice) 16. Prof Gareth Turner Scientific visit for DHF research 3 days Mahidol Oxford Research Unit, Mahidol University, Thailand 17. Professor Emeritus Scientific visit 1 day Dr. Geoffrey A Cordell Dr. Tin Wa University of Illinois, United States of America 18. Associate Professor Robert Scientific visit 1 day Milne, School of Pharmacy and Medical Sciences, University of South Australia 19. Prof. Chris.V. Plowe Howard Hughes Medical Institute, 5 days Malaria Group, Center for Vaccine Development, University of Maryland, USA, (21.1.2013 - 25.1.2013) 20. Dr. Myaing Myaing Nyunt Johns Hopkins Bloomberg School of 5 days Public Health, USA, (21.1.2013 - 25.1.2013) 21. Dr. Paula Fernendes Malaria Molecular External Quality 5 days Assurance Program, (21.1.2013 - 25.1.2013 ) 22. Dr. Malikha Imwong Mahidol-Oxford Research Unit, 5 days Bangkok, (21.1.2013 - 25.1.2013) 23. Ms. Karen Ball International Regulatory Affairs 5 days Specialist , University of Maryland, USA, (21.1.2013 - 25.1.2013) 24. Dr. Mehul Dhorda (21.1.2013- 25.1.2013) 5 days 25. Dr. Meera (21.1.2013- 25.1.2013) 5 days 26. Ms. Sandra Hmon (21.1.2013- 25.1.2013) 5 days 27. Dr. Joe Turning (21.1.2013- 25.1.2013) 5 days 28. Dr. Sun Dae Song Chairman of the Board, International 2 days Tuberculosis Research Institute (ITRC) KOICA, (30.7.2013 – 31.7.2013) 29. Prof. Eun Taek Han Kangwon National University School of 2 days Medicine, Republic of Korea, (30.7.2013 – 31.7.2013) 30. Mr. Sherwin Gait (1.12.2013 – 17.12.2013) 17 days

31. Dr. Dorina Bustos National Workshop on Therapeutic 2 days efficacy, (8.4.2013 - 9.4.2013)

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Sr. Name/Institute Description Duration 32. Associate Professor Margarita Signing ceremony of the Agreement of 3 days Frederico Cooperation between Department of Head, Department of Social Medical Research (lower Myanmar) and Work and Social Policy, Latrobe University, Australia La Trobe University, Australia 33. Dr. Lawan Chanhome Chief of Snake Farm, Queen Saovabha 6 days Memorial Institute, The Thai Red Cross Society,( 28.7.2013 – 3.8.2013) 34. Dr. Lisa Jane White and Economic -epidemiological models to 1 day Dr. Yoel Lubell; Mahidol- support malaria elimination strategy Oxford Tropical Medicine design in Myanmar, (17.11.2013) Research Unit (MORU) 35. Prof. Emeritus Shigeru Okada Team Leader, Clinical Trial of Fekalin 2 days 80, Cervical cancer Screening and Hlaing Thar Yar Health Centre Projects, AED Machine donation ( November 2013) 36. Mr. Keiichi Masamoto For Ferritin determination 1 day (19 th August 2013) 37. Mr. Kazuki Minato For Ferritin determination 1 day (19 th August 2013) 38. Mr. Marmoru Tomita For Ferritin determination 1 day (19 th August 2013) 39. Professor Jae Hun Cheong Establishment of Standardization 7 days Systems for Infectious Disease Diagnostics in Myanmar KNRF Project [Hepatitis ]

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International Seminars, Workshops and Short Training Courses

Sr. Name Designation Seminar/ Workshop/ Training 1. Dr. Kyaw Soe Deputy Director Workshop on “Promotion of a collaborative environmental health project for children in arsenic contaminated area of Myanmar” at University of Miyazaki, Japan (13-7-2013 to 19-7-2013) 2. Dr. Kyaw Soe Deputy Director Workshop on “Good Laboratory Practice” at Mahidol University, Thailand (19-8-2013 to 23-8-2013) 3. Dr. Kyaw Soe Deputy Director Training course on “Alteration of epigenome in Myanmar hepatocellular carcinoma cases” at the Department of Histology and Cell Biology, Graduate School of Biomedical Sciences, Nagasaki University, Japan (5-10-2013 to 18-12-2013) 4. Dr. Mo Mo Win Deputy Director Training workshop for laboratory personnel at Regional Reference. Laboratory Nanthabur, Thailand. (29-7-2013 to 2-8-2013) 5. Dr. Mo Mo Win Deputy Director 7th World Meloidosis Congress, Bangkok, Thailand.(18-9-2013 to 20-9-2013) 6. Dr. Moh Moh Htun Deputy Director Molecular basis of diagnosis, prevention and treatment of infectious diseases, Training Course (12-10-2013 to 29-10-2013), Beijing, China. 7. Dr. Khin Chit Deputy Director Food safety and Health hazard recognition Workshop (Meiho University) Taiwan (4-8-2013 to 11-8-2013) 8. Dr. May Aye Than Deputy Director Seminar for Development of research plan and operational research laboratory on Communicable Diseases of Myanmar (Korea) (13-10-2013 to 19-10-2013) 9. Dr. Ohnmar Deputy Director DFC Proposal for Capacity Building of Researchers and Research Managers, Park Royal Hotel (24-6-2013 to 26-6-2013) 10. Dr. Ohnmar Deputy Director The 5 th International Conference on Public Health among Greater Mekong Sub-regional Countries, University of Public Health (28-9-2013 to 29-9-2013) 11. Dr. Ohnmar Deputy Director Second Global Congress on Verbal Autopsy, Rhodes, Greece(14-10-2013 to 16-10-2013) (Poster presented) 12. Dr. Ohnmar Deputy Director 62 nd Annual Meeting on American Society of Tropical Medicine and Hygiene, Marriott Wardman Park, Washington DC, USA (13-11-2013 to 17-11-2013) (Poster presented) 13. Dr. Ohnmar Deputy Director The 5 th National Scientific Conference on HIV/AIDS, Hanoi, Vietnam (2-12-2013 to 3-12-2013) (Poster presented)

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Sr. Name Designation Seminar/ Workshop/ Training 14. Dr. Win Pa Pa Naing Deputy Director The 2 nd Conference of Thai Society of Hematology: Thrombosis and Hemostasis (Thailand), (24-5-2013 to 26-5-2013) 15. Dr. Win Pa Pa Naing Deputy Director Fellowship training on Infectious Disease Research (South Korea), (12-8-2013 to 19-10-2013) 16. Dr. Thaung Hla Deputy Director Study Tour on Health Research Management. Bangkok, Thailand (2-6-2013 to 8-6-2013) 17. Dr. Saw Saw Deputy Director/ International Conference on the Demography Head of Disasters Implications for future policy on Development and Resilience, Australia National University, Canberra, Australia from (18-9-2013 to 21-9-2013) at Australia. 18. Dr. Win Maw Tun Deputy Director/ Study visit: Development of test kits for Head screening of transfusion transmitted infec- tions in donor blood; Olipro Biotechnology Sdn. Bhd., Malaysia (22-4-2013 to 3-5-2013) 19. Dr. Yi Yi Kyaw Deputy Director/ Scientific visit on Olipro Biotech, Malaysia Head (22-4-2013 to 2-5-2013) 20. Dr. Yi Yi Kyaw Deputy Director/ APASL, Singapore Head (7-6-2013 to 10-6-2013) 21. Dr. Mya Mya Aye Research Study tour to observe Bactalert and Vitek 2 Scientist for automatic culture and sensitivity, Singapore (23-12-2013 to 26-12-2013) 22. Dr. Theingi Win Research Genetic analysis of Dengue viruses Institute Myat Scientist of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia (19-6-2013 to 28-8-2013) 23. Daw Mu Mu Sein Research Safely handling of Biological materials in Myint Scientist Research Laboratory ( Mahidol University, Bangkok ) (25-3-2013 to 29-3-2013) 24. Dr. Kay Thwe Han Research Specialized training to assist in the molecular Scientist analysis of malaria samples (United State) (14-4-2013 to 23-6-2013) The 13 th Workshop of the Regional Network on Asian Schistosomiasis and other Helminth Zoonoses (RNAS+) (Thailand) (24-10-2013 to 26-10-2013) 25. Dr. Yin Thet Nu Oo Research International Conference on AIDS in Asia Scientist and Pacific (ICAPP 11 th ) Bangkok (18-23 November 2013) 26. Dr. Yin Thet Nu Oo Research 7th APCSRHR Conference (Philippine 21-24 Scientist February 2014) 27. Dr. Myo Myo Mon Research The 5 th International Conference on Public Scientist Health among Greater Mekong Sub-regional Countries, University of Public Health (28-9-2013 to 29-9-2013)

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Sr. Name Designation Seminar/ Workshop/ Training 28. Dr. Myo Myo Mon Research The 11 th International Congress on AIDS in Scientist Asia and Pacific, Bangkok, Thailand (18-11-2013 to 22-11-2013) 29. Dr. Aye Aye Lwin Research APASL, Singapore Scientist (7-6-2013 to 10-6-2013) 30. Dr. Aye Aye Lwin Research Seminar for development of research Scientist plan and operational research laboratory on communicable disease of Myanmar (13-10-2013 to 19-10-2013) 31. Dr. Moh Moh Hlaing Research 5th International Conference on Public Health Scientist Among GMS Countries, University of Public Health, Yangon, Myanmar (28-29 September 2013) 32. Dr. Moh Moh Hlaing Research Regional Postgraduate Training on Scientist Introduction to Nutritional Anthropology Southeast Asian Ministers of Education Organization (SEAMEO), Regional Center for Food and Nutrition (RECFON), University of Indonesia, Jakarta., Indonesia. (21-10- 2013 to 25-10-2013) 33. Dr. Zin Zin Thu Research HAA 2013, Conference on Haematology, Scientist Transfusion medicine. (Gold coast Australia), (20-10-2013 to 24-10-2013) 34. Dr. Zin Zin Thu Research The 2 nd Conference of Thai Society of Scientist Hematology: Thrombosis and Hemostasis (Thailand), (24-5-2013 to 26-5-2013) 35. Dr. Thet Thet Mar Research Environmental Toxicology, Okayama Scientist University, Japan (17-9-2013 to 25-12-2013) 36. Daw Than Mya Research Officer Training on safe handling of biological materials in research laboratory, Thailand (25-3-2013 to 29-3-2013) 37. Daw Khin Mar Aye Research Officer Training workshop for laboratory personnel at Regional Reference. Laboratory Nanthabur, Thailand. (29-7-2013 to 2-8-2013) 38. Dr. Nila r Zaw Research Officer Antimicrobial Susceptibility Course, Changi General Hospital, Singapore. (25-9-2013 to 27-9-2013) 39. Dr. Ohnmar Kyaw Research Officer Training in Cervical Cancer screening (Okayama, Japan) (13-10-2013 to 22-12-2013) 40. Dr. Wai Wai Han Research Officer International Conference on Research Methodology and Scientific Writing from at Kerala, India (20-12-2013 to 22-12-2013) 41. Daw Kay Khine Soe Research Officer Good Laboratory Practice (GLP) Nonthaburi, Thailand (26-8-2013 to 30-8-2013) 42. Dr. Su Latt Tun Myint Research Officer Workshop on Scientific Writing in Field Epidemiology, Thailand (4-2-13 to 8-2-13)

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Sr. Name Designation Seminar/ Workshop/ Training 43. Dr. Su Latt Tun Myint Research Officer The 5 th International Conference on Public Health among Greater Mekong Sub-regional Countries, University of Public Health (28-9-2013 to 29-9-2013) 44. Dr. Su Latt Tun Myint Research Officer International Conference on Research Methodology and Scientific Writing, India (20-12-2013 to 22-12-2013) 45. Daw Aye Aye Maw Research Officer IAEA Fellowship on TC Project MYA6/026 "Assessing Risk Factors Associated with obesity in Women" Queensland University, Brisbane, Australia (29-7-2013 to 23-8- 2013) 46. Dr. Mya Ohnmar Research Officer 5th International Conference on Public Health Among GMS Countries, University of Public Health, Yangon, Myanmar. (28-29 September 2013) 47. Dr. Mya Ohnmar Research Officer Regional Postgraduate Training on Nutritional status assessment, Southeast Asian Ministers of Education Organization (SEAMEO), Regional Center for Food and Nutrition (RECFON), University of Indonesia, Jakarta., Indonesia. (30-9-2013 to 12-10-2013) 48. Dr. Mya Ohnmar Research Officer Regional Postgraduate Training on Research Methodology on Food, Nutrition and Health: Project Proposal and Publication. Southeast Asian Ministers of Education Organization (SEAMEO),Regional Center for Food and Nutrition (RECFON), University of Indonesia, Jakarta, Indonesia. (8-12- 2013 to 12-12-2013) 49. Dr. Lai Lai San Research Officer Antimicrobial Susceptibility Test Workshop. Singapore. (26-9-2013 to 30-9-2013) 50. Daw W ai Wai Myint Research Training on Data Management, Prince of Assistant (2) Songkla University, Epidemiology Unit, Thailand (4-3-2013 to 29-3-2013) 51. Daw Thazin Myint Research Training in cervical cancer screening, Kake Assistant (2) University, Japan (13-10-2013 to 21-12-2013) 52. Daw Nay Chi Aung Research Molecular methods for the detection of San Assistant (3) resistant genes in malaria parasite (Kuming University, Peoples’ Republic of China) (30-9-2013 to 33-11-2013) 53. Daw Thin Thin Aye Research Molecular methods for the detection of Assistant (3) resistant genes in malaria parasites (Kuming University, Peoples’ Republic of China) (30-9-2013 to 33-11-2013)

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International Fellowships Sr. Name Designation Fellowship 1. Dr. Wah Wah Aung Deputy Director Training Course for research fellow on communicable diseases research of Myanmar, Republic of Korea (10-8-2013 to 19-10-2013) 2. Dr. Yi Yi Kyaw Deputy Director Training Course for Research Fellow on Communicable Disease Research of Myanmar, Republic of Korea (10-8-2013 to 19-10-2013) 3. Dr. Mya Mya Aye Research Scientist Training Course on Molecular Basis of Diagnosis, Prevention and Treatment of Infectious Diseases, Beijing, China (13-10-2013 to 29-10-2013) 4. Dr Yan Naung Research Scientist PCR and fluorescent in situ hybridization Maung Maung (FISH)of polytene chromosomes, University of Manchester (20-2-2013 to 12-5-2013) 5. Dr. Aye Aye Win Research Scientist Training Course for Research Fellow on Communicable Disease Research of Myanmar, Republic of Korea (10-8-2013 to 19-10-2013) 6. Dr. Phyu Win Ei Research Officer Training Course for research fellow on communicable diseases research of Myanmar, Republic of Korea (10-8-2013 to 19-10-2013) 7. Dr. Htin Lin Research Officer Fellowship training on Laborato ry techniques in diagnosing respiratory virus. NIH, Thailand. (4-3-2013 to 29-3-2013) 8. Daw Kay Thi Aye Research Officer Fellowship Program on Training Course for Research Fellow on Communicable Disease Research of Myanmar, KOICA, Republic of Korea (12-8-2013 to 18-10-2013) 9. Dr. Sai Zaw Min Oo Research Officer Ph.D Candidate, Nagasaki University, Japan (Started from 7-10-2013) 10. Dr. Min Min Win Research Officer Ph.D training in Faculty of Tropical Medicine, Mahidol University (2012-2014) 11. Dr. Wai Wai Han Research Officer Master of Science in International Health, University of Heidelberg, Germany (1-8-2012 to 30-9-2013) 12. Dr. Khin Than Yee Research Officer PhD. Biochemistry 4 years,Thailand 13. Dr. Thae Maung Research Officer M.Sc, Internation al Health, Charité Maung Universtats Medizin, Berlin Germany (1-7-2012 to 31-8-2013) 14. Daw Kyin Hla Aye Research Officer Fellowship program on Training course for Research Fellow on Communicable Disease Research of Myanmar, Republic of Korea (12-8-2013 to 18-10-2013)

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Sr. Name Designation Fellowship 15. Dr. Khin Myo Aye Research Officer Fellowship program on Training course for Research Fellow on Communicable Disease Research of Myanmar), Republic of Korea (12-8-2013 to 18-10-2013) 16. Dr. Nyi Nyi Win Research Officer “Research fellow on Communicable diseases research of Myanmar” (Sogan University), Republic of Korea (10-8-2013 to 19-10-2013)

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Annual Report 2013

Local Seminars, Workshops and Training Courses

Sr. Name Designation Seminar/ Workshop/ Training 1. Dr. Wah Wah Aung Deputy National Committee for Immunization Practices Director (NICP) Meeting 2. Dr. Kyaw Soe Deputy Workshop on “Arsenic contamination in Director drinking water” at Pathein, Ayeyarwaddy Region (29-1-2013 to 30-1-2013) 3. Dr. Moh Moh Htun Deputy Workshop on Evidence –Informed Policy Director making in Health Sector, DMR (UM), Pyin Oo Lwin (2-12-2013 to 6-12-2013) 4. Dr. Khin Chit Deputy Training Course on advanced Laboratory Director Equipment DMR (LM) Research Methodology and Bioethics workshop DMR (LM) (27-8-2013 to 29-8-2013) 5. Dr. May Aye Than Deputy Training on Pharmacokinetic Analysis Director (Department of Medical Research, Lower Myanmar) (24-1-2013 to 25-1-2013) 6. Dr. May Aye Than Deputy Workshop on Research and Development of Director Traditional Medicine (20-2-2013 to 21-2-2013) (Ministry of Science and Technology, Yangon) 7. Dr. May Aye Than Deputy Workshop on Management in Malaria Research Director and Surveillance (21-1-2013 to 23-1-2013) (DMR- LM) 8. Dr. May Aye Than Deputy Upgrading course on Training of Medicinal Director Chemistry for University Teachers of Chemistry subjects. (Chemistry Department, Yangon University) (27-5-2013 to 31-5-2013) 9. Dr. May Aye Than Deputy Pharmaceutical and Compliance Seminar 2013 Director by Agilent Technology (Park Royal Hotel, Yangon) (2-7-2013 to 3-7-2013) 10. Dr. May Aye Than Deputy Workshop on Research Methodology 2013, DMR Director (LM)(27-8-2013 to 29-8-2013 as Group Facilitator) 11. Dr. May Aye Than Deputy The 19 th meeting of ASEAN Traditional Director Medicine and Health Supplement Product working group and its related meetings, (Pagan) (24-6-2013 to 29-6-2013) 12. Dr. May Aye Than Deputy Advocacy meeting on Translational Research in Director malaria (Participant)(Department of Medical Research, Lower Myanmar) (7-10-2013) 13. Dr. Le Le Win Deputy Workshop on HSR protocol Development for Director leprosy HSR protocols. Disease Control, Nay Pyi Taw) (22 to 24 February 2013) 14. Dr. Le Le Win Deputy Workshop on Data collection for HSR protocols Director for leprosy control. Disease Control, Nay Pyi Taw (4-5 March 2013) 15. Dr. Le Le Win Deputy Workshop on Warning against Dangers of Director Tobacco: Packaging and labelling. (25 – 26 April, 2013, UPLT)

163

Annual Report 2013

Sr. Name Designation Seminar/ Workshop/ Training 16. Dr. Le Le Win Deputy Launching Ceremony and Training Workshop Director “Situation Analysis on Orphans and Vulnerable Children Infected and Affected by HIV/AIDS in Myanmar” (12-15 June 2013) 17. Dr. Le Le Win Deputy “Presentation on Nursing Research Report of Director the B.N.Sc (Bridge) Students” presentation. (19-20 September 2013) 18. Dr. Le Le Win Deputy First Steering committee meeting for the study Director of socio-economic impact study on HIV at household level in Myanmar (12-11-2013. Amara Hotel, Nay Pyi Taw.) 19. Dr. Ohnmar Deputy Workshop on Health Research Management at Director DMR(CM) (Participant) (2-4-2013 to 4-4-2013) 20. Dr. Ohnmar Deputy DFC Proposal for Capacity Building of Director Researchers and Research Managers, Park Royal Hotel (24-6-2013 to 26-6-2013) 21. Dr. Ohnmar Deputy Lancet Series: Health in Myanmar, University Director of Public Health (8-7-2013 to 9-7-2013) 22. Dr. Ohnmar Deputy Malaria Community Based Survey Training Director Workshop at Yangon, Crystal Jade Restaurant (6-8-2013 to 8-8-2013) 23. Dr. Ohnmar Deputy Field Research Methodology Workshop at Director DMR(LM) (Lecturer) (12-8-2013 to 14-8-2013) 24. Dr. Ohnmar Deputy Research Methodology Workshop at DMR Director (LM) (Lecturer) (27-8-2013 to 29-8-2013) 25. Dr. Ohnmar Deputy National Consultation Meeting on New-born Director Health, Fantastic Hall, Nay Pyi Taw (24-9-2013 to 25-9-2013) 26. Dr. Ohnmar Deputy Advocacy Meeting on Translational Research in Director Malaria (Participant), DMR (LM) (7-10-2013) 27. Dr. Han Win Deputy Advocacy Workshop for Arsenic Mitigation in Director Ayeyarwaddy Region and Safe Water Provision for Township Level, Pathein (29-1-2013 to 30-1-2013) (Presenter) 28. Dr. Han Win Deputy Awareness Raising of the Arsenic Director Contamination and Mitigation in Drinking Water Sources at Bago Region, Bago (2-5-2013 to 3-5-2013) (Presenter) 29. Dr. Han Win Deputy Workshop on Review and Revision of National Director List of Essential Medicines, Naypyitaw (2-9-2013 to 3-9-2013) 30. Dr. Ko Ko Zaw Deputy Dissemination Workshop on Reproductive Director Health Stakeholder Analysis Workshop, Nay Pyi Taw. (25-7-2013) 31. Dr. Ko Ko Zaw Deputy Coordination Workshop on Strengthening Director Tobacco Control in Myanmar, Nay Pyi Taw. (25-9-2013)

164

Annual Report 2013

Sr. Name Designation Seminar/ Workshop/ Training 32. Dr. Ko Ko Zaw Deputy Workshop on upgrading food based dietary Director guideline for Myanmar People. Department of Medical Research (Lower Myanmar) (9-10 September, 2013) 33. Dr. Thaung Hla Deputy 3rd Green Economy and Green Growth Forum, Director Nay Pyi Taw (20/11/2013 Yangon (21-11-2013 to 22-11-2013) 34. Dr. Win Pa Pa Naing Deputy Training course on English for interpreter Director (5-11-2012 to 9-11-2012) 35. Dr. Win Pa Pa Naing Deputy Workshop on Evidence based Policy making Director (30-11-2013 to 7-12-2013) 36. Dr. Tin Oo Deputy National workshop on monitoring therapeutic Director efficacy of antimalarial drugs, Myanmar Medical Association (8-4-2013) 37. Dr. Tin Oo Deputy Workshop on malaria migrant mapping survey Director (Participant), Park Royal Hotel, (24-6-2013 to 26-6-2013) 38. Dr. Tin Oo Deputy Initial Public Offering (IPO) Seminar, Director Nay Pyi Taw, (30-7-2013) 39. Dr. Tin Oo Deputy Research Methodology Workshop at DMR Director (LM), (Lecturer), (27-8-2013 to 29-8-2013) 40. Dr. Saw Saw Deputy TB Technical and Strategic Group Meeting, Director NTP Office, Yangon. /Head (8-10-2013) and (11-12-2013) 41. Dr. Saw Saw Deputy MMA PPM TB project “7th Anniversary & Director Annual Review Meeting", Ballroom, Cooperative /Head Business Center, Yangon. (19-12-2013) 42. Dr. Saw Saw Deputy Meeting on Addressing Public Health Issues Director through Market- based Approaches, University /Head of Public Health. (12-9-2013) 43. Dr. Saw Saw Deputy Preparatory meeting for 5 th International Director Conference on Public Health Among Greater /Head Mekong Sub- regional Countries, University of Public Health. (21-2-2013) and (2-8-2013) 44. Dr. Saw Saw Deputy Bilateral Dialogue of Health Sector: Grand Director Challenges Canada and Myanmar, DMR(LM) /Head (23-8-2013) 45. Dr. Saw Saw Deputy Symposium on Turning the tide on TB tacking Director MDR-TB and TB / HIV co infection in /Head Myanmar, Inya lake Hotel. (22-8-2013) to (23-8-2013) 46. Dr. Saw Saw Deputy Seminar on International Center of Excellence Director Northern Illinois University ICOE Building, /Head University of Yangon. (ICOE-NIU,(12-7-2013) 47. Dr. Saw Saw Deputy Dissemination workshop on Policy Mapping and Director Analysis on Rural Retention Policy In Myanmar, /Head Nay Pyi Taw (26-7-2013)

165

Annual Report 2013

Sr. Name Designation Seminar/ Workshop/ Training 48. Dr. Saw Saw Deputy Workshop on situation analysis on orphans Director and vulnerable children infected and affected /Head by HIV/ AIDS in Myanmar, Coriander leaf Hotel, Yangon. (12-6-2013) to (15-6-2013) 49. Dr. Saw Saw Deputy National Workshop on formulation country Director roadmaps of information and accountability /Head for women’s and children’s health (COIA), Nay Pyi Taw (13-2-2013) to (15-2-2013) 50. Dr. Saw Saw Deputy Meeting on development of audio script for Director effect of providing health education message /Head on TB in local language FM radio in Southern Shan State, Nay Pyi Taw (22-2-13) to (24-2-13) 51. Dr. Mya Mya Aye Research Research Methodology Workshop, DMR (LM), Scientist (26-8-2013 to 28-8-2013) 52. Dr. Min Wun Research Research Methodology and Bioethics workshop Scientist DMR(LM) (27-8-2013 to 29-8-2013) and Mid- level Officer Management Training Course (47), CICS (Phaung Gyi)(2-12-2013 to 27-12-2013) 53. Daw Khin Khin Aye Research Mid-level Management Training No. (47), Scientist Central Institute of Civil Service, Phaung Gyi (2-12-2013 to 27-12-2013) 54. Dr. Khine Khine Lwin Research Training on Pharmacokinetic Analysis Scientist (Department of Medical Research, Lower Myanmar) (24-1-2013 to 25-1-2013) 55. Dr. Khine Khine Lwin Research Pharmaceutical and Compliance Seminar 2013 Scientist by Agilent Technology (Park Royal Hotel, Yangon) (2-7-2013 to 3-7-2013) 56. Dr. Khine Khine Lwin Research Management Course for Mid-level Manager. Scientist (No. 43), Central Public Services Institute, Phaunggyi, Hlegu. (12-8-2013 to 6-9-2013) 57. Dr. Khine Khine Lwin Research Seminar on International Technical Scientist Co-operation. by Ministry of Science and Technology (IBC, Yangon ) (14-10-2013) 58. Dr. Khine Khine Lwin Research The 14 th Myanmar Traditional Medicine Scientist Practitioner’s Conference, Department of Traditional Medicine, Ministry of Health, Nay Pyi Taw. (26-12-2013 to 27-12-2013) 59. Dr. Kay Thwe Han Research Workshop on Quality Management in Malaria Scientist Research and Public Health Interventions (DMR-LM) (21-1-2013 to 23-1-2013) 60. Dr. Kay Thwe Han Research Malaria-Molecular Workshop (DMR-LM) Scientist (24-1-2013 to 25-1-2013) 61. Dr. Kay Thwe Han Research National workshop on monitoring therapeutic Scientist efficacy of antimalarial drugs, Auditorium A, MMA (8-4-2013 to 9-4-2013) 62. Dr. Kay Thwe Han Research Advocacy meeting on translational research in Scientist malaria and potential solutions for enhancing utili- zation of research findings (DMR LM)(7-10-2013)

166

Annual Report 2013

Sr. Name Designation Seminar/ Workshop/ Training 63. Dr. Yin Thet Nu Oo Research Workshop on HSR protocol Development for Scientist leprosy HSR protocols. Disease Control, Nay Pyi Taw (22 to 24 February 2013) 64. Dr. Yin Thet Nu Oo Research Workshop on Data collection for HSR protocols Scientist for leprosy controlDisease Control, Nay Pyi Taw (4-5 March 2013) 65. Dr. Yin Thet Nu Oo Research Launching Ceremony and Training Workshop Scientist “Situation Analysis on Orphans and Vulnerable Children Infected and Affected by HIV/AIDS in Myanmar” (12-15 June 2013) 66. Dr. Yin Thet Nu Oo Research 7th PLHIV Forum. Excel Tower, Yangon Scientist (24 th Sept 2013) 67. Dr. Myo Myo Mon Research Orphans and Vulnerable Children (OVC) Scientist Technical and Strategy Working Group Meeting, Royal Kumudra Hotel, Nay Pyi Taw (11-3-2013) 68. Dr. Myo Myo Mon Research Advocacy and Coordination Meeting for Scientist Orphans and Vulnerable Children (OVC) Infected and Affected by HIV/AIDS in Myanmar, Royal Kumudra Hotel, Nay Pyi Taw (21-5-2013) 69. Dr. Myo Myo Mon Research Training Workshop on "Situation analysis on Scientist Orphans and Vulnerable Children Infected and Affected by HIV/AIDS in Myanmar", Corriander Leaf (12-6-2013 to 15-6-2013) 70. Dr. Myo Myo Mon Research Field Research Methodology Workshop at Scientist DMR(LM) (Lecturer) (12-8-2013 to 14-8-2013) 71. Dr. Myo Myo Mon Research Research Methodology Workshop at DMR Scientist (LM) (Lecturer) (27-8-2013 to 29-8-2013) 72. Dr Aye Aye Yee Research Research Methodology and Bio-ethic Scientist 73. Dr. Moh Moh Hlaing Research Consultation Workshop for “To Develop the Scientist Evidenced-based Information and Research to Influence Food Security and Livelihoods Programming” Yangon (1-2 August, 2013) 74. Dr. Moh Moh Hlaing Research Workshop on updating management of acute Scientist malnutrition guidelines, 2013, Nay Pyi Taw. (23-25 August, 2013) 75. Dr. Moh Moh Hlaing Research Workshop on upgrading food based dietary Scientist guideline e for Myanmar .People. Department of Medical Research (Lower Myanmar) (9-10 September, 2013) 76. Dr. Moh Moh Hlaing Research ASEAN food Inspection and certificate Project Scientist Phase 3-Training by Australia Maritime College (AMC). University of Public Health, Yangon. (30-9-2013 to 3-10-2013) 77. Dr. Thet Thet Mar Research Health Research Management, DMR (Central Scientist Myanmar) Nay Pyi Taw (2-4-2013 to 4-4-2013)

167

Annual Report 2013

Sr. Name Designation Seminar/ Workshop/ Training 78. Daw Win Thaw Tar Research Urban and Sustainable Development Series: Lwin Scientist Foundation Course on Sustainable Urban and Regional Development, Myanmar-Singapore Training Centre, (Trainee), (16-9-2013 to 20-9-2013) 79. Daw Win Thaw Tar Research Mid -Level Officer Management Course (45), Lwin Scientist Central Institute of Civil Service (Phaunggyi), (5-10-2013 to 1-11-2013) 80. Dr. Moe Moe Han Research Recent Advances in Occupational Medicine Officer Workshop at University of Public Health, (Trainee) (16-9-2013 to 20-9-2013) 81. Dr. Ye Hein Htet Research Training course on “English for Liaison Officer Officer (for Myanmar)”, Singapore Embassy, Yangon (4-3-2013 to 15-3-2013) 82. Dr. Ye Hein Htet Research Workshop on “Arsenic contamination in Officer drinking water” at Bago, Bago Region (2-5-2013 to 3-5-2013) 83. Dr. Tin Sandar Win Research Training course on “Dissolution of artemeter/ Officer lumefantrine fixed dose combination and chloroquine phosphate tablets” at Food and Drug Administration Department, Naypyitaw (9-12-2013 to 13-12-2013) 84. Dr . Maung Maung Research Training Course on Entomology a nd Vector Control Mya Officer in Myanmar, VBDC, Yangon (26-8-2013 to 8-9-2013) 85. U Sein Thaung Research Training Course on Entomology and Vector Officer Control in Myanmar, VBDC, Yangon (26-8-2013 to 8-9-2013) 86. Daw Moe Moe Aye Research “Dissolution of Artemether/ Lumefantrine fixed Officer dose Combination and Chloroquine phosphate tablets” workshop at FDA, Naypyidaw (9-12-2013 to 13-12-2013) 87. Dr. Nyi Nyi Win Research “Refresher Training on establishing drug quality Officer monitoring for anti-malaria drugs and selected antibiotics” workshop at FDA, Naypyidaw (2-12-2013 to 6-12-2013) 88. Dr. Khin Tar Yar Myint Research The 4 th Traditional Medicine Research Officer Congress, Mandalay, 2013, University of Traditional Medicine, Ministry of Health (27-5-2013 to 28-5-2013) 89. Dr. Khin Tar Yar Myint Research The 14 th Myanmar Traditional Medicine Officer Practitioner’s Conference, Department of Traditional Medicine, Ministry of Health, Nay Pyi Taw (26-12-2013 to 27-12-2013) 90. Daw Win Win Maw Research Basic Computer Application Course DMR Officer (Lower Myanmar) (15-8-2013 to 15-11-2013) 91. Daw Kyin Hla Aye Research Workshop on Quality Management in Malaria Officer Research and Public Health Interventions (DMR-LM) (21-1-2013 to 23-1-2013)

168

Annual Report 2013

Sr. Name Designation Seminar/ Workshop/ Training 92. Dr. Khin Myo Aye Research Workshop on Quality Management in Malaria Officer Research and Public Health Interventions (DMR-LM) (21-1-2013 to 23-1-2013) 93. Dr. Myat Htut Nyunt Research Workshop on Quality Management in Malaria Officer Research and Public Health Interventions (DMR-LM) (21-1-2013 to 23-1-2013) 94. Dr. Khin Myo Aye Research Malaria-Molecular Workshop (DMR-LM) Officer (24-1-2013 to 25-1-2013) 95. Dr. Myat Htut Nyunt Research Malaria -Molecular Workshop (DMR -LM) Officer (24-1-2013 to 25-1-2013) 96. Dr. Khin Myo Aye Research National workshop on monitoring therapeutic Officer efficacy of antimalarial drugs, Auditorium A, MMA, (8-4-2013 to 9-4-2013) 97. Dr. Myat Htut Nyunt Research National workshop on monitoring therapeutic Officer efficacy of antimalarial drugs, Auditorium A, MMA, (8-4-2013 to 9-4-2013) 98. Daw Kyin Hla Aye Research Malaria Microscopy Quality Assurance Officer Workshop (DMR LM) (24-1-2013 to 25-1-2013) 99. Daw Kyin Hla Aye Research Refresher Course in Malaria Microscopy Officer Auditorium A, MMA, (8-4-2013 to 11-4-2013) 100. Dr. Kyi Maw Than Research Translation research methodology basic course Officer (1), (25-11-2013) to (29-11-2013) at University of Public Health. 101. Dr. Kyi Maw Than Research Research meeting for leprosy control Officer Nay Pyi Taw (4-4-2013 to 5-4-2013) 102. Dr. Kyi Maw Than Research HSR Protocol Development Workshop Officer Nay Pyi Taw (22-2-2013 to 24-2-2013) 103. Daw Khin Sandar Oo Research Launching Ceremony and Training Workshop Officer Situation Analysis on Orphans and Vulnerable Children Infected and Affected by HIV/AIDS in Myanmar (12-15 June 2013) 104. Daw Khin Sandar Oo Research Workshop on field Research Methodology Officer Training (12-14 August 2013) 105. Dr. Su Latt Tun Research Advocacy and Coordination Meeting for Myint Officer Orphans and Vulnerable Children Infected and Affected by HIV/AIDS in Myanmar, Royal Kumudra Hotel, Nay Pyi Taw (21-5-2013) 106. Dr. Su Latt Tun Research Training Workshop on "Situation Analysis on Myint Officer Orphans and Vulnerable Children Infected and Affected by HIV/AIDS in Myanmar", Corriander Leaf (12-6-2013 to 15-6-2013) 107. Dr. Su Latt Tun Research Field Research Methodology Workshop at Myint Officer DMR (LM) (Lecturer) (12-8-2013 to 14-8-2013) 108. Dr. Su Latt Tun Research Research Methodology Workshop at DMR Myint Officer (LM) (Facilitator) (27-8-2013 to 29-8-2013) 109. Dr. Su Latt Tun Research The 5 th International Conference on Public Health Myint Officer among Greater Mekong Sub-regional Countries, University of Public Health (28-9-13 to 29-9-13)

169

Annual Report 2013

Sr. Name Designation Seminar/ Workshop/ Training 110. Dr. Win Lai May Research Basic Course 1: Translational Research Officer Methodology, University of Public Health, Yangon (25-11-2013 to 29-11-2013) 111. Dr. Mya Ohnmar Research Professional Epidemiology Methods- Officer collaborative certificate course, John Hopkins Bloomberg School of Public Health, University of Public Health, Yangon (28-3-2013 to 30-3-2013) 112. Dr. Mya Ohnmar Research ASEAN food Inspection and certificate Project Officer Phase 3-Training by Australia Maritime College (AMC). University of Public Health, Yangon. (22-5-2013 to 23-5-2013) 113. Dr. Mya Ohnmar Research Food Safety Training for Nutritionist and other Officer Health Professionals for Mekong Countries. University of Public Health, Yangon (3-9-2013 to 6-9-2013) 114. Dr. Mya Ohnmar Research Workshop on upgrading food base d dietary Officer guideline e for Myanmar People. Department of Medical Research (Lower Myanmar) (9-10 September, 2013) 115. Dr. Mya Ohnmar Research 5th International Conference on Public Health Officer Among GMS Countries, University of Public Health, Yangon, Myanmar. (28-29 September 2013) 116. Daw Mar Mar Myint Medical Workshop on Research Methodology. DMR Technician1 (Lower Myanmar) (27-8-2013 to 29-8-2013) 117. Daw Ni Ni Zaw Research Malaria Microscopy Quality Assurance Assistant (1) Workshop (DMR-LM)(24-1-2013 to 25-1-2013) 118. Daw Soe Soe Han Research Malaria Microscopy Quality Assurance Assistant (1) Workshop (DMR-LM)(24-1-2013 to 25-1-2013) 119. Daw Ni Ni Zaw Research Refresher Course in Malaria Microscopy Assistant (1) Auditorium A, MMA, (8-4-2013 to 11-4-2013) 120. Daw Soe Soe Han Research Refresher Course in Malaria Microscopy Assistant (1) Auditorium A, MMA, (8-4-2013 to 11-4-2013) 121. Daw Nay Chi Aung Research Malaria Microscopy Quality Assurance San Assistant (2) Workshop (DMR-LM)(24-1-2013 to 25-1-2013) 122. Daw Thin Thin Aye Research Malaria Microscopy Quality Assurance Assistant (2) Workshop (DMR-LM)(24-1-2013 to 25-1-2013) 123. Daw Cho Cho Research Malaria Microscopy Quality Assurance Assistant (2) Workshop (DMR-LM)(24-1-2013 to 25-1-2013) 124. U Phyo Zaw Aung Research Refresher Course in Malaria Microscopy Assistant (2) Auditorium A, MMA, (8-4-2013 to 11-4-2013) 125. Daw Nay Chi Aung Research Refresher Course in Malaria Microscopy San Assistant (2) Auditorium A, MMA, (8-4-2013 to 11-4-2013) 126. Daw Thin Thin Aye Research Refresher Course in Malaria Microscopy Assistant (2) Auditorium A, MMA, (8-4-2013 to 11-4-2013) 127. Daw Cho Cho Research Refresher Course in Malaria Microscopy Assistant (2) Auditorium A, MMA, (8-4-2013 to 11-4-2013)

170

Annual Report 2013

Sr. Name Designation Seminar/ Workshop/ Training 128. Daw Yamin Ko Ko Research Establishing Medicines Quality Monitoring: Assistant (2) Basic Tests, Sampling Procedure, Data Management and Reporting, FDA, Nay Pyi Taw (2-12-2013 to 6-2-2013) 129. Daw Wai Wai Myint Research Training Workshop on "Situation Analysis on Assistant (2) Orphans and Vulnerable Children Infected and Affected by HIV/AIDS in Myanmar", Corriander Leaf (12-6-2013 to 15-6-2013) 130. Daw Wai Wai Myint Research Field Research Methodology Workshop at Assistant (2) DMR (LM) (Participant) (12-8-13 to 14-8-13) 131. Daw Khin Thet Thet Research Training Workshop on "Situation Analysis on Assistant (2) Orphans and Vulnerable Children Infected and Affected by HIV/AIDS in Myanmar", Corriander Leaf (12-6-2013 to 15-6-2013) 132. Daw Kyi Kyi Mar Research Training Workshop on "Situation Analysis on Assistant (2) Orphans and Vulnerable Children Infected and Affected by HIV/AIDS in Myanmar", Corriander Leaf (12-6-2013 to 15-6-2013) 133. Daw Tin Tin Wai Research Training Workshop on "Situation Analysis on Assistant (2) Orphans and Vulnerable Children Infected and Affected by HIV/AIDS in Myanmar", Corriander Leaf (12-6-2013 to 15-6-2013) 134. Daw Tin Tin Wai Research Training Workshop on “KAP of Malaria among Assistant (2) Migrants Working in Malaria prone Location”, Summit Park View (1-11-2013) 135. Daw Khin San Lwin Research Basic computer application course 2013, Assistant (2) DMR (LM), (15-9-2013 to 15-12-2013) 136. Daw Htet Nandar Research Research Methodology Workshop at DMR Aung Assistant (2) (LM) (Trainee) (27-8-2013 to 29-8-2013) 137. Daw Ni Ni Than Research Basic Computer Course at DMR (LM) Assistant (2) (16-8-2013 to 18-11-2013) 138. U Hein Min Soe Research Refresher Course in Malaria Microscopy Assistant (3) Auditorium A, MMA, (8-4-2013 – 11-4-2013) 139. U Thurein Tun Research Refresher Course in Malaria Microscopy Assistant (3) Auditorium A, MMA, (8-4-2013 – 11-4-2013) 140. U Aung Soe Min Research Training Workshop on "Situation Analysis on Assistant (3) Orphans and Vulnerable Children Infected and Affected by HIV/AIDS in Myanmar", Corriander Leaf (12-6-2013 to 15-6-2013) 141. Da w Zin Mar Aye Research Training Workshop on "Situation Analysis on Assistant (3) Orphans and Vulnerable Children Infected and Affected by HIV/AIDS in Myanmar", Corriander Leaf (12-6-2013 to 15-6-2013) 142. Daw Lwin Lwin Ni Research Training Workshop on "Situation Analysis on Assistant (3) Orphans and Vulnerable Children Infected and Affected by HIV/AIDS in Myanmar", Corriander Leaf (12-6-2013 to 15-6-2013)

171

Annual Report 2013

Sr. Name Designation Seminar/ Workshop/ Training 143. Daw Nay Yee Tun Research Basic Computer Application Course DMR(LM) Assistant (4) (16-8-2013 to 18-11-2013) 144. Daw Phyu Thi Research Training Workshop on "Situation Analysis on Assistant (4) Orphans and Vulnerable Children Infected and Affected by HIV/AIDS in Myanmar", Corriander Leaf (12-6-2013 to 15-6-2013) 145. Daw Lwin Ni Ni Research Training Workshop on "Situation Analysis on Thaung Assistant (4) Orphans and Vulnerable Children Infected and Affected by HIV/AIDS in Myanmar", Corriander Leaf (12-6-2013 to 15-6-2013) 146. Daw Lwin Ni Ni Research Training Workshop on “KAP of Malaria among Thaung Assistant (4) Migrants Working in Malaria prone Location”, Summit Park View (1-11-2013) 147. Daw Ni Ni Htay Research Training Workshop on "Situation Analysis on Aung Assistant (4) Orphans and Vulnerable Children Infected and Affected by HIV/AIDS in Myanmar", Corriander Leaf (12-6-2013 to 15-6-2013) 148. U Kaung Set Laboratory Training Workshop on "Situation Analysis on Attendant Orphans and Vulnerable Children Infected and Affected by HIV/AIDS in Myanmar", Corriander Leaf (12-6-2013 to 15-6-2013)

172

Annual Report 2013

List of Publications

1. Aung Kya w Kyaw, Saw Myat Thwe, Khi Moe Aung, Myint Myint Khaing, Su Su Myaing, Phone Zin Myint, Sanda Lin, Tin Tin Thein and Kyaw Zin Thant (2013). Histopathological and Biochemical study of Alloxan induced Diabetes Mellitus an Albino Rats. Myanmar Health Science Research Journal , Vol. 25, No.1, p-44. 2. Aye Aye Lwin, Yi Yi Kyaw, Khin May Oo, Myo Khin, Toshiyuki Shinji and Norio Koide. The genotype analysis of hepatitis B virus in Myanmar by polymerase chain reaction–restriction fragment length polymorphism (PCR–RFLP). Hepatol Int (2013)7 (Suppl 1): S152. 3. Chie Nakajima, Khin Saw Aye, Aki Tamaru, Zeaur Rahim, Ajay Poudel, Bahagwan Maharjan, et al. Simple multiplex PCR assay for identification of Beijing family Mycobacterium tuberculosis isolates with a lineage-specific mutation in Rv0679c. Journal of Clinical Microbiology 2013; 51(7): 2025-32. 4. Department of Medical Research (Lower Myanmar) in collaboration with Department of Health, Malaria Consortium and World Health Organization (Myanmar). Myanmar Artemisinin Resistance Containment Project: Baseline Survey (2013). (Report submitted to the Three Diseases Fund). 5. Department of Medical Research (Lower Myanmar). Dimensions of malaria research: A collection of abstracts (2001-2011). Eds. Ye Htut, Pe Than Htun, Khin Thet Wai and Tin Oo. DMR (LM). September, 2013. 6. Ei Mon Hla, Marlar Myint, May Aye Than, Khin Tar Yar Myint and Mu Mu Sein Myint. Anti-hyperglycemic effect of the leaves of Moringa oleifera Lam. ( 'efUovGef) and identification of quercetin compound. The Myanmar Health Sciences Research Journal 2013; 25 (1): 67-73. 7. Gonzalo J Domingo, Ari Winasti Satyagraja, Anup Anvikar, Kevin Baird, Germana Bancone, Pooja Bansil, Nick Carter, Qin Cheng, Janice Culpepper, Chi Eziefula, Mark Fukuda, Justin Green, Jimee Hwang, Marcus Lacerda, Sarah McGray, Didier Menard, Francois Nosten, Issrang Nuchprayoon, Nwe Nwe Oo, Pongwit Bualombai, Wadchara Pumpradit, Kun Qian, Judith Recht, Arantxa Roca, Wichai Satimai, Siv Sovannaroth, Lasse Vestergaard and Lorenz Von Seidlein. G6PD testing in support of treatment and elimination of malaria: recommendations for evaluation of G6PD tests. Malaria Journal 2013; 12: 391-402. 8. Kay Thwe Han, Kyin Hla Aye, Myat Phone Kyaw and Ye Htut. In vitro susceptibility status of Plasmodium falciparum to antimalarial drugs and prevalence of its pfmdr1 86 polymorphism in Kawthaung . Myanmar Health Sciences Research Journal (2013); 25(1): 51-55. 9. Khin Khin Aye, Sandar Nyunt, Nu Nu Lwin, Win Aung and Moh Moh Htun.Viability of recombinant hepatitis B surface antigen expressed Hansenula polymorpha yeast cells in the locally prepared master cell bank (lyophilized form). Myanmar Health Sciences Research Journal 2013; 25(3). 10. Khin May Oo, Yi Yi Kyaw, Win Maw Tun. Aspects of Hepatitis B infection in Myanmar. Myanmar Health Sciences Research Journal 2012; 42(3): pp 123-129. 11. Khin Mi Mi Lay, Tin Moe Hlaing, San San Lwin, Mya Thein, Kyawt Kyawt Khaing, Kyi San, Khin Phyu Phyu, Min Than Nyunt and Kyaw Zin Thant. Measurement of Air Quality in Pyin Oo Lwin Township in March, 2011. Myanmar Health Sciences Research Journal 2013; 25(1): 36-40. 12. Khin Phyu Phyu, Khin Mi Mi Lay, Myat Min and Kyaw Zin Thant. The phytochemical activity and wound healing properties of Croton joufra Roxb. (Thet-yin-kado) root in mice. Myanmar Journal of Current Medical Practice 2013; 17(4): 14-18. 173

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13. Khin Phyu Phyu, Mya Marlar, Khaing Khaing Mar, Win Khaing, Khin Tar Yar Myint, May Aye Than, Thaw Zin, Ye Htut and Kyaw Zin Thant (2013). Determination of Myanmar Medical Plant Extracts for Antioxidant Activity. Myanmar Health Science Research Journal , Vol. 25, No.3, p-236. 14. Khin Saw Aye, Min Thein, Win Lai May, Theingi Win Myat, Su Myat Mon Phone, Khin Than Maw, Khine Zar Win and Thazin Myint. Dengue Genetics Population Program. Newsletter. McMaster University, National Institutes of Health 2013; 4: 5. 15. Khin Than Yee, Theingi Thwin, Ei Ei khin, Ko Ko Zaw, Nwe Nwe Oo, Aye Myint Oo, Lwin Zar Maw, May Thu Kyaw and Nwe Ni Aung. Metabolic syndrome in obese and normal weight Myanmar children. Journal of The ASEAN Federation of Endocrine Societies 2013; 28 (1): 52-55. 16. Khine Thin Naing, Tin Nwe Htwe, Ye Hein Htet, Tin Tin Htike, Aung Myat Kyaw, Aye Thidar Tun, Thandar Wint Wint Aung, Thaung Hla and Kyaw Soe (2013). Effectiveness of decontamination methods to reduce pesticide residues on selected fruits and vegetables. Myanmar Health Sciences Research Journal 2013; 25-1: 62-66. 17. Kyaw Oo, Le Le Win, Saw Saw, Myo Myo Mon, Yin Thet Nu Oo, Thae Maung Maung, Su Latt Tun Myint and Theingi Myint. Challenges faced by skilled birth attendants in providing antenatal and intrapartum care in selected rural areas of Myanmar. WHO South-East Asia Journal of Public Health, 2012; 1(4): 467-476. 18. Kyaw Swar Lin, Sabai Phyu and Htin Aung Saw. An experience on Tenofovir. Myanmar Journal of Clinical Practice 2013; (18). 19. Le Le Win, Khin May Oo, Win Maw Tun, Khin Sandar Oo, Thandar Min, Soe Moe Myat and Than Htein Win. Opinion of Caregivers and Midwives towards Hepatitis B Immunization in 3-5 year-old Children from Mawlamyaing and Thaton Townships. Myanmar Health Science Research Journal 2013; 25: 3. 20. Le Le Win, San Shwe, Kyaw Myint, Yutaka Ishida, Myo Than Tun, Kyi Kyi Mar, Thandar Min, Phyo Min Oo and Aye Win Khine. Factors influencing proper plantar ulcer care of leprosy patients: experience from Mon-ywa Township of Disabilities survey project, Myanmar. Global Journal of Dermatology and Venerology, 2013; 1: 37-40. 21. M.M. Mya, P.T. Htun, S. Min and R.K. Saxena. Cytotaxnomical studies of Anopheles culicifacies species complex and its malaria vectorial capacity in Myanmar. International Journal of Contemporary Research in Engineering and Technology 2012; 2(2): 17-26. 22. May Aye Than, Aye Than, Kyaw Zin Thant and et. al., (2013). Myanmar Traditional Medicine Formulary. Golden Jubilee Publication, Department of Medical Research (Lower Myanmar), Ministry of Health. 23. Miao M., Wang, Z., Yang, Z., Yuan, L., Parker, D.M., Putaporntip, C., Jongwutiwes, S., Xangsayarath, P., Pongvongsa, T., Moji, H., Tuong, T. D., Abe, T., Nakazawa, S., Myat Phone Kyaw, Yan, G., Sirichaisinthop, J., Sattabongkot, J., Mu, J., Su, X.-z., Kaneko, O., Cui, L. 2013. Genetic diversity and lack of artemisinin selection signature on the Plasmodium falciparum ATP6 in the Greater Mekong Subregion. PLoS One 8, e59192. 24. Moe Thida Kyaw, Theingi Thwin, Wah Wah Aung, Sein Maung Than, Yin Yin Aye, Nyein Nyein Win and Mya Yi Nyo. Acceptipility of Home-made Weaning Mixes meeting Nutritional Needs. Myanmar Health Sciences Research Journal 2013; 25 (1); 41-43. 25. Mu Mu Shwe , Hlaing Myat Thu, Mo Mo Win, Khin Saw Aye, Khin Khin Oo, Ko Ko Zaw, Aye Aye Win, Nan Cho Nwe Mon and Yin Lin Myint. Genotyping of high-risk type human papillomavirus (HR-HPV) in women with cervical cytological abnormalities. Myanmar Health Sciences Research Journal 2013; 25(1): 1-7. 26. Mya Mya Aye, Wah Wah Aung, Mi Mi Htwe, Aye Aye Maw, Khine Zarwin, Aye Yin Shwe and Khin Nwe Oo. Microbiological analysis and antibacterial effect of hydrogen peroxide on fruits and vegetables. Myanmar Health Sciences Research Journal 2013; 25(1): 79-80.

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27. Myat Htut Nyunt, Myat Phone Kyaw, Kyu Kyu Win, Khin Maung Myint and Khin Maung Nyunt. Field evaluation of HRP2 and pan pLDH-based immune-chromatographic assay in therapeutic monitoring of uncomplicated falciparum malaria in Myanmar (2013). Malaria Journal 2013; 12:123 doi: 10.1186/1475-2875-12-123 28. Myat Phone Kyaw, Myat Htut Nyunt, Khin Chit, Moe Moe Aye, Kyin Hla Aye, Moe Moe Aye, Niklas Lindegardh, Joel Tarning, Mallika Imwong, Christopher G. Jacob, Charlotte Rasmussen, Jamie Perin, Pascal Ringwald, Myaing M. Nyunt. 2013. Reduced Susceptibility of Plasmodium falciparum to Artesunate in Southern Myanmar. PLoS ONE 8(3): e57689. DOI: 10.1371/journal.pone.0057689. 29. Myat Phone Kyaw, Myat Htut Nyunt, Khin Chit, Moe Moe Aye, Kyin Hla Aye, Moe Moe Aye, Niklas Lindegardh, Joel Tarning, Mallika Imwong, Christopher G. Jacob, Charlotte Rasmussen, Jamie Perin, Pascal Ringwald, Myaing M. Nyunt (2013). Reduced Susceptibility of Plasmodium falciparum to Artesunate in Southern Myanmar. PLoS ONE 8(3): e57689. doi:10.1371/journal.pone.0057689. 30. Myo Myo Mon, Saw Saw, Yin Thet Nu Oo, Khin Ohnmar San, Wai Wai Myint, San San Aye and Pyone Thuzar Nge. Treat of HIV/AIDS in children: Social, education and health consequences among HIV orphans and vulnerable children in Myanmar. WHO South- East Asia Journal of Public Health 2013; 1(2): 41-46. 31. Nyein Chan Aung, Myo Myo Mon, Le Le Win, Kyaw Soe & Than Tun Sein. Utilization of clean delivery kit in Insein Township. The Myanmar Health Sciences Research Journal 2013; 25(2): 159. 32. Nyein Chan, Ko Ko Zaw, Saw Saw, Yin Thet Nu Oo, Kyaw Soe and Than Tun Sein. Knowledge on adolescent reproductive health among high school students in Katha Township. Myanmar Health Sciences Research Journal 2013; 25 (2): 102. 33. Phyu Sin Aye, Sabai Phyu, Myo Myo Mon and Htin Aung Saw. Haematological manifestations among HIV-TB co-infected patients prior to ART in Specialist Hospital Waibagi and Specialist Hospital Thakayta, Yangon Region, Myanmar. 2013 Myanmar Health Sciences Research Journal 2013; 25(2): 130-135. 34. Sandar Nyunt, Nu Nu Lwin, Khin Khin Aye, Khin La Pyae Tun, Yi Yi Kyaw and Win Aung. Sero-prevalence of hepatitis B virus infection in healthy carriers and blood donors with HBsAg positivity. Myanmar Health Sciences Research Journal 2013; 25(1): 81-82. 35. Saw Win, Win Lai May, Theingi Thwin, Han Win, Sandar Kyi, Nyan Win, Myat Myat Thu, Khin Thida Wai and Win Lwin. Thiamine status of children at a foster monastery school in Mayangone Township. Myanmar Health Sciences Research Journal 2013; 25 (2): 125-129. 36. Su Latt Tun Myint, Khin Thet Wai, Khaymar Mya, Phyu Sin Aye & Yin Myo Aye. Estimation of Acute Diarrhoea and Acute Respiratory Infections among Children under five years who lived in a peri-urban environment of Myanmar. Outbreaks, Surveillance, Investigation and Reports Journal www.osirjournal.net/issue.phplid : Dec 2013; 6(4): 12-17. 37. Than Than Aye, Yae Chan, Han Win, Kyaw Oo and Khin Thinn Mu. Pattern of metastasis in metastatic breast cancer patients attending Medical Oncology Ward, Yangon General Hospital. Myanmar Health Sciences Research Journal 2013; 25(2): 149-155. 38. Theingi Thwin, Kyu Kyu Maung, Maung Maung Myint, Khin Than Maw, Thidar Khine, Lei Lei Myint, Su Su Haling and Hla Phyo Lin. Effect of dietary cyanidin-3-glucoside on fat accumulation and expression of glycerol 3 phosphate acyltransferase 1 in mice fed a high fat diet an control diet. Myanmar Health Sciences Research Journal 2013; 25 (3). 39. Thein gi Thwin, Moe Thida Kyaw, Mya Ohnmar, Sein maung Than, Su Su Hlaing, Hla Phyo Lin, Yin Yin Aye and Khin Hnin Wint Phyu. Effect of pomegranate juice consumption on oxidative stress and lipoprotein oxidation, aggregation and retention in diabetes patients. Myanmar Health Sciences Research Journal 2013; 25 (2); 156-158.

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40. Thida, Kyaw Zin Thant, Phyu Phyu Khaing, Sandar Htay and Than Tun Sein (2013). Antenatal care and Delivery Practices among Rual Kokang Mothers, Northern Shan State, Myanmar. Myanmar Health Science Research Journal , Vol. 25, No.2, p-9. 41. Thida, Saw Saw, Kyaw Zaw, Kyaw Zeyar Lynn, Phyu Phyu Khaing, Sandar Htay, New New Kyaw, Yee Yee Myint and Kyaw Zin Thant (2013). Accessibility of Health Services among TB patients in Kutkai Township, Northern Shan State, Myanmar. Myanmar Health Science Research Journal , Vol. 25, No.1, p-29. 42. Wah Wah Aung, Khin Thet Wai, Hlaing Myat Thu, Khin Saw Aye, Mya Mya Aye, Htin Lin, Moe Thida, Than Mya and Khine Zar Win. Aetiological agents, modifiable risk factors and gamma interferon status of children with acute respiratory infections attending general practitioner’s clinics. Myanmar Health Sciences Research Journal 2013; 25(3): 1-7. 43. Wah Wah Aung, Myo Thant, Khin Thet Wai, Mya Mya Aye, Phyu Win Ei, Thuzar Myint and Moe Thidar. Sexually transmitted infections among male highway coach drivers in Myanmar. Southeast Asian Journal of Tropical Medicine and Public Health 2013; 44 (3): 436-447. 44. Win Aung, Kyaw Kan Kaung, Htar Htar Lin and Khin Pyone Kyi. Hepatitis B vaccination: A reply to queries (3). Myanmar Journal of Current Medical Practice 2013: 17 (4); 19-24. 45. Ye Hein Htet, Khine Thin Naing, Than Than Swe, Tin Nwe Htwe, Nwe Nwe Soe, Theingi Khin, Khin Moe Latt, Khin Thet Wai and Kyaw Soe. Determination of mercury in skin cosmetics widely used in Myanmar. Myanmar Health Sciences Research Journal 2013; 25(2): 83-86. 46. Yi Yi Kyaw, Khin May Oo, Ohnmar Lwin, Aye Mya Khine and Myo Khin. Genomic distribution of hepatitis B virus in apparently healthy individuals presenting at hepatitis carrier clinic, Department Of Medical Research (Lower Myanmar). Hepatol Int 2013; 7 (Suppl 1):s158. 47. Yi Yi Kyaw,Thuzar Myint, Khin May Oo, Khin Nwe Oo, Thaung Hla and Mya Mya Aye. Development of an Enzyme Linked Immunosorbent Assay (ELISA) for Determination of IgG Antibody to Helicobacter pylori . Myanmar Health Sciences Research Journal 2013; 18-23. 48. Zaw Than Htun, Mo Mo Win, Thaung Hla, Theingi Win Myat, Naing Lin and Thin Thin Wah. Detection of Burkholderia pseudomallei in patients with Suppurative Infections Attending the Yangon General Hospital and New Yangon General Hospital. Myanmar Health Sciences Research Journal 2013; 114-119.

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Golden Jubilee Publications

1. Golden Jubilee Commemorative Volume (1963-2013)

2. Further Development of Medical Research in Myanmar (1987 to 2011)

3. Bibliography of Research Findings on Gastrointestinal Diseases in Myanmar

4. Index of Research Papers Presented at Health Research Congresses (1965-2011)

5. Dimensions of Malaria Research: A Collection of Abstracts (2001-2011)

6. Profile of Pesticides Registered in Myanmar (2012)

7. Golden Jubilee Magazine, Research Projects Carried out by DMR (LM) for Rural Health Development (2000-2010) 8. Annotated bibliography of Traditional Medicine Research Carried out at DMR (LM) during 1965-2011 9. aq;okawoeOD;pD;Xme(atmufNrefrmNynf) a&T&wkr*¾Zif; (1963 -2013)

10. Department of Medical Research (Lower Myanmar) Brief Booklet

11. Myanmar Traditional Medicine Formulary (2013)

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List of Papers Presented

1. Action Study Group (2013). Financial situation prior to cancer diagnosis among women with common malignancies attending selected cancer units: Preliminary findings. 41 st Myanmar Health Research Congress Programme and Abstracts , p.84. (Poster) 2. Action Study Group . Financial situation prior to cancer diagnosis among women with common malignancies attending selected cancer units: Preliminary findings. 41 st Myanmar Health Research Congress Programme and Abstracts , p.84. 3. Aung Zaw Latt, Mo Mo Win, Khin Mar Aye, Khin Khin Oo, Hay Mar Win, Hla Myo Thu, Khaing Moe Aung, Hlaing Myat Thu and Yoksan S (2013). Isolation and identification of Japanese encephalitis virus from piglets in Thaketa pig farm. 41 st Myanmar Health Research Congress Programme and Abstracts, p.56. 4. Aye Aye Lwin, Yi Yi Kyaw, Aye Aye Win, Myat Tin Htwe Kyaw, Hnin Ohnmar Soe, San Nwe, Win Maw Tun and Khin May Oo (2013). Clinical profile of hepatitis B virus infection in patients attending to the Hepatitis Carrier Clinic of Department Of Medical Research (Lower Myanmar). 41 st Myanmar Health Research Congress Programme and Abstracts p.67. 5. Aye Aye Myint, Kyi May Htwe, Myat Min Oo, Sankalyar Htwe and Tun Pe (2013). The protective effects of Mucuna pruriens Linn. DC seeds against Russell's viper (Daboia siamensis) venom. 41 st Myanmar Health Research Congress Programme and Abstracts, p.31. 6. Aye Aye Win, Khin Saw Aye , Min Min Win, Khin Than Maw, Thazin Myint, Tin Tin Han and Aye Aye Myint (2012). Diagnostic accuracy of LAMP (Loop-mediated isothermal amplification) method in diagnosis of Tuberculous lymphadenitis. 41 st Myanmar Health Research Congress Programme and Abstracts, p.76. (Poster) 7. Aye Aye Yee, Khin May Oo, Yin Yin Win, Aye Aye Maw, Khin Thida Wai, Thandar Myint, Sandar Aung and Naw Myat Su Mon (2013). Application of stable isotope method by using Deuterium Oxide (D 2O) and Fourier Transform Infrared Spectrometry (FTIR). 41 st Myanmar Health Research Congress Programme and Abstracts, p.79. 8. Celine Zegers De Beyl, Myat Phone Kyaw, Ohnmar, Thae Maung Maung, Sylvia Meek, Krongthong Thimasarn, Aye Yu Soe, David Sintasath and Thar Tun Kyaw (2013). Myanmar artemisinin resistance containment (MARC) survey: malaria diagnosis and treatment. The American Journal of Tropical Medicine and Hygiene 62 nd annual Meeting Abstract . 9. Chomar Kaung Myint, Saw Saw, Nay Soe Maung, Min Ko Ko, Aye Sandar Mon and Cho Thet Khine (2013). Assessment of school physical activities and healthy eating practices among students in Basic Education primary schools of Mingalardon Township, Yangon. 5th International Conference on Public Health among Greater Mekong Sub-Regional Countries , Yangon, Myanmar. 28-29 September 2013. 10. Han Win, Than Than Aye, Theingi Thwin, Ko Ko, Moh Moh Htun, Moh Moh Hlaing, Sandar Kyi, Myat Myat Thu and Khin Thida Wai (2013). Quality of life and compliance among type-2 diabetes patients attending the Diabetic Clinic at North Okkalapa General Hospital. 41 st Myanmar Health Research Congress Programme and Abstracts, p.42. 11. Htay Htay Lwin and May Aye Than. Diuretic activity of the plant Oldenlandia corymbosa L. The 4 th Traditional Medicine Research Congress Programme and Abstracts , 2013:15. 12. Htet Wai Oo, Myat Thu Soe, Phone Sithu Lwin, Lu Lu Kyaw, Tin Oo, Tin Nwe Htwe, Phyo Zaw Aung, Khin Thet Wai, Thar Tun Kyaw and Myat Phone Kyaw (2013). Malaria experience, treatment-seeking behavior and details of antimalarials among follow-up cases in Myanmar artemisinin ressistance containment areas. 41 st Myanmar Health Research Congress Programme and Abstracts , p.39-40. 178

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13. Htin Lin, Hlaing Myat Thu, Khin Mar Aye, Thida Kyaw, Mo Mo Win, Khin Thet Wai, Amy Khine, Myat Min Zaw and Min Zaw (2013). Detection of early cases of HIV infection by using HIV Combo enzyme-linked immunosorbant assay. 41 st Myanmar Health Research Congress Programme and Abstracts , p.54-55. 14. Kay Thwe Han, Kyin Hla Aye, Tin Oo, Ye Htut, Myat Phone Kyaw and Khin Ohnmar San (2012). Malaria Co-infection among HIV-infected pregnant women in Thaton District. 41 st Myanmar Health Research Congress Programme and Abstracts , p.26. 15. Khin Chit, Khin Saw Aye, Thandar Lwin, Tin Mi Mi Khaing, Khin Zaw Latt, Aye Aye Win, Min Wun, Khin Hnin Pwint and Kyi Kyi Myint. Evaluation of clinical, bacteriological, pharmacological factors and immunological responses of pulmonary TB patients in Yangon. 16. Khin Cho Cho Oo, Kyawt Kyawt Khine, Htay Htay Lwin and May Aye Than Antioxidant activity and hypoglycemic effect of Stephania venosa (Bl.) (awmifMumMuufaoG;). The 4 th Traditional Medicine Research Congress Programme and Abstracts, 2013:21. 17. Khin Khin Aye, Sandar Nyunt, Nu Nu Lwin and Win Aung (2013). Viability of recombinant hepatitis B surface antigen expressed Hansenualapolymorpha yeast cells in the locally prepared master cell bank (lyophilized form). 41 st Myanmar Health Research Congress Programme and Abstracts , p.81. 18. Khin May Oo, Le Le Win, Win Maw Tun, Aye Aye Lwin, Ohmar Lwin, Myat Tin Htwe Kyaw, Khin Sandar Oo, Khaymar Mya and Than Htein Win (2012). Effectiveness of hepatitis b immunization in 3-5 years old children from mon state. 41 st Myanmar Health Research Congress Programme and Abstracts, p.6-7. 19. Khin May Oo, Le Le Win,Win Maw Tun, Aye Aye Lwin, Ohmar Lwin, Myat Tin Htwe Kyaw, Khin Sandar Oo, Khaymar Mya and Than Htein Win (2013). Effectiveness of hepatitis B immunization in 3-5 year-old children from Mon State. 41 st Myanmar Health Research Congress Programme and Abstracts , p6. 20. Khin Myo Aye, Myat Phone Kyaw, Khin Thet Wai, Myo Min, Myat Htut Nyunt, Soe Soe Han and Phyo Zaw Aung (2013).The role of drug vendors in introduction of malaria Rapid Diagnostic Test and prescription of antimalarials in selected malaria micro-stratification areas of Tanintharyi Region. 41 st Myanmar Health Research Congress Programme and Abstracts , p.82. 21. Khin Phyu Phyu, Lei Lei Win, Khin Mi Mi Lay, Kyawt Kyawt Khaing, Kyi San, Aung Thuya, Win Khaing and Kyaw Zin Thant. Nephropharmacologic activity of Watery Extract of Alternanthera pungens (Myae-khat-kyet-mauk) against Cisplatin-induced nephrotoxicity in rats. 4th Research Paper Reading Session on Traditional Medicine University of Traditional Medicine, Mandalay) Programme and Abstracts , p.34. 22. Khin Phyu Phyu, Lei Lei Win, Mya Marlar, Khin Mi Mi Lay, Saw Ohnmar Khin, Kyaw Kyaw Khaing, Kyi San, Win Khaing and Kyaw Zin Thant. Nephroprotective effect of watery extract of Alternathera pungens in albino rats using Cisplatin-induced acute renal failure. 41 st Myanmar Health Research Congress Programme and Abstracts , p.28. 23. Khin Saw Aye, Komgrid Charngkaew, Ne Win, Kyaw Zin Wai, Kyaw Moe, Sanya Sukpanichnant, Prida Malasit and Scott B Halstead (2013). Pathologic Highlights Of Dengue Hemorrhagic Fever in 13 Autopsy Cases from Myanmar. 3rd International Conference on Dengue and DHF , Thailand, October 2013. 24. Khin Saw Aye, Mu Mu Shwe, Aye Aye Win, Min Thein, Win Le May, Chie Nakajima and Yasuhiko Suzuki (2013). Role of Loop-Mediated Isothermal Amplification (LAMP) assay in diagnosis of extrapulmonary tuberculousis. US-Japan Cooperative Medical Science Program: TB and Leprosy Panel Meeting , Hokkaido Japan, August 2013.

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25. Khin Saw Aye, Win Lai May, Aye Aye Win, Mu Mu Shwe, Min Min Win, Khin Than Maw and Thazin Myint (2013). Role of Loop-Mediated Isothermal Amplification (LAMP) assay in rapid diagnosis of tuberculous meningitis. 41 st Myanmar Health Research Congress Programme and Abstracts, p.20-21. 26. Khin Su Myat Win, Mya Thida, Mei Mei Shwe and Saw Saw (2013). Perinatal mortality in North Oakalapa General Hospital, Myanmar Medical Association, 59 th Myanmar Medical Conference Programme and Abstracts, p.41. 27. Khin Tar Yar Myint, Khine Khine Lwin, Mar Mar Myint, Ohnmar Kyaw, Nu Nu Win, May Aye Than, Myint Myint Khine and Mie Mie Thaw (2013). Determination of arsenic and lead content in selected medicinal plants from different areas in Myanmar. 41 st Myanmar Health Research Congress Programme and Abstracts , p.72 (Poster). 28. Khin Tar Yar Myint, Mu Mu Sein Myint, May Aye Than, Phyu Phyu Win, Win Win Maw, Mi Aye Aye Mon and Mie Mie Thaw. Antioxidant activity, total phenol content and ascorbic acid content of three different preparations of noni fruit juice (&JJ,dk). 4th Traditional Medicine Research Congress Programme and Abstracts , 2013: 24. 29. Khin Than Yee, Theingi Thwin, Ei Ei Khin, Ko Ko Zaw, Nwe Nwe Oo, Aye Myint Oo, Lwin Zar Maw, May Thu Kyaw & Nwe Ni Aung (2013). Associated risk factors for metabolic syndrome in normal and obese Myanmar children. 41 st Myanmar Health Research Congress Programme and Abstract , January 2013, p.14. 30. Khin Thet Wai. Control and Research on Parasitic Neglected Tropical Disease in Myanmar. 13 th Regional Network Meeting on Asian Schistosomiasis and other Helminth Zoonoses (RNAS+). Khonkaen, Thailand. 24-26 October, 2013 31. Khin Thet Wai. Future Research Priorities. Bilateral Dialogue on Health Sector: Grand Challenges Canada and Myanmar. Department of Medical Research (Lower Myanmar). 25 August 2013. 32. Khine Khine Lwin, May Aye Than, Khin Thet Wai, Nu Nu Win, Tun Myint Aye, San Yu Aung, San San Myint and Phyu Phyu Win (2013). The use of herbal medicines and Traditional Medicines Formulations (TMFs) for hypertension at Traditional Medicine Hospital, Yangon. 41 st Myanmar Health Research Congress Programme and Abstracts , p.51-52. 33. Khine Thin Naing, Tin Nwe Htwe, Tin Tin Htike, Aye Thidar Tun, Ye Hein Htet, Thaung Hla, Kyaw Soe and Myat Phone Kyaw (2013). Determination of organochlorine pesticides contamination in water from Hlaing-thar-yar Industrial Zone. 41 st Myanmar Health Research Congress Programme and Abstracts , p.48. 34. Ko Ko Zaw, Maung Maung Than Htike, Tint Swe Latt, Nyo Nyo Kyaing, Ko Ko Naing, Kyaw Khine, Ko Ko and Kyi Thar (2013). Alcohol drinking in Myanmar: National levels and associated factors (2013). 41 st Myanmar Health Research Congress Programme and Abstracts, p.11. 35. Kyi Maw Than, Ko Ko Zaw, Le Le Win, Yin Thet Nu Oo, Khin Sandar Oo, San San Aye, Kyi Kyi Mar, Pyone Thuzar Nge and Soe Moe Myat (2013). Assessing community awareness and preparedness on hazards from storms and flood in Kyaung- Kone and Kun-Chan-Kone Townships, Myanmar. 5th International Conference on Public Health among Greater Mekong Sub-regional Countries . Yangon, Myanmar. 28-29 September 2013. 36. Kyu Kyu Than, Yin Thet Nu Oo, Mon Mon, Myo Thant Aung, Tin Tin Mar, Khin Ohnmar San, San Hone, Than Htun & Khin Sandar Oo (2013). Social situation of HIV/ AIDS affected households in Myanmar. 41 st Myanmar Health Research Congress Programme and Abstracts, p.63.

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37. Le Le Win, Saw Saw, Tin Mi Mi Khaing, Thandar Lwin & Yin Thet Nu Oo (2013). Community-based TB care and control: Involvement of volunteers trained by international organizations in Myanmar. 41 st Myanmar Health Research Congress Programme and Abstracts , p.67. (Poster) 38. Lulu Kyaw Tin Oo, Chan Myay Hlaing, Nay Chi Aung San, Cho Cho, Kay Thwe Han, Myat Phone Kyaw, Ye Htut, Than Tun and Thar Tun Kyaw (2012). Sentinel surveillance of Day 3 falciparum malaria parasite positive rate of Artemisinin based combination Therapy (ACT) in Ann Township, Rakhine state. 41 st Myanmar Health Research Congress Programme and Abstracts , p.48. 39. Maung Maung Mya, Aye Mya Thanda, Phyo Wai Win, Thi Ha, Maung Maung Gyi and Yan Naung Maung Maung. Village scale trial of deltamethrin impregnated bed nets for reduction of malaria transmission in forest foot hill areas of Bago Region. 41 st Abstracts of poster, Myanmar Health Research Congress , p. 80-81. 40. Maung Maung Than Htike,Tint Swe Latt, Ko Ko Naing, Nyo Nyo Kyaing, Kyaw Khine, Ko Ko Zaw and Ko Ko (2013). Prevalence of hypertension in Myanmar. 41 st Myanmar Health Research Congress Programme and Abstracts , January, p.8. 41. May Aye Than (2013). Traditional Medicinal Research in Department of Medical Research (Lower Myanmar). At Workshop on Research and Development of Traditional Medicine (Ministry of Science and Technology, Yangon). 20 th to 21 st February; 2013. 42. May Aye Than, Mu Mu Sein Myint, Ohnmar Kyaw, Win Win Maw, Phyu Phyu Win, Myint Myint Khine, San San Myint and Nu Nu Win (2013). Standardization, preclinical acute and sub-acute toxicity testing of antihyperglycemic /hypolipidemic medicinal plant Trigonella foenum-graecum L. (Pe-na-thar) seeds on rats. 41 st Myanmar Health Research Congress Programme and Abstracts , p.30. 43. May Aye Than. General pharmacology and pharmacokinetic, acute toxicity and Hypoglycemic activity testing . At Upgrading course on Training of Medicinal Chemistry for University Teachers of Chemistry subjects. (Chemistry Department, Yangon University) 27 th to 31 th May; 2013. 44. Mo Mo Win, Hlaing Myat Thu, Khin Thet Wai, Thaung Hla, Wah Wah Aung, Mar Mar Nyein and Zaw Than Htun (2013). Meloidosis Research in Myanmar: Implications for an integrated approach. 7th World Meloidosis Congress , Bangkok, Thailand. 45. Moe Moe Han, Ye Hein Htet, Tin Oo, Thaung Hla, Ohnmar Oo, Myat Phone Kyaw, Mariam Bi, Ohnmar Win and Ni Ni Maw (2013). The determination of elemental concentration of soil and water in selected areas. 41 st Myanmar Health Research Congress Programme and Abstracts , p.37. 46. Moh Moh Hlaing, Theingi Thwin, Mya Ohnmar, Sandar Tun, Thuzar Aye, Yin Lynn Myint, Sein Mg Than and Pe Zaw Oo (2013). Effect of health education on changes in dietary habit and cardiovascular risk factors among sedentary workers . 41 st Myanmar Health Research Congress Programme and Abstracts , p.13. 47. Moh Moh Htun, Win Maw Tun, Aye Aye Lwin, Yin Min Htun, Yi Yi Kyaw, Myat Mon Oo, Aye Myint Swe, Khin May Oo and Myo Khin. Analysis of haematological parameters in Anti-HCV positive persons in Yangon 3rd Conference of Myanmar Haematology Society, 2013. 48. Moh Moh Htun, Yin Min Tun, Thant Than Aye, Myat Mon Oo, Khin Myo Set, Mya Thandar Win, Ei Ei Mon, Ohnmar and Myat Thu (2013). Screening of beta thalassaemia carriers in students from the University of Nursing, Yangon. 41 st Myanmar Health Research Congress Programme and Abstracts, p.70-71.

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49. Mu Mu Sein Myint, Kyin Hla Aye, Khin Tar Yar Myint, Ye Htut, May Aye Than, Ei Ei Soe, Aung Aung Maw and Mi Aye Aye Mon. Determination of anti-malarial efficacy of various fractions of Ocimum sanctum Linn. (Pin-sein-net) leaf on Plasmodium berghei infected mice. 41 st Myanmar Health Research Congress Programme and Abstracts ; 2013: 31. 50. Mu Mu Shwe, Kyi Kyi Nyunt, Hlaing Myat Thu, Hla Myat Mo Mo, Mo Mo Win, Khin Thet Wai, Khin Khin Oo, Khin Sandar Aye and Myo Khin (2013). Molecular characterization of human papilloma virus genotypes 16, 18, 31, 33, 52 and 58 in cervical neoplasia and relationship with clinicopathological findings. 41 st Myanmar Health Research Congress Programme and Abstracts p. 22. 51. Mya Ohnmar, Theingi Thwin, Htin Zaw Soe, Moh Moh Hlaing, Sandar Tun & Nay Soe Maung (2013). Dietary Intake and Nutritional Status of Students aged 12-14 years at No (4) Basic Education High School, Ahlone Township, Yangon Region. 5th International conference on Public Health among GMS countries, 28-29 September 2013, University of Public Health, Yangon, Myanmar. 52. Myat Htut Nyunt, Myat Phone Kyaw , Thar Tun Kyaw, Khin Thet Wai, Khin Myo Aye and Khin Thiri Kyaw (2012). Challenges encountered by local health volunteers in Early Diagnosis and Prompt Treatment of malaria in Myanmar Artemisinin Resistance Containment Zones. 41 st Myanmar Health Research Congress Programme and Abstracts p.50. 53. Myat Phone Kyaw, Myat Thu Soe, Phone Sithu Lwin, Lu Lu Kyaw Tin Oo, Htet Wai Oo, Min Myint Shwe, Moe Thida, Khin Thet Wai and Thar Tun Kyaw (2013). Myanmar artesunate resistance containment survey on health facilities before implementation. 41 st Myanmar Health Research Congress Programme and Abstracts p.75. 54. Myo Min Thane, Le Le Win and Swe Swe Win (2013). Epidemiological and clinic- pathological study of 120 cases of Oral Cancel in Myanmar. 41 st Myanmar Health Research Congress Programme and Abstracts , p.83. (Poster) 55. Myo Myo Mon, Saw Saw, Khin Ohnmar San, Yin Thet Nu Oo, Le Le Win, Ko Ko Zaw, Thae Maung Maung and Myo Thant (2013). Role of non-governmental organizations in ART care and support activities at township level in Myanmar. 5th International Conference on Public Health among Greater Mekong Sub-Regional Countries , September 2013, University of Public Health, Union of Republic of Myanmar. 56. Myo Myo Mon, Saw Saw, Wai Wai Myint, Wai Wai Han, Pyae Mon Thaw, San San Aye, Pyone Thuzar Nge and Soe Moe Myat (2013). Communication channels for health messages among the rural ethnic community in Mon and Shan States, Myanmar. 41 st Myanmar Health Research Congress Programme and Abstracts, p. 20. 57. Myo Myo Mon, Saw Saw, Yin Thet Nu Oo, Khin Ohnmar San and Wai Wai Myint (2013). Family and social situation of children affected by HIV/AIDS in Myanmar. 11 th International Congress on AIDS in Asia and the Pacific (ICAAP 11) , 18-22 November, 2013, Bangkok, Thailand. 58. Nay Htut Ko Ko, Saw Saw, Tin Mi Mi Khaing, Wai Wai Han, Thandar Lwin, Naing and Kyi Minn (2013). Highlights on the role of TB patient Self Help Groups in fighting against TB in Myanmar, Myanmar Medical Association, 59 th Myanmar Medical Conference, Programme and Abstracts p.46. 59. Nilar Tin, Saw Saw, Nwe Ni Ohne, San San Aye, Myint Myint Wai and Wai Phyo (2013). Policy Mapping and Analysis on Rural Retention Policies in Myanmar. 5th International Conference on Public Health among Greater Mekong Sub-Regional Countries, Yangon, Myanmar. 28-29 September 2013.

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60. Nilar Zaw, Hlaing Myat Thu, Mo Mo Win, Khin Mar Aye, Kay Thi Aye, Win Mar, San Yu Maw and May Kyi Aung (2013). Detection of Respiratory Syncytial Virus in infants with acute respiratory infection. 41 st Myanmar Health Research Congress Programme and Abstracts p.56. 61. Nwe Nwe Oo, Ye Htut, Myat Phone Kyaw, Malar Than, Win Win Myint, Khin Phyu Pyar, Ni Ni and Khin Nyo (2013). Effect of vitamin E on primaquine induced haemolysis in normal and Glucose 6 Phosphate dehydrogenase (G6PD) deficient persons. 41 st Myanmar Health Research Congress Programme and Abstracts p.26. 62. Nyi Nyi Win, Malar Myint, Khin Thein Oo, Yamin Ko Ko, Moe Moe Aye, Mya Mya Moe, Swe Swe Aung, Thin Thin Hlaing and Thinzar Myo. Influence of low fat food on absorption of Piperaquine in Myanmar healthy Volunteers. 63. Ohmar, Tun Min, San Shwe, Poe Poe Aung, Wai Wai Myint, Swe Mon Oo and Thae Maung Maung (2013). Causes of mortality in malaria endemic villages of Bago Region, Myanmar. 41 st Myanmar Health Research Congress Programme and Abstracts, p.41. 64. Ohnmar, Celine Zegers De Beyl, Thae Maung Maung, Sylvia Meek, Krongthong Thimasarn, Aye Yu Soe, Davidsintasath and Thar Tun Kyaw (2013). Myanmar artemisinin resistance containment (MARC) survey: Malaria awareness and prevention. The American Journal of Tropical Medicine and Hygiene 62 nd annual meeting Abstract. 65. Ohnmar, Than Tun Sein and Kathy Shein (2013). Health related quality of life among people living with HIV/AIDS (PLHA) attending Sunday Empowerment Group's activities of AFXB (Myanmar). 5th National Scientific Conference on HIV/AIDS , 2-3 December 2013, Hanoi, Vietnam, p. 351-353.(Poster) 66. Ohnmar, Tun Min, San Shwe, Poe Poe Aung, Wai Wai Myint, Swe Mon Oo, Thae Maung Maung and Virasakdi Chongsuvivatwong (2013). Verbal autopsy of the deaths in malaria endemic villages, Bago Region, Myanmar. Second Global Congress on Verbal Autopsy, Rhodes, Greece. (Poster) 67. Pe Than Htun, Yan Naung Maung Maung , Sein Min, Sein Thaung, Sai Zaw Min Oo and Maung Maung Mya (2013). Vector surveillance and insecticide efficacy in malaria endemic areas . 41 st Abstracts of poster, Myanmar Health Research Congress . P.72-73. (First runner-up Best Poster Award) 68. Pe Thet Zaw, Myat Phone Kyaw, Khin Thet Wai, Tin Oo, Myat Htut Nyunt, Moe Thida, Aye Than, Lu Lu Kyaw Tin Oo and Thar Tun Kyaw (2013). The effectiveness of migrant mapping tool on formulating strategies to support malaria interventions for temporary mobile/migrant workers in Tanintharyi Region. Poster, 41 st Myanmar Health Research Congress, Programme and Abstracts p.68-69. (Poster) 69. Phyu Cin Thandar Tun, May Sandar Nu and Saw Saw (2013). Culture of health related lifestyle among rural Skaw Kayin ethnic group in Tharyarwady Township, Bago (West). 41 st Myanmar Health Research Congress Programme and Abstracts p.19.1 70. Phyu Win Ei, Mya Thida, Wah Wah Aung, Myo Win, Khin Thant Zin, Aye Nyein Zan, Nan Aye Thida Oo, Thuzar Myint and Aye Aye Maw (2013). Reproductive tract infections among pregnant women attending the antenatal clinic at North Okkalapa General Hospital. 41 st Myanmar Health Research Congress Programme and Abstracts p.10. 71. San San Aye, Ko Ko Zaw, Than Tun Sein, Soe May Tun, Myo Min Tun, Yin Thet Nu Oo, Wai Wai Han, Yoshimi and Khine Soe (2013). Access to and expenditure on health care in Myanmar: a case study in Dike-Oo and Kyauk Taga townships in 2011. 41 st Myanmar Health Research Congress Programme and Abstracts p.10. 72. Sandar Kyi, Win Lai May, Han Win, Aye Aye Khine, Than Than Lwin, Kyu Kyu San, Ni Ni Aye and Khin Moe Latt (2013). Use of Complementary and Alternative Medicine (CAM) in children with cancer at Yangon General Hospital. 41 st Myanmar Health Research Congress Programme and Abstracts p.58.

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73. Saw Saw (2013). Involving the Community and Civil Society in TB care. Symposium on Turning the tide on TB tacking DR-TB and TB/HIV co-infection in Myanmar , Inya Lake Hotel, Yangon. 22-23 rd August 2013. 74. Saw Saw, Khin Ohnmar San, Myo Myo Mon, Le Le Win, Yin Thet Nu Oo, Ko Ko Zaw, Myo Thant , Thae Maung Maung and San Shwe (2013). Role of peers for HIV care and support provided by NGOs in Myanmar: Success and challenges. 5th International Conference on Public Health among Greater Mekong Sub-Regional Countries , Yangon, Myanmar. 28-29 September 2013. 75. Saw Saw, Myo Myo Mon, Khin Ohnmar San, Le Le Win, Yin Thet Nu Oo, Myo Thant, Ko Ko Zaw, Thae Maung Maung and San Shwe (2013). Working together among Non-Governmental Organizations and public health sector for community- based activities of HIV control in Myanmar. 41 st Myanmar Health Research Congress Programme and Abstracts p.74. (Best Poster award) 76. Saw Saw, Nay Htut Ko Ko, Tin Mi Mi Khaing, Wai Wai Han, Thandar Lwin, Naing and Aye Yu Soe (2013). Translation of evidence into policy and practice: A case study of operational research on TB Self-Help Groups in Myanmar, Myanmar Medical Association, 59 th Myanmar Medical Conference , Programme and Abstracts p.45. 77. Saw Saw, Theingi Myint, Chomar Kaung Myint and Than Tun Sein (2013). Community-based emergency referral for maternal and child health in Middle Island, Nga Pu Daw Township after Cyclone Nargis. The Demography of Disasters: Implications for Future Policy on Development and Resilience The Australian National University Canberra, Australia. September 2013 78. Su Latt Tun Myint, Khin Thet W ai, Khaymar Mya, Phyu Sin Aye, Tin Tin Wai, Lwin Lwin Ni, Zin Mar Aye, Aung Soe Min and Phyu Thi (2013). The burden of common childhood illnesses in peri-urban households: The multiple effects of multiple exposures to environmental conditions. 41 st Myanmar Health Research Congress Programme and Abstracts, p. 41-42. 79. Su Nwe San, Myo Myint, May Aye Than, Thein Mi and Win Win Maw (2013). Development of a new formulation of diclofenac sodium as rectal dosage form and in vivo release study in rabbits. 41 st Myanmar Health Research Congress Programme and Abstracts , p.50-51. 80. Than Than Swe, Khine Thin Naing, Ye Hein Htet, Ohnmar Win, Tin Nwe Htwe, Thaung Hla, Win Win Maw, Khin Tar Yar Myint and Kyaw Soe (2013). Determination of artificial dyes in commonly consumed local-brands of non-alcoholic beverages. 41 st Myanmar Health Research Congress Programme and Abstracts , p73-74. 81. Thaw Zin, Parai M, Shenoy Pd, Chen R, Poulsaeman V, Jabbar Ma, Alan Ohk, Ohnmar and Boo Ny (2013). Learning patterns, perception towards learning and teaching methods among pre-clinical medical students in integrating online learning into professional subjects at UTAR. 41 st Myanmar Health Research Congress Programme and Abstracts , p.17. 82. Theingi Thwin, Kyu Kyu Maung, Maung Maung Myint, Khin Tha n Maw, Thida Khine, Lei Lei Myint, Su Su Haling and Hla Phyp Lin. Effect of cyanidin 3-glycoside on fat accumulation and expression of glycerol 3 phosphate acytransferase 1 in mice fed a high fat diet and an control diet. 41 st Myanmar Health Research Congress Program and Abstracts , p.32. 83. Theint Thinzar Wai, Win Pa Pa Naing and Aye Aye Khaing (2013). A study of serum ferritin level and usage of oral iron chelation therapy in multi-transfused thalassemic patients at Yangon Children Hospital. 5th Myanmar Haematology Conference, 2013.

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84. Thin Thin Wah, Tin Tin Htwe, May Than Htay, Nilar, Myo Myo Kyaw, Phyu Phyu Zin, Kyaw Kyaw San and Thaung Hla (2013). Determination of histamine content in commonly consumed fish head. 41 st Myanmar Health Research Congress Programme and Abstracts, p.75. 85. Tin Swe Latt, San Shwe, Mya Thida, Hla Hla Win, Yin Thet Nu Oo, Win Thuzar Aye and Wai Wai Myint (2013). Aspiration on medical professionalism among Final Part 2 MBBS students in Myanmar medical universities. 41 st Myanmar Health Research Congress Programme and Abstracts, p.5. 86. Wah Wah Aung (2013). Highlights on tuberculosis research using molecular techniques in Myanmar. Myanmar-Korea Symposium on Malaria, Tuberculosis and Hepatitis, 41 st Myanmar Health Research Congress. 87. Wah Wah Aung, Khin Thet Wai, Hlaing Myat Thu, Khin Saw Aye, Mya Mya Aye, Htin Lin, Moe Thida, Than Mya and Khine Zar Win (2013). Aetiological agents, modifiable risk factors and immunological status of children with acute respiratory infections attending general practitioner’s clinics. 41 st Myanmar Health Research Congress Programme and Abstracts, p.36. (3 rd prize for Applied Health Research) 88. Wah Wah Swe, Kyi Kyi Win Zaw, Kyaw Oo, Khine Thin Naing, Kyaw Soe, Kaung Mon Win, Khin Myo Win, Sandar Win and Tin Nwe Htwe (2013). Effect of air pollutants on ventilatory functions of workers in a garment factory in Yangon. 41 st Myanmar Health Research Congress Programme and Abstracts , p.78. 89. Wai Wai Han, Saw Saw, Thandar Lwin, Thet Aung & Tin Mi Mi Khing (2013). Community-based TB control in Myanmar: Cost and contribution of TB patient Self Help Groups. International Conference on Research Methodology and Scientific Writing . Kerala, India. 20-22 December, 2013. 90. Win Lai May, Han Win, Kyaw Linn, Kyaw Oo, Sandar Kyi, Aye Hnin Phyu and Dam Lian Pau (2013). Nutritional status of children with cerebral palsy in Cerebral Palsy Clinic, Yangon Children’s Hospital. 41 st Myanmar Health Research Congress Programme and Abstracts , p.15. 91. Win Pa Pa Naing, Rai Mra, Htein Lwin Nyein, Khin Sein Win and Ye Htut Aung (2013). Clinical profile of aplastic anaemia in Yangon General Hospital and Mandalay General Hospital. 41 st Myanmar Health Research Congress Programme and Abstracts , p.61. 92. Ye Hein Htet, Kei Yoshitome, Khine Thin Naing, Khin Moe Latt, Ohnmar Win, Theingi Khin, Kyaw Soe, Myat Phone Kyaw and Satoru Miyaishi (2013). Detection of components of gasoline/kerosine from the autopsy of material of fire victim conserved in formalin by gas chromatography combined with solid phase miro extraction. 41 st Myanmar Health Research Congress Programme and Abstracts , p.71-72. 93. Yin Thet Nu Oo, San Hom, Myo Myo Mon, Saw Saw, Khin Ohanmar San and Khin Sandar Oo (2013). Contraceptive choice and fertility intentions among women living with HIV/AIDS in Yangon, Myanmar. 11 th International Congress on AIDS in Asia and the Pacific . Bangkok, Thailand. 18-22 November, 2013. 94. Zin Zin Thu, Hiroto Kojima, Etsuko Maruya, Aye Aye Myint, Aye Aye Wynn, Kin Pyone Kyi and Hiroh Saji. Genetic Polymorphism at Human Leukocyte Antigen HLA- A Locus in Bamar and Kayin Ethnic Groups of Myanmar. HAA 2013, Gold coast Australia, 2013.

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ACADEMIC ACTIVITIES OF THE EXECUTIVE BOARD

1. ACADEMIC INVOLVEMENT 1.1. Education Board • PhD (Microbiology) (UM 1) Dr. Hlaing Myat Thu • PhD (Microbiology) (UM 2) Dr. Hlaing Myat Thu • MMedSc (Microbiology) (UM 2) Dr. Hlaing Myat Thu • PhD (Pathology) (UM 1) Dr. Khin Saw Aye • PhD (Pathology) (UM 2) Dr. Khin Saw Aye • PhD (Oral Medicine) (U Oral Medicine) Dr. Khin Saw Aye • MMedSc (Pathology) (UM 1) Dr. Khin Saw Aye • MMedSc (Pathology) (UM 2) Dr. Khin Saw Aye • BPSC (Medical Technology) (U MedTech) Dr. Khin Saw Aye

1.2 Health Journal Editorial Board

• Editor in Chief, Myanmar Health Sciences Research Dr. Kyaw Zin Thant Journal, DMR (LM) • Consulting Editor, DMR (LM) Bulletin Dr. Kyaw Zin Thant • Consulting Editor, DMR (LM) E Newsletter Dr. Kyaw Zin Thant • Editor, Myanmar Health Sciences Research Journal, Dr. Myat Phone Kyaw DMR (LM) • Editoral Board Member, DMR (LM) Bulletin Dr. Myat Phone Kyaw • Editor in Chief, DMR (LM) E Newsletter Dr. Myat Phone Kyaw • Editorial Manager, Myanmar Health Sciences Research Dr. Win Aung Journal, DMR (LM) • Editorial Board Member, DMR (LM) Bulletin Dr. Win Aung • Editor, DMR (LM) E Newsletter Dr. Win Aung • Editorial Board Member, Myanmar Health Sciences Dr. Hlaing Myat Thu Research Journal, DMR (LM) • Editorial Board Member, DMR (LM) Bulletin Dr. Hlaing Myat Thu • Editorial Board Member, Myanmar Health Sciences Dr. Khin Saw Aye Research Journal, DMR (LM) • Editorial Board Member, DMR (LM) Bulletin Dr. Khin Saw Aye • Editorial Board Member, Myanmar Health Sciences Dr. Khin Thet Wai Research Journal, DMR (LM) • Editorial Board Member, DMR (LM) Bulletin Dr. Khin Thet Wai • Editorial Board Member, Myanmar Health Sciences Dr. Theingi Thwin Research Journal, DMR (LM) • Editorial Board Member, DMR (LM) Bulletin Dr. Theingi Thwin

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• Business Manager, Myanmar Health Sciences Research Dr. Zaw Myint Journal, DMR (LM) • Editorial Board Member, DMR (LM) Bulletin Dr. Zaw Myint

1.3. Others 1.3.1 Leader, Scientific Working Group on Malaria Research, Dr. Myat Phone Kyaw DMR 1.3.2 Facilitator, Working Committee on Research Methodology, Dr. Myat Phone Kyaw DMR 1.3.3 Member Scientist, WHO Collaborating Centre for Research Dr. Myat Phone Kyaw and Training on Malaria, DMR 1.3.4 Chairman, Academic Committee, Department of Medical Dr. Myat Phone Kyaw Research Lower Myanmar 1.3.5 Vice Chairman, DMR External Grant Review committee Dr. Myat Phone Kyaw 1.3.6 Mem ber, Institutional Ethical Review Committee Dr. Myat Phone Kyaw 1.3.7 Member, Academic board, University of Public Health Dr. Myat Phone Kyaw 1.3.8 Member, Academic board, University of Medicine 1 Dr. Myat Phone Kyaw 1.3.9 Ex -officio Member, National Committee for Immunization Dr. Win Aung in Practice (NCIP), Ministry of Health 1.3.10 Member, External Grant Review Committee, DMR (LM) Dr. Win Aung 1.3.11 Member, Ethical and Research Committee, University of Dr. Win Aung Medicine (2) Yangon 1.3.12 External Examiner, Academic Board of Post Graduate Dr. Win Aung Studies, Department of Biochemistry, University of Medicine, Magway 1.3.13 Vice President, Physiology and Biochemistry Society, MMA Dr. Win Aung 1.3.14 Editorial Manager, Board of Editorial Committee, Myanmar Dr. Win Aung Health Research Journal, DMR (LM) 1.3.15 Vice Chairman, Academic Committee, DMR (LM) Dr. Hlaing Myat Thu 1.3.16 Member, Institutional Ethics Review Committee,DMR(LM) Dr. Hlaing Myat Thu 1.3.17 Editorial Committee Member, DMR (LM) Dr. Hlaing Myat Thu 1.3.18 Member, DMR (LM) External Grant Review Committee Dr. Hlaing Myat Thu 1.3.19 Member, Microbiology Society, Myanmar Medical Dr. Hlaing Myat Thu Association 1.3.20 Member, Asia Pacific Dengue Prevention Board, IVI Dr. Hlaing Myat Thu 1.3.21 Lecturer, Master of Public Health, University of Public Dr. Hlaing Myat Thu Health, Yangon 1.3.22 Member, External Grant Review Committee, DMR (LM) Dr. Khin Saw Aye 1.3.23 Member, Ethical and Research Committee, University of Dr. Khin Saw Aye Medicine (1) Yangon 1.3.24 Member, Ethical and Research Committee, University of Dr. Khin Saw Aye Medicine (2) Yangon 1.3.25 Member, Ethical and Research Committee, University of Dr. Khin Saw Aye Oral Medicine, Yangon 1.3.26 Member, Ethical and Research Committee, University of Dr. Khin Saw Aye Medical Technology, Yangon 1.3.27 External Examiner, Academic Board of Post Graduate Dr. Khin Saw Aye Studies, Department of Pathology, University of Medicine (1), Yangon

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1.3.28 External Examiner, Academic Board of Post Graduate Dr. Khin Saw Aye Studies, Department of Pathology, University of Medicine (2), Yangon 1.3. 29 Member, Board of Editorial Committee, Myanmar Health Dr. Khin Saw Aye Research Journal, DMR (LM) 1.3.30 Member, Clinical Pathology Society, Myanmar Medical Dr. Khin Saw Aye Association 1.3.31 Member, Asia Pacific Dengue Prevention Board, IVI Dr. Khin Saw Aye 1.3.32 Member, Academic Committee, DMR (LM) Dr. Khin Saw Aye 1.3.33 Permanent member, Myanmar Medical Association (MMA) Dr. Khin Saw Aye 1.3.34 Member, Microbiology Society (MMA) Dr. Khin Saw Aye 1.3.35 Presenter, Capacity building workshop for members of Dr. Khin Thet Wai Ethical Review Committees of Health Institutions in Myanmar. Department of Medical Research (Lower Myanmar) 8-10 July, 2013. 1.3.36 Lecturer, Workshop on Field Research Methodology Dr. Khin Thet Wai Training. Department of Medical Research (Lower Myanmar) 12-14 August, 2013. 1.3.37 Lecturer, Workshop on Research Methodology and Dr. Khin Thet Wai Bioethics. Department of Medical Research (Lower Myanmar). 27-29 August, 2013. 1.3.38 Lecturer, Research Methodology Training for PhD common Dr. Khin Thet Wai module. University of Medicine 1, Yangon. 21 February, 2013. 1.3.39 Lecturer, Medicinal Chemistry, Yangon University Dr.Theingi Thwin 1.3.40 Co-organizer, Workshop on upgrading food based dietary Dr. Theingi Thwin guideline for Myanmar People 1.3.41 Lecturer, Research Methodology and Bio-ethic Dr. Theingi Thwin

1.3.42 External Examiner, Master of Public Health, University of Dr. Theingi Thwin Public Health st 1.3.43 Lecturer, 1 Year, M.MedSc (Physiology) Dr. Theingi Thwin

2. SEMINAR/MEETING/CONFERENCES 2.1 Meeting - Informal Preparatory Meeting with Directors of Dr. Kyaw Zin Thant Poison Centers of the South-East Asia Region, Thailand, (24-6-2013 to 26-6-2013) 2.2 Meeting- WHO South-East Asia Region 33 rd Meeting of Dr. Kyaw Zin Thant Advisory Committee on Health Research, Colombo, Sri- Lanka (17-7-2013 to 19-7-2013) 2.3 Meeting - Scientific v isit to Korea (KOICA project), Korea Dr. Kyaw Zin Thant (13-10-2013 to 19-10-2013) 2.4 Meeting - 2013 Grand Challenges Meeting, Rio de Janeiro, Dr. Kyaw Zin Thant Brazil (27-10-2013 to 30-10-2013)

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2.5 Meeting - Annual Meeting of Dengue Population Genetics Dr. Kyaw Zin Thant Program and 62 nd Annual Meeting of American Society of Tropical Medicine and Hygiene,Washington DC, USA (12-11-2013 to 17-11-2013) 2.6 Meeting - Roundtable Consultation on Science Granting Dr. Kyaw Zin Thant Council, India (25-11-2013 to 26-11-2013) 2.7 Meeting - Regional Expert Group Meeting on Strengthening Dr. Kyaw Zin Thant Clinical Research Capacity on Safety, Efficiency & Quality of Care of Traditional Medicine, India (11-12-2013 to 13-12-2013) 2.8 Science of Eradication: Malaria core module, Barcelona, Dr. Myat Phone Kyaw Spain (May 5 – May 10, 2013) 2.9 Managing the End of Malaria advanced meeting module, Dr. Myat Phone Kyaw Barcelona, Spain (May 11 – May 13, 2013) 2.10 The Fundamentals of International Clinical Research Dr. Myat Phone Kyaw Training Workshop, Bangkok, Thailand (15 -20 September 2013) 2.11 Immunization Technical Advisory Group Meeting, Dr. Win Aung WHO/SEAR, New Delhi, India (2-3 April, 2013) 2.12 Development of Blood Check Biochip and LF-Dipstick for Dr. Win Aung Donor Blood Screening, Olipro Biotechnology, Klang, Malaysia (22-4-2013 to 3-5-2013) 2.13 20 th Myanmar Military Medical Conference, Defense Dr. Win Aung Services Orthopedic Hospital Mingalardon, Yangon (13-2-2013 to 15-2-2013) 2.14 Meeting for training of Joint PhD Programme in Biomedical Dr. Win Aung Sciences and Biotechnology, Department of Medical Science, MOH, Nay Pyi Taw (6-3-2013 to 7-3-2013) 2.15 Preliminary meeting on Reviewing and Revising Health Policy Dr. Win Aung and Health Plans (Capacity Building in Health Policy Analysis), Department of Health Planning (8-3-2013 to 9-3- 2013) 2.16 Training Workshop on Results -based Management, Ministry Dr. Win Aung of National Planning and Economic Development, Amara Hotel, Nay Pyi Taw (8-10 April, 2013) 2.17 Consultative Meeting on Establishment of National Planning Dr. Win Aung for 2011-2012 to 2015-2016 Financial year, Ministry of National Planning and Economic Development, Office Building No. 1, Nay Pyi Taw (10-5-2013) 2.18 Consultative meeting on Promotion of e-Government, Dr. Win Aung Department of Health Planning, Nay Pyi Taw (30-5-2013) 2.19 Consultative Meeting on National Committee for Dr. Win Aung Immunization Practice, Department of Health Planning, Nay Pyi Taw (10-7-2013)

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2.20 National Symposium on Snake Bite Problems and Snake Dr. Win Aung Antivenom Production, Ministry of Industry, Office Building No. 37, Nay Pyi Taw (6-8-2013) 2.21 Meeting on Bilateral Technical Corporation between Brazil Dr. Win Aung and Myanmar Governments, Ministry of Sciences and Technology, Office Building No. 21, Nay Pyi Taw (19-8-2013) 2.22 Technical Committee Meeting on Standardization of Medical Dr. Win Aung Equipment and Devices in Myanmar, Department of Health, Office Building No. 4, Nay Pyi Taw (23-8-2013) 2.23 Meeting on Ethical and Research Committee, University of Dr. Win Aung Medicine (2), Yangon (26-8-2013) 2.24 Civil Service Training Course, Ministry of Information, Dr. Win Aung Office Building No. 7, Nay Pyi Taw (2-9-2013 to 4-9-2013) 2.25 Meeting on Ethical and Research Committee, University of Dr. Win Aung Medicine (2), Yangon (6-9-2013) 2.26 Roundtable Discussion on Strengthening Research Capacities Dr. Win Aung in Myanmar, Canada’s International Research Centre (IDCR). Sedona Hotel, Yangon (30-9-2013) 2.27 Advocacy Meeting on Translational Research in Malaria and Dr. Win Aung Potential solutions for enhancing utilization of Research Findings, DMR (LM) (7-10-2013) 2.28 ody HESifhenf;ynmzGHYNzdK;a&;Oya'Ü (jyifqifcsufrlMurf;) jyKpkEdkifa&;ESifh twnfjyK Dr. Win Aung jyXmef;a&; nSdESdkif;tpnf;ta0;? ody HESifhenf;ynm0efBuD;XmeÜ &Hk;trSwf(21) aejynfawmf (4-12-2013) 2.29 Meeting on Academic Board of Post Graduate Studies, Dr. Win Aung Department of Biochemistry, University of Medicine, Magway(12-12-2013) 2.30 KOICA Senior Manager’s Study Visit, Korea, March 17-30, Dr. Hlaing Myat Thu 2013 2.31 Inter-country workshop on sentinel surveillance of Invasive Dr. Hlaing Myat Thu Bacterial Diseases (IBD) and Rotavirus Gastroenteritis(RVGE), WHO, Regional Office for South- East Asia, New Delhi, India, June 20-21, 2013 2.32 Asia Pacific Dengue Prevention Board Meeting, Bangkok, Dr. Hlaing Myat Thu Thailand, October 18-19, 2013 2.33 Scientific visit to Korea (KOICA project) Dr. Khin Saw Aye (17-3-13 to 30-3-13) 2.34 Seminar on Dengue Pathogenesis, San Diego, U.S.A Dr. Khin Saw Aye (17-5-2013 to 27-5-2013) 2.35 US-Japan Cooperative Medical Science Program: TB and Dr. Khin Saw Aye Leprosy Panel Meeting, Hokkaido, Japan (17-8-13 to 20-8-13)

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2.36 3rd International Conference on Dengue and DHF, Thailand Dr. Khin Saw Aye (21-10-2013 to 23-10-2013) 2.37 Annual meeting of Dengue Population Genetics Program Dr. Khin Saw Aye and 62 nd Annual Meeting of American Society of Tropical Medicine and Hygiene, Washington DC, USA. (11-11-2013 to 18-11-2013) 2.38 Symposium on Health Research Information System and Dr. Khin Thet Wai Promoting the Role of Research Institutions in National Health Development (Discussant). 41 st Myanmar Health Research Congress, Yangon, Myanmar, 10 January, 2013. 2.39 National Workshop on Monitoring Therapeutic Efficacy of Dr. Khin Thet Wai Antimalarial Drugs. DMR-LM in collaboration with WHO and Myanmar Medical Association. Yangon, Myanmar. 8-9 April 2013 . (Participant) 2.40 Meeting on Comprehensive Assessment of Health Workforce Dr. Khin Thet Wai Education and Training in Myanmar. Nay Pyi Taw. 26 August 2013. (Participant) 2.41 Advocacy Meeting on Translational Research in Malaria and Dr. Khin Thet Wai Potential Solutions for Enhancing Utilization of Research findings. Department of Medical Research (Lower Myanmar). 7 October, 2013. (Participant) 2.42 13 th Regional Network Meeting on Asian Schistosomiasis Dr. Khin Thet Wai and other Helminth Zoonoses (RNAS+). Annual Board Meeting. Khonkaen, Thailand. 24-26 October, 2013. (Participant) 2.43 Universal Health Coverage in Myanmar: Consultation Dr. Khin Thet Wai Meeting on Formulation of Road Map and Implementation Plan. Ministry of Health, Nay Pyi Taw. 25-26 November, 2013. (Participant) 2.44 Workshop on “Finalization of National Plan of Action on Dr. Theingi Thwin Food and Nutrition (2011-2015)” 12- 3- 2013 to 7-3-2013, Nay Pyi Taw 2.45 Training Workshop on “Result Based Management and Dr . Theingi Thwin Monitoring and Evaluation” 8-4-2013 to 10-4-2013, Nay Pyi Taw 2.46 Technical Working Group Meeting on “Child Survival and Dr. Theingi Thwin Development” 16-5-2013, Nay Pyi Taw 2.47 Meeting on “The First 1000 days Approach to Maternal & Dr. Theingi Thwin Child Health & Nutrition” 24-6-2013 to 25-6-2013, Nay Pyi Taw 2.48 Coordinating Meeting on “Food Standard Sub -committee” Dr . Theingi Thwin 21-8-2013, Nay Pyi Taw 2.49 Technical Working Group Meeting on “Child Survival and Dr. Theingi Thwin Development” 23-10-2013, Nay Pyi Taw

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2.50 National Workshop for “Finalization of NCD Policy and Dr. Theingi Thwin Strategic Plan of Action for Prevention and Control of NCD” 22-11-2013, Nay Pyi Taw 2.51 “Food Safety and Health Hazard Recognition Workshop for Dr. Theingi Thwin ASEAN Countries” 4-8-2013 to 11-8-2013 Meiho University, Pingtung, Taiwan 2.52 Study Tour on Health Research Management. Bangkok, Dr. Zaw Myint Thailand (2-6-2013 to 8-6-2013)

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INSTITUTIONAL ETHICAL REVIEW COMMITTEE

1. Dr. Myint Htwe Chairman Director (Retired), WHO/SEARO 2. Dr. Kyaw Zin Thant Co-chairman Director General 3. Dr. Tun Pe Member Director (Retired) 4. Dr. Myo Khin Member Acting Director General (Retired) 5. Dr. Ye Htut Member Deputy Director General (Retired) 6. Dr. Myat Phone Kyaw Member Deputy Director General 7. Dr. Khin Thet Wai Member Director (Research) 8. Dr. Hlaing Myat Thu Member Director (Research) 9. U Aung Myo Min Member Research Scientist (Retired) 10. Dr. Hla Hla Than Member Lecturer, Myanmar Literature Department, West Yangon University 11. Daw Khin Lei Win Member Myanmar Women Affair Federation 12 . Dr. Yin Thet Nu Oo Secretary Research Scientist

DMR EXTERNAL GRANT REVIEW COMMITTEE

1. Dr. Myat Phone Kyaw Chairman Deputy Director General 2. Dr. Zaw Myint Member Director (Administration) 3. Dr. Win Aung Member Director (Research) 4. Dr. Hlaing Myat Thu Member Director (Research) 5. Dr. Khin Thet Wai Member Director (Research) 6. Dr. Khin Saw Aye Member Director (Research) 7. Dr. Theingi Thwin Member Director (Research) 8. Dr. Saw Saw Secretary Deputy Director

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ACADEMIC COMMITTEE

1. Dr. Kyaw Zin Thant, Director General Patron 2. Dr. Myat Phone Kyaw Chairman 3. Dr. Hlaing Myat Thu Vice-Chairperson 4. Directors (Research) Members 5. Dr. Han Win Secretary 6. Dr. Theingi Win Myat Joint-Secretary (1) 7. Dr. Khin Hnin Pwint Joint-Secretary (2) 8. Dr. Le Le Win Attendees by invitation 9. Dr. Ko Ko Zaw Attendees by invitation 10. Dr. Ohnmar Attendees by invitation 11. Dr. Saw Saw Attendees by invitation

The Academic Committee held a total of 8 Protocol Review Committee (PRC) meetings, reviewing 39 protocols. These protocols included 11 Health Systems Research, 17 Basic Research and 11 Applied Research Proposals by category. Except one protocol, 38 protocols were approved. The committee has also arranged 9 scientific talks given by the international and local speakers.

Scientific Talks Sr. Title Speaker Date No. 1. Update on emerging Professor Jong Koo Lee 14-1-2013 infectious diseases in the Asia Vice President Region Seoul National Medical University, Republic of Korea 2. New insights into malaria Professor Brendan Crabb 8-2-2013 control Director and CEO, Burnet Institute, Australia 3. Methodological issues for Associate Professor Margarita Frederico 20-3-2013 research with vulnerable School of Allied Health children Department of Social Work and Social Policy, Faculty of Health Sciences La Trobe University, Australia 4. Global burden of disease Professor Soe Myint 14 -6-2013 study 2010, profile of Deputy Director General (Retired), Myanmar Ministry of Health 5. Economic-epidemiological (1). Ms. Lisa Jane White 17-6-2013 models to support malaria Head of Mathematical and Economic elimination strategy design in Modeling of Diseases, Mahidol-Oxford Myanmar Tropical Medicine Research Unit, Thailand (2). Mr. Yoel Lubell, Health Economist, University of Oxford Centre for Tropical Medicine, Mahidol- Oxford Tropical Medicine Research Unit

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6. The pathology and Dr. Gareth Turner 3-7-2013 pathophysiology of cerebral Head of Pathology, Mahidol-Oxford malaria Research Unit,Visiting Professor of Tropical Pathology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand 7. Snake husbandry at QSMI Dr. Lawan Chanhome 31-7-2013 snake farm Chief of Snake Farm, Queen Saovabha Memorial Institute, The Thai Red Cross Society 8. Conflict of interest in medical Dr. Catherine DeAngelis 20-9-2013 research and medical Professor of Pediatrics, Deputy Dean, journalism Johns Hopkins School of Medicine Emeritus Editor-in-Chief, JAMA 9. Malaria vaccine update Professor Christopher V. Plowe 24-9-2013 Investigator, Howard Hughes Medical Institute,Professor and Leader, Malaria Group, Center for Vaccine Development University of Maryland School of Medicine

Protocols Reviewed by Protocol Review Committee Sr. Title Principal Investigator No. 1. Nutritional status of children living in foster school, Dr. Mya Ohnmar Yangon Region 2. Detection of monoclonal gammopathies in chronic low Dr.San San Htwe back pain patients at Yangon Orthopaedic Hospital 3. Molecular characterization of hepatitis viruses in Myanmar Dr. Yi Yi Kyaw 4. Quality of life assessment among multi-transfused Dr. Win Pa Pa Naing thalassemia children at Thalassemia Day Care Unit, Yangon Children Hospital 5. Detection of anti-HBc and HBV DNA in HBs Ag negative Dr. Yi Yi Kyaw blood donors 6. Effective utilization in early diagnosis, prompt treatment Dr. Khin Myo Aye and prevalence of malaria in selected township in MARC Zone 7. Determination of radon concentration in environment Dr. Moe Moe Han 8. Risk and protective factors experienced by young men who Dr. Myo Myo Mon have sex with men 9. Preliminary study on mercury content in river water around Daw Khine Thin Naing gold reclamation site 10. Assessment of body composition in children by using Daw Aye Aye Maw stable isotope method 11. Assessment of communication skills of volunteers on Dr. Myo Myo Mon behavior change communication regarding reproductive health and HIV 12. Situation analysis on orphan and vulnerable children Dr. Myo Myo Mon infected and/or affected by HIV and AIDS in Myanmar

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Sr. Title Principal Investigator No. 13. Validation of G6PD Care Start in diagnosis of G6PD Dr. Nwe Nwe Oo enzyme deficiency 14. Accessibility to primary health care services among Dr. Yin Thet Nu Oo mothers of under two years old children in Kayin State 15. Effect of soil-transmitted helminths infection on nutritional Daw Aye Than status of children in poor living condition 16. Health Facility Assessment Survey: Myanmar: Focusing on Dr. Le Le Win maternal, newborn and child health 17. A pilot study on pyrethroid susceptibility status and Dr. Sai Zaw Min Oo detection of (kdr) knock down resistance mutations 18. Study on cellular Tropism of dengue Dr. Khin Saw Aye 19. Assessment of nutritional status throug h body composition Dr. Theingi Thwin measurement by deuterium dilution technique in children living in areas targeted agriculture intervention for food security 20. Effectiveness of aerobic and anaerobic component Daw Kyi Kyi Win Zaw dominants sports discipline on ventilatory function of adolescent athletes 21. Cultivation and fermentation of recombinant hepatitis B Daw Khin Khin Aye surface antigen expressed Hansenula polymorpha yeast cells of the locally prepared master cell bank (Lyophilized form) 22. Efficacy and safety of artemether-lumefantrine and Dr. Kay Thwe Han dihydroartemisinin-piperaquine for treatment of uncomplicated Plasmodium falciparum malaria and chloroquine for P.vivax in Buthitaung, Rakhine State 23. Efficacy and safety of dihydroartemisinin for treatment of Dr. Khin Myo Aye uncomplicated Plasmodium falciparum malaria in Myawaddy sentinel sites, Kayin State in Myanmar 24. Efficacy and safety of Artemisinin Combination Therapies Dr. Myat Htut Nyunt (ACTs) (Dihydroartemisinin-piperaquine) for treatment of uncomplicated Plasmodium falciparum malaria and cholroquine followed by primaquine for the treatment of uncomplicated Plasmodium. vivax malaria in Mawthaung border area, Tanintharyi Region in Myanmar 25. Sublingual misoprostol for th e treatment of incomplete Dr. Myo Myo Mon abortion: Operation Research 26. Bacterial, viral and atypical pathogens associated with Dr. Han Win acute respiratory infection and their clinical characteristics among children admitted to Yangon Children Hospital 27. Effectiveness of Shirodhara Therapy in post stroke patients Dr. Tun Myint Aye Traditional Medicine Hospital, Yangon 28. Knowledge, attitude, risk perception and practices of safety Dr. Kyaw Soe measures on pesticides among agricultural workers in Thabaung Township

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Sr. Title Principal Investigator No. 29. Subtyping of Influenza viruses among children with Dr. Htin Lin influenza-like illness attending Yangon Children Hospital, 2013 30. Knowledge and lifestyle related perception regarding risk Daw Sandar Kyi factors of cardiovascular diseases among adolescents at a private school in Yangon 31. Bacteriological profile of some public access points Daw Thin Thin Wah 32. Sentinel surveillance of Day 3 parasite positivity rate of Dr. Myat Phone Kyaw artemisinin based combination therapy (ACT) in MARC program areas (Tier 2 and 3) Ayeyarwaddy Region, Chin and Kayin State 33. Determination of serum leptin hormone levels in children Daw Yin Yin Win residing in Yangon 34. Detection of Escherichia coli contamination in uncooked Dr. Lai Lai San fast food 35. Detection of Listeria monocytogenes contamination in Dr. Lai Lai San ready to eat foods 36. In vitro anti-malarial activity of ethanolic fraction of Daw Mu Mu Sein Myint Ocimum sanctum Linn. Leaf on Plasmodium falciparum 37. Knowledge of osteoporosis among female teachers from Daw Than Than Lwin two Education Colleges in Yangon Region 38. Vector bionomics and identification of potential vector for Dr. Mg Mg Mya malaria in Kamamoung Sub-township, Phapun District in Kayin State 39. Awareness, perception and satisfaction of women towards Dr. Myo Myo Mon breast cancer screening

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SCIENTIFIC GROUPS

1. Scientific Group on Malaria Research Group Leader Dr. Tin Oo Co- Group Leader Dr. Ohnmar Organizer Dr. Kay Thwe Han Members Dr. May Aye Than, Dr. Nwe Nwe Oo, Dr. Mu Mu Sein Myint, Dr. Yan Naung Maung Maung, Dr. Maung Maung Mya, Dr. Khin Myo Aye, Dr. Myat Htut Nyunt, Daw Kyin Hla Aye, Daw Aye Than, Dr. Min Wun, Dr. Yin Min Htun, U Sein Thaung, Dr. Thae Maung Maung, Dr. Su La tt Tun Myint, Dr. Nan Cho Nwe Mon, Dr. Zin May Khine

2. Scientific Group on Traditional Medicine Research Group Leader Dr. May Aye Than Co - Group Leader Dr. Min Wun Organizer Dr. Khine Khine Lwin Members Dr. Win Maw Tun, Dr. Moh Moh Tun, Dr. Han Win, Dr. Win Pa Pa Naing, Dr. Wah Wah Aung, Daw Khin Khin Aye, Dr. Nyi Nyi Win, Daw Mu Mu Sein Myint, Dr. Khin Hinn Pwint, Daw Khin Taryar Myint, Daw Aye Than, Daw Kyin Hla Aye, Daw Win Win Maw

3. Scientific Group on Snake Bite Research Group Leader Dr. Han Win Co- Group Leader Dr. Thet Thet Mar Organizer Dr. Khin Than Ye Members Dr. Win Maw Tun, Dr. Nwe Nwe Oo, Dr. Aye Aye Myint, Dr. Than Than Aye, Dr. Win Le May, Daw Kyi May Htwe, Dr. Aye Win Oo, Dr. Min Thein

4. Scientific Group on HIV/AIDS and Sexually Transmitted Diseases Research Group Leader Dr. Kay Thwe Han Co- Group Leader Dr. Myo Myo Mon Organizer Dr. Htin Lin Members Dr. Win Pa Pa Naing, Dr. Han Win, Dr. Le Le Win, Dr. Ko Ko Zaw, Dr. Wah Wah Aung, Dr. Ohnmar, Dr. Theingi Win Myat, Daw Kay Thi Aye

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5. Scientific Group on Liver and Gastroenterology Research Group Leader Dr. Win Maw Tun Co- Group Leader Dr. Moh Moh Htun Organizer Dr. Yi Yi Kyaw Members Dr. Aye Aye Lwin, Dr. Theingi Win Myat, Dr. Mya Mya Aye, Dr. Yin Min Tun, Dr. Myat Tin Htwe Kyaw, Daw Khin Khin Aye, Daw Ohnmar Lwin, Daw Thuzar Myint, Daw Kay Khine Soe

6. Scientific Group on Growth and Nutrition Research Group Leader Dr. Ko Ko Zaw Co - Group Leader Dr. Moe Thida Kyaw Organizer Dr. Moh Moh Hlaing Members Dr. Nwe Nwe Oo, Dr. Kyaw Zeya, Daw Kyi Kyi Win Zaw, Dr. Mya Ohmar, Daw Sandar Tun, Dr, Khin Myo Aye, Dr. Su Latt Tun Myint

7. Scientific Group on Arboviral Disease Research Group Leader Dr. Yan Naung Maung Muang Co- Group Leader Dr. Mu Mu Shwe Organizer Dr. Aung Zaw Latt Members Dr.Tin Oo, Dr. Maung Maung Mya, U Sein Thaung, Daw Khin Mar Aye, Dr. Yin Min Tun

8. Scientific Group on Nuclear Medicine Research Group Leader Dr. Nwe Nwe Oo Co- Group Leader Dr. Win Pa Pa Naing Organizer Dr. Moh Moh Hlaing Members Dr. Tin Oo, Daw Win Thawdar Lwin, Dr. Moh Moh Han, Daw Yin Yin Win, Dr. Kay Thwe Han, Daw Aye Than

9. Scientific Group on Health and Social Medicine Research Group Leader Dr. Le Le Win Co- Group Leader Dr. Myo Myo Mon Organizer Dr. Yin Thet Nu Oo Members Dr. Tin Oo, Dr. Ko Ko Zaw, Dr. Saw Saw, Dr. Moh Moh Hlaing, Dr. Yan Naung Maung Maung, Dr. Thae Maung Maung, Dr. Wai Wai Han

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10. Scientific Group on Tuberculosis and Respiratory Tract Diseases Research Group Leader Dr. Wah Wah Aung Co- Group Leader Dr. Saw Saw Organizer Dr. Aye Aye Win Members Dr.Han Win, Dr. Le Le Win, Dr. Mu Mu Swe, Dr. Yin Thet Nu Oo, Dr. Win Le May, Dr. Phyu Win Ei, Dr. Su Latt Tun Myint

11. Scientific Group on Poison Research Group Leader Dr. Thaung Hla Co - Group Leader Dr. Kyaw Soe Organizer Dr. Min Wun Members Dr. Tin Oo, Dr. Moh Moh Win, Dr. Khine Khine Lwin, Daw Win Thawdar Lwin, Dr. Theingi Win Myat, Daw Khine Thin Naing, Daw Khin Taryar Myint, Dr. Khin Hnin Pwint, Dr. Moe Moe Han, Dr. Moe Moe Aye, Dr. Thet Thet Mar

12. Scientific Group on Blood Research Group Leader Dr. Win Pa Pa Naing Co- Group Leader Dr. Yi Yi Kyaw Organizer Dr. San San Htwe Members Dr. Kyaw Soe, Dr. Zin Zin Thu, Dr. Yin Min Htun, Dr. Moh Moh Tun, Dr. Aye Aye Win, Dr. Min Min Win, Dr. Khin Lapyae Tun, Daw Myat Mon Oo

13. Scientific Group on Cancer Research Group Leader Dr. Moh Moh Tun Co - Group Leader Dr. Than Than Aye Organizer Dr. Yin Min Tun Members Dr. Win Pa Pa Naing, Dr. Kyaw Soe, Dr.Yi Yi Kyaw, Dr. San San Htwe, Dr. Mu Mu Shwe, Dr. Myo Myo Mon, Dr. Zin Zin Thu, Daw Myat Mon Oo, Dr. Min Thein, Dr. Wai Wai Han

14. Scientific Group on Information Technology Group Leader Dr. Moh Moh Win Co- Group Leader Dr. Ni Thet Oo Organizer U Tin Maung Maung Members Dr. Ko Ko Zaw, Daw Nilar Khin, U Nyo Aung, U Ye Thway, Daw Wah Wah Hla Phyu , U Maung Maung Gyi, Daw Cho Mar Oo

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MYANMAR HEALTH SCIENCES RESEARCH JOURNAL Editorial Board Editor-in-Chief Dr. Kyaw Zin Thant Editor Dr. Myat Phone Kyaw Associate Editor Dr. Ni Thet Oo Editorial Board Members Prof. Thet Khine Win Prof. Myat Mon Prof. San San Nwet Prof. Win Myint Oo Prof. Myat Thandar Prof. Theingi Myint Prof. Chit Soe Dr. Hlaing Myat Thu Prof. Mg Mg Khin Dr. Khin Saw Aye Prof. Yin Yin Soe Dr. Theingi Thwin Prof. Ye Myint Kyaw Dr. Khin Thet Wai Prof. Wah Win Htike Business Manager Dr. Zaw Myint Editorial Manager Dr. Win Aung Production Manager Daw Nilar Soe

DMR (LM) BULLETIN Editorial Board Consulting Editor Dr. Kyaw Zin Thant Editorial Board Members Dr. Myat Phone Kyaw Dr. Han Win Dr. Win Aung Dr. Tin Oo Dr. Zaw Myint Dr. Moh Moh Win Dr. Hlaing Myat Thu Dr. Saw Saw Dr. Khin Saw Aye Dr. Min won Dr. Khin Thet Wai Dr. Ni Thet Oo Dr. Theingi Thwin Secretary Daw Win Win San

DMR (LM) E Newsletter Editorial Board Consulting Editor Dr. Kyaw Zin Thant Editor in Chief Dr. Myat Phone Kyaw Editor Dr. Win Aung Editorial Board Members Dr. Yi Yi Kyaw Dr. Ni Thet Oo Daw Kyi Kyi Win Zaw Secretary U Ye Thway

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