The Republic of the Union of Myanmar Ministry of Health
42nd MYANMAR HEALTH RESEARCH CONGRESS
Programme and Abstracts
6-10 January 2014
The Republic of the Union of Myanmar Ministry of Health
4422nd MMyyaannmmaarr HHeeaalltthh RReesseeaarrcchh CCoonnggrreessss
Programme and Abstracts
6-10 January 2014
FOREWORD
Since its inception in 1965, the Myanmar Health Research Congress is an annual event as a symbol of coordination, cooperation and, collaboration of various Departments under the Ministry of Health. The Congress reflects the concerted efforts and achievements of academia, researchers and service personnel in the field of basic, applied and health systems research. Multi-stakeholder involvement under favorable conditions while implementing the research projects may lead to constructive approach of evidence-based findings towards formulating strategies for health and health-related policy and programmes. Each and every year, the Congress brings both national and international researchers together for exchanging their views, thoughts and innovative ideas to serve as a driving force in their future plans to meet the specific health needs of the country. This is indeed an essential platform for mutual exchange of knowledge, expertise, experiences, opinions and lessons learned between senior and junior scientists from various disciplines through the responsible conduct of health research.
Ministry of Health encourages health systems strengthening efforts alongside with built-in operational research component for maternal, new-born and child health, emerging and reemerging infectious diseases, non-communicable diseases, and environmental health issues as well as for technology development. The complex nature of research problems in the country calls for multi-sectoral actions that require strong political commitment and health sector reforms at multi-level such as national, state/regional, and township levels, down to the grass-roots. This may further enhance poverty reduction strategies and rural development. For clinical research, it is high time to introduce the clinical registry system to avoid duplications.
This Proceeding includes abstracts of 97 research papers and 34 research posters, and the special features of eight scientific symposia. I would like to sincerely congratulate the researchers for their incredible contributions towards evidence-based findings while observing the research ethics. The products of this bench-mark Congress might contribute towards translational applications and knowledge management for further research capacity strengthening and establishment of health research information system. Moreover, multiple avenues of opportunities shed light for young researchers for their future career and profession. Wide range of abstracts in basic biomedical disciplines, applied research, and health systems research may advocate the scientific community for further improvement in knowledge transfer mechanisms in the local context.
Chairman Organizing Committee 42nd Myanmar Health Research Congress
PROGRAMME
42nd Myanmar Health Research Congress Programme
42nd MYANMAR HEALTH RESEARCH CONGRESS Department of Medical Research (Lower Myanmar) No. 5, Ziwaka Road, Dagon Township, Yangon, Myanmar
INAUGURAL SESSION 6th January, 2014 Reading Room, Central Biomedical Library – Auditorium (2) 08:00hr Inaugural speech by H.E. Professor Dr. Pe Thet Khin Union Minister Ministry of Health
09:00hr Refreshments
ACADEMIC SESSION Department of Medical Research (Lower Myanmar) No. 5, Ziwaka Road, Dagon Township, Yangon
Day 1
Auditorium (1) Day (1)- Morning Session (1)
Chairpersons: H.E. Dr. Than Aung Dr. Kyaw Zin Thant Deputy Minister Director General Ministry of Health Department of Medical Research (Lower Myanmar) 10:00-10:20 Study on use of Health Research Results by National Programmes Paper-1. Maung Maung Toe, Kyaw Oo, Than Sein, Le Le Win, Saw Saw, Phone Myint and Yin Thet Nu Oo 10:20-10:40 Factor influencing the performance of Township Medical Officers in Paper-2. Mandalay and Sagaing Regions Kyaw Kyaw, Myitzu Tin Oung, Phyu Phyu Thin Zaw, G Sen Taung , Kyaw Kyaw, Marlar Aung, Thandar Myint and Pyae Phyo Htwe 10:40-11:00 Study of bone mass density in various age groups of Myanmar population Paper-3. Yi Yi Myint, Nyein Nyein Maw, Myint Han, Thinzar Aung, Kyaw Thu Soe, Kyaw Soe Naing, May Myat Win, Nyein Su Win and Kyi Tha Soe 11:00-11:20 Betel quid chewing in Dagon (East) Township Paper-4. Ko Ko Zaw, Mya Ohnmar, Moh Moh Hlaing, Swe Swe Win, Maung Maung Than Htike, Phyu Phyu Aye, Maung Maung Myint, Sein Shwe and Moe Thida Htwe 11:20-11:40 Prevalence of Vitamin A Deficiency among 6 months to 5 years old Paper-5. children Htin Lin, May Khin Than, Khaing Mar Zaw, Theingi Thwin and Moh Moh Hlaing
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Programme 42nd Myanmar Health Research Congress
Auditorium (1) Day (1) - Afternoon Session (1)
Chairpersons: Dr. Min Than Nyunt U Htay Win Director General Acting Director General Department of Health Department of Health Planning 13:00-13:20 Estimating cost of TB patient Self Help Groups in Hlaingtharyar Paper-6. Township, Myanmar Wai Wai Han, Saw Saw, Thandar Lwin, Tin Mi Mi Khaing and Thet Aung 13:20-13:40 The lived experiences of patients with osteosarcoma who undergo Paper-7. chemotherapy Maw Maw Than, Thein Thein Kyi and Nang Kathy Aung 13:40-14:00 The lived experiences of primary family caregivers of children with Paper-8. acquired hearing loss Naw Htoo Phaw Doh, Ohnmar Myo and Lwin Lwin Kyi 14:00-14:20 Lifestyle and health care practices of fishermen from Kyauk Chaung Paper-9. Village, Hainggyikyun Township, Pathein District, Ayeyarwady Region Naing Lin Tun, Soe Paing Lin and Ohnmar Myint 14:20-14:40 Salt consumption patterns and iodine nutrition status of pregnant Paper-10. women in coastal region Theingi Thwin, Moh Moh Hlaing, Mya Ohnamr, Sandar Tun, Thidar Khine, Wah Wah Win, Su Su Hlaing, Hla Phyo Lin and Nyein Nyein Win
Auditorium (1) Day (1) - Afternoon Session (2)
Chairpersons: Professor Myint Han Professor Win Myint Oo Director General Professor/Head Department of Food and Preventive and Social Medicine Drug Administration University of Medicine (1) 14:55-15:15 Bacteriological analysis of household drinking water in selected Paper-11. wards in North Dagon Township, Yangon Thuzar Myint, Wah Wah Aung, Aye Aye Maw, Aye Yin Shwe, Su Mon Win, Hay Mar Win and Khin Thet Wai 15:15-13:35 Preliminary study on mercury content in river water around Gold Paper-12. Reclamation Site Khine Thin Naing, Tin Nwe Htwe, Ye Hein Htet, Tin Tin Han, Khin Moe Latt, Ohnmar Win, Aye Thidar Tun, Thet Htet Aung and Myat Phone Kyaw 15:35-15:55 Drinking water purification systems: implications for translating Paper-13. knowledge into action peri-urban households with under-five children Su Latt Tun Myint, Moe Thida, Tin Tin Wai, Lwin Lwin Ni, Zin Mar Aye, Aung Soe Min and Phyu Thi
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42nd Myanmar Health Research Congress Programme
15:55-16:15 Cardiovascular Risk in People with chronic exposure to low level of Paper-14. arsenic contamination in drinking water Soe Minn Htway, Ohnmar, May Aye Than, Khin Tar Yar Myint and Mar Mar Myint 16:15-16:35 Determination of multi-element profile in street dust Paper-15. Moe Moe Han, Nyan Htun, Thet Naing, Ohnmar Oo, Tin Oo, Myat Phone Kyaw, Ohnmar Win, Ni Ni Maw and Esther 16:35-16:45 Utilization pattern of drinking water in rural households of arsenic Paper-16. contaminated areas and their awareness on arsenic contamination Ye Hein Htet, Tin Nwe Htwe, Khin Moe Latt, Ohnmar Win, Tin Tin Htike, Aye Thidar Tun, Kyaw Soe, Ohnmar and Khin Thet Wai
Day 2
Auditorium (1) Day (2) - Morning Section (1)
Chairpersons: Professor Tin Maung Han Professor Theingi Myint Rector Department of Biochemistry University of Medicine, Mandalay University of Medicine (1) 08:30-08:50 A Comparative study of enzymatic method and accutrend GCT Paper-17. meter for determination of total cholesterol level in hypertensive patients Thidar Oo, Aye Aye Khin, Khin Thike Win and Aye Aye Myint 08:50-09:10 Study of serum oxidized LDL level and lipid profiles in hypothyroid Paper-18. patients before and after treatment with thyroxine The’Mon La, Hta Kyi Sunn and Theingi Myint 09:10-09:30 Serum leptin and estrogen levels in postmenopausal women with Paper-19. overweight and normal weight Yin Yin Win, Aye Aye Yee, Aye Aye Maw, Khin Thida Wai, Thandar Myint, Sandar Aung, Naw Myat Su Mon and Thae Maung Maung 09:30-09:50 Serum Tumor Necrosis Factor–Alpha (TNF-α) level and insulin Paper-20. resistance in obese adults Moe Moe Khine and Theingi Myint 09:50-10:10 Assessment of body fat percent by using the deuterium dilution Paper-21. technique in postmenopausal women residing in Yangon Aye Aye Maw, Aye Aye Yee, Khin May Oo, Yin Yin Win, Khin Thida Wai, Thandar Myint, Sandar Aung, Naw Myat Su Mon and Ohnmar
10:10-10:30 Serum 25(OH)D3, calcium, phosphorus levels and bone mineral Paper-22. density in adult women Ei Ei Hlaing, Khin Moe Moe Nwe and May Pyone Kyaw
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Programme 42nd Myanmar Health Research Congress
Auditorium (1) Day (2) - Morning Session (2)
Chairpersons: Professor Tint Swe Latt Professor Myat Mon Rector Department of Pathology University of Medicine (2) University of Medicine (1) 10:45-11:05 Development of a new monovalent ovine snake antivenom against Paper-23. Russell's viper (Daboia siamensis) Aung Zaw, Khin Aung Cho, Kyi Kyi Thin and Mon Mon 11:05-11:25 Preliminary dose-finding and safety study of ovine Russell’s viper Paper-24. antivenom in patients envenomed by Russell’s vipers (Daboia siamensis) Han Win, Khin Thida Thwin, Zaw Myint, Hnin Wai Maung, Thi Thi Myint and Win Aung 11:25-11:45 Immunodetection of Ki-67 labelling proliferation index in Paper-25. proliferative breast disease and invasive duct carcinoma of breast Aye Myat Mon, Aye Aye Khin, Myat Mon and Khin Shwe Mar 11:45-12:05 Significance of -catenin immunoexpression in operative cases of Paper-26. prostatic diseases Sann Sanda Khin, Htein Win, Win Khaing, Myint Myint Yee, Zin Node Win, Win Pa Pa Soe, Moh Moh Lwin, Yi Yi Myint and Htun Naing Oo 12: 50-12:25 Immunohistochemical characterization of dengue antigens (NS1 and Paper-27. NS3) and complements in liver tissues of DSS autopsies in Myanmar Khin Saw Aye, Mu Mu Shwe, Aye Aye Win, Min Thein, Prida Malasit and Scott B Halstead
Auditorium (1) Day (2) - Afternoon Session (1)
Chairpersons: Dr. Ye Tint Lwin Professor Ye Myint Kyaw Deputy Director General (Retired) Department of Child Health Department of Medical Research University of Medicine (1) (Lower Myanmar) 13:00-13:20 Molecular genotyping of silent beta thalassaemia carriers among Paper-28. the healthy adult population in Yangon Moh Moh Htun, Yin Min Htun, Than Than Aye, Myat Mon Oo, Than Than Swe, Khin Myo Set, Hnin Nu Htwe, Ohnmar and Hlaing Myat Thu 13:20-13:40 Molecular epidemiology of dengue 1 viruses in Myanmar, 2012-2013 Paper-29. Theingi Win Myat, Hlaing Myat Thu, Saw Win, Mo Mo Win, Kay Thi Aye, Khine Moe Aung, Wenjun Liu, John Aaskov and Kyaw Zin Thant
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42nd Myanmar Health Research Congress Programme
13:40-14:00 Determination of Oncogenic Human Papillomavirus (HPV) Paper-30. genotypes in Anogenital Cancers by Polymerase Chain Reaction and Restriction Fragment Length Polymorphism (PCR-RFLP) Mu Mu Shwe, Hlaing Myat Thu, Khin Saw Aye, Aye Aye Myint, Mya Thida, Khin Shwe Mar, Khin Khin Oo, Khin Sandar Aye and Kyaw Zin Thant 14:00-14:20 Phenotypic and genotypic analysis of anti-tuberculosis drug Paper-31. resistance in Mycobacterium tuberculosis isolates from Myanmar Wah Wah Aung, Phyu Win Ei, Wint Wint Nyunt, Thyn Lei Swe, Thandar Lwin, Mi Mi Htwe, Kyung Jun Kim, Jong Seok Lee and Chulhum L Chang 14:20-14:40 Genotyping Rotavirus strains from under-five children with Paper-32. diarrhea, admitted to Yangon Children Hospital, 2013 Hlaing Myat Thu, Theingi Win Myat, Saw Win, Khin Mar Aye, Mo Mo Win, Htin Lin, Thin Thin Shwe, Win Mar and Kyaw Zin Thant
Auditorium (1) Day 2 Afternoon Session (2)
Chairpersons: Dr. Myo Khin Professor Thet Khaing Win Acting Director General (Retired) Rector Department of Medical Research University of Medicine (1) (Lower Myanmar) Yangon 14:55-15:15 Long-term effect of probiotic Fekalin 80 on the liver enzyme levels Paper-33. of patients with chronic hepatitis C infection Khin May Oo, Aye Aye Lwin, Yi Yi Kyaw, Win Maw Tun, Takashi Shimada and Shigeru Okada 15:15-15:35 Detection of precore promoter mutants in HBeAg negative chronic Paper-34. hepatitis B Myanmar Patients Yi Yi Kyaw, Aye Aye Win, Hyun Kook Cho, Win Maw Tun, Julan Kim, Khin May Oo and Jae Hun Cheong 15:35-15:55 Seroprevalence of hepatitis B and hepatitis C among pregnant Paper-35. women at South Okkalapa Women and Children Hospital Myat Tin Htwe Kyaw, Tin Tin Htwe, Yi Yi Kyaw, Kyaw Oo, Thazin Nyunt, Win Maw Tun and Khin Ohnmar Lwin 15:55-16:15 Antibiotic susceptibility pattern among Helicobacter pylori isolates Paper-36. from chronic dyspepsia patients Mya Mya Aye, Thein Myint, Moe Myint Aung, Thuzar Myint, Aye Aye Maw, Haymar Win and Wah Wah Aung
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Programme 42nd Myanmar Health Research Congress
Day 3
Auditorium (1) Day 3 – Morning Session (1)
Chairpersons: Dr. Ye Htut Dr. Khin Lin Deputy Director General Deputy Director General (Retired.) Department of Medical Research Department of Medical (Upper Myanmar) Research (Lower Myanmar) 08:30-08:50 Clinical study on efficacy and safety of artemether-lumefantrine in Paper-37. uncomplicated falciparum malaria in adults in Loikaw Khin Phyu Pyar, Tin Maung Hlaing, Sai Aik Hla, Khin Zaw Oo, Min Thu, Ye Thwe Hlaing, Min Lwin Oo and Lay Maung Maung 08:50-09:10 Renal involvement in severe malaria (Insein General Hospital, 2012-2013) Paper-38. Mar Mar Kyi, Myat Phone Kyaw, Myat Htut Nyunt, Tint Tint Kyi, Kyi May Htoo, Ne Myo Aung, Thinzar Cho Oo, Mi Mi Khine and Kyi Aye Thet 09:10-09:30 The role of merozoite surface protein (MSP) malaria antibody in Paper-39. treatment response of uncomplicated malaria in Myanmar Khin Myo Aye, Myat Phone Kyaw, Khin Thet Wai, Kay Thwe Han, Myat Htut Nyunt, Lu Lu Kyaw Tin Oo, Htet Wai Oo and Chan Myae Hlaing 09:30-09:50 Community-based survey on knowledge and prevention of malaria Paper-40. in Myanmar (2012) Zayar Lynn, Thar Tun Kyaw, Swe Mon Oo, Zaw Win Thein, Kyi Kyi Mar, Wai Wai Myint, Zin Mar Aye and Ohnmar 09:50:10:10 Availability and dispensing practices of anti-malaria drugs in private Paper-41. drug outlets of Myanmar Thae Maung Maung, Pattara Sanchaisuriya, Frank P Schelp, Myat Phone Kyaw, Thar Tun Kyaw and Ohnmar 10:10-10:30 Community-based survey on prevalence of fever and treatment Paper-42. seeking for malaria in Myanmar (2012) Zayar Lynn, Thar Tun Kyaw, Swai Mon Oo, Zaw Win Thein, Lwin Lwin Ni, Phyu Thi, Ni Ni Htay Aung and Ohnmar
Auditorium (1) Day (3) - Morning Session (2)
Chairpersons: Dr. Thar Htun Kyaw Professor Khin Phyu Pyar Director (Disease Control) Department of Medicine Department of Health Defence Service Medical Academy 10:45-11:05 Molecular epidemiology of drug resistant Plasmodium vivax and Paper-43. therapeutic efficacy of choroquine against Plasmodium vivax in Shwe Kyin, Myanmar Ye Htut, Kay Thwe Han, Eun Tae Han, Kyin Hla Aye and Khin Myo Aye
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42nd Myanmar Health Research Congress Programme
11:05-11:25 Human behavioural practices on prevention of malaria in Mudon Paper-44. Township, Mon State Ohnmar, Thar Tun Kyaw, Nyan Sint, Zayar Lynn, Zaw Win Thein and Swai Mon Oo 11:25-1:45 Evaluation of artemisinin resistant falciparum malaria in Shwe Paper-45. Kyin, Myanmar Ye Htut, Kay Thwe Han, Kyin Hla Aye, Thant Zin Aung, Zayar Han and Than Naing Min 11:45-12:05 Study on protective effects of malaria antibody among the Paper-46. community in malaria endemic areas Moe Kyaw Myint, Khin Lin, Aung Thu, Phyu Phyu Win, Mya Moe, Zaw Lin and Kyaw Zin Thant 12: 05-12:25 Challenges in Universal Coverage and Utilization of Insecticide Paper-47. treated bed nets among the Migrant Plantation Workers in Myanmar Myat Htut Nyunt, Myat Phone Kyaw, Khin Thet Wai, Thar Tun Kyaw, Thaung Hlaing and Khin Myo Aye
Auditorium (1) Day (3) - Afternoon Session (1)
Chairpersons: Dr. Than Zaw Myint Professor Tun Lwin Nyein Director General Hematology, Department of Medical Science Yangon General Hospital Department of Health 13:00-13:20 Patients’ perspectives on HIV care and support services in selected Paper-48. State and Regional Hospitals of Upper Myanmar Hla Soe Tint, Kyaw Ko Ko Htet, Htay Thet Mar, Kyaw Soe and Myint Kyaw 13:20-13:40 Anti-retrovial Therapy (ART) adherence among people living with Paper-49. HIV (PLHIVs) in selected townships of Myanmar) Thet Tin Tun, Kyu Kyu Than, Kyaw Soe, Hnin Kalayar Kyaw, Poe Poe Aung, May Yu Hlaing and Myo Thant Zin 13:40-14:00 Health related quality of life among people living with HIV/AIDS (PLHA) Paper-50. attending Sunday Empowerment Group’s activities of AFXB (Myanmar) Ohnmar, Than Tun Sein and Kathy Shein 14:00-14:20 Management of tuberculosis in hard-to-reach area, Laukkai Paper-51. Township, Northern Shan State, Myanmar Thida, Saw Saw, Thandar Lwin, Kyaw Ko Ko Htet, Nwe Nwe Kyaw, Phyu Phyu Khaing and Kyaw Zin Thant 14:20-14:40 Assessment of general practitioners’ participation on tuberculosis Paper-52. management in PPM DOTS: Patients’ perspective Thet Naing Maung, Ohnmar, Aung Thu, Yu Yu Lwin, Thyn Thyn, Thi Thi Kyaw, Thandar Lwin, Tin Aye and Khin Swe Win 14:40-15:00 Positivity of Acid fast Bacilli Culture and Drug sensitivity Pattern in Paper-53. children with Tuberculosis Swe Zin Zin Aung and Cho Cho San
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Programme 42nd Myanmar Health Research Congress
Auditorium (1) Day (3) - Afternoon session (2)
Chairpersons: Professor Malar Win Professor Myint Myint Nyein Rector Professor/Head University of Nursing, Department of Pathology Mandalay University of Medicine (2) 15:15-15:35 Antimicrobial susceptibility pattern of extended-spectrum beta- Paper-54. lactamase producing Enterobacteriaceae in urinary tract infection Khin Thawtar Shein, Phyu Phyu and Thida 15:35-15:55 Bacteriological and drug sensitivity profile of Vibrio cholerae Paper-55. isolated from children with acute diarrhoea Nan Aye Thida Oo, Wah Wah Aung, Mon Mon, Than Mya, Aye Aye Maw and Aye Yin Shwe 15:55-16:15 Viral etiology in infants with acute respiratory infection Paper-56. Myat Mon Aye and Khin Nyo Thein 16:15-16:35 A comparative study on conventional tube method and gel Paper-57. agglutination technology for detection of warm autoantibodies on red cells at National Blood Centre Thu Zar Ma Ma Moe Min, Thidar Aung, Aye Aye Khin, Tin Hta Nwe and Myint Myint Hla
Day 3 (SRC parallel Session)
SRC Conference Hall Day 3 – Morning Session (1)
Chairpersons: Professor Than Tun Sein Professor Naing Win Director (Retired) Rector Department of Medical University of Medical Technology, Research (Lower Myanmar) Yangon 08:30-08:50 Local problem, local solution: Role of Community-Based Paper-58. Organization in emergency referral for maternal, newborn and child health in Middle Island, Nga Pu-Daw Township Saw Saw, Theingi Myint, Han Lin Zaw, Chomar Kaung Myint, San San Aye, Thandar Min, Kyi Kyi Mar and Hla Thida Tun 08:50-09:10 Effectiveness of condom promotion programme to strengthen the Paper-59. utilization of condom among men having sex with men (MSM) Hla Soe Tint, Khin Wai, Kyaw Soe, Kyaw Ko Ko Htet and Htay Thet Mar 09:10-09:30 Bangkok high school students’ attitudes towards adolescent Paper-60. pregnancy and its prevention Aung Aung Kyi and Khin Khin Aye 09:30-09:50 Quality of antenatal care provided by midwives in selected Paper-61. townships of Upper Myanmar Hla Soe Tint, Theingi Myint, Kyaw Ko Ko Htet and Myitzu Tin Oung
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42nd Myanmar Health Research Congress Programme
Day 3 (SRC parallel Session)
SRC Conference Hall Day 3 – Morning Session (2)
Chairpersons: Professor Nay Soe Maung Professor Khin Htar Yi Rector Professor/Head University of Public Health Obstetrics and Gynecology Department University of Medicine (2) 10:05-10:25 Knowledge, behaviors, and beliefs on Cervical Cancer Prevention Paper-62. (CCP) of Women at North Okkalapa General Hospital (NOGH) Khin Su Myat Win, Mya Thida, Mie Mie Shwe, Myat Theingi and Soe Soe 10:25-10:45 Cervical cytology findings in women attending the Cervical Cancer Paper-63. Screening Clinic, Department of Medical Research (Lower Myanmar) from 2008 to 2013 Aye Aye Win, Mu Mu Shwe, Yin Min Htun, Ohnmar Kyaw, Thazin Myint, Tin Tin Han, Myat Thandar and Khin Saw Aye 10:45-11:05 Visual Inspection with Acetic Acid (VIA) in detection of High Paper-64. Grade Squamous Intraepithelial Lesion (HSIL) and Cancer of Cervix in community setting Thazin Nyunt, Yin Yin Soe, Mar Mar Aye and Hla Hla Win 11:05-11:25 Safety and effectiveness of intravenous glyceryl trinitrate in Paper-65. retained placenta Myint Myint Aye and Khin Htar Yi
Day 4
Auditorium (1) Day (4) - Morning Session (1)
Chairpersons: Professor San San Nwet Professor Nan Hla Hla Win Rector Professor/Head University of Pharmacy, Pharmacology Department Yangon University of Medicine (1) 08:30-03:20 Formulation development and comparison of the bioavailability of Paper-66. formulated tablet prepared by wet granulation method with the market sample Wai Wai Lwin, San San Nwe, Cho Yi Myint, May Aye Than and Myo Myint 08:50-09:10 Study on the five different manufacturing (production) methods of Paper-67. solid dosage form of tablets using Allopurinol as an active ingredient Zabei Phyu, Myo Myint, Myint Oo and Thein Mi 09:10-09:30 Bioequivalence study of metronidazole tablets in Myanmar healthy Paper-68. volunteers Yi Yi Htun, Moh Moh Kyi, Khin Win Sein and Nu Nu Aye
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Programme 42nd Myanmar Health Research Congress
09:30-09:50 Pharmaceutical equivalence and quality assurance of different Paper-69. types of quinolone antimicrobials available in Myanmar Moe Moe Aye, Khin Chit, Min Wun, Nyi Nyi Win, Kyi Kyi Myint, Thiri Aung, Swe Swe Aung and Khin Moe Latt 09:50-10:10 Formulation and manufacturing technology of chewable tablets Paper-70. using ascorbic acid as an active ingredient Myint Zu Aye, Myo Myint, Myint Hla and Myint Oo
Auditorium (1) Day (4) - Morning Session (2)
Chairpersons: Dr. Htun Naing Oo Professor Nu Nu Aye Director General Head, Department of Traditional Department of Pharmacology Medicine University of Medicine, Mandalay 10:25-10:45 Evaluation of pharmacokinetics and pharmacodynamics of Paper-71. levofloxacin in patients with acute exacerbation of chronic obstructive pulmonary disease Khin Hnin Pwint, Mar Mar Kyi, Khin Chit, Yamin Ko Ko, Phyu Phyu Aye, Phyo Wai Aung, Mya Mya Moe, Thin Thin Hlaing and Thinzar Myo 10:45-11:05 Bioefficacy of Cassia fistula Linn.(Ngu) Leaf extract against the Paper-72. dengue vector Aedes aegypti under laboratory condition Naw Hnin Myint, Yi Yi Mya, Mya Nilar Chaw Su, Tun Tun Win, Thin May Tun, Si Si Aung, Than Than Htwe, Ei Ei Htway and Kyaw Oo 11:05-11:25 Comparative study of heavy metals in selected medicinal plants Paper-73. and soils from different sites Khin Phyu Phyu, Khin Mi Mi Lay, Lei Lei Win, Mya Malar, Saw Ohnmar Khin, Kyawt Kyawt Khaing, Kyi San, Aung Thura and Kyaw Zin Thant 11:25-11:45 Antihypertensive effect of Millingtonia hortensis Linn.f. leaves Paper-74. (Aykayit) on stage 1 hypertensive patients Khine Khine Lwin, May Aye Than, Thein Kyaw, Tin Tin Htay, Ko Ko Zaw, Khin Taryar Myint, Nu Nu Win and Win Win Maw 11:45-12:05 Detection of Tricothecenes (T-2) Mycotoxin in selected Paper-75. preparations of peanut Lai Lai San, Thaung Hla, Tin Tin Htwe, May Than Htay, Zin Me Thein, Wai Lwin Oo, Nilar and Myo Myo Kyaw
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42nd Myanmar Health Research Congress Programme
Auditorium (1) Day (4) Afternoon Session (1)
Chairpersons: Professor Mya Thida Professor San San Myint Professor/Head Professor/Head Obstetrics and gynecology Obstetrics and gynecology Department Department University of Medicine (1) University of Medicine, Magway 13:00-13:20 Effect of maternal oral hydration on amniotic fluid index (AFI) Paper-76. Thwe Thwe Thinzar and Khin Htar Yi 13:20-13:40 Diagnostic accuracy of transvaginal sonography versus saline Paper-77. infusion sonohysterography in abnormal uterine bleeding Thin Thin Myat and Khin Htar Yi 13:40-14:00 Complications of hysterectomy for benign gynaecological Paper-78. conditions in Central Women’s Hospital, Yangon Thu Thu Win Lwin, Phyu Phyu Thein and Yin Yin Soe 14:00-14:20 Correlation between maximal pool depth of the amniotic fluid and Paper-79. fetal outcome in postdate pregnant women Beauty Tun, Aye Aung and Khin Lay Kywe 14:20-14:40 Correlation between admission cardiotocography and fetal Paper-80. outcome of high risk obstetric patients Nan Pan Pa Pa Htay, Thin Thin Aung and Khin Lay Kywe 14:40-15:00 Comparative study on pregnancy outcomes of pregnant women Paper-81. without standard antenatal care to pregnant women with standard antenatal care Win Mya Kyay Mone Win, Aye Aye Tint and Win Win Mya
Auditorium (1) Day (4) Afternoon Session (2)
Chairpersons: Professor Nwe Nwe Oo Professor Kyi Kyi Nyunt Rector Professor/Head University of Nursing, Obstetrics and gynecology Department Yangon University of Medicine, Mandalay 15:15-15:35 Improvement in knowledge, perception and practice of men in Paper-82. maternal and child health at South Dagon Township Myo Myo Mon, Kyu Kyu Than, Aye Aye Myint and May May Khin, Wai Wai Myint, Pyone Thuzar Nge, Zin Mar Aye, Aung Soe Min and Phyu Thi 15:35-15:55 Male involvement in reproductive health issues of women in rural Paper-83. settings of Upper Myanmar Hla Soe Tint, Phyoe Maung Thaw, Kyaw Ko Ko Htet, Myitzu Tin Oung, Thida, Theingi Myint and Than Tun Sein
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Programme 42nd Myanmar Health Research Congress
15:55-16:15 Gender differences in utilization of reproductive health services Paper-84. among youths in the poor communities of Mandalay city, Myanmar Phyu Phyu Thin Zaw, Kyaw Ko Ko Htet, Kyaw Thu Soe, Tippawan Liabsuetrakul and Thein Thein Htay 16:15-16:35 Factors influencing male participation in maternal and newborn Paper-85. health in South Dagon Township, Yangon: Qualitative Study May May Khin, Mya Mya Win, Nay Win Ko Ko, Hnin Kalyar Kyaw, Aye Aye Myint, Thwe Thwe Win, Kyu Kyu Than and Myo Myo Mon
Day 5
Auditorium (1) Day (5) - Morning Session (1)
Chairpersons: Professor Win Myat Aye Professor Khin Nyo Thein Rector Professor/Head University of Medicine, Magway Department of Child Health University of Medicine (2) 08:30-08:50 Predictors for diagnosis of neonatal sepsis in Yangon Children Hospital Paper-86. Thazin Mon, Kay Thi Htun, Kyaw Oo, Wah Wah Aung and Ko Ko Zaw 08:50-09:10 Soil-transmitted helminth infections, hematological analysis and Paper-87. growth among primary school children in Tha-Pyay-Chaung Village, Nay Pyi Taw: Reassessment after one year of preventive chemotherapy Nyein Chan Aung, Win Lwin Oo, Htet Win, Thet Maung Maung, Win Ko Ko Htay, Zin Phyo Hlaing, Nyein Chan, Moe Kyaw and Tin Maung Hlaing 09:10-09:30 Mycoplasma pneumoniae infection in children with acute Paper-88. respiratory infection Saw Win, Win Lai May, Wah Wah Aung, Han Win, Phyu Win Ei, Zeya Kyaw Win, Win Maw Tun, Dam Lian Pau and Phyu Hnin Wai 09:30-09:50 The Role of NS-1 Antigen in early diagnosis of Dengue Hemorrhagic Paper-89. Fever in Yangon Children Hospital Aye Aye Myint, Khin Saw Aye, Ko Ko Zaw, Mu Mu Shwe, Saw Win and Kyu Kyu Khin 09:50:10:10 Antibody response to measles vaccine in children attending North Paper-90. Okkalapa General Hospital Cho Cho Myint and Naing U 10:10-10:30 Prevalence and severity of childhood asthma in school children of Paper-91. age 10-14 years in North Okkalapa Township Thet Su Su Aung, Cho Cho San and Saw Win
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42nd Myanmar Health Research Congress Programme
Auditorium (1) Day (5) - Morning Session (2)
Chairpersons: Dr. Yi Yi Myint Professor Chit Soe Director General Professor Department of Medical Department of Medicine Research (Upper Myanmar) University of Medicine (1) 10:45-11:05 Factors influencing motorcycle accidents in Nay Pyi Taw Paper-92. Aye Moe Moe Lwin, Yi Yi Win, Thinzar Aung and Chan Nyein Maung 11:05-11:25 Incidence of injury due to road traffic accidents in Lashio Paper-93. Township, Northern Shan State Moe Kyaw Myint, Lwin Oo, Sai Kyaw Min, Aung Thu, Khin Lin and Kyaw Zin Thant 11:25-11:45 Perception on stress and the coping strategies of Grade-11 Paper-94. students at No.(5), Basic Education High School, Mingaladon Hlaing Zaw Win, Khin Mg Kyaw and Thwet Kyi Thaw 11:45-12:05 A study of the effects of 3 Mix-MP medicament and calcium Paper-95. hydroxide in non-vital pulp treatment of deciduous molars Ei Khine Min, Aung Kyaw Htoo and Sun Sun Win 12:05:12:25 Establishment of the simple extraction of collagen from some Paper-96. fishes in Myanmar and evaluation of effectiveness in wound healing Lin Lin Tun, Kyaw Naing, Moh Moh Htun, Khin Khin Aye, Aye Win Oo, Myat Mon Oo and Win Aung 12:25-12:45 Serum C-telopeptide, serum oestrogen level and bone mineral Paper-97. density in premenopausal and postmenopausal women Ni Ni Lin, Than Than Soe, Kyu Kyu Maung, May Thazin, May Pyone Kyaw and Aye Thida
Auditorium (1) Day (5) - Closing Session
14:40hr Closing Speech by Director General, Department of Medical Research (Lower Myanmar)
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Programme 42nd Myanmar Health Research Congress
BEST PAPERS AND BEST POSTER AWARDING CEREMONY
Department of Medical Research (Lower Myanmar) Auditorium (2) No. 5, Ziwaka Road, Dagon Township, Yangon
15:00hr Speech by: H.E. Professor Dr. Pe Thet Khin Union Minister Ministry of Health
15:10hr Speech by: Chairman Best Papers and Poster Selection Sub-committee
15:20hr Awarding: Best Paper for Basic Research Best Paper for Applied Research Best Paper for Health Systems Research Best Poster Young Researcher Award for Basic Research Young Researcher Award for Applied Research Young Researcher Award for Health Systems Research
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42nd Myanmar Health Research Congress Programme
List of the Posters Displayed
Poster - 1 Characteristics of patients with breast cancer from selected cancer units in Yangon and Mandalay cities Myo Khin, Le Le Win, Khin May Oo, San Shwe, Win Pa Pa Naing, Htain Win and Aung Myo Min Poster - 2 Knowledge, attitude, perception and practice regarding breast cancer prevention among female school teachers in Yangon Region Khaymar Mya, Yin Thet Nu Oo, Aye Sandar Mon, Than Soe Lin, Soe Moe Myat, Ko Ko Zaw and Nay Soe Maung Poster - 3 Study of plasma malondialdehyde and serum zinc level in normal pregnant women Aung Myo, Khin Nwe Kyi, Aye Aye Myat, Ohnmar, Than Oo, Khin Myo Chit, Moe Kyaw and Tin Maung Hlaing Poster - 4 Assessment on effectiveness of safer blood transfusion services in National Blood Center, Myanmar Nwe Nwe Oo, Thaw Zin Aung, Ikuma Nozaki and Thida Aung Poster - 5 Detection of Clostridium botulinum and toxin production from some of salted dry fishes Thin Thin Wah, Lai Lai San, Tin Tin Htwe, May Than Htay, Nilar, Myo Myo Kyaw, Kyaw Kyaw San and Thaung Hla Poster - 6 Bio-efficacy and wash resistance of PermaNet® 2.0, PowerNet and K-O- Tab 123 treated bednets against malaria vector mosquitoes Maung Maung Mya, Pe Than Htun, Myat Phone Kyaw, Sein Min, Sein Thaung, Yee Yee Myint, Thu Zar Nyein Mu, Chit Thet Nwe and Yan Naung Maung Maung Poster - 7 Role of serum protein electrophoresis in detection of multiple myeloma San San Htwe, Rai Mra, Htun Lwin Nyein, Win Pa Pa Naing, Aung Thu, Aye Mya Khine and Moe Thuzar Min Poster - 8 Hepatitis B vaccination response in person with Hepatitis C virus infection Myat Tin Htwe Kyaw, Aye Aye Lwin, Yi Yi Kyaw, Khin Ohmar Lwin, Khin May Oo, Win Maw Tun and Kay Khine Soe Poster - 9 Molecular characterization of Chikungunya Virus in Myanmar Aung Zaw Latt, Thet Khaing Win, Saw Win, Thida Kyaw, Kaythi Aye, Yamin Ko Ko and Hlaing Myat Thu Poster - 10 Population structure of the malaria vector Anopheles baimaii in Myanmar using microsatellite markers Yan Naung Maung Maung, Thaung Hlaing, Sein Min, Sein Thaung, Khin Myo Aye, Petri Kemppainen and Catherine Walton Poster- 11 (awma&Smuf)Evaluation of antispasmodic activity of Atalantia monophylla Correa. root on isolated rat intestine May Aye Than, San San Myint and Khin Mar Naing
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Programme 42nd Myanmar Health Research Congress
Poster- 12 Clinical significance of admission hematological parameters in patients with acute myocardial infarct Zin Zin Thu, Tin Latt, Aye Aye Wynn, Myo Myo Mon, Kyu Kyu Than, Win Pa Pa Naing and Aye Mya Khine Poster- 13 Innovative male participation process in achieving maternal and newborn health outcomes in South Dagon Township, Yangon Hnin Kalayar Kyaw, Mya Mya Win, Nay Win Ko Ko, May May Khin, Aye Aye Myint, Thwe Thwe Win, Kyu Kyu Than and Myo Myo Mon Poster-14 Assessment of the quality of HIV testing in Myanmar Latt Latt Kyaw, Ikuma Nozaki, Khin Yi Oo and Namiko Yoshihara Poster-15 Enhancing bed-net delivery mechanisms and early diagnosis and prompt treatment for malaria among resident and migrant households in Tanintharyi Coastal Region, Myanmar Khin Myo Aye, Myat Phone Kyaw, Khin Thet Wai, Myo Min, Tin Oo, Aye Than, Lu Lu Kyaw Tin Oo, Chan Myae Hlaing and Tin Tin Wai Poster-16 Assessment of osteoporosis in female breast cancer patients attending Medical Oncology Ward, Yangon General Hospital Than Than Aye, Yae Chan, Han Win, Ko Ko Zaw and Khin Thinn Mu Poster-17 (e*g;armufoD;)Evaluation of the antioxidant activity of two species of Hylocereus fruits
Mie Mie Nwe, Khin Taryar Myint, Aung Myat Kyaw, Win Win Maw, Phyu Phyu Zin, Nwe Nwe Oo and May Aye Than Poster-18 Comparative study of effectiveness of Albendazole and Mebandazole in soil-transmitted helminthiasis of school children Aye Than, Khin Maung Lwin, Khin Thet Wai, Ni Ni Zaw, Thin Thin Aye, Khin Mya Ei, Myat Htut Nyunt, Thaung Hlaing and Kay Thwe Han Poster-19 The role of Human Papillomavirus (HPV) in oral leukoplakia, oral submucous fibrosis and oral squamous cell carcinomas Moe Thida Htwe, Zaw Moe Thein and Swe Swe Win Poster-20 Involvement in flood-related-health care activities for the flood victims: who, when and why Le Le Win, Yin Thet Nu Oo, Khin Sandar Oo, Kyi Maw Than, Than Htein Win,Thandar Min, Aye Win Khine, Hla Thida Tun and Soe Moe Myat Poster-21 Application of fluorescence microscopy in the diagnosis of tuberculosis Sann Sanda Khin, Aung Thu, Thandar Lwin, Tun Kyaw Soe, Khin Zaw Latt, Wai Wai Khaing, Yi Yi Myint, Erwin Cooreman and Htun Naing Oo Poster-22 Drug use pattern, HIV knowledge and accessibility to harm reduction services in Pekhon Township Sai Aung Kyaw Myint, Thura Maung Aye, Poe Poe Aung and Khin Hnin Oo Poster-23 Awareness and attitude of public staff towards involvement of General Practitioners (GPs) in TB control in selected townships, Yangon Region Khin Sandar Oo, Saw Saw, Le Le Win, Yin Thet Nu Oo, Tin Mi Mi Khaing, Mya Mya Moe, Thandar Min, Soe Moe Myat and HlaThidaTun
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42nd Myanmar Health Research Congress Programme
Poster-24 Coagulation profile in type-2 diabetes mellitus patients attending the diabetic clinic, Yangon General Hospital Myat Mon Oo, Moh Moh Htun, Win Maw Tun, Ohnmar, Yin Min Htun, Hnin Nu Htwe, Mya Thanda Win and Kay Thwe Win Poster-25 Determination of djenkolic acid concentrations in different preparations of djenkol beans (Da-Nyin Thee) Archidendron pauciflorum Benth. Thet Thet Mar, Thaung Hla, Lai Lai San, Thin Thin Wah, Nilar and Myo Myo Kyaw Poster-26 Body mass index of medical students in University of Medicine, Mandalay Sanda Kyaw, Aye Aye Thein, Nwe Nwe Yee, Mar Mar Lwin, Win Yu Aung, Ei Ei Khin and Khine Cho Myint Poster-27 Assessment of clinical usage of blood transfusion services in National Blood Center, Myanmar Thaw Zin Aung, Nwe Nwe Oo, Ikuma Nozaki and Thida Aung Poster-28 A preliminary analysis of oral cancer patients in Asean Costs In Oncology Study-Myanmar (ACTION Study) 2013 Myomin Thane, Le Le Win and Swe Swe Win Poster-29 In vitro anti-malarial activity of some Myanmar medicinal plants Hla Myat Mon, Khin Khin Win Aung, Kay Thi Kyaw, Gadae Maung Maung, Yu Yu Nwe Oo and Myat Chaw Su Poster-30 Awareness and attitude on Emergency Contraceptive Pills (ECPs) among drug sellers in Pyin Oo Lwin Township Tin Tin Wynn, Theingi Myint, Hla Soe Tint, Moe Kyaw Myint, Yadanar Aung, Kyaw Oo, Khin Lin and Kyaw Zin Thant Poster-31 Community preparedness on hazards from storms and flood in Kyaung-Kone and Kun-Chan-Kone Townships, Myanmar 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 Poster-32 Occurrence of Staphylococcus aureus, Bacillus cereus and their toxins in foods sold on roadside food stalls Thaung Hla, Thet Thet Mar, Zin Mi Thein and Wai Lwin Oo Poster-33 Promoting use of recommended Artemisinin-based Combination Therapy (ACT) in preference to Artesunate Mono-Therapy (AMT) in the private sector, Myanmar Poe Poe Aung, Thar Tun Kyaw, Zaw Linn, Zaw Win Thein, Swai Mon Oo, Zayar Lynn, Phyu Thi and Ohnmar Poster-34 Snack consumption pattern of students aged 12-14 years at No. (4) Basic Education High School, Ahlone Township, Yangon Region Mya Ohnmar, Theingi Thwin, Moh Moh Hlaing, Sandar Tun, Maung Maung Myint, Thidar Khine, Lei Lei Myint, Khin Hnin Wint Phyu and Yin Yin Aye
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Programme 42nd Myanmar Health Research Congress
42nd MYANMAR HEALTH RESEARCH CONGRESS PROGRAMME FOR SYMPOSIA Department of Medical Research (Lower Myanmar) No. 5, Ziwaka Road, Dagon Township, Yangon, Myanmar
Day 1 6.1.2014 (Monday) 13:30 -16:30hr Auditorium (2) Myanmar Korea Joint Symposium on Tuberculosis, Malaria and Hepatitis (2014) Chairpersons: Dr. Kyaw Zin Thant and Dr. Sun Dae Song Session I Opening remarks Rapid Identification and Characterization of Extensively Drug Resistant (XDR) Mycobacterium tuberculosis using Molecular beacon by Dr. Jong-Seok Lee Global trends of drug resistant malaria monitoring system by Dr. Eun Taek Han Characterization of HBV SNP variation related with vaccine ineffectiveness and drug-resistance by Dr. Jae Hun Cheong Coffee break Session II Establishment of Molecular Techniques in the Department of Medical Research(Lower Myanmar) Tuberculosis by Dr. Phyu Win Ei Malaria by Dr. Khin Myo Aye Hepatitis by Dr. Aye Aye Win Closing remarks
Day 2 7.1.2014 (Tuesday) 09:30 - 12:30hr Auditorium (2) Universal Health Coverage for Inclusive and Sustainable Growth in Myanmar Chairperson: Professor Nwe Nwe Oo Opening remark by Prof. Nwe Nwe Oo Overview of UHC by Dr. S. Gopalan Myanmar’s Road to UHC by Dr. San San Aye Benefit package and the Role of Research by Dr. Hnin Hnin Pyne Financial protection and further research needs by Dr. Alex Ergo
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42nd Myanmar Health Research Congress Programme
7.1.2014 (Tuesday) 13:30 - 16:30hr Auditorium (2) Evidence-based Health Policy Chairperson: Professor Nay Soe Maung Making health policy, evidence and what else by Dr. Phone Myint Evidence based health policy, from analysis of digital big data by Dr. Toshiro Kumakawa Are TB control programmes sustainable? by Dr. Samantha Watson How can we know whether we’re getting the best value for our money in health? by Dr. Alex Ergo
7.1.2014 (Tuesday) 14:00 - 15:00hr SRC Conference Hall Scientific Talk on Reconstruction after Excision of Pelvic Tumors Chairperson: Prof. Zaw Wai Soe Reconstruction after Excision of Pelvic Tumors by Prof. Toshifumi Ozaki, Department of Orthopaedic Surgery, Okayama University, Okayama, Japan
Day 3 8.1.2014 (Wednesday) 09:30-12:30hr Auditorium(2) Recent Advance for Environmental Health Chairperson: Dr. Min Than Nyunt University of Miyazaki’s Recent Advance for Environmental Health – Towards a Prosperous Future Together by Prof. Tatsuo Suganuma Mechanism of arsenic contamination of groundwater and arsenic removal units in South Asia by Prof. Hiroshi Yokota Tea break Research on environmental health in Myanmar by Dr. Thaung Hla Lead intoxication in Myanmar by Dr. Kyi Lwin Oo
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Programme 42nd Myanmar Health Research Congress
8.1.2014 (Wednesday) 13:30-16:30hr Auditorium(2) Symposium on Responsible Conduct of Research Chairperson: Dr. Kyaw Zin Thant Overview on RCR and promoting RCR in Myanmar by Dr. Myint Htwe Research monitoring by Dr. Ye Htut Ensuring Research integrity and preventing misconduct by Dr. Hlaing Myat Thu Research mentoring by Dr. Khin Thet Wai
Day 4 9.1.2014 (Thursday) 09:30-12:30hr Auditorium(2) Symposium on Breast Cancer Screening Chairpersons: Dr. Hiroyoshi and Dr. Htun Oo Overview of breast cancer screening by Dr. Naruto Taira Training Program at Okayama UNIV Hospital by Dr. Takayuki Iwamoto Japan’s Screening experience~Importance and benefit of Breast Cancer Screening by Ms Kanoko Oishi Breast Cancer awareness Campaign by MMCWA by Dr. Mon Mon Aung Coffee break Breast Cancer Education activities of MMA by Dr. Nu Nu Swe The outcome of the 1st Phase trial Screening - Radiological outcome by Dr. Hla Hla Myaing The outcome of the 1st Phase trial Screening - Breast Cancer Perception - Client Satisfaction Bio and historical data background of the participants by Dr. Myo Myo Mon
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42nd Myanmar Health Research Congress Programme
9.1.2014 (Thursday) 13:30-16:30hr Auditorium(2) Role of Electron Microscopy in Medical Research and Clinical Practice Chairpersons: Prof. Khine San Yin and Prof. Aye Aye Than Opening Speech by Chairperson Latest development of ultra high resolution scanning electron microscope by Tetsuo Oikawa Electron Microscopy for Clinical and Research applications by Prof. Mah Lee Ng Coffee break Nikon entire range of Biological Microscope including normal microscope, Confocal microscope as well as super resolution microscope by Dr. Clement Khaw TEM in Diagnostic and Research Purposes by Dr. Saw Wut Hmone Discussion Closing
Day 5 10.1.2014 (Friday) 09:30-12:30hr Auditorium(2) NCDs Symposium: The Epidemic of Cardiovascular Disease and Diabetes in Myanmar and Beyond Chairperson: Dr. U Ko Ko Introductory remarks NCDs: global and Myanmar perspectives by Prof. Tint Swe Latt The cost of CVD and diabetes: using health economics for policy formation by Prof. Rob Carter Discussion PEN Project: Myanmar experience by Assoc. Prof. Ko Ko Using STEPS 2014 and PEN to reduce the gap between evidence and practice for CVD and diabetes: a proposal for quality improvement by Prof. James Dunbar Discussion Closing remarks by Prof. Tint Swe Latt
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ABSTRACTS OF THE PAPERS PRESENTED 42nd Myanmar Health Research Congress Abstracts of the papers (Day 1)
Paper Reading Session : Day 1
Morning Session (1), Auditorium (1) Paper-1
Study on use of health research results by National Programmes
Maung Maung Toe1, Kyaw Oo2, Than Sein1, Le Le Win3, Saw Saw3, Phone Myint1 and Yin Thet Nu Oo3
1People’s Health Foundation, Myanmar. 2Department of Medical Research (Upper Myanmar) 3Department of Medical Research (Lower Myanmar)
The study is 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), RH (MCH AND 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 conducted anonymously five Key informant interviews (KII) and five In-depth interviews (IDI) to enquire policy making regarding the planning, implementation, monitoring and evaluation of the above mentioned programs related to research utilization. Utilized researches were found to be operations research, programme evaluation and collaborative research based on the research problems of programmes. Evidence of research finding utilization was found much especially in disease control activities and health systems development. Programme needs more about information on operational problems and solution which could be provided by operations research. Some of the research results that were not utilized by the programme managers were due to the weakness in communication, coordination and collaboration between the researcher and users.
Morning Session (1), Auditorium (1) Paper-2
Factor influencing the performance of Township Medical Officers in Mandalay and Sagaing Regions
Kyaw Kyaw1, Myitzu Tin Oung1, Phyu Phyu Thin Zaw1, G Sen Taung2 , Kyaw Kyaw2 , Marlar Aung1, Thandar Myint1 and Pyae Phyo Htwe1
1Department of Medical Research (Upper Myanmar) 2Department of Health, Mandalay and Sagaing Regions
Township medical officers (TMOs) in Myanmar are the most responsible persons of primary health care at the grass-root level. The understanding of the factors influencing their working performance is essential in establishing primary health
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care programs. This hospital-based, qualitative study aimed to elicit the quality of work-life and working performances among TMOs in all 16 township hospitals of Mandalay and Sagaing Regions. All 16 TMOs were purposively selected to answer the in-depth interviews. They were also asked to fill in the self-administered questionnaires to elicit their socio-demographic conditions and working conditions. The results from the self-administered questionnaires were presented descriptively. All the in-depth interviews were taped-recorded and fully transcribed. After coding, the thematic approach to content analysis was done. Out of 16 TMOs, seven were female and nine were male. Mean age of the TMOs was 49.38 years. The mean of total years of service was 18.25 years. The mean distance of the hospitals from the Regional hospital was 31.69 miles. The villages under the care of the TMOs ranged from 21 to 602. Total numbers of population covered by one TMO ranged from 90762 to 172450. Despite their willingness to work energetically, they were overwhelmed by a heavy work-load. There was a shortage of staffs and resources resulting in poor working conditions. To improve their work-life and working performances, the equitable allocation of resources in all the hospitals in the township level was essential.
Morning Session (1), Auditorium (1) Paper-3
Study of bone mass density in various age groups of Myanmar population
Yi Yi Myint1, Nyein Nyein Maw2, Myint Han3, Thinzar Aung1, Kyaw Thu Soe1, Kyaw Soe Naing4, May Myat Win2, Nyein Su Win2 and Kyi Tha Soe2
1Department of Medical Research (Upper Myanmar) 2Pun Haling Hospital 3Department of Food and Drug Administration 4Ann Civil Hospital, Department of Health
Osteoporosis is common health problem and awareness about osteoporosis associated fracture is relatively low in Myanmar. There are only few systemic researches, studies and reports on Bone Mass Density (BMD) and osteoporosis occurrence in Myanmar people. A community based descriptive and analytic study was done to measure BMD among various age groups in Myanmar population from Dec 2012 to Dec 2013. A total of 423 respondents aged between 20 and 60 were included. BMD was measured by using Quantitative Ultrasound (QUS) and body mass index (BMI) was calculated after measuring heights and weights. Semi- structured questionnaire was used to assess background characteristics, life style factors, past medical and drugs/supplement history as well as knowledge about osteoporosis. Mean age of the study group was 41.3 ± 8.36 year and male to female ratio was 1:9.3. The results of BMD measurement by T score of QUS of calcaneum revealed that 5.0 % of the respondents were osteoporotic, 44.4% were osteopenic, and 50.6% were normal. Among different age groups (20-30 years, 31-40 years, 41- 50 years, 51-60 years), 2.0%, 2.7%, 4.3%, and 14.8% were diagnosed as osteoporosis respectively. There were 12.8%, 53.9%, 25.3%, and 8.0% of underweight, normal weight, overweight, and obese people respectively (mean BMI = 23.49 ± 4.55). Age and BMI were found to have significant association with BMD. Though it is a limited
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study and needs further assessment, the findings of this study will be beneficial for better prevention and management of osteoporotic fracture and associated socioeconomic burden in Myanmar.
Morning Session (1), Auditorium (1) Paper-4
Betel quid chewing in Dagon(East) Township
Ko Ko Zaw1, Mya Ohnmar1, Moh Moh Hlaing1, Swe Swe Win2, Maung Maung Than Htike3, Phyu Phyu Aye4, Maung Maung Myint1, Sein Shwe2 and Moe Thida Htwe2
1Department of Medical Research (Lower Myanmar) 2University of Dental Medicine 3International Health Division, Ministry of Health 4Department of Health
This study aims to describe betel quid chewing practice and compare oral pre- cancerous lesions between chewers and non-chewers of betel quid among residents 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. The trained interviewers collected data using a pretested structured questionnaire. On site oral examination was done by dental surgeons and toluidine blue test and brush biopsy was done for suspected oral lesions. 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). Among 284 current betel quid chewers, 240 (85%) chew betel quids together with tobacco. 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. This highlights the growing importance of betal quid chewing and smokeless tobacco use as public health problem.
Morning Session (1), Auditorium (1) Paper-5
Prevalence of Vitamin A deficiency among 6 months to 5 years old children
Htin Lin1, May Khin Than1, Khaing Mar Zaw1, Theingi Thwin2 and Moh Moh Hlaing2
1National Nutrition Centre, Department of Health 2Department of Medical Research (Lower Myanmar)
Myanmar, likewise other South-East Asian countries, vitamin A deficiency remains a public health problem. The vitamin A status of children around the world is compromised due to inadequate dietary intake and infections resulting potential risk of morbidity. Serum retinol concentrations are useful indicators of vitamin A status and are influenced by inflammation and infection. In Myanmar, universal vitamin A supplementation program had been started since 1993. In 2000, the prevalence of vitamin A deficiency was below the cut-off for public health problem, and since then, there is no community survey on vitamin A. This paper is 5 Abstracts of the papers (Day 1) 42nd Myanmar Health Research Congress
to reveal the prevalence of vitamin A deficiency among 6 months to 5 years children in 13 townships across Myanmar. A total of 1410, 6-59 months old children from 13 townships were included as if representative for the National Level. The caregivers of children were interviewed using questionnaires to investigate socio- demographic background, morbidity history for last month and food intake including vitamin A containing multivitamins, the children were examined for signs of vitamin A deficiency, and their nutritional status were assessed by anthropometry and taken blood samples to assess vitamin A status. Regardless of inflammation, the prevalence of vitamin A deficiency based on serum retinol was 37.2% in National Level; in Yangon (19.0%), Ayeyarwaddy (32.7%), Bago (46.8%), Sagaing (55.1%), Magwe (62.0%), Mandalay (33.3%), Shan-South (30.6%) and Mon (18.5%). Meanwhile, based on the food intake, the consumption of Vitamin A below RDA was 19% across the whole country. In conclusion, vitamin A deficiency is a considerable public health problem according to WHO recommendation.
Afternoon Session (1), Auditorium (1) Paper-6
Estimating cost of TB patient Self Help Groups in Hlaingtharyar Township, Myanmar
Wai Wai Han1, Saw Saw1, Thandar Lwin2, Tin Mi Mi Khaing2 and Thet Aung3
1Department of Medical Research (Lower Myanmar) 2National TB Program 3World Vision Myanmar
The cross-sectional study was conducted to calculate the cost of establishing four TB patient Self Help Groups (SHG) 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 interviews using tool to categorize cost. Five Focus Group Discussions, nine Key Informant Interviews with SHG leaders, members and World Vision staff and ten coins technique were performed to assess financial management of SHGs. Amount of cost spent for the SHGs for two years ranges from more than two to six million kyats depending on the developmental stages of the SHGs. 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 84 patients and provided DOT for 62 patients per year. Most of the groups cannot perform financial management systematically. As the SHGs have been established for only two years, it is difficult to visualize their effectiveness if it is measured only by TB indicators such as treatment success rate and case detection rate. However, 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 members and fund raising activities for the sustainability.
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Afternoon Session (1), Auditorium (1) Paper-7
The lived experiences of patients with osteosarcoma who undergo chemotherapy
Maw Maw Than1, Thein Thein Kyi2 and Nang Kathy Aung3
1Defence Services Orthopedic Hospital (500-Bedded) 2No.(1) Defense Services General Hospital 3Department of Fundamental Nursing, University of Nursing (Yangon)
The research on the lived experiences of patients with osteosarcoma who undergo chemotherapy was conducted using a qualitative phenomenological approach. The purpose of this study was to explore and understand the reality of the lived experiences of patients with osteosarcoma who undergo chemotherapy. This phenomenological study was conducted at oncology unit of Yangon General Hospital (YGH), Yangon Orthopedic Hospital (YOH), and home of the participants. Total six participants within the age of 15 to 21 were included in this study by using purposive sampling method. Data were obtained by conducting in-depth face to face interviewing using with semi-structured questionnaire. The obtained data were analyzed by using van Kamm’s modification of the phenomenological method. Seven major themes emerged from the participants’ description of their experiences. It was revealed that osteosarcoma patients did not take medical advice from any medical person for their early sufferings and delayed practice of seeking health care. The emotional responses of the participants were fear, worry, being sad, feeling of low self-esteem, and anger. They were having experiences of physical sufferings in early period of disease and after treatment procedures. They also encountered many socio- economic experiences related to social problems and economic constraints while suffering illness and recurrent hospitalization. They tried to cope with their stressful aspects of their health problem by using various coping strategies. They expected their future living with illness in anticipating for good prognosis and had a plan to live with full compliance. By applying the findings in this study, comprehensive care plans, discharge plans, advanced knowledge regarding osteosarcoma to the community, health and social welfare system, and health insurance system should be recommended with the expectation of upgrading the quality of lives of osteosarcoma.
Afternoon Session (1), Auditorium (1) Paper-8
The lived experiences of primary family caregivers of children with acquired hearing loss
Naw Htoo Phaw Doh, Ohnmar Myo and Lwin Lwin Kyi
Military Institute of Nursing and Paramedical Sciences
This qualitative phenomenological study was intended to uncover the lived experiences of family caregivers with acquired hearing loss child from Yangon Region. In this study, purposive samples among seven family caregivers who cared for their
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child with acquired hearing loss were in-depth interviewed at participant's home and tape recorded. The recorded data were transcribed and analyzed by van Kaam's phenomenology method. Six major themes were emerged. The changes of child’s behaviour were noticed. Hearing loss was suspected and tested to confirm. As soon as realizing that the child’s hearing defect was sure, family caregivers suffered disbelief, sadness, disappointment, guilt, and worry. They were getting excess physical and emotional stress, social problem and financial hardship while caring the hearing loss child for a long time. However, they adapt their stress with religious believes and accept themselves as responsible person for child growth and development. They do the best for their child’s prospect based on parents’ eternal love although facing with multiple care burdens. It was found that they need supports from professionals who concern with deaf and their family to deal with their situation and care for themselves as well as for their children. Thus, providing health education regarding preventive activities, raising public awareness and early screening of ear diseases, counseling and emotional support, establishment of community based rehabilitation services for deaf children and extensive research have been recommended.
Afternoon Session (1), Auditorium (1) Paper-9
Lifestyle and health care practices of fishermen from Kyauk Chaung Village, Hainggyikyun Township, Pathein District, Ayeyarwady Region
Naing Lin Tun1, Soe Paing Lin1 and Ohnmar Myint2
1No. (1) Defence Services General Hospital (1000-Bedded) 2Military Institute of Nursing and Paramedical Sciences
This community-based cross sectional descriptive study was conducted among fishermen at Kyauk Chaung village, Hainggyikyun, Ayeyarwady Region in order to study their lifestyle and health care practices. Data were collected by conducting face-to-face interview among (110) fishermen selected by simple random sampling using structured questionnaire. Duration for fishing in each time was varied from 15- 35 days (68.2%) to 46-60 days (5.5%). Before going to fishing (26.4%) worshiped the traditional Nats, contributing U Shin Gyi (96.6%) and Hlay-Paing –Apho (3.4%). All respondents brought drinking water, rice and cooking materials, and medicines to the fishing ground. The respondents did not perform fishing in the bad weather (96.4%). Although they avoided taking alcohol in fishing ground, betel quid chewing was found (70%) whereas smoking was (72.7%). Diarrhea (71.2%) and injury (34.5%) were the most common health problem for them and common remedies were a mixture of Na- nwin-hlaw and Pop-qu-que (Chinese medicine) three drops with boiled water for diarrhea, and tamarind seed for injuries due to poisonous fish during the fishing ground. There were significantly relationships between educational level of the respondents and use of rural health center for chronic illness (p = .019) and the use of rural health center for treating malaria (p=.045). Moreover there was a statistical significance between family income and the use of health care services for acute illness (p= 0.043). This study revealed secret health care practices of fishermen and the need for provision of health education programs for abstinence from smoking and betel quick chewing, and the use of health care services were recommended.
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Afternoon Session (1), Auditorium (1) Paper-10
Salt consumption patterns and iodine nutrition status of pregnant women in coastal region
Theingi Thwin, Moh Moh Hlaing, Mya Ohnamr, Sandar Tun, Thidar Khine Wah Wah Win, Su Su Hlaing, Hla Phyo Lin and Nyein Nyein Win
Department of Medical Research (Lower Myanmar)
The cross-sectional, descriptive 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 asked by using structured questionnaires including age, parity, socioeconomic status and patterns of salt and iodine rich foods (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 mean urinary iodine level of pregnant women who consumed iodized salt and that of pregnant women who consumed non-iodizes salt were 110.47±67.34µg/L and 95.83±70.13µg/L (P = 0.336). Iodine content of iodized salt and non-iodized salt were 20.6±9.2ppm and 5.1±1.2ppm, respectively. In conclusion, 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 and the mean iodine content of salt samples was lower than the permissible level of iodine in iodized salt, i.e., 30-40 ppm. Our findings indicate that iodine nutritional status of pregnant women in this area is insufficient and salt iodization needs to be monitored for the optimal iodine content in iodized salt.
Afternoon Session (2), Auditorium (1) Paper-11
Bacteriological analysis of household drinking water in selected wards in North Dagon Township, Yangon
Thuzar Myint, Wah Wah Aung, Aye Aye Maw, Aye Yin Shwe, Su Mon Win, Hay Mar Win and Khin Thet Wai
Department of Medical Research (Lower Myanmar)
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
9 Abstracts of the papers (Day 1) 42nd Myanmar Health Research Congress
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.
Afternoon Session (2), Auditorium (1) Paper-12
Preliminary study on mercury content in river water around Gold Reclamation Site
Khine Thin Naing, Tin Nwe Htwe, Ye Hein Htet, Tin Tin Han, Khin Moe Latt, Ohnmar Win, Aye Thidar Tun, Thet Htet Aung and Myat Phone Kyaw
Department of Medical Research (Lower Myanmar)
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. Mercury was used to extract large gold particles by Amalgam technology for the accelerated growth of gold production. In most areas, the burning of Au-Hg amalgam is done in the open air, releasing Hg vapor to the atmosphere. It can pollute environment such as rivers, soils and atmosphere. In Shwe Kyin, Gold panning has been carried out for many years. Mercury might be used to extract gold particles in the process. Occupational exposure of mercury has resulted in broad- ranging functional disturbance, including irritability, excitability, excessive shyness, and insomnia. Long-term, low-level exposure has been associated with more subtle symptoms of erethism, including fatigue, irritability, loss of memory, vivid dreams and depression. A total of 7 water samples, 2 water samples from 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 of the 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 is not harmful because the results are lower than the Guideline values for chemicals from industrial sources and human dwellings that are of health significance in drinking water (Chemical aspects/ WHO) (6 ppb).
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Afternoon Session (2), Auditorium (1) Paper-13
Drinking water purification systems: implications for translating knowledge into action in peri-urban households with under-five children
Su Latt Tun Myint, Moe Thida, Tin Tin Wai, Lwin Lwin Ni, Zin Mar Aye, Aung Soe Min and Phyu Thi
Department of Medical Research (Lower Myanmar)
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 filter 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 disinfectants 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.
Afternoon Session (2), Auditorium (1) Paper-14
Cardiovascular Risk in People with chronic exposure to low level of arsenic contamination in drinking water
Soe Minn Htway1, Ohnmar2, May Aye Than3, Khin Tar Yar Myint3 and Mar Mar Myint3
1Department of Physiology, University of Medicine, Magway 2Department of Physiology, University of Medicine (2), Yangon 3Department of Medical Research (Lower Myanmar)
Nowadays, the interest of researchers focuses on non-cancer health effects of arsenic contaminated drinking water for a long-time. The aim of this study is to investigate
11 Abstracts of the papers (Day 1) 42nd Myanmar Health Research Congress
the effect of chronic exposure to drinking water with low level of arsenic contamination on arsenic-related cardiovascular risk parameters in apparently healthy subjects. This study was a cross-sectional comparative study, comparing arsenic- related cardiovascular risk parameters between arsenic-exposed group (n=75), drinking water with arsenic contamination of 51g/L and non-exposed group (n=75), drinking water with no arsenic contamination (0 g/L). The cumulative arsenic exposure index (CAI) was calculated and nail arsenic level was determined by using atomic absorption spectrophotometer. Systemic arterial blood pressures were measured by indirect method. The QT interval was recorded by routine 12-lead ECG, and corrected QT interval (QTc) was calculated. Ankle and brachial systolic pressures were determined by Doppler ultrasound and ankle brachial pressure index (ABPI) was calculated. The mean CAI was 1.26±0.46 mg/L-years and the median nail arsenic level was 0.09 µg/g (interquartile range, 0.065-0.195 µg/g) in the exposed group. All cardiovascular risk parameters were within normal limits in both groups. However, the estimate risk of being high normal mean blood pressure, borderline prolongation of QTc interval and borderline decrease in ABPI were 5.3, 1.3 and 2.1 times higher in the exposed group than the non-exposed group, respectively. Therefore, the arsenic- related cardiovascular risks were found to be increased relatively in people with chronic exposure to the low level of arsenic (51g/L) in drinking water.
Afternoon Session (2), Auditorium (1) Paper-15
Determination of multi-element profile in street dust
Moe Moe Han1, Nyan Htun2, Thet Naing3, Ohnmar Oo2, Tin Oo1, Myat Phone Kyaw1, Ohnmar Win2, Ni Ni Maw1 and Esther1
1Department of Medical Resarch (Lower Myanmar) 2Universities Research Centre, University of Yangon 3Department of Physics, University of Yangon
Street dust originates from the interaction of solid, liquid, and gaseous materials from different sources. The composition and quantity of heavy metals of street dust indicates environmental pollution. A total of 75 street dust samples have been collected, from five different routes of Yangon City and coded in accordance with the congestion level of traffic, size of vehicles, level of population and close proximity to industrial area. These samples were prepared along standard method for testing. All samples were subjected to analysis by Atomic Absorption Spectrometry (AAS) flame atomization technique. The presence of lead(Pb), manganese(Mn), cadmium(Cd), copper(Cu) and zinc(Zn) were determined. Among those elements, Pb was (2.805±0.537)ppm in Bayint Naung Road, (2.521±0.171)ppm in Insein Road and (7.973±0.599)ppm in Kyee Myin Daing Strand Road. Mn was (3.105±0.211)ppm in Bayint Naung Road, (2.294±0.684)ppm in Thanthumar Road, (3.522±0.670)ppm in U Wisara Road, (2.695±0.207)ppm in Insein Road and (1.535±0.409)ppm in Kyee Myin Daing Strand Road. These levels were greater than the maximum permissible limits for street dust. Such high concentration level of Pb and Mn signifies a threat to the environment. The concentration of Cd, Cu, Zn were (0.209±0.083)ppm, (0.432±0.087)ppm, (5.961±2.546)ppm in Bayint Naung Road, (0.145±0.047)ppm,
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(0.541±0.099)ppm, (4.963±0.890)ppm in Thanthumar Road, (0.137±0.038)ppm, (0.803±0.077)ppm, (3.431±0.505)ppm in U Wisara Road, (0.161±0.009)ppm, (1.263±0.275)ppm, (4.071±0.181)ppm in Insein Road and (2.485±0.578)ppm, (0.811±0.128)ppm, (3.138±0.264)ppm in Kyee Myin Daing Strand Road which were lower than the maximum permissible limits. Findings of the study point out the need for regular analysis of elements in street dust which affects on environmental pollution.
Afternoon Session (2), Auditorium (1) Paper-16
Utilization pattern of drinking water in rural households of arsenic contaminated areas and their awareness on arsenic contamination
Ye Hein Htet, Tin Nwe Htwe, Khin Moe Latt, Ohnmar Win, Tin Tin Htike, Aye Thidar Tun, Kyaw Soe, Ohnmar and Khin Thet Wai
Department of Medical Research (Lower Myanmar)
The toxic properties of arsenic have been known for centuries. The presence of arsenic in drinking water is considered as one of the most significant environmental causes of cancer in the world. The consequences of chronic arsenic exposure depend on the susceptibility, the dose and the duration of exposure. The objective of this study is to assess the utilization pattern which includes household water treatment and safe storage of drinking water in rural households of arsenic contaminated areas and their knowledge, attitudes and perception on arsenic contaminated water. A total of 236 participants from the four villages of Kyaungone Township, Ayeyarwaddy Region were involved in a cross-sectional descriptive study. The majorities (68.64%) did not have knowledge on safe drinking water such as color, turbidity, smell, taste, temperature, germs and only 30.51% knew arsenic. There was statistically significant association between education status of the respondents and knowledge of arsenic (x2 value= 25.076, p value <0.01).Total 96 water samples were taken from the participant’s well and determined by Arsenator, digital arsenic test kit. The minimum and maximum arsenic level was 0 and 178 ppb (parts per billion). Among them, 63 water samples were more than 50ppb which is Myanmar National Standard for arsenic in drinking water and the mean arsenic level was 67.46 ppb. From overall findings of this study is apparent that respondents in that area do not have adequate knowledge in household water treatment and safe storage of drinking water and knowledge on arsenic contaminated water.
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Paper Reading Session : Day 2
Morning Session (1), Auditorium (1) Paper-17
A comparative study of enzymatic method and accutrend GCT meter for determination of total cholesterol level in hypertensive patients
Thidar Oo1, Aye Aye Khin2, Khin Thike Win2 and Aye Aye Myint3
1Department of Medical Laboratory Technology, University of Medical Technology, Mandalay 2Department of Medical Laboratory Technology, University of Medical Technology, Yangon 3Department of Pathology, University of Medicine (1), Yangon
A laboratory based cross-sectional, comparative and analytical study was performed on 100 hypertensive patients above the age of 20 years from May 1, 2007 to April 30, 2008 to compare the total cholesterol (TC) levels by enzymatic method and Accutrend GCT meter. Capillary blood and venous blood samples from the same patient at Out Patient Department and all general medical wards in Yangon General Hospital were collected simultaneously. Determinations of venous blood were done by Express Plus Clinical Chemistry Analyzer within 3 hours after collection. Capillary blood samples were measured by Accutrend GCT meter. The analytical sensitivity of TC is 50 mg/dL and 150 mg/dL by enzymatic method and Accutrend GCT meter respectively. CV is 3.0% for enzymatic method and 1.1-3.8% for Accutrend GCT meter. The comparison of the results of TC levels measured with these two methods were statistically analysed by Student's 't' test. These findings revealed strong correlations, i.e., (r = 0.8107; n = 100) and (r = 0.9179; n = 96) between the two methods. In this study, 4 patients had ‘Hi’ and 9 patients had ‘Lo’ TC levels by using Accutrend GCT meter. After excluding the patients with high TC level (4 patients), the results of two methods showed no statistically significant (p = 0.15). So, this study revealed that Accutrend GCT meter can be used interchangeably with enzymatic wet chemistry and useful for self- monitoring of TC levels in hypertensive patients at home. But it cannot totally replace the well – standardized laboratory enzymatic wet chemistry method for patients with extremely high and low TC levels.
Morning Session (1), Auditorium (1) Paper-18
Study of serum oxidized LDL level and lipid profiles in hypothyroid patients before and after treatment with thyroxine
The’ Mon La, Hta Kyi Sunn and Theingi Myint
Department of Biochemistry, University of Medicine (1), Yangon
Hypothyroidism is associated with dyslipidemia and increased oxidative stress which may lead to formation of oxidized LDL (oxLDL). Circulating oxLDL is a useful
14 42nd Myanmar Health Research Congress Abstracts of the papers (Day 2)
marker for identifying patients with arthrosclerosis. Thus, aim of the present study was to compare serum oxLDL level and lipid profiles in hypothyroid patients before and after 3 months treatment with thyroxine. Hypothyroid patients were selected from Department of Nuclear Medicine, YGH (n= 27). The mean serum oxLDL level of hypothyroid patients was significantly decreased after treatment (637.24 ± 256.12 vs. 402.10 ± 260.99 ng/ml) (p < 0.01).There were significant decrease in mean levels of total cholesterol (241.48 ± 75.66 vs. 201.35 ± 56.45 mg/dl), LDL (167.65 ± 71.12 vs. 125.41 ± 55.10 mg/dl), TAG (180.56 ± 53.37 vs. 155.69 ± 34.58 mg/dl) and VLDL (36.11 ± 10.67 vs. 25.08 ± 11.02 mg/dl) after treatment (p < 0.001). Mean HDL level was significantly increased after treatment (38.71 ± 6.70 vs. 44.11 ± 4.96 mg/dl) (p <0.001). Before treatment, serum oxLDL level was positively correlated with TSH level (r=0.458, p = 0.016), TAG level (r = 0.394, p = 0.042) and inversely correlated with HDL level (r = -0.574, p = 0.002). After treatment, serum oxLDL level was inversely correlated with T3 level (r = -0.457, p = 0.016) and positively correlated with TAG level (r = 0.390, p = 0.044). It was concluded that thyroxine can reduce serum oxLDL level and lipid profiles, which are associated with increased risk of arthrosclerosis.
Morning Session (1), Auditorium (1) Paper-19
Serum leptin and estrogen levels in postmenopausal women with overweight and normal weight
Yin Yin Win, Aye Aye Yee, Aye Aye Maw, Khin Thida Wai, Thandar Myint, Sandar Aung, Naw Myat Su Mon and Thae Maung Maung
Department of Medical Research (Lower Myanmar)
Hormones are one of the contributing factors for development of obesity such as leptin, estrogen and growth hormone. They influence appetite, metabolism and body fat distribution. This study was carried out to determine the serum leptin and estrogen levels in postmenopausal women residing in Yangon. The aim of the study was to find out the correlation of body fat percentage with serum leptin and estrogen levels. A total of 64 postmenopausal women were recruited in our study including 31 normal weight women (BMI 18.5 – 24.9 kg/m2) and 33 overweight women (BMI > 25 kg/m2). Percentage of body fat was calculated by formula using BMI values. Serum leptin and estrogen levels were determined by using ELISA kits. The mean BMI was 22.4 in normal weight and 29.6 in overweight women. The mean body fat percentage was 34.2% in normal weight and 42.4% in overweight women. Serum leptin level was significantly higher in overweight than in normal weight postmenopausal women (p<0.01); (12.5+ 6.5 ng/ml vs 5.4+ 4.6 ng/ml). Serum estrogen level was not significantly different between the normal and overweight group (p>0.05); (37.0 + 1.8 pg/ml vs 37.6 + 2.6 pg/ml). Body fat percentage was positively correlated with leptin level (p<0.001) but not with estrogen level (p>0.05). It was concluded that leptin level was higher in overweight and obese than in normal weight postmenopausal women but estrogen level was not different between these groups of women. It might be due to low estrogen level in long postmenopausal duration although estrogen is one of the obesity related hormones.
15 Abstracts of the papers (Day 2) 42nd Myanmar Health Research Congress
Morning Session (1), Auditorium (1) Paper-20
Serum Tumor Necrosis Factor–Alpha (TNF-α) level and insulin resistance in obese adults
Moe Moe Khine and Theingi Myint
Department of Biochemistry, University of Medicine (1), Yangon
The prevalence of obesity is increasing dramatically and obesity is associated with insulin resistance or diabetes. Tumor necrosis factor-α is a strong candidate for a mechanism of increased adiposity and it can influence insulin sensitivity. The aim of this study was to determine the serum tumor necrosis factor-α level and insulin resistance in obese adults. Hundred obese adults (> 30 kg/m2) of both sexes (aged 21- 67 years) from Tamwe Township were selected for this study. Weight, height, waist circumference (WC), hip circumference, fasting plasma glucose (FPG), fasting serum insulin (FSI) and fasting serum TNF-α were measured in all subjects. The mean WC of the study population is 102.34 ± 8.9 cm and the mean WHR of the study population is 0.95 ± 0.07. The mean insulin resistance (IR) of the study population was 6.30 ± 5.50 and the mean serum TNF-α of the study population was 1.39 ± 1.37 pg/mL. IR was associated with obesity. The higher the body mass index, the more chance to get insulin resistance and central obesity was significantly associated with insulin resistance. Significant weak correlation was seen between WC and FPG, FSI or IR in the study population. WHR was weakly correlated with FPG in the study population. TNF-α was correlated with FPG in the study population. TNF-α was not correlated with HOMA-IR in the study population. TNF- α is one of the contributing factor for impaired glucose tolerance in obese subjects.
Morning Session (1), Auditorium (1) Paper-21
Assessment of body fat percent using the deuterium dilution technique in postmenopausal women residing in Yangon
Aye Aye Maw , Aye Aye Yee , Khin May Oo , Yin Yin Win , Khin Thida Wai , Thandar Myint , Sandar Aung , Naw Myat Su Mon and Ohnmar
Department of Medical Research (Lower Myanmar)
Overweight and obesity are major risk factors for cardiovascular diseases, type 2 diabetes and other chronic health problems. 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 was to determine the body fat percent by stable isotope using deuterium dilution method in post menopausal women 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). Three times saliva samples (pre dose and two post dose of 30g D2O) were taken from each participant. Body mass indexes (BMI) were calculated by dividing body weight in 16 42nd Myanmar Health Research Congress Abstracts of the papers (Day 2)
kilograms and the height in meter square. The study population consisted of 64 in post menopausal women age from 46 to 72 years. Thirty one post menopausal women had normal BMI (18.5 to 24.9kg/m2) and thirty three had high BMI (>25kg/m2). In the normal BMI group, the mean body fat percent was 37.17 + 4.60, which was significantly lower than that of high BMI group higher at 41.83 +3.33 (p<0.05). All postmenopausal women in high BMI group had > 30% body fat percentage but only 94% (n=29) of women in normal BMI group had > 30% body fat%. In conclusion, percentage of body fat in more than normal range even in women with normal BMI group. Therefore, the body fat percent measurement is more useful indicator than body mass index measurement in assessment of body composition.
Morning Session (1), Auditorium (1) Paper-22
Serum 25(OH) D3, calcium, phosphorus levels and bone mineral density in adult women
Ei Ei Hlaing, Khin Moe Moe Nwe and May Pyone Kyaw
Department of Biochemistry, University of Medicine, Mandalay
Vitamin D is important for bone health. Nowadays, there is a high incidence of low bone mineral density (BMD) and its associated vitamin D status among Myanmar women has needed to be elucidated. This study was aimed to determine the serum 25(OH)D3, calcium, phosphorus and BMD in adult women and the association between biochemical markers and BMD T score. A total of 120 women between 31- 60 years of age were studied for their BMD T score and concentration of serum 25(OH)D3, calcium and phosphorus. The subjects were categorized according to their age (31-40, 41-50 and 51-60 years) and by menstrual status (premenopausal and postmenopausal women). Among the three aged groups, mean serum 25(OH)D3 (108.52±40.77, 113.48±46.57, 54.57±12.66 nmol/L) and BMD T score (-1.67±0.69, -1.93±0.64, -2.74±0.76) were found to be significantly decreased in the oldest group (p<0.0001) whereas serum phosphorus was significantly increased in this group (3.81±0.47, 4.00±0.49, 4.27±0.65 mg/dl, p<0.001). Premenopausal women were found to have significant high level of serum 25(OH)D3 (113.41±43.08 vs. 56.81±15 nmol/L, p<0.0001) and BMD T score (-1.73±0.67 vs.-2.76±0.66, p<0.0001) than those of postmenopausal women. But serum phosphorus level was significantly increased in postmenopausal women (3.89±0.49 vs. 4.26±0.62 mg/dl, p<0.0001).Serum calcium level was not statistically different (p=0.062) among three different age groups as well as between pre and postmenopausal women (p=0.245). There was significant positive correlation between BMD T score and serum 25(OH)D3 level (r=0.645, p<0.05) in the whole group. Thus, it can be concluded that BMD of adult women is positively associated with their vitamin D status.
17 Abstracts of the papers (Day 2) 42nd Myanmar Health Research Congress
Morning Session (2), Auditorium (1) Paper-23
Development of a new monovalent ovine snake antivenom against Russell's viper (Daboia siamensis)
Aung Zaw1, Khin Aung Cho1, Kyi Kyi Thin2 and Mon Mon2
1No. (1) Pharmaceutical Factory (Yangon) 2University of Medicine (1)
Myanmar being an agricultural country and known to be one of the highest snake bite endemic countries in the world. In 2008, shortage of snake antivenom was occurred in Myanmar which was due to the scarcity of healthy horse for immunization. The increased demand of antivenom requirement substitution was initiated to produce new monovalent ovine snake antivenom using sheep as an alternative. Raising of sheep immune sera was produced by giving 15 days interval of intramuscular injection of Russell's viper venom (Daboia siamensis). Antivenom level was monitored on blood samples collected after 10th day of each immunization by neutralization in mice lethality test. Results showed that 61.6% of the immunized sheep (53 out of 86) attained required neutralizing potency level of (0.5mg/mL) at 35 mg venom dose level. It was found that sheep were more resistant to high dose of venom than horses. Purification of hyperimmune plasma was done by ammonium sulfate precipitation method. A comparative study on ovine and equine ASVs was performed by immunoelectrophoresis. Ovine ASV produced 3 precipitin lines less than that of equine. Efficacy of five batches of ovine snake antivenom were done by in vitro neutralization potency assay using double immunodiffusion and in vivo neutralization potency assay in mice lethality test. One mL of new ovine ASV can neutralize 1.0 mg of Russell's viper venom. Antivenom developed in sheep could also be used for treating Russell's viper bite case.
Morning Session (2), Auditorium (1) Paper-24
Preliminary dose-finding and safety study of ovine Russell’s viper antivenom in patients envenomed by Russell’s vipers (Daboia siamensis)
Han Win1, Khin Thida Thwin2, Zaw Myint1, Hnin Wai Maung3, Thi Thi Myint3 and Win Aung1
1Department of Medical Research (Lower Myanmar) 2Thingankyun Sanpya Hospital 3Research Medical Officers
The aim of this study was to determine the minimum effective and safe dose of ovine Russell’s viper antivenom (developed from sheep) in patients envenomed by Russell’s vipers (Daboia siamensis). It was conducted at Thingankyun Sanpya Hospital on Russell’s viper bite victims who fulfilled the eligibility criteria. The
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‘‘3+3’’ dose escalation design was used. Primary outcome was restoration of blood coagulability judged by 20 minute whole blood clotting test (20 WBCT) at 6 hours after the administration of antivenom. A total of 15 patients were included in the study. None of the first three patients treated with 80 ml (starting dose) showed restoration of blood clotting at 6 hours. Then, double dose (160 ml) was given to another 6 patients. Among them, restoration of clotting was observed in 4/6 patients. Same dose (160 ml) was repeated in another 6 patients and all of them (6/6) had restoration of blood coagulability. No adverse reactions (both early and late) were reported in all study patients. Ovine Russell’s viper antivenom which was manufactured by the No. (1) Pharmaceutical Factory (Yangon), Ministry of Industry was found to be safe and effective in treatment of Russell’s viper envenomation, and 160 ml would be an appropriate dose for subsequent randomized controlled trials (RCTs).
Morning Session (2), Auditorium (1) Paper-25
Immunodetection of Ki-67 labelling proliferation index in proliferative breast disease and invasive duct carcinoma of breast
Aye Myat Mon1, Aye Aye Khin1, Myat Mon2 and Khin Shwe Mar3
1Department of Medical Laboratory Technology, University of Medical Technology, Yangon 2Department of Pathology, University of Medicine (1), Yangon 3Department of Pathology, Central Women’s Hospital, Yangon
A laboratory based cross-sectional, descriptive study was performed on fifteen cases of proliferative breast disease (PBD) and fifteen cases of invasive duct carcinoma (IDC) of breast (six cases of Bloom and Richardson’s, B and R, grade II and nine cases of B and R grade III) from April, 2011 to March, 2012 to detect Ki-67 labelling index (LI) in these cases by labelled streptavidin biotin (LSAB) method. Total thirty specimens were collected from Pathology Department of Yangon General Hospital and New Yangon General Hospital. These two categories of breast disease were distinguished according to Haematoxylin and Eosin staining report. Immunohistochemical staining was performed and Ki-67 LI was recorded. LSAB method was used to get high sensitivity for Ki-67 immunoexpression which is expressed in the nucleus of the proliferating cells. Ki-67 LI were scored on a scale from 0 to 3 according to Papantoniou et al, 2004. Fifteen cases of PBD revealed Ki- 67 LI “0” and fifteen cases of IDC revealed Ki-67 LI “1” and “2” only. These finding were statistically significant at p<0.001. Most cases (83.3%) of IDC B&R grade II were Ki-67 LI “1” and most cases (88.9%) of IDC B&R grade III were Ki-67 LI “2”.Therefore a higher Ki-67 LI significantly correlated with a high grade of IDC and this study found out that Ki-67 LI was directly proportional to the B and R grading.
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Morning Session (2), Auditorium (1) Paper-26
Significance of -catenin immunoexpression in operative cases of prostatic diseases
Sann Sanda Khin1, Htein Win1, Win Khaing1, Myint Myint Yee1, Zin Node Win2, Win Pa Pa Soe2, Moh Moh Lwin2, Yi Yi Myint3 and Htun Naing Oo2
1Department of Health, Nay Pyi Taw 2Department of Medical Research (Central Myanmar), Nay Pyi Taw 3Department of Medical Research (Upper Myanmar)
-catenin is central molecule of Wnt pathway, its dysfunction is an important component of prostatic tumorigenesis and offers a variety of treatment targets. We aimed to investigate the immunohistochemical expression of -catenin and its association with clinico-histopathological parameters in operative cases of prostatic diseases, to explore more facts about pathogenesis of prostatitis to benign prostatic hyperplasia/BPH and tumorigenic nature of prostate cancers. We examined - catenin expression immunohisto-chemically in 50 cases of operative cases of prostatic diseases. Standard immuno-peroxidase method was used for immunostaining and the stained slides were examined microscopically using semiquantitative criteria. -catenin immunoreactivity was present in almost all 50 cases (100%) with different expression sites. -catenin mainly stained cell membrane in normal adjacent prostatic tissues; and the cytoplasm and cell membrane of tumor cells with low intensity in BPH and increasing trend of staining intensity in prostate cancer and additional occasional nuclear staining in few cases were noted. Thus, - catenin over expression seems to play an important role in pathogenesis of prostatic diseases especially in tumor progression of prostatic cancer. In conclusion, the over expression and functioning of -catenin in Wnt signaling pathways might be part of crosstalk between other signaling pathways in pathogenesis and progression of prostatic diseases including BPH and prostate cancers.
Morning Session (2), Auditorium (1) Paper-27
Immunohistochemical characterization of dengue antigens (NS1 and NS3) and complements in liver tissues of DSS autopsies in Myanmar
Khin Saw Aye1, Mu Mu Shwe1, Aye Aye Win1, Min Thein1, Prida Malasit2 and Scott B Halstead3
1Department of Medical Research (Lower Myanmar) 2Faculty of Medicine, Siriraj Hospital, Mahidol University, Thailand 3International Vaccine Institute (IVI), Seoul, South Korea
Dengue hemorrhagic fever and dengue shock syndrome (DHF/DSS) is one of the major arthropod borne diseases causing mortality and morbidity in children living in tropical countries. Scanty immunohistopathology data have been available on
20 42nd Myanmar Health Research Congress Abstracts of the papers (Day 2)
the characteristics and cell types in organs responsible for their roles in the pathogenesis. Autopsies of 11 children aged ranged from 3 years to 9 year who died within 1 to 8 days after admission of DHF/DSS were studied. Dengue viral serotypes were detected by RT-PCR; (2) Dengue Virus (DV) serotype-1, (1) DV-2, (7) DV-3 and (1) DV-4. Viral RNA was quantitatively detected by Real-time PCR and correlation with degree of liver damage. Both formalin-fixed and frozen tissues of liver were studied using histopathology and immunohistochemistry. In histopathology, liver showed varying degrees of hemorrhage and necrosis predominantly in midzonal and centrilobular areas. An anti-NS3 monoclonal antibody specific to non-secreting NS3 protein, indicative of virus infection and tropism was used in combination with monoclonal antibody NS1 and complements C5b-9. DENV infection occurred in hepatocytes and Kupffer cells but not in endothelial cells. No correlation between viral RNA load and the degrees of liver damage was found. A unique finding in the liver is the intense deposition of the membrane attack complex C9 on damaged liver areas. Complement pathway associated with the neoC9 highlighted that the classical pathway activation is involved in the activation of hepatocyte. Therefore, liver was the site of complement activation and consumption that might contribute to the generation of mediators of hepatocyte damage and vascular permeability.
Afternoon Session (1), Auditorium (1) Paper-28
Molecular genotyping of silent beta thalassaemia carriers among the healthy adult population in Yangon
Moh Moh Htun, Yin Min Htun, Than Than Aye, Myat Mon Oo, Than Than Swe, Khin Myo Set, Hnin Nu Htwe, Ohnmar and Hlaing Myat Thu
Department of Medical Research (Lower Myanmar)
Beta thalassaemia trait (minor) or heterozygous carrier type has one beta globin gene defect that may be clinically asymptomatic or cause slight anemia. Molecular genetic testing of the gene encoding the hemoglobin subunit beta (HBB) represents advanced method for detection of pre-symptomatic or silent beta thalassaemia carrier in at- risk family members and for prenatal diagnosis. Out of 516 healthy adults (age- 16-45years) living in Yangon Area, 103 adults have anemia (Hb<12g%). Twenty one (4%) of beta thalassaemia carriers were detected according to the results of Osmotic fragility test (OFT), HbF% and HbA2% estimation were done by High Performance Liquid Chromatography (HPLC) and hemoglobinopathies were observed by Iso-electric focusing gel electrophoresis (IEF). HBB gene mutation was detected in 52 adults (10%) by using Polymerase Chain Reaction with Single Strand Conformation Polymorphism (PCR-SSCP). The most common HBB gene mutation was CD 26G>A (HbE). The other common five genetic mutations were CD35 C>A, CD 6A>T (HbS), CD 71/72+A, CD 17A>T and IVSII 654C>T that were diagnosed as silent beta thalassaemia carriers. Molecular screening for HBB mutation is a sensitive test and easy technique to detect the silent beta thalassaemia carriers among the healthy adult population after testing of essential red blood cells parameters (Hb%, MCV, MCH, RDW) by automatic blood analyzer and morphology of red blood cell by
21 Abstracts of the papers (Day 2) 42nd Myanmar Health Research Congress
blood film examination. Screening of thalassaemia carriers and providing the proper health education in adult population are part of main strategies for prevention and control of new cases of thalassaemia major in our country.
Afternoon Session (1), Auditorium (1) Paper-29
Molecular epidemiology of dengue 1 viruses in Myanmar, 2012-2013
Theingi Win Myat1, Hlaing Myat Thu1, Saw Win2, Mo Mo Win1, Kay Thi Aye1, Khine Moe Aung1, Wenjun Liu4, John Aaskov3 and Kyaw Zin Thant1
1Department of Medical Research (Lower Myanmar) 2Yangon Children Hospital 3Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia 4Australian Army Malaria Institute, Queensland, Australia
In the year 2013, Myanmar experienced a large surge of dengue/ dengue haemorrhagic fever (DHF) cases. To determine the characteristics of the circulating strains of dengue virus, sera samples were collected from patients with a clinical diagnosis of dengue/ DHF attending the medical wards of Yangon Children Hospital. These samples were tested by Immunochromatographic Test (Panbio Dengue Duo Cassette) and dengue IgM/IgG capture ELISA (enzyme-linked immunosorbent assay) test (from Panbio, Australia) for detection of dengue infection. Of the 727 samples which tested positive for dengue, 212 (29%) were found to be primary dengue infection and 515 (71%) were secondary dengue infection. Some serologically confirmed samples 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 the immunofluorescent antibody technique. This revealed that 94% of the viruses were dengue type 1 and the rest (6%) were dengue 4 viruses, thus confirming the occurrence of dengue 1 outbreak. To further analyze these dengue 1 viruses, RNA was extracted from the virus isolates and the envelope (E) protein genes were amplified by using the reverse transcriptase polymerase chain reaction (RT-PCR) and further subjected to direct DNA sequencing. A phylogenetic tree was constructed and the DNA sequences were compared to other dengue 1 sequences from Myanmar and global strains. It revealed that the currently circulating Myanmar dengue viruses had close relationship to viruses isolated from Thailand from the year 2006 followed by China 2006 strains.
22 42nd Myanmar Health Research Congress Abstracts of the papers (Day 2)
Afternoon Session (1), Auditorium (1) Paper-30
Determination of oncogenic Human Papillomavirus (HPV) genotypes in anogenital cancers by Polymerase Chain Reaction and Restriction Fragment Length Polymorphism (PCR-RFLP)
Mu Mu Shwe1, Hlaing Myat Thu1, Khin Saw Aye1, Aye Aye Myint2, Mya Thida3, Khin Shwe Mar3, Khin Khin Oo1, Khin Sandar Aye1and Kyaw Zin Thant1
1Department of Medical Research (Lower Myanmar) 2Yangon General Hospital 3Central Women Hospital, Yangon
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% 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%). In penile cancer, HPV-16 (62.5%) was the most common genotype followed by HPV-33 (25%) and HPV-18 (12.5%). This study is 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.
Afternoon Session (1), Auditorium (1) Paper-31
Phenotypic and genotypic analysis of anti-tuberculosis drug resistance in Mycobacterium tuberculosis isolates from Myanmar
Wah Wah Aung1, Phyu Win Ei1, Wint Wint Nyunt2, Thyn Lei Swe2, Thandar Lwin2, Mi Mi Htwe1, Kyung Jun Kim3, Jong Seok Lee4 and Chulhum L Chang3
1Department of Medical Research (Lower Myanmar) 2National Tuberculosis Program, Myanmar 3Pusan National University, Yangsan Hospital, Korea 4International Tuberculosis Research Center, Korea
Tuberculosis (TB), caused by Mycobacterium tuberculosis, is one of the major public health problems in Myanmar. We determined the drug susceptibility profile 23 Abstracts of the papers (Day 2) 42nd Myanmar Health Research Congress
of 191 Mycobacterium tuberculosis strains isolated from sputum smear positive new pulmonary tuberculosis patients attending Latha TB Diagnostic Centre, Yangon Region and Mandalay Regional TB Centre, Myanmar during January to August 2013. Phenotypic drug susceptibility to rifampicin, isoniazid, ethambutol and streptomycin was performed by proportion method at National TB Reference Laboratory and Upper Myanmar TB Laboratory in Myanmar. GenoType MTBDRplus assay was carried out at Pusan National University Yangsan Hospital, Korea for genotypic detection of rifampicin and isoniazid resistance. Common mutations in the rpoB gene, katG gene and inhA gene conferring resistance to rifampicin and isoniazid among drug resistant isolates were determined. Phenotypic analysis showed that 21.46% (41/191) of tested strains were resistant to more than any of two first line drugs including 18.32% (35/191) multidrug resistant TB (MDR-TB, resistant to at least rifampicin and isoniazid) and 2.61% (5/191) monoresistant strains (resistant to one drug). Genotypic assay showed 16.75% (32/191) MDR-TB, 0.52% (1/191) rifampicin monoresistance and 5.76% (11/191) isoniazid monoresistance. The genotypic results were 87.96 % concordant with the phenotypic susceptibility. Discordant results could be explained by rifampicin and isoniazid resistance mutations being located elsewhere than rpoB 81bp hot spot region and codon of katG and inhA genes. This study revealed the anti-TB drug resistance pattern among new pulmonary TB cases and also provided the information on gene mutation patterns of drug resistant Mycobacterium tuberculosis strains from Myanmar.
Afternoon Session (1), Auditorium (1) Paper-32
Genotyping Rotavirus strains from under-five children with diarrhea, admitted to Yangon Children Hospital, 2013
Hlaing Myat Thu1, Theingi Win Myat1, Saw Win2, Khin Mar Aye1, Mo Mo Win1, Htin Lin1, Thin Thin Shwe1, Win Mar1 and Kyaw Zin Thant1
1Department of Medical Research (Lower Myanmar) 2Yangon Children Hospital
Rotavirus is one of the leading causes of diarrheal disease in infants and under five year-old children worldwide. This study involved detection and characterization of rotavirus genotypes in stool samples from children under 5 years admitted with diarrhea to the three medical wards of the Yangon Children Hospital. The stool samples were tested for the presence of rotavirus antigen by a commercial enzyme immunoassay (ProSpect TTM Rotavirus, OXOID, UK). Among 209 stool samples collected and tested from January to September 2013, rotavirus was detected in 118 cases (56%). Rotavirus diarrhea was most prevalent in the 6-11 months age group (51.7%). A sub-sample of rotavirus positive samples were selected and subjected to G and P genotyping by employing multiplex reverse transcription polymerase chain reaction (RT-PCR) using CMC (Christian Medical College, Vellore, India) primers. Of 58 samples subjected to genotyping, the most common G- genotype was found to be of G2 (27.6%) followed by G9 (24.2%), G2G10 (17.3%), G12 (8.6%), untypable (6.9%), G2G9 (5.2%), G1 (3.4%), G3 (3.4%), G8 (1.7%) and
24 42nd Myanmar Health Research Congress Abstracts of the papers (Day 2)
G2G12 (1.7%). As for P-genotypes, P[4] was the most common genotype accounting for 38% followed by untypable (29.3%), P[8] (19%), P[6] (5.2%), P[8]P[6] (3.4%), P[9](1.7%), P[4]P[6] (1.7%) and P[4]P[8] (1.7%) . The most common combination was G2P[4] and G2G10P[4] (12.1%). This combination varied remarkably from previous studies as in the years 2010 to 2012, G12P[8] was the most common combination identified. The distribution of G and P genotypes provides valuable information in the consideration of the effectiveness of rotavirus vaccination.
Afternoon Session (2), Auditorium (1) Paper-33
Long-term effect of probiotic Fekalin 80 on the liver enzyme levels of patients with chronic hepatitis C infection
Khin May Oo1, Aye Aye Lwin1, Yi Yi Kyaw1, Win Maw Tun1, Takashi Shimada2 and Shigeru Okada3
1Department of Medical Research (Lower Myanmar) 2Nichinichi Company, Japan 3Okayama University, Japan
A clinical trial was conducted on (46) adult anti-HCV positive subjects to determine the effect of a probiotic as Fekalin 80 (heat-treated Enterococcus faecalis FK-23) on the reduction of liver enzymes alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels. The ingredients of Fekalin 80 included FK-23 lactic acid bacteria powder, tan soy protein, corn starch and cellulose. Two hundred and sixty anti-HCV positive attendees of the Hepatitis Carrier Clinic, Department of Medical Research (Lower Myanmar) were screened for the study, out of which 46 participants (23 females and 23 males) who fulfilled the selection criteria and give voluntary consent were recruited. The age range of the subjects was (21 years to 60 years) with mean age of (42.73 ± 8.49) years. Each subject was given 2700mg of Fekalin 80 per day (1 packet 3 times daily) by oral route. Blood samples were taken at enrollment and at every 3 months. Among the 39 enrolled subjects, 22 had completed 36 months, 31 had completed 24 months, 35 had completed 12 months and 37 had completed 6 months of therapy. Significant decrease in mean ALT levels were observed at 3 months (34.89 ± 15.07 versus 64.84 ± 17.45 IU/L) and persisted up to 30 months (39.32 ± 21.34 versus 61.72 ± 10.41 IU/L). Decrease of AST was detected after 9 months (62.13 ± 28.11 versus 46.22 ± 21.65 IU/L) of the probiotic therapy. FK-80 preparation was well-tolerated by the subjects with no major side-effects apart from transient headache, giddiness and mild constipation in a small percentage of subjects.
25 Abstracts of the papers (Day 2) 42nd Myanmar Health Research Congress
Afternoon Session (2), Auditorium (1) Paper-34
Detection of precore promoter mutants in HBeAg negative chronic hepatitis B Myanmar Patients
Yi Yi Kyaw1, Aye Aye Win1, Hyun Kook Cho2, Win Maw Tun1, Julan Kim2, Khin May Oo3 and Jae Hun Cheong2
1Department of Medical Research (Lower Myanmar) 2Department of Molecular Biology Pusan National University 3Department of Medical Research (Retired) (Lower Myanmar)
Hepatitis B e antigen-negative chronic hepatitis B (e-CHB) has been reported in Asia. The natural course of chronic hepatitis B (CHB) virus infection is variable, and the long- term outcomes in hepatitis B e antigen (HBeAg)-negative chronic hepatitis B infection are distinct from HBeAg-positive chronic hepatitis. In Myanmar, hepatitis B virus infection along with its fatal sequelae of liver cirrhosis and hepatocellular carcinoma constitutes a public health burden of endemic proportions. However, molecular and virological factors of viral hepatitis B that contribute to the progression of liver disease were still unclear. The aims of this study were to determine the prevalence of Hepatitis B e antigen-negative chronic hepatitis B in Myanmar and to detect the precore promoter mutations in these patients. We studied 96 chronic HBV cases (79 HBeAg negative and 17 HBeAg positive) and all samples (100%) were replicative, HBV DNA by qualitative and quantitative polymerase chain reaction. All ninety six samples were subjected to sequencing to reveal core/ precore variants. Quantitative PCR showed high viral load in HBeAg negative patients. No significant increase in liver enzymes (ALT and AST) was observed in both HBeAg and anti-HBe viraemic cases. Sequencing analysis was carried out on 32 samples and multiple point mutations were detected on 8 samples. These results showed that high viral load and HBV precore promoter mutants were detected in HBeAg negative Myanmar patients and further detailed investigation should be carried out to support the management of such patients.
Afternoon Session (2), Auditorium (1) Paper-35
Seroprevalence of hepatitis B and hepatitis C among pregnant women at South Okkalapa Women and Children Hospital
Myat Tin Htwe Kyaw1, Tin Tin Htwe2, Yi Yi Kyaw1, Kyaw Oo3, Thazin Nyunt4, Win Maw Tun1 and Khin Ohnmar Lwin1
1Department of Medical Research (Lower Myanmar) 2Department of Microbiology (University of Medicine 1) 3Director (Research), Department of Medical Research (Upper Myanmar) 4Department of Obstetrics and Gynaecology, South Okkalapa Women and Children Hospital
Hepatitis B virus (HBV) infection and Hepatitis C virus (HCV) infection are major public health problems in Myanmar. The main transmission route of the HBV is
26 42nd Myanmar Health Research Congress Abstracts of the papers (Day 2)
mother to child transmission and contributes significantly to chronic HBV infection. The aims of this study were to determine the seroprevalence of hepatitis B and hepatitis C and dual HBV and HCV infection among pregnant women. This study was a cross-sectional laboratory-based descriptive study conducted at South Okkalapa Women and Children Hospital during January to October 2013. Serum samples were tested for detection of HBsAg and anti-HCV by using SD HBsAg and anti-HCV ELISA test kits. A total of 255 pregnant women were included in the study. Their overall mean age (SD) was 28.17 ± 5.6 years (age range 17 to 44 years). Of the 255 pregnant women 16 (6.3%) were tested positive for HBsAg and 3 (1.2%) were tested positive for anti-HCV. There was no dual HBV and HCV infection in the study. Statistically significant association was found between HBsAg seropositivity and trimester of pregnancy (χ2=8.118, P=0.017) and also anti-HCV seropositivity and history of miscarriage (χ2=7.473, P=0.006). This finding would suggest for the encouragement of routine screening for HBV and HCV to all pregnant women during the antenatal period, and active and passive immunization are given to all new born babies of mothers who are HBsAg positive so as to reduce and prevent the spread of infection.
Afternoon Session (2), Auditorium (1) Paper-36
Antibiotic susceptibility pattern among Helicobacter pylori isolates from chronic dyspepsia patients
Mya Mya Aye1, Thein Myint2, Moe Myint Aung2, Thuzar Myint1, Aye Aye Maw1, Haymar Win1 and Wah Wah Aung1
1Department of Medical Research (Lower Myanmar) 2Department of Gastroenterology, Yangon General Hospital
The importance of H. pylori as an etiological agent in gastroduodenal disease had suggested antibiotic treatment as a main target for the elimination of infection. A cross- sectional descriptive study was conducted from September 2012 to August 2013 to isolate the H. pylori from chronic dyspepsia patients and also to determine the drug sensitivity profile of isolated H. pylori. Two hundred gastric biopsy specimens were taken from dyspeptic patients comprising 100 gastritis cases and 40 duodenal ulcer cases and 60 gastric ulcer patients. Helicobacter pylori were isolated from 30 cases (15%), comprising 20 cases (20%) of gastritis, 6 cases (10%) of gastric ulcer and 4 cases (10%) of duodenal ulcer. Antibiotic susceptibility profile of isolated H. pylori was determined by using the Epsilometer test (E test). Nineteen (63.6%) of the isolates were resistant to clarithromycin (MICs > 256 µg/l) and all isolates were (100%) was resistant to metronidazole (MICs > 256 µg/ml). However, all isolates were sensitive to amoxicillin (MICs 0.50 µg -1.5µg) and levofloxacin (MIC 0.25 µg - 0.125 µg) respectively. 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. (MIC= Minimum Inhibitory Concentration)
27 Abstracts of the papers (Day 3) 42nd Myanmar Health Research Congress
Paper Reading Session : Day 3
Morning Session (1), Auditorium (1) Paper-37
Clinical study on efficacy and safety of artemether-lumefantrine in uncomplicated falciparum malaria in adults in Loikaw
Khin Phyu Pyar¹, Tin Maung Hlaing3, Sai Aik Hla1, Khin Zaw Oo2, Min Thu2, Ye Thwe Hlaing3, Min Lwin Oo 3 and Lay Maung Maung2
1Clinical Research Unit (Malaria) No.1 DSGH (1000 - Bedded), Mingaladon 2No. (7) Military Hospital (100 Bedded) Loikaw 3Defense Services Medical Research Centre, Nay Pyi Taw
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. 7 Military Hospital, Loikaw to evaluate the clinical and parasitological responses of uncomplicated P. falciparum infections. A total of 51 acute adult uncomplicated falciparum malaria patients were enrolled according to pre-determined criteria from August 2011 to December 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, height and weight were 30 + 9 year, 164.6 + 5.7 cm and 54.9 + 5.3 Kg respectively. Initial temperature was 38.5 + 0.6 ºC. Initial parasitaemia was 22869.84 + 32730.44 /µL. Fever clearance time was 43 ± 7.3 hours and parasite clearance time was 44.94 ± 18.41 hours. There were two cases of late treatment failure. Therefore, adequate clinical and parasitological response was 96%. Day 3 parasitaemia was 13.7%. There were no serious side effects. Artemether-lumefantrine is still safe and effective for the treatment of uncomplicated falciparum malaria in adults.
Morning Session (1), Auditorium (1) Paper-38
Renal involvement in severe malaria (Insein General Hospital, 2012-2013)
Mar Mar Kyi1, Myat Phone Kyaw2, Myat Htut Nyunt2, Tint Tint Kyi3, Kyi May Htoo4, Ne Myo Aung4, Thinzar Cho Oo4, Mi Mi Khine4 and Kyi Aye Thet4
1University of Medicine (2), Yangon 2Department of Medical Research (Lower Myanmar) 3Department of Health 4Insein General Hospital
Malaria remains the fourth leading cause of mortality in Myanmar. Previously cerebral malaria constitutes highest number of motility. There are increasing trend
28 42nd Myanmar Health Research Congress Abstracts of the papers (Day 3)
in malaria renal failure cases. A prospective analytical study was carried out in IGH from October 2012 to September 2013 to know the proportion of renal involvement in severe malaria patients and their outcome .a Total 48 patients were included (41 Male: 7 Female). Confirmed severe malaria patients (MP slide or RDT positive) for PF, PV & Mixed (PF+PV) patient were included. Blood creatinine level of >120mol/L were identified as renal involvement. Renal involvement comprises (17/48) (35.42%) of the severe malaria patient. (14/48) (29.15%) of severe malaria patients had cerebral involvement. 6 patients (12.5%) of severe malaria patients were expired. 5/6 expired patient (82%) had renal involvement and 4/6 expired patient (66%) had cerebral involvement. Renal involvement in severe malaria indicates serious complication and increases fatality. Early referral to hospital and awareness raising among patients as well as clinician will be urgently needed.
Morning Session (1), Auditorium (1) Paper-39
The role of merozoite surface protein (MSP) malaria antibody in treatment response of uncomplicated malaria in Myanmar
Khin Myo Aye1, Myat Phone Kyaw1, Khin Thet Wai1, Kay Thwe Han1, Myat Htut Nyunt1, Lu Lu Kyaw Tin Oo2, Htet Wai Oo2 and Chan Myae Hlaing2
1Department of Medical Research (Lower Myanmar) 2Medical Officer, Clinical Research Unit
Several antigens have been deemed of 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 State 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. 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 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 D0. D0 parasite count is directly correlated to the D0 band intensity of the Ab assay (R2 = 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 provide 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.
29 Abstracts of the papers (Day 3) 42nd Myanmar Health Research Congress
Morning Session (1), Auditorium (1) Paper-40
Community-based survey on knowledge and prevention of malaria in Myanmar (2012)
Zayar Lynn1, Thar Tun Kyaw2, Swe Mon Oo1, Zaw Win Thein1, Kyi Kyi Mar1, Wai Wai Myint1, Zin Mar Aye1 and Ohnmar1
1Department of Medical Research (Lower Myanmar) 2Disease Control Programme, Department of Health
While the National Malaria Control Programme has been scaling up the distribution of long lasting insecticide treated nets (LLINs), a community-based survey was carried out in 2012 (Aug-Dec) to assess knowledge and prevention practice on malaria. In total, 5342 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 25898 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 14871 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.
Morning Session (1), Auditorium (1) Paper-41
Availability and dispensing practices of anti-malaria drugs in private drug outlets of Myanmar
Thae Maung Maung1, Pattara Sanchaisuriya 3, Frank P Schelp3, Myat Phone Kyaw1, Thar Tun Kyaw2 and Ohnmar1
1Department of Medical Research (Lower Myanmar) 2Department of Health 3Khon Kaen University, Thailand
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 outlet were assessed using a face
30 42nd Myanmar Health Research Congress Abstracts of the papers (Day 3)
to face interview with structured questionnaires 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 selling 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.
Morning Session (1), Auditorium (1) Paper-42
Community-based survey on prevalence of fever and treatment seeking for malaria in Myanmar (2012)
Zayar Lynn1, Thar Tun Kyaw2, Swai Mon Oo1, Zaw Win Thein1, Lwin Lwin Ni1, Phyu Thi1, Ni Ni Htay Aung1 and Ohnmar1
1Department of Medical Research (Lower Myanmar) 2Disease Control Programme, Department of Health
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 25898 household members in 5342 households, prevalence 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 less than 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 any those history of fever was 32.1% (25.1% in less than 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 sick for the immediate blood test. The coverage of the use of blood test as the first treatment should be improved.
31 Abstracts of the papers (Day 3) 42nd Myanmar Health Research Congress
Morning Session (2), Auditorium (1) Paper-43
Molecular epidemiology of drug resistant Plasmodium vivax and therapeutic efficacy of choroquine against Plasmodium vivax in Shwe Kyin, Myanmar
Ye Htut1, Kay Thwe Han1, Eun Tae Han2, Kyin Hla Aye1 and Khin Myo Aye1
1Department of Medical Research (Lower Myanmar) 2Kangwon University, Republic of Korea
Plasmodium vivax is the second most prevalent species and reemerging health problem. Chloroquine is still first line treatment for vivax malaria in Myanmar although CQ resistant Plasmodium vivax was reported since 1998. Vivax malaria has been known for decades as uncomplicated and not severe. Reports on severe vivax malaria cases has been emerged and monitoring of chloroquine efficacy now becomes mandatory. A therapeutic efficacy study (TES) on CQ coupled with investigation on molecular epidemiology of P. vivax applying available drug resistant molecular markers was conducted on 61 vivax malaria cases in Shwe Kyin during 2012. Applying WHO guidelines for TES, CQ 10 mg/kg/day on Day 0 and Day1, and 5 mg/kg/day on day 2 was given to patients. There was no case of parasite positive on day3 after treatment. Adequate clinical and parasitological response was observed as 100% on day 28 after treatment. As regards to CQ resistant gene; pvmdr Y967F mutation was detected in 14/58 ( 24.14 %) and pvmdr F1076L mutation was found in 31/58 ( 53.45 %). Double mutant rate was 22.4% (13/58). Any of the sample did not have multiple copy of pvmdr1gene. 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.
Morning Session (2), Auditorium (1) Paper-44
Human behavioural practices on prevention of malaria in Mudon Township, Mon State
Ohnmar1, TharTun Kyaw2, Nyan Sint3, Zayar Lynn1, Zaw Win Thein1 and Swai Mon Oo1
1Department of Medical Research (Lower Myanmar) 2Disease Control Programme, Department of Health, Nay Pyi Taw 3Vector Borne Diseases Control Programme, Mon State, Department of Health
A cross-sectional survey was conducted in 141 households in Mudon Township in 2011 to find out the locally appropriate personal protective measures. 71.5% 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 5pm.
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98.6% slept before 11 pm and less than 5% slept before 7 pm. 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. 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 coil (55%) and mosquito repellent (49%) were the most preferred methods for prevention before sleep. Ninety five percent preferred the use of mosquito nets while sleeping and 92% were willing to impregnate their own clothes. Long sleeved shirts (78%), trousers (65%) and longyi (60%) were the preferred material to be impregnated for men while the proportions of acceptability to impregnate the materials were low (less than 25%) for women. 41% of household members who stayed outside the house after 5pm 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.
Morning Session (2), Auditorium (1) Paper-45
Evaluation of artemisinin resistant falciparum malaria in Shwe Kyin, Myanmar
Ye Htut1, Kay Thwe Han1, Kyin Hla Aye1, Thant Zin Aung1, Zayar Han1 and Than Naing Min2
1Department of Medical Research (Lower Myanmar) 2Shwe Kyin Township Hospital
Artemisinin derivatives are well known potent and rapid schizondicidal antimalarials since their discovery. WHO recommends all malaria endemic countries to practice ACT (artemisinin combination therapy). However decreased efficacy of ACT in falciparum malaria has been reported from Thai-Cambodia border, Thai-Myanmar border, and Southern Myanmar. In order to define the extent of artemisinin resistance with the ultimate aim to provide strategies for elimination of artemisinin resistance, a multi center randomized controlled evaluation of artemisinin resistance was carried out during 2012-2013. Shwe Kyin is one of the 13 study sites conducted in 9 countries. A total of 80 uncomplicated falciparum malaria cases were enrolled in the study. Each group comprising 40 subjects were treated with 2mg/kg/day or 4mg/kg/day oral artesunate followed by 3 day course of artemether-lumefantrine. Median parasite count in 2mg/kg/d group and 4 mg/kg/d group were 78900/ul and 65560/ul respectively. Median parasite clearance time in both groups was 42 hours and mean fever clearance time was 10 hr in 2mg group and 7 hr in 4mg group. Parasite positivity rate on Day 3was 7.5% in both groups. Therapeutic efficacy on day 42 was 100% (95% CI 89-100) in 2mg group and 100% (95% CI 87.9-100) in 4mg group. The results showed a comparable efficacy of two tested groups. The findings of the study indicated that prolonged course of currently used ACT could retain good efficacy in areas with decreased ACT efficacy.
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Morning Session (2), Auditorium (1) Paper-46
Study on protective effects of malaria antibody among the community in malaria endemic areas
Moe Kyaw Myint1, Khin Lin1, Aung Thu1, Phyu Phyu Win1, Mya Moe1, Zaw Lin2 and Kyaw Zin Thant3
1Department of Medical Research (Upper Myanmar) 2Department of Health 3Department of Medical Research (Lower Myanmar)
Malaria antibodies have been associated with transmission intensity and antibody responses are not much varied in seasonal condition. Antibody assessment is probable to provide useful epidemiology tool. This study aimed to detect prevalence of antibody in different risk areas in different seasons. Community based cross-sectional descriptive study was conducted at high risk areas and moderate risk areas during rainy and dry season in 2012-2013. Rapid diagnostic tests were used for examination of antigens and antibodies. Microscopic examinations were done. Among total 414 participants, male were 279(67.4%) and female were 135(32.6%). Mean age was 32.1±14.1 (year). Malaria antigens and antibodies (P.falciparum/P.vivax) were detected in 17.9%(74) and 19.1%(79) of participants, respectively. All antigen positive cases i.e. 74(17.9%) were microscopically tested with parasitaemia. Participants with age of 20 year and above had more prevalence of antibody than those with under 20 year age (p=0.040). Antibody prevalence was higher in participants of high risk areas(20.4%) than participants of moderate risk areas(17.6%). Variation of antibody prevalence between rainy and dry season was less than that of antigen. In high risk areas, antibody was 28.2% in rainy season and 10.4% in dry season. Antigen prevalence had much variation with 36% in rainy season compared to 5.2% in dry season. Similarly, less seasonal variation of antibody between rainy and dry season was observed in moderate risk areas. The study concluded that protective effects of malaria antibody were observed in older age and associated with transmission intensity. Therefore, antibody assessment can probably provide useful epidemiology tool as it has less seasonal variation.
Morning Session (2), Auditorium (1) Paper-47
Challenges in Universal Coverage and Utilization of Insecticide treated bed nets among the Migrant Plantation Workers in Myanmar
Myat Htut Nyunt1, Myat Phone Kyaw1, Khin Thet Wai1, Thar Tun Kyaw2, Thaung Hlaing2 and Khin Myo Aye1
1Department of Medical Research (Lower Myanmar) 2Department of Health
A cross sectional descriptive study was conducted in 170 migrant workers in palm oil plantation sites in Tanintharyi Region and 175 in rubber plantation sites in Mon State.
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The aim of the study was to explore the challenges in utilization of insecticide treated bed net (ITN) by quantitative and qualitative approach. Among them, 332(96.23%) had bed net and 284(82.32%) had ITN while 204(59.13%) had unused extra-nets. Among the ITN users, 28.9% reported the problems including insecticide smell (56.88%), dizziness (20.18%), headache (12.84%) and itchiness (9.17%). More than 75% received ITNs from health authorities and NGOs by free of charge. More than 70% wanted to buy but 64% had unaffordable. On observation, only 5 families could show no bed net but 80% showed 1-3 ITNs. However, consistent utilization was noted in 189(53.1%), that was higher in palm oil plantation than rubber plantation workers (p= 0.0001) due to the nature of the work at night. Perceived malaria risk was also significantly higher in ITN consistent user than non user (p=0.0004) and better attitude to buy ITN (p=0.0005). The effectiveness was reduced after 6 months and 2-3 times washing. They want more durable smooth nets with small holes in lace. Misuses of the ITN such as use the nets for animals and fishing, were also noted. There should be efforts to improve ITN and/or behaviour change interventions to improve net longevity and usage enforcing with continuous mass free distribution, durability monitoring and insecticide resistance of the vector.
Afternoon Session (1), Auditorium (1) Paper-48
Patients’ perspectives on HIV care and support services in selected State and Regional Hospitals of Upper Myanmar
Hla Soe Tint1, Kyaw Ko Ko Htet1, Htay Thet Mar2, Kyaw Soe2 and Myint Kyaw2
1Department of Medical Research (Upper Myanmar) 2Department of Health
A cross-sectional descriptive study using quantitative and qualitative data collection methods was conducted in Mandalay General Hospital of Mandalay Region and Larshio General Hospital of Northern Shan State from January to August, 2013 to determine the patients’ perspectives on services delivered by medico-social unit, Sexually Transmitted Infections Treatment unit and Anti-retroviral Treatment (ART) unit of HIV care and support corners. A total of 100 patients involved in face-to-face interview and 64 patients involved in Focus Group Discussions (FGDs). According to patients, HIV care and support services were received sufficiently free of charge for all registered patients irrespective of socio-demographic background. The majority (89%) of patients were convenient with clinic opening time, 42% reported the waiting time was less than one hour and 33% commented waiting time as acceptable, 65% reported duration of counselling session was adequate, all patients received patients’ records books and 90% reported that, they did not used extra-money to receive ART. In FGDs, the majority reported that they were satisfied with services. However, patients expressed that counselling services in terms of space, manpower and duration were needed to be improved. The roles of volunteers should be considered, however, they need close supervision to prevent misconducts and to ensure quality. Collaboration between National HIV/AIDS Program and Non-Government Organizations have been achieved already, however, further coordination is needed to booster the momentum as well as to avoid the duplication of efforts.
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Afternoon Session (1), Auditorium (1) Paper-49
Anti-retrovial Therapy (ART) adherence among people living with HIV (PLHIVs) in selected townships of Myanmar
Thet Tin Tun1, Kyu Kyu Than1, Kyaw Soe2, Hnin Kalayar Kyaw1, Poe Poe Aung1, May Yu Hlaing3 and Myo Thant Zin4
1Burnet Institute Myanmar 2National AIDS Programme 3Hope Full Star SHG (Saggaing) 4Paungdaw Oo SHG (Mandalay)
Adherence to Anti retroviral treatment (ART) is essential not only for the individual treatment success but also for the prevention of its partner and management of HIV/AIDS. This study access the adherence of ART (ever miss dose) and its determinants among HIV patients (PLHIVs) in selected township in Myanmar. A cross-sectional descriptive survey was conducted with 219 HIV/AIDS patients, who were on ART for over one month period in Mandalay and Sagaing Regions. Self- reported medication adherence was determined by using a pre tested structured questionnaires. Ninety- three percent of the participants said that they had never missed an ARV dose. For those who have ever missed doses, thirty-six percent said forgetting to take the medicine is the main reason for missing dose. Sixty percent of ever miss group received ART counselling less than three times. Among ever miss dose, only forty percent are involving in PLHIV self help group activities. Seventy-two percent used alarm clocks as a reminder for regular taking of ARV drugs. Twenty-four percent said husband/wife/partners and twenty percent said children are good supporter for reminding in taking ARV drugs. Forty-nine percent answered incorrectly for taking measures for miss doses after six hours. Most of the PLHIVs in this study are taking ART regularly. Forgetting to take ARVs are the common cause for missing doses and reminders devices (alarms clocks) and supporters for taking ART play an import role in good ART adherence.
Afternoon Session (1), Auditorium (1) Paper-50
Health related quality of life among people living with HIV/AIDS (PLHA) attending Sunday Empowerment Group’s activities of AFXB (Myanmar)
Ohnmar1, Than Tun Sein1 and Kathy-Shein2
1Department of Medical Research (Lower Myanmar) 2AFXB (Myanmar)
A cross-sectional survey was carried out in 2007 to assess health condition, ART use, risk sex behavior, quality of life (QOL) and its determinants among 250 PLHA and to explore their opinion and attitude towards Sunday Empowerment Group (SEG) activities of AFXB-Myanmar. QOL was measured by 31 items WHOQOL-HIV BREF. Majority were females (58%) with mean (SD) age 33.2 (6.7) years. 75.6% had
36 42nd Myanmar Health Research Congress Abstracts of the papers (Day 3)
asymptomatic normal performance skill. All were aware of ART and 58.8% were current ART users. The proportions of having sex after knowing HIV infection were 73 (69.5%) in males and 98 (67.6%) in females. None of all perceived overall health status as “very poor”. The mean (SD) QOL scores were significantly higher in males than females [all domains - 14.9 (1.7) vs. 13.4 (1.8), physical - 15.6 (2.7) vs. 13.8 (2.8), psychological - 13.3 (2.8) vs. 11.7 (2.7), independence - 15.8 (2.5) vs. 14.8 (2.5), social - 15.6 (1.8) vs. 13.9 (2.5), environment - 12.7 (2.2) vs. 11.7 (1.9), and spirituality - 16.5 (2.4) vs. 14.3 (3.1), respectively]. QOL scores slightly increased with income for both males and females. The results of multivariable analysis showed that male gender, higher educational level, lower clinical stage, and asymptomatic normal performance skills (but not the duration of being SEG member) were significantly associated with higher scores of QOL. Activities to improve quality of life of PLHA should be enhanced especially targeting female PLHA, lower educational level and poor health condition.
Afternoon Session (1), Auditorium (1) Paper-51
Management of tuberculosis in hard-to-reach area, Laukkai Township, Northern Shan State, Myanmar
Thida1, Saw Saw2, Thandar Lwin3, Kyaw Ko Ko Htet1, Nwe Nwe Kyaw1, Phyu Phyu Khaing1and Kyaw Zin Thant2
1Department of Medical Research (Upper Myanmar), 2Department of Medical Research (Lower Myanmar), 3National Tuberculosis Programme, Department of Health
This 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 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 guideline. Therefore organizing them to involve in TB control under guidance of NTP is essential.
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Afternoon Session (1), Auditorium (1) Paper-52
Assessment of general practitioners’ participation on tuberculosis management in PPM DOTS: Patients’ perspective
Thet Naing Maung1, Ohnmar2, Aung Thu3, Yu Yu Lwin1, Thyn Thyn1, Thi Thi Kyaw1, Thandar Lwin4, Tin Aye1 and Khin Swe Win1
1Myanmar Medical Association, Tuberculosis Project 2Department of Medical Research (Lower Myanmar) 3National Technical Officer, TB unit, World Health Organization (Myanmar) 4National Tuberculosis Control Programme, Department of Health
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 4th Quarter 2010 to 3rd Quarter 2011 were interviewed. Of 297 patients, 91.9% were new cases. Treatment outcome 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. 96% considered convenient about clinic opening hours. Median (IQR) waiting time at the clinic was 15 (5 to 30) minutes. 57.6% did not need to spend money for cost for visiting the clinic. Around 66% had to pay for transportation to have chest X-ray 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. 66% of respondents reported receiving information about tuberculosis from general practitioners. All stated that they received anti-TB drugs free of charge. The proportions 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 the free of charge treatment of patients was noted, however, patients had to spend money for the cost for diagnosis and travel.
Afternoon Session (1), Auditorium (1) Paper-53
Positivity of Acid fast Bacilli Culture and Drug sensitivity Pattern in children with Tuberculosis
Swe Zin Zin Aung1 and Cho Cho San2
1South Okkalapa, Women and Child Hospital 2Medical Unit (2), Yankin Children Hospital
The purpose of this study was to determine the smear and culture positivity of M, Tuberculosis in gastric aspirate samples for the diagnosis of childhood pulmonary
38 42nd Myanmar Health Research Congress Abstracts of the papers (Day 3)
tuberculosis and to determine the association between drug sensitivity pattern and AFB positivity Eighty children who had suspected tuberculosis, were assigned randomly to do gastric aspiration using a nasogastric feeding tube after 4 hours fasting. Gastric aspiration on each of three consecutive mornings was done for each child. Early morning gastric aspirates were sent for smear microscopy and mycobacterial culture to National Tuberculosis Reference Laboratory (Aung San). Gastric aspirate smear positivity was 7(8.75%) out of 80 children and gastric aspirate culture positivity was 8(10%) out of 80 children. Out of 80 children, 7 (8.75%) were positive for both gastric aspirate smear and culture 1 (1.25%) was smear negative but culture positive. All the isolates from this study were not resistant to isoniazid, rifampicin, pyrazinamide and streptomycin. The disadvantage of culture method is taking longer duration. But diagnosis is confirmed if AFB culture is positive. Therefore, gastric aspirate culture and drug sensitivity test should be done all cases of severe extra pulmonary TB and contact with adult MDR TB.
Afternoon Session (2), Auditorium (1) Paper-54
Antimicrobial susceptibility pattern of extended-spectrum beta- lactamase producing Enterobacteriaceae in urinary tract infection
Khin Thawtar Shein1, Phyu Phyu2 and Thida2
1Department of Microbiology, University of Nursing, Mandalay 2Department of Microbiology, University of Medicine, Mandalay
Extended-spectrum beta-lactamases (ESBLs) are enzymes conferring broad resistance to penicillin, cephalosporin and monobactam and which are inhibited by clavulanic acid. These enzymes are spreading among Enterobacteriaceae. The study was performed to determine the antimicrobial susceptibility of ESBL-producing Enterobacteriaceae in urinary tract infection. It was a hospital based cross- sectional descriptive study on patients with clinically diagnosed urinary tract infection with or without urinary catheter from Mandalay General Hospital during the period of January to September, 2012. Phenotypic confirmatory test for ESBL production was done by using disks containing cefotaxime and ceftazidime alone, and in combination with clavulanic acid. Antimicrobial susceptibility test was done by the disk diffusion method. From 113 urine specimens, 67 (59.3%) were culture positive and 46 (40.7%) were culture negative. Of 67 positive urine cultures, Enterobacteriaceae were identified from 60 specimens (89.6%). Among 60 isolates of Enterobacteriaceae, 31(51.7%) were confirmed as ESBLs producers. Out of 31 ESBL- producing Enterobacteriaceae, 96.7% of isolates were sensitive to imipenem, 93.5% were sensitive to amikacin, 61.3% were sensitive to cefoperazone/ sulbactum, 22.6% were sensitive to gentamicin, 16.1% were sensitive to trimethoprim- sulfamethoxazole and 3.2% were sensitive to aztreonam and totally resistant to amoxicillin/ clavulanic acid, ciprofloxacin, cefepime, ceftazidime and cefotaxime. This study showed that ESBLs production was found in about half of the isolated Enterobacteriaceae causing urinary tract infections in this region. As most of ESBL- producing isolates are resistant to many classes of antibiotic, it is important to control such strains closely in order to prevent and reduce their spread.
39 Abstracts of the papers (Day 3) 42nd Myanmar Health Research Congress
Afternoon Session (2), Auditorium (1) Paper-55
Bacteriological and drug sensitivity profile of Vibrio cholerae isolated from children with acute diarrhoea
Nan Aye Thida Oo1, Wah Wah Aung1, Mon Mon2, Than Mya1, Aye Aye Maw1 and Aye Yin Shwe1
1Department of Medical Research (Lower Myanmar) 2University of Medicine (1)
Diarrhoeal diseases constitute a leading cause of morbidity and mortality in children particularly in developing countries. Cholera, caused by Vibrio cholera, is one of the major epidemic diarrhoeal diseases. 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 E test. Of 250 samples, V. cholerae was isolated from 14 % (35/250). All isolates were Vibrio 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 g/ml. High level azithromycin resistance MIC ≥ 2 g/ml was seen in one case. The present study highlighted the occurrence of cholera among the paediatric population and determined the drug sensitivity profile of common antibiotics which are currently used for treatment of childhood cholera.
Afternoon Session (2), Auditorium (1) Paper-56
Viral etiology in infants with acute respiratory infection
Myat Mon Aye1 and Khin Nyo Thein 2
1Assistant Lecturer, Department of Paediatrics, University of Medicine II 2Professor and Head, Department of Paediatrics, University of Medicine II
This study involved 100 infants (2 months to 1 year) with acute respiratory tract infection admitted to Paediatric Units of NOGH from March 2010 to December 2010. The objectives of this study were to identify the various viral agents in
40 42nd Myanmar Health Research Congress Abstracts of the papers (Day 3)
infants with ARI, to compare the severity of ARI in different viral agents in children aged from two months to 12 months and to determine the outcome of different viral etiological agents. Nasopharyngeal swabs were taken for viral culture at National Health Laboratory which detected the influenza A, influenza B, parainfluenza type 1, parainfluenza type 2, RSV and adenovirus. Out of 100 specimens, viral culture was positive in 18 (18%) of specimens and negative in 82 (82%) of specimens. Among them, there were influenza A in 5 specimens (5%), influenza B in 7 specimens (7%), Parainfluenza 1 in 3 specimens (3%), parainfluenza 2 in 1 specimen (1%) and parainfluenza 3 in 2 specimens (2%) respectively. When the presenting symptoms of viral cases were analyzed, all these cases present with cough (100%). Fever was found in 50 to 100% of cases. Thus, cough, fever and rhinorrhoea can be regarded as the major symptoms of viral cases but in this study, non viral cases of ARI also presented with cough (100%), fever (90 %) and rhinorrhoea (80%).Fast breathing was found in 0 to 10% of cases, tightness of chest in 0-20% of cases. This study showed the various viral causes in ARI cases. There was no association between severity of ARI and different types of viruses. However, in this study RSV and adenovirus were not included due to various reasons. So further studies will be needed to find out association between severity and various viral etiology in order to support the management of acute respiratory infections.
Afternoon Session (2), Auditorium (1) Paper-57
A comparative study on conventional tube method and gel agglutination technology for detection of warm autoantibodies on red cells at national blood centre
Thu Zar Ma Ma Moe Min1, Thidar Aung2, Aye Aye Khin3, Tin Hta Nwe4 and Myint Myint Hla5
1University of Medical Technology, Mandalay 2National Blood Centre 3University of Medical Technology, Yangon 4Insein General Hospital and North Okkalapa General Hospital 5Department of Pathology, University of Medicine (1), Yangon
A laboratory based cross-sectional comparative and analytical study was performed on 41 patients suspected of autoimmune haemolytic anaemia to compare the detection of warm autoantibodies on red blood cells (RBCs) by the use of conventional tube technique (CTT) and gel or column agglutination technology (CAT) from May 1, 2007 to April 31, 2008. Blood samples at Hematology Ward and all General Medical Wards in Yangon General Hospital were collected in dipotassium ethylene diamine tetra acetic acid (EDTA) tube. All cases of hereditary haemolytic anaemia showed reactions of CTT at cold temperatures (< 37˚C) were excluded from this study. All these samples were tested for direct antiglobulin test (DAT) by CTT and CAT simultaneously at National Blood Centre. CTT was performed using polyspecific antihuman globulin serum and CAT using Ortho BioVueTM DAT/IAT cassette. The grading of the agglutination reactions of both
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techniques were shown as 4+, 3+, 2+, 1+, w+ and negative. Among 41 patients, CTT detected warm autoantibodies in 28 patients (68%) while CAT detected in 40 patients (98%). While sensitivity was 70% for CTT and 100% for CAT, specificity was 100% for both CTT and CAT. Agreement between CTT results and case status were measured by Kappa statistic. Association between categorical variable were described using χ2 test. Fisher’s test was applied where appropriate. A ‘p’ value of less than 0.05 was considered significant. Based on this study, CAT showed to be more sensitive than CTT for the detection of warm autoantibodies (IgG and/or complement) coating RBCs in vivo.
Day 3 (SRC Parallel Section)
Morning Session (1), SRC Conference Hall Paper-58
Local problem, local solution: Role of community-based organization in emergency referral for maternal, newborn and child health in Middle Island, Nga-Pu-Daw Township
Saw Saw1, Theingi Myint2, Han Lin Zaw3, Chomar Kaung Myint4, San San Aye1, Thandar Min1, Kyi Kyi Mar1 and Hla Thida Tun1
1Department of Medical Research (Lower Myanmar) 2Maternal and Child Health Section, Department of Health 3Save the Children 4University of Public Health
The operational research was conducted in six villages of Middle Island, Nga-Pu- Daw Township in 2013. It aimed to describe the role of Village Health Committee (VHC) in community-based emergency referral for maternal, newborn and child health (MNCH). Document review of registers and records from 125 villages for three years; six focus group discussions with women; twelve in-depth interviews with mothers experienced of emergency referrals and 18 key informant interviews with Basic Health Staff (BHS), key persons from VHCs, volunteers and Save the Children staff were conducted. VHCs were formed after the Cyclone Nargis with funding support from Save the Children. Most respondents highlighted that health knowledge and access to health services improved after formation of VHCs. Numbers of emergency referrals increased about five times over three years. All emergency referral cases obtained travel cost from VHC, meal cost for patient and free medical cost at the station hospital. Strong linkage and coordination among VHCs, BHS and Save the Children was observed as one of the main strengths. Most common barriers for emergency referral were variations for defining emergency; over-demand of community for referral; and attitude of BHS. Well functioning health systems plays pivotal role to gear up this community-based emergency referral. Sustainability depends on availability of funding, accountability for fund management, capacity of VHC and stewardship of VHC activities by BHS. It is suggested encouraging community contribution to emergency health fund to obtain ownership of community. The findings from this study were taken up by Department of Health and implementing partners. 42 42nd Myanmar Health Research Congress Abstracts of the papers (Day 3)
Morning Session (1), SRC Conference Hall Paper-59
Effectiveness of condom promotion programme to strengthen the utilization of condom among men having sex with men (MSM)
Hla Soe Tint1, Khin Wai1, Kyaw Soe2, Kyaw Ko Ko Htet1 and Htay Thet Mar2
1Department of Medical Research (Upper Myanmar) 2Ministry of Health, NAP programme
An interventional study was conducted with 109 MSM from Myanmar MSM network in Mandalay from 20th March 2013 to 31st December 2013 to determine the effectiveness of condom promotion program in term of increased condom utilization among MSM. The interventions included weekly sessions of 30 minutes lecture followed by peer education and group discussions, demonstrations on condom use, free condom and pamphlets distribution for four successive weeks. The sexual behaviors among MSM revealed receptive (72.6%), insertive (19.9%) and both (receptive as well as insertive) (7.5%). The sexual behaviours among MSM revealed receptive (70.7%), insertive (29.3%) and both (receptive as well as insertive) were 30 out of 109 MSM (27.5%). In the end-line compared to base-line, significant increments in condom use with self-decision (98.8%versus 57.8%) and joint decision (20.2%versus 17.4% ) were achieved in this study (p=0.000). Increment in condom utilization at the last sexual intercourse was reported at end- line compared to base-line (95.4%versus 88.1%, p=0.039). Moreover, increment in consistent condom use was also reported in the end-line compared to baseline (89.0% versus 78.0%, p=0.012). Participants’ knowledge on source of condom, preventive effective of consistent condom usage against Sexually Transmitted Diseases and HIV/AIDS were also increased in end-line (p<0.05).
Morning Session (1), SRC Conference Hall Paper-60
Bangkok high school students’ attitudes towards adolescent pregnancy and its prevention
Aung Aung Kyi1 and Khin Khin Aye2
1Faculty of Nursing Science, Assumption University, Bangkok 2Sarasas Witaed Romklao School, Bangkok
The causes and consequences of adolescent pregnancy impact everyone from family members to entire communities. This study investigated the attitudes and responses of high school students, who study in a bilingual school in Bangkok, to the issue of adolescent pregnancy. Responses were assessed on three key aspects with 21 items measuring their attitudes based on a five Likert scale namely, causes, consequences and the use of school-based adolescent pregnancy awareness education programs. Data collection required students (N=63) to complete a self-
43 Abstracts of the papers (Day 3) 42nd Myanmar Health Research Congress
administered questionnaire and the responses were analyzed by grade level and gender using both descriptive and inferential statistics. Independent sample t- tests revealed that G-11 students perceived a drop in moral values, and teenagers’ sexual behavior as leading causes of adolescent pregnancy while school dropout and early parenthood were the most serious consequences of adolescent pregnancy. However, female students perceived school dropout as the most serious consequence. Moreover, G-11 students are more likely than G-12 students to respond positively to a school- based adolescent pregnancy awareness education program. A one-way ANOVA test indicated that students aged 16 years are more likely to perceive a drop in moral values and teenagers’ sexual behavior as the most common causes of adolescent pregnancy than those aged 17 and 18 years. This independent study can be applied to designing prevention programs to reduce the incidence of adolescent pregnancy among high school students in every country.
Morning Session (1), SRC Conference Hall Paper-61
Quality of antenatal care provided by midwives in selected townships of Upper Myanmar
Hla Soe Tint1, Theingi Myint2, Kyaw Ko Ko Htet1 and Myitzu Tin Oung1
1Department of Medical Research (Upper Myanmar) 2Department of Health
A cross-sectional descriptive study was conducted in two selected townships of Upper Myanmar from 1st August 2012 to 31stJuly, 2013 to determine the quality of antenatal care (ANC) provided by midwives (MWs) at sub-centers (SCs). Study was conducted only in 10 SCs. SCs were assessed with facility audit checklist, ten midwives providing ANC were assessed through non-participatory observation, one hundred pregnant mothers participated in exit-interview and sixty pregnant mothers involved in 10 Focus Group Discussion Sessions (FGDs). . Out of ten SCs, all health facilities had their owned water supply from tube-well. Seven had toilet and only three had available electricity. The majority (64.0%) of performance of MWs on ANC was fair and 16.0% were excellent. About half of pregnant mothers received ANC at early gestation, 52% at two-month and 43% at three-month respectively. Pregnant mothers suggested in FGDs to provide adequate Clean Delivery Kits with free-of-charge or at a reasonable price and to provide adequate Home Based Maternal Records either in good quality or in low-price quality. In conclusion, the majority of MWs were providing ANC services with a certain level of quality within the limited resource setting at the rural communities. To improve the quality of ANC, it is needed to update the existing level of SCs to be well- equipped comprehensive health facilities and furnish with essential supplies to provide a quality ANC.
44 42nd Myanmar Health Research Congress Abstracts of the papers (Day 3)
Day 3 (SRC Parallel Section)
Morning Session (2), SRC Conference Hall Paper-62
Knowledge, behaviours and beliefs on cervical cancer prevention (CCP) of women at North Okkalapa General Hospital (NOGH)
Khin Su Myat Win1, Mya Thida2, Mie Mie Shwe3, Myat Theingi1 and Soe Soe3
1North Okkalapa General Hospital 2University of Medicine (1), Yangon 3University of Medicine (2), Yangon
Cervical cancer (CC) is second commonest cancer and cancer-deaths among Myanmar women. To explore knowledge, beliefs and behaviors of women on CC prevention is the aim of the study. It is a descriptive study. Women participated to be screened in two-day hand-on training on cervical cytology at North Okkalapa General Hospital (NOGH) were invited to answer pretested structured questionnaires on face-to-face interview. Out of 150 women consented, all knew about CC and stated as important health issue for women. About 83.4% knew CC as preventable one. Nearly 50% wrongly accepted as cancer if cytology is positive and they were excited to have the result. About 15% said that they do not need to repeat it if it is negative. About 80% have heard about vaccine. Nearly 50% think that further actions are not necessary to prevent CC after vaccination. Advertisement of vaccine and health talk contributed to high awareness. But only 14% can correctly answer all questions. Only 9.33% had previous cervical cytology test and no one had vaccination. Lack of knowledge regarding CCS and lack of knowledge how to access CCS sites, no free service, reluctance to expose their private parts and fear to have the positive result and pain were the reasons for low screening rate. Screen positive rate during this training program was 7.3%. Giving correct information and health education are important. A cost-effective way of CCS program is necessary for CC Prevention in Myanmar.
Morning Session (2), SRC Conference Hall Paper-63
Cervical cytology findings in women attending the Cervical Cancer Screening Clinic, Department of Medical Research (Lower Myanmar) from 2008 to 2013
Aye Aye Win, Mu Mu Shwe, Yin Min Htun, Ohnmar Kyaw, Thazin Myint, Tin Tin Han, Myat Thandar and Khin Saw Aye
Department of Medical Research (Lower Myanmar)
Cervical cancer is one of the most common female malignancies with high mortality rates in developing countries. In Myanmar, it ranks the second most frequent cancer in women and currently, Pap smear is accepted as most
45 Abstracts of the papers (Day 3) 42nd Myanmar Health Research Congress
appropriate test for cervical cancer screening. Women at high risk of cervical cancer are associated with human papilloma virus infection. Having an early age of first sexual intercourse, multiple sexual partners, sexual partner with multiple partners, other sexually transmitted infections, no or infrequent screening and tobacco use represent independent risk factors. With the aim of early detection of cervical cancer in any women having awareness of cancer cervix, cervical cancer screening clinic at DMR (LM) was established at July 2008. A total of 4191 conventional Pap smear findings of women attending the clinic from July 2008 to July 2013 were retrospectively analyzed to determine the prevalence of different cervical cytology findings. The numbers and rates of cervical cytology findings were inflammation 2014/4191(48%), normal 1834/4191(43.8%), atypical squamous lesion 177/4191(4.6%), precancerous lesions (mild, moderate and severe dyskaryosis) 143/4191 (3.4%) and cancer cervix 9/4191(0.2%). In our study, majority of Pap smears were evaluated as inflammation that pointed out vaginal infections are important that should received more attention as public health problem. The low frequency of precancerous lesion and carcinoma cervix could be due to represented cases taken only in women at low risk and not include all community. So screening program should be planned nation-wide like Pap smear testing as a routine screening at primary health care unit in order to achieve early detection and treatment of cancer.
Morning Session (2), SRC Conference Hall Paper-64
Visual Inspection with Acetic Acid (VIA) in detection of High Grade Squamous Intraepithelial Lesion (HSIL) and Cancer of Cervix in community setting
Thazin Nyunt1, Yin Yin Soe1, Mar Mar Aye2 and Hla Hla Win3
1Central Women’s Hospital, Yangon 2South Okkalapa Township Health Unit 3MCH Organization, South Okkalapa Township
Cervical cancer, an important public health issue, is the most common cancer among the women in developing countries. Aim of the study is to determine the role of visual inspection with acetic acid (VIA) in detection of high grade squamous intraepithelial lesion (HSIL) and cancer of cervix in community setting. A cross sectional community based study was conducted in 1012 ever married women aged 25- 64 years in South Okkalapa Township, Yangon, Myanmar. Both Pap smear and VIA were done. Biopsy was taken from all VIA positive patients and colposcopy was done in abnormal Pap smear patients and colposcopic directed biopsy was taken. Histology was regarded as a gold standard for diagnosis. Out of total 1012 study population, 54 women (5.34%) were VIA positive and 53 women (5.2%) had abnormal Pap results. The positive predictive value (PPV) of VIA and Pap smear were 38.89% and 50.94% respectively. Among the participants with abnormal histology results, VIA could detect 8 out of the 9 women (89%) for HSIL and two out of the 2 women (100%) with cervical cancer. The estimated prevalence of squamous intraepithelial lesion (SIL) was 2.67%, of which HSIL and cervical cancer represented 0.89% and 0.20% in this study. Regarding agreement between VIA and
46 42nd Myanmar Health Research Congress Abstracts of the papers (Day 3)
Pap smear, K value (kappa agreement) was 0.4.Therefore, the results of VIA were comparable to that of Pap smear. In resource poor setting, where cytopathological service is limited, VIA warrants consideration as an alternative to Pap smear in the detection of HSIL and invasive cervical carcinoma.
Morning Session (2), SRC Conference Hall Paper-65
Safety and effectiveness of intravenous glyceryl trinitrate in retained placenta
Myint Myint Aye1 and Khin Htar Yi 2
1Department of Obstetrics and Gynaecology, University of Medicine, Magway 2Department of Obstetrics and Gynaecology, University of Medicine (2), Yangon
This was a hospital based randomized placebo control trial in obstetric ward of 1000-Bedded General Hospital, Naypyitaw and Central Women's Hospital, Mandalay. The aim was to assess the safety and effectiveness of intravenous glyceryl trinitrate (GTN) in management of retained placenta. Altogether 40 women with retained placenta were studied (from January 2011 to August 2012). In present study, either 50µg of intravenous glyceryl trinitrate or normal saline (0.5 mL) was administered to treatment group or placebo group. Within 10 minutes after intravenous GTN, placenta was successfully delivered in 13 patients (65%). The duration of mean injection-placenta delivery interval was 6.92 ± 1.93 minutes. The remaining 7 patients (35%) required manual removal of placenta under general anaesthesia. Maximum haemodynamic changes (i.e. fall of mean systolic and diastolic blood pressure and compensatory rise of pulse) were observed at 3minutes after injection of GTN and returned to its pre-treatment levels at the end of the procedure. Although higher success rate was seen in treatment group than placebo group (65% versus 55%) , it was 1.38 times more likely to be blood transfused after administration of intravenous GTN than placebo group. However, there was no statistically significant difference (p = 0.3110) in requirements of blood transfusion between two groups. At present study, intravenous GTN in management of retained placenta revealed minor increase (10%) in success rate of placenta delivery comparing placebo arm. However, the use of intravenous GTN (50 µg) in retained placenta with haemodynamically stable cases was found to be safe.
47 Abstracts of the papers (Day 4) 42nd Myanmar Health Research Congress
Paper Reading Session : Day 4
Morning Session (1), Auditorium (1) Paper-66
Formulation development and comparison of the bioavailability of formulated tablet prepared by wet granulation method with the market sample
Wai Wai Lwin1, San San Nwe2, Cho Yi Myint1, May Aye Than3 and Myo Myint4
1University of Pharmacy (Mandalay) 2University of Pharmacy (Yangon) 3Department of Medical Research (Lower Myanmar) 4Central Research and Development Centre
Hypertension has become increasingly devastated disease in public health. It is necessary to manufacture locally the well-qualified antihypertensive drugs with reasonable price. To achieve the effective therapeutic outcomes not only drug product quality but also good bioavailability is critical. The present study was highlighted the formulation development and to compare the in-vitro dissolution test and in-vivo bioavailability between the formulated losartan film coated tablet (25 mg) and the registered market sample. The different formulations prepared by wet granulation method were tested by pharmacopoeial test including in-vitro dissolution test using USP paddle type dissolution test. The optimized drug was compared with the market sample for bioavailability in six rabbits after single oral dose in randomized cross-over study. Both drugs were administered to fasting rabbits. Blood samples were collected at specified time intervals. The plasma losartan concentrations were determined using High Performance Liquid Chromatography (HPLC). The study was based on the assessment of plasma drug concentration in relation with time. The Cmax, Tmax and AUC(Area Under Curve) of the formulated tablets were 1.745 ± 0.7807 µg/mL, 3 ± 0.894 hr, and 3.64 ± 1.33 µg/mL/hr and that of the market sample were 2.5733 ± 1.1543 µg/mL, 1.83 ± 0.40 hr, 5.36 ± 2.64 µg/mL.hr respectively. The overall pharmacokinetics data of the two preparations were not significantly different in Cmax (p = 0.225) and AUC (p = 0.2348). On cost estimation, the formulated tablet has more reasonable price. Therefore, the formulated drug may be useful for local manufacturing of losartan potassium film coated tablets.
Morning Session (1), Auditorium (1) Paper-67
Study on the five different manufacturing (production) methods of solid dosage form of tablets using Allopurinol as an active ingredient
Zabei Phyu1, Myo Myint2, Myint Oo2 and Thein Mi3
1No.(1) Pharmaceutical Factory (Yangon) 2Central Research and Development Centre 3University of Pharmacy (Yangon)
The main aim of this study was to access five different manufacturing methods of solid dosage form of tablets using allopurinol BP powder as an active ingredient.
48 42nd Myanmar Health Research Congress Abstracts of the papers (Day 4)
Allopurinol tablets (100 mg) were manufactured by using wet granulation (kneading), wet granulation (fluid bed), dry granulation, direct compression and film coating methods. In addition, two brands of allopurinol tablets (market samples) were selected to compare the characters and qualities with the tablets prepared by different methods. Moreover, the prediction of shelf-life for allopurinol tablets of different manufacturing methods was determined by using accelerated chemical stability test. In this research, experimental laboratory based design and multiple comparison test were used. The physicochemical properties of dried granules and tablets produced by different manufacturing methods were complied with BP standards. Thereafter, shelf-life of tablets produced by different manufacturing methods had been predicted by application of Arrhenius equation and it was found that film coating tablet had the longest shelf-life 4.5 years because the protective coating prevents the drug from its surrounded environment. In plain tablets, dry granulation methods provided longest shelf-life 3.8 years while the shelf-life of wet granulation kneading, spray and direct compression had 3 years, 3.2 years and 3.4 years respectively. The disintegration time, dissolution percentage and shelf-life of tablets produced by dry granulation methods were always better than other methods. Moreover, processing steps, time consumed and costs were more economical than other methods. Therefore, if the machine is available for making precompression, allopurinol tablet should be manufactured by using dry granulation method.
Morning Session (1), Auditorium (1) Paper-68
Bioequivalence study of metronidazole tablets in Myanmar healthy volunteers
Yi Yi Htun1, Moh Moh Kyi2, Khin Win Sein3 and Nu Nu Aye4
1University of Nursing, Mandalay 3University of Medicine, Magway 2,4University of Medicine, Mandalay
The use of generic drugs, which are safe, effective and lower cost alternatives to innovator, has been steadily increasing internationally. Metronidazole, one of the essential medicines, is widely used as an anti-protozoal and antibacterial drug. This study was performed to compare the bioavailability of generic metronidazole with that of innovator by using serum concentration for determining bioequivalence between them. Bioequivalence of generic and innovator metronidazole were assessed by single dose pharmacokinetic study in fourteen healthy human volunteers by using bioavailability parameters, such as peak serum drug concentration (Cmax), time to reach this concentration (Tmax) and area under the serum drug concentration curve (AUC). A randomized, crossover design with one-week washout period under fasting conditions was performed. Blood samples were taken up to 24 hour after drug administration and serum concentrations were determined by UV-Vis spectrophotometer. Bioavailability parameters were analyzed by WinNonlin version 6.3. AUC(0-24 hr) were 92.96 6.41 versus 89.43 5.08 µg hr/mL, Cmax were 11.46 1.72 versus 9.88 0.93 µg/mL and Tmax were 2.0 versus 1.5 hours for generic and innovator metronidazole, respectively. The 90% confidence intervals for the generic to innovator ratio of mean AUC(0-24 hr) and Cmax were 0. 96 (0.92 - 1.01) and 0.87
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(0.82 - 0.92), respectively, and they were within the accepted bioequivalent range of 0.8 – 1.25 prescribed in ASEAN guideline. Therefore generic metronidazole was bioequivalent to that of innovator and can be used cost effectively and interchangeably because it has similar efficacy and considerably less expensive.
Morning Session (1), Auditorium (1) Paper-69
Pharmaceutical equivalence and quality assurance of different types of quinolone antimicrobials available in Myanmar
Moe Moe Aye, Khin Chit, Min Wun, Nyi Nyi Win Kyi Kyi Myint, Thiri Aung, Swe Swe Aung and Khin Moe Lat
Department of Medical Research (Lower 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. Quinolones 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 different brands of quinolones including ciprofloxacin(18), norfloxacin (16), levofloxacin (8) and ofloxacin (6) brands were done. They were purchased by mystery clients from New Bogyoke market and Shwepyaesone market in Yangon. All were coded and standard quality assurance tests were done according to USP (United States Pharmacopeia) and BP (British Pharmacopeia). Qualitative analysis in uniformity of weight and disintegration in all brands of levofloxacin, ofloxacin and ciprofloxacin are within acceptable range but (2 brands, 12.5%) of norfloxacin were failed. Regarding dissolution test, all brands of levofloxacin, norfloxacin and ofloxacin were passed and (1brand, 5.5%) of ciprofloxacin was failed. Quantitative assay of active compound showed (7 brands, 43.75%) of norfloxacin, (5 brands, 27.7%) of Ciprofloxacin and (3 brands, 37.5%) of levofloxacin failed. The finding indicated the existence of substandard drugs in market 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.
Morning Session (1), Auditorium (1) Paper-70
Formulation and manufacturing technology of chewable tablets using ascorbic acid as an active ingredient
Myint Zu Aye1, Myo Myint2, Myint Hla2 and MyintOo2
1University of Pharmacy (Yangon) 2Central Research and Development Centre
The aim of this study was to study on formulation and manufacturing technology of chewable tablets using ascorbic acid as an active ingredient. Vitamin C is widely used
50 42nd Myanmar Health Research Congress Abstracts of the papers (Day 4)
in prevention of scurvy and as a vitamin C supplement. In order to find out the technology of chewable tablet formulation, each three formulations of chewable vitamin C tablets were prepared by laboratory based design by using two wet granulation methods namely kneading method and fluidised bed method. During granulation, in- process granulation tests were performed and their physicochemical properties were analysed carefully. During and after tabletting, they were evaluated according to the methods described in the British Pharmacopoeia. Moreover, the physicochemical properties of tablets from each formulation were analysed statistically and compared with each other. They all are not statistically different. After that, tablets from the best one formulation from each method and the other chewable vitamin C tablets from local market were subjected to the accelerated stability test at elevated temperatures for specified time intervals. Degradation of content of ascorbic acid in tablets was determined during stability tests. It was observed that the content of ascorbic acid in tablets decreased with the rise in temperature and prolonged periods. Thereafter, the shelf-life of tablets had been predicted by application of Arrhenius equations and it was found that the shelf-life of formulated tablets was 1 year and 9 months. Moreover, the finding represented that formulation of chewable vitamin C tablets prepared by fluidised bed method was more applicable than kneading method.
Morning Session (2), Auditorium (1) Paper-71
Evaluation of pharmacokinetics and pharmacodynamics of levofloxacin in patients with acute exacerbation of chronic obstructive pulmonary disease
Khin Hnin Pwint1, Mar Mar Kyi2, Khin Chit1, Yamin Ko Ko1, Phyu Phyu Aye1, Phyo Wai Aung1, Mya Mya Moe1, Thin Thin Hlaing1 and Thinzar Myo1
1Department of Medical Research (Lower Myanmar) 2Department of Medicine, University of Medicine (2), Yangon
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/ pharmacodynamic (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 pharmacokinetics 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 indicating interchangeability of the route of administration of levofloxacin. Pathogens isolated were Klebsiella sp. (20%), Escherichia coli (10%), Haemophilus influenzae (10%), Staphylococcus aureus (5%), Streptococcus pneumoniae (5%) and Pseudomonas sp. (5%). Although the resulted PK/PD indices were
51 Abstracts of the papers (Day 4) 42nd Myanmar Health Research Congress
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 optimizing antimicrobial therapies in various infections for prevention and reduction of antimicrobial resistance problem in Myanmar.
Morning Session (2), Auditorium (1) Paper-72
Bioefficacy of Cassia fistula Linn.(Ngu) Leaf extract against the Dengue vector Aedes aegypti under laboratory condition
Naw Hnin Myint, Yi Yi Mya, Mya Nilar Chaw Su, Tun Tun Win, Thin May Tun, Si Si Aung, Than Than Htwe, Ei Ei Htway and Kyaw Oo
Department of Medical Research (Upper Myanmar)
Mosquitoes are responsible for spread of many diseases than any other group of arthropods. Diseases such as malaria, filariasis, dengue haemorrhagic fever and chikunguinya are real threat to mankind. Various plant-based products are safe and biodegradable alternatives to synthetic chemicals for use against mosquitoes. This study was evaluated larvicidal and repellent activities of Cassia fistula Linn. crude leaf methanol extract against Aedes aegypti under laboratory situation. The Cassia fistula Linn. leaves were collected from Sitha village in Pyin Oo Lwin township and the leaves were shade-dried, powdered and extracted by using methanol. Twenty five late third and early fourth instar of Aedes aegypti were exposed to various concentrations and the larval mortality was observed after 24hours exposure. The repellent efficacy was determined against Aedes aegypti at 1.0, 2.5 and 5.0 mg/cm2 concentration of methanol extract of Cassia fistula Linn.leaves. Each test concentration was repeated to six times in each experiment. Result indicated that LC50 and LC90 values were 25.81 mg/l and 54.29 mg/l respectively. In the skin repellent test, gave 100% protection up to 60, 90 and 180 mins respectively. The leaf extract of this plant was showed the larvicidal and repellent properties. From the present study Cassia fistula Linn. leaves may serve as botanical insecticide for control of dengue vector Ae. aegypti.
Morning Session (2), Auditorium (1) Paper-73
Comparative study of heavy metals in selected medicinal plants and soils from different sites
Khin Phyu Phyu1, Khin Mi Mi Lay1, Lei Lei Win1, Mya Malar1,Saw Ohnmar Khin1, Kyawt Kyawt Khaing1, Kyi San1, Aung Thura1 and Kyaw Zin Thant2
1Department of Medical Research (Upper Myanmar) 2Department of Medical Research (Lower Myanmar)
Medicinal plants play vital role in healthcare sector for developing nation and potent source of therapeutic molecules to heal various diseases in the world.
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World Health Organization estimated about 75-80% of the world’s population use plant-based medicines. The purpose of the current study was to determine various indigenous medicinal plants for heavy metals contamination and to make awareness among the public regarding its safer use and collection areas, containing high level of heavy metals and their adverse health effects. The atomic absorption spectrophotometer was employed for estimation of heavy metals of four different plant species that were collected from different locations in Mandalay region. The content of (Cd, Cr, Cu, Fe, Pb and Zn) in Andrographis paniculata, Eclipta alba, Curcuma longa and Alternanthera pungens and their soils in which they grown were selected for their analysis. Most of the selected medicinal plants and all soils from Mandalay region contained the metals which are within permissible limit and they are generally safe for use. In few cases; Eclipta alba from Department of Medical Research (Upper Myanmar) contains Cd (0.46 ± 0.04 ppm) and Cr (8.1 ± 0.64 ppm) which is above permissible limit. And also, Alternanthera pungens from Chan-Aye-Tharzan Township and Amarapura contain more Zn than permissible limit (29.71 ± 5.57 ppm and 33.29 ± 2.29 ppm respectively). All plants contain high amount of Fe than permissible limit set by FAO/WHO (1984) in edible plants (20 mg/kg). Consumption of these plants as drugs may constitute possible health hazards to consumers at the time of the sample collection site.
Morning Session (2), Auditorium (1) Paper-74
Antihypertensive effect of Millingtonia hortensis Linn.f. leaves (Aykayit) on stage 1 hypertensive patients
Khine Khine Lwin1, May Aye Than1, Thein Kyaw2, Tin Tin Htay3, Ko Ko Zaw1, Khin Taryar Myint1, Nu Nu Win1 and Win Win Maw1
1Department of Medical Research (Lower Myanmar) 2University of Traditional Medicine (Mandalay) 3Traditional Medicine Hospital, Yangon, Department of Traditional Medicine
This study was done to determine the antihypertensive effect of Millingtonia hortensis Linn.f. dried leave powder tablet on 16 (Stage 1) hypertensive patients attending the Outpatient Department of Traditional Medicine Hospital, Yangon. Study design is open type (Single arm) study. After wash out period of 3 days, the patients were treated orally with dried leaves powder tablet (500 mg), 3 g with three times daily for 4 weeks. Blood pressure was monitored at 0hr, 0.5 hr and hourly up to 6 hr after the first dose of the trial drug. Monitoring of blood pressure and vital signs were done on day 1, day 2, day 3 and 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) and ECG were done before and at the end of the study. It was found that significant reduction of the mean supine blood pressure from baseline level was from 1 hr to 3 hr after the first dose of the trial. At the end of the trial , significant reductions in the mean supine systolic and diastolic blood pressures were found from 144.69± 5.62 mmHg (baseline) to 130.94±8.21 mmHg (P<0.001) and 97.19±
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6.82 mmHg (base line) to 87.38 ±5.56 mmHg (P<0.001) respectively. The results of laboratory investigations were within the reference normal ranges. No side effects were observed. In conclusion, this drug possessed significant antihypertensive effect on stage 1 hypertensive patients with no side effects.
Morning Session (2), Auditorium (1) Paper-75
Detection of tricothecenes (T-2) mycotoxin in selected preparations of peanut
Lai Lai San, Thaung Hla, Tin Tin Htwe, May Than Htay, Zin Me Thein, Wai Lwin Oo, Nilar and Myo Myo Kyaw
Department of Medical Research (Lower Myanmar)
Tricothecene (T-2 toxin) is produced by the species of Fusarium genus i.e. Fusarium acuminatum, Fusarium poae and Fusarium sporotrichioides and is one of the most deadly toxins. It could inhibit the synthesis of DNA and RNA both in vivo. The study of the existence of tricothecenes (T-2) mycotoxin in selected preparations of peanut was conducted from September 2012 to August 2013. It was the cross-sectional laboratory based analytical study. Eight different varieties of peanut preparations such as (1)raw peanut with pod, (2)raw peanut without pod, (3)boiled peanut, (4)fried peanut, (5)roasted peanut, (6)peanut brittle, (7)peanut butter and (8)fermented peanut were included in this study. The samples were collected from five different sources. Total 40 samples (five for each preparation) were tested by using T-2 ELISA test kit (Agra Quant) and Elisa reader (Awareness Technology). Tricothecenes (T-2) level between 75-150 ppb (the minimum detected amount) was found in 2 roasted peanut, 3 raw peanut without pod and 2 fried peanut samples. Tricothecenes (T-2) mycotoxin level ranging from 300 to 500ppb (the maximum detected amount) was observed in one sample of fermented peanut. The permissible level of T-2 mycotoxin for pig and poultry in Canada is less than 1000ppb. Although the maximum permissible level for human has not yet been determined, it should not be contaminated in human food at all. This study provides awareness of the contamination of T-2 mycotoxin in some preparations of peanut which is traditional Myanmar popular snack.
Afternoon Session (1), Auditorium (1) Paper-76
Effect of maternal oral hydration on amniotic fluid index(AFI)
Thwe Thwe Thinzar¹ and Khin Htar Yi²
¹300 Bedded Teaching Hospital, Mandalay ²Department of Obstetrics and Gynaecology, University of Medicine (2), Yangon
A randomized clinical trial was conducted in Central Women’s Hospital, Mandalay from January to December, 2011 aiming to determine the effect of maternal oral hydration on AFI. Forty pregnant women at 37-40 weeks gestation with AFI- (6 to 9cm) were randomized into hydration and non hydration groups. Pregnant women in 54 42nd Myanmar Health Research Congress Abstracts of the papers (Day 4)
hydration group were instructed to drink 2 L of water over 2 hours and then continued drinking it (in addition to usual fluid intake) daily for one week. Those in non hydration group were instructed to drink usual intake of fluid. AFI values were evaluated by measuring it at 0 hour, 4 hours and 1week later. Four hours later, mean AFI was significantly increased in hydration group [7.2cm(1.105) vs 8.6cm(1.391), p=0.00)] but it was not statistically different in non hydration group [7.5cm(±1.10) vs 7.67cm(±0.945), p=0.18]. After one week of hydration, mean AFI was increased in hydration group [7.2cm(1.105) vs 8.75cm(1.750), p=0.000]. But mean AFI was significantly decreased in non hydration group [7.5cm(1.10) vs 6.55cm(2.06), p=0.03]. Increased mean AFI value (4 hours over 0 hour) was significantly higher in hydration group than that of non hydration group [+1.4cm(1.14) vs +0.17cm(±0.81), p=0.0004]. Increased mean AFI value (1week over 0 hour) was also higher in hydration group than that of non hydration group [+1.55cm(1.464) vs -0.95cm(±2.211), p=0.0002]. AFI values were statistically increased in hydration group after acute and one week of oral hydration. Therefore, maternal oral hydration was found to be an effective way of increasing AFI.
Afternoon Session (1), Auditorium (1) Paper-77
Diagnostic accuracy of transvaginal sonography versus saline infusion sonohysterography in abnormal uterine bleeding
Thin Thin Myat1and Khin Htar Yi2
1Department of Obstetrics and Gynaecology, University of Medicine, Mandalay 2Department of Obstetrics and Gynaecology, University of Medicine (2), Yangon
This study was cross sectional comparative study to compare the diagnostic accuracy of transvaginal sonography (TVS) and saline infusion sonohysterography (SIS) in detection of endometrial cavity lesions in abnormal uterine bleeding. Seventy three perimenopausal and postmenopausal patients with abnormal uterine bleeding who were admitted to Central Women’s Hospital, Mandalay from 1st January 2011 to 31st August 2012 were studied. All cases were examined with TVS and further investigated with SIS using saline as contrast medium, finally hysteroscopy and histopathology was used as the gold standard. In detecting normal endometrial cavity, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of TVS were 78.3%, 55.0%, 80.0% and 52.4% whereas SIS had 97.7%, 75.0%, 89.6% and 93.8% respectively. The diagnostic accuracy of SIS and TVS were 90.6 % and 71.2% (p = 0.004). Regarding detection of endometrial polyp, sensitivity, specificity, PPV and NPV of TVS were 33.3%, 96.3%, 66.7% and 86.7% whereas SIS had 91.7%, 96.2%, 84.6% and 98% respectively. Diagnostic accuracy of SIS and TVS to detect endometrial polyp were 95.3% and 84.8% (p = 0.04). Diagnostic accuracy of SIS to detect submucosal myoma was 100% whereas TVS had 97.0% (p = 0.153). Ninety eight percent of patients could tolerate SIS procedure. Only 1.4% of patients had vagal symptoms with Faces pain score of “5”. Most of the patients (95.9%) had no procedure related adverse effects. In conclusion, diagnostic accuracy of SIS was more accurate than TVS in detection of endometrial cavity lesions.
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Afternoon Session (1), Auditorium (1) Paper-78
Complications of hysterectomy for benign gynaecological conditions in Central Women’s Hospital, Yangon
Thu Thu Win Lwin1, Phyu Phyu Thein1 and Yin Yin Soe2
1Central Women’s Hospital, Yangon 2Department of Obstetrics and Gynaecology, University of Medicine(1), Yangon
A hospital based descriptive study on 300 patients who had hysterectomy for benign gynaecological conditions over one year period from July 2009 to June 2010 was carried out in Central Women’s hospital, Yangon. The aim is to determine the types and incidence of complications in hysterectomy for benign gynaecological conditions and to identify the risk factors which predispose to post-operative complications. In this study, total abdominal hysterectomy and bilateral salpingo- oopherectomy (TAH and BSO) was done in 174 cases (58%). TAH was done in 88 patients (29.3%). TAH and unilateral salpingo-oopherectomy was 16 cases (5.3%). Vaginal hysterectomy (VH) and repairs were 21 cases (7.0%). Only one patient (0.3%) was undergone subtotal hysterectomy. Complications occurred in 38 patients (12.7%). Among 38 patients, 19 cases of post-operative pyrexia, 8 cases of wound sepsis, 8 cases of chest infection, 4 cases of urinary tract infection, 4 cases of septicaemia and one case of bowel injury during operation were found. The commonest complication occurring in this study was post-operative pyrexia (6.3%). The statistically significant factors that predispose to post-operative complications were age groups (≥60 years), body mass index (≥25), preoperative anaemia, concurrent disease, levels of surgeon, types of hysterectomy (VH and repairs), duration of operation (>120mins), duration of catheterization (>24hours) and blood transfusion. Based on the clinical relevance of these findings, possible ways to reduce the post-operative complications in hysterectomy for benign gynaecological conditions by improving the preoperative, intraoperative and postoperative care and improving surgical equipments and techniques have been discussed.
Afternoon Session (1), Auditorium (1) Paper-79
Correlation between maximal pool depth of the amniotic fluid and fetal outcome in postdate pregnant women
Beauty Tun1, Aye Aung2 and Khin Lay Kywe3
1West Yangon General Hospital, Yangon 2North Okkalarpa General Hospital, Yangon 3Central Women's Hospital, Yangon
Post date pregnancy is a common problem in daily practice and increases the risks of adverse pregnancy outcome. This study aimed at determining the correlation between the maximal pool depth of amniotic fluid and fetal outcome in post date pregnancy. This is a descriptive study of maximal pool depth of amniotic fluid
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volume and fetal outcome in post date pregnancy in Central Women's Hospital, Yangon. A year study period from September 2009 to August 2010. Maximal vertical pool depth (MPD) assessment were performed in 135 patients. All the patients (13 patients) with gestational age 42+ weeks were associated with oligohydramnios. Thirty four cases (72.3%) of oligohydramnios group were associated with G III meconium stained amniotic fluid. The results found that there is association between MPD value and gestational age. The later the gestation, the more increase the chance of becoming oligohydramnios. The lesser the liquor amount, the higher the grade of meconium staining of liquor. Eight cases (17.0%) of oligohydramnios group had Apgar score < 4 at 1 min and Apgar score < 7 at 5 min was found in 21 cases of oligohydramnios group. Seventeen cases (36.2%) of oligohydramnios group required advanced neonatal resuscitation and twenty one cases (44.7%) were admitted to SCBU with total hospital stay less than 7 days. The evidence from this study indicates that the maximal pool depth of amniotic fluid volume in postdate pregnancy is significantly correlated with gestational age, thick meconium stained liquor, Apgar score, requirement for neonatal resuscitation, and admission to neonatal care unit.
Afternoon Session (1), Auditorium (1) Paper-80
Correlation between admission cardiotocography and fetal outcome of high risk obstetric patients
Nan Pan Pa Pa Htay1, Thin Thin Aung2 and Khin Lay Kywe2
1West Yangon General Hospital 2Central Women’s Hospital, Yangon
Cardiotocography (CTG) is a method of electronic fetal monitoring for examining the condition of a baby in the uterus by noting any unusual heart rate changes. To predict the neonatal outcome in high risk obstetric cases by admission CTG testing is the aim of this study. This is a prospective study conducted in the Central Women’s Hospital (Yangon) during a year period from June 2009 to May 2010. A total of 142 consecutive high risk obstetric patients who were eligible and consented, were tested with admission CTG. The CTG tracing was categorized as normal, suspicious and abnormal according to Royal College of Obstetricians and Gynaecologists (RCOG) criteria. Neonatal outcome measures such as 5 minutes Apgar score and requirement of admission to Special Care Baby Unit (SCBU) for neonatal asphyxia were studied and correlated with the admission CTG testing. Apgar score ≤ 7 at 5 minutes in normal, suspicious and abnormal CTG were 2%, 9.4% and 50% respectively. The admission CTG had sensitivity of 54.5%, specificity of 95.4% and positive predictive value of 50% for predicting an Apgar score ≤ 7 at birth. Sensitivity, specificity and positive predictive value of admission test for admission to SCBU were 28%, 95.7% and 58.3% respectively. There were 1 perinatal death in the suspicious CTG and 4 periantal death in the abnormal CTG group. The result of admission cardiotocography testing could be used to identify patients likely to develop adverse fetal outcomes and help in optimal utilization of labour room resources.
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Afternoon Session (1), Auditorium (1) Paper-81
Comparative study on pregnancy outcomes of pregnant women without standard antenatal care to pregnant women with standard antenatal care
Win Mya Kyay Mone Win1, Aye Aye Tint1 and Win Win Mya2
1Central Women’s Hospital, Yangon 2Department of Obstetrics and Gynaecology, University of Mrdicine (1), Yangon
The aim of this study was to compare pregnancy outcomes in pregnant women with standard antenatal care and without standard antenatal care. This was a hospital based prospective study of 192 cases admitted to Central Women's Hospital, Yangon, during 1st May 2008 to 30th April 2009. The patients were randomly selected, 96 patients for each group. Standard antenatal care in this study was defined as at least four antenatal visits according to new WHO antenatal care model. In the study, unemployment, low education levels, financial problems and lack of knowledge were mostly found among women with substandard care. Among the women with substandard antenatal care, more than half (56.3%) decided to deliver at home where it was none in other group. APH, PPROM, preterm labour, urgent LSCS, retained placenta, PPH and prolonged hospital stay were more common in women with substandard care. Adversed neonatal outcomes were also more common in women with substandard care significantly (P<0.001). There were 14 SB cases and 6 END cases all from substandard care group. Most of babies who needed to admit to SCBU were from substandard care group. This study revealed that poor utilization of antenatal care was associated with increased maternal and perinatal morbidity and mortality and therefore the standard antenatal care is essentially required for good pregnancy outcomes.
Afternoon Session (2), Auditorium (1) Paper-82
Improvement in knowledge, perception and practice of men in maternal and child health at South Dagon Township
Myo Myo Mon1, Kyu Kyu Than2, Aye Aye Myint2, May May Khin2,Wai Wai Myint1, Pyone Thuzar Nge1, Zin Mar Aye1, Aung Soe Min1and Phyu Thi1
1Department of Medical Research (Lower Myanmar) 2Burnet Institute, Myanmar
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
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applied to compare between baseline and end-line. Total of 214 men included in the quantitative survey. Mean age of the respondents was 33.6 years (±7.8). 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 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%). Responsible health authority revealed that aim of the project is achieved to a certain extent. Particularly, it was mentioned that awareness, knowledge and practice of men regarding maternal and child health was improved.
Afternoon Session (2), Auditorium (1) Paper-83
Male involvement in reproductive health issues of women in rural settings of Upper Myanmar
Hla Soe Tint1, Phyoe Maung Thaw2, Kyaw Ko Ko Htet1, Myitzu Tin Oung1, Thida1, Theingi Myint3 and Than Tun Sein4
1Department of Medical Research (Upper Myanmar) 2 Ministry of Defense 3Ministry of Health, Nay Pyi Taw 4Department of Medical Research (Lower Myanmar)
A cross-sectional, community-based, analytic study was conducted with 500 married couples in 16 rural villages of Mandalay Region from 1st September 2012 to 31st August, 2013 to determine the level of male involvement in women’s reproductive health (RH) and how it affects on utilization of women’s RH services. Multistage sampling method was used to select the places of study and the respondents. Among 14 states and regions, Mandalay region was chosen purposively. Out of 26 townships of Mandalay region, two townships were selected randomly. In each township, two village tracts were selected randomly. In each village tract, five villages were selected randomly. Finally, in each village, 25 married couples were interviewed through household survey using systematic sampling method. The majority of husbands were involving in women’s RH issues either fairly or highly. Majority of husbands were heads of families and the most powerful persons in the family. Approximately 30% – 40% of wives had wife’s autonomy. Husbands’ knowledge levels on sources of reproductive health services, reproductive health information and reproductive health issues of mothers were found to be lower than wives (p<0.005), with exceptions of knowledge on contraception and attitude towards reproductive health issues. In multivariate analysis, with good husband’s power in the family with relatively lower wife’s
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autonomy, good wife’s knowledge on maternal healthcare and husbands’ good attitude on reproductive health care were collectively favorable to achieve male involvement (p<0.05). A highly significant positive association between male involvement and utilization of reproductive health services was found in this study (r=0.395, p<0.001).
Afternoon Session (2), Auditorium (1) Paper-84
Gender differences in utilization of reproductive health services among youths in the poor communities of Mandalay city, Myanmar
Phyu Phyu Thin Zaw1, Kyaw Ko Ko Htet1, Kyaw Thu Soe1, Tippawan Liabsuetrakul2 and Thein Thein Htay3
1Department of Medical Research (Upper Myanmar) 2Epidemiology Unit, Prince of Songkla University, Thailand 3Ministry of Health, Nay Pyi Taw
Utilization of reproductive health (RH) services between males and females differ by various socio-economic factors. To tailor RH services to the needs of males and females, understanding what factors separately affect their utilizations is essential. To elicit the gender differences in utilization of RH services among poor youths, a community-based, cross-sectional, descriptive study was conducted from May 2011 to September 2011. A total of 444 randomly selected youths in all suburban communities of Mandalay city answered the face-to-face interviews using structured questionnaires. Six interviewers (3 females and 3 males) were trained on using a rapport approach. Multivariate logistic regression analysis stratified by gender was done by using R 2.15.1 software. Despite females had lower socio- economic status compared to males (e.g. higher rate of unemployment, lower education and lower personal income), they had a significant higher rate of RH service utilization (73% versus 61%). While exposure to sex, exposure to mass media and knowledge of existing RH services were factors which increased males’ RH service utilization, being married and having a perceived norm of peer utilization were the only positive associated factors among females. It was obvious that male factors were rather objective (based on actual facts) such as mass media and existing services, while female factors were quite subjective (based on personal feelings) such as a perceived norms of peer utilization. These findings highlighted that gender-sensitive strategies should be applied in current RH services.
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Afternoon Session (2), Auditorium (1) Paper-85
Factors influencing male participation in maternal and newborn health in South Dagon Township, Yangon: Qualitative Study
May May Khin1, MyaMya Win2, Nay Win Ko Ko1, Hnin Kalyar Kyaw1, Aye Aye Myint1, Thwe Thwe Win1, Kyu Kyu Than1 and Myo Myo Mon3
1Burnet Institute, Myanmar 2Department of Health (South Dagon Township) 3Department of Medical Research (Lower Myanmar)
Promoting male involvement in reproductive health is mentioned as one of the activities to be strengthened in order to achieve the MDG 4 and 5. Along with the growing awareness of the importance of men’s role in reproductive health, this study aimed to explore men’s perception on maternal and child health, existing practice, decision making pattern among the couples in seeking health care regarding maternal and child health. This study was conducted in ten wards of South Dagon townships in Yangon region. Three focus group discussions with husbands of expected mothers, four focus group discussion with mothers with children, one focus group discussion with midwives and one key informant interview with township health officer to explore their perspective, experiences and innovative approach to improve male involvement in maternal and child health. Data were analyzed using a thematic analysis approach. Factors influencing male involvement in maternal and child health include were clinic opening hours, interruption of daily work, perception of care, support provided by family members, communication by health facility, previous birth experiences, availability of services, proximity of birth attendants. Both men and health care providers mentioned about barriers to health services. The participants suggested creating male friendly health centers for promotion of male participation, including provision of enough space for men, some form of reward system and any kind of support or incentive. Men further suggested for health education activities on weekends.
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Paper Reading Session : Day 5
Morning Session (1), Auditorium (1) Paper-86
Predictors for diagnosis of neonatal sepsis in Yangon Children Hospital
Thazin Mon1, Kay Thi Htun2, Kyaw Oo3, Wah Wah Aung4 and Ko Ko Zaw4
1Yangon Children’s Hospital 2Defence Service of Obstetric and Gynaecology and Children’s Hospital 3Department of Medical Research (Upper Myanmar) 4Department of Medical Research (Lower Myanmar)
Clinical diagnosis of sepsis in new born infants is not easy because symptoms and signs are non-specific. There is no laboratory test with 100% specificity and sensitivity. In addition, the emergence of multi-drug resistant microorganisms is of great concern. This study was done to identify predictors, causal bacterial pathogens and their sensitivity in proven neonatal sepsis and to construct a predictive model to get early diagnosis and avoid unnecessary use of antibiotics. The cross sectional hospital based study was carried out on neonates with suspected sepsis in Yangon Children Hospital from May 2011 to April 2012 and attempted to develop a predictive model for diagnosis of neonatal sepsis by multiple logistic regression analysis. Among 150 newborns of suspected neonatal sepsis 54 babies (38.57%) were bacteriologically positive. Majority of proven sepsis was caused by gram positive bacteria (70.37%). The remaining was caused by gram negative bacteria (29.63%). Bulging fontanel (p=0.02) and raised CRP >10mg/L showed significant association with proven neonatal sepsis (p=0.002).In this study abdominal distension, omphalitis and raised CRP were identified to be significant predictors. Predictive model for diagnosis of neonatal sepsis consisted of above 3 variables and showed area under Receiver Operating Characteristic (ROC) curve 0.66 and PPV 69%. . Together with clinical acumen these parameters can be used in clinical practice to detect neonatal sepsis in low resource setting.
Morning Session (1), Auditorium (1) Paper-87
Soil-transmitted helminth infections, hematological analysis and growth among primary school children in Tha-Pyay-Chaung village, Nay Pyi Taw: reassessment after one year of preventive chemotherapy
Nyein Chan Aung, Win Lwin Oo, Htet Win,Thet Maung Maung,Win Ko Ko Htay, Zin Phyo Hlaing, Nyein Chan, Moe Kyaw and Tin Maung Hlaing
Defence Services Medical Research Centre
A longitudinal study was conducted with the objective to find out the prevalence of soil-transmitted helminthic infection in primary school children at Tha-Pyae-Chaung village after one year of preventive chemotherapy. A sample of 200 children (106 boys
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and 94 girls) together with mothers and guardians were selected. Age, sex, weight and height were taken from each child. Faecal samples from 200 primary school children were examined using the modified Kato-Katz technique. Hematological analysis and blood films examination were done. Mothers and guardians of children were explained about the study and informed consent was taken. Children were examined at 0, 3, and 12 months after deworming by 400mg albendazole tablets. Prevalence of ascariasis in initial, interim and final assessment was 17.55%, 9% and 15.5% respectively. Prevalence of anaemia and eosinophilia in initial, interim and final assessment was (48.67%, 46.56%, 39.0%) and (48.15%, 38.62%, 26.0%) respectively. Prevalence of underweight, stunting and wasting in initial, interim and final assessment was (23.8%, 32.3%, 13.0%), (23.8%, 16.9%, 7.0%) and (10.6%, 5.3%, 1.5%) respectively. The reinfection rate at 12 months after deworming was high (93%). Bivariate analyses showed that those living in houses without toilets had significantly higher reinfection rates than others at 12 months (p<0.05). In conclusion, integration of regular deworming with use of sanitary toilets at home and health education activities for guardians must be conducted to decrease parasitic loads, to reduce transmission.
Morning Session (1), Auditorium (1) Paper-88
Mycoplasma pneumoniae infection in children with acute respiratory infection
Saw Win1, Win Lai May2, Wah Wah Aung2, Han Win2, Phyu Win Ei2, Zeya Kyaw Win1, Win Maw Tun2, Dam Lain Pau2 and Phyu Hnin Wai2
1Yangon Children’s Hospital 2Department of Medical Research (Lower Myanmar)
Mycoplasma pneumoniae is an important cause of both upper and lower respiratory tract infections especially in school age children and adolescents. In Myanmar, there was no data on incidence of M.pneumoniae infection and clinicians used to prescribe antibiotics without precise evidence of causal organism. This study was aimed to identify the proportion and the clinical presentation of M.pneumoniae infection in children (>5 years old) with acute respiratory infection (ARI). A total of 82 children admitted to Yangon Children’s Hospital (YCH) with diagnosis of ARI during 15 months period were included in the study. Clinical data were collected and serum specimens obtained at least 7 days after onset of the symptoms were tested for IgM antibody for M.pneumoniae by ELISA. M.pneumoniae IgM was detected in 54% (44/82) of children. Antibody positivity was significantly higher among 5-10 year group compared with ≥10 year group (60.7% vs. 33.3%, p=0.03). Similar to all ARI cases, M.pnuemoniae infection was more prevalent in cooler months (December-February) and also in rainy months (July-August). Fever, cough, coryza and cervical lymphadenopathy were most frequent symptoms in children with M.pneumoniae infection. However, it cannot be predicted on the basis of clinical and routine laboratory and radiology parameters. In children with positive serology for M.pneumoniae, only 11 (25%) received macrolides, which are the first line antibiotics in ARI guideline in this age group. As a significant proportion of ARI in YCH can be attributed to M.pneumoniae infection, it is important to have awareness of these cases to prescribe the appropriate treatment.
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Morning Session (1), Auditorium (1) Paper-89
The Role of NS-1 Antigen in early diagnosis of Dengue Hemorrhagic Fever in Yangon Children Hospital
Aye Aye Myint1, Khin Saw Aye2, Ko Ko Zaw2, Mu Mu Shwe2, Saw Win3 and Kyu Kyu Khin3
1Magway General Hospital 2Department of Medical Research (Lower Myanmar) 3Yangon Children Hospital
Dengue is a major public health problem in Myanmar and detection of dengue virus NS1 antigen in patients’ sera serve as a supplementary assay for early diagnosis of dengue. This study evaluated the usefulness of NS-1 antigen for early diagnosis of dengue infection in children by use of SD Dengue Duo rapid test (ICT). The accuracy of ICT was compared against RT-PCR test in 117 children with suspected dengue infection attending Yangon Children Hospital. All cases were tested for platelet count together with ICT. Among 117 samples, 65 samples were randomly selected and tested by RT-PCR from which 15 (23%) were positive for dengue RT-PCR. The sensitivity of ICT was 40% and specificity was 80% as there were more secondary dengue cases in study population. The accuracy of ICT against RT-PCR in patients with reduced platelet count showed that the sensitivity of NS1 antigen assay was 100 % and specificity was also 100% when the platelet count was below 40,000/cumm. This study demonstrated that the sensitivity and specificity of ICT, at the time of low platelet count, when specimens were collected within 5 days of fever, were relatively high compared to sensitivity and specificity of antibody detection. ICT should be included in the diagnosis of dengue, but with the considerations for limitations such as ICT being less sensitive in secondary dengue. In children, for early dengue diagnosis, with thorough clinical history and examination and also with consideration of platelet count, NS1 assay deserves inclusion in the diagnostic evaluation.
Morning Session (1), Auditorium (1) Paper-90
Antibody response to measles vaccine in children attending North Okkalapa General Hospital
Cho Cho Myint1 and Naing U2
1Department of Child Health, University of Medicine (2) 2Insein General Hospital.
A hospital based longitudinal descriptive study was carried out to study the antibody response to measles vaccine in 91 children who had measles 1 vaccine at North Okkalapa General Hospital from February 2010 to February 2011. Measles
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antibody IgG levels were measured before and 1-3 months after vaccination. Antibody assay was carried out based on personal parameters by using Genzyme Virotech ELISA test kit at the Common Research Laboratory, University of Medicine (2), Yangon. Before vaccination, 81 children (89%) out of 91 children were seronegative, 4 children (4.4%) were borderline and 6 children (6.6%) were seropositive. After vaccination, 29 children (31.9%) out of 91 children were seronegative, 6 children (6.6%) were borderline and 56 children (61.5%) were seropositive. Seven children (7.7%) of total 91 were HIV exposed their prevaccination Ab levels at 9 months were negative. This study showed that measles vaccine should be given to all children nine months older in our country in spite of their minor illness and mild to moderate malnutrition because of its severe complications. But, HIV exposed children should be given at six months of age due to reduced level of their maternal antibody.
Morning Session (1), Auditorium (1) Paper-91
Prevalence and severity of childhood asthma in school childern of age 10-14 years in North Okkalapa Township
Thet Su Su Aung, Cho Cho San and Saw Win
Child Ward, Magway Regional Hospital
A community based cross-sectional analytical study was carried out to determine the prevalence of bronchial asthma in school children of age 10-14 years in North Okkalapa township and to determine severity of childhood bronchial asthma among asthmatic children from July 2011 to December 2011. The study was conducted at Basic Education High School No(1), in North Okkalapa township, Yangon. One thousand and five hundred children involved in answering the questionnaire relating asthmatic symptoms. A standard questionnaire based on the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire was used in the study. It was translated into Myanmar language. The prevalence of bronchial asthma in this study is 9% among school children. In this study, no significant difference in the prevalence of asthma between boys and girls was observed. One hundred and nine students had participated in assessment of asthma severity for answering questionnaires based on GINA guidelines 2008. Lung function measurement using spirometry and PEFR was performed by seventy seven out of one hundred and nine students. Most asthmatic children are confined to intermittent symptoms. cough was the most common daytime and nocturnal symptom of asthmatic children in all age group. The last part of study by spirometry and PEFR assessment of lung function, seventy children had normal lung function. In this study only seven asthmatic children had mild obstructive type of lung function and four had moderate type of obstruction. The questionnaires were administered by the students themselves with the help of the teachers. There may have been respondent or reporting biases due to incorrectly reported symptoms.
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Morning Session (2), Auditorium (1) Paper-92
Factors influencing motorcycle accidents in Nay Pyi Taw
Aye Moe Moe Lwin1, Yi Yi Win2, Thinzar Aung3 and Chan Nyein Maung2
1University of Public Health 2Department of Medical Research (Central Myanmar) 3Department of Medical Research (Upper Myanmar)
A hospital-based cross sectional descriptive study was conducted in Nay Pyi Taw with the aim of exploring the road user pattern, factors related to motorcycle accident and outcomes of accident among 171 motorcyclists, passengers and pedestrians admitted to two hospitals. Face to face interviews were conducted by using pre-tested questionnaire with motorcycle accident patients and their attendants. Male, under 30 year age group, middle school level education and sale workers were most common victims. Motorcyclists were most at risk road users for accidents (57%) and 40% was due to fall or slipped motorcycles. Driving without licenses (31%), drinking alcohol (19%), high speeding (21%) and over-tracking (3.5%), impaired visibility (9.4%) and broken break or tires or engines (4%) were associated with accidents. (48%) of urban accident occurred on the straight roads where as 16% and 6% of rural accident occurred on rough and curved roads. Mortality rate was 9.3% whereas 4% was brought in dead cases. 19% treated as out- patients, 53% as non-severe in-patients and 18% was severe-in patients. Head injury and fracture in lower limbs were most common (36.3% and 30.4% respectively). Dead cases were due to head injury (76.5%) and multiple injuries (23.5%). Only 18% received first aids emergency treatment and 4.5% was sent to hospital with ambulance. Median risk cores of human factors, protective factors, vehicle factors and environmental factors were significantly higher on rural cases, pedestrian, severe in-patients and dead cases. Findings can be applicable for program preventing road traffic accidents.
Morning Session (2), Auditorium (1) Paper-93
Incidence of injury due to road traffic accidents in Lashio Township, Northern Shan State
Moe Kyaw Myint1, Lwin Oo2, Sai Kyaw Min2, Aung Thu1, Khin Lin1 and Kyaw Zin Thant1
1Department of Medical Research (Upper Myanmar) 2General Hospital, Lashio
Road traffic injury is a major public health problem with higher mortality, morbidity, and disability. Trauma due to road traffic accidents (RTA) is the leading cause of mortality in young people and one of the commonest causes of death overall. The paper aimed to study the incidence of injuries due to RTA among the
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patients admitted to Lashio General Hospital. It was cross-sectional descriptive study conducted during August 2012 to July 2013. Among 3268 injury patients, 44.7%(1462) were caused by RTA. Of these (1462), male were 70.5%(1031) and female were 29.5%(431). Mean age was 29±14.3 years. Majority of patients, 76.7%(1121) were motor-cycle users. Motor-car (motor-vehicles), pedestrian, tricycle, bicycle, cart and train were used by 12.8%(187), 8.3%(121), 1.7%(25), 0.4%(6), 0.1%(1) and 0.1%(1) of patients, respectively. Nearly half of the patients, 42.5%(621) were injured at lower limb. It was followed by head, upper limb, face, chest, abdomen, back, neck and perineum injuries in 34.8%(509), 22.2%(324), 21.5%(314), 8.4%(123), 4.7%(68), 2.9%(43), 1.6%(23) and 0.8%(12) of patients, respectively. Blunt injury causing bruise and abrasion were observed in 59.9%(876) of patients. It was followed by laceration, bone fracture, crush injury, penetration, sharp incision, joint dislocation, burn and inhalational injury in 40.2%(587), 17.2%(252), 1.7%(25), 0.8%(11), 0.6%(10), 0.5%(7), 0.2%(3) and 0.1%(1) of patients, respectively. As a conclusion, head injury was second commonest injury in this study and deaths from head injury were observed in 70%(55/79) of all deaths due to RTA (p=0.001). Neuro-surgical management was the important role in care of head injury and Neuro-surgical specialty was needed for Lashio hospital.
Morning Session (2), Auditorium (1) Paper-94
Perception on stress and the coping strategies of Grade-11 students at No. (5), Basic Education High School, Mingaladon
Hlaing Zaw Win1, Khin Mg Kyaw2 and Thwet Kyi Thaw3
1No.(1), Defence Services General Hospital (1000-Bedded) 2DSLH 3Militray Institute of Nursing and Paramedical Sciences
In Myanmar education system, teen-agers have to pass the matriculation exam to be able to learn the higher education. Grade-11 students are not only future generation but also the contributors to our country. They have to face stresses regarding academic, parents, teachers and peers. This study was conducted to find out the sources and coping strategies concerning their stresses. This cross-sectional descriptive study was conducted at No (5), B.E.H.S, Mingaladon Township in Yangon Region from August 2012 to January 2013. The objective was to describe the perception on stress and coping strategies of Grade-11 students. Among (450) students, (200) were selected as a sample population by using simple random sampling method. Data were collected by using a pretested self-administered structured questionnaire and analyzed by SPSS. Pearson Chi Square test was applied in this study. It was found that family members and birth order of the students were significantly related with their total stressful condition at the p (0.044 and 0.025). Moreover, educational level of father and type of family structure were statistically significant related with their total stress coping strategies at p (0.030 and 0.004). If the students could positively cope with their stresses, they would be able to overcome the challenges in their learning. This study provided for health care providers in school health setting and they should
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teach to them about the proper ways of coping with stress and refer to appropriate consultants if necessary.
Morning Session (2), Auditorium (1) Paper-95
A study of the effects of 3Mix-MP medicament and calcium hydroxide in non-vital pulp treatment of deciduous molars
Ei Khine Min, Aung Kyaw Htoo and Sun Sun Win
University of Dental Medicine, Yangon.
Early loss of deciduous teeth is the detrimental effect for development of normal permanent dentition. To maintain the primary teeth until its normal exfoliation time is the major role of paediatric dentistry. Pulp treatment of infected non-vital primary teeth is commonly encountered and camphorated monochlorophenol was accepted as the gold standard disinfected material in pulp treatment with minimal harmful effect. The aim of this study was to compare the effects of 3 Mix-MP medicament and calcium hydroxide in non-vital pulp treatment of deciduous molars. A total of 58 deciduous molars were allocated into 3 groups (19 in group A, B and 20 in group C) with infected pulp and treated with three different medicaments [camphorated monochlorophenol (CMCP) for group A, calcium hydroxide for group B and for group C 3Mix-MP by the concept of Lesion Sterilization and Tissue Repair (LSTR) and Non Instrumentation Endodontic Treatment (NIET)]. The treated teeth were observed clinically and radiographically after 6 weeks and 6 months. As a result, the total clinical and radiographic success rates of CMCP, calcium hydroxide and 3Mix-MP were 57.89%, 47.37% and 95% respectively for 6 weeks. For 6 months, success rates were 47.37% for CMCP and calcium hydroxide and 90% for 3Mix-MP. Total success rates of 3 Mix-MP were significantly higher than other groups (p value is <0.001, Fisher exact test). It can be concluded that 3Mix-MP can be used in non-vital pulp treatment with higher success rate than calcium hydroxide and CMCP.
Morning Session (2), Auditorium (1) Paper-96
Establishment of the simple extraction of collagen from some fishes in Myanmar and evaluation of effectiveness in wound healing
Lin Lin Tun1, Kyaw Naing2, Moh Moh Htun3, Khin Khin Aye3, Aye Win Oo3, Myat Mon Oo3 and Win Aung3
1Dagon University, Yangon 2Department of Higher Education, Yangon 3Department of Medical Research (Lower Myanmar)
Collagen is major component of connective tissue found in the body. Collagen has a wide range of application in cosmetic, biomedical, pharmaceutical industrial
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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 research is 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, -CH2, -CH3 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 collagen from Ngamyitchin was more completed wound healing in skin lesion than that of Ngaphe.
Morning Session (2), Auditorium (1) Paper-97
Serum C-telopeptide, serum oestrogen level and bone mineral density in premenopausal and postmenopausal women
Ni Ni Lin1, Than Than Soe2, Kyu Kyu Maung2, May Thazin2, May Pyone Kyaw3 and Aye Thida2
1Department of Biochemistry, University of Medicine, Magway 2Department of Biochemistry, University of Medicine (2), Yangon 3Department of Biochemistry, University of Medicine, Mandalay
Osteoporosis is the commonest silent disease in postmenopausal women. But these bone changes can only be noticed when the fracture occurs. This study was aimed to determine the serum C-telopeptide (bone resorption marker) and serum oestrogen levels, bone mineral density (BMD) in premenopausal and postmenopausal women. Serum C-telopeptide level was determined by Electrochemiluminescence (ECL) Immunoassay and serum oestrogen level was determined by Enzyme Linked Immunosorbent Assay (ELISA). Bone mineral density measurement was done by Quantitative Ultrasound. Mean serum oestrogen level of 32 premenopausal women was found to be significantly higher (p < 0.05) than that of 45 postmenopausal women (57.43 ± 24.84 pg/ml vs 46.46 ± 12.53 pg/ml). Postmenopausal women were observed to have higher serum C-telopeptide levels (p < 0.001) than those of premenopausal women (0.40 ± 0.15 ng/ml vs 0.16 ± 0.10 ng/ml). No significant correlation were found between serum oestrogen and serum C-telopeptide levels in both premenopausal women (r = 0.164, p = 0.369) and postmenopausal women (r = -0.073, p = 0.635). Bone mineral density expressed as T-score was found to be significantly higher (p < 0.001) in premenopausal women than that of postmenopausal women (-1.42 ± 1.11 vs -3.00 ± 0.54). In
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premenopausal women, 56.2% was osteopenic, 9.4% was osteoporotic and 34.4% was normal. In postmenopausal women, 17.8% was osteopenic and 82.2% was osteoporotic. In this study, serum C-telopeptide is not associated with serum oestrogen but decreased BMD and increased serum C-telopeptide level indicate that the rate of bone remodeling is increased in postmenopausal women.
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ABSTRACTS OF THE POSTERS DISPLAYED 42nd Myanmar Health Research Congress Abstracts of the Posters
Abstracts of the Posters
Poster-1
Characteristics of patients with breast cancer from selected cancer units in Yangon and Mandalay cities
Myo Khin, Le Le Win, Khin May Oo, San Shwe, Win Pa Pa Naing, Htain Win and Aung Myo Min
Department of Medical Research (Lower Myanmar)
Breast cancer is the most frequently diagnosed cancer and the leading cause of cancer deaths in females in the ASEAN Region, as well as worldwide. As part of the ASEAN CosTs In Oncology (ACTION) Study, (209) patients with breast cancer from selected cancer units in Yangon and Mandalay cities were investigated for biodata, clinical staging and grading and treatment. The age of the subjects ranged from 27 to 88 years, (Mean + SD 49.8 + 9.5). The majority of the subjects were married (63.6%) and had low level of education (27.8%) and 28.2% were graduates. Most of them were housewives (37.8%) and manual workers (29.7%). Pathological staging was done by tumor, regional lymph nodes, metastasis (TNM classification) and (31.6 %) was in stage IIA, (28.7%) was in stage IIB and (14.4%) was in stage IIIB. Histological grading of the subjects revealed that moderately differentiated carcinoma is the most commonest type (61.7%). About 15% has history of breast cancer among the family members. Among the five recommended treatment regimes, the majority of the subjects had to undergo surgical intervention (90%) and chemotherapy (97.6%). The findings of this study would improve the awareness of the breast cancer among women in the community and the information can be used for health education in breast cancer prevention and control.
Poster-2
Knowledge, attitude, perception and practice regarding breast cancer prevention among female school teachers in Yangon Region
Khaymar Mya1, Yin Thet Nu Oo2, Aye Sandar Mon1, Than Soe Lin1, Soe Moe Myat2, Ko Ko Zaw 2 and Nay Soe Maung 1
1University of Public Health, Yangon, Department of Medical Science 2Department of Medical Research (Lower Myanmar)
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 HE using poster and pamphlet on breast cancer was given to participants after data collection. Mean age of the teachers was 47 years and mean 73 Abstracts of the Posters 42nd Myanmar Health Research Congress
age of menarche was 13 years. About 45% were single. Among the married respondents, mean number of children was 1.85(SD0.84) and most teachers had breast fed. 28% had family history of cancer and 34.2% reported family history of breast cancer. Mostly reported risk factors were breast lump (67%) and family history (63.4%) and hormone drug users (58%), and 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 early diagnosis way. The study showed moderate to low knowledge among teachers. Most had positive attitude towards early diagnosis and BSE. Only 39.6% perceived that they have 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.
Poster-3
Study of plasma malondialdehyde and serum zinc level in normal pregnant women
Aung Myo1, Khin Nwe Kyi2, Aye Aye Myat2, Ohnmar3, Than Oo3, Khin Myo Chit3, Moe Kyaw1 and Tin Maung Hlaing1
1Defence Services Medical Research Centre 3Defence Services Medical Academy 3University of Medicine (2)
This is a cross-sectional comparative study which was carried out at No.1 Defence Services Obstetrics, Gynaecology and Children’s Hospital (300-bedded). Plasma malondialdehyde and serum zinc levels were determined by using thiobarbituric acid and Atomic Absorption Spectrophotometry respectively. Mean malondialdehyde and zinc level in normal non-pregnant women (n=20) were (1.10 ± 0.124 µmol/L and 0.134 ± 0.0142 mg/dl), pregnant women with gestational period of 10 to 13 week (n=20) were (1.19 ± 0.077 µmol/L and 0.105± 0.01 mg/dl), pregnant women with gestational period of 24 to 26 week (n=20) were (1.68 ± 0.063 µmol/L and 0.093 ± 0.009 mg/dl) and pregnant women with gestational period of 36 to 38 week (n=19) were (1.86 ± 0.046 µmol/L and 0.074 ± 0.009 mg/dl). Serum zinc level was significantly lower in pregnant groups than non-pregnant group (p<0.05). Plasma malondialdehyde level of normal pregnant women was significantly higher than that of non-pregnant women (p<0.05). There was strong and negative association between malondialdehyde and zinc level of pregnant group with gestational period of 10 to 13 week (n= 20, r= -0.703 and p= 0.001). In other gestational period groups, there was no association between malondialdehyde and zinc level. On conclusion, plasma malondialdehyde level was increased and serum zinc level was decreased along with the gestational period. Malondialdehyde and zinc level were strongly and negatively associated in normal pregnant women with gestational period of 10 to 13 week. It can be suggested that zinc supplement should be started in early gestational period before 13 week.
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Poster-4
Assessment on effectiveness of safer blood transfusion services in National Blood Center, Myanmar
Nwe Nwe Oo1, Thaw Zin Aung2, Ikuma Nozaki2, 3 and Thida Aung1
1National Blood Center, Department of Health, Ministry of Health, Myanmar 2JICA Major Infectious Disease Control Project II, Myanmar 3National Center for Global Health and Medicine, Japan
Blood safety is key element of HIV prevention strategy in Myanmar. In order to secure the blood safety, National Blood Center (NBC) introduced several systems including formulation of voluntary donor groups with motivation activities, donor deferral system using questionnaire adapted to Myanmar’s situation, and computer based registration system. The objective of the study was evaluating the effectiveness of those interventions. We collected data of blood transfusion service in NBC retrospectively from 2000 to 2012, including number of voluntary and replacement donations and HIV positivity rate in blood screening. We compared the trend of HIV screening positivity rate with estimated adult HIV prevalence by HIV Estimate and Projection Myanmar 2010-2015. During the study period, estimated adult HIV prevalence had increased from 0.65% in 2000 and peaked out in 2003 with 0.73% prevalence, and gradually decreasing to 0.53% in 2012. HIV screening positivity rate among blood donations was 1.0% in 2000 at beginning, but it has been decreasing and became lower than estimated adult prevalence in 2005, just after introduction of 1st generation deferral system using questionnaire. As increasing the percentage of voluntary donations with introduction of other interventions, HIV screening positivity rate continuously decreased to 0.12 % in 2012. The system introduced in NBC was working effectively and contributed for reducing the risk of HIV transmission by blood transfusion services. It should be considered that expansion of the system into other general hospital and specialist hospitals in order to secure the blood safety nationwide.
Poster-5
Detection of Clostridium botulinum and toxin production from some of salted dry fishes
Thin Thin Wah, Lai Lai San, Tin Tin Htwe, May Than Htay, Nilar, Myo Myo Kyaw, Kyaw Kyaw San and Thaung Hla
Department of Medical Research (Lower Myanmar)
The study of detection of Clostridium botulinum and toxin production from some of salted dry fishes was conducted from May 2012 to April 2013. The study aims to detect Clostridium botulinum and toxin production from some salted dry fishes collected from different kinds of market. Botulism is caused by botulinum toxin
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which is high potent neurotoxin that is formed during the growth of the spore- forming Clostridium botulinum. Among seven types of botulinum toxin, type A, B and E are the most commonly associated with human illnesses. One of the clinical forms of botulism is food-borne botulism which is caused by ingestion of preformed toxin produced in food contaminated with Clostridium botulinum which is gram- positive, spore forming and anaerobic bacilli. Symptoms of botulism may develop between 12 and 72 hours after ingestion of toxin containing food. In this study, total 90 samples (30 samples each of three types of dried form of salted dry fishes such as Heteropneuses fossilis (stinging catfish, nga-gyee), Polydactylus indicus (Indian threadfin, ka-ku-yan) and Lutjanus johnii (john’s snapper, Nga-poke) were collected from different sources. Clostridium botulinum was isolated by plating method under anaerobic condition and was found 24 samples (27%) by morphological identification. Mouse bioassay was done to detect production of toxin from the isolated colonies. The toxin production was not detected in this study. The Clostridium contamination in salted dry fishes need to check for toxin production for public food safety.
Poster-6
Bio-efficacy and wash resistance of PermaNet® 2.0, PowerNet and K-O- Tab 123 treated bednets against malaria vector mosquitoes
Maung Maung Mya, Pe Than Htun, Myat Phone Kyaw, Sein Min, Sein Thaung, Yee Yee Myint, Thu Zar Nyein Mu, Chit Thet Nwe and Yan Naung Maung Maung
Department of Medical Research (Lower Myanmar)
Bio-efficacy and wash resistance of repeatedly hand washed (7 days 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 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 F1 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 LC50 and LC90 values of deltamethrin as determined for An.dirus and An.minimus were 0.000008g/l, 0.0000367g/l (2=3.3883, p=0.05) and 0.000009g/l, 0.0000372g/l (x2=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. All tested
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nets were very effective alternative tools for malaria vector control in support of National Malaria Control
Poster-7
Role of serum protein electrophoresis in detection of multiple myeloma
San San Htwe1, Rai Mra2, Htun Lwin Nyein2, Win Pa Pa Naing1, Aung Thu1, Aye Mya Khine1 and Moe Thuzar Min1
1Department of Medical Research (Lower Myanmar) 2Department of Clinical Haematology, Yangon General Hospital
Multiple myeloma is a neoplasm of B cell lineage characterized by excessive proliferation of abnormal plasma cells, secreting abnormal immunoglobulin causing monoclonal gammopathy which can be detected by the presence of monoclonal (M) protein in serum electrophoresis. The different fractions of the serum proteins separate into 5 bands, as – the albumin, 1, 2, and the globulin fractions by doing electrophoresis. M protein appears as sharp symmetric spike-like peak in the gamma, beta or alpha regions in densitometer tracing. The aim of the study is to detect monoclonal (M) band on serum protein electrophoresis and to quantify monoclonal (M) protein concentration by densitometer. A total of 50 clinically suspected cases of multiple myeloma attended to Department of Clinical Haematology, Yangon General Hospital were selected for the study. Serum protein electrophoresis was performed on cellulose acetate strip. M band was detected visually and estimation of M protein was done by densitometer. Among the 50 cases, 19 cases (38%) had monoclonal gammopathy and were diagnosed to have multiple myeloma. Age of the patients ranged from 52 years to 77 years. The male to female ratio was 1.1:1. All cases had the M band in the gamma () region. The mean concentration of the M protein was 4.63 g/dl, with a range of 3.6 to 7.41 g/dl. Serum protein electrophoresis is an easy to perform laboratory test which can be used for detection and quantification of monoclonal gammopathy and should be recommended as preliminary test for suspected cases of multiple myeloma.
Poster-8
Hepatitis B vaccination response in person with Hepatitis C virus infection
Myat Tin Htwe Kyaw, Aye Aye Lwin, Yi Yi Kyaw, Khin Ohmar Lwin, Khin May Oo, Win Maw Tun and Kay Khine Soe
Department of Medical Research (Lower Myanmar)
Patients with chronic hepatitis C have been recommended to receive vaccinations against hepatitis B. It is based on the fact that hepatitis C patients co-infected
77 Abstracts of the Posters 42nd Myanmar Health Research Congress
with hepatitis B (HB) virus have a higher risk of hepatocellular carcinoma. The aim of the study was to assess the immune response to three doses of plasma-derived HB vaccine in anti-HCV positive persons. A cross-sectional study was conducted among chronic HCV infected persons attending the Hepatitis Carrier Clinic in Department of Medical Research (Lower Myanmar). A total of 75 anti-HCV positive persons were screened. Among them 59 subjects were excluded in whom twenty five subjects were already vaccinated, twenty three were previous anti-HBs positive without HB vaccination, six were cirrhosis of liver detected by USG, three were dual infection and two subjects were anti-HIV antibody positive. Sixteen anti- HCV positive persons were included in the study. Their mean age was 45 ± 12.95 years and male: female was 6:10. Those were vaccinated with three doses of plasma derived HB-DMR vaccine at 0,1, and 2 month schedule by intramuscular route. Antibody to HB surface antigen was measured after completion of second dose and two months after completion of the third dose of vaccination by quantitative ELISA method. Positive anti-HBs antibody with protective level of more than 10 IU/L was only detected in 1/16 (6.25%). The HB 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 persons without HCV infection (98%).
Poster-9
Molecular characterization of Chikungunya Virus in Myanmar
Aung Zaw Latt1, Thet Khaing Win2, Saw Win3, Thida Kyaw1, Kaythi Aye1, Yamin Ko Ko1 and Hlaing Myat Thu1
1Department of Medical Research (Lower Myanmar) 2Ward 17-18, Yangon General Hospital 3Yangon Children Hospital
Chikungunya virus belonging to the Togaviridae family, genus Alpha virus, is transmitted to human by the bite of Aedes species mosquitoes, leads to an acute fever associated with an arthromyalgic syndrome. There are three distinct strains: West Africa, Asia, and East/Central/South Africa. In Myanmar studies on sero- surveillance were done but there were no genotypic studies on Chikungunya virus. Acute serum samples collected from YGH and YCH were used for the study. One- hundred blood samples collected were used for the study. Viral RNA was extracted and RT-PCR was done. Six out of one-hundred samples were RT-PCR positive. Then genetic sequencing was done on RT-PCR positive (two) samples, and analyzed for their genotypes. The resulting genotype was ECSA (East/Central/South Africa) genotype. There is no vaccine available currently and this study will be the first genotyping of Myanmar chikungunya virus done in Department of Medical Research (Lower Myanmar), which is essential to get the base line data especially for vaccine development.
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Poster-10
Population structure of the malaria vector Anopheles baimaii in Myanmar using microsatellite markers
Yan Naung Maung Maung1, Thaung Hlaing2, Sein Min1, Sein Thaung1, Khin Myo Aye1, Petri Kemppainen3 and Catherine Walton3
1Department of Medical Research (Lower Myanmar) 2Vector Borne Diseases Control, Department of Health 3Faculty of Life Sciences, Manchester University
Microsatellite markers are commonly used to investigate the genetic structuring of natural populations. Understanding gene flow and its effects is important in vector ecology and epidemiology. Anopheles baimaii (formerly An. dirus species D) is the main vector in forested and forest–fringe hilly areas of Myanmar An.baimaii also occurs widely in Southeast Asia and North-Eastern region of India. The genetic population structure and the basic population genetics parameters of An.baimaii in Myanmar were estimated using microsatellite markers. Anopheles baimaii well collected from geo-referenced (11) townships in Myanmar. (123) mosquitoes samples from NE India were added to this study. Six microsatellite markers were used for Multiplex PCR and subsequent sequencing. Alleles scoring was done by Gene Mapper and analysed for population parameters using Genepop, Structure, Arlequin and ‘R’ software. The central and southern Myanmar populations were genetically distinct from NE India population but the populations from North-western part of Myanmar were similar to NE India populations, indicating that Arakan mountain range between Myanmar and NE India is a significant barrier to gene flow.
Poster-11
Evaluation of antispasmodicawma&Smuf activity of Atalantia monophylla Correa. root on isolated rat intestine
May Aye Than1, San San Myint1 and Khin Mar Naing 2
1Department of Medical Research (Lower Myanmar) 2Botany Department, Yangon University
In order to combat the problems of spasmodic pain due to spasm of muscle including intestinal smooth muscle locally, most of the people uses lubricants and antispasmodic of natural products. The aim is to evaluate phytochemical, elemental(awma&Smuf) analysis, acute toxicity and antispasmodic activity of Atalantia monophylla Correa. root from Sagaing Division. The phytochemical examination showed the presence of alkaloids, flavonoids, steroids/terpenoids, saponins, carbohydrate, reducing sugars, glycosides, tannins, phenolic compounds and amino acids in the roots. The principal element in root as calcium, potassium and iron were detected. No toxic compound and metal like cyanogenic glycoside and arsenic detected. No acute toxicity effect even
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with maximum permissible dose of 12g/kg per orally. In vitro the antispasmodic activity of 95% ethanolic extracts of A. monophylla were carried out by using acetycholine (Ach) -induced contraction in isolated rat intestine. The relaxation effects on smooth muscle of isolated rat intestines were also observed in various concentrations of 95% ethanolic extracts 2,3,4,5, 6mg/mL bc (bath concentration m=7). The mean percent inhibition of height of contraction of extract 2mg/mLbc, 3mg/mLbc, 4mg/mLbc, 5mg/mLbc and 6mg/mLbc were 56.52±6.17, 70.26±5.84, 78.10±5.76, 85.99±5.50 and 85.99±5.50 respectively, It was dose dependent manner with ED50 of 1.52mg/mLbc. The 95% ethanolic extracts 6mg/mLbc of A. monophylla could completely blocked the contraction caused by Ach 0.1mg/mLbc. This Ach concentration was completely blocked by atropine 5mg/mLbc. So the mechanism of action was antimuscurinic activity. Therefore 95% ethanolic of A. monophylla have the relaxation effect on Ach – induced contraction of intestine smooth muscle in dose dependent manner with atropine like activity and potential utility as antispasmodic agent.
Poster-12
Clinical significance of admission hematological parameters in patients with acute myocardial infarct
Zin Zin Thu1, Tin Latt2, Aye Aye Wynn3, Myo Myo Mon1, Kyu Kyu Than1, Win Pa Pa Naing1 and Aye Mya Khine1
1Department of Medical Research (Lower Myanmar) 2Cardiac Medical Ward, Yangon General Hospital 3University of Medicine (1)
Certain changes in platelet and white blood cells (WBC) have been recognized as an independent risk factor for adverse clinical outcomes among survivors of myocardial infarction. This study aims to assess the clinical importance of hematological parameters in patients with acute myocardial infarction upon hospital admission. A total of 96 acute myocardial infarct patients from cardiac medical ward, YGH were recruited and studied over one year. Hematological analyses of patients were completed within 24 hours after admission and complete blood count was done by using blood film and hematology analyzer. Seventy eight patients (81%) were presented with normal hemoglobin level, 3 patients (3%) with high hemoglobin level and 15 patients (16%) with anemia. Normal platelet count was found in 93 patients (97%) and 3 patient (3%) showed low platelet count. Approximately 30% (31 patients) showed normal WBC count (4-11 x 106/µl), 70% (65patients) was found to have leucocytosis. Among the patients with leucocytosis, 61 patients showed WBC count of 11.1– 20 x106/µl and 4 patients in this group expired (6.6 % fatality rate). Another 4 patients were presented with WBC count of 20.1-33.4x 106/µl and 2 of these patients expired (i.e.50 % fatality) during the period of this study. This study showed that marked leucocytosis (> 20.1 x 106/µl) was associated with increased proportion of hospital death in patients with acute myocardial infarction. Significantly, routine admission WBC count in acute myocardial infarct patients may serve as a potential prognosis tool which is relatively simple to perform and easy interpret, widely available and cost effective.
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Poster-13
Innovative male participation process in achieving maternal and newborn health outcomes in South Dagon Township, Yangon
Hnin Kalayar Kyaw1, Mya Mya Win2, Nay Win Ko Ko1, May May Khin1, Aye Aye Myint1, Thwe Thwe Win1, Kyu Kyu Than1 and Myo Myo Mon3
1Burnet Institute Myanmar 2Department of Health 3Department of Medical Research (Lower Myanmar)
Men in Myanmar play an important role in decisions that are critically to Maternal and Newborn Health. An innovative community base intervention study was carried out from May 2011 to June 2012 in South Dagon Township. Two hundred married men whose wives have experienced at least one child birth and husbands of pregnant women were included in the study.The objective of the study was to find out the knowledge, perception and practice of men regarding antenatal care, postnatal care, contraception and newborn care before and after intervention. Innovative processes includes advocacy process involving male participation and idea generation with various stakeholders, training of Basic Health Staff on role of male in Maternal and Newborn Health, behavior change strategies to involve men with local networks: Myanmar Red Cross Society and Myanmar Maternal and Child Welfare Association, health education to men in the community using participatory approaches and mass mobilization activities: design contest for creating male friendly room in existing health facility and creating an enabling environment for male involvement. Main outcome measures have shown higher achievement in most of the parameters: better knowledge and participation in antenatal care practice and birth preparedness with save daily income for new child. The main lesson learnt through this innovative intervention is that male are willing to learn about the Maternal and Newborn Health care activities and creating male friendly space could initiate men for more involvement in the antenatal, postnatal and contraceptive practices. Keywords: MNCH; male participation; AN care; Yangon
Poster-14
Assessment of the Quality of HIV testing in Myanmar
Latt Latt Kyaw1, Ikuma Nozaki2,3, Khin Yi Oo1and Namiko Yoshihara2
1National Health Laboratory, Ministry of Health, Yangon, Myanmar 2JICA, Major Infectious Disease Control Project II, Yangon, Myanmar 3National Center for Global Health and Medicine, Tokyo, Japan
Early diagnosis of HIV/AIDS has been widely recognized as effective strategy for facilitating behavioral changes and early access to treatment, while resource-limited settings in laboratories often faced difficulties. National Health Laboratory (NHL)
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organized National External Quality Assessment Scheme (NEQAS) for HIV testing using proficiency panel biannually since 2005.Participated laboratory retest 5 serum panels and report back to NHL. We reviewed NEQAS Reports of panel 1 to 16 to collect the data including number of laboratories under NEQAS, reporting rate, rate of laboratories reporting aberrant test results, rate of false positive or false negative, and assessment of those aberrant results. The number of laboratories participating in NEQAS has been gradually increased from 65 in 2005 to 347 in 2012. Responding rate of laboratories slightly dropped from 100% in 2005 to 91.1% in 2012 as expanding the program into laboratories of remote areas. The rate of laboratories reporting the false result was slightly improved from 9.2% in 2005 to 5.4% in 2012. We observed comparatively high false negative rate (63.1%), since aberrant results were most frequently happened with weak positive samples. Supervisory visit revealed some weakness in HIV testing procedures, such as wrong incubation time, using too much amount of the specimen, probably due to lack of necessary equipment such as timers and micro pipettes. Well functioning NEQAS found that most of the laboratories show good performance despite hard situation, but some still need to improve. Continuous technical support through NEQAS is essential for the quality improvement of HIV testing.
Poster-15
Enhancing bed-net delivery mechanisms and early diagnosis and prompt treatment for malaria among resident and migrant households in Tanintharyi Coastal Region, Myanmar
Khin Myo Aye1, Myat Phone Kyaw1, Khin Thet Wai1, Myo Min3, Tin Oo1, Aye Than1, Lu Lu Kyaw Tin Oo2, Chan Myae Hlaing2 and Tin Tin Wai1
1Department of Medical Research (Lower Myanmar) 2Medical Officer, Clinical Research Unit 3 Myanmar Medical Association
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%). 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 villagers knew to confirm with the rapid diagnostic test prior to
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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.
Poster-16
Assessment of osteoporosis in female breast cancer patients attending Medical Oncology Ward, Yangon General Hospital
Than Than Aye1, Yae Chan1, Han Win1, Ko Ko Zaw 1 and Khin Thinn Mu2
1Department of Medical Research (Lower Myanmar) 2Medical 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 kg/m2 and only 31% completed high school and above educational levels. Nearly two third of the subjects (63%) 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 manifestation, 62% did not show any symptom of osteoporosis and the commonest symptoms among symptomatic patients were numbness(21%) which may be due to various cause and back pain (17%). Out of 95 studied subjects, 66(70%) was found to have osteoporosis, 26(27%) osteopenia and only 3(3%) normal. Moreover, osteoporosis was observed more commonly in older age group (≥50 years; p = 0.026), postmenopausal group(p = 0.029) and lower educational group(below high school; p = 0.001)
Poster-17
(e*g;armufoD;) Evaluation of the antioxidant activity of two species of Hylocereus fruits
Mie Mie Nwe, Khin Taryar Myint, Aung Myat Kyaw, Win Win Maw, Phyu Phyu Zin, Nwe Nwe Oo and May Aye Than
Department of Medical Research (Lower Myanmar)
Nowadays people want to eat antioxidant food for many purposes. The aim of the study is to determine the antioxidant activity of peel and pulp of (two) species of
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(e*g;armufoD;tjzL)dragon fruits of the cactaceae family, the white dragon fruit (e*g;armufoD;teD)Hylocereus undatus and red dragon fruit Hylocereus polyrhizus . The white dragon fruits were bought from super market and the red dragon fruits were bought from the plantation site of Myae Padaythar. The antioxidant activities of dragon fruit was evaluated by DPPH (1-1 diphenyl -2-picryhyldrazyl) method. This method is based on the changes in absorbance at 517nm of spectrophotometer. The antioxidant activity or 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. In red fruits both peel and pulp were extracted by 50% ethanol. The antioxidant activity of the extracts and juice of two species of dragon fruits was found in 4g/ml concentration. The percent inhibition of pulp of white dragon fruit was 83.5% and peel of the fruit was 77.9%. In red dragon fruit, the antioxidant activity of pulp was 63.8% and peel was 64.0%. The standard ascorbic acid showed 98.3%. From these findings high level of antioxidant activity was detected in pulp of white dragon fruit. This is the preliminary study and needs to extend on dragon fruits with different species which are cultivated in different areas of the country.
Poster-18
Comparative study of effectiveness of Albendazole and Mebandazole in soil-transmitted Helminthiasis of school children
Aye Than1, Khin Maung Lwin2, Khin Thet Wai1, Ni Ni Zaw1, Thin Thin Aye1, Khin Mya Ei2, Myat Htut Nyunt1, Thaung Hlaing2 and Kay Thwe Han1
1Department of Medical Research (Lower Myanmar) 2Department of Health
Children are mostly at risk of soil-transmitted helminthiasis(STH),which affects their health and development. Therefore, school based helminthiasis control have been discussed and conducted as one way of cost-effective in developing countries, including Myanmar. However, a comparative study to assess the effectiveness of albendazole(400mg) and mebandazole (500mg) in soil-transmitted helminthiasis of school children were done in Kyimyindine Township in 2012. A total of 240 students from 2 primary schools (122 in Albendazole and 118 in Mebandazole) were included in this study. . Prevalence of the Ascaris lumbricoides (roundworm) was 178 (74.2%), Trichuris trichiura (whipworm) was 179 (74.6%) and hookworm spp: 11 (4.17%) respectively. In Albendazole group, prevalence of the Ascariasis was reduced from 70.49% to 27.05% while 77.96% to 33.05% in Mebandazole group. Simarility, Trichuris trichiura infection was reduced from 72.95% to 27.86% in Albendazole group and 73.77% to 38.52% in Mebandazole group. The hookworm spp: prevalence rate was reduced from 5.35% to3.57% in albendazole group and 5.65% to 4.2% in mebandazole group. The cure rate (CR) for Ascariasis was 61.62% in Albendozole and 57.60% in Mebandazole group. For Trichuris trichiura infection, CR was 61.81% in Albendazole and 47.78% in Mebandazole group and hookworm spp: infection was 40% in albendazole and
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33.46% in Mebandazole group. Thus, comprehensive information to soil-transmitted helminth’s drug efficacy is essential in STH control of primary school children.
Poster-19
The role of Human Papillomavirus (HPV) in oral leukoplakia, oral submucous fibrosis and oral squamous cell carcinomas
Moe Thida Htwe¹, Zaw Moe Thein² and Swe Swe Win¹
¹Department of Oral Medicine, University of Dental Medicine, Yangon ²Department of Oral Medicine, University of Dental Medicine, Mandalay
Although tobacco, alcohol abuse and betel quid chewing habit are well recognized risk factors for oral potentially malignant disorders (OPMDs) and oral squamous cell carcinomas (OSCCs), there is evidence to indicate that human papillomavirus (HPV) may also play some inducing role. Human papillomavirus (HPV) infection in OPMDs and OSCCs are controversial. Furthermore, the prevalence of HPV DNA in oral carcinoma varies from study to study. A cross-sectional laboratory based descriptive and analytical study was performed in 62 OPMDs and 62 OSCCs. The presence of HPV infection was detected by Polymerase Chain Reaction (PCR). Buccal mucosa was the most common site for OPMDs [oral leukoplakia (61%) and oral submucous fibrosis (OSMF) (81%)]. In OSCCs, 23% were found in both buccal mucosa and tongue. Mean ± SD for OSCC, OL and OSMF were 59, 50, 33 and they were significantly different (P=0.000). Betel quid chewing habit alone was found to be most common habit in OL, OSMF and OSCCs (38.7%, 54.8% and 54.8%) respectively. HPV was negative in all OPMDs and only three samples (4.8%) of OSCCs were positive and any significant associations were not found between HPV infection and gender, age, site, histological differentiation of OSCCs and grade of epithelial dysplasia for OPMDs. The results suggested that HPV was not play an important role in oral carcinogenesis in this group of Myanmar patients.
Poster-20
Involvement in flood-related-health care activities for the flood victims: who, when and why
Le Le Win1, Yin Thet Nu Oo1, KhinSandarOo1, Kyi Maw Than1, Than Htein Win2, Thandar Min1, Aye Win Khine1, HlaThidaTun1 and Soe Moe Myat1
1Department of Medical Research (Lower Myanmar) 2Department of Health
A cross-sectional study was conducted to assess communication network regarding flood-related-health care for the flood victims in Kyaung-kone and Kun-chan-kone Townships during 2013. Face-to-face-interview was done with 200 adult community members and in-depth interview was done with 41 committee members from
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Township/Village Disaster Preparedness Committees. Interviews were conducted with consent using pretested research tools. Since Kyaung-kone Township was accustomed to flood nearly every year, proper plan for disaster preparation was not prepared and due to bad experience of Nargis, people from Kun-chan-kone Township had well prepared for coming cyclone.In both townships, groups organized by community, village administrators, NGO and INGO helped flood victims for health care. Of which, groups organized by community and village administrators were actively involved in the activities (> 40% each). Most activities were done particularly one month after the flood. Health persons took the main role as they initiated and communicated other people and worked together for the flood victims to get health care in time particularly during flood period.Despite of receiving ample information, a few respondents said they could not follow the instructions, did not understand and/or remember likenames of medicines to keep. Additionally, some barriers slowed down for timely communication like poor transportation, insufficient life-saving routes and shelters were explored. In conclusion, with some limitations, a good communication network was observed in both townships among the committee members, government health workers, local residents and authority person, and international organizations, which resulted in achieving some benefitsfor both community and responsible person.
Poster-21
Application of fluorescence microscopy in the diagnosis of tuberculosis
Sann Sanda Khin1, Aung Thu2, Thandar Lwin1, Tun Kyaw Soe1, Khin Zaw Latt1, Wai Wai Khaing4, Yi Yi Myint4, Erwin Cooreman2 and Htun Naing Oo3
1Department of Health, Nay Pyi Taw 2World Health Organization, Country Office for Myanmar 3Department of Medical Research (Central Myanmar) 4Department of Medical Research (Upper Myanmar)
Most of the world’s tuberculosis cases occur in low-income countries, where sputum microscopy with conventional light microscope is primary method for diagnosing pulmonary tuberculosis (PTB). Myanmar is among 22 countries with highest burdens of TB. Fluorescence microscopy is credited with increased sensitivity and lower work effort. Therefore, the application of fluorescence microscopy in screening diagnosis of PTB in Myanmar was assessed. It was a cross-sectional comparative study and total 200 randomly selected X-ray diagnosed TB cases, aged between 13-74 years were included. The yields obtained with Papanicolaou-fluorescence microscopy and Auramine fluorescence microscopy and Ziehl-Neelsen (ZN) conventional method; assessed the efficiency of the Pap-fluorescence microscopy in terms of work load and turn-around-time for diagnosis of tuberculosis were compared. Out of the 200 smears, 115/200 (57.5%) and 46/200 (23%) were positive by auramine and ZN stain respectively, of which 31 (15.5%) samples were positive on both stains. Similarly, 97/200 (48.5%) and 46/200 (23%) were positive by Papanicolaou and ZN stain respectively, of which 29 (14.5%) samples were positive on both stains. The results suggest that both auramine and Papanicolaou fluorescence microscopy were more
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sensitive than ZN staining in screening diagnosis of pulmonary tuberculosis because of shorter turn-around-time and less work effort. This concludes that it is a better tool for diagnosing pulmonary TB. Further and larger studies are required to recommend Papanicolaou staining for TB in public health program.
Poster-22
Drug use pattern, HIV knowledge and accessibility to harm reduction services in Pekhon Township
Sai Aung Kyaw Myint, Thura Maung Aye, Poe Poe Aung and Khin Hnin Oo
Burnet Institute (Myanmar)
In Myanmar, HIV prevalence is the highest among drug users (21.9%) and the priorities focus on reducing HIV related risk, vulnerability and impact among drug users. To assess drug use pattern, HIV knowledge and accessibility to harm reduction services by the drug users, a cross-sectional survey was conducted using face-to-face interview with 220 drug users in Pekhon Township where harm reduction services are less. Of 217 male and 3 female were interviewed and the mean age was 27 years. Drug users mainly used Yama (84%) and Heroin, Opium, Marijuana, Cough Syrup, Alcohol and Cigarette were also used. Main drug use pattern was inhaling (81.4%) followed by swallowing, smoking, and injecting. About 94% of drug users responded that they did not share needle and syringe during last attempt and 84.1% did not know the availability of new needle and syringes. Although 93.6% of respondents heard about HIV/AIDS, only 23.2% got high knowledge score regarding HIV/AIDS. Mean knowledge score was 6.3 (range 0-11). About 80% of the drug users have never been asking help to stop using drug. About (57.3%) do not know about nearby voluntary counseling and confidential testing (VCCT) service and 90.5% have never been tested HIV before. This study highlight that Yama was major drug which can reduce memory recall and can increase physical violence. The availability and distribution of new needles and syringe is needed to be focused. Low knowledge on HIV highlighted to advance health education on HIV to enhance VCCT services among drug users.
Poster-23
Awareness and attitude of public staff towards involvement of General Practitioners (GPs) in TB control in selected townships, Yangon Region
Khin Sandar Oo1, Saw Saw1, Le Le Win1, Yin Thet Nu Oo1, Tin Mi Mi Khaing2, Mya Mya Moe3, Thandar Min1, Soe Moe Myat1 and HlaThidaTun1
1Department of Medical Research (Lower Myanmar) 2Yangon Divisional TB Center (NTP) 3Township Department of Health (Thanlyin)
With the aim of exploring awareness and attitude of public staff towards involvement of General Practitioners (GPs) in TB control, a cross-sectional descriptive study was
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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 11indepth 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 HE (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% thought all GPs would collaborate,24% thought half of GPs would include and 4% said none of the GPs would involve in PPM. More than 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.
Poster-24
Coagulation profile in type-2 diabetes mellitus patients attending the diabetic clinic, Yangon General Hospital
Myat Mon Oo, Moh Moh Htun, Win Maw Tun, Ohnmar, Yin Min Htun, Hnin Nu Htwe, Mya Thanda Win and Kay Thwe Win.
Department of Medical Research (Lower Myanmar)
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 11.9% in Yangon Division in 2003. Type 2 diabetes mellitus patients had been known to have a hypercoagulable state and hypofibrinolysis. The coagulation profile, fasting blood sugar (FBS), glycosylated hemoglobin (HbA1c), urea and creatinine levels were determined in 187 type 2 diabetes mellitus patients (44 male, 143 female, mean age 55 ± 11 years) with or without complications attending the diabetic clinic at outpatient department of Yangon General Hospital (YGH). In these patients, prothrombin time (PT) (12.2 ± 1.4sec), activated partial thromboplastin time (APTT) (32.2 ± 4.7sec), thrombin time (TT) (18.1 ± 2.6sec) were within normal ranges. Fibrinogen concentrations (4.2 ± 1.3g/l) compared with normal range (2-4g/l) were increased. Among them, 102 (55%) patients were raised in fibrinogen concentration (5.08 ± 1g/l). Fibrinogen concentration was significantly higher in females (4.4 ± 1.2g/l) than males (4.0 ± 1.3g/l) (p<0.001). In diabetic patients with HbA1c levels more than 6.4%, fibrinogen concentration and TT were significantly increased, 4.4 ± 1.3g/l and 18.9 ± 2.7sec respectively. Of 77 diabetic patients with increased fibrinogen levels measured by using Human PAI-1 ELISA Kit, 49 (64%) had PAI-1 level more than 50ng/ml. PAI-1 level had positive correlation (r=0.3) with increased fibrinogen concentration in type 2 diabetes mellitus patients. The findings on coagulation status and fibrinolytic activity of type 2 diabetes mellitus patients may be beneficial for management of diabetic patients with thrombotic complication.
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Poster-25
Determination of djenkolic acid concentrations in different preparations of djenkol beans (Da-Nyin Thee) Archidendron pauciflorum Benth.
Thet Thet Mar, Thaung Hla, Lai Lai San, Thin Thin Wah, Nilar and Myo Myo Kyaw
Department of Medical Research (Lower Myanmar)
Djenkol (jenkol) bean poisoning is a cause of acute renal failure occurring in tropical countries. The beans are mildly toxic due to the presence of djenkolic acid which causes djenkolism (jengkol bean poisoning). Djenkolic acid, sulfur containing non-protein amino acid is a plant toxin of djenkol bean from Archidendron pauciflorum Benth. This amino acid precipitates as crystals which cause mechanical irritation of the renal tubules and urinary tract. The aim of the study was to determine the djenkolic acid concentrations in different preparations of djenkol bean. This study was laboratory based analytical study. About 250 g (9 seeds) of djenkol beans were prepared; raw, boiled, baked, fried and salted with water and extracted with 70% ethyl alcohol. The yield amounts of extracts were 22.23g, 19.95g, 20.89g, 23.46g and 17.34g respectively. Each of the extracts was isolated by using column chromatography and isolated djenkolic acid was confirmed by thin layer chromatography using standard djenkolic acid. The concentrations of djenkolic acids were 2.5329g, 0.3993g, 1.6333g, 0.2779g and 0.8446g respectively. Among all preparations raw bean was highest concentration of djenkolic acid and fried preparation was lowest concentrations. This study showed that djenkolic acid in fried preparation is significantly lower than raw, boiled and salted preparation of beans. So the fried preparation is suitable for people who likes to consume djenkol bean.
Poster-26
Body mass index of medical students in University of Medicine, Mandalay
Sanda Kyaw, Aye Aye Thein, Nwe Nwe Yee, Mar Mar Lwin, Win Yu Aung, Ei Ei Khin and Khine Cho Myint
Department of Physiology, University of Medicine, Mandalay
The study was carried out to quantify the Body mass index (BMI) among the medical students in University of Medicine, Mandalay. The changing trend of body weight was assessed among the students. Second M.B.,B.S students (n=610) were participated in this study. Height was measured to the nearest 0.1cm using standard calibrated scale against a wall. Weight was measured to the nearest 0.5kg using bathroom scale weighing machine. BMI was calculated as weight (kg)/ height (m2) and categorized according to BMI criteria for Asian by WHO which sets BMI <18.5 as underweight, 18.5-22.9 as normal, 23.0-29.9 as overweight and ≥30 as obese respectively. Height, body weight, and BMI (mean±SD) for male (n=377;
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18.34±0.82 year) and female (n=233; 17.94±0.61year) students were 1.68± 0.06 m, 59.72±11.6 kg, 21.05±3.71 kg/m2, and 1.57±0.05 m, 50.54±9.54 kg, 20.49 ± 3.62 kg/ m2 respectively. Out of 377 male students, 50% was normal weight, 26% was underweight, 22% was overweight, 2% was obese. Out of 233 female students, 56% was normal weight, 29% was underweight, 12% was overweight, 3% was obese. In comparison with previous studies, body weight and BMI of medical students in this study were significantly increased (p<0.001), percentage of students with normal weight was higher and that of underweight students declined obviously. This finding highlights that most of students become aware of controlling normal body weight. Meanwhile, both overweight and underweight students still exist. Therefore, there is a need to keep an eye on lifestyle and dietary habits of young adults for body weight control.
Poster-27
Assessment of clinical usage of blood transfusion services in National Blood Center, Myanmar
Thaw Zin Aung1, Nwe New Oo2, Ikuma Nozaki1, 3 and Thida Aung2
1JICA Major Infectious Disease Control Project II, Myanmar 2National Blood Center, Department of Health, Ministry of Health, Myanmar 3National Center for Global Health and Medicine, Japan
Clinical use of blood product is key element of blood safety program. The objective of the study is evaluating the clinical usage of blood product issued by National Blood Center (NBC), the biggest blood transfusion service in Myanmar as a pilot study. We reviewed the NBC issue register of January 20 to 31 and February 21 and 22, 2013, retrospectively. Recipient ID number, issued blood product, amount, blood type, and diagnosis of recipient were collected from the register. NBC issued 1232 blood products during study period, including 431 (35.0%) whole blood, 313 (25.4%) fresh frozen plasma, 382 (31.0%) packed red cell, and 77 (6.3%) platelet rich plasma. Most common diagnosis for requesting blood was disease of digestive system (298, 24.2%) such as cirrhosis, neoplasms (234, 19.0%) and blood diseases (233.18.9%). Average frequency of blood transfusion was 1.7 times and 38 recipients needed 5 to 10 times during study period. Major reasons for frequent- blood-transfusion were Hemophilia, Leukemia and Cirrhosis due to HBV, HCV and/or alcohol. Most common infectious disease required blood transfusion was anemia due to HIV infection. Blood transfusion for injury, maternal and child diseases are not assessed in this study because those are included in issue registers of other hospitals. More than half of blood products issued by NBC were component in this period. Majority of recipients suffered from chronic illness such as leukemia, hemophilia. Current rapid movement of medical service in Myanmar may increase the needs of blood transfusion by introduction of high standard treatment.
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Poster-28
A preliminary analysis of oral cancer patients in Asean Costs in Oncology Study-Myanmar (ACTION Study) 2013
Myomin Thane¹, Le Le Win¹ and Swe Swe Win²
¹ACTION Study Group, Department of Medical Research (Lower Myanmar), ²Department of Oral Medicine and Pathology, University of Dental Medicine
Each year, more than 700,000 new cases of cancer occur in ASEAN countries and oral cancer ranks fifth most common. In Myanmar, the occurrence of oral cancer is not clearly known. The purposes of this study are to determine the demographic and pathologic characteristics, treatments plan, patients’ altitude,and causes of death and to analyze the direct and indirect costs of treatments for oral cancer. In this study, 36 cases of oral cancer patients who expired within one year after diagnosis were selected among patients recruited for ACTION Study, admitted at University of Dental Medicine, Yangon from February 2012 to September 2013. Males were 47% and females were 53%. Ages over 40 years were highest (97%) and mean age was 62 years. Squamous cell carcinomas were 89% and tongue was the most common site (42%). As for tumor staging, stage IV were about 81%. Among the oral cancer patients, 50% were planned radiotherapy and chemotherapy, 47% for surgery, radiotherapy and chemotherapy and 3% for surgery and chemotherapy respectively. 56% of patients didn’t receive any treatment. Cancer related deaths were 89% and only 11% were expired due to other systemic diseases. For total costs, mean costs were 446,447 Myanmar Kyats. Among expired oral cancer patients, squamous cell carcinoma were the commonest type, where as tongue was the most common site. Over 40 years of age with advanced stage were found to be high mortality rate. Costs for cancer medicines and other drugs still expensive and it may burden to low-income families.
Poster-29
In Vitro anti-malarial activity of some Myanmar medicinal plants
Hla Myat Mon1,2,3, Khin Khin Win Aung2, Kay Thi Kyaw2, Gadae Maung Maung2, Yu Yu Nwe Oo2 and Myat Chaw Su2,3
1Yangon Technological University, 2Myanma Scientific and Technological Research Department, Yangon, 3Mandalay Technological University, Ministry of Science and Technology
Malaria is one of the major public health problems in Myanmar. Resistance to routine anti-malarial drugs further creates an alarming situation, which requires intensive search of new, effective, and affordable anti-malarial agents. As part of our medicinal plant research, we investigated the in vitro anti-malarial activity of some Myanmar medicinal plants using their ethanolic extracts. Drug sensitivity tests were carried out using Plasmodium falciparum, chloroquine sensitive strain FCR-3 by
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measuring the percent schizont suppression. The concentrations of plant extracts were 100 µg/ml, 50 µg/ml, 25 µg/ml, 12.5 µg/ml, and 6.25 µg/ml in serial dilution. Initial drug sensitivity tests for screening included the first two highest concentrations. Chloroquine diphosphate was included as a positive control. Promising anti-malarial activity was observed in Cyperus rotundus Linn. (Myet-moun- nyin), Curcuma longa Linn. (Na-nwin), Andrographis paniculata Burm.f. (Say-khar- gyi), and Swertia angustigolia Buch.-Ham. (Shan-say-khar-gyi). Percent schizont suppressions of these four plant extracts at 100 µg/ml concentration were 68.85%, 72.13%, 65.57% and 65.57% respectively. They were further tested individually as well as in combination in serial dilution for their in vitro anti-malarial activity and their potential anti-malarial activity was detected. The combination of these four plant extracts in serial dilution of 100 to 6.25 µg/ml concentrations revealed schizont suppression of 95.18%, 67.0%, 37.03%, 30.64% and 26.36% respectively. Present study partly validates the efficacy of Myanmar medicinal plants as candidates to obtain the novel anti-malarial agents of plant origin.
Poster-30
Awareness and attitude on Emergency Contraceptive Pills (ECPs) among drug sellers in Pyin Oo Lwin Township
Tin Tin Wynn1, Theingi Myint2, Hla Soe Tint1, Moe Kyaw Myint1, Yadanar Aung1, Kyaw Oo1, Khin Lin1 and Kyaw Zin Thant1
1Department of Medical Research (Upper Myanmar) 2Department of Health
A community-based cross-sectional descriptive study was conducted with the objective of assessing the awareness and attitude on Emergency Contraceptive Pills (ECPs) among drug sellers in Pyin Oo Lwin Township, from August 2012 to July 2013. Face-to-face interview with 67 drug sellers, Focus Group Discussion with 30 sellers, Individual In-depth Interview with 3 sellers and mystery client method with 12 drug shops were done. The mean age of seller was 27 years, male 56 (83.6%) and 52 (77.6%) were Buddhists. Graduate was 50 (74.6%), owner seller was 29 (43.3%), 36 (53.7%) had less than 3 years selling practice and only 30 (44.8%) had received training and among them half of sellers had received training more than 2 years ago. Maximum knowledge composite score was 25 (median=16) and 35 (52.2%) of the respondents obtained high knowledge level but 49 (73.1%) of respondents obtained low attitude composite score (0-18, median=9). Among socio-demographic characteristics education level was significantly associated with knowledge level (p<0.05). Eighty percent of respondents mentioned they sell ECPs with or without prescription and 58% of sellers mentioned no limitation in amount of drug. About 29 (43.3%) of sellers responded that they have been advice to consumer for pregnancy test. Drug sellers’ attitude was still limited and malpractice in selling ECP was found. Hence we need to be strengthening the knowledge and attitude of ECP among drug sellers who were one of the sources of information about ECP to clients. In future, training programme for drug sellers must be considered in relation with their education level because it was important to increase knowledge level.
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Poster-31
Community preparedness on hazards from storms and flood in Kyaung-Kone and Kun-Chan-Kone Townships, Myanmar
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
Department of Medical Research (Lower Myanmar), Yangon, Myanmar
A cross-sectional study was done in selected villages of Kyaung-Kone and Kun- Chan-Kone Townships in May and June, 2013. A total of 100 households in each township were studied. Fifty eight percent households in Kyaung-Kone and 41% in Kun-Chan-Kone prepared before natural disasters occur. About 45% and 71% respectively prepared to go to safe place when there was flood. About 60% households in Kyaung-Kone and 59% households in Kun-Chan-Kone had preparations during natural disasters. Some (33.6%) had chosen the safest place within their homes or compounds. Thirty seven percent in Kyaung-Kone and 33 % in Kun-Chan- Kone replied that there are emergency response preparations in their villages when flood occurs. Among them, 19% in Kyaung-Kone and 14% in Kun-Chan-Kone had prepared to send information about disasters. Forty percent in Kyaung-Kone and 14% in Kun-Chan-Kone prepared to do emergency rescue operations. Seven percent in Kyaung-Kone and 14% in Kun-Chan-Kone had learnt disasters prevention training provided by government, non government and other organizations. Nearly 100% in both townships got weather reports from different sources but majority received from radio. The study showed that the community preparations on storms and flood in both townships were slightly low. Thus authorities and policy makers should encourage more for community participation to reduce hazards from natural disasters up to township level in collaboration with local and international organizations.
Poster-32
Occurrence of Staphylococcus aureus, Bacillus cereus and their toxins in foods sold on roadside food stalls
Thaung Hla, Thet Thet Mar, Zin Mi Thein and Wai Lwin Oo
Department of Medical Research (Lower Myanmar)
Food poisoning is one of the acute medical emergencies. These incidents were due to unhygienic conditions from farm to fork and lack of knowledge regarding food safety. The objective of this study is to highlight the frequent occurrence of toxin liberated food poisoning organisms in foods sold on roadside food stalls. A cross- sectional laboratory based analytical study was carried out in five townships in Yangon Downtown Area. A total of 150 food samples (30 from each township) were collected and tested. The samples were processed and cultured in appropriate
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media. The growths were identified by colony characteristics, gram staining, some special tests and biochemical reactions. Sensitivity with relevant antibiotic discs was also conducted. Reverse Passive Latex Agglutination tests were performed to detect toxins. Out of 150 samples, 52 (34.66%) were positive for Staphylococcus aureus and Bacillus cereus. Thirty-two were contaminated with Staphylococcus aureus (3 custards, 7 sandwich, 20 sausage and 2 bread and butter varieties). Twenty samples (17 of reheated fried rice and 3 ice-creams) were colonized with Bacillus cereus. Staphylococcus aureus was (100%) resistant to Amoxicillin. Flucloxacillin (90%), Augmentin (95%), Erythromycin(80%), Clindamycin(95%), Methicillin(92%) and Vancomycin(100%) sensitive to this cocci. Bacillus cereus was 100 % resistant to Amoxicillin but was sensitive to Cephalaxin (90%), Augmentin(88%), Erythromycin (75%), Tetracycline (75%), Chloramphenicol (80%) and Septrin (85%). Staphylococcal enterotoxin B was detected in 23 out of 32 and Diarrhoeal type Bacillus cereus enterotoxin in 14 out of 20. Food poisoning due to bacteria is preventable. It is needed to give health education to persons who prepare, sell, handle and consume foods.
Poster-33
Promoting use of recommended Artemisinin-based Combination Therapy (ACT) in preference to Artesunate Mono-Therapy (AMT) in the private sector, Myanmar
Poe Poe Aung1, Thar Tun Kyaw2, Zaw Linn2, Zaw Win Thein1, Swai Mon Oo1, Zayar Lynn1, Phyu Thi1 and Ohnmar1
1 Department of Medical Research (Lower Myanmar) 2 Disease Control Programme, Department of Health
In Myanmar, anti-malarial treatment policy in 2008 shifted from monotherapy to artemisinin-based combination therapy (ACT). General practitioners (GP) play an important role in treating malaria patients in rural endemic areas. To assess the use of recommended ACT among GP, a cross-sectional survey was conducted in 2012 in 80 private clinics in townships (Moegok, Sintgu, Pyin-oo-lwin and Madaya) in Mandalay Region. In data collection, 82 GP (62 male, 20 female) were interviewed using semi-structured questionnaire. Additionally, 212 malaria patients’ records were reviewed and 54 patients (21 P.falciparum and 33 P.vivax) were interviewed. Mean (sd) duration of GP service was 15.2 (12.2) years and 57.3% had ever attended training on malaria. Regarding diagnosis and treatment, 81.7% of GPs used rapid diagnosis test, 54 (65.8%) used artemisinin (4 monotherapy, 50 combination therapy) for uncomplicated clinically suspected malaria, all used artemisinin (10 monotherapy, 72 combination therapy) for confirmed uncomplicated P.falciparum, and 49 (60%) used chloroquine and primiquine combination for confirmed P.vivax malaria. The availability of standard protocol for uncomplicated malaria and severe malaria were 64(78%) and 42 (51%), respectively. Of 212 records, the cases were 80 P.falciparum, 91 P.vivax, 16 mixed infection and 25 missing results. Of 54 patients, 18 practiced self-medication and seeking treatment at the clinic within 24 hours and 48 hours were 12 (22.2%) and
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21(38.9%), respectively. This study highlighted to improve the use of ACT combination drugs for GPs. The distribution in very low cost and encouragement of using the ACT should enhance the promoting use of ACT.
Poster-34
Snack consumption pattern of students aged 12-14 years at No. (4) Basic Education High School, Ahlone Township, Yangon Region
Mya Ohnmar, Theingi Thwin, Moh Moh Hlaing, Sandar Tun, Maung Maung Myint, Thidar Khine, Lei Lei Myint, Khin Hnin Wint Phyu and Yin Yin Aye
Department of Medical Research (Lower Myanmar)
The school-based cross sectional descriptive study was conducted during the period from September to November 2012 to find out snack consumption pattern of students aged 12-14 years attending the No (4) Basic Education High School, Ahlone Township, Yangon Region. One hundred and forty students from Grades (8) and (9) participated in this study. Snack consumption pattern of students were assessed using food frequency method. Majority of the students ate pre-packed instant noodle (54.6%), ready-made fried packed snack (55.4%), processed meat (59.2%), candy (45.4%) and Myanmar traditional snacks (60.8%) in 1-3 times per week. Most of the students (50.8%) drank soft drinks 1-3 times per week and (49.2%) of the studied students drank fruit juice 1-3 times per week. More than forty percent (41.5%) and 25.4% of the students did not drink malted drink and milk. The most common snacks they ate were potato chips and candy bars which were significant sources of calories with few nutrients. These snacks are not expensive, of good taste, of attractive packaging material and available at the school canteen and most of the food shops. BMI for age was used to assess nutritional status, 82.3% of students were within normal BMI-for-age, 10 % were underweight, 5.4% were overweight and 2.3% were obesity. Thirty percent of the students were stunted. The findings in this study highlighted the future nutrition intervention efforts should also be focused on increasing the demand for healthy snacks among adolescents.
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PREVIOUS AWARD WINNERS
42nd Myanmar Health Research Congress Previous award winners
Previous Award Winners (2003-2012)
2012 (41st Myanmar Health Research Congress) Best Paper for Applied Research Initial trial on Multiple Micronutrient sprinkle among children in Myanmar May Khin Than, Htin Lin, Aye Aye Thaw, Htwe Htwe Yu, Lwin Lwin Yi, Hla Myint and Nilar Tin Best Paper for Basic Research Burkholderia pseudomallei isolates from melioidosis cases in Magway Region, Myanmar Thae Thae Min, Kyi Kyi Thinn, Khin Myat Nwe and Tin Sabai Aung Best Paper for Health Systems Research Raising food safety by food safety training program to street food vendors in urban area of Yangon Nay Soe Maung, Htin Zaw Soe, Aye Moe Moe Lwin, Myint Myint, Cho Cho Oo, Myint Thein, Than Than Aye, Wai Hnin Aye and Myo Myint Aung Best Poster Working together among Non Governmental Organizations and public health sector for community-based activities of HIV control in Myanmar 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 Young Researcher Award Basic Research paper The determination of elemental concentration of soil and water in selected areas Moe Moe Han, Ye Hein Htet, Tin Oo, Thaung Hla, Ohmar Oo, Myat Phone Kyaw, Mariam Bi, Ohmar Win and Ni Ni Maw Health Systems Research paper The burden of common childhood illnesses in peri-urban households: The multiple effects of multiple exposures to environmental conditions Su Latt Tun Myint, Khin Thet Wai, Khaymar Mya, Phyu Sin Aye, Tin Tin Wai, Lwin Lwin Ni, Zin Mar Aye, Aung Soe Min and Phyu Thi
2011 Best Paper for Applied Research Understanding malaria transmission and vector bionomics at a forest fringe hilly rural area incorporating Geographical Information System (GIS) application Pe Than Htun, Myat Phone Kyaw, Sein Thaung, Sein Min, Sai Zaw Min Oo, Htun Min, Yan Naung Maung Maung and Thaung Hlaing Best Paper for Basic Research Detecting rotavirus genotypes in children under five years of age admitted for diarrhea in Yangon Children Hospital, 2010-2011 Hlaing Myat Thu, Theingi Win Myat, Khin Mar Aye, Kyu Kyu Khin, Htay Htay Tin, Mo Mo Win, Htin Lin, Thin Thin Shwe and Khin Khin Oo Best Paper for Health Systems Research Empowering TB patients in TB control activities through formation of self help groups: A process evaluation Saw Saw, Wai Wai Han, Tin Mi Mi Khaing, Nay Htut Ko Ko, Thandar Lwin and Naing
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Best Poster Awareness and attitude towards medical ethics among medical registration license training attendees in 2011 Thein Thein Myint, San Shwe, Yin Thet Nu Oo, Wai Wai Myint and Pyae Mon Thaw Young Researcher Award Basic Research paper Malaria antibody: Is it an alternative tool for estimation of local malaria transmission in malaria micro-stratified areas? Khin Myo Aye, Myat Phone Kyaw, Thaung Hlaing, Khin Thet Wai, Myat Htut, Nyunt, Myo Min, Soe Soe Han and Phyo Zaw Aung Applied Research Paper Field evaluation of HRP2 and pan pLDH based immunochromatographic assay in therapeutic monitoring of uncomplicated falciparum malaria Myat Htut Nyunt, Myat Phone Kyaw, Kyu Kyu Win, Khin Maung Myint and Aung Kyaw Kyaw Health Systems Research paper Identifying requirements for targeted risk communication in prevention of dengue transmission in Mawlamyaing, Mon State, Myanmar Pe Thet Zaw, Khin Thet Wai, Tin Oo, Hlaing Myat Thu, Zaw Win, Moe Thida, Tin Tin Wai, Aung Soe Min and Lwin Lwin Ni
2010 Best Paper for Applied Research Prevalence and associated factors of curable sexually transmitted infections and antibiotic susceptibility pattern of Neisseria gonorrhoeae in highway coach drivers, Myanmar Wah Wah Aung, Myo Thant, Khin Thet Wai, Mya Mya Aye, Phyu Win Ei, Thuzar Myint and Moe Thida Best Paper for Basic Research Pharmacokinetics of piperaquine and clinical outcome of acute, uncomplicated falciparum malarial patients after administration of Piperamisinin, a locally manufactured ACT in Myanmar Marlar Myint, Thaw Zin, Marlar Than, Yamin Ko Ko, Khine Kyi Han, Tin Tin Yee, Thin Sandi Htun, Yee Yee Tin and Than Than Nu Best Paper for Health Systems Research Sustainability oriented Action-Cum Research: Youth to youth peer education programme in Okkan Sub-Township, Yangon Division Kyu Kyu Than, Thae Maung Maung, Poe Poe Aung, Than Tun Sein, Tin Tin Wai, Ko Ko Zaw, Yin Thet Nu Oo and Theingi Myint Best Poster Why has Dengue Hemorrhagic Fever (DHF) been transmitted during the dry season in Dala Township, Yangon Division? Pe Than Htun, Hla Myint, Myo Khin, Ye Htut, Tin Htoo Hlaing, Swe Zin Win and Sein Thaung Young Researcher Award Applied Research Paper Applicability of clinical and routine laboratory parameters in diagnosis of tuberculous meningitis Win Lai May, Ei Ei Khin, Khin Saw Aye, Kyaw Oo and Han Win Basic Research paper Bacteriological profile of surgical site infections in Gynecological ward of North Okkalapa General Hospital Phyu Win Ei, Wah Wah Aung, Khin Thet Wai and Mya Thida
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Health Systems Research paper Basic health staff needs in emergency obstetric care training in selected townships of Yangon Division Thae Maung Maung, Kyu Kyu Than, Theingi Myint, Poe Poe Aung, Tin Tin Wai and Su Latt Tun Myint
2009 Best Paper for Applied Research A simulated field evaluation of temephos, pyriproxyfen and Bacillus thuringiensis israelensis (BTI) against dengue vector Aedes aegypti in productive water containers Pe Than Htun, Sein Thaung, Yi Yi Myint, Khin Myo Aye, Moe Thuzar Min, Thuzar Nyein Mu, Kyi Maw Than and Sai Zaw Min Oo Best Paper for Basic Research Pfmdr1 N86 alleles and in-vitro dihydroartemisinin sensitivity status of Plasmodium falciparum in Kawthaung and Butheedaung Kay Thwe Han, Ye Htut and Kyin Hla Aye Best Paper for Health Systems Research Success and challenges of public-private mix DOTS initiatives in Myanmar: A process evaluation Saw Saw, Thida, Thandar Lwin, Tin Mi Mi Khaing, Bo Myint, Khin Sandar Oo, Cho Cho Myint and Thandar Min Best Poster Health and ecological assessment of pesticide residues in Inlay lake, Southern Shan State Thaw Zin, Than Aye, Khin Chit, Khine Thin Naing, San Aye, Phone Myint, Moe Moe Aye and Thiri Aung
2008 Best Paper for Applied Research Efficacy and safety of artesunate-amodiaquine versus artemether-lumefantrine for the treatment of uncomplicated plasmodium falciparum malaria in 4 sentinel sites (Rakhine, Kayin, Mon and Kachin States) in Myanmar Myat Phone Kyaw, Ye Htut, Than Win, Nwe Nwe Oo, Kyin Hla Aye, Myat Htut Nyunt, Win Htut Linn and Khine Nyein Chan Best Paper for Basic Research Neutralizing efficacy of foreign antivenoms against Myanmar Russell's viper (Daboia russelii siamensis) and cobra (Naja kaouthia) venoms Aye Aye Myint, Tun Pe, Kyi May Htwe, Khin Pyone Kyi, San Kalayar Htwe and Sandar Tun Best Paper for Health Systems Research Research-cum action: Fostering referral and health education of public private mix DOTS through operational research Saw Saw, Tin Aye, Khin Swe Win, Myo Zaw, Thet Naing Maung, Yu Yu Lwin, Kyi Kyi Sein, Thyn Thyn and Sun Tun
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Best Poster Chemical contaminants in domestic fruits: Analysis using simple techniques and possible reduction of residues Ohnmar May Tin Hlaing, Than Than Swe, Tin Nwe Htwe, Aung Myat Kyaw, Tin Tin Htike, Myo Myo Aye and San Aye
2007 Best Paper for Applied Research Safety and immunogenicity of DMR recombinant hepatitis B vaccine Myat Phone Kyaw, Khin Pyone Kyi, Myo Khin, Moh Moh Htun, Khin May Oo, Zaw Myint, Win Aung, Mon Mon Aung and Yin Yin Win Best Paper for Basic Research Potency assay of avian Russell’s viper venom Aye Aye Myint, Tun Pe and Sankalyar Htwe Best Paper for Health Systems Research Understanding referral of tuberculosis suspect patients from general practitioner’s clinics to public tuberculosis centre in Myanmar Saw Saw, Win Maung, Myo Myo Mon, Phyo Min Oo, Nyo Aung and San San Aye Best Poster Laboratory repellency effect of the indigenous plant Cybopogon winterionus Jowitt. (Zabalin-Hmwe) crude extracts on three important mosquito vectors Sein Min, Pe Than Htun, Ei Ei Soe, Yan Naung Maung Maung, Sein Thaung, Khin Myo Aye and Yi Yi Myint
2006 Best Paper for Applied Research Serological response to chemoprophylaxis in extended contacts of leprosy a randomized controlled trial Khin Nwe Oo, Nwe Nwe Yin, Tin Tin Han, Khin Thet Wai, Kyaw Myint and Maung Maung Gyi Best Paper for Basic Research Bacteriological evaluation of multi-drug resistant cases among category II treatment failure pulmonary tuberculosis patients Wah Wah Aung, Kyu Kyu Than, Ti Ti, Ah Mar Sein, Myat Thida, Aye Aye Maw, Khine Zar Win and Win Maung Best Paper for Health Systems Research Effect of community involvement in DOTS implementation of TB program in Bago Division (An intervention study) San Shwe, Thin Thin Yee, Kyaw Oo, Ti Ti, Win Maung, Hlaing Myint, Aye Tun and Nyein Nyein Aye Best Poster Study on factors influencing the treatment outcome of tuberculosis treated by 4-FDC Khin Chit, Thaw Zin, Kyu Kyu Than, Win Mg, Ti Ti, Myo Zaw, Kyi May Htwe and Kyi Kyi Myint
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2005 Best Paper for Applied Research Experimental production of goat Russell’s viper antivenom Aye Aye Myint and Tun Pe Best Paper for Basic Research Genomic characterization of rotavirus isolates from Yangon Children Hospital by reverse transcription Polymerase Chain Reaction Khin Mar Aye, Kyaw Moe, Thandar Lwin, Win Mar Oo, Tin Tin Htwe, Thin Thin Shwe and Win Mar Best Paper for Health Systems Research Family and community practices of newborn care in Pyay District Kyu Kyu Than, Than Tun Sein, Ko Ko Zaw, Mon Mon, Myo Myo Mon, Thein Aung, Khin Mar Aye and Myint Lwin Best Poster The efficacy of Alum-potash on Aedes aegypti larvae in laboratory and field areas in Yangon Division Maung Maung Mya, Sein Min, Khin Myo Aye, Ye Ye Myint, Sein Thaung, Thu Zar Nyaing Mu, Le Mon Kyaw, Thet Thet Tun and Pe Than Htun
2004 Best Paper for Applied Research Cost free system for screening of hepatitis C of blood donors in remote areas Myo Khin, Yi Yi Kyaw, Win Pa Pa Naing, Than Than Aye, Swe Zin Yu, San San Oo and Khine Win Best Paper for Basic Research Antimalaria activity and related chemical constituents of Swertia species which are grown in Kayah State Khin Phyu Phyu, Mya Aye, Win Myint, Ye Htut, Kyin Hla Aye and Ni Ni Best Paper for Health Systems Research Marriage practices among selected ethnic groups in rural area of Pa-an Township Kyu Kyu Than, Than Tun Sein, San Shwe, Saw Saw and Nyo Aung Best Poster Community-based control of dengue haemorrhagic fever using alternative methods in a peri-urban area of Yangon Htin Zaw Soe, W Tun Lin and Saw Lwin
2003 Best Paper for Applied Research Evaluation of results on present conventional and alternative vector control activity in prevention and control of dengue/Dengue Haemorrhagic Fever (DHF) Thaung Hlaing, W. Tun Lin, Pe Than Htun, Sein Min, Sein Thaung, Saw Lwin and Soe Thein Best Paper for Basic Research Evaluation of an insect growth regulator (Pyriproxyfen), against Aedes aegypti and Anopheles dirus in the Laboratory Pe Than Htun, Willoughby Tun Lin, Khin Myo Aye, Yee Yee Myint and Chit Thet Nwe 103 Previous award winners 42nd Myanmar Health Research Congress
Best Paper for Health Systems Research Prevalence, case fatality rate and treatment- seeking behaviour of the snakebite victims from two townships of Myanmar Tun Pe, Aye Aye Myint, Sunn Htut, Khin Aye Kyu and Maung Maung Toe Best Poster A pilot study on community-based pesticides poisoning W. Tun Lin, Phone Myint, Sein Min, Sein Thaung, Than Than Swe, Yan Naung Maung Maung, Tin Nu Swe and Paing Soe
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STEERING COMMITTEE AND SUPPORTING COMMITTEES
42nd Myanmar Health Research Congress Committee
42nd Myanmar Health Research Congress Steering Committee Patron: H. E. Union Minister, Ministry of Health Chairman: H. E. Deputy Minister, Ministry of Health Vice-Chairman: Director General, Department of Medical Research (Lower Myanmar) Members: Director General, Department of Health Director General, Department of Medical Sciences Director General, Department of Health Planning Director General, Department of Traditional Medicine Director General, Department of Medical Research (Upper Myanmar) Director General, Department of Medical Research (Central Myanmar) Director General, Department of Food and Drugs Administration General Staff Officer (1), Defence Services Medical Corps Head of Office/Deputy Director General, Ministry of Health Director, International Health Division, Ministry of Health Secretary: : Deputy Director General, Department of Medical Research (Lower Myanmar) Joint-Secretary 1: Director(Admin.), Department of Medical Research (Lower Myanmar) Joint-Secretary 2: Director(Research), Department of Medical Research (Upper Myanmar)
Executive Committee Chairman: Dr. Kyaw Zin Thant, Director General, Department of Medical Research (Lower Myanmar) Vice-Chairpersons: Dr. Khin Lin, Deputy Director General, Department of Medical Research (Upper Myanmar) Members: Dr. Myat Phone Kyaw, Deputy Director General, Department of Medical Research (Lower Myanmar) Deputy Director General, (Public Health), Department of Health Dr. Tin Tin Lay, Deputy Director General, Department of Medical Sciences Deputy Director General, Department of Health Planning Dr. Htay Aung, Deputy Director General, Department of Traditional Medicine Dr. Zaw Win, Deputy Director General, Food and Drugs Administration Col. Tin Maung Hlaing, Commander, Defense Services Medical Research Centre Prof. Dr. Than Cho, Rector, University of Medicine (1), Yangon Prof. Dr. Tint Swe Latt, Rector, University of Medicine (2), Yangon Prof. Dr. Tin Maung Han, Rector, University of Medicine, Mandalay Prof. Dr. Win Myat Aye, Rector, University of Medicine, Magway Prof. Dr. Thein Kyu, Rector, University of Dental Medicine, Yangon Prof. Dr. Shwe Toe, Rector, University of Dental Medicine, Mandalay Prof. Dr. Nay Soe Maung, Rector, University of Public Health, Yangon Prof. Dr. Nwe Nwe Oo, Rector, University of Nursing, Yangon Prof. Dr. Mar Lar Win, Rector, University of Nursing, Mandalay Prof. Dr. Naing Win, Rector, University of Medical Technology, Yangon Prof. Dr. Theingi Hlaing, Rector, University of Medical Technology, Mandalay Prof. Dr. San San Nwe, Rector, University of Pharmacy, Yangon Rector, University of Pharmacy, Mandalay Prof. Dr. Myo Than, Rector, University of Community Health, Magway Prof. Dr. Than Maung, Rector, University of Traditional Medicine, Mandalay Lt. Col. Ko Ko Lwin, Rector, Defence Services Medical Academy Lt. Col. Khin Zaw, Rector, Defence Services Nursing and Medical Technology Academy Prof. Dr. Chit Soe, Professor, Department of Medicine, University of Medicine (1), Yangon Dr. Win Aung, Director (Research), Department of Medical Research (Lower Myanmar) Dr. Hlaing Myat Thu, Director (Research), Department of Medical Research (Lower Myanmar) Dr. Theingi Thwin, Deputy Director, Department of Medical Research (Lower Myanmar) Secretary: Dr. Zaw Myint, Director (Admin.), Department of Medical Research (Lower Myanmar) Joint Secretaries: Dr. Win Maw Tun, Deputy Director, Department of Medical Research (Lower Myanmar) Dr. Kyaw Soe, Deputy Director, Department of Medical Research (Lower Myanmar)
107 Committee 42nd Myanmar Health Research Congress
Academic Sub-committee Chairperson: Prof. Dr. Chit Soe, Professor, Department of Medicine, University of Medicine (1), Yangon Members: Prof. Dr. Mya Thida, Prof/Head, Department of Obst. and Gynae, University Medicine(1), Yangon Dr. Ye Myint Kyaw, Prof./ Head, Child Health Department, University of Medicine (1), Yangon Prof. Dr. Aye Aye Thein, Professor, Neonatolgy Department, Central Women’s Hospital, Yangon Prof. Dr. May Hla Thwin, Prof./Head, Pharmacology Department, University of Medicine (2), Yangon Prof. Dr. May Pyone Kyaw, Prof./Head, Biochemistry Department, University of Medicine, Mandalay U Win Myint, Director, Department of Traditional Medicine Dr. Khin Phyu Phyu, Director, Department of Medical Research (Upper Myanmar) Prof. Dr. Aye Moe Moe Lwin, Head(Admin), University of Public Health, Yangon Dr. Khin Saw Aye, Director (Research), Department of Medical Research (Lower Myanmar) Dr. Theingi Thwin, Deputy Director, Department of Medical Research (Lower Myanmar) Dr. Kyaw Oo, Director, Department of Medical Research (Upper Myanmar) Dr. Han Win, Deputy Director, Department of Medical Research (Lower Myanmar) Dr. Ko Ko Zaw, Deputy Director, Department of Medical Research (Lower Myanmar) Dr. Htin Zaw Soe, Associate Professor,University of Public Health, Yangon Secretary: Dr. Le Le Win, Deputy Director, Department of Medical Research (Lower Myanmar) Joint Secretaries: Dr. Saw Saw, Research Scientist, Department of Medical Research (Lower Myanmar) Dr. Min Wun, Research Scientist, Department of Medical Research (Lower Myanmar) Dr. Yin Thet Nu Oo, Research Scientist, Department of Medical Research (Lower Myanmar)
Best Paper and Poster Selection Sub-committee Chairperson: Prof. Naing Win, Rector, University of Medical Technology, Yangon Members: Prof. Dr. Nwe Nwe Oo, Rector, University of Nursing, Yangon Prof. Dr. San San Nwe, Rector, University of Medical Technology, Yangon Prof. Dr. Nay Soe Maung, Rector, University of Public Health, Yangon Prof. Dr. Myat Thandar, Pro-Rector, University of Medicine (1), Yangon Prof. Dr. Win Win Maw, Prof./Head, Dept. of Microbiology, University of Medicine(2), Yangon Prof. Dr. Nu Nu Aye, Prof./Head, Dept. of Pharmacology,University of Medicine, Mandalay Prof. Col. Kyaw Thet Htun, Professor, Department of Medicine, Defence Services Medical Academy Prof. Dr.Aye Aye Myint, Prof./Head, Child Health Department, University of Medicine, Magway Prof. Dr. Win Myint Oo, Prof./Head, Dept. of Preventive and Social Medicine, University of Medicine (1), Yangon Associate Professor Dr. Hlaing Mya Win, Department of Medicine, University of Medicine(1), Yangon Prof. Dr. Swe Win, Prof./Head, University of Public Health, Yangon Prof. Dr. Aye Aung, Professor, Department of Obst. and Gynae., University of Medicine (2), Yangon Prof. Dr. Htay Htay Tin, Director, National Health Laboratory, Department of Health Dr. San San Aye, Director, Department of Health Planning Secretary: Dr. Khin Thet Wai, Director (Research), Department of Medical Research (Lower Myanmar) Joint Secretary: Dr. Wah Wah Aung, Deputy Director, Department of Medical Research (Lower Myanmar)
Reception Sub-committee Chairman: Dr. Myat Phone Kyaw, Deputy Director General, Department of Medical Research (Lower Myanmar) Members: U Win Myint, Director, Department of Traditional Medicine Dr. Win Pa Pa Naing, Deputy Director, Department of Medical Research (Lower Myanmar) Dr. Nwe Nwe Oo, Deputy Director, Department of Medical Research (Lower Myanmar) Dr. Mo Mo Win, Deputy Director, Department of Medical Research (Lower Myanmar) Dr. Kay Thwe Han, Research Scientist, Department of Medical Research (Lower Myanmar) Dr. Moe Thida Kyaw, Research Scientist, Department of Medical Research (Lower Myanmar) Dr. Myo Myo Mon, Research Scientist, Department of Medical Research (Lower Myanmar) Dr. Yin Thet Nu Oo, Research Officer, Department of Medical Research (Lower Myanmar) Secretary: Dr. Khin Chit, Deputy Director (Research), Department of Medical Research (Lower Myanmar)
108 42nd Myanmar Health Research Congress Committee
Venue Preparation Sub-committee Chairperson: Dr. Hlaing Myat Thu, Director (Research), Department of Medical Research (Lower Myanmar) Members: Dr. Moh Moh Htun, Deputy Director, Department of Medical Research (Lower Myanmar) Dr. Tin Oo, Deputy Director (Admin.), Department of Medical Research (Lower Myanmar) Dr. Yi Yi Kyaw, Deputy Director, Department of Medical Research (Lower Myanmar) Dr. Theingi Win Myat, Research Scientist, Department of Medical Research (Lower Myanmar) Dr. Phyu Win Ei, Research Officer, Department of Medical Research (Lower Myanmar) Daw Thuzar Myint, Research Officer, Department of Medical Research (Lower Myanmar) Daw Thein Thein Yin, Staff Officer (Admin.), Department of Medical Research (Lower Myanmar) U Tin Maung Maung, Research Officer, Department of Medical Research (Lower Myanmar) Secretary: U Than Win, Research Scientist/Head, Department of Medical Research (Lower Myanmar)
Information Sub-committee Chairman: Dr. Win Aung, Director (Research), Department of Medical Research (Lower Myanmar) Members: Dr. Khin Chit, Deputy Director, Department of Medical Research (Lower Myanmar) Deputy Director, Health Education Bureau, Department of Health Dr. Ko Ko Zaw, Deputy Director, Department of Medical Research (Lower Myanmar) Assistant Director, Health Education Bureau, Department of Health Dr. Ni Thet Oo, Research Scientist, Department of Medical Research (Lower Myanmar) U Ye Thway, Research Officer, Department of Medical Research (Lower Myanmar) Daw Nilar Khin, Research Officer, Department of Medical Research (Lower Myanmar) Secretary: Daw Cho Mar Oo, Research Officer, Department of Medical Research (Lower Myanmar)
Refreshment Sub-committee Chairperson: Dr. Theingi Thwin, Director(Research), Department of Medical Research (Lower Myanmar) Members: Dr. Tin Oo, Deputy Director(Admin), Department of Medical Research (Lower Myanmar) U Tin Maung Tun, Assistant Director(Admin),Department of Medical Research (Lower Myanmar) Daw Kyi May Htwe, Research Officer, Department of Medical Research (Lower Myanmar) Daw Khin Myat Mon, Staff Officer, Department of Medical Research (Lower Myanmar) Daw Aye Aye Shein, Staff Officer, Department of Medical Research (Lower Myanmar) Daw Thein Thein Yin, Staff Officer (Admin.), Department of Medical Research (Lower Myanmar) Secretary: U Aye Kyaw, Assistant Director (Admin.), Department of Medical Research (Lower Myanmar)
Secretarial and Audio-visual Aids Sub-committee Chairperson: Dr. Khin Lin, Deputy Director General, Department of Medical Research (Upper Myanmar) Vice-Chairman: Dr. Zaw Myint, Director (Admin.), Department of Medical Research (Lower Myanmar) Members: Daw Khin Swe Aye, Head (Admin. & Finance), University of Medicine (1), Yangon Deputy Director, Department of Health Dr. Thaung Hla, Deputy Director, Department of Medical Research (Lower Myanmar) Dr. Win Maw Tun, Deputy Director, Department of Medical Research (Lower Myanmar) Dr. Ohnmar, Deputy Director, Department of Medical Research (Lower Myanmar) Dr. Ni Thet Oo, Research Scientist, Department of Medical Research (Lower Myanmar) U Tin Maung Maung, Research Officer, Department of Medical Research (Lower Myanmar) Daw Cho Mar Oo, Research Officer, Department of Medical Research (Lower Myanmar) U Nyo Aung, Research Officer, Department of Medical Research (Lower Myanmar) U Khine Win, Research Officer, Department of Medical Research (Lower Myanmar) Secretary: Dr. Kyaw Soe, Deputy Director, Department of Medical Research (Lower Myanmar)
109 Sponsors 42nd Myanmar Health Research Congress
42nd MYANMAR HEALTH RESEARCH CONGRESS
LISTS OF SPONSORS
DIAMOND SPONSOR Nanova Co., Ltd.
PLATINUM SPONSORS Burnet Institute Great Wall Traditional Medicine Manufacturer Lan San Win Co., Ltd. Myanmar American Vision Co., Ltd.
GOLD SPONSORS Amtt Co., Ltd. Fuji Marie Stopes International, Myanmar Okkar Thiri Co., Ltd. Shwin Chan Trading Co., Ltd. Vital Myanmar Zizawa Healthcare
SILVER SPONSORS Biomed Myanmar Co., Ltd. Concordia Co., Ltd. Dawna Cherry Construction Co., Ltd. Multi-Vortex Co., Ltd. Myanmar Zircon Co., Ltd. Royal Ruby Co., Ltd. Sea Lion Co., Ltd. Yee Shin Co., Ltd.
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