THE REPUBLIC OF THE UNION OF MYANMAR MINISTRY OF HEALTH AND SPORTS

46TH MYANMAR HEALTH RESEARCH CONGRESS

Programme and Abstracts

8-12 January 2018

The Republic of the Union of Myanmar Ministry of Health and Sports

46th MYANMAR HEALTH RESEARCH CONGRESS

Programme and Abstracts

8-12 January 2018

FOREWORD

The 46th Myanmar Health Research Congress, organized by the Ministry of Health and Sports will be held at the Department of Medical Research with the aims of attaining the highest quality in health care by promoting research capacity strengthening of healthcare personnel and providing evidence‐based, applicable research findings to end‐users by researchers. In today’s world, we are facing the growing burden of Non‐Communicable Diseases including cancer therefore this year’s congress theme is most appropriate and timely being “To Prevent, Detect, Treat & Live with Cancer”. As we strive for Universal Health Coverage, we look forward to a healthier Myanmar where cancer is detected at early stage and all cancer patients receive quality health care and quality of life. For this to become a reality, research plays a pivotal role for making the correct decisions in cancer diagnosis and subsequent management. All researchers under the Ministry of Health and Sports felt a surge of pride as our National Health Research Policy was approved by the cabinet in September 2017. Among many important issues, to promote Ethical and Responsible Conduct of Research, to develop a national health research agenda and to establish a national health information system for avoiding duplication and redundancy as well as for promoting effective dissemination and appropriate utilization of research findings were included. For research priorities to be made systematically and duplication avoided, we have recently developed the Myanmar Health Research Registry (MHRR) website. MHRR also provides a mutual platform for communication between researchers of different fields and to generate new knowledge and opportunities to develop collaborations for research. In this year’s Myanmar Health Research Congress, a total of 110 research papers will be presented and 80 posters will be displayed by local and international researchers from many countries over the world. Furthermore, 12 symposia and 4 scientific talks will be conducted, in many diverse priority health problems in Myanmar encompassing not only early diagnosis and management of cancer but also environmental health, child and adolescent health, Universal Health Coverage, important issues by the food and drug administration such as Post Marketing Survey, enhancing quality in laboratory systems and advanced techniques in genome sequencing, medical education, implementation research, emerging infectious diseases in our region and the growing threat of antimicrobial resistance, will be presented and discussed by prominent researchers and academicians. Last but not least, we would like to take this opportunity to congratulate and applaud all researchers for their immense effort to make this year’s congress a huge success.

Chairman Organizing Committee 46th Myanmar Health Research Congress

CONGRESS THEME

“To Prevent, Detect, Treat and Live with Cancer” National Health Research Policy

1. To establish national health research information system for avoiding duplication and redundancy, and for promoting effective dissemination and appropriate utilization of research findings 2. To develop national health research agenda 3. To promote ethical conduct of health research through strong and standardized Ethics Review Committees in academic institutions and health research institutions with extensive networking 4. To promote inter‐sectoral and multidisciplinary collaboration and networking in health research through application of various mechanisms given due consideration on economic, social and environmental issues 5. To strengthen linkages with international and local non‐governmental organizations and civil society organizations in health research 6. To establish a well‐functioning system of "Responsible Conduct of Research" in health research and academic institutions 7. To inculcate a good research culture through creation of favorable research environment and promoting research in academic institutions 8. To conduct quality and cost effective health systems research, translational research, implementation research, and biomedical research on issues and challenges encountered in implementing health care delivery system activities including universal health coverage in the country 9. To ensure timeliness of conducting research on urgent and contemporary health issues of importance 10. To utilize evidence‐based research findings as appropriate in comprehensive rural development plans including underprivileged, underserved and marginalized people living in remote/ hard‐to‐reach areas 11. To promote quality assured traditional medicine research through application of state‐of‐ the‐art technology 12. To collaborate with private sector under the principle of public private partnership and foster their participation in the health research system as equal partners 13. To conduct national health research management forums and national health research congress, and to create platforms for improving the domain of health research 14. To enhance ways and means including mechanisms for resource mobilization, sharing and research funding in carrying out essential national health research related to promotive, preventive, curative, rehabilitative and palliative care for priority national health problems

PROGRAMME

46th Myanmar Health Research Congress Programme

46th MYANMAR HEALTH RESEARCH CONGRESS Department of Medical Research No. 5, Ziwaka Road, Dagon Township, Yangon, Myanmar

INAUGURAL SESSION

8th January, 2018 Auditorium (2), Advanced Molecular Research Centre 08:30hr Inaugural speech by H.E. Dr. Myint Htwe Union Minister Ministry of Health and Sports

09:00hr Refreshments

ACADEMIC SESSION Department of Medical Research No. 5, Ziwaka Road, Dagon Township, Yangon

Day 1

Auditorium -1 Day (1)- Morning Session

Chairpersons: H.E. Dr. Myint Htwe Dr. Kyaw Zin Thant Union Minister Director General Ministry of Health and Sports Department of Medical Research

10:00-10:20 Public-private mix tuberculosis control activities in private Paper-1 hospitals in Myanmar: Providers' perspective Thet Naing Maung, Ye Win Thein, Si Thu Aung, Kyaw Zaw, Tin Aung Moe, Khine Thazin, Thazin Thet Win, Ye Htut Kyaw and Ohnmar 10:20-10:40 Programmatic mapping of key populations to strengthen service Paper-2 delivery models: process and good practice to inform HIV prevention programming at sub-national level in Myanmar San Hone, Aye Myat Soe, Yin Thet Nu Oo, Htun Lynn Oo, Sabe Phyu, Khin Malar Tun, Nwe Ni Myint, Kay Khaing Kaung Nyunt and Soe Htut Aung 10:40-11:00 Knowledge, attitudes and practices of Myanmar health Paper-3 researchers towards research ethics Min Wun, Zaw Win Thein, Yin Thet Nu Oo, Myaing M. Nyunt and Henry J. Silverman

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Programme 46th Myanmar Health Research Congress

11:00-11:20 Heterogeneous prevalence of subclinical malaria measured by Paper-4 ultrasensitive PCR in Myanmar: Findings from year 2 survey Myaing M. Nyunt, Kay Thwe Han, Poe Poe Aung, Tin Maung Hlaing, Si Thura, Myo Min, Hnin Su Su Khin, Win Han Oo and Huang Fang 11:20-11:40 Treatment seeking behaviour and factors influencing compliance Paper-5 among hypertensive patients in community clinics, Pakokku Township Tin Aung Cho, Su Su Hlaing and Ko Ko Zaw

Auditorium -1 Day (1) - Afternoon Session (1)

Chairpersons: Professor Dr. Thet Khaing Win Professor Dr. Ne Win Permanent Secretary President Ministry of Health and Sports Myanmar Academy of Medical Science

1:00-1:20 Evaluation of the Quantamatrix Multiplexed Assay Platform Paper-6 system for simultaneous detection of Mycobacterium tuberculosis and the rifampicin resistance gene using cultured mycobacteria and clinical sputum samples Hye Yong Wang, Young Uh, Seoyong Kim, Yun hee Chang, Tae Sun Shim and Hyeyoung Lee 1:20-1:40 Postmortem tuberculosis – hidden community problem Paper-7 Ne Myo Aung, Aung Soe and Soe Min Min Nyunt 1:40-2:00 Prevalence of diabetes, pre-diabetes and associated risk factors Paper-8 among pulmonary tuberculosis patients Ohnmar Kyaw, Aye Aye Lwin, Kyi May Htwe, Khin Than Maw, Thazin Myint, Khine Zar Win, Tin Mi Mi Khine and Khin Saw Aye 2:00-2:20 Pattern of anti-tuberculosis drug resistance among HIV associated Paper-9 tuberculous meningitis patients Aye Su Mon, Sabai Phyu, Mi Mi Htwe, Phyu Win Ei, Wint Wint Nyunt, Nay Win Aung, Mon Mon, Wah Win Htike and Wah Wah Aung 2:20-2:40 Glucose-6-phosphate dehydrogenase deficiency among children Paper-10 visiting Emergency Department of Yankin Children Hospital Win Lai May, Khin Nyo Thein, Han Win, Mya Mya Win, Tin Htar Lwin, Dam Lian Pau, Phyu Hnin Wai, Theingi Thwin and Myat Phone Kyaw

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Auditorium -1 Day (1) - Afternoon Session (2)

Chairpersons: Dr. Thar Tun Kyaw Dr. Tin Tin Lay Director General Director General Department of Public Health/ Department of Human Department of Medical Services Resources for Health

3:00-3:20 Serodiagnosis of clinically suspected adult dengue cases in Paper-11 Yangon General Hospital Moe Yee Soe, Hla Nu Kyi, Wah Win Htike, Win Win Maw and Hla Sein 3:20-3:40 Virological features of dengue patients during 2015 dengue Paper-12 outbreak in Myanmar Aung Kyaw Kyaw, Mya Myat Ngwe Tun, Kyaw Thu Soe, Saw Myat Thwe, Kyaw Zin Thant and Kouichi Morita 3:40-4:00 Subclinical thyroid dysfunction and cognitive function in Myanmar Paper-13 elderly Khin Mi Mi Lay, Thura Tun Oo, Win Lei Lei Sint, Sandar Win, Htike Htike Soe, Khin San Win, Htet Htet Lwin, Theingi Thwin and Kyaw Zin Thant 4:00-4:20 Prevalence of thyroid disorders among adult women attending Paper-14 medical OPD clinics at 300-bedded Pyin Oo Lwin General Hospital Khin Moe Aung, Haung Naw, Su Su Myaing, Myint Myint Khaing, Tin Moe Khaing, Moe Kyaw Myint, Wint Wint Kyi and Win Aung 4:20-4:40 Challenges in provision of medical services at Mandalay General Paper-15 Hospital Yadanar Aung, Kyaw Ko Ko Htet, Kyaw Thu, Kyaw Thu Hein, Kyaw Thu Soe, Tin Tin Moe and Myitzu Tin Oung

Day 2

Auditorium –1 Day (2) - Morning Session (1)

Chairpersons: Dr. Than Htut Professor Dr. Win Htay Aung Director General Rector Department of Food and University of Medicine, Drug Administration Taunggyi

8:30-8:50 Determination of the lead content in red coloured lipsticks from Paper-16 Mandalay market by flame AAS Thee Oo Lwin, Khin Chit, Khin Myo Oo, Khaing Zar Wai, Cho Cho Lwin and Wah Wah Oo 8:50-9:10 Assessment of non-permitted dyes in chilli powder in the markets Paper-17 of Mandalay Nay Lynn, Hla Moe, Wah Wah Oo, Aye Mya Aung, Min Ko Ko, Zin Zin Nwe, Tun Zaw and Than Htut

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Programme 46th Myanmar Health Research Congress

9:10-9:30 Detection of aflatoxin B1 contamination in different types of Paper-18 chilli powder in markets from 2016-2017 Khin Nyein Aye, Aye Mya Sithu Shein, Thiri Myo Myo, Thin Thin Sein, Zinode Win, Aye Hsu Lae, Khin Zin Mar Thein, Khin Chit and Than Htut 9:30-9:50 Determination of water soluble vitamins in commonly consumed Paper-19 some staple cereal foods of Myanmar by HPLC May Thandar Htun, Aye Aye Phyu, Moh Moh Lwin, Zin Nwe Soe, Ei Ei Htway, Khin May Thi and Win Aung 9:50-10:10 Contamination of Vibrio species in grilled fishes from street Paper-20 vendors in Yangon Kyi Kyi Nyein Win, Mo Mo Win, Thin Thin Wah, Su Nyein Aye, Tin Tin Htwe, May Than Htay, Nilar and Myo Myo Kyaw

Auditorium - 1 Day (2) - Morning Session (2)

Chairpersons: Professor Dr. S. Kyaw Hla Professor Dr. Aye Htun President Rector Myanmar Medical Council University of Medicine 2, Yangon

10:25-10:45 Prevalence of diabetes mellitus in subjects with chronic Paper-21 hepatitis C infection Swe Zin Oo, Baby Hla, Hla Win Aung, Swe Zin Soe, May Mon Win Maw, Thandar Aung, Aye Aye Win and Win Naing 10:45-11:05 Factors influencing obesity indices among school teachers from Paper-22 Dagon Myothit (North) Township in Yangon, Myanmar Khin Mittar Moe San, Umi Fahmida, Fiastuti Wijaksono, Htin Lin, Ko Ko Zaw and Min Kyaw Htet 11:05-11:25 Knowledge and experience related to stroke in rural community Paper-23 of Kyaungon Township, Ayeyawady Region Thandar Aung, Ko Ko Zaw and Su Su Hlaing 11:25-11:45 Prevalence and associated risk factors of hypertension among Paper-24 civil servants at Central Institute of Civil Service (Lower Myanmar), Hlegu Township, Yangon Region Zin Nwe Wint, Moh Moh Kyi and Ko Ko Zaw 11:45-12:05 Major gaps in condom distribution and HIV testing uptake among Paper-25 female sex workers and men who have sex with men in Myanmar 2014-15; a mixed-methods study Yadanar Aung, Wai Wai Han, Petros Isaakidis, Tun Nyunt Oo, Nang Seng Noon Kham, Myo Thiri Myint, Nguyen Binh Hoa and Srinath Satyanarayana

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Auditorium -1 Day (2) - Afternoon Session (1)

Chairpersons: Dr. Theim Kyaw Professor Dr. Thein May Saw Rector Professor/Head University of Traditional Department of Pharmacology Medicine, Mandalay University of Medicine, Mandalay

1:00-1:20 Antimicrobial activity of leaves extracts of Tamarindus indica L. Paper-26 (MA-GYEE) Khin Yadanar Kyaw, Cho Yi Myint and Khine Khine Lwin 1:20-1:40 Determination of total phenolic contents and antioxidant activity Paper-27 of the roots of Pimpinella candolleana Wight and Arnott Kyi Kyi Oo, Ei Ei Thant, Khin Myo Oo, Swe Swe, May Thanda Tun, Soe Myint Aye, Win Aung, Theim Kyaw and Yi Yi Myint 1:40-2:00 Effect of ethanolic extract of fruits of Phyllanthus emblica Linn. Paper-28 (Zi-Byu) on blood glucose, lipid profile and malondialdehyde level in prediabetes Thein Soe, Nwe Nwe Than and Thein May Saw 2:00-2:20 The effect of Moringa oleifera Lam. (Dant-da-lun) leaves on Paper-29 plasma glucose level and serum lipid profile in prediabetic subjects Hnin Lai Mu, Myat Myat Soe and Yee Yee Tin 2:20-2:40 Hypoglycaemic effect of traditional medicine formulation (SNG-01) Paper-30 on alloxan-induced diabetic mice Myo Nanda Aung, Khin Phyu Phyu, Khine Khine Lwin, Mu Mu Sein Myint, Aye Win Oo and Phyo Wai Zin

Auditorium -1 Day (2) Afternoon Session (2)

Chairpersons: Professor Dr. Yee Yee Tin Dr. Khin Phyu Phyu Professor/Head Director (Research) Department of Pharmacology Department of Medical University of Medicine 2, Yangon Research

3:00-3:20 Hypolipidaemic activity of combination of extract of Zingiber Paper-31 officinale Rosc. (Ginger) rhizomes and Citrus aurantifolia Linn. (Lime) fruits juice on triton-induced hyperlipidaemic rats Khine Khine Lwin, Mu Mu Sein Myint, Khin Phyu Phyu, Aye Win Oo, Phyu Phyu Win, Khin Tar Yar Myint, Myint Myint Khine, Hlaing Myat Thu and Kyaw Zin Thant 3:20-3:40 Analysis of element in some medicinal plants which have Paper-32 reputed hypoglycaemic activity Khin Tar Yar Myint, Win Win Maw, Mar Mar Myint, Tin Sein Mar, Khine Khine Lwin, Phyu Phyu Win, Nu Nu Wai, Mu Mu Sein Myint and Hlaing Hlaing Phyo

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Programme 46th Myanmar Health Research Congress

3:40-4:00 Insecticidal activity of Lantana camara (Sein-Nar-Pan) against Paper-33 mosquitoes Anopheles minimus, Aedes aegypti and Culex quinquefasciatus Yi Yi Mya, Mya Nilar Chaw Su, Naw Hnin Myint, Than Myat Soe, Tun Tun Win, Than Than Htwe, Ngwe Paw, Ei Ei Htway and Khin May Thi 4:00-4:20 Sub-lethal effect of larvicide and adulticide on the Paper-34 reproductive parameters of dengue vector in Mandalay Mya Nilar Chaw Su, Yi Yi Mya, Naw Hnin Myint, Tun Tun Win, Than Than Htwe, Si Si Aung and Nwe Nwe Aye 4:20-4:40 Emerging neglected helminthiasis and their determinants in Paper-35 Shwegyin Township Kay Thwe Han, Khin Thet Wai, Kyin Hla Aye, Khine Wah Kyaw, Wai Phyo Maung, Pyae Phyo Htut, Naing Naing Win, Yin Yin Myint Myat, Tin Oo and Kyaw Zin Thant 4:40-5:00 Prevalence of strongyloidiasis in rural population of Kyaungon Paper-36 Township in Ayeyawady Region Okka Kyaw, Khine Mar Oo, Wah Win Htike, Win Maw Tun, Kay Thwe Han, Myo Pa Pa Thet Hnin Htwe Aung and Eiji Nagayasu

Day 2 (Parallel Session)

SRC Conference Hall Day (2) Morning Session (1)

Chairpersons: Professor Dr. San San Nwet Professor Dr. Nang Hla Hla Win Rector Professor/Head (Retired) University of Pharmacy, Department of Pharmacology Yangon University of Medicine 1, Yangon

08:30-08:50 Anti-hyperglycemic effect of aqueous leaf extract of Vernonia Paper-37 amygdalina Del. (jrausmufaq;yif)on patients with type 2 diabetes mellitus Chaw Nandar Khaing, Kyi Kyi Oo, Htin Aung Myo, Win Myint, Win Naing, Mg Mg Thet, Htay Hla, Theim Kyaw and Yi Yi Myint 08:50-09:10 Apo E polymorphism and responses to atorvastatin in Paper-38 hypercholesterolaemic subjects Wah Wah Oo, Myat Min and Thein May Saw 09:10-09:30 Pharmacokinetics of theophylline in asthma patients with Paper-39 CYP1A2*1F polymorphism Kyaw Soe and Thein May Saw 09:30-9:50 Effect of ACE gene I/D polymorphism on renoprotective outcome Paper-40 of losartan in type 2 diabetic nephropathy patients Mya Thuzar, Aye Aye Lwin, Khin Than Maw and Nang Hla Hla Win

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9:50-10:10 Effect of GSTP1 polymorphism in lupus nephropathy patients on Paper-41 cyclophosphamide aggressive therapy K. Khine Thu, Aye Aye Lwin, Khin Than Maw, Chit Soe and Nang Hla Hla Win

SRC Conference Hall Day (2) Morning Session (2)

Chairpersons: Dr. Yi Yi Myint Professor Dr. Nu Nu Aye Director General Professor/Head Department of Traditional Department of Pharmacology Medicine University of Medicine 1, Yangon

10:25-10:45 Effect of rosuvastatin once daily versus alternate day dosing on Paper-42 serum lipid profile in hypercholesterolaemic patients Ei Mon Zaw, Soe Yu Zaw and Nu Nu Aye 10:45-11:05 Effect of telmisartan on lipid profile in hypertensive patients Paper-43 Nilar Win, Phyu Phyu Myo Kyaw and Thein May Saw 11:05-11:25 Bioequivalence study of registered amlodipine in healthy Paper-44 volunteers Ei Kay Khine, Mi Mi Zin and Thein May Saw 11:25-11:45 Analgesic effect of rhizomes and leaves of Angiopteris aevecta Paper-45 (Giant fern) on animal model Phyo Wai Zin, Khin Phyu Phyu, San San Htwe, Mya Marlar, Myo Nanda Aung, Zaw Myo Tint, Aye Win Oo, Mu Mu Sein Myint and Khine Khine Lwin 11:45:12:05 Identification of the functional groups in castor seed oil (Ricinus Paper-46 communis L.)(Muufql½kd;eD) by Fourier Transform Infra-Red Spectrophotometer Aye Thida Tun, Moh Moh Lwin, Swe Zin Aung, Aye Aye Phyu, Rai Kit, Ei Ei Htway, Khin May Thi and Win Aung

SRC Conference Hall Day (2) Afternoon Session (1)

Chairpersons: Professor Dr. Khay Mar Mya Professor Dr. Hla Hla Win Rector Professor/Head University of Public Health Department of Preventive and Social Medicine University of Medicine 1, Yangon

1:00-1:20 Associated factors for childhood obesity among primary school Paper-47 children in Taunggyi, Myanmar Honey Win, Moh Moh Hlaing and Ko Ko Zaw

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Programme 46th Myanmar Health Research Congress

1:20-1:40 Qualitative behavioural change on maternal, newborn and child Paper-48 health in Paletwa Township Yadanar Aung, Kyaw Thu Soe and Kyaw Oo 1:40-2:00 Are we equipped with serving the right care? Implications for Paper-49 programme responses regarding gender-based violence Myitzu Tin Oung, Khaing Nwe Tin, Su Su Yin, Kyu Kyu Than, Kyaw Ko Ko Htet, Kyaw Thu Hein and Hla Mya Thway Eindra 2:00-2:20 Husband’s involvement in family planning practice in Sagaing Paper-50 Township Thaw Ter Htet, Thida Aung, Min Ko Ko and Khay Mar Mya 2:20-2:40 Factors determining on utilization of unskilled birth attendants Paper-51 among rural women in Ayeyarwady Region Moh Moh Win, Min Ko Ko, Thida Aung and Khay Mar Mya

SRC Conference Hall Day (2) Afternoon Session (2)

Chairpersons: Professor Dr. Myat Thandar Professor Dr. San San Htay Rector Professor/Head University of Nursing, Department of Preventive and Yangon Social Medicine University of Medicine 2, Yangon

03:00-03:20 The lived experiences of mothers caring for obese children Paper-52 Khaing Thandar Maung, Ni Ni Aung and Kyu Kyu Win 03:20-03:40 The lived experiences of mothers having a child with Paper-53 haemophilia: A phenomenological approach Khin Sandar Win, Moe Wai and Cho Cho Than 03:40-04:00 Longitudinal assessment of nutritional status of two to five years Paper-54 old children living in areas targeted agricultural interventions for food security Theingi Thwin, Moh Moh Hlaing, Mya Ohnmar, Aye Aye Maw, Khin Mittar Moe San, Khin ThidarWai, Hla Phyo Lin, Su Su Hlaing and Naw Myat Su Mon 04:00-04:20 Caring of elderly people with Alzheimer’s disease: Family Paper-55 caregivers’ perspective Myat Thu Zar Khin, Win Hlaing and Yin Yin 04:20-04:40 The life of family caregivers living with elderly people in Yangon Paper-56 Region by using grounded theory approach Soe Soe, Ni Ni Aung and Mg Mg 04:40-05:00 Being a person with brachial plexus injury on dominant hand: Paper-57 A phenomenological approach Win Pa Pa, Thae Hnin Soe and Su Su Nyein

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Day 3

Auditorium - 1 Day (3) – Morning Session (1)

Chairpersons: Professor Dr. Rai Mra Professor Dr. Myint Myint Nyein President Professor/Head Myanmar Medical Association Department of Pathology University of Medicine 1, Yangon 08:30-08:50 Immunoexpression of Bcl-2 in B-cell non-Hodgkin lymphoma Paper-58 May Thu Lwin, Saw Nu Nu Hlaing, San San Hlaing, Moe Hein, Nyein Chan Khin and Yadanar Htay 08:50-09:10 Accuracy of visual inspection of acetic acid test in detection of Paper-59 premalignant conditions of cervix Htar Nandar, Myint Myint Thin and San San Myint 09:10-09:30 Immunohistochemical expression (IHC) and fluorescence in situ Paper-60 hybridization (FISH) of EGFR in colorectal carcinoma Khin Kant Kaw Oo, Min Min Win, Myat Mon Oo, Hnin Nu Htwe, Ko Ko Zaw, Kyaw Soe, Win Pa Pa Naing, Cho Cho Nyunt and Myint Myint Nyein 09:30-09:50 Immunoexpression of Matrix Metalloproteinase-9 in Colorectal Paper-61 adenocarcinoma Saung Hnin Phyu, Saw Wut Hmone, Myint Myint Nyein and Myat Mon 09:50:10:10 Detection of antinuclear antibodies in systemic lupus Paper-62 erythematosus patients using indirect immunofluorescence and line immunoassay methods Aye Aye Khin, Win Kalayar Kyaw and Khin Aye Thin

Auditorium - 1 Day (3) - Morning Session (2)

Chairpersons: Professor Dr. Mya Thidar Professor Dr. Htay Htay Tin Professor/Head (Retired) Deputy Director General Department of Obstetrics and National Health Laboratory Gynaecology Department of Medical University of Medicine 1, Yangon Services

10:25-10:45 Community-based cervical cancer screening using Cobas human Paper-63 papilloma virus (HPV) test and liquid based cytology (LBC) in married women living in North Okkalapa Township, Yangon Mu Mu Shwe, Kyi Kyi Nyunt, Lynn Pa Pa Aye, Kham Mo Aung, Myat Noe Swe, Ni Ni Aung, Ohnmar Sein, Win Maw Tun and Kyaw Zin Thant 10:45-11:05 Human papilloma virus type 16E7 oncogene in cervical Paper-64 intraepithelial neoplasia, in situ and invasive carcinoma of uterine cervix Thu Ya Aung, Nyo Me May Thyn and Khin Thida Aung

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Programme 46th Myanmar Health Research Congress

11:05-11:25 Role of immunofluorescence in detecting HER2/neu status in Paper-65 breast carcinoma Ohnmar Kyaw, Aye Aye Lwin, Swe Zin Myint, Moh Moh Htun, Myint Myint Nyein and Khin Saw Aye 11:25-11:45 Plasma vascular endothelial growth factor A and immuno- Paper-66 expression of estrogen receptor, progesterone receptor, HER2/neu in invasive ductal carcinoma breast Su Nandar Myint, Saw Wut Hmone, Myint Myint Nyein and Myat Mon 11:45-12:05 Immunohistochemical expression of epidermal growth factor Paper-67 receptor (EGFR) in malignant surface epithelial tumours of ovary Thitsar Htet Htet Htoo, Khin Thida Aung, Lei Shwe Zin, Htar Ei Lwin, San San Htwe, Win Pa Pa Naing and Khin Saw Aye

Auditorium – 1 Day (3) - Afternoon Session (1)

Chairpersons: Professor Dr. Zaw Lin Aung Professor Dr. Than Htut Professor/Head Director (Retired) Department of Medicine Occupational Health University of Medicine 1, Yangon Department

1:00-1:20 Identification of poisoning cases admitted to different level Paper-68 hospitals in Mandalay and Ayeyawady Regions, Myanmar Khin Hnin Pwint, Min Wun, Phyo Kyi Thant, Moe Moe Aye, Thin Thin Wah, Swe Swe Aung, Thinzar Myo, Su Su Hlaing and Kyaw Swar Lwin 1:20-1:40 Neurological changes of adult residing in lead exposed Paper-69 environment of Myeik Township Nway Htike Maw, Khine Khine Lwin, Aye Aye Win, Nyi Nyi Win, Swe Zin Soe, Baby Hla, Swe Zin Oo, Hla Win Aung and Khin Phyu Phyu 1:40-2:00 Drinking water sources, prevalence of arsenic in ground water Paper-70 and introduction of arsenic removal filter in the rural area of Thapaung Township, Myanmar Khin Phyu Phyu, Mya Marlar, Thin Thin War, Phyo Wai Zin, Myo Nanda Aung, Tin Tin Han, Aye Thida Htun and Kyaw Zin Thant 2:00-2:20 Determination of heavy metals in drinking water in Mandalay Paper-71 Region Aye Min Maw, Khin Phyu Phyu, Khin Maung Thin, Khaing Khaing Mar, Saw Ohnmar Khin, Kyawt Kyawt Khaing, Aung Thura, Aung Thu and Kyaw Zin Thant 2:20-2:40 Serum zinc level in cirrhosis of liver patients Paper-72 Nang Thee Su Pwint, Saw Wut Hmone, Myint Myint Nyein and Myat Mon

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Auditorium - 1 Day (3) - Afternoon session (2)

Chairpersons: Professor Dr. Win Win Mya Professor Dr. San San Myint Professor/Head (Retired) Professor/Head Department of Obstetrics Department of Obstetrics and and Gynaecology Gynaecology University of Medicine 1, University of Medicine 1, Yangon Yangon 3:00-3:20 Serum vitamin D level in women with normal and pre-eclamptic Paper-73 pregnancies from North Okkalapa General Hospital, Yangon Thazin Aung, May Pyone Kyaw, Aye Thida and Moh Moh Hlaing 3:20-3:40 Comparative study on efficacy and safety of intravenous Paper-74 oxytocin and tranexamic acid in myomectomy Chaw Ei Win, Swe Swe Myint and San San Myint 3:40-4:00 A comparison of efficacy and safety of sublingual misoprostol Paper-75 with intra-vaginal misoprostol for induction of labour at term Zar Chi Min, Phyu Phyu Thein and San San Myint 4:00-4:20 Effect of intravenous magnesium sulphate on red cell Paper-76 deformability in severe pre-eclampsia and eclampsia Thin Myat Myat Shein, Khin Latt and San San Myint 4:20-4:40 Enhancing awareness and practices of married women regarding Paper-77 cervical cancer: An intervention study Nwe Yee Han, Kyaw Wunna and Thida Aung 4:40-5:00 Dietary sodium intake of housewives from South Okkalapa Paper-78 Township of Yangon Region Moh Moh Hlaing, Mya Ohnmar, Khin Mittar Moe San, Sandar Tun, Thidar Khine, Wah Wah Win, Su Su Hlaing, Hla Phyo Linn, Yin Yin Aye and Nyein Nyein Aye

Day 4

Auditorium - 1 Day (4) - Morning Session (1)

Chairpersons: Professor Dr. Mya Mya Aye Professor Dr. Wah Win Htike Rector Professor/Head University of Medical Department of Microbiology Technology, Mandalay University of Medicine 1, Yangon

08:30-08:50 Identification of bacterial pathogen in malignant ascitic fluid Paper-79 from patients with clinically suspected bacterial peritonitis Myo Myint Maw, Ssu Wynn Mon, Hsu Theingi and Wut Hmone Win Htut

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Programme 46th Myanmar Health Research Congress

08:50-09:10 Antimicrobial susceptibilities of Burkholderia cepacia Paper-80 bacteraemia in No (1) DSGH, Mingaladon Khin Phyu Pyar, Yu Aye Latt, Sai Aik Hla, Htoo Pyae Thar, Khin Win Sein, Soe Hlaing and Saw Lwin 09:10-09:30 Seroprevalence of Chlamydia trachomatis infection in cervical Paper-81 cancer screening clinic attendees Lynn Pa Pa Aye, May Zon Myint, Htwe Htwe Nyunt, Kay Khine Soe, Mu Mu Shwe, San Mya, Mon Mon, Wah Win Htike and Win Maw Tun 09:30-09:50 Bacteriological Study and their antibiotic sensitivity pattern Paper-82 among tonsillitis patients attending selected clinics in Pyin Oo Lwin Township during 2016-2017 Saw Myat Thwe, Wint Wint Kyi, Thu Thu Nyein, Chaw Su, Phyo Mon Oo, San San Shwe, Moe Kyaw Myint, Zaw Lin and Kyaw Zin Thant 09:50-10:10 Bacteriological profile of open fracture wound infection in Paper-83 Yangon General Hospital May Thu Lwin, San Mya, Win Thandar Oo, Wah Win Htike, Cho Cho Oo and Hla Nu Kyi

Auditorium – 1 Day (4) - Morning Session (2)

Chairpersons: Professor Dr. Ne Win Professor Dr. Win Win Maw Director (Retired) Professor/Head National Health Laboratory Department of Microbiology University of Medicine 2, Yangon

10:25-10:45 Distribution of hepatitis B virus genotypes and viral load levels in Paper-84 chronically infected patients from Hepatitis Carrier Clinic, Department of Medical Research Hnin Ohnmar Soe, Aye Aye Lwin, Myat Tin Htwe Kyaw, Ohmar Lwin, Wai Myat Thwe, Ni Ni Zaw, Thin Thin Aye and Yi Yi Kyaw 10:45-11:05 Molecular detection of chikungunya virus among inpatients with Paper-85 clinically suspected acute viral infection in medical units at Yangon General Hospital Myat Khwar Phyu Pe, Aung Zaw Latt, Than Than Su, Wah Win Htike, San Yu Hlaing, Kay Khine Soe, Khin Khin Aye, Win Maw Tun and Kyaw Zin Thant 11:05-11:25 Molecular characterization of quinolone resistant genes in Paper-86 Salmonella isolates from enteric fever patients attending Yangon General Hospital Khine Mar Oo and Wah Win Htike 11:25-11:45 Molecular characterization of influenza A viruses detected in Paper-87 children attending Yangon Children Hospital, 2016 Htin Lin, Hlaing Myat Thu, Lay Myint Yoshida, Theingi Win Myat, Wah Win Htike, Win Win Maw, Kay Thi Aye and Moh Moh Htun

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11:45-12:05 Nationwide overview of the distribution of hepatitis B virus Paper-88 genotypes in Myanmar Yi Yi Kyaw, Aye Aye Lwin, Khin Saw Aye, Moh Moh Htun, Hnin Ohmar Soe, Ohnmar Lwin, Kay Thi Aye and Kyaw Zin Thant

Auditorium - 1 Day (4) Afternoon Session (1)

Chairpersons: Professor Dr. Ko Ko Lwin Professor Dr. Chit Soe Rector Professor/Head Defence Services Medical Department of Rheumatology Academy University of Medicine1, Yangon

1:00-1:20 Readiness of malaria volunteers in malaria elimination: Paper-89 Preliminary study in Ayeyawady Region Kyi Maw Than, Myat Phone Kyaw, Aung Thi, Myat Min Tun, Nan Khaing Zar Aung, Moe Moe Aye, Nyan Win Htet and

Wai Wai Myint 1:20-1:40 Preferences of malaria treatment seeking behaviours among Paper-90 mobile/ migrant workers at remote sites in the context of malaria elimination: A mixed-methods study Aung Ye Naung Win, Thae Maung Maung, Khin Thet Wai, Tin Oo, Aung Thi, Mondha Kengganpanich, Ngamphol Soonthornworasiri, Rungrawee Tipmontree and Jaranit Kaewkungwal 1:40-2:00 Knowledge of high school students about malaria prevention and Paper-91 control in malaria endemic area of Pyin Oo Lwin Township Phyu Phyu Win, Moe Kyaw Myint, Ei Ei Swe, Khine Khine Linn, Aung Kyaw Soe, Lain Lan Maung, Win Pa Pa Win and Khin Lin 2:00-2:20 Drug resistant malaria situation of Buthidaung, Rakhine State: Paper-92 Clinical and molecular perspective Kay Thwe Han, Kyin Hla Aye, Zay Yar Han, Phyo Zaw Aung, San Lin Aung, Soe Soe Han, Nay Chi Aung San, and San Kyawt Khine 2:20-2:40 Challenges, gap and opportunities on malaria research in Paper-93 Myanmar (2000-2017) Myat Htut Nyunt

Auditorium - 1 Day (4) Afternoon Session (2)

Chairpersons: Professor Dr. Aye Maung Han Dr. Than Htun Aung Rector (Retired) Deputy Director General University of Medicine 1, Central Epidemiology Unit Yangon Department of Public Health

3:00-3:20 Antibody response to first and second dose of measles vaccination Paper-94 in children Hnin Phyu Phyu Soe, Wah Wah Oo and Aye Aye Myint

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3:20-3:40 Bacteria and viral profile of severe acute respiratory infections of Paper-95 children attending Yangon Children Hospital and Yankin Children Hospital Moe Myat Aye, Latt Latt Kyaw, San Mya, Htay Htay Tin, Win Thein, May Lwin, Tin Moe Phyu, Kyaw Zin Wai and Khin Myitter 3:40-4:00 Estimation of corrected serum calcium level and platelet count in Paper-96 children with dengue haemorrhagic fever admitted to Yangon Children Hospital Khine Hnin Aye, May Thwe Lin, Myint Myint Nyein, Myat Mon and Khin Thida Aung 4:00-4:20 Assessment of thyroid hormone levels among children with obesity Paper-97 Yin Yin Win, Khin Aye Lwin, Theingi Thwin, Aye Aye Maw, Khin Thida Wai, Thandar Myint, Naw Myat Su Mon and Tin Maung Maung 4:20-4:40 Screening of wasting among children 6-59 months using age and Paper-98 sex specific mid upper arm circumferences cut-off (WHO-2007) in urban, Yangon Su Su Hlaing, Moh Moh Hlaing, Chit Ko Han, Aye Aye Thwe, Tin Aye Cho and Mya Ohnmar 4:40-5:00 Clinical presentation and dengue virus serotypes in infants with Paper-99 dengue haemorrhagic fever Moe Oo Phyu, Kyin Hlaing, Theingi Win Myat, Khin Mar Aye, Khin Nyo Thein, Kyaw Zin Wai and Khin Sandar Aye

Day 5

Auditorium - 1 Day (5) - Morning Session (1)

Chairpersons: Professor Dr. Htin Zaw Soe Professor Dr. San San Myint Aung Rector President University of Community Myanmar Maternal and Child Health, Magway Welfare Association 08:30-08:50 Assessment of oral health status among postpartum women in Paper-100 Thingangyun Sanpya General Hospital, Yangon Region Saw Nandar Aung and Ko Ko Soe 08:50-09:10 Factors associated with compliance to the cascade of services Paper-101 for the prevention of mother to child transmission of HIV in Myanmar San Hone, Roger Detels, Li Li, Sung Jae Lee and W. Scott Comulada 09:10-09:30 Is men who have sex with men (MSM) population effectively Paper-102 covered by HIV prevention services in high burden townships in Myanmar? Findings from programmatic mapping San Hone, Htun Lynn Oo, Sabe Phyu, Yin Thet Nu Oo, Aye Myat Soe, Khin Malar Tun, Nwe Ni Myint, Kay Khaing Kaung Nyunt and Soe Htut Aung

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09:30-09:50 Socio-economic impact of HIV on health and health expenditure Paper-103 at a household level in Myanmar: Findings from National Survey Poe Poe Aung, Etoile Pinder, James Cercone, Htun Nyunt Oo, Thet Tin Tun, Lei Lei Win, Yin Thet Nu Oo, Claire Nightingale and Ben Coghlan 09:50-10:10 Effectiveness and acceptability of participatory reproductive health Paper-104 intervention for HIV infected and affected adolescents in Myanmar Myo Myo Mon, Kyaw Min Htut, Htun Nyunt Oo, Lwin Lwin Ni, Aung Soe Min and Ni Ni Htay Aung

Auditorium - 1 Day (5) - Morning Session (2)

Chairpersons: Professor Dr. Theingi Myint Professor Dr. May Pyone Kyaw Pro-Rector Professor/Head University of Medicine 1, Department of Biochemistry Yangon University of Medicine 2, Yangon

10:25-10:45 Characterization of biochemical composition and biological Paper-105 activities of Cobra (Naja kaouthia) venom Thet Thet Mar, Win Aung, Zaw Myint, Tin Ko Ko Oo and Lwin Zar Maw 10:45-11:05 Construction of the cDNA library and detection of the ten Paper-106 sequences of ten positive clones from Russell’s viper (Daboia siamensis) venom gland Thet Thet Mar, Zaw Myint, Aye Win Oo, Aung Zaw Latt, Tin Ko Ko Oo and Kay Thi Aye 11:05-11:25 Comparison of two bedside methods for determination of Paper-107 whole-blood clotting times in assessing coagulopathy in Russell’s viper bites Han Win, Khin Thida Thwin, Khin Saw Aye, Khin Saw Than, Hlaing Mya Win, Ssu Wynn Mon and Kyaw Zin Thant 11:25-11:45 Clinical characteristics of blood stream infection Paper-108 Ne Myo Aung, Myo Lwin Nyein, Mar Mar Kyi and Kyi Lae Yee Lin 11:45-12:05 Vitamin D and treatment response in systemic lupus Paper-109 erythematosus nephropathy Min Lynn Zaw Oo, Thet Thet Mar, Khin Phyu Pyar, Chit Soe and Kyaw Wunna Tun 12:05- 12:25 The role of technetium-99m sulphur colloid liver-spleen Paper-110 scintigraphy to detect hypersplenism in chronic liver disease patients with pancytopenia Phyo Yadanar, Win Mar, War War Wann Maung, Su Thet Oo, Ko Ko Zaw, Moh Moh Hlaing and Ohnmar Swe

Auditorium (1) Day (5) - Closing Session

12:30hr Closing Speech by Director General, Department of Medical Research

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BEST PAPERS AND BEST POSTER AWARDING CEREMONY

Department of Medical Research No. 5, Ziwaka Road, Dagon Township, Yangon

12th January, 2018 Auditorium (2), Advanced Molecular Research Centre 3:00hr Speech by: Professor Dr. Thet Khaing Win Permanent Secretary Ministry of Health and Sports

3:15hr Speech by: Chairman Best Paper and Poster Selection Sub-committee

3:30hr 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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List of the Posters Displayed

Poster Display Session (A): Day 1 & Day 2

Poster - 1 Performance of midwives on tuberculosis control activities in Mandalay Region, 2016 Kyaw Thu Soe and Ko Ko Htwe Poster - 2 Hair growth activity of Angiopteris evecta in rabbit Myo Nanda Aung, Khin Phyu Phyu, Khine Khine Lwin, Mu Mu Sein Myint, Phyo Wai Zin, Zaw Myo Tint, Aye Win Oo, San San Myint and Aye Zarni Poster - 3 Contributions of auxiliary midwives in providing maternal health care services in Myanmar: Women’s and providers’ perspectives Thida, Tippawan Liabsuetrakul, Kyaw Ko Ko Htet and Khaing Nwe Tin Poster - 4 Carbonic anhydrase 9 (CA 9) level in renal cell carcinoma patients Yin Min Htun, Kyaw Zwa Hlaing, Myo Thet Tin, Win Maw Tun, Kay Khine Soe, San Yu Hlaing, Myat Hnin Ei and Mya Ohnmar Poster - 5 Prevalence of low back pain in Yay-Ka-Moe RHC Myo Tint Tun, Khin Thuzar Myaing, Thazin Myint and Tin Tin Soe Poster - 6 Barriers to generating reliable mortality statistics from the vital registration system in Myanmar: A qualitative assessment in two townships Myitzu Tin Oung, Kerry Richter, Pramote Prasartkul, Yadanar Aung, Kyaw Thu Soe, Thuzar Chit Tin and Viroj Tangcharoensathien Poster - 7 Treatment seeking behaviours and compliance of treatment in diabetes patients living in rural area Nyi Nyi Zayar, Ko Ko Zaw, Ko Ko, Myint Shwe, Phyo Aung Naing, Win Marlar Kyin, Kyi Kyi Mar and Tin Tin Wai Poster - 8 Detection of aflatoxin B contents in some Myanmar beans at Yangon wet markets Myat Mon Oo, Hnin Nu Htwe, Mya Thanda Win, Kay Thwe Win, Khin Zar Chi Aung, Kyaw Soe, Min Min Win, Khin Kant Kaw Oo and Moh Moh Htun Poster - 9 Challenges for general practitioners providing healthcare to gender based violence survivors Su Su Yin, Hnin Shwe Zin Hlaing and Su Sandy Poster - 10 Tobacco use and second-hand smoke exposure among married men and women of rural areas in Myanmar: Perceptions and practices Kyaw Lwin Show, Aung Pyae Phyo, Saw Saw, Ko Ko Zaw, Thuzar Chit Tin, Nyein Aye Tun and Khin Thet Wai Poster- 11 Effect of deworming measure for pin worm (Syphacia spp:) control in laboratory rats (Rattus norvegicus) Aye Win Oo, Maung Maung Mya, Than Myat Htay, Than Than Swe, Khin Hnin Yee, Mya Mya Sein, Kay Thwe Han and Win Maw Tun

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Poster- 12 Way forward for Methadone Maintenance Treatment (MMT) Program: looking at a glance at a high burden area Nanda Myo Aung Wan, Kyaw Lwin Show, Yin Thet Nu Oo, Le Le Win and Kyaw Thu Hein Poster- 13 Intestinal parasitic contamination of selected raw leafy vegetables from open-aired market and supermarket of Thingangyun Township Khine Wah Kyaw, Win Win Maw and Hninzi Poster-14 Genome analysis of infectious agents by using next generation sequencing in the Department of Medical Research Kay Thi Aye, Aung Zaw Latt, Nyi Nyi Win, Myat Htut Nyunt, Hnin Ohnmar Soe, Hsu Htet Thwe, Wah Wah Aung, Hlaing Myat Thu and Kyaw Zin Thant Poster-15 Detection of human influenza virus infection with rapid diagnostic testing Moe Kyaw Myint, Saw Myat Thwe, Nay Lin, Aung Kyaw Soe, Win Htay Hlaing and Yi Yi Myint Poster-16 Bacterial contamination of freshly prepared fruit juices from street vendors Tin Tin Htwe, Mo Mo Win, Thin Thin Wah, Kyi Kyi Nyein Win, Su Nyein Aye, May Than Htay, Wai Lwin Oo and Kyaw Kyaw San Poster-17 Immunohistochemical expression of MMP-2 and MMP-9 in oral squamous cell carcinoma Sann Win, Moe Thida Htwe and Zaw Moe Thein Poster-18 Reproductive health communication and behaviours among university students in Yangon Region Nyein Su Aye, Ko Ko Zaw, Phyo Aung Naing, Hnin Hnin Lwin, Tin Tin Wai and Zin Mar Aye Poster-19 Expression of inflammatory markers and glutamic acid decarboxylase level in a rat model of valproic acid induced autism Tin Tin Win Shwe, Motoki Imai, Nay Chi Nway, Thet Thet Lwin, Ohn Mar and Hidehiro Watanabe Poster-20 Effects of intermediate frequency magnetic field exposure on apoptotic and inflammatory genes in brain of young adult male mice Tin Tin Win Shwe, Shin Ohtani, Naoki Kunugita and Akira Ushiyama Poster-21 Developmental exposure to diesel exhaust origin secondary organic aerosol and role of TLR4 in olfactory-based spatial learning activity of neonatal mice Nay Chi Nway, Yuji Fujitani, Ohn Mar, Seishiro Hirano and Tin Tin Win Shwe Poster-22 Phase contrast X-ray tomography brain imaging of rat model autism Thet Thet Lwin, Tin Tin Win Shwe, Motoki Imai, Hidehiro Watanabe, Hiroko Maruyama and Tohoru Takeda Poster-23 Seaweed extract inhibit phosphorylation of tau in human tau stable expressed HEK293 cells Motoki Imai, Fumitaka Kawakami, Keiko Yoshinaga, Takashi Kahara and Hiroko Maruyama

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Poster-24 The association between arsenic-related LINE-1 methylation changes and blood pressure in Bangladesh Takehiro Suzuki, Khaled Hossain, M. M. Hasibuzzaman, Md. Shofikul Islam, Atiqur Rahman, Sudip Kumar Paul, Seiichiro Himeno and Keiko Nohara Poster-25 Preliminary study of concentration and size distribution of atmospheric particulates in Yangon city Daisuke Nakajima, Nay Chi Nway, Win Yu Aung, Zarli Thant, Ei Ei Pan Nu Yee, Ei Ei Phyo Myint, Mayuko Yagishita, Tin Tin Win Shwe and Ohn Mar Poster-26 Novel long lasting pyriproxyfen larvicide (SumiLarv®2MR) against Aedes mosquitoes in schools in Yangon, Myanmar Sai Zaw Min Oo, Sein Thaung, Yan Naung Maung Maung, Khin Myo Aye, Zar Zar Aung, Hlaing Myat Thu, Kyaw Zin Thant and Noboru Minakawa Poster-27 Acquired immunity to malaria in the pre-elimination setting of South- East Myanmar Katherine O’Flaherty, Win Han Oo, Htin Kyaw Thu, Nyi Nyi Zaw, Kyaw Zayar Aung, Myat Mon Thein, Aung Thi, Wai Yan Min Htay, Aung Paing Soe and Freya J. Fowkes Poster-28 Effectiveness of repellent delivered through village health volunteers on malaria incidence in villages in South-East Myanmar: a stepped-wedge cluster-randomised controlled trial Win Han Oo, Paul A. Agius, Katherine O’Flaherty, Kyaw Zayar Aung, Myat Mon Thein, Aung Thi, Htin Kyaw Thu, Aung Paing Soe and Freya Fowkes Poster-29 Effect of enteral tube feeding formula containing local Myanmar ingredients on nitrogen balance study Su May Aung, Wantanee Kriengsinyos, Chanida Pachotikarn and Nipa Rojroongwasinkul Poster-30 Profiling the upper respiratory tract microbiota of patients living with HIV, TB and HIV/TB from Myanmar Kyaw Soe Htun, Yang Fong, Tun Nyunt Oo, Si Thu Aung, Khine Zaw Oo, Thein Zaw, Gregory M. Cook, Htin Lin Aung and Tin Maung Hlaing Poster-31 Possible involvement of hypoacetylation of histone H3K9 in estrogen- dependent transdifferentiation of LH cells to PRL cells in male mouse pituitary Nandar Tun, Myat Thu Soe, Daisuke Endo, Yasuaki Shibata and Takehiko Koji Poster-32 Egg positivity rate of pinworm among primary school children in three townships of Yangon Region Thi Thi Htoon, Saw Mitchell, Win Thein, Htay Htay Tin, Jong-Yil Chai, Woon-Mok Sohn, Bong-Kwang Jung, Min-Jae Kim and Jaeeun Cho Poster-33 The external quality assessment of laboratory testing related to HIV services Eh Htoo Pe, Latt Latt Kyaw, Ohn Mar Lwin, Ikuma Nozaki and Htay Htay Tin

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Poster-34 Population kinetics of Sox9 positive liver progenitor cells in normal and iron-overloaded rat liver: Effects of partial hepatectomy Myat Thu Soe, Yasuaki Shibata, Kyaw Soe, Nandar Tun, Daisuke Endo and Takehiko Koji Poster-35 Detection and molecular characterization of extensively drug resistant Mycobacterium tuberculosis strains in Myanmar Phyu Win Ei, Wah Wah Aung, Wint Wint Nyunt, Thyn Lei Swe, Si Thu Aung, Kay Thi Aye, Chulhun L. Chang, Hyeyoung Lee and Jong Seok Lee Poster-36 A comprehensive model of patient-centred community-based treatment and care for drug-resistant TB (DR-TB) patients in South Dagon Township, Yangon Region Thazin La, Naanki Pasricha, Aye Aye Myint, Tope Adepoyibi, Khin Zaw, Aye Aye Myint and Suman Majumadar Poster-37 HMGB1 modulates the phenotype transformation of vascular smooth muscle cells via NLRP3 inflammasome Sang Wook Shin, Eun Jung Kim, So Youn Park and Chi Dae Kim Poster-38 5-Lipoxygenase in monocytes plays a pivotal role in the progression of vascular inflammation Chi Dae Kim, Seung Eun Baek, So Youn Park and Sang Wook Shin Poster-39 Is gp 130 expression by circulating CD4+ T cells a marker of early rheumatoid arthritis? Si Thu Aung, L.A. Ridgley, J. D. Isaacs, A. G. Pratt and A. E. Anderson Poster-40 Effect of HBV Core promoter mutation and detection of PreS genotype in Myanmar Mi So Seong, Ye Eun Jeong, So Young Kim, Yi Yi Kyaw and Jae Hun Cheong

Poster Display Session (B): Day 3 to Day 5

Poster-41 Needs assessment of WASH in health care facilities in Myanmar Thae Maung Maung, Wah Wah Aung, Mya Mya Aye, Htay Win, Penelope Dutton, Alison Macintyre, Tim Davis and So Pyay Naing Poster-42 Detection of birth defects among newborns at seven tertiary hospitals in Yangon Region Mya Ohnmar, Khin Mittar Moe San, Nway Htike Maw, Moh Moh Hlaing, Sandar Tun, Myat Myat Thu and Khin Hnin Wint Phyu Poster-43 Metabolic risk markers in leptin resistant and leptin sensitive obese adult subjects Hnin Phyu Soe, Sanda Kyaw and Ohnmar Poster-44 Evaluation of wound healing activity of gelatin-polyvinyl alcohol- Chitosan-Eclipta Alba Leaves (Kyeik-hman) composite film Khin Khin Aye, Aye Win Oo, Nu Nu Lwin, Than Myat Htay, Myo Myo Aye, April Pyone, Moh Moh Htun and Win Maw Tun Poster-45 Environmental study on carbapenem-resistant Enterobacteriaceae in drinking water and waste water in selected townships of Yangon, Myanmar Thuzar Myint, Hideharu Hagiya, Mya Mya Aye, Hpoo Pwint Myo Win, Aye Aye Maw, Aye Yin Shwe, Moh Moh Htun and Shigeyuki Hamada

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Poster-46 Fasting lipid profile, hs-CRP and fibrinogen levels in apparently healthy subjects with asymptomatic peripheral arterial disease Wut Hmone Lwin, Thidar Aung and Ohnmar Poster-47 Immunohistochemical expression of RANKL (Receptor Activator of Nuclear Factor Kappa-B Ligand) in ameloblastoma cases Kumudra Kyaw, Kyaw Soe, Yoshitaka Hishikawa and Zaw Moe Thein Poster-48 Utilization of skilled birth attendant at delivery in rural area of Myanmar Khin Htwe Myint and Thiri Win Poster-49 Bacteriological profile and antibiotic susceptibility patterns of multi drug resistant bacteria in diabetic wounds Mya Mya Aye, Yu Wah Lwin, Than Mya, Hpoo Pwint Myo Win, Aye Aye Maw, Hay Mar Win and Moh Moh Htun Poster-50 Biological control of Aedes larvae using native larvivorus fish Aplocheilus panchax in Hpa-an Township, Kayin State Maung Maung Mya, Nan Than Than Kyi, Nyunt Nyunt Oo, Sein Thaung, Zar Ni Min Hein, Yi Yi Myint, Chit That Nwe, Yan Naung Maung Maung and Moh Moh Tun Poster-51 Care of patients with cancer: Role of the family members Myo Khin, Khin May Oo, San Shwe, Le Le Win, Htain Win and Aung Myo Min Poster-52 Seroprevalence of hepatitis B virus among people living with HIV/AIDS at Waibargi Specialist Hospital Min Min Win, Aung Zaw Latt, Khin La Pyae Tun, Khin Than Maw, Kay Khine Soe, Nwe Nwe Soe, Mya Ohnmar, Win Aung and Htin Aung Saw Poster-53 Prevalence of abnormal cervical cytology and associated vaginal infections in HIV seropositive women attending Antiretroviral Therapy Clinic at Insein General Hospital, Yangon Nan Cho Nwe Mon, Hnin Ohnmar Soe, Thazin Myint, Aye Aye Lwin, Mya Mya Aye, Aung Zaw Nyunt, Ne Myo Aung, Mar Mar Kyi and Khin Saw Aye Poster-54 The requisition and utilization of blood in Yangon Children Hospital, Yangon, Myanmar Kay Kay Khine, Thidar Aung, Myint Myint Than, Aye Myint Oo, Hla Hla Win, Zaw Min Latt, Win Pa Pa Naing, Myo Myo Mon and Zin Zin Thu Poster-55 Toward a surrogate model for Hepatitis B virus: molecular clones of core-promoter gene from Myanmar isolates in PGL3B expression vector Mi Mi Htwe, Myat Htut Nyunt, Ei Kyar Phyu Toe, Hsu Htet Thwe, Su Mon Win, Sandar Aung, Cho Cho and Yi Yi Kyaw Poster-56 Bridging the gaps for delivering health messages: Identifying barriers and braces for broadcasting health messages through FM radios Saw Saw, Thanda Linn, Phyu Phyu Aye, Kyaw Lwin Show, Khine Nyein Chan, Myat Hsu Paing Thaw, Saw Hsar Mu Htaw Paw and Kyaw Thu

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Poster-57 A study of growth and virulence of Candida albicans in oral squamous cell carcinoma patients Yin Wai Hlaing, Khin Mya Tun, Kumudra Kyaw, Thein Tun, Sann Win, Sein Shwe and Zaw Moe Thein Poster-58 Antibiogram of patients admitted to medical unit 3, Yangon General Hospital Min Zaw Oo, Aye Mon Win, Kyaw Lwin Show and Saw Saw Poster-59 Relationship between plasma nitric oxide level and peripheral sensory neuropathy in type-2 diabetes mellitus patients with neuropathy Lwin Zin Phyo, Thae Nu Htwe and Ohnmar Poster-60 Assessment of the efficacy of locally delivered Azadirachta indica (Neem) extract gel in chronic periodontitis Hnin Yu Lwin Poster-61 Detection of norovirus among children under five years old with acute gastroenteritis and comparison of clinical features of norovirus and rotavirus gastroenteritis Theingi Win Myat, Hlaing Myat Thu, Ye Myint Kyaw, Nang Sarm Hom, Thin Thin Shwe, Thida Kyaw, Khin Khin Oo, Moh Moh Htun and Kyaw Zin Thant Poster-62 Detection of extended spectrum beta lactamase and carbapenemase producing extra-intestinal pathogenic Escherichia coli by phenotypic methods and antimicrobial sensitivity profile Nilar San, Win Win Maw, Mya Mya Lwin and Thin Thin Mar Poster-63 Determination of formaldehyde content in clothing and toys for children Mya Mar Lar, Khin Phyu Phyu, San San Htwe, Phyo Wai Zin, Tin Tin Han, Ohanmar Win, Tin Tin Htike, Aye Thidar Htun and Thandar Wint Wint Aung Poster-64 Characterization of Culex Flavivirus isolated from mosquitoes collected in Myanmar Aung Kyaw Kyaw, Mya Myat Ngwe Tun, Yi Yi Mya, Hlaing Myat Thu, Kyaw Zin Thant and Kouichi Morita Poster-65 Relationship between insulin sensitivity and body fat composition, and leptin sensitivity in non-obese and obese adults Khin Mi Mi Lay, Sanda Kyaw and Ohnmar Poster-66 Parvovirus B19 infection in children with fever and rash Mo Mo Win, Kyi Kyi Nyein Win, Thin Thin Wah, Kay Thi Aye, Ye Myint Kyaw, Su Nyein Aye, Tin Tin Htwe, May Than Htay and Zin Mi Thein Poster-67 Effectiveness of green tea (Camellia sinensis) mouthwash on periodontal wound healing following gingivectomy Ye Myat Hein, Soe Tun, Kyaw Thiha and Mar Lar Kyi Poster-68 Sexual and reproductive health behaviors of young people in Southern Shan State, Myanmar Hla Mya Thway Einda, Khaing Nwe Tin, Wai Wai Han, Saw Saw and Sabai Thet

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Poster-69 Diagnosis of extra-pulmonary tuberculosis of clinically suspected cases by PCR Kyi May Htwe, Aye Aye Lwin, Khine Zar Win, Hlaing Mya Win and Khin Saw Aye Poster-70 The blood pressure responses after oral glucose load in lean and centrally obese adult male subjects Thiri Win Htein, Zarli Thant and Ohnmar Poster-71 Relationship between blood flow velocity indices of various arterial sites and microangiopathy in type 2 diabetes mellitus patients Nan Yadanar Lwin, Ohnmar Myint Thein and Ohnmar Poster-72 Effects of King Cobra (Ophiophagus hannah) venom and Tamarind (Tamarindus indica) seed extract on liver and kidney of mice Khin Maung Maung, Imad M. Al-Ani, Soraya Ismail and Pakeer Oothuman Poster-73 Screening of hearing impairment with pure-tone audiometer among military personnel Kyaw Soe Htun, Kyaw Htin Latt, Htun Lin Moe, Thein Zaw and Tin Maung Hlaing Poster-74 Point of care diagnosis of asymptomatic falciparum malaria cases by ultrasensitive rapid diagnostic test Myat Phone Kyaw, Aung Thi, Than Naing Soe, Tint Wai Tun, Sithu Ye Naung, Aye Than, Cho Cho, Kyaw Kyaw San and Zaw Lin Poster-75 Parameters predicting poor prognosis in patients with malignant ascites Ssu Wynn Mon, Myo Myint Maw, Han Win, Hsu Theingi and Theingi Thwin Poster-76 Ultrastructural study of dengue virus replication in suckling mouse neuron Min Min Win, Komgrid Charnkaew, Urai Chaisri, Khin Saw Aye and Prida Malasit Poster-77 Prevalence of hepatitis B and C virus infection among chronic liver disease patients in North Okkalapa General and Teaching Hospital (NOGTH) Aye Aye Win, Swe Zin Oo, Nway Htike Maw, Swe Zin Soe, May Mon Win Maw, Zin Mar Soe, San Nwe, Aye Thida and Win Win Swe Poster-78 Young key affected population: Is there any challenge in seeking reproductive health information and care? Kyaw Min Htut, Myo Myo Mon, Htun Nyunt Oo, Zin Mar Aye, Lwin Lwin Ni, Aung Soe Min and Ni Ni Htay Aung Poster-79 Trends in prevalence of influenza A subtypes and influenza B lineages among children attending Yangon Children Hospital, January 2013- September 2017 Htin Lin, Hlaing Myat Thu, Theingi Win Myat, Khaing Moe Aung, Win Mar, Khin Sandar Aye, Thida Kyaw and Kyaw Zin Thant Poster-80 Factors associated with mortality in an HIV cohort in Myanmar (2009- 2016): A retrospective cohort analysis Ni Ni Tun, Alistair McLean, Myo Ma Ma Hlaing, Htun Nyunt Oo, Edmund Wilkins, Elizabeth Ashley and Frank Smithuis

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46th MYANMAR HEALTH RESEARCH CONGRESS PROGRAMME FOR SYMPOSIA AND SCIENTIFIC TALK Department of Medical Research No. 5, Ziwaka Road, Dagon Township, Yangon, Myanmar

8.1.2018 (Monday) 13:00‐16:00hr Day 1 Auditorium (2) Advanced Molecular Research Centre (AMRC)

Symposium on Arsenic Contamination of Groundwater and Chronic Symptoms of Arsenicosis in Myanmar Chairpersons: (1) Dr. Kyaw Zin Thant Director General Department of Medical Research (2) Professor Masugi Maruyama Dean of Faculty of Medicine University of Miyazaki, Japan

Speakers: (1) Arsenic contamination pollution in underground water, Myanmar Dr. Khin Phyu Phyu Director, National Poison Control Centre Department of Medical Research (2) Explanation of the arsenic mitigation project Asst. Prof. Yasunori Yano Project Manager, University of Miyazaki, Japan (3) Assessment of arsenicosis symptoms in arsenic contaminated area, Thabaung Township Dr. Phyo Wai Zin Research Officer, Department of Medical Research (4) The effects of arsenic exposure on nervous system in Miyazaki and Myanmar Asso. Prof. Hitoshi Mochizuki Department of Neurology, University of Miyazaki, Japan (5) Neurological consequences of Arsenic Professor Win Min Thit Professor and Head, Department of Neurology, Yangon General Hospital (6) The role of Dermatology in Arsenicosis Asst. Prof. Hideki Koketsu Department of Dermatology, University of Miyazaki, Japan (7) Arsenic keratosis and squamous cell carcinoma in Dermatology Department, Yangon General Hospital Professor Khaing Khaing Zaw Professor and Head, Department of Dermatology, Yangon General Hospital

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Day 2 9.1.2018 (Tuesday) 09:30‐12:30hr ‐ Auditorium (2), AMRC

Environment and Future Generation (Save Environment, Save our Children) Chairpersons: (1) Professor Khin Maung Lwin Director (Retired) Occupational Health, Adviser, Public Health Domain, Ministry of Health and Sports (2) Dr. Chiho Watanabe President National Institute for Environmental Studies (NIES), Japan

Speakers: (1) What is ‘children’s environment’ and what are its implications on health? Dr. Chiho Watanabe President, National Institute for Environmental Studies, Japan (2) The Impact of the Environmental Hazards on Children’s Health Dr. Cho Cho Win Associate Professor Department of Paediatrics, University of Medicine 2, Yangon (3) Children’s Exposure Science Shoji F. Nakayama, MD, PhD Head, Exposure Dynamics Research Section Head, Office of Research and Development, JECS Programme Office Centre for Health and Environmental Risk Research, NIES, Japan (4) Healthy School Environment for Healthy Student (Through Health Promoting Schools) Dr. Win Lae Htut Assistant Director, School Health Division, Department of Public Health

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Programme 46th Myanmar Health Research Congress

Day 2 9.1.2018 (Tuesday) 13:30‐16:30hr ‐ Auditorium (2), AMRC

Myanmar‐Korea Joint Symposium (2018) on Laboratory Issues: Quality System and Application of Genome Sequencing Technology Chairpersons: (1) Professor Dr. Ne Win, Director (Retired), National Health Laboratory, Myanmar (2) Professor Chulhun L. Chang, Department of Laboratory Medicine, Pusan National University, Yangsan Hospital, Korea Speakers: (1) Quality Systems in Clinical Laboratory‐ Korean Practice Professor Hyosoon Park Sungkyunkwan University School of Medicine, Korea (2) Quality Management Systems for Research and Clinical Laboratories in Myanmar Dr. Moh Moh Htun Director (Research), Department of Medical Research (3) Whole Genome Sequencing Technology of Mycobacterium tuberculosis: Where to go? Dr. Jong Seok Lee Section Head, Microbiology Section, International Tuberculosis Research Center, Korea (4) Application DNA Sequencing Technology in Infectious Diseases Research in Myanmar: Where are we? Dr. Wah Wah Aung Director (Research), Department of Medical Research • Product Talk: Next Generation Sequencing in Microbiology Mr. Terry Loo, Segment Manager for Microbiology and Forensics, Asia Pacific Japan Region (Illumina Inc., ScienceVision Sdn Bhd)

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Day 3 10.1.2018 (Wednesday) 09:30‐12:30hr ‐ Auditorium (2), AMRC

From Vulnerable to Capable: Investing in young people’s health Chairperson: Professor Dr. Thein Thein Htay Former Deputy Minister Ministry of health

Speakers: (1) Global Policy Overview (Presenting Burnet’s Credentials) Professor Margaret Hellard Deputy Director (Programs), Burnet Institute Adjunct Professor, Monash University, DEPM (2) Overview of National Youth Policy: Multi‐sectoral Approach and Colloboration Dr. San San Aye Director General, Department of Social Welfare, Ministry of Social Welfare, Relief and Resettlement (3) Five‐Year Strategic Plan for Young People’s Health: Challenges and Opportunities Dr. Sanda Director, School Health Division, Department of Public Health, Ministry of Health and Sports (4) Young People in a Digital World Dr. Alisa Pedrana EC Partnership Coordinator, Burnet Institute (5) Vulnerable to Capable: why invest in adolescent health Dr. Peter Azzopardi Co‐Head, Global Adolescent Health, Burnet Institute

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Programme 46th Myanmar Health Research Congress

10.1.2018 (Wednesday) 09:30‐12:30hr Day 3 Auditorium (3) Central Biomedical Library

Post market Surveillance on Food and Drug in Myanmar Chairpersons: (1) Dr. Than Htut Director General Department of Food and Drug Administration, Myanmar (2) Ms. Karen Cavanaugh Director of Public Health USAID

Speakers: (1) Post market surveillance on Food and Drug in Myanmar Dr. Htoon Lin Aung Deputy Director Department of Food and Drug Administration (2) Monitoring and surveillance of the food chain in the European Union: Protesting consumer’s health Professor Alan Reilly Adjunct Professor, Institute of Food and Health, University of College Dublin, Belfield, Dublin, Ireland (3) Post Market Surveillance on Drug in Myanmar U Sai Phone Myint Kyaw Drug Control officer (4) The role of Laboratory in Post Market surveillance : Evaluation the quality of medicine to strength the health apparatus of a country Dr. Yanga K. Dijiba Program Manager‐Asia Programs US Pharmacopeia Convention (USP) Promoting the Quality of Medicine Program (PQM) (5) Counterfeit and substandard Drug Mr. Micheal Deats Group Leader‐ Substandard and Falsified Medical Products Essential Medicines and Health Products World Health Organization

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Day 3 10.1.2018 (Wednesday) 13:30‐16:30hr ‐ Auditorium (2), AMRC

Are you aware of cancer? Take action for early diagnosis and effective management Chairpersons: (1) Professor Dr. Soe Aung President of Myanmar Oncology Society, Myanmar Medical Association Professor Emeritus (Medical Oncology), University of Medicine 1 Visiting Professor (Oncology), Defence Services Medical Academy Special Advisor to the Union Minister on Oncology, MoHS ESMO Global Policy Committee Member (2) Professor Dr. Soe Oo Maung Professor/Head (Retired), Radiation Oncology Department, Yangon General Hospital

Speakers: (1) Cancer Control in LMICs (Low and Middle Income Countries); C/CAN 2025: City Cancer Challenge in Yangon Dr. Rolando Camacho Special Advisor Union for International Cancer Control, C/Can 2025 (2) Population Based Cancer Registry (IT'S TIME TO IMPLEMENT NOW) Dr. Kaung Myat Shwe Consultant Clinical Oncologist Nay Pyi Taw General Hospital (1000 Bedded) (3) Early Detection of Cancer Dr. Win Pa Pa Naing Director (Research) Department of Medical Research (4) Towards Novel Imaging Technologies Professor Dr. Tint Lwin Hon. Professor Defence Services Medical Academy Special Advisor to the Union Minister on Radiology, MoHS (5) Cancer Management, Current and Future Perspective Professor Dr. Myo Myint Maw Medical Oncology Department, Yangon General Hospital Professor Dr. Khin Cho Win Radiation Oncology Department, Yangon General Hospital (6) Role of Palliative Care in Survivorship” Dr. Wah Wah Myint Zu Consultant Radiation Oncologist Palliative Care Clinician, Palliative Care OPD Radiotherapy Department, Yangon General Hospital

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Programme 46th Myanmar Health Research Congress

10.1.2018 (Wednesday) 13:30‐16:30hr Day 3 Auditorium (3) Central Biomedical Library

Symposium on Antimicrobial Resistance Chairpersons: (1) Dr. Hlaing Myat Thu Deputy Director General Department of Medical Research (2) Professor Dr. Htay Htay Tin Deputy Director General (Labs) National Health Laboratory

Speakers: (1) Rational Antibiotic Therapy Professor Zaw Lin Aung Professor and Head, Department of Medicine, University of Medicine (1), New Yangon General Hospital (2) Tackling Antimicrobial Resistance by One Health Approach and role of veterinarian in Myanmar Dr. Min Thein Maw Deputy Director, Veterinary Assay Laboratory, Research and Disease Control Division, Livestock Breeding and Veterinary Department, Yangon (3) Emergence of Antimicrobial Resistance and Antimicrobial Stewardship Dr. Hideharu Hagiya Assistant Professor, Division of Infection Control and Prevention, Osaka University, Japan (4) AMR Situation and National External Quality Assessment Scheme of Bacteria Culture and Sensitivity in Central, Teaching, States, Regional and District Level Hospitals, Myanmar Dr. San Mya Deputy Director, Bacteriology Section, National Health Laboratory (5) Antimicrobial resistant bacteria; Carbapenem‐Resistant Enterobacteriaceae Dr. Mya Mya Aye Deputy Director, Bacteriology Research Division, Department of Medical Research

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Day 4 11.1.2018 (Thursday) 09:00‐12:30hr ‐ Auditorium (2), AMRC

Implementation Research: What, Why and How Chairperson: Dr. Than Tun Sein Free Lance Professional for Community Health Development Member of WHO/TDR Scientific Group on Implementation Research

Speakers: (1) Concept of Implementation Research/ Understanding IR Dr. Yodi Mahendradhata Vice Dean for Research & Development, Faculty of Medicine, Universitas Gadjah Mada, Indonesia (2) Designing an Implementation Research: Question, context, and the nature Dr. Khin Thet Wai Director (retired)/Expert, Department of Medical Research (3) Conducting Implementation Research for Strategic Purchasing in Practice: An Implementer’s Perspectives Dr. Han Win Htat National Director Sun Quality Health (SQH) Network of the Population Services International Myanmar (PSI/M) (4) Integrating Implementation Research into Health Systems Dr. Saw Saw Director (Planning) Department of Medical Research

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Programme 46th Myanmar Health Research Congress

11.1.2018 (Thursday) 09:30‐12:30hr Day 4 Auditorium (3), Central Biomedical Library

Gastrointestinal cancer prevention and screening in Myanmar and Japan: Gastric cancer and colon cancer Chairpersons: (1) Professor Hiroyuki Okada Professor, Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences (2) Dr Khin Saw Aye Deputy Director General, Department of Medical Research

Speakers: (1) The Mission of Endoscopic Examination in Society Dr. Sugihara Yuusaku, Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences (2) Diagnosis and Treatment of Helicobacter pylori infection, with special reference to Sero‐diagnosis and antibiotics resistant Professor Kenji Yokota, Department of Bacteriology and Immunology, Okayama University Graduate school of Health Science (3) Helicobacter pylori eradication therapy and endoscopic approach for gastric cancer prevention Professor Hiroyuki Okada, Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences

(4) Colon Cancer Screening Update Professor Thein Myint Professor and Head, Gastroenterology Department, Yangon General Hospital

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Day 4 11.1.2018 (Thursday) 13:30‐16:30hr ‐ Auditorium (2), AMRC

"Making health care Everybody’s business” via innovative community mobilization Chairpersons: (1) Dr. Thar Tun Kyaw Director General Department of Public Health/ Department of Health Services

(2) Dr. Than Tun Sein Free Lance Professional for Community Health Development Member of WHO/TDR Scientific Group on Implementation Research

Speakers: (1) Role of community participation in health care setting Dr. Nanda Win Medical Superintendent Hsipaw Hospital, Shan (North) (2) Social activities at the hospital and in community (Everyone participating health system in Pindaya) Dr. Than Min Htut Medical Superintendent Pintaya Hospital, Shan State (3) Community participation in hospital development plan and role of health managers Dr. Ye Win Township Medical Officer Latpatan Township, Bago Region (4) Special effort 2017: Community engagement for better health care delivery Dr. Yan Naing Maung Medical Superintendent Bago Hospital

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Programme 46th Myanmar Health Research Congress

11.1.2018 (Thursday) 13:30‐16:30hr Day 4 Auditorium (3), Central Biomedical Library

Scientific Talk Chairpersons: (1) Professor Shigeru Okada Chairperson, Myanmar‐Japan Collaboration Project for Fostering Medical Human Resources (MCJP) Emeritus Professor, Okayama University School of Medicine and Pharmaceutical Sciences, Okayama, Japan

(2) Dr. Myo Khin Member, Ethics Review Committee, Department of Medical Research Professor, Center for Global Partnerships and Education Project, Okayama University

Speakers: (1) Future direction of medical and nursing care in super‐aged society Professor Fumihiro Mitsunobu Department of Longevity and Social Medicine (Geriatrics), Okayama University (2) Air Pollution and Health in Asian Countries Associate Professor Takashi Yorifuji Department of Human Ecology, Graduate School of Environmental and Life Science, Okayama University (3) Recent advances in Translational Cancer Research: Building Bridges between Bench and Clinical Practice Associate Professor Dr. Si Lay Khaing Consultant Obstetrics & Gynaecology, Faculty of Medicine, University of Malaya (4) Development of Innovative Research in Medical Science and Technology in Myanmar Professor Aung Than Batu Emeritus Medical Researcher Former Director General, Department of Medical Research Director (Research & Human Resources), WHO S.E.A Region; Professor of Medicine, Institute of Medicine 2, Yangon

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Day 5 12.1.2018 (Friday) 09:30‐12:30hr ‐ Auditorium (2), AMRC

Building bridges for Emerging Infectious Diseases in the Region Chairpersons: (1) Professor Dr. Pe Thet Khin Chairman Ethics Review Committee Department of Medical Research (2) Professor Herawati Sudoyo Deputy Director Fundamental Research Eijkman Institute, Jakarta, Indonesia

Speakers: (1) The threat of emerging vector‐borne viruses in Southeast Asia Dr. Ron Rosenberg Associate Director for Science, Division of Vector‐Borne Diseases, National Centre for Emerging & Zoonotic Infectious Diseases, Centres for Disease Control & Prevention (2) Influence of Genetic Diversity on Infectious Diseases, Indonesian Perspective Professor Herawati Sudoyo Deputy Director Fundamental Research, Eijkman Institute, Jakarta, Indonesia (3) Whole‐Genome Sequencing: Role in Emerging Infectious Diseases Ms. Frilasita Yudhaputri Researcher Emerging Virus Research Unit (4) Zika Updates Dr. Khin Saw Aye Myint Head Emerging Virus Research Unit (5) Emerging infectious diseases in Myanmar Dr. Aung Zaw Latt Research Scientist, Quality Control Division, Department of Medical Research

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Programme 46th Myanmar Health Research Congress

12.1.2018 (Friday) 09:30‐12:30hr Day 5 Auditorium (3), Central Biomedical Library

How to turn out high quality medical doctors in the field of education, clinics and research Chairpersons: (1) Prof. Yoshihiro Kimata Director, Myanmar‐Japan Collaboration Project for Fostering Medical Human Resources (MCJP) Professor& chairman, Department of Plastic Surgery, Okayama University School of Medicine and Pharmaceutical Sciences, Okayama, Japan

(2) Prof. Zaw Wai Soe Rector, University of Medicine (1), Yangon Department of Human Resource for Health

Speakers: (1) What are students from Myanmar are doing at Okayama University? Prof. Akihiro Matsukawa Vice Dean, Okayama University Medical School, Director, Medical Education Renovation Center, Professor and Chair, Department of Pathology and Experimental Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University

(2) Quality Healthcare through Quality Educators, Clinicians, Researchers and Administrators Dr Tin Tun Deputy Director General Department of Human Resources for Health Ministry of Health and Sports

(3) Experience and Reflection of study in Okayama university Dr Tun Pauk, University of Medicine 1, Yangon Mr Aung Ye Oo Final Part II student, University of Medicine 1, Yangon Mr Pyae Phyo Hein Final part I student University of Medicine 2, Yangon

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ABSTRACT OF THE TALK 46th Myanmar Health Research Congress Abstract of the Talk

DEVELOPMENT OF INNOVATIVE MEDICAL SCIENCE AND TECHNOLOGY IN MYANMAR

Professor Aung Than Batu Emeritus Medical Researcher Former Director General, Department of Medical Research Director (Research & Human Resources), WHO S.E.A Region Professor of Medicine, Institute of Medicine 2, Yangon

1. Concise overview of medical research in Myanmar Since the beginning of organized medical research in Myanmar in 1962/63, supported by government, the twin aims of medical research ‐ which is to improve the health of the people and advance medical and allied sciences through research ‐ has remained unchanged. The six missions of the newly created Burma Medical Research Institute enunciated then were to investigate the following factors affecting national health: nutrition, infections, their interaction, others; and in order to do so ‐ to develop drug research and supportive services. These six missions remain unchanged for decades, although there were shifts in emphasis and modifications from time to time. Then from the late eighties and nineties till the end of the millennium, there were major ventures into new research areas such as the study of toxic environmental factors, advances beyond research at the cellular level into the rapidly emerging science of molecular biology, molecular genetics and DNA technology and the establishment of new research centers. Research upstream into some aspects of human behavior affecting health in vulnerable groups was undertaken using innovative methods that won international acclaim. Research downstream into commercial production of newly devised health products was undertaken causing policy clashes with higher authorities; and as a departure from previous well entrenched functions, even emergency services were provided in some areas of expertise. All this went on till the end of the century and beyond, bringing up the need for a review of DMR/ Medical Research Council’s role and research policy in response to accelerating changes in science worldwide and rapidly evolving government health policy. A concise overview of DMR’s research‐related activities in this decade (2000 ‐ 2017) shows that, as before but with changing emphasis , they are mostly importation and establishment from elsewhere of already known medical science and technology, transfer to other institutions in Myanmar, and their utilization to support health services and teaching of postgraduates at medical universities, thus helping to improve health of the people and advance medical science ‐ which is the twin aim of Myanmar’s medical research policy. However, the balance between exploitation of existing knowledge and technology and exploration of the new – is one‐sided; mostly exploitation and very little exploration at the frontiers of medical science and at the intersection of medical science and other sciences. The response to emerging knowledge and technology in this age of rapid changes is cumbersome and hampered by bureaucracy as a government department. Most of the medical research activities are operational level research which improves clinical and public health care and supportive laboratory services. Strategic level research, compared with previous decades, is now quantitatively and qualitatively low and often embedded in aid

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Abstract of the Talk 46th Myanmar Health Research Congress programs of foreign governments and UN bodies such as WHO, UNICEF and other NGO’s, with very few initiated and executed independently by Myanmar health institutions before or after start of these long term health programs. Fundamental research is very seldom done, and those undertaken are mostly, with very few exceptions, component parts of global surveillance programs or those conceived and executed by individual foreign scientists or research institutions. Nevertheless they are beneficial in providing training and materials to Myanmar scientists and institutions. Medical Universities in Myanmar, like others world‐wide, accept that their function is to transfer knowledge and to generate knowledge, and a large volume of research is carried out by postgraduates and sometimes by teachers also, but the quality of their output is generally regarded as low, although a proper, objective, independent appraisal has not yet been carried out recently, according to available information. Most Master level postgraduates in clinical subjects are intent on a career as clinicians and the research they undertake is merely to satisfy current requirements for Master’s degree and research interest is seldom sustained. The present system of postgraduate training at Master level ‐ which aims to produce an individual with both sufficient knowledgeable and skills as a specialist in clinical medicine as well as a well‐trained researcher with practical experience in undertaking a research project and defending the results in a thesis – defeats both ends; one activity distracts the other. The two streams ‐ pursuit of a clinical career OR a research/ teaching career should be separated early. The two may or may not be combined at Doctorate level. This early separation of the two streams is the practice followed by the Royal Colleges and the Universities in the United Kingdom as well as in similar institutions in the USA. 2. Development of Innovative Medical Science and Technology in Myanmar Research activities consist of Discovery, Invention, and Innovation –all combined together or comprising only some of them in different combinations; they differ in the thinking process as well as in the subsequent actions carried out. All research is done in accordance with the Scientific Method which consists of Observation, Hypothesis, Experiment, and Confirmation, Refutation or Falsification. Because of all the reasons already stated, there is a NEED to promote, support, develop, maintain and implement “Innovative Medical Science and Technology in Myanmar” – more than it is being done now and at an increased pace and in a different way. There is such a NEED, particularly at Medical Research Councils & Medical Research Institutions; Universities of Medicine and allied sciences, the Myanmar Medical Academies, Myanmar Medical Association and similar Non‐Governmental Organizations (NGO’s) ‐ so that Myanmar medical scientists and medical scientific institutions will be more innovative in ideas, outlook and the way they do science ‐ and thus ultimately benefit medical science in the country and the health of the people of Myanmar. Within the context of medical research being promoted, supported and executed by various concerned institutions, there is a NICHE which is not yet adequately filled; there is still a need for further Innovative Research especially in scientific fields at the outer fringes of current medical science and technology and at the intersection of medical science and other sciences.

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ABSTRACTS OF THE PAPERS PRESENTED 46th Myanmar Health Research Congress Abstracts of the papers (Day 1)

Paper Reading Session: Day 1

Morning Session, Auditorium (1) Paper-1

Public‐private mix tuberculosis control activities in private hospitals in Myanmar: Providers' perspective

Thet Naing Maung1, Ye Win Thein1, Si Thu Aung2, Kyaw Zaw1, Tin Aung Moe1, Khine Thazin1, Thazin Thet Win1, Ye Htut Kyaw1 and Ohnmar1

1Myanmar Medical Association, Public‐Private Mix TB Project 2National TB Programme, Department of Public Health, Nay Pyi Taw

This study aims to identify activities concerned with tuberculosis (TB) diagnosis, process and management system in private hospitals in Myanmar and their linkage to National TB Programme (NTP). In a cross‐sectional survey, structured questionnaires were used to assess hospital structural profile and diagnostic facilities for TB in 22 private hospitals, and 143 clinicians’ knowledge and management of TB. In qualitative approach, 7 focus group discussions and 23 key informant interviews were performed. Of all hospitals, lack of hospital guideline for TB control (90.9%), no reporting system to NTP (95.5%), poor knowledge about administrative TB infection control measures, and non‐use of external quality assurance for sputum smear microscopy (12 out of 14 laboratories) were reported. Clinicians included medical officers (MOs) (61.5%), general physicians (15.4%) and chest physicians (2.1%). Findings were: clinicians’ awareness about sputum examinations for diagnosis of presumptive adult (73.4%) and childhood TB patients (26.6%); Gene X’ pert (68.5%) and the criteria for use (35%); current practice of making TB diagnosis (57.3%) and treating TB patients (14.7%); and use of chest X‐ray (96.1%) and sputum microscopy (87.4%). All chest physicians had correct knowledge and referred TB patients to NTP for treatment. Among general physicians and MOs, correct knowledge included TB evaluation with sputum examination for all adults (90.9%; 76.1%), number of sputum specimen required (18.2%, 25%) and timing of three follow‐up sputum examinations (18.2%; 3.4%) respectively. Despite all general physicians knew treatment regimen for a new adult drug sensitive TB patient, 4.5% incorrectly answered drugs used in initial phase, and 54.5% of general physicians and most of pediatricians reported non‐referral of TB patients for treatment. In qualitative findings, there were no specific financial and social support programme for TB management at private hospitals, limitations in missed dose tracing, contact and loss to follow‐up tracing, no TB case notification and outcome report from private hospitals to NTP, and they reported not receiving feedback for their referred patients from NTP. In conclusion, private hospitals need to engage in Public‐Private Mix TB control activities by establishing systematic linkage with NTP and TB combating partners to fulfill the End TB Strategy’s goals.

 3  Abstracts of the papers (Day 1) 46th Myanmar Health Research Congress

Morning Session, Auditorium (1) Paper-2

Programmatic mapping of key populations to strengthen service delivery models: process and good practice to inform HIV prevention programming at sub‐national in Myanmar

San Hone1, Aye Myat Soe3, Yin Thet Nu Oo2, Htun Lynn Oo5, Sabe Phyu4, Khin Malar Tun6, Nwe Ni Myint5, Kay Khaing Kaung Nyunt1 and Soe Htut Aung7

1National AIDS Program, Department of Public Health 2Department of Medical Research 3World Health Organization, Myanmar 4UNAIDS, Myanmar 5Alliance, Myanmar 6ICAP at Columbia University in Myanmar 7FHI360, Myanmar

The National Strategic Plan for HIV (2016‐2020) has prioritized townships according to the HIV burden and size of key populations (KP). Optimizing resources allocated to these townships requires a systematic assessment of where KP can be reached and the best method for delivering services within local areas. Pursuant to it, Programmatic Mapping (PM) was implemented in 46 high burden townships to collect critical information to identify the high risk venues, service delivery gaps, and understand the social network structures which KP use to share information and support each other. This paper highlights the process, challenges and good practices of implementing PM. In each township, a mapping team composed mostly of KP members was recruited for each KP group to conduct geographical and social mapping. Master hotspot list for each KP was prepared with the involvement of all stakeholders; and those hotspots were visited by mappers. Quantitative interviews were used to gather information on the nature of hotspot, average number of KP for a week and at peak time, the availability of preventive measures and outreach. Qualitative methods were used to explore the social networks, nature of hidden populations and ways to reach prevention measures. A total of 1,726 Female Sex Worker (FSW) hotspots; 1,538 Men who have Sex with Men (MSM) hotspots; and 765 People Who Inject Drugs (PWID) hotspots were mapped. These represented an average of 37 FSW, 33 MSM, and 18 PWID hotspots per township. Challenges included recruiting motivated and dedicated mappers, time constraint, and finding a better advocacy strategy that minimize the risk of harassment to KP and non‐acceptance rate at the hotspots. PM helps policy makers, planners and implementers to understand the local context and to strengthen service delivery models in line with the operational dynamics of the target populations. Findings from the PM alarms the NAP and local health officials on the existence of hidden groups/new hotspots and the urgent needs to redesign HIV prevention services in the local contexts. In this sense, township HIV plans should be developed tailoring service delivery to improve the quality and coverage of the HIV service continuum for KP.

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Morning Session, Auditorium (1) Paper-3

Knowledge, attitudes and practices of Myanmar health researchers towards research ethics

Min Wun1, Zaw Win Thein3, Yin Thet Nu Oo1, Myaing M. Nyunt2,3 and Henry J. Silverman2

1Department of Medical Research, Ministry of Health and Sports 2Department of Medicine, University of Maryland School of Medicine, Baltimore, USA 3Institute for Global Health, University of Maryland School of Medicine, Baltimore, USA

An increase in health research in Myanmar has enhanced the importance of research ethics. Our objective was to assess the knowledge, attitudes and practices of health researchers (HR) regarding research ethics and informed consent (IC) practices. We distributed a (anonymous) self‐administered questionnaire to a convenient sample of HRs from governmental and non‐governmental research Institutions. We used descriptive and chi‐ square statistics to analyze the data. Of 169 participants, 65.1% were female, 74.0% held a Masters or Doctoral degree, 43.2% had >5 years of research experience, and 35.5% had previous ethics training. More than 95% thought that research involving human participants should be reviewed by an ethics review committee (ERC), that researchers should have training on research ethics, and that there should be measures to enhance confidentiality. Of these participants, 13.6% thought that it was not necessary to give full information to participants with limited understanding, 15.0% thought that ERC review would delay research, 15.6% agreed it is acceptable to fabricate research data, and 6.6% thought that it was sufficient to obtain IC from a community leader, rather than the participant. Regarding IC practices, 89.9% obtained IC from research participants; >90% said the IC forms were written in lay‐person’s language, that adequate time was provided for discussion before signing the IC form, 41.3% gave a copy of IC to the participant, and 77.9% provided alternate methods of providing information to illiterate participants. Majority of HRs held positives attitudes regarding ERCs; agreed with receiving training in research ethics; and conveyed good IC practices. However, many HRs held suboptimal opinions regarding other aspects of research ethics and certain IC practices. We recommend additional training in research ethics and additional review of IC practices for HRs. We also recommend further studies to determine the generalizability of our findings to other institutions in Myanmar.

 5  Abstracts of the papers (Day 1) 46th Myanmar Health Research Congress

Morning Session, Auditorium (1) Paper-4

Heterogeneous prevalence of subclinical malaria measured by ultrasensitive PCR in Myanmar: Findings from year 2 survey

Myaing Myaing Nyunt1, Kay Thwe Han2, Poe Poe Aung3, Tin Maung Hlaing4, Si Thura5, Myo Min6, Hnin Su Su Khin7, Win Han Oo8 and Christopher V Plowe1

1Duke Global Health Institute, Duke University, USA 2Department of Medical Research 3Institute for Global Health, University of Maryland School of Medicine 4Defense Services Medical Research Center, 5Community Partners International 6Myanmar Medical Association, 7Population Services International, 8Burnet Institute

A malaria elimination campaign underway in the Greater Mekong Sub‐region (GMS) aims to prevent the spread of artemisinin‐resistant falciparum malaria beyond the region. Elimination may require drug treatment of all malaria infections, including low density, subclinical infections that may represent a previously unrecognized transmission reservoir. In Myanmar, targeted mass drug treatment is being evaluated using ultrasensitive PCR‐ based testing that is thousands‐fold more sensitive than rapid diagnostic tests (RDT) and hundreds‐fold more sensitive than standard PCR. In collaboration with seven governmental and non‐governmental malaria elimination partners, cross‐sectional surveys of malaria prevalence in 43 villages located in 13 malaria endemic rural townships of in nine State and Regions of Myanmar was conducted. A total of 7,735 finger‐prick blood was collected for rapid diagnostic testing and for ultrasensitive multiplex reverse transcription real‐time PCR (usPCR) analyses. Of them, 7,728 samples (99.0%) were successful for PCR analysis. In preliminary analyses, mean age of participants were 26 years with 49.0% female and 2.2% pregnant women. About 96.0% were stable population and 4.7% had reported fever within 24 hour. The prevalence of P. falciparum (both mono‐infection and mixed with P. vivax) ranged from 0‐0.1% by RDT, and 0‐7.2% by usPCR; and P. vivax (both mono‐ and mixed with P. falciparum) 0‐0.2% by RDT and 0‐23.8% by usPCR. Prevalence by usPCR by villages varies from as high as 2.8% to 7.2% for P. falciparum and 5.8% to 23.8% for P. vivax, and as low as 0% to 0.3% for P. falciparum and 0% to 4.2% for P. vivax. Subclinical malaria at very low densities can be reliably detected by a new, DNA and RNA‐based, finger‐prick usPCR method. Data revealed that the prevalence of malaria in Myanmar is highly heterogeneous from village to village, even within the same township, highlighting the need for microstratification of malaria risk to target interventions. Prospective longitudinal studies assessing the clinical and transmission risks posed by this subclinical malaria reservoir are being planned. Results are expected to guide decisions about whether, when, where and how to implement targeted mass treatment and other interventions to eliminate this reservoir.

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Morning Session, Auditorium (1) Paper-5

Treatment seeking behaviour and factors influencing compliance among hypertensive patients in community clinics, Pakokku Township

Tin Aung Cho, Su Su Hlaing and Ko Ko Zaw

University of Public Health, Yangon

This study aimed to assess the treatment seeking behaviours and factors influencing compliance among hypertensive patients in community clinics (outpatient clinics opened in Urban Health Centers and Rural Health Centers), Pakokku Township. A cross sectional study was conducted among hypertensive patients (≥25 years old) in community clinics from one urban health center and five rural health centers from September to November in 2017. A total of 217 respondents were interviewed face to face by questionnaires. Their high blood pressure was first diagnosed accidently by health care providers (73%), or detected on medical check‐up (26%). About 57% of the patients were diagnosed by doctors and the remaining by basic health staff. Among the respondents, 40% took treatment from both public health centers and private health centers, and 13% from both public health centers and philanthropic clinics. Main reasons for choosing public health centers were proximity (68%), health care qualification (24%), advice from friends or relatives (17%), and availability of treatment without payment (16%). Frequency of monitoring blood pressure varied: about 1% for daily, 26% for at least once a week, and 44% for at least once a month. About 69% of respondents checked the blood pressure with mid‐wives, 34% with doctors, and 22% with health assistants. Among the patients, 41% had good compliance and 26.7% had controlled blood pressure. There was significant association between compliance and controlled blood pressure (p<0.0001). There was significant association between treatment compliance and some variables like frequency of monitoring blood pressure (p=0.01), taking regular follow up (p<0.0001), having recent medical records or anti‐hypertensive drugs (p<0.0001), good communication with health care providers (p=0.005), help from family members in reminding medication (p<0.0001) and duration of hypertension (p=0.008). The findings can be concluded that regular blood pressure monitoring and follow up gave good compliance and control of hypertension among patients in community clinics. This study contribute to evidence for effective interventions to enhance compliance and control hypertension among hypertensive patients in community clinics.

 7  Abstracts of the papers (Day 1) 46th Myanmar Health Research Congress

Afternoon Session(1), Auditorium (1) Paper-6

Evaluation of the Quantamatrix Multiplexed Assay Platform system for simultaneous detection of Mycobacterium tuberculosis and the rifampicin resistance gene using cultured mycobacteria and clinical sputum samples

Hye‐Yong Wang1, Young Uh2, Seoyong Kim1, Yun‐hee Chang1, Tae‐Sun Shim3 and Hyeyoung Lee1

1Department of Biomedical Laboratory Science, College of Health Sciences, Yonsei University 2Department of Laboratory Medicine, Yonsei University Wonju College of Medicine 3Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine University of Ulsan College of Medicine

The differentiation of Mycobacterium tuberculosis complex (MTBC) from non‐tuberculous mycobacteria (NTM) is of primary importance for infection control and the selection of anti‐ tuberculosis drugs. Up to date data on rifampicin (RIF)‐resistant tuberculosis (TB) is essential for the early management of multidrug‐resistant TB. The aim of this study was to evaluate the usefulness of a newly developed multiplexed, bead‐based bioassay (Quantamatrix Multiplexed Assay Platform, QMAP) for the rapid differentiation of 23 Mycobacterium species including MTBC and RIF‐resistant strains. A total of 314 clinical Mycobacterium isolates cultured from respiratory specimens and 259 clinical sputum samples were used in this study. The sensitivity and specificity of the QMAP system for Mycobacterium species were 100% (95% CI: 99.15‐100%, p<0.0001) and 97.8% (95% CI: 91.86‐99.87%, p<0.0001), respectively. The results of conventional drug susceptibility testing and the QMAP Dual‐ID assay were completely concordant for all clinical isolates (100%, 95% CI: 98.56‐100%). Out of 223 M. tuberculosis (MTB) isolates, 196 were pan‐susceptible and 27 were resistant to RIF according to QMAP results. All of the mutations in the RIF resistance‐determining region detected by the QMAP system were confirmed by rpoB sequence analysis and a REBA MTB‐ Rifa reverse blot hybridization assay. The majority of the mutations (n=26, 96.3%), including those missing wild‐type probe signals, were located in three codons (529‐534, 524‐529, and 514‐520), and 17 (65.4%) of these mutations were detected by three mutation probes (531TTG, 526TAC, and 516GTC). For the clinical sputum, sensitivity and specificity of the QMAP system were 93.9% and 90.3%, respectively. For rifampin resistant result, sensitivity and specificity was 92.9% and 86.4%, respectively. Among 130 drug susceptible samples, 7 were detected as drug resistant by QMAP system (531TTG and ΔWT5).The entire QMAP system assay takes about 3 hr to complete, while results from the culture‐based conventional method can take up to 48‐72 hr. Although improvements to the QMAP system are needed for direct respiratory specimens, it may be useful for rapid screening, not only to identify and accurately discriminate MTBC from NTM, but also to identify RIF‐resistant MTB strains in positive culture samples.

 8  46th Myanmar Health Research Congress Abstracts of the papers (Day 1)

Afternoon Session(1), Auditorium (1) Paper-7

Postmortem tuberculosis – hidden community problem

Ne Myo Aung1, Aung Soe2 and Soe Min Min Nyunt2

1Department of Medicine, University of Medicine 2, Yangon 2Department of Forensic Medicine, University of Medicine 2, Yangon

Myanmar is a country of high TB burden. In 2016, the incidence of TB was 365 per 100,000 populations. It was estimated that up to 40 percent of TB cases were undiagnosed or unreported. A large burden of hidden cases leads to TB transmission in the population, which is a barrier of TB elimination – bending the curve. This study aimed to find out the burden of tuberculosis cases found at post‐mortem. The retrospective observational study was conducted in North Okkalapa General Hospital during January 2016 to December 2016. All the cases that needed postmortem from forensic purpose were observed for evidence of tuberculosis after opening the chest at postmortem. Their current and past medical history was retrospectively analyzed. During the study period, 1,785 cases needed autopsy for forensic purposes. Among them, 186 cases (10.4%) were identified as pulmonary tuberculosis by the presence of caseation. The history of tuberculosis or current diagnosis of tuberculosis was obtained in 58 cases (31.2%). A majority (68.8%) of post‐mortem TB cases were never diagnosed. Bilateral lung involvement was observed in 176 cases (94.6%). Primary cause of death was tuberculosis in 152 (81.7%) of all TB cases. Non‐communicable diseases as cause of death was accompanied in 58 (31.2%) of TB cases. TB remains as a significant cause of death and a vast majority of cases were never diagnosed as TB. Most post‐mortem cases had extensive TB that they could act as reservoir for TB transmission. More intensive public health action will be necessary to reduce the TB burden. Early detection and proper treatment of TB are important as control measures for community health.

Afternoon Session(1), Auditorium (1) Paper-8

Prevalence of diabetes, pre‐diabetes and associated risk factors among pulmonary tuberculosis patients

Ohnmar Kyaw, Aye Aye Lwin, Kyi May Htwe, Khin Than Maw, Thazin Myint, Khine Zar Win, San Kalyar Htwe and Khin Saw Aye

Department of Medical Research

Because of the rapid changes in lifestyle in Myanmar, there is concern that diabetes may become epidemic and the National survey in 2014 pointed out the prevalence of confirmed diabetes mellitus in general population in Myanmar was 10.5%. Myanmar is also one of the 30 countries of highest burden of tuberculosis (TB) and the relationship between these two

 9  Abstracts of the papers (Day 1) 46th Myanmar Health Research Congress

diseases is reemerging as a significant public health problem. This study aimed to determine diabetes prevalence and its associated risk factors among pulmonary TB cases registered in National TB Control Centers, Lathar and Aung‐san. Total 196 patients underwent random blood sugar testing, HbA1c and anthropometric measurements. A pretested questionnaire was used to collect information on socio‐demographics, habitual risk factors, and type of TB. Prevalence of diabetes mellitus was 26.53% (52/196) and that of pre‐diabetes was 16.8% (33/196). Risk factors significantly associated with diabetes mellitus among TB patients were age group and duration of TB treatment. The most prevalent age group and duration of TB treatment among TB patients were 50‐59 year group (28.8%) and 6‐12 months (75%) respectively. Mean BMI of diabetes was 19.99 ± 3.99 kg/m2 and that of pre‐diabetes was 18.52 ± 16.4 kg/m2. Waist hip ratio of diabetes was <0.9 in 71.4% (male) and <0.8 in 87.5% (female) and that of pre‐diabetes was <0.9 in 85% (male) and <0.8 in 92.3% (female) respectively. Mean HbA1c was 9% in diabetes and 6% in pre‐diabetes. Positive AFB smear was diagnosed in 46.2% of diabetes and 27.3% of pre‐diabetes. There was no difference observed with respect to sex, BMI, waist‐hip ratio, sputum positivity, smoking status, fast food eating habit, regular exercise and hypertension. We have found a strong association of TB and diabetes and almost all relatively young, lean TB patients presented with diabetes. Because diabetes was unnoticed and untreated in the majority of TB patients in our setting, it seems wise to screen TB patients for diabetes. Based on our study, we would recommend screening all TB patients over 35 years of age at least once for diabetes, and looking for symptoms of diabetes in younger patients.

Afternoon Session(1), Auditorium (1) Paper-9

Pattern of anti‐tuberculosis drug resistance among HIV associated tuberculous meningitis patients

Aye Su Mon1, Sabai Phyu3, Mi Mi Htwe1, Su Mon Win 1, Phyu Wun Ei 1, Wint Wint Nyunt5 Nay Win Aung4, Mon Mon2 and Wah Wah Aung1

1Department of Medical Research 2University of Medicine 1, Yangon 3University of Medicine 2, Yangon 4National Tuberculosis Reference Laboratory 5Defence Services Science and Technology Research Center

Drug resistant tuberculosis (TB) is a major public health problem worldwide. Human immunodeficiency virus (HIV) infection associated tuberculous meningitis (TBM) patients further complicates the management and has poor prognosis. A cross‐sectional laboratory based study was carried out to determine anti‐TB drug susceptibility pattern of Mycobacterium tuberculosis complex isolated from HIV‐TBM coinfected patients at Waibagi, Thaketa and Mingaladon Specialist Hospitals in Yangon. During January to October 2017, cerebrospinal fluid (CSF) samples collected from 140 HIV patients with clinically presumptive TBM were proceeded for isolation and drug susceptibility testing (DST) of Mycobacterium tuberculosis complex. First line DST of isoniazid (INH), rifampicin (RIF), ethambutol (EMB) and streptomycin (SM) was carried out by solid culture based‐proportion method.  10  46th Myanmar Health Research Congress Abstracts of the papers (Day 1)

Pyrazinamide (PZA) and second line anti‐TB drug susceptibility (fluoroquinolones and aminoglycosides) were detected by liquid culture based Mycobacterial Growth Indicator Tube (MGIT) method. The culture positive isolates were found in 12% (17/140) cases. Among 17 MTB isolates, resistance to SM was 4 (23.53%), INH 8 (47.05%), RIF 8 (47.05%), EMB 3 (17.64%) and PZA 2 (11.76%) isolates respectively. Overall drug susceptibility pattern revealed that 7 isolates (41.17%) were sensitive to all first line anti‐TB drugs and 10 isolates (58.82%) were resistant to at least one of the first line anti‐TB drugs. Two (11.76%) cases showed mono‐resistance including one SM resistance (5.88%) and one EMB resistance (5.88%); 4 (23.52%) isolates showed two‐drug resistance (INH and RIF), 2 isolates (11.76%) showed three‐drug resistance (SM+INH+RIF and INH+RIF+PZA), 1(5.88%) isolate showed four‐drug resistance (SM+INH+RIF+EMB), and 1 (5.88%) isolate showed five‐drug resistance (SM+INH+RIF+EMB+PZA). Eight isolates (47.05%) showed multi‐drug resistance (MDR) which were resistant to at least INH and RIF. All the 8 MDR isolates were sensitive to tested second line anti‐TB drugs. Patients with CD4 count of  100 cells/µl and previously treated cases were significantly associated with any anti‐TB drug resistance (P<0.05). These findings highlight high burden of anti‐TB drug resistance among HIV infected patients and can support for elaborative management strategies of HIV associated tuberculous meningitis.

Afternoon Session(1), Auditorium (1) Paper-10

Glucose‐6‐phosphate dehydrogenase deficiency among children visiting Emergency Department of Yankin Children Hospital

Win Lai May1, Khin Nyo Thein2, Han Win1, Mya Mya Win2, Tin Htar Lwin1, Dam Lian Pau1, Phyu Hnin Wai1, Theingi Thwin1 and Myat Phone Kyaw1

1Department of Medical Research 2Department of Paediatrics, University of Medicine 2, Yangon

Yankin Children Hospital is one of the tertiary children hospitals in Myanmar, where some oxidative medications are commonly used in the management of illnesses. Paediatrician’s awareness of G6PD status in this population is very important for effective management and prevention of complications in G6PD deficient children. This preliminary study aims to determine the prevalence of G6PD deficiency according to WHO classification among children seeking medical care at Emergency Department of Yankin Children Hospital (YKCH). It was a cross‐sectional descriptive study on 124 children, aged 1month to 13 years. G6PD enzyme activity was determined by spectrophotometric assay within 24 hours of sample collection. Randox G6PD quantitative in vitro test kit (Randox Laboratories, Crumlin, UK) was used and G6PD activity was calculated per gHb. For classification of G6PD deficiency, 10% and 60% level of normal enzyme activities were calculated according to the suggestion by World Health Organization (WHO); G6PD activity <10% was defined as severe deficiency and 10‐60% was defined as moderate deficiency. According to WHO classification, 18.5% (23/124) of children in this study was classified as G6PD deficient, with 3.2% severe deficiency and 15.3% moderate deficiency. The prevalence of G6PD deficiency in Myanmar children is higher than the previous reported prevalence if quantitative spectrophotometric method is used for diagnosis, detecting more individuals with moderate deficiency. The high  11  Abstracts of the papers (Day 1) 46th Myanmar Health Research Congress

prevalence of G6PD deficiency in this study warrants for the need to do neonatal screening to avoid the potentially fatal complications of this disease.

Afternoon Session(2), Auditorium (1) Paper-11

Serodiagnosis of clinically suspected adult dengue cases in Yangon General Hospital

Moe Yee Soe1, Hla Nu Kyi1, Wah Win Htike1, Win Win Maw2 and Hla Sein1

1Department of Microbiology, University of Medicine 1, Yangon 2Department of Microbiology, University of Medicine 2, Yangon

Dengue is one of the most important mosquito borne viral diseases spreading all regions of the world. Myanmar is one of the dengue endemic countries in SEA. Dengue infections now colonize to adult populations although it had been known formerly as childhood disease. This study was conducted with the aim of serological diagnosis of clinically suspected dengue cases in adult population. A total of 73 serum samples were collected from clinically suspected dengue patients attending the medical wards of Yangon General Hospital from January 2016 to August 2016. NS1 antigen detection by immuno‐chromatographic test (SD BIOLINE) and anti‐dengue IgM and anti‐dengue IgG by ELISA (SD BIOLINE) was done. Among 73 tested samples, 50 samples (68.5%) were seropositive with the majority age groups of 13‐20 years followed by 21‐30 years. Female population contributed larger than the male population (54% and 46%). Season‐wise distribution showed peak occurrence in July followed by August. Among 50 seropositive cases, NS1 antigen was detected in 17 cases (34%), anti‐dengue IgM was observed in 18 cases (36%) and anti‐dengue IgG was detected in 46 cases (92%) respectively. Regarding the type of infection, primary infection were 2 cases (4%), secondary infection were 46 cases (92%) and acute infection were 2 cases (4%). 13 ‐20 years age group suffer secondary infection (92.3%), acute infection (7.7%) and no primary infection . Among 21‐30 years age group, 94.4% were secondary infection and 5.6% were primary infection. Surprisingly, primary and secondary infection were identified equally (50%) in 41‐50 years age group. In two age groups, 31‐40 years and 51‐60 year, only secondary infection was observed (100%) each. Regarding severity, 100% of primary infection revealed DHF Grade‐I and 82.6% of secondary infections were DHF Grade‐I, 10.9% were DHF Grade‐II, 4.3% were DHF Grade‐III, 2.2% were DHF Grade‐IV and no fatal case was detected. Increasing incidence of dengue infections in adults lead to health care burden as the most affected victims were working age group. Therefore, continuous monitoring is crucial to reduce incidence and this study may help to decline disease burden to some extent.

 12  46th Myanmar Health Research Congress Abstracts of the papers (Day 1)

Afternoon Session(2), Auditorium (1) Paper-12

Virological features of dengue patients during 2015 dengue outbreak in Myanmar

Aung Kyaw Kyaw1,2, Mya Myat Ngwe Tun1, Kyaw Thu Soe2, Saw Myat Thwe2, Kyaw Zin Thant2 and Kouichi Morita1

1Department of Virology, Nagasaki University 2Department of Medical Research

Dengue (DEN) is an endemic disease in Southeast Asian countries including Myanmar. In this study, hospital‐based surveillance was conducted in 2015 when the largest dengue epidemic occurred in Myanmar to characterize the viremia pattern of DEN patients. Acute phase serum samples were collected from 332 clinically diagnosed DEN patients in Upper Myanmar and Lower Myanmar from July‐August, 2015. Of the 280 DENV‐confirmed patients, 121(43.2%) and 111(39.6%) had primary and secondary infections, respectively. A high number of cases with severe DEN had primary infection (24.5%; 12/49). Patients with primary infection or negative for DENV IgM antibody demonstrated significantly higher viremia levels through plaque assays in FcγRIIA‐expressing and non‐FcγRIIA expressing BHK cells. However, the mean viremia levels were not significantly different among the different severity groups (DEN with and without warning sign and severe DEN) but remained high up to day 5 in patients with severe DEN and with warning sign. Patients with primary infection regardless of the disease severity demonstrated high levels of viremia in this study. The epidemic in Myanmar in 2015 was dominated by DENV‐1 with the same genotype (Genotype I) and viremia levels among dengue patients were notably high for a long period which was assumed to support the spread of the virus by the mosquito vector during epidemic.

Afternoon Session(2), Auditorium (1) Paper-13

Subclinical thyroid dysfunction and cognitive function in Myanmar elderly

Khin Mi Mi Lay, Thura Tun Oo, Win Lei Lei Sint, Sandar Win, Htike Htike Soe, Khin San Lwin, Htet Htet Lwin, Theingi Thwin and Kyaw Zin Thant

Department of Medical Research

Although both subclinical hyper‐ and hypothyroidism have been implicated as risk factors for cognitive decline, the clinical relevance of this finding is still controversial. Thus, this institution‐based cross‐sectional analytical study aimed to find out the association between subclinical thyroid dysfunction and cognitive function of elderly people. A total of 157 elderly (60‐70 years old, 47 men and 110 women) from Tha‐Ba‐Wa meditation center, Thanlyin participated. Serum triiodthyronine (T3), thyroxine (T4) and thyroid stimulating

 13  Abstracts of the papers (Day 1) 46th Myanmar Health Research Congress

hormone (TSH) were measured as indicators for thyroid function and determined by direct sandwich ELISA method. Cognitive function was assessed by using mini‐mental state examination (MMSE). It was found that 85.99% of the elderly had normal thyroid function and 14.01% had thyroid dysfunction. The most common was subclinical hypothyroidism (11.46%), followed by subclinical hyperthyroidism (1.27%) and overt hyperthyroidism (1.27%), respectively. Among the elderly, 49.04% had normal cognitive function (MMSE score ≥28), 38.85% had impaired cognitive ability (MMSE score between 27‐24) and 12.11% had dementia (MMSE score ≤23). Although no significant correlation was found between T3, T4, TSH level and MMSE score in the whole study group, a moderate degree of significant negative correlation between TSH level and MMSE score (r = ‐ 0.49, p < 0.05, n = 18) was found in those with subclinical hypothyroidism when analyzed in each group according to thyroid function. This could be simply due to the fact that TSH is the most sensitive measure of thyroid status. This study pointed out that subclinical hypothyroidism is the most prevalent thyroid dysfunction among the asymptomatic elderly and the elderly with subclinical hypothyroidism were more likely to have cognitive impairment.

Afternoon Session(2), Auditorium (1) Paper-14

Prevalence of thyroid disorders among adult women attending medical OPD clinics at 300‐bedded Pyin Oo Lwin General Hospital

Khin Moe Aung1, Haung Naw1, Su Su Myaing1, Myint Myint Khaing1, Tin Moe Khaing1, Moe Kyaw Myint1, Wint Wint Kyi2 and Win Aung1

1Department of Medical Research 2Department of Medical Services

A Hospital based cross‐sectional descriptive study was carried out to identify thyroid hormone levels, different types of thyroid dysfunction and to find out the prevalence of thyroid disorders in adult women. It was done at 300‐bedded Pyin Oo Lwin General Hospital during September 2016 through February 2017. A total of 115 adult women in the age 18‐ 85 years (mean of 47.37±15.7 year) who were attending medical clinics outpatient department of study hospital were enrolled. Serum Thyroxine (T4), serum triiodothyronine (T3) and serum thyroid stimulation hormones (TSH) were determined by using Mini‐vidas, fully automated Immunology analyzer at Pathology Research Division, Department of Medical Research (Pyin Oo Lwin Branch). Data entry and analysis was done by SPSS software 20.0 version. Among different age groups, highest number of subject lies between age group of 46‐60 years. Thyroid function status was considered as according to American Thyroid Association (ATA, 2000), abnormalities in thyroid hormone levels were detected in 36/115 cases (31.7%) of adult women. Hyperthyroidism was observed in 10 cases (8.7%) and hypothyroidism in 8 cases (7.0%). Sub‐clinical hyperthyroidism was found in 12 cases (10.4%) and sub‐clinical hypothyroidism was also occurred in 6 cases (5.2%). High number of total subclinical hyperthyroidism was observed in 31‐60 age groups. In age 18‐30 years, no cases of hypothyroidism and subclinical hypothyroidism were observed, both hyperthyroidism and hypothyroidism were more prevalent in above 60 years and subclinical

 14  46th Myanmar Health Research Congress Abstracts of the papers (Day 1)

hypothyroidism was prevalent in 31‐45 years. Serum fT3, fT4 and TSH were significantly different in various groups of thyroid dysfunction (p value <0.001). Taking into consideration of the above results, this study recognizes the high prevalence rate and highlight that thyroid dysfunction remains a common health problem among adult women and is also useful for screening programs and clinical management of consequences of thyroid disorders in this area.

Afternoon Session(2), Auditorium (1) Paper-15

Challenges in provision of medical services at Mandalay General Hospital

Yadanar Aung1, Kyaw Ko Ko Htet1, Kyaw Thu1, Kyaw Thu Hein1, Kyaw Thu Soe1, Tin Tin Moe2 and Myitzu Tin Oung1

1Department of Medical Research 2Department of Medical Services

In Myanmar, the main challenge to provide quality healthcare by Universal Health Care approach is documented as poor health services functions. To achieve the effective health care system, strong medical care system is essential. Understanding on challenges and needs in provision of medical services among patients and health care providers is critical to provide quality care with desirable outcomes. The aim of the study was to explore the patients and health care providers’ perceptions on the challenges in provision of medical services at the Mandalay General Hospital. This was a qualitative study conducted at the tertiary level hospital (Mandalay General Hospital). The data was collected by using focus group discussions and in‐depth interviews with hospitalized patients or attendants, healthcare providers such as medical doctors, nurses, laboratory scientists and hospital administrators in March 2017. The qualitative data was analyzed using themes by themes matrix analysis. Most of the patients satisfied with the care provided by the doctors because they believed that they received quality care. However, some patients complained about long waiting time for elective operation, congested conditions in the ward, burden for investigations outside the hospital for urgent needs and impolite manners of general workers. Healthcare providers reported that they had heavy workload due to limited human and financial resources in the hospital, poor compliances with hospital rules and regulation among patients and attendants, and inefficient referral practices from other health facilities. Other challenges experienced by healthcare providers were lack of ongoing training to improve knowledge and skills, limited health infrastructure and inadequate medicinal supplies. The findings highlighted the areas needed to be improved to provide quality health care at the tertiary level hospital. The challenges and problems encountered in this hospital can be improved by allocating adequate financial and human resources. The systematic referral system and hospital management guidelines are needed to reduce workload of health staff.

 15  Abstracts of the papers (Day 2) 46th Myanmar Health Research Congress

Paper Reading Session : Day 2

Morning Session (1), Auditorium (1) Paper-16

Determination of lead content in red colored lipsticks from Mandalay market by flame AAS

Thee Oo Lwin1, Khin Chit2, Khin Myo Oo1, Khaing Zar Wai1, Cho Cho Lwin1 and Wah Wah Oo 3

1University of Pharmacy, Mandalay 2Department of Food and Drug Administration 3Department of Food and Drug Administration, Mandalay Branch

Red colored lipstick is the most widely used cosmetic product. Although lipstick gives a lot of social, psychological and therapeutic benefits, it may harm the consumers. Because lipstick contains a considerable amount of heavy metal especially lead. Lead is being used in lipstick mainly for the pigments required to obtain needed colors. Lead accumulates in the body over time and lead‐containing lipstick applied several times a day, every day, combined with lead in water and other sources, could add up to significant exposure levels. Therefore, this study was aimed to determine lead content in red colored lipsticks from market. This research was laboratory based analytical study by using 25 lipstick samples. Red colored lipsticks were bought from Mandalay market by random sampling procedure and they were completely coded to avoid the bias. Then, lead content in coded samples was determined by Flame AAS according to International Conference on Harmonization (ICH) guideline and Good Laboratory Practice. Lead contents of 88% of the lipsticks samples were more than specified limit 20 ppm of Food and Drug Administration, United State. All of them, lead content of counterfeit lipsticks group was highest. Among the tested lipstick samples, lipstick with lowest lead content was LE‐RL 01 (15.74ppm) and the lipstick with highest lead content was CF‐RL 01(60.09 ppm). In conclusion, lead content of red colored lipsticks (22 out of 25) from market samples were higher than allowable limit 20 ppm.

 16  46th Myanmar Health Research Congress Abstracts of the papers (Day 2)

Morning Session (1), Auditorium (1) Paper-17

Assessment of non‐permitted dyes in chili powder in the markets of Mandalay

Nay Lynn1,5, Hla Moe2, Wah Wah Oo3, Aye Mya Aung4, Min Ko Ko5, Zin Zin Nwe3, Tun Zaw6 and Than Htut6

1Department of Food and Drug Administration (Shan State) 2University of Medicine, Mandalay 3Department of Food and Drug Administration (Mandalay Branch) 4Department of Human Resource for Health 5University of Public Health, Yangon 6Department of Food and Drug Administration

Non‐permitted food dyes are one of the most widely used and dangerous food additives that are associated with various diseases like urticaria, asthma, neurotoxicity and developmental problem. To protect consumers for the sake of better health, it is illegal to add them to all types of food in Myanmar and also other countries. This study was a laboratory‐based, cross‐sectional descriptive study for determination of non‐permitted dyes in chili powder samples and individual depth interview of 15 persons for perception of non‐ permitted dyes in chili powder for daily food preparation. Chili powder samples were extracted by paper chromatography. Among 100 chili powder samples, non‐permitted dyes (Rhodamine B, Orange II, Sudan III and Auramine O) were detected in 32 (32%) samples which contributed 13 samples of coarse chili powder and 19 samples of fine chili powder. Permitted‐dyes alone were detected in 11 (11%) samples and 57 (57%) samples did not contain any types of dyes in paper chromatography. Twenty six out of 32 samples were found to be contaminated with non‐permitted dyes alone and 6 (6%) samples were found as containing with both permitted and non‐permitted dyes. In this study, most commonly used non‐permitted dyes were Rhodamine‐B (17 samples) and Sudan III (15 samples). In this study, 80% of respondents noticed about non‐permitted dyes issued in newspaper. All (ten respondents) of grinding owners and grocery sellers answered that they are not grinding or selling those contaminated chili powder during these years because of post‐market surveillance by government staffs. But there must be still remaining of sellers who have been selling those contaminated chili powders according to test results. All of the participants mostly preferred with natural products (dyes free) because they knew those dyes can give adverse effects for their health. Grinding owners and grocery sellers did not know clearly about adverse health effects but five consumers did. Their opinions for reducing of non‐permitted dyes in their daily preparation were frequent examination of food‐related products and regular conduction of health education sessions to all levels of community. These findings might be supported for further surveys and regulatory activities.

 17  Abstracts of the papers (Day 2) 46th Myanmar Health Research Congress

Morning Session (1), Auditorium (1) Paper-18

Detection of aflatoxin B1 contamination in different types of chilli powder in markets from 2016‐2017

Khin Nyein Aye, Aye Mya Sithu Shein, Thiri Myo Myo, Thin Thin Sein, Zinode Win, Aye Hsu Lae, Khine Zin Mar Thein, Khin Chit and Than Htut

Department of Food and Drug Administration

Food is essential in life. Unsafe food and water are linked to the deaths of estimated 2 million people annually including many children. Foodborne illnesses may occur through the consumption of food or water contaminated by bacteria, virus, pararsites and chemical substances. Unsafe foods include mycotoxin contaminated coffee, milk and milk products, chilli powder, peanut and peanut products, corn and corn products. Long term consumption of harmful chemical contaminated food can lead to chronic diseases such as cancer. Ensuring product safety start from production at the farm level. But mycotoxin contamination of chilli could be in post harvest stage. Myanmar people have culture of preparing traditional curries with chilli to be attractive and spicy. So, this commonly used food commodity should be safe for consumption. Chilli and related products are favourable for the growth of fungus, Aspargillus flavus. It is important in post harvesting storage condition because growth of Aspargillus flavus depends on temperature and humidity and it produces aflatoxin. Among aflatoxins, aflatoxin B1 has great health impact. It is related with liver malignancy and is 30% increase risk in cirrhotic patient. The aim of this study was to determine aflatoxin B1 contamination in different types of chilli powder from markets. A total of (1264) samples were collected randomly from markets of (11) states and regions, Yangon, Magway, Sagaing, Mandalay, Mon, Bago, Shan, Nay Pyi Taw, Ayeyarwaddy, Rakhine and Kayin. Laboratory based analytical study was done by ELISA method at Food Microbiology Laboratory, Department of Food and Drug Administration (Nay Pyi Taw). Different types of chilli includes chilli powder (46.3%), roasted chilli flakes (22.8%), raw chilli flakes (28.1%), raw dried chilli (1.9%) and chilli paste (0.9%). Among those, chilli powder has the highest contamination with aflatoxin B1 (48.1%). The highest aflatoxin B1 level detected is >60ppb. Result of this study plays important role in food safety of public and gets awareness to follow Good Agriculture Practice, Good Distribution Practice and Good Storage Practice in the production of chilli powder.

 18  46th Myanmar Health Research Congress Abstracts of the papers (Day 2)

Morning Session (1), Auditorium (1) Paper-19

Determination of water soluble vitamins in commonly consumed some staple cereal foods of Myanmar by HPLC

May Thandar Htun, Aye Aye Phyu, Moh Moh Lwin, Zin Nwe Soe, Ei Ei Htway, Khin May Thi and Win Aung

Department of Medical Research

In Myanmar, many people have been consuming the foods that are made of various kinds of cereals as a snack and staple foods. Vitamins, one of the essential nutrients, contained in the cereal foods are relatively unstable and can be lost during processing and storage of food. The determination of water‐soluble vitamins in various food samples is difficult due to their chemical instability and complexity. This study aimed to investigate the qualitative and quantitative of water soluble vitamins in commonly consumed some staple cereal foods and also to develop the simultaneous determination method of water soluble vitamins by using High Performance Liquid Chromatography (HPLC). Four types of sample; rice powder, mont‐ phat (rice noodle), not fortified wheat powder and wheat noodle were determined for seven types of water soluble vitamins namely B1, B2, B6, B12, ascorbic acid, niacin and folic acid by using HPLC with Photodiode Arrary Detector (254 nm) in which the mobile phase was 0.1 M of KH2PO4–methanol, 90:10 and the flow‐rate was 0.7 mL/ min. The HPLC analysis of all food samples showedS the presence of ascorbic acid, niacin and folic acid. Among these four food samples, wheat powder showed the highest concentration of 2.413 ppm for ascorbic acid, 0.877 ppm for niacin and 0.704 ppm for folic acid. The concentrations of these three water soluble vitamins in the remaining three food samples were relatively high in order of wheat noodle, rice powder and mont‐phat (rice noodle). But the other four kinds of water soluble vitamins (B1, B2, B6 and B12) were not detected in these four food samples. It may be due to the deterioration of B vitamins during the sample preparation, processing of foods and storage conditions. Although some kinds of water soluble vitamins were detected in these samples of staple cereal foods, the detection amount is apparently low. So it could be suggested that the proper food processing method and the storage condition should be considered for the constitution of the reliable amount of water soluble vitamins in staple cereal food and of Myanmar.

 19  Abstracts of the papers (Day 2) 46th Myanmar Health Research Congress

Morning Session (1), Auditorium (1) Paper-20

Contamination of Vibrio species in grilled fishes from street vendors in Yangon

Kyi Kyi Nyein Win, Mo Mo Win, Thin Thin Wah, Su Nyein Aye, Tin Tin Htwe, May Than Htay, Nilar and Myo Myo Kyaw

Department of Medical Research

The pathogenic Vibrios are serious threats to human health and wellbeing. In Myanmar, diarrhoea and gastroenteritis of presumed infectious origin stands for fourth leading cause of morbidity. Among various food that can hold Vibrio, fishes are the potential sources of infection, and grilled fishes are easily and widely available from street vendors in these days. This study was aimed to detect the contamination of Vibrio species and identify the antibiotics sensitivity of the isolated Vibrio species. In this study, a total of 84 samples were collected from street vendors of 7 townships (Sanchaung, Kyee Myin Taing, Kamayut, Latha, Dagon, Pazuntaung and North Dagon). The isolation of Vibrio species was conducted by conventional culture method and antibiotics sensitivity was performed by Modified Kirby‐ Bauer’s method. Among 84 samples collected, 23 isolates (27.4%) of different Vibrio species were detected, which were differentiated into 8 Vibrio parahaemolyticus (34.7%), 5 Vibrio vulnificus (21.7%), 3 Vibrio alginolyticus (13%), 3 Vibrio fluvialis (13%), 2 non‐O1 Vibrio cholerae (8.8%) and 2 Vibrio mimicus (8.8%). In comparing the 23 isolates, 13 isolates were detected from body parts and 10 isolates from head and gills. The antibiotics sensitivity pattern of the isolates showed that 19 were sensitive to cotrimoxazole, 18 were sensitive to norfloxacin, 17 each were sensitive to gentamicin and chloramphenicol, 16 were sensitive to doxycycline, 13 were sensitive to cefotaxime and 12 were sensitive to ampicillin. The result of this study revealed that different species of Vibrio were contaminated in grilled fishes to a considerable amount and also they were somewhat resistant to currently used antibiotics. Therefore, the cleanliness of utensils, personal hygiene of the food handlers, adequate cooking of the grilled fishes and appropriate storage temperature should be regularly monitored for the safety of food.

Morning Session (2), Auditorium (1) Paper-21

Prevalence of diabetes mellitus in subjects with chronic hepatitis C infection

Swe Zin Oo1, Baby Hla1, Hla Win Aung1, Swe Zin Soe1, May Mon Win Maw1, Thandar Aung1, Aye Aye Win1 and Win Naing2

1Department of Medical Research 2Liver Medical Unit, Yangon Speciality Hospital

Hepatitis C virus (HCV) infection and type 2 diabetes mellitus (T2DM) are two major public health problems associated with increasing complications and mortality rates worldwide.

 20  46th Myanmar Health Research Congress Abstracts of the papers (Day 2)

HCV infection and T2DM may coexist in an individual. HCV infected individuals have a greater chance of developing insulin resistance (IR) and diabetes (DM). Moreover, HCV patients with IR, with or without diabetes, have a poor response to antiviral treatment, increased progression of liver fibrosis and greater risk of developing hepatocellular carcinoma. Objectives of this study were to find out the estimated prevalence of diabetes mellitus in subjects with chronic hepatitis C infection and to analyze the association between chronic HCV infection with other related features of diabetes such as age, gender, family history of diabetes and body mass index. A cross‐sectional descriptive study was done in total 130 HCV positive subjects from December 2016 to June 2017 in Hepatitis Carrier Clinic, Department of Medical Research (DMR) and OPD of Liver Medical Unit, Yangon Speciality Hospital (YSH). Plasma glucose test and HbA1c test were done. In this study, male were 56 (43.1%) and female were 74 (56.9%). Out of 130 subjects, 5 subjects (3.9%) were diagnosed as DM, where 63 subjects (48.5%) and 62 subjects (47.7%) were diagnosed as pre‐diabetes and normal blood sugar level respectively. In this study, the prevalence of DM case was low and the prevalence of Pre‐DM was relatively higher. In conclusion, early diagnosis of DM in HCV positive subjects can give early treatment and better management of DM. This study also provided the awareness of Pre‐DM and early prevention of DM in Pre‐DM subjects by changing the healthy life styles. Well control glycemic status in HCV positive subjects will give slow progression of liver fibrosis and better response of antiviral treatment.

Morning Session (2), Auditorium (1) Paper-22

Factors influencing obesity indices among school teachers from Dagon Myothit (North) Township in Yangon, Myanmar

Khin Mittar Moe San1, Umi Fahmida2, Fiastuti Wijaksono3, Htin Lin4, Ko Ko Zaw5 and Min Kyaw Htet6

1Department of Medical Research 2South East Asian Ministers of Education Organization Regional Centre for Food and Nutrition (SEAMEO‐RECFON), Universitas Indonesia 3Nutrition Department, Faculty of Medicine, Universitas Indonesia 4State Public Health Department (Northern Shan State) 5 University of Public Health, Yangon 6School of Public Health, The Sydney University

Worldwide the prevalence of overweight/ obesity had risen at an alarming rate and become major public health problem due to its life‐long consequences. In Myanmar, one third of middle aged women had problem of overweight and obesity (BMI > 25 kg/m2) and the prevalence amongst women (30.3%) was twice higher than that in men (17.7%). This cross‐ sectional study was aimed to assess the proportion of obesity indices and its associated factors among 234 female school teachers from Dagon Myothit (North) Township in Yangon, Myanmar during January‐March 2015. The factors influencing obesity were assessed by pretest and structured questionnaires. Anthropometric measurements were investigated by using standardized SECA machines and guidelines. Body fat percent (BF%) was assessed by  21  Abstracts of the papers (Day 2) 46th Myanmar Health Research Congress

Bio‐electrical Impedance Analysis (BIA) method using BC 541 TANITA machine. The chi square test was performed to find the associated factors of obesity. The percentage of school teachers classified as overweight/ obesity (BMI > 25 kg/m2) was 46.5% while 38.7% and 58.7% of them had abdominal obesity (Waist circumference ≥ 80 cm) and high body fat mass (BF% ≥ 34%). Being married and taking contraception had higher risk of obese (OR‐1.9, CI: 1.2‐3.4, p value‐ 0.01) and (OR‐3.4, CI: 1.‐1.4‐11.0, p value‐ 0.31). Family histories of non‐ communicable diseases like hypertension and heart diseases were positively associated with higher obesity risks (OR‐1.9, CI: 1.1‐3.2, p value‐ 0.02) and (OR‐1.8, CI: 1.1‐3.0, p value‐ 0.04). Abdominal obesity was significantly associated with elder age, being married, multiparous and taking contraception. Factors independently associated with high body fat mass were multiparous and family history of hypertension. The proportion of obesity indices was high in our study population and some non‐modifiable risk factors were mainly associated with obesity. Although our study could not show significant association between obesity and selective modifiable risk factors like physical activity and dietary intake, modifiable risk factors were vital to reduce obesity indices. To prevent obesity and non‐ communicable diseases, healthy life style education program in school environment should be implemented via school teachers as guiding stars for the community.

Morning Session (2), Auditorium (1) Paper-23

Knowledge and experience related to stroke in rural community of Kyaunggon Township, Ayeyawady Region

Thandar Aung, Ko Ko Zaw and Su Su Hlaing

University of Public Health, Yangon

Stroke is one of the major causes of death in Myanmar. The prevention of stroke needs high level of knowledge of its risk factors and how to reduce these risk factors. A cross‐sectional study was done with 340 households in rural community of Kyaunggon Township, Ayeyawady Region in 2017 to assess knowledge and experience related to stroke among this community. Pretested standard questionnaire was used with 340 respondents aged over 40 years from 340 households. The majority of the respondents were 40 to 59 years and two thirds of the respondents was female (64%) in the study. The respondents (66%) were married and most of them (92%) had under high school level of education. Among 340 respondents, 64% had low knowledge of stroke. The proportion of ever‐stroke among the respondents was 6.7% and the proportion of the respondents who had stroke in last year was 3.2%. Known hypertension (42%) was higher percentage than known diabetes (6.2%), ever experience of heart attack (21%), known high cholesterol (4%). There was low percentage of current smoking (24%) and alcohol drinking (19%). Majority of the respondents had insufficient physical activity (76%) and inadequate taking of fruit and vegetable consumption (99%). There was a highly significant association between education and knowledge of stroke (p=0.007).The respondents with high school and above level had higher level of knowledge of stroke than those with under high school and above level. According to this study, known hypertension was associated with ever experience of stroke (p=0.008).The mean systolic blood pressure was 135 mmHg and mean diastolic blood  22  46th Myanmar Health Research Congress Abstracts of the papers (Day 2)

pressure was 80 mmHg among the study population. Known hypertension was the higher percentage (42%) regarding other risk factors of stroke. The results indicated that more attention was needed for raising knowledge on prevention of biological risk factors as well as behavioral risk factors of stroke.

Morning Session (2), Auditorium (1) Paper-24

Prevalence and associated risk factors of hypertension among civil servants at Central Institute of Civil Service (Lower Myanmar), Hlegu Township, Yangon Region

Zin Nwe Wint, Moh Moh Kyi and Ko Ko Zaw

University of Public Health, Yangon

Hypertension is the global public health crisis and major concern in developing countries. It has a large impact on morbidity, mortality and a big economic impact as a significant proportion of the productive population. This study aimed to determine prevalence and associated risk factors of hypertension among civil servants in Central Institute of Civil Service (Lower Myanmar), Hlegu Township, Yangon Region. There are total of 626 civil servants in Central Institute of Civil Service (Lower Myanmar) and 350 out of them are 40 years and above of age. This cross‐sectional study was conducted among total 300 civil servants with 40 years and above of age. Data collection was done from September‐ October 2017 by using WHO STEPS survey questionnaire (version 3.1) and showing show cards. Measurements of blood pressure, weight and height were done by using standardized instruments. In this study, hypertension was defined according to JNC VIII criteria as systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg or known hypertensive patients on treatment. The prevalence of hypertension was 121 (40.3%) among 300 civil servants with 40 to 60 years of age. Among male civil servants, 65 (55.1%) had hypertension and among female civil servants, 56 (30.8%) had hypertension. The prevalence of associated risk factors were current tobacco use (17.3%), current alcohol drinking (18.3%), low fruits and vegetables intake (61.7%), dietary salt consumption habit (55%), physical inactivity (80.7%), stressful conditions at home and at work during last year (40%) and (39%), overweight (41.3%) and obese (69.2%). There was a significant association between some background characteristics and hypertension such as age (p=0.002), gender (p<0.001), low education (p=0.001), rank (p=0.001) and monthly household income (p=0.04). There was a significant association between behavioural factors and hypertension such as current smoking (p=0.02), current alcohol drinking (p=0.001), current drinking at high level within 7 days (p=0.03) and increased body mass index (p=0.03). The findings of this study suggested that the prevalence of hypertension was high in civil servants and current smoking, current dinking, overweight and obesity were independent risk factors of hypertension.

 23  Abstracts of the papers (Day 2) 46th Myanmar Health Research Congress

Morning Session (2), Auditorium (1) Paper-25

Major gaps in condom distribution and HIV testing uptake among female sex workers and men who have sex with men in Myanmar 2014‐15; a mixed‐methods study

Yadanar Aung1, Wai Wai Han1, Petros Isaakidis2, Tun Nyunt Oo3, Nang Seng Noon Kham3, Myo Thiri Myint4, Nguyen Binh Hoa5,6 and Srinath Satyanarayana6

1Department of Medical Research 2Médecins Sans Frontières (MSF)/Doctors Without Borders, Operational Research Unit, Luxembourg, The Union 3National AIDS Programme, Myanmar 4World Health Organization, Myanmar Country Office, Myanmar 5National Tuberculosis Programme Vietnam, Hanoi Viet Nam 6Center for Operational Research, The Union, Paris, France

In order to reduce HIV transmission among Female sex workers (FSW) and Men who have sex with men (MSM), Myanmar National AIDS Programme (NAP) is implementing “100% targeted condom promotion (TCP) programme” since 2001. In 2014 and 2015, the project was being implemented in 45 and 55 townships respectively. The study aimed to describe the challenges in implementing the programme and to assess the extent of condom distribution and HIV testing of FSW and MSM in 2014 & 2015. This was a descriptive study using mixed methods; quantitative study involved review of routinely collected programmatic data from township monthly reports and qualitative study involved key informant interviews with central level TCP implementers, Township Medical Officers, Focal Persons, Peers of FSWs and MSMs. The results shown the pooled average number of condoms distributed per FSW were 91 and 80 while per MSM were 4 and 6 respectively in year 2014 & 2015. The proportion of estimated FSW and MSM who underwent HIV testing in 2014 was 6% and 1%, and in 2015 was 6% and 2% respectively. The township key informants mentioned that the supervision or monitoring visits from the central level were irregular and there were shortages of supply materials like condoms and lubricants frequently. The major constraints were difficult to find peers (especially for MSM) and migration of identified target key populations from one place to another. This study highlighted several major gaps in the 100% TCP programme implementation in Myanmar, especially extremely low HIV‐testing uptake.

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Afternoon Session (1), Auditorium (1) Paper-26

Antimicrobial activity of leaves extracts of Tamarindus indica L. (MA‐GYEE)

Khin Yadanar Kyaw1, Cho Yi Myint2 and Khine Khine Lwin3

1University of Pharmacy, Yangon 2University of Pharmacy, Mandalay 3Department of Medical Research

In this study, the leaves of Tamarindus indica L. were identified by morphological examinations. Physicochemical and phytochemical studies were conducted according to reference analytical procedures. Phytochemical analysis of Tamarindus indica L. leaves are found the presence of alkaloids, amino acids, carbohydrates, flavonoids, glycosides, polyphenol, starches, steroids/ terpenoids, tannins, reducing sugars and anthroquinone. The leaves of Tamarindus indica L. were extracted with petroleum ether, ethanol and distilled water by successive soxhlet extraction method. In vitro antimicrobial activity of three extracts of Tamarindus indica L. leaves were studied on control strains of bacteria (Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus and Klebsiella pneumoniae) by agar disc diffusion method. Zones of inhibition with aqueous extract against each organism were 12 mm for Klebsiella pneumoniae, 18 mm for Pseudomonas aeruginosa, 15 mm for Staphylococcus aureus and 9 mm was shown for Escherichia coli. With ethanolic extract, the zones of inhibition results were 12 mm for Escherichia coli, 15 mm for Pseudomonas aeruginosa, 12 mm for Staphylococcus aureus and no action against Klebsiella pneumoniae. However, the petroleum ether extract did not show antibacterial activity against all tested organisms. The minimum inhibitory concentrations (MIC) of ethanolic extract by tube dilution method were found to be 25 mg/mL, 12.5 mg/mL, 6.25 mg/mL for Staphylococcus aureus and Pseudomonas aeruginosa, 25 mg/mL for Escherichia coli. While MIC of aqueous extract were 25 mg/mL, 12.5 mg/mL for Staphylococcus aureus and Pseudomonas aeruginosa and 25 mg/mL for Klebsiella pneumoniae. Acute toxicity study was performed according to OECD guideline 425 as a safety test. The oral acute administration of 5000 mg/kg mice body weight of ethanolic and aqueous extracts of Tamarindus indica L. leaves resulted in no mortality. Therefore, the crude extracts from Tamarindus indica L. leaves can be used as antimicrobial agents against Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus and Escherichia coli.

 25  Abstracts of the papers (Day 2) 46th Myanmar Health Research Congress

Afternoon Session (1), Auditorium (1) Paper-27

Determination of total phenolic contents and antioxidant activity of the roots of Pimpinella candolleana Wight & Arnott

Kyi Kyi Oo1, Ei Ei Thant1, Khin Myo Oo3, Swe Swe2, May Thandar Tun4, Soe Myint Aye5, Win Aung4, Theim Kyaw1 and Yi Yi Myint2

1University of Traditional Medicine, Mandalay 2Department of Traditional Medicine, Nay Pyi Taw 3University of Pharmacy, Mandalay 4Department of Medical Research 5Department of Botany, University of Mandalay

Pimpinella candolleana Wight & Arnott belonging to Apiaceae is a valuable medicinal plant which root is a commercial raw material, namely Shan kokkaya in Myanmar Traditional Medicine crude drug markets. The plant specimens were collected from Pindaya Township, Southern Shan State in July 2014 for experimental procedure and botanical identification. The total polyphenolic contents in the aqueous, ethanolic and methanolic extracts of the roots of Pimpinella candolleana Wight & Arnott were determined at Food and Drug Administration Department, Mandalay by Folin‐Ciocalteu colorimetric method using gallic acid as the standard. The antioxidant activity of the different concentrations (100µg/ml, 200µg/ml, 300µg/ml, 400µg/ml and 500µg/ml) of three extracts was evaluated at Department of Medical Research, Pyin Oo Lwin (Branch) by using DPPH free radical scavenging method. The total polyphenolic contents of aqueous, ethanolic and methanolic extracts of roots were 83.63 mg GAE/g extract, 93.87 mg GAE/g extract and 118.85 mg GAE/g extract respectively. The IC50 values of aqueous, ethanolic and methanolic extracts were 69.183 µg/mL, 63.096 µg/mL and 31.622 µg/mL respectively. The results showed that is a positive correlation between free radical scavenging effect and total polyphenolic contents. Thus, this study scientifically proved that this resource sample is rich in total phenolic contents and significantly has antioxidant activity.

Afternoon Session (1), Auditorium (1) Paper-28

Effect of ethanolic extract of fruits of Phyllanthus emblica Linn. (Zibyu) on blood glucose, lipid profile and malondialdehyde level in prediabetes

Thein Soe, Nwe Nwe Than and Thein May Saw

Department of Pharmacology, University of Medicine, Mandalay

Diabetes mellitus is one of the most common non‐communicable diseases, with high morbidity and mortality. Prediabetes is a state of intermediate hyperglycemia, and in the absence of intervention, it is likely to develop type 2 diabetes with yearly conversion rate of

 26  46th Myanmar Health Research Congress Abstracts of the papers (Day 2)

5%‐10%. Hyperglycemia and hyperlipidemia in prediabetes are associated with increased oxidative stress that plays a central role in development of atherosclerosis and coronary heart disease. In prediabetes, lifestyle changes and drug treatment can prevent diabetes. The aim of this study was to explore the effect of ethanolic extract of fruits of Phyllanthus emblica Linn. (P. emblica L.) (Zibyu) on blood glucose, lipid profile and malondialdehyde (oxidative marker) in prediabetes. In this study, the powdered ethanolic extracts of fruits of P. emblica L. were made into 250 mg capsules. Thirty prediabetes persons were given 500 mg of P. emblica L. twice a day for 8 weeks. Fasting serum glucose, lipid profile and malondialdehyde levels were determined before and after 4 weeks and 8 weeks administration of fruits of P. emblica L. capsules. At week 4 and week 8, mean fasting serum glucose was significantly decreased by 25.25% (p<0.001) and 38.38% (p<0.001), respectively. In lipid profile, there was significant decrease in mean serum total cholesterol by 14.91% (p<0.001), triglyceride by 22.32% (p<0.001%), LDL by 22.31% (p<0.001%) at week 4. There was also greater decreased in mean serum total cholesterol by 24.42% (p<0.001), triglyceride by 39.32% (p<0.001%), LDL by 37.58% (p<0.001%) at week 8. The mean serum HDL was significantly increased by 19.48% (p<0.001) and 38.25% (p<0.001) at week 4 and week 8, respectively. The mean serum malondialdehyde level was significantly decreased by 28.22% (p<0.001) and 50.60% (p<0.001) at week 4 and week 8, respectively. According to the above results, the fruits of P. emblica L. have antihyperglycemic effect, favourable effect on lipid profile and antioxidant effect in prediabetes. Therefore, fruits of P. emblica L. can be consumed as food supplement in prediabetes to prevent diabetes.

Afternoon Session (1), Auditorium (1) Paper-29

The effect of Moringa oleifera Lam. (Dant‐da‐lun) leaves on plasma glucose level and serum lipid profile in prediabetic subjects

Hnin Lai Mu1, Myat Myat Soe2 and Yee Yee Tin1

1Department of Pharmacology, University of Medicine, Magway 2Department of Pharmacology, University of Medicine 1, Yangon

Prediabetes has an increased risk both of progression to type 2 diabetes and of developing cardiovascular disease. Prevention of diabetes from prediabetic condition can reduce the burden of diabetes as well as the risk of coronary artery disease. Moringa oleifera Lam. is known as Dant‐da‐lun in Myanmar. It is widely distributed in all areas of Myanmar, easily cultivated and the leaves and fruits are used as vegetables. Many studies have revealed that the leaves possess both anti‐diabetes activity and antidyslipidemic activity. This study aims to find out the dried powder of Moringa oleiferaLam. (Dant‐da‐lun) leaves on plasma glucose level and serum lipid profile in prediabetic subjects. The study design is before and after clinical study. Thirty five human volunteers of both genders, between 30‐60 years age with fasting plasma glucose level (110‐125 mg/dL) and met the selection criteria were chosen as prediabetic subjects. Mean fasting plasma glucose and serum lipid profile were determined before and 6 weeks after treatment with 8 g of dried leaves powder once daily orally by using semi‐auto chemical analyzer. There were statistically significant reductions of mean fasting plasma glucose (8.33%) (p< 0.001), mean two hour post‐prandial plasma  27  Abstracts of the papers (Day 2) 46th Myanmar Health Research Congress

glucose (9.55%) (p< 0.001), mean serum total cholesterol (7.27%) (p< 0.001), mean serum triglyceride (9.19%)(p< 0.001) and mean serum low‐density lipoprotein (10.35%) (p< 0.001) respectively from baseline levels after 6 weeks of treatment. Mean serum high‐density lipoprotein was significantly increased (0.78%) (p<0.05) at the end of the study. There was no significant changes in mean alanine aminotransferase (ALT) values (p=0.54) for liver function test of all subjects and no side effects were observed during 6 weeks. In conclusion, the results of the present study indicated that ingestion of dried powder of Moringa oleifera Lam. (Dant‐da‐lun) leaves had both glucose lowering and lipid lowering effect and it can be used as adjunctive therapy in prediabetic subjects among Myanmar population to reduce diabetes and cardiovascular risk.

Afternoon Session (1), Auditorium (1) Paper-30

Hypoglycemic effect of traditional medicine formulation (SNG‐01) on alloxan induced diabetic mice

Myo Nanda Aung, Khin Phyu Phyu, Khine Khine Lwin, Mu Mu Sein Myint, Aye Win Oo and Phyo Wai Zin,

Department of Medical Research

Diabetes mellitus has become important disease causing high rate of morbidity and mortality. There is growing interest in herbal remedies because of their effectiveness and relatively low costs. This study was performed to find out the hypoglycemic effect of Traditional Medicine Formulation (TMF‐SNG‐01). In this study, the objectives were to find out the acute toxicity of (TMF‐SNG‐01), to determine the hypoglycemic effect of different doses of (TMF‐SNG‐01) on alloxan induced albino mice and to compare the hypoglycemic effect of standard drug, metformin and (TMF‐SNG‐01). Acute toxicity test was done according to OECD guideline 423. Hyperglycemia was induced by intra‐peritoneal injection of 150 mg/kg body weight of 5% alloxan monohydrate. Alloxan induced albino mice were divided into 5 groups. Each group consisted of 6 mice. Group 1 was given 10 ml/kg body weight of distilled water. Group 2 to group 4 were treated with (TMF‐SNG‐01) at dose of 1 g/kg, 2 g/kg and 4 g/kg body weight respectively. Group 5 was given 500 mg/kg of Metformin Denk 500. All groups were given test substance orally for 14 days. Blood glucose levels were measured at 0 hour before administration and 1 hour interval for 4 consecutive hours. These test procedures were done on Day 1, Day 7 and Day 14. On day 7, 4 g/kg body weight and 2 g/kg body weight of (TMF‐SNG‐01)showed significant decrease in blood glucose level at 3 hours and 4 hours after administration of test drug when compared with untreated diabetic group (p < 0.05). On day 14, 4 g/kg body weight of (TMF‐SNG‐01) showed significant decrease in blood glucose level at 2 hours when compared with control group (p < 0.05). Significant decrease in blood glucose level was observed on day 1, day 7 and day 14 of treatment with metformin (p< 0.05‐0.001). In conclusion, (TMF‐SNG‐01) possessed significant hypoglycemic effect at the dose of 2 g/kg and 4 g/kg after 7 days of treatment on alloxon induced diabetic mice. Among 3 doses, TMF‐SNG‐01(4 g/kg) had the most effective hypoglycemic activity. Comparison between hypoglycemic effect of test drug, (TMF‐SNG‐01)

 28  46th Myanmar Health Research Congress Abstracts of the papers (Day 2)

and standard drug, metformin, hypoglycemic effect of (TMF‐SNG‐01) is lower than that of metformin.

Afternoon Session (2), Auditorium (1) Paper-31

Hypolipidemic activity of combination of extract of Zingiber officinale Rosc. (Ginger) rhizomes and Citrus aurantifolia Linn. (Lime) fruits juice on triton induced hyperlipidemic rats

Khine Khine Lwin, Mu Mu Sein Myint, Khin Phyu Phyu, Aye Win Oo, Phyu Phyu Win, Khin Tar Yar Myint, Myint Myint Khine, Hlaing Myat Thu and Kyaw Zin Thant

Department of Medical Research

This study was done to investigate the hypolipidemic activity of combination of watery extract of Zingiber officinale Rosc.(Ginger) rhizomes and fruit juice of Citrus aurantifolia Linn.(Lime) in triton induced hyperlipidemic rats. Acute oral toxicity test of combination of watery extract of Ginger and Lime juice was done on albino mice by using method of Litchfield and Wilcoxan (1949). Phytochemical tests of the combination of Ginger extract and Lime juice was also performed. Twenty four Wistar albino rats of both sexes were divided into four groups consisting six rats each. Group 1 was normal control group. Group 2 served as triton induced hyperlipidemic control group. Group 3 was given combination of watery extract of Ginger and Lime juice (10 g/kg) and Group 4 was standard drug (atorvastatin 30 mg/kg) group. The combination of the test drugs were administered orally once daily for 14 days. On day 14 of treatment, after the rats were kept fasting, Group 2 to 4 were given single intraperitoneal injection of triton WR 1339 (400 mg/kg) to induce hyperlipidemia. 24 hours after administration of triton, blood samples of the rats were collected to determine serum lipid profiles. Fasting serum lipid levels (total cholesterol, High density lipoprotein (HDL) and triglyceride) of all rats were determined with Semi Auto Chemistry Analyzer. Low Density Lipoprotein (LDL) levels of the rats were calculated by using formula. It was observed that LD50 value of the combination of Ginger and Lime was more than 16 g/kg. Phytochemical tests showed the presence of alkaloids, flavonoids, glycoside, amino acid, polyphenol, tannin, saponin, steroid/terpene and resin. The results showed that serum total cholesterol and LDL levels were reduced significantly in the combination of Ginger extract and Lime juice (10 g/kg) treated group (p<0.001) when compared with hyperlipidemic control group and mean reductions of total cholesterol and LDL levels were 29.92% and 53.73% respectively. Mean serum HDL level was not significantly increased in the combination of Ginger and Lime group. In conclusion, the combination of watery extract of Ginger and Lime juice possessed significant hypolipidemic effect on serum total cholesterol and LDL levels in hyperlipidemic rats.

 29  Abstracts of the papers (Day 2) 46th Myanmar Health Research Congress

Afternoon Session (2), Auditorium (1) Paper-32

Analysis of element in some medicinal plants which have reputed hypoglycaemic activity

Khin Tar Yar Myint1, Win Win Maw1, Mar Mar Myint1, Tin Sein Mar2, Khine Khine Lwin1, Phyu Phyu Win1, Nu Nu Win1, Mu Mu Sein Myint1 and Hlaing Hlaing Phyo1

1Department of Medical Research 2Botany Department, University of Taungngu

Modern clinical research suggests that the body's balance of mineral trace elements is disrupted by diabetes. The aim of this study is to evaluate the elemental content in some anti‐diabetic ethano‐medicinal plants using atomic absorption spectrometer. Among them, fifteen selected different parts of medicinal plants on which already laboratory animal tests have been done show that these plant parts have hypoglycaemic effect. Botanical identification was done by taxonomic and microscopic characters of part use of plant samples. Physico chemical characterization was investigated by quality control method for medicinal plants material (WHO, 2011). Content of lower to upper concentration of calcium (Ca) was (674.5± 0.57 mg/kg ‐ 17472.0±3.5 mg/kg) in leaves of Morus alba Lin (ydk;pm&Guf), leaves of Ocimum sanctum Linn (yifpdrf;euf&Guf), stem of Tinospora cordifolia wild (qifwHk;rEG,f), leaves of Cephalandra indica Naud (uif;yHk&Guf), fruit of Cephalandra indica Naud (uif;yHkoD;), bulb of Allium cepa Linn (MuufoGefeDO), leaves of Momordica charantia Linn (Muuf[if;cg;&Guf), fruit of Momordica charantia Linn (Muuf[if;cg;oD;), leaves of Andrographis paniculata Nees (aq;cg;BuD;&Guf), leaves of Orthosiphon stamineus Benth (qD;csdK&Guf), whole plant of Scoparia dulcis Linn ('EÅokcyif), whole plant of Vinca rosea Linn. (oabFmrnSdK;yif), leaves of Adhatoda vasica Nees (rk&mBuD;&Guf), bark of Ficus benghalensis Linn. (jynfanmiftacguf) and bark of Eugenia jambolana Lamk.(oajytacguf). Magnesium (Mg) (335.9 ± 0.15 mg/kg ‐20840.0 ± 0.19 mg/kg), potassium (K) (3868.0 ± 0.5 mg/kg ‐ 47800.0 ± 0.36 mg/kg), manganese (Mn) (6.99 ± 0.13 mg/kg – 178.7 ± 0.16 mg/kg), iron (Fe) (38.37 ± 0.5 mg/kg – 813.5 ± 5.9 mg/kg), copper (Cu) (1.88 ± 0.04 mg/kg – 15.47 ± 0.09 mg/kg), zinc (Zn) (5.29 ± 0.003 mg/kg ‐ 117.3± 0.89 mg/kg), were present in selected medicinal plants and Chromium (Cr) was absent. The WHO recommended permissible levels of elements in medicinal plant are not more than copper (10 mg/kg), zinc (50 mg/kg), iron (20 mg/kg), manganese (200 mg/kg) and chromium (1.5 mg/kg) in medicinal plants. Copper and zinc in five samples and iron in all parts of plant were more than permissible amount. Manganese in all part of plant samples contained within permissible amount.

 30  46th Myanmar Health Research Congress Abstracts of the papers (Day 2)

Afternoon Session (2), Auditorium (1) Paper-33

Insecticidal activity of Lantana camara (Sein‐Nar‐Pan) against mosquitoes Anopheles minimus, Aedes aegypti and Culex quinquefasciatus

Yi Yi Mya, Mya Nilar Chaw Su, Naw Hnin Myint, Than Myat Soe, Tun Tun Win, Than Than Htwe, Ngwe Paw, Ei Ei Htway and Khin May Thi

Department of Medical Research

Dengue haemorrhagic fever, Japanese encephalitis, malaria and filariasis, etc. are mosquito‐ borne diseases. One of the vector‐borne disease controls is the interruption of disease transmission by using synthetic insecticides as adulticides and larvicides. However, synthetic insecticides are known to cause the problem of environmental pollution, residual effects and resistance among vectors by improper use of the insecticide. Plant‐based products (e.g. Azadirachta indica) are used as alternate insecticides instead of synthetic insecticides. Lantana camara (Sein‐Nar‐Pan) is widely distributed in Myanmar including Pyin Oo Lwin. The aim of present study was to investigate the adulticidal potential of Lantana camara (Sein‐Nar‐Pan) against Anopheles minimus, Aedes aegypti and Culex quinquefasciatus. Three species of mosquitoes were collected from Pyin Oo Lwin Township in Mandalay Region. Adulticidal assay was performed using the WHO standard bioassay procedures. Sugar‐fed females; An. minimus, Ae. aegypti and Cx. quinquefasciatus (3‐7 days post emergence) were used in adulticidal activity. A batch of 20‐25 mosquitoes were exposed to test paper impregnated with each dose and four replicates were used for each test. Median lethal 2 doses (LD50) of essential oil were 0.0261, 0.0816 and 0.0922 mg/cm against An. minimus, Cx. quinquefasciatus and Ae. aegypti, respectively. And 95% lethal doses (LD95) were found to be 0.0503 mg/cm2 for An. minimus, 0.1278 mg/cm2 for Cx. quinquefasciatus and 0.2032 mg/cm2 for Ae. aegypti. At a dose tested 0.21 mg/cm2 (1.5%) of essential oil, the results of 50% and 95% knockdown time (KT50 and KT95) of mosquitoes were 10.81 and 18.58 min to An. minimus, 12.14 and 20.50 min to Cx. quinquefasciatus and 15.75 and 29.26 min to Ae. aegypti, respectively. After 24 hours exposure period, 100% mortality was found in both An. minimus and Cx. quinquefasciatus, but 96% mortality was observed in Ae. aegypti. The essential oil of Lantana camara (Sein‐Nar‐Pan) possesses the potential to be used as plant‐ based insecticide.

 31  Abstracts of the papers (Day 2) 46th Myanmar Health Research Congress

Afternoon Session (2), Auditorium (1) Paper-34

Sub‐lethal effect of larvicide and adulticide on the reproductive parameters of dengue vector in Mandalay

Mya Nilar Chawsu1, Yi Yi Mya1, Naw Hnin Myint1, Tun Tun Win1, Than Than Htwe1, Si Si Aung1 and Nwe Nwe Aye2

1Department of Medical Research 2Vector Borne Disease Control Program (Mandalay Region)

Dengue is a major public health problem globally and Aedes aegypti plays a major role in dengue transmission. Chemical control is an effective way to reduce vector population. Although pesticides are designed to kill pest populations, they are seldom 100% effective and a few individuals usually survive. Sub‐lethal doses of insecticides can affect populations of insect in several ways. This study aimed to investigate the effect of sub‐lethal exposure of larvicide and adulticide on the reproductive parameters of Ae. aegypti. Bioassays were conducted in both larval and adult stages following WHO standard procedures. Selection pressure were applied by using abate and deltamethrin in three different groups (larval, adult, larval and adult) of five generations of Ae. aegypti from Mandalay. In each group fifty male and female adults were selected for the experiments. Result revealed that Ae. aegypti from Mandalay was susceptible to abate and resistant to 0.05% of deltamethrin. Abate treated Ae. aegypti showed the longest and abate and deltamethrin treated Ae. aegypti was the shortest duration in gonotrophic cycle. There was considerable decrease in egg production and hatchability rates in the insecticide treated Ae. aegypti as compare to control (insecticide free strain). It was concluded that sub‐lethal exposures of mosquito had potentially important effects on the reproductive activity and could reduce mosquito population.

Afternoon Session (2), Auditorium (1) Paper-35

Emerging neglected helminthiasis and their determinants in Shwe Gyin

Kay Thwe Han, Khin Thet Wai, Kyin Hla Aye, Khine Wah Kyaw, Wai Phyo Maung, Pyae Phyo Htut, Naing Naing Win, Yin Yin Myint Myat and Tin Oo

Department of Medical Research

Globally, helminthic parasites such as nematodiasis, trematodiasis and cestodiasis are among the most prevalent neglected tropical diseases in low‐ and middle‐ income countries. Helminth infections are most commonly found in Southeast Asia. Myanmar being one of the members of Greater Mekong sub‐region and has similar agro‐based ecology, environmental sanitation risks, poor hygiene and food habits, there is a possibility of broad array of neglected helminth infections. To explore how diverse helminth infections are and which

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determinants are prevailed, a cross‐sectional study has been conducted in Shwegyin Township during 2017. A total of 224 households were randomly selected from two villages each in two different sites (inland and river‐side). The research team collected stool samples from 701 household members within the age range of 7 months to 87 years and examined by both wet mount and Kato‐Katz smear microscopy to detect helminth infections. Trained interviewers administered the pre‐tested structured questionnaire to the household head or the assigned person to underscore the environmental, demographic and socio‐behavioural determinants of these infections. By Kato‐Katz method, the estimated prevalence of at least single helminth infection was 23.9% (168/701). The overall soil transmitted helminth infection rate was 14.6% (102/701). Among the nematodes, Ascaris lumbricoides was most prevalent (13.7%; 96/701), for cestodes, Taenia spp. was identified as 0.7% (5/701), and for trematodes, schistosoma spp. was detected in 3.2% (23/701). Nearly 14% (96/701) had multiple helminth infections. Nearly half of the gold panning workers had helminth infections. Even though female were infected slightly higher than male, all age groups were found to be equally infected indicating the sharing of common risk. Kato‐Katz method was able to detect more helminths infection especially trematodes. This study reported diverse helminth species prevailed in the study area. The prevalence of helminths was more in riverside villages (34%) than in inland villages (11%) and environmental factors, occupational hazards, and eating raw vegetables and uncooked/fermented fish were identified as potential determinants. The emerging evidence of neglected zoonotic and foodborne helminths in the study area required attention for strengthening preventive interventions and regular deworming that covered community risk groups apart from school‐based deworming program.

Afternoon Session (2), Auditorium (1) Paper-36

Prevalence of strongyloidiasis in rural population of Kyaung Gone Township in Ayeyarwady Region

Okka Kyaw1, Khine Mar Oo1, Wah Win Htike1, Win Maw Tun2, Kay Thwe Han2, Myo Pa Pa Thet Hnin Htwe Aung3 and Eiji Nagayasu4

1Department of Microbiology, University of Medicine 1, Yangon 2Department of Medical Research 3Department of Microbiology, University of Medicine 2, Yangon 4Division of Parasitology, Department of Infectious Diseases, Faculty of Medicine, University of Miyazaki, Japan

Strongyloidiasis is an intestinal infection in humans caused by the nematode Strongyloides stercoralis, distributed in tropical and subtropical areas, which infect 30‐100 million people worldwide. In normal healthy individuals, the infection is usually asymptomatic, with low and intermittent larval excretion. In some people, hyperinfection syndrome may occur by dissemination of Strongyloides stercoralis in immunocompromised patients, particularly those receiving corticosteroids or other immunosuppressive medication, which can lead to death if untreated. Disseminated strongyloidiasis is characterized by severe gastrointestinal and respiratory tract involvement, meningitis, skin rash, or gram‐negative bacteremia.  33  Abstracts of the papers (Day 2) 46th Myanmar Health Research Congress

Disseminated strongyloidiasis is fatal in most cases. Therefore, it is very important to diagnose and treat this condition before long‐term corticosteroid therapy. With the aim to study the prevalence of strongyloidiasis in rural population of Kyaung Gone Township in Ayeyarwady Region, cross‐sectional descriptive study has been conducted in 470 villagers from Kyaung Gone Township during January 2016 to August 2016. In this study, strongyloidiasis was detected by using agar plate culture method and examined under stereomicroscope for larval detection. From the agar culture plate, isolated larvae were picked up and put into PCR tubes containing lysis solution to extract DNA. And then, specific species of isolated larvae were identified by 18S PCR. Among the total study population, 27 persons (5.7%) were culture positive, and of which hookworms were detected in 20 persons (4.2%), Strongyloides stercoralis in 8 persons (1.7%) and other nematode in 1 person (0.2%). Out of 27 infected persons, 16 were males (59.3%) and 11 were females (40.7%). All infected persons were in the >15 years age group. Among them, 3 males and 5 females were infected with Strongyloides stercoralis infection. Although the prevalence of strongyloidiasis in Myanmar situation is still low level, laboratory‐based surveillance should be conducted on a continuous basis to detect Strongyloides stercoralis among population because complications of strongyloidiasis is severe in immunocompromised patients. The findings of this study will be used to develop the appropriate strategies for control of STH including strongyloidiasis.

Day 2 (Parallel Session)

Morning Session (1), SRC Conference Hall Paper-37

Anti‐hyperglycemic effect of aqueous leaf extract of Vernonia amygdalina Del. (jrausmufaq;yif)on patients with type 2 diabetes mellitus

Chaw Nandar Khaing1, Kyi Kyi Oo1, Htin Aung Myo1, Win Myint1, Win Naing1, Mg Mg Thet1, Htay Hla3, Theim Kyaw1 and Yi Yi Myint2

1University of Traditional Medicine, Mandalay 2Department of Traditional Medicine 3University of Medicine 2, Yangon

Vernonia amygdalina Del. belonging to Asteraceae is a valuable medicinal plant for diabetes mellitus, a serious global health problem. This study was undertaken to determine the anti‐ hyperglycemic effect of aqueous leaf extract on patients with type 2 diabetes mellitus. The design of this study was hospital based open type clinical study and the clinical trial took out from May 2015 to October 2016. 20 patients from 100 bedded Traditional Medicine Hospital, Mandalay who fulfill the inclusion and exclusion criteria were studied in this study. The mean age of patients (35% of male and 65% female) in 40‐60 years was 50.2 years. The aqueous leaf extract was made as powder by freeze‐dryer. A capsule was filled with 300 mg of the extract powder and the 4 capsules were administered to each patient twice a day for two weeks. The fasting and 2 hour postprandial blood sugar levels, liver function tests,

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serum creatinine and lipid profiles were determined before and after intervention. The mean FBS levels were significantly decreased 17.2% (p < 0.05) from 267.18 ± 84.85 mg/dL to 221.13 ± 71.41mg/dL. The blood glucose levels in 2HPP were significantly reduced 15.8% (p < 0.05) from 407.98 ± 110.59 mg/dL to 343.71 ± 88.21 mg/dL. It was observed that the total bilirubin, alkaline phosphate, serum creatinine were within normal range after treatment. The total cholesterol, triglycerides and low density lipoprotein were decreased after treatment compared with before but high density lipoprotein was increased. It was clinically proved that the aqueous extract of V. amygdalina Del. has the anti‐hyperglycemic effect on patients with type 2 diabetes mellitus. Therefore, it could be provided that the aqueous leaf extract is an effective natural herbal medicine for type 2 diabetes mellitus patients.

Morning Session (1), SRC Conference Hall Paper-38

Apo E polymorphism and responses to atorvastatin in hypercholesterolaemic subjects

Wah Wah Oo, Myat Min and Thein May Saw

Department of Pharmacology, University of Medicine, Mandalay

Atorvastatin, a HMG CoA reductase inhibitor, is commonly used for treatment of hypercholesterolaemia to prevent ischaemic heart disease. Apo E polymorphism is one of the factors in interindividual variation in response to statin therapy. Therefore, this study was aimed to determine the proportion of Apo E polymorphism in hypercholesterolaemic subjects and to compare the responses to atorvastatin in those subjects in Myanmar population. In first part of the study, 100 hypercholesterolaemic subjects (Monks and Nuns) with TC  200 mg/dL were participated for determination of the frequency of Apo E genotypes by PCR‐RFLP. Among them, Apo E normal genotype E3/3 was found in 56 subjects and Apo E polymorphic genotypes (E3/4, heterozygous and E4/4, homozygous) were found in 28 subjects. In second part, 8 weeks therapy of atorvastatin 10 mg/day was given to those two groups of hypercholesterolaemic subjects with Apo E normal genotype and Apo E polymorphic genotypes. Each group consisted of 28 subjects. Fasting serum lipid profile was determined and compared between two groups before and after 8 weeks therapy of atorvastatin. It was found that subjects with Apo E polymorphic genotypes had more increase in baseline TC (256.3 ± 29.18 vs 220.6 ± 15.08), TG (167.2 ± 25.26 vs 134 ± 22.64) and LDL‐C (178.2 ± 26. vs 144.9 ± 16.06) respectively than those with Apo E normal genotype (p < 0.001). Regarding the responses to atorvastatin treatment, there were less % reduction in TC, TG and LDL‐C in Apo E polymorphic genotypes group than in Apo E normal genotype group, i.e. (16.1 ± 2.1 vs 33.6 ± 3.97), (18.2 ± 4.9 vs 34.4 ± 6.6) and (22 ± 2.86 vs 53 ± 8) respectively (p < 0.001). HDL‐C was also significantly less increased (10.7 ± 4.18 vs 26.3 ± 9.53) in Apo E polymorphic genotypes group than Apo E normal genotype group (p < 0.001). Therefore, subjects with Apo E normal genotype were good responders to atorvastatin therapy whereas those with Apo E polymorphic genotypes were poor responders. This study provides genetic information for prescribing atorvastatin for treatment of hypercholesterolaemia.  35  Abstracts of the papers (Day 2) 46th Myanmar Health Research Congress

Morning Session (1), SRC Conference Hall Paper-39

Pharmacokinetics of theophylline in asthma patients with CYP1A2*1F polymorphism

Kyaw Soe and Thein May Saw

Department of Pharmacology, University of Medicine, Mandalay

The aim of this study was to determine the proportion of CYP1A2*1F polymorphism in asthma patients and to compare the pharmacokinetic parameters of theophylline in asthma patients with CYP1A2*1F polymorphism. Three different genotypes of CYP1A2*1F were determined by PCR‐RFLP in 76 asthma patients of Mandalay General Hospital. Sixteen patients of each genotype group were participated in pharmacokinetic study of theophylline in three genotype groups. After single oral dose of 200 mg theophylline, 2 mL of blood from each patient was collected at 0, 0.5, 1, 1.5, 2, 6 and 10 hr. Serum theophylline levels were measured by validated HPLC method. Pharmacokinetic parameters were compared among 3 genotypes by one way ANOVA. Out of 76 asthma patients, 17 patients (22.37%) were wild genotype, 37 patients (48.68%) were heterozygous genotype and 22 patients (28.95%) were homozygous genotype. AUC(0‐) (Mean + SD) of theophylline in heterozygous, wild and homozygous genotype groups were 47.69 ± 14.23, 41.25 ± 13.12 and 35.85 ± 8.21 µg/mL.hr, respectively (p =0.03). CL, Kel and T1/2el of theophylline were also significantly different among 3 genotype groups with p = 0.024, p = 0.004 and p = 0.002 respectively in which CL (Mean ± SD) in heterozygous, wild and homozygous genotype groups were 0.07 ± 0.02, 0.08 ± 0.02 and 0.09 ± 0.01 L/hr/kg, respectively. The highest AUC and lowest CL levels of theophylline might be due to low metabolism. The lowest AUC and highest CL levels of theophylline in patients with homozygous genotype might be due to high metabolism. Pharmacokinetics of theophylline are variable among asthma patients with different genotypes of CYP1A2*1F polymorphism.

Morning Session (1), SRC Conference Hall Paper-40

Effect of ACE gene I/D polymorphism on renoprotective outcome of losartan in type2 diabetic nephropathy patents

Mya Thuzar1, Aye Aye Lwin2, Khin Than Maw2 and Nang Hla Hla Win3

1University of Nursing, Yangon 2Department of Medical Research 3University of Medicine 1, Yangon

Diabetic Nephropathy (DN) is the most devastating complication and is the leading cause of end stage renal disease. Approximately 20‐40% of type 2 diabetes will eventually develop DN and activation of renin‐angiotensin‐aldosterone system (RAAS) has a major role in the

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initiation of pathological process and in the progression of DN. Gene involved in the RAAS has been suggested as potential genetic predisposition for the development of DN. The aim of the present study was to find out the frequency of angiotensin I converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism and its influence on the renoprotective outcomes of losartan in type 2 DN patients. In this prospective study, ACE gene I/D polymorphism was identified by polymerase chain reaction (PCR) in total 73 type 2 diabetes patients with urine albumin creatinine ratio (UACR) ≥ 150 mg/g. Among them, 45.2% (33/73), 42.5% (31/73) and 12.3% (9/73) were homozygous for insertion (II), heterozygous (ID) and homozygous for deletion (DD) genotype respectively. The frequencies of I and D alleles showed 0.66 and 0.34 respectively. Mean decreased in systemic blood pressure from the baseline in DD group had significant better effects (p < 0.001). Decrease in mean UARC from the baseline was seen in those with macroalbuminuria of all genotypic subgroup. Significant better antiproteinuric effect of losartan was found in DD group when comparing mean differences and percent decreases in UACR (p < 0.001). The serum creatinine level significantly lowered only within DD genotypic group from the baseline level after 12 weeks (p < 0.05). Consequently, significant change in estimated glomerular filtration rate (eGFR) was seen only in DD carriers, increasing from the baseline level after 12 weeks (p < 0.01), while II and ID groups showed no significant improvement. According to these results, DD genotype in which all patients showed macroalbuminuria, have higher risk for progressive nephropathy and showed better renoprotective effects of losartan than other genotypic groups. It can be concluded that ACE gene I/D polymorphisms might have influence on the renoprotective outcomes of losartan in type 2 DN patients depending on their severity of albuminuria.

Morning Session (1), SRC Conference Hall Paper-41

Effect of GSTP1 polymorphism in lupus nephropathy patients on cyclophosphamide aggressive therapy

K. Khine Thu1, Aye Aye Lwin2, Khin Than Maw2, Chit Soe3 and Nang Hla Hla Win1

1University of Medicine 1, Yangon 2Department of Medical Research 3500 bedded Yangon Specialty Hospital

Systemic lupus erythematosus nephropathy (LN) occurs in up to 60% of adults with systemic lupus erythematosus (SLE) and predicts poor survival of SLE. Cyclophosphamide (CYC) is regarded as the most effective immunosuppressive medication for LN to improve survival. Genetic factors may be one of the important factors that influencing the response to CYC therapy. This study is carried out to identify the frequencies of Glutathione S transferase Pi ‐ 1(GSTP1) genotypes and its effect on efficacy and safety regarding CYC therapy. Ninety five SLE nephropathy patients who received CYC aggressive therapy for 6 months according to treatment guideline for LN of Rheumatology department, Yangon Specialty Hospital were participated. The efficacy, myelotoxicity and other toxic manifestations of CYC were investigated during treatment period. DNA extraction and genotyping was done by PCR‐ RFLP method. The frequencies of I/I, I/V and V/V genotypes of GSTP1 were 54.7%, 41.1%  37  Abstracts of the papers (Day 2) 46th Myanmar Health Research Congress

and 4.2% respectively. Comparison of efficacy of CYC aggressive therapy between wild GSTP1 (I/I) and polymorphic GSTP1 (I/V or V/V) genotypes of LN patients was done by comparing the 24 hr urinary protein and the remission at 3 months and 6 months after initiation of CYC aggressive therapy. At 3 months after CYC treatment, the change in 24 hr urinary protein from baseline in patients with wild GSTP1 (I/I) group was (2758.5 ± 2321.15 to 1436.0 ± 1797.63 mg/day, p < 0.0001) and that of in patients with polymorphic GSTP1 (I/V or V/V) genotype was (3399.7 ± 2870.74 to 2010.2 ± 2470.21 mg/day, p < 0.015). Both groups showed significant decreased in 24 hr urinary protein but patients with wild GSTP1 (I/I) genotype group has better response to CYC therapy at early month of therapy. There was no significant difference in remission between two genotypes. At 3rd month, 54.4% of the patients got remission and at 6th month, 63.5% of the patients got remission with CYC aggressive therapy. There was also no significant difference in myelotoxicity due to CYC aggressive therapy between two genotypes. From this finding, it also suggested that the influence of GSTP1 polymorphism on treatment response of CYC might be present.

Morning Session (2), SRC Conference Hall Paper-42

Effect of rosuvastatin once daily versus alternate day dosing on serum lipid profile in hypercholesterolemic patients

Ei Mon Zaw, Soe Yu Zaw and Nu Nu Aye

Department of Pharmacology, University of Medicine 2, Yangon

Hypercholesterolemia is one of the main causes of coronary atherosclerosis. Among lipid lowering agents, rosuvastatin is suggested to be given as alternate day therapy because of its long half‐life. This study aimed to compare the effect of rosuvastatin (10 mg) once daily versus alternate day dosing therapy on serum lipid profile in hypercholesterolemic patients. Lipid lowering effect of rosuvastatin was compared after six weeks therapy. Randomized comparative study was carried out in outpatient department and medical ward of North Okkalapa General and Teaching Hospital. Fifty numbers of both male and female hypercholesterolemic patients (25 patients in each therapy), between 45‐65 years of age were recruited. Serum lipid profile such as total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL‐C) and high density lipoprotein cholesterol (HDL‐C) was measured by Humanlyzer Primus. The baseline serum lipid profiles were not significantly different. Significant changes in serum lipid profiles were observed at the end of six weeks in both therapies (p<0.001). Regarding once daily therapy, TC was decreased from 254.415.7 mg/dL to 154.727.7 mg/dL. TG was decreased from 189.650.1 mg/dL to 114.353.7 mg/dL and LDL‐C was decreased from 178.110.8 mg/dL to 85.324.5 mg/dL. HDL‐C was increased from 38.57.1 mg/dL to 46.57.8 mg/dL. Regarding alternate day therapy, TC was decreased from 260.315.7 mg/dL to 165.125.8 mg/dL. TG was decreased from 185.854.7 mg/dL to 113.456.9 mg/dL and LDL‐C was decreased from 182.415.3 mg/dL to 96.223.6 mg/dL. HDL‐C was increased from 40.76.5 mg/dL to 46.38.2 mg/dL. After six weeks therapy, there were no significant differences of serum lipid profile in both once daily and alternate day therapies of rosuvastatin; TC (154.727.7 versus

 38  46th Myanmar Health Research Congress Abstracts of the papers (Day 2)

165.125.8 mg/dL), TG (114.353.7 versus 113.456.9 mg/dL), LDL‐C (85.324.5 versus 96.223.6 mg/dL) and HDL‐C (46.57.8 versus 46.38.2 mg/dL), respectively (p>0.05). Therefore, alternate day therapy of rosuvastatin could have comparable efficacy with once daily therapy in hypercholesterolemic patients.

Morning Session (2), SRC Conference Hall Paper-43

Effect of telmisartan on lipid profile in hypertensive patients

Nilar Win, Phyu Phyu Myo Kyaw and Thein May Saw

Department of Pharmacology, University of Medicine, Mandalay

Hypertension and hyperlipidemia are the most common risk factors for cardiovascular disease which is a common leading cause of mortality all over the world. Management of hyperlipidemia in a hypertensive patient significantly reduces the total cardiovascular risk. Telmisartan, an angiotensin receptor blocker that has been found to be a beneficial effect on lipid profile in many previous clinical studies but the results showed variable and inconsistent. Therefore, the study was aimed to assess the effect of telmisartan on lipid profile in hypertensive patients with borderline hypercholesterolemia. The study was a quasi experimental study, consisting of thirty two patients with stage I hypertension and borderline hypercholesterolemia of both sexes between 40‐60 years of age. They were treated with telmisartan 40 mg once daily orally for 12 weeks. Blood pressure and serum lipid profile were measured before and after taking telmisartan 12 weeks therapy. Twelve weeks administration of telmisartan 40 mg reduced total cholesterol (TC) by 7.6 ± 5.6%, triglycerides (TG) by 10.7 ± 4% and low density lipoprotein cholesterol (LDL‐C) by 10.7 ± 9.3% from baseline levels. However, serum high density lipoprotein cholesterol was not significantly changed (p =0.09). It was also found that it significantly reduced both systolic blood pressure and diastolic blood pressure by 16.3 ± 4.9% and 13 ± 6.3%, respectively. Although telmisartan 12 weeks therapy did not reduce the lipid to desirable levels, it resulted in significant reduction of TC, TG and LDL‐C in hypertensive patients. Therefore, telmisartan can improve lipid profile in addition to its blood pressure lowering effect.

Morning Session (2), SRC Conference Hall Paper-44

Bioequivalence study of registered amlodipine in healthy volunteers

Ei Kay Khine, Mi Mi Zin and Thein May Saw

Department of Pharmacology, University of Medicine, Mandalay

Amlodipine was manufactured by Pfizer incorporated and patented under the name of Norvasc. Thus it is an innovator drug. Generic amlodipine, Amlosun 5 is widely used to treat hypertension in clinical practice. It is relatively less expensive than Norvasc and commonly prescribed antihypertensive drug in medical stores. It is important to approve the high

 39  Abstracts of the papers (Day 2) 46th Myanmar Health Research Congress

quality of generic drug which was based on pharmaceutical equivalence and bioequivalence with innovator drug. The aim of this study was to determine the bioequivalence of registered amlodipine in healthy volunteers. Pharmaceutical equivalence of both brands was tested and it was found that test drug, Amlosun 5 was pharmaceutical equivalent to reference drug, Norvasc. Bioequivalence study was conducted in 15 healthy subjects with 4 weeks washout period by a randomized, open label, two periods, two sequences, crossover study design according to ASEAN guideline, 2015. Blood samples were taken at 0, 2, 4, 6, 8, 10, 24, 48 and 72 hr post dosing of two brands of 10 mg amlodipine. Plasma amlodipine concentrations were measured by a validated HPLC assay method and pharmacokinetic parameters such as AUC(0‐72hr), Cmax, Tmax were calculated and compared. Bioequivalence parameters (Mean  SD) of Norvasc and Amlosun 5 were AUC(0‐72hr) of 222.77  32.18 ng/mL.hr vs. 220.38  28.88 ng/mL.hr, Cmax of 6.29  0.61 ng/mL vs. 6.06  0.72 ng/mL and Tmax of 7.47  1.41 hr vs. 7.60  1.35 hr, respectively and they were not statistically significant (p > 0.05). The 90% confidence intervals for the mean ratio of the log‐ transformed Cmax and AUC(0‐72hr) were within the acceptance range of 80% to 125%. These results indicated that both brands were bioequivalent. Since Amlosun 5 and Norvasc were pharmaceutically equivalent and bioequivalent, they are therapeutically equivalent in efficacy and safety. Therefore, they can be used interchangeably in clinical practice. Therefore, generic amlodipine, Amlosun 5 can be used cost effectively and it is comparable with innovator in quality, safety and efficacy.

Morning Session (2), SRC Conference Hall Paper-45

Analgesic effect of rhizomes and leaves of Angiopteris evecta (Giant fern) on animal model

Phyo Wai Zin, Khin Phyu Phyu, San San Htwe, Mya Marlar, Myo Nanda Aung, Zaw Myo Tint, Aye Win Oo, Mu Mu Sein Myint and Khine Khine Lwin

Department of Medical Research

Plants are one of the sources of many modern drugs. Myanmar has many plants which have great medicinal values. Among them, Angiopteris evecta, Say‐myin‐khwar, is one of the traditional indigenous medicinal plants, which has many pharmacological properties such as antimicrobial activity, antihyperglycemic and hair growth activity. The aim of this study is to determine the analgesic effect of rhizomes and leaves of Angiopteris evecta (Giant fern) on albino mice. The plant material, Angiopteris evecta, was collected from Western Bago Yoma, Thabaung Township. The rhizomes and leaves of Angiopteris evecta were air‐dried under shade for 7 days. Methanol extraction was done by soxhlet method. Yield percentage of rhizomes and leaves were 20.82 and 9.74 respectively. Acetic acid was used by intraperitoneally to cause pain in mice model and, the number of writhings produced was observed and recorded. The percent inhibitions of writhings were calculated in comparison to those of control. The standard analgesic, diclofenac, at the dose of 50 mg/kg body weight (Bwt) reduced the number of writhings by 61%. Methanolic extract of rhizomes at the dose of 100 mg/kg Bwt reduced the number of writhings by 30%; at the dose of 200 mg/kg Bwt by 0% and; at the dose of 400 mg/kg Bwt by 21% respectively. Methanolic extract of leaves  40  46th Myanmar Health Research Congress Abstracts of the papers (Day 2)

at the dose of 100 mg/kg Bwt reduced the number of writhings by 24%; at the dose of 200 mg/kg Bwt by 35% and; at the dose of 400 mg/kg Bwt by 22% respectively. Methanolic extract of leaves at the dose of 200 mg/kg Bwt showed statistically significant reduction of pain (p < 0.05) compared to control and had the best analgesic activity among the other dosages of rhizomes and leaves of Angiopteris evecta. However, both methanolic extracts of rhizomes and leaves showed no statistically significant analgesic effect (p ≥ 0.05) compared to the standard drug, diclofenac. In conclusion, methanolic extracts of rhizomes and leaves of Angiopteris evecta have analgesic activity which is about half of the activity of standard analgesic drug, diclofenac.

Morning Session (2), SRC Conference Hall Paper-46

Identification of the functional groups in castor seed oil (Ricinus communis L.) (Muufql½kd;eD) by Fourier Transform Infra‐Red Spectrophotometer

Aye Thida Tun, Moh Moh Lwin, Swe Zin Aung, Aye Aye Phyu, Rai Kit, Ei Ei Htway, Khin May Thi and Win Aung

Department of Medical Research

Ricinus communis L. (Euphorbiaceae) is indigenous to the South Eastern Mediterranean region and India but it is widespread throughout tropical regions. It is popularly known as castor plant (Kyat‐Hsu‐Yoe‐Ni) in Myanmar and reputed for effective purgatives in clinical practice. The botanical identification of castor plant was carried out by The Flora of Ceylon. At this study, Soxhlet extraction was used for the extraction of the oil and n‐hexane was used as a solvent. The screening tests were also performed for the presence of phytochemical constituents such as alkaloids, glycosides, amino acid, steroids and saponins in the castor seed. The present investigation was done to identify the functional groups present in castor seed oil in mid IR region (4000‐400cm‐1) by Fourier Transformer Infra‐red (FTIR) Spectrophotometer. The organic compounds in crude castor seed oil using FTIR were identified. The various absorptions of the functional groups in FTIR spectra were O‐H ‐1 ‐1 stretching at 3425 cm , C‐H (CH2) stretching at 2929 cm , C=O (carbonyl) stretching at ‐1 ‐1 ‐1 1737cm , C‐H (CH2) bending at 1447 cm , C‐H (CH3) bending at 1363 cm , C‐O‐C stretching at 1115 cm‐1 and HC=CH (cis) bending at 721 cm‐1. The findings from this study can be applied to authenticate its purity and detect adulteration in castor oil and then giving useful information for further research on traditional medicines in Myanmar.

 41  Abstracts of the papers (Day 2) 46th Myanmar Health Research Congress

Afternoon Session (1), SRC Conference Hall Paper-47

Associated factors for childhood obesity among primary school children in Taunggyi, Myanmar

Honey Win1, Moh Moh Hlaing2 and Ko Ko Zaw1

1University of Public Health, Yangon 2Department of Medical Research

Childhood obesity is an emerging public health problem in both developed and developing country. School based comparative cross sectional study was conducted in three Basic Education High School in urban area of Taunggyi during September to October 2017. The aim of this study is to compare the dietary patterns of overweight and normal weight among primary school children. A total of 220 students were studied: 97 from Grade III and 123 from Grade IV. They comprise 110 overweight students and 110 normal weight students. Among them 53% were boys and 47% were girls. They were interviewed using pretested structured questionnaire including socio‐demographic background, meal consumption and consumption of snack food, fruits and vegetables. More than 55% of children were 9 year old and mean aged of children was 8.67 year. The major ethnicity was Bama (35.9%) followed by Shan (20%), Chinese (16.8%) and the other (27.3%). The 32.7% of mother were dependent and 83.6% of fathers were work outside home. Only 1.4% in overweight and 0.9% in normal weight consumed main meal 4 times per day, 9.5% and 5.9% was 2 times and 39.1% and 43.2% was 3 times respectively. In overweight children the most frequent missed meal was dinner (7.7%), breakfast (4.5%) and lunch (0.9%) and in normal weight children the most frequent missed meal was breakfast (3.6%), dinner (2.7%) and lunch (0.5%).There was significant association between skipping dinner and overweight (p=0.015). Most of the children got pocket money and only 5.9% and 6.4% did not get pocket money in overweight and normal weight children. Most of the children ate snack 1‐2 times per day. The snack eating pattern of overweight and normal weight children were similar. Packaged snacked food and instant noodle consumption were more common in overweight/obese children. In conclusion, skipping dinner was the significant risk factor in childhood overweight/obesity. Children are the future of the nation and the school period is the golden opportunity for developing good habits including dietary pattern and nutritional education is still essential in primary school children.

 42  46th Myanmar Health Research Congress Abstracts of the papers (Day 2)

Afternoon Session (1), SRC Conference Hall Paper-48

Qualitative behavioural change on maternal, newborn and child health in Paletwa Township

Yadanar Aung1, Kyaw Thu Soe1 and Kyaw Oo2

1Department of Medical Research 2Department of Human Resources for Health

The strengthening local capacities to improve Maternal, Newborn and Child Health (MNCH) was launched in 2010 across 100 villages in in Paletwa Township, Chin state. This qualitative study was aimed to assess the knowledge, practices in MNCH care and also the health sector response to MNCH issues in study area. Nine villages were selected by multi‐stage sampling method. Village selection was made in purposive method sampling. Security is seriously concerned and those areas were excluded prior sampling. At each and every village, focus groups of mothers who giving care to their under 2 children (a total of 72 mothers participated in 9 FGD sessions), in‐depth interview methods (mothers) and key informant interviews of health care providers (midwifes/AMWs) from all selected villages were also carried out. Sessions were taped by using the digital voice recorders and manual note taking for late transcription. Recordings were transcribed and coded using ATLAS.ti software. Major themes and subthemes were identified by two co‐investigators on initial review of the transcripts. Women generally had good knowledge of AN, PN and newborn care. But there were some behaviors related to traditions preference like cord care and nutrition for mothers which were risky for women and newborn. Home delivery and use of TBA were still practicing due to some limitations for use of SBA and hospital delivery. AN care, referral for obstetric emergencies, PN care, newborn care and child care services were apparently provided by BHS. Refresher trainings were suggested as priority action for service sector to provide quality healthcare. There was considerable cultural barrier for modern health care services utilization. IEC tools were suggested to develop in the way overcoming cultural and language barriers. Fund pooling mechanism must be more efficient and adaptable with local context in some areas. Three main practices to be change were home delivery with unskilled/no provider, contraception and newborn/infant feeding practices. Community awareness about existence, mechanism and support functions of Village Health Committee among local community members should be increased. MNCH related IEC materials reflecting findings on needs in unhealthy behaviors and locally adaptable language and simplicity are crucial to develop.

 43  Abstracts of the papers (Day 2) 46th Myanmar Health Research Congress

Afternoon Session (1), SRC Conference Hall Paper-49

Are we equipped with serving the right care? Implications for program responses regarding gender‐based violence

Myitzu Tin Oung1, Khaing Nwe Tin2, Su Su Yin1, Kyu Kyu Than3, Kyaw Ko Ko Htet1, Kyaw Thu Hein1 and Hla Mya Thway Eindra2

1Department of Medical Research 2Department of Public Health 3Burnet Institute

Gender‐based violence (GBV) is the most widespread human rights violations and an important public health issue, seriously affecting all aspects of women’s health, including physical, sexual, reproductive, mental and behavioural health. To provide proper treatment and services to GBV survivors and avoid negative health consequences, the health sector has many limitations and challenges. This study was conducted to assess healthcare providers’ knowledge, attitudes and practices regarding GBV management and to explore challenges in the health sector for provision of services to GBV survivors. The study was a cross‐sectional descriptive study using a mixed‐method design. It was conducted in four purposively selected townships, Hlaing Thar Yar, Kawhmu, Sintgu and Patheingyi townships, with a high prevalence of GBV cases. Quantitative data was collected by face‐to‐face interviews with 233 healthcare providers using a structured questionnaire and qualitative data was collected by conducting 14 key informant interviews with healthcare providers. Qualitative findings indicated that more than two‐third of healthcare providers had general knowledge of GBV, such as meaning and types of GBV, vulnerability to GBV and potential perpetrators of GBV. However, majority of them (around 80%) had limited knowledge on signs and symptoms of GBV, its negative health consequences and its management. More importantly, more than half of healthcare providers (62.7%) agreed on the statement that violence occurred between husbands and wives was their personal matter and no one should involve in it. Approximately 75% of respondents had an experience of providing services for physical violence and only a quarter had provided services for sexual violence. Mostly, they (75.6%) provided injury treatment to the survivors whereas only 20.7% had provided psychological counseling. On assessing challenges in the health sector for provision of care to GBV survivors, both quantitative and qualitative results suggested that the health sector had limited facilities for GBV management, such as absence of standard treatment guideline, limited supply of medicines, lack of trained and skilled staff, limited facilities for counselling services and lack of systematic linkages with other organizations. The findings call for actions to implement programs and to establish linkages among organizations that enable health staff to address GBV efficiently.

 44  46th Myanmar Health Research Congress Abstracts of the papers (Day 2)

Afternoon Session (1), SRC Conference Hall Paper-50

Husband’s involvement in family planning practice in Sagaing Township

Thaw Ter Htet, Thida Aung, Min Ko Ko and Khay Mar Mya

University of Public Health

Family planning is allowing individuals and couples to anticipate and attain their desire number of children and the spacing and timing of their births. Husband’s involvement in family planning has been demonstrated a significant positive effect on contraceptive use. A community based cross‐sectional descriptive study was carried out in Sagaing Township from September to November 2017 aiming to identify husband’s involvement in family planning practice, knowledge and attitude of husbands on family planning and current use of contraceptives among couples and to find out the factors associated with husband’s involvement in family planning practice. A total of 270 husbands of reproductive age women were recruited by multistage sampling method and interviewed by using pre‐tested semi‐ structured questionnaire. Most of the respondents (70.4%) were from rural area. Most husbands had studied primary (33.7) and middle school level education (32.2). About 95% of respondents were aware of at least one contraceptive method, however, 90% showed low knowledge level. Regarding attitude, only 17.4% of respondents disagree on statement that contraception is against nature. In terms of total attitude towards family planning, 94.4% of the respondents had positive attitude. About 65% of the respondents received family planning information within 12 months. The study found that 75.9% of the couples were currently using contraceptives and among them, 97.5% used female contraceptive methods and only 1.5% of the respondents used male methods. Regarding husband’s involvement in family planning practice, 75.2% of the husbands were adequately involved in family planning. Husbands involvement in family planning practice was significantly associated with residence (p<0.05), education level (p<0.001), occupation (p<0.01), monthly family income (p<0.05), family type (p<0.05), marriage duration (p<0.05), number of children (p<0.01), status of head of household (p<0.05) and status of receiving family planning information (p<0.001). Moreover, the results revealed that husband’s knowledge and attitude on family planning had significant relationship with involvement in family planning practice (p<0.01). These findings suggest that better education and effective information on family planning is needed to promote husbands’ knowledge and attitude on family planning which consequently increases their involvement in family planning practice.

 45  Abstracts of the papers (Day 2) 46th Myanmar Health Research Congress

Afternoon Session (1), SRC Conference Hall Paper-51

Factors determining on utilization of unskilled birth attendants among rural women in Ayeyarwady Region

Moh Moh Win, Min Ko Ko, Thida Aung and Khay Mar Mya

University of Public Health

An unskilled birth attendant means a birth attendant who is not recognized as a skilled provider. Throughout history traditional birth attendants (TBAs) have been the main birth attendants for women during childbirth in rural area of developing countries. A community based cross‐sectional descriptive study (both quantitative and qualitative methods) was used to study factors determining on utilization of unskilled birth attendants (UBA) among rural women in Ayeyarwady Region in 2017. Respondents were rural women who had childbirth within three years and total of 310 respondents in quantitative and 12 indepth‐ interviews in qualitative were conducted. Ethical consideration was approved by University of Public Health, Yangon. Majority were 25‐34 years (50.8%), pregnant 2 to 4 times (54%), attained up to primary education level (72.9%), farmer (33.5%), Buddhist (92.6%) and Kayin ethnic (52.3%). Most of women (57.7%) were residing in near the health center and 50% had health care person in their village. The proportion of women utilization of UBAs was 45.2% among them. Factors determining on utilization of UAB in this study were respondents’ number of previous pregnancy (p < 0.001), number of children (p < 0.001), education level (p < 0.001), occupation (p < 0.001), ethnicity (p < 0.05), religion (p < 0.01), monthly family income (p < 0.01), distance to nearest health centre (p < 0.001) and attitude on TBAs (p < 0.05), with statistically significant at 95% confident interval. From the qualitative analysis, the seven key themes were emerged: accessibility, economic reason, services offered by UBAs, social welfare services, cultural belief, trustworthy and different performance between TBAs and AMWs. The findings in this study indicated that proportion of the utilization of UBAs was similar to Myanmar Demography and Health Survey and Local Statistics. The results indicated that UBAs still have a role to play in the community in maternal care services. Therefore, policy makers and health care providers should emphasize on UBAs such as training and incorporating. Moreover, they should be focused on the acceptability, accessibility, availability and quality of UBAs for reduction of maternal morbidity and mortality and leading to safe motherhood.

 46  46th Myanmar Health Research Congress Abstracts of the papers (Day 2)

Afternoon Session (2), SRC Conference Hall Paper-52

The lived experiences of mothers caring for obese children

Khaing Thandar Maung1, Ni Ni Aung2 and Kyu Kyu Win3

1 5/100 Military Hospital, Mawlamyine 2Military Institute of Nursing and Paramedical Sciences 3University of Nursing, Yangon

This study was a phenomenological study aimed to explore the lived experiences of mothers caring for obese children. Purposive sampling method was used and necessary data were collected by face‐to‐face interviewed by using in‐depth interviewing method at the home and convenience place of seven participants. The descriptions of participants were analyzed by using van Kaam’s (1969) modification method. Emerging themes in this study were perceived reasons for obesity, reasons for receiving health care, facing difficulties in caring obese child, feeling of being mother with obese child, trying to adhere to treatment regieme, getting support in caring obese child and expectations for the future. According to the findings of this study, participants had encountered bio‐psycho‐social, financial challenges and long term caring burdens. All participants used various strategies to overcome their stressful situation. Although people were accepted fatness as cute and chubby, when mothers realize obesity as a disease, they seek medical care for better future of their children and they tried to change the life style of their obese children in spite of facing physical and psychological burdens. Moreover, as adherence of treatment regieme depended on various aspects of support (man, money, time, severity of obesity and accessibility of clinic), mothers were doing the best for their obese children with the expectation of the child would be normal weight by taking treatment from Nutrition Department. Thus, support services from various points of view such as health education program, training course for health care personnel, sports and physical activities in school and community environment were recommended.

Afternoon Session (1), SRC Conference Hall Paper-53

The lived experiences of mothers having a child with hemophilia: A phenomenological approach

Khin Sandar Win, Moe Wai and Cho Cho Than

Military Institute of Nursing and Paramedical Sciences (MINP)

In Myanmar, till today, although the management of hemophilia has been improving, children with moderate or severe hemophilia as well as their mothers still have physical and social impact. This qualitative study with phenomenological approach was conducted at Hemato‐Oncology Unit, Yangon Children Hospital to uncover the lived experiences of

 47  Abstracts of the papers (Day 2) 46th Myanmar Health Research Congress

mothers who have children with hemophilia. Seven participants were interviewed by using face‐to‐face in‐depth interviewing method. Participants’ descriptions were analyzed by using van Kaam’s (1969) modification method and seven major themes emerged as experiences before diagnosis, feelings at the point of diagnosis, ongoing challenges in long term treatment, emotional responses to child’s sufferings, impact on the whole family dynamics, overcoming difficulties through supports and encouragement and future expectations for their children. Based on them, the structural definition was developed as, mothers whose children with hemophilia had come across a variety of difficulties since the time they had noticed much bleeding symptoms. At the time of confirming their child’s diagnosis, they felt huge emotional shock as hemophilia is a life‐threatening disease and need to take lifelong treatment. Throughout taking treatment, the whole family dynamic was affected. However, they tried to overcome the hardships by getting supports including the Myanmar Hemophilia Patients Association and religious view. Although they knew their child’s suffering, they expected to be educated and live independent one in their child future. This study highlighted that health care personnel should provide psychosocial supports to these mothers. It is also recommended that to disseminate knowledge to both community and health care professionals at rural area about advanced knowledge on hemophilia through performing the Myanmar Hemophilia Patients Association activities regularly and encourage mothers to join these association activities. In addition, it is needed to educate these female carriers at the Hemophilia Treatment Center before they plan to start a family. By educating the female carriers, they can gain a greater understanding of their carriership, so that they can make informed decisions concerning their child‐bearing.

Afternoon Session (1), SRC Conference Hall Paper-54

Longitudinal assessment of nutritional status of two to five years old children living in areas targeted agricultural interventions for food security

Theingi Thwin, Moh Moh Hlaing, Mya Ohnmar, Aye Aye Maw, Khin Mittar Moe San, Khin Thidar Wai, Hla Phyo Lin, Su Su Hlaing and Naw Myat Su Mon

Department of Medical Research

Agricultural interventions can directly affect food and nutrition security by alterations in the production of foods and/or income derived through agricultural livelihoods. Therefore, a longitudinal study was carried out to assess the nutritional status of two‐five years old children living in three selected villages (Kyar Hone, Kyein Pike and Yaeso) of Htan Ta Bin Township, Yangon Region where WelthHungerHlife (International non‐governmental organization for food security) has implemented agricultural interventions since 2014. The matched children were selected as controls living in non‐intervention villages (Thanpayarkhon, and Lamutangyi). A total of 140 children (70 from families receiving agricultural interventions by WelthHungerHlife and 70 from farmer‐headed families in non‐ intervention villages) participated in baseline data collection. Interview with mothers or care givers of the study children for diet diversity and measurements of weight, height and body composition (fat mass and fat free mass by deuterium dilution technique) were carried out longitudinally in four times with eight‐month intervals over three years. Using a mixed  48  46th Myanmar Health Research Congress Abstracts of the papers (Day 2)

ANOVA data analysis, changes in nutritional status revealed that the overall mean weight, height, and fat free mass of non‐intervention children were significantly greater (p=0.01) than those of intervention group in all time points (p<0.001). The mean fat mass of non‐ intervention group was larger than those of intervention group in baseline and second measurement but not different in third and end line measurement. The mean weight for age, height for age and weight for height z scores of intervention and non‐intervention group were not significantly different (p=0.1, p=0.2, and p=0.2). Diet diversity scores of intervention group were greater than those of non‐intervention group in all time points but not significantly different (p=0.09). The significant changes in overall mean weight, height and fat free mass were affected by time factor, agricultural interventions and interaction of them. However, no significant main effect of intervention on changes in weight for age, height for age and weight for height z scores was found. Based on the findings, the effect of agricultural intervention on nutritional status of children was insignificant after three years but interaction between time factor and agricultural interventions affected significantly on promotion of nutritional status of children.

Afternoon Session (1), SRC Conference Hall Paper-55

Caring of elderly people with Alzheimer’s disease: Family caregivers’ perspective

Myat Thuzar Khin1, Win Hlaing2 and Yin Yin2

14/300 Military Hospital, Monywa 2Military Institute of Nursing and Paramedical Sciences

This phenomenological study explored the lived experiences of family caregivers undergoing caring for elderly parents and siblings who were the victims of Alzheimer’s disease and it was conducted from January to July, 2017. Purposive sampling was used and necessary data were collected by using face‐to‐face interviews at the home of seven respective participants in Yangon. Data analysis was done with van Kaam’s six steps of analysis method. Firstly, elicit the descriptive expressions and identified common elements from them. Next, the unrelated ones were eliminated to formulate hypothetical definition which was applied to original descriptions and structural definition was identified, lastly. From this analysis, the lives of family care givers were normal and peaceful from the beginning which was interrupted by fearful disease with the theme, life is a road of many turnings, difficulties encountered through caring with miseries established, seeking helping hands to get relief with lend a hand, getting long term pressure of caring with burdens of daily care, preparing for their mind and body to immerse in care with perception towards home care and bravely but patiently continued their journey with the theme of accompany the journey were elicited. The caregivers’ challenges were relieved by admonishments of Buddha and their ancestors’ teachings. This study highlighted that after facing many challenges, the caregivers could control upon their physical as well as emotional frustrations with lessons learnt not only from surrounding but also from the experiences they went through all along. Therefore, the caregivers should be organized with self‐ help groups within community and caregivers training on caring of such disease should be implemented.  49  Abstracts of the papers (Day 2) 46th Myanmar Health Research Congress

Afternoon Session (1), SRC Conference Hall Paper-56

The life of family caregivers living with elderly people in Yangon Region by using grounded theory approach

Soe Soe, Ni Ni Aung and Mg Mg

Military Institute of Nursing and Paramedical Sciences

Along with the advanced medicine and technology, aging population rapidly grows and daily care activities shift to the shoulder of family caregivers, especially in Myanmar. This study explored and developed the substantive theory of the life of family caregivers living with the elderly people in Yangon Region, Myanmar using grounded theory approach. The first two participants selected by purposive sampling method and the rest ten selected by using theoretical sampling method contributing a total of twelve participants were interviewed and grounded theory analysis of Strauss and Corbin (1998) was used to analyse the data. The core category "the filial moral obligatory care" was uncovered and an explanatory model that explained care giving process was influenced by cultural and religious factors, affectionate care, family value system and perception of doing best. The interrelatedness of categories was caring activities for the elderly, bearing the burden, influencing factors on caring the elderly, and perception of elderly care as merits or demerits. Although caregiving was stressful, caregiverswith no financial problem had less burden, and support by family members, relatives and others also facilitated the care giving situation. Despite the physical or emotional or economic burden were threatened well‐being of the caregivers, most of the participants were very glad to take care of their elderly parents and they perceived presence of their parents were strength and blessing to them, caring of elderly parents was more than an obligation and it made them pleased and to gain merits. Therefore, the family and particularly adult children continue to be the core of support and care for elderly people in Myanmar, reflecting the strong sense of filial responsibility rooted in culture throughout the country. This study recommended to develop further models which are representative for Myanmar culture of family care in aging population.

 50  46th Myanmar Health Research Congress Abstracts of the papers (Day 2)

Afternoon Session (1), SRC Conference Hall Paper-57

Being a person with brachial plexus injury on dominant hand: A phenomenological approach

Win Pa Pa1, Su Su Nyein2 and Thae Hnin Soe2

1No. (15) Military Hospital (100 bedded), Than Taung Gyi 2Military Institute of Nursing and Paramedical Sciences

This study was a phenomenological study to uncover the lived experiences of persons with Brachial Plexus Injury (BPI) on dominant hand at Yangon Orthopaedic Hospital (YOH) (Kyee‐ Myint‐Dine). Seven participants were selected using purposive sampling method and face to face in‐depth interview was done to collect the data. Data were analysed by van Kaam's method, seven major themes emerged in this study such as process of seeking care, physical sufferings, emotional feelings, socioeconomic constraints, overcoming challenges, hope for better life and ways of coping. It was discovered that participants encountered numerous problems after suffering from BPI on dominant hand such as physical problems regarding chronic pain and difficulties in activities of daily living, emotional problems due to unpredictable outcome, chronic disabled conditions and lack of income, social problems such as altered family relationship, discrimination from environment and difficulties in participating social activities. It was also found that most of the participants tried to cope with their illness and life changes by various ways. Their expectations regarding their disabled conditions and future plan were also identified in this study. The structural definition of this study emerged as “Adaptation of the chronically disabled living with BPI is the challenging issue to attempt balancing with both positive and negative compensation and coping to create better future”. These results accentuated that the BPI seemed not only injury to the nerve but also emotional, physical, economic and social challenges. This study would be able to be deeper understanding of the patients for providing holistic care to the patients with BPI on dominant hand. It recommended to strengthen public health care services, to introduce health insurance policy, to conduct job fair programs and future research studies using mixed method for providing competency nursing care to those patients.

 51  Abstracts of the papers (Day 3) 46th Myanmar Health Research Congress

Paper Reading Session: Day 3

Morning Session (1), Auditorium (1) Paper-58

Immunoexpression of Bcl‐2 in B‐cell Non‐Hodgkin lymphoma

May Thu Lwin1, Saw Nu Nu Hlaing1, San San Hlaing1, Moe Hein2, Nyein Chan Khin3 and Yadanar Htay3

1Department of Pathology, University of Medicine, Mandalay 2Department of Clinical Haematology, Mandalay General Hospital 3Common Research Laboratory, University of Medicine, Mandalay

The purpose of this study was to determine immunoexpression of Bcl‐2 in B‐cell Non‐ Hodgkin Lymphoma (NHL). This is a hospital‐based cross‐sectional descriptive study involving forty patients of B‐cell NHL admitted to Mandalay General Hospital from 1st July 2016 to 30th June 2017. All cases were subclassified into low, intermediate and high grade according to working formulation on Haematoxylin & Eosin examination. Immuno‐ histochemistry study using rabbit monoclonal Anti‐Bcl‐2 antibodies (BioGenex) was done on all cases by HRP (horseradish peroxidase) polymer method at the Common Research Laboratory, University of Medicine, Mandalay. In this study, the age distribution of B‐cell NHL ranged from 13 to 80 years and the peak was seen between 41 to 60 years age group. Male to female ratio was found to be 1:1.3. Out of 40 cases, 22 cases (55%) were nodal NHL and 18 cases (45%) were extranodal NHL. According to working formulation, 5 cases (12.5%) were low grade, 33 cases (82.5%) were intermediate grade, and 2 cases (5%) were high grade. Most of the cases were diffuse large B‐cell lymphoma. Immunoexpression of Bcl‐2 in all 40 cases showed that 38 cases (95%) were Bcl‐2 positive and 2 cases (5%) of diffuse large cell NHL were Bcl‐2 negative. There were no obvious differences between Bcl‐2 immunoexpression in both nodal and extranodal B‐cell NHL. Positive Bcl‐2 immunoexpression was found in 100% in low grade (5/5 cases), 94% in intermediate grade (31/33 cases) and 100% in high grade (2/2 cases). In conclusion, Bcl‐2 was expressed frequently in B‐cell NHL. Majority of the cases were intermediate grade, diffuse large cell type. Bcl‐2 immunostaining can find out follicular lymphoma indicating that it must be considered as routine IHC marker in B‐cell NHL. It is also needed to study adding more IHC markers in large population with longer duration to identify the role of Bcl‐2 in prognosis and treatment of B‐cell NHL.

 52  46th Myanmar Health Research Congress Abstracts of the papers (Day 3)

Morning Session (1), Auditorium (1) Paper-59

Accuracy of visual inspection of acetic acid test in detection of premalignant conditions of cervix

Htar Nandar, Myint Myint Thin and San San Myint

Central Women Hospital, Yangon

Cervical cancer is the fourth most common cancer in women and second most common cancer in women aged 15‐44 years. Almost nine out of ten cervical cancer deaths occur in the less developed regions. Cervical cancer is preventable one because of its premalignant conditions. Early detection of premalignant conditions can reduce the incidence of cervical cancer. The aim of the study was to study the accuracy of visual inspection with acetic acid (VIA) test in detection of premalignant conditions of cervix. This study was a hospital based descriptive study which was carried out in Central Women’s Hospital (CWH), Yangon from January 2015 to December 2015. A total of 200 sexually active women of age 30 to 49 years, admitted to gynecology ward in CWH, Yangon were enrolled in this study, after taking informed consent. Visual inspection with acetic acid test using (3‐5%) acetic acid was performed to patient prior to operation. The VIA positive cervices were reported according to WHO VIA classification. After operation, tissue biopsies were taken from VIA positive and negative cervices from two quadrants. In this study, total (24) patients were tested for VIA. Among them (after confirmation with histology) (16) women found to have normal cervix where as (7) with CIN I and (1) woman with CIN II. Out of (175) VIA negative women, only one female was diagnosed as CIN I. The results were analyzed and accuracy of VIA test was calculated in accordance with histopathology. The study showed that sensitivity and specificity of VIA test in the prediction of premalignant conditions of cervix were 88.9%, 91.6% respectively. The accuracy of test is 91.5%. This study stated that the accuracy of VIA test was high and also simple, cheap and easy to perform. The result of this study indicates that VIA may be a useful and feasible screening test for cervical precancerous.

 53  Abstracts of the papers (Day 3) 46th Myanmar Health Research Congress

Morning Session (1), Auditorium (1) Paper-60

Immunohistochemical expression (IHC) and fluorescence in situ hybridization (FISH) of EGFR in colorectal carcinoma

Khin Kant Kaw Oo1, Min MinWin1, Myat Mon Oo1, Hnin Nu Htwe1, Ko Ko Zaw2, Kyaw Soe1, Win Pa Pa Naing1, Cho Cho Nyunt3 and Myint Myint Nyein3

1Department of Medical Research 2University of Public Health 3Department of Pathology, Yangon General Hospital

Adenocarcinoma of the colon is the most common malignancy of the GI tract and is a major cause of morbidity and mortality worldwide. Epidermal growth factor receptor (EGFR) is also known as HER‐1 or erb‐B1. The beginning of EGF to EGFR produces a biological signal to the cell that initiates several functions that promote tumor growth, including cell invasion and metastasis, repair and new blood vessel formation. Thus, EGFR is recognized as an important player in colorectal cancer (CRC) initiation and progression. In this study, total 61 cases of colorectal carcinoma were included and histological grading, immunohistochemical expression and fluorescence in situ hybridization of EGFR were conducted. For the grading, 11/61 (18%) cases were well differentiated, 38/61 (62%) cases were moderately differentiated and 12/61 (20%) were poorly differentiated colorectal carcinoma. EGFR IHC immunoexpression was positive in 50/61 (82%) cases and negative in 11/61 (18%) cases. All the 11 cases of well differentiated cases gave EGFR IHC positive immunoreaction. Among the 38 cases of moderately differentiated adenocarcinoma, 30 cases showed EGFR IHC positivity and 8 cases gave no reaction. Nine out of 12 cases of poorly differentiated adenocarcinoma showed EGFR IHC positive and 3 cases gave no reaction. In this study, EGFR IHC is highly expressed (82%) in colorectal carcinoma and their expression is not associated with age, sex, grading and site of tumor. For fluorescence in situ hybridization method, total 20 cases of EGFR IHC highly positive cases were selected. Half of the cases 10/20 (50%) showed FISH positive and other half cases give FISH negative reaction. Detection of EGFR is mainly for anti‐EGFR targeted therapy. So, this study aids in selection of patients for anti‐ EGFR targeted therapy and helpful in treatment options and disease management. Moreover, EGFR FISH can be tested together with KRAS mutation and can predict the treatment response and the disease outcome.

 54  46th Myanmar Health Research Congress Abstracts of the papers (Day 3)

Morning Session (1), Auditorium (1) Paper-61

Immunoexpression of Matrix Metalloproteinase‐9 in colorectal adenocarcinoma

Saung Hnin Phyu1, Saw Wut Hmone2, Myint Myint Nyein2 and Myat Mon 2

1National Health Laboratory 2University of Medicine (1), Yangon

Colorectal carcinoma is one of the most common malignant tumors of gastrointestinal tract and is a contributing factor of cancer mortality in Myanmar. Prognosis depends on many factors including age and sex of the patients, histological types, grades and tumor staging. MMP‐9 is a proteolytic enzyme which breaks down extracellular matrix leading to tumor progression, contributing as a potential prognostic marker nowadays. The study was aimed to determine MMP‐9 immunoexpression in colorectal adenocarcinoma and its association with Astler‐Coller staging. A cross‐sectional descriptive study was done on 42 specimens of colorectal adenocarcinoma. The mean age of the colorectal adenocarcinoma was 53 ±13.22 years with male: female ratio of 1:1.8. All tissue specimens were studied with haematoxylin and eosin to categorize histological types and grades. Out of 42 cases, 21.4% (9/42) were well differentiated, 57.2% (24/42) were moderately differentiated and 21.4% (9/42) were poorly differentiated. According to Astler‐Coller staging, 11.9% (5/42) were found to be in stage B1, 40.5% (17/42) in stage B2, 7.1% (3/42) in stage C1, 33.3% (14/42) in stage C2 and 7.1% (3/42) in stage D. MMP‐9 immunoexpression was determined by peroxidase‐ antiperoxidase method in which 81% (34/42) of colorectal carcinoma showed positive MMP‐9 immunoexpression. Positive MMP‐9 immunoexpression was seen in 91% of conventional adenocarcinoma, 40% of mucinous carcinoma and 0% of signet ring carcinoma. The findings of the study pointed out that MMP‐9 immunoexpression was positively associated with histological types (p = 0.001). MMP‐9 immunoexpression was positive in 88.9% of well differentiated adenocarcinoma, 91.7% of moderately differentiated adenocarcinoma and 44.4% of poorly differentiated adenocarcinoma (p = 0.007). Regarding the immunoexpression of MMP‐9 in different Astler‐Coller staging, positive MMP‐9 immunoexpression was seen in 60% of the cases in stage B1, 76.5% in stage B2, 66.7% in stage C1, 92.9% in stage C2 and 100% in stage D. Although MMP‐9 immunoexpression was seemed to be increased in higher Astler‐Coller staging but it was not statistically significant (p = 0.324). The findings of the study might be useful for predicting prognosis and helpful in better management of colorectal adenocarcinoma by introducing targeted therapy against MMP‐9 in future.

 55  Abstracts of the papers (Day 3) 46th Myanmar Health Research Congress

Morning Session (1), Auditorium (1) Paper-62

Detection of antinuclear antibodies in systemic lupus erythematosus patients using indirect immunofluorescence and line immunoassay methods

Aye Aye Khin, Win Kalayar Kyaw and Khin Aye Thin

Department of Medical Laboratory Technology, University of Medical Technology, Yangon

Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by the production of various pathological autoantibodies. Antinuclear antibody (ANA) is useful in the diagnosis of SLE. The aim of this study was to detect antinuclear antibodies in clinically suspected SLE patients by indirect immunofluorescence (IIF) and line immunoassay (LIA) method. ANA patterns were screened by IIF method and specific antinuclear antibodies were detected by LIA method. A laboratory based cross‐sectional descriptive study including 30 serum samples of clinically suspected SLE patients from 500 bedded Yangon Speciality Hospital was tested. In this study, out of total 30 clinically suspected SLE patients, 29 females (96.7%) and only 1 male (3.3%) was found. The youngest patient was 2 years and the oldest was 58 years. Most of the patients in this study were in 21‐30 years age group (40%) followed by 31‐40 years age group (23.33%). ANA IIF was positive in 28 (93.33%) cases and LIA was positive in 21 (70%) cases. Percent agreement between the two methods was 76.7%. Four patterns of nuclear fluorescence (homogenous, speckled, homogenous and speckled and nuclear dots patterns) were noted with IIF method. The ANA pattern observed in this study were mostly homogenous (39.28%). Specific antibodies detected in LIA method were dsDNA, histone, nucleosome, Sm, RNP/Sm, SS‐A, SS‐B, Ribosomal P‐protein, Ro‐52, Scl‐ 70 and mostly with nucleosome and RNP/Sm (18%) respectively. Intermediate to good agreement (kappa=0.516) was observed between result of ANA (weak positive up to strong positive) by IIF and LIA method. It was statistically significant (p=0.003). However, poor agreement (kappa=0) was observed between result of ANA (trace positive) by IIF and LIA method. LIA negative cases become trace positive in ANA IIF. So that ANA IIF method is more sensitive than LIA test. Sensitivity of IIF was 100% and specificity was 96%. Sensitivity and specificity of LIA test were 75% and 100% respectively. This study found out that LIA method can be used interchangeably with IIF method in samples from weak positive up to strong positive cases but IIF method should be used in samples negative for LIA to detect trace positivity of ANA.

 56  46th Myanmar Health Research Congress Abstracts of the papers (Day 3)

Morning Session (2), Auditorium (1) Paper-63

Community‐based cervical cancer screening using cobas human papillomavirus (HPV) test and liquid based cytology (LBC) in married women living in North Okkalapa Township, Yangon

Mu Mu Shwe1, Kyi Kyi Nyunt2, Lin Pa Pa Aye1, Kham Mo Aung1, Myat Noe Swe2, Ni Ni Aung2, Ohnmar Sein3, Win Maw Tun1 and Kyaw Zin Thant1

1Department of Medical Research 2Department of Obstetrics & Gynecology, North Okkalapa General Hospital 3Public Health Care Center, North Okkalapa Township

Cervical cancer is caused by persistent infection with high‐risk human papillomavirus (HR‐ HPV) types. Based on this strong etiologic link between HR‐HPV and cervical cancer, primary HPV testing for cervical cancer screening is now being implemented in many countries. This study aimed to perform the community‐based cervical cancer screening using Cobas HPV test and liquid based cytology (LBC) in married women by a cross‐sectional descriptive method. A total of 312 married women (median age 45‐years; range 30‐64) residing in Kyauk‐Ye‐Twin Ward, North Okkalapa Township, Yangon were screened using LBC in 2017. Among them, 220 women aged between 30‐49 years were also investigated using Cobas HPV test. Cervical cells were obtained from the cervix by sterile disposable cytobrush and collected in Cobas PCR cell collection media. HR‐HPV testing was performed by Cobas HPV Test. It is an automated, polymerase chain reaction and nucleic acid hybridization test for the detection of 14 HR‐HPV types in a single analysis. It identifies HPV‐16 and HPV‐18 specifically which are associated for over 70% of cervical cancer while concurrently detecting other 12 HR‐HPV types (‐31,‐33,‐35,‐39,‐45,‐51,‐52,‐56,‐58,‐59,‐66‐and‐68) as pooled‐12‐HR‐HPV. In this study, HR‐HPV was identified in 5.5% (12/220) of women in general population of Kyauk Ye Twin Ward. Among HPV positive cases, pooled‐12‐HR‐HPV types were 66.7%, HPV‐16 (25.0%) and HPV‐18 (8.3%). Using LBC (Bethesda‐system), negative for intraepithelial lesion or malignancy (NILM) was 79.5% (248/312). Epithelial cell abnormalities such as atypical squamous cells and/or atypical glandular cells (ASC/AGC), low grade squamous intraepithelial lesion (LSIL) and high grade squamous intraepithelial lesion (HSIL) were detected 11.9% (37/312), 7.4% (23/312) and 1.3% (4/312) respectively. Women with positive HPV‐16 or HPV‐18 and/or epithelial cell abnormalities were referred to North Okkalapa General Hospital for colposcopy, histopathology and treatment. Positive pooled‐ 12‐HR‐HPV types with NILM were instructed to screen/follow up after one year. This study highlighted that all women who had positive HR‐HPV types and/or epithelial cell abnormalities had no previous history of cervical cancer screening. To reduce the incidence and mortality of cervical cancer in Myanmar, well organized National Cervical Cancer Screening Program (NCCSP) should be established as a priority. If we use the primary HPV testing in NCCSP, the most‐highest risk women who will develop cervical cancer can be ruled out. In addition, refer to hospital for appropriate management and/or follow up and burden of health care providers will be certainly reduced.

 57  Abstracts of the papers (Day 3) 46th Myanmar Health Research Congress

Morning Session (2), Auditorium (1) Paper-64

Human papilloma virus type 16 E7 oncogene in cervical intraepithelial neoplasia, in situ and invasive carcinoma of uterine cervix

Thu Ya Aung1, Nyo Me May Thyn1, Khin Thida Aung1 and Myint Myint Nyein2

1Department of Pathology, University of Medicine 2, Yangon 2Department of Pathology, University of Medicine 1, Yangon

This study aimed to detect the human papillomavirus type 16 E7 oncogene in cervical intraepithelial neoplasia, in situ and invasive carcinoma of uterine cervix. Total 30 cervical intraepithelial neoplasia (CIN) cases and 60 invasive carcinoma cervix cases were studied histologically and detection of HPV 16 E7 oncogene was done by polymerase chain reaction (PCR) method. There were 10 cases of CIN I, 14 cases of CIN II and 6 cases of CIN III/CIS. Out of 60 cases of invasive cervical carcinoma, 50 cases (83.4%) were squamous cell carcinoma (SCC), 8 cases (13.3%) were adenocarcinoma and 2 cases (3.3%) were adenosquamous carcinoma. In 50 cases of squamous cell carcinoma cervix, 10 cases (20%) were well differentiated, 35 cases (70%) were moderately differentiated and 5 cases (10%) were poorly differentiated carcinoma. In 8 cases of adenocarcinoma, 7 cases (87.5%) were moderately differentiated and one case (12.5%) was well differentiated adenocarcinoma. Two cases of poorly differentiated adenosquamous carcinoma cervix were included in this study. DNA was extracted from formalin fixed paraffin embedded tissue using QIAamp DNA FFPE tissue kit method. Concentration and purity of extracted DNA was measured using GeneQuant 1300 spectrophotometer. Extracted DNA were also tested for amplification with internal house‐keeping (β globin) gene using PCR method. Positive control and negative control were run along with each test. HPV 16 E7 oncogene was detected in 9/30 cases (30%) of cervical intraepithelial neoplasia and 39/60 cases (65%) of invasive cervical cancer. HPV 16 E7 oncogene positive patients were more likely to have high grade CIN (i.e. CIN III/CIS) although it was statistically not significant (p>0.05). HPV 16 E7 oncogene positivity was statistically higher in squamous cell carcinoma than other histological types (p<0.05). There was significant association between moderately and poorly differentiated SCC and HPV 16 E7 oncogene (p<0.05) but there was no significant association between different histological grades of adenocarcinoma and HPV 16 E7 oncogene (p>0.05).

 58  46th Myanmar Health Research Congress Abstracts of the papers (Day 3)

Morning Session (2), Auditorium (1) Paper-65

Role of immunofluorescence in detecting HER2/neu status in breast carcinoma

Ohnmar Kyaw1, Aye Aye Lwin1, Swe Zin Myint2, Moh Moh Htun1, Myint Myint Nyein2 and Khin Saw Aye1

1Department of Medical Research 2University of Medicine 1, Yangon

Cancer rates are expected to grow worldwide in recent years and breast carcinoma becomes the third most common female cancer in Myanmar accounting for 11.8% of all cancer cases. HER2/neu, one of the prognostic markers of breast carcinoma, is a member of human epidermal growth factor family and it triggers cell proliferation, differentiation and inhibits apoptosis and is associated with worse prognosis. Targeted therapy against HER2/neu, trastuzumab (Herceptin), significantly increases disease‐free intervals and overall survivals in both early stage and metastatic breast carcinomas. And so, an appropriate HER2/neu evaluation becomes important for the proper identification of patients eligible for treatment with anti‐HER2 targeted therapies. The present study was aimed to study HER2/neu status in (94) Myanmar breast carcinoma patients by immunofluorescence and its expression was compared with immunohistochemistry (IHC) which is routinely used in most pathology laboratories in Myanmar to determine the accuracy of immunofluorescence. The mean age of the patients was 52.23 ± 11.82 years and 60% of cases were B‐R grade2 (moderately differentiated) according to the Bloom‐Richardson System. HER2/neu expression was compared between two different methods. One case, 13 cases, 51 cases and 29 cases were determined as score 0, +1, +2 and +3 respectively by IHC. Immuno‐ fluorescence also detected 1 case, 16 cases, 32 cases and 45 cases as score 0, +1, +2 and +3 respectively. Immunofluorescence detected higher expression of HER2/neu in score +1 and score +3 but less expression in score +2. There was significant statistical association between HER2/neu positivity and histological grade of breast carcinoma (p value=0.000) in both methods and sensitivity of immunofluorescence was 91.25% and specificity was 71.43%. Positive predictive value was 94.81% and negative predictive value was 58.82%. Concordance rate between IHC method and immunofluorescence was 88.3% (95% CI). The present study showed that the evaluation of HER2/neu expression by IHC method and immunofluorescence offered a highly reproducible and very robust method with good concordance. The results highlight the accurate assessment of HER2/neu status is a critical issue in selecting breast carcinoma patients that might benefit from targeted therapy, trastuzumab.

 59  Abstracts of the papers (Day 3) 46th Myanmar Health Research Congress

Morning Session (2), Auditorium (1) Paper-66

Plasma vascular endothelial growth factor A and immunoexpression of estrogen receptor, progesterone receptor, HER2/neu in invasive ductal carcinoma breast

Su Nandar Myint, Saw Wut Hmone, Myint Myint Nyein and Myat Mon

Department of Pathology, University of Medicine 1, Yangon

Although invasive ductal carcinoma of the breast is the most frequently diagnosed and encountered as rising incidence in Myanmar, it can be cured by effective treatment strategies. The prognosis and treatment of invasive duct carcinoma breast mainly depend on hormone receptor and HER2/neu status. Vascular endothelial growth factor A is the most potent angiogenic factor essential for tumour growth and metastasis, the amount of which expressed by cancer cells have been found to be correlated with poor prognosis in invasive ductal carcinoma breast. The study was a cross sectional, analytical study aimed to study the association between the plasma VEGF A level and histological grades, estrogen and progesterone receptor status, HER2/neu immunoexpression in invasive ductal carcinoma breast. Fifty six cases of histologically proven invasive ductal carcinoma breast were included in this study. Histological grading was done according to Bloom and Richardson grading system. Estrogen and progesterone receptor and HER2/neu immunoexpression were done by immunohistochemical technique. The plasma VEGF A level was measured by ELISA method. The mean age of the patients was 52.89 years. Most of the cases were Bloom and Richardson grade II (67.86%) followed by grade III (28.57%) and grade I (3.57%). ER immunoexpression was positive in (75%) and progesterone receptor immunoexpression was positive in (57.14%). HER2/neu positivity were observed in (30.36%). The Bloom and Richardson grade III cases were found to be associated with (25%) of positive ER immunoexpression and (17.86%) of positive PR immunoexpression. In addition, (28.57%) cases of BR grade III invasive duct carcinoma breast showed HER2/ neu immunoexpression positive. The mean plasma VEGF A level among study population was 94.34±51.62 pg/mL (normal range =15‐65 pg/mL). A statistically significant association were observed between the mean plasma VEGF A level and high BR histologic grade (p<0.001), positive immunoexpression of estrogen receptor (p=0.003), progesterone receptor (p=0.020), and HER2/neu (p=0.001) showing a positively association. This study may highlight to select out the individual patients with high plasma level of VEGF A who may benefit from combined treatments with antiangiogenic agents in addition to the usual antihormonal and anti HER2/neu targeted therapy in invasive ductal carcinoma breast.

 60  46th Myanmar Health Research Congress Abstracts of the papers (Day 3)

Morning Session (2), Auditorium (1) Paper-67

Immunohistochemical expression of Epidermal Growth Factor Receptor (EGFR) in malignant surface epithelial tumors of ovary

Thitsar Htet Htet Htoo1, Khin Thida Aung2, Lei Shwe Zin2, Htar Ei Lwin2, San San Htwe1, Win Pa Pa Naing1 and Khin Saw Aye1

1Department of Medical Research 2University of Medicine 2, Yangon

Ovarian cancer is the deadliest gynaecologic cancer and represents approximately 70% of ovarian cancers are diagnosed in an advanced stage and 5 years survival rate is only 35%. The aim of this study is to find out the distribution of the immunoreactivity of EGFR in different histologic types and grades of malignant surface epithelial tumors of ovary. Total 54 cases of malignant surface epithelial tumors of ovary from North Okkalapa General and Teaching Hospital and Thingangyun Sanpya General Hospital during a period of one year, from August 2015 to September 2016 were included. In this study, the youngest age was 15 years and the oldest age was 93 years. Histological types and grades of ovarian tumors were determined and EGFR immunoexpression was studied. Complete or incomplete circumferential brown membrane staining tumor cells was regarded as positive immunoreactivity. <5% positivity was regarded as (‐). The proportions of positive cells were graded as: 5‐25% (+) positivity, 26‐50% (++) positivity, 51‐75% (+++) positivity and 76‐100% (++++) positivity, respectively. Out of 54 cases, EGFR immunoexpression was found in 31 cases (57%) and 23 cases (43%) showed (‐). Among 31 cases, 21 cases (39%) showed (+) positivity, 6 cases (11%) revealed (++) positivity and 4 cases (7%) revealed (+++) positivity of EGFR immunoexpression, respectively. This study could not give a statistically significant association between EGFR immunoexpression and histological types of ovarian cancers. But, the immunoexpression of EGFR in well differentiated tumors showed (++) positivity (9%), moderately differentiated tumors revealed strongest (+++) positivity (6.1%) and poorly differentiated tumors gave strongest (+++) positivity (20%). Increased EGFR immunoexpression (++, +++) positivity was observed predominantly in high histological grades of ovarian cancers. Since, high EGFR levels have a negative prognostic role in ovarian cancers further studies with large sample sizes and long term follow up are required for prognosis and further management.

 61  Abstracts of the papers (Day 3) 46th Myanmar Health Research Congress

Afternoon Session (1), Auditorium (1) Paper-68

Identification of poisoning cases admitted to different level hospitals in Mandalay and Ayeyawady Regions, Myanmar

Khin Hnin Pwint1, Min Wun1, Phyo Kyi Thant1, Moe Moe Aye1, Thin Thin Wah1, Swe Swe Aung1, Thinzar Myo1, Su Su Hlaing2 and Kyaw Swar Lwin2

1Department of Medical Research 2Department of Medical Services

A retrospective, record‐review study was done at eight different level hospitals in Mandalay and Ayeyawady Regions. Charts of all patients admitted to the study hospitals for poisoning during September 2015 to August 2016 were reviewed and required information was extracted. Poisoning cases were diagnosed according to ICD‐10, T36 to T65. Although the population of Mandalay and Ayeyawady regions were almost the same (6165723 vs. 6184829) according to 2014 Census data, the number of poisoning patients admitted to hospitals in Mandalay Region was about fourfold higher than that of Ayeyawady Region (1914 vs. 454). Insecticide poisoning was the highest in both Regions (35.41%; 193/545 in Mandalay Region and 39.61%; 61/154 in Ayeyawady Region) as well as in all level hospitals. In Mandalay Region, drug poisoning (30.46%; 166/545) was the second commonest poisoning followed by unknown poisoning (9.91%; 54/545), food poisoning (9.36%; 51/545) and chemical poisoning (7.52%; 41/545). In Ayeyawady Region, chemical poisoning (27.27%; 42/154) was second common and food poisoning (11.69%; 18/154), unknown poisoning (7.14%; 11/154) and drug poisoning (6.49%; 10/154) followed. Regarding snake bite, it was much higher in Mandalay Region than Ayeyawady (1203 vs. 122). Viper bite was the highest (67.58%; 813/1203) followed by unknown snake bite (22.69%; 273/1203), green snake bite (7.56%; 91/1203) and cobra bite (2.16%; 26/1203). In Ayeyawady Region, unknown snake bite was the highest (43.44%; 54/122) followed by cobra bite (29.51%; 36/122), viper bite (20.49%; 25/122) and green snake bite (6.56%; 8/122). Mortality was the highest among patients with insecticide poisoning (10.63%; 27/254) and the highest cause of morbidity was found out to be viper bite as 12.89% (108/838) of the patients needed to be transferred or referred for the treatment of complications. As it was a retrospective study, the factors contributing higher burden of poisoning in Mandalay Region were not able to be explored. Educational program for safe handling and storage of agriculture related poisonous products and snake protective measures should be promoted.

 62  46th Myanmar Health Research Congress Abstracts of the papers (Day 3)

Afternoon Session (1), Auditorium (1) Paper-69

Neuroloigical changes of adult residing in lead exposed environment of Myeik Township

Nway Htike Maw, Khine Khine Lwin, Aye Aye Win, Nyi Nyi Win, Swe Zin Soe, Baby Hla, Swe Zin Oo, Hla Win Aung and Khin Phyu Phyu

Department of Medical Research

Lead cross blood brain barrier and adversely affect the cognitive function, causing impairment of neuropsychological functions. Most of the lead poisonings are asymptomatic and subclinical cases. A cross‐sectional analytical study was designed to assess the neurological changes of adult, aged between 20 to 45 years old, residing in lead exposed environment of Myeik Township. The study focused on the cognitive and psychomotor ability of people who lived in those areas at least one year. A total of 95 subjects were interviewed by using the structured questionnaires for assessment of cognitive and psychomotor ability by well‐trained researchers. The mean age of all participants was 32.7 ± 8.5 years. The average duration of stay in these areas was approximately 20 years (maximum duration =47 years). The blood lead level was measured by graphite furnace Atomic Absorption Spectrophotometric method. The mean blood lead level of all participants was 19.91±1.8µg/dL. All the participants were divided into two groups: lower blood lead group (blood lead < 10 µg/dL) (n=37) and higher blood lead group (blood lead >= 10 µg/dL) (n=58).The cognitive function was assessed by using three subtests (digit span, visual memory and paired associate learning) from the General Memory Scale. The mean scores were (10.51±2.0, 5.59±0.5 and 20.01±8.3) in lower blood lead and (9.55±1.8, 5.12±0.7 and 15.23±5.2) in higher lead group, respectively. In addition, the mean total score of cognitive ability test in lower blood lead group was (36.12±9.5) and higher group was (29.90±5.8). All 3 test scores and total scores were significantly lower in higher blood lead group then it could be concluded that the higher the blood lead level, the lower the cognitive ability. To assess psychomotor ability, we used digit symbol, Bourdon‐Wiersma vigilance tests and Santa‐Ana dexterity test and the mean scores were (49.32±14.8, 7.54±2.4 (min) and 54.40±10.9 (sec) (dominant hand) in lower blood lead group and (47.31±18.6, 7.17±2.0 (min) and 59.46±10.18 (sec) (dominant hand)) in higher blood lead group. It indicated that lead exposure would reduce the psychomotor ability regarding perceptual motor ability such as manual dexterity and eye hand coordination.

 63  Abstracts of the papers (Day 3) 46th Myanmar Health Research Congress

Afternoon Session (1), Auditorium (1) Paper-70

Drinking water sources, prevalence of arsenic in ground water and introduction of arsenic removal filter in the rural area of Thabaung Township, Myanmar

Khin Phyu Phyu, Mya Marlar, Thin Thin Wah, Phyo Wai Zin, Myo Nanda Aung, Tin Tin Han, Aye Thida Htun and Kyaw Zin Thant

Department of Medical Research

Arsenic contamination in drinking water sources is an important public health issue in Myanmar and the estimated 2.5 million people are potentially at risk of arsenic poisoning from drinking water sources especially in ground water. The highest arsenic contamination is found in the delta region. The objectives of this study were to investigate the primary sources of drinking water in rural households in the arsenic contaminated area and to find out the prevalence of contaminated wells and the level of arsenic contamination in that area and to construct the safe water supply system in that area. The study area encompassed seven villages in Thabaung Township, Ayeyarwady region. An intervention study has been conducted in 2016. Data entry was done by using EPI DATA and analyzed by SPSS software. About 89% of households reported tube well water as their primary source of drinking water. In rainy season, all households reported rain water as a source of drinking water. But in summer season, the majority used tube wells for drinking. Before the initiation of the water safety intervention, arsenic contamination in wells was measured by using arsenator method. Two‐thirds of the total tube wells (n=181) in seven villages were contaminated with arsenic (>50 μg/L). Nearly 90% of drinking water sources were contaminated with arsenic (>50 μg/L) in Konetangyi village. The arsenic filtration system was constructed in Konetangyi village where most of the tube wells were contaminated. In conclusion, especially in summer, most of the households were at risk of arsenic poisoning through drinking water from contaminated tube wells. In the context of low socioeconomic status and lack of awareness of arsenic contamination, community arsenic filtration system is presumed to promote health of the population in that area.

Afternoon Session (1), Auditorium (1) Paper-71

Determination of heavy metals in drinking water in Mandalay Region

Aye Min Maw1, Khin Phyu Phyu1, Khin Maung Thin2, Khaing Khaing Mar1, Saw Ohnmar Khin1, Kyawt Kyawt Khaing1, Aung Thura1, Aung Thu1 and Kyaw Zin Thant1

1Department of Medical Research, 2Mandalay City Development Committee

Water is essential to sustain life and improving access to safe drinking‐water can result in tangible benefits to health. In developing countries of the world, people use their drinking water sources from either surface water (rivers, dams, etc.) or ground water (tube wells,

 64  46th Myanmar Health Research Congress Abstracts of the papers (Day 3)

hand pumps, etc.). Contaminants such as bacteria, viruses and heavy metals have found their way into water supplies due to inadequate treatment and disposal of waste, industrial discharges, and over‐use of limited water resources. This study aimed to assess the level of heavy metals in drinking water from tube wells in selected townships of Mandalay region. This study was the cross‐sectional analytical study and it was done in 6 selected townships (Aung‐Myay‐Tharzan, Chan‐Aye‐Tharzan, Chan‐Mya‐Tharzi, Mahar‐Aung‐Myay, Pyigyi‐Tagon and Amarapura) in Mandalay Region. Total 120 water samples, 20 samples from each township, were obtained from different tube wells. Lovibond Water Testing (Photometer SpectroDirect), Germany was used for testing turbidity, total hardness, chloride, cyanide and nitrite. Acidity (pH), electrical conductivity and total dissolved solids of water samples were tested by using Pocket ProTMTester, China. Arsenic, calcium, copper, iron, magnesium, manganese, mercury, lead and zinc were analyzed by using Atomic Absorption Spectrophotometer (AAS), Shimadzu, Japan. Among 9 metals determined in this study, the levels of iron in all townships, manganese in 3 townships, arsenic and lead in 1 township respectively were detected more than the maximum permissible limit (MPL) of WHO. Concerning with physicochemical parameters, pH and turbidity were higher than MPL of WHO in 5 out of 6 townships. And hence, total dissolved solids in 4 townships and electrical conductivity in 3 townships were higher than MPL. Although those parameters were detected above the maximum permissible limit of WHO, the other remaining parameters were compiled with the limit. Therefore, the quality of water samples were needed the constant monitoring and the people should be given the health education about the safe drinking water because people may be suffered from various diseases on drinking the water with the high concentration of heavy metals.

Afternoon Session (1), Auditorium (1) Paper-72

Serum zinc level in cirrhosis of liver patients

Nang Thee Su Pwint1, Saw Wut Hmone1, Myint Myint Nyein1 and Myat Mon 2

1University of Medicine, Magway 2Department of Pathology, University of Medicine 1, Yangon

Cirrhosis of liver is one of the common medical problem in daily clinical practice and one of the leading causes of morbidity and mortality affecting the people of working age group. So it is not only a social but also an economy burden for individual’s family the country. Zinc is an essential trace element for human and zinc deficiency was thought to be involved in metabolism of ammonia and cause hyperammonia that worsen hepatic encephalopathy. A hospital based cross sectional descriptive study was performed on 78 patients with different underlying causes of cirrhosis of liver at the Medical Units of Yangon General Hospital and Yangon Specialty Hospital. This study was aimed to categorize the severity of cirrhosis of liver by Child Pugh score, to estimate serum zinc level by atomic absorption spectrophotometry and to find out the associations between serum zinc level and severity of cirrhosis. The mean age of the cirrhotic patients was 46 years with male: female ratio of 4.5:1. Among the study population, Child grade A was found to be 28.21% (22/78), Child grade B was 30.77% (24/78) and Child grade C was 41.03% (32/78). Regarding result of

 65  Abstracts of the papers (Day 3) 46th Myanmar Health Research Congress

serum zinc level, 62.8% (49/78) were low level, 28.2% (22/78) were within normal level and 8.9% (7/78) were high level. Mean value of serum zinc level in grade A was 0.68 mg/L, grade B was 0.54 mg/L and grade C was 0.48 mg/L (p = 0.001). The zinc level was significantly lowest among patients with Child‐Pugh C as compare to those with Child‐Pugh B and C. It was found out that there was a high prevalence of zinc deficiency in severe cirrhotic patients. Screening for zinc deficiency might be needed in these patients with more advanced cirrhosis that seems to be warranted as a marker of advanced liver disease and it can be deducted that awareness of serum zinc level among cirrhotic patients is very important in clinical practice. Furthermore, therapeutic zinc supplementation should be given in treating cirrhosis of liver patients to prevent complication of cirrhosis such as hepatic encephalopathy.

Afternoon Session (2), Auditorium (1) Paper-73

Serum vitamin D levels in women with normal and pre‐eclamptic pregnancies from North Okkalapa General Hospital, Yangon

Thazin Aung1, May Pyone Kyaw2, Aye Thida2 and Moh Moh Hlaing1

1Department of Medical Research 2University of Medicine 2, Yangon

Pre‐eclampsia is one of the main causes of maternal and fetal morbidity and mortality. Maternal and perinatal outcomes are usually favorable in women with mild pre‐eclampsia developing beyond 36 weeks gestation. In contrast, maternal and perinatal morbidities and mortalities are increased in women who develop preeclampsia before 33 weeks gestation, in those with preexisting medical conditions, and in those from the developing countries. Vitamin D deficiency during pregnancy is common in many parts of the world and there is a very strong relationship between vitamin D deficiency and multiple potential adverse pregnancy outcomes. This study aimed to study serum vitamin D level in normal pregnancy and preeclampsia in third trimester and to measure the association between vitamin D status with normal and preeclamptic pregnancy. It was a comparative study conducted from April, 2016 to December, 2016. A total of 112 pregnant women were recruited from North Okkalapa General Hospital. There were 56 women with normal pregnancy and 56 women with preeclamptic pregnancy. Pregnancy with a history of cardiovascular disease, renal disease, chronic liver disease and history of diabetes were excluded. Blood pressure measurement were done and 3mL of blood were collected. In both groups, serum 25(OH)D level was measured by using Enzyme‐Linked Immunosorbant Assay (ELISA) method. Preeclamptic pregnant women were found to have significantly lower serum vitamin D level when compared to normal pregnancy group (26.28 ± 8.93 ng/mL Vs 31.15±8.26 ng/mL) and the difference was significant (p=0.003). Among 56 normal pregnant women, 7.1% were vitamin D deficient. In 56 preeclamptic pregnant women, 23.2% were also vitamin D deficient. A significant association was found (p= 0.02) between vitamin D status and preeclampsia. Thus, it can be concluded that preeclampsia in pregnant women is strongly associated with deficient vitamin D status in third trimester.

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Afternoon Session (2), Auditorium (1) Paper-74

Comparative study on efficacy and safety of intravenous oxytocin and tranexamic acid in myomectomy

Chaw Ei Win, Swe Swe Myint and San San Myint

Central Women’s Hospital, Yangon

Oxytocin, a uterotonic, is used for prevention and treatment of post‐partum haemorrhage. Tranexamic acid reduces blood loss in various settings e.g. gastrointestinal bleeding, traumatic bleeding, etc. This study aimed to compare the efficacy and safety of intravenous oxytocin and tranexamic acid infusion in reducing intra‐operative blood loss during trans‐ abdominal myomectomy. A hospital‐based prospective randomized controlled clinical trial was conducted on forty women with uterine fibroids, who underwent abdominal myomectomy. These patients were randomized to give oxytocin infusion or tranexamic acid infusion just before myomectomy. Amount of intra‐operative blood loss duration of operation, and occurrence of side effects of the drugs were compared. The demographic features which included age, marital status, clinical symptoms and characteristics of myoma which include location, size and numbers of myoma of both groups were compared and there was no significant difference. When comparing the mean intra‐operative blood loss, it was 375197.5 mL in oxytocin group and 451154.8 mL in tranexamic acid group. It was seen that oxytocin group had lesser blood loss compared to tranexamic acid group, however, it was not statistically significant (p= 0.15). The mean haemoglobin difference was (1.53 ± 2.39) in oxytocin group and (1.54 ± 3.70) in tranexamic acid group which was not statistically significant (p=0.74). Only four cases of myomectomy proceeded to hysterectomy in oxytocin group. Among them 2 patients hysterectomies were due to uncontrolled bleeding and two were due to distorted anatomy of uterus. There was one hysterectomy patient in tranexamic acid group due to uncontrolled bleeding. Duration of surgery in oxytocin group was 83.88±34.32 min and 82.33±35.22 min in tranexamic acid group and showed no significant difference (p=0.16). In this study, side effects drugs occurred were nausea 2 patients and vomiting 1 patient in oxytocin group and nausea 1 patient and vomiting 2 patients in tranexamic acid group. Otherwise there was no major side effect of the drug seen in both groups. This study revealed both oxytocin infusion and intravenous tranexamic acid infusion has similar efficacy in reducing intra‐operative bleeding without serious side effects in myomectomy patients.

 67  Abstracts of the papers (Day 3) 46th Myanmar Health Research Congress

Afternoon Session (2), Auditorium (1) Paper-75

A comparison of efficacy and safety of sublingual misoprostol with intra‐ vaginal misoprostol for induction of labour at term

Zar Chi Min, Phyu Phyu Thein and San San Myint

Central Women's Hospital, Yangon

This study was a hospital‐based comparative study which was carried out in Central Women's Hospital, Yangon from 1st January to 31st December, 2015. The aim of this study was to compare the efficacy and safety of sublingual misoprostol and intra‐vaginal misoprostol for induction of labour at term. Women with indications for labour induction were assigned randomly to receive misoprostol sublingually or intra‐vaginally. Women in both groups received misoprostol 25 µg at 4 hourly intervals until the onset of labour or a maximum of 6 doses. One hundred and thirty two pregnant women were enrolled. Sixty six women received misoprostol sublingually and another sixty six women received intra‐ vaginally. There were no differences in the patient's background characteristics. Mean frequency of misoprostol required for labour induction was 2.09  1.28 doses in sublingual group and 1.56  0.86 doses in intra‐vaginal group (p=0.006). Mean induction‐labour interval was 7.971 hours in sublingual group and 7.280 hours in intra‐vaginal group. The difference was statistically significant (p=0.033). Mean induction‐delivery time of sublingual group was 12.643  6.473 hours and of the intra‐vaginal group was 13.234  5.098 hours (p=0.425). Among the studied patients, 66.7% in sublingual group and 72.7% of intra‐vaginal group had vaginal delivery. The caesarean section rate in sublingual group was 33.3% and intra‐vaginal group was 27.3% (p=0.449). The difference was not significant statistically. The passage of fetal meconium, Apgar score at 5 minutes, necessity for neonatal resuscitation and maternal complications were not different statistically in the two groups. In conclusion, vaginal administration of misoprostol (25 µg) required less doses of misoprostol for successful labour induction and shorter induction‐labour interval than the same dose of sublingual administration.

Afternoon Session (2), Auditorium (1) Paper-76

Effect of intravenous magnesium sulfate on red cell deformability in severe pre‐eclampsia and eclampsia

Thin Myat Myat Shein, Khin Latt and San San Myint

Central Women’s Hospital, Yangon

The aim of this study was to detect the effect of intravenous magnesium sulfate (MgSO4) on red cell deformability in severe pre‐eclampsia and eclampsia. This study was a hospital‐ based prospective study which was carried out in Central Women’s Hospital, Yangon from

 68  46th Myanmar Health Research Congress Abstracts of the papers (Day 3)

1st January 2015 to 31st December 2015. Altogether 50 pregnant women with severe pre‐ eclampsia and eclampsia, eligible for the present study were recruited. These patients were treated with intravenous MgSO4 according to hospital guideline. Red cell deformability index (RCDI) was measured before and after MgSO4 administration. RCDI was increased after MgSO4 administration. Regarding the maternal outcomes, RCDI after MgSO4 administration was significantly increased in patients without complication (0.02462±0.003583 before MgSO4 administration and 0.032±0.005127 after MgSO4 administration). It was statistically significant (p<0.001). RCDI was not significantly increased in patients with complication (0.0165±0.000707 before MgSO4 administration and 0.016±0.004243 after MgSO4 administration). It was not statistically significant (p= 0.5). Regarding the fetal outcomes, RCDI after MgSO4 administration were significantly increased in the group with good Apgar score (0.0239±0.0063 before MgSO4 administration and 0.032±0.009 after MgSO4 administration). It was statistically significant (p<0.001). However in the group with poor Apgar and babies who need for neonatal resuscitation and Neonatal Intensive Care Unit (NICU) admission, there were no statistically significant increase in RCDI after MgSO4 administration (p= 0.215). In conclusion, administration of MgSO4 caused increased RCDI which was associated with good maternal and fetal outcomes.

Afternoon Session (2), Auditorium (1) Paper-77

Enhancing awareness and practices of married women regarding cervical cancer: An intervention study

Nwet Yee Han, Kyaw Wunna and Thida Aung

Military Institute of Nursing and Paramedical Sciences

Now, cervical cancer becomes important community health problems and the chance of surviving increases when diagnosed early. The incidence of this disease can be minimized by imparting knowledge through health education. This study aimed to determine the effectiveness of an educational intervention among married women by using one group pre‐ test, post‐test study design at Ywar‐Gyi‐Gone Ward, Tharyarwaddy Township. A total of 120 married women were selected using a simple random sampling method. Data were collected by using face‐to‐face interview with the aid of pre‐tested structured questionnaire before intervention and four weeks after providing health education. The educational intervention based on Health Belief Model was implemented by using audio‐visual aids. In addition, researcher invited Shwe‐Yaung‐Hnin‐Si Cancer Foundation to provide cervical cancer screening for respondents with free of charge. Data were analyzed using descriptive and inferential statistics that alpha value of 0.05 was used for statistical significance and calculated effect size (eta square) for strength of association. It showed that post intervention mean knowledge score was 39.78% increased more than pre intervention (p<0.001). Similarly, mean attitude score was 12.42% and practice was 14.63% higher than pre intervention (p<0.001) respectively. The mean of knowledge score before and after intervention was 35.128.96 and 62.574.11 respectively. So, the mean post‐test knowledge, attitude and practice score of the women regarding cervical cancer was significantly higher than that of their mean pre‐test score, indicating that educational intervention was effective in enhancing the awareness and preventive practice of

 69  Abstracts of the papers (Day 3) 46th Myanmar Health Research Congress

women on cervical cancer. The association between pre‐test knowledge scores and selected demo‐graphic variables were computed using chi‐square test. It was associated with the respondent's age and occupation at p value of 0.006 and 0.045. Therefore, this study highlighted that not only appropriate channels for providing health education regards to cervical cancer and screening, but also implementation of accessible and affordable screening program is the essential for increasing screening utilization which will lead to reducing morbidity, mortality and better quality of life among Myanmar women as a result of the enhancing of their awareness, positive attitude and improving of preventive practices.

Afternoon Session (2), Auditorium (1) Paper-78

Dietary sodium intake of housewives from South Okklapa Township of Yangon Region

Moh Moh Hlaing, Mya Ohnmar, Khin Mittar Moe San, Sandar Tun, Thidar Khine, Wah Wah Win, Su Su Hlaing, Hla Phyo Linn and Yin Yin Aye

Department of Medical Research

Dietary sodium intake and the major sources vary among different regions and populations, largely determined by cultural preference. Awareness of contemporaneous sodium intake and identification of food sources of sodium in diets will inform more specific tailoring of salt reduction policies in local population. The community based descriptive study was conducted from November 2016 to September 2017 to assess the dietary sodium intake of housewives. A total of 147 housewives residing at South Okklapa Township was included in the study. After getting informed consent, housewives were interviewed for socio‐ demographic data and food frequency questionnaires including uses of salt, monosodium glutamate, fermented fish paste, fish sauce, pickled food, dried meat/prawn and fish and condiments during the preceding month. Dietary sodium intake was estimated from measuring spot urine sample. Body weight, height and blood pressure were also measured. About 67% of housewives was age range between 40‐ 60 years old with minimum 25 years and maximum 70 years. Among 147 housewives, 34.7% of housewives had high blood pressure at the time of blood pressure measurement and 35.5% and 46.9% of housewives were overweight and obese respectively according to Asian BMI cut off point. Mean (SD) sodium and salt intake of housewives were 3.78(0.92) g and 9.46(2.28) g respectively (Recommended daily allowance= 2.4 g/day for sodium and 6 g/day for salt). The findings indicated that only 5.4% of housewives had daily salt intake within the limits of the daily recommended allowance (6 g/day). More than 90% of housewives use salt and mono‐ sodium glutamate (MSG) while cooking and 78.9%, 67.3% and 66.7% of housewives used fish sauce, soy sauce and fish paste while cooking respectively. About one third of house wives consumed fermented fish paste more than 7 times per week and 48.3% and 43.5% of house wives consumed salted dried fish and prawn1‐3 times/week. In conclusion, dietary sodium intake among housewives living in South Okkalarpa Township were higher than the recommended level. Promotion of a healthy lifestyle with emphasis on low sodium consumption is essential in encouraging women to adopt habits that will help prevent hypertension and renal disease in later life.  70  46th Myanmar Health Research Congress Abstracts of the papers (Day 4)

Paper Reading Session: Day 4

Morning Session (1), Auditorium (1) Paper-79

Identification of bacterial pathogen in malignant ascitic fluid from patients with clinically suspected bacterial peritonitis

Myo Myint Maw1, Ssu Wynn Mon2, Hsu Theingi2 and Wut Hmone Win Htut3

1Medical Oncology Department, Yangon General Hospital 2Department of Medical Research 3Microbiology Department, New Yangon General Hospital

Bacterial peritonitis is a common and potentially fatal bacterial infection in patients with malignant ascites and is associated with poor prognosis. This hospital‐based cross‐sectional study was carried out to identify the causative organisms responsible for bacterial peritonitis in suspected patients with malignant ascites. Total 52 suspected patients, 8 male and 44 female, with confirmed malignant ascites admitted to Oncology Department, Yangon General Hospital were studied. Age was ranging from 18 to 67 years (mean age 47±10 years). Commonest malignancies associated with malignant ascites were malignant ovarian tumour (21/52 cases, 40.38%) followed by stomach cancer (11/52, 21.15%) and cervical cancer (5/52, 9.61%). Twenty four patients (46%) presented at stage 4. Liver metastasis was seen in 12 patients (23%), 7 patients (13.46%) showed pulmonary metastasis and 4 patients had omental metastasis. First time parenthesis fluid of every suspected patient was collected under aseptic condition and sent to Microbiology Department, New Yangon General Hospital for culture and sensitivity. Among 52 suspected patients, 5 patients (9.6%) had positive culture results. Positive organisms were Acinitobacter baunanni, Citrobacter species, Pseudomonus species and Klebsiella species. These organisms were sensitive to 3rd and 4th generation cephalosporin, quinolones, aminoglycosides and carbapenams. So identification of the causative organisms responsible for bacterial peritonitis is particularly useful in current oncology practice because timely and appropriate antibiotic treatment can improve the clinical outcome.

 71  Abstracts of the papers (Day 4) 46th Myanmar Health Research Congress

Morning Session (1), Auditorium (1) Paper-80

Antimicrobial susceptibilities of Burkholderia cepacia bacteraemia in No (1) DSGH, Mingaladon

Khin Phyu Pyar1, Yu Aye Latt1, Sai Aik Hla2, Htoo Pyae Thar1, Khin Win Sein1, Soe Hlaing3 and Saw Lwin1

1No.1 Defence Services General Hospital (1000 Bedded), Mingaladon 2No. 2 Defence Services General Hospital (1000 Bedded), Nay Pyi Taw 3Directorate of Medical Services, Nay Pyi Taw

Burkholderia cepacia is a common commensal of our environment and it causes deterioration in patients with cystic fibrosis. Reports on endemic Burkholderia cepacia bacteraemia in non‐cystic fibrosis patients are rare. The problem of antibiotic resistance and high mortality rate is the major issue in clinical practice. This study was a hospital‐based descriptive study and aimed to detect the drug sensitivity pattern of Burkholderia cepacia grown in blood culture of patients with septicaemia. Patients admitted to intensive care unit or high dependency unit of No (1) Defence Services General Hospital (1000 bedded hospital), Mingaladon, having fever with septicaemia (tachycardia, tachypnea) were included. The study period was from May 2015 to October 2017. The ethical approval from the hospital ethics committee was obtained and informed consent from each patient was taken. Blood culture with sterile bottle was taken from one of the peripheral veins under aseptic condition and sent to microbiology department. The suspected colonies of Burkholderia species were identified by Vitek 2 (GN ID, AST GN 90 card) (Biomerieux). Antimicrobial susceptibility testing of Burkholderia cepacia was done and reported. After getting the results, the antibiotics was reviewed. Clinical response was monitored. Their clinical presentation, their comorbidities and the course of the disease were assessed. Data entry was done. Descriptive statistics was used. Of the 300 patients with fever and septicaemia, Burkholderia cepacia was grown in the blood culture of only 9 patients. Age ranged from 33 to 87 year. Four male and five female were included. All cases were sensitive to trimethoprim and sulphamethoxazole. Meropenem was the second most sensitive antibiotics (55.55%) followed by levofloxacin (44.44%) and cefepime (33.33%). Only 22% of cases were sensitive to azetronen and 11% to amikacin. The mortality rate was high (55.55%). Only 44.44% (4/9) survived. All isolates were susceptible to trimethoprim and sulphamethoxazole combination therapy and 50% of the isolates were susceptible to meropenem. Burkholderia cepacia should be considered a potential pathogen in patients with septicaemia, particularly those with severe underlying diseases.

 72  46th Myanmar Health Research Congress Abstracts of the papers (Day 4)

Morning Session (1), Auditorium (1) Paper-81

Seroprevalence of Chlamydia trachomatis infection in cervical cancer screening clinic attendees

Lynn Pa Pa Aye1, May Zon Myint1, Htwe Htwe Nyunt1, Kay Khine Soe1, Mu Mu Shwe1, San Mya2, Mon Mon3, Wah Win Htike3 and Win Maw Tun1

1Department of Medical Research 2National Health Laboratory 3Department of Microbiology, University of Medicine 1, Yangon

Chlamydia trachomatis infection is one of the most common curable sexually transmitted bacterial infections. Nature of the infection is asymptomatic in some cases. Timely diagnosis followed by proper treatment can prevent long term reproductive sequelae. This study was conducted to determine the prevalence of Chlamydia trachomatis infection in cervical cancer screening clinic attendees at Department of Medical Research between January and October of 2016. The Chlamydia trachomatis IgM and IgG were determined in sera by qualitative ELISA. Among 347 participants, 6.3% (22/347) was positive for IgM and 20.2% (70/347) was positive for IgG. The infection rate is slightly lower than other Myanmar studies. Almost all of them (96.7%) were married and their education status is relatively high. More than half of study population 59.4% (206/347) revealed about the STI symptoms such as vaginal discharge, pruritus, dysuria, lower abdominal pain and frequent urination. Chlamydia trachomatis IgM was positive in 6.3% (13/206) of women with STI symptoms and 6.4% (9/141) of asymptomatic women. Chlamydia trachomatis IgG was positive in 19.4% (40/206) of women with STI symptoms and 21.3% (30/141) of asymptomatic women. This study highlighted the rate of Chlamydia trachomatis infection in both symptomatic as well as asymptomatic women attending cervical cancer screening clinic, Department of Medical Research. The screening of Chlamydia infection in both symptomatic and asymptomatic women is beneficial and especially women presenting with STI symptoms should be screened to assure early diagnosis and timely treatment. Infection screening in antenatal, fertility and STI clinics and medical checkup sessions during recruiting new workers are advantageous to estimate the infection burden and beneficial for early diagnosis and timely treatment for the individuals.

 73  Abstracts of the papers (Day 4) 46th Myanmar Health Research Congress

Morning Session (1), Auditorium (1) Paper-82

Bacteriological study and their antibiotic sensitivity pattern among tonsillitis patients attending selected clinics in Pyin Oo Lwin Township during 2016‐2017

Saw Myat Thwe1, Wint Wint Kyi2, Thu Thu Nyein3, Chaw Su4, Phyo Mon Oo4, San San Shwe4, Moe Kyaw Myint4, Zaw Lin1 and Kyaw Zin Thant4

1Kyaing Tong General Hospital 2Pyin Oo Lwin General Hospital 3GP, Pyin Oo Lwin 4Department of Medical Research

Tonsillitis is an infection of the tonsils that causes inflammation and most commonly caused by viral or bacterial infection. When caused by a bacterium belonging to the group A Streptococcus, it is typically referred to as strep throat. Tonsillitis is most common in children and teenagers. The prominent clinical features of tonsilitis are red, swollen tonsils, sore throat, pain when swallowing, coughing, headache, tiredness, chills, malaise white pus filled spot, swollen lymph glands and pain in ears or neck. A total of 400 patients from 1st May 2016 to 30th November 2016 were enrolled in this study and analyzed the data. After explaining the procedure and getting written informed consent from both guardians as well as from participants, throat swab was taken by using disposable tongue depressor and swab stick. Then, direct inoculate onto blood agar, incubate aerobically overnight at 37°C, then examined haemolytic pattern of the blood agar plate, species identified and antibiotic sensitivity pattern were done according to standard microbial technique. Out of 400 participants, commonest age group suffering tonsillitis during the study period is under 12 years 379 cases (94.8%). In this study, out of 400 patients, 393 patients (98.3%) suffered sore throat, 391 patients (97.8%) suffered pain when swallowing, 367 patients (91.8%) suffered coughing, 339 patients (84.8%) suffered headache respectively. On examination, all cases had fever with body temperature ranges from 99°F to 102°F and 398 patients (99.5%) out of 400 participants had red swollen tonsil. On bacteriological examination, 281patients (70.3%) were infected with group A alpha haemolytic streptococcus, followed by Streptococcus Pneumoniae, 42 patients (10.5%) and group A beta haemolytic streptococcus 2 patients (0.5%). Antibiotic sensitivity pattern of group A alpha haemolytic streptococcus, Streptococcus Pneumoniae and group A beta haemolytic streptococcus showed resistant to co trimoxazole (70.3%) and sensitive to amikacin (72%), co amoxy clauv (73.8%), ceftriazone (79.3%), amoxicillin (71.5%), erythromycin (61.3%) and penicillin G (72%) respectively. In this study, 73 patients (18.3%) out of 400 participants revealed no pathogenic organism isolated in their throat swab culture result and in this cases it might be due to fastidious organism, anaerobic bacteria or viral origin.

 74  46th Myanmar Health Research Congress Abstracts of the papers (Day 4)

Morning Session (1), Auditorium (1) Paper-83

Bacteriological profile of open fracture wound infection in Yangon General Hospital

May Thu Lwin1, San Mya2, Win Thandar Oo1, Wah Win Htike1, Cho Cho Oo3 and Hla Nu Kyi1

1Department of Microbiology, University of Medicine 1, Yangon 2Bacteriology Section, National Health Laboratory 3Department of Microbiology, University of Medicine, Mandalay

Open fractures are major causes of morbidity and mortality. Sixty to seventy percent of them are contaminated at the time of injury. The aim of this study was to study the bacteriological profile of open fracture wound infection at Orthopaedic Trauma ward of Yangon General Hospital. A cross‐sectional hospital‐based descriptive study was done on 115 wound swabs of clinically diagnosed open fracture wound infection from January to October 2016. Among them, 80.87% were male and 19.13% were female. Majority (46.96%) was 15‐35 years age group and 72.17% of open fractures were caused by RTA. Bacterial pathogens were isolated in 52.17% in which 39.13% were single infection and 13.04% were mixed infection. Among isolated bacteria, gram‐positive bacteria were 12% and gram‐ negative bacteria were 88%. The predominant bacteria were Pseudomonas aeruginosa (26.67%), Escherichia coli (21.33%). Others were Acinetobacter baumannii, Klebsiella pneumoniae, coagulase‐negative staphylococci, Enterobacter cloacae, Proteus mirabilis, Pseudomonas cepacia, Staphylococcus aureus and Citrobacter freundii. All Staphylococcus aureus isolates were MRSA detected by disk diffusion test and Vitek® 2 Compact System. They were totally sensitive to gentamicin, linezolid, moxifloxacin, nitrofurantoin, quinupristin/dalfopristin, rifampicin, tigecycline and vancomycin. More than 50% of Enterobacteriaceae were sensitive to amikacin and carbapenems, 10‐30% were sensitive to ampicillin‐sulbactam, monobactams, 2nd and 3rd generation cephalosporins, cotrimoxazole, gentamicin, piperacillin‐tazobactam, quinolones and ticarcillin‐clavulanic acid. Only 3% were sensitive to amoxicillin‐clavulanic acid. The isolated Citrobacter freundii was resistant to all antibiotic drugs that were tested. More than 50% of Pseudomonas species were sensitive to amikacin and piperacillin‐tazobactam, 10‐30% were sensitive to carbapenems, monobactams and tobramycin, and less than 5% were sensitive 3rd generation cephalosporins, and gentamicin. All of them were resistant to quinolones and ticarcillin. Among Acinetobacter baumannii isolates, 40% were sensitive to ampicillin‐sulbactam, cotrimoxazole and doxycycline, about 20‐30% were sensitive to carbapenems, gentamicin and tobramycin. They were totally resistant to amikacin, ampicillin, 3rd generation cephalosporins and monobactams. All isolated bacterial pathogens were highly sensitive to amikacin and carbapenems (about 40‐50%), and least sensitive to amoxicillin‐clavulanic acid (only 2%). The data from this study could be applied in management of open fracture wound infection to reduce morbidity and mortality of patients.

 75  Abstracts of the papers (Day 4) 46th Myanmar Health Research Congress

Morning Session (2), Auditorium (1) Paper-84

Distribution of hepatitis B virus genotypes and viral load levels in chronically infected patients from Hepatitis Carrier Clinic, Depertment of Medical Research

Hnin Ohnmar Soe, Aye Aye Lwin, Myat Tin Htwe Kyaw, Ohmar Lwin, Wai Myat Thwe, Ni Ni Zaw, Thin Thin Aye and Yi Yi Kyaw

Department of Medical Research

Knowledge of the HBV genotype in an infected patient is crucial information for a physician to plan the clinical treatment for that patient. Moreover, viral load testing is also important in making management decisions in HBV infection. It will help to avoid unnecessary therapies, commence treatment appropriately and save the cost. Therefore, the prevalence of the different HBV genotypes and viral load were determined in chronic hepatitis patients who attended the Hepatitis Carrier Clinic, DMR. A total of 77 HBsAg‐positive patients were included in this study. The method used for genotyping and subtyping of HBV was partial HBsAg/preS gene sequencing by using primers that were complementary to all known genotypes. HBV genotype D was the most prevalent (63.3%) genotype identified in our study populations, followed by genotypes C (30%) and A and B (3.33%) each respectively. The HBV DNA viral load was higher in HBeAg‐positive patients than in patients who were HBeAg‐negative. HBV infection is a major health problem in Myanmar, and although genotypes B and C are the most prevalent HBV genotypes in Asian populations, our study revealed that genotype D is the predominant genotype circulations in Myanmar. In this study, the HBeAg–negative patients (70/77, 90.9%) were found to be more than HBeAg‐ positive patients (7/77, 9.09%) which could be due to the duration of infection of the study population. Additionally, the viral loads of the HBeAg‐positive patients were higher than those of the HBeAg‐negative patients. Thus, future research and a wide access to HBV DNA assay need to be promoted in Myanmar to compliment the local management guidelines and to enhance the quality care of the patients.

Morning Session (2), Auditorium (1) Paper-85

Molecular detection of chikungunya virus among inpatients with clinically suspected acute viral infection in medical units at Yangon General Hospital

Myat Khwar Phyu Pe1, Aung Zaw Latt1, Than Than Su2, Wah Win Htike2, San Yu Hlaing1, Kay Khine Soe1, Khin Khin Aye1, Win Maw Tun1 and Kyaw Zin Thant1

1Department of Medical Research 2Department of Microbiology, University of Medicine 1, Yangon

Chikungunya virus infection is one of the commonest causes of mosquito‐borne viral infection in Myanmar. It is transmitted by the bite of the infected female Aedes mosquitoes.

 76  46th Myanmar Health Research Congress Abstracts of the papers (Day 4)

The aim of this research is to study the prevalence of chikungunya virus infection in adult patients presented with fever, joint pain and/or rash who attended to medical units of Yangon General Hospital. Blood samples were collected and tested by immunochromatographic test (ICT) and reverse‐transcriptase polymerase chain reaction (RT‐PCR) methods. A total of 100 blood samples were collected between January to August 2016. Chikungunya IgM antibody was positive in 12 patients and 6 patients were confirmed of both chikungunya IgM antibody and RT‐PCR. In Myanmar, chikungunya fever outbreaks had been occurred frequently since 1970s. Molecular detection of chikungunya virus in adult patients was not performed since 2009. Although it is not a fatal disease, the sequelae are critical. The findings from this study will be helpful for clinical management of patients with chikungunya virus infection and may also beneficial for epidemiological and further molecular studies.

Morning Session (2), Auditorium (1) Paper-86

Molecular characterization of quinolone resistant genes in salmonella isolates from enteric fever patients attending Yangon General Hospital

Khine Mar Oo and Wah Win Htike

Department of Microbiology, University of Medicine 1, Yangon

Myanmar is one of the enteric fever endemic regions. The purpose of this study was to identify the causal bacteria and to determine their antibiogram from the blood culture of the enteric fever patients attending Yangon General Hospital by using automated blood culture method and VITEK 2 compact system. The molecular analysis of quinolone resistant isolates was detected by whole genome sequencing. Blood cultures were done from 500 enteric fever patients. Bacteria were isolated from 90 (18%) of blood cultures and the remaining 410 (82%) were sterile. A total of 73 Salmonella isolates including Salmonella enterica serovar Typhi 39 (53%) and Salmonella enterica serovar Paratyphi A 34 (47%) were isolated. Most of the Salmonella isolates were isolated from aged 21–40 years and there was male preponderance over female. The highest number of Salmonella were isolated in May (15 isolates), June (13 isolates) and July 2016 (14 isolates). Regarding their antibiogram, all 73 isolates were 100% resistant to nalidixic acid, ciprofloxacin and levofloxacin. But they were 100% sensitive to amoxacillin‐clavulanic acid, azithromycin, aztreonam, ceftriaxone, ceftazidime, cefotaxime, cefepime, cefotaxime, colistin, ertapenem, imipenem, meropenem, nitrofurantoin, piperacillin+tazobactam and ticarcillin. The mechanism of quinolone resistant was mediated mainly by chromosomal mutation. The most common types of mutation were gyrA mutation S (Serine) 83 F (Phenyalanine), D (Aspartate), 87 N (Asparagine) followed by parC mutation T (Threonine) 57 S (Serine) and S (Serine) 80 I (Isoleucine). Gyr B mutation S (Serine) 464 F (Phenyalanine) was detected in only one isolate of Salmonella enterica serovar Typhi. No parE mutation was detected in all isolates. According to the new SNP‐based genotyping framework, all isolates in the present study were part of the H58 clade (4.3.1). The present study not only gives the information regarding the antibiogram of current circulating Salmonella but also provide the genotypic

 77  Abstracts of the papers (Day 4) 46th Myanmar Health Research Congress

framework for the further analysis of epidemiology and types of antibiotic resistant pattern of Salmonella enterica.

Morning Session (2), Auditorium (1) Paper-87

Molecular characterization of influenza A viruses detected in children attending Yangon Children Hospital, 2016

Htin Lin1, Hlaing Myat Thu1, Lay Myint Yoshida2, Theingi Win Myat1, Wah Win Htike3, Win Win Maw4, Kay Thi Aye1 and Moh Moh Htun1

1Department of Medical Research 2Department of Paediatirc Infectious Diseases, Institute of Tropical Medicine, Nagasaki University 3Department of Microbiology, University of Medicine 1, Yangon 4Department of Microbiology, University of Medicine 2, Yangon

Genetic instability of influenza A viruses periodically results in appearance of new strains and subsequently new clades of influenza viruses that may lead to influenza pandemics. The aim of this study was to characterize predominant subtype of influenza A viruses among children attending Yangon Children Hospital (YCH). It was a cross‐sectional descriptive study conducted at YCH. Nasopharyngeal swabs were collected from 153 children who attended the hospital due to influenza‐like illness (ILI) during January‐December, 2016. Viral RNA was extracted by QIAamp® Viral Mini Kit. Matrix genes of influenza A and influenza B virus were detected by multiplex Reverse Transcription‐ Polymerase Chain Reaction (RT‐PCR). Influenza A virus matrix gene positive samples were subjected to subtyping by detection of haemagglutinin (HA) genes of seasonal subtypes and H5N1 subtype. Predominant subtype of influenza A viruses were subjected to sequencing and phylogenetic analysis of their HA gene and neuraminidase (NA) gene. Influenza viruses were detected in about 14% (22/153) children having ILI with the ratio of males to females 2.1:1. Higher positivity of influenza virus was seen in children above 5 years of age. Fever, cough and rhinorrhoea were observed as main symptoms of influenza infected children accounting for 100%, 100% and 82% respectively. Maximum number of influenza virus positive children was seen in June and July. Among influenza infected children, 55% (12/22) showed influenza A virus positive and 45% (10/22) showed influenza B virus positive. Influenza A(H3N2) virus was found to be predominant among influenza A virus positive children accounting for 83.4% (10/12). There was one case (8.3%) of influenza A(H1N1)pdm09 virus and one case (8.3%) of unsubtyped influenza A virus. Phylogenetic analysis of HA and NA gene of two Myanmar strains of H3N2 subtype revealed that they belonged to clade 3C.2a1 and closely related to a strain in Nonthaburi in 2016. They had 99.3‐99.4% nucleotide identity with A/Hong Kong/ 4801/2014, vaccine strain of H3N2 subtype, that was contained in southern hemisphere influenza vaccine for 2016 and northern hemisphere vaccine for 2016‐2017 season. This study generated information useful for the assessment of influenza outbreak, selection of upcoming vaccine strains and further evolutionary and epidemiological studies on influenza viruses.

 78  46th Myanmar Health Research Congress Abstracts of the papers (Day 4)

Morning Session (2), Auditorium (1) Paper-88

Nationwide overview of the distribution of hepatitis B virus genotypes in Myanmar

Yi Yi Kyaw, Aye Aye Lwin, Khin Saw Aye, Moh Moh Htun, Hnin Ohmar Soe, Ohnmar Lwin, Kay Thi Aye and Kyaw Zin Thant

Department of Medical Research

Hepatitis B virus (HBV) infection is a severe health concern worldwide. HBV is a DNA virus with a rapid rate of mutation. Based on the heterogeneity of the HBV nucleotide sequence, the HBV strains are divided into eight genotypes, A to H, with a characteristic geographical distribution. Identifying and tracking the changes of HBV genotypes is important in terms of both monitoring infection rates and predicting disease and treatment. The present study was conducted to amplify the partial genome of HBV and apply the direct sequencing method for determination of HBV genotypes different States and Regions in Myanmar. A total of three hundred and fifty three HBsAg positive samples screened from 5,400 peoples who residing at seven States, seven Regions and Nay Pyi Taw Union Territory. HBV DNA was detected using polymerase chain reactions (PCR) targeting the DNA sequences encoding the Pre‐S region. Primer design and optimization of Pre‐S PCR was carried out and purified PCR products were sequenced from both directions on an ABI Prism 3500 (Applied Bio‐systems, Sequencer), using the Pre‐S PCR primers. Sequences were then edited, aligned and compared with reference sequences using NCBI genotyping tool. Differential genotype prevalence was seen in different regions of Myanmar. Regarding overall prevalence of study population, Genotype C (62.04%) is the predominant type in Myanmar. Most prevalent genotype for Central region is genotype C but Chin state which near to India border was shown 93% of genotype D. Differential prevalence of HBV genotypes in States and Regions of Myanmar was also seen in this study. The sampling covered all States and Regions of Myanmar which is the continuation of Nation‐wide sero‐survey carried out in 2015. This study provides the most complete overview of HBV genotype distribution in Myanmar to date and reflects the origin and plurality of genotypes in the Myanmar population.

 79  Abstracts of the papers (Day 4) 46th Myanmar Health Research Congress

Afternoon Session (1), Auditorium (1) Paper-89

Readiness of malaria volunteers in malaria elimination: Preliminary study in Ayeyarwaddy Region

Kyi Maw Than1, Myat Phone Kyaw1, Aung Thi2, Myat Min Tun2, Nan Khaing Zar Aung3, Moe Moe Aye3, Nyan Win Htet3 and Wai Wai Myint1

1Department of Medical Research 2National Malaria Control Program 3Clinton Health Access Initiative

Readiness of malaria volunteers is one of the important factors to fulfil the target of malaria elimination in 2030. This project aimed to develop an active surveillance system for case investigation, reporting, active case detection, and foci investigation and response in townships in Ayeyawady Region. The volunteers list was collected from Township Health Departments. All of the available local health volunteers from each of the health centers were included in this study. A total of 172 Village Health Volunteers (VHV) (79 males and 93 females) was collected from six selected townships (Ingapu, Lay Myatnar, Kyan Khinn, Yay Kyi, Myan Aung and Tharpaung) in Ayeyawaddy Region. The median age of VHV was 28 years (IQR: 23‐37). The 92.4% of VHV had attended public volunteer training and 7.6% completed malaria course by private sectors. Regarding malaria health services, 96.5% provided malaria diagnosis, 82.6% gave malaria treatment, 20.9% distributed long lasting insecticide nets, 8.7% had KO (Deltamethrin‐based tablets for bed net impregnation) distribution, 77.3% gave malaria health education. The 96.5% provided on call services. The 97.1% had National Treatment Guidelines for malaria. The 92.3% did not treat severe or complicated cases of malaria. The 61.9% referred severe or complicated cases of malaria. Regarding knowledge on the treatment of malaria, 56.4%, 76.7% and 54.7% of VHV knew current recommended drugs for the treatment of uncomplicated falciparum, vivax and mixed malaria infections, respectively. Among IEC (Information, Education and Communication) materials, posters (71.4%) were most frequently used. The 99.4% knew Rapid Diagnostic Test (RDT) but 70.8% could not mention the brands of RDT. Nearly cent percent of VHV replied that results of RDT are reliable. Almost all of VHV had mobile phones. The 63.1% knew how to message via phones while 48.4% was able to use internet including social media. In current reporting system, 46.2% have difficulties in timely reporting especially in rainy season. Nearly 65% perceived as convenient by sending monthly reports via mobile phones instead of using carbonless papers under favorable conditions. In conclusion, most of the malaria volunteers from all study sites were found as ready to be equipped in knowledge and skill to contribute in malaria elimination activities in Myanmar.

 80  46th Myanmar Health Research Congress Abstracts of the papers (Day 4)

Afternoon Session (1), Auditorium (1) Paper-90

Preferences of malaria treatment seeking behaviors among mobile/ migrant workers at remote sites in the context of malaria elimination: A mixed‐methods study

Aung Ye Naung Win1,2, Thae Maung Maung1, Khin Thet Wai1, Tin Oo1, Aung Thi3, Mondha Kengganpanich4, Ngamphol Soonthornworasiri2, Rungrawee Tipmontree5 and Jaranit Kaewkungwal2

1Department of Medical Research 2Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand 3National Malaria Control Program 4Department of Health Education & Behavior Science, Faculty of Public Health, Mahidol University, Thailand 5Department of Disease Control, Ministry of Public Health, Thailand

Migration flows and emerging resistance to artemisinin‐based combination therapies in the Greater Mekong Sub‐region (GMS) create challenges to meeting 2030 malaria elimination target in Myanmar. The National Malaria Control Program (NMCP) targeted migrant workers based on stability of their worksites (categories 1: permanent work‐setting; categories 2 and 3: less stable work‐settings). This study aims to assess migration patterns and malaria treatment‐seeking preferences encountered by migrant workers at remote sites in a malaria elimination setting. A mixed‐methods explanatory sequential study retrospectively analyzed secondary data acquired through migrant mapping surveys (2013‐2015) in six endemic regions (Bago, Ayeyarwady and Tanintharyi Regions, Mon, Kayin and Kayah States) (n=9,603). A multivariate logistic regression model was used to ascertain contributing factors. A qualitative strand (2016‐2017) was added by conducting five focus group discussions (Gold panning, rubber plantation and farming groups) (n=50) and five in‐depth interviews with migrant workers from less stable worksites in Shwegyin Township, Bago Region. Among migrant workers, those from Bago Region had duration of stay ≥12 months (63% vs. 49%) and high seasonal mobility (40% vs. 35%) than other regions. Particularly in less stable settings, a very low proportion of migrant workers (17%) preferred to seek malaria treatment from public sector and influenced by worksite stability (adjusted OR=1.4 and 2.3 respectively for categories 2 and 1); longer duration of stay (adjusted OR=3.5); received malaria messages (adjusted OR=1.2); knowledge of malaria symptoms (adjusted OR=1.7) and awareness of means of malaria diagnosis (adjusted OR=1.4) (p< 0.001). Qualitative data elucidated their preference for informal healthcare sector, due to convenience, trust, good relations and put migrant workers at risk of substandard care. Moreover, the availability of cheap antimalarial in unregistered small groceries encouraged self‐medication. Infrequent or no contact with rural health centers and voluntary health workers worsened the situation. Mitigating key drivers that favor poor utilization of public‐ sector services among highly mobile migrant workers in less stable work‐settings should be

 81  Abstracts of the papers (Day 4) 46th Myanmar Health Research Congress

given priority in a malaria‐elimination setting. These issues are challenging for NMCP in Myanmar and might be generalized to achieve malaria‐elimination goals. Further innovative out‐reach programs designed and implemented specific to the nature of mobile/migrant workers is crucial.

Afternoon Session (1), Auditorium (1) Paper-91

Knowledge of high school students about malaria prevention and control in malaria endemic area of Pyin Oo LwinTownship

Phyu Phyu Win1, Moe KyawMyint1, Ei Ei Swe1, Khine Khine Linn1, Aung Kyaw Soe2, Lain Lan Maung1, Win Pa Pa Win3 and Khin Lin1

1Department of Medical Research 2Department of Public Health 3Department of Medical Services

A community‐based cross sectional descriptive study was conducted with the high school students from selected three schools situated in malaria endemic rural area of Pyin Oo Lwin Township to assess knowledge about malaria prevention and control. A total of 183 students were selected by systematic random sampling method. Self‐administered questionnaire was used in this study. Out of all students, female occupied 65.5% and most of the students (78.1%) were at the grade nine. Majority of students (93.4%) reported that the cause of malaria was due to mosquito bite. The students who correctly answered that biting time of mosquito for malaria was at night time were only 47.0%. Regarding signs and symptoms of malaria, almost all students (92.9%) knew that fever with chills were the major symptom of malaria. With regard to prevention of malaria, the students (95.1%) reported that using the bed net is a way of preventing malaria and 82.5% of the students answered that taking drug as preventing malaria. About (80.0%) of all students knew that spraying could prevent malaria infection. Most of the students (83.6%) answered that well drainage of water is important to reduce mosquito breeding. Relation to diagnosis and treatment of malaria, the proportion of students reported that malaria could be diagnosed by microscope and Rapid Diagnosis Testing were (62.8%) and (77.6%), respectively. Of all students, 76.0% perceived that malaria disease can be cured by early diagnosis and effective treatment provided by healthcare workers. The 79.2% of students revealed that malaria was curable disease. Moreover, they (92.9%) had perceived the severity of malaria as a deadly disease if there is no proper diagnosis and treatment. Although the 74.3% of students had known that malaria could not be treated effectively by taking drugs from drug shop, about half of all the students misunderstood that malaria can be cured without taking complete course of treatment. In conclusion, although the high school students had good knowledge on causes of malaria and prevention, promoting the knowledge providing about prompt diagnosis and effective treatment of malaria by healthcare worker should be encouraged more.

 82  46th Myanmar Health Research Congress Abstracts of the papers (Day 4)

Afternoon Session (1), Auditorium (1) Paper-92

Drug resistant malaria situation of Buthidaung, Rakhine State: Clinical and molecular perspective

Kay Thwe Han1, Kyin Hla Aye1, Zay Yar Han1, Phyo Zaw Aung1, San Lin Aung1, Soe Soe Han1, Nay Chi Aung San1 and San Kyawt Khine 2

1Department of Medical Research 2Vector Borne Desease Control (VBDC)

Malaria elimination by 2030, has been adopted in all Greater Mekong Sub‐region Countries including Myanmar. Antimalarials are playing the major role in malaria treatment, control, and in future will be one of the key strategies towards malaria elimination. However antimalarial drug resistance problem hinders the widely use of them. While regional and global efforts are trying to control and contain the antmalarial resistance not to spread to the Indian and African continents, the western border of Myanmar is the area where should be under continuous surveillance. Buthidaung is one of the WHO sentinel sites for Therapeutic Efficacy Study (TES) of currently used antimalarials. Therapeutic efficacy of artemisnin combination treatment (ACTs) namely artemether‐lumefantrine (AL), and dihydroartemisinin‐piperaquine (DHA‐PIP) in Rakhine State stayed at 100% adequate clinical and parasitological response (ACPR) up to 2015. Recent TES 2016 revealed ACPR 98% in both ACTs (n=54 in AL, 53 in DHA‐PIP) with 2% recrudescence. From molecular perspective, K13 mutation was not emerged upto 2015. K13 mutation was detected in 3.4% (2/58) of AL trial group from TES 2016. Absence of day 3 persistent parasite positive case and no correlation of K13 mutation with treatment failure would state that artemisinin resistance has not been emerged. However, timely response to decreased sensitivity of ACT and partner drug efficacy monitoring is highly recommended.

Afternoon Session (1), Auditorium (1) Paper-93

Challenges, gap and opportunities on malaria research in Myanmar (2000‐2017)

Myat Htut Nyunt

Department of Medical Research

As malaria is one of the major public health problems in Myanmar, plenty of studies focusing on multi‐dimension of malaria are conducting. To explore the challenges, gap and opportunities on the trends of malaria research, a study of systematic analysis and bibliometric analysis were conducted for the period of 2000‐2017. Electronic bibliographic databases such as PubMed, MEDLINE, Google Scholar, Web of Science and Scopus were included for searching of published data using specific keywords with no language

 83  Abstracts of the papers (Day 4) 46th Myanmar Health Research Congress

restriction for the study period. Similarly, unpublished databases were retrieved from thesis and dissertations submitted to the medical related universities, the abstract books of Myanmar Health Research Congress, Myanmar Military Medical Conference and Myanmar Medical Conference. A total of 2,730 studies were initially screened and after data extraction, 413 studies were included for analysis in which composed of clinical research (159, 38.50%), social research (147, 35.59%), molecular research (54, 13.08%), vector study (17, 4.12%) and others such as pathophysiology, review and methodology (10, 2.42%). Most of them were cross‐sectional observational study (296, 71.67%), followed by cohort study (57, 13.80%), clinical trial (44, 10.65%), case‐control study (6, 1.45%), methodology (6, 1.45%) and review (4, 0.97%) respectively. Only one‐third (149, 36.08%) of the studies were appeared as published papers. Although the Department of Medical Research was the most productive institute with 162 studies (39.2%), only few publications (36/149, 24.2%) were documented. "Malaria Journal" was found to be the first ranked journal in publishing articles on malaria research in Myanmar (49/149, 32.89%). Both the number of presentations and publications on malaria research in Myanmar have been increasing significantly (p=<0.0001) between the period (2000‐2009) and (2010‐2017). Interventional studies especially on entomological aspect should be focused for future research. Moreover, situational analysis to explore the challenges and constraints of the researchers for publications should be addressed. Research strategy focusing to fill the gap of knowledge on malaria research in Myanmar should be formulated in accordance with malaria elimination plan.

Afternoon Session (2), Auditorium (1) Paper-94

Antibody response to first and second dose of measles vaccination in children

Hnin Phyu Phyu Soe 1, Wah Wah Oo 2 and Aye Aye Myint 3

1University of Medicine, Mandalay 2(300) bedded Teaching Hospital, Mandalay 3(550) bedded Children Hospital, Mandalay

To study the antibody response to first and second dose of measles vaccination in children, a community based prospective study was carried out at Chan Mya Thar Zi Township, Mandalay from 1st January 2015 to 31st December 2015. This study evaluated 100 children from 12 through 24 months of age after first and second dose of measles immunization. Before second dose was given, measles antibody IgG levels were measured to find the immunity status after first dose. Post vaccination antibody titers were measured two months after vaccination. According to sex distribution, 53% of vaccinated children were male and 47% were female. There was no significant difference between male and female population. 74% of the children were seropositive before second vaccination while 26% were seronegative. Of these seropositive cases, 53 (53%) were male and 47 (47%) were female. Nutritional status was assessed clinically by using weight for height score. There was no child with severe malnutrition among the study population. Measles specific Immunoglobulin after second dose of vaccination in seronegative group were studied in 26 children, 4 (15.4%) children were still seronegative and 22 (84.6%) became seropositive

 84  46th Myanmar Health Research Congress Abstracts of the papers (Day 4)

after second dose of vaccination. So after second dose of vaccination, seroconversion rates increased from 74% to 84.6%.

Afternoon Session (2), Auditorium (1) Paper-95

Bacteria and viral profile of severe acute respiratory infections of children attending Yangon Children Hospital and Yankin Children Hospital

Moe Myat Aye1, Latt Latt Kyaw1, San Mya1, Htay Htay Tin1, Win Thein1, May Lwin2, Tin Moe Phyu2, Kyaw Zin Wai3 and Khin Myitter3

1National Health Laboratory 2Yangon Children Hospital 3Yankin Children Hospital

This study was conducted under ECOMORE (Economic Development Ecosystem Modification and Emerging Infectious Diseases Risk Evaluation) project. Objectives of study are (1) To reinforce the national capacity for diagnosis of some infectious diseases causing sever acute respiratory infection (SARI) and (2) To build a network for the diagnosis and surveillance of SARI in Yangon. This study is a cross‐sectional hospital and laboratory based descriptive study. Among 511 children attending Yangon Children Hospital and Yankin Children Hospital from December 2014 to April2016, Bacteriology section tested 825 samples including respiratory samples, blood samples for culture and sensitivity by using Vitek 2 and Bact/Alert machine. Out of 129 Gram negative bacilli (GNB), K.pneumoniae 32%, P. aeruginosa 18%, A. baumannii 13%, E. coli 9% were mostly isolated. Among 35 Gram positive cocci (GPC) isolation, S. aureus 42% and S. pneumonia 6% were mostly isolated. Multidrug resistance rate were E. coli 100%, K. pneumonia 95%, A. baumanii 82% and P. aeruginosa 17%. Extended spectrum beta latamase (ESBL) producing K. pneumoniae and E.coli was 6 out of 10 tested organisms. Carbarpenemase producing GNB and Methicillin resistant Staphylococcus aureus (MRSA) were 21% and 33% respectively. Out of 262 urine samples, 48 were positive for S. pneumoniae antigen, 1 for Legionella antigen. Virology section tested 529 samples of 490 inclusions using the FTD33 multiplex PCR method which can detect 33 pathogens including 20 viruses, 12 bacteria and 1 fungus. Out of 490 inclusions, 374 were PCR positive. Different types of samples including nasopharyngeal, throat, endotracheal and laryngeal swab, tracheal secretion and bronchoalveolar lavage were tested. Out of 566 viruses, respiratory syncytial virus (RSV) (19.3%), rhinovirus (17.0%), parechovirus (14.3%), bocavirus (11.1%), adenovirus (10.2%), metapneumovirus A and B (10.2%), parainfluenza virus (5.7%), enterovirus (3.0%), Influenza A virus (2.8%), coronavirus (4%), parainfluenza virus (0.9%), influenza C virus (0.4%), were detected. This study highlighted the etiological agents of bacteria, viruses and choice of antibiotics for bacterial pathogens in SARI.

 85  Abstracts of the papers (Day 4) 46th Myanmar Health Research Congress

Afternoon Session (2), Auditorium (1) Paper-96

Estimation of corrected serum calcium level and platelet count in children with dengue haemorrhagic fever admitted to Yangon Children Hospital

Khine Hnin Aye1, May Thwe Lin2, Myint Myint Nyein2, Myat Mon2 and Khin Thida Aung1

1University of Medicine 2, Yangon 2University of Medicine 1, Yangon

Dengue virus infection is the most rapidly spreading mosquito‐borne viral disease which is a major public health concern throughout tropical and subtropical regions of the world. It is a serious cause of morbidity and mortality and is considered to be one of the most important infectious diseases in these regions. Infection with dengue virus may be asymptomatic or may give rise to a spectrum of clinical illness ranging from undifferentiated fever to a severe life threatening haemorrhagic/shock syndrome (DHF/DSS) with multiple organ failure and fatality. Early recognition of dengue with prompt and adequate treatment is vital to limit morbidity and mortality. There are a number of parameters currently accepted in assessing the severity of DHF. Among these, one such parameter is platelet count. Hypocalcaemia may be associated with cardiovascular complications such as hypotension and may precipitate shock in patients with dengue infection. A hospital based cross‐sectional descriptive study was carried out on 90 cases of clinically and serologically confirmed DHF at Yangon Children Hospital. The mean age of the patients was 7.4 years with male: female ratio of 1:1.05. These cases were classified into four grades according to severity by WHO criteria. Among 90 cases of studied DHF population, 39 cases were grade 1, 34 cases were grade 2, 13 cases were grade 3 and 4 cases were grade 4 respectively. Corrected serum calcium level and platelet count were measured in these cases and evaluated as indicators of disease severity. In this study, the prevalence of hypocalcaemia in study population was 42.2% and it is correlated with severity of dengue infection which is statistically significant at p<0.001. There was also a significant association between thrombocytopenia and grading of DHF (p=0.045). The correlation between corrected serum calcium level and platelet count was also studied and it was found that there was significant association between corrected serum calcium level and platelet count (p=0.001). The findings of this study highlight the role of calcium in assessment of severity of DHF and correlate it with conventional prognostic indicator such as platelet count.

 86  46th Myanmar Health Research Congress Abstracts of the papers (Day 4)

Afternoon Session (2), Auditorium (1) Paper-97

Assessment of thyroid hormone levels among children with obesity

Yin Yin Win1, Khin Aye Lwin2, Theingi Thwin1, Aye Aye Maw1, Khin Thida Wai1, Thandar Myint1, Naw Myat Su Mon1 and Tin Maung Maung1

1Department of Medical Research 2Yangon Children Hospital

Overweight and obesity are considered as a major public health problem in many countries. Obesity affects hypothalamic‐pituitary‐thyroid axis either directly or indirectly leading to alterations in thyroid function tests (thyroid stimulating hormone, total triiodothyronine and total thyroxine). Thyroid function in obesity reveals a variety of patterns sorting from normal to elevated thyroid stimulating hormone (TSH) and total T3 or total T4 levels. This study aimed to compare thyroid hormone levels between obese children and normal weight children and to find out correlations between body mass index (BMI) and thyroid hormones. In the study, 45 obese children and 48 normal weight children of the same age and sex were participated. Thyroid function tests were measured in all participants by using ELISA kits. The mean age of children was 10.18 ± 1.84 years. The mean BMI was 15.61 ± 1.84 kg/m2 in normal weight children and 28.65 ± 4.84 kg/m2 in obese children. The mean serum TSH level (2.47 ± 1.30 mIU/L) and T3 level (1.48 ± 0.27 ng/mL) were significantly higher (p<0.05) in obese children than in normal weight children (1.89 ± 0.92 mIU/L and 1.29 ± 0.28 ng/mL). A higher prevalence of increased TSH level (>4 mIU/L) was found in the obese group (17.8%) than in the normal weight children (4.2%). Weak positive correlations were found between BMI and TSH level (r=0.219, p=0.034) and total T3 level (r=0.248, p=0.016) but there was no significant correlation between BMI and total T4 level (p=0.40). Subclinical hypothyroidism was found in 17.8% of obese children which was significantly higher (p<0.05) than that of normal weight children (4.2%). In conclusion, elevated serum TSH levels were associated with obesity; therefore, thyroid function could be one of several factors acting in concert to body weight. Since an increased TSH levels with positive thyroid antibodies are likely due to thyroid disease, it is recommended to assess thyroid antibodies (thyroid peroxidase and thyroglobulin) in all individuals with increased TSH levels.

 87  Abstracts of the papers (Day 4) 46th Myanmar Health Research Congress

Afternoon Session (2), Auditorium (1) Paper-98

Screening of wasting among children 6‐59 months using age and sex specific mid upper arm circumferences cut‐offs (WHO‐2007) in urban, Yangon

Su Su Hlaing1, Moh Moh Hlaing2, Chit Ko Han1, Aye Aye Thwe1, Tin Aye Cho1 and Mya Ohnmar2

1Yangon Regional Health Department 2Department of Medical Research

The mid upper arm circumferences (MUAC) is an important measurement which is often used for the assessment among pre‐school children. Although the mid upper arm circumference (MUAC) is used as a proxy to assess wasting in children, its validity is still in controversies. This study therefore aimed to assess the prevalence of acute under nutrition among children aged 6‐59 months in urban setting in Yangon using age and sex specific mid upper arm circumferences (MUAC) cut‐offs World Health Organization (WHO 2007) and the validity of MUAC as a measure of nutritional status . A cross sectional study was conducted in Urban Health Centres of Kyinemyindine, Kamaryut, South okkalapa, South Dagon and East Dagon townships in Yangon from February to September 2007. Of 873 children, 54.6% was boys and 45.45 was girls and the mean (SD) age of the children was 36.01 (16.9) months. The mean (SD) MUAC was 15.76 (1.71) cm and increase with age from 14.99 (1.35) at 6‐11 months to 14.88 (1.41), 15.44 (1.37), 15.78 (1.47) and 16.51 (1.84) at 1 year, 2 years, 3 years and 4 years respectively. The overall prevalence of wasting among children was 2.9% of which 3.1% was boys and 2.5% was girls using age and sex specific MUAC cut‐offs (WHO 2007). By using MUAC with fixed cut‐off, prevalence of wasting among children was only 0.5% of which 0.6% was boys and 0.3% was girls (MUAC < 12.5 cm). The overall prevalence of wasting among the children was 13.4% (15.1% in boys and 11.5% in girls) using weight‐for‐height Z‐score (WHZ) . Comparing age and sex MUAC cut‐offs (WHO 2007) with weight for height as gold standard the sensitivity of MUAC was 9.4%and the specificity was 98%, with a Kappa of 0.113. Comparing the conventional MAC cut off levels of <12.5cm with gold standard, the sensitivity of MUAC was 3.4%, and the specificity was 100%, with a Kappa of 0.058. The results showed that MUAC of children were increasing with age and a single cut‐off point of MUAC has poor agreement with gold standard. Therefore, age and sex specific mid upper arm circumferences cut‐off should be used in screening of wasting under 5 year old children.

 88  46th Myanmar Health Research Congress Abstracts of the papers (Day 4)

Afternoon Session (2), Auditorium (1) Paper-99

Clinical presentation and dengue virus serotypes in infants with Dengue Hemorrhagic Fever

Moe Oo Phyu1, Kyin Hlaing2, Theingi Win Myat3, Khin Mar Aye3, Khin Nyo Thein1, Kyaw Zin Wai1 and Khin Sandar Aye3

1Yankin Children Hospital 2550 bedded Children Hospital, Mandalay 3Department of Medical Research

Dengue is a major cause of morbidity throughout the world and continues to spread alarmingly. Up to 2.5 billion people live under the threat of dengue and its severe forms of dengue hemorrhagic fever (DHF) and dengue shock syndrome. Dengue (DEN) is caused by four serologically related but antigenically distinct viruses designated as DEN 1 to DEN 4 belonging to Flaviviridae family. Presentations of dengue in infants are different from older children. The objectives of this study were to describe the clinical presentation of DHF in infants, to assess the severity of dengue according to WHO grading 2009 and to identify the different serotypes of dengue virus by indirect immunofluorescence assay (IFA). This was a hospital based descriptive study done in medical units of Yankin Children Hospital and Virology Research Division of Department of Medical Research from 2015 January to 2015 December. Hundred and seven infants with dengue virus infection diagnosed by NS 1 Ag (+) and/or IgM (+) were included in the study. These infants were assessed for clinical examination and blood samples were sent for serotyping of dengue virus using IFA. Out of 107 infants, the most affected age group was 6‐9 months and males were more commonly affected. Commonest presentation were hepatomegaly (96.3%), drowsiness (49.5%), bleeding manifestation (15.9%) and diarrhea (11.2%). Seventeen out of 107 (14%) were severe infections (WHO grade III and IV). Fifty five percent were serotype 1, 22.2% were serotype 2, 5.6% were serotype 4 and 16.7% were serotype 1 and 2.

 89  Abstracts of the papers (Day 5) 46th Myanmar Health Research Congress

Paper Reading Session: Day 5

Morning Session (1), Auditorium (1) Paper-100

Assessment of oral health status among postpartum women in Thingangyun Sanpya General Hospital, Yangon Region

Saw Nandar Aung and Ko Ko Soe

Department of Preventive and Community Dentistry University of Dental Medicine, Yangon

Although oral cavity forms only a small part of the human body, its state of health has many implications for health of the rest of body. The oral diseases and conditions are not only markers for underlying health problems, but also important determinants influencing the development and management of adverse health conditions such as adversed pregnancy outcomes. The aim of this study was to assess oral health status and any relationship between oral and general health among postpartum women. Cross‐sectional, analytic, hospital‐based, non‐intervention type of study was carried out among 344 postpartum women attending at Obstetrics and Gynaecology Ward, Thingungyan Sanpya General Hospital, Yangon Region in 2015. Data concerning sociodemographic characteristics, maternal and infant data, oral hygiene behaviour, dental visit behaviour and oral health status were assessed. Mean age of the participants was 28.28 (6.54) years and two third had completed primary education. Mean gestational period of postpartum women was 37.29 (2.71) weeks and newborns had mean birth weight of 3.13 (0.53) kg. Regarding adversed pregnancy outcomes, 38.1% of participants delivered preterm and 8.7% gave birth of low birth weight infant. More than two third of participants reported that they brushed twice a day. Although 97.7% presented using toothbrush and toothpaste, only a few knew the right timing in correct tooth brushing technique. Nearly half (44.7%) did not know whether toothpaste contained fluoride or not. More than one quarter of respondents (26.2%) visited a dentist in which pain was a major reason. Dental caries prevalence was 53.5% with mean DMF‐T of 1.83 (2.87) where decayed was dominant portion. Thus preventive as well as curative measures should be provided. Higher mean DMF‐T was found in individuals with higher education. Prevalence and mean value of periodontal conditions were quite low. There was no statistically significant association between oral health status i.e. dentition and periodontal status and adversed pregnancy outcomes (preterm and low birthweight infant delivery). It may be due to low level of oral health status in this study. Further researches should be performed among other subpopulation groups and other places in Myanmar.

 90  46th Myanmar Health Research Congress Abstracts of the papers (Day 5)

Morning Session (1), Auditorium (1) Paper-101

Factors associated with compliance to the cascade of services for the prevention of mother to child transmission of HIV in Myanmar

San Hone1, Roger Detels2, W. Scott Comulada3, Li Li2 and Sung‐Jae Lee2

1National AIDS Program, Department of Public Health 2 Epidemiology Department, University of California, Los Angeles 3Psychiatry and Biobehavioral Sciences Department, University of California, Los Angeles

Myanmar has implemented the Prevention of Mother to Child Transmission of HIV (PMCT) program as one of the prioritized HIV interventions since the early 2000. The updated WHO recommendations on treatment regimens for the (PMCT) have been fully followed. This study explored factors associated with mother‐infant pair compliance to the cascade of PMCT services. This study included cohorts of 607 HIV‐positive pregnant women and 577 mother‐baby pairs identified from 2011 to 2014 through community antenatal clinics in 23 townships of Myanmar. A marginal correlated modelling strategy was employed to assess factors associated with compliance to the cascade of PMCT services. Of the 607 pregnant women, 272 (45%) were from rural area and 335 (55%) from urban area. About 57% of women in both urban and rural areas were in the age group 26 to 35 years, and 89% were married at the time of diagnosis. Findings indicated that the level of compliance to cascades of PMCT services dropped through the subsequent stages: 82% compliance before delivery dropped to 73% after delivery which dropped to 66% for follow‐up HIV testing of exposed infants. It was found out that living in a rural area, having a low level of education, and being dependent on one’s husband for economic support were associated with the lower odds of complying with prescribed treatment throughout pregnancy (Adjusted ORs: 0.7 (0.4‐1); 0.4 (0.2‐0.9); and 0.6 (0.3‐0.9) respectively). In addition, initiation of treatment in late pregnancy and prophylactic treatment were associated with lower the odds of compliance (Adjusted ORs: 0.6 (0.4‐1); and 0.5 (0.3‐0.7) respectively). Of the 577 exposed infants, 382 (63%) received follow up HIV testing out of which only 73 (19%) received the test within two months of age. Regarding the initiation of treatment for positive infants only 10 out of 19 identified received treatment, and the earliest age at treatment initiation was 18 months. There is an urgent need to design community‐based interventions that enhance adherence to prescribed treatment among socio‐demographically disadvantaged women. Services for early infant diagnosis and proper linkage for prompt initiation of ART should be established at the local level.

 91  Abstracts of the papers (Day 5) 46th Myanmar Health Research Congress

Morning Session (1), Auditorium (1) Paper-102

Is men who have sex with men (MSM) population effectively covered by HIV prevention services in high burden townships in Myanmar? Findings from programmatic mapping

San Hone1, Htun Lynn Oo5, Sabe Phyu4, Yin Thet Nu Oo2, Aye Myat Soe3, Khin Malar Tun6, Nwe Ni Myint5, Kay Khaing Kaung Nyunt1 and Soe Htut Aung7

1National AIDS Program, Department of Public Health 2Department of Medical Research 3World Health Organization, Myanmar 4UNAIDS, Myanmar 5Alliance, Myanmar 6ICAP at Columbia University in Myanmar 7FHI 360, Myanmar

In line with the National Strategic Plan for HIV/AIDS, programmatic mapping (PM) was conducted for men who have sex with men (MSM) to identify the characteristics of hotspots, barriers to access, service delivery gaps, and social networks in 46 high priority townships in twelve States/Regions to inform HIV prevention programming at sub‐national level in 2016. In each township, data collection was done through a field team consisting of MSM peers. It started with a list of known hotspots compiled with inputs from stakeholders, service providers and MSM representatives. On‐site observations, structured interviews, in‐ depth interviews and focus‐group discussions were used. Hotspots were grouped into six categories: public spots, beauty salons, restaurants, entertainment sites, socializing spots and others. Of the total 1,538 MSM hotspots mapped: the largest proportions were beauty salons (27%), public spots (28%) and social spots (25%). Largest proportions of MSM were found in public spots (32%), social spots (23%) and beauty salons (21%). Most beauty salons were gathering sites for all MSM types, and owners of beauty salons were leaders in MSM communities/sub‐communities. Sex took place in 45% of all hotspots. Outreach services covered 51% of all hotspots within one month before the mapping. Condoms were available at 62% of all hotspots. Prominent MSM community leaders, many of them respected by local communities, were identified. The use of information technology for socializing and finding sex partners was common and growing, especially among hidden MSM. The most popular platforms were Beetalk, Facebook, Viber, Grindr and WeChat. There were exclusive MSM groups and local groupings on social media for easy networking among local MSM. Findings highlighted the urgent needs to improve prevention service coverage and to design interventions deploying information technology. Service delivery modality channeling through less stigmatizing health programs and through networking with MSM community leaders should be considered in program design. In addition, prevention programs targeting specific hidden MSM subgroups, and migrants, should be established.

 92  46th Myanmar Health Research Congress Abstracts of the papers (Day 5)

Morning Session (1), Auditorium (1) Paper-103

Socio‐economic impact of HIV on health and health expenditure at a household level in Myanmar: Findings from National Survey

Poe Poe Aung1,4, Etoile Pinder2, James Cercone2, Htun Nyunt Oo3, Thet Tin Tun4, Lei Lei Win5, Yin Thet Nu Oo5, Claire Nightingale6 and Ben Coghlan6

1University of Maryland Baltimore, School of Medicine 2Sanigest International 3National AIDS Program 4Burnet Institute Myanmar 5Department of Medical Research 6Burnet Institute Australia

Myanmar is one of the 5 largest populations living with HIV (PLHIV) in the Asia‐ Pacific region with an estimated 189,000 positive residents. However, the social and economic challenges of these people are poorly understood. As part of a UNDP regional initiative to determine the impacts of HIV on households throughout Asia, the study aimed to document these challenges in 2014‐15 to inform Myanmar’s health and social policies to reduce stigma, vulnerability and improve outcomes. A cross‐sectional comparative design using a multi‐stage cluster sampling strategy was employed to select a nationally representative sample 1,256 PLHIV households and 1,256 non‐PLHIV households from 30 urban and 30 rural clusters throughout Myanmar. PLHIV were recruited from ART clinics; comparison households were geographically matched to PLHIV households and recruited separately. Interviewers administered a standard questionnaire to assess the social and economic situation of each household. Individual and household level analyses compared PLHIV and non‐PLHIV households. Compared to non‐PLHIV households, families with a PLHIV have lower annual incomes (USD 768 vs. USD 807), lower home‐ownership (p<0.001), fewer assets (p<0.001), more household debt (33% vs. 24%) (p<0.001) and pay a higher rate of interest on consumer loans. More HIV‐affected households are led by a single parent (widows: 20.3% vs. 13.2%) (p<0.001) with these families especially economically vulnerable. HIV‐affected families are more likely to go hungry despite receiving food support (p<0.001), and their children are more than twice as likely to have missed school to help their family with household chores or paid work. While PLHIV have better access to and lower charges for healthcare (they are exempt from many health costs), they had more hospitalizations (14.1% vs. 2.9%) and their families incurred higher average annual out‐of‐ pocket health expenses (USD 272 vs. USD 146) (p<0.001). PLHIV reported high levels of substance use: 42% smoked or used betel nut compared to non‐PLHIV. For those who regularly drink alcohol, 13% missed doses of their HIV treatment. This study provides strong evidence for development policies including universal health coverage and other social protection schemes that address the disproportionate health, economic and social challenges faced by people and households affected by HIV.

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Morning Session (1), Auditorium (1) Paper-104

Effectiveness and acceptability of participatory reproductive health intervention for HIV infected and affected adolescents in Myanmar

Myo Myo Mon1, Kyaw Min Htut1, Htun Nyunt Oo2, Lwin Lwin Ni1, Aung Soe Min1 and Ni Ni Htay Aung1

1Department of Medical Research 2National AIDS Program, Department of Public Health

Comprehensive knowledge on HIV and reproductive health (RH) is essential for HIV infected and affected adolescents in order to prevent them from adopting RH risk behaviours. Applying participatory intervention could be more beneficial for young adolescents to learn health knowledge than usual way of providing health education. Current study aimed to assess the effectiveness and acceptability of intervention package on HIV and RH among adolescents infected and affected by HIV. Participatory package including body mapping, group discussion on RH issues, two‐way discussion using case scenarios and meditation practice were applied during 3 months period. Baseline and post assessment at 3 months after the intervention were conducted using both quantitative and qualitative research methods. A total of 80 HIV infected and affected adolescents included in the intervention. Age of adolescents ranged from 10‐16 years with the mean age of 12.8±1.9 years. Over 76% were currently in‐school and were orphans. At the start of intervention, body mapping exercises were conducted separately for male and female where reproductive organs and puberty changes were discussed. Although the adolescents were aware of puberty changes for their respective gender, most of them could not mention about the opposite gender. Many of them did not know the connection between menstrual cycle and conception. Improvement in knowledge scores on RH regarding puberty changes (2.7±1.3 vs. 4.2±0.7, p<0.05), adolescent pregnancy and consequences (4.0±1.0 vs. 5.0±0.5, p<0.05), contraception (3.2±1.4 vs. 4.1±0.8, p<0.05), STI (3.0±1.1 vs. 4.1±0.8, p<0.05) and HIV (4.0±0.9 vs. 5.0±0.5, p<0.05) were seen at post‐intervention assessment. Overall knowledge scores on RH was significantly increased (18.1±3.4 vs. 22.0±2.3, p<0.001). Majority could apply the knowledge gained from the intervention and could highlight the adverse consequences of HIV/STI and adolescent pregnancy during discussion on case scenarios. Over 98% of the adolescents satisfied towards the intervention and 91.2% felt that the intervention is interesting. Over 38% could follow all the intervention activities while 60% could follow most activities. Many of them (80%) were willing to attend similar training in the future. Improvement in knowledge of RH and HIV/STI among HIV infected and affected adolescents were achieved by applying participatory intervention package.

 94  46th Myanmar Health Research Congress Abstracts of the papers (Day 5)

Morning Session (2), Auditorium (1) Paper-105

Characterization of biochemical composition and biological activities of Cobra (Naja kaouthia) venom

Thet Thet Mar, Win Aung, Zaw Myint, Tin Ko Ko Oo and Lwin Zar Maw

Department of Medical Research

Second common species of snake, responsible for high mortality rate in Myanmar is Cobra (Naja kaouthia). Cobra venom contains several enzymes and proteins including cobra venom factor, kaouthiagin, phospholipases, cardiotoxin, neurotoxin and myotoxin. This study was conducted to determine the biochemical composition and biological activities of cobra venom. Crude venom was fractionated by using HiTrapFF cation exchange chromatography into seven protein peaks. Characterization of crude venom on SDS‐PAGE revealed that proteins were found to have molecular weight (MW) ranged between 5 and 250 KDa. Enzymatic activity of phospholipase A2 (PLA2) was found in fraction 1, 2, 3, 6 and 7. Activities of hyaluronidase, protease, acetylthiocholine, alkaline phosphomonoesterase and phosphodiesterase were detected in fraction 3, 3, 6, 2 and 6, 4 and 6 respectively. The LD50 (i.v) of venom was 0.184 mg/kg and above LD50 dose injected mice died within 2hrs. Neurotoxic symptoms like difficulty in movement and breathing were observed after injection of LD50 dose and some mice died within 1 hr. The concentration of serum CK from heart vessel after injection of LD100 of venom in mouse was 858.97 U/L. When citrated plasma was treated with 0.2 µg each protein from all fractions, no clot was found till 30minutes. Similarly when citrated plasma was treated with 0.01, 0.1 and 0.5 µg of crude venom, no clot formation occurs till 30 minutes. When detected with cobra ASV (1:100 dilution) by ELISA method, positive signals could be detected in venom as well as all fractions. Components of venom and fractions with MW above 30 KDa were more intensely recognized with ASV, but low MW components in venom and fraction 1, 2, 3 and 4 were weakly recognized with ASV by western blot analysis. Therefore, it was concluded that cobra venom had various enzymatic activities. Also low immunogenicity of low MW components of venom can also be seen by western blot pattern. By knowing the components of cobra venom proteins can be useful for explaining clinical effects of snake bite victims. Result of present study fulfill the lack of scientific information regarding the components of cobra venom in Myanmar which is lethally toxic and provide potential benefit for development of cobra specific anti‐venom by advanced molecular technology.

 95  Abstracts of the papers (Day 5) 46th Myanmar Health Research Congress

Morning Session (2), Auditorium (1) Paper-106

Construction of the cDNA library and detection of the sequences of ten positive clones from Russell’s Viper (Daboia siamensis) Venom gland

Thet Thet Mar, Zaw Myint, Aye Win Oo, Aung Zaw Lat, Tin Ko Ko Oo and Kay Thi Aye

Department of Medical Research

Snakebite is endemic in Myanmar and the incidence of snake bite is estimated for more than 10,000 per year with an average case fatality rate of 2.2%. In snake envenoming cases, 80% of the morbidity and mortality resulted from Russell’s viper (RV) (Daboia siamensis). Major toxic components in RV are PLA2 and metalloproteinase, leading to unclottable blood and acute renal failure. Although F(ab’)2 rich anti‐venoms are effective in neutralizing venom toxins, their side effects and ability to activate the host complement system have not been eliminated. This study was aimed to construct the cDNA library and detection of the sequences of ten positive clones from Daboia siamensis venom gland. The venom glands of single snake were dissected 4 days after venom milking and homogenized under liquid nitrogen. Total RNA and mRA were extracted using TRIZOL reagent and Qiagen mRNA reagent. The cDNA library of RV was constructed and inserted into pDONR222 vector. The inserted vector was transformed into One Shot MAX Efficiency DH10BT1 cells and plated onto LB plate containing 50 µg/mL kanamycin. Ten positive clones were randomly picked up and cultured in LB broth containing 50 µg/mL kanamycin, then plasmid DNAs were extracted. The nucleotide sequences of plasmid DNAs were determined by using ABI3500XL genetic analyzer and aligned with online BLAST (Basic Local Alignment Search Tool) program of National Center for Biotechnology Information (NCBI). According to BLAST search results, two PLA2 (Daboia siamensis) clones, protein disulfide isomerase family member 3(PDIA3) (Protobothrops mucrosquamatus) clone, myosin light chain 5(MYL5) (Protobothrops mucrosquamatus) clone, troponin T3, fast skeletal type (TNNT3) (Protobothrops mucrosquamatus) clone and five complete genome of Daboia russellii’s mitochondrion clones were found in this library. It was concluded that the construction of cDNA library of Daboia siamensis has been successfully established in Myanmar for the first time. The cDNA library of present study would provide the cloning of PLA2 and cloned PLA2cDNA can be expressed in an appropriate expression vector. By using this expressed PLA2 which will be useful for large production of PLA2 protein and development of specific anti‐PLA2 antibody that can be used for the improvement of anti‐venom therapy and management of Russell’s viper‐bite victims.

 96  46th Myanmar Health Research Congress Abstracts of the papers (Day 5)

Morning Session (2), Auditorium (1) Paper-107

Comparison of two bedside methods for determination of whole‐blood clotting times in assessing coagulopathy in Russell’s viper bites

Han Win1, Khin Thida Thwin2, Khin Saw Aye1, Khin Saw Than3, Hlaing Mya Win3, Ssu Wynn Mon1 and Kyaw Zin Thant1

1Department of Medical Research 2Department of Nephrology, Yangon Specialty Hospital 3Department of Medicine, Yangon General Hospital

One of the most important effects of Russell’s vipers (RV) envenoming is coagulopathy. In the absence of significant local and systemic symptoms, many clinicians have to rely on bedside whole‐blood clotting times to assess whether their patients have coagulopathy and need antivenom. Instead of using glass test tube, easily available empty injection bottles are commonly used for performing whole‐blood clotting times in many heath care settings in our country. The study was aimed to compare this bottle method with standard 20 minutes whole‐blood clotting test (20 WBCT) in assessing coagulopathy in Russell’s viper bite patients. It was a cross‐sectional study which was carried out at Medical Unit (1) and (2) of Yangon General Hospital. Demographic and clinical information of the patients with RV bite were recorded in proforma and venous blood was taken to do clotting tests. Fifty‐five confirmed cases of RV bite were recruited after getting informed consent. They included 48 males (87.3%) and 7 females (12.7%). Their mean age was 38 years (range: 14 to 70 yrs). Sensitivity and specificity of bottle method was calculated using 20 WBCT as the comparator standard. Sensitivity was 100% (95% CI: 90.3‐100) but specificity was only 73.7% (95% CI: 48.8‐90.8). It shows that the bottle method can give false positive results that can lead to unnecessary use of antivenom, risk of systemic antivenom reactions and the antivenom wastage.

Morning Session (2), Auditorium (1) Paper-108

Clinical characteristics of blood stream infections

Ne Myo Aung, Myo Lwin Nyein, Mar Mar Kyi and Kyi Lae Yee Lin

University of Medicine 2, Yangon

Sepsis is one of the leading causes of hospital mortality. The highest mortality among the sepsis patients was seen in those with blood stream infection. This study is an observational study to elucidate the characteristic features of blood stream infection in hospitalized adult patients. Hospitalized adult patient at medical ward of Insein General Hospital (January to May 2017) were recruited in the study. Patients with fever and two organ dysfunctions (reduced consciousness, hypotension, respiratory failure, jaundice, DIC or renal injury according to RIFLE criteria) were collected for blood culture and appropriate body fluid  97  Abstracts of the papers (Day 5) 46th Myanmar Health Research Congress

cultures. Those with previous exposure to 3 days antibiotics or 1 dose of parenteral antibiotics were excluded. Their clinical and laboratory parameters were observed. The clinical outcome was observed up to discharge. During the study, 143 cases with possible sepsis were recruited. Among them 26 cases (18.2%) were identified as blood stream infection (BSI). The majority of causal organisms were Gram negative organisms (73%) and Gram positive organisms account for 27%. Among the Gram negative organisms, Escherichia coli, Pseudomonas spp and Salmonella typhi were most commonly isolated. Among the Gram positive organisms coagulase negative Staphylococci were the most commonly isolated. ESBL bacteria accounted for 47.4% of Gram negative organisms. Source of BSI were Biliary (8%), gastrointestinal (23%), respiratory (31%), urinary (15%) and unidentified (23%). Those with BSI were more likely to die (OR 3.1; 95% CI: 1.3 to 7.5, p value 0.01) and more likely to develop shock (OR 13.2; 95% CI: 4.9 to 35.4, p value 0.01) than those without BSI. BSI is mainly caused by Gram negative bacteria and increases the risk of mortality and shock. Antibiotic resistance is a serious problem.

Morning Session (2), Auditorium (1) Paper-109

Vitamin D and treatment response in systemic lupus erythematosus nephropathy

Min Lynn Zaw Oo1, Thet Thet Mar2, Kyaw Wunna Tun1, Khin Phyu Pyar1 and Chit Soe3

1Defence Services Medical Academy 2Department of Medical Research 3University of Medicine 1, Yangon

The objective was to find out the association between serum 25‐hydroxy vitamin D and treatment response in SLE nephropathy. Hospital based cross‐sectional before and after study was carried out in 74 patients with SLE nephropathy who admitted to Rheumatology Department (500‐Bedded Yangon Specialty Hospital) from January 2016 to October 2017. Vitamin D level, 24‐hour urinary protein, ESR and complement C3 were done before the treatment start. After the completion of 6 months of cyclophosphamide aggressive regime, 24‐ hour urinary protein, ESR and C3 were done. SLEDAI score (before and after the treatment) were calculated. This study showed that 67.8% and 12.6% of SLE nephropathy patients were at the Vitamin D deficiency state and insufficiency state respectively. The mean serum vitamin D level was 17.89 ± 12.19 ng/mL. There was no significant association of vitamin D level with age, sex and duration of SLE patients. There was significant negative correlation between serum Vitamin D level and 24‐hour urinary protein (before the aggressive treatment) (r= ‐0.324, p value=0.002). There was significant negative correlation between vitamin D and mean difference of 24‐hours urinary protein (r=‐0.311, p value=0.007). After therapy, ESR dramatically dropped from 104.59 ± 21.31 to 33.84 ± 17.96 mm/1st hour. There was significant negative correlation between serum vitamin D level and initial ESR (r=‐0.335, p value=0.001). The serum complement C3 level of patients with SLE nephropathy became double after aggressive therapy. More than 70% responded to treatment in the vitamin D deficiency group and 5% in the vitamin D insufficiency group. There was positive correlation between serum vitamin D level and initial

 98  46th Myanmar Health Research Congress Abstracts of the papers (Day 5)

complement C3 (r=0.27, p value=0.009). There was significant positive correlation between vitamin D and complement C3 mean difference (r=0.312, p value=0.007). After aggressive therapy, SLEDAI score reduced to nearly one third of its initial score which reflected disease activity. There was significant negative correlation between serum vitamin D and SLEDAI (after the aggressive treatment) (r= ‐0.38, p value=0.001). Analyzing with ROC curve showed cut off level of 17.88 ng/mL can predict the treatment response with sensitivity of 72.7% and specificity of 66.7%. The area under the curve was 0.675 and p value was 0.027.

Morning Session (2), Auditorium (1) Paper-110

The role of technetium‐99m sulphur colloid liver‐spleen scintigraphy to detect hypersplenism in chronic liver disease patients with pancytopenia

Phyo Yadanar1, Win Mar2, War War Wann Maung2, Su Thet Oo3, Ko Ko Zaw4, Moh Moh Hlaing1 and Ohnmar Swe2

1Department of Medical Research 2Department of Nuclear Medicine, Yangon General Hospital 3Department of Nuclear Medicine, North Okkalapa General Hospital 4Department of Epidemiology, University of Public Health

Chronic liver disease (CLD) is a major cause of morbidity and mortality worldwide. One of the haematological manifestations in CLD is pancytopenia and it can be due to hypersplenism, megaloblasticanaemia and primary bone marrow suppression. Among them, hypersplenism is the most frequent and treatable cause of pancytopenia in chronic liver disease, and timely intervention can reduce patient morbidity and mortality to a great extent. Spleen to liver ratio by 99mTc‐sulphur colloid liver spleen scan correlate better with the hypersplenism, and can be assessed during routine liver scan. In CLD patients with hypersplenism, there is poor uptake in the liver and most of the colloid is taken up in the spleen and bone marrow. Spleen to liver ratio greater than 2:1 is considered evidence of colloid shift. In liver‐spleen scan, presence of sulphur colloid shift to the spleen would support hypersplenism as an etiology of pancytopenia. This hospital based descriptive study was conducted to study CLD patients with pancytopenia admitted to in‐patients wards and out‐patient clinics in Yangon General Hospital (Clinical Haematology) and Yangon Speciality Hospital (Liver Medical Unit). Study was carried out in 48 CLD patients presenting with pancytopenia within the period of one year, starting from November 2015 to October 2016. History taking, clinical examination, bone marrow examination and liver‐spleen scintigraphy using a gamma camera were done to all patients. This study showed that sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 99mTc‐Sulphur Colloid Liver/Spleen scintigraphy were 69%, 91%, 79%, 85% and 83% respectively for detection of hypersplenism in chronic liver disease patients. Thus, Liver‐Spleen scan can be applied as a better collaboration with bone marrow biopsy in the detection of hypersplenism. Therefore, Technetium‐99m Sulphur Colloid Liver/Spleen scintigraphy is a non‐invasive procedure and plays an important role as an adjunctive test in detecting hypersplenism for chronic liver disease with pancytopenia patients.

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ABSTRACTS OF THE POSTERS DISPLAYED 46th Myanmar Health Research Congress Abstracts of the Posters

Abstracts of the Posters

Poster ‐ 1 Performance of midwives on tuberculosis control activities in Mandalay Region, 2016

Kyaw Thu Soe1 and Ko Ko Htwe2

1Department of Medical Research 2Upper Myanmar TB Center

In Mandalay Region, there were 9,420 registered TB cases in 2015, and the region is one of the areas with high MDR‐TB cases in Myanmar. Out of 28 townships in Mandalay Region, 14 townships did not get treatment success rate (85%) in 2015. This study was conducted to evaluate the performance of midwives for tuberculosis control activities, and to explore challenges to conduct the activities. The pre‐tested self‐administered questionnaires were used as the assessment tool, and distributed to 255 midwives working at different public health facilities from six townships of the Region. Two focus group discussions with midwives were also done. The mean (SD) age of participants was 36 (10) years. Most of them (62%) were working at sub‐centers. Almost all (93%) of them had ever received trainings on TB control during their working years. Majority (86%) of them had received the manual for TB control activities for basic health staffs. One third of midwives had poor knowledge on tuberculosis. For TB control activities, 70% of midwives responded that they had performed all activities. However, 30% couldn’t make it. The most common activities they could perform were health education to the patients and communities (99%), referring presumptive TB patients (97%), and sputum collection (96%). Age, service years, and incentives for TB control activities were found to be statistically associated with performance of all TB control activities among midwives. Major challenges for them to perform TB control activities included being assigned with various health‐related activities for midwives, weak community engagement. NTP should urgently need to update the knowledge on TB for midwives and other basic health staffs, distribution of updated TB control manual for every one of them, review on important registers they are using.

Poster ‐ 2 Hair growth activity of Angiopteris evecta in rabbit

Myo Nanda Aung, Khin Phyu Phyu, Khine Khine Lwin, Mu Mu Sein Myint, Phyo Wai Zin, Zaw Myo Tint, Aye Win Oo, San San Myint and Aye Zarni

Department of Medical Research

One of the problems often experienced by humans is baldness or hair growth that is not normal. Angiopteris evecta (Say‐myin‐khwar) is one of the traditional indigenous medicinal plants which have many pharmacological properties. The aim of the study was to detect the

 103  Abstracts of the Posters 46th Myanmar Health Research Congress

skin irritation activity and to determine hair growth activity of the watery and ethanol extracts of Angiopteris evecta on rabbit. Six male albino rabbits were used as test animals. Each rabbit was sheared back and divided into four plots, one for negative control, one for standard 2% minixidol and the others two were tested extracts. Each plot has a size of 2 x 2 cm. One mL of different concentration of 10%, 20% and 40% watery and ethanol extracts was given 2 times per day consecutively for 18 days. Measurement of rabbit hair length was done on every 3 days. Five strands of hair were used to measure the length and average lengths of the five strands were calculated. The results of skin irritation showed that the irritation degree was categorized as negligible. Mean length of hair growth for negative control was 0.74 cm and that of standard 2% minoxidil was 1.5 cm. Mean length of hair growth at doses of 10%, 20% and 40% of watery extract were 0.82 cm, 1.28 cm and 1.4 cm, respectively. For ethanolic extract, mean length of hair growth for doses of 10%, 20% and 40% were 0.81 cm, 1.29 cm and 1.39 cm, respectively. The rabbit treated with watery and ethanolic extract of Angiopteris evecta (Say‐myin‐khwar) showed increased in hair length when compared with those of control group (p<0.01). Hair growth activity of 40% watery and 40% Ethanolic extract of Angiopteris evecta were compared with standard 2% minoxidil and there was statistically significant between the two test groups and standard group. Therefore, hair growth activity of watery and ethanol extract were as comparable with standard 2% minoxidil.

Poster ‐ 3 Contributions of auxiliary midwives in providing maternal health care services in Myanmar: Women’s and providers’ perspectives

Thida1, Tippawan Liabsuetrakul2, Kyaw Ko Ko Htet1 and Khaing Nwe Tin3

1Department of Medical Research 2Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Thailand 3Maternal and Reproductive Health Division, Department of Public Health

This study aimed to explore the maternal health care services received by the women from auxiliary midwife (AMW) and the consistency of different health care providers’ perspectives on the AMW’s contributions. A cross‐sectional study exploring maternal health care services provided in the community was conducted in three purposively selected townships of Mandalay, Magway and Bago regions of Myanmar during 2016. This report is part of that study and included 218 postpartum women who have received antenatal care (ANC) with the AMWs and 369 providers (health assistants/lady health visitors, midwives and AMWs). Cramer’s V was used to measure the strength of association and the consistency of the different health care providers’ perspectives. Sixty‐five percent of the women had ANC4+ and 36% initiated ANC within 12 weeks of pregnancy. Medical and obstetric history was asked for 92% and 90%, respectively. During the ANC visits, the services provided for at least four times were measuring body weight (23%), checking blood pressure (56%), and counseling on birth preparedness (49%). Women who were provided with blood for hemoglobin and urine for protein testing at least once were 63% and 37%, respectively. Sixty‐two percent of the women were provided with at least 3 months of iron/folate supplementations and 91% received at least two doses of tetanus toxoid

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immunization. Among 207 women whose last childbirths were assisted by the AMW, 98% said they received social supports during the labor pain and delivery, 78% and 74% had received injection (types and reasons of medication were not explored) during the labor pain and immediately after delivery, respectively, 89% received oral medications, and 88% were ensured of having no heavy bleeding after the delivery. The perspectives of the different providers on the AMW’s contributions of ANC and delivery care services were significantly different. However, consistent perspectives were found to be measuring body weight (40‐58%), blood testing for hemoglobin (14‐23%) for the ANC services, and giving injection during labor pain (29‐39%) and immediately after delivery (28‐39%). AMWs’ contribution in the maternal health care service provision was not negligible, but having supportive supervision is essential to help them being in line with the AMW guideline.

Poster ‐ 4 Carbonic anhydrase 9 (CA 9) level in renal cell carcinoma patients

Yin Min Htun1, Kyaw Zwa Hlaing2, Myo Thet Tin2, Win Maw Tun1, Kay Khine Soe1, San Yu Hlaing1, Myat Hnin Ei1 and Mya Ohnmar1

Department of Medical Research1 Yangon Specialty Hospital2

Renal cell carcinoma (RCC) accounts for over 2.5% of all cancers, 2% of cancer mortality and 95,000 deaths per year worldwide. Around 208,500 new cases of kidney cancer are diagnosed in the world each year. Carbonic anhydrase is a Von Hippel‐Linda‐hypoxia inducible factor target up regulated in clear cell RCC. Carbonic anhydrase 9 (CA9) is a protein maintaining intracellular and extracellular pH‐reportedly also influences regulation of cell proliferation, oncogenesis, and tumor progression. This study was a cross‐sectional, descriptive, hospital and laboratory based collaborative study including forty clinically diagnosed renal cell carcinoma who were going to undergo operation attending at Urosurgical ward, Yangon Specialty Hospital. The aim of this study was to determine CA 9 level in renal cell carcinoma patients and to correlate CA 9 level with different histological types and grades. After getting informed consent, half teaspoonful (2mL) of venous blood were collected before operation. These samples were sent to Quality Control Division, Department of Medical Research and CA 9 level was measured by ELISA test kit (Enzyme Linked Immunosorbant assay). Among forty patients, thirty six cases were renal cell carcinoma cases and found between 25‐77 years of age with male: female ratio was 3:1. The right and left kidney involvement was 1:1 and the histological types were clear cell, papillary and chromophobe types, 32, 3, and 1 respectively. Clear cell carcinoma is the commonest histological type and the mean CA 9 level was 32 pg/mL. The mean CA 9 level in higher and lower grade of renal cell carcinoma were not different. The mean CA 9 level in higher stage was 40 pg/mL and the lower stage, 16.3 pg/mL. Therefore CA 9 is regarded as one of the most prominent markers of tumor hypoxia with potential to serve as a prognostic indicator and its status may potentially aid in the selection of patients who might benefit from CA 9‐ targeted therapies.

 105  Abstracts of the Posters 46th Myanmar Health Research Congress

Poster ‐ 5 Prevalence of low back pain in Yay‐Ka‐Moe RHC

Myo Tint Tun, Khin Thuzar Myaing, Thazin Myint and Tin Tin Soe

Department of Physiotherapy, University of Medical Technology, Mandalay

The aim of this study is to study the prevalence of low back pain in Yay‐Ka‐Moe RHC. The objectives are to describe the demographic background of the participants with back pain, to determine the prevalence of back pain in Yay‐Ka‐Moe RHC and to determine the occupation, habits, ADL and leisure activities of the participants with back pain. In a descriptive clinical trial all participants were explained about the present study and taken informed consent form. Data was collected according to pro forma. We visited to Yay‐Ka‐Moe RHC, Ta‐Dar‐Oo township about 14 times to collect the data. There are nearly about 3,500 population. We collected the data 2 times in each sub‐center. We found that the prevalence of low back pain is 1.4% in Yay‐Ka‐Moe RHC. The result showed that the effected aged group was over 40 years and females were more affected than males. In these females, menopausal females were affected in LBP concerned with occupation such as farmers and housekeepers. Among them, it had higher LBP prevalence compared to other occupations. Regarding with the ADL, washing, cleaning and housekeeping activities were more associated with LBP. According to leisure activities, mostly people who always watch TV/Video for > 45 min. Whose habit like gossiping while walking long distance or prolong sitting were associated with more back pain. In conclusion, in this study, the female participants with over the 40 years are more significant LBP in any other age groups. People with primary school level and middle school level education have higher LBP and they are the most farmers and housekeepers. This study shows that housekeeping activities in ADL, watching TV/Video (>45 min) in leisure activities and walking long distance and prolong sitting for gossiping in their habit are the most significant factors for having LBP in rural area.

Poster ‐ 6 Barriers to generating reliable mortality statistics from the vital registration system in Myanmar: A qualitative assessment in two townships

Myitzu Tin Oung1, Kerry Richter2, Pramote Prasartkul2, Yadanar Aung1, Kyaw Thu Soe1, Thuzar Chit Tin3 and Viroj Tangcharoensathien4

1Department of Medical Research 2Institute for Population and Social Research, Mahidol University 3Department of Public Health 4International Health Policy Program Foundation, Thailand

Reliable mortality indicators can be generated from a well‐functioning vital registration system which is universally recognized as the main source of mortality statistics. A recent assessment of the ability of vital registration systems to generate reliable mortality data

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showed poor performance of the death registration in Myanmar, suggesting the need for further investigation. This study was conducted in 2015‐16 to identify barriers to generating reliable mortality statistics from the vital registration system using a qualitative approach. The information was obtained by reviewing relevant documents and conducting 16 key informant interviews and 14 focus group discussions with those who were involved in death registration process at the operational level, such as healthcare providers, knowledgeable adults in the households and local administrators. The study was conducted in two purposively selected townships of Mandalay Region, i.e. Myitthar and Myingyan. Like many other developing countries, the death registration system in Myanmar has many weaknesses in the areas of administration (i.e. lack of specific and adequate laws for vital registration, no formal notification process for deaths occurred in the community, lack of a systematic linkage among partner organizations, limited usage of death certificates), technical efficiency (i.e. absence of proper and regular on‐the‐job trainings on death registration and cause‐of‐death certification, lack of adequate knowledge related to death registration procedures and lack of awareness of the importance of accuracy of data items among healthcare providers, ineffective cause‐of‐death certification practice for deaths occurred in the community and no routine data plausibility check at the local level) and public awareness and cooperation (i.e. poor community awareness and participation in death registration process). The findings highlight the areas of problems in the death registration, which needs improvement. In response to monitoring mortalities as mandated by the Sustainable Development Goals, formulating strategies for strengthening the vital registration system in Myanmar is recommended.

Poster ‐ 7 Treatment seeking behaviours and compliance of treatment in diabetes patients living in rural area

Nyi Nyi Zayar1, Ko Ko Zaw2, Ko Ko3, Myint Shwe4, Phyo Aung Naing1, Win Marlar Kyin5, Kyi Kyi Mar1 and Tin Tin Wai1

1Department of Medical Research 2University of Public Health 3Department of Medicine, North Okkalapa General Hospital 4Non‐communicable Diseases Control Division, Department of Public Health 5Department of Food and Drug Administration

Diabetes Mellitus (DM) is an important health problem. Persons with DM need long term follow up and control. In 2014, the prevalence of DM was 8.8% in the world and 10.5% in Myanmar. The study aimed to determine the treatment seeking behavior and compliance of treatment in DM patients living in rural area. A cross sectional study was done in Thanatpin Township, Bago Region in 2016. A total of 288 reported diabetes patients were interviewed with structured questionnaire and their glycosylated hemoglobin (HbA1c) was measured. Among them, (18%, 51/288) were male and (82%, 237/288) were female. Mean age of respondents was 55.5 ± 10.2 years old with range of 28 to 84 years old. Only (41%, 118/288) of respondents sought care for DM in government health centers, mostly (45%, 53/118) in rural health centers (RHC), (29%, 34/118) in township hospitals and about (14%, 17/118) in  107  Abstracts of the Posters 46th Myanmar Health Research Congress

sub‐centers and station hospitals. Major reasons for choosing government health facilities were closeness to respondents’ home (49%, 58/118) and recommendation by others (24%, 28/118). Among (59%, 170/288) respondents who sought care in private health facilities, (89%, 152/170) visited private clinics and (8%, 13/170) received care from quacks. Major reasons were recommendation by others (37%, 63/170) and trust in health facility (33%, 56/170). However, (37%, 44/118) respondents from government health centers did not continue follow up in those facilities because of relief of symptoms (16%, 7/44). And (41%, 69/170) from private health facilities discontinued follow up because of expensiveness of seeking care (20%, 14/69) followed by relief of symptoms (13%, 9/69). Almost half of all respondents (46.5%, 134/286) had not managed their diet to control diabetes and only (48%, 138/288) strictly followed the providers’ instruction of taking medicine regularly. Only (12%, 33/288) of respondents achieved the recommended goal of HbA1c level (<7%) which was significantly lower than 50% compliance to treatment in developed countries. In conclusion, it is important to provide proper health education and counselling by health care person for diabetic care and regular follow up. DM care and management services in both government and private health facilities should be integrated to achieve quality care.

Poster ‐ 8

Detection of aflatoxin B1 contents in some Myanmar beans at Yangon wet markets

Myat Mon Oo, Hnin Nu Htwe, Mya Thanda Win, Kay Thwe Win, Khin Zar Chi Aung, Kyaw Soe, Min Min Win, Khin Kant Kaw Oo and Moh Moh Htun

Department of Medical Research

The aflatoxins are a group of secondary metabolites produced by Aspergillus flavus and Aspergillus parasiticus. Aflatoxin B1 (AFB1) is the most toxic compound of this group which is more commonly found in traditional of Myanmar food. Aflatoxins may be present in a wide range of food commodities, particularly cereals, oilseeds, spices and tree nuts. The aim of this study was to determine of the contents of AFB1 levels in some beans in Myanmar by TM using commercially available AFB1 ELISA Test Kit (REAGEN ). A cross‐sectional descriptive study was carried out in total 40 beans samples including each eight samples of groundnut (ajryJ), chick‐pea (ukvm;yJ), lentil red (yJeDav;), lentil yellow (yJ0gav;) and pigeon pea (yJpif;iHk) from Yangon wet markets in Myanmar. This study showed that all samples had the contents of AFB1. The mean AFB1 contents were 7.06 ppb, 7.03 ppb, 6.56 ppb, 6.10 ppb and 4.9 ppb, in ground nut (ajryJ), chick‐pea (ukvm;yJ), lentil red (yJeDav;), lentil yellow (yJ0gav;) and pigeon pea (yJpif;iHk), respectively. AFB1 levels were slightly increased in groundnut (ajryJ), chick‐pea (ukvm;yJ), lentil red (yJeDav;), lentil yellow (yJ0gav;) than the permissible level of 5 ppb according to the Scientific Commission of the European Community. Pigeon pea (yJpif;iHk) was 4.9 ppb less than 5 ppb (references). Aflatoxin levels were required for human consumption to contain less than 15 ppb of aflatoxin in food is the legal standard in Australia (Australia and New Zealand Food Authority. ANZFA). Among each eight samples tested, 2 (25%) in groundnut (ajryJ) and chick‐pea (ukvm;yJ), 1 (12.5%) in lentil red (yJeDav;) and lentil yellow (yJ0gav;) contained AFB1 more than 15 ppb but pigeon pea (yJpif;iHk) did not contain AFB1. In

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food safety point of view, chronic toxicity might be very important even in the developed countries. AFB1 is a very potent carcinogen and mutagen in many animals and humans, and the liver is the main target organ. Aflatoxin is one of the causes that increase the risk of liver disease.

Poster ‐ 9 Challenges for general practitioners providing healthcare to gender based violence survivors

Su Su Yin1, Hnin Shwe Zin Hlaing2 and Su Sandy2

1Department of Medical Research 2Population Services International

Studies from different countries showed that the percentage of women 15 to 49 years old who have experienced physical or sexual violence and experienced both by their intimate partner in their live times ranges from 15% to 71%. Lifetime prevalence of physical and/or sexual intimate partner violence among ever‐partnered women is 37.7% in Southeast Asia. Incidence of gender‐based violence is markedly increased in both urban area and rural area in Myanmar. In Myanmar, there were tangible and intangible obstacles and challenges for survivors to get health services and to inform the Gender Based Violence (GBV) for justice. Similarly, there were many limitations and challenges for general practitioners to provide quality health services and social assistants for GBV survivors. To explore the limitations and challenges for general practitioners to provide quality health services and social assistants for GBV survivors, qualitative methodology was conducted in year 2016. Twenty general practitioners from Mandalay Region were recruited. Three focus group discussions were conducted. Six to seven participants were involved in each discussion. Among twenty participants, seven of them had over 20 years of experienced in general practitioners, five GPs had over 10 years and rests of them were under 10 years. Participants discussed the opportunities to overcome the limitations and challenges for gender justice. Almost all general practitioners had experiences with providing healthcare to the patients who had signs and symptoms of gender‐based violence. The discussion between general practitioners and clients on gender‐based violence is still limited under the social norms to be defined as gender‐based‐violence especially for the married couples. The question that exists all the time in the discussion was how to define it in the thin lines when happens to the youth, those who practice living together and report as GVB at the clinic. General practitioners used to feel interpersonal conflicts between safety of survivors and respects to dignity and choice of survivors. Two of participants shared their experiences that survivors did not complaint about gender‐based violence but they complained for accident. Participants discussed the opportunities to overcome the limitations and challenges for gender justice.

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Poster ‐ 10 Tobacco use and second‐hand smoke exposure among married men and women of rural areas in Myanmar: Perceptions and practices

Kyaw Lwin Show1, Aung Pyae Phyo1, Saw Saw1, Ko Ko Zaw2, Thuzar Chit Tin3, Nyein Aye Tun3 and Khin Thet Wai1

1Department of Medical Research 2University of Public Health 3Department of Public Health

Tobacco use during pregnancy is recognized as the most important modifiable risk factor to prevent pregnancy complications and unfavorable fetal outcomes. In Myanmar, the prevalence of tobacco use is estimated as 27% in rural areas of Yangon Region in 2014. This study aims to explore the perceived risk of pregnancy complications and unfavorable fetal outcomes due to tobacco use (smoked tobacco, smokeless tobacco, and second‐hand tobacco smoke) and practices among married people of rural areas. A cross‐sectional study was conducted among married people from 32 villages of Kyaunggon and Lemyethna Townships in Ayeyawady Region in 2016. Face‐to‐face interviews by using pre‐tested structured questionnaire with currently married men (n=301) and married women of reproductive age (n=316) in selected households were done. Bivariate and multivariable analysis using binary logistic regression were done to ascertain the explanatory variables for both smoking and smokeless tobacco use. Mean age of married men and women were 36.3±8.4 years and 35±7.3 years respectively. Around 65% to 86% of men and 71% to 90% of women expressed perceived risks of smoking on miscarriages and fetal outcomes. Around 60% to 80% of married men and married women had perceived risks of second‐hand smoke on miscarriages and fetal outcomes. Moreover, between 53% and 73% of married women perceived the risks on miscarriages and fetal outcomes when they used smokeless tobacco. Among married women of reproductive age, 3.8% were current smokers and 23.4% were currently using smokeless tobacco. One in five respondents was a current smoker and cheroot was the major type. Smoking practice was significantly common among married men (aOR=12.9, 95% CI: 6.5‐25.8) and who lacked knowledge on the risk of smoking on miscarriages and fetal outcomes (aOR=1.94, 95% CI: 1.2‐3.1). A majority of current smokers (85.2%) smoked at home and 16.4% reported that there was a pregnant woman in their smoking area. Nearly half of the respondents were currently using smokeless tobacco and it was significant in married males(aOR=8, 95% CI: 5.3‐12.1).This study highlighted to develop behavior change intervention to reduce practice of smoking especially for married men in order to prevent unfavorable fetal outcomes due to second‐hand smoke exposure.

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Poster ‐ 11 Effect of deworming measure for pin worm (Syphacia spp:) control in laboratory rats (Rattus norvegicus)

Aye Win Oo, Maung Maung Mya, Than Myat Htay, Than Than Swe, Khin Hnin Yee, Mya Mya Sein, Kay Thwe Han and Win Maw Tun

Department of Medical Research

Rodents, as mice and rats are the most common laboratory animals used in research and testing. The parasite infections can affect investigations by inducing physiological and immunological alterations in the hosts. Several nematodes have been reported from the rat and mouse. In the mouse and rat caecum and colon, Aspicularis tetraptera may be found together with Syphacia muris or obvelata. The prevalence of helminthiasis was higher in mice (28.57%) than rats (7.14%) in Ethiopian study. Internal and external parasites remain a significant concern in laboratory rodent facilities, and many research facilities harbor some parasitized animals. Two qualitative parasitological methods for the diagnosis of Syphacia muris infection in laboratory rats (Rattus norvegicus) infected naturally, methods of spontaneous flotation (Willis) for faecal samples and a method of taping (Graham) were performed and compared. The Graham method was the most efficient of those tested in this study for detection of S. muris infection in rats. In this experimental study, two deworming drugs (albendazole and prazivet) were applied. Total 60 rats (30 males and 30 females) were divided into three groups each consisted 10 males and 10 females. Out of three groups, two groups were dewormed by oral administration of 10 mg/kg/day for 10 days with either albendazole or prazivet while one group was kept as negative control. After deworming, two deworming groups of rats showed parasites negative condition by rechecking detection. Due to detect parasite eggs on all groups of the rat weekly, re‐ infection incidence was occurred in 12 weeks later. It was found out to internal parasites control schedule with deworming drug in laboratory rats’ colonies of DMR every three months.

Poster ‐ 12 Way forward for Methadone Maintenance Treatment (MMT) Program: looking at a glance at a high burden area

Nanda Myo Aung Wan1, Kyaw Lwin Show2, Yin Thet Nu Oo2, Le Le Win2 and Kyaw Thu Hein2

1Drug Dependency Treatment and Research Unit, National Drug Abuse Prevention and Control Program 2Department of Medical Research

Prevalence of HIV/AIDS among people who inject drugs (PWID) is highest compared to other key populations. Methadone maintenance treatment (MMT) is one of the strategies of harm

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reduction to lessen the problem. There are 51 MMT clinics in Myanmar covering more than 13,000 drug users. This study aimed to determine the profile of current MMT users including proportion of PWID, prevalence of major blood‐borne viral infections, and to explore challenges from service providers’ perspective. This cross‐sectional study was conducted with 153 patients receiving MMT at methadone clinic, in Tachileik, eastern Shan State during September, 2017. Record review on MMT register, daily dispensing record, information card and monthly report, and in‐depth interviews (IDI) with service providers from public sector and NGO were conducted. Quantitative data and IDI findings were analyzed using descriptive analysis and thematic analysis and triangulated. Mean age of enrolled MMT patients was 38.75±11 years and 93.5% were males. There were 8 new enrollments with starting dose of 30mg. Mean MMT dose was 51.8±21.2 mg per day with median duration of 18 months. Drop out proportion among current MMT users was 7.8%. Nearly half of clients (47.1%) were PWIDs, and majority were referred from Myanmar Anti‐ Narcotics Association (MANA). Prevalence of major blood‐borne infections among current MMT patients were HIV (6.5%), HCV (4.6%) and HBV (0.7%). Among HIV patients, 70% (7/10) were taking Anti‐Retroviral Treatment with median duration of 9 months. IDI findings revealed that methadone program had a good coordination with NAP and local MANA. Responsible staff for MMT were taking dual duties at methadone clinic and general hospital. Nurses were rotated three monthly for providing supervised dose including weekends, however, they received little guidance for recording and record keeping. MANA assisted in recording and reporting to some extent. In conclusion, methadone program has been functioning with some limitations‐absence of permanent staff and lack of proper training on recording and record keeping. Since the magnitude of PWIDs taking methadone was increasing over the years and the program is planning to expand the methadone sites in high burden areas across the country, it is time to strengthen the program to enhance effective service delivery.

Poster ‐ 13 Intestinal parasitic contamination of selected raw leafy vegetables form open‐aired market and supermarket of Thingangyun Township

Khine Wah Kyaw, Win Win Maw and Hninzi

Department of Microbiology, University of Medicine 2, Yangon

There has been an increase in the number of food‐borne illness related to fresh vegetables. The consumption of raw vegetables and undercooking to retain the natural taste and preserve heat‐labile nutrients can increase the risk of food‐borne transmission of intestinal parasites. This study aimed to determine the prevalence and frequency distribution of intestinal parasitic contamination in selected raw leafy vegetables. A total 100 samples of five different kinds of raw leafy vegetables were collected randomly from open‐aired market and supermarket of Thingangyun Township and examined for intestinal parasitic contamination from January to October, 2017 in University of Medicine (2), Yangon. Sixty two percent (62%) of vegetable samples were detected for egg, larvae, trophozoites, cysts and oocysts of intestinal parasitic contamination. Among them, 23% of total samples were contaminated with more than one parasite. So, total 91 parasites were detected. The most

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predominant parasite encountered was Chilomastix mesnili (27.5%), followed by Giardia intestinalis (20.9%), Entamoeba histolytica (15.4%), Ascaris lumbricoides (12%), Cryptosporidium parvum (6.6%), Balantidium coli (4.4%), helminth larvae (4.4%), Cyclospora cayetanensis (2.2%), Trichuris trichiura (2.2%), hookworm (2.2%), Clonorchis sinensis, (1.1%) and (1.1%) of vegetable was found to be contaminated with Entamoeba coli. Out of 20 samples each, highest parasitic contamination was recorded in 16 water spinach samples (80%), followed by 15 basil and cabbage samples (75%) each and 9 Chinese cabbage samples (45%), while leek was least contaminated with 7 samples (35%). Most of the vegetables were contaminated with few or rare parasitic load of different parasites except Chilomastix mesnili which contaminated moderate to high density. The overall result highlights the potential of raw vegetables serving as major sources of intestinal parasitic infections.

Poster ‐ 14 Genome analysis of infectious agents by using next generation sequencing in the Department of Medical Research

Kay Thi Aye, Aung Zaw Latt, Nyi Nyi Win, Myat Htut Nyunt, Hnin Ohnmar Soe, Hsu Htet Thwe, Wah Wah Aung, Hlaing Myat Thu and Kyaw Zin Thant

Department of Medical Research

Globally, infectious diseases represent the greatest cause of death and burden of disease. Sequencing tools, bioinformatics and information technologies provide to enable faster and more effective infectious disease prevention and control. Sequencing the entire microbial genome is important for generating accurate reference genomes, for microbial identification and other comparative genomic studies. Next Generation Sequencing (NGS), one of the latest advanced molecular techniques, is currently the method of choice for whole genome sequencing of infectious agents; bacteria, viruses and parasites. Recently, NGS technology was established in the Department of Medical Research. DNA samples from Mycobacterium tuberculosis cultures, cDNA of Dengue virus, recombinant DNA of Hepatitis B virus and Rabies virus were extracted. NGS was performed using Illumina Miseq (Illumina, San Diego, CA, USA) with the workflow including: i) library preparation by random fragmentation of the DNA sample, followed by adapter ligation; ii) cluster generation by loading the library into a flow‐cell, followed by amplification of each fragment of the library into distinct clonal clusters; iii) sequencing by a reversible terminator‐based method that detects the single base as they are incorporated into DNA template strands; iv) data analysis and alignment of the newly identified sequence reads to a reference genome. Following alignment, a variety of analysis was performed, such as single nucleotide polymorphism (SNP) or insertion‐deletion identification, phylogenetic analysis. The resulting whole genome sequences will act as baseline data for further exploring in‐depth genetic studies in Myanmar. As NGS can provide valuable information on outbreak investigations, clinical diagnostics and therapeutics, drug resistance, virulence determinants, and genome evolution, the established NGS technology can be a useful tool for research and clinical applications of communicable as well as non‐communicable diseases.

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Poster ‐ 15 Detection of human influenza virus infection with rapid diagnostic testing

Moe Kyaw Myint1, Saw Myat Thwe1, Nay Lin2, Aung Kyaw Soe3, Win Htay Hlaing1 and Yi Yi Myint4

1Department of Medical Research 2Department of Medical Services 3Department of Public Health 4Department of Traditional Medicine

Human influenza or flu is caused by influenza virus type A, B and C. It cannot be diagnosed by clinical confirmation alone because its illnesses may be similar to other infections. Rapid influenza diagnostic testing (RIDT) of antigen can provide more accurate detection. A descriptive study was done in a clinic of Pyin Oo Lwin Township to find out human influenza virus infection with rapid diagnostic testing from July 2014 to December 2015. The patients who attended at clinic with influenza like illness were included in the study and their nasal swabs were taken and tested with RIDT (Quick Navi‐Flu rapid test, Japan). Among the total 1380 participants, male were 750 (54.3%) and female were 630 (45.7%). Mean age (±SD) was 24.3 (±18.2) in year. The youngest was one and the oldest was 82 years old. Mean body temperature (±SD) in Celsius was 38.4 (±0.8). Mean duration of onset of clinical symptoms of influenza was 2.0 (±1.2) in days. Fever, cough, runny nose, muscle pain, joint pain, head ache and diarrhea were observed in 1303 (94.3%), 1310 (94.9%), 1132 (82.0%), 531 (38.5%), 869 (63.0%), 689 (49.9%) and 41 (3.0%), respectively. According to results of rapid diagnostic testing, influenza type A and type B were detected in 261 (18.9%) and 94 (6.8%) participants, respectively. Moreover, type A or type B positive cases (n=351) were significantly observed in the months from June to November of both years than other months (p=0.001). Therefore, human influenza infection is common in rainy season in the study area and rapid influenza diagnostic testing is useful in diagnosis and treatment decision if the clinical features are provided by the patients. It was also recommended that more detailed diagnosis with Polymerase Chain Reaction should be used to detect serious kind of human influenza infection.

Poster ‐ 16 Bacterial contamination of freshly prepared fruit juices from street vendors

Tin Tin Htwe, Mo Mo Win, Thin Thin Wah, Kyi Kyi Nyein Win, Su Nyein Aye, May Than Htay, Wai Lwin Oo and Kyaw Kyaw San

Department of Medical Research

The study of bacterial contamination of freshly prepared fruit juices was conducted from November 2016 to October 2017. This study aimed to determine the bacterial contamination of freshly prepared fruit juices collected from some street vendor shops.

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Fruit juices can be contaminated by pathogens at any stage of preparation. In this study, a total of 60 samples (20 samples each of three kinds of fruit juices such as papaya juice, pineapple juice and water melon juice)were collected from different sources of some street vendor shops. Detection of bacterial contamination was done by standard microbiological guideline according to Andrew’s manual of food quality control 4.Rev.1. Microbiological analysis and 15 samples (25%) were found to be contaminated by bacterial pathogens. The bacterial pathogens isolated were Staphylococcus aureus (46.7%), Pseudomonas spp (20%), Escherichia coli (20%), Salmonella spp (6.7%) and Vibrio spp (6.7%).The highest contamination was observed in papaya juice (8/15), pineapple juice (4/15) and watermelon juice (3/15). Among 8 isolates of Gram negative bacilli, 4 isolates were resistant to amoxicillin‐clavulanic acid (4/8, 50%), 4 isolates were resistant to ceftriaxone (4/8, 50%), 2 isolates were resistant to doxycycline (2/8, 25%), 1 isolates was resistant to gentamicin (1/8, 12.5%) and 1 isolates was resistant to co‐trimoxazole (1/8, 12.5%). Among 7 isolates of Staphylococcus aureus, 3 isolates were resistant to amoxicillin‐clavulanic acid (3/7, 42%), 3 isolates were resistant to doxycycline (3/7, 42%), 2 isolates were resistant to gentamicin (2/7, 39%) and 1 isolate was resistant to ceftriaxone (1/7, 14.2%). All the isolates are sensitive to cefoperazone–sulbactum and ciprofloxacin. The contamination can be reduced by washing of utensils, using clean water and ice, good personal and domestic hygiene, peeling of fruits with washed hand, covering of fruits and utensils from air borne contamination. This study provided the information regarding contamination of various juices by bacteria which can cause food poisoning. Thus regular monitoring of the quality of fruit juices should be introduced to avoid any future bacterial pathogen contamination.

Poster ‐ 17 Immunohistochemical expression of MMP‐2 and MMP‐9 in oral squamous cell carcinoma

Sann Win¹, Moe Thida Htwe² and Zaw Moe Thein¹

¹Department of Oral Medicine, University of Dental Medicine, Yangon ²Department of Oral Medicine, University of Dental Medicine, Mandalay

Most mortality in oral squamous cell carcinoma (OSCC) patients is due to local recurrence and regional metastasis following the surgical treatment failure at the primary site. Valuable markers associated with biological aggressiveness of the tumour are needed to predict the outcome of the disease. The aim of this study was to evaluate immunohistochemical expression of MMP ‐2 (Matrix metalloproteinase‐2) and MMP‐9 (Matrix metalloproteinase‐ 9) in OSCC. The study consists of 33 histological proven OSCC cases in each one involving the one clear surgical margin without tumour invasion and one malignant portion. A statistically significant correlation was observed between the MMP‐2 expression in surgical margin with both MMP‐2 and MMP‐9 expression in malignant portion (p = 0.0001 and p = 0.001 respectively). A statistically significant correlation between the MMP‐9 expression in surgical margin with MMP‐2 expression and MMP‐9 expression in malignant portion were also observed (p = 0.002 and p = 0.048 respectively). Both MMP‐2 and MMP‐9 expressions in surgical margin were related with MMP‐2 and MMP‐9 expression in malignant portion. These findings indicated the high expression of both MMP‐2 and MMP‐9 in surgical margin  115  Abstracts of the Posters 46th Myanmar Health Research Congress

was indicator of the highly tumorigenic potential as well as the increased potential for recurrence even in histological negative features. Therefore this research implied that analysis of MMP‐2 and MMP‐9 expressions must have a predictive value for the actual recurrence or potentially recurrence.

Poster ‐ 18 Reproductive health communication and behaviours among university students in Yangon Region

Nyein Su Aye1, Ko Ko Zaw2, Phyo Aung Naing1, Hnin Hnin Lwin 3, Tin Tin Wai1 and Zin Mar Aye1

1Department of Medical Research 2University of Public Health 3Department of Public Health

University students are the great potential resources and being youth, they face with many challenges including sexual behaviours change as globalization occurs. A cross‐sectional descriptive study was done by using structured pre‐tested, self‐administered questionnaires for unmarried 460 students in Dagon University, University of West Yangon and Yangon University of Foreign Languages to identify their reproductive health (RH) communication and behaviours. Among the participants, (170/460, 37%) were male and (290/460, 63%) were female with the mean age of 18.78 ± 1.01 years. In concerning with RH communication within previous six months, respondents were discussed about menstruation (272/460, 59%), sexuality (189/460, 41%), sexually transmitted infections including HIV/AIDS (161/460, 35%), contraception (108/460, 23%) and abortion (74/460, 16%). Although their credibility was low, (98/161, 21%) to (146/189, 77%) of respondents discussed about these issues with their friends. Health care persons were indicated as the most reliable person for discussion, however, most of the participants obtained RH information mainly from the internet ranged from (201/272, 44%) to (153/189, 81%). About (75/460, 16%) of the participants including (23/460, 14%) of male and (52/460, 18%) of female knew four out of ten contraceptive measures. Mostly known contraceptive measure was three‐month depo injection (303/460, 65%) followed by sterilization (293/460, 64%) and condom (280/460, 61%)by both sexes. About (223/460, 49%) of students considered that using condom is the most suitable contraceptive method for youth. Nearly (273/460, 60%) of both sexes had moderate RH knowledge score including pubertal changes of adolescent. About (68/460, 45%) sought RH services from general practitioners followed by health centers (42/460, 28%). Nearly (49/460, 11%) experienced sexual intercourse including (33/49, 19%) of male and (16/49, 6%) of female. Among the sexual exposure group, (32/49, 97%) of male and all female students used contraception. Mostly used contraceptive measure was condom mentioned by male (18/33, 54%) and emergency contraceptive pills by female (7/16, 44%). In conclusion, it is vital to strengthen RH information, education and communication services to university students by health care persons for awareness raising and thereby promoting adolescent reproductive health.

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Poster ‐ 19 Expression of inflammatory markers and glutamic acid decarboxylase level in a rat model of valproic acid induced autism

Tin Tin Win Shwe1, Motoki Imai2, Nay Chi Nway3, Thet Thet Lwin2, Ohn Mar3 and Hidehiro Watanabe1

1National Institute for Environmental Studies, Tsukuba, Japan 2Graduate School of Medical Sciences, Kitasato University, Sagamihara, Japan 3University of Medicine 1, Yangon

Autism is a complex neurodevelopmental disorder characterized by impaired social communication and social interactions, and repetitive behaviors. The etiology of autism remains unknown and its molecular basis is not yet well understood. This study aimed to examine the social behaviors and expressions of inflammatory cytokines and gamma amino butyric acid (GABA) synthetic enzymes in the hippocampi of a rat model of valproic acid (VPA)‐induced autism. Pregnant Sprague‐Dawley (SD) rats were administered 600 mg/kg of VPA by intraperitoneal injection on day 12.5 of gestation. Then, 11‐ to 13‐week‐old male and female offspring were subjected to the 3‐chamber social behavior test and preference for social novelty tests. After these behavioral tests, the rats were sacrificed and hippocampi were collected for examining the expression level of proinflammatory cytokines by real‐time RT‐PCR assay. We also investigated the hippocampal expression levels of the rate limiting enzyme, glutamic acid decarboxylase (GAD65 and GAD67), which is responsible for conversion of glutamate to GABA in the brain under normal physiological conditions, was investigated by western blot analysis. Both the male and female rat models of VPA‐induced autism showed impaired sociability and impaired preference for social novelty as compared to the corresponding control SD rats. Significantly increased expression levels of proinflammatory cytokines, such as interleukin‐1 β and tumor necrosis factor‐α were noted in the hippocampi of both the male and female rats exposed to VPA in utero. The hippocampal expression level of GAD 67 protein was reduced in both male and female VPA‐ exposed rats, while that of GAD65 was reduced only in the male model, as compared to the levels in the corresponding control animals. This findings indicate that developmental exposure to VPA affects the social behavior by modulating the inflammatory mediators in the hippocampus. GAD deficiency may be associated with abnormalities in the levels of glutamate/GABA balance in the autistic brain. This animal model would be helpful to study neurodevelopmental alterations induced by exposure to environmental chemicals.

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Poster ‐ 20 Effects of intermediate frequency magnetic field exposure on apoptotic and inflammatory genes in brain of young adult male mice

Tin Tin Win Shwe1, Shin Ohtani2, Naoki Kunugita3 and Akira Ushiyama 3

1National Institute for Environmental Studies, Tsukuba, Ibaraki, Japan 2Meiji Pharmaceutical University, Kiyose, Tokyo, Japan 3 National Institute of Public Health, Wako City, Saitama, Japan

Experimental evidence has indicated that there is a positive correlation between magnetic field exposure and an increased risk of cancer and neurological disorders. Major source of intermediate frequency magnetic fields (IF‐MF) includes induction heating (IH) cookers, inductively coupled power transmission for industrial material handling machines or home appliances, and a variety of wireless communication systems, magnetic resonance imaging machines, induction heaters, and welding machines. Previously, we have reported that developmental period (gestational and adolescent) exposure to 21‐kHz sinusoidal IF‐MF reversibly affect memory function‐related gene expressions in adult mice. However, the effects of IF‐MF on neuronal apoptosis is not clear yet. In the present study, we investigated the effect of IF‐MF exposure during adolescence on apoptotic and inflammatory genes in the hippocampus of 7‐week‐old male mice. C57BL/6J mice were purchased from Japan SLC Inc. (Shizuoka, Japan). Four week old C57BL/6J male mice were allotted into 5 groups such as control, sham, low dose IF‐MF(21 kHz, 1.9 mT), high dose IF‐MF (3.8 mT), high dose IF‐MF with 5 days recover groups and exposed for one hour per day, 5 days a week for two weeks in the whole body exposure chambers. Twenty‐four hour after last exposure, at the age of 7‐week‐old, the hippocampus from the each mouse was collected to detect the expression level of apoptotic and inflammatory genes using a real‐time RT‐PCR method. The hippocampal expression levels of pro‐apoptotic gene Bax [B‐cell lymphoma(Bcl)‐2like protein 4] and anti‐apoptotic gene Bcl‐2 ratio (Bax/Bcl2) and tumor suppressor gene p53as well as inflammatory mediator cyclooxygenase (COX)‐2, and brain immune cell microglia marker ionized calcium‐binding adapter molecule (Iba)‐1 were significantly up‐regulated in the high‐dose IF‐MF‐exposed mice compared with the control group. The findings of this study indicate that exposure to high‐dose IF‐MF during adolescence period induces apoptosis as well as neuroinflammation in the hippocampus of young adult mice.

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Poster ‐ 21 Developmental exposure to diesel exhaust origin secondary organic aerosol and role of TLR4 in olfactory‐based spatial learning activity of neonatal mice

Nay Chi Nway1, Yuji Fujitani2, Ohn Mar1, Seishiro Hirano2 and Tin Tin Win Shwe2

1University of Medicine 1, Yangon 2National Institute for Environmental Studies, Tsukuba, Japan

Exposure to ambient air pollutants has been reported to have various adverse health impacts. Ambient particulate matter comprises primary particles released directly via engine exhaust and secondary organic aerosols (SOAs) formed from oxidative reactions of the ultrafine particle fraction of diesel exhaust (DE). Toll‐like receptor 4 (TLR4) is well known to initiate the inflammatory cascade in the central nervous system. However, whether and how DE and DE‐SOA exposure influences TLR4 signaling in the immature brain remains unclear. We attempted to evaluate the roles of TLR‐4, inflammatory mediators and microglial markers in the impaired spatial learning ability of neonatal mice exposed to DE and DE‐SOAs. Pregnant C3H/HeN (TLR4‐intact) and C3H/HeJ (TLR4‐ mutated) mice were exposed to clean air, DE or DE‐SOA from gestational day 14 to postnatal day (PND) 10 (5 hr/day for 5 days) in exposure chambers. PND11 neonatal mice were examined for their performance in the olfactory‐based spatial learning test. After the spatial learning test, the hippocampi of the mice were removed and real‐time RT‐PCR analysis was performed to examine the neurological and immunological markers. Both male and female C3H/HeN and C3H/HeJ neonatal mice exposed to DE and DE‐SOAs showed poor performance in the test phase of spatial learning as compared to the mice exposed to clean air. However, this spatial learning deficit was prominent in C3H/HeJ neonatal mice. In the neonatal C3H/HeN male mice exposed to DE and DE‐SOAs, the mRNA expression levels of the N‐methyl‐D‐aspartate receptor subunits (NR1, NR2B), proinflammatory cytokines, tumor necrosis factor‐α and cyclooxygenase‐2, oxidative stress marker, heme oxygenase‐1, and microglial marker, Iba1, in the hippocampus were significantly increased, but these changes were not observed in female mice. Our findings indicate that activation of the neuroimmune system and TLR4 signaling may possibly be involved in environmental pollutant‐induced spatial learning impairment in neonatal mice.

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Poster ‐ 22 Phase contrast X‐ray tomography brain imaging of rat model autism

Thet Thet Lwin1, Tin Tin Win Shwe2, Motoki Imai1, Hidehiro Watanabe2, Hiroko Maruyama1 and Tohoru Takeda1

1Graduate School of Medical Sciences, Kitasato University, Sagamihara, Japan 2National Institute for Environmental Studies, Tsukuba, Japan

Recently, many researchers have been studied for developmental neurotoxicity using autistic rat model. Noninvasive imaging technique plays an important role in inside studies of autism spectrum disorder. New imaging method phase‐contrast X‐ray computed tomography (CT), used phase shift, has high spatial and density resolution and it can provide high contrast images. This technique is approximately 1000 times higher sensitivity than conventional absorption X‐ray technique for biological soft tissue consisting of low atomic number such as H, C, N, O. The purpose of this study was to determine the feasibility of this technique in detailed visualization of morphological structures changes in valproic acid rat model of autistic brain. Valproic acid rat models (VPA rats) were created by intraperitoneal injection of valproic acid (600 mg/kg) into 12.5th day of gestation. Normal control rats were created by intraperitoneal injection of normal saline at the same condition. Thirteen weeks old VPA (number 4) and normal rats (number 2) brain were used in this study. All brains were imaged by phase‐contrast X‐ray CT without contrast agent. Images were reconstructed using 3D volume‐rending software (Real INTAGE; KGT Inc., Japan), and compared with corresponding histopathological pictures. Phase‐contrast X‐ray CT clearly depicted the anatomical structures of rat’s brain including cortex, caudate putamen, thalamus, hippocampus, corpus callosum and lateral ventricle. Especially, high‐resolution phase‐ contrast CT enabled to differentiate the density changes of hippocampus owing to its high sensitivity. Relative density of hippocampus as CA1, CA3 regions and dentate gyrus of VPA rats is approximately 27% higher than control rats. Corresponding histological section of VPA rat’s brain also showed increased neuronal cell density in the CA1, CA2/CA3 regions and dentate gyrus of hippocampus. It is suggested that neurogenes is in the hippocampus is increased in the VPA rats. In addition, lateral ventricles of VPA rats were mild to moderate dilated compared to that of control rats. It is thought to be caused by axonal decline in periventricular white matter. Phase‐contrast X‐ray CT enables to depict the autistic neuronal morphology in detail, and will use a helpful tool for various developmental neurotoxicity research.

 120  46th Myanmar Health Research Congress Abstracts of the Posters

Poster ‐ 23 Seaweed extract inhibit phosphorylation of tau in human tau stable expressed HEK293 cells

Motoki Imai1, Fumitaka Kawakami1, Keiko Yoshinaga2, Takashi Kahara2 and Hiroko Maruyama1

1Graduate School of Medical Science, Kitasato University, Yokohama, Japan 2Riken Vitamin Co. Ltd., Tokyo, Japan

Recently, diet habit changes to high fatty food, thus obesity, diabetes and lifestyle diseases are increasing in Japan. There was reported that development of Alzheimer's disease is high risk in diabetes mellitus patients compared to normal person. However, clear mechanism of Alzheimer's onset has not been elucidated. The present study was investigated seaweed, Japanese traditional diet to effect on prevention and onset of Alzheimer's disease. We have already obtained data showing the prevention and improvement effect of diabetes by improving glucose metabolism abnormality by seaweed ingestion. The mice were divided into four groups as high fat diet, normal diet, high fat diet with 1% seaweed, and normal diet with 1% seaweed. In addition, all groups were fed ad libitum for 6 months. Furthermore, seaweed extract related to inhibition of phosphorylation of tau are identified while focusing on signal systems using cultured cell human tau stable expressed HEK293. Phosphorylation of tau protein in mouse olfactory bulb part and HEK293 cells were analyzed by western blotting method. It was found that phosphorylation of tau was suppressed in high fat diet with seaweed. In addition, phosphorylation of tau was inhibited in Human tau stable expressed HEK293 cells treated with seaweed extract. This result suggested that feeding of seaweed suppresses tau phosphorylation and it might be related to reduce onset of Alzheimer's disease.

Poster ‐ 24 The association between arsenic‐related LINE‐1 methylation changes and blood pressure in Bangladesh

Takehiro Suzuki1, Khaled Hossain2, M. M. Hasibuzzaman2, Md. Shofikul Islam2,3, Atiqur Rahman2, Sudip Kumar Paul2,3, Seiichiro Himeno4 and Keiko Nohara1

1National Institute for Environmental Studies, Tsukuba, Japan 2Rajshahi University, Rajshahi, Bangladesh 3Islamic University, Kushtia, Bangladesh 4Tokushima Bunri University, Tokushima, Japan

Chronic exposure to arsenic is associated with cancer and hypertension. Growing evidence suggests that altered methylation in long interspersed nuclear element‐1 (LINE‐1) is involved in many types of disorders, including cardiovascular disease. In this study, we evaluated the association between arsenic exposure and LINE‐1 methylation levels, especially in relation

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to blood pressure (BP). A total of 236 subjects (175 from arsenic‐endemic areas and 61 from a non‐endemic area) in rural Bangladesh were recruited. The subjects’ arsenic exposure levels (i.e., drinking water, hair and nail arsenic concentrations) were measured by inductively coupled plasma mass spectroscopy. The subjects’ LINE‐1 methylation levels were determined by pyrosequencing. We found that the average LINE‐1 methylation levels of the subjects living in the arsenic‐endemic areas were significantly lower than those of the subjects living in the non‐endemic area. In a sex‐stratified analysis, the arsenic exposure levels in female but not male subjects showed a significant inverse association with LINE‐1 methylation levels before and after adjustment for age, body mass index and smoking. We also found that arsenic‐related elevated levels of BP were associated with LINE‐1 hypomethylation. These results demonstrated that chronic exposure to arsenic was inversely associated with LINE‐1 methylation levels in blood leukocyte DNA and this was more pronounced in females than males; in addition, the decreased levels of LINE‐1 methylation might be involved in the arsenic‐induced elevation of BP.

Poster ‐ 25 Preliminary study of concentration and size distribution of atmospheric particulates in Yangon city

Daisuke Nakajima1, Nay Chi Nway2, Win Yu Aung2, Zarli Thant2, Ei Ei Pan Nu Yee2, Ei Ei Phyo Myint2, Mayuko Yagishita1, Tin Tin Win Shwe1 and Ohn Mar2

1Center for Health and Environmental Risk Research, National Institute for Environmental Studies, Tsukuba, Japan 2Department of Physiology, University of Medicine 1, Yangon

Air pollution is a major environmental risk to health. By reducing air pollution levels, countries can reduce the burden of disease from stroke, heart disease, lung cancer, and both chronic and acute respiratory diseases, including asthma. There are scientific methods of studying the quality of air to determine how polluted it is. As a preliminary study to investigate air pollution status in Yangon, our joint research team measured particle concentration and size distribution of atmospheric dust using Optical Particle Sizer OPS 3330 (Trust, Science, Innovation (TSI), United States of America). The particle size was measured by classifying the range from 0.3 μm to 10 μm into 16 stages. Measurement was done for 1 minute and performed two times, and the average value was taken as the estimated value. This preliminary study was started in summer May, 2017 and we measured at the seven locations including the hotel room, furniture factory, pharmacy store, elementary school classroom, University of Medicine (1) (UM 1) campus, paper mill, and roadside in Yangon city. There were different data depending on the location. The total concentration of dust on the roadside was about 50‐200 μg/m3. In contrast, the inside of the classroom of the elementary school showed a low value of about 33 μg/m3. The ratio of the indoor to the outdoor concentration (I/O ratio) was 0.63 in the elementary school and 0.67 in the UM 1. However, I/O ratio was higher in the inside of in the furniture factory (1.5) and in the pharmacy store (2.3). The particle size distribution varies depending on the measurement point. Further study is needed to elucidate the seasonal variation of air quality status in Yangon city.

 122  46th Myanmar Health Research Congress Abstracts of the Posters

Poster ‐ 26 Novel long lasting pyriproxyfen larvicide (SumiLarv®2MR) against Aedes mosquitoes in schools in Yangon, Myanmar

Sai Zaw Min Oo1, Sein Thaung1, Yan Naung Maung Maung1, Khin Myo Aye1, Zar Zar Aung1, Hlaing Myat Thu1, Kyaw Zin Thant1 and Noboru Minakawa2

1Departement of Medical Research 2Institute of Tropical Medicine, Nagasaki University, Japan

Myanmar is under the threat of several mosquito‐borne diseases. In particular, the number of dengue cases has significantly increased in recent years. Due to the development of insecticide resistance by vectors and the short term effectiveness of currently used larvicides, an alternative larvicide is urgently needed. The present study evaluated the larvicidal effectiveness of long lasting pyriproxyfen resin discs (SumiLarv® 2MR) against dengue virus vectors in schools in Hlaing Thar Yar Township, Yangon. The proportion of Aedes mosquito infested containers were significantly reduced in the schools applied with the larvicide (OR: 0.24, 95% CI: 0.12 to 0.48) while there was no significant reduction in the control schools (OR: 0.97, 95% CI: 0.55 to 1.72). Water samples were collected from both control and intervention containers in each survey. The proportion of adult emergences was less than 20% in the treated water collected from the intervention for six months while the proportion was over 90% in the untreated water. In addition, eight‐month old discs were recollected from the field and tested in laboratory. These eight months old discs were still fully effective (100% mortality rate). The SumiLarv® 2MR reduced the density and the occurrence of Aedes‐infested containers in the schools. The larvicide was still fully effective after six to eight months of application at least. This new pyriproxyfen formulation has great potential for improving the current dengue virus vector control program in Myanmar.

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Poster ‐ 27 Acquired immunity to malaria in the pre‐elimination setting of South‐East Myanmar

Katherine O’Flaherty 1, 2, Win Han Oo 3, 4, Htin Kyaw Thu3, Nyi Nyi Zaw3, Kyaw Zayar Aung3, Myat Mon Thein 3, Aung Thi 5, Wai Yan Min Htay 3, Aung Paing Soe 3 and Freya J.I. Fowkes 1, 2, 6, 7

1Burnet Institute for Medical Research and Public Health, Australia 2Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, the University of Melbourne, Australia 3Burnet Institute Myanmar 4School of Health and Social Development, Deakin University, Australia 5Department of Public Health 6Department of Epidemiology and Preventative Medicine, Monash University, Australia 7Department of Infectious Disease, Monash University, Australia

Malaria transmission in Myanmar has declined dramatically over the past decade, and Plasmodium spp. case incidence declined by as much as 90% between the years 2005‐2014 in some provinces. Malaria transmission in Myanmar is expected to continue on this trajectory, with the National Malaria Control Program committed to eliminating malaria by 2030. These rapid declines in malaria transmission and thus, exposure, may lead to declines in population levels of antimalarial immunity, which typically develops after repeated malaria exposure and can provide protection from clinical disease. Loss of antimalarial immunity may leave some populations vulnerable to clinical malaria if transmission of malaria rebounds. The objective of this study was to longitudinally observe changes in the immune response to Plasmodium spp. in a region that has recently achieved a marked decline in malaria transmission. A longitudinal study of 114 villages was performed in the south‐eastern States of Bago, Kayin and Kayah. From April 2015 to June 2016, village health volunteers (VHV) collected 14,934 rapid diagnostic tests (RDT) and dried blood samples. Dried blood spots were used to measure IgG antibodies specific for P. falciparum blood stage antigens, and multilevel mixed effects modelling was used to determine the trajectory of antimalarial antibody responses over time. High levels of antimalarial antibodies were measured, despite an extremely low prevalence of infection (<1%). This work demonstrates the utility of trained VHVs for performing malaria surveillance in Southeast Myanmar. By assessing antibody levels in this longitudinal study demonstrates that antimalarial immunity is being maintained despite very few infections being measured by RDT. Further work is needed to determine whether serosurveillance will be a useful tool to inform malaria elimination in Myanmar.

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Poster ‐ 28 Effectiveness of repellent delivered through village health volunteers on malaria incidence in villages in South‐East Myanmar: a stepped‐wedge cluster‐randomised controlled trial

Win Han Oo1, Paul A. Agius2,5,6, Katherine O’Flaherty2,3, Kyaw Zayar Aung1, Myat Mon Thein1, Aung Thi4, Htin Kyaw Thu1, Aung Paing Soe1 and Freya Fowkes2,3,5

1Burnet Institute Myanmar, Yangon 2Burnet Institute, VIC, Australia 3Melbourne School of Population and Global Health, University of Melbourne, VIC, Australia 4Department of Public Health 5Department of Epidemiology and Preventive Medicine, Monash University, VIC, Australia 6Judith Lumley Centre, La Trobe University, VIC, Australia

Evidence for the effectiveness of repellents distributed to villages through Village Health Volunteers (VHV) in protecting against episodes of malaria is required to inform the implementation of repellents as a component of malaria control and elimination programs in the Greater Mekong Subregion including Myanmar. A 15‐month stepped‐wedge cluster randomised study using routinely collected data was implemented to test the effectiveness of distribution of topical mosquito repellent (N,N‐Diethyl benzamide, 12% w/w cream) on Plasmodium spp. infection. Crossed‐random effects mixed modelling was undertaken to estimate the effect of repellent distribution on Plasmodium spp. Infection. Generalized Linear Mixed Models (GLMM) showed that, conditional on the effects of time and seasonality, Plasmodium spp. infection was less likely once villages transitioned into repellent distribution (adjusted odds ratio [AOR]=0.25) although this difference was not statistically significant (Wald χ2(1) = 0.436, p=0.512). There was a significant decline (AOR=0.87, Wald χ2(1) = 6.1, p=0.013) in Plasmodium spp. infection across the length of the trial. There was significant heterogeneity observed in the nature of the effect of repellent distribution between villages and we observed a greater level of heterogeneity in Plasmodium spp. infection between villages than across cross‐sectional testing occasions. We observed a significant decline in of Plasmodium spp. infection across the study period, independent of the intervention and seasonal variations in incidence which is most likely due to the increased access to malaria services provided by the VHV. We did observe a reduction in the incidence of Plasmodium spp. infection once repellent was distributed to villages, however this difference was not statistically significant because Plasmodium spp infection incidence was also lower than expected.

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Poster ‐ 29 Effect of enteral tube feeding formula containing local Myanmar ingredients on nitrogen balance study

Su May Aung, Wantanee Kriengsinyos, Chanida Pachotikarn and Nipa Rojroongwasinkul

Institute of Nutrition, Mahidol University, Thailand

In Myanmar, the blenderized tube feeding diet was not usually recommended for enteral feeding by health care professionals. Therefore this study was carried out to determine the effect of blenderized tube feeding diet on nitrogen balance in comparison with traditional tube feeding diet. This study was conducted with 19 participants with neurogenic dysphagia on nasogastric tube feeding who had been admitted to Kwe Ka Baw Hospital, Yangon. The participants were divided into two groups: traditional tube feeding (TTF) group consisted of 10 participants receiving traditional tube feeding diet and blenderized tube feeding (BTF) group consisted of 9 participants receiving blenderized tube feeding diet. TTF diet was food that had been commonly used for enteral tube feeding at Myanmar such as chicken broth soup, rice porridge and commercial formula. BTF diet was food that had been liquidized by an electric blender according to standard procedure and recipe. All the participants were studied for nitrogen balance on day 4, day 5 and day 6 of enteral feeding and tolerability for 7 days. Because of low protein intake, the nitrogen balance of TTF group was negative, ‐7.34 g/d. The nitrogen balance of BTF group improved nearly up to ‐2.5 g/d. The macronutrients distribution of TTF group was 56%, 16% and 28% for carbohydrate, protein and fat, respectively and BTF group was 50%, 20% and 30%, respectively. The blenderized diet was well tolerated by all the participants. There was no case vomiting and high gastric residual volume; one case of diarrhea and abdominal distension. In conclusion, the results of the present study support that blenderized tube feeding diet should be recommended to use for enteral feeding in order to give a better nutritional support to patients.

Poster ‐ 30 Profiling the upper respiratory tract microbiota of patients living with HIV, TB and HIV/TB from Myanmar

Kyaw Soe Htun1, Yang Fong2, Tun Nyunt Oo3, Si Thu Aung4, Khine Zaw Oo1, Thein Zaw1, Gregory M. Cook5, Htin Lin Aung1,5 and Tin Maung Hlaing1

1Defence Services Medical Research Centre 2Institute of Fundamental Sciences, Massey University, New Zealand 3National AIDS Programme 4National Tuberculosis Programme 5Department of Microbiology and Immunology, School of Biomedical Sciences, University of Otago, New Zealand

HIV and TB are the world’s leading infectious killers due to opportunistic bacterial infections which occur more frequently in HIV and TB patients than in the general population.

 126  46th Myanmar Health Research Congress Abstracts of the Posters

Although there have been reports of microbiome studies from either HIV or TB patients, no studies have ever been conducted to identify bacterial communities in the upper respiratory tract of HIV and TB co‐infected patients. Myanmar is one of the countries with high prevalence of HIV/TB, HIV and TB. Using next‐generation sequencing technology, author conducted a preliminary study to profile the upper respiratory tract microbiota in patients living with HIV, TB and HIV/TB patients in Myanmar. The objective was to explore the microorganisms from nasopharynx and oropharynx by using next generation sequencing technique in HIV, TB and HIV/TB patients. This study was cross‐sectional descriptive study on naso and oropharyngeal swabs from 36 participants. The subjects were properly explained and consent was taken. Nasopharyngeal swab and oropharyngeal swab specimens were collected using a flexible swab strips with transport medium. Bacterial microbiome DNAs were extracted by using DNA microbiome extraction Kit and then sequenced by next‐generation 16s rRNA amplicon sequencing. Patients living with HIV (22), TB (6) and HIV/TB (8) were included and compared with the upper respiratory tract microbiota in six healthy adults. Mean age was 37±7.49 years. There was 20 (55.56%) male and 16 (44.44%) female patients in this study. We found that the upper respiratory tract bacterial communities in HIV treatment‐naive patients and HIV/TB patients were dominated by Streptococcaceae, whereas Staphylococceaceae was dominant in HIV patients on treatment. Due to limited resolution of the 16s rRNA gene among closely related species, the VITEK 2 system was employed for the identification of them as Streptococcus pneumoniae and Staphylococcus aureus. The abundance of Veillonellaceae was observed in TB patients and HIV treatment‐naive patients. Considering results, this study lays the vivid foundations for basic information warranting further studies to gain better insight into the prevention and treatment of bacterial infections in the respiratory tract associated with HIV, TB and HIV/TB including the use of an innovative approach such as probiotics.

Poster ‐ 31 Possible involvement of hypoacetylation of histone H3K9 in estrogen‐dependent transdifferentiation of LH cells to PRL cells in male mouse pituitary

Nandar Tun, Myat Thu Soe, Daisuke Endo, Yasuaki Shibata and Takehiko Koji

Department of Histology and Cell Biology, Graduate School of Biomedical Sciences, Nagasaki University, Japan

Diethylstilbestrol (DES), an estrogen agonist, increased population of prolactin (PRL) cells partly through transdifferentiation of follicle stimulating hormone (FSH) and luteinizing hormone (LH) cells in adult male mouse pituitary. To understand the effect of DES better, we examined involvement of histone modification. Eight weeks old male ICR mice weighing 30‐33 g were injected 3 times with 20 mg/kg BW of DES at every 5th day. Valproic acid (VPA) or sodium phenylbutyrate (NaPB) were used as HDAC inhibitors (HDACi). The mice were daily injected intraperitoneally at a dose of 300 mg/kg BW or 800 mg/kg BW of HDACi, respectively for 10 days from the 2nd injection (at day 5) with DES, and sacrificed at 15 days of treatment. The sections of pituitary glands, fixed with 4% PFA in PBS and embedded in

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paraffin, were used for the present study. Acetylation level of histone H3 at K9, 18 and 23 and PRL, FSH and LH cells were identified by immunohistochemistry. As a result, DES decreased the acetylation levels of H3K9 in those pituitary cells and increased prolactin cell population. With VPA or NaPB, the acetylation level of those pituitary cells in DES treated pituitary returned to the normal level, resulting in a loss of increase in PRL population. The number of LH cells was significantly decreased in DES treatment, but returned to the control level by the injection with VPA or NaPB. For FSH cells, no significant effect was found with VPA or NaPB treatment. These indicated that hypoacetylation might play a role in transdifferentiation of LH but not of FSH cells. Unexpectedly, acetylation level was decreased in VPA alone treated pituitary but not in NaPB treated pituitary. Since VPA, but not NaPB, increased 4‐hydroxynonenal positive cells, hypoacetylation caused by VPA may be due to oxidative stress. In conclusion, both VPA and NaPB attenuated the effects of DES on histone acetylation and population of LH cells, strongly indicating that hypoacetylation of H3K9 in LH cells may be involved in transdifferentiation to PRL cells by DES.

Poster ‐ 32 Egg positivity rate of pinworm among primary school children in three townships of Yangon Region

Thi Thi Htoon1, Saw Mitchell1, Win Thein1, Htay Htay Tin1, Jong‐Yil Chai2, Woon‐Mok Sohn2, Bong‐Kwang Jung2, Min‐Jae Kim2 and Jaeeun Cho2

1National Health Laboratory 2Korea Association of Health Promotion

Enterobius vermicularis, also known as pinworm or seatworm, is one of the most common intestinal helminths of humans and has a worldwide distribution including developed countries. It is estimated that 4‐28% of the children are infected globally. A cross‐sectional descriptive study was carried out among school children from 7 Primary schools in three selected townships (Hlaingtharyar, South Dagon and North Dagon) of Yangon Region in June 2014. A total of 761 Primary school children (383 boys and 378 girls) aged ranging from 5 to 7 years were included in this study. The objective of this study was to determine the egg positivity rate of E. vermicularis among selected primary school children. The cellophane tape anal swab method was used to collect sample from children and collected samples were examined under light microscopy. Polymerase chain reaction and nucleotide sequencing were also performed on two randomly selected positive samples that were confirmed by microscopy for identification of the pinworm species at Seoul National University College of Medicine, Korea. The overall egg positive rate of E. vermicularis was found to be 47.2% (359/761). Out of 383 boys, 48.6% (186/383) were found infested with E. vermicularis while 45.8% (173/378) of the girls were positive for eggs of E. vermicularis showing sex difference was not remarkable. However, the positive rate was highest in South Dagon township (54.6%, 214/392) followed by Hlaingtharyar (43.8%, 81/185) and North Dagon (34.8%, 64/184). Nucleotide sequence of the 5S rDNA from the eggs on the cello‐tape (2 children) revealed 99.7% identity with that of E. vermicularis reported in GenBank. These findings strongly suggested that specific control measures including improved sanitation and

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personal hygiene are urgently required to interrupt the transmission cycle of E. vermicularis among school children who are residing in these highly prevalent areas of enterobiasis.

Poster ‐ 33 The external quality assessment of laboratory testing related to HIV services

Eh Htoo Pe1, Latt Latt Kyaw1, Ohn Mar Lwin1, Ikuma Nozaki2 and Htay Htay Tin1

1National Health Laboratory 2JICA, Infectious Disease Control and Laboratory Services, Myanmar

Importance of laboratory service has been growing in the era of Sustainable Development Goals. More accurate diagnosis and treatment coverage are required to reach the end epidemic target of HIV. HIV diagnosis and CD4 count testing is key for coverage and quality of treatment. And Syphilis diagnosis is critical for STDs control and triple elimination of vertical transmission of HIV, Syphilis, and Hepatitis. National Health Laboratory (NHL) organized National External Quality Assessment Scheme (NEQAS) for HIV, syphilis, and CD4 count testing using the proficiency panel specimen method. We reviewed the NEQAS Reports on HIV, syphilis, and CD4 count testing from beginning to end of 2016 to collect the data including number of participating laboratories, responding rate, and quality assessment data. HIV testing NEQAS has started in 2005 and gradually expanded to more than 400 laboratories. The aberrant results reporting rate are gradually decreased to 2.4% at latest panel. Syphilis testing NEQAS established in 2012 and expanded to 96 laboratories. At the beginning, the proportion of the laboratories with more than 90% scored had been increased, but started to be decreased after expanding to peripheral laboratories. CD4 count testing NEQAS introduced in 2015 and expanded to more than 60 laboratories. Rate of laboratories within ±2SD range was fluctuated but we could see the improving tendency. NHL has been organizing joint supervisory visit to the poor performance laboratories on HIV, syphilis, and CD4 count testing since 2005, 2010 and 2015 respectively. Regular refresher trainings were also provided. We found that NEQAS using the proficiency panel specimen method can clearly show the performance of each laboratory and their needs to support. Supportive supervisory visit and regular refresher training are another key element of quality improvement after the assessment. The well functioning NEQAS is foundation of quality improvement of laboratory service while it required never‐ending effort.

 129  Abstracts of the Posters 46th Myanmar Health Research Congress

Poster ‐ 34 Population kinetics of Sox9 positive liver progenitor cells in normal and iron‐overloaded rat liver: Effects of partial hepatectomy

Myat Thu Soe1, Yasuaki Shibata1, Kyaw Soe2, Nandar Tun1, Daisuke Endo1 and Takehiko Koji1

1Department of Histology and Cell Biology, Graduate School of Biomedical Sciences, Nagasaki University, Japan 2Department of Medical Research

Recruitment of liver progenitor cells (LPCs) may be essential for liver mass homeostasis and their kinetics can be influenced by liver injury. Iron overload in the liver causes hepatocyte injury and accelerates hepatocytes proliferation after partial hepatectomy (PHx) was reported, previously. To examine the influence of iron overload on the recruitment of LPCs from bile ducts, immunohistochemistry for SRY‐related HMG‐box containing 9 (Sox9), a marker of LPCs, in normal and iron‐overloaded liver after PHx was performed. Moreover, immunohistochemistry for 5‐methylcystosine (5mC) was also done, since the DNA methylation is implicated in the differentiation of cells. Adult male Wistar rats, weighing 200‐255 g, were fed with normal diet (ND) or 3% carbonyl iron diet (FeD) for 3 months and then 70% PHx was performed. The livers were excised at 0, 12, 24, 36 and 48 hr after PHx, fixed with 4% PFA/PBS and embedded in paraffin. Double‐staining immunohistochemistry revealed that ductular cells were divided into three population of Sox9+5mC‐, Sox9‐5mC+ and Sox9+5mC+. At 0 hr, Sox9+5mC‐ cells (about 40% of total ductular cells) were detected in the ducts of FeD rat, but not in ND. On the contrary, Sox9‐5mC+cells in FeD were extremely low (about 5%) whereas that of ND was 40%. Sox9+5mC+cells in ND and FeD were almost the same (about 50‐60%). After PHx, Sox9+5mC‐cells in ND liver increased in parallel with the number of PCNA positive cells and reached a peak at 24 hr after PHx, while the changes in Sox9+5mC‐in FeD liver were not correlated with PCNA staining. Sox9+5mC‐cells in FeD liver were almost constant throughout the time‐points examined after PHx. These results indicate that iron overload increases Sox9+5mC‐population, supporting the role of LPCs in liver regeneration.

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Poster ‐ 35 Detection and molecular characterization of extensively drug resistant Mycobacterium tuberculosis strains in Myanmar

Phyu Win Ei1,2, Wah Wah Aung1, Wint Wint Nyunt3, Thyn Lei Swe3, Si Thu Aung3, Kay Thi Aye1, Chulhun L. Chang4, Hyeyoung Lee2 and Jong Seok Lee5

1Department of Medical Research 2Department of Biomedical Laboratory Science, Collage of Health Sciences, Yonsei University (Wonju) 3National Tuberculosis Program 4Pusan National University Yangsan Hospital 5International Tuberculosis Research Center, Changwon

The emergence of drug‐resistant strains of Mycobacterium tuberculosis (MTB), especially those that are multidrug resistant (MDR) and extensively drug resistant (XDR), has posed a serious threat to global TB control. This study aimed to detect XDR‐TB cases among MDR‐ TB patients attending Yangon and Mandalay TB Centers and to identify the genotypes and mutation pattern conferring resistance to second line anti‐TB drugs; fluoquinolones and second line injectables. Mycobacterium tuberculosis isolates from patients who enrolled for multidrug‐resistant tuberculosis treatment in Yangon and Mandalay Regions during 2015‐16 were collected. Phenotypic drug susceptibility testing for first‐line and second‐line anti‐TB drugs was performed by solid agar‐based methods. Mutation in drug target genes for fluoroquinolones (gyrA, gyrB), and second line injectables (rrs, eis) were ascertained by Sanger sequencing. Genotyping was performed based on Mycobacterial Interspersed Repetitive Unit‐Variable Number Tandem Repeat (MIRU‐VNTR) method. Of 89 MDR‐TB isolates, 13.5% was XDR‐TB and 27% was pre‐extensively drug‐resistant tuberculosis (Pre‐ XDR‐TB) including 23.6% of fluoroquinolone‐resistant and 3.4% of second‐line injectables‐ resistant pre‐extensively drug‐resistant tuberculosis (Pre‐XDR‐TB). High proportion of cross‐ resistance among fluoroquinolones as well as second‐line injectables was detected. The correlations between phenotypic and molecular drug susceptibility test for fluoroquinolones and second‐line injectables were 91% respectively. Twelve different types of mutations were detected in quinolone‐resistant determining region of gyrA, two in quinolone‐resistant determining region of gyrB, three in rrs and no mutation in eis. Most frequent mutation in relation to fluoroquinolone resistance was D94G (8/21, 38.1%), followed by A90V and D94Y in gyrA and to second‐line injectables was A1401G (11/15, 73.3%) in rrs. A new non‐ synonymous mutation (S62A) was found in one fluoroquinolone‐resistant isolate. The dominant genotype was Beijing type. This study highlighted the high proportion of XDR‐TB and fluoroquinolone resistance among MDR‐TB in Myanmar. All health personnel should be aware of the potential spread of MDR and XDR Beijing genotype in the community. Information on prevailing mutation patterns of fluoroquinolone and second line injectables‐ resistant MTB strains can be useful for development and improvement of rapid diagnosis tools for drug resistance.

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Poster ‐ 36 A comprehensive model of patient‐centred community‐based treatment and care for drug‐resistant TB (DR‐TB) patients in South Dagon Township, Yangon Region

Thazin La1, Naanki Pasricha2, Aye Aye Myint1, Tope Adepoyibi2, Khin Zaw1, Aye Aye Myint1 and Suman Majumadar2

1Burnet Institute Myanmar 2Burnet Institute Melbourne, Australia

TB is a major public health concern in Myanmar. The country is listed among the 22 high tuberculosis (TB) burden countries, the 41 high TB/HIV burden countries, and the 27 high multidrug‐resistant TB (MDR‐TB) burden countries. The recent drug resistant survey revealed MDR‐TB transmission “hotspots” in Yangon Region. Between 2014‐2017, the Burnet Institute piloted a comprehensive model of patient‐centred community‐based care and treatment (PCCBCT) for drug resistant tuberculosis (DR‐TB) patients in South Dagon, integrating activities into the township level health system. Project interventions focused on two key areas: 1) Strengthening of township, health and community systems to enable delivery of MDR‐TB services. Utilizing a capacity‐building approach, Burnet staff partnered with government authorities to strengthen the planning, implementation and monitoring cycle for a community‐based DR‐TB care and treatment in South Dagon. Key features of the model included; support for microplanning; the provision of comprehensive training and monitoring for 42 community treatment supporters (CTS’s); and supporting establishment of electronic data management systems at the Township Health Department level. 2) Delivery a comprehensive model of community care and prevention for MDR‐TB patients and their families. In addition to the standard provision of TB treatment monitoring and education by CTS’s, the following additional services were provided to MDR‐TB patients in South Dagon: side effect referral, counselling (individual, peer group and family), social mobilization and household TB screening and infection control. Additionally, an in‐depth analysis was conducted to identify vulnerable patient groups at risk of poorer outcomes, in order to provide targeted activities. TB/HIV patients, married women, women of reproductive age, and TB/diabetes patients were identified to be at risk of treatment interruption. These vulnerable groups were provided with additional services, including: family planning (counselling, financial support for products), referral for HIV testing and counselling, HIV ART adherence counselling, blood glucose monitoring and diabetes counselling. Between 2014‐2017 there was 100% treatment adherence among MDR‐TB patients receiving the PCCBCT package. Additionally, a 2017 satisfaction survey found that 100% of patients were either very satisfied or satisfied with overall project activities. To conclude, in South Dagon, a comprehensive model of PCCBCT for DR‐TB patients has been successfully demonstrated.

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Poster ‐ 37 HMGB1 modulates the phenotype transformation of vascular smooth muscle cells via NLRP3 inflammasome

Sang Wook Shin1, Eun Jung Kim2, So Youn Park2,3 and Chi Dae Kim2,3

1Department of Anesthesia and Pain Medicine, Pusan National University Hospital, Korea 2Department of Pharmacology, Pusan National University Hospital, Korea 3Gene & Cell Therapy Research Center for Vessel‐associated Diseases, Pusan National University, Korea

Vascular smooth muscle cells (VSMCs) are the major cell type in the blood vessel walls, and their phenotypic modulation is a key cellular event driving vascular remodeling. Although HMGB1 plays a pivotal role in the inflammatory responses in the injured vasculatures, the potential importance of VSMC in linking HMGB1 to vascular inflammation has not been clarified. To determine the hypothesis that VSMC might be an active player in vascular inflammatory processes through secretion of inflammatory cytokines, this study investigated the proinflammatory effects of HMGB1 and their intermediary signaling pathways in human VSMCs. When VSMCs were stimulated with 10 to 500 ng/mL of recombinant human HMGB1, the production of IL‐1β was markedly elevated in association with a promoted processing of IL‐1B. HMGB1 also increased the expression of inflammasome components including NLRP3, ASC and Caspase‐1. HMGB1‐induced expression of NLRP3 and Caspase‐1 was markedly attenuated in TLR‐2‐deficient cells using siRNA, whereas ASC expression induced in HMGB1‐stimulated cells was inhibited in RAGE‐ deficient cells. In TLR4‐deficient cells, HMGB1‐induced Caspase‐1 expression was markedly attenuated. Moreover, IL‐1β production in HMGB1‐stimulated cells were also significantly attenuated in cells treated with monoclonal antibodies for TLR2, TLR4, and RAGE. The findings of this study identified a novel signaling pathway in which HMGB1 increases the expression of inflammasome components and production of IL‐1β in VSMCs. Overall, this study provides new insights to the understanding of the innate response that contributes to pathogenesis of vascular remodeling diseases.

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Poster ‐ 38 5‐Lipoxygenase in monocytes plays a pivotal role in the progression of vascular inflammation

Chi Dae Kim1,2, Seung Eun Baek1,2, So Youn Park1,2 and Sang Wook Shin3

1Department of Pharmacology, Pusan National University, Korea 2Gene & Cell Therapy Research Center for Vessel‐associated Diseases, Pusan National University, Korea 3Department of Anesthesia and Pain Medicine, Pusan National University Hospital, Korea

5‐Lipoxygenase (5‐LO) mediates various inflammatory diseases, however, the precise role in the progression of vascular inflammation remains unclear. Thus, this study aimed to identify the role of 5‐LO in monocytes in monocyte‐to‐macrophage differentiation (MMD) with subsequent production of inflammatory cytokines. In THP‐1 monocytes, MMD and cytokine production were markedly increased by treatment with phorbol‐12‐myristate‐13‐acetate (PMA), which was dose‐dependently attenuated by MK886, an inhibitor for 5‐lipoxygenase activating protein. Monocyte differentiation induced by PMA was also attenuated in cells treated with a 5‐LO inhibitor as well as in bone marrow‐derived cells isolated from 5‐LO‐KO mice, suggesting a pivotal role for 5‐LO in monocyte in MMD. In cells treated with PMA, the expression of leukotriene B4 receptor 1 (BLTR1), but not other LTRs including BLTR2, cysLTR1 and cysLTR2, was increased in association with an increase in 5‐LO activity. Moreover, monocyte differentiation induced by PMA was attenuated in THP‐1 monocytes treated with a BLTR1 inhibitor as well as in cells transfected with siRNA for BLTR1. These findings identified a pivotal role for 5‐LO‐BLTR1 signaling in MMD and inflammatory cytokine production. Thus, 5‐LO‐BLTR1 signaling in monocyte might be a novel therapeutic targets for vascular inflammatory diseases including atherosclerosis.

Poster ‐ 39 Is gp 130 expression by circulating CD4+ T cells a marker of early rheumatoid arthritis?

Si Thu Aung, L.A. Ridgley, J. D. Isaacs, A. G. Pratt and A. E. Anderson

Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University, UK

Rheumatoid Arthritis (RA) is a disease of immune dys‐regulation. Previous data suggested that systemic IL‐6 preferentially induces STAT3 phosphorylation in circulating naïve CD4+ T cells of early RA patients. CD4+ T cell expression of the IL‐6 receptor α subunit (IL‐6R) had no diagnostic utility for RA. Therefore, we hypothesised that surface expression by CD4+ T cells of the β receptor subunit, gp130, might determine their sensitivity to IL‐6 pSTAT3 induction in this setting, and so have value as a diagnostic biomarker for RA. The research was aimed to investigate whether gp130 is expressed differentially between circulating CD4+ T cell

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subsets of early RA patients, and whether its expression is a potential biomarker to diagnose RA patients. The expression level of IL‐6R and gp130 in the whole CD4+ T cell population and its subsets were measured using flow cytometry amongst 60 patients from an early arthritis clinic. IL‐6R expression is not significantly different in CD4+ T cell subsets (non‐parametric analysis of variance, Kruskal–Wallis test, p>0.01), whereas gp130 expression is highest in the true naïve CD4+ T cell subset (p<0.0001). However, there is no significant difference in expression of IL‐6R and gp130 between different arthritic disease groups (p>0.01). Naïve CD4+ T cells express the highest level of gp130 but there is no significant difference in expression between different arthritic disease groups (p>0.01). Therefore, increased pSTAT3 expression in CD4+ T cells of early RA patients may be driven solely by increased circulating levels of IL‐6, whose major source(s) in early RA await further investigation. Although it was unable to prove that gp130 is an efficient biomarker for early RA, if we could use a larger sample size together with more comprehensive and advanced research technologies/ techniques, carrying out extensive research, it is wholeheartedly believed that the hypothesis would be proved and a practically useful biomarker for early RA would be discovered in the near future.

Poster ‐ 40 Effect of HBV Core promoter mutation and detection of PreS genotype in Myanmar

Mi So Seong1, Ye Eun Jeong1, So Young Kim1, Yi Yi Kyaw2 and Jae Hun Cheong1

1Molecular Biology Department, Pusan National University 2Department of Medical Research

Hepatitis B virus (HBV) infection is a global public health problem causing various types of liver diseases including fulminant, chronic hepatitis, liver cirrhosis and hepatocellular carcinoma (HCC). The mutation rate of HBV is higher than that of other DNA viruses owing to the reverse transcription in its life cycle. In the viral genome, the core promoter is located in front of the start site of the genomic DNA and plays an important role in HBV replication. Mutations in the core promoter result in increased HBV replication and decreased virion secretion. This study was carried out to detect corepromoter mutations, its functional relation and viral genotypes in chronic hepatitis B patients. A total of 96 sera samples from HBs Ag positive patients between the periods of July to September 2013 who came for routine follow up at Hepatitis Clinic at DMR were included in this study. HBV genoyping and corepromoter mutation detection were carried by sequencing method. Mutations were found in nt1713, nt1798 of core promoter gene in one patient and nt1806 in another one isolate. Four HBV core promoter constructs were carried out from the core promoter mutated isolates and one non mutated isolate. Functional analysis of HBV core promotermutant contracts was performed by luciferase assay after transfection in to HepG2 cell line. All core promoter activities in mutant one was thirty fold higher than compare with no mutation. As the c/EBPβ binds to the HBV core promoter and regulates HBV gene expression, the c/EBPβ increased the activity of the mutant HBV core promoter. Genotyping and phylogenetic analysis of HBVpreS region indicated that majority of HBV infected

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Myanmar patients were genotype C and D. Further research on core promoter mutations and HBV genotypes in Myanmar is encouraged.

Poster ‐ 41 Needs assessment of WASH in health care facilities in Myanmar

Thae Maung Maung1, Wah Wah Aung1, Mya Mya Aye1, Htay Win2, Penelope Dutton3, Alison Macintyre3, Tim Davis3 and So Pyay Naing3

1Department of Medical Research 2Department of Public Health 3WaterAid

Improved hygiene, safe water, and adequate sanitation (WASH) conditions in health care facilities (HCF) are vital for safe, quality health care provision. According to WASH in HCF system analysis report, the previous assessments could not reflect the current status of WASH and Infection Prevention and Control (IPC) conditions in HCF. This study was a cross‐ sectional descriptive study conducted in 2017 aiming to understand the current situation of WASH facilities in HCFs and to identify WASH‐focused action to improve the safety and quality of care around deliveries in health facilities. The present study involved 33 different levels HCF in Ayeyarwady, Bago and Magway regions. The findings were interpreted against WHO’s Standards for Improving Quality of Maternal and Newborn Care in Health Facilities, WHO/UNICEF joint‐monitoring program (JMP) indicators, and national water quality standards. Among 33 HCF, 94% met all JMP requirements for basic service for water supply while 67% of HCF met one primary JMP indicator for sanitation. About 58% of HCF had effective waste separation in the OPD area. Only 21% of facilities dispose of infectious and sharps waste using an incinerator. Most health care facilities (88%) had a handwashing facility in the OPD consultation area, with 93% of those having soap or a suitable handwashing available. The results from swab samples revealed that Staphylococcus aureus was isolated from 35 swab samples out of 298 samples. Methicillin Resistant Staphylococcus aureus (MRSA) was not detected in isolated Staphylococcus aureus. The resistant antibiotics for Staphylococcus aureus were amoxicillin/clavulanic acid (97.1%), erythromycin (34.3%), clindamycin (31.4%), oxacillin (22.9%), cotrimoxazole (20%) and doxycycline (2.9%). For water quality testing, E.coli tests were positive in 23 water samples from handwashing facilities in delivery rooms and 20 samples from handwashing facilities in OPD. This assessment highlighted the current situation of different WASH, IPC conditions and healthcare waste management in HCF. The findings identified priority areas for improvement including waste separation and disposal, quality of water, accessible toilets, training, and increased numbers of staff.

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Poster ‐ 42 Detection of birth defects among newborns at seven tertiary hospitals in Yangon Region

Mya Ohnmar, Khin Mittar Moe San, Nway Htike Maw, Moh Moh Hlaing, Sandar Tun, Myat Myat Thu and Khin Hnin Wint Phyu

Department of Medical Research

Birth defects are one of the most common causes of disability in developed and developing countries. Birth defects are structural or functional anomalies, including metabolic disorders, which are present at the time of birth. This study aimed to document the overall frequency and pattern of birth defects of newborns delivered in seven hospitals in Yangon region. The study was a retrospective, hospital‐record review study to find the prevalence of birth defect in newborns at seven tertiary hospitals during the period of January 2014‐ December 2015 in Yangon Region. Seven hospitals in Yangon Region where both OG wards and baby units are co‐existed, were selected purposively. The selected hospitals were Central Women’s Hospital (CWH), Thingankyun Sanpya General Hospital, South Okkalapa Women and Children’s Hospital, North Okkalapa General Hospital (NOGH), Insein General Hospital (IGH), East Yangon General Hospital and West Yangon General Hospital. Cases with birth defects were identified from the birth registry and the corresponding files were retrieved from the hospital medical records section. The details were recorded in the designed proforma. During the study period, the incidence of birth defect in CWH, Thingankyun Sanpya General Hospital, South Okkalapa Women and Children’s Hospital, NOGH, IGH, East Yangon General Hospital and West Yangon General Hospital were 1.21%, 0.99%, 0.57%, 0.45%, 0.17%, 0.33% and 0.21% in 2014 and 1.11%, 0.93%, 0.54%, 0.88%, 0.5%, 0.48% and 1.49% in 2015, respectively. Of these, multi‐organ defects (21.7%) were the commonest, followed by central nervous system (15.9%), cleft lip and cleft palate (15.5%), musculo‐skeletal system (14.3%) and gastrointestinal tract (13.6%) in 2014. In 2015, multi‐organ defects (20.17%) were also commonest, followed by muscular‐skeletal system (19%), central nervous system (17.8%), cleft lip and cleft palate (14.1%) and gastrointestinal tract (7.9%). There was increase in incidence of birth defect in NOGH, IGH, East Yangon General Hospital and West Yangon General Hospital and according to system defect, muscular‐skeletal system, central nervous system defect were increasing in 2015. This study helps define the burden of birth defects in the Yangon Region. There is a need for more extensive, nationwide studies to determine the birth prevalence, types and distribution of birth defects in Myanmar.

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Poster ‐ 43 Metabolic risk markers in leptin resistant and leptin sensitive obese adult subjects

Hnin Phyu Soe, Sanda Kyaw and Ohnmar

Department of Physiology, University of Medicine 1, Yangon

There is positive association between serum leptin level and metabolic disorders. Leptin resistance refers to a condition in which some actions of leptin are impaired though its concentration is high. Therefore, the present study aimed to determine the metabolic risk markers in leptin resistant and leptin sensitive obese adult subjects.This study was carried out in 123 obese adult subjects (BMI ≥ 30 kg/m2) aged 20‐60 years. Serum leptin level was determined by ELISA (enzyme‐linked immunosorbent assay) method. Fasting plasma glucose, serum triglyceride and high density lipoprotein cholesterol levels were determined by enzymatic colorimetric methods. Leptin‐to‐BMI ratio (1.55) was used as a cut‐off point to categorize the leptin resistant and leptin sensitive obese groups. Metabolic syndrome was assessed by IDF (International Diabetes Federation) criteria. Among 123 obese adult subjects, 39.8% (n=49) was leptin resistant and 60.2% (n=74) was leptin sensitive. There was no significant difference in metabolic risk markers between the leptin resistant and leptin sensitive obese subjects. Among 123 obese adult subjects, 72.4% (n=89) have metabolic syndrome. The association between leptin sensitivity and metabolic syndrome among obese adult subjects was not found in the present study. Therefore, it is concluded that the present study could not show any conclusive evidence of the role of leptin resistance on metabolic disorders in obese subjects.

Poster ‐ 44 Evaluation of wound healing activity of gelatin‐polyvinyl alcohol‐ Chitosan‐ Eclipta Alba Leaves (Kyeik‐hman) composite film

Khin Khin Aye1, Aye Win Oo1, Nu Nu Lwin1, Than Myat Htay1, Myo Myo Aye1, April Pyone2, Moh Moh Htun1 and Win Maw Tun1

1Department of Medical Research 2University of Yangon

Biomaterials are natural polymers and are biodegradable. The two polymers of Chitosan and gelatin have wound healing properties individually. The gelatin and combination of chitosan‐ gelatin may show improvement in wound healing property. In this study, gelatin was extracted from fish skins of Ngaphe (Notopterus notopterus) which was prepared by simple method using sodium chloride. The gelatin‐polyvinyl alcohol‐chitosan composite films (GPC) and gelatin‐polyvinyl alcohol‐chitosan–Eclipta Alba films (GPCE) were prepared combination for wound healing activity on albino rats. Eighteen healthy albino rats were used in this study and divided into three groups. Each group had six albino rats. The films were prepared

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by (1) chitosan (SIGMA) (1%) and gelatin (10%) solution proportion (1:40) (composite films) with 0.2 ml. Polyvinyl alcohol as plasticizer (GPC) for Group (1) rats, (2) (GPC) and 20% of Eclipta Alba liquid was put in beaker and stirred for 1 hour, after vacuum filtration for removal of entrapped air bubbles on the plastic tray and air dry at room temperature (GPCE) for Group (2) rats. The Group (3) (negative control group) was not applied any treatment on the induced excision wounds (1 cm in diameter) of albino rats. Application mode of all treatment composite film was applied topically, once per day for 20 days was done. The wound area of each animal was measured on the 1st, 3rd, 7th, 10th, 14th, 18th and 20th day after treatment. Specimens of skin from healed wounds from each rat were taken at the 20th day of treatment and were fixed in 10% buffered formalin solution for histopathological studies. Specimens of the healed skin were made at a thickness of 5μ and, were stained with hematoxylin and eosin (H&E), and assessed for histopathological changes. The results showed that the treatment with GPC was the best and showed well wound healing in skin of rat and the presence of complete epithelialization in epidermis layer and normal appearance of granulation tissues in the dermis were observed. Slightly delayed wound healing process in GPCE group of rats. Wound healing was not good in skin of the rats of negative control group and normal epithelial healing process is delayed in epidermis. The present study clearly demonstrated that gelatin‐ polyvinyl alcohol‐chitosan composite film (GPC) and gelatin‐ polyvinyl alcohol‐chitosan‐Eclipta Alba composite film (GPCE) can be used in the management of wound healings.

Poster ‐ 45 Environmental study on Carbapenem‐Resistant Enterobacteriaceae in drinking water and waste water in selected townships of Yangon, Myanmar

Thuzar Myint1, Hideharu Hagiya2, Mya Mya Aye1, Hpoo Pwint Myo Win1, Aye Aye Maw1, Aye Yin Shwe1, Moh Moh Htun1 and Shigeyuki Hamada3

1Department of Medical Research 2Division of Infection Control and Prevention, Osaka University Hospital 3Research Institute for Microbial Diseases, Osaka University

Carbapenem‐resistant Enterobacteriaceae (CRE) is Gram negative bacteria that are difficult to treat because of the highly resistance to antibiotics and an emerging problem of this century. Preventing the transmission of CRE is a public health priority. A cross‐sectional descriptive study was carried out to detect CRE in drinking and waste water samples in Latha and North Okkalapa townships in Yangon from December 2016 to November 2017. Drinking water samples were collected from currently using containers and waste water samples were collected from street drains of the selected households. A total of 220 samples (108 from Latha and 112 from North Okkalapa townships, respectively) were aseptically collected in sterile 50 mL tubes and transported to Bacteriology Research Division. After concentration by centrifugation, each sample was inoculated onto M‐ECC: CHROM agar containing 0.25 µg/mL meropenem and incubated at 37°C overnight. Then the microbial organism identification and antimicrobial susceptibility testing were carried out by using the Vitek 2 automated system and carbapenemase genes were detected by Polymerase Chain Reaction (PCR). CRE were not detected in all drinking water samples from  139  Abstracts of the Posters 46th Myanmar Health Research Congress

both townships. A total of 181 bacterial isolates were detected in 54 waste water samples from Latha Township. Of these isolates, CRE was detected in 8.8% (16/181); Escherichia coli 31.2% (5/16), Citrobacter freundii 25% (4/16) and Enterobacteras buriae 25% (4/16), and Klebsiella pneumoniae 18.8% (3/16). A total of 305 bacterial isolates were detected in 56 waste water samples from North Okkalapa Township. Of these isolates, CRE were detected in 11.1% (34/305); E. coli 52.9% (18/34), K.pneumoniae 17.6% (6/34), E. clocacae 23.5% (8/34) and Providencia spp 5.9% (2/34). Among the CRE isolates, molecular analysis based on PCR revealed that 12 NDM genes from Latha township (25%), and 28 NDM genes (82.4%) and 1 NDM & OXA‐48 genes (2.9%) from North Okkalapa Township. CRE positive waste water sampling sites were found in 16.7% (9/54) in Latha and 21.4% (12/56) in North Okkalapa townships. This study demonstrated the current distribution of CRE in environments in Yangon and is of great help in grasping the real spread of CRE in Myanmar.

Poster ‐ 46 Fasting lipid profile, hs‐CRP and fibrinogen levels in apparently healthy subjects with asymptomatic peripheral arterial disease

Wut Hmone Lwin1, Thidar Aung2 and Ohnmar2

1Department of Physiology, University of Nursing, Yangon 2Department of Physiology, University of Medicine 1, Yangon

Lower extremity atherosclerotic peripheral arterial disease (PAD) is the third leading cause of cardiovascular morbidity, following coronary artery disease and stroke. The present study aimed to find out the prevalence of asymptomatic PAD by measuring ankle brachial pressure index (ABPI) and to determine the serum lipid profile, hs‐CRP and plasma fibrinogen levels in asymptomatic PAD subjects. The present study was a cross‐sectional analytical study, carried out in 441 apparently healthy people aged between 35‐65 years, from North Okkalapa Township, Yangon. Prevalence of asymptomatic PAD was assessed by using Doppler machine and Edinburgh Claudication Questionnaire. For lipid profile, serum total cholesterol level was determined by cholesterol oxidase/phenol aminophenazone method, serum triglyceride level by glycerol phosphate oxidase/phenol aminophenazone method, and serum HDLc level by precipitation method respectively. Serum LDLc level was calculated using Friedewald’s formula. Serum hs‐CRP level was measured by ELISA. Plasma fibrinogen level was determined by coagulation point detection method. The prevalence of asymptomatic PAD was 9.1% (95% CI: 6.4‐11.8%) with mean value of ABPI 0.72±0.09. Among asymptomatic PAD subjects, 92.5% had increased TC level, 57.5% had increased TG level, 90% had increased LDLc level, 67.5% had decreased HDLc level, 60% had increased TC/HDLc ratio, and 92.5% had increased atherogenic index of plasma (AIP). Increased hs‐CRP level was also found in 77.5% and increased plasma fibrinogen level was found in 27.5%. The present study indicated that majority of the asymptomatic PAD subjects were found to have dyslipidemia and systemic inflammation. In addition, there was a significant negative correlation between ABPI and serum TG level (Pearson’s r=‐0.395, p=0.012), between ABPI and AIP (Pearson’s r=‐0.366, p=0.020), between ABPI and serum hs‐CRP level (Pearson’s r=‐ 0.543, p<0.001) and between ABPI and plasma fibrinogen level (Pearson’s r=‐0.489, p=0.001). Regarding the CVD risk assessment, 12.5% of the asymptomatic PAD subjects

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were found to have high risk by Framingham risk score, 77.5% by scoring with hs‐CRP level and 92.5% by AIP scoring. Therefore, it could be concluded that atherosclerotic inflammatory mechanism may be operative even in apparently healthy subjects with asymptomatic PAD and they also have high CVD risk.

Poster ‐ 47 Immunohistochemical expression of RANKL (Receptor Activator of Nuclear Factor Kappa‐B Ligand) in ameloblastoma cases

Kumudra Kyaw1, Kyaw Soe2, Yoshitaka Hishikawa3 and Zaw Moe Thein1

1Department of Oral Medicine, University of Dental Medicine, Yangon 2Department of Medical Research 3Department of Anatomy, Histochemistry and Cell Biology, University of Miyazaki, Japan

Ameloblastoma is a locally invasive and highly recurrent benign odontogenic tumor of oral and maxillofacial region. Solid/multicystic ameloblastoma (SMA) is believed to be more aggressive and need more complicated treatment than unicystic ameloblastoma (UA). Increased production of bone resorption regulators are believed to play an important role in the invasiveness of ameloblastoma within the jaws. The objective of this study was to determine the expression of a bone resorption regulator, RANKL (receptor activator of nuclear factor kappa‐B ligand) in SMA and UA cases. Sixty paraffin‐embedded tissue specimens of histopathologically proven ameloblastoma cases (thirty SMA and thirty UA) were subjected for immunohistochemical examination using anti‐RANKL antibody. RANKL expression was assessed by mean labeling index and compared between SMA and UA cases. No statistically significant difference in RANKL labeling index was detected between SMA and UA cases (p = 0.097). Likewise, no significant difference in RANKL expression was detected among different histopathological subtypes of SMA (p = 0.495) as well as different histopathological subtypes of UA (p = 0.763). Regarding the clincopathological parameters in recurrent ameloblastomas (n = 9), there was a significant association between history of recurrence of ameloblastoma and RANKL expression (p = 0.003). The results indicated an important role of RANKL in bony invasion as well as recurrence of ameloblastoma cases. Almost similar RANKL labeling indices highlighted a comparably aggressive behavior of UA to SMA, thus emphasizing the necessity for equal effort of treatment for UA as in SMA cases.

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Poster ‐ 48 Utilization of skilled birth attendant at delivery in rural area of Myanmar

Khin Htwe Myint1 and Thiri Win2

1Yangon Regional Health Department 2Department of Public Health

Skilled Birth Attendant (SBA) utilization is important to savethe maternal and neonatal lives at delivery which had been set as an indicator for Millennium Development Goals (MDG) 5. The aim of this study was to access the percentage utilization of skilled birth attendant and the associated factors with the using of SBA at delivery in selected rural area of Myanmar. This study was community‐based and the secondary data was collected from the rural area of Thanlyin Township in the southern part of Yangon Region. The sample included 191 mothers who had at least one child within one year delivery. The finding of this study was (76.4%) of the sample used skilled birth attendant at delivery and the significantly association between factor of the utilization of skilled birth attendant at antenatal care for last pregnancy with the utilization of skilled birth attendant at delivery of last child. The result revealed that skilled birth attendant rate of this study was lower than that of the global target of utilization of skilled birth attendant rate for rural area but higher than the national level of skilled birth attendant rate of rural area. The result of suggestion of this study that by improving the utilization of skilled birth attendant at rural area to get the global target of rural areamay be reduce the maternal mortality rate for rural area of Myanmar. In addition, by knowing the requirement factors for utilization of skilled birth attendant at rural area cause the program intervention to encourage the requirement factors from the demand side or maternal side.

Poster ‐ 49 Bacteriological profile and antibiotic susceptibility patterns of multi drug resistant bacteria in diabetic wounds

Mya Mya Aye, Yu Wah Lwin, Than Mya, Hpoo Pwint Myo Win, Aye Aye Maw, Hay Mar Win and Moh Moh Htun

Department of Medical Research

Diabetes mellitus has become a global epidemic illness and poses a threat for development of resistant bacterial infections. Infection in diabetic patients can progress rapidly and difficult to treat because patients have impaired microvascular circulation, resulting in poor concentration of antibiotics in infected tissues. The increasing incidence of antibiotic resistant pathogens in diabetic wounds makes the selection of empiric antibiotic therapy more difficult. Early detection of the causative agent, appropriate antibiotic choice and timely administrated therapy are crucial roles in management of diabetic patients. This cross ‐ sectional hospital and laboratory based descriptive study was conducted during July 2016

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to April 2017 with an aim to isolate multi‐drug resistant bacteria from wound swab samples of chronic diabetic wounds. The isolation, identification and drug susceptibility profile of isolated pathogenic bacteria were done by VITEK 2 automated system. Among the tested 90 wound swab samples, 82 samples (91.1%) showed growth of bacteria. Out of 82 samples, 46 samples (56.1%) had growth of single organism while the rest 36 samples (43.9%) were polymicrobial. A total of 120 bacterial pathogens were isolated. Among the isolated pathogenic bacteria, the predominant gram positive bacteria was Staphylococcus aureus 9.2% (11 of 120), followed by Enterococcus species 2.5% (3 of 120) and coagulase negative staphylococci 1.7% (2 of 120). Among the gram negative bacteria, Pseudomonas species was the predominant isolate, being 31.7% (38 of 120), followed by Citrobacter freundii 25% (30 of 120), Escherichia coli 11.7% (14 of 120), Acinetobacter species 11.7% (14 of 120), Proteus species 5% (6 of 120) and Klebsiella pneumoniae 1.7% (2 of 120). Among isolated gram positive bacteria, 75% (12 of 16) were found to be multidrug resistant bacteria (MDR). Enterococcus species showed 100% resistant to levofloxacin and gentamicin. Among gram negative bacteria, 83.7% (87 of 104) were multidrug resistant bacteria. Isolated Acinetobacter species and E.coli were 100% resistant to cefuroxime and cefotaxime. The findings from this research could help the clinicians in the management of diabetic wound infection and also aid in the management of septic morbidity and mortality.

Poster ‐ 50 Biological control of Aedes larvae using native larvivorus fish Aplocheilus panchax in Hpa‐an Township, Kayin State

Maung Maung Mya1, Nan Than Than Kyi2, Nyunt Nyunt Oo2, Sein Thaung1, Zar Ni Min Hein1, Yi Yi Myint1, Chit That Nwe1, Yan Naung Maung Maung1 and Moh Moh Tun1

1Department of Medical Research 2Hpa‐an University

In temporary water storage containers in community are urgently needed to reduce DF and DHF through mosquito larvae reduction without harmful to environment, ecosystems and community. For biological control of Aedes aegypti larvae, native larvivorus fish as Aplocheilus panchax were collected from creeks, rice fields and ponds in Hpa‐an Township Kayin State. 51 households each were randomly selected in Mingalar Ywar Thit and Taung Nar village as test and control villages in Hpa‐an Township. Laboratory and field study were done from February 2016 to January 2017. In the laboratory a series of laboratory experiments compared Aedes larva consuming rates of Aplocheilus panchax and Trichogaster trichopterus in different water volumes, in order to determine their potential as larva control agent in water storage containers. In the field, Aedes larvae and pupae positivity in containers were recorded in both villages. For intervention, two Aplocheilus panchax/container were put into all containers monthly for 3months in test area of Mingalar Ywar Thit village. Larval and pupal indices were determined before and after intervention. Laboratory result found that one gram weight of Aplocheilus panchax consumed 463.04 3rdand 4th instar Aedes larvae within 24 hours. It was 3.727 fold higher in consuming rate than one gram of Trichogaster trichopterus against Aedes aegypti larvae in

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the laboratory. After intervention, House Index (HI), Container Index (CI) and Breteau Index (BI) were significantly reduced from 86.27%, 59.86% and 172.55 to 1.96%, 1.36% and 3.92 respectively (p<0.05). Hundred percent reduction was found in key containers (500 & above larvae positive/container) and 90% reduction was found in key premises (3 & above larval positive container/house) in test area. Pupae/house, pupae/person, and pupae/child were also significantly reduced from 14.02 pupae/house, 3.59 pupae/person and 12.54 pupae/children to 0.25 pupae/house, 0.07 pupae/person and 0.23 pupae/children. But in control area, larval and pupal indices were gradually increased throughout the study periods. Native larvivorus fish Aplocheilux panchax is an efficient biological agent for the control of DF and DHF vector Aedes immature stages in Kayin State. The biological method is simple and cost effective method for control of DF/DHF in community.

Poster ‐ 51 Care of patients with cancer: Role of the family members

Myo Khin, Khin May Oo, San Shwe, Le Le Win, Htain Win and Aung Myo Min

Department of Medical Research

Many cancer patients today receive part of their care at home. Care is usually given by informal caregivers such as spouses, children, relatives, or even close friends of the community. We analyzed data from the ACTION study to determine some aspects of cancer patients and of those supporting treatment of cancer patients. The study population consisted of 1178 patients seeking treatment at hospitals in Yangon and Mandalay during February 2012 to February 2013. Males (n=489) were significantly older than females (n=689); (51.3 ± 13.2 yrs vs 50.2 ± 11.8 yrs; p=0.05, t test). Analysis was done at three months after diagnosis of cancer. One‐third of patients could not perform their household work anymore; a few (7.2%) need help in personal care (bathing, using the toilet, brushing teeth, etc.), walking around, or getting in and out of the car. Help was routinely provided by family members as 58.2 % of households had more than 4 family members. Those with less than 4 household members help had to be sought from none‐family members such as relatives or community members. Although formal caregivers were hired in a few (12%) of cancer patients, the majority (85%) received care from informal caregivers; mainly from their household members (spouse 28.6%, children 42.9%). The major portion of treatment cost (98%) was borne by the patient and the immediate family while 22.1% of relatives, 5% of close friends, 1.7 % of employers and 5.5% of community members contributed to some of the costs. It is evident that family members play an essential role in the care of cancer patients. Although care is based on love and compassion, majority of the family caregivers need to have some knowledge on side effects of treatment, general nursing care and encouragement of cancer patients, training of home‐based care givers should be considered to improve the quality of care for the cancer patients.

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Poster ‐ 52 Seroprevalence of hepatitis B virus among people living with HIV/AIDS at Waibargi Specialist Hospital

Min Min Win1, Aung Zaw Latt1, Khin La Pyae Tun1, Khin Than Maw1, Kay Khine Soe1 Nwe Nwe Soe1, Mya Ohnmar1, Win Aung1 and Htin Aung Saw 2

1Department of Medical Research 2 Waibargi Specialist Hospital

Hepatitis B virus (HBV) infection is a major global health problem, with 2 billion people infected worldwide, and is the 10th leading cause of death worldwide. Since both the hepatitis B virus and the HIV virus share similar transmission routes, it is not surprising that there is a high frequency of co‐infection. In Myanmar, information is not much on the prevalence of HBV among people living with HIV/ AIDS (PLWHA) patients. Therefore, the aim of the study is to determine the prevalence of HBsAg, anti HBs antibody and HBeAg among PLWHA patients. A total of 171 PLWHA patients were entitled and some questions regarding the risk factors of co‐infection were asked. All entitled patients were tested for HBsAg and anti‐HBs antibody by Enzyme Linked Immunosorbent Assay (ELISA) kit of Standard Diagnostics, Korea and HBsAg positive samples were tested again for HBeAg by ICT device of Standard Diagnostics, Korea. The patient's age range was 20‐65 years, with a mean of 35±7 years with male, female ratio of 1.2:1. Prevalence of HBsAg anti HBs and HBeAg were 11.7%, 32.7% and 20%, respectively. The mean CD4 cell count was 219.7±200.3 cells/mm3 in HBsAg positive HIV patients, 197.8±193.3 cells/mm3 in anti HBs positive HIV patients and 106.0±111.7 cells/mm3 in HBeAg positive in HIV/HBV co‐infection. The degree of immunosuppression is not significantly correlated with HIV/HBV co‐infection, and also no significant associated risk factors for HBV co‐infection in PLWHA patients. In HIV patients with presence of HBV surface antigen, it is important to establish the activity of HBV to differentiate those with active viral replication from chronic carriers. Chronic hepatitis caused by HBV can significantly affect the morbidity of HIV‐infected patients and influence the antiretroviral therapy. Therefore effective prevention is needed to reduce the HBV transmission in HIV/AIDS patients.

 145  Abstracts of the Posters 46th Myanmar Health Research Congress

Poster ‐ 53 Prevalence of abnormal cervical cytology and associated vaginal infections in HIV seropositive women attending Antiretroviral Therapy Clinic at Insein General Hospital, Yangon

Nan Cho Nwe Mon1, Hnin Ohnmar Soe1, Thazin Myint1, Aye Aye Lwin1, Mya Mya Aye1, Aung Zaw Nyunt2, Ne Myo Aung3, Mar Mar Kyi3 and Khin Saw Aye1

1Department of Medical Research 2Obstetrics and Gynecology Unit 3Medical Unit, Insein General Hospital

Human Immunodeficiency Virus (HIV) seropositive women have a higher risk of cervical lesions and cervical cancer than general population because their immunosuppression status might be a constituting a factor that contributes towards the development of pre‐ invasive lesions. This study was aimed to determine the prevalence of abnormal cervical cytology and associated vaginal infections among women attending Anti‐Retroviral Therapy (ART) Clinic, Insein General Hospital. A cross sectional study was conducted among 200 women aged 16‐68 years during 2016 October to 2017 July. The conventional pap smear of cervix was taken by using sterile disposable Ayre’s spatula and modified Papanicolaou method was used for staining. Evaluation and interpretation was done by two senior pathologists and were reported by using Bethesda (2014). A total of 200 women were involved in this study, in which the youngest one was 16 years and the eldest one was 68 years. Their mean age and CD4 count was (34 years) and (466 cells/mm3) respectively. Normal cytology resulted in (81%, 162 cases) and the others were abnormal cervical cytology results (19%, 38 cases) which was significantly higher compared to (8.5%) in women attending cervical cancer screening clinic of Department of Medical Research (DMR) in last year. Among the abnormal cytology cases, 26/38 cases (68.4%) had atypical squamous cell of undetermined significance (ASCUS), 6/38 cases (15.8%) had low‐grade squamous intraepithelial lesion (LSIL), 3/38 cases (7.9%) had high‐grade squamous intraepithelial lesion (HSIL), 2/38 cases (5.3%) had Atypical squamous cells but cannot exclude HSIL (ASC‐H), and 1/38 case (2.6%) had Atypical Glandular Cell (AGC). There was significant association between CD4 count (<=350 cells/mm3) and abnormal cytology results which revealed p value <0.001. Association between abnormal cytology and parity, HIV disease duration, usage and duration of Anti‐Retroviral Therapy were found to be not statistically significant. High vaginal swab culture resulted candida infections (17.8%), candida with associated pathogenic bacterial infection (7.6%), gonococcal infection (2.7%), gram‐negative bacterial infection (21.1%) and gram‐positive bacterial infection (9.2%). According to the results, HIV infection with reduced CD4 count was highly associated with cervical cytology abnormalities. Hence regular cervical smear screening in this group should be needed to reduce the burden of cervical cancer.

 146  46th Myanmar Health Research Congress Abstracts of the Posters

Poster ‐ 54 The requisition and utilization of blood in Yangon Children Hospital, Yangon, Myanmar

Kay Kay Khine2, Thidar Aung1, Myint Myint Than1, Aye Myint Oo2, Hla Hla Win2, Zaw Min Latt2, Win Pa Pa Naing2, Myo Myo Mon2 and Zin Zin Thu2

1Department of Medical Services 2Department of Medical Research

Excess blood requests are a common problem in hospitals. Reservation of blood leads to blood wastage if the blood is not transfused. This study we access on requisition and utilization of blood from different wards in Yangon Children Hospital, Yangon, Myanmar. The study was approved by the Ethics Review committee at the Department of Medical Research, Ministry of Health and Sports, Myanmar. The research project was carried out at the Blood Bank and Clinical Pathology Department, Yangon Children Hospital, Yangon, Myanmar. Blood and blood component requesting forms of 1,003 patients from the different wards of Yangon Children Hospital were included in this study. Blood and blood components order forms were collected and necessary information (gender, ward, diagnosis along with indications for transfusion, patients’ blood group, hemoglobin, platelet count, etc.) were noted as followed with proforma. A total of 3,238 units of blood and blood component requesting from of 1,003 patients from the different wards of Yangon Children Hospital were included in this study. The actual usage of blood units per requested units in each wards were 540/619 (87.2%) in medical wards, 424/591 (71.7%) surgical wards, 1,099/1,117 (98.4%) in hemato‐oncology ward, 356/362 (98.3 %) in Daycare‐Return‐Hemato ward, 148/163 (90.8%) in intensive care unit, 254/295 (86.1%) in neonate wards, 13/37 (35.1%) paediatric orthopedic ward, and 49/54 (90.7%) renal‐medical ward, respectively. We found that more than 75% of ordered blood units were actual used in all wards of Yangon Children Hospital expect surgical and paediatric orthopedic wards. Over ordering with minimal utilization squanders technical time, reagent and imposes extra expenses on patients. This study was conducted to assess blood ordering and utilization according to different wards, Yangon Children Hospital, Yangon, Myanmar. Blood ordering pattern for elective procedures need to be revised and over ordering of blood should be minimized. It will be great supported for the update of blood transfusion guidelines.

 147  Abstracts of the Posters 46th Myanmar Health Research Congress

Poster ‐ 55 Toward a surrogate model for Hepatitis B virus: molecular clones of core‐promoter gene from Myanmar isolates in PGL3B expression vector

Mi Mi Htwe, Myat Htut Nyunt, Ei Kyar Phyu Toe, Su Htet Thwe, Su Mon Win, Sandar Aung, Cho Cho and Yi Yi Kyaw

Department of Medical Research

Hepatitis B virus is regarded as one of the main etiologic factors involved in the development of human hepatocellular carcinoma. HBV has eight different genotypes that are geographically distributed. In Myanmar, A, B, C and D are common genotype. The hepatitis B virus, core gene (C gene) codes for HBeAg and HBcAg. The C gene has a precore and a core region. If translation is initiated at the precore region, the protein product is HBeAg. If translation begins with the core region, HBcAg is the protein product. HBeAg is a marker of HBV replication and infectivity. As the precore region is not necessary for viral replication, the precore mutants can replicate. They are readily detectable by HBV DNA in serum, but hepatitis B e‐antigen (HBeAg) is absent. For downstream applications and functional analysis of the core‐promoter gene of Myanmar genotypes, recombinant DNA technology was applied to create the molecular clones of most prevalent genotypes of HBV in Myanmar and 1.2‐mer WT replicon genome into the luciferase tagged expression vector, PGL3B. All the molecular clones were confirmed by colony PCR, restriction enzyme digestions and targeted sequencing. The clones provide as the molecular models for Myanmar isolates for genotype specific functional expression analysis of the core‐promoter gene in future studies.

Poster ‐ 56 Bridging the gaps for delivering health messages: Identifying barriers and braces for broadcasting health messages through FM radios

Saw Saw1, Thanda Linn1, Phyu Phyu Aye2, Kyaw Lwin Show1, Khine Nyein Chan2, Myat Hsu Paing Thaw2, Saw Hsar Mu Htaw Paw2 and Kyaw Thu1

1Department of Medical Research 2Health Literacy Promotion Unit, Department of Public Health

Frequency modulation (FM) radio which is accessible for the community even in rural areas is an effective channel for delivering health messages. A Cross‐sectional study was conducted in 2017 to describe process of developing health education programmes by FM radios and current linkage between health service programmes and FM radios; and to identify barriers and possible solutions for broadcasting health messages through FM radios. Total of 208audio files related to health were collected for one month from nine FM radios. Eleven key informant interviews (KIIs) with programmers from FM radios and focal persons from health literacy promotion unit (HLPU) were conducted. Qualitative data from KIIs and

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audio files were analyzed with assistance of ATLAS ti version 6.1 software. All FM programmers mentioned source of health messages as mainly from printed media such as newspaper and magazines. There are three main types of health education programmes— Public Service Announcement, Mini drama/radio play and health talks. FM radios received important health announcements through Myanmar Radio and Tele Vision (MRTV). Both programmers from FM radios and respondents from HLPU pointed out weak coordination among them and there was no regular linkage. The most common barrier for FM radios was getting health messages from service programmes regularly and finding speakers for health programmes. Another limitation from FM radio was sparing air‐time if the health talk is long (i.e. more than 15 minutes). Almost all FM radios contact health personal whom they were acquainting previously to make a health programme such as interview or discussion or health talk. All respondents from FM radios suggested to have updated health messages from health service programmes in time. They highlighted there should be regular communications by emails between health service departments and FM radios. All FM radios are willing to deliver health messages and create health programmes. They also preferred having a book includes key health messages from the Ministry of Health and Sports. Findings from this study were utilized by health literacy and promotion unit for strengthening regular communication with FM radios and sending key health messages to FM Radios by emails.

Poster ‐ 57 A study of growth and virulence of Candida albicans in oral squamous cell carcinoma patients

Yin Wai Hlaing, Khin Mya Tun, Kumudra Kyaw, Thein Tun, Sann Win, Sein Shwe and Zaw Moe Thein

Department of Oral Medicine, University of Dental Medicine, Yangon

Candida species are the common oral commensal of the oral cavity and Candida albicans is the most frequently isolated organism in oral candidiasis. Oral squamous cell carcinoma (OSCC) is the commonest cancer in head and neck region. Many authors reported the association between the oral carriage of C. albicans and the development of OSCC. The literatures suggested that the extracellular phospholipases of C. albicans have a significant role in the invasion to mucosal epithelia and further lead to carcinogenic evolvement and the subsequent OSCC development. The purpose of this research was to study the growth and virulence of Candida albicans in OSCC patients. Therefore, a cross sectional descriptive study was conducted on histologically proved 34 OSCC patients and 34 healthy volunteers who came to Department of Oral Medicine, University of Dental Medicine, Yangon. The samples were collected by using oral rinse method. Sabouraud’s dextrose agar and egg yolk agar were used for fungal growth and phospholipase activity testing respectively. After the interpretation of the results of this study, a significant difference in fungal growth was found between OSCC patients and healthy volunteers (p <0.001). In addition, the phospholipase activity was significantly higher in OSCC patients than healthy volunteers (p <0.001). These findings indicated that the growth and phospholipase activity of Candida albicans had a role in the pathogenesis of OSCC.  149  Abstracts of the Posters 46th Myanmar Health Research Congress

Poster ‐ 58 Antibiogram of patients admitted to Medical Unit 3, Yangon General Hospital

Min Zaw Oo1, Aye Mon Win1, Kyaw Lwin Show2 and Saw Saw2

1Department of Medical Services 2Department of Medical Research

Antibiotics is one of the greatest development of medicinal field. However, its resistance followed due to improper and irrational usage. Antimicrobial resistance is an emerging global public health threat especially in developing countries according to World Health Organization (WHO). This study aimed to find out types of common pathogens and antibiotic sensitivity among hospitalized patients. The cross‐sectional study was conducted from January to September, 2017 in Medical Unit 3, Yangon General Hospital. Two hundred and thirteen patients who were suspected febrile sepsis were taken samples for culture and sensitivity (C&S) tests and sent to the laboratory. Descriptive analysis was carried out by SPSS version 21.0. The mean age of the person sent for C&S was 52.62 ± 18.26 years and half of them were males. The samples were sent from sputum (50%, 106/213), urine (22%, 48/213), blood (11%, 23/213), wound (10%, 22/213) and others (7%, 14/213). In this study, 137 (66.2 %) from 213 patients had positive results. Among cultures, sputum (77%, 82/106) and wound (82%, 18/22) samples had the most positive result. The most common pathogens presented from C&S were Klebsiella, Escherichia coli and Staphylococcus. Klebsiella, Acinetobacter, Streptococcus and Staphylococcus were most common pathogens found in sputum C&S. Among urine C&S, Escherichia coli, Enterococcus and Klebsiella were most common and Escherichia coli, Klebsiella and Staphylococcus were most common in both blood and wound C&S. Imipenem and meropenem were most sensitive antibiotics against Klebsiella and Escherichia coli. For Staphylococcus infection, quinupristin/ dalfopristin, Vancomycin and Clindamycin were most sensitive antibiotics. The study highlighted most of the microorganisms isolated were resistant to different types of antibiotics. Therefore, it is necessary to ensure rational use of antibiotics based on isolated pathogens, clinical course and culture sensitivity results.

Poster ‐ 59 Relationship between plasma nitric oxide level and peripheral sensory neuropathy in type‐2 diabetes mellitus patients with neuropathy

Lwin Zin Phyo, Thae Nu Htwe and Ohnmar

Department of Physiology, University of Medicine 1, Yangon

Diabetes mellitus is a state of chronic hyperglycaemia. As a consequence of longstanding hyperglycaemia, a downstream metabolic cascade leads to peripheral nerve injury. It is unclear whether plasma NO level is reduced or increased in diabetic peripheral neuropathy. Therefore, this study aimed to find out the relationship between plasma NO level and

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vibration perception threshold (VPT) in type‐2 diabetes mellitus patients with neuropathy. Plasma NO level was determined by Griess method with Cayman Chemical Nitric Oxide Colorimetric Assay kit. Peripheral neuropathy was determined by biothesiometer and expressed as VPT. The present study was a cross‐sectional descriptive study carried out in 116 type‐2 diabetes mellitus patients with 5 years or more disease duration. Mean VPT of all patients was 21.2±10.67V. Among them, 66.4% of the patients had neuropathy (n=77, mean VPT‐26.33±9.45V) and 33.6% had no neuropathy (n=39, mean VPT‐11.08±2.69V). Tenpatients were randomly selected as a control group from T2DM patients without neuropathy. According to VPT score, patients with neuropathy were subdivided into mild (24.1%), moderate (12.9%) and severe (29.4%). Mean plasma NO level of patients with severe neuropathy (15.21±5.23 µmol/L) was significantly higher than that of those with mild neuropathy (11.8±4.27 µmol/L) (p<0.008) and that of those with no neuropathy (10.18±4.27 µmol/L) (p<0.008). A weak positive correlation was found between plasma NO level and VPT in patients with neuropathy (r=0.33, p<0.05, n=77) and also found in T2DM patients (r=0.38, p<0.05, n=87).According to the results of the present study, it was found that NO seems to be involved in the development of diabetic peripheral neuropathy.

Poster ‐ 60 Assessment of the efficacy of locally delivered Azadirachta indica (Neem) extract gel in chronic periodontitis

Hnin Yu Lwin

Department of Periodontology, University of Dental Medicine, Yangon

The present study aimed to assess the efficacy of locally delivered Azadirachta indica (Neem) extract gel as an adjunct to nonsurgical periodontal therapy in the management of chronic periodontitis. The treatment of periodontitis mainly focuses on the reduction of the total bacterial count. Plaque control in periodontics range from mechanical debridement of tooth surfaces and home plaque removal to local and systemic delivery of chemical antimicrobial agents. In recent times, herbal products as novel drugs are tried in local drug delivery. Neem has multi‐various actions like anti‐microbial, anti‐septic, and anti‐ inflammatory properties. This study was conducted at the Department of Periodontology, University of Dental Medicine, Yangon. A total of 44 sites from 44 subjects with chronic periodontitis were included after obtaining a fully‐formed consent and were randomly collected by balanced randomization method into two groups. This study was approved by the Ethical Review Committee of the University of Dental medicine, Yangon. Study group was treated by scaling and root planing with locally delivered neem extract gel whereas control group was treated by scaling and root planing alone. The clinical parameters [Plaque Index (PlI), Gingival Index (GI), Probing Pocket Depth (PPD), Clinical Attachment Level (CAL)] were recorded at baseline and 6th week after treatment. The results showed improvements in clinical parameters at both study and control sites. On comparison of clinical parameters at baseline and 6th week after treatment, a mean change of PPD of 1.79±0.04 in study group and 1.12±0.04 in control group were observed. It indicated a statistically high significant difference (p<0.05). This study revealed that the adjunctive use of locally delivered neem extract gel with no known side effects has promising results.  151  Abstracts of the Posters 46th Myanmar Health Research Congress

Poster ‐ 61 Detection of norovirus among children under five years old with acute gastroenteritis and comparison of clinical features of norovirus and rotavirus gastroenteritis

Theingi Win Myat1, Hlaing Myat Thu1, Ye Myint Kyaw2, Nang Sarm Hom1, Thin Thin Shwe1, Thida Kyaw1, Khin Khin Oo1, Moh Moh Htun1 and Kyaw Zin Thant1

1Department of Medical Research 2Yangon Children Hospital

Enteric viruses have been recognized as the most significant etiological agents of acute gastroenteritis (AGE) in children under five years old worldwide. Among enteric viruses, rotavirus (RV) is the commonest causal agent and norovirus (NoV) is next to RV. There is no study on detection of NoV and no baseline data in Myanmar although NoV is on the rising trend and of increasing global interest. This study, therefore, aims to investigate the proportion of diarrhea caused by NoV in children under five years old and compare the clinical features of NoV and RV gastroenteritis. From 820 stool samples collected and previously screened for RV in under‐five children admitted to Yangon Children Hospital (YCH) for diarrhea between January and December 2016, 270 samples were randomly selected for detection of NoV by IDEIATM Norovirus EIA kit. NoV was detected in 10/270 (3.7%) and all positive cases were under 2 years of age, comprising 5/10 (50%) of 6‐11 month and 5/10 (50%) of 12‐23 month age groups. More males were infected with NoV than females accounting male to female ratio of 2.3:1. Proportion of RV positive cases accounted for 125/270 (46%) and the most affected age group was 6‐11 month. Dual infection of RV and NoV was not found in this study. Compared with NoV infections, RV gastroenteritis cases had a significant higher percentage of fever (82% vs. 40%, p<0.05) and severe category of Vesikari scoring (80% vs. 50%, p<0.05). Dehydration was more common in RV infections (62% vs. 40%) and vomiting was more common in NoV infections (90% vs. 84%), however, these differences were not statistically significant. This information is the first and baseline data of NoV infection in under five years old children hospitalized for diarrhea in Myanmar. In countries where rotavirus vaccine has been introduced, the prevalence of RV infection is decreasing and NoV is taking place as the leading cause. Therefore, although percentage of NoV infection is low at present, surveillance is recommended to carry out alongside with RV to understand the disease pattern and changes in post rotavirus vaccination era and future norovirus vaccine development.

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Poster ‐ 62 Detection of extended spectrum beta lactamase and carbapenemase producing extra‐intestinal pathogenic Escherichia coli by phenotypic methods and antimicrobial sensitivity profile

Nilar San, Win Win Maw, Mya Mya Lwin and Thin Thin Mar

Department of Microbiology, University of Medicine 2, Yangon

Extended spectrum beta‐lactamase (ESBL) producing extra‐intestinal pathogenic Escherichia coli is associated with antibiotic resistance among different infections and cause treatment failure. The microbiology laboratory plays an important role in routinely detecting and reporting the isolation of ESBL‐producing isolates. This study revealed the recent status of ESBL producing E. coli in NOGTH, Myanmar, providing useful information to improve clinical infection control practice and help in guiding appropriate antibiotic use. In this study, 426 (5.6%) E. coli isolates were identified from 7611 clinical specimens submitted to Microbiology laboratory of North Okkalapa General and Teaching Hospital during 2016. Identification of E. coli and antimicrobial sensitivitywas done by conventional method. ESBL productions were detected by phenotypic confirmatory tests (combination disc test, double disc synergy test) and carbapenemase productions (Modified Hodge Test). Of 426 isolated E. coli, (84.5%) were sensitive to meropenem, the most sensitive antibiotic. The second highly susceptible antibiotic was amikacin (67.8%), followed by cefoperazone/sulbactum (66.4%). Among them, 209 (49.1%) isolates were ESBL producers. ESBL producing strains were more resistant to antibiotic than non‐ESBL strains, resistant to meropenem was (20.1% vs 9.2%), cefoperazone/sulbactum (33.5% vs17.1%), amikacin (36.4% vs18.9%), gentamicin (76.1% vs 47.9%), levofloxacin (87.1% vs 52.1%), cotrimoxazole (93.3% vs65.4%), amoxicillin clavulanic acid (92.3% vs 71%), ceftriazone (99% vs 28.6%). Among 209 ESBL‐ E. coli, 24 (11.5%) isolates were resistant to all (18) antibiotics tested in the current study. Phenotypically carbapenemase producing strains were detected in 8.9% (38/426) of total E.coli isolates. The reporting of ESBL producing strains from the clinical samples will be useful for the clinicians to select the appropriate antibiotics for the treatment of these strains and to take proper precautions to prevent the spread of these resistant organisms. The failure to detect these enzymes results in an uncontrolled spread of these organisms and finally, therapeutic failures. This study highlights the need for the routine detection of ESBL producers by specific tests.

 153  Abstracts of the Posters 46th Myanmar Health Research Congress

Poster ‐ 63 Determination of formaldehyde content in clothing and toys for children

Mya Mar Lar, Khin Phyu Phyu, San San Htwe, Phyo Wai Zin, Tin Tin Han, Ohanmar Win, Tin Tin Htike, Aye Thidar Htun and Thandar Wint Wint Aung

Department of Medical Research

Formaldehyde is a colourless, reactive and strong smelling gas at room temperature. It is one chemical in a large family of chemical compounds, CH2O, called volatile organic compounds (VOCs). Formaldehyde resins are used in fabrics to bind pigments to the cloth, to enhance wrinkle resistance and water repellency, as well as to provide stiffness and to use as a fire retardant. Increases in temperature (hot days) and increased humidity both increase the release of formaldehyde from coated textiles. Formaldehyde is carcinogenic and allergenic. The permissible limit of formaldehyde content in textiles used in clothing and toys for children under 3 years of age is 30 mg/kg or 2.5 mg/L (The European standard). The aim of this study was to determine and compare the content of formaldehyde concentration of clothing and toys for children. Fifty clothing samples and 50 stuffed toy samples were collected randomly from the various markets in Yangon during January to March 2017. Formaldehyde content was determined by UV/Vis Spectrometry (UVmini‐1240, Shimadzu Japan) according to the water extraction method (ISO 1418‐1). The result showed that formaldehyde content was in the range of 0 to 4629 mg/kg for clothing samples. Forty‐one clothing samples (82%) showed free of formaldehyde. Nine clothing samples (18%) found above the permissible limit of formaldehyde. Among 9 samples, 1 sample showed 154 times higher than the permissible limit. In the toy samples, formaldehyde concentration was in the range of 0 to 57 mg/kg. Formaldehyde was free in all toy samples except one sample. The level of formaldehyde concentration was higher in clothing samples than toy samples. This study showed that high formaldehyde concentration in clothing and toys for children under 3 years of age and recommended that new clothing should be washed before wearing to reduce the level of formaldehyde.

Poster ‐ 64 Characterization of Culex Flavivirus isolated from mosquitoes collected in Myanmar

Aung Kyaw Kyaw1,2, Mya Myat Ngwe Tun1, Yi Yi Mya2, Hlaing Myat Thu2, Kyaw Zin Thant2 and Kouichi Morita1

1Virology Department, Institute of Tropical Medicine, Nagasaki University, Japan 2Department of Medical Research

An entomological surveillance of arboviruses was conducted in Myanmar in 2014. A total of 8,357 Culex mosquito vectors were collected in the Mandalay area and virus isolation was done by using mosquito cell line. A total of eighteen strains of Culex flavivirus (CFV) were

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isolated from Culex tritaeniorrhynchus, Culex vishuni and Culex fusocephalus. Like other insect‐specific flaviviruses, CFV can replicate only in mosquito cells but not in mammalian cells. CFV strains isolated in Myanmar were closely related to the Wang Thong virus detected from Culex fusocephalus in Thailand and Culex theiliri flavivirus (CTFV) isolated from Culex theileri mosquitoes in Portugal and Turkey. They encode a single open reading frame with 3357 amino acid residues. They have the characteristics of flaviviruses and have 95.62% amino acid identity with CTFV. This is the first report of CFV in Myanmar with the characterized viral genome. This study illustrated that CFV was circulating among the vectors of human pathogenic arboviruses in Myanmar but the impact of CFV on other flaviviruses which are endemic in the study area still remains to be explored.

Poster ‐ 65 Relationship between insulin sensitivity and body fat composition, and leptin sensitivity in non‐obese and obese adults

Khin Mi Mi Lay1, Sanda Kyaw2 and Ohnmar2

1Department of Medical Research 2University of Medicine 1, Yangon

Both leptin and insulin are major contributors for the body energy balance. Obesity is a state of energy imbalance. Obesity is associated with both leptin sensitivity and insulin sensitivity. The aim of this cross‐sectional analytical study was to find out the relationship between insulin sensitivity and body fat composition, and leptin sensitivity in non‐obese and obese adults. A total of 86 adults participated: 42 non‐obese (body mass index (BMI) between 18.5 and 24.9 kg/m2) and 44 obese (BMI≥25 kg/m2). Body fat (BF) percent was determined by skinfold method. Fasting plasma glucose was analyzed by glucose oxidase‐phenol and 4 aminophenazone (GOD‐PAP) method using spectrophotometer, fasting serum insulin and leptin concentrations by direct sandwich ELISA method and resting energy expenditure (REE) by indirect calorimetry. Leptin sensitivity index and insulin sensitivity were expressed as REE : Leptin ratio and homeostatic model assessment‐insulin resistance (HOMA‐IR), respectively. It was found that median (interquartile range, IQR) values of HOMA‐IR was significantly higher [2.93 (1.77‐4.15) vs 1.72 (1.35‐2.65), p<0.01] and leptin sensitivity was significantly lower [116.76 (77.28‐202.94) vs 265.66 (166.3‐489.71), p<0.001] in the obese adults than the non‐obese adults, indicating that insulin sensitivity and leptin sensitivity were markedly reduced in obese adults in compare to non‐obese adults. There was a significant positive relationship between HOMA‐IR and BF in all adults (ρ = 0.39, n = 86, p< 0.001) whereas a significant negative relationship between leptin sensitivity index and BF was found in all adults (ρ = ‐ 0.656, n = 86, p < 0.001). A weak negative relationship between leptin sensitivity index and HOMA‐IR was found in all adults (ρ = ‐ 0.354, n = 86, p < 0.01). It can be concluded that the insulin sensitivity was adiposity dependent, but, it did not depend on leptin sensitivity.

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Poster ‐ 66 Parvovirus B19 infection in children with fever and rash

Mo Mo Win1, Kyi Kyi Nyein Win1, Thin Thin Wah1, Kay Thi Aye1, Ye Myint Kyaw2, Su Nyein Aye1, Tin Tin Htwe1, May Than Htay1 and Zin Mi Thein1

1Department of Medical Research 2Yangon Children Hospital

Parvovirus B19 infection, also known as Fifth disease or Erythema Infectiosum is common worldwide with prevalence that varies according to age and geographical location. Despite Parvovirus B19 has the wide range of clinical manifestations, there is still no available data on the prevalence of it’s infection in Myanmar. The aim of this study was to identify Parvovirus B19 infection in children with fever and rash admitted to medical wards of Yangon Children Hospital (YCH). Two hundred and thirty nine serum samples were collected from children with fever and rash at YCH during 2016‐2017. The samples were collected within 7‐10 days of illness to detect IgM and NS1gene (a non‐ structural regulatory gene) of Parvovirus B19. The age of the children with fever and rash ranged from 2 months to 12 years. The serum samples were tested for anti‐Parvovirus B19 IgM by using Enzyme Linked Immunosorbent Assay (ELISA) (EUROIMMUN, Germany). Of 239 serum samples tested, Anti Parvovirus B19 IgM was detected in 16 cases (6.69%). Age of the IgM detected cases ranged from 1 to10 years and among them 5‐9 year age group comprised the highest proportion i.e 11 cases (68.75%). All 16 parvovirus B19 IgM positive cases presented with fever and rash (100%each), 12 cases (75%) had rhinorrhoea, 7 cases (43.75%) had headache and 5 cases (31.25%) had arthritis but typical presentation, a slapped cheek rash was not detected in all cases. Extraction of DNA was done on IgM positive 16 serum samples and further analyzed by nested conventional polymerase chain reaction using primers designed from Department of Infection and Immunity, Luxembourg to detect NS1 gene of Parvovirus B19. NS1 gene of Parvovirus B19 was detected in 12 cases (75%). This study contributes the baseline virologic data for introducing awareness of Parvovirus B19 infection in Myanmar.

Poster ‐ 67 Effectiveness of green tea (Camellia sinensis) mouthwash on periodontal wound healing following gingivectomy

Ye Myat Hein1, Soe Tun1, Kyaw Thiha1 and Mar Lar Kyi2

1University of Dental Medicine, Mandalay 2University of Dental Medicine, Yangon

Green tea (Camellia sinensis) is considered as a healthful beverage due to the biological activity of its polyphenols, catechins which have diverse biological properties such as anti‐ oxidative, antimicrobial and anti‐inflammatory for periodontal health. Gingival overgrowth is rather common and related to a variety of etiologic factors and pathogenic processes.

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Gingivectomy may be indicated to remove diseased tissue, for prosthetic reasons, to improve esthetics and/or establish normal gingival architecture, and to reduce probing depth of periodontal pockets. The aim of the present study was to investigate the effectiveness of green tea mouthwash on periodontal wound healing following gingivectomy. A total of 36 participants with gingival enlargement, aged 30‐55 years, [18 for study group (5% green tea mouthwash) and 18 for control group (0.12%chlorhexidine mouthwash)] were included in this double‐blind randomized controlled trial. Periodontal wound healing is assessed by clinical parameters of plaque index (PI), gingival index (GI) and bleeding on probing (BOP) at baseline, 2nd week and 4th week after gingivectomy. After given prescribed mouthwash for seven days following gingivectomy, the PI, GI and BOP scores of both groups were significantly decreased clinically and statistically. No obvious side effects were noticed in the study group. The mean scores of the PI, GI and BOP of the study group at 2nd week were 2 ± 0.49, 1.33 ± 0.77 and 0.11 ± 0.32 respectively while the mean scores of the control group were 2.06 ± 0.24, 1.28 ± 0.67 and 0.33 ± 0.59. At the 4th week, the mean scores of the PI, GI and BOP of the study group were 1.61 ± 0.61, 0.67 ± 0.59, and 0 whereas the mean scores of the control group were 1.28 ± 0.46, 0.39 ± 0.5 and 0.06 ± 0.24. There was no statistical significance (p>0.05) of clinical parameters between study and control groups. The results showed that green tea mouthwash and chlorhexidine mouthwash have similar effects in reduction of dental plaque and gingival inflammation which promote the periodontal wound healing. This study supports that the effectiveness of green tea mouthwash is comparable with chlorhexidine gluconate mouthwash on periodontal wound healing after surgery.

Poster ‐ 68 Sexual and reproductive health behaviors of young people in Southern Shan State, Myanmar

Hla Mya Thway Einda1, Khaing Nwe Tin1, Wai Wai Han2, Saw Saw2 and Sabai Thet3

1Maternal and Reproductive Health Division 2Department of Medical Research 3Myanmar Partners for Policy and Research

Despite many male youth in Myanmar are engaging in sexual activity before marriage, information about sexual activity among unmarried youth is not available. This study was performed with the aim of identifying sexual reproductive behaviors of young people and their contraceptive utilization to provide evidence in establishing contraceptive service delivery which will fulfill the young people’s needs. A mixed method research was conducted targeting 18‐24 years old unmarried men and women both in‐school and out‐of‐ school in two townships of Southern Shan State, Myanmar. This study involved structured self‐administered tablet based questionnaire survey with 424 young people and 12 focus‐ group‐discussions with young people. Focus groups were assigned by residential area (rural or urban) and sex of the respondents. Half of them (222, 52.4%) had boy/girlfriends and 50 (11.8%) had pre‐marital sex. About 50% of them did not know any kind of contraceptive methods. Among those who have had sex, 31 (62%) had used contraceptives. They mostly obtained contraceptives from drug shops (23, 74.2%). The average age of first sex was  157  Abstracts of the Posters 46th Myanmar Health Research Congress

191.8 years. Focus‐group‐discussions revealed that most of them encountered challenges in obtaining contraceptives and the key barriers were too shy to buy and afraid of being reproached. Financial barrier to obtain contraceptives was rarely found. Family planning services provided at government‐health‐facilities were hardly aware. Being young and unmarried was also a barrier in receiving contraceptive services. Almost all agreed that contraceptive information and services should be given to unmarried young people to prevent unwanted pregnancy, abortion and sexually transmitted infections (STIs). Facebook was one of the most popular and influential media among them in obtaining reproductive health related information. The average age of first sex among respondents was compatible with other Asian studies. Although pre‐marital sex becomes increasing among young people, contraceptive services are not targeting towards them. In order to avoid contracting STIs including HIV, unwanted pregnancy, unsafe abortion and their social consequences, reproductive health information including knowledge about contraception should be provided to youth as early as possible through facebook as their craving channel. Contraceptive services targeting unmarried young people are urgently needed through establishing youth friendly health facilities.

Poster ‐ 69 Diagnosis of extra‐pulmonary tuberculosis of clinically suspected cases by PCR

Kyi May Htwe1, Aye Aye Lwin1, Khine Zar Win1, Hlaing Mya Win2 and Khin Saw Aye1

1Department of Medical Research 2Yangon General Hospital

Tuberculosis (TB) is one of the major public health problems and caused by various species of mycobacteria among which Mycobacterium tuberculosis (MTB) is the most frequent specie. Extra‐pulmonary tuberculosis (EPTB) constitutes about 15‐20% of TB cases. This study was conducted to diagnose EPTB by polymerase chain reaction (PCR) as an additional tool along with conventional method which is AFB smear by Ziehl‐Neelsen staining. A total of 109 clinically suspected tuberculosis patients attending Medical Unit 1, Yangon General Hospital from 2016 to 2017 were included in this study. All patients were AFB smear negative and three different types of samples were analysed for MTB. Mycobacterial DNA was extracted from 47 samples (43.1%) of cerebrospinal fluid, 32 samples (29.4%) of pleural fluid, 29 samples (26.6%) of ascitic fluid and 1 sample (0.9%) of pericardial fluid using beads solution method. PCR amplification was performed to detect a 123‐bp region from MTB targeting the IS6110. Mean age of study population was 44.7 ± 16.8 and age ranged from 13 to 78 years. About 55.04% (60/109) of male gender were included in this study. 16.5% (18/109) of patients had previous history of TB, 9.2% (10/109) got anti‐TB treatment and 10.1% (11/109) had history of TB contact in family. Most of patients (70%) had low grade fever and weight loss. About 3.7% (4/109 samples) were positive by PCR for MTB and those were three pleural fluid and one ascetic fluid sample. All PCR positive patients were male. In suspected EPTB cases, when conventional microbiological tests almost fail, PCR results along with the clinical presentation may be adequate to initiate anti‐tuberculous treatment.

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Poster ‐ 70 The blood pressure responses after oral glucose load in lean and centrally obese adult male subjects

Thiri Win Htein, Zarli Thant and Ohnmar

Department of Physiology, University of Medicine 1, Yangon

The vasodilator action of insulin might contribute to the reduction of blood pressure in the postprandial state and it remains to be clarified whether this action is impaired in the insulin‐ resistant obese state or not. The present study aimed to determine the blood pressure responses after an oral glucose load in lean and insulin resistant centrally obese adult male subjects. It was a quasi‐experimental study with repeated measures. This study was carried out in eleven lean and eleven centrally obese adult male subjects. After a 75 g oral glucose load, blood pressures were measured at 15‐minute intervals and the serum insulin level was determined at 30‐minute intervals for two hours. Blood pressure was measured by manual sphygmomanometry. Plasma glucose concentration was determined by glucose oxidase method and serum insulin concentration was analyzed by ELISA method. All centrally obese subjects were insulin resistant (HOMA‐IR≥2.6). After oral glucose load, serum insulin level reached to peak value at 60 minutes in the lean subjects and at 90 minutes in the centrally obese subjects. The per cent change in glucose‐stimulated insulin responses at 30 minutes (626% vs 344%, p<0.05) and at 60 minutes (756% vs 417%, p<0.01) were significantly greater in the lean group than the centrally obese group. The fall in postprandial blood pressures started at 15 minutes and returned to baseline values at 120 minutes, with a maximal fall at 30 minutes in both groups. The percent change in SBP at 15 minutes (‐2.2% vs ‐1.2%, p<0.05) and at 30 minutes (‐3.2% vs ‐2.1%, p<0.05) were significantly greater in the lean group than the centrally obese group. There was no statistically significant correlation between change in serum insulin and change in BPs at all time‐points in both groups. A lesser change in glucose‐stimulated insulin responses as well as attenuation in BP responses in the centrally obese subjects might be attributable to the presence of insulin resistance.

Poster ‐ 71 Relationship between blood flow velocity indices of various arterial sites and microangiopathy in type 2 diabetes mellitus patients

Nan Yadanar Lwin, Ohnmar Myint Thein and Ohnmar

Department of Physiology, University of Medicine 1, Yangon

Haemodynamic changes are first to develop in type 2 diabetes mellitus patients (T2DM) with its vascular complications such as microangiopathy and macroangiopathy. The present study aimed to find out the relationship between haemodynamic parameters (blood flow velocity indices) of various arterial sites (carotid, brachial and dorsalispedis arteries on both

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right and left sides) and the degree of microangiopathy in T2DM patients. The present study was a hospital‐based cross‐sectional analytical study including 62 T2DM patients (45 ‐ 65 years) and 10 apparently healthy subjects (45 ‐ 65 years) as a normal control group. Blood flow velocity indices (resistance index, RI and pulsatility index, PI) were measured at various arterial sites by using continuous wave Doppler ultrasound with 8 MHz probe under resting condition. The degree of microangiopathy was assessed by the urine albumin‐to‐creatinine ratio (uACR). Urine albumin was determined by HemoCueurine albumin 201 analyzer and urine creatinine by auto‐creatinineliquicolor with Jaffe reaction. Those with uACR< 30 mg/g were regarded as T2DM without microangiopathy (n = 30) and those with uACR≥ 30 mg/g were regarded as T2DM with microangiopathy(n = 32). Both RI and PI on both right and left sides were found to be progressively and significantly increased from carotid to dorsalispedis arteriesin all three study groups. The RI of right brachial artery and PIs of both right and left brachial arteries were found to be significantly higher in T2DM with microangiopathythan normal control subjects and T2DM without microangiopathy. However, there was no significant difference in these indices in all other arterial sites. In addition, there was a significant positive correlation between uACR and PI in right (Spearman’s ρ = 0.39, p = 0.002) and left (Spearman’s ρ = 0.32, p = 0.013) brachial arteries in all T2DM patients. It can be concluded that peripheral resistance is increased in medium‐ sized brachial arteries in T2DM patients with microangiopathy. Thus, it could be assumed that other medium‐sized arteries in the body might also have increased peripheral resistance and atherosclerosis.

Poster ‐ 72 Effects of King Cobra (Ophiophagus hannah) venom and Tamarind (Tamarindus indica) seed extract on liver and kidney of mice

Khin Maung Maung1, Imad M. Al‐Ani2, Soraya Ismail2 and Pakeer Oothuman2

1Department of Medical Research 2Kulliyyah of Medicine, International Islamic University, Malaysia

The objective of the present study is to investigate protective effects of tamarind (Tamarindus indica) seed extract on adverse histological reaction of venoms of the King Cobra (Ophiophagus hannah). Twenty healthy mature male mice were randomly divided into 4 groups with 5 mice in each. The control group (C) was injected with 0.1 mL of normal saline. The second group (V), third group (TV1) and fourth group (TV2) was injected subcutaneously with a single dose of 24.96 µg/20 g King Cobra venom (KCV) solution. Thirty minutes after injection of the venom 10 mg/20 g and 15 mg/20 g of Tamarind seed extract (TSE) were injected subcutaneously to third group (TV1) and fourth group (TV2) respectively. The animals were sacrificed after 24 hours of injection of the solution. Fragments of kidney and liver were fixed in 10% buffered formalin, and processed for light microscopical studies. The liver mice of group V, treated with KCV solution showed degenerative changes in most of the hepatic lobules and dilatation in the central veins and the sinusoids. The kidney revealed shrunken glomeruli, dilatation of Bowman capsule and degenerative changes in the renal tubules. Treatment with TSE reduced the histopathological changes induced by the King Cobra venom in liver and kidney and the

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improvement was proportional to the applied dose of the TSE. The observation indicates that tamarind seed extract prevents adverse histological changes in the liver and kidney.

Poster ‐ 73 Screening of hearing impairment with pure‐tone audiometer among military personnel

Kyaw Soe Htun, Kyaw Htin Latt, Htun Lin Moe, Thein Zaw and Tin Maung Hlaing

Defence Services Medical Research Centre

Hearing impairment is a common problem but under‐reported in many circumstances. Hearing loss and impairment affects health and quality of life causing hard time in social life. More than 4% of the world’s population (278 million) is estimated to have impaired hearing with disability while approximately two‐thirds of them live in developing countries. In WHO report (2012), the highest prevalence rate of hearing loss was observed in Southeast Asia reaching 27%. The objectives were to describe the socio‐demographic and risk factors, to determine the prevalence of hearing impairment and/or loss, and to evaluate utility of hearing handicap inventory for the screening (HHI‐S) questionnaire. Participants were recruited into this study from military training school during August – September, 2017. The subjects were properly explained and consent was taken. History taking including HHI‐S questionnaire, general examination and assessment of hearing status by portable pure tone audiometer were performed in a quiet room. One hundred participants were involved in the study. The prevalence of hearing loss was 67%. The greater rank of participants had more chance to cause impairment because they had longer duration of services (OR = 4.316, P = 0.038). The subjects who did not wear personal protective equipment (PPE) were associated with hearing loss (OR = 8.547, p = 0.003). The age group above 40 years was more affected because most of them were strongly exposed to weapon noise. Using HHI‐S questionnaire, the sensitivity of question on self‐reported on hearing loss was 78%. Fifty‐two staffs were self‐perceived. Hearing impairment was confirmed with audiometer. Negative psychosocial impact as a result of hearing loss was 30.77%. Fifty‐one percent did not like to use the hearing aid even if it was recommended. It can be concluded that prevention and screening should begin as early as in young adult particularly in this kind of working environment. Minimizing this morbidity with effective preventive measures like using suitable gear in high‐risk groups may improve the quality of life and then to bring public health benefits.

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Poster ‐ 74 Point of care diagnosis of asymptomatic falciparum malaria cases by ultrasensitive rapid diagnostic test

Myat Phone Kyaw1, Aung Thi2, Than Naing Soe2, Tint Wai Tun2, Sithu Ye Naung2, Aye Than1, Cho Cho1, Kyaw Kyaw San1 and Zaw Lin2

1Department of Medical Research 2National Malaria Control Program

Asymptomatic malaria infection serves as a critical silent reservoir. The molecular method (qPCR[Quantitative Polymerase chain reaction]) can detect more asymptomatic falciparum malaria cases but it takes time to get result. The artemisinin resistance has come out that it is necessary to detect positive cases at point of care. The prevalence of asymptomatic falciparum malaria by using ultra‐sensitive RDT (usRDT) will estimate the true burden of infection at point of care. Therefore, field based cross sectional simple descriptive research was carried out in 12 villages in 4 townships, Bilin (Mon State), Paletwa (Chin State), Tabeikyin (Mandalay Region) and Banmauk (Sagaing Region) where high malaria prevalence rate of 0.18%; 20.1%, 0.82% and 0.87% have been noted in 2016 together with entomological finding of primary malaria vector Anopheles dirus and A. minimus. Mass blood survey was done during June and July 2017. Study population is all the people age one year and above with no symptoms of malaria and was selected randomly to get targeted sample size. The conventional RDT and parasite counts by malaria microscopy by expert microscopist has also done together with usRDT in the field, including internal validation of Microscopy. Paletwa has highest positive rate of asymptomatic malaria 2.04% (13 positive out of 636 screened), Banmauk has 1.27% (8/631), Tabeikkyin has 0.48% (2/412) and Bilin has no positive cases in 315 persons screened. Conventional RDT results were negative and only one subject at Paletwa has been positive by Microscopy. The prevalence of asymptomatic falciparum malaria detected by qPCR in 9 villages of 3 townships in Tanintharyi Region is between 2% to 10.2% during May to July 2015 done by Community Partners International. Thus the usage of usRDT with careful travel histories, will help in identifying areas with ongoing malaria transmission in future. This strategy will be useful in malaria elimination.

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Poster ‐ 75 Parameters predicting poor prognosis in patients with malignant ascites

Ssu Wynn Mon1, Myo Myint Maw2, Han Win1, Hsu Theingi1 and Theingi Thwin1

1Department of Medical Research 2Medical oncology Department, Yangon General Hospital

Prognosis for patients with malignant ascites is poor and median survival is only a few months. Treatment of malignant ascites ranges from simple drainage procedures to chemotherapy and debulking surgery. Careful selection of treatment modality by using clinico‐pathological parameters could improve not only the survival but also the quality of life of the patients. So this hospital based prospective study aimed to find out the parameters predicting poor prognosis among patients with confirmed malignant ascites admitted to Oncology Department, Yangon General Hospital. Although 104 cancer patients with malignant ascites were recruited, only 102 patients could be studied because two patients were lost to follow up. Among them, 19 (18.6%) were male patients and 83 (81.4%) were female with age ranging from 15 to 73 years (mean age 46.35 ± 12.9 years). Common cancer associated with malignant ascites were ovarian cancer (32.35%), stomach cancer (19.61%) and breast cancer (9.80%). More than half of the patients (63.7%) presented with stage IV. Common metastatic sites were liver (37 patients), peritoneum (17 patients) and lungs (12 patients). Twenty eight patients (27.5%) had more than one site of metastasis. Eight patients (7.8%) were in Eastern Cooperative Oncology Group (ECOG) performance status score 1 and 23 patients (22.5%) were in ECOG score 4. Nineteen patients (18.62%) knew they had malignant ascites since the time of the diagnosis of primary cancer and the time interval between first diagnosis and development of malignant ascites ranged from 0 to 120 months. Only 33 patients (32.4%) were still alive after 6 month follow up. Primary cancer type (p = 0.03), advanced stage (OR = 6.88, 95% CI: 2.74‐17.26) (p = 0.00), poor ECOG performance status (OR = 6.09, 95% CI: 1.72‐21.64) (p = 0.004), high serum urea (OR = 3.67, 95% CI: 1.53‐8.82) (p = 0.03), high serum creatinine level (OR = 4.57, 95% CI: 1.88‐11.1) (p = 0.01) and low serum albumin concentration(OR = 2.76, 95% CI: 1.159‐6.57) (p = 0.01) could significantly worsen the prognosis in patients with malignant ascites.

 163  Abstracts of the Posters 46th Myanmar Health Research Congress

Poster ‐ 76 Ultrastructural study of dengue virus replication in suckling mouse neuron

Min Min Win1, Komgrid Charnkaew2, Urai Chaisri3, Khin Saw Aye1 and Prida Malasit4

1Department of Medical Research 2Department of Pathology, Faculty of Medicine, Siriraj Hospital, Mahidol University 3Department of Tropical Pathology, Faculty of Tropical Medicine, Mahidol University 4Dengue Hemorrhagic Fever Research Unit, Faculty of Medicine, Siriraj Hospital, Mahidol University

Dengue virus (DENV) is one of the positive‐strand RNA viruses and induced subcellular organelles that have been described as virus replication factories facilitating viral genome replication, virus assembly, and provide environment free from host innate surveillance systems. In addition, replication complexes is a molecular complex comprised of host and viral proteins responsible for the replication of positive strand RNA and deliver the RNA to be packaged into new viruses. It is interesting to investigate whether similar structures happen in in‐vivo infection. Intracranial infection of type‐2 DENV in suckling mouse brain is done to study the changes of mainly neuron to the virus infection. There are aggregates of perinuclear virus‐induced membrane structures containing double membrane vesicles (Ve), vesicle packets (Vp), tubules (T), convoluted membrane (CM), and virion packages in DENV infected neurons of suckling mice. These virus induced membrane structures are seen in dilated rough endoplasmic reticulum. Mature virions are identified as about 55nm in diameter of electron dense material with central dense core and enveloped with regular spikes are arranged singly or in groups in the Endoplasmic reticulum cistern. Packages of various forms and mature virions within the Ve and their relationships to the membrane structures, the Golgi and the features of autophagy are demonstrated in these DENV infected neurons. Viral replication complexes are also identified in these Ve. Electron microscopic finding from this study confirmed the presence of the new virus‐induced ultra‐ structural changes as in the in‐vitro studies.

Poster ‐ 77 Prevalence of hepatitis B and C virus infection among chronic liver disease patients in North Okkalapa General and Teaching Hospital (NOGTH)

Aye Aye Win1, Swe Zin Oo1, Nway Htike Maw1, Swe Zin Soe1, May Mon Win Maw1, Zin Mar Soe1, San Nwe1, Aye Thida2 and Win Win Swe2

1Department of Medical Research 2Department of Hepatology, North Okkalapa General and Teaching Hospital

Hepatitis B and hepatitis C viruses are major public health problems worldwide and common among patients with chronic liver disease (CLD). Co‐infection with the two viruses is also common, especially among people at high risk for parenteral infection and in areas with a high prevalence of HBV infection. Myanmar is one of countries of South East Asia with high burden of  164  46th Myanmar Health Research Congress Abstracts of the Posters

liver diseases with high liver cancer incidence. Infection with HBV, HCV and chronic alcoholism are considered the most common etiology of CLD in our country. The disease severity ranges from mild illness to cirrhosis and hepatocellular carcinoma which is the most common cause of death in patients with CLD. This study aimed to determine the prevalence of Hepatitis B Virus and Hepatitis C virus among CLD patients in NOGTH and to know the co‐infection of HBV and HCV in those patients. The study was conducted on 550 clinically diagnosed CLD patients attending during January to September 2017, consisting 145 (26.4%) of chronic hepatitis, 275 (50%) of cirrhosis and 130 (23.6%) of HCC cases. Male were 354 (64.4%) and female were 196 (35.6%). Mean age was 54 years where as the youngest one was 22 years and oldest one was 88 years old. Serum was screened for the presence of hepatitis B surface antigen (HBsAg) and anti‐ hepatitis C virus antibodies (anti‐HCV Ab) using qualitative immunochromatographic method. HBsAg and anti‐HCV Ab was detected in 122 (22.2%) and 285 (51.8%) of clinically diagnosed CLD patients respectively. Of the study participants, 21 (3.8%) had dual hepatitis B and C virus coinfection and 105 (19%) patients also had history of alcohol taking. Since HBV and HCV are major health problem in chronic liver disease patients in this study, Myanmar people must be educated about their mode of transmission to prevent the spread and new infections. Furthermore all clinically diagnosed CLD patients should be tested for HBV and HCV serostatus to prevent the mortality and morbidity by providing early diagnosis and prompt treatment of disease sequel by expert specialists.

Poster ‐ 78 Young key affected population: Is there any challenge in seeking reproductive health information and care?

Kyaw Min Htut1, Myo Myo Mon1, Htun Nyunt Oo2, Zin Mar Aye1, Lwin Lwin Ni1, Aung Soe Min1 and Ni Ni Htay Aung1

1Department of Medical Research 2National AIDS Program

Reducing HIV/RH related risks among young people is one of the priority interventions in Myanmar. Although health care services are being provided, unmet needs and barriers in seeking reproductive health are still present especially among young key affected population (YKAP). A cross‐sectional study was conducted applying both quantitative and qualitative research methods with the aim of determining the health seeking behaviors regarding reproductive health (RH) and its challenges among young key affected population. A total of 119 young men who have sex with men (YMSM) and 123 young female sex workers (YFSW) from Yangon and Mandalay included in the study. Mean age of YMSM and YFSW were 20.9±2.4 and 21.7±2.2 years. Regarding their education status, 72.3% and 86.2% of YMSM and YFSW were out of school whereas 8.4% of YMSM were university graduates. About 53% of YFSW are mobile and 70% of them migrate from one place to another within one year. Nearly 60% of YMSM are Ah‐pwint as identified by themselves. Based on the place of sex work, YFSW were identified as brothel‐based (40%), entertainment‐based (karaoke/restaurant/nightclub/massage) (32.5%) and street‐based (28.5%) respectively. Over 30% of YMSM and 49.3% of YFSW had experience of any STI symptom. Particularly, 17% of YMSM and 10% of YFSW had genital ulcer and 5% of both populations had genital  165  Abstracts of the Posters 46th Myanmar Health Research Congress

warts. Many of them sought health care at NGO clinics for STI treatment. Many YMSM (79%) and YFSW (56.9%) have ever visited drop‐in‐centre (DIC) from INGO whereas 37.2% of YMSM and 40% of YFSW have visited DIC within one to six months. Over 13% of YMSM and 14.6% of YFSW mentioned that they have challenges in seeking health information on RH. Similarly, 11% of YMSM and 12% of YFSW have barriers in seeking STI/HIV information. Common reasons they mentioned during in‐depth interviews were “reluctant to ask” and “not knowing relevant person to ask”. Special attention in provision of health information should be paid to YKAP (10‐15%) since there is a considerable proportion of YKAP with unmet need in seeking RH information and care.

Poster ‐ 79 Trends in prevalence of influenza A subtypes and influenza B lineages among children attending Yangon Children Hospital, January 2013‐ September 2017

Htin Lin, Hlaing Myat Thu, Theingi Win Myat, Khaing Moe Aung, Win Mar, Khin Sandar Aye, Thida Kyaw and Kyaw Zin Thant

Department of Medical Research

Determining trends in prevalence of influenza A subtypes and influenza B lineages helps assessment of influenza outbreaks. A cross‐sectional study was conducted at Yangon Children Hospital (YCH) from January 2013 to September 2017. The objective was to determine the pattern of circulation and trends in prevalence of influenza A subtypes and influenza B lineages among children attending YCH. Nasopharyngeal swab specimens were collected from 474 children with influenza‐like illness (ILI) attending YCH as out‐patients. Matrix genes of influenza A and influenza B viruses were detected by multiplex Reverse Transcription‐ Polymerase Chain Reaction (RT‐PCR). Influenza A virus positive samples were subjected to subtyping and influenza B virus positive samples to lineage identification by multiplex RT‐PCR. Overall prevalence of influenza viruses among children with ILI gradually increased from about 6% in 2013 to 14% in 2016. It was about 20% in January‐September 2017. Influenza A viruses were detected in all influenza virus positive children found during the study period except in 2016 in which they accounted for about 55% whereas influenza B viruses for about 45% of influenza virus positive children. Regarding influenza A subtypes, influenza A(H3N2) virus predominated in 2013‐2015 accounting for 66.7‐85.7% of influenza virus positive children but it accounted for 45.5% in 2016 and 27.3% in 2017. Influenza A(H1N1)pdm09 virus accounted for 14.3‐33.3% of influenza virus positive children during 2013‐2015. In 2016, its prevalence among influenza virus positive cases decreased to 4.5% but suddenly increased to 45.5% in 2017. First case of unsubtyped influenza A virus was detected in 2016 and another three cases in 2017. Seasonal H1N1 and avian H5N1 subtype were not detected throughout the study period. Regarding influenza B lineages, all influenza B viruses detected in 2016 were of Victoria lineage that was contained in trivalent influenza vaccine recommended for use in southern hemisphere in 2016 and northern hemisphere in 2016‐2017 season. Both influenza A and B viruses showed distinct seasonality in rainy season peaking in June and July. This study generated information useful for assessment of influenza outbreaks, timing for influenza vaccination and selection of influenza vaccine for use in Myanmar.

 166  46th Myanmar Health Research Congress Abstracts of the Posters

Poster ‐ 80 Factors associated with mortality in an HIV cohort in Myanmar (2009‐2016): A retrospective cohort analysis

Ni Ni Tun1, Alistair McLean2, Myo Ma Ma Hlaing1, Htun Nyunt Oo3, Edmund Wilkins1, Elizabeth Ashley2 and Frank Smithuis1,2

1Medical Action Myanmar 2Myanmar Oxford Clinical Research Unit 3National AIDS Programme

In Myanmar, prevalence of HIV among 15 years and above is less than 1%, however, highly concentrated in key affected populations such as 28.5% among people who inject drugs and 14.6% among female sex workers and 11.6% among men who have sex with men. Medical Action Myanmar (MAM) is a non‐profit, medical organization which operates four HIV satellite clinics for integrated HIV/TB services in Yangon suburban areas. Routine data are collected using FUCHIA software created by Epicentre/Médecins Sans Frontières. The aim of this analysis was to describe the characteristics of the patients in the programme, in particular factors associated with mortality. We conducted a retrospective cohort analysis of 4,128 HIV positive patients commencing antiretroviral therapy between 2009 and 2016. We assessed time from ART initiation (baseline) to death. Kaplan‐Meier techniques were used to estimate the probability of mortality over time. Risk factors for death were assessed using Cox regression models stratified by clinic. Risk factors assessed included baseline age, sex, mode of entry to program, calendar time, time‐updated CD4 count, time‐updated WHO staging and time‐updated ART prescribed. The median age at baseline was 32 years (interquartile range (IQR): 27‐39 years) and 53% of the cohort was male. The median CD4 count at ART initiation was 173 (IQR: 65‐296), CD4 counts at ART initiation increased with calendar time. The overall mortality rate was 27.5 per 1000 person years. Lower CD4 count (adjusted hazard ratio (aHR) =4.0 for 50 vs 200 cells/µL; 95% CI 3.0, 5.4) and advanced WHO staging (aHR=4.5 for WHO stage 4 vs WHO stage 1; 95% CI 5.2, 31.1) were associated with higher risk of mortality. Lower risk of mortality was observed in patients entering the program via antental care pathways, partner/parent referral and NGO transfer (unadjusted HR (95% CI) relative to Voluntary Confidential Counselling and Testing pathway = 0.3 (0.08, 0.73); 0.5 (0.3, 0.9); and 0.6 (0.4, 0.9) respectively). HIV patients with advanced disease are at increased risk of mortality. Ensuring early diagnosis and linkage to care of HIV positive individuals is critical to minimize HIV mortality. Antenatal care testing programmes and partner notification, disclosure and testing programmes can facilitate early linkage to care. Additional programmes and pathways to link HIV patients into early care are needed.

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PREVIOUS AWARD WINNERS

46th Myanmar Health Research Congress Previous award winners

Previous Award Winners

45th Myanmar Health Research Congress

Best Paper for Applied Research Comparison of clinical and virological characteristics among infants, children and adults with dengue infection during 2015 dengue outbreak Theingi Win Myat, Hlaing Myat Thu, Ye Myint Kyaw, Khin Saw Than, Hlaing Mya Win, Zaw Than Tun, Htin Lin, Win Kay Khine and Kyaw Zin Thant Best Paper for Basic Research Effect of omeprazole on pharmacokinetics of metformin in healthy volunteers Ei Ei Aung, Khine Khine Lwin, Nu Nu Aye and Thein May Saw Best Paper for Health Systems Research Mindfulness‐integrated reproductive health package for adolescents with parental HIV infection: A group randomized‐controlled trial Myo Myo Mon, Kyaw Min Htut, Htun Nyunt Oo, Wai Wai Myint, Lwin Lwin Ni, Aung Soe Min and Ni Ni Htay Aung Best Poster What does not make work and why?: Challenges and possible ways for engaging voluntary health workers into health care systems in Myanmar Saw Saw, Wai Wai Han, Nyi Nyi Zayar, Lin Yadanar Ko, Pyae Sone Thar, Aye Thida, Myo Myo Mon and Theingi Myint Young Researcher Award Basic Research paper Hepatoprotective effect of ethanolic extract of Andrographis paniculata Nees. (say‐gha‐gyi) leaves on paracetamol‐induced hepatotoxicity in albino rats Ei Mon Mon Hlaing, Myint Myint Than, Khin Phyu Phyu and Nu Nu Aye Health Systems Research Maternal, newborn and child health care practices among mothers from Paletwa Township in Southern Chin State, Myanmar Kyaw Thu Soe, Yadanar Aung and Kyaw Oo

44th Myanmar Health Research Congress

Best Paper for Applied Research Output towards input: Input for consideration of Rotavirus vaccine introduction in Myanmar by output from Rotavirus Sentinel Surveillance Theingi Win Myat, Hlaing Myat Thu, Ye Myint Kyaw, Khin Mar Aye, Mo Mo Win, Thin Thin Shwe, Khin Khin Oo, Khine Moe Aung and Kyaw Zin Thant Best Paper for Basic Research Characterization of Hyaluronidase isolated from Russell’s Viper (Daboia siamnesis) Venom of Myanmar Thet Thet Mar, Win Aung, Zaw Myint, Lwin Zar Maw, Tin Ko Ko Oo and Nweni Aung Best Paper for Health Systems Research Every child count: The immunization status of mobile migrant children in Bogale and Mawlamyinegyun Townships, Ayeyarwaddy Region Nyi Nyi Zayar, Wai Wai Han, Saw Saw, Zayar Lynn, Theingi Myint, Myo Myo Mon, Kyaw Myint Tun, Ye Ye Win and Kyaw Myo Htut

 171  Previous award winners 46th Myanmar Health Research Congress

Best Poster Are they disclosed?: Situation of HIV status disclosure among adolescents Kyaw Min Htut, Myo Myo Mon, Lwin Lwin Ni, Aung Soe Min and Ni Ni Htay Aung Young Researcher Award Basic Research paper Whole Genome Sequencing of Hepatitis B Virus (HBV) Strains from Myanmar Nyi Nyi Win, Aung Zaw Latt, Kay Thi Aye, Hlaing Myat Thu, Yi Yi Kyaw and Kyaw Zin Thant Applied Research paper The role of delay in receipt of standard cardiac treatment in clinical outcomes of acute myocardial infarction patients admitted to Yangon General Hospital Su Su Hlaing, KoKo Zaw and Nwe Nwe Health Systems Research Every child count: The immunization status of mobile migrant children in Bogale and Mawlamyinegyun Townships, Ayeyarwaddy Region Nyi Nyi Zayar, Wai Wai Han, Saw Saw, Zayar Lynn, Theingi Myint, Myo Myo Mon, Kyaw Myint Tun, Ye Ye Win and Kyaw Myo Htut

43rd Myanmar Health Research Congress

Best Paper for Applied Research Prelinimary report on K 13 gene analysis of Plasmodium falciparum and therapeutic efficacy of Artemether‐lumifantrine in uncomplicated falciparum malaria in Buthidaung, Rakhine State Kay Thwe Han, Kyin Hla Aye, Myo Win Htun, Zay Yar Han, Nyi Nyi Win, Kay Thi Aye, Phyo Zaw Aung, Myat Phone Kyaw and Kyaw Zin Thant Best Paper for Basic Research Cardioprotective effect of seed juice extract of Punicagranatum Linn. (Tha‐Le) on Isopro terenol‐induced myocardial infarction in Albino rats Nwe Nwe Than, Nu Nu Aye, Kyae Mone Htwe, Lae Lae Win, Khin Mi Mi Lay, Khaing Khaing Mar and Khin Phyu Phyu Best Paper for Health Systems Research Is it enough? Source, credibility and extent of reproductive health information among the youth in selected townships, Myanmar Wai Wai Han, Saw Saw, Theingi Myint, Myo Myo Mon, Soe Moe Myat, Kyaw Myo Htut, Pyone Thuzar Nge, Yee Yee Win and San San Aye Best Poster Voices and Choices of youths for Reproductive Health services in rural and urban areas of Myanmar Saw Saw, Theingi Myint, Wai Wai Han, Myo Myo Mon, San San Aye, Ye Ye Win, Pyone Thuzar Nge, Hla Thida Htun and Lwin Lwin Ni Young Researcher Award Basic Research paper Molecular detection of Human Rhinovirus in under 5 children with acute respiratory infection attending Yangon Children Hospital, 2014 Nila Zaw, Hlaing Myat Thu, Ye Myint Kyaw, Mo Mo Win, Kay Thi Aye, Aung Zaw Latt, Thida Kyaw, Aung Hlaing Phyo and Kyaw Zin Thant Applied Research paper Lipid lowering and antioxidant effects of atorvastatin and rosuvastatin in Myanmar hypercholesterolemic subjects Nilar Win Htut, Win Win May and May Hla Thwin

 172  46th Myanmar Health Research Congress Previous award winners

42nd Myanmar Health Research Congress

Best Paper for Applied Research Development of a new monovalent ovine snake antivenom against Russell's viper (Daboia siamensis) Aung Zaw, Khin Aung Cho, Kyi Kyi Thin and Mon Mon Best Paper for Basic Research Determination of Oncogenic Human Papillomavirus (HPV) 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 Best Paper for Health Systems Research Challenges in universal coverage and utilization of insecticide 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 Best Poster 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 Young Researcher Award Basic Research paper 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 Health Systems Research paper Estimating cost of TB patient Self Help Groups in Hlaingtharyar Township, Myanmar Wai Wai Han, Saw Saw, Thandar Lwin, Tin Mi Mi Khaing and Thet Aung

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

 173  Previous award winners 46th Myanmar Health Research Congress

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 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

 174  46th Myanmar Health Research Congress Previous award winners

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 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

 175  Previous award winners 46th Myanmar Health Research Congress

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

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

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STEERING COMMITTEE AND SUPPORTING COMMITTEES 46th Myanmar Health Research Congress Committee

46th Myanmar Health Research Congress Steering Committee Patron: H. E. Union Minister, Ministry of Health and Sports Chairman: Permanent Secretary, Ministry of Health and Sports Vice‐Chairman: Director General, Department of Medical Research Members: Director General, Department of Public Health Director General, Department of Medical Services Director General, Department of Human Resources for Health Director General, Department of Traditional Medicine Director General, Department of Food and Drug Administration Director General, Department of Sports and Physical Education General Staff Officer (Grade 1), Defence Services Medical Corps Deputy Permanent Secretary, International Health Division, Ministry of Health and Sports Assistant Secretary, International Health Division, Ministry of Health and Sports Deputy Director Generals (Research), Department of Medical Research Secretary: Deputy Director General (Admin/Finance), Department of Medical Research Joint‐Secretary: Director(General Admin.), Department of Medical Research

Executive Committee Chairman: Dr. Kyaw Zin Thant, Director General, Department of Medical Research Vice‐Chairman: Dr. Khin Saw Aye, Deputy Director General (Pyin Oo Lwin Branch), Department of Medical Research Members: Brig. Gen. Tin Maung Hlaing, Commander, Defense Services Medical Research Centre Prof. Dr. Zaw Wai Soe, Rector, University of Medicine 1, Yangon Prof. Dr. Khaymar Mya, Rector, University of Public Health, Yangon Brig. Gen. Ko Ko Lwin, Rector, Defence Services Medical Academy Dr. Zaw Myint, Deputy Director General (Admin/Finance), Department of Medical Research Dr. Hlaing Myat Thu, Deputy Director General (Research), Department of Medical Research Dr. Yin Thandar Lwin, Deputy Director General, Department of Public Health Dr. Myat Wunna Soe, Deputy Director General, Department of Medical Services Dr. Tin Tun, Deputy Director General, Department of Human Resources for Health U Kyaw Soe, Deputy Director General, Department of Traditional Medicine Dr. Khin Chit, Deputy Director General, Department of Food and Drug Administration U Kyaw San, Deputy Director General, Department of Sports and Physical Education Secretary: Dr. Tin Oo, Director (General Admin.), Department of Medical Research Joint Secretary: Dr. Han Win, Director (Planning), Department of Medical Research

Academic Sub‐committee Chairman: Prof. Dr. Chit Soe, Prof./Head, Department of Rheumatology, University of Medicine 1, Yangon Members: Prof. Dr. San San Myint, Prof./Head, Dept. of Obst. and Gynae, University Medicine 1, Yangon Prof. Dr. Ye Myint Kyaw, Prof./Head, Child Health Department, University of Medicine 1, Yangon Prof. Dr. Nang Hla Hla Win , Prof./Head, Pharmacology Dept., University of Medicine 1, Yangon Prof. Dr. May Pyone Kyaw, Prof./Head, Biochemistry Department, University of Medicine 2, Yangon Col. Myat Khaing, Head, Traditional Medicine, Defence Services Medical Research Centre Director(Research & Development), Department of Traditional Medicine Dr. Win Pa Pa Naing, Director(Research), Department of Medical Research Dr. Thida, Deputy Director(Epi), Department of Medical Research (Pyin Oo Lwin) Dr. Yin Thet Nu Oo, Research Scientist(HSR), Department of Medical Research Dr. Myo Myo Mon, Deputy Director (Epidemiology), Department of Medical Research Secretary: Dr. Aye Aye Lwin, Deputy Director (Immunology), Department of Medical Research Joint Secretary: Dr. Nyi Nyi Win, Research Scientists (Pharmacology), Department of Medical Research

 179  Committee 46th Myanmar Health Research Congress

Best Paper and Poster Selection Sub‐committee Chairman: Prof.Dr. San San Nwet, Rector, University of Pharmacy , Yangon Members: Prof. Dr.Khaymar Mya, Rector, University of Public Health, Yangon Col. Prof. Khin Phyu Pyar, Dept. of Medicine, Defence Services Medical Academy 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 2, Yangon Prof. Dr. Aye Aye Myint, Prof./Head, Child Health Department, University of Medicine, Mandalay Prof. Dr. Hla Hla Win, Prof./Head, Dept. of Preventive and Social Medicine, University of Medicine 1, Yangon Prof. Dr.San San Htay, Prof./Head, Dept. of Preventive and Social Medicine, University of Medicine 2, Yangon Prof. Dr. Hlaing Mya Win, Prof, Dept. of Medicine, University of Medicine 1, Yangon Prof. Dr. Khin May Thin, Professor, Dept. of Obst. and Gynae, University Medicine 2, Yangon Prof. Dr. Htay Htay Tin, Deputy Director General, National Health Laboratory, Department of Medical Services Dr. Khin Thet Wai, Director(Retired/Expert), Department of Medical Research Secretary: Dr. Wah Wah Aung, Director(AMRC), Department of Medical Research Joint Secretary: Dr.Theingi Win Myat, Deputy Director(Virology), Department of Medical Research

Reception Sub‐committee Chairperson: Dr. Khin Phyu Phyu, Director(Research), Department of Medical Research Members: Dr. Saw Saw, Director(Planning), Department of Medical Research Dr. Min Wun, Deputy Director, Department of Food and Drug Administration, Dr. Mu Mu Shwe, Deputy Director(Technology Development), Department of Medical Research Dr. Kay Thwe Han, Deputy Director(Parasitology), Department of Medical Research Dr. Thet Thet Mar, Deputy Director(Biochemistry), Department of Medical Research Dr. Khine Khine Lwin, Deputy Director(Pharmacology), Department of Medical Research Dr. Khin Hnin Pwint, Research Scientist(PharmaceuticalToxicology), Department of Medical Research Secretary: Dr.Mo Mo Win, Deputy Director (Biological Toxicology), Department of Medical Research

Venue Preparation Sub‐committee Chairperson: Dr. Moh Moh Htun, Director(Research), Department of Medical Research Members: Dr. Yi Yi Kyaw, Deputy Director(Mol. Tech. Appl.), Department of Medical Research Dr. Mya Mya Aye, Deputy Director(Bacteriology),Department of Medical Research Dr. Thida Maw, Deputy Director (Computer), Department of Medical Research Dr. Ni Thet Oo, Deputy Director(Gen. Admin), Department of Medical Research U Tin Maung Maung, Research Scientist(Computer), Department of Medical Research Daw Thuzar Myint, Research Scientist(Bacteriology), Department of Medical Research Dr. Ssu Wynn Mon, Research Scientist(Clinical Res.), Department of Medical Research U Kyaw Min Oo, Research Officer(Mol. Tech. Appl.), Department of Medical Research U Tin Shein, Staff Officer (Admin.), Department of Medical Research Secretary: U Po Htwe, Research Scientist(Instrumentation), Department of Medical Research

Information Sub‐committee Chairman: Dr. Win Maw Tun, Director (Research), Department of Medical Research Members: Dr. Phyu Phyu Aye, Director, Health Education Bureau, Department of Public Health Dr. Su Su Lin, Deputy Director, International Health Division, Ministry of Health and Sports Dr. Moh Moh Hlaing, Deputy Director (Nutrition), Department of Medical Research Dr. Myat Htut Nyunt, Research Scientist (Mol. Tech. Appl.), Department of Medical Research Daw Cho Mar Oo, Research Scientist (Library), Department of Medical Research U Ye Thway, Research Officer (Publication), Department of Medical Research Secretary: Daw Ni Thet Oo, Deputy Director (General Admin), Department of Medical Research

 180  46th Myanmar Health Research Congress Committee

Refreshment Sub‐committee Chairperson: Dr. Theingi Thwin, Director(Research), Department of Medical Research Members: Dr. Han Win, Director (Finance), Department of Medical Research U Tin Maung Tun, Deputy Director(Finance), Department of Medical Research Daw Kyi May Htwe, Research Scientist (Immunology), Depart ment of Medical Research Daw Than Than Lwin, Assist. Dir. ( Procurement & Distribution), Department of Medical Research Daw Aye Aye Shein, Assist. Dir. (Personnel Administration), Department of Medical Research U Tin Shein, Staff Officer (Admin), Department of Medical Research Daw Tin Latt Latt, Staff Officer (Foreign Relations), Department of Medical Research Secretary: U Aye Kyaw, Deputy Director (Foreign Relations), Department of Medical Research

Secretarial and Audio‐visual Aids Sub‐committee Chairman: Dr. Tin Oo, Director (General Admin), Department of Medical Research Members: Director (Socio‐Medical Research), Department of Medical Research(Pyin Oo Lwin) Dr. Cho Cho Han, Head (Admin. & Finance), University of Medicine 1, Yangon Dr. Nyunt Nyunt Wai, Medical Supritendent, New Yangon General Hospital Dr. Kyaw Soe, Deputy Director (Pathology), Department of Medical Research Dr. Ni Thet Oo, Deputy Director (General Admin), Department of Medical Research Dr. Thidar Maw, Deputy Director (Computer), Department of Medical Research U Tin Maung Maung, Research Scientist (Computer), Department of Medical Research U Cho Thandar Tun, Research Officer (Bioinformatics), Department of Medical Research U Khine Win, Research Officer (Instrumentation), Department of Medical Research Secretary: Daw Cho Mar Oo, Research Scientist (Library), Department of Medical Research

 181  Sponsors 46th Myanmar Health Research Congress

46th MYANMAR HEALTH RESEARCH CONGRESS LIST OF SPONSORS

DIAMOND SPONSOR  Delta Science Co., Ltd.

PLATINUM SPONSORS  Okkar Thiri Co., Ltd.  Nanova Co., Ltd.

GOLD SPONSORS  Myanmar Zircon Co., Ltd.  BioMed Myanmar Co., Ltd.  Advanced Diagnostic Co., Ltd.  Sciencewerke (Myanmar) Co., Ltd.  First Prime Co., Ltd.  Grand Max Co., Ltd.  Supreme Co., Ltd.  Burnet Institute  Fujitsu Co., Ltd

SILVER SPONSORS  UCM Bioscience Co., Ltd.  Every Glory Co., Ltd.  Gaia Science Myanmar Co., Ltd.  Myanmar Research & Research Ethics Program (UMB)  SciMe Tech International Co., Ltd.  Shwin Chan Trading Co., Ltd.  AMTT Co., Ltd.  Lucky World Co., Ltd.  Yee Shin Co., Ltd.  Advancelab Scientific & Engineering Co., Ltd.

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