Policy Outcomes in Indonesia Before and After Democratization

Different types of regimes face different political situations and have different incentives to pursue different policies. In this paper, I am examining whether there are any differences in economic and social policy outcomes under democracy and dictatorship in Indonesia. The study is divided into two periods. The first period covers the authoritarian rule of President Suharto(1966 to 1998) and the second period covers the new democratic government(1999 to 2010). I set out by analyzing the rules used in distinguishing democracy from dictatorship and discussing the process by which Suharto\u27s regime was categorized as a dictatorship and the Indonesian government after 1999 as democratic. Then I compare and contrast the economic and social policies pursued under each of the two regime types and the policy outcomes achieved. Some authors suggest that democracy is more conducive to economic and human development than authoritarian leadership whereas others suggest that there is no significant difference. Some even suggest the authoritarian regime to be better at developing a country. In the case of Indonesia, I found that there is no significant change in the trend both in economic and human development and in some cases, the development rate is slower under democracy. I discuss the findings in light of literatures on democracy and development. Indonesia\u27s democracy is still young and the democratic period covered by the study is relatively short compared to the authoritarian period. Better comparison of policy outcomes could be made in the future if further research can be done after Indonesia\u27s democracy becomes stronger

the case of oil and gas companies

Thesis(Master) --KDI School:Master of Public Policy,2016This study aims to learn the foreign investors’ perception of FDI investment climate in and explore the major influencing factors for their investment decisions and their social contribution in the case of oil and gas companies operating in Myanmar. Primary data is collected from Foreign Investor Perception Survey and key informant interview with different stakeholders. Based on this survey, the study found that the foreign investors’ retrospective and prospective views on FDI climate is magnificent while the New Myanmar Investment Law (2016) become the main factor in promoting FDI. Concerned with the principal drivers of investment decision, resource availability is the most important factor, and the cost of production, the rule of law, and stable policy environment and political commitments are major influencing factors. The tax incentive is not the major driver for their investment decision even though the government is offering generous tax incentives. In examining the influencing factors of social contribution, almost all of the respondents are very keen to contribute human capital development programs and willingness to deal with local governments. Community support from the project area is also a major factor driving factor. Hence, the study suggests creating the dialogue channels with foreign companies and a better understanding of the government’s policies. Besides, the study also recommends to build the capacity of the civil servants, to strengthen the state/region governments’ capability to administer foreign investment projects and to enforce social contribution programs through the PSC obligation or MIC and reviewing tax expenditure when giving generous tax incentives and incorporating tax expenditure report in the budget preparation.Chapter I:Introduction Chapter II: Methodology Chapter III: Findings and Discussion Chapter IV: ConclusionmasterpublishedAung Phyo KYAW

Item analysis of multiple-choice questions in summative assessment for professional examination I of an outcome-based integrated MBBS curriculum

Background: This study presents an item analysis of multiple-choice questions (MCQ-Type A) used in the summative assessment for Professional Examination I at Defence Services Medical Academy, Yangon, Myanmar. The objectives of the study were to perform item analysis using Difficulty Index (DIF I) and Discrimination Index (DI) and to correlate between DIF I and DI. Methods: A cross-sectional observational study was conducted with 200 multiple-choice questions from two written examination papers answered by 46 medical year 2 students of Defence Services Medical Academy, Yangon, Myanmar. Item analysis of multiple-choice questions were done by using DIF I and DI calculated post-exam. Results: Results showed that the majority of items were categorized as easy based on DIF I, with 63% and 60% in Papers I and II, respectively. Only about one-third of items were deemed acceptable, and few fell into the difficult category. DI ranged from negative to excellent, with 62% and 61% of MCQs in Papers I and II showing acceptable to excellent discrimination. Items with poor discrimination (35% and 34% in Papers I and II) should be revised or discarded. Moreover, items with negative DI should be re-evaluated for potential key errors or vague wording. A low negative correlation between DIF I and DI was observed, indicating that as DIF I increased, discrimination power decreased. Notably, items with easy DIF I demonstrated a moderate negative correlation with DI, consistent with previous research. Conclusions: This study underscores the importance of item analysis to enhance the validity of assessment tools and ensure the effective evaluation of student cognition levels. Consequently, reconstruction and modification of MCQs are recommended to improve assessment quality and accurately measure student abilities

Mass drug administration for the acceleration of malaria elimination in a region of Myanmar with artemisinin-resistant falciparum malaria: a cluster-randomised trial

Background: To contain multidrug-resistant Plasmodium falciparum, malaria elimination in the Greater Mekong subregion needs to be accelerated while current antimalarials remain effective. We evaluated the safety, effectiveness, and potential resistance selection of dihydroartemisinin–piperaquine mass drug administration (MDA) in a region with artemisinin resistance in Myanmar. Methods: We did a cluster-randomised controlled trial in rural community clusters in Kayin (Karen) state in southeast Myanmar. Malaria prevalence was assessed using ultrasensitive quantitative PCR (uPCR) in villages that were operationally suitable for MDA (villages with community willingness, no other malaria control campaigns, and a population of 50–1200). Villages were eligible to participate if the prevalence of malaria (all species) in adults was greater than 30% or P falciparum prevalence was greater than 10% (or both). Contiguous villages were combined into clusters. Eligible clusters were paired based on P falciparum prevalence (estimates within 10%) and proximity. Community health workers provided routine malaria case management and distributed long-lasting insecticidal bed-nets (LLINs) in all clusters. Randomisation of clusters (1:1) to the MDA intervention group or control group was by public coin-flip. Group allocations were not concealed. Three MDA rounds (3 days of supervised dihydroartemisinin–piperaquine [target total dose 7 mg/kg dihydroartemisinin and 55 mg/kg piperaquine] and single low-dose primaquine [target dose 0·25 mg base per kg]) were delivered to intervention clusters. Parasitaemia prevalence was assessed at 3, 5, 10, 15, 21, 27, and 33 months. The primary outcomes were P falciparum prevalence at months 3 and 10. All clusters were included in the primary analysis. Adverse events were monitored from the first MDA dose until 1 month after the final dose, or until resolution of any adverse event occurring during follow-up. This trial is registered with ClinicalTrials.gov, NCT01872702. Findings: Baseline uPCR malaria surveys were done in January, 2015, in 43 villages that were operationally suitable for MDA (2671 individuals). 18 villages met the eligibility criteria. Three villages in close proximity were combined into one cluster because a border between them could not be defined. This gave a total of 16 clusters in eight pairs. In the intervention clusters, MDA was delivered from March 4 to March 17, from March 30 to April 10, and from April 27 to May 10, 2015. The weighted mean absolute difference in P falciparum prevalence in the MDA group relative to the control group was −10·6% (95% CI −15·1 to −6·1; p=0·0008) at month 3 and −4·5% (−10·9 to 1·9; p=0·14) at month 10. At month 3, the weighted P falciparum prevalence was 1·4% (0·6 to 3·6; 12 of 747) in the MDA group and 10·6% (7·0 to 15·6; 56 of 485) in the control group. Corresponding prevalences at month 10 were 3·2% (1·5 to 6·8; 34 of 1013) and 5·8% (2·5 to 12·9; 33 of 515). Adverse events were reported for 151 (3·6%) of 4173 treated individuals. The most common adverse events were dizziness (n=109) and rash or itching (n=20). No treatment-related deaths occurred. Interpretation: In this low-transmission setting, the substantial reduction in P falciparum prevalence resulting from support of community case management was accelerated by MDA. In addition to supporting community health worker case management and LLIN distribution, malaria elimination programmes should consider using MDA to reduce P falciparum prevalence rapidly in foci of higher transmission. Funding: The Global Fund to Fight AIDS, Tuberculosis and Malaria

Observational study of adult respiratory infections in primary care clinics in Myanmar: understanding the burden of melioidosis, tuberculosis and other infections not covered by empirical treatment regimes.

BACKGROUND: Lower respiratory infections constitute a major disease burden worldwide. Treatment is usually empiric and targeted towards typical bacterial pathogens. Understanding the prevalence of pathogens not covered by empirical treatment is important to improve diagnostic and treatment algorithms. METHODS: A prospective observational study in peri-urban communities of Yangon, Myanmar was conducted between July 2018 and April 2019. Sputum specimens of 299 adults presenting with fever and productive cough were tested for Mycobacterium tuberculosis (microscopy and GeneXpert MTB/RIF [Mycobacterium tuberculosis/resistance to rifampicin]) and Burkholderia pseudomallei (Active Melioidosis Detect Lateral Flow Assay and culture). Nasopharyngeal swabs underwent respiratory virus (influenza A, B, respiratory syncytial virus) polymerase chain reaction testing. RESULTS: Among 299 patients, 32% (95% confidence interval [CI] 26 to 37) were diagnosed with tuberculosis (TB), including 9 rifampicin-resistant cases. TB patients presented with a longer duration of fever (median 14 d) and productive cough (median 30 d) than non-TB patients (median fever duration 6 d, cough 7 d). One case of melioidosis pneumonia was detected by rapid test and confirmed by culture. Respiratory viruses were detected in 16% (95% CI 12 to 21) of patients. CONCLUSIONS: TB was very common in this population, suggesting that microscopy and GeneXpert MTB/RIF on all sputum samples should be routinely included in diagnostic algorithms for fever and cough. Melioidosis was uncommon in this population

Malaria incidence in Myanmar 2005–2014: steady but fragile progress towards elimination

Abstract Background There has been an impressive recent reduction in the global incidence of malaria, but the development of artemisinin resistance in the Greater Mekong Region threatens this progress. Increasing artemisinin resistance is particularly important in Myanmar, as it is the country in the Greater Mekong Region with the greatest malaria burden. If malaria is to be eliminated in the region, it is essential to define the spatial and temporal epidemiology of the disease in Myanmar to inform control strategies optimally. Results Between the years 2005 and 2014 there was an 81.1 % decline in the reported annual incidence of malaria in Myanmar (1341.8 cases per 100,000 population to 253.3 cases per 100,000 population). In the same period, there was a 93.5 % decline in reported annual mortality from malaria (3.79 deaths per 100,000 population to 0.25 deaths per 100,000 population) and a 87.2 % decline in the proportion of hospitalizations due to malaria (7.8 to 1.0 %). Chin State had the highest reported malaria incidence and mortality at the end of the study period, although socio-economic and geographical factors appear a more likely explanation for this finding than artemisinin resistance. The reduced malaria burden coincided with significant upscaling of disease control measures by the national government with support from international partners. These programmes included the training and deployment of over 40,000 community health care workers, the coverage of over 60 % of the at-risk population with insecticide-treated bed nets and significant efforts to improve access to artemesinin-based combination treatment. Beyond these malaria-specific programmes, increased general investment in the health sector, changing population demographics and deforestation are also likely to have contributed to the decline in malaria incidence seen over this time. Conclusions There has been a dramatic fall in the burden of malaria in Myanmar since 2005. However, with the rise of artemisinin resistance, continued political, financial and scientific commitment is required if the ambitious goal of malaria elimination in the country is to be realized

Clinical importance of the Mandalay spitting cobra (Naja mandalayensis) in Upper Myanmar – Bites, envenoming and ophthalmia

This is an accepted manuscript of an article published by Elsevier in Toxicon on 03/06/2020, available online: https://doi.org/10.1016/j.toxicon.2020.05.023 The accepted version of the publication may differ from the final published version.© 2020 Elsevier Ltd Examination of 18 cobras brought to three hospitals in the Mandalay Region by patients bitten or spat at by them distinguished 3 monocled cobras (Naja kaouthia) and 15 Mandalay spitting cobras (N. mandalayensis), based on their morphological characteristics. We confirm and extend the known distributions and habitats of both N. mandalayensis and N. kaouthia in Upper Myanmar. Clinical symptoms of local and systemic envenoming by N. mandalayensis are described for the first time. These included local swelling, blistering and necrosis and life-threatening systemic neurotoxicity. More information is needed about the clinical phenotype and management of bites by N. mandalayensis, the commoner of the two cobras in Upper Myanmar. Since the current cobra antivenom manufactured in Myanmar has lower pre-clinical efficacy against N. mandalayensis than N. kaouthia, there is a need for more specific antivenom therapy.Published versio

Geographical distribution of Burkholderia pseudomallei in soil in Myanmar.

BACKGROUND: Burkholderia pseudomallei is a Gram-negative bacterium found in soil and water in many tropical countries. It causes melioidosis, a potentially fatal infection first described in 1911 in Myanmar. Melioidosis is a common cause of sepsis and death in South and South-east Asia, but it is rarely diagnosed in Myanmar. We conducted a nationwide soil study to identify areas where B. pseudomallei is present. METHODOLOGY/PRINCIPAL FINDINGS: We collected soil samples from 387 locations in all 15 states and regions of Myanmar between September 2017 and June 2019. At each site, three samples were taken at each of three different depths (30, 60 and 90 cm) and were cultured for B. pseudomallei separately, along with a pooled sample from each site (i.e. 10 cultures per site). We used a negative binomial regression model to assess associations between isolation of B. pseudomallei and environmental factors (season, soil depth, soil type, land use and climate zones). B. pseudomallei was isolated in 7 of 15 states and regions. Of the 387 sites, 31 (8%) had one or more positive samples and of the 3,870 samples cultured, 103 (2.7%) tested positive for B. pseudomallei. B. pseudomallei was isolated more frequently during the monsoon season [RR-2.28 (95% CI: 0.70-7.38)] and less in the hot dry season [RR-0.70 (95% CI: 0.19-2.56)] compared to the cool dry season, and in the tropical monsoon climate zone [RR-2.26; 95% CI (0.21-6.21)] compared to the tropical dry winter climate zone. However, these associations were not statistically significant. B. pseudomallei was detected at all three depths and from various soil types (clay, silt and sand). Isolation was higher in agricultural land (2.2%), pasture land (8.5%) and disused land (5.8%) than in residential land (0.4%), but these differences were also not significant. CONCLUSION/SIGNIFICANCE: This study confirms a widespread distribution of B. pseudomallei in Myanmar. Clinical studies should follow to obtain a better picture of the burden of melioidosis in Myanmar