Successful elimination of falciparum malaria following the introduction of community-based health workers in Eastern Myanmar: a retrospective analysis

Background: Myanmar has a large majority of all malaria in the Greater Mekong Subregion. In the past decade, substantial progress was made in malaria control. The residual burden of malaria is in remote areas where currently recommended malaria elimination approaches are generally not feasible. In such hard-to-reach communities in Mon state, East Myanmar, Medical Action Myanmar introduced community health workers (CHWs) to deliver early diagnosis and treatment for malaria. We conducted a retrospective analysis to assess the impact of this intervention. Methods and findings: This retrospective analysis involved data collected routinely from a CHW programme in Mon state conducted between 2011 and 2018. A network of 172 CHWs serving a population of 236,340 was deployed. These CHWs carried out 260,201 malaria rapid diagnostic tests (RDTs) to investigate patients with acute febrile illness. The median blood examination rate was 1.33%; interquartile range (IQR) (0.38 to 3.48%); 95% CI [1.28%, 1.36%] per month. The changes in malaria incidence and prevalence in patients presenting with fever were assessed using negative binomial regression mixed effects models fitted to the observed data. The incidence of Plasmodium falciparum malaria (including mixed infections) declined by 70%; 95% CI [65%, 75%]; p < 0.001 for each year of CHW operation. The incidence of P. vivax malaria declined by 56%; 95% CI [50%, 62%]; p < 0.001 per year. Malaria RDT positivity rates for P. falciparum and P. vivax declined by 69%; 95% CI [62%, 75%]; p < 0.001 and 53%; 95% CI [47%, 59%]; p < 0.001 per year, respectively. Between 2017 and 2018, only 1 imported P. falciparum case was detected in 54,961 RDTs. The main limitations of the study are use of retrospective data with possible unidentified confounders and uncharacterised population movement. Conclusions: The introduction of CHWs providing community-based malaria diagnosis and treatment and basic health care services in remote communities in Mon state was associated with a substantial reduction in malaria. Within 6 years, P. falciparum was eliminated and the incidence of P. vivax fell markedly

Non Linear Great Deluge Hyper Heuristic with Reinforcement Learning for Scheduling Problem

Nowadays, scheduling problems arise in almostall areas of human activity. To handle the complexityof the real world scheduling problems, manyresearchers have been invested over the years.Currently research is being directed to raise the levelof generality. Therefore, this has led to thedevelopment of hyper heuristics system. A hyperheuristic is high level problem solving methodologythat performs a search over the space generated by aset of low level heuristics. A motivating goal of hyperheuristic research is to create automated techniquesthat applicable to a wide range of problems withdifferent characteristics. One of the hyper heuristicframeworks is based on a single point searchcontaining two main stages: heuristic selection andmove acceptance. By using exam timetablingproblem as a test bed, this paper proposes the nonlinear great deluge hyper heuristic withreinforcement learning method to intend to improvethe performance of hyper heuristi

Finite element analysis of interference fit considering geometrical form errors

Interference fitted connections are widely used in the assembly of two cylindrical parts which are either shrink fitted or press fitted. They are commonly used in assembly between shaft and bearings and gears and collars. There have been many analyses of interference fit in the literature. This will be elaborated detail in chapter 2.Bachelor of Engineering (Mechanical Engineering

Image Authentication System based on Digital Watermark and Digital Signature

In this paper to protect copyright, ownershipand content integrity of digital media includingdigital watermarking techniques. The primarymotivation of this article is to study the principles ofcryptographic primitives and watermarking schemes.In this paper, we propose a secure verificationsystem for watermarked images with the intention ofcopyright protection. RSA algorithm, RSA signature,multi-signatures,, and LSB technique are employedin the proposed system. The proposed system isdeveloped by C# programming language. Thisprojected system can withstand compressionbrightness and no attack can destroy copyright of theimage, in addition, no one can alter content oftransmitted images. In this paper ,we use RSA multi-signature algorithm to protect unauthorizeddistribution and LSB technique to embed and detectwatermark

An Investigation into Variants of Great Deluge(GD) for Hyper-Heuristic (HH) Approach

Today, Hyper-Heuristic is not new in AI Field. It is an emerged search technology to select or generate (new) low level heuristics for combinatorial optimization problem and has been applied in many problem domains: personal scheduling, channel assignment and university timetabling and so on. In general, it has two main stages: heuristics selection and move acceptance method. For the latter stage, most of Meta heuristics algorithms are used. Among them Simulated Annealing (SA) and Great Deluge (GD) are very popular. Based on the numerous well-known papers and the previous experience, now, this paper is investigated the variants of GD such as NLGD (non-linear GD), FD (flex deluge) and EGD (extended GD) for the hyper heuristics approach. These variants of GD are also applied as move acceptance method in HH approaches for the university exam time tabling problem

A Comparative Study of EGD Based Hyper Heuristic for ETP

This paper makes a comparative study of theExtended Great Deluge (EGD) based hypeheuristic (HH) for the university examtimetabling problem. Indeed, Hyper-Heuristic isnot new in AI field. It is an emerged searchtechnology to select or generate (new) low levelheuristics for combinatorial optimizationproblems. In the general framework of HH, it hastwo main stages: heuristic selection and moveacceptance. For the latter stage, most of Metaheuristic algorithms are used. EGD has beenfirstly proposed and also used in HH as ourprevious job. Based on the numerous well-knownpapers and our previous experience, now, weinvestigate again the proposed EGD based HHto make the analysis of its performance andcomparable with other methods in the literatureor not. As another contribution for morecomparison, Simple Random, Variants of GreatDeluge(GD):Non linear GD( NLGD) and FlexDeluge(FD) are also employed in EGD basedHH by applying it on the ETP

Nagaland health assessment: High mortality rates and difficulty accessing essential health services in Lahe Township, Republic of the Union of Myanmar.

IntroductionLahe Township belongs to Myanmar`s Naga Self-administered Zone, which is one of the most remote and mountainous areas in Myanmar. However, the limited health data available for the region suggests that there could be neglected health needs that require attention. The purpose of this study was to assess the health status of the population of Lahe Township.MethodsA cross-sectional study design incorporating a two-stage cluster sampling methodology recommended by the WHO was used to conduct a household level survey. In the first stage, 30 village clusters were selected from all villages situated in the Lahe Township through systematic sampling with probability of selection proportional to the population size of each village based on the 2014 Myanmar census. In the second stage, a GPS-based sampling method was used to select 30 households within a village cluster. The head of the household completed the survey for all members of the household. Questionnaires inquired about maternal health, mortality, morbidities, childhood nutritional status, access to health care, and water & sanitation. The resulting data was stratified by urban/rural status.ResultsData was collected on 5,929 individuals living in 879 households, of which 993 individuals (16.7%) were children 5 years old or younger. The median age was 18.0 (IQR 8.0-35.0). Children 15 years old or younger represented 44.7% of the population. 19.8% of households reported at least 1 household member sick during the previous 30 days. The crude mortality rate per 10,000 people per day was 0.58 (95% CI: 0.48-0.69). The under 5 mortality per 10,000 people per day was 0.74 (95% CI: 0.50-1.06). Only 46.7% of households could access a hospital if there was a need.ConclusionOur results demonstrate a high rate of mortality and the inability to access healthcare in Lahe Township, which should be addressed to prevent further deterioration of health

Antimicrobials use and resistance on integrated poultry-fish farming systems in the Ayeyarwady Delta of Myanmar

Antimicrobials are used to support livestock health and productivity, but might pose a risk for the development of antimicrobial resistance; in particular, when multiple livestock species are raised together in production systems. On integrated chicken-fish farms, chickens are raised over fish ponds and poultry faeces is excreted into the ponds. We investigated antimicrobial usage and the antimicrobial susceptibility of Escherichia coli cultured from poultry faeces on 301 integrated farms in Ayeyarwady Delta of Myanmar. Antimicrobials were used by 92.4% of farmers for chickens, but they were not applied to fish. The most common antimicrobials used were Octamix (amoxicillin and colistin sulfate) on 28.4%, enrofloxacin on 21.0% and amoxicillin on 16% of farms. Overall, 83.1% (152/183) of the E. coli were resistant to at least one antimicrobial. The highest level of resistance was to amoxicillin (54.6%), tetracycline (39.9%), sulfamethoxazole/trimethoprim (35.5%) and enrofloxacin (34.4%). Multidrug resistance was identified in 42.4% of isolates. In general, we found similar levels of antimicrobial resistance in non-users of antimicrobials as in users of antimicrobials for more commonly applied antimicrobials. Overall, antimicrobial resistance was lower in chickens on these integrated farms in Myanmar, compared to poultry farms in other countries of South East and East Asia