Community health worker in hard-to-reach rural areas of Myanmar: filling primary health care service gaps.

BACKGROUND: Myanmar is classified as critical shortage of health workforce. In responses to limited number of trained health workforce in the hard-to-reach and remote areas, the MOH trained the Community Health Worker (CHW) as health volunteers serving these communities on a pro bono basis. This study aimed to assess the socio-economic profiles, contributions of CHW to primary health care services and their needs for supports to maintain their quality contributions in rural hard to reach areas in Myanmar. METHODS: In 2013, cross-sectional census survey was conducted on all three groups of CHW classified by their training dates: (1) prior to 2000, (2) between 2000 and 2011, and (3) more recently trained in 2012, who are still working in 21 townships of 17 states and regions in Myanmar, using a self-administered questionnaire survey in the Burmese language. FINDINGS: The total 715 CHWs from 21 townships had completely responded to the questionnaire. CHWs were trained to support the work of midwives in the sub-centres and health assistant and midwives in rural health centres (RHCs) such as community mobilization for immunization, advocates of safe water and sanitation, and general health education and health awareness for the citizens. CHWs were able to provide some of the services by themselves, such as treatment of simple illnesses, and they provided services to 62 patients in the last 6 months. Their contributions to primary health care services were well accepted by the communities as they are geographically and culturally accessible. However, supports from the RHC were inadequate in particular technical supervision, as well as replenishment of CHW kits and financial support for their work and transportation. In practice, 6 % of service provided by CHWs was funded by the community and 22 % by the patients. The CHW's confidence in providing health services was positively associated with their age, education, and more recent training. A majority of them intended to serve as a CHW for more than the next 5 years which was determined by their ages, confidence, and training batch. CONCLUSIONS: CHWs are the health volunteers in the community supporting the midwives in hard-to-reach areas; given their contributions and easy access, policies to strengthen support to sustain their contributions and ensure the quality of services are recommended

Prevalence and determinants of tobacco use among youth in Myanmar: review of findings from Global Youth Tobacco Survey 2016 Data

Background The study aims to reassess the health, knowledge and practice of students, (9-11 Grades) after the introduction of New National Tobacco Control program for 5 years. This study includes data on prevalence of cigarettes and other tobacco use as well as information on five determinants of tobacco use: access, exposure to secondhand smoke (SHS), cessation, media and advertising, and other indicators. Methods Myanmar GYTS uses a two-stage sample design with schools selected proportional to enrolment size. A total of 3633 eligible students in grades 9-11 completed the survey ,of which 2621 were aged 13-15 years Results Between 2011 and 2016, a reduction in the proportion of students currently use any tobacco products is observed (a fall from overall prevalence among 13-15 year olds of 18.6% to 14%). but currently smoked cigarettes had increased during the period from 6.8% to 8.3%. Currently use any smokeless tobacco products had decreased (9.8% to 5.7%). 74.5% of current smokers tried to stop smoking in the past 12 months.33.2% are exposed to tobacco smoke at home as well as 28.4% are exposed tobacco smoke inside any enclosed public place. 61% of current cigarette smokers bought cigarettes from a store, shop or street vendors. 42.3% of students noticed tobacco advertisements on point of sale. 65% of students thought other people's smoking is harmful to them. Conclusions Myanmar Youth Tobacco program should strengthen in all schools to be 100% tobacco-free and also incorporate training of school personnel on tobacco control, specifically youth-focused programs as joint efforts between Ministry of Health and Sports and Ministry of Education in collaboration with related ministries. Enforcement of the national legislation on tobacco control needs to be strengthened, and the National Tobacco Control Program needs to be more comprehensive incorporating measures to reduce smokeless tobacco use and other non-cigarette tobacco products

Experiences from the pilot implementation of the Package of Essential Non-communicable Disease Interventions (PEN) in Myanmar, 2017-18: A mixed methods study.

BACKGROUND AND OBJECTIVES:Myanmar adopted the World Health Organization (WHO) Package for Essential Non-Communicable Disease Interventions (PEN) in 20 pilot townships in 2017. This study was conducted to assess the implementation of PEN, its effectiveness and understand the facilitators and barriers in its implementation. METHODS:Mixed methods design involving a quantitative component (retrospective study analysing both aggregate and individual patient data from PEN project records; cross-sectional facility survey using a structured checklist) and a descriptive qualitative component. RESULTS:A total of 152,446 individuals were screened between May 2017-December 2018 comprising of current smokers (17.5%), tobacco chewers (26.3%), Body Mass Index ≥25 kg/m2 (30.6%), raised blood pressure i.e. ≥ 140/90 mmHg (35.2%) and raised blood sugar i.e. Random Blood Sugar >200 mg/dl, Fasting Blood Sugar >126 mg/dl (17.1%). Nearly 14.8% of those screened had Cardiovascular Disease (CVD) risk score ≥20%, 34.6% had CVD risk not recorded. Of 663 patients registered with diabetes and/or hypertension in 05 townships, 27 (4.1%) patients made three follow-up visits after the baseline visit, of whom, CVD risk assessment, systolic blood pressure and blood sugar measurement was done in all visits in 89.0%, 100.0% and 78.0% of cases respectively. Health facility assessment showed 64% of the sanctioned posts were filled; 90% of those appointed been trained in PEN; key essential medicines for PEN were available in half of the facilities surveyed. Confidence of the health care staff in managing common NCD and perceived benefits of the project were some of the strengths. CONCLUSION:High loss to follow up, poor recording of CVD risk score, lack of essential medicines and equipments were the key challenges identified that need to be addressed before further expansion of PEN project to other townships