The salt between the beans: a qualitative study of the role of auxiliary midwives in a hard-to-reach area of Myanmar

Background: Auxiliary Midwives (AMWs) are unpaid volunteer health workers assisting qualified paid midwives in maternal and child health care mainly in hard-to-reach areas of Myanmar. This paper describes the relationship between AMWs and the health system in providing maternal and child services as perceived by the community, AMWs themselves and health care providers in one remote township of Myanmar. Method: A qualitative study was conducted in Ngape Township, Myanmar. A total of 15 focus group discussions with midwives, AMWs, community members and mothers were conducted. Ten key informant interviews were performed with national, district and township level health planners and implementers of maternal and child health services. Thematic analysis was done using the ATLAS.ti software. Results: AMWs occupy a unique position between the community and the health sector in the study township. The relationship and trust with the community is built upon prolonged presence providing health care, skill building and fulfilling community expectations. Health care providers’ expectations to provide only preventive care, health promotion and education and childbirth care are often exceeded in reality when emergencies occur in hard-to-reach areas. This challenge to handle emergency situations with no support and limited skills and training is considered as most difficult by the AMWs. This mismatch of service provision expectations by both the community and other health care providers has put AMWs in a position which they describe as being the “salt between the beans” an essential ingredient but often invisible between the beans. Conclusion: The trust and relationship developed by AMWs over four decades of community practice serving as the mediator role is an untapped resource that can facilitate future community-based maternal and child health interventions in Myanmar

Anti-hyperglycemic Activity in Vitro, Actuate Toxicity in Vivo and Antioxidant Activity of the Crude Extract of the Root of Plumeria alba L.

Medicinal plants are the single most productive sources for the development of drugs and play an important role in treating and preventing a variety of diseases through the world.  Plumeria alba Linn. commonly known as Tayoke-sakar-aphyu in Myanmar is one of the medicinal plants belonging to Apocynaceae family. The pharmacological studies were carried out to investigate antimicrobial activity, antioxidant activity, anti-hyperglycemic activity in vitro and acute toxicity in vivo. The main aim of the present research is to evaluate the biological activities of the root of Plumeria alba L, Firstly, phytochemical screening of the collected sample was performed. Elemental composition of the crude sample was examined by EDXRF (Energy Dispersive X-ray Fluorescence) spectroscopy. Moreover three different solvents such as ethanol, ethyl acetate and n-hexane extracts of the sample were examined for their antimicrobial activities against Bacillus subtilis, Staphylococcus aureus, Pseudomonas aeruginosa, Bacillus pumilus, Candida albicans and E. coli by Agar- well diffusion method. The antioxidant activity of ethanol extract of the root of Plumeria alba L. was studied by DPPH (1,1-Diphenyl-2-picryl-hydrayl) assay. The acute toxicity of ethanol extract of the root of Plumeria alba L. on Artemia salinna were investigated. The glucose lowering activities of the water and ethanol extracts of the sample were determined by iodometric titration

The potential of task shifting selected maternal interventions to auxiliary midwives in Myanmar: a mixed-method study

Background: An estimated 282 women die for every 100,000 live births in Myanmar, most due to preventable causes. Auxiliary Midwives (AMWs) in Myanmar are responsible for providing a package of care during pregnancy and childbirth to women in rural hard to reach areas where skilled birth attendants (Midwives) are not accessible. This study aims to examine the role of AMWs in Myanmar and to assess the current practices of three proposed essential maternal interventions (oral supplement distribution to pregnant women; administration of misoprostol to prevent postpartum haemorrhage; management of puerperal sepsis with oral antibiotics) in order to facilitate a formal integration of these tasks to AMWs in Myanmar. Methods: A mixed methods study was conducted in Magwe Region, Myanmar involving a survey of 262 AMWs, complemented by 15 focus group discussions with midwives (MWs), AMWs, mothers and community members, and 10 key informant interviews with health care providers at different levels within the health care system. Results: According to current government policy, AMWs are responsible for identifying pregnant women, screening for danger signs and facilitating early referral, provision of counselling on nutrition and birth preparedness for women in hard-to-reach areas. AMWs also assist at normal deliveries and help MWs provide immunization services. In practice, they also provide oral supplements to pregnant women (84%), provide antibiotics to mothers during the puerperium (43%), and provide misoprostol to prevent postpartum haemorrhage (41%). The current practices of AMWs demonstrate the potential for task shifting on selected essential maternal interventions. However, to integrate these interventions into formal practice they must be complemented with appropriate training, clear guidelines on drug use, systematic recording and reporting, supportive monitoring and supervision and a clear political commitment towards task shifting. Conclusion: With the current national government’s commitment towards one AMW in one village, this study highlights the potential for shifting specific maternal lifesaving tasks to AMWs

Impact of rapid Industrialization of Mandalay on Dokhtawady River

Analysis of water quality is required for pollution control, the assessment of environmental impacts for human beings. In this paper, it is pointed out that how the effect of industrialization of Mandalay Industrial Zone (II) impacts on Dokhtawady River. Water quality of three different sites and periods of Dokhtawady River were compared. These sites are near Shwesaryan Pagoda (Site-I), upper and lower places of Dokhtawady river that flowed Mandalay industrial sewage Ditch (Site-II and Site-III). The characteristic properties of water samples were studied by various analytical methods applying sophisticated instruments such as pH meter, spectrophotometer and conductivity meter. The physical and chemical parameters were determined such as colour, turbidity, pH, conductivity, total hardness, total alkalinity, total iron, manganese, chloride, and sulphate. Heavy metal contamination in water samples were detected by using Atomic Absorption Spectroscopic method. In addition, the biological examination of water samples was estimated. The results showed that the water samples were contaminated with some heavy metals

Women’s knowledge on common non-communicable diseases and nutritional need during pregnancy in three townships of Ayeyarwaddy region, Myanmar: a cross-sectional study

Abstract Background Health systems in many countries do not adequately address non-communicable diseases (NCDs) during pregnancy, especially in low- and middle-income countries. In Myanmar, most studies on NCDs have investigated risk factors and prevalence of NCDs in the general population. This study aimed to assess the level of knowledge of common NCDs and nutritional need during pregnancy and to identify the factors associated with such knowledge, in three townships of Ayeyarwaddy region in Myanmar. Methods A cross-sectional study was conducted among pregnant women aged between 18 and 49 years. We interviewed 630 pregnant women by using a pretested structured questionnaire. Knowledge questionnaire had five categories: general knowledge in NCDs, hypertension, diabetes, anemia, and nutritional need during pregnancy. Knowledge scores ranged from 0 to 56. We used Bloom’s cut-off point to classify the knowledge into three levels: low level as 59% or below (0–33 scores), moderate level as 60–80% (34–49 scores), and high level as 80–100% (50–56 scores). We conducted multiple linear regression analyses to find the association between different exposure variables (behavioral risk factors, pre-existing NCDs in pregnant women, and family history of NCDs) and knowledge on common NCDs and nutritional need during pregnancy adjusted for socioeconomic factors. Results Among pregnant women, 64.8% had moderate level of knowledge, 22.7% had low level, and only 12.5% had high level. The mean knowledge scores were 39.6 (standard deviation 10.2). Pregnant women with the following factors were more likely to have higher knowledge: their belonging to the second, middle, and fourth quintiles of wealth index and their family members’ status of having some kind of NCDs. Conclusions Majority of pregnant women had low to moderate level of knowledge on common NCDs and nutritional need during pregnancy. Wealth and family history of NCDs were significantly associated with their knowledge. Prevention and promotion of NCDs should be integrated in maternal and child health programs and should emphasize for the pregnant women who are in the poorest or richest wealth quintiles and who do not have family history of NCDs

Feasibility and readiness to implement Robson classification to monitor caesarean sections in public hospitals in Myanmar: Formative research.

Recent years have demonstrated an increase in caesarean section (CS) in most countries worldwide with considerable concern for the potential consequences. In 2015, WHO proposed the use of Robson classification as a global standard for assessing, monitoring and comparing CS rates. Currently, there is no standardized method to assess CS in Myanmar. The aim of this study was to explore health provider's perceptions about the feasibility, acceptability and readiness to implement the Robson classification in public hospitals across Myanmar. Ten maternities were purposively chosen, including all five teaching hospitals (tertiary referral hospital-level) affiliated to each medical university in Myanmar, which provide maternal and newborn care services, and district/township hospitals. Face-to-face in-depth interviews (IDI) with healthcare providers and facility administrators were conducted using semi-structured discussion guides. Facility and medical records systems were also assessed. We used the thematic analysis approach and Atlas.ti qualitative analysis software. A total of 67 IDIs were conducted. Most participants had willingness to implement Robson classification if there were sufficient human resources and training. Limited human resources, heavy workloads, and infrastructure resources were the major challenges described that may hinder implementation. The focal person for data entry, analysis, or reporting could be differed according to the level of facility, availability of human resources, and ability to understand medical terms and statistics. The respondents mentioned the important role of policy enforcement for the sustainability of data collection, interpretation and feedback. The optimal review interval period could therefore differ according to the availability of responsible persons, and the number of births. However, setting a fixed schedule according to the specific hospital for continuous monitoring of CS rate is required. In Myanmar, implementation of Robson classification is feasible while key barriers mainly related to human resource and training must be addressed to sustain

Medical Students’ Perception of Learning Environment in New Campus of University Malaysia Sarawak (UNIMAS): Measured by DREEM

Background: The ultimate goal of the medical education is to produce the competent and qualified medical professionals. One essential component of medical education is to provide a good learning environment. The assessment of learning environment has been determined as a key instrument for the delivery of high quality and effective education and curriculum. Objective of this study: It is to evaluate the strengths and weaknesses of learning environment in new campus of medical faculty in Kotasamarahan. Methods: It was a cross-sectional, questionnaire based study and ninety year-two medical students were recruited for the study. Dundee Ready Education Environment Measure (DREEM) questionnaire was used to collect the data. Results: The total score of DREEM was 124.05 / 200 and scores of all subdomains indicate ‘More positive than negative’ however there are items, 3,4,9,14,17,25,27 and 48 scored <2 which need improvements to be made to further enhance the quality of learning environment in new medical faculty of UNIMAS. Conclusion: This study can be used as a pivoting point to help produce more competent medical graduates in the future with the implementation of an efficient learning environmen

Qualitative interview guide.

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