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Forensic laboratory work in Burma (with special reference to the Office of the Chemical Examiner, Burma).

Burma is a country in Southeast Asia which is slightly smaller than Texas and has a population of 30 million people. The British colonial era brought the Chemical Examiner's laboratory to Burma. This was an all-purpose analytic laboratory. The forensic laboratory evolved within this structure as the need arose. The Medico-legal Division of this laboratory examined trace evidence, drugs, and body fluids of felons and there victims. Various aspects of investigation are discussed.

Chemistry, Analytic↗

Assessing the magnitude of the HIV/AIDS epidemic in Burma.

OBJECTIVES: Estimates of the HIV/AIDS burden in Burma (Myanmar) are uncertain. Using data from the 1999 national HIV sentinel surveillance and available population data, we generated estimates of Burma's HIV burden in 1999. METHODOLOGY: The 1999 sentinel surveillance included women attending antenatal clinics, male military recruits, blood donors, injecting drug users, patients of sexually transmitted disease clinics, and sex workers. We used data for women attending antenatal clinics and male recruits aged 20-29 years to estimate HIV prevalence among women and men, respectively. Data points were merged to give five regional estimates of prevalence for men and women. Census figures were used to obtain national population estimates of the numbers of Burmese living with HIV infection, along with confidence intervals (CIs). RESULTS: HIV prevalence varied by region, with the lowest rates in the West, intermediate rates in the central region, and highest rates in the North, East, and South. The highest rates were in the East (Shan State), with female prevalence of 3.0% (95% CI, 1.9-4.5). The total number of infected women nationwide was 218,300 (95% CI, 159,400-277,100), and that of men was 468,700 (95% CI, 343,300-594,200). We estimated HIV prevalence of at least 3.46% (95% CI, 2.72-4.19) among adults aged 15-44 years; 5700 infants were born with HIV infection in 1999. DISCUSSION: Burma has a generalized epidemic of HIV-1 in reproductive age adults. We estimated that there were 687,000 (95% CI, 541,100-832,900) Burmese adults living with HIV infection in 1999, or about one of every 29 adult citizens. This estimate is higher than the UNAIDS estimate for the same year of 530,000 adults and children living with AIDS, or a population prevalence of about one in 50 adults. HIV prevention and care programs are urgently needed in Burma.

Acquired Immunodeficiency Syndrome↗

Insecticide susceptibility of some vector fleas and mosquitoes in Burma.

Rat fleas and mosquitoes are insect vectors of public health importance in Burma. Plague is endemic in Central Burma and DDT has been the principal insecticide used for its control to date. Dengue haemorrhagic fever, recently introduced and transmitted by Aedes aegypti, has been spreading to major towns since 1971. The rodents, Rattus rattus, R. exulans, Bandicota bengalensis, Mus musculus, as well as shrews were commonly caught during routine trapping in the country. Rattus norvegicus, prevalent in Rangoon City, is not found in Central Burma. The rat fleas, Xenopsylla cheopis and X. astia, were found to be infesting these rodents, the former being the principal vector of plague. Insecticide susceptibility tests have been carried out periodically in plague endemic areas and Rangoon since 1966 and it is now observed that rat fleas in most of these endemic towns and Rangoon Port are no longer susceptible to DDT. Subsequent rechecks in towns where fleas became resistance to DDT show that fleas are persistently resistant to the insecticide. Aedes aegypti is found to be highly prevalent both in rural and urban areas of almost every major town and townships below 900 meters. Insecticide susceptible tests on this mosquito in limited areas show that the mosquito is generally resistant to DDT but susceptible to other insecticides. With the development of DDT resistance in fleas, it is now necessary to change to an effective insecticide in the control of plague in Burma.

Aedes↗

Results of medical examination of refugees from Burma.

OBJECTIVES: To describe exposure to human rights violations among refugees from rural Burma; to compare exposure experienced by an ethnic Burmese minority group, the Shans, with that of the rest of the study population; and to compare exposure of those who had fled Burma recently with that of refugees who had arrived in Thailand earlier. DESIGN: Cross-sectional interview and clinical examination. SETTING: Refugee settlements and refugee camps in Northern Thailand near the border to Burma in November 1997. SUBJECTS: 92 persons (group A) were examined according to the program. Fourty-six were Shans; 34 had migrated within the past five months. A further 96 person (group B), more randomly selected, were interviewed according to an abbreviated interview program; of these, 38 had fled recently. MAIN OUTCOME MEASURES: A score was used to quantify the exposure. Testimonies of exposure to physical violence were validated, assessing the consistency between the reported exposure, reported ensuing symptoms and the result of the clinical examination. RESULTS: Both groups reported massive exposure to the following human rights violations: forced labour (group A: 66%, group B: 35%), porter service (65%, 44%), forced relocation (51%, 51%), killing of family members (36%, 29%). In group A, there were twelve cases of self-reported torture. Moreover, there were reports of rape, disappearances and land mine accidents. In all cases of exposure to physical violence the testimonies were appraised to be valid. CONCLUSION: The violations of human rights in Burma were massive. The Shans were exposed as heavily as the others. Those who had arrived recently were as heavily exposed as the other groups. Apart from the land mine problem, the Burmese army was held responsible for all the reported and documented human rights violations.

Adolescent↗

Late Eocene of Burma yields earliest anthropoid primate, Pondaungia cotteri.

In April 1978, a fragment of a primate lower jaw containing the second and third molar teeth was found in late Eocene exposures of the Pondaung Hills about 1 mile north-west of Mogaung village in northwestern Central Burma. This approximately 40-Myr-old specimen is the first fossil primate found in Burma since the fragmentary remains of the controversial earliest anthropoids Pondaungia cotteri Pilgrim and Amphipithecus mogaungensis Colbert were recovered more than 50 yr ago. The jaw described here is believed to represent further evidence of P. cotteri. Its recovery from undoubled late Eocene exposures coupled with its salient higher primate characters and excellent state of preservation provides the opportunity to substantiate further that the Pondaung primates of Burma are the earliest known record of the Anthropoidea.

Animals↗

Measures to prevent and reduce drug abuse among young people in Burma.

Opium and to a certain extent cannabis were the only drugs of abuse in Burma until the early 1970s when heroin addiction spread rapidly among young people, reaching epidemic proportions. Heroin addiction has caused serious social and health problems that prompted the authorities to adopt new legislation in 1974, the Narcotic and Dangerous Drugs Law, which provided for compulsory treatment and severe penalties for drug-related infractions, including the death sentence for certain categories of drug trafficking. The authorities in Burma consider that legislation, drug-law enforcement, prevention, treatment and rehabilitation, and community measures are important and interrelated strategies in combating drug abuse among young people. Various forms of drug-abuse preventive programmes are carried out for such groups as youths, parents, community leaders and professionals dealing with the problems of the young. Preventive school programmes include lectures and discussions; exhibitions; essay writing and other forms of competition for students; in-service training for teachers; healthy alternatives to drug use; a scheme for talented students; and participation in a national mass movement for literacy. Young people are also encouraged to take active part in various community programmes such as the "Red Cross" and voluntary fire brigades as well as in specially designed programmes that are carried out at the local level to prevent and reduce drug abuse. As the extended family still prevails in Burma, with parents and elders being respected by the young, this important resource is utilized in coping with drug abuse among young people.(ABSTRACT TRUNCATED AT 250 WORDS)

Codeine↗

Burma: the political economy of violence.

Protracted conflict and violence in Burma have been conducive to the growth of the opium industry, Burma's single financial success in recent years of economic crisis and authoritarian rule. This in turn has fed violence and subsequent humanitarian crisis. This paper argues that the underlying political economy of the conflict has been overlooked, while conflict itself has been treated as a peripheral factor in questions of 'development', and further that the opium dynamic is a vital factor in continued violence and vulnerability for non-combatants in the region. A political economy approach, identifying the beneficiaries of violence, will offer a more holistic and effective approach to the protracted crisis.

Authoritarianism↗

Internal displacement in Burma.

The internal displacement of populations in Burma is not a new phenomenon. Displacement is caused by numerous factors. Not all of it is due to outright violence, but much is a consequence of misguided social and economic development initiatives. Efforts to consolidate the state by assimilating populations in government-controlled areas by military authorities on the one hand, while brokering cease-fires with non-state actors on the other, has uprooted civilian populations throughout the country. Very few areas in which internally displaced persons (IDPs) are found are not facing social turmoil within a climate of impunity. Humanitarian access to IDP populations remains extremely problematic. While relatively little information has been collected, assistance has been focused on targeting accessible groups. International concern within Burma has couched the problems of displacement within general development modalities, while international attention along its borders has sought to contain displacement. With the exception of several recent initiatives, few approaches have gone beyond assistance and engaged in the prevention or protection of the displaced.

Altruism↗

Burma revisited.

The author, who had spent a year with a mobile field hospital in Burma in 1944 during World War II, was able to visit Rangoon for 5 days in 1977 with the assistance of a grant from the Association of Anaesthetists of Great Britain and Ireland. Some impressions of life in Burma today are given, especially in relation to the problem of providing an anaesthetic service for the main hospitals in Rangoon and the work of Professor Win Maung, FFARCS and his University department. The author also describes some of the aid which it has been possible to organise since his return to the United Kingdom and outlines requirements for the future.

Anesthesiology↗

The spectrum of beta thalassaemia in Burma.

The molecular defects causing beta thalassaemia have been analysed in 85 unrelated Burmese patients. The patients included 14 with homozygous beta thalassaemia, 70 with HbE/beta thalassaemia and one with HbS/beta thalassaemia. Using a combination of allele-specific oligoprobe hybridization and direct sequencing of genomic DNA amplified by the polymerase chain reaction, 95/99 of the beta-thalassaemia alleles have been characterized. Six mutations have been identified of which three, the G-T at IVS-1 position 1, the G-C at IVS-1 position 5 and the deletion of TCTT in codons 41/42, accounted for 85% of the alleles. Despite the diversity of ethnic groups in Burma, the number of beta-thalassaemia alleles in Burma is relatively small. Thus, diagnosis of the majority of the beta thalassaemias would be possible using a limited number of oligonucleotide probes.

Alleles↗

Cost effectiveness and cost utility of preventing trachomatous visual impairment: lessons from 30 years of trachoma control in Burma.

AIMS/BACKGROUND: This paper reports on the findings of a cost and effectiveness study of the trachoma control programme (TCP) in Burma. The TCP began in 1964 employing non-surgical interventions (community education and mass treatment with topical antibiotics) and surgical correction of trichiasis. METHODS: Fixed and variable costs of the TCP are assessed over 30 years (1964-93) and apportioned to either surgical or non-surgical interventions. The change in the prevalence of trachoma blindness during this period is used to calculate cases of visual impairment prevented by the TCP. The years of life saved because of premature mortality averted and from living in a handicapped state are added to yield a single measure of utility called handicap adjusted life years (HALYs). RESULTS: The cost effectiveness of the TCP is $54 per case of visual impairment prevented: $193 and $47 for surgical and non-surgical interventions respectively. The cost utility of the TCP is $4 per HALY averted: $10 and $3 for surgical and non-surgical interventions respectively. Results are highly sensitive to the 1965 prevalence of blindness, the choice of discount rate, and the effectiveness of both interventions. CONCLUSIONS: Thirty years of trachoma control in Burma are associated with a remarkable decline in trachomatous blindness. Both surgical and non-surgical interventions are cost effective means of preventing trachomatous visual impairment. Discussion focuses on methodological limitations and implications for research and policy.

Blindness↗

Menstrual madness: women's health and well-being in urban Burma.

Women's health in peri-urban Burma is conceived of in terms of blood, strength, and the relationship between the body, the body politic, and the local environment. The regulation and volume of blood at menstruation and childbirth are the fundamental indicators of health and well-being. Well-being is contingent on harmony in and between the body and the universe. Blood flow is a key symbol through which women's beliefs and practices concerning their health and well-being can be understood at the levels of pathophysiology, interpersonal relations, the local environment, and the wider political and moral economies of urban Burma.

Adult↗

Urbanization and economic development in Burma.

"Since British colonial rule in Burma [Myanmar], urban centres have emerged and grown. This has continued with independence in 1948. Urbanization has proceeded apace, first primarily because of rural-urban migration and then mainly because of natural growth in cities and towns, leading to a host of urban problems exacerbated by an ailing economy which has not permitted adequate levels of investment in, and development of, urban infrastructure. This article examines these issues in urbanization and economic development and concludes that long-term solutions to these problems can only be arrived at if population growth and urbanization are given sufficient attention in economic policies which must, necessarily, seek to restructure the economy. The urban future of Burma, otherwise, remains bleak."

Asia↗

Burma and Cambodia: Human Rights, Social Disruption, and the Spread of HIV/AIDS.

The debate around the issues raised by HIV/AIDS and human rights has largely focused on the protection from rights violations of individuals or groups affected by the disease. The relationship between political and social conditions where human rights abuses are frequent and the spread of HIV infection has been less studied. Two countries in Southeast Asia, Burma and Cambodia, are currently undergoing serious and uncontrolled epidemics of HIV; both are marked by political cultures of state violence and corruption, chronic civil war and insurgency, and widespread human rights violations. This article attempts to investigate associations between rapid HIV spread and political and social crises, using Burma and Cambodia as case studies. The climate and context of rights abuses are seen as significant factors of national vulnerability to the epidemic spread of HIV/AIDS.

Journal Article↗

Epidemiological features of dengue and chikungunya infections in Burma.

A serological survey for antibody to dengue and chikungunya was carried out in all 14 divisions and states and 2 border towns in Burma during 1973-74. Dengue HI antibody prevalence rate of less than 10% was observed in Arakan and Shan States, 10 to 30% in the Irrawaddy, Pegu, Mandalay Divisions and Kachin, Mon and Karen States, 31 to 60% in Sagaing Division, and over 60% in Rangoon, Magwe and Tenasserim Divisions. Similarly, chikungunya HI antibody prevalence rate of less than 10% was observed in Arakan State, 10 to 30% in the Irrawaddy, Pegu, Mandalay and Sagaing Divisions and Kachin State, 31 to 60% in Rangoon Division and Mon State. Both dengue and chikungunya antibodies were detected where Aedes aegypti mosquitoes were prevalent but the antibody prevalent rates were not directly proportional to the premises index. No HI antibody to dengue nor chikungunya was detected in Aedes aegypti free hilly areas, Chin and Kayah States, but was detected in the Shan State, Dengue and chikungunya infections were observed both in rural and urban populations. Dengue and chikungunya infections affected all socioeconomic classes in Rangoon equally but in Mandalay high socioeconomic class was nearly 3 times less affected than lower socioeconomic class. The infrequencies of dengue and chikungunya infections were observed to be 2 to 3 times higher in residents of Rangoon City than those of other towns. In Rangoon the antibody prevalence rates to dengue increased progressively with age while in other towns no appreciable increase in rates with age was observed. Both sexes were equally affected. This study provides strong circumstantial evidence that dengue and chikungunya viruses are highly and widely distributed throughout Burma, and that new outbreaks of haemorrhagic fever could occur in previously free areas following introduction of dengue viruses into populations previously exposed to one type of dengue.

Aedes↗

Control of trachoma and prevention of blindness in rural communities in Burma.

Trachoma was identified as the single most important cause of blindness in central Burma in a study carried out in 1961-1962. Control measures started in 1964 considerably reduced the degree of endemicity and severity of the disease in the areas treated. According to recent simplified criteria of evaluation, the prevalence of active trachoma has been reduced by more than 60% and that of active inflammatory disease of moderate and severe intensity from 7.4% to 1.8% of the active cases. A reduction in the risk of becoming infected is evident from changes that have occurred among the younger age groups.The experience acquired by the trachoma control project in central Burma-covering a population of more than 4 million in 8000 villages-emphasizes the importance of the active participation of the community and the role of local auxiliary personnel. Most of the activities, including surgical repair of trichiasis, are the responsibility of health assistants; their training includes, in addition to the recognition and treatment of patients requiring topical application of antibiotics or surgical repair of trichiasis, the screening and referral to the general practitioner or to the eye specialist of those needing more specialized attention.The results already obtained have made possible a gradual replacement of control activities by a surveillance programme, and their integration into the basic health services. The objectives of the trachoma control programme have been expanded to include the prevention and management of other causes of preventable or curable blindness, with special emphasis on eye injuries and glaucoma.

Adolescent↗

Veterinary experiences as a Japanese prisoner of war and ex-POW along the Burma railroad from 1942 to January 1946.

As a prisoner of war the writer was working for nearly three years in different POW camps, and outside them, along the Burma railway from Thanbyuyzat in southern Burma up to Kanchanabury in Thiland. In the army of the Netherlands-Indian archipelago (KNIL) he had the military rank of reserve horse-doctor. In civilian life he was attached to the Veterinary Institute in Buitenzorg(now Bogor) as a veterinary bacteriologist. His task as a POW became that of meathygienist and supervisor of the living animals in the camps. In this function he diagnosed swine fever in growing pigs which had mainly been fed on the offal of the Japanese kitchen. The acute course and the pathological alterations observed during the post-mortem examinations were identical with those of the Southern-African type of the disease. In slaughter cattle the author diagnosed some cases of lung tuberculosis, one of anthrax, several of rinderpest, some of rhinal granulomatosis and one of foot and mouth disease. In chickens he found NCD (pseudo-fowlpest) and in ducklings a mortal disease which the author then called 'keeling disease' but which he many years later, recognized as virus hepatitis. As assistant bacteriologist and ex-POW he joined the British regimental hospital in Bangkok. Here he had the apportunity to assist the bacteriologist pathologist, Maj. C. R. Peck IMS/IAMC in diagnosing the first case of melioidosis in an ex-POW of the KNIL who died from the sub-acute infection, notwithstanding treatment in the hospital with sulfa-drugs and penicillin.

Concentration Camps↗