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Glucose-6-phosphate dehydrogenase (G6PD) mutations in Myanmar: G6PD Mahidol (487G>A) is the most common variant in the Myanmar population.

We conducted a survey of malaria diagnoses and treatments in remote areas of Myanmar. Blood specimens from more than 1,000 people were collected by the finger-prick method, and 121 (11%) of these people were found to be glucose-6-phosphate dehydrogenase (G6PD) deficient. Of these 121, 50 consented to analysis of the G6PD genome. We read the G6PD sequences of these subjects and found 45 cases of G6PD Mahidol (487G>A), two of G6PD Coimbra (592C>T), two of G6PD Union (1360C>T), and one of G6PD Canton (1376G>T). Taken together with data from our previous report, 91.3% (73/80) of G6PD variants were G6PD Mahidol. This finding suggests that the Myanmar population is derived from homogeneous ancestries and are different from Thai, Malaysian, and Indonesian populations.

Ethnicity↗

[Background of development and effectiveness of myanmar sandals (the activity of Leprosy Control and Basic Health Services Project in Myanmar)].

"Leprosy control and Basic health service Project" was terminated at March 2005 within the scope of the period. I was assigned to develop the Plantar protect footwear for neuropathic feet, which called "Myanmar Sandals" in common. These sandals are not made by new technologies but made by basic knowledge. I would like to report about this activity as which is a part of distinguished strategy of ODA (Official Development Assistance) for developing country, but not as the technical report of these sandals. There is only one National Leprosy Hospital in Myanmar. At the time this project started, there were only two footwear technicians for the people who had disabilities by after effect of Hansen's disease in this country. And, it would appear that the number of the people is over 50,000. Furthermore, the budget of national hospital is not enough to refill necessary consumable supplies and materials. Although, I should instruct new technique which like making in Japan in ordinary circumstances, I could not think that such technical transfer by using costly imported materials woud bring beneficial effect and be continued. We were bound to be anxious about such situations when we made the plan. As a result of examining a plan based on these situations, we reached the conclusion that development of the simplified ready-made footwear was pressing need.

Clinical Trials as Topic↗

Cross neutralization of the lethal activities of Myanmar and Thai Russell's viper venoms by Thai and Myanmar antivenoms.

The efficacy of homologous neutralization of the lethal activity of Myanmar Russell's viper venom (MRV) and Thai Russell's viper venom (TRV) by Myanmar antivenom (MAV) and Thai antivenom (TAV), respectively, were studied and compared with the heterologous neutralization of the lethal activity of MRV and TRV by TAV and MAV, respectively, in experimental mice. Although MRV and TRV were the same subspecies, their lethal activities and protective efficacy of MAV and TAV were apparently different from each other. However, there was some extent of cross reactivities between MRV and TAV, and TRV and MAV. The findings of this study suggested that it is necessary to administer heterologous antivenom in dosage of 1.7-4 times greater than that of homologous antivenom to achieve an equal potency.

Animals↗

Prevalence of anti-HIV seropositivity in Myanmar migrators in a rural area of Thailand.

Although the prevalence of anti-HIV seropositivity in the Thai population has decreased in the recent years, migration of Myanmar labors as carriers into Thailand may increase the prevalence of anti-HIV seropositivity. Screening is recommended for the Myanmar migrators. Of interest, the epidemiology of anti-HIV seropositivity in Myanmar migrators has not been precisely determined. In this study, we report the prevalence of anti-HIV seropositivity in Myanmar migrators in a rural community in the Southern Region of Thailand with a high density of Myanmar migrators as fishermen. We analyzed the screening data for anti-HIV seropositivity among 250 Myanmar migrators (169 males and 81 females) who were in Thailand for less than 1 month. The anti-HIV seropositivity rate among these Myanmar migrants was 3.2%. The rates in males and females were 4.1% and 1.2%, respectively. Since these migrants can carry the disease into Thailand, screening tests as a prevention strategies are necessary.

Adult↗

Policy and practice in Myanmar's protected area system.

Myanmar's protected area (PA) system began nearly 150 years ago under royal patronage. Park policies and practices, embodied in 19 pieces of legislation developed sporadically during and after the colonial period. As a result of the FAO-UNDP's Nature Conservation and National Parks Project (1981-1985) the government established the Nature & Wildlife Conservation Division and placed it within the Forest Department as the agency responsible for PA management. As a consequence the number of parks increased from 14 to 33. Myanmar's median park size is less than 50 km(2), but only five parks (15%) are larger than 1000 km(2). Most parks conserve terrestrial habitats; parks encompassing inland wetlands, mangrove, and marine habitats are limited in number and size. Existing PAs unequally represent Myanmar's ecosystems; the Malay Transition, Burmese coast, Burmese Transition and Cardamom Mountains bio-units are under-represented within the system. The effective total PA size (i.e., area of all parks less the area of 13 paper parks) is currently about 2.1%. Budgetary support for parks increased 11% since 1996, but is insufficient to address park needs, particularly in remote parks that are understaffed. Limited education and training of PA staff is a major factor limiting effective park management. Fifty-eight percent of park wardens are educated as foresters, and 42% have university degrees. The average posting in a park is 4 years, which is less than ideal for management continuity. Recommended actions to secure Myanmar's PAs include evaluation and reformulation of policies, increasing representation of Myanmar's habitats within the PA system, management planning, and standardizing protocols for anti-poaching patrols and other forms of law enforcement. Improved leadership training for wardens and range forest officers can also improve park management. Funding for community relations and more integrated management of parks and people can reduce conflicts, while environmental education and outreach activities can provide some needed services. Finally, new ways and means are needed to support these activities. Myanmar's PAs need creative and sustainable means of support, including partnerships with non-government organizations to supplement traditional means of support.

Animals↗

Genetic and serologic characterization of HIV type 1 prevailing in Myanmar (Burma).

To study the molecular epidemiology of HIV-1 spread in Myanmar and the interplay with the epidemic in surrounding Southeast Asian countries, we determined the HIV-1 subtypes prevailing in Myanmar. Thirty HIV-positive blood specimens were sampled in the capital city, Yangon, and an additional 459 sera were collected nationwide in 1995. Genetic subtyping based on the env C2/V3 sequence and serologic data, using a V3 peptide enzyme immunoassay (PEIA), revealed three patterns of HIV spread in different geographic regions in Myanmar: (1) in the capital city, Yangon, HIV-1 subtype B' ("Thai-B" cluster within subtype B) predominated both in IDUs and heterosexuals; (2) in the cities near the border with Thailand, including Tachelaik and Kawthaung, where heterosexual transmission is a major pathway of HIV-1 spread, HIV-1 subtype E was predominantly distributed among the commercial sex workers and heterosexuals; (3) in central and northeast Myanmar, both HIV-1 subtypes B' and E occurred in a mixed distribution, without showing any significant segregation by risk group. In addition, the PEIA data implied the occurrence of other subtype(s) in these areas. The interperson nucleotide sequence variations in env C2/V3 regions of B' and E, prevailing in Yangon, were 6.7 +/- 2.1 and 7.1 +/- 0.7%, respectively. They were similar to those levels observed in Thailand. These findings are consistent with the view that HIV spread in Myanmar might have taken place at about the same time as that in Thailand, and that multiple entries and exchanges of HIV-1 with neighboring countries are important factors contributing to the current distribution of subtypes in Myanmar.

Amino Acid Sequence↗

[Leprosy situation in Myanmar before and after multidrug therapy].

We introduced history of leprosy in Myanmar based on the book of Myanmar Academy of Medical Science published entitled "CONQUEST OF SCOURGES IN MYANMAR (Complied and Edited by Ko Ko, Kyaw and U Thaung) at 2002. "Leprosy Elimination Programme in Myanmar (Kyaw Lwin and Kyaw Nyunt Stein)" was appeared at chapter III in it. After dapsone treatment appeared, leprosy control program has started. Health system and service were developed and leprosy control program was also included in them. The integration of the elimination activities into basic health workers, such as midwives and health volunteers, has enabled the participation of a wide range of people in the community. After 1990s, multidrug therapy (MDT) was covered whole area of Myanmar, and task force for leprosy elimination was formed at Sate/Division, District and Township level. Finally Myanmar achieved the elimination of leprosy in January in 2003.

Dapsone↗

Progress toward poliomyelitis eradication--Myanmar, 1996-1999.

Myanmar borders polio-free countries (China, Laos, and Thailand) and countries with widespread poliovirus transmission (India and Bangladesh). Myanmar began to intensify its efforts toward polio eradication in 1996, when National Immunization Days (NIDs) were initiated. That year, wild polioviruses (one type 1 virus and two type 3 viruses) were isolated from Myanmar children with acute poliomyelitis seeking care in Yunnan Province, China. The importation of poliovirus from Myanmar into China stimulated the establishment of surveillance for acute flaccid paralysis (AFP) in 1996 and discussions between Myanmar and China on cross-border management of poliomyelitis eradication. This report summarizes polio eradication efforts in Myanmar, which focus primarily on supplemental vaccination activities and AFP surveillance.

Child↗

High prevalence of bancroftian filariasis in Myanmar-migrant workers: a study in Mae Sot district, Tak province, Thailand.

Although the prevalence of lymphatic filariasis in the Thai population is low, migration of Myanmar labor into Thailand may increase the incidence of bancroftian filariasis. Epidemiology of filariasis in Myanmars has not been precisely determined. By using microscopic examination, we found that the microfilarial rate in 654 Myanmar migrants working in Mae Sot, Tak province, was 4.4 per cent. The highest microfilarial rate was found in males aged 21-30 years (6.8%). History of mosquito bites was significantly correlated with microfilaremia. The majority of Myanmar migrants (55.5%) have been staying in Thailand 1-6 years; most (82.0%) have never been back to Myanmar. Seventy-nine per cent of infected Myanmars were from Moulmein (Maulamyine) city. Since these migrants carry the parasite with high infected rate and the mosquito vector Culex quinquefasciatus is also prevalent in Thailand, Thai people are at high risk of acquiring this disease if good control and prevention strategies are not implemented.

Adolescent↗

Chronology of primate discoveries in Myanmar: influences on the anthropoid origins debate.

The history of primate paleontology in Asia is long and complex, beginning with the first discoveries of fossil primates on the Indian subcontinent in the early 1830's. The first Eocene mammals from Asia were collected in Myanmar and described in 1916, while the first primates, Pondaungia and Amphipithecus, were described in 1927 and 1937, respectively, both from the Pondaung Formation in Myanmar. For the next 60 years, these two Pondaung taxa remained as the only known Eocene primates from Myanmar and one of the few records of Eocene primates from all of Asia. Taxonomically, Pondaungia and Amphipithecus were linked with a number of different groups, including archaic, hoofed ungulates (condylarths), adapiform primates, omomyid primates, and anthropoids. While no consensus existed, Pondaungia and Amphipithecus were most commonly compared with anthropoids. Beginning in the late 1990s, new primates were discovered in Myanmar, including smaller-bodied forms such as Bahinia and Myanmarpithecus. Also, new and better specimens of the larger-bodied Pondaungia and Amphipithecus began to appear, including the first cranial and postcranial fragments. Evaluations based on these new specimens, especially the postcrania, indicate that the two larger-bodied Myanmar taxa are adapiform primates that show their closest affinities to North American notharctines. The smaller-bodied taxa remain enigmatic, but may share their closest affinities with North American and Asian omomyid primates and Asian Tarsius. None of the known Asian primate taxa appear closely related to African anthropoids, which suggests that true anthropoids did not reach Asia until the latest Oligocene or earliest Miocene. These facts make an Asian origin for Anthropoidea unlikely. Additional and earlier evidence from both Asia and Africa is required before the ultimate origin of anthropoids can be determined. It appears possible that true anthropoids were an ancient radiation that may have been part of a Gondwanan (southern hemisphere) community that is, at present, poorly sampled and little understood.

Animals↗

Sequence comparison of the capsid region of hepatitis E viruses isolated from Myanmar and China.

Hepatitis E viruses (HEVs) were isolated during epidemics, one from Myanmar (formerly called Burma) and one from China and were partially sequenced. Another HEV Myanmar strain from sporadic hepatitis was previously sequenced by us. A cDNA sequence comparison was performed among them in the 3'-terminal region, approximately 750-base long. This region contained at least two immunological epitopes and was considered to correspond to the structural protein. The nucleotide sequence identity was 97.2% between the two Myanmar strains and 93.3 and 92.5% between the two Myanmar and the China strain. The deduced amino acid sequence identity ranged from 98.4 to 100.0% among the three strains. Thus this segment was well conserved on the amino acid level among the different strains isolated from these two Asian countries, although the China strain diverged more from the Myanmar strains on the nucleotide sequence level. This data may provide important information for the development of a vaccine and for identification of the virological link between different geographical locations.

Amino Acid Sequence↗

Hemoglobin E prevalence in malaria-endemic villages in Myanmar.

The population of Myanmar comprises 8 major indigenous races (Bamar, Kayin, Kachin, Shan, Rakhine, Mon, Chin, and Kayah). The Bamar reside in the 7 central divisions of the country, and the others reside in the 7 peripheral states that border neighboring countries, including China, Laos, and Thailand in the east and India and Bangladesh in the west. Both malaria and HbE are endemic in Myanmar, although the actual prevalence of the latter in the different indigenous races is not yet known. Hemoglobin electrophoresis was performed in 4 malaria-endemic villages, each having a different predominating indigenous race. The overall prevalence of HbE was 11.4% (52/456 villagers), ranging from 2-6% in the Kayin-predominant villages to 13.1-24.4% in the Bamar-predominant villages. Although the overall HbE prevalence in the villages studied was not significantly different from that of the general Myanmar population, this study strongly documented the influence of racial differences on the prevalence of HbE in Myanmar. To prevent and control severe thalassemia syndromes in Myanmar, extensive prevalence studies of the country?s indigenous races are suggested.

Adolescent↗

Evaluation of chloroquine (CQ) and sulphadoxine/pyrimethamine (SP) therapy in uncomplicated falciparum malaria in Indo-Myanmar border areas.

Chloroquine (CQ) and sulphadoxine/pyrimethamine (SP) are two first-line antimalarials used under the existing Indian National Drug Policy in the north-eastern region of India bordering several countries including Myanmar. Although widespread resistance to antimalarials in Plasmodium falciparum has been reported from western Myanmar, information from the Indian side of the border is scarce. We studied the therapeutic response to CQ and SP at four sites in Changlang and Lohit, two administrative districts of Arunachal Pradesh bordering Myanmar. We monitored uncomplicated falciparum malaria patients after treatment with standard regimens of CQ and SP for 28 days following the revised in-vivo protocol of the World Health Organization. A total of 236 patients, 95 in the CQ group and 141 in the SP group, participated. We recorded 23.8% early treatment failures to CQ and 14.1% to SP; late clinical failures of 14.3 and 12.6%; late parasitological failures of 10.7 and 8.1% and adequate clinical and parasitological responses of 51.2 and 65.2%, respectively. The significantly different treatment failure rates seen in Chowkham (furthest from Indo-Myanmar border) and Jairampur/Nampong (nearest to Indo-Myanmar border) for chloroquine (Cox proportion hazard ratio 9.1, P<0.0001) and SP (Cox proportion hazard ratio 7.35, P=0.001) denote a non-response gradient to the two antimalarials extending from the international border. The gradient is probably indicative of the direction of movement of the drug-resistant P. falciparum parasite. The utility of chloroquine as the first-line drug under the present National Drug Policy in these areas needs reconsideration.

Adolescent↗

Developing a national tiger action plan for The Union of Myanmar.

A century ago, tigers were considered pests in Myanmar. Hunters claimed thousands, yet populations persisted. In the past century, because of habitat loss and prey depletion, coupled with the recent demand for traditional medicines, tiger populations have been reduced to a few hundred individuals. As a first step toward long-term planning for tigers, and to guide efforts to increase protected area coverage, the Myanmar government in 1998 initiated a project to develop a revised National Tiger Action Plan. Extensive surveys confirmed tigers in only 4 of 17 survey locations. Significant populations are thought to persist in the far North and far South of the country, where large, intact forests offer the potential for tiger recovery. With partnerships and collaborations, tiger populations can be protected in the short term (<5 years) by expanding protected areas and corridors, mobilizing enforcement staff to reduce poaching of tigers and prey, and amending existing wildlife legislation in accordance with international laws. Over the long term (5-20 years), recovery of Myanmar's tiger populations will depend on increasing support from local people, zoning tiger areas to reduce habitat loss and disturbance, and maintaining connectivity of existing national and transboundary forests. This article reviews the development of a new National Tiger Action Plan for the Union of Myanmar and discusses a blueprint for conservation measures aimed at saving tigers from extinction.

Animals↗

Strong association of a tumor necrosis factor-alpha promoter allele with cerebral malaria in Myanmar.

To investigate the host genetic factors affecting the clinical course of falciparum malaria, polymorphism of the tumor necrosis factor-alpha (TNF-alpha) promoter region was analyzed in patients with cerebral malaria. Two hundred and forty-three Myanmar patients with falciparum malaria at Mae Sot Malaria clinic and Mae Sot General Hospital located at the border between Thailand and Myanmar, were included in this study. Among the patients (128 from Karen, 115 from Burma), 200 were uncomplicated and 43 had cerebral malaria. The TNF-alpha 5'- flanking region showed biallelic polymorphic sites at -238, -308, -857, -863, -1031, and there were 7 alleles (TNFP-A, B, C, D, M1, M4, M7) found in the patients from Myanmar. We found that the TNFP-D allele was significantly associated with cerebral malaria in the populations from Karen (Pc<0.0001, OR=124.86) and Burma (Pc<0.0001, OR=34.50). TNFP-D showed no significant linkage disequilibrium with any alleles of HLA-B or HLA-DRB1, suggesting that TNFP-D was primarily associated with cerebral malaria in Myanmar.

Gene Frequency↗

HIV/AIDS education and prevention in Myanmar.

Myanmar has a diverse population, 70% of whom reside in rural areas. These factors, along with limited resources, create a challenge for monitoring and controlling the HIV/AIDS epidemic. The first HIV-infected individual was identified in 1988, and the first AIDS case was reported in 1991. The National AIDS Control Program and the National AIDS Committee were established in 1989. Sentinel surveillance was begun in 1992. A cumulative total of 45,968 HIV/AIDS cases have been reported through 2003. UNAIDS and the government of Myanmar estimated that there were 177,279 persons living with HIV/AIDS in Myanmar in December 2001. High prevalence rates of HIV have been identified in injection drug users (IDUs), commercial sex workers (CSWs), and men attending sexually transmited disease clinics. Levels of HIV in all groups appear to have leveled off, but the prevalence remains high in IDUs and CSWs. A 100% targetted condom promotion program was implemented in 2001. Political commitment to control HIV/AIDS has been established through the leadership of the government and establishment of AIDS committees extending down to the township and rural health center levels. An increased understanding of the problems that Myanmar faces in controlling HIV transmission and increased support from international agencies and nongovernmental organizations can play an important role in facilitating more intensive intervention activities.

Acquired Immunodeficiency Syndrome↗

Assessment of dengue hemorrhagic fever in Myanmar.

This study assesses the burden of dengue hemorrhagic fever (DHF) and effectiveness of an intervention package in Myanmar. Disability adjusted life years (DALYs) lost for fatal and non-fatal DHF cases and DALYs averted due to intervention for DHF from 1970-1997 were estimated. The data are based on reported cases and deaths from DHF extracted from annual reports of the Myanmar vector borne disease control program. Sensitivity analyses were performed for robustness of conclusions. DALYs lost from both fatal and non-fatal DHF cases in Myanmar were estimated as 83.83 DALYs per year per million population (range = 83.33-86.32) for the period 1970-1997. DALYs averted from DHF due to intervention were estimated as 134 DALYs per year per million population (range = 47-159). The burden of DHF in Myanmar for the selected year 1990 was 91.3 DALYs per year per million population (range = 90.1-96.5). A comparison was made with China, India and other Asian countries based on information provided by a World Bank study.

Cost of Illness↗