Outbreak detection of influenza-like illness in Prey Veng Province, Cambodia: a community-based surveillance

On June 4, 2016, the Prey Veng Provincial Health Department reported a total of 107 patients with influenza-like illness (ILI) from Chakhlanh village to the Cambodian Ministry of Health. To confirm the outbreak and evaluate its clinical and epidemiological characteristics, the investigation team visited the village and reviewed the case-based surveillance (CBS) data on severe respiratory infection (SRI) and patients' records in health facilities. The team interviewed all households in the village from May 1 to June 5, 2016 and obtained the following data: age, medical history, date of onset, treatment, symptoms, and history of contact with patients or dead poultry. Nasal swab samples were collected from suspected ILI cases to test for influenza virus by RT-PCR. The investigation detected 498 suspected ILI cases, including 288 females. Although the incidence of suspected ILI cases who visited health centers was 63.0 per 1,000 persons per month, the attack rate was 27.1 per 100 population. The major age group was 5-14 years followed by 0-4 years. Major symptoms were cough, fever, runny nose, and headache. Six of seven nasal swab samples were positive for influenza A/H1N1 pdm09 virus. Most children with flu symptoms had contact with previous cases. This study showed that the ILI outbreak might be caused by seasonal influenza A/H1N1 pdm09 spread from person to person. Poor living conditions and poor hygiene and sanitation practices were environmental factors that caused the outbreak. As the CBS system was unable to identify this epidemic, it needs to be improved.

Consumption of foods containing prohibited artificial colors among middle-school children in Nay Pyi Taw union territory, Myanmar

Background

Food safety control in Myanmar is regulated by the Department of Food and Drug Administration (FDA). FDA conducts food safety education programs in schools and regular market surveys of foods containing prohibited artificial colors. However, the consumption of foods containing FDA-prohibited artificial colors among school children is understudied. This study aimed to assess the consumption of foods containing FDA-prohibited artificial colors among middle-school children in Nay Pyi Taw Union Territory, Myanmar.

Methods

A cross-sectional study was conducted at eight public schools in Nay Pyi Taw Union Territory in 2017. The schools were selected using simple random sampling with a drawing method. In total, 776 students (359 boys and 417 girls) participated in face-to-face interviews using a structured questionnaire and photos of foods containing artificial color published by FDA. A multiple logistic regression was performed to estimate adjusted odds ratio (AOR) for consumption of such foods.

Results

In total, 519 (66.9%) children consumed foods with the FDA-prohibited colors. It was revealed that students at suburban schools were nearly five times more likely to consume foods containing FDA-prohibited artificial colors (AOR = 4.84; 95% confidence interval (CI) 2.99–7.82) compared to those at urban schools. In addition, being in the seventh grade (AOR = 3.38; 95% CI 2.30–4.98), availability of prohibited food in school canteen (AOR = 6.16; 95% CI 2.67–14.22), and having a less educated father (AOR = 1.76; 95% CI 1.06–2.92) were positively associated with consumption of the foods with the prohibited colors.

Conclusion

More than half of the students consumed foods with the prohibited colors. Consumption was more frequent among students from suburban schools, those with unsafe foods accessible at their school canteen, seventh graders, and students with a less educated father. The findings highlighted that school food safety programs, which focus on preventing consumption of foods containing FDA-prohibited artificial colors, are urgently required. Food safety regulation is also required to ban the sale of unsafe food, especially in school canteens.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-6669-5) contains supplementary material, which is available to authorized users.

Healthcare waste management at primary health centres in Mon State, Myanmar: the comparisons between hospital and non-hospital type primary health centres

Improper healthcare waste management (HCWM) poses a serious public health problem worldwide. Primary health centres (PHCs) provide public health and medical care services as the basic structural and functional units of healthcare services in Myanmar. However, no study has been conducted in Myanmar about HCWM at PHCs. This study aims to assess the practice of HCWM at PHCs in Mon State, Myanmar. A cross-sectional study was conducted in all ten townships in Mon State, Myanmar. In total, 93 PHCs (71 non-hospitals and 22 hospitals) were selected using simple random sampling. The observational checklist which was developed based on the World Health Organization’s standard guideline procedure of HCWM was used to determine the practice of HCWM at PHCs. Binary logistic regression was used for final data analysis. The burning in pits method was used as the final disposal method of healthcare waste in 78.5% of PHCs. Non-hospital type PHC were more likely not to have colour coding system for HCWM (odds ratio [OR] 7.54; 95% confidence interval [CI] 2.15–26.52), did not have equipment for accidental spillage of healthcare waste (OR 3.92; 95% CI 1.3–11.77) and did not have separate staff for HCWM (OR 8.27; 95% CI 2.77–24.64), relative to hospitals. Non-hospital type PHCs practices poorly on the colour coding for waste segregation, assigning separate staff for HCWM, and possessing equipment for accidental spillage of healthcare waste than hospital type PHCs. The Ministry of Health and Sports should issue technical guidelines of safe HCWM as a compulsory policy for both hospitals and non-hospital type PHCs.

Factors associated with antenatal care visits in Afghanistan: secondary analysis of Afghanistan Demographic and Health Survey 2015

Afghanistan is one of the countries with the poorest maternal mortality ratio in the world. Inadequate utilization of antenatal care (ANC) services increases the risk of maternal mortality. This study aimed to identify the factors associated with ANC visits in Afghanistan. The dataset of the Afghanistan Demographic and Health Survey (AfDHS) 2015 were used for taking the socio-demographic factors, cultural factors, and the number of ANC visits. The subjects of this study were 18,790 women who had at least one live birth in the last five years, and 10,554 women (56.2%) had availed of at least one ANC visit. Most women were 20-29 years old (53.3%), poor (41.7%), had 2–4 children (43.9%), lived in rural areas (76.1%), and had no education (85.0%) or no job (86.7%). Most women answered that husbands made a decision about their healthcare and that getting permission from their husbands was a major challenge. Multivariate analysis showed that age, ethnicity, area of residence, parity, women’s education, husband’s education, literacy, having a job, wealth, the decision maker for healthcare, and difficulty in getting permission from the husband were significantly correlated with availing of the ANC visits. This study showed that not only the socio-demographic factors but also the cultural factors were associated with ANC visits. The Afghanistan government should improve the education programs at schools and healthcare facilities, for both men and women. To augment women’s propensity to take a decision, the programs for women’s empowerment need to be supported and extended across the country.

Factors associated with HIV testing among the general male population in Cambodia: A secondary data analysis of the Demographic Health Survey in 2005, 2010, and 2014

In Cambodia, the human immunodeficiency virus (HIV) is predominantly transmitted between spouses and casual partners, with men having higher mortality and morbidity from HIV infection than women due to lesser access to healthcare services and antiretroviral therapy. This study aimed to identify the rate of HIV testing and barriers to HIV testing among the general male population in Cambodia. We analyzed secondary data of men who underwent HIV testing at Voluntary Confidential Counseling and Testing (VCCT) sites in 2006–2017 and of male participants in the Cambodia Demographic and Health Survey (CDHS) in 2005, 2010, and 2014. The number of men who underwent HIV testing at the VCCT sites increased during 2006–2010 and decreased during 2012–2015. CDHS data showed that the lifetime prevalence of HIV testing among men aged 15–49 years gradually increased from 14.7% in 2005 to 36.4% in 2014. Multivariate analysis revealed nine factors associated with a higher lifetime prevalence of HIV testing including: seven sociodemographic factors, namely CDHS year (2010 and 2014), age groups (20–35 and 36–49 years), urban residence, higher education, higher wealth index, having occupations other than agriculture, ever-married status (married and widowed/divorced); and two factors of HIV risk behavior, namely two or more lifetime sexual partners and condom use during the last sexual intercourse. To our knowledge, this is the first study that assessed factors associated with the lifetime prevalence of HIV testing among the general male population in Cambodia. The factors were mostly sociodemographic factors, and no factors were related to condom use, or the diagnosis or symptoms of sexually transmitted infections (STIs). These results suggest that reproductive health education at primary schools and strengthening of healthcare provider-initiated testing and counseling for patients with STIs are highly needed in Cambodia.

Cognitive function measured with the Revised Hasegawa's Dementia Scale among elderly individuals in Lao PDR

In Lao PDR, measurement of cognitive function has rarely been conducted among elderly individuals. This study aimed to investigate the cognitive function among elderly individuals who lived at their homes with family in Lao PDR. Participants were elderly individuals aged 60 years or over registered with the local government in urban (Vientiane capital; VC) and rural areas (Khammouane province; KP). Those with serious mental/physical diseases, those who could not walk by themselves, or those who could not speak the Lao language were excluded. The information was collected through interviews with the participants and their family members. A newly developed Lao version of the Revised Hasegawa’s Dementia Scale (HDS-R) was applied to measure cognitive function. The participants were 414 elderly individuals (224 males and 190 females) aged 60 to 98 years. The average HDS-R score was 23.0 among 115 men in VC, 22.7 among 92 women in VC, 20.3 among 109 men in KP, and 17.5 among 98 women in KP. The main caregiver was a daughter (40.6%) followed by a spouse (31.4%). Among 414 elderly individuals, 42 (10.0%) stated the necessity of support. Those with HDS-R < 20 accounted for 38.8% in men and 48.9% in women. The adjusted odds ratio of HDS-R < 20 was significant for those in rural areas (3.83) relative to those in urban areas. Among superficially healthy elderly individuals residing with their families, those with reduced cognitive function were more common among women and in rural areas.

Antibiotic prescription for under-fives with common cold or upper respiratory tract infection in Savannakhet Province, Lao PDR

Background

The irrational use of antibiotics has been identified as a major problem in healthcare, and it can lead to antimicrobial resistance, treatment failure, and increased healthcare costs. Although many studies worldwide have focused on the irrational use of drugs, reports on prescription practice in Lao PDR remained limited. This study aimed to examine the patterns of antibiotic prescription for under-fives with common cold or upper respiratory tract infection (URTI) at pediatric outpatient divisions.

Methods

One provincial hospital (PH) at Kaisone Phomvihane and four district hospitals (DHs) at Songkhone, Champhone, Atsaphangthong, and Xepon in Savannakhet Province were selected. Healthcare providers at these hospitals were interviewed and medical records of under-fives from 2016 were examined.

Results

Of the 54 healthcare providers interviewed, 85.2% had seen the standard treatment guideline, 77.8% adhered to this guideline, and 90.7% knew about antimicrobial resistance, while 18.5% participated in antimicrobial resistance activities. Medical records of 576 outpatients (311 boys and 265 girls) with common cold or URTI were examined, 154 at the PH and 422 at the DHs. Although antibiotics prescription proportions were similar between facilities at both levels (68.8% and 70.9% at the PH and DHs, respectively), antibiotics were exclusively prescribed for URTIs (96.4%), not for common cold (4.9%). First-line antibiotics recommended by WHO Model List of Essential Medicines for Children the 6th List were prescribed for 81.5% of patients; mainly, beta-lactam antibiotics were prescribed (87.2% of prescribed antibiotics). There were no cases in which two or more antibiotics were prescribed. The correct dose according to the National STG was 31.9% as a whole. The difference in the correct dose between the PH (52.8%) and the DHs (24.4%) was significant (p < 0.001).

Conclusions

This study demonstrated the patterns of antibiotic prescription for under-fives with common cold or URTI among healthcare providers from two different levels of facilities. Although an appropriate number of generic first-line antibiotics in the essential drug list were prescribed, the dosage and duration of antibiotic use were not appropriate. In order to further improve antibiotic prescription practices, regulation by the government is necessary; this could also decrease antimicrobial resistance and improve treatment outcomes.

Free and universal access to primary healthcare in Mongolia: the service availability and readiness assessment

BACKGROUND

The government of Mongolia mandates free access to primary healthcare (PHC) for its citizens. However, no evidence is available on the physical presence of PHC services within health facilities. Thus, the present study assessed the capacity of health facilities to provide basic services, at minimum standards, using a World Health Organization (WHO) standardized assessment tool.

METHODS

The service availability and readiness assessment (SARA) tool was used, which comprised a set of indicators for defining whether a health facility meets the required conditions for providing basic or specific services. The study examined all 146 health facilities in Chingeltei and Khan-Uul districts of Ulaanbaatar city, including private and public hospitals, family health centers (FHCs), outpatient clinics, and sanatoriums. The assessment questionnaire was modified to the country context, and data were collected through interviews and direct observations. Data were analyzed using SPSS 21.0, and relevant nonparametric tests were used to compare median parameters.

RESULTS

A general service readiness index, or the capacity of health facilities to provide basic services at minimum standards, was 44.1% overall and 36.3, 61.5, and 62.4% for private clinics, FHCs, and hospitals, respectively. Major deficiencies were found in diagnostic capacity, supply of essential medicines, and availability of basic equipment; the mean scores for general service readiness was 13.9, 14.5 and 47.2%, respectively. Availability of selected PHC services was 19.8%. FHCs were evaluated as best capable (69.5%) to provide PHC among all health facilities reviewed (p < 0.001). Contribution of private clinics and sanatoriums to PHC service provisions were minimal (4.1 and 0.5%, respectively). Service-specific readiness among FHCs for family planning services was 44.0%, routine immunization was 83.6%, antenatal care was 56.5%, preventive and curative care for children was 44.5%, adolescent health services was 74.2%, tuberculosis services was 53.4%, HIV and STI services was 52.2%, and non-communicable disease services was 51.7%.

CONCLUSIONS

Universal access to PHC is stipulated throughout various policies in Mongolia; however, the present results revealed that availability of PHC services within health facilities is very low. FHCs contribute most to providing PHC, but readiness is mostly hampered by a lack of diagnostic capacity and essential medicines.

Epidemiological characteristics and trends of a Nationwide measles outbreak in Mongolia, 2015-2016

Background

Mongolia was one of the four countries that received a measles-elimination certificate from the World Health Organization Regional Office for the Western Pacific in 2014. Following the outbreaks in many countries including China, a large measles outbreak occurred in Mongolia in 2015. This study reports 2015–2016 measles outbreak incidence, mortality, and complications, according to time, geographical distribution, and host characteristics.

Methods

The epidemiological characteristics and trends of measles outbreak were analyzed using the Mongolian national surveillance data reported to the Center for Health Development, Ministry of Health, from January 2015 to December 2016.

Results

In total, 23,464 cases of measles including eight deaths were reported in 2015, and 30,273 cases of measles including 132 deaths were reported in 2016, which peaked in June 2015 and March 2016, respectively. Majority of the cases were reported from Ulaanbaatar (35,397, 65.9%). The highest attack rates were 241 per 10,000 population in Darkhan-Uul aimag, and 263 per 10,000 population in Ulaanbaatar. Measles-related death, nosocomial infection, and complications were most frequent among children aged < 1 year.

Conclusions

Following no reports of measles since 2011, a large nationwide outbreak occurred in Mongolia, despite the high vaccination coverage in the past. The highest incidence rate was reported in Ulaanbaatar city, and Umnugovi aimag in 2015 and Darkhan-Uul aimag in 2016. The most affected age group were aged < 1 year and those aged 15–24 years. Mortality cases were prominent among children aged < 1 year who were not eligible for vaccination. A systematic vaccination strategy is required to prevent another measles outbreak.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-6511-0) contains supplementary material, which is available to authorized users.

Myanmar language version of the Revised Hasegawa's Dementia Scale

Reduced cognitive function among the elderly is an important issue not only in developed countries, but also in developing countries. As a test to measure cognitive function, the Revised Hasegawa’s Dementia Scale (HDS-R) has been used in Asian countries including Japan, Korea, and China. Since there was no HDS-R version in Myanmar language, a questionnaire and manual for the HDS-R were developed. The translation from English to Myanmar language was done by two Myanmar researchers. Back-translation was conducted to confirm the accuracy of the translation by two other Myanmar researchers. Back-translated English was compared to the original by two Japanese researchers, and inconsistencies were discussed by all six researchers to reach consensus. Five Myanmar researchers independently read the questionnaire and manual to verify the expressions are familiar in Myanmar language. The modified points were as follows. 1) The date order in Question 2 is day/month/year. 2) The words to be memorized in Questions 4 and 7 are padauk tree, cat, and bullock cart for the first set, and tamarind tree, dog, and car for the second set. 3) The objects to be memorized in Question 8 are shown with pictures, not actual objects. 4) Like the Lao version, we introduced two new rules; a clear time definition for no reply (10 seconds), and repeating questions twice for those with hearing problems. The revised version of the HDS-R has been prepared to be an applicable standard questionnaire for use on assessment of cognitive function in suspected dementia cases in Myanmar, both in the clinical and public healthcare setting.

Patient satisfaction on the utilization of traditional and complementary medicine services at public hospitals in Malaysia

BACKGROUND

Traditional and complementary medicine (T&CM) has been integrated into the Malaysian public healthcare system since the establishment of the first T&CM unit at a public hospital in 2007. Assessing patient satisfaction is a vital component of health service evaluation. The main objective of this study is to determine the level of patient satisfaction with the utilization of T&CM services at public hospitals in Malaysia and assess the sociodemographic influence on the overall reporting of satisfaction. This study also aims to analyze the response of the patients towards expansion of T&CM services in the public sector in Malaysia.

MATERIALS AND METHODS

A study was conducted to analyze data on the utilization of T&CM services within public hospitals. Secondary data on 822 patients' satisfaction with services offered at 15 T&CM units was analyzed to examine the overall levels of satisfaction with T&CM services in public hospitals in Malaysia.

RESULTS

Overall, 99.4% of patients were satisfied with T&CM services and most patients (91.8%) felt that T&CM treatment positively impacted their health. Overall satisfaction was not affected by lower levels of satisfaction with subcategories of service, such as the number of treatment sessions received (90.7% satisfied), date to the next appointment (90.7% satisfied), and the absence of adverse effects of treatment received (87.1% satisfied). There were no significant associations between the socioeconomic status of the respondents and the level of satisfaction reported; however, respondents with a monthly salary of Ringgit Malaysia (RM) 1000 to RM 3000 were more than twice as likely to be strongly satisfied with services received (adjusted odds ratios [AOR]: 2.12, 95% CI: 1.19-3.78).

CONCLUSION

This study revealed a high level of satisfaction among patients who had received T&CM treatment at public hospitals in Malaysia. High satisfaction with T&CM treatment validates the integrative management approach adopted in patient care within the public hospitals in Malaysia.

Increase of Eosinophil in Dialysate during Induction of Peritoneal Dialysis

As a rare complication in patients on peritoneal dialysis (PD), increase of eosinophil (peritoneal dialysate fluid [PDF] eosinophilia), including eosinophilic peritonitis, was observed in PDF. The majority of eosinophilic peritonitis cases are detected during the early phase of PD induction. However, the frequency of and mechanisms underlying PDF eosinophilia remain unclear. We therefore investigated the frequency of PDF eosinophilia and what mechanisms, specifically complement activation, might contribute to its occurrence. In 48 patients, eosinophil counts and concentrations of complement activation products, such as C3a, C5a, and sC5b-9, interleukin (IL)-5, and IL-6 in PDF were evaluated on days 1, 2, and 4 after starting PD therapy. We focused on the relationships between patient background characteristics and eosinophil counts and levels of C3a, C5a, and sC5b-9 as complement activation products in PDF. In 33.3% of PD patients, increased PDF eosinophils were observed on day 1. Eosinophil counts correlated with PDF levels of C3a on days 1 and 2, IL-5 on days 1, 2, and 4, and IL-6 on day 1. In terms of background characteristics, only the duration the PD catheter was left in place differed significantly between PDF eosinophilia and non-PDF eosinophilia. Notably, PDF levels of C3a differed significantly between patients with and without eosinophilia, suggesting that C3a might be a candidate for induction of increased eosinophil.

PDF eosinophilia was frequently observed during PD initiation. Our results suggest that PD catheter insertion and complement activation might be related to increases in eosinophils in PDF during PD initiation.

Survival rate and mortality risk factors among TB-HIV co-infected patients at an HIV-specialist hospital in Myanmar: A 12-year retrospective follow-up study

BACKGROUND

Myanmar is listed as one of the countries with the highest burden of tuberculosis and HIV infections (TB-HIV) in the world. However, the survival rate and risk factors for mortality among TB-HIV co-infected patients in the country remain unstudied. Therefore, the purpose of this study was to examine these factors.

METHODS

A 12-year retrospective follow-up study was conducted among 3598 TB-HIV co-infected patients (2452 male and 1146 female) aged 15 years and above, enrolled on antiretroviral therapy (ART) from July 1, 2005 to December 31, 2016. Hazard ratios (HR) were estimated using the Cox proportional hazards model. Survival rates at the beginning of ART were calculated using the Kaplan-Meier method.

RESULTS

A total of 494 (13.7%) patients died during this period. The survival rate of TB-HIV co-infected patients was 82.0% at 5 years and 58.1% at 10 years. The risk factors for mortality were being bedridden (adjusted hazard ratio (aHR) 2.70, 95% confidence interval (CI) 2.13-3.42), having a low baseline CD4 count (aHR 1.53, 95% CI 1.25-1.87), and being on a second-line ART regimen (aHR 8.12, 95% CI 3.56-18.54).

CONCLUSIONS

Two out of five TB-HIV patients died within 10 years after ART initiation. Current HIV prevention and treatment programs should focus more on bedridden patients, those on second-line ART, and those with low baseline CD4 counts.

Medical facility statistics in Japan

Medical facility statistics provide essential information to policymakers, administrators, academics, and practitioners in the field of health services. In Japan, the Health Statistics Office of the Director-General for Statistics and Information Policy at the Ministry of Health, Labour and Welfare is generating these statistics. Although the statistics are widely available in both Japanese and English, the methodology described in the technical reports are primarily in Japanese, and are not fully described in English. This article aimed to describe these processes for readers in the English-speaking world. The Health Statistics Office routinely conduct two surveys called the Hospital Report and the Survey of Medical Institutions. The subjects of the former are all the hospitals and clinics with long-term care beds in Japan. It comprises a Patient Questionnaire focusing on the numbers of inpatients, admissions, discharges, and outpatients in one month, and an Employee Questionnaire, which asks about the number of employees as of October 1. The Survey of Medical Institutions consists of the Dynamic Survey, which focuses on the opening and closing of facilities every month, and the Static Survey, which focuses on staff, facilities, and services as of October 1, as well as the number of inpatients as of September 30 and the total number of outpatients during September. All hospitals, clinics, and dental clinics are requested to submit the Static Survey questionnaire every three years. These surveys are useful tools for collecting essential information, as well as providing occasions to implicitly inform facilities of the movements of government policy.

Assessing the operational costs of routine immunization activities at the sub-center level in Myanmar: What matters for increasing national immunization coverage?

BACKGROUND

Myanmar's national immunization program was launched in 1978. Routine immunization is mainly provided at sub-center level with midwives assigned as main vaccinators. The vaccinators at the sub-centers have to obtain vaccines from their designated township health department's cold room for immunization services. This study aimed to calculate the operational costs of routine immunization at sub-centers in Myanmar.

METHODS

A cross-sectional study was conducted among 160 sub-centers throughout the country. Face-to-face interviews were conducted with the main vaccinator at each sub-center using a pre-tested questionnaire. The study analyzed the operational costs per facility and the associations between sub-center characteristics and operational costs.

RESULTS

In Myanmar, the average operational costs of routine immunization per sub-center ranged from 434,700-990,125 MMK for rural areas and 235,875-674,250 MMK for urban areas. The operational costs increased by 8,749.50 MMK (95% CI: 6,805.79-10,693.21; p < 0.001) per mile and 5,752.50 MMK (95% CI: 914.22-10,590.79; p < 0.05) per working day.

CONCLUSION

This study indicated that the operational costs at sub-centers were high and varied significantly among the different geographical areas. The operational costs could be reduced by additional support for the resources, for example, installing cold chain facilities at sub-centers and opening new sub-centers throughout the country.

Tobacco Control Law awareness, enforcement, and compliance among high school students in Myanmar

In Myanmar, the Control of Smoking and Consumption of Tobacco Products Law (Tobacco Control Law; TCL), which covers the prohibition of sale of tobacco to minors and all forms of tobacco advertisement, was enacted in 2006. This study aimed to examine the awareness of the TCL among high school students. A cross-sectional study was conducted in November 2015. Participants were 1,339 high school students (554 boys and 785 girls) from two regions and two states of Myanmar. Data were collected using anonymous self-administered questionnaires and revealed that 78.0% of boys and 86.5% of girls responded the sale of tobacco products in or within 100 feet from school, and 83.4% of boys had ever seen someone selling tobacco products to minors. More than half of the students had ever seen minors selling or distributing tobacco products, and had knowledge about the TCL, while only 9.7% knew about the penalties. The adjusted odds ratio (95% confidence interval) of awareness of the TCL was 2.12 (1.35-3.31) for students who had ever received tobacco products free of charge, or seen/heard about their distribution free of charge, 1.86 (1.20-2.89) for current smokeless tobacco users, and 0.58 (0.43-0.77) for students who had ever seen someone selling tobacco products to minors. The majority of high school students did not know that the violation of the TCL could be punished with a fine and/or imprisonment. These findings suggest that awareness of the TCL was very low among high school students, highlighting that TCL enforcement and compliance, and tobacco-related health education programs are not satisfactory in Myanmar.

Associations of treatment completion against drug addiction with motivational interviewing and related factors in Afghanistan

Despite the increase in the number of drug treatment centers, patients with drug addicts have been increasing without the improvement of treatment in Afghanistan. This study aimed to examine the associations of the completion of drug addiction treatment with motivational interviewing (MI) and other factors among male drug users in Afghanistan. Subjects were patients admitted to Jangalak Hospital in Kabul, Afghanistan in 2014 and 2015. Systematic sampling and supplementary sampling were applied. The records of 327 males aged 18 to 54 years were collected from those of 3,373 male inpatients. Completion of treatment was defined as presence and receiving treatment in the hospital for at least 45 days. Multiple logistic regression models were applied to estimate the adjusted odds ratio (AOR) and 95% confidence interval (CI) for the completion of drug addiction treatment. Among the patients, heroin was the most commonly used drug, followed by opium, crystal, hashish, and other drugs. Patients with treatment history for drug addiction (AOR 2.46; 95% CI 1.14-5.30), those attended MI before admission (AOR 43.98; 95% CI 17.21-112.39), and those used heroin (AOR 4.74; 95% CI 1.32-16.97) were more likely to complete the drug addiction treatment. Among the factors examined in this study, attending MI was most strongly associated with the completion of drug addiction treatment. Amendments to policies to include compulsory MI in standard operational procedures of drug addiction treatment before hospitalization may be recommended.

TGF-β1-VEGF-A pathway induces neoangiogenesis with peritoneal fibrosis in patients undergoing peritoneal dialysis

The characteristic features of chronic peritoneal injury with peritoneal dialysis (PD) are submesothelial fibrosis and neoangiogenesis. Transforming growth factor (TGF)β and vascular endothelial growth factor (VEGF)-A are the main mediators of fibrosis and neoangiogenesis, respectively; however, the effect of the interaction between them on the peritoneum is not well known. In this study, we investigated the relationship between TGF-β1 and VEGF-A in inducing peritoneal fibrosis by use of human tissues and dialysate, cultured cells, and animal models. The VEGF-A concentration correlated with the dialysate-to-plasma ratio of creatinine (D/P Cr) ( P < 0.001) and TGF-β1 ( P < 0.001) in human PD effluent. VEGF-A mRNA levels increased significantly in the peritoneal tissues of human ultrafiltration failure (UFF) patients and correlated with number of vessels ( P < 0.01) and peritoneal thickness ( P < 0.001). TGF-β1 increased VEGF-A production in human mesothelial cell lines and fibroblast cell lines, and TGF-β1-induced VEGF-A was suppressed by TGF-β receptor I (TGFβR-I) inhibitor. Incremental peak values of VEGF-A mRNA stimulated by TGF-β1 in human cultured mesothelial cells derived from PD patients with a range of peritoneal membrane functions correlated with D/P Cr ( P < 0.05). To evaluate the regulatory mechanisms of VEGF-A and neoangiogenesis in vivo, we administered TGFβR-I inhibitor intraperitoneally in a rat chlorhexidine-induced peritoneal injury (CG) model. TGFβR-I inhibitor administration in the CG model decreased peritoneal thickness ( P < 0.001), the number of vessels ( P < 0.001), and VEGF-A levels ( P < 0.05). These results suggest that neoangiogenesis is associated with fibrosis through the TGF-β1-VEGF-A pathway in mesothelial cells and fibroblasts. These findings are important when considering the strategy for management of UFF in PD patients.

Unit cost of healthcare services at 200-bed public hospitals in Myanmar: what plays an important role of hospital budgeting?

Background

Cost information is important for efficient allocation of healthcare expenditure, estimating future budget allocation, and setting user fees to start new financing systems. Myanmar is in political transition, and trying to achieve universal health coverage by 2030. This study assessed the unit cost of healthcare services at two public hospitals in the country from the provider perspective. The study also analyzed the cost structure of the hospitals to allocate and manage the budgets appropriately.

Methods

A hospital-based cross-sectional study was conducted at 200-bed Magway Teaching Hospital (MTH) and Pyinmanar General Hospital (PMN GH), in Myanmar, for the financial year 2015–2016. The step-down costing method was applied to calculate unit cost per inpatient day and per outpatient visit. The costs were calculated by using Microsoft Excel 2010.

Results

The unit costs per inpatient day varied largely from unit to unit in both hospitals. At PMN GH, unit cost per inpatient day was 28,374 Kyats (27.60 USD) for pediatric unit and 1,961,806 Kyats (1908.37 USD) for ear, nose, and throat unit. At MTH, the unit costs per inpatient day were 19,704 Kyats (19.17 USD) for medicine unit and 168,835 Kyats (164.24 USD) for eye unit. The unit cost of outpatient visit was 14,882 Kyats (14.48 USD) at PMN GH, while 23,059 Kyats (22.43 USD) at MTH. Regarding cost structure, medicines and medical supplies was the largest component at MTH, and the equipment was the largest component at PMN GH. The surgery unit of MTH and the eye unit of PMN GH consumed most of the total cost of the hospitals.

Conclusion

The unit costs were influenced by the utilization of hospital services by the patients, the efficiency of available resources, type of medical services provided, and medical practice of the physicians. The cost structures variation was also found between MTH and PMN GH. The findings provided the basic information regarding the healthcare cost of public hospitals which can apply the efficient utilization of the available resources.

Electronic supplementary material

The online version of this article (10.1186/s12913-017-2619-z) contains supplementary material, which is available to authorized users.