Children In Myanmar Research Articles

Social Determinants of Undernutrition Among Under-5 Children in Rural Areas of Myanmar: A Narrative Review.

Childhood undernutrition is a major public health challenge in Myanmar. To reduce the prevalence of childhood undernutrition in Myanmar, it is important to understand the social determinants of under-5 undernutrition. This review aimed to identify the social determinants of undernutrition in under-5 children in rural areas of Myanmar. A systematic search strategy was conducted through databases- Medline (Ovid), PubMed, SCOPUS, ProQuest Central, Web of science, and POPLINE. The grey literatures from relevant websites were also searched. Keywords were identified and used to search the literature published from 2007 to 2020 in English. Thematic analysis was performed. Twenty-five publications met the selection criteria and were reviewed. Five major themes were identified as important social determinants of under-5 undernutrition in Myanmar-food insecurity, poverty, maternal factors, an unhealthy environment, and low access to health services. This review highlights the need for a systematic and multisectoral approach to address under-5 undernutrition in Myanmar. Investment in agriculture and rural infrastructure development, and women's education and empowerment may be major contributors to improving the nutritional status of children in rural Myanmar. Findings from this study can be used to develop nutrition-related policies and programs to reduce childhood undernutrition and improve nutrition outcomes in rural Myanmar.

Arima forecasting of the prevalence of anemia in children in Myanmar

Using annual time series data on the prevalence of anemia in children under 5 years of age in Myanmar from 1990 – 2016, the study makes predictions for the period 2017 – 2025. The study applies the Box-Jenkins ARIMA methodology. The diagnostic ADF tests show that, AM, the series under consideration is an I (0) variable. Based on the AIC, the study presents an AR (4) model, which is also called the ARIMA (4, 0, 0) model. This has been found to be the parsimonious model. The diagnostic tests further reveal that the presented model is quite stable and its residuals are not serially correlated. The results of the research indicate that the prevalence of anemia in children in Myanmar will rise from approximately 54.5% in 2017 to almost 64.8% by 2025. This means that anemia is not yet under control in the country. This is a wake up call to both public health policy makers and nutrition specialists in the country. Using annual time series data on the prevalence of anemia in children under 5 years of age in Myanmar from 1990 – 2016, the study makes predictions for the period 2017 – 2025. The study applies the Box-Jenkins ARIMA methodology. The diagnostic ADF tests show that, AM, the series under consideration is an I (0) variable. Based on the AIC, the study presents an AR (4) model, which is also called the ARIMA (4, 0, 0) model.

Arima Forecasting of ohe prevalence of Anemia in children in Myanmar

Using annual time series data on the prevalence of anemia in children under 5 years of age in Myanmar from 1990 – 2016, the study makes predictions for the period 2017 – 2025. The study applies the Box-Jenkins ARIMA methodology. The diagnostic ADF tests show that, AM, the series under consideration is an I (0) variable. Based on the AIC, the study presents an AR (4) model, which is also called the ARIMA (4, 0, 0) model. This has been found to be the parsimonious model. The diagnostic tests further reveal that the presented model is quite stable and its residuals are not serially correlated. The results of the research indicate that the prevalence of anemia in children in Myanmar will rise from approximately 54.5% in 2017 to almost 64.8% by 2025. This means that anemia is not yet under control in the country. This is a wake up call to both public health policy makers and nutrition specialists in the country.

Arima forecasting of the prevalence of anemia in children in Myanmar

Using annual time series data on the prevalence of anemia in children under 5 years of age in Myanmar from 1990 – 2016, the study makes predictions for the period 2017 – 2025. The study applies the Box-Jenkins ARIMA methodology. The diagnostic ADF tests show that, AM, the series under consideration is an I (0) variable. Based on the AIC, the study presents an AR (4) model, which is also called the ARIMA (4, 0, 0) model. This has been found to be the parsimonious model. The diagnostic tests further reveal that the presented model is quite stable and its residuals are not serially correlated. The results of the research indicate that the prevalence of anemia in children in Myanmar will rise from approximately 54.5% in 2017 to almost 64.8% by 2025. This means that anemia is not yet under control in the country. This is a wake up call to both public health policy makers and nutrition specialists in the country.

Associations between parental socioeconomic position and health-seeking behaviour for diarrhoea and acute respiratory infection among under-5 children in Myanmar: a cross-sectional study

ObjectivesTo examine the associations of parental social and economic position with health-seeking behaviour for diarrhoea and acute respiratory infection (ARI) among under-5 children in Myanmar and explore potential underlying mechanisms.DesignA...

Age-specific risk factors for child anaemia in Myanmar: Analysis from the Demographic and Health Survey 2015-2016.

Anaemia is prevalent among preschool-aged children in Myanmar, but few epidemiological studies of anaemia at the national level were reported. Using data from the Myanmar Demographic and Health Survey 2015-2016, we examined risk factors for anaemia at household, maternal, and individual levels for children aged 6-23months (n=1,133) and 24-59months (n=2,393) separately. Survey design and sampling weights were adjusted for in multivariate regression analyses. The prevalence of anaemia was 77.2% in children aged 6-23months and 50.8% in those aged 24-59months. Living in geographic zones other than the hilly zone was associated with a higher odds of anaemia in both age groups (OR=1.86-2.51 [95% lower limit>1.0]). Maternal anaemia predicted child anaemia in a dose-response manner in both groups (6-23months of age, OR=2.01, 95% CI [1.38, 2.92; mild] and OR=2.41, 95% CI [1.12, 5.19; moderate]; and 24-59months of age, OR=1.42, 95% CI [1.12, 1.81; mild] and OR=2.92, 95% CI [1.91,4.46; moderate]). A maternal age of 14-24years (ref: 25-34years, OR=1.67, 95% CI [1.06, 2.64]) and maternal tolerant attitude to domestic violence (OR=1.61, 95% CI [1.13, 2.31]) predicted anaemia in children aged 6-23months only. Younger child age (OR=0.97, 95% CI [0.96, 0.98]), stunting (OR=1.35, 95% CI [1.08, 1.69]) and using unimproved drinking water sources (OR=1.38, 95% CI [1.10, 1.75]) were associated with anaemia in children aged 24-59months. Consideration of age-specific risks factors for child anaemia will help in planning anaemia control programmes in Myanmar.

Seroprevalence of Toxoplasma gondii among School Children in Pyin Oo Lwin and Naung Cho, Upper Myanmar.

Toxoplasma gondii is an apicomplexan parasite that can cause toxoplasmosis in a wide range of warm-blooded animals including humans. In this study, we analyzed seroprevalence of T. gondii among 467 school children living in the rural areas of Pyin Oo Lwin and Naung Cho, Myanmar. The overall seroprevalence of T. gondii among school children was 23.5%; 22.5% of children were positive for T. gondii IgG, 0.4% of children were positive for T. gondii IgM, and 0.6% of children were positive for both T. gondii IgG and IgM. Geographical factors did not significantly affect the seroprevalence frequency between Pyin Oo Lwin and Naung Cho, Myanmar. No significant difference was found between males (22.2%) and females (25.0%). The overall seroprevalence among school children differed by ages (10 years old [13.6%], 11–12 years old [19.8%], 13–14 years old [24.6%], and 15–16 years old [28.0%]), however, the result was not significant. Polymerase chain reaction analysis for T. gondii B1 gene for IgG-positive and IgM-positive blood samples were negative, indicating no direct evidence of active infection. These results collectively suggest that T. gondii infection among school children in Myanmar was relatively high. Integrated and improved strategies including reinforced education on toxoplasmosis should be implemented to prevent and control T. gondii infection among school children in Myanmar.

The Experiences of Mothers Living with Autistic Children: A Qualitative Descriptive Phenomenological Approach

This study adopts a qualitative descriptive phenomenological approach to explore, analyze and document the experiences of mothers raising and living with autistic children. In doing so, the study recruited seven mothers of autistic children in Myanmar using a non-probability, purposive sampling method. Data was obtained through in-depth interviews and focus group discussion, and it was analyzed using Giorgi’s method. Six major themes emerged: loss of parental hopes and childhood significances, initial recognition and diagnosis, misunderstanding and assumptions about autism, mixtures of emotions experienced by the mothers, challenges in nurturing autistic children, and the mothers’ expectations about the future of their children. Raising and caring for an autistic child was challenging for the mothers as their children required constant care round the clock and for the entire span of their lives. Therefore, a comprehensive training in nursing is vital for these mothers. The findings of the study contribute to the literature on autism and forms as a basis for future research on this topic, especially on how living with an autistic child can have an effect on their siblings and other caregivers of autistic children using different approaches.

Feeding practices and nutritional status of children age 6-23 months in Myanmar: A secondary analysis of the 2015-16 Demographic and Health Survey.

Nutritional deficiencies are a major problem among developing countries including Myanmar. They can occur in all age groups, but the impact is more severe among children age 6–23 months as this period is critical for child development, and irreversible damages can occur due to nutritional deficiencies. Proper infant and young child feeding practices are pivotal to tackle nutritional problems and to prevent irreversible consequences among children. To assess the current feeding practices and associations with nutritional status, we conducted a secondary data analysis using the 2015–16 Myanmar Demographic and Health Survey. Multiple logistic regression analysis was done adjusting for covariates and the results were presented by adjusted odds ratios with 95% confidence intervals. A total of 1,222 children age 6–23 months were included in this analysis. Twenty percent were stunted and 43% were moderately anemic. Only 16% of children received a minimum acceptable diet, 25% received diverse food groups, 58% were fed with minimum meal frequency, 85% currently breastfed, and 59% consumed iron-rich foods. Breastfeeding reduced the odds of being stunted. Male sex, perceived small birth size, mother with short stature, and working mother were significant predictors of stunting. Iron-rich food consumption was inversely associated with moderate anemia. Male sex and maternal anemia were also significant predictors of moderate anemia. The study concluded that stunting and anemia among young children in Myanmar are major public health challenges that need urgent action. While further prospective research is needed to determine the effect of feeding practice on linear growth, interventions such as iron supplementation, and nutritional education programs according to the World Health Organization complementary feeding guidelines could help prevent stunting and childhood anemia and might reduce their prevalence in Myanmar.

The links between agricultural production and the nutritional status of children in rural Myanmar

This paper seeks to analyse and test empirically the relationship between household agricultural production and crop diversity on child nutritional status in rural Myanmar, using data from the nationally representative 2013 Livelihoods and Food Security Trust Fund (LIFT) survey. We are interested in analysing if higher agriculture production and greater crop diversity in the household translates into better nutritional status among children, measured using the three anthropometric measures height-for-age, weight-for-height and weight-for-age. The primary unit of analysis was the individual child aged between 7 and 60 months for whom complete information was available for all our variables of interest. We estimated a series of regression models to explain stunting, wasting and underweight outcomes among 1037 children aged 7–60 months. Our results show that: (i) 37% of the children in our sample were stunted, with stunting more prevalent among older children (aged 31–60 months), (ii) children from households where agriculture was the main income source had a lower probability of being wasted, and (iii) there was no statistically significant relationship between crop harvest size and child nutrition outcomes among agriculture households. Our results clearly suggest that agricultural own-production is important as a food safety net, mitigating acute malnutrition, but this fades away for non-acute measures, reiterating its relative unimportance in terms of the livelihood drivers of child nutrition outcomes.

Evaluation of Xpert® MTB/RIF assay as a diagnostic test for pulmonary tuberculosis in children in Myanmar.

The Xpert® MTB/RIF assay has been recommended for the diagnosis of pulmonary tuberculosis (PTB). However, there are limited data from the South-East Asian region. This study was carried out at a tertiary-level children's hospital in Mandalay, Myanmar. To evaluate the performance of Xpert as a diagnostic test for PTB in children. A cross-sectional descriptive study of children with suspected PTB. Gastric lavage aspirate samples were tested using Xpert, solid culture and smear microscopy. The performance of Xpert, solid culture and smear microscopy were evaluated using the revised National Institute of Health classification for intrathoracic TB in children as the reference standard. TB was bacteriologically confirmed in 38 (16.5%) of 231 children with suspected PTB. Of the 38 children with confirmed TB, 36 cases were identified using Xpert, 16 using solid culture and 12 using smear microscopy. With confirmed TB as the reference standard, the sensitivity of Xpert, solid culture and smear microscopy was respectively 94.7% (95%CI 80.9-99.1), 42.1% (95%CI 26.7-59.1) and 31.6% (95%CI 18.0-48.8). Xpert has improved the bacteriological confirmation of PTB among hospitalised children in Myanmar.

Prevalence of Anemia and Hemoglobin Disorders Among School Children in Myanmar

The prevalence of anemia is high in the population of Myanmar and hypochromic microcytic anemia (HMA) is predominant. The objective of our study was to determine the prevalence of anemia and causes of HMA among school children. A cross-sectional study was conducted on 239 children from Thanlyin and Insein Townships, Yangon Region, Myanmar. Complete blood count (CBC) and blood film morphology was examined on venous blood samples. Hypochromic microcytic anemia cases were subsequently analyzed for serum ferritin and cellulose acetate hemoglobin (Hb) electrophoresis. The prevalence of anemia was 46.4%; 27.6% had mild, while 18.8% had moderate anemia, and no case of severe anemia was detected. The mean Hb concentration was 11.7 ± 0.9 g/dL. The younger age group (8–11 years) had a significantly higher prevalence of anemia than the older age group (12–15 years) (p = 0.029). Blood film morphology revealed a 50.6% red blood cell (RBC) disorder; HMA was the most common type (70.2%). Out of 85 children with HMA, three children (3.5%) had iron deficiency and all had comorbidity with Hb AE (βA/βE) (Hb E trait). Hemoglobin electrophoresis illustrated that Hb AA (βA/βA) (31, 36.5%) and Hb AE (βA/βE) trait (31, 36.5%) were the most common types followed by β-thalassemia (β-thal) trait (19, 22.3%) and Hb EE (βE/βE) (homozygous Hb E; HBB: c.79G>A) (three, 3.5%). Hematocrit [or packed cell volume (PCV)], mean corpuscular volume (MCV), mean corpuscular Hb (MCH) and mean corpuscular Hb concentration (MCHC), showed a significant difference between Hb AE, Hb EE and β-thal trait (p = 0.029, 0.023, 0.015 and 0.01, respectively). Our findings will provide valuable information for the management of anemia in the Myanmar school-age population.

Reliability of the test of gross motor development second edition (TGMD-2) for Kindergarten children in Myanmar.

[Purpose] The purpose of this study was to investigate reliability of the test of gross motor development second edition (TGMD-2) for Kindergarten children in Myanmar. [Subjects and Methods] Fifty healthy Kindergarten children (23 males, 27 females) whose parents/guardians had given written consent were participated. The subjects were explained and demonstrated all 12 gross motor skills of TGMD-2 before the assessment. Each subject individually performed two trials for each gross motor skill and the performance was video recorded. Three raters separately watched the video recordings and rated for inter-rater reliability. The second assessment was done one month later with 25 out of 50 subjects for test-rest reliability. The video recordings of 12 subjects were randomly selected from the first 50 recordings for intra-rater reliability six weeks after the first assessment. The agreement on the locomotor and object control raw scores and the gross motor quotient (GMQ) were calculated. [Results] The findings of all the reliability coefficients for the locomotor and object control raw scores and the GMQ were interpreted as good and excellent reliability. [Conclusion] The results represented that TGMD-2 is a highly reliable and appropriate assessment tool for assessing gross motor skill development of Kindergarten children in Myanmar.

Gross motor skill development of 5-year-old Kindergarten children in Myanmar.

[Purpose] The purpose of this study was to examine the gross motor skill development of 5-year-old Kindergarten children in Myanmar. [Subjects and Methods] Total 472 healthy Kindergarten children (237 males, 235 females) of 2016–2017 academic year from four schools in urban area and four schools in rural area of Myanmar were recruited. The gross motor skill development of all subjects was assessed with the test of gross motor development second edition (TGMD-2). All subjects performed two trials for each gross motor skill and the performance was video recorded and scored. The assessment procedures were done according to the standardized guidelines of TGMD-2. [Results] The majority of subjects had average level of gross motor skill rank. The significant differences were found on the run and gallop of locomotor skills and the most of object control skills except the catch between males and females. The significant differences were also found between subjects from urban and rural areas. [Conclusion] Gross motor skill development of 5-year-old Kindergarten children in Myanmar had gender-based and region-based differences on both locomotor and object control skills. This study added a valuable information to the establishment of a normative reference of Kindergarten aged children for future studies.

Inappropriate Feeding Behavior: One of the Important Causes of Malnutrition in 6- to 36-Month-Old Children in Myanmar.

The complementary feeding period is an important time for children's growth and development. This study was conducted to 1) determine the feeding behaviors of 6- to 36-month-old children in Myanmar, 2) explore health effects of feeding behaviors, and 3) determine factors associated with feeding behaviors. A total of 807 children and their mothers (N = 642) were recruited from nine villages in Kachin, Shan, and Kokang, Myanmar. Feeding behaviors and sociodemographic characteristics were investigated using a validated questionnaire. Hemoglobin and anthropometric indicators were measured during the fieldwork. In our sample, 18.6%, 72.7%, and 9.8% of children were introduced to complementary foods (CFs) earlier than 4 months of age, between 4 and 8 months of age, and later than 8 months of age, respectively. For different types of CFs, up to the age of 24.1-36 months, there were still 6.5% and 4.1% of the children who had never been introduced to eggs and meat. Introduction of CFs earlier than 4 months of age was a risk factor for being underweight (age-adjusted odds ratio (ORadjust-age) = 1.7, 95% confidence interval (CI) = 1.2-2.5) and for stunting (ORadjust-age = 1.6, 95% CI = 1.1-2.3), whereas introduction of CFs later than 8 months of age was a risk factor for anemia (ORadjust-age = 3.5, 95% CI = 1.7-7.2). Mothers who had anemia (OR = 3.7, 95% CI = 2.0-6.9) tended toward early introduction of CFs. Women with a lower family income tended toward later introduction of CFs (OR = 2.0, 95% CI = 1.3-3.3). This study demonstrated that inappropriate feeding behavior was one of the important causes of malnutrition.

Potential Contribution of Iron Deficiency and Multiple Factors to Anemia Among 6- to 72-Month-Old Children in the Kokang Area of Myanmar.

The prevalence of anemia among children in Myanmar has been reported to be among the highest in the world. This study was conducted to determine 1) the prevalence of anemia in preschool children and 2) risk factors associated with anemia. A total of 138 children aged from 6 to 72 months were recruited through cluster sampling from six villages in Kokang. Hemoglobin (Hb) concentration, blood trace elements, and anthropometric indicators were measured. Feces samples were collected to examine for the presence of ascarid eggs. The overall prevalence of anemia in children was 61.6%, including 10.9% with severe anemia. Meanwhile, high prevalence of stunting (40.0%), underweight (22.4%), wasting (6.3%), and small head circumference (6.7%) was found. Children with anemia were more prone to stunting. Children with severe anemia and moderate anemia had significantly lower blood iron and zinc levels than children without anemia (P < 0.001 and P = 0.007). The prevalence of ascarid infection was 64.9%; however, it was not associated with anemia. Drinking spring water was positively associated with anemia (odds ratio [OR] = 6.368). This study demonstrated that anemia is an important public health problem among children from the Kokang area. Iron deficiency and drinking spring water may be the important causes of anemia among children.

Bacille Calmette–Guérin vaccination: the current situation in Europe

Tuberculosis is a major public health priority. This is not only because of its daunting morbidity and mortality rates, both globally and in Europe (summarised in figs 1 and 2) [1, 3–5], but also because of the natural history of the disease. Active (contagious) tuberculosis disease occurs after a period of latency (or subclinical infection), and different risk factors [6–13], in combination with latent infection, introduce challenges to prevention, diagnosis and treatment of the disease. Vaccination against tuberculosis, if effective, would be therefore critical to control and elimination strategies [14–16]. The bacille Calmette–Guerin (BCG) vaccine is, from a historical perspective, a milestone of tuberculosis control (figs 3–7). During the first half of the 20th century, it was administered ubiquitously throughout Europe, but is now recommended by the World Health Organization (WHO) to be given once at birth, specifically in tuberculosis-endemic areas. Figure 1– Global estimated tuberculosis (TB) incidence rates, 2011. Reproduced from [1] with permission from the publisher. Figure 2– World Health Organization European Region estimated tuberculosis incidence rates per 100 000 population, 2011. Data from the United Nations Administrated Province of Kosovo (in accordance with Security Council Resolution 1244 (1999)) is not included in the figures reported for Serbia. Reproduced from [2] with permission from the publisher. Figure 3– Wooden mask worn by health workers to announce a forthcoming vaccination campaign (Republic of Benin). Image courtesy of J.P. Zellweger. Figure 4– “To defeat tuberculosis is easy with the BCG”. Advertisement in a peripheral tuberculosis dispensary, dating from the time of French colonisation ( circa 1950) (Republic of Benin). Image courtesy of J.P. Zellweger. Figure 5– French Ministry of Health educational poster supporting bacille Calmette–Guerin vaccination. Image courtesy of J.P. Zellweger. Figure 6– Tuberculosis/HIV-infected children in Myanmar. ©2012 Matthieu Zellweger (with AIDSpartners.org)/matthieuzellweger.com. Figure 7– Romania, 1974. …

Teachers' perceptions of the importance of stories in the lives of children in Myanmar

Children's active involvement in storytelling develops diverse lifelong skills for critical thinking, cognitive, social, and emotional skills. Central to the success of attracting the attention of students for storytelling are the social−emotional roles that teachers play in children's lives. This study investigated 23 kindergarten teachers' views in Myanmar on the importance of stories, how they carry out storytelling as a part of curriculum, and how they view stories as a way to promote children's development, as well as how students respond to the stories. In general, teachers in Myanmar report feeling supportive of the importance of stories in children's lives. However, many teachers also reported lack of time, authentic materials, and teaching aids for conducting stories in classrooms in local schools. They noted that international schools do include stories and have a fixed and regular programme with fully equipped facilities.

Threat of HIV/AIDS in children: social, education and health consequences among HIV orphans and vulnerable children in Myanmar.

There is very limited information available on HIV related orphans and vulnerable children (HIV-OVC) in Myanmar. Hence, the objective of this study was to identify and compare the social, education and health consequences among HIV-OVC and children from the families not related to HIV in the same neighbourhoods (neighbouring children). A cross-sectional, comparative survey was carried out in three geographical locations. Face-to-face interviews were conducted with guardians and children using a pretested structured questionnaire including Strength and Difficulties Questionnaire (SDQ) for behavioural problems. Outcome measures were compared using Chi-squared test or 't' test or 'Rank-sum' test. A total of 300 HIV-OVC and 300 neighbouring children were included. A greater number of HIV-OVC than their neighbouring children have experienced family displacement from their original homes (27% and 1%), child/sibling displacement (20% and 2.7%) and family dispersion (20.3% and 1.3%) (P < 0.001). More guardians of HIV-OVC reported that the disease affected their children's education (28.2% and 16.3%; P < 0.05). Fifteen per cent of HIV-OVC and 10.5% of neighbouring children had to work for their families (P < 0.05). Psychological condition was assessed on emotional, conduct, hyperactivity/inattention, peer relationship and prosocial behaviour. A greater number of HIV-OVC were noted in the abnormal category with regard to hyperactivity and prosocial behaviours (P < 0.05). Higher incidence of social and psychological consequences among HIV-OVC call for more community support programmes and creation of job opportunities to minimize social impact in the affected families. Future programmes should focus on counselling of HIV-OVC and providing psychological support.

Incidence of pediatric diarrhea and public-private preferences for treatment in rural Myanmar: a randomized cluster survey

The incidence of pediatric diarrhea in countries neighboring Myanmar is high (>9%). No national data exist in Myanmar, however hospital treatment data indicate that diarrhea is a major cause of morbidity. This study seeks to determine diarrhea incidence among children in rural Myanmar and document health-seeking behavior and treatment costs. We surveyed 2033 caregivers in households with under-five children, in 104 randomly selected villages in rural Myanmar. The incidence of diarrhea in the 2 weeks prior to the survey was 4.9%. Home treatment was common (50.6%); among those who consulted a professional 35.6% went to government clinics, 28.8% to private clinics and 28.0% to a community health worker. The cost of treatment was highest ($15) at government clinics and lowest ($1.3) for self-treatment at home. Pediatric diarrhea is an important cause of morbidity in rural Myanmar. Self-treatment and treatment by private providers is common.