Disease Control Programme

     Regarding the disease control activities in Myanmar since 1978, integration of health service activities was carried out where the vertical disease campaign staff were integrated into the basic health staff.

     Since then the basic health staff have been involved in providing services for Malaria Control, Implementation of Multi Drug Therapy Programme in leprosy, case finding and treatment of TB cases, immunization of children against 6 major childhood diseases, control of diarrhoeal diseases and surveillance activities etc. Technical support is provided by disease control teams at State/Division level and Central level.

     Myanmar after gaining independence, establish campaigns to fight against major infectious diseases. Later, the campaign or vertical programmes were all integrated into Primary Health Care using PHC approach in the People's Health Plan (PHP) and also in the National Health Plans (NHPs).

     Diseases such as Malaria, Tuberculosis and Acute Immunodeficiency Syndrome (AIDS) are regarded as diseases of National Concern by the government along with other communicable and non-communicable diseases.

      Malaria is one of the top leading priority diseases in the country. Malaria contributes 10% of total outpatients attended at health institutions and 12% of total inpatients admitted in hospitals. The malaria morbidity and mortality is more or less stabilized during the last 4 years.

Conducting Research on

Larva Control

     Clinical Suspected Malaria cases (CSM) treated as outpatients were about 600,000 annually and clinical malaria cases  admitted as inpatients in hospital were over 130,000 annually. Over 3700 deaths were recorded as deaths in hospital due to clinical malaria, case fatality rate was over 3% in hospitals. Clinical malaria morbidity rate was over 12.2 per 1000 population and clinical malaria mortality was about 7.5/100,000 population.

Cleaning breeding sites of Mosquitoes by the community

Malaria control activities are carried out by coordination and cooperation among the various organizations . It consists of malaria staff, basic health staff, voluntary heath workers, NGOs, health related ministries and the private sectors.

Objectives of the National Malaria Control program are:

1. To implement malaria control as a national concern and to carry out this responsibility with added momentum.
2. To reduce malaria morbidity and mortality.
3. To reduce socioeconomic loss due to malaria.
4. To increase awareness and knowledge of the individual, family and community on malaria transmission and its socioeconomic impact and prompt treatment and promote behavioral changes as regards to personal protection.
5. To reduce/ eliminate transmission of malaria by means of mosquito vector control.
6. To prevent transmission of malaria by encouraging the use of personal protective measure in endemic areas.

Strategies for National Malaria Control Programme are:

1. Prevention and control of Malaria by providing information, education and communication down to the grass root level.
2. Prevention and control of Malaria by promoting personal protective measures by introducing environmental measures  as a principal method and chemical and biological method in selected area, depending on local epidemiological conditions and available resources.
3. Prevention, early detection and containment of epidemics.
4. Provision of early diagnosis and prompt treatment.
5. To promote capacity building of malaria control programme (human, financial and technical).
6. To strengthen the partnership by means of intrasectoral and inter sectoral cooperation and collaboration and with the public sectors, private sectors, local and international non governmental organizations, UN agencies and with the neighboring countering for resource generation.
7. To intensify community participation, involvement and empowerment.
8. To promote basic and applied field research.

      Activities of the Roll Back Malaria initiative have been implemented in 1999-2000. Myanmar hosted the intercountry meeting on "Task Force Border Malaria between Myanmar and Thailand" in July 1999.
Intrasectoral and Intersectoral partnerships have been formed with the involvement of health related sectors, representatives from various government ministries and the NGOs.

Malaria Morbidity among Out-patients (Thousands) Malaria Mortality among In-patients (Thousands)

Tuberculosis is one of the major public health problems in Myanmar, and it is considered as the second priority disease in the National Health Plan (1996-2001). Recent estimates suggest that 1.66% of the population become infected with tuberculosis every year, out of which about 100,000 people progress to develop tuberculosis. Half of these cases are infectious with positive sputum smears and serve as a source of infection, spreading the disease in the community. According to the National Surveillance Reports, it is the 5^th leading cause of morbidity, 2^nd leading cause of mortality in Myanmar, mainly effecting the most productive age group of (15-59) years. 5% of TB cases were HIV positive and 60-80% of AIDS patients had TB. Multi Drug Resistant (MDR) TB among new smear positive TB cases is 1.25%.

Training for quality assessment of
sputum microscopy for Tuberculosis

   Myanmar TB control programme has long history of progressive efforts. It struggled against successes and challenges over more than 30 years of operation. Experiences and lessons learnt, together with new development in medicine and management methodology, led Myanmar TB programme to seriously consider genuine community involvement in its operational activities. Community has to involve from planning and implementation through evaluation and adoptive further planning, with its commitment and enthusiasm.

   To control tuberculosis, Directly Observed Treatment Short Course (DOTS) strategy was introduced on 1997. It covers 168 townships in 1999 accomplishing a 83% cure rate and 45% case detection rate.

   In 2000 a total of 223 townships in the whole country will be covered by DOTS.

A strong grass root health infra structure is necessary for effective delivery of DOTS program. Fortunately, Myanmar has been able to provide DOTS to cover 223 townships (69%) covering 80% of the population in the country , with technical and financial support from the WHO. In addition to the basic health staff in the rural areas, voluntary health workers and national NGOs-Myanmar Maternal and Child Welfare Association and Myanmar Red Cross society - whose membership extends down to the grass roots level, have been mobilized to deliver DOTS to tuberculosis cases.

The general objectives of the National Tuberculosis Control Programme are:

1. To reduce the mortality, morbidity and transmission of  TB, until it is no longer a public   health problem.
2. To Prevent development of drug resistant TB.

The specific objectives of the National Tuberculosis Control Programme are:

1. To cure 85% of detected new cases of sputum smear positive pulmonary TB.
2. To detect 70% of cases of sputum smear positive pulmonary TB case occurring in the area of operation.
3. T o expand the DOTS strategy to all townships in Myanmar.

The strategy of the National Tuberculosis Control Programme are:

1. Intensification of health education by using multi-mediator of increase community awareness about TB.
2. Implementing the NTP activities through coordination and collaboration with other health sectors (e.g. National AIDS Programme, Drug Abuse Prevention and Control etc.) and NGOs.
3. BCG immunization to all under one year children.
4. Early case detection through direct sputum microscopy of chest symptomatic patients attending health services.
5. Implementing Directly Observed Treatment (DOTS) down to the grass root level.
6. Regular supervision and monitoring of NTP activities at all level.
7. Strengthening partnership.
8. Capacity building.
9. Promotive basis and application

AIDS is a disease of national concern and occupied a third position after malaria and tuberculosis in priority diseases of National Health Plan (1996- 2001).

     The fight against AIDS has been given top priority by the Government of Myanmar and the importance of dealing with the problem in a multisectoral approach has also been well recognized. Participation of NGOs in AIDS control activities is being encouraged and in the coming years it is hoped that they will play and important role in the fight against this dreadful disease.

   Active surveillance for HIV and AIDS began in Myanmar since 1985, well before the detection of first HIV positive man in 1988. The first AIDS patient was reported in 1991,
an injecting Drug User. Biannual HIV sentinel surveillance started in 1992. Monthly HIV positive reporting of blood donors and hospital patients clinically suspected of AIDS cases were also taken into consideration in the analysis of HIV prevalence trends in the country. HIV Sentinel Surveillance has now been expended to all States and Divisions totaling 21 sentinel sites.

   The HIV sentinel subpopulations are injecting Drug Users (IDUs), Male STD Patients (MSTD), Female STD Patients (FSTD), Commercial Sex Workers (CSW), Pregnant Women, Blood Donors (BD), and New Military Recruits (MR). About 32,000 individuals were tested for HIV antibody, each year for sentinel surveillance. A sample size of 6,000 at each round was surveyed for HIV/AIDS/STD related rates behaviours. Sentinel surveillance system is strengthened by Behavioural Sentinel Surveillance System, STD (Syphilis) Sentinel Surveillance and AIDS death reporting .

   During the period 1988 to September 1999, the National AIDS Programme has recorded a cumulative total of 25749 HIV Positive cases (among blood donors suspected hospital patients) and 3400 AIDS Patients. A total of 1344 AIDS Deaths were reported from hospitals in different parts of nation. Most of the AIDS patients and HIV positives detected were in the age group (20-40) years with a male to female ratio of 6:1

A marked East to West gradient of HIV/AIDS spread is evident when seroprevalence levels of sentinel populations and AIDS case reporting were mapped out according to geographical areas.

General objective of National AIDS programme is to increase the awareness and perception of HIV/AIDS in the community by promoting access to information and education leading to behavioural change and adoption of healthy life- style.

Small group discussion on HIV/AIDS among women

Specific objectives of the programmes are:

1. To increase awareness on HIV/AIDS in the whole community.
2. To ensure safe blood and blood products.
3. To prevent transmission of HIV through surgical and medical equipment
4. To prevent transmission of HIV through sexual activity
5. To systematically collect information regarding the epidemiological pattern of HIV infection in the country
6. To provide effective health care and counseling services for people with HIV/ AIDS
7. To train health workers and community in health education, counseling and provision of care
8. To train public and private sector employees on HIV/AIDS/STD prevention education
9. To strengthen the potential of the individual, the family and community.

Strategies for the National AIDS programme for control the disease are:

1. Uplifting the awareness and provision of behavior change communication conducive to adoption of sound and healthy life-styles
2. Promotion of concepts and practices of cultural and traditional values towards sexuality by the community
3. Promotion of accessibility of condoms to high risk groups
4.  Prevention of parenteral transmission due to diagnostic and therapeutic interventions and promoting safe cultural practices like tattooing and ear-piercing
5.  Provision of proper care, management, counseling and socio-economic support to those infected and affected by HIV/AID
6.  Enhancing the capacity of health systems with simultaneous strengthening of community participation, intra-sectoral (health sector) and inter -sectoral collaboration and coordination with National and international NGOs, UN Agencies and Donor Agencies and Private Sector
7.  Promotion of research activities and service systems
8.  Strengthening of the monitoring evaluation and surveillance programmes for HIV/ AIDS and Sexually Transmitted Diseases

Leprosy has been endemic in Myanmar since the ancient days. Among the communicable diseases, it causes the greatest, socio-economic problem due to its disfigurement and disabilities.

     In accordance with the national policy guide line, leprosy elimination was given a high priority and is committed to the WHO's global goal of leprosy elimination by reducing the leprosy prevalence to bellow 1/10,000 population by the year 2000.

   Moreover control of other diseases, communicables as well as non-communicable, are being implemented in accordance with the National Health Plan.

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