A reproductive health needs assessment in Myanmar

A Reproductive Health Needs Assessment in Myanmar
Reproductive Tract Infections
The term “reproductive tract infection” (RTI) is used to refer to a variety of infections that
may occur in men and women. It includes the numerous sexually transmitted diseases
(STDs), as well as iatrogenic and endogenous infections of the reproductive tract. The latter
are most common among women and either result from genital tract procedures, such as IUD
insertion and induced abortion (iatrogenic infection), or the disturbance of vaginal ecology,
with an associated overgrowth of organisms normally present in the vagina (endogenous
infection). Bacterial vaginosis and candida (yeast) infection are the common endogenous
RTIs and together are responsible for the majority of vaginal discharge symptoms among
women. STDs include genital ulcerative diseases (such as syphilis, chancroid, and herpes),
gonorrhoea and chlamydia (the most common causes of urethral and cervical infection), and
numerous viral infections. Viral pathogens include Human Papilloma Virus (HPV), which
has been associated with the development of several genital tract cancers, and Human
Immunodeficiency Virus (HIV), the cause of Acquired Immune Deficiency Syndrome
(AIDS).
Given the serious and well-described epidemic of HIV that emerged in neighbouring
Thailand in 1989, great concern has been raised regarding the potential spread of HIV/AIDS
within Myanmar over the past several years. Relatively less attention has been directed
toward the broader category of STDs, although a vertical programme for the control of STDs
has existed for many years. Endogenous RTIs have received very little attention and the need
to address this category of infection has only been brought into focus by recent attempts to
expand and integrate the provision of reproductive health services. As in most other
countries, iatrogenic infections have remained almost entirely undocumented.
OVERVIEW OF RTI PREVALENCE
Ironically, the best prevalence data currently available concern the newest RTI pathogen,
HIV. A national sentinel surveillance programme for HIV infection was established in
March 1992. This programme involves the semi-annual (March and September) collection of
anonymous, unlinked blood samples from a number of “sentinel” groups. The sentinel
groups are designed to include a number of “at risk” groups (e.g., STD patients, sex workers,
and injection drug users), as well as several groups more indicative of prevalence among the
general population (e.g., pregnant women, blood donors, and new military recruits). Results
from the September 1997 round of surveillance screening are summarised in Table 10 (March
1998 results were not available at the time of this report). Review of the site specific data
reveal a considerable amount of geographic variation in the prevalence of HIV among the
various sentinel populations, with rates generally higher in the eastern States and Divisions
bordering Thailand, Laos, and southwestern China (Yunnan) (DOH 1997). A review of
temporal trends (Table 11) indicates that rates of HIV infection are extremely high among
injection drug users and are generally increasing among sex workers and STD clients (male
and female). Of particular concern is the steady rise in seroprevalence rates among the
“lower risk” sentinel groups (blood donors, pregnant women, and military recruits). This
suggests that current efforts to reach “high risk” populations are ineffective and the epidemic
is spreading further within the general population. The most recent HIV prevalence rates
among antenatal clients range between 0.0 per cent in Yangon and Bago and 5.1 per cent in
Kawthaung on the Myanmar-Thailand border.
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