A reproductive health needs assessment in Myanmar

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A Reproductive Health Needs Assessment in Myanmar Table 10. Sentinel surveillance results for September 1997 Population Group Number Number Number Percent Median Range of Sites screened Positive Seropositive Male STD clients 18 1723 145 8.4 8.0 0.0 _ 21.0 Female STD clients 7 666 71 10.7 10.0 4.0 _ 19.0 Sex Workers 2 200 52 26.0 - 16.0 _ 36.0 Injection drug users 5 445 250 56.2 65.0 19.0 - 80.0 Pregnant women 14 2799 54 1.9 2.0 0.0 _ 5.1 Blood donors 2 11126 107 1.0 - 0.8 _ 1.5 Military recruits 2 1199 28 2.3 - 1.2 _ 3.5 Source: Department of Health (1997) Sentinel Surveillance Data for September 1997. Yangon: AIDS Prevention and Control Project. The Tuberculosis Institute, in co-operation with the National AIDS Programme, began surveying new TB patients for HIV infection in March 1995. Among 15 sites surveyed in September 1996, rates ranged from 0.0 per cent to 14.0 per cent, with a median of 5.0 per cent. The temporal trend shows steadily increasing prevalence (from 1.7 per cent in March 1995 to 4.4 per cent in September 1996). Rates are higher among male TB patients than female patients. Table 11. Sentinel Surveillance Results: March 1992 to September 1997 Population Group 1992 1993 1994 1995 1996 1996 1997 1997 March March March March March Sept March Sept Male STD clients 9.0 6.9 5.7 7.1 7.7 10.2 8.9 8.4 Female STD clients 6.5 3.1 4.7 4.4 4.0 8.3 8.2 10.7 Sex workers 4.3 8.9 16.4 18.0 21.5 20.5 25.0 26.0 Injection drug users 62.8 74.3 71.4 54.5 66.4 65.0 54.1 56.2 Pregnant women 0.0 1.3 1.5 1.3 1.3 1.3 1.5 1.9 Blood donors 0.3 0.5 0.5 0.4 0.7 0.7 0.7 1.0 Military recruits 1.3 0.4 0.5 0.5 0.4 1.3 0.5 2.3 Source: Department of Health (1997) Sentinel Surveillance Data for September 1997. Yangon: AIDS Prevention and Control Project, and Institute of Economics (1997) Socio- Economic Conditions of Migrant and Transport Workers in Border Areas of Myanmar and HIV Transmission. There is little data on the epidemiology of non-sexually transmitted RTIs and the prevalence of STDs aside from facility-based studies. RTI prevalence data from a clinic-based study conducted at the Central Women’s Hospital, Yangon are summarised in Table 12. The study measured the prevalence of RTI among 346 women with symptoms of “white discharge” or “pelvic pain” who came to an out-patient gynaecological service in Yangon. Unfortunately, this study did not assess the prevalence of chlamydia and used some imprecise definitions of “RTI” (e.g., the prevalence of “non-specific” infection was 54.4 per cent) (Khin Myint Wai et al. 1997). There are no prevalence data available from community-based studies concerning any RTI. The FRHS did include several questions regarding current symptom status. Fourteen percent of women surveyed reported currently suffering from vaginal discharge (4 per cent had “smelly discharge”) and 3 per cent had vaginal itching. Given a rather poor correlation 40
A Reproductive Health Needs Assessment in Myanmar between reported symptoms and the presence of infection as documented by clinical and laboratory exam, it is not clear how well these reported symptoms describe the actual situation concerning RTIs in the community. Table 12. Prevalence of RTIs in a Women’s Out-Patient Department (per cent) Presenting Gonorrhoea Trichomonas Candida Syphilis (VDRL+) N symptom vaginalis White discharge 0.8 10.5 0.8 2.8 247 Pelvic Pain 4.0 3.0 - 2.0 99 Source: Khin Myint Wai et al. (1997) Reproductive Tract Infections among OPD attendees of Central Women’s Hospital, Yangon In all the townships visited by the RH assessment team, both government health workers and private general practitioners (GPs) reported seeing STD patients in their clinics, however, the number of patients varied considerably. Government STD teams reported that the number of clients at their clinics ranged from 3 to 30 per day. While some community members were not aware of STDs, many people interviewed believed that STDs were quite prevalent in their community. Health care providers of various types shared the opinion that STDs were common. Syphilis (VDRL) serosurveillance has recently been included within the national HIV sentinel surveillance programme and behavioural sentinel surveillance was introduced in the sentinel surveillance sites in Yangon and Mandalay for the first time in September 1997. The behavioural sentinel surveillance attempts to link HIV prevalence data with information on the frequency of high-risk behaviours. Questionnaires are administered at the time of blood sampling, asking individuals in the surveillance programme to provide information on condom use, symptoms of other STDs, and sexual and drug use practices. Table 13 summarises this data for the first round of behavioural surveillance, conducted in September and October, 1997. The sample included 632 individuals from Yangon and 417 from Mandalay (Department of Health 1997). Table 13. Results from first round of behavioural sentinel surveillance Sentinel Number Regular # of partners past IDU Needle VDRL Discharge Ulcer Group screened condom use 6 months (range) alone sharing positive Male STD 180 7.8 l-5 2.8 1.1 N/A 11.1 30.6 Clients Female 72 4.2 l-5 1.7 N/A 43.9 12.5 11.1 STD Clients Sex 201 34.3 1- 100 2.5 N/A 41.0 3.5 4.0 Workers Injection 80 28.8 0-5 86.2 58.8 N/A 8.8 10.0 Drug Users Pregnant 307 2.0 1 N/A N/A 8.8 0.3 1.6 Women Blood 209 8.6 0-2 0.5 0.5 N/A N/A 1.9 Donors Source: Department of Health (1997) Sentinel Surveillance Data for September 1997. Yangon: AIDS Prevention and Control Project. 41
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A Reproductive Health Needs Assessm
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ANNEX I Summary of Reproductive Hea
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Agency UNHCR Programme Local Reinte
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ANNEX III Summary Reproductive Heal
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Assuming that: (1) TFR in 1990 was
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