A reproductive health needs assessment in Myanmar

A Reproductive Health Needs Assessment in Myanmar
more common in most areas. This misunderstanding can result in accusation of infidelity and
marital discord.
Training should be organized for both public and private sector providers (including
GPs, STD clinic staff and basic health staff in the use of standardized case management
guidelines, including the need to incorporate condom promotion, counselling,
compliance, and partner notification into their routine care for clients with RTI
symptoms. Such training should emphasize that some RTI syndromes are caused by both
STDs and endogenous infections.
One responsibility of the STD Teams is to provide training for basic health staff concerning
STD prevention and treatment. Similarly, in recent years the MMA has begun to provide
such training to private GPs. It is not clear how comprehensive the coverage of such training
is, however, especially given the high rates of health staff turnover in some townships.
There is a need to strengthen the role of the STD Teams and MMA in training a variety of
providers who see clients with RTI symptoms in both the public and private sectors. A
schedule of periodic refresher training should be developed to ensure that all providers
receive accurate information based on the latest scientific knowledge and national data
concerning antimicrobial resistance.
Periodic lapses in the supply of essential drugs for the management of STDs and other RTIs
was found to be a major threat to the provision of quality care for clients presenting to public
health facilities with symptoms related to RTIs. If a client cannot receive the required
therapy when they come for care, the credibility of the health care system suffers and the
client may receive delayed or inappropriate treatment.
There is a need to strengthen the logistic and supply systems to ensure essential drugs
for STD and RTI treatment are available where they are needed. The use of a limited
number of drugs to be provided in accordance with national standards as
promulgated in the case management guidelines will help to simplify drug
procurement procedures.
STD screening - Given the severity of congenital syphilis, experience indicates that antenatal
syphilis screening is a highly cost-effective intervention, even in areas where the prevalence
of infection is quite low. To be effective, however, all pregnant women must be screened and
a positive result must be followed by appropriate treatment. Unfortunately, given that
antenatal care is fairly decentralised and the facilities that conduct VDRL testing are located
at township and station hospitals, we observed that a significant proportion of pregnant
women are not adequately screening for syphilis infection.
Antenatal syphilis screening programmes need considerable strengthening to ensure
that all pregnant women are screened results are promptly reported, and VDRLpositive
women and their partners receive correct therapy. To ensure that syphilis
screening receives the full participation of all pregnant women, the confidentiality of
test results must be assured and the cost should be subsidised.
Presumptive treatment - Congenital eye infection caused by sexually transmitted disease
pathogens acquired during the passage through the birth canal represent a rare, but
preventable cause of blindness. Given that an extremely inexpensive and safe intervention
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