A reproductive health needs assessment in Myanmar

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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 72
A Reproductive Health Needs Assessment in Myanmar exists to prevent these infections - the instillation of eyedrops immediately after birth - current international recommendations are that all newborn infants receive presumptive treatment to prevent ophthalmia neonatorum. This was not reported to be routine practice among TBAs, AMWs, midwives, or hospitals in facilities visited during the assessment. National guidelines regarding the importance of administering ophthalmia neonatorum prophylaxis for all newborn infants should be developed and disseminated widely to all health staff who provide care for newborn infants. Given the high social costs associated with preventable blindness, consideration should be given to public subsidy of such prophylaxis. Research needs International experience suggests that the task of developing standardised case management guidelines for symptomatic RTIs is greatly simplified by the availability of accurate prevalence data regarding the most common pathogens associated with the various RTI syndromes. At present very little data are available concerning RTI prevalence in Myanmar. Better data are needed regarding the prevalence of RTIs, including both STDs and endogenous infections. Studies should focus on those client populations most in need of RTI case management, for example, clients of private GPs, women seeking services at rural and urban health centres, and men and women attending STD clinics. Broadening the testing for syphilis in routinely collected blood samples drawn for the semi-annual HIV sentinel surveillance programme would be desirable. Deciding which antibiotics to recommend as part of the national RTI treatment guidelines requires a careful consideration of the cost, likelihood of patient compliance, and effectiveness of various antibiotic for the treatment of various RTI syndromes. There is a need for periodic studies of the antimicrobial resistance of gonorrhoea in order to inform the selection of antibiotics for standardized RTI case management guidelines. Once standardized flowcharts have been developed it is important to validate them among the client populations for which they will be used. Experience from other countries suggests that variations in the epidemiology of RTIs require flowcharts that are adapted to the national context. Some flowcharts have been found to result in significant over-treatment with antibiotic therapy, a unnecessary expense that potentially contributes to increased antimicrobial resistance. Research is needed to validate the RTI flowcharts recommended as part of standardized case management guidelines. Several recent studies suggest that a number of interventions may be partially effective in reducing the perinatal transmission of HIV from mothers to newborns. This includes providing safe alternatives to breastmilk for HIV infected women, as well as the administration of antiretroviral drugs in the peripartum period. The cost and operational feasibility of this strategy for use in Myanmar has yet to be explored. 73
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