Cancer can be a major cause of poverty. This may be due either to the costs of treating and managing the illness as well as its impact upon people's ability to work. This is a concern that particularly affects countries that lack comprehensive social health insurance systems and other types of social safety nets. The ACTION study is a longitudinal cohort study of 10,000 hospital patients with a first time diagnosis of cancer. It aims to assess the impact of cancer on the economic circumstances of patients and their households, patients' quality of life, costs of treatment and survival. Patients will be followed throughout the first year after their cancer diagnosis, with interviews conducted at baseline (after diagnosis), three and 12 months. A cross-section of public and private hospitals as well as cancer centers across eight member countries of the Association of Southeast Asian Nations (ASEAN) will invite patients to participate. The primary outcome is incidence of financial catastrophe following treatment for cancer, defined as out-of-pocket health care expenditure at 12 months exceeding 30% of household income. Secondary outcomes include illness induced poverty, quality of life, psychological distress, economic hardship, survival and disease status. The findings can raise awareness of the extent of the cancer problem in South East Asia and its breadth in terms of its implications for households and the communities in which cancer patients live, identify priorities for further research and catalyze political action to put in place effective cancer control policies.
To identify socioeconomic and behavioural risk factors for development of persistent diarrhoea and malnutrition in children, a case-control study was carried out in Burma. Cases were 67 children 1-59 months old hospitalized for diarrhoea lasting > 14 days and complicated by severe malnutrition; for each case, a healthy control child was selected who was age- and sex-matched from the same neighbourhood. Homes of cases and controls were visited for interviews and for direct observation of household child-care practices. Risk factors were catalogued and calculations made for relative risk and etiologic fractions. Risk factors that were associated with persistent diarrhoea and malnutrition included low family income, low education of mothers, unhygienic latrines, flies in the house and on the child, dirty appearance of child and mother, mother not using soap and water when washing child's hands, defaecation of child on floor, breastfeeding on demand, child eating food from floor, not feeding recommended weaning foods, and lack of knowledge by mother about causes of diarrhoea and about foods that prevent malnutrition. These results indicated that persistent diarrhoea and malnutrition in Burma is caused by a complex of several interrelated socioeconomic factors, unsanitary behaviour pertaining to personal hygiene, the practice of demand breastfeeding and lack of certain weaning foods, and low education of mothers who showed less knowledge about causes of diarrhoea and prevention of malnutrition.
To ascertain whether measles vaccination was associated with reduced measles associated mortality and morbidity in the Yangon Children's Hospital (YCH), the hospital records of children admitted to YCH in 1985 and 1989 with the diagnosis of measles or measles associated conditions, were analysed retrospectively. Measles vaccination was associated with a 90.7% reduction of deaths directly attributed to measles or ascribed to diarrhoea, respiratory illness, malnutrition or fits. An 85% reduction in the percentage of medical admissions related to measles and measles associated conditions was also seen. The case-fatality rate from measles declined from 25.3% to 15.6%. We conclude that measles immunization has been associated with a marked reduction in morbidity and mortality.
HIV infection has been shown to be strongly associated with the development of active tuberculosis. However, its association with leprosy was much less clear. Moreover, seroprevalence of HIV infection among leprosy patients has never been reported in Myanmar. This study aimed to determine the seroprevalence of HIV among leprosy patients and the association between HIV infection and types of leprosy in central Myanmar during 2008. A total of 299 leprosy patients, including 242 multibacillary (MB) and 57 paucibacillary (PB) leprosy patients, were enrolled. The overall HIV seroprevalence was 3.7%, with 4.1% in MB leprosy patients and 1.8% in PB leprosy patients. Fifty MB leprosy patients (20.7%) had history of multi-drug therapy (MDT) and 4 of them (8.0%) were HIV infected. Six out of 192 MB leprosy patients without history of MDT were HIV infected (3.1%). MB leprosy cases with history of previous treatment had greater prevalence of HIV infection. Further study should be considered whether HIV infection may cause difficulty to cure leprosy and additional MDT course may require in HIV infected leprosy patients with previous history of MDT.
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