It might hurt him now but a vaccination could save this boy's life later. Pic: Aung Tun Win

A HEALTHY pool of labour is vital to the development of a nation and to safeguard these people, a country must offer effective healthcare services.
The effectiveness of services is also a good measuring stick for the living standards of a population once the country has begun to develop.

Dr U Ko Ko, president of the Myanmar Academy of Medical Science, says the health of women and children is vital to this country’s future. Women, he says, make up more than half of the estimated population of 55 million, while children are another one quarter.

“That means the country has about 40 million vulnerable women and children,” he says.

To better protect these vulnerable people the Ministry of Health conducts many nutritional programs for infants to reduce the current mortality rate (deaths of infants below one year) of about 45 per 1000 births to between 40 and 30 in the next 15 to 20 years.

He says current survival levels are markedly higher than those of the 1950s when nearly one in three infants died before reaching their first birthday.
A keystone of these programs is a concerted effort to control communicable diseases among infants. One of these is the Expanded Program on Immunisation (EPI) that provides seven vaccines to infants and children.

Myanmar’s first immunisation program – targeting tuberculosis (TB), tetanus, diphtheria and whooping cough – was launched by the Ministry of Health in 1978.

It was expanded in 1987 to include polio and measles, while hepatitis B was added in 2002.

Dr U Ko Ko says the EPI has greatly helped to reduce the incidences of infection.

“Polio eradication was declared in 2003 but we still see some imported cases. Efforts to control that disease and those targeting measles and tetanus have been stepped up,” he says.

There have been two reported polio cases in Myanmar after eradication. One was reported in Pyin Oo Lwin township, Mandalay Division, during May 2006, while another was discovered in Maungdaw township, Rakhine State, in April this year.

The Ministry of Health introduced a new dual-stage immunisation strategy for measles this year. It will see children vaccinated once at nine months and again when they are aged 18 months to two years.

It also conducted a mass measles campaign earlier this year aimed at more than seven million children aged between nine months and five years.

The program came as a response to the doubling of reported measles infections between 2005 and 2006. The ministry’s figures show 649 cases of measles were reported in 19 townships last year, up from 314 cases in 10 townships in 2005.

The ministry says the increase was due to two reasons: Some children simply missed the vaccination program, while others contracted the disease despite being vaccinated.

Dr U Ko Ko says the ministry is winning the battle against communicable diseases.

“The causes of infant deaths in the past were mostly due to various communicable diseases like acute respiratory infections, diarrhoea, polio and measles. Now most of these are under control. Unfortunately, we're now seeing that rates of under nutrition – not malnutrition – are rising because children don’t get a balanced diet,” he says.

Two things influence cases of under nutrition: One is the low socioeconomic status of some parents, who struggle to provide a healthy diet for their children. The second, he says, is a lack of education that leaves many parents unsure of what constitutes a balanced diet.

“Some parents simply choose poor foods or cook the food badly. These are definitely contributing factors to cases of under nutrition,” he says.

Dr U Ko Ko says providing health education to the community is a priority for the ministry, especially teaching people about healthy eating and how to cook for their children.

“We also stress the importance of environmental health and personal hygiene,” he says.

“Participation of the community is critical to the success of all of these activities,” he says, adding that even though the government is offering health facilities and advice on nutritional supplements, it is up to people to look after themselves.

The Ministry of Health also provides several reproductive health programs for women under the title of maternal and child health.

The aim of these programs is to improve the health of expecting mothers, which is closely linked to the health of their offspring.

A serious problem for pregnant women in Myanmar, he says, is anaemia, which is a deficiency of iron in the body. Government figures show that 50 percent of pregnant women suffer from the problem that hampers the growth and development of infants.

As much as 80pc of the country’s population lives in rural areas and Dr U Ko Ko says the ministry is working to improve the delivery of services to these people.

The Ministry of Health promotes rural health development as one of the objectives of National Health Plan (2006-2011), which includes 66 healthcare projects, with several aimed squarely at malaria.

Malaria is one of the major diseases plaguing Myanmar and had a mortality rate of 3.1 per 100,000 people in 2005–06, down from 3.65 in 2004–05.

Dr U Ko Ko says the drop is thanks to preventative measures like education, distribution of insecticide–treated nets and effective treatment through artemisinin–based combination therapy.

According to average malaria morbidity rates between 2001 and 2005, Paletwa in Chin State, Naungmon in Kachin State, Bawlakhae, Maeset and Shadaw in Kayah State, Kyauktaw and Ponnakyun in Rakhine State are the most affected. These townships average more than 100 deaths for every 1000 people – a truly staggering figure.

In the fight against TB, Myanmar has an estimated 95pc detection rate and an 84pc treatment success rate.

These figures show the nation has met global detection targets and has nearly met the successful treatment rate of 85pc.

But there is still work to be done because the ministry estimates that more than 100,000 people contract TB every year.

Myanmar has been able to provide TB treatment services in all townships of the country since 2003. It introduced treatment for TB-HIV co–infection patients in five townships in Mandalay in May 2005.

Myanmar has an estimated 338,911 HIV/AIDS patients, according to the Ministry of Health.

Analysis of HIV patients seeking treatment at government hospitals reveals that 68 to 70pc of infections were sexually transmitted, about 28pc resulted from needle–sharing during drug use and the rest were other causes such as mother–to–child transmissions.

However, HIV prevalence in pregnant women between the ages of 15 and 24 was 1.31pc in 2005, down from 2.78pc in 2000.

“HIV/AIDS is not one of the leading causes of mortality but considering other important factors, such as sociological and community aspects, the government included it as one of our major health problems along with malaria and TB,” says Dr U Ko Ko.

To effectively treat all patients, the Ministry of Health operates 832 hospitals throughout the country and has also increased funding to Universities of Medicine, dental medicine, traditional medicine, nursing and other medical-related universities to allow more students to learn these vital skills.