Background: Complications in dengue usually occur between day four and day six after fever onset. Hence, early diagnosis and haematological monitoring are vital. Among all hospital reported dengue deaths in Myanmar in 2017-18, we assessed the i) patient profile, ii) proportion of patients who arrived with a dengue diagnosis at admission and iii) delays in diagnosis after fever onset. Methods: This was a descriptive study involving secondary data. For all the notified deaths, death investigation forms were not available in prescribed format and therefore, data were extracted from hospital case records.  Results: Of 304 deaths, 184 (60.5%) were female and 233 (76.6%) were less than 10 years old. Township level hospitals or below reported 36 deaths (11.8%) and the remaining deaths were from higher level facilities. Dengue was diagnosed before admission in 26 (8.5%) people and 169 (55.6%) were in shock at admission. Of 208 with date of fever onset recorded, the median diagnosis delay was four (interquartile range-IQR: 3, 5) days. Patient level delay (median three days) was a major contributor to the diagnosis delay. Conclusions: Most of the patients who died did not have a diagnosis of dengue before admission. This calls for an urgent review of health system preparedness in peripheral health facilities to suspect, diagnose, monitor, refer and treat dengue in children and patient level factors for better understanding of the reasons of delay. Timely filling of death investigation forms in a prescribed format and quarterly death reviews based on these is recommended.

BackgroundMyanmar has targeted elimination of malaria by 2030. In three targeted townships of Rakhine state of Myanmar, a project is being piloted to eliminate malaria by 2025. The comprehensive case investigation (CCI) and geotagging of cases by health workers is a core activity under the project. However, the CCI data is not analyzed for obtaining information on geospatial distribution of cases and timeliness of diagnosis. In this regard, we aimed to depict geospatial distribution and assess the proportion with delayed diagnosis among diagnosed malaria cases residing in three targeted townships during April 2018 to March 2019.MethodsThis was a cross sectional analysis of CCI data routinely collected by national malaria control programme. The geocode (latitude and longitude) of the address was analysed using Quantum Geographic Information System software to deduce spot maps and hotspots of cases. The EpiData analysis software was used to summarize the proportion with delay in diagnosis (diagnosed ≥24 hours after the fever onset).ResultsOf the 171 malaria cases diagnosed during study period, the CCI was conducted in 157 (92%) cases. Of them, 127 (81%) cases reported delay in diagnosis, 138 (88%) cases were indigenous who got infection within the township and 13 (8%) were imported from outside the township. Malaria hotspots were found along the foothills with increase in cases during the rainy season. The indigenous cases were concentrated over the foothills in the northern and southern borders of Toungup township.ConclusionIn the targeted townships for malaria elimination, the high proportion of the cases was indigenous and clustered at the foothill areas during rainy season. The programme should strengthen case surveillance and healthcare services in the areas with aggregation of cases to eliminate the malaria in the township. As high majority of patients have delayed diagnosis, the reasons for delay has to be explored and corrective measures needs to be taken.

Rakhine State is the state with highest number of malaria cases in Myanmar. The objective of the study was to investigate the malaria situation in Rakhine State during 2000-2014. Data on malaria monthly reports from all townships during 2000-2014 were reviewed and analyzed. The malaria morbidity rate in Rakhine State was observed to decrease from 40.0 per 1,000 population in 2000 to 13.5 per 1,000 in 2014. Marked reduction in mortality and case-fatality rates were also observed. Although the morbidity and mortality rates were reduced in all townships, some townships had maintained high malaria positivity rate and low annual blood examination rate. Ten percent of cases in under 5-year children indicated the endemicity and local transmission of malaria. Malaria cases treated by community volunteers were increased from 1.7% in 2011 to 27.9% in 2014. The majority of malaria cases were caused by Plasmodium falciparum. Reduction in malaria morbidity and mortality might be due to early detection and treatment of cases. Efforts to detect and treat cases earlier should be a high priority in townships with high malaria positive rate and low annual blood examination rate in order to reduce the burden of malaria infection in Myanmar.

Japanese Encephalitis is endemic in Rakhine State, western Myanmar. In July 2014, 27 patients were admitted to Sittwe General Hospital, Rakhine State. Few patients died and some patients were confirmed as having Japanese Encephalitis (JE) infection. An outbreak investigation was conducted in forty six villages of nine JE affected townships in Rakhine state. The objectives were to describe the outbreak and to identify potential risk factors, reservoir and vector of JE virus in Rakhine State. Active case findings, environmental and entomological study were performed. We found 49 JE suspected cases with 10 deaths. Among them, 21 cases were confirmed as Japanese encephalitis infection by positive immunoglobulin M (IgM) ELISA. Culex tritaeniorhynchus was found in most JE affected townships. Almost all villagers had no awareness about JE transmission and prevention. Our investigation underscored the importance of collaboration between human and animal doctors, the raising of knowledge and awareness about JE transmission and prevention before the rainy season in Rakhine State, and the need for more studies on usefulness of JE vaccination among high risk population.

Evaluation of the malaria surveillance system was conducted in Sai Yok District, Kanchanaburi Province, Thailand. The objective of the study was to describe the surveillance system and assess the system performance in reporting malaria cases. The study applied cross-sectional approach. Key qualitative and quantitative attributes were assessed. Document review on malaria cases treated in Sai Yok Hospital and data collection at Vector Borne Disease Control Unit (VBDU) in 2015 were performed. In-depth interviews with policy makers and health care workers were exercised. Findings showed that sustainability of the surveillance system might be undermined if the Global Fund support would curtail after 2017. There were some discrepancies between number of cases reported by VBDU and those by health facility via the R506 national reporting system. Sensitivity of VBDU reports was slightly higher than the reports by the hospital though the overall sensitivity of the whole district was of acceptable quality. Concerning policy recommendations, a substantial shift of budgetary support from the Global Fund to domestic resources was suggested. Health personnel at the hospital should be more emphasized on the utilization of R506 reporting system. In addition, the R506 reporting system and the VBDU system should be harmonized.