Public Health Information Officer

2009
Fact Sheet
Myanmar
Public Health & HIV
Total Population of Concern
850,594
UNHCR Operational Area
Northern Rakhine State
Banglades h
160,631
185,902
504,061
Mau
Ca h L a h D a y Ph a t
Ba u k S h u Ph wa Ya
i h
Ye Au n g Sa n Y a h Ph wa i
n gd a
Ky a u n g N a P h a y
H la in g T h i
But
Kh a Mo u n g Z e ik
Ng a r Y a n Ch
t au ng
N a n Y a r Ga n g
T h Ht
it o n e Na h K h w a S o n e
T a Ma n T h a r
B aD aG ar
Ye Na u k Ng a r T h a r
Me e T ik e
Th e K
t a in e N y a r
a un
T a u n g P y o L e Ya
t h
P a D a K h a Da W
i a hN ah Li
P a D a K h a W y a T h it
K wa n T h P
i in
T in Ma y
K y a un gT au ng
h
M in G y Y
i wa
W e d K y e in
Ky u n Pa u k
Sa n K a r P in Y in
L a k e Ya h
Ky u n Pa u k Sin Oh
T a Ra Gu
Au n g Se ik P y in
K y u n P a u k Py u S u
Ky a u k Ch a u n g
My o M Ch
i au ng
M y a w Ch a u n g
Go a tP i
Ky e in Ch a u n g
L o u n d Do n e
Z e e B in Ch a u n g
th
Ye T win Py in
L o n g Do n e
or
g N
T h e Ch a u n g
K h a Ma u n g Ch a u n g
hi d
rt
w No
600000
other
500000
400000
300000
200000
100000
0
nI T u L a h
T a u n g Py o L e W
t e
[map]
∗
T u Ch
t au ng
Under-fives children
Women of reproductive age
S a Pa Ko
i ne
Ah et P
t y e u Ma
D o e Ta n
Pa n B a iC h a u n g
N g a r S a r Ky e u
P y u e H ma Ka Ny in T a n
Ku p P a G o u n g
My o T h it
Z e e Do n
E ast Rak hine
Y in M a K y a u n g T a u n g
K y e Yo
t e P y in
Ng a r K h u Ya
T a u n g Ba z a a r
Ya y M y e T
t a un g
Ng a n Ch a u n g
T h in G a N e t
Oo Sh a K
i ya
A ur aM a
P win Hp
t y u Ch a u n g
C h a n P y in
Ba Da Na r
A y e Ra C h a
K y a r G o u n g Ta u n g
In n Ch a u n g
M y a wT a u n g
Ph u r W u Ch
t au ng
Ya T
i w in Ky u n
Implementing Partners:
Y aK
i h u Ch
t a u n g Kh wa So n
Me e G y a u n g Z a y
Ma u n g H n a M a
M e e Gy a u n g Ga u n g S we
Da h G y Z
i a rr
Y w eN
t y o Ta u n g
T h a Ye Oa
t t
T h u Oo H la
L on gC h au ng
O a k Ta u n g
Kr in T h a Ma r
K y a u k Py in S e ik
N g a Ky iDa u k
Da r B in e S a r a
T a tM in C h a u n g
Py in Sh a y
Ma u n g G y iD a u n t
H la P o e Kh a u n g
K y a u k Hla Kh
i ar
ay
K a N y in Ch a u n g
Ky Ka
i n P y in
K y a u k Ph r u T a u n g
But
Na
N a n Ya h G o n e
Z in Pa in g Ny a r
Yw a M a
L e tW a iD a d Pa Z u n C h a u n g
T h a Y e tK in M a n u
L a Ba wZ a r r
BU T HID AU NG
P o u n g Za r r
Nw a h Yo n T a u n g
D a B y u Ch a u n g
L e tW a iDa d Py in S h a y
Kw a n Din e
K a G y a Be tK a n Py in
Bu K
t a r Go n e Na h
K a Gy a B e t
B aG on eN ar
S hw eZ ar r
er
hi d
iv
f R
Yw e tN h y o T a u n g
Ay T a h L Y
i ah
Ale lCh a u n g
M a u n g Na h
O o H la P e
My o T h u G y i
M AU NG DA W
P y in Ch a u n g
Kin T a u n g
La y M y o
My o m a Ka Ny in T a n
N y a un gC ha un g
P a n Da wP y in
T h a Ye tPy in
Kin g C h a u n g
M
Ba Go n e Na h
A twin Ng e tT h a y
P h o n e Ny o L a k e
T h a Pa te T a u n g
W aR aK y u n
au
Du C h e e Y a r T a n
P a D in n
D u N y a u n g Pin Gy i
S a y Oh Ky a
S e in Ny in P y a
S a n Go T a u n g
K y a u k Ya n
G a w Dh u T h a r Ya
Sa Pa r H ta r
Oo Ky a w
G u d e r Py in
Ph o K a u n g Ch a u n g
Ph a Y a r Py in T h e in T a n
Sa y H ta u n g
P h aY on eC ha un g
Z e DiT a u n g
T h a Ya iGo n e T a n
T ha nD a
W a r r Ch a
Ky a u k P r u T h a r T h a y Ga n
da
Z a wM a T a t
Ye Ga u n g Ch a u n g
S in K o n e T a in g
T h a y Ga n G wa So n e
Oa tPh o e
w
C h e in K h a r L i
Ale lT h a n K y a wK a N y in T a n
K a n Hp o o
out
g S
ng
Pa Ny a u n g Bin Gy i
aun
Health/ HIV
ACF,AMI, Malteser
S a n Ny in W
T h e Ka
t Py
i in
M in G a L a h G y i
B in e T a Bo a t
N y a u n g Ch a u n g Ky we Gy o M a w
Oh Ch a u n g
Ra Ko n e T a in g
Ph a Y a r Py in A u n g P a
Ale T
l h a n Ky a w
D u P y in S h a ir
O oD ou ng
T h e in T a u n g Py in
P e T h a tu
Ze e G a u n g
h/ R
So
Kw e W in e K a t
Ga wY a h K h a r L i
P r in e L o n g
R e Z o e Ch a u n g
P a O h T h e Ma
N g a Sa n B a w
Do O h T h e Ma
Ng a H la n Py in
K y a u k Ya n T h a Z a w
T h a P a y Da w
ut
P r in e T a w
Ye My a t
ath
Ky in e T a n
P y in Sh a y ( R td )
T h e in T a u n g
Min K u n Ky u n
Bay of Bengal
Ky a u k T a n
Hte e S wa y
Ch o o tPy in
O a tK y a u n g T a u n g
P a u k Pin Yin
T h in n Ba wK wa y
Ky u n Pa wP a u k T a w
u ng
T h itG a D o e
N g a Ta u k T u S h a y
Py a P in Y in
Y a n Au n g P y in
T u nR aW a y
Py a C h a u n g Gy i
S o e Ma y
RA T H E DA UN G
Ky a u k Sa r D in e
La y K an
N y a u n g B in H la
Ko n T a n
T o wn s h ip Bo u n d a ry
Pa u k T a wS h a y
S a y O h K y a ( R td )
N a tC h a u n g
Vi ll a g e tra ct B o u n d a ry
WatSan
ACF, Malteser
Ky in e T h a
L a y Gw a S o n e
Ng a T a u k T u G r i
Ba rT ra y
In n D in
T h a W in Ch a u n g
Sa P a r Hta r K a n Py in ( Rtd )
Kh a N a u n g G y i
Ka n y in C h a u n g
Pa n P h a wP y in
LEGEND
L a M u T a in g
T ha un gD r a r
A u k Na n Y a r
Ate tNa n Ra
K y a u k Pu n D h u
N wa r L a r Ky a w
T h a iMe e H la
Z a y D e Py in
ed a
Ng a G a r Mo t
My in P h o o
M o to ra b l e Ro a d
Ka u n g Y e e C h a u n g
M in G a n
Ko e T a n Ka u k
M o to ra b l e Ro a d Gra v l e
Ku T a u n g
Au n g Se ik
T in G o a t
M o to ra b l e Ro a d Ea rt h
P o u n g Z a r r ( R td )
T ha nC ha un g
F o o t p a t h Ro a d
T h a Z iT a u n g
A n a u k Py in
T h a Y e tC h a u n g
T h a Y e tP y in Is la n d
M o u n ta in Ra n g e
S h we L o n g Htin
L o n g Ch a u n g ( Rtd )
My in G a n Ch a u n g
K a P a in g C h a u n g
K a n Py in
D o n e P ik e
Ri v e r/ Cre e k
U G ar
Ku tCh a u n g
S in P ik e
Min Nh y o Hta u k
Ph y u Ch a u n g
K y a tYo e S e ik
A u n g B a la
K a L a r Ch a u n g
T o wn s h ip
N y a u n g B in G y i
L a P a n Bin Y in
N y a u n Ch a u n g ( R td )
Ky u n Gy i
S a r Py in C h a y
Z e e Kh in e
S a r Py in G y e e
Vi ll a g e T ra c t
Bay of Bengal
M a G y iC h a u n g
Ah Ng u M a w Ko n T a n
S
ittw
e
9 N ov ember 2006
UNHCR FO Maungdaw
to
w
ns
hip
Buthidaung
P au k T aw
h
Maungdaw
Nutrition
ACF, Malteser
Ph e tL e ik
Sh we T a r
My in n Hlu t
Operational Summary
Achievements:
- Completed the construction of two delivery units in Maungdaw North.
- Completed the construction of an isolation ward in Maungdaw Township hospital.
- Renovated some health facilities in order to utilize as EmOC units.
- Constructed a clinic at Auk Nan Yar, Rathedaung Township.
- Kept stockpile in Maungdaw UNHCR to response to any emergency/ disease outbreak
- Provided support for the repair and reconstructive surgery for some gynaecological cases including 9 utero-vaginal prolapse and one vesico-vaginal fistula.
- Provided 991 Chulli water filters to 991 houshold in Maungdaw and Buthidaung Townships.
- Renovated 4 existing public water points with storage facilities, renovated one opened well, provided 965 ceramic clay water filters at household level, protected two ponds with fences, tested water quality
at the supported sites, established 8 water users groups and trained, constructed three public latrines as demonstration and provided the material to 437 household to construct the HH latrines at Sittwe.
Constraints:
- Travel restriction for Muslim population to get timely referral and treatment
- Social and cultural barriers to change the communities’ attitude and practices on health seeking bebaviour.
- There are still gaps in very remote areas although many agencies are now working in NRS
- Overlapping, duplication of some programs in some operational areas
- Difficult to get the approval for some activities such as surveys and assessments
- Lack of support and cooperation by some health staff who see NGOs as their competitors.
- Difficult to get the data from IPs and health departments.
- Deadline to submit Health and Nutrition report to regional office is earlier than the deadline for IPs to submit report to UNHCR country office.
- Limited opportunities of IP and UNHCR staff to attend trainings, workshops and meetings in order to share and learn from other colleagues.
Conclusions
Recommendations and Action Points
According to IP reports and data from government health department, many of the expected
achievements have been reached. However, many gaps remain, among those such that are
difficult to address, such as, not reaching to very remote areas, no access to all PoCs and the
further need to expand the programmes. It was observed that community participation, initiatives
are needed to strengthen sustainability in health promotion programmes.
- UNHCR should intensify coordination efforts so to ensure that all stakeholders are involved in
planning, implementation, monitoring, and evaluation.
- It is also necessary among agencies and health authorities to be transparent, in order to compliment,
to avoid duplication, overlapping and to ensure the effective and efficient division/sharing of resources
among all implementers.
Coordination
Do regular health coordination meetings take place?
Standard
Yes
79
N/A
N/A
N/A
1:≤10,000
≤ 50
1-4
variable
Access to Health Services
№ of HC facilities
№ of consultations per trained clinician per day
Utilisation Rate (new consultations/person/year)
Proportion of host population consultations
UNHCR organised monthly health coordination meeting at UNHCR Field Office regularly, and also
organised regular meeting with State and Township level health authorities. In addition, UNHCR
regularly coordinate with other UN agencies, UNICEF and UNFPA to support each others and to
plan for collaborated programme.
Malaria
Has ACT been introduced as 1st-line treatment?
Yes
Public Health Impact
2009
N/A
N/A
N/A
N/A
Crude Mortality Rate (CMR) (1000/month)
Under-fives Mortality Rate (U5MR) (1000/month)
Infant Mortality Rate (IMR) (1000 live births/year)
Neonatal Mortality Rate (NMR) (1000 live births/yr)
Mortality rates by camp
Page 1 of 2
Yes
Standard
CMR
0.00
1.11
1.0
0.5
0.0
Maungdaw
Buthidaung
≤ 1.5
≤ 3.0
≤ 60
≤ 40
U5MR
1.5
0.35
deaths/ 1000/ month
Public Health Status
2009
Yes
0.00
Public Health Programme
Activities and priorities needed to achieve the expected goals in 2010:
- support to establish comprehensive EmOC, child health and nutrition programmes.
- Add adolescent RH with HIV/AIDS prevention into on-going RH programmes.
- expand malaria prevention and control programmes in highly endemic village tracts
- expand WASH programme
- Contingency plan for disease outbreak
- Expand the operation area to Rathedaung and Sittwe Townships and provide necessary services to all
members in the communities
Birth and death registration have some limitation for PoCs, there are many non-reported bith and
death. In practical, CMR, U5 MR, and NMR could be higher than the reported figures. The
Township Health Department collects birth and deaths for all persons with or without citizenship
on a monthly basis, hence these indicators are the most reliable data.
Myanmar
Fact Sheet 2009 Public Health & HIV
■
■
■
■
■
U5
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
■
■
■
■
■
Crude
N/A
N/A
N/A
N/A
N/A
Vaccination coverage
Measles
Crude Morbidity (cases/ 1000/ month)
Proportional Morbidity
N/A
0%
N/A
0%
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
others ##
N/A
N/A
N/A
N/A
N/A
others
EPI
N/A
N/A
N/A
N/A
N/A
85.0%
80.8%
98.0%
25%
0%
Maungdaw
Buthidaung
Maternal and Newborn Health
Reproductive Health
In Maungdaw Township, vaccination coverage is still good as there is good collaboration and
coordination among DoH and agencies. Agencies have supported DoH in the transportation of
required vaccines.
Due to the absence of a Township Medical Officer in Buthidaung the EPI vaccination coverage is
reduced in 2009.
Target
75%
50%
There were seasonal variations in the incidence rate of malaria and diarrhoea. However, no
incidence rates or proportional morbidity rates are available.
0% 0%
100%
95.0%
Immunization
Disease Burden
U5 Morbidity (cases/ 1000/ month)
N/A
N/A
N/A
N/A
N/A
Coverage of complete ANC care (4 or more visits)
Proportion births attended by skilled person
Proportion of birth taking place in EmOC facilities
Proportion of low birth weight deliveries (<2500g)
Standard
100%
≥ 50%
≥ 50%
≤ 15%
68%
32%
2%
3%
Family Planning
Proportion of women using contraceptives
N/A
≥ 30%
Awareness raising on prevention and management of physical/medical, psychological and legal
aspects of SGBV remain to be implemented.
Sexual and Gender-based Violence
Incidence of rape (reported cases / 10,000/ year)
Proportion of rape survivors who receive PEP <72 h
Proportion of rape survivors who receive ECP <120 h
Prop. of rape survivors receiving STI prophylaxis <2wks
N/A
N/A
N/A
N/A
variable
100%
100%
100%
Yes
Standard
Yes
Protection
Are PoCs included in national HIV strategic plans?
Although Basic Health staff and IPs' MCH fixed and mobile clinics are providing ANC/PNC,
awareness raising, coverage of complete ANC has not reached to the standard. The reasons
include lack of awareness, cultural barriers, travel restriction and other social factors. The
partnership programme on MNCH is still needed to continue and to expand to most remote areas.
In addition, promotion of deliveries by skilled person, timely referrals, promotion of maternal
nutrition and exclusive breast feeding and immunization should be strengthened to reach all
required standard.
Health departments have some programmes on HIV prevention and treatment including
awareness raising/education on prevention of HIV as well as care and support of PLWHIV in the
community.
Monitoring and Evaluation
Are PoCs included in national HIV sentinel surveillance?
Date of last BSS/ KAPB survey
No
N/A
Yes
HIV/AIDS
Prevention
Condom distribution rate (Nr. of condoms/person/month)
Does appropriate IEC material exist for PoCs?
Are risk groups targeted with prevention programs?
Proportion of donated blood units screened for HIV
PMTCT coverage rate
N/A
Yes
Yes
N/A
N/A
≥ 0.5
Yes
Yes
100%
100%
Yes
200
N/A
N/A
Yes
variable
100%
100%
N/A
N/A
Standard
1 per year
1 per year
Surveys & Assessments
Date of last nutrition survey
Date of last Joint Assessment Mission (JAM)
Nutrition
Malnutrition
Global acute malnutrition rate (GAM)
Severe acute malnutrition rate (SAM)
Prevalence of anaemia in children under five
Prevalence of anaemia in women of reproductive age
Average number of kilocalories per person per day
Since PoCs in NRS have lack of knowledge on HIV/AIDS prevention, care and support, HIV
programmes should be expanded not only by health department and agencies but also involved
by other department like social welfare, education and NNGOs.
The PMTCT programme for Maungdaw health department is supported by UNFPA and UNICEF for
Buthidaung Township.
Care and Treatment
Do PoC's have equal access to ART as host community?
Nr. of HIV Positive POCs receiving ART
Prop. of HIV-pos mothers receiving cotrim. prophylaxis
Prop. of HIV-pos infants receiving cotrim. prophylaxis
MSF-AZG has established one clinic in each Township, supporting PoCs for STI treatment, VCT,
ART, prevention program for high-risk groups and providing of food rations for ART cases with the
support of WFP. AMI, Malteser and ACF referred the suspected cases, high-risk cases and drugresistant TB to MSF_AZG clinic for VCT and further necessary treatment, care and support.
21.0%
3.5%
N/A
N/A
N/A
≤ 5%
≤ 2%
≤ 20%
≤ 20%
2100
No
Yes
≤ 30%
Nutrition and food security surveys are usually conducted by ACF and WFP. According to the
surveillance finding of the health department, the nutrition status of under 3 children in NRS
reached a borderline standard. At community level, IPs identified many malnourished children and
women and provided feeding programmes, referral for therapeutic feeding, treatment of
underlying disesaes, nutrtion/ hygiene education and demonstration & education on the
preparation of balance food with locally available resources for the mothers of malnourished
children, care takers and the community.
Food Security
Does UNHCR provide complimentary food?
Did the general food ration change during the year?
Did WFP report any pipeline/stock breaks during the year?
Are PoCs included in national Food Security strategy?
Proportion of ration sold by PoCs to buy other food items
Yes
Yes
N/A
WASH
Water, Sanitation and Hygiene
Average quantity of potable water per person per day
Nr. of persons per water tap
Proportion of pop. living within 200 m from water point
Nr. of persons per drop-hole in communal latrine
Proportion of families with latrines
Proportion of camps with 1 hygiene promoter/ 500 persons
Proport. of families receiving >250g soap/person/month
Page 1 of 2
N/A
N/A
N/A
N/A
67%
N/A
N/A
Standard
≥ 20L
≤ 80
100%
≤ 20
100%
≥ 75%
≥ 90%
Although indicator data are not available, ACF has been implementing water, sanitation and
hygene promotion programmes since ten years, reaching even to the remote areas. However,
some of the villages struggle with sub-standards for non-accessibility of roads and transportation
of machines and manpower. There are also some constraints in the maintenance of water sources,
hand-pumps and tube-wells. Hygiene education and behavior change is also needed to strengthen
the overall impact of WASH interventions.
Malteser provided safe water systems and some public and household latrines to the community
in Sittwe Township.
2009
Fact Sheet
Maungdaw
Public Health & HIV
Myanmar
Total Population
UNHCR Operation Area
Maungdaw
511,575
∗
TuC
t ha u n g
Under-fives children
Women of reproductive age
n
I TuLah
101,379
114,708
295,488
C ah L a h D a y Ph a t
B a u kS h u P h w a Ya
i h
Y e Au n g S a n Y ah P h w a i
Ky a u n g N a Ph a y
Ha
l n
i g Th i
Kh a M o u n g Ze ki
a
N ga r Y a n C
t h au n g
to n
H
T hit
eN
S one
Khw
ah
G ang
Y ar
N an
T a Ma n T h a r
ar
r Th
N ga
uk
Na
Ye
M e e T ki e
Th e K
t an
i e N ya r
Pa D
a Kh a
D a i W ah
Na h
L i
T a un g P y o L e tYa h
Buthi daung North
t
t
other
B angl ades h
T hi
T a u ng P y o L e tW e
Thi
a
D ai
W ya
ya
W
Kha
Mi
Sa
Pi
Gy
i
Da
Pa
Ywa
ain
K y
a
Pi
K ar
Ka
r
Yw
n
au n g
P a
yi
n G
n
n YIn
nY
Ky
W
In
K yun
Ch
T he
Dai
Da
Kh
Mi
San
Kwa n T h P
i n
i
un
ed
Pa
Pauk
uk
Si n
Sin
Oh
Oh
k
S ei
L a k e Ya h
Pyi
n
A ung
My
aw
My
o
o
i Cahu
i Ca
Kyu
h aun
wC
Cha
un
M
M
n
ung
ng
g
P auk
Pauk
hung
20%
My
M ya
Ky
K ya u k C h a u ng
Pyu
P y
u
Su
ni
Su
K ye
Z e eB n
i Ch a u n g
C ha
un
g
L o u n dD o n
Ye T w n
i Py n
i
Sa Pa K
i o ne
Ah e
t P
t y e uM a
D oe T a n
ni Ta
a Ny
a K
r K ye u
N ga r S a
n
M yo
Ku p
Th it
Pa G
o un g
e Hm
N g ar K h u Y a
Yay
M
y et
tY
K ye
Taung
oe
n
P yi
C ha
N g an
un
g
ng
P yu
Implementing Partners:
Pwn
i H
t p y uC h a u n g
C hau
O oS h a K
i y a
Ph ur
W ut
K y a r Ga u n g T a u ng
Ch a n Py n
i
M ya w
T au ng
Ya T
i wn
iKy u n
Bu
Y aiK h u C
t h a u ng K h w a S o n
Y w et
N hy
o Ta
un g
Ma
Da h Gy Z
i ar r
K ya
Thu
un g
Hn a
Ma
uk P y in
S ei k
id
t Oat
la
H
Ol
Ye
th
Tha
K yi
K
g
Ra
e
Ya
r Ta
n
th
Dh
ed
P in
u T ha
r Ya
G yi
at
T
a w
a
n D
W ar
r Ch
W ar
har C
MV
ng
Z
T ha
A el
lT h
an K
y aw
au
a
M
Th a Ya G
io n e T a n
a
n
C h ei
K h ar
Li
KT
K an
H po
o
Oo
D aung
Ale T
l h a n K y aw
LEGEND
Daun
g
Ga
wY
rL
K ha
a h
i
Oo
w
My n
i n Hu
l t
n
g
a
l
Ot h ers
T o wn
V i l l ag e Tra c t
UNHCR FO M au n g da w
Da
Pa y
Th a
a
L a nd f o rm a nd P hy s i o gra p hy
F l a t p l a in
F o ot s l o pe -h i ll
Ri v er/ Cree k
B
Ro ad
M o to ra bl e
M o to ra bl e Grav e l /E a rt h
F o ot p a t h-Gra v e l / Ea rt h
B o un d a ry
UNHCR Fi e l d Are a
V i l l ag e Tra c t
f
Public Health Programme
y i
u G
h/
ng
o
Public Health Status
ut
aun
Ch
N ah
C he
G aw
au
y
Nutrition
So
o ne
Du
D uN y a u n g P n
i Gy i
Pa
Ny
a
Reproductive Health
ng
Th
M yo
ng
N yau
G
Ba
Pa Dn
i
B
HIV/AIDS
au
N ah
G o ne
P a n Da w P y n
i
ve r
Sexual and Gender-based Violence
t K ar
Bu
i
f R
Maternal and Newborn Health
Do pregnant women have access to antenatal care?
Do pregnant women have access to safe delivery care?
Do women have access to family planning?
Na
Malnutrition
Global acute malnutrition rate (GAM)
Severe acute malnutrition rate (SAM)
Prevalence of anaemia in children under five
Prevalence of anaemia in women of reproductive age
Average number of kilocalories per person per day
ah
2.9
Li
Yah
Li Y
%
37.3
28.9
20.5
10.3
Tah
T ah
TB
■
■
■
■
■
%
40.8
22.3
14.6
12.0
9.7
Ay
Ay
Crude Morbidity (&)
Malaria
Respiratory Tract Infection
Diarrhoea
Dysentery
■
■
■
■
■
Nwa h
Y on T
au n g
rr
ng Za
U5 Morbidity (%)
Diarrhoea
Low birth weight & Prematurity
Malnutrition
ARI
Neonatal Jaundice
y ar
r
Sh w
e Za r
r
M A UN G D A W
M y o m a K a Ny n
i Tan
Dhu
P un
auk
K y
aw
n B
Th in
ay
Kw
I nn
Di
n
T ha
Wi n
C
ha ung
18 March 2009
UNHCR FO Maungdaw
Standard
Yes
N
Zar
P ou
Patient load
Average number of new patients per month
Average number of repeat patients per month
Average number of referrals per month
B aw
y ar
Crude Mortality Rate (CMR) (from survey)
Under-fives Mortality Rate (U5MR) (from survey)
La
N
Public Health Impact
2009
Yes
No
46
N/A
Yes
Yes
Yes
ng
ing
Access to Health Services
Do PoCs have access to national health facilities?
Do PoCs have to pay for primary health care?
№ of HC facilities where PoCs have free access
№ of consultations per trained clinician per day
Do PoCs have access to 2nd and 3rd level care?
Does a referral system exist?
Are referral cases reviewed by a board (or alt. system)?
Pai
Pa
22%
n
T h e t K a i P yi
Zin
Z in
Health/ HIV
ACF, Malteser
Nutrition
ACF, Malteser
WatSan
ACF, Malteser
a n
Py ni
H la P o e K h au ng
ar
K y au k H al i K h
M in
Ga L
ah G
yi
≤ 50
Yes
Yes
Yes
Overall Objective:
To promote the integration of persons of concern into Myanmar's society, to improve their
livelihoods and the peaceful co-existence with their neighbors of different ethnicity.
Health and Nutrition Sector Objectives for 2009
1. Improved reproductive health status of the population of concern to UNHCR in NRS.
2. Population of concern to UNHCR enjoys improved health care services, with special focus on
malaria and TB.
Activities:
1. Reproductive Health/ Maternal & Neonatal Health
0.35
≤ 1.5
(a) provision of antenatal care, safe delivery, post-natal care,
1.11
≤ 3.0
(b) awareness raising on RH and safe delivery for pregnant women and community,
(c) provision of Clean Delivery Kits,
(d) provision of family planning,
N/A
(e) promotion of breast-feeding practices,
N/A
(g) prevention and treatment of HIV/AIDS and STI
N/A
(h) support of some gynaecological cases for repair/ reconstructive surgery in coordination and
collaboration with Department of Health, UNFPA and Malteser,
Proportional Morbidity
(i) construction of two delivery units in Maungdaw North and
10%
Diarrhoea
### 1%
(j) renovation and provision of essential equipment for some health facilities in NRS.
Low birth weight
### & Prematurity
2. Primary Health Care including prevention and treatment of Malaria and TB
12%
41%
(a) awareness raising,
Malnutrition
###
14%
(b) improving the diagnosis and treatment of malaria/ TB with nutrition support,
ARI
###
22%
(c) establishment of referral system in coordination with township health department,
Neonatal Jaundice
9.7
(d) emergency response, management and reporting of diseases outbreak and prevention like
others 0.6
diarrhoea, AH1N1,
10% 3%
(e) screening for malnutrition for under 5 children, pregnant/ lactating women and therapeutic/
Malaria ###
37%Infection supplementary feeding programs
Respiratory###
Tract
21%
(f) training and support for community health workers.
Diarrhoea ###
3. Water, Sanitation and Hygiene (WASH)
Dysentery29%
###
(a) Hygiene promotion awareness raising
TB
2.9
(b) community training and provision of water purifiers,
2009
Standard
2009
16.3%
2.4%
N/A
N/A
N/A
Standard
≤ 5%
≤ 2%
≤ 20%
≤ 20%
2100
The prevalence of anaemia in children under 5 and women of reproductive age is not assessed
routinely. However, more than 80% of pregnant women in Myanmar are believed to be anaemic.
Pregnant women receive routinely Ferrous-Folate during pregnancy.
ACF, Malteser and MSF-AZG are conducting screenings for malnutrition and are providing
therapeutic/ supplementary feeding programme. The prevalence of GAM is still high. During the
hunger period, June-September, there was an increased number of malnourished children
admitted to ACF's TFCs as compared to the previous year.
Standard
Yes
Yes
Yes
The proportion of deliveries attended by skilled staff was 32% in 2009 compared with 15% in 2006. 32% of
pregnant women benefited from ANC by qualified health staff. IPs have been providing ANC/PNC through PHC
and mobile clinics, complimenting government MNH programs. Family planning services along with advocacy
to the communities for their acceptance are carried out by IPs. According to Township Health Department,
contraceptive prevalence rate is 27.8%; still low compared to the national rate. Reported by Township Medical
Officer, the abortion rate is 4.1% which is likely underreported; NNMR 13.9 per 1000 live birth, IMR is 5.5 per
1,000 live birth, and MMR is very high at 210 per 100,000 live birth. Clinical management of rape survivors are
currently provided by MSF-AZG and the Township hospital. UNHCR and IP constructed two delivery room in
Maungdaw North.
2009
Yes
Yes
Yes
Proportion of rape survivors who receive PEP <72 h
Proportion of rape survivors who receive ECP <120 h
2009
N/A
N/A
Prevention
2009
Condom distribution rate (Nr. of condoms/person/month)
Does appropriate IEC material exist for PoCs?
Are risk groups targeted with prevention programs?
Proportion of donated blood units screened for HIV
Do pregnant & lactating women have access to PMTCT?
No
Yes
100%
No
100%
100%
Standard
≥ 0.5
Yes
Yes
100%
Yes
Care and Treatment
Do PoC's have equal access to ART as host community?
Nr. of HIV Positive POCs receiving ART
Prop. of HIV-pos mothers receiving cotrim. prophylaxis
Yes
N/A
Yes
variable
100%
Prop. of HIV-pos infants receiving cotrim. prophylaxis
N/A
100%
Since Maungdaw is not a high-prevalence HIV/AIDS area, the government health department and
IPs mainly focus on awareness raising and health education on HIV/AIDS/STI prevention for
general community and for pregnant women. However, MSF-AZG has been providing VCT and ART
for the PLWHIV and focus on prevention programs for high risk groups.
As government hospitals are the only blood transfusion facilities, (Living Blood Bank), all of
donated blood units are screened for HIV, however, patients need to pay for testing. Condom
distribution has been conducted by both government and IP/OPs, MSF-AZG and Malteser in
Maungdaw Township with desensitization. During the reporting period, Malteser distributed
estimated 100,000 male condoms via PHC centres, TBAs and CHWs. According to the TBAs, even
the men came and asked the condoms from the TBAs. The PMTCT program in Maungdaw is
coordinated by UNFPA and no data is available from Township Health department. All IPs and OPs
are conducting HIV HE on prevention, care & support.
Buthidaung
2009
Fact Sheet
Public Health & HIV
Myanmar
Total Population
339,019
AMI Project Area
Buthidaung
59,252
71,194
208,573
other
(
K h a Mau n g C h au n g
B a D a G ar
Kyaung
T in May
Taung
L o n g Do n e
State
K yu n P au k
G o at P i
Pan
Bai
Cha
ung
T a R a Gu
A u r a Ma
Z ee D o n
Tau
ng
Y in Ma K yau n g T au n g
Baz
aar
A ye R a C h a
T h in G a N et
Da
ung
Cha
Ba
I nn
Implementing Partners:
aw
Maungd
17%
[map]
hine
East Rak
Under-fives children
Women of reproductive age
Nar
a un
Gy
g Zay
Krin
Shay
Way
Pyin
Nyin
San
Lay
Myo
Kin Taung Myo
K a G ya B et
Y w et N h yo T au n g
A l el C h au n g
Maung
Nah
%
N/A
N/A
N/A
N/A
N/A
■
■
■
■
■
%
N/A
N/A
N/A
N/A
N/A
Crude Morbidity (&)
Malnutrition
Global acute malnutrition rate (GAM)
Severe acute malnutrition rate (SAM)
Prevalence of anaemia in children under five
Prevalence of anaemia in women of reproductive age
Average number of kilocalories per person per day
Maternal and Newborn Health
Do pregnant women have access to antenatal care?
Do pregnant women have access to safe delivery care?
Do women have access to family planning?
Sexual and Gender-based Violence
Proportion of rape survivors who receive PEP <72 h
Proportion of rape survivors who receive ECP <120 h
Prevention
Condom distribution rate (Nr. of condoms/person/month)
Does appropriate IEC material exist for PoCs?
Are risk groups targeted with prevention programs?
Proportion of donated blood units screened for HIV
Do pregnant & lactating women have access to PMTCT?
ng
Tau
Go
San
Hta
un
g
Say
Sone
Gan
Pyi
n Sha
ir
Kwe
Wi
Wine
ne Kat
Thay
Pa Oh
Taw
Ra
th
ed
Du
Maw
P ri n e T au n g
au
ng
Gan
D o O h T h e Ma
S h w e T ar
Par
Thay
Thay
Kyw
e Gyo
T h ei n T au n g P yi n
Htar
Sa
Gwa
Tau
Di
Thar
Cha
ung
N g a H l an P yin
10 October 2006
UNHCR FO Maungdaw
Standard
Yes
≤ 50
Yes
Yes
Yes
2009
N/A
N/A
Standard
N/A
N/A
N/A
≤ 1.5
≤ 3.0
Proportional Morbidity
0% N/A
0%
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
others ##
0% 0%
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
Overall Objective:
To promote the integration of persons of concern into the mainstream of Myanmar society, to
improve their livelihoods and the peaceful co-existence with their neighbors of different ethnicity.
Health and Nutrition Sector Objectives for 2009
1. Improved reproductive health status of the population of concern to UNHCR in NRS.
2. Population of concern to UNHCR enjoys improved health care services, with special focus on
malaria and TB.
3. Coordinated approach to health care services in NRS, with particular focus on reproductive
health.
Activities:
1. Reproductive Health/ Maternal & Neonatal Health
(a) Antenatal Care, and Post-natal Care provided by mobile MCH, (b) skilled care in delivery
provided, (c) family planning sessions delivered to women of reproductive age, and (d) education
sessions on RH issues delivered in schools and in community.
2. Primary Health Care
(a) Basic medical care provided to under 5 children, (b) prompt detection and referral to trained
care providers, (c) support provided to two local communities to run a community-based referral
system, and (d) screening for malnutrition for under 5 children, pregnant women and lactating
mothers.
3. HIV/ AIDS prevention
(a) VCT counseling provided to pregnant women in the screening centre.
Achievement/ Constraints:
- PoCs do not necessarily pay for services but need to pay for medicine.
- Referrals can be delayed because of delayed decision of family members to send the patients,
cultural barriers, needed travel authorization, or delayed treatment because of lack/ insufficient
human resource/medicine/ equipment at the hospitals,
- During 2009, UNHCR distributed 20,000 LLIN, UNCEF 11,500 and CARE 3,000 in Buthidaung
Township.
- Malterser are supporting the identification, investigation, referral, closed monitoring and follow
up of patients on DOTS, with nutrition provision for the TB patients,
- ACF provides feeding programme and
- MSF AZG provided HIV prevention and provision of treatment for People Living with HIV.
- ACF/UNHCR provided 426 Chulli water filters to the household level in Buthidaung Township.
2009
25.7%
4.5%
N/A
N/A
Standard
≤ 5%
≤ 2%
≤ 20%
≤ 20%
2100
AMI has conducted malnutrition screening of under 5 children, pregnant women and lactating
women. AMI referred severely malnourished clients to ACF for therapeutic feeding and the
malnourished clients with medical problems to government hospital for necessary treatment.
During the hunger period, June-September, there was an increase in the number of malnourished
children admitted to ACF tharapeutic feeding centres. Because of low coverage and lack of
collaborative efforts among INGOs and health department, malnutrition rate is still very high.
2009
Yes
Yes
Yes
Standard
Yes
Yes
Yes
According to data collected by AMI's MCH activities, 63% of women of reproductive age range ave
access to RH services (ANC, PNC and skilled birth attendance). Antenatal coverage by the skilled
BHS is 45.5% and 24 % of pregnant women were delivered by skilled persons. The contraceptive
prevalence rate in Buthidaung is 12.3 % in AMI covered areas and 7.8% for the whole Township
2009
N/A
N/A
2009
N/A
No
Yes
100%
No
N/A
100%
100%
Standard
≥ 0.5
Yes
Yes
100%
Yes
Care and Treatment
Do PoC's have equal access to ART as host community?
Nr. of HIV Positive POCs receiving ART
Prop. of HIV-pos mothers receiving cotrim. prophylaxis
Prop. of HIV-pos infants receiving cotrim. prophylaxis
ng
Ze
Kya
uk Pru
Nya
ung
P yar P yi n A u n g P a
t
Boa
Ot h e rs
T o wn
Vi ll a g e T ra c t
UNHCR T r a n s it O ff ic e
G u d er P yin
The Ma
Bo u n d a ry
UNHCR F i e ld Are a
Vi ll a g e T ra c t
Pha Yo
ne Chaung
Ta
■
■
■
■
■
ng
ha ung
hau
Say
K yau k Y an
Oh
Kya
Oo
Kya
w
P h o K au n g C h au Pn yar
g P yin T h ein T an
Bine
U5 Morbidity (%)
nC
Pyi
T h a Y et P yi n
P h o n e N yo L ake
n
Kyu
2009
Yes
Yes
33
N/A
Yes
Yes
Yes
Taung
n Pya
Nyi
Sein
Pauk
Tha Pate
Atwi
n Nget
K i n g C h au n g
Ra
Public Health Programme
K a N yi n C h au n g
Ywa Ma
T h a Y et K in Man u
BUT HI DAUNG
K w an D i n e
D a B yu C h au ng
Ka G ya Bet
Kan Pyin
LE GEND
Patient load
Average number of new patients per month
Average number of repeat patients per month
Average number of referrals per month
Public Health Status
Sh ay
Wa
Public Health Impact
Nutrition
Dad Pyin
e
Gon
t
Daun
g
Yah
Access to Health Services
Do PoCs have access to national health facilities?
Do PoCs have to pay for primary health care?
№ of HC facilities where PoCs have free access
№ of consultations per trained clinician per day
Do PoCs have access to 2nd and 3rd level care?
Does a referral system exist?
Are referral cases reviewed by a board (or alt. system)?
Crude Mortality Rate (CMR) (from survey)
Under-fives Mortality Rate (U5MR) (from survey)
Reproductive Health
Gyi
Nan
Taun
B a G o n e N ar
Ro a d
M o to r a b l e
F o o t p a t h -Gr a v e l /Ea r th
WatSan
ACF
HIV/AIDS
Dau
ng
Phr u
Let Wai
L a n d f o rm a n d Ph y s i o g r a p h y
F l a t p l a in
F o o t s l o p e -h i ll
Ri v e r/ Cr e e k
N/A
N/A
N/A
N/A
N/A
Kyi
k
Kyauk
L et Wai D ad P a Z u n C h au n g
g
Taun
Oo H l a P e
Nutrition
ACF, AMI
N/A
N/A
N/A
N/A
N/A
Nga
g
Mau
21%
Chaun
Tat Min
Oak
Tha
Mee G yau n g G au n g S w e
D ar B i n e S ara
Health/ HIV
AMI, Malteser, ACF
Mar
Mee
L o n g C h au n g
Yes
200
N/A
N/A
Yes
variable
100%
100%
Because of social and traditional barriers, inequality of power relation, stigma & discrimination,
lack of information and lack of awareness and lack of PEP services, most of the rape cases are not
reported, or reported very late and could not receive PEP.
Condom distribution has been conducted by the government health department and IPs, AMI and
Malteser in Buthidaung Township.
There is a UNICEF funded- PMTCT program in Buthidaung and one mother and her baby have been
found positive for HIV. Currently, AZG is supporting ART to estimated 200 positive patients in
Buthidaung Township. All IPs and OPs are providing HIV education on prevention, care & support
and reducing stigma. AMI is providing VCT counseling to pregnant women in the screening centre.