Transcript Quality of care of Myanmar
Quality of care of Myanmar
Dr. Tint Wai Deputy Director Oral Health Department Ministry of Health Nay Pyi Taw , Myanmar
27 August, 2013
Country Myanmar Profile
Country profile
The Republic of the Union of Myanmar _ westernmost country in South-East Asia
Bounded by Bangladesh, India, China, Laos and Thailand on the landward side
1760 miles of the coast line _ bounded on the west by the Bay of Bengal and on the south by the Andaman Sea
covers an area of 676,578 square kilometers of Indo-China peninsular
Approx: the size of France and England combined
administrative divisions_ Nay Pyi Taw Union Territory + (14) States and Regions
(70) Districts, (330) Townships
(64134) Villages
Population 60.38 million in 2011-2012
Growth Rate 1.01 %
Population Density 89 per square kilometers
About 70%
Remaining rural areas urban dwellers
Estimates of population and it’s structure- by Population Dept: ministry of immigration and population 2013 Population Structure 2000- 01 2010- 11 2011- 12 Estimate % Estimate % Estimate % 0 – 14 years 15 – 59 years 16.43
29.72
60 years and above 3.98
Total 50.13
32.77
59.29
7.94
100 17.60
36.94
5.24
59.78
29.44
17.62
61.79
37.45
8.77
100 5.31
60.38
29.19
62.01
8.80
100
Health Expenditure
Total government health expenditure …..increased!!!
- from (7,688) Million Kyats in 2000-2001 -to (100, 825) Million kyats in 2011- 2012
Organization of Health Service Delivery Ministry of Health Department of Health Planning Department of Health Department of Medical Sciences Department of Medical Research (Lower) Department of Medical Research (Upper) Department of Medical Research (Central) Department of Traditional Medicine Department of Food and Drug Administration
Medical Care Department of Health Oral Health Department State /Region Health Department District Health Department Township Health Department
Oral Health System in Myanmar
Governmental service and Private Clinics
Most of private clinics urban area
so people in rural areal(70%) have lack of oral care
Now a day – outreach treatment, - projects, - school health team
Oral Health Men Power in Myanmar
Total Registered Dentist- 3372
Total Dentist under DOH - 512
Total Dentist in UDM(Mandalay) - 54
Total Dentist in UDM(Yangon) - 71
Total Dentist in other Ministries - 15
Number and distribution of dental professionals In Myanmar
Health facility
Central Unit Hospitals Urban Health Centre School Health Teams Prison dept: Railway Dept Workers’ Hospital YCDC UDNR MOGE Others Total
No. of dentists
4 420 39 49 3 3 3 1 1 1 3 527
Coverage
Total registered Dentists- 3372
Total Population- 60.38 million
Regd.dentist/ Pop Ratio= 1:17906
Public sector dentist/ Pop ratio =1:113851
Oral Health Status
Caries prevalence in 12 years old- 37%
Caries prevalence in (35-44)- 69%
Caries prevalence in (65-75)- 91%
90% of (64-74) years old – Periodontal Problem (+)
>95% of 12 years old _ calculus in oral cavity
Oral cancer occurrence _ 0.03% (8% of all cancer)
Oral Health Care in Myanmar
Routine oral health care delivery in fixed stations
School Health teams- examination, basic treatment, referral to appropriate centre, H.E
Outreach activities cooperate with MDC, MDA, MMCWA, NGO( charity organizations)
DOH collaborate with Colgate- Pulmolive (Thailand) company introduced “Bright Smiles Bright Future” program on grade 4 students
New approach to Oral Health Care System for Elderly; - oral health survey for elderly at selected townships since 2012
Primary Oral Health Care Project-
start from 1991 - task coordination, supervision & monitoring of POHC services in project tsp - support of equipments for care givers & effective fluoride toothpaste and toothbrush - distribution of IEC materials to promote self care
- advocacy meetings on promoting
efficacy, affordability ,user instructions and appropriate use of fluoride toothpaste -refresher training on POHC for BHS
POHC Project
POHC Project
Oral Cancer Survey 2012
Epidemiological and clinico pathological study of 120 cases of Oral Cancer in Myanmar in 2012 -together with Dept; of Medical Research(Lower Myanmar) and Dept; of Oral Medicine, UDM(ygn)
-
120 pts with o.c from UDM ;OMFS- YGH from January 2012 to September 2012 -Myanmar is a high risk country in betel quid chewing and smoking habits - results from this study _ 46- 65 age group are commonest (54.17%) -74.68% of pts chewed betel quid -60 % of pts are in late stage of oral cancer
Survey on Premalignant Lesions
Study Period 2010 (Jan-Dec) 2011 (Jan-Dec) 2012 (Jan-Dec) 2013 (Jan Jun) Total No. of Pts 9741 9465 7513 3856 OSMF 22(0.2%) 37(0.4%) 27(0.4%) 25(0.6%) OLP 7(0.1%) 14(0.2%) 14(0.2%) 5(0.1%) OLK 5(0.1%) 9(0.1%) 2(0.02%) OSCC 84(0.9%) 64(0.7%) 84(1.1%) 37(1%)
Oral cancer is fifth most common cancer in ASEAN
In ASEAN countries- o.c contributes up to 50% of all new cases of cancer
77.5 % of all o.c – squamous cell carcinoma
Increase in recent year in Myanmar
despite advances in Tx, 5 years survival rate has remained apprx: 50% for the last 50 years
should be encouraged- primary prevention, promotion of H.E programs related to oral cancer and early detection
Oral cancer Screening Project
Fluoride related Activities of DOH
Meeting on Fluoride Exposure for Oral Health in Myanmar- 2002
Distribution of compatibility of fluoride and abrasive system and user-instruction to local toothpaste manufacturers – 2006-07
World Oral Health Day , fluoride symposium 2008
Fluorosis Project
Outline of Fluorosis Project Activities
2000 - First Explorative Study on Dental Fluorosis (Wet- Let) (ORH- DOH)
2001-02- Pilot study in Wet-Let for planning in-depth study (ORH)
2003- Study on Dental Fluorosis among adolescents of Wet-Let
2005- F-Analysis for drinking Water of Wet-Let(ORH-DOH/WHOCC-Netherlands)
2006- Dental Fluorosis Postal Survey (0RH/WHOCC)
2012- Effect of drinking water in Myingyan & Shwebo Tsp(Dept; of PCD, UDM (Mdy))
2012- Pilot Visit for Dental Fluorosis Research(collaborated with occupational Health) (Wet- Let)
2012- Dental Fluorosis survey on Grade 10 students of BEHS (Wet-Let tsp)
2013- “Workshop on fluorosis case Finding in Wet-Let ” Multisectoral
Fluorosis Survey
Fluorosis Study in Myingyan & Shwebo(2012)
482 (12yrs & 35-44 yrs) subjects for Fluorosis
Fluoride content in drinking water from study area - Myingyan (well) -1.28 ppm -Htanaungdine (Myingyan) (well) -1.45 ppm -Kyaukpyoke (Myingyan) (well) - 2.5 ppm -Shwebo (well) - 1.8 ppm - Shwebo (lake ) - 0.85 ppm
Fluorosis Case Finding in Myingyan & Shwebo Location Fluorosis(+) Fluorosis(-) Total Shwebo Myingyan Total 49 182 231 157 94 251 206 276 482 Very Highly Significant Fluoride contents in drinking water Myingyan > Shwebo Fluorosis Finding Myingyan > Shwebo
Fluorosis Study in Wet-Let
Analysis of Fluoride Contents in all Drinking Water Sources at selected villages in Wet-Let
Tested on 1114 drinking water sources at 20 selected villages in Wet- Let Tsp No Type of Water source ≤ 1.5 mg/ l ≥ 1.5 mg/l 3 4 1 2 Dug well Shallow Tube Well Deep Tube Well Pond/Lake 141(43.79%) 530(74.96%) 13 (27.08%) 36(97.30%) 181(56.21%) 177(25.04%) 35 (72.92%) 1 (2.70%) Total 720(64.64%) 394(35.36%)
Distribution of tested drinking water sources according to their fluoride contents 4 5 6 No 1 2 3 Fluoride Level 0.00 – 0.50 mg/l 0.51 – 1.00 mg/l 1.01 – 1.50 mg/l 1.51 – 2.00 mg/l 2.01 – 2.50 mg/l 2.51 – 3.00 mg/l Total Number 106 252 362 356 28 10 1114 Percent 9.52
22.62
32.50
31.96
2.51
0.90
100
720 (64.64%) ≤ 1.5 mg/l
394 (35.36%) ≥ 1.5mg/l
survey on 9 th standard students of Wet-Let urban and rural schools (702 students)
Cross-sectional, descriptive study- oct 2012
assess the prevalence and severity of fluorosis
assess the prevalence and severity of dental caries
assess the perception of aesthetic impact of dental fluorosis (questionnaire)
find out the relationship between dental caries and dental fluorosis
Results
Prevalence of dental caries among sampled students, measured as DMFT(WHO criteria for dental caries) (N=702) Variable Prevalence of dental caries Category n without caries(DMFT=0) 459 % 65.4
with caries 243 34.6
Prevalence and severity of Dental Fluorosis conditions among sampled students, measured according to the highest TFI score in their dentition, (N=702) Variable Prevalence of dental fluorosis Category without fluorosis(TFI=0) n 65 with fluorosis 637 % 9.3
90.7
Severity of Dental Fluorosis conditions among sampled students, measured according to the highest TFI score in their dentition, (N=702) n % 1 2 3 4 5 6 7 8 9 Severity Fluorosis of dental 0 65 52 31 38 31 8 64 82 243 88 9.3
9.2
11.7
34.6
12.5
7.4
4.4
5.4
4.4
1.1
90% of sample students had dental fluorosis and nearly ¼ of which was severely affected
More than half of the students with TFI highest score >4 (55.6%) felt their teeth were somewhat defective
About 1/3 of sampled students with TFI >4 (35%) has to cover their mouth while smiling
98.9% of students wanted treatment to improve their colour of teeth
although most subjects wanted the treatment……!!!
-they had not taken any treatment because of…..
unavailability of non invasive cosmetic dental Tx
lack of knowledge for possibility of cosmetic correction
cost of treatment
now start to give cosmetic treatment for fluorosis cases at Wet-Let tsp (collaborate with UNICEF)
Fluorosis Case Findings