Quality of care of Myanmar

Dr. Tint WaiDeputy Director

Oral Health DepartmentMinistry of Health

Nay Pyi Taw , Myanmar

27 August, 2013

Myanmar

Country Profile

Country profileThe Republic of the Union of Myanmar _

westernmost country in South-East AsiaBounded by Bangladesh, India, China,

Laos and Thailand on the landward side1760 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 peninsularApprox: 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% rural areas

Remaining 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 16.43 32.77 17.60 29.44 17.62 29.19

15 – 59 years 29.72 59.29 36.94 61.79 37.45 62.01

60 years and above 3.98 7.94 5.24 8.77 5.31 8.80

Total 50.13 100 59.78 100 60.38 100

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 DeliveryMinistry 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

Department of Health

Medical Care State /Region Health Department

Oral Health Department

District Health Department

Township Health Department

Oral Health System in MyanmarGovernmental service and Private ClinicsMost of private clinics urban areaso people in rural areal(70%) have lack of

oral careNow a day – outreach treatment, - projects, - school health team

Oral Health Men Power in MyanmarTotal Registered Dentist- 3372Total Dentist under DOH - 512Total Dentist in UDM(Mandalay) - 54Total Dentist in UDM(Yangon) - 71Total Dentist in other Ministries - 15

Number and distribution of dental professionals In Myanmar

Health facility No. of dentists

Central Unit 4Hospitals 420Urban Health Centre 39School Health Teams 49Prison dept: 3Railway Dept 3Workers’ Hospital 3YCDC 1UDNR 1MOGE 1Others 3Total 527

CoverageTotal registered Dentists- 3372Total Population- 60.38 millionRegd.dentist/ Pop Ratio= 1:17906Public sector dentist/ Pop ratio =1:113851

Oral Health StatusCaries 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 cavityOral cancer occurrence _ 0.03% (8% of all

cancer)

Oral Health Care in MyanmarRoutine oral health care delivery in fixed

stationsSchool Health teams- examination, basic

treatment, referral to appropriate centre, H.EOutreach 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

“Bright Smiles Bright Future”

program

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 2012Epidemiological 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

Total No. of Pts

OSMF OLP OLK OSCC

2010(Jan-Dec)

9741 22(0.2%) 7(0.1%) 5(0.1%) 84(0.9%)

2011(Jan-Dec)

9465 37(0.4%) 14(0.2%) 9(0.1%) 64(0.7%)

2012(Jan-Dec)

7513 27(0.4%) 14(0.2%) 2(0.02%) 84(1.1%)

2013 (Jan-Jun)

3856 25(0.6%) 5(0.1%) - 37(1%)

Oral cancer is fifth most common cancer in

ASEANIn ASEAN countries- o.c contributes up to 50% of

all new cases of cancer77.5 % of all o.c – squamous cell carcinomaIncrease in recent year in Myanmardespite advances in Tx, 5 years survival rate has

remained apprx: 50% for the last 50 yearsshould be encouraged- primary prevention,

promotion of H.E programs related to oral cancer and early detection

Oral cancer Screening

Project

Fluoride related Activities of DOHMeeting on Fluoride Exposure for Oral

Health in Myanmar- 2002Distribution 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

Fluoride contents in drinking water Myingyan > ShweboFluorosis Finding Myingyan > Shwebo

Location Fluorosis(+) Fluorosis(-) Total

Shwebo 49 157 206

Myingyan 182 94 276

Total 231 251 482

Very Highly Significant

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 TspNo Type of Water source ≤ 1.5 mg/ l ≥ 1.5 mg/l

1234

Dug wellShallow Tube WellDeep Tube WellPond/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

720 (64.64%) ≤ 1.5 mg/l394 (35.36%) ≥ 1.5mg/l

No Fluoride Level Number Percent

1 0.00 – 0.50 mg/l 106 9.52

2 0.51 – 1.00 mg/l 252 22.62

3 1.01 – 1.50 mg/l 362 32.50

4 1.51 – 2.00 mg/l 356 31.96

5 2.01 – 2.50 mg/l 28 2.51

6 2.51 – 3.00 mg/l 10 0.90Total 1114 100

survey on 9 th standard students of Wet-Let urban and rural schools (702 students)

Cross-sectional, descriptive study- oct 2012assess the prevalence and severity of fluorosisassess the prevalence and severity of dental

cariesassess the perception of aesthetic impact of

dental fluorosis (questionnaire)find out the relationship between dental caries

and dental fluorosis

ResultsPrevalence of dental caries among sampled

students, measured as DMFT(WHO criteria for dental caries) (N=702)

Variable Category n %Prevalence of dental caries

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 Category n %

Prevalence of dental fluorosis

without fluorosis(TFI=0)

65 9.3

with fluorosis 637 90.7

Severity of Dental Fluorosis conditions among sampled

students, measured according to the highest TFI score in their dentition, (N=702)

Severity of dental Fluorosis

n %

0 65 9.3

1 64 9.2

2 82 11.7

3 243 34.6

4 88 12.5

5 52 7.4

6 31 4.4

7 38 5.4

8 31 4.4

9 8 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

correctioncost of treatment now start to give cosmetic treatment for fluorosis

cases at Wet-Let tsp (collaborate with UNICEF)

Fluorosis Case Findings

Thanks