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SUMMARY
This Public Health Statistics was generated from monthly report, quarterly and annual reports of Health Management Information System. It is the combined effort of health staff giving service delivery at community, supervisor and health managers at various levels and central/regions/state statisticians. The data was processed by using DHIS2 software in 2016 together with excel programme in previous years. The quality of data was assessed by using WHO Data Quality Assessment tool, http://www.who.int/healthinfo/tools_data_analysis/en/.
The domain 1 of data quality assessment focused on completeness of reporting; the completeness rate was 97%. Domain 2, internal consistency of reported data showed no extreme outliers and moderate outlier with >5% was seen in deliveries data. Assessing consistency over time, there is no region/state outside the 33% relative difference from national ratio; it s the Ratio of total events in the current year to the mean number of events for past 3 years. Consistency check between Penta1 immunization& ANC1, and between Penta1 & Penta3 showed all the regions/sates are situated near national ratio line and within +/‐ 33% difference. Domain 3 external consistency with population data revealed that reported live births to UN live birth projection is 1.12, and official estimation of denominator for ANC coverage and immunization coverage is not too high as well as not too low compared with most recent survey. Domain 4 external comparison of coverage rate with most recent survey showed 6 regions/states had more than +/‐33% difference between the two coverage rates in delivery, 7 regions/states in Penta3 coverage, no difference was found in antenatal care.
Regarding to SDGs, the 10 indicators representatives for health care services was available from routine HMIS as baseline for monitoring SDGs. Skilled birth attendants (%) was 78.4% and it was ranged from 51% to 91% among regions/states; compared with the other source, world health statistics 2016 showed 78%. It is noted that the data available for disease incidence from HMIS is representative only for the new cases found by basic health staff, it might be lower than exact situation. Hepatitis‐B vaccine was already combined into Pentavalent vaccine; the Penta coverage(3rd dose) was 87.3%. Suicide mortality rate per 100,000 population was increasing; 1 death per 100,000 population in 2010 and triple in 2016, 3 deaths per 100,000 population. Mortality rate of unintentional poisoning was increased 1.5 times last five years,
0.76 per 100000 population in 2016. Road traffic mortality rate (per 100 000 population) was 9.2. Adolescent birth rate was 17.9 per 1000 women aged 15–19 years, contrast with 2015‐16 MDHS, it was 36. Proportion of population using improved drinking water sources was 81.3% which was similar to MDHS 2015‐16, it showed 80.4%. The proportion of population using improved sanitation was 62.1%; the calculation was based on 2014 census household size.
The composite index was applied for assessing maternal and child health up to township level; Tanintharyi and Bago showed low discrepancy among their townships while highest in Shan (N) and Ayeyarwady in maternal health services. The unequal distribution was seen among townships by each regions/states in child health. The 21 townships had less than 0.7 of child health index and needed more attention.
The Skill birth attendants(%) in rural area across the country was assessed. The (1402) out of (1825) rural health facility reporting in 2016 showed that lowest SBA% was 3% ranged to highest 100%. The assessing of services by Health Facility supports the township health planning better; and need to explore resource allocation and need to fulfill enabling working environment.
Regarding to utilization of public health services, the 23 million patients utilized public health facilities and coming to clinics over the country. The basic health staff delivered health care services during field visits to wards/villages; nearly 11 million patients seek care from basic health staff. Public health services were utilized highest in Kayah and lowest in Yangon where a private health service is increasing.
The maternal health, maternal nutrition, newborn health and reproductive heath services showed antenatal care coverage (86.1%), Delivery by SBA(78.4%), Postnatal Care(91%),
TT 2nd dose immunization(81.2%), Deworming (74.3%), Iron supplementation 4 times and above(63.5%) and B1 supplementation during pregnancy(59.7%). B1 supplementation is given up to postnatal and breastfeeding period; B1 supplementation in PN period(73.6%), B1 in breastfeeding mother(74.5%) was achieved. The births occurred at public health facilities (41%), at private facility(10%), home delivery by BHS (27%), home deliveries by AMW(8%), by TTBA(6%) and other(8%) in 2016. The newborn care within three days of birth(84.2%), newborn receiving breastfeeding within one hour of birth (83.3%) was found in 2016 under essential newborn care services. Birth spacing helped reducing closed birth interval, the women become pregnant within 24 months after last delivery, and promotes both maternal and newborn health; the higher contraceptive prevalence rate the lower the closed birth interval was seen among regions/states. Injection method is prefer modern contraceptive method (58%) among clients, followed by pills(31%).
Diarrhoea, ARI and fever was common in children; nearly all under five children with diarrhea who had met with health staff received oral rehydration therapy(ORT) (98.9%), similarly, antibiotics treatment for under 5 pneumonia was 96.7%. The immunization coverage in infant showed BCG(92%), Polio3(87%), Penta3(87%), PCV3(13%) and MR(9 months)(88%).
Less than 80% coverage was seen in 56 townships, Two‐fifth of townships were between 80 to 90% coverage in Penta3 immunization.
Non‐communicable diseases occurrence was increasingly nowadays; the detection of high blood pressure, new hypertension cases in out‐patients attending to BHS was 3.8%.
Hypertension cases detected by BHS among 15+ population was calculated as proxy prevalence, thirteen hypertension cases per 1000 population of aged 15+ was found. The current smoker, taking any types of smoking within 1 month, was 175 people in 1000 population of aged 15+.
The injuries become increasingly high; road traffic accident is a big magnitude compare with poisoning, drowning and suicide problems, where the case fatality rate is high. Among 11282 reported deaths due to injury, two‐fifth was due to RTA and near one‐fourth was due to drowning, 12.5% was due to suicide. Early detection and treatment of congenital deafness prevents the deaf and dumb life of children, the basic health staff reported 0.17 per 1000 Live births. Mental health problem per 100,000 population in 2016 revealed that 9 person reported with psychosis, 6 person had depression, 7 person showed anxiety and mental retardation, 5 stayed with epilepsy, 120 depend on alcohol.
Malaria was detected using RDT by basic health staff, 7.5 Lakh people received malaria checkup by BHS and 4.2 % was found as positive patients and it ranged across the country, Chin (12.3%) to Yangon(<0.1%) in 2016. Sixty percent of malaria case was in 15‐44 years age group and male was more affected. In both Cases and Death due to TB, the proportion of sputum smear negative TB patients is largest portion; 49% in cases and 45% in death, followed by sputum smear positive tuberculosis patients, it showed about one‐third. Male was about 2 times common than female. Leprosy prevalence rate was 0.3 per 10,000 Population, the under 15 year patients was 5.1% among new patients in 2016, 31.3% of new patients were female patients. The basic health staff reported one hundred and sixteen thousand primigravida mothers received VDRL testing during pregnancy period; the positive rate was 0.33%.
Opthalmia neonatorum cases were reported by 19 townships; 90 newborns suffered and it represented as about 1 case per 10,000 newborns in Myanmar. The fifty six thousand cases of dog bite occurred in 2016, among those, 1.3% were rabid dog bite. The 64% of dog bite cases had taken anti‐rabies vaccines.
Access to sanitary latrine and clean water by students in school was needed for school health; 96.2% of schools were examined by basic health staff and school health team in 2016, 88% of schools had fly proof latrines with the standard ratio of 50 students to 1 latrine, 86.5 % of schools had clean water source. The primary school children received medical examination in school, 93.8% of primary school children received in 2016. The Sanitary latrine coverage for the whole population was 62.1% and proportion of population using improved drinking water sources was 81.3%.
Average 55 times per month per township for advocacy meeting, average 1 time for exhibition and contest, average 80 times for public talks and 18 times for distribution of IEC materials per month per township was conducted in 2016, it was the performance of all basic health staff in the township.
The data available from routine HMIS data system pointed out the public health services delivered over the country. To preserve valid timely complete data from health staff through DHIS2 software, the exploration of difficulties and challenges of basic health staff regarding to data reporting is needed; and continuing to support enabling working environment.