Quality of care of Myanmar

1. Quality of care of Myanmar Dr. Tint Wai Deputy Director Oral Health Department Ministry of Health Nay Pyi Taw , Myanmar 27 August, 2013

2. Myanmar Country Profile

3. 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

4. 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

5. Population 60.38 million in 2011-2012 • Growth Rate 1.01 % • Population Density 89 per square kilometers • About 70% rural areas • Remaining urban dwellers

6. Estimates of population and it’s structure- by Population Dept: ministry of immigration and population 2013

7. Health Expenditure • Total government health expenditure- …..increased!!! - from (7,688) Million Kyats in 2000-2001 -to (100, 825) Million kyats in 2011- 2012

8. Organization of Health Service Delivery

10. 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

11. 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

12. Number and distribution of dental professionals In Myanmar

13. Coverage • Total registered Dentists- 3372 • Total Population- 60.38 million • Regd.dentist/ Pop Ratio= 1:17906 • Public sector dentist/ Pop ratio =1:113851

14. 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)

15. 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) • DOHcollaborate with Colgate- Pulmolive (Thailand) company introduced “Bright Smiles Bright Future” program on grade 4 students

16. “Bright Smiles Bright Future” program

18. New approach to Oral Health Care System for Elderly; - oral health survey for elderly at selected townships since 2012

19. 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

20. - advocacy meetings on promoting efficacy, affordability ,user instructions and appropriate use of fluoride toothpaste -refresher training on POHC for BHS

21. POHC Project

22. POHC Project

23. 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)

24. - 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

25. Survey on Premalignant Lesions

26. 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

27. Oral cancer ScreeningProject

29. 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

30. 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)

31. 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

32. Fluorosis Survey

33. 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

34. Fluorosis Case Finding in Myingyan & Shwebo Fluoride contents in drinking water Myingyan > Shwebo Fluorosis Finding Myingyan > Shwebo

35. 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

36. Distribution of tested drinking water sources according to their fluoride contents • 720 (64.64%) ≤ 1.5 mg/l • 394 (35.36%) ≥ 1.5mg/l

37. survey on 9thstandard 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

38. Results • Prevalence of dental caries among sampled students, measured as DMFT(WHO criteria for dental caries) (N=702)

39. Prevalence and severity of Dental Fluorosis conditions among sampled students, measured according to the highest TFI score in their dentition, (N=702)

40. Severity of Dental Fluorosis conditions among sampled students, measured according to the highest TFI score in their dentition, (N=702)

41. 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

42. 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)

43. Fluorosis Case Findings

44. Thanks