Dataset Information

Validation of G6PD Point-of-Care Tests among Healthy Volunteers in Yangon, Myanmar.

ABSTRACT: Primaquine and other 8-amnoquinoline based anti-malarials can cause haemolysis in subjects with glucose-6-phosphate dehydrogenase (G6PD) deficiency. Correct diagnosis of G6PD status in patients is crucial for safe treatment of both relapsing stages of Plasmodium vivax and transmitting forms of Plasmodium falciparum. Lack of suitable point-of-care tests has hampered a much needed wide use of primaquine for malaria elimination. In this study we have assessed the performances of two qualitative tests, the fluorescent spot test (FST) and the G6PD CareStart test (CST), against the gold standard quantitative spectrophotometric assay in a population of 1000 random adult healthy volunteers living in Yangon, Myanmar. The prevalence of G6PD deficiency in the Bamar, Karen and in the whole sample set was 6.6% (10.1% in males), 9.2% (21.0% in males) and 6.8% (11.1% in males) respectively. The FST and CST showed comparable performances with sensitivity over 95% and specificity over 90%, however for cases with severe G6PD activity the FTS had improved performance. If used with a conservative interpretation of the signal, the CareStart test has the potential to be used in the field and, by allowing a wider use of primaquine, to help malaria elimination.

SUBMITTER: Oo NN

PROVIDER: S-EPMC4818080 | biostudies-literature | 2016

REPOSITORIES: biostudies-literature

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Validation of G6PD Point-of-Care Tests among Healthy Volunteers in Yangon, Myanmar.

Oo Nwe Nwe NN Bancone Germana G Maw Lwin Zar LZ Chowwiwat Nongnud N Bansil Pooja P Domingo Gonzalo J GJ Htun Moh Moh MM Thant Kyaw Zin KZ Htut Ye Y Nosten Francois F

PloS one 20160401 4

Primaquine and other 8-amnoquinoline based anti-malarials can cause haemolysis in subjects with glucose-6-phosphate dehydrogenase (G6PD) deficiency. Correct diagnosis of G6PD status in patients is crucial for safe treatment of both relapsing stages of Plasmodium vivax and transmitting forms of Plasmodium falciparum. Lack of suitable point-of-care tests has hampered a much needed wide use of primaquine for malaria elimination. In this study we have assessed the performances of two qualitative tes ...[more]

PMID: 27035821

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Project description:Introduction: Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common enzymopathy in the human population affecting an estimated 8% of the world population, especially those living in areas of past and present malaria endemicity. Decreased G6PD enzymatic activity is associated with drug-induced hemolysis and increased risk of severe neonatal hyperbilirubinemia leading to brain damage. The G6PD gene is on the X chromosome therefore mutations cause enzymatic deficiency in hemizygote males and homozygote females while the majority of heterozygous females have an intermediate activity (between 30-80% of normal) with a large distribution into the range of deficiency and normality. Current G6PD qualitative tests are unable to diagnose G6PD intermediate activities which could hinder wide use of 8-aminoquinolines for Plasmodium vivax elimination. The aim of the study was to assess the diagnostic performances of the new Carestart G6PD quantitative biosensor.Methods: A total of 150 samples of venous blood with G6PD deficient, intermediate and normal phenotypes were collected among healthy volunteers living along the north-western Thailand-Myanmar border. Samples were analyzed by complete blood count, by gold standard spectrophotometric assay using Trinity kits and by the latest model of Carestart G6PD biosensor which analyzes both G6PD and hemoglobin.Results: Bland-Altman comparison of the CareStart normalized G6PD values to that of the gold standard assay showed a strong bias in values resulting in poor area under-the-curve values for both 30% and 80% thresholds. Performing a receiver operator curve identified threshold values for the CareStart product equivalent to the 30% and 80% gold standard values with good sensitivity and specificity values, 100% and 92% (for 30% G6PD activity) and 92% and 94% (for 80% activity) respectively.Conclusion: The Carestart G6PD biosensor represents a significant improvement for quantitative diagnosis of G6PD deficiency over previous versions. Further improvements and validation studies are required to assess its utility for informing radical cure decisions in malaria endemic settings.

Project description:Data on causes of community-onset bloodstream infection in Myanmar are scarce. We aimed to identify etiological agents of bloodstream infections and patterns of antimicrobial resistance among febrile adolescents and adults attending Yangon General Hospital (YGH), Yangon, Myanmar. We recruited patients ≥12 years old with fever ≥38°C who attended YGH from 5 October 2015 through 4 October 2016. A standardized clinical history and physical examination was performed. Provisional diagnoses and vital status at discharge was recorded. Blood was collected for culture, bloodstream isolates were identified, and antimicrobial susceptibility testing was performed. Using whole-genome sequencing, we identified antimicrobial resistance mechanisms of Enterobacteriaceae and sequence types of Enterobacteriaceae and Streptococcus agalactiae. Among 947 participants, 90 (9.5%) had bloodstream infections (BSI) of which 82 (91.1%) were of community-onset. Of 91 pathogens isolated from 90 positive blood cultures, we identified 43 (47.3%) Salmonella enterica including 33 (76.7%) serovar Typhi and 10 (23.3%) serovar Paratyphi A; 20 (22.0%) Escherichia coli; 7 (7.7%) Klebsiella pneumoniae; 6 (6.6%), Staphylococcus aureus; 4 (4.4%) yeasts; and 1 (1.1%) each of Burkholderia pseudomallei and Streptococcus agalactiae. Of 70 Enterobacteriaceae, 62 (88.6%) were fluoroquinolone-resistant. Among 27 E. coli and K. pneumoniae, 18 (66.6%) were extended-spectrum beta-lactamase (ESBL)-producers, and 1 (3.7%) each were AmpC beta-lactamase- and carbapenemase-producers. Fluoroquinolone resistance was associated predominantly with mutations in the quinolone resistance-determining region. blaCTX-M-15 expression was common among ESBL-producers. Methicillin-resistant S. aureus was not detected. Fluoroquinolone-resistant, but not multiple drug-resistant, typhoidal S. enterica was the leading cause of community-onset BSI at a tertiary hospital in Yangon, Myanmar. Fluoroquinolone and extended-spectrum cephalosporin resistance was common among other Enterobactericeae. Our findings inform empiric management of severe febrile illness in Yangon and indicate that measures to prevent and control enteric fever are warranted. We suggest ongoing monitoring and efforts to mitigate antimicrobial resistance among community-onset pathogens.

Project description:IntroductionHusbands can play a crucial role in pregnancy and childbirth, especially in patriarchal societies of developing countries. In Myanmar, despite the critical influence of husbands on the health of mothers and newborns, their roles in maternal health have not been well explored. Therefore, the aim of this study was to identify the factors associated with husbands' involvement in maternal health in Myanmar. This study also examined the associations between husbands' involvement and their spouses' utilization of maternal care services during antenatal, delivery and postnatal periods.MethodsA community-based, cross sectional study was conducted with 426 husbands in Thingangyun Township, Yangon, Myanmar. Participants were husbands aged 18 years or older who had at least one child within two years at the time of interview. Face to face interviews were conducted using a pretested structured questionnaire. Factors associated with the characteristics of husband's involvement as well as their spouses' utilization of maternal care services were analyzed by multivariable logistic regression models.ResultsOf 426 husbands, 64.8% accompanied their spouses for an antenatal visit more than once while 51.6% accompanied them for a postnatal visit. Husbands were major financial supporters for both antenatal (95.8%) and postnatal care (68.5%). Overall, 69.7% were involved in decision making about the place of delivery. Regarding birth preparedness, the majority of husbands prepared for skilled birth attendance (91.1%), delivery place (83.6%), and money saving (81.7%) before their spouses gave birth. In contrast, fewer planned for a potential blood donor (15.5%) and a safe delivery kit (21.1%). In the context of maternal health, predictors of husband's involvement were parity, educational level, type of marriage, decision making level in family, exposure to maternal health education and perception of risk during pregnancy and childbirth. Increased utilization of maternal health services was found among spouses of husbands who accompanied them to antenatal visits (AOR 5.82, 95% CI, 3.34-10.15) and those who had a well birth plan (AOR 2.42, 95% CI, 1.34-4.39 for antenatal visit and AOR 2.88, 95% CI, 1.52-5.47 for postnatal visit).ConclusionThe majority of husbands supported their spouses' maternal care services use financially; however, they were less involved in birth preparedness and postnatal care. Exposure to maternal health education and their maternal health knowledge were main predictors of their involvement. Women were more likely to use maternal care services when their husbands company them for ANC visits and had a well-birth plan in advance.

Project description:Under-nutrition is a public health problem in Myanmar. Despite current efforts, the exclusive breastfeeding rate (EBF) for children under six months is only 24%. Intention to breastfeed is a strong predictor for long-term breastfeeding, however, little is known about pregnant women's breastfeeding intentions in Myanmar. We, therefore, aimed to identify the factors associated with women's intention to EBF.Data in this article was collected in a baseline survey for a randomized controlled trial, which aimed to assess the impact of mobile text messages on the breastfeeding practices of women in Yangon, Myanmar. A total of 353 pregnant women at 28-34 weeks of gestation, recruited into the trial from the antenatal clinics of the Central Women's Hospital, Yangon, Myanmar, responded to the baseline survey questions, which included background information and breastfeeding related characteristics. To determine factors associated with women's intention to EBF logistic regression was used to analyse individual demographic, household economic and breastfeeding characteristics. In-depth interviews were performed with a sub-sample of 24 women who participated in the survey, to gain a further understanding of these associated factors.After adjusting for potential confounders, working women were less likely to intend to EBF (adjusted odds ratio (AOR) = 0.30, CI 0.17-0.53). Women from rich households (AOR = 2.43, CI 1.08-5.47) and middle income households (AOR = 1.79, CI 1.01-3.16); those who had high (AOR = 10.19, CI 3.43-30.23) and medium (AOR = 5.46, CI 1.79-16.72) breastfeeding knowledge levels, and received information from health professionals (AOR = 2.29, CI 1.29-4.03) and mobile internet (AOR 3.62, CI 2.04-6.41) had a higher intention to EBF. These findings were supported by qualitative analysis, which revealed that returning to work was the main barrier; health staff and printed media are reliable sources and; women with higher knowledge had high intentions to EBF.EBF intention was influenced by many factors. Breastfeeding promotion programs should target the poor, working women and women with lower breastfeeding knowledge. Breastfeeding education via health staff and the Internet, breastfeeding facilities at the work place and longer maternity leave in the private sector should all be encouraged.Australian New Zealand Clinical Trials Registry ACTRN12615000063516.

Dataset Information

Validation of G6PD Point-of-Care Tests among Healthy Volunteers in Yangon, Myanmar.

Publications

Validation of G6PD Point-of-Care Tests among Healthy Volunteers in Yangon, Myanmar.

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