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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is a major health concern globally. Genomic epidemiology is an important tool to assess the pandemic of coronavirus disease 2019 (COVID-19). Several mutations have been reported by genome analysis of the SARS-CoV-2. In the present study, we investigated the mutational and phylogenetic analysis of 30 whole-genome sequences for the virus's genomic characteristics in the specimens collected in the early phase of the pandemic (March–June, 2020) and the sudden surge of local transmission (August–September, 2020). The four samples in the early phase of infection were B.6 lineage and located within a clade of the samples collected at the same time in Singapore and Malaysia, while five returnees by rescue flights showed the lineage B. 1.36.1 (three from India), B.1.1 (one from India) and B.1.80 (one from China). However, there was no evidence of local spread from these returnees. Further, all 19 whole-genome sequences collected in the sudden surge of local transmission showed lineage B.1.36. The surge of the second wave on SARS-CoV-2 infection was linked to the single-introduction of a variant (B.1.36) that may result from the strict restriction of international travel and containment efforts. These genomic data provides the useful information to disease control and prevention strategy.

The Greater Mekong subregion is a recurrent source of antimalarial drug resistance in Plasmodium falciparum malaria. This study aimed to characterise the extent and spread of resistance across this entire region between 2007 and 2018. P falciparum isolates from Myanmar, Thailand, Laos, and Cambodia were obtained from clinical trials and epidemiological studies done between Jan 1, 2007, and Dec 31, 2018, and were genotyped for molecular markers (pfkelch, pfcrt, pfplasmepsin2, and pfmdr1) of antimalarial drug resistance. Genetic relatedness was assessed using microsatellite and single nucleotide polymorphism typing of flanking sequences around target genes. 10 632 isolates were genotyped. A single long pfkelch Cys580Tyr haplotype (from −50 kb to +31·5 kb) conferring artemisinin resistance (PfPailin) now dominates across the eastern Greater Mekong subregion. Piperaquine resistance associated with pfplasmepsin2 gene amplification and mutations in pfcrt downstream of the Lys76Thr chloroquine resistance locus has also developed. On the Thailand–Myanmar border a different pfkelch Cys580Tyr lineage rose to high frequencies before it was eliminated. Elsewhere in Myanmar the Cys580Tyr allele remains widespread at low allele frequencies. Meanwhile a single artemisinin-resistant pfkelch Phe446Ile haplotype has spread across Myanmar. Despite intense use of dihydroartemisinin–piperaquine in Kayin state, eastern Myanmar, both in treatment and mass drug administrations, no selection of piperaquine resistance markers was observed. pfmdr1 amplification, a marker of resistance to mefloquine, remains at low prevalence across the entire region. Artemisinin resistance in P falciparum is now prevalent across the Greater Mekong subregion. In the eastern Greater Mekong subregion a multidrug resistant P falciparum lineage (PfPailin) dominates. In Myanmar a long pfkelch Phe446Ile haplotype has spread widely but, by contrast with the eastern Greater Mekong subregion, there is no indication of artemisinin combination therapy (ACT) partner drug resistance from genotyping known markers, and no evidence of spread of ACT resistant P falciparum from the east to the west. There is still a window of opportunity to prevent global spread of ACT resistance. Thailand Science Research and Innovation, Initiative 5%, Expertise France, Wellcome Trust.

Although the help-seeking behaviors of intimate partner violence survivors have been imperative, less evidence has been shown on ethnic women’s help-seeking behaviors. As such, this study aims to explore women survivors’ help-seeking behaviors in Kachin State, an ethnic area of Myanmar with an online in-depth interview approach. Twelve women survivors who were recruited by social workers, camp leaders, and volunteers participated in the study. Findings were analyzed by using the intimate partner violence help-seeking theory. In contrast to the extant literature, this study found an equal number of women survivors reached out to both formal and informal sources. Their help-seeking behaviors were influenced by their violence perception, cultural norms, lack of information on support services availability, the violence severity, and social support. Exposure to parental violence and women’s unique personal attributes had a negative impact on their decision to seek formal help. Results underscored the importance of sociocultural norms in an ethnic patriarchal society. As such, addressing deep-rooted patriarchal sociocultural norms, effective awareness raising, women’s empowerment, establishment of anti-domestic violence law, and multi-sectoral collaboration with men’s engagement and inclusion of cultural and religious leaders are urgently needed in ethnic communities to enhance formal help-seeking.

This study explores the prevalence of physical, sexual and emotional intimate partner violence in Myanmar, attitudes towards violence, and the association between wealth and intimate partner violence. We analysed a nationally representative sample of 3425 married women aged 15–49 years from Myanmar Demographic and Health survey 2015–2016. In this cross-sectional study, data was collected by in-person interviews using a standardized questionnaire. Wealth was operationalized into five groups depending on how much the household owns. Intimate partner violence was measured based on the standard methods of Demographic and Health Survey. The overall prevalence of intimate partner violence (physical, sexual and emotional) was 20.6% (95% confidence interval (95% CI) 18.9–22.3). Less severe physical intimate partner violence was reported by 14.8% (95% CI 13.5–16.3), while 4.4% (95% CI 3.8–5.2) reported severe physical violence. The prevalence of sexual and emotional violence were 2.8% (95% CI 2.2–3.6) and 13.1% (95% CI 11.7–14.6), respectively. Many women believed that a husband has the right to beat his wife if she acts inappropriate, with the highest prevalence at 43% of the women justifying beating if the wife neglects her children. In logistic regression analysis, low wealth as compared with higher wealth, was associated with a higher prevalence of intimate partner violence. The results reveals that intimate partner violence against ever-married women in Myanmar is present, that many women justify beating, and that wealth and intimate partner violence is associated.

The model single-stranded DNA binding protein of bacteriophage T4, gene 32 protein (gp32) has well-established roles in DNA replication, recombination, and repair. gp32 is a single-chain polypeptide consisting of three domains. Based on thermodynamics and kinetics measurements, we have proposed that gp32 can undergo a conformational change where the acidic C-terminal domain binds internally to or near the single-stranded (ss) DNA binding surface in the core (central) domain, blocking ssDNA interaction. To test this model, we have employed a variety of experimental approaches and gp32 variants to characterize this conformational change. Utilizing stopped-flow methods, the association kinetics of wild type and truncated forms of gp32 with ssDNA were measured. When the C-domain is present, the log-log plot of k vs. [NaCl] shows a positive slope, whereas when it is absent (*I protein), there is little rate change with salt concentration, as expected for this model.A gp32 variant lacking residues 292-296 within the C-domain, ΔPR201, displays kinetic properties intermediate between gp32 and *I. The single molecule force-induced DNA helix-destabilizing activitiesas well as the single- and double-stranded DNA affinities of ΔPR201 and gp32 truncated at residue 295 also fall between full-length protein and *I. Finally, chemical cross-linking of recombinant C-domain and gp32 lacking both N- and C-terminal domains is inhibited by increasing concentrations of a short single-stranded oligonucleotide, and the salt dependence of cross-linking mirrors that expected for the model. Taken together, these results provide the first evidence in support of this model that have been obtained through structural probes.

Emergence of artemisinin resistance in southeast Asia poses a serious threat to the global control of Plasmodium falciparum malaria. Discovery of the K13 marker has transformed approaches to the monitoring of artemisinin resistance, allowing introduction of molecular surveillance in remote areas through analysis of DNA. We aimed to assess the spread of artemisinin-resistant P falciparum in Myanmar by determining the relative prevalence of P falciparum parasites carrying K13-propeller mutations. We did this cross-sectional survey at malaria treatment centres at 55 sites in ten administrative regions in Myanmar, and in relevant border regions in Thailand and Bangladesh, between January, 2013, and September, 2014. K13 sequences from P falciparum infections were obtained mainly by passive case detection. We entered data into two geostatistical models to produce predictive maps of the estimated prevalence of mutations of the K13 propeller region across Myanmar. Overall, 371 (39%) of 940 samples carried a K13-propeller mutation. We recorded 26 different mutations, including nine mutations not described previously in southeast Asia. In seven (70%) of the ten administrative regions of Myanmar, the combined K13-mutation prevalence was more than 20%. Geospatial mapping showed that the overall prevalence of K13 mutations exceeded 10% in much of the east and north of the country. In Homalin, Sagaing Region, 25 km from the Indian border, 21 (47%) of 45 parasite samples carried K13-propeller mutations. Artemisinin resistance extends across much of Myanmar. We recorded P falciparum parasites carrying K13-propeller mutations at high prevalence next to the northwestern border with India. Appropriate therapeutic regimens should be tested urgently and implemented comprehensively if spread of artemisinin resistance to other regions is to be avoided. Wellcome Trust–Mahidol University–Oxford Tropical Medicine Research Programme and the Bill & Melinda Gates Foundation.

Serologic and molecular surveillance of serum collected from 152 suspected scrub typhus patients in Myanmar revealed Orientia tsutsugamushi of genotypic heterogeneity. In addition, potential co-infection with severe fever with thrombocytopenia syndrome virus was observed in 5 (3.3%) patients. Both scrub typhus and severe fever with thrombocytopenia syndrome are endemic in Myanmar.

In 2022, Myanmar reported the second-highest number of aid workers killed globally.15 In addition, the MMC introduced new registration requirements and procedures for NGOs that affected their zones of operation and the delivery of life-saving humanitarian assistance (mainly affecting the national and international NGOs who are main contributors to the humanitarian aid programme).14 Even before the coup Myanmar was already facing several challenges in the health sector. The parliamentary government in Myanmar that came to power in 2011 increased spending on health, but it was still only 3·7% of the total government budget in 2016.16 Out-of-pocket spending accounted for 75% of all health spending in 2016.16 The economic recession in 2022, which saw inflation reach 18%, affected health care as people continue to have less disposable income for medical expenses. [...]the prevalence of depression and anxiety has increased from 18% before the coup19 to 61% in 2021.20 The deterioration of health services and the high prevalence of mental distress are most likely attributed to the polycrisis of war and conflict, forced migration, the COVID-19 pandemic, and a weakened health-care system post-coup.21 Those affected directly by the coup's trauma, or indirectly by displacement or loss of protective factors (eg, family, financial protection, and socioeconomic factors) are at risk of developing post-traumatic stress disorder (PTSD), anxiety, depression, and other psychiatric disorders.22 Community mental health programmes, reaching displaced people in the border area and hard-to-reach areas, should be given priority. For children and adolescents, focused psychosocial interventions can help reduce symptoms of depression, anxiety, and PTSD and enhance hope, coping, and social support.23 For adults, WHO has developed the Self-Help Plus intervention to manage psychological distress and mental health problems in vulnerable populations, shown to have effects on symptoms up to 3 months after delivery.24 To help resolve the conflict and put the democratisation process back on track, we suggest using health as a bridge for peace through strengthening of health services and humanitarian aid delivery reaching displaced people in the border areas and hard-to-reach areas inside Myanmar.

BackgroundA healthy wetland provides a range of goods and services contributing to human wellbeing. Inle Lake, the first Biosphere Reserve in Myanmar, has been supporting the local inhabitants with ecosystem services (ES) including habitat for a wide range of biodiversity. In the recent years, influenced by land use land cover change (LULCC), the lake has witnessed changes with altered flow of ES, affecting human well-being. Communities’ perceptions are often undermined, when it comes to research LULCC. We analyzed LULCC change data from 1989–2000 to 2000–2014 using Landsat imageries. This was then linked to ES considering dependency through qualitative data collated from participatory rural appraisal tools and structured questionnaires focusing on people’s perception to understand the LULCC dynamics and its implication.ResultsDuring 25 years (1989–2014), there has been a sharp reduction of 164 km2 perennial wetland area in the Inle Lake, which is 4.2-fold higher in 2014 to that of 1989. Similarly, forest area has been declined by 92 km2 (8.56%) in last 25 years. Contrary to this, cropland area showed an increment of 60.67% in 2000 and 64.53% in the year 2014 alone giving a total increase by 268 km2 over the last 25 years and an expansion of 40 km2 seasonal freshwater area were observed showing periodic increment over the time. Communities from the three study areas, namely, Kyaung Taung, Zay Gon and Kyar Taw are found to have high dependence in their surrounding ecosystems. These villages utilizes 17 ES from forest ecosystem, 13 from agro-ecosystem, 10 from seasonal and 4 from perennial water body for their livelihood respectively. Around 93% of the respondents opined that forest ecosystem has decreased over the last 10 years. Around 40% of the respondents reflected an increase in area used for cropland; 43% conversely perceived a declination. About 63% of the respondents perceived such changes have brought huge reduction in availability of freshwater ES. A significant number of respondents (92%) perceived an enormous reduction in seasonal water body during the dry season.ConclusionObserved decreasing trends in forest and perennial wetland areas were consistent with people’s perceived changes. Communities associate loss of forest and wetland area with reduced availability of ES as well as degraded health of the lake.

Background Poor mental health is an important contributor to the global burden of disease. Mental health problems are often neglected in communities, and are scarcely studied in developing countries, including Myanmar. This study estimates the prevalence of mental distress by socio-demographic and health related factors, and the association between education and mental distress. As far as the authors are aware, this is the first population-based study in Myanmar estimating the prevalence of mental distress. Methods Between October and November 2016, a cross sectional study was conducted using a multi-stage sampling design with face-to-face interviews using the Hopkins Symptom Checklist (HSCL-10) for mental distress (symptoms of depression and anxiety). The multivariable analysis strategy was based on Directed Acyclic Graphs (DAGs), to identify confounders, mediators and colliders. Pearson’s chi-square was used for testing differences between proportions and multiple linear regression analysis was applied to explore the association between education (years at school) and mental distress (HSCL score). Results A random sample of 2391 (99.6% response) men and women aged 18–49 years participated in the study. The prevalence of mental distress was 18.0% (95% confidence interval (CI): 14.7–21.9), being higher among women (21.2%; 95% (CI): 16.6–26.6) than men (14.9%; 95% (CI): 11.4–19.2). Older-age, being separated or divorced and having a higher number of children were associated with increased mental distress. In linear regression analyses, adjusted for confounders (age, marital status and income), there was a significant negative association between years at school and mental distress among women and older men (> 30 years), but not among the youngest men. Conclusions The prevalence of mental distress is high, and there is an association between HSCL-10 score and education. Due to the scarcity of mental health services in Myanmar, the findings indicate a need for a mental health policy to handle the burden of mental health problems in Yangon, a burden which is probably high within the country.