Myanmar - Interview with Minister of Health Dr Myint Htwe

Dr Myint Htwe, minister for health, presides over a ceremony in Nay Pyi Taw on August 10. Photo: Pyae Thet Phyo / The Myanmar Times

The World Health Organization (WHO) held its annual Southeast Asia regional conference in Colombo, Sri Lanka, from September 5 to 9. On the sidelines of the conference, The Myanmar Times’ Aung Shin spoke with Dr Myint Htwe, Union Minister for Health and Sport. The interview has been edited for clarity and length.

What have you mainly discussed at the conference?

The WHO holds these conferences annually to review what every country in the region has accomplished within the last year. Every country presents their health sector needs, and the regional health ministers discuss the WHO projects in their country and whether they are performing well or not. This year, our discussions have focused on non-communicable diseases and also universal healthcare.

What are the main health issues in Myanmar?

We are now starting in Myanmar to update our health information system. It is a very important step. In every country, conditions of disease outbreak and control depend on having precise statistics. Some countries make announcements about disease eradication and outbreak control with imprecise data. But every country needs to make sure their health information systems are strong. We call it “systematisation”. Without that, planning or projections can go wrong.

Is this your priority under the new government in Myanmar?

Yes, we have been starting on that. We have a lot to do for the systematisation of the health sector. The working procedures of the health sector, in all the ministry’s offices, need to be standardised. We also must standarise codes of ethics for all personnel in the health sector, such ethics for doctors, ethics for nurses and ethics for medical science. We are working on these issues.

The private health sector is growing fast in Myanmar, with most people relying on private hospitals and clinics. How will the Ministry of Health regulate the private health sector?

This is why we have the Myanmar Medical Council, which I chair. We have to cooperate with the private health sector and also monitor what they are doing to see whether their medical treatment is qualified or not, whether they are asking fair charges for treatment or not. We cannot let them operate without oversight. At the same time, we [the public health sector] have to monitor our health services too to ensure quality services.

Many people complain about the poor standards of medicine, with a lot of fake medicine distributed locally. How will the Ministry of Health control this private medicine market?

This falls under the responsibilities of the Myanmar Medical Council. People can complain to the ministry or file a medical case. The council will examine whether the case is true or not, and whether it is a mistake or misunderstanding. The medical council must monitor the whole medical service sector … So far not many issues or case have been received, only a few.

You presented something about the health budget at this WHO regional conference. What was it?

WHO has a lot of health projects in each country. They must review which projects are the more important. It shouldn’t happen that a large share of the budget goes to less important project. So the WHO has to review their budgeting system to ensure the most important projects get the most funding.

Another hot issue at this conference is the Zika virus. The WHO has confirmed Zika cases in Thailand, Singapore and Indonesia. What has Myanmar done to prepare for that disease?

We have standard procedure guidelines for all disease outbreaks. We have alerted all responsible departments and personnel. We are not careless about Zika or any disease outbreak. It is not an easy job if we have some infections of that disease.

There are some countries announcing they have officially eradicated some diseases, meeting the UN’s Millennium Development Goals. We have never heard of this happening in Myanmar. What MDGs has Myanmar achieved?

You should ask other the countries if these announcements are technically true or for a certification of their having met MDGs or eradicating particular diseases. Actually, no one has achieved the MDGs. It is impossible so far. The systematisation of the health sector is still poor.

Aung Shin

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Myanmar - Seven suspected of anthrax infection in central Myanmar

NAY PYI TAW - Seven people are infected with a disease thought to be anthrax in a village in Chaung U Township, Sagaing Region in central Myanmar, according to health officials.

Dr San Nu Htike from a public hospital said several cows died of the disease on September 4, and seven people who handled the deceased cows are believed to be infected with the disease.

"One seriously infected patient was transferred to Monywa General Hospital. No casualties have been reported. Some of those suffering from the disease are under intensive care in village. The disease is suspected to be anthrax. It has yet to be identified," said the doctor.

"Only those who handled the deceased cows got sick. Not everyone who ate the meat got sick," said Aung Yin, one of the people infected by the disease.

"The infected cows were not vaccinated," said the village administrator.

In another similar incident, eight people from two villages in Monywa District were infected with anthrax after eating the meat of a deceased cow on August 27. They were hospitalised at Monywa General Hospital, and one of them, named Aung Su, died later.

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Myanmar - Myawady authorities try to stop Zika at the border

Fumigation is carried out at the Myawady Friendship Bridge

The Myawady Friendship Bridge, which is used by hundreds of tourists, Thai visitors and Myanmar migrant workers each day, is being fumigated daily in an effort to curb the spread of the Zika virus.

Preventive efforts against the Zika virus are being carried out by the local department of public health and the municipality.

“The main target is mosquitoes. Attempts to shrink their numbers have been regularly carried out in Myawady before, especially amid dengue outbreaks. It’s important that people don’t get bitten by mosquitoes carrying the Zika virus. 

If pregnant woman are bitten, the child will contract the disease. Tthe disease may make men infertile,” said Dr Thandar Soe from Myawady’s public health department.

Regular check-ups are also carried out for patients that visit the Myawady Hospital. Talks and events aimed at educating the public on the importance of eliminating mosquitoes are also held regularly.

As per the directive from the World Health Organisation and Myanmar’s Ministry of Health and Sports, all signs and symptoms of the Zika virus are being monitored at various borders and ports, such as the Yangon International Airport.

The Aedes agypti mosquito thrives in tropical and sub-tropical environments around the world. In Myanmar, the Aedes genus is famous for being the main cause of dengue and yellow fevers.

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Myanmar - Govt plans national guidelines to combat ‘forgotten’ leprosy

Leprosy, the “forgotten disease”, is still raging in Myanmar, with about 3000 patients suffering from it. Despite measures taken toward elimination, the incidence has been unchanged for more than a decade, experts say.

According to 2015 statistics, 70 percent of leprosy patients in Myanmar are at risk of further infections. Children aged under 15 represent 5pc of sufferers, and about 14pc of the total patients suffer from severe, Grade-2 disabilities.

The People’s Health Foundation, in cooperation with the Ministry of Health and Sport and the Mitta Arr Man Organisation, held a seminar on leprosy on August 26 in Yangon.

Health experts told the seminar that the number of patients had stabilised at between 2500 and 3000 for the past 12 years or so.

Dr Oke Soe, deputy director of the leprosy project at the public health department, said the ministry is planning to draw up national guidelines for combating the disease from 2016 to 2020. “We aim to complete the guidelines this year,”he said.

“Funding requests have been submitted to organisations supporting anti-leprosy activities, and the government has been implementing an awareness campaign,” he said.

“Nine patients out of 10 come to the health centre only when the symptoms are already apparent. That’s why so many suffer disabilities. For every 30 leprosy victims, two suffer a severe disability.”

Health workers’ biggest fear is the spread of leprosy among children, said Dr Myat Thida of the Leprosy Mission Myanmar. “The number of children coming to the clinics with leprosy that could lead to disabilities is very worrying. Every year, about 3000 patients come to the clinic. If we could go out and search in the community, we don’t know how many more we might find.”

Dr Oak Soe said 4-5pc of total new cases were under 15 years of age. Staff shortages meant that prevention activities in pockets of infection were hard to sustain. He added that 10-15pc of new cases involve a Grade 2 disability on the WHO’s 0-2 grading scale.

Dr Than Sein, president of the People’s Health Foundation, said, “Most people forgot about leprosy after the announcement that the disease had been eliminated.” That was why protection and prevention activities and programs had been weakened, he said. Victims of the disease failed to recognise its early symptoms, and did not know where the nearest health centre was located.

The WHO said in 2014 that Myanmar, with 2877 sufferers, was fifth in the world for leprosy cases. India, at number one, has 125,785 cases.

In 1986, when the WHO introduced multi-drug therapy to Myanmar, the number of registered leprosy cases was 222,209 and the prevalence rate was 59.3 per 10,000 population. Myanmar achieved its elimination target in 2003 when the incidence fell to less than one person in 10,000.

About 90 percent of patients come from Yangon, Mandalay, Sagaing, Magwe, Bago and Ayeyarwady regions and Shan State, said Dr Oke Soe.

Daw Thida, 75, who has a leprosy-related disability, said, “I developed the symptoms of leprosy when I was 17 years old. There was a white spot on my skin. The disease has cost me many opportunities in my life.”

Health experts say leprosy patients are still struggling with discrimination, in addition to their physical and mental distress.

Htike Nanda Win and Myint Kay Thi

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Myanmar - The baby blues

Women in Myanmar enduring the misery of postpartum depression can expect to suffer in silence and one reason is a paucity of health professionals with knowledge of the illness.

THE BIRTH of a baby is typically a time of celebration, joy and good fortune. Yet there are those who find themselves with a far different experience – one of crippling depression, physical exhaustion and even thoughts of suicide. The cause is an easily detectable yet widely undiagnosed culprit: postpartum depression.

Also called postnatal depression or postpartum blues, postpartum depression is a form of clinical depression that can affect both sexes after childbirth, though it most commonly diagnosed in women. 

The symptoms include anxiety, low energy, extreme sadness and sleep deprivation.

The exact cause of PPD is unknown, but hypothesised potential causes include genetic predisposition and hormonal changes resulting from pregnancy. External factors such as birth-related trauma, major life events or changes, low social support and socioeconomic status have also been suggested as being likely to increase the risk.

"Many of us don’t know what it is and because of that we suffer in silence."

“[In Myanmar] training on postpartum depression and any other forms of mental health disorders is poor to non-existent,” said Ms Gracia Fellmeth, a researcher at Oxford University who has studied PPD in Myanmar. “General healthcare staff, such as medics, nurses and midwives, normally receive very little teaching on this subject.”

Fellmeth’s statement isn’t unfounded. Staff at Yangon Central Women’s Hospital said they were not aware of PPD treatment being provided there. Mr Daniel Crapper, the deputy country director of Population Services International, a US-based non-government organisation that has provided reproductive health and other programs in Myanmar since 1995, said the organisation has “no specific information or knowledge” about PPD in Myanmar.

The 2006 World Health Organization Assessment Instrument for Mental Health Systems (WHO-AIMS) found that there were 265 people working in mental health facilities or private practice in Myanmar, a rate of 0.477 for every 100,000 people, with no mention of maternal-specific resources – a statistic that further highlights the lack of mental health care in the country.

“This topic is something that is neglected and ignored in society,” said Daw Htar Htar, the founder and director of Akhaya Women, an organisation that engages and educates women about emotional, social and sexual health issues.

“Many of us don’t know what it is and because of that we suffer in silence,” she said.

Htar Htar said common birthing practices and procedures typically remove power from the mother. They are often a source of increased anxiety and stress, both of which are considered possible triggers of PPD in women.

“Women in Myanmar are often cut when they are giving birth,” she said, referring to the procedure known as an episiotomy that makes birth easier and prevents severe tears. “Even when they don’t want to be, they are given no choice and it can be traumatising.”

Some post-natal rituals and traditional beliefs, such as isolating the mother for long periods, can also create added stress on postpartum mothers, she said.

“Women are often considered the lowest in their life after they give birth. People consider them dirty and untouchable,” Htar Htar said. “In some parts of Myanmar women are subjected to practices such as being wrapped with a mat and instructed to stand over boiling water, so that they are ‘purified’, causing them to pass out. These things are hard on women.”

The side effects of PPD can also have social and economic ramifications that linger long past the depression itself.

There can be negative financial effects because many employers are “unwilling to employ women with mental disorders due to a lack of knowledge and understanding of the conditions”, said Fellmeth. “Women who previously were financially independent or able to contribute to household finances may therefore no longer be able to do so.”

Fellmeth said evidence was emerging that showed perinatal depression – associated with the period immediately before and after birth – could also affect the newborn child.

“There is a growing body of evidence that shows perinatal depression has lasting physical, cognitive, social and emotional effects on children,” she said. “Mothers with depression are less likely to form a strong bond with their infants and less likely to breastfeed. Infants of depressed mothers are more likely to have low birth weight and experience stunting, malnutrition and diarrheal infections in childhood.”

However, there have been some positive developments. NGOs and research projects, such as the one in which Fellmeth is involved, are taking steps to gain a better understanding of methods for diagnosing and treating PPD in Myanmar.

“We found that if women were not depressed, they didn't mind being asked these questions: If they were depressed, they were pleased to have an opportunity to talk,” said Fellmeth. “For many women it was the very first time they had ever had the opportunity to talk about how they feel and they were thankful for the opportunity.”

Screening tools for PPD, such as questionnaires, have been translated into Myanmar and have proven effective in early detection of the disease. A class of drugs known as selective serotonin reuptake inhibitors that provide relief from the symptoms of PPD are becoming increasingly available at health centres and hospitals.

Htar Htar said the number of doctors with training in PPD was slowly increasing, but they were more likely to be concentrated in big cities such as Yangon and Mandalay.

She said many cultural changes were needed in order to address women’s health issues more comprehensively.

“Until women are seen and included as equal to men, there will always be unfair practices in this country,” she said. “There is still much to be done.”

Victoria Milko

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Myanmar - Most mental health patients in Myanmar are alcoholics: Dr Tin Oo

A view of the interior of the Yangon Mental Health Hospital.

According to Professor Dr Tin Oo, the manager of the National Health Project and head of the metal health department at the University of Medicine (1), said that an average of 50 mentally ill patients are committed to the Yangon Mental Health Hospital every year.

“Under Myanmar’s laws, if a mentally ill person commits a crime, that crime will not be considered a crime on the grounds that he or she was not capable of deciding [to commit the crime]. Some psychological conditions are uncontrollable. It all depends on the presiding judge, though. Some mentally ill patients are deemed too dangerous to be let free and are sent to us for rehabilitation. We have a separate ward for them. One such person will take around six years before his condition is cured or lessened,” said Dr Tin Oo.

He also said that among the annual patient intake of 1,300, most are alcoholics.

 According to official records from a government survey conducted on 5,000 people, between 75 and 85 per cent regularly consumes hard liquor, while around 10 per cent consumes traditional liquors and 15 per cent consumes beer.

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Myanmar - Kayin disease kills three

The authorities spray pesticide at Htilong village in Hlaignbwe Township. (Photo-EMG)

An outbreak of Japanese encephalitis has killed three out of 17 patients in four townships in Kayin State.

Hpa-an, Kawkareik, Hlaignbwe and Hpapun townships were affected. Japanese encephalitis was common in rural areas, said Dr Tun Min, health officer at the Kayin Public Health Department.

“The disease is transmitted by mosquitoes in the paddy plantations. Human are also infected through cattle and birds,” said Tun Min.

Encephalitis inflames the central nervous system and disrupts normal functions.

In 2014, 319 out of 18,690 child patients at the Yangon Paediatric Hospital were infected with different types of encephalitis, of whom 26 died.

“We reported the outbreak of the disease to the Kayin State government and also instructed hospitals and clinics to take blood samples of suspected patients. Rural doctors are now conducting educational talks on preventive measures against the disease in cooperation with volunteers, medical staff and NGOs," the medic said.

"A plan is underway to vaccinate against Japanese encephalitis nationally next year,” said Tun Min.

The disease was first detected in Laukkai and Hopang townships of the Chinese border in July. An estimated 13 patients out of 35 suspects have been reported in northern Shan State. Three of them died. The Public Health Department said it was currently planning to vaccinate against the disease.

Myanmar is contributing to the Southeast Asia Encephalitis Project on communicable encephalitis to tackle the disease in Cambodia, Laos and Vietnam.

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Myanmar - Government crackdown prompts calls for reform as drug addicts suffer

A miner injects heroin at a jade mine in Hpakant township in Kachin state. (Photo: Htet Khaung Linn/Myanmar Now)

YANGON (Myanmar Now) - Several young men were standing near the entrance of Thingangyun Hospital in central Yangon on a recent July morning, waiting impatiently for a fellow drug addict to exit the facility.

They had just received their daily dosage of methadone, but one man was not coming out. After a few minutes, they concluded he must have failed the mandatory illegal drugs test and got detained. The group quickly left.

“One of the guys was arrested by police at the hospital,” an addict named Soe Maung said later. “Recently, a girl was arrested in the same hospital while getting methadone… she tried to run away but a policeman caught her by the neck.”

Like the others, Soe Maung, 28, is taking methadone to wean himself off heroin and fight its withdrawal symptoms. He is also a contact person for the Burnet Institute’s HIV Mitigation programme for drug-injecting users and he helps Yangon’s opiate addicts enter methadone therapy.

Drug users who register their addiction with police and health authorities can avoid criminal punishment from Myanmar laws, which set tough prison sentences for narcotics use, possession and sale. They can enter mandatory methadone maintenance therapy at 46 hospitals across Myanmar, including Thingangyun Hospital, to suppress withdrawal symptoms as they give up illegal drugs.

Health experts, representatives of drug users, and some politicians say methadone therapy, and other so-called harm reduction strategies for drug users, should be expanded to bring Myanmar’s rampant drug abuse problems under control.

They say the government should also change laws that penalise recovering addicts who test positive for illegal drugs, or punish those who fail to attend methadone therapy and regular police registration.

They warn, however, that the NLD government’s approach so far has only been punitive, as the Ministry of Home Affairs launched a nationwide drugs and crime crackdown that arrested many addicts, but did little to help them.

The ministry recently said it wants more money for its crackdown, while some MPs have called for tougher actions against drugs and crime.

GOVERNMENT CRACKDOWN NETS MOSTLY ADDICTS

Soe Maung said the NLD’s approach had raised fears among Yangon’s addicts, while police were more quick to arrest recovering users who failed the conditions of the methadone therapy programme.

“More addicts who are taking methadone have been arrested during the first 100-days plan of the new government,” he said.

Okkar Min, an Upper House NLD lawmaker from Tanintharyi Region, urged his government to abandon this repressive approach and introduce genuine reforms.

“The government needs to lay down a policy to open more rehab centres for drug addicts. If it keeps arresting all drug users, as it has been doing over the past few months, then they will fill up the prisons but the problem won’t be solved,” he said.

According to the Ministry of Home Affairs, police arrested 4,761 people in 3,197 drug-related cases between April 1 and July 31. Several hundred kilos of opium and heroin, and millions of methamphetamine pills were seized, but arrests of those running the drug rings remain rare.

“When I asked police officers about those arrested in the drugs crackdown they were just small dealers or users,” Okkar Min said. It would be more effective, he added, to fight government corruption and increase public education campaigns that warn youths about narcotics.

PLANS TO REFORM LAWS, EXPAND REHAB

Myanmar has long been a major producer of opium, its derivate heroin and methamphetamine, much of which originates from and passes through its poor, ethnic borderlands, where the government remains weak. Drug abuse in these areas and in Myanmar’s major cities has reportedly worsened sharply in recent years, prompting calls for a new approach to drug addiction.

The Drug Policy Advocacy Group, a network of health experts and NGOs, has worked with health officials on expanding harm reduction and rehabilitation programs, while it cooperated with law enforcement officials to develop plans for amending drug laws.

Dr. Hla Htay, senior technical manager at the Burnet Institute and a member of the group, said the government’s capacity to provide methadone therapy is hindered by current laws and limited due to a lack of resources and facilities.

He said there are now about 7,000 registered addicts seeking rehabilitation, but Thingangyun Hospital, for example, can only provide methadone for 400 addicts on a daily basis.

 An opiate detoxification centre at Yangon Mental Health Hospital in East Dagon Township, on the city’s outskirts, can treat only 50 patients at a time for a two-week treatment.

According to some estimates there are 81,000 drug users in Myanmar.

Dr. Hla Htay said methadone supplies at the Yangon Mental Health Hospital were often not sufficient for the detoxification treatment. “We cannot give addicts the amount of methadone they asked for, and every project needs good facilities and skilled staff,” he said. “But we have plans to expand this project”

The Thingangyun Hospital methadone service is limited to 8 a.m. to 11 a.m., another practical hindrance for addicts, who might relapse if they miss the methadone’s clinic opening hours, according to Win Min, a Burnet Institute staffer who counsels addicts.

Dr. Hla Htay said drug reform advocates have worked together with police officers of the Central Committee for Drug Abuse Control (CCDAC) to draft amendments to the 1993 Narcotic Drugs and Psychotropic Substances Law, which would remove penalties for drug users.

Police Colonel Myint Aung, who heads the International Department of the CCDAC, confirmed the draft amendments had been completed. “We are going to send this bill to the Union Attorney General’s Office and later it will be discussed in parliament,” he said.

“Drug users are now arrested, but this bill would enforce steps that would make it a health issue, rather than a criminal one,” he added.

Dr. Hla Htay said he hoped the bill could be brought to the attention of the NLD government and parliament within the next few months so that it could begin reforms.

“Drug addicts should not be imprisoned, instead they need opiate detoxification treatment,” he said. “If they were found to be using drugs, police should urge them to go to hospital.”

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Myanmar - Health assistants want changes to the system

Health assistants want more opportunities for promotion, better education and a new name, the Blue Ribbon campaign committee announced at an event in Nay Pyi Taw’s Sky Palace hotel on August 13 and 14.

Health assistants working in villages can prescribe medicine and provide health education. When someone gets very sick, health assistants direct them to the appropriate doctor or hospital.

Health assistants would like to be addressed as “public health officers”, committee members said at the event. They want more transparent and specific policies surrounding the transfer of health assistants.

And as soon as possible, they want the government to enact rules that protect public health workers, and they would like access to post-graduation courses.

The committee’s chair, U Aung Cho, said their demands will be sent to Union Minister for Health and Sport U Myint Htwe.

“After the submission of the outcome of this meeting, we will negotiate,” he said.

Ko Tun Myo Aung, who is participating in the campaign, said the committee was not bringing up new ideas but was focusing on things that needed to be addressed.

“We health assistants have tried to provide the best service we could,” he said. “But we did not get the opportunities we deserved because of bad management.”

Myanmar’s healthcare service was ranked 190th in the world last year, according to a report from the World Health Organisation.

“We are waging the campaign not because we want to get an official post in our department, but because we want to see changes there,” said Ko Tun Myo Aung.

When they tried to address problems within the system, bureaucracy and bad management put a stop to progress, he said.

“We are not given the rights to make decisions,” he said.

“But those who can make decisions never take responsibility. And there is no transparency in the decision-

making. If someone complains about these issues, they are persecuted for it.”

Health assistants face threats from supervisors when they try to improve the system, Ko Tun Myo Aung said.

“When someone points out the errors of a supervisor, they are punished,” he said. “For example, they are transferred from our department to another department or ordered to work in a remote area and they lose their chance to improve their skills.”

The campaign, which is being waged by health assistants across the country, started on July 25.

Pyae Thet Phyo

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Myanmar - Naga slam slow response to measles deaths

Naga tribeswomen and children gather in the grounds of Lahal Township in Sagaing Region, December 2014. (Phyo Hein Kyaw / AFP)

The deaths of more than 40 people, most of them children, from a measles outbreak in a remote, mountainous area of northwestern Sagaing Region was partly because of a slow response from the local authorities, a Naga community group said.

“The government blames communication and transportation [problems], but another problem is the slow response by the local government that has made the situation worse,” Naw Aung Sann, the general secretary of the Council of Naga Affairs, told Frontier on August 8.

His comment came as a spokesperson for the World Health Organization told Frontier that tests at a Yangon laboratory on August 5 had confirmed measles as the cause of the outbreak. Most of the fatalities are reported to have been children aged under five.

The WHO spokesperson said a rapid response and investigation team from the Ministry of Health and Sports, supported by WHO regional surveillance officers, was in the area supervising investigation, treatment and control measures.

The areas worst affected by the outbreak are the isolated townships of Lahe and Nanyun, in the Naga Self-Administered Zone adjoining the border with India, one of least inaccessible areas of Myanmar, where poor road conditions are made worse by monsoon weather.

The death toll from the outbreak stood at 41, of whom 21 were females, the Council of Naga Affairs said on August 8.

Dr Than Htun Aung, deputy director general of the Department of Public Health, told Frontier on August 8 that the outbreak had mainly been confined to Htan Thaw Lama, a village about 64 kilometres (40 miles) from Lahe.

“We were delayed in receiving the information”, Than Htun Aung said when asked about the response to the outbreak.

“The first case was reported on June 6, but we did not hear anything until July 28. This is for many reasons; because of very bad weather in the area, a lack of manpower and many people in these villages do not have access to cell phones,” he said.

A measles vaccination program was conducted in Lahe Township in January 2015, Than Htun Aung said.

“The reported coverage was 94 percent but I don’t think that can be correct. If that figure was correct, then we would not have the outbreak that we are having now,” he said.

A statement issued by the Council of Naga Affairs on August 6 said health concerns had begun rising in mid-June when a 10-year-old girl in Lahe Township died of a “strange disease”.

The government’s slow response had exacerbated the situation, said Aung Sann, who acknowledged that poor communications was a factor.

Phone coverage was available only in Lahe and other villages were unable to communicate with the authorities, he said, adding that another contributing factor was a lack of healthcare facilities in the region.

Aung Sann rejected claims by the government that the situation was under control.

“The government says that the situation is under control but this morning [August 8] we found out that two more girls have died, so I don’t agree that the situation is under control,” he said.

The WHO says measles is a leading cause of death among young children despite the availability of a safe and cost-effective vaccine. Young, malnourished children are most vulnerable to the highly contagious disease.

Although Myanmar has increased health spending in recent years, it still has one of the lowest health budgets in Southeast Asia, and access to healthcare is limited in many parts of the country, particularly remote areas.

Oliver Slow

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Myanmar - Measles behind Myanmar outbreak

This photograph taken on December 24, 2014 shows a Naga ethnic woman bathing her child in Lahal township in the remote Sagaing region located in northern Myanmar. (AFP photo)

YANGON - Myanmar health officials have confirmed that a measles outbreak is behind the deaths of more than 30 people, mostly children, in a remote part of the country as authorities rush to treat victims.

The outbreak has struck the far corner of Myanmar's northern Sagaing region, a remote and mountainous area which borders eastern India and is populated by people from the Naga tribes.

The deaths began in June and highlight how vulnerable Myanmar's more isolated populations are in a country where health care was never prioritised under decades of brutal and inept junta rule.

It is one of the many crippling legacies that the newly installed civilian government of Aung San Suu Kyi is trying to tackle.

Than Tun Aung, deputy director general of the disease control department at Myanmar's health ministry, said labwork from the worst hit town of Lahal had come back positive for measles.

"It's measles," he told AFP late Friday. "So we are sending more team members and cooperating with medical doctors from the military as well."

Local Naga representatives had previously accused the central government of being slow to act.

The region is impoverished and very remote, a mountainous border area where roads and electricity are scant.

out six days to reach the villages. Communication there is also difficult," Than Tun Aung said.

He said they had confirmed a total of 31 deaths in Lahal region, half of whom were under 15.

The Council of Naga Affairs gave a higher toll of 39 dead in nine villages with all the deceased children.

Although health budgets slightly increased in the last few years of outright army rule -- which ended with last November's elections -- Myanmar is still one of the lowest spenders in the world on healthcare as a share of GDP.

Last year, with the help of the World Health Organization and the UN, Myanmar embarked on a mass vaccination programme with the aim of eradicating measles and rubella by 2020.

AFP

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