Myanmar Artemisinin Resistance Containment Project Baseline … · 2018-04-09 · Myanmar...
Transcript of Myanmar Artemisinin Resistance Containment Project Baseline … · 2018-04-09 · Myanmar...
Myanmar Artemisinin Resistance Containment Baseline Survey 1
Myanmar Artemisinin Resistance Containment Project
Baseline survey
Final report
December 2012
Myanmar Artemisinin Resistance Containment Baseline Survey 2
In collaboration with:
Department of Medical Research (Lower Myanmar)
With technical assistance from Malaria Consortium and World Health Organization
Funding provided by the Three Diseases Fund
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TABLE OF CONTENTS
Table of contents ............................................................................................................................................................... 3
List of Tables ....................................................................................................................................................................... 5
List of Figures ...................................................................................................................................................................... 8
Acknowledgements .......................................................................................................................................................... 9
Abbreviations ................................................................................................................................................................... 10
Executive Summary ........................................................................................................................................................ 12
Background ....................................................................................................................................................................... 19
Objectives of the Survey ................................................................................................................................................ 21
Methods ............................................................................................................................................................................... 22
Survey Areas ....................................................................................................................................................................................... 23
Survey Design and Sampling ........................................................................................................................................................ 24
Fieldwork process ............................................................................................................................................................................. 26
Ethical considerations..................................................................................................................................................................... 27
Data processing and analysis ....................................................................................................................................................... 27
Results ................................................................................................................................................................................. 29
Issues to consider .............................................................................................................................................................................. 29
HOUSEHOLD AND PREVALENCE SURVEYS ........................................................................................................................... 30 Malaria prevalence and fever ............................................................................................................................................... 34 Malaria prevention ................................................................................................................................................................... 39 Malaria treatment ..................................................................................................................................................................... 47
DRUG OUTLET SURVEY .................................................................................................................................................................. 56 Characteristic of Drug outlets .............................................................................................................................................. 56 Antimalarial drugs stock and selling habits .................................................................................................................. 59
HEALTH FACILITY SURVEY .......................................................................................................................................................... 66 Health Facility Audit ................................................................................................................................................................. 67 Malaria Patient Follow-Up and Exit Interviews ........................................................................................................... 72
Discussion .......................................................................................................................................................................... 75
Key Recommendations .................................................................................................................................................. 80
References .......................................................................................................................................................................... 82
Annexes ............................................................................................................................................................................... 83
Annex 1. Household Questionnaire ........................................................................................................................................... 84
Annex 2. Drug Outlet Questionnaire ...................................................................................................................................... 112
Annex 3. Health Facility Questionnaire – Part 1 (Facility Audit) .............................................................................. 123
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Annex 4. Health Facility Questionnaire – Part 2 (Malaria Follow-up) .................................................................... 138
Annex 5. Health Facility Questionnaire – Part 3 (Exit Interview) ............................................................................. 152
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LIST OF TABLES
Table 1. Summary indicators
1. HOUSEHOLD AND PREVALENCE SURVEYS
1.1 Characteristics of the sample and summary results
Table 1.1.1 Denominators for households and sampled individuals
Table 1.1.2 Age and sex distribution of residents, visitors, people who travel away from home,
and people who go to the forest
Table 1.1.3 Details of temporary visitors in households
Table 1.1.4 Details of people in households who go to the forest and sleep overnight
Table 1.1.5 Details of usual residents away for more than 6 months
1.2 Malaria prevalence and fever
Table 1.2.1 Malaria prevalence by species and zone, and reported fever by Tier
Table 1.2.2 Malaria species by age/sex and socioeconomic group
Table 1.2.3 Malaria species by State
Table 1.2.4 Determinants of a positive blood slide
Table 1.2.5 Distribution of fever by socioeconomic group within Tiers
1.3 Malaria prevention
Table 1.3.1 Summary of household ownership of mosquito nets
Table 1.3.2 Summary of household ownership of sufficient mosquito nets
Table 1.3.3 Characteristics of household nets
Table 1.3.4 Places to obtain or retreat a net
Table 1.3.5 Household ownership of nets by State
Table 1.3.6 Summary of mosquito net usage (previous night) by target populations
Table 1.3.7 Determinants of the use of any mosquito nets and long lasting insecticide-treated
nets
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1.4 Malaria treatment
Table 1.4.1 Household respondents’ knowledge of malaria and danger signs by Tier
Table 1.4.2 Respondent’s confirmation of signs and symptoms
Table 1.4.3 Respondents’ knowledge of malaria treatment
Table 1.4.4 Household respondents’ knowledge of providers for malaria diagnosis and
treatment
Table 1.4.5 Respondents’ reported prevalence and treatment of fever during the previous two
weeks
Table 1.4.6 Treatment seeking behavior of forest goers on last visit
Table 1.4.7 Specific drugs taken for fever
Table 1.4.8 Type, source, test and test result for individuals with fever in the past two weeks
who took any ACT
2. DRUG OUTLET SURVEY
2.1 Characteristic of sampled outlets
Table 2.1.1 Private providers (outlets) selling antimalarial drugs by Tier
Table 2.1.2 Knowledge among drug outlet respondents of drug resistance and ban on
monotherapies
2.2 Antimalarial drugs stock and selling habits
Table 2.2.1 Availability of antimalarial drugs sold in private drug outlets on survey day by Tier
Table 2.2.2 Details of rapid diagnostic tests sold in drug outlets
Table 2.2.3 Recommended antimalarial drugs in drug outlets by Tier
Table 2.2.4 Popularity of antimalarial by Tier
Table 2.2.5 Consumption habits by Tier
Table 2.2.6 Activity during the previous week by Tier
Table 2.2.7 Artesunate
Table 2.2.8 Coartem (A + L)
Table 2.2.9 Duocotexcin
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Table 2.2.10 Cost of specific antimalarial drugs
3. HEALTH FACILITY SURVEY
Table 3.1 Description of the health facilities in the survey
Table 3.2 Health facility respondent characteristics
Table 3.3 Health facility staff characteristics
Table 3.4 Antimalarials, other drugs and RDTs usually stocked by Health Facilities
Table 3.5 Summary of artemisinin-based combination therapy (ACTs), antimalarials and rapid
diagnostic tests (RDTs) stocked at health facilities
Table 3.6 Laboratory services and equipment available at health facilities
Table 3.7 Details of malaria cases followed up and exit interview patients
Table 3.8 Assessment and antimalarials received by malaria cases and fever patients
Table 3.9 Treatment prescribed at public and private health facilities among malaria and fever
cases
Table 3.10 Reported diagnosis and treatment among exit interview fever patients
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LIST OF FIGURES
Figure 1: Components of the MARC baseline survey
Figure 2: Rainfall intensity and pattern in the Study area
Figure 1.1.1: Selected clusters of the baseline survey
Figure 1.3.1 Knowledge of causes of malaria transmission mentioned by Tier
Figure 1.3.2 Knowledge of means of malaria prevention mentioned by tier
Figure 1.3.3 Attitude about ITN benefits mentioned by Tier
Figure 1.3.4 Malaria messages seen or heard in past 6 months by Tier
Figure 1.3.5 Source of malaria messages mentioned by Tier
Figure 1.4.1 Knowledge of signs or symptoms of malaria mentioned by Tier
Figure 1.4.2 Recognition of symptoms of serious illness by Tier
Figure 1.4.3 Antimalarial drug mentioned by respondents by Tier
Figure 1.4.4 Source of treatment by Tier
Figure 1.4.5 Reasons for not seeking treatment by Tier
Figure 2.1.1 Respondents knowledge of malaria signs and symptoms by Tier
Figure 2.1.2 Attitude of respondents if suspected malaria case
Figure 2.2.1 Factors determinant for stocking of antimalarial drugs
Figure 3.1 Location of public Health Facilities, MARC survey 2011
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ACKNOWLEDGEMENTS
The authors would like to thank the Ministry of Health of Myanmar; in particular, Dr Saw Lwin, Deputy Director General, and Dr Thar Tun Kyaw, Director of the National Malaria Control Programme, for their guidance and support which has made the baseline survey for the Myanmar Artemisinin Resistance Containment (MARC) possible.
We would also like to thank the staff of the Vector borne Disease Control Division, Department of Health, Myanmar, and Dr Myat Phone Kyaw, Deputy Director, Head of Parasitology Research Division, Department of Medical Research, Lower Myanmar, and local partners for their dedication to the malaria control programme and their commitment to contain artemisinin resistance and controlling malaria in Myanmar. Special thanks to the Three Diseases Fund (3DF) for supporting this survey, with additional support from the World Health Organisation, Myanmar.
We also would like to express our sincere appreciation to all the members of the MARC 2011 baseline survey teams and technical partners, in particular WHO-Myanmar and Department of Medical Research, Lower Myanmar who provided invaluable technical support and assurance that field work and laboratory analyses were undertaken to the highest quality standards.
Special thanks to the many field interviewers and blood takers who worked arduously for data collection, as well as laboratory technicians who read and rechecked all the blood slides, without whose commitment and dedication we would not have been able to produce the following results.
And finally, we would like to express our gratitude to the thousands of households of Myanmar who participated in this large-scale baseline survey and contributed to the improving our understanding of the malaria situation and epidemiology of the country.
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ABBREVIATIONS
3DF Three Diseases Fund
ACTs Artemisinin-based Combination Therapy
CQ Chloroquine
DBS Dried Blood Spot
DHA-PIP Dihydroartemisinin-Piperaquine
DHS Demographic and Health Survey
DMR Department of Medical Research
FDA Food and Drug Administration
GFATM Global Fund to fight AIDS, Tuberculosis, and Malaria
GPARC Global Plan for Artemisinin Resistance Containment
GPS Geographic Positioning System
HF Health Facility
IMCI Integrated Management of Childhood Illnesses
IOM International Organization for Migration
IPD In-patient Department
M&E Monitoring and Evaluation
MARC Myanmar Artemisinin Resistance Containment
MC Malaria Consortium
MICS Malaria Indicator Cluster Surveys
MQ Mefloquine
NMCP National Malaria Control Programme
OPD Out-patient Department
PCA Principle Components Analysis
PQ Primaquine
PSI Population Services International
SP Sulfadoxine-Pyrimethamine
TA Technical Assistance
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TSG Technical Strategic Group
TORs Terms of Reference
VBDC Vector-Borne Disease Control
WHO World Health Organization
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EXECUTIVE SUMMARY
The Myanmar Artemisinin Resistance Containment (MARC) baseline survey was conducted
from end of December 2011 through mid-March 2012, before the start of the rainy season by a
partnership of organisations supporting the Vector Borne Disease Control (VBDC) Division in
Myanmar. This large-scale household, drug outlet, and health facility survey was funded by the
Three Diseases Fund (3DF) and World Health Organization (WHO) and addressed indicators for
containment of artemisinin resistanceand provided key monitoring and evaluation data for the
MARC Task Force as well as the Technical Strategic Group (TSG) for refinement and
improvement of the containment strategy.
The main purpose of the MARC baseline survey was to assess the overall malaria prevalence in
the containment areas (Tier 1 and Tier 2), to assess and monitor the availability of oral
artemisinin monotherapies in the containment areas and to serve as baseline for the MARC
strategic and Monitoring and Evaluation Framework in 2011, as well as contribute to baselines
for other projects including the Global Fund to fight AIDS, Tuberculosis, and Malaria (GFATM).
The household malariometric survey focused on the populations living within the containment
of artemisinin resistance areas in Myanmar, particularly Tier 1 (21 townships) and Tier 2 (31
townships). A total of 1992 households were visited and interviewed (40 clusters of 25
households in each Tier). Within the sampled households, individuals representing four age
categories were randomly selected for the malaria prevalence survey; a total of 5264 blood
samples were collected and analysed using standard microscopy and PCR.
A total of 120 drug outlets were visited (two drug outlets per cluster), purposely selected
based on the most popular source for antimalarial drugs in the vicinity of the community, using
local key informants in each cluster.
A total of 129 health facilities were included in the survey (50 public and 79 private facilities).
Health facilities were selected using stratified sampling within the catchment area of the
clusters for the household survey. In these health facilities, 362 malaria cases within the past
three months were followed up for case records (294 cases at public facilities and 68 at private
facilities). Furthermore, 232 exit interviews were conducted for fever cases presented at
health facilities during the time of the survey (183 at public facilities and 49 at private facilities).
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Malaria and reported fever prevalence
Malaria prevalence using microscopy was overall 0.5% in the target area at the time of the
survey. There was a higher prevalence of Plasmodium vivax infection compared to Plasmodium
falciparum and there were no cases of mixed species infection. Malaria tended to be more
prevalent among children under five and among poorer households. People living in Tier 1 and
as expected in endemic malaria risk areas were more likely to have a malaria positive slide.
Comparison across tiers revealed that the proportion of infections of Plasmodium falciparum
was higher than Plasmodium vivax in Tier 1 but this trend was reversed in Tier 2. Although very
few malaria cases were detected on the survey day, there appears to be ongoing malaria
transmission in the studied villages and it would be useful to understand more about the levels
of transmission through the use of molecular (PCR) and serological techniques. It also may
suggest that malaria transmission was heterogeneous as the trends observed in Tier 1 tended to
reflect a lower transmission setting compared to Tier 2, considering the proportion of positive
slides and the species patterns.
Malaria awareness and prevention
In general, 20% of the respondents could not mention any transmission mode and several
misconceptions were cited but about 65% of respondents knew that mosquitoes could
transmit malaria. The most popular method for prevention appeared to be related to mosquito
net use and to insecticide treated nets (ITNs) to a lesser extent. In the same way, awareness
about ITN benefit was still relatively low. In the previous six months, only 12% mentioned
having received any information about malaria and the main message recalled was related to
mosquito net or ITN use, mainly cited from health facility or NGO staff as a source.
On the survey day, household ownership of any mosquito net was 97.4%, of any ITN was
35.1% and any long-lasting insecticidal net (LLIN) was 11.1%. The coverage of any mosquito
net was higher among richer households while ITN ownership appeared to be associated with
poorer households and concentrated in higher malaria risk area. Unsurprisingly, more mosquito
nets were found in the Tier 1 area and these nets tended to be more recent than those in Tier 2,
which is consistent with the above observation as malaria was more prevalent in Tier 1. In
general, the most popular source of these mosquito nets was a shop or the market in both tiers.
The proportion of all people who slept under a mosquito net the previous night was 76.5%
and as expected, these estimates for ITN and LLIN were much lower at 15.9% and 3.9%
respectively. Although more than a quarter of households had insufficient quantity of
mosquito nets (at least one mosquito net for every two people), 20% to 30% of households had
either an old or net that was not currently used by the household and the main reasons were to
save it for the future or for visitors. Furthermore, mosquito net use among mobile groups as
forest goers, travellers and temporary visitors tended to be significantly lower compared to all
individuals.
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Malaria treatment
Nearly half (47.3%) of the respondents mentioned chills and fever as malaria signs and
symptoms, 30.4% could cite the main sign for fever severity (unconscious, fast breathing or
convulsion) and these proportions were higher in Tier 1. The most popular methods to confirm
the signs and symptoms mentioned were first “Doctor’s examination” followed by “Self-
assessment”. Less than 3% cited a rapid diagnostic test (RDT) or blood slide.
Less than 30% of household respondents could cite any antimalarial drug and less than 10%
mentioned any artemisinin-based combination therapy (ACT). However, artemisinin
monotherapies were mentioned by more than 10% in each tier.
The most popular source for diagnostic services and treatment appeared to be the rural health
centres, hospitals and private doctors while community malaria workers were mentioned by
only about 3%. The public sector appeared to be the most commonly cited source for diagnostic
services and treatment for malaria. Among all individuals in the households sampled, 2.6%
reported any fever in the previous two weeks. Among these 241 people, 70% sought treatment
mostly from a private doctor, a health centre or a midwife clinic and overall, public sector
channels appeared to be more common.
Interestingly, in Tier 2, fewer people sought treatment and an important source of advice or
treatment was a grocery shop. The first source for treatment in case of reported fever among
respondents in Tier 2 appeared to be from a private channel, as opposed to Tier 1. In both tiers,
time to treatment was fast, within 2 days for a vast majority of cases. Among all fever cases,
69% had either an RDT or a blood test for malaria. In most cases, the treatment consists of
non-antimalarial drugs (80.8%) and only 4 people had any ACT (Coartem).
Drug outlet surveys
The main finding from the drug outlet survey was that more than half of providers had no
previous health training and 80% of the drug outlets were in a general store where
consultations were offered. Awareness about artemisinin resistance was low in the sampled
outlets and in general, the most popular antimalarial drugs sold in the sampled outlets were: 1)
artesunate tablets, 2) chloroquine, 3) artemether injectables, and 4) artemether tablets. This
confirms that in the target area, artemisinin monotherapies (artesunate) was still the most
popular malaria treatment obtained in drug outlets.
The sale of partial packs of treatment regimens appeared to be common practice as 55.2% of
drug outlets reported selling incomplete doses in the previous month. Selling activity
during the past week was low, which is consistent with the low malaria prevalence and reported
fever found in the households surrounding these outlets and 60.4% reported selling less
antimalarial drugs than the previous year. On the other hand, availability of diagnostic services
was low with 20.8% outlets selling any test for malaria of which most tests were RDTs. Across
tiers, artemisinin-based antimalarils, either monotherapies or combined with another drug was
the most common treatment sold in Tier 1. However, in Tier 2, the most popular treatment was
chloroquine, suggesting that the clusters in Tier 2 were perhaps more underserved compared to
Tier 1. Likewise, drug providers in Tier 1 were more likely to refer customers to health facilities
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and clients were more likely to bring in a prescription, suggesting better linkages between drug
outlets and the formal health system.
In Tier 2, consumption appeared more driven by customer demand. Considering the above
observations, it appeared that although availability of any antimalarial drugs was high among
the selected clusters, ACTs were found in less than 40% of outlets and artemisinin
monotherapies were still the most popular and widely available treatment for malaria.
Health facility survey
The aim of the health facility survey was to assess the delivery of services for fever and malaria
episodes within the public and private sectors. Due to the relatively low incidence of malaria
throughout the country, it was a challenge to identify and follow up prospective malaria cases.
Exit interviews and respective malaria case follow up interviews can provide a good way to
correlate patient’s perceived malaria services with those of providers. Public health facilities
were more likely to provide malaria diagnoses and health education compared to private
health facilities. However, private facilities were more likely to refer cases of severe malaria,
and had significantly more staff with malaria related training compared to public health
facilities. This was contradicted by the fact that knowledge of the recommended treatment for
P. falciparum and P. vivax was relatively higher among public health facilities.
Availability of ACTs (specifically Coartem) was higher among public health facilities;
however, stocks of ACTs and RDTs among private facilities may not be adequate to
currently address the need among those who seek treatment from private sources. An
high proportion of public and private facilites reported available stocks of chloroquine –
probably for the treatment of P. vivax. All public facilities seem to have good diagnostic
capabilities whereas 40% of private facilities lacked capacity for malaria diagnosis.
Although nearly all malaria cases who saw a health worker had a blood test, one of the key
findings from the malaria case follow up survey was that less than a quarter of cases in public
facilities received an ACT. This percentage was higher in the private sector but the number of
cases followed up in the private sector was low (68%). Among the patients receiving IV
infusion, 20% and 50% were diagnosed as malaria in the public and private health facility,
respectively. The over-reliance on the use of intravenous infusions for the treatment of fevers
and malaria should be assessed. Particularly as malaria declines in the country, more fevers
presented at public and private health facilities will likely be non-malaria related. Improved
and more sensitive algorithms and training for the treatment of these non-malaria fevers
should be developed and implemented.
In short, despite the low prevalence of malaria and fever cases at the time of the survey, the
trends highlighted in this report suggest heterogeneous malaria transmission in the areas
sampled. General awareness among the respondents about malaria, prevention measures,
diagnostic services and treatment was low. Although any mosquito net could be found in most
households, the coverage of ITN and LLIN was insufficient to have an impact on reducing or
preventing malaria transmission. On the other hand, general access to health care appeared
encouraging, considering the isolation of some of the selected villages. At this point in time, the
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public sector seems to be the most popular source of malaria services and commodities
(mosquito net or retreatment). However, availability of diagnostic services and recommended
antimalarial drugs (ACTs) was low and insufficient for effective case management in order to
stop the spread of artemisinin resistance in the target area and in the country.
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Table 1. SUMMARY OF KEY INDICATORS BY TIER
Indicator Indicator as measured in survey Tier 1 Tier 2
N % 95% CI N % 95% CI P-value
Household survey
Malaria prevalence in containment area
% malaria positive slides
% P. falciparum positive slides
% P. vivax slides
2557
0.8
0.2
0.5
0.4 to 1.6
0.0 to 0.5
0.2 to 1.1
2707 0.1
0.1
0.0
0.0 to 0.4
0.0 to 0.5
0.0 to 0.3
0.01*
Proportion of people with a history of fever in the last 2 weeks that have been tested for malaria (RDT or microscopy)
% with reported fever in the past 2 weeks and who had any test for malaria
128 21.9 14.9 to 31.0 113 24.8 16.3 to 35.7 0.88
% of confirmed malaria cases treated in accordance with any antimalarial drug within 24 hours of onset of symptoms
12 83.1 25.9 to 98.6 0 0.0 - 0.02*
% of confirmed malaria cases treated with any ACT within 24 hours of onset of symptoms
12 33.2 5.3 to 81.5 0 0.0 - 0.20
Proportion of people sleeping under an ITN/LLIN the previous night
% total population sleeping under any net the previous night
4612 78.0 72.2 to 82.8 4796 75.2 70.2 to 79.5 0.43
% total population sleeping under an ITN/LLIN the previous night
4612 18.8 13.7 to 25.2 4796 13.2 8.5 to 19.7 0.17
% of migrants/mobile populations sleeping under an ITN the previous night1: - Forest goers - Travelers away from home - Temporary visitors
14.4 9.9
23.7
8.2 to 24.1 5.6 to 16.7 9.7 to 47.5
10.8 12.4 3.7
5.0 to 21.8 6.8 to 21.5 0.8 to 15.4
1 This indicator may be better addressed through more specialized migrant studies and methodologies.
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Proportion of households in target areas with at least 1 LLIN/ITN per 2 persons
% of households that owned any: - net - LLIN - LLIN/ITN for every 2 persons
997 997 997
96.6 10.9 3.0
92.2 to 98.5 6.3 to 18.2 1.4 to 6.3
995 995 995
98.3 11.3 2.9
95.2 to 99.4 6.1 to 19.9 1.4 to 6.0
0.30 0.93 0.94
% of respondents that mentioned: - using a net as prevention method
- using an ITN as prevention method
965 965
65.5 21.6
60.6 to 70.1 17.2 to 26.7
933 933
52.7 9.5
46.4 to 59.0 6.4 to 14.0
0.01* 0.01*
% of respondents that could name any ACT
997 2.4 1.4 to 4.0 995 1.1 0.6 to 2.1 0.05*
Drug outlet survey
% providers that know malaria signs2 61 77.0 66.2 to 88.0 59 49.2 36.0 to 62.3 0.01*
% providers that know the national recommended3 treatment for P.f.
61 26.2 14.9 to 37.6 59 8.5 1.2 to 15.8 0.01*
% providers that know the national recommended4 treatment for P.v.
61 1.6 0.0 to 4.9 59 3.4 0.0 to 8.1 0.54
Average number of anti-malarial treatment sold/distributed to consumers in the past seven days
61 mean=5.8 SD=1.8
59 mean=2.4 SD=0.49
Health facility survey Public Private
% of health facilities with no stockout of ACT5 50 92.0 79 57.0
% of health facilities with oral artemisinin monotherapy
50 16.0 79 36.7
% of health facilities with any RDT in stock 50 96.0 79 62.0
% of health facilities with appropriate diagnostic tools (slides and RDTs)
50 30.0 79 10.1
% of health staff interviewed who have had malaria related training in 2011
50 87.3 79 39.7
2 Know malaria if mentioned both fever and chills 3 ACT (A + L or Artesunate + Mefloquine) 4 Primaquine * Statistically significant, p<0.05 5 On day of the survey
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BACKGROUND
The shift over the last few years away from failing drugs to the highly effective artemisinin-
based combination therapies (ACTs) has been a breakthrough, and it was hoped that their
design as combinations of two efficacious drugs with different modes of action would preserve
them for many years of use. However, recent evidence suggests that artemisinin resistant
Plasmodium falciparum parasites have emerged along the Thai-Cambodian border and it is
imperative to mount a vigorous response to stop spread from areas where artemisinin
resistance has been identified, whilst simultaneously undertaking further research to define
the nature and geographical extent of the problem.
In a region where resistance to chloroquine (CQ), sulfadoxine-pyrimethamine (SP) and
mefloquine (MQ) has previously emerged, the declining efficacy of artemisinin would indeed
be a catastrophic setback for the progress achieved thus far in the global fight against malaria
if it were to spread to Africa. Recent evidence through routine antimalarial drug efficacy
monitoring suggests that artemisinin resistance may also be present in Myanmar and
therefore an urgent response was needed to determine the extent of resistance, contain it, and
prevent its spread across Myanmar and beyond. As malaria incidence rates in parts of
Myanmar are higher than those on the Thai-Cambodian border, the impact of resistance on
effective control in Myanmar and beyond could be serious.
After the experience of implementing programmes to contain artemisinin resistance in
Cambodia and Thailand and consultations with international experts, the World Health
Organization (WHO) launched the Global Plan for Artemisinin Resistance Containment
(GPARC) in January 2011. In line with the GPARC and with support from the Ministry of
Health, WHO and key nongovernmental implementing partners of malaria control in country,
the Myanmar Artemisinin Resistance Containment (MARC) strategy and framework was
released in April 2011. The stratification for artemisinin resistance containment operations in
Myanmar are based on the three-tier classification of the Global Plan for Artemisinin
Resistance Containment (GPARC) and available data from in vivo therapeutic efficacy
monitoring studies. Tier 1 includes all Tanintharyi Region (10 townships), Mon State (10
townships), and Bago East Region (1 township) where there is strong evidence of suspected
artemisinin resistance and a critical need to respond with intensive containment
interventions. Tier 2 includes Kayin State (7 townships), Kayah State (7 townships), Kachin
State (4 townships) and Bago East Region (13 townships) where there is currently unclear
evidence of suspected artemisinin resistance but borders areas in Myanmar, Thailand, and
China where resistance has been detected. Tier 3 covers the rest of the country where it is
expected that scale up and strengthening of malaria control activities will continue as planned
under Global Fund Round 9.
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MARC Goal and Objectives:
The overarching goal of malaria control in Myanmar is to reduce malaria mortality and
morbidity (MDG6). The aim of the containment project is to build on and strengthen existing
control efforts to prevent, or at minimum, significantly delay the spread of artemisinin
resistant parasites within the country and beyond its borders. This implies intensification of
present activities and an expansion of specific interventions that target migrants and mobile
populations, set up extra sentinel sites to monitor efficacy of antimalarial medicines, increase
advocacy to engage local authorities and relevant stakeholders, engage the private sector and
bridgeinterventions with neighboring countries.
The objectives of the MARC are the following:
1. To improve access to and use of early diagnosis and quality treatment according to the
national treatment guidelines
2. To decrease drug pressure for selection of artemisinin resistant malaria parasites by
stopping the use of artemisinin mono‐therapies and substandard/fake drugs
3. To limit the transmission of malaria by vector control and personal protection
4. To increase migrant/mobile populations’ access to and use of malaria diagnosis,
treatment and vector control measures including personal protection
5. To support containment of artemisinin resistant parasites through advocacy and
BCC/IEC
6. To conduct studies, especially operational research to support the development of
evidence‐based containment policies and strategies
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7. To provide effective management and coordination to enable rapid and high quality
implementation of the containment strategy
OBJECTIVES OF THE SURVEY
A key component of the monitoring and evaluation plan of MARC is to conduct surveys
(malariometric, coverage and behavior) at household, health facility, and drug outlet levels
undertaken in year 1 and follow-up in subsequent years of the project. These surveys were
expected to serve as the baseline for the containment framework and any future containment-
related projects; to monitor critical milestones and indicators for the project; and provide key
evaluation data for the MARC Task Force and/or Technical Strategy Group (TSG) for
refinement and improvement of the implementation of the containment strategy.
The objectives of the MARC Surveys were the following:
1. To determine the baseline malaria prevalence in the Containment areas (Tier 1 and
Tier 2)
2. To assess and monitor the availability of oral artemisinin monotherapies in the
Containment areas
3. To serve as baseline for the MARC Strategic and M&E Framework in 2011, as well as
contribute to baselines for other projects including Global Fund
Specific indicators that were estimated from MARC survey:
Household survey
proportion of confirmed malaria cases treated in accordance with national malaria
treatment guidelines within 24 hours of onset of symptoms
proportion of households in target areas with at least one LLINs/ITNs per 2 persons
proportion of population at risk sleeping under an ITN/LLIN the previous night
proportion of persons with a history of fever in the last two weeks who had been
tested for malaria (RDT or microscopy)
proportion of respondents aware of key messages
Drug outlet survey
proportion of private drug outlets selling artesunate monotherapies
Volumes of anti-malarial drugs sold/distributed to consumers in the past seven days
proportion of private drug sellers/providers that can correctly state that people
suspected of having malaria should be diagnosed (by RDT or microscopy);
proportion of private drug sellers/providers that can correctly state that people who
are malaria positive should be treated with ACT and Primaquine (if P.f. positive) and
take the full course of treatment
Health facility survey
proportion of health facilities with no stockout of nationally recommended treatment
proportion of health facilities with appriopriate diagnositic tools (slides and/or RDT’s)
proportion of health facilities with nationally recommended treatment in stock
proportion of health facilities with staff who have malaria related training
Myanmar Artemisinin Resistance Containment Baseline Survey 22
METHODS
The MARC baseline survey was composed of three components, namely:
o Household survey (including prevalence survey)
o Outlet (drugs and nets) survey (in parallel with the household survey)
o Health facility survey
These surveys used a combination of survey techniques to obtain data that allowed key
indicators to be estimated and the provider/user situation to be assessed.
Figure 1: Components of the MARC baseline survey
Household Survey Household data Household characteristics
Residents
Household nets
People who travel to the forest
Mobile populations
People with fever
Prevalence data 0-4 years
5 to 14 years
Adult males
Adult females
Pregnant women
Temporary visitors
Drug Outlet Outlet data Drug availability and provider knowledge
Health Facility Survey Health Facility
Health facility services
Review of antimalarial & diagnostics stock
Outpatient records
Laboratory review
Health worker capacity & training
Exit interviews of fever cases
Malaria cases follow up
The household survey provides information about current knowledge, attitude, behaviour, and
practices (KABP) of people in villages at risk of malaria in prevention and treatment.
Additionally, the prevalence of Plasmodium infection and malaria illness was estimated by a
malariometric survey at household level. Blood samples were collected for preparation of
blood smears and dried blood spots for: 1) detection and species identification for malaria
measures, 2) seroprevalence analysis, and 3) remaining blood spots have been stored for
future screening of potential molecular markers and genotyping for drug resistance.
The drug outlet survey was conducted to assess whether malaria services were available and
adequate for the treatment and prevention of malaria within the community. Brands and types
of antimalarial medicines and diagnostics were recorded and enabled estimation of the key
provider indicators. In addition, samples of anti-malarial drugs were purchased for testing for
active ingredients, which could then be triangulated with the other methods used by the Food
and Drug Administration (FDA) of Myanmar and other partners.
Myanmar Artemisinin Resistance Containment Baseline Survey 23
The health facility survey was conducted in public and private health facilities in malaria
endemic areas. It was expected to provide an overview of malaria-related health care services
in target provinces and to assess the capacity of the health facilities to provide appropriate
diagnosis and treatment of malaria. The survey included an audit of malaria-related services,
including availability of antimalarial medicines, treatment guidelines, health worker training,
and laboratory diagnostic capacity. Exit interviews with current fever cases and follow-up
interviews with malaria cases recently listed in the case register (public health facilities only)
were also conducted to assess the quality of services and care provided at these health
facilities.
SURVEY AREAS
The surveys were undertaken in Tier 1 and Tier 2 of the containment area, these are
administrative townships that have evidence of delayed response to ACTs or are at risk of
spread of resistant parasites. Survey clusters were selected from malaria risk areas (risk strata
1a, 1b, 1c, 2, and 3)6, which includes all of Tier 1 and a subset of Tier 2. These townships are
the focus of the majority of the containment project interventions (e.g., LLIN distribution,
training of village health volunteers and BCC strategy). The survey areas are located in the
South East part of Myanmar and include Kayah, Kayin, Mon, Tanintharyi and Bago States. The
climate is tropical with three seasons: the southwest monsoon from mid-May to mid-October,
the cold season from mid-October till mid-February and the hot season from mid-February till
mid-May.
Figure 2: Rainfall intensity and pattern in the Study area
6 Based on the risk categories in “Malaria Risk Micro-stratification in UNICEF 80 Townships”. Stratum 1a = high
risk village, 1b = moderate risk village, 1c = low risk village, 2 = potentially malarious villages, and 3 = non-malarious villages
Data collected
from mid-December
till mid-
February
Myanmar Artemisinin Resistance Containment Baseline Survey 24
SURVEY DESIGN AND SAMPLING
Household survey
The household survey design is multi-stage, sampling of clusters at the first stage, households
within each cluster at the second stage, and then individuals within each household, for the
prevalence survey. Assuming an overall malaria prevalence of 9%7, a precision of +2.5%,
design effect of 1.75, non-response rate of 10%, power of 80% (beta error), and confidence
interval of 95% (alpha error), a sample size of 1000 households (e.g. 40 clusters with 25
households) was required in each Tier. As a result, the total number of households required
for the survey was 2000 households. Within each cluster, 25 households were randomly
selected from a list of all registered and unregistered families in the village obtained from local
authorities, with additional information provided by village based volunteers wherever
possible. A questionnaire was administered to a respondent in each selected household. The
person interviewed was the female head of household whenever possible. Questions
addressed household composition, characteristics and assets, mosquito net use, health and
treatment seeking behavior, knowledge of malaria transmission and prevention, frequent
travel, forest-related activities, and travel amongst permanent and temporary visitors.
Malaria prevalence survey
A finger prick blood sample was taken from a sub-sample of four individuals within the
household. One person was randomly sampled from each of the following groups: 1) aged 0 to
4 years, 2) aged 5-14 years, 3) adult female (15+ years), and 4) adult male (15+ years), to
compare malaria risk among these groups. The individuals for whom blood samples were
taken were recorded in the household schedule in the household questionnaire. A household
survey blood sample sheet was used to record details to identify and link the samples taken.
Blood smears were prepared for microscopy and two dried blood spots (DBS) for molecular
analysis using polymerase chain reaction (PCR) and serology were collected on filter paper. If
there were any pregnant women in the household, who were not included in the blood taking
sample for adult woman, their blood sample was also collected. In addition, blood samples
were obtained from temporary visitors residing in the household; up to four visitors per
household were randomly selected from this group. Additionally if there were any people in
the household who appeared to be symptomatic for malaria (fever), they were given a rapid
diagnostic test (RDT) and those with a positive result were treated with the appropriate first-
line antimalarial drug according to national treatment guidelines. Microscopic examinations of
Giemsa-stained blood smears were performed to determine the presence of malaria parasites.
An extensive training and quality assurance programme was implemented to best ensure
accuracy of prevalence data. Blood takers were trained in smear preparation and smear
staining procedures prior to the start of data collection.
7 Based on very limited information available and consultations
Myanmar Artemisinin Resistance Containment Baseline Survey 25
Drug outlet survey
For each selected household survey cluster (village), two drug outlets that serve the village
were conveniently sampled to triangulate the household survey data on treatment-seeking. It
is important to note that the drug outlets did not include any health facilities where drugs
could be purchased. These drug outlets were located within the village or in the nearest/most
easily accessible market or town. Information on all private, including informal drug outlets in
Tiers 1 and 2, were not readily available. The most common and accessible outlets were
selected, one in a central location and one in periphery of the village. A structured
questionnaire was used to document details of the outlet and the respondent. For drug outlets,
information on sale and stock management of ACTs, other antimalarial drugs and RDTs were
recorded, together with knowledge of national drug policy for malaria and common
dispensing practice. Awareness of ongoing activities to contain artemisinin resistance and
banned oral artemisinin monotherapies were also noted and referral practices for potential
severe malaria cases. Interviewers administered the questionnaire to the owner or any adult
(>15 years) respondents who was available to be interviewed.
Health facility survey
The health facility survey was conducted among a sample of public health facilities that have
within their catchment area villages or towns designated as high risk in Tier 1 and Tier 2. This
survey aimed to provide an overview of malaria-related services in Tier 1 and Tier 2 and the
capacity of the health facilities to provide appropriate diagnosis and treatment of malaria.
The health facility survey included 3 components: 1) an audit of malaria services, 2) exit
interviews of individuals with recent fevers, and 3) follow up of malaria patients within the
last month.
The first component comprised of an audit of malaria-related services, including availability of
antimalarial medicines, existence of treatment guidelines and protocols, and availability of
laboratory diagnostic capacity.
Due to the low incidence of malaria, it was not possible to do structured observations of
patients presenting at the health facility. Since it was important to assess the delivery of
services for malaria within the public health facility system, a second component of the health
facility survey included exit interviews of patients (or caregivers) with recent fever to ascertain
the level of service received at the time of the survey. Teams remained at the health facility for
up to 3 days or until the sample size was reached.
A third component of the health facility survey included a follow-up of patients who were
recently treated for malaria within the past month. Up to 20 malaria cases from the register
books were followed up in their homes for a maximum of 3 days.
The health facility survey was conducted at the same time as the household and drug outlet
surveys, and required a different team of field staff. It was anticipated that 80 health facilities
Myanmar Artemisinin Resistance Containment Baseline Survey 26
each for public and private facility was sampled for a total of 160 health facilities (1 public and
1 private facility for each cluster). This sample size was based on an estimate that 70% of
public facilities were fully functioning, with 30% precision and a design effect (DE) of 1.75.
The public health facility was randomly selected from a list of all public facilities in the
catchment area of the selected clusters and sampling was done prior to the field work. For the
selection of private facilities, a list of all private care providers in the village was compiled by
the field team upon arrival and from this list, one facility was randomly selected, with the aim
to provide a sample including a range of private provider type in the study area.
FIELDWORK PROCESS
Household & Drug Outlet surveys
The sample design was 40 clusters in both Tier 1 and Tier 2, a total of 80 clusters.
2 x 40 clusters x 25 households / cluster = 2000 households
It was anticipated that each team would visit each cluster for one day and one night to avoid
bias from people absent during the day and to ensure that all of the blood samples would be
collected. Each team was assumed to be able to do three-four clusters per week (Monday to
Thursday days and nights) with Friday for planning, reporting and resupplying.
80 clusters @ 4 clusters per week = approximately 20 team-weeks
Proposed team composition for the household and outlet survey was 9 people consisting of:
1 x survey supervisor 4 x household interviewers 1 x supervisory technician 1 x outlet interviewer 2 x drivers
Blood takers were found locally in each cluster and integrated to the team on the survey day.
With 5 teams, 45 fieldworkers in total, each team would be in the field for 4 weeks. The 20
household interviewers were able to interview 6-7 households per day (approximately 45
minutes to 1 hour per household); the outlet interviewer visited one drug outlet in the
selected cluster, plus one drug outlet in the nearest market or town. Households with
individuals absent during the time of the visit were revisited by the survey team up to three
times. The team also took GPS coordinates for a central point in the village.
Health Facility Survey
The health facility survey required 5 teams of 5 field workers = 25 field workers. A total of 5
teams of 5 individuals (3 interviewers, 1 supervisor, and 1 driver) were trained. Each team
spent up to 3 days for data collection at each health facility. The interviewer roles were as
follows: Interviewer #1 was responsible for conducting exit interviews for all fever cases and
Myanmar Artemisinin Resistance Containment Baseline Survey 27
malaria cases at health facilities. Interviewer #2 conducted the checklist for the health facility,
staff details, and health facility, laboratory, and pharmacy inventories. Interviewer #3 did
follow-up malaria cases recorded in the register in the previous 3 months including
administering the questionnaire for private providers within the catchment area of the public
health facility.
ETHICAL CONSIDERATIONS
Individual informed consent was sought from all respondents before interviews were
conducted. Before each interviewee was asked to give consent, the interviewer gave a brief
description of the study objectives, the data collection procedure, the expected benefits, and
the voluntary nature of participation at all stages of the interview. Community consent was
obtained by holding a meeting with the village and commune leaders prior to the scheduled
visit to the study villages, informing them of the purpose and procedures involved and
obtaining their agreement. Assurances were given to all participants that data would be kept
private and confidential.
DATA PROCESSING AND ANALYSIS
Data entry for all survey data was done using Epidata 3.1, with the exception of slide readings which were recorded in Microsoft Excel. Double entry was done for all data and appropriate verification and validation carried out. All data was transferred to Stata 12.0 (StataCorp LP, College Station, TX USA) for data processing and analysis. After initial data cleaning and consistency checks, data were re-coded and key indicators generated using pre-defined definitions.
After this re-code stage, all household data analysis were adjusted for the survey design, i.e. clustering, and sample strata and sample weights at the household level and individual level were applied as appropriate. Analysis focused on key indicators providing overall estimates by background characteristics including tier, risk category and socioeconomic status (wealth quintiles).
A wealth index was obtained for each household in the survey based on household characteristics and assets using principle components analysis (PCA). All variables input to the PCA were itemized and the first component was used as the wealth index. Households were then classified into five wealth index quintiles and these were used as the relative socioeconomic groups. Wealth quintiles were calculated separately for each tier. The household quintile was applied to an individual for individual level analysis.
Sample weights
Within each tier, the sampling of clusters was non-proportional across risk categories;
therefore the sample data for the household survey was non-self-weighting. All household
survey analysis accounted for sample weights within each tier together with adjustment for
clusters and sampling strata, i.e. risk category strata. In addition, for the prevalence survey
Myanmar Artemisinin Resistance Containment Baseline Survey 28
where individuals were sampled for 4 different age and sex groups (under 5 years, 5 to 14
year olds, adult males (15+ years), and adult females (15+ years)), additional weighting was
required. Analysis of prevalence survey data accounts for these individual weights.
Myanmar Artemisinin Resistance Containment Baseline Survey 29
RESULTS
ISSUES TO CONSIDER
1. Representativeness. The intention of this data collection was to obtain information from
households on malaria prevalence and other malaria indicators that would be statistically
representative of the population in the Containment areas (Tier 1 vs. Tier 2 excluding
Kachin State). In order to achieve such representativeness, the sampling methodology
involved a two stage cluster sampling which is similar to those used in standard national
surveys as Malaria Indicator Cluster Surveys (MICS) and Demographic Health Surveys
(DHS).
2. Accessibility. A total of 16 out of 80 clusters (20%) were considered inaccessible due to
security concerns during the period of the survey. These clusters were then systematically
replaced, selecting randomly another cluster with the same tier and risk category.
However, one could expect the population living in inaccessible villages to be more prone
to get malaria due to poorer access to health care. As a result, it may be likely that the true
malaria prevalence presented in Tier 1 and Tier 2 may be under-estimated.
3. Sampling of individuals. The prevalence survey aimed at collecting blood from one
individual in each of the following age group in every household: children from 1-4,
children from 5 to 14, female over 15 and male over 15. Considering any household with
any individual in these categories, the theoretical sample size for the prevalence survey
was 5509. Overall, 5264 blood samples were collected and analysed, which means that
245 samples or 4.4% of the target were missed.
4. Risk stratification. Clusters were sampled using the malaria risk stratification performed
in 2007-2008 and based on ecological factors and long term malaria data. However, it is
likely that this stratification was not truly representative of the true malaria risk of the
population at the time of the survey (for example due to deforestation) given that this data
was already outdated. But it seems reasonable to suspect that any alteration of risk
stratification would rather occur in lower malaria risk area first as these were more
accessible. As clusters were purposely oversampled in higher risk area, this factor is
unlikely to have significantly impacted on the precision of the prevalence estimate.
5. Seasonality. Data collection occurred between mid-December 2011 through mid-
February 2012 towards the tail-end of the usual malaria transmission season. This will
inevitably affect the malaria prevalence based on traditional blood smears. However, this
survey included molecular analysis of samples to be able to detect low and sub-
microscopic parasitemia and even serological measures for transmission. Furthermore, it
is also important to balance the fact that collecting data during the dry season allowed
field teams to access villages that were likely to be in hard-to-reach area during the rainy
season.
6. Migrants and mobile populations. These populations are often most vulnerable and
most difficult to sample from. Although this survey attempted to include questionnaires
for mobile populations (including temporary visitors and those who go to the forest), the
Myanmar Artemisinin Resistance Containment Baseline Survey 30
design of the household survey was not intended to specifically address this population.
More specialized survey methodologies may be needed.
HOUSEHOLD AND PREVALENCE SURVEYS
1.1 Characteristics of the sample and summary results
Figure 1.1.1: Selected clusters of the baseline survey
Myanmar Artemisinin Resistance Containment Baseline Survey 31
Table 1.1.1 Denominators for households and sampled individuals
TOTAL Tier 1 Tier 2
N (100%) N (%) N (%)
Households 1992 997 (50.1) 995 (49.9)
People in households 9408 4612 (49.0) 4796 (51.0)
Under 5 years 886 405 (45.7) 481 (54.3) 5 to 14 year olds 2280 1065 (46.7) 1215 (53.3)
Male adults, 15+ years 2782 1383 (49.7) 1399 (50.3)
Female adults, 15+ years 3460 1759 (50.9) 1701 (49.1)
Currently pregnant (% of all eligible women)
74 33 (44.6) 41 (55.4)
Household nets: Any type of mosquito net ITN8 LLIN9
5986 1248 313
3011 (50.3) 690 (55.3) 147 (47.1)
2975 (49.7) 558 (44.7) 166 (52.9)
People who go to the forest and sleep overnight
453 167 (36.9) 286 (63.1)
People who travel and sleep away from home (past 6 months)
730 304 (41.6) 426 (58.4)
Temporary visitors in the household
124 42 (33.9) 82 (66.1)
People who reported fever in the previous two weeks
241 128 (53.1) 113 (46.9)
Blood samples taken for microscopy
5264 2557 (48.6) 2707 (51.4)
Number of drug outlets 120 61 (50.8) 59 (49.2)
A total of 1992 households were interviewed, which corresponds to 99.6% response rate of
the target sample size of 2000 households. The two tiers appeared quite different in terms of
basic demographic characteristics and distribution. The population living in the sampled
households appeared to be younger and more mobile in Tier 2 compared to Tier 1 and
included a larger proportion of pregnant women. More ITNs were found in the households of
Tier 1 while a larger proportion of LLIN were found in Tier 2. Finally, more people reported
fever in the previous two weeks in Tier 1.
8 ITN = insecticide-treated net, which includes recently treated and LLINs 9 LLIN = long lasting insecticide-treated net
Myanmar Artemisinin Resistance Containment Baseline Survey 32
Table 1.1.2 Age and sex distribution of residents, visitors, people who travel away from home, and people who go to the forest
TOTAL < 5 years 5-14 years 15+ years Males
15+ years Females
N % (N) % (N) % (N) % (N)
Total (N=9408)
Usual residents 9282 9.4 (877) 24.3 (2258) 29.4 (2729) 36.8 (3418)
Temporary visitors 124 7.3 (9) 17.0 (21) 41.9 (52) 33.9 (42) Travel away from home
730 3.8 (28) 8.2 (60) 53.7 (392) 34.2 (250)
Go to the forest 453 2.4 (11) 4.9 (22) 74.4 (337) 18.3 (83)
Tier 1 (N=4612)
Usual residents 4570 8.8 (403) 23.1 (1057) 29.9 (1367) 38.1 (1743)
Temporary visitors 42 4.8 (2) 19.1 (8) 38.1 (16) 38.0 (16)
Travel away from home
304 2.3 (7) 7.9 (24) 56.3 (171) 33.5 (102)
Go to the forest 167 4.8 (8) 3.0 (5) 72.5 (121) 19.8 (33)
Tier 2 (N=4796)
Usual residents 4712 10.1 (474) 25.5 (1201) 28.9 (1362) 35.5 (1675)
Temporary visitors 82 8.5 (7) 15.9 (13) 43.9 (36) 31.7 (26) Travel away from home
426 4.9 (21) 8.4 (36) 51.9 (221) 34.7 (148)
Go to the forest 286 1.0 (3) 5.9 (17) 75.5 (216) 17.5 (50)
Although not designed to specifically address indicators for mobile and migrant populations, this survey attempted to include as many migrant and mobile populations as possible. These included temporary visitors, those who traveled from their home within the past 3 months, and those who had spent the night in the forest. The distribution of those sampled was not significantly different among the different age and sex groups, and between tiers. Although it should be noted that there appeared to be slightly higher proportions of “mobile populations” (defined as temporary vistors, recent travelers, and those who spent the night in the forest) in Tier 2 (16.6%) compared to Tier 1 (11.1%).
Table 1.1.3 Details of temporary visitors in households
Temporary Visitors TOTAL (N=124) Tier 1 (N=42) Tier 2 (N=82)
% (N) % (N) % (N)
Length of time in the village < 1 month 1–2 months 3–6 months > 6 months
37.5 (45) 19.2 (23) 15.0 (18) 28.3 (34)
33.3 (14) 23.9 (10) 21.4 (9) 21.4 (9)
39.7 (31) 16.6 (13) 11.5 (9)
32.1 (25)
Reason to travel in the village Work (arranged before arrival) Look for work Make new home Visit relatives Other
18.5 (23) 0.8 (1) 4.9 (6)
56.5 (70) 19.4 (24)
23.8 (10) 0.0 (0) 9.6 (4)
45.3 (19) 21.4 (9)
15.8 (13) 1.2 (1) 2.4 (2)
62.2 (51) 18.3 (15)
Intention of length of stay
Myanmar Artemisinin Resistance Containment Baseline Survey 33
< 2 weeks 2–4 weeks 1–3 months 3–6 months 6–12 months > 12 months Not sure
21.8 (27) 9.7 (12)
19.4 (24) 6.4 (8) 0.8 (1)
12.1 (15) 29.8 (37)
31.0 (13) 2.4 (1)
16.7 (7) 4.7 (2) 0.0 (0)
14.3 (6) 30.9 (13)
17.1 (14) 13.4 (11) 20.7 (17)
7.3 (6) 1.2 (1)
11.0 (9) 29.2 (24)
Intention to travel next
Return home Work in this province Work in another province Other Don't Know
88.7 (110) 1.6 (2) 2.4 (3) 4.8 (6) 2.4 (3)
90.5 (38) 0.0 (0) 7.1 (3) 0.0 (0) 2.4 (1)
87.8 (72) 2.4 (2) 0.0 (0) 7.3 (6) 2.4 (2)
Travelled abroad during 2011
Thailand 5.6 (7) 2.4 (1) 7.3 (6)
Most of the temporary visitors were in the selected villages for a month or more and the main
reason was to visit relatives. Tier 1 had a higher proportion of visitors coming for work reason
compared to Tier 2. About thirty percent were not sure how long they would stay but in Tier
1, visitors intended to stay for a shorter period than in Tier 2. The vast majority of visitors
intended to return home, although in Tier 1 some visitors planned to work in another
province. This may suggest that many of the temporary visitors were there more for economic
reasons and may reinforce the transient nature of this highly mobile population.
Of those who travelled abroad in 2011, only a few (5.6%) had visited Thailand but the
proportion was slightly higher for Tier 2.
Table 1.1.4 Details of people in households who go to the forest and sleep overnight
TOTAL (N=453) Tier 1 (N=167) Tier 2 (N=286)
% (N) % (N) % (N)
Last visit to the forest
Last night < 1 week 1 to < 4 weeks ≥ 4 weeks Not sure
23.0 (104) 28.0 (127) 18.6 (84)
28.5 (129) 2.0 (9)
29.3 (49) 26.9 (45) 10.8 (18) 31.1 (52)
1.8 (3)
19.2 (55) 28.7 (82) 23.1 (66) 26.9 (77)
2.1 (6)
Number of nights in the forest (last visit)
1–2 3–5 6–10 > 10 Not sure
22.7 (103) 22.1 (100) 22.3 (101) 22.5 (102) 10.4 (47)
17.9 (30) 19.1 (32) 16.2 (27) 32.9 (55) 13.8 (23)
25.5 (73) 23.8 (68) 25.9 (74) 16.4 (47) 8.4 (24)
The pattern of population mobility for forest goers seemed more frequent and for longer
periods in Tier 1 compared to Tier 2 (although there were more in Tier 2), suggesting that Tier
1 may have clusters that could be closer to the forest.
Myanmar Artemisinin Resistance Containment Baseline Survey 34
Table 1.1.5 Details of usual residents away for more than 6 months
TOTAL (N=1139) Tier 1 (N=495) Tier 2 (N=644)
% (N) % (N) % (N)
Age & sex
< 5 years 5 to 14 years 15+ male 15+ female
0.4 (5) 4.8 (55)
56.4 (642) 38.4 (437)
0.8 (4) 5.5 (27)
56.8 (281) 37.0 (183)
0.2 (1) 4.3 (28)
56.1 )361) 39.4 (254)
Education level
No education Some primary Completed primary Some secondary Completed secondary More than secondary
11.6 (132) 25.3 (288) 15.7 (179) 22.1 (252)
6.8 (78) 18.4 (210)
7.3 (36) 20.8 (103) 23.2 (115) 22.4 (111)
8.1 (40) 18.2 (90)
14.9 (96) 28.7 (185)
9.9 (64) 21.9 (141)
5.9 (38) 18.6 (120)
Reason for absence
Working on farm or forest Working in other township Working in Thailand Studying Holidays Other Not sure
2.7 (31) 16.7 (190) 66.5 (758)
7.6 (87) 1.1 (12) 3.6 (41) 1.8 (20)
3.6 (18) 19.8 (98)
61.2 (303) 8.5 (42) 0.8 (4)
2.4 (12) 3.6 (18)
2.0 (13) 14.3 (92)
70.6 (455) 7.0 (45) 1.2 (8)
4.5 (29) 0.3 (2)
The level of education of the usual resident that were absent for more than six months in Tier
1 was higher than in Tier 2 and the reason for absence was more likely to be to work or study
in the country; while in Tier 2, there were more people working in Thailand. This confirms
that the travelling habits in Tier 1 appeared shorter and more frequent compared to Tier 2. It
is also interesting to note that there were similar numbers of people moving out of the target
area than moving in (1317 considered as mobile population versus 1139 usual residents
absent for more than six months).
MALARIA PREVALENCE AND FEVER
Table 1.2.1 Malaria prevalence by species and zone, and reported fever by Tier
TOTAL (N=5264)
Tier 1 (N=2557)
Tier 2 (N=2707)
P-value*
% (N) 95% CI % (N) 95% CI % (N) 95% CI
Slides
Total Positive 0.5 (24) 0.3 to 0.8 0.8 (20) 0.4 to 1.6 0.1 (4) 0.0 to 0.4 0.01
P. f. prevalence 0.1 (7) 0.1 to 0.3 0.2 (4) 0.0 to 0.5 0.1 (3) 0.0 to 0.5 0.02
P. v prevalence 0.3 (14) 0.1 to 0.6 0.5 (13) 0.2 to 1.1 0.0 (1) 0.0 to 0.3
Species among positive slides (N=24)
P. falciparum 29.2 (7) 14.0 to 51.0 20.0 (4) 9.0 to 39.0 75.0 (3) 15.1 to 98.1 0.20
P. vivax 58.4 (14) 38.1 to 76.2 65.0 (13) 47.3 to 79.4 25.0 (1) 1.9 to 84.9
Myanmar Artemisinin Resistance Containment Baseline Survey 35
Not sure 12.4 (3) 3.0 to 39.4 14.9 (3) 3.4 to 46.6 0.0 (0) -
Fever in the household previous 2 weeks
Yes 2.6 (241) 2.1 to 3.1 2.8 (128) 2.1 to 3.7 2.4 (113) 1.9 to 2.9 0.37
* Comparison of Tier 1 and Tier 2
The overall proportion of positive slides was 0.5% and it is interesting to note that the
prevalence of Plasmodium vivax infections was higher than Plasmodium falciparum, although
this difference was not significant. The comparison by tier tells us that the malaria prevalence
was higher in Tier 1 and this was true for both malaria species. This trend was also observed
in reported prevalence of fever in the previous two weeks.
Looking at malaria species among the positive slides tells us that P. vivax accounted for the
highest proportion overall in Tier 1 while in Tier 2 this pattern was reversed. It is worth
noting that none of the cases had a mix infection of Pf and Pv.
Table 1.2.2 Malaria species by age/sex and socioeconomic group
Number of blood samples
Total positive % (N)
P-value P. falciparum % (N)
P. vivax % (N)
Not sure % (N)
Age group
< 5 years 562 1.3 (5) 0.05* 22.2 (1) 55.7 (3) 22.0 (1)
5 to 14 years 1152 0.6 (8) 0.0 (0) 100 (8) 0.0 (0)
Male 15+ years 1595 0.6 (7) 40.8 (4) 48.3 (2) 10.9 (1)
Female 15+ years 1955 0.3 (4) 28.8 (2) 17.1 (1) 54.1 (1)
SES
Q1 (poorest) 1076 1.3 (9) 0.28 23.6 (4) 45.5 (3) 30.9 (2)
Q2 1093 0.4 (4) 75.1 (2) 24.9 (2) 0.0 (0)
Q3 1037 0.9 (5) 0.0 (0) 100 (5) 0.0 (0)
Q4 1044 0.3 (4) 26.1 (1) 73.9 (3) 0.0 (0)
Q5 (least poor) 1014 0.3 (2) 0.0 (0) 44.7 (1) 55.3 (1)
* Significant at p<0.05
Malaria infection was higher among young children under 5 and this association was of
borderline significance. This is interesting compared to Thailand and Cambodia where adults
had higher prevalence rates. This suggests that local transmission may still be occuring in the
studied area.
As expected, people living in households in the poorest wealth quintile had a higher
probability to have a positive slide.
The interpretation of low numbers of positive slides should consider that data were collected
during the season of low malaria transmission. Often, in South East Asia, higher rates of P.
Myanmar Artemisinin Resistance Containment Baseline Survey 36
falciparum can be observed in higher transmission setting while as transmission decreases,
rates of P. vivax increases but this was not evident in these data.
Table 1.2.3 Malaria species by State/Division
State/Division Number of blood samples
Total positive % (N)
P. falciparum % (N)
P. vivax % (N)
Not sure % (N)
Bago 1167 0.3 (3) 100 (3) - -
Kayah 115 0.0 (0) - - -
Kayin 1496 0.1 (1) - 100 (1) -
Mon 1557 0.4 (6) 13.6 (1) 38.6 (3) 47.7 (2)
Tanintharyi 929 1.5 (14) 21.2 (3) 66.6 (10) 12.2 (1)
The most affected state in terms of malaria prevalence was Tanintharyi while in Kayah State,
there was no positive slide detected. It should be noted that these data presented by township
are interesting, but was not powered to be representative at township level.
Table 1.2.4 Determinants of a positive blood slide
Positive slides (N=5264)
% (N) 95% CI P value
Tier 1 (N=2557)
2 (N=2707)
1.1 (20) 0.1 (4)
0.4 to 2.5 0.0 to 0.2
<0.01*
Age and sex < 5 years (N=562)
5 to 14 years (N=1152) Male 15+ years (N=1595)
Female 15+ years (N=1955)
1.3 (5) 0.6 (8) 0.6 (7) 0.3 (4)
0.4 to 3.8 0.2 to 1.8 0.6 to 1.7 0.1 to 0.9
0.05
Wealth quintile Q1 (poorest) (N=1076)
Q2 (N=1093) Q3 (N=1037) Q4 (N=1044)
Q5 (least poor) (N=1014)
1.3 (9) 0.4 (4) 0.9 (5) 0.3 (4) 0.3 (2)
0.4 to 4.3 0.1 to 2.1 0.2 to 3.4 0.1 to 1.1 0.1 to 1.4
0.28
Go to the forest Yes (N=222)
No (N=5042)
0.8 (3)
0.6 (21)
0.2 to 3.0 0.3 to 1.6
0.80
Travel Yes (N=279) No (4985)
0.2 (1)
0.7 (23)
0.3 to 1.6 0.0 to 1.7
0.27
Myanmar Artemisinin Resistance Containment Baseline Survey 37
Reported fever in past 2 weeks
Yes (N=166) No (N=5098)
3.4 (7) 0.5 (17)
1.2 to 9.7 0.2 to 1.4
<0.01*
Used any net the previous night
Yes (N=4280) No (N=984)
0.5 (16) 1.4 (8)
0.2 to 1.2 0.5 to 3.7
<0.01*
Risk category 1a (N=1634) 1b (N=1324) 1c (N=1049)
2 (N=775) 3 (N=482)
2.9 (15) 0.4 (8) 0.0 (0) 0.0 (0) 0.0 (1)
1.3 to 6.4 0.2 to 0.8
- -
0.0 to 0.4
0.23
* Significant at p<0.05
Living in Tier 1 and living in a household in a higher malaria risk category significantly
increased the risk of having a positive slide for malaria. Other patterns can be observed
although these are not statistically significant. Proportions of positive slides appeared to
increase across age category, with female adults having the lower chance of having a positive
chance. Unsurprisingly, the probably of a positive slide was also associated with poverty.
Interestingly, going to the forest increased slightly the chance of having a positive slide while
travelling away from home lowered the chance of being malaria positive. Finally, people who
reported fever in the previous two weeks had a higher proportion of positive slides as well as
those who did not use any net the previous night.
Table 1.2.5 Distribution of fever by socioeconomic group within Tiers
TOTAL (N=241)
Tier 1 (N=128)
Tier 2 (N=113)
P-value*
% (N) 95% CI % (N) 95% CI % (N) 95% CI
Prevalence of reported fever in the previous two weeks (N=9408)
Reported fever
2.6 (241) 2.1 to 3.1 2.8 (128) 2.1 to 3.7 2.4 (113) 1.9 to 2.9 0.37
Socioeconomic Group
Q1 (poorest) Q2 Q3 Q4 Q5 (least
poor)
24.9 (60) 25.3 (61) 18.3 (44) 17.0 (41) 14.5 (35)
17.1 to 34.9 17.9 to 34.5 13.6 to 24.1 11.9 to 23.8 9.4 to 21.7
21.1 (27) 34.4 (44) 14.8 (19) 16.4 (21) 13.3 (17)
12.7 to 33.0 23.2 to 47.6 9.4 to 22.7 9.9 to 26.0 7.3 to 22.8
29.2 (33) 15.0 (17) 22.1 (25) 17.7 (20) 15.9 (18)
16.9 to 45.6 8.1 to 26.1
14.5 to 32.2 10.5 to 28.2 8.4 to 28.2
0.13
* Comparison of Tier 1 and Tier 2
Fever within the past 2 weeks was positively associated with malaria slide positivity. The
prevalence of reported fever in the previous two weeks was similar across tiers. In general,
people living in poorer households tended to have higher risk of reporting fever in the
previous two weeks.
Myanmar Artemisinin Resistance Containment Baseline Survey 38
Table 1.2.6 Determinants of fever in the past two weeks
Tier 1 (N=4612) Tier 2 (N=4796)
N % 95% CI P-value N % 95% CI P-value
Age and sex < 5 years
5 to 14 years Male 15+ years
Female 15+ years
25 42 30 31
6.2 3.9 2.2 1.8
3.3 to 11.3 2.4 to 6.5 1.5 to 3.2 1.2 to 2.5
<0.01*
481 20 36 30
5.6 1.6 2.6 1.8
3.6 to 8.6 1.1 to 2.4 1.9 to 3.5 1.1 to 2.7
<0.01*
Wealth quintile Q1 (poorest)
Q2 Q3 Q4
Q5 (least poor)
28 43 19 21 17
3.2 4.5 2.0 2.3 1.8
2.2 to 4.8 3.1 to 6.6 1.1 to 3.6 1.4 to 3.8 1.0 to 3.2
<0.01*
33 17 25 20 18
3.5 1.8 2.6 2.0 1.8
2.3 to 5.2 1.1 to 3.1 1.7 to 4.0 1.3 to 3.0 1.0 to 3.2
0.12
Go to the forest Yes
No
5
123
3.0 2.8
1.3 to 6.7 2.0 to 3.7
0.86
17 96
5.9 2.1
3.0 to 11.3 1.7 to 2.7
<0.01*
Travel Yes
No
7
121
2.3 2.8
1.0 to 5.1 2.1 to 3.8
0.66
10
103
2.3 2.4
1.3 to 4.3 1.8 to 3.0
0.99
Used any net the previous night
Yes No
106 22
2.9 2.2
2.2 to 4.0 1.3 to 3.5
0.17
3605 1191
2.6 1.5
2.1 to 3.4 1.0 to 2.4
0.02*
Used any LLIN the previous night
Yes No
175 121
4.0 2.7
1.7 to 9.0 2.0 to 3.6
0.34
187 4609
1.6 2.4
0.4 to 6.8 1.9 to 3.0
0.57
Risk category 1a 1b 1c
2 3
53 35 17 17 6
3.7 3.1 1.9 2.3 1.5
2.8 to 4.8 1.4 to 6.7 0.8 to 4.5 1.2 to 4.3 0.5 to 3.9
0.39
42 26 26 9
10
3.0 2.1 2.8 1.2 2.2
2.0 to 4.3 1.1 to 4.0 2.1 to 3.8 0.7 to 2.0 1.4 to 3.4
0.16
* Significant at p<0.05
This table presents the determinants of reported fever prevalence in the previous two weeks, by tier. Age and sex appeared to be associated in both tier with prevalence of reported fever, with children under five having a significantly higher risk of reporting fever in the previous two weeks. Another association was found in Tier 2, across forest-goers category, with an increased risk of reporting fever among the group that goes to the forest.
Myanmar Artemisinin Resistance Containment Baseline Survey 39
MALARIA PREVENTION
Figure 1.3.1 Knowledge of causes of malaria transmission mentioned by Tier (N=1898)
Household respondents were asked to mention any transmission mode for malaria. Although
the vast majority answered “mosquito bites”, it is worth noting the multitude of erroneous
ideas on transmission modes also mentioned. A non-negligible proportion of respondents
cited transmission modes related to drinking or bathing in dirty or river water. Also, nearly
20% of respondents in each tier did not know any transmission mode, which is relatively high
and suggests a need for more specifically targeted behaviour change communication.
Figure 1.3.2 Knowledge of means of malaria prevention mentioned by tier (N=1898)
0%10%20%30%40%50%60%70%80%90%
100%
Tier 1
Tier 2
0%10%20%30%40%50%60%70%80%90%
100%
Tier 1
Tier 2
Myanmar Artemisinin Resistance Containment Baseline Survey 40
The main prevention method mentioned by respondents was “Sleeping under a net” and this
proportion was higher among respondents in Tier 1. This suggests that the population living in
the target area may not be familiar to a large extent with insecticide treated net and this seems
particularly true for Tier 2. This is triangulated with the relatively low knowledge of the
benefits of using an ITN (Figure 1.3.3). In terms of personal protection methods, the most
popular answer was “mosquito coil”, with more than 15% in Tier 1 and over 10% in Tier 2.
Similarly to the awareness of transmission modes, a significant proportion of respondents
(nearly 20% in Tier 1 and nearly 30% in Tier 2) did not mention or did not know any
prevention method at all.
Figure 1.3.3 Perceptions about ITN benefits mentioned by Tier (N=1898)
The three most mentioned benefits of using an ITN were “prevent mosquito bites”, “repels
mosquitoes” and “kills mosquitoes”. Awareness of ITN benefits appeared higher in Tier 1
although very few respondent mentioned “protects against malaria”.
Figure 1.3.4 Malaria messages seen or heard in past 6 months by Tier (N=241)
0%10%20%30%40%50%60%70%80%90%
100%
Tier 1
Tier 2
0%10%20%30%40%50%60%70%80%90%
100%
Tier 1
Tier 2
Myanmar Artemisinin Resistance Containment Baseline Survey 41
Overall, only 12.1% (N=241) of household respondents had heard or seen any message
about malaria in the past six months and this proportion was similar across tiers (Tier 1,
11.9% versus Tier 2, 12.3%) . Among those who received any information, the messages most
mentioned were related to the use of any net and any ITN. It also appeared that behaviour
change communication coverage may be higher in Tier 1.
Figure 1.3.5 Source of malaria messages mentioned by Tier (N=241)
The most popular source of information was health facility staff in both tiers and the second
most common source of message in Tier 1 was “NGO”.
Table 1.3.1 Summary of household ownership of mosquito nets
Number of House-holds
At least one mosquito net
Any Type Any ITN Any LLIN
% (95% CI) P-value
% (95% CI) P-value
% (95% CI) P- value
Total 1992 97.4 (95.1 to 98.7) - 35.1 (28.4 to 42.4) - 11.1 (7.3 to 16.4) -
Tier
1 2
997 995
96.6 (92.2 to 98.5) 98.3 (95.2 to 99.4)
0.30 39.3 (29.8 to 49.6) 30.8 (21.9 to 41.5)
0.24 10.9 (6.3 to 18.2) 11.3 (6.1 to 19.9)
0.93
Risk Category
1a 1b 1c 2 3
599 495 400 299 199
95.3 (88.2 to 98.2) 96.6 (89.4 to 98.9) 99.5 (98.2 to 99.9) 99.3 (95.2 to 99.9) 99.0 (92.9 to 99.9)
0.10 55.1 (37.8 to 71.2) 41.6 (27.4 to 57.4) 19.0 (11.0 to 30.9) 23.1 (14.3 to 35.1)
9.0 (2.7 to 26.0)
0.01* 18.9 (10.1 to 32.7) 13.1 (5.6 to 27.7)
2.5 (1.4 to 4.5) 9.7 (4.3 to 20.3) 1.5 (0.5 to 4.1)
0.01*
Socioeconomic Group
Q1 (poorest) Q2 Q3 Q4 Q5 (least poor)
399 398 399 398 398
94.0 (86.0 to 97.5) 96.7 (93.0 to 98.5) 98.5 (96.2 to 99.4) 99.5 (97.9 to 99.9) 98.5 (96.4 to 99.4)
0.01* 41.0 (28.8 to 54.5) 38.2 (28.3 to 49.1) 34.3 (25.9 to 43.8) 33.2 (26.0 to 41.3) 28.6 (22.0 to 36.3)
0.18 14.8 (8.5 to 24.4) 13.6 (7.5 to 23.4) 11.0 (6.4 to 18.4) 10.3 (6.1 to 16.9)
5.5 (3.4 to 8.9)
0.05
* Significant at p<0.05
Although a vast majority of households (97.4%) possessed at least one mosquito net on the
survey day, ownership of any ITN was much lower (35.1%) and this was even more marked
0%10%20%30%40%50%60%70%80%90%
100%
Tier 1
Tier 2
Myanmar Artemisinin Resistance Containment Baseline Survey 42
for any LLIN (11.1%). While coverage of any net appeared similar across tier and risk
category, there was a positive association with wealth. Coverage of any ITN and LLN showed a
significant association with risk category, suggesting that ITN and LLN distribution were more
intense in higher malaria risk areas. It is interesting to note that household ownership of any
ITN and LLIN was higher among poorer households and this trend was significant for any
LLIN. This probably reflects the free or subsidized distributions in the target areas by the
national malaria programme or non-governmental partners. Given the greater protection
provided by an insecticide-treated net, the strong culture of net ownership may provide a
great opportunity to shift from untreated to treated mosquito nets.
Table 1.3.2 Summary of household ownership of sufficient mosquito nets
Number of House-holds
Sufficient Nets (i.e., 2 people/net)
Any Type ITN LLIN
% (95% CI) P-value
% (95% CI) P-value
% (95% CI) P-value
Total 1992 73.2 (68.6 to 77.4) - 13.1 (9.9 to 17.3) - 3.0 (1.7 to 5.0) -
Tier
1 2
997 995
73.8 (65.3 to 80.8) 72.7 (68.2 to 76.7)
0.80 15.2 (10.2 to 22.2) 11.0 (7.3 to 16.4)
0.26 3.0 (1.4 to 6.3) 2.9 (1.4 to 6.0)
0.94
Risk Category
1a 1b 1c 2 3
599 495 400 299 199
65.9 (55.9 to 74.6) 72.4 (61.9 to 80.8) 80.3 (72.1 to 86.5) 71.9 (58.0 to 82.6) 85.4 (78.2 to 90.6)
0.05 20.3 (12.2 to 32.0) 13.5 (9.1 to 19.6) 11.0 (5.3 to 21.6) 7.4 (3.6 to 14.4) 3.5 (0.7 to 15.1)
0.03* 6.2 (2.8 to 13.0) 2.2 (1.0 to 4.9)
0.0 (-) 3.7 (1.7 to 7.7)
0.0 (-)
0.01*
Socioeconomic Group
Q1 (poorest) Q2 Q3 Q4 Q5 (least poor)
399 398 399 398 398
60.6 (51.2 to 69.3) 66.1 (59.4 to 72.2) 76.9 (70.8 to 82.1) 78.1 (72.2 to 83.1) 84.4 (80.2 to 87.9)
0.01* 17.8 (11.1 to 27.2) 13.8 (9.3 to 20.1) 12.3 (8.2 to 18.0) 9.3 (6.3 to 13.6)
12.6 (8.2 to 18.8)
0.12 4.8 (2.5 to 9.0) 4.0 (1.9 to 8.5) 3.3 (1.5 to 6.9) 1.8 (0.9 to 3.6) 1.0 (0.2 to 4.7)
0.07
* Significant at p<0.05
Although nearly three quarters (73.2%) of the sampled households owned at least one
mosquito net for every two people, very few reached universal coverage target with LLIN
(3.0%). A similar trend for household coverage of any type of mosquito net was observed.
Table 1.3.3 Characteristics of household nets
TOTAL Tier 1 Tier 2
N Mean ± SD (95% CI)
N Mean ± SD (95% CI)
N Mean ± SD (95% CI)
Number of nets in household
5986 3.08 ± 0.08 (2.93 to 3.23)
3011 3.13 ± 0.12 (2.87 to 3.38)
2975 3.04 ± 0.09 (2.87 to 3.21)
Age of net
< 6 months 6 mo to < 1 year 1 year to < 2 years 2 years to < 3 years 3 years to < 5 years ≥ 5 years Not sure
695 841
1456 1050 853
1036 55
11.6 14.1 24.3 17.5 14.2 17.3 0.9
406 541 775 502 383 381 23
13.5 18.0 25.7 16.7 12.7 12.7 0.8
289 300 681 548 470 655 32
9.7 10.1 22.9 18.4 15.8 22.0 1.1
Source of net
Myanmar Artemisinin Resistance Containment Baseline Survey 43
Gift (family/friend) Government NGO Shop/Market Itinerant seller Other Not sure
302 427 419
4236 525 68 9
5.0 7.1 7.0
70.8 8.8 1.1 0.2
133 221 248
2205 151 51 2
4.4 7.3 8.2
73.2 5.0 1.7 0.1
169 206 171
2031 374 17 7
5.7 6.9 5.7
68.3 12.6 0.6 0.2
Price of net
No cost < 4,000 4,000 to < 12,000 12,000 or more Not sure
663 1400 1388 1386 1149
11.1 23.4 23.2 23.2 19.2
410 667 690 647 597
13.6 22.2 22.9 21.5 19.8
253 733 698 739 552
8.5 24.6 23.5 24.8 18.6
Type of net
LLIN: Powernet Permanet JICA MoH Olyset CONVENTIONAL: Lace Military No logo Cotton CYC Other
8
166 1 4
222
3249 207 377
1021 731
0.1 2.8 0.0 0.1 3.7
54.3 3.5 6.3
17.1 12.2
2
104 0 2
77
1852 89
104 417 364
0.1 3.5 0.0 0.1 2.6
61.5 3.0 3.4
13.8 12.1
6
62 1 2
145
1397 118 273 604 367
0.2 2.1 0.0 0.1 4.9
47.0 4.0 9.2
20.3 12.3
Holes in net (based on asking respondent if net has any holes)
Yes No
1190 4796
19.9 80.1
478 2533
15.9 84.1
712 2263
23.9 76.1
Net repaired
Yes No
616 5370
10.3 89.7
235 2776
7.8 92.2
381 2594
12.8 87.2
Frequency washed
Never Weekly Every 2-3 weeks Monthly Every 2 - 3 months Twice per year Once a year < once a year Not sure
1008 500 998
1516 1013 490 254 66
141
16.8 8.4
16.7 25.3 16.9 8.2 4.2 1.1 2.4
576 284 509 814 459 180 79 39 71
19.1 9.4
16.9 27.0 15.2 6.0 2.6 1.3 2.4
432 216 489 702 554 310 175 27 70
14.5 7.3
16.4 23.6 18.6 10.4 5.9 0.9 2.4
Used last night
Yes No
3566 2416
59.6 40.4
1865 1145
61.9 38.0
1701 1271
57.2 42.7
Any old nets not being used for sleeping? (N=1941 households)
Yes No Not sure
321 1618
2
16.5 83.4 0.1
148 814
1
15.4 84.5 0.1
173 804
1
17.7 82.2 0.1
What are these old nets being used for? (N=321 households)
Saving for visitors Fishing Protect garden Protect animals Other
214 6 6 7
143
66.7 1.9 1.9 2.2
44.5
102 4 5 4
51
68.9 2.7 3.4 2.7
34.5
112 2 1 3
92
64.7 1.2 0.6 1.7
53.2
Any new nets not being used for sleeping? (N=1941 households)
Yes No
678 1262
34.9 65.0
379 583
39.4 60.5
299 679
30.6 69.4
Why aren't these new nets being used? (N=678 households)
Saving for visitors Saving for future No place to hang Have enough nets
374 184
5 115
55.2 27.1 0.7
17.0
214 101
4 60
56.5 26.6 1.1
15.8
160 83 1
55
53.5 27.8 0.3
18.4
Myanmar Artemisinin Resistance Containment Baseline Survey 44
The average number of mosquito nets of any sort found among households surveyed
was 3.1 and was similar across tier. Half of these nets were less than 2 years old and it seemed
that in Tier 1, nets tended to be younger than in Tier 2. Also, it was interesting to see quite a
high number of very old nets still in use by the household members – nearly one-quarter of
mosquito nets used in Tier 2 were more than 5 years old!
A majority of the household nets (70%) were purchased from the shop or the market and half
of these were conventional, untreated nets. In Tier 1, a higher proportion of the nets were
given out freely (13.6 versus 8.5%). As expected, the vast majority of the nets were
conventional or untreated and nets tended to be in better condition or intact in Tier 1 than
Tier 2.
Similarly, washing frequency seemed higher in Tier 1 as well as the proportion of net used the
previous night. These observations suggest that net distributions recently focused primarily in
Tier 1. On the other hand, less than 20% of households reported owning any old net used for
other purpose while more than 30% possessed any new nets not currently used for sleeping.
The main reason for not using these old or new nets was to save them for future use or for
visitors, a habit that could have some benefit to limit malaria transmission among mobile
populations.
Table 1.3.4 Places to obtain or retreat a net
TOTAL (N=1992) Tier 1 (N=997) Tier 2 (N=995)
N % N % N %
Place to obtain a new net
Shop/seller in village Nearest market Itinerant seller Wait for distribution Would not buy other Other Don’t know where to buy Not sure
87 1563 265 10 41 9
16 1
4.4 78.5 13.3 0.5 2.1 0.5 0.8 0.1
38 819 112
3 10 4
11 0
3.8 82.2 11.2 0.3 1.0 0.4 1.1 0.0
49 744 153
7 31 5 5 1
4.9 74.8 15.4 0.7 3.1 0.5 0.5 0.1
Place to treat or retreat a net
Wait for health staff Go to health centre/hospital Private health facility NGO Pharmacy Market/shop VHM/VHV Net all pre-treated Don’t want insecticide Have no net Other School Pagoda Don’t know
301 230 57 27 9 6
43 6
100 10
122 6 6
1069
15.1 11.5 2.9 1.4 0.5 0.3 2.2 0.3 5.0 0.5 6.1 0.3 0.3
53.7
155 135 44 24 4 2
16 3
26 9
33 6 2
538
15.6 13.5 4.4 2.4 0.4 0.2 1.6 0.3 2.6 0.9 3.3 0.6 0.2
54.0
146 95 13 3 5 4
27 3
74 1
89 0 4
531
14.7 9.5 1.3 0.3 0.5 0.4 2.7 0.3 7.4 0.1 9.0 0.0 0.4
53.4
Most households mentioned a private source to obtain a new mosquito net, mainly a
shop or the market or an itinerant seller. On the other hand, more than half of respondents did
Myanmar Artemisinin Resistance Containment Baseline Survey 45
not know where to go to retreat their net and the most popular places mentioned were “wait
for health staff” or “go to health centre or hospital”.
Table 1.3.5 Household ownership of nets by State
State Number House- holds
At least one mosquito net Sufficient nets
% (95% CI)
Sufficient ITN
% (95% CI) Any type
% (95% CI) LLIN
% (95% CI)
Bago Kayah Kayin Mon Tanintharyi
425 46
549 622 350
99.5 (96.7 to 99.9) 100 (-)
97.3 (91.8 to 99.1) 99.8 (98.8 to 100) 90.5 (80.3 to 95.7)
7.8 (2.5 to 21.3) 4.3 (1.2 to 14.9)
14.4 (6.5 to 28.9) 15.0 (8.3 to 25.6)
3.7 (1.8 to 7.5)
75.8 (70.8 to 80.1) 65.2 (50.2 to 77.8) 70.5 (63.3 to 76.8) 85.8 (81.5 to 89.3) 53.1 (36.6 to 69.0)
4.7 (1.9 to 11.3) 17.4 (15.4 to 19.6) 15.3 (9.4 to 23.8)
20.1 (13.4 to 29.0) 7.1 (2.9 to 16.6)
Household ownership of nets by State/Division tells us that Mon and Kayin States had the
highest coverage of any LLIN ownership, reaching respectively 15.0% and 14.4%, perhaps due
to the high numbers of NGOs operating in these areas.
Table 1.3.6 Summary of mosquito net usage (previous night) by target populations
N TOTAL % (95% CI)
Tier 1 % (95% CI)
Tier 2 % (95% CI)
P-value*
Any Net
All people 9408 76.5 (72.9 to 79.8) 78.0 (72.2 to 82.8) 75.2 (70.2 to 79.5) 0.43
Under 5 years 886 82.8 (78.2 to 86.7) 81.2 (74.3 to 86.6) 84.2 (77.6 to 89.1) 0.48
Pregnant women 74 77.0 (66.6 to 84.9) 81.8 (63.5 to 92.1) 73.1 (60.0 to 83.2) 0.37
People who go to the forest
453 53.0 (44.9 to 60.8) 47.3 (36.9 to 58.0) 56.3 (45.2 to 66.7) 0.25
People who travel away from home
730 44.8 (38.1 to 51.7) 34.5 (24.8 to 45.8) 52.1 (43.7 to 60.4) 0.01*
Temporary visitors 124 57.3 (43.1 to 70.3) 57.1 (36.0 to 75.9) 57.3 (39.0 to 73.8) 0.99
ITN
All people 9408 15.9 (12.4 to 20.3) 18.8 (13.7 to 25.2) 13.2 (8.5 to 19.7) 0.17
Under 5 years 886 19.4 (14.6 to 25.4) 21.3 (14.9 to 29.4) 17.9 (11.2 to 27.3) 0.54
Pregnant women 74 20.3 (12.5 to 31.1) 21.2 (10.3 to 38.8) 19.5 (10.0 to 34.5) 0.85
People who go to the forest
453 12.1 (7.4 to 19.2) 14.4 (8.2 to 24.1) 10.8 (5.0 to 21.8) 0.53
People who travel away from home
730 11.4 (7.4 to 17.1) 9.9 (5.6 to 16.7) 12.4 (6.8 to 21.5) 0.56
Temporary visitors 124 10.5 (4.9 to 21.0) 23.7 (9.7 to 47.5) 3.7 (0.8 to 15.4) 0.01*
LLIN
All people 9408 3.9 (2.4 to 6.1) 3.8 (1.9 to 7.4) 3.9 (2.0 to 7.4) 0.96
Under 5 years 886 5.3 (3.1 to 9.0) 5.0 (2.1 to 11.5) 5.6 (2.8 to 11.0) 0.83
Pregnant women 74 4.1 (1.2 to 12.4) 3.0 (0.4 to 20.3) 4.9 (1.2 to 18.5) 0.70
People who go to the forest
453 1.8 (0.7 to 4.2) 1.2 (0.3 to 4.9) 2.1 (0.7 to 6.0) 0.53
People who travel away from home
730 1.0 (0.3 to 2.8) 0.7 (0.1 to 4.5) 1.2 (0.3 to 4.4) 0.62
Temporary visitors 124 1.6 (0.4 to 6.8) 2.4 (0.3 to 17.1) 1.2 (0.2 to 9.0) 0.64
*Comparison between Tier 1 and 2, significant at p<0.05
In general, groups traditionally considered as most vulnerable for malaria (children under five
and pregnant women) had the highest proportion of net use in the survey. Also, estimates of
any net, ITN, and LLIN use among all people, under five and pregnant women appeared not to
differe significantly across tier.
Myanmar Artemisinin Resistance Containment Baseline Survey 46
Considering “mobile” groups in general, mosquito net use was the highest among temporary
visitors, then forest goers and finally travellers, for any mosquito net. However, ITN and LLIN
use was higher among forest goers. This could potentially reflect the rise in awareness about
malaria risk among households owning insecticide treated nets, assuming these nets were
more recent.
Table 1.3.7 Determinants of the use of any mosquito nets or insecticide-treated net
Slept under a mosquito net last night
Any Net P-value Any ITN P-value
N % (95% CI)
N % (95% CI)
Tier
1 2
4612 4796
78.0 (72.2 to 82.8) 75.2 (70.2 to 79.5)
0.43 4612 4796
18.8 (13.7 to 25.2) 13.2 (8.5 to 19.7)
0.17
Risk Category
1a 1b 1c 2 3
2859 2376 1810 1494 869
68.1 (59.6 to 75.5) 72.2 (64.0 to 79.2) 85.0 (79.9 to 89.0) 79.8 (70.3 to 86.8) 92.7 (89.0 to 95.3)
<0.01* 2859 2376 1810 1494 869
22.6 (14.8 to 32.8) 17.4 (11.2 to 26.1) 12.9 (6.7 to 23.5) 10.2 (4.9 to 20.1) 6.2 (1.3 to 25.0)
0.11
Socioeconomic Group
Q1 (poorest) Q2 Q3 Q4 Q5 (least poor)
1804 1873 1900 1900 1931
70.7 (62.4 to 77.7) 75.9 (70.6 to 80.5) 75.3 (69.6 to 80.3) 77.2 (72.6 to 81.2) 83.2 (77.7 to 87.5)
0.01* 1804 1873 1900 1900 1931
20.6 (13.9 to 29.4) 17.3 (12.2 to 23.9) 14.1 (9.8 to 19.8) 13.5 (9.5 to 18.9) 14.4 (9.5 to 21.2)
0.21
Age / Sex
< 5 years 5 to < 15 years Male 15+ years Female 15+ years
886 2280 2782 3460
82.8 (78.2 to 86.7) 77.5 (73.0 to 81.5) 69.9 (66.0 to 73.6) 79.6 (75.8 to 82.8)
<0.01* 886 2280 2782 3460
19.4 (14.6 to 25.4) 16.6 (12.6 to 21.6) 14.5 (11.3 to 18.3) 15.7 (12.1 to 20.2)
<0.01*
Goes to forest and sleeps overnight
Yes No
453 8955
53.0 (45.0 to 60.8) 77.7 (74.0 to 81.1
<0.01* 453 8955
12.2 (7.5 to 19.1) 16.1 (12.5 to 20.6)
0.20
Travels away from home
Yes No
730 8678
44.8 (38.1 to 51.7) 79.2 (75.6 to 82.4)
<0.01* 730 8678
11.4 (7.4 to 17.1) 16.3 (12.7 to 20.7)
0.03*
Residence
Usual Resident Temporary Visitor
9282 126
76.8 (73.2 to 80.1) 56.3 (42.6 to 69.2)
<0.01* 9282 126
16.0 (12.4 to 20.4) 10.3 (4.9 to 20.5)
0.21
Had fever past two weeks
Yes No
241 9167
83.4 (77.5 to 88.0) 76.4 (72.7 to 79.7)
0.01* 241 9167
19.9 (13.9 to 27.7) 15.8 (12.3 to 20.2)
0.11
Sufficient nets/LLINs10
Yes No
6083 3325
84.6 (81.6 to 87.1) 61.9 (56.3 to 67.1)
<0.01* 934 8474
16.9 (13.1 to 21.6) 14.1 (10.2 to 19.2)
0.15
Heard message about sleeping under a net/ITN (N=1203)
Yes No
692 511
80.3 (72.8 to 86.2) 70.9 (61.5 to 78.7)
0.05 360 843
37.0 (26.8 to 48.4) 28.1 (21.1 to 36.4)
0.16
*Significant at p<0.05
Several factors appeared to be associated with use of any mosquito net. People living in lower
malaria risk categories had higher mosquito net use proportions, probably reflecting better
socio-economic conditions and access to nets in these more accessible areas. Also, net use was
10 Sufficient net = at least one mosquito net for every two persons
Myanmar Artemisinin Resistance Containment Baseline Survey 47
higher among wealthier groups. It is encouraging to note that these trends disappeared or
even were reversed for use any ITN, even if this was not statistically significant.
Mobile groups including travelers, visitors, and forest goers had lower net use
proportions and children under five had a higher proportion compared to other age and sex
categories. Finally, net use was significantly associated with the availability of sufficient
quantity of nets at household level, encouraging increasing net ownership to reach
universal coverage, here defined as one net for every two people.
MALARIA TREATMENT
Table 1.4.1 Household respondents’ knowledge of malaria and danger signs by Tier
TOTAL (N=1992) Tier 1 (N=997) Tier 2 (N=995) P-value*
% (N) 95% CI % (N) 95% CI % (N) 95% CI
Know malaria11 47.3 (943)
44.5 to 50.2 52.8 (527) 48.3 to 57.3 41.8 (416) 38.2 to 45.5 0.01
Know serious fever12
30.4 (605)
27.2 to 33.7 37.3 (372) 32.2 to 42.7 23.4 (233) 19.7 to 27.5 0.01
* Significant at p<0.05
Household respondents were asked to mention any malaria sign or symptoms they could
recall. Overall, less than half (47.3%) cited both chills and fever as malaria signs. The
awareness of any sign of severity for fever cases was even lower with only 30.4% of
respondents that could mention any of the signs. Knowledge of malaria and danger signs was
significantly higher among Tier 1 respondents. These low rates suggest that BCC on the
malaria signs and symptoms and severe malaria could be further improved.
Figure 1.4.1 Knowledge of signs or symptoms of malaria mentioned by Tier (N=1898)
11 Know malaria if mention chills and fever among symptoms 12 Know at least one of three signs of fever severity: unconscious, fast breathing, convulsion
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Tier 1
Tier 2
Myanmar Artemisinin Resistance Containment Baseline Survey 48
Table 1.4.2 Respondent’s confirmation of signs and symptoms
TOTAL (N=1605) Tier 1 (N=845) Tier 2 (N=760) N % N % N %
Previous experience Symptoms Doctors examination HA/LVH/MW/PHS exam Blood test or RDT Other Don’t know
237 460 483 251 41 28
105
14.8 28.7 30.1 15.6 2.6 1.7 6.5
128 235 320 91 18 17 36
15.1 27.8 37.9 10.8 2.1 2.0 4.3
109 225 163 160 23 11 69
14.3 29.6 21.4 21.1 3.0 1.4 9.1
Overall, most respondents would confirm the signs and symptoms through a doctor’s
examination or they would judge based on their recognition of the symptoms. It is worth
noting that very few respondents mentioned confirmation via RDT or blood test (2.6%).
Figure 1.4.2 Recognition of symptoms of serious illness by Tier, among those who
know malaria signs (N=1605)
Nearly one-third of respondents did not know or could not recall at least one of the danger signs of severe malaria illness. Further BCC in this regard may be warranted.
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Tier 1
Tier 2
Myanmar Artemisinin Resistance Containment Baseline Survey 49
Table 1.4.3 Respondents’ knowledge of malaria treatment
TOTAL Tier 1 Tier 2
N % N % N %
Know names of specific malaria drug (N=1898)
Yes No
549 1349
28.9 71.1
309 656
32.0 68.0
240 693
25.7 74.3
Know correct duration of most of treatment (N=1073)
Less than 3 days 3 days More than 3 days
84 516 473
7.8 48.1 44.1
47 249 238
8.8 46.6 44.6
37 267 235
6.9 49.5 43.6
Know consequence of not respecting duration of treatment (N=1992)
Nothing Get sick again Does not recover Other Don’t know
45 605 774 39
432
2.3 30.4 38.8 2.0
21.7
27 381 326 11
217
2.7 38.2 32.7 1.1
21.8
18 224 448 28
215
1.8 22.5 45.0 2.8
21.6
Know consequence of not respecting dosage of treatment (N=1992)
Nothing Get sick again Does not recover Other Don’t know
44 601 798 25
428
2.2 30.2 40.0 1.3
21.5
17 396 313 10
217
1.7 39.7 31.4 1.0
21.8
27 205 485 15
211
2.7 20.6 48.7 1.5
21.2
Know any malaria drug not recommended anymore (N=1898)
Yes No
21 1877
1.1 98.9
8 957
0.8 99.2
13 920
1.4 98.6
The proportion of respondents’ knowledge of any antimalarial drug was low, with only 28.9%
being able to name any specific drug. Very few people were aware that some antimalarial
drugs are no longer recommended and this proportion was lower in Tier 2. However, the
majority knew that the duration of most treatment against malaria was at least three days or
more. The main consequences of not respecting treatment duration or dosage were thought to
be “get sick again” or “does not recover”. So in general, awareness on the ban on
monotherapies was low in both tiers.
Figure 1.4.3 Antimalarial drug mentioned by respondents by Tier (N=528)
0%10%20%30%40%50%60%70%80%90%
100%
Tier 1
Tier 2
Myanmar Artemisinin Resistance Containment Baseline Survey 50
Very few or less than 10% of respondents mentioned any ACT as antimalarial drug. The main
drugs cited were cocktail drugs (40% in Tier 1), chloroquine, and quinine. It is surprising that
cocktails were mentioned almost as frequently as chloroquine and quinine. Even of more
concer, artemisinin monotherapies were mentioned by more than 10% in both Tier 1
and Tier 2.
Table 1.4.4 Household respondents’ knowledge of providers for malaria diagnosis and treatment
TYPE OF PROVIDER Place to go for a test (N=1898)
Place to go for advice or treatment (N=1898)
Tier 1 (N=965) Tier 2 (N=933) Tier 1 (N=965) Tier 2 (N=933)
% (N) % (N) % (N) % (N)
VHW/HW in village - - 1.5 (14) 2.8 (26)
Malaria staff 1.2 (12) 1.3 (12) - -
VMW 3.1 (30) 1.9 (18) 2.0 (19) 1.0 (9)
Rural health centre 27.1 (262) 32.9 (307) 29.5 (285) 32.9 (307)
Township hospital 22.8 (220) 35.9 (335) 19.2 (185) 31.6 (295)
Private doctor 22.3 (215) 8.8 (82) 27.1 (261) 11.7 (109)
Midwife 10.7 (103) 7.5 (70) 11.2 (108) 8.2 (77)
Auxiliary midwife 3.6 (35) 4.2 (39) 3.5 (34) 5.0 (47)
Unlicensed practitioner 1.5 (14) 0.6 (6) 1.9 (18) 1.7 (16)
Drug store (drugs only) - - 0.3 (3) 0.9 (8)
Grocery shop - - 0.5 (5) 0.6 (6)
Private laboratory 2.6 (25) 0.6 (6) - -
Home treatment - - 0.9 (9) 1.3 (12)
Other 0.8 (8) 0. (3) 0.9 (9) 0.6 (6)
Don’t know 4.3 (41) 5.9 (55) 1.6 (15) 1.6 (15)
Delivery channel
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Bago Kayah Kayin Mon Tanintharyi
Any ACT
Artemisinin mono
Any other antimalarial
Myanmar Artemisinin Resistance Containment Baseline Survey 51
Public13 68.6 (662) 83.7 (781) 66.8 (645) 81.6 (761)
Private14 26.3 (254) 10.1 (94) 30.7 (296) 16.2 (151)
Other 0.8 (8) 0.3 (3) 0.9 (9) 0.6 (6)
Not sure 4.3 (41) 5.9 (55) 1.6 (15) 1.6 (15)
The most popular sources for diagnostic services and treatment were rural health centres,
township hospitals and private doctors. Village malaria workers did not seem to be a common
source for diagnosis or treatment. Private doctors or laboratories appeared to be more
popular in Tier 1 than in Tier 2 and this was true for both diagnostic services and advice or
treatment. In general, the public sector appeared to be the most popular source for test and
for treatment and this is even more marked in Tier 2 were the private sector seemed to be less
common source for diagnosis and treatment than in Tier 1. This could suggest that the private
sector may be less developed in Tier 2.
Table 1.4.5 Respondents’ reported prevalence and treatment of fever during the previous two weeks
FEVER PAST 2 WEEKS TOTAL Tier 1 Tier 2
% (N) 95% CI % (N) 95% CI % (N) 95% CI
Total (N=9408) 2.6 (241) 2.1 to 3.1 2.8 (128) 2.1 to 3.7 2.4 (113) 1.9 to 2.9)
Seek treatment for fever (N= 241)
Yes No
71.8 (173) 28.2 (68)
64.6 to 77.9 22.1 to 35.4
79.6 (102) 20.4 (26)
70.0 to 86.8 13.2 to 30.0
62.8 (71) 37.2 (42)
53.4 to 71.4 28.6 to 46.6
Where first seek treatment (N=173)
VHW VMW Rural health center Township hospital Private clinic Midwife clinic Aux midwife Unlicensed practitioner Drug store (drugs only) Grocery shop Traditional healer Don’t remember
5.8 (10) 5.8 (10)
18.5 (32) 2.9 (5)
19.1 (33) 12.1 (21) 12.7 (22)
3.5 (6) 4.6 (8)
8.7 (15) 1.2 (2) 5.2 (9)
2.5 to 12.7 1.8 to 16.9
11.9 to 27.5 1.0 to 8.2
11.3 to 30.4 7.4 to 19.3 5.9 to 25.2 1.1 to 10.6 2.3 to 9.0
4.8 to 15.1 0.3 to 4.8
2.1 to 12.5
5.9 (6) 9.8 (10)
22.5 (23) 2.0 (2)
20.6 (21) 7.8 (8)
16.6 (17) 3.9 (4) 2.0 (2) 2.0 (2) 2.0 (2) 4.9 (5)
2.3 to 14.2 3.3 to 25.6
13.3 to 35.5 0.5 to 8.0
9.7 to 38.6 3.3 to 17.4 6.4 to 36.7 0.8 to 17.3 0.5 to 7.8 0.5 to 7.6 0.4 to 8.3
1.6 to 14.5
5.6 (4) 0.0 (0)
12.7 (9) 4.2 (3)
16.9 (12) 18.3 (13)
7.0 (5) 2.8 (2) 8.4 (6)
18.3 (13) 0.0 (0) 5.6 (4)
1.2 to 22.7 -
5.9 to 25.2 0.9 to 16.9 8.9 to 29.8
10.3 to 30.6 2.8 to 16.7 0.7 to 11.1 4.1 to 16.5
10.6 to 29.6 -
1.2 to 22.2
Delivery channel for the first source of treatment for fever
Public Private Not sure
57.8 (100) 37.0 (64)
5.2 (9)
45.7 to 69.0 26.0 to 49.6 2.1 to 12.5
64.6 (66) 30.4 (31)
4.9 (5)
47.1 to 78.9 16.8 to 48.7 1.6 to 14.5
47.9 (34) 46.5 (33)
5.6 (4)
35.1 to 61.0 32.2 to 61.4 1.2 to 22.2
Time to treatment (N=173)
Same day Day after Two days after 3+ days after Not sure
66.5 (115) 28.3 (49)
2.3 (4) 2.3 (4) 0.6 (1)
58.2 to 73.9 20.9 to 37.2 0.5 to 10.1 0.5 to 10.2 0.1 to 3.7
70.6 (72) 21.5 (22)
3.9 (4) 2.9 (3) 1.0 (1)
61.3 to 78.5 14.0 to 31.6 0.9 to 16.1 0.4 to 18.0 0.2 to 5.7
60.6 (43) 38.0 (27)
0.0 (0) 1.4 (1) 0.0 (0)
45.5 to 73.9 25.0 to 53.0
- 0.2 to 9.5
-
Diagnostic test (N=241)
Yes No Not sure
23.2 (56) 75.1 (181)
1.7 (4)
17.6 to 30.0 68.3 to 80.9
0.6 to 4.5
21.9 (28) 76.6 (98)
1.6 (2)
14.9 to 30.9 67.7 to 83.6
0.4 to 6.5
24.8 (28) 73.4 (83)
1.8 (2)
16.3 to 35.9 62.1 to 82.3
0.4 to 7.0
Tested before treatment (N=56)
Yes No
69.6 (39) 26.8 (15)
53.6 to 82.0 15.1 to 43.1
85.7 (24) 14.3 (4)
64.3 to 95.2 4.8 to 35.7
53.5 (15) 39.3 (11)
31.0 to 74.7 19.4 to 63.5
13 VHM/HW, Malaria staff, VMW, rural health centre, Township hospital, Midwife and aux midwife 14
Private doctor, unlicensed practitioner, drug store, grocery shop, private laboratory, home treatment
Myanmar Artemisinin Resistance Containment Baseline Survey 52
Not sure 3.6 (2) 0.8 to 14.0 0.0 (0) - 7.1 (2) 1.7 to 25.4
Place of test
VMW Public health facility Private facility/lab Private nurse/dr Other
3.6 (2) 64.2 (36)
7.1 (4) 14.3 (8) 14.3 (6)
0.8 to 14.5 48.6 to 77.3 2.6 to 18.0 6.3 to 29.4 4.4 to 23.7
3.6 (1) 60.6 (17)
3.6 (1) 14.3 (4) 17.9 (5)
0.4 to 24.6 37.2 to 80.0 0.4 to 24.2 3.8 to 41.3 6.9 to 39.1
3.6 (1) 67.9 (19) 10.7 (3) 14.3 (4) 3.6 (1)
0.4 to 23.6 46.8 to 83.5 3.7 to 27.5 5.1 to 33.9 0.5 to 22.2
Type of test (N=56)
RDT Blood slide Not sure
73.2 (41) 10.7 (6) 16.0 (9)
55.2 to 85.9 4.4 to 24.0 5.9 to 36.9
71.5 (20) 10.7 (3) 17.8 (5)
41.7 to 89.8 3.6 to 27.9 3.4 to 57.2
75.0 (21) 10.7 (3) 14.3 (4)
53.7 to 88.6 2.5 to 35.9 5.1 to 33.9
Test result (N=56)
Positive Negative Not sure
21.5 (12) 67.8 (38) 10.7 (6)
11.9 to 35.6 50.6 to 81.3 2.6 to 34.9
21.5 (6) 64.2 (18) 14.2 (4)
8.0 to 46.6 34.6 to 85.9 1.9 to 58.8
21.4 (6) 71.4 (20)
7.1 (2)
10.9 to 37.9 55.5 to 83.4 1.7 to 25.4
Type of malaria (N=12)
Not told species P. falciparum P. vivax Mixed (Pf & Pv) Not sure
49.9 (6) 25.0 (3) 8.3 (1) 8.3 (1) 8.5 (1)
18.8 to 81.0 4.7 to 69.3 0.8 to 51.4 0.8 to 51.5 0.8 to 52.0
33.1 (2) 50 (3) 0.0 (0) 0.0 (0)
16.9 (1)
5.5 to 81.5 9.9 to 90.0
- -
1.4 to 74.1
66.7 (4) 0.0 (0)
16.6 (1) 16.7 (1) 0.0 (0)
20.9 to 93.8 -
1.5 to 72.1 1.5 to 72.1
-
Still having fever on survey day (N=241)
Yes No Not sure
37.3 (90) 60.2 (145)
2.5 (6)
28.8 to 46.8 50.5 to 69.1
1.0 to 6.1
38.3 (49) 61.0 (78)
0.8 (1)
26.1 to 52.1 47.2 to 73.2
0.1 to 5.7
36.3 (41) 59.3 (67)
4.4 (5)
25.3 to 49.0 45.5 to 71.8 1.7 to 11.1
The overall prevalence of reported fever in the previous two weeks was 2.6%. More than 70%
of the fever cases sought treatment and this proportion was higher in Tier 1 (79.6%) versus
Tier 2 (62.8%). The most popular sources of treatment were private doctors, rural health
centres and midwives; overall, more people tended to go to the public sector for treatment. In
Tier 2, there were substantially more people seeking treatment from a grocery shop
compared to rural health centre, suggesting that access to health care might be poorer in these
areas. Indeed, similar proportions were found across delivery channels.
Time to treatment was the same day in the majority of cases (66.5%) and this proportion was
higher in Tier 1 (70.6% vs 60.6%) but nearly all cases sought treatment within the next 2
days. However, diagnostic services were accessed by less than a quarter of the fever cases and
among these, 69% had a test for malaria. This proportion was higher in Tier 1 (85.7% versus
53.5%), probably due to fewer people seeking treatment in a health facility in Tier 2. Indeed,
the main source of diagnostic services was from public health facilities and the main type of
test was with an RDT. Among fever cases tested, 21.5% were positive but among these, nearly
half of them were not told the species. Interestingly, nearly 40% reported still having fever on
the survey day.
Sector most cited for test and treatment
Myanmar Artemisinin Resistance Containment Baseline Survey 53
When comparing where a respondent would go for testing and treatment, two-thirds mentioned that they would go to the public sector which included malaria staff, rural health centre, township hospital, midwife and auxiliary midwife. Interestingly, this also correlates with what respondents with a recent fever within the past two weeks did as a first source of treatment (55% in the public sector). Treatment seeking from the private sectors was about one-third. However, it is important to note that public and private sector providers can sometimes be blurred and difficult to differentiate. Treatment-seeking from VHWs was low in both Tiers but it is unclear which of these villages actually had VHWs available. Further analysis on this may be warranted.
Figure 1.4.4 Source of treatment by Tier (N=213)
15 Malaria staff, rural health centre, township hospital, midwife and auxiliary midwife 16 Private clinic, unlicensed practitioner, drug store, grocery shop, traditional healer
0%10%20%30%40%50%60%70%80%90%
100%
Tier 1
Tier 2
Place to go for a test Place to go for treatment Place to go for a test Place to go for treatment
Tier 1 Tier 2 Tier 1 Tier 2
VMW 3.1 (30) 1.9 (18) 2.0 (19) 1.0 (9)
Public15 65.5 (632) 81.8 (763) 64.8 (626) 80.6 (752) Private16 26.3 (254) 10.1 (94) 30.7 (296) 16.2 (151)
Other 0.8 (8) 0.3 (3) 0.9 (9) 0.6 (6)
Not sure 4.3 (41) 5.9 (55) 1.6 (15) 1.6 (15)
First source of treatment of recent fever cases (N=173)
VMW 9.8 (10) - (0) Public15 54.8 (56) 47.9 (34)
Private16 30.4 (31) 46.5 (33)
Not sure 4.9 (5) 5.6 (4)
Myanmar Artemisinin Resistance Containment Baseline Survey 54
The sources of treatment were from rural health centers and private doctors in Tier 1, whereas mainly from market or shops in Tier 2.
Table 1.4.6 Treatment seeking behavior of forest goers on last visit
TOTAL (N=453) Tier 1 (N=167) Tier 2 (N=286)
N % N % N %
Got sick last time in the forest
Yes No Don’t remember
66 383
4
14.6 84.6 0.9
20 147
0
12.0 88.0 0.0
46 236
4
16.1 82.5 1.4
Source of treatment last time while away (N=66)
VHW/VMW Rural health centre Township hospital Private clinic Midwife clinic Aux midwife Unlicensed practitioner Drug store (drugs only) Grocery shop Private laboratory Not sure
5 8 1 4
15 7 1 6 3 2
14
7.6 12.1 1.5 6.0
22.8 10.6 1.5 9.1 4.5 3.0
21.2
3 0 0 0 3 2 0 2 3 1 6
15.0 0.0 0.0 0.0
15.0 10.0 0.0
10.0 15.0 5.0
30.1
2 8 1 4
12 5 1 4 0 1 8
4.4 17.4 2.2 8.7
26.1 10.9 2.2 8.7 0.0 2.2
17.4
Delivery channel (N=66)
Public Private Not sure
36 16 14
54.6 24.2 21.2
8 6 6
40.0 29.9 30.1
28 10 8
60.9 21.7 17.4
Less than 15% of people going to the forest reported having been sick during their previous
visit to the forest and the main source of treatment was the midwife, the auxiliary midwife or
the health center. Indeed, more people got treatment from the public sector and this was true
across tier.
Figure 1.4.5 Reasons for not seeking treatment by Tier (N=68)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Waitedfever go
away
No money Difficulttransport
Not illenough
Traditionalmedicine
Other
Tier 1
Tier 2
Myanmar Artemisinin Resistance Containment Baseline Survey 55
The most common reason for not seeking treatment promptly or at all included for both Tier 1 and Tier 2 was that the respondent was not ill enough. With more than half of respondents delaying treatment seeking if the illness was not serious enough, it will be important to ensure that proper BCC for symptoms of danger signs are properly promoted in communities.
Table 1.4.7 Specific drugs taken for fever
TOTAL (N=213)
% (N)
Tier 1 (N=117)
% (N)
Tier 2 (N=96) % (N)
Coartem (AL) 1.9 (4) 1.7 (2) 2.1 (2)
Cotecxin 0.5 (1) 0.9 (1) 0.0 (0)
Artesunate 0.5 (1) 0.9 (1) 0.0 (0)
Artemether 1.4 (3) 1.7 (2) 1.0 (1)
Chloroquine 1.9 (4) 0.9 (1) 3.1 (3)
Primaquine 0.5 (1) 0.9 (1) 0.0 (0)
Other antimalarial drugs 0.9 (2) 0.9 (1) 1.0 (1)
Antibiotics 3.8 (8) 3.4 (4) 4.2 (4)
Paracetamol/Aspirin 32.4 (69) 22.2 (26) 44.8 (43)
Vitamin 0.5 (1) 0.0 (0) 1.0 (1)
Traditional herbs 2.4 (5) 0.9 (1) 4.2 (4)
Other non-antimalarial drugs 41.8 (89) 49.6 (58) 32.3 (31)
Not sure 11.7 (25) 16.2 (19) 6.3 (6)
Drugs category
Any ACT17 1.9 (4) 1.7 (2) 2.1 (2)
Any Artemisinin based monotherapy18 2.4 (5) 3.4 (4) 1.0 (1)
Other antimalarial drugs 3.3 (7) 2.6 (3) 4.2 (4)
Other non-antimalarial drugs 80.8 (172) 76.1 (89) 86.5 (83)
Not sure 11.7 (25) 16.2 (19) 6.3 (6)
The majority of fever cases (80.8%) were treated with non-antimalarial drugs and this
proportion was higher in Tier 2. However, only 1.2% or 4 fever cases (Table 1.4.8) took any
ACT, which was lower than expected considering that 12 people tested positive, although
some may have been P. vivax infections.
Table 1.4.8 Type, source, test and test result for individuals with fever in the past two weeks who took any ACT (N=4)
Source Had test for malaria
Test result
Tier Sex and sex State ACT brand
Rural health centre Yes Positive 1 15+ male Mon Coartem
Auxiliary midwife Yes Positive 1 0-4 years Tanintharyi Coartem
Auxiliary midwife Yes Positive 2 15+ female Kayin Coartem
Private clinic Yes Positive 2 0-4 years Kayin Coartem
17 A+Lum, Art+Mefl, As+Mq, Duo-Cotexcin 18 Artesunate, Artemether, Cotexcin
Myanmar Artemisinin Resistance Containment Baseline Survey 56
DRUG OUTLET SURVEY
CHARACTERISTIC OF DRUG OUTLETS
Table 2.1.1 Private providers (outlets19) selling antimalarial drugs by Tier
DRUG OUTLETS TOTAL % (N)
Tier 1 % (N)
Tier 2 % (N)
Total 100 (120) 50.8 (61) 49.2 (59)
Respondents’ position
Owner Employee Family member
85.0 (102) 4.2 (5)
10.8 (13)
91.8 (56) 4.9 (3) 3.3 (2)
78.0 (46) 3.4 (2)
18.6 (11)
Respondents’ sex
Male Female
38.3 (46) 61.7 (74)
36.1 (22) 63.9 (39)
40.7 (24) 59.3 (35)
Respondents’ training
Doctor Pharmacist Health assistant Nurse Midwife Other health training No health training
1.7 (2) 9.2 (11) 0.8 (1) 4.2 (5) 5.0 (6)
27.5 (33) 51.7 (62)
1.6 (1) 9.8 (6 1.6 (1) 4.9 (3) 6.6 (4)
29.5 (18) 45.9 (28)
1.7 (1) 8.5 (5) 0.0 (0) 3.4 (2) 3.4 (2)
25.4 )15) 57.6 (34)
Location of outlet
Village Town
52.6 (63) 47.5 (57)
42.6 (26) 57.4 (35)
62.7 (37) 37.3 (22)
Type of outlet
Village drug outlet Private clinic Health centre/Worker Pharmacy General store/shop
9.2 (11) 5.8 (7) 5.0 (6)
35.0 (42) 45.0 (54)
4.9 (3) 4.9 (3) 8.2 (5)
45.9 (28) 36.1 (22)
13.6 (8) 6.8 (4) 1.7 (1)
23.7 (14) 54.2 (32)
Offer consultations
Yes 78.3 (94) 78.7 (48) 78.0 (46)
Number of consultations a day
< 1 per day 1 to 5 per day 6 to 10 per day More than 10 per day Don’t know
8.5 (8) 53.2 (50) 18.1 (17) 19.2 (18)
1.1 (1)
6.3 (3) 43.8 (21) 25.0 (12) 22.9 (11)
2.1 (1)
10.9 (5) 63.0 (29) 10.9 (5) 15.2 (7) 0.0 (0)
Offer consultations for malaria (N=94)
Yes No
58.5 (55) 41.5 (39)
50.0 (24) 50.0 (24)
67.4 (31) 32.6 (15)
Number of malaria consultations a day (N=55)
< 1 per day 1 to 5 per day
30.9 (17) 52.7 (29)
37.5 (9) 45.8 (11)
25.8 (8) 58.1 (18)
19 Including village drug shops, private clinic, health centre or health workers’ home, pharmacy, or general store or shop
Myanmar Artemisinin Resistance Containment Baseline Survey 57
6 to 10 per day More than 10 per day
10.9 (6) 5.5 (3)
16.7 (4) 0.0 (0)
6.5 (2) 9.7 (3)
Provide any information about malaria
Yes No
15.0 (18) 85.0 (102)
24.6 (15) 75.4 (46)
5.1 (3) 94.9 (56)
Keep records/register of malaria cases diagnosed or treated
Yes 5.0 (6) 9.8 (6) 0.0 (0)
Inspection in past 6 months
Yes No
9.2 (11) 90.8 (109)
11.5 (7) 88.5 (54)
6.8 (4) 93.2 (55)
Have a license to sell drugs
Yes No
58.3 (70) 41.7 (50)
73.8 (45) 26.2 (16)
42.4 (25) 57.6 (34)
License on display on survey day (N=70)
Yes No Not sure
28.6 (20) 70.0 (49)
1.4 (1)
33.3 (15) 20.0 (5) 2.2 (1)
64.4 (29) 80.0 (20)
0.0 (0)
Drug outlets in the survey included any place where antimalarial drugs are known to be sold
in the community, including village drug shops, private clinic, health centre or health workers’
home, pharmacy, or general store or shop.
The characteristics of the selected drug outlets appeared very different between tiers, pointing
out the heterogeneity of private providers in the target areas. In Tier 1, more respondents
tended to be female and were more likely to have had health related training. Drug outlets in
Tier 1 were more likely to be located in a town and situated in a pharmacy or the health
centre; whereas in Tier 2, a higher proportion were in a village and were found in a general
store or village drug outlet.
In both Tiers, about 78% of drug outlets did offer consultation and the daily activity appeared
higher in Tier 1. On the other hand, Tier 2 providers were more likely to provide malaria
consultation but only a few outlets provided malaria information. This proportion was higher
in Tier 1. Also, in Tier 1, drug outlets tended to be more likely to keep records of malaria cases
and to have had an inspection in the past six months although these proportions were only
9.8% and 11.5% respectively. Finally, nearly three quarters of outlets in Tier 1 had a
license to sell drugs compared to 42.4% in Tier 2 but the latter were more likely to have
displayed their license on the survey day compared to Tier 1 outlets.
This strongly suggests that the villages located in Tier 2 are more remote and probably implies
poorer access to health care compared to Tier 1.
Table 2.1.2 Knowledge among drug outlet respondents of drug resistance and ban on monotherapies
TOTAL N=120 % (N)
Tier 1 N=61 % (N)
Tier 2 N=59 % (N)
Heard of activities to stop spread of drug resistance
Yes 10 (12) 16.4 (10) 3.4 (2)
Aware that some antimalarial drugs are banned
Yes 11.7 (14) 16.4 (10) 6.8 (4)
Myanmar Artemisinin Resistance Containment Baseline Survey 58
Specified an oral monotherapies20 as a banned drug (N=14)
Artesunate 14.3 (2) 10.0 (1) 25.0 (1)
Heard about fake drugs
Yes No
70.0 (84) 30.0 (36)
73.8 (45) 26.2 (16)
66.1 (39) 33.9 (20)
Seen any fake drug (N=84)
Yes No
19.1 (16) 80.9 (68)
15.6 (7) 84.4 (38)
23.1 (9) 76.9 (30)
Respondent’s awareness about drug resistance was low in general but as expected was higher
in Tier 1, although some caution is required in interpreting these estimates as questions about
fake drugs seemed sensitive. On the other hand, it is interesting that about 11.7% of the
respondents specified an oral monotherapy as banned since the official ban had not yet been
implemented at the time of data collection.
Figure 2.1.1 Respondents knowledge of malaria signs and symptoms by Tier (N=120)
Figure 2.1.2 Attitude of respondents if suspected malaria case (N=113)
20 Artesunate or artemisinin monotherapies
0%10%20%30%40%50%60%70%80%90%
100%
Tier 1
Tier 2
0%10%20%30%40%50%60%70%80%90%
100%
Examinepatient
Sell/performtest
Refer to HF Sellantimalarial
drug
Other
Tier 1
Tier 2
Myanmar Artemisinin Resistance Containment Baseline Survey 59
The two figures above suggest that access to formal health care structures tended to be more
available in Tier 1 as more drug providers would refer suspected malaria cases to health
facilities; whereas in Tier 2, they would be more likely to sell directly an antimalarial drug. It is
important to note the small proportions of respondents that would sell or perform a malaria
test, reflecting the lack of availability of diagnostic services (RDT) among drug outlets.
ANTIMALARIAL DRUGS STOCK AND SELLING HABITS
Table 2.2.1 Availability of antimalarial drugs sold in private drug outlets on survey day
by Tier
TOTAL N=120 % (N)
Tier 1 N=61 % (N)
Tier 2 N=59 % (N)
Coartem (A + Lum) > 15 years 2.5 (3) 3.3 (2) 1.7 (1)
Artefan 0.0 (0) - -
Duocotexcin 0.8 (1) 0.0 (0) 1.7 (1)
Artecom 2.5 (3) 1.6 (1) 3.4 (2)
Arfloquin 0.0 (0) - -
Artemodi 0.0 (0) - -
Arco 4.2 (5) 3.3 (2) 5.1 (3)
Artesunate tablets 50.0 (60) 55.7 (34) 44.1 (26)
Artesunate injectables 12.5 (15) 14.8 (9) 10.2 (6)
Artemether tablets 34.2 (41) 45.9 (28) 22.0 (13)
Artemether injectables 35.0 (42) 44.3 (27) 25.4 (15)
Artemisinin tablets 0.8 (1) 0.0 (0) 1.7 (1)
Chloroquine 47.5 (57) 41.0 (25) 54.2 (32)
Quinine tablets 21.7 (26) 19.7 (12) 23.7 (14)
Quinine injectables 24.2 (29) 26.2 (16) 22.0 (13)
Mefloquine 17.5 (21) 18.0 (11) 16.9 (10)
Primaquine 5.0 (6) 8.2 (5) 1.7 (1)
Sulfadoxine + Pyrimethamine (SP) 5.0 (6) 4.9 (3) 5.1 (3)
Cocktail drugs 9.2 (11) 6.6 (4) 11.9 (7)
In general, the most popular antimalarial drugs sold in the sampled outlets were: 1)
artesunate tablets, 2) chloroquine, 3) artemether injectables, and 4) artemether tablets. This
suggests that most customers would still be sold monotherapy (e.g., artesunate) at the time of
the survey. Comparison between tiers the most common treatment sold in Tier 1 was
artesunate, whereas in Tier 2, the most popular treatment available was chloroquine,
reinforcing that the notion that clusters in Tier 2 tended to be more underserved compared to
Tier 1. Furthermore, Coartem was only reported to be available in 2.5% of drug outlets.
Myanmar Artemisinin Resistance Containment Baseline Survey 60
Table 2.2.2 Details of rapid diagnostic tests sold in drug outlets
TOTAL N=120 % (N)
Tier 1 N=61 % (N)
Tier 2 N=59 % (N)
RDT type
CareStart Paracheck
0.8 (1) 6.7 (8)
0.0 (0) 9.8 (6)
1.7 (1) 3.4 (2)
Overall, availability of rapid diagnostic test was low, with 0.8% for CareStart™ and 6.7% for
Paracheck™.
Table 2.2.3 Recommended antimalarial drugs in drug outlets by Tier
TOTAL N=120 % (N)
Tier 1 N=61 % (N)
Tier 2 N=59 % (N)
Most recommended drug for P. falciparum
Coartem (A+L) Mefloquine Artesunate Artemether Quinine Chloroquine Other antimalarial drugs Antibiotics Don’t Know
9.2 (11) 4.2 (5)
9.2 (11) 8.3 (10) 4.2 (5) 1.7 (2) 0.8 (1) 0.0 (0)
62.5 (75)
13.1 (8) 1.6 (1) 6.6 (4) 9.8 (6) 1.6 (1) 0.0 (0) 0.0 (0) 0.0 (0)
67.2 (41)
5.1 (3) 6.8 (4)
11.9 (7) 6.8 (4) 6.8 (4) 3.4 (2) 1.7 (1) 0.0 (0)
57.6 (34)
Know the national recommended treatment for P.f. (Coartem = Artemether + Lumefantrine)
Yes No
17.5 (21) 82.5 (99)
26.2 (16) 73.7 (45)
8.5 (5) 91.5 (54)
Most recommended drug for P. vivax
Coartem (A+L) Mefloquine Artesunate Artemether Quinine Chloroquine Other antimalarial drugs Antibiotics Don’t Know
0.8 (1) 0.8 (1)
10.0 (12) 6.7 (8) 2.5 (3)
25.8 (31) 0.8 (1) 0.8 (1)
51.7 (62)
0.0 (0) 1.6 (1) 8.2 (5) 4.9 (3) 0.0 (0)
24.6 (15) 0.0 (0) 0.0 (0)
60.7 (37)
1.7 (1) 0.0 (0)
11.9 (7) 8.5 (5) 5.1 (3)
27.1 (16) 1.7 (1) 1.7 (1)
42.4 (25)
Know the national recommended treatment for P.v. (=Primaquine)
Yes No
2.5 (3) 97.5 (117)
1.6 (1) 98.4 (60)
3.4 (2) 96.6 (57)
More than 80% of the respondents did not know the recommended treatment for P.
falciparum. Perhaps due to sensitivity issues, the majority of the respondents (62%) were
not able to recommend any drug for the treatment of P. falciparum. In Tier 1, the most
commonly recommended drugs were Coartem, artesunate, and artemether; whereas in Tier 2,
artesunate, mefloquine, artemether, or quinine were most commonly mentioned.
The most commonly recommended drugs for P. vivax were chloroquine, artesunate and
artemether and these patterns were similar across tier. Likewise, very few respondents
Myanmar Artemisinin Resistance Containment Baseline Survey 61
(2.5%) among drug outlets were aware of the nationally recommended treatment for P.
vivax.
Table 2.2.4 Popularity of antimalarial by Tier
TOTAL N=120 % (N)
Tier 1 N=61 % (N)
Tier 2 N=59 % (N)
Sell any antimalarial drugs
Yes No
80.0 (96) 20.0 (24)
75.4 (46) 24.6 (15)
84.8 (50) 15.3 (9)
Most popular drug for malaria (N=96)
Coartem (A+L) Artesunate + Mefloquine Artesunate Artemether Quinine Chloroquine Other antimalarial drugs
2.1 (2) 1.0 (1)
54.2 (52) 16.7 (16)
4.2 (4) 20.8 (20)
1.0 (1)
2.2 (1) 2.2 (1)
60.9 (28) 19.6 (9) 2.2 (1)
13.0 (6) 0.0 (0)
2.0 (1) 0.0 (0)
48.0 (24) 14.0 (7) 6.0 (3)
28.0 (14) 2.0 (1)
Source of antimalarial drugs (N=96)
Yangon whole seller Province whole seller Medical detailer Province pharmacy (Gvt)
8.3 (8) 71.9 (69) 18.8 (18)
1.0 (1)
4.4 (2) 63.0 (29) 32.6 (15)
0.0 (0)
12.0 (6) 80.0 (40)
6.0 (3) 2.0 (1)
According to drug outlet respondents, the most commonly sold anti-malarial drugs were
overwhelmingly artesunate (54%), artemether (17%) and chloroquine (21%). Among Tier 2
respondents, chloroquine was reported to be the second most commonly sold anti-malarial
drug. The main source of drugs was purchased from a state or division whole seller.
Figure 2.2.1 Factors determinant for stocking of antimalarial drugs (N=96)
0%10%20%30%40%50%60%70%80%90%
100%
Tier 1
Tier 2
Myanmar Artemisinin Resistance Containment Baseline Survey 62
Not surprisingly, the main factors that determine which antimalarials to stock were mainly
profit and demand driven.
Table 2.2.5 Consumption habits by Tier
TOTAL % (N)
Tier 1 % (N)
Tier 2 % (N)
Customer ask for drug by name (N=96)
Yes No, ask for recommendation No, bring in prescription
74.0 (71) 10.4 (10) 15.6 (15)
69.6 (32) 8.7 (4)
21.7 (10)
78.0 (39) 12.0 (6) 10.0 (5)
Provider decide which drug customer receives (N=96)
Yes No, give what is requested No, bring in a prescription Don’t know
39.6 (38) 37.5 (36) 21.9 (21)
1.0 (1)
34.8 (16) 32.6 (15) 32.6 (15)
0.0 (0)
44.0 (22) 42.0 (21) 12.0 (6) 2.0 (1)
Antimalarial sold compared to last year (N=96)
Selling more Selling same Selling less Don’t know Did not sell last year
4.2 (4) 25.0 (24) 60.4 (58)
6.3 (6) 4.2 (4)
2.2 (1) 19.6 (9)
71.7 (33) 6.5 (3) 0.0 (0)
6.0 (3) 30.0 (15) 50.0 (25)
6.0 (3) 8.0 (4)
Sold partial pack in past month (N=96)
Yes No Don’t know
55.2 (53) 43.8 (42)
1.0 (1)
41.3 (19) 58.7 (27)
0.0 (0)
68.0 (34) 30.0 (15)
2.0 (1)
Sell malaria cocktails (N=96)
Yes No
25.0 (24) 75.0 (72)
15.2 (7) 84.8 (39)
34.0 (17) 66.0 (33)
Sell any malaria test (N=120)
Yes No
20.8 (25) 79.2 (95)
26.2 (16) 73.8 (45)
15.3 (9) 84.8 (50)
Type of test (N=25)
RDT / Dipstick Both RDT and Blood slide
96.0 (24) 4.0 (1)
100 (16) 0.0 (0)
88.9 (8) 11.1 (1)
Tests sold compared to last year (N=25)
Selling more Selling same Selling less Did not sell last year
12.0 (3) 24.0 (6)
52.0 (13) 12.0 (3)
6.3 (1) 25.0 (4)
68.8 (11) 0.0 (0)
22.2 (2) 22.2 (2) 22.2 (2) 33.3 (3)
Customer ask for malaria test (N=120)
Yes No
25.0 (30) 75.0 (90)
24.6 (15) 75.4 (46)
25.4 (15) 74.6 (44)
Response to test request (N=30)
Sell and test them with RDT Refer to public HF Refer to private clinic/lab Other
20.0 (6) 50.0 (15) 10.0 (3) 20.0 (6)
20.0 (3) 40.0 (6) 6.7 (1)
33.3 (5)
20.0 (3) 60.0 (9) 13.3 (2) 6.7 (1)
Nearly three quarters of drug providers reported that customers requested a drug by name
and 39.6% said they usually decide which drug the customer receives. In Tier 2, it appeared
that the selling habits are more driven by customer demand compared to Tier 1, potentially
suggesting that the providers in Tier 2 tended to be less considered as a good source for advice
than in Tier 1. In the same way, customers in Tier 1 were more likely to bring in a
prescription compared to Tier 2, reinforcing the fact that the population in Tier 2 had a
poorer access to health care and were more likely to opt for self-treatment.
Myanmar Artemisinin Resistance Containment Baseline Survey 63
More than 60% of providers reported selling less antimalarial drugs compared to last
year, 55% admitted to selling partial pack in the previous month, and 25% had sold
antimalarial cocktails. In Tier 2, there were higher proportion of providers selling the same
quantity of antimalarial drugs as the previous year; more of them reported having sold partial
packs and antimalarial cocktails, supporting the fact that these sellers are less aware of
current good practices.
Nearly 80% reported not selling any malaria test and if any did sell a test, it was mostly
RDT or dipstick tests. Similarly to what was observed for antimalarial drugs, the providers
mostly reported selling less than the previous year and three quarters said customers do not
ask for malaria test and in most cases. They would refer the patient to a health facility if the
customer would ask for the test. Diagnostic services appeared to be less available in Tier
2.
Table 2.2.6 Activity during the previous week by Tier
TOTAL N=120
Mean (SD)
Tier 1 N=61
Mean (SD)
Tier 2 N=59
Mean (SD)
Number of clients bought antimalarial drug
4.07 (0.90) 5.84 (1.75) 2.42 (0.49)
Number of clients bought cocktail drugs
3.64 (1.01) 2.17 (0.75) 4.19 (1.35)
Number of clients that were tested or bought a test
1.09 (0.38) 1.28 (0.55) 0.75 (0.41)
The mean number of patients seen by drug outlet respondents during the past 7 days was
reported to be significantly higher in Tier 1 (mean=5.8, SD 1.8) compared to Tier 2 (mean=2.4,
SD 0.5). On the converse, more antimalarial cocktails were sold and purchased from Tier
2 drug outlets during the past week.
Table 2.2.7 Artesunate
TOTAL % (N)
Tier 1 % (N)
Tier 2 % (N)
Heard of artesunate (N=120)
Yes No
90.8 (109) 9.2 (11)
91.8 (56) 8.2 (5)
89.8 (53) 10.2 (6)
Sell artesunate (N=109)
Yes No
71.6 (78) 28.4 (31)
71.4 (40) 28.6 (16)
71.7 (38) 28.3 (15)
Last bought artesunate (N=78)
Within last week Within last month More than a month ago Not sure
28.2 (22) 32.1 (25) 37.2 (29)
2.6 (2)
27.5 (11) 35.0 (14) 37.5 (15)
0.0 (0)
28.9 (11) 28.9 (11) 36.8 (14)
5.3 (2)
Number of tablets per pack (N=78)
12 tablets 24 tablets
97.4 (76) 2.6 (2)
97.5 (39) 2.5 (1)
97.4 (37) 2.6 (1)
Next buy artesunate (N=78)
Within next week Within next month
16.7 (13) 9.0 (7)
15.0 (6) 2.5 (1)
18.4 (7) 15.8 (6)
Myanmar Artemisinin Resistance Containment Baseline Survey 64
In more than a month No plan to buy Not sure
5.1 (4) 19.2 (15) 50.0 (39)
5.0 (2) 15.0 (6)
62.5 (25)
5.3 (2) 23.7 (9)
36.8 (14)
Table 2.2.8 Coartem (A + L)
TOTAL % (N)
Tier 1 % (N)
Tier 2 % (N)
Heard of Coartem (N=120)
Yes No
53.3 (64) 46.7 (56)
62.3 (38) 37.7 (23)
44.1 (26) 55.9 (33)
Sell Coartem (N=64)
Yes No
9.4 (6) 90.6 (58)
7.9 (3) 92.1 (35)
11.5 (3) 88.5 (23)
Last bought Coartem (N=6)
Within last week Within last month More than a month ago Not sure
- - 0.0 (0) 16.7 (1) 66.7 (4) 16.7 (1)
Next buy Coartem (N=6)
Within next week Within next month In more than a month No plan to buy Not sure
- - 16.7 (1) 16.7 (1)
0.0 () 16.7 (1) 50.0 (3)
Table 2.2.9 Duocotexcin
TOTAL % (N)
Tier 1 % (N)
Tier 2 % (N)
Heard of Duocotexcin (N=120)
Yes No
8.3 (10) 91.7 (110)
6.6 (4) 93.4 (57)
10.2 (6) 89.8 (53)
Sell Duocotexcin (N=10)
Yes No
30.0 (3) 70.0 (7)
0.0 (0)
100 (4)
50.0 (3) 50.0 (3)
Last bought Duocotexcin (N=3)
Within last week Within last month More than a month ago Not sure
- - 0.0 (0) 0.0 (0) 66.7 (2) 33.3 (1)
Next buy Duocotexcin (N=3)
Within next week Within next month In more than a month No plan to buy Not sure
- - 0.0 (0) 0.0 (0) 0.0 (0) 100 (3) 0.0 (0)
Overall, most providers had heard about artesunate (90.8%), more than half heard about
Coartem (53.3%) and less than 10% heard about Duo-Cotexcin (8.3%). In Tier 1, more drug
providers heard of these drugs compared to Tier 2, except for Duo-Cotexcin where this trend
was reversed (6.6% versus 10.2%).
Myanmar Artemisinin Resistance Containment Baseline Survey 65
Table 2.2.10 Cost of specific antimalarial drugs (in Kyats)
TOTAL N=120
Mean (SD)
Tier 1 N=61
Mean (SD)
Tier 2 N=59
Mean (SD)
Artesunate 1509.3 (45.8) 1435.0 (66.1) 1587.5 (61.6)
Coartem 1766.7 (459.4) 1700 (435.9) 1833.3 (928.0)
Duocotexcin 2633.3 (233.3) - 2633.3 (233.3)
The mean price of a full treatment course of artesunate was 1500 Kyats (approximately $1.75 USD) which did not different significantly between Tier 1 and Tier 2. The mean price of Coartem was 1766 Kyats ($2.00 USD) and Duo-Cotexcin was 2633 Kyats ($3.00 USD). Prices remained fairly consistent between Tier 1 and Tier 2.
Myanmar Artemisinin Resistance Containment Baseline Survey 66
HEALTH FACILITY SURVEY
There were a total of 129 health facilities included in the survey, 50 public facilities (63% of
the target sample) and 79 private facilities (99% of target sample). Figure 3.1 shows the
location of public health facilities included in the survey; GPS data was not available for the
private health facilities.
In the absence of sufficient daily malaria cases in order to assess malaria services, a total of
362 malaria cases within the last 3 months were followed up from case records, 294 cases
at public facilities and 68 cases at private facilities. To address the quality of services received,
a total of 232 exit interviews were carried out among fever patients (or their caregivers) at
both public (n=183) and private (n=49) facilities.
Figure 3.1 Location of public health facilities (N=50), MARC survey 2011
Myanmar Artemisinin Resistance Containment Baseline Survey 67
HEALTH FACILITY AUDIT
Table 3.1 Description of the health facilities in the survey
Public facilities N=50 N (%)
Private facilities N=79 N (%)
Total N=129 N (%)
Type of facility
Referral hospital Township hospital Station hospital Rural Health center Rural health sub center Private specialist hospital Private polyclinic General practitioner clinic (with beds) General practitioner clinic (without beds) Other
6 (12.0) 8 (16.0) 4 (8.0)
10 (20.0) 15 (30.0)
0 (-) 0 (-) 0 (-) 0 (-)
7 (14)
0 (-) 0 (-) 0 (-) 0 (-) 0 (-)
3 (3.8) 5 (6.3)
0 (-) 45 (57.0) 26 (32.9)
6 (4.7) 8 (6.2) 4 (3.1) 10 (7.8)
15 (11.6) 3 (2.3) 5 (3.9)
0 (-) 45 (34.9) 33 (25.6)
Services provided
Malaria case management Inpatient Department (IPD) Outpatient Department (OPD) Malaria diagnosis ITN distribution/Tablet distribution Malaria education Antenatal screening for malaria IMCI21 Blood bank Referral of severe malaria
48 (98.0) 18 (36.0)
50 (100.0) 48 (96.0) 20 (40.0) 47 (94.0) 39 (78.0) 49 (98.0) 9 (18.0)
38 (76.0)
78 (98.7) 5 (6.3)
79 (100.0) 53 (67.1) 20 (25.3) 41 (51.9) 34 (43.0) 28 (35.4)
0 (-) 64 (81.0)
127 (98.5) 23 (17.8)
129 (100.0) 101 (78.3) 40 (31.0) 88 (68.2) 73 (56.6) 77 (59.7)
9 (7.0) 102 (79.1)
Table 3.1 details the services provided by the health facilities selected in the survey. The
majority of public health facilities were rural health centres/sub centres, while the majority of
private facilities were general practitoner clinics. Both public and private facilities were
similar for the provision of services for malaria case management, outpatient department and
referral of severe malaria. Compared to private facilities a significantly higher percentage of
public facilities had an inpatient department, offered malaria diagnosis, gave malaria
education, provided antenatal screening for malaria, implemented Integrated Management of
Childhood Illnesses (IMCI) and had a blood bank.
Private facilities were reported to be opened for more days and more hours per day compared
to public facilities. Supervisory visits were only carried out in public facilities only with 78%
of public facilities having had a supervisory visit during the previous 6 months. Almost
all public facilities had a copy of the National Malaria Treatment Guidelines compared to less
than half of the private facilities. Treatment of severe cases was higher in public facilities,
while referral of severe cases was significantly higher in private facilities.
21 Integrated Management of Childhood Illnesses
Myanmar Artemisinin Resistance Containment Baseline Survey 68
Table 3.1 cont. Description of the health facilities in the survey
Public facilities N=50 N (%)
Private facilities N=79 N (%)
Total N=129 N (%)
Days per week (median (min,max)) 5 (1,5) 5 (3,7) 5 (1,7)
Hours per day (median (min,max)) 4 (2,6) 9 (1,24) 6 (1,24)
Facility had a supervisory visit in last 6 months
39 (78.0) -
Visit by TMO22/PHD 18 (36.0)
Visit by project manager 3 (6.0)
Visit by person responsible for supervising
17 (34.0)
Other supervisor 20 (40.0)
Has copy of the National Treatment Guidelines for Malaria
45 (90.0) 34 (43.6) 79 (61.7)
Treat severe cases of malaria 20 (40.0) 13 (16.5) 33 (25.6)
Refer severe cases of malaria 31 (62.0) 75 (94.9) 106 (82.2)
Has outpatient register 43 (86.0) 22 (27.9) 65 (50.4)
Outpatient register up to date 42 (97.7) 17 (77.3) 59 (90.8)
Monthly list of cases 26 (59.1) 12 (54.6) 38(57.6)
The characteristics and knowledge of the key respondent in each health facility are shown in
Table 3.2. In both public and private facilities, the main respondent was the head of the
health facility. In public facilities, females were the majority of respondents whereas for
private facility the majority were male. Respondents were younger in public facilities and
older in private facilities. In private facilities, doctors were the main respondents, while in
public both doctors and midwives combined formed the majority of respondents
Knowledge regarding the recommended drug for P.falciparum and P.vivax was higher among
respondents in public facilities compared to those in private facilities. Over two thirds of
facilities had heard of activities to contain resistance; however, less than a quarter were
aware that some antimalarials were banned and this was similar in both public and private
facilities. A relatively high percentage of respondents in both public and private facilities had
heard about fake drugs however those who reported having seen fake drugs were more
prevalent among private facilities. Malaria related training during 2011 was high in public
facilities and low in private facilities.
Table 3.2 Health facility respondent characteristics
Public facilities N=50 N (%)
Private facilities N=79 N (%)
Total N=129 N (%)
Total 100 (50) 100 (79) 100 (129)
Respondent’s position
Health Facility Chief 84.0 (42) 81.0 (64) 82.2 (106)
22 Township Medical Officer
Myanmar Artemisinin Resistance Containment Baseline Survey 69
Deputy chief 4.0 (2) 1.3 (1) 2.3 (3)
Acting officer 6.0 (3) 2.5 (2) 3.9 (5)
Other 6.0 (3) 15.2 (12) 11.6 (15)
Respondent’s sex
Male 40.0 (20) 64.6 (51) 55.0 (71)
Female 60.0 (30) 35.4 (28) 45.0 (58)
Respondent’s age
20 to <40 years 64.0 (32) 35.4 (28) 46.5 (60)
40 to 49 years 24.0 (12) 25.3 (20) 24.8 (32)
>=50 years 12.0 (6) 39.2 (31) 28.7 (37)
Formal training
Doctor 36.0 (18) 58.2 (46) 49.6 (64)
Health Assistant 16.0 (8) 3.8 (3) 8.5 (11)
Public Health Supervisor (1) 2.0 (1) 3.8 (3) 3.1 (4)
Lady Health Visitor 4.0 (2) 5.1 (4) 4.7 (6)
Trained Nurse 6.0 (3) 3.8 (3) 4.7 (6)
Midwife 30.0 (15) 2.5 (2) 13.2 (17)
Public Health Supervisor (2) - (0) 3.8 (3) 2.3 (3)
Other Health Training 6.0 (3) 19.0 (15) 14.0 (18)
Knowledge of antimalarials
Knows recommended drug for uncomplicated P.falciparum
90.0 (45) 54.4 (43) 68.2 (88)
Knows recommended drug for uncomplicated P.vivax
76.0 (38) 45.6 (36) 57.4 (74)
Heard about activities to stop resistance
76.0 (38) 67.1 (53) 70.5 (91)
Aware that some antimalarials are banned
28.0 (14) 19.0 (15) 22.5 (29)
Knows which drugs are banned (any oral artemisinin based monotherapy)
42.9 (6) 26.7 (4) 34.5 (10)
Heard about fake drugs 66.0 (33) 77.2 (61) 72.9 (94)
Seen fake drugs 15.2 (5) 30.5 (18) 25.0 (23)
Had malaria related training in 2011 83.7 (41) 39.7 (31) 56.7 (72)
The results of facility staff review are shown in Table 3.3. Public facilities had significantly
more staff compared to private facilities. The majority of staff in public facilities was nurses /
midwives, while in private facilities the majority of staff was doctors, a reflection that private
facilities with only one member of staff will most likely be a trained doctor. Staff were most
likely to be present at the facility rather than in the field on the day of the survey. Private
facility staff had relatively fewer years in service than public health facility staff.
Table 3.3 Health facility staff characteristics
Public facility staff (N=312)
Private facility staff (N=138)
Number of staff per facility
Mean 11.6 4.0
Median 4 1
Minimum 1 1
Maximum 23 12
Myanmar Artemisinin Resistance Containment Baseline Survey 70
Highest qualification
Doctor 17.0 (53) 51.8 (71)
Health Assistant 3.2 (10) 3.7 (5)
Public Health Supervisor (1)
7.7 (24) 5.8 (8)
Trained Nurse 36.5 (114) 9.5 (13)
Midwife 24.7 (77) 3.7 (5)
Other Health Training 10.9 (34) 25.6 (35)
Other
Present on day of survey
In facility 78.5 (245) 85.4 (117)
In field 21.5 (67) 14.6 (20)
Years in service
=<5 years 22.4 (70) 35.0 (48)
>5 to <10 years 26.9 (84) 8.0 (11)
>10 to 20 years 29.2 (91) 22.6 (31)
>20 years 9.3 (29) 11.7 (16)
The inventory of antimalarial drugs, antibiotics and RDTs available in public and private
facilities is shown in Table 3.4 and summarised in Table 3.5. It is encouraging that stocks of
the nationally recommended antimalarials, Coartem and primaquine were high in public
facilities; however this was the case in less than half of the private facilities. Availability of
specified antibiotics was low in both sectors. Drug cocktails were only available in a small
number of private facilities. Carestart was the most commonly available RDT in both
public and private facilities.
Overall antimalarials were available in all but one public health facility and the majority
usually stocked appropriate ACTs. Almost a fifth of private facilities did not have any
antimalarials and just over half stocked ACTs. There were a small number of public facilities
(16%) with tablet formulations of artemisinin based monotherapy compared to relatively
higher number of private facilities (37%). Almost 70% of public facilities stocked
injections/suppositories of artemisinin based monotherapy compared to 38% of private
facilities. Nearly all public facilities and 62% private facilities stocked RDT’s.
Table 3.4 Antimalarials, other drugs and RDTs usually stocked by Health Facilities
Public facilities (N=50) % (N)
Private facilities (N=79) % (N)
AL (COARTEM 24) 90.0 (45) 45.6 (36)
AL (COARTEM 18) 68.0 (34) 26.6 (21)
AL (COARTEM 12) 72.0 (36) 20.3 (16)
AL (COARTEM 6) 72.0 (36) 19.0 (15)
DHA-piperaquine (DUO-COTECXIN)
- (0) 15.2 (12)
Artesunate tablet 12.0 (6) 34.2 (27)
Artesunate suppository - (0) - (0)
Artemether injection (80mg) 64.0 (32) 36.7 (29)
Artemether injection (40mg) 8.0 (4) 1.3 (1)
Myanmar Artemisinin Resistance Containment Baseline Survey 71
Artemether tablet 8.0 (4) 5.1 (4)
Artesunate + Amodiaquine - (0) 5.1 (4)
Artesunate + Mefloquine - (0) 3.8 (3)
Mefloquine tablet 14.0 (7) 15.2 (12)
Quinine Injection 16.0 (8) 13.9 (11)
Quinine tablet 22.0 (11) 21.5 (17)
Primaquine tablet (15 mg) 80.0 (40) 36.7 (29)
Primaquine tablet (7.5 mg) 16.0 (8) 12.7 (10)
Chloroquine tablet 88.0 (44) 53.2 (42)
Doxycycline 26.0 (13) 32.9 (26)
Tetracycline 12.0 (6) 22.8 (18)
Clindamycin 8.0 (4) 19.0(15)
Mixture of drugs for fever/malaria - (0) 5.1 (4)
Carestart (combo) 34.0 (17) 24.1 (19)
Carestart (SD) 84.0 (42) 49.4 (39)
Paracheck 22.0 (110 7.6 (6)
Other tests for malaria 2.0 (1) 3.8 (3)
Table 3.5 Summary of artemisinin-based combination therapy (ACTs), antimalarials and rapid diagnostic tests (RDTs) stocked at health facilities
Public facilities (N=50) % (N)
Private facilities (N=79) % (N)
Any antimalarial 98.0 (49) 82.3 (65)
ACTs 92.0 (46) 57.0 (45)
AMT (artemisinin based monotherapy) tablets 16.0 (8) 36.7 (29)
AMT (artemisinin based monotherapy) injections/suppositories
68.0 (34) 38.0 (30)
Non artemisinin antimalarials 96.0 (48) 70.9 (56)
Drug cocktail 0 (-) 5.1 (4)
Any RDTs 96.0 (48) 62.0 (49)
Table 3.6 summarises the laboratory services available in the health facilities. All public
facilities offer microscopy and/or RDTs compared to only 60% of private facilities and for the
latter testing was mostly performed with RDTs. Where facilities had microscopy, most had a
full time technician. Stockout of microscopy supplies and RDTs were low. Even though the
majority of public facilities said they usually stocked RDTs, availability as recorded in the
laboratory review was low. Use of an up-to-date laboratory register was good for facilities
with microscopy diagnostics. Only a third of the public facilities and very few private facilities
had a manual for malaria in the laboratory.
Table 3.6 Laboratory services and equipment available at health facilities
Public facilities (N=50) % (N)
Private facilities (N=79) % (N)
Malaria service
Microscopy & RDT 30 (15) 10.1 (8)
Microscopy only 8.0 (4) - (0)
Myanmar Artemisinin Resistance Containment Baseline Survey 72
RDT only 62.0 (31) 50.6 (40)
None - (0) 39.2 (31)
Has laboratory technician (for facilities which use microscopy)
Full time technician 89.5 (17) 87.5 (7)
Part time technician 5.3 (1) 12.5 (1)
None 5.3 (1) - (0)
Has working microscope (for facilities which use microscopy)
100.0 (19) 100.0 (8)
>1 week with no microscope in the last 3 months 10.5 (2) - (0)
>1 week with no slides in the last 3 months 10.5 (2) - (0)
>1 week with no giemsa stain in the last 3 months 5.3 (1) - (0)
Availability of RDTs (for facilities who use RDTs)
Carestart Combo 26.0 (13) 17.0 (8)
Carestart SD 46.0 (23) 42.6 (20)
Paracheck 12.0 (6) 10.6 (5)
Other 32.0 (16) 42.6 (20)
>1 week with no stock of RDTs 4.0 (2) 8.5 (4)
Has laboratory register/book 44.0 (22) 17.0 (8)
Laboratory register/book up to date (for those who had a register)
100.0 (22) 87.5 (7)
Has laboratory manual for malaria 34.0 (17) 8.3 (4)
In order to assess service delivery for malaria cases and episodes of fever, follow up interviews at home were done with malaria cases and exit interviews at the health facility for fever cases.
MALARIA PATIENT FOLLOW-UP AND EXIT INTERVIEWS
Table 3.7 Details of malaria cases followed up and exit interview patients
Case follow up- Malaria Cases
Exit interviews - Fever patients
Public facilities (N=294)
% (N)
Private facilities (N=68) % (N)
Public facilities (N=183)
% (N)
Private facilities (N=49) % (N)
Age / sex
Under 5 years 3.4 (10) - (0) 13.1 (24) 10.2 (5)
5 to 14 years 15.6 (46) 13.2 (9) 18.6 (34) 18.4 (9)
15+years male 57.5 (169) 61.8 (42) 39.3 (72) 30.6 (15)
15+ years female 23.5 (69) 25.0 (17) 29.0 (53) 40.8 (20)
Education
Child <5years 3.4 (10) -(0) 14.2 (26) 16.3 (8)
No school 6.1 (18) 7.4 (50 4.4 (8) 6.1 (3)
Primary 45.2 (133) 25.0 (17) 45.9 (84) 36.7 (18)
Secondary 26.2 (77) 42.6 (29) 20.8 (38) 18.4 (9)
High school 11.2 (33) 11.8 (8) 10.4 (19) 16.3 (8)
University 7.5 (22) 5.9 (4) 3.3 (6) 4.1 (2)
Other 0.3 (1) 7.4 (5) 1.1 (2) 2.0 (1)
Occupation
Child 5.4 (16) 1.5 (1) 14.8 (27) 18.4 (9)
Student 14.6 (43) 11.8 (8) 19.1 (35) 12.2 (6)
Farmer 19.7 (58) 7.4 (5) 9.8 (18) 4.1 (2)
Myanmar Artemisinin Resistance Containment Baseline Survey 73
Labourer 6.1 (18) - (0) 6.0 (11) 2.0 (1)
Fisherman 1.4 (4) -(0) 1.1 (2) 4.2 (2)
Merchant 7.1 (21) 5.9 (4) 4.9 (9) 14.3 (7)
Housewife 4.8 (14) 7.4 (5) 11.5 (21) 10.2 (5)
Soldier 1.4 (4) - (0) - (0) - (0)
Other 39.5 (116) 66.2 (45) 32.8 (60) 34.7 (17)
Time at current address
<6 months 3.0 (9) 7.3 (5) 6.0 (11) 8.1 (4)
6 months to <1 year 2.4 (7) 2.9 (2) 3.3 (6) - (0)
More than 1 year 94.6 (278) 89.7 (61) 90.7 (166) 91.8 (45)
Slept in forest in the last 6 months 41.2 (121) 44.1 (30) 29.0 (53) 38.8 (19)
Travelled in the 2 weeks prior to illness
67.8 (82) 66.7 (20) na na
Sleep under net previous night 74.8 (220) 77.9 (53) 83.1 (152) 89.8 (440
A total of 362 patients with a malaria diagnosis in the previous 3 months were followed up
and interviewed (294 in public facilities, 68 in privates facilities) and a further 231 patients
presenting with fever (183 public facilities, 49 private facilities) were administered an exit
interview upon leaving the facility.
Table 3.8 shows demographics of malaria cases and fever patients found at the public and
private health facilities. Overall both groups were similar. A majority of malaria cases were
male adults. Nearly all cases and fever patients had resided at their current address for over
one year, suggesting they were residents of the communities.
Table 3.8 Assessment and antimalarials received by malaria cases and fever patients
Case follow up- Malaria Cases
Exit interviews - Fever patients
Public
facilities (N=294)
% (N)
Private facilities (N=68) % (N)
Public facilities (N=183)
% (N)
Private facilities (N=49) % (N)
Saw health worker and had blood test 98.3 (289) 100.0 (68) 38.8 (71) 44.9 (22)
Saw health worker and received ACTs 22.4 (66) 44.1 (30) 5.5 (10) 8.2 (4)
Saw health worker and received antimalarials
25.2 (74) 50.0 (34) 7.7 (14) 12.2 (6)
Reported all 3 key assessments performed by health worker23
52.7 (155) 44.1 (30) 16.4 (30) 18.4 (9)
Reported all 3 key assessments performed by health worker (excluding travel)24
87.8 (258) 73.5 (50) 33.9 (62) 32.7 (16)
If given antimalarials health worker advised how to take them
100.0 (74) 97.1 (33) 100.0 (14) 83.3 (5)
23 Health care provider asked about travel & fever, auxiliary temperature taken, and tested 24 Health care provider asked about fever, auxiliary temperature taken, and tested
Myanmar Artemisinin Resistance Containment Baseline Survey 74
Table 3.9 provides a summary of health worker assessments and antimalarials received for
malaria cases and fever patients. It was encouraging to see that nearly all the malaria cases
who visited the health facility saw a health worker and had been administered a blood test,
however these are patients who have been recorded in outpatient records as having a malaria
diagnosis so it is unlikely they would not have had a blood test. The low percentage of fever
cases seeing a health worker reflects that many of these would be unlikely to be malaria and
the clinical assessment most likely resulted in a different diagnosis.
For both malaria cases and fever patients it seemed that where an antimalarial was given it
was most likely an ACT. In public facilities less than a quarter of the malaria patients received
an ACT but this was double among private facilities. Less than 10% of fever patients in both
public and private facilities received an ACT.
It was interesting that the percentage of fever patients reporting being asked about all three
key assessments (travel and fever, auxillary temperature taken, and tested) was low and the
same across both public and private sector, suggesting attention may be needed to improve
quality of care through further training and supervision.
In contrast, the percentage of malaria cases reporting all three key assessments, especially
when travel was excluded from the assessment was high, and again similar for both public and
private facilities. Health worker advice on taking antimalarials was high for malaria cases and
fever patients in both public and private facilities.
Table 3.9 below shows the reported treatment received among malaria cases and fever
patients. Focusing first on malaria cases, the percentage who reported receiving an ACT
(specifically Coartem) was very low and more so among private facilities. A considerable
percentage received paracetamol and vitamins (15% in public facilities, 20% in private
facilities). Reporting of any treatment was surprisingly low for fever patients with
approximately 6% receiving Coartem in both public and private facilities. There seemed to be
some confusion about infusion in treatment prescribed. Some malaria cases (28.2% and
14.7% in public and private facilities, respectively) reported to have had an infusion but did
not specify this when asked about drugs prescribed at health facilities. Similarly in exit
interviews with fever cases (20.2% and 2.0% in public and private facilities, respectively)
reported having had an infusion when asked directly but did not specify this when asked
about specific treatments. This suggested under-reporting of infusion use.
Table 3.9 Treatment prescribed at public and private health facilities among malaria
and fever cases
Case follow up- Malaria Cases Exit interviews - Fever patients
Public facilities (N=294)
% (N)
Private facilities (N=68) % (N)
Public facilities (N=183)
% (N)
Private facilities (N=49) % (N)
Coartem (AL) 14.4 (52) 5.2 (19) 5.5 (10) 6.1 (3)
Artesunate + Mefloquine 1.7 (5) 1.5 (1) - (0) - (0)
Other artesunate + mefloquine 1.7 (5) 1.5 (1) - (0) - (0)
Myanmar Artemisinin Resistance Containment Baseline Survey 75
Duo-Cotecxin 1.4 (4) - (0) - (0) - (0)
Other DHA-piperaquine - (0) 13.2 (9) - (0) 2.0 (1)
Cotecxin 0.7 (2) 4.4 (3) 0.5 (1) 2.0 (1)
Mefloquine - (0) - (0) - (0) - (0)
Artesunate only 2.0 (6) - (0) 0.5 (1) - (0)
Artemether only - (0) - (0) 0.5 (1) - (0)
Artemisinin only 0.3 (1) - (0) - (0) - (0)
Quinine - (0) - (0) - (0) - (0)
Chloroquine - (0) 1.5 (1) - (0) - (0)
Primaquine 1.4 (4) - (0) 1.1 (2) - (0)
Mixture of drugs for fever/malaria - (0) - (0) 0.5 (1) 2.0 (1)
Antibiotics 6.8 (20) 10.3 (7) 0.5 (1) 2.0 (1)
Paracetamol 7.1 (21) 5.9 (4) - (0) 2.0 (1)
Vitamins 8.2 (24) 14.7 (10) 1.6 (3) 2.0 (1)
Infusion 0.3 (1) - (0) - (0) - (0)
Traditional herbs - (0) - (0) - (0) 2.0 (1)
Other non anti malarial 0.7 (2) 2.9 (2) 0.5 (1) - (0)
Table 3.10 shows the reported diagnoses for prescribed treatment categories among exit
patients only. Patients can have multiple diagnoses and multiple treatments. Malaria was the
most common diagnosis among respondents of the exit interviews followed by respiratory
infection, gastric intestinal (GI) infections and other. Although the numbers were small, it is
encouraging to see that all patients receiving an ACT/antimalarial had been diagnosed
with malaria. Infusion appears to be the most common treatment for all diagnosis groups
demonstrating a huge over-reliance on infusions.
Table 3.10 Reported diagnosis and treatment among exit interview fever patients
Diagnosis Treatment received
N ACT Any antimalarial
Any antibiotic Infusion
% of patients receiving
treatment (N)
% of patients receiving
treatment (N)
% of patients receiving
treatment (N)
% of patients receiving
treatment (N)
Public health facility
Malaria 29 100.0 (9) 100.0 (11) 100.0 (1) 19.6 (19)
Acute/upper respiratory infection
5 - (0) - (0) - (0) 4.1 (4)
Cold / flu 73 - (0) - (0) - (0) 73.2 (71)
GI infection 6 - (0) - (0) - (0) 3.1 (3)
Private health facility
Malaria 15 100.0 (4) 100.0 (6) 100.0 (1) 50.0 (14)
Acute/upper respiratory infection
11 - (0) - (0) - (0) 3.6 (1)
Cold / flu 12 - (0) - (0) - (0) 42.9 (12)
GI infection 1 - (0) - (0) - (0) 3.6 (1)
DISCUSSION
Myanmar Artemisinin Resistance Containment Baseline Survey 76
HOUSEHOLD AND PREVALENCE SURVEYS
Malaria prevalence
Overall, malaria prevalence was only 0.5% in both Tier 1 and Tier 2 at the time of the survey.
There was a higher prevalence of Plasmodium vivax infection compared to Plasmodium
falciparum and there were no cases of mixed species infection. Malaria tended to be more
prevalent among children under five and poorer households and people living in Tier 1 and in
higher malaria risk area had higher chance of having a positive slide.
In absolute numbers, there were more malaria cases found in Tier 1 (4 Pf and 13 Pv) than in
Tier 2 (3 Pf and 1 Pv). However, comparison across tier suggested that the proportion of
infections of P. falciparum was higher than P. vivax in Tier 2 but this trend was reversed in Tier
1. With respect to the containment of artemisinin resistance, the fact that there were more P.
falciparum cases proportionally in Tier 2 suggests that more intensive efforts should be
placed in Tier 2.
The higher prevalence of malaria among children under five years of age suggests that there
may be ongoing malaria transmission in the studied villages. Further routine monitoring of
confirmed malaria cases throughout the year may help to shed some light on the malaria
epidemiology and trends in Tier 1 and Tier 2 areas. Malaria transmission appeared to be
heterogeneous as the trends observed in Tier 1 tended to reflect a lower transmission setting
compared to Tier 2. However, the association of malaria slide positivity with children under 5
years of age, presence of fever, net use the previous night, and high malaria risk strata all
suggest much more stable transmission. Thus, it will be even more critical to include more
sensitive end-points for measuring parasitemia and transmission with molecular tools such as
PCR and serology, respectively, into this analysis.
Malaria awareness and prevention
In general, 20% of the respondents could not mention any transmission mode and several
misconceptions were cited but about 65% of respondents knew that mosquitoes transmit
malaria. Awareness about ITN benefit was low. In the previous six months, only 12%
mentioned having received any information about malaria and the main message remembered
was related to net or ITN use, from health facility or NGO staff.
On the survey day, household ownership of any net was 97.4%, of any ITN was 35.1% and any
LLIN was 11.1%. The coverage of any net was higher among richer households while the
availability and use of insecticide treated nets appeared to be associated with less wealthy
households and those living in higher malaria risk area. Considering already very high
coverage of any net among households, it may be worthwhile to look at intermediate
strategies for converting these conventional nets into LLINs as soon as possible – while
being careful not to adversely affect household behaviors and perceptions of these important
prevention tools. The longer term strategy, however, should be to replace conventional nets
with LLINs that households want to have and to use.
Myanmar Artemisinin Resistance Containment Baseline Survey 77
Unsurprisingly, more nets were found in the Tier 1 and the nets tended to be ‘newer’ than
those in Tier 2, perhaps due to the intensified activities in this priority area for containment of
artemisinin resistance. However, with many mosquito nets found in Tier 2 more than 5 years
old, it will be important to expand these intensive efforts to the more remote, harder to
reach areas of Tier 2 as well.
The proportion of all people who slept under a net the previous night was a respectable 76.5%
but these estimates for ITN and LLIN were much lower at 16% and 4%, respectively. Although
more than a quarter of households had insufficient nets (at least one net per every two
people), at least 20% of households also possessed nets that were not currently used by the
household and were saved for the future or for visitors. Lastly, net use among mobile
groups as forest goers, travellers and temporary visitors tend to be significantly lower
compared to all individuals. More efforts are needed to target BCC messages around the
importance of having and sleeping under an insecticide-treated net, particularly among
populations that are highly mobile.
Malaria treatment
Nearly half of the respondents knew the signs and symptoms of malaria (chills and fever) but
only one-third could cite the main sign for fever severity (unconscious, fast breathing or
convulsion). These figures suggest that more BCC is needed to improve malaria knowledge
and treatment-seeking behaviors.
Less than 30% of household respondents knew any antimalarial drug and less than 10% could
mention an ACT. However, artesunate monotherapy was mentioned by more than 10% by
respondents living in either tier. Considering that the ban on artesunate monotherapies had
not been fully implementated during the time of the survey, there are still opportunities for
improving peoples’ knowledge and awareness about the use of ACTs for the treatment of
malaria.
Among all individuals in the sampled households, 3% reported fever during the previous two
weeks. Among these 241 people, 70% sought treatment mostly to a private doctor, a health
centre or a midwife clinic and overall, public sector channels were more common. However, in
Tier 2, fewer people sought treatment and an important source of advice or treatment was a
grocery shop. There is particular need to address this potentially dangerous practice of
treatment seeking from unqualified shopkeepers.
For the most part, the first source of treatment-seeking for reported fevers appeared to be a
private channel. In both tiers, time to treatment was fast, within 2 days for a vast majority of
cases. Among all fever cases, 69% had either an RDT or a blood test for malaria. In most cases,
the treatment consisted of non-antimalarial drugs (80.8%) for presumably non-malaria fevers
and only 4 out of 12 (33%) confirmed cases received an ACT (Coartem).
DRUG OUTLET SURVEY
The main finding from the drug outlet survey was that more than half of providers did not
have appropriate health training and 80% of the drug outlets were part of a general store
Myanmar Artemisinin Resistance Containment Baseline Survey 78
where consultations were offered. Awareness about artemisinin resistance was low in the
sampled outlets and in general, the most popular antimalarial drugs sold in the sampled
outlets were: 1) artesunate tablets, 2) chloroquine, 3) artemether injectables, and 4)
artemether tablets. This confirms that in the target area, artemisinin monotherapies (i.e.,
artesunate) were still the most popular malaria treatment obtained from drug outlets.
Also, more than half of the drug outles sold partial packs of antimalarial treatments in
previous month. Selling activity during the past week was low, which is consistent with the
low malaria prevalence and reported fever found in the households surrounding these outlets
and 60% reported selling less antimalarial drugs than the previous year.
Although availability of any antimalarial drugs was high among the sampled drug outlets, ACTs
were found in less than 40% of outlets and artemisinin monotherapies were still the most
popular and widely available treatment for malaria. Since the ban on oral artemisinin
monotherapies had not been fully implemented at the time of the survey, it was not surprising
that most drug providers were unaware of the issue of artemisinin resistance. Further work
on providing appropriate BCC training for drug outlet providers and ensuring the drug
outlets are stocking quality-asured antimalarials will be essential.
HEALTH FACILITY SURVEY
The aim of the health facility survey was to assess the delivery of services for management of
fever and malaria in both the public and private sectors. Due to the relatively low incidence of
malaria throughout the country, it was increasingly more difficult to conduct proper
assessment based on prospective malaria cases. As a result, exit interviews and malaria case
follow up interviews provided a good way to correlate patient’s perceived malaria services
with those of providers.
Public health facilities were more likely to provide malaria diagnosis and malaria
education compared to private facilities, in part due to the support from the National Malaria
Programme and Ministry of Health. On the other hand, private health facilities were more
likely to refer cases of severe malaria, and had significanlty less respondents with malaria
related training compared to public facilities. This is reflected in the low level of knowledge
about the recommended treatments for P. falciparum and P. vivax. These findings warrant
more intensive training for malaria case management, particularly among private
providers.
All public facilities seem to have good diagnostic capabilities whereas 40% of private facilites
had no facility for malaria diagnosis. If the private facilites are able to refer cases this is not
problematic, referal of potential malaria cases for testing and/or testing in private facilites
should be addressed.
Although nearly all malaria cases who saw a health worker had a blood test, one of the key
findings from the malaria case follow up survey was that less than a quarter of cases in public
facilites received an ACT. This percentage was higher in the private sector but the number of
cases followed up in the private sector was low (68). Among the patients receiving IV infusion,
20% and 50% were diagnosed as malaria in the public and private health facility, respectively.
The over-reliance on the use of intravenous infusions for the treatment of fevers and malaria
should be assessed. Particularly as malaria declines in the country, more fevers presented at
Myanmar Artemisinin Resistance Containment Baseline Survey 79
public and private health facilities will be non-malaria related. Improved and more sensitive
algorithms and training for the treatment of these non-malaria fevers should be developed and
implemented
Myanmar Artemisinin Resistance Containment Baseline Survey 80
KEY RECOMMENDATIONS
1. Promote better understanding of the malaria epidemiology in Myanmar
The low malaria prevalence (based on microscopy) and reported fevers found in this survey is
an encouraging testament of the progress achieved in Myanmar to date. However, further
analysis using molecular (PCR) and serological methods, if possible, should be completed as
soon as possible to complement these findings. In the longer term, the malaria surveillance
system in Myanmar should be strengthened to provide quality and reliable data on the malaria
trends over time across seasons and localities.
The epidemiology of malaria will likely change as the incidence of malaria continues to decline in the region and already in parts of Myanmar. Therefore, more research may be needed to evaluate the impact of changing species distributions (i.e., increasing P. vivax burden) on disease transmission dynamics. There is also a need for more information on the effect of the rapidly changing environment on malaria vector behavior and possible secondary malaria species.
2. Promote further awareness of malaria prevention and case management
General awareness of malaria and fever case management was found to be modest and further
work should be reinforced by behavior change communication focusing on prevention and
treatment of malaria and availablility of diagnostic services and treatment. In particular,
awareness about the benefits of using ITNs/LLINs was relatively low. Further efforts should
be placed on improving community perceptions and behaviors for malaria prevention,
building on the fact that nearly all households currently own at least one mosquito net and
nearly three-quarters of individuals slept under a mosquito net the previous night.
Areas for further intensification of BCC activities include ensuring that health staff (both public
and private) are properly trained, able to prescribe correct treatments, and able to give the
appropriate messages, as health facility staff are cited as one of the most common sources of
information about malaria messages. The opportunities to expand these interpersonal
communication channels through village malaria workers or volunteers should be explored.
3. Expand the availability and promote the use of ITNs/LLINs
The coverage of any mosquito net (i.e., at least one mosquito net per household) in both Tier 1
and Tier 2 was more than 96%. However, household coverage of any ITN or LLIN was
insufficient to impact on malaria prevention and transmission. Considering the high
household coverage of at least one mosquito net, the national malaria prevention strategy
could explore the role of short to medium-term approaches for net retreatment kits or
campaigns. For the longer term, strategies should be in place to promote the replacement of
current conventional mosquito nets, building on the existing opportunity of the “net culture”
in Myanmar.
Myanmar Artemisinin Resistance Containment Baseline Survey 81
4. Promote innovative strategies targeting vulnerable groups including mobile or
migrant population
The national malaria programme should specifically address this vulnerable risk group as they
are highly at risk for malaria. They should have access to prevention methods such as
insecticide treated nets or other personal prevention methods, be aware and have access to
diagnostic services and malaria treatment and be sensitized on the importance to seek health
care in case of fever. Innovative strategies and approaches should be piloted to specifically
address improving case management, prevention, as well as M&E and surveillance among
mobile populations. Furthermore, linkages with the private sector (i.e., development projects
and businesses employing migrants) should be strengthened.
5. Enforce the national ban on oral artemisinin monotherapies
Artemisinin monotherapies were found widely available and knowledge about the ban among drug sellers was limited. Despite efforts to enforce the ban on the importation of oral artemisinin monotherapies in the country, the availability of such monotherapies (e.g., artesunate) in 56% and 44% of private drug outlets in Tier 1 and Tier 2, respectively, highlights the need to intensify efforts on drug regulation and enforcement.
At the same time, there is also a need to improve the availability and knowledge of
artemisinin-based combination therapies in both public and private sectors, particularly
among community members and private providers. There is a need to strengthen
collaboration with private providers for training, M&E, and surveillance.
6. Promote awareness and increase knowledge of health care providers
Knowledge on management of severe malaria and recommended treatment for P. falciparum and P. vivax should be increased and strengthened among both public and private health facility staff through in-service and refresher trainings, particularly addressing the current reliance on intravenous infusion to treat uncomplicated malaria cases. As malaria transmission will most likely decrease in the coming years, it becomes more important and relevant to develop improved and more sensitive algorithms and approaches for the management of non-malaria fevers. 7. Strengthen routine malaria information systems at all levels
Malaria transmission will become more heterogeneous and localized as malaria continues to
decline in the region. Large scale malariometric surveys are useful for a ‘snap-shot’ and can
complement analysis of the malaria situation, but can inevitably be costly and not sensitive
enough for local decision-making. As a result, it will be critical to begin moving towards
improving the routine malaria information systems in Myanmar as a longer term strategy.
Myanmar Artemisinin Resistance Containment Baseline Survey 82
REFERENCES
UNICEF (2008) Malaria Risk Micro-stratification in UNICEF 80 Townships
Ministry of Health, Myanmar. National Treatment Guidelines for Malaria
WHO (2011) Strategic Framework for Artemisinin Resistance Containment in Myanmar
(MARC) 2011‐2015
Myanmar Artemisinin Resistance Containment Baseline Survey 83
ANNEXES
Annex 1. Household Questionnaire
Annex 2. Drug Outlet Questionnaire
Annex 3. Health Facility Questionnaire – Part 1
Annex 4. Health Facility Questionnaire – Part 2
Annex 5. Health Facility Questionnaire – Part 3
Myanmar Artemisinin Resistance Containment Baseline Survey 84
ANNEX 1. HOUSEHOLD QUESTIONNAIRE
IDENTIFICATION
Cluster code (01-80): Household number (01-25): ........................................
Head of Household: __________________________ Name of respondent: _____________
(enter code from section 1 - the household list line code)
State/Region: _______________________________ Township: ....................................................................
Village Tract: ________________________ Village: ________________________
HOUSEHOLD VISITS Visit 1 Visit 2 Visit 3 Final Visit
Date:
Interviewer's Name:
Result code:
_ _ / _ _ / _ _ (dd/mm/yy)
__________
_____
_ _ / _ _ / _ _ (dd/mm/yy)
__________
_____
_ _ / _ _ / _ _ (dd/mm/yy)
__________
_____
Date: __ __ / __ __ / __ __ (dd/mm/yy) Interviewer ID: Result code:
Next planned visit: Date:
Time:
_ _ / _ _ / _ _
_________
_ _ / _ _ / _ _
_________
Total number of visits:
* Result Codes:
1 = Completed 2 = No one (or no potential respondent) at home 3 = Refused 4 = Dwelling not found 5 = Other
COMPLETE AFTER HOUSEHOLD LISTING
Total members in household: Total visitors in the household: Line code of respondent:
(anyone who can answer, mostly females)
SUPERVISOR FIELD EDITOR OFFICE EDITOR DATA ENTRY
Name: _______________
Code:
Date: _ _ / _ _ / _ _
Name: _______________
Code:
Date: _ _ / _ _ / _ _
Name: _______________
Code:
Date: _ _ / _ _ / _ _
Name: _______________
Code:
Date: _ _ / _ _ / _ _
Myanmar Artemisinin Resistance Containment Baseline Survey 85
Section 1: Household Listing
"We would first like to ask you some information about the members of your household and any
temporary visitors to your household."
(Usual residents do not include those who are away from home for more than six months)
LINE NO. USUAL RESIDENTS AND TEMPORARY
VISITORS
RELATIONSHIP TO HEAD OF HOUSEHOLD
SEX AGE EDUCATION
Circle the line number if blood samples taken
Give the names of people who usually live in the house and visitors last night (If a baby does not have a name, write babymother's name)
What is the relationship of (NAME) to the head of household?
Is (NAME) male or female?
How old is (NAME)? [If <1 year, write "00" for years and record number of months]
Has (NAME) ever attended school?
What is the highest level of education attained?
Q1 Q2 Q3 Q4 Q5 Q6 Q7
Line code Name Code* Male Female Years Months Yes No Code**
01 1 2 1 2
02 1 2 1 2
03 1 2 1 2
04 1 2 1 2
05 1 2 1 2
06 1 2 1 2
07 1 2 1 2
08 1 2 1 2
09 1 2 1 2
10 1 2 1 2
11 1 2 1 2
12 1 2 1 2
13 1 2 1 2
14 1 2 1 2
15 1 2 1 2
"Just to make sure that I have a complete listing, are there any other persons living in your household that we have not listed, such as small children or infants?"
If yes, add these individuals to the two tables above
"Are there any other people living or staying here who may not be members of your family, such as visitors or friends or temporary workers?"
Myanmar Artemisinin Resistance Containment Baseline Survey 86
If yes, add these individuals to the two tables above Tick here if more than 14 people in the house and continuation sheet used:
LINE NO.
USUAL RESIDENTS
AND TEMPORARY
VISITORS
PERSON WHO TRAVELS AWAY
FROM HOME
SLEPT HERE LAST NIGHT
REASON FOR ABSENCE LAST
NIGHT
CURRENTLY FEBRILE
CURRENTLY PREGNANT
Circle the line number
if blood samples
taken
Is (NAME) a usual resident of the household or a
temporary visitor?
During the past 6 months, did
(NAME) travel away from home
and stay overnight?
Did (NAME) sleep here last night?
If (NAME) did not sleep here last
night, what was the reason?
Is (NAME) febrile? FOR ELIGIBLE WOMEN: Is (NAME) currently
pregnant?
Q1 Q8 Q9 Q10 Q11 Q12 Q13
Line code Resident Visitor Yes No Yes No Code*** Yes No Yes No DK
01 1 2 1 2 1 2 1 2 1 2 8
02 1 2 1 2 1 2 1 2 1 2 8
03 1 2 1 2 1 2 1 2 1 2 8
04 1 2 1 2 1 2 1 2 1 2 8
05 1 2 1 2 1 2 1 2 1 2 8
06 1 2 1 2 1 2 1 2 1 2 8
07 1 2 1 2 1 2 1 2 1 2 8
08 1 2 1 2 1 2 1 2 1 2 8
09 1 2 1 2 1 2 1 2 1 2 8
10 1 2 1 2 1 2 1 2 1 2 8
11 1 2 1 2 1 2 1 2 1 2 8
12 1 2 1 2 1 2 1 2 1 2 8
13 1 2 1 2 1 2 1 2 1 2 8
14 1 2 1 2 1 2 1 2 1 2 8
15 1 2 1 2 1 2 1 2 1 2 8
Myanmar Artemisinin Resistance Containment Baseline Survey 87
AFTER LISTING HOUSEHOLD MEMBERS, SELECT MEMBERS FOR TAKING BLOOD. MAKE
RANDOM SELECTION FOR DIFFERENT AGE GROUPS AND CIRCLE LINE NO. FOR
SELECTED ONES. Check for completeness.
One to -4 years one person 5 – 14 one person
Above 15 (female) one person Above 15 (male) one person
Then, Pregnant women all
Temporary visitors all
Those with malaria symptoms all
Myanmar Artemisinin Resistance Containment Baseline Survey 88
"Now, we would continue to ask you some information about usual residents of your household who are away from house for more than 6 months."
LINE NO.
USUAL RESIDENTS AWAY FROM HOME FOR MORE THAN 6
MONTHS
RELATIONSHIP TO HEAD OF HOUSEHOLD
SEX AGE EDUCATION
REASON FOR
ABSENCE
CURRENT RESIDENCE
Give the names of people who are away from home for more than 6 months
What is the relationship of (NAME) to the head of household?
Is (NAME) male or female?
How old is (NAME)? [If <1 year, write "00" for years and record number of months]
Has (NAME) ever attended school?
What is the highest level of education attained?
What was the reason for being away?
Where does (NAME) stay?
Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q11 Q11b
Line code Name Code* Male
Female Years
Months
Yes No Code** Code*** Country Township Others (specify)
01 1 2 1 2
02 1 2 1 2
03 1 2 1 2
04 1 2 1 2
05 1 2 1 2
06 1 2 1 2
07 1 2 1 2
Myanmar Artemisinin Resistance Containment Baseline Survey 89
* Codes for relationship to head of household (Q3):
01 = Head of household
02 = Spouse (wife/husband/partner)
03 = Son or daughter
04 = Son or daughter-in-law
05 = Grandchild
06 = Parent
07 = Parent in-law
08 = Brother or sister
09 = Niece or nephew
10 = Other relative
11 = Adopted/foster/stepchild
12 = Not related
** Codes for level of education (Q7):
0 = Never attended school
1 = Some primary
2 = Completed primary (Grade 6)
3 = Some secondary
4 = Completed secondary (Grade 12)
5 = More than secondary
8 = Don't know
*** Codes for reason for absence last night (Q11):
1 = Working on chamkar or plantation in this province
2 = Working on chamkar/plantation in another province
3 = Working in forest in this province
4 = Working in forest in another province
5 = Working in another province
6 = Working in Thailand
7 = Away at school / studying
8 = Holidays / visiting relatives or friends
9 = Hospitalized or caretaker of a patient
10 = Other (specify)
98 = Don't know
Myanmar Artemisinin Resistance Containment Baseline Survey 90
Section 2: Household Details
"Now I would like to ask you some general questions about this household."
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
Q14 What is the main source of drinking water in your household? (SINGLE RESPONSE)
Piped water into house or yard ................... 1 Rain water/gutter pipe ................................. 2 Tube well or borehole ................................. 3 Public tap/standpipe ................................... 4 Protected well/Spring .................................. 5 Cart or truck with tank ................................. 6 River/Stream/Pond/Lake ............................. 7 Other ........................................................... 8 Specify:_______________________________
Q15 What kind of toilet facility does your household use? (SINGLE RESPONSE)
Flush or pour toilet ...................................... 1 Pit latrine- ventilated or with slab ................ 2 Open pit (no slab) ....................................... 3 No facility/field/forest ................................... 4 Other ........................................................... 5 Specify:_______________________________
Q16 Does your dwelling have electricity? IF GENERATOR IS USED FOR THE WHOLE VILLAGE, ELECTRICITY WILL BE CONSIDERED AVAILABLE.
Yes .............................................................. 1 No ............................................................... 2
Q17 Does your household have any of the following assets? ASK ABOUT EACH OF THE ASSESTS AND CIRCLE "YES" IF THEY OWN IT OR "NO" IF THEY DO NOT
Yes No Radio ........................................... 1 2 Television .................................... 1 2 DVD player.................................. 1 2 Mobile phone/landline ................. 1 2 Freezer/refrigerator ..................... 1 2 Water storage jar ........................ 1 2 Bed .............................................. 1 2 Electric Kettle .............................. 1 2 Plastic bucket .............................. 1 2 Generator .................................... 1 2 Battery (12v) .............................. 1 2 Floor mat (smooth) ..................... 1 2 Pigs ............................................. 1 2 Cows/Buffalo/Goats .................... 1 2 Chickens/Ducks .......................... 1 2
Q18 What type of fuel does your household mainly use for cooking? (SINGLE RESPONSE)
Electricity..................................................... 1 Gas/kerosene ............................................. 2 Charcoal...................................................... 3 Firewood/straw ........................................... 4 Other ........................................................... 5 Specify:_______________________________
Q19 What is the main material of the roof? (SINGLE RESPONSE)
Plastic sheet/tent ........................................ 1 Thatch/palm/bamboo .................................. 2 Fibre glass/iron/aluminum ........................... 3 Tiles/cement................................................ 4 Other ........................................................... 5 Specify:_______________________________
Myanmar Artemisinin Resistance Containment Baseline Survey 91
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
Q20 What is the main material of the floor? (SINGLE RESPONSE)
Bamboo ....................................................... 1 Wood ........................................................... 2 Tiles/cement................................................ 3 Earth ........................................................... 4 Other ........................................................... 5 Specify:_______________________________
Q21 Does any household member own the following types of transport? ASK ABOUT EACH AND CIRCLE "YES" IF THEY OWN IT OR "NO" IF THEY DO NOT
Yes No Ox or horse cart .......................... 1 2 Bicycle ......................................... 1 2 Motorcycle or scooter ................. 1 2 Car or truck or Trollergy .............. 1 2 Motor boat .................................. 1 2
Q22 Does your household use metal or plastic screens on your windows to keep mosquitoes out?
Yes .............................................................. 1 No ............................................................... 2
Q23 Does your household use any chemicals to keep mosquitoes away (e.g., spray, coil or repellent)?
Yes .............................................................. 1 No ............................................................... 2
Q25
Q24 In the past month, how much did your household spend on chemicals to keep mosquitoes away?
Riel: ...............................................................
Not Sure .................................................... 98
Q25 During the past 12 months, has anyone sprayed the interior walls of your home against mosquitoes?
Yes .............................................................. 1 No ............................................................... 2 Don't know .................................................. 8
Q28 Q28
Q26 Who sprayed the house? Government worker/program ...................... 1 NGO worker/program ................................. 2 Private company ......................................... 3 Household member .................................... 4 Other ........................................................... 5 Specify:_______________________________
Not sure ...................................................... 8
Q27 Did you pay for the spraying? Yes .............................................................. 1 No ............................................................... 2 Don't know .................................................. 8
Q28 How many separate sleeping spaces are there in your household? INCLUDE ALL SLEEPING SPACES, INCLUDING IF THERE IS MORE THAN ONE SLEEPING SPACE IN EACH ROOM USED FOR SLEEPING
Number of sleeping spaces ..........................
Section 3: Household Nets
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
Q29 Does your household have any mosquito nets (bed nets or hammock nets) that can be used while sleeping?
Yes ............................................................. 1 No ............................................................... 2 Not sure ...................................................... 8
Q52 Q52
Myanmar Artemisinin Resistance Containment Baseline Survey 92
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
Q30 How many mosquito nets does your household have? ALSO INCLUDE ANY THAT ARE NOT CURRENTLY IN USE
Number of bed nets: ..................................... Number of hammock nets: ........................... Total number of mosquito nets: ....................
NO. QUESTIONS Net 1 Net 2 Net 3
Q31 Ask to see the nets in the household.
Observed ................ 1 Not observed .......... 2
Observed ................ 1 Not observed .......... 2
Observed ............... 1 Not observed .......... 2
NOTE: IF THERE ARE MORE THAN THREE NETS IN THE HOUSEHOLD, USE ADDITIONAL SHEETS. FIRST ASK Q31-Q48 FOR NET 1, THEN Q31-Q48 FOR NET 2, THEN Q31-Q48 FOR NET 3, …
Q32 How long ago did your household obtain this net?
< 6 months ............. 1 6 mo to <1 year ...... 2 1 yr to < 2 yr ........... 3 2 yr to < 3 yr ........... 4 3 yr to < 5 yr ........... 5 ≥ 5 years ................. 6 Don't know .............. 8
< 6 months ............. 1 6 mo to <1 year ...... 2 1 yr to < 2 yr ........... 3 2 yr to < 3 yr ........... 4 3 yr to < 5 yr ........... 5 ≥ 5 years ................ 6 Don't know.............. 8
< 6 months ............. 1 6 mo to <1 year ...... 2 1 yr to < 2 yr ........... 3 2 yr to < 3 yr ........... 4 3 yr to < 5 yr ........... 5 ≥ 5 years ................ 6 Don't know ............. 8
Q33 Where did your household obtain this net?
Gift (family/friend) ... 1 Government ............ 2 NGO ....................... 3 Shop/Market ........... 4 Itinerant seller ......... 5 Other ...................... 6 Spec_____________ Don't know .............. 8
IF GIFT, SKIP TO Q35
Gift (family/friend) ... 1 Government ........... 2 NGO ....................... 3 Shop/Market ........... 4 Itinerant seller ......... 5 Other ...................... 6 Spec_____________ Don't know.............. 8
IF GIFT, SKIP TO Q35
Gift (family/friend) ... 1 Government ........... 2 NGO ....................... 3 Shop/Market ........... 4 Itinerant seller ........ 5 Other ...................... 6 Spec_____________ Don't know ............. 8
IF GIFT, SKIP TO Q35
Q34 How much did you pay for this net?
Kyat: ____________
Don't know .............. 8
Kyat: ____________
Don't know.............. 8
Kyat: ____________
Don't know ............. 8
Q35 Observe or ask the brand of the mosquito net. If brand is unknown, and you cannot observe the net, show pictures of typical net types/brands to respondent.
ITNs Powernet ................ 1 Permanet ................ 2 JICA ........................ 3 MoH ........................ 4 Olyset…………….. 5 Conventional nets: Lace ....................... 6 Military ................... 7 No logo ................. 8 Cotton CYC .......... 9 Other .................... 10 Spec_____________ Don't know ............ 98
ITNs Powernet ................ 1 Permanet ................ 2 JICA ....................... 3 MoH ........................ 4 Olyset…………….. 5 Conventional nets: Lace ...................... 6 Military ................... 7 No logo ................. 8 Cotton CYC .......... 9 Other .................... 10 Spec_____________ Don't know............ 98
ITNs Powernet ................ 1 Permanet ............... 2 JICA ....................... 3 MoH........................ 4 Olyset…………….. 5 Conventional nets: Lace ...................... 6 Military ................... 7 No logo ................. 8 Cotton CYC .......... 9 Other.................... 10 Spec_____________ Don't know ........... 98
Q36 Observe or ask the size of the mosquito net.
Single size .............. 1 Family size ............. 2 Hammock ............... 3
Single size .............. 1 Family size ............. 2 Hammock ............... 3
Single size .............. 1 Family size ............. 2 Hammock ............... 3
Myanmar Artemisinin Resistance Containment Baseline Survey 93
NO. QUESTIONS Net 1 Net 2 Net 3
Q37 Observe or ask the colour of the mosquito net.
White ...................... 1 Blue ........................ 2 Green ..................... 3 Pink ........................ 4 Other ...................... 5 Spec_____________ Don't know .............. 8
White ...................... 1 Blue ........................ 2 Green ..................... 3 Pink ........................ 4 Other ...................... 5 Spec_____________ Don't know.............. 8
White ...................... 1 Blue ........................ 2 Green ..................... 3 Pink ........................ 4 Other ...................... 5 Spec_____________ Don't know ............. 8
Q38 Does the net have any holes? Yes ......................... 1 No ........................... 2
Yes ......................... 1 No ........................... 2
Yes ......................... 1 No........................... 2
Q39 Has the net been repaired? Yes ......................... 1 No ........................... 2
Yes ......................... 1 No ........................... 2
Yes ......................... 1 No........................... 2
Q40 When you got the mosquito net was it already treated with an insecticide to kill or repel mosquitoes?
Yes ......................... 1 No ........................... 2 Not sure .................. 8
IF YES, SKIP TO Q42
Yes ......................... 1 No ........................... 2 Not sure .................. 8
IF YES, SKIP TO Q42
Yes ......................... 1 No........................... 2 Not sure ................. 8
IF YES, SKIP TO Q42
Q41 Since you have had the net, has it ever been soaked or dipped in a liquid to kill/repel mosquitoes?
Yes ......................... 1 No ........................... 2 Not sure .................. 8
IF NO, SKIP TO Q44
Yes ......................... 1 No ........................... 2 Not sure .................. 8
IF NO, SKIP TO Q44
Yes ......................... 1 No........................... 2 Not sure ................. 8
IF NO, SKIP TO Q44
Q42 Where did you get your net treated the last time? IF NEVER RETREATED, SKIP TO Q44
At home .................. 1 In village ................. 2 In another village .... 3 Other ...................... 4 Spec_____________
Never retreated for original treated net .8
At home .................. 1 In village ................. 2 In another village .... 3 Other ...................... 4 Spec_____________
Never retreated for original treated net .8
At home .................. 1 In village ................. 2 In another village .... 3 Other ...................... 4 Spec_____________
Never retreated for original treated net .8
Q43 The last time you treated your net, how much did your household pay for dipping the net, if it paid anything?
Kyat: ____________
Don't know .............. 8
Kyat: ____________
Don't know.............. 8
Kyat: ____________
Don't know ............. 8
Q44 How long since the net was last soaked or dipped in a liquid to kill/repel mosquitoes?
IF LESS THAN ONE MONTH, WRITE "00"
Months: .....................
More than 3 years (36 months) ago ..... 95
Not sure ................ 98
Months: ....................
More than 3 years (36 months) ago ..... 95
Not sure ................ 98
Months: ....................
More than 3 years (36 months) ago ..... 95
Not sure ............... 98
Q45 How frequently has this net been washed since you received it?
Weekly ................... 1 Every 2-3 weeks…..2 Monthly ................... 3 Every 2-3 months ... 4 Twice per year ........ 5 Once per year ......... 6 < Once a year ......... 7 Never ...................... 0 Not sure .................. 8
Weekly ................... 1 Monthly ................... 2 Every 2-3 months ... 3 Twice per year ........ 4 Once per year ........ 5 < Once a year ........ 6 Never ...................... 7 Not sure .................. 8
Weekly ................... 1 Monthly .................. 2 Every 2-3 months ... 3 Twice per year ....... 4 Once per year ........ 5 < Once a year ........ 6 Never...................... 7 Not sure ................. 8
Q46 Did anyone sleep under this mosquito net last night?
Yes ......................... 1 No ........................... 2 Not sure .................. 8
IF NO, SKIP TO Q48
Yes ......................... 1 No ........................... 2 Not sure .................. 8
IF NO, SKIP TO Q48
Yes ......................... 1 No........................... 2 Not sure ................. 8
IF NO, SKIP TO Q48
Myanmar Artemisinin Resistance Containment Baseline Survey 94
NO. QUESTIONS Net 1 Net 2 Net 3
Q47 Who slept under this mosquito net last night? ASK FOR THE NAME AND AGE OF EACH PERSON WHO SLEPT UNDER THE NET, THEN CHECK SECTION 1 FOR THE LIST OF HOUSEHOLD MEMBERS AND VISITORS AND WRITE THEIR LINE CODE (Q1)
1) Name__________
Line code: .................
2) Name__________
Line code: .................
3) Name__________
Line code: .................
4) Name__________
Line code: .................
5) Name__________
Line code: .................
1) Name__________
Line code: .................
2) Name__________
Line code: .................
3) Name__________
Line code: .................
4) Name__________
Line code: .................
5) Name__________
Line code: .................
1) Name__________
Line code: ................
2) Name__________
Line code: ................
3) Name__________
Line code: ................
4) Name__________
Line code: ................
5) Name__________
Line code: ................
Myanmar Artemisinin Resistance Containment Baseline Survey 95
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
Q48 Do you have any old nets that you are not using to sleep under?
Yes .............................................................. 1 No ............................................................... 2
Q50
Q49 What are you using these old nets for?
MULTIPLE RESPONSES POSSIBLE CIRCLE ALL MENTIONED
PROBE ONCE: ANYTHING ELSE?
Saving for visitors ....................................... 1 Fishing ........................................................ 2 Protect garden ............................................ 3 Protect animals ........................................... 4 Other ........................................................... 5 Specify:_______________________________
Q50 Do you have any new nets that you are not using to sleep under?
Yes .............................................................. 1 No ............................................................... 2
Q52
Q51 Why aren't you using these new nets? Saving for visitors ....................................... 1 Saving for future use ................................... 2 No place to hang up .................................... 3 Currently have enough nets in use ............. 4 Other ........................................................... 5 Specify:_______________________________
Q52 If you need to buy a net where would you go to buy one?
Shop or seller in village ............................... 1 Nearest market ........................................... 2 Itinerant seller ............................................. 3 Would not buy- wait for distribution ............ 4 Would not buy- other .................................. 5 Other ........................................................... 6 Specify:_______________________________
Don't know .................................................. 8
Q53 If you decided you needed to treat or re-treat a net (i.e., soaking or dipping in a liquid), where would you go?
Wait for project/health staff ......................... 1 Health center/hospital ................................. 2 Private health facility ................................... 3 NGO office .................................................. 4 Pharmacy .................................................... 5 Market/shop ................................................ 6 VMW/VHV ................................................... 7 Nets are all pre-treated ............................... 8 Don't want insecticide ................................. 9 Have no nets ............................................. 10 Other ......................................................... 11 Specify:_______________________________
Don't know ................................................ 98
Q54 What are the benefits of a mosquito net treated with insecticide compared to an untreated net?
MULTIPLE RESPONSES POSSIBLE CIRCLE ALL MENTIONED
PROBE ONCE: ANYTHING ELSE?
Prevents mosquito bites ............................. 1 Repels mosquitoes ..................................... 2 Kills mosquitoes .......................................... 3 Kills other insects ........................................ 4 Sleep better................................................. 5 Protects against malaria ............................. 6 Other ........................................................... 7 Specify:_______________________________
Don't know .................................................. 8
Section 4: People who go to the forest
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
Myanmar Artemisinin Resistance Containment Baseline Survey 96
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
Q55 Does anyone in your household sometimes go to the forest and sleep there overnight?
Yes .............................................................. 1 No ............................................................... 2 Don't know .................................................. 2
Q69 Q69
Q56 How many people in your household sometimes go to the forest and sleep there overnight?
Number of people: ........................................
NO. QUESTIONS Person 1 Person 2 Person 3
Q57 Who in your household sometimes go to the forest and sleeps there overnight?
ASK FOR NAME AND AGE, CHECK SECTION 1 FOR THEIR LINE CODE (Q1) (Use additional sheets if more than 3 persons)
Name ____________
Line code: .................
Name ____________
Line code: .................
Name ____________
Line code: ................
Q58 When was (NAME) last in the forest?
Last night ................ 1 < 1 week ................. 2 1 to < 4 weeks ........ 3 ≥ 4 weeks ............... 4 Not sure .................. 8
Last night ................ 1 < 1 week ................. 2 1 to < 4 weeks ........ 3 ≥ 4 weeks ............... 4 Not sure .................. 8
Last night ............... 1 < 1 week ................. 2 1 to < 4 weeks ........ 3 ≥ 4 weeks ............... 4 Not sure ................. 8
Q59 How many nights did (NAME) stay in the forest on their last visit?
Nights: ......................
Not sure ................ 98
Nights: ......................
Not sure ................ 98
Nights: ......................
Not sure ............... 98
Q60 Did (NAME) take a hammock net or mosquito net with them the last time they went to the forest?
Yes ......................... 1 No ........................... 2 Not sure .................. 8
IF NO, SKIP TO Q65
Yes ......................... 1 No ........................... 2 Not sure .................. 8
IF NO, SKIP TO Q65
Yes ......................... 1 No........................... 2 Not sure ................. 8
IF NO, SKIP TO Q65
Q61 From where did (NAME) obtain the net?
Home ...................... 1 Shop near home ..... 2 Shop near forest ..... 3 Co-workers ............. 4 Other ...................... 5 Spec_____________ Don't know .............. 8
Home ...................... 1 Shop near home ..... 2 Shop near forest ..... 3 Co-workers ............. 4 Other ...................... 5 Spec_____________ Don't know.............. 8
Home...................... 1 Shop near home .... 2 Shop near forest .... 3 Co-workers ............. 4 Other ...................... 5 Spec_____________ Don't know ............. 8
Q62 Did (NAME) use a hammock net or mosquito net in the forest last time?
Yes ......................... 1 No ........................... 2 Not sure .................. 8
IF NO, SKIP TO Q65
Yes ......................... 1 No ........................... 2 Not sure .................. 8
IF NO, SKIP TO Q65
Yes ......................... 1 No........................... 2 Not sure ................. 8
IF NO, SKIP TO Q65
Q63 What type of net did (NAME) use in the forest last time?
Mosquito net ........... 1 Hammock net ......... 2 Not sure .................. 8
Mosquito net ........... 1 Hammock net ......... 2 Not sure .................. 8
Mosquito net .......... 1 Hammock net ......... 2 Not sure ................. 8
Q64 Was the net that (NAME) used last time treated to kill/repel mosquitoes?
Yes ......................... 1 No ........................... 2 Not sure .................. 8
SKIP TO Q66
Yes ......................... 1 No ........................... 2 Not sure .................. 8
SKIP TO Q66
Yes ......................... 1 No........................... 2 Not sure ................. 8
SKIP TO Q66
Myanmar Artemisinin Resistance Containment Baseline Survey 97
NO. QUESTIONS Person 1 Person 2 Person 3
Q65 If (NAME) did not take a net with them to the forest last time or did not use it, what was the reason why?
Didn't want to use ... 1 Forgot to take ......... 2 Not enough nets in house .................... 3 Don't have hammock net ........................ 4 Nowhere to hang in forest .................... 5 No money to buy .... 6 Other ...................... 7 Don't know .............. 8
Didn't want to use ... 1 Forgot to take ......... 2 Not enough nets in house ................... 3 Don't have hammock net ........................ 4 Nowhere to hang in forest .................... 5 No money to buy .... 6 Other ...................... 7 Don't know.............. 8
Didn't want to use .. 1 Forgot to take ......... 2 Not enough nets in house ................... 3 Don't have hammock net ........................ 4 Nowhere to hang in forest .................... 5 No money to buy .... 6 Other ...................... 7 Don't know ............. 8
Q66 Did (NAME) take any other action to avoid getting malaria?
MULTIPLE RESPONSES, CIRCLE ALL MENTIONED
PROBE: ANYTHING ELSE?
Mosquito coil .......... 1 Repellent ................ 2 Boiled water ............ 3 Burned leaves ........ 4 Took medication ..... 5 Wore long clothes... 6 No action taken ...... 7 Other ...................... 8 Spec_____________ Don't know ............ 98
Mosquito coil .......... 1 Repellent ................ 2 Boiled water ........... 3 Burned leaves ........ 4 Took medication ..... 5 Wore long clothes .. 6 No action taken ...... 7 Other ...................... 8 Spec_____________ Don't know............ 98
Mosquito coil .......... 1 Repellent ................ 2 Boiled water ........... 3 Burned leaves ........ 4 Took medication ..... 5 Wore long clothes .. 6 No action taken ...... 7 Other ...................... 8 Spec_____________ Don't know ........... 98
Q67 Did (NAME) get sick while away from home?
Yes ......................... 1 No ........................... 2 Don't know .............. 8
IF NO, SKIP TO Q69
Yes ......................... 1 No ........................... 2 Don't know.............. 8
IF NO, SKIP TO Q69
Yes ......................... 1 No........................... 2 Don't know ............. 8
IF NO, SKIP TO Q69
Q68 Where did (NAME) get treatment while away?
Facility/Provider code: .......................
Other .................... 97 Spec_____________
Not sure ................ 98
Facility/Provider code: ......................
Other .................... 97 Spec_____________
Not sure ................ 98
Facility/Provider code: .......................
Other .................... 97 Spec_____________
Not sure ............... 98
Section 5: People who are temporary visitors
"I would now like to ask you about the temporary visitors in your household."
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
Q69 Are any people in your household temporary visitors?
CHECK Q8 (SECTION 1) TO VERIFY THEIR ANSWER WITH WHAT THEY SAID BEFORE, AND CORRECT ANY INCONSISTENCIES
Yes .............................................................. 1 No ............................................................... 2
Q80
Q70 How many people in your household are temporary visitors?
COUNT THE NUMBER OF LINE CODES WITH "VISITOR" CIRCLED FOR Q8
Number of people: ........................................
NO. QUESTIONS Person 1 Person 2 Person 3
Myanmar Artemisinin Resistance Containment Baseline Survey 98
NO. QUESTIONS Person 1 Person 2 Person 3
Q71 WRITE THE NAME AND LINE CODE OF THE TEMPORARY VISITORS FROM Q8
[Use additional sheets if more than 3 persons]
Name ____________
Line code: .................
Name ____________
Line code: .................
Name ____________
Line code: ................
Q72 How long has (NAME) stayed here in this village? (completed
months)
IF < ONE MONTH, WRITE "00"
Months: .....................
Not sure ................ 98
Months: ....................
Not sure ................ 98
Months: ....................
Not sure 98
Q73 Where does (NAME) come from (i.e., permanent address)? WRITE THE NAMES OF THE TOWNSHIP, AND VILLAGE OR TOWN. (FILL IN CODES LATER TO SAVE TIME)
State/Division ..............
_________________
Township
________________
Village tract/Village: _________________
State/Division ...............
_________________
Township
________________
Village tract/Village: _________________
State/Division ...............
_________________
Township
________________
Village tract/Village: _________________
Q74 For what reason did (NAME) travel to this village?
Work (arranged before arrival) ......... 1 Look for work .......... 2 Make new home ..... 3 Visit relatives .......... 4 Other ...................... 5 Spec_____________ Don't know .............. 8
Work (arranged before arrival) ......... 1 Look for work .......... 2 Make new home ..... 3 Visit relatives .......... 4 Other ...................... 5 Spec_____________ Don't know.............. 8
Work (arranged before arrival) ......... 1 Look for work ......... 2 Make new home ..... 3 Visit relatives .......... 4 Other ...................... 5 Spec_____________ Don't know 8
Q75 How long does (NAME) intend to stay here in this village?
< 2 weeks ............... 1 2-4 weeks ............... 2 1-3 months ............. 3 3-6 months ............. 4 6-12 months ........... 5 > 12 months ........... 6 Not sure .................. 8
< 2 weeks ............... 1 2-4 weeks ............... 2 1-3 months ............. 3 3-6 months ............. 4 6-12 months ........... 5 > 12 months ........... 6 Not sure .................. 8
< 2 weeks ............... 1 2-4 weeks ............... 2 1-3 months ............. 3 3-6 months ............. 4 6-12 months ........... 5 > 12 months ........... 6 Not sure ................. 8
Q76 Where does (NAME) plan to travel to next?
Return home (Q73) 1 Another place of work in this township ..... 2 Work in another township ............... 3 Other ...................... 4 Spec_____________ Don't know .............. 8 IF 1, SKIP TO 78
Return home (Q73) 1 Another place of work in this township ..... 2 Work in another township ............... 3 Other ...................... 4 Spec_____________ Don't know.............. 8 IF 1, SKIP TO 78
Return home (Q73) 1 Another place of work in this township .... 2 Work in another township ............... 3 Other ...................... 4 Spec_____________ Don't know ............. 8 IF 1, SKIP TO 78
Q77 What is the name of the place where (NAME) plans to travel to next? WRITE THE NAMES OF THE TOWNSHIP, AND VILLAGE OR TOWN. (FILL IN CODES LATER TO SAVE TIME)
State/Division ..............
_________________
Township
________________
Village tract/Village: _________________
State/Division ...............
_________________
Township
________________
Village tract/Village: _________________
State/Division ...............
_________________
Township
________________
Village tract/Village: _________________
Myanmar Artemisinin Resistance Containment Baseline Survey 99
NO. QUESTIONS Person 1 Person 2 Person 3
Q78 Has (NAME) travelled abroad during 2011?
Yes ......................... 1 1. Thailand 2. India 3. China 4. Others (spfy)
No ........................... 2 Don't know .............. 8
Yes ......................... 1 1. Thailand 2. India 3. China 4. Others (spfy)
No ........................... 2 Don't know.............. 8
Yes ......................... 1 1. Thailand 2. India 3. China 4. Others (spfy)
No........................... 2 Don't know ............. 8
Q79 Has (NAME) taken any actions during their travels to avoid getting malaria? MULTIPLE RESPONSES, CIRCLE ALL MENTIONED
(IF MOSQUITO NET MENTIONED, ASK WHAT TYPE TO DETERMINE IF IT WAS AN INSECTICIDE-TREATED NET)
PROBE: ANYTHING ELSE?
Traveled with a mosquito net ........... 1 Traveled with a treated net (ITN) ..... 2 Mosquito coil .......... 3 Repellant ................ 4 Boiled water ............ 5 Burned leaves ........ 6 Took medication ..... 7 Wore long clothes... 8 No action taken ...... 9 Boiled water ............ 5 Other .................... 10 Spec_____________ Don't know ............ 98
Traveled with a mosquito net ........... 1 Traveled with a treated net (ITN) ..... 2 Mosquito coil .......... 3 Repellant ................ 4 Boiled water ........... 5 Burned leaves ........ 6 Took medication ..... 7 Wore long clothes .. 8 No action taken ...... 9 Boiled water ........... 5 Other .................... 10 Spec_____________ Don't know............ 98
Traveled with a mosquito net .......... 1 Traveled with a treated net (ITN) ..... 2 Mosquito coil .......... 3 Repellant ................ 4 Boiled water ........... 5 Burned leaves ........ 6 Took medication ..... 7 Wore long clothes .. 8 No action taken ...... 9 Boiled water ........... 5 Other .................... 10 Spec_____________ Don't know ........... 98
Section 6: People who travel and sleep away from home
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
Q80 Has anyone currently staying in your household traveled away from home and stayed overnight during the past 6 months?
CHECK Q9 (SECTION 1) TO VERIFY THEIR ANSWER WITH WHAT THEY SAID BEFORE, AND CORRECT ANY INCONSISTENCIES
Yes .............................................................. 1 No ............................................................... 2
Q89
Q81 How many people in your household traveled away from home and stayed overnight during the past 6 months?
COUNT THE NUMBER OF LINE CODES WITH "YES" CIRCLED FOR Q9
Number of people: ........................................
NO. QUESTIONS Person 1 Person 2 Person 3
Q82 WRITE THE NAME AND LINE CODE OF THOSE WHO TRAVEL AWAY FROM HOME
[Use additional sheets if more than 3 persons]
Name ____________
Line code: .................
Name ____________
Line code: .................
Name ____________
Line code: ................
Q83 When did (NAME) last travel away from home?
(don't include the last time that they were in the forest)
Last night ................ 1 < 1 week ................. 2 1 to < 4 weeks ........ 3 ≥ 4 weeks ............... 4 Not sure .................. 8
Last night ................ 1 < 1 week ................. 2 1 to < 4 weeks ........ 3 ≥ 4 weeks ............... 4 Not sure .................. 8
Last night ............... 1 < 1 week ................. 2 1 to < 4 weeks ........ 3 ≥ 4 weeks ............... 4 Not sure 8
Myanmar Artemisinin Resistance Containment Baseline Survey 100
NO. QUESTIONS Person 1 Person 2 Person 3
Q84 Where did (NAME) last travel to?
WRITE THE NAMES OF THE TOWNSHIP, DISTRICT, AND VILLAGE OR TOWN. (FILL IN CODES LATER TO SAVE TIME)
State/Division ..............
_________________
Township
________________
Village tract/Village: _________________Not sure ................ 98
Township: ....................
_________________
District: .........................
_________________
Village/Town: _________________
Not sure ................ 98
Township: ....................
_________________
District: .........................
_________________
Village/Town: _________________
Not sure ............... 98
Q85 For what reason did (NAME) travel away from home?
MULTIPLE RESPONSES, CIRCLE ALL MENTIONED
PROBE: ANYWHERE ELSE?
Work in forest ......... 1 Work on farm .......... 2 Work on plantation . 3 Work in Thailand .... 4 Visit relatives .......... 5 Other ...................... 6 Spec_____________ Don't know .............. 8
Work in forest ......... 1 Work on farm .......... 2 Work on plantation . 3 Work in Thailand .... 4 Visit relatives .......... 5 Other ...................... 6 Spec_____________ Don't know.............. 8
Work in forest ......... 1 Work on farm ......... 2 Work on plantation . 3 Work in Thailand .... 4 Visit relatives .......... 5 Other ...................... 6 Spec_____________ Don't know ............. 8
Q86 In the past 3 months, how many times has (NAME) traveled away from home?
Trips: ........................
Not sure ................ 98
Trips: ........................
Not sure ................ 98
Trips: ........................
Not sure 98
Q87 Has (NAME) travelled abroad during 2011?
Yes ......................... 1 1. Thailand 2. India 3. China 4. Others (spfy)
No ........................... 2 Don't know .............. 8
Yes ......................... 1 1. Thailand 2. India 3. China 4. Others (spfy)
No ........................... 2 Don't know.............. 8
Yes ......................... 1 1. Thailand 2. India 3. China 4. Others (spfy)
No........................... 2 Don't know ............. 8
Q88 Has (NAME) taken any actions during their travels to avoid getting malaria? MULTIPLE RESPONSES, CIRCLE ALL MENTIONED
(IF MOSQUITO NET MENTIONED, ASK WHAT TYPE TO DETERMINE IF IT WAS AN INSECTICIDE-TREATED NET)
PROBE: ANYTHING ELSE?
Traveled with a mosquito net ........... 1 Traveled with a treated net (ITN) ..... 2 Mosquito coil .......... 3 Repellant ................ 4 Boiled water ............ 5 Burned leaves ........ 6 Took medication ..... 7 Wore long clothes... 8 No action taken ...... 9 Boiled water ............ 5 Other .................... 10 Spec_____________ Don't know ............ 98
Traveled with a mosquito net ........... 1 Traveled with a treated net (ITN) ..... 2 Mosquito coil .......... 3 Repellant ................ 4 Boiled water ........... 5 Burned leaves ........ 6 Took medication ..... 7 Wore long clothes .. 8 No action taken ...... 9 Boiled water ........... 5 Other .................... 10 Spec_____________ Don't know............ 98
Traveled with a mosquito net .......... 1 Traveled with a treated net (ITN) ..... 2 Mosquito coil .......... 3 Repellant ................ 4 Boiled water ........... 5 Burned leaves ........ 6 Took medication ..... 7 Wore long clothes .. 8 No action taken ...... 9 Boiled water ........... 5 Other .................... 10 Spec_____________ Don't know ........... 98
Section 7: Malaria Knowledge and Recognition
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
Q89 Have you ever heard of an illness called malaria? IF ANSWER IS "NO", REPEAT ASKING QUESTION IN LOCAL COLLOQUIAL WORD FOR MALARIA
Yes ............................................................. 1 No ............................................................... 2
Q108
Myanmar Artemisinin Resistance Containment Baseline Survey 101
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
Q90 What are the signs or symptoms of malaria? MULTIPLE RESPONSES POSSIBLE CIRCLE ALL MENTIONED
PROBE ONCE: ANYTHING ELSE?
Fever .......................................................... 1 Chills ........................................................... 2 Headache ................................................... 3 Body ache ................................................... 4 Sweating ..................................................... 5 Fatigue ........................................................ 6 Loss of appetite .......................................... 7 Diarrhoea .................................................... 8 Other ........................................................... 9 Specify:_______________________________
Don't know ................................................ 98
Q93
Q91 How can you be sure that you or someone in your household with these signs and symptoms (read what he/she said) has malaria and not another illness?
Previous experience ................................... 1 Symptoms ................................................... 2 Doctor's examination .................................. 3 HA/LHV/MW/PHS examination…………… 4 Blood test (slide or dipstick) ....................... 5 Other ........................................................... 6 Specify:_______________________________
Don't know .................................................. 8
Q92 What signs and symptoms make you decide the illness is serious? MULTIPLE RESPONSES POSSIBLE CIRCLE ALL MENTIONED
PROBE ONCE: ANYTHING ELSE?
Unconscious ............................................... 1 Convulsions ................................................ 2 Fast breathing............................................. 3 Very hot ...................................................... 4 Yellow eye color ......................................... 5 Very pale skin ............................................. 6 Not breastfeeding ....................................... 7 Not eating ................................................... 8 Frequent vomiting ....................................... 9 Diarrhoea .................................................. 10 Other ......................................................... 11 Specify:_______________________________ Don't know ................................................ 98
Q93 How do people get malaria? MULTIPLE RESPONSES POSSIBLE CIRCLE ALL MENTIONED
PROBE ONCE: ANYTHING ELSE?
Mosquito bites ............................................ 1 Drinking dirty water ..................................... 2 Not boiling water ......................................... 3 Drinking spring/stream water ...................... 4 Bathing in spring/river water ....................... 5 Visiting forest .............................................. 6 Staying/sleeping in forest ........................... 7 Eating banana.............................................8 Bad food ..................................................... 9 Spirits ........................................................ 10 Poor hygiene ............................................ 11 Bad air ...................................................... 12 Bad talking ................................................ 13 Other ......................................................... 14 Specify:_______________________________ Don't know ................................................ 98
Myanmar Artemisinin Resistance Containment Baseline Survey 102
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
Q94 How do people prevent malaria? (NOTE: If they say "mosquito net", ask about the type of net to assess if they know about treated nets or not)
MULTIPLE RESPONSES POSSIBLE CIRCLE ALL MENTIONED
PROBE ONCE: ANYTHING ELSE?
Sleep under a mosquito net ....................... 1 Insecticide-treated net ................................ 2 Mosquito coil ............................................... 3 Mosquito repellent ...................................... 4 Insecticide spray ......................................... 5 Burn leaves ................................................. 6 Boil water .................................................... 7 Wear covered clothing ................................ 8 Stay out of forest ........................................ 9 Other ......................................................... 10 Specify:_______________________________ Don't know ................................................ 98 (A few codes differ from above questions Q88 for inclusion of insecticide spray)
Q95 If you suspect someone in your household has malaria, where would you go for advice or treatment?
Village Health Volunteer ............................. 1 Village Malaria Volunteer ………………… 2 Rural Health Center/Sub Centre ................ 3 Township/Station Hospital .......................... 4 Private doctor's clinic .................................. 5 Private other health staff clinic ................... 6 Auxiliary midwife ……………………………7 Unlicensed practitioner (quack)…………....8 Pharmacy (sell drugs only) ......................... 9 Shop/market (sell goods etc.) ................... 10 Self treat with drugs at home .................... 11 Private laboratory ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,12 Other source ............................................. 13 Specify:_______________________________
Don't know ................................................ 98
Q96 If you suspect someone in your household might have malaria, where would you go to get a test to find out if it really is malaria?
Malaria staff………………………………….1 Village Malaria Volunteer ………………… 2 Rural Health Center/Sub Centre ................ 3 Township/Station Hospital .......................... 4 Private doctor's clinic .................................. 5 Private other health staff clinic ................... 6 Auxiliary midwife ……………………………7 Unlicensed practitioner (quack)…………....8 Private laboratory ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,12 Other source ............................................. 13 Specify:_______________________________
Don't know about malaria test .................. 97 Don't know where to get a test ................. 98
Q97 In the past 6 months, have you heard or seen any messages or information about malaria?
Yes ............................................................. 1 No ............................................................... 2
Q102
Q98 How long ago did you first see or hear these messages?
Months: .........................................................
Not Sure ................................................... 98
Myanmar Artemisinin Resistance Containment Baseline Survey 103
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
Q99 What messages or information related to malaria did you see or hear? MULTIPLE RESPONSES POSSIBLE CIRCLE ALL MENTIONED
PROBE ONCE: ANYTHING ELSE?
Sleeping under a mosquito net is important ................................................... 1 Sleep under an insecticide-treated net (ITN) ................................................... 2 Carry and sleep under a mosquito net when traveling .................................... 3 Carry and sleep under a mosquito net when visiting the forest ....................... 4 Seek treatment for malaria from a VMW or health facility ............................... 5 Seek treatment for malaria promptly/within 24 hours .......................... 6 Complete antimalarial treatment ................ 7 Get a blood test before taking antimalarial drugs ..................................... 8 Malaria is dangerous .................................. 9 Malaria can kill .......................................... 10 Mosquitoes spread malaria ...................... 11 Other ......................................................... 12 Specify:_______________________________ Don't Remember ...................................... 98
Q100 Where or from whom did you see or hear these messages/information about malaria? MULTIPLE RESPONSES POSSIBLE CIRCLE ALL MENTIONED
PROBE ONCE: ANYWHERE ELSE?
VMW/VHV .................................................. 1 Health facility staff ...................................... 2 Private health provider ............................... 3 Pharmacy ................................................... 4 Teachers ..................................................... 5 Religious leaders/Monks ............................ 6 Family members ......................................... 7 Friends/neighbours ..................................... 8 TV ............................................................... 9 Radio ........................................................ 10 Video ........................................................ 11 Posters ..................................................... 12 Leaflets/Brochures ................................... 13 Billboards .................................................. 14 NGO staff .................................................. 15 Other ......................................................... 16 Specify:_______________________________ Don't Remember ...................................... 98
Q101 What is the MOST common or popular source of information or advice on malaria? What is the SECOND most common or popular source of information or advice on malaria? WRITE "1" NEXT TO THE CATEGORY THAT IS THE MOST COMMON AND "2" NEXT TO THE CATEGORY THAT IS THE SECOND MOST COMMON
VMW/VHV .......................................... _____ Health facility staff .............................. _____ Private health provider ....................... _____ Pharmacy ........................................... _____ Teachers ............................................. _____ Religious leaders/Monks .................... _____ Family members ................................. _____ Friends/neighbours ............................. _____ TV ....................................................... _____ Radio .................................................. _____ Video ................................................. _____ Posters ............................................... _____ Leaflets/Brochures ............................. _____ Billboards ............................................ _____ NGO staff Other ................................................... _____ Specify:_______________________________ Don't Know ............................................... 98
Myanmar Artemisinin Resistance Containment Baseline Survey 104
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
Q102 Do you know the names of any specific antimalarial drugs?
Yes ............................................................. 1 No ............................................................... 2
Q104
Q103 Of the antimalarial drugs you know, tell me the names of the three that you are most familiar with? IF < 3, WRITE THE ONES THAT THEY KNOW (FILL IN THE DRUG CODES LATER TO SAVE TIME) IF THE NAME IS IN LOCAL TERMS (e.g. cross-tablet for mefloquine), ASK ENGLISH NAME FROM LOCAL STAFF TO WRITE DOWN. IF YOU DON'T KNOW, WRITE DOWN LOCAL TERM.
Name Code
Antimalarial 1: _________________ Antimalarial 2: _________________ Antimalarial 3: _________________
Q104 Do you know how many days most antimalarial drugs should be taken?
NOT SPECIFIC TO EACH DRUG THEY KNOW
Number of days: .............................................
Don't know .................................................. 98
Q105 What happens if you don’t take antimalarial drugs for the recommended number of days?
Nothing ...................................................... 1 Patient gets sick again ............................... 2 Patient does not recover ............................ 3 Other ........................................................... 4 Specify:_______________________________ Don't know .................................................. 8
Q106 What happens if you don’t take all the tablets (i.e., total number of tablets prescribed)?
Nothing ...................................................... 1 Patient gets sick again ............................... 2 Patient does not recover ............................ 3 Other ........................................................... 4 Specify:_______________________________ Don't know .................................................. 8
Q107 Do you know of any antimalarial drugs that should no longer be used to treat malaria?
Yes ............................................................. 1 No ............................................................... 2
Q109
Q108 What are the names of the drugs that should no longer be used to treat malaria? IF < 3, WRITE THE ONES THAT THEY KNOW (FILL IN THE DRUG CODES LATER TO SAVE TIME)
Name Code
Antimalarial 1: _________________ Antimalarial 2: _________________ Antimalarial 3: _________________
Section 8: Malaria Diagnosis and Treatment
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
Q109 Has anyone in the household been ill with a fever during the last two weeks?
Yes .............................................................. 1 No ............................................................... 2
END
Q110 How many people in the household have been ill with fever during the last two weeks?
(Use additional sheets if more than 2 persons)
Number ill with fever: ....................................
Myanmar Artemisinin Resistance Containment Baseline Survey 105
NO. QUESTIONS Person 1 Person 2
Q111 Who was ill with fever in the last two weeks?
Name: __________________
Line code: .....................
Name: __________________
Line code: ..........................
Q112 Did (NAME) seek advice or treatment outside of the home for the fever?
Yes ........................................ 1 No .......................................... 2 Not sure ................................. 8 IF NO, SKIP TO Q121
Yes ........................................ 1 No .......................................... 2 Not sure ................................. 8 IF NO, SKIP TO Q121
Q113 Where did (NAME) first seek advice or treatment for the fever?
(1st facility/provider)
Facility/Provider code: ............
Other .................................... 97 Specify: ___________________
Not sure ................................ 98
Facility/Provider code: ............
Other .................................... 97 Specify: ___________________
Not sure ............................... 98
Q114 How long after the fever started did (NAME) first seek advice or treatment from this facility/provider?
Same day .............................. 1 Day after ................................ 2 Two days after ....................... 3 Three or more days ............... 4 Don't know ............................. 8
Same day .............................. 1 Day after ................................ 2 Two days after ....................... 3 Three or more days ............... 4 Don't know ............................. 8
Q115 Did (NAME) seek advice or treatment for the fever anywhere else?
Yes ........................................ 1 No .......................................... 2 Not sure ................................. 8 IF NO, SKIP TO Q122
Yes ........................................ 1 No .......................................... 2 Not sure ................................. 8 IF NO, SKIP TO Q122
Q116 Where did (NAME) next seek advice or treatment for the fever?
(2nd
facility/provider)
Facility/Provider code: ............
Other .................................... 97 Specify: ___________________
Not sure ................................ 98
Facility/Provider code: ............
Other .................................... 97 Specify: ___________________
Not sure ............................... 98
Q117 How long after the fever started did (NAME) seek advice or treatment from this second facility/provider?
Same day .............................. 1 Day after ................................ 2 Two days after ....................... 3 Three or more days ............... 4 Don't know ............................. 8
Same day .............................. 1 Day after ................................ 2 Two days after ....................... 3 Three or more days ............... 4 Don't know ............................. 8
Q118 Did (NAME) seek advice or treatment for the fever anywhere else?
Yes ........................................ 1 No .......................................... 2 Not sure ................................. 8 IF NO, SKIP TO Q122
Yes ........................................ 1 No .......................................... 2 Not sure ................................. 8 IF NO, SKIP TO Q122
Q119 Where did (NAME) next seek advice or treatment for the fever?
(3rd
facility/provider)
Facility/Provider code: ............
Other .................................... 97 Specify: ___________________
Not sure ................................ 98
Facility/Provider code: ............
Other .................................... 97 Specify: ___________________
Not sure ............................... 98
Q120 How long after the fever started did (NAME) seek advice or treatment from this third facility/provider?
Same day .............................. 1 Day after ................................ 2 Two days after ....................... 3 Three or more days ............... 4 Don't know ............................. 8
SKIP TO Q122
Same day .............................. 1 Day after ................................ 2 Two days after ....................... 3 Three or more days ............... 4 Don't know ............................. 8
SKIP TO Q122
Myanmar Artemisinin Resistance Containment Baseline Survey 106
NO. QUESTIONS Person 1 Person 2
Q121 Why didn't (NAME) seek treatment outside the home?
Waited for fever to go ............ 1 No money for treatment ........ 2 No transport........................... 3 Not sure where to get drugs .. 4 Didn't feel ill enough .............. 5 Spiritual treatment ................. 6 Traditional medicine .............. 7 Other ..................................... 8 Specify: ___________________
Don't know ............................. 9
Waited for fever to go ............ 1 No money for treatment ........ 2 No transport........................... 3 Not sure where to get drugs .. 4 Didn't feel ill enough .............. 5 Spiritual treatment ................. 6 Traditional medicine .............. 7 Other ..................................... 8 Specify: ___________________
Don't know ............................. 9
Q122 Did (NAME) take drugs for the fever?
Yes ........................................ 1 No .......................................... 2 Not sure ................................. 8 IF NO, SKIP TO Q158
Yes ........................................ 1 No .......................................... 2 Not sure ................................. 8 IF NO, SKIP TO Q158
Q123 Where did these drugs come from? MULTIPLE RESPONSES CIRCLE ALL MENTIONED
PROBE ONCE: ANYWHERE ELSE?
(coding is the same as Q95
except omitting 12)
Village Health Volunteer…….1 Village Malaria Volunteer….. 2 Rural Health Center/Sub
Centre……………………3 Township/Station Hospital….4 Private doctor's clinic………..5 Private other health
staff clinic………………..6 Auxiliary midwife..……………7 Unlicensed practitioner
(quack)…………….…....8 Pharmacy (sell drugs only)…9 Shop/market
(sell goods etc.)……….10 Self treat with drugs at home………………. 11 Other source ……………….13 Specify:__________________
Don't know…………………..98
Village Health Volunteer…….1 Village Malaria Volunteer….. 2 Rural Health Center/Sub
Centre……………………3 Township/Station Hospital….4 Private doctor's clinic………..5 Private other health
staff clinic………………..6 Auxiliary midwife..……………7 Unlicensed practitioner
(quack)…………….…....8 Pharmacy (sell drugs only)…9 Shop/market
(sell goods etc.)……….10 Self treat with drugs at home………………. 11 Other source ……………….13 Specify:__________________
Don't know…………………..98
Q124 How long after the fever started did (NAME) first take drugs?
Same day .............................. 1 Day after ................................ 2 Two days after ....................... 3 Three or more days ............... 4 Don't know ............................. 8
Same day .............................. 1 Day after ................................ 2 Two days after ....................... 3 Three or more days ............... 4 Don't know ............................. 8
Q125 What drugs did (NAME) take for the fever?
(Include any drugs that were from self-medication and/or from a health service provider) RECORD THE DRUG CODE AND NAME, TICK THE BOX IF THE DRUG IS AN ANTIMALARIAL (AM)
Code Name AM?
Drug 1: _________
Drug 2: _________
Drug 3: _________
Drug 4: _________
Drug 5: _________
Code Name AM?
Drug 1: _________
Drug 2: _________
Drug 3: _________
Drug 4: _________
Drug 5: _________
GO THROUGH THE LIST ABOVE (Q125) AND NOTE THE ANTIMALARIAL DRUGS. IF ANTIMALARIAL DRUGS RECORDED, ASK THE FOLLOWING QUESTIONS ABOUT EACH ANTIMALARIAL DRUG TAKEN FOR EACH PERSON: IF NO ANTIMALARIAL DRUGS RECORDED, SKIP TO Q158.
Q126 What was the first antimalarial drug that (NAME) took?
Drug code: ..............................
Not sure ............................... 98
Drug code: ..............................
Not sure ............................... 98
Myanmar Artemisinin Resistance Containment Baseline Survey 107
NO. QUESTIONS Person 1 Person 2
Q127 What was the form of this first antimalarial drug?
Tablets ................................... 1 Syrup ..................................... 2 Suppository ........................... 3 Injection ................................. 4 Don't know ............................. 8
Tablets ................................... 1 Syrup ..................................... 2 Suppository ........................... 3 Injection ................................. 4 Don't know ............................. 8
Q128 Where did (NAME) get this first antimalarial drug? (Should match the codes listed in Q113, Q116, or Q119)
Facility/Provider code: ............
Other .................................... 97 Specify: ___________________
Not sure ............................... 98
Facility/Provider code: ............
Other .................................... 97 Specify: ___________________
Not sure ............................... 98
Q129 How long after their fever began did (NAME) start taking this first antimalarial drug?
Same day .............................. 1 Day after ................................ 2 Two days after ....................... 3 Three or more days ............... 4 Don't know ............................. 8
Same day .............................. 1 Day after ................................ 2 Two days after ....................... 3 Three or more days ............... 4 Don't know ............................. 8
Q130 How many times a day did (NAME) take this first antimalarial drug?
Times per day:........................
Not sure ............................... 98
Times per day:........................
Not sure ............................... 98
Q131 How many tablets/spoons did (NAME) take each time?
Dose each time: .....................
Not sure ............................... 98
Dose each time: .....................
Not sure ............................... 98
Q132 For how many days did (NAME) take this first antimalarial drug?
Number of days: .....................
Not sure ............................... 98
Number of days: .....................
Not sure ............................... 98
Q133 Did (NAME) take all the prescribed/purchased tablets or syrup of this antimalarial drug?
Yes ........................................ 1 No .......................................... 2 Still taking the drug ................ 3 Not sure ................................. 8
Yes ........................................ 1 No .......................................... 2 Still taking the drug ................ 3 Not sure ................................. 8
Q134 What was the second antimalarial drug that (NAME) took? (CROSS CHECK WITH Q125)
Drug code: ..............................
Not sure ............................... 98
IF NO 2ND
DRUG, SKIP TO Q158
Drug code: ..............................
Not sure ............................... 98
IF NO 2ND
DRUG, SKIP TO Q158
Q135 What was the form of this second antimalarial drug?
Tablets ................................... 1 Syrup ..................................... 2 Suppository ........................... 3 Injection ................................. 4 Don't know ............................. 8
Tablets ................................... 1 Syrup ..................................... 2 Suppository ........................... 3 Injection ................................. 4 Don't know ............................. 8
Q136 Where did (NAME) get this second antimalarial drug? (Should match the codes listed in Q113, Q116 or Q119)
Facility/Provider code: ............
Other .................................... 97 Specify: ___________________
Not sure ............................... 98
Facility/Provider code: ............
Other .................................... 97 Specify: ___________________
Not sure ............................... 98
Q137 How long after their fever began did (NAME) start taking this second antimalarial drug?
Same day .............................. 1 Day after ................................ 2 Two days after ....................... 3 Three or more days ............... 4 Don't know ............................. 8
Same day .............................. 1 Day after ................................ 2 Two days after ....................... 3 Three or more days ............... 4 Don't know ............................. 8
Q138 How many times a day did (NAME) take this second antimalarial drug?
Times per day:........................
Not sure ............................... 98
Times per day:........................
Not sure ............................... 98
Myanmar Artemisinin Resistance Containment Baseline Survey 108
NO. QUESTIONS Person 1 Person 2
Q139 How many tablets/spoons did (NAME) take each time?
Dose each time: .....................
Not sure ............................... 98
Dose each time: .....................
Not sure ............................... 98
Q140 For how many days did (NAME) take this second antimalarial drug?
Number of days: .....................
Not sure ............................... 98
Number of days: .....................
Not sure ............................... 98
Q141 Did (NAME) take all the prescribed/purchased tablets or syrup of this antimalarial drug?
Yes ........................................ 1 No .......................................... 2 Still taking the drug ................ 3 Not sure ................................. 8
Yes ........................................ 1 No .......................................... 2 Still taking the drug ................ 3 Not sure ................................. 8
Q142 What was the third antimalarial drug that (NAME) took? (CROSS CHECK WITH Q125)
Drug code: ..............................
Not sure ............................... 98
IF NO 3RD
DRUG, SKIP TO Q158
Drug code: ..............................
Not sure ............................... 98
IF NO 3RD
DRUG, SKIP TO Q158
Q143 What was the form of this third antimalarial drug?
Tablets ................................... 1 Syrup ..................................... 2 Suppository ........................... 3 Injection ................................. 4 Don't know ............................. 8
Tablets ................................... 1 Syrup ..................................... 2 Suppository ........................... 3 Injection ................................. 4 Don't know ............................. 8
Q144 Where did (NAME) get this third antimalarial drug? (Should match the codes listed in Q113, Q116 or Q119)
Facility/Provider code: ............
Other .................................... 97 Specify: ___________________
Not sure ............................... 98
Facility/Provider code: ............
Other .................................... 97 Specify: ___________________
Not sure ............................... 98
Q145 How long after their symptoms began did (NAME) start taking this third antimalarial drug?
Same day .............................. 1 Day after ................................ 2 Two days after ....................... 3 Three or more days ............... 4 Don't know ............................. 8
Same day .............................. 1 Day after ................................ 2 Two days after ....................... 3 Three or more days ............... 4 Don't know ............................. 8
Q146 How many times a day did (NAME) take this third antimalarial drug?
Times per day:........................
Not sure ............................... 98
Times per day:........................
Not sure ............................... 98
Q147 How many tablets/spoons did (NAME) take each time?
Dose each time: .....................
Not sure ............................... 98
Dose each time: .....................
Not sure ............................... 98
Q148 For how many days did (NAME) take this third antimalarial drug?
Number of days: .....................
Not sure ............................... 98
Number of days: .....................
Not sure ............................... 98
Q149 Did (NAME) take all the prescribed/purchased tablets or syrup of this antimalarial?
Yes ........................................ 1 No .......................................... 2 Still taking the drug ................ 3 Not sure ................................. 8
Yes ........................................ 1 No .......................................... 2 Still taking the drug ................ 3 Not sure ................................. 8
Q150 What was the fourth antimalarial drug that (NAME) took? (CROSS CHECK WITH Q125)
Drug code: ..............................
Not sure ............................... 98
IF NO 4TH
DRUG, SKIP TO Q158
Drug code: ..............................
Not sure ............................... 98
IF NO 4TH
DRUG, SKIP TO Q158
Myanmar Artemisinin Resistance Containment Baseline Survey 109
NO. QUESTIONS Person 1 Person 2
Q151 What was the form of this fourth antimalarial drug?
Tablets ................................... 1 Syrup ..................................... 2 Suppository ........................... 3 Injection ................................. 4 Don't know ............................. 8
Tablets ................................... 1 Syrup ..................................... 2 Suppository ........................... 3 Injection ................................. 4 Don't know ............................. 8
Q152 Where did (NAME) get this fourth antimalarial drug? (Should match the codes listed in Q113, Q116 or Q119)
Facility/Provider code: ............
Other .................................... 97 Specify: ___________________
Not sure ............................... 98
Facility/Provider code: ............
Other .................................... 97 Specify: ___________________
Not sure ............................... 98
Q153 How long after their symptoms began did (NAME) start taking this fourth antimalarial drug?
Same day .............................. 1 Day after ................................ 2 Two days after ....................... 3 Three or more days ............... 4 Don't know ............................. 8
Same day .............................. 1 Day after ................................ 2 Two days after ....................... 3 Three or more days ............... 4 Don't know ............................. 8
Q154 How many times a day did (NAME) take this fourth antimalarial drug?
Times per day:........................
Not sure ............................... 98
Times per day:........................
Not sure ............................... 98
Q155 How many tablets/spoons did (NAME) take each time?
Dose each time: .....................
Not sure ............................... 98
Dose each time: .....................
Not sure ............................... 98
Q156 For how many days did (NAME) take this fourth antimalarial drug?
Number of days: .....................
Not sure ............................... 98
Number of days: .....................
Not sure ............................... 98
Q157 Did (NAME) take all the prescribed/purchased tablets or syrup of this antimalarial?
Yes ........................................ 1 No .......................................... 2 Still taking the drug ................ 3 Not sure ................................. 8
Yes ........................................ 1 No .......................................... 2 Still taking the drug ................ 3 Not sure ................................. 8
Q158 Did (NAME) have a blood test for malaria?
Yes ........................................ 1 No .......................................... 2 Not sure ................................. 8 IF NO, SKIP TO Q164
Yes ........................................ 1 No .......................................... 2 Not sure ................................. 8 IF NO, SKIP TO Q164
Q159 Did (NAME) have the malaria test before or after taking drugs?
Before taking drugs ............... 1 After taking drugs .................. 2 Not sure ................................. 8
Before taking drugs ............... 1 After taking drugs .................. 2 Not sure ................................. 8
Q160 What type of malaria test did (NAME) have?
RDT/dipstick .......................... 1 Blood slide/microscopy ......... 2 Not sure ................................. 8
Dipstick .................................. 1 Blood slide ............................. 2 Not sure ................................. 8
Q161 Where did (NAME) get the malaria test done?
VMW ...................................... 1 Health facility (public) ............ 2 Pharmacy/Shop ..................... 3 Private health facility/lab ....... 4 Private doctor/nurse .............. 5 Other ..................................... 6 Specify: ___________________
Don't know ............................. 8
VMW ...................................... 1 Health facility (public) ............ 2 Pharmacy/Shop ..................... 3 Private health facility/lab ....... 4 Private doctor/nurse .............. 5 Other ..................................... 6 Specify: ___________________
Don't know ............................. 8
Q162 What was the result of the malaria test?
Positive .................................. 1 Negative ................................ 2 Don't know ............................. 8 IF NEGATIVE, SKIP TO Q164
Positive .................................. 1 Negative ................................ 2 Don't know ............................. 8 IF NEGATIVE, SKIP TO Q164
Myanmar Artemisinin Resistance Containment Baseline Survey 110
NO. QUESTIONS Person 1 Person 2
Q163 What type of malaria did (NAME) have?
Not told species ..................... 1 Falciparum (Pf) ...................... 2 Vivax (Pv) .............................. 3 Mixed (both Pf & Pv) ............. 4
Not told species ..................... 1 Falciparum (Pf) ...................... 2 Vivax (Pv) .............................. 3 Mixed (both Pf & Pv) ............. 4
Q164 Does (NAME) still have a fever? Yes ........................................ 1 No .......................................... 2 Not sure ................................. 8
Yes ........................................ 1 No .......................................... 2 Not sure ................................. 8
END INTERVIEW
Thank respondent for taking the time to be interviewed.
Myanmar Artemisinin Resistance Containment Baseline Survey 111
Code Facility / Provider Type
Public Sector:
1 State or Regional Hospital
2 Sub-Health Center
3 Station hospital
4 Village Malaria Worker
5 Village Health Volunteer
Private Sector:
6 Private hospital
7 Private clinic run by health staff
8 Private laboratory
9 Drug Store A or B (registered)
10 Drug store (unregistered)
11 Shop/Market
12 Grocery store
13 Traditional practitioner
14 Other
Code Drugs
Antimalarials:
1
2 A+M (Artesunate-Mefloquine)
3 Other Artesunate-Mefloquine (e.g., Artequin)
4 Duo-Cotecxin (DHA-piperaquine)
5 Other DHA-Piperaquine (e.g., Artekin or Artequick)
6 Cotecxin (dihydroartemisinin only)
7 Mefloquine (e.g., Lariam)
8 Artesunate
9 Artemether
10 Artemisinin
11 Quinine
12 Chloroquine
13 Primaquine
14 Drug cocktail for malaria
15 Other antimalarial drug
Non-malaria drugs:
16 Antibiotics
17 Paracetamol/Aspirin
Code Drugs
18 Vitamins/Tonics
19 Infusion/ IV fluids
20 Traditional herbs
21 Other non-malaria drugs
Myanmar Artemisinin Resistance Containment Baseline Survey 112
ANNEX 2. DRUG OUTLET QUESTIONNAIRE
Identification
Related cluster in household survey:
(01-80) Outlet number: ……………………………….
State/Region: ………………………………… Township ………………………………………
Village Tract: …………………………………………… Village: ………………………………………………….
Where is the outlet located? Village ..................................................................... 1
Town ....................................................................... 2
What is the sex of the respondent?
What is the age of the respondent?
Male ........................................................................ 1
Female .................................................................... 2
Age in years: .............................................................
What is the respondent's role?
NOTE: THE RESPONDENT MUST BE SOMEONE WHO
SELLS DRUGS IN THIS OUTLET
Owner ..................................................................... 1
Employee ................................................................ 2
Family member ....................................................... 3
Other ....................................................................... 4
Specify: ________________________________
What formal health training has the respondent had? Doctor ..................................................................... 1
Pharmacist .............................................................. 2
Health assistant ...................................................... 3
Nurse ...................................................................... 4
Midwife .................................................................... 5
Other health training ............................................... 6
Specify: ________________________________
No health training ......................................... 7 Q1
How long did you receive formal training? Years of training: .......................................................
Months of training: ...................................................
Myanmar Artemisinin Resistance Containment Baseline Survey 113
Section 1: Details of Outlet
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
Q1 Type of outlet Village drug outlet ...................................... 1
Private clinic ............................................... 2
Health cabinet/worker's home .................... 3
Pharmacy ................................................... 4
General store/shop..................................... 5
Other .......................................................... 7 Specify:_______________________________
Q2 Do you offer consultations? Yes ............................................................. 1
No ............................................................... 2
Q6
Q3 Approximately how many consultations do
you provide each day?
< 1 per day ................................................. 1
1 to 5 per day ............................................. 2
6 to 10 per day ........................................... 3
> 10 per day ............................................... 4
Don't know.................................................. 8
Q4 Do you offer consultations for malaria? Yes ............................................................. 1
No ............................................................... 2
Q6
Q5 Approximately how many consultations for
malaria do you provide each week?
< 1 per week............................................... 1
1 to 5 per week ........................................... 2
6 to 10 per week ......................................... 3
> 10 per week ............................................ 4
Don't know.................................................. 8
Q6 What are your normal hours of operation for
this drug outlet, that is what time do you
open and what time do you close?
AM/PM AM/PM
Open: __ __:__ __
Close: __ __:__ __
Open: __ __:__ __
Close: __ __:__ __
Q7
Do you distribute or display any information
for your clients about malaria?
Check this box if they were able to show
any education materials about malaria
Yes ............................................................. 1
No ............................................................... 2
Myanmar Artemisinin Resistance Containment Baseline Survey 114
Section 2: Knowledge, practice, inspections and training
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
Q8 What are the signs or symptoms of
malaria?
MULTIPLE RESPONSES POSSIBLE
CIRCLE ALL MENTIONED
PROBE ONCE: ANYTHING ELSE?
Fever ............................................................. 1
Chills ............................................................. 2
Headache ...................................................... 3
Body ache ..................................................... 4
Sweating ....................................................... 5
Fatigue .......................................................... 6
Loss of appetite............................................. 7
Diarrhoea ...................................................... 8
Other ............................................................. 9 Specify:_______________________________
Don't know .................................................. 98
Q10
Q9 What do you do if you suspect the patient
has malaria?
MULTIPLE RESPONSES POSSIBLE
CIRCLE ALL MENTIONED
PROBE ONCE: ANYTHING ELSE?
Examine patient ............................................ 1
Sell/perform blood test (slide or dipstick) ...... 2
Refer to health facility ................................... 3
Sell antimalarial drugs .................................. 4
Other ............................................................. 5 Specify:_______________________________
Don't know .................................................. 98
Q11
Q10 Have you ever referred suspected cases of
malaria for treatment?
Yes ................................................................ 1
No ................................................................. 2
Q13
Q11 What types of cases do you refer?
MULTIPLE RESPONSES POSSIBLE
CIRCLE ALL MENTIONED
PROBE ONCE: ANYTHING ELSE?
Children < 5 years ......................................... 1
Children < 2 years ......................................... 2
Pregnant women ........................................... 3
Symptoms of severe malaria ........................ 4
Previously treated but symptoms persist ...... 5
Other ............................................................. 6 Specify:_______________________________
Q12 Where do you refer suspected cases of
malaria?
Referral/Provincial hospital ........................... 1
Health Center/FDH ....................................... 2
VMW ............................................................. 3
Private clinic/laboratory ................................. 4
Other ............................................................. 5 Specify: ______________________________
Q13 Do you keep records or a register of the
malaria cases that you diagnose or treat?
Check this box if they were able to show
records or a register
Yes ................................................................ 1
No ................................................................. 2
Q15
Myanmar Artemisinin Resistance Containment Baseline Survey 115
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
Q14 What type of records do you keep of
malaria cases tested and/or treated?
MULTIPLE RESPONSES POSSIBLE
CIRCLE ALL MENTIONED
PROBE ONCE: ANYTHING ELSE?
Age ................................................................ 1
Sex ................................................................ 2
Test result (pos or neg) ................................. 3
Type of malaria (species) ............................. 4
Severity of malaria ........................................ 5
Treatment given ............................................ 6
Referrals ....................................................... 7
Date of visit .................................................. 8
Other ............................................................. 9 Specify: ______________________________
Q15 During 2011, have you attended any
trainings or workshops about malaria?
Yes ................................................................ 1
No ................................................................. 2
Q18
Q16 What topics were discussed during these
trainings/workshops?
MULTIPLE RESPONSES POSSIBLE
CIRCLE ALL MENTIONED
PROBE ONCE: ANYTHING ELSE?
Diagnosis ...................................................... 1
RDTs ............................................................. 2
Treatment ...................................................... 3
ACTs ............................................................. 4
Drug resistance ............................................. 5
Ban on monotherapy .................................... 6
Signs and symptoms .................................... 7
How to recognize fake drugs ........................ 8
New treatment policies ................................. 9
Other ........................................................... 10 Specify:_______________________________
Don't know .................................................. 98
Q17 Who conducted these trainings?
MULTIPLE RESPONSES POSSIBLE
CIRCLE ALL MENTIONED
PROBE ONCE: ANYTHING ELSE?
Health Center/Hospital .................................. 1
Province (PHD)/OD ...................................... 2
Government-MoH/CNM ................................ 3
Government-DDF ......................................... 4
NGO .............................................................. 5
Other ............................................................. 6 Specify:_______________________________
Not sure ........................................................ 8
Q18 In your opinion, what is the most effective
antimalarial medicine?
Drug Name: _________________________
Drug Code: ......................................................
Don't know .................................................. 98
Q19 Which drug do you most recommend for
P. falciparum?
Drug Name: .....................................................
Don't Recommend ...................................... 87
Don't know .................................................. 98
Q20 Which drug do you most recommend for
P. vivax?
Drug Name: .....................................................
Don't Recommend ...................................... 87
Don't know .................................................. 98
Q21 What is the nationally recommended
drug for P. falciparum?
Drug Name: .....................................................
Don't know .................................................. 98
Q22 What is the nationally recommended drug
for P. vivax?
Drug Name: .....................................................
Don't know .................................................. 98
Q23 Have you heard about the activities to stop
the spread of drug?
Yes ................................................................ 1
No ................................................................. 2
Myanmar Artemisinin Resistance Containment Baseline Survey 116
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
Q24 Are you aware that some antimalarial drugs
are banned in Myanmar?
Yes ................................................................ 1
No ................................................................. 2
Q27
Q25 Do you know which antimalarial drugs are
banned in Myanmar?
Drug Name 1:..................................................
Drug Name 2:..................................................
Drug Name 3:..................................................
Other ........................................................... 87
Specify: ____________________________
Don't know .................................................. 98
Q26 Where did you hear about the ban on these
antimalarial drugs?
MULTIPLE RESPONSES POSSIBLE
CIRCLE ALL MENTIONED
PROBE ONCE: ANYWHERE ELSE?
TV/Radio ....................................................... 1
Training ......................................................... 2
Health Center/Hospital staff .......................... 3
Provincial/OD staff ........................................ 4
NGO staff ...................................................... 5
Drug inspector............................................... 6
Other ............................................................. 7 Specify:_______________________________
Not sure ...................................................... 98
Q27 Have you heard about fake/counterfeit
drugs?
Yes ................................................................ 1
No ................................................................. 2
Q29
Q28 Have you seen any fake/counterfeit drugs? Yes ................................................................ 1
No ................................................................. 2
Q29 In the past 6 months, has anyone come to
inspect your outlet?
Yes ................................................................ 1
No ................................................................. 2
Q32
Q30 Who came to inspect your outlet?
MULTIPLE RESPONSES POSSIBLE
CIRCLE ALL MENTIONED
PROBE ONCE: ANYONE ELSE?
Health authorities (PHD/OD/MoH) ................ 1
Inspection group ........................................... 2
DDF Inspector ............................................... 3
Police ............................................................ 4
NGO .............................................................. 7
Other government official .............................. 8
Other ............................................................. 9 Specify:_______________________________
Not sure ...................................................... 98
Q31 What action did they take if any?
MULTIPLE RESPONSES POSSIBLE
CIRCLE ALL MENTIONED
PROBE ONCE: ANYWHERE ELSE?
Took away some drugs ................................. 1
Threw away some drugs ............................... 2
Administered a fine ....................................... 3
Discussed the problem of fake drugs ........... 4
Wrote a report ............................................... 5
Took photographs ......................................... 6
Did nothing .................................................... 7
Other ............................................................. 8 Specify:_______________________________
Not sure ...................................................... 98
Q32 Do you have a license to sell drugs?
Check this box if their license is
displayed on the wall:
Yes ................................................................ 1
No ................................................................. 2
Myanmar Artemisinin Resistance Containment Baseline Survey 117
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
Q33 Do you sell antimalarials?
(If No, probe the names of antimalarials
to make sure that the shop does not sell
antimalarials)
Yes ……………………………………………. 1
No …………………………………………….. 2
Q44
Q34 What are the three most common drugs
you sell for malaria? And how much do you
sell a single complete treatment course for?
USE DRUG CODES LISTED
Drug 1st : …………………………..
Price (Ks) : ________ Tablets : ……………
Drug 2nd
: …………………………..
Price (Ks) : ________ Tablets : ……………
Drug 3rd
: …………………………..
Price (Ks) : ________ Tablets : ……………
Q35 How do you typically decide which
antimalarial drugs to stock?
MULTIPLE RESPONSES POSSIBLE
CIRCLE ALL MENTIONED
PROBE ONCE: ANYTHING ELSE?
Most profitable .............................................. 1
Recommended by government ..................... 2
Lowest priced ................................................ 3
Drug company/Sales rep influence ............... 4
Consumer demand ....................................... 5
Brand reputation ........................................... 6
Dosage form ................................................. 7
Easily available ............................................. 8
Prescribed most often by doctors ................. 9
Other ........................................................... 10 Specify:_______________________________
Not sure ...................................................... 98
Q36 Where do you normally obtain your
antimalarial drugs?
Only one answer to be circled
Yangon wholesaler ....................................... 1
Province wholesaler ...................................... 2
Medical detailer ............................................. 4
Province pharmacy (government)................. 6
Non-government supplier ............................. 4
Other ............................................................. 5
Specify:___________________________
Don't know .................................................... 6
Q37 Do your customers usually ask for a
specific antimalarial drug by name?
If No, probe the names of the drugs
Yes ............................................................... 1
No - ask for recommendation ....................... 2
No - bring in prescription ............................... 3
Don't know .................................................... 8
Q38 Do you normally decide which antimalarial
drug customers receive?
If No, probe the names of the drugs
Yes ............................................................... 1
No - give what is requested .......................... 2
No - they bring in a prescription .................... 3
Don't know .................................................... 8
Q39 In the past week, approximately how many
people bought or were dispensed an
antimalarial drug from your outlet?
Number of people: ..........................................
Don't know ................................................ 888
Q40 Compared to this same time last year,
would you say that you are selling more
antimalarial drugs, about the same amount,
or fewer antimalarial drugs?
Selling more .................................................. 1
Selling same ................................................. 2
Selling less .................................................... 3
Don't know .................................................... 8
N/A (didn't sell last year) ............................... 9
Myanmar Artemisinin Resistance Containment Baseline Survey 118
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
Q41 In the past month, did you ever cut blisters
or sell partial packs of antimalarials for
customers who cannot afford to buy the
entire pack?
Yes ................................................................ 1
No ................................................................. 2
Don't know .................................................... 8
Q42 Do you sell drug cocktails for malaria? Yes ................................................................ 1
No ................................................................. 2
Don't know .................................................... 8
Q44
Q43 In the past week, approximately how many
people bought or were dispensed a drug
cocktail from your outlet?
Number of people: ..........................................
Don't know ................................................ 888
Q44 Does your drug outlet provide diagnostic
testing for malaria?
Yes ................................................................ 1
No ................................................................. 2
Q49
Q45 Which type of diagnostic testing for malaria
does your outlet provide?
RDT/dipstick .................................................. 1
Blood slide .................................................... 2
Both RDT and Blood slide ............................ 3
Q46 In the past week, approximately how many
people bought or were dispensed a RDT
from your outlet?
Number of people: ..........................................
Don't know ................................................ 888
Q47 What percentage (%) of customers to
whom you sell antimalarial drugs have a
parasite diagnosis first?
0% ................................................................. 1
Less than 10% .............................................. 2
10% to <50% ................................................ 3
50% to <100% .............................................. 4
100% ............................................................. 5
Don't know .................................................... 8
Q48 Compared to this same time last year,
would you say that you are selling more
RDTs, about the same amount, or fewer
RDTs?
Selling more .................................................. 1
Selling same ................................................. 2
Selling less .................................................... 3
Don't know .................................................... 8
N/A (didn't sell last year) ............................... 9
Q49 Do your customers ever ask for a malaria
test?
Yes ................................................................ 1
No ................................................................. 2
Q51
Q50 What do you do or tell your customers who
ask for a malaria test?
Only one answer to be circled
Sell them a RDT only .................................... 1
Sell AND test them with RDT ........................ 2
Take a blood slide ......................................... 3
Refer them to public health facility ................ 4
Refer them to private provider or lab ............ 5
Sell them drugs for malaria ........................... 6
Other ............................................................. 7 Specify:_______________________________
Not sure ......................................................... 8
Myanmar Artemisinin Resistance Containment Baseline Survey 119
Section 3: Artesunate, Artemether + Lumefantrine and Duo-Cotecxin
"I would first like to ask you about three specific drugs."
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
Q51 Have you heard of a drug called
Artesunate?
Yes ............................................................. 1
No ............................................................... 2
Q59
Q52 Do you sell Artesunate? Yes ............................................................. 1
No ............................................................... 2
Q58
Q53 How much do you sell one box of
Artesunate for? Ks: ................................................................
Q54 How much Artesunate did you sell last
week?
(i.e., number of blister packets)
Number of packets: ......................................
Number of tablets if <1packet ………………
Don't know.............................................. 888
Q55 When did you last buy stock of Artesunate? Within last week ......................................... 1
Within last month ........................................ 2
More than a month ago .............................. 3
Not sure ...................................................... 8
Q56 How much Artesunate did you buy the last
time you bought stock?
(i.e., number of blister packets)
Note: one dispenser = 12 blister packets
Number of packets: ......................................
Number of tablets / packet ………………
Don't know.............................................. 888
Number of bottles: ........................................
Number of tablets / bottle ………………
Don't know.............................................. 888
Q57 When will you buy your next stock of
Artesunate?
Within next week ........................................ 1
Within next month ...................................... 2
In more than a month ................................. 3
No plans to buy .......................................... 4
Not sure ...................................................... 8
Skip to
Q59
Q58 Why don't you sell Artesunate?
MULTIPLE RESPONSES POSSIBLE
RECORD ALL MENTIONED
PROBE ONCE: ANYTHING ELSE?
Not available .............................................. 1
Too expensive to buy stock ....................... 2
No demand ................................................. 3
People Don't know it .................................. 4
Don't know where to buy drug.................... 5
Other .......................................................... 6 Specify:_______________________________
Not sure ...................................................... 8
Myanmar Artemisinin Resistance Containment Baseline Survey 120
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
Q59 Have you heard of a drug called
Artemether + Lumefantrine (Coartem;
etc:) ?
Yes ............................................................. 1
No ............................................................... 2
Q67
Q60 Do you sell Artemether + Lumefantrine?
(Please check antimalarials available in
the drug outlet- e.g. Coartem may be
understood by the seller as artemether)
Yes ............................................................. 1
No ............................................................... 2
Q66
Q61 How much do you sell one box of
Artemether + Lumefantrine for?
Ks: ................................................................
Q62 How much Artemether + Lumefantrine did
you sell last week?
(i.e., number of blister packets)
Number of packets: ......................................
Number of tablets if<1packet ……………….
Don't know.............................................. 888
Q63 When did you last buy stock of Artemether
+ Lumefantrine?
Within last week ......................................... 1
Within last month ........................................ 2
More than a month ago .............................. 3
Not sure ...................................................... 8
Q64 How much Artemether + Lumefantrine did
you buy the last time you bought stock?
(i.e., number of blister packets)
Number of packets: ......................................
Don't know.............................................. 888
Q65 When will you buy your next stock of
Artemether + Lumefantrine?
Within next week ........................................ 1
Within next month ...................................... 2
In more than a month ................................. 3
No plans to buy .......................................... 4
Not sure ...................................................... 8
Skip to
Q67
Q66 Why don't you sell Artemether +
Lumefantrine?
MULTIPLE RESPONSES POSSIBLE
RECORD ALL MENTIONED
PROBE ONCE: ANY OTHER REASONS?
Not available .............................................. 1
Too expensive to buy stock ....................... 2
No demand ................................................. 3
People Don't know it .................................. 4
Don't know where to buy drug.................... 5
Other .......................................................... 6 Specify:_______________________________
Not sure ...................................................... 8
Q67 Have you heard of a drug called
Duo-Cotecxin (Dihydroartemisinin +
Piperaquine)?
Yes ............................................................. 1
No ............................................................... 2
Q75
Q68 Do you sell Duo-Cotecxin? Yes ............................................................. 1
No ............................................................... 2
Q74
Q69 How much do you sell one box of
Duo-Cotecxin for? Ks: ................................................................
Myanmar Artemisinin Resistance Containment Baseline Survey 121
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
Q70 How much Duo-Cotecxin did you sell last
week?
(i.e., number of blister packets)
Number of packets: ......................................
Number of tablets if <1packet ………………
Don't know.............................................. 888
Q71 When did you last buy stock of
Duo-Cotecxin?
Within last week ......................................... 1
Within last month ........................................ 2
More than a month ago .............................. 3
Not sure ...................................................... 8
Q72 How much Duo-Cotecxin did you buy the
last time you bought stock?
(i.e., number of blister packets)
Number of packets: ......................................
Don't know.............................................. 888
Q73 When will you buy your next stock of
Duo-Cotecxin?
Within next week ........................................ 1
Within next month ...................................... 2
In more than a month ................................. 3
No plans to buy .......................................... 4
Not sure ...................................................... 8
Skip to
Q75
Q74 Why don't you sell Duo-Cotecxin?
MULTIPLE RESPONSES POSSIBLE
RECORD ALL MENTIONED
PROBE ONCE: ANY OTHER REASONS?
Not available .............................................. 1
Too expensive to buy stock ....................... 2
No demand ................................................. 3
People Don't know it .................................. 4
Don't know where to buy drug.................... 5
Other .......................................................... 6 Specify:_______________________________
Not sure ...................................................... 8
Section 4: Antimalarials and diagnostics sold
"I would now like to ask you about all the antimalarial drugs and diagnostics you provide. I would like you to
list all the drugs and Rapid Diagnostic Tests (RDTs) that you sell. If possible can I check your current stock?"
Q75
Code
Drug / Test Name
Sold in past
6 months?
In stock
now?
Have you
ever been
out of stock
of this drug?
If YES, within the past
3 months, was this
drug/test out of stock
for more than 1 week?
Yes No Yes No Yes No Yes No Not
Known
01 COARTEM (A+L) (1-4 YEARS) 1 2 1 2 1 2 1 2 8
02 COARTEM (A+L) (5-9 YEARS) 1 2 1 2 1 2 1 2 8
03 COARTEM (A+L) (10-14 YEARS) 1 2 1 2 1 2 1 2 8
04 COARTEM (A+L) (>15 YEARS) 1 2 1 2 1 2 1 2 8
05 ARTEFAN (A+L) 1 2 1 2 1 2 1 2 8
06 DUO-COTECXIN (D+P) 1 2 1 2 1 2 1 2 8
07 ARTECOM (D+P) 1 2 1 2 1 2 1 2 8
08 ARTEQUIN (A+M) 1 2 1 2 1 2 1 2 8
Myanmar Artemisinin Resistance Containment Baseline Survey 122
Q75
Code
Drug / Test Name
Sold in past
6 months?
In stock
now?
Have you
ever been
out of stock
of this drug?
If YES, within the past
3 months, was this
drug/test out of stock
for more than 1 week?
Yes No Yes No Yes No Yes No Not
Known
09 ARFLOQUIN (A+M) 1 2 1 2 1 2 1 2 8
10 ARTEMODI (A+AD) 1 2 1 2 1 2 1 2 8
11 ARCO (A+N) 1 2 1 2 1 2 1 2 8
12 ARTESUNATE TAB 1 2 1 2 1 2 1 2 8
13 ARTESUNATE INJECTION 1 2 1 2 1 2 1 2 8
14 ARTEMETHER TAB 1 2 1 2 1 2 1 2 8
15 ARTEMETHER INJECTION 1 2 1 2 1 2 1 2 8
16 ARTEMISININ TAB 1 2 1 2 1 2 1 2 8
17 CHLOROQUINE 1 2 1 2 1 2 1 2 8
18 QUININE TAB 1 2 1 2 1 2 1 2 8
19 QUININE INJECTION 1 2 1 2 1 2 1 2 8
20 MEFLOQUINE 1 2 1 2 1 2 1 2 8
21 PRIMAQUINE 1 2 1 2 1 2 1 2 8
22 OTHER DRUG FOR MALARIA Specify ……………………………
1 2 1 2 1 2 1 2 8
23 OTHER DRUG FOR MALARIA Specify ……………………………
1 2 1 2 1 2 1 2 8
24 OTHER DRUG FOR MALARIA Specify ……………………………
1 2 1 2 1 2 1 2 8
25 OTHER DRUG FOR MALARIA Specify ……………………………
1 2 1 2 1 2 1 2 8
26 OTHER DRUG FOR MALARIA Specify ……………………………
1 2 1 2 1 2 1 2 8
27 DRUG COCKTAIL FOR MALARIA 1 2 1 2 1 2 1 2 8
28 ANTIBIOTICS (DOXYCYCLINE) 1 2 1 2 1 2 1 2 8
29 ANTIBIOTICS (CLINDAMYCIN) 1 2 1 2 1 2 1 2 8
30 ANTIBIOTICS OTHERS …………………………
1 2 1 2 1 2 1 2 8
31 PARACETAMOL / ASPIRIN 1 2 1 2 1 2 1 2 8
32 CARESTART (COMBO TEST) 1 2 1 2 1 2 1 2 8
33 PARACHECK 1 2 1 2 1 2 1 2 8
34 MALACHECK 1 2 1 2 1 2 1 2 8
35 OPTIMAL 1 2 1 2 1 2 1 2 8
36 OTHER TEST FOR MALARIA (1) …………………………..
1 2 1 2 1 2 1 2 8
(2) ………………………….. 1 2 1 2 1 2 1 2 8
(3) ………………………….. 1 2 1 2 1 2 1 2 8
Myanmar Artemisinin Resistance Containment Baseline Survey 123
A = Artemether L = Lumefantrine M = Mefloquine D = Dihydroartemisinin P = Piperaquine N = Naphthoquine AD = Amodiaquine
END INTERVIEW
Thank respondent for taking the time to be interviewed.
ANNEX 3. HEALTH FACILITY QUESTIONNAIRE – PART 1 (FACILITY AUDIT)
Facility Identification Details
Health Facility Cluster: [____|____] (01-80)
Health Facility Name: ______________________ Service Type [______] (1: Public, 2 Private)
Date of interview: __ __ / __ __ / __ __ __ __
Health Facility Type: [______] Referral hospital(Sate/Region/District)…………..1 Township hospital…………………………………..2 Station hospital……………………………………..3 Rural Health center ………………………………..4 Rural health sub center……………………………5 Private specialist hospital………………………….6 Private polyclinic……………………………………7 General practitioner clinic(with beds)…………….8 General practitioner clinic (without beds)………..9 Other Specify:_________________________...10
Facility Code: [____|____] [____] Cluster Number Service Type (Example: Cluster Number = 01, Service Type = 1 so Facility Code = 011)
State/Region:_______________________________ S/R code: ...............................................................
Operational District: __________________________ OD code: ................................................................
Town/Village name: ________________________ GPS coordinates Latitude: ________________ Longitude: ________________
Primary respondent’s position Chief of Health Facility ........................................... 1 Deputy chief............................................................ 2 Acting officer in charge ........................................... 3 Other ....................................................................... 4 Specify :__________________________________
What is the sex of the respondent? Male ........................................................................ 1 Female .................................................................... 2
What is the age of the respondent? Age in years:.........................................................
Myanmar Artemisinin Resistance Containment Baseline Survey 124
SUPERVISOR FIELD EDITOR OFFICE EDITOR DATA ENTRY
Name: _______________ Code: Date: _ _ / _ _ / _ _
Name: _______________ Code: Date: _ _ / _ _ / _ _
Name: _______________ Code: Date: _ _ / _ _ / _ _
Name: _______________ Code: Date: _ _ / _ _ / _ _
What formal health training has the respondent had?
Doctor ..................................................................... 1 Health Assistant ..................................................... 2 Public Health Supervisor(1) .................................... 3 Lady health visitor .................................................. 4 Trained Nurse ......................................................... 5 Midwife ................................................................... 6 Public Health Supervisor(2) .................................... 7 Other health training ............................................... 8 Specify: _________________________
How many years of formal training did you receive? If it was less than one year, fill in month box.
Years of training: ....................................................... Month of training: .......................................................
Myanmar Artemisinin Resistance Containment Baseline Survey 125
Section 1: Description of the health facility
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
Q1 Is the facility public or private? Public facility ............................................... 1 Private facility (for profit) ............................. 2 Private facility (not for profit) ....................... 3 Other ........................................................... 4 Specify:_______________________________
Q2 Type of health facility:
Referral hospital(Sate/Region/District). Township hospital …………………….. Station hospital ………………………… Rural Health center ………………….. Rural health sub center ……………….. Private specialist hospital …………….. Private polyclinic ………………………. General practitioner clinic(with beds)… General practitioner clinic (without beds) …………………………………… Other ………………………………. Specify:________________________
1 2 3 4 5 6 7 8 9 10
Q3 What malaria related services does the health facility provide ? MULTIPLE RESPONSES POSSIBLE CIRCLE ALL MENTIONED PROBE ONCE: ANY OTHERS?
Malaria case management ......................... 1 IPD .............................................................. 2 OPD ............................................................ 3 Malaria diagnosis ........................................ 4 ITN distribution/Tablet distribution .............. 5 Malaria health education............................. 6 Antenatal screening for malaria .................. 7 IMCI ............................................................ 8 Blood bank .................................................. 9 Referral of severe malaria ........................ 10 Other ......................................................... 11 Specify:_______________________________
Q4 How many days per week is the facility open?
Days: .............................................................
Q5 How many hours per day is the facility open?
Hours: ...........................................................
Q6 Does the facility provide on call services? Yes .............................................................. 1 No ............................................................... 2
Q7 Has this health facility received a supervisory visit in the last 6 months? IF PRIVATE FACILITY, SKIP TO Q14
Yes .............................................................. 1 No ............................................................... 2 Not sure ...................................................... 8
Q12 Q12
Q8 Who came to supervise in the last 6 months? MULTIPLE RESPONSES, CIRCLE ALL MENTIONED
TMO/PHD ................................................... 1 Project manager ......................................... 2 Person responsible for supervising ............ 3 Other ........................................................... 4 Specify:_______________________________
Myanmar Artemisinin Resistance Containment Baseline Survey 126
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
Q9 When was the date of the last supervisory visit? IF THEY CAN'T REMEMBER THE DAY, JUST FILL IN THE MONTH
__ __ / __ __ / __ __ __ __ DD MM YYYY
Q10 What did the supervisor’s do during their visit? MULTIPLE RESPONSES, CIRCLE ALL MENTIONED
Checked records/reports ............................ 1 Checked supplies ....................................... 2 Observed work ............................................ 3 Provided feedback ...................................... 4 Gave praise ................................................ 5 Provided updates ........................................ 6 Discussed problems and solutions ............. 7 Other ........................................................... 8 Specify:_______________________________
Q11 Did you get any feedback about the results of the supervisory visit?
Yes .............................................................. 1 No ............................................................... 2 Not sure ...................................................... 8
Q12 Does this facility supervise any health posts, or village malaria workers (VMWs), or mobile malaria workers (MMWs) or village health volunteers (VHVs)? PUBLIC HEALTH FACILITIES ONLY If None fill in 98.
Yes No No. Other health post ............... 1 2 __ __ VMW .................................. 1 2 __ __ MMW.................................. 1 2 __ __ VHV .................................... 1 2 __ __
IF NO, SKIP TO Q14
Q13 When was the date of the last VMW/MMW/VHV meeting at the health center? PUBLIC HEALTH FACILITIES ONLY
VMW/MMW: __ __ / __ __ / __ __ __ __ VHV: __ __ / __ __ / __ __ __ __
Q14 Does the health facility have a copy of the National Treatment Guidelines for Malaria?
Yes .............................................................. 1 No ............................................................... 2
Q16
Q15 What version of the National Treatment Guidelines for Malaria does this facility have? ASK THEM TO SHOW YOU A COPY OF THE GUIDELINES
__ __ / __ __ __ __ MM YYYY Shown a copy (tick this box) ..................
Q16 Does this facility treat severe or complicated cases of malaria?
Yes .............................................................. 1 No ............................................................... 2
Q17 Does this facility refer severe or complicated cases of malaria?
Yes .............................................................. 1 No ............................................................... 2
Q22
Q18 Do you issue the patient a referral card/letter? ASK THEM TO SHOW YOU A COPY OF THE REFERRAL CARD/letter
Yes .............................................................. 1 No ............................................................... 2 Shown a copy (tick this box) ..................
Q19 When you refer cases, do you provide transport?
Yes .............................................................. 1 No ............................................................... 2 Not sure ...................................................... 8
Q21 Q21
Q20 Do the patients have to pay for this transport?
Yes .............................................................. 1 No ............................................................... 2 Not sure ...................................................... 8
Myanmar Artemisinin Resistance Containment Baseline Survey 127
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
Q21 What type of transport is used?
Ambulance from health facility .................... 1 Ambulance from OD/referral hospital ......... 2 Self/patient organized transport .................. 3 Other ........................................................... 4 Specify:_______________________________
Q22 Where do you refer severe or complicated cases of malaria? MULTIPLE RESPONSES POSSIBLE CIRCLE ALL MENTIONED PROBE ONCE: ANYWHERE ELSE?
Referral hospital(Sate/Region/District)……..1 Township hospital…………………………….2 Station hospital………………………………..3 Rural Health center…………………………..4 Rural health sub center………………………5 Private specialist hospital……………………6 Private polyclinic……………………………...7 General practitioner clinic(with beds)………8 General practitioner clinic (without beds)…………………………………………..9 Other …………………………… …….. Specify:_________________________... 10
Q23 Approximately how many miles away is the nearest referral hospital to this health facility? LEAVE BLANK IF REFERRAL HOSPITAL
Distance (miles): .....................................
Q24 Do you know the currently recommended drug for uncomplicated P.falciparum?
Yes .............................................................. 1 No ............................................................... 2
Q26
Q25 What is the currently recommended drug for uncomplicated P.falciparum?
Drug Code: ................................................ Drug Code: ................................................ Drug Code: ................................................ Other ........................................................ 97 Specify:_______________________________
Q26 Do you know the currently recommended drug for uncomplicated P.vivax?
Yes .............................................................. 1 No ............................................................... 2
Q28
Q27 What is the currently recommended drug for uncomplicated P.vivax?
Drug Code: ................................................ Drug Code: ................................................ Drug Code: ................................................ Other ........................................................ 97 Specify:_______________________________
Q28 During 2011, have you attended any trainings or workshops about malaria?
Yes .............................................................. 1 No ............................................................... 2
Q31
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NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
Q29 What topics were discussed during these trainings/workshops? MULTIPLE RESPONSES POSSIBLE CIRCLE ALL MENTIONED PROBE ONCE: ANYTHING ELSE?
Case management ..................................... 1 Laboratory diagnosis .................................. 2 Rational antimalarial drug use .................... 3 Management of severe malaria .................. 4 Epidemiology .............................................. 5 ITN .............................................................. 6 Health education ......................................... 7 Microplanning ............................................. 8 VMW/MMW training .................................... 9 VHV training .............................................. 10 Other ......................................................... 11 Specify:_______________________________ Don't know ................................................ 98
Q30 Who conducted these trainings? MULTIPLE RESPONSES POSSIBLE CIRCLE ALL MENTIONED PROBE ONCE: ANYONE ELSE?
Health Center/Hospital ................................ 1 State/Region (S/R HD) ............................... 2 Central Malaria Team ................................. 3 NGO ............................................................ 4 Other ........................................................... 5 Specify:_______________________________ Don't remember .......................................... 8
Q31 Have you heard about activities in the past year to stop the spread of drug resistance in Myanmar?
Yes .............................................................. 1 No ............................................................... 2
Q32 Are you aware that some antimalarial drugs are banned in Myanmar?
Yes .............................................................. 1 No ............................................................... 2
Q35
Q33 Which antimalarial drugs are banned in Myanmar? USE THE CODES FROM THE STOCK REVIEW IN SECTION 3.
NAME CODE Drug 1: _____________________ Drug 2: _____________________ Drug 3: _____________________ Other ......................................................... 97 Specify: ___________________________ Don't know ................................................ 98
Q34 Where did you hear about the ban on these antimalarial drugs? MULTIPLE RESPONSES POSSIBLE CIRCLE ALL MENTIONED PROBE ONCE: ANYWHERE ELSE?
TV/Radio ..................................................... 1 Training ....................................................... 2 Health Center/Hospital staff ........................ 3 State/Region (S/R HD) staff........................ 4 NGO staff .................................................... 5 Committee for food and Drug control ......... 6 Other ........................................................... 7 Specify:_______________________________ Not sure .................................................... 98
Q35 Have you heard about fake/counterfeit drugs?
Yes .............................................................. 1 No ............................................................... 2
Q37
Q36 Have you seen any fake/counterfeit drugs? Yes .............................................................. 1 No ............................................................... 2 Don't know .................................................. 8
Q37 Have you heard about sub standard drugs? Yes .............................................................. 1 No ............................................................... 2
Section
2
Myanmar Artemisinin Resistance Containment Baseline Survey 129
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
Q38 Have you seen any sub standard drugs? Yes .............................................................. 1 No ............................................................... 2 Don't know .................................................. 8
Myanmar Artemisinin Resistance Containment Baseline Survey 130
Section 2: Review of health facility staff The interviewer should ask the head of the health facility about all current staff positions. For current staff details of length of service and training should be recorded. If referral hospital, list only health workers in the Outpatient Department (OPD).If the facility is a private one, list only health workers in Out Patient Department(OPD).
Q39 Q40 Q41 Q42 Q43 Q44
No.
Position
(list all posts even if
currently vacant)
Staff Name
(leave blank for vacant posts)
Highest Qualification Code for qualification: Doctor……………………….…….....1 Health Assistant………………….…2 Public Health Supervisor(1)……….3 Lady health visitor…………………..4 Trained Nurse……………………….5 Midwife………………………………6 Public Health Supervisor(2)……….7 Other health training……………….8 Specify: _________________________
Is the staff member present in the facility or engaged in field work today? 1 = Yes 2 = No
Years in service (Count from the first day of service as health care provider) (leave blank for vacant posts)
Last malaria-related in service training Code for type of training: 1 = Malaria laboratory 2 = Case management 3 = IBN 4 = Health education 5 = Epidemiology 6 = Other (specify)
Type of training
Date (MM/YY)
Duration (days)
1
2
3
4
5
6
7
Myanmar Artemisinin Resistance Containment Baseline Survey 131
Q39 Q40 Q41 Q42 Q43 Q44
Type of training
Date (MM/YY)
Duration (days)
8
9
10
11
12
13
14
15
Myanmar Artemisinin Resistance Containment Baseline Survey 132
Section 3: Pharmacy Stock Review The interviewer visits the facility’s pharmacy, and checks stock levels of all antimalarial drugs and expiry dates on each type.
Q43 Q44 Q45 Q46 Q47
Code Stock item
Usually in stock
In stock on day of
survey
Quantity in stock
Max. continuous
days stockout in last 3 months
Any items past
expiry?
Yes No Yes No Units Number
Yes No
1 Artemether-Lumefantrine (COARTEM 24)
1 2 1 2
1 2
2 Artemether-Lumefantrine (COARTEM 18)
1 2 1 2
1 2
3 Artemether-Lumefantrine (COARTEM 12)
1 2 1 2
1 2
4 Artemether-Lumefantrine (COARTEM 6)
1 2 1 2
1 2
5 DHA-piperaquine (DUO-COTECXIN)
1 2 1 2
1 2
6 ARTESUNATE TABLET 1 2 1 2 1 2
7 ARTESUNATE SUPPOSITORY 1 2 1 2 1 2
8 ARTEMETHER INJECTION(80mg)
1 2 1 2
1 2
9 ARTEMETHER INJECTION(40mg)
1 2 1 2
1 2
10 Artemethar Tab. 1 2 1 2 1 2
11 Artesunate + Amodiaquin 1 2 1 2 1 2
12 Artesunate + Mefloquin 1 2 1 2 1 2
13 Mefloquin Tab. 1 2 1 2 1 2
14 Quinine Inj. 1 2 1 2 1 2
15 Quinine Tab 1 2 1 2 1 2
16 Primaquin Tab. 15 mg) 1 2 1 2 1 2
17 Primaquin Tab. 7.5 mg 1 2 1 2 1 2
18 Chloroquin Tab 1 2 1 2 1 2
19 Doxycycline 1 2 1 2 1 2
20 Tetracycline 1 2 1 2 1 2
21 Clindamycin 1 2 1 2 1 2
22 Mixture of drugs for fever (or) Malaria
1 2 1 2
1 2
23 OTHER DRUG FOR MALARIA Specify: _____________________
1 2 1 2
1 2
1 2 1 2 1 2
1 2 1 2 1 2
Myanmar Artemisinin Resistance Containment Baseline Survey 133
Q43 Q44 Q45 Q46 Q47
Code Stock item
Usually in stock
In stock on day of
survey
Quantity in stock
Max. continuous
days stockout in last 3 months
Any items past
expiry?
Yes No Yes No Units Number
Yes No
1 2 1 2 1 2
1 2 1 2 1 2
24 Combo test(Care start) 1 2 1 2 1 2
25 Combo test (SD) 1 2 1 2 1 2
26 Paracheck 1 2 1 2 1 2
27 Other tests for malaria 1 2 1 2 1 2
1 2 1 2 1 2
1 2 1 2 1 2
28 MOSQUITO NETS Specify brand: ______________
1 2 1 2
1 2
29 K O tab 1 2 1 2 1 2
Give the maximum number of continuous days without the drug in the past 3 months
Myanmar Artemisinin Resistance Containment Baseline Survey 134
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
Q50 Did this health facility have stockout (more than 7 days without a drug) of any drugs during the past 3 months
Yes ............................................................. 1 No ............................................................... 2
Q52
Q51 What were the reasons for the stockouts?
No supply from CMS .................................. 1 No supply from State/Division health department ................................................. 2 Unexpected demand .................................. 3 Other .......................................................... 4 Specify:_______________________________
Q52 Are the stock records up-to-date? DO NOT ASK, OBSERVE ONLY
Yes ............................................................. 1 No ............................................................... 2
Q53 Do they tally with the stocks on hand? DO NOT ASK, OBSERVE ONLY
Yes ............................................................. 1 No ............................................................... 2
Q54 Does the facility use the principle of “First Expiry , first out” (FEFO) for managing their drug stocks?
Yes ............................................................. 1 No ............................................................... 2 Don’t know ................................................. 8
Section 4a: Review of outpatient services
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
Q55 Are there malaria-related summary tables or graphs displayed in the OPD? DO NOT ASK, OBSERVE ONLY
Yes ............................................................. 1 No ............................................................... 2
Q56 Does this health facility have an outpatient register or book?
Yes ............................................................. 1 No ............................................................... 2
Q61
Q57 Is the outpatient register in MOH or standard format? DO NOT ASK, OBSERVE ONLY
Yes ............................................................. 1 No ............................................................... 2
Q58 Is the outpatient register up to date? DO NOT ASK, OBSERVE ONLY
Yes ............................................................. 1 No ............................................................... 2
Q59 Is the health facility filling out the monthly line list of cases by village for CNM?
Yes ............................................................. 1 No ............................................................... 2
Q60 When did they last send a copy of the monthly line list to the PHD?
Date line list sent: __ __ / __ __ __ __ MM YYYY
Section 4b: Review of 2011 OPD and IPD register records Use the clinical case registers in the OPD and IPD to fill out the health facility case register sheet for all treated malaria cases from , up to the present, beginning with the most recent. Section 5a: Review of Laboratory Services (OPD)
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
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NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
Q61 Does the health facility provide laboratory services for malaria, meaning microscopy and/or RDTs? (Microscope or RDT)
Yes - microscopy & RDT ............................ 1 Yes - microscopy only ................................ 2 Yes - RDT only ........................................... 3 No ............................................................... 4
Q71 END
Q62 Do they have a trained lab technician who is able to perform microscopy?
Yes-full time ............................................... 1 Yes-part time .............................................. 2 No ............................................................... 3
Q64
Q63 In the past 3 months have you had more than a week without a trained lab technician who is able to perform microscopy?
Yes ............................................................. 1 No ............................................................... 2 Not sure ...................................................... 8
Q64 Do they have a microscope in good working order?
Yes ............................................................. 1 No ............................................................... 2
Q66
Q65 In the past 3 months have you had more than a week without a microscope in good working order?
Yes ............................................................. 1 No ............................................................... 2 Not sure ...................................................... 8
Q66 In the past 3 months have you had more than a week without enough slides?
Yes ............................................................. 1 No ............................................................... 2 Not sure ...................................................... 8
Q67 In the past 3 months have you had more than a week without enough Giemsa stain?
Yes ............................................................. 1 No ............................................................... 2 Not sure ...................................................... 8
Q68 When did you last send slides for quality control?
Date sent slides: __ __ / __ __ __ __ MM YYYY
Q69 Where did you send slides for quality control?
Township hospital ...................................... 1 State health department ............................. 2 National programme................................... 3 Both Province & National programme........ 4 Other .......................................................... 5 Specify:_______________________________
Q70 Did you receive any feedback on the quality control of slides?
Yes ............................................................. 1 No ............................................................... 2 Not sure ...................................................... 8
Q71 Which brand of RDT do you currently use? MULTIPLE RESPONSES POSSIBLE CIRCLE ALL MENTIONED
Carestart (Combo) ..................................... 1 Paracheck .................................................. 2 Malacheck .................................................. 3 Carestart (SD) ............................................ 4 Other .......................................................... 5 Specify:_______________________________
Q72 In the past 3 months have you had more than a week without enough RDTs?
Yes ............................................................. 1 No ............................................................... 2 Not sure ...................................................... 8
Myanmar Artemisinin Resistance Containment Baseline Survey 136
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
Q73 Where do you keep the RDTs? OBSERVE
On the counter/table................................... 1 Inside cupboard .......................................... 2 In a cooler box ............................................ 3 In the refrigerator ........................................ 4 Other .......................................................... 5 Specify:_______________________________
Q74 Does this health facility have a laboratory register or book?
Yes ............................................................. 1 No ............................................................... 2
Q77
Q75 Is the laboratory register up to date? DO NOT ASK, OBSERVE ONLY
Yes ............................................................. 1 No ............................................................... 2
Q76 Is the laboratory register in MoH format? DO NOT ASK, OBSERVE ONLY
Yes ............................................................. 1 No ............................................................... 2
Q77 Does the health facility have National Laboratory Diagnosis Manual for Malaria? Ask to see a copy for verification
Yes ............................................................. 1 No ............................................................... 2 Shown a copy (tick this box) .......................
Section 5b: Review of 2011 Laboratory Register
NO. QUESTIONS AND FILTERS Month
August September October
Q78 Number of slides positive for P. falciparum
Q79 Number of slides positive for P. vivax
Q80 Number of slides positive for Mixed infections (Pf/Pv)
Q81 Number of negative slides
Q82 Number of RDTs positive for P. falciparum
Q83 Number of RDTs positive for P. vivax
Q84 Number of RDTs positive for Mixed infections
Q85 Number of negative RDTs
Myanmar Artemisinin Resistance Containment Baseline Survey 137
Section 6: List of malaria-related BCC/IEC materials at the health facility
Q86 Q87 Q88
No. Type of IEC material 1 = Poster 2 = Leaflet 3 = Calendar 4 = Flip chart 5 = T-shirt/hat 8 = Other (specify)
Message Malaria prevention = 1 Malaria case management = 2
Location 1 = Displayed on wall or table 2 = In store room 3 = Other (specify)
Myanmar Artemisinin Resistance Containment Baseline Survey 138
ANNEX 4. HEALTH FACILITY QUESTIONNAIRE – PART 2 (MALARIA FOLLOW-UP)
Patient Follow-up Interview Form
USE THIS FORM TO FOLLOW UP AND INTERVIEW PATIENTS WHO WERE TREATED FOR MALARIA AT THE HEALTH FACILITY IN THE PAST ONE MONTH
Health Facility Cluster: [____|____] (01-32)
Health Facility Name: ______________________
Service Type [______] (1: Public, 2 Private) Date of interview: __ __ / __ __ / __ __ __ __
Health Facility Type: [______]
Referral hospital(Sate/Region/District)…………………1
Township hospital……………………………………......2
Station hospital……………………………………………3
Rural Health center ……………………………………...4
Rural health sub center…………………………………..5
Private specialist hospital………………………………..6
Private polyclinic………………………………………….7
General practitioner clinic(with beds)……………........8
General practitioner clinic (without beds)……………..9
Other Specify:_________________________.........10
Facility Code: [____|____] [____]
Cluster Number Service Type
(Example: Cluster Number = 01, Service Type = 1
so Facility Code = 011)
State/Region: ___________________________________
S/R code: ..............................................................
Operational District: __________________________ OD code: ...............................................................
Patient No.: ........................................................... USE THE LINE NUMBER FROM THE HEALTH FACILITY CASE RECORD SHEET
Patient ID:
O=outpatient I=inpatient
Patient’s name: ___________________________ Carer’s name: __________________________
HOUSEHOLD VISITS Visit 1 Visit 2 Visit 3 Final Visit
Date:
Interviewer's Name:
Result code:
_ _ / _ _ / _ _
__________
_____
_ _ / _ _ / _ _
__________
_____
_ _ / _ _ / _ _
__________
_____
Date: __ __ / __ __ / __ __ Interviewer ID: Result code:
Next planned visit: Date:
Time:
_ _ / _ _ / _ _
_________
_ _ / _ _ / _ _
_________
Total number of visits:
− −
Myanmar Artemisinin Resistance Containment Baseline Survey 139
HOUSEHOLD VISITS Visit 1 Visit 2 Visit 3 Final Visit
* Result Codes:
1 = Completed 5 = Patient away from village 2 = No one at home 6 = Could not locate patient 3 = Refused 7 = Other 4 = Dwelling not found
SUPERVISOR FIELD EDITOR OFFICE EDITOR DATA ENTRY
Name: _______________
Code:
Date: _ _ / _ _ / _ _
Name: _______________
Code:
Date: _ _ / _ _ / _ _
Name: _______________
Code:
Date: _ _ / _ _ / _ _
Name: _______________
Code:
Date: _ _ / _ _ / _ _
Myanmar Artemisinin Resistance Containment Baseline Survey 140
Section 1: Demographics of patient treated for malaria
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
Q1 How old is the patient who was treated for malaria at (HEALTH FACILITY NAME)? IF THE PATIENT IS A CHILD < 5 YEARS, RECORD THEIR AGE IN MONTHS
Age (years): ..................................................
Age (months): ...............................................
Q2 What is the sex of the patient?
Male ........................................................... 1
Female ....................................................... 2 Q4
Q3 Is the patient currently pregnant?
ONLY ASK IF THEY ARE FEMALES, AGED 15-49 YEARS
Yes ............................................................. 1
No ............................................................... 2
Don’t know ................................................. 8
Q4 Was the patient taken to (HEALTH FACILITY NAME) in the past month by a carer?
Yes ............................................................. 1
No ............................................................... 2
Q8
Q5 What is the age of the patient’s carer?
Age (years): ..................................................
Q6 What is the sex of the patient’s carer?
Male ........................................................... 1
Female ....................................................... 2
Q7 What is the relationship of the carer to the patient treated for malaria?
Parents ....................................................... 1
Spouse ....................................................... 2
Offspring ..................................................... 3
Sibling ........................................................ 4
Grandparents..............................................5
Other .......................................................... 6
Specify:_______________________________
Q8 Where does the patient currently live? WRITE THE NAMES OF THE STATE/REGION, DISTRICT, TOWSHIP, AND VILLAGE OR WARD. FILL IN CODES LATER TO SAVE TIME.
State/Region:
__________________________________
District:
__________________________________
Township:
__________________________________
Village/Ward: __________________________________
Not sure .................................................... 98
Q9 Is the patient’s current address also their permanent address?
Yes ............................................................. 1
No ............................................................... 2
Myanmar Artemisinin Resistance Containment Baseline Survey 141
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
Q10 How long has the patient been living at their current address?
< 2 weeks ................................................... 1
< 1 month ................................................... 2
1 to < 3 months .......................................... 3
3 to < 6 months ......................................... 4
6 months to < 1 year .................................. 5
≥ 1 year ..................................................... 6
Q11 What is the highest level of education attained by the patient?
Child <5 years, not in school ...................... 0
Never attended school ............................... 1
Primary(including Monastic+read/write) ... 2
Secondary .................................................. 3
High school ............................................... 4
University ................................................... 5
Other .......................................................... 6
Specify:_______________________________
Q12 What is the patient’s primary profession or job?
Child, not in school ..................................... 1
Student ....................................................... 2
Farmer ........................................................ 3
Laborer ....................................................... 4
Fisherman .................................................. 5
Merchant/Seller .......................................... 6
Housewife .................................................. 7
Soldier ........................................................ 8
Other .......................................................... 9
Specify: __________________________
Q13 In the past 6 months, did the patient ever go to the forest and sleep there overnight? (Including the travel through the forest)
Yes ............................................................. 1
No ............................................................... 2
Q18
Q14 When was the patient last in the forest?
Last night .................................................... 1
< 1 week ..................................................... 2
1 to < 2 weeks ............................................ 3
2 to < 4 weeks ............................................ 4
≥ 4 weeks ................................................... 5
Not sure ...................................................... 8
Q15 How many nights did the patient stay in the forest on their last visit?
Nights: ..........................................................
Not sure .................................................... 98
Q16 Did the patient sleep overnight in the forest in the two weeks before they became ill?
Yes ............................................................. 1
No ............................................................... 2
Don’t remember ......................................... 8
Q18
Q18
Q17 Was the patient in the forest when they became ill?
Yes ............................................................. 1
No ............................................................... 2
Don’t remember ......................................... 8
Myanmar Artemisinin Resistance Containment Baseline Survey 142
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
Q18 In the past 6 months, has the patient ever travelled away from home and stayed overnight?
Yes ............................................................. 1
No ............................................................... 2
Q23
Q19 When did the patient last travel away from home?
Last night .................................................... 1
< 1 week ..................................................... 2
1 to < 2 weeks ............................................ 3
2 to < 4 weeks ............................................ 4
≥ 4 weeks ................................................... 5
Not sure ...................................................... 8
Q20 For what reason(s) did the patient last travel away from home? MULTIPLE RESPONSES, CIRCLE ALL MENTIONED
Work in forest ............................................ 1
Work on agricultural fields/plantations ...... 2
Work in Thailand ....................................... 3
Work in other country ................................ 4
Visit relatives ............................................. 5
Other ......................................................... 6
Specify: ___________________________
Don't know................................................. 8
Q21 Did the patient travel away from home in the two weeks before they became ill?
Yes ............................................................. 1
No ............................................................... 2
Don’t remember ......................................... 8
Q23
Q23
Q22 Was the patient traveling away from home when they became ill?
Yes ............................................................. 1
No ............................................................... 2
Don’t remember ......................................... 8
Q23 Did the patient sleep under a mosquito net last night?
Yes ............................................................. 1
No ............................................................... 2
Not sure ...................................................... 8
Q24 Does the patient’s household own any mosquito nets?
Yes ............................................................. 1
No ............................................................... 2
Not sure ...................................................... 8
Section 2: Details of treatment seeking, symptoms, consultation and diagnosis
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
Q25 How long after the fever began did you/your child first seek advice or treatment?
Same day ................................................... 1
Day after ..................................................... 2
Two days after ............................................ 3
Three or more days .................................... 4
Don’t remember ......................................... 8
Q26 Did you/your child seek treatment anywhere else before going to (HEALTH FACILITY NAME)?
Yes ............................................................. 1
No ............................................................... 2
Don’t remember ......................................... 8
Q34
Q34
Myanmar Artemisinin Resistance Containment Baseline Survey 143
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
Q27 Where else did you/your child seek treatment? MULTIPLE RESPONSES POSSIBLE, CIRCLE ALL MENTIONED
PROBE: ANYWHERE ELSE?
Referral hospital(Sate/Region/District)……1
Township hospital…………………………...2
Station hospital………………………………3
Rural Health center …………………………4
VMW/ VHV…………………………………...5
Rural health sub center……………………..6
Private specialist hospital…………………..7
Private polyclinic…………………………….8
General practitioner clinic (with beds)…….9
General practitioner clinic (without beds)..10
Private laboratory………………………… 11
Drug store ……………………………12
Shop/market ……………………………13
Traditional practitioner…………………… 14
Other Specify:_________________________...15
Can’t remember 98
Q28 Why did you/your child go to that provider/facility/place for treatment? MULTIPLE RESPONSES POSSIBLE, CIRCLE ALL MENTIONED
To seek advice ........................................... 1
To buy/get medication ................................ 2
Because it is close to my house ................. 3
To get a test ............................................... 4
To get traditional treatment ........................ 5
Transport expensive to health facility......... 6
Other .......................................................... 7
Specify: ___________________________
Q29 Why didn’t you first go to (HEALTH FACILITY NAME) for treatment? MULTIPLE RESPONSES POSSIBLE, CIRCLE ALL MENTIONED
Too far away .............................................. 1
Transport expensive to health facility......... 2
Fees expensive at health facility ................ 3
Didn’t think illness was serious .................. 4
To get traditional treatment ........................ 5
Other .......................................................... 6
Specify: ___________________________
Q30 Did you get drugs from that provider/facility/place?
Yes ............................................................. 1
No ............................................................... 2
Don’t remember ......................................... 8
Q32
Q32
Myanmar Artemisinin Resistance Containment Baseline Survey 144
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
Q31 Which drugs did you get from that provider/facility/place? INCLUDE ALL DRUGS, SUCH AS ANTIMALARIALS, ANTIBIOTICS, PARACETAMOL, ETC.
DON’T INCLUDE DRUGS THEY WERE PRESCRIBED FROM THE HEALTH FACILITY IF THEY DON’T KNOW OR CAN’T REMEMBER, WRITE “98” FOR THE DRUG 1 CODE
TICK THE CHECKBOX IF THE DRUG IS AN
ANTIMALARIAL
anti-
Code Name malarial?
Drug 1: _________________
Drug 2: _________________
Drug 3: _________________
Drug 4: _________________
Drug 5: _________________
Q32 How much did you pay to get treatment from that provider/facility/place?
Kyat: .............................................................
Not Sure ................................................... 98
Q33 How long after you went to the other provider/facility/place did you go to (HEALTH FACILITY NAME) for treatment?
Number of days: ...........................................
Not Sure ................................................... 98
Q34 Why did you decide to go to (HEALTH FACILITY NAME)? MULTIPLE RESPONSES POSSIBLE, CIRCLE ALL MENTIONED
Referred from public health facility ............. 1
Referred from private provider ................... 2
Because it is close to my house ................. 3
To get a test ............................................... 4
Symptoms were getting worse ................... 5
Other .......................................................... 6
Specify: ___________________________
Q35 What signs and symptoms did you/your child have when you went to (HEALTH FACILITY NAME)? MULTIPLE RESPONSES POSSIBLE CIRCLE ALL MENTIONED
PROBE ONCE: ANY OTHER SYMPTOMS?
Fever .......................................................... 1
Chills .......................................................... 2
Sweating .................................................... 3
Headache ................................................... 4
Body ache/Joint pain .................................. 5
Fatigue ....................................................... 6
Loss of appetite .......................................... 7
Diarrhoea ................................................... 8
Vomiting ..................................................... 9
Other ........................................................ 10
Specify: ___________________________
Don't remember ....................................... 98
Myanmar Artemisinin Resistance Containment Baseline Survey 145
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
Q36 By what means did you travel to (HEALTH FACILITY NAME)? MULTIPLE RESPONSES POSSIBLE CIRCLE ALL MENTIONED
PROBE ONCE: ANY OTHER SYMPTOMS?
Walked ....................................................... 1
Motorcycle .................................................. 2
Car.............................................................. 3
Boat ............................................................ 4
Ambulance ................................................. 5
Taxi............................................................. 6
Other .......................................................... 7
Specify: ___________________________
Q37 How long did it take you/ health personnel to travel to/from (HEALTH FACILITY NAME)?
Time (minutes): ............................................
Q38 How much did you pay to travel to (HEALTH FACILITY NAME)?
Travel cost (Kyat): ........................................
If there was no cost, fill up 99999.
Not Sure ................................................... 98
Q39 When you/your child arrived at the health facility, how long did you wait to see the nurse/doctor?
Time (minutes): ............................................
Don’t remember ----- 98
Q40 How long did the consultation take, that is how much time did you/your child spend with the nurse/doctor?
Time (minutes): ............................................
Don’t remember ----- 98
Q41 During the consultation did the nurse/doctor ask about your/your child’s fever and travel history?
Yes No
Fever history ............................... 1 2
Travel history ............................... 1 2
Don’t remember ----- 98
Q42 During the consultation did the nurse/doctor take your/your child’s temperature or blood pressure or weight or height? ASK ABOUT EACH AND CIRCLE "YES" (1) IF IT WAS DONE OR "NO" (2) IF IT WASN’T
Yes No
Temperature ................................ 1 2
Blood pressure ............................ 1 2
Weight ......................................... 1 2
Height .......................................... 1 2
Q43 Did the nurse/doctor give you a diagnosis for your/your child’s illness?
Yes ............................................................. 1
No ............................................................... 2
Not sure ...................................................... 8
Q45
Q45
Q44 What diagnosis did the nurse/doctor give you/your child? MULTIPLE RESPONSES POSSIBLE CIRCLE ALL MENTIONED
PROBE ONCE: ANY OTHERS?
Malaria ....................................................... 1
Anaemia (short of blood) ............................ 2
Dehydration ................................................ 3
Respiratory infection .................................. 4
Cold/Flu ...................................................... 5
Dengue ....................................................... 6
Malnutrition ................................................. 7
Other .......................................................... 8
Specify:_______________________________
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NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
Q45 Were you/your child given a blood test for malaria at the health facility?
Yes ............................................................. 1
No ............................................................... 2
Q49
Q46 What type of test? RDT/dipstick ............................................... 1
Blood slide/microscopy .............................. 2
Not sure ...................................................... 8
Q47 Do you know the result of the test? Positive ....................................................... 1
Negative ..................................................... 2
Not told result ............................................. 3
Not sure ...................................................... 8
Q49
Q49
Q49
Q48 Do you know what type of malaria you/your child had?
Not told ....................................................... 1
Falciparum ................................................. 2
Vivax .......................................................... 3
Mixed (Pf & Pv) .......................................... 4
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Section 3: Details of treatment
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
Q49 Did you/your child get an infusion?
Yes ............................................................. 1
No ............................................................... 2
Q50 Did the doctor/nurse/basic health staff prescribe any drugs for you/your child?
Yes ............................................................. 1
No ............................................................... 2
Q63
Q51 What drugs were prescribed for you/your child? INCLUDE ALL DRUGS, SUCH AS ANTIMALARIALS, ANTIBIOTICS, PARACETAMOL, ETC. IF THEY DON’T KNOW OR CAN’T REMEMBER, WRITE “98” FOR THE DRUG 1 CODE
anti-
Code Name malarial?
Drug 1: _________________
Drug 2: _________________
Drug 3: _________________
Drug 4: _________________
Drug 5: _________________
Q52 Can you tell me why you/your child were prescribed these drugs?
MULTIPLE RESPONSES POSSIBLE CIRCLE ALL MENTIONED
To treat malaria .......................................... 1
To reduce the fever .................................... 2
To reduce body pain/joint ache .................. 3
To make stronger ....................................... 4
Other .......................................................... 5
Specify:_______________________________
Don’t know .................................................. 8
Q53 Were you given any information about the drugs you/your child were prescribed by the doctor/nurse/basic health staff?
MULTIPLE RESPONSES POSSIBLE CIRCLE ALL MENTIONED
Yes (verbally) ............................................. 1
Yes (written) ............................................... 2
Yes (verbally & written) .............................. 3
No ............................................................... 4
Not sure ...................................................... 8
Q54 (For antimalarials only) Were you told how to take/administer the drug by the doctor/nurse/basic health staff?
CHECK Q51 AND MENTION THE DRUGS BY NAME TO THE PATIENT/CARER
Yes ............................................................ 1
No .............................................................. 2
Not sure ..................................................... 8
Q55 Can you show me the drugs you/your child were prescribed from (HEALTH FACILITY NAME)?
Yes ............................................................. 1
No .............................................................. 2
No more, take all ........................................ 8
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NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
Q56 Did you get these drugs from (HEALTH FACILITY NAME) or from another place?
Didn’t buy antimalarials .............................. 0
Referral hospital ......................................... 1
Health centre or FDH ................................ 2
Health post ................................................. 3
VMW/ VHV ................................................. 4
Polyclinic .................................................... 5
Private laboratory ....................................... 6
Drug store ................................................... 7
Shop/market ............................................... 8
Traditional practitioner ................................ 9
Other ........................................................ 10
Specify: ___________________________
Q62
Q57 How many tablets per dose did you/your child take of the antimalaria medicine?
WRITE “98” IF THEY DON’T KNOW
No. tablets: ...................................................
Q58 How many times per day did you/your child take the antimalaria medication?
WRITE “98” IF THEY DON’T KNOW
No. times/day: ..............................................
Q59 How many days in total did you/your child take of the antimalaria medicine?
WRITE “98” IF THEY DON’T KNOW
No. days: ......................................................
Q60 Did you/your child finish taking all of the antimalaria medicine that you were prescribed by (HEALTH FACILITY NAME)?
Yes ............................................................. 1
No ............................................................... 2
Q63
Q61 Why didn’t you/your child finish taking all of the antimalaria medicine that you were prescribed?
Still taking the medication ......................... 1
Had side effects ......................................... 2
Felt better ................................................... 3
Other .......................................................... 4
Specify: ___________________________
Don’t know ................................................. 8
SKIP TO Q63
Q62 Why didn’t you get the antimalarial medicine that you/your child were prescribed at (HEALTH FACILITY NAME)?
Not available at health facility .................... 1
Didn’t have enough money ........................ 2
Didn’t know where to buy ........................... 3
Afraid of side effects ................................... 4
Other .......................................................... 5
Specify: ___________________________
Don’t know ................................................. 8
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NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
Q63 What happens if you don’t take antimalarial drugs for the recommended number of days or don't take all of the tablets as prescribed?
MULTIPLE RESPONSES POSSIBLE CIRCLE ALL MENTIONED
Nothing ...................................................... 1
Parasite remains in the body...................... 2
Patient will continue to transmit malaria ..... 3
Parasite will become resistant.................... 4
Patient gets sick again ............................... 5
Patient does not recover ............................ 6
Other .......................................................... 7
Specify:_______________________________
Don't know .................................................. 8
Q64 Why do you think you/your child became sick? MULTIPLE RESPONSES POSSIBLE CIRCLE ALL MENTIONED
PROBE ONCE: ANY OTHER REASONS?
.................................................................. 10
Mosquito bites ............................................ 1
Didn’t sleep under net ................................ 2
Stayed/slept in forest .................................. 3
Stayed/slept in plantation ........................... 4
Drank dirty water ........................................ 5
Didn’t boil water .......................................... 6
Bathed in river ............................................ 7
Bad air ........................................................ 8
Bad talking .................................................. 9
Spirits ....................................................... 10
Bad food ................................................... 11
Poor hygiene ............................................ 12
Other ........................................................ 13
Specify:_______________________________
Don't know ................................................ 98
Q65 Has anyone else in your household been sick with fever in the past two weeks?
Yes ............................................................. 1
No ............................................................... 2
Q66 Did you return to (HEALTH FACILITY NAME) for more treatment or advice after your/your child’s first visit?
Yes ............................................................. 1
No ............................................................... 2
Q69
Q67 How long after the first visit to (HEALTH FACILITY NAME) did you/your child return?
No. days: ......................................................
Don’t remember-----------98
Q68 Why did you/your child return to the health facility? MULTIPLE RESPONSES POSSIBLE CIRCLE ALL MENTIONED
PROBE ONCE: ANY OTHER REASONS?
Fever returned ............................................ 1
Didn’t feel better/symptoms got worse ....... 2
To get a test ............................................... 3
To get more medicine ................................ 4
Health worker told me to return .................. 5
Other .......................................................... 6
Specify:_______________________________
Don't know .................................................. 8
Q69 Have you/your child recovered from the illness? Have you/your child been able to return to your normal activities and work/study?
Yes ............................................................. 1
No ............................................................... 2
Q73
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NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
Q70 What symptoms do you/your child still have? MULTIPLE RESPONSES POSSIBLE CIRCLE ALL MENTIONED
PROBE ONCE: ANY OTHER SYMPTOMS?
Fever .......................................................... 1
Chills ........................................................... 2
Sweating ..................................................... 3
Headache ................................................... 4
Body ache/Joint pain .................................. 5
Fatigue ....................................................... 6
Loss of appetite .......................................... 7
Diarrhoea .................................................... 8
Vomiting ..................................................... 9
Other ........................................................ 10
Specify: ___________________________
Don't remember ........................................ 98
Q71 Were you given any health education about your illness by the doctor/nurse/basic health staff at (HEALTH FACILITY NAME)?
Yes (verbally) ............................................. 1
Yes (written) ............................................... 2
Yes (verbally & written) .............................. 3
No ............................................................... 4
Not sure ...................................................... 8
Q72 How much did you pay for your/your child’s treatment?
Cost of treatment (Kyats): ............................
Not Sure ................................................... 98
Q73 Were you satisfied with the services that you/your child received at (HEALTH FACILITY NAME)?
Yes ............................................................. 1
No ............................................................... 2
Q74 Are there any improvements that you would like to see at (HEALTH FACILITY NAME)? MULTIPLE RESPONSES POSSIBLE CIRCLE ALL MENTIONED
PROBE ONCE: ANYTHING ELSE?
None, no improvements needed ................ 0
Reduce waiting times ................................. 1
Reduce/eliminate user fees ........................ 2
More explanation about illness................... 3
Better staff attitude toward patients ........... 4
More time with health worker ..................... 5
More detailed exam by health worker ........ 6
Availability of the prescribed drugs ............ 7
Better quality drugs .................................... 8
Longer opening hours ................................ 9
Cleaner facility or nicer building ............... 10
Other ........................................................ 11
Specify: ______________________________
Don't know ................................................ 98
END INTERVIEW
Thank respondent for taking the time to be interviewed.
Myanmar Artemisinin Resistance Containment Baseline Survey 151
Patient Information from the clinical register:
THIS INFORMATION SHOULD BE PROVIDED AND FILLED IN BY THE SUPERVISOR FROM THE HEALTH FACILITY CASE RECORD SHEET
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
Q75 Line number/ID from the case record sheet: Line No. _____
Q76 Register number from the case record sheet:
Register No. ______________
Q77 Date of treatment at health facility Treatment date: . __ __ / __ __ / __ __ __ __
Q78 Age of the patient
IF THE PATIENT IS A CHILD < 5 YEARS, RECORD THEIR AGE IN MONTHS
Age: .............................................................. Age (months): ...............................................
Q79 Sex of the patient Male ........................................................... 1
Female ....................................................... 2
Q80 Diagnosis Simple malaria ........................................... 1
Severe malaria ........................................... 2
Other .......................................................... 3
Specify: __________________________
Q81 Was the diagnosis confirmed by a blood test?
Yes ............................................................. 1
No ............................................................... 2
Don’t know ................................................. 8
if no skip to Q 84
Q82 What type of test was used to confirm the patient had malaria?
RDT/dipstick ............................................. 1
Blood slide/microscopy ............................. 2
Don’t know ................................................. 8
Q83 What species of malaria did the patient have?
Falciparum ................................................ 2
Vivax ......................................................... 3
Mixed (Pf & Pv) ......................................... 4
Don’t know ................................................. 8
Q84 What drug(s) was the patient treated with? MULTIPLE RESPONSES POSSIBLE CIRCLE ALL MENTIONED
AS-MQ ....................................................... 1
DHA-Pip ..................................................... 2
Chloroquine ................................................ 3
Quinine ....................................................... 4
Artemether ................................................. 5
Infusion ....................................................... 6
Paracetamol ............................................... 7
Antibiotics ................................................... 8
Other .......................................................... 9
Specify: __________________________
Don’t know ............................................... 98
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ANNEX 5. HEALTH FACILITY QUESTIONNAIRE – PART 3 (EXIT INTERVIEW)
Patient Exit Interview Form
USE THIS FORM TO INTERVIEW PATIENTS WHO WERE TREATED FOR FEVER AT THE SELECTED PUBLIC HEALTH FACILITY
Health Facility Cluster: [____|____] (01-38)
Health Facility Name: ______________________
Service Type [______] (1: Public, 2 Private) Date of interview: __ __ / __ __ / __ __ __ __
Health Facility Type: [______]
Referral hospital(Sate/Region/District)…………..1
Township hospital…………………………………..2
Station hospital……………………………………..3
Rural Health center ………………………………..4
Rural health sub center……………………………5
Private specialist hospital………………………….6
Private polyclinic……………………………………7
General practitioner clinic(with beds)…………….8
General practitioner clinic (without beds)………..9
Other Specify:_________________________...10
Facility Code: [____|____] [____]
Cluster Number Service Type
(Example: Cluster Number = 01, Service Type = 1
so Facility Code = 011)
State/Region: ___________________________________
S/R code: ..............................................................
Operational District: __________________________ OD code: ...............................................................
Patient No.: ...........................................................
Interviewer’s name: ________________________ Interviewer’s code: ..............................................
SUPERVISOR FIELD EDITOR OFFICE EDITOR DATA ENTRY
Name: _______________
Code:
Date: _ _ / _ _ / _ _
Name: _______________
Code:
Date: _ _ / _ _ / _ _
Name: _______________
Code:
Date: _ _ / _ _ / _ _
Name: _______________
Code:
Date: _ _ / _ _ / _ _
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Section 1: Demographics of patient with fever
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
Q1 How old is the patient with fever? IF THE PATIENT IS A CHILD < 5 YEARS, RECORD THEIR AGE IN MONTHS
Age (years): ..................................................
Age (months): ...............................................
Q2 What is the sex of the patient? Male............................................................ 1
Female ....................................................... 2
Q4
Q3 Is the patient currently pregnant?
ONLY ASK IF THEY ARE FEMALE, AGED 15-49 YEARS
Yes ............................................................. 1
No ............................................................... 2
Q4 Is the patient visiting the health facility today with a carer?
Yes ............................................................. 1
No ............................................................... 2
Q8
Q5 What is the age of the patient’s carer? Age (years): ..................................................
Q6 What is the sex of the patient’s carer? Male............................................................ 1
Female ....................................................... 2
Q7 What is the relationship of the carer to the patient with fever?
Parents ....................................................... 1
Spouse ....................................................... 2
Offspring ..................................................... 3
Sibling......................................................... 4
Grandparents..............................................5
Other .......................................................... 6
Specify:_______________________________
Q8 Where does the patient currently live? WRITE THE NAMES OF THE STATE/REGION, DISTRICT, TOWSHIP, AND VILLAGE OR WARD. FILL IN CODES LATER TO SAVE TIME.
State/Region:
__________________________________
District:
__________________________________
Township:
__________________________________
Village/Ward: __________________________________
Not sure .................................................... 98
Q9 Is the patient’s current address also their permanent address?
Yes ............................................................. 1
No ............................................................... 2
Myanmar Artemisinin Resistance Containment Baseline Survey 154
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
Q10 How long has the patient been living at their current address?
< 2 weeks ................................................... 1
< 1 month ................................................... 2
1 to < 3 months .......................................... 3
3 to < 6 months ......................................... 4
6 months to < 1 year .................................. 5
≥ 1 year ..................................................... 6
Q11 What is the highest level of education attained by the patient?
Child <5 years, not in school ...................... 0
Never attended school ............................... 1
Primary(including Monastic + read/write) . 2
Secondary .................................................. 3
High school ............................................... 4
University ................................................... 5
Other .......................................................... 6
Specify:_______________________________
Q12 What is the patient’s primary profession or job?
Child, not in school ..................................... 1
Student ....................................................... 2
Farmer ........................................................ 3
Laborer ....................................................... 4
Fisherman .................................................. 5
Merchant/Seller .......................................... 6
Housewife .................................................. 7
Soldier ........................................................ 8
Other .......................................................... 9
Specify: __________________________
Q13 In the past 6 months, did the patient ever go to the forest and sleep there overnight?
Yes ............................................................. 1
No ............................................................... 2
Q16
Q14 When was the patient last in the forest?
Last night .................................................... 1
< 1 week ..................................................... 2
1 to < 2 weeks ............................................ 3
2 to < 4 weeks ............................................ 4
≥ 4 weeks ................................................... 5
Not sure ...................................................... 8
Q15 How many nights did the patient stay in the forest on their last visit?
Nights: ..........................................................
Not sure .................................................... 98
Q16 In the past 6 months, has the patient ever travelled away from home and stayed overnight?
Yes ............................................................. 1
No ............................................................... 2
Q19
Myanmar Artemisinin Resistance Containment Baseline Survey 155
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
Q17 When did the patient last travel away from home?
Last night .................................................... 1
< 1 week ..................................................... 2
1 to < 2 weeks ............................................ 3
2 to < 4 weeks ............................................ 4
≥ 4 weeks ................................................... 5
Not sure ...................................................... 8
Q18 For what reason(s) did the patient last travel away from home? MULTIPLE RESPONSES, CIRCLE ALL MENTIONED
Work in forest ............................................ 1
Work on plantations .................................. 2
Work in Thailand ....................................... 3
Work in other country ................................ 4
Visit relatives ............................................. 5
Other ......................................................... 6
Specify: ___________________________
Don't know ................................................. 8
Q19 Did the patient sleep under a mosquito net last night?
Yes ............................................................. 1
No ............................................................... 2
Not sure ...................................................... 8
Q20 Does the patient’s household own any mosquito nets?
Yes ............................................................. 1
No ............................................................... 2
Not sure ...................................................... 8
Section 2: Details of treatment seeking, symptoms, consultation and diagnosis
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
Q21 When did you/your child’s fever begin? Today ......................................................... 1
Yesterday ................................................... 2
Two days ago ............................................. 3
Three days ago .......................................... 4
> 3 days ago............................................... 5
Don’t remember ......................................... 8
Q22 Did you/your child seek treatment anywhere else before coming here today?
Yes ............................................................. 1
No ............................................................... 2
Don’t remember ......................................... 8
Q25
Q25
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NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
Q23 Where else did you/you child seek treatment?
MULTIPLE RESPONSES, CIRCLE ALL MENTIONED
PROBE: ANYWHERE ELSE?
Referral hospital(Sate/Region/District)……1
Township hospital…………………………...2
Station hospital………………………………3
Rural Health center …………………………4
VMW/ VHV…………………………………...5
Rural health sub center……………………..6
Private specialist hospital…………………..7
Private polyclinic…………………………….8
General practitioner clinic(with beds)……..9
General practitioner clinic (without beds)..10
Private laboratory ..................................... 11
Drug store ................................................ 12
Shop/market ............................................. 13
Traditional practitioner.............................. 14
Other Specify:_________________________...15
Can’t remember ...................................... 98
Q24 Why did you/your child go to that provider/facility/place for treatment? MULTIPLE RESPONSES POSSIBLE, CIRCLE ALL MENTIONED
To seek advice ........................................... 1
To buy/get medication ................................ 2
Because it is close to my house ................. 3
To get a test ............................................... 4
To get traditional treatment ........................ 5
Transport expensive to health facility ......... 6
Other .......................................................... 8
Specify: ___________________________
Q25 Why did you/your child come to (HEALTH FACILITY NAME) today?
Referred from public health facility ............. 1
Referred from private provider ................... 2
Because it is close to my house ................. 3
To get a test ............................................... 4
Symptoms were getting worse ................... 5
To get medication ....................................... 6
Other .......................................................... 7
Specify: ___________________________
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NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
Q26 What signs and symptoms do you/your child have today? MULTIPLE RESPONSES POSSIBLE CIRCLE ALL MENTIONED
PROBE ONCE: ANY OTHER SYMPTOMS?
Unconscious ............................................... 1
Convulsions ................................................ 2
Fast breathing ............................................ 3
Very hot ...................................................... 4
Yellow eye color ......................................... 5
Very pale skin ............................................. 6
Not breastfeeding ....................................... 7
Not eating ................................................... 8
Frequent vomiting ...................................... 9
Diarrhoea ................................................. 10
Coughing .................................................. 11
Other ........................................................ 12
Specify: ___________________________
Don't know ................................................ 98
Q27 By what means did you travel to this health facility today?
Walked ....................................................... 1
Motorcycle .................................................. 2
Car .............................................................. 3
Boat ............................................................ 4
Ambulance ................................................. 5
Taxi ............................................................. 6
Other .......................................................... 7
Specify: ___________________________
Q28 How long did it take you to travel to this health facility today?
Time (minutes): ............................................
Don’t remember--------98
Q29 How much did you pay to travel to this health facility today?
Travel cost (Kyat): ........................................
Don’t remember--------98
Q30 When you/your child arrived at the health facility today, how long did you/your child wait to see the doctor/nurse/basic health staff ?
Time (minutes): ............................................
Don’t remember--------98
Q31 How long did the consultation take, that is how much time did you/your child spend with the doctor/nurse/basic health staff?
Time (minutes): ............................................
Don’t remember--------98
Q32 During the consultation did the doctor/nurse/basic health staff ask about your/your child’s fever and travel history?
Yes No
Fever history .............................. 1 2
Travel history .............................. 1 2
Don’t remember----------98
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NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
Q33 During the consultation did the doctor/nurse/basic health staff take your/your child’s temperature or blood pressure or weight or height? ASK ABOUT EACH AND CIRCLE "YES" (1) IF IT WAS DONE OR "NO" (2) IF IT WASN’T
Yes No
Temperature ............................... 1 2
Blood pressure ........................... 1 2
Weight ........................................ 1 2
Height ......................................... 1 2
Q34 Did the doctor/nurse/basic health staff give you/you child a diagnosis for your/your child’s fever?
Yes ............................................................. 1
No ............................................................... 2
Not sure ...................................................... 8
Q36
Q36
Q35 What diagnosis did the doctor/nurse/basic health staff give you for your/your child’s fever?
Malaria........................................................ 1
Acute respiratory infection.......................... 2
Upper respiratory infection ......................... 3
Cold/Flu ...................................................... 4
Dengue ....................................................... 5
Diarrhoea ................................................... 6
Anaemia (short of blood) ............................ 7
Dehydration ................................................ 8
Malnutrition ................................................. 9
Other ........................................................ 10
Specify:_______________________________
Q36 Did you/your child have a blood test for malaria?
Yes ............................................................. 1
No ............................................................... 2
Q40
Q37 What type of test? RDT/dipstick ............................................... 1
Blood slide/microscopy .............................. 2
Not sure ...................................................... 8
Q38 Do you know the result of the test? Positive ....................................................... 1
Negative ..................................................... 2
Not told result ............................................. 3
Not sure ...................................................... 8
Q40
Q40
Q40
Q39 Do you know what type of malaria you/your child have?
Not told ....................................................... 1
Falciparum ................................................. 2
Vivax........................................................... 3
Mixed (Pf & Pv) .......................................... 4
Section 3: Details of treatment
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
Myanmar Artemisinin Resistance Containment Baseline Survey 159
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
Q40 Did the doctor/nurse/basic health staff give you/your child an infusion today?
Yes ............................................................. 1
No ............................................................... 2
Q41 Did the doctor/nurse/basic health staff prescribe any drugs for you/your child today?
Yes ............................................................. 1
No ............................................................... 2
Q51
Q42 What drugs were prescribed for you/your child today? INCLUDE ALL DRUGS, SUCH AS ANTIMALARIALS, ANTIBIOTICS, PARACETAMOL, ETC. TICK THE CHECKBOX IF THE DRUG IS AN ANTIMALARIAL.
anti-
Code Name malarial?
Drug 1: _________________
Drug 2: _________________
Drug 3: _________________
Drug 4: _________________
Drug 5: _________________
Don’t know the name of drug given------98
Q43 Can you tell me why you/your child were prescribed these drugs today? MULTIPLE RESPONSES POSSIBLE CIRCLE ALL MENTIONED
To treat malaria .......................................... 1
To reduce the fever .................................... 2
To reduce body pain/joint ache .................. 3
To reduce coughing ................................... 4
To make stronger ....................................... 5
Other .......................................................... 6
Specify:_______________________________
Don’t know ................................................. 8
Q44 Were you given any information about the drugs you/your child were prescribed by the doctor/nurse/basic health staff?
Yes (verbally) ............................................. 1
Yes (written) ............................................... 2
Yes (verbally & written) .............................. 3
No ............................................................... 4
Not sure ...................................................... 8
Q45 Can you show me the drugs you/your child were prescribed?
Yes ............................................................. 1
No ............................................................... 2
Q46 (For antimalarials only)Were you told how to take/administer the drug? CHECK Q42 AND MENTION THE DRUGS BY NAME TO THE PATIENT/CARER
Yes ............................................................. 1
No ............................................................... 2
Not sure ...................................................... 8
Q47 How many tablets per dose? FOR ANTIMALARIALS ONLY
No. tablets: ...................................................
Q48 How many times per day? FOR ANTIMALARIALS ONLY
No. times/day: ..............................................
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NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
Q49 How many days? FOR ANTIMALARIALS ONLY
No. days: ......................................................
Q50 What happens if you don’t take antimalarial drugs for the recommended number of days or don't take all of the tablets as prescribed? MULTIPLE RESPONSES POSSIBLE, CIRCLE ALL MENTIONED
Nothing ....................................................... 1
Parasite remains in the body ..................... 2
Patient will continue to transmit malaria ..... 3
Parasite will become resistant ................... 4
Patient gets sick again ............................... 5
Patient does not recover ............................ 6
Other .......................................................... 7
Specify:_______________________________
Don't know .................................................. 8
Q51 Do you know of any antimalarial drugs that should no longer be used to treat malaria?
Yes ............................................................. 1
No ............................................................... 2
Q53
Q52 What are the names of the drugs that should no longer be used to treat malaria? IF < 3, WRITE THE ONES THAT THEY KNOW (FILL IN THE DRUG CODES LATER TO SAVE TIME)
Name Code
Antimalarial 1: _________________ Antimalarial 2: _________________ Antimalarial 3: _________________
Q53 Why do you think you/your child became sick with fever? MULTIPLE RESPONSES POSSIBLE CIRCLE ALL MENTIONED PROBE ONCE: ANY OTHER REASONS?
Got malaria ................................................. 1
Slept in forest ............................................. 2
Slept in plantation ....................................... 3
Family member had fever .......................... 4
Family member had cold ............................ 5
Slept in forest without net ........................... 6
Spirit ........................................................... 7
Got wound .................................................. 9
Other ........................................................ 10
Specify: ______________________________
Don't know ................................................ 98
Q54 Has anyone else in your household been sick with fever in the past two weeks?
Yes ............................................................. 1
No ............................................................... 2
Q55 Were you given any health education about your/your child’s illness by the doctor/nurse/basic health staff?
Yes (verbally) ............................................. 1
Yes (written) ............................................... 2
Yes (verbally & written) .............................. 3
No ............................................................... 4
Not sure ...................................................... 8
Q56 How much did you pay for your/your child’s treatment today?
Cost of treatment (Kyat): ..............................
Not Sure ................................................... 98
Myanmar Artemisinin Resistance Containment Baseline Survey 161
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
Q57 Were you satisfied with the treatment you received at the health facility today?
Yes ............................................................. 1
No ............................................................... 2
Q58 What sort of improvements would you like to see at this health facility? MULTIPLE RESPONSES POSSIBLE CIRCLE ALL MENTIONED
PROBE ONCE: ANYTHING ELSE?
None, no improvements needed ................ 0
Reduce waiting times ................................. 1
Reduce/eliminate user fees ....................... 2
More explanation about illness .................. 3
Better staff attitude toward patients ........... 4
More time with health worker ..................... 5
More detailed exam by health worker ........ 6
Availability of the prescribed drugs ............ 7
Better quality drugs .................................... 8
Longer opening hours ................................ 9
Cleaner facility or nicer building ............... 10
Other ........................................................ 11
Specify: ______________________________
Don't know ................................................ 98
END INTERVIEW
Thank respondent for taking the time to be interviewed.