RATIONALE:Induction of labour (IoL) aims to initiate labour when the risks of continuing pregnancy outweigh the benefits. Over 10 methods are currently available, yet the most effective and safest method remains unclear. OBJECTIVES:To compare the benefits and harms of various cervical ripening and IoL methods at or beyond term labour and to rank the methods. SEARCH METHODS:We searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, and the WHO ICTRP until 1 February 2023. ELIGIBILITY CRITERIA:We included randomised controlled trials (RCTs) evaluating IoL methods among women with a live fetus at or beyond term labour (gestational age ≥ 37 weeks). We focused on the methods currently recommended by international guidelines and those proposed by previous Cochrane reviews. OUTCOMES:Our critical outcomes included failure to achieve vaginal delivery within 24 hours, caesarean section due to any causes, caesarean section due to non-reassuring fetal status, uterine hyperstimulation with changes in the heartbeat of the baby before birth, perinatal death, and severe neonatal morbidity. RISK OF BIAS:We assessed bias and trustworthiness using the Cochrane RoB 1 tool and the Cochrane Pregnancy and Childbirth Trustworthiness Tool (CPS-TST), respectively. The final analyses only included trials that met the CPS-TST. SYNTHESIS METHODS:We performed pair-wise meta-analyses using a random-effects model and network meta-analyses (NMA) with a frequentist approach. We reported analyses and results separately for two populations: 1) women without a previous caesarean section and a mix of women with or without a previous caesarean section (where more than 50% of participants had no previous caesarean section), and 2) women with a previous caesarean section. We used risk ratio (RR) and mean difference (MD) to present treatment effects with 95% confidence intervals (CIs). We assessed the certainty of evidence for critical outcomes using the GRADE approach for NMA. We used the surface under the cumulative ranking curve (SUCRA) to estimate treatment ranking. INCLUDED STUDIES:The analysis included 106 RCTs assessing 13 IoL methods among 30,348 women. Most trials (84.9%) were conducted in inpatient settings. Only two RCTs recruited women with previous caesarean section, and seven RCTs recruited a mix of women with or without a previous caesarean section. SYNTHESIS OF RESULTS:We evaluated the effects of the following IoL methods: vaginal misoprostol (≤ 50 μg), oral misoprostol (≤ 50 μg), sublingual or buccal misoprostol (≤ 50 μg), controlled-release misoprostol vaginal pessary, vaginal dinoprostone (tablet or gel), controlled-release dinoprostone vaginal pessary, oxytocin (alone), nitric oxide donors, balloon catheters, osmotic cervical dilators, oxytocin plus amniotomy (Oxytocin+Amniotomy), balloon catheters plus oxytocin (Balloon+Oxytocin), balloon catheters plus vaginal/oral misoprostol (≤ 50 μg) (Balloon+Misoprostol ≤ 50 μg), and inactive methods (placebo, no intervention, and expectant management). The following results show the relative effects of NMA for four of the six critical outcomes among women without previous caesarean section and a mix of women with or without previous caesarean section. The findings of women with previous caesarean section are not presented here due to limited evidence. We used vaginal misoprostol (≤ 50 μg) as the reference method for presenting results, where data for this method were available in the network. 1) Failure to achieve vaginal delivery within 24 hours There was no clear evidence that any of the methods were more effective than vaginal misoprostol (≤ 50 μg) in reducing the risk of this outcome. Oxytocin+Amniotomy (RR 0.41, 95% CI 0.14 to 1.24, 22.4% fewer, moderate-certainty evidence), Balloon+Misoprostol ≤ 50 μg (RR 0.85, 95% CI 0.60 to 1.19, 5.7% fewer, high-certainty evidence), and Balloon+Oxytocin (RR 0.94, 95% CI 0.71 to 1.26, 2.3% fewer, low-certainty evidence) likely resulted in little to no difference in this outcome compared with vaginal misoprostol (≤ 50 μg). Despite the comparable relative treatment effects between some methods and vaginal misoprostol (≤ 50 μg), these three methods ranked highest. 2) Caesarean section due to non-reassuring fetal status There was no clear evidence that any of the methods were more effective than vaginal misoprostol (≤ 50 μg) in reducing the risk of this outcome. Balloon+Oxytocin (RR 0.77, 95% CI 0.47 to 1.25, 2.0% fewer, moderate-certainty evidence), controlled-release dinoprostone vaginal pessary (RR 0.86, 0.62 to 1.18, 1.2% fewer, low-certainty evidence), and balloon catheters (RR 0.88, 95% CI 0.70 to 1.11, 1.0% fewer, low-certainty evidence) may result in little to no difference in this outcome when compared with vaginal misoprostol (≤ 50 μg). Despite the comparable relative treatment effects between all methods and vaginal misoprostol (≤ 50 μg), these three methods ranked highest. 3) Uterine hyperstimulation with changes in the heartbeat of the baby before birth Nitric oxide donors (RR 0.05, 95% CI 0.01 to 0.47, 3.9% fewer, moderate-certainty evidence), osmotic cervical dilators (RR 0.07, 95% CI 0.01 to 0.42, 3.8% fewer, moderate-certainty evidence), balloon catheters (RR 0.38, 95% CI 0.21 to 0.69, 2.5% fewer, moderate-certainty evidence), and oral misoprostol (≤ 50 μg) (RR 0.62, 95% CI 0.39 to 0.99, 1.6% fewer, moderate-certainty evidence) probably reduce this outcome compared with vaginal misoprostol (≤ 50 μg). When compared with inactive interventions (placebo, no intervention, or expectant management), vaginal misoprostol (≤ 50 μg) (RR 3.47, 95% CI 1.16 to 10.35) probably increases the risk of this outcome. The three highest-ranked methods were nitric oxide donors, osmotic cervical dilators, and inactive methods (placebo, no intervention, and expectant management). 4) Perinatal death There was no clear evidence for this outcome, as it was rare (10 cases reported across trials). AUTHORS' CONCLUSIONS:For women without previous caesarean section and a mix of women with or without previous caesarean section, there was no clear evidence that any of the IoL methods were more effective than vaginal misoprostol (≤ 50 μg) for the outcomes of failure to achieve vaginal delivery within 24 hours, caesarean section due to non-reassuring fetal status, and perinatal death. Nitric oxide donors, osmotic cervical dilators, balloon catheters, and oral misoprostol (≤ 50 μg) probably reduce the risk of uterine hyperstimulation with changes in the heartbeat of the baby before birth. FUNDING:This review had no dedicated funding. REGISTRATION:Protocol (2023): https://doi.org/10.1002/14651858.CD015234.

Introduction Malaria remains a major public health challenge in rural Myanmar, where culturally appropriate community-based health promotion strategies are needed to improve malaria knowledge and preventive practices. This study evaluated a monastery-based health education program led by Buddhist monks in northern Myanmar. Methods A quasi-experimental design was used, with one village assigned to the intervention group and another to the control group. Between July and September 2022, the intervention group participated in six monastery-based education sessions, while both groups continued routine malaria control activities. Surveys were conducted at baseline and at three- and six-month post-intervention using structured questionnaires. Data were analyzed using descriptive statistics, chi-squared tests, and generalized estimating equations (GEE) models. Results Baseline demographic characteristics and outcome scores were comparable between groups (p > 0.05). At three and six months, the intervention group showed significant improvements in malaria knowledge (3 months: β = 4.32, 95% CI: 2.72–5.92, p < 0.001; 6 months: β = 2.09, 95% CI: 0.29–3.88, p = 0.023) and preventive practices (3 months: β = 6.47, 95% CI: 5.15–7.78, p < 0.001; 6 months: β = 4.88, 95% CI: 3.38–6.38, p < 0.001) compared with controls. Previous malaria experience was positively associated with preventive practices (β = 0.73, 95% CI: 0.12–1.34, p = 0.019). Conclusions Monastery-based education represents a culturally grounded, participatory approach that was associated with improved malaria knowledge and self-reported preventive practices. This approach may complement community-based malaria control in resource-limited settings where monasteries serve as trusted community institutions.

Vector control has played a pivotal role in malaria control and elimination efforts, with insecticide-treated nets (ITNs) recognized as one of the most effective and widely accepted strategies. This study assessed ITN use and identified factors associated with non-use among individuals with access to ITNs in Myanmar. Data were drawn from the nationally representative 2015–2016 Myanmar Demographic and Health Survey. Access to ITNs was defined as having at least one ITN per two household members, and ITN use as having slept under an ITN the night before the survey. Descriptive statistics and multivariable logistic regression models were conducted using the “svyset” command in STATA to account for the two-stage stratified cluster sampling design. Among 6,140 individuals with access to ITNs, approximately one-third (31.6

Objectives This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effectiveness and adverse effects of imiquimod in the treatment of women with cervical intraepithelial neoplasia.

Objectives This study aims to assess inequalities in skilled birth attendance and utilisation of caesarean section (CS) in Myanmar.Study design Cross-sectional study design.Setting and population We used secondary data from the Myanmar Demographic and Health Survey (2015–2016). Our outcome measures of skilled birth attendance and utilisation of CS were taken from the most recent birth of interviewed women. Absolute and relative inequalities across several sociodemographic characteristics were assessed and evaluated by calculating rate differences, rate ratio and concentration indexes.Results More than one-third (36%, 95% CI 32.5% to 39.4%) of women gave birth without a skilled birth attendant present at their most recent birth. 40.7% (95% CI 37.8% to 43.7%) gave birth in healthcare facilities, and the CS rate was 19.7% (95% CI 17.9% to 21.8%) for their most recent birth. The highest proportion of birth without a skilled provider was found in the hilly regions and rural residents, poorest and less educated women, and those with less than four antenatal care visits. Inequalities in birth without a skilled provider were observed across regions, place of residence, wealth quintile, education level and number of antenatal care taken. The highest rate of CS was found among plain regions and urban residents, richest women, more than secondary education, those with more than four antenatal care visits and in private health facilities. Inequalities in CS utilisation were observed across place of residence, wealth quintiles, education level, number of antenatal care taken and type of health facilities.Conclusion This study provides evidence regarding inequalities in maternal health service utilisation in Myanmar. Increasing maternal health service availability and accessibility, promoting quality of care and health education campaigns to increase maternal health services utilisation are recommended.

Abstract Background Malaria poses a substantial public health threat in Myanmar, indicating the need for rigorous efforts to achieve elimination of the disease nationwide by 2030. The use of insecticide-treated nets (ITNs) forms part of a pivotal strategy for preventing transmission. This study explored the ownership and use of ITNs in Myanmar and identified factors associated with non-use of ITNs. Methods Household datasets from the 2015–2016 Myanmar Demographic and Health Survey were utilised, which encompassed all household members except children under the age of five. Descriptive statistics and inferential tests, including simple and multiple logistics regression models and Pearson correlations, were employed for analysis. All analyses, taking the two-stage stratified cluster sampling design into account, used weighting factors and the “svyset” command in STATA. The ownership and use of bed nets were also visualised in QGIS maps. Results Among the 46,507 participants, 22.3% (95% CI 20.0%, 24.5%) had access to ITNs, with only 15.3% (95% CI 13.7, 17.1%) sleeping under an ITN the night before the survey. Factors associated with the non-use of ITNs included age category (15–34 years—aOR: 1.17, 95% CI 1.01, 1.30; 50+ years—aOR: 1.19, 95% CI 1.06, 1.33), location (delta or lowland—aOR: 5.39, 95% CI 3.94, 7.38; hills—aOR: 1.80, 95% CI 1.20, 2.71; plains—aOR: 3.89, 95% CI 2.51, 6.03), urban residency (aOR: 1.63, 95% CI 1.22, 2.17), and wealth quintile (third—aOR: 1.38, 95% CI 1.08, 1.75; fourth—aOR: 1.65, 95% CI 1.23, 2.23; fifth—aOR: 1.47, 95% CI 1.02, 2.13). A coherent distribution of the ownership and use of ITNs was seen across all states/regions, and a strong correlation existed between the ownership and use of ITNs (r: 0.9795, 95% CI 0.9377, 0.9933, alpha < 0.001). Conclusions This study identified relatively low percentages of ITN ownership and use, indicating the need to increase the distribution of ITNs to achieve the target of at least one ITN per every two people. Strengthening the use of ITNs requires targeted health promotion interventions, especially among relatively affluent individuals residing in delta or lowland areas, hills, and plains.

Diagnosis of encephalitis is a challenging problem due to the heterogeneity of clinical presentations and the myriad of aetiology. The objective was to determine the aetiology, clinical features, laboratory parameters, radiological findings and in-hospital outcome of acute encephalitis syndrome (AES) cases in Myanmar. Methods: A prospective analytic study was conducted at Neuromedical Ward of Yangon General Hospital during March to August 2023. 81 AES cases were enrolled and cerebrospinal fluids (CSF) samples were collected. Qiastat ME Panelwas used to detect viral, bacterial and fungal pathogens. Results: 17 out of 81 (21%) cases were non-encephalitis with alternative definite diagnosis. Among the remaining 64 encephalitis cases, the exact infectious and immune aetiologies were identified in 31/64 (48.4%); 26/31 cases (83.9%) were infectious causes and 5/31 patients (16.1%) were immune encephalitis. Among the infection causes, six Herpes Simplex Virus-1, one bacteriologically confirmed and seven probable Mycobacterium tuberculosis, three Haemophilus influenzae, two Streptococcus pneumoniae, one Streptococcus pyogenes, one Varicella-Zoster Virus (Ramsay Hunt Syndrome with meningoencephalitis), two Cryptococcus neoformans infected patients and rare causes such as Listeria monocytogenes, Burkholdelria cepacia, Sphingomonas paucimobilis and Aspergillus were identified. One case was dual infection with Haemophilus influenzae and Cryptococcus neformans. Abnormal protein levels and CSF pleocytosis were significantly higher among bacterial causes (P<0.05). 6.45% (2/31) of encephalitis patients with identified causes and 12.12% (4/33) of those without organism identified had bad outcome. Conclusions: Herpes encephalitis and tuberculous meningoencepalitis were the commonest. This study highlighted that molecular testing with multidisciplinary approach is required to ensure the right treatment on time.

The effect of caesarean section (CS) on breastfeeding initiation has been extensively studied, but its influence on exclusive breastfeeding practices remains inconclusive. Therefore, this study aims to investigate the impact of CS on exclusive breastfeeding using evidence from four countries in the Southeast Asian region. This cross-sectional study used secondary data obtained from the Demographic and Health Surveys (DHS) conducted between 2016 and 2022 in four countries within the Southeast Asian Region. We included information on the youngest children aged 0–5 months living with their mothers within the DHS datasets. The association between CS and exclusive breastfeeding was determined using a simple and multiple logistic regression models. Weight factors were taken into account in all analyses for the two-stage stratified cluster sampling design. Among 3420 children, nearly half (49.1

Background/Objectives: The diagnosis of encephalitis is a challenging problem due to the heterogeneity of clinical presentations. The objective was to determine the etiology, clinical features, laboratory parameters, radiological findings, and in-hospital outcome of acute encephalitis syndrome (AES) cases in Myanmar. Methods: A prospective descriptive study was conducted at the Neuromedical Ward of Yangon General Hospital from March to August 2023. Eighty-one AES cases were enrolled, and cerebrospinal fluid (CSF) samples were collected. A Qiastat ME Panel was used to detect viral, bacterial, and fungal pathogens. Results: Seventeen out of eighty-one (21%) cases were non-encephalitis with alternative definite diagnosis. Among the remaining 64 encephalitis cases, the exact infectious and immune etiologies were identified in 31 of 64 cases (48.4%); 26 of these (83.9%) were due to infectious causes and 5 (16.1%) were immune encephalitis. Among the infectious causes, six Herpes Simplex Virus-1-, one bacteriologically confirmed and seven probable Mycobacterium tuberculosis-, three Haemophilus influenzae-, two Streptococcus pneumoniae-, one Streptococcus pyogenes-, one Varicella-Zoster Virus (Ramsay Hunt Syndrome with meningoencephalitis)-, and two Cryptococcus neoformans-infected patients and rare causes such as Listeria monocytogenes, Burkholdelria cepacia, Sphingomonas paucimobilis, and Aspergillus were identified. One case was a dual infection with Haemophilus influenzae and Cryptococcus neformans. Abnormal protein levels and CSF pleocytosis were significantly higher among bacterial causes (p < 0.05). In total, 6.45% (2/31) of encephalitis patients with identified causes and 12.12% (4/33) of those without an identified organism had poor outcome. Conclusions: Herpes encephalitis and tuberculous meningoencepalitis were the commonest. This study highlighted that molecular testing with a multidisciplinary approach is required to ensure the right treatment on time.

Background Adolescent pregnancy is a global public health problem. Numerous approaches for Comprehensive Sexuality Education (CSE) delivery in schools have been implemented around the world. Previous reviews on CSE did not follow the International Technical Guidance on Sexuality Education (ITGSE) because CSE is very diverse in terms of population, interventions, settings and outcomes. We conducted this scoping review to identify and map the evidence of school-based CSE for prevention of adolescent pregnancy with emphasis on adolescents’ contraceptive use, unintended pregnancy and abortion. Methods We searched PubMed, CENTRAL, Scopus, ISI Web of Science, CINAHL, and WHO ICTRP to identify potential eligible studies from their inception to 4 th Nov 2023.We included randomized controlled trials (RCTs) and non-RCTs of CSE implemented in public or private schools for adolescents. CSE was defined as a multi-session intervention in school that covered topics including contraception, pregnancy, abortion, and HIV/STI. School-based interventions were the main intervention that may be either stand-alone or multicomponent. There was no limitation on study’s geographical area, but only English-language studies were considered. Two reviewers selected and extracted data independently, discussed for consensus or consulted the third reviewer if there were discrepancies for final conclusion. Data were presented using figures, map and table. Results Out of 5897 records, 79 studies (101 reports) were included in this review. Most studies were conducted in the United States and other high-income countries in secondary or high schools with cluster RCTs. All studies included participatory methods. Almost all studies included Sexual and Reproductive Health which is the eighth concept of CSE. Very few studies reported the prespecified primary outcomes of contraceptive use during last sex, unintended pregnancy and abortion and hence this highlighted the gaps of available evidence for these outcomes. The number of concepts, components, duration and providers of CSE varied across the included studies. However, none of the interventions identified in this scoping review adhered to the ITGSE recommended approach. Conclusions Our scoping review shows gaps in school-based CSE implementation in terms of completeness of concepts, components, providers, duration and outcomes recommended by ITGSE.

Background Access and use of early postnatal care (PNC) by skilled providers are crucial for reducing maternal and newborn deaths. However, use of PNC among the deliveries by skilled providers in some developing countries remains unsatisfactory. Furthermore, literature concerning PNC among home deliveries remains limited, particularly in resource-limited countries such as Myanmar. This study aimed to estimate the prevalence of having early PNC contact by skilled providers and its determinants among home deliveries in Myanmar. Methods This cross-sectional study used secondary data from the Myanmar Demographic and Health Survey 2015–16. We included information on all home deliveries in the interviewed mothers aged 15–49 years in the 2 years preceding the survey. Early PNC attendance and its determinants were assessed (using modified Poisson regression with robust variance estimates). All analyses were performed using STATA, Version 15. A p-value <0.05 was considered statistically significant. Results Of a total of 2,129 home deliveries, 36.1% (95%CI: 32.4%, 39.9%) did not receive PNC from any providers. Among all home deliveries included in this study, 468 (22.0%, 95%CI: 19.1%, 25.1%) received early postnatal checkup within 24 hours by skilled providers (doctors/nurses/midwives/Lady Health Visitors). Factors associated with early PNC contact among home deliveries by skilled providers included possessing higher education (adjusted Prevalence Ratio (aPR: 1.40, 95%CI: 1.01, 1.94), resident from coastal regions (aPR:1.37, 95%CI: 1.04, 1.80), currently married (aPR: 1.87, 95%CI: 1.01, 3.49), attaining antenatal care (ANC) at least four times (aPR:1.47, 95%CI: 1.22, 1.77), giving birth by a skilled birth attendant (aPR:8.80, 95%CI: 6.67, 11.61), and having access to mass media at least once weekly (aPR:1.23, 95%CI: 1.03, 1.46). Conclusion A high percentage of home deliveries (78%) were not receiving early PNC by skilled providers. To facilitate early and safe PNC, expanding the coverage of skilled birth attendants and promoting the utilization of ANC should be strengthened. Targeted health education should be delivered through mass media especially for those with low education levels residing in delta, lowland, hills and plains.

Recent years have demonstrated an increase in caesarean section (CS) in most countries worldwide with considerable concern for the potential consequences. In 2015, WHO proposed the use of Robson classification as a global standard for assessing, monitoring and comparing CS rates. Currently, there is no standardized method to assess CS in Myanmar. The aim of this study was to explore health provider’s perceptions about the feasibility, acceptability and readiness to implement the Robson classification in public hospitals across Myanmar. Ten maternities were purposively chosen, including all five teaching hospitals (tertiary referral hospital-level) affiliated to each medical university in Myanmar, which provide maternal and newborn care services, and district/township hospitals. Face-to-face in-depth interviews (IDI) with healthcare providers and facility administrators were conducted using semi-structured discussion guides. Facility and medical records systems were also assessed. We used the thematic analysis approach and Atlas.ti qualitative analysis software. A total of 67 IDIs were conducted. Most participants had willingness to implement Robson classification if there were sufficient human resources and training. Limited human resources, heavy workloads, and infrastructure resources were the major challenges described that may hinder implementation. The focal person for data entry, analysis, or reporting could be differed according to the level of facility, availability of human resources, and ability to understand medical terms and statistics. The respondents mentioned the important role of policy enforcement for the sustainability of data collection, interpretation and feedback. The optimal review interval period could therefore differ according to the availability of responsible persons, and the number of births. However, setting a fixed schedule according to the specific hospital for continuous monitoring of CS rate is required. In Myanmar, implementation of Robson classification is feasible while key barriers mainly related to human resource and training must be addressed to sustain.

INTRODUCTION:Myanmar has been identified as one of the tuberculosis (TB) high-burden countries and having an understanding of TB transmission is vital for personal infection prevention as well as preventing transmission to others. This study aimed to identify the determinants of correct knowledge on TB transmission and self-reported TB prevalence among general population in Myanmar. METHODS:This is a cross-sectional study using secondary data from Myanmar demographic and health survey 2015-16. The determinants of correct knowledge on TB transmission mode and self-reported prevalence of TB were assessed using multivariable logistic regression models. Weighted estimates were provided in all analyses to account for the multistage sampling design used in the survey. RESULTS:Among the respondents, less than half (44.6%, 95% CI: 43.9, 45.4) had the overall correct knowledge about TB transmission and misconceptions. Older age group, female gender, those with higher education and higher socioeconomic status, and exposed to mass media at least once a week, residents from the delta and lowland region or plain areas were more likely to have correct knowledge about TB transmission. The overall prevalence rate of self-reported TB was 2.6% (95%CI: 2.4, 2.9) and the prevalence was higher among older age group and males. CONCLUSION:Our study highlights the need for targeted efforts to improve awareness and understanding of TB transmission among general population in Myanmar. The study suggests the implementation of appropriate, innovative, and comprehensive targeted TB education and communication strategies.

Background Due to the effectiveness of insecticide-treated nets (ITNs), most malaria-endemic countries resort to free distributions in the population with particular attention to pregnant women, a more vulnerable group. However, the mere issuance of ITNs does not usually translate to proper utilization. This study aimed to examine the utilization of ITNs and its associated factors among pregnant women in Myanmar. Methods The data analyzed in this cross-sectional study were extracted from available survey datasets of the 2015–16 Myanmar Demographic Health Survey. The secondary data were presented using a chart, descriptive statistics and inferential statistics including simple and multiple logistic regression models. All analyses were performed using STATA, Version 15. A p-value <0.05 was considered statistically significant. Results Of 466 currently pregnant women, the majority (96%) possessed bed nets for sleeping. Among them, 15.9% slept without a bed net the night before the survey, while 65.7% slept with untreated nets. Only about 1 in 5 (18.4%) slept under ITNs. In the multivariate logistic regression analysis, pregnant women residing in delta and lowland regions [adjusted odds ratio (aOR) = 7.70, 95% confidence interval (CI): 3.62, 16.38], plains (aOR = 7.09, 95%CI: 3.09, 16.25) or hilly areas (aOR = 4.26, 95%CI: 1.91, 9.52) were more likely to report non-utilization of ITNs than those residing in coastal regions. Conclusion Relatively poor ITN utilization was observed among pregnant women in Myanmar. Health promotion activities for ITN utilization should be implemented especially for pregnant women residing in the delta, lowland, plain and hilly regions. Other social-behavioral factors including perceived susceptibility to malaria, knowledge of ITNs, and attitude towards ITN that might favor the non-utilization of ITNs need to be further explored.

BACKGROUND:Labour pain has been identified as an important reason for women to prefer caesarean section (CS). Fentanyl is one of the short acting opioids recommended by World Health Organization for pain relief during labour. This study aimed to identify and describe the available evidence on the use of fentanyl (monotherapy) for labour pain management by any routes of administration or regime. METHODS:We included the records published until 31 December 2021 which reported administration of fentanyl to women with normal labour for labour pain relief. Data were extracted by one reviewer and checked by another reviewer using a standardised agreement form. We mapped and presented data descriptively in figure and tabular format. RESULTS:We included 51 records from 49 studies in our scoping review. The studies were conducted in 12 countries, mostly high-income countries. The study designs of the 51 included records were varied as follows: 38 (74.5%) experimental studies (35 randomised controlled trials and three quasi-experimental studies), and 12 (23.5%) observational studies (five retrospective cohort studies, four prospective cohort studies, two retrospective descriptive studies, and one descriptive study) and one qualitative study. Of the included records, six used intranasal fentanyl, five used subcutaneous fentanyl, 18 (35.3%) used intravenous fentanyl, 18 (35.3%) used intrathecal fentanyl, and nine used epidural fentanyl. Many records compared fentanyl with another analgesic agent while five records (9.8%) had no comparison group and seven records (13.7%) compared with no analgesia group. The doses of fentanyl varied by routes, study and the requirement depended on the women. Pain assessment was the most frequent outcome measure presented in the records (78.4%). Only nine records (17.6%) investigated women's satisfaction about labour pain relief using fentanyl and seven records (13.7%) reported the effect of fentanyl on breastfeeding. The most common reported neonatal outcomes were foetal heart rate (33 records, 64.7%) and Apgar score (32 records, 62.7%). CONCLUSION:There is limited primary evidence especially randomised controlled trials to evaluate the effectiveness and harms of different routes of fentanyl in low- or middle-income countries. There is a need for high-quality research to establish the most effective route of fentanyl and associated effects for evidence-based international guidelines.

SETTING: Nobel Medical College and Teaching Hospital, Biratnagar, Nepal. OBJECTIVE: To determine the pattern of antimicrobial resistance and hospital exit outcomes in neonates with suspected sepsis in a tertiary neonatal intensive care unit (NICU). DESIGN: This hospital-based cohort study was conducted to follow patients from January to December 2019. All identified cases of suspected sepsis were enlisted from hospital records. RESULTS: Sepsis was suspected in 177 (88%) of the 200 cases admitted in the NICU; 52 (29%) were culture-positive. Pseudomonas was the predominant organism isolated ( n = 40; 78%), followed by coagulase negative staphylococcus ( n = 12, 23%). Nine (17%) of the 52 isolates were resistant to the Access and Watch group of antibiotics, including some resistance to Reserve group drugs such as imipenem and linezolid. Most treated cases ( n = 170, 96%) improved, although 7 (4%) left against medical advice. CONCLUSION: Most of the pathogens were resistant to WHO Access and Watch antibiotics and occasional resistance was observed to Reserve group drugs. Most sepsis was caused by Gram-negative bacilli. Improving turnaround times for antibiotic sensitivity testing using point-of-care testing, and a greater yield of culture-positive results are needed to enhance the management of neonatal sepsis.

Ethical oversight of the Institutional Review Boards (IRB) could facilitate the beneficial impact on the conduct of implementation research in rural settings during the public health emergency of international concern (PHEIC).There is a knowledge gap in the application of implementation research ethics to uphold the impact on the planning of community surveys during the COVID-19 outbreak in remote rural settings.This study aimed to underscore the implementation research ethics principles incorporated in the IRB review practice at the Department of Medical Research, Myanmar by examining the records of three implementation research proposals submitted between April to October 2020.These records targeted the self-help groups, malaria volunteers, and nutrition-support groups who will introduce the innovative interventions in the remote rural areas, malaria-afflicted communities and the households of women with young children in their first 1,000-days respectively.Given that social, economic, and local administrative issues contribute for the acceptability, adoption, and effectiveness of interventions, the IRB has seriously considered the strategic plan for community engagement at vulnerable sites during PHEIC in addition to the contextual equipoise.It is also imperative to introduce the protective measures to mitigate the transmission among the research team members and the target audience in the COVID-19 period.Safe data collection modes without any interpersonal contact are desirable.The improved awareness of implementation research ethics principles and the applications is crucial for further capacity strengthening of IRBs as next steps to fit their reviews with PHEIC in a resource-constrained environment

In response to a global public health emergency, it is critical to focus ethical considerations in public health and socio-behavioral research proposals concerning COVID-19 containment. A desk-based review during October 2020 analyzed two mixed methods studies and three quantitative observational studies submitted to the Institutional Review Board (IRB) of which one study emphasized the Case Report Forms (CRFs) and the rest were online surveys. Main tools intended for primary data collection in the submitted research proposals covered the google forms, Facebook messenger, and mobile phones to access the general public, healthcare providers, and civil society organizations. The waiver of the documented ‘Informed Consent' to decide for filling the online google forms, intensive pretesting and data collector training for interviews via digital platforms, and data security issues were priority ethical concerns addressed during the IRB appraisal in addition to preserve anonymity in retrieving and reporting the findings in CRF. The virtual dissemination plan is acceptable during the pandemic. A regional networking scheme of IRBs could foster ways to deal with ethical dilemmas during the public health emergency especially when using the internet and other digital platforms for data collection.