A systematic review of neglected tropical diseases (NTDs) in Myanmar

Abstract

Background: Neglected tropical diseases (NTDs) affect most impoverished communities in developing countries, like Myanmar in Southeast Asia. NTDs have been understudied and underreported in Myanmar.

Methods: A systematic review of published and grey literature (1900-2023) on neglected tropical diseases (NTDs) in Myanmar was conducted. The literature search included five international databases: PubMed, EMBASE, Ovid Global Health, and Web of Science Core Collection and one national database: the Myanmar Central Biomedical Library (locally published papers and grey literature). The selection criteria included articles with all types of study designs of current or previous infections conducted in humans, that reported NTDs, recognised by WHO, US CDC, and listed in PLoS NTDs. We included melioidosis and rickettsioses which we consider also meet the definition of an NTD.

Results: A total of 5941 records were retrieved and screened, of which, 672 (11%) met the selection criteria and were included in this review. Of the included articles, 449 (65%) were published after 2000 and 369 (55%) were from two regions (Yangon and Mandalay) of Myanmar. Of the included articles, 238 (35%) reported bacterial NTDs, 212 (32%) viral NTDs, 153 (23%) helminth NTDs, 25 (4%) protozoal NTDs and 39 (6%) reported more than one aetiology. Based on reported frequency in descending order, the bacterial NTDs were leprosy, Escherichia coli enteritis, salmonellosis, cholera, shigellosis, melioidosis, leptospirosis and rickettsioses; the viral NTDs were dengue, chikungunya and Japanese encephalitis virus (JEV) infection; the protozoal NTDs were amoebiasis, giardiasis and leishmaniasis, and the helminth NTDs were ascariasis, trichuriasis, hookworm disease, filariasis and strongyloidiasis.

Conclusion: This review summarises NTDs reported in Myanmar over the past 100 years. The findings suggest that most NTDs are likely to be under reported, especially from the majority of the country which is far from academic centres. Research capacity building together with strengthening of laboratory systems would lead to better understanding of the true burden of NTDs in Myanmar.

Trial registration: PROSPERO registration ID: CRD42018092627.

Fig 1. PRISMA flow diagram showing process of article selection.

Fig 2. Waffle plots showing distribution of participant age, study design and study setting of included articles.

Fig 3. Circular bar plot showing distribution of articles reporting NTDs by aetiology.

Four articles that reported deep fungal infection (mycoses) and one article reporting ectoparasitic infection (myiasis) are not shown in the figure for clarity. STH = soil transmitted helminth infections.

Fig 4. Lollipop plots showing number of articles reporting NTDs stratified by aetiology in children, adolescents and adults.

Fig 5. Lollipop plots showing number of articles reporting NTDs stratified by aetiology in both age group and non-specified age group.

Fig 6

Maps showing location of reported NTDs in the included articles: bacterial NTDs (A) and viral NTDs (B). The number inside each region represents number of pathogens reported in the articles and the colour represents percentage of total articles of corresponding aetiology. Maps were created using ArcGIS version 10.4.1 and the base layer of the map was produced using Geotag (https://geotag.sourceforge.net/).

Fig 7

Maps showing location of reported NTDs in the included articles: protozoal NTDs (A) and helminthiasis (B). The number inside each region represents number of pathogens reported in the articles and the colour represents percentage of total articles of corresponding aetiology. Maps were created using ArcGIS version 10.4.1 and the base layer of the map was produced using Geotag (https://geotag.sourceforge.net/).