Ma Hnin, 26, lives in South Dagon township, a suburb to the northeast of Yangon, Myanmar's commercial capital. Ma Hnin’s family moved to South Dagon six years ago from a village further east. “It is easier to earn money in Yangon. That’s why my family moved here,” she says. Ma Hnin lives together with her parents, husband and two children - a three-year-old daughter and three-month-old son. Her husband and father both work for a local saw mill. Just over three years ago, when she was pregnant with her first child, Ma Hnin found out that she was hepatitis B positive.
South Dagon was created in 1989 as one of a handful of satellite towns to receive low-income communities who were moved out of urban slums in central Yangon. Over the years, the township’s population has swelled with migrants from other parts of Myanmar, drawn by the hope of work in the city and the nearby industrial zones. However, permanent work is scarce, and many residents of South Dagon can only find casual labor doing dangerous and difficult jobs. Poverty is widespread and many families fall prey to loan sharks and end up in severe debt.
In 2018, Community Partners International (CPI) launched a five-year research project in South Dagon and nearby Dagon Seikkan township, in partnership with the B. K. Kee Foundation and the Myanmar Liver Foundation, to develop a model for the prevention of mother-to-child transmission (MTCT) of the hepatitis B virus (HBV) in low-income, peri-urban communities. An estimated 3.5 million people in Myanmar are living with HBV. The virus is sometimes referred to as the 'silent killer' as many people are unaware that they are infected. Those who remain untested and untreated face a significantly higher risk of contracting liver disease, including cirrhosis and liver cancer.
In Myanmar (as in the rest of Southeast Asia), HBV is most commonly transmitted from mothers to children during childbirth. In up to 95% of cases, mother-to-child transmission can be prevented by testing mothers during pregnancy, treating those who test positive for HBV with antiviral medication, and ensuring that newborns receive the birth dose HBV vaccine within 24 hours of birth. However, for low-income communities in Myanmar, the lack of access to health education, testing and treatment for HBV significantly increases the risk of mother-to-child transmission.
As part of this research project, CPI is recruiting 110 HBV positive women in early pregnancy, reached through hospital-based screening, community-based pregnancy surveillance, and community-based HBV education sessions. These women will be enrolled on an antiviral treatment program, and the study will develop an outreach strategy to ensure that at least 90% of newborns born to this HBV positive group receive the HBV vaccine within 24 hours of birth.
Ma Hnin found out that she was HBV positive when she came to the clinic run by the B. K. Kee Foundation in South Dagon for a prenatal check-up. The clinic staff tested her blood for HBV as part of a routine examination. The diagnosis meant that Ma Hnin’s daughter was vaccinated against HBV at birth, and is HBV negative.
Ma Hnin was downcast when she found out she was HBV positive but her family encouraged her. “After knowing the result, I tried to find out how to cure it. Some people suggested that I should go downtown and find a clinic or hospital to treat it. Some said I could get a vaccination. But I didn’t get exact information so I consulted with a traditional healer. He said that someone who had been infected was cured by drinking an infusion of boiled leaves. So I followed this method and drank boiled leaves after weaning my baby.” Ma Hnin continued to take this traditional medicine until she became pregnant with her son in early 2018.
She was enrolled on CPI’s research project in 2018 when she was in the early stages of pregnancy with her second child, and received prenatal care through the B. K. Kee Foundation clinic. “I am happy because I know both me and my baby are going to be healthier by joining this project. [The clinic staff] were helpful in many ways. They explained a lot about HBV. [During my pregnancy], the clinic provided vitamins, iron tablets, deworming and tetanus vaccinations.”
Ma Hnin gave birth at home, like the majority of women in Myanmar, with support from a midwife who helped deliver her first child. She did not want to give birth in hospital. “I was scared of other mothers screaming when giving birth,” she explains. “I felt warm and secure at home with my family. Some people said that I wouldn’t be able to have my family beside me at the hospital.”
Within 24 hours after the birth of her son, staff at the B. K. Kee Foundation clinic delivered the HBV birth dose vaccine to the home of a local doctor who vaccinated the baby. Ma Hnin’s son has since received follow-up doses of the HBV vaccination. It will be a few months before Ma Hnin will know for sure whether her son is HBV negative, but she is confident. “My daughter had the vaccinations and she tested negative, so I think my son will too.”
Now that Ma Hnin knows how HBV is transmitted, she is more careful at home. “I take care to prevent my blood and body fluids coming into contact with my family.”
Ma Hnin’s story highlights the widespread lack of awareness and understanding of HBV in Myanmar. With limited access to health information, many communities remain unaware of how they can protect themselves and their loved ones.
A key part of CPI’s research project in South Dagon will be able to identify barriers and facilitators for low-income communities in accessing HBV information and health services. The findings will be used to inform future initiatives to reach other mothers like Ma Hnin, and their families, with lifesaving HBV prevention and treatment.
Names have been changed to protect client confidentiality.