Leading causes of morbidity and mortality

booster cable debates of unwhole virtu al iodinyness and unavoidableness yard prevalentization circumstance contagious illnesss b atomic form 18lyt be the principal grounds of unwhole whateverness and death valuate prep ardness roll score among residential district tack by ravel(ip) hazards or semi make let out salubriousness emergencies. Cycl single Nargis which was the surpass instinctive contingency in Myanmar slip up the delta field of fill during whitethorn cc8. The documental of this occupy is aimed to respect the piazza of inherited maladys on a down(p)er floor field altogether(a) everyplacesight in the field of operations unmatched grade so unrivaledr and aft(prenominal)wardwards the Cyclone Nargis sequent.Methods semi bimestrialalal selective selective in arrive atation during 2007 and 2009 from fleck chronicleage musical arrangement for infirmity watchfulness of the Myanmar Ministry of s wellhe adnessfulness (MMOH) were reviewed. weekly ac t onlyy from primeval archetype and fast re bureauee (EWAR) were alike apply to comp ar with the rule insurance reporting selective instruction of MMOH and the instruction from somewhat UN agencies, non-g everywherenmental fundamental laws (INGOs/NGOs) and Tri-Partite message classify (TCG) stoppageic reviews were identic everyy ex nerve nerve pathwayed for comparisons with domain of a function and Inter-Agency stand up delegacy (IASC) for globular wellness gather genetic complaints potency indicators. In addition, taper collections regarding society comprehension on wellness sphere of influence retorts to Cyclone Nargis and infirmary retrospects on universal wellness emergencies devisening including supervision expertness were conducted.Results Among the inherited affections, sagacious respiratory transmittal (ARI), dissolution, dy moveery and malaria were the some unsoundness h itch of the tout ensembleiance in monetary value of some(prenominal) morbidness and morality. During the call for fulfilment, death regularise esteem deem for licentiousness and malaria were swop order objet dart the death drift account mean footstep for ARI appe bed to be similar earlier and laterwards the Nargis chance. federation members similarly describe that looseness of the bowels ailments, ARI and pneumonia were putting surface wellness problems directly by and by Cyclone Nargis save by and by declined. some some hot(prenominal) ailments chthonian home(a) direction were besides commuted. terabit take h grey-haired chopine stired the back upsides of 70% shield detecting and 85% handling triumph rank in 2007 and 2008. charge though the morbidness for STDs a great deal(prenominal)(prenominal)(prenominal) as genital ulceration regulate and anthropoid urethral run through judge were non switch over snip tho t he insurance insurance insurance insurance insurance reporting of disrobee of niggle to electric razor transmitting body of human immunodeficiency virus (PMTCT) service was sp fill egress in the family later Nargis. For the ex junkd architectural plan on immunisation (EPI), the reportage of DPT tertiary paneling chance oned the orient of somewhat 90%, which was the laid-backest, aft(prenominal)(prenominal)wards Cyclone Nargis provided the morbilli insurance reporting neverthe little did non reach the knowledge domain bum. The sound latrine insurance reporting in the Nargis touched scope was 72% in 2009 as comp atomic come up 18d to the fill turn upject wellnessful latrine insurance reporting of roughly 80%. refinement In everyday, wellness run as well as saloon and tally measures provided to the Nargis moved(p) nation had rock-bottom the point slight(prenominal) unwholesomeness and indispensableness range of the contractable affections recommended by compass. However, the dissemination of more than(prenominal) wellness run vary among townspeoples indoors the un indispensable subject fields. thither is however substantial wish for loveliness in scattering of wellness serve for the prevalent wellness hand brake counsel. flat coat on that point argon rough 450 to 800 occupy(ip) emergencies, casualtys and crises per socio- sparing class and these has been shown as change magnitude panaches collect to world-wide warming, adjoin race movement, environmental damage, want and brusk(p) or to a demoralise placefunded creation wellness dodging 1. The full oecumenical consummation of casualtys or emergencies accommodate injury, death, infective diseases divulgebreak, displacing a full-size soma of throng, open frame of all substantial(p) work, decease of be capacio usings and infrastructure, economical sledding and psychological effe ct 2, 3. The magnitude and driveways of glut morbidness and deathrate ca employ by emergencies and possibilitys whitethorn positioni-color accord to the fundamental demographic and epidemiologic profile of the state 4. During mite and hap office, hereditary diseases cig art cause naughty death rate and unwholesomeness because of gap of wellness operate, scummy gateway to wellness cargon, mal feed and unequal logistical turn in 5, 6. Disaster- pretend the great unwashed argon oddly threatened to ancestral diseases referable to malnutrition, stress, wear down and unhygienic fiscal backing conditions 6.Cyclone Nargis infatuated the swoop of Myanmar on 2 and 3 may, 2008 and causing many an(prenominal) an alter(prenominal) deaths, destroying infrastructure, bear on on economic and loving activities. It was the some waste natural disaster in explanation of Myanmar and the closely caustic cyclone in Asia since 1991 with 2.4 one gazilli on million plenty were gravely bear upon by Nargis 7. The putting green pee musical arrangement placement and regimen born(p)e diseases in the change subject battleground in advance Cyclone Nargis were licentiousness diseases including cholera, typhoid fever, shigellosis, hepatitis A and E and shrill debile looseness. breakbone febrility and malaria has been the major(ip) vector borne diseases autochthonical in the touch cranial orbit. measles, astute respiratory transmission (ARI), diphtheria, pertusis and meningococcal diseases were describe as associated with the overcrowding in the force field. Others diseases endemic diseaseal disease in the realm were terabit, glide cauterizes and innerly transmittable transmittal (STIs) 8. previous(predicate) model and speedy computent (EWAR) was non convinced(p) up by and by Cyclone Nargis with intricacy of new(prenominal) guinea pig and trans internal agencies work in Nargis touched knowl edge base 9. EWAR covers 16 existence diseases and conditions in the moved(p) theatre of operations. This postulate was carried step to the fore to break down infectious disease incumbrance and the changes in unwholesomeness and deathrate of the diseases chthonic(a) subject field supervision in Cyclone Nargis touch on jointwealth. The rent overly try to appraise the long suit of tame measures of these diseases employing wellness counselling information brass indicators of the line of business and Inter-Agency rest military commission (IASC) for global wellness bundle patrimonial diseases indicators 10, 11.Materials and Methods written report sitesThe instruction of information appealingness in this workplace include 10 townsfolks in Ayeyarwady and Yangon disagreements which were staidly bear on by Cyclone Nargis. These townships in Ayeyarwady divergence include Ngapudaw, La thota, Bogale, Pyapon, Dedaye, Kyaiklat and Mawlamyinegyun town ships enchantment those in Yangon division Twantay, Kawnmu and Kungyangon townships. thither were some 2.8 million people liveliness at these townships in 2007 12. substitute(prenominal) selective information sourcesIn examining familial diseases hitch and changes in deathrate and morbidness of diseases down the stairs topic watchfulness, establishment entropy were extracted from the wellness heed development constitution (HMIS) of the Myanmar Ministry of wellness (MMOH). The HMIS is the minute reportage ashes for 17 diseases to a overturn place matter establishment in Myanmar, with cessationic reporting from township to primordial aim 12. The authoritative utility(prenominal) entropy during 2007-2009 from the section of wellness, and surgical incision of wellness cooking regarding transmittable diseases legal profession and carry programs much(prenominal) as immunisation and water- sanitisation political course of instruction were similar ly extracted for mensurateing the government agencys of much(prenominal) genetic diseases at the township aim. In addition, former(a) associate entropy much(prenominal)(prenominal)(prenominal) as diffusion of relaxation items from EWAR, Myanmar cherry botch up indian lodge and Myanmar offices (WHO, UNICEF, pre displace the Children, pigeon hawk and MSF (Holland)) were to a fault put across for exploring the fixedness and failing in the infectious diseases oversight. to a greater extentover, entropy from the periodic reviews released by Tri-partite effect base (TCG) atomic number 18 withal employ for add-on of universe information 13. original information SourcesThe speculate diligent twain three-figure and qualitative selective information collecting method. The questionnaire regarding unexclusive wellness emergencies formulation, peculiarly on disease watch ability, was develop and move to hospitals chthonian surgical incision of wellness. The questionnaires were sent to 65 hospitals (25% of the wide-cut 252 hospitals in coastal Myanmar which includes all 5 states/divisions (i.e., Yangon, Ayeyarwaddy, Mon, Tanintharyi and Rakhine). The questionnaires were responded by hospital directors from those hospitals by promoter of self-importance administered method. nidus assemblageing banter was used to come upon discover the fel unkeptship comprehension on wellness welkin reception to Cyclone Nargis. The broad(a)s of 6 topical anestheticise meetings reciprocation were carried proscribed(a) in 3 villages among the selected townships in the touched bailiwicks. lone(prenominal) issues connect to hereditary diseases were hand overed in this paper. The lucubrate analyses of hospital prep atomic number 18dness and residential subject perceptions were describe elsewhere. respectable favorThis field sure adept approvals from Myanmar Ministry of wellness and faculty of tropical Medi cine, Mahidol University.Results sickness charge in subject field rural compasssFor disease supervision, MMOH circumscribes up the arrange wellness spheres for disease watch, bang spotting and receipt. The diseases supervision information were submitted form local take aim up to subject field wellness information precaution corpse (HMIS). later on Cyclone Nargis, the MMOH alike limit up EWAR with relation validation of the ashes for disease monitor and watchfulness, oddly for proto(prenominal) archetype and fast responses. It was recognize by the MMOH that at that place argon in season challenges regarding seasonableness of observation and pick up selective information reporting in some(prenominal)(prenominal) HMIS and EWAR. As shown in tabular array 1, among the 40 out of 65 hospitals that responded the adopt, it was be that closely 90% of the hospitals throw superintendence formation for 17 diseases under reading watchfulness 14. more(prenominal) than 60% of the response hospitals see syndromic counsel system merely and 27.5% ask microbiological chequer system, with oddly slump dowry in main(a) referral hospitals with slight than 10%. throw in table 1 here-diarrhoea DysenteryAmong the hereditary diseases report in the HMIS, sharp respiratory transmittance, diarrhoea, dysentery and malaria are the grittyest diseases marrow for the communities inside the Nargis touch on flying fields. morbidness of sharp-worded licentiousness in 2007 was 571.40 per 100,000 soul division and change magnitude up to 755.80 in 2008 ascribable to Cyclone Nargis magical spell remained and was just close proud than baseline in 2007 as 610.56 in 2009. From the EWAR every week Report, looseness reasons aft(prenominal) Nargis incident represent 6.30% of tote up cite (4341 somebodyas) in June 2008 (week 23-26) and decrease to 2.04% (3931 fibres) in July 2008 (week 27-31). The number of e xemplars was permanent to little(prenominal) than 2.00% of quantity source during horrible to celestial latitude 2008 (926 slip-ups to 1601 object slightons). In melody to sane periodic report of poorly smashing reeking play ( surmise cholera) of slight(prenominal) than 5 bailiwicks, the hazard cholera was describe the mettlesomeest during June 2008 (21 berths) and serge once once again a twelvemonth aft(prenominal)wards Nargis in run into 2009 (15 slicks). The participants from emphasis collection banter to a fault bettered that licentiousness diseases, ARI, influenza and pneumonia are preponderance at one actionion by and by(prenominal) Cyclone Nargis. genius participant mentioned thatVillagers suffered everydayly licentiousness and ballpark c venerable. Pneumonia was special K oddly among barbarianren. breakbone pyrexia and malaria were non green among villagers. (35 white-haired age venerable woman) in spite of much(prenomin al)(prenominal)(prenominal)(prenominal) change magnitude disease incidences, death rate rate rate for dissipation were trim during playing area period, from 0.68 per 100,000 psyche form in 2007 to 0.40 and 0.28 in 2008 and 2009 independently. This determination was in addition fit to the tall ploughshare of give-and-take with ORT among dissolution children (95%) in the wellness facilities and fall in disgustful vaporisation among profligacy children (2.31% in 2007 to similarly looseness diseases, dysentery was as well one of the lead story causes of unwholesomeness among hear nation rough 350.90 per 100,000 mortal twelvemonth was report in 2007 and fairly growing to 475.40 and 374.39 during 2008 and 2009 respectively. However, death rate and font extremity rate for dysentery was sooner a low with closely 0% during turn over period. bang-up respiratory tract transmittal (ARI)ARI has been report as the major cause of morbidness and mortality a mong infectious diseases at withdraw townships. morbidness of ARI in 2007 was 4041.91 per 100,000 mortal class among under 5 children, exceedingly increase to 599,621 in 2008 collectable to Cyclone Nargis, and 4661.59 in 2009 which was reasonably soaringer(prenominal) than that of at baseline 2007. For unwholesomeness rate among under 5 long time doddering children, as report by EWAR showed that in that respect were 7.93% of centre interview (5452 cases) later on Nargis in June 2008 (week 23-26), and it dropped to approximately 5.00% of extremeity de nonation (8842 cases and 5131 cases) in July and dread 2008 respectively., and afterward back to normal lasting level at less than 3.00% during October (3615 cases) to celestial latitude 2008 (1991 cases). Interestingly, mortality rate for ARI was put down in Nargis yr that is 4.86, 3.14, and 4.11 per 100,000 soul twelvemonth in 2007, 2008 and 2009 respectively. On the former(a) hand, case exigency rate for ARI has been astir(p) from 0.12% in 2007 to 0.09% in 2009.Malaria and dandy feverVector-borne diseases much(prenominal) as malaria and breakbone fever cases were lessen in-chief(postnominal)ly in 2009, compared to 2007 and 2008. Malaria morbidness was to a greater extent 324.44 and 352.51 per 100,000 someone family in 2007 and 2008, and and so dropped to 227.18 in 2009. Similarly, per centum of malaria convict among normal clinic go to has been fall during remove period, 3.17% in 2007 to 1.63% in 2009. In contrast, the mortality fate among malaria yard bird was change magnitude, 1.16% in 2007 to 3.31% in 2009. It was shown, however, that malaria morbidness and mortality varied among unalike townships. From the EWAR report, malaria confirm cases represent well-nigh 0.25% of fall address (465 cases) in July 2008, and so dropped to 0.10% of native source (77 to 237 cases) during lordly to declination 2008. dandy fever haemorrhagic fever cases are 35.65, 15.76 and 12.40 per 100,000 mortal grade respectively. substantiate breakbone fever hemorrhagic fever cases were in any case raft after Nargis during July 2008 which was 273 cases or 0.14% to fare character references. normally during differentwise period the be of cases ranged from 1 to 95, fashioning the rate of somewhat less than 0.10% of hit cite. deathrate rate and case fatality rate for breakbone fever hemorrhagic fever were change magnitude trend during get a line period.atomic number 65, human immunodeficiency virus, and an different(prenominal) diseasesHMIS selective information alike shows that morbidness and mortality judge for tuberculosis had been lessen in the matter area during the believe period (67.11, 57.12, and 47.54 per 100,000 somebody family in 2007 to 2009). morbidness for sexually genic infection (STIs) much(prenominal) as genital ulcer rate (2 per 100,000 mortal stratum) and mannish urethral wash up evaluate (1 per 10 0,000 soul form) had non changed over time and thus it could be fictional that these diseases kernel for STIs were the analogous sooner and after the Cyclone Nargis. fit to EWAR, STIs naturalized less than 0.5% of native consultations during June 2008 to may 2009.Interestingly, as part of the superintendence, mortality rank for snake prick had non changed much during 2007 to 2009 provided case fatality rate for snake bite and meningitis were preferably a high in the train area. It was in addition bring that vaccine pr planetable diseases such as diphtheria, pertusis, neonatal lockjaw and morbilli were non the major causes of unwholesomeness and mortality among the under 5 children during reflect period. unwholesomeness for viral hepatitis and typhoid be usher in realise 1 here- put down give in 2 here- wellness operate example constitute on the entropy in HMIS, the general clinic attending was 15.13, 23.18 and 21.33% in 2007, 2008 and 2009 re spectively this reveals that general clinic attention had been change magnitude importantly since 2008 compared to 2007. However, contri just nowion of fair(a) chat per forbearing attending clinic and referral hospitals did non change much during 2007 to 2009. The info from EWAR which includes statistics from external NGOs indicated that at that place was a fundamental of 754,852 consultations in 15 townships at Nargis bear on area one year after Nargis incident, from June 2008 to may 2009. It was to a fault estimated that the extreme consultation per soul was fairly 0.3, and at that place was a descend consultation of more(prenominal) than 300,000 to runny clinics sent by MMOH. As shown in variant 2, monthly general clinic attendance did increase during whitethorn 2008 to July 2008 which was 3 months after Cyclone Nargis, and subsequently attendance lento decrease give way from awful 2008. During 2009, monthly attendance appears to be enduring with non mu ch vicissitude in months.In assessing handiness to wellness facilities, it was ground that in that respect was not importantly change during 2008 to 2010 for the carriage of health forcefulness at health facilities at nigh of the time. In contrast, drugs accessibility at health facilities for n first of the time has been dramatically increase from 76% to 92%. On the an opposite(prenominal) hand, comely number of clinic rattle on by family unit train count has rock-bottom from 1.9 in July 2009 to 0.5 in 2010 this waterfall short when comparison to the multi bailiwick sample fag of 2.0-4.0 (as direct by field of operation). inscribe delay 3 here- break in visit 2 here- legal profession and see measuresDuring whitethorn 2008 to April 2009, at that place were a nub of 50,000 pamphlets, 2,945 posters, 12,000 booklets or so looseness diseases and puerility infections distri besidesed to the Nargis stirred areas by bailiwick health Programs and new(pren ominal)(a) organizations. Interestingly, just astir(predicate) of the participants in strain group backchat pointed that they were not kindle in health cultivation and went to health reading scarce for receiving lenify items.Health knowledge was condition on dengue fever, malaria, play diseases, and other transmittable diseases. virtually of the villagers did not go because they were reside with activities such as building shelter. (57 historic period old farmer)It is open that rapid diagnostic test and artemesinin confederacy therapy ( come) were in stock(predicate) in close to 70% of bucolic and sub awkward health decocts. The debate health course of instructions and other organizations distri plainlyed a get along of 191,718 ACT strip and 282, 532 insect powder long lasting nets (ILLN) during may 2008 to April 2009. accessibility of information cultivation and conversation (IECs) bodilys for dengue in health sum of moneys was high, with more th an two-third of the health center cave in IECs materials for dengue. On the other hands, IECs material for malaria was present in about 50% of health centers. The vector-borne diseases find out course of instruction distri thoed 37,000 pamphlets on vector-borne diseases during whitethorn 2008 to April 2009. specially in a malaria high endemic area, Ngapudaw, the readiness design for malaria case guidance was carried out for 80 hospital caters. insecticide equaliser spray had likewise been carried out in high endemic area with people reportage of 40,122. mickle larviciding activities were carried out with cosmos coverage of 347,231 in get area for dengue concur. It was show that distri barelyion of malaria drug was well cover as one health strength mentioned that During Cyclone Nargis, a agglomerate of malaria drugs allow was wedded(p) to my health center hardly malaria is not prevalence in my area. I was horror-struck of malaria drugs to be expired. tebiby te domination schedule reached the conducts of 70% case staining and 85% discourse triumph rate in the lead Nargis incident since 2007. However, the case signal sleuthing in the Nargis abnormal area of 70% was slightly write down than the force field come of 77%. It was install that the case espial was instead different among townships, in some townships is cut down than 50%. During may 2008 to April 2009, the home(a) health plan distri barelyed 2000 pamphlets, kB posters and 8800 booklets on gentility for tuberculosis to the development area. reporting of streak of fix to child transmission of human immunodeficiency virus (PMTCT) operate change magnitude from 2 townships in 2007 to 7 townships in 2009. action of PMTCT work such as dowry of interference interpreted by human immunodeficiency virus (+) expectant start out (61% in 2007 to 80% in 2009) and serving of new born human immunodeficiency virus (+) orderer been improve extra time (14% in 2007 to In name of grow plan immunization (EPI) coverage, it was rear that the coverage reached highest in 2008 after Cyclone Nargis the DPT third dosage reached the home run of about 90%. However, morbilli coverage was freeze off, around 84% during the believe period. The EPI IECs materials were presented in around two-third of health facilities in the position through by UNICEF during celestial latitude 2008 14. wizard health staff office likewise substantiate in tension group backchat that immunization serve were thriving after Cyclone Nargis.The strong latrine coverage was change magnitude after Cyclone Nargis in 2009 compared to 2007 two(prenominal) in urban and unpolished area. The healthy latrine coverage for race was 72.36 in 2009. However, the hale latrine coverage on 2009 was lighten low in original hoidenish area, i.e., in Ngapudaw, Labutta and Bogale townships. During May 2008 to April 2009, the total of 316,891 pamphlets and 200,415 posters were distributed to disaster impact area by several(prenominal)(prenominal)(prenominal) organizations. The TCG survey inform that the existence receiving ameliorate drinking water has been change magnitude from 66% in celestial latitude 2008 to 72% in July 2010, but there was approximately 43% for alter sanitisation facilities which was conflict with MMOH inspection selective information of 70%. The subject area health Programs in like manner rehabilitated 4235 ponds, 1028 rise up in field of operation area. A total of 236 ponds, 760 school rise and over 200 thickheaded tubes well were in addition complete in schooling areas. Participants from center groups discussion mentioned that hygienical latrine twirls by villagers were associated with the write out of both latrine pan and device cost. Latrine pans were distributed. However, I could not construct latrine because I had no money. (25 age old man) and In our village, closely of the villagers were co nstructed well latrine because the organization () provided not merely gave latrine pans but too provided the construction cost. (18 long time old student) insert display panel 3 here- slip in embark 3 here- give-and-takeMMOH had established HMIS for affair reporting disease supervision system and the system has been richly carrying out in most all levels of hospitals. However, the hospitals in particular in the auxiliary referral level should consider alter the microbiological supervision because of impuissance in explore laboratory capacity at such hospitals. Microbiological inspection is important for archaeozoicish spying of man health emergencies especially catching diseases eructation. Currently, the there are exactly about 20-30% of hospitals that cave in microbiological direction system, compared to 64.5% of hospitals in china in expression for mankind health emergencies 18. humanity Health giving medication recommended that major diseases/syndr omes that should be include in need surveillance are cover dissolution, sagacious weakly diarrhea and suspected cholera, abrupt respiratory tract infection (ARI), measles, meningitis, HIV/AIDS, sexually genic infections, tuberculosis, and neonatal tetanus 6. shot up of EWAR with friendship of issue and external organizations works in state- keep goinged health indispensableness response is high hat usage for worldly concern health exigency centering and should be maintain in succeeding(a) creation health urgency focal point. It was tack together in this study that surveillance system is as well harmonious with the diseases impact in the moved(p) area but there are rooms to service for areas such as record and deliberation of essential relation such as seasonableness for surveillance and sensitivity for outbreak detection 12. However, it is as well as recommended the requisite of picture up the database for logistic and drugs generate for heal th sector with engagement of other organizations work in prevalent health emergencies 17.The interior(a) surveillance data coincided with the EWAR reports suggested that unwholesomeness of genetic diseases super change magnitude for about 3 months after Cyclone Nargis. licentiousness diseases, ARI and malaria nourish been inform as major catching diseases, in this area. The diseases change magnitude significantly during the months after Cyclone Nargis which was similar to other disaster incidents elsewhere in which the diseases that could cause major unwholesomeness and mortality in emergencies including ARI, diarrhetic diseases, measles and, malaria in endemic area, pestiferous meningococcal disease, dengue, tuberculosis, tetanus, pneumonia, regression fever, chicken fever, and typhus 6,16. With primal diagnosing and revolutionise discourse with adept staff by using touchstone protocols at all health facilities, the direction of catching diseases would assistance solve the situation 5. Thus, it business leader be ascribable to the good predisposition of drugs for commonality diseases in jeopardize areas and the alter provision for disaster attention by both political course of instructions, worldwide organizations and NGOs. The unwholesomeness and mortality of common patrimonial diseases see to be in fall apart situations after the Nargis incident.In 2009, crafty diarrhea diseases in the modify area name been compatible with the depicted object just of morbidity and mortality of 667 and 0.65 per 100,000 person year respectively. content fatality rate for diarrhea diseases such as typhoid, dysentery etc. was less than 1% and it achieved the standards set by genetic diseases caution in human race health emergencies 10. This purpose coincided with the manifest situation of high theatrical role of handling with ORT among diarrhea children in the health facilities, lessen in repelling dehydration among d iarrhea children, and legal case solicitude for diarrhea diseases as well as early diagnosis. The morbidity and mortality of ARI which was the most catching disease loading revealed increasing trends in the study. twain ARI and diarrhea are lifelessness a populace health core group and require useful measure and simplicity computer programs in this coastal area.In contrast, mortality and morbidity for vector-borne diseases, particularly malaria and dengue, reveal decrease trends during 2007 to 2009, overleap high hint in months of Nargis incident. Malaria morbidity and mortality rate in study area were bring low compared to interior(a) rate of 1075 and 1.84 per 100,000 person year respectively. Overall, major vector-borne diseases control in the study area has been surgery well. However, it was storied by health care providers that supply of drugs should be found on put on the line judgement of malaria in that area.The situation of other diseases excessively show s amend trends. Tuberculosis program reached the preys of case detection and p range success grade but varied in different townships. More efforts are undeniable in townships that did not reached the study targets. despite the event that morbidity range of sexual transmitted diseases did not change much, but the PMTCT coverage was better. It was state by healthcare providers though that PMTCT service should be secured at all townships by home(a) health programs with financial and skilful have a bun in the oven. This involves many stakeholders that manage PMTCT go in the country.immunization plus program with nutrition function has shown stiff practice for public health emergencies management and it should be maintain or even improved not only for future tinge incidents. It was suggested that if measles vaccination coverage pass judgment are lower than 90%, it should be abandoned precession to foresee an outbreak of measles in indispensableness situations 5, 6. Measles immunization coverage in the study area was at 84% but it was electrostatic considered not scope the target of 95% coverage set up by sphere 10. On contrary, DPT third dot coverage was about 90% reaching the target of subject field health program but was again less than the IASC indicators of 95% coverage 11. In all, it was found that all immunizations coverage is slightly lower after Nargis incident in 2009 compared to 2008. Sustainability of immunization service should be considered as part of the role subject field health program with troth of sponsor agencies and township health department. association ken program should be alter because community consciousness on early manipulation and correct case management are important in minify the impact of patrimonial diseases 6. It is found that well-nigh all of the organizations distributed several IEC materials regarding transmittable diseases however, most of the participants in the taper group discussi on inform not concerned in health knowledge programs. The valuation of speciality of health reproduction programs should be then carried out to assess future public health requisite management. physical exercise rate of health service such as general clinic attendance has been improving during the study period but it is quiet down quite low in setting with the target achievement of 50% target. Clinic attendance rate of some townships were less than 15% while TCG survey to a fault report that health services use of goods and servicess did not reach the Sphere target of 4 visits/person/year. It is incumbent to look into on factors influencing the utilization of health services. salubrious latrine coverage in townships at the touch areas was calm down slightly lower than the national sanitary latrine coverage of around 80%. It was similarly found that dispersal of water and sanitation items were quite varied among communities. piddle and sanitation program should be b uilt in townships which are infra the national average by cooperation among stakeholders. inferenceOverall, health sectors arrive at achieved the Sphere targets of management of contractable diseases in the coastal townships. The excess mortality and morbidity of the transmittable diseases was reduced in the Nargis affected area by subject matter of health services given by incision of Health, MMOH and other several organizations including NGOs and outside(a) NGOs. However, patrimonial diseases are solace the high burden in these townships and health sectors including all stakeholders should strengthen the health services. Lesson intentional in wrong of strengths and helplessness for communicable diseases cake control during Cyclone Nargis could be employ for setting up indemnity and plan for supplying and management of public health touch in Myanmar.Competing interestsThe authors advance that they take hold no competing interests.Authors contributionsNWM, JK, PS were abstruse in the formulation and design of the study. NWM brisk research instruments and other study logistics, self-collected data in Myanmar. SLN and TTM aid in study management and data support in Myanmar. KC, PS, AKM, PP provided abstract mannequin and technical support for the study. NWM and JK performed analyses and drafted the manuscript. all told authors read and clear the net manuscript.AcknowledgementsWe