Jaranit Kaewkungwal

Protecting personal health information has long been a key ethical concern in healthcare. With the rise of digital health systems, privacy concerns have intensified. In least developed countries like Myanmar, where digital literacy is low, public and governmental awareness of privacy issues is limited, and data protection laws are lacking, the health information privacy area remains largely unaddressed and understudied. This study, therefore, aimed to assess the level of privacy concerns related to personal health information in Myanmar and identify the factors associated with these concerns. A cross-sectional survey was conducted from March to May 2024 among 424 participants recruited online and through two private clinics. A validated 21-item scale measuring six domains: Collection, Errors, Unauthorized Secondary Use, Improper Access, Control, and Awareness, was used. Confirmatory factor analysis was performed to validate the scale, and logistic regression was used to identify factors associated with the concerns. Among the 424 participants, 77.83% reported high concerns. The highest concern was observed in the Awareness domain (mean 5.02, SD 1.65), while the Collection domain showed the lowest (mean 3.41, SD 1.44). Participants aged 45 years or older had significantly lower odds of high concerns compared to those aged 18–24 years, with an adjusted odds ratio (aOR) of 0.29 (95% CI 0.09-0.88). In contrast, those reporting good health (aOR 3.72, 95% CI 1.69-8.23) and high health concerns (aOR 5.26, 95% CI 3.02-9.45) had increased odds of high privacy concerns. These findings highlight the need for robust privacy safeguards, legal frameworks, and trust-building measures to support Myanmar’s transition to digital health systems. Sampling via online channels and private clinics likely introduced an urban/educated bias, limiting generalizability. However, the findings may still provide insights relevant for other least developed countries facing similar challenges in balancing digital innovation with the protection of personal health information.

Timely malaria care-seeking and treatment is crucial to prevent severe illness and reduce onward transmission. This study assessed the reported time to care-seeking and identified its associated factors among febrile patients attending community-based malaria facilities in Myanmar and Thailand. Longitudinal data were collected from febrile patients suspected of malaria who sought care through Village Health Volunteers in Myanmar (December 2017-June 2021) and at malaria clinics and posts in Thailand (January 2018-June 2024). Standardized case record forms in local languages were used at diagnosis. Descriptive statistics and multivariable log-logistic Accelerated Failure Time (AFT) models were used to estimate Time Ratios (TRs). In Myanmar (n = 2,960), the reported mean fever duration at diagnosis was 1.8 days (SD: 1.3). Longer time to care-seeking was associated with Shan ethnicity (TR: 1.48; 95% CI 1.41-1.55), other ethnicities (TR: 1.24; 95% CI 1.08-1.41), farmers (TR: 1.12; 95% CI 1.0-1.25), uncertain malaria history (TR: 1.26; 95% CI 1.09-1.47), and diagnosis with Plasmodium falciparum (TR: 1.10; 95% CI 1.02-1.19) or Plasmodium vivax (TR: 1.23; 95% CI 1.13-1.34). Shorter delays were associated with daily bed net use and diagnosis during the third or fourth quarters of the year. In Thailand (n = 15,576), the reported mean fever duration was 2.9 days (SD: 1.8). Longer delays were linked to farmers (TR: 1.07; 95% CI 1.02-1.11), pre- or primary education (TR: 1.02; 95% CI 1.00-1.04), uncertain malaria history (TR: 1.10; 95% CI 1.06-1.14), diagnosis with P. falciparum (TR: 1.27; 95% CI 1.09-1.46), P. vivax (TR: 1.20; 95% CI 1.17-1.23), or other malaria species (TR: 1.32; 95% CI 1.12-1.56), and diagnosis during the third (TR: 1.03; 95% CI 1.00-1.05) or fourth quarters of the year (TR: 1.06; 95% CI 1.04-1.09). Shorter care-seeking times were observed among non-agricultural occupations such as merchants and monks, individuals with prior malaria episodes, and occasional or daily bed net users. Delays in malaria care-seeking remain common in both Myanmar and Thailand. The identified risk factors, including ethnicity, occupation, malaria history, and preventive behaviours, should be considered in the design of targeted interventions to promote timely care-seeking in malaria-endemic settings.

Timely malaria care-seeking and treatment is crucial to prevent severe illness and reduce onward transmission. This study assessed the time to care-seeking and identified its associated factors among febrile patients attending community-based malaria facilities in Myanmar and Thailand. Longitudinal data were collected from febrile patients suspected of malaria who sought care through Village Health Volunteers in Myanmar (December 2017–June 2021) and at malaria clinics and posts in Thailand (January 2018–June 2024). Standardized case record forms in local languages were used at diagnosis. Descriptive statistics and log-logistic Accelerated Failure Time (AFT) models were used to estimate Time Ratios (TRs). In Myanmar (n = 2,960), the mean fever duration at diagnosis was 1.8 days (SD: 1.3). Longer time to care-seeking was associated with Shan ethnicity (TR: 1.48; 95% CI: 1.41–1.55), other ethnicities (TR: 1.24; 95% CI: 1.08–1.41), farmers (TR: 1.12; 95% CI: 1.0–1.25), uncertain malaria history (TR: 1.26; 95% CI: 1.09–1.47), and diagnosis with Plasmodium falciparum (TR: 1.10; 95% CI: 1.02–1.19) or P. vivax (TR: 1.23; 95% CI: 1.13–1.34). Shorter delays were associated with daily bed net use and diagnosis during the third or fourth quarters of the year. In Thailand (n = 15,576), the mean fever duration was 2.9 days (SD: 1.8). Longer delays were linked to farmers (TR: 1.07; 95% CI: 1.02–1.11), pre- or primary education (TR: 1.02; 95% CI: 1.00–1.04), uncertain malaria history (TR: 1.10; 95% CI: 1.06–1.14), diagnosis with P. falciparum (TR: 1.27; 95% CI: 1.09–1.46), P. vivax (TR: 1.20; 95% CI: 1.17–1.23), or other malaria species (TR: 1.32; 95% CI: 1.12–1.56), and diagnosis during the third (TR: 1.03; 95% CI: 1.00–1.05) or fourth quarters of the year (TR: 1.06; 95% CI: 1.04–1.09). Shorter care-seeking times were observed among non-agricultural occupations such as merchants and monks, individuals with prior malaria episodes, and occasional or daily bed net users. Delays in malaria care-seeking remain common in both Myanmar and Thailand. The identified risk factors, including ethnicity, occupation, malaria history, and preventive behaviors, should be considered in the design of targeted interventions to promote timely care-seeking in malaria-endemic settings.

Protecting personal health information has long been a key ethical concern in healthcare. With the rise of digital health systems, privacy concerns have intensified. In least developed countries like Myanmar, where digital literacy is low, public and governmental awareness of privacy issues is limited, and data protection laws are lacking, the health information privacy area remains largely unaddressed and understudied. This study, therefore, aimed to assess the extent of privacy concerns related to personal health information in Myanmar and identify the factors associated with these concerns. A cross-sectional survey was conducted from March to May 2024 among 424 participants recruited online and through two private clinics. A validated 21-item scale measuring six domains: Collection, Errors, Unauthorized Secondary Use, Improper Access, Control, and Awareness, was used. Confirmatory factor analysis was performed to validate the scale, and logistic regression was used to identify factors associated with the concerns. Among the 424 participants, 77.83% reported high concerns. The highest concern was observed in the Awareness domain (mean 5.02, SD 1.65), while the Collection domain showed the lowest (mean 3.41, SD 1.44). Participants aged 45 years or older had significantly lower odds of high concerns compared to those aged 18-24 years, with an adjusted odds ratio (aOR) of 0.29 (95% CI 0.09-0.88). In contrast, those reporting good health (aOR 3.72, 95% CI 1.69-8.23) and high health concerns (aOR 5.26, 95% CI 3.02-9.45) had increased odds of high privacy concerns. These findings highlight the need for robust privacy safeguards, legal frameworks, and trust-building measures to support Myanmar’s transition to digital health systems. They also provide insights relevant for other least developed countries facing similar challenges in balancing digital innovation with the protection of personal health information. Author Summary: We examined the extent of personal health information privacy concerns of people in Myanmar at a time when digital health tools are growing but legal protections and public awareness remain limited. From March to May 2024, we surveyed 424 adults online and in two private clinics. We asked about six kinds of concerns, related to the amount of personal health information collected, errors in the information, who can access the information, whether they are reused without permission, how much control people have over their own information, and how clearly rules are explained. More than three in four participants reported high overall concern. People were more worried about not knowing how their information would be used, and least worried about the act of collection itself. Older adults tended to be less concerned than younger adults, while those who felt in good health and those who were more worried about their health showed greater concern. Patterns also varied by sex, place of residence, type of occupation, and familiarity with electronic medical records. Our findings point to practical steps for Myanmar’s digital health transition: communicate clearly about data practices, give people meaningful control, prevent misuse and improper access, and strengthen organizational and legal safeguards. These actions can build trust and support safe, more equitable health information systems in Myanmar and in similar settings.