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PLoS One. 2017 Aug 10;12(8):e0181603. doi: 10.1371/journal.pone.0181603. eCollection 2017.

Physician perspectives on the management of viral hepatitis and hepatocellular carcinoma in Myanmar.

Author information

Division of Gastroenterology and Hepatology, Stanford University, Stanford, California, United States of America.
Community Partners International, Berkeley, California, United States of America.
Myanmar Liver Foundation, Yangon, Myanmar.
Department of Emergency Medicine, University of California Los Angeles, Los Angeles, California, United States of America.
B.K. Kee Foundation, Yangon, Myanmar.
Division of General Internal Medicine and Health Services Research, University of California Los Angeles, Los Angeles, California, United States of America.
Division of Gastroenterology and Hepatology, University of Chicago Medical Center, Chicago, Illinois, United States of America.
Institute of Digestive Disease and Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong, Peoples Republic of China.
Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Kings College Hospital and University College School of Medicine, London, United Kingdom.



In Myanmar, over five million people are infected with hepatitis B virus (HBV) and hepatitis C virus (HCV). Hepatitis has been a recent focus with the development of a National Strategic Plan on Hepatitis and plans to subsidize HCV treatment.


During a two-day national liver disease symposium covering HCV, HBV, hepatocellular (HCC), and end-stage liver disease (ESLD), physician surveys were administered using the automated response system (ARS) to assess physician knowledge, perceptions of barriers to screening and treatment, and proposed solutions. Multivariate logistic regression was used to estimate odds ratio (OR) relating demography and practice factors with higher provider knowledge and improvement.


One hundred two physicians attending from various specialty areas (31.0% specializing in gastroenterology/hepatology and/or infectious disease) were of mixed gender (46.8% male), were younger than or equal to 40 years old (51.1% 20 to 40 years), had less experience (61.6% with ≤10 years of medical practice), were from the metropolitan area of Yangon (72.1%), and saw <10 liver disease patients per week (74.3%). The majority of physicians were not comfortable with treating or managing patients with liver disease. The post-test scores demonstrated an improvement in liver disease knowledge (9.0% ± 27.0) compared to the baseline pre-test scores; no variables were associated with significant improvement in hepatitis knowledge. Physicians identified the cost of diagnostic blood tests and treatment as the most significant barrier to treatment. Top solutions proposed were universal screening policies (46%), removal of financial barriers for treatment (29%), patient education (14%) and provider education (11%).


Physician knowledge improved after this symposium, and many other needs were revealed by the physician input on barriers to care and their solutions. These survey results are important in guiding the next steps to improve liver disease management and future medical education efforts in Myanmar.

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