Promotion of the health of rural women towards safe motherhood--an intervention project in northeast Thailand.

An intervention project focusing on the health of women in the reproductive age was conducted in three districts of Khon Kaen Province, northeast Thailand between 1991 and 1996. Main emphasis was placed on improving reproductive health, the nutritional status including the iron deficiency anemia (IDA) as well as iodine deficiency disorders (IDD), and the parasitic diseases liver fluke (Opisthorchis viverrini) and hookworm. For implementation a community based Primary Health Care approach was used including the training of health officials in health matters, primary health care workers and villagers as well as enhancing health education and the dissemination of health information. The health delivery system was encouraged to take appropriate actions such as in the treatment of parasitic diseases and the control of IDA and IDD. Monitoring was done on a regular basis. The outcome of the project was assessed by comparing baseline data compiled from a random sample of the target population with the results of the final evaluation. An attempt to compare results obtained from villages within and outside of the project area failed most probably because of spill over effects. A number of important indicators on family planning and mother and child health care improved during the time the project was implemented; this included practising family planning, and participation in antenatal care. Also the proportion of females becoming pregnant for the first time when 20 years or older increased. Child-raising also improved in that almost all females gave colostrum to their babies by this time. Almost 75% of the women breast-fed their children. Improvements occurred in the nutritional status as far as the micronutrients iron and iodine were concerned, however the overall nutritional status of females did not change, but a rather high proportion of females were found to be overnourished. The project failed in reducing abortion and the proportion of females becoming pregnant when they are 18 years old or younger. It was also not possible to improve the usage of postnatal care. As anticipated, the results achieved so far are most suitable in serving as a training ground and providing a favorable example to improve family planning, mother- and child health care, and also the general health of females in the region, particularly in neighboring countries such as Lao PDR, Cambodia and Vietnam.

Control of intestinal parasitic infection--a pilot project in Lao PDR.

Intestinal helminths are a very common but still rather unrecognized public health problem. An attempt was undertaken to control the three important parasites, ie Ascaris, Trichuris and hookworm. Two villages in Vientiane Province in Lao PDR were selected, one as an intervention and the other as control village. Intervention measures started by providing mass treatment against Ascaris, Trichuris, hookworm and other intestinal parasitic infections in both villages. Health education and other intervention measures were implemented in the intervention village, which significantly influenced the re-infection rates in this village. These achievements were not due to an improvement of the availability of toilets or personal hygiene alone but more to the villagers' improved understanding of the route of the parasitic infections. It was concluded that intervention methods should be directed more towards particular age groups. Particular attention should be paid to control parasitic infections among females.

Reproductive health in selected villages in Lao PDR.

The aim of the project was to improve the knowledge and attitude towards birth spacing by training the villagers in the selected villages of Vientiane Province in Lao PDR in family planning, providing them with the various family planning methods, and improving antenatal (ANC) and postnatal (PNC) care in the villages. Throughout the province, traditional birth attendants (TBA) were trained on several occasions during the project period. There were clear indications that reproductive health improved between 1995 and 1997. Considerable improvements were observed in the percentage of women making use of ANC and practising birth spacing by using some form of contraception or other. The most common methods used were contraceptive pills and injectables. In the case of child mortality a slight decrease was found in the percentage of women having their first pregnancy below the age of 18 years. A still unsolved problem is the high number of abortions.

Nutritional status of pre-school children and women in selected villages in the Suvannakhet Province, Lao PDR--an intervention trial.

A project to promote the health and nutritional status of women and pre-school children was started from 1995 to 1997 in three villages in Suvannakhet Province, Lao PDR. One village served as control. In 1995, for the baseline survey, 456 females, and in 1997, for the final evaluation, 363 females from the four villages volunteered for further investigations. An attempt was made to involve all females in the reproductive age residing in the villages. At the same time also the nutritional status of 321 and about 540 randomly selected pre-school children respectively was also assessed through physical examination and anthropometric measurements. Intervention measures included introducing growth charts and taking regular anthropometric measurements of women in the reproductive age and of pre-school children. Training in nutritional aspects such as giving colostrum to new-borns, prepare proper weaning food and supplementary feeding, animal-raising and home gardening was also introduced and provided to health personnel, village leaders and in women clubs. Special attention was given to the control of acute infectious diseases. The conventional EPI program was enforced as well. Health education in matters of mother and child health care was also provided. The proportion of undernourished women was rather high at about 15%. For pre-school children, the proportion of wasting was around 5%, and of stunting 50% and above. Intervention did not improve the nutritional status either of the women or of the children. It was concluded that the time span of two years is too short for a decrease in the proportion of undernourishment to be observed. An improvement was achieved for some indicators of mother and child health care. This seems to indicate the population's willingness to follow suggestions to improve their health. Most probably, if attempts to improve the nutritional status were continued, an improvement in this aspect could also be observed, if the population can be encouraged to take actions and develop initiatives by themselves.

Community based intervention of iron deficiency anemia in females and iodine deficiency disorders in school children in Lao PDR.

Under the supervision of the central and local health authorities, a pilot project was conducted in four villages in the Luangprabang Province, Lao PDR. The objective of the project was to test different regimes to supplement females with oral iron preparations to reduce iron deficient anemia (IDA) and control iodine deficiency disorders (IDD) in school children. Compared with iron sulphate tablets, iron fumerate tablets were well accepted and good compliance results were achieved. Hemoglobin concentration improved only in the group of females taking iron fumerate tablets. The goiter rate decreased from approximately 90% to about 45% for school children, regardless of whether iodine salt were used by their families or whether iodine capsules were used to treat the children. The latter attempt was hampered by the fact that also in the control village iodine fortified salt was used. This was due to a governmental attempt to control IDD nation-wide. Therefore, also in the control village a significant decrease in the goiter rate was observed.

Malaria control through impregnated bednets--a pilot project in selected villages in Lao PDR.

In 7 villages on the foothills of the Houayxai district of the Bokeo Province in Lao PDR between midyear 1995 to midyear 1997 an attempt was made to test the acceptability and use of DDT impregnated bed nets as well as environmental and behavioral risk factors. About 380 women between 15 to 45 years old and their children in the age range of 1 to 14 years had been studied. A pre-tested questionnaire had been applied and blood from women and children was taken from the finger prick and a conventional thick and thin blood smear was performed, fixed Giemsa stained and examined for malaria parasites. DDT (dichlorodiphenyltrichloroethane) impregnated mosquito nets were distributed in the intervention villages. The availability of mosquito nets increased statistically significant from approximately 50% to 70% for all family members in the intervention area between 1995 and 1997 and statistically significant decreased in the control area from 79% to 45.1%. There was a statistically significant decrease in malaria attacks as claimed by the females for the intervention area but not for the control villages. The proportion of positive blood smears did decrease overall for women and children in between 1995 to 1997. Occupation, location of the house and use of mosquito nets had been determined as the most important risk factors.

Prevalence of abnormal glucose tolerance in Khon Kaen Province and validity of urine stick and fasting blood sugar as screening tools.

Three hundred and fifty-five individuals, 152 males and 203 females, aged between 30 and 74 years, were randomly selected in a two stage selection process from rural communities in three districts of Khon Kaen Province, Northeast Thailand. The prevalence of impaired glucose tolerance (IGT) and non-insulin dependent diabetes mellitus (NIDDM) in the rural area of Northeast Thailand were measured. In addition, the validity of the urine stick and fasting blood sugar as screening tools against the two hours glucose loading test as golden standard were determined. The survey was conducted in July 1995. The glucose loading test was performed on 277 individuals. IGT and NIDDM were classified according to current World Health Organization suggestions. Prevalence rates for IGT were 18.1 per cent and for NIDDM 11.9 per cent. No difference was found between males and females, also when controlled for age. NIDDM prevalence increased with age but IGT rates already were high in the younger age groups. This finding suggests that IGT precedes NIDDM in Thailand. The validity of the urine stick as a screening tool in communities was insufficient, with a sensitivity of less than 20 per cent. When using fasting blood sugar as a screening test, the sensitivity was close to 44 per cent and the specificity 90 per cent. It is concluded that the urine stick is not a useful screening tool and the method of using blood sugar concentrations for screening have to be improved before it can be applied within communities.