Bacterial causes of AIDS-associated diarrhea in Thailand.

The incidence of bacterial diarrhea in AIDS patients has increased steadily and has led to enormous medical and public health problems. In this study, the clinical data together with 350 rectal swab samples each from AIDS patients with diarrhea (APD) and non-AIDS patients with diarrhea (NAPD), were collected and examined for bacterial enteropathogens at the Bamrasnaradura Infectious Diseases Hospital (BIDH), Nonthaburi, Thailand from May to December 1996. Patients were matched by age and sex. The majority of these patients were male (79%, 554/700), aged between 15 and 34 years (70.9%). The study found that the isolation rates of bacterial enteropathogens causing diarrhea in APD (18%, 62/350) were considerably lower than those in NAPD (43%, 152/350) (p<0.05). The infection rate with Salmonella group B (19.7%, 12/61) in APD was found to be significantly higher than that in NAPD (14.3%, 2/14) (p<0.05). Vibrio parahaemolyticus (53.3%, 81/152), Plesiomonas shigelloides (27%, 41/152), Aeromonas spp (19.1%, 29/152) and V. cholerae O1 (15.1%, 23/152), were more frequently detected in NAPD than in APD (p<0.05). Only nine Escherichia coli strains were isolated from APD, of which six were enteroinvasive E. coli, two enterotoxigenic E. coli and one enterohemorrhagic E. coli (non O157) possessing both vtl and vt2. No V. cholerae strains were detected in APD. The least effective antibiotics were ampicillin, tetracycline and cotrimoxazole. Antibiotic resistant patterns of the isolated organisms were similar from both groups. The results from this study might be useful in Thailand in the diagnosis and management of clinical cases of bacterial diarrhea, especially APD.

Bacterial contamination of bottle milk in infants under 6 months in Children's Hospital, Bangkok, Thailand.

The bacterial contamination of bottle milk samples obtained randomly from 500 infants under 6 months of age who came to the Out-patient Department of Children's Hospital Bangkok was determined by collecting bottle milk samples prepared at home following interview of their caretakers after obtaining their consent. Bacterial contamination was found in 91.8% (459/500) of bottle milk samples. Among the positive samples, 82.8% (380/459) contained enteric bacteria, another 17.2% were unidentified bacteria. The dominant enteric bacteria isolated from bottle milk were Klebsiella spp (56.6%), Enterobacter spp (41.3%), Aeromonas spp (14.4%), E. coli (13.4 %) and Vibrio cholerae non 0-1 (1.8%). Isolated E. coli were further identified as enteropathogenic E. coli (7.8%, 4/51) and enterotoxigenic E. coli (3.9%, 2/51). About 74% of the contaminated bottle milk contained one type of bacteria, 23.7% had two types and 2.3 % had 3 or more types of bacteria. A level of bacterial contamination greater than the US government limited number (USGLN 2x10(4) CFU/ml) was found in 86.4% of total examined samples (432/500) [geometric mean (GM) of 2.9 x 10(6) CFU/ml]. About 66% (333/500) of bottle milk samples had coliforms greater than the USGLN (1 x l0(2) CFU/ml) with GM of 1.3 x 10(4) CFU/ml. Therefore, in the preparation of bottle milk, feeding practice should be emphasized in every setting of maternal-child health care and promotion of breast-feeding should be encouraged by the health personnel.

Overview reflection of primary health care in Thailand supported from 1976 to 1996 by Japan-Thailand partnership.

The international health cooperation of Japan for developing countries has been mostly concentrated on matters such as improvement of hygienic environment, prevention of tropical infectious diseases, establishment of hospitals with modern medical instruments and devices, and dispatch of medical experts. PHC (Primary Health Care) activities based on voluntary participation of local inhabitants in developing countries have been largely neglected. In the field of health and medical care, sufficient effect may not be achieved unless the local health activity is based on voluntary participation of the inhabitants. The introduction of advanced modern medical technics may be beneficial to some of the inhabitants, while most of the local inhabitants may not have the chance to receive such benefits, and additionally it is difficult to propagate modern medical care and technics widely to rural areas. In Thailand, PHC activity based on community participation was started in 1985, with the following three main themes: (1) Training of Village Health Volunteers (VHV) and Village Health Communicators (VHC), and development of their activities. (2) Establishment and operation of Health Centers. (3) Establishment and operation of a Drug Cooperative System (DC). Earlier, one of PHC activities developed by Japan, "Thailand Local Health Activity Improvement Project" based on the program of Thailand-Japan Partnership, was initiated in 1976 in rural areas of Chanthaburi Prefecture. From 1982, third country training programs have been carried out by the Japan International Cooperation Agency (JICA). As 10 years have elapsed since the initiation of PHC activity in rural areas in Thailand under the cooperation of the Governments of Thailand and Japan, it seems to be time to reconsider how PHC activity should be developed in future based on a candid evaluation of achievements and results.