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.

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.

Nutritional status of school children in an endemic area of iodine deficiency disorders (IDD) after one year of iodine supplementation.

To improve the health and nutritional status of school children in an area of iodine deficiency disorders (IDD) by means of different iodine fortifications in salt, fish sauce and drinking water, anthropometric assessment for nutritional measurement, including hematological status, were performed. There was a significant difference in the weight and height of the children from the four schools investigated, before and after supplementation in each school. The prevalence of anemia (as indicated by hematological measurement) and iodine deficiency (as indicated by urinary iodine concentration in the children from the four schools) were assessed and compared before and after iodine supplementation; a decrease in prevalence was found in all school children, however, serum ferritin did not change before and after supplementation.

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.

Breast feeding behavior and supplementary food pattern of villagers in Udon Thani Province, northeast Thailand.

Breast feeding and supplementary food patterns were studied in 3 villages, of Udon Thani Province in Northeast Thailand. All children of 58 mothers were breast fed. Moreover, 42 mothers (72.4%), advised by health workers, fed their children with colostrum. Those who did not give colostrum believed that colostrum may cause diarrhea. Fifty-one (87.9%) children were fed Kaw Yam, northeast native food made out of baked chewed banana and sticky rice, within 1-7 days after birth. The mothers believed that the food will fill the child's stomach, and consequently, her baby will stop to cry. Powder milk was also given to the child as supplementary food. A powder milk had a high social value for the mother and also health worker advised them to feed the children with it. Rice porridge was additionally supplemented at the age of 6-8 months until weaning or, at the time when the child had two front teeth. Child's weaning was forced by applying the nipples with local bitter tasting herb. This study indicates that any health education within a community should be aware of traditional belief and customs of the population. The promotion of proper breast feeding, and the introduction of supplementary food to children should be consider traditional beliefs and combine it with health educational means, which will result in a better adoptability of the villagers to the promotion of adequate infant feeding.

Quetelet index, hemoglobin and parasitic infection of rural women in northeast Thailand.

The Quetelet index, hemoglobin and parasitic infection rates of adolescent and young women from 21 villages in Northeast Thailand were assessed. Data were collected in the hot, rainy and cold seasons of the year. The proportion of undernourished females varied between 10 and 15% when a cut-off point of 18.7 of the Quetelet index was chosen. 23 to 33% of the women had hemoglobin levels below 12 g%. Parasitic infection rates with various intestinal helminths were high but not related to the nutritional status or anemia.

Urine iodine concentration and prevalence of goiter among rural women of child bearing ages in Northeast Thailand.

Iodine deficiency was investigated in 575 women from 12 villages of Pupaman, Si Chomphu and Amphoe Chum Phae in Khon Kaen province in a project survey under Thai-German cooperation entitled "Promotion of Health and Nutrition Status of Rural Women in Northeast Thailand". The prevalence of goiter (grades 1A, 1B, 2 and 3) were 71.6 per cent in Pupaman, 58.4 per cent in Amphoe Si Chomphu and 35.1 per cent in Amphoe Chum Phae. However, the percentage of urine iodine deficiency of the women from these districts, is reversely with the palpation grading of thyroid gland. The high prevalence of goiter in Pupaman might occur due to goitrogenic effects, although the urine iodine concentration was lower than other districts. Further study about the determination of thiocyanate should be suggested in the high prevalence of goiter.

Nutritional health and parasitic infection of rural Thai women of the child bearing age.

The nutritional and health status of non-pregnant women of child bearing age from 20 villages of two districts in Maha Sarakham Province, approximately 500 km northeast of Bangkok, were investigated in April 1987. About 12 per cent of the studied women had a body mass index below 18.7 which is used as a cut-off point of being undernourished. Fat stores and muscle mass were smaller when compared to western females. Only two per cent of the women investigated had low serum albumin, indicating a severe deprivation in the nutritional status. A relatively high prevalence of anaemia was also found. Iron deficiency and haemoglobinopathy are common causes of anaemia. In addition, vitamin B2 depletion also contributes to the high rate of anaemia. Gastrointestinal parasitic infection rates were high with liver fluke, hookworm and echinostomiasis. Hookworm infection had no effect on the rate of anaemic, most probably the worm load in the women infected was rather low. It is recommended that the nutritional health of rural adolescents and young women should be enhanced by generally improving dietary habits and the quality of nutrient intake especially through protein, vitamins and micronutrient. Public health programmes focused on preventive activities should be aimed at this group in order to reduce the prevalent rate of undernutrition, anaemia and parasitic infection.

Familial clustering of presumptive sudden unexplained death syndrome (PSUDS).

Regarding the suggestion that presumptive sudden unexplained death syndrome (PSUDS) may be genetically associated, we recently conducted a study to reveal the clustering of the PSUDS in extended families. The data collection was done through case searching, interviewing using structured questionnaires and cross-referencing among informants. The precise criteria were used to identify the SUNDS cases. The collected data were age, sex, time and place of death, details of events at death, and vital statistics of relatives. There were forty-nine families with 418 family members included in the study. Twenty-five cases of PSUDS were reported from 14 families. All were men, with the mean age (+/- SD) 31.26 (+/- 7.01) years and the age range was 25-50. There were 6 clusters of SUNDS in sibling groups. Three of the clusters consisted of three siblings each and the other three clusters consisted of two siblings each. Most of the individuals in the siblings clusters had different occupations and died in different places and in different years. The aggregation of PSUDS in families is demonstrated. However, whether it is genetically related needs further study.

G-6-PD deficiency in the Pootai and the So communities in northeast Thailand.

The distribution of G-6-PD deficiency amongst two ethnic groups the Pootai and the So in northeast Thailand were studied. The prevalence of G-6-PD deficiency amongst the Pootai males was 9.7% while that amongst the So males was only 2.3%.