A mobile unit: an effective service for cervical cancer screening among rural Thai women.

BACKGROUND: We carried out a systematic screening programme using a mobile unit with the purpose of increasing use of Papanicolaou (Pap) smear screening among rural Thai women. The mobile unit campaign was carried out initially between January and February 1993 and then in 1996 in all the 54 rural villages in Mae Sot District, Tak Province, northern Thailand. METHODS: To evaluate the effect of the programme on changes in knowledge and use of screening, we compared the results of three interview surveys of women, 18-65 years old, in villages selected by systematic sampling for each survey; first in 1991 (before the operation of the programme), secondly in 1994 (one year after the first screening campaign), and last in 1997 (one year after the second campaign). This report also compares data on Pap smears taken by the mobile unit with other existing screening services in the study area. RESULTS: A total of 1603, 1369, and 1576 women respectively, participated in each survey. The proportion of women reported knowing of the Pap smear test increased from 20.8% in 1991 to 57.3% in 1994 and to 75.5% in 1997. The proportion of women who had ever had a Pap smear increased from 19.9% in 1991 to 58.1% in 1994 and to 70.1% by 1997. Screening by the mobile unit accounted for 85.2% of all cervical intraepithelial neoplasia (CIN) III and all invasive cancers identified among the Pap smears taken by screening services in the area between 1992 and 1996. The rate of CIN III was 3.5/1000 smears in this screening programme, which was 5.2 and 2.0 times higher than the rates in the maternal and child health/family planning clinic and the annual one-week mass screening campaign respectively. CONCLUSIONS: The use of a mobile unit may be an effective screening programme in rural areas where existing screening activities cannot effectively reach the female population at risk.

PIP: A mobile cervical cancer screening campaign was conducted in both 1993 and 1996 in all 54 rural villages in Mae Sot District, Tak Province, in northern Thailand. The impact of the program on women's knowledge of cervical cancer and uptake of Pap smear testing was evaluated in 3 rounds of survey of women 18-65 years of age from the area served by the mobile unit. 1603 women were interviewed in 1991 before program implementation, another 1369 women were surveyed in 1994, and 1576 were enrolled in the 1997 survey. Awareness that cervical cancer can be asymptomatic increased from 19.5% in the baseline survey to 52.8% in 1994 and 63.9% in 1997. The proportion of women knowledgeable about Pap smears increased from 20.8% in 1991 to 57.3% in 1994 and 75.5% in 1997. The proportion of women who had ever had a Pap smear rose from 19.9% in 1991 to 58.1% in 1994 and 70.1% in 1997. Screening by the mobile unit accounted for 85.2% of all cervical intraepithelial neoplasia (CIN) III and all invasive cancers detected by Pap smear in the study area during 1992-96. The rate of CIN III was 3.5/1000 smears in the mobile screening program compared with 0.7/1000 in the maternal-child health/family planning clinic and 1.8/1000 in the annual 1-week mass screening campaign. These findings confirm that a mobile unit is an effective tool in rural areas where existing screening activities cannot reach all the women at risk of cervical cancer.

Screening assessment of persons 40-59 years of age in rural Thailand by a mobile health unit.

This paper reports a screening survey using a mobile unit to determine the prevalence of chronic disorders among persons aged 40-59 years in rural Thailand. A total of 4,812 persons from all the 54 rural villages in Mae Sot District, Tak Province, northern Thailand, were interviewed and examined in 1995. A higher proportion (59.3%) of men were current tobacco smokers than among women (40.4%). A higher proportion (69.6%) of men were current alcohol drinkers compared with women (38.6%). Cutting/piercing was the most frequently reported injury, followed by falls. About half (47.9%) of the persons surveyed had a body mass index (BMI) between 20 and 24.9 and only 2.6 per cent had a BMI of 30 or over. The overall prevalence rates of hypertension and diabetes in the persons surveyed were 13.3 per cent and 2.4 per cent respectively. Of the persons screened, 28.8 per cent had borderline-high blood cholesterol (200-239 mg/dl) and 12.9 per cent had high blood cholesterol (> or = 240 mg/dl). About 61 per cent of hypertensive persons, 92 per cent of diabetic persons, and nearly all of those with dyslipidaemia were first detected during this screening programme. Five women with breast cancer and 22 with benign breast disorders were also identified during the survey. A screening programme using a mobile unit may be useful in identifying treatable disorders in rural areas, where existing screening services cannot effectively cover the population at risk.

Effect of motorcycle rider education on changes in risk behaviours and motorcycle-related injuries in rural Thailand.

A community-based programme for motorcycle rider education was provided for motorcyclists in all villages of 3 randomly selected subdistricts in Mae Sot District, Tak Province, northern Thailand, between January and March 1995. To determine the extent of changes in risk-taking behaviours, we conducted an interview survey of motorcyclists in 3 villages selected by systematic sampling from the 3 intervention subdistricts and in 3 control (without intervention) villages for comparison in March 1997, 2 years after the programme. Motorcyclists in the intervention villages (69.7%) were significantly more likely to have valid licences than those in the control villages (46.5%). The proportion of motorcyclists who always or often wore helmets was significantly greater in the intervention sample (46.0%) than in the control sample (20.5%). In 1994, the annual incidence rate of motorcycle-related injuries was slightly higher in the intervention areas than in the control areas Following the education programme, the injury rates for 1995 and 1996 were significantly lower in the intervention than in the control population. The annual number and rate of fatal motorcycle injuries decreased after the intervention although there was no significant difference between the two populations. Motorcycle rider education may be a promising intervention for prevention of motorcycle-related injuries in rural areas where road safety measures, particularly enforcement activities, are commonly limited.

Screening assessment of the elderly in rural Thailand by a mobile unit.

Using a mobile health unit, we conducted a survey to determine the prevalence of social and medical problems among an elderly population in rural Thailand. 3302 persons aged 60 years and older from 54 villages in Mae Sot District, Tak Province, northern Thailand, were interviewed and examined between November 1993 and April 1994. About 4% of those surveyed lived alone and most of them preferred to remain with their relatives and neighbours in the community. The proportion of current tobacco smokers was slightly higher in men (55.5%) than in women (51.4%). Men also had a higher proportion of current alcohol drinkers (20.3%) than women (5.3%). About 80% of the elderly reported having used medication within one month before the interview. Falls were the most common cause of reported injury, followed by cutting/piercing. The proportion of the elderly who had difficulty with activities of daily living was higher for women than men and increased with age. Meal preparation was the most common activity needing help. About 58% of hypertensive persons and 75% of those with diabetes were first detected during the survey. Some persons with treatable disorders such as senile cataract and dyslipidaemia were also detected by the screening programme. Geriatric screening assessment using mobile units may be helpful in uncovering treatable conditions among the elderly in rural areas.