Effect of a mobile unit on changes in knowledge and use of cervical cancer screening among rural Thai women.

BACKGROUND: A large proportion of women in most developing countries, particularly in rural areas, have never had cervical cancer screening. This paper reports the effect of a cervical cancer screening programme using a mobile unit on changes in knowledge and use of Papanicolaou (Pap) smear screening among rural Thai women. METHODS: Health education and collection of Pap smears were carried out by the mobile unit throughout the 54 rural villages in Mae Sot District, Tak Province, between January and February 1993. To determine the extent of changes, we compared the results of two interview surveys of women 18-65 years old in the villages selected by systematic sampling for each survey, first in January 1991 and then in January 1994. RESULTS: A total of 1603 and 1369 women participated in each survey respectively. The proportion of women who knew of the Pap smear test increased from 20.8% in the first survey sample to 57.3% in the second survey sample. The proportion of those who had even been screened increased from 19.9% in the first survey sample to 58.1% in the second survey sample. These increases were observed solely among ever-married women and there were no significant changes among single women, most of whom remained unscreened. Of ever-married women, the magnitude of increase was highest in the age group 25-34 years, and declined with increasing age. CONCLUSIONS: Greater efforts should be made to encourage the use of screening among the older women. The use of mobile units may be helpful for rapid achievement of higher screening coverage in rural areas, where existing screening services cannot effectively cover the female population at risk.

PIP: A study was conducted in Mae Sot District, Tak Province, north of Bangkok. To determine knowledge and prevalence of use of the Pap smear screening, an interview survey was conducted of women 18-65 years old who had not undergone a hysterectomy in 7 villages selected from the 54 villages in January 1991. Only 333 of the 1603 women interviewed (20.8%) knew of the Pap smear test, and only 319 (19.9%) had ever been screened. To increase knowledge about the importance of the benefit of the Pap test and achieve a higher coverage, a mass screening campaign by a mobile unit was carried out between January and February 1993. Subsequently, in January 1994 an identical interview survey was conducted in 7 selected villages, which were entirely different from those in the previous survey, in order to evaluate the extent of changes of knowledge and use of the Pap smear screening among these rural women. 1369 eligible women participated in the 2nd survey. The proportion of those who knew of the Pap smear test increased from 20.8% in the 1st survey to 57.3% in the 2nd survey. The overall prevalence of screening increased from 19.9% in the 1st survey sample to 58.1% in the 2nd survey sample. Of those ever-screened women in the 2nd survey, 87.7% reported receiving a last Pap smear or = 1 year preceding the interview, compared with 52.0% in the 1st survey. Increase in screening prevalence was significantly evident in all age groups. Of ever-married women, the magnitude of increase was highest in the age group 25-34 years, and declined with increasing age. The results of the 2nd survey showed that women who reported knowing of the Pap test were more likely to receive a Pap smear (92.5%) than those who did not (12.1%). During the screening campaign by the mobile unit in 1993, 6816 out of 16,705 women 18-65 years old in the villages were screened, giving an attendance rate of 40.8%.

Effect of health education on community participation in control of dengue hemorrhagic fever in an urban area of Thailand.

Dengue hemorrhagic fever (DHF), a disease transmitted by Aedes mosquitos, remains a serious public health problem in Thailand. This paper describes the effect of health education efforts on a community-based DHF vector control program in the municipality of Mae Sot District, Tak Province, northern Thailand, from 1988 through 1990. In 1988, public health education on DHF and larval control through mass media, lectures and discussions reduced the Aedes Breteau index from 241 in March to 126 in June 1988. In 1989 and 1990, twice a year house-to-house visits by trained health workers were added to the health education campaigns. Aedes larval indices were decreased far more in the epidemic year of 1990 than in 1989. During this 3-year period, water-storage containers for drinking, washing, bathing and ant-traps were the primary sources of larval habitats, accounting for about 90% of the total breeding places. Reduction of Aedes larvae in these sources was due to various larval control measures. By August 1990 water containers for non-drinking purposes were the remaining important breeding places. The introduction of larvivorous fish may be an effective method of larval control for these containers. Most houses were supplied by public piped water system; however, a shortage of piped water for a period of time resulted in a significant increase in the number of water containers. An adequate water supply to the community should be provided continuously to prevent creation of new breeding places. Modifying behavioral practices to reduce domestic man-made water containers should be encouraged.

A survey of knowledge, attitude and practice of the prevention of dengue hemorrhagic fever in an urban community of Thailand.

To evaluate the effect of a health education program on the prevention and control of dengue hemorrhagic fever (DHF) in the municipality of Mae Sot, Tak Province, a survey of adult residents, mainly housewives, was conducted in late April 1990 to assess their knowledge of DHF and practice of preventive methods. A total of 417 respondents from 417 households selected by a systematic-cluster sampling method were interviewed. More than 90% of them knew that the disease is transmitted by Aedes mosquitos and indicated water jars and water retention in the houses as the common breeding places. However, the other two common breeding places, ant-traps and cement baths, were less frequently mentioned. This finding was consistent with the greater proportion of respondents who reported no larval control methods for these two kinds of containers than for the others. Covering water containers was the most common practice to prevent mosquito breeding in drinking-water containers whereas addition of abate (temephos sand granules) or changing stored water frequently was commonly used for non-drinking water storage. Larval control for ant-traps was mainly accomplished by the addition of chemicals, including abate, salt, oil or detergent. Health education efforts in this area could induce the majority of respondents to accept themselves as responsible for the Aedes control program. Health education by health personnel played an important role in disseminating DHF information and prevention methods. Radio and television were the main effective mass media for public health education on DHF in this area.

A survey of knowledge about AIDS and sexual behavior in sexually active men in Mae Sot, Tak, Thailand.

A survey of 15-34 year old men in Mae Sot, Tak, was conducted in December 1989 to determine their knowledge about AIDS, HIV transmission, and sexual behavior to guide future AIDS prevention programs. A total of 172 men from the municipality (urban) and 311 men from the surrounding villages (rural) were interviewed. More than 90% of both groups possessed knowledge about the existing modes of HIV transmission, however, there were some who had the mistaken belief that AIDS can be spread by mosquito bites, using public toilets, or through various forms of casual contact. These misconceptions in the community underscore the need for more education designed to counteract them. Although nearly all of them knew that condoms can prevent infection, only half of the urban and one-third of the rural sexually active men had ever used a condom during their sexual intercourse with prostitutes. However, condom use increased over time. Since a number of these men first engaged in sexual intercourse at an early age, the promotion of health education about AIDS in the schools is essential.

Effect of health education and condom promotion on behavioral change among low socioeconomic prostitutes in Mae Sot, Tak, Thailand.

A study was conducted to determine the effect of preventive educational efforts among 621 female prostitutes in Mae Sot, Tak Province, in 1989. The intensive health education program at a personal level and free condom distribution to the prostitutes began in March and June 1989, respectively. The proportion of prostitutes' sexual partners using condoms increased from 13.5% in January 1989 to 50.4% by December 1989. The reported increase in condom use was supported by the decline in the incidence rate of gonorrhea among the prostitutes during the same period. Anal intercourse was not commonly practised in these women and decreased from 9.7% in January to 1.8% in December 1989. None of the prostitutes interviewed throughout the year reported using intravenous drugs, nor reported having a steady sexual partner who was an intravenous drug user. None out of 248 prostitutes tested in January 1989 were HIV-1 seropositive. After that throughout the year, 15 of 373 (4.0%) additional prostitutes in this area were found to be seropositive on their first test. Ten out of 405 (2.5%) initially-seronegative prostitutes who were subsequently tested at 3-month intervals became seropositive. The effect of health education and condom promotion among our study prostitutes was modest. Similar studies are needed to evaluate the programs in other settings of Thailand, particularly in areas with high prevalence of HIV-1 infection.

Sociodemographic characteristics and incidence of gonorrhoea in prostitutes working near the Thai-Burmese border.

A study was conducted to determine the sociodemographic characteristics and incidence of gonorrhoea among the prostitutes working in Mae Sot District, Tak in 1988. Of the 238 prostitutes included in the study, 130 were Thai and 108 were Burmese. About 55% of the Thai group and 65% of the Burmese engaged in prostitution before being 19 years old. Most of them experienced sexual intercourse at early age of life. The charge per sex partner ranged from 50-500 baht (US$2-20), with a median of 100 baht (US$4) for both groups. The Thai prostitutes had a significantly higher mean number of clients per day and received more Thai clients than the Burmese. Anal and oral sex were not commonly practised among these prostitutes. Approximately 14% of the prostitutes' clients in both group used condoms. The mean infection rate of gonorrhoea was significantly greater in the Thai prostitute group than the Burmese. Multiple linear regression analysis revealed that the infection rate of both groups was inversely associated with the percentage of client using condoms and the duration of having been prostitutes, and positively associated with the percentage of Thai clients. The program for STD control should be directed towards the increase use of condoms, spermicides, and other barrier methods, and massive health education program on safer sex to this high risk group and the general population.