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.

Effect of dietary modification on changes in serum lipids among rural Thai persons with hypercholesterolemia.

This article reports on the effect of dietary modification on changes in eating patterns and serum lipids among hypercholesterolemic persons aged 40-59 years with no evidence of coronary heart disease in Mae Sot District, Tak Province, between 1995 and 1996. A total of 381 persons with total cholesterol levels > or = 240 mg/dl and triglyceride levels < 400 mg/dl were educated, counseled, and followed-up by the mobile health team at the health centres in the communities. The team comprised both hospital personnel (a physician, a health educator, and public health nurses) and the health centre workers. Of the 381 study persons, 331 (86.9%) completed the one-year follow-up. The participants at one-year follow-up were more likely than at baseline to reduce intakes of dietary fat and cholesterol, whereas, there was an increased intake of vegetables and fruits. The mean total cholesterol level significantly decreased from 258.9 mg/dl at baseline to 236.1 mg/dl at one-year follow-up (p < 0.01), giving an 8.8 per cent reduction. The mean change in low-density lipoprotein cholesterol levels was a 26.0 mg/dl decrease (p < 0.01), yielding a 15.1 per cent fall. The mean high-density lipoprotein cholesterol level increased from 44.6 mg/dl at baseline to 46.8 mg/dl at one-year follow-up (p < 0.01). The proportion of those who had a body mass index of < 25 slightly increased from 70.7 per cent at baseline to 72.5 per cent at one-year follow-up. The dietary intervention program by the mobile team may be useful for lowering serum cholesterol among the rural population with hypercholesterolemia.

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.

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%.

Epidemiologic characteristics of drivers, vehicles, pedestrians and road environments involved in road traffic injuries in rural Thailand.

This report presents descriptive epidemiology of vehicle-related crashes that caused severe injuries in a defined geographical area in northern Thailand, conducted to determine the nature of injuries and factors that contributed to the crashes. In each incident, the driver and other victims were identified and interviewed by a trained public health worker using a standard investigation form. During 1991, 286 single-vehicle crashes (66.4%), 117 crashes with other vehicles (27.1%), and 28 crashes involving pedestrians (6.5%) occurred in the area. These crashes injured 581 persons (551 vehicle occupants and 30 pedestrians), of whom 36 (6.2%) died. The vehicles involved in the crashes included 11 bicycles (2.3%), 371 motorcycles (78.6%), and 90 other motor vehicles (ie, pick-up trucks, lorries, and cars) (19.1%). Motorcycle-related crashes accounted for the majority of injuries and deaths. Driver risk factors for traffic injuries, such as alcohol consumption, lack of a valid driving licence, limited driving experience, and being a teenage driver, occurred more commonly among drivers of motorcycles than of other motor vehicles. Poor vehicle conditions and road environments reported in some incidents may have posed additional risks. Pedestrian factors, including young and old age, and alcohol use, may also have contributed to the occurrence of pedestrian injuries. Our system of data collection using an investigation form can provide relevant information, leading to the development of appropriate accident prevention programs for the community.