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.

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.

Nutritional status and serum lipids of a rural population in Northeast Thailand--an example of health transition.

An investigation was undertaken in Northeast Thailand, a country undergoing rapid health transition, to find out whether there is a likelihood that the nutritional and lipid pattern of an adult population in Northeast Thailand is related to coronary heart disease in the same way as in western countries. In a cross-sectional study, the body mass index (BMI) and the waist-hip ratio as well as the important plasma lipids were determined. The nutritional status and the lipid profile of the predominantly middle-aged population is characterised by a generally favourable nutritional status and lipid concentrations, where the distribution, indicated by the medians, of the relevant variables over the total population is concerned. A rather high proportion of individuals was found to be overnourished and to have high triglyceride levels. Individuals with high triglyceride levels run a risk of developing coronary heart disease only when the LDL-HDL fraction is above 5. Only 3% of the total population investigated had a LDL-HDL ratio above that value. Since hypertriglyceridaemia is also linked to the insulin-resistant syndrome, it is concluded that, if the mortality of coronary heart disease increases in future, then this must be accounted probably more to the after-effects of the insulin-resistant syndrome than to the direct effect of an atherogenic lipid pattern. This view is supported by a high prevalence of impaired glucose tolerance (IGT) and non-insulin dependent diabetes mellitus (NIDDM) in the population under survey. Preventive measures in the area should concentrate among others on reducing overnutrition, especially among women, and increasing physical activity and screening for NIDDM.

Evaluation and monitoring of iodine deficiency disorders in school children in north-east Thailand.

The possibility of improving iodine deficiency disorder (IDD) in school children in Khon Kaen province was investigated during the period of 1 year, using an operational research approach. Four schools in Pupaman and Srichompu districts, namely Ban Khoa Wong, Na Fai Witaya, Ban Pa Num Tieng and Ban Non Khom, were selected for this study. Ban Non Khom served as the control school. Different methods were used for iodine fortification. Iodized salt was used for the children of the Ban Khoa Wong school, iodized water was used for Na Fai Witaya school and iodized fish sauce was used for Ban Pa Num Tieng school. The iodized salt, water and fish sauce were provided with the help of the school teachers under the supervision and advice of the team of investigators. Urine iodine excretion as well as palpation of the thyroid gland and the thyroid hormones T4, T3 and TSH were selected for monitoring and evaluation. The proportion of children with low urine iodine excretion, indicated by a cut-off point suggested by the WHO/ICCIDD/UNICEF working group, decreased during the course of the project in all schools receiving iodine supplementation as well as in the control school. However, the decrease was less in the control school in comparison with the implementation schools. Furthermore, the goitre rate decreased in all schools under investigation. The decrease of the goitre rate for the children of the control school might have been due to the activities of a village health volunteer from a nearby village who was using iodized salt for IDD control according to the ongoing national programme initiated by the Ministry of Public Health. No significant difference in the level of thyroid hormones was detected before or at the end of the supplementation for either the experimental schools or the control school. The results from the determination of thyroid hormone serum levels could not be used for assessing the outcome of the project. The measuring of urinary iodine excretion might be helpful in monitoring the iodine intake during the intervention phase. Long-term effects of iodine fortification could be seen best by the declining proportion of children with goitre. However, an observation of 1 year might not have been enough to clearly see the outcome of the project. The other possible contributing error to this study is intra-observer variation of the palpation technique when the sample size was not big enough. Goitrogens in this area might be another risk factor for the high prevalence rate of goitre. Further study in this field should be encouraged. The results of the study indicate that iodine fortification of salt and fish sauce is more effective than iodine fortification of drinking water. Due to the local preference of adding fish sauce (nam pla) instead of salt to almost all dishes, fish sauce proved to be the best vehicle for iodine fortification. The success of the project depended heavily on the understanding and cooperation of the school teachers and the school children. Major constraints in conducting this project were the insufficient distribution of iodized salt and potassium iodide solution for the fortification of drinking water, and the inconsistency of iodide concentration in the salt after fortification.

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.

A self-administered device for cervical cancer screening in northeast Thailand.

OBJECTIVE: To test a self-scraping device as a mass screening device against a routine scraping method and to evaluate the acceptance of the self-scraping device by a group of rural females from Northeast Thailand. STUDY DESIGN: From a rural area of Northeast Thailand, 552 women were trained and motivated, through primary health care structures, to participate in a cervical cancer screening exercise using a self-scraping device. After one week, the same females were reexamined by gynecologists using the routine scraping method. In both cases the specimens were stained according to Papanicolaou. Through questionnaires the acceptance of the self-scraping device was evaluated. RESULTS: Through the self-scraping method, 13 cases suspicious for malignancy were detected. Specimens obtained through examination by physicians confirmed 11 cases to be suspicious for malignancy. No false negative cases were found. In the detection of inflammation, the self-scraping method was not as accurate as examination by a physician. The device was accepted by the females who participated in the study. CONCLUSION: In the rural areas of developing countries, where physicians and other trained medical personnel are not often available to carry out regular screening tests on a population basis, the self-scraping method can be applied as an integral part of primary health care for mass screening for uterine cervical cancer.

Vitamin B12, folic acid, ferritin and haemoglobin status of rural women in child-bearing age in northeast Thailand.

Serum vitamin B12, folic acid, ferritin and haematological variables were investigated in six hundred and seven women from 12 villages of 3 districts namely Chumpae, Srichumpu and Pupaman of Khon Kaen province, Northeast Thailand within the age range of 15-45 years. The cut-off point of haemoglobin concentration < 12 g/dl was applied for defining the normal and anaemic group (17.3%). The result showed that the concentration of ferritin, folic acid and vitamin B12 in the anaemic group were less than that of the normal group. Forty six out of 607 women or 7.6 per cent were found to be undernourished and 27.2 per cent of females were overnourished. The prevalence of deficiencies of vitamin B12, folic acid and ferritin were 6.3 per cent, 4.3 per cent and 12.5 per cent respectively.

Compliance of population groups of iodine fortification in an endemic area of goiter in northeast Thailand.

Methods of iodine fortification were tested among women of child bearing ages in four villages of Khon Kaen province, an endemic area of goiter in northeast Thailand, Ban Wang Pa Dum, Ban Pa Klauy and Ban Non Chart received iodine fortified in fish sauce, salt and drinking water respectively, whereas, Ban Non Sa-aad served as a control village. Urine iodine concentrations were investigated before supplement and after three and six months of the experimental period. Three months after supplement, urine iodine levels of villagers from Ban Non Chart and Ban Non Sa-aad were higher than those of Ban Wang Pa Dum and Ban Pa Klauy. Six months later, subjects from Ban Wang Pa Dum and Ban Pa Klauy who had received fortified fish sauce and iodinated salt respectively had significantly higher urine iodine concentrations than those of the other two villages. The result implied that fortified fish sauce and iodinated salt were well accepted by the villagers. However, fortified fish sauce might be the best and most feasible method because villagers use fish sauce more constantly in cooking and salting dishes.

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.

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%.