Matters of Gender and Social Disparities Regarding Postnatal Care Use Among Nepalese Women: A Cross-Sectional Study in Morang District.

Objective: The study compares the uses of postnatal care (PNC) and women's autonomy gradients across social caste and used intersectionality concepts to estimate odds ratio of women's autonomy and social caste on complete PNC. Methods: A community-based cross-sectional study among 600 women aged 15-49 years who had at least one child younger than the age of 2 years in Morang District, Nepal, was conducted from April to July 2019. PNC, women's autonomy (decision-making power, freedom of movement, and control over finances) and social caste were collected by both methods. Multivariable logistic regressions were used to determine associations between women's autonomy, social caste, and complete PNC. Results: Complete PNC totaled 13.5% of respondents. About one-fourth of respondents reported poor overall autonomy; however, non-Dalit demonstrated higher autonomy than Dalit. Non-Dalit exhibited greater odds of complete PNC by four times. Women exhibited high women's autonomy in decision-making power, control over finance, and freedom of movement and have greater odds of complete PNC than low autonomy by 17, 3, and 7 times, respectively. Conclusion: The study raises awareness of intersectionality (gender and social caste), relating to maternal health in caste-based system countries. To improve maternal health outcomes, health care personnel should identify and systematically address barriers that women of lower-caste membership face and offer these women appropriate advice or resources to obtain care. A multilevel change program that involves different actors like husbands and community leaders is needed for improving women's autonomy and lessening stigmatized perceptions, attitudes, or practices toward non-Dalit caste-members.

Effects of psychosocial factors on nonadherence to ART in Ganta, Nimba county, Liberia.

BACKGROUND: It has been widely noted that lifetime adherence to antiretroviral therapy (ART) is necessary for HIV treatment outcome; however, retention on ART among people living with HIV (PLWH) remains a great challenge to achieve the Global AIDS Strategy: End inequalities, End AIDS. Nonadherence to ART is one of the HIV care problem in Liberia despite the availability of free ART. Psychosocial factors, i.e., perceived stigma and social support likely contributed to nonadherence to ART. We investigated associations among clinical factors, psychosocial factors, and nonadherence to ART. METHODS: A community-based cross-sectional study was conducted among 185 PLWH, age ≥ 18 years receiving ART in Ganta, Nimba county, Liberia at least 3 months. The structured questionnaire was used to collect data from April to May 2020. Associated factors of nonadherence to ART were identified using multivariable binary logistic regression, and the p-value < 0.05 was considered statistically significant. RESULTS: Of 185 respondents, 62.2% showed nonadherence to ART. Females reported higher nonadherence compared with males (64.4% vs. 56.6%). Multivariable binary logistic regression revealed strong experiences of stigma (PORadj = 2.392, p-value = 0.018), poor information support (PORadj = 2.102, p-value = 0.026) increased prevalence of ART nonadherence among Liberian PLWH. CONCLUSIONS: The healthcare providers may apply interventions to reduce perceived stigma and to enhance continuous information provision in addition to support from health care providers and family members. An intensive monitoring of ART side effects is needed to be strengthened in particular among newly started ART patients.

Access to Health Service and Social Support Related to Self-Medication.

BACKGROUND: In developing countries including Nepal, medicine is easy to purchase with or without prescription over the counter. People's self-medication practice is a leading cause of antibiotic resistance. The purpose of this study was to assess self-medication practice and its influencing factors among rural people of Nepal. METHODS: A cross-sectional survey was conducted from total 62 wards in rural Rolpa district of Nepal.The probability proportional to size was applied to select 6 wards, then 115 households from each ward was selected by applying systematic random sampling.  Data collection was done by interviewing 720 household heads age 18 to 70 years old using a structured questionnaire in Nepal Results: The proportion of regular self-medication practice was 54.6%. Among them, 96.4% practiced self-medication when they got diarrhea/dysentery and 94.2% when they got a stomach ache. The factors associated with self-medication practice included gender (OR=2.24,95%CI=0.23-0.42), age (OR=5.59,95%CI=3.68-8.47), religion(OR=0.57,95%CI=0.42-0.77), family type (OR=4.00,95%CI=2.93-5.47), average income (OR=7.31,95%CI=5.04-10.56), decision making (OR=0.6,95%CI=0.44-0.82, health insurance(OR=1.64,95%CI=1.22-2.22), overall access to health service (OR=3.53,95%CI=2.55-4.90), and appraisal support(OR=2.24, 95%CI=1.66-3.02) Conclusions: Prevalence of self-medication in rural areas of Rolpa district was high among female, older people Accessibility to health service should be improved to reduce risk of self-medication practice. The health promotion related with benefit and side effect from self-medication are important for high risk group i.e. people over 30 years .

Intention to Extend Working Life among Thai Registered Nurses in Ministry of Public Health: A National Survey.

The serious shortage of registered nurses (RNs) in Thailand has made the Thai government tentatively propose a policy to extend the working life of Ministry of Public Health nurses. This study aimed to estimate the proportion of those RNs who intend to extend their working life and analyzed the associations between general characteristics, quality of work life, and job characteristics of the RNs and their intention to work past retirement age. This cross-sectional study was conducted from October 2016 to April 2017. Self-administered questionnaires were distributed nationally to 3,629 RNs in the age group 55-59 years and working for the Ministry of Public Health (MoPH), Thailand. The response rate was 85.0% (3,092 RNs). Due to the small number of male participants (n=74), males were excluded from the study. The analysis was limited to the 3,018 participants who returned the questionnaire and met the inclusion criteria. Descriptive statistics and multiple logistic regression were used for data analysis. Of the 3,018 participants, the proportion of RNs intending to extend their working life from 60 to 65 years was 30.5%. In the Service Department, the factors significantly associated with intention to extend working life were perceived good or very good health status, no shift work, monthly income more than 50,000 THB (1,595 USD), and having moderate or good working resources (p<0.01). In the four Academic Departments, perceived good or very good health status, monthly income more than 50,000 THB, family members not against the working life extension, and moderate or good working resources were the factors affecting intention to extend working life (p<0.01). This study indicated that understanding the various factors related to the intention to extend working life among RNs could lead to the design of appropriate programs to encourage them to continue working after the current retirement age.

Participatory capacity building for improving quality of childcare centers in Thailand.

INTRODUCTION: Childcare centers (CCCs) with good quality standards can be effective in reducing the risk of diseases being easily spread from person to person. The aim of the present study's program, adapted from a method used by the United Nations Development Program, was to increase the capacity of local administrators(s) and heads of CCCs to improve quality standards. METHODS: This study was quasi-experimental, with a one group pretest-post-test design. In this study the authors describe the effects and impacts of the program in Chonburi Province in eastern Thailand. Six LAs and 48 CCC heads were trained regarding (1) knowledge of the Thai Department of Health quality standards, (2) implementation and assurance and (3) program evaluation. The program consisted of three sequential participatory workshops. Effects at the center level were increased overall knowledge of quality standards of CCCs (QCCC), and developed skills of improvement plans. The impact at the center level was CCCs achieving the QCCC. At the child level it was the reduction in the period prevalence of three diseases and two symptoms. RESULTS: The significant (p<0.05) effects and impacts at the center level were increased overall knowledge of QCCC in LAs and CCC heads and increased overall managerial skills of CCC heads. At the child level, the period prevalence of chickenpox and diarrhea symptom were reduced. CONCLUSION: Participatory capacity building is an appropriate way to enhance the managerial skills of LAs and heads of CCCs for improving quality of CCCs to meet the local authority and the Ministry of Public Health quality standards.

Sleep quality and associated factors among the elderly living in rural Chiang Rai, northern Thailand.

OBJECTIVES: This study aimed to characterize the prevalence of poor sleep quality and to identify associated factors among community-dwelling elderly individuals in northern Thailand. METHODS: A cross-sectional study was conducted among 266 randomly selected elderly people in a sub-district in rural Chiang Rai Province, northern Thailand. The participants were interviewed using the Thai version of the Pittsburgh Sleep Quality Index (PSQI). RESULTS: Roughly 44.0% of the participants had poor sleep quality (PSQI score, >5), 9.4% used sleep medication, 27.1% had poor family relationships, and 12.0% had mild depression. Multiple logistic regression analysis indicated that being female (odds ratio [OR], 1.74; 95% confidence interval [CI], 1.10 to 3.02), a higher education level (OR, 3.03; 95% CI, 1.34 to 6.86 for primary school; OR, 2.48; 95% CI, 1.31 to 5.44 for higher than primary school), mild depression (OR, 2.65; 95% CI, 1.11 to 6.36), and poor family relationships (OR, 3.65; 95% CI, 1.98 to 6.75) were significantly associated with poor sleep quality. CONCLUSIONS: The prevalence of poor sleep quality among the elderly was moderately high. Healthcare providers should regularly conduct screenings for sleep quality and depression; provide sleep health education; and conduct interventions to encourage participating in family activities, resolving conflicts, sharing ideas, and making compromises within the family.

Assessing disaster preparedness and mental health of community members in Aceh, Indonesia: a community-based, descriptive household survey of a national program.

INTRODUCTON: Disaster preparedness of the community is an essential disaster-mitigation strategy to protect human life and to prevent injuries and property damage. This study aimed to assess the knowledge of disaster, and the disaster preparedness of community members in Aceh, Indonesia. METHODS: A community-based descriptive household survey was conducted in 40 villages of three tsunami-affected districts in Aceh State, Indonesia. In total, 827 randomly selected community members were interviewed with structured questionnaires during the period September-October 2014. RESULTS: About 57.6% of community members had good knowledge of disaster, while 26.0% had good community disaster preparedness. Neither knowledge of disaster nor disaster preparedness of community members achieved the target of the Community Mental Health Nurse Program outcome indicators (<70.0%). CONCLUSIONS: The proportions of people with good knowledge of disaster and disaster preparedness were quite low. The government of Aceh State should revitalize the program to improve the effectiveness of community mental health nurses in transferring the knowledge of disasters and disaster preparedness to the community's members, then expand it to other provinces of Indonesia, using standard approaches and the lessons learned from Aceh.

Evaluation of mass drug administration in the program to control imported lymphatic filariasis in Thailand.

BACKGROUND: Migration plays a major role in the emergence and resurgence of lymphatic filariasis (LF) in many countries. Because of the high prevalence of Imported Bancroftian Filariasis (IBF) caused by nocturnally periodic Wuchereria bancrofti and the intensive movement of immigrant workers from endemic areas, Thailand has implemented two doses of 6 mg/kg diethylcarbamazine (DEC) with interval of 6 months to prevent IBF. In areas where immigrants are very mobile, the administration of DEC may be compromised. This study aimed to evaluate DEC administration and its barriers in such areas. METHODS: A cross-sectional study with two-stage stratified cluster sampling was conducted. We selected Myanmar immigrants aged >18 years from factory and fishery areas of Samut Sakhon Province for interview with a structured questionnaire. We also interviewed health personnel regarding the functions of the LF program and practice of DEC delivery among immigrants. Associations were measured by multiple logistic regression, at P <0.05. RESULTS: DEC coverage among the immigrants was 75 %, below the national target. All had received DEC only once during health examinations at general hospitals for work permit renewals. None of the health centers in each community provided DEC. Significant barriers to DEC access included being undocumented (adjusted OR = 74.23; 95 % CI = 26.32-209.34), unemployed (adjusted OR = 5.09; 95 % CI = 3.39-7.64), daily employed (adjusted OR = 4.33; 95 % CI = 2.91-6.46), short-term immigrant (adjusted OR = 1.62; 95 % CI = 1.04-2.52) and living in a fishery area (adjusted OR = 1.57; 95 % CI = 1.04-2.52). Incorrect perceptions about the side-effects of DEC also obstructed DEC access for Myanmar immigrants. All positive LF antigenic immigrants reported visiting and emigrating from LF-endemic areas. CONCLUSION: Hospital-based DEC administration was an inappropriate approach to DEC delivery in areas with highly mobile Myanmar immigrants. Incorporating health-center personnel in DEC delivery twice yearly and improving the perceptions of DEC side effects would likely increase DEC coverage among Myanmar immigrants.

Smoking, alcohol consumption and betal-quid chewing among young adult Myanmar laborers in Thailand.

Health-risk behaviors among young adults are a serious public health problem. This cross sectional study aimed to estimate the prevalence of single and concurrent multiple health-risk behaviors: smoking tobacco, consuming alcohol, and chewing betel quid among young adult Myanmar laborers in Mae Sot District, Tak Province, Thailand. Three hundred Myanmar laborers, aged 18-24 years, were interviewed using a structured questionnaire. About 33.6% reported no risk behaviors, 24.7% had one, and 41.7% had two or three risk behaviors. Multinomial logistic regression analysis showed six variables were significantly associated with health-risk behaviors: male gender, high/moderate custom/traditional influences, friends who smoked/consumed alcohol/chewed betel quid, and exposure to betel-quid chewing by other family members.

The effort-reward imbalance work-stress model and daytime salivary cortisol and dehydroepiandrosterone (DHEA) among Japanese women.

We examined the influence of work-related effort-reward imbalance and overcommitment to work (OC), as derived from Siegrist's Effort-Reward Imbalance (ERI) model, on the hypothalamic-pituitary-adrenocortical (HPA) axis. We hypothesized that, among healthy workers, both cortisol and dehydroepiandrosterone (DHEA) secretion would be increased by effort-reward imbalance and OC and, as a result, cortisol-to-DHEA ratio (C/D ratio) would not differ by effort-reward imbalance or OC. The subjects were 115 healthy female nursery school teachers. Salivary cortisol, DHEA, and C/D ratio were used as indexes of HPA activity. Mixed-model analyses of variance revealed that neither the interaction between the ERI model indicators (i.e., effort, reward, effort-to-reward ratio, and OC) and the series of measurement times (9:00, 12:00, and 15:00) nor the main effect of the ERI model indicators was significant for daytime salivary cortisol, DHEA, or C/D ratio. Multiple linear regression analyses indicated that none of the ERI model indicators was significantly associated with area under the curve of daytime salivary cortisol, DHEA, or C/D ratio. We found that effort, reward, effort-reward imbalance, and OC had little influence on daytime variation patterns, levels, or amounts of salivary HPA-axis-related hormones. Thus, our hypotheses were not supported.

Health-science students' self-efficacy, social support, and intention to work in rural areas of the Lao People's Democratic Republic.

INTRODUCTION: The Lao People's Democratic Republic (PDR), like almost all countries, is faced with a shortage of qualified health workers in rural and remote areas. The situation has worsened due to the unbalanced distribution of the health workforce, resulting from a tendency to gravitate to more central areas. METHODS: This cross-sectional study aimed to assess the proportion and associated factors affecting intention to work in a rural area among health science students in Vientiane, Lao PDR. All 403 final-year undergraduate and postgraduate students at the University of Health Sciences (UHS) in Vientiane - the only tertiary education facility that produces medical, family medicine, dentistry, pharmacy, medical technology, and nursing students - were asked to fill out self-administered questionnaires. In total, 356 respondents returned the completed questionnaires, yielding a response rate of 88.3%. RESULTS: Of the respondents, 40.7% (145/356) reported an intention to work in a rural area; 90.0% (131/145) preferred to work at district level; 21.3% reported high self-efficacy, whereas 79.8% reported low perceived social support for working in a rural area. Multiple logistic regression analysis revealed four variables were associated with intention to work in a rural area: hometown in a rural area; moderate/high self-efficacy; father having a secondary/high school education; and being a medical, family medicine/dentistry/pharmacy student. CONCLUSIONS: To increase the proportion of UHS graduates intending to work in a rural area, improved recruitment of students from rural areas, and enhanced self-efficacy and social support, are required.

Quality of life of stroke survivors: a 3-month follow-up study.

The assessment of stroke survivors' quality of life (QoL) is essential for planning poststroke therapy strategies. This study aimed to assess, compare, and identify predictors of unsatisfactory QoL in different dimensions of stroke survivors at 1 month and 3 months poststroke. A total of 125 stroke survivors were recruited from 4 public hospitals under the auspices of the Department of Medical Services, Bangkok Metropolitan Administration, Thailand, and followed for 3 months. QoL was assessed using the self-administered SF-36 Health Survey, version 2.0. Six specific dimensions of QoL--physical function, role-physical, bodily pain, general health, vitality, and role-emotional--were significantly improved at 3 months poststroke; however, 2 dimensions--social function and mental health--were not. Multiple logistic regression analysis revealed that at 1 month poststroke, significant predictors of unsatisfactory QoL were being dependent (Barthel Index score <80), severe cognitive impairment (Canadian Neurological Scale score <7), right hemisphere lesions, being single or widowed, age ≥ 60 years, and being unemployed poststroke. At 3 months poststroke, significant predictors of unsatisfactory QoL were being dependent (Barthel Index score <80), severe cognitive impairment (Canadian Neurological Scale score <7), being single or widowed, being unemployed poststroke, and self-supporting/other support for treatment fees. This follow-up study demonstrated a significant improvement in QoL from 1 month to 3 months poststroke. Predictors of QoL varied both over time poststroke and over the specific dimensions of QoL being considered.

Improvement of district hospital service system to increase treatment adherence among tuberculosis patients in Pakistan.

Adherence to medication regimen is essential for tuberculosis (TB) treatment success. We carried out quasi-experimental, single group intervention study at Rawalpindi District Hospital to improve TB patient treatment adherence using a Chronic Care Model (CCM). Ninety-nine newly diagnosed TB patients at the TB Clinic, Rawalpindi District Hospital, during February-March 2009, were included in the study. A set of four quality indicators were determined based on current scientific evidence: quality of service system, patient satisfaction, treatment adherence and cure rate. Care quality changes over time were analyzed by paired t-test. Significant improvements in service quality were seen post-intervention. Overall, the hospital service system quality improved to "good" (from 1.0% to 28.3%), and patient satisfaction increased to "good" (10.2% to 54.1%). Treatment adherence increased (from 23.2% to 56.1%). The quarterly cure rate increased notably (5.3% to 17.2%). The overall mean scores for hospital service system quality, patient satisfaction, and TB patient treatment adherence, improved significantly 6 month post-intervention (p<0.001).

Self-efficacy, self-care behaviors and glycemic control among type-2 diabetes patients attending two private clinics in Yangon, Myanmar.

This cross-sectional study aimed to estimate the prevalence of glycemic control and its associated factors among type-2 diabetes patients attending two private clinics in Yangon, Myanmar. Two hundred sixty-six diabetes patients attending two private diabetes clinics in Yangon during February and March, 2009 were included in the study. The participants completed a structured questionnaire. HbA(1c) was used as the index for glycemic control. The prevalence of successful glycemic control (HbA(1c) < or =7%) was 27.1%. The median HbA(1c) value was 7.8%. About 62.0% of patients had high self-efficacy levels, and 30.8% had good self-care behavior. Multiple logistic regression analysis revealed four variables associated with glycemic control: age > or =60 years (OR 2.46, 95% CI 1.17-5.21), taking one oral hypoglycemic agent (OHA) (OR 2.56, 95% CI 1.26-5.19), being overweight (OR 2.01, 95% CI 1.02-3.95) and having a high self-efficacy level (OR 5.29, 95% CI 2.20-12.75). Interventions to increase diabetic patient self-efficacy levels and self-care behavior, especially related to diet and exercise, are needed to reduce poor glycemic control.

Job strain among rubber-glove-factory workers in central Thailand.

Job strain has become a major concern because of its potential impacts on worker well-being and performance. This cross-sectional study aimed to assess the prevalence of, and examine factors associated with, job strain among workers in a rubber-glove factory, in a central province of Thailand. A total of 200 workers aged 18-55 yr, who had worked at the factory for at least 6 months, completed the Job Content Questionnaire (JCQ) (Thai Version). Two of 5 scales in the JCQ were used to measure job strain, i.e.; job control and psychological job demand. The prevalence of job strain was 27.5%. Multiple logistic regression analysis indicated two variables significantly associated with job strain: low supervisor social support (adjusted OR=3.08; 95%CI: 1.38-6.91) and high job insecurity (adjusted OR=2.25; 95%CI: 1.04-4.88). Effective training for supervisors, to create good relationships among workers and supervisors, and ensuring steady and secure jobs for good employees, are necessary.

Serum cholinesterase levels of Thai chilli-farm workers exposed to chemical pesticides: prevalence estimates and associated factors.

OBJECTIVE: To estimate the prevalence of, and factors associated with, abnormal serum cholinesterase (SChE) levels among chilli-farm workers in Chatturat District, Chaiyaphum Province. METHODS: A total of 350 chilli-farm workers aged 18-60 yr were randomly sampled and interviewed. A reactive-paper finger-blood test was used to assess SChE levels. RESULTS: The prevalence of abnormal SChE levels was 32.0%. The most common pesticide-related symptoms were dizziness (38.0%), headache (30.9%), nausea/vomiting (26.9%), and fever (26.9%). Multiple logistic regression analysis revealed 7 factors were independently associated with abnormal SChE level: male gender, single/separated/divorced, being a permanent worker, spraying pesticide more than 3 times per month, having moderate or poor pesticide-use behaviors, and low perceived susceptibility and severity of pesticide use. CONCLUSIONS: The prevalence of abnormal SChE levels among chilli-farm workers was quite high. It would be beneficial to decrease pesticide use and encourage alternative measures. Effective preventive interventions to increase correct perceptions of pesticide use, the use of personal protective measures and continuing monitoring for blood cholinesterase, especially for male permanent farm workers, are recommended.

Factors relating to acceptance of hepatitis B virus vaccination by nursing students in a tertiary hospital, Pakistan.

This cross-sectional study aimed at assessing the prevalence of, and factors relating to, the acceptance of hepatitis B virus (HBV) vaccination by nursing students in a tertiary hospital in Pakistan. In total, 210 nursing students of Year 2 to Year 4 were invited to participate in the study; of them, 196 (93.3%) returned completed questionnaires. Overall, the prevalence of acceptance of HBV vaccination among them was 75.0%. Of these, 37.2% (73/196) were completely vaccinated, and 25.0% (49/196) had not been vaccinated at all. More than half (27/49, 55.1%) of the unvaccinated nursing students stated that they would accept vaccination if offered. Multiple logistic regression analysis indicated three variables significantly related to acceptance of HBV vaccination: history of accidental exposure to blood or blood products, acceptable knowledge about HBV infection, and adequate budget for HBV vaccination. Health institutions should allocate adequate budgets to vaccinate their nursing students. Effective intervention programmes designed to increase knowledge about HBV infection and adhering to universally-accepted precautions are needed.

Participatory supervision model: building health promotion capacity among health officers and the community.

INTRODUCTION: The Thai traditional health supervision model has been developed since 1991. However, many supervisors lack supervisory knowledge and skills. This study aimed to compare and identify the strengths and challenges of two different supervision models, in order to determine their effects on enhancing the health promotion capacity of health officers in two primary care units (PCU) in Chiang Mai Province, northern Thailand. METHODS: The two models were implemented at two PCU in one semi-district, Chiang Mai Province, over a six-month period. The first model involved supervisors from the district level, with the full participation of health officers at the sub-district level. The second model was designed with the addition of community involvement in the supervision process. Before implementing the models, the district supervisors attended a retraining course to enhance their supervisory knowledge and ability. Questionnaires were used to assess health officers' job satisfaction, clients' perceived service quality and care satisfaction. Semi-structured interviews and qualitative observations were used to explore the involvement of health officers and the community, and to determine the strengths and challenges of each supervisory model. RESULTS: Both before and after the intervention, the PCU health officers appeared to have good and comparable job satisfaction levels. Bivariate analysis indicated that after the intervention, both supervisory models appeared effective in terms of clients' perceived service quality and satisfaction with care, among those who utilized the PCU. However, the second model, which allowed the community to participate in the supervision process, achieved better results. The qualitative findings suggested that the involvement of health officers caused a rapid change and improvement after the supervision. The involvement of the community helped the community itself to identify problems and formulate alternatives to meet the community's needs. CONCLUSIONS: This study shows positive outcomes for two forms of participatory supervision in a rural setting. There appear to be additional positive outcomes for the model that involved community participation. To ensure successful implementation, several issues, such as the supervisor's knowledge and ability, health officer workload and supervisory communication skills, need to be improved.

Behaviors and perceptions of Japanese tourists affecting diarrheal illness and health care need assessment: A questionnaire study.

OBJECTIVES: To measure the prevalence rate of, and determine the association between food and drink related behaviors and diarrheal illness among Japanese tourists, and assess their health care needs. METHODS: Eligible Japanese tourists (1,480) aged ≥15 years traveling in Chiangmai Province in the north, Ayutthaya Province in the center, Kanchanaburi Province in the west, Pattaya City in the east, and Krabi Province in the south of Thailand were enrolled in the study. Of these tourists, 1,318 consented to participate in this study and completed questionnaires in Japanese, giving a response rate of 89.1%. RESULTS: Among these Japanese tourists 21.3% had diarrheal illness, and of these tourists, 5.0% had classical travelers' diarrhea (TD), 11.8% had mild TD, 3.3% had good food and drink related behaviors, and 75.4% had moderate level of perception of diarrhea related to drinking and eating. Multiple logistic regression analysis indicated three significant diarrheal illness predictors: large number of previous visits to Thailand, longer stay in Thailand, and the experience of visiting other countries. Furthermore, 56.9% suggested providing an adequate number of toilets at tourist destinations; 53.9% suggested providing a 24-hour emergency call facility for a public ambulance; and 51.9% suggested providing garbage bins and garbage disposal facilities at tourist destinations. CONCLUSIONS: TD still affects experienced Japanese tourists who visit Thailand. Although the proportions of the good levels of food and drink related behaviors were low, there were indications that Japanese tourists perceived the risk of contracting TD.

Strengthening the capability of family health leaders for sustainable community-based health promotion.

The Family Health Leader (FHL) Project was initiated in 1997 to encourage self-care and health promotion. Since then, there has been no retraining. This study aimed to strengthen the FHLs' capability to sustain community-based health promotion and network establishment. The study, of a quasi-experimental design, was conducted in a village in Phan Thong district, Chon Buri Province, Thailand. The intervention emphasized enhancing the FHLs' knowledge, ability, leadership and motivation to advance health promotion activities. Before implementing the main intervention, 5 community health workers were trained as facilitators to strengthen 36 FHL capabilities. The curriculum and manual for training facilitators and FHLs were also developed. The intervention for strengthening FHLs' capabilities lasted for 7 months using participatory training. A within-subject repeated ANOVA was used to measure changes in the main outcome variables immediately, and at three and six months after the intervention. A qualitative methodology was utilized to assess network establishment. The results indicate that the FHLs' knowledge of self-care and health promotion, ability, leadership and motivation had increased significantly after the intervention (p < 0.001). The FHLs also sought to extend their network by involving both the community committee and the local authorities. The intervention appeared to be successful in strengthening the FHLs' capabilities to sustain health promotion within the community, and it established networks vertically and horizontally. The FHLs were the key persons to bring good health to family members. Periodical participatory learning and group empowerment are recommended for encouraging the FHLs to maximize their potential for family self-care and health promotion.