Women oppressed in the daily lives and cultural practices of the akha people, Thailand: how can the situation change?

BACKGROUND: Gender equality is one of the most concerning issues globally. Females lacking equality could lead to several impacts, including health and economic impacts. Gender equality is often present in some minorities, such as the Akha hill tribe people who live in remote areas and have poor educational and economic statuses. This study aimed to understand the patterns and forms of women's oppression through their norms and cultures. METHODS: A qualitative method was used to elicit information from participants in twelve group discussions. The participants were Pha Mee and Ulau Akha people living in six selected villages along the border of Thailand and Myanmar. Twenty-two main questions were used as a guide in the discussions, which were grouped by gender and conducted by a same-gender moderator. The findings were extracted and formed according to a thematic approach. RESULTS: A total of 72 Akha from six villages were invited to participate in the study: 29 males and 43 females. The average age was 47.7 years, 69.4% were married, 63.8% were Buddhist, 47.2% had never attended a school, and 47.2% worked in the agricultural sector. Several forms of Akha women's oppression were identified: oppression through daily life, religious rituals, son preference, novels and cradle songs, naming ceremonies, and work performances. Many factors acted as unorthodox patterns to relieve the oppression of Akha women: religious conversion, educational impact, exposure to people from outside villages, and social and economic roles. Oppressed Akha women moved through four layers: individual, family, community, and external culture and modernization. The combination of culture and globalization was a key factor in gender inequity through these four layers to balance the pressures to oppress and resist. CONCLUSIONS: Akha women have lived under the power of men for several years, and these men have built up common features to control women in their society. Improving gender inequity is important for moving to a better stage of health, quality of life, and social roles, which will increase the power of all people to improve their society in the future.

Epidemiology of and Factors Associated with Prehypertension Among Hill Tribe Adults Aged 30-59 Years in Thailand: A Cross-Sectional Study.

The study aimed to estimate the prevalence of and to determine the factors associated with prehypertension among the hill tribe aged 30-59 years. A cross-sectional study was conducted to collect data using a validated questionnaire and 5 mL blood specimens among six main hill tribe people living in 30 villages. Logistic regression was used to assess the associations between variables at a significance level of α = 0.05. A total of 1,076 individuals were recruited into the study: 67.3% were females, and 22.6% were aged 30-39 years. The overall prevalence was 67.8%. Six variables were found to be associated with prehypertension: being female; had family members ≤ 4 people; being members of Lahu, Hmong, Yao, Karen, and Lisu; had family debt; had overweight; and had a high total cholesterol. The implementation focused on encouraging active physical activity to reduce prehypertension is serious concerned and introduced.

Influences and patterns of intimate partner violence among married Akha and Lahu women in northern Thailand.

BACKGROUND: Intimate partner violence (IPV) is a major global public health problem. Women are the principal victims of IPV, and some special populations have been particularly impacted. The Akha and Lahu women are vulnerable populations for IPV due to the modernization and changes of their culture and norms. This study aimed to understand premarriage factors related to IPV, including associated factors, influencers, patterns and impacts, in Akha and Lahu women in Thailand. METHODS: A qualitative method was used to gather information among Akha and Lahu women who had experienced IPV in the previous year and were fluent in Thai. Women who had experienced IPV in the previous year and lived in the border area of Thailand and Myanmar were invited to provide information. A thematic analysis was used to extract information from the participants and develop findings. RESULTS: A total of fifty-two married women were recruited into the study: 46.2% were Akha and 53.8% were Lahu. Those married Akha and Lahu women younger than 39 years found their partner through social media, had conditions before getting married, had high self-confidence, and tended to marry people from different tribes. While those aged 40 years and over met their husbands in village activities, were highly compliant with the norms of their culture, and married men from the same tribe. Three factors were detected as associated factors of IPV: cultural differences between partners from different tribes, substance use, and personality. Differences in age between partners, living in poor family economic status, and poor education were also detected as influencers of IPV. Four patterns of IPV were observed among Akha and Lahu married women: neglect, emotional abuse, verbal abuse, and physical abuse. Several patterns of the impacts were presented: children were neglected, especially in the preparation of daily food, having stress, having poor family relationships, and having children with unsuccessful lives in terms of education and getting a good job. Almost all married Akha and Lahu women had no particular expectations in their lives. CONCLUSION: Akha and Lahu women face IPV problems with several key influences and impacts. Effective implementations are required to monitor and reduce the problem in the Akha and Lahu families, especially where the women are younger than 40 years old and married to men from different tribes.

Components of stigma and its impact on maternal and child health service and outcomes: perspective of Akha hill tribe women in Thailand.

BACKGROUND: Maternal and child health (MCH) is crucial to the well-being of mothers and children. Stigma regarding access to MCH services is a major challenge, especially for hill tribe people in Thailand. The study aimed to understand the components of stigma and its impact on MCH service and outcomes including experiences and expectations to address the stigma in perspective of Akha hill tribe women in Thailand. METHODS: A phenomenological qualitative approach was used to gather information from Akha women who had attended MCH service one year prior and had an experience with stigma. A validated question guide was used in the study. The interview was conducted in private and confidential rooms in the Akha hill tribe villages between June and September 2021. A thematic analysis was used to extract the major and minor themes and develop the findings. RESULTS: A total of 61 Akha postdelivery participants were recruited to provide information; the average age was 28.9 years, 32.8% had no Thai ID card, and 93.4% were married. Language, traditional clothing, poverty, and name were identified as drivers of stigma, while health care providers' background, gender differences between clients and health care providers, and knowledge gaps facilitated the stigma. Being a member of a hill tribe acted as the stigma marker. Stigma manifestation was presented in the forms of verbal or physical abuse, refusal to provide treatment, and intentional disclosure of personal information to the public. Accepting the situation with no better option, defending oneself to receive better care and services, and using a private care service were experiences in addressing the stigma. Gender matching, active MCH service, mobile emergency clinics, and appropriate, permanent medical equipment in health care facilities located in their villages were the expectations. CONCLUSION: Akha women face a variety of stigmas in access to MCH services, with substantial impacts on health outcomes, especially the rate of services in women and child health. Creating laws to prevent the occurrence of any forms of stigma and implementing gender matching in MCH services should be considered.

Epidemiology of prediabetes mellitus among hill tribe adults in Thailand.

BACKGROUND: Prediabetes is a major silent health problem that leads to the development of diabetes within a few years, particularly among those who have a low socioeconomic status. Hill tribe people are vulnerable to prediabetes due to their unique cultural cooking methods and their hard work on farms, as well as their low economic status and educational levels. This study aimed to estimate the prevalence of prediabetes among hill tribe people in Thailand and identify the related factors. METHODS: This cross-sectional study included participants who belong to one of the six main hill tribes: Akah, Lahu, Hmong, Yao, Karen, and Lisu. The study was conducted in 30 hill tribe villages in Chiang Rai Province, Thailand. A validated questionnaire was administered, and 5-mL blood specimens were collected. Data were collected between November 2019 and March 2020. Logistic regression was used to determine the associations between independent variables and prediabetes. RESULTS: A total of 1,406 participants were recruited for the study; 67.8% were women, 77.2% were between 40 and 59 years old, and 82.9% were married. The majority worked in the agricultural sector (57.2%), had an annual income ≤ 50,000 baht (67.5%), and had never attended school (69.3%). The prevalence of prediabetes was 11.2%. After controlling for age and sex, five factors were found to be associated with prediabetes. Members of the Akha and Lisu tribes had 2.03 (95% CI = 1.03-3.99) and 2.20 (95% CI = 1.10-4.42) times higher odds of having prediabetes than Karen tribe members, respectively. Those with hypertension (HT) had 1.47 (95% CI = 1.03-2.08) times higher odds of having prediabetes than those with normal blood pressure. Those with a normal total cholesterol level had 2.43 (95% CI = 1.65-3.58) times higher odds of having prediabetes than those with a high total cholesterol level. Those with a high triglyceride level had 1.64 (95% CI = 1.16-2.32) times higher odds of having prediabetes than those with a normal triglyceride level. Those with a high low-density lipoprotein cholesterol (LDL-C) level had 1.96 (95% CI = 1.30-2.96) times higher odds of having prediabetes than those with a normal LDL-C level. CONCLUSION: Appropriate dietary guidelines and exercise should be promoted among hill tribe people between 30 and 59 years old to reduce the probability of developing prediabetes.

Drivers, facilitators, and sources of stigma among Akha and Lahu hill tribe people who used methamphetamine in Thailand: a qualitative approach.

BACKGROUND: The stigma related to drug use has several impacts, including effects on users' physical and mental health. Methamphetamine is a major drug that is used among hill tribes living in the border areas of Thailand and Myanmar. This study aimed to understand the drivers, facilitators, sources and outcomes of the stigma surrounding drug use, including the expectations among Akha and Lau hill tribe people who use methamphetamine in Thailand. METHODS: Qualitative data were used to elicit information from key informants and members of the hill tribes who used methamphetamine. The questionnaire was developed from a literature review and tested for validity before use. In-depth interviews were used to confidentially gather information from the participants in private rooms in villages. Each interview lasted 45 min, and a thematic analysis was conducted to examine the findings. RESULTS: A total of 46 participants were recruited to provide information; 95.7% were male, and 50.0% were aged 15-34 years. The majority were married (47.8%), 76.1% were Christian, and 45.7% graduated high school. Six drivers of stigma were detected: being poor, illiterate, unemployed, working aged, female, and married. Culture and tribe acted as facilitators of the stigma attached to methamphetamine use. Four sources of stigma were found: self, family members, peers, and community members. Three outcomes of stigma were determined: poor physical health, mental health, and relationships with others. There were four levels of expectations: no expectations, expectations for themselves, expectations for their family members, and expectations for their community members. CONCLUSIONS: Many personal traits, people living nearby, and socioeconomic factors, including culture and tribes, act as drivers, facilitators, and sources of stigma among hill tribe people who use methamphetamine. A program to reduce methamphetamine use among hill tribes should be implemented, which could eventually minimize stigma.

Epidemiology of undiagnosed type 2 diabetes mellitus among hill tribe adults in Thailand.

A community-based cross-sectional study was performed to estimate the prevalence of and determine factors associated with undiagnosed type 2 diabetes (T2DM) among hill tribe adults aged 30 years and over. Data were collected from the target hill tribe people living in the 30 selected villages in Chiang Rai Province in northern Thailand. A total of 2365 people were invited to participate in the study; 65.9% were female, 72.4% were aged 40-69 years, 0.9% regularly received preventive healthcare, and only 41.2% understood Thai. The overall prevalence of undiagnosed T2DM was 7.5%. After adjusting for age and sex, two factors were found to be associated with T2DM: triglycerides and high-density lipoprotein cholesterol (HDL-C). Those with high triglyceride levels were 2.80 (95% CI 1.99-3.94) times more likely to be suffering from T2DM than those with a normal triglyceride level. Those with low HDL-C levels were 1.65 (95% CI 1.16-2.34) times more likely to be suffering from T2DM than those with normal HDL-C. Appropriate public health interventions should be developed and implemented to reduce T2DM by providing regular preventive healthcare, educating patients on DM prevention and control, and encouraging regular exercise and reduced consumption of fatty food.

Status of the stateless population in Thailand: How does stigma matter in their life?

BACKGROUND: The stateless population in Thailand live by accessing all public services, including the health care system. Stigma is a crucial factor impacting these individuals' lives and their access to medical care. This study aimed to understand the experience of the stateless population in Thailand and how they overcome the problem of stigma. METHODS: A qualitative method was used to elicit information from key informants who were members of the stateless population, which was classified as those who did not hold Thai identification cards (IDs). A questionnaire was used to guide the interview, which was conducted in a private and confidential room. The interviews were conducted after voluntary agreement was obtained from the participants; each interview was held in August 2021 and lasted for approximately 45 minutes. RESULTS: Fifty-one people participated in the study; 68.6% were females, 86.3% were married, and 90.2% were Akha or Lahu. The stateless population in Thailand reported four types of perceived stigma: having a lower ability to request that their needs be met, not being equal to others, not being able to qualify for health care services and being ranked below other hill tribe people who have IDs. The phrase "life is nothing" was presented by the participants, who reported that they felt like an invisible population in Thailand. Some participants reported that other hill tribe people who have IDs act as stigma perpetuators among members of the stateless population who do not have IDs. Maintaining their privacy within their village, trying to obtain a Thai ID, and practicing the Thai language were the main ways of avoiding the stigma reported by the stateless population. Obtaining a Thai ID was detected as the top goal in their aim to overcome the stigma problem. CONCLUSIONS: The stateless population in Thailand live as an invisible population and are negatively treated via various patterns from others. Accessing Thai IDs and education are argued to be the most effective procedures for addressing the problem under the implementation schemes of the relevant organizations.

Association Between Lifestyle Behaviors and Hypertension Among Hill Tribe Adults in Thailand: a Cross-Sectional Study.

BACKGROUND: Hypertension (HT) is a serious problem in the adult population, particularly among individuals who are living in poor economic conditions and have a low education level. This study aimed to determine the associations between lifestyle and HT among adult hill tribe populations in Thailand. METHODS: A cross-sectional study was conducted to gather information on several risk behaviors related to HT among the hill tribe population aged 30 years and older by using a validated questionnaire and 5 mL blood specimens. The study was conducted in 30 selected hill tribe villages in Chiang Rai Province, Northern Thailand. Logistic regression was used to detect the associations. RESULTS: A total of 2552 participants participated in the project; 65.9% were female, 72.4% were aged 40-69 years, and 54.2% were Buddhist. The overall prevalence of HT was 33.7%. After controlling for all potential confounding variables, two variables were found to be associated with HT: participants who used moderate (AOR=1.57; 95% CI=1.03-3.76) and high amounts (AOR=1.59; 95% CI=1.05-3.78) of oil for cooking had greater odds of having HT than those who used small amounts. Those who had low (AOR=1.45; 95% CI=1.13-1.88), moderate (AOR=2.68; 95% CI=1.80-8.78), and high (AOR=1.61; 95% CI=1.36-7.26) levels of depression had greater odds of having HT than those who were not depressed. CONCLUSIONS: Effective public health programs that focus on reducing the use of daily oil for cooking and decreasing the prevalence of depression in hill tribe people are urgently needed.

Associations between sexual violence, domestic violence, neglect, and alcohol consumption among Lahu hill tribe families in northern Thailand.

BACKGROUND: Domestic violence is one of the largest silent problems in the world. Women, children, and elderly individuals often fall victims to family members who use alcohol. However, there is lack of scientific evidence on alcohol consumption and domestic violence among Lahu hill tribe families. OBJECTIVES: The objective of this study was to investigate the prevalence of family violence, violence against women, and alcohol-related harm to children and elderly individuals and to determine the correlations between alcohol consumption and family violence among Lahu tribe families in northern Thailand. METHOD: A cross-sectional study was applied to collect data from participants living in 10 randomly selected villages from the list of Lahu villages in Chiang Rai Province, Thailand. A validated questionnaire and the Alcohol Use Disorders Identification Test were used to collect information from the participants in private and confidential rooms at a community hall between March and August 2019. Data were described and tested for correlation at the significance levels of α = 0.05 and 0.01. FINDINGS: A total of 350 of 719 recruited Lahu families participated in the study (response rate = 48.7%). Among female participants, 22.3% reported history of sexual harassment and 4.1% had been forced to have sex. Children and elderly individuals reported several experiences with people who had used alcohol in the past year; 6.4% had been left to live alone, 5.0% experienced financial neglect, and 1.8% had been neglected while sick. In a correlation analysis, it was found that age (r = -0.02, p value < 0.009), education (r = 0.15, p value < 0.047), marital status (r = 0.25, p value < 0.001), and religion (r = 0.20, p value < 0.008) were significantly correlated with verbal arguments among family members. Experience of sexual harassment was correlated with the presence of a drinker in the family (r = 0.22, p value < 0.001). CONCLUSION: Government and relevant agencies should cooperate to reduce the consumption of alcohol among Lahu men. Moreover, a specific training program to personally improve one's skill in responding to domestic violence among children, women, and elderly individuals should also be developed and implemented in Lahu communities.

Factors associated with hypertriglyceridemia among the hill tribe people aged 30 years and over, Thailand: a cross-sectional study.

BACKGROUND: Triglycerides are lipids in the human body that are produced from the consumption of daily food and drink. However, elevated serum triglycerides, also known as hypertriglyceridemia (HTG), are key biomarkers indicating an unhealthy status and increased risks of cardiovascular diseases (CVDs) and pancreatitis. Different groups of people have different patterns and styles of cooking and different patterns of consumption, such as hill tribe people, who have their own unique culture and cooking practices. This study aimed to estimate the prevalence of and determine the factors associated with HTG among the hill tribe population in Thailand. METHOD: A cross-sectional study was performed. Data and a-5 mL blood sample were collected from participants who were members of one of the six main hill tribes in Thailand: Akah, Lahu, Hmong, Yao, Karen, and Lisu. People who lived in 30 selected hill tribe villages and aged 30 years over were asked to participate the study. Pearson correlation and logistic regression were used to detect the correlations and determine the associations between variables, respectively, at a significant level of α = 0.05. RESULTS: A total of 2552 participants participated this study; 65.9% were females, 72.35% were aged 40-69 years, 76.7% had no education, 48.7% worked in the agricultural section, and 71.2% had an annual income of less than 50,000 baht/family. Regarding the triglyceride level, 41.7% of participants had elevated levels of serum triglyceride or HTG; 16.4% had a borderline high level, and 25.3% had a high level. After controlling for all potential confounder factors, three variables were found to be associated with elevated serum triglycerides. Those who were members of the Lahu and Hmong tribes were 1.62 times (95%CI = 1.25-2.01) and 1.63 times (95%CI = 1.23-2.16) more likely to have elevated serum triglycerides than those who were members of the Akha tribe, respectively. Those who used a high quantity of cooking oil for daily cooking were 0.73 times less likely to have an abnormal level of triglycerides than those who used a low quantity of cooking oil for daily cooking (95%CI = 0.58-0.91), and those who had a waist circumference indicating obesity were 1.28 times more likely to have an abnormal level of triglycerides than those who had a normal waist circumference (95%CI = 1.08-1.52). CONCLUSION: Public health programs that focus on encouraging people to have regular exercise to reduce their body weight, particularly in some tribes, such as Lahu and Hmong, should be implemented.

Factors associated with domestic violence in the Lahu hill tribe of northern Thailand: A cross-sectional study.

BACKGROUND: Domestic violence significantly affects physical and mental health, particularly among children, women, and the elderly. Living in certain family environments could lead to victimization by domestic violence, especially among families with a poor socioeconomic status, such as the Lahu hill tribe people in Thailand. This study aimed to estimate the prevalence of and determine the factors associated with domestic violence among Lahu children, women, and the elderly. METHODS: A cross-sectional study was conducted of participants who belonged to the Lahu hill tribe and lived in 20 selected villages in Chiang Rai Province, Thailand. A validated questionnaire was used to collect personal information and information regarding experiences related to domestic violence in the past year from children (aged 5-15 years), women (aged 16-59 years), and the elderly (aged 60 years and over). A binary logistic regression was used to detect associations between the variables. RESULTS: A total of 646 participants were recruited into the study, specifically, 98 children aged 5-15 years, 430 women aged 16-59 years, and 118 elderly people. Children who smoked (AOR = 8.70; 95%CI = 1.27-59.45) had greater odds of experiencing domestic violence than children who did not smoke. Women who had a role as a family member (AOR = 1.59; 95%CI = 1.02-2.50), used alcohol (AOR = 3.36; 95%CI = 2.27-4.99), lived in a family with financial problems (AOR = 4.01; 95%CI = 2.52-7.66), and lived with a family member who uses alcohol (AOR = 2.87; 95%CI = 2.20-5.63) had greater odds of suffering domestic violence than women who did not share these characteristics. The elderly who used alcohol (AOR = 3.25, 95%CI = 1.08-9.81), lived with a family member who uses alcohol (AOR = 3.31; 95%CI = 1.26-7.34), or lived in a family with financial problems in the past year (AOR = 2.16; 95%CI = 1.16-8.77) had greater odds of facing domestic violence than the elderly who did not have these characteristics. CONCLUSION: Family financial problems and substance use are associated with domestic violence in Lahu families in Thailand. Health interventions to reduce the use of substances, including training programs to respond to domestic violence, should be promoted for Lahu children, women, and the elderly.

Factors associated with elevated low-density lipoprotein cholesterol levels among hill tribe people aged 30 years and over in Thailand: a cross-sectional study.

BACKGROUND: Low-density lipoprotein cholesterol (LDL-C) is one of the most important types of cholesterol and has an impact on health. Certain lifestyle and dietary habits in different populations may leads to increased levels of LDL-C, particularly among those with poor education and economic statuses, such as hill tribe people in Thailand. This study aimed to estimate the prevalence of and determine the factors associated with high LDL-C levels among hill tribe people in northern Thailand. METHODS: A cross-sectional study was performed to gather information from six main hill tribe populations: Akha, Lahu, Hmong, Yao, Karen, and Lisu. Individuals who were aged over 30 years and living in 30 selected hill tribe villages were invited to participate in the study. A validated questionnaire and 5-mL blood specimens were used to obtain data. Correlation analyses, chi-square tests, t-tests, and logistic regression were used to detect correlations and associations. RESULTS: A total of 2552 participants were recruited into the study; 65.9% were females, and 64.1% were aged younger than 60 years old. Approximately 69.6% of participants had abnormal LDL-C levels; 33.6% had above-optimal levels, 24.3% had borderline high levels, 8.0% had high levels, and 3.7% had very high levels. A total of 17.4% of participants had low high-density lipoprotein cholesterol (HDL-C) and high LDL-C levels, while 14.9% had high triglyceride and LDL-C levels. After controlling for sex, age, religion, education, annual family income, and marital status in the multivariate model, three variables were found to be associated with high LDL-C levels: occupation, the amount of lard used in daily cooking, and glycated hemoglobin (HbA1c). Those who were working as agriculturalists had a 1.34-fold greater chance of having abnormal LDL-C than traders and others (95% CI = 1.09-1.34). Those who used moderate and high quantities of lard in their daily cooking had a 1.45-fold (95% CI = 1.15-1.82) and 1.31-fold (95% CI = 1.04-1.68) greater likelihood of having abnormal LDL-C levels than those who used low quantities, respectively. Those who had abnormal HbA1c levels were less likely to develop abnormal LDL-C levels than those who had normal HbA1c levels (AOR = 0.69, 95% CI = 0.51-92). CONCLUSIONS: Effective public health programs that do not conflict with the cultures of hill tribes are urgently needed, particularly programs encouraging the use of small quantities of lard for daily cooking practices.

Epidemiology of thalassemia among the hill tribe population in Thailand.

BACKGROUND: Thalassemia is a severe disease that occurs due to abnormalities in hemoglobin genes. Various genetic factors in different populations lead to different clinical manifestations of thalassemia disease, particularly among people who have a long history of migration and who have married among tribes, such as the hill tribe people in Thailand. This genetic epidemiological study aimed to estimate the prevalence of various forms of thalassemia among the six main hill tribe populations in Thailand. METHODS: A cross-sectional study was conducted to obtain information and blood specimens from school children belonging to one of the six main hill tribes in Thailand: Akha, Lau, Hmong, Yao, Karen, and Lisu. Hill tribe children who were attending grades 4-6 in 13 selected schools in Chiang Rai Province, Thailand, were invited to participate in the study. A validated questionnaire and 3 mL blood specimens were collected after obtaining information consent forms from both the children and their parents on a voluntary basis. A complete blood count (CBC) was performed, followed by osmotic fragility (OF) and dichlorophenol indophenol precipitation (DCIP) tests to screen for thalassemia. High-performance liquid chromatography (HPLC) and real-time quantitative polymerase chain reaction (qPCR) were used to identify hemoglobin type and α-thalassemia, respectively. A t-test, chi-square and logistic regression were used to detect the associations between variables at the significance level of α = 0.05. RESULTS: A total of 1,200 participants from 6 different tribes were recruited for the study; 50.0% were males, and 67.3% were aged 11-12 years. The overall prevalence of thalassemia carriers according to the screening tests was 9.8% (117 of 1,200). Among the cases, 83 were A2A (59 cases were α-thalassemia 1 carrier or α-thalassemia 2 carrier or homozygous α-thalassemia 2, and 24 cases were ß-thalassemia trait with or without α-thalassemia); 1 case was EE (homozygous Hb E with or without α-thalassemia); 31 cases were EA (30 cases were the Hb E trait, and 1 case was Hb E trait with or without α-thalassemia); 1 case was A2A Bart's H (Hb H disease α-thalassemia 1/α-thalassemia 2); and 1 case was A2A with abnormal Hb. The prevalence of the α-thalassemia 1 trait among the hill tribe population was 2.5%. The greatest prevalence of the α-thalassemia 1 trait was found in the Karen (3.0%) and Hmong (3.0%) tribes. CONCLUSIONS: The prevalence of some forms of thalassemia in the hill tribe population is higher than that in the Thai and other populations. Effective and available thalassemia screening tests, including essential information to protect the next generation through the specific counseling clinic, are crucial, particularly due to increasing marriages within these populations.

Prevalence and determinants of TB infection in a rural population in northeastern Myanmar.

BACKGROUND: Tuberculosis (TB) is a major human threat, as evidenced by the large numbers of cases and deaths, particularly in developing countries with poor economic and educational statuses. Myanmar has one of the highest TB burdens in the world, but no TB information is available for people living in the rural northeastern regions of Myanmar. The present study estimated the prevalence of TB and identified factors associated with TB infection in people living in rural communities in Shan State. METHODS: A cross-sectional study was performed to gather information from participants. People aged 18-59 years who lived in the three areas with the highest numbers of TB cases in Shan State in northeastern Myanmar were included in the study population. A simple random method was used to select the sample from the villages. A validated questionnaire was used for data collection in face-to-face interviews after obtaining signed informed consent from the selected participants. The Mantoux tuberculin skin test (TST) was administered to detect TB infection, and a result that was 10 mm or greater after 48 h was considered positive. Chi-squared tests and logistic regression were used to identify the associations between the variables at a significance level of α = 0.05. RESULTS: A total of 303 participants were recruited for the study; 64.7% were females, and the mean age was 37 years (SD = 12.5). Most participants were Burmese (25.4%), and 14.95% were Shan. Sixty-three participants (20.8%) had a positive TST. Four variables were associated with TB infection in the multivariate model. Males had a greater chance of TB infection than females (AOR = 2.51; 95% CI = 1.32-4.76). Participants who were ever married had a greater chance of TB infection than participants who were single (AOR = 3.93; 95% CI = 1.18-13.00). Participants who used wood and charcoal as their main sources of energy for cooking had a greater chance of TB infection than participants who used electricity (AOR = 4.23; 95% CI = 1.25-9.64). Participants who had a low level of TB prevention and care knowledge had a greater chance of TB infection than participants with a high level of TB prevention and care knowledge (AOR = 4.49; 95% CI = 1.88-10.72). CONCLUSIONS: Public health programs that focus on improving knowledge of TB prevention and care and avoiding the use of wood and charcoal as the primary sources of energy for cooking, particularly in males and ever-married individuals, are urgently needed.

Pulmonary function and factors associated with current smoking among the hill tribe populations in northern Thailand: a cross-sectional study.

BACKGROUND: Smoking is considered one of the major poor health behaviors leading to several health problems. Individuals with a poor education and economic status are vulnerable to smoking, particularly the hill tribe people in Thailand. This study aimed to estimate the prevalence of current smoking, assess pulmonary function, and identify factors associated with current smoking among individuals aged 20 years and older of the hill tribes in northern Thailand. METHOD: A cross-sectional study was conducted to gather information from the hill tribe people living in 42 hill tribe villages. A validated questionnaire, spirometry, and pulse oximetry were used as the research tools. Face-to-face interviews were conducted to collect data from the participants in a private room after obtaining informed consent voluntarily. Chi-squared test and logistic regression were used to detect the associations between the variables at the significance level of α = 0.05. RESULTS: In total, 2216 participants were recruited into the study: 54.6% were women, 80.3% were aged 31-59 years, and 86.1% were married. The prevalence of smoking was 36.3%; 20.6% were current smokers (36.7% among men and 7.0% among women), and 15.7% were ever smokers. Half of the participants (50.1%) had smoked for ≤9 years, 80.1% smoked ≤10 pieces per day, 64.2% smoked traditional tobacco, 42.8% had low-to-moderate levels of knowledge of the harms of smoking, and 68.4% had low-to-moderate levels of attitudes toward the harms of smoking. Only sex was statistically significant among the different smoking behaviors (p-value< 0.001), and the participants' pulmonary function was not significantly different. After controlling for age, sex, religion, and education, three variables were found to be associated with current smoking among the hill tribe people in Thailand: men were more likely to smoke than women (AOR = 7.52, 95% CI = 5.53-10.24); those who used amphetamines were more likely to smoke than those who did not (AOR = 2.92, 95% CI = 1.69-5.03); those who had poor attitudes toward the harms of smoking were more likely to smoke than those who had a positive attitude toward the harms of smoking (AOR = 2.47, 95% CI = 1.53-3.97). CONCLUSION: Translating essential health messages into the hill tribe language and improving the channel to deliver this information to the target populations, particularly men, are crucial strategies for improving their knowledge and attitudes toward the harms of smoking and making them quit smoking.

Knowledge, attitudes and preparedness to respond to COVID-19 among the border population of northern Thailand in the early period of the pandemic: a cross-sectional study.

Background: Chiang Rai province in northern Thailand is a site of many people travelling among nearby countries and areas, including Yunnan province, China. In February 2020, there was concern about the population's vulnerability to coronavirus disease 2019 (COVID-19). Methods: A cross-sectional study was conducted in 15 villages less than 10 km from a border. A questionnaire was developed and tested for reliability and validity; 48 questions covered participant characteristics, plus knowledge about, attitudes to and preparedness for COVID-19. Chi-squared tests were used to detect any significant association between variables. Unadjusted and adjusted odds ratios with 95% confidence intervals (CIs) were calculated to assess the possible association of various factors with participants' level of reported knowledge, attitudes and preparedness. Results: A total of 520 participants were recruited of whom 320 (61.5%) were women. The age range was 18-90 years; the average age was 45.2 years. Variables with an association with good to moderate preparedness for COVID-19 prevention and control that remained after adjustment were: women were better prepared than men (adjusted odds ratio (ORadj) = 2.52; 95% CI = 1.36-4.68); those aged 18-30 years (ORadj = 4.26; 95% CI = 1.18-15.30), 31-45 years (ORadj = 4.60; 95% CI = 1.59-13.32) or 46-60 years (ORadj = 2.69; 95% CI = 1.16-6.26) were better prepared than those aged 60-90 years; and, compared with those with no formal education, those educated to primary school level (ORadj = 2.43; 95% CI = 1.09-5.43) or to university level (ORadj = 3.18; 95% CI = 1.06-9.51) were better prepared. Conclusion: Effective communication of essential, accurate and up-to-date information regarding COVID-19 prevention and control is essential in this population - especially for men, older age groups and those lacking formal education.

Seroprevalence and factors associated with hepatitis B infection among the hill tribe adult population in Thailand: a cross-sectional study.

BACKGROUND: Hepatitis B virus (HBV) infection is one of the greatest public health burdens, particularly for people living with several barriers to access to health care services, such as the hill tribe adult population in Thailand. People aged 25 years and over who are out of the target population for HBV immunization under the national Expanded Program on Immunization (EPI) are at risk of HBV infection. The study aimed to estimate the prevalence and determine the factors associated with HBV infection among hill tribe adults aged 25 years and over living in Chiang Rai Province, Thailand. METHODS: A cross-sectional study design was used to collect information on hill tribe adults aged 25 years and over living in 36 selected hill tribe villages in Chiang Rai Province. All people living in the selected villages who met the criteria were invited to participate in the study. A validated questionnaire and a 5-mL blood specimen were used as research instruments. Hepatitis B surface antigen (HBsAg), antibody to hepatitis B surface (anti-HBs), and antibody to hepatitis B core (anti-HBc) were detected by using the Wondfo Test Kit@, which has high sensitivity and specificity. Logistic regression was used to detect the associations between variables at the significance level of α = 0.05. RESULTS: A total of 1491 individuals were recruited into the analysis; 60.8% were females, 81.3% were aged between 30 and 60 years, and 86.0% were married. The majority were illiterate (54.9%), were Buddhist (55.7%), worked in agricultural sectors (87.3%), and had an annual income of less than 50,000 baht per year (72.9%). The overall prevalence of hepatitis B infection was 26.6%; 7.6% were positive for HBsAg, 19.2% were positive for anti-HBs, and 18.9% were positive for anti-HBc. In the multivariate analysis, three variables were found to be associated with hepatitis B infection: those who were in the Yao and Lisu tribes had a 1.64-fold (95% CI = 1.08-2.49) and a 1.93-fold (95% CI = 1.10-3.31) greater chance, respectively, of HBV infection than did those in the Karen tribe; those who were Christian had a 1.41-fold (95% CI = 1.06-1.87) greater chance of HBV infection than did those who were Buddhist; and those who did not use alcohol had a 1.29-fold (95% CI = 1.01-1.65) greater chance of HBV infection than did those who used alcohol. CONCLUSIONS: It is necessary to develop and implement effective public health interventions among hill tribe adult populations who are not part of the EPI-targeted population, particularly Christians, those in the Lisu and Yao tribes, and those who do not use alcohol, to reduce the HBV infection rate, save lives and reduce medical expenses.

Prevalence of and factors associated with depression among hill tribe individuals aged 30 years and over in Thailand.

BACKGROUND: Depression is a silent health problem that can lead to severe and sometimes fatal outcomes if individuals are not diagnosed and treated properly; this is particularly true in populations with limited education, low economic status and several barriers to accessing health services, such as the hill tribe people in Thailand. METHODS: This cross-sectional study aimed to explore the prevalence of and factors associated with depression among hill tribe individuals aged 30 years and over. A validated questionnaire and the Patient Health Questionnaire-9 (PHQ-9) were used for data collection in an interview format in a private and confidential room. Logistic regression was used to detect the associations of variables with depression at a significance level of α = 0.05. RESULTS: A total of 2,552 participants were recruited for the analysis; 65.9% were females, 79.9% were married, 35.8% were aged 50 years and over, and 54.2% were Buddhist. The majority were uneducated (76.7%), were agriculturalists (48.4%), and had a low family income (71.2%). The overall prevalence of depression was 12.0%. In the multivariate analysis, eight variables were found to be significantly associated with depression among hill tribe adults aged 30 years and over in Thailand. Being female, 50 years or older, married, and Christian; living with a relative; smoking; using opium; and having moderate and high stress levels were associated with depression. CONCLUSION: Effective public health interventions should be considered to reduce the burden of depression in the hill tribe population by focusing on individuals who are female, 50 years or older, married, Christian, and stressed and those who abuse substances.

Associations of childhood experiences and methamphetamine use among Akha and Lahu hill tribe youths in northern Thailand: A cross-sectional study.

BACKGROUND: Methamphetamine (MA) is a commonly used substance among youths, particularly those who are living in poor economic conditions with low levels of education and who have had bad childhood experiences. The Akha and Lahu hill tribe youths living on the Thailand-Myanmar-Laos border are identified as the group most vulnerable to MA use in Thailand. The study aimed to estimate the prevalence of MA use and determine its associations with childhood experiences among Akha and Lahu youths aged 15-24 years in northern Thailand. METHODS: A cross-sectional study was performed. Validated and sealed questionnaires were used to gather information from participants after obtaining the informed consent form. Questionnaires were completed by participants and their parents at home. Logistic regression was used to identify the associations between variables at the α = 0.05 level. RESULTS: A total of 710 participants participated in the study: 54.2% were Akha, 52.5% were females, 50.6% were aged 15-17 years, and 11.4% did not have Thai identification card (ID) cards. The overall prevalence of MA use at least once among Akha and Lahu youths was 14.5%. After controlling for all potential confounding factors, 8 variables were found to be associated with MA use. Males had a greater chance of MA use than females (AOR = 4.75; 95% CI = 2.27-9.95). Participants aged 21-24 years had a greater chance of MA use than those aged 15-17 years (AOR = 2.51; 95% CI = 1.11-5.71). Those who had a family member who used MA had a greater chance of MA use than those who did not (AOR = 5.04; 95% CI = 1.66-15.32). Those who had been physically assaulted by a family member while aged 0-5 years had a greater chance of MA use than those who had not (AOR = 2.29; 95% CI = 1.02-5.12). Those who had been physically assaulted by a family member while aged 6-14 years had a greater chance of MA use than those who had not (AOR = 3.15; 95% CI = 1.32-7.54). Those who had a close friend who used alcohol had a greater chance of MA use than those who did not (AOR = 2.24; 95% CI = 1.24-4.72). Those who had a highly confident personality had a greater chance of MA use than those who did not (AOR = 2.35; 95% CI = 1.17-4.69), and those who smoked had a greater chance of MA use than those who did not (AOR = 8.27; 95% CI = 4.42-15.46). CONCLUSIONS: All relevant government and nongovernment agencies together with the Ministry of Public Health Thailand should address MA use among Akha and Lahu youths by properly developing a community health intervention that lowers risk of MA use by addressing family relationships, male youth behaviors, and focused on those individuals with a highly confident personality.