A mobile unit: an effective service for cervical cancer screening among rural Thai women.

BACKGROUND: We carried out a systematic screening programme using a mobile unit with the purpose of increasing use of Papanicolaou (Pap) smear screening among rural Thai women. The mobile unit campaign was carried out initially between January and February 1993 and then in 1996 in all the 54 rural villages in Mae Sot District, Tak Province, northern Thailand. METHODS: To evaluate the effect of the programme on changes in knowledge and use of screening, we compared the results of three interview surveys of women, 18-65 years old, in villages selected by systematic sampling for each survey; first in 1991 (before the operation of the programme), secondly in 1994 (one year after the first screening campaign), and last in 1997 (one year after the second campaign). This report also compares data on Pap smears taken by the mobile unit with other existing screening services in the study area. RESULTS: A total of 1603, 1369, and 1576 women respectively, participated in each survey. The proportion of women reported knowing of the Pap smear test increased from 20.8% in 1991 to 57.3% in 1994 and to 75.5% in 1997. The proportion of women who had ever had a Pap smear increased from 19.9% in 1991 to 58.1% in 1994 and to 70.1% by 1997. Screening by the mobile unit accounted for 85.2% of all cervical intraepithelial neoplasia (CIN) III and all invasive cancers identified among the Pap smears taken by screening services in the area between 1992 and 1996. The rate of CIN III was 3.5/1000 smears in this screening programme, which was 5.2 and 2.0 times higher than the rates in the maternal and child health/family planning clinic and the annual one-week mass screening campaign respectively. CONCLUSIONS: The use of a mobile unit may be an effective screening programme in rural areas where existing screening activities cannot effectively reach the female population at risk.

PIP: A mobile cervical cancer screening campaign was conducted in both 1993 and 1996 in all 54 rural villages in Mae Sot District, Tak Province, in northern Thailand. The impact of the program on women's knowledge of cervical cancer and uptake of Pap smear testing was evaluated in 3 rounds of survey of women 18-65 years of age from the area served by the mobile unit. 1603 women were interviewed in 1991 before program implementation, another 1369 women were surveyed in 1994, and 1576 were enrolled in the 1997 survey. Awareness that cervical cancer can be asymptomatic increased from 19.5% in the baseline survey to 52.8% in 1994 and 63.9% in 1997. The proportion of women knowledgeable about Pap smears increased from 20.8% in 1991 to 57.3% in 1994 and 75.5% in 1997. The proportion of women who had ever had a Pap smear rose from 19.9% in 1991 to 58.1% in 1994 and 70.1% in 1997. Screening by the mobile unit accounted for 85.2% of all cervical intraepithelial neoplasia (CIN) III and all invasive cancers detected by Pap smear in the study area during 1992-96. The rate of CIN III was 3.5/1000 smears in the mobile screening program compared with 0.7/1000 in the maternal-child health/family planning clinic and 1.8/1000 in the annual 1-week mass screening campaign. These findings confirm that a mobile unit is an effective tool in rural areas where existing screening activities cannot reach all the women at risk of cervical cancer.

Screening assessment of persons 40-59 years of age in rural Thailand by a mobile health unit.

This paper reports a screening survey using a mobile unit to determine the prevalence of chronic disorders among persons aged 40-59 years in rural Thailand. A total of 4,812 persons from all the 54 rural villages in Mae Sot District, Tak Province, northern Thailand, were interviewed and examined in 1995. A higher proportion (59.3%) of men were current tobacco smokers than among women (40.4%). A higher proportion (69.6%) of men were current alcohol drinkers compared with women (38.6%). Cutting/piercing was the most frequently reported injury, followed by falls. About half (47.9%) of the persons surveyed had a body mass index (BMI) between 20 and 24.9 and only 2.6 per cent had a BMI of 30 or over. The overall prevalence rates of hypertension and diabetes in the persons surveyed were 13.3 per cent and 2.4 per cent respectively. Of the persons screened, 28.8 per cent had borderline-high blood cholesterol (200-239 mg/dl) and 12.9 per cent had high blood cholesterol (> or = 240 mg/dl). About 61 per cent of hypertensive persons, 92 per cent of diabetic persons, and nearly all of those with dyslipidaemia were first detected during this screening programme. Five women with breast cancer and 22 with benign breast disorders were also identified during the survey. A screening programme using a mobile unit may be useful in identifying treatable disorders in rural areas, where existing screening services cannot effectively cover the population at risk.

Effect of motorcycle rider education on changes in risk behaviours and motorcycle-related injuries in rural Thailand.

A community-based programme for motorcycle rider education was provided for motorcyclists in all villages of 3 randomly selected subdistricts in Mae Sot District, Tak Province, northern Thailand, between January and March 1995. To determine the extent of changes in risk-taking behaviours, we conducted an interview survey of motorcyclists in 3 villages selected by systematic sampling from the 3 intervention subdistricts and in 3 control (without intervention) villages for comparison in March 1997, 2 years after the programme. Motorcyclists in the intervention villages (69.7%) were significantly more likely to have valid licences than those in the control villages (46.5%). The proportion of motorcyclists who always or often wore helmets was significantly greater in the intervention sample (46.0%) than in the control sample (20.5%). In 1994, the annual incidence rate of motorcycle-related injuries was slightly higher in the intervention areas than in the control areas Following the education programme, the injury rates for 1995 and 1996 were significantly lower in the intervention than in the control population. The annual number and rate of fatal motorcycle injuries decreased after the intervention although there was no significant difference between the two populations. Motorcycle rider education may be a promising intervention for prevention of motorcycle-related injuries in rural areas where road safety measures, particularly enforcement activities, are commonly limited.

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

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

Screening assessment of the elderly in rural Thailand by a mobile unit.

Using a mobile health unit, we conducted a survey to determine the prevalence of social and medical problems among an elderly population in rural Thailand. 3302 persons aged 60 years and older from 54 villages in Mae Sot District, Tak Province, northern Thailand, were interviewed and examined between November 1993 and April 1994. About 4% of those surveyed lived alone and most of them preferred to remain with their relatives and neighbours in the community. The proportion of current tobacco smokers was slightly higher in men (55.5%) than in women (51.4%). Men also had a higher proportion of current alcohol drinkers (20.3%) than women (5.3%). About 80% of the elderly reported having used medication within one month before the interview. Falls were the most common cause of reported injury, followed by cutting/piercing. The proportion of the elderly who had difficulty with activities of daily living was higher for women than men and increased with age. Meal preparation was the most common activity needing help. About 58% of hypertensive persons and 75% of those with diabetes were first detected during the survey. Some persons with treatable disorders such as senile cataract and dyslipidaemia were also detected by the screening programme. Geriatric screening assessment using mobile units may be helpful in uncovering treatable conditions among the elderly in rural areas.

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

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

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

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

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

A Thai monk: an agent for smoking reduction in a rural population.

Monks in a rural community in northern Thailand were observed to conduct anti-smoking activities. To evaluate the effects of the monks' efforts on change of people's smoking behaviour and attitudes, we conducted a survey of adults > or = 15 years of age in this village (intervention village sample) and a randomly selected village (control village sample) in the same subdistrict. Between March and April 1991, we interviewed 372 individuals in the intervention village and 664 in the control village. The two villages were of similar socioeconomic status. The proportion of ever smokers who had tried to quit was greater in the intervention sample (79.6%) than in the control sample (72.0%) (P = 0.048). The proportion of former smokers who had stopped smoking for > or = 1 year was significantly greater in the intervention sample (25.5% of ever smokers) than in the control sample (16.6%) (P = 0.011). Of current smokers in the intervention village, 45.8% reported smoking less tobacco during the year preceding the survey than in the previous 1-year period compared with 35.2% in the control village (P = 0.034). Many former smokers (80.3%) in the intervention village cited the suggestion of a monk as one important reason for quitting compared with 25.6% in the control village (P = 0.000). The proportion of individuals who were well aware of the harmful effects of smoking on health was greater in the intervention village than in the control village. Religious leaders may be helpful in a community-based smoking prevention programme.

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

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

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

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

Assessment of socio-economic, functional and medical problems among the elderly in one rural community of Thailand.

A survey of persons aged 60 years and over in Mae Sot in Tak Province, Thailand was conducted in 1989 to determine the prevalence of socio-economic, functional and medical problems. A total of 567 elderly persons from 8 villages systematically selected from 54 villages outside the municipality were interviewed and examined. Ninety-eight percent of them lived with their children or relatives. There were few elderly persons reporting difficulty performing basic physical activities of daily living due to the very low proportion of older elderly in this area. 13.3% of men and 14.5% of women reported some degree of urinary incontinence; however, most of them complained of only slight incontinence at occasional intervals. 62.4% of the study elderly had a body mass index below 20. The mean body mass index for men (19.5) was slightly higher than that for women (18.7). One hundred and two out of the 567 elderly surveyed were found to have hypertension and 51% of these hypertensives were newly diagnosed during this study. There was no association between the prevalence rate of hypertension and any of the other studied variables, including age, sex, educational level and smoking habits. The overall prevalence rate of diabetes in these elderly people was 1.6%. The mean body mass index of the diabetic group (23.1) was significantly (p less than 0.05) greater than that of the non-diabetic group (19.1). Special homes for the aged may become necessary in the future as young people migrate away from rural areas where their aging parents live to urban areas.(ABSTRACT TRUNCATED AT 250 WORDS)

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

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

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

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