Control of intestinal parasitic infection--a pilot project in Lao PDR.

Intestinal helminths are a very common but still rather unrecognized public health problem. An attempt was undertaken to control the three important parasites, ie Ascaris, Trichuris and hookworm. Two villages in Vientiane Province in Lao PDR were selected, one as an intervention and the other as control village. Intervention measures started by providing mass treatment against Ascaris, Trichuris, hookworm and other intestinal parasitic infections in both villages. Health education and other intervention measures were implemented in the intervention village, which significantly influenced the re-infection rates in this village. These achievements were not due to an improvement of the availability of toilets or personal hygiene alone but more to the villagers' improved understanding of the route of the parasitic infections. It was concluded that intervention methods should be directed more towards particular age groups. Particular attention should be paid to control parasitic infections among females.

Promotion of the health of rural women towards safe motherhood--an intervention project in northeast Thailand.

An intervention project focusing on the health of women in the reproductive age was conducted in three districts of Khon Kaen Province, northeast Thailand between 1991 and 1996. Main emphasis was placed on improving reproductive health, the nutritional status including the iron deficiency anemia (IDA) as well as iodine deficiency disorders (IDD), and the parasitic diseases liver fluke (Opisthorchis viverrini) and hookworm. For implementation a community based Primary Health Care approach was used including the training of health officials in health matters, primary health care workers and villagers as well as enhancing health education and the dissemination of health information. The health delivery system was encouraged to take appropriate actions such as in the treatment of parasitic diseases and the control of IDA and IDD. Monitoring was done on a regular basis. The outcome of the project was assessed by comparing baseline data compiled from a random sample of the target population with the results of the final evaluation. An attempt to compare results obtained from villages within and outside of the project area failed most probably because of spill over effects. A number of important indicators on family planning and mother and child health care improved during the time the project was implemented; this included practising family planning, and participation in antenatal care. Also the proportion of females becoming pregnant for the first time when 20 years or older increased. Child-raising also improved in that almost all females gave colostrum to their babies by this time. Almost 75% of the women breast-fed their children. Improvements occurred in the nutritional status as far as the micronutrients iron and iodine were concerned, however the overall nutritional status of females did not change, but a rather high proportion of females were found to be overnourished. The project failed in reducing abortion and the proportion of females becoming pregnant when they are 18 years old or younger. It was also not possible to improve the usage of postnatal care. As anticipated, the results achieved so far are most suitable in serving as a training ground and providing a favorable example to improve family planning, mother- and child health care, and also the general health of females in the region, particularly in neighboring countries such as Lao PDR, Cambodia and Vietnam.

Urinary iodine excretion as a predictor of the iodine content of breast milk.

Endemic goitre has re-emerged in Thailand. This is particularly dangerous for children since iodine deficiency disorders (IDDs) might negatively influence their intellectual and mental development. In order to assess the situation, the iodine content of breast milk was determined and a method is proposed on how to monitor IDDs in lactating mothers later on. Seventy-five lactating women aged from 15 to 45 years, from 12 villages of 3 districts, namely Chumpae. Srichompu and Pupaman within the mountainous areas of Khon Kaen province, Northeast of Thailand were investigated. The breast milk from 46.7 per cent of mothers was found to be below recommended standards. In addition, 52.0 per cent of the women investigated had low urinary iodine excretion. The risk of women with low iodine excretion was 15 fold higher in comparison to women with sufficient iodine excretion to provide breast milk for their babies with insufficient iodine content. It is concluded that urinary iodine excretion can be used to monitor the IDDs in lactating mothers.

Nutritional status of school children in an endemic area of iodine deficiency disorders (IDD) after one year of iodine supplementation.

To improve the health and nutritional status of school children in an area of iodine deficiency disorders (IDD) by means of different iodine fortifications in salt, fish sauce and drinking water, anthropometric assessment for nutritional measurement, including hematological status, were performed. There was a significant difference in the weight and height of the children from the four schools investigated, before and after supplementation in each school. The prevalence of anemia (as indicated by hematological measurement) and iodine deficiency (as indicated by urinary iodine concentration in the children from the four schools) were assessed and compared before and after iodine supplementation; a decrease in prevalence was found in all school children, however, serum ferritin did not change before and after supplementation.

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

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

Prevalence of abnormal glucose tolerance in Khon Kaen Province and validity of urine stick and fasting blood sugar as screening tools.

Three hundred and fifty-five individuals, 152 males and 203 females, aged between 30 and 74 years, were randomly selected in a two stage selection process from rural communities in three districts of Khon Kaen Province, Northeast Thailand. The prevalence of impaired glucose tolerance (IGT) and non-insulin dependent diabetes mellitus (NIDDM) in the rural area of Northeast Thailand were measured. In addition, the validity of the urine stick and fasting blood sugar as screening tools against the two hours glucose loading test as golden standard were determined. The survey was conducted in July 1995. The glucose loading test was performed on 277 individuals. IGT and NIDDM were classified according to current World Health Organization suggestions. Prevalence rates for IGT were 18.1 per cent and for NIDDM 11.9 per cent. No difference was found between males and females, also when controlled for age. NIDDM prevalence increased with age but IGT rates already were high in the younger age groups. This finding suggests that IGT precedes NIDDM in Thailand. The validity of the urine stick as a screening tool in communities was insufficient, with a sensitivity of less than 20 per cent. When using fasting blood sugar as a screening test, the sensitivity was close to 44 per cent and the specificity 90 per cent. It is concluded that the urine stick is not a useful screening tool and the method of using blood sugar concentrations for screening have to be improved before it can be applied within communities.

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

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

Quetelet index, hemoglobin and parasitic infection of rural women in northeast Thailand.

The Quetelet index, hemoglobin and parasitic infection rates of adolescent and young women from 21 villages in Northeast Thailand were assessed. Data were collected in the hot, rainy and cold seasons of the year. The proportion of undernourished females varied between 10 and 15% when a cut-off point of 18.7 of the Quetelet index was chosen. 23 to 33% of the women had hemoglobin levels below 12 g%. Parasitic infection rates with various intestinal helminths were high but not related to the nutritional status or anemia.