Prevalence of osteopenia and osteoporosis in Thai women.

OBJECTIVE: To determine the age-specific and age-adjusted prevalence of osteopenia and osteoporosis in pre- and postmenopausal Thai women. METHODS: This was a descriptive study of 1,935 Thai women ranging in age from 40 to 80 years, with randomly selected strata using multistage sampling and stratifying from six representative provinces of the country. After recruiting, all the women were interviewed by a well-trained interviewer using structured questionnaires. Bone mineral density (BMD) of lumbar spine 1-4 and nondominant hip was measured by a dual energy photon absorptiometer. The investigators were trained and standardized; inter- and intraobserver variations were measured periodically. Every BMD outcome was re-examined by the specialist. Age-specific prevalence of osteoporosis and osteopenia were determined using both Thai and Western standard BMD values. Age-adjusted prevalence of osteopenia and osteoporosis was calculated using the age-adjusted direct method. RESULTS: Using the Thai BMD reference, the age-specific prevalence of osteoporosis among Thai women rose progressively with increasing age to more than 50% after the age of 70. The age-adjusted prevalence of osteoporosis also rose progressively. It was 19.8%, 13.6%, and 10% for lumbar spine, femoral neck, and intertrochanteric. The age-adjusted prevalence of osteoporosis indicates the overall magnitude of that condition in the population or country. In our study, using a Western BMD reference resulted in a misleadingly high prevalence of osteoporosis in the population of Asian countries. CONCLUSION: It is important to calculate the age-adjusted prevalence of osteopenia and osteoporosis to address the overall magnitude of the problem in Thai women. This will allow us to predict the socioeconomic impact of preventable chronic conditions such as osteoporosis. The results obtained from this study are important data for public health policy: maximizing bone mass throughout life as well as detection of important risk factors is essential.

Study on the factors associated with contraceptive discontinuations in Bangkok.

Detailed information was collected from 666 cohorts of pill, injectable-DMPA and IUD acceptors at 14 Bangkok Metropolis Health Clinics (MHCs). The contraceptive status at 12-month follow-up home interview shows that 47% of pill acceptors, 39% of DMPA acceptors and 55% of IUD acceptors were still using the same contraceptive method and receiving them from the original source. The women who initially adopted the pill could seek the oral contraceptive from other sources with a higher significant percentage (14%) than was found in the DMPA and IUD group. The DMPA group revealed the lowest percent of using same method and same source but higher rate of clinic switch (15%), including method and clinic switch (18%), than the pill and IUD acceptors. The women who adopted the pill had stopped using any contraceptive method with the highest percentage (31%). The main reason for method switch among the three contraceptive acceptors was disagreeable health effects; 50% of pill acceptors, 75% for DMPA acceptors and 49% for IUD acceptors. Another important reason for IUD switch was a 32% expulsion of IUD. Those who switched clinic gave the three important reasons of distance inconvenience, opening hour inconvenience and disagreeable health effects. Service-related factors are likely to play a less important role in determining discontinuation of the pill and DMPA, while the reasons on doctors objecting to removing the IUD appear to be the major service-related factor in discontinuation of IUD (19%). The decision to stop using any contraceptive appeared to be related to dissatisfaction with the method and side effects was the primary reason and the secondary reason was that they wanted another child.(ABSTRACT TRUNCATED AT 250 WORDS)

Factors associated with family planning acceptance in Bangkok metropolis health clinic areas (MHCs).

To study contraceptive use in Bangkok, 6,809 eligible women were interviewed in a community survey of 5 Metropolis areas. 34.7% were current users of interval contraception and the pill was the most common method. 29.9% were not currently in need of family planning. 18.3% of women were not using contraception, but only 6.2% were in need of family planning (FP) and not currently practising contraception. Non-acceptors who were in need of FP, had a lower educational level; 13.4% did not know about contraception but 52.4% previously used contraception. The most common reason for not currently practising FP was fears about contraceptive safety (37.5%). The prevalence of pregnancy in the community was 10.4%. The fact that only 6.2% of women were not practising FP and were in need of contraception suggests that the services in Bangkok are adequate to meet the needs of most women. However, the subgroup of non-acceptors in need of FP who were from a low socio-economic group require special motivation and services. 1,835 women attending Metropolis Health Centres in the same areas were interviewed to determine their choice of contraception; 57.4% chose the pill.

A comparative controlled trial in rural Thailand of three intrauterine devices.

PIP: The 1st controlled clinical IUD trial carried out as a rural field trial in a developing country was conducted in Thailand. 2452 insertions of 3 different IUDs -- Lippes Loop C, Antigon-F, and Ypsilon -- were made and followed up for a 2-year period. The women were fully informed volunteers who were screened for contraindications to IUDs. The 3 groups were comparable in age, parity, open birth intervals, previous contraceptive use, and hematocrit level. Life table analysis indicated comparable cumulative pregnancy rates for the 3 devices at 12 and at 24 months. Antigon-F had significantly lower expulsion rates and Lippes C the highest expulsion rates of the 3. In fact, expulsion rates for this entire study were atypically high when compared to other studies. This may be attributable to differences in subject characteristics, ethnic factors, or follow-up procedures. The cumulative removal rates for all reasons were found to be comparable for the 3 devices. During most of the period of observation, cumulative total termination rates for all events were significantly lower for the Antigon-F, which recommends this as the preferable IUD for this population.^ieng

Maternal risk factors for low birth weight newborn in Thailand.

The present study assesses the risk approach for maternal risk factors for LBW newborn in Thailand. This study can be considered as a managerial tool for developing local strategies and is particularly useful in the field of maternal and child health care. A summary of maternal risk factors for LBW newborn as listed in Table 7 and can be used as a health educational tool for pregnant women and as basic data for marital counseling. It can also be used to keep the public informed about the maternal risk factors for LBW newborn which will help Thai women of reproductive age avoid the chance of having such babies.

PIP: This multi-center, unmatched, case-control study was conducted at all the 5 maternal-child health care centers in Thailand by administering questionnaires by trained interviewers. Additionally, Chulalongkorn Hospital Medical School and the Maharaj Hospital were also included. The entire sample of 2000 cases were recruited from all pregnant women who delivered a low birth weight (LBW) newborn weighing 2500 gm. 4095 controls were selected from pregnant women in the same hospitals who delivered neonates weighing 2500-4000 gm. Among biological factors influencing LBW, small maternal stature and weight ( 45 kg) was highly associated with LBW neonates (113 cases and 50 controls, relative risk [RR] = 7.15). Maternal age of less than 18 years and 35 years and over ranked 2nd for relative risk (390 cases and 499 controls, RR = 1.75). The other risk factors were parity of 1 or greater than 4 (1379 cases and 2396 controls, RR = 1.68), Quetelet's index of less than 20 (1696 cases and 3259 controls, RR = 1.37). These were all statistically significant risk factors. An accident during the 2nd trimester (RR = 1.34) was also a risk factor. The maternal psychosocial risk factors for LBW newborns were: low family income (RR = 1.75), education ( 4 years of formal education, RR = 1.35), hard work such as agricultural labor (RR = 1.46), and the need to travel (RR = 1.50) or to walk more than 2 hours to the work place (RR = 1.29). Paternal status of being a laborer, an agricultural worker, unemployed (RR = 1.39), or under 19 years old (RR = 1.74) were also risk factors. Pregnancy weight gain of 10 kg had the highest degree of association with having an LBW newborn (RR = 2.21). Other risk factors were: decreased food intake during pregnancy, maternal hematocrit count below 30%, and interpregnancy interval of less than 12 months. Maternal obstetrical risk factors for LBW included: vaginal bleeding during early pregnancy (RR = 3.28), maternal hypertension (RR = 3.48), convulsion during pregnancy (RR = 3.29), no prenatal care or less than 4 visits, maternal drug addiction (RR = 5.13), cigarette smoking (RR = 2.04), coffee or tea drinking during pregnancy, and repeated induced abortions (RR = 2.16).

Bone mineral density of lumbar spine and proximal femur in normal Thai women.

OBJECTIVE: To find the reference data for age-specific normal bone mineral density in a Thai female population. STUDY DESIGN: Cross-sectional, Descriptive study. MATERIAL AND METHOD: 1773 Thai women aged between 11-80 years were recruited, using multistage cluster sampling and stratifying from six represented provinces in the country, each strata was randomly selected. After recruiting, the women were interviewed by well-trained personnel using structured questionnaires. Bone mineral density of the lumbar spine 1-4 and nondominant hip were measured by Dual Energy Photon Absorptiometer. The scientists, X-rays technician were trained and standardized inter and intra observers variation. Quality control of examination was measured periodically. Every BMD outcome was re-examined by a specialist. RESULTS: The peak bone mineral density of both spines and hips was between the age of 30 to 34 years old. Mean Value for spine and femoral neck was 0.957 and 0.814 g/cm2 respectively. The BMD of spine and hip was significantly decreased after the age of 35 and the loss was accelerated at age 50. Osteoporosis for spine and femoral neck is considered when BMD are below 0.682 and 0.569 g/cm2 respectively. CONCLUSION: The results are important data for public health policy, by maximizing bone mass during skeletal growth before menopause and minimizing bone loss throughout life as well as for detection of important risk factors.

Hill tribe opium addicts: a retrospective study of 1,382 patients.

This paper presents the results of a retrospective study of 1,382 patients admitted to the Narcotics Treatment Centre for Hill Tribes in Thailand, which was operated by the WHO/UN/Thai Programme for Drug Abuse Control. The study revealed widespread opium addiction among the hill tribes. Of these, the Karen were the largest group. Mean age on admission for treatment was 35 years. The male:female ratio was 7:1. Sixty-six per cent were heads of households. About one-third came from households with more than one addict. The mean duration of daily opium use before admission was 7.9 years. Over 90% of them were addicted to opium; there were eight heroin users. The mean amount of opium used daily was 3.9 g for males and 3.2 g for females. About three-quarters of them used salicylate analgesics with opium. Illness, in particular abdominal pain, was the most frequent cause of their addiction.

Postpartum tubal ligation by nurse--midwives in Thailand: a field trial.

PIP: 25 nurse midwives with at least 12 years of schooling, 3 1/2 years of training in nursing and midwifery, and a minimum of 1 year of operating room experience were selected from 18 provincial hospitals in Thailand for training in tubal ligations. During the 12 week course in a maternal and child health center in northeastern Thailand, the nurses received preliminary training and assisted surgeons with 3-5 operations; if their performance was approved, they performed 20 operations under a doctor's supervision. All completed the training and returned to be primarily responsible for postpartum sterilizations at their hospitals under the supervision of a gynecologist. Informed volunteer subjects, apparently healthy women having vaginal deliveries who had requested sterilization before delivery, were screened before the operations. The nurse midwives successfully performed 3549 postpartum tubal ligations in the 1st 12 months. The mean age of the sterilization acceptors was 28.2 years and the mean number of living children was 3.6. Assistance was needed from supervising doctors in 18 cases. After 12 months the average operation time was 14.8 plus or minus .3 minutes. The postoperative complications were similar to those in a pilot study, except that mild pyrexia was more common, occurring in 9.1% of cases. 97.4% expressed complete satisfaction on discharge from the hospital. At 6 weeks postpartum 28 of the 1746 cases returning for checkups had minor local complaints. Attitudes of the doctors at the participating hospitals were generally favorable.^ieng

Reasons for discontinuing contraception among women in Bangkok.

PIP: In an attempt to investigate in detail clients' reasons for discontinuing use of a particular contraceptive, a study was undertaken to develop and test a system of classification that would allow precise categorization of individuals in the study and to ascertain detailed medical and social reasons for discontinuing contraception. A total of 666 women, who had accepted a family planning method from 1 of 14 health clinics administered by the Bangkok Metropolitan Health Authority over a 6-month period in 1977, were traced and interviewed 1 year later. Of these, 46% were still using their initial method of contraception and their original supply source. A further 29% had changed either their method or their source of supply or both, and 26% were not using any contraception. The most frequent reason given for discontinuation referred to medical side effects; the 2nd most frequent reason was the woman's feeling that she had no need for contraception. However, the study indicated that preconceived ideas of a contraceptive method, rather than the side effects experienced, may play a leading role in determining whether the method will continue to be used. (author's modified)^ieng