Thalassemia and Hemoglobinopathies in an Ethnic Minority Group in Northern Vietnam.

This study assessed thalassemia and hemoglobinopathies in a group of the Tay ethnic minority. Participants included 289 women of reproductive-age who enrolled in a pilot screening program for thalassemia conducted at six communities of Thai Nguyen Province, northern Vietnam. Standard procedures including complete blood count (CBC), hemoglobin (Hb) and DNA analyses were performed for all samples. The prevalence of thalassemia in 289 Tay women was 15.6% (gene frequency 0.078) for α0-thalassemia (α0-thal), 10.0% (gene frequency 0.050) for α+-thal, 7.3% (gene frequency 0.036) for ß-thalassemia (ß-thal), 2.4% (gene frequency 0.012) for Hb Constant Spring [Hb CS; α142, Term→Gln, TAA>CAA (α2), HBA2: c.427T>C] and 1.7% (gene frequency 0.009) for Hb E [ß26(B8)Glu→Lys, GAG>AAG; HBB: c.79G>A]. Further analysis of ß-globin gene abnormalities identified four mutations including codons 41/42 (-TCTT) (HBB: c.126_129delCTTT), codon 17 (A>T) (HBB: c.52A>T), codons 71/72 (+A) (HBB: c.216_217insA), and -28 (A>G) (HBB: c.78A>G). The results hint at the remarkably high frequencies of severe forms of thalassemia that indicate a serious public health problem requiring further exploration, and most probably, also intervention within the country.

Molecular Heterogeneity of Thalassemia among Pregnant Laotian Women.

BACKGROUND AND AIMS: A pilot screening program for thalassemia was initiated in the Lao People's Democratic Republic. This study aimed to describe the genotype diversity and hematologic features of thalassemia among the participating pregnant women. METHODS: Blood samples of 411 pregnant Laotian women were collected. Hemoglobin (Hb) profiles were determined using a capillary zone electrophoresis system. Mutations of α- and ß-globin genes were investigated using a polymerase chain reaction and related techniques. RESULTS: As many as 26 different thalassemia genotypes including non-transfusion-dependent thalassemia, i.e. Hb E-ß-thalassemia, Hb H, and EA Bart's diseases, were identified. A variety of phenotypic expressions of hematologic features and Hb profiles were observed, including an unusual phenotype of Hb E-ß0 thalassemia with 89.1% Hb E, 1.6% Hb F, and 9.3% Hb A2. CONCLUSIONS: The remarkable genotype-phenotype diversity indicates a need for careful laboratory interpretation in order to provide appropriate genetic counseling and care to the Laotian population.

PILOT SCREENING PROGRAM FOR THALASSEMIA IN A COUNTRY WITH LIMITED RESOURCES: A COLLABORATION MODEL BETWEEN CLOSE NEIGHBORING COUNTRIES.

Screening for thalassemia carriers should not only be conducted in middle-income countries but also can be possible in low-middle income countries, through cooperation of experienced professionals from middle income countries. We describe a collaborating model between two close neighboring countries in establishing such a screening program for thalassemia. After training and setting up of facilities, a total of 152 out of 187 hospital staff were screened as a pilot activity to encourage community participation. Referring system for sending blood samples to a reference center in Thailand was also established. Among 152 health staff, 12.5% α0-thal, 2% ß-thal and 13% Hb E carriers were found. Applying thalassemia screening to 411 pregnant women and 71 spouses, 5 couples at risk of bearing a child of thalassemia disease were identified. The thalassemia screening program has a sensitivity of 99.5%, specificity of 77%, positive predictive value of 73%, and negative predictive value of 99.5%. Thus, it is possible to operate a thalassemia screening program with acceptable performance in a low-middle income country (Lao People's Democratic Republic) with the cooperation of a referral center located within close proximity in a middle income country (Thailand).

A first-degree relative with diabetes mellitus is an important risk factor for rural Thai villagers to develop type 2 diabetes mellitus.

The screening of 609 villagers in rural areas of northeastern Thailand resulted in the detection of 110 (18.1%) new cases of type 2 diabetes (T2DM). The diagnoses were made on the basis of a glycated hemoglobin (HbA1c) value ≤ 6.5%. Among all those screened, 243 (40%) reported having a father or mother with T2DM. Among the new cases, 66 (60%) reported a first-degree relative, predominantly their mothers, who had the disease. Together with age and the body mass index, a mother or father with DM was strong risk factor for the development of T2DM (adjusted odds ratio = 2.9, 95% confidence interval = 1.84-4.57) when compared with the absence of a first-degree relative with DM. It is concluded that family history of a first-degree relative is an important additional information that might improve the validity of the screening procedure.

Hemoglobin Constant Spring is markedly high in women of an ethnic minority group in Vietnam: a community-based survey and hematologic features.

A community-based survey was conducted to determine the prevalence and gene frequency of Hemoglobin Constant Spring (Hb CS) and other forms of thalassemia among an ethnic minority in Vietnam. A total of 298 ethnic minority women, the Có-Tu, participated. Hematological parameters and hemoglobin profiles were analyzed using standard automated analyzers. Alpha- and beta-thalassemia mutations were identified using polymerase chain reaction (PCR) based technology. Of the 298 women, 141 (47.3%) carried thalassemia genes. Hemoglobin Constant Spring (Hb CS) is the most common with a markedly high frequency of 0.143 (overall prevalence=26.2%). The heterozygous state of Hb CS was found in one-fifth (20.5%) of women participating. Seven women (2.4%) were Hb CS homozygote. The overall prevalence for Hb E was 13.8%, and 10.7% for α(+)-thalassemia. Other forms of thalassemia included 0.67% ß-thalassemia, and 0.34% Hb Paksé. None of the participants had the α(0)-thalassemia gene. The study provides basic epidemiological information about Hb CS as well as other forms of thalassemia for a specific group of an ethnic minority in Vietnam. The data will be useful for further study on the distribution of thalassemia in Southeast Asia.

Burden of anemia in relation to thalassemia and iron deficiency among Vietnamese pregnant women.

BACKGROUND AND AIMS: Information about the extent to which anemia is related to thalassemia and iron deficiency (ID) is not available in Vietnam. This study investigated the burden of anemia in relation to thalassemia and ID among Vietnamese pregnant women. METHODS: A cross-sectional study was conducted in Thua Thien Hue, Central Vietnam. Blood samples taken from 399 pregnant women with a gestational age <12 weeks were analyzed. Anemia was defined as Hb levels <11 g/dl, and ID as ferritin values <15 ng/ml. RESULTS: Out of 399 participants, 77 (19.3%) were anemic. While the prevalence of ID was 20.1%, the prevalence of ID anemia was 6.0%. The overall prevalence of thalassemia was 7.3%. Of the 77 anemic women, 24 (31.2%) had ID, and 20 (26.0%) had thalassemia genes. The rest (42.9%) were anemic due to unknown causes. CONCLUSIONS: The results indicate that ID remains a significant health burden among the study population, together with anemia caused by unknown factors. Thalassemias appear not to contribute to a great extent to anemia among Vietnamese pregnant women. Other causes need to be investigated further in order to develop an effective control program for anemia within the population.

Benefits and constraints in screening for non-communicable diseases in the rural area of Thailand's northeast.

OBJECTIVE: To investigate the benefits and constraints of a screening attempt as initiated by the Ministry of Public Health (MoPH) measuring over-nutrition, hypertension and type 2 diabetes mellitus (T2DM) undertaken by the local health officials on sub-district level. MATERIAL AND METHOD: Capillary blood glucose (CBG), body mass index (BMI), blood pressure, and history of type 2 diabetes mellitus (T2DM) of first degree relatives was assessed following the direction of the Ministry of Public Health (MoPH) by the local health officials. RESULTS: The proportions of obesity, hypertension, and T2DM from 7,698 villagers were about 35%, 20%, and suspected to be 9%, respectively. This was similar to previous investigations except for the history of T2DM of first-degree relatives, which strongly relates to elevated CBG levels. A high percentage of missing value was recognized for all variables. CONCLUSION: The screening of non-communicable disease program executed by the lower level of the health delivery system is an achievement by itself It can detect new cases of diseases. However incompleteness of variables is a constraint observed due to high workload of the health staff To decrease the burden of the public health staff and the curative sector and increase accuracy, the proportion of the population eligible for screening should be restricted to a higher age, being obese, and having a first-degree relative with diabetes mellitus.

Thalassemia and hemoglobinopathies in Thua Thien Hue Province, Central Vietnam.

A community-based assessment of thalassemias and hemoglobinopathies was conducted at the Thua Thien Hue Province, Central Vietnam. By cluster sampling, a total of 410 pregnant women attending the antenatal care service at 30 commune health centers were recruited consecutively from September 2011 to June 2012. Hemoglobin (Hb) analysis was performed using an automated Hb analyzer. α-Thalassemia (α-thal) genes were identified by polymerase chain reaction (PCR)-based techniques. Out of the 410 pregnant women, 2.7% carried α(0)-thal and 1.2% were ß-thal carriers. One woman with the - -(THAI) deletion was also found. Among the females under survey, structural Hb variants with 3.2% Hb E [ß26(B8)Glu→Lys, GAG>AAG; HBB: c.78G>C] and 3.7% Hb Constant Spring [Hb CS; α142, Term→Gln, TAA>CAA (α2); HBA2: c.427T>C] were found. Assessing the frequency of thalassemias and hemoglobinopathies by ethnicity, Kinh (Vietnamese) and ethnic minority groups, Hb CS with a high frequency of 24.0% was observed in the ethnic minority groups. These results provide basic population-based information, are useful not only for implementing measures for prevention and control of thalassemias in the region but also for studying the importance of thalassemias and hemoglobinopathies in ethnic minorities within Southeast Asia.

Use of glucometer and fasting blood glucose as screening tools for diabetes mellitus type 2 and glycated haemoglobin as clinical reference in rural community primary care settings of a middle income country.

BACKGROUND: Thailand is considered to be a middle income country, and to control and prevent type 2 diabetes mellitus (T2DM) is one of the main concerns of the Thai Ministry of Public Health (MoPH). Screening for T2DM and care for T2DM patients has been integrated into the primary health care system, especially in rural areas. The intention of this investigation is to link public health research at the academic level with the local health authorities of a district of a north-eastern province of the country. METHODS: Epidemiological methods were applied to validate the screening tools fasting capillary blood glucose (CBG), measured by glucometer and venous blood for the determination of plasma glucose (VPG), used for screening for T2DM among asymptomatic villagers. For assessing the validity of these two methods glycated haemoglobin (HbA1c) values were determined and used as the 'clinical reference'. RESULTS: All together 669 villagers were investigated. Determinations of CBG and VPG resulted in suspected T2DM cases, with 7.3% when assessed by CBG and 6.4% by VPG using a cutoff point of 7 mmol/L (126 mg/dl). Taking HbA1c determinations with a cutoff point of 7% into account, the proportion of T2DM suspected participants increased to 10.4%. By estimating sensitivity, specificity and the positive predictive value of CBG and VPG against the 'clinical reference' of HbA1c, sensitivity below 50% for both screening methods has been observed. The positive predictive value was determined to be 58.5% for CBG and 56.8% for VPG. The specificity of the two screening tests was over 96%. CONCLUSIONS: The low sensitivity indicates that using fasting CBG or VPG as a screening tool in the field results in a high proportion of diseased individuals remaining undetected. The equally low positive predictive values (below 60%) indicate a high working load for the curative sector in investigating suspected T2DM cases to determine whether they are truly diseased or false positive cases according to the screening method. Further implications of the results and the controversial discussion related to the use of HbA1c as clinical evidence for suffering from T2DM are also discussed.

Micromapping of thalassemia and hemoglobinopathies in diferent regions of northeast Thailand and Vientiane, Laos People's Democratic Republic.

In order to determine the prevalence of thalassemia and hemoglobinopathies in different regions of northeast (NE) Thailand and Vientiane, Laos People's Democratic Republic (PDR), a total of 1,809 blood samples were collected consecutively from individuals attending antenatal care services at 11 community hospitals in different regions of NE Thailand and three hospitals in Vientiane, Laos PDR, from May 2009 to April 2010. All individuals were investigated for thalassemia and hemoglobinopathies using standard methods. For individuals from NE Thailand, the carrier frequencies were 41.7% for Hb E [ß26(B8)Glu→Lys, GAG>AAG], 5.8% for α(0)-thalassemia (α(0)-thal), and 0.9% for ß-thal. The THAI deletion type of α(0)-thal was found in one individual from an ethnic minority. From a group of pregnant Laotian women, 30.1% were Hb E carriers. The prevalence of α(0)-thal of 8.6% for the Laotian women was similar to that found in the upper northeastern part of Thailand. The frequency of ß-thal was 2.3 %. The proportion of carriers of α(+)-thal and Hb Constant Spring (Hb CS, α142, Term→Gln (TAA>CAA in α2)] ) from Thailand and Laos was significantly different. The frequency of Hb Paksé [α142, Term→Tyr (TAA>TAT in α2)] was relatively low for Thailand as well as for Laos. The results indicate that thalassemia and hemoglobinopathies are a significant health burden in the region and that a prevention and control program for severe thalassemia diseases should be established in Laos.

Thalassemia and iron deficiency in a group of northeast Thai school children: relationship to the occurrence of anemia.

UNLABELLED: The cross-sectional study assessed anemia, thalassemia, and hemoglobinopathies, as well as iron deficiency, among 190 northeastern Thai school children aged 10 to 11 years. The aim was to analyze the reasons for anemia among the group. Hemoglobin concentration and other hematological parameters were determined using an automated blood cell counter. Beta-thalassemia and other hemoglobinopathies were identified by high performance liquid chromatography (HPLC) analysis of hemoglobin. Alpha-thalassemia was identified by polymerase chain reaction (PCR) and related techniques. Iron deficiency was assessed using serum ferritin (SF) <20 ng/ml as indicator. Based on the WHO criteria, anemia was defined by hemoglobin (Hb) level <11.5 g/dl. Twenty five out of 190 children (13.2%; 95% CI = 8.7-18.8%) were anemic. Iron deficiency was found in only two out of 190 children (1.0%; 95% CI = 0.1-3.8%), but the two iron deficient children were not anemic. The proportion of thalassemia and hemoglobinopathies among the group was 61.1% (95% CI = 53.7-68.0%). As underlying reasons for anemia, thalassemia and hemoglobinopathies were found in 22 out of 25 (88.0%) anemic children. Beta-thalassemia and homozygous Hb E seem to be important, while this was less obvious for heterozygous α-thalassemia and heterozygous Hb E. CONCLUSION: The results suggest that thalassemia and hemoglobinopathies may be major contributing factors to the occurrence of anemia in this area among the children's population.

Effect of the maternal betaE-globin gene on hematologic responses to iron supplementation during pregnancy.

BACKGROUND: It is customary in Southeast Asia to treat pregnant anemic women with iron supplements, but anemia in this region may be complicated by thalassemia and hemoglobinopathies, which lead to an ineffective response. OBJECTIVE: The aim was to determine whether routine iron supplementation during pregnancy in this area, which has a high prevalence of thalassemia and hemoglobinopathies, is an effective control strategy for iron deficiency anemia. DESIGN: A prospective study was conducted. Seventy-six pregnant women, including 43 who were heterozygous for the hemoglobin E (Hb E) gene, 20 who were heterozygous for Hb E and had alpha-thalassemia, and 13 who were homozygous Hb E, as well as 77 pregnant women who had no thalassemia gene, participated in this investigation. All pregnant women received a daily dose of 120 mg elemental Fe for an average of 133.5 d. Hematologic variables and serum ferritin concentrations were measured before supplementation and after supplementation at the gestational age of 28-32 wk. Differences in hematologic variables and serum ferritin were assessed. RESULTS: Significant differences in hemoglobin, mean corpuscular volume, and mean corpuscular hemoglobin responses were found between the nonthalassemia group and the 3 groups with the Hb E gene after adjustment for the following baseline values: age, body mass index, duration of iron supplementation, and ferritin concentration. Significant differences in the improvements in mean corpuscular volume and mean corpuscular hemoglobin values between the 3 groups indicate a poorer response at the cellular level in the pregnant women with the Hb E gene. Further analysis showed a significant difference in the hemoglobin response only for women who were homozygous for Hb E. CONCLUSION: Iron supplementation during pregnancy is not beneficial for pregnant women who are homozygous for Hb E, but a routine intervention should not cause iron overload, as judged from this short observation period.

Nutritional status of pregnant women in Northeast Thailand.

A comparative study on the nutritional status of primiparous and multiparous women in the first trimester of pregnancy was conducted in the northeastern province of Thailand, Khon Kaen, to investigate differences in protein-energy-malnutrition, iron deficiency anaemia, vitamin A deficiency and carotenoid status between both parity groups. 94 subjects were recruited at first attendance of antenatal clinic. Data about weight, height, haemoglobin and haematocrit were obtained from hospital records. Anthropometric measurements of mid-upper arm circumference and triceps skinfold were done on a sub sample. Retinol, carotenoids and alpha-tocopherol were analysed using a reversed-phase high-performance liquid chromatography method. Ferritin, transthyretin and retinol-binding protein were determined by enzyme-linked immunosorbent assay. Primiparous women showed lower body mass index, mid-upper arm circumference, corrected arm muscle area (P<0.001) as well as lower retinol, cholesterol and triceps skinfold (P<0.05). After adjusting for age and socio-economical status the significant difference persisted for all parameters but triceps skinfold. No significant differences of alpha-tocopherol, serum proteins, carotenoids and iron indices could be observed, even though a tendency to higher values for ferritin, haemoglobin and haematocrit was shown in multiparous women. Prevalence of protein-energy-malnutrition (body mass index <18.5 kg/m2) in the primiparous group was significantly higher compared to the multiparous group (P<0.05). Prevalence of protein-energy-malnutrition, iron deficiency anaemia and vitamin A deficiency were 15.1%,6.3% and 3.3%, respectively, in the total study population. No differences between parity groups could be observed for prevalence of iron deficiency anaemia and vitamin A deficiency.

Thalassemia and hemoglobinopathies rather than iron deficiency are major causes of pregnancy-related anemia in northeast Thailand.

A cross-sectional prevalence study of anemia was undertaken on 412 pregnant women in northeast Thailand during January 2003 to May 2004. With standardized diagnostic protocols and the CDC criteria of anemia [hemoglobin (Hb) < 11 g/dl at < or = 12 weeks of gestation and Hb < 10.5 g/dl at < or = 20 weeks of gestation], 71 (17.2%) subjects were anemic. Of these, 42 (59.2%) subjects had thalassemia, 5 (7.0%) had iron deficiency, 18 (25.4%) had combined thalassemia and iron deficiency and 6 (8.5%) had no thalassemia nor iron deficiency. Adjusted logistic regression analyses indicated that various thalassemia genotypes were significantly related to anemia, while homozygous Hb E had the highest risk with an odds ratio (OR) of 44.8 (95% CI 12.6-159.7). In comparison, iron deficiency demonstrated a much lower risk with OR of 3.1 (95% CI 1.4-6.8). This finding suggests that the contribution of iron deficiency to pregnancy associated anemia in this region is low.

Relationship between soluble leptin receptor, leptin, lipid profiles and anthropometric parameters in overweight and obese Thai subjects.

Median, range and 95% confidence interval (CI) for median of age, anthropometric variables, soluble leptin receptor, serum leptin and lipid profile levels of 48 overweight (Body mass index (BMI) = 25.00-29.99 kg/m2) and obese (BMI > or = 30. 00 kg/m2) Thai males and 166 overweight and obese Thai females, compared with 26 males and 81 females in a control group (BMI = 18.50-24.99 kg/m2), were determined The study subjects were persons who turned up regularly for physical check-ups at the Out-patient Department, General Practice Section, Ratchawithi Hospital, Bangkok, aged between 18-60 years. Serum leptin, triglyceride and low density lipoprotein cholesterol/high density lipoprotein cholesterol ratios (LDL-C/ HDL-C ratio) were significantly higher in the overweight and obese males and females. Soluble leptin receptor and HDL-C were significantly lower in the overweight and obese males and females. Cholesterol and LDL-C were significantly higher in the overweight and obese females, but there was no significant difference in the overweight and obese males when compared with the control males. Low soluble leptin receptor levels were found in 38.1% (8/21) of the overweight and obese males, while 31.5% (29/92) were found in the overweight and obese females. Elevated leptin levels were found in 66.7% (32/48) and 89.8% (149/166) of the overweight and obese males and females, respectively. Both low soluble leptin receptor levels and elevated leptin levels were found in 9.5% (2/21) and 29.4% (27/92) of the overweight and obese males and females, respectively. A significant positive correlation was found between soluble leptin receptor and cholesterol, and between weight, BMI, waist, hip and HDL-C, with leptin. Serum soluble leptin receptor levels were significantly negatively correlated with leptin and BMI. The results can elucidate the causes and consequences of obesity, and are expected to aid the provision of care for overweight and obese Thai people.

A reliable screening protocol for thalassemia and hemoglobinopathies in pregnancy: an alternative approach to electronic blood cell counting.

Primary screening for thalassemia and hemoglobinopathies usually involves an accurate blood count using an expensive electronic blood cell counter A cheaper alternative method was tested by using a modified osmotic fragility (OF) test and a modified dichlorophenolindophenol (DCIP) test. Altogether 423 pregnant Thai women participated in this project. Hemoglobin patterns and globin genotypes were determined using an automated high-performance liquid chromatography analyzer and polymerase chain reaction analysis of alpha- and beta-globin genes. Among the 423 subjects, 264 (62.4%) carried thalassemia genes. The combined OF and DCIP tests detected all pregnant carriers of the 3 clinically important thalassemias, ie, alpha0-thalassemia, beta-thalassemia, and hemoglobin E with a sensitivity of 100.0%, specificity of 87.1%, positive predictive value of 84.5%, and negative predictive value of 100.0%, which show more effectiveness than these values for the standard method based on RBC counts. A combination of modified OF and DCIP tests should prove useful and applicable to prenatal screening programs for thalassemia and hemoglobinopathies in communities with limited facilities and economic resources.

Experience with a self-administered device for cervical cancer screening by Thai women with different educational backgrounds.

BACKGROUND: This descriptive study was carried out to test the acceptability of a self-administered device for cervical cancer screening and assess certain risk factors in relation to the cancer in two districts of Khon Kaen province in Northeast Thailand. METHODS: A total of 354 women from the villages were selected (including 143 teachers from secondary and primary schools; 24 health officers from the rural health centres, and 37 nurses from the University Hospital, Khon Kaen University). The Kato device was introduced and used by the women, who were then asked to give their opinion on its usage. RESULTS: The Kato device was generally well accepted by the women. However, many of those with a higher educational background were more sceptical towards the device than their counterparts from the villages. CONCLUSIONS: A suitable approach to strengthen the control of cervical cancer in the rural areas of Thailand might be to introduce the Kato device as an integral part of primary health care. The introduction of the device should go along with health education on the importance of avoiding infection with the papilloma viruses. This message should be transmitted to both females and males.

The relationships between anthropometric measurements, serum vitamin A and E concentrations and lipid profiles in overweight and obese subjects.

The weight, height, body mass index (BMI), waist/hip ratio, serum retinol and alpha-tocopherol and lipid profiles of 16 overweight (BMI > or = 25.0 kg/m2) Thai males and 56 overweight females, compared with 14 males and 58 females in a control group (BMI 18.5-24.9 kg/m2), were investigated. Subjects for the study were those persons who turned up regularly for physical check-up at the Outpatient Department, General Practice Section of Rajvithi Hospital, Bangkok. The study was conducted between December 2000-March 2001. Higher levels of cholesterol, LDL-C, LDL-C/HDL-C ratio were found in the overweight compared with the control subjects. Statistically significant higher triglyceride levels were found in the overweight compared with the control subjects. The median serum retinol concentration in overweight subjects was 2.80 mumol/L (range 0.53-4.62 mumol/L) compared with 2.97 mumol/L (range 1.21-4.12 mumol/L) in control subjects (p = 0.0736). The median serum alpha-tocopherol concentration in overweight subjects was 17.30 mumol/L (range 6.29-28.65 mumol/L) compared with 18.75 mumol/L (range 5.30-30.28 mumol/L) in control subjects (P < 0.05). The median values of retinol and alpha-tocopherol serum concentrations in the overweight and obese males were lower than those of the overweight and obese females. A total of 6.3% (1 out of 16) and 12.5% (2 out of 16) of the overweight/obese males had decreased retinol and alpha-tocopherol levels, while the overweight/obese females had decreased retinol and alpha-tocopherol level of 1.8% (1 out of 56) and 10.7% (6 out of 56), respectively. A total of 12.5% and 39.3% of the overweight/obese males and females had cholesterol concentrations of > or = 6.48 mmol/l. However, the prevalence of low HDL-C (HDL-C < or = 0.91 mmol/l) was found to be 50% in the overweight and obese males and 10.7% in the overweight and obese females. Statistically significant associations were found between age, cholesterol, LDL-C, and serum alpha-tocopherol in the overweight and obese male and female subjects. A negative correlation was found between weight, BMI, AC, MAMC, hip circumference and serum retinol in both the overweight and obese subjects. A negative correlation was found between weight, BMI, MAMC, waist, hip circumferences and serum alpha-tocopherol in both the overweight and obese subjects.

Advantages of trained TBA and the perception of females and their experiences with reproductive health in two districts of the Luangprabang Province, Lao PDR.

The study describes reproductive health in two districts of the Luangprabang Province in northern Lao PDR. The aim was to find out whether training traditional birth attendants (TBA) might have an impact on reproductive health. In June/July 2000, a total of 298 women of reproductive age, with children below two years of age, from 30 villages were interviewed by means of a closed questionnaire. In 1996/1997, a training course for TBA was conducted in one of the districts under survey. Information was obtained for demography, symptoms and risks during pregnancy and delivery, antenatal care (ANC), tetanus immunization, food taboos, place of delivery, birth attendant, practising of birth spacing and their attitude towards the services of TBA. The results obtained indirectly pointed towards a high fertility rate and a high rate of child death and abortion. An overwhelming majority of the women delivered at home, attended only by untrained individuals. During pregnancy and after delivery, the women claimed that they often suffered from edema of legs and feet, high fever and hemorrhages. Only 50% of the females in the district where TBA training were conducted, made use of the services of trained TBA. Nevertheless, females in the district with trained TBA, who made use of the TBA service in comparison with women in the same district not using the service of TBA, were 3.8 times more likely to also make use of the ANC service; 3.3 times more likely to seek immunization, and 8.6 times more likely to give colostrum to their new-borns. The educational level of the females proved to be an important factor. Literate women were more likely to practise birth spacing and have been vaccinated. Illiterate women were more likely to be at higher risk for losing a child. In the district without TBA service the loss of a child was less likely among literate than illiterate women. It is concluded that through adequately trained TBA and through their continuous support and supervision, ANC and health education can be improved. In addition to the improvement of the referral system for emergency cases and manpower development within the obstetric curative service, the training of TBA will have a positive impact on reproductive health. However, maternal health depends, to a large extent, on the educational level of the women.