Knowledge, attitudes and practices (kap) regarding influenza A (H1N1) among a population living along Thai-Myanmar border, Ratchaburi Province, Thailand.

The 2009 influenza A (H1N1) outbreaks in Thailand was successfully controlled, partly through the use of electronic media to educate the public. People living along the Thai-Myanmar border may have less access to this electronic media or might have health beliefs that differ from the general Thai population with potential to impact an influenza outbreak. We conducted a survey to assess the knowledge, attitudes and practices regarding influenza among people living along the Thai-Myanmar boder in Ratchaburi Province, Thailand. Of 110 house- holds surveyed, 96% were Karen ethnicity. Greater than 50% were uneducated and most had a low family income. Knowledge about influenza was low. Attitudes regarding infection were mostly negative among the elderly in this area. Practices regarding influenza were moderately good. Education level was associated with knowledge and practice. Income level and wealth indicators were associated with knowledge and having a radio or TV was associated with good practices. Preventive behavior was associated with good knowledge but not with attitudes about influenza. Health education campaigns are needed in these communities to help people adopt desired changes in behavior to improve personal hygiene.

Directly observed therapy with primaquine to reduce the recurrence rate of plasmodium vivax infection along the Thai-Myanmar border.

This study was carried out from April 2005 to June 2006 to evaluate the recurrence of P. vivax malaria infection in relation to drug compliance along the Thai-Myanmar border in Ratchaburi, Thailand. Ninety-two patients with vivax malaria were sequentially assigned to 2 groups. Both groups received a standard dose of chloroquine (total dose = 2.5 g) for 3 days and primaquine (total dose = 210 mg) for 14 days. The experimental group received a full course of treatment using daily directly observed therapy (DOT) while subjects in the control group were given the medication with necessary instructions to take as self-administered therapy (SAT). Patients were followed up for 3 months on Days 14, 21, 28, 60 and 90. Five of 46 patients from the SAT group had recurrence of malaria on Days 21, 44, 60, 72 and 87. Recurrence was not observed among patients in the DOT group. Survival analysis also showed significant differences between the SAT and DOT groups (p <0.05). The study suggests patient compliance with the 14-day primaquine treatment with DOT improve the outcome of .vivax malaria treatment.

Longitudinal study of Plasmodium falciparum and Plasmodium vivax in a Karen population in Thailand.

BACKGROUND: Clinical case treatment of malaria infections where Plasmodium falciparum and Plasmodium vivax are sympatric has achieved effective reductions in P. falciparum prevalence and incidence rates, but has been less successful for P. vivax. The high transmissibility of P. vivax and its capacity to relapse have been suggested to make it a harder parasite species to control. METHODS: A clinical malaria case treatment programme was carried out over a decade in a Karen community composed of seven hamlets on the Thai-Myanmar border. RESULTS: From 1994 to 2004, prevalence rates of both P. falciparum and P. vivax decreased by 70-90% in six of the seven study hamlets, but were unchanged in one hamlet. Overall, incidence rates decreased by 72% and 76% for P. falciparum and P. vivax respectively over the period 1999-2004. The age-incidence and prevalence curves suggested that P. vivax was more transmissible than P. falciparum despite a greater overall burden of infection with P. falciparum. Male gender was associated with increased risk of clinical presentation with either parasite species. Children (< 15 years old) had an increased risk of presenting with P. vivax but not P. falciparum. CONCLUSION: There was a considerable reduction in incidence rates of both P. vivax and P. falciparum over a decade following implementation of a case treatment programme. The concern that intervention methods would inadvertently favour one species over another, or even lead to an increase in one parasite species, does not appear to be fulfilled in this case.