Chewing of betel quid: why do health careproviders in Thimphu, Bhutan, do it?

OBJECTIVE: This cross-sectional study aimed to determine the prevalence of betel quid chewing and related factors including general characteristics, behavioral pattern, perception and social influences among health care providers in Thimphu, Bhutan. MATERIAL AND METHOD: A self-administered questionnaire was handed to 478 health care providers working in different units of health care centers in Thimphu during June-July 2010. A total of 391 (81.8%) questionnaires were returned. Chi-square test and multiple logistic regression were applied. RESULTS: The prevalence of current betel quid chewers among this group was 26.6%. Males chewed betel quid more than females (29.5%, 23.9% respectively). Forty-two percent of current chewers had no specific reasons for chewing betel quid, although 18.2% declared that they were addicted. Both friends and family members were key persons involved in influencing betel quid chewing. Marital status was significantly associated with betel quid chewing, married health care providers being 2 times more likely to chew betel quid (OR = 2.09, 95% CI = 1.02-4.28) than those of single marital status. Similarly, those coming from West Bhutan, were 2 times more likely to be currently using betel quid (OR = 2.71, 95% CI = 1.32-5.55) than other regions. Health care providers from families with more than half of their members chewing betel quid were 14 times more likely to be currently chewing it (OR = 14.52, 95% CI = 6.02-35.04) than families having none of their members chewing it. Health care smokers were more likely to chew betel quid than non-smoking ones (p-value = 0.012). Also occasional drinkers were 3 times more likely to be currently using betel quid (OR = 3.52, 95% CI = 1.78-6.96). Those who perceived a high barrier to quit chewing were about 2.6 times more likely to be current chewers of betel quid, than those who perceived less of a barrier to quit (OR = 2.62, 95% CI = 1.21-5.67). CONCLUSION: The present study revealed betel quid chewing prevalence rate of 26.6%. Of the various factors considered under study, marital status, region of origin, family members chewing betel quid, status of smoking and drinking were statistically proven significant.

Improvement of district hospital service system to increase treatment adherence among tuberculosis patients in Pakistan.

Adherence to medication regimen is essential for tuberculosis (TB) treatment success. We carried out quasi-experimental, single group intervention study at Rawalpindi District Hospital to improve TB patient treatment adherence using a Chronic Care Model (CCM). Ninety-nine newly diagnosed TB patients at the TB Clinic, Rawalpindi District Hospital, during February-March 2009, were included in the study. A set of four quality indicators were determined based on current scientific evidence: quality of service system, patient satisfaction, treatment adherence and cure rate. Care quality changes over time were analyzed by paired t-test. Significant improvements in service quality were seen post-intervention. Overall, the hospital service system quality improved to "good" (from 1.0% to 28.3%), and patient satisfaction increased to "good" (10.2% to 54.1%). Treatment adherence increased (from 23.2% to 56.1%). The quarterly cure rate increased notably (5.3% to 17.2%). The overall mean scores for hospital service system quality, patient satisfaction, and TB patient treatment adherence, improved significantly 6 month post-intervention (p<0.001).

Health Literacy Toward Zoonotic Diseases Among Livestock Farmers in Vietnam.

BACKGROUND: Zoonoses are an increasing concern worldwide, particularly in low- and middle-income countries. People with close contact with animals are at high risk for contracting and transmitting the zoonotic diseases. OBJECTIVES: To determine health literacy of livestock farmers toward biosecurity to prevent zoonotic diseases. METHODS: This cross-sectional mixed-methods study was conducted in Thai Nguyen Province, Vietnam, where livestock and farming are the main occupation. The questionnaire survey was submitted to 218 farmers who have close contact with livestock. In addition, 8 farmers were invited to an in-depth interview to further explore the health literacy. RESULTS: Half of the participants were men. The average age (standard deviation) of the participants was 49.3(11.5) years. The median years with experience in farming was 15 years. The majority (82.0%) of the participants had moderate health literacy level regarding zoonoses. Improper use of antibiotics was referred by 58.0% of participants, including antibiotic use as feeding supplements (34.0%) and the use of human antibiotics to treat sick animals (24.0%). Many participants were unaware of zoonotic prevention measures and due to this had practices such as not wearing protective equipment (60.0%), an absence of acaricides to prevent vector infestations (52.0%), an absence of disinfection measures (42.0%), low rate of rabies vaccination (54.0%), and do not quarantining sick animals (38.0%). In-depth interviews revealed great concern among farmers about a collective lack of participation from local veterinarians, health workers, and government authorities in zoonoses-prevention efforts. Statistical models showed that farm scale, ethnic groups, and perceived income were associated with the overall health literacy about zoonoses. CONCLUSION: Comprehensive health education related to zoonotic diseases is recommended to improve overall knowledge, including routes of transmission, symptoms and consequences of diseases, and antibiotic usage. In addition, guidance should be provided to farmers on how to treat sick animals, the appropriate use of antibiotics, and waste management. Local veterinarians and health workers are important contact points and should work closely with the farmers to prevent zoonotic diseases.

Risk behaviors for HIV/AIDS among youth in rural area of Myanmar.

In some areas of Myanmar up to 1.8 percent of young people aged 15-24 are living with HIV. This study was to describe risk behaviors on HIV/AIDS among youth in rural area of Myanmar. Multistage random sampling was used. A sample of 210 youths aged 15-24 were interviewed. Majority of respondents (70%) were in low level of HIV/AIDS risk behavior. Among those who had sex experiences (30%), more than half had sex before marriage, only 15.9% of them always use condom and 27% of them have had more than one partner. Age, marital status, occupation, monthly income and level of knowledge were found to be significantly associated with level of risk behaviors. Education programs on HIV prevention should be conducted extensively among youths as community based program and also in schools to reinforce health promoting behaviors.

Addressing challenges faced by insecticide spraying for the control of dengue fever in Bangkok, Thailand: a qualitative approach.

Background: This study focused on evaluating the fumigation scheme and identifying problems encountered during the operation in the Bangkok Metropolitan Administration area. Methods: Ten district health officers working in different fumigation teams of the dengue outbreak control programme around Bangkok had participated in an in-depth interview. Five predetermined themes, including (i) dengue surveillance and control strategy, (ii) quality and availability of equipment, (iii) delays, (iv) human resources, and (v) area coverage, and other emerging themes were addressed during the interviews. Results: Although the staff seemed to know the operation protocol of the dengue surveillance and control programmes well, they encountered some difficulties in accessing households for proper spraying, and a lack of human and material resources, especially during an outbreak. Other emerging themes concerned inefficient communications among the sectors from hospital to district offices, leading to inaccurate or missing patient addresses for spraying, and the lack of community networks and public cooperation for the dengue control programmes. Conclusions: The findings suggest that coordination among the relevant health sectors to acquire accurate and timely information about dengue cases is essential. Involving community networks should help to improve public engagement with and participation in the surveillance and outbreak control programmes.

An empowerment program to enhance women's ability to prevent and control malaria in the community, Chiang Mai Province, Thailand.

Paulo Freire's theory was modified to empower a women's group in Chiang Mai Province, Thailand, to prevent and control malaria. This study conducted an intervention in Mueang Na Wan Village, Mueang Na Sub-district, Chiang Dao District, Chiang Mai Province, where 45 women were systematically recruited into the study cohort. Navail Village was selected as a control village because it resembled the intervention village. The empowerment program emphasized enhancement of malaria preventive levels, using insecticide-treated bed nets, self-esteem, and self confidence expectation to prevent and control malaria. Intensive training was conducted and activities performed among the women's group, with 10 participatory meetings in all. Data collection was conducted for the pre-test in month 1, and post-intervention in months 3, 6, 9, and 12. The qualitative methods used were focus-group discussions, non-participant observations, and in-depth interviews with housewives, their husbands, and youths at risk for malaria. The results showed that, post-intervention, there were significantly increased levels for malaria preventive behaviors, behaviors of using insecticide-treated nets, self-esteem, and self confidence expectations, in the intervention village compared with the control village. Insecticide-treated net usage and insecticide-treated net usage behaviors increased in the intervention village more than before and more than that in the control village. The women's group in the intervention village created the following plans, which were crucial to malaria prevention: (1) a family protection plan, (2) providing malaria education to community members, (3) a mosquito-control campaign, (4) scaling-up insecticide-impregnated bed nets, and (5) malaria control among foreign laborers. Finally, the empowered women's group performed sustainable activities. Between malaria-prevention activities, they conducted a joint program to raise income for their families.

Participatory supervision model: building health promotion capacity among health officers and the community.

INTRODUCTION: The Thai traditional health supervision model has been developed since 1991. However, many supervisors lack supervisory knowledge and skills. This study aimed to compare and identify the strengths and challenges of two different supervision models, in order to determine their effects on enhancing the health promotion capacity of health officers in two primary care units (PCU) in Chiang Mai Province, northern Thailand. METHODS: The two models were implemented at two PCU in one semi-district, Chiang Mai Province, over a six-month period. The first model involved supervisors from the district level, with the full participation of health officers at the sub-district level. The second model was designed with the addition of community involvement in the supervision process. Before implementing the models, the district supervisors attended a retraining course to enhance their supervisory knowledge and ability. Questionnaires were used to assess health officers' job satisfaction, clients' perceived service quality and care satisfaction. Semi-structured interviews and qualitative observations were used to explore the involvement of health officers and the community, and to determine the strengths and challenges of each supervisory model. RESULTS: Both before and after the intervention, the PCU health officers appeared to have good and comparable job satisfaction levels. Bivariate analysis indicated that after the intervention, both supervisory models appeared effective in terms of clients' perceived service quality and satisfaction with care, among those who utilized the PCU. However, the second model, which allowed the community to participate in the supervision process, achieved better results. The qualitative findings suggested that the involvement of health officers caused a rapid change and improvement after the supervision. The involvement of the community helped the community itself to identify problems and formulate alternatives to meet the community's needs. CONCLUSIONS: This study shows positive outcomes for two forms of participatory supervision in a rural setting. There appear to be additional positive outcomes for the model that involved community participation. To ensure successful implementation, several issues, such as the supervisor's knowledge and ability, health officer workload and supervisory communication skills, need to be improved.

Strengthening the capability of family health leaders for sustainable community-based health promotion.

The Family Health Leader (FHL) Project was initiated in 1997 to encourage self-care and health promotion. Since then, there has been no retraining. This study aimed to strengthen the FHLs' capability to sustain community-based health promotion and network establishment. The study, of a quasi-experimental design, was conducted in a village in Phan Thong district, Chon Buri Province, Thailand. The intervention emphasized enhancing the FHLs' knowledge, ability, leadership and motivation to advance health promotion activities. Before implementing the main intervention, 5 community health workers were trained as facilitators to strengthen 36 FHL capabilities. The curriculum and manual for training facilitators and FHLs were also developed. The intervention for strengthening FHLs' capabilities lasted for 7 months using participatory training. A within-subject repeated ANOVA was used to measure changes in the main outcome variables immediately, and at three and six months after the intervention. A qualitative methodology was utilized to assess network establishment. The results indicate that the FHLs' knowledge of self-care and health promotion, ability, leadership and motivation had increased significantly after the intervention (p < 0.001). The FHLs also sought to extend their network by involving both the community committee and the local authorities. The intervention appeared to be successful in strengthening the FHLs' capabilities to sustain health promotion within the community, and it established networks vertically and horizontally. The FHLs were the key persons to bring good health to family members. Periodical participatory learning and group empowerment are recommended for encouraging the FHLs to maximize their potential for family self-care and health promotion.