Frank P. Schelp

Micromapping of Thalassemia and Hemoglobinopathies in Diferent Regions of Northeast Thailand and Vientaine, 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 Peoples 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 [β26(B8)Glu→Lys, GAG>AAG], 5.8% for α0-thalassemia (α0-thal), and 0.9% for β-thal. The THAI deletion type of α0-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 α0-thal of 8.6% for the Laotian women was similar to that found in the upper northeastern part of Thailand. The frequency of β-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.

A Self-Administered Device for Cervical Cancer Screening in Northeast Thailand

OBJECTIVE To test a self-scraping device as a mass screening device against a routine scraping method and to evaluate the acceptance of the self-scraping device by a group of rural females from Northeast Thailand. STUDY DESIGN From a rural area of Northeast Thailand, 552 women were trained and motivated, through primary health care structures, to participate in a cervical cancer screening exercise using a self-scraping device. After one week, the same females were reexamined by gynecologists using the routine scraping method. In both cases the specimens were stained according to Papanicolaou. Through questionnaires the acceptance of the self-scraping device was evaluated. RESULTS Through the self-scraping method, 13 cases suspicious for malignancy were detected. Specimens obtained through examination by physicians confirmed 11 cases to be suspicious for malignancy. No false negative cases were found. In the detection of inflammation, the self-scraping method was not as accurate as examination by a physician. The device was accepted by the females who participated in the study. CONCLUSION In the rural areas of developing countries, where physicians and other trained medical personnel are not often available to carry out regular screening tests on a population basis, the self-scraping method can be applied as an integral part of primary health care for mass screening for uterine cervical cancer.

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.

BackgroundThailand 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.MethodsEpidemiological 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’.ResultsAll 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%.ConclusionsThe 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.

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% β-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.

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 α0-thal and 1.2% were β-thal carriers. One woman with the – –THAI deletion was also found. Among the females under survey, structural Hb variants with 3.2% Hb E [β26(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.

Health status of diabetes type 2 patients in Thailand contradicts their perception and admitted compliance

A nationwide data set about the health status of diabetes mellitus type 2 (DM) patients and a questionnaire of a sub-sample of the DM patients about their know-how, behavior and perception about health care had been re-assessed. Laboratory results revealed that in average 70% of the patients had been over nourished, over 50% had abnormal cholesterol-, over 55% had high triglyceride levels and 51% had high density lipid (HDL) values below 45 mg/dl. Sixty percent of patients had glycated hemoglobin (HbA1c) levels over 7%. About 60% of study participants answered a questionnaire. In contrast to the laboratory findings about 90% claimed to take the medicine as the doctor advised, 60% said that they adjusted their food intake as advised and more than 80% said that they know well how to take care of themselves. They were only superficially informed about the complications of DM. Almost 95% were satisfied with the health service they receive and over 70% were satisfied with their health status. The results are discussed in connection with the need to control DM on the basis of primary health care (PHC). It is argued that the assessment of health programs solely through questionnaires might be misleading, if the findings are not confirmed by clinical and biochemical parameters.

Community Participation for Thalassemia Prevention Initiated by Village Health Volunteers in Northeastern Thailand

The study was conducted to assess the achievement of a thalassemia screening program at a community level supported by village health volunteers (VHVs) of 2 subdistricts in the northeast of Thailand. One subdistrict served as the intervention and the other as the control area. A training program was organized for the village health volunteers from the intervention area. Essential information about the risk and danger of thalassemia was given to the participants who wanted to have children in the community as well. Of the 206 individuals who wanted to have children living in the intervention area, 190 (92.2%) agreed to undergo screening. Of the 196 individuals within the control area, only 26 (13.3%) voluntarily participated in the screening tests. Attitude toward prevention and knowledge about the disease improved significantly in both areas, but the differences between the scores were statistically significantly higher for individuals living in the intervention area.

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.

Dietary patterns and their association with the components of metabolic syndrome: A cross-sectional study of adults from northeast Thailand

Background: Nutritional transition influences a shift in eating behaviour that is associated with a rise in the prevalence of non-communicable diseases (NCDs). Metabolic syndrome (MetS) comprises a set of NCD risk factors. This study aimed to investigate dietary patterns and to determine the relationship between dietary patterns and MetS and its components. Methods: A cross-sectional study was conducted among 468 healthy adults aged 35-60 years who were residents of a semi-urban district of one of the central provinces in the northeast of Thailand. A factor analysis identified dietary patterns based on the consumption of 21 food groups, which were assessed by using a semi-quantitative food frequency questionnaire. MetS was identified by using the harmonized criteria that were stipulated by six leading international organisations. The association between dietary patterns and MetS and its components were evaluated by multiple logistic regressions. The confounding factors adjusted in the model were age, sex, smoking status, physical activity, and medication intake. Results: Two dietary patterns were identified: a traditional pattern characterised by high intakes of sticky rice and animal source foods; a mixed pattern included high intakes of white rice and a variety of food groups. The two dietary patterns did not show any association with MetS. Participants in the highest tertile of the traditional pattern was significantly related to high triglycerides (adjusted OR = 1.74, 95% CI: 1.10-2.88), in comparison to those from the lowest tertile, whereas participants in the highest tertile of the mixed pattern was inversely associated with abdominal obesity (adjusted OR= 0.49, 95% CI: 0.30-0.81) than those in the lowest tertile. Conclusions: Adherence to a traditional dietary pattern among the northeast Thai adults, in the context of nutrition transition, was associated with high triglyceride levels while the mixed dietary pattern was inversely related to abdominal obesity.

Epidemiological transition in type 2 diabetes mellitus: the role and function of a sub-district health promoting hospital

Health authorities in Thailand implemented a policy especially to cope with chronic diseases in that they transformed former health stations into sub-district health promoting hospitals (SHPH). The “top down” measure left the staff of the SHPH somewhat confused and uncertain how to manage their duties effectively. One of the weak points was the questionable outreach of care into the community. In an attempt to demonstrate how to enhance community participation, one SHPH was selected and assisted in improving the care of type 2 diabetes mellitus (T2DM) patients. Patients from another SHPH served as controls. The combined efforts of patients, their families, SHPH staff, and the community with the help of village health workers succeeded in improving the control of T2DM in that a steady decline in capillary blood glucose (CBG) could be observed and the results could also be verified by the determination of glycated hemoglobin (HbA1c).