Ratana Somrongthong

Facilitators and barriers to accessing reproductive health care for migrant beer promoters in Cambodia, Laos, Thailand and Vietnam: A mixed methods study

BackgroundThe purpose of the research was to assess access to sexual and reproductive health services for migrant women who work as beer promoters. This mixed methods research was conducted in Phnom Penh, Cambodia, Bangkok, Thailand, Vientiane, Laos, and Hanoi, Vietnam during 2010 to 2011.MethodsFocus groups were held with beer promoters and separate focus groups or interviews with key informants to explore the factors affecting beer promoters’ access to health care institutions for reproductive health care. The findings of the focus groups were used to develop a survey for beer promoters. This survey was conducted in popular health institutions for these women in each of the four Asian cities.ResultsSeveral common themes were evident. Work demands prevented beer promoters from accessing health care. Institutional factors affecting care included cost, location, environmental factors (e.g. waiting times, cleanliness and confidentiality) and service factors (e.g. staff attitudes, clinic hours, and availability of medications). Personal factors affecting access were shyness and fear, lack of knowledge, and support from family and friends.The survey of the beer promoters confirmed that cost, location and both environmental and service factors impact on access to health care services for beer promoters. Many beer promoters are sexually active, and a significant proportion of those surveyed rely on sex work to supplement their income. Many also drink with their clients. Despite a few differences amongst the surveyed population, the findings were remarkably similar across the four research sites.ConclusionsRecommendations from the research include the provision of evening and weekend clinic hours to facilitate access, free or low cost clinics, and health insurance through employer or government plans which are easy to access for migrants. Other improvements that would facilitate the access of beer promoters to these services include increased funding to hire more staff (reducing waiting times) and to stock more needed medications, mobile clinics to come to the workplace or free transportation for beer promoters to the clinics, improved training to reduce health care provider stigma against beer promoters, and public education about the importance of reproductive health care, including preventative services.

Seven attributes of primary care in Thailand.

Primary care must be defined with a given country’s contexts because primary care services vary across countries. This study aimed to define the concept of primary care in Thailand, which had not been systematically formulated. Methods of in-depth interview, focus group discussion, and Delphi were used to derive the attributes of primary care from 66 participants, including primary care providers, community representatives, general population, and national experts.The study yielded a total of 7 attributes of primary care categorized into 3 dimensions: medical care services (accessibility, continuity, comprehensiveness, and coordination), individual and family (trust and patient-centeredness), and population and community (population and community orientation).These 7 attributes provide a conceptual framework of how primary care in Thailand should be evaluated. Results of the evaluation will offer insights on which aspects of primary care need to be improved to achieve better health care.

Globalization and health viewed from three parts of the world

In recent years Thailand’s economy has becomeincreasingly dependent on international forces (1).Withthisexposurehavecomeadvancesinhealthcaretechnologyand improvements in living standards,aswell as increasing disparities between social groups(2) and exposure to health risks from other parts ofthe world (3, 4).Prior to 1997, when the economy was strong,there was intense competition for a share of thehealth market. Resources were invested in specu-lative markets with potential for large expansion.Private hospital beds increased from 8066 in 1982to 21 297 in 1992 and 34 973 in 1996. The numberof specialized doctors in private hospitals increased,leading to shortages in the public sector (5). Thecultureoffreeenterprisebroughtwithitanenlarged middle class, insurance coverage forhospitalization, tax incentives for private healthcare, heavy investment in advanced health technol-ogy for private sector use, and an internal ‘‘braindrain’’, at the expense of public health (5, 6).Aggressive promotion increased the demand forexpensive imported medicines and procedures (7,8). The cost of medical care for civil servants andstate employees has quadrupled in the last sevenyears, reflecting the lack of adequate governance inthe health care business sector (5, 9). Meanwhilethe share of the underprivileged in the country’soverall wealth was decreasing (4). The slump of1997, followed by devaluation of the baht, andrecession with its concomitant negative healthimpact, reflects the country’s overdependence oncheap labour and foreign investment, and conse-quent inability to control and protect its owneconomy.Direct health effectsPerhapsthemostimportant directeffectofglobaliza-tiononhealthinThailandisunequalaccesstomedicalcare by different social groups. The rise in importedsophisticated technologies has increased costs andnecessitated new training. An analysis made in 1996found that the average cost of medical care peradmission was 1558 bahts for health cardholders(rural) and 9981 bahts for civil servants (privileged), asixfold difference (10). If these facilities were treatingsimilar diseases, explanations are needed for the hugevariation. The economic gap might create demandunrelatedtoneedanddistortmarketcompetition.Theorganization of health service delivery was obscure,and there were no rules governing the payment ofproviders. Unequal access to care was reflected byunequal health status (2). Infant mortality in thepoorestregionswastwiceashighasintherichestones.Second, there are increasing problems ofenvironmental pollution. These include inadequatetreatmentofrawsewage(forinstance,intouristareas),and the notorious air pollution in Bangkok and otherbig cities(11).Environmentaldegradation anddisrup-tion of the ecosystem have led to frequent floods andchangesindisease vectorbehaviour.Theconstructionof a dam in the North-eastern region, financed by aloan from a development bank, has caused naturaldisasters affecting food production (12).Third, concerns about new infections and theresurgence of old ones have been on the rise.Internationaltradeandtravelareshapingthepatternsof epidemics. The plague scare in India had world-wide reverberations. The nipah virus outbreak inMalaysia caused concerns in Thailand (13). Choleraepidemics can inflict enormous costs on a countryandthisresultsinattemptstohidethembycallingthedisease‘‘severediarrhoea’’.Thecostsassociatedwithcontrolling HIV infection continue to rise. Fears offoot and mouth disease have affected meat con-sumption. The control of new dangers of this kindwill require global cooperation but many aspects ofcontrol have to be country-specific.Fourth, globalization has brought with itunhealthy lifestyles. Health has been damaged bythepromotionoffashionabledrugs,foodsandotherconsumer products such as tobacco, alcohol,melatonin and Viagra. Fifth and finally, globalizationbringswithitmanyconcernsabouthealthethics.Forinstance, the options for genetic manipulation andthepatentingofthetechnologieswillhavedirectandfar-reaching effects on health and social well-being.

Practices and challenges of infectious waste management: A qualitative descriptive study from tertiary care hospitals in Pakistan.

Background and Objective: Infectious waste management practices among health care workers in the tertiary care hospitals have been questionable. The study intended to identify issues that impede a proper infectious waste management. Methods: Besides direct observation, in-depths interviews were conducted with the hospital administrators and senior management involved in healthcare waste management during March 2014. We looked at the processes related to segregation, collection, storage and disposal of hospital waste, and identified variety of issues in all the steps. Results: Serious gaps and deficiencies were observed related to segregation, collection, storage and disposal of the hospital wastes, hence proving to be hazardous to the patients as well as the visitors. Poor safety, insufficient budget, lack of trainings, weak monitoring and supervision, and poor coordination has eventually resulted in improper waste management in the tertiary hospitals of Rawalpindi. Conclusion: Study has concluded that the poor resources and lack of healthcare worker’s training in infectious waste results in poor waste management at hospitals.

Effect of Intensive Hand Washing Education on Hand Washing Behaviors in Thai Households with an Influenza-Positive Child in Urban Thailand

This study assessed the effect of intensive education on self-reported frequency of hand washing (FHW), measured quality of hand washing (QHW), and measured scores of knowledge, attitude, and practice (KAP) after 7 days and 90 days home-based intensive education of participants (aged >7 years) in households with a influenza-positive child. The authors provided intensive hand washing education using interactive participation including individual training, self-monitoring diary, provision of soap, and so on. There were significant improvements on FHW and QHW on day 7, control group (n1 = 135) reported 3.9 hand washing episodes/day, whereas the intervention group (n2 = 140) reported 5.7 episodes/day; control group (n1 = 164) obtained a 3.2 measured quality score, whereas the intervention group (n2 = 166) obtained a score of 6.4. Pre-education and 90 days post-education, FHW significantly improved by 2 episodes/day and QHW increased by 3 scores/episode. Knowledge of influenza and hand washing following coughing/sneezing showed significant improvement, but attitude modification toward severity of influenza requires a more intensified and longer intervention.

Impact of waste management training intervention on knowledge, attitude and practices of teaching hospital workers in Pakistan.

Objective: To evaluate the sustainability and effectiveness of training as an intervention to improve the knowledge, attitude and practices of hospital workers on health care waste management. Method: We conducted this quasi-experimental study in two tertiary care teaching hospitals in Rawalpindi in October 2013. Training, practical demonstrations and reminders on standard waste management were given to 138 hospital workers in one hospital and compared with 137 workers from the control hospital. We collected data 18 months after intervention through a structured questionnaire to assess the impact of the intervention. We used paired t-test to compare the scores on knowledge, attitude and practices at baseline and first follow up and final impact assessment. Chi square test was used to compare group variables between intervention and control groups. Results: After 18 months since intervention the mean scores on knowledge attitude and practices differed statistically significantly since baseline and intervention group had statistically significantly better knowledge positive attitudes and good health care waste management practices (p < 0.001). Health care and sanitary workers in intervention group scored statistically significantly higher (p < 0.001). Conclusion: Trainings of health and sanitary workers on health care waste management guidelines were sustainable among the intervention group after 18 months which shows the positive impact of our intervention. It is recommended that the trainings as intervention be included in the overall policies of the public and private sector hospitals in Pakistan and other similar settings.

Migrant beer promoters' experiences accessing reproductive health care in Cambodia, Laos, Thailand, and Vietnam: lessons for planners and providers

Migrant beer promoters in Cambodia, Laos, Thailand, and Vietnam were surveyed to determine their experiences in accessing reproductive health care services in the cities of Phnom Penh, Vientiane, Bangkok, and Hanoi. A total of 7 health care institutions were chosen as popular with migrant beer promoters. Staff at these institutions provided information on the institution, and 390 beer promoters were surveyed about their experiences while accessing services. There were discrepancies between findings from the staff interviews and the experiences of the beer promoters. In general, the migrant women were satisfied with the cost, location, friendliness of the health care providers, and knowledge and skills of the providers. They were less positive about confidentiality and waiting times, though many still agreed that these were not an issue. Health care planners and providers should take note of the issues affecting access to reproductive health care services for migrant women when they design and implement services.

Use of personal protective measures by Thai households in areas with avian influenza outbreaks.

Thailand has had multiple poultry outbreaks of highly pathogenic avian influenza (HPAI) H5N1 since its first emergence in 2004. Twenty‐five human cases of HPAI H5N1 avian influenza have been reported in the country, including 17 fatalities, and contact with infected dead or dying poultry has been identified as a risk factor for human infection. This study assessed the use of protective equipment and hand hygiene measures by Thai poultry‐owning households during activities involving poultry contact. Surveys conducted in 2008 included questions regarding poultry‐related activities and protective measures used during an HPAI outbreak (2005) and 3 years after the study location’s last reported outbreak (2008). For both time periods, poultry owners reported limited use of personal protective equipment (PPE) during all activities and inconsistent hand washing practices after carrying poultry and gathering eggs. This is the first time that PPE use in Thailand has been quantified for a large study group. These data are important for ongoing characterization of HPAI risk and for the crafting of educational messages.

Factors Related to Physical Activity Among the Elderly Population in Rural Thailand

Physical activity in later years of life is not only essential to healthy aging and independent functioning, but it also helps prevent chronic diseases. We aimed this cross-sectional study to assess the prevalence of physical activity and associated factors among rural elderly Thais. We conducted this study on a sample of 300 elderly in 2 rural districts of Phranakornsiayutthaya province in Thailand. The mean age of participants were 67.5±6 years and 42% of them did not perform physical activity. Prevalence of vigorous and moderate intensity physical activity was 43.7% and 48.7%, respectively. About 43.7% elderly used any active transport and spent 2.81 hours on sedentary activities, daily. Females and those with enough income were 3.64 and 0.59 times, respectively, less likely to be physically active (P < .05). Our study concluded that almost half of the rural Thai elderly were physically inactive. Also male and wealthy elderly were less likely to be engaged in physical activity. We recommend for improved efforts to involve rural Thai elderly in physical activity by offering them opportunities for locally relevant recreational and leisure time physical activities, with special focus on males and higher income elderly.

Personal Protective Equipment Use and Handwashing Among Animal Farmers: A Multi-site Assessment

The goal of this study was to compare and contrast the use of personal protective equipment (PPE) and the practice of handwashing among participants of four studies assessing poultry and swine farms in the midwestern United States and in Thailand. This largely descriptive exercise was designed to assess and compare the frequency of these protective practices among the study populations. There were a total of 1113 surveys analyzed across the four studies. The respondents included workers in direct contact with animals as well as flock owners and veterinarians tending to farms. Handwashing was the most common practice observed among all participants with 42% “always” and 35% “sometimes” washing their hands after contact with the animals. This practice was least common among Minnesota swine workers. Even Thai poultry farmers, who demonstrated the lowest overall PPE use, reported a higher frequency of handwashing. Mask use during animal farming activities (“always” or “sometimes”) was least commonly practiced, ranging from 1% in Thailand to 26% among backyard poultry farmers in Minnesota. Minnesota poultry and swine farmers had similar frequencies of mask (26%) and glove use (51% and 49%). All other comparisons differed significantly across the four sites (p-values <0.05). The use of PPE in animal farming differed by study location and is likely related to prevalent norms in the respective regions. Overall, the use of PPE did not appear to be influenced by the particular animal (poultry or swine) being farmed. These findings may prove useful to regulating bodies and farm owners in formulating policy or planning strategies for improving personal hygiene practices in animal farming and preparing for influenza and other potential zoonotic disease outbreaks.