Strengthening livelihood resilience through community-based aquaculture in rural Northern Thailand: Successes and challenges

From the mid-1960s to the mid-1970s, when fertility was declining in Thailand as a whole, especially rapid declines occurred in Northern Thailand, but they did not occur uniformly in all the region's provinces. The Northern Thailand Fertility Study, initiated in 1975 to study the reported fertility changes, gathered data in two provinces: Chiang Mai, where fertility decline has been quite rapid, and Chiang Rai, which experienced relatively little decline until 1974. This preliminary report discusses fertility levels and trends in the two provinces, fertility experience and expectations of respondents, attitudes toward and knowledge of family planning, and contraceptive practice. The results suggest that most of the difference in fertility decline is related to the different level of family planning program activity in the two provinces.Substantial declines in Thai fertility levels coincide with a marked increase in family planning activity, both public--the National Family Planning Program, announced in 1970--and private--e.g., McCormick Hospital Program, started in Chiang Mai in 1963. Regional and changwat (provincial) differentials in rate of fertility decline have been observed. In Chiang Mai changwat, for example, where efforts began in 1963, there has been a more rapid decline than in Chiang Rai, where family planning was introduced only in 1970. The Study of Social and Psychological Barriers to the Adoption of Family Planning in Rural Northern Thailand (The Northern Thailand Fertility Study, NTFS) was an attempt to identify the reasons for this differential and the relationship of family planning activities to fertility decline. A random sample was drawn from each of 190 rural villages chosen randomly from Chiang Mai and Chiang Rai. All ever-married women aged 15-44 and husbands of currently married women were interviewed from September 1976 to February 1977. Response rates were 88.5% of 1921 women and 80.5% of 1615 men. Interviewers were mostly students from Chiang Mai University, intensively trained and closely supervised. Substantial declines in age-specific fertility rates occurred in both changwats between 1968-1972 and 1973-1976, with the Chaing Rai fertility level lagging about 5 years behind that of Chiang Mai. In both changwats, expectations of and desire for large families have virtually disappeared although Chaing Rai women expected larger families than Chiang Mai women. Infant mortality rates were lower in Chiang Mai due to improved MCH services. While the reported rates of induced abortion were low for both provinces, indications are that the actual rates are about 3 times higher for Chiang Mai -- in line with the lower fertility performance and desires reported there. Attitudes toward family planning were favorable in both changwats but knowledge of contraceptive use was greater in Chiang Mai. Statistics of contraceptive use correlated to levels of knowledge and to activities of family planning programs. The article concludes that nearly all of the fertility declines observed are the result of organized family planning activities.

Information orientation of small-scale farmers' community enterprises in Northern Thailand

Rural coastal area in northern part of Sayung subdistrict isprone to tidal flood as effect of abrasion and sea level rise. This studylooks at the condition of five villages that suffer the most tidal flood thereand tries to measure the livelihood resilience of the people throughhousehold survey. Livelihood Resilience Index (LRI) and Resilience Radarare adapted to calculate the score and level of livelihood resilience. Fourdimensions (social dimension, economic dimension, environmentdimension, and physical-infrastructure dimension) are used to express thelivelihood resilience score of each study area. Sriwulan village has thehighest score among the study areas and it has medium level of livelihoodresilience while Timbulsloko village which has the lowest score becomesthe only study area with low level livelihood resilience. However, thisresult in score and level categorization are only an attempt to describe thespectrum of livelihood resilience instead of intending to provide a set ofclassification. It hopefully can help to identify what can be started first inthe work of building resilience of the people and community in tidal floodproneareas.

HIV/ AIDS transmission is a major threat to married women around the world and especially in developing areas such as rural northern Thailand. Heterosexual transmission is the dominant route by which this disease is acquired. Married women routinely have unprotected sex with their husbands and have limited ability to change this behaviour to protect themselves. Specific intervention is needed to enable married women to take action to protect themselves from HIV/AIDS. The study aims to develop, conduct and evaluate the effectiveness of an HIV/AIDS prevention and intervention program in rural northern Thailand. It used a community development model to enable married women to improve their internal factors of self-efficacy, self-esteem and hope and to increase their behavioural skills for negotiation of safe sex practices and condom use with their husbands. The method was used in which eight villages were randomly assigned to either treatment or control conditions, with the village as the unit of randomisation. The intervention program was delivered by health volunteers and trained as agents of change to motivate and mobilise married women in the program. The intervention was implemented through community mobilisation and a grass roots community-based initiative. Pretest and post-test questionnaires were administered to assess internal factors and behaviour skills among 607 married women aged between 18-49 who were living in the villages participating in the study. The results of the intervention program showed enhanced internal factors among the married women. Most importantly, the number of married women demonstrating ability in negotiation skills increased from 33% to 92%, and the percentage of couples using condoms more frequently increased from 24% to 59%. In conclusion, the trial demonstrated that HIV/AIDS prevention intervention increases married women?s ability to protect themselves against HIV infection. This inexpensive education and skills building package to help the prevention level of HIV/AIDS could be widely implemented throughout Thailand and in other developing countries, which have similar social structures

ObjectivesThis study aimed to explore perceptions of dengue fever according to the health belief model, assess prevention practices, and evaluate the density of Aedes larvae in northern Thailand, while identifying factors associated with these practices and larvae presence.MethodsA cross-sectional study was conducted with 279 household heads or their representatives. Data were collected via a questionnaire and Aedes larvae inspection forms. The density of Aedes larvae: House Index (HI), Container Index (CI), and Breteau Index (BI) were calculated. Ordinal and binary logistic regressions were used to identify factors associated with dengue prevention practices and the presence of Aedes larvae.ResultsMost respondents had good level of perceived susceptibility (87.1%) and benefits (65.6%), while about half had fair perceptions of severity (52.7%) and barriers (47.3%). Over half (55.9%) exhibited fair dengue prevention practices. Aedes larvae density was high, with HI, CI, and BI values of 38.7%, 14.8%, and 71.3%, respectively. Better prevention practices were associated with holding a social role (AOR = 2.5; 95% CI = 1.3–5.0) and lower perceived barriers (AOR = 2.6; 95% CI = 1.0–6.8). Aedes larvae presence was associated with living in wooden houses (AOR = 2.4; 95% CI = 1.1–5.3), improper waste disposal (landfills) (AOR = 1.7; 95% CI = 1.0–2.9), and failure to recycle waste (AOR = 2.3; 95% CI = 1.0–5.1).ConclusionsThe findings of this study point to the potential importance of addressing individual perceptions, behaviors, and housing environmental conditions in efforts to control Aedes mosquitoes. These insights may be useful for local health authorities in northern Thailand when considering context-specific dengue prevention strategies.

From the mid-1960s to the mid-1970s, when fertility was declining in Thailand as a whole, especially rapid declines occurred in Northern Thailand, but they did not occur uniformly in all the region's provinces. The Northern Thailand Fertility Study, initiated in 1975 to study the reported fertility changes, gathered data in two provinces: Chiang Mai, where fertility decline has been quite rapid, and Chiang Rai, which experienced relatively little decline until 1974. This preliminary report discusses fertility levels and trends in the two provinces, fertility experience and expectations of respondents, attitudes toward and knowledge of family planning, and contraceptive practice. The results suggest that most of the difference in fertility decline is related to the different level of family planning program activity in the two provinces.

QEST nD: n-dimensional extension and generalisation of a software performance measurement model

Sustainable development is based on environmental, social, economic, and technical dimensions. In this study, the sustainability of wastewater treatment techniques in urban areas of Iraq was assessed using a multi-criteria decision analysis (MCDA)/the weighted sum model (WSM). The analysis was performed on 13 operating wastewater treatment plants in 10 provinces, Iraq, using a questionnaire sheet with the assistance of 52 specialists in the Ministry of Municipalities and Public Works, Iraq. Four types of wastewater treatment techniques (Conventional Treatment, Oxidation Ditches, Aeration Lagoons, and membrane bio-reactor (MBR)) were assessed. The environmental, social, economic, and technical dimensions were represented by 11, 5, 7, and 4 indicators, respectively. The main results of this study indicate that the sustainability of MBR recorded the highest total importance; the order of the total importance from the highest to the lowest was: MBR > Oxidation Ditches > Aeration Lagoons > Conventional Treatment. The environmental dimension proved its dominance in the four studied treatment techniques' sustainability as it recorded the maximum contribution to sustainability. While the technical dimension recorded the least contribution to sustainability, the order from the highest to the lowest was: Environmental Dimension > Economic Dimension > Social Dimension > Technical Dimension.

Background Fear of falling is a prevalent concern among older adults and is associated with physical inactivity, reduced independence, and decreased quality of life. Although various factors contribute to the fear of falling, limited evidence exists regarding the relationship between body mass index status, balance impairment, and fear of falling, particularly in rural populations. Objective This study aimed to examine the association between body mass index, balance impairment, and fear of falling among community-dwelling older adults in a rural area. Methods A cross-sectional study was conducted among 439 older adults aged 60 years and above residing in rural Thailand. In the initial phase, a list of older adults was obtained from primary care center records, and simple random sampling was employed to select participants according to the inclusion criteria. Data were collected on demographic characteristics, body mass index, balanced performance (measured using the Berg Balance Scale and the Timed Up and Go test), and fear of falling (assessed using the Short Falls Efficacy Scale-International). Multiple linear regression analysis was conducted to determine the factors significantly associated with fear of falling. Results The results showed that 56.7%, 18.5%, and 24.8% of the elderly had low, moderate, and high fear of falling, respectively. Multiple regression analysis revealed that balance performance, as measured by the Berg Balance Scale, was the only significant predictor of fear of falling (β = –0.298, p < 0.001), whereas the Timed Up and Go test and body mass index were not significantly associated. Conclusion Balance impairment is a key determinant of fear of falling among older adults in rural areas. Interventions to improve balance may be effective in reducing fear of falling and preventing functional decline in this population.

Although grandparents play a significant role in caring for their grandchildren in Asian culture, few studies have examined how grandparents from skipped families care for their children in rural areas. This study aims to explore grandparents’ perceptions and experiences in providing care for their grandchildren in rural Thailand, where support is limited. Utilizing a qualitative approach, in‐depth interviews and focus group discussions were conducted with 20 grandparents caring for children under 5 years old. The coding of interview transcripts was followed by thematic analysis. In this study, the participants shared their experiences about raising and caring for their grandchildren in rural areas. “We were held in bondage” is the overarching theme. Interviews revealed two main themes: (1) feeling of burden, divided into the following three subthemes: lack of parenting skills, worries regarding grandchildren’s health and well‐being, and emotional stress and financial/physical strain; (2) maintaining family bonds, which were further divided into the following subthemes: supporting adult children, being parents again, and becoming more loving and bonded. According to the findings, healthcare providers may be able to anticipate the needs of grandparents in rural areas and provide support, culturally relevant interventions, and training programs for grandparents to care for their grandchildren. Further research is essential to explore the dynamics of family bonding and responsibilities in Thai families and to develop interventions supporting these families.

Background: Dengue is a common mosquito-borne disease in Thailand and poses an increased risk of severe illness among adults. The TAK-003 quadrivalent dengue vaccine is newly introduced in Thailand and has demonstrated promising efficacy. This study aimed to assess intention to receive the vaccine, knowledge, attitudes, and associated factors with TAK-003 among participants. Methods: A cross-sectional study was conducted from September 2024 to July 2025 among Thai adults aged ≥20 years living in rural areas of Chiang Mai. Individuals with prior dengue vaccination were excluded. Binary logistic regression identified factors associated with intention to the receive vaccine. Results: A total of 482 participants were enrolled. The mean age was 61.3 years (SD 11.5), and 73.2% (n = 353) were female. Most participants had primary education or lower (64.3%, n = 310), and 62.9% (n = 303) reported a monthly household income < 10,000 THB (314 USD). The intention to receive the TAK-003 vaccine was 68.7% (n = 331). Only 31.5–35.1% correctly answered dengue treatment questions, and 38.6% believed they would contract dengue within five years. Concerns regarding vaccine side effects (76.1%) and efficacy (56.4%) were common. Local healthcare providers were the most trusted source of vaccine information (78.0%), followed by doctors (49.2%). Prior influenza vaccination (aOR 1.57, 95% CI 1.02–2.41) and more positive attitudes toward dengue vaccination (aOR 1.06, 95% CI 1.02–1.10) were associated with intention to receive the vaccination. Conclusions: Intention to vaccinate with the TAK-003 vaccine among adults in rural Chiang Mai was moderate. These findings can inform community-based vaccination programs and strategic planning for dengue vaccine rollout in rural northern Thailand.

Hypertension and its connection to high salt consumption have been observed in the Thai population. This study mainly contributed to the literature to examine the dietary-salt-related determinants associated with the risk of hypertension in rural northern Thailand, which exhibited the highest prevalence of hypertension. A total of 376 adults residing in San Pa Tong District, Chiang Mai province, were face-to-face interviewed using a structured questionnaire assessing dietary-salt-related knowledge, attitudes, consumption, sources, and habits. The subject’s blood pressure (BP) was measured twice before and after the interview. Hypertension was defined as a systolic BP ≥ 130 mmHg or a diastolic BP ≥ 80 mmHg. The dietary-salt-related knowledge, attitude, and habits toward salt reduction were positively correlated; however, knowledge and attitudes were not significantly correlated with consumption. Multivariate logistic regression results indicated subjects who frequently bought ready-to-eat food, ate out, or used bouillon cube/monosodium glutamate (MSG) during food preparation were likely to have hypertension (OR = 2.24, 95% CI: 1.36–3.69, p = 0.002). MSG was heavily consumed and used as a flavor enhancer in northern Thai cuisine; however, a few subjects realized it contains sodium due to no salty taste. The deficiency of specific dietary-salt-related knowledge illustrated the need for tailored educational intervention strategies.

ObjectivesWe aimed to determine the cost‐effectiveness of supplementing standard care with pulse oximetry among children <5 years with acute respiratory infection (ARI) presenting to 32 primary care units in a rural district (total population 241,436) of Chiang Rai province, Thailand, and to assess the economic effects of extending pulse oximetry to older patients with ARI in this setting.MethodsWe performed a model‐based cost‐effectiveness analysis from a health systems perspective. Decision trees were constructed for three patient categories (children <5 years, children 5–14 years, and adults), with a 1‐year time horizon. Model parameters were based on data from 49,958 patients included in a review of acute infection management in the 32 primary care units, published studies, and procurement price lists. Parameters were varied in deterministic sensitivity analyses. Costs were expressed in 2021 US dollars with a willingness‐to‐pay threshold per DALY averted of $8624.ResultsThe annual direct cost of pulse oximetry, associated staff, training, and monitoring was $24,243. It reduced deaths from severe lower respiratory tract infections in children <5 years by 0.19 per 100,000 patients annually. In our population of 14,075 children <5 years, this was equivalent to 2.0 DALYs averted per year. When downstream costs such as those related to hospitalisation and inappropriate antibiotic prescription were considered, pulse oximetry dominated standard care, saving $12,757 annually. This intervention yielded smaller mortality gains in older patients but resulted in further cost savings, primarily by reducing inappropriate antibiotic prescriptions in these age groups. The dominance of the intervention was also demonstrated in all sensitivity analyses.ConclusionsPulse oximetry is a life‐saving, cost‐effective adjunct in ARI primary care management in rural northern Thailand. This finding is likely to be generalisable to neighbouring countries with similar disease epidemiology and health systems.

Despite advancements in antiretroviral therapy (ART) that extend life expectancy, older adults with HIV (OAHIV) face elevated cardiovascular disease risks. This study examines the impact of arterial stiffness on health-related quality of life (HRQoL) among OAHIV in rural Northern Thailand. We conducted a 5-year prospective cohort study from 2015, including 338 OAHIV aged ≥ 50 without prior cardiovascular disease who received ART in 12 community hospitals in Chiang Mai. Arterial stiffness was assessed using Cardio-Ankle Vascular Index (CAVI), with values ≥ 8 indicating significant stiffness. HRQoL was measured using the MOS-HIV Health Survey at baseline, one year, and five years. Analysis adjusted for HIV/AIDS severity, cardiovascular comorbidities, and socioeconomic factors. Elevated CAVI (≥ 8) was associated with lower HRQoL scores. The elevated CAVI group showed lower physical health summary scores (average difference:-2.2 points, 95%CI: -3.5 to -0.9) and mental health summary scores (average difference: -1.2 points, 95%CI: -2.2 to -0.3) compared to the normal CAVI group (CAVI < 8). Findings highlight the importance of routine screening for arterial stiffness and support the implementation of comprehensive care strategies that incorporate cardiovascular risk management. Such approaches could guide public health interventions and clinical practices to enhance the overall health and well-being of OAHIV, potentially through targeted cardiovascular risk reduction programs and personalized care plans. However, the study's regional focus in rural Northern Thailand and participant attrition over the five-year period limit the generalizability of the findings. Future research in diverse settings with larger sample sizes is needed to confirm these results.

Livelihood resilience in pastoral communities: Methodological and field insights from Qinghai-Tibetan Plateau