Border Of Thailand Research Articles

Assessment of a Voluntary Non-Profit Health Insurance Scheme for Migrants along the Thai-Myanmar Border: A Case Study of the Migrant Fund in Thailand.

Access to health care and financial protection for migrants can be promoted through diverse health insurance schemes, designed to suit migrants’ needs within a specific context. The Migrant Fund (M-Fund) is a voluntary, non-profit health insurance scheme operating along the Thai–Myanmar border in Thailand since 2017 and aims to protect the health of migrants uncovered by existing government insurance schemes. A qualitative evaluation was conducted between December 2018 and March 2019 to determine M-Fund’s operational impacts, provide recommendations for improvement, and draw suggestions about its role in protecting migrant health. In-depth interviews with 20 individuals and 5 groups were conducted in three categories: (1) International, national, and local partners; (2) M-Fund clients; and (3) M-Fund staff. Interview information was triangulated with findings from other informants, a document review, and researchers’ observations. Despite covering a small number of 9131 migrants, the M-Fund has contributed to improving access to care for migrants, raised awareness about migrant health protection, and reduced the financial burden for public hospitals. The M-Fund acts as a safety-net initiative for those left behind due to unclear government policy to protect the health of undocumented/illegal migrants. Despite clear merits, the issue of adverse selection to the scheme is a critical challenge. Evidence from this evaluation is useful to inform the future design of government insurance schemes for migrants.

Narcotics Smuggling Routes in the Southeast Asia Region (Case Study in the Riau Province, Indonesia)

Purpose: This paper describes narcotics smuggling routes in the Southeast Asia region, with a special focus on the case of the Riau Province, Indonesia). Southeast Asia occupies the area of 4,4 million square kilometers. The populations of ASEAN has increased from 563.7 million in 2006 to 631.8 million in 2015 at a rate of 1,14% per annum. The population growth in Southeast Asia has impacted the increased use of drugs. The Golden Triangle, i.e. the territory where the borders of Myanmar, Laos and Thailand meet, is a hub for narcotics smuggling. Riau Province is one of gates for narcotics smuggling from other states in Southeast Asia to Indonesia. Method: The paper uses qualitative methods with accompanying descriptions. The theories applied in this paper are realism approach together with international security concept, human security, and narcotics smuggling. Findings: Narcotics smuggling routes in the Riau Province, Indonesia run along unofficial port lines along the coastline. Some regencies that participate in narcotic smuggling are Bengkalis, Dumai, Meranti, Rokan Hilir and Indragiri Hilir Regency. Narcotics smugglers use sea lanes and fishing boats, and act at night to trick patrol officers in the border region.

The Silent Expansion of Rabies in Borneo

Among dengue, malaria, leptospirosis, cholera and tuberculosis, we often forget about rabies. Globally, an estimated 60,000 people die of rabies annually, and more than half of these deaths occur in Asia1. Among all infectious diseases, rabies is most fatal where the mortality rate of human rabies is 100%. On the other hand, rabies is 100% preventable if vaccine is administered timely. Rabies has been known to occur in Peninsular Malaysia since 1884, and since 1924 human rabies cases have been recorded. Most of these cases occurred in states bordering Thailand, which is highly endemic for rabies2. The incidence rose markedly in late 1945 with the reoccupation by Allied Forces, many of whom had come from India had brought their dogs with them3. A major outbreak of rabies occurred in Province Wellesley and Perak in 1945, and subsequently in Selangor in 19523 The total human death from rabies in Malaya from 1946 to 1952 was only 253. Outbreak was controlled by compulsory mass vaccination of dogs, stringent legislation, intensive stray-dog destruction, and mass education. These prompted a National Rabies Control Programme of compulsory vaccination of all dogs and a rigorous programme of destruction of stray dogs3 . However, small outbreaks and sporadic cases of animal and human rabies continued to occur in the northern states of Perlis, Kedah and Kelantan and also in Selangor2 . With continuous efforts, Malaysia was declared rabies free in 2013. However, rabies outbreak occurred in July 2015 in three states – Perlis, Kedah and Penang. After several years this was a new challenge for the authorities and was resolved by November 2015 after extensive vaccination and culling of dogs and awareness campaign4 . The outbreak in Perlis and Kedah were hypothesized to have originated from neighbouring Thailand by land movement, but the outbreak in Pulau Penang was hypothesized to have originated by sea through fishermen boat4. It is noticeable that the first rabies outbreak in Terengganu in 1996 was also by dogs from Thailand brought by fishermen boat4.

Extramarital relationships in the Vietnamese migrant community in Laos: reasserting patriarchal ideologies and double standards

Undocumented migration from Central Vietnam to Laos stretches Vietnamese families and generates marital tensions and social anxieties around the extramarital relationships that migrant husbands establish with vợ hầu (second wives), an emic term that encompasses mistresses and more stable partners. This paper sheds light on these processes via an ethnographic study on how migration from Central Vietnam to Savannakhet – a town located in Central Laos bordering Thailand – shapes family formation, marital relationships and double standards in gender and sexuality. It argues that husbands and first and second wives manage these issues by preserving family integrity, negotiating extramarital relationships and retreating from marriage. These strategies are shaped by and constitutive of normative double standards that families refer to, reinforce and in some cases transcend to make sense of the marital challenges and disruptions caused by dislocation, translocality and the intrusion of second wives in their marriages. Overall, the study emphasises that families remain committed to a domestic division of labour and to the institutions of marriage and family, albeit with some adjustments. This argument resonates with broader discussions about migration, gender and sexuality in Vietnam.

Tuberculosis in the borderlands: migrants, microbes and more-than-human borders

Multidrug-resistant tuberculosis (MDR-TB) has been a widely recognized threat since the TB epidemic was declared a global emergency in the 1990s. The epidemic is particularly critical in the borderlands where humans and microbes move across geographic borders. In this article, we explore the contingency of human-microbe relations in Thailand-Myanmar borderlands. Initially constituted by the colonial encounters, the Siam–Burma border’s continuing existence was constantly enacted, negotiated, and co-produced through the entangled interplay of various actors, microbes and pharmaceuticals included. We examine how global forms such as biomedical science, epidemiological practices, and public health interventions were actualized in an attempt to control MDR-TB in this borderland. While disease surveillance and control were seemingly hindered by the permeability of the border and geographic mobility of migrants, the potency of Mycobacterium tuberculosis to lie dormant in human bodies for long periods of time without symptoms posed an additional challenge to epidemiological attempts to segregate the healthy from the contaminated. Combining ethnographic materials from Umphang District, Tak Province at the western border of Thailand with national policy analysis, natural history, and microbiological insights, we reveal how the indeterminacy of borders and complex microbe-human entanglements necessitate changes in the prevailing biocontainment model of infectious disease control. We propose that disease surveillance and response need to transcend the rigid geographic notion of space and include a more flexible topological conception of spatiality that embraces the fluidity of pharmaceuticals, microbes, and human relations. This reinvention of the spatial approach in epidemic control begins by attending more closely to the entanglement of human-microbe relations in the more-than-human borders.

Intestinal helminth infections in HIV-infected patients in Savannakhet after establishment of an HIV registration network in Lao People\u2019s Democratic Republic

BackgroundIn Lao People’s Democratic Republic (PDR), which borders China, Vietnam, Cambodia, Thailand, and Myanmar, the number of HIV-infected patients has increased in recent years. HIV-infected patients diagnosed in Lao PDR are enrolled in a registration network and receive antiretroviral therapy (ART) covered by governmental financial support. Based on the registration network, we investigated intestinal helminth infections and coinfection with HTLV-1 in HIV-infected patients treated with an early intervention using ART in Lao PDR.MethodsThis cross-sectional study of all 252 HIV-infected patients at Savannakhet Provincial Hospital, located in the southern part of Lao PDR, was conducted between February and March 2018. Socioepidemiological information and clinical information were collected from a registration network database and by questionnaire administered to participants. Microscopic examination of intestinal helminth infections in stool samples and particle agglutination for anti-HTLV-1 antibody in plasma were performed.ResultsThe median age of all 252 participants was 39 years old (range, 18–59). Based on the registration network database, there were 156 (61.9%) HIV-infected patients with a CD4-positive cell count ≥ 200 cells/μL and 146 (57.9%) with an HIV viral load < 250 copies/mL. Among 212 stool samples, 75 (35.4%) were found to contain one or more intestinal helminth species, including Opisthorchis viverrini (16.5%), Strongyloides stercoralis (10.8%), hookworm (10.4%), and Taenia saginata (3.3%). This rate of intestinal helminth infections was lower than that of a previous report conducted before the establishment of the registration network for HIV-infected patients in Lao PDR. There was no significant association between intestinal helminth infections and a lower CD4-positive T cell count or higher HIV viral load. HIV-infected patients with anti-HTLV-1 antibody positivity were not found in this cohort.ConclusionThe registration network and an early intervention using ART may provide good medical care and improve the clinical course of HIV-infected patients in Lao PDR. However, the incidence of intestinal helminth infections remains high at 35.4%. The development of a specific medical care system for helminth infection for HIV-infected patients is necessary.

Phylogenetic characterization of Salmonella enterica from pig production and humans in Thailand and Laos border provinces.

Background and Aim:The genetic relationship among serotypes of Salmonella enterica from food animals, food of animal origin, and human is of interest as the data could provide an important clue for the source of human infection. This study aimed to determine the genetic relatedness of S. enterica from pig production and human in Thailand–Laos border provinces.Materials and Methods:A total of 195 S. enterica serotypes isolated from pig and pork (n=178) and human (n=17) including four serotypes (Typhimurium, Rissen, Derby, and Stanley) were randomly selected to examine their genetic relatedness using highly conserved sequence of three genes (fim A, man B, and mdh).Results:The results showed that 195 Salmonella isolates of four different serotypes were grouped into five different clusters, and members of the same Salmonella serotypes were found in the same cluster. Salmonella isolated from pig production and human in Thailand–Laos border provinces represented overlapping population and revealed a high degree of similarity, indicating close genetic relationship among the isolates.Conclusion:The results support that the determination of Salmonella serotyping combined with analysis of phylogenetic tree can be used track the clonal evolution and genetic diversity of Salmonella serotypes in different host species.

Rate of children at Thailand–Myanmar border area prone to tuberculosis infection: An epidemiological prediction with referencing to bacillus Calmette–Guerin vaccination in Thailand

Background: The high incidence of tuberculosis exists in several areas around the world. In Indochina, the area between Thailand and Myanmar is presently the problematic endemic area of tuberculosis. The extremely high incidence of tuberculosis at this area becomes an important global public health consideration. Methods: In this specific article, the authors perform a mathematical model study based on the local available data on the efficacy and coverage rate of Bacillus Calmette–Guerin vaccination in Thailand. The specific situation at the Thailand–Myanmar border is focused in the present assessment. Results: The high incidence of children at Thailand–Myanmar border area prone to tuberculosis infection can be detected. Conclusion: The increase Bacillus Calmette–Guerin coverage and finding for new effective tuberculosis vaccine might be necessary for reduce the problem of high incidence of tuberculosis at the Thailand and Myanmar border area.

Evaluation of a treatment protocol for anaemia in pregnancy nested in routine antenatal care in a limited-resource setting

ABSTRACTBackground: Anaemia in pregnancy is typically due to iron deficiency (IDA) but remains a complex and pervasive problem, particularly in low resource settings. At clinics on the Myanmar–Thailand border, a protocol was developed to guide treatment by health workers in antenatal care (ANC).Objective: To evaluate the clinical use of a protocol to treat anaemia in pregnancy.Methods: The design was a descriptive retrospective analysis of antenatal data obtained during the use of a standard anaemia treatment protocol. Two consecutive haematocrits (HCT) <30% prompted a change from routine prophylaxis to treatment doses of haematinics. Endpoints were anaemia at delivery (most recent HCT before delivery <30%) and timeliness of treatment initiation. Women whose HCT failed to respond to the treatment were investigated.Results: From August 2007 to July 2012, a median [IQR] of five [4–11] HCT measurements per woman resulted in the treatment of anaemia in 20.7% (2,246/10,886) of pregnancies. Anaemia at delivery was present in 22.8% (511/2,246) of treated women and 1.4% (123/8,640) who remained on prophylaxis. Human error resulted in a failure to start treatment in 97 anaemic women (4.1%, denominator 2,343 (2,246 + 97)). Fluctuation of HCT around the cut-point of 30% was the major problem with the protocol accounting for half of the cases where treatment was delayed greater than 4 weeks. Delay in treatment was associated with a 1.5 fold higher odds of anaemia at delivery (95% CI 1.18, 1.97).Conclusion: There was high compliance to the protocol by the health workers. An important outcome of this evaluation was that the clinical definition of anaemia was changed to diminish missed opportunities for initiating treatment. Reduction of anaemia in pregnancy requires early ANC attendance, prompt treatment at the first HCT <30%, and support for health workers.

Site Selection of Housing Development Projects in Thailand and Malaysia Border Trade Areas by Modified Sieve Analysis

This study sought to select the appropriate sites for the housing projects in Thailand and Malaysia Border Trade areas. The Modified Sieve Analysis was adopted as the instrument for searching and selecting sites. The Modified Sieve Analysis is the technique used to assess the urban expansion, which has been modified from the traditional sieve analysis by overlaying the map with its scores and calculate the total scores for selecting the suitable sites for the urban and housing development. The findings from this study help identify the suitable sites to build housing projects in the four cities – three sites for each.

International Trade Cooperation between Thailand, Laos and Myanmar (Golden Triangle Economic Zone) to Develop the Well-being of the People Along the Northern Border of Thailand

The purpose of this study is to study the model of international trade cooperation between Thailand, Laos, and Myanmar, to develop the well-being of the people along the northern border of Thailand, in order to reduce poverty of the people living in the area of the 3 countries. The study is done from documents, in-depth interviews with 50 Thai, Laos and Myanmar business people in the trading field, those involved in supporting the trading, local people in the area, and 25 main informants. From the study it is found that: 1) The model of creating the link of international trading between the countries and the sustainable development of well-being for the people in the area, is the expansion of economic growth, leading to employment, earning income, reducing the poverty, having no impact on society and the environment, 2) The model of international trading cooperation between the countries to develop the well-being of the people, through 3 channels of driving forces: Price Channel, Enterprise Channel and Government Channel. Driving in 3 dimensions: Economic Dimension, Environmental Dimension and Social Dimension.

Prevalence of asymptomatic Plasmodium infections with sub-microscopic parasite densities in the northwestern border of Thailand: a potential threat to malaria elimination

BackgroundAsymptomatic infections with sub-microscopic Plasmodium serve as a silent reservoir of disease, critical to sustaining a low level of remanent malaria in the population. These infections must be effectively identified and targeted for elimination. The sensitivity of light microscopy, the traditional method used for diagnosing Plasmodium infections, is frequently insufficient for detecting asymptomatic infections due to the low density of parasitaemia. The objective of this study was to explore the current prevalence of asymptomatic sub-microscopic Plasmodium carriages to evaluate the parasite reservoir amongst residents from 7 hamlets in Tak Province in northwestern Thailand using a highly sensitive molecular method.MethodsMalaria infection was screened in a real-world setting from 3650 finger-prick blood specimens collected in a mass cross-sectional survey using light microscopy and loop-mediated isothermal amplification (LAMP). LAMP results were later confirmed in a laboratory setting in Bangkok using nested PCR, restriction enzyme digestion and DNA sequencing. The association of malaria infection with demographic factors was explored.ResultsParasite prevalence was 0.27% (10/3650) as determined by microscopy. Sub-microscopic infection prevalence was 2.33% (85/3650) by LAMP. Of these, 30.6% (26/85) were infected with Plasmodium falciparum, 52.9% (45/85) with Plasmodium vivax, 2.4% (2/85) with Plasmodium malariae, 4.7% (4/85) with mixed P. falciparum and P. vivax, and 9.4% (8/85) had parasite densities too low for species identification. Asymptomatic carriages (T < 37.5 °C) accounted for 95% (76/80) of all sub-microscopic cases with the highest prevalence occurring in the subjects 31–45 years of age (p ≤ 0.035). Participants working on plantations or as merchants had an increased infection risk. Evaluation by microscopy identified 10.53% (10/95) of all Plasmodium infected participants.ConclusionParticipants carrying asymptomatic Plasmodium infections with sub-microscopic parasite densities are considerable in this area. These findings provide the true disease burden and risk factors in this region. This information helps to direct policy makers towards better schemes and delivery of targeted interventions. Moreover, this is the first study to use LAMP in mass screening for sub-clinical and sub-microscopic infections in a field setting in Thailand. LAMP proves to be a sensitive and field-deployable assay suitable for national malaria control screening campaigns.

A new species of Leptobrachium (Anura, Megophryidae) from western Thailand.

We describe a new species of the genus Leptobrachium from the Khao Laem Mountain, Suan Phung District, Ratchaburi Province, Tenasserim Region, western Thailand, based on molecular and morphological evidences. The new species, Leptobrachium tenasserimense sp. nov., can be distinguished from all other congeners by the following combination of characters: (1) adult SVL of 41.4–58.8 mm in males and 54.7–58.6 mm in females; (2) rounded finger and toe tips; (3) relative finger lengths: II<IV<I<III; relative toe lengths: I<II<V<III<IV; (4) toe webbing thick and well developed; (5) inner metatarsal tubercle small; (6) iris bicolored, black ventrally and turquoise dorsally, with light blue sclera; (7) dorsum brown to grey with distinct darker markings edged with brown; (8) belly and limbs ventrally whitish with contrasting confluent black reticulations; (9) tympanum mostly free of dark marking; (10) narrow dark canthal stripe present; (11) lateral row of dark spots absent; (12) limbs dorsally with distinct dark bars; tibia with four to five dark transverse bars; (13) dense dark reticulation or large dark blotch at groin continuing to ventral and posterior sides of thighs; (14) femoral gland in shape of large white blotch; (15) males with single vocal sac, mature males lack lip spinules. Our study provides further evidence for a hidden biodiversity of montane areas of Tenasserim Region on the border of Thailand and Myanmar.

Unraveling Haplotype Diversity of the Apical Membrane Antigen-1 Gene in Plasmodium falciparum Populations in Thailand.

Development of an effective vaccine is critically needed for the prevention of malaria. One of the key antigens for malaria vaccines is the apical membrane antigen 1 (AMA-1) of the human malaria parasite Plasmodium falciparum, the surface protein for erythrocyte invasion of the parasite. The gene encoding AMA-1 has been sequenced from populations of P. falciparum worldwide, but the haplotype diversity of the gene in P. falciparum populations in the Greater Mekong Subregion (GMS), including Thailand, remains to be characterized. In the present study, the AMA-1 gene was PCR amplified and sequenced from the genomic DNA of 65 P. falciparum isolates from 5 endemic areas in Thailand. The nearly full-length 1,848 nucleotide sequence of AMA-1 was subjected to molecular analyses, including nucleotide sequence diversity, haplotype diversity and deduced amino acid sequence diversity and neutrality tests. Phylogenetic analysis and pairwise population differentiation (Fst indices) were performed to infer the population structure. The analyses identified 60 single nucleotide polymorphic loci, predominately located in domain I of AMA-1. A total of 31 unique AMA-1 haplotypes were identified, which included 11 novel ones. The phylogenetic tree of the AMA-1 haplotypes revealed multiple clades of AMA-1, each of which contained parasites of multiple geographical origins, consistent with the Fst indices indicating genetic homogeneity or gene flow among geographically distinct populations of P. falciparum in Thailand’s borders with Myanmar, Laos and Cambodia. In summary, the study revealed novel haplotypes and population structure needed for the further advancement of AMA-1-based malaria vaccines in the GMS.

Plasmodium Infections in Anopheles Mosquitoes in Ubon Ratchathani Province, Northeastern Thailand During a Malaria Outbreak.

An unprecedented malaria outbreak occurred in Ubon Ratchathani Province, northeastern Thailand, in 2014. The province showed the highest number of malaria cases of all Thai provinces. Five entomological surveys were conducted at 8 sentinel sites from September 2013 to September 2015 to address the role of different Anopheles species in malaria transmission. Mosquito collections were conducted using human landing catches and cow bait. A total of 10,369 Anopheles mosquitoes were collected and 2,240 were morphologically identified as potential malaria vectors, including An. dirus (n = 78), An. minimus (n = 18), An. sawadwongporni (n = 4), An. barbirostris s.l. (n = 819), An. philippinensis (n = 612), An. nivipes (n = 676), An. annularis (n = 42), An. aconitus (n = 7), and An. rampae (n = 142). Real-time polymerase chain reaction was used to screen for the presence of Plasmodium spp. in salivary glands. The proportion of primary vectors of surveyed villages was very low (<1%), and no Plasmodium-infected specimens were detected among in the 2,240 Anopheles mosquitoes tested. The absence of positive Plasmodium samples during malaria outbreaks suggests that malaria transmission most likely occurred outside the villages, particularly in the deep-forested hilly areas that provided suitable habitats for competent malaria vectors. These results emphasize the need to develop vector control related to village community activities to reduce malaria transmission along Thailand border areas.

Trends in the use of illicit substances in Thailand: Results from national household surveys.

Thailand borders some of the world's largest methamphetamine and opioid producing countries and trafficking routes. Thailand's 'War on Drugs' campaign was launched in 2003. This study reports trends in illicit substance use in Thailand over the period 2001-2011. National Household surveys on illicit drug use were conducted in 2001, 2003, 2007, 2008 and 2011. A stratified multi-stage cluster random sampling technique was implemented for each survey. Provinces in four regions were systematically selected using a probability proportionate to the size of the targeted population. Participants were interviewed using structured questionnaires on their history of substance use. The prevalence of illicit drug use within the past drastically decreased from 4.5% in 2001 to 1.0% in 2003 (P < 0.05). Since 2003, the prevalence of illicit use within the past year varied between 1.0% and 1.3%. By 2011, it was estimated that 0.84% have used kratom (a substance derived from Mitragyna speciosa) within the past year. Around 0.20% and 0.19% reported using cannibis and yaba (metamphetamine tablet) within a year of the 2011 survey. Other types of illicit drugs were less commonly used in Thailand. There was a decrease in prevalence of illicit drug use within the past year between 2001 and 2003 in Thailand. Since 2003, the past year prelavence of illicit drug use has remained relatively stable. From 2001 to 2011, cannabis, kratom and yaba have remained the three most commonly reported types of illicit drugs used in Thailand.

‘Because the baby asks for it’: a mixed-methods study on local perceptions toward nutrition during pregnancy among marginalised migrant women along the Myanmar–Thailand border

ABSTRACTBackground: Under- and over-nutrition during pregnancy are known risk factors for pregnancy complications and adverse pregnancy and infant outcomes. Understanding perceptions around nutrition in pregnancy can create culturally appropriate interventions for improved health outcomes.Objective: A mixed-methods study was performed to explore local perceptions and practices of diet and physical activity in pregnancy in a marginalised population along the Myanmar–Thailand border.Methods: From April to July 2017, a cross-sectional survey and focus group discussions were conducted with pregnant women reporting to antenatal care; in-depth interviews were conducted with senior midwives at participating organisations along the Myanmar–Thailand border.Results: A total of 388 pregnant women were interviewed at two clinic sites along the Myanmar–Thailand border. A high proportion of women had limited knowledge of and poor dietary practices. Consuming a sweetened drink in the last 24 hours as well as being a non-teenage, multigravida woman was significantly associated with high body mass index (BMI) compared to normal BMI. Qualitative analysis combined focus group discussions (n = 66) and in-depth interviews (n = 4) summarising emergent themes: common foods eaten or avoided and rationale; benefits of nutrition; perceptions of overweight and weight gain during pregnancy; barriers to a healthy diet; and sources of diet information.Conclusions: There is limited awareness about healthy diets and lifestyle in these marginalised, migrant communities along the Myanmar–Thailand border. This study suggests that simple, culturally appropriate messaging should be provided to women and communities with low health literacy to generate awareness about healthy lifestyles and their effects on pregnancy outcomes as an important element of a broader strategy to address maternal nutrition in this population. However, more studies to determine the effectiveness of a broad range of interventions in low- and middle-income countries (LMIC) are needed, especially in marginalised migrant populations.

Accessibility to health services among migrant workers in the Northeast of Thailand

Background. There is an increasing trend of trans-border migration from neighboring countries to Thailand. According to human rights laws, everyone must have access to health services, even if they are from other nationalities. However, a small minority of health personnel in Thailand discriminate against immigrant workers, as they are from a lower financial bracket. Methods. This cross-sectional study aims to determine the prevalence of accessibility to health services and factors associated with access to health services among migrant workers who work along the Northeast border of Thailand. A total of 621 legal migrant workers were randomly selected to respond to a structured questionnaire about the satisfaction of health services, using the 5As of health services: availability; accessibility; accommodation; affordability; acceptability. Associations between independent variables and access to health services were analysed using multiple logistic regression analysis. Results. The results indicated that the majority of these registered migrant workers were female (63.9%) with an average age of 29± 8.61 years old, and were married (54.3%). Most of the workers worked at restaurants (80%), whereas only 20% were in agricultural sectors. Only 14% (95% CI: 11-17%) of migrant workers had access to health services. The factors that were significantly associated with accessibility to health service experienced ill health during the past one year (OR = 2.48; 95%CI; 1.54–3.97; p-value<0.001) ; have been married (OR = 2.32; 95% CI: 1.40 – 3.90; p-value <0.001). Conclusions. Most of the migrant workers could not access health services. The ones who did access health services were married or ill.

Plasmodium vivax rhomboid-like protease 1 gene diversity in Thailand

BackgroundPlasmodium vivax infection remains a major public health problem, especially along the Thailand border regions. We examined the genetic diversity of this parasite by analyzing single-nucleotide polymorphisms (SNPs) of the P. vivax rhomboid-like protease 1 gene (Pvrom1) in parasites collected from western (Tak province, Thai-Myanmar border) and eastern (Chanthaburi province, Thai-Cambodia border) regions. MethodsData were collected by a cross-sectional survey, consisting of 47 and 45 P. vivax-infected filter paper-spotted blood samples from the western and eastern regions of Thailand, respectively during September 2013 to May 2014. Extracted DNA was examined for presence of P. vivax using Plasmodium species-specific nested PCR. Pvrom1 gene was PCR amplified, sequenced and the SNP diversity was analyzed using F-STAT, DnaSP, MEGA and LIAN programs. ResultsComparison of sequences of the 92 Pvrom1 831-base open reading frames with that of a reference sequence (GenBank acc. no. XM001615211) revealed 17 samples with a total of 8 polymorphic sites, consisting of singleton (exon 3, nt 645) and parsimony informative (exon 1, nt 22 and 39; exon 3, nt 336, 537 and 656; and exon 4, nt 719 and 748) sites, which resulted in six different deduced Pvrom1 variants. Non-synonymous to synonymous substitutions ratio estimated by the DnaSP program was 1.65 indicating positive selection, but the Z-tests of selection showed no significant deviations from neutrality for Pvrom1 samples from western region of Thailand. In addition McDonald Kreitman test (MK) showed not significant, and Fst values are not different between the two regions and the regions combined. Interestingly, only Pvrom1 exon 2 was the most conserved sequences among the four exons. ConclusionsThe relatively high degree of Pvrom1 polymorphism suggests that the protein is important for parasite survival in face of changes in both insect vector and human populations. These polymorphisms could serve as a sensitive marker for studying plasmodial genetic diversity. The significance of Pvrom1 conserved exon 2 sequence remains to be investigated.

Genetic diversity of Plasmodium falciparum populations in southeast and western Myanmar

BackgroundThe genetic diversity of malaria parasites reflects the complexity and size of the parasite populations. This study was designed to explore the genetic diversity of Plasmodium falciparum populations collected from two southeastern areas (Shwekyin and Myawaddy bordering Thailand) and one western area (Kyauktaw bordering Bangladesh) of Myanmar.MethodsA total of 267 blood samples collected from patients with acute P. falciparum infections during 2009 and 2010 were used for genotyping at the merozoite surface protein 1 (Msp1), Msp2 and glutamate-rich protein (Glurp) loci.ResultsOne hundred and eighty four samples were successfully genotyped at three genes. The allelic distributions of the three genes were all significantly different among three areas. MAD20 and 3D7 were the most prevalent alleles in three areas for Msp1 and Msp2, respectively. The Glurp allele with a bin size of 700–750 bp was the most prevalent both in Shwekyin and Myawaddy, whereas two alleles with bin sizes of 800–850 bp and 900–1000 bp were the most prevalent in the western site Kyauktaw. Overall, 73.91% of samples contained multiclonal infections, resulting in a mean multiplicity of infection (MOI) of 1.94. Interestingly, the MOI level presented a rising trend with the order of Myawaddy, Kyauktaw and Shwekyin, which also paralleled with the increasing frequencies of Msp1 RO33 and Msp2 FC27 200–250 bp alleles. Msp1 and Msp2 genes displayed higher levels of diversity and higher MOI rates than Glurp. PCR revealed four samples (two from Shwekyin and two from Myawaddy) with mixed infections of P. falciparum and P. vivax.ConclusionsThis study genotyped parasite clinical samples from two southeast regions and one western state of Myanmar at the Msp1, Msp2 and Glurp loci, which revealed high levels of genetic diversity and mixed-strain infections of P. falciparum populations at these sites. The results indicated that malaria transmission intensity in these regions remained high and more strengthened control efforts are needed. The genotypic data provided baseline information for monitoring the impacts of malaria elimination efforts in the region.