Rural Northern Thailand Research Articles

A HIV/AIDS Prevention Program for Married Women in Rural Northern Thailand

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

ATTITUDES OF YOUNG ADULTS TOWARD OLDER ADULTS: EVIDENCE FROM THE UNITED STATES AND THAILAND

Negative attitudes toward older adults are often thought to be diminished in cultures that preserve gerontocratic tendencies. Little empirical evidence concerning this belief, however, is extant in the literature. The present study employed an adjective‐generation instrument to measure attitudes toward the elderly. This instrument was administered to young adults in rural northern Thailand, a culture which is widely reported to maintain a strong tradition of filial piety, and to young adults in the United States, a culture in which widespread ageism is suspected. A significant interaction was observed; contrary to initial expectations, Thai students were somewhat more negative about elders than were their American counterparts. Results indicate that gerontocratic traditions within a given society do not necessarily insulate the aged from negative stereotyping.

Occupation Structure and Socio-Economic Stratification in Rural Northern Thailand : A Case Study of Klang Dong Village, Chiang Mai Basin

Occupation Structure and Socio-Economic Stratification in Rural Northern Thailand : A Case Study of Klang Dong Village, Chiang Mai Basin

Maternal Behaviour and Socio-economic Influences on the Bacterial Content of Infant Weaning Foods in Rural Northern Thailand

The bacterial contamination of infant weaning foods was examined in the context of a longitudinal study of lactation and infant growth, the Chiang Mai Lactation Study. Sixty-two mother-infant pairs were selected by random sampling from a rural area outside the city of Chiang Mai and studied for 48 hours in their homes on six occasions over the first year of life. Data on food hygiene practices and maternal factors were related to the total bacterial count per gram and coliform content of weaning foods. Bottle feeding, premastication, and mashing were significantly related to an increased bacterial content of weaning foods, while boiling foods to make soups, preparing in and feeding from a banana leaf, and using boiled water to prepare foods all reduced their bacterial content. Storage also increased the bacterial contamination in foods and foods were more highly contaminated in the rainy season. Maternal age and education were also related to some feeding practices. By promoting the feeding of traditional, but less contaminated weaning foods, an intervention is put forward which would aim to reduce weaning food contamination and thereby reduce incidence of diarrhoea in this area of Northern Thailand.

Predictors of Breast Milk Intake in Rural Northern Thailand

SUMMARYA random sample of 52 mothers and infants from a rural area of Northern Thailand were studied in their homes for 48 h. Infants were breast fed on demand. Daytime feeds were test weighed with electronic averaging balances and nighttime intake estimated using a new method, Indirect Test Weighing (23,24). All feeds, both day and night, were timed to the nearest minute. Other variables measured by direct observation were infant weight, and supplementary food and water intake. Mean 24‐h breast milk intake was 579 g (range 78–1,011 g) with a median between day coefficient of variation of 8.8%. The proportion of 24‐h breast milk intake consumed at night ranged from 8 to 91%, and increased with increasing infant age. Significant positive associations were found between breast milk intake, and sucking time and infant weight. There were significant negative associations between breast milk intake and age, and supplementary food and water intake.

Predictors of breast milk intake in rural northern Thailand.

A random sample of 52 mothers and infants from a rural area of Northern Thailand were studied in their homes for 48 h. Infants were breast fed on demand. Daytime feeds were test weighed with electronic averaging balances and nighttime intake estimated using a new method, Indirect Test Weighing. All feeds, both day and night, were timed to the nearest minute. Other variables measured by direct observation were infant weight, and supplementary food and water intake. Mean 24-h breast milk intake was 579 g (range 78-1,011 g) with a median between day coefficient of variation of 8.8%. The proportion of 24-h breast milk intake consumed at night ranged from 8 to 91%, and increased with increasing infant age. Significant positive associations were found between breast milk intake, and sucking time and infant weight. There were significant negative associations between breast milk intake and age, and supplementary food and water intake.

The bacterial content of infant weaning foods and water in rural northern Thailand.

Samples of weaning food and supplementary water were collected for analysis of bacterial content from among a random sample of 65 infants under the age of 1 year living in a rural area of northern Thailand. Using geometric means, mean total bacterial count of infant's drinking water was 351 organisms/ml (95 per cent CIs 170-770), and the most probable number (MPN) of faecal coliforms/ml was 47 (95 per cent CIs 19-78). Mean total bacterial count of weaning foods was 38,000 (95 per cent CIs 25,000-59,000) organisms/g with 10 per cent recording counts greater than 1,000,000 organisms/g. Bacterial counts were similar to those reported in weaning food and water in other developing countries, and were above internationally recommended 'safe' levels. The bacterial count of water was not affected by boiling, due to poor cleaning and frequent re-use of utensils. Weaning foods were contaminated during preparation, in part through premastication and also via mode of cleaning of utensils.

Serological studies of patients with cutaneous and oral-oropharyngeal anthrax from northern Thailand.

An outbreak of 52 cases of cutaneous anthrax and 24 cases of oral-oropharyngeal anthrax occurred in rural Northern Thailand in 1982, caused by contaminated water buffalo meat. Microbiologic diagnosis of many of these cases was hindered by delayed presentation for care and by prior antibiotic therapy. In a retrospective investigation, we used enzyme-linked immunosorbent assays to measure antibody titers to components of anthrax edema toxin (edema factor [EF] and protective antigen [PA]), lethal toxin (lethal factor [LF] and PA), and poly-D-glutamic acid capsule. Electrophoretic-immunotransblots (EITB, Western blot) were used to detect antibodies to PA and LF. Nine patients with cutaneous anthrax, 10 patients with oral-oropharyngeal anthrax, and 43 healthy unexposed Thai control villagers were studied. Over all, EITB was positive in 13/18 patients (sensitivity 72%) and 0/43 controls (specificity 100%). The sensitivity of the ELISA was 72% for PA, 42% for LF, 26% for EF, and 95-100% for capsule. Although a few control sera had apparent false positive titers to PA, the specificity of the ELISA confirmed by EITB (100%) demonstrated the applicability of these tests for the diagnosis of anthrax.

Estimation of 24 h breast-milk fat concentration and fat intake in rural northern Thailand.

1. The present study assesses the accuracy with which mean 24 h breast-milk composition can be estimated if milk samples can only be collected during the daytime. 2. Twenty-five northern Thai mothers, feeding their infants on demand, were studied in their homes for 24 h. All feeds were test-weighed and 0.5 ml pre- and post-feed expressed milk samples taken at each feed. 3. If daytime sampling was restricted to two breast-feeds, it was found that the best estimate of 24 h fat concentration was given by two randomly chosen daytime feeds, predicting 24 h fat concentration with 95% confidence limits of +/- 7.0 g/l (equivalent to 21% of mean 24 h fat concentration). 4. Alternative sampling methods using the mean fat concentration of the feed after 08.00 hours and after 18.00 hours, or the first two feeds after 12.00 hours, predicted fat concentration with 95% confidence limits of +/- 9.7 g/l and +/- 8.9 g/l (28 and 26% of mean 24 h fat concentration) respectively. 5. If well-tolerated by mothers, it would be preferable to sample all daytime feeds, since this reduces the 95% confidence limits to +/- 3.3 g/l, equivalent to 10% of the mean 24 h fat concentration.

The impact of class, education, and health care on infant mortality in a developing society: The case of rural Thailand

Demographic and social factors affecting infant mortality in rural northern Thailand are examined using log-linear modified multiple regression models and data drawn from a representative sample of married couples in Chiang Mai and Chiang Rai provinces. Demographic factors do not account for the effects of variations in parental ability or willingness to provide adequate infant care. The final model estimated incorporated both these social dimensions of child care. Parental ability, measured by father's social class, mother's health information, and local community development levels, continued to have significant independent effects upon infant survival. Parental willingness, measured by parent's beliefs about intergenerational wealth transfers, no longer had a significant effect net of other social variables, but infant survival was still affected by whether both parents wanted a birth.

Fertility and Family Planning in Rural Northern Thailand.

Fertility and Family Planning in Rural Northern Thailand.

Antecedents to Contraceptive Innovation: Evidence from Rural Northern Thailand

A number of different causal mechanisms have been proposed to explain the onset of fertility declines in populations with previously uncontrolled fertility, but they have never been adequately tested. The present study identifies and tests five antecedents to family limitation practices in a sample of 755 currently married couples resident in rural Northern Thailand. The log-linear multiple regression models estimated indicate that couples in more developed districts, more modern couples, couples in which wives have more equal roles, couples believing that intergenerational wealth transfers favor children rather than their parents, and more wealthy couples, were all significantly more likely to be early adopters of contraception. Local development levels appeared to have the greatest net effects on the timing of adoption of fertility control. In addition, couples in areas where contraceptive services were more readily available were also significantly more likely to be contraceptive innovators, net of these five variables.

Fertility and Family Planning in Rural Northern Thailand

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.

Fertility and Family Planning in Rural Northern Thailand

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.