Rural Thailand Research Articles

Fine Arts Education in Rural Thailand: A Case Study of the Department of Art and Design, University of Phayao

Contemporary art is a global subculture typically associated with urban contexts. Infrastructure such as galleries, networks of brokers and collectors, auction houses, and museums, as well as an informed and engaged audience, are conventional hallmarks of a flourishing art scene. Educational institutions are also a crucial part of this infrastructure, not only in shaping the next generation of artists, but in presenting and promoting young artists’ work while simultaneously cultivating audiences. Thailand, with the exception of the Bangkok Greater Metropolitan Area, is devoid of any major urban centers. Numerous institutions of higher education have been established throughout the country, yet perhaps unsurprisingly, few of these institutions offer degrees in fine arts. However, as in the case of the University of Phayao (founded in 1996, and offering a BA in art and design beginning in 2012), more institutions are beginning to acknowledge the benefits of arts education regardless of an existing “arts infrastructure” to support them. Such benefits may include developing critical thinking, cultural awareness, and creative development. This research paper surveys the curriculum of the Department of Art and Design at the University of Phayao. Through interviews and site visits, the author examines the aims and objectives of these universities, their strategic plans for development, their impact on local communities, and how they envision the growth and development of their program.

Industrialized Gut Microbiota Promote Intestinal Inflammation in Mice

Immigration to a highly industrialized nation has been associated with metabolic disease and simultaneous shifts in microbiota composition, but the underlying mechanisms are challenging to test in human studies. Here, we assessed the differential effects of human gut microbiota collected from the United States (US) and rural Thailand on the murine gut mucosa and immune system. Colonization of germ-free mice with microbiota from US individuals resulted in an increased accumulation of innate-like CD8 T cells in the small intestine lamina propria and intra-epithelial compartments when compared to colonization with microbiota from Thai individuals. Both TCRgd and CD8aa T cells showed marked increase in mice receiving the Western microbiota and, interestingly this phenotype was also associated with an increase in intestinal mucus thickness. Serendipitously, an accidentally infected group of mice corroborated this association between elevated inflammatory response and increased mucus thickness. These results suggest that Western-associated human gut microbes contribute to a pro-inflammatory immune response.

Short-Term Impact of an Early Childhood Education Intervention in Rural Thailand

This paper evaluates the short-term impact of an early childhood education intervention on child development. The program randomly assigned an additional 19 teachers to coteach using a new curricul...

Underlying cardiopulmonary conditions as a risk factor for influenza and respiratory syncytial virus infection among community-dwelling adults aged≥65 years in Thailand: Findings from a two-year prospective cohort study.

BackgroundAdults with cardiopulmonary conditions may be at increased risk of influenza and respiratory syncytial virus (RSV) infection, but it is not well‐established and few data are available from middle‐income countries.MethodsUsing data from a prospective cohort study of influenza vaccine effectiveness, we estimated and compared the incidences of influenza and RSV between community‐dwelling Thai adults aged ≥ 65 years with and without cardiopulmonary conditions. During May 2015‐May 2017, older adults in a rural province in Thailand were followed‐up with weekly surveillance for acute respiratory illness (ARI), defined broadly as new onset or worsening of cough with or without fever, and hospitalized ARI. When ill, nasal self‐swabs and/or nasopharyngeal swabs were collected for reverse‐transcription polymerase chain reaction testing. We used Poisson regression to calculate incidence rate ratios (IRR), adjusting for age, sex, current smoking, number of hospital visits, weekly influenza activity, and influenza vaccination.ResultsOverall, 3220 adults with a median age of 71 years (IQR 68‐76) were enrolled; 1324 (41.1%) were male; and 313 (9.7%) had ≥1 underlying cardiopulmonary condition, most commonly chronic obstructive pulmonary disease (131; 41.2%) or asthma (73; 23.3%). Participants with cardiopulmonary conditions had higher incidences of ARI, influenza, and RSV than those without (Adjusted IRR: 1.84, 95% CI 1.64‐2.07; 1.86, 95% CI 1.07‐3.26; 2.04, 95% CI 1.11‐3.76, respectively).ConclusionOlder adults in rural Thailand with cardiopulmonary conditions have increased rates of ARI, influenza, and RSV infections. Our findings support efforts to ensure this population has access to influenza vaccines and other respiratory illness prevention measures.

Entrepreneurship during an Economic Crisis: Evidence from Rural Thailand

AbstractI analyze entrepreneurship among rural households in Thailand during the 1997 Asian crisis, when the rate of business ownership increased from 17% to 37% within a period of 1 year. I argue ...

The impact of cash transfers on child outcomes in rural Thailand: Evidence from a social pension reform

Previous studies have identified a causal relationship between pension eligibility for the elderly and an improvement in education-related outcomes of co-residing children. In contrast to the often generous schemes considered before, this study investigates the effects of a non-contributory pension scheme in Thailand that grants much smaller benefits. Our empirical analysis exploits a reform which expanded the scheme from a targeted program to universal coverage. Using a generalized difference-in-difference model, we provide evidence that gaining eligibility for the scheme can affect work status and literacy of children living with eligible pensioners, while not actually raising total net household income. The effect sizes we find for older children in our sample are within the range of those estimated from more generous schemes. Younger children do not benefit from the reform.

Distinguishing Barriers to Insurance in Thai Villages

In both developing and developed countries, consumption insurance is incomplete: consumption co-moves with income. Models with limited commitment, moral hazard, and hidden income have been proposed to explain this lack of full insurance. Limited commitment and moral hazard have generally been found to fit the data better than full insurance or permanent income models, but these models have not been tested against the alternative of hidden income. I show that the way history matters in forecasting consumption can be used to distinguish the hidden income model from other models of incomplete insurance. I also argue that accounting for measurement error in consumption is important in identifying barriers to insurance. In a ten-year panel from rural Thailand, neither limited commitment or moral hazard can fully explain the relationship between income and consumption--the need to give households incentives to truthfully reveal their income appears to play a role in constraining insurance.

Effectiveness of a sepsis programme in a resource-limited setting: a retrospective analysis of data of a prospective observational study (Ubon-sepsis)

ObjectiveTo evaluate the effectiveness of a Sepsis Fast Track (SFT) programme initiated at a regional referral hospital in Thailand in January 2015.DesignA retrospective analysis using the data of a prospective...

From village health volunteers to paid care givers: the optimal mix for a multidisciplinary home health care workforce in rural Thailand

BackgroundThailand is a rapidly aging society, which places high demand on home health care services for the elderly. The shortage of health care workforce in rural areas is a crucial obstacle to the delivery of adequate home health care services. The appropriate skill-mix between multidisciplinary health team and care givers (CGs) is an attractive solution for improving home health care services in rural Thailand. This study assessed the potential of trained CGs to provide home health care services and projected what the optimal mix for a multidisciplinary home health care team in rural Thailand would be in 2030.MethodsEleven pilot districts in Thailand were recruited for the study. Secondary data were collected along with surveys of home health care providers. A total of 130 care managers (nurses) and 351 care givers (CG) were recruited for the survey. Workload, skill-mix potential, and acceptance of care givers were assessed in the surveys. The results from secondary data and the survey were used to project the health workforce requirements in 2030.ResultsIt is projected that in 2030 the number of elderly living in rural areas will be 7,156,700 (27% of the projected rural population). Of this, 20.3% will be home-bound, 1.1% will be bed-ridden and 1.6% will need rehabilitation. The main members of the multidisciplinary health workforce involved in home health care were nurses, doctors, and physiotherapists. The home health care services that were provided by the multidisciplinary health workforce included patient assessment, development of a care plan and case conference, home visits, and teaching and supervision of CGs. The CGs were village health volunteers trained to carry out regular home visits to patients. The CGs provided assistance with the activities of daily living, basic health services, moral support to patients and relatives, and surveillance of the home environment during home visits. CGs were well accepted by both the health professionals and the patients. Projections showed that 16,094 nurses, 1,542 doctors, 1,022 physiotherapists and 50,148 CGs will be required in 2030 to meet the needs of the dependent elderly for home health care in rural Thailand.ConclusionWith the increased need for home health care services in the future, appropriate team work between the members of the multidisciplinary health team and the CGs in the community is the appropriate solution for likely shortages of health professional workforce.

Dietary Salt-Related Determinants of Hypertension 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.

The Effect of Financial Constraints on In-Group Bias: Evidence from Rice Farmers in Thailand

In-group bias can be detrimental for communities and economic development. We study the causal effect of financial constraints on in-group bias in prosocial behaviors – cooperation, norm enforcement, and sharing – among low-income rice farmers in rural Thailand, who cultivate and harvest rice once a year. We use a between-subjects design – randomly assigning participants to experiments either before harvest (more financially constrained) or after harvest. Farmers interacted with either in-group or out-group partners at village level. We find that in-group bias in cooperation and norm enforcement exist only after harvest, that is, when people are less financially constrained.

Knowledge-Behavior Gap on COVID-19 among Older People in Rural Thailand

This study analyzed the difference between rural and urban older adults in Thailand regarding the relationship between the knowledge and behavior toward the prevention of contracting COVID-19. Path analysis was used to observe if the performance of protective behaviors was affected by the level of knowledge that older people have about the disease. This study used the Impact of COVID-19 on Older Persons in Thailand survey collected across the five regions of the country.Rural residents benefited from community network of village health volunteers who provided information during the pandemic but, they had disadvantages on accessing newer media sources, mainly the internet, for the latest developments on COVID-19. Rural older adults had a higher level of knowledge about COVID-19 than those in urban areas; no difference was observed regarding their behavior to prevent themselves from being infected. The knowledge-behavior gap was viewed as a mechanism of cognitive avoidance because of overwhelming unprecedented information.

Significant Association between Physical Performance and Inflammatory Biomarkers in Older Adults with Frailty in Rural Thailand

Background: The etiology of frailty is complex and incompletely understood, and is associated with alterations in the immune system, resulting in chronic low-grade inflammation. However, few studies have explored the inflammatory biomarkers related to physical performance in the elderly. Methods: We evaluated the prevalence of frailty with a cross-sectional study among older adults in rural communities in Thailand (n = 457, mean age of 71.4 ± 5.8 years) with Fried’s frailty phenotype including five criteria: weight loss, exhaustion, slowness, weakness, and inactivity. The association between inflammatory biomarkers (serum interleukin-6, IL-6 and C-reactive protein, CRP levels) and physical performance (grip strength, walk times and VO2Max) was examined in frail participants (n=64). Results: The prevalence of frailty and pre-frailty in this population was 37.4% (95% CI, 32.9-42.0) and 54% (95% CI, 49.4-58.7). Multiple linear regression analysis found that serum IL-6 level was significantly elevated in frail older adults with low grip strength (beta = -0.348, SE= 0.155, p = 0.029). Serum CRP level was also elevated significantly in frail older adults with low grip strength (beta = -0.049, SE= 0.023, p = 0.04) and low VO2Max (beta = -0.047, SE= 0.019, p = 0.016) after adjustment for sex, age, hypertension, diabetes, osteoporosis, heart disease, and BMI. Conclusion: Our findings support a low level of grip strength as predictor of inflammatory biomarkers in older adults with frailty. Primary care practitioners could use frailty indicators and performance combined with serum biomarkers for early health risk detection in older adults.

What to do with the farmland? Coping with ageing in rural Thailand

As Thai farmers get older they need to plan what to do with their farm business and land given younger people tend to out-migrate to urban areas and shift their interests away from farming. Such demographic trends may reduce agricultural productivity and increase food insecurity, both among farmers and in the region. Using data collected through interviews with 368 farmers in the Prachin Buri province of Thailand, this research aims to examine how ageing is affecting farm activities of older farmers (60 years and older) and how they are adapting. We found that, while a small percentage of older farmers intended to continue farming without making any changes over the next five years (~9%), most were concerned about their health and farm work capacity, and were looking to leave farming and implement strategies to reduce both work intensity and time. Most farmers intended to stop farming and transfer farmland to their children (~40%), or continue farming while making some changes (~30%), such as employing additional workers or switching to less labour intense crops. Some intended to stop farming altogether and dispose of farmland outside their family (~21%; e.g. leasing out or selling or returning farmland to owner if leased). As expected, the chosen strategy depended on personal (old-age income security and gender) and farm characteristics (e.g. successor, farm activities, and subsidy). Having a dedicated successor had a substantial impact on transferring land to the children, reflecting the importance of commitment for farming by the next generation, which will be challenging. A pension higher than the widely available old-age allowance could support farmers in maintaining a better living standard after retiring. However, only a fraction of farmers currently had access to a pension. Both short- and long-term policies are, therefore, needed to support elderly farmers, improve their living standards after retirement, and attract young people back to farming. • Interviews conducted with 368 elderly Thai farmers about the impacts of ageing and coping strategies. • Elderly Thai farmers suffer age-related chronic illnesses which affect their work capacity. • 61% of farmers intended to exit from farming and 39% to continue. • 40% of those who exit intended to transfer farmland to their children and 21% to lease it out or sell it otherwise. • Having a successor, produce types, subsidy and old-age income security affected farmers' decisions on future land use.

Is There a Rainbow after the Rain? How Do Agricultural Shocks Affect Non‐Farm Enterprises? Evidence from Thailand

Increasing weather volatility manifesting itself through extreme rainfall and drought poses a significant threat to the livelihood of rural households in poor countries. Although it is documented how rainfall shocks affect agricultural activities, there is not much evidence on the indirect effects on the rest of the rural economy. Merging household panel data with grid‐level precipitation data, we study the indirect effects of rainfall shocks on non‐farm enterprises in rural Thailand. We not only consider the effects on labor supply to non‐farm enterprises but also focus on the performance of non‐farm enterprises. We find that households increase their labor participation in non‐farm self‐employment in response to excessive rainfall shocks. We do not find such a response for deficit rainfall shocks, which we explain by the increased demand for agricultural labor needed to cope with rainfall shortages. We also find suggestive evidence that rainfall shocks lead to increased input costs for non‐farm enterprises in the food processing industry, to higher input costs for farms, to higher sales revenues for agriculture‐related non‐farm enterprises and to lower expenditures for farm households on food and other consumption items. Overall, our analysis suggests that the costs of agricultural shocks are higher than what much of the literature has suggested so far. Despite limited market integration in poor rural economies, the spillovers are sizable and are transmitted through various channels. One implication is that safety nets targeted at farms may need to consider non‐farm enterprises too.

Precarity and clinical determinants of healthcare-seeking behaviour and antibiotic use in rural Laos and Thailand

BackgroundThe social determinants of health are a decisive yet persistently understudied area for tackling global health challenges like antimicrobial resistance (AMR). Precarity is one determinant whose importance is increasingly recognised,...

Decoupled but Not Neutral: The Effects of Counter‐Cyclical Cash Transfers on Investment and Incomes in Rural Thailand†

In 2009, the Thai government implemented a price insurance scheme for rice, cassava, and maize farmers. The program, which was abandoned after only two years, added to the incomes of registered farmers a non‐negative but stochastic amount that was decoupled from farmers' agricultural activities. We apply a simple machine learning algorithm based on rich panel data to control for self‐selection into the program and study its impact on small‐scale rice farmers in relatively poor Northeastern Thailand. Program participation increases rice production but also leads to shifts in investment behavior and the composition of income generating activities away from agriculture, which may be beneficial for rural development. Moreover, farmers who are initially less poor experience a substantial increase in overall income. Decreasing risk‐aversion and relieved credit constraints may be possible channels for these effects.

Cost of Dementia Care in Rural Thai Households

Objective: The purpose of the present paper was to quantify the cost associated with dementia care in rural Thailand. Materials and Methods: A cross-sectional study was done on 140 dementia households with caregivers living in rural areas. The activity of daily living (ADL) and the instrumental activity of daily living (IADL), Resource Utilization in Dementia (RUD, Thai version) were used. The socioeconomic status of people with dementia, their families and their caregivers was collected. The hospital utilization data of people with dementia was obtained from the community and the sub-district health promoting hospitals. In terms of indirect costs, the replacement cost approach was employed. Results: Most of the people with dementia were at low-income levels. The majority of dementia care cost was related to the non-medical care cost. The second highest cost was indirect costs or informal care cost, estimated as productivity loss of unpaid caregivers basing on replacement cost concept. The annual costs associated with dementia were estimated to be 90,644 Thai Baht (US$ 2,629) per person, of which 95% of the costs were associated with non-medical care and included 30% of indirect cost. Lastly, the dependency score was elastic to the total dementia care cost. Conclusion: Informal care by family members, which normally was more common in low income family, was a major part of the time spent on caring for people with dementia, and accounted for 30% of the total cost of care. Policymakers should explore furthering the policy options of subsidizing rural households based on the dependency level. Keywords: Cost of dementia care, Caregiving time, Dementia caregiver, Long-term care, Health services utilization

Occupational Attainment and Earnings in Southeast Asia: The Role of Non-cognitive Skills

Studies from industrialised countries show the importance of non-cognitive skills for occupational outcomes. However, rural labour markets in developing and emerging economies differ from industrialised labour markets, and evidence on the role of non-cognitive skills across labour markets is limited. Using new micro-level data from rural Thailand and Vietnam, we provide unique insights into the role of non-cognitive skills in occupational attainment and earnings in rural labour markets. In particular, we use nine measures (the Big Five personality traits, locus of control, risk, trust, and patience) and confirm their importance for both occupational attainment and individual earnings. We further find that returns to non-cognitive skills differ between developing and developed countries.

You’ve got a friend in me: How social networks and mobile phones facilitate healthcare access among marginalised groups in rural Thailand and Lao PDR

The seeming “ubiquity” of mobile phones has spawned a wave of interventions that use mobiles as platforms for health service delivery (mHealth). Operating in more than 100 countries, mHealth interventions commonly aspire to make healthcare more inclusive and efficient. Yet, mobile phone diffusion also stimulates locally emerging forms of health-related phone use that could create new digital inequalities among marginalised groups or compete with mHealth and other technology-based development interventions. We aim to inform this subject by asking, “How do mobile phone use and social support networks influence rural treatment-seeking behaviours among marginalised groups?” We hypothesise that (1) resource constraints drive marginalised groups towards informal healthcare access, and that (2) mobile phone use and social support networks facilitate access to formal healthcare with a bias towards private doctors. Analysing representative survey data from 2141 Thai and Lao villagers with descriptive statistics and multi-level regression models, we demonstrate that: (a) health-related phone use is concentrated among less marginalised groups, while social support networks are distributed more equitably; (b) marginalised villagers are more likely to utilise informal healthcare providers; and (c) mobile phones and social support networks are linked to increased yet delayed formal healthcare access that is directed towards public healthcare. We conclude that mobile phone diffusion has a mildly positive association with rural healthcare access, operating in a similar fashion but without (yet) appearing to crowd out social support. However encouraging, this is problematic news for mHealth and technology-based development interventions. The potential behavioural consequences of “informal mHealth” reinforce the notion that mobile phones are a non-neutral platform for mHealth and development interventions. The long-term implications require more research, but the literature suggests that increasing phone-aided healthcare facilitation could undermine local social support networks and leave already marginalised rural dwellers in yet more precarious circumstances.