A major consequence of all elements of the ‘epidemiological transition’ is the rapid emergence of... more A major consequence of all elements of the ‘epidemiological transition’ is the rapid emergence of non-communicable diseases (NCDs) in low- and middle-income countries. In contrast to the outcomes of the ‘Alma Ata Conference for Primary Health Care’, it has not yet been possible to introduce an equally powerful health policy for the prevention and control of NCDs. Major strategies so far are to advise individuals not to smoke and drink alcohol in excess. Additionally, ‘healthy’ nutrition and increased physical activity are also advocated. Policy for preventing and working against NCDs is now part of the Sustainable Development Goals, specifically target 3.4. So far, attempts to soften the influence of NCDs on the health of the people in low- and middle-income countries have been unsuccessful. It is argued here that additional concepts on how public health could operate against NCDs are needed. Major risk factors for NCDs interfere with and alter complex steps within the human metabo...
Background: Nutritional transition influences a shift in eating behaviour that is associated with... more Background: Nutritional transition influences a shift in eating behaviour that is associated with a rise in the prevalence of non-communicable diseases (NCDs). Metabolic syndrome (MetS) comprises a set of NCD risk factors. This study aimed to investigate dietary patterns and to determine the relationship between dietary patterns and MetS and its components. Methods: A cross-sectional study was conducted among 468 healthy adults aged 35–60 years who were residents of a semi-urban district of one of the central provinces in the northeast of Thailand. A factor analysis identified dietary patterns based on the consumption of 21 food groups, which were assessed by using a semi-quantitative food frequency questionnaire. MetS was identified by using the harmonized criteria that were stipulated by six leading international organisations. The association between dietary patterns and MetS and its components were evaluated by multiple logistic regressions. The confounding factors adjusted in t...
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2013
To investigate the benefits and constraints of a screening attempt as initiated by the Ministry o... more To investigate the benefits and constraints of a screening attempt as initiated by the Ministry of Public Health (MoPH) measuring over-nutrition, hypertension and type 2 diabetes mellitus (T2DM) undertaken by the local health officials on sub-district level. Capillary blood glucose (CBG), body mass index (BMI), blood pressure, and history of type 2 diabetes mellitus (T2DM) of first degree relatives was assessed following the direction of the Ministry of Public Health (MoPH) by the local health officials. The proportions of obesity, hypertension, and T2DM from 7,698 villagers were about 35%, 20%, and suspected to be 9%, respectively. This was similar to previous investigations except for the history of T2DM of first-degree relatives, which strongly relates to elevated CBG levels. A high percentage of missing value was recognized for all variables. The screening of non-communicable disease program executed by the lower level of the health delivery system is an achievement by itself It...
The Southeast Asian journal of tropical medicine and public health, 2009
The purpose of study was to determine the effect of a self-help group program on the quality of l... more The purpose of study was to determine the effect of a self-help group program on the quality of life among type 2 diabetic patients. The study subjects were type 2 diabetic patients attending one of six studied health centers or a community hospital in Saraburi Province, Thailand. At each health center/hospital, the patients were randomly allocated into the intervention group attending the self-help group program or the control group receiving diabetic services. Information was collected from September 2007 to April 2008 using a structured questionnaire with interview technique at baseline, 12 and 24 weeks. One hundred forty-six patients completed the program. Five self-help group programs carried out for 16 weeks gave instruction regarding building-up good relationships, improvement of knowledge about diabetes and skills for dietary control, skills in physical exercise, improvement of group structure, improvement of training skills for group leaders, self-monitoring, motivation in ...
The Southeast Asian journal of tropical medicine and public health, 2008
A cross-sectional study was conducted to explore the quality of life (QOL) and compliance among t... more A cross-sectional study was conducted to explore the quality of life (QOL) and compliance among type 2 diabetic patients in Saraburi Province, Thailand. Compliance was assessed by evaluating dietary intake and life style patterns useful for diabetes patients to maintain health and prevent complications of the disease. A multistage sampling technique was used for selecting patients from 2 districts (Wihan Daeng and Nong Don) and subjects were classified into 2 groups according to a quality of life (QOL) score (good = 70, poor to moderate = 94) using WHOQOL-BREF-THAI criteria. Data were collected from September to December 2007 using a self-administered questionnaire. Simple descriptive statistics were used to provide basic information about the two groups and for analytical purposes the chi-square test and multiple logistic regression were applied. The majority (78.7%) of study participants were females. Most patients belonged to the age groups of either > 50 years (50%) or 40-49 ...
A comparative study on the nutritional status of primiparous and multiparous women in the first t... more A comparative study on the nutritional status of primiparous and multiparous women in the first trimester of pregnancy was conducted in the northeastern province of Thailand, Khon Kaen, to investigate differences in protein-energy-malnutrition, iron deficiency anaemia, vitamin A deficiency and carotenoid status between both parity groups. 94 subjects were recruited at first attendance of antenatal clinic. Data about weight, height, haemoglobin and haematocrit were obtained from hospital records. Anthropometric measurements of mid-upper arm circumference and triceps skinfold were done on a sub sample. Retinol, carotenoids and alpha-tocopherol were analysed using a reversed-phase high-performance liquid chromatography method. Ferritin, transthyretin and retinol-binding protein were determined by enzyme-linked immunosorbent assay. Primiparous women showed lower body mass index, mid-upper arm circumference, corrected arm muscle area (P<0.001) as well as lower retinol, cholesterol and...
Background: A dataset from a nationwide assessment of type 2 diabetes mellitus (T2DM) patients fr... more Background: A dataset from a nationwide assessment of type 2 diabetes mellitus (T2DM) patients from Thailand was reassessed. Objective: Prevalence of T2DM is highest in the northeast of Thailand and the intention of the study was to assess whether the clinical picture and behavior of patients from the northeast differ from the rest of the country. Materials and Methods: The variables of two groups of patients i.e. those from the northeast of Thailand and patients from the remaining three other regions, with the exception of Bangkok, were compared. The dataset consisted out of clinical laboratory data and the results of a questionnaire recording knowledge and admitted compliance of patients. Results: A higher proportion of patients from the northeast have elevated triglyceride levels and lower high density lipoprotein (HDL) fractions in comparison with the patients derived from the other three regions. The northeasterners know very well and better than the patients of the other regions how to take care of them while having T2DM yet the proportion of those with glycated hemoglobin (HbA1c) values over 6.4% was higher for them than for the other group of patients. Conclusion: In depth investigation by health educators would be useful in order to find out how the relationship between knowledge and practice could be improved for patients from the northeast of Thailand.
Objectives:To investigate the effects of tobacco smoking on serum vitamin B12, folic acid and hae... more Objectives:To investigate the effects of tobacco smoking on serum vitamin B12, folic acid and haematological parameters in healthy Thai smokers and non-smokers.Design:Cross-sectional study of smokers and non-smokers in a military unit in Bangkok, Thailand.Setting:A military unit in Thailand.Subjects:One hundred and twenty-three male smokers from a military unit in Bangkok, who participated voluntarily in the study, were investigated. Sixty-six male non-smokers from the same unit were selected as controls. Fasting blood samples were collected for investigation of vitamin B12, folic acid and haematological variables.Results:The serum folic acid concentration of smokers was lower than that of non-smokers, but was not statistically significantly different. Haemoglobin was lower in smokers than in non-smokers; 16.3% of smokers were anaemic compared with only 3.0% of non-smokers. Anaemia was not related to folate deficiency. The white blood cell count was found to be higher in smokers tha...
Between 1991 and 1996 attempts were made to control iodine deficiency disorder (IDD) in the North... more Between 1991 and 1996 attempts were made to control iodine deficiency disorder (IDD) in the Northeast of Thailand. The project was conducted within the framework of an intervention project with emphasis on women's health in the reproductive age. IDD was found to be highly prevalent in the project area. The goitre rate of the women was 50,6%. In school children it was between 27 to 93%. The use of iodinated water was not successful. In the project area, iodinated fish sauce was favoured over iodinated salt. This was because the local population mostly use fish sauce instead of salt in their cooking. The results of two independent intervention trials, one with females and another with school children, indicated that iodinated fish sauce could be the best means to control IDD in the area. The experiences gained in the trials were used to control IDD in the whole project area. From 1991 to 1996 the goitre rate of females in the reproductive age decreased to about 20%.
The aim of this study was to assess anthropometric variables and the lipid pattern in relation to... more The aim of this study was to assess anthropometric variables and the lipid pattern in relation to alpha-2-macroglobulin in normal-and over-nourished Thai individuals, to further support the hypothesis that alpha-2-macroglobulin plays a beneficial role in the determination of nutritional status. The study sample comprised of 48 male and 166 female overweight and obese Thai volunteers and 26 male and 81 female normal subjects. The overweight individuals had statistically significant lower alpha-2-macroglobulin (A2M) serum levels. The total serum cholesterol, low density lipoprotein-cholesterol (LDL-C) and triglycerides were significantly higher and high density lipoprotein-cholesterol (HDL-C) lower in the over-nourished group as compared with the normal subjects. The LDL/HDL ratio was slightly but significantly higher in the over-nourished group, but still well below the value of 5 for both groups. In using a stepwise multiple linear regression, the model, which best explained the variation of A2M for all individuals including age, HDL-C, BMI, and gender. The relationship of A2M to the variables under study differed between males and females. For males, a model which includes cholesterol and BMI explained best the variation of the proteinase inhibitor. For the females, the best
... PREGNANCY, NUTRITION AND PARASITIC INFECTION OF RURAL AND URBAN WOMEN IN NORTHEAST THAILAND S... more ... PREGNANCY, NUTRITION AND PARASITIC INFECTION OF RURAL AND URBAN WOMEN IN NORTHEAST THAILAND Sastri Saowakontha1, Praneet Pongpaew2, Frank-P ... Total energy intake was the same in both groups but higher intakes of fat, protein, vitamins and trace ...
Journal of Nutritional Science and Vitaminology, 1978
Serum cholesterol, triglyceride, phospholipid, total lipid and weight to height ratio were studie... more Serum cholesterol, triglyceride, phospholipid, total lipid and weight to height ratio were studied in 172 individuals from Bangkok, mainly university staff, and in 247 individuals from rural areas of northeast Thailand. Total lipid and phospholipid levels were statistically significant higher and triglyceride lower in the Bangkok group compared with the group from the rural areas. A cholesterol level did not differ significantly between the groups. The results are discussed in respect of a possible difference in the nutritional status between the individuals from the urban and rural area.
The study was conducted to assess the achievement of a thalassemia screening program at a communi... more The study was conducted to assess the achievement of a thalassemia screening program at a community level supported by village health volunteers (VHVs) of 2 subdistricts in the northeast of Thailand. One subdistrict served as the intervention and the other as the control area. A training program was organized for the village health volunteers from the intervention area. Essential information about the risk and danger of thalassemia was given to the participants who wanted to have children in the community as well. Of the 206 individuals who wanted to have children living in the intervention area, 190 (92.2%) agreed to undergo screening. Of the 196 individuals within the control area, only 26 (13.3%) voluntarily participated in the screening tests. Attitude toward prevention and knowledge about the disease improved significantly in both areas, but the differences between the scores were statistically significantly higher for individuals living in the intervention area.
Socio-demographic, anthropometric assessment, dietary pattern, lifestyle of 384 Thai elderly (55 ... more Socio-demographic, anthropometric assessment, dietary pattern, lifestyle of 384 Thai elderly (55 males and 329 females) aged 60-94 years, who were members of an informal social activity group, were investigated. The 3-day dietary record was determined with the help of food models by random sampling of the group (seven males and 25 females). Most of the males investigated were married (88.9%), whereas 42.9% of the females were widowed. Nearly all of the elderly investigated lived with their relatives. Only 3% of the elderly had never attended school. More elderly males than females smoked or had smoked in the past, and this applies also to their drinking habits. The health situation of the individuals investigated seemed to be satisfactory. The most frequent diseases found among the elderly were chronic diseases, such as hypertension, hyperlipidemia and diabetes mellitus. No statistically significant difference in body mass index (BMI), arm circumference (AC), and hip circumference was found between males and females. Weight, height, mid-arm muscle circumference (MAMC), arm span, waist, waist/hip ratio and blood pressure of the males were significantly higher than those of the females. Tricep skin-fold thickness (TSF) and subscapular skin-fold thickness (SST) were lower for males than for females. A total of 54.5% of the males and 50.5% of the females were found to be over-nourished. Less than 2% of all the individuals investigated were undernourished. No significant differences were observed for all nutrients between the males and females. Intake of dietary energy from food for males and females was 69.8 and 75.5%, respectively, compared with the Thai RDA. When calculating the intake of macro-nutrients as percentage of total calorie intake, about 17% of the total calorie intake was attributed to fat, 13% to protein and 70% to carbohydrate for the males. For the females, the figures were 17, 15, and 68%, respectively. Intake of calcium, phosphorus, vitamin B1, B2 and niacin seem to be inadequate for both sexes.
Fifty-six Thai males and 146 Thai females aged 60 years and above visiting a special clinic for t... more Fifty-six Thai males and 146 Thai females aged 60 years and above visiting a special clinic for the elderly were investigated. The serum protein and immunoglobulin of these elderly were assessed. Anthropometric measurements were also taken. From a random sample of the group, the dietary intake of main nutrients was determined by a 24 h recall method with the help of food models. Weight, height and mid-arm muscle circumference of males were greater than those of females. Triceps skinfold thickness was less in the males than in the females. Forty-seven per cent of the individuals investigated had cq-antitrypsin levels below 200 mg/dl and 25.4% had IgG levels of 200 mg/dl and 39% lgA levels above 450 mg/dl. The males tend to consume more calories in the form of carbohydrates than the females. The nutritional density of fat was less than 20% in the males. A negative correlation between serum albumin and height and a positive correlation between serum lgG and tricep skinfold thickness were found. Weight was found to have a positive correlation with calories, carbohydrates and fat. Height correlated positively with calories, protein and carbohydrates. Serum prealbumin correlated with fat intake. It is concluded that, except for a~-antitrypsin, IgG and IgA, serum proteins are found in a range normally detected also in elderlies in western countries. Body composition does not relate to level of protein intake.
To test a self-scraping device as a mass screening device against a routine scraping method and t... more To test a self-scraping device as a mass screening device against a routine scraping method and to evaluate the acceptance of the self-scraping device by a group of rural females from Northeast Thailand. From a rural area of Northeast Thailand, 552 women were trained and motivated, through primary health care structures, to participate in a cervical cancer screening exercise using a self-scraping device. After one week, the same females were reexamined by gynecologists using the routine scraping method. In both cases the specimens were stained according to Papanicolaou. Through questionnaires the acceptance of the self-scraping device was evaluated. Through the self-scraping method, 13 cases suspicious for malignancy were detected. Specimens obtained through examination by physicians confirmed 11 cases to be suspicious for malignancy. No false negative cases were found. In the detection of inflammation, the self-scraping method was not as accurate as examination by a physician. The device was accepted by the females who participated in the study. In the rural areas of developing countries, where physicians and other trained medical personnel are not often available to carry out regular screening tests on a population basis, the self-scraping method can be applied as an integral part of primary health care for mass screening for uterine cervical cancer.
Background Thailand is considered to be a middle income country, and to control and prevent type ... more Background Thailand is considered to be a middle income country, and to control and prevent type 2 diabetes mellitus (T2DM) is one of the main concerns of the Thai Ministry of Public Health (MoPH). Screening for T2DM and care for T2DM patients has been integrated into the primary health care system, especially in rural areas. The intention of this investigation is to link public health research at the academic level with the local health authorities of a district of a north-eastern province of the country. Methods Epidemiological methods were applied to validate the screening tools fasting capillary blood glucose (CBG), measured by glucometer and venous blood for the determination of plasma glucose (VPG), used for screening for T2DM among asymptomatic villagers. For assessing the validity of these two methods glycated haemoglobin (HbA1c) values were determined and used as the ‘clinical reference’. Results All together 669 villagers were investigated. Determinations of CBG and VPG re...
The Southeast Asian journal of tropical medicine and public health, 2001
From March to July 1998 the infection rates of 732 children aged below 15 years were assessed. Th... more From March to July 1998 the infection rates of 732 children aged below 15 years were assessed. The investigation was conducted in selected villages of the Bolikhamxai Province in Lao PDR. Socio-economic conditions and behavioral pattern were studied. The three soil-transmitted helminths, Ascaris lumbricoides, Trichuris trichiura and hookworm were found with prevalence rates of 67.14, 17.49 and 12.83%, respectively. Infection rates with other intestinal parasites were negligible. Of the children investigated, 56.7% harbored one and 20.45% more than one parasite. Except for hookworms, no statistically significant differences were found between genders. The probability of being infected with A. lumbricoides is associated with living in mountainous areas. For hookworms, infection is associated with staying in the plains. A river in the vicinity of the village is linked with the probability of being infested with Trichuris trichiura. Not to belong to a family with the ability to own expe...
Public health authorities in low- and middle-income countries face dramatic challenges in handlin... more Public health authorities in low- and middle-income countries face dramatic challenges in handling rapidly increasing non-communicable diseases (NCDs), due to the epidemiological- and particularly nutritional transition. Among major reasons for the development of NCDs are smoking and alcohol, but overnutrition and obesity are also major threats to population health. Obesity is related to diabetes and cancer, but also has a genetic background. It is difficult to recommend a healthy nutrition. This is because of conflicting nutritional conceptions, and given the complexity of human metabolism understanding this topic can be difficult for the laymen. Public health measures advocating physical activity and refraining from high intake of energy, sugar and soft drinks need to be enhanced by supporting the ‘intrinsic motivation’ to preserve a good health. The mission of public health should be to increase awareness about the complexity of human metabolism, and the involvement of genetic a...
The study describes reproductive health in two districts of the Luangprabang Province in northern... more The study describes reproductive health in two districts of the Luangprabang Province in northern Lao PDR. The aim was to find out whether training traditional birth attendants (TBA) might have an impact on reproductive health. In June/July 2000, a total of 298 women of reproductive age, with children below two years of age, from 30 villages were interviewed by means of a closed questionnaire. In 1996/1997, a training course for TBA was conducted in one of the districts under survey. Information was obtained for demography, symptoms and risks during pregnancy and delivery, antenatal care (ANC), tetanus immunization, food taboos, place of delivery, birth attendant, practising of birth spacing and their attitude towards the services of TBA. The results obtained indirectly pointed towards a high fertility rate and a high rate of child death and abortion. An overwhelming majority of the women delivered at home, attended only by untrained individuals. During pregnancy and after delivery, the women claimed that they often suffered from edema of legs and feet, high fever and hemorrhages. Only 50% of the females in the district where TBA training were conducted, made use of the services of trained TBA. Nevertheless, females in the district with trained TBA, who made use of the TBA service in comparison with women in the same district not using the service of TBA, were 3.8 times more likely to also make use of the ANC service; 3.3 times more likely to seek immunization, and 8.6 times more likely to give colostrum to their new-borns. The educational level of the females proved to be an important factor. Literate women were more likely to practise birth spacing and have been vaccinated. Illiterate women were more likely to be at higher risk for losing a child. In the district without TBA service the loss of a child was less likely among literate than illiterate women. It is concluded that through adequately trained TBA and through their continuous support and supervision, ANC and health education can be improved. In addition to the improvement of the referral system for emergency cases and manpower development within the obstetric curative service, the training of TBA will have a positive impact on reproductive health. However, maternal health depends, to a large extent, on the educational level of the women.
A major consequence of all elements of the ‘epidemiological transition’ is the rapid emergence of... more A major consequence of all elements of the ‘epidemiological transition’ is the rapid emergence of non-communicable diseases (NCDs) in low- and middle-income countries. In contrast to the outcomes of the ‘Alma Ata Conference for Primary Health Care’, it has not yet been possible to introduce an equally powerful health policy for the prevention and control of NCDs. Major strategies so far are to advise individuals not to smoke and drink alcohol in excess. Additionally, ‘healthy’ nutrition and increased physical activity are also advocated. Policy for preventing and working against NCDs is now part of the Sustainable Development Goals, specifically target 3.4. So far, attempts to soften the influence of NCDs on the health of the people in low- and middle-income countries have been unsuccessful. It is argued here that additional concepts on how public health could operate against NCDs are needed. Major risk factors for NCDs interfere with and alter complex steps within the human metabo...
Background: Nutritional transition influences a shift in eating behaviour that is associated with... more Background: Nutritional transition influences a shift in eating behaviour that is associated with a rise in the prevalence of non-communicable diseases (NCDs). Metabolic syndrome (MetS) comprises a set of NCD risk factors. This study aimed to investigate dietary patterns and to determine the relationship between dietary patterns and MetS and its components. Methods: A cross-sectional study was conducted among 468 healthy adults aged 35–60 years who were residents of a semi-urban district of one of the central provinces in the northeast of Thailand. A factor analysis identified dietary patterns based on the consumption of 21 food groups, which were assessed by using a semi-quantitative food frequency questionnaire. MetS was identified by using the harmonized criteria that were stipulated by six leading international organisations. The association between dietary patterns and MetS and its components were evaluated by multiple logistic regressions. The confounding factors adjusted in t...
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2013
To investigate the benefits and constraints of a screening attempt as initiated by the Ministry o... more To investigate the benefits and constraints of a screening attempt as initiated by the Ministry of Public Health (MoPH) measuring over-nutrition, hypertension and type 2 diabetes mellitus (T2DM) undertaken by the local health officials on sub-district level. Capillary blood glucose (CBG), body mass index (BMI), blood pressure, and history of type 2 diabetes mellitus (T2DM) of first degree relatives was assessed following the direction of the Ministry of Public Health (MoPH) by the local health officials. The proportions of obesity, hypertension, and T2DM from 7,698 villagers were about 35%, 20%, and suspected to be 9%, respectively. This was similar to previous investigations except for the history of T2DM of first-degree relatives, which strongly relates to elevated CBG levels. A high percentage of missing value was recognized for all variables. The screening of non-communicable disease program executed by the lower level of the health delivery system is an achievement by itself It...
The Southeast Asian journal of tropical medicine and public health, 2009
The purpose of study was to determine the effect of a self-help group program on the quality of l... more The purpose of study was to determine the effect of a self-help group program on the quality of life among type 2 diabetic patients. The study subjects were type 2 diabetic patients attending one of six studied health centers or a community hospital in Saraburi Province, Thailand. At each health center/hospital, the patients were randomly allocated into the intervention group attending the self-help group program or the control group receiving diabetic services. Information was collected from September 2007 to April 2008 using a structured questionnaire with interview technique at baseline, 12 and 24 weeks. One hundred forty-six patients completed the program. Five self-help group programs carried out for 16 weeks gave instruction regarding building-up good relationships, improvement of knowledge about diabetes and skills for dietary control, skills in physical exercise, improvement of group structure, improvement of training skills for group leaders, self-monitoring, motivation in ...
The Southeast Asian journal of tropical medicine and public health, 2008
A cross-sectional study was conducted to explore the quality of life (QOL) and compliance among t... more A cross-sectional study was conducted to explore the quality of life (QOL) and compliance among type 2 diabetic patients in Saraburi Province, Thailand. Compliance was assessed by evaluating dietary intake and life style patterns useful for diabetes patients to maintain health and prevent complications of the disease. A multistage sampling technique was used for selecting patients from 2 districts (Wihan Daeng and Nong Don) and subjects were classified into 2 groups according to a quality of life (QOL) score (good = 70, poor to moderate = 94) using WHOQOL-BREF-THAI criteria. Data were collected from September to December 2007 using a self-administered questionnaire. Simple descriptive statistics were used to provide basic information about the two groups and for analytical purposes the chi-square test and multiple logistic regression were applied. The majority (78.7%) of study participants were females. Most patients belonged to the age groups of either > 50 years (50%) or 40-49 ...
A comparative study on the nutritional status of primiparous and multiparous women in the first t... more A comparative study on the nutritional status of primiparous and multiparous women in the first trimester of pregnancy was conducted in the northeastern province of Thailand, Khon Kaen, to investigate differences in protein-energy-malnutrition, iron deficiency anaemia, vitamin A deficiency and carotenoid status between both parity groups. 94 subjects were recruited at first attendance of antenatal clinic. Data about weight, height, haemoglobin and haematocrit were obtained from hospital records. Anthropometric measurements of mid-upper arm circumference and triceps skinfold were done on a sub sample. Retinol, carotenoids and alpha-tocopherol were analysed using a reversed-phase high-performance liquid chromatography method. Ferritin, transthyretin and retinol-binding protein were determined by enzyme-linked immunosorbent assay. Primiparous women showed lower body mass index, mid-upper arm circumference, corrected arm muscle area (P<0.001) as well as lower retinol, cholesterol and...
Background: A dataset from a nationwide assessment of type 2 diabetes mellitus (T2DM) patients fr... more Background: A dataset from a nationwide assessment of type 2 diabetes mellitus (T2DM) patients from Thailand was reassessed. Objective: Prevalence of T2DM is highest in the northeast of Thailand and the intention of the study was to assess whether the clinical picture and behavior of patients from the northeast differ from the rest of the country. Materials and Methods: The variables of two groups of patients i.e. those from the northeast of Thailand and patients from the remaining three other regions, with the exception of Bangkok, were compared. The dataset consisted out of clinical laboratory data and the results of a questionnaire recording knowledge and admitted compliance of patients. Results: A higher proportion of patients from the northeast have elevated triglyceride levels and lower high density lipoprotein (HDL) fractions in comparison with the patients derived from the other three regions. The northeasterners know very well and better than the patients of the other regions how to take care of them while having T2DM yet the proportion of those with glycated hemoglobin (HbA1c) values over 6.4% was higher for them than for the other group of patients. Conclusion: In depth investigation by health educators would be useful in order to find out how the relationship between knowledge and practice could be improved for patients from the northeast of Thailand.
Objectives:To investigate the effects of tobacco smoking on serum vitamin B12, folic acid and hae... more Objectives:To investigate the effects of tobacco smoking on serum vitamin B12, folic acid and haematological parameters in healthy Thai smokers and non-smokers.Design:Cross-sectional study of smokers and non-smokers in a military unit in Bangkok, Thailand.Setting:A military unit in Thailand.Subjects:One hundred and twenty-three male smokers from a military unit in Bangkok, who participated voluntarily in the study, were investigated. Sixty-six male non-smokers from the same unit were selected as controls. Fasting blood samples were collected for investigation of vitamin B12, folic acid and haematological variables.Results:The serum folic acid concentration of smokers was lower than that of non-smokers, but was not statistically significantly different. Haemoglobin was lower in smokers than in non-smokers; 16.3% of smokers were anaemic compared with only 3.0% of non-smokers. Anaemia was not related to folate deficiency. The white blood cell count was found to be higher in smokers tha...
Between 1991 and 1996 attempts were made to control iodine deficiency disorder (IDD) in the North... more Between 1991 and 1996 attempts were made to control iodine deficiency disorder (IDD) in the Northeast of Thailand. The project was conducted within the framework of an intervention project with emphasis on women's health in the reproductive age. IDD was found to be highly prevalent in the project area. The goitre rate of the women was 50,6%. In school children it was between 27 to 93%. The use of iodinated water was not successful. In the project area, iodinated fish sauce was favoured over iodinated salt. This was because the local population mostly use fish sauce instead of salt in their cooking. The results of two independent intervention trials, one with females and another with school children, indicated that iodinated fish sauce could be the best means to control IDD in the area. The experiences gained in the trials were used to control IDD in the whole project area. From 1991 to 1996 the goitre rate of females in the reproductive age decreased to about 20%.
The aim of this study was to assess anthropometric variables and the lipid pattern in relation to... more The aim of this study was to assess anthropometric variables and the lipid pattern in relation to alpha-2-macroglobulin in normal-and over-nourished Thai individuals, to further support the hypothesis that alpha-2-macroglobulin plays a beneficial role in the determination of nutritional status. The study sample comprised of 48 male and 166 female overweight and obese Thai volunteers and 26 male and 81 female normal subjects. The overweight individuals had statistically significant lower alpha-2-macroglobulin (A2M) serum levels. The total serum cholesterol, low density lipoprotein-cholesterol (LDL-C) and triglycerides were significantly higher and high density lipoprotein-cholesterol (HDL-C) lower in the over-nourished group as compared with the normal subjects. The LDL/HDL ratio was slightly but significantly higher in the over-nourished group, but still well below the value of 5 for both groups. In using a stepwise multiple linear regression, the model, which best explained the variation of A2M for all individuals including age, HDL-C, BMI, and gender. The relationship of A2M to the variables under study differed between males and females. For males, a model which includes cholesterol and BMI explained best the variation of the proteinase inhibitor. For the females, the best
... PREGNANCY, NUTRITION AND PARASITIC INFECTION OF RURAL AND URBAN WOMEN IN NORTHEAST THAILAND S... more ... PREGNANCY, NUTRITION AND PARASITIC INFECTION OF RURAL AND URBAN WOMEN IN NORTHEAST THAILAND Sastri Saowakontha1, Praneet Pongpaew2, Frank-P ... Total energy intake was the same in both groups but higher intakes of fat, protein, vitamins and trace ...
Journal of Nutritional Science and Vitaminology, 1978
Serum cholesterol, triglyceride, phospholipid, total lipid and weight to height ratio were studie... more Serum cholesterol, triglyceride, phospholipid, total lipid and weight to height ratio were studied in 172 individuals from Bangkok, mainly university staff, and in 247 individuals from rural areas of northeast Thailand. Total lipid and phospholipid levels were statistically significant higher and triglyceride lower in the Bangkok group compared with the group from the rural areas. A cholesterol level did not differ significantly between the groups. The results are discussed in respect of a possible difference in the nutritional status between the individuals from the urban and rural area.
The study was conducted to assess the achievement of a thalassemia screening program at a communi... more The study was conducted to assess the achievement of a thalassemia screening program at a community level supported by village health volunteers (VHVs) of 2 subdistricts in the northeast of Thailand. One subdistrict served as the intervention and the other as the control area. A training program was organized for the village health volunteers from the intervention area. Essential information about the risk and danger of thalassemia was given to the participants who wanted to have children in the community as well. Of the 206 individuals who wanted to have children living in the intervention area, 190 (92.2%) agreed to undergo screening. Of the 196 individuals within the control area, only 26 (13.3%) voluntarily participated in the screening tests. Attitude toward prevention and knowledge about the disease improved significantly in both areas, but the differences between the scores were statistically significantly higher for individuals living in the intervention area.
Socio-demographic, anthropometric assessment, dietary pattern, lifestyle of 384 Thai elderly (55 ... more Socio-demographic, anthropometric assessment, dietary pattern, lifestyle of 384 Thai elderly (55 males and 329 females) aged 60-94 years, who were members of an informal social activity group, were investigated. The 3-day dietary record was determined with the help of food models by random sampling of the group (seven males and 25 females). Most of the males investigated were married (88.9%), whereas 42.9% of the females were widowed. Nearly all of the elderly investigated lived with their relatives. Only 3% of the elderly had never attended school. More elderly males than females smoked or had smoked in the past, and this applies also to their drinking habits. The health situation of the individuals investigated seemed to be satisfactory. The most frequent diseases found among the elderly were chronic diseases, such as hypertension, hyperlipidemia and diabetes mellitus. No statistically significant difference in body mass index (BMI), arm circumference (AC), and hip circumference was found between males and females. Weight, height, mid-arm muscle circumference (MAMC), arm span, waist, waist/hip ratio and blood pressure of the males were significantly higher than those of the females. Tricep skin-fold thickness (TSF) and subscapular skin-fold thickness (SST) were lower for males than for females. A total of 54.5% of the males and 50.5% of the females were found to be over-nourished. Less than 2% of all the individuals investigated were undernourished. No significant differences were observed for all nutrients between the males and females. Intake of dietary energy from food for males and females was 69.8 and 75.5%, respectively, compared with the Thai RDA. When calculating the intake of macro-nutrients as percentage of total calorie intake, about 17% of the total calorie intake was attributed to fat, 13% to protein and 70% to carbohydrate for the males. For the females, the figures were 17, 15, and 68%, respectively. Intake of calcium, phosphorus, vitamin B1, B2 and niacin seem to be inadequate for both sexes.
Fifty-six Thai males and 146 Thai females aged 60 years and above visiting a special clinic for t... more Fifty-six Thai males and 146 Thai females aged 60 years and above visiting a special clinic for the elderly were investigated. The serum protein and immunoglobulin of these elderly were assessed. Anthropometric measurements were also taken. From a random sample of the group, the dietary intake of main nutrients was determined by a 24 h recall method with the help of food models. Weight, height and mid-arm muscle circumference of males were greater than those of females. Triceps skinfold thickness was less in the males than in the females. Forty-seven per cent of the individuals investigated had cq-antitrypsin levels below 200 mg/dl and 25.4% had IgG levels of 200 mg/dl and 39% lgA levels above 450 mg/dl. The males tend to consume more calories in the form of carbohydrates than the females. The nutritional density of fat was less than 20% in the males. A negative correlation between serum albumin and height and a positive correlation between serum lgG and tricep skinfold thickness were found. Weight was found to have a positive correlation with calories, carbohydrates and fat. Height correlated positively with calories, protein and carbohydrates. Serum prealbumin correlated with fat intake. It is concluded that, except for a~-antitrypsin, IgG and IgA, serum proteins are found in a range normally detected also in elderlies in western countries. Body composition does not relate to level of protein intake.
To test a self-scraping device as a mass screening device against a routine scraping method and t... more To test a self-scraping device as a mass screening device against a routine scraping method and to evaluate the acceptance of the self-scraping device by a group of rural females from Northeast Thailand. From a rural area of Northeast Thailand, 552 women were trained and motivated, through primary health care structures, to participate in a cervical cancer screening exercise using a self-scraping device. After one week, the same females were reexamined by gynecologists using the routine scraping method. In both cases the specimens were stained according to Papanicolaou. Through questionnaires the acceptance of the self-scraping device was evaluated. Through the self-scraping method, 13 cases suspicious for malignancy were detected. Specimens obtained through examination by physicians confirmed 11 cases to be suspicious for malignancy. No false negative cases were found. In the detection of inflammation, the self-scraping method was not as accurate as examination by a physician. The device was accepted by the females who participated in the study. In the rural areas of developing countries, where physicians and other trained medical personnel are not often available to carry out regular screening tests on a population basis, the self-scraping method can be applied as an integral part of primary health care for mass screening for uterine cervical cancer.
Background Thailand is considered to be a middle income country, and to control and prevent type ... more Background Thailand is considered to be a middle income country, and to control and prevent type 2 diabetes mellitus (T2DM) is one of the main concerns of the Thai Ministry of Public Health (MoPH). Screening for T2DM and care for T2DM patients has been integrated into the primary health care system, especially in rural areas. The intention of this investigation is to link public health research at the academic level with the local health authorities of a district of a north-eastern province of the country. Methods Epidemiological methods were applied to validate the screening tools fasting capillary blood glucose (CBG), measured by glucometer and venous blood for the determination of plasma glucose (VPG), used for screening for T2DM among asymptomatic villagers. For assessing the validity of these two methods glycated haemoglobin (HbA1c) values were determined and used as the ‘clinical reference’. Results All together 669 villagers were investigated. Determinations of CBG and VPG re...
The Southeast Asian journal of tropical medicine and public health, 2001
From March to July 1998 the infection rates of 732 children aged below 15 years were assessed. Th... more From March to July 1998 the infection rates of 732 children aged below 15 years were assessed. The investigation was conducted in selected villages of the Bolikhamxai Province in Lao PDR. Socio-economic conditions and behavioral pattern were studied. The three soil-transmitted helminths, Ascaris lumbricoides, Trichuris trichiura and hookworm were found with prevalence rates of 67.14, 17.49 and 12.83%, respectively. Infection rates with other intestinal parasites were negligible. Of the children investigated, 56.7% harbored one and 20.45% more than one parasite. Except for hookworms, no statistically significant differences were found between genders. The probability of being infected with A. lumbricoides is associated with living in mountainous areas. For hookworms, infection is associated with staying in the plains. A river in the vicinity of the village is linked with the probability of being infested with Trichuris trichiura. Not to belong to a family with the ability to own expe...
Public health authorities in low- and middle-income countries face dramatic challenges in handlin... more Public health authorities in low- and middle-income countries face dramatic challenges in handling rapidly increasing non-communicable diseases (NCDs), due to the epidemiological- and particularly nutritional transition. Among major reasons for the development of NCDs are smoking and alcohol, but overnutrition and obesity are also major threats to population health. Obesity is related to diabetes and cancer, but also has a genetic background. It is difficult to recommend a healthy nutrition. This is because of conflicting nutritional conceptions, and given the complexity of human metabolism understanding this topic can be difficult for the laymen. Public health measures advocating physical activity and refraining from high intake of energy, sugar and soft drinks need to be enhanced by supporting the ‘intrinsic motivation’ to preserve a good health. The mission of public health should be to increase awareness about the complexity of human metabolism, and the involvement of genetic a...
The study describes reproductive health in two districts of the Luangprabang Province in northern... more The study describes reproductive health in two districts of the Luangprabang Province in northern Lao PDR. The aim was to find out whether training traditional birth attendants (TBA) might have an impact on reproductive health. In June/July 2000, a total of 298 women of reproductive age, with children below two years of age, from 30 villages were interviewed by means of a closed questionnaire. In 1996/1997, a training course for TBA was conducted in one of the districts under survey. Information was obtained for demography, symptoms and risks during pregnancy and delivery, antenatal care (ANC), tetanus immunization, food taboos, place of delivery, birth attendant, practising of birth spacing and their attitude towards the services of TBA. The results obtained indirectly pointed towards a high fertility rate and a high rate of child death and abortion. An overwhelming majority of the women delivered at home, attended only by untrained individuals. During pregnancy and after delivery, the women claimed that they often suffered from edema of legs and feet, high fever and hemorrhages. Only 50% of the females in the district where TBA training were conducted, made use of the services of trained TBA. Nevertheless, females in the district with trained TBA, who made use of the TBA service in comparison with women in the same district not using the service of TBA, were 3.8 times more likely to also make use of the ANC service; 3.3 times more likely to seek immunization, and 8.6 times more likely to give colostrum to their new-borns. The educational level of the females proved to be an important factor. Literate women were more likely to practise birth spacing and have been vaccinated. Illiterate women were more likely to be at higher risk for losing a child. In the district without TBA service the loss of a child was less likely among literate than illiterate women. It is concluded that through adequately trained TBA and through their continuous support and supervision, ANC and health education can be improved. In addition to the improvement of the referral system for emergency cases and manpower development within the obstetric curative service, the training of TBA will have a positive impact on reproductive health. However, maternal health depends, to a large extent, on the educational level of the women.
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