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Publication Open Access Participants’ perceptions and understanding of a malaria clinical trial in Bangladesh(2014) Debashish Das; Cheah, Phaik Yeong; Fateha Akter; Dulal Paul; Akhterul Islam; Rasheda Samad; Ridwanur Rahman; Amir Hossain; Arjen Dondorp; Day, Nicholas P; White, Nicholas J; Mahtabuddin Hasan; Aniruddha Ghose; Ashley, Elizabeth A; Abul Faiz; Mahidol University. Faculty of Tropical Medicine. Mahidol-Oxford Tropical Medicine Research UnitBackground: Existing evidence suggests that there is often limited understanding among participants in clinical trials about the informed consent process, resulting in their providing consent without really understanding the purpose of the study, specific procedures, and their rights. The objective of the study was to determine the subjects’ understanding of research, perceptions of voluntariness and motivations for participation in a malaria clinical trial. Methods: In this study semi-structured interviews of adult clinical trial participants with uncomplicated falciparum malaria were conducted in Ramu Upazila Health Complex, in Bangladesh. Results: Of 16 participants, the vast majority (81%) were illiterate. All subjects had a ‘therapeutic misconception’ i.e. the trial was perceived to be conducted primarily for the benefit of individual patients when in fact the main objective was to provide information to inform public health policy. From the patients’ perspective, getting well from their illness was their major concern. Poor actual understanding of trial specific procedures was reported despite participants’ satisfaction with treatment and nursing care. Conclusion: There is frequently a degree of overlap between research and provision of clinical care in malaria research studies. Patients may be motivated to participate to research without a good understanding of the principal objectives of the study despite a lengthy consent process. The findings suggest that use of a standard consent form following the current ICH-GCP guidelines does not result in achieving fully informed consent and the process should be revised, simplified and adapted to individual trial settingsPublication Open Access Swine is a possible source of hepatitis E virus infection by comparative study of hepatitis A and E seroprevalence in Thailand.(2015-04-30) Pattaratida Sa-nguanmoo; Nawarat Posuwan; Preeyaporn Vichaiwattana; Norra Wutthiratkowit; Somchai Owatanapanich; Rujipat Wasitthankasem; Thanunrat Thongmee; Kittiyod Poovorawan; กิตติยศ ภู่วรวรรณ; Apiradee Theamboonlers; Sompong Vongpunsawad; Yong Poovorawan; Yong Poovorawan; Mahidol University. Faculty of Tropical Medicine. Department of Clinical Tropical Medicinebetween 7 months to 69 years (mean age = 32.8) from predominantly Islamic Narathiwat (n = 305) and swine farm-dense Lop Buri (n = 416) provinces were screened for anti-HEV and anti-HAV antibodies by commercial enzyme-linked immunosorbent assayPublication Open Access The relevance of longitudinal research for population and health(2008-01) Bencha Yoddumnern-Attig; เบญจา ยอดดำเนิน-แอตติกจ์; Guest, Philip; Varachai Thongthai; วรชัย ทองไทย; Sureeporn Punpuing; สุรีย์พร พันพึ่ง; Chanya Sethaput; จรรยา เศรษฐบุตร; Aree Jampaklay; อารี จำปากลาย; Rossarin Gray; รศรินทร์ เกรย์; Yupin Vorasiriamorn; ยุพิน วรสิริอมร; Boonlert Leoprapai; Mahidol University. Institute for Population and Social ResearchLongitudinal research is the term coined to differentiate the methodology and utility of this type of research with that of cross-sectional research. It is a necessary tool for studying social change and dynamic behavior due to its ability to track individuals over time to assess change. A prime principle of longitudinal studies is to link individual data across time. The need for and utility of longitudinal research are extremely relevant today. The growing diversity of changes led by globalization, population trends and epidemiological transitions force researchers to better understand and grasp the nature and processes of change associated with social and behavioral dynamics. This paper synthesizes the ways in which longitudinal research has been a valuable tool for analyzing changing trends in population and health and the causal factors contributing to these changes, with special attention to its use in the Asia and Pacific Region. The discussion centers on three main aspects, beginning with an overview of longitudinal research, its development and changing needs, its distinctive features, and its relevance to population and health research. The presentation continues with a review of the utility of longitudinal studies in population and health research, followed by an assessment of the prospects and challenges for longitudinal studies.Publication Open Access Spatio-temporal effects of estimated pollutants released from an industrial estate on the occurrence of respiratory disease in Maptaphut Municipality, Thailand(2006-11-08) Somchai Jadsri; สมชาย จาดศรี; Pratap Singhasivanon; ประตาป สิงหศิวานนท์; Jaranit Kaewkungwal; จรณิต แก้วกังวาล; Rattana Sithiprasasna; Somkiat Siriruttanapruk; Supawadee Konchom; Somchai Jadsri; Mahidol University. Faculty of Tropical Medicine. Department of Tropical Hygiene.BACKGROUND: Maptaphut Industrial Estate (MIE) was established with a single factory in 1988, increasing to 50 by 1998. This development has resulted in undesirable impacts on the environment and the health of the people in the surrounding areas, evidenced by frequent complaints of bad odours making the people living there ill. In 1999, the Bureau of Environmental Health, Department of Health, Ministry of Public Health, conducted a study of the health status of people in Rayong Province and found a marked increase in respiratory diseases over the period 1993-1996, higher than the overall prevalence of such diseases in Thailand. However, the relationship between the pollutants and the respiratory diseases of the people in the surrounding area has still not been quantified. Therefore, this study aimed to determine the spatial distribution of respiratory disease, to estimate pollutants released from the industrial estates, and to quantify the relationship between estimated pollutants and respiratory disease in the Maptaphut Municipality. RESULTS: Disease mapping showed a much higher risk of respiratory disease in communities adjacent to the Maptaphut Industrial Estate. Disease occurrence formed significant clusters centred on communities near the estate, relative to the weighted mean centre of chimney stacks. Analysis of the rates of respiratory disease in the communities, categorized by different concentrations of estimated pollutants, found a dose-response effect. Spatial regression analysis found that the distance between community and health providers decreased the rate of respiratory disease (p < 0.05). However, after taking into account distance, total pollutant (p < 0.05), SO2 (p < 0.05) and NOx (p < 0.05) played a role in adverse health effects during the summer. Total pollutant (p < 0.05) and NOx (p < 0.05) played a role in adverse health effects during the rainy season after taking into account distance, but during winter there was no observed relationship between pollutants and rates of respiratory disease after taking into account distance. A 12-month time-series analysis of six communities selected from the disease clusters and the areas impacted most by pollutant dispersion, found significant effects for SO2 (p < 0.05), NOx (p < 0.05), and TSP (p < 0.05) after taking into account rainfall. CONCLUSION: This study employed disease mapping to present the spatial distribution of disease. Excessive risk of respiratory disease, and disease clusters, were found among communities near Maptaphut Industrial Estate. Study of the relationship between estimated pollutants and the occurrence of respiratory disease found significant relationships between estimated SO2, NOx, and TSP, and the rate of respiratory disease.Publication Open Access Proper hand washing practices among elementary school students in Selat sub-district, Indonesia(2012) Tri Setyautami; Santhat Sermsri; Jiraporn Chompikul; Mahidol University. ASEAN Institute for Health DevelopmentEven though proper hand washing is the most effective and easiest way to prevent many diseases, unfortunately many people do not practice hand washing correctly. The worldwide Global Hand Washing Day campaign which targets school children as the most effective agents for behavior change is both evidence of this problem and an attempt to address it. This study considers the implications of this practical policy for local government, health professionals and other stakeholders concerned with improving school-based hygiene intervention programs. This paper describes a cross-sectional descriptive study about hand washing practice, the prevalence of proper hand washing, and related factors among sixth grade of elementary students in Selat sub-district, Indonesia. A self administered questionnaire was administered to 274 students at seven schools randomly selected by proportion to size from five villages. Data were analyzed using descriptive statistics, Chi square tests, and multiple logistic regression to explore associations between the various study factors (i.e. socio-demographic characteristics, attitudes, subjective norms, perceived control, and availability of facilities). Nine combinations of hand washing emerged from this study which combined washing hands by using water and soap with two critical events: before eating and after visiting the toilet. Only 40.5% of the respondents washed their hands properly. Availability of clean water (Adj OR = 4.24, 95% CI = 1.92-9.35) and soap (Adj OR = 5.55, 95% CI = 2.36-13.08) at hand washing stands were found to be significant predictors of proper hand washing, when adjusted with other factors. This study demonstrates that the prevalence of proper hand washing was very low among the school students. Hand washing promotion should be more effective in schools and better facilities need to be more widely available to improve the prevalence of proper hand washing by students.Publication Open Access Primaquine: the risks and the benefits(2014) Ashley, Elizabeth A; Judith Recht; White, Nicholas J; Mahidol University. Faculty of Tropical Medicine. Mahidol-Oxford Tropical Medicine Research UnitPrimaquine is the only generally available anti-malarial that prevents relapse in vivax and ovale malaria, and the only potent gametocytocide in falciparum malaria. Primaquine becomes increasingly important as malaria-endemic countries move towards elimination, and although it is widely recommended, it is commonly not given to malaria patients because of haemolytic toxicity in subjects who are glucose-6-phosphate dehydrogenase (G6PD) deficient (gene frequency typically 3-30% in malaria endemic areas; >180 different genetic variants). In six decades of primaquine use in approximately 200 million people, 14 deaths have been reported. Confining the estimate to reports with known denominators gives an estimated mortality of one in 621,428 (upper 95% CI: one in 407,807). All but one death followed multiple dosing to prevent vivax malaria relapse. Review of dose-response relationships and clinical trials of primaquine in G6PD deficiency suggests that the currently recommended WHO single low dose (0.25 mg base/kg) to block falciparum malaria transmission confers a very low risk of haemolytic toxicity.Publication Open Access The perceptions of safe delivery among married women of reproductive age between 20 and 49 years old in Parkgneum district, Vientiane Capital, Lao PDR(2009) Khanthong Siharath; Sirikul Isaranurug; ศิริกุล อิศรานุรักษ์; Jiraporn Chompikul; จิราพร ชมพิกุล; Sirikul Isaranurug; Mahidol University. ASEAN Institute for Health DevelopmentA cross-sectional study was conducted to determine the perceptions of safe delivery and their related factors among married women of reproductive age (MWRA) between 20 and 49 years old living in Parkgneum district, Vientiane Capital, Lao PDR. The data were collected from January 9 to 30, 2009 by interviewing 160 MWRA between 20 and 49 years old using a structured questionnaire. Data analysis was performed by using Descriptive Statistics, Chi-square test and Multiple Logistic Regression. The study found that 53.1% of MWRA were aged between 20 and 34 years old, 70% of them were farmers. Most MWRA had good knowledge about safe delivery, only 27% of them had poor knowledge about safe delivery. 46% of respondents were difficult access to health services, 49.4% were difficult access to safe delivery information and 57.5% of them received good support from their husbands. Half of respondents had negative perceptions about safe delivery and the other half had positive perceptions. The study revealed that MWRA of old age, poor access to safe delivery information and less husband support were associated with negative perceptions of safe delivery, OR= 2.2 (95% CI =1.1-4.3), 2.4 (95% CI =1.2-4.6) and 2.4 (95%CI =1.2-4.8) respectively. The findings recommended that increasing accessibility to information and promoting husband’s support are critical to encourage women to access safe delivery services.Publication Open Access Emergence of HIV-1 drug resistance mutations among antiretroviral-naïve HIV-1-infected patients after rapid scaling up of antiretroviral therapy in Thailand(2012) Somnuek Sungkanuparph; Chonlaphat Sukasem; Sasisopin Kiertiburanakul; Ekawat Pasomsub; Wasun Chantratita; Mahidol University. Faculty of Medicine Ramathibodi Hospital. Division of Infectious DiseasesBackground: After rapid scaling up of antiretroviral therapy in HIV-1-infected patients, the data of primary HIV-1 drug resistance in Thailand is still limited. This study aims to determine the prevalence and associated factors of primary HIV-1 drug resistance in Thailand. Methods: A prospective observational study was conducted among antiretroviral-naïve HIV-1-infected Thai patients from 2007 to 2010. HIV-1 subtypes and mutations were assayed by sequencing a region of HIV-1 pol gene. Surveillance drug resistance mutations recommended by the World Health Organization for surveillance of transmitted HIV-1 drug resistance in 2009 were used in all analyses. Primary HIV-1 drug resistance was defined as the presence of one or more surveillance drug resistance mutations. Results: Of 466 patients with a mean age of 38.8 years, 58.6% were males. Risks of HIV-1 infection included heterosexual (77.7%), homosexual (16.7%), and intravenous drug use (5.6%). Median (IQR) CD4 cell count and HIV-1 RNA were 176 (42-317) cells/mm3 and 68,600 (19,515-220,330) copies/mL, respectively. HIV-1 subtypes were CRF01_AE (86.9%), B (8.6) and other recombinants (4.5%). The prevalence of primary HIV-1 drug resistance was 4.9%; most of these (73.9%) had surveillance drug resistance mutations to only one class of antiretroviral drugs. The prevalence of patients with NRTI, NNRTI, and PI surveillance drug resistance mutations was 1.9%, 2.8% and 1.7%, respectively. From logistic regression analysis, there was no factor significantly associated with primary HIV-1 drug resistance. There was a trend toward higher prevalence in females [odds ratio 2.18; 95% confidence interval 0.896-5.304; p = 0.086]. Conclusions: There is a significant emergence of primary HIV-1 drug resistance in Thailand after rapid scaling up of antiretroviral therapy. Although HIV-1 genotyping prior to antiretroviral therapy initiation is not routinely recommended in Thailand, our results raise concerns about the risk of early treatment failure in patients with primary HIV-1 drug resistance. Interventions to prevent the transmission of HIV-1 drug resistance and continuation of surveillance for primary HIV-1 drug resistance in Thailand are indicated.Publication Open Access Antibacterial activity of Ocimum sanctum oil against Streptococcus mutans : in vitro.(2015-09) Rattiporn Kaypetch; รัตติพร กายเพชร; Thaniya Muadcheingka; ธนิยา หมวดเชียงคะ; Pairin Tonput; Rattiporn Kaypetch; รัตติพร กายเพชร; Mahidol University. Faculty of Dentistry. Research Office; Mahidol University. Faculty of Dentistry. Department of Oral MicrobiologyObjectives: This study aimed to investigate the antibacterial effect of essential oil extracted from Ocimum sanctum against caries-related bacteria, Streptococcus mutans. Materials and methods: Essential oil extracted from leaves of Ocimum sanctum by steam distillation (Botanicessence, Bangkok, Thailand) were used in this study. The antibacterial effect was determined against Streptococcus mutans ATCC 25175 and Streptococcus mutans KPSK2 using disc diffusion and micro broth dilution technique. Results: Ocimum sanctum essential oil had antibacterial effects against both strains of Streptococcus mutans with the zone of inhibition ranging from 7 to 25.95 mm. The antibacterial effect against Streptococcus mutans KPSK2 was more potent than that on Streptococcus mutans ATCC 25175. Minimum inhibitory concentration of Streptococcus mutans ATCC 25175 and Streptococcus mutans KPSK2 equal to 0.188 and 0.047 mg/ml, respectively. Minimum bactericidal concentration against Streptococcus mutans ATCC 25175 and Streptococcus mutans KPSK2 equal to 0.377 and 0.095 mg/ml. Conclusion: Essential oils from Ocimum sanctum showed moderate antibacterial effect against both strains of Streptococcus mutans. It can be beneficial to use as an agent to prevent or aid the treatment of dental caries.Publication Open Access Differential utilization of health care services among ethnic groups on the Thailand-Myanmar border: A case study of Kanchanaburi province, Thailand(2008-07) Hu,Jian; Chai Podhisita; ชาย โพธิสิตา; Boonlert Leoprapai; Mahidol University. Institute for Population and Social ResearchThis cross-sectional study is based mainly on the 2000 dataset of the Kanchanaburi Demographic Surveillance System (KDSS), with additional variables from the 2002 and 2004 datasets of the same project. The aim is to explore patterns of health care utilization among three ethnic groups on the Thailand-Myanmar border and to investigate the extent to which differences in reported use of health care related to different characteristics of each group. About 58 percent of ethnic Thai, 43 percent of the native-born and 28 percent of the foreign-born minority respondents reported that they had used service of the health care providers when they were ill in 2000. Results show that the foreign-born and native-born minority respondents were significantly less likely to use health care services than Thais after controlling for type of self-reported illness. Further analysis reveals that ethnic gap in utilization of health care services disappears if there is no difference in access to health insurance, religion, ability to speak Thai, source of health information, type of village, and availability of health and transportation facilities in the village. In short, this difference can be mitigated if access to health insurance, cultural and communication barriers, and community resources for health care are improved.