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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.Publication Open Access Expanded program on immunization (EPI) for children of Myanmar migrants living in Bangkok, Thailand(2013-01) Tussnai Kantayaporn; Kritaya Archavanitkul; กฤตยา อาชวนิจกุล; Wiwat Peerapatanapokin; Nonglak Disthawong; Nattawut Singkul; Sasithorn Sinvuttaya; Pasupha Chinvarasopak; Kritica Panatanasan; Mahidol University. Institute for Population and Social ResearchAlthough Thailand has established and maintained an immunization policy for children regardless of ethnic origin, the National Expanded Program on Immunizations (EPI) has not been able to reach many children of migrants, due to a lack of information on both the size and location of this population. This article presents the results of a study of the migrant population that provides recommendations for improving EPI coverage. Quantitative and qualitative data were collected from 133 migrant women from Myanmar living in the Bangkok Metropolitan Area (BMA). From the results of the study, it is estimated that there are 39,292 children of migrants aged 0-14 years living in the BMA. Among these, approximately 22,907 children are in the age range of 0-2 years, most of whom were born in Thailand. Results reveal that although vaccine services for children of migrants is a major initiative of the Thai health system, immunization coverage is less than that of Thai children and that of non-migrants in their countries of origin. This low coverage level indicates that human migration is a significant factor limiting access to vaccine services. The study also generated key recommendations for better immunization services to children of migrants living in Thailand.Publication Open Access Systematic review and meta-analysis of the effectiveness of continuous glucose monitoring (CGM) on glucose control in diabetes(2013) Nalinee Poolsup; Naeti Suksomboon; Aye Mon Kyaw; Mahidol University. Faculty of PharmacyDiabetes mellitus is a chronic disease that necessitates continuing treatment and patient self-care education. Monitoring of blood glucose to near normal level without hypoglycemia becomes a challenge in the management of diabetes. Although self monitoring of blood glucose (SMBG) can provide daily monitoring of blood glucose level and help to adjust therapy, it cannot detect hypoglycemic unawareness and nocturnal hypoglycemia which occurred mostly in T1DM pediatrics. Continuous glucose monitoring (CGM) offers continuous glucose data every 5 minutes to adjust insulin therapy especially for T1DM patients and to monitor lifestyle intervention especially for T2DM patients by care providers or even patients themselves. The main objective of this study was to assess the effects of continuous glucose monitoring (CGM) on glycemic control in Type 1 diabetic pediatrics and Type 2 diabetic adults by collecting randomized controlled trials from MEDLINE (pubmed), SCOPUS, CINAHL, Web of Science and The Cochrane Library up to May 2013 and historical search through the reference lists of relevant articles. There are two types of CGM device: real-time CGM and retrospective CGM and both types of the device were included in the analysis. In T1DM pediatrics, CGM use was no more effective than SMBG in reducing HbA1c [mean difference – 0.13% (95% CI -0.38% to 0.11%,]. This effect was independent of HbA1c level at baseline. Subgroup analysis indicated that retrospective CGM was not superior to SMBG [mean difference -0.05% (95% CI -0.46% to 0.35%)]. In contrast, real-time CGM revealed better effect in lowering HbA1c level compared with SMBG [mean difference -0.18% (95% CI -0.35% to -0.02%, p = 0.02)]. In T2DM adults, significant reduction in HbA1c level was detected with CGM compared with SMBG [mean difference – 0.31% (95% CI -0.6% to -0.02%, p = 0.04)]. This systematic review and meta-analysis suggested that real-time CGM can be more effective than SMBG in T1DM pediatrics, though retrospective CGM was not. CGM provided better glycemic control in T2DM adults compared with SMBG.Publication Open Access Validity and reliability of quality of recovery-35 Thai version: a prospective questionnaire-based study(2016) Siriporn Pitimana-aree; Suthipol Udompanthurak; Saowaphak Lapmahapaisan; Matula Tareerath; Aungsumat Wangdee; Mahidol University. Faculty of Medicine Siriraj Hospital. Department of AnesthesiologyEnglish-language QoR-40 into the Thai language and evaluate the Quality of Recovery-35 Thai version for measuring health outcomes in Thai patients after surgery and anesthesia. Methods: Translation was performed according to internationally recognized... translation standards to ensure the integrity of the translated version. Consistent with the recommendations of 25 anesthesiologists, five questions from the original QoR-40 were excluded. The 35-item questionnaire was then translated into the Thai languagePublication Open Access The reality of using primaquine(2010) Burgoine, Kathy L.; Bancone, Germana; Nosten, François; Burgoine, Kathy L.; Mahidol University. Faculty of Tropical Medicine. Mahidol-Oxford Tropical Medicine Research Unit (MORU).given in a language understood by the patient and he had not been tested for G6PD deficiency. The patient was not only G6PD deficient but misunderstood the instructions and took all his primaquine tablets together. With appropriate treatmentPublication Open Access Respondent-driven sampling on the Thailand-Cambodia border. I. Can malaria cases be contained in mobile migrant workers?(2011-05-10) Amnat Khamsiriwatchara; Piyaporn Wangroongsarb; Thwing, Julie; Eliades, James; Wichai Satimai; Delacollette, Charles; Jaranit Kaewkungwal; จรณิต แก้วกังวาล; Delacollette, Charles; Mahidol University. Faculty of Tropical Medicine.frequency of greater than once per month. Of migrants from Cambodia, 32% of M1 and 68% of M2 were planning to return, and named provinces across Cambodia as their likely next destinations. Most workers from Myanmar came from Mon state (86%), had neverPublication Open Access Application of smart phone in "Better Border Healthcare Program": a module for mother and child care(2010-11) Jaranit Kaewkungwal; จรณิต แก้วกังวาล; Pratap Singhasivanon; ประตาป สิงหศิวานนท์; Amnat Khamsiriwatchara; อำนาจ คำศิริวัชรา; Surasak Sawang; Pongthep Meankaew; พงษ์เทพ เมียนแก้ว; Apisit Wechsart; Jaranit Kaewkungwal; Mahidol University. Faculty of Tropical Mediicine. Department of Tropical HygieneBACKGROUND: To assess the application of cell phone integrating into the healthcare system to improve antenatal care (ANC) and expanded programme on immunization (EPI) services for the under-served population in border area. METHODS: A module combining web-based and mobile technology was developed to generate ANC/EPI visit schedule dates in which the healthcare personnel can cross-check, identify and update the mother's ANC and child's EPI status at the healthcare facility or at the household location when performing home visit; with additional feature of sending appointment reminder directly to the scheduled mother in the community. RESULTS: The module improved ANC/EPI coverage in the study area along the country border including for both Thai and non-Thai mothers and children who were either permanent resident or migrants; numbers of ANC and EPI visit on-time as per schedule significantly increased; there was less delay of antenatal visits and immunizations. CONCLUSIONS: The module integrated and functioned successfully as part of the healthcare system; it is proved for its feasibility and the extent to which community healthcare personnel in the low resource setting could efficiently utilize it to perform their duties.Publication Open Access Ethical issues in research involving minority populations: the process and outcomes of protocol review by the Ethics Committee of the Faculty of Tropical Medicine, Mahidol University, Thailand.(2013-09-11) Pornpimon Adams; พรพิมล อดัมส์; Waranya Wongwit; วรัญญา ว่องวิทย์; Krisana Pengsaa; กฤษณา เพ็งสา; Srisin Khusmith; ศรีสิน คูสมิทธิ์; Wijitr Fungladda; วิจิตร ฟุ้งลัดดา; Warissara Chaiyaphan; วริสรา ไชยพันธุ์; Chanthima Limphattharacharoen; จันทิมา ลิ่มภัทรเจริญ; Sukanya Prakobtham; สุกัญญา ประกอบธรรม; Jaranit Kaewkungwal; จรณิต แก้วกังวาน; Jaranit Kaewkungwal; Mahidol University. Faculty of Tropical Medicine. Office of Research Services.; Mahidol University. Faculty of Tropical Medicine. Department of Social and Environmental Medicine.; Mahidol University. Faculty of Tropical Medicine. Department of Tropical Pediatrics.; Mahidol University. Faculty of Tropical Medicine. Department of Microbiology and Immunology.; Mahidol University. Faculty of Tropical Medicine. Department of Tropical Hygiene.BACKGROUND: Recruiting minorities into research studies requires special attention, particularly when studies involve "extra-vulnerable" participants with multiple vulnerabilities, e.g., pregnant women, the fetuses/neonates of ethnic minorities, children in refugee camps, or cross-border migrants. This study retrospectively analyzed submissions to the Ethics Committee of the Faculty of Tropical Medicine (FTM-EC) in Thailand. Issues related to the process and outcomes of proposal review, and the main issues for which clarification/revision were requested on studies, are discussed extensively. METHODS: The study data were extracted from proposals and amendments submitted to the FTM-EC during the period October 2009 - September 2012, and then analyzed qualitatively and quantitatively. The main issues for clarification/revision were analyzed by thematic content analysis. RESULTS: 373 proposals were submitted; 44 studies involved minority groups with 21 extra-vulnerable minorities. All clinical and 2/3 of non-clinical studies submitted for initial review underwent full-board review. For combined clinical and non-clinical study submissions, 92.1% were referred back to the investigators and approved after clarification/revision, while 2.7% were deferred due to major/critical changes, and 2.1% not approved due to substantial violations of ethical principles. The main issues needing clarification/revision differed between all studies and those involving minorities: participant information sheet (62.2% vs. 86.4%), informed consent/assent form (51.2% vs. 86.4%), and research methodology (80.7% vs. 84.1%), respectively. The main ethical issues arising during the meetings, regarding studies involving minorities, included ensuring no exploitation, coercion, or pressure on the minority to participate; methodology not affecting their legal status; considering ethnicity and cultural structure; and providing appropriate compensation. CONCLUSION: Delays in the approval or non-approval of studies involving minorities were mainly due to major or minor deviations from acceptable ethical standards and/or unclear research methodology. The FTM-EC has employed several mechanisms in its operations, including transparency in the review process, building good relationships via open communication with investigators, requesting investigators to consider closely the necessity to enroll minority groups and the risk-benefits for individuals and their communities, and the inclusion of minority-community engagement when developing the proposal. Other effective activities include annual study-site inspections, and offering refresher courses to raise awareness of minority and vulnerability issues among researchers.Publication Open Access Motivations and perceptions of community advisory boards in the ethics of medical research: the case of the Thai-Myanmar border.(2014-02-17) Maung, Lwin K.; Cheah, Phaik Yeong; Cheah, Phaik Kin; White, Nicholas J.; Day, Nicholas P.; Nosten, Francois; Parker, Michael; Parker, Michael; Mahidol University. Faculty of Tropical Medicine. Mahidol Oxford Research Unit.BACKGROUND: Community engagement is increasingly promoted as a marker of good, ethical practice in the context of international collaborative research in low-income countries. There is, however, no widely agreed definition of community engagement or of approaches adopted. Justifications given for its use also vary. Community engagement is, for example, variously seen to be of value in: the development of more effective and appropriate consent processes; improved understanding of the aims and forms of research; higher recruitment rates; the identification of important ethical issues; the building of better relationships between the community and researchers; the obtaining of community permission to approach potential research participants; and, the provision of better health care. Despite these diverse and potentially competing claims made for the importance of community engagement, there is very little published evidence on effective models of engagement or their evaluation. METHODS: In this paper, drawing upon interviews with the members of a Community Advisory Board on the Thai-Myanmar border, we describe and critically reflect upon an approach to community engagement which was developed in the context of international collaborative research in the border region. RESULTS AND CONCLUSIONS: Drawing on our analysis, we identify a number of considerations relevant to the development of an approach to evaluating community engagement in this complex research setting. The paper also identifies a range of important ways in which the Community Advisory Board is in practice understood by its members (and perhaps by community members beyond this) to have morally significant roles and responsibilities beyond those usually associated with the successful and appropriate conduct of research.Publication Open Access The utilization of traditional, complementary and alternative medicine for non-communicable diseases and mental disorders in health care patients in Cambodia, Thailand and Vietnam(2016) Peltzer, Karl; Supa Pengpid; Apa Puckpinyo; Siyan Yi; Le Vu Anh; Mahidol University. ASEAN Institute for Health DevelopmentBackground: The purpose of our study was to determine the prevalence of traditional, complementary and alternative medicine (TCAM) use in patients with chronic diseases in lower Mekong countries. Methods: A cross-sectional study was conducted in a health care setting using a random sample of 4799 adult patients (Mean age: 52.3 years, SD = 22.7) with chronic diseases in Cambodia, Vietnam and Thailand. The measure included the International Questionnaire to measure usage of complementary and alternative medicine (I-CAM). Results: The 1 year prevalence of consulting TCAM providers was 26.0 %; 27.0 % in Cambodia, 26.3 % in Thailand, 23.9 % in Vietnam. The most commonly consulted TCAM providers were the herbalist (17.3 %), massage therapist (6.0 %), and acupuncturist (5.5 %). For all different types of TCAM providers more than 80 % of participants perceived the consultation as very or somewhat helpful. The own use of herbal medicine was 41.0 %, own use of vitamins 26.5 % and the own use of other supplements 9.7 % in the past 12 months. The most common self-help practices in the past 12 months included praying for your own health (30.1 %), meditation (13.9 %) and relaxation techniques (9.9 %). In multivariate logistic regression analyses, older age, rural residence and having two or more chronic conditions was associated with the use a TCAM provider; being female, urban residence, residing in Vietnam and having two or more chronic conditions was associated with the use of TCAM products; and being female, older age, rural residence, higher formal education, and residing in Cambodia was associated with the use of TCAM self-help practices. Conclusions: TCAM use is common among chronic disease patients in lower Mekong countries and is associated with several sociodemographic and disease specific factors.