Uptake of COVID-19 vaccine among high-risk urban populations in Southern Thailand using the COM-B model

BACKGROUND

The COVID-19 pandemic has imposed unprecedented suffering on social and individual levels worldwide. Vaccines against COVID-19 have been prioritized as a crucial strategy for ending the pandemic as well as minimizing its consequences.

OBJECTIVES

This study aimed to determine the uptake of COVID-19 vaccine among high-risk urban populations in Southern Thailand using the Capability, Opportunity, Motivation, and Behavior (COM-B) model.

METHODS

We conducted a web-based cross-sectional study in the Hat Yai district, Songkhla province in Southern Thailand, in September and October 2021. The questionnaire was composed of sections on sociodemographic characteristics, COVID-19 vaccination status, and COM-B constructs. We employed a multivariable logistic regression analysis to determine factors associated with the uptake of the COVID-19 vaccine. We set statistical significance at p < 0.05.

RESULTS

In this study, females constituted 54.7% of the total participants (n = 358), and nearly half of the participants (45.8%) were in the younger age group (18-29). Of all the participants, 59.5% (95%CI: 54.2%-64.6%) received at least one dose of the COVID-19 vaccine. Factors associated with the uptake of COVID-19 vaccine and their adjusted OR (95% CI) were being married: 3.59 (2.06-6.24), having a graduate degree: 2.34 (1.38-3.96), gainfully employed: 3.30 (1.91-5.67), having a high level of opportunity: 2.90 (1.48-5.66), and having a high level of motivation: 2.87 (1.17-17.08).

CONCLUSION

The uptake of COVID-19 vaccines was moderate in this population. Moreover, the results showed that the COM-B model is useful in predicting COVID-19 vaccine uptake. The findings of this study could be used to aid future public health interventions in any event of outbreaks similar to COVID-19 disease in Thailand and beyond.

Predictors of non-adherence to antihypertensive medications: A cross-sectional study from a regional hospital in Afghanistan

BACKGROUND

Non-adherence to antihypertensive medications (AHMs) is a widespread problem. Cardiovascular morbidity and mortality reduction is possible via better adherence rates among hypertensive patients.

OBJECTIVES

This study aimed to assess the prevalence of non-adherence to AHMs and its predictors among hypertensive patients who attended Mirwais Regional Hospital in Kandahar, Afghanistan.

METHODS

A cross-sectional study using random sampling method was conducted among hypertensive patients, aged ≥18 years in Mirwais Regional Hospital at a 6-month follow-up between October and December 2022. To assess non-adherence to AHMs, we employed the Hill-Bone Medication Adherence scale. A value below or equal to 80% of the total score was used to signify non-adherence. A multivariable binary logistic regression model was used to identify predictors of non-adherence to AHMs.

RESULTS

We used data from 669 patients and found that 47.9% (95%CI: 44.1-51.8%) of them were non-adherent to AHMs. The majority (71.2%) of patients had poorly controlled blood pressure (BP). The likelihood of non-adherence to AHMs was significantly higher among patients from low monthly-income households [Adjusted odds ratio (AOR) 1.70 (95%CI: 1.13-2.55)], those with daily intake of multiple AHMs [AOR 2.02 (1.29-3.16)], presence of comorbid medical conditions [AOR 1.68 (1.05-2.67), lack of awareness of hypertension-related complications [AOR 2.40 (1.59-3.63)], and presence of depressive symptoms [AOR 1.65 (1.14-2.38)].

CONCLUSION

Non-adherence to AHMs was high. Non-adherence to AHMs is a potential risk factor for uncontrolled hypertension and subsequent cardiovascular complications. Policymakers and clinicians should implement evidence-based interventions to address factors undermining AHMs adherence in Afghanistan.

Unhealthy Dietary Patterns and Their Associations with Sociodemographic Factors as Predictors among Underweight and Overweight Adolescents in Southern Thailand

(1) Background: Adolescence is a critical developmental phase; dietary intake and nutritional status significantly impact health outcomes. (2) Objective: This cross-sectional study investigated dietary patterns (DPs) and the association between sociodemographic factors and unhealthy DPs among adolescents in Thailand. (3) Methods: A multi-stage sampling selected 1480 participants from three public high schools in Nakhon Si Thammarat province. A food frequency questionnaire assessed dietary habits, and principal component analysis was used to identify DPs. Multinomial logistic regression examined the association between sociodemographic factors and DPs. (4) Results: The findings show that 25.9% of adolescents were underweight, 14.7% were overweight, and 5.8% were obese. Three DPs were identified: a healthy 'protein and vegetables' pattern and two unhealthy patterns: 'snacks' and 'processed foods', which explained 12.49%, 10.37%, and 7.07% of the dietary variance, respectively. Among underweight adolescents, higher snack consumption was associated with being younger (odds ratio (OR) = 3.24) and receiving a higher daily allowance (OR = 3.43). Additionally, female adolescents who engaged in frequent exercise had a 2.15 times higher intake of processed foods. Among overweight adolescents, higher snack intake was linked to being younger (OR = 8.65) and having larger families (OR = 6.37). Moreover, an increased daily allowance was associated with higher consumption of processed foods (OR = 11.47). (5) Conclusion: This study underscores the socio-demographic influence on unhealthy DPs. Insights can guide targeted interventions to foster healthier dietary habits during adolescence.

Levels and Predictors of Proactive Practical Experience to Solve COVID-19 among Public Health Officers in Primary Care Units in the Upper Southern Region, Thailand: An Explanatory Mixed Methods Approach

Public Health Officers (PHOs)' experiences in reaction to the COVID-19 pandemic can be based on whether the PHO is active or passive regarding five experience aspects, including knowledge, understanding, opinion, participation, and practice. Therefore, this study's objectives are to identify the types of experiences and analyse the predictors of proactive practical experiences in addressing the COVID-19 pandemic among PHOs in the southern region of Thailand.

METHODS

An explanatory mixed methods approach was used to collect data, through questionnaires and online in-depth interviews. This study was conducted from 4 August 2020 to 3 August 2021.

RESULTS

The results include 60 PHOs from 60 Primary Care Units in six provinces, with 41 (68.3%) females and an average age of 35.57 years (SD = 11.61). The PHOs' knowledge, understanding, and participation experience aspects were mostly proactive rather than passive. The factors that significantly predicted proactive practical experiences included sex (ORadj = 1.52, 95% CI = 1.04-2.21), age (ORadj = 1.69, 95% CI = 1.16-2.48), married status (ORadj = 1.69, 95% CI = 1.16-2.48), education level (ORadj = 1.50, 95% CI = 1.02-2.20), and position for work (ORadj = 1.69, 95% CI = 1.16-2.48). The results of quantitative method were confirmed by 12 sub-themes of 8 PHOs' experiences from qualitative method.

CONCLUSIONS

The PHOs' knowledge, understanding, opinion, and participation experiences were significant predictors of practical experience. Primary health care systems should promote proactive experiences in all four aspects to increase proactive practical experiences.

Prevalence and factors associated with long COVID and mental health status among recovered COVID-19 patients in southern Thailand

Mental health disorders have become a growing public health concern among individuals recovering from COVID-19. Long COVID, a condition where symptoms persist for an extended period, can predict psychological problems among COVID-19 patients. This study aimed to investigate the prevalence of long COVID and mental health status among Thai adults who had recovered from COVID-19, identify the association between the mental health status and long COVID symptoms, and investigate the risk factors associated with the correlation between long COVID and mental health outcomes. A cross-sectional study was conducted among 939 randomly selected participants in Nakhon Si Thammarat province, southern Thailand. The Depression, Anxiety, and Stress Scale-21 was used to investigate mental health symptoms, and a checklist comprised of thirteen common symptoms was used to identify the long COVID among participants. Logistic regression models were used to investigate the risk factors associated with mental health status and long COVID symptoms among participants. Among the 939 participants, 104 (11.1%) had depression, 179 (19.1%) had anxiety, and 42 (4.8%) were stressed. A total of 745 participants (79.3%) reported experiencing at least one symptom of long COVID, with fatigue (72.9%, SE±0.02), cough (66.0%, SE±0.02), and muscle pain (54.1%, SE±0.02) being the most frequently reported symptoms. All long COVID symptoms were significantly associated with mental health status. Shortness of breath, fatigue, and chest tightness were the highest risk factors for mental health status among COVID-19 patients. The final multivariable model indicated that female patients (OR = 1.89), medical history (OR = 1.92), and monthly income lower than 5,000 Thai baht (OR = 2.09) were associated with developing long COVID symptoms and mental health status (all p<0.01). This study provides valuable insights into the potential long-term effects of COVID-19 on mental health and enhances understanding of the mechanisms underlying the condition for predicting the occurrence of mental health issues in Thai COVID-19 patients.

Health workers' capability, opportunity, motivation, and behavior to prevent and control COVID-19 in a high-risk district in Thailand

Background

Village health volunteers have been an important group who plays the role in prevention and control of COVID-19 pandemic situations at primary care units, Thailand.

Objective

The objective of this cross-sectional analytic study was to assess the level and analyze the association between personal information, capability, opportunities, motivations, and behaviors to prevent and control COVID-19 among Village healthy volunteers in a high risk district, Southern Thailand.

Material and Methods

G*power program was used to calculate the sample size of 145 VHVs recruited for this study. Data collection was done using a well-structured questionnaire with 5-point Likert scale for capability, opportunities, motivations, and behaviors component, and multi-stage sampling of 18 sub-district health promoting hospitals was carried out. Data analysis was done using descriptive, Chi-square and Fisher Exact test.

Results

Majority (89.7%) of the VHVs were female, and 62.8% were 28-59 years old. More than half, 55.9% (81) have been VHVs for 11-36 years. Generally, higher capacity was found among 59.3% (86) of the VHVs, low opportunity level among 81.4% (118), high motivation among 53.8% (78) and a good behavior towards the prevention and control of COVID-19 among 72.4% (105). The VHVs' age and duration of practicing were significantly (P< 0.01 and P < 0.05 respectively) associated with COVID-19 prevention behavior (x2 =6.894 and 5.255 respectively). Likewise, there are significant association between capacity (p ≤ 0.001 and x2 = 31.014), opportunity (p≤ 0.05 and x2 = 9.473), motivation (p ≤ 0.001 and x2 = 0.0001) and VHVs' behaviour to prevent and control COVID-19.

Conclusion

HVHs' opportunity is very low in the study area and it negatively affects good behavior for the prevention and control of COVID-19. All stakeholders in the district can use the association among the capability, opportunity, motivation and behavioral model to develop practice guideline and set policy for preventing COVID-19 in the community.

Prevalence and predictors of depression, anxiety, and stress among recovered COVID-19 patients in Vietnam

Background

During the COVID-19 pandemic, a high prevalence of mental health distress has been reported among people who have recovered from the disease.

Objectives

To assess the prevalence of depression, anxiety, and stress as well as identify predictors among recovered COVID-19 patients after more than six months of being discharged in Dong Thap Province, Vietnam.

Material and methods

The cross-sectional study was conducted among 549 eligible participants recruited by stratified sampling. Data was collected using the depression, anxiety and stress scale - 21 items had Content Validity Index = 0.9, and Cronbach's alpha for depression, anxiety and stress sub-scales were 0.95, 0.81, and 0.86, respectively. Descriptive statistics were used to measure the prevalence levels and distribution of characteristics of the participant, while factors influencing depression, anxiety, and stress were predicted using binary logistic regression.

Results

The overall prevalence of depression, anxiety, and stress were 24.8% (95% CI: 21.2-28.6), 41.5% (95% CI: 37.4-45.8), and 25.3% (95% CI: 21.7-29.2), respectively. The predictors of depression were living in urban area (OR = 1.97; 95% CI: 1.27-3.08), holding a bachelor's degree (OR:3.51; 95% CI: 1.13-10.8), having a high monthly income (OR: 2.57; 95% CI: 1.03-6.38), diabetes (OR: 2.21; 95% CI: 1.04-4.68), heart disease (OR: 3.83; 95% CI: 1.79-8.17), respiratory disease (OR: 3.49; 95% CI: 1.24-9.84), and diarrhea (OR: 4.07; 95% CI: 1.06-15.6). Living in the urban area (OR: 1.57; 95% CI: 1.07-2.29), having sleep disturbance (OR: 2.32; 95% CI: 1.56-3.46), and fatigue (OR: 1.57; 95% CI: 1.03-2.39) were predictors for anxiety. Having respiratory disease (OR: 3.75; 95% CI: 1.47-9.60) or diarrhea (OR: 4.34; 95% CI: 1.18-15.9) were predictors of stress.

Conclusion

People who have recovered from COVID-19 should be assessed for symptoms of depression, anxiety, and stress. Primary healthcare providers should develop interventions to support their recovery.

The experiences of district public health officers during the COVID-19 crisis and its management in the upper southern region of Thailand: A mixed methods approach

District public health officers (DPHO) are the major health care providers and vital resources for tackling the coronavirus disease 2019 (COVID-19) outbreak in Thailand. No studies have been published on their experiences of combating COVID-19 in Thailand. To guide and improve COVID-19 control efforts, we aimed to describe their experiences and analyze associated factors for tackling the outbreak. This mixed-methods design involved providing structured questionnaires to selected DPHOs across 52 districts of seven provinces in the upper southern region Thailand. We performed data analysis using descriptive and multivariate statistics. The quantitative approach used questionnaires that demonstrated the content validity and reliability. Data collection involved Google forms, analyzed by multivariate statistics. The qualitative approach comprised an online in-depth interview of 11 DPHOs and a thematic analysis. Results found of the 52 DPHOs, 41 were men (78.8%), and the mean age was 50.02 years (SD = 8.52 years). Their proactive experiences were significantly associated with sex (OR_adj = 2.38, 95% CI = 1.11-3.30), age (OR_adj = 1.73, 95% CI = 1.09-2.76), the length of experience in the current position (OR_adj = 2.27, 95% CI = 1.43-3.63), and working time in the current position (OR_adj = 2.27, 95% CI = 1.43-3.63). There was no significant association between marital status, knowledge, understanding, opinion, proactive practice, and participation experiences. These results were related to six themes of the qualitative approach as follows: High morbidity and mortality of COVID-19, COVID-19 concomitant with several problems, Reaching out to the community for better COVID-19 solutions, The importance of regular reports and feedback, Solution planning based on the situation, and Providing relief to all stakeholders from COVID-19 issue. Proactive experiences of district public health officers are important for sustainable COVID-19 solutions. Disseminating relevant equipment, guidelines, policy, and government regulations is necessary to promote preparedness and efficacy in the crisis management of COVID-19.

Understanding dengue solution and larval indices surveillance system among village health volunteers in high- and low-risk dengue villages in southern Thailand

Background

Successful dengue solutions require community collaboration between agencies engaged in human health, vector control and the environment. In Thailand, village health volunteers emphasize the need for a health working group to interact, collaborate, and coordinate actions. The objectives of this study were to acquire an understanding of dengue solutions, as well as the larval indices surveillance system of village health volunteers in high- and low-risk dengue villages.

Methods

After 12 months of training in dengue prevention and setting larval indices surveillance systems, an analytical cross-sectional survey was conducted. A total of 117 villages were included in the 18 primary care facilities within one district in southern Thailand, and they were divided into 71 high-risk and 46 low-risk dengue villages. Sample size was determined using the G*power formula. The content validity index and reliability values of Cronbach's alpha coefficient for the questionnaires were 0.91 and 0.83, respectively. A random sampling approach was used to acquire data. The chi-square test, t-test, and odds ratio were used to assess the sample's level of understanding.

Results

The study included 1302 village health volunteers, including 895 and 407 from high- and low-risk dengue communities, respectively. In total, 87.9% were female, 51.6% were 20–35 years old, 48.8% had worked as a village health volunteer for 11–20 years, 27.1% had an upper elementary education, and 59.1% had dengue in the previous 12 months. Understanding of the dengue solution and larval indices surveillance system varied across high- and low-risk dengue villages. Village health volunteers with a high level of understanding of the dengue solution and larval indies surveillance system were 1.064 and 1.504 times more likely to stay in high-risk dengue villages, respectively (odds ratio [OR] = 1.064, 95% confidence interval [CI]:0.798–1.419, p = 0.672 and OR = 1.504, 95% CI:1.044–2.167, p = 0.028).

Conclusions

Village health volunteers require ongoing training to understand the prevention and control of dengue and larval indices surveillance systems, promote awareness, and monitor dengue in both high- and low-risk dengue villages.

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Village health volunteers' understandings of dengue-related issues were explored.

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High-risk dengue village volunteers better understood the larval indices surveillance system.

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Continuous dengue education training programs and surveillance system are needed to build the capacity of the volunteers.

Effects of the Developing and Using a Model to Predict Dengue Risk Villages Based on Subdistrict Administrative Organization in Southern Thailand

The purpose of this study was to evaluate the effects of developing and using a model to predict dengue risk in villages and of a larval indices surveillance system for 2372 households in 10 Thai villages. A community participatory action research method was used in five steps: (1) community preparation covering all stakeholders, (2) assessment of the understanding of a dengue solution and a larval indices surveillance system, (3) development of a prediction and intervention model for dengue risk villages, (4) implementation of the model that responds to all stakeholders, and (5) evaluation of the effects of using the model. The questionnaires to assess and evaluate were validated and reliability tested. The chi-square test and Fisher's exact test were used to analyze the quantitative data collected by means of questionnaires. Thematic analysis was applied to the qualitative data collected through interviews. The results found that the model consisted of six main activities, including (1) setting team leader responsibility, (2) situation assessment, (3) prediction of the dengue risk in villages, (4) the six steps of the larval indices surveillance system, (5) the understanding of the dengue solution and the understanding of the larval indices surveillance system training program, and (6) local wisdom innovation. The effects of using the model showed a statistically significant increase in correct understanding among 932 family leaders, 109 village health volunteers, and 59 student leaders regarding dengue prevention and control (p < 0.05). The larval indices and dengue morbidity were diminished and related to the nine themes present in the community leaders' reflections and to the satisfaction of the community members. Hence, local administrative organizations should use community-based approaches as the subdistrict dengue solution innovation to reduce the dengue problem.

Development and evaluation of a visible reverse transcription-loop-mediated isothermal amplification (RT-LAMP) for the detection of Asian lineage ZIKV in field-caught mosquitoes

The Zika virus (ZIKV) infection is an emerging and re-emerging arbovirus infection that is transmitted to humans through the bite of infected mosquitoes. Early detection of ZIKV in mosquitoes is one of the prerequisite approaches for tracking the spread of the virus. Therefore, this study aims to develop and validate a visual reverse transcription-loop-mediated isothermal amplification (RT-LAMP) method called ZIKV-RT-LAMP, for detecting ZIKV in field collected mosquito samples from Thailand. A single-tube ZIKV-RT-LAMP assay was developed to detect Asian lineage ZIKV RNA. The detection limit and cross-reactivity of ZIKV were investigated. The hemi-nested RT-PCR (hn-RT-PCR) and the colorimetric LAMP kit (cLAMP kit) were performed as reference assays. The detection limit of the ZIKV-RT-LAMP assay was 10^-6 ffu/ml or pfu/ml, making it highly specific and 100 times more sensitive than the hn-RT-PCR and cLAMP kits. The ZIKV-RT-LAMP assay detected the Asian lineage of ZIKV RNA without cross-reactivity with other arthropod-borne viruses. The sensitivity and specificity of the ZIKV-RT-LAMP assay were 92.31% and 100%, respectively. The ZIKV-RT-LAMP is a simple, rapid, and inexpensive method for detecting ZIKV in field-caught mosquitos. In the future, extensive surveys of field-caught mosquito populations should be conducted. Early detection of ZIKV in field-caught mosquitoes provides for prompt and effective implementation of mosquito control strategies in endemic areas.

Developing Risk Assessment Criteria and Predicting High- and Low-Dengue Risk Villages for Strengthening Dengue Prevention Activities: Community Participatory Action Research, Thailand

Background:

Risk assessment criteria for predicting dengue outbreak must be appropriated at village levels. We aimed to develop risk dengue village prediction criteria, predict village dengue risk, and strengthen dengue prevention based on community participation.

Methods:

This participatory research conducted in Southern Thailand included the following 5 phases: (i) preparing communities in 3 districts; (ii) developing risk dengue village prediction criteria; (iii) applying computer program; (iv) predicting village dengue risk with 75 public health providers in 39 PCUs; and (v) utilizing findings to strengthen dengue prevention activities in 220 villages. Data collecting for prediction used secondary data from primary care units in the past 5 year and current year. Descriptive statistics used calculating criteria and comparing with standard level to adjust score of risk.

Results:

Risk dengue village assessment criteria had 2 aspects: dengue severity (3 factors) and dengue outbreak opportunity (3 factors). Total scores were 33 points and cut-off of 17 points for high and low dengue risks villages. All criteria were applied using computer program (http://surat.denguelim.com). Risk prediction involved stakeholder participation in 220 villages, and used for strengthening dengue prevention activities. The concept of integrated vector management included larval indices surveillance system, garbage management, larval indices level lower than the standard, community capacity activities for dengue prevention, and school-based dengue prevention. The risk prediction criteria and process mobilized villages for dengue prevention activities to decrease morbidity rate.

Conclusion:

Dengue risk assessment criteria were appropriated within the village, with its smallest unit, the household, included. The data can be utilized at village levels for evaluating dengue outbreak risks.

Knowledge, attitudes, and practices towards dengue prevention among primary school children with and without experience of previous dengue infection in southern Thailand

To develop more effective intervention strategies against dengue, it is necessary to identify determinants of knowledge, attitudes, and practices (KAP), which may be influenced by the dengue experiences of the population at risk. The aim of this study was to assess and compare KAP regarding dengue prevention between Thai primary school children with and without experiences of dengue. A cross-sectional study was conducted among children between ages 8 and 13, attending the 50 public primary schools in Kanchanadit district, between October and November 2019. A 32-item questionnaire was used to collect children's socio-demographic characteristics (4 items), health information (2 items), knowledge (10 items), attitudes (7 items), and practices (9 items) towards dengue prevention, which required 30 min to complete. The KAP between groups was then statistically compared, to identify possible causes of observed differences. Of 1979 children, 15.6% self-reported that they had been infected with dengue, while 84.4% had no history of the disease. Most children indicated that they obtained dengue-related information from primary school teachers (73.6%) and their parents (68.5%). No statistically significant differences in mean KAP scores were observed between children with and without dengue experiences (P > 0.05). When KAP scores were categorized as good or poor levels, based on an 80% cut-off, 12.3% of all children had good dengue-related knowledge, 41.6% had good attitudes, and 25.9% reported good preventive practices. Dengue experience was significantly and positively associated with exercising good preventive practices (odds ratio [OR] = 1.34, 95% confidence interval [CI]: 1.03-1.75, P = 0.031). There were significant positive correlations between attitudes and practices in both children with and without dengue experiences (P < 0.001). To enhance KAP towards dengue prevention, further efforts are needed to increase routine dengue health education programs for primary school students who have and have not experienced dengue, and to improve health education programs within communities, especially to assist guardians with the dissemination of dengue literature.

Factors Correlated with Practices Regarding Care of Dengue Patients Among Nurses from 94 Primary Care Units in a High- Risk Province in Southern Thailand

Background

In Thailand, primary care units (PCUs) play a part in the health assessment, diagnosis, care, basic treatment and referral of patients suffering from dengue.

Methods

In Nakhon Si Thammarat province in Thailand, we (i) undertook assessment of the personal information, experience, knowledge, attitudes, preparation of equipment and use of medical supplies of nurses in PCUs with regard to dengue patient care (DPC); (ii) analyzed the factors and practices of nurses regarding DPC; (iii) explored nurses’ opinions regarding DPC in PCUs. A cross-sectional mixed methods of collecting data consisted of quantitative and qualitative methods. The study cohort was 94 nurses from 94 PCUs in an area of high risk of dengue outbreaks. The quantitative component involved questionnaires. The qualitative component consisted of nurses’ discussions in focus groups. Spearman’s test was employed to analyze quantitative data, and thematic analyses were employed for qualitative data.

Results

Of 94 nurses from 94 PCUs, 77.7% (n = 73) had a poor knowledge level of DPC and negative attitude, preparation of equipment was carried out by 60.6% (n = 58), and 1 to 6 aspects of DPC were at good practice level: 88.3% (n = 83), 87.2% (n = 82), 85.1% (n = 80), 50.0% (n = 47), 51.1% (n = 48) and 77.7% (n = 73). There was no significant correlation (i) between the knowledge, attitudes and practices with regard to DPC (P > 0.05); (ii) with practice guidelines for dengue prevention (P > 0.05). The quantitative results were related to the four main themes of the qualitative study.

Conclusion

There was a few who had good knowledge and positive attitude levels among participants, and >90% of all nurses had good practices regarding DPC. PCU nurses need training and supporting equipment to carry out a DPC program.

Developing and using a dengue patient care guideline for patients admitted from households to primary care units and the district hospital: A community participatory approach in Southern Thailand

BACKGROUND

Dengue has been an important health issue in southern Thailand. However, this area has only a surveillance-prevention system, without step-by-step guidelines on dengue treatment for patients admitted from households to primary care units (PCUs) and district hospitals. Therefore, this study were to develop and use a dengue patient care guideline (DPCG), and to evaluate knowledge, attitude, practice (KAP) of dengue patient care.

METHODS

26 health care providers (13 nurses, and 13 public health officials) from eight PCUs and the district hospital developed the DPCG. The study design was based on the community participatory action research that integrated the Iowa model involving the following steps: preparation, guideline development, use and monitoring, evaluation and conclusion, and referring technology. We assessed the improvement between before and after using the DPCG regarding the participants' KAP on patient care and preparedness of equipment. McNamara's test was used to compare the changing results before and after using the DPCG. Qualitative data collection was performed in two meeting discussions with six open-end items. Using a thematic analysis technique, we extracted conclusions and suggested solutions.

RESULTS

The guideline included four steps for patients' care provision at households, PCUs, outpatient departments, emergency rooms, and inpatient departments. After using the DPCG in 39 dengue patients of which 30 patients were admitted to the inpatient department1 and two patients were referred to the tertiary care hospital without mortality. The overall participants' knowledge and attitude, two of six aspects of patients' care, and three of eight types of equipment management were significantly improved (p < 0.05). Eleven themes were evaluated which were associated with the quantitative data.

CONCLUSION

The DPCG instructed dengue patient's care for health care providers from households to the PCUs and district hospital. All participants improved KAP, and equipment management. Step-by-step of DPCG use and participation of all stakeholders are needed.

Risk factors related to dengue infections in primary school students: exploring students' basic knowledge of dengue and examining the larval indices in southern Thailand

Dengue is a major problem in southern Thailand.

OBJECTIVES

(1) To determine students' basic knowledge of dengue and (2) to examine the larval indices in primary schools and in the students' households.

METHODS

This study employed a cross-sectional quantitative and qualitative approach involving meetings with students, discussions with groups of teachers, a questionnaire investigating students' basic knowledge of dengue, and a survey of the larval indices in primary schools and in the students' households. The study consisted of three stages: (1) community preparation, (2) data collection and analysis, and (3) feedback.

RESULTS

A total of 306 students (from primary education levels 4-6) from five primary schools in the community were included in the study. Of a total of 15 items on the basic dengue questionnaire, only five were answered correctly by more than 80% of the students. Most of the knowledge items showed statistically significantly different distributions of correct, incorrect, and unknown answers (P ≤ 0.05, P ≤ 0.01, and P ≤ 0.001). The larval indices surveyed in the five schools and in 302 student households showed a high risk of dengue, with high indices in the five schools (Breteau Index: BI=200; House Index: HI=60; and Container Index: CI=7.94) and in the students' households (BI=754; HI=77; and CI=35).

CONCLUSION

Risk factors for dengue were related to the students' basic knowledge of dengue and to the larval indices in both the schools and the students' households. Additionally, a coordinated effort will be required to eliminate Aedes aegypti mosquito breeding sites in the community.