Hepatitis B virus genotypes associated with pregnant women in Northern Thailand

BACKGROUND

Mother-to-child transmission of hepatitis B virus (HBV) is the major route of transmission causing persistent infection. The prevalence of HBV infection and HBV genotypes found in different geographical areas varies from country to country. Therefore, this study was conducted to identify the HBV genotypes in HBV-infected pregnant women in Northern Thailand.

METHODS

Stored blood samples that were collected from 145 HBsAg-positive pregnant women who gave birth at Maharaj Nakorn Chiang Mai Hospital, Chiang Mai, Thailand from 2017 to 2020 were analyzed. The partial nucleotide sequence of the S gene of HBV was amplified by nested PCR and sequenced. All sequences were analyzed phylogenetically together with the reference strains to define the HBV genotypes.

RESULTS

A total of 31 blood samples from 145 HBsAg-positive pregnant women were positive for HBV by nested PCR. The detected HBV strains were identified as presumptive subgenotypes C1 (77.4%; 24/31), B9 (9.7%; 3/31), C2 (3.2%; 1/31), B2 (3.2%; 1/31), B4 (3.2%; 1/31), and presumptive B4/C2 recombinant subgenotype (3.2%; 1/31).

CONCLUSIONS

The findings revealed that presumptive subgenotype C1 was the most common subgenotype circulating in pregnant women in Northern Thailand and accounted for 77.4% of cases, followed by presumptive subgenotypes B9, C2, B2, and B4. Furthermore, this study reported, for the first time in Thailand, the HBV genotypes and presumptive subgenotypes, particularly subgenotype B9 circulating in pregnant women.

Clinical and Microbiological Manifestations of Endogenous Endophthalmitis in Tertiary Care Hospital, Northern Thailand

PURPOSE

To determine the characteristics, primary sources, pathogens, risk factors, and visual outcomes in patients with endogenous endophthalmitis (EE).

METHODS

We performed a retrospective cohort study of 61 consecutive patients with EE (74 affected eyes) and reported on prevalence, clinical courses, prognostic factors and visual outcomes.

RESULTS

Prevalence of EE was 5% of all patients with endophthalmitis. Among culture-positive cases (89%), Gram-positive species dominating (69%) followed by Gram-negative with 22% and fungal species with 9%. Regarding to visual outcomes, the mean visual acuity (VA, ETDRS letters) at baseline, 3-months, 6-months and 1-year follow-up was 0.85, 9, 8 and 9, respectively. Initial VA of hand movement or better (P 0.007) and bilateral infection (P 0.004) were associated with better visual outcome.

CONCLUSION

The prognosis for EE remained poor despite aggressive and immediate treatment. The high suspicion, early diagnosis and prompt treatment are important factors that might lead to the better outcome.

Transnational Mobility and Utilization of Health Services in Northern Thailand: Implications and Challenges for Border Public Health Facilities

INTRODUCTION/OBJECTIVE

Transnational populations from the Association of Southeast Asian Nations are crossing borders regardless of whether their status is legal or undocumented, to receive health services in the border regions of Thailand. The implications and challenges of transnational mobility and the utilization of public health facilities in Thailand's border regions are therefore investigated in this study.

METHODS

Four public health facilities were selected, located in 2 economically-active border areas in Northern Thailand: Mae Sai-Tachileik at the Thailand-Myanmar border and Chiang Saen-Ton Phueng at the Thailand-Lao PDR border. Qualitative data were obtained from in-depth interviews with 8 medical and non-medical hospital staff responsible for implementing facility-level policies and providing health services for the transnational population.

RESULTS

Five themes were identified through analysis of the implications and challenges for transnational mobility and the utilization of public health facilities under study: contextual determinants of illness in specific border areas; uncompensated care as opposed to financial management in serving the transnational population; health service opportunities for the transnational population; cross-border collaboration on public health; and the remaining challenges of transnational mobility in border regions.

CONCLUSION

Conventional content analysis with interpretative induction of in-depth interview data offers recommendations for improving the capacity of border health facilities to reduce the burden placed upon them to provide services to the transnational population.

Balancing Commercialization and Sustainability in Community-Based Tourism Practices - A Qualitative Study of Factors Affecting Elephant Habitat Communities in Northern Thailand

Community-Based Tourism (CBT) offers local residents opportunities to manage local tourism resources while sustaining their lifestyle at the same time. The research objective of the study was to explore the process and experience of communities in Northern Thailand which are known as elephant habitats, how these communities strive for stimulating the local economy without jeopardizing the way of life. The study was qualitative in nature. Qualitative data collection methods such as field observations and in-depth interviews were employed. The qualitative data were further analyzed with thematic analysis. In practicing CBT, the findings identified positive factors (Establishment of Elephant Camps), negative factors (Waste from Tourism Activity and Effects of Global Crisis on Employment and Local Income), and suggestions (Waste and Environment Management). The study found that the communities took pride in their cultural as well as natural resources and they are willing to commercialize these resources to a certain degree, i.e. founding elephant themed facilities, as has evidently been indicated. Consequently, as many issues factor into the practice of CBT, the study concluded that community participation and government support should have played a crucial role in maintaining new balance of overall local lifestyle sustainability and commercialization during and after the pandemic.

Cattle Manure Trade Network Analysis and the Relevant Spatial Pathways in an Endemic Area of Foot and Mouth Disease in Northern Thailand

Animal movement is one of the most important risk factors for outbreaks of foot and mouth disease (FMD) in cattle. Likewise, FMD can spread to cattle farms via vehicles contaminated with the FMD virus. In Northern Thailand, the movement of manure transport vehicles and the circulation of manure bags among cattle farms are considered as potential risk factors for FMD outbreaks among cattle farms. This study aimed to determine the characteristics and movement patterns of manure tradesman using social network analysis. A structured questionnaire was used to identify sequences of farms routinely visited by each tradesman. A total of 611 participants were interviewed, including 154 beef farmers, 407 dairy farmers, 36 tradesmen, and 14 final purchasers. A static weighted directed one-mode network was constructed, and the network metrics were measured. For the manure tradesman–cattle farmer network, the tradesman possessed the highest value of in- and out-degree centralities (71 and 4), betweenness centralities (114.5), and k-core values (2). These results indicated that the tradesman had a high frequency of farm visits and had a remarkable influence on other persons (nodes) in the network. The movement of vehicles ranged from within local districts, among districts, or even across provinces. Unclean manure plastic bags were circulated among cattle farms. Therefore, both vehicles and the bags may act as a disease fomite. Interestingly, no recording system was implemented for the movement of manure transport vehicles. This study suggested that the relevant authority and stakeholders should be aware of the risk of FMD spreading within this manure trading network. The findings from this study can be used as supporting data that can be used for enhancing FMD control measures, especially for FMD endemic areas.

Spatiotemporal analyses of foot and mouth disease outbreaks in cattle farms in Chiang Mai and Lamphun, Thailand

Background

Foot and mouth disease (FMD) is a highly infectious and contagious febrile vesicular disease of cloven-hoofed livestock with high socio-economic consequences globally. In Thailand, FMD is endemic with 183 and 262 outbreaks occurring in the years 2015 and 2016, respectively. In this study, we aimed to assess the spatiotemporal distribution of FMD outbreaks among cattle in Chiang Mai and Lamphun provinces in the northern part of Thailand during the period of 2015–2016. A retrospective space-time scan statistic including a space-time permutation (STP) and the Poisson and Bernoulli models were applied in order to detect areas of high incidence of FMD.

Results

Results have shown that 9 and 8 clusters were identified by the STP model in 2015 and 2016, respectively, whereas 1 and 3 clusters were identified by the Poisson model, and 3 and 4 clusters were detected when the Bernoulli model was applied for the same time period. In 2015, the most likely clusters were observed in Chiang Mai and these had a minimum radius of 1.49 km and a maximum radius of 20 km. Outbreaks were clustered in the period between the months of May and October of 2015. The most likely clusters in 2016 were observed in central Lamphun based on the STP model and in the eastern area of Chiang Mai by the Poisson and Bernoulli models. The cluster size of the STP model (8.51 km) was smaller than those of the Poisson and Bernoulli models (> 20 km). The cluster periods in 2016 were approximately 7 months, while 4 months and 1 month were identified by the Poisson, Bernoulli and STP models respectively.

Conclusions

The application of three models provided more information for FMD outbreak epidemiology. The findings from this study suggest the use of three different space-time scan models for the investigation process of outbreaks along with the follow-up process to identify FMD outbreak clusters. Therefore, active prevention and control strategies should be implemented in the areas that are most susceptible to FMD outbreaks.

Factors Related Intention To Smoking Cessation Among Thai People Who Joined Quit Smoking Project For The King: A Cross-Sectional Study Of Northern Thailand

BACKGROUND

Smoking causes direct and indirect health problems among people. The purpose of this paper is to explore factors influencing intention to cessation smoking among Thai people who joined quit smoking project for the King.

METHODS

This cross-sectional study survey. The samples of 626 participants were recruited to the study. They were randomly selected by using stratified multi-stage cluster sampling from community area of Phayao and Nan Provinces. The data was analysed using Pearson product-moment correlation. Factors influencing intention to quit smoking were analysed using multiple linear regression.

RESULTS

The results showed that participants' perception towards health consequences of smoking was at low level (35.1%). Participants' communication skills, decision making, and self-management were at fair level (35.5%, 41.8% and 43.0% respectively). There were statistically significant relationships between personal factors and intention to cessation smoking among participants in the quit smoking project (p=.007). It was found that factors including intention to cessation smoking, joining the program, receive invitation to join the program, and participants' willingness to participate in the program had statistically significant relationships with quit smoking (p<.001), (p<.001), (p<.001) and (p<0.009). There were statistically significant relationships of knowledge and communication skills on intention to cessation smoking (p=.030) and (p=.039) respectively.

CONCLUSIONS

Furthermore, they are willing to cooperate with public health personnel regarding to prevention and control of smoking. Therefore, quit smoking campaign by using health communication will help approaching people in the public and enhance knowledge and understanding among people in term of health effects and consequences of smoking.

Health-Related Quality of Life and Self-Care Management Among People With Diabetic Foot Ulcers in Northern Thailand

Diabetic foot ulcers (DFUs) are a common complication of diabetes that impacts on the health-related quality of life (HRQOL). Foot care is an important factor in the self-care management of patients with DFUs. The objective of this study was to investigate the HRQOL and foot care management of people with DFUs. A cross-sectional study involving 41 people with DFUs was conducted at a large tertiary hospital in Northern Thailand. The Diabetic Foot Ulcer Scale-Short Form and the VA-Diabetes Foot Care Survey were used to assess the HRQOL and foot care management among people with DFUs. The majority of the participants were female (n = 24, 58.5%), and the mean age was 62.13 years. The scores for HRQOL in the six domains were as follows: leisure (66.95 ± 28.03), physical health (68.93 ± 28.51), dependence or daily life (80.08 ± 25.23), negative emotions (71.23 ± 29.48), worried about ulcers (62.20 ± 31.97), and bothered by ulcer care (69.36 ± 25.20). High scores indicate a high (good) HRQOL. Less than a third of the participants reported that they had received education about foot care management. Almost all participants reported that they washed their feet daily; however, a large proportion did not test the water temperature or use lubricants on their feet. Most of the participants did not have a mirror for checking under their feet (48.8%), and there was a lack of knowledge about how to use a mirror for foot inspections (51.2%). This study provides guidance for clinicians on the content and delivery of diabetes education programs for people with diabetes (and DFUs) in Northern Thailand. The findings provide guidance on existing knowledge and the need for programs to address barriers to foot self-care management both in terms of skills and attitudes.

Mapping exposure to particulate pollution during severe haze episode using improved MODIS AOT-PM10 regression model with synoptic meteorology classification

Severe smoke haze from biomass burning is frequently observed in Northern Thailand during dry months of February-April. Sparsely located monitoring stations operated in this vast mountainous region could not provide sufficient particulate matter (PM) data for exposure risk assessment. Satellite aerosol optical thickness (AOT) data could be used, but their reliable relationship with ground-based PM data should be first established. This study aimed to improve the regression model between PM10 and Moderate Resolution Imaging Spectroradiometer AOT with consideration of synoptic patterns to better assess the exposure risk in the area. Among four synoptic patterns, each representing the totality of meteorology governing Northern Thailand on a given day, most severe haze days belonged to pattern 2 that featured conditions of clear sky, stagnant air, and high PM10 levels. AOT-24 h PM10 regression model for pattern 2 had coefficient of determination improved to 0.51 from 0.39 of combined case. Daily exposure maps to PM10 in most severe haze period of February-April 2007 were produced for Chiangmai, the largest and most populated province in Northern Thailand. Regression model for pattern 2 was used to convert 24 h PM10 ranges of modified risk scale to corresponding AOT ranges, and the mapping was done using spatially continuous AOT values. The highest exposure risk to PM10 was shown in urban populated areas. Larger numbers of forest fire hot spots and more calm winds were observed on the days of higher exposure risk. Early warning and adequate health care plan are necessary to reduce exposure risk to future haze episodes in the area.

Endogamous marriage and the prevalence of hemoglobin E in ethnic groups of northern Thailand

OBJECTIVE

To investigate the impact of the endogamous marriage culture on the prevalence of the hemoglobin E (HbE) recessive variant.

METHODS

The prevalence of the hemoglobin E (HbE) recessive variant was determined by dot-blot hybridization in 4 endogamous villages (1 Mlabri and 3 Htin ethnic groups) in comparison with 9 other nearby non-endogamous populations.

RESULTS

Although the overall HbE prevalence in the population studied (8.44%, 33/391) was not significantly different from that of the general southeast Asian population, a high prevalence and individuals with homozygous HbE were observed in two villages, the Mlabri from Wiang Sa district and the Htin from Thung Chang district of Nan province (26.3% and 26.9%, respectively). The low HbE allelic frequency noticed in some endogamous populations suggests that not only endogamy but also other evolutionary forces, such as founder effect and HbE/β-thalassemia negative selection may have an effect on the distribution of the HbE trait.

CONCLUSION

Our study strongly documents that cultural impact has to be considered in the extensive prevalence studies for genetic disorders in the ethnic groups of northern Thailand.

Urinary dialkylphosphate metabolites and health symptoms among farmers in Thailand

Using a cross-sectional study, we investigated urinary DAPs levels and health symptoms related to the type of crop cultivation and farm tasks among 84 farmers in Phayao Province of northern Thailand. The results showed that the average of ∑DAPs levels was 10.93 ± 19.64 μg/g creatinine (range 1.48-163.90 μg/g creatinine). The compound found the most was DEP, followed by DETP, DEDTP, DMP, DMTP, and DMDTP, respectively. The type of crop cultivation may be associated with an increasing prevalence of respiratory tract, muscle system, and skin irritation. Farm tasks were associated with an increasing prevalence of muscle system and skin irritation. It was difficult to assess adverse health symptoms associated with urinary DAPs in low levels of exposure; therefore, further investigation is needed using more sensitive biomarkers and more sensitive health symptom measurement.

Autosomal STR variations reveal genetic heterogeneity in the Mon-Khmer speaking group of Northern Thailand

Since prehistoric times, Mon-Khmer speaking people have been recognized as indigenous ethnic groups living in northern Thailand. After the period of Tai colonization in the thirteenth century CE, the Mon-Khmer inhabitants were fragmented; some were expelled to rural areas while some were integrated into the mainstream of Tai society. Autosomal STR variations revealed that the present-day Mon-Khmer people could be genetically divided into two clusters. This finding appears to be consistent with the level of historical contact with the Tai majority ethnic groups. The cluster consisting of the Khamu, Lua, Paluang and Htin people, indicate that they have lived in remote areas and have had little historical contact with the Tai people. In this way, they appeared to have maintained aspects of their Mon-Khmer ancestral genetic bloodline but have genetically diverged from the Tai people. The cluster comprised of the Mon and Lawa people had an exclusively close relationship with the Tai people during the establishment of the prosperous Lan Na Kingdom. A fraction of the Tai genetic component investigated among the Mon people and some Lawa populations reflected the evidence of genetic admixture. However, some Lawa people, who have lived in the mountainous area of Mae Hong Son Province have exhibited a unique gene pool, which might have been shaped by the founder effect that occurred during their historical fragmentation. The rise of the genetic assimilation of the hill-tribe Karen people into the Mon-Khmer and the Tai gene pools indicated that different languages, cultures, and geographical distances have lost their power as barriers of inter-ethnic marriages in the present day.

The prevalence of alpha-thalassemia amongst Tai and Mon-Khmer ethnic groups residing in northern Thailand: A population-based study

BACKGROUND

Northern Thailand is one of the highest α-thalassemia incidence areas where 30-40% of inhabitants have been reported to carry aberrant α-globin genes. However, all previous α-thalassemia prevalence surveys in northern Thailand have been undertaken without consideration of ethnicity. Here we report the prevalence of α-thalassemia genes in 4 Tai (Yong, Yuan, Khuen, Lue) and 4 Mon-Khmer speaking populations (Blang, Mon, Paluang, Lawa).

METHODS

DNA extracted from 141 individuals was genotyped for 4 α-thalassemia deletional types (--(SEA), --(THAI), -α(3.7), -α(4.2)) using MultiplexGap-PCR analysis and 2 non-deletional types (Hb CS, Hb Pakse) using dot-blot hybridization technique.

RESULTS AND DISCUSSION

A total of 33 α-thalassemia carrying individuals (23.4%) were detected of which 32 were heterozygotes and one was a homozygote. The most common α-thalassemia detected were -α(3.7) (17.7%) and --(SEA) (3.5%), while Hb CS was detected in 2.1% of cases. No occurrence of --(THAI), -α(4.2) and Hb Pakse was observed. The prevalence of α-thalassemia carriers varied between the different ethnic groups, with the Yuan having the highest prevalence of α-thalassemia carriers (50%) while the Lawa had the lowest prevalence (0%). The Paluang had a high prevalence (42%) of a single deletion type (-α(3.7)) possibly related to the endogamous marriage traditions of this ethnic group.

CONCLUSION

The extreme variation of α-thalassemia prevalence among the different ethnic groups highlights the significantly different genetic backgrounds found in these peoples, as consequences of dissimilar cultures. Our study suggests that ethnicity must be considered in any of the disease-causing allele prevalence surveys in this region.

Occurrence and HAT-RAPD analysis of gastrointestinal helminths in domestic chickens (Gallus gallus domesticus) in Phayao province, northern Thailand

The present study determined the prevalence and distribution of gastrointestinal helminths in domestic chickens (Gallus gallus domesticus) between November 2012 and August 2013. One hundred and twenty domestic chickens were purchased from villages in four districts of Phayao province; Mae Chai, Dok Khamtai, Chun and Chiang Kham. Morphological differences were used to identify the helminth species, and HAT-RAPD technique was used to differentiate among closely related species. The results revealed that the total prevalence of infection was 99.2%. Cestode and nematode infections showed the highest prevalence in rainy season, while trematode infections were low and only found in hot season. The species and their prevalence were: Ascaridia galli (50.8%), Heterakis gallinarum (86.7%), Prosthogonimus macrorchis (1.7%), Echinostoma revolutum (0.8%), Raillietina echinobothrida (48.3%), Raillietina tetragona (57.5%), Raillietina cesticillus (12.5%), Raillietina sp. (35.8%), Cotugnia chiangmaii (14.2%) and Cotugnia sp. (32.5%). The prevalence of helminth infections did not differ significantly between male and female chickens. HAT-RAPD analysis, the specific fragment of 400 and 250 bp indicated that Raillietina sp. and Cotugnia sp. found, respectively, differ from other closely related species. This study has confirmed that HAT-RAPD technique can be used to differentiate among related species combined with morphological observations.

Low-Oxygen Atmosphere and its Predictors among Agricultural Shallow Wells in Northern Thailand

Background

In 2006, three farmers died at the bottom of an agricultural shallow well where the atmosphere contained only 6% oxygen. This study aimed to document the variability of levels of oxygen and selected hazardous gases in the atmosphere of wells, and to identify ambient conditions associated with the low-oxygen situation.

Methods

A cross-sectional survey, conducted in June 2007 and July 2007, measured the levels of oxygen, carbon monoxide, hydrogen sulfide, and explosive gas (percentage of lower explosive limit) at different depths of the atmosphere inside 253 wells in Kamphaengphet and Phitsanulok provinces. Ambient conditions and well use by farmers were recorded. Carbon dioxide was measured in a subset of wells. Variables independently associated with low-oxygen condition (<19.5%) were identified using multivariate logistic regression.

Results

One in five agricultural shallow wells had a low-oxygen status, with oxygen concentration decreasing with increasing depth within the well. The deepest-depth oxygen reading ranged from 0.0% to 20.9%. Low levels of other hazardous gases were detected in a small number of wells. The low-oxygen status was independently associated with the depth of the atmosphere column to the water surface [odds ratio (OR) = 13.5 for 8–11 m vs. <6 m], depth of water (OR = 0.17 for 3–<8 m vs. 0–1 m), well cover (OR = 3.95), time elapsed since the last rainfall (OR = 7.44 for >2 days vs. <1 day), and location of well in sandy soil (OR = 3.72). Among 11 wells tested, carbon dioxide was detected in high concentration (>25,000 ppm) in seven wells with a low oxygen level.

Conclusion

Oxygen concentrations in the wells vary widely even within a small area and decrease with increasing depth.

Assessing risks to adults and preschool children posed by PM2.5-bound polycyclic aromatic hydrocarbons (PAHs) during a biomass burning episode in Northern Thailand

To investigate the potential cancer risk resulting from biomass burning, polycyclic aromatic hydrocarbons (PAHs) bound to fine particles (PM2.5) were assessed in nine administrative northern provinces (NNP) of Thailand, before (N-I) and after (N-II) a haze episode. The average values of Σ 3,4-ring PAHs and B[a] P Equivalent concentrations in world urban cities were significantly (p<0.05) much higher than those in samples collected from northern provinces during both sampling periods. Application of diagnostic binary ratios of PAHs underlined the predominant contribution of vehicular exhaust to PM2.5-bound PAH levels in NNP areas, even in the middle of the agricultural waste burning period. The proximity of N-I and N-II values in three-dimensional (3D) principal component analysis (PCA) plots also supports this conclusion. Although the excess cancer risk in NNP areas is much lower than those of other urban area and industrialized cities, there are nevertheless some concerns relating to adverse health impacts on preschool children due to non-dietary exposure to PAHs in home environments.

Karen and Lawa medicinal plant use: uniformity or ethnic divergence?

ETHNOPHARMACOLOGICAL RELEVANCE

We here tease apart the ethnopharmacological knowledge of plants in two Thai villages to determine to which degree the uses are particular to individual ethnic groups and to which degree they are part of a generalized and uniform set of widespread medicinal plants used over a large geographic range. We compared Karen and Lawa knowledge of medicinal plants in the Mae Cheam watershed of northern Thailand, where both ethnic groups have settled and share ecological conditions for resource extraction. We were interested in documenting the degree to which these two ethnic groups use the same or different medicinal plant species. The use of the same plant species by the two groups was considered a sign of uniform and cross-cultural local knowledge, whereas the use of different medicinal plants by each group was considered a sign of culturally specific local knowledge that developed within each ethnic group.

MATERIALS AND METHODS

We inventoried the plant species in different habitats around one Karen village and one Lawa village using stratified vegetation plots and using semi-structured questionnaires we interviewed 67 key informants regarding their use of plants for medicine. We then calculated the Fidelity level FL (FL values near 100% for a species indicate that almost all use reports refer to the same way of using the species, whereas low FL values indicate that a species is used for many different purposes) and cultural importance index CI (the sum of the proportion of informants that mention each of the use categories for a given species) to estimate the variation in medicinal plant use. We used Jaccard's Index JI (This index relates the number of shared species to the total number of species) to analyze the similarity of medicinal plant use between the two villages.

RESULTS

A total of 103 species of medicinal plant species in 87 genera and 41 families were identified and they were used to cure 35 ailments. The FL of the medicinal plant species varied from 10% to 100%, was different for each ailment, and differed between the two ethnic groups. The most important medicinal plant species, those with the highest CI value, were not the same in the two villages. Costus speciosus, which is used to treat urinary infections and wounds in animals, had the highest CI value in the Karen village, whereas Sambucus javanica, which is used to treat wounds, fractures, bloat, and edema in humans, had the highest CI value in the Lawa village. Only 17 medicinal species (16.5%) were shared between the two villages. Methods of preparation and application were significantly different between the two villages, whereas the plant parts used, habit, and route of administration were similar.

CONCLUSION

Our study demonstrates that ethnic groups that live in the same geographic area can have significantly different traditional knowledge systems for medicinal plants, at least when it comes to the species used and their preparation and medicinal application. We assume that differences in cultural history and background in the two villages led to differences in medicinal plant use, preparation, and application.