Intestinal parasitic infections in rural west Malaysia

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Intestinal parasitic infections have a worldwide distribution and have been identified as one of the most significant causes of illnesses and diseases among disadvantaged populations. A study finds that intestinal parasitic infections are highly prevalent (nearly 75 percent) among the poor rural communities in west Malaysia.

Soil-transmitted helminth infections (73.2 percent) were significantly more common compared to protozoa infections (21.4 percent). Those aged 12 years and younger showed significantly higher rates of intestinal parasitic infections.

Poverty and low socioeconomic with poor environmental sanitation were indicated as important predictors of these types of infections.

“Effective poverty reduction programs, promotion of deworming, and mass campaigns to heighten awareness on health and hygiene are urgently needed to reduce [intestinal parasitic infections],” the study concluded.

1. Ngui R, Ishak S, Chuen CS, et al. Prevalence and risk factors of intestinal parasitism in rural and remote west Malaysia. PLoS Neglected Tropical Diseases 2011; 5(3): e974. (open access)

Recommendations for addressing smoking among doctors in Laos

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Doctors in Laos, a low-income country in Southeast Asia where community smoking prevalence is high, are prepared to contribute to tobacco control programs if equipped with the appropriate tools, according to a study assessing smoking prevalence among Laotian medical doctors. The study also makes government recommendations to engage doctors in tobacco control.

The study found that 9.2 percent of medical doctors in Laos are current smokers, the majority being male (17.3 percent, compared to only 0.4 percent of female doctors) and older. Over 84 percent of current smokers wanted to quit, and 74.7 percent had made a recent serious attempt to do so. More than 18 percent were ex-smokers.

Doctors had excellent knowledge about the harms of smoking and had positive attitudes towards quitting, but the large majority lacked confidence in providing assistance for cessation, with few having undergone training. Three-fourths of doctors were engaged in cessation support, but just 24 percent had been trained to do so, and a mere 8.8 percent considered themselves ‘well prepared.’

“The willingness of doctors to take up their tobacco control role and the lower smoking rates among younger respondents offers an important window of opportunity to consolidate their knowledge, attitudes, skills and enthusiasm as cessation advocates and supports,” the study concluded.

Recommendations for the Laos Ministry of Health

The study offered the following recommendations to engage doctors in smoking prevention and cessation more actively:

  • Targeted cessation support for doctors to assist their quit attempts and bolster their image as role models for non-smoking;
  • Training programs for doctors (and medical students) on brief advice and cessation counseling to enable them to support patients and community;
  • Training programs for lower level health professionals in cessation support to reach greater numbers of the Lao population;
  • Expansion to all regions of nicotine replacement therapy and medications of proved effectiveness to aid cessation;
  • Medical school and in-service education for doctors (and health professionals) on the health, financial and other costs of tobacco use;
  • Raising consciousness for doctors and the broader community about the negative impacts of gender norms for men and boys that encourage tobacco uptake; and
  • Implementation of Framework Convention on Tobacco Control (FCTC) measures of greatest impact on prevention and cessation of tobacco use, including price increases and strict enforcement of smoking bans in workplaces and public spaces.

1. Vanphanom S, Morrow M, Phengsavanh A, et al. Smoking among Lao medical doctors: challenges and opportunities for tobacco control. Tobacco Control 2011; 20: 144-150. (open access)

Number of uninsured reduced by universal health care insurance in Thailand

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Thailand implemented a Universal Coverage Scheme of national health insurance in 2001 to finance equitable access to health care. After the Universal Coverage Scheme was introduced, the number of uninsured in Thailand fell substantially and use of health centers and community hospitals increased among lower income groups, according to a study that analyzed data from the Thai national health and welfare surveys in 2001 and 2005.

With the establishment of the Universal Coverage Scheme, Thai citizens are now covered by three main public health insurance schemes: the Civil Servant Medical Benefit Scheme for employees of the government and state enterprises, the Social Security Scheme for formal private sector employees and the Universal Coverage Scheme for the rest of the population. Health service utilization has shifted from tertiary towards primary health care facilities, an intended impact of the Universal Coverage Scheme.

As a result of Thailand’s universal health insurance, the number of uninsured fell from 24 percent in 2001 to three percent in 2005 and health service patterns changed. Use of public primary health care facilities such as health centers became more concentrated among the poor, while use of provincial/general hospitals became more concentrated among the better-off.

The increasingly common use of health centers among the poor in 2005 was substantially associated with those with lower income, residence in the rural northeast and the introduction of the Universal Coverage Scheme. The increasing use of provincial/general hospitals and private clinics among the better-off in 2005 was substantially associated with the government and private employee insurance schemes.

Although the Universal Coverage Scheme has achieved its objective in increasing insurance coverage and utilization of primary health services, “our findings point to the need for future policies to focus on the quality of this primary care and equitable referrals to secondary and tertiary health facilities when required,” the study concluded.
1. Yiengprugsawan V, Carmichael GA, Lim LL-Y, et al. Explanation of inequality in utilization of ambulatory care before and after universal health insurance in Thailand. Health Policy and Planning 2011; 26(2): 105-114. (open access)

Bed nets prevent malaria when used in farming huts in Laos

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Bed nets prevent malaria infection

Overnight stays in farming huts are known to pose a risk of malaria infection. But a study conducted among farmers in rural Laos suggests that malaria infection is likely preventable if insecticide-treated bed nets are properly used in farming huts.

Malaria is the leading cause of illness and death in Laos, with 70 percent of the population at risk. Most of the Laotian population lives in rural areas and 84 percent of households engage in rice farming. During the rice farming season, farmers and their family members often move from their village to a farm, where they stay in a temporary shelter (farming huts).

“The finding is important not only because overnight stays in farming huts are reported in malaria endemic countries other than Laos, but because overnight stays in farming huts are not confined to adult population,” the study reported. Children under age five years, those most vulnerable to malaria infection, are usually taken to the farming huts by their parents.

1. Nonaka D, Laimanivong S, Kobayashi J, et al. Is staying overnight in a farming hut a risk factor for malaria infection in a setting with insecticide-treated bed nets in rural Laos? Malaria Journal 2010; 9: 372. (open access).