Cross-sectional study of nutritional intake among patients undergoing tuberculosis treatment along the Myanmar-Thailand border

OBJECTIVE: This study summarises nutritional intake among patients with tuberculosis (TB) along the Myanmar-Thailand border according to the local diet. SETTING: TB clinic along the Myanmar-Thailand border. PARTICIPANTS: Cross-sectional surveys of 24-hour food recall were conducted with participants receiving anti-TB treatment. Participants were purposively selected to reflect proportion of age, sex and HIV co-infection based on historical patient records. Out of a total of 28 participants, 20 (71.4%) were men and 5 (17.9%) were co-infected with HIV. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome compared actual recorded intake to recommended intake. Secondary outcomes compared weight gain and body mass index (BMI) from diagnosis to time of survey. RESULTS: There were no significant differences in macronutrient or micronutrient intake by sex or for patients supplementing their rations. Mean treatment length at time of survey was 20.7 weeks (95% CI: 16.5 to 24.8). A significantly higher proportion of women (8/8, 100%) met caloric requirements compared with men (9/20, 45.0%, p=0.010), but few participants met other macronutrient or micronutrient requirements, with no significant differences by sex or for patients supplementing their rations. From diagnosis to the time of the survey, participants averaged significant weight gain of 6.48 kg (95% CI: 3.87 to 9.10) and increased BMI of 2.47 kg/m(2) (95% CI: 1.45 to 3.49; p=0.0001 for both). However, 50% (14/28) still had mild or more severe forms of malnutrition. CONCLUSIONS: This cross-sectional survey of nutritional intake in patients undergoing TB treatment in a sanatorium setting demonstrates the difficulty in sufficiently meeting nutritional demands, even when providing nutritional support

Ecological Study of HIV Infection and Hypertension in Sub-Saharan Africa: Is There a Double Burden of Disease?

An ecological correlation study of the prevalence of hypertension with human immunodeficiency virus (HIV) prevalence in sub-Saharan Africa was conducted to determine the extent to which these conditions coincide at country level. Data on prevalence of hypertension were derived from a systematic search of literature published between 1975 and 2014 with corresponding national estimates on HIV prevalence and antiretroviral therapy (ART) coverage from the Demographic and Health Surveys and the joint United Nations Programme on HIV/AIDS databases. National estimates on gross national income (GNI) and under-five mortality were obtained from the World Bank database. Linear regression analyses using robust standard errors (allowing for clustering at country level) were carried out for associations of age-standardised hypertension prevalence ratios (standardized to rural Uganda’s hypertension prevalence data) with HIV prevalence, adjusted for national indicators, year of study and sex of the study population. In total, 140 estimates of prevalence of hypertension representing 25 nations were sex-and area-matched with corresponding HIV prevalence. A two-fold increase in HIV prevalence was associated with a 9.29% increase in age, sex and study year-adjusted prevalence ratio for hypertension (95% CI 2.0 to 16.5, p = 0.01), which increased to 16.3% (95% CI 9.3 to 21.1) after adjusting for under-five mortality, GNI per capita and ART coverage. Countries with a pronounced burden of HIV may also have an increased burden of non-communicable diseases such as hypertension with potential economic and health systems implications

Urbanization and internal migration as risk factors for non-communicable diseases in Thailand

Urbanization, which is driven mainly by the expansion of cities and urban migration, is considered one of the key drivers of non-communicable diseases (NCDs) in developing countries. This research aims to investigate the patterns and associations between different levels of urban exposures and NCD risk factors, NCD morbidity and NCD mortality in Thailand, to better understand the mechanisms underlying the link between urbanization and NCD in Thailand. Using several study designs and analytical techniques, the research described in this thesis found that the process of migration and living in an urban environment were associated with lower social trust and higher levels of emotional problems. Urban environments were also associated with behavioural and physiological risk factors for NCDs, including smoking, heavy alcohol consumption, inadequate physical activity, inadequate fruit/vegetable consumption, high BMI, and high blood pressure. Both early life urban exposure and accumulation of urban exposure throughout life potentially play a role in these increases in behavioural and physiological risk factors for NCDs. Early life urban exposure was also found to be associated with an increased risk of developing obesity in adulthood. Increased psychosocial, behavioural and physiological risk factors associated with living in an urban environment may not translate directly into increased prevalence of biological risk factors for NCDs (such as high cholesterol), the development of NCDs, or into NCD-related mortality. It is likely that biological risk factors for NCDs, as well as NCD incidence and mortality are more amendable to change from the positive influences of urbanization through higher socioeconomic status and potential access to better health care

Active commuting and cardiovascular risk among health care workers.

Background Although the benefit of physical activity on cardiovascular health has been well demonstrated, being physically active can be difficult for healthcare workers. Active commuting such as walking or cycling may be a good way to promote physical activity. Aims To investigate the relationship between active commuting and cardiovascular disease (CVD) risk factors in healthcare workers. Methods A cross-sectional study of healthcare workers conducted in Chiang Mai University Hospital, Thailand. Information on demographics and lifestyle, including active commuting, was obtained from questionnaires. Results were analysed with multiple logistic regression, adjusting for other physical activity and possible confounders. Results Among 3204 participants fewer than half engaged in active commuting. After adjustment for possible confounders, low active commuting was associated with increased risk of hypertension (adjusted OR (aOR) 1.3, 95% CI: 1.1-1.7). High active commuting was associated with central obesity (aOR 1.4, 95% CI: 1.0-1.8). Compared to non-active commuters, younger active commuters (aged under 40) had reduced prevalence of hypertension (aOR 0.4, 95% CI: 0.2-1.0), while older active commuters (aged 40 or over) demonstrated increased hypertension (aOR 1.6, 95% CI: 1.1-2.3) and central obesity (aOR 1.5, 95% CI: 1.1-2.1). Conclusions We found conflicting evidence on the relationship between active commuting and cardiovascular risk factors. Reverse causation may explain the association between active commuting and hypertension and central obesity and should be investigated further. </p

Urbanization and non-communicable disease in Southeast Asia: a review of current evidence.

OBJECTIVE: Non-communicable diseases (NCDs) have been highlighted as a major public health issue in the Southeast (SE) Asian region. One of the major socio-environmental factors that are considered to be associated with such a rise in NCDs is urbanization. Urbanization is associated with behavioural changes such as eating an unhealthy diet, and a decrease in physical activities, which may result in associated obesity. The SE Asian region also has a substantive burden of infectious disease such as HIV and malaria, which may modify associations between urbanization and development of NCDs. STUDY DESIGN: A systematic review was conducted until April 2013. METHODS: Using four databases: EMBASE, PubMed, GlobalHealth and DigitalJournal, the systematic review pools existing evidence on urban-rural gradients in NCD prevalence/incidence. RESULTS: The study found that in SE Asia, urban exposure was positively associated with coronary heart disease, diabetes and respiratory diseases in children. Urban exposure was negatively associated with rheumatic heart diseases. The stages of economic development may also modify the association between urbanization and NCDs such as diabetes. CONCLUSION: There was pronounced heterogeneity between associations. It is recommended that future studies examine the major constituents of NCDs separately and also focus on the interplay between lifestyle and infectious risk factors for NCDs. Prospective studies are needed to understand the diverse causal pathways between urbanization and NCDs in SE Asia

Active commuting and cardiovascular risk among health care workers.

Background Although the benefit of physical activity on cardiovascular health has been well demonstrated, being physically active can be difficult for healthcare workers. Active commuting such as walking or cycling may be a good way to promote physical activity. Aims To investigate the relationship between active commuting and cardiovascular disease (CVD) risk factors in healthcare workers. Methods A cross-sectional study of healthcare workers conducted in Chiang Mai University Hospital, Thailand. Information on demographics and lifestyle, including active commuting, was obtained from questionnaires. Results were analysed with multiple logistic regression, adjusting for other physical activity and possible confounders. Results Among 3204 participants fewer than half engaged in active commuting. After adjustment for possible confounders, low active commuting was associated with increased risk of hypertension (adjusted OR (aOR) 1.3, 95% CI: 1.1-1.7). High active commuting was associated with central obesity (aOR 1.4, 95% CI: 1.0-1.8). Compared to non-active commuters, younger active commuters (aged under 40) had reduced prevalence of hypertension (aOR 0.4, 95% CI: 0.2-1.0), while older active commuters (aged 40 or over) demonstrated increased hypertension (aOR 1.6, 95% CI: 1.1-2.3) and central obesity (aOR 1.5, 95% CI: 1.1-2.1). Conclusions We found conflicting evidence on the relationship between active commuting and cardiovascular risk factors. Reverse causation may explain the association between active commuting and hypertension and central obesity and should be investigated further. </p

Choosing where to give birth: Factors influencing migrant women’s decision making in two regions of Thailand

Background: Choosing where to give birth can be a matter of life and death for both mother and child. Migrants, registered or unregistered, may face different choices and challenges than non-migrants. Despite this, previous research on the factors migrant women consider when deciding where to give birth is very limited. This paper addresses this gap by examining women’s decision making in a respective border and urban locale in Thailand. Methods: We held focus group discussions [13] with 72 non-Thai pregnant migrant women at non-government clinics in a rural border area and at two hospitals in Chiang Mai, a large city in Northern Thailand in 2018. We asked women where they will go to give birth and to explain the factors that influenced their decision. Results: Women identified getting the relevant documentation necessary to register their child’s birth, safe birth and medical advice/quality care, as the top three factors that influenced their care seeking decision making. Language of service, free or low cost care, language of services, proximity to home, and limited alternate options for care were also identified as important considerations. Conclusion: Understanding factors that migrant women value when choosing where to deliver can help health care providers to create services that are responsive to migrants’ preferences and encourage provision of relevant information which may influence patient decision making. The desire to obtain birth documentation for their child appears to be important for migrants who understand the importance of personal documentation for the lives of their children. Healthcare institutions may wish to introduce processes to facilitate obtaining documentation for pregnant migrant women and their newborns.</p

Challenges of implementing tenofovir disoproxil fumarate in pregnancy for prevention of hepatitis B mother to child transmission in a rural population

Background: Hepatitis B is highly endemic in south-east Asia with the most common route of transmission being from mother to child. In rural settings, current preventive strategies with hepatitis B immunoglobulins and vaccinations fail due to costs, need for cold chain, homebirths, and transportation difficulties. A new strategy for prevention of mother to child transmission (PMTCT) could be early (<20 weeks gestation) daily tenofovir disoproxil fumarate (TDF), a potent antiviral agent that is safe in pregnancy. Assessment of barriers to early TDF for PMTCT-Hep B is important before possible implementation. Methods & Materials: Narrative and visual review of start-up challenges encountered during implementation of a study of TDF for PMTCT before 20 weeks gestation in rural areas on the Thailand-Myanmar border. ClinicalTrials.gov Identifier: NCT02995005. Results: Major challenges of implementation from June 2018 to September 2019 included: gestation of pregnancy at presentation, point-of-care (POC)-testing reliability, tablet storage and handling. Overall, 156 women tested positive for HBsAg by Rapid Diagnostic Test (RDT) POC-testing but late presentation (≥20 weeks) was common: 53% (83/156). In women <20 weeks gestation with positive-HBsAg, consent for study screening was 89.0% (65/73). Exclusion after RDT-testing was 21.5% (14/65): three had a negative HBsAg at confirmation, nine had an undetectable viral load, two had elevated phosphate levels. Daily ambient temperatures were high: only 3/365 days (0.8%) were within manufacturer recommended TDF storage temperatures (20–25 °C), and for 187 days of the year the temperature was 30 °C. Drug accountability was high but one in 10 of the women reported incidents of tablet misplacement: “pills dropped though the [bamboo] floor and fell in the mud”, “children played with the bottle”. Financial support of transportation resulted in follow-up rates of 84.3% (43/51) attending all of the expected appointments. The missed appointments were highest in rainy season when the rivers become impassable, 62.5% (5/8). Conclusion: Improved public awareness of the benefits or early antenatal care, better RDT-tests, and confirmation of TDF bioavailability at higher ambient temperatures, are important in the rural tropics for prevention of mother to child transmission for hepatitis B programs