Predictors of Swimming Skill of Primary School Children in Rural Thailand

Drowning is a leading cause of childhood deaths in Asian countries. Children in primary school have a high rate of fatal drowning. These fatal drownings commonly occur in natural water bodies near the child’s residence. The 2004 Thai National Injury Survey reported a higher rate of drowning death in rural settings. While swimming skill is recommended to decrease drowning risk, there is a lack of information on factors contributing to a child’s swimming skill. This study assesses guardians’ perceptions of the swimming skill of rural primary school children and identifies associated risk and protective factors. A cross-sectional household survey was conducted during August-September 2009 in rural communities of Chiang Rai province, Thailand. We analyzed a total of 633 interview surveys completed with guardians of primary school children. Results revealed that less than one-fifth (19%) of the school children (age 6-12 years old) could swim. Multiple logistic regression showed that children who can swim are more likely to have attended swimming lessons Ratio [OR] = 23.95; 95% CI = 12.21-46.98); be 10-12 years of age (OR = 4.15; 95% CI = 2.35-7.30); be male (OR = 2.82; 95% CI = 1.67-4.77); have had self-reported life-threatening submersion experience (OR = 2.14; 95% CI = 1.10-4.12); or be the child of a guardian who can swim (OR = 2.10; 95% CI = 1.25-3.44). The results highlight the need to provide swimming lessons targeting all children beginning in the younger age groups. Local resources in natural water sites may provide a place for safe swimming lessons in rural areas

Genetic diversity and population structure of <it>Plasmodium falciparum </it>in Thailand, a low transmission country

Abstract Background The population structure of the causative agents of human malaria, Plasmodium sp., including the most serious agent Plasmodium falciparum, depends on the local epidemiological and demographic situations, such as the incidence of infected people, the vector transmission intensity and migration of inhabitants (i.e. exchange between sites). Analysing the structure of P. falciparum populations at a large scale, such as continents, or with markers that are subject to non-neutral selection, can lead to a masking and misunderstanding of the effective process of transmission. Thus, knowledge of the genetic structure and organization of P. falciparum populations in a particular area with neutral genetic markers is needed to understand which epidemiological factors should be targeted for disease control. Limited reports are available on the population genetic diversity and structure of P. falciparum in Thailand, and this is of particular concern at the Thai-Myanmar and Thai-Cambodian borders, where there is a reported high resistance to anti-malarial drugs, for example mefloquine, with little understanding of its potential gene flow. Methods The diversity and genetic differentiation of P. falciparum populations were analysed using 12 polymorphic apparently neutral microsatellite loci distributed on eight of the 14 different chromosomes. Samples were collected from seven provinces in the western, eastern and southern parts of Thailand. Results A strong difference in the nuclear genetic structure was observed between most of the assayed populations. The genetic diversity was comparable to the intermediate level observed in low P. falciparum transmission areas (average HS = 0.65 ± 0.17), where the lowest is observed in South America and the highest in Africa. However, uniquely the Yala province, had only a single multilocus genotype present in all samples, leading to a strong geographic differentiation when compared to the other Thai populations during this study. Comparison of the genetic structure of P. falciparum populations in Thailand with those in the French Guyana, Congo and Cameroon revealed a significant genetic differentiation between all of them, except the two African countries, whilst the genetic variability of P. falciparum amongst countries showed overlapping distributions. Conclusion Plasmodium falciparum shows genetically structured populations across local areas of Thailand. Although Thailand is considered to be a low transmission area, a relatively high level of genetic diversity and no linkage disequilibrium was found in five of the studied areas, the exception being the Yala province (Southern peninsular Thailand), where a clonal population structure was revealed and in Kanchanaburi province (Western Thailand). This finding is particularly relevant in the context of malaria control, because it could help in understanding the special dynamics of parasite populations in areas with different histories of, and exposure to, drug regimens.</p

Lipid profile, plasma apolipoproteins, and risk of a first myocardial infarction among Asians:an analysis from the INTERHEART study

ObjectivesThis study sought to determine the prevalence of lipid and lipoprotein abnormalities and their association with the risk of a first acute myocardial infarction (AMI) among Asians.BackgroundPatterns of lipid abnormalities among Asians and their relative impact on cardiovascular risk have not been well characterized.MethodsIn a case-control study, 65 centers in Asia recruited 5,731 cases of a first AMI and 6,459 control subjects. Plasma levels of lipids and apolipoproteins in the different Asian subgroups (South Asians, Chinese, Southeast Asians, and Japanese) were determined and correlated with the risk of AMI.ResultsAmong both cases and controls, mean low-density lipoprotein cholesterol (LDL-C) levels were about 10 mg/dl lower in Asians compared with non-Asians. A greater proportion of Asian cases and controls had LDL-C ≤100 mg/dl (25.5% and 32.3% in Asians vs. 19.4% and 25.3% in non-Asians, respectively). High-density lipoprotein cholesterol (HDL-C) levels were slightly lower among Asians compared with non-Asians. There was a preponderance of people with low HDL-C among South Asians (South Asia vs. rest of Asia: cases 82.3% vs. 57.4%; controls 81% vs. 51.6%; p < 0.0001 for both comparisons). However, despite these differences in absolute levels, the risk of AMI associated with increases in LDL-C and decreases in HDL-C was similar for Asians and non-Asians. Among South Asians, changes in apolipoprotein (Apo)A1 predicted risk better than HDL-C. ApoB/ApoA1 showed the strongest association with the risk of AMI.ConclusionsThe preserved association of LDL-C with risk of AMI among Asians, despite the lower baseline levels, suggests the need to rethink treatment thresholds and targets in this population. The low HDL-C level among South Asians requires further study and targeted intervention