Community Health Nurses’ Perspective on the Introduced Rational Drug Use Policy in Primary Care Settings in Thailand: A Descriptive Qualitative Study

Background: To address the problems related to drug resistance and medication safety, the rational drug use (RDU) policy has been implemented in Thailand since 2014. Theoretically, the policy was supposed to bring drastic changes to the way clinicians prescribe medications and its impacts on clinical practice, however, it has not yet been investigated. The study aimed to describe the experience of community health nurses with regard to the impact of RDU policy implementation on their practices. Methods: Focus group interviews and in-depth interviews with community nurses were conducted. Thematic analysis was performed. Results: Five themes emerged from the analysis, namely, (1) a welcome opportunity, (2) RDU as the quality of healthcare, (3) multidisciplinary collaboration, (4) reinventing productive interactions between nurses and patients, and (5) challenges over control of medications prescribed or purchased elsewhere. Conclusions: Implementing RDU in primary care provides opportunities for protecting individual patients and public health as well as safeguarding against professional prescription error. This can be made possible by adopting a systemic approach to changes. Additional educational and organizational support will optimize health professionals’ contribution to the implementation and hence optimal outcomes of this important policy

Acculturation and Its Effects on Health Risk Behaviors among Myanmar Migrant Workers: A Cross-Sectional Survey in Chiang Mai, Northern Thailand

Thailand hosts many workers who have migrated from neighboring countries and is facing a large burden of non-communicable diseases (NCDs). Health screening for migrant workers routinely emphasizes infectious diseases but overlooks NCDs. We surveyed prevalent health behaviors for NCDs and their influencing factors, particularly cultural adaptation patterns among Myanmar migrant workers in Chiang Mai, Northern Thailand. A total of 414 migrant workers consented to participate in the study. Lack of exercise (75.8%), current alcohol consumption (40.8%), current smoking (26.9%), and central obesity (24.3%) were major lifestyle problems. Being female and uneducated was associated with a lack of exercise. Current alcohol consumption was significantly associated with being male and being of Myanmar ethnicity, with an integrative strategy for acculturation, and with a higher income. Male participants and participants with a lower mean score of marginalization were more likely to smoke. Central obesity was associated with being older than 40 years, being female, engaging in an assimilation strategy, and being uneducated. These findings highlight the need for gender inclusive health promotion, the screening of NCD risk behaviors, and timely health education for migrant workers. It may assist authorities to devise strategies to extend health promotion and universal health coverage to the migrant population

Prevalence and social determinants of depression: A cross-sectional survey of Myanmar migrant workers in Chiang Mai, Northern Thailand

ABSTRACTBackground: Depression is a common mental disorder and the sixth leading cause of disability in Thailand. Chiang Mai has historically been a city of attraction for labour migration for Shan migrants from the adjacent Southern Shan State of Myanmar. Currently, only infectious diseases are screened during the pre-employment period. Prevention and early detection of noncommunicable diseases can improve a healthy workforce and reduce the healthcare burden on the host country. Therefore, we aimed to determine the prevalence of depression and associated factors.Methods: A cross-sectional survey was done among Myanmar migrant adults legally working in Chiang Mai, Thailand.Results: The final analysis included 360 participants and the prevalence of depression was 14.4%. Being female, duration of stay in Thailand of more than 10 years, co-residence with co-workers, and marginalisation pattern of acculturation were significant associated factors affecting depression in a multivariate regression analysis model.Conclusion: Although the culture and dialect were not different between the host and country of origin, Myanmar migrant workers of Shan ethnicity suffered from depression. Our findings highlighted the importance of social determinants beyond common predictors of depression among migrants and the need for public health measures to promote migrants' integration into the host culture

Global evidence directing regional preventive strategies in Southeast Asia for fighting TB/HIV

Tuberculosis (TB) and human immunodeficiency virus (HIV) co-epidemics form a huge burden of disease in the Southeast Asia region. Five out of eleven nations in this region are high TB/HIV burden countries: Myanmar, Thailand, India, Indonesia and Nepal. The trends of TB incidence in these countries have been rising in recent years, in contrast to a falling global trend. Experts in the field of TB control and health service providers have been perplexed by the association of TB and HIV infections which causes a mosaic clinical presentation, a unique course with poor treatment outcomes including death. We conducted a review of contemporary evidence relating to TB/HIV control with the aims of assisting integrated health system responses in Southeast Asia and demystifying current evidence to facilitate translating it into practice

Effectiveness of a new multi-component smoking cessation service package for patients with hypertension and diabetes in northern Thailand: a randomized controlled trial (ESCAPE study)

Abstract Background Smoking cessation is an achievable behavioral change, which reduces the risks of cardiovascular diseases, cancers and tobacco-related diseases. There is a need for an effective smoking cessation service for low and middle income country settings where the smoking rate is generally very high whilst a cessation service is not usually accessible. This study devised a new smoking cessation service package and assessed its effectiveness in the primary health care setting of northern Thailand. Methods This randomized controlled trial was centered at Maetha district hospital, Lampang province, Thailand, and its network of mobile non-communicable disease clinics at seven primary care units. A total of 319 eligible patients who consented to participate in the study, were randomly allocated to an intervention arm (160) and a control arm (159), applying block randomization. The multi-component intervention service consisted of:(1)regular patient motivation by the same nurse over a 3-month period;(2)a monthly piCO+ Smokerlyzer test for 3 months;(3)continual assistance from a trained family member, using a smoking-cessation- diary; and(4)optional nicotine replacement chewing gum therapy. The control group received the routine service comprising of brief counseling and casual follow-up. Smoking cessation, confirmed by six months of abstinence and the piCo+ Smokerlyzer breath test, was compared between the two services after a year follow-up. The trial is registered as an international current control trial at the ISRCTN registry. ISRCTN89315117. Results The median age of the participants was 64 years, with females constituting 28.84%. Most of the participants smoke hand-rolled cigarettes (85%). The intervention arm participants achieved a significantly higher smoking cessation rate than the control arm 25.62% vs 11.32%, with an adjusted odd ratio of 2.95 and 95% confidence interval 1.55–5.61. Conclusion In relation to accessing smoking cessation services within the primary health care setting, participants who received the evidence-based intervention package were about three times more likely to succeed in giving up smoking than those who received the routine service. Utilizing community resources as major intervention components, the evidence from this trial may provide a useful and scalable smoking cessation intervention for low and middle income countries. Trial registration Current controlled trials ISRCTN89315117. WHO international clinical trial identifier number: U1111–1145-6916; 3/2013