Summary The distribution of Ascaris lumbricoides within a community was examined at an initial mass anthelmintic treatment programme (January 1984) and following an 11-month period of reinfection (November 1984). Similar patterns of the negative binomial parameter k (an inverse measure of parasite aggregation) and the proportion of parasites within the most heavily infected quartile of the community were recorded at the two dates. The pattern of parasite aggregation within individuals, measured by parameter k , appears to be a stable characteristic of this host-parasite relationship. Significant variation in the intensity of infection was observed between households in the community. The number of family members living in the house strongly influenced the mean Ascaris burden and proportion of relatively heavy infections within adults and children. This finding suggests that the density of people in a house positively influences the frequency of exposure to infective stages of Ascaris , which in turn plays a major role in determining which individuals will harbour heavy infections. Positive correlations were recorded between the initial and reinfection burdens of individuals, relative to others in the community. The correlations were strongest in the youngest and oldest age groups and were more frequently significant among age-stratified groups of females, compared to males. A comparative examination of hypothetical treatment strategies suggests that for Ascaris infections in this community, targetting age groups with anthelmintic treatment would probably be more cost-effective in the long term in reducing the abundance of this parasite than selective treatment of individually identified heavy infections.
This paper presents two arguments relevant to both past and present efforts to improve Indigenous health. It advocates for ways of thinking about and doing health promotion that begin with empowerment to help people gain a greater level of control over their lives and circumstances.
In north-east Thailand a five-act drama is broadcast on the village sound system to catalyse involvement in planning and carrying out AIDS prevention activities. Each community's own suggestions for an effective strategy are presented to the relevant government and nongovernmental agencies for endorsement and support.The multisectoral AIDS prevention strategy (MAPS) was implemented in four northeastern provinces of Thailand where a very developed infrastructure for health, education, and social welfare exists. (MAPS entails use of integrated government and nongovernmental AIDS-related services to conduct community-defined initiatives.) An audio-drama was used to introduce MAPS at the community level. It included risks, precautions, local beliefs, and modes of personal interaction pertaining to prevention of the spread of AIDS. The five-act audio-drama was entitled On the Brink and was broadcast over each of the 43 communities' public address systems. It revolved around the needs of married women in relation to AIDS prevention and addressed how men and rural people in general are involved. The stages of the MAPS program were a pre-drama subdistrict meeting, a week of drama in the communities, a post-drama community meeting to discuss a community AIDS strategy, a post-drama subdistrict meeting to present and consolidate the strategy, and implementation of the strategy. Three teams implemented MAPS. The post-drama community meetings began with games and a quiz on AIDS with small prizes to encourage participation in discussions. Identified local HIV risk situations included brothels, cattle auctions, certain festivals during which prostitution occurs, and intravenous drug use among young men. The first priority identified in all the subdistricts was open and free availability of condoms (e.g., available where alcohol is sold). Other suggested interventions were publicity about the danger of commercial sex work and training for women whose husbands travel in developing sexual negotiation skills. During the post-drama subdistrict meeting, an AIDS implementation committee was chosen to coordinate AIDS prevention activities conducted by both the government and nongovernmental organizations' staff in the subdistrict.
We recently demonstrated a number of biliary tract abnormalities associated with moderate to heavy Opisthorchis viverrini infection among 95 selected village residents in north-east Thailand, who were treated with praziquantel immediately after initial examination and re-examined by abdominal ultrasonography 10 months later. Dramatic improvement in the gall-bladder status of previously infected individuals was observed, including reduction of gall-bladder length and width and regained contractibility of the organ following fatty meal consumption. The frequency of severe enhanced portal vein radicle echoes and gall-bladder sludge and wall irregularities also decreased following treatment, but persisted in many individuals. Two masses were observed in the right hepatic lobe of one individual who was previously considered normal. The findings suggest that gall-bladder abnormalities are reversible following elimination of liver fluke infection, but malignancies, once initiated, are not likely to be affected by treatment.
This paper presents a case study of the development, implementation and evaluation of an HIV prevention strategy for rural, married women in the northeastern, Isan region of Thailand. The strategy is based on established principles of behaviour change, social learning, and community health promotion; grounded in baseline research, that identifies relevant contextual factors; community-based; evaluated; and applicable elsewhere. The methodology of the project includes four phases: data collection, strategy design, implementation, and evaluation. Baseline data were collected from an age-stratified sample of married women from 24 randomly chosen villages in Khon Kaen province in two waves. A total of 654 women participated in structured face-to-face interviews and 150 also participated in focus groups. Using the baseline data, a health promotion strategy including three components was designed: meetings with and training of village leaders and health workers; a five-part week long audio-drama, together with posters and other publicity conducted in villages; and village meetings to discuss the potential impact of HIV/AIDS on the village and to establish a village strategy to address this. This paper reports the results of the baseline data collection, how the data were used to produce an HIV prevention initiative for rural villages, results of the process evaluation and future development in HIV/AIDS prevention initiatives in this region.
Revalidation -what is the problem and what are the possible solutions?TO THE EDITOR: Kerry Breen has hit the nail squarely on the head. 1 The Medical Board of Australia should heed Peter Ustinov's advice, "Don't just do something, stand there!"And Oliver Cromwell's plea, "think it possible you may be mistaken".And mine: "Please think again!"It is easier (more effective and cost-effective) to move the tail of the bell curve to the right than to shift the bulk of it to the right.While every doctor's performance could possibly be improved, there is little point and dubious costeffectiveness in improving doctors on the right of the bell curve from "good" or "very good" to "a little bit better", when the point of the exercise is to improve the game of poor performers.Alison Reid, former Medical Director of the New South Wales Medical Board, has suggested that the focus could readily be directed at doctors about whom there are a number of complaints, and at those in the groups known to be at risk: those with an impairment, the aged, and the professionally and geographically isolated. 2 It is among these groups that the evidence shows that poor performance is most likely to be found.It would seem to me that assessment of doctors in these groups, in their practices, as is done by the Royal Australasian College of Physicians in its clinical audit program, 3 would be more productive and cost-effective than wholesale assessment of all practising doctors.
Unpaid carers have a crucial role in supporting older people with cognitive impairment and disability, but their own health and wellbeing are often impacted. There are limited data on how carer strain, depression and empowerment may be improved for carers.This was a cluster randomised controlled trial to compare the effect of a carer support program developed with a community-based participatory action research (PAR) approach to the delivery of information sessions to 100 carers of people aged 45 years or more living in four remote Aboriginal communities in Western Australia.The mean age of carers was 38.3±14.9 years, 76% were female and 77% were children or grandchildren of the care recipient. Carer strain and empowerment measures did not change significantly between baseline and follow-up. A statistically significant decrease in depression scores was observed in the PAR group. However, decreases were observed in both the PAR and control groups, and the change in scores did not differ significantly between groups. Depression scores decreased most in those who had not attended high school. Overall, the proportion of participants meeting criteria for depression decreased from 18.8% at baseline to 8.3% at follow-up.A carer support program was of equivocal benefit, although this research demonstrates that the wellbeing of carers in remote Aboriginal communities can potentially be markedly improved by outreach strategies.
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