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Evaluation of Leptospirosis Risk Reduction Project in Northeast Thailand

Shioda, Kayoko (2014)
Master's Thesis (126 pages)
Committee Chair / Thesis Adviser: Sullivan, Patrick S
Committee Members:
Research Fields: Health Sciences, Epidemiology; Health Sciences, Public Health
Partnering Agencies: International governmental organization (e.g., Agency for International Development, etc.) ; Non-US governmental agency (e.g., Minister of Health in Haiti) ; Emory University schools, faculty or affiliated programs
Keywords: Leptospiroris; Northeast Thailand; Project evaluation; KAP study
Program: Rollins School of Public Health, Epidemiology (Epidemiology)
Permanent url: http://pid.emory.edu/ark:/25593/g0zkq

Abstract

Background: The number of leptospirosis has been considerably increasing in these decades in Thailand, and 90% were reported from the northeast region. Therefore, a project was launched to reduce the risk of leptospirosis by providing villagers with basic knowledge of the disease and personal protective equipment in northeast Thailand. Objective: This study aims to evaluate the efficacy of the intervention by assessing villagers' improvement of knowledge, attitudes, and practices regarding control of leptospirosis using a questionnaire. Methods: One thousand randomly recruited villagers in South Korn Buri subdistrict in Nakornratchsrima Province received the intervention and answered the questionnaire before and three months after the education campaign delivered by the trained village health volunteers. Two hundred and fifty randomly selected villagers in Bantoom subdistrict in Khon Kaen Province answered the same questionnaire twice without receiving any intervention. Paired t tests were performed to compare the scores of knowledge, attitudes, and practices before and after the intervention. Multiple linear regression (MLR) models were created whose outcomes were the score changes of knowledge, attitudes, and practices, and the primary exposure was the presence of intervention. Results: In the intervention group, the score of knowledge (score range: 0 to 22) increased by 0.94 points (95%CI: 0.73 to 1.15), and the score of practices (score range: 0 to 48) increased by 1.81 points (95%CI: 1.41 to 2.21) after the intervention, on average (both p<.0001). The score of attitudes (score range: 0 to 10 for field workers, 0 to 6 for non-field workers) increased by 0.27 (95%CI: 0.14 to 0.40, p<.0001) among field workers, but did not change among non-field workers. According to the MLR models, receiving the intervention had positive associations with the improvement of knowledge, attitudes, and practices among both field workers and non-field workers, after adjusting for potential confounders, except the attitudes among non-field workers. Discussion: This study demonstrated that the intervention with narrow budget and limited human resources could improve villagers' knowledge, attitudes, and practices regarding prevention of leptospirosis. It could be a model to control preventable infectious diseases at a community level, which could be easily applied to other regions in Thailand.

Table of Contents

List of Tables .......................................................................ii -- List of Figures .....................................................................iv -- CHAPTER I - BACKGROUND AND LITERATURE REVIEW ..........1 -- 1-1. Background and Description of the Project ..........................2 -- 1-2. Study Site .....................................................................5 -- 1-3. Leptospirosis .................................................................9 -- 1-4. Village Health Volunteers ...............................................16 -- 1-5. References ..................................................................19 -- CHAPTER II - PILOT STUDY ................................................22 -- 2-1. Study Objectives ...........................................................23 -- 2-2. Methodology .................................................................23 -- 2-3. Results ........................................................................26 -- 2-4. Discussion and Future Directions ......................................31 -- Tables and Figures ...............................................................35 -- Appendix 2-A: Original Questionnaire ......................................44 -- Appendix 2-B: Program of One-day Workshop ...........................50 -- Appendix 2-C: Poster of Leptospirosis ......................................51 -- CHAPTER III - IMPLEMENTATION STUDY .............................52 -- 3-1. Study Objectives ...........................................................53 -- 3-2. Research Hypotheses .....................................................54 -- 3-3. Methodology .................................................................55 -- 3-4. Results ........................................................................63 -- 3-5. Discussion ....................................................................79 -- Tables and Figures ................................................................87 -- Appendix 3-A: Revised Questionnaire ......................................109 -- Appendix 3-B: Letter from Emory Institutional Review Board .......116

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