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Pisake Lumbiganon

Publications and source records attributed to Pisake Lumbiganon.

At least 19 recordsLinked to original sources
PubMed2006

Perinatal research in developing countries--is it possible?

Maternal mortality remains the health statistic for which there is the greatest disparity between developing and developed countries. The risk of stillbirth or neonatal death is also high in developing countries. The inequality of research funding between rich and poor countries is dramatic, with only 10% of research funding directed towards diseases which contribute 90% of the global burden of disease. The need for high-quality, relevant perinatal research in developing countries is compelling. There are many examples of good perinatal research in developing countries. Nevertheless, significant challenges remain and are being tackled. We need better information about maternal and perinatal health, and about performance of the health services, we need more evaluation of what helps and what harms within the existing health services, and we need improved strategies for implementation of research findings.

Biomedical Research↗
PubMed2006

Preeclampsia, gestational hypertension and intrauterine growth restriction, related or independent conditions?

OBJECTIVE: Preeclampsia, gestational hypertension, and unexplained intrauterine growth restriction may have similar determinants and consequences. In this study, we compared determinants and perinatal outcomes associated with these obstetric conditions. STUDY DESIGN: We analyzed 39,615 pregnancies (data from the WHO Antenatal Care Trial), of which 2.2% were complicated by preeclampsia, 7.0% by gestational hypertension, and 8.1% by unexplained intrauterine growth restriction (ie, not associated with maternal smoking, maternal undernutrition, preeclampsia, gestational hypertension, or congenital malformations). We compared the risk factors associated with these groups. Fetal death, preterm delivery, and severe neonatal morbidity and mortality were the primary outcomes. Logistic regression analyses were adjusted for study site, socioeconomic status, and (if appropriate) birth weight and gestational age. RESULTS: Diabetes, renal or cardiac disease, previous preeclampsia, urinary tract infection, high maternal age, twin pregnancy, and obesity increased the risk of both hypertensive conditions. Previous large-for-age birth, reproductive tract surgery, antepartum hemorrhage and reproductive tract infection increased the risk for gestational hypertension only. Independent of maternal age, primiparity was a risk factor only for preeclampsia. Both preeclampsia and gestational hypertension were associated with increased risk for fetal death and severe neonatal morbidity and mortality. Mothers with preeclampsia compared with those with unexplained intrauterine growth restriction were more likely to have a history of diabetes, renal or cardiac disease, chronic hypertension, previous preeclampsia, body mass index more than 30 kg/cm2, urinary tract infection and extremes of maternal age. Conversely, unexplained intrauterine growth restriction was associated with higher risk of low birth weight in previous pregnancies, but not with previous preeclampsia. Both conditions increased the risk for perinatal outcomes independently but preeclampsia was associated with considerable higher risk. CONCLUSION: Preeclampsia and gestational hypertension shared many risk factors, although there are differences that need further evaluation. Both conditions significantly increased morbidity and mortality. Conversely, preeclampsia and unexplained intrauterine growth restriction, often assumed to be related to placental insufficiency, seem to be independent biologic entities.

Female↗
PubMed2006

The International Infections in Pregnancy (IIP) study: variations in the prevalence of bacterial vaginosis and distribution of morphotypes in vaginal smears among pregnant women.

OBJECTIVE: The objective of the study was to determine the prevalence of bacterial vaginosis and the distribution of associated morphotypes among asymptomatic pregnant women in different countries. STUDY DESIGN: In 8 institutions participating in the Global Network for Perinatal and Reproductive Health (www.gnprh.org) from July 1999 to September 2001, 1466 women were enrolled. Vaginal smears were Gram stained and scored with Nugent's method at a reference laboratory. The prevalence of bacterial vaginosis and bacterial morphotype distributions were compared. RESULTS: Overall, 12.3% of women had bacterial vaginosis according to Nugent's criteria. Zimbabwe had the highest prevalence (24.4%) when compared with all other sites, except Myanmar (P < .05). Among bacterial vaginosis cases, 98.9% of vaginal smears had more than 30 Gardnerella/Bacteroides morphotypes present per oil immersion field. Individual centers showed significant differences in the number of Mobiluncus and lactobacillus morphotypes (P < .01). CONCLUSION: The prevalence of bacterial vaginosis and distribution of bacterial morphotypes in vaginal smears among asymptomatic pregnant women vary significantly in populations from different countries.

Actinomycetales Infections↗
PubMed2006

VIA and cryotherapy: doing what's best.

Cervical cancer kills about 6,000 Thai women annually and has been for decades. The age-standardized incidence ratio (ASR) is 20.9 per 100,000 women-years. A multi-province survey by the Thai National Cancer Institute found that coverage of the previous cervical cancer screening program (i.e. the opportunistic Pap smear) was only 5%. Visual inspection with acetic acid (VIA) and cryotherapy, a secondary prevention program, could be a more practical approach for cervical cancer prevention, particularly in low resource, rural, and remote settings. The authors are expanding this program throughout Thailand (in conjunction with the use of the Pap smear when appropriate) with an 80% coverage target. Using both approaches in a complementary fashion should significantly reduce the incidence and mortality of cervical cancer among Thai women.

Acetic Acid↗
PubMed2004

Cluster randomized trial of an active, multifaceted information dissemination intervention based on The WHO Reproductive health library to change obstetric practices: methods and design issues [ISRCTN14055385].

BACKGROUND: Effective strategies for implementing best practices in low and middle income countries are needed. RHL is an annually updated electronic publication containing Cochrane systematic reviews, commentaries and practical recommendations on how to implement evidence-based practices. We are conducting a trial to evaluate the improvement in obstetric practices using an active dissemination strategy to promote uptake of recommendations in The WHO Reproductive Health Library (RHL). METHODS: A cluster randomized trial to improve obstetric practices in 40 hospitals in Mexico and Thailand is conducted. The trial uses a stratified random allocation based on country, size and type of hospitals. The core intervention consists of three interactive workshops delivered over a period of six months. The main outcome measures are changes in clinical practices that are recommended in RHL measured approximately a year after the first workshop. RESULTS: The design and implementation of a complex intervention using a cluster randomized trial design are presented. CONCLUSION: Designing the intervention, choosing outcome variables and implementing the protocol in two diverse settings has been a time-consuming and challenging process. We hope that sharing this experience will help others planning similar projects and improve our ability to implement change.

Female↗
PubMed2004

Heterogeneity of perinatal outcomes in the preterm delivery syndrome.

OBJECTIVE: Our aim was to document the differential neonatal morbidity and intrapartum and neonatal mortality of subgroups of preterm delivery. METHODS: This analysis included 38,319 singleton pregnancies, of which 3,304 (8.6%) were preterm deliveries (less than 37 completed weeks) enrolled in the World Health Organization randomized trial of a new antenatal care model. We classified them as preterm deliveries after spontaneous initiation of labor, either with or without maternal obstetric and medical complications; preterm deliveries after prelabor spontaneous rupture of amniotic membranes (PROM), either with or without obstetric and medical complications; and medically indicated preterm deliveries with maternal obstetric and medical complications. Severe neonatal morbidity and neonatal mortality were the primary outcomes. RESULTS: Fifty-six percent of all preterm deliveries were spontaneous, without maternal complications. Small for gestational age was increased only among the medically indicated preterm delivery group (22.3%). Very early preterm delivery (less than 32 weeks of gestation) was highest among PROM with complications (37%). For intrapartum fetal death and neonatal death, after adjusting by gestational age and other confounding variables, we found that the obstetric and medical complications preceding preterm delivery predicted the different risk levels. Conversely, for severe neonatal morbidity the clinical presentation, ie, PROM or medically indicated, predicted the increased risk. CONCLUSION: There are differential neonatal outcomes among preterm deliveries according to clinical presentation, pregnancy complications, gestational age at delivery, and its association with small for gestational age. This syndromic nature of the condition should be considered if preterm delivery is to be fully understood and thus reduced.

Adolescent↗
PubMed2004

Effectiveness of vaginal douching on febrile and infectious morbidities after total abdominal hysterectomy: a multicenter randomized controlled trial.

OBJECTIVE: To evaluate the effectiveness of vaginal douching with 1 per cent povidone-iodine in reducing febrile and infectious morbidities after total abdominal hysterectomy (TAH). METHOD: The authors conducted a randomized controlled trial in 300 patients undergoing elective TAH in three hospitals in Northeast Thailand: a university, a regional and a general hospital. The patients were randomly allocated to the intervention or control groups. Patients in the intervention group received pre-operative vaginal douching with 1 per cent povidone-iodine while patients in the control group did not. External evaluators not apprised of the intervention assessed febrile and infectious morbidities. RESULTS: 300 patients were enrolled in the study. The incidences of febrile morbidity in patients with and without pre-operative vaginal douching were 25 and 35 per cent, respectively, though not statistically significant (risk difference -9.6%, 95% CI -19.9%, 0.8%, adjusted odds ratio 0.6, 95% CI 0.3%, 1.0%). A statistically significant difference in infectious morbidity was found between the groups (8 vs 19%, risk difference -10.0%, 95% CI -17.8%, -2.2%, adjusted odds ratio 0.4, 95% CI 0.2%, 0.9%). CONCLUSION: Pre-operative vaginal douching with 1 per cent povidone-iodine significantly reduces infectious morbidities after TAH.

Administration, Intravaginal↗
PubMed2004

From research to practice: the example of antenatal care in Thailand.

The rationale for providing antenatal care is to screen predominantly healthy pregnant women to detect early signs of, or risk factors for, abnormal conditions or diseases and to follow this detection with effective and timely intervention. The recommended antenatal care programme in most developing countries is often the same as the programmes used in developed countries. However, in developing countries there is wide variation in the proportion of women who receive antenatal care. The WHO randomized trial of antenatal care and the WHO systematic review indicated that a model of care that provided fewer antenatal visits could be introduced into clinical practice without causing adverse consequences to the woman or the fetus. This new model of antenatal care is being implemented in Thailand. Action has been required at all levels of the health-care system, from consumers through to health professionals, the Ministry of Public Health and international organizations. The Thai experience is a good example of moving research findings into practice, and it should be replicated elsewhere to effectively manage other health problems.

Developing Countries↗
PubMed2003

Womens' opinions on antenatal care in developing countries: results of a study in Cuba, Thailand, Saudi Arabia and Argentina.

BACKGROUND: The results of a qualitative study carried out in four developing countries (Cuba, Thailand, Saudi Arabia and Argentina) are presented. The study was conducted in the context of a randomised controlled trial to test the benefits of a new antenatal care protocol that reduced the number of visits to the doctor, rationalised the application of technology, and improved the provision of information to women in relation to the traditional protocol applied in each country. METHODS: Through focus groups discussions we were able to assess the concepts and expectations underlying women's evaluation of concepts and experiences of the care received in antenatal care clinics. 164 women participated in 24 focus groups discussion in all countries. RESULTS: Three areas are particularly addressed in this paper: a) concepts about pregnancy and health care, b) experience with health services and health providers, and c) opinions about the modified Antenatal Care (ANC) programme. In all three topics similarities were identified as well as particular opinions related to country specific social and cultural values. In general women have a positive view of the new ANC protocol, particularly regarding the information they receive. However, controversial issues emerged such as the reduction in the number of visits, particularly in Cuba where women are used to have 18 ANC visits in one pregnancy period. CONCLUSION: Recommendations to improve ANC services performance are being proposed. Any country interested in the application of a new ANC protocol should regard the opinion and acceptability of women towards changes.

Adult↗
PubMed2003

International survey on variations in practice of the management of the third stage of labour.

OBJECTIVE: To determine the use of the active management of the third stage of labour in 15 university-based obstetric centres in ten developing and developed countries and to determine whether evidence-based practices were being used. METHODS: From March 1999 to December 1999, the Global Network for Perinatal and Reproductive Health (GNPRH) conducted an observational, cross-sectional survey to assess the use of the practice and its components. Prospective data on patient characteristics and the interventions used in the management of the third stage of labour were collected using standardized methods. Data on approximately 30 consecutive vaginal deliveries in each centre (452 in total) were included. FINDINGS: Significant intracountry and intercountry variation in the practice of the active management of the third stage of labour was found (111/452 deliveries used active management), which confirmed the existence of a large gap between knowledge and practice. CONCLUSION: Areas identified for improvement are the urgent implementation of the evidence-based clinical management practice defined as the active management of the third stage of labour; increased accessibility to systematic reviews in developing countries; and the conduction of clinical trials that assess the impact of this intervention in other settings.

Cross-Sectional Studies↗
PubMed2003

Obstetricians' attitudes, subjective norms, perceived controls, and intentions on antibiotic prophylaxis in caesarean section.

Over 10% of current births in all countries of the world are delivered by caesarean section. Single-dose ampicillin or cefazolin administered after cord clamping has been proven to be effective for the prevention of post-caesarean infections as indicated in many randomised trials and reviews in the Cochrane Library. This study aimed to determine three determinants of behavioural intention using the theory of planned behaviour: attitudes, subjective norms, and perceived controls. Intentions were examined for five aspects of the use of antibiotic prophylaxis, namely whether or not antibiotics were used, used in all caesarean sections, after rather than before cord clamping, whether ampicillin/cefazolin or broader-spectrum antibiotics were used, and whether single or multiple doses were given. Fifty obstetricians selected from university, regional, and general hospitals in southern Thailand, were surveyed using a questionnaire and in-depth interview. Their intentions to use a single dose and to use in all cases were low, and this was related to negative attitudes and reference groups who did not approve of the single dose. The negative attitude was based on scepticism concerning the applicability of well-equipped trials from the developed world and fear of consequences of post-caesarean infections. Norms carried over from residency training had more long-term influence in their practice than newer information from books or journals. Perceived external controls on their practice were less predictive of intentions. Intentions were only partly predictive of behaviour. Changing attitudes, introducing evidence-based information into residency training and strengthening control systems in the hospital are essential to improve intentions.

Adult↗
PubMed2003

Iron status in anemic pregnant women.

AIM: A descriptive study at a tertiary care center was carried out to assess the prevalence of iron status in anemic pregnant women and to determine the appropriate iron supplement. METHODS: Eligible subjects were pregnant women with a hemoglobin concentration <11 g/dL. Pregnant women who received antenatal vitamin and/or iron supplements before blood testing and women with an underlying chronic disease were excluded. Hemoglobinopathy was defined by hemoglobin typing other than HbA2A, percentage of HbA2 >4%, and HbF >1.1%. We diagnosed iron deficiency and iron depletion if their serum ferritin were <12 and 20 ng/mL, respectively, whereas anemia from undetermined causes was defined by hemoglobin typing, namely: A2A, HbA2 <4% and HbF <1.1%, and serum ferritin >20 ng/mL. RESULTS: Among the 137 anemic pregnant women recruited, 67 (49.8%) had HbA2A, 47(34.3%) HbEA, 15 (10.9%) HbEE, 3 (2.2%) HbCSA2A, 2 (1.5%) HbCSEA, 1 (0.7%) HbCSA2A Bart's, 1 (0.7%) HbEA Bart's, and 1 (0.7%) beta-thalassemia. Among the 67 women with normal hemoglobin (HbA2A), 14 (20.9%) had iron deficiency, and 12 (17.9%) iron depletion. Among the 70 women with hemoglobinopathy, 6 (8.6%) had iron deficiency, and 10 (14.3%) iron depletion. CONCLUSIONS: Anemic pregnant women with hemoglobinopathy could also be iron deficient so will need iron supplementation, as other pregnant women do, and some iron replacement therapy.

Adolescent↗
PubMed2003

Infections in international pregnancy study: performance of the optical immunoassay test for detection of group B streptococcus.

We evaluated the Strep B optical immunoassay (OIA; ThermoBiostar, Inc.) for detecting light and heavy group B streptococcus colonization in 1,306 pregnant women. The women were examined at 20 to 32 weeks gestation and were from six countries. Compared to culture, the sensitivity and specificity of OIA were 13.3 and 98.4%, respectively, for light colonization and 41.5 and 97.7%, respectively, for heavy colonization.

Female↗
PubMed2002

Costs and benefits of different strategies to screen for cervical cancer in less-developed countries.

BACKGROUND: About 80% of cervical cancers occur in less-developed countries. This disproportionate burden of cervical cancer in such countries is due mainly to the lack of well-organized screening programs. Several cervical cancer screening strategies have been proposed as more cost-effective than cytology screening. We compared the costs and benefits of different strategies and their effectiveness in saving lives in a less-developed country. METHODS: We used a population-based simulation model to evaluate the incremental societal costs and benefits in Thailand of seven screening techniques, including visual inspection of the cervix after applying acetic acid (VIA), human papillomavirus (HPV) testing, Pap smear, and combinations of screening tests, and examined the discounted costs per year of life saved (LYS). RESULTS: Compared with no (i.e., not well-organized) screening, all strategies saved lives, at costs ranging from 121 US dollars to 6720 US dollars per LYS, and reduced mortality, by up to 58%. Comparing each strategy with the next least expensive alternative, VIA performed at 5-year intervals in women of ages 35-55 with immediate treatment if abnormalities are found was the least expensive option and saved the greatest number of lives, with a cost of 517 US dollars per LYS. HPV screening resulted in similar costs and benefits, if the test cost is 5 US dollars and if 90% of women undergo follow-up after an abnormal screen. Cytology (Pap smear) was a reasonable alternative if sensitivity exceeds 80% and if 90% of women undergo follow-up. Compared with no screening, use of a combination of Pap smear and HPV testing at 5-year intervals in women of ages 20-70 could achieve greater than 90% reduction in cervical cancer mortality at a cost of 1683 US dollars per LYS, and VIA could achieve 83% reduction at 524 US dollars per LYS. CONCLUSIONS: Well-organized screening programs can reduce cervical cancer mortality in less-developed countries at low costs. These cost-effectiveness data can enhance decision-making about optimal policies for a given setting.

Acetic Acid↗
PubMed2002

Are women and providers satisfied with antenatal care? Views on a standard and a simplified, evidence-based model of care in four developing countries.

BACKGROUND: This study assessed women and providers' satisfaction with a new evidence-based antenatal care (ANC) model within the WHO randomized trial conducted in four developing countries. The WHO study was a randomized controlled trial that compared a new ANC model with the standard type offered in each country. The new model of ANC emphasized actions known to be effective in improving maternal or neonatal health, excluded other interventions that have not proved to be beneficial, and improved the information component, especially alerting pregnant women to potential health problems and instructing them on appropriate responses. These activities were distributed within four antenatal care visits for women that did not need any further assessment. METHODS: Satisfaction was measured through a standardized questionnaire administered to a random sample of 1,600 pregnant women and another to all antenatal care providers. RESULTS: Most women in both arms expressed satisfaction with ANC. More women in the intervention arm were satisfied with information on labor, delivery, family planning, pregnancy complications and emergency procedures. More providers in the experimental clinics were worried about visit spacing, but more satisfied with the time spent and information provided. CONCLUSIONS: Women and providers accepted the new ANC model generally. The safety of fewer visits for women without complications with longer spacing would have to be reinforced, if such a model is to be introduced into routine practice.

Journal Article↗
PubMed2002

Current status of prophylactic use of antimicrobial agents for cesarean section in Thailand.

AIMS: To evaluate actual practices and physician reasons for variation in prophylactic use of antimicrobial agents for cesarean section (CS). METHODS: The study combined a survey of 2726 medical records and an interview of 50 practicing physicians at the obstetric departments of a university, a regional and a general hospital in Songkhla Province, Southern Thailand. RESULTS: Practices that were consistent with systematic reviews were use in 94%, prescription after cord clamping in 86%, and choosing ampicillin in 91%, because physicians believed in the advantages of these practices. Indications for prophylactic use ranged from routine use for all cases to selective use for indicated cases such as ruptured membranes, vaginal examinations, labor, maternal obesity, or unplanned CS. Single-dose practice was varied greatly across hospitals, from 9% to 84%. The reasons given by physicians for a multiple-dose regimen were personal experience in this regimen and belief in its superiority under their local conditions. This practice was less common where the hospital had practice recommendations. CONCLUSIONS: Not all evidence-based knowledge is adopted in practice. The prophylactic use of antimicrobial agents for CS varies among physicians. Past experience and personal beliefs in the limitation of research generalizability are the barriers to such adoption.

Adult↗