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Health Situation of Akha Hill Tribe in Chiang Rai Province, Thailand

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Health Situation of Akha Hill Tribe in Chiang Rai Province, Thailand Journal of Public Health and Development Vol. 14 No. 1 January-April 2016 GENERAL ARTICLE Health situation of Akha Hill Tribe in Chiang Rai Province, Thailand Tawatchai Apidechkul1, Pilasinee Wongnuch2, Siriyaporn Sittisarn3 and Thapakorn Ruanjai4 1 Dr.P.H.(Epidemiology), School of Health Science, Mae Fah Luang University, Thailand, Center of Excellence for the Hill tribe Health Research, Mae Fah Luang University, Thailand 2 M.Sc (Counseling Psychology), School of Health Science, Mae Fah Luang University, Thailand, Center of Excellence for the Hill tribe Health Research, Mae Fah Luang University, Thailand 3 M.Sc (Public Health), School of Health Science, Mae Fah Luang University, Thailand, Center of Excellence for the Hill tribe Health Research, Mae Fah Luang University, Thailand 4 M.Sc.(Public Health), School of Health Science, Mae Fah Laung University, Thailand Corresponding author: Tawatchai Apidechkul Email: [email protected], [email protected] Received: 24 March 2016 Revisde: 21 June 2016 Accepted: 29 June 2016 Available online: June 2016 Abstract Apidechkul T, Wongnuch P, Sittisarn S and Ruanjai T. Health situation of Akha Hill Tribe in Chiang Rai Province, Thailand J Pub Health Dev.2016;14(1):77-97 Akha is one of six main hill tribe groups living in northern Thailand, and approximately 150,000 persons in 2014. This study was to assess the Akha population health status who lived in Chiang Rai province. A cross-sectional study design was applied. Totally, 550 participants were recruited into the study by a cluster sampling from 20 of 243 Akha villages from Chiang Rai Province, Thailand. Participants were grouped into 8 aged clusters; 0-1 year old, 1-5 years old, 6-12 years old, males aged 13-25 years old, females aged 13-44 years old, males aged 26-60 years old, females aged 45-60 years old, and aged ≥ 60 years old. Data were obtained by validated questionnaires which included general information, history of vaccination, child development assessment, child and mother health assessment, and family planning, etc. Results showed among chlidren aged < 1 year old; 30.0% received Measle Mumps, and Rubella (MMR) vaccine, 70.0% received the 3rd dose of Diptheria, Tetanus, and Pertussis/ Polio vaccine (DTP/OPV). Children aged 1-5 years old; 90.0% gave birth at home, 40.0% received the 5th dose of DTP/OPV, and only 4.0% had been assessed health development regarding to the Ministry of Public Health (MOPH) protocol Children aged 6-12 years old; 22.04% had health development assessment, 66.0% had dental carries. Men aged 13-25 years old; 28.0% smoked, 18.0% drank alcohol and 26.0% used marijuana, 64.3% had sexual experience before aged 16 years old. Women aged 13-44 years old; 56.0% were illiterate, 50.0% did not receive antenatal clinic (ANC) during their pregnancies, 64.3% gave birth at home by un-trained midwives, 7.1% received three doses of Tetanus Toxoid (TT) during pregnancy, 12.5% had been screened a PAP smear. Men aged 26-60 years old; 78.0 % were illiterate, 28.0% could not communicate in Thai, 62.0% smoked, 64.0% drank alcohol. Women aged 45-60 years old; 92.0% were illiterate, 92.0% could not communicate in Thai, 84.0% ate raw food. Those aged ≥ 60 years old; 100.0% were illiterate and 74.0% could not communicate in Thai. Akha people in Thailand are having many risk behaviors and difficulty accessing health care due to language barrier. There is an urgent need to develop a proper health promotion program to reduce susceptibility to diseases. Keywords: Akha, Hill tribe, Health status, Thailand 77 วารสารสาธารณสุขและการพัฒนา ปีที่ 14 ฉบับที่ 1 มกราคม-เมษายน 2559 สถานะสุขภาพชาวอาข่า จังหวัดเชียงราย ประเทศไทย ธวัชชัย อภิเดชกุล1 พิลาสินี วงษ์นุช2 ศิริญาพร สิทธิสาร3 และฐาปกรณ์ เรือนใจ4 1 Dr.P.H.(Epidemiology), ส�านักวิชาวิทยาศาสตร์สุขภาพ มหาวิทยาลัยแม่ฟ้าหลวง ประเทศไทย 1 ศูนย์ความเป็นเลิศการวิจัยสุขภาพชาวเขา มหาวิทยาลัยแม่ฟ้าหลวง ประเทศไทย 2 M.Sc (Counseling Psychology), ส�านักวิชาวิทยาศาสตร์สุขภาพ มหาวิทยาลัยแม่ฟ้าหลวง ประเทศไทย 2 ศูนย์ความเป็นเลิศการวิจัยสุขภาพชาวเขา มหาวิทยาลัยแม่ฟ้าหลวง ประเทศไทย 3 M.Sc (Public Health), ส�านักวิชาวิทยาศาสตร์สุขภาพ มหาวิทยาลัยแม่ฟ้าหลวง ประเทศไทย 3 ศูนย์ความเป็นเลิศการวิจัยสุขภาพชาวเขา มหาวิทยาลัยแม่ฟ้าหลวง ประเทศไทย 4 MSc(Public Health), ส�านักวิชาวิทยาศาสตร์สุขภาพ มหาวิทยาลัยแม่ฟ้าหลวง ประเทศไทย บทคัดย่อ ธวัชชัย อภิเดชกุล พิลาสินี วงษ์นุช ศิริญาพร สิทธิสาร และฐาปกรณ์ เรือนใจ สถานะสุขภาพชาวอาข่า จังหวัดเชียงราย ประเทศไทย ว. สาธารณสุขและการพัฒนา. 2559;14(1):77-97 ชาวอาข่าเป็นชาวเขากลุ่มหนึ่งที่อาศัยอยู่ทางภาคเหนือของประเทศไทย ซึ่งมีประมาณ 150,000 คนในปี 2557 โดย ในการศึกษาครั้งนี้มีวัตถุประสงค์เพื่อประเมินภาวะสุขภาพของชาวอาข่าโดยวิธีศึกษาแบบภาคตัดขวาง กลุ่มตัวอย่างทั้งหมด 550 คน สุ่มคัดเลือกจาก 20 หมู่บ้านจากทั้งหมด 243 หมู่บ้านของอาข่าในจังหวัดเชียงราย กลุ่มตัวอย่างแบ่งออกเป็น 8 กลุ่มอายุ กล่าวคือ เด็กอายุ 0-1 ปี เด็กอายุ 1-5 ปี เด็กอายุ 6-12 ปี ผู้ชายอายุ 13-25 ปี ผู้หญิงอายุ 13-44 ปี ผู้ชายอายุ 26-60 ปี ผู้หญิงอายุ 45-60 ปี และกลุ่มอายุ 60 ปีขึ้นไป ข้อมูลเก็บด้วยแบบสอบถามที่ผ่านการทดสอบคุณภาพ ข้อมูลที่ เก็บประกอบด้วย ข้อมูลทั่วไป ประวัติการรับวัคซีน การประเมินพัฒนาการเด็ก การประเมินสุขภาพอนามัยแม่และเด็ก การวางแผนครอบครัวเป็นต้น ผลการวิจัยพบว่า ในกลุ่มเด็กอายุต�่ากว่า 1 ปี ได้รับวัคซีน MMR ร้อยละ 30.0 และร้อยละ 70.0 ได้ DTP/ OPV 3 ครั้ง กลุ่มเด็ก 1-5 ปี ร้อยละ 90.0 คลอดที่บ้าน ร้อยละ 40.0 ได้รับวัคซีน DTP/OPV เข็มที่ 5 ร้อยละ 4.8 ได้รับการประเมินพัฒนาการตามแบบประเมินกระทรวงสาธารณสุข และร้อยละ 66.0 มีฟันผุ ในกลุ่ม 6-12 ปี ร้อยละ 22.0 ได้รับการประเมินพัฒนาการ และร้อยละ 66.0 มีฝันผุ ในกลุ่มชายอายุ 13-25 ปี ร้อยละ 28.0 สูบบุหรี่ ร้อยละ 18.0 ดื่มสุราและร้อยละ 26.0 เสพกัญชา ร้อยละ 40.0 มีประวัติมีเพศสัมพันธ์ก่อนอายุ 16 ปี ในกลุ่ม หญิงอายุ 13-44 ปี ร้อยละ 56.0 ไม่ได้เรียนหนังสือ ร้อยละ 64.3 ไม่ได้รับการดูแลขณะตั้งครรภ์ ร้อยละ 64.3 คลอดที่ บ้านโดยหมอต�าแย ร้อยละ 7.1 ได้รับวัคซีน TT ครบ 3 ครั้งช่วงตั้งครรภ์ ร้อยละ 12.5 ได้รับการตรวจคัดกรองมะเร็ง ปากมดลูก ในกลุ่มผู้ชาย 26-60 ปี ร้อยละ 78.0 ไม่ได้เรียนหนังสือ ร้อยละ 28.0 ไม่สามารถสื่อสารภาษาไทยได้ ร้อยละ 62.0 สูบบุหรี่ ร้อยละ 64.0 ดื่มสุรา ในกลุ่มหญิงอายุ 45-60 ปี ร้อยละ 92.0 ไม่ได้เรียนหนังสือ ร้อยละ 92.0 ไม่สามารถ สื่อสารภาษาไทยได้ ร้อยละ 84.0 กินอาหารสุกๆ ดิบๆ ในกลุ่มอายุตั้งแต่ 60 ปีขึ้นไป ร้อยละ 100.0 ไม่ได้เรียนหนังสือ ร้อยละ 94.0 ไม่สามารถสื่อสารภาษาไทยได้ ชาวอาข่าในประเทศไทยมีพฤติกรรมเสี่ยงหลายอย่างและมีความยากล�าบากในการเข้าถึงสุขภาพเนื่องจากความสามารถ ในการใช้ภาษาไทย เราควรพัฒนาโครงการส่งเสริมสุขภาพในกลุ่มประชากรเหล่านี้ที่เหมาะสมเพื่อให้เกิดสุขภาพดีและ มีความยั่งยืนต่อไป ค�าส�าคัญ: อาข่า ชาวเขา ภาวะสุขภาพ ประเทศไทย 78 Journal of Public Health and Development Vol. 14 No. 1 January-April 2016 Introduction system while getting health problems together with Health is a status of complete physical, mental, using their own traditional belief and medical systems. and social well-being and not merely the absence Akha is one of a Lo-Lo group who have original of diease and infirmity1. Thailand has a good health residence in southern China6. Akha language is a care system and health care facilities for providing Tibatient-Burman which is in a Burmese-Loloish health care services for its citizens. Generally, health branch6. There is little documentation about the health care system provided in Thailand is for everyone in status of Akha people in Thailand. The objective of the country, however, there is need to evaluate the this study was to investigate the health status by health status of some groups like the hill tribe in pooling the subjects from different age categories order to improve the health care system. Hill tribe to draw a whole picture of the Ahka people health people are non-Thais living in the mountainous areas in Thailand. in 16 provinces in northern Thailand. They have been migrating to and formed settlements along the Thai Methods border areas for many decades2. Their settlements A cross sectional study design aimed to assess are gradually becoming more permanent with later health status of the Akha people who lived in Chiang generations but there is still a tradition of hill tribe Rai Province, Thailand. A validated questionnaire people crisscrossing the border according to their was used for assessing health status in different age economic, cultural or political necessity from time categories. to time. Their villages are often in very remote areas making applying for a house registration or address Study design either difficult or unnecessary. Their status is rather A cross-sectional study design was carried out like one of alien refugees even well into a second to assess the health status of the Akha people from or third generation of immigrants. 20 selected Akha villages in Chiang Rai Province. The hill tribe in Thailand is divided into six main groups: Akha Lahu, Lisu, Kmong, Yao, and Karen. Study sites There are having different cultures, languages, and In 2013, there were 243 Akha villages in Chiang beliefs particularly in health care practices3,4. Akha Rai Province7. The simple random sampling technique tribe is the greatest group of the hill tribe, migrated by computer program was used for selecting 20 of from the South China to Thailand since 150 years 243 Akha villages in Chiang Rai Province to be the ago, and living in 5 major provinces in Thailand: study sites, with results as follows: Chiang Rai, Chiang Mai, Tak, Phrae, and Lampang a) Six villages from Muang District; Hua Kum provinces. Akha people predominately lives in Chiang Nai (312 males, and 214 females), Ban Ruam Mit Rai Province with totally 243 villages in 2014; 12,564 (225 males, and 290 females), Ban Pa Na Sa Wan households, and 68,897 populations
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