Pansatiankul Boonchian, Saisorn Supachai
Department of Pediatrics, Queen Sirikit National Institute of Child Health, Bangkok 10400, Thailand.
J Med Assoc Thai. 2003 Aug;86 Suppl 3:S576-82.
To describe a community-based model for prevention and control of thalassemias and haemoglobinopathies in northern Thailand.
Operational research composed of two components. First, a model to test whether thalassemic cases and carriers could be retrospectively detected from school children. Second, a model for prevention of prospective cases of thalassemic babies among pregnant women.
Phan District of Chiang Rai Province in northern Thailand.
Component one: 5,617 preschool children and 21,123 school children were screened during May and July 1997. Component two: 256 pregnant women, 16 weeks or less gestation were screened during January and December 1997.
Component one: Sub-district public health officers and school teachers were trained to use pictures and simple clinical examination to detect suspected thalassemics among preschool and school children. Suspected cases were then referred for further clinical examination and blood testing. Blood smear examination was done at the Phan Community Hospital but Hb typing lusing on electrophoresis was done at the provincial hospital. The cellulose acetate was sent for re-reading at the Department of Medical Sciences. Component two: Osmotic fragility (OF) and dichlorophenol-indolephenol (DCIP) tests were abol in pregnant women (< or = 16 weeks of gestation) in the Phan Community Hospital. If OF test was positive, Hb typing was done at a regional medical sciences center. Their spouses were also located and tested for Hb typing. Prenatal diagnosis was done and therapeutic abortion was offered, if indicated.
Cases, carriers, suspected cases, Hb typing, OF and DCIP tests.
In Component one: 26,740 children were screened of whom 893 cases were suspected. Out of those suspected, 296 (33.2%) were normal, 140 (15.6%) were diseased, and 457 (51.2%) were carriers. 56 cases had major thalassemia diseases. Their parents were counseled. Forty couples were determined to need some form of family planning and 39 (97.5%) accepted. In Component two: 256 pregnant women were screened and 56 were found to be carriers. Only 45 husbands could be located and Hb typed. Five couples were determined to require prenatal diagnosis (PND). One happened to undergo therapeutic abortion because of HIV infection in the mother without PND. Of the four who underwent PND, one was found to have a fetus with major thalassemia. However, this couple refused therapeutic abortion because of religious reasons.
This study combined both prospective and retrospective approaches and can be considered successful. However, as the only available option for pregnant women with affected fetuses is therapeutic abortion, this makes it difficult to expand the program because abortion may not be acceptable in certain communities. In addition, this model requires PND and other laboratory and clinical facilities as backups. Such backups may not be available in certain settings.
描述泰国北部基于社区的地中海贫血和血红蛋白病防控模式。
由两个部分组成的运筹学研究。第一，一个用于测试能否从学童中回顾性检测出地中海贫血病例和携带者的模式。第二，一个用于预防孕妇中地中海贫血婴儿未来病例的模式。
泰国北部清莱府攀县。
第一部分：1997年5月至7月期间，对5617名学龄前儿童和21123名学童进行了筛查。第二部分：1997年1月至12月期间，对256名妊娠16周及以内的孕妇进行了筛查。
第一部分：对分区公共卫生官员和学校教师进行培训，使其学会使用图片和简单临床检查来检测学龄前儿童和学童中的疑似地中海贫血患者。然后将疑似病例转诊进行进一步临床检查和血液检测。血液涂片检查在攀社区医院进行，但血红蛋白分型（采用电泳法）在省级医院进行。醋酸纤维素膜送至医学科学部进行复检。第二部分：在攀社区医院对妊娠16周及以内的孕妇进行渗透脆性（OF）和二氯酚靛酚（DCIP）试验。如果OF试验呈阳性，则在区域医学科学中心进行血红蛋白分型。还找到其配偶并进行血红蛋白分型检测。进行产前诊断，并在有指征时提供治疗性流产。
病例、携带者、疑似病例、血红蛋白分型、OF和DCIP试验。
在第一部分中：筛查了26740名儿童，其中893例为疑似病例。在这些疑似病例中，296例（33.2%）正常，140例（15.6%）患病，457例（51.
