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Tschirhart N, Jiraporncharoen W, Angkurawaranon C, Hashmi A, Hla S, Nosten S, McGready R, Ottersen T. Giving birth on the way to the clinic: undocumented migrant women's perceptions and experiences of maternal healthcare accessibility along the Thailand-Myanmar border. Reprod Health 2023; 20:178. [PMID: 38057915 DOI: 10.1186/s12978-023-01722-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/30/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Millions of women give birth annually without the support of a trained birth attendant. Generally and globally, countries provide maternal health services for their citizens but there is a coverage gap for undocumented migrant women who often can't access the same care due to their legal status. The objective of this investigation is to explore undocumented migrants' experiences and perceptions of maternal healthcare accessibility. METHODS We held focus groups discussions with 64 pregnant women at 3 migrant health clinics on the Thailand-Myanmar border and asked how they learned about the clinic, their health care options, travel and past experiences with birth services. In this context undocumented women could sign up for migrant health insurance at the clinic that would allow them to be referred for tertiary care at government hospitals if needed. RESULTS Women learned about care options through a network approach often relying on information from community members and trusted care providers. For many, choice of alternate care was limited by lack of antenatal care services close to their homes, limited knowledge of other services and inability to pay fees associated with hospital care. Women travelled up to 4 h to get to the clinic by foot, bicycle, tractor, motorcycle or car, sometimes using multiple modes of transport. Journeys from the Myanmar side of the border were sometimes complicated by nighttime border crossing closures, limited transport and heavy rain. CONCLUSIONS Undocumented migrant women in our study experienced a type of conditional or variable accessibility where time of day, transport and weather needed to align with the onset of labour to ensure that they could get to the migrant clinic on time to give birth. We anticipate that undocumented migrants in other countries may also experience conditional accessibility to birth care, especially where travel is necessary due to limited local services. Care providers may improve opportunities for undocumented pregnant women to access maternal care by disseminating information on available services through informal networks and addressing travel barriers through mobile services and other travel supports. Trial registration The research project was approved by Research Ethics Committee at the Faculty of Medicine, Chiang Mai University (FAM-2560-05204), and the Department of Community Medicine and Global Health at the University of Oslo-Norwegian Centre for Research Data (58542).
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Affiliation(s)
- Naomi Tschirhart
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada.
- Department of Family Medicine, Chiang Mai University, Chiang Mai, Thailand.
| | - Wichuda Jiraporncharoen
- Department of Family Medicine, Chiang Mai University, Chiang Mai, Thailand.
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, Thailand.
- Faculty of Medicine, Chiang Mai University, 110 Intawaroros Road, Si Phum, Muang, Chiang Mai, 50200, Thailand.
| | - Chaisiri Angkurawaranon
- Department of Family Medicine, Chiang Mai University, Chiang Mai, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, Thailand
| | - Ahmar Hashmi
- Institute for Implementation Science, University of Texas Health Sciences Center (UTHealth), Houston, TX, USA
- Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Sciences Center (UTHealth) Houston, Houston, TX, USA
| | | | - Suphak Nosten
- Borderland Health Foundation, Mae Sot, Tak, Thailand
| | - Rose McGready
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Trygve Ottersen
- Oslo Group on Global Health Policy, Department of Community Medicine and Global Health and Centre for Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
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Holst C, Tschirhart N, Ngowi B, Noll J, Winkler AS. Utilizing community InfoSpots for health education: perspectives and experiences in Migoli and Izazi, Tanzania. Health Promot Int 2023; 38:daab187. [PMID: 34897433 PMCID: PMC10439510 DOI: 10.1093/heapro/daab187] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Limited access to health education can be a barrier for reaching the Sustainable Development Goals, especially in rural communities in sub-Saharan Africa. We addressed this gap by installing community information spots (InfoSpots) with access to the internet and a locally stored digital health education platform (the platform) in Migoli and Izazi, Tanzania. The objective of this case study was to explore the perspectives and experiences of InfoSpot users and non-users in these communities. We conducted 35 semi-structured interviews with participants living, working or studying in Migoli or Izazi in February 2020 and subsequently analysed the data using content analysis. The 25 InfoSpot users reported variations in use patterns. Users with more education utilized the platform for their own health education and that of others, in addition to internet surfing. High school students also used the platform for practicing English, in addition to health education. Most InfoSpot users found the platform easy to use; however, those with less education received guidance from other users. Non-users reported that they would have used the InfoSpot with the platform if they had been aware of its existence. All participants reported a positive view of the digital health messages, especially animations as a health knowledge transfer tool. In conclusion, different and unintended use of the platform shows that the communities are creative in ways of utilizing the InfoSpots and gaining knowledge. The platform could have been used by more people if it had been promoted better in the communities.
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Affiliation(s)
- Christine Holst
- Centre for Global Health, Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, P.O box 1130, Blindern, 0318 Oslo, Norway
| | - Naomi Tschirhart
- Centre for Global Health, Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, P.O box 1130, Blindern, 0318 Oslo, Norway
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Thompson Hall - THN 136, 25 University Private, Ottawa, ON K1N 7K4, Canada
- Oslo Group on Global Health Policy, Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, P.O. box 1130, Blindern, 0318 Oslo, Norway
- Department of Family Medicine, Chiang Mai University, 239 Huay Kaew Road, Muang District, 50200 Chiang Mai Thailand, Thailand
| | - Bernard Ngowi
- Muhimbili Medical Research Centre, National Institute for Medical Research (NIMR), 3 Barack Obama Drive, P.O. box 9653, 11101 Dar es Salaam, Tanzania
- University of Dar es Salaam, Mbeya College of Health and Allied Sciences, P.O. box 608, Mbeya, Tanzania
| | - Josef Noll
- Basic Internet Foundation, Gunnar Randers vei 19, 2007 Kjeller, Norway
- Department of Technology Systems, University of Oslo, P.O box 70, 2027 Kjeller, Norway
| | - Andrea Sylvia Winkler
- Centre for Global Health, Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, P.O box 1130, Blindern, 0318 Oslo, Norway
- Center for Global Health, Department of Neurology, Technical University of Munich, Ismaninger Straße 22, 81675 München, Germany
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Tschirhart N, Jiraporncharoen W, Thongkhamcharoen R, Yoonut K, Ottersen T, Angkurawaranon C. Including undocumented migrants in universal health coverage: a maternal health case study from the Thailand-Myanmar border. BMC Health Serv Res 2021; 21:1315. [PMID: 34876107 PMCID: PMC8650330 DOI: 10.1186/s12913-021-07325-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 11/23/2021] [Indexed: 11/23/2022] Open
Abstract
Background Many countries aspiring to achieve universal health coverage struggle with how to ensure health coverage for undocumented migrants. Using a case study of maternal health care in a Thailand-Myanmar border region this article explores coverage for migrants, service provision challenges and the contribution of a voluntary health insurance program. Methods In 2018 we interviewed 18 key informants who provided, oversaw or contributed to maternal healthcare services for migrant women in the border region of Tak province, Thailand. Results In this region, we found that public and non-profit providers helped increase healthcare coverage beyond undocumented migrants’ official entitlements. Interview participants explained that Free and low-cost antenatal care (ANC) is provided to undocumented migrants through migrant specific clinics, outreach programs and health posts. Hospitals offer emergency birth care, although uninsured migrant patients are subsequently billed for the services. Care providers identified sustainability, institutional debt from unpaid obstetric hospital bills, cross border logistical difficulties and the late arrival of patients requiring emergency lifesaving interventions as challenges when providing care to undocumented migrants. An insurance fund was developed to provide coverage for costly emergency interventions at Thai government hospitals. The insurance fund, along with existing free and low-cost services, helped increase population coverage, range of services and financial protection for undocumented migrants. Conclusions This case study offers considerations for extending health coverage to undocumented populations. Non-profit insurance funds can help to improve healthcare entitlements, provide financial protection and reduce service providers’ debt. However, there are limits to programs that offer voluntary coverage for undocumented migrants. High costs associated with emergency interventions along with gaps in insurance coverage challenge the sustainability for NGO, non-profit and government health providers and may be financially disastrous for patients. Finally, in international border regions with high mobility, it may be valuable to implement and strengthen cross border referrals and health insurance for migrants. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07325-z.
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Affiliation(s)
- Naomi Tschirhart
- Oslo Group on Global Health Policy, Department of Community Medicine and Global Health and Centre for Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway. .,Interdisciplinary School of Health Sciences, Department of Health Sciences, University of Ottawa, Ottawa, Canada. .,Department of Family Medicine, Chiang Mai University, Chiang Mai, Thailand.
| | | | | | - Kulyapa Yoonut
- Department of Family Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Trygve Ottersen
- Oslo Group on Global Health Policy, Department of Community Medicine and Global Health and Centre for Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.,Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
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Karunananthan S, Maxwell LJ, Welch V, Petkovic J, Pardo JP, Rader T, Avey MT, Baptiste‐Ngobi J, Batista R, Curran JA, Ghogomu ET, Graham ID, Grimshaw JM, Ioannidis JPA, Jordan Z, Jull J, Lyddiatt A, Moher D, Petticrew M, Pottie K, Rada G, Shamseer L, Shea B, Siontis KC, Tschirhart N, Vachon B, Wells GA, White H, Tugwell P. PROTOCOL: When and how to replicate systematic reviews. Campbell Syst Rev 2020; 16:e1087. [PMID: 37131421 PMCID: PMC8356303 DOI: 10.1002/cl2.1087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
This is a protocol for a co-registered Cochrane and Campbell Review (Methodology). The objectives are as follows: To identify, describe and assess methods for: when to replicate a systematic review; how to replicate a systematic review.
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Affiliation(s)
| | | | - Vivian Welch
- Methods CentreBruyère Research InstituteOttawaCanada
| | | | - Jordi Pardo Pardo
- Centre for Practice‐Changing Research, Ottawa Hospital Research InstituteThe Ottawa Hospital ‐ General CampusOttawaCanada
| | - Tamara Rader
- Canadian Agency for Drugs and Technologies in Health (CADTH)OttawaCanada
| | - Marc T. Avey
- Global Health and Guidelines DivisionPublic Health Agency of CanadaOttawaCanada
| | | | | | | | | | - Ian D. Graham
- School of Epidemiology, Public Health and Preventative MedicineUniversity of OttawaOttawaCanada
| | - Jeremy M. Grimshaw
- Clinical Epidemiology ProgramOttawa Hospital Research InstituteOttawaCanada
| | - John PA. Ioannidis
- Stanford Prevention Research CenterDepartment of Medicine and Department of Health Research and PolicyPalo AltoCaliforniaUSA
| | - Zoe Jordan
- The Joanna Briggs InstituteAdelaideAustralia
| | - Janet Jull
- School of Rehabilitation Therapy, Faculty of Health SciencesQueen's UniversityKingstonCanada
| | | | - David Moher
- Ottawa Hospital Research InstituteOttawaCanada
| | - Mark Petticrew
- Department of Social & Environmental Health Research, Faculty of Public Health & PolicyLondon School of Hygiene and Tropical MedicineLondonUK
| | | | - Gabriel Rada
- Department of Internal Medicine and Evidence‐Based Healthcare Program, Faculty of MedicinePontificia Universidad Católica de ChileSantiagoChile
| | | | - Beverley Shea
- Department of Epidemiology and Community MedicineUniversity of OttawaOttawaCanada
| | | | | | - Brigitte Vachon
- School of Rehabilitation, Occupational Therapy ProgramUniversity of MontrealMontrealCanada
| | - George A. Wells
- School of Epidemiology and Public HealthUniversity of OttawaOttawaCanada
| | | | - Peter Tugwell
- Department of Medicine, Faculty of MedicineUniversity of OttawaOttawaCanada
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Tschirhart N, Jiraporncharoen W, Angkurawaranon C, Hashmi A, Nosten S, McGready R, Ottersen T. Choosing where to give birth: Factors influencing migrant women's decision making in two regions of Thailand. PLoS One 2020; 15:e0230407. [PMID: 32240176 PMCID: PMC7117675 DOI: 10.1371/journal.pone.0230407] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 03/01/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Choosing where to give birth can be a matter of life and death for both mother and child. Migrants, registered or unregistered, may face different choices and challenges than non-migrants. Despite this, previous research on the factors migrant women consider when deciding where to give birth is very limited. This paper addresses this gap by examining women's decision making in a respective border and urban locale in Thailand. METHODS We held focus group discussions [13] with 72 non-Thai pregnant migrant women at non-government clinics in a rural border area and at two hospitals in Chiang Mai, a large city in Northern Thailand in 2018. We asked women where they will go to give birth and to explain the factors that influenced their decision. RESULTS Women identified getting the relevant documentation necessary to register their child's birth, safe birth and medical advice/quality care, as the top three factors that influenced their care seeking decision making. Language of service, free or low cost care, language of services, proximity to home, and limited alternate options for care were also identified as important considerations. CONCLUSION Understanding factors that migrant women value when choosing where to deliver can help health care providers to create services that are responsive to migrants' preferences and encourage provision of relevant information which may influence patient decision making. The desire to obtain birth documentation for their child appears to be important for migrants who understand the importance of personal documentation for the lives of their children. Healthcare institutions may wish to introduce processes to facilitate obtaining documentation for pregnant migrant women and their newborns.
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Affiliation(s)
- Naomi Tschirhart
- Department of Community Medicine and Global Health and Centre for Global Health, Oslo Group on Global Health Policy, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | | | - Ahmar Hashmi
- Department of Family Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Rose McGready
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Trygve Ottersen
- Department of Community Medicine and Global Health and Centre for Global Health, Oslo Group on Global Health Policy, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
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Karunananthan S, Maxwell LJ, Welch V, Petkovic J, Pardo Pardo J, Rader T, Avey MT, Baptiste-Ngobi J, Batista R, Curran JA, Tanjong Ghogomu E, Graham ID, Grimshaw JM, Ioannidis JPA, Jordan Z, Jull J, Lyddiatt A, Moher D, Petticrew M, Pottie K, Rada G, Shamseer L, Shea B, Siontis K, Tschirhart N, Vachon B, Wells GA, White H, Tugwell P. When and how to replicate systematic reviews. Hippokratia 2020. [DOI: 10.1002/14651858.mr000052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Sathya Karunananthan
- Ottawa Hospital Research Institute; Clinical Epidemiology; 501 Smyth Rd Ottawa ON Canada K1H 8L6
| | - Lara J Maxwell
- University of Ottawa; Cochrane Musculoskeletal; Ottawa ON Canada
| | - Vivian Welch
- Bruyère Research Institute; Methods Centre; Ottawa ON Canada
| | - Jennifer Petkovic
- University of Ottawa; Bruyère Research Institute; 43 Bruyère St Annex E, room 312 Ottawa ON Canada K1N 5C8
| | - Jordi Pardo Pardo
- Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus; Centre for Practice-Changing Research; 501 Smyth Road, Box 711 Room L1258 Ottawa ON Canada K1H 8L6
| | - Tamara Rader
- Canadian Agency for Drugs and Technologies in Health (CADTH); 600-865 Carling Avenue Ottawa ON Canada
| | - Marc T Avey
- Public Health Agency of Canada; Global Health and Guidelines Division; 785 Carling Avenue, AL : 6809B 9th Floor, 919B2 Ottawa Ontario Canada K1A 0K9
| | | | | | - Janet A Curran
- IWK Health Centre; Interdisciplinary Research; 5850 University Ave PO Box 9700 Halifax NS Canada B3K 6R8
| | - Elizabeth Tanjong Ghogomu
- University of Ottawa; Bruyère Research Institute; 43 Bruyère St Annex E, room 312 Ottawa ON Canada K1N 5C8
| | - Ian D Graham
- University of Ottawa; School of Epidemiology, Public Health and Preventative Medicine; 600 Peter Morand Crescent Ottawa ON Canada
| | - Jeremy M Grimshaw
- Ottawa Hospital Research Institute; Clinical Epidemiology Program; The Ottawa Hospital - General Campus 501 Smyth Road, Box 711 Ottawa ON Canada K1H 8L6
| | - John PA Ioannidis
- Department of Medicine and Department of Health Research and Policy; Stanford Prevention Research Center; Stanford University School of Medicine Palo Alto California USA
| | - Zoe Jordan
- The Joanna Briggs Institute; Adelaide South Australia Australia
| | - Janet Jull
- Queen's University; School of Rehabilitation Therapy, Faculty of Health Sciences; Kingston ON Canada
| | - Anne Lyddiatt
- No affiliation; 28 Greenwood Road Ingersoll ON Canada N5C 3N1
| | - David Moher
- Ottawa Hospital Research Institute; Box 208, 501 Smyth Road Ottawa ON Canada K1H 8L6
| | - Mark Petticrew
- London School of Hygiene and Tropical Medicine; Department of Social & Environmental Health Research, Faculty of Public Health & Policy; 15-17 Tavistock Place London UK WC1H 9SH
| | - Kevin Pottie
- University of Ottawa; Family Medicine; 75 Bruyere St Ottawa ON Canada K1N 5C8
| | - Gabriel Rada
- Pontificia Universidad Católica de Chile; Department of Internal Medicine and Evidence-Based Healthcare Program, Faculty of Medicine; Lira 44, Decanato Primer piso Santiago Chile
| | - Larissa Shamseer
- Ottawa Hospital Research Institute; Box 208, 501 Smyth Road Ottawa ON Canada K1H 8L6
| | - Beverley Shea
- University of Ottawa; Department of Epidemiology and Community Medicine; 501 Smyth Road Ottawa ON Canada K1H 8L6
| | | | | | - Brigitte Vachon
- University of Montreal; School of Rehabilitation, Occupational Therapy Program; Montreal QC Canada
| | - George A Wells
- University of Ottawa; School of Epidemiology and Public Health; Ottawa Canada
| | - Howard White
- Campbell Collaboration; c/0 GD ISID Complex 110070 Vasant Kunj New Delhi India
| | - Peter Tugwell
- University of Ottawa; Department of Medicine, Faculty of Medicine; Ottawa ON Canada K1H 8M5
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Tschirhart N, Straiton M, Ottersen T, Winkler AS. "Living like I am in Thailand": stress and coping strategies among Thai migrant masseuses in Oslo, Norway. BMC Womens Health 2019; 19:139. [PMID: 31729987 PMCID: PMC6858645 DOI: 10.1186/s12905-019-0836-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 10/29/2019] [Indexed: 11/25/2022]
Abstract
Background Migrants experience stress before, during and after migrating to a new country, all of which influences their mental wellbeing. In Norway, migration from Thailand is highly gendered as most Thai migrants are women who migrate to live with their Norwegian spouse. Massage shops, often owned by Thai entrepreneurs, are a locale where women use their cultural knowledge to bridge into the local economy. There is little knowledge about Thai migrant masseuses’ experience of stress in daily life and associated coping strategies. The objective of this inquiry was to examine stressors and coping strategies among Thai migrant masseuses in Oslo, Norway. Methods We conducted in-depth interviews with 14 Thai migrants who were working as masseuses in Oslo, Norway. We asked participants about their health, experiences of stress, and coping strategies and subsequently analyzed the data using thematic analysis. Results Stress in participants’ lives related to settling in, loneliness, finances and spousal relationships. Of these, relationship conflict was the largest source of stress. Women largely embraced self-coping strategies and utilized Thai cultural practices and Buddhist cognitive thinking. Once relationship conflict became untenable, participants fought to change their situation. Limited fluency in Norwegian, Thai stigma about mental health and limited knowledge of the Norwegian health system were barriers to seeking healthcare. Conclusions Migrants in our study often adopted “Thainess”, the use of Thai cultural practices and Buddhist cognitive thinking, as a strategy for coping with stress. Preferences for self-coping, mental health stigma, and linguistic competency are important considerations when designing mental wellbeing interventions for Thai women. Use of an interpreter or systems navigator can help overcome language barriers. Clinicians can take detailed case histories to better understand Thai patients’ stress, coping strategies and wellbeing. Health policy makers could consider network approaches, including using Thai health systems navigators to bridge the health system and Thai communities.
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Affiliation(s)
- Naomi Tschirhart
- Oslo Group on Global Health Policy, Department of Community Medicine and Global Health and Centre for Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Postboks 1130 Blindern, 0318, Oslo, Norway.
| | - Melanie Straiton
- Department for Mental Health and Suicide, Norwegian Institute of Public Health, PO Box 222 Skøyen, 0213, Oslo, Norway
| | - Trygve Ottersen
- Oslo Group on Global Health Policy, Department of Community Medicine and Global Health and Centre for Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Postboks 1130 Blindern, 0318, Oslo, Norway. .,Division for Health Services, Norwegian Institute of Public Health, PO Box 222 Skøyen, 0213, Oslo, Norway.
| | - Andrea S Winkler
- Centre for Global Health, Institute of Health and Society, University of Oslo, Postboks 1130 Blindern, 0318, Oslo, Norway.,Department of Neurology, Center for Global Health, Technical University of Munich, Ismaninger Straße 22, 81675 Munich, Germany
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Tschirhart N, Nosten F, Foster AM. Migrant tuberculosis patient needs and health system response along the Thailand-Myanmar border. Health Policy Plan 2017; 32:1212-1219. [PMID: 28931117 PMCID: PMC5886238 DOI: 10.1093/heapol/czx074] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2017] [Indexed: 11/29/2022] Open
Abstract
This article aims to identify how the health system in Tak province, Thailand has responded to migrants' barriers to tuberculosis (TB) treatment. Our qualitatively driven multi-methods project utilized focus group discussions, key informant interviews, and a survey of community health volunteers to collect data in 2014 from multiple perspectives. Migrants identified legal status and transportation difficulties as the primary barriers to seeking TB treatment. Lack of financial resources and difficulties locating appropriate and affordable health services in other Thai provinces or across the border in Myanmar further contributed to migrants' challenges. TB care providers responded to barriers to treatment by bringing care out into the community, enhancing patient mobility, providing supportive services, and reaching out to potential patients. Interventions to improve migrant access and adherence to TB treatment necessarily extend outside of the health system and require significant resources to expand equitable access to treatment. Although this research is specific to the Thailand-Myanmar border, we anticipate that the findings will contribute to broader conversations around the inputs that are necessary to address disparities and inequities. Our study suggests that migrants need to be provided with resources that help stabilize their financial situation and overcome difficulties associated with their legal status in order to access and continue TB treatment.
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Affiliation(s)
- Naomi Tschirhart
- Faculty of Health Sciences, Interdisciplinary School of Health Sciences, University of Ottawa, 1 Stewart Street, Ottawa, ON, Canada K1N 6N5
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, PO Box 46, Mae Sot, Tak 63110, Thailand and
| | - Francois Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, PO Box 46, Mae Sot, Tak 63110, Thailand and
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Churchill Hospital, Oxford, UK
| | - Angel M Foster
- Faculty of Health Sciences, Interdisciplinary School of Health Sciences, University of Ottawa, 1 Stewart Street, Ottawa, ON, Canada K1N 6N5
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Tschirhart N, Thi SS, Swe LL, Nosten F, Foster AM. Erratum to: Treating the invisible: Gaps and opportunities for enhanced TB control along the Thailand-Myanmar border. BMC Health Serv Res 2017; 17:215. [PMID: 28302127 PMCID: PMC5356356 DOI: 10.1186/s12913-017-2113-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 02/23/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Naomi Tschirhart
- Faculty of Health Sciences, University of Ottawa, 1 Stewart Street, Ottawa, K1N 6N5, ON, Canada. .,Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, PO Box 46, Mae Sot, Tak 63110, Thailand.
| | - Sein Sein Thi
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, PO Box 46, Mae Sot, Tak 63110, Thailand
| | - Lei Lei Swe
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, PO Box 46, Mae Sot, Tak 63110, Thailand
| | - Francois Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, PO Box 46, Mae Sot, Tak 63110, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Churchill Hospital, Oxford, UK
| | - Angel M Foster
- Faculty of Health Sciences, University of Ottawa, 1 Stewart Street, Ottawa, K1N 6N5, ON, Canada
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Tschirhart N, Thi SS, Swe LL, Nosten F, Foster AM. Treating the invisible: Gaps and opportunities for enhanced TB control along the Thailand-Myanmar border. BMC Health Serv Res 2017; 17:29. [PMID: 28086877 PMCID: PMC5237139 DOI: 10.1186/s12913-016-1954-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 12/15/2016] [Indexed: 12/04/2022] Open
Abstract
Background In Thailand’s northwestern Tak province, contextual conditions along the border with Myanmar pose difficulties for TB control among migrant populations. Incomplete surveillance data, migrant patient mobility, and loss to follow-up make it difficult to estimate the TB burden and implement effective TB control measures. This multi-methods study examined tuberculosis, tuberculosis and human immunodeficiency virus co-infection, and multidrug-resistant tuberculosis treatment accessibility for migrants and refugees in Tak province, health system response, and public health surveillance. Methods In this study we conducted 13 interviews with key informants working in public health or TB treatment provision to elicit information on TB treatment availability and TB surveillance practices. In addition we organized 15 focus group discussions with refugee and migrant TB, TB/HIV, and MDR-TB patients and non-patients to discuss treatment access. We analyzed the data using thematic analysis and created treatment availability maps with Google maps. Results The study identified surveillance, treatment, and funding gaps. Migrant TB cases are underreported in the provincial statistics due to jurisdictional interpretations and resource barriers. Our results suggest that TB/HIV and MDR-TB treatment options are limited for migrants and a heavy reliance on donor funding may lead to potential funding gaps for migrant TB services. We identified several opportunities that positively contribute to TB control in Tak province: improved diagnostics, comprehensive care, and collaboration through data sharing, planning, and patient referrals. The various organizations providing TB treatment to migrant and refugee populations along the border and the Tak Provincial Public Health Office are highly collaborative which offers a strong foundation for future TB control initiatives. Conclusions Our findings suggest the need to enhance the surveillance system to include all migrant TB patients who seek treatment in Tak province and support efforts by stakeholders on both sides of the border to continue to share data and engage in collaborative planning on TB, TB/HIV, and MDR-TB treatment provision for migrant populations.
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Affiliation(s)
- Naomi Tschirhart
- Faculty of Health Sciences, University of Ottawa, 1 Stewart Street, Ottawa, K1N 6N5, ON, Canada. .,Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, PO Box 46, Mae Sot, Tak, 63110, Thailand.
| | - Sein Sein Thi
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, PO Box 46, Mae Sot, Tak, 63110, Thailand
| | - Lei Lei Swe
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, PO Box 46, Mae Sot, Tak, 63110, Thailand
| | - Francois Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, PO Box 46, Mae Sot, Tak, 63110, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Churchill Hospital, Oxford, UK
| | - Angel M Foster
- Faculty of Health Sciences, University of Ottawa, 1 Stewart Street, Ottawa, K1N 6N5, ON, Canada
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Tschirhart N, Sein T, Nosten F, Foster AM. Migrant and Refugee Patient Perspectives on Travel and Tuberculosis along the Thailand-Myanmar Border: A Qualitative Study. PLoS One 2016; 11:e0160222. [PMID: 27509036 PMCID: PMC4980053 DOI: 10.1371/journal.pone.0160222] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 07/17/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The Thailand-Myanmar border separates two very different health systems. The healthcare system in eastern Myanmar remains underdeveloped as a result of decades of instability. Comparatively, Tak province, Thailand has more healthcare resources. In this Thai border province government hospitals and non-governmental organizations provide tuberculosis (TB) treatment to migrants and refugees. OBJECTIVES Our overall study aimed to explore accessibility of TB treatment, TB surveillance and health system responsiveness specific to migrant and refugee populations in Tak province. In this paper, we focus on the perspectives of migrant and refugee TB patients with respect to travel and treatment in Tak province. METHODS In 2014 we conducted focus group discussions with 61 TB, Tuberculosis and Human Immunodeficiency Virus co-infection, and multidrug-resistant TB patients in Tak province. We analyzed the data for content and themes and documented individual travel trajectories. RESULTS AND DISCUSSION Migrants are travelling with active TB within the country and between Thailand and Myanmar. Migrants primarily travelled to obtain treatment but two participants reported travelling home to seek family care in Myanmar before returning to Thailand for treatment. Travel, while expensive and arduous, is an adaptive strategy that migrants use to access healthcare. CONCLUSIONS Migrant's need for travel points to larger difficulties associated with healthcare access in the border region. Long distance travel with an infectious disease can be seen as an indicator that local healthcare is not available or affordable. These findings suggest that public health officials from both sides of the border should discuss the factors that contribute to travel with active TB and explore potential solutions to mitigate disease transmission in migrant populations.
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Affiliation(s)
- Naomi Tschirhart
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- * E-mail:
| | - Tabitha Sein
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Francois Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Angel M. Foster
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
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Abstract
This paper examines the convergence of HIV/AIDS and the social processes through which women access customary land in rural Malawi. Data were collected from focus group discussions with women in patrilineal and matrilineal communities. Women's land tenure is primarily determined through kinship group membership, customary inheritance practices and location of residence. In patrilineal communities, land is inherited through the male lineage and women access land through relationships with male members who are the rightful heirs. Conversely in matrilineal matrilocal communities, women as daughters directly inherit the land. This research found that in patrilineal communities, HIV/AIDS, gendered inequalities embedded in customary inheritance practices and resource shortages combine to affect women's access to land. HIV/AIDS may cause the termination of a woman's relationship with the access individual due to stigma or the individual's death. Termination of such relationships increases tenure insecurity for women accessing land in a community where they do not have inheritance rights. In contrast to the patrilineal patrilocal experience, research on matrilineal matrilocal communities demonstrates that where women are the inheritors of the land and have robust land tenure rights, they are not at risk of losing their access to land due to HIV/AIDS.
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Affiliation(s)
- Naomi Tschirhart
- a MPhil, Centre for Property Studies , University of New Brunswick , Fredericton , New Brunswick , Canada
| | - Lucky Kabanga
- b MSc, Lecturer at the Department of Land Management , Mzuzu University , Mzuzu , Malawi
| | - Sue Nichols
- c PhD, Professor Emeritus at the Department of Geodesy and Geomatics Engineering , University of New Brunswick , Fredericton , NB , Canada
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