Knowledge, Cultural, and Structural Barriers to Thalassemia Screening in Migrant Populations in Thailand
Background: Thalassemia is a devastating inherited hematological disorder, and as a result of population migration, has become a global public health problem. Thailand has one of the highest burdens of thalassemia in the world and has developed a successful prevention and control program, but nearly 4 million migrants living in Thailand are excluded. Strategies for thalassemia screening in migrants are needed. This study aims to characterize migrants' awareness and knowledge of and attitudes toward thalassemia screening. Methods: 300 adult Myanmar or Cambodian migrant workers and 200 adult Thai citizens residing in the industrial province of Chonburi, Thailand were enrolled and given a demographic and KAP (Knowledge, Attitudes, and Practices) survey on thalassemia. Descriptive statistics, tabulations, Wilcoxon Rank Sum Tests, Kruskal-Wallis Test, and Chi-Square analysis were used to compare socio-demographic variables and levels of thalassemia awareness between migrant and Thai subjects. Results: Myanmar and Cambodian subjects had very low awareness of thalassemia, in contrast with Thai subjects (4.1% vs 79.6%, respectively). Migrants also had lower knowledge of thalassemia, but showed strong interest in thalassemia screening. Gender and education level predicted thalassemia awareness in Thai subjects, but length of residence in Thailand was the only demographic variable associated with awareness in migrants. Conclusions: This study revealed a tremendous awareness gap between Thai and migrant populations surrounding thalassemia, suggesting that public education is a crucial starting point for a thalassemia prevention and control program in migrants. A number of structural and cultural barriers identified in this study will also need to be addressed.
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