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KKU Faculty of Public Health Journal of

Community Research

Volume 5, Spring 2017



KKU Faculty of Public Health Journal of Community Research, Vol. 5 1

Table of Contents
Concerns, Uses, and Home Treatment of the Community Water Supply
System in Ban Tha Pho, Thailand .................................................................... 2
Hsa Hser Ku, Sara Mar, Abbey Marino

Risk Factors for Dog Biting and Owners’ Knowledge of Responsible Dog
Ownership ........................................................................................................ 10
Aja Beckham, Victoria Lai, Olivia Rainer

Strengths and Weaknesses of Farmers’ Health in Rural Thai Village:


Community Development of a Survey Instrument ....................................... 18
Cristeen Anyanwu, Brennan Torpey, Avanti Mohan
KKU Faculty of Public Health Journal of Community Research, Vol. 5 2

Concerns, Uses, and Home Treatment of the


Community Water Supply System in Ban Tha
Pho, Thailand

Hsa Hser Kua, Sara Mar b, Abbey Marinoc


a
College of Liberal Arts, Bethel University, Saint Paul, MN USA
b
School of Public Health, University of Washington, Seattle, WA USA
c
College of Arts & Sciences, The University of Tulsa, Tulsa, OK USA

Abstract. Aims: The objectives of this investigation were to identify common uses of the community water supply in the vil-
lage of Ban Tha Pho and to determine community members’ concerns and behaviors regarding the water supply. Methods:
One focus group and 30 semi-structured interviews were conducted. The participants in the focus group were sampled pur-
posefully, including the village headman, the headman assistant, head VHV, and one worker from the water treatment plant.
Participants for the semi-structured interviews were selected using stratified convenience sampling. Results: In Ban Tha Pho,
22 people (73.3%) stated the cleanliness of water was a concern, such as seeing dirt and dust in the water. Reports of foul-
smelling water, especially during the summer, was a concern for 12 participants (40%). At-home water treatment methods are
used by one-third of the villagers interviewed. The two methods used were alum and a cloth. The community water supply is
not used as a source of drinking water. Rainwater was the most common drinking water source (75%), followed by the weekly
water truck. Conclusion: Increasing knowledge of water treatment methods may be beneficial in addressing community mem-
bers’ concerns about the water supply quality in Ban Tha Pho.

Keywords: water supply, water treatment, alum, rainwater


KKU Faculty of Public Health Journal of Community Research, Vol. 5 3

1.0 Introduction and is used in rural areas of Northeastern Thailand


for domestic purposes. Due to seasonal heavy rains,
Water contamination is a major environmental villagers can collect large quantities of water to last
problem in Thailand that is exacerbated by the through the dry season given proper storage and
growing population and booming industrial sector collection methods (Pinfold, Horan, Wirojanagud, &
(Singkran, 2017). Increases in land clearing and Mara, 1992). Rainwater quality is a concern, as it
farming practices has contributed to soil erosion in can be contaminated with organic material, chemi-
agricultural areas which has negatively impacted the cals from atmospheric deposition, and fecal material
water quality. Elevated levels of suspended solids in from animals who defecate around the storage tanks
the water from erosion affects the turbidity, thus and on rooftops (Kwaadsteiniet et al., 2013).
limiting its usages and decreasing the water quality
(Sthiannopkao, Takizawa,Homewong, & Wirojana- 1.2. Water Treatment Technologies in Developing
gud, 2006). Furthermore, agricultural runoff is a Countries
concern in rural communities, especially during
times of heavy rainfall. The water may be contami- Water contaminants can be removed by a variety
nated by pesticides, fertilizers, and fecal material of techniques. In rural communities, water treatment
from nearby animals (Krupa, Tate, Kessel, Sarwar, methods are chosen based on accessibility, afforda-
& Linquist, 2011). Rural communities surrounding ble cost, and the required level of maintenance. One
polluted water sources are left with water that is treatment technique common in rural communities is
often not safe for drinking, showering or cleaning slow sand filtration (SSF). SSF is a low-cost method
purposes. Such populations are forced to employ that is effective at removing microorganisms from
their own water quality assurance methods and are the water as long as turbidity is low (Gottinger,
becoming increasingly reliant on bottled water McMartin, Price, & Hanson, 2011). However, this
(Kruawal, Sacher, Werner, Muller, & Knepper, could pose a problem in rural communities where
2004). high turbidity of the reservoir water is an issue. SSF
requires minimal maintenance, namely regular
1.1. Rural Water Supply in Developing Countries cleaning to clear the biological material that can
build up over time. Additionally, SSF can be modi-
In many developing countries, surface water, such fied for improved effectiveness, such as adding peb-
as rivers and creeks, can be used as a water supply bles to remove suspended solids or adding granular
source (Singkran, 2017). Surface water is an easily activated carbon to remove organics and pesticides
accessible source for many rural communities and is (Gottinger et al., 2011).
often employed for other purposes such as irrigation A second option is a conventional Water Treat-
(Bordalo, Nilsumranchit, & Chalermwat, 2001). ment Plant (WTP) which employs clearing, coagula-
However, the water quality of river and creeks do tion, filtration, and chlorination techniques (Babayan,
not always meet specified standards for human Sakoyan, & Sahakyan, 2017). In developing coun-
health and safety. A study conducted in Thailand tries, these WTP’s tend to be unsanitary, unhygienic,
found that major rivers contained high levels of fe- and have out-of-date technology (Babayan et al.,
cal coliform bacteria and suspended solids (Singkran, 2017).
2017). Erosion and land runoff were major contrib- Treatment of rainwater is recommended by the
uting factors to this decrease in water quality. The WHO because of the high probability of biological
presence of fecal coliforms suggests that there are and chemical contamination. There are many meth-
pathogenic bacteria in the water, which is especially ods for rainwater treatment, the most basic one be-
concerning for human health (Singkran, 2017). Ad- ing using a screen or filter to prevent debris from
ditionally, there are seasonal variations in surface entering the collection container. Additional treat-
water quality which tends to decrease during the dry ment options include SSF, the usage of chlorine for
season as indicated by factors such as high turbidity disinfection, and granular activated carbon
(Bordalo et al., 2001). (Kwaadsteiniet et al., 2013).
Rainwater is another commonly used source of If water treatment techniques are insufficient,
potable and non-potable water in rural communities there are human health risks associated with ingest-
(Kwaadsteniet, Dobrosky, Deventer, Khan & Cloete, ing contaminated water. The purpose of this re-
2013). Rainwater collection is a low-cost method search was to identify the top concerns about the
KKU Faculty of Public Health Journal of Community Research, Vol. 5 4

water supply in a rural community, and to discover pond that is shared among multiple villages in the
the most common home treatment techniques em- area including Ban Tha Pho. Water from the pond
ployed to clean the water. then flows into the pump house where it is trans-
ferred to the water treatment plant (Fig. 1).
2.0 Methods and Materials

2.1 Study Design and Site Description

This descriptive, cross-sectional study was con-


ducted in the community of Ban Tha Pho, which is
located in the Nam Phong district of the Khon Kaen
province in northeast Thailand. Ban Tha Pho is a
small rural village with a population of approximate-
ly 1,200-1,300 people within 200 households. Ban
Tha Pho is a tight-knit community situated next to
the Nam Phong River. Research was conducted
from April 24th, 2017 to April 26th, 2017. The
study used a focus group, stratified convenience
Figure 1: Reservoir pond that is the source of
sampling, and semi-structured interviews.
Ban Tha Pho’s non-potable water and the pump
The community of Ban Tha Pho obtains its non-
house (lower right of photo)
potable water from a reservoir behind the Ubonrat
Dam in Northeastern Thailand. Water from Ubonrat
Dam flows into irrigation canals, one of which fills a

Figure 2: Schematic of Water Source, Distribution, and Treatment Process


KKU Faculty of Public Health Journal of Community Research, Vol. 5 5

The water treatment plant in Ban Tha Pho uses mat and translated to community members in Thai
alum as a coagulant followed by a series of 20 baf- using a translator.
fles. The water then proceeds to a settling tank be-
fore entering a sand and gravel filter. Chlorine is Table 1. Sample of Semi-Structured Interview Questions
added to the filtered water, piped into a storage tank
and then stored in the water tower before being dis- 1 How do you use your tap water?
tributed to community homes (Fig. 2). Maintenance
of the water treatment plant occurs once every three 1a What do you not use your tap water for?
months. Common maintenance activities include
removing the dirt that collects in the settling tank 2 How often do you (a) shower, (b) wash
and washing the baffles. clothes, (c) wash dishes, (d) wash produce,
(e) cook with the tap water?
2.2 Participants and Sampling Strategy
3 What source of water do you use for
drinking water?
The participants in the focus group were sampled
purposefully, including the village headman, the
4 Do you have any concerns about the tap
headman assistant, head VHV, and one worker from
water? If so, what are the concerns?
the water treatment plant. The target population for
the semi-structured interviews was 30 households in
4a Do you think this causes any problems? If
Ban Tha Pho and were selected using stratified con-
so, what?
venience sampling. Researchers divided the com-
munity into three zones and sampled approximately 5 Do you do anything to try and make the
10 households from each zone. One of the village tap water cleaner? If so, do you think it is
health volunteers led researchers through the com- effective? Why or why not?
munity to find participants for the semi-structured
interviews. The target participants of the semi- 6 Are you aware of the upcoming change to
structured interviews were the heads of the house- the community water supply?
holds. Inclusion criteria for participation were (a)
household tap water came from the reservoir, (b) 6a What do you think about the change?
lived in Ban Tha Pho for at least five years, (c) can
read, write, and understand Thai, and (d) were at
least 18 years old.

2.3 Instruments and Data Collection 2.4 Data Analysis

A focus group was conducted with the village Data collected from the semi-structured inter-
headman, the headman assistant, head VHV, and views was analyzed using qualitative content analy-
one worker from the water treatment plant. The fo- sis. After all the interviews were completed, catego-
cus group lasted approximately 45 minutes and was ries for coding and coding units were defined based
used to gather information about the overall com- on recurring themes and responses. Data was ana-
munity perspectives about the water supply. Addi- lyzed using descriptive statistics in Microsoft Excel
tionally, the focus group defined coding responses to determine the frequency of responses. Additional-
for some of the semi-structured questions. ly, thematic analysis was used to report the focus
Semi-structured interviews were held to collect group and interview responses in a narrative format.
information about how community members use the
reservoir water, their concerns about the water sup-
ply, and any actions they take to remediate the prob- 2.5 Ethics
lem. Each interview lasted approximately 10
minutes. Questions for the interview were developed Translators were employed to gain verbal consent
prior to the community visit and refined after infor- from each participant at the commencement of each
mation was obtained during the focus group (Table interview and focus group. Participants were aware
1). Questions were presented in an open-ended for- that the study was completely voluntary and all of
KKU Faculty of Public Health Journal of Community Research, Vol. 5 6

Figure 3: Community Concerns about the Water Supply (n=30)

their responses would remain confidential and anon-


ymous. Furthermore, they understood that all infor- 3.2 Uses of Tap Water
mation gained from the study would only be shared
amongst the researchers. Participants then signed an Common uses of the tap water as identified dur-
informed consent form that stated their understand- ing the semi-structured interviews were showering,
ing of their rights as a volunteer participant in this washing clothes, washing dishes, washing produce,
study. watering gardens, and cooking. All 30 interview
participants reported they take a shower about 2-3
3.0 Results times a day with the tap water. Many participants
wash their clothes using tap water almost everyday,
3.1 Views about the Community Water Supply while some wash clothes 2-3 times a week. As for
washing dishes, all 30 participants reported that they
The water supply system is very important to the use tap water everyday to wash their dishes, and
community because it gives them better access to they do this up to 3 or 4 times a day. Some partici-
the water. From the focus group, community leaders pants have small gardens, where they plant vegeta-
expressed concerns that the water from the water bles and herbs. They water these plants with tap
supply is not very clean, and they do not always water twice a day, 3-5 times a week. Participants
have enough water to provide for all community reported avoiding using tap water for cooking and
members. The piping system that distributes water washing produce.
to community homes is at least 26 years old. The
head of the village health volunteers reported that
there are cases of rashes from the use of water from 3.3 Community Members’ Concerns about the
the water supply system. Community leaders and Water Supply
members are in the process of adding another water
source for the water supply to try to address water Of the 30 participants interviewed in Ban Tha
quality and occasional shortages. The community is Pho, 22 people (73.3%) reported cleanliness of wa-
currently 90% complete with a project that will draw ter was a concern (Fig. 3). Community members
water from the Nam Phong River which will then go described seeing dust and dirt in their tap water.
through the water treatment plant and to community Additionally, many expressed that they felt the wa-
homes. ter was generally unclean. Complaints about smell
were common as well, especially during the summer.
KKU Faculty of Public Health Journal of Community Research, Vol. 5 7

The presence of worms and insects in the water sup- 3.5 Drinking Water Sources
ply was a concern for six villagers (20%).
Rash development and itchiness after showering Of those interviewed, no families reported using
were concerns expressed by four community mem- the reservoir water for drinking. The most common
bers. There were also reports that after doing laun- source of drinking water was from rainwater collect-
dry, their clothes would come out dirtier than before. ed at their homes. 21 participants, or 75%, use this
Other community members reported a mental health source (Fig. 5). The other 25% purchase their drink-
effect from frequent paranoia because they were ing water from the water truck that comes every
uncomfortable with using the water supply knowing week.
that it was unclean. Some worried about the invisi-
ble contaminants within the water, namely that there
may be bacteria in the water that could cause disease.
Participants also expressed that the reservoir is
not sufficient for meeting community water needs,
as it has been known to run out. When asked about
how they felt about the water supply switch to the
Nam Phong River, most people said they thought
the water would be cleaner because the water is reg-
ularly tested and compared to a national standard.
Furthermore, villagers believed using the Nam
Phong River would meet the demands of all the sur-
rounding villages who use this source and address
the problem of water quantity.

3.4 At-Home Water Treatment Methods Figure 5: Drinking Water Sources (n=28)

Only 33% of participants reported using some 4.0 Discussion


form of at-home water treatment. Of these treat-
ments, alum usage was the most common with 7 Community members’ concerns about the water
participants (24%) using this method. Another three supply reflected that turbidity is the main issue with-
participants (10%) filter their water through a cloth. in this community water supply. Turbidity in itself is
All participants who use these forms of water treat- not a significant public health concern; however, it
ment believed they were effective and better than is very observable which can cause distress among
using no treatment at all. users about the water’s usability. Furthermore, high
turbidity can decrease the effectiveness of water
treatment methods (Gottinger et al., 2011). The re-
ports of worms and insects present in the water were
a surprising result. These contaminants should be
removed during the sand and gravel filtration pro-
cess at the treatment plant, but their presence sug-
gests they may be entering the water through the
distribution system’s pipes due to a lack of mainte-
nance.
Based on the focus group and prior discussion, re-
searchers assumed rashes and itchiness after shower-
ing would be the main water-related health concern.
Unexpectedly, there were only four reports of these
complications. However, based on the many uses of
tap water identified during the interviews such as
showering, washing dishes, and washing clothes,
Figure 4: At-Home Water Treatment Methods dermal exposure is still a concern.
(n=30) Less than half of participants employed at-home
water treatment methods, yet they expressed concern
KKU Faculty of Public Health Journal of Community Research, Vol. 5 8

with the water’s cleanliness. Generally, community the water supply through the unmaintained distribu-
members were unaware of possible at-home meth- tion pipes. Some community members take the initi-
ods and those that did treat at home were uncertain ative to treat their tap water at home using cloth fil-
of the effectiveness. Many community members tration and alum, but in general most participants do
believe switching the tap water source to the Nam not self-treat their water. The results suggest a gap
Phong River will be beneficial to the community, in understanding the community water treatment and
despite knowledge of pollution from upstream facto- supply system. Increasing knowledge of methods for
ries. This demonstrates how the risk perception of at-home water treatment may be beneficial in ad-
the water quality is largely based on what is “known” dressing community members’ concerns about the
to the community. Community members would ra- water supply quality in Ban Tha Pho.
ther draw their tap water from the river because they
know it is tested by the Pollution Control Depart- 6.0 Acknowledgements
ment and thus believe it meets a standard that is safe
for their health. However, should the water not meet This research would not have been possible had it
the standard, it is unclear how quickly the problem not been for the community members of Ban Tha
could be resolved. Pho who graciously welcomed us into their homes,
Research was conducted from different house- introduced us to the Isaan way of life, and were in-
holds representing three areas of the community. credibly willing to share their knowledge with us.
Researchers were able to meet with community We would specifically like to thank Ban Tha Pho’s
leaders and water treatment employees to gain a Headman, Headman’s Assistant, and the many Vil-
broader understanding of the treatment system and lage Health Volunteers for the hours spent in focus
general community perspective. Some of this per- groups, interviews, and on tours of the water treat-
spective, however, was lost in translation. ment plant. We would also like to thank our transla-
The language barrier presented an issue during tor, Ban Ban, for interpreting our conversations,
the interviews, as there were moments when English striving for answers, and maintaining positivity
translations were exceptionally shorter than the an- throughout all phases of this research project. Lastly,
swers given in Thai. The sampling scheme was also we are incredibly appreciative to all of our CIEE
not completely random in each of the three areas, as faculty, specifically Ajaan Toon and Ajaan Anthony
the snowball effect was often employed. Research- in the Faculty of Public Health for a semester of
ers were led to homes filled with groups of neigh- guidance, input, and support.
bors and families who were working together. At
these homes, multiple interviews were conducted
within the same area, allowing participants to hear 7.0 References
interview questions and others’ answers long before
it was their turn to answer. Community members Babayan, G. H., Sakoyan, G. A., &
were engaged and willing to help with this process, Sahakyan, G. A. (2017). Assessing the
but there was one Meh specifically who accompa-
Quality of Water from Surface Sources
nied researchers to interviewees’ homes. Meh would,
at times, join in the questioning process. She would of Drinking Water Supply to Towns of
offer suggestions for answers that converted some South Armenia. Electronic Journal Of
open-ended questions into leading questions. Thus, Natural Sciences, 28(1), 3-9.
these influences may have introduced bias into the Bordalo, A. A., Nilsumranchit, W., &
results. Chalermwat, K. (2001). Water Quality
and Uses of the Bangpakong River
5.0 Conclusion
(Eastern Thailand). Water Research,
Research reflected community members’ con- 35(15): 3635-3642.
cerns regarding water quality, including turbidity, Gottinger, A. M., McMartin, D. W., Price,
insects, and other particulates often found in their D. & Hanson, B. (2011). The
tap water. These particulates should have been re- effectiveness of slow sand filters to
moved in the water treatment process, which leads treat Canadian rural prairie water.
community members to assume particulates re-enter Canadian Journal of Civil Engineering,
KKU Faculty of Public Health Journal of Community Research, Vol. 5 9

38, 455-463.
Krupa, M., Tate, K. W., Kessel, C., Sarwar,
N. & Linquist, B. A. (2011). Water
quality in rice-growing watersheds in a
Mediterranean climate. Agriculture,
Ecosystems and Environment, 144,
290-301.
Kruawal K, Sacher F, Werner A, Muller J,
Knepper TP. (2004). Chemical water
quality in Thailand and its impacts on
the drinking water production in
Thailand. Science of the Total
Environment. 340: 57-70.
Kwaandsteneit, M., Dobrowsky, P. H.,
Deventer, A., Khan, W., & Cloete, T. E.
(2013). Domestic Rainwater Harvesting:
Microbial and Chemical Water Quality
and Point-of-Use Treatment Systems.
Water Air and Soil Pollution, 224, 1629.
Pinfold, J. V., Horan, N. J., Wirojanagud,
W., & Mara, D. (1992). The
Bacteriological Quality of Rainjar
Water in Rural Northeast Thailand.
Water Research, 27(2): 297-302.
Singkran, N. (2017). Determining overall
water quality related to anthropogenic
influences across freshwater systems
of Thailand. International Journal of
Water Resources Development, 33(1):
132-151.
Sthiannopkao, S., Takizawa, S., Homewang,
J., & Wirojanagud, W. (2006). Soil
erosion and its impacts on water
treatment in the northeastern provinces
of Thailand. Environment International,
33:706-711.
KKU Faculty of Public Health Journal of Community Research, Vol. 5 10

Risk Factors for Dog Biting and Owners’


Knowledge of Responsible Dog Ownership
Aja Beckhama, , Victoria Laib and Olivia Rainerc
a
Social Work, University of Illinois, Chicago, IL, USA
b
Public Health & Health Equity, Mills College, Oakland, CA, USA
c
Biology, Wofford College, Spartanburg, SC, USA

Abstract. Aims: This study aimed to identify potential risk factors that induce dog bites and to assess villagers’ knowledge of
dog ownership and how this relates to dog bite prevention in Ban Sam Ran. Methods: Students conducted 10 semi-structured
interviews with dog bite victims to identify potential trends that provoke dog biting. To qualify dog ownership in the village,
13 semi-structured interviews with dog owners were given, including three of the 10 dog biting victims who owned dogs. Re-
searchers conducted in-depth interviews with representatives from the Health Promoting Hospital and Municipality to gather
records on number of dog biting incidents and existing programs and policies. Results: Two of the 13 dog owners interviewed
had been bitten by their own dog. Most bites were delivered to the extremities and did not cause severe injury. Out of the 13
dog owners, 10 let their dogs freely roam during the day; this may be a factor in that 8 out of 10 victims were bit by dogs
owned by another community member. Conclusion: There is a deficit in community members’ knowledge of risky situations
that can lead to a dog bite injury. Students will host a community meeting with a vet to increase education and awareness of
risky situations that may result in a dog bite injury.

Keywords: dogs, dog training, rabies vaccination, veterinary health


KKU Faculty of Public Health Journal of Community Research, Vol. 5 11

1.0 Introduction biting is still a public health issue. Dogs harbor


many pathogens that can be harmful when intro-
Dog bites pose a variety of health impacts, includ- duced via the bite wound. Bacteria can be trans-
ing physical trauma, possible disfigurement, psycho- ferred from the mucosa in the dog's mouth, for ex-
logical trauma, and bacterial infections (Tanzin et al., ample Pasturella canis, Capnocytophaga canimor-
2011). Approximately 17-18% of dog bites injuries sus, and Leptospirosis or from the outside of the
receive medical attention, while only 1-2% require victim's skin, including Stapylococcus MRSA and
hospitalization (Overall and Love, 2001). Physical MRSP (Damborg et al., 2016). The aforementioned
deformities and trauma are more likely to happen bacteria from the mucosa can worsen soft tissue
with children; because of their height, children are damage inflicted by sharp teeth, and if left untreated,
more likely to be bitten on their face and neck (Bro- causes septicemia and shock (Bongyoung, et al.,
gan et al., 1995). In comparison, adults usually re- 2016). Staphylococcus aureus, Pasteurella multo-
ceive bite injuries to the extremities. Although dog cida, E. coli, Moraxella species, Pasteurella canis,
bite wounds are considered a public health epidemic, and Enterobacter cloacae were found to be the pre-
fatalities attributed to bites are relatively low: about dominant bacterial species infecting a dog bite
1 death per 5 million dogs (Callaham, 1980). Bacte- wound (Kasempilmoporn et al., 2003).
rial infection may occur if the dog bite wound is not If a dog bite wound is deep or dirty, it may be in-
treated properly. Human behavior can be a factor in fected with tetanus. Clostridium tetenai is anaerobic
determining the severity of a dog bite, therefore it is bacteria that can thrive in deep wounds where oxy-
important for owners to be educated in proper treat- gen is lacking. The bacteria are more likely to enter
ment and housing of their dogs. a wound from the environment than from a dog’s
mouth (Radjou, Hanifah, & Govindaraj, 2012). Of-
ten rabies prevention through vaccination is the
1.1 Rabies Situation in Thailand main focus when treating a dog bite wound, howev-
er tetanus also poses severe health risks.
Rabies virus is an infectious disease usually
spread from dogs to humans via saliva from bites or 1.3 Risk Factors for Dog Bites
scratches. The virus is in the family of bullet-shaped
Rhabdoviridae that infect many hosts including ver- Most dog bites are inflicted on children less than
tebrates; Lyssavirus is the particular genus that 15 years old (Kizer, 1979). Human behavior factors
commonly infects humans. Incubation time is typi- into how much damage is done by a dog bite. For
cally 1-3 months during which the virus invades the example, children's jerky movements can be unpre-
central nervous system causing a wide variety of dictable to a wary dog, and their shrill shrieks can be
nonspecific symptoms; mortality rate is 100% after interpreted as prey (Overall and Love, 2001). Pet
clinical symptoms appear (Rupprecht, 1996). Mor- owners are more likely to be bit by their own dogs,
tality from rabies is highest in Asian and African or neighborhood dogs, more likely than by strays
countries where domestic dogs roam freely. As a (Moss and Wright, 1987). In 1974, data collected
result, the Ministry of Public Health in Thailand has from 1,724 bite injuries and found that “owned dogs
successfully promoted mass rabies vaccination cam- delivered more bites, were larger, bit more victims
paigns for dogs. Human deaths from rabies has de- on the head and neck, delivered more bites needing
creased from 370 in 1980, to 75 in 1996 medical treatment, and, in short, were more danger-
(Mitmoonpitak, Tepsumethenon, & Wilde,1998), ous than strays” (Harris et al., 1974). However, this
and to fewer than 20 cases in 2003 (Denduangbor- may not be the case for less developed countries
ipant et al., 2005). where stray dogs still roam in relatively high popu-
lations. Dogs are more likely to bite in the summer
1.2 Dog Bites and Associated Health Risks and during the evening (Kizer, 1979).

Although less than 20 people died from rabies in 1.4 Existing Policy and Practice in Thailand
2003, over 400,000 people required rabies post-
exposure prophylaxis that year (Denduangboripant Local municipalities in Thailand are responsible
et al., 2005). While transmission of the rabies virus for monitoring the local dog population. In accord-
is relatively controlled, the high frequency of dog ance with chapter 5 of the Animal Welfare law, the
KKU Faculty of Public Health Journal of Community Research, Vol. 5 12

owner must provide appropriate measures to ensure forts, enforcement of related laws, and about general
the wellbeing of their pet, and will receive a fine or practices of community dog owners. The first inter-
jail time if they unlawfully abandon their animal. view was conducted with a local practicing veteri-
Additionally, through the national rabies program, narian. The second interview was conducted with an
Thailand has started a national responsible pet own- officer from the Ban Sam Ran Municipality, who is
ership campaign. This campaign has four main ac- responsible for monitoring the dog population.
tivities: dog population survey and registration, Another 10 participants were selected using pur-
mass vaccination campaign, dog population control, posive sampling. The participants had to be a dog
and public relation and parade campaign (OIE, owner whose dog had never bitten anyone. Because
2014). most residents arrived home late in the evening be-
tween 6:00 and 10:00 p.m., it was difficult to ar-
1.5 Education and Prevention range interviews with some dog owners. Research-
ers then, used snowball sampling to ask if partici-
Raising awareness and increasing education may pants’ neighbors who owned dogs were available to
be the easiest ways to decrease dog biting incidences. be interviewed. Additionally, if dogs were gated
For example, knowing how to interpret dogs behav- within a home, researchers went to that home to
iors can be learned even by preschool children and interview the dog owner. Also, if there were free-
can be a useful tool to incorporate into prevention roaming dogs in the community, researchers asked
programs (Lakestani and Donaldson, 2015). neighbors who owned the dog and went to interview
Thailand has seen dramatic improvements in the the dog owner.
rabies epidemic, such that many villages report no All participants needed to be at least 18 years of
issues with rabies. Still, dogs pose health risks par- age, current residents of the community, and able to
ticularly from bite wounds. The objective of this communicate in Thai.
research was to identify the trends that may provoke
dog biting in a semi-urban community of Northeast 2.3 Instruments and Data Collection
Thailand with a large dog population. A community
action plan to increase awareness and education on Three in-depth interviews were conducted to in-
risky situations will be implemented after analyzing form researchers about existing programs and poli-
the data. cies in place to address the risk factors associated
with dog biting. The first interview was conducted
2.0 Methods and Materials with a representative at the HPH, who kept record of
the number of annual dog biting incidents. The se-
2.1 Study Design and Study Setting cond interview was conducted with an officer from
the Ban Sam Ran Municipality, who is responsible
This study took place in Ban Sam Ran, a semi- for monitoring the dog population. Additionally,
urban village in Northeast Thailand with a popula- researchers interviewed a practicing vet who works
tion of 373 people. This village is located in Ban at a clinic in Udon Thani Province. A Thai translator
Sam Ran sub-district, Muang district of Khon Kaen translated the interview questions for the HPH and
Province. Municipality into Thai. The vet spoke English and
researchers asked questions in English without an
2.2 Participants and Sampling Strategy interpreter present.
Semi-structured interviews with community
A list was obtained from the HPH that included members lasted approximately 10 minutes. Re-
the names and addresses of people who reported searchers collected information about participants’
being bitten by dogs during the previous year. Con- knowledge of dog training, how care for their dogs,
venience sampling was used to select ten partici- and dog biting incidents (Table 1). A Thai translator
pants to be interviewed. Researchers used the list to translated the interview questions from English to
find the homes of the patients, and then asked who- Thai. Additionally, clarifying and follow-up ques-
ever was home if they were available to participate tions were also translated.
in the interview.
In addition, two in-depth interviews were con-
ducted to inform researchers about vaccination ef-
KKU Faculty of Public Health Journal of Community Research, Vol. 5 13

Table 1. Abbreviated List of Interview Questions


2.4 Data Analysis

Responses from the semi-structured interviews


1 Do you own a dog? were coded and entered into a database using Mi-
crosoft Excel 2013. Trends among owners with bit-
2 Do you own a dog that allegedly bit some- ing dogs were compared to trends among owners
one? with non-biting dogs.

3 How many dogs do you own? 2.5 Ethical Considerations


4 Have you gone to Vaccination Day?
Translators were employed to gain verbal consent
from each participant prior to the interview. Partici-
5 What vaccinations did your dog receive?
pants were aware that the study was completely vol-
6 How many times did your dog have a bath untary and their responses would be confidential and
in the past month? anonymous. The participants were informed that
their responses would only be shared amongst re-
7 How much do you spend time with your searchers.
dog? Consent was documented with a signature by the
participant on a printed informed consent sheet. The
8 Is your dog trained? interpreter assisted those who were unable to physi-
cally write their signatures on the consent sheet,
9 Where do you keep your dog during the with the verbal consent from the participant.
day/night?

10 How many hours is your dog caged last


3.0 Results
week?
3.1 Dog Bite Incidence
11 How many times do feed your dog(s)?
The HPH reported that the number of dog biting
12 What type of food do your dogs eat? incidents have become reported more frequently
because there is an increase in community aware-
13 Has your dog ever bitten someone? ness about health outcomes that result from contract-
ing rabies. An average of about 24 people were bit-
14 Where did this occur? ten annually. The number of people bitten shows an
increasing trend.
15 Describe the situation.

16 Was it severe enough for you to go to the


HPH for a vaccine?

17 Have you changed how you handle your


dog since the incident?

18 If your dog bites someone, who is responsi-


ble?

19 Are there any consequences for the owner?

20 Should there be any consequences?

21 What should the consequence be? Figure 1. Number of dog bite victims that re-
ceived the PEP vaccine per year.
KKU Faculty of Public Health Journal of Community Research, Vol. 5 14

3.2 Municipality’s Perspective into the water of the rice fields. Big dogs were usu-
ally never bathed in comparison to smaller dog.
The Municipality reported that people are not ed- All owners provided their dogs two meals a day,
ucated about how to identifying risky dog behaviors in the morning and at night. Most owners gave their
such as how to stop a dog fight, looking under their dogs leftovers including liver, chicken, sticky rice.
cars for dogs before approaching it, and general dog
safety precautions. They think the community would
benefit from having a vet come to educate commu-
nity members about safety involving dogs.

3.3 Dog Bite Victims

11 out of the 13 of the participants had dogs that


have not bitten anyone. Of the 10 participants who
were bitten, two participants reported being bitten
by their own dog. All dog owners in this study re-
ported that their dog was vaccinated.

3.4 Dog Care Figure 4. Frequency of dog bathing

3.4.1 Dog Enclosures 3.4.3 Time with Dog


None of the owners kept their dogs on leashes Villagers generally reported that they would be
regularly, nor did the owners keep any of them outside the front of their homes with the dog nearby.
caged. Most dog owners allowed their dogs to freely For them, this was considered interaction time with
roam the village during the day; however, many their dog(s). Some households reported that their
would keep their dogs at home with the gate locked children would run around with the dog(s). Big dogs
during the night (Figure 3). Owners that kept dogs would usually roam freely in the community for
behind a locked gate live near a busy road or owned large parts of the day. The few people that interacted
dogs aggressive towards other dogs. Those that kept with the dog all day kept the dog in the house.
dogs in the house owned smaller dogs with no
guarding purpose.

Figure 5. Interaction time between dog and owner.


Figure 3. Dog enclosure environment

3.4.4 Dog Training


3.4.2 Food and Hygiene When asked if their dog was trained, owners re-
The frequency of bathing varied greatly among sponded in hesitation. Rarely would the dog obey
the dog owners (Figure 4). Owners usually bathed the command of its owner. Usually the dog would
their dogs with human shampoo or only with water acknowledge the owner but not move or not
and no shampoo. Some owners stated that their dogs acknowledge the owner at all. Owners said the
would go “bathe” themselves on their own by going dog(s) obeys when food is present. Around a quarter
KKU Faculty of Public Health Journal of Community Research, Vol. 5 15

(23.1%) of the dogs were trained to some capacity.


The remaining (76.9%) were not. Table 2. Summary of Dog Bite Incidents
Characteristic Percent (%)
3.4.5 Dog Care after Dog Bite Incident Body Part Bitten
Most villagers did not change the way that they Leg 50%
trained or interacted with their dog after the dog bite Ankle/Heel 20%
incident. One villager noted that because her small Hand 10%
dog had previously bit a visitor, she now keeps the Shoulder 10%
dog in the house when guests come to her home. Butt 10%
Season
3.5 Dog Bite Incidents Cool 40%
Hot 30%
Most participants reported that the bites were nips Rainy 10%
to the ankle and calf area (Table 2). Victims that had No Data 20%
a dog bite an extremity: the leg, ankle, or hand, were Category of Dog Bite
typically involved with a startled or defensive dog. Aggressive dog 40%
Incidents occurred while dogs were not seen sleep- Accidental encounter 30%
ing under a car and were startled when someone Defensive dog 30%
approached and bit the person, usually on the lower
Location of Incident
extremities. People who were bitten by aggressive
Work 40%
dogs were bitten on the shoulder or butt. Some other
House 30%
incidents were because mother dogs were defensive
Motorcycle/Road 20%
of their newborn puppies. An electrician reported
Market 10%
being bitten multiple times after entering homes to
fix appliances. One woman was bit on her shoulder 4.0 Discussion
when at a friend’s home who owned a puppy mill.
She was taken to a hospital outside the village and
The increase in dog biting incidents was a con-
was not on the original list of HPH patients.
cern expressed in the community. This number may
People were bit at relatively the same frequency
still be an underestimate of the true number of dog
during the hot and cool seasons. Only one person
bites because a participant in the study reported go-
was bit in the rainy season. The question was not
ing to a hospital outside of the community and the
asked in two interviews.
incident was not reported to the local HPH.
Situations that qualified as accidental involved
The results show that although dog biting inci-
dogs that were stepped on or startled, a person was
dents are increasing most incidents are accidental or
bitten when trying to stop a dogfight, or when a dog
because the dog was being defensive of its newborn
was involved in a road accident. Defensive dogs bit
puppies. Those who reported that dogs were aggres-
because their puppies were nearby. Dogs identified
sive towards humans said the dog had bitten many
as aggressive bit motorcyclists, were unprovoked, or
people, which may indicate that there are a small
bit owners who were attempting to keep their pets
number of community dogs that are aggressive to-
from biting a stranger.
wards humans.
All participants went to the hospital after being
The Municipality hosts an annual free Vaccina-
bitten. All participants including the person bitten
tion Day program and Universal Health Coverage
and dog owners reported that it is the dog owner’s
provides free rabies vaccine to the HPH. Rabies is
responsibility to take the bitten person to the hospi-
controlled in the community. However, these pro-
tal. All participants who were bitten were taken to
grams may deter the community from wanting to
the hospital by the owner. No children were reported
learn about safety precautions to take with dogs be-
in this study because the HPH records report that
cause they can get a free vaccination if bitten. Addi-
children have not been involved in any dog biting
tionally, there is a low risk of rabies because most
incidents.
dogs have been vaccinated.
In regards to dog ownership, dog owners do not
have a strong relationship with their dogs because
53.4 percent of dog owners reported not interacting
KKU Faculty of Public Health Journal of Community Research, Vol. 5 16

with their dog. Additionally, most dogs were al- 7.0 References
lowed to free-roam for large parts of the day. Alt-
hough rabies is controlled, there are risks of expo- Bongyoung K, Hyunjoo P, Yangsoon L. (2016)
sure to other infectious disease when a dog free Identification of Pasteurella canis in a soft tissue
roams (Durr, 2017). The community may benefit infection caused by a dog bite: the first report in
from a dog ownership program. Korea. Ann Lab Med; 36(6): 617-619.
Research was conducted from different house- Brogan TV, Bratton SL, Dowd MD, et al. (1995).
holds within the community. Researchers gathered Severe dog bites in children. Pediatrics; 96: 947-
information about the risk factors associated with 950.
dog bites and the knowledge that dog owners have Callaham M (1980). Dog bite wounds. JAMA; 244:
about taking care of dogs. 2327-2328.
One of the limitations of this study was that it was Denduangboripant et al (2005). Transmission dy-
difficult to interview the people on the HPH list be- namics of rabies virus in Thailand: Implications
cause many people arrived home in the late evening. for disease control. BMC Infectious Diseases.
It was challenging to find participants for the inter- Damborg P, Broens EM, Chomel BB, et al. (2016)
view. Thus, these factors may have limited our in- Bacterial zoonoses transmitted by household
sight to the risk factors associated with dog biting pets: state of the art and future perspectives for
and knowledge of responsible dog ownership targeted research and policy actions. Journal of
amongst community members. Comparative Pathology; 155(1): s27-s40.
Durr, S., Dhand, N., Bombara, C., Molloy, S., &
5.0 Conclusion Ward, M. (2017). What influences the home
range size of free-roaming domestic dogs? Epi-
This research highlighted some of the most com- demiology and Infection, 145(7),1339-1350.
mon situations in which dog biting incidents oc- Kasempilmoporn S, Benjavongkulchai M, Saengs-
curred, including aggressive, protective, and acci- eesom W, Sitprija V (2003). Oral bacterial flora
dental incidents. Increasing knowledge about safety of dogs with and without rabies: a preliminary
precautions with dogs may be beneficial. Addition- study of Thailand. J Med Assoc Thai; 86(12):
ally, research reports highlight dog owners’ 1162-1166.
knowledge of dog ownership responsibilities. In Kizer KW (1979). Epidemiologic and clinical as-
general, most dog owners do not take care of their pects of animal bite injuries. JACEP; 8: 134-141.
responsibilities to the pet. The community may ben- Lakestani N, Donaldson ML (2015) Dog Bite Pre-
efit from having a vet come educate the community vention: Effect of a Short Educational Interven-
and distribute educational material. tion for Preschool Children. PLoS ONE 10(8).
Mitmoonpitak C, Tepsumethenon V, Wilde H.
6.0 Acknowledgements (2013) Rabies in Thailand. Epidemiology Infec-
tious; 120: 165-169.
This research would not have been possible with- Moss SP and Wright JC (1987). The effects of dog
out the community members of Ban Sam Ran who ownership on judgements of dog bite likelihood.
participated in interviews and helped provide re- Anthrozoos; 1: 95-99.
searchers with insight about the community. Thank World Organisation for Animal Welfare (OIE).
you specifically to the Ban Sam Ran Headman, “Benchmark Document: Rabies and Rabies-
Headman Assistants, Head of the Health Promotion Related Initiatives in ASEAN Member States
Hospital, Head of the Village Health Volunteers, (2014).” (2014). Proceedings from the Workshop
and Village Health Volunteers. Also, thank you to on Relevant International Standard for Rabies.
our translator for helping us interpret conversations Chiang Mai, Thailand, 11-13 June 2014.
and better communicate with community members. Overall K and Love M (2001). Dog bites to humans
Thank you to Ajaan Anthony and Ajaan Toon for - demography, epidemiology, injury, and risk.
helping guide our research project. Finally, thank Journal of the American Veterinary Medical As-
you to CIEE for providing students with the oppor- sociation; 218(12): 1923-1934.
tunity to study abroad in Thailand and learn in a new Radjou A, Hanifah M, Govindaraj V. (2012) Teta-
environment. nus following dog bite. Indian Journal of Com-
munity Medicine; 37(3): 200-205.
KKU Faculty of Public Health Journal of Community Research, Vol. 5 17

Rupprecht CE. (1996) Rhabdoviruses: rabies virus.


Medical Microbiology, 4th edition; chapter 61.
Tenzin, Dhand NK, Gyeltshen T, Firestone S,
Zangmo C, Dema C, et al. (2011) Dog Bites in
Humans and Estimating Human Rabies Mortality
in Rabies Endemic Areas of Bhutan. PLoS Negl
Trop Dis 5(11).
Thailand Animal Welfare law, English translation,
2014. Accessed via globalanimallaw.org
KKU Faculty of Public Health Journal of Community Research, Vol. 5 18

Strengths and Weaknesses of Farmers’ Health


in Rural Thai Village: Community
Development of a Survey Instrument
Cristeen Anyanwua, , Brennan Torpeyb and Avanti Mohanc
a
College of Arts and Science, Georgetown University, Washington, DC, USA
b
School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
c
College of Arts and Science, Brandeis University, Waltham, MA, USA

Abstract. The purpose of this investigation was to determine strength and weaknesses in the lives of rural farmers in Northeast
Thailand. Methods. This study used a 6-person focus group to construct a Healthy Farmer Chart. This chart was then
disseminated in the form of 34 surveys to be completed by other rural farmers in the community. The farmers for the focus
group were sampled with the assistance of village health villagers. The 34 participants for the survey were selected due to their
occupation and availability during the day. Results: The main strengths listed by rural farmers were confidence/independence
(44%) followed by the ability to earn money, pride in work and pride in occupation as a farmer (38%). The main weaknesses
listed by rural farmers were their inability to earn enough money (73%), issues with aches and pains from farming (59%), and
poor physical health from using chemical fertilizer (56%). Farmers mentioned pride in their work as a family tradition but the
work ultimately takes a toll on their physical health while hindering their ability to earn enough income. Conclusion: Farming
for rural farmers in this village is met by many challenges. The first challenge is the falling rice prices, a major source of
income in this area, matched with increased burden of debt. The combination of low prices and high debt pushes farmers to
overextend themselves physically in the field, leading to a host of physical ailments.

Keywords: agriculture, Northeast Thailand, participatory research


KKU Faculty of Public Health Journal of Community Research, Vol. 5 19

1.0 Introduction 1.3 Health Challenges of Farmers

Agriculture is one of Thailand’s top-grossing in- As agriculture continues to remain a cornerstone


dustries and has made significant contributions to of Thailand’s economy and culture, the well-being
the country’s economic success. It has served as a of Thai farmers, or lack thereof, can therefore direct-
“social safety net, in terms of food security and as a ly impact the country’s economic prosperity. There-
source of employment” (Jitsanguan, 2001). Much of fore, injuries resulting from the work of farmers
Thailand’s countryside remains populated largely by should be paid attention. Some of such physical
farming communities with villagers leading rural health ailments and injuries incurred include chronic
lifestyles. cases with mean durations of almost 6 years (Nop-
kesorn, 2011). Demographics such as age and gen-
1.1 Historical Context: Agricultural Sector der are influences that need to be taken into account
when discussing the health of rural farmers in Thai-
Thailand’s agricultural market has recently been land. The older population, 65 and above, plays a
struggling to compete with comparative rice prices key role in farming, especially rice cultivation
in other ASEAN nations, such as Vietnam (Sirikan- (Poungchompu et al, 2012). For this population, the
chanarak, 2016). As a result of this competition in strongest determinants of self-assessed health may
the international agricultural market, what was once be seen in the presence of chronic diseases, func-
a safety net has become a conundrum for rural Thai tional status, and/or psychosocial symptoms (Hassen
farmers who predominantly farm rice (Bhongmaka- et al, 2010). These determinants can be used to help
pat, 1990). Farmers feel pressure to produce larger better assess the strengths and weaknesses of Thai
quantities of crops to earn enough income to make farmers, specifically in the northeast region.
ends meet, necessitating an increased application of Given the decreasing price of rice and in turn
agricultural chemicals (Jitsanguan, 2001). Increased the decreasing income of many rural farmers in
used of pesticides damages fertile soil and causes Thailand, this study aimed to determine and assess
farmers to increase the amount and strength of the strengths and weaknesses of farmers’ health in Ban
fertilizer they must spray on crops (Thapinta et al, Tha Pho.
2000).
2.0 Methods and Materials
1.2 Financial Difficulties of Farmers
2.1 Study Design and Study Setting
While competition in the agricultural sector, spe-
cifically in international markets such as that of Vi- This descriptive study took place in Ban Tha Pho,
etnam, has required increased fertilizer use, the need Moo 4, a small village in Northeast Thailand. This
to protect crops incentivizes fertilizer usage just as village is located in the Tha Krasoem sub-district
much (Sirikanchanarak, 2016). Most Thai farmers and Nam Phong district in the Khon Kaen province.
use fertilizers in order to facilitate production of
crops as well as ensure the quality of crops produced 2.2 Participants and Sampling Strategy
(HSRI, 2005). Crops with the highest market value
contain the highest amounts of pesticides in The focus group had six participants, five female
field/soil due to a shift away from low-value crops and one male. The survey had 34 participants, 12
and towards high-value crops in the agricultural males and 22 females. All participants actively farm
market (Poapongsakorn et al, 1998). As a result of for profit and were contacted during hours conven-
this shift, farmland used by rural Thai farmers has ient to them. This study used convenience sampling.
compromised soil quality and has decreased crop Participants were at least 18 years of age, current
yields, which has been corroborated by Thai farmers residents of this community, and at least half of their
during a previous community needs assessment in salary supported by farming; participants were ex-
Ban Tha Pho. With all these factors being consid- cluded if they did not fit the above criteria.
ered, farmers are confronted with a wide range of
challenges socially, financially, and in terms of their
own health.
KKU Faculty of Public Health Journal of Community Research, Vol. 5 20

2.3 Instruments and Data Collection 2.4 Data Analysis

A 40-minute focus group established qualities of Quantitative data gathered from the survey was
a healthy and an unhealthy farmer. This discussion entered and coded into a database using Microsoft
was facilitated using guided questions regarding Excel 2013. Descriptive statistics, namely the mean
physical, mental, and social health within the con- of participant’s ages and frequency of responses,
text of their profession as farmers. Participants cre- were calculated using Microsoft Excel.
ated a “healthy farmer chart” to describe the The farmers in the focus group defined the
strengths and weaknesses of farmers in the village strengths and weaknesses used in the Healthy
with regards to physical, mental, and social health. Farmer Chart. Strengths were defined as characteris-
This collaborative activity included the opinions of tics or qualities, which are beneficial to being a
all participants and the focus group’s consensus well-rounded and strong farmer in this village.
served as an accurate representation of criteria for Weaknesses were defined as characteristics, which
adequate versus inadequate health statuses of farm- would negatively impact a farmer and/or is seen as a
ers in Ban Tha Pho. quality of substandard farmer in the community.
The “healthy farmer chart” was generated collab- Both strengths and weaknesses were defined by un-
oratively with the community, and the definitions der the broad term of health and were chosen by
were created by participants in the focus group (Ta- participants in the focus group because of im-
ble 1). portance to themselves, the farming lifestyle, and/or
Using Table 1, a survey was conducted where the community. This allowed the community to
farmers in the community were asked to identify build the tool used in the surveys, rather than outsid-
which three healthy qualities they relate to as ers without knowledge of the farming community to
strengths and three unhealthy qualities they relate to define what are strong versus weak qualities of a
as weaknesses. This illustrated which strengths and farmer in this village. The strengths and weaknesses
weaknesses, within the scope of mental, physical, of a farmer were placed into the Healthy Farmer
and social health, hold the most significance in the Chart. During the survey, strengths and weaknesses
farmer’s personal experience given the list compiled for the community were defined as responses with
in the chart. the highest frequency. This conclusively brought the
A qualified translator familiar with the Isaan dia- standard for strong and weak qualities of a farmer
lect was used to translate questions and explanations into the Healthy Farmer Chart, and then defined
given by English-speaking researchers. what were strengths and what were weaknesses for
actual farmers in Ban Tha Pho.
.
Table 1. Healthy Farmer Chart
KKU Faculty of Public Health Journal of Community Research, Vol. 5 21

2.5 Ethical Considerations Table 2. Strengths and Weaknesses of Farmers (n = 34)


Strengths Number (%)
All participants voluntarily gave written or verbal Confident & Independent 15 (44)
informed consent via a translator before participat- Earns Money 13 (38)
ing in this project. Consent was documented using a
Proud of Work 13 (38)
signature on a printed informed consent sheet. Re-
Proud to Continue Family Tra- 13 (38)
sponses remain confidential, and no responses were
dition
or will be shared with any law enforcement or those
Weaknesses Number (%)
without a professional duty to the research. The data
Doesn’t Earn Enough Money 25 (74)
has been and will continue to be securely stored with
a password only accessible to the researchers Lots of Aches and Pains 20 (59)
Poor Health from Chemical Use 19 (56)
3.0 Results

3.1 Demographics enough money as the main weakness. Based on the


Healthy Farmer chart generated by the community
Six farmers participated in the focus group, one and then grouped by theme and physical, mental, or
male and five females. All participants are rice or social health, mental health would be viewed as a
vegetable farmers in Ban Tha Pho and helped collect strength amongst farmers in this village because of
the data shown in Table 1. their resilience and appreciation for farming as cul-
Of the thirty-four participants who took the sur- tural trademark and family tradition.
vey, 67% of participants were female, and 33% were Resilience and appreciation for farming are two
male. The average age was 55, and 91% were rice features, which make farming an honorable profes-
farmers. sion in this community. Yet, the work is detrimental
to their physical and social health. Aging is viewed
as a weakness due to the amount of energy a farmer
3.2 Strengths identified by farmers
must exert in order to make enough money to sup-
port their family. Their lack of substantial income is
Participants listed four major qualities as personal
categorized as a quality of poor social health since
strengths of being a farmer; 44% said they are con-
low income is a social determinant that can nega-
fidence/independence; 38% said they earn money;
tively impact their overall health and lead to risky
38% said they take pride in continuing their family
health behaviors.
tradition; and 38% said they are proud to be a farmer.
Mental health for a healthy farmer was broadly
Other qualities from the Healthy Farmer chart were
defined by their ability to feel confident and inde-
chosen, but the frequencies of responses were fewer
pendent, free from stress, and proud of their work.
than the four major strengths listed (Table 2).
The majority of participants agreed that confidence
and independence are qualities that they deem as
3.3 Weaknesses identified by farmers
strengths. On the survey, very few participants iden-
tified feeling stressed due to their occupation. Many
Qualities considered weaknesses with a high fre-
viewed farming as profitable work, but not lucrative.
quency of responses were an inability to earn It is not lucrative due to the rise and fall of crop
enough money (73%); issues with aches and pains prices, particularly the steady decline of rice prices.
from farming (59%) and poor health from chemical Many found that low rice crops made it hard to con-
fertilizer use (56%). Other qualities were listed, but tinue their family tradition of being rice farmers and
the frequencies of responses were fewer than the had to invest in other crops. The problem with di-
three major strengths listed (Table 2).
versifying crops is that farmers often have to take
out loans from the agricultural bank, compounding
4.0 Discussion
this debt with previous debt from possibly accumu-
lated from buying fertilizers for crops or paying for
Results indicate that the majority of farmers in their children’s education. The continued depend-
Ban Tha Pho view confidence and independence as ence on loans to sustain their trade as farmers make
a main personal strength and the inability to make it hard for be rid of debt. Such challenges cause a
KKU Faculty of Public Health Journal of Community Research, Vol. 5 22

cascade of problems in their social and physical 6.0 Acknowledgements


health. Crop yield and income would be classified
under social health, which farmers characterized as We thank the village of Ban Tha Pho for their
not only income but also community relationships warm welcome, the community members who were
and personal life. participants in our focus group and survey, and those
Physical health for a healthy farmer was broadly who cared for us during our stay. We thank our team
defined by themes such as a pain and wellbeing. of translators and Maw Thoo and her team of village
Well-being is perceived as regularly exercising, be- health volunteers for their guidance. Lastly, we
ing well rested, and healthy aging. The debt accu- thank both Dr. Anootnara T. Kuster and Anthony C.
mulated by being a farmer disrupts a farmer’s ability Kuster for advising us throughout the course of the
to engage in many healthy activities such as rest and research, which greatly helped our study.
healthy aging. Many farmers found that as they were
aging their ability to sustain their farms decreased. 7.0 References
Participants seemed to prioritize their crops and in-
come over physical health, though it was a concern Bhongmakapat, T. (1990). Income distribution in a
of theirs. They would work through their back and rapidly growing economy: the case of Thailand.
leg aches as well as any headaches in order to com- The Singapore Economics Review, 35(1), 161-
plete necessary tasks for the day. Some farmers con- 189.
sidered the act of farming as exercise while others Haseen, Fariha, Ramesh Adhikari, and Kusol
wouldn’t work at all if their pain were unbearable, Soonthorndhada. "Self-assessed health among
losing a day of income. It is reasonable to say that Thai elderly." BMC geriatrics 10.1 (2010): 30.
physical health is an area in need of interventions. Health System Research Institute (HSRI).
An intervention that can teach farmers to prevent Knowledge Needed for Effective Decision of Pes-
injury could also help them decrease the number of ticide Policy in Thailand. Nonthaburi: Ministry of
days they lose from injury and possibly help in- Public Health; 2005.
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tems for small-scale farmers in Thailand: implica-
5.0 Conclusion tions for the environment. Food and Fertilizer
Technology Center.
The results indicate that farmers in Ban Tha Pho Nopkesorn, T., & Supasit Pannarunothai, (2011).
have (a) a strong perception of their mental health Prevalence of low back pain among rice farmers
and (b) a need for improvement in their physical and in a rural community in Thailand. J Med Assoc
social health. Mentally, farmers in Ban Tha Pho see Thai, 94(5), 616-21.
their work as a source of pride, which continues Poapongsakorn, N., Ruhs, M., & Tangjitwisuth, S.
their family and community tradition. Physically, (1998). Problems and outlook of agriculture in
their work in the fields increases their aches and Thailand. TDRI Quarterly Review, 13(2), 3-14.
pain and because their crops have a low financial Poungchompu, S., Tsuneo, K., & Poungchompu, P.
yield, they are at risk of many negative physical, (2012). Aspects of the Aging Farming Population
mental, and social health effects. While perceptions and Food Security in Agriculture for Thailand
of weaknesses highlight areas in need of support, it and Japan”. International Journal of Environmen-
is important that interventions are culturally relevant tal and Rural Development, 3(1), 102-107.
and financially beneficial. Farmers would respond Sirikanchanarak, D., Liu, J., Sriboonchitta, S., & Xie,
well to programs that recognize pride in farming as a J. (2016). Analysis of transmission and co-
culturally important quality for this agricultural movement of rice export prices between Thailand
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