Modelimng of Health Education Planning Through High Risk Approach for Pregnant Mothers

为了在清迈省农村地区促进母婴健康，不使用需要较大预算或高技术的方法，而是使用简单和廉价的方法以及当地人力，最有效和最重要的方法是健康促进教育。我们与清迈大学医学院家庭医学系合作进行了一项为期三年的研究，为这一教育系统创建了一个模型。我们选择了两个街道作为研究对象。在第一年（1988年），我们向每位母亲分发了一本最初在日本制作并翻译成泰语的妇幼保健手册，并通过问卷调查了这两组人的社会、卫生和营养状况。A组是典型的农民群体，而B组则是由在城市有工作的家庭组成，他们的收入足以购买富含蛋白质的食物。第二年（1989年），我们对母亲及其子女进行了人体测量和健康检查。结果显示，A组自然流产病例并不少见，B组未见。B组儿童年龄皮褶厚度变化规律提示近期可能出现肥胖问题。在去年（1990年），我们进行了一项调查，以澄清母亲对我们在第一年研究中分发的妇幼保健手册的使用情况。几乎所有的母亲都保留着这些手册，但并不经常使用。我们的结论是，有必要创造机会使用手册，并教授有关记录和如何使用它们。这将有助于记录可靠的个人数据，并进一步为母亲提供获得适当健康信息的机会。

To promote mother and child health (MCH) in the rural area of Chiang Mai Province without using methods which require relatively big budget or high technologies but use simple and cheap methods along with local manpower, the most effective and important method is health promotional education. We have carried out a three year study cooperated with the Department of Family Medicine, Faculty of Medicine Chiang Mai University to create a model for this educational system. Two sub-districts were chosen for our study. Forty families were selected from each sub-district and grouped as A and B. In the first year (1988) we distributed to each mother a MCH handbook which is originally made in Japan and translated to Thai and investigated the social, sanitary, and nutritional status of the two groups by questionnaires. Group A was a typical farmer group but group B was consisted of families which have jobs in the city and earn money which enables to buy protein rich foods. In the second year (1989) we carried out anthropometric measurements and health check of the mothers and their children. It revealed that cases of spontaneous abortion were not rare in group A but were not observed in group B. The pattern of the change of skinfold thickness in age of children in group B suggested the occurrence of an obesity problem in near future. In the last year (1990) we made a survey to clarify the use by the mothers of the MCH handbook which we distributed in the first year of study. Almost alle mothers kept the handbooks but had not used frequently. We conclude that it is necessary to make opportunities to use the handbook and to teach about the records and how to use them. These will help reliable personal data to be recorded and further, will offer the mothers chances to get appropriate health information.