Malnutrition and dental problems in children have been identified as important
problems in Thailand.  Several studies and research activities have been undertaken in
order to identify solutions, but the problems still exist.  The Chiang-Klang Hospital Health
Team conducted a study by involving the community to become concerned about their
problems and become a part of the committee to solve problems themselves.  Namkha
village in Phayakaew sub-district of Chiang-Klang was selected to be a community model.
A quality measurement study was conducted as PAR (Participatory Action Research).
The study was conducted between June 2002 and December 2003.  Seven malnourished
children (15.22% of the total) were identifinal at the start (June 2002).  No children (0%)
were seen with malnutrition after six months.  The study team followed up the result for
one year and found that there were no cases of malnutrition.  Dental health was significantly improved in both the nursery center and primary school. This study has shown
that the communityûs health problems had been completely solved because of the cooperation of the community itself, which had been involved in all the relevent steps: problem investigation, finding a solution and following up on the health-care procedures
adopted by the team.


The problem of substance addiction in communities is still a serious and increasing
social problem.  It has a great impact on families, communities, society and the country.
Inefficient means for prevention and control of this problem will shortly lead to substan-tial social complications in communities. Therefore, the participation of the community
in coping with widespread substance addiction is crucial.
The objectives of this participatory action research study were to explore the situation of addictive substance abuse and develop a model for prevention and control by
emphasizing community involvement.  One hundred and fifty villagers, who were community leaders, health volunteers, guardians, and youths living in villages 5, 9, and 11 of
Patan, Khuntan district, Chiang Rai Province, participated in the research activities. The
researchers and the community groups analyzed problems and determined solutions by
using the AIC-technique.  They collected information by using the participatory observation method and focus group discussion technique. The study was conducted between
October 2001 and February 2002.
The result of the study revealed that there were 40 drug users in these villages. The
sources of substance distribution were identified in all three villages. Community regulations for the prevention and control of addictive substance abuse were established through
village consultative meetings. After the regulations were implemented continuously, the
scale of substance addiction became dramatically more limited in these three villages.
Local organizations played a very important role in minimizing these social problems.
However, community participation needs to be strengthened and continued in order to
sustain the success of substance control in these villages.


The study took a phenomenological approach to qualitative research, aimed at
studying disaster management following the destructive flooding and landslides in Lablae
district of Uttaradit Privince, and the development planning for disaster relief conducted
by the Lablae Public Health Team.  Specific data were collected from 69 persons who
experienced the disaster, members of the rescue team and persons on whom the flooding
and landslides in Lablae district had an impact, 32 persons from an in-depth interview
and 47 persons from a focus group discussion as well as participants and non-participants, observers during the disaster, development of a disaster scenario for disaster relief
by the Lablae Public Health Team based on 90 participants, and analysis by data triangulation, using the Excel software program for category and data content analysis.
We was found that the flooding and landslide disaster that occurred during the
period May 22-24, 2006 adversely impacted the people of Lablae, Mange, and Thapla
districts and the surrounding province.  Most people in Lablae suffered severe effects on
their lives and property. Many houses in the area of heavy flooding and landslides were
destroyed.  Electricity, communication and transport systems were cuts making evaluation of the affected area impossible.  The rescues were made only during the first stage;
they were delayed and not comprehensive.  Also, the disaster relief plan of every office
involved was ineffective.  The emergency team was unable to operate during the crisis.
The primary response was only to provide a safe area for the surveyed patients and medical
supplies.  After the incident, although many organizations and volunteers rushed to the
area, they could not implement the relief plan, which resulted in incomplete data collection and the inefficient provision of security welfare.
The relief disaster plan of the health team must be operated in coordination with
public health and other relevant offices at all times: before, during and after such incidents, both at the district and provincial levels.   The defined roles of the command post
and volunteers during the incident, together with the development of an emergency medical system, care-giving, epidemic prevention, psychotherapy, the readiness of the rescue
team, data on risky areas, rehearsal of integrated relief plans in all areas at risk of natural
disasters, and relief networks as well as the coordinating system and data collection must
be seriously considered before such incidents occur.


The incidence of mental health problems among patients who visited Langu Hospital Out-patient Department increased from 3,330 and 3,539 to 4,625 cases per 100,000 populations in 2004, 2005 and 2006, respectively.  The incidence of cases that committed suicide
in 2006 was 7.57 cases per 100,000 population, which was much higher than the rate for
Thailand as a whole. The objectives of this study were to survey mental health status  and to determine depression and suicidal attempts among the population 15-59-yearsold who lived in the period May to June 2007 in Langu District, Satun Province,
Thailand.  This  was a descriptive cross-sectional study and survey that used the Thai
General Health Questionaire-12 in the first step; it was then followed by the DepressionScreening, Suicidal Attempt and/or Psychotic-screening Test, all of which were established by the Mental Health Department, Ministry of Public Health.  There were 22,093
samples; the male to female ratio was 1:1.2.  Mental health status was divided into three
groups: normal, high risk and the mental heath problem group.  The mental health problem group was 0.23 percent, equally male and female.  The highest percentage were in
the 35-44-year-old age group (34%), in the married group (48%) and in the  insufficientincome group (42%).  Mental health problems were psychosis disorder (0.12%), paranoid
schizophrenia (0.04%), schizophrenia (0.07%), mania (0.01%), bipolar disorder (0.02%),
psychosis due to multiple drug dependence (0.04%), GAD (0.09%), agoraphobia (0.01%),
and panic (0.01%).  There were 20 cases of depression (0.09%) and no attempted suicide
case.  Furthermore, this study showed that we should launch preventive interventions in
each mental health status group and collaborate with families, community leaders, village health volunteers, the local authority and NGOs


The objectives of this mixed method study were to investigate the incidence, patterns and risk factors related to abused and neglected children aged 0-18 years in the
catchment area of Nam Phong Hospital, Nam Phong district, Khon Kaen Province. Of the
13 villages, in the area, four were randomly selected.  Five hundred and thirty-one children participated. Data were collected during the period from September 1, 2005 to June
30, 2007 by well-trained research assistants, using questionnaires for children and parents or child- caregivers. They were living in the village in order to conduct surveillance
and report the incidence of abuse and neglect as well as risk behaviors. In that connection, the identified cases, parents or child-caregivers, neighbors and village leaders were
interviewed indepth and observed by the researchers.  Quantitative data were described
as percentages and means. Content analysis was employed for analyzing the qualitative
data.
The results showed that abused and neglected children amounted to 30.3 percent of
the total. The majority were physically abused (42.2%) followed by those mentally abused
(41.6 %). It was reported that 12.5 percent were neglected and 3.7 percent sexually abused.
Children were subjected mainly to multi-forms of abuse (57.1 percent).  In all, 44.7 percent of the cases of abuse were found in children aged 5-12-years.  Regarding the risk
behaviors, 32.7 percent were gambling and illicit drug use; followed by irregularities in
emotion, function and expression, 26.4 percent; social interaction, 21.5 percent; and sexuality, 19.6 percent.  The risk factors and condition of the parents related to child abuse and
neglect included the following:  1) drinking and gambling, 2) middle and low economic
status, and 3) poor family relationships (with domestic violence) in addition to parents
sparing only limited time for their children.  Risk factors related directly to the children
were overindulgence in social life compared with other responsibilities.


A quasi-experimental research study was carried out in the period from January to
June 2007 in order to study the development of a care system for diabetes mellitus patients with regard to self-care behaviors and blood sugar level (HbA1
c) control in type II diabetes mellitus patients.  The patients  were divided into two study groups comparing
50 patients each.  The experimental group included patients who lived in Banphue subdistrict (catchment area of Banphue Hospital).  The control group constituted those living
in the other subdistrict. The information was collected by interview on self-care behaviors and blood sugar level (HbA1
c) determination. Data were analyzed by the SPSS program using frequency expressed by percentage, means and standard deviation, and by ttest and paired t-test for the differential test.  The statistical significance was at 0.05 and
lower.
The development of the system was divided into two sections: 1. caring at the hospital, such as a one-stop service, self-help group, individual counselling for the patients
and their families, diabetes mellitus society setting, diabetes mellitus camping, and empowerment to the diabetes mellitus care network by a multidisciplinary health team;  and
2. caring in the community in the form of home visits by a multidisciplinary health team.
The study revealed that the development of the diabetes mellitus patients care system affected statistical significance at the level of 0.05, both on better self-care behaviors
and blood sugar level (HbA1
c).
It indicates that the development of a care system for diabetes mellitus patients is
necessary and very important for improving service quality and the quality of life of the
patients.  It should be extended to other primary care units in Banphue District elsewhere.


Following a flood disaster in 2006, the victims suffered both physical and mental
affliction because of the loss of their property and loved ones.  Post-disaster stress persisted in some persons.  We, therefore, conducted this study to determine what risk factors are related to the maintenance of postflood disaster stress on people in Pamoke district.  We also studied the relationship between remainder stress and socio-demographic
factors, health status and psychosocial factors. The subjects comprised 61 people who
suffered stress from a flood in 2006 in Pamok district.   General Health Questionnaire 12
Plus R (GHQ-12 Plus-R) was used for this study.  The frequency, percentage, odds ratio
(OR) and Chi-square test were used to analyze the data.  The results showed that the risk
factors for post-flood disaster stress were age over 60 years and lacking income.


This action research was aimed at studying a behavior-adaptation model through a
group process for cardiovascular disease prevention. The sample population comprised
395 civil servants in Khirimat district of Sukhothai Province, who voluntarily participated in the research; they were divided into 30 sub-groups. All groups had an explicitly
defined structure and relationship, including group activities. Knowledge and support
staff were provided continuously by the hospital.  In addition, the subjects also exchanged
group experiences regarding their activities. The research was conducted during the period June 1 to October 1, 2006.  Data on the knowledge gained on health behavior and
health status improvement were collected.  The data were compared and analyzed by
using a simple statistical method, such as percentage, mean, and standard deviation, and
then tested for significance by using the paired t-test.
The results revealed an improvement in eating behavior among the sample population.  The questionnaire results showed that frequent or daily consumption of meat or
pork with fat decreased respectively from 12.56 percent and 2.53 percent to 5.50 percent
and 2.62 percent, frequent or daily consumption of giblets decreased respectively from
4.20 percent and 4.20 percent to 1.84 percent and 2.06 percent, that of consuming egg yolk
and egg products decreased respectively from 21.19 percent and 2.33 percent to 14.02
percent and 1.59 percent, frequent or daily consumption of vegetables increased from
8.14 percent and 1.57 percent to 39.07 percent and 36.76 percent and frequent or daily
consumption of fruits increased respectively from 41.24 percent and 21.13 percent to 37.17
percent and 28.86 percent.
At the end of the research it was found that the sample population exercised regularly.   They had increased their level of exercise from 31.3 percent to 40.7 percent, reduced their cigarette smoking from 11.65 percent to 8.6 percent.  In measuring those who
stopped consuming alcohol, the change was in the opposite direction, i.e., from 57.5 percent to 68.1 percent.  Knowledge about cardiovascular risk factors was tested for statistical significance, and the difference was found at p<0.05. Other risk factors, such as waist
circumference, systolic and diastolic blood pressure, serum cholesterol and triglyceride
levels, were reduced significantly at p<0.05.
In conclusion, the group activities undertaken as part of the research improved the
knowledge and health behavior, with regard to cardiovascular risk prevention, of Khirimat
civil servants as the sample population. We recommend that the behavior adaptation
model can be applied and developed for civil servants in other areas.


This cross-sectional descriptive study was aimed at studying the situation of occupational health and environmental surveillance in the Northern Region Industrial Estate, Lamphun Province.  There were seven small, eight medium-sized and four large factories, that were chosen by purposive sampling.  A total of 503 workers were chosen as
subjects by simple random sampling of workers in the 19 factories plus 19 administrative
staff.  The instruments used in this study were an interview form and questionnaire.
Content validity was reviewed by five experts.  Data were analyzed by using descriptive
statistics (the SPSS software program for Windows) The duration of the study was from
January to September 1999.
The findings from this study showed that all sizes of factory posed similar health
and environmental risks.  The data collection and analysis were not efficient.  In addition,
the Action Plan of Occupational Diseases was not applicable, and the data coordination
system was not appropriate for the participating organizations, although all administrative staff were ready to develop a more effective workers’ health and environmental      surveillance system.
The following are recommendations from this study:  Factories should design occupational health and environmental surveillance in line with the occupational risks and in
accordance with the factories and the participating organizations.  They should also implement continuous tracking and evaluation as well as develop an effective data-coordinating system.


This study assesses some of the lessons learned in primary care management under
the universal health-care coverage scheme in the contracting unit for primary care at PhuKradueng Hospital, which received the Golden Universal Coverage Innovation Award
(UCIA) from the National Health Security Office in 2004.  The study was conducted by
analyzing the hospital’s management in terms of structure, process and output, comparing the outcome before and after starting the universal coverage programme and comparing the outcome with that of other contracting units for primary care in the same
province.  This study showed that the contracting unit for primary care could meet service standards in manpower by motivating nurses from Phu Kradueng Hospital to work
in subdistrict health centers.  Every subdistrict health center could meet the manpower
standard in terms of quantity (health officer per population 1:1,250) and quality (every
subdistrict health center operated with more than one nurse).  Although the manpower
levels were lower than the mean for the whole country, Phu Kradueng Hospital could
still provide health services with a customer-focus policy, extending service times in both
the hospital and subdistric health centers.  Among its innovations were those related to
the distribution of resources, recruiting manpower as in the private sector, paying staff
according to a performance-based budgeting system, and dividing family health status
into four levels, which enabled health officers to plan in a systematic maneuver to provide efficient health care.  This study concluded that a small rural health service unit
could provide standard services while reducing indirect and direct household costs, if
the health organization had a common goal, modified private management and managed human resources efficiently


This was a descriptive research study, the purposes of which were to study the nature of participation of village health volunteers (VHVs) in all the community primary
health care center (CPHCC) activities and to investigate the relationships between the
supporting factors and the participation of VHVs in Ban Maung district of Sakhon Nakhon
Province.
The samples comprised 104 VHVs who were selected by the multistage random
sampling method.  The subjects were interviewed, using the following instruments for
gathering data:  1) the general characteristics of VHVs,  2) supporting factors,  and 3) the
participation of VHVs. Reliability of the supporting factors and the participation of VHVs
were tested by Cronbach’s alpha coefficient; reliability was 0.92 for supporting factors,
and 0.78 for the participation of VHVs. The statistical procedures employed were frequency distribution and percentage; the data were analyzed using descriptive statistics,
while the relationship between the independent and dependent variables was carried out
using Pearson’s Product Moment Correlation Coefficient. Then t-test was done to test for
statistical significance. The open-ended and independent questionnaires were analyzed
by content analysis.
The findings were as follows:
On average, the VHVs participated moderately in CPHCC activities.  In terms of
assessment of needs and planning,  the VHVs participated in the meeting and were more
likely to comply with the  policy and planning.  Participation in implementation, organization and resource mobilization. The VHVs were most likely to participate in the following
activities: nutritional surveillance, disease preventation, immunization, maternal and child
health promotion, and family planning.  However, they were less likely to participate in
health promotion activities.  The VHVs and their  families tended to claim the right to free
treatment and medication. Participation in evaluation.  Most of the VHVs shared their experiences in problem-solving to improve their work. This study was supported by public
health officials, and villagers; support facilitating the activities was highly  correlated
with the participation of VHVs (r = 0.597,0.309 and 0.338  p < 0.01)
The findings of this study led to the recommendation that public heath officials
should set forth a plan to educate the villagers and VHVs to understand fully the concepts that underline the establishment of CPHCC, revolving funds and mobilizing resources, including the management of the organization.  In-service training should also
be promoted and incentives should be provided.  In addition, the area of evaluation should
be considered to enable the VHVs to properly implement their activities.


This research was aimed at studying the health status and risk behavior of workers
in factories in Chakkarat district, Nakhon Ratchasima Province in the period March-May
2007. The methodology involved data a collection form; secondary data, questionnaire
and risk-screening data. The results showed that there were 8 factories with 2,274
workers; data were collected on 2,227 of them, or 97.9 percent of the total. These factories
produce clothing, underwear and shoes. Most of the workers were women (74 percent),
aged between 25 and 29 years; most were married and had a primary level education.
Seamstress accounted for 68.5 percent of the total. Those who sat working totaled 77.3
percent. The top-five out-patient cases were respiratory tract infection, dyspepsia, myalgia,
headache and oral disease, in that order. With regard to accidents in workplace, it
was found that the most were needle accidents. Annual health examination data found
that only two patients had lung problems; eyes problems accounted for 21.6 percent of
the total. The patients with presbyopia problems comprised 8.0 percent of the total, but
there were no hearing problems. The result of risk screening found that 20.8 percent of
the workers’ parents had diabetes and high blood pressure; 6.8 percent of their brothers
and sisters has these health conditions, while only 1.8 percent of the workers themselves
did so, and additional new cases accounted for 0.9 percent, a total of 2.7 percent. The
workers who had diabetes and hypertension were following doctors’ supervision. As for
the behavior of workers, 10.6 percent smoked, 21.8 percent drank alcohol; 12.4 percent of
the workers usually exercised. With regard to eating behavior, it was found that most of
the workers consumed sweet, more salty and fatty food. As for driving/riding behavior,
it was found that most workers wore helmets and safety belts (75.6%). Unsafe sexual
behavior was practiced by some workers. The shape of body (waist/hip) exceeded the
standard for 26.54 percent of the subjects. The body mass index (BMI) exceeded the standard
in 43.7 percent of the workers. Health care for all the workers should be the responsibility
of the related organization; health promotion activities including solving problems,
should be carried out by each factory with appropriate conditions.


The objective of this experimental study was to evaluate the therapeutic effect of
acupuncture on diabetic peripheral neuropathy (DPN) in 40 diabetic patients attending
the Diabetes Clinic of Laungpoh Pern Hospital; the methodology used simple random
sampling technique. Twenty patients served as the group studied, receiving acupuncture
and the remaining 20 cases acted as a control group. Both groups received the same
conventional treatment from the hospital. In both groups, the degree of foot numbness
was measured and recorded, using Semmes -Weinstein monofilament one week before
and one week after the study period of four weeks (equal to the twice-a-week application
of eight acupunctures). Statistical comparison of the therapeutic results in individual
groups, and between the acupuncture-treated and the control groups were made by
using the t-test.
The results showed a statistically significant improvement of the numbness symptoms
in the experimental group compared with the control group (p < 0.05). Therefore, it
was concluded that acupuncture has a supplementary therapeutic effect on DPN in addition
to the conventional treatment.


HIV-counseling for couples considering voluntary counseling and testing (VCT) is
very important in HIV prevalent areas. This research was carried out in this belief with
the objective of incorporating the counseling system into health centers and increasing the coverage of HIV counseling to more than 80 percent of couples. The work conducted
in the period 2004 -2006 covered 703 pregnant women and their partners who visited the
Antenatal Care Unit at Chun Hospital and health centers in Chun district, Phayao Province.
The results show the success of developing the counseling system so that it can be
incorperated into all health centers during the three successive years (2004-2006). The
coverage of couple HIV-counseling increased to 74, 94 and 89 percent, respectively. The
HIV infection rate in the pregnant women decreased to 1.8, 1.5 and 1.3, respectively. Moreover,
among 11 discordant infected couples with different blood mates, one couple was
evidently infected by each other. No infected born baby was born to these couples during
the period of study.
HIV couple counseling was very useful in protecting against the HIV epidemic; it
encourageed HIV-positive persons to join the system. The service at the Antenatal Care
Unit was suitable for inducing couples to be interested in HIV screening. Distributing the
service among the communities served by health centers was very important since it
made people feel very comfortable to take the service. Moreover, strengthening followup
programs and launching proactive public relations campaigns would produce more
success.


In the period from March to June 2007, a trial was carried out in 14 asthmatics in
order to observe the therapeutic effects on dyspneic symptoms produced by embedding
subcutaneously soluble catgut threads. All patients, eight men and six women, aged 35 -
76 years, who had had 3-8 years of asthmatic symptoms, had received treatment with
oral bronchodilators and meter-dose inhalers regularly. The treatment technique used
soluble chromic catgut No. 0 embedded subcutaneously into an area between the midline
of the back and inner border of both scapulae at the level of the T2 and T3 vertebrae twice
one month apart. Based on the Classification Asthma Score, pre and post-treatment asthmatic
scores were compared. It revealed that the treatment had satisfactorily reduced the
asthmatic symptoms in all patients, having improved asthmatic scores in 12 of the 14
patients. The OPD visits and hospitalization were reduced. This therapeutic technique is
recommended for an alternative treatment for asthmatic patients.


This qualitative research, conducted on 60 uncontrolled hypertensive volunteers,
using in-depth interviews, participant observation, group discussion and content analysis.
The aim was to study suitable forms of the holistic health-care service for hypertensive
patients available in the three primary care units at Bangmunak District, Pichit Province.
The objectives were to 1) Study the perception of hypertension disease and behavioral
self-care, 2) Study the situable health-care service for hypertensive patients in the
primary care units, 3) synthesize the situable health-care service for hypertensive patients.


Diabetes and hypertension increase the chance of a person developing heart disease
or stroke, which is called metabolic syndrome. We found that many diabetes patients attending the out-patient department in Krathumban Hospital could not control their
blood sugar levels. This quasi-experimental design was aimed at comparing fasting blood
sugar levels and blood pressure levels between pre and post utilization of service for
competency promotion of self-care intervention at 3-month, 6-month and 9-month intervals.
The 288 samples were selected by purposive sampling. The research instruments
comprised research questionnaire, digital weight and hight scale, sphygmomanometer,
and the service pattern for competency promotion for self-care intervention. The problems
of the patients and the health-care team were assessed iointly. They were advised
about diet control and exercise practiced for 30 minutes. The service pattern for competency
promotion to self-care intervention was utilized every 3 months. All samples underwent
blood tests and blood pressure testing pre and post utilization of service for
competency promotion of self-care intervention at 3-month, 6-month and 9-month intervals.
The results showed that there were significant differences among the fasting blood
sugar levels and systolic blood pressure levels pre and post service (F = 7.18, P = 0.00) and
(F= 6.95, P = 0.00) by using repeated measure analysis of variance. Service pattern
for competency promotion for self-care intervention should be included in the care of
diabetes and hypertension disease in hospitals.


This descriptive study was designed to analyze risky behavior that makes people
vulnerable to HIV infection in Phan district. Among the sample of 330 people, 48.19
percent were unaware of HIV infection, and 76.67 percent were practicing unsafe sex. Of
222 samples who were tested for anti-HIV antibodies, 11 of them were HIV-positive, producing
an HIV prevalence rate of 4.95 percent in Phan district, whereas the prevalence
rate for the country as a whole is 1.4 percent. It seems that there is a high possibility of an
HIV outbreak in the near future in view of the present situation. The basic problems are
the same as encountered in the previous era, e.g. a lack of knowledge, values, and sense
of social responsibility. These are universal concerns, not just those of HIV-infected persons.
Sustained collaboration is truly needed in order to strictly control the spread of
HIV.


This was a one-group quasi-experimental study carried out at Waritchaphum Hospital
in 2006, with the objective of determining the health benefits of a running campaign.
The study population comprised personnel who were working at Waritchaphum Hospital
in 2006. Descriptive statistics were used to summarize demographic characteristics
and the level of cooperation. The difference in the results before and after the campaign
on body mass index, blood levels of sugar, cholesterol, and triglyceride was analyzed by
paired t-test.
Of the 122 persons analyzed, 67 percent were women and the average age of the
sample was 35 years; of the total, only 76 percent participated in the campaign. Over 58
percent of the persons had good physical ability. From the analytical results, the mean
blood cholesterol and triglyceride levels obtained before and after the campaign were
statistically significantly different (p-value < 0.05), whereas the means of fasting blood
sugar and body mass index were not statistically different.
As exercise is known to be necessary for health, this study of the running campaign
was conducted in the hope that, if the persons studied could change their behavior so
that they took exercise regularly for better health, they could become leaders in promoting
exercise in the community.


This research involved a descriptive study, the objectives of which were to assess
the knowledge of and the level of preventive behaviors for avian influenza (bird flu),
including the comparative avian flu prevention behaviors of district public health volunteers
in Phakhai District, Phranakhon Si Ayutthaya Province, as categorized by sex, age, educational background, level of knowledge, work experience as district public health
volunteers, and relationship between poultry and one’s residence. The samples comprised
265 district public health volunteers. The instrument used for data collection was
a questionnaire verified for content validity and reliability. Data were collected in August
2007. Descriptive and inferential statistics (t-test, F-test) were used for analysis. Most
of district public health volunteers were female (83.4%), aged between 50 and 59 (37.4%),
who had compleated primary school (68.3%), with 5-15 years of experience as district
public health volunteers (60%), not involved in poultry business (87.5%), and resided in a
non-risk area (93.6%). The sample for the most part had a high level of knowledge about
avian influenza (80%). The prevention behaviors for avian flu were at a moderate level
(58.9%). The comparison of preventive behaviors for avian influenza demonstrated that
the sex of the district public health volunteers was not related to preventive behavior,
while age, educational background, level of knowledge, work experience of district public
health volunteers, relationship between poultry and their residence, did affect the prevention
behavior for avian flu at the 0.05 level of statistical significance.
Suggestions for this study were that public health and livestock officers should provide
intensive learning programs for district public health volunteers so that they could
improve their prior incorrect practices by regularly imparting knowledge about avian
influenza to people in every area, encouraging people to understand the present situation.
It was also necessary to study problems and operational requirements in order to
apply the findings of the study report for potential development.


This study was conducted in Chainat Province, comparing the results of treatment
of type II-diabetic patients treated at two health centers with those treated at a community
hospital. The study group of 39 patients voluntarily agreed to attend the District
Health Center for at least six months of treatment; they were cases receiving oral medications
and were not at risk of serious complications. Results of treatment were based upon
blood pressure, body mass index, waist circumference, and blood chemistry parameters,
i.e., fasting plasma glucose (FPG), HbA1c, total cholesterol, triglyceride, HDL and LDL.
Data were analyzed statistically using percentage, mean and standard deviation in order
to assess the value of the treatment. The non-parametric (chi-square) test was used for
showing the differences of treatment results between the hospital and health centers. Successful
of treatment was demonstrated by the following: FPG (46.3%), HbA1c (23.1%),
blood pressure (20.5%), total cholesterol (41.0%), triglyceride (43.6 %), HDL (53.8%), LDL
(17.9%), BMI (33.3%) and waist circumference (23.1%) for the patients treated at the two
health centers compared with those obtained at the community hospital. Only the results
of blood pressure testing were of statistically and significantly different.


Objective : To compare the outcome among patients using the diabetes foot care
program and those who did not use it.
Material & Methods : This quasi-experimental research focused on the effects of
using the diabetes mellitus foot care program in terms of sensory receptor score. The
controlled patients were non-insulin-dependent cases of diabetes mellitus. They had been
treated in the diabetes mellitus clinic of Bangbo Hospital, Samutprakarn Province. There
were 100 cases divided into experimental and control groups. They were followed up
using the diabetes mellitus foot care program. The data were analyzed by the method of
percentages, means, descriptive statistics and compared means by t-test.
Result : In the experimental group, their foot problems decreased and there was an
improvement in their sensory receptor score better than that of the control group (95%
confidence interval; p-value <0.05).


A study was conducted to evaluate a gas-fired incinerator system for the eradication
of infectious waste compared with a fuel-fired one, with regard to their efficiency in
destroying such materials, their cost of operation, and the satisfaction of the 127 hospital
staff who have to work with them. The materials employed in the study comprised the reports on hospital infectious
waste incineration, the Yala City Municipality Rule 2007 dealing with such services, the
collection and eradication of infectious waste, and the statements of hospital staff as contained
in questionnaires which had been approved in substance and for accuracy, with a
confidential value of 0.83; they were tested using Cronbach’s alpha coefficient. The data
were analyzed by using percentage statistics and average.
Findings :
1. As regard the effective budget for destroying infectious waste, comparing a gasfired
incinerator with a fuel-fired system at the Yala Municipal waste treatment plant, it
appeared that:
- The average cost for eradicating infectious waste, using the gas-fired incinerator
system, is 3.34 baht perkilogram, while that for the fuel-fired system is 23.42 baht
per kilogram; the average cost of eradicating infectious waste transported to the Yala
Municipal waste treatment plant is 81.56 per kilogram.
2. The comparison between the gas-fired incinerator and the fuel-fired one showed
that the gas-fired system had greater efficiency than the fuel-fired system, with regard to
combustion rate, quantity of ash produced, residues following combustion and number
of staff need to operate the system.
3. As for the satisfaction of the 127 hospital staff concerned, it was found that a
good level of satisfaction was 12.68 percent, and a very good contentment level was 87.32
percent.


The aim of this development research study was to develop the patterns of the primary
care service in Sritia and Laoyaw tambons of Baan Hong District in Lamphun Province,
where they conjoin with Chiang Mai Province. The study was undertaken in the
period 2003 - 2006. The study was conducted in a number of phases: first, correcting the data, then planning, followed by processing, and finally evaluating the outcome. In the
first period of this study, the population of the Sunpulauy Primary Care Unit (PCU) required
extraordinary health-care service out that posed a budgetary problem under the
Universal Coverage system in the Banhong PCU. Subsequently a meeting was held to
study and correct the statistical data, the health-care services received, the number of
patients with chronic illness, the ways to establish health-care services, the ability to recruit
new patients, evaluate the competency of the health-care team, and prepare to develop
the pattern of health-care services. In second phase, arrangements were made for
family nurses to work in the PCU full time and be associated with the community based
health-care services. In the third phase the Laoyaw PCU was developed to become the
center for community medical-care services with the provision of a doctor for providing
medical care and evaluating the outcome of processing.
In the fourth phase, the people in Sritia and Laoyaw tambons enjoyed a greater
range of health-care services. Patients in the Laoyaw PCU increased from 11.94 percent
of the population in 2004 to 24.60 percent in 2006, because family nurses were working in
this PCU and developed it into a community medical-care center. The Laoyaw PCU decreased
the UC budget following the DRGs of the Sunpulauy PCU. The population receiving
health-care services increased from 20.69 percent in 2004 to 36.13 percent in 2006.
The screening of patients with hypertension increased 3.32 more than three fold, and that
of patients with diabetes mellitus increased more than 5.6 times from 2003. The number
of patients with respiratory diseases decreased; increased screening was carried out for
diseases associated with community problems, that is, myalgia of the muscle and skeleton
systems. The community medical hub was connected to the primary health-care
service system in this area. The study found that it is possible to develop persons in the
community and public health volunteers following the system policy that stresses improving
health using the Banhong UC budget.


The purpose of this research survey was to study the risky health behaviors in terms
of non-communicable diseases among government officers stationed in Long District,
Phrae Province. The research samples involved 864 government officers in that district.
Questionnaires and a screening protocol were used as the main instruments in collecting
the data, which were analyzed by descriptive statistics. The risk behaviors were as follows:
Smoking was 11.7 percent, alcohol consumption 50.3 percent, and physical inactivity
64.7 percent. For unhealthy diet behaviors, 30.2 percent of the subjects favored high
sugar diets, 18.2 percent favored high sodium diets and 3.8 percent high fat diets. For
traffic accident prevention, 37.4 percent seldom wore helmets or fastened the seat belts
in their vehicles. The results of the health screening revealed that the body mass index
indicating overweight or obesity was found in 54.4 percent of those surveyed, while
waist circumference that posed risks for obesity was found in 29.8 percent; by sex, these indicators were found in 31.8 percent of the male and 27.4 percent of the female officials.
It was also found that 38.3 percent of them were at risk of hypertension and 21.1 percent
had hypertension; 15.9 percent had excess blood sugar, making them prone to diabetes.
Overall health-risk behaviors of the government officers in Long District put them
at a high risk of developing non-communicable diseases (90.4 percent). It is urgent that
preventive measures be developed to alter the risky behaviors by introducing effective
health programs for these government officers so that they might avoid contracting noncommunicable
diseases.


This action research was developed to assess the results of good-quality care and
practical guidelines for alcohol-dependent patients in Phimai Hospital during the period
from October 1, 2004 to July 31, 2007. The first group of subjects included 808 alcoholdependent
patients in the three subgroups studied in successive periods of care development:
261 patients treated in the early developing period (Oct. 1, 2004 to Sept. 30, 2005);
241 patients in the developing period (Oct. 1, 2005 to Sept. 30, 2006); and 306 patients in
the post-developing period (Oct. 1, 2006 to Jul. 31, 2007), respectively. The second sample
group was selected by randomized purposive sampling consisting of 35 patients who
received brief counseling and relapse prevention in the alcohol clinic of Phimai Hospital
in the period from February 1, 2005 to July 31, 2007.
The results of the quality care development revealed that the severity of withdrawal
symptoms in the post-developing group had statistically significantly decreased, but
showed no significant difference in average length of stay from any other groups at the 99
percent confident interval (p value < 0.01); relapse prevention showed that 37.14 percent
(13 out of 35), 34.29 percent (12 out of 35) and 8.57 percent (2 out of 35) could continuously
stop drinking over three months, six months and 12 months, respectively.
In conclusion, this action research focussed on the improvement of care and relapse
prevention. However, there were other opportunities to make improvements, such as
combination therapy, counseling in skills training for medical personnel, continuing care
in primary care units and community participation.


The Public Health Coordination Committee of Wangchan District, Rayong Province
has started a new form of health promotion for the people of Wangchan District under a
project named “Caravan for active health promotion, conducted by networks of participants
in the community.” The objectives were: (1) to compare activities between the new
and the former health services on aspects of their activities, budget, personnel, time consumption,
and involvement of health networks in the community; (2) to evaluate the
outcomes regarding the expected target establised by provincial as well as ministerial
public health policy; and (3) to determine satisfaction with the project among public health
staff, the target group, community leaders and health network participants. Information
sources were derived from questionnaires and working records.
The overall results of the descriptive study demonstrated the superiority of the new
form of health-promotion service to the former one on aspects of health benefits to the
community as well as the satisfaction of the participants involved in the study.


The study was undertaken to determine the effectiveness of bilateral hypogastric
artery occlusion in minimizing blood loss from abdominal hysterectomy. The subjects
under study were patients with myoma uteri who attended the Kabinburi Hospital for
surgical intervention in the period August 1, 2000 to July 31, 2007. The patients were
divided by simple random sampling into two groups; the initial numbers were 33 in the study group undergoing bilateral hypogastric artery occlusion right before hysterectomy
and 32 in the control group with no artery occlusion. After the abdominal hysterectomy,
Five patients were excluded after hysterectomy but not the cases of myoma, thus making
the patients numbers 30 each in both groups. With the same provision of preoperative,
operative and postoperative care for all patients, the procedure of bilateral hypogastric
artery occlusion was performed on the study group by the present author just before the
uterus removal operation and occlusion release after the hysterectomy was completed
and all the bleeders were checked.
The results of this study showed no statistically significant differences between the
two groups regarding their personal data and the operative outcomes. The average blood
loss in the study group was 350.67 ± 140.38 ml, whereas in the control group it was 572.83
± 207.82 ml; the difference was statistically significant (p < 0.05). The study group received
0.13 ± 0.346 units of blood transfusion during the operation, whereas the control
group received 0.63 ± 0.765 units; the difference was statistically significant (p < 0.05).
The operative time taken in the study group was 85.23 ± 17.17 minutes compared with
104.53 ± 16.06 minutes in the control group; the difference was statistically significant (p
< 0.05). There were no significant differences between the two groups regarding preoperative
and the 24-hour postoperative hematocrit levels, the numbers of pads used in the
first post- operative days, incidence of postoperative fever or infection, other organ injuries,
and the average length of hospital stay post operation. The study was conducted to
support the practice of temporary bilateral hypogastric artery occlusion in order to minimize
blood loss during abdominal hysterectomy.


The software program OPDAudit was developed from Microsoft Visual Foxpro. It
was used to audit outpatient data in contracting units of primary care (CUP) of Sisaket
Province, to analyze the outpatient services: health-care services or health promotion services
and finally to made a report for claims to the Sisaket Provincial Health Office. Input
files for this program comprised 12 electronic files, which every CUP sends to the Sisaket
Provincial Health Office monthly.


Background This study of 118 non-insulin-dependent diabetes mellitus patients
attending the out-patient department of Tesabarn Nakorn Chiangmai Hospital in the period
from January 2001 to June 2005 was conducted in order to study factors that affect
the change in blood sugar and blood lipid levels of those practicing self-dietary control
and self-care behavior.
Methods To evaluate the effects of dietary self-control, and self-care behavior on
blood sugar and blood lipid levels, a descriptive and retrospective study using an interview
form and a blood sugar record form was undertaken.
Results Of the total 118 patients aged 33-86 years, comprising 33 males (27.97%) and 85 females (72.03%), 66 of them (55.93%) had blood sugar levels below 120 mg/dl; 36
(30.51 %) had blood sugar levels of 121-140 mg/dl; and 16 (13.56%) had blood sugar
levels above 140 mg/dl. Sixty-nine patients (58.47%) had total cholesterol levels above
200 mg/dl; 58 patients (49.15%) had triglyceride levels above 150 mg/dl; 60 patients
(50.85%) had low-density lipid levels (LDL-C) above 130 mg/dl; and 46 patients (38.98%)
had high-density lipid (HDL-C) levels below 40 mg/dl.
Normal body mass index (BMI), good dietary control and good self-care behavior
tended to decrease blood sugar levels better than others, but the result was not statistically
significant.
Conclusions Multi-medical personnel should work together in the management of
diabetic patients in order to enable good control of blood sugar levels.


This cross-sectional descriptive research was carried out in January 2007 to study
the factors that affect stress and happiness in 1,426 public health personnel working in
Chachoengsao; included in the study were 1,024 community hospital staff, 59 provincial
public health officers and 343 district health officers. Happiness and stress questionnaires
were used to determine personal factors. The data were analyzed using t-test and
one- way ANOVA. The major findings showed the mean score of happiness of the sample was equal to
that of the general population (mean = 31.49) and the mean score of stress was at a
moderate level (mean = 40.61). Age, education, family incomes, workplace and kind of
services, all were factors affecting the happiness and stress at a statistically significant
level (p <.05). There were no statistically significant relationships between marriage status
and duration of work with regard to happiness and stress.
In conclusion, the sample has the same level of happiness as the general population
and stress was at a medium level. While the workplaces were related to low levels of
happiness and high stress, this factor should be analyzed further and corrected. It is
suggested that raising incomes would increase the happiness and lessen stress for these
officers, resulting in an improved quality of services.


This non-randomized controlled study was carried out in order to compare the efficiency
of simple breast massage with breast massage combined with warm compress
regarding milk production in 1,150 non-complicated postpartum women in five district
hospitals of Sakhon Nakhon Province. The subjects were assigned to two groups. The
first group of 567 pregnant women went into labor during the period 1 October 2005 - 31
March 2006. The second group comprised 583 pregnant women who went into labor
during the period 1 April 2006 - 30 September 2006. The first group had only simple
breast massage after vaginal delivery. The second group had breast massage with a warm
compress after vaginal delivery. The proportion of pregnant women producing milk within
six hours, and within 48 hours post partum was measured. The proportion of pregnant
women in whom the production of milk started within six hours post partum: 1st group
and 2nd group, was 61.9/97.1 percent respectively; those producing milk within 48 hours
post partum: 1st group and 2nd group was 75/98.8 percent respectively. The differences
were statistically significant (p < 0.001) in both groups. The conclusion of this study is
that breast massage with a warm compress is a better method than breast massage alone
in promoting milk production within six hours post partum and effectual milk production
within 48 hours post partum.


Factors affecting treatment outcome of new pulmonary tuberculosis patients in
Pannanikhom District, Sakhon Nakhon Province.
The study focuses on the relationship between predisposing factors, reinforcing factors
and enabling factors in a cohort of new pulmonary tuberculosis patients registered at
the tuberculosis clinic of Praarjanphun Arjaro Hospital in Pannanikhom District Sakhon
Nakhon Province during the period October 2004 - September 2006. The data were collected
using an interview form and analyzed by using retrospective study statistics, Chi -
square, Fisher’s exact test and correlation coeffcients.
The predisposing factors significantly associated with treatment outcome in new
pulmonary tuberculosis patients were age, marital status, education and economic factors
(p < 0.05).
The reinforcing factors were no cigaratte smoking or drinking of alcohol while under
the care of their doctor, during introduction and while reserve care from family, and
observers. Consultants explained the DOTS strategy to the pulmonary tuberculosis patients,
observers, Medical packing, checking and allergy drug (p < 0.05).
The enabling factors were distance and convenience of transportation (p < 0.05).


The living behaviors of people change in line with their economic and social status,
among others, often leading to incorrect health behavior with regard to nutrition, exercise,
and elimination of stress. This was a quasi-experimental research study. The sample
comprised 120 people from village 4 Banwangyai and village 5 Banwangplub is Tambon
Wanghin, Wangpong District, Petchabun Province. A multistage random sampling method
was used, with the sample divided into an experimental group and a comparison group,
each comprising 60 people. The experimental group was exposed to a health education
program with social support. The research instruments for data collection were questionnaires assessing knowledge of health-promotion behavior concerning susceptibility to
various types of diseases caused by behavior, severity of the diseases, social support by
public health volunteers, and health promotion behavior, among others. The statistical
methods used were means, standard deviation, paired-sample t-test, student’s t-test, and
Pearson’s correlation coefficient.
The findings showed that the experimental group had higher scores than the comparison
groups on these aspects following the program and the increase was statistically
significant.


The purpose of this study was to consider the result of the management of
Rongkwang Hospital in “sufficient economy.” The authors planned continuous management
and changed the way of creating suitable benefits for consumers, care-givers and
the hospital. This retrospective study compared financial liquidity, the quality of healthcare
services, the contentment of officers with the “sufficient economy” theory both premanagement
and post-management. Result of the study indicated that the average in-crease in financial liquidity was 80.82 percnt, which in pre-value and post-value measure
were 0.99 and 1.80, respectively. The decreased expenses included the public utility’s
value at 7.64, investigated material’s value at 0.08, and supportive medicine’s value at
28.63. The value of other materials was 10.42 when the quality service of health care in
the remedication rate for seven days decreased from 2 to 0.01 percent, the readmission
rate decreased in 28 days from 3.16 to 3.05 percent, the OPD consumer contentment rate
increased from 84.62 to 95.49 percent, the IPD consumer contentment rate increased
from 87.61 to 100 percent and the officer contentment rate increased from 74.75 to 75.31
percent. In conclusion, the result shows that management, in utilizing the principle of a
“sufficient economy” in Rongkwang Hospital, increased its financial liquidity without
any adverse effect on the quality of health-care services and the satisfaction of the officers
concerned.


This descriptive study was conducted in Huai Rai-Sajae Village of Mae Chan district,
Chiang Rai Province in the period from May 20, 2007 to July 20, 2007 to determine
the characteristic of the dengue hemorrhagic disease in order to understand the distribution
of the disease and independent factors for outbreaks, and to identify patients in the
community for treatment and prevention the epidemic. The data were analyzed by using
the SPSS version 12 software package for Windows to calculate the percentage, ratio,
means, cross-tabulations and chi-square.
The first case of dengue hemorrhagic fever emerged on May 21, 2007. The outbreak
became progressively worse, reaching a total number of 568 cases, among whom the diagnosis
of 63 cases was confirmed by serology and 525 cases remained probable cases
according to clinical criteria. The prevalence Rate of the disease in Mae Chan district was
492.33 cases per 100,000 population; the mortality rate was 0.17 percent. Most patients
(534 cases) lived in Huai Rai-Sajae Village; the remainder lived in other villages in Mae
chan district. The mean age was 24.88 years (SD= 16.82). Patients represented all age
groups, the youngest being 1 month old and the oldest 84 years old; the male to female
ratio was 1:1.24. The frequency of clinical signs and symptoms of the patients were fever,
99.31 percent; headache, 80.1 percent; myalgia, 63.27 percent; positive tourniquet test,
62.18 percent; and maculopapular rash, 43.5 percent. Impending shock and dengue shock
syndrome were seen in 12.41 percent of the cases.
The causes of the dengue epidemic in this village were inadequate control of mosquito
larvae in the community, poor sanitation and environment, lack of knowledge, and
a poor health-care system. In recent years, public health authorities have emphasized
disease prevention and mosquito control through community efforts to reduce larval breeding
sources. Although this approach will probably be effective in the long run, it is unlikely
to have a beneficial impact on disease transmission in the near future. We must,
therefore, develop improved, proactive, laboratory-based surveillance systems that can
provide early warning of an impending dengue epidemic. At the very least, surveillance
results can alert the public to take action and physicians to diagnose and properly treat of
cases.


This descriptive study was aimed at assessing the results from the monitoring process
in following the quality standards of the Ministry of Public Health in Sungmen District
Hospital. The survey, which was conducted on June 27, 2007 by the Ministry of Public
Health Standards Committee, was done by random sampling of people visiting 10
health-care service interfaces: ER, OPD, IPD, LR, Dental Clinic, OR, Laboratory, X-ray,
Pharmacy and community medicine. The Ministry of Public Health standard 2007 questionnaire
was used in collecting data. Data were statistically analyzed in terms of the
quality of services received compared with the service specifications subjects’ understanding
and satisfaction.
It was found that (1) 85.75 percent of the respondents received services as stated in
the service specification (covering four aspects of the Ministry of Public Health standard),
and all respondents understood the process of services, with 92.78 percent of them being
satisfied with the services, (2) the result of the award audit monitoring among the 10
health-care service interfaces was 91.96 percent.


Asthma is an ambulatory care-sensitive condition (ACSC). With effective ambulatory
care, this condition need not necessitate hospital admission. Avoiding disease exacerbation
and hospital admission of asthma sufferers can save health-care costs and improve
the quality of life of those affected. This study was aimed at determining the cost of
asthma treatment, either outpatient or inpatient, in order to obtain basic information for
asthma administration in the hospital. This was a retrospective and descriptive study using a prevalence-based approach.
The cost was calculated by a bottom-up method from a provider’s perspective. Those
eligible to participate in the study were either outpatient or inpatient asthmatics at
Prankratai Hospital, a 60-bed community hospital. Occurrences of asthma were identified
using the International Statistical Classification of Diseases and Related Health Problems,
10th Revision (ICD-10) codes J45 and J46. The data were collected from an electronic
database.
The cost of treating asthma consisted of nebulization (28.85%), medication (26.28%),
hospitalization (25.76%), outpatient visit (14.64%), oxygen therapy (2.97%), and x-ray
(1.50%). The average cost was 1,424.19 baht per patient per year. The average cost of
outpatient and inpatient treatment was 742 and 3,580 baht per patient per year, respectively.
During the study period, one-fifth of the asthmatic patients were admitted, but
accounted for about half of the total cost of all treatment.
Hospitalization comprised a considerable cost for treating asthma. To improve
asthma management and control, hospital administrators should establish simple asthma
clinics, develop guidelines, and encourage greater participation in asthma care by a broader
range of health-care professionals and not just doctors. Such initiatives are predictably
likely to decrease admission rates and the burden on health-care costs.


The study involved descriptive research using the survey method to study the healthpromoting
behavior, quality of life and relationship between health-promoting behavior
and quality of life of the elderly in Khowrai subdistrict. It was conducted in the period
February-May 2007. Data were collected by interviewing the sample population using
modified questionnaires of Kwanjai Tantiwattasatien, Pechara Intarapanich and
Daowrueng Khommuang puk, which utilized alpha coefficient for accuracy. Samples
included the elderly over 60 years old. Both men and women subjects lived in Khowrai
subdistrict; 248 persons were selected by cluster sampling from 18 villages. Data were
analyzed by descriptive statistics, mean, percentage, standard diviation and Pearson’s
coefficient for assessing the relationship between health-promoting behavior and quality
of life.
The findings were as follows: health-promoting behavior regarding nutrition, exercise,
daily hygiene, sociability, stress management, and health responsibility were medium
grade; quality of life was high grade by if considered in detail the quality of life in
terms of residence and social interaction were low level, but the quality of life in health,
recreation and self-assessment were high. Health-promoting behavior relates significantly
to quality of life. The results can be used for policy and strategic planning for health
promoting innovation for the elderly by cooperating with health personnel and subdistrict
organizations to solve social, economic and health problem in the elderly.


The objective of this study was to determine the differences in socio-economic status,
service utilization, and pregnancy outcomes between teenage and adult mothers aged
20-25 years old. Data were collected by interviewing and reviewing the medical records
of all mothers 13-25 years old who gave birth in Samroiyod Hospital, Prachuap Khiri
Khan Province, during the period September 1, 2006 to August 31, 2007. The study consisted
of 150 teenage mothers whose age was 13-19 years old and 255 mothers whose age
was 20-25 years old. Descriptive statistics including proportion, mean, and standard deviation
were used to present the analysis. The chi-square test or the Fisher’s exact test
was used to compare between the proportions of the two groups. Among the pregnant
women giving birth in the hospital during the study period, 29.0 percent were teenage
mothers. About 54.0 percent of the teenage mothers were 18-19 years old and 9.3 percent
were between 13 and 15 years of age. Their mean age was about 17.5 years old. The
teenage mothers had significantly higher educational levels than the adult cases. Insufficient
earnings, no home of their own, and being separated were significantly more common
in the teenage mothers than the adults. The proportions of teenage mothers completing
the antenatal care of four visits and taking iron supplement tablets regularly were
significantly lower than those of the adults. The teenage mothers were significantly more
likely to be in their first and unplanned pregnancies and have a history of abortion than
the adults. Stress was significantly more common in the teenage mothers than the adults.
The teenage mothers significantly had a higher incidence of antenatal complications, including
anemia and low weight gain during pregnancy, and low birth weight infants
than the adult mothers. Good antenatal care should intensively be provided to these
risky pregnancies. A reduction of the numbers of teenage pregnancies in the community
is essential.


This was a participatory-action-research study aimed at examining a model healthpromoting
village, using community participation, conducted in three villages in Denchai
district, Phrae Province. The health-leading teams comprised 10 specifically selected persons
from each village, a total of 30 persons; representative villagers were 50 residents selected by simple random sampling from each village, a total of 150 respondents. Data
were collected by interviews, group discussion, and health leading-team conferences.
Results of the study revealed that health leading-teams were the leaders of developing,
controlling the plans and activities of health promoting villages and coordination with
other organizations. Health-promoting activities in the villages were as follows: 80 percent
of the villagers planted and consumed local vegetables, meaning that there was no
chemical contamination in food; there was one elderly social group in each village; because
of project implementation, the health knowledge of villagers was improved to 100
percent, which was statistically significant.
With regard to health problems, 49.3 percent of the villagers undertook regular physical
exercise for 30 minutes per day thrice a week; 88 percent washed their hands before
and after eating; 84 percent brought food substances approved by the Food and Drug
Administration as certified by labels and symbols; 75.3 percent eradicated mosquito breeding
sites; 73.3 percent were members of the “To Be Number One Club”, which works
against amphetamine addiction 88 percent had their blood pressure measured within
one year; 63.3 percent of the female villagers had had a pap smear examination; and 93.7
percent had performed breast examinations by themselves. Based on the results of the
study, the author suggests that community health promotion should be promoted and
models of implementation should be developed with the support of every organization
and civil society concerned. Government authorities should support community participation
in the management of health-promoting plans of the villages.


This report describes an investigation of a measles outbreak in Umphang District,
Tak Province, in the period 2004-2005 and emphasizes the importance of coverage of
measles immunization in children. Medical records of measles cases diagnosed between
January 2004 and April 2005 in the district were reviewed. Data on measles immunization
in children 9 months of age or older and measles-mumps-rubella immunization in
school children were retrieved from Umphang Community Hospital and 4 out of the 7
health centers to determine the coverage. Over the outbreak period, among the 187 measles
cases, about 85 percent were Thai and 15 percent were cases among citizens of Myanmar.
One case died from pneumonia, producing a fatality rate of 0.5 percent. Of the 187 cases,
89.8 percent were children 0 - 14 years old and 10.2 percent were 15 years of age or older.
Measles cases were reported from all subdistricts in Umphang District. Sporadic cases
were reported from January to April 2003 and the cases increased thereafter. Clinical manifestations
included fever (100%), rash (100%), cough (80.2%), and rhinorrhea (67.9%).
Measles complications in these cases were pneumonia (17.6%), diarrhea (10.7%), and otitis
(5.9%). About 61.6 percent of the Thai cases had not received measles immunization
and the remainder could not be determined. Of the 106 measles cases examined for
measles-specific IgM by ELISA, 80.2 percent were positive. The coverage of measles immunization
in both > 9-month and school children was low in some areas of the district.
The outbreak tapered off after providing preventive and control measures. The authors
suggest that full coverage of measles immunization among the target children is essential.
For remote areas in the district where people face difficulty in traveling and limited
outreach of health services, the provision of an immunization program in dry season may
be useful.


The purpose of this study was to determine the effectiveness of the full denture
process by the cabinet control dispersion of acrylic resin in Sichon District Hospital from
2005 to 2007. According to the Royal Denture Project, the number of elderly Thais who
want full dentures is increasing and of acrylic resin denture products is increasing. Many problems are caused by acrylic resin contamination, such as health hazards, environmental
damage, bad odor and dust. New equipment for making full dentures uses local
materials. With regard to the production of full dentures, the level of patient and dentist
satisfaction before and after the use of this equipment was measured. The data were
collected using a questionnaire which assessed the patients’ and dentists’ satisfaction by
using the Likert scale. The data were analyzed using the SPSS program Version 10. The
study showed that the total number of elderly persons who received complete dentures
during the three-year period was 433 people and the efficiency of the dentists were 100,
98.2 and 154.4 percent respectively. The results of the dispersion acrylic resin control rate
were 100 percent in the 2nd, 4th, 6th, 8th, 16th, and 24th weeks of data collection. The
findings also showed that the patients were highly satisfied with this approach when
compared with the previous procedure. Moreover, the results showed that dentists were
also satisfied.
This study demonstrated that the effectiveness of the full denture process was significantly
increased by using this cabinet for dispersion of acrylic resin control.


The objective was to examine vegetables and fruit consumption patterns
among Thai population across four regions and Bangkok.  This study was a part
of the National Health Examination Survey III in Thailand conducting between
2003 and 2004.  A total of 39,290 individuals aged ≥ 15 years were interviewed by
using a set of questionnaire including information on sociodemographic and
vegetables and fruit consumption.  Employing descriptive statistics, Wilcoxon
rank-sum test and Kruskal-Willis test at 0.05 level of confidence.  The findings
demonstrated that overall, an individual had average frequencies of vegetables
and fruit consumptions equal to 5.97 and 4.56 day per week, respectively.  Individuals living in the Central and Northeastern regions had the highest number of
days per week for vegetables consumption, while those living in Bangkok had
the highest number of days for fruit consumption.  On average, numbers of
servings of vegetables, fruit, and both vegetables and fruit consumed a day were
1.78 (median = 1.14), 1.46 (median = 1.00), 3.24 (median = 2.86), respectively.
People in Bangkok ate more vegetables, fruit, and both vegetables and fruit than
those in other regions.  There were significantly differences in median number of
days per week and the amount of servings per day for vegetables and fruit consumed across four regions and the metropolitan (p< 0.05). Proportion of individuals who met the recommendation for vegetables, fruit, and both vegetables
and fruit consumptions were 26.9 percent, 35.4 percent, and 26.6 percent, respectively.  In conclusion, frequencies and amount of vegetables and fruit consumptions in Thai people varied by regions of residence. Majority of Thais had an
inadequate daily amount of vegetables and fruit consumption.


As part of the National Health Examination Survey III, the objectives of
this study were to determine the health problems of Thai elderly in 4 dimensions; self-reported health status, prevalence of behavioral risks, biological risks
and examine an awareness, treatment and control of the leading chronic
diseases.
The samples of 19,372 respondents aged 60 years and over were drawn
from those included in the multi-staged sample national survey during JanuaryAugust 2004.  Methods of data collection were interview, physical examination
and laboratory findings. Descriptive analysis was used to estimate the size of the
conditions and prevalence at the national level, base on standard criteria for diagnosis of chronic diseases and levels of their effective control.
With regard to behavioral risks, prevalence of cigarette smokers decreased
with ages, the rate among males was nine times over that of females. Alcohol
drinking decreased in a small proportion. Insufficient physical activities as well
as fruit and vegetables intakes based on standard criteria were observed at high
rates (80-90percent), increased with advanced ages and the oldest females were
the worst.  For biological health risks, anemia and underweight appeared to increase with advanced ages and lower proportion of obese elderly respondents
with advanced age was observed.  Selected chronic diseases were hypertension,
hypercholesterolemia and Diabetes Mellitus, of which known as high risks associated with major cardiovascular events for example, stroke, ischemic heart, and
long- termed diabetic consequences.Age-adjusted prevalence of hypertension
were at 51.6 percent, diabetes 14.8 percent and high cholesterol 25.4 percent.  While
overall proportion of unawareness of those chronic diseases were reported to be
56.8 percent for hypertension, 41.2 for diabetes and 81.5 percent for high cholesterol.  The proportions of those treated and control of blood pressure, blood sugar
and blood cholesterol were12.4, 26.4 and 10.3 percent respectively.  Women were
found to be more aware of their illnesses, received treatment with effective control than their men counterparts. An ineffective control group was observed
among the oldest - 80 years and over- of both genders.
In conclusion, there were high prevalence of hypertension and diabetes
in the Thai elderly with high percentage of unawareness and inadequate control
of those treated.Screening program for early detection was essential.  Treatments
of these diseases to maintain adequate control should be improved


The violence in the Southern provinces in Thailand took a toll on physical, psycho-social and spiritual health.  Data collection began from March 2004
to March 2007 using questionnaires, face to face interview including group seminars and brainstorming sessions.  It was found that the frequency of chaotic events
occured 5,460 times during January 2003 to August 2006.  About 1,730 have been
killed and 2,513 injured.  These victims included 22 health workers and 31 health
volunteers.
In the prime of the violence, every single hospital has prepared itself to be
ready to cope with those crises.  Health workers, for example, suddenly changed
their behaviors substantially such as adjusting their work schedules, not
wearing uniform, taking more precautions, decreasing or avoiding their proactive roles in field works, particularly health promotion and health prevention.
These were remarkable changes in health care roles which would have long term
serious effects on the communitiy health.  In addition, security in hospitals has
been tightened while stocks of food became critically necessary.  Some local health
offices rearranged their teams by having village health volunteers working closely
with their health officers.  These actions could boost their morale and ensure
their safety. Community faith in them and being natives inspired health workers
to remain in their posts.
It was interesting that the number of cases of out-patient and in-patient
departments had not changed much but the number of patients visiting local
health offices clearly decreased.  Nevertheless, the number of patients in labor
departments increased and the chronic disease cases increased as well.  Besides,
the number of cases with psychosis or having mental problems sharply increased.
Eventhough, the turn over and replacement of health workers became even but
the lack of medical specialists in some areas remained.  Number of registered
nurses would become the major concern in the near future if the violence is not
restrained.
The crisis dictates requirements on short-term measures to focus on security, life protection, creating the supporting systems about counseling, referring,
transferring and maintaining the systems.  In the long run, measures include
peace restoration, then, create health participatory system of people in communities, self-care system and enhance effectiveness of health system.  It should be
concerned about the opportunity to build Muslim medical curriculum and
agenda.  Having a specific team work to monitor the situation closely, connecting and communicating with the government and developing the participatory
management of data system and solving the problem may gradually decrease
the violence.  In addition, research and development on the consequences of the
health system of the restive southern provinces are required in order to cope
with the drastic change.


The prevalence and burden of chronic diseases, particularly diabetes, are
rapidly increasing in Thailand and worldwide. Yet in a national survey, it was
reported that 41 percent of those diagnosed with the diabetes were unaware of
the condition and only 26 percent had their blood glucose controlled effectively.
The national health care cost for the  3 million cases is estimated to amount to
350-840 billion baht in 2007. Several studies have been reported that microvascular complications existed prior to the diagnosis of diabetes and later resulted in
retinopathy (10-29%), proteinuria (10-36%) and neuropathy (9%). Furthermore,
risk of macrovascular complications and their death rates of those with prediabetes were equal to those with diabetes and twice of those without. Studies
showed that among those with high risk, the chance of developing to diabetes
can be reduced by changing to  of healthy life style - nutrition, physical activity,
and weight reduction - which cut down the incidence of diabetes by 58 percent.
It was reported that risk factors among Thais that might be related to diabetes were   high blood pressure, over weight, high blood cholesterol, inadequate
fruit and vegetables intakes, limited physical activity and malnutrition.
In Thailand, among those with diabetes, the prevalence of diabetic complications were nephropathy 43.9%, cataract 42.8%, retinopathy 30.7%, ischemic
heart disease 8.1% and stroke 4.4%. In Finland, the major causes of death among
over half of cases with diabetes type 1 and 2, were myocardial infarction and
ischemic heart disease.
Review of national diabetes prevention and control programs of the United
State of America, Canada, England, Finland and Australia shows that programs
on prevention of diabetes type 2 by changing of life style were commonly endorsed. Advocacy on early diagnoses by screening service for high risk group
and underserved population were clearly spelled out. However, the program in
Finland used a screening questionnaire focusing on risk factors to identify those
with high risk rather than depending alone on laboratory test. Similarities were
reported on the efforts of the 5 developed nations to provide high quality service, continuing care and forming networks at all levels reaching communities
in particular. Many of them underlined the essential of adequate information for
general population in order to increase awareness and commitment in changing
life style. Likewise diabetic patients need this continuing health information pertinent to their participation in treatment and self-care. The national health plans
always underline strategies to strengthen infrastructure and capability of the
health services and health manpower development.


Second opinion is one of the efficient medical procedures to enhance
quality and reliability of health care system, particularly from the patient’s point
of view. To be applied in Thailand, this will provide evidence of Thai patient’s
rights enhancement as well as consumer empowerment, in terms of allowing
consumers to receive better quality of health care services.  The objective of this
study is to review the literatures related to second opinions and people’s access
to public health information, with the aim to find out preliminary information
required for a proper development of second opinion system in Thailand.


Outstanding labour migration has been reported in the northern region
of Thailand leading to changes in physical and social aspects.  Subsequently effects on health status at individual, household and eventually community level
shall be witnessed.  This article was aimed at presenting situation, recommended
research issues and strategies in order to develop preventive measures and reassurance of adequate health services accordingly.
Presently, labour is classified as formal and informal.  Whereas, the latter
is not yet entitled to legal protection and benefits of the social security scheme.
These discriminations exist among some industrial labors undergoing unfairly a
series of probation periods.  As such, the phenomena calls for research related to
situation and pattern of employment; classificaiton of labor and required health
care/insurance; their health behaviors and proper health promotion measures.
Safety regulations and guidelines in working place, particularly in small,
and medium enterprises have often been neglected and the premises can avoid
monitoring of the public sector.  It may critically call for strong participation of
community and local health facility.  Research effort should, then, be made on;
development on tripartite monitoring and surveillance on safety work place,
labor protection system by community, and labor in home industries, guideline
for labor protection from occupational health risk, guideline on rehabilitation of
vulnerable labor with participation of family and community, an of health status
and safety of labor in service sector.
Haphazard movements of labor on provincial, regional and national
levels do not accommodate registration, provision and coverage of health care
and insurance with respect to their health needs.  Further development of health
care system, hence, should focus on accessibility.
Health and safety regulation information should also be disseminated.
The research issues should cover on an effective model for disseminating health
and safety regulation information at community level, life skill for adapting in
cross cultural environment, community and health facilities roles and functions
on surveillance on health, and self-care empowerment of labor Based on information synthesis and brain storm of experts and stakeholders, research strategies and issues were formulated as follows: strategic I promotion health of labor at community and strategic II self-care empowerment of migrant labor.  The research issues of strategic I include situation of labor health,
classification of labor based on health care system, effect and impact of Free Trade
Act (FTA) and new production pattern on health, monitoring and surveillance
on safety work place and labor health problem, labor protection at community
industries, health protection and rehabilitation of labor with high risk, and perception on labor’s right at community.


The objective of the study is to study the mechanism of human subject protections focusing on ethics committee in central part of the Ministry of Public Health. The methodologies include literature review, questionaire, and indepth interview. The study revealed that most of Departments in the Ministry had established ethics committee, i.e., Ministry of Public Health, Department for the Development of Thai Traditional and Alternative Medicine, Department of Medical Service, Department of Disease Control, Department of Medical Science, Department of Mental Health and the Health System Research Institute. There are institutional ethics committee in Department of Medical Service, e.g., the National Neurological Institute and the Queen Sirikit National Institute of Child Health. Most of members of the committees acquainted with the international ethical principles and guidelines for research involving human. The composition of the committees are in line with international guidelines. Each committee have their own guidelines and standard operating procedures. Only one committee has been surveyed, evaluated, and recognized by SIDCER/ FERCAP Recognition Program, i.e., the Ethics Committee for Thai Traditional and Alternative Medicine. Since the research is not the first priority of the Ministry of Public Health, there are some shortcomings that need consideration for correction and improvement. Most of medical and health journals have no policy for requirement of ethical clearance of the studies submitted for publication. Most of the ethics committee focussed only on preview of the protocol, no proactive activities on continuous review and site visit. Most of the committees review both scientific and ethical aspects meanwhile most members of the ethics committee have limited knowledge and experience in research on advance and complicated sciences. The supports of most committees are insufficient. The information  technology are not fully used in most committees. Some committees have problems in timely review and may have doubt of independence in some cases.


The objective of the study is to review ethical considerations for research in routine practices. The main question is whether these researches need ethical review or not. The study concluded that, first, there is need to distinguish among practice, experiment and research. Any works that contain research element in part or whole should be submitted for review by Ethics Research Committee, if the researches involving human subjects, which included biomedical, behavioral and social sciences researches. The rationale is to ensure that  human subjects or research participants are appropriately protected in dignity, rights, safety and well-being according to international ethical principles in human research. However, the burden of ethical review should be appropriately managed. The researches should be categorized by their risks. The researches that contain minimal risks should be considered for expedited review.


In 1992 Thailand made another big step in reforming her health care financing system i.e., the promulgation of the Act on Road Accident Victim Protection.  This was aimed to ensure that over a million of people suffering from road traffic injuries(100,000 cases need hospitalization) would be promptly taken care of; those becoming disabled(10,000 cases per year) or families of the deceased(13,000-15,000 cases per year) from the injury would be compensated.
According to the law, auto-insurance industry was assigned to collect premium from all motor vehicle owners and to pay compensation to hospitals caring for the victims, the disabled and families of the deceased. These roles and functions of the industry were under supervision of the Department of Insurance, Ministry of Commerce. The compensation for each case was divided into 2 parts. The first was paid on no-fault basis. The rest was on fault-basis which meant only victims not found to be responsible for the accident were entitled to the second part. For each type of compensation, the amount of money for the first part was about 1/3 that of the second part.
This report is another step of on-going academic contributions commenced in 1995 to shed light on the performance of the law. To do so, it employed a combined approach comprising literature review; cross-sectional surveys on hospitalized victims and on disabled accessed through telephones; analysis of in-patient dataset submitted to the National Health Security Office and injury surveillance dataset; and informal interviews with hospital officers dealing with the compensation for medical care of the victims.
16 years after the law came into effect, coverage of the compensation to the hospitalized victims had increased from under 10% in 1995 to 35% (an estimate for the best case scenario) in 2008.  46% of the disabled were compensated for medical care in 2008.
Among hospitalized victims, the barriers to full coverage were identified as ignorance of the entitlement, difficulties in gathering documents demanded for compensation, perceived threats of legal actions on failure to renew vehicle license or to pay the premium.
With regard to financial performance, evidence from the Department of Insurance revealed that since the law was in operation a surplus had been accumulated to 10,759 million baths (1997-2006). Regrettably, a loss ratio of 46% on average was recorded for the period. This strongly indicated that the money had been far from adequate to fulfill the aims of the law. In addition, it was found that 40% of the premium went to administration.  As a result, it raises a serious question about efficiency in compensating the victims.
Probably, the concern on efficiency could be more alarming when the financial performance of the law was compared to 1) that of the Road Accident Fund of South Africa which spent just 1/3 the administrative cost of the Thai counterpart, yet with a loss ratio of 109% in 2003 or to 2) that of the National Health Security Office spending just 0.6% on administration to disburse 129,627 million baths for health care of 48 million people in 2007.
Rooms for improvement of the law were, thus, clear.  Two alternative approaches were offered. One is a radical approach to replace the existing law with a new proposal endorsed by the Government of former PM Surayut Chulanont.  In essence, the new proposal hoped to install a virtually no-fault system in which the premium would be collected by the Department of Land Transport and the payment to be made by the Comptroller General’s Department currently overseeing compensation to hospitals under the Civil Servant Medical Benefit Scheme. Under the proposed system, overall administrative cost would be cut down to just 6% of the premium. As a result, more money would be available to compensate the victims to a much larger extent in terms of % of victims being covered and the amount of compensation in each case.
The other approach is to improve efficiency of the operation of the existing law through: 1) cutting down administrative cost by switching to fuel levy instead of the premium collection; and 2) setting up so-called “compensation recovery unit” similar to that of the U.K. to act as a clearing house for the compensation to victims and health care providers.


This qualitative research aimed to study hospital food safety development and network, food safety development process, success factors supportive to hospital food safety as well as constraints.  The study was done at 4 food safety model hospitals of Department of Health Service Support, Ministry of Pubic Health; Chiang Rai Prachanukrao, Khon Kaen, Ratchaburi and Songkla hospitals.  Key informants were hospital administrators, nutritionist, multidiscipline health team, support groups from within and outside hospitals.  Data collection used interview, observation, focus group discussion and evidence-based document review, for systematically explaining and synthesizing phenomena.
The study results found all of the four hospitals were tertiary care service level while having 480-1000 beds with food service delivery 500-1000 persons per day.  The Nutrition Department of each hospital produced and managed food services for general, special, case-specific and tube-liquid meal patients.  The food was also serviced for hospital staff, patients’ relative general visitors by the hospital food outlet welfare unit.
For development on hospital food safety policy, this was originated from the hospital accreditation policy while later in 2004 the Thai Government announced to be one of the national development agendas.  The Ministry of Public Health by Department of Health Service Support has launched the food safety pilot project at 4 hospitals, and therefore initiated many model development activities while integrating the food safety with other health care activities.
For the key aim of development of hospital food safety, it found that the hospitals wanted their food service being clean and safe for their customers and staff.  Also, they wished to build customers’ capacity in selection of buying a safe food, to advocate the hospital food service out let to produce hygiene food, and to encourage hospital staff being a good health behavior model and to extend the food safety to other institutions and communities.
For the development of hospital food safety process, this found all hospitals has established the food safety committee and taskforce while being the key human resources who developed food safety model and activity both within and outside hospital.  The activities were firstly finding safe raw materials by incorporating with provincial and district agricultural and poultry offices.  They also explored source and product network as well as coordinator for producing and transporting raw materials to the hospitals.  Development of hospital food safety standard applied the food sanitation standard of Ministry of Public Health 30 items with additional assigned criterion made by the committee and taskforce.  Surveillance was made on raw material contamination, cooked food and utensils, and catering food to the wards.  Follow-up and evaluation was made by sampling food for investigation for health hazard and harmful.  Development and extending food safety network, the hospitals have expanded to other settings, i.e., food safety farmer group, coordinating and technical support network, hospital weekend food market network, food safety hospital network, school network, prison network, monastery and hospital food outlet network.  The development of these network applied participatory process with brainstorming in problem search, co-implementation, organizing knowledge building event for the network.  Also, the hospitals have learnt with the network, done followed-up and evaluation as well as made network visits.
For the supportive factors which leading to the success, these were development and policy translation activities; 1) food safety policy of Ministry of Public Health and province, hospital health service quality policy, the hospitals translated these policy directly and indirectly to committee and taskforce for policy implementation, 2) support of the hospital administrators while all prioritized and provided various resource to the committee and taskforce, 4) clear assignment and support of team work oriented, each hospital clearly appointed the committee and taskforce, which consisted of health team representing from each hospital department with a clear division of job responsibility, 4) resource allocation, the hospital administrators have provided financial support for office and building space set-up for proactive activities to both within and outside hospitals, 5) modification of system and method in support of hospital food safety, which were modifying purchasing procedure, opened system by encouraging the farmer group together with responsible hospital staff setting the price of product, food menu adjustment in line with the raw material availability as well as local vegetable and seasonal fruits, 6) building motivation force, the hospital administrators admired and appraised the hospital food safety team at the hospital meeting, general public and reward, beside the hospitals presented the “Food Safety” and “Clean Food Good Taste” banners to the networks that could pass the hospital food safety assessment criteria, 7) team strength, it found that the core team played a critical role contributing to the project success, the team was at high leadership, continuous and proactive, intentional, devoted, organization beloved, consultation and exchanged ideas even now no new policy and financial support from the central government.
For supportive factors which arisen from outside hospital; these were local policy, provincial food safety and consumer protection policy and collaboration of other agencies.  The limiting factors to the hospital food safety were 1) raw materials produced by local farmers did not meet the hospital demand and listed even the hospital tried to adjust the menu suited to the raw product availability, the remote network lacked of management competency and hardship of transporting raw materials to the hospitals, 2) discontinuous of central policy and financial support, 3) lack of suitable performance indicator used for assessment of the project as well as lack of knowledge on systematic evaluation, 4) implementation by sectoral government agencies could not done in a full integration manner, and 5) the administrators failed to pay attention to the hospital food safety program.
The overall outcome arisen from the hospital food safety program which found mass advocacy to the development of food safety movement within and outside hospital.  These were; origination of many safe food producers supplying to the hospital and increased farmer income, the hospital food service were safe and satisfied by the customers and hospital staff, the hospital adjusted its menu fitted to local seasonal raw product and availability, the food handlers changed their process for hygienic and safe food, advocacy to the emergence on development of food safety in community hospital, school, prison and monastery, and collaboration encouragement between the hospital and local institutions for the development of safe food for consumers.


In late 2006 and early 2007, the Thai government announced its intention to introduce the use by the
government of patents for three pharmaceutical products: two antiretrovirals (ARVs) and an anti-thrombotic
drug. This action, which was aimed at improving access to essential medicines in the public sector,
complied with the flexibilities of the Agreement on Trade-related Aspects of Intellectual Property Rights
(TRIPS). By employing qualitative approaches, this study assesses the involvement of key stakeholders in
the policy process. This analysis suggests that the idea of enforcing TRIPS flexibilities for expanded access to essential
medicines in Thailand was adopted as a public policy when the new government took office after a change
in the political system in September 2006. This policy obtained significant support from non-governmental
organizations in the health sector, patient groups and academics, both inside and outside the country.
However, the action by Thailand was strongly opposed by patent-holding companies, the multinational
medical industry and their national governments. The contributions from civil society were managed in
several forms, such as technical and information support and demonstrations to advocate the policy. Meanwhile,
powerful nations introduced trade retaliation and put political pressure on the Thai side. Global
concern about the unaffordable costs of patented medicines that hampered access to essential health care
in the South was beneficial to the enforcement of the government use provision. The potential diffusion of
this policy from Thailand to other developing countries triggered serious opposition from stakeholders
who lost their benefits.