Background: The rapid increase in COVID-19 cases puts significant stress on the health system. Healthcare workers (HCWs) who are at the frontline responding to the crisis are particularly susceptible to this highly transmissible infection, given their long and close exposure to infected persons. Decision-makers are in need of the information to appropriately determine a quarantine guideline and policy for healthcare workers while maximizing the patient’s safety and ensuring the continuous provision of services to society. Objectives: The primary objective of this study is to develop recommendations for quarantining HCWs who have been exposed to COVID-19. The secondary objectives are 1. to estimate the proportion of HCWs with COVID-19 by nucleic-acid amplification test (NAAT) within the quarantine period and the difference in proportions of HCWs with COVID-19 by NAAT at day 5, 10 and 14 of the quarantine period; 2. to descriptively report the incubation period (from the date of exposure to COVID-19 source case to when the symptom first appear (symptomatic case) or to when the NAAT is positive (asymptomatic case); and 3. to estimate the proportion of asymptomatic COVID-19 among those HCWs with COVID-19. Methods: This is a prospective cohort study to identify the incidence of COVID-19 among health care workers who had been in contact with COVID-19 cases. The inclusion criteria were HCWs aged over 18 years old who have been identified as HCWs in which a patient with laboratory confirmed COVID-19 infection is receiving care or ‘HCWs contact’. Following the initial routine test (Nucleic acid amplification tests, RT-PCR), if the result is PCR negative ‘HCWs contact’ with or without any respiratory symptoms and works in a health care facility were included for this study. The sample size calculation was 375 participants. Data collection included 1) daily self-monitoring symptoms and temperature for 14 days, 2) Nasopharyngeal & oropharyngeal swabs and saliva at day 5, 10 and 14 of the quarantine period and 3) serum at day 0 and 14 of the quarantine period. For confirmation of COVID-19 cases, it was based on detection of unique sequences of virus RNA by Nucleic acid amplification tests such as real-time reverse-transcription polymerase chain reaction (rRT-PCR) from nasopharyngeal & oropharyngeal swab and saliva samples at day 5, 10 and 14. For monitoring purposes, serum immunoglobulin G (IgG) were analyzed by ELISA for antibody against SAR-CoV-2 virus at day 0 and 14 of the quarantine period. Results: From January to July 2021, 153 eligible health care workers met the inclusion criteria and provided consent. Most participants were women (84%), age range between 22 and 63 (mean age, 34 years old) and worked as nurses (52%), assistant nurses (14%), doctor/dentist/pharmacist/laboratory staff (20%) or other supporting HCWs (15%). Most of the participants worked at an emergency room (ER) or intensive care unit (ICU) (41%). Most of the participants reported to have been vaccinated (78%) and only 5% of the HCWs reported to have full PPE when exposed to COVID-19 patients. Three HCWs were tested positive for SARS-CoV-2, giving the positivity rate of 2.08% (95%CI: -0.28% to 4.44%) of the HCW contact which was detected at day 5 for 2 HCWs and at day 10 for 1 HCW. All three HCWs received 2-dose COVID-19 vaccination (Sinovac) at an average of 40 days before the contact. They did not use the complete set of PPE and were only put surgical masks and gloves on while in contact with COVID-19 patients. This study reported the incubation period from the date of exposure to known COVID-19 source to when the PCR positive is positive of 6.33 days. Two out of three (66%) COVID-19 positive cases are symptomatic. The overall positivity rate for SARS-CoV-2 serostatus from the blood sample was 84.15% (95%CI: 76.07% to 92.22%) at day 0-5 and 79.07% (95%CI: 71.96% to 86.18%) at day 14. Most of the positivity rates for SARS-CoV-2 serostatus were correlated with vaccination status. The level of anti-SARS-CoV-2 IgG antibody titer from COVID-19 positive HCWs at day 14 ranged between 20,665 to 40,000 AU/mL. During the 14-day monitoring period, health-related quality of life (measured using the EQ-5D-5L) of HCWs decreased due to depression and anxiety domain. On average, the quality of life of HCWs decreased from the baseline up until day 5 of monitoring and increased as the PCR results became available. The decreased quality of life was significantly associated with increasing age and showing signs of respiratory disease. The increased quality of life was significantly associated with those who used the full set of PPE. Discussion: The study can only be carried out after the reopening policy in Thailand was implemented. From January to July 2021, there was a national campaign to encourage healthcare workers to receive COVID-19 vaccination. Around 78% of the healthcare workers were vaccinated against the COVID-19, and 82.8% of these groups received two doses as scheduled. This study did not recruit enough sample sizes, and only 2% of the HCWs were positive for COVID-19.Therefore, it is unclear whether to reduce the number of days of quarantine or be certain about the factors associated with infection. However, this research highlighted that HCWs in all departments are at risk of being exposed to COVID-19 patients. Closely monitoring high-risk COVID-19 contact cases during the first 5 to 10 days after exposure and periodic testing for infection remains essential for controlling the spread of the disease in healthcare facilities. Nurses and axillary nurses who work in emergency departments and intensive care units are at high risk of COVID-19 exposure. HCWs who work directly with known COVID-19 patients may take full precaution and be equipped with a full set of PPE while those working in other departments may have less awareness or lack of adequate protective equipment. The government should therefore focus on supporting PPE for all HCWs and should develop a working system to minimise the risks of being exposed among coworkers such as shift arrangement. Additional supports for HCWs to tackle mental health issues and compensation in various forms should also be considered. Recommendations: 1. Closely monitoring of healthcare workers who had been in high-risk contact with COVID-19 patients for 5 to 10 days remains necessary even if personnel have been vaccinated. 2. A booster dose of COVID-19 vaccination for healthcare workers is still necessary to control the epidemic. 3. The government should procure and distribute sufficient Personal Protective Equipment (PPE) for all healthcare workers who were on duty whether working directly with COVID-19 patients or not. This is because all personnel are at risk of coming into contact with COVID-19 patients who have no symptoms. 4. The government should have measures to support healthcare workers who perform their duties to ease mental health problems.


Background: Breast and ovarian cancers are common cancers in female. In Thailand, breast cancer is the most common type of cancer and ovarian cancer is identified at 6th rank in female. BRCA1/BRCA2 are the most common types of hereditary cancer. The prognosis of woman who inherited mutations in the BRCA1/BRCA2 genes could be predicted; as the group with high risk of developing breast cancer (80%) and ovarian cancer (15-40%) in their life time. The detection of germline BRCA1/BRCA2 could lend the opportunity for offering choices of prophylactic treatments. Moreover, recent advance in development of technique for detecting BRCA1/BRCA2 with a lower price raises the question whether this intervention is affordable at the national level in Thai context. Method: The objectives of this study were to evaluate the cost-utility of testing for BRCA1/BRCA2 followed by preventive interventions compared to no genetic test in both high-risk breast cancer patients and their first-degree relatives and to estimate government budget impact using an economic model. A Markov model was used to estimate relevant costs and health outcomes using a lifetime horizon from the societal perspective for Thai healthcare system. Direct medical and non-medical costs were included. Health outcome was quality adjusted life years (QALYs). The results were presented as incremental cost effectiveness ratio (ICER) in Thai baht per QALY gained. One-way sensitivity and probabilistic sensitivity analyses were performed to investigate effects of model variable uncertainties on the results. Results: The results of this study showed that genetic testing for BRCA1/BRCA2 in high-risk breast cancer patients who should be screened for the BRCA1/BRCA2 gene mutations followed by preventive intervention was cost-effectiveness when compare with no genetic testing. The ICER of this intervention was 18,591 Baht/QALY gained which accounted as cost effective based on current willingness to pay (WTP) threshold in Thailand (160,000 Baht/QALY gained). Moreover, offering genetic testing in first-degree relatives of patients with BRCA1/BRCA2 gene mutations was found to be dominant and a cost-saving option compared to no genetic testing. The estimated five years budget impact is approximately 1,011 million Thai baht at BRCA1/BRCA2 testing cost of 21,340 baht. Policy recommendation: The results of this study suggested that providing BRCA1/BRCA2 genetic testing in high-risk breast cancer patients who should be screened for the BRCA1/BRCA2 gene mutations and first-degree relatives of patients with BRCA1/BRCA2 gene mutations detected should include in the National benefit package in Thailand.


Background and Objectives: Familial hypercholesterolemia (FH) is the most common genetic cause of cardiovascular disease. This study was aimed to 1) compare Achilles tendon thickness and characteristics using skin calipers, plain radiograph of lateral heels and ultrasonography in 63 FH patients (diagnosed using the Dutch Lipid Clinic Network [DLCN] score above 3 [possible, probable or definite FH]), 58 non-FH patients with elevated LDL-cholesterol (LDL-C) >130 mg/dL and 55 subjects with LDL-C below 130 mg/dL and determine the cutoff values with the highest diagnostic accuracy for FH diagnosis among Thai patients. 2) compare the coronary calcium score (CAC) and aortic valve calcium (AoVC) score using computed tomography in 62 FH patients and 58 non-FH patients Results: 1) Skinfold calipers demonstrated 61% accuracy for diagnosing FH. An anteroposterior (AP) diameter on plain radiographs ≥7.7 mm showed 75% sensitivity, 82% specificity, and 80% accuracy whereas ultrasonographic thickness ≥6.4 mm showed 46% sensitivity, 93% specificity and 76% accuracy and tendon area ≥78 mm2 showed 47% sensitivity, 93% specificity and 77% accuracy. Tendon border irregularities, diffuse hypoechogenicity and calcification were reported in a higher percentage of patients with FH compared with the other 2 groups. 2) FH participants had a nonsignificantly higher CAC score than that of non-FH participants (56.90 AU (0-2,370.5 AU) vs. 26.65 AU (0-512 AU), P = 0.105) with a higher proportion of patients who had a CAC score >0 AU (50.0% vs. 36.2%, P = 0.476). In addition, the FH group also had a greater proportion of subjects who had an AoVC score >0 AU (16.1% vs. 1.7%, P = 0.006). The CAC score of all participants was strongly correlated with age, total LDL-C burden, Achilles tendon thickness and a Thai CV risk score (R = 0.530, 0.364, 0.293 and 0. 528 respectively, P <0.005). Age, Achilles tendon thickness and statin use were significantly associated with CAC >0 AU (OR 14.30 for age >56 years, P = 0.002, OR 11.91, P = 0.005 and OR 5.91, P = 0.007, respectively) Conclusions: 1) Achilles tendon thickness measured by calipers showed low accuracy for diagnosis of FH. An AP diameter on plain radiographs demonstrated highest sensitivity and accuracy, whereas ultrasonographic thickness and area of Achilles tendon showed high specificity. Tendon irregularities, diffuse hypoechogenicity and calcification might serve as supportive findings. These findings may be helpful for the diagnostic criteria for FH in Thailand. 2) FH patients exhibited nonsignificantly higher CAC score than that of non-FH subjects, but the proportion of patients with AoVC >0 was significantly higher. Age, Achilles tendon thickness and statin use were associated with the CAC score >0 in all patients. These findings may be useful in tailoring treatment based on an individual risk of a particular subject.


Inborn errors of metabolism (IEM) are rare genetic (inherited) disorders comprising hundreds of diseases. The signs and symptoms of IEMs can mimic almost any pediatric disease. The symptoms may be similar to infectious diseases such as lethargy, not suckling, vomiting, convulsions, panting, etc. Therefore, it is difficult for non-specialist physicians to detect the disorders resulting in delayed diagnosis and treatment which may further lead to mental retardation, permanent disabilities, or death during infancy or childhood. Currently, there is a technology called Tandem Mass Spectrometry (MS/MS) that can detect more than 40 IEMs in a single blood spot. MS/MS is therefore being used for screening and diagnosis of IEMs in newborns and sick infants in many countries. In 2013, an economic study to evaluate value for money of expanded newborn screening for 6 IEMs with MS/MS was performed. At that time, it was found that such screening was not worthwhile. But now the situation has changed, such as the willingness to pay threshold for Thailand, the number of IEMs that can be screened, cost of medical care and quality of life of patients, etc., thus leading to a recent study on economic evaluation and feasibility assessment of expanded newborn screening for IEMs using MS/MS technology. There are four specific objectives of this study: 1) to assess cost utility of the expanded newborn screening using MS/MS (cost-utility analysis) and treatment of patients with IEMs; 2) to study the cost of illness (cost-of-illness) of IEM patients 3) To analyze budget impact of expanded newborn screening and treatment of IEM patients and 4) To study feasibility of including expanded newborn screening using MS/MS for all Thai newborns in the benefit package of the Universal Coverage Scheme. The study used a combination between Decision tree analysis model for simulation of screening scenarios and the Markov model for simulating the health status of IEM patients. A total of 41 IEMs that can be screened by MS/MS were included. The study estimates costs and outcomes in terms of life year and Quality-Adjusted Life-Year (QALY), reported as incremental cost-effectiveness ratio: ICER in baht per QALY gained, comparing the situation between providing expanded newborn screening and current situation without expanded newborn screening. A comparison of the outcome and cost of treatment before and after clinical presentations were also analyzed to illustrate the potential benefit of early treatment for affected children. A lifetime time horizon and societal perspective were applied. For budget impact analysis, provider’s perspective was used. In addition, the study employed survey and in-depth interviews with key stakeholders to explore the feasibility and current capacity of proving expanded newborn screening. The study found that providing early treatment before clinical manifestation is cost effective compared to providing late treatment. The ICER was between dominant ICER to 120,995 THB per QALY gained, depending on the disease groups and its complications, except for Tyrosinemia Type I, with an ICER of 1,073,540 THB per QALY gained. The ICER of expanded newborn screening using MS/MS ranged between 259,824 – 576,711 THB per QALY gained depending on cost of screening and incidence of IEMs. The cost of illness for a patient is as high as 3.6 million up to 8.7 million THB because the patient needs a lifelong treatment by medical professionals. The additional budget for screening and treating patients in the first year is at 30 million THB. The total budget for 5 years is 283 million THB. Currently, there are 2 MS/MS providing services in Thailand that can serve up to about 60,000 patients per year. In order to cover all newborn nationwide, 14 MS/MS should be put in place. Therefore, 12 MS/MS is still needed and trainings for staff should be also provided. Policy recommendations 1. NHSO should consider including expanded newborn screening with MS/MS technology as a benefit package under the Universal Coverage Scheme. Although the expanded newborn screening was not cost-effective, it is the only accurate method of early detection and providing pre-clinical treatment that improves health outcomes and prevents complications leading to permanent disabilities. Providing early treatment was cost effective. In addition, IEMs cause huge economic burden to patients and their relatives and were regarded as a catastrophic illness. Furthermore, treatment for IEMs is already covered by the UCS, but identify potential patients for treatment remains a major obstacle that prevents these patients from accessing the services. 2. Recommend NHSO to 2.1 Negotiate the price of screening that the government can afford with the participation of responsible government agencies and service providers. If the expanded newborn screening is operated throughout the country, the cost of supplies from private firms may be negotiated. 2.2 Collect information about screening service utilization, incidence of IEM, following-up for diagnosis, as well as problems and obstacles for further development and expansion of the program 2.3 Assign the rare disease working group under UCS to develop an action plan for providing expanded newborn screening in order to achieve universal service access as quickly as possible. This will include establishing guidelines for registration of rare disease screening centers, guidelines for providing screening services and information systems (software) and adding representatives from the Ministry of Social Development and Human Security, Thailand (PMO) to join the rare disease working group. 2.4 Coordinate with the Food and Drug Administration to speed up the registration process of drugs and metabolic formula for the treatment of IEM patients. 3 . Relevant agencies should discuss and establish an effective system to deliver blood specimen to the MS/MS Screening Center within 24 hours. 4. A National Newborn Screening Advisory Committee should be established to provide advices and recommendations on the integration of Thailand's newborn screening system, newborn screening database, accreditation of newborn screening centers, and monitoring and evaluation of newborn screening in the country.


Telepharmacy is another service system that helps to enhance the efficiency of the health service system under the situation of the Covid-19 epidemic. It can also support the government's public health policy and create a new alternative service model to support a new way of medicine. Methodology: This research has a participatory action research which aims to design a new normal hospital telepharmacy service system, Pharmacy that is a joint service unit with a hospital and a single pharmacy in the region 7 health district and pushes it to be a policy of the region 7 health district. To study the effectiveness of telepharmacy services in hospitals and drugstores. Evaluate the cost-effectiveness of telepharmacy services from a provider-client perspective. Study the satisfaction and opinions of the service recipients and providers and synthesize policy recommendations for the development of telepharmacy systems. Results: A platform has been developed to be used to provide remote health services under the name telehealthregion7 which can be used in all fields of health professions at https://www.telehealthregion7.com/ which is a web application and has designed a long-distance health service system in the normal era, the new way of hospitals and drugstores can be divided into 4 systems, namely, the telepharmacy service system in the hospital, telepharmacy service system in Primary care cluster, telepharmacy service system in Pharmacy and telepharmacy service system for COVID Patient Care Home Isolation. Results of service from February 2021 to December 2021. The total number of medical personnel registered on the platform is 332, including 240 pharmacists, 35 doctors, 43 nurses and 14 other medical personnel. Medical personnel who are provided services through the platform A total of 235 people, representing 70.78% of those registered, were divided into 152 pharmacists (63.33%), 33 doctors (94.29%), 40 nurses (93.02%) and 10 other medical personnel. (71.43 %). The total number of registered service recipients was 1392. The number of service recipients who had access to the service via the platform was 801 (57.54%). The total number of visits to the service was 2040, representing an average of 2.55 times per person. The service can cover all the region 7 health district, including: Khon Kaen Hospital Mahasarakham Hospital, Kalasin Hospital, Roi Et Hospital and Srinagarind Hospital and outside the region 7 health district, including Ratchaburi and Kabinburi hospitals. In terms of the effectiveness of the telepharmacy service system of the hospital. The total number of service recipients was 297, the number of visits was 604 times. The clinical symptoms after receiving the service were not different or improved, totaling 294 people, representing 98.99%. The number of problems that pharmacists found was a total of 323 problems and pharmacists were able to resolve 262 problems or 81.11%. For the effectiveness of smoking cessation services by telepharmacy service system. The total number of service recipients was 167, the number of people who successfully quit smoking for at least 1 month, at least 2 months, at least 3 months, at least 4 months and at least 6 months were 118 (70.66%), 64 (38.32%), 36 (21.56%), 14 (8.38%), 3 (1.80%), respectively. Overall satisfaction scores of recipients and providers in the hospital sector were at the most satisfied level, 4.81±0.42 and 4.61±0.50 (full score 5), respectively. Overall satisfaction scores of recipients and providers in the pharmacy sector were at the most satisfactory level of 4.37±0.64 and 4.4±0.50 (5 full scores), respectively. The total cost per time of telemedicine service at the hospital was 95.58 baht. The cost-effectiveness at which the patient's condition stabilized or improved was 196.36 baht per patient. The cost-effectiveness in resolving the problem successfully was 220.34 baht per problem. The results of the cost-effectiveness assessment of telepharmacy services by pharmacy was found that the total cost per person of complete A1-A5 service with A1-A4, A4F and A5 service 5 times was 631.55 baht. The total cost per 1 month, 2 months, 3 months of successful smoking cessation was 298 baht. 549.44 baht and 976.78 baht, respectively. % Cost saving of travel expenses, food and accommodation, Opportunity loss and total cost of service recipients are as follows: 65.37±4.50, 60.22±18.36, 10.39±24.34 and 54.75±17.99, respectively. Conclusion: Telepharmacy is an efficient service. The service recipient is most satisfied because it benefits the service recipient. Help facilitate patients without having to travel to hospitals and drugstores to receive medicines. Increasing the quality of pharmaceutical services. Reduce the length of time patients stay in hospitals and drugstores. Reduce the cost of traveling to hospitals and drugstores and create a system to encourage people to stay home, reducing the risk and reducing the chance of infection during the epidemic situation. Therefore, the country's policy should encourage telepharmacy services in both hospitals and drugstores.


COVID-19 is a pandemic disease. Healthcare workers (HCWs) have a high risk of SARS-CoV-2 infection. However, the information of HCWs with COVID-19 in Thailand is still limited. The objective of the study was to evaluate rate and risk factors of COVID-19 among HCWs in Thailand. Methods: The prospective cohort study was conducted at the tertiary care hospitals in Thailand from May 2020 to May 2021. The study participants were HCWs in Thailand who presented with fever and/or acute respiratory tract symptoms. All of them were tested with RT-PCR for SARS-CoV-2 and their clinical data were collected. Results: There were 1,432 HCWs in this study. Among them, 167 patients were front-line HCWs and 1,265 patients were non-front-line HCWs. Of 60 HCWs with COVID-19, 2 patients were the front-line HCWs, and 58 patients were the non-front-line HCWs. Rate of COVID-19 in all HCWs was 4.2% (60/1,432). Rate of COVID-19 in the front-line HCWs was 1.7% (2/167), whereas rate of COVID-19 in non-front-line HCWs was 4.6% (58/1,265) (p=0.04). In addition, non-front-line HCWs, non-medical staffs, history of contact confirmed COVID-19 case at home/family, unvaccinated status, fair compliance to personal protective equipment (PPE) standard, and initial presentation with pneumonia were significantly more common in HCWs with COVID-19 than those without COVID-19. Front-line HCWs, history of contact confirmed COVID-19 case at the clinical care areas, vaccinated status, good compliance to PPE standard, and initial presentation with upper respiratory infection were significantly more common in HCWs without COVID-19 than those with COVID-19. Conclusions: COVID-19 was more frequently found in the non-front-line HCWs than the front-line HCWs. Thai guidelines of infection prevention and control are effective in preventing SARS-CoV-2 transmission. Therefore, these interventions should be encouraged.


The COVID-19 pandemic causes sudden public panic and people take appropriate precautions by wearing masks, physical distancing in public according to new-normal life style. If an antiseptic can exert rapid virucidal effect with prolonged activity on SARS-CoV-2 that accumulate on nasal, buccal and pharyngeal epithelia, it can help prevent the spread of the virus from infected persons to healthy people including medical personnel during resuscitation, treatment or transportation. Numerous existing in vitro data have confirmed that povidone-iodine (PVI) inactivates many common respiratory viruses, including SARS-CoV-2 approximaltely 100 folds in less than one minute of PVI exposure. Povidone-iodine also has good profile for mucosal tolerance in upper aerodigestive tract. Thus, we propose a pilot study to demonstrate its virucidal efficacy of SARS-CoV-2 by the application of topical PVI or diluted solution of PVI to the upper aerodigestive tract in infected patients using the self comparison study design method. The first three serial pilot studies recruited 55 infected patients and illustrated that SARS-CoV-2 could be detected by the RT-PCR in both specimens of nasopharyngeal and throat swabs but the Ct values of throat specimens were usually higher compared to the nasal specimens in the same patient and at the same time of specimen collection. Viable SARS-CoV-2 was detected only from nasopharyngeal specimens with Ct values equal or less than 25 using vero-E6 cells for tissue culture. Viable SARS-CoV-2 cannot be cultured from throat or tongue samples which made oral samples inappropriate for the demonstration of virucidal effect of PVI. The fourth study in 14 patients revealed viable culture was obtained from 12 patients and involved only nasopharyngeal specimens. After 3 minutes of contact time with nasal spray of PVI or 0.4% PVI solution, a median value of 1.1 log reduction of viable viruses (IQR: 0.6-1.7 log reduction) or 90.7% virus reduction (median; IQR: 75.0%-98.0%) were found. After 4 hours of contact, a median value of 0.8 log reduction (IQR: 0.4-1.8 log reduction) or 81.3% virus reduction (IQR: 56.3%-98.4%) were found. The amount of virus reduction after PVI contact and speed of virucidal activity were much less impressive than the results from the in vitro study. In conclusion, we were able to consistently culture viable SARS-CoV-2 in vero-E6 cells only from nasopharyngeal specimens in newly infected patients who had Ct value equal or less than 25 from RT-PCR testing. Viable SARS-CoV-2 can not be cultured from any oropharyngeal samples. Commercial PVI nasal spray or 0.4% PVI solution have minimally, if there is any, virucidal activity in nasal cavities of infected patients after PVI exposure for three minutes and four hours. This level of virucidal activity from the study may not be significant to prevent the spread of COVID-19. The PVI nasal spray and 0.4% PVI solution were very safe, very tolerable without any side effect.


The development of economy and society significantly affect to many factors involving national health system including the demographic and population behavior change, the increasing of senior citizen while workforce age is decreasing significantly, the expanding of industry and urbanization, the Inefficient natural resource management causing environment pollution, and the emerging infectious diseases and non-communicable disease causing the increasing of direct and indirect health cost. Consequently, Health system competency evaluation is necessary in formulating effective health policy for Thailand. However, Thailand still does not have an overall health system competency evaluation, while there are only specific aspects health evaluation report such as health systems financing research, health promotion in different age populations and health impact assessment This research is to evaluate overall health system competency by using international organization health impact assessment concept as well as comparing Thailand's health result to other ASEAN countries and the average value of Organisation for Economic Co-operation and Development (OECD) country in health dimensions consist of health status, health risk factor, service access, healthcare quality and health resource. We are hoping that this research would be useful in health policy making level. Health executive boards at every level can manage their health resource and compare results at provincial, regional, national and international levels.


COVID-19 The epidemic continues to find more infected people, especially in the Eastern Economic Corridor (EEC) area, which is the highest controlled area. There became a public health crisis which doctors, nurses and emergency room are the front line at the risk of being exposed to germs easily. It increased workflows and processes resulting in long working hours. The fatigue and mental stress became stressful. It affects the body and mind both in the short and long term. The purpose of this research was to study the factors affecting the quality of life of emergency room physicians and nurses in public and private hospitals affected by COVID-19 in the EEC area. It is a specific population. The study was conducted from a population of 400 people. The targets were divided into 2 groups: 1) emergency room physicians 2) emergency room nurses. There perform both full-time and temporary contract work in emergency rooms during COVID-19 in public and private hospitals in the EEC area. The analyze data conducting both qualitative and quantitative research. It is a tool to perceive an opinion piece on current situation factors (WRQoL) that affect the quality of work life to measure quality of work life. A total of 472 real data were collected using both descriptive and reference statistics. The study found that the factors affecting the quality of life of doctors and emergency room nurses in public and private hospitals affected by COVID-19 in the EEC area with the highest mean were social relativity factors, including the team that support patients are part of the success. The psychological factors include that I have pride in myself every time and I take care of and keep patients out of danger. The physical factors include work performed with too much risk of harm to health and environmental factors such as receiving compensation for risks during COVID-19 delayed and overwhelmed. The results of the analysis of the importance of factors affecting the quality of life from the hypothesis. It found that there were no significant differences between public and private hospitals in the overall quality of life of physicians and emergency room nurses at the .05 level. There are improving the quality of life passed the assessment criteria were consistent with the empirical data. The probability chi-squared was .170, the relative chi-squared was 1.189, the concordance index was .979, and the mean squared root index of the error estimation was .020. The recommendations were as a result of this research, hospital administrators and agencies that utilize the research can apply factors affecting the quality of life of physicians and nurses to improve quality of life in order to create models and contextual guidelines which on each organization in accordance with the policy and culture. It can also be adapted to other agencies that need to receive critically ill patients and should be studied further developing a model to enhance the quality of life of personnel working in emergency room departments under the COVID-19 outbreak.


Introduction: Chronic kidney disease (CKD) is the main health problem in Thailand and worldwide. Patients with CKD can progress to end-stage kidney disease (ESKD) requiring kidney replacement therapy which has high expense and burden to the national health budget. In addition, they have a poor quality of life. The major causes of CKD are diabetes and/or hypertension. There are many interventions, guidelines, and policies to prevent CKD that have been implemented but the number of patients with CKD is increasing leading to an overwhelming workload of healthcare providers especially those who work under public health. The objective of this study aimed to set up system processes of care to prevent CKD in high-risk patients and monitoring method by collaborating with private primary care clinics located in the communities. Methods: The owners of private primary care clinics registered with the National Health Security Office and located in the central part of Thailand were invited to participate voluntarily in the research. After they signed the contract, the healthcare workers in each clinic were trained in processes of intervention to prevent CKD or slow progression of the disease. The healthcare providers in each clinic identified patients with a high risk of CKD, educated them to raise awareness of CKD, invited them to participate in CKD prevention programs which were composed of providing education, counselling to identify individual problem obstructing the achievement to the goal of treatment, positive motivation and empowering them to be able to the self-management to prevent CKD. Each clinic was audited and monitored two times in the pattern of mentoring and coaching. The outcome of patients was determined in the rate of decline estimated glomerular filtration rate (eGFR) compared between pre-and post-intervention. Results: 42 private primary care clinics were participating in this study. The 35 (83.3%) of clinics having patients with diabetes and/or hypertension higher than 100 cases. The number of patients joining in CKD prevention programs at clinics was 847 cases. The ratio of male to female was 397 (46.9%) and 450 (53.1%) cases, respectively. The mean (SD) age of patients was 62.9 ± 10 years (95% confidence interval 62.3-63.6 years). The 66.9% of patients had education levels in illiterate or primary school. 46.4% of patients were unemployed, 31.8% were freelance, 21.4% were private employees, and 0.4% were civil service. Most of the patients were hypertension (51.6%) followed by diabetes and hypertension (40.1%), diabetes (8.1%), and others (0.2%). 46.6% of patients had eGFR less than 60 ml/min/1.73 m2 before starting the intervention. 74% of patients achieved a rate of eGFR decline of less than 5 ml/min/1.73 m2 after 6 months of intervention. Conclusion: The collaboration between the private primary care clinics and academics from the university was successful in setting up the processes of care to delay progression of CKD in high risk patients with diabetes and/or hypertension. They were the main groups of patients in private primary care clinics. In addition, the monitoring method in the pattern of mentoring and coaching was important to get the good collaboration. It would be a strategy to reduce the number of CKD patients, if this model could be expanded to other primary care clinics.


Background: Healthcare workers (HCWs) pose a higher risk of infection caused by SARS-CoV-2, leading to more frequent swab and testing with real-time PCR. Serology test to detect SARS-CoV-2 antibodies in the blood is easier and could be useful as part of surveillance. This study aims to determine the prevalence and incidence of infection caused by SARS-CoV-2 by serology testing in frontline HCWs. Methods: This study was prospectively conducted in 360 HCWs (240 frontline and 120 non-frontline HCWs) at Siriraj Hospital between June 2020 and April 2021. Blood samples taken at baseline, 4 weeks, 12 weeks and 48 weeks were tested for qualitative IgG using Pan-IgG [Elecsys Anti-SARS-CoV-2]) and quantitative IgG measured by anti-SARS-CoV-2 RBD IgG enzymes-linked immunoassay (ELISA). The cut-off of negative and positive control were 0.64 and 1.60, respectively. The samples positive by anti-SARS-CoV-2 RBD IgG were tested with micro-neutralizing assay (NT). Results: Among 360 HCWs, 82.2% were female and the median age was 32.5 years. One participant in non-frontline HCWs had positive rapid IgG test from baseline throughout 48 weeks but negative testing by anti-SARS-CoV-2 RBD IgG. With the cut-off determined in the study, two participants in frontline HCWs had positive anti-SARS-CoV-2 RBD IgG from baseline throughout 48 weeks and no participants had seroconversion afterward, given the prevalence of SARS-CoV-2 infection among frontline HCWs of 0.83% (2/240). One participant in non-frontline HCWs had seroconversion at 12 weeks, given the incidence of SARS-CoV-2 infection among non-frontline HCWs of 0.83% (1/120). Approximately 13-17 participants in frontline and 4-7 participants in non-frontline HCWs had borderline level of anti-SARS-CoV-2 RBD IgG. Testing with micro-NT for all samples with positive and borderline anti-SARS-CoV-2 RBD IgG showed negative result with the titers less than 1:10. Further study of the cross-reactivity with other human coronavirus is ongoing. Conclusions: The prevalence and incidence of HCWs was extremely low and no difference of infection was found between the frontline and non-frontline HCWs during the limited spread of transmission and well-control of COVID-19 outbreak. Serology testing with different methods may show the discordant result. Further study of the cross-reactivity with other human coronavirus is ongoing


Background: The COVID-19 pandemic has caused immense health and financial loss globally. Prior to mass vaccination, the only way to limit its spread was with standard health precautions, including mask-wearing, hand washing and social distancing. Compliance with these measures vary between countries, depending on the culture, the public awareness and the policies enacted by the government. A higher rate of mask-wearing is thought to be more effective in limiting the spread of the disease and methods of monitoring mask-wearing would be useful for campaigns to increase mask-wearing. Although the mask-wearing rate has been estimated with questionnaires and episodic counting studies, there are very few reports visually documenting the rate of mask wearing sequentially over time. In this study we developed an artificial intelligence (AI) system to analyze images from public CCTV’s to document the rate of mask wearing in Bangkok, Thailand, and correlate the rate with public health policies and COVID-19 events. Methodology: Public CCTV cameras in the Bangkok Metropolitan Area (BMA) were selected in view of their location and camera viewpoints. Every week, 9 hours of video clips from each of these cameras were downloaded and sent for analysis by an AI that had been trained to detect mask-wearing using pictures with and without masks from public databases. Images were divided for analysis into 2 parts, one part containing the mobile population and the other the non-mobile/vendor population. A number of the images was also visually checked for accuracy. The rate of mask-wearing was analyzed and correlated to public health measures and COVID-19 infections. The images of faces without masks were reviewed to understand factors related to not wearing masks. An in-person questionnaire was also performed on pedestrians in Bangkok to ascertain the factors for mask-wearing, or not, and to try to ascertain the attitudes, understanding and behavior of the general population in Bangkok. The mask-wearing rate seen on CCTV was compared with the mask-wearing rate obtained by a governmental online questionnaire.


The project of wastewater surveillance for SAR-CoV-2 in provinces that have comfirmed COVID-19 cases was conducted by Division of Communicable Diseases, Department of Disease Control. The objectives of this project were to detect SARS-CoV-2 in wastewater and to characterize the relationship between the presences of SARS-CoV-2 genetic materials and the number of infected cases in the particular areas. The result could elucidate the correlation between degree of SARS-CoV-2 genetic materials and the number of COVID-19 patients in the community. Moreover, our result could be useful for disease surveillance and monitoring programs, conducive to setting appropriate measures and policies in controlling this kind of virus effectively in the future. From May to December 2021, a total of 248 of wastewater samples was collected from 11 places, including markets, apartments, universities, and prisons, located in the COVID-19 outbreak areas, Bangkok and Samut Sakhon. The real time RT-PCR technique was used for SARS-CoV-2 detection. The results showed that 118 samples were detected from 10 places, related to the number of infected cases. Moreover, variant of COVID-19 was also analyzed. Based on our results, we suggest that the detection of SARS-CoV-2 in wastewater can be used for COVID-19 monitoring and for integrating with other disease investigation practices in the community. Since individual detection of COVID-19 infection is limited, wastewater analysis could be considered one of the sensitive and cost-effective strategies. Routine implementation of this surveillance tool together with personal hygiene practices and social distancing would significantly improve our preparedness against new or re-occurring viral outbreaks.


The burden of antimicrobial resistance (AMR) has been increasing worldwide including Thailand. Global Antimicrobial Resistance Surveillance System (GLASS) and antimicrobial stewardship (AMS) are two important pillars of the global action plan on AMR launched by the World Health Organization (WHO) in 2015. Our project aimed to evaluate the impact and feasibility of customised AMS strategies implementation (GLASS antibiogram, Clinical Practice Guideline (CPG) for common infections (bacteremia or sepsis without identified source, urinary tract infections and pneumonia), and antibiotic authorization) under the support of the AMS team at the university hospital. Therefore, we conducted a quasi-experimental (pre- and postintervention) study at three participating hospitals: Sakaeo Crown Prince Hospital, Surin Hospital, and Surat Thani Hospital. Before starting the project, we conducted a national survey to identify the obstacles for AMS implementation at 399 hospitals in Thailand. The major obstacles of AMS program (ASP) implementation identified in this survey were increased workload, lack of AMS knowledge and skills of relevant personnel, and lack of hospital administrator concern. During Jan 2020-Dec 2021, the study enrolled a total of 6,625 patients from three participating hospitals. The summary results of each study are shown below. 1. GLASS antibiogram: Laboratory-based antibiograms from 2019 and GLASS-based antibiograms from 2020 were created and compared. Prevalence of multidrug-resistance in community-acquired infection (CAI)-related bacteria was higher than those in hospital-acquired infection (HAI)-related bacteria, which may have been related to misclassification of colonized bacteria as “true” pathogens and HAIs as CAIs. The results of this study on AMR surveillance using GLASS methodology may not be valid owing to several inadequate data collections and the problem of specimen contamination. Given these considerations, the related personnel should receive additional training on the best practice in specimen collection and the management of AMR surveillance data using the GLASS approach. 2. Clinical practice guideline After the CPG implementation, there were significant reductions in the mean duration of intensive care unit stay, and the mean duration of ventilator use. The CPG-implementation was independently associated with favourable clinical outcomes. These findings confirmed that the locally developed CPG implementation is feasible and effective in improving patient outcomes and reducing antimicrobial consumption. 3. Antibiotic authorization: Implementation of antibiotic authorization could reduce the amount of targeted antimicrobial consumption, the mean length of hospital stay, and increase the favourable clinical response. The study findings confirmed that implementation of antibiotic authorization at provincial hospitals under experienced AMS team’s guidance was feasible and useful. In conclusions, our studies confirmed that the implementation of GLASS antibiogram, CPG, and antibiotic authorization at non-university hospitals under the guidance of an experienced AMS team could reduce inappropriate antimicrobial consumption and improve patients’ clinical outcomes. However, the COVID-19 situation during the postimplementation period may confound the study results. It was possible that the pattern of antimicrobial use and characteristics of hospitalized patients altered by the COVID-19 situation. Therefore, we do believe that the study findings could be a good model for the implementation of customized AMS strategies at other hospitals with limited resources. The related personnel should receive additional training to strengthening the ability to perform a good practice in AMR surveillance and AMS program.


The purpose of this mixed-method study was to syntheses policy recommendations nursing workforce development: production, distribution, and retention as COVID-19 pandemic. The quantitative data were collected from 396 samples through the questionnaire of actual and expected workforce retention operation due to COVID-19 pandemic. The qualitative data were collected from 120 subjects through in-depth interview. The findings were as follow: 1) The production of nursing workforce, the Ministry of Public Health, governer, and educational institute network should mutually plan to determin the nursing workforce production needs in longterm period, analyze recent nursing curriculum to find the competency gap due to the pandemic, develop the knowledge and skills of professional nurses according to new normal services, establish clearly procedure to support nursing students when they got infection or high risk to infection. 2) The distribution of nursing workforce, the ministry of public health should systematically review and plan to distribute nursing workforce in all level-ministry, area health, and settings for appropriate manpower rate according to the contex of areas and the complex of nursing services. The nursing administrators should consider the distribution of nursing workforce of their setting. 3) The retention of nursing workforce, the administrators should determin the nursing workforce retention procedures or protocals, encourage and motivation through appoint the worker to be a government officer; promote to a higher position; set up the clearly systems of compensation, welfare benefit and privilege; follow up the health of nursing personel in order to safe them from COVID-19 infection. Moreover, they should have a human development plan for nursing career progression.


This mixed-methods study consists of quantitative research using questionnaires and qualitative research using focus group discussion. The aim of this study was to examine the impact of the COVID-19 on occupational engagement of physical, developmental, learning and psychosocial impairment clients and study of their needs for healthcare services, and adaptation of OT services in public and private hospital. Addition with the impact on practical fieldwork education and guideline for solution. The Occupational Therapists (OTs) (n = 153) were asked to complete the questionnaires while those (n = 45) were invited to once in focus group sessions. Results showed that COVID-19 has caused a negative impact on clients with occupational deprivation owing to uncontrolled situations especially social participation and health management. Three service types provided by the OTs in the pandemic have emerged along with infection control which are onsite, online or telehealth, and hybrid. OTs are developing telethealth services by use information and communication technology or social media through telephone, the LINE application, and VDO calls. Performances evaluation and home-based rehab training activities were provided according to the personal context. Caregiver consultation and education with media resources were innovatively enhanced in various channels. Contributing and barrier factors related to the institute’s policy, supporting infrastructure and readiness to use digital technology-assisted devices was highlighted in both service providers and clients. The impact of COVID-19 on occupational therapy students (OTS) were lack of fieldwork settings and clinical skills due to the decrease in number of clients. To maintain standards of clinical teaching in fieldwork placements, a combination of online case simulation and real client practice was used. The necessary skills for enhancing OTS’s competency in this situation were awareness and practice according to the infection control procedure, resilience skills, good communication, and the creation of innovative skills for telehealth services to be an OTs who response with the needs of client and society in the future.


Data on real-life vaccine effectiveness (VE) against the delta and omicron variant of COVID-19 infection among COVID-19 vaccine regimens are urgently needed to impede the COVID-19 pandemic. We conducted a test-negative case-control study to assess the VE of various vaccine regimens for preventing COVID-19 during the period when the delta variant and omicron was the dominant causative virus in Thailand. All individuals (age ≥18 years) at-risk for COVID-19 who presented for nasopharyngeal real-time polymerase chain reaction (RT-PCR) testing were prospectively enrolled and followed-up for disease development. Vaccine effectiveness was estimated with adjustment for individual demographic and clinical characteristics. Concerning the period of delta variant, there were 1,871 cases of the total of 4,589. The adjusted VE among persons receiving two-dose CoronaVac plus one BNT162b2 booster was highest (98%; 95% confidence interval [CI] 87 to 100), followed by those receiving two-dose CoronaVac plus one ChAdOx1 nCoV-19 booster (86%; 95% CI 74 to 93), two-dose ChAdOx1 nCoV-19 (83%; 95% CI 70 to 90), one CoronaVac dose and one ChAdOx1 nCoV-19 dose (74%; 95% CI 43 to 88) and two-dose CoronaVac (60%; 95% CI 49 to 69). Concerning the period of omicron variant, there were 471 cases of the total of 1,975. The diseases severity markly decreased while the vaccine effectiveness aso markly decreased, compared to the period of delta variant. Our study demonstrated the incremental VE with the increase in number of vaccine doses received. The two-dose CoronaVac plus one BNT162b2 or ChAdOx1 nCoV-19 booster regimens were highly effective in preventing COVID-19 during the rise of delta variant.


Background and Objectives Thailand has experienced the COVID-19 pandemic since mid-January 2020. Symptomatic COVID-19 patients are admitted for hospital inpatient treatment. At present, there is limited information on the association between treatment time and dynamics of viral load, as well as incidence of sero-conversion of household close contacts of COVID-19 patients after the patients are discharged and return home. Such information may have implications for stakeholders in COVID-19 prevention and control. The objectives of this study were: 1) to describe the association between treatment period and presence of viable virus in respiratory fluids of COVID=19 patients, and; 2) to describe the incidence of sero-conversion among household contacts of discharged COVID-19 patients. Methods For Objective 1, we conducted a retrospective cohort study among COVID-19 patients at Songklanagarind Hospital and an affiliated field hospital who were admitted in early 2020 and received at least two nasopharyngeal swab tests. We extracted data regarding patient characteristics and rRT-PCR results in the hospital information system, and sent leftover swab samples to the Department of Medical Sciences' central laboratory for viral culture with anonymized unique ID designated for each sample. We then merged culture results data with the rest of the data set and performed data analyses using descriptive statistics and regression analyses. For Objective 2, we conducted a prospective cohort study among household close contacts of COVID-19 patients who were discharged from the study hospital. Investigators contacted the patients and asked for the contact details of their adult household members, then contacted the mentioned household members and invited them to participate in the study. After giving informed consent, investigators briefly interviewed the household contacts (study participants) and collected blood samples on the day of the discharge or day after the discharge (Day 0), at 7 days after discharge (Day 7), and at 28 days after discharge (Day 28). Data were analyzed using descriptive statistics. Results For objective 1, there were 20 patients in the data set, 16 of whom met the study inclusion criteria with adequate data available (n=16 patients). The median length of stay was approximately 28 days, and more than half of the patients did not have positive viral culture in any sample. Among patients with at least one sample with positive culture, while the median length of time from admission to the date when viral culture became consistently negative was 10 days. There were large fluctuations in the patients' rRT-PCR cycle time during the course of treatment, but the rRT-PCR cycle time gradually increased and became plateaued after the first 15 days. Pattern of changes in cycle time differed between patients with viable virus in swab samples and patients without viable virus in swab samples. Discussions and Conclusion For objective 1, we found indications that patients might have unnecessarily overstayed at the hospital during their treatment. However, the study findings should be used selectively and cautiously, with due considerations for the study limitations including limited generalizability and lack of statistical power. For Objective 2, the absence of evidence on infection based on RT-PCR test results (which cannot be published) suggested that there was no new COVID-19 infection among the study participants, and thus there was no evidence that the 10-days stay guidelines for treatment of COVID-19 patients had become inadequate for prevention of intra-household COVID-19 transmission. Caveats regarding the lack of generalizability and potential effect of vaccination should be considered in the interpretation of the study findings.


Thailand could achieve the goals of the universal health coverage (UHC). But there are some remaining challenges on inequities in cost protection and quality of services. This study endeavored to report the country’s inequity situation in terms of coverages of population, cost, and services. Using the 2020 Household Socio-Economic Survey, the analysis covered disparities across health insurance schemes, household wealth quintile, sex, age group, region, and urban/rural area. The results show that the highest inequity was among different health insurance schemes of the UHC system. Therefore, it is essential to implement national health reform to solve the disparity issues by integration of the health insurance schemes.


Background and Rationale: Thailand becomes an ageing society. The Thai government officially implemented long-term care (LTC) for dependent older persons in 2016. Sa-ard subdistrict of Namphong, Khon Kaen, has provided an LTC service program by the family care team and the LTC center since August 2017. However, the impacts of this program, particularly social impact, have not been reported. This study aimed to determine social return on investment (SROI) of the LTC program for dependent older persons in this setting. Methodology: A mixed-methods approach was used to collect data on outcomes, program impacts, and costs of the LTC program for dependent older persons (37 people with the Barthel index of activity of daily living (ADL) ≤ 11 points) in the fiscal year 2018. We conducted a questionnaire survey among 74 program beneficiaries (dependent older persons and family caregivers) and focus group interviews among 49 program stakeholders (dependent older persons, family caregivers, family care team members, trained caregivers, and community and local government representatives). Secondary data were gathered from reports, records, and databases of the hospital, the local government, and the LTC center. SROI was calculated and sensitivity analysis was performed. Results: Outcomes of LTC program delivered better conditions (walkability or doing usual activities by themselves) to the dependent older person group, more relaxation/leisure time and saving costs from going to hospitals to family caregivers, happiness in helping other people to the family care teams and trained caregivers, and the healthy community. Of the total 37 dependent older persons, after participating in the LTC program their ADL increased significantly on average 3.9 ± 5.2 points (p < 0.001) and 73% had better outcomes. The older persons valued their better outcomes at a median of 708,432 baht (Q1-Q3 = 699,216 - 2,000,000). For a one-year investment of LTC program of 2,138,704 baht and its benefit of 15,853,919 baht, the SROI ratio of this program was 7.4 with a range of sensitivity analysis values between 1.3 and 20.5. Conclusion: This study indicated that the LTC program for older persons could effectively improve their outcomes and provide values to stakeholders and society. The LTC program provided social return higher than investment. Therefore, the LTC program should be promoted and expanded to other settings.


Background and rationale: The Thai medical cannabis (or medical marijuana: MMJ) system was first established in February of 2019. This study aimed to identify the most essential and urgent policy and research and initial policy recommendations regarding the implementation and impacts of the MMJ policy in Thailand. Methodology: A narrative literature review and other qualitative methods; 18 in-depth interviews with key stakeholders, focus group discussions of nine service providers and patients, and a participant observation in the MMJ clinic at the Ministry of Public Health. Results: Our crucial findings showed that: (a) the Thai MMJ system is complex, consisting of three subsystems: modern medicine, Thai traditional medicine, and folk medicine. These subsystems are not harmonized, and have resulted in poor access to legal MMJ products. (b) MMJ is a new entity in Thailand, and a comprehensive monitoring and evaluation system is needed. (c) the MMJ movement in Thailand has “political economy” attribute, meaning that the policies may be driven by benefits beyond a medical rationale. These findings lead to six research questions. (1) What do the governance structure and plans regarding MMJ policy in Thailand look like? (2) How do we improve the complex MMJ system to best serve patients? (3) How much and how to invest in a knowledge-generation system, and a monitoring and evaluation system regarding the MMJ policy? (4) How do we build MMJ consumers’ health literacy? (5) What are the efficacy levels and cost-effectiveness of the Thai medical cannabis products? And (6) What should be the future MMJ policy in Thailand? Conclusion: The newly established and complicated Thai medical cannabis system is novel for Thai society. This system has potentials to produce both positive and negative consequences, with potentially enormous underlying economic benefits. Therefore, the government and all relevant sectors must collaboratively manage the medical cannabis system in a transparent, creative, and considerate way, to provide the best benefits for patients and the whole of Thai society, in both the short- and long-term.


This cross-sectional research focused on studying the prevalence of mental health outcomes and preventive behaviors, and to examine work-related factors associated with mental health outcomes during the COVID-19 pandemic amongst the healthcare workers employed by the Ministry of Public Health Thailand. The data were collected by the online questionnaire from 12 health regions, 417 healthcare workers administered during the first wave (May 1-15, 2020). The Depression Anxiety and Stress Scale – 21 Items (DASS-21) Thai version was used to assess mental health outcomes. The Chi-square test was used to examine association between depression, anxiety and stress-related factors. The results found that 2.4%, 7.2%, and 3.9% of all respondents demonstrated severe to extremely severe depression, anxiety, and stress; while practices of preventive behaviors were as high as 82.0% of wearing masks and 76% of practicing hand-hygiene. The associated factors of mental health outcomes were: (i) working with COVID-19 inpatients; (ii) organizational management to ensure low infection risk; (iii) inadequate of personal protective equipment (PPE); (iv) work with the fear of contracting infection; (v) the non-adherence behavior of patients towards safety protocols. The study recommends that effective management practices towards reducing infection was predominant associating and modifiable factor of mental health outcome. In particular, this should be applied to the healthcare workers coming in direct contact with patients in the “new-emerging phase” or a “repeated wave” of COVID-19 outbreaks.


Physical inactivity is ranked number four leading risk factor of premature deaths from non-communicable diseases. The Global Action Plan on Physical Activity 2018-2030 (GAPPA), adopted in the 71st World Health Assembly in 2018 emphasizes the need for a whole-of-society approach to creating social, cultural, economic, and environments conducive to physical activity. This study assessed the promotion of physical activity in the urban setting of twelve selected municipalities in Thailand against the four GAPPA strategic actions. The findings revealed that all twelve municipalities implemented at least one intervention of the four strategic actions, and achieved 12 out of 20 (60%) GAPPA recommended actions. The city municipalities achieved the highest score, followed by the town and the subdistrict municipalities. The highest achievements were the implementations of strategic action 3: create active people, and strategic action 1: create active societies. This study showed that GAPPA recommendations were relevant and feasible in the Thai context. However, gaps remained in the promotion of strategic action 2: create active environments, and strategic action 4: create active systems. In conclusion, the municipality could be one of the lead agencies for physical activity promotion in an urban setting in collaboration with other public and private stakeholders. GAPPA strategic actions should be translated to be specific tools and indicators for monitoring the progress of policy implementation.


The health benefits of physical activity are linked to active transport. The Thai Walking and Cycling Institute has implemented a project to promote walking and bicycle use in daily life in many provinces since 2017. This study aimed to identify the association between local demographic characteristics (sex, age, body mass index (BMI), education, occupation, and income), and the effects of physical activity from active transport. This was done in three purposive selected sites namely, 1) King Taksin Community, Chachoengsao, 2) Suksabaijai Community, Kalasin, and 3) Ban Thatsobvan Community, Phayao. A cross-sectional study was carried out through a self-administered questionnaire survey. The questionnaire was randomly distributed via community leaders. Multivariate Poisson regression was performed. The average amount of active transport energy expenditure in three communities at 180 metabolic equivalent task-minutes/week contributed to 30% of the World Health Organization’s recommended physical activity levels. Being female, overweight or obese, higher educational attainment, higher income, and office-based employee had a significantly reduced chance of having higher energy from active transport than their counterparts. While being older and living in optimal size community and near the city center had significantly raised chance of having higher energy from active transport. Interventions for active transport promotion should be more attractive and appropriate to all demographics and contexts. In addition, the policy should aim not only at individual lifestyle modification but also at re-shaping the physical environments that facilitate active transport.


Prince Mahidol Award Conference (PMAC) is a well-known international conference organized annually by the Prince Mahidol Award Foundation and the Royal Thai Government with collaboration from multiple partners to share experiences focusing on policy-related public health issues among the global community. Due to COVID-19 pandemic, the PMAC 2021 under the theme “COVID-19: Advancing towards an Equitable and Healthy World” was held virtually with significant changes made to its program and management. The rapporteur system, a main component of the program conference synthesis, was also adjusted to fit with an online platform. This paper aimed to draw lessons learnt from the PMAC 2021 by the viewpoint of the rapporteur team, including lead rapporteur, rapporteur coordinator, and session rapporteur, covering three main points; (i) the structure of rapporteur team, (ii) the process of work, and (iii) the output of the rapporteur system. This paper provides useful ideas to any organization that organizes an international conference requiring accurate and comprehensive conference synthesis.


Effective coverage is a concept of measuring health gain which incorporates health needs, utilization of health services, and the benefits to patients from using them into a single metric. In the past two decades, the World Health Organization and other agencies advocated the use of effective coverage as a way to assess health systems performance and track outcomes of universal health coverage. Two main objectives of this paper were to review literature relevant to definition, methodologies, and international and domestic experience; and to synthesize the recommendations for effective coverage assessment in the Thai context. The literature review found discrepancies of definition and measurement across various studies which caused confusions in communication, comparison and interpretation of the results. The authors proposed that Thailand should apply the definition of ‘the proportion of a population in need of a service that had a positive health outcome from using the service’. This definition communicated clearer meaning and reduced methodological complexities. Selection of proxy interventions should be guided by national health priorities, the possibility of making a positive change in the coverage and health gain, and reliable data sources. Key challenges of measuring effective coverage include defining operational criteria, understanding data requirement and results of low coverage as well as inequity dimensions across sub-population groups. Stakeholder participatory process of effective coverage monitoring should improve policy usefulness.


The study of willingness to accept and pay for a COVID-19 vaccine in Thailand aims to 1) explore the prevalence of accepting the COVID-19 vaccine and vaccine booster shots 2) factors associated with accepting the COVID-19 vaccine and vaccine booster shots 3) reasons and willingness to pay for the COVID-19 vaccine and vaccine booster shots and 4) the policy recommendation for the COVID-19 vaccine and vaccine booster shots. This study conducts 3 phases. Phase 1 is to study the prevalence and factors of accepting the COVID-19 vaccine and vaccine booster shots by cross-sectional research of having vaccinated COVID-19 group and having not been vaccinated COVID-19 group, covered four regions in Thailand, by an online survey questionnaire. The total sample is 1,740 used multiple stratified sampling techniques. Data analysis were by a descriptive statistic and multiple logistic regression. Phase 2 is associated with exploring the reasons and willingness to pay for the COVID-19 vaccine and vaccine booster shots. The developed questionnaire is from an online survey. Data analysis is a descriptive statistic. The results from phase 2 are defined policy recommendations. Phase 3 is an expert and stakeholder meeting to propose and discuss policy recommendations. The result showed 86.38% of respondents reported the COVID-19 vaccine acceptance. Respondents had no vaccination accounting for 9.16%, 10.76%, and 53.19% for the first, second, and third doses, respectively. 66.72% of the respondents accepted to have the next dose of the COVID-19 vaccine. Only 8.22% of the respondents refused the COVID-19 vaccine. One-third of the respondents received their desired COVID-19 vaccine. Factors related to the willingness to accept the COVID-19 vaccine and vaccine booster shots were an intention to take the vaccine, vaccine efficacy, attitude towards the COVID-19 vaccine, some doses of the COVID-19 vaccine, age, living area, having Influenza vaccination history, medical personnel, and income. Reasons and willingness to pay for the COVID-19 vaccine and vaccine booster shots were self-efficacy, safety, and proof by WHO. The main reason for refusing the COVID-19 vaccine was negative news on vaccines. Whereas the main reasons for the COVID-19 vaccine acceptance were protecting themselves, the safety of their families, social responsibility, herd immunity, and safety of their co-workers. One-fifth of respondents reported the willingness to pay for a booster shots vaccine between 1-5,000 Thai baht. News objectivity, in a particular vaccine against the severity of illness more than prevention, increased confidence towards the vaccine to higher-educated and higher-income groups, promoted a campaign for a single status group, priority groups for vaccination, combating fake news, and developed efficacy of the COVID-19 vaccine created in Thailand were the policy recommendations for the COVID-19 vaccine and vaccine booster shots in Thailand.


During the COVID-19 pandemic, the patient isolation chamber is crucial as it helps reduce the infection, numbers of medical personnel while transferring patients, and time, as well as protect their safety while taking good care of the COVID-19 patients. The general negative pressure chambers are currently expensive and have various limitations. For example, unable to move intensive care patients with ventilators, inconvenient in some medical procedures e.g., radiation treatment or CT scan, inconvenient and high costs for maintenance, and lack of quality testing and certification of equipment in safety and performance. Therefore, the MTEC research team had developed the PETE (Patient Isolation and Transportation Chamber), a device for transferring patients with respiratory tract problems. The PETE consists of 2 main parts; a clear plastic patient isolator and a negative pressure unit designed to control the air circulation inside the chamber. This PETE innovation is developed in consideration of local manufacture, reduction of shortage necessary medical equipment, and future improvement on the medical devices in accordance with global safety standards. The PETE is designed efficiently and approved after being reviewed along with literature and solution ideas gathered from concerned parties. The outcomes attached with this innovation are an air circulation system, a high-efficiency particulate air filter (HEPA filter), and a UV-C light sterilization system. From a study of current problems and reviews by actual users from 10 sampling institutions, the MTEC research team had digested and concluded for specification of the equipment which its main characteristics or essential features of a product are as follows: Compatible with existing patient transport equipment such as spinal board, stretcher, or scoop, The chamber can be put into the X-ray machine and CT scan, Foldable chamber requires small space to keep and be easy to transport, Pre-inlet filter prevent redundant disease, Chamber gloves ensure safe patient manipulation and additional ports for connection external medical devices and Complies with ISO 14644 standard (Clean room and associated controlled environments), IEC 60601-1 standard (electrical safety testing standard for medical devices) and IEC 60601-1-2 (electromagnetic compatibility)


Rare diseases affect more than 350 million people worldwide. Of those, more than 80 percent are of genetic origins. The diseases are severe, frequently cause congenital deformities, and rapidly deteriorated. Diagnosis of rare diseases is complicated and could take up to 8 years. Long-lasting diagnostic procedures mean wasting time and opportunity of medical personals to treat other patients, several laboratory tests, repeated hospital admission, and unnecessary treatment. These deteriorate the physical, psychological, and economic conditions of the patients and their families. To date, a vast number of patients with rare diseases lack an opportunity to access precise or correct diagnosis and treatment. Previous studies have demonstrated that more than 52 million children worldwide are died before the age of 5 years due to rare diseases. These show that urgent implementation must be employed to tackle undiagnosed rare diseases. With the Next Generation Sequencing (NGS) technology including whole exome sequencing (WES) and whole genome sequencing (WGS), up to 50 percent of rare diseases have been successfully diagnosed in the last 10 years. NGS has improved disease prevention, prenatal diagnosis, prognosis, and pharmacogenomics. Although WES/ WGS which are the short-read technologies (< 150bp nucleotides) have increased diagnostic yield of rare diseases, the yield is limited at 50 percent of cases. One founding reason is that short-read WGS is unable to diagnose certain molecular pathologies including structural mutation, inversion, and repeats. Our research team therefore has utilized a recent sequencing technology “long-read sequencing”, which can sequence more than 20,000 nucleotides in length, to do whole genome sequencing for 60 individuals comprising patients and their parents. We successfully performed the high-molecular weight DNA extraction, checked the DNA quality, optimized sequencing condition, analysed the genome information and sent the genome data to NSTDA for the establishment of long-read genome database. We have found that long-read sequencing could identify the diversity of genomics including single nucleotide variation (SNV), in/del (insertion/deletion), structural variation (SV), and copy number variation (CNV) which were unable to be identified by short-read sequencing. During the process which required short-read exome/genome sequencing and subsequently long-read sequencing, we could published 22 articles in international academic peer-review journals. The database will be beneficial to genomic research and medical service in the era of genomics medicine. The long-read WGS has a great potential to be the new standard in the era of precision medicine when personalized therapy can benefit the patient, family, society, and economy.


This study was descriptive research using both qualitative and quantitative methods. The “CIPP Model” was used as a conceptual framework. The aims of the study were 1) to evaluate the structure of ARI Clinics; 2) to evaluate the process of setting up ARI Clinics; 3) to evaluate the outcomes of ARI Clinics; 4) to synthesize knowledge of COVID-19 screening and management to improve ARI Clinics’ services. Data for the qualitative method were collected by in-depth interviewing using semi-structured questions and document analysis. This study recruited physician executive directors, nurse administrators, health care providers who worked at the ARI clinics, and clients who attended ARI clinics. Samples selected. The persons with a high risk for coronavirus infection who attended the ARI clinics were recruited in a quantitative method. Data were collected by 4 questionnaires including questionnaires for personal information, anxiety numeric rating scale, self-care competency, and satisfaction with ARI clinic service. The content validity indexes of the self-care competency questionnaire and the satisfaction for the ARI clinic service questionnaire were 1 and .93, respectively. The reliability of two instruments was tested in 30 clients who were not included in the study. The Cronbach’s coefficients were .78 and .84, respectively. The study respondents included 350 clients who attended the ARI clinics between September and November 2021. Data were collected from August to November 2021. Content analysis was used for analyzing qualitative data. Descriptive statistics were used for quantitative data. Results of the qualitative part showed that the operation of Acute Respiratory Infection (ARI) Clinics for COVID-19 screening and management at Ramathibodi hospital could be described in three aspects as follow. 1)Structure of the ARI clinics showed that the services of ARI clinics at Ramathibodi hospital had an appropriate structure corresponding with organizational context and policy in COVID-19 prevention and control. Teamwork and employee engagement were encouraging and used to develop and improve the quality and the feasibility of the services. These mechanisms were used to help people, healthcare personnel, and society. The hospital administrators have supported academic information, resources, and welfare appropriately and continuously. The developmental process was adequate. Moreover, the staff understood the principle and guidelines of infection control. Shared resources by rotating medical staff from all related units. The advantages of the ARI clinics at Ramathibodi hospital were IT development including application and software called Rama Care to reduce workload and risk. 2)Evaluation of the process showed that adequately updated information was provided to increase knowledge and skills for staff working at the ARI clinics. The original administration structure was applied for setting the master plan, workflow, roles, and responsibilities in managing the ARI clinics. Health care service systems and working processes were operated by the infectious control department. All units had regular meetings to evaluate the ARI clinic's operation and improve the working process. The medical resources preparation and staff training were performed. Rama Care was introduced to related persons. The cleaning staff was also trained in infection control. The steps of service (screening-swab-report-refer-follow up) were followed. ARI clinics at Ramathibodi hospital and Ramathibodi Chakri Naruebodindra Medical Institute have the same working process including 1) One-Stop Service 2) Fast track 3) One-way flow and 4) Modular swab unit which followed the standard guidelines from the Department of Disease Control, Ministry of Public Health. 3) Evaluation of outcomes is divided into two parts. 1) Output: It was reported that 58,395 persons attended the ARI clinics between March and September 2021, 54,207 of them were patients under investigation (PUI) for COVID-19 (92.83%), and 53,583 suspected persons were performed RT-PCR tests (98.85%). All COVID-19 cases were treated and followed by phone. 2) Outcome: The 350 respondents who attended the ARI clinics were included in the quantitative and qualitative analyses. The average age of the respondents was 35.74 years (SD 14.27). Most of them were female 74.6%, graduate study 48.6%, single 58.6%. The reasons that recipients attended the ARI clinics were because they contacted the patients confirmed with COVID-19 48.6%. The underlying diseases were allergic rhinitis and asthma 11.7%, hypertension, and diabetes mellitus 8%. About 44.9% reporting that they had anxiety at a moderate level (Mean 5.20, SD 2.63, ranging from 0-10). About 89.4% of them had a high level of self-care competency (Mean 30.35, SD 4.78, ranging from 9-36). Most of the respondents (96.0%) were satisfied with the ARI clinic service at a high level (Mean 68.95, SD 7.49, ranging from 34-75). In conclusion, the evaluation of ARI clinics at Ramathibodi hospital showed several advantages in the services of the ARI clinic clients. The results are suggested to use as the model development for setting ARI clinics. The clients would receive the best care. Both healthcare providers and receivers would be safe from the infection. The prompt and continuous services would increase clients’ satisfaction. The organization should readily prepare for respiratory infections disease or emerging diseases.


The purpose of this research was to study the patient journey, health literacy, and operations in fighting against type 2 diabetes in Thailand as well as to establish communication strategies to combat type 2 diabetes using mixed methods which consisted of: 1) an in-depth interview using selective sampling of 31 people residing in provinces with a high prevalence of type 2 diabetes from each region and Bangkok, 2) a survey research using a sample size of 1,600 people in Thailand aged 20-60 years who have type 2 diabetes or are at risk of developing type 2 diabetes, selected by simple randomization, 3) a document analysis of documents related to operations in fighting against diabetes in Thailand including reports, articles, research papers, symposium papers, and news, and 4) the research synthesis to develop communication strategies to combat type 2 diabetes in which the accuracy, appropriateness, and applications were reviewed by specialists in health campaigns, public health, and communication arts. The research findings are as follows: The patient journey of type 2 diabetes consists of 3 stages which are 1) the pre-diabetic stage, the stage before the patient meets the criteria of the disease, shows symptoms, and receives the diagnosis, 2) the treatment stage, the stage that the patient receives the diagnosis, decides to get treatments, and acknowledges lifestyle changes according to the doctors’ recommendations on how to manage the symptoms, 3) the long-term living with the disease stage, the stage in which the patient acknowledges the changing life conditions, sees the physicians regularly, and watches out for worsening symptoms, which is related to the patient’s future lifestyle. The survey findings indicated that 37.6% of the respondents started testing for diabetes when they were 41-50 years old, followed by 30.0% who started testing when they were 31-40 years old. Also, 79.1% of the respondents who have been diagnosed with diabetes were previously unaware that they were at risk. There were also more female than male respondents who have obesity (55.1%). In terms of health literacy regarding type 2 diabetes, the respondents had some skills to access to health information. Moreover, their ability to utilize health information, take actions to control and prevent the disease, and screen the information from friends and online media were moderate, while their ability to see through the advertisements on food and desserts as a cause of the disease and their skills of health communication were high. Finally, their knowledge on health is at the highest level. The document analysis results revealed that Thailand acknowledges the importance of operations in fighting against type 2 diabetes and puts an emphasis on promoting good health and fitness for Thai people. This is reflected in different levels of strategic plans including the 20-year national strategy that is linked to the plans of the public health authorities and includes the developments of policies, partnerships, databases, bodies of knowledge, communications, community capacity, health service system competency, and appropriate environments to aid the changes in behaviors of children, working adults, and senior citizens. All research findings were used to create three communication strategies to combat type 2 diabetes as follows: Strategy 1: Public campaigns to fight against type 2 diabetes. The objective of this strategy is to raise awareness and encourage changes in behaviors that will lead to the reduction in the risks of the disease. This strategy is aimed at young working adults (18-29 years old) and middle-aged working adults (30-44 years old). Strategy 2: Health education. The objective of this strategy is to raise knowledge and understanding on type 2 diabetes as well as to prevent the disease. This strategy is aimed at young children to university-aged individuals. Strategy 3: Policy advocacy to fight against type 2 diabetes. The objective of this strategy is to encourage the public to exchange ideas and engage in discussions about type 2 diabetes to contribute to the changes in policies on the fight against type 2 diabetes.


Despite the adoption of the 1999 decentralization legislation, Thailand has made limited progress in devolving public service functions to local government. Primary care in particular remains largely centralized. However, upon the end of the current operational plan on decentralization, it is required that ownership and management of the subdistrict health promotion hospitals must be transferred to provincial administrative organizations. To help inform government officials and policymakers in Thailand on how to expedite the decentralization process and ensure the smooth transfer of the primary care services to local government authority, this research has three primary objectives. First, it seeks to analyze the management system and performance of subdistrict health promotion hospitals that have already been devolved to municipalities and subdistrict administrative organizations. Second, future scenarios for the transfer of primary care functions to provincial administrative organizations are formulated, using a double-variable scenario method. Third, based on findings from the first and second objectives, policy recommendations are presented. Qualitative and quantitative techniques were used to analyze data that were collected from multiple sources, including documentary review, a citizen perception survey, a survey of subdistrict health promotion hospital personnel, interviews with 27 key policymakers and subdistrict health promotion hospital directors, and focus group discussions with 58 officials from provincial administrative organizations and citizen representatives. In total, 6,304 citizens responded to the survey. Personnel from 70 subdistrict health promotion hospitals that have already been devolved to municipalities and subdistrict health promotion hospitals participated in the survey. This research finds that although small in number, the subdistrict health promotion hospitals that have successfully been transferred from the public health ministry to local administrative organizations have shown significant progress in primary care quality. Intermediate health outcomes—particularly citizens’ behavioral changes in physical activity and eating habit—in the decentralized areas continue to improve, while citizens harbor more positive attitudes towards the devolved subdistrict health promotion hospitals than those not devolved to local administrative organizations. However, there are mounting concerns among local government officials about personnel recruitment and retention, as well as continuity of the intergovernmental grants. Based on the future scenario analysis, a desirable scenario depicts a devolved primary care system in which the provincial administrative organizations have adequate management capacity, while the central government agencies proactively provide technical advice and effectively perform their regulatory function. The major policy recommendations for the relevant government agencies include: 1) accelerate the transfer of subdistrict health promotion hospitals to the provincial administrative organizations; 2) establish citizens’ consultative councils at the provincial, district, and hospital levels to facilitate citizen engagement in local health policy making; 3) develop explicit criteria for determining the amount of intergovernmental grants for the devolved primary care functions; 4) generate a list of essential primary care services and associated costs based on the Primary Care System Act of 2019 and collaborate with the National Health Security Office in reforming the health financing system by separating primary care from secondary and tertiary care; 5) strengthen citizens’ consultative councils and develop it into a central decision-making body charged with providing linkage and referrals between provincial administrative organizations and the public health ministry’s hospitals, preparing the provincial health strategy, and integrating different health databases and; 6) propose to the Ministry of Interior that it should enable the provincial administrative organizations, municipalities, and subdistrict administrative organizations to share resources, budget, and personnel in providing primary care services and financial assistance for the subdistrict health promotion hospitals


Three major institutes in Thailand, including King Chulalongkorn Memorial Hospital, Queen Sirikit National Institute of Child Health, and Faculty of Medicine, Chiang Mai University, worked in collaboration to establish the management plan for drug-resistant tuberculosis in children mainly consists of two paralleled projects, including the prevalence of drug-resistant tuberculosis in Thai children and the study of pharmacokinetics and safety of levofloxacin in pediatric tuberculosis treatment. The prevalence study of drug-resistant tuberculosis in Thai children had screened 186 children during 2019 and 2021, of which 104 children were diagnosed with tuberculosis, including 11 children with any forms of drug-resistant tuberculosis; 7 (7%) children were resistant to isoniazid, 2 (2%) were rifampicin, and 1 (1%) was multi-drug-resistant. In comparison with the medical records data from Siriraj hospital (the year 2009 to 2011) and Queen Sirikit National Institute of Child Health (the year 2001 to 2010), the prevalence tended to decrease over time. As a result, the prevalence of tuberculosis in children was similar to that in adults in 2017-2018. Thus, the characteristics of tuberculosis in children may represent those in adults. Moreover, the majority of drug resistant tuberculosis in children is isoniazid resistant tuberculosis which may reflect the similar prevalence of isoniazid-resistant tuberculosis in adults. The current World Health Organization’s recommendation and the Thai National tuberculosis management guidelines have implemented the treatment regimen of rifampicin, pyrazinamide, ethambutol, and levofloxacin for 6 months for isoniazid resistant tuberculosis has been shown to reduce the mortality and recurrent rates. However, the current application of molecular diagnosis as Xpert MTB/RIF could not detect isoniazid-resistant tuberculosis. Therefore, the culture for tuberculosis within two months after the treatment is still mandatory to consider the appropriate treatment regimen for the specific patient. However, the use of line probe assay 1st line drug or Xpert MTB/XDR is able to detect levofloxacin-resistant tuberculosis, thus helping establish the treatment regimen in the meantime. Additionally, for the pharmacokinetics and safety study of Levofloxacin in children with tuberculosis, a total of 10 children were equally divided into two groups which the first group received levofloxacin dosed 15-20 mg/kg/day which is a WHO recommendation dose in 2020 and 20-30 mg/kg/day in the second group. As a result, the serum levofloxacin level was lower than the therapeutic level in the first group and reached the therapeutic level in the second one, with no significant adverse event. Therefore, our study recommended increasing the levofloxacin dose to 20-30 mg/kg/day as the standard treatment of drug-resistant tuberculosis in children in order to enhance the therapeutic efficacy and minimize the risk of levofloxacin-resistant tuberculosis in the future.


This research aimed to develop essential competencies of registered nurses in terms of nursing for emerging infectious disease COVID-19 and develop a competency development model of emerging infectious disease COVID-19 nursing of primary, secondary, and tertiary health service units in collaboration with stakeholders. Research implementation was conducted using Emancipatory Action Research. Research participants were 6 physicians and 53 registered nurses, of which 10 were from primary, 31 from secondary, and 12 from a tertiary health service unit. Research instruments consisted of 1) instruments for quantitative data collection including the questionnaire of essential competencies of registered nurses in terms of nursing for emerging infectious disease COVID-19, the questionnaire of the competency development model of registered nurses in terms of nursing for emerging infectious disease COVID-19, and questionnaire of satisfaction of competency development model of emerging infectious disease COVID-19 nursing, 2) instruments for qualitative data collection including 1) behavioral-based interview form, 2) in-depth interview form, and 3 focus group discussion form. Quantitative data were analyzed using descriptive statistics and content analysis was used for qualitative data. Research results revealed that 1) registered nurses of primary, secondary, and tertiary health service units had an overall higher mean score of essential competencies of registered nurses in terms of nursing for emerging infectious disease COVID-19 in each loop of research. A higher mean score was found on both professional and technical competencies. 2. Competency development model of registered nurses in terms of nursing for emerging infectious disease COVID-19 consisted of 3 components including practice guidelines, competency development method, and factors promoting competency development. Practice guidelines consisted of 5 main steps including 1) specification of essential performance competencies, 2) development of monitoring system, support, and empowerment, 3) specification of self-competence development guideline, 4) implementation of the competency development plan and, 5) summarization and report of development result. The Competency development method consisted of 6 activities including 1) workshop, 2) on-the-job training, 3) learning from experts, 4) coaching, 5) self-study, and 6 knowledge sharing. Factors promoting competency development included the role of nursing leaders, policy and explicit practice guidelines, and a good attitude towards the profession