Nan province is an index area of leptospirosis study model in Thailand where provided the evidence linkage between human and rodents but lack of a data in domestic animals such as cattle, pigs and dogs. This study aimed to detect and isolate the pathogenic Leptospira spp. from domestic animals by serological assay, Microscopic Agglutination Test (MAT), molecular assay, rrs nested polymerase chain reaction (PCR), and culture. Identification Leptospira species by near-full length 16S rRNA sequencing, determination Leptospira genetic relationship and clonality by constructed phylogenetic tree and MLST and PFGE from a total of 525 sample of bloods and urine from animal in Nan province during 2013 to 2015. Overall, the seroprevalence to leptospiral detection by MAT was 8.09% (95% confident interval (CI) 4.38-11.74). The major leptospiral serogroup was Shermani and the minor serogroup were Sejroe and Tarassovi, respectively. By rrs nested PCR, 7.42% (95% confident interval (CI) 5.18-9.66) of samples were positive to pathogenic Leptospira spp.. DNA sequencing and phylogenetic analysis found the positive samples were clustered in a branch of L. interrogans, L. weilii and unidentified Leptospira spp.. We could successfully isolate four leptospires from dogs and identification Leptospira species by near-full length 16S rRNA sequencing revealed L. interrogans (n=2) and L. weilii (n=2). In molecular epidemiological study by MLST, we found novel sequence type (STs) of Leptospira; ST26 and ST33 for L. interrogans and ST94 for L. weilii. ST26 and ST33 was a singleton without clonality to Leptospira species in database. ST94, however, was a putative founder of ST193 and ST183 isolated from human leptospirosis in China and Laos. Our study provides an important epidemiological information of animal leptospirosis in an endemic area that may be continually useful for disease control and prevention strategies.


This study aimed to explore the epidemiological information of Streptococcus suis (S. suis), either in pigs and human. Those information was used to find the appropriate method to reduce the number of S. suis infection in human. The tonsil swab samples from sows and fattening pigs, pork from pig slaughter houses and pork in wet and super markets in Chiang Mai province were collected for S. suis culture. Moreover, demographic data, education attitude and risk factors data from 35 S. suis infection patients were collected. The results indicated that from 43 farm, sow samples from 13 farms were detected S. suis (30.23%). In fattening pigs, S. suis was detected in 57 farms from 111 farms (30.23%). Pork sample from pig slaughter houses and pork in wet and super markets were detected S. suis 26 from 119 (21.85%) and 5 from 50 samples (10.00%), respectively. S. suis type 2 were found in 1 pork sample from pig slaughter houses and 1 pork sample from wet market. The virulence gene, including gdh+,arcA+,mrp+,thrA+ and sly+ were detected from those sample. The data in human showed that S. suis patients were male more than female. All of them had underlying diseases and always drank alcohol. They had the history of raw pork or unsure well cooked pork before showed clinical signs. Nine patients (27.71%) showed deafness and trend to be permanent deafness. This study indicated that even though pigs is the important carrier of S.suis and the agent can transmit to human via slaughter process, the consuming behavior is the key factor that effect S. suis in human.


Acute febrile illness (undiffenerentiated fever, AFI) is common disease and problem in worldwide including Thailand. Symptoms in early phase of AFI are non-specific resulting in mistakenly diagnosing it in acute febrile illness group. Laboratory diagnosis is important to confirm the definite clinical diagnosis. A rapid and accurate diagnostic test is essential tests for Point-of-care diagnosis. The objective was to generate the template products for diagnosis of scrub typhus and leptospirosis based on the principle of immunochromatrogaphy with gold nanoparticles (strip test). In preparation of recombinant proteins, the specific primers of entire genes were designed. PCR product from extracted DNA was cloned into plasmid and then selected positive clones were performed by PCR and restriction fragment analysis. Recombinant plasmids were transformed into expression cells. The characterized and purified recombinant proteins for scrub typhus and leptospirosis were 56 kDa proteins from Orientia tsutsugamushi prototype strains of Karp, Kato and Gilliam and 25 kDa protein of (Electron transfer flavoprotein subunit beta, ETF_beta), respectively. In the development of scrub typhus test kit, the nucleotide sequences of the recombinant proteins of all three strains showed the identity percentage of 97.8, 97.7 and 97.4 respectively. IgM/IgG immunoreactivity indicated that the recombinant proteins could be used as excellent antigens for antibody detection against all three strains and others two strains of TA716 and TA763.
Evaluation of scrub typhus test kit IgM (Scrub_M) and IgG (Scrub_G) by using immunofluorescence assay (IFA) as a reference test. The titer >1:400 of IFA_M/G was considered to be positive. Scrub_M/G were tested in 318 sera from 100 scrub typhus patients and 218 non-scrub typhus patients (53 leptospirosis, 96 dengue, 30 murine typhus and 39 unknown). Scrub_M/G yielded the values of sensitivity, specificity; positive predictive value and negaitive predictive value were 97.0%, 100%, 100% and 98.6%, respectively. Scrub_M showed the values of sensitivity, specificity, positive predictive value (PPV) and negaitive predictive value (PNV) were 81%, 100%, 100 and 92.0, respectively. Scrub_G showed the values of sensitivity, specificity, positive predictive value (PPV) and negaitive predictive value (PNV) were 93.0%, 100%, 100 and 96.9, respectively. Evaluation of leptospirosis test kit IgM (LepProt_M) and IgG (LepProt_G) with recombinant ETF protein as antigen (version 1), was tested in 60 sera by using immunofluorescence assay (IFA) as a reference test. Correlation of (LepProt_M) and LepLPS_M with LPS as antigen was observed. The titer >1:400 of IFA_M/G was considered to be positive. LepProt_M and LepLPS_M gave the same negative results of 43.5 in sera with IFA_M (titer <1:50). In the group of positive results for IFA_M, LepProt_M gave the negative results of 44.4 (4/9 samples) while LepLPS_M yielded 100% of positive results. LepProt_M and LepProt_G which were further developed to be version 2 as compared with commercial kit SD BIOLINE Leptospira IgM/IgG (SD Lep_M/G) which demonstrating sensitivity of 96.2% and specificity of 95.7%, was evaluated The results showed that leptospiral isolation as reference standard test could not be used as a tool of evaluation. However, LepProt_M gave the higher rate than SD Lep_M in antibody detection of early phase of illness. Using microscopic agglutination test (MAT) as reference test, the sera in the positive group (titer > 1:400) showed that LepProt_M/G yieled the the values of sensitivity, PPV and PNV were higher than SD_M/G, except specificity of SD_M was higher than LepProt_M (100% vs 91.7%). In conclusion, two template products of rapid diagnostic tests were Scrub_M and Scrub_G (for Scrub typhus) and LepProt_M and IgG LepProt_G (for leptospirosis) with high sensitivity, specificity; positive predictive value and negaitive predictive value.


Burkholderia pseudomallei are a causative agent of melioidosis and ceftazidime is the drug of choice for treatment. However, the motility rate is high in endemic areas. This study aimed to investigate an incident of the blaPenA and blaOXA mutation and tendency of β-lactam antibiotics in B. pseudomallei from patients admitted to hospitals in lower North-East Thailand. A total of 1,340 isolates of patients with B. pseudomallei admitted to Sappasitthiprasong Hospital, Sisaket Hospital, and Amnatcharoen Hospital between January 2013 and February 2015 were determined for antimicrobial susceptibility by standard disk diffusion and minimum inhibitory concentration (MIC). The conventional polymerase chain reaction (PCR) was used for the detection of blaPenA and blaOXA in β-lactamase genes with the specific primers. Almost all of the clinical isolates of B. pseudomallei were susceptible to ceftazidime, piperacillin, cotrimoxazole, cipofloxacin, and imipenem by the standard disk diffusion test. Cefatzidime MIC was ≤1-≥32 μg/ml and imipenem MIC was ≤0.5-≥8 μg/ml. MIC50 and MIC90 of ceftazidime were 2 μg/ml and 4 μg/ml respectively, and MIC50 and MIC90 of imipenem were ≤0.5 μg/ml and 1 μg/ml respectively. The conventional PCR followed by gel electrophoresis revealed that only Class D beta-lactamase gene or oxa was detected in all DNA samples isolated from B. pseudomallei. DNA sequencing followed by amino acid analysis and comparison by the bioinformatic approach found that all translated amino acid sequences showed 100% identity to those reported in the National Center for Biotechnology Information (NCBI) database. This result demonstrated that there were no any mutations in oxa gene in B. pseudomallei. PenA gene was not detected in all DNA samples. However, the penA gene with the length of 300-500 bp was detected from the beginning of this study. It is suggested that this amplified product be sent for sequencing to confirm that it is penA.


Currently, lung cancer treatment has been developing in several approaches such as; conservative chemotherapy or novel targeted therapies which increase the overall response rate, survival rate with good quality of life for the patients. Thus this research project’s goal is to explore the molecular alterations in Thai lung cancer patients which could be different from the other ethnicities. The result of this research will lead to targeted drug development in Thailand for Thai lung cancer patients which the investigators will co-operate with ECDD (Excellence Center of Drug Discovery). This center was established in July 2016 by the co-operation and commitment between Faculty of Science, Mahidol University and Faculty of Medicine Ramathibodi Hospital, Mahidol University. The preliminary result of molecular alterations in 56 Thai lung cancer patients from this research project by NGS method from both FFPE and fresh frozen tumor tissue (initial analyzed only the common mutations in lung cancer) showed EGFR mutation 39%,
BRAF mutation 13%, KRAS mutation 20%, and MET mutation 2%. We also found 9 patients (16%) whom had more than one mutation. These preliminary results were very interesting and different from the other countries’ results, but we need to wait for the further analysis in larger sample size including deeper analysis for novel and uncommon mutations in Thai lung cancer patients in the second and third year for this research project. Even though we explore the diagnostic technique and the approach for lung cancer treatment as mentioned above, but the cancer prevention is also very important for the oncology world right now. The previous literatures reported the role of Metformin (anti-diabetic drug), Aspirin (anti-platelet drug), and Statins (lipid lowering agents) in decreasing cancer incidence rate, but the results were not homogenous and most of studies were small population based studies only. These 3 groups of drug involve in the metabolism of human body, thus cancer metabolism is the important and interesting field which could
lead to cancer prevention in the future. This research project also focuses in cancer metabolism and cancer prevention by studying the largest and longest follow-up of population based study in Thailand (EGAT database: Electricity Generating Authority of Thailand). The preliminary results showed Statins had statistically significant decreased the cancer incidence rate with the hazard ratio of 0.42 (P <0.001). Aspirin and Metformin also had the trend of lowering the cancer incidence rate but they were not statistically significant. Although this report is only the initial result, but it is very interesting and
fascinating to explore more in term of cancer prevention and wait for the deeper analysis in the next report. In conclusion, the study of molecular alterations in Thai lung cancer patients is very important for targeted drug development in order to drive the innovative lung cancer treatment. However, the other important issue and concern is cancer prevention. Nowadays cancer is the most leading cause of death in Thailand and cancer also causes a lot of burdens in Thailand and Global public health. We believe that cancer metabolism is one of the key factors for cancer prevention in the future which could probably help to prevent and decrease the cancer incidence rate and solve the cancer burden in Thailand.


Health Region 7th has developed strategies to build up and enhance capacity for medical services in orthopedic at the M1 level hospital. This study was aimed to assess cost utility of arthroscopic knee surgery in patients who had anterior cruciate ligament injury with or without meniscus injury at M1 hospital level as compared to the operation performed at only the provincial hospital level. The present study was based on decision tree analysis with the time horizon of 1 year using a societal perspective. The primary data collection was performed to obtain the following key variables: waiting time, complication rate, return to sport outcome (up to 1 year), direct medical cost, direct nonmedical cost, indirect cost, and utility (EuroQoL-EQ-5D-5L). The study sites included Sirindhorn Hospital (M1 level) and Khon Kaen Hospital (provincial hospital). The training cost and cost of instruments were 99,328 Baht. At Sirindhorn and Khon kaen hospitals, proportions of patients undergone surgery within 2 months were 93% and 25%, and the averages of waiting time were 1.03 ± 0.67 and 4.3 ± 3.0 months, respectively. The complication rates were similar of 7%. All patients with or without complications could return to sport within 1 year. Utilities at baseline, after surgery, 3, 6, 12 months thereafter were 0.66±0.15, 0.77±0.22, 0.92±0.07, 0.93±0.06 respectively. Under the timeframe of 1 year, direct medical cost, direct non-medical cost, and indirect cost for one case were 19,215, 7,488, and 1,479 Baht at Sirindhorn Hospital and 19,413, 7,888, and 1,538 Baht at Khon Kaen Hospital. For one case, total costs were 31,493 and 28,839 Baht, and quality-adjusted life years were 0.91 and 0.85, respectively. An incremental cost effectiveness ratio was 41,058 Baht/Quality adjusted life year. In conclusion, arthroscopic knee surgery for anterior cruciate ligament injury at M1 hospital level could reduce waiting time and was cost effective as compared to the operation performed at the provincial hospital level. The complication rates were similar and relatively low. All patients with and without complications in both hospitals could return to sport within 1 year. The policy recommendation proposes that provision of orthopedic services at the M1 hospital level should be promoted for the procedures that complication rates were similar and relatively low in both levels, complications do not lead to the final clinical outcomes, post-treatment utility outcome would increase by 0.24 (EQ5D 5L), and waiting time should not be greater than 2 months. The procedure as such would be cost-effectiveness if the initial program cost is about 662 Baht per one case.


Chronic kidney disease (CKD) is one of the major public health problem in Thailand. The Nephrology Society of Thailand was granted the community-based cross-sectional survey study using stratified-cluster sampling method to represent population from all region of Thailand called Thai SEEK (Screening and Early Evaluation of Kidney Disease) study during 2007 to 2008. The overall prevalence of CKD from Thai SEEK was 17.5% which increased awareness of CKD burden and lead to deliver strategic planning for CKD prevention and management programs. However, study about the natural history of CKD progression, particularly among Asian and Thai population which might useful for the estimation of health cost and strategies prioritization for slow CKD progression stills limited. Moreover, we still lack of information of the incident of CKD using a standardized method for GFR estimation in representative Thai adult populations. So the research committee of The Nephrology Society of Thailand was conducted this follow-up study from Thai SEEK population.


This research aims to identify and disseminate the local wisdom knowledge on equipment for people with disabilities and develop care systems for people with disabilities by using the rehabilitative devices and assistive devices from local wisdom. There were 2 phases in this research; phase 1: find, collect, analyze and disseminate information on the disabled equipment. The data was collected by quality of life questionnaire, the Barthel Activities of Daily Living, data recorder, and interview guideline with 70 disabled people and families with disabilities in Phitsanulok Province. Phase 2: development of care systems for people with disabilities by using the rehabilitative devices and assistive devices from local wisdom
within stages of action research. The data was collected by quality of life questionnaire, Barthel ADL index, group discussion, interview, and brainstorming guideline from 48 of 1) District Health Officers 2) District Sub District Health Officers 3) Community Leaders 4) Sub District Administration Officers 5) Volunteers 6) Village Health Volunteers 7) Disabled People And 8) families of PWDs. Content analysis was used analysis in qualitative data. Frequency, mean, percentage, median, deviations, and Paired t-test were used analysis quantitative data. The results found that 1) there were 53 the rehabilitative devices and assistive devices from local wisdom. The security and be careful in how to use the device
were advised. 2) The development of care systems for people with disabilities by using the rehabilitative devices and assistive devices from local wisdom was found that the system consisted of two levels, namely, the support of the district level, 1) vision and goals, 2) the management center, and 3) the development of human resources for the care of the disabled. 4) supporting budget 5) The Disability Resource Center 6) providing 24-hour for counseling 7) supporting by health organization administrator and the prefect. The process of caring for people with disabilities at the sub-district and community level consisted of: 1) assessment of disability condition and ability for finding the need 2) coordinate with the community health center of the hospital for plan 3) think and design the production of
equipment to care for people with disabilities; 4) physiotherapists to verify academic
accuracy and safety; 5) take care of people with disabilities at home; 6) develop knowledge between carry out of caregiver. 7) publish the work on the line group and
8) evaluate the use of the equipment. The results of the development of the system
found that the quality of life of the disabled and the movement of people with
disabilities improved.


For an analysis of an inequality in health service use across areas, a recommended measure is
slope index of inequalities (SII). The SII captures area variations in users of health services as associated
with total population in the areas ranked by a descending order by health service use. In practice, a
binary outcome, such as use vs. no use, measured at an individual level needs to be aggregated at
the area level in terms of proportion of populations who were the users. To account for uncertainty
due to sampling, the SII could be estimated statistically using linear regression analysis. This paper
used the data in 12 health regions, excluding Bangkok from Health and Welfare Survey in 2015, the SII
revealed statistically significant inequalities in the use of health services from public facilities for both
outpatients and inpatients across 12 regions. The Universal Coverage Scheme population showed a
lower extent of inequalities in health service use than Civil Servant Medical Benefit Scheme.


Non-communicable Diseases (NCDs) are a major public health problem. NCDs can be prevented by reducing risk factors such as smoking, alcohol consumption, sweetened beverage consumption, and inadequate physical activity. For a more effective solution, the ordinary NCDs treatment should be adopted, as well as the preventions of the NCDs risk factors. This study aimed to report the situ¬ation of NCD patients’ risk behaviors in Thailand. The secondary data from the 2015 National Health and Welfare Survey was adopted for analysis on NCD patients aged 15-65 years who had cardiovascu-lar disease, diabetes mellitus, cancer, or chronic respiratory disease. The study showed that risk be¬haviors in smoking (10.7%), alcohol consumption (16.8%), sweetened beverage consumption (51.34%) and inadequate physical activity (68.8%) were still occurring among NCD patients. The evaluation also suggested that while the male group had increased risk behaviors of smoking and alcohol consump¬tion than female group, however the latter had increased risk behavior of sweetened beverage con¬sumption and inadequate physical activity. By considering the socio-economic characteristics of the NCD patients, the study found that the majority of NCD patients consisted of ageing and adult workers in agricultural and low-skill industrial sectors, and those who lived in outer urban area. It was further noted that different economic status was not a significant factor in affecting the NCD risk behaviors. The findings confirmed that Thailand’s NCD patients had high risky health behaviors and health pro-motion activities were highly recommended for reversing these risks.


This study aimed to determine the amount of energy expenditure from moderate to vigorous intensity physical activity in 3 domains (occupation, transportation, and recreation), and sedentary behavior of Thai adults disaggregated by subgroups of participants. The data of 113,882 Thai adults aged 15 and above from the 2015 National Health and Welfare Survey conducted by National Statistical Office were analyzed using descriptive statistics and two-part model. The results showed that the average energy expenditure from moderate to vigorous intensity physical activity by 3 domains was 1,728 metabolic equivalent of task-minute/week. The energyexpenditure from work domain was the highest (1,113 MET-minute/week), followed by transportation (286 MET-minute/week), and recreation (230 MET-minute/week), much lower than the results from other international studies. The energy expenditure in sedentary activities was also high at 774 MET-minute/week. The energy expenditure from 3 physical activity domains was higher in males and adults (aged 30-44) living in rural areas including farmers and laborers, and those who had lowest education and income levels, without underlying diseases, and self-reported with lower health problem status. These subgroups with higher energy expenditure from physical activity also reported lower energy spent sedentary. Our findings will benefit to the national policy development on physical activity by transforming energy expenditure in sedentary activities to other physical activity domains. For example, office-based employee spent low energy expenditure from work domain should be encouraged to the standing break or walking every hour of sitting, using stairs instead of elevator, or using public transport, walking or biking to workplace. In addition, we urge for the improvement of national physical activity to be more accurate and conducted continuously.


Universal Health Coverage aims to increase access to essential health services to minimize household health expenditure. However, a number of people still do not use services provided under the Universal Health Coverage. These people prefer self-medication by buying medicines from community pharmacy. This research aims to study characteristics of these people and the expenditure for self-medication. Descriptive study design was used. The 2015 Health and Welfare Survey data conducted by National Statistical Office containing 139,848 individual persons were analyzed. Based on the survey, an individual who had at least one time of illness that did not require hospitalization within the last month was identified and then the data about self-medication and out-of-pocket payment were collected. Sampling weight was applied using appropriate statistics to make sure that the dataset could represent all Thai population in all 13 health regions. Findings showed that 27.2% of those who had at least one time of illness that did not require hospitalization had self-medication. The percentage of self-medication of region 7 (37.7%) was the highest compared to other regions. By scheme, the highest rate of self-medication was found in the social security members (35.0%). Rural population had 10.4% more self-medication than urban population. Most of the people who used self-medication strategy were in the lowest quintile and had no underlying diseases. Their symptoms included common cold/cough and running nose (44.4%). The median cost of self-medication was 60 Baht per visit. For patients with underlying diseases, cost was as high as 120 Baht per visit. Factors associated with self-medication should be examined in further studies. Quality development of community pharmacy should be implemented because community pharmacy is still the major source of self-treatment.


This study analyzed health care utilization of Thai people who did not have or were not aware of health insurance, using data from Health and Welfare Survey 2015. Demographic, socio-economic characteristics plus utilization patterns of outpatient (OP) and inpatient (IP) services were analyzed. Out of pocket payment was reported as the median amount. The results showed that 1.49% of Thai population neither had health insurance nor knew their status. Majority (38%) lived in Bangkok while 17% and 12% lived in Health Region 5 and 6, respectively. Approximately 51% were male and aged 30 years on average. Sixty-five percent completed up to the primary schools and 41% were private employees. With respect to economic gradients as measured by household asset index, the poorest quintile had a greater proportion of the primary school graduates and private employees than the rest. Of all Thai population, ten percent reported having non-hospitalized illnesses (outpatient, OP) during one month and mainly received care at private hospitals (37%) and clinics followed by drug stores or traditional healers, and public hospitals. Median paid amounts for the above OP services were 350, 80, and 2,300 baht per visit, respectively. The poorest quintile used drug stores in the largest proportion, followed by private and public facilities, and paid for a visit of 80, 300, and 200 baht, respectively. The richest quintile used private facilities the most, followed by public facilities, and drug stores. There were only four percent reporting being hospitalized during the past year, which was not different across economic quintiles. Approximately, 70% of those hospitalized were admitted to public hospitals. All people in the poorest quintile were hospitalized in the public hospitals and paid 8,000 baht per admission, while 69% of the richest quintile were hospitalized in the private hospitals and paid 40,000 baht per admission. To mitigate financial risks to health payments by households, especially among the poor, and strategies for identifying the Thai population who did not get access to the UCS registration are thekey priority issues, especially in the urban areas and big cities.


Holistic and humanized health care is an essential guideline for health care personnel. The modern medicine that focuses on only biological aspect is not adequate and has neglected the psychosocial and spiritual aspects. The clients may feel that their self-esteem and dignity have been decreased especially for people living with HIV/AIDS (PLWHA) suffering from society’s stigma and discrimination. This article illustrates the experiences of holistic and humanized health care for PLWHA provided by Bamrasnaradura Infectious Diseases Institute. This institute has been providing care for PLWHA since the early period of HIV infection and has continually improved its services to be recognized nationally and internationally. This article also displays evidence to confirm that holistic and humanized health care has yielded excellent outcomes for the clients, health care providers, and health service systems. However, implementing this concept systematically and broadly remains challenging for health care personnel and health service systems of Thailand.


An achievement of the Universal Health Coverage since 2002 has increased an access in health care utilization of the Thai population. However, populations in Bangkok tend to have an access problem. Basic structure of health service system in Bangkok is different from other regions. This study aims to analyze healthcare utilization and unmet health need both in outpatient (OP) and inpatient (IP) services of population in Bangkok. This is a descriptive study. The 2015 Health and Welfare Survey provided a sample of 5,893 individual persons living in Bangkok for data analysis. Majority of population in Bangkok were covered by the Universal Coverage Scheme (UC) (47.9%) and Social Security Scheme (33.8%). 64.2% of population under UC were in age group 15-60 years, however, 35.8% of them did not work and 18.8% of them were in the poorest quintile. For the OP illnesses, 35.2% of the UC had self-care, mostly by purchasing medication from drug stores. When seeking care at the public hospitals, the UC poorest quintile paid out of pocket disproportionately higher (24%) than patients of other quintiles, with the median amount 1,500 baht higher than the richer quintiles. For IP services, majority of the UC (71.1%) admitted to public hospitals. 32.5% of the poorest quintile had to pay out of pocket for the service with median amount 2,000 baht. Among UC respondents, unmet health need for services was 7.4% for OP and 1.3% for IP, higher than other schemes. The main reasons of the unmet health need for IP services among the UC were unaffordability, inconvenience in travelling, and time barrier (34.6%, 22.3%, and 13.9%, respectively) In Bangkok Metropolitan Area, public hospitals should facilitate an easy access to health services for the UC beneficiaries who had relatively low socio-economic status. This would help mitigate the unmet health need caused by financial hardship due to health payments.


Caries and gingivitis are major and chronic problems in dental public health especially among adolescence. In particular junior high school students, they lack continuous oral health care. The present study adopts PRECEDE model as a study’s framework to determine association of predisposing, reinforcing, and enabling factors with oral health promotion behavior in ninth graders. The study was a cross-sectional analytical design. The population was ninth graders who lived in Maesai district, Chiang Rai province during academic year of 2015. Sample size was estimated by proportion of factor. Three hundred and seventy-five students were simple randomly selected from 13 schools in Maesai district. The study instrument was a questionnaire asking general information, enabling factors, predisposing factors, reinforcing factors, and oral health behavior. Data analyses were performed using descriptive statistics, chi-square, Pearson’s correlation for univariate, and multivariate ordinal logistic regressions were used to analyze adjusted effects of independent factors. Data were presented using Pearson’s correlation coefficient, adjusted odds ratio and 95% confidence interval. The results revealed that parent’s education had significant association with oral health behaviors. Correlation analyses found that knowledge had a significant inverse correlation with oral behavior (r=-0.164, p=0.001). While attitude, values, and enabling factors had significant positive correlations with oral health behavior (r=0.119, p=0.021; r=0.152, p=0.003; and r=0.392, p<0.001 respectively). By multivariate analysis, fac¬tors that positively affected on oral health behavior were the opportunity expansion school with the highest education of grade 9 (adj. OR 1.70; 95%CI 1.12-2.57, p=0.012), parent with graduate degree compared to those with no/primary school education (adj. OR 2.58; 95%CI 1.19-5.59, p=0.016), value of food consumption (adj. OR1.32; 95%CI 1.04-1.68), and enabling factors (adj. OR 1.60; 95%CI 1.25- 2.05). But knowledge negatively affected on behavior (adj. OR 0.60; 95%CI 0.43-0.82). These findings will facilitate planning and guidance for dentistry personnel in changing oral health behaviors among grade 9 students.


The objective of this study is to evaluate the effectiveness of the provision of nutrition informa¬tion on food consumption behavior. Field experiments were conducted on undergraduate students from three universities. The total number of research participants was 375 undergraduate students. Each participant was randomly selected to answer one of 12 possible questionnaires, each with a different set of nutrition information. They were subsequently provided with a meal of their choice. At each university, the experiment was conducted twice, within a one-week interval. Mean differences and regression analyses based on an ordinary least squares (OLS) technique were used. The results show that the provision of calorie information for each item on the menu and the provision of information on daily recommended caloric intake did not have an impact on food consumption behavior. Nevertheless, the selection of dishes into a recommended menu had an effect. Participants who answered questionnaires with healthy recommended dishes were more likely to choose a meal that contained lower calories by 73.97-105.4 Kcal, compared to those who were assigned with a menu highlighting unhealthy recommended dishes. However, the effect was found only in the first week and dissipated by the second week. The implication is that featuring a healthy recommended menu may have only a contemporaneous effect on food consumption.


An unhealthy diet is a major risk factor of obesity and non-communicable diseases (NCDs). The diet-related health problems are increasing continually in Thailand. This study aimed to assess the association between dietary patterns of Thai adults (15 years old and above) and their demographic, socio-economic and health status. In this study, the dietary patterns asked on daily consumption of sugar-sweetened beverages (SSBs), and adequate intake of fruits and vegetables (FVs) at least 4 ladles and above per day. The data, obtained from the 2015 National Health and Welfare Survey, were ana¬lyzed using descriptive data analysis and multiple logistic regression. The results show that Thai adults aged 15-24 years old were more likely to drink SSBs and to consume less than 4 ladles a day of FVs compared to other age groups. Government/state and private employees were more likely to drink SSBs every day than the business owners. Compared to the poorest, people with higher economic status were more likely to drink SSBs daily. The findings suggest that nutrition policy should focus in¬tensively on high risk groups including students, government/state and private employees and people with high ability to pay for SSBs. Potential interventions include a comprehensive nutrition promotion program in and around education institutions as well as in workplace. Pricing and taxation and social marketing campaign are also the promising strategies to promote the consumption of healthy diet among Thai population.


This research aimed to formulate and develop the labor price index (LPI) for physicians in Thailand in both public and private health service sectors. LPI was developed and used extensively in the US, Australia, New Zealand and Canada to enable the monitoring of labor cost in the healthcare market and planning wage policies in public and private sectors. However, LPI is new and has not been comprehensively studied and developed in Thailand. Physician compensation in this study included salaries and benefit or welfare. The total physician compensation in public and private hospitals was estimated from the annual budget and the survey by the National Statistical Office (NSO). The weight was calculated by the ratio of share for labor expenditure in a base year. The LPIs of 2008 to 2011 were calculated. The Laspeyres LPI was used in this study, and LPI of 2010 was defined as the base year. It was found that between 2008 and 2011, the average of physician compensation in private hospitals was higher than public hospitals. On the contrary, the average growth rate of physician compensation in public hospitals was higher than private hospitals. The results showed that the LPI of public hospitals increased approximately 1.5-1.6% annually while the LPI of private hospitals declined approximately 1.4-1.5%. This study recommended that surveys to represent physician populations should be undertaken. Moreover, LPIs for other professional groups such as nurses, dentists, pharmacists, other medical workers working at back offices should also be studied.


This study is a mixed methods research between quantitative and qualitative research focusing on action that aimed to develop a Trang province tobacco control model by using healthy public pol¬icy concept. Purposive sampling was employed to recruit the target groups including: 1) 50 leaders of the central and local government and people sectors, and 2) 120 cigarette sellers and 120 restaurant owners; 240 persons, altogether. The operation comprised two phases: preparation phase and the 5 steps of healthy public policy process phase (as agenda setting, policy formulation, decision-making, policy implementation and policy evaluation). Data were collected by the survey, group discussions, and in-depth interviews, and analyzed by descriptive statistics for quantitative data, and by content and thematic analysis for qualitative data. The results showed that the model of driving public policy to tobacco control of Trang province consisted of 1) provincial network coordination, 2) team estab¬lishment, 3) exploration on the tobacco control awareness of the people, 4) the establishment of tobacco control measures in the province, 5) driving tobacco control measures into practice, as 5.1) measures to understand the law: focusing on the outreach campaign at the provincial and district levels to inform the effects of smoking in all media accessible to the public (such as location-based, radio campaigns, posters and leaflets, and 5.2) non-smoking enforcement measures: starting from government offices and expanding to public areas (such as markets, bus stations, and parks), and 6) performance evaluation. The research found the increases in the perception of non-smoking law enforcement in the restaurant without air condition, hospitals and health care services, other gov¬ernment offices and fresh markets (21.16%, 19.71%, 15.39%, and 15.16%, respectively). The cigarette sellers were more aware of the cigarette/tobacco vending law that selling cigarette to those under 18 years of age is illegal, and displaying cigarettes in the window even without seeing brands also consid-ered advertising (4.11% and 3.7%). The key success factors were identified: 1) having a non-smoking leader (the governor of Trang province himself) 2) having a dedicated and capable team to coordinate the network and 3) having a variety of communication channels. Therefore, the provincial tobacco control model requires strong public communication management to empower network partners to participate in the public policy process and to develop people to be an active citizen and care for the health and well-being of the society.


This study aims to study environmental management in household and community by elderly people and by local administrative organization (LAOs) in rural areas of Thailand, to synthesize model for the environmental management and then to assess the model. Questionnaires with four hundreds elderly people and one hundred local administrative organization and a survey of eight case studies in environmental management for elderly people from local administrative organization were used to gather data. Interviews to experts on elderly people and environmental management were also carried out.Data was analyzed in order to find out model for environmental management for elderly people.
The results showed that LAOs have allocated resources for environmental management for elderly people at high level and provided facilities for elderly people at moderate level. While, LAOs have law enforcement, measures, plans to support environment management for elderly people at moderate level. The influencing factor for enhancing quality of life of elderly people is to be a volunteer.The results from questionnaires of elderly people indicated that municipal waste, natural disasters, floods, droughts, landsides, soil subsidence and storm are major environmental and natural resource problems in community. More than half of the elderly people resemble a residential two-floor detached house, which have bed bathroom, toilet bowl and seat and handrail. There is no device or place for recreation activities for elderly people. According to elderly quality of life, they have problems about uncertain incomes. From the results mentioned above, a manual for environmental management for elderly people in rural areas is composed of 1) energy
management, 2) water management, 3) waste management in households and 4) local wisdom in organic agriculture. The manual was tested to five communities and it was found that LAOs have issued policy in environmental management especially waste management. Assessment of the model for environmental management for elderly people
in rural areas of Thailand by using the manual showed that LAOs in each rural area
have clearly issued in environmental development strategies and have carried out
projects and activities for improving quality of life of elderly people to support environmental management in the community for example the waste bank project,
the municipal waste management campaign project and the increase forest areas in
community project.


Background and significance: Peritoneal dialysis (PD)-related peritonitis is a common serious complication among PD patients leading to technical failure and a significant cause of morbidity, mortality, and healthcare costs. For the treatment of peritoneal dialysis (PD)-relatedperitonitis, intraperitoneal (IP) administration of antimicrobial agents is recommended due to its higher concentrations at the target site and more success compare to intravenous administration. Besides, prevention strategies of PD-related infection are still unclear. This research programs consists of three research topics. Objectives: 1) To (1) systematically review and meta-analyses the effectiveness of different empirical treatment options for PD-related peritonitis and (2) to examine the temporal trends, potential predictors, microbiological pattern with antimicrobial susceptibility rates, treatment patterns, and clinical outcomes of PD-related peritonitis. 2) To (1) systematically review bundles all published stability and compatibility of data on IP administration of antimicrobial agents via PD solutions and (2) to investigate the physical and chemical stability of selected antimicrobial namely: imipenem, meropenem, ertapenem, cefazolin/ceftazidime, and cefoperazone/sulbactam in 6 type of commercial PD solutions with polyvinyl chloride container that available in Thailand (Extraneal®, Dianeal® PD2: 1.36%, 2.27%, and Dianeal® Low calcium: 1.36%, 2.27%, 3.86%) at different temperatures for various time points. 3) To compare effectiveness, safety, and cost-utility of chlorhexidine gluconate (CHG)-soaked cloths to mupirocin ointment and exit site usual care (normal saline) with aseptic technique in prevention of PD-related infection. Conclusions: In contemporary review, evidence of antimicrobial for treatment of PD-related peritonitis is limited. No specific antimicrobial in terms of route, dose, schedules, and optimal antimicrobial agent or regimen appear to have superior efficacy for treatment of PD-related peritonitis. There was a downward trend in PD-related peritonitis incidence over this past 10 years to 0.39 episode per patient-years. Causative organisms for peritonitis of gram positive bacteria decreased, but gram negative bacteria increased over time. In daily practice, a combination of cefazolin and ceftazidime is suitable for mixed with icodextrin-based and glucose-based PD solutions at least 24 hours at body temperature. Carbapenems group appear insuitable for IP administration. Likewise, to concern the degradation products, a combination of cefoperazone with sulbactam should not be mixed with PD solutions. In addition, the study to compare effectiveness, safety, and cost-utility of chlorhexidine gluconate (CHG)-soaked cloths to mupirocin ointment and exit site usual care (normal saline) with aseptic technique in prevention of PD-related infection is ongoing to the second year.


Background: ADHD is the most prevalent brain disorder in children in elementary school
compared with other diseases that interferes functions and development. Integrated care
among parents, teachers, and healthcare providers might improve positive behaviors and
increase chances to succeed in academic performances. Objectives: 1) To develop and test parent training curriculum and manuals to screen and provide behavioral adjustment for children with ADHD symptoms; 2) To develop and test elementary school teacher training curriculum and manuals on screening and classroom adjustment for children with ADHD symptoms; and 3) Draft an integrated care model among parents, teacher, and healthcare providers for children with ADHD symptoms. Methods: We applied one-group pre-post test design to test knowledge and attitudes of parents and teachers before and after the training based on the curriculum and manuals. Subjects were 1) parents of children age 6-7 years, studying in elementary school level, and agreed to participate in this study, and 2) elementary school teachers who are willing to participate in this study. Both groups of subjects were recruited from 2 elementary schools in Chiang Mai Province and 1 in Lamphun Province, Thailand. Parents were trained based on the curriculum and manuals for 2 days. Elementary school teachers were trained by the teacher specialized in children with special needs for 2 days based on the curriculum and manuals. Knowledge and attitudes towards children with ADHD symptoms and behavioral adjustment were assessed before and after using questionnaires developed for this study. Feasibility data of behavioral adjustment by parents was collected using focus group interview after 1 month. Teacher skills on behavioral and classroom adjustment were assessed using self-report on report form after 1 month. Results: We trained 78 parents. Most parents were female, age of 30-39 years, married, twothird were high school or college educated, and 37.2% had no experience in caring children with ADHD symptoms. Most parents relied on books or websites to search for information about ADHD. After training, parent’s knowledge and attitudes improved significantly on children with ADHD and behavioral adjustment (p<0.01). From focus group interview, parents reported of feasible use of behavioral adjustment techniques at home, mostly time management and emotional control techniques. We trained 144 elementary school teachers on ADHD screening and behavioral/classroom adjustment. Most teachers were female; half of them were 50-59 years of age; two-third had experience in caring children with ADHD symptoms for 1-5 years. Knowledge and attitudes of teachers on ADHD symptoms, behavioral adjustment, classroom adjustment, and ADHD medication treatment increased significantly after the training (p<0.01). After 1 month of follow-up, 32 teachers reported the skills and practices that they encouraged parents to screen and monitor the symptoms, using SNAP-IV and behavioral adjustment by at home. In case on children with ADHD symptoms were assessed, teachers encouraged parents to take the child to see the doctor. Teachers reported of positive feedback from parents after the interventions. This study also drafted an ADHD integrated care model using healthcare providers at primary or secondary care settings as center of referral and monitoring with the ADHD Refer database systems to assist the referral and monitoring along with parents and teachers. Conclusion: The ADHD children screening and behavioral adjustment for parents and the ADHD children screening and behavioral/classroom adjustment for elementary school teachers significantly improved knowledge and attitudes of both groups on children with ADHD symptoms and behavioral adjustment. Behavioral adjustment techniques provided in both curriculum and manuals were feasible to practice at home and at schools. Test of the proposed integrated care model should be further conducted.


Childhood is an important age for growth and continuing development. A child is more
likely to reach their full potential if they recieved adequate care. The care giver has a crucial role in raising, delveloping and making sure the child receives adequate care and health supervision to enable the child to be healthy so that they become our country's future asset . Mobile applications are becoming more popular with increase usage at affordable prices. We developed a mobile application (KhunLook Mobile Application) as a platform for parents, caregivers and health care providers. It can keep health and immunization records, eases basic child health supervision assessment, developmental screening and enables notifications. It contains health supervision and anticipatory guidance information from creditable sources made readily accessible to its users in Thai language. The information can be accessed from smartphones, tablets or computers and supports numerous and a wide range of users. It also has a back up feature and can be easily updated when health care information and child health supervision guidelines are revised KhunLook Mobile Application is easy to use and enables parents to initially assess their child’s health parameters. It is distinctive for it’s mobile and back-up features; it supports up to date health care knowledge and is scalable. There was no statistically significant difference between the agreement of parent-physician assessment of their child’s health status by using KhunLook Mobile Application or the Maternal and Child Book. KhunLook Mobile Application received higher overall scores than the Maternal and Child Book; the difference was statistically significant in all subject groups. KhunLook Mobile Application benefits parents, caregivers and health care professionals. For maximal potential it should be ongoing studies, it should be endorsed and supported for more user coverage and sustainable future development.


The second year of Healthcare Healing Environment Design project (HHED) focus on the implementation of the HHED’s Assessment tool on the 17 project member hospitals along with the environmental improvement according to the assessment tool and selecting an area or a building to improve to be a model of HHED and also develop a related research topic according to HHED concept, finally, evaluating users experience from the improvement of the physical environment in order to create academics reference and development of Thai healthcare system.  The reflection from the users on the visiting of 17 member hospitals on healthcare healing environment problem, we found problems in 2 dimensions, firstly, for the infrastructure, it is lack of functional using area, secondly is the poor environmental quality that impact work performance and user’s well-being such as heat, poor air quality, bad ventilation which cause staffs’ infection as well as the exceeded standard of carbon dioxide quantity, too many sources of noise that reduce the efficacy of staffs’ productivities, lighting with both not enough light cause the medical errors and the reflection of glare light.  From research team’s perspectives, besides those 2 dimensions of problems, we found that there are too many poor-quality media installed on the visual field that increase stress for the user such as direction signposts, room name/ department name those are too diversity and not in a unity format. Sometimes it cause confusion or even straying. While producing various media to communicate to the users, for example, the service instructions, Patients’ terms of service, etc. These badges do not work in practical, the staff still have to answer the same questions which appearing on those badges there is also a large amount of health education media board that is not designed to be interesting. On the contrary, the user refuses to consume the medical education information provided by the hospital because there is too much details that users cannot remember and apply in daily life.  From such problems, there is a key issue in selection areas/ department/ buildings as the hospital selected pilot areas for the development of environmental quality that will be caped as healing environment. It is still in the process of collecting evidence of the problem to improve physical environment and the central research team will assist on designing the area according to the context. After the improvements, the research team will collecting data to evaluate user experience according to the improvements that is in the research processes of the third-year of the research project based on user experiences from 5 aspects from the HHED assessment tools which are: 1) Function and safety, 2) Sensing and comfort, 3) Interaction and support, 4) Empowerment and informed choice, and 5) Value and spirituality.


An attempt to expand health insurance to cover ‘everybody’ on the Thai soil has been
implemented for years, as evidenced in the Vision of the National Health Security Office (NHSO) and the Border Health Plan of the Ministry of Public Health (MOPH). One of the issues that have caught political attention is a continuing growth in the volume of migrant children born in Thailand. However, the number of migrant children, who have been enrolled in the public insurance is quite limited. Such a situation creates a concern as to whether these migrant children received adequate immunization. This point also links to a risk of emerging and reemerging diseases that cause public health threats. Therefore, the objectives of this study are (1) to draw lessons from international experiences in managing health promotion and disease prevention services for migrant children, (2) to explore the current situation in managing health promotion and disease prevention services for migrant children in Thailand in terms of pros, cons, and challenges from the perspectives of policy makers, local implementers, and service users, and (3) to estimate budget impact for supporting vaccination program for migrant children in Thailand. The researchers applied parallel mixed methods design. Objective 1 employed narrative literature review approach as the main data collection tool. The majority of literature was retrieved from grey literature databases in the European Union. Objective 2 used in-depth interviews with policy makers, local implementers, and service users. Objective 3 applied quantitative analysis on secondary data (43 standard folders of the MOPH). Fieldwork was conducted in 4 provinces where migrants are concentrated.  This study still faces some limitations as follows. Firstly, a narrative literature review is more prone to bias than a systematic review. This is because the narrative literature review lacks rigorous quality screening process on the selected articles. Secondly, the interviews in Objective 2 involved a small number of participants, and other qualitative data-collection techniues, such as participant observation, were not extensively exercised. Moreover, it is difficult to blind the interviewees to the professional status and workplace of the researchers. These factors more or less affected the validity of the interviewed information. Thirdly, the study involved only 4 provinces. Thus generalization ability of the findings is quite limited. Lastly, the calculation in Objective 3 relies on many presumptions. Some postulations used fingures or numbers from previous studies that were conducted long ago, and the analysis was confined to material cost only. Hence, if the findings in this study are to be used for policy advocacy, there should be a process that allows all stakeholders to discuss and agree on the assumptions since the beginning, before delving into the calculation. Besides more updated figures should be used as references and the calculation should include other incurred costs (such as administrative cost and labour cost).


This Mixed-method research design aimed to evaluate Motivational Interviewing utilization on health behavior changes in chronic non-communicable disease patients at regional health 2, during May 2016 to April 2017. The explanatory design was performed with consisted of two phases. The first phrase was quantitative data collection by surveying the use of MI techniques to alter health behavior. There were 579 health care units in 5 provinces including Uttaradit, Phitsanulok, Tak, Sukhothai and Phetchabun provinces. Moreover, MI competence was also evaluated in this period. Four hundred and thirty personnel who using MI technique were purposive sampled. The second phrase was qualitative data collection following CIPP model evaluation. Health care unit visiting
was conducted in five provinces; focus group and in-depth interview were performed in 380 staffs. Ten health care units were purposing selected with five units achieved versus not achieved goals. The in-depth interviewees in each unit were 3-5 persons including administrator and personnel responsible for health behavior change and used MI technique. Five research tools were developed by researcher team, that were questionnaires including MI service survey, MI performance evaluation, MI competence evaluation, In-depth interview question and MI using outcome record. Determination the reliability of MI performance evaluation and MI competence evaluation questionnaires by alpha coefficients that were 0.97 and 0.99, respectively. The quantitative data were analyzed by percentage, mean, standard deviation, Chi-square, Pearson Product Moment
Correlation and Multiple regression analysis. Content analysis was also used for qualitative data and verify correctness by reflecting the summary data to personnel to agree on the correctness. The results were as follows. 1. The MI techniques utilization to modify health behavior was collected from 579 health care units. Numbers of diabetes and hypertension patients in their responsibilities were 112,867 and 238,607 respectively. They were 47,316 (41.9%) of diabetes patients and 91,636 (38.4%) of hypertension patients that received behavior change. 73.2% of health care units were using MI technique for behavior change. The average length of MI was 1.18 years. The personnel were trained to improve MI skill with 1,529, but only 686 people used MI technique (44.9%). They were 293 of MI mentor or counselor. Moreover, community volunteers (VHV.) were also trained to develop MI skills (13,363). The amount of overall budget was 1,583,826 baths for MI support in all 5 provinces. 2. The overall MI performance was at low level (Mean 2.30, SD 1.1). The overall MI adherence was considered at moderate level (Mean 2.27, SD 1.3). The overall MI competence was at novice level (Mean 1.71, SD 1.1). The important thing, advanced and expert competence level were indicated 3.8 % and 1.2 %, respectively. MI competence of personnel from different province was different statistically significant at 0.001, however, different types of health care units and staff positions were not significantly different (p>0.05). Personal factors, MI skill training factors and MI using experience factors were significantly correlated with MI competence (p <0.001). The MI performance factor was correlated with MI competence at medium level statistically significant (r=0.654, p <0.001). Interestingly, MI adherence was associated with a high level of MI competence
statistically significance (r=0.767, p <0.001). Factors that could predict the MI competence statistically significant (p <0.001) including, MI Adherence (b=0.493), MI using performance (b=0.346), MI skill training (b=0.187) and duration of work time (b=0.007). Consequently, all factors were cooperatively predict MI competence at 67.0 percents (r2 = 0.67).  3. Consideration an outcome of MI implementation for altering health behavior in chronic non-communicable diseases, 412 (71.2%) and 399 (38.8%) of health care units were using MI in diabetes and hypertension group respectively. 34,101 of diabetes group received MI technique for behavior change, with 13,994 persons (41.0%) were achieving goals. In 2016 period outcome, people at the risk of diabetes were achievement higher than those with diabetes patients. It was found that the percentage of patients with glycemic control were 49.1% and 69.1%, respectively. The percentages of Hb1Ac below 6.5% were 43.0% and 69.6%, respectively. Behaviors changes were also detected at 56.1% and 70.7% respectively. Furthermore, 62,725 persons of hypertensive group received MI technique for behavior change, and 34,665 people (55.3%) achieved the goals. In 2016 period outcome, people at the risk of hypertension achieved goals the same as those with hypertension patients. The percentages of blood pressure control were 63.4% and 67% respectively. Behaviors changes were also indicated at 67.0% and 71.6%, respectively. 4. The results of qualitative data that evaluation using the MI technique based on the CIPP Concept Framework Model. Policy and Indicators, it founded that regional health 2 had announced a policy; however, personnel perception did not cover all areas. The policy was appropriate to be practical. Four types of MI techniques were conducted including: 1) No clear pattern, 2) 7-colors ping pong, 3) Clinical setting and 4) Particular project. Health care units were supported not only administrators but also budget. However, in all areas lack of information systems for MI tracking and evaluation. MI data were recorded through Excel, HosXp and JHCIS formats. Remarkably, factors and barriers to using MI techniques were including lack of budget support, personnel have a lot of workload, lack of MI skills and experience, lack of MI learning and share and service recipients do not cooperate. Therefore, requirement to encourage support are including: 1) Regional health 2 defined as the main MI policy; 2) Construct pattern of using MI
techniques; 3) the development of MI skills; 4) Consultant team; 5) Provide manuals and tools for MI operation. 6) Support staffing, 7) Motivation support and 8) Support operating budget. Notably, the patterns and factors supporting that different between achieve versus not achieve MI goals health care unit, in conclusion, that administrators should be promote including Inner inspiration, MI commitment, Relationship, Self study learning, MI home visit, and MI Dynamic improvement.


Background: End stage renal disease (ESRD) affects the quality of life and causes the high cost in health care system. The prevention of ESRD is the early recognition and appropriate treatment. Glomerulonephritis is the third most common cause of ESRD in Thailand. Thai Glomerular Disease Collaborative Network (TGCN) was established to evaluate the epidemiology and clinical outcomes in the glomerular diseases and helped to promote the good system to taking care of these patients. Methods: TGCN originally consists of 9 tertiary care centers and expands to 20 hospitals. We conducted a prospective cohort study in the adults’ native kidney biopsy proven glomerular diseases between July 2014 and Mar 2017. The clinical and laboratory parameters at the time of biopsy, pathologic findings, treatment regimens and clinical outcomes were recorded via on-line registry. Results: We recruited 1,556 patients performed native kidney biopsy during Jul 1, 2014 to Mar, 2017. The female to male ratio was 1.88:1. The average age, creatinine, albumin, and cholesterol were 43.4+16 years, 2.11+19 mg/dL, 2.9+0.8 g/dL, and 294+131 mg/dL in respectively. The median proteinuria was 3.7 (0.02-25.3) g/day. The patients presented with 40% of nephrotic syndrome, 21.7% of nephritis, 19.4% of nephrotic nephritis, and 60.8% of renal impairment (creatinine>1.2 mg/dL). The renal pathological findings showed 33.9% of LN, 13.5% of IgAN, 10.5% of FSGS, 7.4% of minimal change disease(MCD), and 7.1% of membranous nephropathy (MN). The mean age of LN, IgAN, FSGS, MCD, and MN were 34.9, 39.4, 47.7, 46.5 and 52.6 years. The median creatinine at biopsy of LN, IgAN, FSGS, MCD, and MN were 1.08, 1.76, 1.65, 1.02 and 0.98 mg/dL. Conclusion: Our study described the common renal pathological findings including LN, IgAN, FSGS, MCD, and MN. The clinical outcomes and prognosis of these diseases were described in the complete report. In the second year, we have performed the recommendation for management in glomerular disease, FSGS and MCD in adult Thai patients.


This research aims to 1) propel the handicapped elderly care in the community to
receive rehabilitation properly. 2.) developments in public health volunteers, a case
manager in the care of older people with disabilities in the community effectively 3) Create
a list of cases of people with disabilities. The cooperative research (PAR) of the research
team with the Nakean community in Nakhon-si-thammarat province using the AIC technique, which has the creation of knowledge, development guidelines, practice and evaluation. The sample are 32 village health volunteers who jointly take care of 50 elderly people with disabilities in the community. The data were collected using pre-post test. Data analysis by content analysis, mean and percentages. The study found that: The management pattern can be summarized as follows: 1) sub-district health promotion hospital explore elderly with disabilities 2) Clarify the role of case manager with public health volunteers. 3) Training course “Capacity Building of Community Volunteers to be Case Manager of Community Dwelling Elderly with Disabilities.” 4) Organize teams to take care of elderly with disabilities people in the community. 5) Record visit and sent to sub-district health promotion hospitals every month. 6) Sub-district health promotion hospitals monitor the performance of public health volunteers 7) coordinate with external agencies involved in helping and caring for the elderly disabled. Public health volunteers are trained in both theoretical and practical subjects pass 100 percent. After the training they have increased in all aspects. In terms of basic knowledge on the rights of elderly with disabilities people (97.34%), knowledge on health assessment and screening (95.78%). Thus The Department of Health Service ,Support Local administration and Subdistrict Health Promotion Hospital should a role in the health of people in the area. Especially bedside patients and should provide services that facilitate access to older with disabilities people. And should provide training for public health volunteers.


Development of data visualization system for the National Health Examination Survey data on the internet is a data presentation platform in addition to traditinal survey report. Users of the system can access via the internet and can select data and related variables for comparision as well as compare data over time between survey rounds. The National Health Examination Survey data used in this system consists of 3 rounds including the 3rd round in 2004, the 4th round in 2009 and the 5th round in 2014. This data visualization system presents 17 groups and 63 lists of outcome data. There are 3 types of outcome data consisting of proportion, multinomial proportion and mean. Data analysis for preparing data to be used in data visualization system is pre-calculated data from individual survey data for each survey round. It is a semi-automated process using ready-to-use command scripts that create summary tables to be further imported into the data visualization system. The design and development of data visualization system focuses on the flexibility of data selection and variables selection for disaggregation that can be 1 variable or 2 variables for presenting one particular round of survey data or one variable for presenting overtime comparison across 2 or 3 survey rounds. The variables for disagregation consist of sex, age group, region and administrative type of area. The data presentation is in form of bar chart for proportion and mean while stack bar chart is used for multinomial proportion. Graphs created by the system can be exported into image file, document file and spreadsheet file (Excel) for futher use in other platform. The system also provides the number of samples for each data disaggregated by selected variables for further use and reference. The aspect and use of data can be various such as indicating target population and area for each health problem, indicating distribution of severity of selected health problem and indicating trend of health problems over time. The access and use of the system covers general users as well as specific technical users related to specific health topics or health systems. Data presented in the system can be extended to further health movement and relevant policy recommendation. For system maintenance and updating of survey data in the future, the system allows modification and addition of new data by adjusting reference table and variables. The command script for preparing and analyzing data is semi-automated process creating new summary data for importing into data visualization system on the internet without need for development of new system.


The Thailand Antimicrobial Resistance (AMR) Containment and Prevention Program, utilizing a One Health approach, has been implementing the following 10 operational actions in accordance with the World Health Organization (WHO) global action plan on AMR since 2013. They are: 1) estimate the national AMR burden; 2) determine the AMR prevalence and AMR chain in Thailand; 3) develop a national AMR containment and prevention governance structure; 4) develop laboratory and information technology systems for surveillance of AMR, antibiotic use and hospital-acquired infections; 5) regulate the use and distribution of antibiotics in humans and food animals; 6) design AMR containment and prevention campaigns; 7) generate local evidence to promote responsible antibiotic use and infection prevention and control practices; 8) create the AMR campaign packages; 9) implement the AMR campaign packages in selected communities; and 10) conduct research and development of AMR surveillance, diagnostics, and therapy and prevention of AMR infections. The major outputs, outcomes and impacts of the Thailand AMR program are: the magnitude of the AMR burden in Thailand was established; AMR campaign packages for health professionals and laypeople were developed according
to the established AMR chain and AMR prevalence in Thailand; and locally-generated evidence on the responsible use of antibiotics and infection prevention and control (IPC) is available. Implementation of AMR campaign packages in 4 pilot communities revealed their effectiveness in terms of improved awareness and understanding of AMR, responsible use of antibiotics, and compliance with IPC practices. Many containment and prevention measures from the Thailand AMR program have been adopted as national policy and implemented nationally.


Irrational use of antimicrobials is a major problem that leads to antimicrobial resistance. Examining patterns and amounts of antibacterials prescribed from health facilities is one strategy to monitor antimicrobial use. Method: This study employed claims data of the National Health Security Office and pharmaceutical manufacture and imports of the Food and Drug Administration in 2013 to calculate amounts and costs of antibacterials prescribed in outpatient departments. Findings: The total amount of antibacterials prescribed to outpatients in 2013 was 117.3 million defined daily doses or 7.1 DDDs per 1,000 population per day. Prescriptions with antibacterial agents accounted for 19% of all outpatient prescriptions. Amoxicilin was prescribed the most at the amount 58.7 million DDDs and costed 215 million Baht. Health centres were the main prescribers using 52% of the overall antibacterial use. Mae Hong Son, Ayutthaya, Samut Songkhram and Phatthalung were found to have high proportions of prescribed antibacterials. Conclusion: Monitoring antibacterial uses should be integrated in the national drug surveillance in addition to the normal reporting system of pharmaceutical manufacture and imports.


This quasi-experimental research aimed to determine effects of campaign using change agent team and mass media for promotion of Antibiotic Smart Use (ASU) concept and new social norm towards ASU. A correlation between social norm and ASU behaviors was also examined. The sample was 624 subjects, 348 were assigned to the intervention group, and 276 to the control group. The interintervention group was implemented with a campaign using change agent team and mass media aimed at promotion of ASU concept and new social norm. Paired t-test was used to compare social norm and ASU behaviors between baseline data and after the campaign implementation. An independent t-test was used to compare those between the intervention and control groups. Results at the end of the campaign implementation demonstrated that social norm in the intervention group was significantly higher than the baseline data, but no significant difference in social norm was found between the intervention and control groups. With regard to ASU behaviors, there was significant improvement in ASU behaviors after the campaign implementation in the intervention group. A Significant difference was also found for ASU behaviors between the intervention and control groups after the campaign implementation. In addition, this study demonstrated that changes in social norm towards ASU were significantly correlated with changes in ASU behavior.


Antibiotics Smart Use (ASU) was introduced in 2007 by Thai Food and Drug Administration. Its goal was to create new social norm on rational use of antibiotics in Thailand. Qualitative research was used to investigate factors for sustainability of the ASU. Semi-structured interviews were conducted with 39 key informants (30 projects, 18 provinces) between January 21 and March 28, 2013 (2 months). Content analysis was used. The key informants were purposively selected from health care professionals who experienced the ASU as a coordinator, supporter, promoter and driver at least one year.
Results show that key factors that affect the start up of ASU and sustainability in the organizations include policy support, institutionalization, leadership support, staff involvement, partnership, community participation, public behavior on antibiotics use, and program monitoring and evaluation. These findings will be useful for decision makers, program managers and program evaluators for driving the ASU to achieve the goal.


Background: Contact investigation (CI) reduces tuberculosis (TB) burden. Yet, implementing CI is still low. One of CI Barriers is health workers’ knowledge and attitude about TB. Design/Methods: Mixed-methods. A focus group discussion with doctors and nurses who had TB was conducted. A self-administered questionnaire was distributed to 60 doctors and 178 nurses. The questionnaire measured TB knowledge, stigma and CI practice. A stepwise multiple regression analysis was employed. Results: Response rate was 100%. Almost 20% of doctors and about 14% of nurses prefer a job without exposure to TB patients. Female doctors practiced CI 2.07 scores more than male doctors (95%CI 0.21, 3.92). The internists and the pediatricians had less CI scores than the resident doctors, respectively, 3.82 scores (95%CI -6.04, -1.60) and 0.17 scores (95%CI -2.51, 2.17). For nurses, an additional one year working experience increased 0.09 CI scores (95%CI 0.01, 0.17). Nurses obtaining TB training had 2.52 CI scores more than nurses without training (95%CI 0.99, 4.05). All household contacts of doctors and nurses having TB received TB screening. But contacts at the workplace (colleagues and patients) were not systematically investigated. Conclusions: TB training may increase CI practice in nurses. Annual health check for doctors and nurses should be reinforced. When doctors and nurses have TB, their contacts in the workplaces (co-workers and patients) should receive CI.


Transmission of tuberculosis (TB) has a negative impact on patients, personnel and hospitals.
This descriptive study aimed to determine implementation, obstacles and supporting needs of Thai
hospitals in preventing TB transmission. Data were collected by using self-administered questionnaire
developed by the researchers from the Guidelines for Preventing the Transmission of Mycobacterium
tuberculosis in Health-Care Settings 2005 of the US Centers for Disease Control and Prevention.
The questionnaire was sent to an infection control nurse of 524 hospitals, including 93 regional and
general government hospitals, 316 community hospitals randomly selected from 45% of all community
government hospitals, 8 university government hospitals, 33 other government hospitals and 74
private hospitals randomly selected from 111 private hospitals with 100 beds and more in all regions
of the country. The study was conducted during May to September 2009. The response rate was
72.5%.
The study results revealed that 93.6%, 73.9% and 47.3% of hospitals have implemented
measures of respiratory tract disease prevention, administrative controls, and environmental controls,
respectively. The most important obstacle in preventing TB transmission in hospitals was an
insufficient number of isolation rooms (80.2%), other obstacles were having an inappropriate area to
conduct the physical examination for TB patients (51.8%) and insufficient time for screening suspected
TB patients (50.2%). Most hospitals needed technical support for their ventilation system (86.3%),
training for personnel in charge of TB patients (76.8%), guidelines for preventing TB transmission in
hospitals (71.3%), guidelines for screening TB patients in the outpatient department (69.7%) and
screening forms for TB patients (60.2%).
Relevant organization should provide guidelines for preventing TB transmission, including guideline
for educating hospital personnel on caring for TB patients and preventing TB transmission for
every hospital and support expert consultation on hospital environment, especially ventilation
system, so that the hospitals can prevent TB transmission efficiently.


Burkholderia pseudomallei is a causative agent of melioidosis. Ceftazidime is a drug of choice
for treatment of this infection but the mortality rate is high in some endemic areas. This study investigates
the effectiveness of antibiotics by an in vitro antimicrobial susceptibility test. A total of
1,340 B. pseudomallei samples were isolated from patients admitted to Sappasitthiprasong Hospital,
Sisaket Hospital, and Amnatcharoen Hospital between January 2013 and February 2015. Antimicrobial
susceptibility of B. pseudomallei were evaluated by the standard disk diffusion test and to determine
minimum inhibitory concentration (MIC). Ceftazidime, imipenem, trimethoprim+sulfamethoxazole,
and ciprofloxacin were used as antimicrobial agents for the standard disk diffusion test, and MIC was
determined for ceftazidime, imipenem, and trimethoprim+sulfamethoxazole. Bacteria strains were
randomly selected for conventional polymerase chain reaction (PCR) followed by gel electrophoresis
analysis for penA and oxa gene.
Results demonstrated that all the antimicrobial agents were effective against B. pseudomallei.
Trimethoprim+sulfamethoxazole was 100% effective, and ceftazidime and imipenem were 98.36%
and 99.10% effective respectively. Ceftazidime MIC was 0.25 to ≥32 mg/ml and imipenem MIC was ≤0.5
to 16 mg/ml. It was found that 1.27% of B. pseudomallei was resistant to ceftazidime and 0.37% was
resistant to imipenem. All random samples found oxa gene but not penA gene.
It was concluded that all antimicrobial agents tested effective. Ceftazidime and imipenem were
bactericidal drugs of choice for melioidosis treatment. The bacteriostatic agent for B. pseudomallei
was trimethoprim+sulfamethoxazole. Although, the activity of the antimicrobial agents was effective
in vitro, early diagnostic and prompt clinical treatment to which drugs be administered intravenously
still urgently needed.


Antimicrobial resistance (AMR) is one of the most serious health threats worldwide, including Thailand. It has been estimated that failing to tackle AMR will result in up to 10 million deaths a year, a 3.8% decrease in Gross Domestic Product (GDP) and the world economy losses of US$100 trillion by 2050. Irrational drug use is a major cause of AMR and the factor associated with irrational use of drugs includes incorrect and inappropriate use of medicines. In addition, Thailand has developed the National Strategic Plan on Antimicrobial Resistance 2017-2021 (NSP-AMR). One of the five goals of NSPAMR is to increase 20% of public knowledge and awareness on control of AMR bacteria and appropriate use of antimicrobials. In order to monitor public awareness on AMR (Goal 4), it is important to design method to obtain baseline data to benchmark changes after the NSP-AMR implementation. National Statistical Office (NSO) has conducted the biannual Health and Welfare Survey (HWS) and the most current was in 2017 to incorporate the AMR module, a modified version of the Eurobarometer 445 reviewed by International Health Policy Program (IHPP) under Thailand’s Ministry of Public Health (MOPH). The key indicators such as knowledge about antibiotics, exposures to message on AMR and rational use of antibiotics would be generated. The integration of AMR module into HWS 2017 was achieved because of the rising concern on AMR at global and national level, linkage to NSP goals and the cooperation between NSO and IHPP, in order to generate baseline data among the population in Thailand. This would contribute to the monitoring of progress on the goal of NSP-AMR.


Introduction: Zika virus infection and its consequences have become increasingly concerned
recently. As a member of Flaviviruses, zika virus shares some clinical dengue fever manifestations. The
actual burden of zika virus infection in Thailand is unclear, and could be underestimated due to nonspecific
clinical pictures and the diagnostic testing has not been routinely available. We aim to study
the zika incidence among the suspected dengue fever patients. Methodology: From December 2016
to August 2017, adult and children who had clinical diagnosis of dengue fever at Bamrasnaradura Infectious
Diseases Institute were prospectively enrolled. After informed consent, a urine sample would
be collected for zika molecular testing by polymerase chain reaction (PCR). At 2 weeks later, a blood
sample was collected for zika and dengue serologic tests by ELISA. Results: A total of 73 suspected
dengue fever patients were enrolled; 64 were hospitalized, 46 cases were children (< 15 years of age).
The ratio of children to adult was 1.7:1. There were 3 confirmed zika-infected cases by urine PCR, a
4.1% incidence. All were adult treated as outpatients. The cases were found during June–August. All 3
cases had positive anti zika IgG (mean titer of 4.43 unit, range: 2.6-6.9 unit), but anti-zika IgM was found
to be positive (titer 2.9 unit), indeterminate (titer 0.9 unit) and negative (0.4 unit), one case each. All
had negative anti-dengue IgG or IgM titer. Conclusions: The patients presented with dengue fever may
actually had zika infection, although at low rate. The anti-zika IgM was not useful in making diagnosis.
High risk group such as pregnant women who presented with dengue fever should be tested for zika
infection.


Humans and companion dogs have directly been in close contacts which may pose an important
risk of transmitting pathogens and infections. The domestic animals may contribute to antimicrobial
resistance problem because antimicrobial resistant bacteria and antimicrobial resistant genes were increasingly
found in pets. Thus, the aim of this study was to survey fecal carriage of antimicrobial resistant
bacteria in dogs resided in the central region of Thailand. The rectal swabs were taken from 100 apparently
healthy dogs (50 stray dogs and 50 household dogs) for bacterial cultures and antibiotic susceptibility
testing. The results revealed that an overall prevalence of extended-spectrum beta-lactamase (ESBL)-
producing Enterobacteriaceae in dogs was 35%. ESBL-producing Enterobacteriaceae in fecal carriage
in the stray dog samples (62%) was significantly more than the household dog samples (8%), (p<0.001).
Methicillin-resistant Staphylococcus aureus was also isolated from a household dog. Escherichia coli
isolated from the household dogs tended to be more resistant to some antibiotics than those from the
stray dogs. These observations imply that the dogs resided in the central region of Thailand are also the
reservoir of antimicrobial resistant bacteria.


This study has been conducted under the Thai Surveillance of Antimicrobial Consumption which
is an official partnership program between Department of Agriculture (DOA), Department of Livestock
Development (DLD), Department of Fishery (DOF), Food and Drug Administration (FDA), Department
of Medical Sciences (DMSC), International Health Policy Program (IHPP), Ministry of Public Health, and
Kasetsart University. The study aims to (1) review measures used to control antimicrobial use in plant
agriculture in developed countries including registration of antimicrobials for plants, list of approved
antimicrobials for plants, relevant authority agencies, regulations, and surveillance system for antimicrobial
use in plants, and (2) to explain the current situation in Thailand regarding the control of
antimicrobial use in plants. The results of this study can contribute to the development of effective
surveillance system for antimicrobial consumption in plants and all living things.
In the United States, the U.S. Environmental Protection Agency (U.S.EPA) has approved three
antimicrobials for using in plants, namely streptomycin, oxytetracycline, and kasugamycin. In addition,
there is the national program under the United States Department of Agriculture (USDA) that
takes part in the surveillance of antimicrobial use in plants. In Thailand, antimicrobials are used to
control plant diseases caused by bacterial infection, for example, Greening or Huanglongbing disease
in mandarins. Since there is no antimicrobial registered for plant agriculture, farmers then used the
antimicrobials registered for human use on plant. So far, the attempt to control and monitor antimicrobial
consumption in Thailand is limited to certain some antimicrobials for human use. There is
neither surveillance system for antimicrobial use in plants nor development plan to increase capacity of
relevant personnel and laboratories in order to detect residual antimicrobials and antimicrobial
resistant bacteria contaminated in the environment. Hence, the development of the surveillance
system for antimicrobial use in plants and capacity building for personnel and laboratories are the
important areas for further studies in order to control environmental contamination from antimicrobials.


Antimicrobial resistance (AMR) is one of the most serious health threats worldwide and it has
become more intense to day-to-day concerns. Excessive and inappropriate uses of antimicrobial are
main drivers of the emergence of resistant bacterial strains. To optimize use of antimicrobial agents in
human and animal, as recommended by the Global Action Plan on AMR, countries need to develop
and sustain the system which monitors antimicrobial consumption in human and animal and disseminate
for policy decision. Hence, national surveillance of antimicrobial consumption is an important
tool to provide these useful evidences to policy makers and relevant AMR agencies on antimicrobial
consumption in humans and animals and its distribution at the national level.
The objective of this paper is to review surveillance systems of antimicrobial consumption in
European countries and to explore the possibility of establishment of the Thai Surveillance of Antimicrobial
Consumption (Thai-SAC) in humans and animals. Developed countries, including European
countries have institutionalized capacities to sustain SAC system and ensure policy uses. In Thailand,
with the application of experiences and guidelines from the European SAC and European Surveillance
of Veterinary Antimicrobial Consumption, the national SAC covering human and animal sector
consumptions are in development process by the Thai working group consisting of multi-sectoral,
multi-disciplinary researchers and key stakeholders particularly the Thai Food and Drug Administration.
In human sector, the current estimate of human medicine consumption including antibiotics in
monetary value does not provide data on the volume of consumption hence unable to monitor the
use of antibiotics and benchmark with other countries in particular European countries. The challenges
for Thai-SAC include law and enforcement on antimicrobial regulation, and the relevant database of
antimicrobial consumption in human and animal populations in Thailand.


The scoping review found no published research in the past decade that was focused on tuberculosis
surveillance in migrant labors in Thailand. The review data comparing the number of tuberculosis
patients in Thailand from three sources: the World Health Organization and two of the Ministry of
Public Health - the Permanent Secretary Office’s Information and Communication Technology Center
and the Department of Disease Control’s Bureau of Tuberculosis; indicated large disparities in terms
of both the number of migrant labors and the number of migrant labor tuberculosis cases in Thailand.
The chest X-ray screening for tuberculosis in migrant labors used by the Department of Employment of Thailand was in accordance with the tuberculosis screening guidelines of most Western and Asian
countries such as Singapore and Taiwan. The difference of tuberculosis screening processes was that
Western nations usually required pre-arrival screening from the country of origin of immigrants. Meanwhile,
migrant labors entered Thailand’s territory before any tuberculosis screening had been done.
The screening was then done after labor registration which might hinder the tuberculosis screening
process in the country. Singapore and Taiwan implemented time limits as to when the tuberculosis
screening would have to take place for migrant workers after arrival. The other countries also
screened to identify latent tuberculosis in vulnerable and high-risk groups. Major barriers of tuberculosis
monitoring in migrant labors in Thailand were the frequent relocating of labors and changes of
employment that made it difficult for the authorities to screen, monitor and treat tuberculosis in this
population as well as impeded the tuberculosis control efforts of public health agencies. The search
and review of information identified opportunities for improving tuberculosis management by enhancing
the efficiency of the tuberculosis surveillance in migrant labors in terms of coverage and quality
of health data.


This research is a participatory action research study which aims to (1) develop a health
service network for elderly people in home-bound and bed-bound groups while the
involvement of 3 main community parties (health service providers, social service providers,
community/local service providers) was considered, and (2) develop information technology
systems regarding home-bound and bed-bound elderly information to meet the needs of any
use. Data were collected using quantitative and qualitative methods from persons and parties
involved in the care of dependent elderly people in the communities of Hong Ha (Moo 1, 6, 7,
and 8, Nam Cho Sub-district, Mae Tha District, Lampang Province). Involved persons and parties
were (1) 62 elderly people with dependency and 62 relative caregivers of both home-bound
and bed-bound, (2) 15 caregivers (CG) of elderly with dependency, and (3) 3 representatives
from the main community parties (health service providers, social service providers,
community/local service providers). More data were from best practice sources in Surin,
Lampang and Chiang Mai Provinces. Quantitative data were analyzed by frequency, percentage,
mean, standard deviation, and the Effectiveness Index (E.I.) of learning. After verified, qualitative
data were organized and used content analysis.
Results:
1. Health Networking System for the elderly, home-bound and bed-bound groups In the
responsible area of Hong Ha Health Promotion Hospital was summarized by a linkage of 5
components which are (1) assessing the condition of the elderly with dependency and the
potential of the caregivers, (2) caring for the elderly with dependency by the community, (3)
health service system, continuous care system and management information system &
technology, (4) the policy formulation, the project plan and the budget from Nam Cho Subdistrict
Municipality, and (5) the care of the elderly with dependency from other related
organizations.
2. COC Link Program was an off-line system that had been developed to an on-line. It
can transmit two-way information and link the continuum of follow-up care between Mae Tha
Hospital and all Health Promotion Hospitals in its area. 3. Most of dependent elderlies were 78.15 years old female with chronic illnesses and
hospitalized experience. Health problems included oral disorder (58.06%), reduced sight
(66.13%), cognitive disorder (62.90%), knee pain and risk of falls (70.97%), lower standard BMI
(38.71%), risk of malnutrition (66.13%), and urinary leakage or incontinence (37.10%).
4. For Effectiveness Index (E.I) in learning of the caregivers (CG), the value of developed
skills and potential, after related knowledge and skills development, was at 0.4909, indicating
that caregivers had gained 0.4909 related knowledge and skills on dependent elderly caregiving.
It was accounted for 49.09 percent.
It can be concluded that health care system in the community should respond to the
needs of dependent elderly people and relative caregivers, taking into account on the
differences of individuals. Dependent elderly people and caregivers should be encouraged with
an ability to assess and care for themselves. It is recommended that the care direction should
be integrated and substantial by people in the community, government agencies, and the
private sector. Continuity and care linkage are considered while redundancy of health care roles
can be reduced. Community and local resources planning is applied together in all community
levels (personnel, materials and equipment, budget and allocation, management). The
importance of information technology system development and introduction of new
technologies should be recognized in elderly with dependency caregiving. It is to maintain and
to achieve the goal of health care service for elderly people with dependency in order to have
a good quality of life and to live with value and dignity of human beings.