location: , 'Thailand year: 2023 source: HSRI

title: Development of Mechanisms for Rational Drug Use Country: Phase I Study

abstract: Background: Since the 1970s, Thailand has recognized the irrational use of medicine in both public and private healthcare delivery, as well as in self-medication from unreliable sources. Various governments have attempted to address this issue. During the last decade, the Rational Drug Use (RDU) hospital policy was systematically implemented nationwide; however, RDU remains a big challenge. With no paucity, Thailand is moving forward with the "RDU Country" policy for the next decade. The goals of this policy are to make RDU as a social norm, a basic right, and a quality of healthcare service in Thailand. Purposes: To develop a mechanism for implementing the "RDU Country" policy and to create a model for achieving it by focusing on a health systems approach, monitoring and evaluation, and developing mechanisms for cooperation in the development of national indicators. This includes studying the form and structure of the central agency responsible for rational drug use (the RDU Center) and analyzing its working mechanism with the concept of political economy. Methods: A 4 steps with 1- cycle of action research was employed to gather data using qualitative methods. The principal investigators, who are embedded as practitioners within the central government agency responsible for promoting rational drug use, collected the data between May 2021 and October 2022. The development of mechanisms for implementing national policies on rational drug use using an integrated theoretical framework to put policy into practice. The action research began with a review of the problem situation, past actions, set goals, operational definitions, principles, and guidelines were established for implementing the "RDU Country" policy, and plans were made to put these guidelines into practice at both the central and regional levels. At the central level, this was achieved through the efforts of the Sub-Committee for the Promotion of Rational Use of Drugs and related working groups, using the concept of a triangle that moves mountains. At the regional level, the development of a "Rational Drug Use Province" (RDU Province) was proposed as a policy package. The goal of an "RDU Province" is to enhance the quality of services to promote rational drug use in both public and private sectors and to solve drug problems in the community sustainably through the development of mechanisms at the provincial level. This would involve achieving propulsion in each district through the participation of all sectors, in line with the concept of developing a district health system using the six-building block health system development concept according to the guidelines of the World Health Organization. This is also relevant to the development of healthy communities to make rational drug use a new social norm. There were four research areas distributed in each region with different contexts. Lessons were learned from operations in these areas, and observations and evaluations were conducted to provide feedback to the research areas. Results: The development of systems and mechanisms for implementing the country's policy on rational drug use and monitoring its implementation requires a system governance mechanism for effective policy implementation at both the central and regional levels. This relies on an efficient mechanism among policy makers, policy actors, and those affected by the policy. There is a mechanism for the central agency responsible for rational drug use (the RDU center), which is a sub-government mechanism that acts as a "connection" between policy makers and practitioners. In addition, provincial and district agencies have a coordinator or responsible person (the RDU coordinator) with appropriate capacity in terms of both leadership and technical competency. An important leverage point for the development of an "RDU Province" is the presence of policy actors at the local level who need direction and support from executives at both the provincial and regional levels. One of the policy actors responsible for promoting rational drug use (RDU coordinator) at the provincial and district levels must be competent in collaboration with the stakeholders. Developing RDU Province faced several significant challenges such as the cooperation with private healthcare settings, limited understanding of healthcare practitioners and health workers about rational drug use literacy, and RDU information systems in hospitals and communities. Furthermore, a study and development of the implementation model of an RDU Center under the structure of the National Drug Policy Division of the Food and Drug Administration is necessary to enable it to perform its role as the resolution of the National Drug System Development Committee. This includes the development of mechanisms to drive policy implementation in both central and regional areas, as well as the development of monitoring and evaluation systems and information systems for monitoring and evaluation in collaboration with related agencies. This is being driven by a "superstructure” with bureaucracy that represents the power of the state, using the concept of “a triangle that moves the mountain” and extending the work system between government agencies using the concept of political economy with 3 main mechanisms as follows: firstly, health care service quality supervision through professional councils, quality system mechanisms, regulatory mechanisms from the ministry that oversees public health facilities, and legal mechanisms; secondly, a mechanism for regulatory activities of pharmaceutical manufacturers/companies through law; and thirdly, a financial mechanism through the government health insurance fund, which is the positive reinforcement. However, the RDU Center also needs to make decisions and seriously take action on proper management of structures and roles under the mission of the Food and Drug Administration, including both its consumer protection role for health products and its mission as a government agency at the department level in implementing national drug policy to routine work system. Conclusion: An important and challenging issue for Thailand's health system in achieving rational drug use, which have been persisting for more than four decades, is finding a solution to drug problems in the community. Therefore, the design of the superstructure of the health system is required to provide alternative access to basic essential medicines from reliable drug distribution sources for people in all districts, regardless of differences in education, income, or area of residence. People should have access to necessary and reliable information to make informed decisions about their own health or that of their families when they are ill, including information for the use of drug and non-drug products. This includes a system for creating health literacy about taking care of one's own health, with and without the use of drugs, using technology such as telemedicine or telepharmacy, or having a health service system that everyone in the community can access with RDU as quality of health care services.


location: , 'Thailand year: 2021 source: HSRI

title: Efficacy of povidone iodine spray for SARS-CoV-2 eradication in upper respiratory tract of patients with COVID-19: A pilot study

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


location: , 'Thailand year: 2020 source: HSRI

title: Virtual Reality Based System for Stroke Rehabilitation

abstract: Rehabilitation therapy requires stroke patients to train muscles controlled by the brain that have been damaged. The challenge of the therapy is caused by improper and irregularly training from patients. An effective recovery process requires patients to cooperate in a training course designed by the medical team. The current practices of trainings are plain and might be discouraging resulting in a somewhat unsatisfied outcome. This research is to create an interdisciplinary intervention tool by integration of “Serious game” and rehabilitation body of knowledge. This proposed system is a 3D game having features to encourage the patient by immersing the patient in the Thai temple fair atmosphere games where they must make movements to complete the virtual reality games (VR). The games help patients to train in three patterns of movement required in daily living. The first pattern is focused on practicing a reaching out gesture, which involves practicing movement in the following muscles: Deltoid, Triceps, Biceps, Pectoralis and Serratus anterior muscles through selling ice-cream game. Second movement is to train arm-sweeping from left and right, which involves practicing the following muscles Deltoid, Pectoralis, Infraspinatus, Latissimus, Rhomboid and Trapezius through a shooting game. Third movement training is to train arm-lifting involved practicing the following muscles Deltoid, Triceps, Trapezius and Serratus anterior through the picking stars game. Moreover, in every game, players and patients will use their small muscles by stimulating picking up an object gesture. The game collects data from plays to formulate progression planning. Thirty eligible patients with stroke who were admitted to the Rehab ward, Maharaj Nakorn Chiang Mai Hospital, Chiang Mai University Medical School were randomly allocated into an intervention group (6 patients treated with conventional therapy and VR) and a control group (7 patients treated with conventional therapy only).  Rehab outcome measurements including Fugl-Meyer Assessment of the arm (FMA), ArmA, Barthel index (BI) and Wolf Motor Function test (WMFT) were evaluated before, during and at the protocol completion. Our results revealed significant FMA score differences within group in both groups (p=0.039) implying that motor and sensory recovery was equivalent, however there was a trend toward better outcome in the intervention group. The ArmA, WMFT and BI scores showed no significant differences between groups on nonparametric analysis at any point of time. The FMA scores were moderately correlated with the “ice-cream selling” game scores (r = 0.57) which might be related to arm recovery. The “ice-cream selling” and “star picking” game scores were moderately to highly correlated with ArmA score (r = 0.65). The WMFT showed no significant correlation with all game scores which might be attributable to less hand and arm use in most of the WMFT items. The BI scores had significantly moderate to high correlation with “ice-cream selling” and “star picking” game scores as the game plays stimulated postural and balance training (r = 0.64 and 0.61, respectively). To sum up, combination of rehabilitation through virtual reality system and conventional therapy showed a trend toward better efficacy for stroke patients than the conventional therapy alone, especially arm and shoulder recovery.


location: , 'Thailand year: 2020 source: HSRI

title: Lessons Learnt from Prevention and Control of COVID-19 Pandemic: A Case Study of Angthong Municipality

abstract: The world is in the grip of the novel coronavirus or COVID-19 pandemic. Since it was first identified in Wuhan, a city in China at the end of 2019, the disease has rapidly spread to countries around the world. This pandemic is likening to occur once in a century. In Thailand, there were 3,000 accumulative cases from 68 out of 77 provinces. This article reviewed the essence of COVID-19 prevention and control activities by Angthong municipality in Angthong province from 1 February to 12 May 2020 that led Angthong as 1 out of 9 provinces that had no provincial inhabitants infected. The aim of the study was to understand COVID-19 prevention and control highlighting collaboration of community-level stakeholders. Lessons learnt from this study provided an insight on Angthong provincial disease control committee mechanism, the arts of implementation of Angthong municipality, importance of local leadership, and dynamic of daily life shifting of local people for further development on disease control policy at both local and national levels.


location: , 'Thailand year: 2023 source: HSRI

title: Comprehensive Treatment and Rehabilitation Model Development of Adolescence’s Drug and Substance Abuse at Provincial Level

abstract: The prevalence of substance use among adolescents has been increasing and found in lower age, twelve years. It creates impacts on their health and future lives, as well as society at large. In Thailand, although there are laws and policies that supportive for problems solving but the implementation has been rather inefficient. Petchaboon province has actively put these policies into practice using integrative and collaborative concepts among all stakeholders since 2015. A community-based approach has been used particularly with school settings. However, it cannot mitigate the problems in terms of magnitude and access to treatment and rehabilitation services. This study aimed at developing a comprehensive treatment and rehabilitation model of adolescents’ drug and substance abuse at a provincial level which enhances access to care and improves retention until outcomes achievement. Community-based participatory action research approach was employed using both qualitative and quantitative data. The review of related literature and policy context, as well as an analysis of situation about drug use and access to treatment and rehabilitation of school adolescents in Petchaboon province were conducted. The participatory action case studies of community-based model were done in nine subdistrict units (Tumbol) and four school-based sites. All action sites were under supervised by the Family Medicine Unit of Petchaboon hospital. It was found that both community-based and school-based comprehensive treatment and rehabilitation model for school adolescents who use drug could be codesigned and operated by using interventions included a Low-intensity Cognitive behavioral therapy, (Li-CBT) and Motivational Interviewing (MI). The mechanism of changes at individual level could be explained while at a system level might need for further study in term of improving access and retention. It also suggested that school-based psychosocial therapy model would be an opportunity to bring in school students to actively participate as peers.


location: , 'Thailand year: 2001 source: HSRI

title: Essential features for healthy public policy development : 5 case studies

abstract: This report had three objectives. Firstly, it aimed to review the existing knowledge and analyzed about system, structure, and mechanisms of healthy public policy development in 5 case studies: namely, health promotion policy, healthy child development, anti-tobacco policy, AIDS policy, and anti-Amphetamine drug and its derivatives policy. The cases were both from domestic and international experiences. Secondly, it intended to study about community involvement and participation along policy process in each case. Lastly, structure and mechanisms of development were synthesized and proposed as options for Thailand. Case studies shed light lesson learnt at least in 6 areas as follows: 1) re-organization or re-structure is essential to establish with new health promotion approach in the Ottawa Charter. New management, through the concept as health is cross-cutting issue, would give advantage of working together, co-ordination, and collaboration between and among the sectors, as well as strengthening the communities and people participation. 2) appropriateness and relevancy of policy measures depends on health promotion view of the leader / administer and wherter such measure is based on correct knowledge 3) mechanisms for good health information development and transfer, knowledge establishment, research and development, and monitoring and evaluation are required. 4) Law enactment for health promotion, besides justice purpose, need to be enhanced and law enforcement needs to be strengthened. Paradigm to draft such a law for supporting health promotion activities like Thai Health Promotion Fund have to be changed. 5) As key success factor, health promotion activities are central to have partnership involvement and people participation. therefore, effective management and good information exchange are crucial. Appropriate knowledge transfer and awareness of self and community care would alert and call for impact assessment as well as healthy policy measures and transparent decision-making. 6) The government should act as a collaborator to link each partner to assist people and communities to formulate their action plan for health promotion. In summary, development of health public policy needs to change policy process which enhances all stakeholders involvement and participation. To formulate public policy, policy-makers have to think about the impact that might be happened after implement process. Decision-makers should be responsible for mistakes if negative impact occurs. Therefore, it is required to establish new organization with new health promotion approach and good mechanisms for information and knowledge transfer, as well as monitoring and evaluation process.


location: , 'Thailand year: 2009 source: HSRI

title: A Preliminary Study on Hemostatic Efficacy Comparing Chitosan Derivative-based Material and Two Commercial Materials in Split-thickness Skin Graft Wound Sites

abstract: The objective of this clinical preliminary study was to evaluate the hemostatic efficacy of a chitosan derivative-based hemostat prototype (MTEC prototype), compared with that of two commercial materials, SPONGOSTAN@ Standard and Algisite-M, in split-thickness skin graft donor sites. The study was conducted at Ang Thong Hospital in Ang Thong Province involving eight patients who underwent skin grafting during the period June-November 2008. The three tested materials were randomly put on wound sites from the direction of the patients’ toes to their heads. Gauze was placed on top of the materials. To secure the materials, they were gently pressed by hand. Bleeding was visually observed and the wound sites were photographed at 5 and 8 minutes. At each time point, the wounds were uncovered for 30 seconds for the observation of blood ooze. The wounds were photographed again at 5 1/2 and 8 1/2 minutes. At last, the materials and gauze were weighed for the determination of blood loss. The results revealed that the amount of blood loss found in the materials was in the following order: SPONGOSTAN@ Standard < Algisite-M < MTEC prototype, while the amount of blood loss found in the gauze was in the following order: MTEC prototype < SPONGOSTAN@ Standard < Algisite-M. Nonetheless, there were no significant differences in the total amount of blood loss when the wound sites were treated with these three materials. From visual observation, the MTEC prototype, however, seemed to stop the bleeding most efficiently as determined by the least blood ooze apparent at 8 1/2 minutes.


location: , 'Thailand year: 2010 source: HSRI

title: Art and Language Arts for Handicapped Children

abstract: This is a translated and edited version of chapter VI (pp. 132-158) of the book by Frances E. Anderson,
entitled Art-centered Education and Therapy for Children with Disabilities, published in 1944 by Charles C.
Thomas Publisher, Springfield, Illinois. Introduced in this chapter are art-based creative activities called
language arts, which include visual vocabulary activities (reading aloud), writing activities, puppet plays,
and poetry. In practice, it is of the same fashion in expressing mentality as symbolic expressions in
drawings in individuals that would not or could not reveal themselves in verbal communication.
Of note, the art-based creative activities presented in this paper will be just the beginning – a jum
ping- off place – for the creative teacher. Teaching children with special needs is a constant challenge. These
children need more practice than other children in learning skills and concepts. There is no reason to make
practice a dull, boring drill when there are so many alternative ways to learn. For some reason, educators
seem to believe that the brightest, most competent learners should be afforded the most creative teaching.
On the contrary, if every child with special needs were taught with the same energy and creativity as a
gifted child we might see far more enthusiastic, energetic progress in them. There is no excuse for boring
any learner of any age with dull, uninspired teaching. Special children need special teaching far more than
any others because they have so much farther to go. “Art-based academic learning can make the journey a
joyful experience.”... F.E. Anderson.


location: , 'Thailand year: 2002 source: HSRI

title: Community self-reliant health : action research project

abstract: Community Self-reliant Health Action Research Project has been implemented in 10 communities of the Phumpanya Thai Network, covering all the four main regions of the country. Its main aim is to study community health management system which could lead to a more self-reliant health system of the communities. This is to be based not on mono-type or ready made model but on diversified ways of learning and types of knowledge about health of the communities. This research has used a tool called “People Research and Development” (PR&D).The community is the centre of learning process. The researchers team facilitated the process of learning and interaction among the 10 communities, which share their experiences, plan and assess their action plan together. The process of learning consists of :	Search for identify. This is the process of surveying basic data of the community, identifying its resources and management, knowledge and wisdom, occupations and sources of income, expenditure, debt, illnesses and treatment of illnessess. The survey has proved that communities have potential in terms of richness of resources, knowledge and wisdom, to be developed toward self-sufficiency in health. Some communities have succeeded even to create a welfare system paying 100% of health care bills. Some communities can provide basic health care with traditional knowledge and resources, such as massage and herbs with collaboration and support of community health centres and community hospitals. This search for identify has helped communities regain their self-confidence lost during the past 40 years of “modernization”. They realize that they can take care of themselves in many ways with their local resources. Community analysis. This is a process of learning about health, about illnesses, causes and ways for self-help health scheme. It consisted of learning within the communities and by sharing experiences with other communities in the same area as well among the 10 members of this network. At the same time, the communities are exposed to other models of community health scheme and activities related. They have learned about more possibilities in developing their own health scheme. Experiment community health promotion programme. After several learning forums organized within each community and with other communities, some activities in relation to community health promotion came about, such as, food system management, massage training, herbs training for self-care, for family and community care, setting up community health fund to support extention of “health friendly” occupations. After this, each community started to implement these activities in their own community, recording the result in terms of new knowledge, and the impact on the community. Community Health Masterplan. This is the plan developed by each community as a result of learning process. This is based on data and information collected and analyzed. The plan is a guideline for self-development process of each community. Health is the main point of this masterplan. The aim is “self-reliance” in health programme. Within this programme there are “projects” which will be implemented mainly with local resources and by the community itself. At the end of this action research project it can be said that it has been a process to increase immune system of the community. It is the discovery of the “self” of the community, its strength, its potential, its alternatives for management of its health. This process is strengthened through cooperation and interaction with other communities of this network in their joint learning programme, made possible by this action research project.


location: , 'Thailand year: 2007 source: HSRI

title: Introducing Group Activities for Preventing Cardiovascular Disease Risk Factors among Civil Servants in Khirimat District, Sukhothai Province

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


location: , 'Thailand year: 2018 source: HSRI

title: Factors Predicting Food Consumption Behavior of Hemodialysis Patients with End Stage Renal Disease at Maharaj Nakorn Chiang Mai Hospital

abstract: Malnutrition from inappropriate food consumption behaviors is often found in end stage renal disease (ESRD) with hemodialysis (HD) patients. It may be a risk factor for increased morbidity and mortality in these patients. The purposes of the present study were to examine factors predicting of consumption behavior among ESRD with HD patients. Sample was 120 ESRD patients on HD in hemodialysis unit, Maharaj Nakorn Chiang Mai Hospital, by purposive sampling according to the specification. Data were collected using the questionnaire interviewing personal data, the self-efficacy, the social support and the food consumption behavior. Data were analyzed using descriptive statistics, Pearson’s correlation and multiple regression analysis. The results showed that the sample had overall food consumption behaviors at a medium level (xˉ= 2.58, SD = 0.47). Patient’s age, income, duration of hemodialysis treatment, self-efficacy, and social support could predict food consumption behavior (R2 = 0.607, p < 0.01). The finding of this study could be used as a guideline to promote the appropriate food consumption behavior along with social support to stimulate self-efficacy of the patients that enhance appropriate food consumption behavior in ESRD patients to improve their health status and quality of life.


location: , 'Thailand year: 2009 source: HSRI

title: Occupational Health and Safety Management System and Health Risk Assessment

abstract: Occupational Health and Safety Assessment Series (OHSAS) 18001:2007 is an occupational health
and safety management system utilized in the United Kingdom. This article addresses the importance of
health and safety in today’s legal milieu, as well as establishing, implementing and maintaining procedures
for ongoing hazard identification, risk assessment, and determination of necessary controls. It also
explains the managment and control of workplace and occupational risks, and gives some successful
examples.


location: , 'Thailand year: 2017 source: HSRI

title: Comparison of Superficial Surgical Site Infection between Delayed Primary versus Primary Wound Closure in Complicated Appendicitis : A Multicenter Randomized Controlled Trial

abstract: Importance: Superficial surgical site infection (SSI) is common in appendectomy for complicated appendicitis. Delayed primary wound closure (DPC) is preferentially used over primary closure (PC) but its efficacy is still controversial. Objective: To compare superficial SSI rates between DPC and PC for complicated appendicitis. Design, setting, participants: A multicenter, randomized controlled trial of complicated appendicitis, involving 607 adult patients from 6 hospitals in Thailand between November 2012 to February 2016. This included cases of gangrenous appendicitis, as well as rupture. Intervention: Patients were randomized to PC (i.e., immediately wound closure after operation) or DPC (i.e., wound closure at postoperative days 3 to 5). Main outcome and measure: Superficial SSI, as defined by the Center for Disease Control criteria. Secondary outcomes included postoperative pain, length of stay, recovery time, quality of life and cost of treatment. Results: Among 303 and 304 patients in the PC and DPC groups, 5 and 4 patients were lost follow up respectively, leaving 300 and 298 patients for intention-to-treat (ITT) analysis. The superficial SSI rate was lower in the PC than DPC group (i.e., 7.3% (95% CI: 4.4, 10.3) versus 10% (6.6, 13.3)) with a risk difference (RD) of -2.7% (-7.1%, 1.9%). Protocol violations occurred in 15 patients (i.e., 9 in PC and 6 in DPC groups).  RDs for per-protocol and as-treated approaches were respectively -1.9% (-6.5%, 2.6%) and -1.1% (-5.6%, 3.4%). In addition, a counterfactual approach using instrumental-variable analysis yielded a RD of -3.6% (-8.3%, 1.1%).  Postoperative pain, length of stay, recovery times, and quality of life were not significantly different between groups with corresponding RDs of 0.3 (-2.5, 3.0), -0.1 (-0.5, 0.3), -0.2 (-0.8, 0.4), and 0.02 (-0.01, 0.04). However, costs for DPC were 2083 (1410, 2756) Baht higher than PC (~$60 USD or 56 euros). Conclusion and Relevance: Superficial SSI rates were slightly lower for PC than DPC groups, although this did not reach statistical significance. Costs were modestly but statistically significantly lower for the PC group. Trial Registration: clinicaltrial.org Identifier:  NCT01659983


location: , 'Thailand year: 2008 source: HSRI

title: Information management process for persons terated for nacrotics in the implementation of the policy to with the war against nacrotic drugs, 2004

abstract: The objectives of this mixed-method study were to investigate the implementation
of the persons treated with narcotics with regard to the information management process
in the Policy to Win the War against Narcotic Drugs, from 1 February to 30 April 2004. A
management model was applied and data were collected from the public health personnel
who worked in the information management process, two provincial personnel, two
district personnel, four tambon personnel and the personnel responsible for finding narcotic
takers/addicts, six district personnel, 6 tambon personnel and 70 village leaders
using in-depth interviews. For 47 public health personnel, focus group discussion was
used as well as documents study and data analysis from the registration form (BST.1-5).
Qualitative data were checked and analyzed by triangulation techniques. Quantitative
data were described as percentages.
The urgent activities followed by the policy, especially determeneing the number of
narcotic takers/addicts, could not be rechecked. There were some persons who had quit
taking narcotics and some persons who had never taken any illicit drugs. The registration
and report form for selecting them and the treatment activities that had been used before
was changed to BST.1-5 and reported on the hospital‘s website. The change occurred after
these processes had already been done; thus, the personnel had to register and report
later. Inadequate essential supporting activities; technological skills (computer and
Internet), urgent problem-solving ability affected some elements of personal data loss,
especially in the area where computer and/or high-speed Internet were not available.
Data diviations occurred in all processes so that the data reported by the website could
not be used for monitoring and evaluation. However, the policy was the most important
factor reinforcing the development of information systems useful for multi-sectors.
Implementation of the policy should be in the same direction. Rechecking the understanding
of personnal and adequate essential support must be provided.


location: , 'Thailand year: 1999 source: HSRI

title: Health care financing for low income population in Thailand

abstract: Health Care Financing for Low Income Population in Thailand	The present study investigated a current public health care policy for low income population in Thailand on the financing and expenditures as well as evaluated the post-policy implementation outcome of the current system of health financing for the low income population aiming at the satisfaction and perception of health care providers, the poor who have enrolled in the free medical care project (FMCP) and the poor who have not enrolled in the free medical care project (NFMCP), but received free care or paid partial expenses. The study also tested the hypothesis of differences on the satisfaction and perception between the FMCP in the provinces that have the highest utilization rate of free medical care enrollees at health centers and the FMCP in the provinces that have the lowest utilization rate of free medical care enrollees at health centers.The secondary data on number of free medical care project enrollees, budget and health care expenditures revealed that the increasing number of enrollees in each year did not correspond to the total number of the poor in the country. Although the budget allocation for each region harmonized with the number of the poor in each region, the ways the budget was set for every group in the government welfare programs together has not reflected the real expenditure for each group, especially for the poor. Each region and each level of health facilities also experienced different patterns of changes in the health expenditure for the FMCP. The health expenditure for the NFMCP was in a high level compared with that of the FMCP. However, unlike the FMCP, the inpatient expenditure of the NFMCP still increased.	The analysis on primary data collecting from 10 provinces in the north, northeast, central, east and south regions showed that both providers and poor patients mostly satisfied with and agreed to the health policy for the poor. The assessment of the impact of the policy for the poor on the providers showed that most providers satisfied with the policy, practice, expenditure calculation in health facilities. The providers also mainly satisfied with the work and job related to the poor in the workplace. Nonetheless, most providers did not satisfied with the budget and the ways the budget was allocated in the provinces. Most providers also agreed that the poor should pay a proportion of total health expenses or a proportion of health expenses on some types of services.	By assessing the satisfaction and attitude of the FMCP on the health policy for the poor, the results depicted that most FMCP satisfied with the policy and service received. However, some FMCP patients misunderstood or did not know about the right and benefits of being enrolled in the FMCP. Furthermore, most patients agreed that the poor should pay a proportion of total health expenses or a proportion of health expenses on some types of services. The hypothesis testing of differences on the satisfaction and perception between the FMCP in the provinces that have the highest utilization rate of free medical care enrollees at health centers and the FMCP in the provinces that have the lowest utilization rate of free medical care enrollees at health centers showed that the high (low) utilization resulted in lower (higher) patient satisfaction.	By assessing the satisfaction and attitude of the NFMCP on the service received, the results revealed that most NFMCP satisfied with the services, providers and facilities. Some NFMCP were previous FMCP, but the free medical care cards had expired. Some NFMCP had requested for the free medical care cards, but they did not get the approval. Part of the NFMCP did not know about the free medical care project or knew about the project, but lack of some important document. Most NFMCP also agreed that the poor should pay a proportion of total health expenses or a proportion of health expenses on some types of services.


location: , 'Thailand year: 2023 source: HSRI

title: Research and Development of Massive Open Online Course (MOOC) Curriculum for Teachers and Caregivers of 0–3-Year Old Children

abstract: This research and development project on Massive Open Online Course (MOOC) for teachers and carers of children under 3 is to create a set of online courses for teachers and caregivers of children under 3. This set of online courses is designed to raise awareness about the importance of nurturing infants and young children, aged between 0-3 years, a critical period that requires fostering and instilling a stable and appropriate foundation for life. The project aims to 1) upskill and reskill teachers and caregivers of early childhood development institutions accepting children under the age of 3 by creating MOOC courses, 2) evaluate the effectiveness of the created courses in the development of teachers and caregivers of early childhood development institutions, and 3) assess the efficiency of MOOC in teaching and training. The main target groups used in this study were teachers and caregivers of early childhood development institutions and students in the field of early childhood education. Evaluation of course effectiveness was conducted in three key areas: learning, reaction, and attitude. The assessment of the efficiency of MOOC was achieved by analyzing learners’ video clip traffic, because video clips are the most important medium of MOOC courses. The results showed that assessment of the learning and reaction effectiveness of the MOOC courses yielded markedly positive results. As for the attitude, there was no difference between before and after learning the courses. In the evaluation of the efficiency of the MOOC system, it was found that creating learning content in the form of video clips should be made into a short clip. Each clip should not exceed 5 minutes. This set of courses can be revised and expanded to develop into a non-degree program, as they are licensed under Creative Commons CC: BY-NC-SA.


location: , 'Thailand year: 1998 source: HSRI

title: Diagnosis related groups for the low income,development and application

abstract: Diagnosis related groups for the low income, development and applicationInpatient services are complex and costly. The US Medicare, the elderly health benefit scheme, had faced uncontrollable expenses in the 1970s because the scheme reimbursed hospitals retrospectively. Diagnosis related group (DRG) was invented in  the early 1980s to be used in a prospective payment system to control the rising cost. After it has been proved successful, DRG has migrated and been adopted into health care systems in  many countries. Some use DRG on a case by case payment basis, some use DRG in a resource allocation formula and some use it to compare the hospitals' activities. DRG is considered  non-foreign to the Thai health care context. Classifying cases into DRGs requires information that is readily available  (diagnoses, operating room procedures, age, type of discharge). DRG can be used to predict the lengths of stay and resources  used to treat patients in the hospitals, so we are able to use DRG for resource allocation, for case-based payment and for comparison between hospitals. Assigning patients into DRGs  requires data on ICD-10 and ICD-9-CM (for diagnosis and  procedure respectively)of individual patient. So far, research activities on DRG in Thailand based on the 10th revision of Health Care Financing Administration (HCFA-DRG). Relative weight for each DRG is estimated by using patient-based costing methodology and cost to charge conversion ratio, then compare the cost mean of each DRG to the average cost of all patients. After reviewing the weights from many piec of research results and with inpatient data from Ramathibodi hospitals, the final version of relative weights to be used in the Thai context is endorsed by the Health Insurance Office. The uses of DRGs are many folds. In 1997, allication of non-salary recurrent budget to 92 general and regional hospitals used the average relative weights to better reflect their case complexity and cost. The second example, relative weights for different schemes of the low income were used to estimate budget requirements if the Thai government were to propose a universal converage scheme to the majority of Thais.  The third example, relative weights were used to evaluate hospital achievements. The future use of DRG within the global budget ceiling in the reform of civil servant medical benefit scheme should be cautiously laid out. Finally, if DRG is to be used in the Thai health care context, it needs to set the system that recalibration of DRG weight can be done systematically. The dataset for hospitals to report for each patient to be examined is the important strategy for continuity of the system. Finally, cost accounting studies in a few efficient hospitals need to be done to tell the true cost of providing care to each DRG.


location: , 'Thailand year: 2017 source: HSRI

title: Situation review on potential benefits and risks from medicalisation and legalisation of cannabis

abstract: Cannabis is traditional plant that contains psychoactive substances. In the past, there were reports suggesting the utilisation of cannabis for various purposes, for instance, recreation, medicine, and textile. However, many countries, including Thailand, probihited the use of cannabis, and included it in the narcotic or addictive substabce list. So far, there have been a number of reports suggesting harmful effects of cannabis on health, especially, deleterious effects on brain function and increasing risk of the use of other substances.
	Between 2015 and 2016, there were massive campaigns from both public and private agencies urging an amendment of the 1979 Narcotics Act in the way that withdraws cannabis from the narcotic drug list. This campaign is related to not only medicalisation, but also legalisation of cannabis. This report therefore sought to review the current situation regarding the use of cannabis for medical purposes in various aspects, such as benefits, caveats, as well as international experience in cannabis legalisation and challenges in the Thai healthcare system. It is hoped that results from this study will serve as grounds for future research, and can be useful to later policy decision. The main data collection technique is literature review on electronic databases, especially, Medline.
	The findings show that most research on cannabis was confined in laboratory or animal studies. Though there were some clinical trials on humans, the majority of them still had limited number of participants, and compared clinical effects of cannabis with placebo. Regarding international experiences, the scope of cannabis medicalisation varies substantially; from extracting some substances in cannabis or using cannabis-like derivatives to produce second- or third-line drugs for treating patients with certain diseases, using herbal cannabis (by oral route or smoking) under supervision of physicians, to using cannabis in recreational activities. Some countries implemented decriminalisation measures. The openness of cannabis policies in many countries has some similar features, namely, (1) cannabis related laws were gradually amended over time rather than having a radical change, and (2) there were several measures implemented in parallel with the cannabis legalisation/medicalisation in order to prevent the use of cannabis in the way that deviates from original policy intentions.
	Note that this review found that most information was retrieved from international literature. This observation reflected gaps in knowledge regarding medical use of cannabis in Thailand. Thus it is imperative to support domestic research on cannais in various angles, such as how to improve species of cannabis for better botanical use, how to extract medical substance from cannabis, and how to promote pharmacological studies on the effectiveness and efficacy of cannabis for treating certain diseases. This point should include research questions outside health service system arena, such as social science research and law studies. Some broader research questions should be taken into account, such as public opinions towards cannabis and the readiness and aprropriateness of existing laws in controlling cannabis. If the Thai government aims to implement policies vis-à-vis the utilisation of cannabis, it is imperative to distinguish medicalisation issue from legalisation issue while communicating with the wider publi. Moreover, the government should assess its capacity in regulating the use of cannabis before introducing cannabis-medicalisation/legalisation policies and the potential cost of treating patients with substance abuse.


location: , 'Thailand year: 2016 source: HSRI

title: Prevalence and Predictors of Insulin Non Adherence in T2DM

abstract: This study was conducted to determine the prevalence of insulin non adherence and identify factors
associated with insulin non adherence among 95 patients with type 2 diabetes mellitus in Nongjik Hospital,
Pattani province from June to September 2015. Non adherence to insulin was measured by self-report
questionnaire. Frequency, percentage, mean and standard deviation were used to present the analysis
results. Logistic regression was used to identify multivariate predictors of insulin non adherence. Adjusted
odds ratios (aOR) and their 95% confidence interval (CI) were used to present the strength of association.
Prevalence of insulin non adherence was 80%. In multivariate analyses, predictors of insulin non
adherence were: age 51-60 (aOR 20.38, 95% CI 1.32, 315.71), BMI (aOR 25.11, 95% CI 1.96, 321.17), selfinsulin
administering (aOR 22.25, 95% CI 1.51, 328.2), hypoglycemia (aOR 21.0, 95% CI 1.35, 326.23), insulin
keeping (aOR 42.02, 95% CI 3.16, 558.42) and dinner management (aOR 22.6, 95% CI 2.48, 205.68).
This study has demonstrated a high prevalence of insulin non adherence in patients with type 2
diabetes. Improving insulin adherence by paying particular attention to different age groups and patients
with self-administered, insulin keeping and dinner management inappropriate could help improve adherence.


location: , 'Thailand year: 2022 source: HSRI

title: Treatment Patterns and Effectiveness of Tyrosine Kinase Inhibitors in Patients with Chronic Myeloid Leukemia: Evidence from a Real-World Data Analysis

abstract: A retrospective cohort study using real-world data was conducted to analyze the treatment patterns of tyrosine kinase inhibitors in patients with chronic myeloid leukemia (CML), compared with the guideline for regulating drug use of the National List of Essential Medicine (NLEM) category E(2), with the purpose of determining the effectiveness of tyrosine kinase inhibitors in CML patients covered by Thailand’s universal coverage scheme and social security scheme. This study focused on the treatment patterns and effectiveness of imatinib, nilotinib, and dasatinib. Data were obtained from the reimbursement database of the NLEM category E(2) during fiscal year 2012-2018. Patients were followed up until death or the end of fiscal year 2019. Descriptive statistics and non-parametric test using Kaplan-Meier method were performed in the analysis. CML patients were divided into 3 groups based on their medical history until the time of death or last follow-up as follows; 1) patients who received imatinib only (group A), 2) patients who received first-line imatinib and second-line nilotinib (group B), and 3) patients who received first-line imatinib, second-line nilotinib, and third-line dasatinib (group C). Of 574 CML patients, there were 400, 113 and 61 CML patients in groups A, B and C, respectively. The majority of patients in each group were between the ages of 30 and 39 years old (34.2%, 36.3% and 29.5 %, respectively), with a median follow-up of 36.6, 50.7 and 47.6 months. Prior to the last follow-up or drug switching, the average daily dose of imatinib in group A, B and C was 444.3, 474.1 and 474.8 mg, respectively. Real-world effectiveness using survival analysis revealed 2-year survival rates at 84.3% (95%CI: 80.3-87.6%) for group A, 91.0% (95%CI: 83.9-95.1%) for group B and 85.2% (95%CI: 73.4-92.0%) for group C, with 5-year survival rates in each group were 83.2% (95%CI: 78.9-86.7%), 85.7% (95%CI: 76.7-91.4%), and 66.4% (95%CI: 52.3-77.2%), respectively. Average daily dose of imatinib prior to drug switching was not complied with the guideline, which recommended high-dose imatinib (600-800 mg/day). The 2-year survival rates were comparable across groups (log-rank p-value 0.295), while the 5-year survival rates in group A and B were significantly higher than in group C (log-rank p-value: group A vs. C; 0.016, group B vs. C; 0.004). However, the causes of non-adherence to the guideline could not be identified due to the lack of important clinical data including cytogenic/hematologic response, drug resistance, and occurrence of adverse drug events during the treatment of CML.


location: , 'Thailand year: 2008 source: HSRI

title: Long-term cohort study of parents in a prospective cohort of children, Thepa district, Songkhla province

abstract: A long-term follow-up study of mortality and morbidity in normal subjects has not
yet been conducted in Thailand owing to the limited resources available and time constraints.
This was a long-term cohort study (5 years) carried out as part of an existing
research project of Thepa Hospital, namely the Prospective Cohort of Thai Children (PCTC)
in Thepa District. In this study, the parents of these children involved were taken for a
follow-up study in a co-research project in the period 2003-2007. Out of 2,000 parents,
1,325 volunteers (mean age 30.84 years) were interviewed and underwent several medical
examinations in 2003. Although the other 675 parents did not enter the program, they
were also taken for monitoring their status throughout the study period. In addition, 75 health worker couples from the hospital (mean age 36.5 years) were included in the study
as well. The mortality rate in this five-year study was 1.9 cases per 1,000 person-years (20
deaths). The incidence of disease, as observed from closely monitoring the subjects in the
last two and a half years of the study, was 9.7 cases per 1,000 person-years. The causes of
death and of diseases varied from road accidents and violence to infectious and cardiovascular
diseases. The incidence of hypertension and diabetes mellitus was five cases per
1,000 person-years and 1.6 cases per 1,000 person-years, respectively.
This study demonstrated that health personnel in community hospitals could develop
their research skills for conducting long-term studies through a strategy using a
“routine-to-research” philosophy.


location: , 'Thailand year: 2022 source: HSRI

title: The Effectiveness of Acceptance and Commitment Group Therapy for Cultivating Resilience and Intention to Drug Abstinence on Youths with Substance Abuse

abstract: The considerable care for youths with substance abuse in recovering phase is enhancing resilience, cultivate life immunity in order for relapse prevention. This quasi-experimental study was to examine the effectiveness of Acceptance Commitment Group Therapy on resilience and intention to drug abstinence among youths with amphetamine abuse. One hundred youths from the rehabilitation treatment at Wiwatphonlamuang School, Thai Royal Navy in Chonburi Province, Thailand were recruited and randomly selected to participate in experimental group and control group. Fifty participants in the experimental group participated the Acceptance and Commitment Group Therapy for cultivating resilience and intention to drug abstinence, and both experimental and control group attended the routine psychosocial rehabilitation program. The group therapy was carried on twice a week for 4 weeks. The resilience and Intention to drug abstinence questionnaires were applied for data collection before and after participation, then four weeks follow up. Descriptive statistics and Two-way repeated measurement ANOVA were used for data analysis. The results revealed as follows: 1. The mean scores of resilience in experimental group were higher than control group at post-test and 1-month follow-up were significantly different at .001 2. In experimental group, the mean scores of resiliance at pre-test and 1 month follow up were significantly different at .05 and 3. The mean scores of intention to drug abstienance in experimental group were higher than control group at post-test and 1-month follow-up were significantly different at .05 The results suggest that nurses and health care providers could apply this program to promote resilience and intention to drug abstinence in youth with substance abuse. This therapy will be an alternative treatment for both health personnel and those who work in the drug treatment and rehabilitation facilities. Those personnel can employ the body of knowledge to develop and improve their drug treatment skills.


location: , 'Thailand year: 2018 source: HSRI

title: Accessibility to Dental Care According to Type of Service in Thai Population

abstract: Equity in health and health service are the ultimate goals of Universal Health Coverage. One key performance indicator for achieving that goal is about accessibility. However, Thailand in previous 10 years, while the number of dentists in service system was steadily increased, the utilization rates for dental service were nearly stable at lower than 10 percent. This study aimed to analyze utilization of dental services in 3 categories (oral health prevention, simple dental treatment, and complicated dental treatment), by using secondary data from the series of 5 Health and Welfare Surveys from 2007 to 2015. The results showed an increased number of people who received some dental service in the last 12 months. However, the number of people who did not receive any dental service were nearly the same in every survey. Moreover, people with unmet dental service need still exist. The proportion of complicated dental service use was increasing while simple level was in the contrast. Therefore, dental service productivity might be mainly from those complicated dental services. This would lead to a wider gap of accessibility to dental service among the population in the long-term. The findings from this study might be useful for planning and monitoring the future dental service system.


location: , 'Thailand year: 2014 source: HSRI

title: The Development of Participatory Community-based Rehabilitation Program for Persons with Disabilities in the Community

abstract: This is a participatory action research using a community-based rehabilitation model as a conceptual
framework. The research aims to develop caretaking programs for persons with disabilities (PWDs)
in the community through the use of the International Classification of Functioning, Disability and Health
(ICF) data and explore the participants’ basic knowledge and attitudes towards PWDs. The study comprised
of three phases: 1) situation and health needs analysis and planning; 2) development of participatory program for PWDs; and 3) evaluation. Fifty-two participants working with PWDs from four provinces
(Roiet, Khonkaen, Mahasarakham and Kalasin) were involved. Quantitative and qualitative data
were collected through questionnaire, seminar workshops, observations, field notes and informal interviews.
All participants were involved in all three phases. The participatory rehabilitation program comprised
of five steps: 1) initial screening; 2) target group selection; 3) function and need assessment;
4) provision of care; and 5) engagement across different organizations. Knowledge, attitude and satisfaction
toward participatory rehabilitation programs for PWDs were improved after the workshops. Comprehension
of the PWD functioning data should be encouraged among participants. An appropriate program
should be developed from the multidisciplinary teamwork across different organizations following
the five steps as mentioned. Care network should also be expanded to improve the quality of life of the
PWDs and families.


location: , 'Thailand year: 1998 source: HSRI

title: The evolution of the tobacco consumption control in Thailand

abstract: The Evolution of the Tobacco Consumption Control in ThailandThis qualitative research study entitles “the Evolution of the Tobacco Consumption Control in Thailand” was conducted with an aim to systematically chronicle the evolution of the control of tobacco consumption as well as identify the factors leading to those critical events. Moreover, the process and approaches used by the organizations of various parties and impacts from those critical events were also investigated through the methods of reviewing of all documents available in Thailand relation to the tobacco consumption control and interviewing of 15 persons. The investigators also set up an arena for two sessions of brainstorming of thoughts from academics, administrators and implementing staff involved.This study uses the critical events as the determinant units of analysis and denominators for classification of the development periods in Thailand’s tobacco consumption control that can be divided into four periods. They are 1) prior to 1986: a period of unorganized efforts without continuity; 2) 1986-1989: a period of coordination and setting up of organizations; 3) 1989-1991: a period of forced open market to the imported cigarettes; and 4) 1991-1996: a period of legislative measures and tax enforcement. The classification of periods mentioned above makes one realize that the control of tobacco consumption in Thailand has been in existence for over four decades with the initial characteristics of lack of organized activities and continuity. It was not until 1986 that a non-governmental organization by the name of a No Smoking Campaign Project was established. This organization has set up interesting strategy, process and method of working in collaboration with other agencies. Later, there was an establishment of the National Committee for Control of Tobacco Use in 1989. A setting up of the Office of Tobacco Consumption Control in 1990 has subsequently led to a formulation of a policy, plan and better coordination among all agencies from different parties concerned. In addition, during the period of 1998-1991, a critical event took place where the United States of America used the article 301 of its trade law to force Thailand to open its market to the US cigarettes. This incident at the period of time has had major impacts on Thailand in many ways. It caused  the Thai society to realize the negative impacts on the health, economic, social as well as environmental issues from opening its market to the imported cigarettes. It also accelerated the drive in campaigning against cigarette smoking in Thailand. An implementation of activities to control the consumption of tobacco during the past decade (1986-1996) has fostered a “value” in the Thai society to reject the practice of cigarette smoking in public places. This has resulted in a better protection of the right of non-smokers and a decrease in the rate of cigarette smoking among the Thai population, particularly those in the age group of over 40 years. The results of the data analysis of this study have shown the implementation procedures and methods used by individuals, offices, and organizations from many parties in the critical events. The data analysis also revealed the supporting factors leading to the success and those failing to facilitate the control of tobacco consumption in the past. Recommendations deemed beneficial to the future implementation of the tobacco consumption control have also been proposed for consideration.


location: , 'Thailand year: 2022 source: HSRI

title: Pharmacogenomics of Thai Kidney Transplant Patients

abstract: Kidney transplantation (KT) prolongs life in patients with kidney failure. KT requires the use of immunosuppressive agents such as tacrolimus (TAC) and mycophenolate mofetil (MMF) to prevent rejection of the donor kidney, which will result in graft loss. Drug levels for both TAC and MMF vary very widely in individual patients. Too high levels may increase the risk of complications such as infections and bone marrow suppression whereas too low can lead to KT rejection. MMF is a prodrug, which is hydrolyzed to mycophenolic acid (MPA) after oral administration. Quantification of MPA levels requires several measurements to construct an area under the curve over a 12 hr. period (AUC0-12) as a single trough level is a poor predictor of AUC. Because of the time constraint and cost, a full MPA AUC is rarely performed, and MMF is usually given as a fixed-dose combination. Unlike MPA, trough levels of TAC are an accepted method to estimate TAC AUC and are widely used in clinical practice. Trough levels vary widely between individuals after a fixed dose. Low trough levels of TAC has been shown to be related to the risk of rejection and decreased long-term outcome. Known genetic polymorphisms in enzymes related to MMF hydrolysis, MPA excretion, and reabsorption have been shown to contribute to the highly variable individual MPA AUC Similarly, several genes have been identified to account for variations in TAC trough levels. Previously, we have demonstrated the importance of polymorphisms of a few genes linked pharmacokinetics of MMF and TAC in Thais that differs in some aspects from the Western population. Nonetheless, all known genes that can influence drug levels have not been evaluated in Thais. Moreover, additional genetic polymorphisms as yet unknown may be important to determine drug pharmacokinetics and could predict the risk of transplant complications. A complete knowledge of gene polymorphisms and their frequency in the Thai population would lead to the development of a more accurate algorithm for individualized prescription of immunosuppressive agents, reducing complications and leading to improved patient care. Study objectives i) Collect DNA for whole genome sequencing of patients undergoing kidney transplantation for Genomic Thailand 2) To identify novel polymorphisms and evaluate contributions of known and unknown polymorphisms linked to trough-level tacrolimus in KT patients 3) To identify novel polymorphisms and evaluate contributions of known and unknown polymorphisms linked to area under the curve level of MPA in KT patients 4) To develop algorithms to dose MMF และ tacrolimus using clinical and genetic data 5) To evaluate risk of gene polymorphisms of alleles linked to MPA and TAC levels and complications of KT Methods This was planned as a retrospective and prospective study of patients with diseased-donor and living-related KT from Ramathibodi Hospital, Siriraj Hospital, and Chiangmai Hospital (n=1000) over a 2-year period. Relevant clinical details and drug details will be collected. Blood was collected for Genomics Thailand, and a separate sample will be kept for on-site analysis. Results We have enrolled 841 patients (in excess of the 500 planned for the first year). We have set up an assay of MPA and metabolite assay by ultra-high-performance liquid chromatography-tandem mass spectrometry. We measured AUC 12 hr. of MPA in 200 patients and are measuring known gene polymorphisms using a targeted high-evidence pharmacogenomic PCR array, which includes 2,000 variants in 150 genes in these patients. We will link MPA levels and TAC to these genotypes as well as develop a predictive algorithm in the first part of year 2. Conclusions and plan We have enrolled 841 patients (of target of 500 in year 1). In year 2, we requested to increase our enrollment to 1500 patients. (in total years 1 and 2). In the early part of Year 2, we will conclude an analysis of associations of known gene polymorphisms with MPA AUC and trough TAC levels using PCR array as well as develop an algorithm to predict outcomes. Later in Year 2, we will evaluate the relationship between MPA AUC and TAC levels in the rest of the patients once the Genomic Thailand data becomes available. In addition, we will link the risk of complications such as rejection and infection or marrow suppression with gene polymorphisms linked to drug metabolism.


location: , 'Thailand year: 2003 source: HSRI

title: Issues associated with the Ping river and public health conditions

abstract: This study describers a Health Impact Assessment (HIA) to identify issues associated with the Ping River which affect public health. The first step in the project, scoping, has been conducted for 8 months, from December 2002 to July 2003. The main objectives of the project are 1) to study 4 dimensions  (physical, mental, social and spiritual) of the public health issues associated with the Ping River; 2) to identify the impacts from those public health problems; and 3) to create learning processes at the local level, which will lead to development of better public policy.	The study area was three districts in Chiang Mai Province (Mae Rim, Muang and Saraphree). Each of these districts lie on the Ping River. The main differences between them are in land use. Mae Rim, the northernmost (upstream) District, is rapidly urbanizing from a rural basis, because of its many popular tourist attractions and its position on the main highway north from Chiang Mai. Agriculture is still extensive around Mae Rim. Muang District, in the central part of Chiang Mai province, has a relatively high population density. Here the dominant uses of the Ping River are residential and leisure activities. There are many restaurants on the river banks and the scenery is quite beautiful. The southernmost and most downstream district is Saraphree. This is still a rural area and local culture has been retained. The three districts are connected by the Ping River and share a similar geography, human society and ecology. Any changes in the river’s upstream character will be transmitted to the downstream areas and may influence the physical, mental, social and spiritual dimensions of public health.	The realization of the need for effective decision making by governmental organizations which can affect the Ping River, and which can impact local communities in both positive and negative ways, produced a brainstorming seminar between researchers of this project and government representatives from the local and central levels. In the past, local government officers have conducted many missions, without approaching the public for advice, which have promoted resistance to government ideas and a lack of public participation as a consequence. There has also been overlap in the activities of some different government organizations, which has resulted in waste of time and loss of public money. After the brainstorming sessions, more than 500 questionaires were issues to the public living in the areas of study, asking them how issues related to the Ping River related to the 4 dimensions of public health described above. The results of the survey showed that the most serious for the public was loss of access to the Ping River. The river was reported to be narrower and shallower than before, because of soil erosion from the banks and intrusion of businesses into the river area. These issues affect the 4 dimensions public health as follows: 1) Social public health is affected because of fewer traditional cultural activities; 2) the mental health of the population is reduced due to irritation over poorer water quality and/or riverbank intrusions; 3) physical health is worse because of rashes from contact with river water; and 4) spiritual  health can be negatively affected by human intrusions into the common river area for private personal benefit without community agreement. Spiritual health can also be affected positively, through the retention of culture and tradition, which respects and values the river.	An analysis of the answers and responses from the questionaires was presented to the “Ping River, Environment and Public Health Meeting”, attended by many stake holders. The aim of the meeting was to inform the public, listen to the response and share ideas about the issues. The meeting concluded that the main problems were; 1) Uncontrolled urban development, which caused contamination of water, improper land use along riverbanks and loss of local cultures and traditions; 2) Lack of public participation in decisions over the usage and care of the Ping River, which allowed individuals and small groups to gain  personal  benefit, and avoid law enforcement; 3) Lack of knowledge of consequences of their actions by managers causing more problems, such as changing the direction river flow increasing bank erosion and concrete  construction that ruined river scenery.	These issues arose because some government organizations and members of the public still lack appreciation for the importance of conserving the Ping River. The three issues mentioned above could be solved by a public relations program to promote the appreciation of the value of the Ping River to  the  community. Also government must act with understanding on issues in each particular area and address the real cause of the problems. It is most important to listen to public concerns and get both public and non-governmental organizations, which can be important contributors to policy, to be involved together in the successful long term protection of the Ping River and for sustainable local development.


location: , 'Thailand year: 2023 source: HSRI

title: Knowledge and Policy Linkage Mechanism between Health and International Trade: A Case Study of the National Committee on International Trade and Health Studies (NCITHS)

abstract: This research article studied the role of the National Committee on International Trade and Health Studies (NCITHS) in terms of policy coherence linking knowledge to performance and outcomes. The research employed qualitative methods including documentary research and in-depth interview to collect data based on the research framework namely strategic-constituencies approach, goal attainment, and theory of change. The findings showed that NCITHS could frame knowledge and policy coherence in case of monitoring public policies and became a participatory platform to create ‘trust’ among policy actors to willingly share information. However, there were some obstacles, including the organizational structure, limitation of policy recommendation, inconsistence of position and person in committee’s composition as well as the limitation of presenting academic information to reach policy stream. The research suggests that NCITHS should become a formal platform for participation and create a databank about international trade and health policy. Moreover, the working process should be proactive and support political communication beyond academic circles to the broader public.


location: , 'Thailand year: 2020 source: HSRI

title: Thailand’s COVID-19 Integrated Systems Simulation Modeling

abstract: The conceptual framework that policymakers in Thailand can use to deal with the pandemic of the novel coronavirus SARS-CoV-2 (the COVID-19 pandemic) under the contexts of Thailand‖s health systems might be driven from compartmentalized thinking or decision supports from experts in health disciplines. But the COVID-19 pandemic is a complex problem, with interconnected causes of the health, social and economic problems, and uncertainties of how to solve such problems as only limited knowledge exists due to its nature of an emerging disease. With compartmentalized thinking, any decision-making could create unintended adverse consequences. However, epidemiologists and health systems researchers can apply concepts and tools of systems thinking to create well-rounded policy options to address the COVID-19 pandemic by investigating all interconnected relationship among factors that can influence the outcome of the disease epidemic, and considering the society as a complex adaptive system that will adapt to both the disease and the disease control policies. Literature suggests that behavioral change of stakeholders can lead to many avoidable problems of COVID-19 in Thai health systems contexts. By the nature of infectious disease, the number of infected people has not increased linearly, but non-linearly. The speed that the disease spreading out depends on the basic reproduction number (R0) that represents an average number of susceptible people who get infected from one infected person, and the effective reproduction number (Rt) that represents an average number of susceptible people who get infected from one infected person taking into the accent of the effectiveness of policies and measures in disease control, where Rt < 1 indicates an effective disease control. A causal loop diagram (CLD) was constructed from qualitative data analyses to demonstrate the relationships among all factors relevant to the epidemic. The CLD points out that many epidemic problems can be a result of adaptations of stakeholders. For instance, the number of infected people in Thailand were minimum and only gradually increased in the early phase of the epidemic, thanks to effective quarantine and isolation measures of those who came back from an international trip, as well as personal hygiene and physical distancing behaviors of the population. But the clustered epidemics at pubs, bars, and a boxing stadium in Bangkok increased the number of newly infected each day in late March led to policy-decision to use the “hammer” measures (closing workplace, stay-at-home policy, work-from-home policy, and travel bans). However, such the policies also created adverse consequences as the workers in Bangkok who lost their jobs due to the workplace close needed to travel back to their hometown, spreading the disease to all over the country. The understanding of epidemic systems from CLD led to the development of system dynamics simulation models (SD), which can be used as an integrated systems tool for addressing the COVID-19 problems by adding policies and measures upon the epidemic model, such as increasing personal hygiene and physical distancing, and enhancing the capacity of outbreak investigators and healthcare facilities. Experimenting each policy option on the simulation modeling can help policymakers decide which policy potentially results into the most effectiveness and the least unintended consequences. In the long-run, it can also be used for synthesizing healthcare reforms strategies on how to mitigate the future epidemics, reduce consequences of epidemics on the vulnerable populations and health inequity, and improve the health systems resilience and be more ready for any future crises.


location: , 'Thailand year: 2013 source: HSRI

title: Purchasing and Eating of Food and Beverages in Primary 6 Students

abstract: Unhealthy diets consumption in particular early starting in children is a crucial determinant of health
conditions and diseases. There is less research on diet purchasing and eating behaviors among children in Thailand. The objectives of this study were to explore food and beverages purchasing and eating behaviors
of primary grade 6 students. A hundred of students were randomly selected from 453 students in two
provinces. The students were asked to complete a self-administered questionnaire on food and beverages
consumption. They received a certain amount of cashes to buy any food and beverages in convenience
stores; type and prices of food and beverages they bought together with purchasing behaviors were observed.
To gain more understanding of students’ eating and purchasing behaviors, 39 out of them were
drawn for semi-structured in-depth interview. Descriptive statistics and content analysis were applied to
these data. Of total 100 students, most of them had good eating behaviors as consuming breakfast (89%)
and vegetables and fruit (97%). The proportions of students reported eating unhealthy diets: snack, bakery,
fast food, candy and sweetened beverages were 100%, 98%, 97%, 90.9% and 90.9%, respectively. In
purchasing part, the most bought unhealthy food and beverages were sweetened beverages (91.7%), followed
by snack (67.9%), bakery (46.4%) and candy (39.3%) which expenses were between 21 and 40 baht.
It was explained that not only food and beverage taste and personal preference but also environmental
factors as family roles, availability and location of outlets around schools, and ease to access as arrangement
in front of the counter together with advertisement of unhealthy food and beverages had potentially
influence on students’ eating and purchasing behaviors. The findings of this study illustrate that children
substantially consume unhealthy food and beverages. Therefore, there are needed for more attentions and
measures at both individual and environmental levels.


location: , 'Thailand year: 2001 source: HSRI

title: The concept and the role of NGOs in health reform

abstract: This research aims to study the concept and the role of NGOs in health reform. It explores NGO network which has been involved in community development, target group development or public social development. The main methodology includes focus group discussion, complied six case studies of NGOs as well as conducting in depth interview with 14 activists who have played significant roles in the health system. The research discovered that, from the NGOs’ perspective, the general health system problems arise from the national development policy that principally aim for economic growth. Health services and public health are adopted systems that are too westernized and only seek profit maximization. In the same vein, economic production and labor development are based on the principle of western education, which is rooted in self-interest attitude. Consequently, any laws related to health issues are controlled by the principle of western medicine, clinging to government administration and being influenced by private sector. Furthermore, the government is viewed as operating its public health system under centralized control, with an emphasis on curing rather than preventing. Its principle is strongly rested on non-integration and a single plan in order to solve health problem all over Thailand. NGOs have been taking part in resolving health and public health issues through various approaches. This is seen as an important role in reforming health system in particular by supporting community organization, research development and knowledge rehabilitation as well as health technology development. At the same time, herbal medicine, Thai traditional message, alternative medicine, consumer protection as well as social empowerment to answer any health-related issues. It is agreed by the NGOs that the governmental health reform only recognizes the important of institution and organizational reform. In term of health issue, a personnel development and capacity building to raise self-reliant, including the protection of consumer rights must be in the heart of government’s working operation. This is believed to be an alternative thinking against the mainstream principle. While the NGOs are viewed as one of the main stakeholders in promoting public health reform, but they do not see the importance of governmental public health reform’s approach. Suggestion emerges from the NGOs regards to the public health reform is to provide equitable access to government health service so that every group of people in the society achieve healthy livelihood and become self-reliant. Equally important, the government should support people participation, decentralization, flexible attitude, support alternative medicine, self-reliant as well as policy and legislation adjustment.


location: , 'Thailand year: 2002 source: HSRI

title: Promoting the civil society and mass media for health system reform

abstract: Promoting the Civil Society and Mass Media for Health System ReformThis study is a participatory action research project launched in 4 provinces of 4 pouts of Thailand, including: Nakornratchasima, Trung , Phitsanuloke and Samutprakarn for 18 months  during May 2000 to October 2001.The objectives are to study existing relationships among three local networks:   public health network, mass media network and civil society network ; and to promote learning processes and cooperation model development for creating  health system reform movements at local level.The project  was  delivered by a central team and 4 area teams of researchers. The operation has 4 steps: (1) study the area contexts and mapping local potentialities (2) workshop of the researchers and some key persons from the target networks to identify a definite issue for social movement, target  groups and to design a process of movements (3) take action (4) workshop for lessons learning and synthesizing a body of knowledge about the possible roles of civil society and mass media for promoting the health system reform.The project findings are:	1. In the process of social movements promoting the health system reform to be a consensus local agenda, the issue of “social health” is sound possible and appropriate because local communities have holistic viewpoints for their health.	2. The powerful communications to promote local agenda of health need an integrative model of mass media, traditional media and personal media which request an appropriate designing for a specific area. 	3. A civil society of mass media for local health could be easily organized by setting a angular platform for health issue dialogue. The stakeholders, local intellectuals, academics, professionals, mass media and traditional media are the target groups to participate the forum, which should be started from their common heath problems or same local public issues.	4. The local civil society has potential roles of  “the learning process” and “the movements for social change” which takes part in social a wareness, promoting of  people   participation and local interactive learning through actions as well.


location: , 'Thailand year: 2003 source: HSRI

title: Cost and efficiency of public and private hemodialysis centers in 2001

abstract: This study was aimed to estimate cost profile, unit cost and performance of public and private hemodialysis (HD) centers throughout the country for the year 2001(2544BE). A self administered questionnaire survey was distributed to the whole 170 HD centers. This is to solicit information on labor cost (including salary, wages, fringe benefit and overtime payment) and time allocation for HD center only, direct material cost for providing HD services (excluding public utilities and related drugs for the treatment of complications). We use straight line depreciation cost for capital investment in HD machines (5 years useful life) and buildings (20 years useful life).A multiple regression was used to estimate cost function of HD centersWe got 117 questionnaire returned, 69% response rate, with 108 complete forms for analysis (64%). By 2001, there were 730 machines operating, 56% owned by publicand 44% by private. Private HD centers had higher productivity (number of sessionper HD per day) than public. On cost profile, the ratio of labor cost to material cost to capital cost was 40:43:17. Total costs of public and private HD center were 273.9 and 259.7 million Baht respectively. Capital cost of public HD center was 10% higher than the private HD centers. Unit cost per HD session was 1,927 Baht in public and 1,525 Baht in private HD centers. Multiple regression demonstrated that total sessions and session per HD per day determined total cost of public and private HD centers, with R2 of 0.865.We performed breakeven analysis, the current charge per session was high enough in both public and private to perform their productivity higher than the breakeven point.Reimbursement of 1,500 Baht for social security workers was too low and that hospital set charge higher than 1,500 Baht for them. Scatter-gram where X axis represented session per HD per day and Y axis represented unit cost, demonstrated that private HD centers were more efficient than public centers.This study should provide a strong ground for further policy analysis on expansion of renal replacement therapy for the Universal Coverage scheme. In the meantime, HD centers could improve its performance through reduction of unit cost and increase productivity. To improve the performance, there was a need to solve administrative problems at micro-level, such as staff incentives.


location: , 'Thailand year: 2022 source: HSRI

title: New Normal of Emergency Stroke Care System in Public and Private Hospitals during COVID-19 Pandemic

abstract: The situation of the COVID-19 pandemic affects the modification of the public and the private healthcare system. The new normal emergency care system for patients with stroke in public and private hospitals during the COVID-19 pandemic research project aimed to 1) review literature specifically addressing emergency care models for stroke patients during the COVID-19 outbreak, 2) develop a new normal emergency care model for this particular patient group, and 3) study the effects of this proposed model that were implemented in public and private hospitals. This research and development project integrated a mixed-method design that included a systematic review and quasi-experimental research. The research instruments were the checklist for evaluating the model and semi-structured interviews. Each one of the public and private hospitals in Trang were purposely selected to participate in the study. Forty participants were recruited including ten pre-hospital patients with acute stroke, two heads of emergency departments (EDs), four ED physicians, twenty ED nurses, and four emergency medical technicians (EMTs). The findings showed that the common emergency care model for stroke patients during the COVID-19 outbreak was divided into three phases. The first phase was prehospital care which consisted of telestroke, modified code stroke with CORONA protocol, and transport team COVID-19 specific ambulances. The second one was in-hospital care at the ED which included the OVID-19 screening protocol and protected strike code. The last one was hospitalization which was focused on universal pandemic precautions and isolation. The selected hospitals developed three emergency stroke guidelines for COVID-19 that were 1) the stroke fast track for stroke patients with PUI/COVID-19 infection, 2) the mechanical thrombectomy for stroke patients with PUI/COVID-19 infection, and 3) the stroke unit (SU) admission during the COVID-19 pandemic. Both hospitals developed the new normal emergency stroke care which differed from the pre-COVID-19 pandemic protocol. The main differences between pre- and poststroke care models were 1) universal prevention for COVID-19: patient isolation, mandatory mask-wearing, and personal protective equipment for health care personnel, 2) medication: do not use rt-PA for stroke patients with severe COVID-19 infection and coagulopathy and be aware of antiplatelet and antiviral drug interaction, and 3) use telemedicine for minimizing in-person contact. Three specific protocols were established following these considerations which consisted of 1) the COVID-19 stroke fast track protocol, 2) the mechanical thrombectomy protocol for patients with PUI or COVID-19 infection, and 3) the stroke unit admission protocol during COVID-19. After the proposed model was implemented in both hospitals, the results revealed that ninety-nine percent of the respondents agreed on the appropriateness and applicability of the model content and process. Moreover, the proposed model increased patient and staff safety and reduced patient mortality rates. However, the time from stroke symptom onset to emergency room arrival was longer than usual due to the procedure for putting on the full personal protective equipment (PPE). The problem and obstacle in implementing the proposed model was the limitation of the mechanical thrombectomy for stroke patients with PUI/COVID-19 infection because there were a few neurointerventional radiologists and nurses who could help physicians performing the mechanical thrombectomy. In addition, there was a lack of a training program for neurointerventional radiologists in Thailand. Per the findings, the proposed policies for all stakeholders consisted of 1) the training program development for neurointerventional radiologists, 2) the development of nurses' competency in performing specific procedures for stroke patients, and 3) the diminishment of delay in hospital arrival and stroke treatment.


location: , 'Thailand year: 1998 source: HSRI

title: The outcome study of the decentralize budgeting system of Nonthaburi provincial public health office

abstract: The decentralize budgeting system of Nonthaburi Provincial Public Health Office 	The effectiveness study of Nonthaburi Provincial Public Health Office (NPPHO) budget allocation was carried out using both qualitative and quantitative ทmethod. The qualitative study was done by indepth interview and focus group discussion with 72staffs from retrospective document analysis The study consisted of two parts :  the first part was carried on during 1997 fiscal year , the second part carries on during 1998 fiscal year. 	The outcome of the first part show that the strategy of NPPHO, which allowed multi health care worker to participate in project developing process, increased both work morale and compliance. The majority of the projects were about health promotion and human resource development. The evaluation about the appropriateness of the project by the relevant between the objectives and existing health problems, the objective and strategies used, the objective strategies and the budget show that the mean was about the middle. The project development was done by whole district health alliance team or separately done by the hospital and district health office the merge the project together to make the district major plan.	The outcome of the second part reveal that appropriateness of the projects improve and there were more health team approach to solve district health problems, and the activities of the project was initiate by the DPHC personal. The study also reveal that every district followed the activities plan of each project. The indepth study of best project of each district show that each of best projects had strong points about activities initiation that correlate with potential of the personal and the health care team.


location: , 'Thailand year: 2020 source: HSRI

title: An Application of Cultural Pluralism Healthcare System in All Healthcare Services for Health Promotion and Services in   Accordance with Sociological Context of Deep South, Thailand

abstract: Background: The deep southern border provinces consist of Pattani, Yala, Narathiwat and 4 districts of Songkhla province--Nathawi, Chana Thepha and Sabayoi, which are the diverse areas of life under the framework of beliefs, religions, cultures, and other traditional ethnic groups. Besides, there has been a situation of unrest and violence for more than 15 years, affecting health service systems, quality and accessibility. This research is a descriptive study aimed to explore the feasibility of applying the multicultural health service standards for the three levels of health services in those areas to meet the spiritual needs, religions, cultures and customs of each ethnic group or focus on the culture of the sub-groups, contributing to health equity. Methods: The study consisted of 2 phases between June 2018 - November 2019: phase 1, the draft criteria were developed in 5 steps. First, documentary research was reviewed and synthesized to provide a general understanding of the multicultural health service standards in other countries. Second, the survey was conducted to draw the opinions of people in the area by using questionnaires. Third, the focus group discussion was performed between the recipients and health service providers. Fourth, in-depth interviewing was a loosely structured interview among the service management team such as the hospital director, head of district public health, and the local government organizations. Fifth, the content of the standards was screened and standardized by experts such as provincial public health doctors in Delphi techniques. A total number of 5,555 people were given information in these processes. Phase 2, a feasibility study of using standards was launched in the pilot areas with 3 steps: (1) the standards were approved by policymakers to consider into action, (2) the standards were implemented in pilot hospitals, and (3) an evaluation and monitoring was then proceeded to announce as a policy. Results: The multicultural health service standards were finally drafted and organized into 7 main criteria and 47 sub-criteria. The standards were then implemented in 4 hospitals in study areas and 1 hospital in the other area that has a similar context. The parallel evaluation during the trial period revealed that the customers’ opinions for the service quality were 88.6-99.4%. They knew, needed and satisfied this service that was 34.3%, 99.2%, and 97.1% respectively. While the health care providers know about this service 100% and need it 85.0%. The outcomes also provided 97.9% of the concrete model and 98.6% having good management for customer complaints. Suggestion and conclusion: The feasibility study of the multicultural health service standards utilization in the Southern border provinces has contributed to familiar and acceptance among recipients and health service providers. Therefore, this is an opportunity for the Ministry of public health and local administrative organizations to promoting as a policy to apply in all health services and in communities for better service accessibility in the long run.