location: , 'Thailand year: 2022 source: HSRI

title: The Effects of Hospital and Home Telerehabilitation Based-Program on the Cardiopulmonary Function in Patients with COVID-19

abstract: Background: There are several recommendations for the role of a physiotherapy program (PTP) in patients with COVID-19. However, the role of PTP in COVID-19 patients with mild to moderate severity during their hospital stay remains limited. In addition, there are lack of studies on the effects of telerehabilitation in COVID-19 after discharge from the hospital. Thus, these are the reason for the current study. Objectives: 1) to determine the feasibility, safety, and effect of PTP programs in acute phase of COVID-19 patients, and 2) to investigate the effect of home-based telerehabilitation (HBT) in COVID-19 patients after discharge from the hospital. Study design: This research was a quasi-experimental study design Methods: This study comprised of two phases. Phase I (In-patient phase): Fifty-two participants were equally assigned into two groups matched on gender and age (1:1 ratio). Most of participants were identified as mild to moderate severity of disease. Experimental Group one (Ex-G1) and Experimental Group two (Ex-G2) received 1-2 times and once a day of PTP, respectively. Outcome measures included the survival and mortality rates, length of hospitalization (LoH), referrals to the intensive care unit (ICU), in-hospital complications, adverse events for patients and the physiotherapists Phase II (Out-patient phase): Participants in the control group (n = 26) were instructed to perform stretching exercises, breathing exercises, and their preferred general exercise program. Participants in experimental group (HBT) (n = 25) received aerobic exercise combined with resisted exercise and breathing exercise for 3 months. Participants in control and experimental group were called by the physiotherapists one time/ month, and one time/ week, respectively for monitoring their exercise program. The outcome measurement comprised of six minutes walk test (6MWT), one minute sit to stand (1MSTS), pulmonary function test (PFT), hand grip dynamometer, body composition, and quality of life (SF-36). Results: Phase I (In-patient phase): The overall survival rate was 98%. There was no difference in LoH between groups. One participant from the Ex-G2 was referred to the ICU. Two and four of the participants had complications in Ex-G1 and Ex-G2, respectively. There were no participants who had serious adverse events during and immediately after PTP. None of the physiotherapists tested positive for COVID-19 after performed bedside PTP. Phase II (Out-patient phase): None of participants of both groups reported of any adverse events during performed their exercise at home. There were no physical fitness components found significant differences between the group. 6MWT, and 1MSTS, were significantly increased compared to the baseline of both groups. Conclusions Phase I: The PTP is safe and feasible for COVID-19 patients in the acute phase, and safe for physiotherapists. A randomized controlled group should be confirmed the beneficial effects in the future. Phase II: The HBT is safe and feasible for patients with mild to moderate severity of COVID- 19. The higher degree of COVID-19 severity might have seen the differences in outcome measurements.


location: , 'Thailand year: 2012 source: HSRI

title: Research questions for health decentralization in Thailand

abstract: The Constitution of the Kingdom of Thailand mandated the decentralization of public services including
health; however, not only has there been no significant progress, existing evidence has not been
systematically synthesized. The purpose of this study is to identify the missing knowledge about health
decentralization in Thailand. Documentary research was employed to create the initial research framework,
which was then compared against the pool of existing evidence. The final framework was criticized
in order to bring forward specific research questions.
Three main research areas for health decentralization in Thailand were identified: (1) Regional Health
model development, (2) Capacity strengthening of local authority, and (3) People participation model in
health decentralization.


location: , 'Thailand year: 2022 source: HSRI

title: Artificial Intelligence for Active TB Case Finding

abstract: Tuberculosis (TB) is a global health problem. It not only causes disease burden measured by combining the years of life lost due to premature death and years of life lost due to time lived in state of less than full health, but also results in economic burden. In 2015, the World Health Organization classified Thailand as one of 14 countries on all three “high burden country” (HBC) lists: tuberculosis (TB), multidrug-resistant tuberculosis (MDR-TB), and TB/HIV. Based on recent estimates made by the WHO, Thailand had 119,000 new TB patients in 2016, equivalent to an incidence rate of 172 per 100,000 population. This rate is more than 50 times higher than those in developed countries and is the cause of death for up to 12,500 people per year (1). Artificial intelligence (AI) algorithms can be trained to recognize tuberculosis-related abnormalities on chest radiographs. This study aims to develop deep learning model to classify tuberculosis related chest radiographs using data from the national tuberculosis program. Method: We collected chest radiographs from the active TB screening project of the national tuberculosis program. Then, expert chest radiologists reviewed and classified images into one of six categories according to the standard recommendation for reporting chest radiograph for TB screening from the royal college of radiology of Thailand. Next, we developed deep learning model from this dataset. Conclusion: In the first part, we collected and classified 80,086 chest radiographs according to the study protocol. In the second part, we successfully developed deep learning model to classify TB related or non-TB related chest radiographs with AUC of 0.94.


location: , 'Thailand year: 2019 source: HSRI

title: Development of genome-based analysis platform and identification of genomic markers for epidemiological investigation and prediction of drug resistance in Mycobacterium tuberculosis (Year 2)

abstract: Tuberculosis (TB) remains a public health problem in Thailand and causes socio-economic consequences. Studying of epidemiology and biology of Mycobacterium tuberculosis, a causative agent of TB, development of rapid diagnosis of drug-resistant TB, and effective treatment are urgently required for effective prevention and control of TB. Genotyping of M. tuberculosis strain based on specific genomic markers has been widely used for epidemiological study. Particularly, single nucleotide polymorphisms (SNPs) are current genomic markers appropriate for epidemiological and evolutional study and also for prediction of drug resistance. From the first-year study, we could develop the whole genome sequence analysis pipeline for prediction of resistance to first-line anti-TB drugs (isoniazid, rifampicin, streptomycin and ethambutol) and for rapid genotyping. Comparison with results obtained from standard drug susceptibility testing, the analysis pipeline had sensitivity and specificity of 94.6% and 98.5% for isoniazid, of 92.4% and 99.6% for rifampicin, of 85.3% and 98.9% for streptomycin, and of 66.7% and 97.9% for ethambutol, respectively.  For genotyping the pipeline showed 100% concordant results with the standard LSP. In addition, SNPs databases for drug resistance and genotyping were created from this study. In the second year of the study, the automatic genome analysis pipeline for prediction of drug resistance and for genotyping was developed and validated with a test sample set of 50 M. tuberculosis strains comprising of 41 isoniazid-, 43 rifampicin-, 23 streptomycin-, 27 ethambutol-, 12 amikacin-, 13 kanamycin-, 25 fluoroquinolone-, 11 ethionamide- and 15 PAS-resistant strains. Results were compared with those obtained from the standard drug susceptibility testing and revealed the sensitivity and specificity from 82.6 to 92.6% and from 87.0 to 100%, respectively, for prediction of first-line anti-TB drugs. The sensitivity was lower for prediction of second-line drugs; sensitivity and specificity ranged from 66.7 to 80.0% and from 92.0 to 100%, respectively. The automatic genome analysis pipeline also showed 100% concordant results with the standard LSP for genotyping.


location: , 'Thailand year: 2001 source: HSRI

title: Self-care development in family and community

abstract: This study was aimed at firstly analysing and reviewing domestic and international issues of self-care for individuals and communities, secondly synthesising recommendation for developing self-care behaviour at various levels and thirdly synthesising statements which should be put in the National Health Act and National Educational Act. The study was carried out by reviewing written document and gathering views of many experienced people. All inputs were analysed, interpreted and synthesised recommendation. The results were as following:to understand the development of self-care behaviour, we must understand interrelationship of three parties which were governments, professionals and people,self-care behaviour could be classified into 5 levels, individual self-care, individual self-medication, individual self-care for chronic diseases, group self-care and health promotion, and individual self-care in form of social movement,self-care is regarded as a dimension of life,proposed statement should include the government support and promotion for proper self-care,self-medication is more likely to damage health than create health,proposed statement should include the government support for right self-medication and for consumer protection at all levels,support / self-help group is considered useful for stigmatised health problems,proposed statement should include emphasis on strengthening family institution and community,building groups for self-care is important and appropriate for current Thai society.


location: , 'Thailand year: 2022 source: HSRI

title: Immunologic and Molecular Genetics Studies of Diabetes Diagnosed Before Age 30 Years in Thailand

abstract: Currently, there are no epidemiological studies in Thailand on diabetes diagnosed before the age of 30. Long-term studies in Thai children and adolescents have been published periodically less 5 years ago. Recent evidence has shown that the ratio of type 2 diabetes in Thai children has increased as well as type 1 diabetes. The etiology and clinical features of diabetes in children and adolescents have tendency to change according to environmental factors and lifestyles. The study of diabetes diagnosed under 30 years old, The project was to collect baseline patient data for registration of diabetic patients admitted to network hospitals across the country. Basic data from the patients were analyzed. Autoantibodies against three islets antigens, GAD65, IA2 and ZnT8 were measured in the laboratory to determine the incidence of type 1 diabetes. To examine the molecular genetics of diabetic patients diagnosed before the age of 30. This study was conducted in patients who were clinically compatible with NDM and MODY. The subject who had negative autoantibodies will be used to study the variation of diabetic genes by whole exome sequencing. Data on the number of people with diabetes diagnosed before the age of 30 in Thailand were collected from 31 network hospitals nationwide. Sample specimens were obtained from 750 diabetic patients diagnosed before the age of 30 years. 448 cases of type 1 diabetes (59.7%), type 2 diabetes 156 (20.8%), 43 cases of MODY diabetes (5.7%) A study of autoantibodies against three antigens islets GAD65, IA2 and ZnT8 found that patients with type 1 diabetes were positive 61.3 %. Of the 316 patients with type 1 diabetes, GAD antibody positive 52.2%, IA2 antibody positive 34.8%, and ZnT8 antibody positive 28.7%. Fourty-four patients clinically compatible with MODY subtype, in which diabetes is a dominant familial trait and no islets autoantibodies. Based on exome sequencing analysis, gene variations associated with diabetes were reported in 15 cases, while the other 29 patients with MODY had no previously reported pathogenic genes (MODY-X). This study, systematic nationwide, is a preclinical and scientific study that directly contributes to Thailand's cognition related to diagnosed diabetes under 30 years of age in Thailand. It can be used as an empirical reference and may lead to the formulation of appropriate public health policies related to diagnosis. Treatment and prevention of diabetes in young people in Thailand as well.


location: , 'Thailand year: 2000 source: HSRI

title: The effectiveness of health education activity with support from village health volunteers to preventive on hemorrhagic fever and diarrhea among family health leaders in Trang province

abstract: The effectiveness of Health education activity with Social support from Village Health Volunteers to Preventive behaviour on hemorrhagic fever and diarrhea among Family health Leaders in Trang Province	The research aims to evaluate the effected of health education by social support of village health volunteer. The PRECEDE model to diagnose the effected of knowledge and behavior for preventing Dengue Hemorrhagic Fever and Diarrhea of the family health leader.  The results from this research aim to apply for planning and group processing for changing behavior of family health leader. The quasi experimental model is research design. The family health leaders were sampling from 4 villages of tambol Nakhaosia in Nayong district.  There are one village was a Dengue Hemorrhagic Fever preventing project and another one was a Diarrhea preventing project village. The other two villages are control area. The samples collected from 60 people of any village by interview form, observation form and social support asses form. The data were collected pre-intervention and after 6 month intervention. The media intervened are video, poster and documentary sheet. 	The results found that family health leaders have a significant changing behavior for preventing Dengue Hemorrhagic Fever and Diarrhea. They have improving in knowledge of disease, risk factors, violence of disease. The results also showed the social support are significant relation for Dengue Hemorrhagic Fever and Diarrhea prevention behavior.


location: , 'Thailand year: 2016 source: HSRI

title: Cost-effectiveness of Thrombolysis Service for Patient with ST Segment Elevation Myocardial Infarction in Community Hospital

abstract: ST segment elevation myocardial infarction (STEMI) is a major cause of death. Recent evidences
showed that primary percutaneous coronary intervention (PPCI) can reduce mortality rate. However, in a
situation where PPCI is unavailable, a facilitated percutaneous coronary intervention (FPCI) using fibrinolytic drug before patient referral could be an important life-saving solution. Since FPCI may increase the
risk of major bleeding and incur more expenditure, the information on cost-effectiveness of FPCI is useful
for policy makers.
A Markov model was used to compare the lifetime cost and quality-adjusted life years (QALYs)
accrued to patients receiving FPCI before referral and PPCI at referral center from societal and health
system perspectives. All analyses were performed using Microsoft Excel. Input data were retrieved from
literatures and electronic databases.
We found that FPCI program at community hospital is a dominant alternative given its lower cost
and higher effectiveness than PPCI at referral center. This means it is a cost-effective policy option.
Therefore, community hospitals with the capacity to provide FPCI service for STEMI patients should
be supported to offer such service for better access to the patients with higher overall quality of life and
lower costs to the systems. We suggest that policy makers in the Ministry of Public Health and the hospital
administrators should consider these findings and provide support to make FPCI available in community
hospitals with existing capacity. Capacity strengthening particularly in terms of manpower, and budget
should be provided especially in the areas where there is still shortage of supply.


location: , 'Thailand year: 2023 source: HSRI

title: Development of a Model of Primary Health Care Services of the Social-Bonded Elderly for Transferring Health-Promoting Hospitals Sub-District to Provincial Administrative Organization Kamphaeng Phet Province

abstract: The objective of this study is to examine access to and obstacles in accessing health promotion and disease prevention services in health-promoting hospitals Sub-district transferred to the Provincial Administrative Organization (PAO), Kamphaeng Phet Province. The data was collected through in-depth interviews, questionnaires, and group discussions. The participants were selected based on specific criteria through in-depth interviews and group discussions with service providers, recipients, and stakeholders, totaling 70 people. The questionnaire was distributed to 418 service recipients. Content analysis and statistical analysis were used to analyze the data. The study found that during the transfer of the Sub-district Health Promoting Hospitals to the provincial administration in Kamphaeng Phet, the primary healthcare services provided to socially isolated elderly people through the hospital network remained unchanged. For example, community hospital or hospital network continued to provide support in terms of medicine, medical supplies, and medical equipment to the health center just as before the transfer. However, there were still some obstacles to service delivery, including 1) Insufficient personnel for service delivery, particularly in cases where health centers did not have enough staff to support the transfer or did not meet the required staffing levels. 2) No family medicine physicians were available to provide services at health centers as required by law. 3) Delayed and restricted budget allocation for supporting health centers. 4) Personnel were concerned about compliance with the Ministry of Public Health regulations. 5) Village health volunteers were concerned about work practices. 6) Communication of information was not comprehensive. 7) In the long term, community hospital or hospital network may not be able to allocate resources (people, money, materials) to health centers outside its jurisdiction. On the patient side, the study found that patients without transportation or who worked on a daily basis were unable to access services/activities. In addition, it has been found that the public places importance on promoting health and preventing diseases. According to a survey of factors influencing the decision to use basic healthcare services among socially isolated elderly people in Kamphaeng Phet province, they generally expressed a high level of satisfaction with the basic healthcare services, at 67.7%. They also had a high level of interest in overall activities, at 51.9%, with the top five activities they wanted organized being group exercise, elderly schools, elderly clubs, vocational training for the elderly, and monthly meetings to reduce stress among the elderly. Furthermore, the majority of the elderly people believed that if the health-promoting hospitals Sub-district transferred to the PAO, the quality of service would improve, at 72.8%. This is because it would be a change in management and service delivery to a larger organization that would be better able to manage budget, personnel, vehicles, and equipment to provide better service. The desired activities after the transfer, ranked in order of importance, were having a resident physician at the public hospital, having exercise/health promotion activities for the elderly while waiting for medication, and having more staff available at the public hospital. The results of this study will be useful for guiding service provision in the context of health-promoting hospitals Sub-district under the PAO that are responsive to the needs of the population, comprehensive, and integrated, which will improve the quality of life of the people.


location: , 'Thailand year: 2001 source: HSRI

title: Current Potential of Pharmaceutical Manufacturing and Trend of Production Technology

abstract: Thai Pharmaceutical Industry:Present Status and Potential-Future TrendThe purpose of this study was to find appropriate means to support and strengthen the pharmaceutical industry.  The present status and potential of the industry were analyzed and the future trend of technology was predicted.  The study comprised two parts.  The first one involved a brain storming session among 34 participants from both private and governmental sectors including one FDA personnel.  Sending a questionnaire to the pharmaceutical manufacturers asking about their activities was the second part of the study.  Twenty six factories, 2 of which did not obtain GMP certificates, responded to the questionnaire.	It could be concluded that the nature of the industry was formulation process.  The research and development dealt with formulation and process improvement.  The industry received little support in production and quality control aspects from both the government and the universities.  However, satisfactory support was received in the areas of GMP improvement and drug importation.  Approximately 90% of the raw materials was imported while only 6% of the finished products was exported.  Most formulations were generic products.  Due to a lack of technology and expensive equipment, very little products required sophisticate technique.  To develop and strengthen the industry, fair competition should be stressed.  Instead of emphasizing low pricing, the government should urge the manufacturers to concern more in the quality of the products.	The study indicated that Thai industry had a potential to develop and compete with the neighboring countries.  It was believed that both the numbers of factories and drug registration would be declined.  If the government authority supported fair and free competition and reviewed the low-priced bidding policy, in addition to the universities’ assistance, the pharmaceutical industry would be moving forward.


location: , 'Thailand year: 2021 source: HSRI

title: Smartphone-Based Point-of-Care Testing (POCT) System and Platform

abstract: Development of rapid diagnostic tests are a fundamental component for an effective public health system. At present, the availability of rapid diagnostic test and equipment quality in Thailand still insufficient. In this study, we aimed to develop the smartphone-controlled electrochemical sensor operated via Near Field Communication (NFC) as portable devices for screening test. This study used the electrochemical gas sensor to detect blood alcohol concentration from breath sample. For hepatitis B detection kit, the operating system was composed of a card-sized electrochemical NFC tag sensor integrated with a smartphone and antibody-modified electrode with gold nanoparticles to provide high sensitivity and β-cyclodextrin (β-CD). The modification and immobilization processes were verified by electrochemical impedance spectroscopy (EIS) and cyclic voltammetry (CV). The electrochemical immunosensor was then used to quantify Hepatitis B surface antigen (HBsAg) by measuring the current-time response obtained from amperometric detection. The current from the Fe(CN)63-/4- redox couple was measured before and after addition of HBsAg. A resistance-based lateral flow immunosensor diagnosis device (R-LFI) that integrated NFC with portable smartphone for L. interrogans detection in clinical samples. The performance of R-LFI sensor was evaluated using recombinant LipL32 (rLipL32), L. interrogans, and clinical samples. The results showed that the performance of the smartphone-based breath alcohol sensor was acceptable (SD ≤ 1.4mg%). Under optimal conditions, a linear calibration curve and a limit of detection for HBsAg were found to be 10-200 μg/mL and 0.17 μg/mL, respectively. The R-LFI device exhibited linear responses toward rLipL32 protein in phosphate buffer and L. interrogans spiked in healthy human serum samples within concentration ranging from 1 to 100 ng (limit of detection, LOD: 0.16 ng). This platform is sensitive, specific, simple, label-free, and requires small sample volume. These desirable features make it particularly suitable for resource-poor settings. However, these device improvement needs to be studied for commercial use in the future.


location: , 'Thailand year: 2008 source: HSRI

title: Clinical Research Collaboration Network and Basic Bio-medical Research

abstract: Basic bio-medical research is an essential component in public health for dealing with increased and
complex threats from emerging, re-emerging and existing prevalent diseases in the modern world. The
existence of a critical mass of scientists, personnel, facilities and technology, working concurrently with
efficient public health and clinical facilities, capable of producing high-quality scientific information
related to diseases or problems, is a critical component for any nation, in particular for developing countries facing health threats. The article gives a close-up view of the experiences of a network of bio-medical
research within academic institutions collaborating with clinical facilities within the Ministry of Public
Health. The purpose of collaboration was the production of essential scientific information that could
translate into useful clinical and epidemiological applications. The article reveals the tacit potentials, in
personnel and facility, embedded within the Ministry that, if properly managed and supported, could be
utilized in order to enhance this essential collaborative activity


location: , 'Thailand year: 2011 source: HSRI

title: Food and Beverage Tax and Price Interventions: A Systematic Review

abstract: While a fiscal policy has been shown to influence food and beverage prices in ways which help encourage
healthier eating behaviour, evidence about the use of tax and price interventions is still unclear and
questions about their effect still remain. A systematic review on food and beverage tax and price interventions
was conducted in order to explore evidence about tax and price interventions to promote healthy
dietary behaviours and investigate their effect on consumers. The English and Thai-language published and
grey literature for studies on tax and price interventions including monetary subsidies or taxes levied on
food and beverage and their effects were searched. Twenty-seven studies met the inclusion criteria. 4 were
from the peer-reviewed literature, 21 were published online and 2 were from grey literature. The studies
mostly focused on taxing snack, confectionary, soft drink and soda, and on subsidizing staple food such as
rice, wheat and maize. These interventions particularly taxation were found in influencing diet and body
weight. In conclusion, taxes and subsidies in food and beverage may be a useful tool contributing to healthier
consumption patterns at the population level. However, more information is needed on actual response on
food and beverage and consumers in food and beverage taxation and subsidy in developing country particularly
Thailand along with information on how effective food and beverage taxation and subsidy would
be and particularly their effect on people in developing countries.


location: , 'Thailand year: 2016 source: HSRI

title: The Cost of Institutional Long Term Care for Older Persons: a Case Study of Thammapakorn Social Welfare Development Center for Older Persons, Chiang Mai Province

abstract: This study aimed to quantify the cost of institutional long-term care at Thammapakorn Social Welfare
Development Center for Older Persons in Chiang Mai Province in 2014. The population of the study
was all 104 older persons who lived at the center. The sample comprised 24 older persons with at least moderate dependence level as measured by activity of daily living or ADL scale (N = 24). Activity-based
costing was used. Cost allocation was based on long-term care needs of each older person in the sample,
documented through activity logs and records of resource utilization pertaining to each activity within 72
consecutive hours. Two sets of costs were estimated, depending on assumptions related to depreciation
expenses of the following cost items: buildings, vehicles and equipment. It was found that, based on the
first set of assumptions, the average costs of institutional long-term care for older persons with total ADL
dependence (N = 19), with severe ADL dependence (N = 4) and with moderate ADL dependence (N = 1)
were 461.39, 456.91 and 445.20 baht per person per day respectively. Based on the second set of assumptions,
the average costs of institutional long-term care for older persons with total ADL dependence, with
severe ADL dependence and with moderate ADL dependence were 449.89, 445.42 and 433.71 baht per
person per day respectively. Approximately 17% of the estimated costs came from cash and non-cash
donations. The results reflected the fact that the budget received from the government, without monetary
and non-monetary support from other sources, would be insufficient for the level of long-term care being
provided at the center.


location: , 'Thailand year: 2000 source: HSRI

title: Development of alternative health systems to promote the health of middle-aged women : a situational analysis in the North, Northeast, and South

abstract: The purpose of this qualitative study was to explore the situation of alternative health systems for promoting the health of middle-aged women in 3 regions of Thailand. The study was undertaken at health services institutions and public places both in urban and rural areas of Chiang Mai (North), Khon Kaen (Northeast), and Songkhla (South), Three hundred and fifty seven women age 40-59 and eighty-two health discussions were used for data collection during March 1999-Februry 2000. Triangulation and content analysis were used for validation and analysis. Seven main themes emerged in describing an existing situation of alternative health promotion in the way of living and holism 2) Factors and conditions within women’s life and social context that lead to health promotion practice 3) Abundant and confusing information on the health promotion for middle-aged women 4) A modern health system which is based on health profession 5) An alternative health system which is independent and community based 6) Alternative health practices which emphasize mostly on nutrition, mind control, exercise, and using chemical agent and 7) Middle-aged women used alternative health systems more than modern medicine but health insurance undermined the health promotion activities. It is suggested that empowering women group in using alternative health systems and expanding their social arena are ways of developing alternative health systems to promote the health of middle-aged women.


location: , 'Thailand year: 2019 source: HSRI

title: Monitoring Prices of and Sugar Content in Sugar-Sweetened Beverages from Pre to Post Excise Tax Adjustment in Thailand

abstract: Thailand has enacted the Excise Tax Act B.E. 2560 and relevant regulations since 2017. As a result, the structure and tax rates of sugar-sweetened beverages (SSBs) have been adjusted with an intention to reduce sugar intake from SSBs. The majority of SSBs containing sugar more than 6 grams/100 ml. have been taxed with different rates according to the sugar contents. However, dairy products have been exempted. The objective of this study was to monitor SSBs’ prices and sugar content, compared between pre and post SSBs tax adjustment. This study used a comparative analysis of prices of and sugar content in SSBs from two surveys (March 2015 and March 2018) and used Mann-Whitney U test to test differences between pre and post SSBs tax adjustment. The results indicated that overall of SSBs’ prices were increased after the tax adjustment (+11.1% by median), both domestic beverages (+12.7% by median) and imported beverages (+18.1% by median). Sugar contents in domestic SSBs were declined (-9.6%), while in imported SSBs increased. In addition, high sugar content in dairy products was not decreased. Conclusion, the study shows that the SSBs tax adjustment may provide a positive change in terms of prices and sugar content as intended, except for imported SSBs and dairy products. Therefore, the excise tax should cover all SSBs and there should be complementary measures to reduce SSBs consumption.


location: , 'Thailand year: 2019 source: HSRI

title: Invention of an Instrument for Balance Assessment and Feedback (2nd year)

abstract: The present study was invention of an instrument for balance assessment and feedback in second year. The purpose of this research was to test the efficiency of the instrument by testing reliability. Forty-two participations, aged range 40-93 years, were recruited into this study. Participants were divided into two groups, including aging group (n=22) and people with stroke group (n=20). The finding showed that reliability of force measurement was very high for both plates (ICC (3,1) = 0.945 for plate 1 and 0.978 for plate 2, p<0.000) in aging group, while reliability of force measurement in people with stroke group was between high and very high (ICC (3,1) = 0.872 for plate 1 and 0.968 for plate 2, p<0.000). Reliability of center of pressure was between middle and high in both groups. In conclusion, the instrument was able to measure force efficiently. However, this instrument should be developed in order to increase effectiveness of measuring center of pressure.


location: , 'Thailand year: 2014 source: HSRI

title: The Effects of Health Behavioral Adaptation Program on Weight Loss among Overweight Secondary School Students in Hat Yai District, Songkhla Province

abstract: The incidence of childhood obesity in Hat Yai District, has become increasingly
high and its effects are likely to worsen in the future. To control and prevent obesity
effectively by behavioral changes, various levels of control and factors are needed.
This quasi-experiment are two-group pretest-posttest non-equivalent control. The
main objectives of the study were to compare health behavior and weight loss among
secondary school students whose weights were higher than the standard body weights
before and after participating in the programs, and to investigate the results of the
programs in terms of policy of school administrators, school physical environments,
peer influence, health service systems, school food sellers program, overweight
students program, and parents and guardians program. The subjects consisted of
school administrators, school physical environments, peer groups, health service
systems, school food sellers, parents and guardians. The key subjects were male and
female secondary school students with body weights higher than the standard body
weights in Hat Yai District, Songkhla Province. There were 51 students in each group of
the control and the experimental groups. The behavioral change tools consisted of
administrative policy, physical environmental development, peer influence, health
service systems, parents program, food sellers program, and health behavioral change
program for overweight children. The experiment was from July 2014 to February
2015. The general data were analyzed with frequency and percentage, health
behavior and weights before and after the experiment were compared using Wilcoxon
Signed Ranks Test and Mann-Whitney U Test. Analysis was performed with qualitative
data on school administrative policy, physical environmental development, health
service system, and food sellers in the school.
The study found that after the experiment, the experimental group had a
higher level of health behavior in food consumption than the control group at a
statistically significant level of p<.05, the level of health behavior in exercise for the
experimental group was also higher than that for the control group at the level of
p=.05. The effects of the programs on weight loss revealed that the average of
ordinal scale for the experiment group decreased with a statistic significance of (p<
0.05) while that for the control group increased with a statistic significance of (p< 0.05).
The results of the study indicate that the health behavioral change program
improved health behavior among the overweight secondary school students, and
decreased their weights.


location: , 'Thailand year: 2010 source: HSRI

title: Resolution on Managing Overweight and Obesity in the 11th National Economic and Social Development Plan

abstract: Obesity is a global epidemic affecting both the developed and developing worlds alike. Overweight
and obesity has also been found to be on the rise among Thailand’s male and female population. More-over, they are considered as a leading health risk factor in the Thai population. Tackling overweight and
obesity in Thailand has lead to the formation of the Resolution on Managing Overweight and Obesity,
which has finally been endorsed by the National Health Commission, and was also approved by the
Cabinet in 2010 as part of the Thai national agenda. Meanwhile, the Office of the National Economic and
Social Development Board (NESDB) developed the 11th National Economic and Social Development Plan
as a strategy for national development over the next five years. The aim of this study is to analyze the
consistency between the Resolution and the 11th Five-Year Plan. The results of the study will be useful in
formulating the National Action Plan for overweight and obesity, as well as in reflecting the drafting and
approval process of the 11th Plan.
Comparatively, the key approach for the development of the 11th Plan focuses on an individual-level
defensive approach, such as the promotion of education among the Thai population. The Resolution
focuses not only on a defensive approach, but also on an offensive approach, with a wide array of regulatory
interventions, such as tax, pricing, nutrition and food labeling, and food marketing restrictions. The
strategies of the 11th Plan, for example, trade liberalization, discourage regulatory interventions for curbing
overweight and obesity. Unhealthy foods have increasing access to the market. Although preventive
approaches that would affect trade agreements and trade liberalization are proposed, they would be implemented
after these foods access markets. It seems clear from the literature that the international trade
issues need to be considered in the context of public health, including improving diets and health education.
The implementation of both defensive and offensive approaches, for example, the promotion of
education through food and nutrition labeling interventions, may increase the effectiveness of efforts to
improve healthy behaviors among the population.


location: , 'Thailand year: 2022 source: HSRI

title: Determination of Research Direction/Questions to Inform the Introduction of the National Drug System Development Strategy

abstract: Rationale: Founded in 2009, HSRI’s Drug System Research Program has been operated as research granter and manager. In response to continual changes in Thailand’s drug system and its environment, it is necessary to revise the research direction and also enhance the Program’s management capability. Objectives: 1) to propose research direction and questions those help strengthen the Thai drug system; 2) to conduct a review of HSRI’s Drug System Research Program since its establishment in 2009; and 3) to make recommendations to the HSRI concerning drug system research management over the next five years. Methods: This study was conducted during November 2021 to June 2022. Qualitative approaches, namely document analysis, in-depth interview, and focus group discussion were involved. Results: 1. Research direction for Thailand’s drug system: over the next five years, priority should be given to research in six areas: 1) Governance of the drug system, 2) ‘pharmaceutical management and care’ to catch up the transforming health service delivery, 3) Medication literacy, 4) Roles of civil society in drug policy development and implementation, 5) Drug system and disasters /public health emergency, and 6) Development of drug industry for the country’s self reliance. 2. Review of HSRI’s Drug System Research Program: The Program’s focus was on research management at the program and organization level, without formal mechanism to gather and prioritize research questions from policymakers and stakeholders. A framework for drug system research was set annually, but some elements were left without submission from researchers. Most of the research grants were given to address the issue of rational drug use and antimicrobial resistance. Additionally, different tactics were employed in order to encourage research utilization. 3. Recommendations for drug system research management: over the next five years, HSRI should pay attention to managing drug system research at country level. The following actions should be taken: 1) Enhancing the capability of research managers, 2) Learning from past experiences of HSRI and other organizations, 3) Setting a clear definition and scope of “drug system research”, 4) Analysing the landscape of the country’s drug system research, and 5) Building drug system research capacity. Conclusion: The landscape of drug system research in Thailand is complex, as different groups of actors have a role in evidence generation and utilization. This means that national research strategy and effective governance mechanism are required, in order to pursue not only policy-relevant research with high quality, but also efficient use of resources.


location: , 'Thailand year: 2011 source: HSRI

title: Hospital Production Function : Technical Efficiency and Its Determinants of University, Regional, and General Hospitals in Thailand

abstract: Input-orientated Data Envelopment Analysis was used to measure the technical efficiency of 7
university hospitals, 24 regional hospitals and 43 general hospitals in Thailand in year 2009. The results
revealed there were 53 efficient hospitals (71.62%) from 74 total hospitals; in addition, the percentages of
efficient hospitalsin order of highest to least percentage were university, regional, and general hospital
(85.7%, 83.3%, and 62.8%).While the percentages of scale efficiency (SE = 1) in order of highest to least
percentage were regional, university, and general hospitals (75.0%, 71.4%, and 44.2%).
The next step was to identify the determinants of hospital efficiency with regression analysis using
ordinary least squares (OLS). The results revealed three significant explanatory variables for TEVRSi scores
such as bed-physician ratio, numbers of physicians, and nurses-physician ratio. The most positive influential
determinant of TEVRS scores was bed-physician ratio; however, the negative influential determinant of
TEVRS scores was nurse-physician ratio. While the significant explanatory variable for scale efficiency (SEi)
scores was the in-patient visits adjusted with median relative weight of DRG


location: , 'Thailand year: 2008 source: HSRI

title: A note on an outbreak of Botulism in Phayao province, 2006

abstract: The objectives of this descriptive study of a food-borne botulism outbreak caused
by the consumption of minced barking-deer meat in Phusang district, Phayao Province
were: (1) to confirm the diagnosis of botulism and the outbreak of the disease; (2) to
study the characteristics of the disease’s epidemiology, the outbreak and the distribution
of the disease; (3) to find the cause of the outbreak, source and vector of transmission of
the disease, and (4) to measure the disease control interventions. Descriptive and analytical
epidemiological studies used retrospective cohort studies to prove the hypo- thesis
of relative risk (RR) factors.
The result of this study found that 69 persons (26.53%) of the 260 persons who ate
the barking-deer were hospitalized in Chiangkham Hospital (between 24 June and 5 July
2006). The majority were males (62.31%), aged 30 - 60 years (34.62%). The main symptoms
of infection were abdominal distension, stomach ache, nausea, diarrhea, dry mouth,
difficulty breathing, and vomiting, respectively. An analytical epidemiological study
found that the food that caused the illness was raw minced barking-deer meat (RR = 2.04,
95% CI = [1.11 - 3.75] and showed that the persons who ate the raw meat were two times more to get the disease. As for other barking-deer body parts, it was found that the bile
(RR = 1.66,95 % CI = [1.13 - 2.43]) and entrails (RR = 1.66, 95% CI = [1.10-2.05] were the
main risk factors. The laboratory results confirmed that seven of the patients who got
botulism survived.
It was suggested to the public health institute and the officials related to the Bureau
of Epidemiology that they should take care of the people by emphasizing the importance
of hygiene and not eating raw meat, especially entrails, and that they should change their
consumption behaviors.
It was also suggested that the next research (1) study the consumption behaviors
related to eating raw meat and find methods for reducing illness, and (2) study ways to
communicate information on safe consumption behavior.


location: , 'Thailand year: 2016 source: HSRI

title: Social Stratification Social Inequality and the Explanation for being Vulnerable People in Society

abstract: This article aims to apply the concept of social stratification to explain social inequality. This will
help understand who is vulnerable population in the society. The authors have reviewed the literature of
concepts and theories in social sciences that can explain and rank the social stratification. Moreover, this
first phase of the big research project “Social Stratification in the Context of Thai Society and Health Status”
applied in-depth interviews and meetings with experts from March 2015 to March 2016 to select indicators of social stratification measurement appropriate to the context of Thai society. The research finding explains that social stratification and social inequality are conceived from the life chances concept as the beginning point of differences of human being. Life chance either by nature, by culture, or by social situation, leads to social differentiation, social stratification and eventually social inequality. Social stratification measures can be used to rank people by two approaches: 1. Objective measures of social stratification cover five indicators; 1) Birth origins 2) Standard of living in household 3) Economy 4) Education and 5) Health, and 2. Subjective measures of social stratification also cover five indicators; 1) Social status 2) Freedom and liberty 3) Fraternity 4) Consumption and lifestyle and 5) Class awareness. All of the above indicators of social stratification will be utilized to find populations who are the most disadvantaged, or the “vulnerable populations.” This finding has contributed to help build life chance guarantees, social equality and social equity for the vulnerable in Thai society in the future.


location: , 'Thailand year: 2009 source: HSRI

title: Synthesis of Public Policy: The Road Accident Victim Protection Act, 1992

abstract: This synthesis paper was aimed at sheding light on the current performance of the Road Accident Victim Protection Act, 1992. It also attempted to identify ways and means to improve the status quo. The paper drew from the literature information pertinent to the law and its enforcement in Thailand and to similar laws and their enforcement in other countries. A comparison of concepts, principles and evidence related to these laws and their performance was also made. Public interest was put ahead of private interests in the comparison. It was found that over a period of 16 years of the law’s enforcement, it succeeded to a certain extent in protecting the interests of Thai road accident victims in terms of compensation
for medical costs and loss of life. Nevertheless, success came at the expense of road accident victims and health insurance systems:
1. Hundreds of thousands of victims and their families were not covered by insurance due to ignorance, concern about legal action under the fault system of the law, and difficulties in making claims owing to the complicated extra rules and regulations set up by private insurance companies.
2. Unnecessary costs were incurred under the current compensation system operated by private insurance companies.
3. Opportunities to make use of medical care with ongoing quality improvement were lost, which could have been financed by a more efficient compensation system.
4. The burden of medical care costs on the victims was shifted to other health insurance schemes due to cumbersome access to the road victim compensation scheme.
Proposed strategies to improve the current system are the following:
1. Replace the existing law with a proposed bill so that public agencies will replace private insurance companies; hence, unnecessary costs could be cut and claim procedures could be simplified greatly.
2. Modify premium collection by point-of-sale revenue collection from the price of fuel. This would preclude the need to pay commissions and other costs related to premium collection.
3. Adopt the compensation recovery unit model of the United Kingdom to improve efficiency in processing claims.
4. Expand the scope of missions to include financing for quality improvement of medical care and road accident injury prevention.


location: , 'Thailand year: 2017 source: HSRI

title: Peritoneal Dialysis Patients Care: Treatment, Surveillance, and Prevention of Peritoneal Dialysis-Related Infection Using Evidence-Based

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


location: , 'Thailand year: 1999 source: HSRI

title: Legislation for road safety

abstract: Legislation for Road Safety	Law is a tool for road accident prevention by controlling social behaviors and resources allocation. It is simply said that law shapes road users’ behaviors into more safety conscious behaviors and forces car producers to develop their products more regarding safety use. Despite having 3 Acts relating to road safety, Thailand has never reduced numbers of road accidents for the past three decades. This review was aimed at answering such problems and led to recommendations for improvement. According to the review, the three Thai Acts were similar to many developed countries’ in many ways; however, their limitations found in the review were: 	1. the Acts partly needed amendment in line with dynamic changes of road communications,	2.  lack of continuity of law enforcement and the bias of enforcement partly due to shortage of community preparation and of knowledge integration in terms of automobile engineering and financing knowledge, 	3.   lack of knowledge-based policy and law development,	4.  Thailand’s governance of strong centralization inhibitive to law enforcement,	The review recommended that contexts of the Acts be amended and related policy and law development be more accountable to social equity and efficiency.


location: , 'Thailand year: 2023 source: HSRI

title: Primary Care Services Provision during the Implementation of 3-Healthcare Team Policy in the Northeast of Thailand

abstract: This research aimed to evaluate situations of primary care services and to examine influencing factors towards providing desirable primary care in 7 dimensions: service delivery, health workforce, health information systems, accessibility to essential medicines, financing, leadership/governance, and community participation. A total of 468 respondents from the community health centers and subdistrict health promoting hospitals in the Northeast of Thailand responded to the questionnaires based on guidelines for health service systems improvement. The data were analyzed using descriptive statistics (frequency, percentage, mean and standard deviation); and inferential statistics (binary logistic regression). The results showed that the overall mean score in providing desirable primary care services was 2.29 (SD = 0.39) from full score 3. Service delivery and health workforce had the lowest scores at 1.73 (SD = 0.51) and 1.92 (SD = 0.68), respectively. Of these respondents, 66.0% reported that their patients were cared for by family doctors, 52.4% was the proactive care service provided by the 3-healthcare teams (family doctor, public health professional and village health volunteer) and 50.2% by village health volunteers. Ten of the 76 primary care providers had doctors working after office hours, 96 primary care providers had no doctors even on the rotating schedule. Village health volunteers were reported to be an active health information sender by 78.0%. Moreover, 73.7% requested for improvement of the 3-healthcare team service. The five lowest-score services needed improvement were rehabilitation, consumer protection of the health products, physical activity promotion, emergency medical service, and sanitation. Influencing factor towards the provision of desirable primary care services was the registered primary care unit (adjusted odds ratio = 5.16, 95%CI 1.33 to 20.12, p value = 0.018), while the factors of health region, size of population, size and standard of primary care units were not statistically significant. To improve primary care services, the adequate human resources as the requirement for registered primary care unit according to the Primary Care System Act should be adhered. This would help provide essential primary care services entirely, adequately, and appropriately for Thais.


location: , 'Thailand year: 2021 source: HSRI

title: Economic Evaluation of rasagiline and apomorphine for treatment of patients with advanced Parkinson's disease in Thailand

abstract: BACKGROUND: Patients with advanced Parkinson’s disease (PD) usually experience motor complications including dyskinesia and on-off fluctuations or off-state, defined as the amount of time spent with poor or absent motor function per waking hours, which substantially impact on the quality of life and cost of treatments. Current treatment guidelines included dopamine agonist or monoamine oxidase B (MAO-B) inhibitors or catechol-o-methyl transferase (COMT) inhibitors as adjunct treatment to Levodopa. The benefit of these treatments could affect to reduce the amount of time spent in off state and physical disabilities. Because of those treatments are still expensive and there was a limited cost-effectiveness study of anti-Parkinson drugs in advanced PD in Thailand, the cost–effective study is an important tool to inform policy decision making. Moreover, the results of this study will be used to support policy makers to determine whether the treatments should be included into the National list of essential medicines (NLEM). OBJECTIVES : The objectives of this analysis were to evaluate cost-utility of continuous subcutaneous apomorphine infusion (Apomorphine) + Levodopa tablet (tab.) and Rasagiline tab. + Levodopa tab. compared with Entacapone tab. + Levodopa tab in advanced PD patients and to estimate budget impact for providing drug treatment in next 5 years. METHODS: Markov model was used to estimate relevant costs and health outcomes using a lifetime horizon from societal and government perspectives. Direct medical and direct nonmedical costs were collected. Health outcomes were life years (LYs) and quality adjusted life years (QALYs). The results were presented as the incremental cost-effectiveness ratio (ICER) in Thai baht (THB) per LYs and QALYs. Costs and outcomes were discounted by 3% per year. Oneway and probabilistic sensitivity analyses were performed to investigate effects of model variable uncertainties on the results. RESULTS: Base on societal perspective, Apomorphine + Levodopa could reduce off-time and delay disability which resulted in increasing life years and quality of life compared with Entacapone tab. + Levodopa tab. The ICER value of lifetime treatment was 3,532,143 THB/QALY. In case that dropout rate was 55% and lifetime treatment was assumed, the ICER value was higher than that of providing 5-year treatment (3,426,000 and 2,997,588 THB/QALY, respectively). In those receiving treatment for 4, 3, 2 and 1 years, the ICER were 2,952,609, 2,944,111, 3,280,817 and 4,966,960 THB/QALY, respectively. Moreover, Rasagiline + Levodopa treatment could decrease off-time the same as Entacapone + Levodopa, whereas the cost of Rasagiline was higher than Entacapone (ICER value=1,551,447 THB/QALY). The additional budget required for providing Apomorphine for recent patients (18 cases) and new case (10 cases) was 6.9 million THB per year. Moreover, providing Rasagiline for recent patients (25,322 cases) and new case (595 cases) was 138 million THB per year. CONCLUSIONS: Based on the willingness to pay threshold 160,000 THB/QALY, Apomorphine + Levodopa and Rasagiline + Levodopa would not be cost-effective compared with Entacapone tab. in Advanced PD patients, in recent drug price. However, based on the cost-effective threshold, the price of Apomorphine and Rasagiline should be reduced by 90% and 25%, respectively.


location: , 'Thailand year: 2022 source: HSRI

title: Hill Tribe Community Model Development for Preparedness and Response COVID-19 Epidemic, in the Border Area of Thailand-Myanmar

abstract: A community participatory action research aimed to assess knowledge, attitudes, and practices to prevent COVID-19 among the hill tribe population living in border areas including the impacts of the COVID-19. The ultimate goal was to to develop a model for preparedness and response COVID-19epidemic in the area. A validity questionnaire and special training programs developed were used as the tools. A total of 2,518 people were recruited. A moderate level of knowledge and attitude were detected. While a good level of practice to prevent the disease was found. Students were impacted from the pandemic of the COVID-19 in several dimensions such as having to stop studying and having trouble with online learning. The employees were terminated, and their salaries. Many people had debt during the pandemic. Farmers could not sell their products. A large proportion did not get the compensation from the government due to lack of Thailand national identification card (ID card). After the training, it was found that knowledge and attitude towards COVID-19 prevention and control of the participants improved significantly. The villagers were transformed from knowledge and prevention skills from people who attended the training program. There were many approaches to transferring knowledge and skills to the villagers: village broadcast, small group discussion, and small group training. All people in the villages had a better knowledge and skills in COVID-19 prevention and control with evidence of regular hands washing, wearing a mask and social distancing. Disease prevention and control implementation should be collaborated among community leaders, village health volunteers and villagers to maximize the effectiveness and efficacy especially under the situation of travelling restriction.


location: , 'Thailand year: 2000 source: HSRI

title: Health Promotion in the Support Services Department's Personel and their Families

abstract: Health Promotion in the Support Services Department’s Personnel and their Families	The pilot project of health promotion for the military personnel in the Support Services Department and their families is aimed for altering health behavior, physical environment and social environment. The expectations are hoping them to have better health, delightful office work, warm families and peaceful community without temptation by letting the personnel and member of their families to take part in the activities as much as possible. There were 997 personnel and 1,227 member of their families took part in this program.	The research was assessed by comparing the variation in 3 target groups which are administrators, military personnel and medical staffs, whose in charge of looking after their health, by hold on interview and answer questionnaires collaborating with the activities for brain storming in searching problems and answers, including physical environment survey around their office and their living area.	After collecting data for 1 year, the project was succeeded according to the 18 steps plan. 3 target groups were identified as follows: the military personnel has better knowledge how to keep healthy e.g., smoking was reduced from 26.90% to 24.82%; health problem survey is improving e.g., excess BMI was reduced from 18.21% to 9.43%, high blood lipid was down  from 11.27% to 10.36%; the administrators decided to improve their welfare, accident prevention and alter policy, rules and orders  facilitating healthiness. The promising result from this research can be used as a guideline promoting health to a military personnel at any other Thai Armed Forces’ units.


location: , 'Thailand year: 2005 source: HSRI

title: Grievance System in Public Health Insurance Schemes

abstract: This study explore grievance and compensation systems in the major public health insurance schemes, namely the Civil Servant Medical Benefit Scheme ( CSMBS ), the Social Security Scheme ( SSS ), the 30 Baht Scheme, and the Compulsory Car Accident Insurance Scheme.	The Servant Medical Benefit Scheme ( CSMBS ) has practically no grievance or compensation systems. However, its fee-for-service payment scheme coupled with eligible member’s rights to choose their ( usually public ) providers help making the scheme less susceptible to substandard care experienced in other scheme that pay providers mainly on capitation basis. The Social Security Scheme ( SSS ) was the first public health insurance scheme that set up a formal grievance system. The grievances are usually sent to the SS’s medical committee. If the committee decides that the provider is at fault, it will also recommend the penalty. The penalty ranges from warning, probation, reducing the ceiling number of insured patients, to termination of contract. However, the vast majority of grievances were lifted on the ground that they were caused by miscommunications or patient’s misunderstandings. The 30 Baht Scheme although the intention of such a compensation scheme is to provide relief/settlement that would curb the increasing trend of medical malpractice suits, medical associations view it as a vehicle that would lead to more lawsuits ( or at least complaints ) and have fought vigorously against it. Thus far, there is no convincing evidence to disprove either claim. As a result of the fighting, the scheme is now equipped with regulations that, if strictly interpreted, would allow only compensation to substandard or malpractice cases. In practice, however, many ( provincial ) compensation subcommittees still use the regulation’s ambiguity to interpret it in such a way that they could provide compensation to some other cases based on humanitarian reasons. The Compulsory Car Accident Insurance Scheme is private insurance based and is therefore using the same grievance and arbitrator systems as present in other private insurance schemes.


location: , 'Thailand year: 2022 source: HSRI

title: Evaluation of Acute respiratory infections (ARI) Clinics for COVID-19 treatment and infection control in Ramathibodi Hospital

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


location: , 'Thailand year: 2021 source: HSRI

title: Prediction of Workers’ Health in Gas Stations in Eastern Economic Corridor (EEC) for Screening Purpose

abstract: The aim of this study was to study the health effects among workers from BTEX exposure in gas stations. Data were collected from study group of 100 employees who were working in the fuel dispenser area and the control group of 100 workers who were operating outside the fuel dispenser area. The data collection was conducted thro μg h the interview, determined BTEX compounds in the working atmosphere by using a passive badge sampler, and BTEX compounds from urine as well as the blood test serving a biochemical analysis. The findings of the study had shown that, from 200 informants, the majority of study subjects was female with 68.5%, the average age (SD) was 27.78 (5.95) years-old with body mass index exceeded 32%, smoking 21% and alcohol consumption 17%. The physical and mental health condition during the past year was good 85.0% and 74.0%. Percentage of hours worked per week, mostly workers had 1-2 years 28% whereas the percentage of the working hour for more than 8 hours per day was 36%, and worked 6 days per week was 55%. From the interview, 73% of the workers had abnormal symptoms of neurological system, 52.5% had respiratory tract. Personal exposure to ambient concentrations of benzene, toluene, ethylbenzene and xylene (BTEX) assessed by passive-diffusive samplers in a subgroup of 200 workers were expressed as non-detected for all samplers. Urinary concentrations of biomarkers in the whole group were 431.232 (233.69) g/ g creatinine [59.71-1482.46 g/ g creatinine] for t, t-MA, 0.011 (0.001). mg/ l[0.011-0.013 mg/ l for toluene in urine, 0.341(0.125) g/ g creatinine [0.061-0.772 g/ g creatinine] for hippuric acid, 0.062 (0.015) g/ g creatinine [0.03-0.11 g/ g creatinine] for mandelic acid, 0.414 (0.104) g/ g creatinine [0.20-0.88 g/ g creatinine] for methyl hippuric acid. The means ± SD of hemoglobin between exposed group and non-exposed group, hemoglobin (13.08 ± 1.67 g/ dL vs 13.29 ± 1.53 g/ dL), hematocrit (39.75 ± 5.41% vs , 39.95 ± 4.39%), red blood cell count (5.13 ± 0.77 mil/ μl vs 5.33 ± 0.62 mil/ μl), mean corpuscular volume (MCV) (78.82 ± 10.54 fl vs 78.38 ± 10.53 fl), mean corpuscular hemoglobin (MCH) (26.85 ± 3.72 pg vs 27.69 ± 3.11 pg), mean corpuscular hemoglobin concentration (MCHC) (33.34 ± 1.52 pg vs 33.53 ± 1.05 g/ dl), plt (283.91 ± 67.54 x103 cell/ ul vs 285.94 ± 62.80 x103 cell/ ul), white blood cell (8.65 ± 2.46 x103/ ul vs 8.14 ± 1.82 x103/ ul), aspartate aminotransferase (AST) (29.63 ± 29.87 u/ l vs 36.30 ± 10.67 u/ l), alanine Aminotransferase (ALT) (33.88 ± 48.91 u/ l vs 36.15 ± 19.75 u/ l), blood urea nitrogen (17.72 ± 2.52 mg/ dl vs 12.72 ± 3.21 mg/ dl), creatinine (0.77 ± 0.17 mg/ dl vs 0.68 ± 0.14 mg/ dl), HbA1C(5.72 ± 1.06 vs 5.45 ± 0.94), acetylcholinesterase (7.38 ± 1.73 u/ ml vs 7.85 ± 1.49 u/ ml), cardiac troponin(0.49 ± 0.03 ng/ ml vs 0.51 ± 0.08 ng/ ml). Multivariate logistic regression showed that female [P = 0.001, OR = 2.946 (95% CI 1.586,5.471)] were associated with MCH as well as female [P = 0.043, OR = 2.683 (95% CI 1.032,6.979)] were associated with MCHC. Fueling up to 11 or more vans per day [P = 0.019, OR = 3.952 (95% CI 1.252,12.479)] were associated with WBC. Additionally, no wearing a mask [P = 0.021, OR = 4.797 (95% CI 1.264, 18.211)] were associated with BUN. The number of working hours per day was more than 8 hours. [P = 0.032, OR = 3.122 (95% CI 1.101, 8.851)] were associated with SGPT. Operation at the dispenser P = 0.044, OR = 2.618 (95% CI 1.028-6.667)] were associated with acetylcholinesterase enzyme  Multivariate logistic regression showed that overtime over 6 hours per week [P = 0.067, OR = 2.212 (95% CI 945,5.177)] and no wearing closed shoes [P = 0.033, OR = 2.027 (95% CI 1.057-3.887)] were associated with development of neurological symptoms as well as the duration of sleep per day was less than 8 hours [P = 0.008, OR = 2.932 (95% CI 11.1197,7.18)], overtime over 6 hours per week[P = 0.019, OR = 2.932 (95% CI 1.197, 7.18)] were associated with development of mental and emotional disorders symptoms. As a result of these factors can potentially increase risk of developing the neurological system as well as mental and emotional disorders related illness which results from the exposure to BTEX. Therefore, one should find ways to continuously monitor health and working environment surveillance.


location: , 'Thailand year: 2014 source: HSRI

title: Return to work for stroke patients after treatment

abstract: We aim to study the rates and correlating factors of stroke patients returning to work after treatment
byretrospective descriptive cohort at Prasat Neurological Institute. 198 stroke patients who received treatment
and were subsequently discharged from the Prasat Neurological Institute during January 2010 to
December 2011.Patient medical records were reviewed to select patients who satisfied the inclusion criteria
of the study. Follow-up questionnaires about patient’s return to work were sent to the patients via post.
71.72 % of the 198 stroke patients surveyed could return to work. Statistically significant differences
were found when accounting for occupation, job characteristics, muscle weakness, aphasia of speech,
altered level of consciousness (Glasgow coma score<15), pre-discharge Barthel Index (BI) score, and physical
therapy during hospital admission. Multivariate analysis indicated that only occupation and pre-discharge
BI score contributed to the prediction of returning to work. Patients from private companies vs. governmental
employees had BI scores of 80-100 vs. 0-39, with an odds ratio of 1.279 (0.255-6.41) and 7.333 (2.821-
19.062) respectively. Significant predictors for returning to work after stroke were occupation and predischarge
BI score.


location: , 'Thailand year: 2021 source: HSRI

title: Development of lung model by using a 3D cell culture model for COVID-19 drug development

abstract: The current situation of the SARS-CoV-2 virus infection causing COVID-19 is more serious. The development of antiretroviral drugs is urgently important. To stop the spread of the virus, the lungs model is critical to develop of antiretroviral drugs. Due to, SARS-CoV-2 relies on the Angiotensin-converting enzyme 2 (ACE2) target receptor protein, which is more common in lung cells, and caused of pneumonia. Thus, the focus of this research is to develop a lung model to study the mechanism of viral infection and develop the treatment of COVID-19, because of it is difficult to study biopsy samples from infected people. The aim of this research project is to simulate lung tissue structures using a technique as the Air-liquid interface to create conditions like the pulmonary scaffolds with ACE2 receptor protein expression. Development of therapeutic and drug testing guidelines for COVID-19. The experimental results in two-dimensional A549 lung cancer cells that were induced inflammation by lipopolysaccharide (LPS) was found the highest protein concentration of 0.2 micrograms per microliter. The nitric oxide measurement was observed in LPS-stimulated samples for 24 hours. Inflammation was observed with low nitric oxide about 2 µM, while the three-dimensional with LPS and hydrogen peroxide (H2O2) stimulation, the nitric oxide was not detected. As for the expression of ACE2 receptor that analyzed by Western blot method, the result can be found at approximately 97 kilodalton (kDa) size of the ACE2 receptor. Consequently, the lungs cancer cell line A549 in three-dimensional Air-Liquid Interface was expression ACE-2 receptor. However, the experiments also need to be repeated in the analysis of ACE2 and AT1R expression and control as beta-actin with western blot, and further at the gene level through qPCR analysis in a two-dimensional versus three-dimensional model. To determine the difference in receptor expression in inflammatory stimulation. The model will further investigation of the substance and the stimulation concentration was selected with spike protein instead for stimulation. The antioxidant was measured, and nitrate content will detect inflammation by LPS and H2O2. The problems that cannot trigger inflammation. So, the experiment still needs quality testing and test the concentration of the substance again.


location: , 'Thailand year: 2015 source: HSRI

title: Nutritional Status Changes after Denture Treatment among Elderly in Royal Denture Bestowed Project : A Case Study of Second Health Services Region

abstract: The purpose of this study was to examine changes in body mass index among elderly in royal denture bestowed project. The study design was a retrospective cohort study. Data collection was carried out in 436 subjects, from 6 months to 2 years after denture services. Multiple linear regression was used to analyses the relationship between denture use and body mass index adjusted for gender, age, income level and baseline body mass index.
The results showed that the denture use significantly increased body mass index of elderly in royal denture bestowed project (P < 0.05)


location: , 'Thailand year: 2017 source: HSRI

title: Antibacterials Prescribed to Universal Health Coverage Beneficiaries in Outpatient Departments, Thailand

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


location: , 'Thailand year: 2017 source: HSRI

title: Development of Environmental Management Model by the Aging people in rural areas in Thailand

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


location: , 'Thailand year: 2023 source: HSRI

title: Estimating Cost of Illness of COVID-19 in Bamrasnaradura Infectious Diseases Institute, Thailand

abstract: This study aimed to estimate direct medical cost associated with COVID-19 and compare between COVID-19 severity and pre-existing condition, based on provider perspective. The study was conducted based on a retrospective descriptive study design, incidence-based approached, from 1 January 2020 to 31 December 2021 among 1,667 COVID-19 patients. The direct medical cost was collated using a bottom-up approach. The total hospitalization stays were 23,839 days with average 14.2 days per case. Data were analyzed by descriptive statistics, i.e. number, percentage, mean (standard deviation), median (interquartile range), the minimum and the maximum value. The findings revealed a total direct cost of 608,979,250 baht, the cost per admission was 362,746 baht. The direct labor cost of health personnel caring for patients with COVID-19 was 126,864 baht per admission, 68.5% of total labor cost. The direct medical cost for COVID-19 varied between the severity of COVID-19, and the highest cost was among critically ill and deceased patients was 387,914 baht per admission. The highest direct medical cost among patients with 3 pre-existing conditions and more was 220,463 baht per admission. The study on the direct medical cost for COVID-19 reflected a burden of expenses that the government needed to bear among critically ill and deceased patients caused by COVID-19, as well as patients with pre-existing conditions. The effective preventive measures, i.e. strengthening immunity among high-risk groups of people, can reduce the number of patients undergoing treatments and reduce number of severe patients, the burden of direct medical cost for COVID-19 shall be minimized accordingly.


location: , 'Thailand year: 2018 source: HSRI

title: Effectiveness Evaluation of CARE-call System on Medication Adherence and Reduction of Default Rate in Tuberculosis

abstract: Thailand is one of the 14 listed countries encountering TB, TB/HIV and MDR-TB burden. Poor adherence could cause longer treatment, drug resistance, relapse and death in TB patients. With limited-resources, the coverage of Directly Observed Treatment, Short Course (DOTS) is low. Most of TB patients are under self-medication or family-member DOT, which a forgetfulness to take medicine or an improperly early medicine discontinuation caused by side effects or etiological misunderstanding may exist. Most of adherence measurements performed at a next follow-up, not at real-time, is considered as an end point.  Hence, TB/HIV Research Foundation has developed a CARE-call system, an ICT-based medication adherence monitoring system having an electronic pill box (CARE-box) to further function by alarming patients to take medicine, notifying a health care worker (HCW) to follow up a non-adherence patients and providing two-way communication for the patients seeking for advice from the HCW. In order to evaluate the system’s effectiveness, 300 TB patients were randomly recruited into intervention or control group. Preliminary result obtained from treatment-outcome available participants showed that statistically higher adherence rate was observed in the intervention group while treatment success rate is at 88.2%, higher than the 85% NTP target and lost to follow-up cases were found only in the control group. The CARE-call system was proved to achieve its two-way communication function under around four-time lower per capita cost compared to that of the DOT supported by the global fund. Qualitative study remarked the benefits of CARE-call system through the CARE-box including alarming system, daily pack, two-way communication by meeting the satisfactions of the all the participants invited to attend focus group discussion. From the result, it is believed that the CARE-call system could improve the TB patient’s medication adherence and provide two-way communication at low cost, which is more suitable for a high TB burden country like Thailand to achieve the NTP targets for treatment success and loss to follow-up rates. However, the stability of CARE-call should be improved and provide more useful functions to facilitate the TB treatment and care.


location: , 'Thailand year: 2019 source: HSRI

title: The 2011 Flood Crisis in Bangkok and the Central Region of Thailand: Challenges to a Resilient Health System

abstract: Background and Rationale: The flood disaster which affected Bangkok and the central region of Thailand in 2011 presented a critical challenge to the resilience of Thailand’s health system in the face of sudden crisis. Objective: To explore the extent to which the Thai health system was capable of responding to a public health shock, through the lens of health system resilience, with a particular focus on the issues of ‘awareness’ and ‘adaptability’. Methodology: A cross sectional study design was applied. Data were obtained from the representative household survey in 2011. Descriptive statistics and inferential statistics using t-test, Chi-square test and rank-sum test were applied. Results: Overall, the Thai health system is quite ‘resilient’ especially in terms of ‘awareness’, as demonstrated by the good level of satisfaction that people had with the flood warning messages that they received. However, concerning ‘adaptability’, and using public health relief as an indicator, the Thai health system did not appear to perform well. Households in Bangkok had a better level of awareness than those in the central region. Households in the central region reported greater satisfaction in obtaining external public health assistance than the Bangkokian households. Conclusion: The Thai health system is somewhat resilient in coping with public health shocks, but there remains room for further improvement. An expansion of public health collaboration to all relevant sectors including local communities, non-governmental organizations, as well as media and social networks is needed. Furthermore, re-orientating the health registration system to have clearer catchment areas is recommended.


location: , 'Thailand year: 2022 source: HSRI

title: A Synthesis of Policy Recommendations for Management of The Health Service System at Tertiary Level: North-East Thailand to Support the Critical Epidemic of COVID-19

abstract: The purpose of this research is to synthesis policy recommendations for management of the health service system at the tertiary level in North-East of Thailand in order to support the critical epidemic of COVID-19. This research was conducted between September 2021 and February 2022. Four provinces in the public health region 7,8,9 and 10 namely Khon Kaen, Udon Thani, Surin and Ubon Ratchathani were stratified selected. Mix-methods was adopted based upon the Health Care Capacity indicator and six-building blocks together with policies and regulations issued by the Emergency Decree on Public Administration in Emergency Situations and other related measures. The participants were purposively recruited through administrators at a public health region, provinces, hospitals, COVID-19 committees, health professional and responsible for environmental work of Tertiary hospitals within four provinces, and secondary key informants were a group of stakeholders. The research instrument was the health service management assessment form, in-depth interview, focus group, lesson learn form, and relevant document record form. Quantitative data were analyzed by statistical percentage, mean. Qualitative data were analyzed by content analysis. Each interview was digitally recorded, and the data from the interviews were analysed using Nvivo. The findings revealed ten policy recommendations covering ten issues for public sector organizations as follows: 1) A clear policies and utilization are needed; 2) considering a framework for expanding health professionals; 3) developing a large-scale centralized database system and connecting the use of sharing-data network with public health sectors; 4) establishing a public health region as a juristic person for the development and flexible service; 5) providing training programs to continuously upskill personnel's potential; 6) having a committee to consider the risk compensation of health professionals working during COVID-19 with all health sectors covered by a good moral and fairness and equality 7) Providing clear and accurate information and having public relations which covering target groups and easy to access 8) establishing guidelines for vaccine administration management in accordance with the context and having a committee to consider the compensational payment 9) all hospitals should have the resources planning with an effective strategy, and 10) having a clear organized-screening and health service standards in all public health sectors which participate in raising awareness of people's self-management. This will result in the management system for the management of the health service system at tertiary level to support the outbreak of the COVID-19 crisis in the future.


location: , 'Thailand year: 2020 source: HSRI

title: Effectiveness of Program for Promoting Contraceptive Behaviors to Prevent Repeated Pregnancy in Postpartum Teenage Mothers

abstract: Repeated pregnancy in postpartum adolescents is a crisis that affects their physical and psychosocial wellbeing, including the newborn, family, economic and society. This quasi-experimental study aimed to examine the effectiveness of program for promoting contraceptive behaviors to prevent repeated pregnancy in postpartum teenage mothers. The subjects were 170 postpartum adolescents attending postpartum units at Maharaj Nakorn Chiang Mai Hospital, Lamphung Hospital, Lamphun Hospital, and Phayao Hospital during August 2018 to November 2019. The subjects were purposively selected and divided into 89 as a control group and 81 as an experimental group. The control group received routine postpartum care and the experimental group received the program for promoting contraceptive behaviors. The intervention instruments consisted of 1) the Program for Promoting Contraceptive Behaviors and 2) Handbook of Contraceptive Used for Postpartum Adolescents which developed by the researchers. Instruments for data collection consisted of 1) the Intension on Contraceptive Use for Postpartum Adolescents Recording Form, 2) the Decision on Contraceptive Use for Postpartum Adolescents Recording Form, 3) the Selection of Contraceptive Uses Recording Form, 4) the Utilization Rate of Contraceptive Use for Postpartum Adolescents Recording Form, and 5) the Repeated Pregnancy Rate of Postpartum Adolescents Recording Form.  Data were analyzed using descriptive statistic, t-test for independent sample and Chi-square test.
The results revealed that:
1) The proportion of participant intended to use contraception after the 48-hour postpartum, both groups were not different. The period intended to start contraception in both groups is statistically significant different (p<.01). The experimental group intends to start contraception before returning home or at the postpartum check up more than the control group.
2) The experimental group, which recieced the Program for Promoting Contraceptive Behaviors, has a proportion of the participants that decide to use contraception for three months statistically significant higher than the control group (p<.05), however, there are no different proportions at 6 weeks, 6 months and 12 months after birth of both groups.
3) The experimental groups and control groups have no different proportion of utilization rate of contraceptive use in the three months, 6 months and 12 months after birth.
4) The proportion of repeated pregnancies at 1 year after birth of both groups is no different. The results of this study showed that the Program for Promoting Contraceptive Behaviors to prevent repeated pregnancies in the postpartum teenage mothers is suitable to the context of teenage mothers in the Northern region. Nurse-midwives can be used as a guideline to promote contraceptive use and to prevent repeated pregnancy in postpartum adolescents