Prevalence estimation of dementia among Thai elderly: a national survey.

OBJECTIVE: To determine the prevalence of dementia and its associated factors among Thai elderly. DESIGN: A one-stage cross-sectional national survey. SETTING: National communities in Thailand. SUBJECTS: 4,048 elderly subjects aged 60 and above. RESULTS: There were 668 (16.5%) elderly with a CMT score below 15. Among these elderly, 132 were dependent as to certain aspects of self-care. According to the definition of dementia used in this one-stage survey design (i.e. subjects with a low CMT score and self-care dependence), 3.3 per cent of Thai elderly (95% confidence interval = 2.7-3.8) were classified as having dementia. After adjusting to geographic and municipal area, the prevalence rate was 3.4 per cent (95% confidence interval = 2.8-4). Age-specific prevalence rate increased dramatically from 1.0 per cent in the 60-64 age-group to 31.3 per cent in the 90+ age-group. The prevalence rate of dementia among Thai elderly found in this study did not differ from the prevalence rates among the elderly in other Asian and developed countries. Using a logistic regression analysis, 3 independent factors associated with dementia were age, literacy (writing) and geographic area. CONCLUSION: With a one-stage survey design for determining the prevalence of dementia, the prevalence rate and age-specific prevalence rate among the Thai elderly did not differ from those found in other Asian and developed countries.

Evolution of medical services for HIV/AIDS in Thailand.

BACKGROUND: Thailand started the anti-retroviral supply program in 1992 primarily for low income groups. The budget has increased but coverage has decreased due to the large number of cases requesting supply. Rapid advancement of HIV therapy has resulted in higher drug cost which is not affordable to people in developing countries. The cost effectiveness review in 1995, conducted by staff of the World Bank, World Health Organization, and Ministry of Public Health (MOPH), demonstrated high cost with limited benefit. It encouraged program evolution, from "supply for services" to "supply for research". Faced with an expanding AIDS epidemic and economic set back, Thailand has to adapt its program to fit scientific, ethic, and economic situations. ACTIVITIES: The program now extends to (a) adapting current therapeutic regimens, (b) developing new treatment and (c) natural history study of people with HIV/AIDS who receive anti-retrovirals (ARV), anti-opportunistic infections (anti OIs), or alternative care. Laboratory issues, and prevention activities are also included. To allocate an approximately 300 million baht budget each year, participating hospitals were invited to submit proposals for consideration. Proposals were ranked and supported according to scores and research priority. A clinical research network was set up in 1996 and supply was shipped out in 1997 on double combination for 1,200 cases, with triple combination for 40 cases, all in 58 sites. Investigators were trained for Good Clinical Practices (GCP) to reassure data handling quality. Psychological and social support were encouraged through the health system research network. Until 15 Jan 98, 49 proposals were submitted (42 ARV, 1 herbal medicine, 6 pediatrics/perinatals). A working group consisting of local experts from medical schools, and the MOPH together ranked these proposals. Those with high scores received medical supplies while the low scores received technological advice in order to increase their capability to participate in research in the near future. CONCLUSIONS: Central supply encouraged physicians to treat more cases but discouraged their hospitals to set up their own budget. The clinical research network allowed team and infrastructure building up which can be adapted for drug, vaccine trials and observational databases. More training is needed. For other developing countries, Thailand's experiences should be perceived as an example not a model.