Estimation of non-fatal road traffic injuries in Thai Nguyen, Vietnam using capture-recapture method.

Road traffic injuries (RTIs) are increasing in developing countries where accurate routine data are usually not available. Although a capture-recapture technique has increasingly been employed in studies of human populations to provide reliable estimates of the magnitude of problems, it has rarely been used in road traffic injury research. We applied two sample capture-recapture methods using hospital and traffic police records to estimate non-fatal road traffic injuries in Thai Nguyen City during the years 2000-2004. We generated a conservative adjusted estimate of non-fatal RTIs using data from the two sources matched by name, surname, sex of victims and at least one of the other matching variables, of age, address of victim and date of injuries. We then compared the estimated rates with those reported based on police and hospital data. The results show that during years 2000-2004, the police reported 1,373 non-fatal RTIs, while hospital records revealed 6,069 non-fatal RTIs. Most reported victims on both hospital and police reports were males (67.3 % and 74.4%, respectively). More than half the victims on both hospital and police reports were drivers (77.5% and 66.1%, respectively) or pedestrians (10.6% and 7.1%, respectively). Youth and young adults (ages 15-34) constituted the majority of the victims on the hospital and police reports (52.8% and 63.7%, respectively). The capture-recapture analysis estimated that 11,140 (95% CI: 10,626-11,654) subjects were involved in RTIs during the study period. In comparison to the estimated figure, official sources accounted for only 21.9 to 60.1% of total non-fatal RTIs. Estimated rates of non-fatal RTIs were 105.5 injuries/10,000 population per year and 393 injuries/10,000 vehicles. Given the fact that under reporting of RTIs has been a major limitation of routine official data sets in developing countries, we suggested the capture-recapture method be used as a tool to provide affordable and reliable estimates of RTIs in resource-poor countries.

Serum lipid levels and the prevalence of dyslipidaemia among rural and urban Thai adults--are the NCEP III guidelines appropriate?

The authors' objective was to describe the distribution of serum lipids and the prevalence of dyslipidaemia using US lipid-lowering guidelines in an adult Thai population. Fasting serum lipids were measured in a population-based survey that included 5305 rural and urban Thai adults aged 335 years. The US National Cholesterol Education Program (NCEP) guidelines were used to determine the eligibility of each individual for lipid-lowering therapy. Compared with urban residents, rural residents had lower mean levels of total cholesterol (men. 4.80 vs 5.54 mmol/L, women: 5.18 vs 5.71 mmol/L, both p < 0.001) and high density lipoprotein cholesterol (men: 1.06 vs 1.19 mmol/L, women: 1.13 vs 1.34 mmol/L, both p < 0.001). Mean triglyceride levels were higher in rural compared to urban populations, for both men (2.15 vs 1.88 mmol/L, p = 0.001) and women (1. 73 vs 1.51 mmol/L, p = 0.01). Direct application of the NCEP guidelines identified up to 37% of the adult population (or 10 million adult Thais) as eligible for lipid-lowering drug therapy, which is an unfeasibly high proportion of the population. Urgent strategies are required to prevent increasing levels of dyslipidaemia in Thailand, as well as to develop and promulgate treatment guidelines that incorporate locally-relevant risk prediction functions.

Assessment of capacity for cardiovascular disease control and prevention in Thailand: a qualitative study.

The present study explored community members' knowledge and perceptions about cardiovascular disease (CVD), risk factors and prevention, and identified the current capacity of primary care providers to manage and control CVD at the provincial level. A qualitative study, including in-depth interviews and focus group discussions, was conducted in Suphan Buri Province, Thailand. Participants included community members, CVD patients and healthcare providers in health centers and hospitals. The results showed that community members had little knowledge about the symptoms and signs of heart attack or stroke. They perceived that existing health centers and community hospitals were not sufficiently equipped to treat CVD patients. Primary healthcare workers reported that they lacked skills to manage heart disease, particularly emergency care. Physicians said that they had too little time to educate patients and felt that medical schools should update their curricula, including practical training on CVD management in a low-resource setting. Nurses reported that they had inadequate training in health education for the prevention of CVD. There was a problem of inadequate feedback mechanisms in the existing referral system for continuing improvement. All of the health professionals agreed that more community participation and the involvement of non-health sectors and non-government organizations were needed in the national CVD control program. In conclusion, capacity building for strengthening CVD prevention and control at the primary care level should be implemented. The existing training and education systems have to be revised with an orientation towards health promotion and disease prevention. Publicity of CVD burden and preventive measures, and local programs, should be implemented with community participation.

Prevalence and determinants of overweight and obesity in Thai adults: results of the Second National Health Examination Survey.

To describe the prevalence of overweight and obesity and examine their relationship with socio-demographic factors in Thai adults. Using data from a cross-sectional survey, the National Health Examination Survey II (NHESII), the authors examined the prevalence of overweight (BMI > or = 25 kg/m2) and obesity (BMI > or = 30 kg/m2) in 3,220 Thai adults aged 20-59 yr. Univariate analyses and Logistic regression models were used to examine the association of overweight and obesity with socio-demographic and behavioral risk factors. The overall age-adjusted prevalence of overweight and obesity were 28.3% and 6.8% respectively, with a higher prevalence for women than for men (overweight: 33.9% vs 19.2% and obesity: 8.8% vs 3.5%). The prevalence of overweight and obesity was greater among older compared to younger people and among residents of urban (34.8% and 9.9%) compared to rural areas (26.4% and 5.9%). The prevalence of overweight and obesity varied by region in line with the level of economic development--Bangkok, Central, North, South and North-East. By using logistic regression analysis, overweight was associated with a number of characteristics as follows: age (per ten years increase) with adjusted Odds Ratio (OR) of 1.3; women 1.4; married 2.2; being a current smoker 0.4, and living in Bangkok and the central region 1.6 (compare to North-East). There was no clear difference in prevalence of overweight and obesity among education levels and type of occupation after controlling for other covariates. In conclusion, women of middle age, married, and living in Bangkok and the Central region, are at greater risk of overweight and obesity. Without effective lifestyle modification programs to curb these physiologic risk factors at population level, it is likely that related disease burden will ensue. Public health surveillance and intervention to modify the risk factors of excessive weight should be implemented.

Determining public health priorities for an ageing population: the value of a disability survey.

In order to determine which diseases and health problems were most strongly associated with long-term disability among the Thai elderly and to determine their public health priority, a national cross-sectional multistage random sampling survey was conducted in 1997. Four thousand and forty-eight Thai older persons aged 60 years and over were recruited and interviewed by trained interviewers. Overall, 769 (19%) people reported having a long-term disability. Participants with long-term disability (LD) reported having between one and 21 long-term diseases or health problems. Eighteen of these problems were independently associated with LD in logistic regression analysis. Nearly half of the cases with LD (46.4%) suffered from two or more health problems. The odds of LD increased with the number of problems suffered. The problems contributing most to the population burden of disease as assessed by population attributable risk fractions were hemiparesis, arthritis, accidents (unintentional injuries), blindness and other eye diseases, kyphosis, weakness of limbs, deafness, and hypertension. This ranking of public health priority differs from conventional approaches using mortality statistics and disability adjusted life years (DALYs). In conclusion, national disability surveys provide a valuable means of assessing the population burden of disability and determining the underlying causes of disability. These methods provide a direct assessment of disability prevalence and disease priorities for rapidly ageing transitional countries where death certification may be incomplete or inaccurate.

The association between television viewing and childhood obesity: a national survey in Thailand.

OBJECTIVE: To determine the relationship between television viewing and obesity among Thai children. DESIGN: A one-stage cross-sectional national survey. SETTING: National communities in Thailand. SUBJECTS: Four thousand one hundred and ninety-seven children aged 6 to 12 years old. RESULTS: By using the new national growth reference as a normative data, 262 (6.2%) children in this survey were obese. According to the caregivers, 62 per cent of children watched television I to 3 hours per day. Children who spent more than 3 hours per day watching television were more likely to be obese than the children who watched television less with the odd ratio of 1.8 (95% confidence interval = 1.2-2.8). CONCLUSION: With a one-stage design for determining the association between television viewing and childhood obesity, Thai school age children who watched television more than 3 hours per day were more likely to be obese with statistical significance.

Assessment of public opinion on legislation to deter drunk driving.

Existing legislative measures on blood-alcohol control of drivers failed to show a substantial effect in reducing the incidence of crash injury and mortality. Recently, a government initiative to limit locations and operating time (service hours) of nighttime entertainment venues was introduced. A telephone interviewed-survey of 500 random-samples to assess public opinion on the initiative and other legislative measures was conducted in Bangkok. The results showed that 88 per cent of the respondents supported the idea of prohibiting alcohol sale to youngsters aged <21 years old and 91 per cent agreed to limit the operating time of pubs, bars and nightclubs to no later than 2 a.m. The majority asserted that laws against drink driving were seldom enforced. More than half of the respondents agreed with the ideas of restricting medical care benefit for injured drunk drivers, and of prosecuting the related alcohol-sellers. Eighteen per cent of male respondents had drunk alcohol and driven in the past one month. A telephone survey is an efficient tool for providing timely information for policy decisions. More stringent enforcement of laws against drunk drivers should be implemented in parallel with traffic safety programs and other social control initiatives.

Incidence of hip fracture in Chiang Mai.

The reported incidence of hip fracture varies to a large extent across regions. Most studies relied on hospital data under the assumption that nearly all cases of hip fracture get access to hospital care. As in many developing countries, a number of hip fracture cases in Thailand might not seek care in hospitals due to geographical, socio-cultural and financial barriers. Therefore, using hospital data alone, could lead to under estimation of the magnitude of hip fracture. This study was undertaken to obtain such information using a combined method of hospital discharge survey and a cross sectional community survey. It resulted in an estimated incidence of 151.2 per 100,000 (95% CI 136.7-167.2) from the hospital survey and 185.2 per 100,000 (95% CI 138.1-247.6) from the community survey. In comparison to developed countries, age-adjusted incidence of hip fracture in this study was markedly lower than that reported from developed countries. It was argued that different degree of urbanization might explain the discrepancy. This implicated promotion of physical activity as a public health measure to prevent hip fracture.

Application of 0.05 per cent legal blood alcohol limits to traffic injury control in Bangkok.

A substantial proportion (44%) of traffic injury cases seeking emergency services in public hospitals had a blood alcohol concentration (BAC) of 0.1 per cent or more. To reduce alcohol related traffic injuries and deaths, a law was enacted setting a criminal per se legal blood alcohol limit at 0.05 per cent in 1994. However, not until 1997, was an active public education program undertaken on a national scale to raise awareness against drink driving and to support law enforcement. This includes dissemination of knowledge through multiple channels e.g., roadside posters; stickers on the back of vehicles; sporadic radio and TV programs or spots; public announcements; press reports. In 1999, highly visible sobriety check points were set up as a measure for law enforcement. In order to systematically assess the campaign, multiple methods were used to collect relevant data. This report focused on the outcomes of the campaign based on hospital surveillance data in the emergency rooms of 4 public hospitals from March to November, 2000 on alternate months. It was found that the campaign succeeded in raising public awareness and support for law enforcement against drink driving. However, the proportion of road victims with illegal BAC seeking emergency care did not decline after 17 months of the campaign. Limitations and weaknesses of law enforcement activities were discussed along with recommendation for future action.

The diagnosis and reporting of occupational diseases: the performance of physicians in Thailand.

The diagnosis and reporting of occupational diseases are important components of any occupational disease surveillance system. These two factors were assessed in 222 Thai physicians by using a self-administered questionnaire. Study results show that a proper diagnosis of occupational disease is hampered by the following: lack of knowledge about occupational medicine; a shortage of environmental data; a lack of consultation services and laboratory facilities. Concern about possible legal implications also prevents physicians from making a diagnosis of occupational disease. Evidence shows that financial incentive seems to play a crucial role in physicians' compliance with the reporting system. A number of remedial approaches are proposed, including the improvement of professional training, the development of standard practice guidelines, and novel financial measures for healthcare providers. Improvement calls for the collaborative effort of all responsible agencies and warrants further research that will guide policy and practice.