Dependence and active life expectancy of the elderly population living in the central region of Thailand.

OBJECTIVE: To determine the prevalence and the independent socio-economic factors with respect to the dependence status of the Thai elderly population living in the central region and to calculate the active life expectancy (ALE) based on the results of this survey and abridged life tables for Thailand. DESIGN: A cross-sectional mulitistage random sampling survey. SETTING: Communities in the central region, Thailand. SUBJECTS: 723 elderly subjects. RESULTS: Mean age and its standard deviation (SD) of the 723 recruited subjects were 69.9 and 7.3 years, respectively. Forty three per cent of the subjects were men. Mean values (SD) of the BAI score and the CAI score were 18.78 (2.6) and 6.47 (2.4), respectively. Except for housework, elderly women had a higher prevalence rate of dependence on activities of daily living (ADL) compared with elderly men. Seven univariate factors of the BAI and the CAI were demonstrated. According to the multiple linear regression analysis by entering all univariate factors of the BAI and the CAI except "working status", independent factors of both the BAI (adjusted R2 = 0.051) and the CAI (adjusted R2 = 0.146) were age, sex and writing ability. The prevalence rate (95% confidence interval) of dependence regarding self-care activities of daily living was 5.9 per cent (4.2-7.6%). The rate of dependence increased with age. The female elderly were more dependent on self care than their male counterparts. Although the elderly women live longer than the elderly men, they spend more years in a severely dependent state. Findings on ratios between health and life expectancy demonstrate that Thai men spend more proportional time leading a healthy life than Thai women. CONCLUSION: Prevalence rates of dependence regarding activities of daily living among the Thai elderly living in the Central region were rather high showing the health of elderly women to be worse than that of elderly men. The elderly women spend more years in a severely dependent state although they live longer than the elderly men.

Situational analysis of the health insurance market and related educational needs in the era of health care reform in Thailand.

The purposes of this study were to explore the situation of health insurance in Thailand, to compare public and private perspectives and to identify related educational needs. Between March and April of 1998, the study employed in-depth interviews of 12 public and private major stakeholders of the health insurance systems, including policy makers, providers and insurers. Additional inputs were gathered in a brainstorming session with 41 participants from organizations with important roles in regulating, monitoring, paying, or providing health care services, as well as research and education. The findings indicated the health insurance market was expanding. But there was no national policy on health insurance. Insurance-related law was outdated. Public and private schemes overlapped, and were generally characterized by inadequate risk diversification, overutilization of services, lack of effective cost containment, inconsistent service quality, and poor understanding of health insurance principles. There were needs for more education and training in various aspects of health services management and health-insurance related functions. Consequently, continuing education and training related to health insurance services for policy makers, system administrators, managers, providers and insurers are strongly recommended during the health-care reform process.

Bone mineral density of lumbar spine and proximal femur in normal Thai women.

OBJECTIVE: To find the reference data for age-specific normal bone mineral density in a Thai female population. STUDY DESIGN: Cross-sectional, Descriptive study. MATERIAL AND METHOD: 1773 Thai women aged between 11-80 years were recruited, using multistage cluster sampling and stratifying from six represented provinces in the country, each strata was randomly selected. After recruiting, the women were interviewed by well-trained personnel using structured questionnaires. Bone mineral density of the lumbar spine 1-4 and nondominant hip were measured by Dual Energy Photon Absorptiometer. The scientists, X-rays technician were trained and standardized inter and intra observers variation. Quality control of examination was measured periodically. Every BMD outcome was re-examined by a specialist. RESULTS: The peak bone mineral density of both spines and hips was between the age of 30 to 34 years old. Mean Value for spine and femoral neck was 0.957 and 0.814 g/cm2 respectively. The BMD of spine and hip was significantly decreased after the age of 35 and the loss was accelerated at age 50. Osteoporosis for spine and femoral neck is considered when BMD are below 0.682 and 0.569 g/cm2 respectively. CONCLUSION: The results are important data for public health policy, by maximizing bone mass during skeletal growth before menopause and minimizing bone loss throughout life as well as for detection of important risk factors.

Cost-effectiveness analysis of lambdacyhalothrin-treated nets for malaria control: the patients' perspective.

The present study was undertaken to evaluate the cost-effectiveness of lambdacyhalothrin-treated nets in comparison with conventional DDT-spraying as a method of malaria control according to the patients' perspective among migrant populations in a high-risk area along the Thai-Myanmar border in Thailand. Ten hamlets comprising 243 houses with 948 inhabitants were given only treated nets. Twelve hamlets comprising 294 houses and 1,315 inhabitants represented the DDT-treated area and another six hamlets with 171 houses and 695 inhabitants served as controls. Information as to consumer costs was obtained by interviewing 3,214 patients seeking care at all levels of the health care system in the study area. Analysis showed that the impregnated-net program was more cost-effective than the DDT-spraying program or surveillance alone (US$ 0.59 vs US$ 0.74 vs US$ 0.79 per 1 case of prevented malaria). We conclude that in a high-risk area such as along the Thai-Myanmar border in western Thailand, integrating the use of impregnated nets with large-scale primary health care programs is likely to constitute the most cost-effective method for controlling malaria according to the patients' perspective.

Cost and performance of malaria sector: a case study at Malaria Sector 11, Tak Province, Thailand.

The objective of this study was to assess the cost and performance of each operational unit at the malaria sector level and to calculate the unit cost of each activity accordingly. Data were collected at Malaria Sector No.11 situated at the western border of Thailand with Myanmar during the fiscal year of 1995. The unit cost was calculated by dividing the total cost of each activity by its output using appropriate units of analysis. The result showed that 67% of the total cost of malaria sector was labor cost and 45% of the total cost was allocated to diagnosis and treatment activities. Unit cost in terms of cost/visit, cost/case found, cost/case of falciparum malaria treated, cost/case of vivax malaria treated, cost/house spray and cost/impregnated net were US$1.85, 8.21, 10.07, 8.46, 2.24 and 1.54 respectively. The results of this study will provide important information as to the best use of limited available resources to determine which activities should be stopped, continued, increased or decreased at the malaria sector level.

Epidemiological studies of malaria at Pong Nam Ron, eastern Thailand.

Malaria is still a serious health problem in Thailand. Present attempts at controlling the disease by drug treatment and other means remain unsatisfactory. Thus, development of vaccination against malaria is a major research goal of malaria immunology. The objective of this study was to acquire epidemiological base line data for subsequent vaccine trials. A cross-sectional descriptive survey was conducted among 451 local inhabitants during the beginning of the transmission season in June 1989 at Pong Nam Ron District, Chanthaburi Province, Eastern Thailand where malaria transmission was likely to be high. Following the cross-sectional survey weekly morbidity surveillance was started to detect new cases of malaria by using active and passive case detection at the district hospital, local health centers and at neighboring malaria clinics. Entomological observations were made monthly to determine inoculation rates. Forty-six percent of the population were male and 54% female; one third were under the age of 15 and 14% under the age of 5 years. Eighty percent of the adults were married. Sixty percent of the subjects interviewed gave a history of malarial illness in the past. Malaria, malnutrition, abnormal hemoglobin diseases and parasitic infestation were the main health problems in the study area. The annual parasite incidence of malaria was 149.6/1,000 population and two-thirds of them were asymptomatic indicating a semi-immune condition among these subjects. It was difficult to interpret the results of entomological studies due to low density of the malaria vector.

Disability among Thai elderly living in Klong Toey slum.

Forty three per cent of the elderly in Klong Toey slum had BAI score less than 20. One point six per cent were moderately severe or severely disabled and needed special care. Around one-third of them caused by stroke. Locomotion, reaching and stretching, dexterity, continence and seeing are common significant types of disability among this population study. Perceived health status, age and working status are independent factors related to disability level. The Barthel ADL index is suitable for using as a tool for a disability survey among Thai elderly. The ODS questionnaire may be applied after considerable modification of the questions concerning behavior and intelligence dimensions.

Economic analysis of malaria control for migrant workers in eastern Thailand.

A randomized, double-blind field trial was carried out to compare the economic impact of permethrin-treated nets with that of untreated nets as a method of malaria control. The study was conducted in 261 long-term migrant workers and 138 seasonal agricultural migrant workers in the eastern rural areas known to be highly endemic for multidrug-resistant Plasmodium falciparum infection. One hundred and twenty-six longterm migrants and 59 seasonal migrants used treated nets, while 135 and 79, respectively, used untreated nets. The impregnated-nets program was cost-saving as well as offering improved effectiveness. The net benefit of using a treated net was US$1.17 per worker from the Malaria Division's perspective and US$1.61 per worker from the worker viewpoint. The use of impregnated nets with large-scale primary health care programs likely will be the most cost-effective and cost-beneficial method for controlling malaria in eastern Thailand.

Malaria in a rural area of eastern Thailand: baseline epidemiological studies at Bo Thong.

Malaria is still a serious health problem in Thailand. Present attempts at controlling the disease by drug treatment and other means remain unsatisfactory. Thus, development of vaccination against malaria is a major research goal of malaria immunology. The objective of this study was to acquire epidemiological base line data for subsequent vaccine trials. A cross-sectional descriptive survey was conducted among 253 local inhabitants during the beginning of the transmission season in July 1989 at Bo Thong District, Chonburi Province, Eastern Thailand where malaria transmission was likely to be moderately high. Following the cross-sectional survey weekly morbidity surveillance was started to detect new cases of malaria by using active and passive case detection at the district hospital, local health centers and at neighboring malaria clinics. Fifty-four percent of the population were male and forty-six percent female: nearly a half (48.3%) were under the age of 15 and 17% under the age of 5 years. Eighty percent of the adults were married. Seventy percent of the subjects interviewed gave a history of malarial illness in the past. Malaria, malnutrition, anemia abnormal hemoglobin diseases and parasitic infestations were the main health problems in the study area. The annual parasite incidence of malaria was 169.4/1,000 population and 77% of parasitemic individuals were asymptomatic, indicating the existence of a semi-immune condition among these subjects. Antibody level to crude parasite antigen increased with age. It is hoped that the information obtained from these field studies may be useful in malaria vaccine trials in the near future.

Anti-tuberculosis programs in Thailand: a cost analysis.

The standard regimen, a combination of isoniazid and thiacetazone, which has been used for treatment of tuberculosis (TB) in Thailand for the past 20 years is inexpensive, but possesses a high degree of toxicity and requires 18-24 months of continuous treatment, resulting in poor compliance and a low success rate of treatment. The more efficacious short-course chemotherapy introduced into the National Tuberculosis Program in 1985 is limited by the high costs of drugs. However, the cost of providing care is not limited only to drug costs but also includes other services costs. The present study was undertaken to compare the total provider costs of 3 short-course regimens with that of the standard program in the treatment of newly diagnosed pulmonary TB. Data were collected at 4 zonal TB centers through out Thailand in 1987-1988. Analysis showed that the 3 short-course regimens had lower costs than the standard regimen from the provider perspective. Among these 3 regimens that of isoniazid, rifampicin and pyrazinamide for 2 months, followed by isoniazid and rifampicin twice a week for 4 months had the lowest costs (Baht 1,499). Despite the lowest drug cost (B 431) of the standard regimen, the total provider costs were the highest (B 2,541) due to the highest routine service cost of B 2,066. Thus to determine the cost of a disease requires consideration of both drug costs and also other cost components.

Human behavior in relation to selection of malaria treatment.

People in rural areas usually help themselves when malaria attacks by using a drug preparation under the name of "ya-chud" bought from the grocery in the village. The objective of this study was to determine the behavior towards malarial treatment of local inhabitants in two malarious areas in eastern Thailand. Groups of 271 and 131 local inhabitants in villages in Pong Nam Ron and Bo Thong Districts, respectively, aged more than 15 years were interviewed regarding health behavior in seeking care when they became ill with malaria. Forty-two percent of the population at Pong Nam Ron and fifteen percent at Bo Thong went to drug-stores or groceries when they developed minor illness, while 85.2% of the subjects interviewed at Bo Thong went to the local health center. However, when they became severely ill, treatment-seeking patterns were similar in the two study areas. Ninety-four percent of the subjects interviewed at Bo Thong and eighty-seven percent at Pong Nam Ron gave a history of having used ya-chud in the past. On average, a set of ya-chud for malaria infection consists of 3-5 drugs: antimalarial drugs together with others such as analgesic-antipyretics, steroids, anti-histamines, vitamins and antimicrobial agents (tetracycline). The price of one ya-chud varied from 3-9 baht. Such improperly use of antimalarial drugs in malarious areas can result in treatment failure and cause the development of drug resistance, which is a problem in the malaria control program in Thailand.

Seroepidemiology of antibody to hepatitis A in the rural eastern part of Thailand.

Hepatitis A is a disease commonly found in Thai children. However, there are very few reports on the age specific prevalence in Thailand. We studied the hapatitis A virus (HAV) antibody titer in a population in the rural eastern part of Thailand, using an antiHAV ELISA test (Abbott Laboratories, North Chicago Ill). Three hundred and sixty four subjects from Pong Nam Ron, Chanthaburi Province and 236 of children and adults from Bo Thong, Chon Buri Province were studied for age specific prevalence of antiHAV. The immunity against HAV increased with age. Fifty percent of Pong Nam Ron children had antiHAV antibodies at the age of 8-9 years and at the age of 12-13 years of Bo Thong children. The overall antibody prevalence rate was 67.9% in Pong Nam Ron and 59.3% in Bo Thong Districts. According to our data, less than 30 percent of children under 10 years old in the eastern part of Thailand were seropositive for HAV. This finding indicated a much lower incidence than previously reported which may reflect better personal and food hygiene.