The prevalence of unrecognized congenital heart disease among healthy elementary school students in northern Thailand

Background: Congenital heart disease (CHD) is one of the major congenital anomalies among newborns. Although many infants with CHD are symptomatic and identified soon after birth, others remain undiagnosed until the disease becomes severe. Objectives: Unravel the number of CHD cases among 7-12 years old students who reported neither clinical complication nor history about cardiac diseases, stressing the importance for regular cardiac examination in children, even if they appeared healthy. Methods: The study selected students without clinical history of heart disease from 1,041 elementary schools in northern Thailand (Tak, Nakhon Sawan and Uttaradit). Certified nurses and health officers examined the students for abnormal heart conditions. Pediatric cardiologists scrutinized the students with suspected CHD for confirmation and characterization of cardiac lesion types. Results: Out of 144,293 students included in the study, 851 students showed atypical heart symptoms, and 87 were verified to have the CHD. This conferred the prevalence rate of unrecognized CHD among the elementary school children to be 0.60 per 1,000. The frequently-detected heart defects were ventricular septal defect (41.4%) and pulmonary stenosis (16.1%). Fifty-one children (58.6%) required surgery for cardiovascular correction. The prevalence of the CHD in elementary school students ranged from 0.41 to 1.05 cases per 1000 study subjects. The greatest number of incidences was found in Tak province where medical resources are inadequate. Conclusion: This study highlights the significance of routine cardiac examination among school-aged students, particularly in the regions with limited medical facilities, providing information essential for appropriate health care planning and managements.

Implementing the universal health coverage: which source of information is more reliable?

The implementation of universal health coverage needs accurate data on the distribution of health benefit coverage, particularly the uninsured. The national surveys and routine reports are two important sources of information ready for use. This study shows the validation of data from two sources. The data from national household surveys on the medical welfare, the health card and the social security schemes were validated with the routine report data of the Ministry of Public Health (MOPH) and the Social Security Office (SSO) by provinces. There were considerable differences between these data sets. The national survey data gave a 1.5 times higher estimate than the report data of the MOPH and the SSO. Financial implications of using inaccurate data to implement the universal health coverage could be huge, depending on the capitation rate.

Costs-effectiveness of the urban health center in Nakhon Ratchasima: a case study on diabetes and hypertension.

Health care reforms in Thailand are looking for a better health infrastructure within the urban setting. The urban health center is one of the models tried in many provinces. This study compared the costs--effectiveness of the urban health center in Nakhon Ratchsima with the Maharaj Nakhon Ratchasima Hospital, using diabetes and hypertension as tracer conditions. The point estimates by a retrospective review and cross-sectional study revealed that the overall costs (provider plus patient costs) of the urban health center for these tracers were lower than the costs of the Maharaj Hospital. The effectiveness of treatment at the urban health center was also better. It was concluded that the urban health center should be considered as a better alternative of primary care institution within the urban area.

The present situation of paragonimiasis in endemic area in Phitsanulok Province.

A cross-sectional survey and evaluation of paragonimiasis situation from endemic area in Phitsanulok Province was studied. Studies on the species and prevalence of parasites which infected people in Noen Maprang, Phitsanulok Province were also conducted during October 1999-March 2000. The sputum specimens were collected and examined to identify Paragonimus heterotremus eggs. In addition fecal samples were collected and examined for parasites by the formalin-ethyl acetate concentration technique. P. heterotremus eggs were detected in 2 out of 391 sputum specimens; a prevalence of 0.51%. A total of 584 stool specimens were obtained and examined. It was found that the prevalence of parasitic infection was 36.30%. Opisthorchis viverrini infection was the most prevalent (10.78%), followed by Strongyloides stercoralis (9.59%), hookworm (8.22%), Echinostoma spp (2.23%), minute intestinal flukes (1.54%), Taenia species (1.37%), Enterobius vermicularis (0.68%), Entamoeba coli (1.03%) and Giardia lamblia (0.86%). The prevalent rate of paragonimiasis in this endemic area in Phitsanulok Province has decreased during the past decade. However, there were other important parasite infections, especially opisthorchiasis and strongylodiasis and these should be studied further.

Nosocomial infection control activities in Thailand 1989.

The study on the infection control activities was done in 89 general regional and community hospitals. Seventy-seven hospitals responded to the questionnaire (87%). All hospitals had set up infection control committees. Infection control nurses had been appointed in 84 per cent; 45 and 39 per cent were part-time and full-time ICNs respectively. Reports of surveillance were sent to the committees in 74 of the hospitals. Doctors took part in infection control in 75 per cent of the hospitals. Isolation units were available in 86 per cent and incinerators were installed in 13 per cent of the hospitals. These results indicate that the allocation of manpower and resources are not sufficient for effective nosocomial infection control.