Trends in liver cancer, Sa Kaeo Province Thailand.

OBJECTIVE: To determine liver cancer trends in Sa Kaeo Province, Thailand. METHODS: Death certificate (1993-2003) and hospital records (1999-2003) were reviewed and compared to national averages and other provinces. RESULTS: According to data from death certificates, liver cancer mortality in Sa Kaeo Province increased from 3.1 to 26.1 per 100,000 population between 1993 and 2003. In Thailand overall rates increased from 9.0 to 19.8 per 100,000 population between 1996 and 2003. According to electronic hospital records, the total number of patient encounters (in-patient admissions and out-patient visits) for liver cancer in the two main hospitals in Sa Kaeo Province increased 56% (14% annually) between 1999 and 2003. The number of cases of hepatocellular carcinoma increased from 42 in 2001 to 73 in 2003, while the number of cases of cholangiocarcinoma showed little change. CONCLUSIONS: Thailand as a whole and Sa Kaeo Province specifically have a high burden of liver cancer, which appears to have increased substantially in the past 10 years. Demonstrating the impact of ongoing strategies aimed at reducing risk factors for liver cancer, such as universal hepatitis B vaccination of infants, will require reliable data describing liver cancer disease burden and etiology. Rapid investigations using available data from death certificates, electronic admissions records, and patient charts can provide valuable insights on disease burden and trends.

Pneumonia surveillance in Thailand: current practice and future needs.

We reviewed reported pneumonia cases and deaths in Thailand since 1975 to evaluate the pneumonia surveillance system. In Sa Kaeo Province, we analyzed 3 years in detail (1999--2001) from electronic surveillance data, and compared deaths reported through surveillance to death certificate data in 1999 and 2000. In addition, we interviewed surveillance personnel who collected the data from all 7 hospitals and from a 10% random sample of health centers. Since the mid-1980s, reported illnesses and deaths from pneumonia have been increasing. In Sa Kaeo, an average of 925 pneumonia cases were reported each year, for an estimated average annual incidence of 211 per 100,000. The age-specific incidence peaked at 1,418 per 100,000 in children less than 5 years. In 1999 and 2000, there were 7 and 6 pneumonia deaths, respectively, reported through the surveillance system, compared with 28 and 53, respectively, reported by death certificate. Sixty-two (82%) of the 72 surveillance personnel reported receiving some training, but most of this was informal. Although written criteria to diagnose pneumonia were established in 1996, those who report cases did not know these criteria. A combination of physician, nurse, and public health workers diagnoses were used. According to the written criteria, cases of suspect or rule out pneumonia should be reported, but when asked about specific examples only 79% of persons interviewed said they would report "tuberculosis with pneumonia" and 44% would report "bronchitis, rule out pneumonia." Seventy-four percent of persons interviewed completed the surveillance report within one day of patient admission.