Perceived Barriers of Accessing Healthcare among Migrant Workers in Thailand during the Coronavirus Disease 2019 (COVID-19) Pandemic: A Qualitative Study.

The outbreak of Coronavirus Disease 2019 (COVID-19) has threatened health and well-being in all populations. This impact is also deepening structural inequalities for migrant workers in Thailand. Due to their vulnerability and limited opportunity to access health services, they have greater risks in many health aspects compared to other populations. This qualitative study sought to examine the key health concerns and barriers during the COVID-19 pandemic on healthcare access among migrant workers in Thailand through the lens of policymakers, healthcare professionals, experts on migrant health, and migrant workers. We conducted 17 semi-structured in-depth interviews of stakeholders from health and non-health sectors in Thailand from July to October 2021. The interviews were transcribed and analyzed using both deductive and inductive thematic approaches. Thematic coding was applied. The results showed that financial constraints were a major barrier for healthcare access among migrant workers. These included affordability of healthcare and difficulty accessing funds (migrant health insurance). Structural barriers included some health facilities opening for emergency cases only. Insufficient healthcare resources were profound during the peak of positive cases. Cognitive barriers included negative attitudes and diverse understanding of healthcare rights. Language and communication barriers, and a lack of information also played an important role. Conclusion, our study highlights healthcare access barriers to migrant workers in Thailand during the COVID-19 pandemic. Recommendations for future resolution of these barriers were also proposed.

Psychosocial Problems Among Primary School Children in Thailand During the COVID-19 Pandemic, 2022.

Background: During the COVID-19 pandemic, primary school children are particularly vulnerable as restriction measures have caused a huge impact on their health and well-being. This study aims to assess the prevalence of mental health among primary school children in Thailand during the COVID-19 pandemic and identify factors associated with psychosocial problems. Methods: A survey was conducted among 701 Thai parents of primary school children from January to March 2022 - when teaching modalities between onsite and online learning were alternated. Parents were requested to assess the mental health of their youngest child at primary school age level. Psychosocial problems were measured by the Strengths and Difficulties Questionnaire (SDQ) with a total score of 40, based on 4 domains (emotion, behavior, hyperactivity, and relationship). Independent variables included (1) parental/household factors, (2) children characteristics, and (3) online learning-related issues. The dependent variable was the prevalence of children with a total score of 14-40, which indicates at risk and/or having mental health problems. The analysis was performed using logistic regression model. Results: Thai parents reported that 41.1% of children had psychosocial problems. Children in a single-parent family (adjusted odds ratio [AOR] = 1.7; 95% confidence interval (CI) = 1.1-2.8), male children (AOR = 1.7, 95% CI = 1.2-2.4), and children who did not receive adequate assistance for online learning from their parents (AOR = 2.1, 95% CI = 1.1-4.0) significantly faced greater odds of mental health problems. Conclusion: The prevalence of Thai primary school children confronting psychosocial difficulties during the COVID-19 pandemic increased, with significant concern. Public health interventions that aim to protect the mental health of primary school children during the pandemic should be introduced and targeted male children and those living with a single parent. Social support that facilitates online learning for children whose parents have limited capacity in supporting them should be implemented.

Self-Reported Anxiety and Depression among Parents of Primary School Children during the COVID-19 Pandemic in Thailand, 2022.

One significant concern during the COVID-19 pandemic is parents' mental health, which may consequently affect children's health and well-being. The objective of this study is to investigate generalized anxiety and depression in parents of primary-school-aged children and identify risk factors for mental health problems. A cross-sectional survey comprising 701 parents of primary school children in five of Thailand's major provinces was carried out from January to March 2022. Generalized anxiety and depression levels were assessed using the GAD-7 and PHQ-9. Logistic regression was performed to determine the effects of independent variables on anxiety and depression. Results showed that the prevalence of generalized anxiety and depression was 42.7% and 28.5%, respectively, among Thai parents. Three strong associative factors included: (1) having a youngest child with mental health problems; (2) not assisting their children every day; and (3) drinking alcohol. These findings show that the parents must deal with several difficulties when trying to maintain work and parenting duties while being confined at home during emergency situations. The government should provide sufficient assistance to parents who lack skills in handling children with emotional and behavioral problems. Meanwhile, health promotion to reduce alcohol consumption should continue to be an area of focus.

Patterns of Physical Activity and Sedentary Behavior During the COVID-19 Pandemic in the Thai 2021 National Health Survey.

BACKGROUND: Understanding patterns of physical activity and sedentary behavior is essential, but evidence from low- and middle-income countries remains limited. This study aimed to investigate the prevalence of physical activity and sedentary behavior in the Thai population; their sociodemographic correlates; and the contribution of specific domains to total physical activity. METHODS: We analyzed data from the 2021 Health Behavior Survey, a nationally representative survey, conducted by the Thailand National Statistical Office during the COVID-19 pandemic. Physical activity and sedentary behavior were assessed using the Global Physical Activity Questionnaire. "Sufficiently active" was defined according to the World Health Organization guidelines. "Highly sedentary" was defined as sitting ≥7 hours per day. The contribution of work, transport, and recreational physical activity was determined as the proportion of total physical activity. Multivariable logistic regression was conducted to determine the correlates of being sufficiently active and being highly sedentary. RESULTS: Of the total study population (N = 78,717), 71.9% were sufficiently active, whereas 75.8% were highly sedentary. Females, having a labor-intensive work, and living in Bangkok had a higher likelihood of being sufficiently active. Those with higher education and income levels, and living in Bangkok and the Central region had a greater likelihood of being highly sedentary. The work domain contributed the highest proportion toward physical activity (82.1%), followed by the recreation (10.0%) and transport domains (7.9%). CONCLUSIONS: Policies should focus on promoting transport and recreational physical activity and activity that can break up sedentary behavior among adults because when countries become technologically advanced, physical activity at work declines.

Cost-Effectiveness Analysis of COVID-19 Vaccine Booster Dose in the Thai Setting during the Period of Omicron Variant Predominance.

The Thai government implemented COVID-19 booster vaccines to prevent morbidity and mortality during the spreading of the Omicron variant. However, little is known about which types of vaccine should be invested in as the booster dose for the Thai population. This study aims to investigate the most cost-effective COVID-19 vaccine for a booster shot as empirical evidence for Thai policymakers. This study applied a stochastic simulation based on a compartmental susceptible-exposed-infectious-recovered model and included system dynamics in the model. We evaluated three scenarios: (1) No booster, (2) A viral vector vaccine as the booster dose, (3) An mRNA vaccine as the booster dose. The incremental cost-effectiveness ratio (ICER) was calculated based on provider perspectives. We found the number of cases in scenarios with viral vector and mRNA booster doses to be lower than in the non-booster group. Likewise, the number of deaths in the viral vector and the mRNA booster scenarios was threefold lower than in the no-booster scenario. Moreover, the estimated grand cost for the no-booster scenario was over 100 billion baht, while viral vector and mRNA scenario costs were 70 and 64.7 billion baht, respectively. ICER shows that viral vector and mRNA scenarios are more cost-effective than the no-booster scenario. Viral vector booster shot appeared to be slightly more cost-effective than mRNA booster shot in terms of death aversion. However, being boosted by an mRNA vaccine seemed slightly more cost-effective than a viral vector vaccine concerning case aversion. In conclusion, policies to promote COVID-19 booster shots in the Thai population by either mRNA or viral vector vaccines are likely to be worthwhile for both economic and public health reasons.

Learning from pandemic responses: Informing a resilient and equitable health system recovery in Thailand.

This article is part of the Research Topic 'Health Systems Recovery in the Context of COVID-19 and Protracted Conflict'. The third quarter of 2022 saw COVID-19 cases and deaths in Thailand reduced significantly, and high levels of COVID-19 vaccine coverage. COVID-19 was declared an "endemic" disease, and economic activities resumed. This paper reviews pre-pandemic health systems capacity and identifies pandemic response strengths, weaknesses and lessons that guided resilient and equitable health system recovery. Robust health systems and adaptive strategies drive an effective pandemic response. To support health system recovery Thailand should (1) minimize vulnerability and extend universal health coverage to include migrant workers and dependents; (2) sustain provincial primary healthcare (PHC) capacity and strengthen PHC in greater Bangkok; (3) leverage information technology for telemedicine and teleconsultation; (4) enhance and extend case and event-based surveillance of notifiable diseases, and for public health threats, including pathogens with pandemic potential in wildlife and domesticated animals. This requires policy and financial commitment across successive governments, adequate numbers of committed and competent health workforce at all levels supported by over a million village health volunteers, strong social capital and community resilience. A strengthened global health architecture and international collaboration also have critical roles in establishing local capacities to develop and manufacture pandemic response products through transfer of technology and know-how. Countries should engage in the ongoing Inter-government Negotiating Body to ensure a legally binding instrument to safeguard the world from catastrophic impacts of future pandemics.

Learning from pandemic responses: Informing a resilient and equitable health system recovery in Thailand

This article is part of the Research Topic ‘Health Systems Recovery in the Context of COVID-19 and Protracted Conflict'. The third quarter of 2022 saw COVID-19 cases and deaths in Thailand reduced significantly, and high levels of COVID-19 vaccine coverage. COVID-19 was declared an "endemic” disease, and economic activities resumed. This paper reviews pre-pandemic health systems capacity and identifies pandemic response strengths, weaknesses and lessons that guided resilient and equitable health system recovery. Robust health systems and adaptive strategies drive an effective pandemic response. To support health system recovery Thailand should (1) minimize vulnerability and extend universal health coverage to include migrant workers and dependents;(2) sustain provincial primary healthcare (PHC) capacity and strengthen PHC in greater Bangkok;(3) leverage information technology for telemedicine and teleconsultation;(4) enhance and extend case and event-based surveillance of notifiable diseases, and for public health threats, including pathogens with pandemic potential in wildlife and domesticated animals. This requires policy and financial commitment across successive governments, adequate numbers of committed and competent health workforce at all levels supported by over a million village health volunteers, strong social capital and community resilience. A strengthened global health architecture and international collaboration also have critical roles in establishing local capacities to develop and manufacture pandemic response products through transfer of technology and know-how. Countries should engage in the ongoing Inter-government Negotiating Body to ensure a legally binding instrument to safeguard the world from catastrophic impacts of future pandemics.

Real-World Effectiveness of COVID-19 Vaccines against Severe Outcomes during the Period of Omicron Predominance in Thailand: A Test-Negative Nationwide Case-Control Study.

Due to the widespread Omicron variant of SARS-CoV-2 in Thailand, the effectiveness of COVID-19 vaccines has become a major issue. The primary objective of this study is to examine the real-world effectiveness of COVID-19 vaccines based on secondary data acquired under normal circumstances in a real-world setting, to protect against treatment with invasive ventilation of pneumonia during January to April 2022, a period when Omicron was predominant. We conducted a nationwide test-negative case-control study. The case and control were matched with a ratio of 1:4 in terms of age, date of specimen collection, and hospital collection specimen and the odds ratio was calculated using conditional logistic regression. Overall, there was neither a distinction between mix-and-match regimens and homologous mRNA regimens against severe symptoms, nor was there a decline of the protective effect over the study period. The third and fourth dose boosters with ChAdOx1 nCoV-19 or mRNA vaccines provided high levels of protection against severe outcomes, approximately 87% to 100%, whereas two doses provided a moderate degree (70%). Thus, this study concludes that current national vaccine strategies provide favourable protective benefits against the Omicron variant. All Thais should receive at least two doses, while high-risk or vulnerable groups should be administered at least three doses.

Family Health among Families with Primary School Children during the COVID Pandemic in Thailand, 2022.

Despite evidence suggesting that the COVID pandemic has negatively affected the mental health and well-being of school aged children and parents, there are limited studies describing the state of family well-being. This study aimed to use the family health lens to assess the well-being of Thai families with primary school children and to identify its associated factors. A cross-sectional survey was conducted during January and March 2022, a period of school closure when onsite education was replaced by online education from time to time. The family health scale (FHS) questionnaire survey was carried out among 701 parents of Thai families with primary school children. The questionnaire comprised 10 questions regarding family belief, health, relationships, financial security, and housing environment. Independent variables included: (1) parental/household factors; (2) online learning related issues; (3) children's mental health; and (4) parents' health behaviors. Multinomial logistic regression was undertaken. Results showed that half of Thai families (54.6%) reported having moderate health status. Factors that were associated with lower levels of family health, such as poor or moderate levels, included families with a child that had mental health problems (adjusted odd ratio (AOR) = 5.0 [95% CI = 2.6-9.5] for poor v. excellent, and AOR = 2.7 [95% CI = 1.9-4.0] for moderate v. excellent), single parents (AOR = 2.5 [95% CI = 1.2-5.2] for poor v. excellent), a higher number (≥3) of children (AOR = 2.1 [95% CI = 1.0-4.0] for moderate v. excellent), and smoking parents (AOR = 6.5 [95% CI =1.2-34.8] for poor v. excellent). During health emergencies, health policy for providing adequate assistance to single parents, especially those that have a child with mental health problems, is of utmost importance. The design of health promotion activities and interventions should be targeted not only at single families, but also families with higher numbers of children and parents who smoke at home.

Risk Communication Distributed among Migrant Workers during the COVID-19 Crisis in Thailand: Analysis on Structural and Networking Gaps.

Language and cultural barriers among migrant workers hamper access to health risk information. This study aims to explore health risk communication structure and processes and identify the communication network of migrant workers during the COVID-19 pandemic in Thailand. This study used a parallel mixed-methods design combined with in-depth interviews and questionnaires for social network analysis from November 2020 to June 2021 in the headquarter district of Samut Sakhon, Ranong, and Phuket provinces. We conducted purposive sampling of representatives from public and non-public organisations and local communities. Thirty-six key informants participated in in-depth interviews, and fifty-six respondents completed the questionnaire for social network analysis. Although health risk communication included various activities, there was no formal governing body responsible for health risk communication among migrants, and monitoring and evaluation of communication process were not well-implemented. The health risk communication network was centralised, especially in the rural area; however, migrant health volunteers (MHVs) and local media were key sources of information for most migrants in communities. Overall, a governing body led by the government with intersectional collaboration and a health risk communication process should be promoted while considering migrants' characteristics and concerns. The health risk communication network should identify key communicators such as MHVs and local media. This can be an effective strategy to fill the gap of information dependency.

Real-World Effectiveness of Mix-and-Match Vaccine Regimens against SARS-CoV-2 Delta Variant in Thailand: A Nationwide Test-Negative Matched Case-Control Study.

The objective of this study is to explore the real-world effectiveness of various vaccine regimens to tackle the epidemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Delta variant in Thailand during September-December 2021. We applied a test-negative case control study, using nationwide records of people tested for SARS-CoV-2. Each case was matched with two controls with respect to age, detection date, and specimen collection site. A conditional logistic regression was performed. Results were presented in the form vaccine effectiveness (VE) and 95% confidence interval. A total of 1,460,458 observations were analyzed. Overall, the two-dose heterologous prime-boost, ChAdOx1 + BNT162b2 and CoronaVac + BNT162b2, manifested the largest protection level (79.9% (74.0-84.5%) and 74.7% (62.8-82.8%)) and remained stable over the whole study course. The three-dose schedules (CoronaVac + CoronaVac + ChAdOx1, and CoronaVac + CoronaVac + BNT162b2) expressed very high degree of VE estimate (above 80.0% at any time interval). Concerning severe infection, almost all regimens displayed very high VE estimate. For the two-dose schedules, heterologous prime-boost regimens seemed to have slightly better protection for severe infection relative to homologous regimens. Campaigns to expedite the rollout of third-dose booster shot should be carried out. Heterologous prime-boost regimens should be considered as an option to enhance protection for the entire population.

Forecasted Trends of the New COVID-19 Epidemic Due to the Omicron Variant in Thailand, 2022.

Thailand is among many countries severely affected by COVID-19 since the beginning of the global pandemic. Thus, a deliberate planning of health care resource allocation against health care demand in light of the new SARS-CoV-2 variant, Omicron, is crucial. This study aims to forecast the trends in COVID-19 cases and deaths from the Omicron variant in Thailand. We used a compartmental susceptible-exposed-infectious-recovered model combined with a system dynamics model. We developed four scenarios with differing values of the reproduction number (R) and vaccination rates. In the most pessimistic scenario (R = 7.5 and base vaccination rate), the number of incident cases reached a peak of 49,523 (95% CI: 20,599 to 99,362) by day 73, and the peak daily deaths grew to 270 by day 50. The predicted cumulative cases and deaths at the end of the wave were approximately 3.7 million and 22,000, respectively. In the most optimistic assumption (R = 4.5 and speedy vaccination rate), the peak incident cases was about one third the cases in the pessimistic assumption (15,650, 95% CI: 12,688 to 17,603). In the coming months, Thailand may face a new wave of the COVID-19 epidemic due to the Omicron variant. The case toll due to the Omicron wave is likely to outnumber the earlier Delta wave, but the death toll is proportionately lower. Vaccination campaigns for the booster dose should be expedited to prevent severe illnesses and deaths in the population.

Investigation of a Cluster of Immunization Stress-Related Reactions after Coronavirus Disease 2019 (COVID-19) Vaccination, Thailand, 2021.

On 28 April 2021, the investigation team of the Department of Disease Control, Ministry of Public Health, was notified of a cluster of people developing neurological symptoms following COVID-19 vaccination in a province in eastern Thailand. We conducted an investigation from 29 April to 20 May 2021 to confirm the outbreak, describe the epidemiological characteristics and identify possible risk factors. A matched case-control study was conducted. Matching factors were gender and vaccination site. A confirmed case was a person receiving COVID-19 vaccination in the province and developed at least one neurological symptom between 21 April and 20 May 2021. The rapid assessment of the vaccination cold chain system was carried out. We found a total of 36 cases out of 3920 vaccinees (attack rate = 0.92%), all cases were recovered and classified as an immunization stress-related reaction (ISRR) by the National AEFI Expert Committee. An analytic study found that menstruation was significantly associated with ISRR (AOR = 6.84 [95%CI = 1.09-42.91]). The environmental survey suggested that the cold chain system was properly managed. Further studies on other precipitating causes of ISRR should be performed. In terms of recommendation, health providers should pay greater attention to women menstruating during and after COVID-19 immunization.

Rapid method through routine data to evaluate real-world vaccine effectiveness against coronavirus disease 2019 (COVID-19) infection: lessons from Thailand.

The objective of this article is to draw lessons from the Thai experience in estimating vaccine effectiveness (VE) for coronavirus disease 2019 (COVID-19) based on routine service data. We found that a matched case-control design, using probability-based controls representing the varying vaccine coverage across the population over time, yielded a valid result for VE assessment. The proposed design has an advantage in its applicability drawing from the routine data monitoring system. Future studies that exercise other designs, such as test-negative and cohort studies, are recommended in order to compare and contrast the findings across different designs. To implement a continuous monitoring system on VE, the integration of data from different sources is needed. This requires long-term investment in the data monitoring system for the entire healthcare system.

Access to Healthcare and Social Protection among Migrant Workers in Thailand before and during COVID-19 Era: A Qualitative Study.

Thailand is a popular host nation for international migrant workers, particularly those from Cambodia, Lao PDR, and Myanmar. Thailand has introduced approaches to protect their rights for health and social welfare, using various mechanisms over many years. However, the implementation of these policies is dynamic and has been influenced by national security, economic necessity, and public health concerns. The aim of this study was to explore how Thailand designs and implements health and social welfare policies for migrants in Thailand, both before and during COVID-19. A qualitative analysis was used alongside interviews with 18 key informants in various sectors in this field. Thematic coding was applied. Results show that there were seven key themes emerging from the analysis, including: (i) sustainability of the HICS; (ii) people dropping out from the Social Security Scheme (SSS); (iii) quality of health screening in the Memorandum of Understanding (MOU) migrants; (iv) health screening problems and state quarantine management in response to COVID-19; (v) managing the migration quota and dependency on migrant workers; (vi) influx of migrants in the backdrop of COVID-19; and (vii) poor living conditions of migrants and the impact of COVID-19. The majority of interviewees agreed that undocumented migrants is a critical concern that impedes access to migrants' health and social welfare. This situation was especially pronounced during the second wave of COVID-19 in Thailand, which took hold in migrant communities. In the short term, the poor living conditions of migrants urgently need to be addressed in order to contain and mitigate this crisis. In the long term, there needs to be an improved health system design that includes migrants, regardless of their immigration status. This requires intersectoral policy coherence, including the hastening of nationality verification to sustainably mitigate undocumented migrants.

Predicted Impact of the Lockdown Measure in Response to Coronavirus Disease 2019 (COVID-19) in Greater Bangkok, Thailand, 2021.

In mid-2021, Thailand faced a fourth wave of Coronavirus Disease 2019 (COVID-19) predominantly fueled by the Delta and Alpha variants. The number of cases and deaths rose exponentially, alongside a sharp increase in hospitalizations and intubated patients. The Thai Government then implemented a lockdown to mitigate the outbreak magnitude and prevent cases from overwhelming the healthcare system. This study aimed to model the severity of the outbreak over the following months by different levels of lockdown effectiveness. Secondary analysis was performed on data primarily obtained from the Ministry of Health; the data were analyzed using both the deterministic compartmental model and the system dynamics model. The model was calibrated against the number of daily cases in Greater Bangkok during June-July 2021. We then assessed the outcomes (daily cases, daily deaths, and intubated patients) according to hypothetical lockdowns of varying effectiveness and duration. The findings revealed that lockdown measures could reduce and delay the peak of COVID-19 cases and deaths. A two-month lockdown with 60% effectiveness in the reduction in reproduction number caused the lowest number of cases, deaths, and intubated patients, with a peak about one-fifth of the size of a no-lockdown peak. The two-month lockdown policy also delayed the peak until after December, while in the context of a one-month lockdown, cases peaked during the end of September to early December (depending on the varying degrees of lockdown effectiveness in the reduction in reproduction number). In other words, the implementation of a lockdown policy did not mean the end of the outbreak, but it helped delay the peak. In this sense, implementing a lockdown helped to buy time for the healthcare system to recover and better prepare for any future outbreaks. We recommend further studies that explore the impact of lockdown measures at a sub-provincial level, and examine the impact of lockdowns on parameters not directly related to the spread of disease, such as quality of life and economic implications for individuals and society.

Education for non-citizen children in Malaysia during the COVID-19 pandemic: A qualitative study.

The COVID-19 pandemic disrupted schooling for children worldwide. Most vulnerable are non-citizen children without access to public education. This study aims to explore challenges faced in achieving education access for children of refugee and asylum-seekers, migrant workers, stateless and undocumented persons in Malaysia during the pandemic. In-depth interviews of 33 stakeholders were conducted from June 2020 to March 2021. Data were thematically analysed. Our findings suggest that lockdowns disproportionately impacted non-citizen households as employment, food and housing insecurity were compounded by xenophobia, exacerbating pre-existing inequities. School closures disrupted school meals and deprived children of social interaction needed for mental wellbeing. Many non-citizen children were unable to participate in online learning due to the scarcity of digital devices, and poor internet connectivity, parental support, and home learning environments. Teachers were forced to adapt to online learning and adopt alternative arrangements to ensure continuity of learning and prevent school dropouts. The lack of government oversight over learning centres meant that measures taken were not uniform. The COVID-19 pandemic presents an opportunity for the design of more inclusive national educational policies, by recognising and supporting informal learning centres, to ensure that no child is left behind.

Factors Related to Health Risk Communication Outcomes among Migrant Workers in Thailand during COVID-19: A Case Study of Three Provinces.

Coronavirus disease 2019 (COVID-19) is a newly emerging infectious disease, and risk communication is one of several public health emergency responses. During the pandemic, many migrant workers in Thailand experienced barriers that hamper access to health information. This study aims to explore factors related to the outcomes of health risk communication, including awareness of public health measures and preventive practices. We conducted a cross-sectional survey on migrants between January and April 2021 using cluster sampling in Phuket, Ranong, and Samut Sakhon. In the descriptive analysis, we presented the median, proportion, and ratio, while in the inferential analysis, we employed a logistic regression with robust standard errors. Although a total of 303 participants were initially included in this study, the final number was narrowed down to 288 samples due to insufficient information required for the analysis. Frequent reception of health information and primary school education showed a statistically significant association with preventive practices. Middle-aged migrant workers demonstrated a significantly lower level of preventive practices than younger migrant workers. A longer stay in Thailand was significantly related to a lower degree of awareness toward public health measures. Thus, it is necessary to promote the accessibility of health information among migrant workers in Thailand, especially those who have lived in Thailand for more than eight years, are older, and have no formal education.