Health situation analysis of Thai population 2010: implications for health education and health service reform.

BACKGROUND: Between 1990 and 2010, many national and international factors converged to both beneficially and antagonistically affect people's health and the Thai healthcare system. Moreover Thailand is moving to aged society and a low birth rates. OBJECTIVE: To analyze Thailand's health issues for baseline information for changing medical education, services and researches. MATERIAL AND METHOD: Information on illness of in-patients, out-patients and casualties came from hospitals nationwide and from hospitals withdrawals from the three health insurance schemes in fiscal 2010. The data included 96% of the population. Research literature was also extensively reviewed. The data were analyzed by age groups and burdensome diseases. RESULTS: Out-patients were treated 326,230,155 times and in-patients 6,880,815 times at Community Hospitals (44%), Provincial Hospitals (22%), Central or University Hospitals (26%) and Private Hospitals (8%). Infants and elderly were the patients most commonly treated in hospital. Among pediatric patients, perinatal disease, intestinal infection, respiratory tract infection, injury and poisoning and teenage pregnancy predominated; while among adults, it was accident, non-communicable and chronic disease. CONCLUSION: Thailand is faced with the dual burden of infection and non-communicable diseases. Risky behavior and changing social structure are underlined this epidemiological transition. Medical schools and health service systems need to be recalibrated to response proactively to these challenges.

Burden of acute, persistent and chronic diarrhea, Thailand, 2010.

BACKGROUND: The incidence of diarrhea in Thai children under five years of age increased over the last decade while mortality dramatically decreased. To evaluate the effectiveness of MCH services under Universal Coverage Schemes, health outcomes should be performed. OBJECTIVE: To assess the burden and pattern of childhood diarrheal diseases in Thai children under five. MATERIALS AND METHOD: The information on Intestinal Infectious Diseases ICD10: A00-A09 was divided into two groups: 1. Infectious diarrhea: A04, A05, A08, A09 and 2. Dysentery: A02, A03. The authors investigated the number of OPD visits, IPD, mortality, length of hospital stay and co-morbidity of severe cases. RESULTS: The burden of diarrhea was: 3.7 million (1:1) episodes, 756,552 OPD visits (1:5), 124, 403 IPD admissions (1:30), 202 (1:18,460) persistent diarrhea and 48 (1:77, 685) deaths. Diarrheal incidence had two peaks: cool season and early rainy season. Admissions lasted a collective 309,398 days. Diarrhea was persistent in 202 episodes (1.6 per 1,000 admissions) and the associated factors included: age, sepsis, anemia, chronic diseases, malnutrition and HIV. The risks for diarrhea-related mortality included: infant, septicemia and dehydration. CONCLUSION: The incidence of diarrhea was higher than expected albeit mortality was low. The mortality rate was associated with age under one year persistent diarrhea, septicemia, chronic and underlying diseases.

Evaluation of causes-of-death: which statistics should we rely on, hospital deaths or vital statistics?

BACKGROUND: Age-specific causes of death yield important information for planning health services and medical education. OBJECTIVE: To compare the age-specific causes of death between in-hospital deaths and death registration statistics. MATERIAL AND METHOD: Information on in-hospital mortality in fiscal 2010 was extracted from the three health insurance schemes. Death registrations (ICD-10 coding) were from the Bureau of Registration Administration, Ministry of Interior Statistics on the age-specific causes of death were analyzed. RESULTS: In-hospital deaths numbered 132,512 (47.5% occurring in tertiary care) vs. 411,331 recorded in vital statistics (68% died outside hospitals). Most (74%) infants died in-hospital so causes were clearly documented vs. death registration. A minority (6.2%) of in-hospital deaths and of death registrations (9.7%) were due to unnatural causes. The majority (79.5%) of unnatural deaths died before arriving at hospital. Ill-defined codes for causes of death were found in 6.1% of in-hospital records and 42.2% of death registrations. After censoring ill-defined codes, the ten leading, age-specific causes of death agreed between the two data sets. CONCLUSION: Medical personnel should receive training to do proper death certification. Periodic validation of hospital COD certification should also be done. Use of verbal autopsy in the Thai context would help to standardize record-keeping and to reduce ill-defined codes for deaths occurred outside hospital.

Comparison of the effectiveness of six and two acupuncture point regimens in osteoarthritis of the knee: a randomised trial.

BACKGROUND: Although substantial data have supported the effectiveness of acupuncture for treating knee osteoarthritis (OA), the number of points used has varied. The objective of this study was to compare the effectiveness of six and two acupuncture points in the treatment of knee OA. METHODS: A randomised trial of knee OA patients was conducted. Patients were randomly allocated into two groups of 35. The "six point group" received treatment at six acupuncture points, ST35, EX-LE4 (Neixiyan), ST36, SP9, SP10 and ST34, while the "two point group" received treatment at just the first pair of points, ST35 and EX-LE4. Both groups received twice weekly electroacupuncture on 10 occasions. Electrical stimulation was carried out at low-frequency of 3 Hz to all points, with the intensity as high as tolerable. Both groups were allowed to take a 200 mg celecoxib capsule per day for intolerable pain. Patients were assessed at baseline, week 5, week 9 and week 13, using a Thai language version of the Western Ontario and McMaster Osteoarthritis Index (WOMAC). Global assessment of change after 10 treatments was also recorded. RESULTS: Acupuncture at both six and two acupuncture points was associated with significant improvement. Mean total WOMAC score at weeks 5 and 13 of patients in both groups showed no significant difference statistically (p = 0.75 and p = 0.51). Moreover, the number of celecoxib capsules taken, global assessment of global change and body weight change of both groups also showed no statistical difference. CONCLUSION: This evidence suggests that electroacupuncture to two local points may be sufficient to treat knee OA, but in view of some limitations to this study further research is necessary before this can be stated conclusively.