Cost analysis of a teaching hospital in Thailand: Impacts of the first wave of COVID-19.

COVID-19 has had adverse impacts on the health sector in Thailand and information on hospital costs is required for planning and budgeting. The aim of this study was to estimate costs that the pandemic imposed on a teaching hospital in the country, focusing on the first wave which took place in March-May 2020. A retrospective cost analysis was performed. Data on COVID-related activities, including when and where they were undertaken, were retrieved from existing sources and supplemented by in-depth interviews with the hospital's staff. The data collection period was January-October 2020, covering three distinct phases: before, during, and after the first wave of the pandemic. The total costs during the preparation phase in January-February, the pandemic phase in March-May, and the standby phase in June-October were 0.6, 3.9, and 1.2 million US dollars respectively. Costs related to treatment of COVID-19 patients were higher than those related to infection control in the first two phases but not in the standby phase, making up 82.09%, 75.23%, and 43.95% of the total costs in the three phases respectively. Costs were incurred in all areas of the hospital, including those that were set up to serve COVID patients, those serving non-COVID patients, and those serving both groups. Public donations were integral to the provision of services and made up 20.94% of the total cost during the pandemic phase. This study was the first to estimate hospital costs of COVID-19 in Thailand. It demonstrated high costs of a national outbreak and supported the establishment of a contingency fund for medical emergencies at the hospital level.

Investigation of tobacco and alcohol co-consumption in Thailand: A joint estimation approach.

INTRODUCTION AND AIMS: Most studies on tobacco and alcohol consumption empirically model the two behaviours separately. The primary aim of this study was to investigate the patterns of tobacco and alcohol co-consumption in Thailand, modelling the two behaviours jointly and identifying whether they complemented or substituted each other. DESIGN AND METHODS: Data were extracted from the 2007, 2011, 2014 and 2017 waves of the nationally representative Tobacco and Alcohol Consumption Survey in Thailand. A bivariate ordered probit model, under which the frequencies of tobacco and alcohol consumption were jointly estimated, was performed on the repeated cross-sectional sample as well as each of the cross-sectional samples. RESULTS: Based on the repeated cross-sectional sample (n = 411 981), the analyses suggested that tobacco and alcohol consumption were complementary behaviours. The predicted conditional probabilities revealed that the more frequently one drank, the higher the likelihood that he/she also smoked at a higher frequency, and vice versa. DISCUSSION AND CONCLUSIONS: Given the complementary nature of tobacco and alcohol consumption in Thailand, tobacco- and alcohol-prevention strategies should be realigned and better co-ordinated for greater efficiency. The net impacts of a given tobacco or alcohol policy should be incorporated into the optimal policy design to avoid duplication of efforts. Also, future studies of tobacco and alcohol consumption should consider modelling the two behaviours together using a joint estimation approach.

Determinants of breastfeeding practices in Myanmar: Results from the latest nationally representative survey.

Optimal breastfeeding practices can ensure healthy growth and development of infants, which in the long term can impact the country's economic development. Nevertheless, Myanmar has yet to achieve the WHO's target of 70% for early initiation of breastfeeding, and the country's target of 90% for exclusive breastfeeding. The purpose of this study was to assess the associations between early initiation of breastfeeding and exclusive breastfeeding and bio-demographic, socio-economic and behavioral factors in Myanmar. Using the 2015-2016 Myanmar Demographic and Health Survey, the analysis of early initiation of breastfeeding was based on a sample of 1,506 under-2 children and the analysis of exclusive breastfeeding was based on a sample of 376 children aged 0-5 months. Multiple logistic modeling, with heteroskedasticity-adjusted standard errors, was used. The prevalence rates of early initiation of breastfeeding and exclusive breastfeeding in the study were 67.9% and 52.2% respectively. Having a vaginal delivery (AOR = 2.5; 95% CI = 1.7-3.7) and having frequent (≥ 4) antenatal visits (AOR = 2.4; 95% CI = 1.5-3.8) were associated with higher odds of early initiation of breastfeeding. Having a postnatal checkup (AOR = 0.5; 95% CI = 0.3-0.9) and having an infant that was perceived to be small at birth (AOR = 2.5; 95% CI = 1.1-5.7, for infants perceived to be large at birth) were significantly associated with decreased odds of exclusive breastfeeding. In order to promote optimal breastfeeding practices, this study suggested that delivery and quality of health services during pregnancy need to be strengthened in Myanmar.

Effectiveness of antimalarial interventions in Nigeria: Evidence from facility-level longitudinal data.

OBJECTIVE: To evaluate the effectiveness of a program of antimalarial interventions implemented in 2010-2013 in Niger State, Nigeria. DATA SOURCES: Utilization reports from 99 intervention and 51 non-intervention health facilities from the Niger State Malaria Elimination Program, supplemented by data on facility-level characteristics from the Niger State Primary Health Care Development Agency and Local Government Malaria Control units. STUDY DESIGN: Estimated with mixed-effects negative binomial modeling, a difference-in-differences method was used to quantify the impact of the program on the number of febrile illness cases and confirmed malaria cases. Potential confounding factors, non-stationarity, seasonality, and autocorrelation were explicitly accounted for. DATA EXTRACTION METHODS: Data were retrieved from hard copies of utilization reports and manually inputted to create a panel of 5550 facility-month observations. PRINCIPAL FINDINGS: The program was implemented in two phases. The first phase (August 2010-June 2012) involved the provision of free artemisinin-based combination therapies, long-lasting insecticidal nets, and intermittent preventive treatments. In the second phase (July 2012-March 2013), the program introduced an additional intervention: free parasite-based rapid diagnostic tests. Compared to the pre-intervention period, the average number of monthly febrile illness and malaria cases increased by 20.876 (P < 0.01) and 22.835 (P < 0.01) in the first phase, and by 19.007 (P < 0.05) and 19.681 (P < 0.05) in the second phase, respectively. The results are consistent across different evaluation methods. CONCLUSIONS: This study suggests that user-fee removal leads to increased utilization of antimalarial services. It motivates future studies to cautiously select their investigative methods.

Impact of Buddhist Lent Dry Campaign on alcohol consumption behaviour: A community level study.

"Buddhist Lent Dry Campaign" is an alcohol-control programme that uses religious opportunities to promote behavioural changes among the Thai population. It is undertaken at the national and community levels. This study aimed to systematically evaluate the effectiveness of the community-level intervention under the campaign on alcohol consumption behaviour. A prospective cohort study was conducted. The sample comprised 447 drinkers from four intervention communities and 388 from four non-intervention communities. All were subjected to a series of sequential interviews. Our findings showed that the availability of the community intervention had a significant effect on alcohol abstinence not only during Buddhist Lent (OR = 2.74, 95% CI = 1.96, 3.85), but also 3 months after the end of Buddhist Lent (OR = 2.19, 95% CI = 1.42, 3.38). Furthermore, the intervention was very effective among drinkers who took an abstinence pledge (OR = 7.04, 95% CI = 4.49, 11.04). However, the effectiveness of the community intervention weakened after the intervention it ended. Additional interventions might be required to maintain the effects of the community intervention.

Healthy behaviours and productive activities among Thai older adults: A repeated cross-sectional analysis.

Based on a nationally representative repeated cross-sectional sample of older individuals from the 2007 and 2011 Surveys of Older Persons in Thailand (n = 50,138, with the participation rate of 95.79%), this study investigates the extent to which healthy behaviours are interrelated with productive activities in old age. Healthy behaviours were represented by alcohol abstinence, tobacco abstinence, physical exercise, and consumption of a nutritious diet, encompassing all major lifestyle choices that could lower mortality risks among the general population. Productive activities were represented by social participation and labour participation, consistent with the paradigms of Active and Productive Ageing promoted by the World Health Organization. A multivariate probit model, whereby all six behaviours were jointly estimated, was explored. Conditional on pairwise combinations of the two productive activities, the probabilities of contemporaneously undertaking all four healthy behaviours were calculated. The results illustrate that the relationships among productive activities and health behaviours are inextricable and complex. Considering each of the four healthy behaviours separately, social participation and labour participation are associated with lower probabilities of abstaining from alcohol and tobacco but higher probabilities of exercising and keeping a nutritious diet among older adults. Considering all four healthy behaviours together, the productive activities are associated with a significant increase in the probability that a Thai older adult would simultaneously abstain from alcohol, abstain from tobacco, exercise, and eat healthily, compared to if the same individual undertakes neither social participation nor labour participation. This study calls for a consistent set of multiple-behaviour interventions to promote healthy and productive ageing.

The impact of a conditional cash transfer program on the utilization of non-targeted services: Evidence from Afghanistan.

While existing research suggests that health-related conditional cash transfer (CCT) programs have positive impacts on the utilization of CCT-targeted health services, little is known as to whether they also influence the utilization of non-targeted health services-defined as general health services for which program participants are not financially motivated. Based on a sample of 6649 households in a CCT program that took place in May 2009-June 2011 in Afghanistan, we evaluate the impact of the receipt of CCTs on the utilization of non-targeted health services both by women, who were direct beneficiaries of the program, and by members of their households. We estimate the outcomes of interest through four probit models, accounting for potential endogeneity of the CCT receipt and dealing with lack of credible exclusion restrictions in different ways. In comparison with the control group, the receipt of CCTs is found to be associated with an increase in the probability of utilizing non-targeted services among household members across regression models. The results are mixed, with regard to the utilization by women, suggesting that there exist non-economic barriers to health care, unique to women, that are not captured by the data. The results confirm the importance of accounting for direct as well as indirect effects in policy evaluation and suggest that future studies investigate more deeply the role of community health workers in removing non-economic barriers for Afghan women and the possibility of introducing an incentive structure to motivate them to contribute more actively to population health in Afghanistan.

Social Participation and Disaster Risk Reduction Behaviors in Tsunami Prone Areas.

This paper examines the relationships between social participation and disaster risk reduction actions. A survey of 557 households in tsunami prone areas in Phang Nga, Thailand was conducted following the 2012 Indian Ocean earthquakes. We use a multivariate probit model to jointly estimate the likelihood of undertaking three responses to earthquake and tsunami hazards (namely, (1) following disaster-related news closely, (2) preparing emergency kits and/or having a family emergency plan, and (3) having an intention to migrate) and community participation. We find that those who experienced losses from the 2004 tsunami are more likely to participate in community activities and respond to earthquake hazards. Compared to men, women are more likely to prepare emergency kits and/or have an emergency plan and have a greater intention to migrate. Living in a community with a higher proportion of women with tertiary education increases the probability of engaging in community activities and carrying out disaster risk reduction measures. Individuals who participate in village-based activities are 5.2% more likely to undertake all three risk reduction actions compared to those not engaging in community activities. This implies that encouraging participation in community activities can have positive externalities in disaster mitigation.