Healthcare providers' perspectives on integrating NCDs into primary healthcare in Thailand: a mixed method study.

BACKGROUND: In response to an increased health burden from non-communicable diseases (NCDs), primary health care (PHC) is effective platform to support NCDs prevention and control. This study aims to assess Thailand's PHC capacity in providing NCDs services, identify enabling factors and challenges and provide policy recommendations for improvement. METHODS: This cross-sectional mixed-method study was conducted between October 2019 and May 2020. Two provinces, one rich and one poor, were randomly selected and then a city and rural district from each province were randomly selected. From these 4 sites in the 2 provinces, all 56 PHC centres responded to a self-administrative questionnaire survey on their capacities and practices related to NCDs. A total of 79 participants from Provincial and District Health Offices, provincial and district hospitals, and PHC centres who are involved with NCDs participated in focus group discussions or in-depth interviews. RESULTS: Strong health infrastructure, competent staff (however not with increased workload), essential medicines and secured budget boost PHC capacity to address NCDs prevention, control, case management, referral and rehabilitation. Community engagement through village health volunteers improves NCDs awareness, supports enrolment in screening and raises adherence to interventions. Village health volunteers, the crucial link between the health system and the community, are key in supporting health promotion and NCDs prevention and control. Collaboration between provincial and district hospitals in providing resources and technical support enhance the capacity of PHC centres to provide NCDs services. However, inconsistent national policy directions and uncertainty related to key performance indicators hamper progress in NCDs management at the operational level. The dynamic of urbanization and socialization, especially living in obesogenic environments, is one of the greatest challenges for dealing with NCDs. CONCLUSION: PHC centres play a vital role in NCDs prevention and control. Adequate human and financial resources and policy guidance are required to improve PHC performance in managing NCDs. Implementing best buy measures at national level provides synergies for NCDS control at PHC level.

A cross sectional study of unmet need for health services amongst urban refugees and asylum seekers in Thailand in comparison with Thai population, 2019.

BACKGROUND: Although the Thai government has introduced policies to promote the health of migrants, it is still the case that urban refugees and asylum seekers (URAS) seem to be neglected. This study aimed to explore the degree of healthcare access through the perspective of unmet need in URAS, relative to the Thai population. METHODS: A cross-sectional survey, using a self-reporting questionnaire adapted from the Thai Health and Welfare Survey (HWS), was performed in late 2019, with 181 URAS completing the survey. The respondents were were randomly selected from the roster of the Bangkok Refugee Center. The data of the URAS survey were combined with data of the Thai population (n = 2941) from the HWS. Unmet need for health services was defined as the status of needing healthcare in the past 12 months but failing to receive it. Bivariate analysis was conducted to explore the demographic and unmet need difference between URAS and Thais. Multivariable logistic regression and mixed-effects (ME) model were performed to determine factors associated with unmet need. RESULTS: Overall, URAS were young, less educated and living in more economically deprived households, compared with Thais. About 98% of URAS were uninsured by any of the existing health insurance schemes. The prevalence of unmet need among URAS was significantly higher than among Thais in both outpatient (OP) and inpatient (IP) services (54.1% versus 2.1 and 28.0% versus 2.1%, respectively). Being uninsured showed the strongest association with unmet need, especially for OP care. The association between insurance status and unmet need was more pronounced in the ME model, relative to multivariable logistic regression. URAS migrating from Arab nations suffered from unmet need to a greater extent, compared with those originating from non-Arab nations. CONCLUSION: The prevalence of unmet need in URAS was drastically high, relative to the prevalence in Thais. Factors correlated with unmet need included advanced age, lower educational achievement, and, most evidently, being uninsured. Policy makers should consider a policy option to enrol URAS in the nationwide public insurance scheme to create health security for Thai society.

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.

Characteristics of distance education interventions and related outcomes in primary school children during COVID-19 pandemic: A systematic review.

The COVID-19 pandemic containment measures such as school closures remarkably disrupt the educational system, from in-person learning to remote or distance education with different interventions. This study aimed to identify the characteristics of interventions in remote or distance education during the COVID-19 pandemic and evaluate the outcomes of each intervention. A systematic review was conducted between October 2021 and May 2022 using four databases. Finally, 22 studies met the eligibility criteria and were included for data analysis. Most of the interventions were synchronous student-centered approaches followed by asynchronous student-centered approaches and mixed-learning through online channels such as desktop- and web-based modality. Remote or distance education is effective in academic development in any learning approach while having mixed effects in student attitudes and perceptions. Academic-related behaviors were most engaged by students in synchronous student-centered approaches. Finally, difficulties or burdens, and mental health or social interaction were similar for all learning approaches in technological problems and support systems from families and teachers. Synchronous student-centered approaches should be the main method of education, but other approaches can be used to complement based on the students' needs. Finally, educational infrastructure and support from teachers and parents are also necessary in remote or distance education. Further studies are needed to focus on primary school students, especially in low-income regions, and apply a randomized study design.

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.

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.

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.

Spatial Panel Data Analysis on the Relationship between Provincial Economic Status and Enrolment in the Social Security Scheme amongst Migrant Workers in Thailand, 2015-2018.

BACKGROUND: Thailand has a large flow of migrants from neighbouring countries; however, the relationship between economic status at the provincial level and the insured status of migrants is still vague. This study aimed to examine the association between provincial economy and the coverage of the Social Security Scheme (SSS) for migrants. METHODS: Time-series data were analysed. The units of analysis were 77 provinces during 2015-2018. Data were obtained from the Social Security Office (SSO). Spatiotemporal regression (Spatial Durbin model (SDM)) was applied. RESULTS: Migrant workers were mostly concentrated in Greater Bangkok, the capital city and areas surrounding it, but SSS coverage was less than 50%. However, the ratio of insured migrants to all migrants seemed to have positive relationship with the provincial economy in SDM. The ratio of insured migrants to all migrants was enlarged in all regions outside Greater Bangkok with statistical significance. CONCLUSIONS: Low enforcement on employment law in some areas, particularly Greater Bangkok, can result in lesser SSS coverage. The provincial economic prosperity did not guarantee large SSS coverage. Interventions to ensure strict insurance enrolment are required.

Situation of Self-Reported Anxiety and Depression among Urban Refugees and Asylum Seekers in Thailand, 2019.

Academic evidence on the health of urban refugees and asylum seekers (URAS) in Thailand is extremely sparse, especially for neglected problems such as mental health disorders. This study aimed to investigate the prevalence of anxiety and depression and factors associated with these problems among URAS in Bangkok. A cross-sectional study was conducted in 2019. The URAS were randomly selected from the roster of the Bangkok Refugee Centre (BRC). A self-administered questionnaire was used and 180 samples were recruited. Descriptive statistics and multivariable logistic regression were used for the analysis. We found a prevalence of 70.0% for anxiety and 39.5% for depression. Compared to Southeast Asia and China, URAS from other regions were 3.4 times (95% CI 1.5-7.5, p < 0.05) and 4.0 times (95% CI 1.1-14.0, p < 0.05) more likely to experience anxiety and depression, respectively. URAS with chronic co-morbidities (OR = 3.4, 95% CI 1.2-9.4, p < 0.05) and being divorced or widowed (OR = 11.1, 95% CI 2.1-57.2, p < 0.05) faced greater odds of depression than those without co-morbidities and being single. Related health authorities should play a proactive role in providing mental healthcare services for URAS, with greater consideration for those of certain nationalities and with chronic diseases.

A Cross-Sectional Study on Disparities in Unmet Need among Refugees and Asylum Seekers in Thailand in 2019.

The health of urban refugees and asylum seekers (URAS) in Thailand has been under-researched compared with other groups of non-Thai populations, especially on the topic of unmet need. The aim of this study is to examine the level of unmet need among URAS in Thailand, focusing on out-patient (OP) and in-patient (IP) care. A cross-sectional study was conducted between October and December 2019. Stratified random sampling was undertaken and a total of 181 participants were included. A bivariate analysis was used to explore the level of unmet need among different URAS groups. Multivariate logistic regression was undertaken to examine the association between potential correlations and unmet need of IP and OP care. The majority of participants were female and aged below 30 years, with a low educational background and poor economic status. Most of them had experienced an illness in the past month before the interview, and some suffered from chronic diseases. The prevalence of both OP and IP unmet needs was more frequent among URAS from Arab countries. Furthermore, being from Arab countries indicated a strong link with OP and IP unmet need. Additionally, having illness over the past six months and chronic diseases were found to be significant determinants of IP unmet need. Our analysis showed that nationality had a strong association with both IP and OP unmet need, especially among those from Arab countries. Therefore, culturally appropriate health services should be considered to promote healthcare access among diverse groups of URAS. Further qualitative studies on barriers to accessing OP and IP care, such as communication, interpretation, and social dimensions, are required.

Access to Non-Communicable Disease (NCD) Services Among Urban Refugees and Asylum Seekers, Relative to the Thai Population, 2019: A Case Study in Bangkok, Thailand.

BACKGROUND: The health of urban refugees and asylum seekers (URAS) in Thailand has been under-researched compared with other groups of non-Thai populations, especially in the area of chronic non-communicable diseases (NCD). The objectives of this study were to i) examine NCD prevalence; ii) access to NCD services; and iii) factors associated with access to NCD services among urban refugees and asylum seekers (URAS) in comparison with the Thai population. METHODS: A cross-sectional study, using a self-administrative questionnaire adapted from the Thai Health and Welfare Survey (HWS), was conducted in 2019. URAS were randomly selected from the register of the Bangkok Refugee Center. One hundred and eighty-one URAS participated in the survey. The data were combined with 2941 Thai records from the HWS. The population scope was confined to Bangkok. Bivariate analysis by Chi-square, Fisher's exact, and Mann-Whitney U-tests was conducted to examine difference in demographic and access to NCD services between URAS and Thais. Multivariable logistic regression was performed to identify factors associated with access to NCD services. RESULTS: Overall, URAS were young, less educated, and poorer than Thais. The trend of NCDs was similar to the Thai population, except mental health disorders appeared to be more prevalent in URAS. Almost half of the URAS did not receive any formal treatment. Being insured, abiding with Buddhism, and living in more affluent households were factors associated with better access to NCD services. URAS from Asian countries had greater access to NCD care than those from non-Asian countries. CONCLUSION: Policymakers should consider expanding the insurance coverage to URAS, similar to coverage for Thai populations. Additional studies on refugees' health status and service utilization in other settings outside Bangkok are strongly recommended.

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.

Health Status and Barriers to Healthcare Access among "Son-in-Law Westerners": A Qualitative Case Study in the Northeast of Thailand.

The northeast of Thailand is well-known as a popular destination where many male Westerners marry Thai women and settle down there. However, little is known about their health and well-being. This study aims to explore the Western husbands' health status and identify barriers hindering their healthcare access. A qualitative case study was conducted from November 2020 to May 2021. In-depth interviews and focus group discussions with 42 key informants who were involved with social and health issues among these expatriates were carried out. The social determinants framework was adapted for guiding the interviews. Data were triangulated with field notes, document reviews, and researchers' observations. Inductive thematic analysis was applied. Results showed that most male expatriates who married Thai women in the northeast were in their retirement years and had non-communicable diseases, health risk behaviors, and mental health problems. Most of them did not purchase health insurance and held negative impressions toward Thai public hospitals' quality of care, which was denoted as the main barrier to accessing healthcare services. Other significant barriers consisted of high treatment costs commonly charged by private hospitals and language issues. While the improvement of healthcare quality and the provision of friendly health services are important, public communication with foreign residents, especially male expatriates, is recommended to increase understanding and improve perceptions of the Thai healthcare systems. A regular population-based survey on the health and well-being of expatriates in Thailand, a cost study of a health insurance package, a survey study on willingness to pay for health insurance premiums, and a feasibility survey exploring the opportunity to establish either voluntary or compulsory health insurance among this group should be undertaken.

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.

Analysis of Policies to Protect the Health of Urban Refugees and Asylum Seekers in Thailand: A Qualitative Study and Delphi Survey.

The health of urban refugees and asylum seekers (URAS) in Bangkok has been neglected and health policies for USAR have not materialized. This study aimed to explore the views of stakeholders on policies to protect URAS well-being in Thailand. This study conducted a mixed-methods approach comprising both in-depth interviews and Delphi survey. The interview findings revealed six main themes: (1) the government position on URAS; (2) opinions on Thailand becoming a party of the 1951 Refugee Convention; (3) NGOs on health promotion for URAS; (4) options on health insurance management for URAS; (5) working potential of URAS; and (6) uncertainty of future life plans for URAS. The Delphi survey showed that URAS should have the right to acquire a work permit and be enrolled in the public insurance scheme managed by the Ministry of Public Health. Moreover, the ideology of national security was more influential than the concept of human rights. The ambiguity of the central authorities' policy direction to take care of URAS creates haphazard legal interpretations. The Delphi survey findings suggested the need for a more inclusive policy for URAS, however actual policy implementation requires further research on policy feasibility and acceptance by the wider public.

Prioritization of the Target Population for Coronavirus Disease 2019 (COVID-19) Vaccination Program in Thailand.

Thailand was hit by the second wave of Coronavirus Disease 2019 (COVID-19) in a densely migrant-populated province (Samut Sakhon). COVID-19 vaccines were known to be effective; however, the supply was limited. Therefore, this study aimed to predict the effectiveness of Thailand's COVID-19 vaccination strategy. We obtained most of the data from the Ministry of Public Health. Deterministic system dynamics and compartmental models were utilized. The reproduction number (R) between Thais and migrants was estimated at 1.25 and 2.5, respectively. Vaccine effectiveness (VE) to prevent infection was assumed at 50%. In Samut Sakhon, there were 500,000 resident Thais and 360,000 resident migrants. The contribution of migrants to the province's gross domestic product was estimated at 20%. Different policy scenarios were analyzed. The migrant-centric vaccination policy scenario received the lowest incremental cost per one case or one death averted compared with the other scenarios. The Thai-centric policy scenario yielded an incremental cost of 27,191 Baht per one life saved, while the migrant-centric policy scenario produced a comparable incremental cost of 3782 Baht. Sensitivity analysis also demonstrated that the migrant-centric scenario presented the most cost-effective outcome even when VE diminished to 20%. A migrant-centric policy yielded the smallest volume of cumulative infections and deaths and was the most cost-effective scenario, independent of R and VE values. Further studies should address political feasibility and social acceptability of migrant vaccine prioritization.

Noncommunicable Disease Service Utilization among Expatriate Patients in Thailand: An Analysis of Hospital Service Data, 2014-2018.

Global morbidity associated with noncommunicable diseases (NCDs) has increased over the years. In Thailand, NCDs are among the most prevalent of all health problems, and affect both Thai citizens and non-Thai residents, such as expatriates. Key barriers to NCD health service utilization among expatriates include cultural and language differences. This study aimed to describe the situation and factors associated with NCD service utilizations among expatriate patients in Thailand. We employed a cross-sectional study design and used the service records of public hospitals from the Ministry of Public Health (MOPH) during the fiscal years 2014-2018. The focus of this study was on expatriates or those who had stayed in Thailand for at least three months. The results showed that, after 2014, there was an increasing trend in NCD service utilizations among expatriate patients for both outpatient (OP) and inpatient (IP) care. For OP care, Cambodia, Laos PDR, Myanmar, and Vietnam (CLMV) expatriates had fewer odds of NCD service utilization, relative to non-CLMV expatriates (p-value < 0.001). For IP care, males tended to have greater odds of NCD service utilization compared with females (AdjOR = 1.35, 95% CI = 1.05-1.74, p-value = 0.019). Increasing age showed a significant association with NCD service utilization. In addition, there was a growing trend of the NCD prevalence amongst expatriate patients. This issue points to a need for prompt public health actions if Thailand aims to have all people on its soil protected with universal health coverage for their well-being, as stipulated in the Sustainable Development Goals. Future studies that aim to collect primary evidence of expatriates at the household level should be conducted. Additional research on other societal factors that may help provide a better insight into access to healthcare for NCDs, such as socioeconomic status, beliefs, and attitudes, should be conducted.

Evidence on Child Nutrition Recommendations and Challenges in Crisis Settings: A Scoping Review.

Adequate child nutrition is critical to child development, yet child malnutrition is prevalent in crisis settings. However, the intersection of malnutrition and disasters is sparse. This study reviews existing evidence on nutrition responses and outcomes for infants and young children during times of crisis. The scoping review was conducted via two approaches: a systematic search and a purposive search. For the systematic search, two key online databases, PubMed and Science Direct, were utilized. In total, data from 32 studies were extracted and included in the data extraction form. Additionally, seven guidelines and policy documents were included, based on relevance to this study. Overall, the existing evidence demonstrates the negative impacts of crises on nutritional status, diet intake, anthropometric failure, and long-term child development. On the other hand, crisis-related interventions positively affected nutrition-related knowledge and practices. Further studies should be carried out to explore the sustainability of the interventions and the success of existing guidelines. Since this study focuses only on nutrition among children under three, further studies should likewise consider an extended age range from three to five years.

Perspectives of Migrants and Employers on the National Insurance Policy (Health Insurance Card Scheme) for Migrants: A Case Study in Ranong, Thailand.

BACKGROUND AND PURPOSES: Thailand has implemented a nationwide insurance policy for migrants, namely the Health Insurance Card Scheme (HICS), for a long time. However, numerous implementation challenges remain and migrant perspectives on the policy are rarely known. The aim of this study was to examine migrant service users' perspectives and their consequent response towards the HICS. METHODS: A qualitative case-study approach was employed. In-depth interviews with ten local migrants and four employers were conducted in one of the most densely migrant-populated provinces in Thailand. Document review was used as a means for data triangulation. Inductive thematic analysis was exercised on interview data. RESULTS: The findings revealed that most migrants were not aware of the benefit, they are entitled to receive from the HICS due to unclear communication and inadequate announcements about the policy. The registration costs needed for legalising migrants' precarious status were a major concern. Adequate support from employers was a key determining factor that encouraged migrants to participate in the registration process and purchase the insurance card. Some employers sought assistance from private intermediaries or brokers to facilitate the registration process for migrants. CONCLUSION: Proper communication and promotion regarding the benefits of the HICS and local authorities taking action to expedite the registration process for migrants are recommended. The policy should also establish a mechanism to receive feedback from migrants. This will help resolve implementation challenges and lead to further improvement of the policy.

Health Literacy and Its Related Determinants in Migrant Health Workers and Migrant Health Volunteers: A Case Study of Thailand, 2019.

Migrant health workers (MHWs) and migrant health volunteers (MHVs) are key health workforce actors who play a substantial role in improving the health of migrants in Thailand. The objective of this study was to explore the factors associated with health literacy in MHWs and MHVs in Thailand. A self-administered questionnaire was conducted from December 2018 to April 2019 in two migrant-populated provinces. A total of 40 MHWs, 78 MHVs, and 116 general migrants were included in the survey. Results showed that a higher education level was associated with a greater health literacy score. MHWs were more likely to have a higher health literacy score (5.59 points difference) than general migrants. The province per se and type of affiliations did not significantly contribute to the difference in the health literacy score of each individual. Most MHWs received health information from health professionals, health staff, and the internet, while MHVs and general migrants received information from health professionals, MHWs/MHVs, family/friends, and posters/leaflets. This study suggests that a higher education level should be used as a criterion for recruitment of MHWs and MHVs. Access to interactive health information like health professionals should be promoted as the main source of information to ensure better health literacy among MHWs and MHVs.