Epidemiology and factors associated with preterm births in multiple pregnancy: a retrospective cohort study.

OBJECTIVE: Multiple pregnancies carry an increased risk of maternal and perinatal complications, notably prematurity. Few studies have evaluated the risk factors for preterm births in multiple pregnancies within the Thai population. This study aims to ascertain maternal and perinatal outcomes and identify factors linked to preterm births in multiple pregnancies. METHODS: This study was carried out at Khon Kaen University, Faculty of Medicine, Department of Obstetrics and Gynecology in Thailand. We reviewed the medical records of women with multiple pregnancies who delivered at a gestational age of more than 20 weeks between January 1, 2012 and December 31, 2021. We excluded patients with incomplete data or those for whom data were missing. RESULTS: Out of 21,400 pregnancies, 427 were multiple pregnancies, constituting approximately 1.99%. Over the ten-year period, 269 multiple pregnancies (65.1%) resulted in preterm births. Of these, 173 (64.3%) were monochorionic twins, and 96 (35.7%) were dichorionic twins. Monochorionic twins had a notably higher rate of preterm delivery (AOR, 2.06; 95%CI 1.29-3.30). Vaginal delivery was observed in 7.9% of the cases, while cesarean sections were performed for both twins in 91.5% of cases. In 0.5% of the cases, only the second twin was delivered by cesarean section. In terms of neonatal outcomes, 160 infants (19.4%) weighed less than 1,500 g at birth, and there were 78 perinatal deaths (9.4%). Birth asphyxia was noted in 97 cases (20.2%) among monochorionic twins and in 28 cases (8.1%) for dichorionic twins. CONCLUSION: The prevalence of multiple pregnancies was 1.99%, with 65.1% resulting in preterm births. Neonatal complications were notably more frequent in monochorionic twins. Monochorionic placenta and antepartum complications emerged as significant risk factors for preterm birth.

The impact of rotavirus vaccination on acute diarrhea in Thai children under 5 years of age in the first year of universal implementation of rotavirus vaccines in the National Immunization Program (NIP) in Thailand: a 6-year analysis.

BACKGROUND: Two types of rotavirus vaccines (RVs), Rotarix (RV1) and RotaTeq (RV5), were licensed as optional vaccines in 2012 and became part of the National Immunization Program (NIP) in the fiscal year 2020 in Thailand. The main objective was to evaluate the impact of rotavirus vaccines on the burden of acute diarrheal severity ranging from outpatient visits, diarrheal-related admission or deaths in the pre-NIP period (fiscal year 2015-2019) and in the fiscal year 2020. The minor objectives were assessed on the monthly admission rate, rotavirus vaccine coverage rate and rotavirus vaccine completed dose (RotaC). METHODS: Data regarding OPD, admission, and death cases under the Thailand National Health Coverage (NHC) from fiscal year 2015-2020, which were recorded as International Classification of Diseases and Related Health Problem 10th (ICD-10), were analyzed. RESULTS: The burden of diarrheal-related disease diminished after the rotavirus vaccine was introduced in the fiscal year 2020 when compared to the previous 5 fiscal years. The OPD visit rate decreased from 10.1 to 8.3 visits per 100 person-years (P < 0.001), or a 17.8% reduction (incidence rate ratio (IRR) = 0.82; 95% confidence interval (CI): 0.81 to 0.82). The admission rate significantly declined from 31.4 to 30.5 cases per 1,000 person-years, (P < 0.001), or a 2.9% reduction (IRR = 0.97; 95% CI: 0.96 to 0.98). The diarrheal-related mortality rate also subsided from 10.2 to 8.1 cases per 100,000 person-years (P 0.3), or a 20.0% reduction (IRR = 0.88; 95% CI: 0.50 to 1.22). The major population in both admissions and deaths was infants under 1 year of age (P < 0.001). Seasonality was seen as a constant bimodal pattern, with a significant decrease in monthly admissions after 6 months of rotavirus vaccine introduction to NIP (P < 0.001). RotaC was 37.4% in the first year of NIP. CONCLUSIONS: The rotavirus vaccine had a potential benefit for reducing the diarrheal disease burden, especially in infants under one year of age. Seasonality outbreaks of acute diarrhea subsided after the rotavirus vaccine was introduced. The RotaC was fairly low in the first year of the NIP. The quality of the rotavirus vaccine should be warranted. TRIAL REGISTRATION: Number TCTR20220120003 , date of registration: 20/01/2022, site: Thai Clinical Trials Registry.

Burden and pattern of acute diarrhea in Thai children under 5 years of age: a 5-year descriptive analysis based on Thailand National Health Coverage (NHC) data.

BACKGROUND: The incidence of acute diarrhea in Thai children under five years of age has increased over the last three decades. Even though mortality has significantly declined, the burden and cost of medical treatment are still high. Our objectives are to describe the burden and pattern of acute diarrhea cases that required admissions by Thai children under five years of age from 2015 to 2019. METHODS: Data regarding the admission of acute diarrhea cases of Thai children with Thailand National Health Coverage (NHC) under five years of age from 2015 to 2019, recorded as International Statistical Classification of Diseases and Related Health Problems, tenth Revision, Thai Modification (ICD-10-TM), were analyzed. RESULTS: The incidence trend of yearly acute diarrhea in children 0-5 years of age slightly increased from 33.36 cases per 1,000 population in 2010 to an average of 33.79 cases per 1,000 population/ year from 2015 to 2019 or approximately 0.43 cases per 1,000 population over the last decade while diarrhea-related mortality had a low, constant rate of 0.71 to 1.16 per 100,000 population per year. Two thirds of the mortality rate was observed in children under 1 year of age or 4.1 cases per 100,000 person-years in 5-year period (P < 0.01). The high cost of performing the medical treatment of approximately four hundred million baht per year. Seasonal variations demonstrated consistency with similar patterns during the cold and rainy seasons throughout the 5-year period. Regional distribution of the causative agent was also observed in Cholera, Typhoid, and Amoebiasis cases. A08: viral and other specified intestinal infections and A09: other gastroenteritis and colitis of infectious and unspecified origin were the two most common causes of diarrheal diseases. CONCLUSIONS: The incidence rate of acute diarrhea in Thai children under five years of age was higher while the mortality rate of acute diarrhea was lower than those in the past decade. A similar seasonal outbreak of acute diarrhea was seen during each examined year. The causative agent was not significant and was mainly unspecific. TRIAL REGISTRATION: Number TCTR20220117002, date of registration: 17/01/2022, site: Thai Clinical Trials Registry, URL http://www.thaiclinicaltrials.org/show/TCTR20220117002.

Mortality and treatment costs of hospitalized chronic kidney disease patients between the three major health insurance schemes in Thailand.

BACKGROUND: Thailand has reformed its healthcare to ensure fairness and universality. Previous reports comparing the fairness among the 3 main healthcare schemes, including the Universal Coverage Scheme (UCS), the Civil Servant Medical Benefit Scheme (CSMBS) and the Social Health Insurance (SHI) have been published. They focused mainly on provision of medication for cancers and human immunodeficiency virus infection. Since chronic kidney disease (CKD) patients have a high rate of hospitalization and high risk of death, they also require special care and need more than access to medicine. We, therefore, performed a 1-year, nationwide, evaluation on the clinical outcomes (i.e., mortality rates and complication rates) and treatment costs for hospitalized CKD patients across the 3 main health insurance schemes. METHODS: All adult in-patient CKD medical expense forms in fiscal 2010 were analyzed. The outcomes focused on were clinical outcomes, access to special care and equipment (especially dialysis), and expenses on CKD patients. Factors influencing mortality rates were evaluated by multiple logistic regression. RESULTS: There were 128,338 CKD patients, accounting for 236,439 admissions. The CSMBS group was older on average, had the most severe co-morbidities, and had the highest hospital charges, while the UCS group had the highest rate of complications. The mortality rates differed among the 3 insurance schemes; the crude odds ratio (OR) for mortality was highest in the CSMBS scheme. After adjustment for biological, economic, and geographic variables, the UCS group had the highest risk of in-hospital death (OR 1.13;95 % confidence interval (CI) 1.07-1.20; p < 0.001) while the SHI group had lowest mortality (OR 0.87; 95 % CI 0.76-0.99; p = 0.038). The circumscribed healthcare benefits and limited access to specialists and dialysis care in the UCS may account for less favorable comparison with the CSMBS and SHI groups. CONCLUSIONS: Significant differences are observed in mortality rates among CKD patients from among the 3 main healthcare schemes. Improvements in equity of care might minimize the differences.

Incidences and outcomes of status epilepticus: A 9-year longitudinal national study.

INTRODUCTION: The national database of status epilepticus (SE) in Thailand is limited in terms of the characteristics of the demographics, outcome, and prognostic factors. MATERIALS AND METHODS: We retrospectively explored national data in Thailand for reimbursement of all adult patients with SE admitted in the fiscal year 2004-2012. Patients with SE were diagnosed and searched based on ICD 10 (G41) from the national database of the Universal Health Coverage Insurance office. RESULTS: There were 12,367 patients with SE. The average age was 48.14 years, and 8119 patients were males (65.7%). At discharge, 75.2% of patients were improved, while 16.4% were not improved, and in-hospital mortality rate was 8.4%. The first three most common comorbid conditions were hypertension (1790 patients, 14.5%), diabetes mellitus (1064 patients, 8.6%), and previous stroke (819 patients, 6.6%). The common complications were respiratory failure (3990 patients, 32.3%), pneumonia (1201 patients, 9.7%) and septicemia (876 patients, 7.1%). The mean (SD) hospital stay was 5.48 (11.44) days. Patients with SE with age over 60 years, female patients, and patients at primary care hospitals had higher proportions of poor outcomes at 36.1%, 39.6%, and 40.9%. Out of 11 comorbid conditions, six of them were significantly associated with poor outcomes. Additionally, 5 complications and two procedures were significant factors of poor outcomes. CONCLUSIONS: Factors associated with poor outcome in admitted patients with SE by the national data were age, gender, hospital level, comorbid conditions, complications of SE, and procedural intervention. This article is part of a Special Issue entitled "Status Epilepticus".

The burden of cirrhosis and impact of universal coverage public health care system in Thailand: Nationwide study.

BACKGROUND AND RATIONALE: Cirrhosis is responsible for significant health-care costs and morbidity. This study aims to evaluate the burden of illness associated with cirrhosis, its impact on the universal coverage public health care system in Thailand. MATERIAL AND METHODS: We used data from the 2010 Nationwide Hospital Admission Data, the National Health Security Office (NHSO), Thailand. Their baseline characteristics, hospital costs, and outcomes were analyzed according to national health insurance categories including medical welfare scheme (MWFS), social security scheme (SSS) and civil servant medical benefit scheme (CSMBS). RESULTS: 92,301 admissions were eligible for analysis. The mean age was 55 ± 12.8 years, and 63.3% of patients were above 50 years old. The majority of patients (79%) belonged to the MWFS group. The MWFS group incurred the lowest medical expense and had the shortest hospital stay compared to the SSS and CSMBS groups. Overall in-hospital mortality was 10.7%. Cirrhosis complications include bleeding esophageal varices, spontaneous bacterial peritonitis, hepatic encephalopathy, hepatorenal syndrome, and hepatocellular carcinoma. These complications significantly increased mortality rates compared to patients without complications (26 vs. 8.9%, p < 0.001). In-hospital mortality of patients with cirrhosis complications did not differ among the three national health insurance groups. Respiratory failure and septicemia were associated with the highest risk of death (HR 5.4; 95% CI: 4.8-5.9 and HR 5.2; 95% CI: 4.9-5.6 respectively; P < 0.001). CONCLUSIONS: Illness associated with cirrhosis is a significant public health problem in Thailand. Outcomes of cirrhosis complications did not differ between universal public health care coverage systems in Thailand.

Hospital mortality from atrial fibrillation associated with ischemic stroke: a national data report.

PURPOSE: To study factors associated with poor outcomes in acute ischemic stroke patients with atrial fibrillation (AF) by using a national database. MATERIALS AND METHODS: This study was a retrospective analytical study by retrieving data from the Thailand national database system for universal coverage (UC) health insurance system. All adult patients aged over 18 years who were admitted with acute ischemic stroke during the fiscal years 2004-2012 by the appropriate ICD codes were searched. Eligible patients with AF were categorized as alive or dead during hospital stay. The mortality rate and factors associated with in-hospital mortality were studied. RESULTS: There were 522,699 patients diagnosed as acute stroke; 277,291 patients (53.1%) had acute ischemic stroke. Of those with ischemic stroke, 25,319 patients (9.1%) had AF. The mortality rates of acute ischemic stroke with AF were 14.1% and without AF were 6.2%, (p < 0.001). Significant factors associated with mortality in acute stroke patients with AF by multivariate logistic regression were female gender (adjusted odds ratio; AOR 1.28), co-morbid diseases such as diabetes (AOR 1.28), hypertension (AOR 1.26), rt-PA treatment (AOR 0.55), and stroke complications, such as pneumonia (AOR 2.60), septicemia (AOR 6.50), or gastrointestinal bleeding (AOR 2.16). CONCLUSIONS: At the national level, AF caused a higher mortality rate in acute ischemic stroke than in non-AF patients. Gender, co-morbid diseases, rt-PA treatment, and stroke complications were associated with mortality in acute ischemic stroke with AF.

An Evaluation of Blood Glucose Measurement Using TRUEresult Blood Glucose Monitoring System.

BACKGROUND: Point of care testing using glucose meters that measure capillary blood are the most popular and widely used method for the routine monitoring ofblood glucose level. TR UEresult is one ofsuch commonly used blood glucose measuring tools with high accuracy and precision profile according to the manufacturer's data. OBJECTIVE: To evaluate the performance of TRUEresult in real life practice by examining the agreement between capillary and venous glucose result using TR UEresult and a laboratory plasma glucose. MATERIAL AND METHOD: The present study is a cross sectional analytical study. All the data were collected from the patients whose blood samples were drawn for the measurement of plasma glucose at the outpatient department of Srinagarind Hospital, Khon Kaen University Thailand. TR UEresult blood glucose monitoring system was used to perform blood glucose measurement in whole blood samples from capillary and veins. This was compared with plasma glucose result from the automated analyzer in the central laboratory, which was considered as reference method at Srinagarind Hospital. RESULTS: The ISO 15197:2013 criteria was used to determine technical accuracy of the TRUEresult tool. Blood glucose levels in whole blood sample from capillary and veins, as measured using the TRUEresult, were 88.24% and 92.16% of the acceptable bias limits. This is below the minimal acceptable criteria. When Parkes error grid analysis was used to define the significance in clinical decision, all the errors of blood glucose levels measured using the TRUEresult were within zone A and zone B, meaning that the errors have no or little influence on clinical decision. CONCLUSION: The blood glucose levels in whole bloodfrom capillary and veins measured using TR UEresult blood glucose monitoring was within acceptable accuracy limit. The observed error had no or little influence on clinical decision.

A national database of incidence and treatment outcomes of status epilepticus in Thailand.

Status epilepticus (SE) is a serious neurological condition. The national database of SE in Thailand and other developing countries is limited in terms of incidence and treatment outcomes. This study was conducted on the prevalence of status epilepticus (SE). The study group comprised of adult inpatients (over 18 years old) with SE throughout Thailand. SE patients were diagnosed and searched based on ICD 10 (G41) from the national database. The database used was from reimbursement documents submitted by the hospitals under the three health insurance systems, namely, the universal health coverage insurance, social security, and government health welfare system during the fiscal year 2010. We found 2190 SE patients receiving treatment at hospitals (5.10/100 000 population). The average age was 50.5 years and 1413 patients were males (64.5%). Mortality rate was 0.6 death/100 000 population or 11.96% of total patients. Significant factors associated with death or a nonimproved status at discharge were type of insurance, hospital level, chronic kidney disease, having pneumonia, having shock, on mechanical ventilator, and having cardiopulmonary resuscitation. In conclusion, the incidence of SE in Thailand was 5.10/100 000 population with mortality rate of 0.6/100 000 population.

Prevalence of factors associated with poor outcomes of hospitalized myasthenia gravis patients in Thailand.

OBJECTIVE: To examine the prevalence of hospitalized myasthenia gravis (MG), and to determine the factors associated with poor outcomes of hospitalized MG patients at a national level. METHODS: This study was based on a retrospective design. We collected data of hospitalized MG adults recorded by the National Health Security Office, Bangkok, Thailand between October 2009 and September 2010. Clinical data and treatment outcomes were examined. RESULTS: The total number of hospitalized MG patients was 936 cases. The prevalence rate of hospitalized MG patients was 2.17/100,000 population. The average age (SD) was 44.93 (14.16) years. Regarding the discharge status of MG patients, 845 cases (90.3%) had improved. The total hospital charge of MG patients was 64,332,806 baht (USD 2,144,426.87) or an average of 68,731.63 baht/admission (USD 2,291.05), with an average length of stay of 10.45 days. There were 3 significant factors associated with poor outcomes in hospitalized MG patients; namely, hospital category, pneumonia, and respiratory failure. CONCLUSION: The prevalence of admission in MG patients was 2.17 persons/100,000 population. Hospital category, pneumonia, and respiratory failure were significant factors associated with poor outcomes.

The health situation among Thai elementary school-age children: 2010.

BACKGROUND: The school years are a crucial time in the development of the basic life skills necessary for learning in the various and different fields to be encountered in life, as well as for developing and acquiring the knowledge, skills and attitudes necessary to establish and maintain a healthy lifestyle. In general, elementary school-age children rarely present at health service centers but may nevertheless have health problems that affect their ability to learn. OBJECTIVE: To analyze the health situation among elementary school-age children in Thailand, for the creation of baseline information to serve as an evential basis for making recommendations for adjusting the medical education curriculum and for improving health service provision. MATERIAL AND METHOD: To analyze nationwide, hospital data, for the morbidity and mortality of children age 6-12 years in fiscal year 2010. RESULTS: Respiratory infections represented the leading cause for out-patient visits-approximately one-fifth. Respiratory infections were also a significant cause for admissions (21.6%), followed by dengue hemorrhagic fever (14.8%), injury and poisoning (11.3%), disease of digestive system (11.1%) and intestinal infection (10.3%). The leading causes of death were injury and poisoning (22.7%), followed by neoplasm (14.4%), other infection (13.5%) and respiratory infection (12.6%). Overall, about 50-60% of the causes of admissions and of deaths were due to infectious diseases and injury & poisoning. CONCLUSION: Infectious diseases and injury & poisoning were the major physical illnesses among school-age children. Notwithstanding, there were other health issues-including nutrition, growth & development, mental health & psychosocial problems-that need to be recognized and addressed in order to ensure the health and well-being of school-age children in Thailand.

Burden of acute lower respiratory infection in children in Thailand in 2010: have we achieved the national target in under-five morbidity and mortality?

BACKGROUND: National reports indicate that morbidity and mortality from pneumonia among Thai children has decreased dramatically since the turn of the millennia; notwithstanding, pneumonia remains the leading cause of admission and death in Thai children under five years of age. OBJECTIVE: To assess the burden and pattern of acute lower respiratory infection in under-fives in Thailand from the health data in 2010. MATERIAL AND METHOD: Information on respiratory infection using the ICD10: J09-J22 was evaluated for the number of OPD visits, admissions, mortality, monthly incidence and co-morbidities of the mortality. RESULTS: 73% of all OPD visits with ALRI were in under-fives: one-fourth of whom required hospitalization. Pneumonia is the leading cause of both admissions and mortality (3.22% and 11.29/100,000 population for this age group, respectively). The highest mortality was in the first year of life (39/100,000). One-fourth of the children (168/639) died within 24 hours of admission and septicemia was the most common co-morbidity. CONCLUSION: The respective morbidity and mortality of pneumonia in under-fives fell far short of national targets. To achieve these targets, many key aspects are needed; such as, strengthening the knowledge of healthcare personnel, the cost-effectiveness researches on the causative organism detection and the expanding coverage of the preventable-vaccine.

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.

Dengue mortality in patients under 18 years old: an analysis from the health situation analysis of Thai population in 2010 project.

BACKGROUND: Dengue is an important cause of morbidity and mortality in tropical and subtropical regions of the world. In Thailand, there has been no detailed research on mortality in children in terms of duration of admission and associated complications in the cases that died. OBJECTIVE: To assess the burden of dengue in Thailand in 2010 and to analyze the complications in patients aged under 18 years who died. MATERIAL AND METHOD: The authors described the mortality and complications of dengue fever and dengue hemorrhagic fever in patients under 18 years old using the information from the Health Situation Analysis of the Thai Population 2010 Project. RESULTS: In 2010, the overall mortality of dengue in all age groups and in patients aged under 18 years were 0.3 and 0.6/ 100,000, respectively. The mortality rate was highest among children aged 6-12 years (0.8/100,000). Among the 8 children with dengue fever that died, the 2 most common complications were fluid electrolyte and acid-base imbalance and disseminated intravascular coagulation (DIC). The common complications among the 91 cases with dengue hemorrhagic fever that died included fluid electrolyte and acid-base imbalance, hepatic failure, respiratory failure, bacterial infection, DIC and renal failure. CONCLUSION: Early diagnosis, careful management of fluid therapy, awareness of hepatic and renal impairment and early treatment of co-infection should decrease mortality of dengue hemorrhagic fever

Coronary artery disease in the Thai population: data from health situation analysis 2010.

BACKGROUND: The rate of cardiovascular disease marked by coronary artery disease (CAD) is increasing in low-middle income countries including Thailand. The burden of CAD will have a significant impact on the healthcare system and the national budget. OBJECTIVE: To identify the CAD-related hospitalization rate over one year; to determine in-hospital mortality in various subgroups of patients with CAD and to examine the hospitalization costs of patients with CAD. MATERIAL AND METHOD: The data were extracted from in-patient discharge forms from the three main health insurance schemes in Thailand for the fiscal year 2010 (October 1, 2009 to September 30, 2010. The data included the three major health insurance schemes which provided coverage for about 62 million people (96% of the population). Data regarding coronary artery disease using the ICD-10 (I20-angina, I21-acute myocardial infarction (AMI) and I25-chronic ischemic heart disease) were extracted and analyzed for number of admissions, mortality rate, length of hospital stay and hospital charges. RESULTS: In 2010, the total admissions of patients with coronary artery disease were 22,507. The most common presentation of CAD was angina pectoris (10,822 admissions)followed by AMI (6,391 admissions) and chronic ischemic heart disease (5,294 admissions). The respective in-hospital mortality rates in patients admitted with AMI, chronic ischemic heart disease and angina pectoris were 11.3%, 2.9% and 0.7%. CONCLUSION: Thailand is entering a period of epidemiologic transition marked by an increase of cardiovascular disease and hospital expenses dominated by cardiovascular disease. Information on the burden of CAD--indicates a need to improve health care system.

The burden of head and neck cancers in Thailand.

OBJECTIVE: To determine the overall burden of disease vis-a-vis head and neck cancers in Thailand, as indicated by visits to healthcare units, admissions for treatment and expenditures at all levels of the healthcare delivery system. MATERIAL AND METHOD: A descriptive study was conducted by retrieving and analysing data for the fiscal year 2010 from the National Health Security Office (NHSO) and the Social Security Office, Thailand and from in-patient data of the Civil Servants Benefit System from the Comptroller General's Department. RESULTS: In 2010, there were 167,199 visits to outpatient departments (OPDs) and 26,012 admissions to hospital (IPD) for diagnosis and treatment of head and neck cancers. The most common diagnosis for visits to OPD and admission to IPD was oral cancer (28.2% and 25%, respectively). The mean length of hospital stay was 9 days. About half of admissions took place in the central region. The hospital charges totalled 691 million Baht (US$ 21.8 million), or an average of 26,556 Baht (USS 838) per admission. CONCLUSION: Since a relatively high volume of hospital visits was found, there is an urgent need to train sufficient numbers of specialists in the field of head and neck cancer treatments to provide efficient healthcare.

Current challenges in reducing neonatal morbidity and mortality in Thailand.

BACKGROUND: Information on neonatal mortality and burden of illness during the neonatal period is an essential guide for prioritizing interventions for solving health problems and allocating resources. OBJECTIVE: To evaluate the burden of diseases and the current health situation among Thai neonates under the Universal Health Insurance Coverage Scheme. MATERIALS AND METHOD: The number of admissions according to mortality, length of hospital stay and cost of hospital charges during the neonatal period was analyzed. RESULTS: There were 638,795 live births according to the data extracted from the three healthcare schemes supporting universal healthcare' in Thailand, which is lower than the data from the Health Information Unit of the Bureau of Health Policy and Strategy at the Ministry of Public Health. The neonatal death rate was 3.98 per 1,000 live births comprising 58.9% of all infant deaths. Major proportion of neonatal deaths (700%) occurred in early neonatal period and 43% of which occurred within the first two days of life. The leading causes of neonatal deaths were prematurity, respiratory problems, congenital malformation, birth asphyxia and infection. The most prevalent diagnosis for admissions was neonatal jaundice, disorders related to short gestation, respiratory disorders and neonatal infection. CONCLUSION: More investment is required to improve education and implement health interventions that can be integrated into existing health systems for better neonatal outcomes.

Health situation analysis of Thai children aged 1-5 years in 2010: implications for health education and health service reform.

BACKGROUND: To make the world fit for children is a task necessarily involves all organizations working with children. The real health situation will be useful for strategic planning for them. OBJECTIVE: To emphasize Thailand's health burdens of children between 1 and 5 years in 2010. MATERIAL AND METHOD: The authors analyzed the fiscal 2010 data from the three health insurance schemes from hospitals nationwide for information on: out-patient and in-patient visits, common illnesses of Thai children between 1 and 5 years, lengths of stay, hospital charges and deaths. Most (96%) of the population was represented in this data. RESULTS: Respiratory infection was the most common admission (225,183 times) while intestinal infection was the second (83,293 times). Respiratory infection was the second most common for an out-patient visit (7, 387,132 times = 23.6%) after other factors influencing health (17,384,963 times = 55.5%). The most common causes of death were injury and poisoning (178 patients) and respiratory infection (175 patients). Pneumonia required the most budget and resulted in the longest stays. Among accidents, accidental drowning and submersion caused the most deaths. CONCLUSION: Respiratory infection, pneumonia, intestinal infection, injuries, poisoning and accidental drowning were the most common health burdens among children between 1 and 5 years of age.

Thailand's adolescent health situation: prevention is the key.

BACKGROUND: Adolescence is generally a period of good physical health, but future health problems may begin at this age due to exposure to risk factors for diseases. OBJECTIVE: To analyze the health situation of adolescents (age 13-18years) in Thailand in order to derive guidance for the refinement and calibration of the medical curriculum and enhance health service provision to adolescents. MATERIAL AND METHOD: National data from Thailand's 3 major health care systems, regarding; the causes of out-patient visits, in-patient admissions and deaths in the fiscal year 2010 were analyzed. RESULTS: The leading causes of out-patient visits were (1) factors influencing health (2) respiratory infections (3) diseases of the digestive system (4) injury and poisoning and (5) external causes of morbidity and mortality. The leading causes of admissions were (1) pregnancy (2) injury and poisoning and (3) arthropod-borne viral fevers. The leading causes of hospital deaths were (1) injury and poisoning (2) neoplasms and (3) other infections. CONCLUSION: The majority of the causes of morbidity and mortality were related to psychosocial factors and engagement in high risk behaviors.

Unintentional injury among Thai children and adolescents in 2010.

BACKGROUND: Unintentional injury has been identified as a public health problem in Thailand as it is the leading cause of death among both children and adolescents. OBJECTIVE: To explore the number of admissions by unintentional injury and cause(s) among Thai children and adolescents in 2010. MATERIAL AND METHOD: Data on the number of admissions by unintentional injury in the fiscal year, 2010, were derived from hospitals nationwide as well as the three health insurance schemes. Data on Thai children and adolescents (0-18 years) was collected between October 1, 2009 and September 30, 2010. The coding for underlying cause(s) of unintentional injuries and death were done using the International Classification of Diseases, 10th edition. RESULTS: A total of 118,323 unintentional injuries were reported. The majority of patients were male and falls were the major cause of unintentional injuries (27,139 admissions; 22.94%) followed by motorcycle injuries (20,499 admissions; 17.32%). Accidental drowning and submersion was the major cause of death in the present study, followed by lightning strikes and accidental threats to breathing (i.e., choking and suffocation). CONCLUSION: The current study revealed that falls were the major cause of unintentional injury and accidental drowning and submersion the major cause of death.