Children orphaned from COVID-19 in Thailand: maximize use of civil registration database for policies.

Orphans, especially those who experience maternal loss at a young age, face significant long-term negative impacts on their lives and psychological well-being, extending beyond the age of 18. As of July 2023, the global death toll of COVID-19 has reached 6.9 million, leaving behind an unknown number of orphans who require immediate attention and support from policymakers. In Thailand, from April 2020 to July 2022, the total number of COVID-19-related deaths reached 42,194, resulting in 4,139 parental orphans. Among them, 452 (10.9%) were children under the age of five, who are particularly vulnerable and necessitate special policy attention and ongoing support. While the provision of 12 years of free education for all and Universal Health Coverage helps alleviate the education and health expenses borne by households supporting these orphans, the monthly government support of 2,000 Baht until the age of 18 is insufficient to cover their living costs and other education-related expenditures. We advocate for adequate financial and social support for COVID-19 orphans, emphasizing the importance of placing them with relatives rather than institutional homes. In the context of post-pandemic recovery, this perspective calls upon governments and global communities to estimate the number of orphans and implement policies to safeguard and support them in the aftermath of COVID-19.

Household Need and Unmet Need for Caregivers of Older Persons in Thailand.

The need for caregivers is a crucial issue in Thailand. This research examined levels and trends of household needs and unmet needs for caregivers of older persons and explored potential factors associated with these needs. The analysis utilized data from the Survey of Older Persons in Thailand 2007, 2011, 2014, and 2017. The household need for a caregiver of older persons was defined as a household with one or more older people who needed a caregiver to help them perform basic activities of daily living. The unmet need for a caregiver referred to households where at least one older person in the household needed care but did not receive it. Findings illustrated the increasing levels and trends of household needs as well as unmet needs over time. In terms of potential determinants, older person households in Bangkok and households with higher socioeconomic status were more likely to be the household need for caregivers. In contrast, those households in the Northeastern, the poorest region, were more likely to be the unmet need household. These findings are indicative of the rising demand for long-term care services in Thailand. However, it is vital to consider unmet household needs, especially in the worse-off area, when designing national policies.

In Caring for Older People in Low- and Middle-Income Countries, Do Older Caregivers Have a High Level of Care Burden and Psychological Morbidity Compared to Younger Caregivers?

Caregivers have become older as longevity increases. Caregiving for older people can cause burdens and psychological morbidity, which are the chronic stresses perceived by informal caregivers. This study aimed to compare the levels of care burden and psychological morbidity between older and younger caregivers in low- and middle-income countries. A cross-sectional survey was conducted in Cuba, the Dominican Republic, Peru, Venezuela, Mexico, Puerto Rico, and China. Data were collected by the 10/66 Dementia Research Group. The Zarit Burden Inventory was used to measure the levels of burden on caregivers. Psychological morbidity was assessed through the Self-Reporting Questionnaire. Data from 1348 households in which informal caregivers provided home care for one older person were included in the analysis. Multivariable logistic regression was used to investigate the effects of caregiver age upon care burden and psychological morbidity. A fixed-effect meta-analysis model was used to obtain a pooled estimate of the overall odds ratios of each country. The unadjusted and the adjusted model for potential covariates revealed no significant difference in care burden and psychological morbidity between older caregivers and younger caregivers. The adjusted pooled estimates, however, indicated a lower psychological morbidity among older caregivers (OR = 0.61, 95% CI: 0.41-0.93, I2 = 0.0%). The demographic implications of caregiver age may suggest different policy responses across low- and middle-income countries.

Reducing the Physical Burden of Older Persons' Household Caregivers: The Effect of Household Handrail Provision.

The household handrail is necessary for dependent older people to perform their daily living activities, improve caregiving competency, and reduce caregiver burden. This study aimed to explore physical burden levels and examine their association with handrail provision among caregivers in older people's households in Phuttamonthon District, Thailand, in 2017. This study used the physical dimension of the Caregiver Burden Inventory to quantify the levels of physical burden among 254 caregivers in households with a dependent older person. It classified the studied households into three categories: no handrail, one handrail, and more than one handrail. The analysis employed the ordinal logistic model approach. The findings showed that the mean physical burden score was 5 ± 3.85, indicating a high burden. After adjusting for potential factors, the caregivers in older people's households with one handrail were less likely to experience a high physical burden than those without a handrail (OR = 0.30, 95% CI = 0.14-0.67). Nonetheless, the analysis found no significant differences in physical burden between caregivers of households with more than one handrail and those of households with no handrails. Having handrails in housing might enhance older people's ability to adjust to disability and illness, ultimately reducing the physical care burden of caregivers. However, having the appropriate number of handrails in older people's households should be considered.

State of household need for caregivers and determinants of psychological burden among caregivers of older people in Thailand: An analysis from national surveys on older persons.

OBJECTIVES: To explore the levels and trends of household need for caregivers of older people and to explore the impact of potential determinants of psychological burden among caregivers of older people in Thailand. METHODS: The secondary data analysis was performed using the Survey of Older Persons in Thailand 2007, 2011, and 2014 datasets which conducted by the National Statistical Office of Thailand. The household need for caregivers of older persons refers to having at least one older person in the household who needs a caregiver for assistance with activities of daily living. Caregiver mental health, which is confined to the available 2011 data, is defined as a state of psychological burden. Ordinal logistic regression models were used to explore the impact of potential determinants of psychological caregiver burden. RESULTS: The household need for caregivers in Thailand tends to be increasing, from 5.0% in 2007 to 6.6% in 2014. The levels of the household need for caregivers were significantly higher in urban areas, Bangkok, and high socioeconomic households. In terms of psychological caregiver burden, the Thai Mental Health Indicators in 2011 produced, on average, a fair level of mental health, but one-fourth of caregivers had poor mental health. Duration of care for older people, household wealth, and functional dependency significantly predict total caregiver burden. Household characteristics are vital in predicting psychological caregiver burden, and the adjusted effect of the fifth quintile of household wealth was high (odds ratio = 2.34; 95% confidence interval = 1.47-3.73). CONCLUSION: The increasing need for caregiving in households with an older person can lead to a higher caregiver burden, particularly among those caregivers who care for dependent older people in poor households. Longer duration of caregiving is a factor that mitigates this burden.

A Longitudinal Study of Changes in Cognition Among Older Thais: Studying From the Kanchanaburi Demographic Surveillance System.

Objectives: To examine the impacts of changes in social determinants of health (SDH) toward changes in cognition. Methods: Longitudinal data came from the Kanchanaburi Demographic Surveillance System (KDSS) collected in 2007 and 2011. Cognitive impairment was measured by category fluency and delayed recall. Generalized estimating equation (GEE) was used to investigate changes in cognition by taking SDH and other variables including age, gender, marital status, education, and depression into the model. Results: GEE revealed longitudinal effects of wealth index and working status against cognition. Older Thais living with richest wealth index (odds ratio [OR] = 0.54; 95% confidence interval [CI] = 0.31-0.94) and still being employed (OR = 0.65; 95% CI = 0.47-0.89) were less likely to have cognitive impairment. Discussion: Poorer wealth index and being unemployed were served as a risk factor for cognitive impairment over time. Increasing age was still the major risk for cognitive impairment.

Rethinking early childbearing in Indonesia: is it preceded by a premarital first birth?

PURPOSE: This study aimed to present the level and patterns of premarital first births in Indonesia, and its association with early childbearing. METHODS: This study used three rounds of the Indonesia Demographic and Health Survey, including a total of 29,483 women in 2002; 32,895 in 2007 and 45,607 in 2012. Those women who had their first child before reaching 19 years of age were defined as early child bearers, otherwise, the women were known as later child bearers. All conceptions that occurred 9 months after the first marriage were defined as timely births within marriage, thus, premarital first birth is a first birth that occurred less than 7 months after the first marriage. FINDINGS: About 7-11% of Indonesian women conceived their first child before marriage. Both early and later child bearers experienced their first birth less than 7 months after their first marriage, however, women who experienced conception before marriage were twice as likely to become early child bearers compared to women who had their first birth occurred timely. CONCLUSION: The results of the present analysis show that some Indonesian women had their first child before marriage. Although the unavailability of marriage and birth registrations is the most plausible explanation for the decline in premarital first births among the youngest cohort, regional differences suggest there is also an influence of socio-cultural diversity in the premarital sexual practices of Indonesian women.

Regional and Gender Differences in Years with and without Mobility Limitation in the Older Population of Thailand.

OBJECTIVES: To examine gender and regional differences in health expectancies based on the measure of mobility. METHODS: Health expectancies by gender and region were computed by Sullivan's method from the fourth Thai National Health Examination Survey (2009). A total of 9,210 older persons aged 60 years and older were included. Mobility limitation was defined as self-reporting of ability to perform only with assistances/aids at least one of: walking at least 400 metres; or going up or down a flight of 10 stairs. Severe limitation was defined as complete inability to do at least one of these two functions, even with assistances or aids. RESULTS: At age 60, females compared to males, spent significantly fewer years without mobility limitation (male-female = 3.2 years) and more years with any limitation (female-male = 6.7 years) and with severe limitation (female-male = 3.2 years). For both genders, years lived with severe limitation were remarkably constant across age. Significant regional inequalities in years lived without and with limitation were evident, with a consistent pattern by gender in years free of mobility limitation (Central ranked the best and the North East ranked the worst). Finally, both males and females in the South had the longest life expectancy and the most years of life with severe mobility limitation. CONCLUSION: This study identifies inequalities in years without and with mobility limitations with important policy implication.

Gender differences in health expectancies across the disablement process among older Thais.

OBJECTIVES: To estimate health expectancies based on measures that more fully cover the stages in the disablement process for the older Thais and examine gender differences in these health expectancies. METHODS: Health expectancies by genders using Sullivan's method were computed from the fourth Thai National Health Examination Survey conducted in 2009. A total of 9,210 participants aged 60 years and older were included in the analysis. Health measures included chronic diseases; cognitive impairment; depression; disability in instrumental activities of daily living (IADL); and disability in activities of daily living (ADL). RESULTS: The average number of years lived with and without morbidity and disability as measured by multiple dimensions of health varied and gender differences were not consistent across measures. At age 60, males could expect to live the most years on average free of depression (18.6 years) and ADL disability (18.6 years) and the least years free of chronic diseases (9.1 years). Females, on the contrary, could expect to live the most years free of ADL disability (21.7 years) and the least years free of IADL disability (8.1 years), and they consistently spent more years with all forms of morbidity and disability. Finally, and for both genders, years lived with cognitive impairment, depression and ADL disability were almost constant with increasing age. CONCLUSION: This study adds knowledge of gender differences in healthy life expectancy in the older Thai population using a wider spectrum of health which provides useful information to diverse policy audiences.

The impact of parental migration on the mental health of children left behind.

This study aims to examine the impact of parental international migration on the mental health of children left behind. Data for this paper were taken from the "Child Health and Migrant Parents in South-East Asia, Thailand, 2008" project. A total of 1,030 children (519 from emigrant parents and 511 from non-migrant parents) were covered. Data were collected from the caregivers of children using the Strength and Difficulties Questionnaire. Multivariate analyses were performed to determine the association between parental migration and the mental health status of children left behind. Several factors were significantly associated with children's mental health. Our study did not find any association between current parental migration status and mental health status of the children left behind. The study found, however, that mother's earlier migration history had a significant, independent association with mental health problems of the children left behind. Therefore, effective strategies to prevent such mental health problems among children are warranted.

The Subjective Well-Being of Children in Transnational and Non-Migrant Households: Evidence from Thailand.

To date, research that includes children's views on parental migration has been insufficient. Based on the children's assessment of well-being, we use a case study of Thailand to ask whether children of overseas migrant parents are less or more resilient compared to children of non-migrant parents. We make use of data from the Child Health and Migrant Parents in South-East Asia (CHAMPSEA) Project, one of the few studies that provide space for children, both of migrant and non-migrant parents, to voice their views. Our sample includes 496 children aged 9 to 11 years old. The outcome variable captures children's subjective well-being as an indicator of whether they are a resilient child. Our multivariate analysis controls for other potential contributing factors, including the children's individual attributes, carer's mental health, parents' education, family functioning as reported by the children, and household economic status in order to investigate the effects of parental migration. Qualitative information from in-depth interviews with selected carers and group interviews with community leaders are also used to explain the results. Our findings highlight the importance of taking into account children's own perceptions. Compared to children of non-migrant parents, those of migrant parents are more likely to give a positive assessment of their own well-being. The other contributing factors include whether the child sees their family as functioning well. In Thailand, international migration is predominantly undertaken by fathers while childcare remains the responsibility of mothers, and public attitudes towards overseas migration, especially paternal migration, is generally favorable. This may help explain the positive perception of children of migrants towards themselves.

Changes in active life expectancy among older thais: results from the 1997 and 2004 national health examination surveys.

This study aims to determine the disability prevalence and changes in active life expectancy of the Thai older people between 1997 and 2004. Data on disability of older people aged ≥60 years were obtained from the National Health Examination Surveys. Disability refers to one or more restrictions on the activities of daily living. The Sullivan method was used to calculate active life expectancy. A total of 4048 older people in 1997 and 19 372 older people in 2004 were included in the analysis. Active life expectancy at age 60 of men was 16.5 years in 1997 and 17.6 years in 2004, whereas that of women was 17.9 and 19.9 years, respectively. Women spent a greater proportion of the remaining life with disability. The proportion of active life for both genders also increased during the 7-year period suggesting an evidence of the compression of morbidity in Thai older people.

Under-registration of deaths in Thailand in 2005-2006: results of cross-matching data from two sources.

OBJECTIVE: To estimate the magnitude of under-registration of deaths, by age and sex, in Thailand. METHODS: THE DATA IN THIS STUDY WERE DERIVED FROM TWO SOURCES: the Thai Survey of Population Changes (SPC) 2005-2006, a consecutive multi-round household survey conducted over a 12-month period, and Thailand's vital registration records. SPC death entries for people of all ages were matched to 2005-2006 death records from vital registration. The principles of a dual records system were applied to estimate the magnitude of under-registration of deaths, classified by age and sex, using the Chandrasekaran-Deming formula. FINDINGS: Overall under-registration of deaths during 2005-2006 was 9.00% (95% confidence interval, CI: 8.95-9.05) for males and 8.36% (95% CI: 8.31-8.41) for females. For both males and females, under-registration decreased as age increased. Under-registration was greatest among people of either sex aged 1-4 years, whereas it was < 10% among people 60 years of age and older, both males and females. CONCLUSION: These findings provided correction factors that can be used for adjusting mortality data from the registration system.

Obesity and mortality among older Thais: a four year follow up study.

BACKGROUND: To assess the association of body mass index with mortality in a population-based setting of older people in Thailand. METHODS: Baseline data from the National Health Examination Survey III (NHES III) conducted in 2004 was linked to death records from vital registration for 2004-2007. Complete information regarding body mass index (BMI) (n = 15997) and mortality data were separately analysed by sex. The Cox Proportional Hazard Model was used to test the association between BMI and all-cause mortality controlling for demographic, socioeconomic, and health risk factors. RESULTS: During a mean follow-up time of 3.8 years (60545.8 person-years), a total of 1575 older persons, (936 men and 639 women) had died. A U-shaped and reverse J-shaped of association between BMI and all-cause mortality were observed in men and women, respectively. However there was no significant increased risk in the higher BMI categories. Compared to those with BMI 18.5-22.9 kg/m2, the adjusted hazard ratios (HR) of all-cause mortality for those with BMI <18.5, 23.0-24.9, 25.0-27.4, 27.5-29.9, 30.0-34.9, and ≥35.0 were 1.34 (95% CI, 1.14-1.58), 0.79 (95% CI, 0.65-0.97), 0.81 (95% CI, 0.65-1.00), 0.67 (95% CI, 0.48-0.94), 0.60 (95% CI, 0.35-1.03), and 1.87 (95% CI, 0.77-4.56), respectively, for men, and were 1.29 (95% CI,1.04-1.60), 0.70 (95% CI, 0.55-0.90), 0.79 (95% CI, 0.62-1.01), 0.57 (95% CI, 0.41-0.81), 0.58 (95% CI, 0.39-0.87), and 0.78 (95% CI, 0.38-1.59), respectively, for women. CONCLUSIONS: The results of this study support the obesity paradox phenomenon in older Thai people, especially in women. Improvement in quality of mortality data and further investigation to confirm such association are needed in this population.

Reductions in child mortality levels and inequalities in Thailand: analysis of two censuses.

BACKGROUND: Thailand's progress in reducing the under-five mortality rate (U5MR) puts the country on track to achieve the fourth Millennium Development Goal (MDG). Whether this success has been accompanied by a widening or narrowing of the child mortality gap between the poorest and richest populations is unknown. We aimed to measure changes in child-mortality inequalities by household-level socioeconomic strata of the Thai population between 1990 and 2000. METHODS: We measured changes in the distribution of the U5MR by economic strata using data from the 1990 and 2000 censuses. Economic status was measured using household assets and characteristics. The U5MR was estimated using the Trussell version of the Brass indirect method. FINDINGS: Average household economic status improved and inequalities declined between the two censuses. There were substantially larger reductions in U5MR in the poorer segments of the population. Excess child mortality risk between the poorest and richest quintile decreased by 55% (95% CI 39% to 68%). The concentration index, measured using percentiles of economic status, in 1990 was -0.20 (-0.23 to -0.18), whereas in 2000 it had dropped to -0.12 (-0.15 to -0.08), a 43% (22% to 63%) reduction. INTERPRETATION: These findings draw attention to the feasibility of incorporating equity measurement into census data. Thailand has achieved both an impressive average decrease in U5MR and substantial reductions in U5MR inequality over a 10 year period. Contributing factors include overall economic growth and poverty reduction, improved insurance coverage, and a scaling-up and more equitable distribution of primary health-care infrastructure and intervention coverage. Understanding the factors that have led to Thailand's success could help inform countries struggling to meet the fourth MDG and reduce inequality.

Epidemiologic transition interrupted: a reassessment of mortality trends in Thailand, 1980-2000.

BACKGROUND: In the late 1980s and early 1990s a generalized HIV epidemic affected Thailand which was relatively well controlled by an intensive national campaign by the mid 1990s. The extent to which the epidemic has slowed or possibly reversed the epidemiological transition in Thailand is relatively unknown. METHODS: Under-five mortality rates (U5MR) were determined from various sources and weighted least squares regression conducted to determine U5MR over the years 1980-2000. Direct and indirect estimates of the completeness of death registration were used to estimate mortality levels in those aged more than 5 years for the 1980-90 and 1990-2000 periods. Life tables were constructed using the various estimates to determine changes in life-expectancy between the two time periods. RESULTS: U5MR in Thailand is estimated to have been 58/1000 live births in 1980, declining to 30 in 1990 and to 23 in 2000. The vital registration system clearly underestimates U5MR. Successive surveys of Population Change (SPC) imply coverage of death registration improving from 75-77% in 1985-86 to 95% in 1995-96, partly due to a reliance on self-reported registration in the latter survey. In contrast, the General Growth Balance-Synthetic Extinction Generations (GGB-SEG) method suggests coverage worsening from 78-85% in 1980-90 to 64-72% in 1990-2000. Life tables based on SPC adjustments show continued declines in female, and to a lesser extent, male adult mortality with corresponding increases in life-expectancy at birth of around 6 years for both sexes from 1980-90 to 1990-2000. In contrast, the indirect adjustments suggest a substantial increase in male adult mortality with female adult mortality unchanged; life expectancy decreased by 4 years for males and was only marginally higher in females. CONCLUSION: Given the conflicting evidence a definitive assessment of mortality change in Thailand between 1980 and 2000 is difficult to make. Indirect adjustments, based on demographic methods point to a major reversal in mortality decline among males, and a slowing in females. If adult mortality registration has declined, and given the continued under-registration of infant and child deaths, remedial measures are urgently required if the mortality system is to better inform and monitor health development in Thailand.

The completeness of death registration in Thailand: Evidence from demographic surveillance system of the Kanchanaburi Project.

This study aims to assess the quality of mortality data from the registration system of Thailand. The study takes advantage of the Kanchanaburi Project by comparing the deaths found in the annual censuses to those recorded in the civil registration system in order to measure the level of under-registration. The age and sex pattern of death registration found in this study might be useful information in adjusting the data from this source. Moreover, this study also pointed out a possible gap between the multiple steps of death registration, from notifying the death to officially registering it. This finding suggested a hypothesis to be further tested.