Patterns of Socioeconomic Inequities in SDGs Relating to Children's Well-Being in Thailand and Policy Implications.

Thailand faces many wealth inequities and child health-related problems. This study aimed to describe Thai child health and determine socioeconomic inequities following the child flourishing index, a tool used to measure children's wellbeing based on the key relevant Sustainable Development Goals. The data from Thailand Multiple Indicator Cluster Survey 2019 were used to examine five indicators where Thailand had not yet achieved good results. The association of socioeconomic status with the five outcomes was explored using logistic regressions, comparing pseudo R-squared, and population attributable fraction analyses. Household wealth, urbanization, education, and primary language were significantly associated with Thai child health. Over 10% of children under 5 years were stunted and had a low birth weight. Fourteen percent of teenage girls had already become mothers. Living in poor households and rural areas, having a head-of-household who was non-Thai speaking, non-Buddhist, and had a low education were identified as risk factors for children with undernutrition status and low birth weight. However, having a head-of-household who spoke a non-Thai language was a protective factor against teenage mothers and having early marriages. Households with better economic status and education provided significant benefits for children and women's health. The result of this study calls for public policies and multisectoral actions in the wider social and economic spheres that address the social determinants that span across lives and generations. Furthermore, specific social protection programs should be designed to be accessible by these most vulnerable and disadvantaged people.

Hospital-based intervention to enhance hypertension diagnosis in Kalasin hospital, Thailand, 2017-2019: A pre-post pilot intervention study.

In Thailand 5.9 million individuals ≥15 years old have undiagnosed hypertension. The intervention to reduce undiagnosed hypertension was piloted and aimed to compare pre- and post-intervention hypertension diagnosis rate and follow-up rate. A hospital-based pre- and post-intervention study was piloted in a general hospital in Thailand. The intervention included an electronic pop-up alert when raised blood pressure was observed and a follow-up protocol. The follow-up protocol entered patient information in a follow-up book that scheduled an appointment to recheck blood pressure. Statistical analyses compared the rate of hypertension diagnosis and follow-up between the pre- and post-intervention periods, adjusted for differences in baseline characteristics. A post-intervention, self-report survey among nurses and nurse-aids explored perceptions about raised blood pressure management and solicited suggestions to improve the intervention. 574 raised blood pressure patients visited the hospital in the pre-intervention period; 27.4% returned for follow--up; and hypertension diagnosis rate was 1.4%. Among 686 post-intervention raised blood pressure patients, overall hypertension diagnosis rate improved to 6.1%. In per-protocol patients, 81.9% were booked to follow--up, hypertension diagnosis rate was 18.6%, and the adjusted odds ratio of hypertension diagnosis was 4.5 times higher compared with the pre-intervention period. By self-report, 20% of health workers had no time to provide the follow-up book due to work overload, yet >57% reported that information technology improved detection of raised blood pressure and improved follow-up. The interventions significantly increased the hypertension diagnosis rate and follow-up among raised blood pressure patients in a single hospital but may benefit from incorporating an information technology-assisted follow-up protocol.

Assessing costs of a hypertension management program: An application of the HEARTS costing tool in a program planning workshop in Thailand.

The HEARTS technical package, a part of the Global Hearts Initiative to improve cardiovascular health globally, is a strategic approach for cardiovascular disease prevention and control at the primary care level. To support the evaluation of costs associated with HEARTS program components, a costing tool was developed to evaluate the incremental cost of program implementation. This report documents an application of the HEARTS costing tool during a costing workshop prior to the initiation of a HEARTS pilot program in Thailand's Phothong District, 2019-2020. During the workshop, a mock exercise was conducted to estimate the expected costs of the pilot study. The workshop application of the tool underscored its applicability to the HEARTS program planning process by identifying cost drivers associated with individual program elements. It further illustrated that by supporting disaggregation of costs into fixed and variable categories, the tool can inform the scalability of pilot projects to larger populations. Lessons learned during the initial development and application of the costing tool can inform future HEARTS evaluation efforts.