Case 2 : The Double Burden of Malnutrition: Challenges and Opportunities in Thailand

Sanji Suresh, a senior-level researcher at the Association of Southeast Asian Nations (ASEAN) Institute of Health Development, received a document containing national child development survey data from Thailand. The data indicates that children under the age of five have high rates of being overweight and stunted. After seeing this literature, Sanji realizes that there is the potential for a double burden of malnutrition in Thailand. Sanji is tasked with identifying current initiatives and possible solutions to help address this dual burden. The country’s diverse sociodemographic data adds to the complications Sanji must account for to ensure the health of the children of Thailand. Being underweight in early childhood can predispose children to be overweight and have noncommunicable diseases such as diabetes and heart disease later in life. Sanji understands that the establishment of healthful behaviours and physical activity patterns during early childhood are key to health promotion and act as protective factors against noncommunicable disease over the child\u27s life. Realizing the complexity of addressing such an immense problem, will Sanji be able to come up with suggestions to tackle it

A cost-utility and budget impact analysis of allogeneic hematopoietic stem cell transplantation for severe thalassemic patients in Thailand

<p>Abstract</p> <p>Background</p> <p>Hematopoietic stem cell transplantation (HSCT) is the only curative treatment available to severe thalassemic patients. The treatment, however, is very costly, particularly in the context of low and middle income countries, and no studies have been carried out to explore its economic justifiability. This study aimed to estimate the cost-utility of HSCT compared with blood transfusions combined with iron chelating therapy (BT-ICT) for severe thalassemia in Thailand, and to investigate the affordability of HSCT using a budget impact analysis.</p> <p>Methods</p> <p>A Markov model was used to estimate the relevant costs and health outcomes over the patients' lifetimes taking a societal perspective as recommended by Thailand's health technology assessment guidelines. All future costs and outcomes were discounted at a rate of 3% per annum. Primary outcomes of interest were lifetime costs, quality adjusted life years (QALYs) gained, and the incremental cost-effectiveness ratio (ICER) in Thai baht (THB) per QALY gained.</p> <p>Results</p> <p>Compared to BT-ICT, the incremental cost-effectiveness ratio increased with patient age from 80,700 to 183,000 THB per QALY gained for related HSCT and 209,000 to 953,000 THB per QALY gained for unrelated HSCT among patients aged 1 to 15 years (US$1= 34 THB). The governmental budget impact analysis showed that providing 200 related HSCT to patients aged 1 to 10 years, in accordance with the current infrastructure limitations, would initially require approximately 90 million additional THB per year.</p> <p>Conclusions</p> <p>At a societal willingness to pay of 100,000 THB per QALY gained, related HSCT was likely to be a cost-effective and affordable treatment for young children with severe thalassemia in Thailand.</p

Reorienting health services to people with chronic health conditions: diabetes and stroke services in Malaysia, Sri Lanka and Thailand

This paper explores whether middle-income Asian countries are reorienting their health services in response to non- communicable diseases (NCDs). Malaysia, Sri Lanka, and Thailand were selected as case studies of Asian societies experiencing rapid increases both in NCDs and an aging population. While NCD programs, especially those related to diabetes and stroke, are well-established in Thailand, health services struggle to respond to increasing numbers of people with chronic health problems. Health services at all levels must plan ahead for more patients with chronic and often multiple conditions who require better integrated health care.VY is supported by the Australian Research Council Centre of Excellence in Population Ageing Research (CE110001029)

Item Analysis, Validity and Reliability of the Patient–Reported Outcome Measure of Pharmaceutical Therapy for Quality of Life (PROMPT-QoL) at Ramathibodi Hospital

Objective: To conduct item analysis and investigate validity and reliabilityof the Patient-Reported Outcome Measure of Pharmaceutical Therapy forQuality of Life (PROMPT-QoL) questionnaire by using classical test theory.Method: In this study, data were collected from 400 outpatients who hadbeen using medications for at least 3 months at Ramathibodi hospital.Participants completed PROMPT-QoL, Medication Taking Behaviorquestionnaire (MTB), WHOQOL-BREF-THAI and EQ-5D-5L Thai version bythemselves and retested these questionnaires in one week later. Classicaltest theory was used to analyze item and test construct validity, criterionvalidity, internal consistency reliability and test-retest reliability. Results:Among 9 PROMPT-QoL domains, 7 domains were correlated with overallquality of life domain significantly. Different sex, age, levels of education,number of medicines per day, disease control level and incidence ofadverse drug reaction affected PROMPT-QoL scores in each domaindifferently. For criterion validity, PROMPT-QoL moderately correlated withWHOQOL–BREF-THAI and EQ-5D-5L (r = 0.25 – 0.50). Every domain inPROMPT-QoL showed excellent test-retest reliability (ICCs 0.75). Mostdomains revealed acceptable internal consistency reliability (Cronbach’salpha 0.7) except availability/accessibility domain. However this domainshowed acceptable corrected item-total correlations. Conclusion:PROMPT-QoL consists of 9 domains (43 items) that reveal acceptablevalidity and reliability. Further studies about responsiveness are required tocomplete psychometric properties.Keywords: item analysis, validity, reliability, Patient–Reported OutcomeMeasure of Pharmaceutical Therapy for Quality of Life,PROMPT-Qo

Underestimation of overweight weight status in children and adolescents aged 0-19 years: A systematic review and meta-analysis

Background: Perceptions of children's weight status may be important in obesity prevention and treatment. Aims: This review identifies the prevalence of the underestimation of overweight status in children by parents/main carers, children, and healthcare professionals (HCP). The review critically synthesized both quantitative and qualitative evidence to explore the factors associated with this underestimation. The diverse methods used to assess this phenomenon are reported. Methods: Pooled effect sizes were calculated using random-effects model. Published studies, up to 2020, were accessed using the following search engines: CINAHL, EMBASE, PUBMED, and Psych-Info and including the “Cited by” and “Related Articles” functions. Hand-searching was used to retrieve further articles. Publication language and location had no bearing on the nature of the included studies. Results: A total of 91 articles were included. In the quantitative studies, 55% (95% CI 49%–61%) of caregivers underestimated their child's level of overweight and obesity using a verbal scale and 47% (95% CI 36%–55%) using visual scales. Of the children studied, 34% (95% CI 25%–43%) underestimated their own level of overweight and obesity using both scales. In (n = 3) articles, HCPs reflected this misperception, but limited studies prevented meta-analysis. Underestimation was associated with the child's age, gender, BMI and parental weight status, ethnicity and education. In the qualitative studies, parents/main carers of children with overweight and obesity described their child's weight in terms other than overweight, for example, “big boned,” “thick,” and “solid.”. Conclusion: The results confirm the prevalence of underestimation of child overweight status across international studies. Understanding the factors which lead to this inaccuracy may help to improve communication within the therapeutic triad and facilitate the recognition and management of children's overweight status

Health Utility Measured with EQ-5D in Thai Patients Undergoing Peritoneal Dialysis

AbstractObjectivesTo measure health utility by using the EuroQol five-dimensional questionnaire (EQ-5D) in Thai patients undergoing peritoneal dialysis (PD) and to examine the relationship between the EQ-5D and patient characteristics including sociodemographic and clinical data and end-stage renal disease symptoms.MethodsThis was a cross-sectional study. About 10 to 12 patients undergoing PD were randomly selected from each of the 10 hospitals located in every part of Thailand. Face-to-face interviews were conducted from October 2008 to February 2009. Patients assessed their health status by using five domains and a visual analogue scale. The EQ-5D score was calculated on the basis of responses to five domains by using the Thai value set. Multiple regression analyses using a stepwise method were employed to model the associations between the EQ-5D score, the VAS score, and patient characteristics.ResultsThe patients' mean age was 42.2 ± 13.8 years; 53% were male. The mean PD duration was 7.4 ± 6.0 months. The mean EQ-5D and visual analogue scale scores were 0.65 ± 0.23 and 0.65 ± 0.26, respectively. The EQ-5D score was higher than that obtained from a meta-analysis study (0.58). The multivariate regression model showed that education, work status, diabetes, and end-stage renal disease symptoms were significant predictors of the EQ-5D score. The significant predictors of the VAS score included work status, albumin level, use of erythropoietin, and end-stage renal disease symptoms.ConclusionsThis Thai PD sample yielded higher EQ-5D scores than did other PD populations. To improve the health utility of Thai patients undergoing PD, the significant factors should be addressed. Because our PD sample had a short PD duration, their long-term health utility should be evaluated in future research

Thailand conquered under-nutrition very successfully but has not slowed obesity

Non-communicable diseases (NCDs) became a significant public health problem for Thailand during the last decade. In 2011, cardiovascular diseases and stroke were the leading causes of death among the Thai population. The article reviews past intervention initiatives to curb obesity and the non-communicable diseases associated with it. Current strategies under the National Food Committee are comprehensive, focusing on the links among agriculture, food, nutrition and health with the ultimate goal of food and nutrition security alongside prosperity. More research and capacity development on various issues are still required to support implementation