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

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

The Roles of Village Health Volunteers: COVID-19 Prevention and Control in Thailand

Taiwan and Thailand have effectively responded to the COVID-19 pandemic more so than more advanced health systems. Both countries have an effective focus on primary healthcare and multi- sectoral collaboration with effective and open communication of powerful health messages. In the case of Thailand, the central role of village health volunteers has also made a significant contribution. The lessons from recent experiences need to be further evaluated to consolidate the lessons learned in anticipation of meeting continuing and future challenges

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

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

Acceptability and Willingness to Pay for Influenza Vaccination among Healthcare Professionals in Vietnam

Background: While Vietnam’s Expanded Program on Immunization does not cover influenza vaccines, people must pay out-of-pocket for influenza vaccination. Healthcare professionals have a high risk of contracting influenza, but their vaccination rate is low.  Objective: To examine the willingness to pay (WTP) for influenza vaccination among healthcare professionals in Vietnam. It also recommends financing sources for influenza vaccination among healthcare professionals and determines possible measures to expand vaccine coverage. Method: We interviewed 130 healthcare professionals in a national hospital in Hanoi in July 2021. We used Andersen’s behavioral Model (ABM) as an initial approach. The double-bounded dichotomous-choice questions were used to determine WTP for influenza vaccination among the target group. Collected responses were coded and analysed through IBM SPSS version 20 for descriptive, chi-square analyses.  Results: Most of the healthcare professionals who responded to this study were female with 75.4 % of the total 130 respondents. The mean age of participants was 34.08 years old. The average maximum WTP for influenza vaccination services was 357.57 VND (USD 15.3). Most of the participants reported that individuals should pay a part of the cost, and four-fifths reported they believed that the government and medical insurance should subsidize the service (80.8 % and 85.4 %). The Chi-square test showed that there was a significant association between perceived severity and history of influenza vaccination with the WTP, X2(1, N=130) = 4.18, p = 0.04 and X2 (1, N=130) = 7.81, p = 0.005, respectively. Conclusion: The WTP for influenza vaccination among healthcare professionals was found relatively high. Suggesting that price is not a primary barrier. The government and medical insurance were believed to be the potential agencies for improving vaccination uptake as these agencies were expected to be the subsidized actors. Other health interventions such as influenza literacy and communication methods are also needed to expand vaccine coverage. (*The paper was presented at The Hong Kong Polytechnic University’s College of Professional and Continuing Education (CPCE) Conference “Post-pandemic health and long-term care: A new paradigm”. September 2021