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Aging populations are gradually creating financial distress for governments, and Thailand is no exception. Effective policies for improving elderly welfare must be formulated since the population shift to older age is moving at a faster pace than economic growth. Older people prefer to live actively and independently in order to be less burdensome to their family members and are actively engaged in activities, either voluntarily or because of necessity, even after retirement age. The Thai government initiated a microcredit scheme for eligible older people in order to overcome the difficulty of gaining access to credit. The objective of this research is to explore and evaluate the effectiveness of the Older Persons Fund (OPF) organized by the Thai government to provide seed money for loans to promote active aging in Thailand. Data were collected nationwide using stratified sampling in urban and rural districts from members affiliated with the Older Persons Fund. Structured interviews were conducted with 578 loan recipients. The methodology includes inferential statistics and the multinomial logit choice probabilities model to determine the factors for successful active aging of the loan recipients. The results indicate that the purpose of the loan is a significant factor for a successful outcome. The results also imply that older people provide input into the economy and are not a burden on government expenditure in the long run by promoting active aging projects through microcredit schemes in Thailand.

Thailand's antimicrobial stewardship strategy has focussed on promoting 'rational drug use' in the public sector, to reduce the threat of drug resistance and control healthcare expenditure. The strategy's next ambition is to attend to the private sector, where antibiotics are widely available over the counter without prescription. Using ethnographic and survey data, this paper follows antibiotics through community pharmacies, to explore drug distribution and access, and identify potential challenges for stewardship. We extend the analytical frame beyond 'irrational' dispenser-customer transactions, to explore the logics of practice of a multiplicity of actors in the context of a highly competitive pharmaceutical market. Highlighting the role of the pharmaceutical industry in mystifying medicines, we show how antibiotics are collapsed into a category of 'strong medicines' and requested by customers using 'prescriptions by proxy'. We further examine how Thailand's drug regulation and classificatory systems, historically orientated around access to medicines, enable the proliferation of antibiotics in the context of contemporary efforts to control distribution. Recognising the negotiations involved in dispensing antibiotics in a pluralistic health system, we attempt to reconfigure allocations of responsibility, advocating for stewardship approaches that take into account local ecologies of care, as well as implications for access, equity, and accountability.

Filial piety is a Buddhist virtue, and its meaning varies across cultures. In Thailand, filial piety refers to an appreciation of one’s indebtedness to others. Previous studies showed that filial piety is deeply grounded in longstanding culture values and related to the health of the elderly. Information from some literature revealed that medicinal products given to the elderly by their children, called “Ya-Luk-Ka-Tan-Yoo”, were apparent in the communities of rural southern Thailand. This study aims to explore in depth how “Ya-Luk-Ka-Tan-Yoo” is perceived, valued, and functions in southern Thailand’s socio-cultural contexts. Ethnography methodology is used, and a researcher was embedded in the field for six months, gathering data through participant observation and ethno-graphic interviews with fifty-two respondents. The findings reveal that filial piety medication is related to the local meanings of medicine, children, and gratitude. “Ya-Luk-Ka-Tan-Yoo,” in the eyes of both the elderly and their children, encompasses more than just health. Implicit herein are the concepts of a means of care and gratitude and a symbol of life. Filial piety medication is thus a carrier/medium of physical, financial, and emotional support. This research reveals how the ill health of the elderly is transformed to a commodity. Nonetheless, the negative impact of the efficacy of filial piety medication remains an issue of concern among professionals. The findings indicate that people are aware of the risks associated with self-medication. However, they insisted that their use was still necessary and justifiable.

BACKGROUND Kidney selling is a global phenomenon, with higher-income countries functioning as recipients and lower-income countries as donors, reflecting the gaps due to poverty and vulnerability. In recent years, an increasing number of residents in a village near the capital city of Nepal have been selling their kidneys; however, the factors embedded in the local social, cultural, political, and individual context driving kidney selling are poorly understood. OBJECTIVE The aim of this study is to explore the drivers of kidney selling and its consequences in Hokse village in central Nepal, using ethnographic methods and multistakeholder consultations. METHODS An ethnographic approach will be adopted along with in-depth interviews and key informant interviews among the residents and kidney sellers in the village. Relevant participants in the village will be selected purposively using a snowball approach. The number of participants will be predicated on the principles of data saturation. In addition, consultations with relevant stakeholders will be conducted at various levels, which will include authorities within and outside the village, and policymakers. All interviews will be conducted face to face, audio-recorded for transcription, and subjected to a thematic analysis. RESULTS This study was approved by Mahidol University Central Institutional Review Board (MU-CIRB 2020/217.1808) in September 2020 and by Nepal Health Research Council (NHRC 716/2020 PhD) in January 2021. The fieldwork started in February 2021 and the data analysis was completed in September 2021. CONCLUSIONS This study is expected to provide insight into the reasons underlying the practice of kidney selling based on the example of Hokse village, along with the perspectives of multiple stakeholders. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/29364

Objectives Antibacterial resistance (ABR) is a major global health security threat, with a disproportionate burden on lower-and middle-income countries (LMICs). It is not understood how ‘One Health’, where human health is co-dependent on animal health and the environment, might impact the burden of ABR in LMICs. Thailand's 2017 “National Strategic Plan on Antimicrobial Resistance” (NSP-AMR) aims to reduce AMR morbidity by 50% through 20% reductions in human and 30% in animal antibacterial use (ABU). There is a need to understand the implications of such a plan within a One Health perspective. Methods A model of ABU, gut colonisation with extended-spectrum beta-lactamase (ESBL)-producing bacteria and transmission was calibrated using estimates of the prevalence of ESBL-producing bacteria in Thailand. This model was used to project the reduction in human ABR over 20 years (2020–2040) for each One Health driver, including individual transmission rates between humans, animals and the environment, and to estimate the long-term impact of the NSP-AMR intervention. Results The model predicts that human ABU was the most important factor in reducing the colonisation of humans with resistant bacteria (maximum 65.7–99.7% reduction). The NSP-AMR is projected to reduce human colonisation by 6.0–18.8%, with more ambitious targets (30% reductions in human ABU) increasing this to 8.5–24.9%. Conclusions Our model provides a simple framework to explain the mechanisms underpinning ABR, suggesting that future interventions targeting the simultaneous reduction of transmission and ABU would help to control ABR more effectively in Thailand., Highlights • We present a novel mathematical model of human, animal and environment ABR transmission and ABU. • Human ABU was identified as the main driver of human ABR. • Resistance within humans was primarily driven by human activity rather than animal or environmental usage or transmission. • One Health interventions which consider human, animal and environmental transmission and usage can yield the highest impact.

There is increasing concern globally about the enormity of the threats posed by antimicrobial resistance (AMR) to human, animal, plant and environmental health. A proliferation of international, national and institutional reports on the problems posed by AMR and the need for antibiotic stewardship have galvanised attention on the global stage. However, the AMR community increasingly laments a lack of action, often identified as an ‘implementation gap’. At a policy level, the design of internationally salient solutions that are able to address AMR’s interconnected biological and social (historical, political, economic and cultural) dimensions is not straightforward. This multidisciplinary paper responds by asking two basic questions: (A) Is a universal approach to AMR policy and antibiotic stewardship possible? (B) If yes, what hallmarks characterise ‘good’ antibiotic policy? Our multistage analysis revealed four central challenges facing current international antibiotic policy: metrics, prioritisation, implementation and inequality. In response to this diagnosis, we propose three hallmarks that can support robust international antibiotic policy. Emerging hallmarks for good antibiotic policies are: Structural, Equitable and Tracked. We describe these hallmarks and propose their consideration should aid the design and evaluation of international antibiotic policies with maximal benefit at both local and international scales.

Background Kidney selling is a global phenomenon, with higher-income countries functioning as recipients and lower-income countries as donors, reflecting the gaps due to poverty and vulnerability. In recent years, an increasing number of residents in a village near the capital city of Nepal have been selling their kidneys; however, the factors embedded in the local social, cultural, political, and individual context driving kidney selling are poorly understood. Objective The aim of this study is to explore the drivers of kidney selling and its consequences in Hokse village in central Nepal, using ethnographic methods and multistakeholder consultations. Methods An ethnographic approach will be adopted along with in-depth interviews and key informant interviews among the residents and kidney sellers in the village. Relevant participants in the village will be selected purposively using a snowball approach. The number of participants will be predicated on the principles of data saturation. In addition, consultations with relevant stakeholders will be conducted at various levels, which will include authorities within and outside the village, and policymakers. All interviews will be conducted face to face, audio-recorded for transcription, and subjected to a thematic analysis. Results This study was approved by Mahidol University Central Institutional Review Board (MU-CIRB 2020/217.1808) in September 2020 and by Nepal Health Research Council (NHRC 716/2020 PhD) in January 2021. The fieldwork started in February 2021 and the data analysis was completed in September 2021. Conclusions This study is expected to provide insight into the reasons underlying the practice of kidney selling based on the example of Hokse village, along with the perspectives of multiple stakeholders. International Registered Report Identifier (IRRID) DERR1-10.2196/29364

Inaccessibility to services and the prevalence of oral health problems in the school-age children group is consistently increasing and has become a major driver to establish a dental fund since the 2011 fiscal year with productive indicators to increase accessibility to oral health service as the major strategy of the fund. Therefore, the purpose of this study was to investigate equity in the accessibility to oral health promotion and prevention based on this fund. Thus, the research questions formed were whether or not the mechanism of a dental fund has created equity in the accessibility to services of the students and what is the consequence of the funding operation? This study used ethnographical research in a small province in the central region of Thailand and was conducted from May 2012 to January 2013. The key informants consisted of 8 dentists and 14 dental hygienists. The research methods were in-depth interviews, observations, and group discussions. Content analysis was applied and the results were considered based on the concept of health equity. The research findings showed that though the operation had been successful based on the productive indicators of the dental fund, inequity in oral health service provision for school-age children still existed in the research area. Only 20 percent of the students in the suburban area received complete dental treatment which was lower than the target indicator, while more than 20 percent of the students in the district town received the service. Since the operation aimed to achieve the productive indicator, this resulted in dental personnel selecting only the less problematical group of students from the large-sized schools to be able to achieve the indicator easily. Moreover, the procedure indicator findings showed that the goal of having participation from the District Health Coordinating Committee (DHCC) was not achieved in developing oral health promotion and prevention for grade 1 students because the DHCC deferred to the knowledge and expertise of the dentists who still operated based on bio-medicine. As a result, the present work plan and methods for organizing activities with the student group are still emphasizing a full mouth examination and complete treatment according to the quantitative indicator only, without any new approaches or operational concepts.

This study explored the health problems of never-married women as they relate to modern social life. In-depth interviews were conducted with a purposive sample of 45 never-married women aged 30–50 working or living in Bangkok and having health problems. It was found that never-married women in this modern era have experienced a variety of illnesses, such as “office syndrome” symptoms, chronic illnesses, and psychological and psychosomatic symptoms. Their social life resulted from the response to the context of modernity and was made through careful thought and deliberation. Whichever choice of social life they make, the consequences may lead them to a state of illness, distress, anxiety, and paranoia. These choices involve work, living conditions/environments, and intimacy aspects of their modern social life. This is the result of procuring by “husky modernity” which seems to be merely a “husk” or superficial modernization and changes so rapidly, but there is no core and it is full of double standards of traditional and new norms that have mixed together and fight against each other. Supporting health-related knowledge and information exchange within the network coupled with experience sharing essential for living in the modern society will enable them to sensibly decide on a path to good health.

This paper analyzes the interrelationships between the stigma of HIV/AIDS stigma and the co-stigmas of commercial sex (CS) and injecting drug use (IDU). Students of a Bangkok nursing college (N = 144) were presented with vignettes describing a person varying in the disease diagnoses (AIDS, leukemia, no disease) and co-characteristics (IDU, CS, blood transfusion, no co-characteristic). For each vignette, participants completed a social distance measure assessing their attitudes towards the hypothetical person portrayed. Multivariate analyses showed strong interactions between the stigmas of AIDS and IDU but not between AIDS and CS. Although AIDS was shown to be stigmatizing in and of itself, it was significantly less stigmatizing than IDU. The findings highlight the need to consider the non-disease-related stigmas associated with HIV as well as the actual stigma of HIV/AIDS in treatment and care settings. Methodological strengths and limitations were evaluated and implications for future research discussed.

ISPA (Infeksi Saluran Pernafasan Akut) adalah (Acute Respiratory Infection) salah satu penyakit utama pada anak. Pada umumnya perilaku pencarian pengobatan untuk ISPA berakhir dengan penggunaan obat. Efikasi obat tidak hanya merupakan pengetahuan medis tetapi merupakan konstruksi budaya. Penelitian dilakukan untuk memahami bagaimana obat diinterpretasikan oleh orang awam di wilayah kumuh perkotaan. Penelitian dilakukan pada bulan Oktober 2009 di sebuah komunitas pemulung yang tinggal di kota Depok. Data dikumpulkan dengan melakukan wawancara mendalam terhadap 20 orang ibu yang memiliki balita dengan gejala ISPA dalam waktu paling lama sebulan sebelum penelitian dilakukan. Informan diwawancarai mengenai pengalaman dalam menangani balita dengan gejala ISPA, pengobatan yang dilakukan dan bagaimana mereka mengevaluasi obat yang digunakan. Hasil menunjukkan bahwa dalam menghadapi balita ISPA, para ibu melakukan pengobatan sendiri, membawa anak ke Puskesmas atau praktek swasta yang semuanya berujung pada penggunaan obat. Istilah “cocok” merupakan kata kunci dalam mengevaluasi efikasi dan kompatibilitas obat.

The article presents the results of an exploratory study conducted in Thailand in 1988, comparing the results of two approaches to encourage the use of herbal medicine as a safe and cheap alternative to pharmaceuticals. The study included one government programme using a clinic-oriented approach and one non-governmental programme using a community-oriented approach. Drug use in response to illness episodes was surveyed among households in two villages covered by each programme and hospital out-patient prescription records were sampled. Herbal medicines were used to treat 14.8% and 14.0% of the illness-episodes in the villages taking part in the clinic-oriented programme and to treat 62.1% and 29.7% of the episodes in the villages covered by the community-oriented programme. Herbs are mostly used after a prior treatment with pharmaceuticals has failed. Only 12.4% of out-patient prescriptions from the hospital in the government programme included herbal drugs, compared to 47.3% of prescriptions from the hospital in the non-governmental programme. The results of the study suggest that a community-oriented approach can most effectively influence the pattern of drug use in self-care. Complementary to the community-oriented approach, the government should support efforts to change the prescribing attitude of physicians and include training in traditional medicine in medical curricula.

The latest data indicate that between 540,000 and 760,000 people are infected with HIV in China. Although minority nationalities represent 8.1% of China's total population, they account for more than 30% of the reported HIV/AIDS cases. This study examined stigma and discrimination against drug abusers and people living with HIV/AIDS (PLHA) in a Dai minority nationality community in Yunnan, China. The study used qualitative research methods, which included participatory observations, in-depth interviews, focus-group discussions, transect walking and community mapping. A combination of different sampling strategies was used to maximise diversity of the initially selected sample. The data revealed deeply entrenched stigma and overt discrimination against drug abusers and PLHA that manifested in familial, work, civil and institutional contexts. The stigma reflected pre-existing cultural, religious sanctions against "deviant behaviours". Intervention programmes that were insensitive to the local culture and religion may have also contributed in part to the stigmatisation of drug abusers and PLHA. The major impact of stigma was that it created a vicious cycle of social isolation, marginalisation and thus addiction relapse. This in turn reinforced the stigmatisation and discrimination against drug abusers and thus hindered efforts towards prevention and control of HIV/AIDS.

The paper describes the situation of drugs and drug sources found available at the village level in Thailand. It concludes, from village-survey data (N = 195) and village case studies (N=15), that drugs are available in abundance. A vast variety of drugs, including prescription drugs, are available at various sources, of which the most common ones are grocery stores. The situation reflects the failure of the drug regulation system as well as the influence of commercial pharmaceutical sector in drug provision. This situation hampers attempts to rationalize drug use by consumers.

Background There is an urgent need to protect children against dengue since this age group is particularly sensitive to the disease. Since dengue vectors are active mainly during the day, a potential target for control should be schools where children spend a considerable amount of their day. School uniforms are the cultural norm in most developing countries, worn throughout the day. We hypothesise that insecticide-treated school uniforms will reduce the incidence of dengue infection in school-aged children. Our objective is to determine the impact of impregnated school uniforms on dengue incidence. Methods A randomised controlled trial will be conducted in eastern Thailand in a group of schools with approximately 2,000 students aged 7–18 years. Pre-fabricated school uniforms will be commercially treated to ensure consistent, high-quality insecticide impregnation with permethrin. A double-blind, randomised, crossover trial at the school level will cover two dengue transmission seasons. Discussion Practical issues and plans concerning intervention implementation, evaluation, analysing and interpreting the data, and possible policy implications arising from the trial are discussed. Trial registration clinicaltrial.gov. Registration number: NCT01563640