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BackgroundIn Thailand, children born in government hospitals receive a maternal and child health handbook (MCHH). However, when a new MCHH edition is released, those with the previous editions do not have access to the updated information. A mobile app is an appealing platform to fill this gap. We developed a mobile app called “KhunLook” as an interactive electronic MCHH intended to assist parents in child health supervision. ObjectiveThis study describes the user requirements and development of the KhunLook mobile app, validity of parents’ growth assessments, and parents’ evaluation of feasibility and acceptability of the app. MethodsPhase 1 was a qualitative study using individual interviews. The interview data were used to revise the prototype. In phase 2, parents were randomly assigned to assess their children’s growth with the app or the MCHH. The outcomes were compared to those of the physician’s assessment, and congruence was determined. In phase 3, parents evaluated the feasibility and acceptability of the app in comparison to the MCHH through a web-based survey. ResultsFour health care providers and 8 parents participated in phase 1. Two themes were identified: (1) the mobile app potentially counters parents’ infrequent use of the MCHH with accuracy, attractiveness, convenience, and simplicity, and (2) health supervision needs to be standard, up-to-date, and understandable. KhunLook was publicly launched with a family page and 7 key features: growth and nutrition, development, immunizations, oral health, reminders for the next appointment, memories, and health advice. In phase 2, 56 parents participated in the growth parameter assessments; 34 were in the App group and 22 in the MCHH group. The outcomes of the growth parameter assessments between parents and physicians in both the App and MCHH groups were not significantly different. The congruence proportions were higher in the App group for weight and head circumference, but the differences were not statistically significant. In phase 3, 356 parents from all over Thailand participated in a web-based survey. Parents rated the app feasibility as “very easy to easy” to use at higher proportions than the MCHH in all health assessment domains (growth, development, and immunizations) and ease-of-use domains with statistical significance (P

Background: Lower respiratory tract infections (LRTIs) are the most common cause for hospitalization in pediatric patients. Pediatric patients with LRTIs are at an increased risk of morbidity and mortality. The national data analysis of epidemiologic variations facilitates awareness and develops solutions to prevent these conditions in the future. Objective: This study aims to evaluate the epidemiology, causative pathogens, morbidity, and mortality of LRTIs in pediatric patients of Thailand from 2015 to 2019. Methods: This was a retrospective study among pediatric patients aged between 0 and 18 years old admitted in hospitals due to LRTIs in Thailand from January 2015 to December 2019. The data were extracted from National Health Security Office using the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Thai Modification; ICD‐10‐TM of J09 to J22. Results: A total of 1,423,509 children hospitalized due to LRTIs were identified. Most of the patients were of age 1–5 years. Pneumonia was the most common LRTI (876,557 children, 61.58%) in hospitalized children. Respiratory syncytial virus (RSV) is the main etiologic pathogen of bronchiolitis, which presents in approximately 10.86% of all episodes. Influenza viruses were found predominantly in children with pneumonia (15.52%). The mortality rate since 2015–2019 was highest in pneumonia under 1 year old (P < 0.001). Pneumonia in children under 5 years old had the highest mortality rate, which accounted for 11.85 per 100,000 children in 2019. Conclusions: LRTIs had a high incidence rate of hospitalization and mortality, especially in children under 5 years old. Influenza virus was the most common pathogen of pneumonia. [ABSTRACT FROM AUTHOR]

Objective: To quantify the admission mortality, pathogens,factors related to mortality, length of hospital stay, and healthcare costs in adult hospitalized pneumonia in Thailand, Material and Method: The data on hospitalized pneumonia for the 2010 fiscal year extracted from the three main health insurance coverage schemes in Thailand (the Social Security System (SSS), the Medical Welfare System (MWS), and the Civil Servant Medical Benefit System (CSMBS)) were analyzed, Results: Adult hospitalized pneumonia admissions numbered 136,696, with mortality rate 9.63%. The mortality increased with increasing age, 15.49% for age > 80 years. Influenza virus was the major etiology for 19 to 25 years old (49.30%) with low mortality (1-2%). S. pneumoniae and typical pathogens were found in every age group. The mortality rate for S. pneumoniae increased with age, viz. 0%, 1.96%, 5.56%, 7.02%, 6.98%, and 24.24% for 19 to 25, 26 to 40, 41 to 60, 61 to 70, 71 to 80, and 81+ years old. The mortality rate from C. pneumonia was about 10% and high among the younger age group. Gram-negative bacilli and Staphylococcus caused high mortality (about 20 to 35%), especially in the older age group. The major risk factors for increasing mortality were: elderly (OR 3.46, 95% CI 3.27-3.77), alcoholic liver disease (OR 3.26, 95% CI 2.85-3.72), cirrhosis (OR 3.45, 95% CI 2.93-4.08), heart disease (OR 2.47, 95% CI 2.38-2.56), ischemic heart disease (OR 2.21, 95% CI 2.07-2.36), renal failure (OR 5.26, 95% CI 5.07-5.49), and cerebrovascular disease (OR 3.62, 95% CI 3.43-3.82). The median length of hospital stay was four days (IQR, 3-7 days) and the median cost of treatment per admission was US$ 256.63 (IQR, US$ 147.81-531.21). Complications such as acute respiratory failure, acute respiratory distress syndrome (ARDS), septicemia, shock, and acute renal failure made hospital stays two to three days longer and costs three to seven times higher than no complications., Conclusion: The mortality from pneumonia among the elderly was high, especially for those over 80 and with multiple medical co-morbidities.

Background: The incidence of diarrhea in Thai children under five years of age increased over the last decade while mortality dramatically decreased. To evaluate the effectiveness of MCH services under Universal Coverage Schemes, health outcomes should be performed., Objective: To assess the burden and pattern of childhood diarrheal diseases in Thai children under five., Materials and Method: The information on Intestinal Infectious Diseases ICD10: A00-A09 was divided into two groups: 1. Infectious diarrhea: A04, A05, A08, A09 and 2. Dysentery: A02, A03. The authors investigated the number of OPD visits, IPD, mortality, length of hospital stay and co-morbidity of severe cases., Results: The burden of diarrhea was: 3.7 million (1:1) episodes, 756,552 OPD visits (1:5), 124, 403 IPD admissions (1:30), 202 (1:18,460) persistent diarrhea and 48 (1:77, 685) deaths. Diarrheal incidence had two peaks: cool season and early rainy season. Admissions lasted a collective 309,398 days. Diarrhea was persistent in 202 episodes (1.6 per 1,000 admissions) and the associated factors included: age, sepsis, anemia, chronic diseases, malnutrition and HIV. The risks for diarrhea-related mortality included: infant, septicemia and dehydration., Conclusion: The incidence of diarrhea was higher than expected albeit mortality was low. The mortality rate was associated with age under one year persistent diarrhea, septicemia, chronic and underlying diseases.

Background: Health problems and service utilization patterns among Thai populations have changed significantly over the past three decades. It is imperative to scrutinize the changes so that the health service and human resource development systems can appropriately respond to the changing health needs., Objective: To synthesize critical issues for future planning of health service reforms, medical education reforms and health research for Thai society., Material and Method: The authors analyzed data on health service utilization, types of illnesses and hospital deaths among Thais in the fiscal year 2010. Information on the illnesses of in-/out-patients and hospital deaths was extracted from the three main health insurance schemes providing coverage to 96% of the population. The authors then synthesized the key issues for reforming medical education and health services., Results: In summary, Thai patients have better access to health services. The total number of out-patient visits was 326,230,155 times or 5.23 visits per population. The total number of in-patient admissions was 6,880,815 times or 0.11 admissions per population. The most frequent users were between 40-59 years of age. The most common conditions seen at OPD and IPD and the causes of in-hospital mortality varied between age-groups. The key health issues identified were: psychosocial conditions, health behaviour problems, perinatal complications, congenital malformations, teenage pregnancy, injury, infectious diseases, cardiovascular diseases and neoplasms. Medical education reforms need to be designed in terms of both undergraduate and post-graduate education and/or specialty clinical needs. Health service reforms should be designed in terms of patient care systems, roles of multidisciplinary teams and community involvement., Conclusion: The government and other responsible organizations need to actively respond by designing the health service systems and human resource development systems that are relevant, appropriate and integrated. Different levels of care need to work collaboratively in order to achieve the greatest quality and efficiency.

Background: Assault is a leading cause of injury and death; however little is known regarding the psychiatric epidemiology of assault-related hospitalizations (ARH) in Thailand., Objective: To analyze the epidemiological data of ARH in Thailand for the fiscal year 2010 and to compare the epidemiology of ARH between with and without psychiatric disorder, Material and Method: The data analyzed were from the annual reports for the fiscal year 2010 (October 1, 2009-September 30, 2010), on every kind of hospitalization reimbursed by the Universal Health Coverage System, the Social Welfare System, and the Civil Servant Medical Benefits Scheme, altogether provided medical coverage for more than 96% of the Thai population. The information on ARH (X85-Y09: ICD-10 version for 2010) and comorbid psychiatric disorder(s) (F00-F99) were extracted. Number of in-patient hospitalizations by sex, age, geographical region, month, hospital charges, length of hospital stay (LOS) and mortality rate (MR) were analyzed. Frequencies (percentages) of ARH and subgroups were reported., Results: The national ARH care cost was 0.98% of the overall national in-patient care expenses (88,964 million Baht). The rate of ARH was 0.72 of every 100 hospitalizations or 7.74 incidents/100,000 general population. Assaults leading to hospitalizations frequently occurred among males (80.86%); in 25-39 year-olds (35.60%), 40-59 year-olds (22.85%); by sharp object (29.44%), blunt object (24.40%) and bodily force (23.71%); in the Central (39.48%) and Northeast region (31.16%). There was a tri-modal monthly peak distribution: April (11.12%), December (9.45%) and October (8.90%). A minority i.e. 0.4% (male to female ratio of 4.22:1) of ARH had a concomitant psychiatric disorder(s): the most frequent being 'mental and behavioral disorders due to psychoactive substance use' (66.54%) followed by 'schizophrenia, schizotypal and delusional disorders' (14.230%). The MR of ARH with and without concomitant psychiatric disorder was 1.03% and 0.30%, respectively. The LOS of overall ARH was 5.15 +/- 12.41 days, min-max was 1-568 days and the mode was 1 day. The LOS of ARH with/without psychiatric disorder was 5.2 +/- 12.4 vs. 3.7 +/- 7.5 days. The expenses paid for ARH with/without psychiatric disorder was 75,811,383.40 Baht vs. 791,214,659.90 Baht., Conclusion: Assault accounted for 0.72 hospitalization of every 100 hospitalizations and 7.74 times/100,000 population. A fraction (0.04%) of ARH had concomitant psychiatric disorder(s): most frequently psychoactive substance use disorders followed by schizophrenia and related psychosis.

Background: Unintended pregnancy during adolescence can have profound effects on adolescents, their parents and family, the child and the country's developing population., Objective: To analyze the adolescent pregnancy situation in Thailand in order to provide data and suggestions for refining the nation's medical curricula and enhancing health services for adolescents., Material and Method: National data from Thailand's 3 major health care systems, regarding; adolescent pregnancy complications, deliveries, outcomes and deaths in the 2010 fiscal year were analyzed and compared to women 20-34 years of age., Results: There were 80,523 adolescent pregnancies, comprising 25.9% of all pregnancies. The pregnancy rate for 15-19 year-olds was 33.4 per 1,000 and abortion was the outcome in 14.4%, (18.0% of all abortions). The adolescent birth rate was 28.7 in women 15-19 years of age-on average, there were 188.8 adolescent deliveries per day. Adolescents gave birth to 37.2% of all preterm infants: the preterm birth rate was significantly greater than in women in the optimum reproductive age. Most deliveries were spontaneous vertex deliveries with lower complications and mortality rates than for women in the optimum reproductive age., Conclusion: Unintended pregnancy can have profound effects on adolescent parents, their parents and families, the child and the country's developing population. It should, therefore, be considered a major public health problem that warrants immediate intervention at the national level.

Background: Fall is a preventable condition associated with disability and mortality in elders. The overall data regarding admission rates and its impact in Thai elderly are lacking., Objective: To identify admission, mortality rates of older persons with fall, its causes and consequences., Material and Method: Information on illness of inpatients and casualties came from hospitals nationwide and from hospital withdrawals from the 3 health insurance schemes in fiscal 2010. The data included 96% of the population. The data were analyzed by age groups in older patients with fall., Results: There were 311,132 falls of all admissions; accounting for admission and mortality rates of 423.4 and 11.1/100,000 older persons. The number rose with age. Slipping, tripping were the major causes. The average length of stay (LOS) of fallers with and without fractures was 8.1 and 6.4 days. The average hospital costs in these same groups were 25,728 and 19,419.3 Baht., Conclusion: The increasing age is related to an increased admission and mortality rates of fall. Slipping, tripping was the frequent causes. Greater LOS and hospital charges were found in fallers with fractures. Allied-healthcare workers should routinely implement a fall assessment and educate modifiable factors to elders to prevent future fall.

Background: To date, only small, selected groups of elderly hospitalized with mental and behavioral disorders (EHMBD) have been studied. Since no national epidemiological studies have been published, the recent advent of universal healthcare in Thailand makes doing such a study timely for improving the medical curricula and service provision., Objective: To analyze the epidemiology of the EHMBD in the year 2010 of Thailand., Material and Method: The data analyzed were gathered from Medical Expense Reimbursement forms submitted for the fiscal year 2010. The particular focus of this research was on elderly inpatient aged 60 years and over with ICD-10 (for 2010) diagnosis: F00-F99 Mental and Behavioral Disorders. The authors extracted and analyzed the number of in-patient department (IPD) admissions, psychiatric diagnoses, length of hospital stays, hospital charges and mortality rate. Data were analyzed using SPSS 17 for Windows., Results: In 2010, EHMBD accounted for 11,418 admissions which was 1.56 admission per 1000 elderly people or 13.9% of overall admission (19 years and over). Of the 11,418 admission, 44 died (0.39%). The mean in-patient charges/admission in Thai Baht (SD) for the EHMBD with any F00-F99 diagnosis was 12,896 (51,659). The average range of stay was 8.3 +/- 22.2 days. The leading diagnosed clusters of behavioral and mental disorders were organic mental disorders (F00-F09: 23.8%), neurotic, stress-related and somatoform disorders (F40-F48: 21.1%); and mental and behavioral disorders due to use of alcohol (F10: 20.3%). Alcohol use disorders among the elderly resulted in four times more men being hospitalized than women. Regarding the F30-F39 cluster mood (affective) disorders, the prevalence of depressive episodes increased with age and bipolar affective disorder decreased with age., Conclusion: The prevalence of hospitalization among the elderly with mental and behavioral disorders was about one-eighth that of all admission of adult from 19 years old. Death was an uncommon result. The most common psychiatric diagnoses were organic mental disorders, neurotic, stress-related and somatoform disorders and mental and behavioral disorders due to use of alcohol.

Background: To make the world fit for children is a task necessarily involves all organizations working with children. The real health situation will be useful for strategic planning for them., Objective: To emphasize Thailand's health burdens of children between 1 and 5 years in 2010., Material and Method: The authors analyzed the fiscal 2010 data from the three health insurance schemes from hospitals nationwide for information on: out-patient and in-patient visits, common illnesses of Thai children between 1 and 5 years, lengths of stay, hospital charges and deaths. Most (96%) of the population was represented in this data., Results: Respiratory infection was the most common admission (225,183 times) while intestinal infection was the second (83,293 times). Respiratory infection was the second most common for an out-patient visit (7, 387,132 times = 23.6%) after other factors influencing health (17,384,963 times = 55.5%). The most common causes of death were injury and poisoning (178 patients) and respiratory infection (175 patients). Pneumonia required the most budget and resulted in the longest stays. Among accidents, accidental drowning and submersion caused the most deaths., Conclusion: Respiratory infection, pneumonia, intestinal infection, injuries, poisoning and accidental drowning were the most common health burdens among children between 1 and 5 years of age.

Background: Dengue is an important cause of morbidity and mortality in tropical and subtropical regions of the world. In Thailand, there has been no detailed research on mortality in children in terms of duration of admission and associated complications in the cases that died., Objective: To assess the burden of dengue in Thailand in 2010 and to analyze the complications in patients aged under 18 years who died., Material and Method: The authors described the mortality and complications of dengue fever and dengue hemorrhagic fever in patients under 18 years old using the information from the Health Situation Analysis of the Thai Population 2010 Project., Results: In 2010, the overall mortality of dengue in all age groups and in patients aged under 18 years were 0.3 and 0.6/ 100,000, respectively. The mortality rate was highest among children aged 6-12 years (0.8/100,000). Among the 8 children with dengue fever that died, the 2 most common complications were fluid electrolyte and acid-base imbalance and disseminated intravascular coagulation (DIC). The common complications among the 91 cases with dengue hemorrhagic fever that died included fluid electrolyte and acid-base imbalance, hepatic failure, respiratory failure, bacterial infection, DIC and renal failure., Conclusion: Early diagnosis, careful management of fluid therapy, awareness of hepatic and renal impairment and early treatment of co-infection should decrease mortality of dengue hemorrhagic fever

Background: Delirium is a frequent complication associated with hospitalization of older adults leading to serious complications but it is potentially preventable. The overall data regarding admission rates and its impact in Thai geriatrics are limited., Objective: To identify admission, mortality rates of older persons with delirium and its consequences., Material and Method: Information on illness of inpatients and casualties came from hospitals nationwide and from hospital withdrawals from the three health insurance schemes in fiscal 2010. The data included 96% of the population. The data were analyzed by age groups in delirious patients., Results: Delirium occurred in 11,410 of all admissions; contributing admission and mortality rates of 155.4 and 6.4/100,000 older persons. These figures increased with age. The average length of stay in persons with and without delirium were 22.3 and 5.4 days and the average hospital charges were 53,174 and 18,230.8 Baht, respectively., Conclusion: The admission rate of patients with delirium was lower than prior reports; underdetection and underreport should be considered. Admission and mortality rates rose with age. There was an increase in length of stay and hospital charges.

Background: Information on neonatal mortality and burden of illness during the neonatal period is an essential guide for prioritizing interventions for solving health problems and allocating resources., Objective: To evaluate the burden of diseases and the current health situation among Thai neonates under the Universal Health Insurance Coverage Scheme., Materials and Method: The number of admissions according to mortality, length of hospital stay and cost of hospital charges during the neonatal period was analyzed., Results: There were 638,795 live births according to the data extracted from the three healthcare schemes supporting universal healthcare' in Thailand, which is lower than the data from the Health Information Unit of the Bureau of Health Policy and Strategy at the Ministry of Public Health. The neonatal death rate was 3.98 per 1,000 live births comprising 58.9% of all infant deaths. Major proportion of neonatal deaths (700%) occurred in early neonatal period and 43% of which occurred within the first two days of life. The leading causes of neonatal deaths were prematurity, respiratory problems, congenital malformation, birth asphyxia and infection. The most prevalent diagnosis for admissions was neonatal jaundice, disorders related to short gestation, respiratory disorders and neonatal infection., Conclusion: More investment is required to improve education and implement health interventions that can be integrated into existing health systems for better neonatal outcomes.

Background: Adolescence is generally a period of good physical health, but future health problems may begin at this age due to exposure to risk factors for diseases., Objective: To analyze the health situation of adolescents (age 13-18years) in Thailand in order to derive guidance for the refinement and calibration of the medical curriculum and enhance health service provision to adolescents., Material and Method: National data from Thailand's 3 major health care systems, regarding; the causes of out-patient visits, in-patient admissions and deaths in the fiscal year 2010 were analyzed., Results: The leading causes of out-patient visits were (1) factors influencing health (2) respiratory infections (3) diseases of the digestive system (4) injury and poisoning and (5) external causes of morbidity and mortality. The leading causes of admissions were (1) pregnancy (2) injury and poisoning and (3) arthropod-borne viral fevers. The leading causes of hospital deaths were (1) injury and poisoning (2) neoplasms and (3) other infections., Conclusion: The majority of the causes of morbidity and mortality were related to psychosocial factors and engagement in high risk behaviors.

Background: The school years are a crucial time in the development of the basic life skills necessary for learning in the various and different fields to be encountered in life, as well as for developing and acquiring the knowledge, skills and attitudes necessary to establish and maintain a healthy lifestyle. In general, elementary school-age children rarely present at health service centers but may nevertheless have health problems that affect their ability to learn., Objective: To analyze the health situation among elementary school-age children in Thailand, for the creation of baseline information to serve as an evential basis for making recommendations for adjusting the medical education curriculum and for improving health service provision., Material and Method: To analyze nationwide, hospital data, for the morbidity and mortality of children age 6-12 years in fiscal year 2010., Results: Respiratory infections represented the leading cause for out-patient visits-approximately one-fifth. Respiratory infections were also a significant cause for admissions (21.6%), followed by dengue hemorrhagic fever (14.8%), injury and poisoning (11.3%), disease of digestive system (11.1%) and intestinal infection (10.3%). The leading causes of death were injury and poisoning (22.7%), followed by neoplasm (14.4%), other infection (13.5%) and respiratory infection (12.6%). Overall, about 50-60% of the causes of admissions and of deaths were due to infectious diseases and injury & poisoning., Conclusion: Infectious diseases and injury & poisoning were the major physical illnesses among school-age children. Notwithstanding, there were other health issues-including nutrition, growth & development, mental health & psychosocial problems-that need to be recognized and addressed in order to ensure the health and well-being of school-age children in Thailand.

Background: Between 1990 and 2010, many national and international factors converged to both beneficially and antagonistically affect people's health as well as the Thai healthcare system. Among these were: a falling birth rate in Thailand and a gradual decline in poverty-related diseases. Cancer becomes the most common cause of death., Objective: To analyze Thailand's childhood neoplasm issues for baseline information for changing medical education, services and research., Material and Method: Information on the illnesses of in-patients, out-patients and casualties was based on hospital withdrawals nationwide from the three health insurance schemes in the fiscal year 2010. The data, which included 96% of the population, were analyzed by age groups and burden of neoplasm disease., Results: The children with neoplasms were treated 127,597 times at outpatient departments (OPD) and 19,159 times at inpatient departments (IPD) at community hospitals (4.3%), provincial hospitals (8.50%), regional or university hospitals (86.1%) and private hospitals (1.1%). Malignant neoplasms of lymphoid hematopoietic and related tissues were the most common in both IPD and OPD settings, which resulted in the highest cost of treatment. Tumors of the central nervous system were associated with the highest cost. The mean length of stay for all patients with neoplasm was 7.85 days., Conclusion: Sufficient budget should be allocated to the more heavily frequented treatment center Specific and better care, national treatment protocols for each type of childhood cancer (including palliative care) should be developed to improve the treatment outcomes and/or the quality of life. Medical schools and health service systems need to be recalibrated to respond proactively to these changes being experienced by the healthcare system.

Background: Immune thrombocytopenic purpura (ITP) is not rare disease and it ispotentially fatal, particularly in patients with bleeding events which usually lead to hospitalization. Current data on the impact and disease burden of ITP in Thailand are lacking., Objective: To determine admission rate, mortality rate, hospital cost, length of hospital stay, co-morbidities, treatment and major bleeding events in patients with ITP., Material and Method: The authors analyzed the data of inpatients with a diagnosis of ITP according to ICD10 coded D69.3 which were retrieved from a nationwide health financing schemes in fiscal 2010. The data were analyzed by age groups, gender and health financing schemes., Results: The overall admission rate and mortality rate were 7.68 and 0.29 per 100,000 populations, respectively and increased with age. Women were predominant. Average hospital costs and hospital stays were 27,133 Baht and 6.7 days per admission, respectively and slightly higher among men than women. The most common co-morbidity was hypertension. Gastrointestinal hemorrhage was the most common bleeding event which was 21.5 per 1,000 admissions. Patients in the civil servant medical benefit scheme had the highest percentage of high cost treatment accessibility., Conclusion: The admission rate, mortality rate and major bleeding events increased with age and was higher among women than men. Average hospital cost and length of hospital stay are higher in men than women. Common co-morbidities may be related to the treatment of ITP There are the differences in high-cost treatment accessibility between health insurance schemes.

Background: National reports indicate that morbidity and mortality from pneumonia among Thai children has decreased dramatically since the turn of the millennia; notwithstanding, pneumonia remains the leading cause of admission and death in Thai children under five years of age., Objective: To assess the burden and pattern of acute lower respiratory infection in under-fives in Thailand from the health data in 2010., Material and Method: Information on respiratory infection using the ICD10: J09-J22 was evaluated for the number of OPD visits, admissions, mortality, monthly incidence and co-morbidities of the mortality., Results: 73% of all OPD visits with ALRI were in under-fives: one-fourth of whom required hospitalization. Pneumonia is the leading cause of both admissions and mortality (3.22% and 11.29/100,000 population for this age group, respectively). The highest mortality was in the first year of life (39/100,000). One-fourth of the children (168/639) died within 24 hours of admission and septicemia was the most common co-morbidity., Conclusion: The respective morbidity and mortality of pneumonia in under-fives fell far short of national targets. To achieve these targets, many key aspects are needed; such as, strengthening the knowledge of healthcare personnel, the cost-effectiveness researches on the causative organism detection and the expanding coverage of the preventable-vaccine.

Background: Upper gastrointestinal bleeding (UGIB) is a common emergency gastrointestinal problem which has substantial mortality and health care resources use. The nationwide basic information on UGIB is not available in Thailand., Objective: To identify the hospitalized incidence, outcomes and hospitalization cost of patients who presented with UGIB in Thailand., Material and Method: Information on illness of in-patients from hospitals nationwide was retrieved from three major health schemes database in fiscal year 2010., Results: The hospitalized incidence rate of UGIB was 166.3 admissions per 100,000 populations and the hospitalized incidence rate of non-variceal upper gastrointestinal bleeding (NVUGIB) and variceal bleeding were 152.9 and 13.5 admissions per 100,000 populations respectively. Endoscopic procedure was undertaken in 27.6% of NVUGIB admissions and 80.7% of variceal bleeding admissions. The in-hospital mortality rate, hospitalization cost and length of stay were higher in variceal bleeding patients compared with NVUGIB patients., Conclusion: UGIB is an important emergency gastrointestinal problem which has significant mortality and substantial health care resources consumption.

Background: The rate of cardiovascular disease marked by coronary artery disease (CAD) is increasing in low-middle income countries including Thailand. The burden of CAD will have a significant impact on the healthcare system and the national budget., Objective: To identify the CAD-related hospitalization rate over one year; to determine in-hospital mortality in various subgroups of patients with CAD and to examine the hospitalization costs of patients with CAD., Material and Method: The data were extracted from in-patient discharge forms from the three main health insurance schemes in Thailand for the fiscal year 2010 (October 1, 2009 to September 30, 2010. The data included the three major health insurance schemes which provided coverage for about 62 million people (96% of the population). Data regarding coronary artery disease using the ICD-10 (I20-angina, I21-acute myocardial infarction (AMI) and I25-chronic ischemic heart disease) were extracted and analyzed for number of admissions, mortality rate, length of hospital stay and hospital charges., Results: In 2010, the total admissions of patients with coronary artery disease were 22,507. The most common presentation of CAD was angina pectoris (10,822 admissions)followed by AMI (6,391 admissions) and chronic ischemic heart disease (5,294 admissions). The respective in-hospital mortality rates in patients admitted with AMI, chronic ischemic heart disease and angina pectoris were 11.3%, 2.9% and 0.7%., Conclusion: Thailand is entering a period of epidemiologic transition marked by an increase of cardiovascular disease and hospital expenses dominated by cardiovascular disease. Information on the burden of CAD--indicates a need to improve health care system.

Background: Age-specific causes of death yield important information for planning health services and medical education., Objective: To compare the age-specific causes of death between in-hospital deaths and death registration statistics., Material and Method: Information on in-hospital mortality in fiscal 2010 was extracted from the three health insurance schemes. Death registrations (ICD-10 coding) were from the Bureau of Registration Administration, Ministry of Interior Statistics on the age-specific causes of death were analyzed., Results: In-hospital deaths numbered 132,512 (47.5% occurring in tertiary care) vs. 411,331 recorded in vital statistics (68% died outside hospitals). Most (74%) infants died in-hospital so causes were clearly documented vs. death registration. A minority (6.2%) of in-hospital deaths and of death registrations (9.7%) were due to unnatural causes. The majority (79.5%) of unnatural deaths died before arriving at hospital. Ill-defined codes for causes of death were found in 6.1% of in-hospital records and 42.2% of death registrations. After censoring ill-defined codes, the ten leading, age-specific causes of death agreed between the two data sets., Conclusion: Medical personnel should receive training to do proper death certification. Periodic validation of hospital COD certification should also be done. Use of verbal autopsy in the Thai context would help to standardize record-keeping and to reduce ill-defined codes for deaths occurred outside hospital.

Background: Colorectal cancer incidence rate is high and expected to increase in Thailand. But it is a preventable and curable disease if found in the early stage of development. The overall data regarding admission rates and healthcare cost in Thai patients are lacking., Objective: To identify admission rates and healthcare cost of colorectal cancer., Material and Method: Information on illness of inpatients and casualties came from hospitals nationwide and from hospital withdrawals from the 3 health insurance schemes in fiscal 2010. The data included 96% of the population and were analyzed by age groups, hospital level and insurance schemes in patients with colorectal cancer., Results: Colorectal cancer occurred in 45,692 of all admissions, contributing to admission rates of 98.5 per 100,000 persons. These figures increased with age. The highest admission was found in the central region including Bangkok (43%) followed by the northeast region (23%). The average hospital charges per admission in three insurance schemes groups: government welfare, social welfare and universal coverage were 64,241, 49,490 and 28,588 Baht, respectively, Conclusion: Admission rates showed that colorectal cancer increased with age. The highest rate was observed in sixty years and older The hospital charges were extensive, especially in those on the government welfare scheme. Thus, screening programs, cost-effective analysis of treatment modalities and treatment protocol for the elderly should be examined.

Background: Between 1990 and 2010, many national and international factors converged to both beneficially and antagonistically affect people's health and the Thai healthcare system. Moreover Thailand is moving to aged society and a low birth rates., Objective: To analyze Thailand's health issues for baseline information for changing medical education, services and researches., Material and Method: Information on illness of in-patients, out-patients and casualties came from hospitals nationwide and from hospitals withdrawals from the three health insurance schemes in fiscal 2010. The data included 96% of the population. Research literature was also extensively reviewed. The data were analyzed by age groups and burdensome diseases., Results: Out-patients were treated 326,230,155 times and in-patients 6,880,815 times at Community Hospitals (44%), Provincial Hospitals (22%), Central or University Hospitals (26%) and Private Hospitals (8%). Infants and elderly were the patients most commonly treated in hospital. Among pediatric patients, perinatal disease, intestinal infection, respiratory tract infection, injury and poisoning and teenage pregnancy predominated; while among adults, it was accident, non-communicable and chronic disease., Conclusion: Thailand is faced with the dual burden of infection and non-communicable diseases. Risky behavior and changing social structure are underlined this epidemiological transition. Medical schools and health service systems need to be recalibrated to response proactively to these challenges.

Background: The family-centered care requires reliable information on morbidity, mortality and related health problems to educate the responsible families., Objective: To explore diseases and deaths of infants aged 29 days-12 months under the 2010 Universal Health Insurance in Thailand., Material and Method: As per Sutra et al in 'Health situation analysis of Thai population 2010. The data included in the analysis were numbers and percents of primary diagnosis of each visit in the outpatient department (OPD), admitted cases and infant death. Other health related issues were also retrieved from the existing sources of health information at country level., Results: The infants aged 29 days-12 month had 9,721, 266 OPD visits including factors influencing health (69.6%), respiratory infections (16.3%), Intestinal infection (2.4%) and other diseases (11.7%). The admitted cases commonly had respiratory infections (47.5%), intestinal infections (23.4%), other infections (4.8%) and congenital malformation (2.8%). The three most common causes of hospital deaths were perinatal conditions (25.2%), congenital malformation (21.4%) and respiratory infection (18.5%). There were also neonatal problems of low birth weight and iodine deficiency., Conclusion: The infectious diseases and perinatal health problems were the main issues for family education in the family centered care to reduce the burden of diseases and infant death.

Background: Unintentional injury has been identified as a public health problem in Thailand as it is the leading cause of death among both children and adolescents., Objective: To explore the number of admissions by unintentional injury and cause(s) among Thai children and adolescents in 2010., Material and Method: Data on the number of admissions by unintentional injury in the fiscal year, 2010, were derived from hospitals nationwide as well as the three health insurance schemes. Data on Thai children and adolescents (0-18 years) was collected between October 1, 2009 and September 30, 2010. The coding for underlying cause(s) of unintentional injuries and death were done using the International Classification of Diseases, 10th edition., Results: A total of 118,323 unintentional injuries were reported. The majority of patients were male and falls were the major cause of unintentional injuries (27,139 admissions; 22.94%) followed by motorcycle injuries (20,499 admissions; 17.32%). Accidental drowning and submersion was the major cause of death in the present study, followed by lightning strikes and accidental threats to breathing (i.e., choking and suffocation)., Conclusion: The current study revealed that falls were the major cause of unintentional injury and accidental drowning and submersion the major cause of death.

Background: Thailand has reached an ageing society on account of demographic transitions. Hospitalized elders are susceptible to having detrimental consequences in many aspects. Understanding the situation regarding elders being hospitalized would help allied-healthcare workers to focus and take necessary action on particular issues., Objective: To demonstrate the admission rate of elders, common causes of hospitalization and their mortality rates., Material and Method: Information on illness of inpatients and casualties came from hospitals nationwide and from hospitals withdrawals from the 3 health insurance schemes in fiscal 2010. The data included 96% of the population. The data were analyzed by age groups and burdensome diseases., Results: Elders posed the highest rate of all hospitalization (24.3/100 older persons) and the proportion increased with age. The top three common causes for hospitalization were diseases of respiratory tract (13%), circulatory (12%) and digestive system (11%). Mortality rates were highest in elders with pneumonia (129.7/100,000 persons)., Conclusion: Older hospitalization was the highest for all hospitalization ages. Common causes for hospitalization are partly the consequences of modifiable factors. Thus, healthcare providers require extensive effort to enhance education and training to allied-healthcare workers regarding preventive and early diagnosis strategies to those with frequent illnesses.

Objective: To determine the magnitude and investigate causes of perinatal deaths of a cohort of the Prospective Cohort Study of Thai Children., Material and Method: A semi-structured verbal autopsy questionnaire and review of medical records were used to ascertain the causes of deaths during the perinatal period in four districts of Thailand., Results: The total numbers of 3,522 babies (with 28 pairs of twins) were born from 3,494 pregnant women. The perinatal mortality rate was 10.69 per 1,000 total births, the stillbirth rate was 6.75 per 1,000 births, and the early neonatal mortality rate was 3.97 per 1,000 live-births. About 37.8% of the perinatal deaths were agreed to by two pediatricians and a neonatologist as preventable. About 90% of the preventable stillbirths occurred in the antepartum period., Conclusion: Findings from the present study indicates that to further reduce the perinatal death rate, attention should be focused on reducing the stillbirths by a quality antenatal care.

The authors report on three infants with cystic fibrosis (CF), with different genotypes, presenting with different clinical manifestations, but having similar abnormal serum electrolytes (i.e. hyponatremia, severe hypochloremia and metabolic alkalosis). Despite the diagnostic investigations, the child who presents with severe electrolyte imbalance especially persistent hypochloremia and a family history of early infant death with respiratory or gastrointestinal problems should point to a diagnosis of CF Early identification and treatment remain critical to effective management. The diagnostic tool used, especially the sweat test, is needed for diagnostic investigations in Thailand.

Non-typhoidal salmonellosis is a major cause of food-borne illness in Thailand. Specific serotyping of Salmonellae, linked with certain foods, can be used to identify outbreaks, transmission, and for surveillance. We aimed to identify the chain of non-typhoidal Salmonella transmission from food to humans in five slums, two open markets, four supermarkets and an abattoir in the municipality of Khon Kaen. During three months representing the cool-dry, hot-dry, and rainy seasons of 2002, culture samples were collected from water, food, pork, and chicken. Stool cultures of food venders, and others in the same area, were performed. Serological typing was done by the WHO National Salmonella and Shigella Center in Thailand. Of the food, drinking water, and stool samples from food handlers and healthy persons, 18, 7, 11, and 5%, respectively, were positive for Salmonella. Nearly all (96-98%) of the fresh pork and chicken, both from the open markets and supermarkets, were positive for Salmonella. The major Salmonella serovars were S. Anatum, S. Rissen, S. Virchow, S. Enteritidis and S. Panama, similar throughout the food chain and to the other reports that year. To reduce the incidence of human salmonellosis, several preventative measures must be taken where animals are produced, slaughtered and processed, and at home and in eateries. Vulnerable groups, such as infants, the elderly and the immuno-compromised, should be made aware of their increased susceptibility to food-borne disease.

The authors present the case of a 2-month-old infant with double aortic arch that developed massive bright red upper gastrointestinal hemorrhage from aortoesophageal fistula (AEF) after prolonged endotracheal and nasogastric intubation. Emergency thoracotomy with AEF and double aortic arch repaired were done successfully under cardiopulmonary bypass. Due to tracheomalacia and left phrenic nerve injury, tracheal extubation could not be done until 1 month after correction of the vascular ring. The endotracheal and nasogastric tube led to fistula formation by compression of the esophageal wall against an abnormal double aortic arch. When a double aortic arch is suspected, prolonged nasogastric intubation should be avoided.