Disease Control Journal

Using a script file in developing a COVID-19 surveillance for acute respiratory infection and community acquired pneumonia cases in community hospitals, Nan Province

Apichit Sathawornwiwat — 2024-09-18

The timeliness of data reporting affects the efficiency of implementing the surveillance system for respiratory and pneumonia patients to detect coronavirus 2019 patients who do not meet the disease investigation criteria of the Ministry of Public Health. Therefore, the research team used a research and development model to develop a surveillance reporting system by writing a software command set (MySQL script file), which is a command set for extracting disease surveillance data from the hospital information system of 14 community hospitals in Nan Province. Then the information was reported electronically into the disease surveillance system instead of the old system where the data were collected manually. The effectiveness of the developed system was evaluated by using mixed methods. The total of 8,620 visits of patients with respiratory illnesses and pneumonia from the disease surveillance system was included into the study and total of 30 officials involved in the surveillance system was recruited as the key informants for semi-structured interview. Quantitative data were analyzed using descriptive statistics and the effectiveness was compared using paired t-test and McNemar’s test. Content analysis was used for qualitative data. The results of the study indicated that 1) the developed system was user friendly and simple steps, and it had no adverse impacts on the routine work, 2) it provided stability in data and information reporting, 3) it offered fast data connection, 4) the system was well accepted by practitioners and they became more cooperative in sending data and information, and 5) the system ensures easy and fast data retrieval. As a result, the proportion of timely data reporting increased with statistical significance (p<0.001) from 46.67% to 99.17% of all weeks that must be reported and ATK examination coverage increased with statistical significance (p<0.001) from 17.85% to 71.20% of patients with respiratory infection and pneumonia in one week. Therefore, the Ministry of Public Health can adopt this MySQL script file to expand its use in other provincial health offices across the country to help lighten the workload of practitioners and work more easily, thus leading to more effective and efficient disease surveillance efforts under existing human resources.

Factors related to smoking behaviors among male secondary school students: A school case study from Tha-it Sub-district, Pakkret District, Nonthaburi Province, Thailand

Thanarat Mudchiew — 2024-09-18

The aim of this cross-sectional descriptive study was to determine smoking behavior and the related factors among male secondary school students at a school in Tha-it sub-district, Pakkret district, Nonthaburi province. Samples were collected by two-stage sampling method and 105 male students were recruited. Data collection was done from November to December 2023. Data were collected by using self-administered questionnaire: predisposing factors including general information, smoking behavior, and attitude for smoking behavior; enabling factors including accessibility of smoking prevention; and reinforcing factors with social support from family and school for smoking prevention. Descriptive statistics and binary logistic regression analysis were used for data analysis. The result found that 32.4% of the samples had ever tried to smoke (24.8%) and smoke currently (7.6%). The factors related to smoking behavior among male secondary school students were predisposing factors including their level of studying (p-value=0.021). smoking among family members (p-value=0.002) and having friends who smoke (p-value=<0.001. Male students studying in Mathayom 1 and Mathayom 2 had a higher risk of smoking than those in Mathayom 3 5.05 and 3.55 times (95% CI: 1.59-16.07 and 1.10-11.41, respectively). Male students whose family members smoke have a 3.85 times risk of engaging in smoking (95% CI: 1.63-9.08) than those without family members smoke, having friends in a group who smoke has a 6.61 times greater risk of smoking (95% CI: 2.64-16.54) than those without friends who smoke in a group. These findings suggest that the skills on reject smoking should be introduced among students to prevent smoking initiation and the non-smoking behavior campaigns should be implemented from primary school. A counseling program should be established for students who smoke. Developing and raising standards for smoke-free schools and a participatory smoke-free community are also suggested

Chest X-ray findings in Mpox patients and the correlation between cycle threshold of Real-time PCR for Mpox relative to pneumonia and death in Bamrasnaradura Infectious Disease Institute

Parichut Vongthawatchai — 2024-09-18

Mpox is an ongoing global pandemic disease. There was the first outbreak in Thailand. The study aimed to study CXR findings of Mpox patients and describe the correlation between cycle threshold (Ct) from Real-time Polymerase Chain Reaction (Real-time PCR) for Mpox relative to pneumonia and death. This retrospective study evaluated Mpox patients treated at the Bamrasnaradura Infectious Diseases Institute during August 1, 2022 to September 30, 2023. There were 40 Mpox patients included in this study. Of these patients, 95.0% were Thai, 90.0% were male, and 55.0% were HIV positive. The average age of patients was 31.6 years. Among these patients, 15.4% were having pneumonia. The mortality rate was 5.0%. The most common CXR findings of Mpox-related pneumonia were reticular opacity (100%), bilateral lungs involvement (100%), both central and peripheral distribution (100%). Mean Ct from Real-time PCR for Mpox with pneumonia group was 19.21+1.97 and non-pneumonia group was 20.65+0.80 (p-value=0.562). Mean Ct from Real-time PCR for Mpox among fatal group was 16.32+0.18 and non-fatal group was 20.73+4.65 (p-value=0.193). Respiratory symptoms were not observed in all Mpox patients, so performing CXR was solely at the discretion of the treating physician. Lower value of Ct from Real-time PCR for Mpox that suggests higher pathogen load was not significantly correlated with pneumonia and death.

Evaluation and policy proposals for management of emergency response operations centers in the case of the new coronavirus disease 2019, Department of Disease Control

Pairoj Prompunjai — 2024-09-18

This qualitative study was conducted to evaluate and review the emergency management of the emergency response operations centers during the coronavirus disease 2019 pandemic, and to provide policy proposals for improving the efficiency of the emergency response operations centers of the Department of Disease Control for the coronavirus disease 2019 outbreak. The target groups for the study included the senior executives of the Department of Disease Control, the director of office or division in the Department of Disease Control, and those who carry out missions in the center both centrally and regionally. The study consisted of 2 steps: (1) evaluating and reviewing the management of the center, and (2) making policy proposals. In-depth interview or group interview, online questionnaire, group chat and Delphi technique were conducted. The results of the study found that the strengths include knowledgeable and skilled personnel in incident command system and good working system, having supported laws, resources, budget and information technology; and having strong networking and disease control capacities. Weak points were reported that the incomplete data or information were obtained. The strategy analysis was not aligned with the situation contexts. The personnel struggled with fatigue, stress accumulation, and skills needed to work for others. The
information technology systems had limitations in linking data with other agencies. The standard work procedures did not exist. The command or role assignments were unclearly delivered. The recommendations suggested that the incident commander should be appointed from the position of deputy director-general or above. The courses for executives at the level of deputy director of legal development agencies should be provided as well as the courses for the senior executives from the Ministry of Public Health and other ministries. The proposed policy proposals recommended 3 aspects: personnel, supporting system, and work systems. The personnel aspect mentioned in the incident commander should be appointed from the deputy director-general or above. The manpower reserve plan should be ready to handle the emergency situations at the highest level. Capacity building courses in emergency management should be developed for senior executives from government agencies in different responsibilities including public health, governance, social development and military as well as the advance technical skills for IT personnel. The supporting system aspect included providing welfare, the safety atmosphere, and mental support to the personnel and their
families, developing information systems to be able to support the future responses which can link the data between agencies. having plan to reserve expenses for emergency response operations. The work systems aspect noticed creating action plans or proactive communication strategies in emergency and countering fake news as well as creating a manpower plan that had competencies which match the missions and be able to perform interchangeably.

Evaluation of strengthening measures to accelerate routine immunization coverage in Thailand which impacted by COVID-19 pandemic

Chaninan Sonthichai — 2024-09-18

Vaccine is an effective tool to raise immunity and prevent diseases among population. Due to COVID-19 pandemic, vaccine uptake has reduced globally including Thailand. The Ministry of Public Health recognized this issue and implemented a policy to accelerate routine vaccination coverage toward the normal level. This study aimed to assess routine vaccine coverage in Thailand. Data were analyzed using mixed method including document review and descriptive statistical analyses on vaccine coverage in the Ministry of Public Health’s health data center. The result shown that, during the pandemic, the routine vaccine coverage decreased from 82.9-97.4% (median 90.1%) to 65.9-94.3% (median 75.2%). The reduction was noticeably observed in all vaccination programs that require parents to get an appointment to bring their children for the services, except for the birth dose vaccines. Since the Ministry of Public Health implemented policies and integrated measures to accelerate vaccine uptake, the vaccine coverage was raised to 72.2-90.6% (median 83.8%), which was 2.8-19.9% (median 8.6%) higher than pre-implementation phase. However, to increase Thailand’s vaccine coverage to achieve the long-term target, the significant measures should be implemented continuously including advocating the policies through health system administration, using communication and social platforms to drive the policies, revising the strategy for vaccination service management, and improving the efficiency of electronic vaccination database.

The capacity for infectious waste management in Thailand under normal circumstances and during the COVID-19 pandemic

Kullatida Sukmak — 2024-09-18

This study aimed to (1) assess the capacity of Thailand's primary infectious waste management facilities and (2) compare their capacity under normal circumstances (2017-2019) versus during the COVID-19 pandemic (2020-2022). Data on infectious waste volumes in Thailand from 2017 to 2022 were analyzed using descriptive statistics, based on information collected from the Bureau of Environmental Health, Department of Health, Ministry of Public Health. Results revealed that infectious waste volumes increased from 78,330 tons during normal circumstances to 150,527 tons during COVID-19 pandemic. Currently, 19 agencies provide infectious waste disposal services in Thailand, with a total capacity of 188,321 tons per year, comprising 18 waste incineration plants (186,479 tons/year) and one steam sterilizer (1,752 tons/year). The study found that Thailand has sufficient capacity to dispose of infectious waste, with 58.4% excess capacity under normal circumstances and 20.1% excess capacity during the pandemic. However, only 89.74-98.4% of infectious waste from various sources was properly disposed according to standard procedures. The accumulation of untreated infectious waste primarily occurs due to improper waste segregation at the source, leading to a significant amount of accumulated infectious waste before the disposal stage. This research concludes that comprehensive monitoring of infectious waste generation requires mandatory reporting from all sources to address the challenge of infectious waste management, particularly during public health crises.

Prevalence and risk factors of hepatitis B, hepatitis C, HIV and syphilis among inmates in Udon Thani Provincial Prison

Olarn Wiwattanachang — 2024-09-18

Hepatitis B, hepatitis C, HIV and syphilis are common infections among prisoners. Incarceration setting is suitable for a screening program. This descriptive cross-sectional study, which performed blood screening from May to October 2022, aimed to assess prevalence, and risk factors associated with these infections in all prisoners of Udon Thani Provincial Prison. Total of 90.36% of 3,466 inmates were voluntarily enrolled. Prevalence of hepatitis B, hepatitis C, HIV and syphilis were 5.17%, 1.76%, 1.05%, and 2.65%, respectively. Prisoners who were born before 1992 are common risk factor of hepatitis B, hepatitis C and HIV. Important risk factor for hepatitis B is concurrent Anti-HIV AB+ (AOR=4.13, 95% CI:1.65-10.32); for hepatitis C, the most common risk factor is injection drug use (AOR=17.65, 95% CI:8.76-35.55); for HIV is HIV-positive sexual partners (AOR=86.73, 95% CI:21.11-356.43), and for syphilis is tattoos and body piercings (AOR=2.17, 95% CI:1.14-4.14). Screening and early treatment for all prisoners will reduce prison and household transmission, which in turn will help reduce overall infection rates at a national level.

Effectiveness of self-care promotion program on self-efficacy, expectations for the treatment outcomes and self-care behaviors of pulmonary tuberculosis patients in Mukdahan Province

Supannika Jumpates — 2024-09-18

This quasi-pre-post experiment and control research was conducted to evaluate the effectiveness of a self-care promotion program on self-efficacy, expectations for treatment outcomes, and self-care behaviors of pulmonary tuberculosis patients. Data were collected using a questionnaire from a total of 74 patients newly diagnosed with all types of pulmonary tuberculosis undergoing treatment at a hospital in Mukdahan Province. Patients were divided into an experimental group of 37 people and a comparison group of 37 people. The experimental group participated in activities according to the self-care promotion program for a period of 8 weeks, divided into 3 phases with 5 activities: Phase 1, the process of creating awareness of “Health Consciousness” consisting of 2 activities; Phase 2: knowledge exchange process and motivation “Toward Golden Health” consisting of 2 activities; and Phase 3: Monitoring and evaluation of effectiveness consisting of 1 activity. Data were collected using questionnaires. Intra-group comparison was made for self-efficacy perception, expectations for treatment outcomes, and self-care behaviors using the paired sample t-test and inter-group comparison was made using the independent sample t-test at the significance level of 0.05. The research results found that after the study the experimental group had a better changes of the average scores from baseline of self-efficacy, expectations for the treatment outcomes, and self-care behaviors than the comparison group (p-value<0,001) . Therefore, TB clinic staff is suggested to apply the self-care promotion program for TB patients to encourage patients on awareness the importance of receiving continuous treatment and to develop expectations for treatment results so that the patients could have better self-care behaviors.

Participatory networks in surveillance and prevention of dengue haemorrhagic fever: case study of Child-daycare Development Center, Khlonghae Subdistrict, Hat Yai District, Songkhla Province

Siriporn Wattanapurk — 2024-09-18

In 2019, an epidemic of dengue haemorrhagic fever (DHF) occurred at Bannongnaikhui community and had spread to urban areas including the Bannongnaikhui elementary school. Bannongnaikhui Child-Daycare Development Center located within the same boundary of the elementary school. As a result, the Child-Daycare Development Center seemed to become high-risk zone for the third wave of DHF epidemic. This study aimed to develop guidelines applying the concept of network involvement and participation in monitoring and preventing a new wave of DHF spread. The action research was performed including 4 steps: situation analysis and needs assessment, planning, implementation, and evaluation. Primary data were collected by interviewing stakeholders from many sectors along with participatory observation of risky physical environments. Secondary data were analyzed from the questionnaire and the assessment. The study results found that network partners which included officials or personnel of public health agencies, personnel of the child-daycare development center, personnel of the school, village health volunteer leaders, community representatives, and municipal officials worked in a cooperative effort by applying the Google Map application to proactively screen and locate the patients. Besides, jointly assess physical risk areas and create innovations including “Bergamot spray” and “Cyclical rule” were applied to prevent the spread of the disease at the child-daycare development center. In conclusion, the participation of network partners is the key to success in monitoring and preventing disease from spreading DHF epidemic in high-risk areas. This concept should therefore be applied to other high-risk areas with similar contexts.

Factors associated with risk of stroke among hypertensive patients in Non Sung District, Nakhon Ratchasima Province

Gungsadarn Judpho — 2024-09-18

This cross-sectional analytical study aimed to assess risk of stroke and its related factors among hypertensive patients in Non-Sung District, Nakhon Ratchasima Province. A total of 455 essential hypertensive patients registered for treatment at primary health care facilities of Non-Sung municipality, Non-Sung District, Nakhon Ratchasima Province were recruited into the study. The questionnaire was used for data collection and descriptive statistics were used to describe sample characteristics. Multiple logistic regression analysis was used to analyze factors associated with risk of stroke among hypertensive patients. The adjusted odds ratio (AOR) along with its 95% confidence interval and p-value were presented. The results showed that 85.05% of the hypertensive patients reported having stroke prevention behaviors at a sufficient level. 69.45% had risk of stroke at a low level. Factors significantly associated with risk of stroke among this hypertensive patients were male (AOR=7.22, 95%CI: 3.79-13.72, p<0.001), aged 60 years and older (AOR=63.00, 95%CI: 26.19-153.27, p<0.001), high systolic blood pressure (AOR=8.96, 95%CI: 4.26-18.81, p<0.001), high fasting blood sugar level (AOR=7.21, 95%CI: 3.40-15.28, p<0.001) and poor stroke prevention behaviors (AOR=2.36, 95%CI: 1.10-5.47, p=0.045).

Situation of colorectal cancer in the national health security system, Thailand fiscal year 2004-2021

Pianghatai Ingun — 2024-09-18

This study was a part of the program to develop evaluation capacity of the National Health Security Office (NHSO)’s staff by assigning personal from various strategic groups and regional offices working together in agile teams and colorectal cancer was chosen for the study. Data from NHSO database were analyzed in terms of situations on epidemiology, results of treatment focusing survival rate, and service provisions. The study was performed during August - September B.E.2565. The study reveals colorectal cases were continuously increase. There were 5,245 new cases in fiscal year 2547 and rose to 12,998 cases in fiscal year 2564. Incidence rates during fiscal year 2560-2564 increased from 21.83 to 27.41 cases per 100,000 population. Survival rates at year 1 and year 2 were 67.42 and 54.02% respectively and year 5 was 37.53%. Data concerning treatment with chemotherapy, radiation or surgery indicated that there was no data of such treatment in 54.74-62.89 % of cases, and among cases with existed data, 83.37-87.33 of cases diagnosed during fiscal year 2560-2564 received such treatment initially within 3 months after diagnosis. In addition, number of cases receiving any kind of services rose from 12,732 to 82,680 times during fiscal year 2547 to 2564, while number of treatments with chemotherapy, radiation or surgery rose from 2,041 to 9,626 times during the same period. This study points out that colorectal cancer cases were increasing alarmingly. Researches should be conducted to explore the causes and guide formulation of more effective interventions for further prevention and control. Further health care system should be developed and resources should be prepared to accommodate expected higher number of cases in the future.

The recall prevalence in congenital hypothyroidism screening due to thyroid stimulating hormone levels among newborns using dried blood spot samples in Thailand from 2015 to 2022

Hansa Thaisri — 2024-09-18

The measurement of thyroid stimulating hormone (TSH) levels in dried blood spots (DBS) samples collected from newborns aged 48-72 hours using the ELISA technique has been a common practice for neonatal screening for congenital hypothyroidism (CHT) in Thailand since 1996. A TSH level of ≥ 25 mU/L is the established cutoff value for recalling newborns for further confirmation testing. In compliance with national guidelines, the newborns testing positive should receive prompt treatment within 14 days old. This study aims to assess the recall rate prevalence and determine the incidence of CHT through the screening program administered by the National Neonatal Screening Operation Center under the Department of Medical Sciences from 2015 to 2022. A total of 4,621,808 newborns were screened, covering 96.12% of total live births. Of these, 21,970 newborns (0.48%) required the confirmation tests for CHT positive, but only 13,021 (59.27%) responded to receive the confirmation test. Among these cases, 2,706 were found to be abnormal, resulting in an incidence rate of 1 in 1,708 with a positive predictive value (PPV) of 20.78%. Results indicated that, for each year, an increasing prevalence of recalled cases corresponding to a higher incidence rate of CHT. Therefore, conducting confirmation tests for all screened abnormal newborns could provide a more accurate depiction of the actual incidence of CHT in Thailand.

Monitoring and evaluation of environmental surveillance programs at Thailand's points of entry as part of capacity development in accordance with the International Health Regulations (2005)

Ekkaphop Boonkrue — 2024-09-18

Thailand has 69 points of entry (PoEs), comprising 15 airports, 18 ports, and 36 ground crossings. These points of entries operate under the International Health Regulations (IHR) 2005, and the Border Disease Control Checkpoints are one of the key responsible for implementing these regulations. Besides the core components, the significant aspects including environmental surveillance, vector surveillance, and relevant control measures are the integral parts of IHR implementation framework at POEs. This cross-sectional descriptive study aimed to examine the environmental and vector surveillance and sanitation inspections conducted by the officials at POEs. and to compare the results of surveillance inspections within Thailand's POEs between two fiscal years 2022 and 2023. Self-assessment on competency of POEs officials on implementing the regulations was conducted. The competency on the environmental surveillance was not different from the vector surveillance and control. No differences of both competences in 2022 and 2023 fiscal years and among different entry points: airports, ports, and ground crossings. Further analysis on sanitation inspection reports from the Estimates Strategic Management System (ESMS) program, including 7 categories: 1) potable water, 2) food sanitation, 3) wastewater and sewage management, 4) lavatories, 5) indoor air quality, 6) solid waste management, and 7) vector surveillance and control was performed. The number of reported activities was slightly increased from 133 in 2022 to 146 in 2023. The number of reported activities among 3-point of entry: airports, ports, and ground crossings were similar. In conclusion, the Border Disease Control Checkpoints have intensified inspection regimes within their respective POEs. The PoEs inspection requires a comprehensive approach encompassing policy and planning, budget allocation, operational skills training, and enhanced interagency cooperation.

Assessment of health risks and effects from pesticides used among chili farmers in Kham Sakaesang District, Nakhon Ratchasima Province

Wararat Sangwalee — 2024-09-18

The objective of this research was to assess health risks and effects from organophosphate and carbamate-class insecticides among chili farmers in Kham Sakaesang District, Nakhon Ratchasima Province. The samples included 267 chili farmers. Data were collected by using the health risk assessment form from the Department of Disease Control and cholinesterase reactive paper was used for screening tests of pesticide exposure in the farmers’ blood. The study was conducted between June and December 2022. Data were analyzed using descriptive statistics which include number, percentage, mean, and standard deviation. In addition, chi-Square test was utilized to analyze factors associated with acetylcholinesterase or cholinesterase enzyme levels. The results showed that 58.1% of the farmers were at low risk from exposure to organophosphate and carbamate insecticides; 30.7% were at medium risk; 9.0% were at relatively high risk; and 2.2% were at high risk. Risk screening results from pesticide exposure, by examining cholinesterase enzyme levels in the blood, revealed that 88.8% were within normal and safe levels, while 11.2% were at risky and unsafe levels. A significant relationship was identified between the level of pesticide exposure with cholinesterase enzyme levels in the blood and abnormal symptoms post-pesticide exposure (p-value<.05). Therefore, healthcare workers in primary health care units should continually monitor farmers' health by screening and tracking cholinesterase enzyme levels in their blood so that necessary steps can be taken to reduce organophosphate and carbamate insecticide residues in their system.

Investigation of malaria outbreak in a Karen hill tribe community, Ban Rai District, Uthai Thani Province between April and May 2023

Tippawan Asura — 2024-09-18

Uthai Thani Provincial Health Office was alerted by Ban Rai Hospital regarding the detection of five confirmed cases of malaria among the Karen hill tribe community situated in Village Group No. 2, Kaen Makrut Subdistrict, Ban Rai District, Uthai Thani Province. These malaria cases were reported between April 14 and May 9, 2023. Subsequently, an outbreak investigation team was deployed to the affected area from May 10-12, 2023, to validate the diagnosis, characterize the epidemiological profile of the confirmed cases, identify potential sources and modes of disease transmission, and provide recommendations for disease prevention and control. The study employed a descriptive research design. During the investigation, the team meticulously scrutinized medical records and conducted an active case finding among 166 villagers in Village Group No. 2, utilizing a specialized case investigation form developed by Division of Epidemiology and Rapid Diagnostic Test (RDT) kit. Individuals testing positive via RDT underwent further examination using the thin/thick film method and among 166 villagers tested, 1 Plasmodium vivax case was detected. The investigation team confirmed a total of six cases of P. vivax malaria. The majority of affected individuals were male agricultural laborers with a history of travel between the village and neighboring provinces classified as malaria high-risk areas. The investigation team observed that communal living conditions within the community futher amplified the risk of infection. While the principal vector, i.e., Anopheles minimus mosquitoes and larvae were identified, Plasmodium spp. was not detected in the adult mosquitoes. It was observed that a significant proportion (98.19 %) of villagers relied on conventional mosquito nets for sleeping, with only one-fifth (21.08%) possessing awareness regarding the disease-causing potential of mosquitoes, and a minority (4.82%) utilizing mosquito repellents for personal protection. This circumstance significantly heightened the risk of potential future outbreaks. In light of these findings, the investigation team recommends continuous surveillance, intensifying awareness campaigns concerning the disease and advocating for self-protection measures, particularly in anticipation of the outbreak season. Moreover, the provision of resources for disease prevention and control, alongside the implementation of surveillance measures targeting individuals with a history of travel from high-risk areas, is strongly recommended.