Journal of Medical and Public Health Region 4

Association between unvaccinated COVID-19 and COVID-19 mortality in Udonthani province

kitsana sugawong — 2024-08-06

Coronavirus 2019 (COVID-19) outbreak was the cause of many COVID-19 patients and deaths. The Thai government have a policy for people to get vaccinated since April 2021 to reduce its severity. However, mortality in the 607 group became higher. This research aimed at investigating the association between unvaccinated COVID-19 and COVID-19 mortality in Udonthani Province and finding out the COVID-19 mortality. This is a retrospective cohort study conducted from monitoring registered patients from January 1 to August 31,2022 totaled 6,921 individuals over a 30-day period to ascertain treatment outcomes. Generalized Linear Model (GLM) was used for association analysis, and Adjusted RR with 95% confidence intervals was presented. The finding revealed that COVID-19 mortality in the unvaccinated was 3.1% (95%CI : 2.60-3.76); however, it became lower after getting the 2^nd dose and boosters (3^rd and 4^th doses). The unvaccinated was significantly associated with the mortality (p-value < 0.001). In other words, when controlling the effect from age and chronic disease variables in the last equation, the unvaccinated was 1.9 times more likely to have mortality than the vaccinated (Adjusted RR 1.9, 95%CI : 1.49-2.50). As a result, public health services should provide vaccination services against COVID-19. Proactive among the elderly and those with underlying medical conditions Increase access to COVID-19 immunization services Under the standard, the vaccine service continues.

Factors affecting the success of policy implementation Volunteer Home Doctor to practice at Nakhon Nayok province

Unchalee Ngampiw — 2024-08-06

This analytical Cross-sectional study aimed to study the level of success and factors affecting the success of policy implementation. Village health volunteers go to practice Nakhon Nayok Province. Study between September and November 2022. The sample group consisted of 204, village health volunteers by multi-stage random sampling. The tool used was a questionnaire on success levels and 6 related factors. Statistics used were mean, percentage, standard deviation, and multiple regression. The study found that. The success in implementing the policy was at a high level. The top 3 rankings were surveillance, prevention, and disease control ( = 4.03 S.D. = 0.55), followed by health promotion ( = 3.89, S.D. = 0.56) and the use of digital technology ( = 3.86, S.D. = 0.65), respectively. As for the factors significantly related to the success level of policy implementation (p < 0.001), It was found that aspect 1 was the clarity of the policy objectives, the qualifications of the hospital, and the persons involved. Factors 2: Qualifications of Public Health Hospital and personnel performing duties. Factor 3: Qualifications of Public Health Hospital and personnel performing duties. Factor 4: Policy resource factors. and personnel performing duties. The 5^th aspect is policy resource factors. and the person performing the duty and the 6^th aspect is the policy resource factor and persons performing duties. It can be seen that the personal factor of duty personnel is related to the level of success in all aspects. Therefore, this factor can be applied to the implementation of other public health policies.

Qualified antenatal care during the COVID – 19 pandemic in public hospitals of the Saraburi Province

Nantita Wongsuwon — 2024-08-06

The objectives of the descriptive were to assess the rate of quality antenatal care and to study the relationship of personal factors, knowledge of pregnancy and quality antenatal care, knowledge of Covid-19 risks, perceived risk and severity of quality non-antenatal care, perceived benefits and barriers to quality antenatal visits, and social support between individuals and society and quality antenatal care among postpartum women in government hospital, Saraburi Province. Data were collected from May to September 2022 by using the online questionnaires of 341 postpartum women. Descriptive statistics and binary logistic regression at 5% significance level were adopted for the analysis. Results showed that 48.7% of postpartum women received quality antenatal care, 74.3% had monthly incomes of 15,001 – 50,000 baht, 46.9 %, had a low level of perceived benefits and obstacles of quality antenatal care. Those who had monthly incomes of 15,001 - 50,000 baht had higher rate of quality antenatal care than those without income (Adjusted Odds Ratio; AOR= 3.37, 95 % CI: 1.74 - 6.54). Good level of perceived benefits and barriers to quality antenatal visits had high level and moderate level of quality antenatal care than those with low level (AOR = 4.76, 2.71, 95% CI: 1.63 - 13.95, 1.58 - 4.65, respectively). Therefore, access to quality prenatal care services should be proactively increased in the community, proactive public health services should be provided. Promoting perception of the benefits and raising awareness of quality antenatal care, in particular during the pandemic of COVID-19 or other diseases.

Transferring the control over sub-district health promoting hospital from the Ministry of Public Health to the provincial administration organization, a case study in Phitsanulok

Kanida Narattharaksa — 2024-08-06

Phitsanulok Provincial Administrative Organization (PPAO) was carried out with 3 objectives 1) To determine relevant laws on such transfer 2) To determine problems and obstacles pertaining to implementation of such laws
3) To provide recommendations on amendments of such laws to enable such transfer more efficiently. According to the Mechanisms and Processes on Decentralization to Local Administrative Organization Act BE 2542, sub-district health stations have been transferred to be under the control of the Phitsanulok Provincial Administrative Organization from the Ministry of Public Health as of October 2023. Methodologies are 1) Content analysis and inference on existing relevant laws and regulations 2) In-depth interviews involving relevant personnel using thematic analysis 3) Group discussions involving administrative personnel from the PAO, the Provincial Health Office, and sub-district health stations of the Phitsanulok province, and 4) Presentations and inquiries for opinions on the results of the study from officials at both the policy setting and operational levels. Findings are 1) PAO duties and powers on the existing acts, announcements, rules and regulations, letters of notification, memorandums of understanding, interagency agreements, and relevant operational manuals, there were problems and issues in how to interpret and implement them in a unified manner 2) Measures to encourage all relevant public agencies to implement pertinent policies and procedures within specific timeframes were lacking, 3) Lack of communications to relevant personnel to obtain positive attitudes towards such transfer. This study provides policy recommendations on various issues regarding the need for legal reform including relevant issues, coordination and cooperation between a given POA and relevant local administrative organizations, alternative approaches on public health promotion, memorandums of understanding between central government, rules and regulations on personnel administration, and acquisition of medicine and medical supplies by the PAO, etc.

Effectiveness of health promoting program for preventing Diabetes Mellitus among risk group in Nongbuohee Sub–district, Phibun Mangsahan District, Ubonratchathani Province

Chuthamat Kaewchandee — 2024-08-06

This research aimed to study the effectiveness of a health promotion program to prevent diabetes in high–risk groups living in Nong Bua Hi Subdistrict, Phibun Mangsahan District at Ubon Ratchathani Province. This is a quasi-experimental study. The sample group was a group at risk for diabetes aged 35 years and over in the areas of Nong Bua Hee Subdistrict and Ang Sila Subdistrict. Phibun Mangsahan District Ubon Ratchathani Province in 2020. Then calculate the sample size with the “Sample Size Calculators package” by setting the test power at 0.80, the confidence value at 0.05, and the correlation size of the variables at 0.50, resulting in a sample size of 80 people. By dividing into experimental groups and a control group of
40 people per group purposely to compare the difference in mean scores on knowledge about diabetes, to gain a perception of the risk of diabetes and the perceived severity of diabetes, benefits of treating and preventing diabetes, barriers of diabetes prevention, behavior of diabetes prevention and blood sugar levels before & after the experiment within the experimental group and the control group. With Paired t-test statistics and before & after of the experiment between the experimental group and the control group together with independent t-test statistics at the statistical significance level, Statistics P-value showed < 0.05. The study results found that the experimental group had an average score of knowledge about diabetes, perception of the risk of diabetes, severity of diabetes, benefits of treating and preventing diabetes, barriers to diabetes prevention, and diabetes prevention behavior regarding diet and exercise. Stress relief was higher than before the experiment and higher than in the comparison group. The blood sugar level decreased significantly higher than the control group at the P-value < 0.05 level, resulting from the experimental group receiving a health promotion program to prevent diabetes in high–risk groups. Therefore, public health officials should publicize and educate the public on health promotion by continuously encouraging and following up which leads to health promotion to properly prevent diabetes in high-risk groups and to be tested for effectiveness as appropriate in the local context to increase efficiency in health promotion and prevention of diabetes in high-risk groups in the future.

A study of factors affecting Alcohol consumption among students in one secondary school in Dan Khun Thot district, Nakhon Ratchasima Province

Sirirat Seekhuntod — 2024-08-06

The trend of alcohol consumption among secondary school students in the eastern and northern regions of Thailand is increasing. The purpose of this study is to examine the factors influencing alcohol consumption among high school students in one Secondary School in Dan Khun Thot district, Nakhon Ratchasima Province. A sample of 325 students completed a questionnaire, and the data was analyzed using descriptive statistics and binary logistic regression. The results, presented as adjusted odds ratios with a 95% confidence interval, Result showed that 71.4% of students consumed alcohol. 75% of male students consume alcohol, which is higher than the 65.9% among female students. The majority had their first drink between ages 13 and 16. Beer was the most popular choice (60.8%), often consumed for socializing with friends. Students demonstrated limited knowledge about alcohol (56%). Socio-economic factors revealed that students with sufficient income had lower alcohol consumption rates compared to those with insufficient income (AOR 0.26, 95% CI = 0.10 - 0.64, p = 0.004). Students living in community areas were more likely to drink than those outside the community (AOR 2.50, 95% CI = 1.09 - 5.70, p < 0.03). Additionally, students who have a moderate or high level of attitude (that drinking is not good) are less likely to consume alcohol than students with a low level of attitude (AOR 0.05 - 0.46 95% CI = 0.01 - 0.81, p < 0.01). In conclusion, students with sufficient income, living outside the community, and having neutral or negative attitudes towards alcohol were less prone to alcohol consumption. Therefore, schools should be aware of this issue and find ways to promote accurate attitudes towards alcohol consumption. Additionally, integrating knowledge about alcohol into the curriculum can help reduce the potential risks of alcohol consumption among students in the future.

Development of a food literacy program for delayed progression of diabetic kidney disease

Apichart Suppapitnarm — 2024-08-06

This study was a randomized controlled trial. The objective was to study the effect of a food literacy program in patients with diabetic kidney disease whether it could help control their blood sugar levels, and, improve or stabilize the levels of chronic kidney disease of such diabetic patients. The population and sample were diabetic patients in the chronic kidney clinic, Bangkruai hospital, Nonthaburi province, stages 2 – 4, receiving continuous treatment and were unable to control their blood sugar levels, randomized using the block of four method to a total of 48 people (24 people in the control group and 24 people in the study group). The study group would receive a food literacy program while the control group would receive regular follow–up examinations by a doctor at the chronic kidney clinic. Conduct research was carried out between August 2022 – August 2023. The study found that the majority of the sample were elderly patients (with mean age about 70 years). Most of which were males in the control group, but most were females in the study group. When compared between groups, the mean glomerular filtration rate (GFR) tended to improve in the study group. Especially, such difference was found to be statistically significant at 12 months (p = 0.013). Mean fasting blood sugar (FBS) and mean hemoglobin A1c (HbA1c) were not significantly different between groups (p > 0.05). It can be concluded that such a food literacy development program could not significantly reduce blood sugar levels in patients with diabetic kidney disease, but it could help control the level of chronic kidney disease from diabetes, either by improving or stabilizing, over a 1–year period. Therefore, it will be useful for further development into a program on nutritional therapy for patients in other chronic disease clinics.

Factors affecting the tobacco selling behavior of retail operators to youth near educational institutes in Nakhon Nayok Province

Ruchinan Laochiraunggoon — 2024-08-06

This research is survey research with the objective of studying factors affecting the behavior of selling tobacco products to youth of retail store operators near educational institutions in Nakhon Nayok Province. The population studied was retail operators near educational institutions in Nakhon Nayok Province. Specifically stores near educational institutions within a radius of 1,000 meters, a total of 120 stores near educational institutions within a radius of 1,000 meters between November and December 2022. Descriptive statistics and multiple regression analysis were used in this study. The research results found that most retail operators at are female 71.67%, 38.83% aged 60 - 69 years, 75.83% marital status, 40.83% high school education, 83.33% non-smoker, 95.00% stores owner, 55.83% working time at the stores 11 - 20 years. The most retail operators had a high level of knowledge about the Tobacco Product Control Act and related laws, attitudes towards the sale of tobacco products to wards law enforcement, and behavior in selling tobacco products to youth were at a high level of 95.83%, 72.50%, and 90%, respectively. Factors that affect the behavior of selling tobacco products to youth with statistical significance at p < 0.05 include 4 factors: 1) distance between stores and educational institutions, 2) price of tobacco per pack, 3) number of tobacco packs sold and 4) types of tobacco sold. Therefore, emphasis should be placed on studying compliance with the law. And behavior is monitored, especially in stores that sell tobacco products.

Vaccination service model for preventing COVID-19 in elderly by the participation of network partners in Num Yuen District, Ubon Ratchathani Province

Chaiwat Darasit — 2024-08-06

The spreading of Corona Virus 2019 caused many countries in the world to create and develop the vaccine. For Thailand. The Ministry of public Health had launched the policy that Thai population must be vaccinated at least 70% in each district. In addition, Nam Yuen district population had gotten vaccinated for only 44.54% which is not covering enough of the whole population. Therefore, this research has objective to develop the guideline for Corona Virus 2019 vaccine service in the elderly with the cooperation of party networks in Namyuen district, Ubonratchathani Province. This is the Action Research on 73 samples from party networks and 320 elderly. The researcher used the form of Descriptive statistics to analyze the collected data and used Paired t-Test to evaluate them. The P-value level was set to < 0.05. The result found that after joining the program, the average point of severely acknowledgement, risk awareness, the expectation of vaccine effectiveness, and the perception of self–protection of the samples is in “good” level. Overall, the P-value is < 0.05 which is statistically significantly increased. Moreover, for the average points about knowledge, attitude, the expectation of vaccine effectiveness and the satisfaction is in “good” level. And the P-value is < 0.05 which is significantly increased. It can be seen that the party partners and the elderly had more knowledge and understood more about COVID 19 vaccines. Therefore, the related organizations should provide continuously service and should expand to other risk targets in the area.

Development of malaria surveillance and control system by community participation Cha Om and Tha Maprang Sub-districts, Kaeng Khoi District, Saraburi Province

Dissapol Chamchan — 2024-08-06

Malaria remains a significant public health issue in Thailand, and efforts have been made to develop a monitoring and control system with community involvement. The objectives of this research are as follows: 1) To assess the current situation and activities of the community-involved malaria monitoring and control system. 2) To study the operational guidelines of the community-involved malaria monitoring and control system.3) To examine the outcomes of developing the malaria monitoring and control system with community participation. 4) To explore the model of the malaria monitoring and control system with community involvement. This research is a collaborative, practical, and participatory study, utilizing the Deming cycle (PDCA) concept, and following qualitative research methodologies. Data was collected through important data provider groups and data contributor groups, employing three data collection methods: 1) In-depth interviews.2) Focus group discussions. 3) Observations. The study was conducted in the fiscal year 2023. The results of the research revealed that public health agencies, community networks, and the general public have knowledge, understanding, and a recognition of the importance of working together in a proactive approach to monitor and control malaria. They actively track outcomes and provide feedback to the community to improve their efforts. The key success factors include the collaboration of public health agencies and the community, addressing community needs, and establishing local leadership. It is recommended to further develop and enhance the monitoring system for the community-involved malaria monitoring and control system to ensure continuous and effective operations.

Developing a proactive service model of field hospital and disease screening center at the Royal Thai Army club During the COVID-19 crisis

Mila Issarasongkhram — 2024-08-06

This action research uses the PAOR cycle: P (Planning) A (Acting) O (Observing) R (Reflecting) 4 steps with objectives to developing a proactive service model of field hospital and disease screening center at the Royal Thai Army club during the COVID-19 crisis. Target groups are divided into 2 groups including 1) Group 1 is those whose duties are involved in setting up a field hospital and providing proactive services, totaling 18 people. 2) People undergoing COVID-19 screening at the field hospital and disease screening center at the club, Royal Thai Army, 2,381 people, study period Between 2 August 2021 - 4 March 2022, qualitative and quantitative data were collected. The tools used include recording forms, questionnaires and in-depth interviews. Content data were analyzed according to the 4-step PAOR cycle and descriptive statistics. The results of the study found that the proactive services of field hospitals and disease screening centers by implementing expedited measures to proactively search for infected people (active finding), outpatient treatment for COVID-19 patients with mild symptoms (Green group) “Meet, distribute, end” and providing home isolation services for COVID-19 patients combined into a complete service model (One Stop Service). This proactive service model has increased access to the health service system more quickly, reduce panic, relieve anxiety, help people feel safe in their daily lives and reduce the spread of disease in the community.

A study of the effect of senior Sikhio Program toward fall risk reduction among the elderly in Sikhio district, Nakhon Ratchasima province

Nutthalot Woetkhuntot — 2024-08-06

This research aimed to study the effect of senior Sikhio program toward fall risk reduction for elderly in Sikhio district, Nakhon Ratchasima province among 36 participants. The research is quasi-experimental study with one group pre- and post- follow-up test. Data were collected four times consisting of before and after the 1^st, the 3^rd, and the 6^th months of falling reduction participation. Research tools consisting of senior Sikhio program, individual data interview, Thai falls risk assessment test (Thai-FRAT), 4 stages balance test (4SBT), and Time up and go test (TUGT). Data analyzed by using descriptive statistics and either Paired t-test or Wilcoxon signed–rank test. The results revealed that the pair differentiated comparison of mean fall risk score of Thai-FRAT and 4SBT between before and after the program participation at the 3^rd and the 6^th month (p < 0.01), between the 1^st and the 3^rd month (p < 0.01), and the 1^st and the 6^th (p < 0.01), and between the 3^rd and the 6^th month (p < 0.05) were statistically significant difference. While the mean time of TUGT indicated that there was statistically significant difference between before and after the 1^st, the 3^rd, and the 6^th month (p < 0.01), between the 1^st and the 3^rd and the 6^th month (p < 0.01), and between the 3^rd and the 6^th month (p < 0.01). In conclusion, the applied of senior Sikhio program can reduce the fall risk among the elderly and can promote fall prevention behaviors and physical performance in balance.

Effectiveness of Modified matrix program among drug dependent patients at Banna Hospital Nakhon Nayok Province. : A cross-sectional descriptive study

Sasitorn Buophun — 2024-08-06

This research is a cross - sectional design to study the effectiveness of the treatment is complete and factors association of complete modified matrix program treatment among drug dependent patients at Banna Hospital Nakhon Nayok Province. The population studied is the entire drug patient database of Banna Hospital Nakhon Nayok Province. The sample group is drug dependent patients who received treatment and rehabilitation for drug addiction at Banna Hospital during 2019 to 2021, Total 956 cases. Data were analyzed using Multivariate logistic regression analysis was used to analyze the data.
The results of the study revealed that the factors associated with the efficacy of the modified matrix program among drug-dependent patients were: being aged over 35 years, Parental separation status, age of onset of substance use over 20 years and never history of drug treatment. The present study found that the completed treatment of the modified matrix program increased with age over 35 years, never history of drug treatment, and age of onset of substance use over 20 years. Meanwhile, the parental separation status factor increases the risk of failure rates of the modified matrix program. Therefore,drug-dependent patients living with parental separation status should be provided with appropriate management and treatment options.

Development of a health literacy building model to promote self-management behaviors and Health outcomes among adult patients with uncontrolled hypertension

Rattainee Thanaseth — 2024-08-06

This action research aimed to development of a health literacy building model to promote self – management behaviors and health outcomes among adult patients with uncontrolled hypertension. the study was conducted in 3 phases: 1. Study the situation 2. development of a health literacy 3. evaluate the effectiveness of the development of a health literacy. The study period is from September 2020 – March 2023. The population is adult patients with uncontrolled hypertension. the instruments consisted of 1) a health literacy promotion program 2) questionnaires for knowledge and self-management behaviors 3) health literacy series on non – communicable diseases division of non-communicable diseases, department of disease control 4) satisfaction questionnaire for participating in activities. 5) guidelines for reasonable adjustment of drugs of Pak Thong Chai hospital model. data were analyzed using descriptive statistics, paired t-test and independent samples t-test, and content analysis. After implementing the program. the results of the comparative study between the experimental group and the control group before the experiment, it was found that average scores on health literacy and self – management behavior There is a statistically significant difference (p < 0.05), but the mean systolic and diastolic blood pressures are not statistically significantly different (p < 0.05). after the experiment, it was found that average scores on health literacy and self-management behavior average blood pressure as the heart contracts and relaxes statistically significantly different (p < 0.001). and health results from continuous follow-up until 1 year by reporting the results of weight, waist circumference, and blood pressure measurement by yourself at home or at a health station in the community via Line group every week as information for doctors to adjust medications. the study also found that 70% of the patients had been reduced medicine and terminations of medical use in 26.67 %. increasing health knowledge skills in self-management with principles of 4ORs.2P is one strategy that can control disease well. the medication was reduced according to Pak Thong Chai's guidelines for adjusting medication. enter a state of remission and help reduce the government budget for treating patients with chronic non-communicable diseases. health teams can use this model for developing health literacy and apply the behavior modification model according to the principles of 4ORs.2P. to managing other chronic non – communicable diseases. including applying the guidelines for adjusting drug use of the Pak Thong Chai model and expanding them in other areas.

Factors related to the return of spontaneous circulation in sudden cardiac arrest at a Tertiary Care Hospital in Lower Northern Region

Pensuda Iamlaor — 2024-08-06

This research is a retrospective analytic study aimed at investigating related factors and the outcomes of cardiac arrest patients who received cardiopulmonary resuscitation (CPR) in a tertiary hospital in the lower northern region of Thailand. The study reviewed medical records of cardiac arrest patients between January 1,2018 and December 31,2020 and identified a total of 132 cases of successful resuscitation, with a return of spontaneous circulation (ROSC) rate of 37.9% within the first 24 hours after CPR and a survival rate of 25.8% to discharge. The most common electrocardiogram finding was asystole/pulseless electrical activity (71.2%). The average time to defibrillation was 5.27 ± 1.01 minutes. The total duration of CPR was 17.46 ± 1.44 minutes. The most common causes of cardiac arrest were acidosis (52.3%), hypoxia (40.2%), and coronary thrombosis (35.1%). Factors related to a decreased ROSC as determined by Multiple Logistic Regression included dyslipidemia with an adjusted odds ratio (AOR) of 0.27 (95%CI : 0.10 - 0.76, p = 0.013), hypovolemia with an AOR of 0.15 (95%CI : 0.03 - 0.77, p = 0.023),and hypoxia with an AOR of 0.27 (95%CI : 0.10 - 0.76, p = 0.014). Additionally, it was observed that the presence of ventricular fibrillation or pulseless ventricular tachycardia (VF/pVT) had a positive effect on increasing survival to discharge, with an AOR of 2.98 (95%CI: 1.11 - 7.97, p = 0.030), in comparison to asystole/PEA. The total duration of CPR had a negative effect on survival to discharge with an AOR of 0.95 (95%CI : 0.92 - 0.99, p = 0.009) for every one – minute increase. Moreover, factors related to both the patient and the treatment were identified to significantly affect the survival of patients with cardiac arrest. From this research, it is found that each additional minute in the total of duration of life – saving decreases the ROSC rate. Therefore, prompt and effective CPR is important and affects the chances of survival following in – hospital cardiac arrest.