Pirom Kamolratanakul

The Influence of dissemination of information on the changes of knowledge, attitude and acceptance of hepatitis B vaccination among hospital personnel in Chulalongkorn Hospital

Lack of knowledge and negative attitudes were the main reasons for refusal, in a vaccination programme against hepatitis B using plasma-derived vaccine which was offered to the hospital personnel of Chulalongkorn University Hospital, Bangkok. Therefore, to ascertain whether an educational intervention among hospital personnel is effective in modifying acceptance of the vaccine, a quasi-experimental design (using a before and after approach) was used to compare the knowledge, attitudes and acceptance rate of hepatitis B vaccination among 1,915 hospital personnel. After dissemination of information, knowledge and attitudes improved significantly, and acceptance rates were increased from 56.9% to 77.7% (P < 0.0000). More specific educational efforts should be started before launching vaccination programmes of this kind in order to increase acceptance.

Economic impact of tuberculosis at the household level

OBJECTIVE Previous economic analyses of tuberculosis control interventions have focused on the provider perspective. To assess the overall economic impact of the disease and the adequacy of current control strategies from a societal viewpoint, the determination of direct and indirect patient costs is required. SETTING AND DESIGN In a cross-sectional survey, all adult tuberculosis patients who completed treatment between August 1996 and February 1997 at 16 randomly selected government health care facilities in Thailand (n = 673) were interviewed using a structured questionnaire. Information were obtained on direct and indirect patient costs before and after diagnosis, and on financing methods and changes in household consumption patterns. All results were stratified for three levels of patient household income: above national average, below national average but above the poverty line, and below the poverty line. RESULTS Illness-related costs particularly affected patients with incomes below the poverty line (n = 153). In this group, average out-of-pocket expenditures for the disease amounted to more than 15% of annual household income, while incomes were reduced by 5 % due to illness-related effects. Expenditures were most frequently financed from household savings or transfer payments from community members and relatives. However, 11.8% of patient households took out bank loans, and 15.9% sold part of their property. CONCLUSION The current low case detection and treatment completion rates for tuberculosis patients in Thailand may partly be due to the inability of poor patients to cope with the economic consequences of diagnosis and treatment. Suggested improvements include the strict enforcement of an existing government policy of free care, the further decentralization of services to reduce travel costs and work absences, and social security payments for patients undergoing treatment.

Cost‐effectiveness of using angiotensin‐converting enzyme inhibitors to slow nephropathy in normotensive patients with diabetes type II and microalbuminuria

SUMMARY: We assessed the cost‐effectiveness of prescribing angiotensin‐converting enzyme (ACE) inhibitors to delay progression of diabetic nephropathy in normotensive patients with type II diabetes and microalbuminuria. The Markov models determined by DATATreeAGE software were used to calculate the lifetime medical costs and life expectancy in patients treated with or without ACE inhibitors. The incremental cost‐effectiveness ratio (ICER), defined as the change in medical costs divided by the change in life expectancy, was the main outcome parameter. The ICER for ACE inhibitor therapy was US

The effectiveness of chemoprophylaxis against malaria for non-immune migrant workers in eastern Thailand

788.37 per life‐year saved. Sensitivity analysis showed that ACE inhibitor therapy had no cost‐effectiveness value when the cost of ACE inhibitors was increased for more than 90% or when the cost of haemodialysis was decreased for greater than 48%, or when the efficacy of the treatment was reduced until the cumulative incidence of macroalbuminuria was increased from 18 to 48%.

The effect of health surveillance and health education on primary school children

A randomized, double-blind field trial was carried out to compare the effectiveness of mefloquine plus sulfadoxine-pyrimethamine (MSP) with that of sulfadoxine-pyrimethamine (SP) in chemoprophylaxis against malaria. The study was conducted in 193 migrant workers in the eastern rural areas of Thailand which are known to be highly endemic for multidrug-resistant Plasmodium falciparum infection. MSP was found to be more effective than SP in the suppression of both P. falciparum and P. vivax parasitaemias, when administered weekly for 12 weeks (P = 0.0014). Complete suppression of P. falciparum was achieved by MSP while 8 subjects receiving SP developed parasitaemia. One subject in the MSP group developed P. vivax parasitaemia, compared with 4 in the SP group. However, in view of the reported complications associated with the use of long-acting sulphonamides, some of which can be life threatening, prophylactic regimens containing sulfadoxine, though proved efficacious, must be used with extreme caution.

Randomized controlled trial of directly observed treatment (DOT) for patients with pulmonary tuberculosis in Thailand

Abstract The study of the effect of health surveillance and health education on primary school children was done in grades 3-6 of three primary schools in Cholburi province, eastern region of Thailand. They were randomly assigned as control school, Experiment 1 (health surveillance) school, and Experiment 2 (health surveillance and health education) school. Test scores of health knowledge increased with the grades of the school children. The mean differences between preliminary (pre-test) and subsequent test (post-test) scores of health knowledge in the Experiment 2 school and the control school were significant (P