Thailand's National Death Registration Reform: Verifying the Causes of Death between July 1997 and December 1999

A fundamental aspect of public health is the accuracy of death certification. Assessing the death registration system is a step toward improving the quality of death reporting. Thailand implemented a more rigorous and informative pilot death registration system in March 2001 in 18 provinces, followed by nationwide implementation in August 2003. Since Thailand is an industrializing nation, its experiences will be of interest to other developing nations planning similar reforms. The causes of all deaths in the 15 provincial pilot projects (of Thailand's 76 provinces) and a random sampling in Bangkok were investigated between July 1997 and December 1999. Health workers interviewed close relatives and three medical doctors reviewed hospital records to verify the causes of death. We were able to interview 78% of the relatives ( i.e. 47,632 in number). Three-quarters (76%) of the deceased had sought prior medical care; 41% died in hospital and 54% at home. The overall agreement between the causes of death in our survey vs. that reported on the death certificate was 29%. The highest agreement was for: III-defined' causes (33%), 'Cancer and Tumors' (17%), 'External Causes' (16%), and 'Infectious Diseases' (10%). Considering the different patterns among age groups and sex, hypertension with stroke, cancer of the liver and bile duct, and HIV infection, were the highest ranking causes among females. Infectious diseases (especially HIV/AIDS), hypertension with stroke and accidents, were the leading causes of deaths among males. External causes were highest among children and young adults. Asia Pac J Public Health 2005; 17(2): 110-116.

Prevalence, awareness, treatment and control of hypertension and diabetes mellitus among the elderly: the 2004 National Health Examination Survey III, Thailand

INTRODUCTION

This study aims to determine the prevalence of hypertension, diabetes mellitus, and both conditions combined, and to examine factors related to awareness, treatment and control among the elderly in Thailand.

METHODS

Data from a multistaged National Health Examination Survey III of 19,374 individuals aged 60 years and older in Thailand was used. Information on the socioeconomic status was obtained by interview. Blood pressure was measured with a sphygmomanometer. Fasting plasma glucose was obtained. Logistic regression models were used to examine the determinants of awareness, treatment and control of blood pressure and plasma glucose.

RESULTS

Age-adjusted prevalence of hypertension was 51.1 percent, diabetes mellitus 14.0 percent, and diabetes mellitus with hypertension 8.0 percent. Overall, the proportion of unawareness for hypertension, diabetes mellitus and both conditions combined were 56.1, 41.2 and 21.9 percent, respectively. For those undergoing treatment for the control of blood pressure (less than 140/90 mmHg) was 12.4 percent, diabetes mellitus (fasting plasma glucose less than 140 mg/ dL) 26.4 percent, and control of both conditions combined was 7.4 percent. Factors associated with unawareness and inadequate controls of the illnesses were subjects from rural areas, with low income, low educational levels, currently working, and the oldest age group.

CONCLUSION

There was a high prevalence of hypertension and diabetes mellitus among the older people in Thailand, with high percentages of unawareness and inadequate control for those treated. Screening programmes for early detection, treatment and control of hypertension and diabetes mellitus need to be improved.

Agranulocytosis in Bangkok, Thailand: a predominantly drug-induced disease with an unusually low incidence. Aplastic Anemia Study Group

Agranulocytosis, a syndrome characterized by a marked reduction in circulating granulocytes, is strongly associated with medical drug use in Europe and the United States. Unregulated use of common pharmaceutical agents in developing countries has been suspected of causing large numbers of cases of agranulocytosis and deaths, especially among children. To elucidate the incidence and etiology of agranulocytosis in Thailand, a population-based case-control study of symptomatic agranulocytosis that resulted in hospital admission was conducted in Bangkok from 1990 to 1994. An attempt was also made to study the disease in Khonkaen (in northeastern Thailand) and Songkla (in southern Thailand), but there were insufficient cases in the latter regions, and the analysis was confined to subjects from Bangkok. In that region, the overall incidence of agranulocytosis was 0.8 per million per year; there were no deaths. As expected, the incidence was higher in females (0.9 per million), and it increased with age (4.3 per million beyond age 60). Among 25 cases and 529 controls the relative risk estimate for a combined category of all suspect drugs was 9.2 (95% confidence interval = 3.9-21), and the proportion of cases that could be attributed to drug use was 68%. For individual drugs and drug classes the data were sparse; within these limitations, the strongest association appeared to be with antithyroid drugs. One case and three controls were exposed to dipyrone, a drug known to cause agranulocytosis; with such scanty data the risk could not be evaluated. Exposure to pesticides or solvents was not associated with an increased risk. This is the first formal epidemiologic study of agranulocytosis in a developing country. As in the West, most cases are attributable to medical drug use. However, the incidence of agranulocytosis in Bangkok, and apparently, in Thailand as a whole, is unusually low, and the disease does not pose a public health risk.

Use of household pesticides and the risk of aplastic anaemia in Thailand. The Aplastic Anemia Study Group

BACKGROUND

Aplastic anaemia is a severe blood dyscrasia that is more common in Thailand than in Western countries. Its a etiology remains poorly understood.

METHODS

A case-control study was conducted in Bangkok and two rural regions of Thailand. The effect of household pesticides was evaluated among 253 incident cases of aplastic anaemia and 1174 hospital controls.

RESULTS

A total of 54% of the cases and 61% of the controls were exposed 1-6 months previously. For most individual household pesticides and for groups classified according to chemical type (organophosphates, pyrethrins, and organochlorines), the relative risk (RR) estimates approximated 1.0; upper 95% confidence limits were below 2.0 for many comparisons. A significant association was observed for exposure to combination products containing dichlorvos and propoxur, with an overall RR estimate of 1.7 (95% confidence interval [CI]: 1.1-2.6); the estimate for regular use was 1.6 (95% CI: 0.9-2.9).

CONCLUSIONS

The absence of a higher risk for the regular use of dichlorvos/propoxur reduces the credibility of the apparent association, which could well have been an artefact of multiple comparisons. We conclude that most household pesticides used in Thailand do not appear to increase the risk of aplastic anaemia.

Low drug attributability of aplastic anemia in Thailand. The Aplastic Anemia Study Group

From 1989 to 1994, a population-based, case-control study of aplastic anemia was conducted in Thailand, including the regions of Bangkok, Khonkaen in the northeast, and Songkla in the south. An annual incidence in Bangkok of 3.7 cases per million population, about twice as high as in Western countries, has been reported. To evaluate the etiologic role of drugs, 253 subjects were compared with 1,174 hospital controls. With multivariate adjustment for confounding, a significant association was identified for exposure 2 to 6 months before admission to thiazide diuretics (relative risk estimate 7.7; 1.5 to 40). There were crude associations with sulfonamides (relative risk estimate, 7.9; P = 0.004) and mebendazole (6.3; P = 0.03) (there were insufficient data for multivariate adjustment). Excess risks for the three drugs were in the range of 9 to 12 cases per million users. There was no significant association with chloramphenicol, although the multivariate relative-risk estimate was elevated (2.7; 0.7 to 10). Other drugs that have been reported to increase the risk of aplastic anemia, such as nonsteroidal anti-inflammatory drugs and anticonvulsants, were not commonly used. There were no associations with commonly used drugs, including benzodiazepines, antihistamines, oral contraceptives, and herbal preparations. For all associated drugs, the overall etiologic fraction (the proportion of cases attributable to an exposure) was 5%, compared with 25% in Europe and Israel. Drugs are uncommon causes of aplastic anemia in Thailand, and their use does not explain the relatively high incidence of the disease in that country.

Incidence of aplastic anemia in Bangkok. The Aplastic Anemia Study Group

The annual incidence of aplastic anemia in metropolitan Bangkok, Thailand, and its five suburban provinces was prospectively determined. All patients first diagnosed during the period from January through December 1989 who met specific clinical and pathologic criteria were included. Thirty-two cases were identified, yielding an overall incidence of 3.7 per million. The incidence rates for the age groups 0 through 24, 25 through 59, and over 60 years were 4.3, 3.2, and 2.1 per million, respectively; the highest rate, 7.2 per million, was found for individuals aged 15 to 24 years. The male-to-female ratio was 1.9. The incidence of aplastic anemia in Bangkok is higher than that reported in recent European studies. The peak rate in young persons is almost fourfold higher than in comparable recent western studies and suggests an environmental etiology peculiar to Thailand.

Impact study of Thailand's National Family Planning Programme on fertility decline in the first half of the Fifth National Socio-Economic Development Plan (1982-1986)

The evaluation of the National Family Planning Programme (NFPP) in the First Half of the Fifth National Socio-economic Development Plan (1982-1986) was conducted by the joint Thai-US team in mid 1984. It was found that the continuing fertility decline, from a crude birth rate of 26.9 per 1, 000 in 1981 to 21 per 1, 000 in 1984, was attributable to increased contraceptive prevalence, which was largely a result of the NFPP. This has affected the population growth rate, which has declined from 1.8% to an estimated 1.6% over the 1981 to 1984 period. This study forecasted that there would be a 30% increase in the number of currently-married women, aged 15-44 by the end of the Sixth Development Plan (1991). This increase will put a great burden on the NFPP. However, the possibility of attaining the growth rate of 1.2% by the end of 1991 is conditional upon the persistence of current trends in contraceptive prevalence with the full support of all family planning and FP-related agencies.