Cause-specific mortality statistics by age and sex are primary evidence for epidemiological research and health policy. Annual mortality statistics from vital registration systems in Thailand are of limited utility because about 40% of deaths are registered with unknown or nonspecific causes. This paper reports the rationale, methods, and broad results from a comprehensive study to verify registered causes in Thailand. A nationally representative sample of 11,984 deaths was selected using a multistage stratified cluster sampling approach, distributed across 28 districts located in nine provinces of Thailand. Registered causes were verified through medical record review for deaths in hospitals and standard verbal autopsy procedures for deaths outside hospitals, the results of which were used to measure validity and reliability of registration data. Study findings were used to develop descriptive estimates of cause-specific mortality by age and sex in Thailand. Causes of death were verified for a total of 9,644 deaths in the study sample, comprised of 3,316 deaths in hospitals and 6,328 deaths outside hospitals. Field studies yielded specific diagnoses in almost all deaths in the sample originally assigned an ill-defined cause of death at registration. Study findings suggest that the leading causes of death in Thailand among males are stroke (9.4%); transport accidents (8.1%); HIV/AIDS (7.9%); ischemic heart diseases (6.4%); and chronic obstructive lung diseases (5.7%). Among females, the leading causes are stroke (11.3%); diabetes (8%); ischemic heart disease (7.5%); HIV/AIDS (5.7%); and renal diseases (4%). Empirical investigation of registered causes of death in the study sample yielded adequate information to enable estimation of cause-specific mortality patterns in Thailand. These findings will inform burden of disease estimation and economic evaluation of health policy choices in the country. The development and implementation of research methods in this study will contribute to improvements in the quality of annual mortality statistics in Thailand. Similar research is recommended for other countries where the quality of mortality statistics is poor.
Tobacco use has been identified by the World Health Organization (WHO) as the most preventable cause of death and disability in the world. Globally, there are 1.1 billion people who smoke, over 80 per cent of whom live in low- and middle-income countries. Of all the people alive today, 500 million will die of tobacco-related causes. Although a staggering 100 million tobacco-related deaths occurred in the twentieth century, it is estimated that, by the end of the twenty-first century, 10 times that number, or 1 billion people, will have died because of tobacco use, and this burden will be borne most heavily by developing countries.
Background: Almost 400,000 deaths are registered each year in Thailand. Their value for public health policy and planning is greatly diminished by incomplete registration of deaths and by concerns about the quality of cause-ofdeath information. This arises from misclassification of specified causes of death, particularly in hospitals, as well as from extensive use of ill-defined and vague codes to attribute the underlying cause of death. Detailed investigations of a sample of deaths in and out of hospital were carried out to identify misclassification of causes and thus derive a best estimate of national mortality patterns by age, sex, and cause of death. Methods: A nationally representative sample of 11,984 deaths in 2005 was selected, and verbal autopsy interviews were conducted for almost 10,000 deaths. Verbal autopsy procedures were validated against 2,558 cases for which medical record review was possible. Misclassification matrices for leading causes of death, including ill-defined causes, were developed separately for deaths inside and outside of hospitals and proportionate mortality distributions constructed. Estimates of mortality undercount were derived from capture-recapture methods applied to the 200506 Survey of Population Change. Proportionate mortality distributions were applied to this mortality envelope and illdefined causes redistributed according to Global Burden of Disease methods to yield final estimates of mortality levels and patterns in 2005. Results: Estimated life expectancy in Thailand in 2005 was 68.5 years for males and 75.6 years for females, two years lower than vital registration data suggest. Upon correction, stroke is the leading cause of death in Thailand (10.7%), followed by ischemic heart disease (7.8%) and HIV/AIDS (7.4%). Other leading causes are road traffic accidents (males) and diabetes mellitus (females). In many cases, estimated mortality is at least twice what is estimated in vital registration. Leading causes of death have remained stable since 1999, with the exception of a large decline in HIV/ AIDS mortality. Conclusions: Field research into the accuracy of cause-of-death data can result in substantially different patterns of mortality than suggested by routine death registration. Misclassification errors are likely to have very significant implications for health policy debates. Routine incorporation of validated verbal autopsy methods could significantly improve cause-of-death data quality in Thailand.
Abstract Introduction: Constitution of the Kingdom of Thailand 1997 chapter 8 “State shall promote public healthand public service performance standards throughout.” The pharmaceutical service must comply with the standardsas well. The aims of this analytic study were (1) to determine the personnel, motivation and maintenancefactors that affect to pharmacist standard performance; (2) influences of main factors related to pharmacist standardperformance in community hospitals; (3) identify the problem and suggestion about determinants. Method: Allpharmacists in community hospitals of Public Health Inspection Region 6 were recruited in the total number of156 people. The questionnaires had been approved with reliability 0.93. Mail questionnaires were distributed andthe response rate was 80.77 %. Data were analyzed and reported as descriptive statistics such as frequency,percentage and standard deviation including analytic statisticswith multiple regression analysis. Results: The resultsrevealed that most of pharmacists were female; average age was 33.33 years old. Most of them were single andhighest educational levels were master degree. Average working experience was 9.22 years. Pharmacist standardperformances was in high level. Motivation factor was found in high level while maintenance factor was found inmoderate level. Factors that directly influenced pharmacist standard performance were composed of variables frommotivation and maintenance factor with statistical significant difference (p=0.001).Both motivation and maintenancefactor predicted pharmacist standard performance in 30.70%. This study demonstrated the difficulties in promotingof rational drug usage were the major problem that related to clinical practice of pharmacists in hospitals. Conclusion: Factors Affecting Pharmacist Standard Performance in Community Hospitals, Public Health InspectionRegion 6 are motivation factor and maintenance factor. The strategy proceeding of proper rational drug usage shouldbe considered by the policy maker and hospital administration committee. Moreover, professional developmentstrategies should be promoted to pharmacists according to performance and competency evaluation. Keywords: Motivation, Pharmacist standard performance, Community hospital, Pharmacist
This study examines the influence of household and community risk factors on labor force aged mortality. The investigation observed the effect of both social context as measured by household factors and community variables which are related to the exposure to disease factors and the resistance to disease variables on various causes of death. To explore and measure the size of the effect, the examination employed longitudinal data from Nang Rong Project between 1994 and 2000. The unit of analysis was population who were among the labor force age. The survival analysis under the method of piece-wise exponential hazard model with left truncated was used. Furthermore, the study also employed the Verbal Autopsy method to examine the accuracy of the cause of death. The major causes of death were mostly from non-communicable disease, external causes, and communicable disease respectively. Household sanitation and household density had some effects on mortality. When considering community risk factors, the community density and the number of health personnel in the areas had an effect on mortality. For instance, when population in community increases, the hazard of dying increases. In addition, when number of health personnel increases, the hazard of dying decreases.
Objective Study the influences of socio-demographic and social context risk factors on labor force aged mortality from communicable disease. Material and method A sample of 28,298 individuals were used to build a piece-wise exponential hazard model. Investigation of the cause of death used verbal autopsy. Result It was found that more males are likely to die than females (Exp. = 1.54, S.E. = 0.19). Mortality risk for those who work is lower than for the jobless while mortality risk for laborers is greater than for the jobless (Exp. = 2.80, S.E. = 0.54). Migrants are more likely to die than those who have not migrated (Exp. = 12.68, S.E. = 0.22). People who live in households with debt are more likely to die than those who live in debt-free households (Exp. = 1.21, S.E. = 0. 17). Environmental problems and drinking water quality have significant positive relationship with death due to communicable disease. Conclusion A health prevention plan for individual, household, and community level for this labor force aged population needs to be provided.
Ascertainment of cause for deaths that occur in the absence of medical attention is a significant problem in many countries, including Thailand, where more than 50% of such deaths are registered with ill-defined causes. Routine implementation of standardized, rigorous verbal autopsy methods is a potential solution. This paper reports findings from field research conducted to develop, test, and validate the use of verbal autopsy (VA) methods in Thailand.International verbal autopsy methods were first adapted to the Thai context and then implemented to ascertain causes of death for a nationally representative sample of 11,984 deaths that occurred in Thailand in 2005. Causes of death were derived from completed VA questionnaires by physicians trained in ICD-based cause-of-death certification. VA diagnoses were validated in the sample of hospital deaths for which reference diagnoses were available from medical record review. Validated study findings were used to adjust VA-based causes of death derived for deaths in the study sample that had occurred outside hospitals. Results were used to estimate cause-specific mortality patterns for deaths outside hospitals in Thailand in 2005.VA-based causes of death were derived for 6,328 out of 7,340 deaths in the study sample that had occurred outside hospitals, constituting the verification arm of the study. The use of VA resulted in large-scale reassignment of deaths from ill-defined categories to specific causes of death. The validation study identified that VA tends to overdiagnose important causes such as diabetes, liver cancer, and tuberculosis, while undercounting deaths from HIV/AIDS, liver diseases, genitourinary (essential renal), and digestive system disorders.The use of standard VA methods adapted to Thailand enabled a plausible assessment of cause-specific mortality patterns and a substantial reduction of ill-defined diagnoses. Validation studies enhance the utility of findings from the application of verbal autopsy. Regular implementation of VA in Thailand could accelerate development of the quality and utility of vital registration data for deaths outside hospitals.
Almost 400,000 deaths are registered each year in Thailand. Their value for public health policy and planning is greatly diminished by incomplete registration of deaths and by concerns about the quality of cause-of-death information. This arises from misclassification of specified causes of death, particularly in hospitals, as well as from extensive use of ill-defined and vague codes to attribute the underlying cause of death. Detailed investigations of a sample of deaths in and out of hospital were carried out to identify misclassification of causes and thus derive a best estimate of national mortality patterns by age, sex, and cause of death.A nationally representative sample of 11,984 deaths in 2005 was selected, and verbal autopsy interviews were conducted for almost 10,000 deaths. Verbal autopsy procedures were validated against 2,558 cases for which medical record review was possible. Misclassification matrices for leading causes of death, including ill-defined causes, were developed separately for deaths inside and outside of hospitals and proportionate mortality distributions constructed. Estimates of mortality undercount were derived from "capture-recapture" methods applied to the 2005-06 Survey of Population Change. Proportionate mortality distributions were applied to this mortality "envelope" and ill-defined causes redistributed according to Global Burden of Disease methods to yield final estimates of mortality levels and patterns in 2005.Estimated life expectancy in Thailand in 2005 was 68.5 years for males and 75.6 years for females, two years lower than vital registration data suggest. Upon correction, stroke is the leading cause of death in Thailand (10.7%), followed by ischemic heart disease (7.8%) and HIV/AIDS (7.4%). Other leading causes are road traffic accidents (males) and diabetes mellitus (females). In many cases, estimated mortality is at least twice what is estimated in vital registration. Leading causes of death have remained stable since 1999, with the exception of a large decline in HIV/AIDS mortality.Field research into the accuracy of cause-of-death data can result in substantially different patterns of mortality than suggested by routine death registration. Misclassification errors are likely to have very significant implications for health policy debates. Routine incorporation of validated verbal autopsy methods could significantly improve cause-of-death data quality in Thailand.
Background: Ascertainment of cause for deaths that occur in the absence of medical attention is a significant problem in many countries, including Thailand, where more than 50% of such deaths are registered with ill-defined causes. Routine implementation of standardized, rigorous verbal autopsy methods is a potential solution. This paper reports findings from field research conducted to develop, test, and validate the use of verbal autopsy (VA) methods in Thailand. Methods: International verbal autopsy methods were first adapted to the Thai context and then implemented to ascertain causes of death for a nationally representative sample of 11,984 deaths that occurred in Thailand in 2005. Causes of death were derived from completed VA questionnaires by physicians trained in ICD-based cause-of-death certification. VA diagnoses were validated in the sample of hospital deaths for which reference diagnoses were available from medical record review. Validated study findings were used to adjust VA-based causes of death derived for deaths in the study sample that had occurred outside hospitals. Results were used to estimate cause-specific mortality patterns for deaths outside hospitals in Thailand in 2005. Results: VA-based causes of death were derived for 6,328 out of 7,340 deaths in the study sample that had occurred outside hospitals, constituting the verification arm of the study. The use of VA resulted in large-scale reassignment of deaths from ill-defined categories to specific causes of death. The validation study identified that VA tends to overdiagnose important causes such as diabetes, liver cancer, and tuberculosis, while undercounting deaths from HIV/ AIDS, liver diseases, genitourinary (essential renal), and digestive system disorders. Conclusions: The use of standard VA methods adapted to Thailand enabled a plausible assessment of cause-specific mortality patterns and a substantial reduction of ill-defined diagnoses. Validation studies enhance the utility of findings from the application of verbal autopsy. Regular implementation of VA in Thailand could accelerate development of the quality and utility of vital registration data for deaths outside hospitals.
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