Showing papers by "Tippawan Liabsuetrakul published in 2012"

Health system responsiveness for delivery care in Southern Thailand.

Abstract: Objective. To assess the perception of women who gave birth in a hospital on health system responsiveness and their satisfaction. Design. A cross-sectional study. Setting. Four district, one regional and one university hospitals in the Songkhla province, Southern Thailand. Participants. All women who delivered in the participating hospitals from November 2007 to December 2008. Methods. All women were interviewed at 24- or 48-h post partum by well-trained interviewers who worked independently outside the hospital. Main Outcome Measures. Eight components of health system responsiveness were measured. The factors associated with high rate of health responsiveness and its effect on the women’s satisfaction was estimated by multiple logistic regression. Results. A total of 2822 women were interviewed and their ages ranged from 12 to 48 years (mean+ SD: 27.6+ 6.3). The components of health system responsiveness, which influenced the women’s decision for delivering in a hospital were, in the order of importance, prompt attention, dignity, clear communication, autonomy, basic amenities, confidentiality, choice of provider and social support. The majority of women (.80%) gave high ratings for dignity, clear communication, prompt attention and autonomy. The type of hospital was a significant factor in all components of health responsiveness. Compared with women with universal coverage, women insured with the social security and civil servant medical benefit schemes gave higher ratings of dignity, confidentiality and choice of provider. Women’s satisfaction for delivery care was significantly associated with high rates of all health responsiveness components, except choice of health providers. Conclusions. Prompt attention, dignity, clear communication and autonomy influenced women’s decision to deliver in the hospital. High health system responsiveness is important for women’s satisfaction.

Postoperative depot medroxyprogesterone acetate versus continuous oral contraceptive pills in the treatment of endometriosis-associated pain: a randomized comparative trial.

Abstract: Background/Aim: To evaluate the efficacy and tolerability of postoperative depot medroxyprogesterone acetate (DMPA) versus postoperative continuous oral contracep

Equity of access to reproductive health services among youths in resource-limited suburban communities of Mandalay City, Myanmar

Abstract: Inequity of accessibility to and utilization of reproductive health (RH) services among youths is a global concern, especially in resource-limited areas. The level of inequity also varies by cultural and socio-economic contexts. To tailor RH services to the needs of youths, relevant solutions are required. This study aimed to assess baseline information on access to and utilization of RH services and unmet needs among youths living in resource-limited, suburban communities of Mandalay City, Myanmar. A community-based, cross-sectional study was conducted in all resource-limited, suburban communities of Mandalay City, Myanmar. A total of 444 randomly selected youths aged between 15 and 24 years were interviewed for three main outcomes, namely accessibility to and utilization of RH services and youth's unmet needs for these services. Factors associated with these outcomes were determined using multivariate logistic regression. Although geographical accessibility was high (79.3%), financial accessibility was low (19.1%) resulting in a low overall accessibility (34.5%) to RH services. Two-thirds of youths used some kind of RH services at least once in the past. Levels of unmet needs for sexual RH information, family planning, maternal care and HIV testing were 62.6%, 31.9%, 38.7% and 56.2%, respectively. Youths living in the south or south-western suburbs, having a deceased parent, never being married or never exposed to mass media were less likely to access RH services. Being a young adult, current student, working as a waste recycler, having ever experienced a sexual relationship, ever being married, ever exposed to mass media, having a high knowledge of RH services and providers or a high level of accessibility to RH services significantly increased the likelihood of utilization of those services. In addition to youths’ socio-demographic characteristics, exposure to mass media, norm of peer exposure and knowledge on types of providers and services significantly influenced the unmet needs of youths towards RH services. Despite the availability of RH services, youth’s accessibility to and utilization of those services were unsatisfactory. The levels of youths’ unmet RH needs were alarmingly high.

Predictors of Contraceptive Use Among Married Youths and Their Husbands in a Rural Area of Myanmar

Abstract: This study aimed to determine the predictors of contraceptive use among married female youths and their husbands using the behavioral theory of the Health Belief Model (HBM). A community-based surv...

Health care expenditure for hospital-based delivery care in Lao PDR.

Abstract: Background: Delivery by a skilled birth attendant (SBA) in a hospital is advocated to improve maternal health; however, hospital expenses for delivery care services are a concern for women and their families, particularly for women who pay out-of-pocket. Although health insurance is now implemented in Lao PDR, it is not universal throughout the country. The objectives of this study are to estimate the total health care expenses for vaginal delivery and caesarean section, to determine the association between health insurance and family income with health care expenditure and assess the effect of health insurance from the perspectives of the women and the skilled birth attendants (SBAs) in Lao PDR. Methods: A cross-sectional study was carried out in two provincial hospitals in Lao PDR, from June to October 2010. Face to face interviews of 581 women who gave birth in hospital and 27 SBAs was carried out. Both medical and non-medical expenses were considered. A linear regression model was used to assess influencing factors on health care expenditure and trends of medical and non-medical expenditure by monthly family income stratified by mode of delivery were assessed. Results: Of 581 women, 25% had health care insurance. Health care expenses for delivery care services were significantly higher for caesarean section (270 USD) than for vaginal delivery (59 USD). After adjusting for the effect of hospital, family income was significantly associated with all types of expenditure in caesarean section, while it was associated with non-medical and total expenditures in vaginal delivery. Both delivering women and health providers thought that health insurance increased the utilisation of delivery care. Conclusions: Substantially higher delivery care expenses were incurred for caesarean section compared to vaginal delivery. Three-fourths of the women who were not insured needed to be responsible for their own health care payment. Women who had higher family incomes were able to pay for more non-medical care expenses. The effect of health insurance on service utilization was noted by women and SBAs. To achieve the goal of utilizing delivery care in the hospitals, coverage of health insurance needs to be expanded.

Ability to pay and impoverishment among women who give birth at a University Hospital in Kathmandu, Nepal.

Abstract: Pregnant women giving birth in Nepal need to use out-of-pocket payment for delivery care services due to a lack of insurance policies. The objective of this study was to examine the ability of pregnant Nepalese women to pay for delivery care services and the effects of the current household health expenditure on impoverishment due to hospital-based delivery services, especially normal delivery (ND) and caesarean section (CS). A cross-sectional study was conducted from May to August 2009 at Tribhuvan University Teaching Hospital. Ability to pay was defined as the current health spending being less than 5% of annual household income. Poverty occurred when a household's per capita income fell to less than US$1 per day. Impoverishment was considered as poverty headcount and normalised poverty gap. On average, the percentage of annual household income spent on current delivery care was 5.9% in the ND group and 9.7% in the CS group. The CS group had a stronger impoverishment effect resulting in a high ...

Trends of Teenage Pregnancy and Pregnancy Outcomes

Abstract: Adolescent or teenage birth rate, one of indicators of Millennium Development Goal 5, is a concern worldwide. Its rate and trend vary across countries depending on study design of data collection either hospital- or population-based information, age-limited variation for adolescent either 10-19 or 15-19 years, study setting either developing or developed countries, or different year of reference. Adolescent birth rate is calculated as the number of teens giving birth per 1000 adolescent population. Teen mothers presented the adverse pregnancy outcomes as well as the other potential attributed factors.

Cost of standard indoor ultra-low-volume space spraying as a method to control adult dengue vectors.

Abstract: Objectives To access the costs of standard indoor ultra-low-volume (SID-ULV) space spraying for controlling dengue vectors in Thailand. Methods Resources related to SID-ULV space spraying as a method to control dengue vectors between July and December 2009 were identified, measured and valued taking a societal perspective into consideration. Information on costs was collected from direct observations, interviews and bookkeeping records. Uncertainty of unit costs was investigated using a bootstrap technique. Results Costs of SID-ULV were calculated from 18 new dengue cases that covered 1492 surrounding houses. The average coverage of the SID-ULV was 64.4%. In the first round of spraying, 53% of target houses were sprayed and 44.6% in the second round, of which 69.2% and 54.7% received entire indoor space spraying. Unit costs per case, per 10 houses and per 100 m2 were USD 705 (95% Confidence Interval CI, 539–888), 180 (95% CI, 150–212) and USD 23 (95% CI, 17–30). The majority of SID-ULV unit cost per case was attributed to productivity loss (83.9%) and recurrent costs (15.2%). The unit cost of the SID-ULV per case and per house in rural was 2.8 and 1.6 times lower than municipal area. The estimated annual cost of SID-ULV space spraying from 2005 to 2009 using healthcare perspective ranged from USD 5.3 to 10.3 million. Conclusions The majority of the cost of SID-ULV space spraying was attributed to productivity loss. Potential productivity loss influences the achievement of high coverage, so well-planned SID-ULV space spraying strategies are needed to reduce costs. Objectifs: Evaluer les couts de la pulverisation standard d’interieurs avec un volume ultra faible (SID-ULV) pour lutter contre les vecteurs de dengue en Thailande. Methodes: Les ressources liees a la pulverisation d’interieur avec SID-ULV comme methode pour lutter contre les vecteurs de la dengue entre juillet et decembre 2009 ont ete identifiees, mesurees et evaluees avec une perspective societale. Les informations sur les couts ont ete recueillies a partir d’observations directes, des interviews et des registres de comptabilite. L’incertitude des couts unitaires a eteetudiee en utilisant une technique d’amorcage ‘bootstrap’. Resultats: Les couts du SID-ULV ont ete calcules a partir de 18 nouveaux cas de dengue survenus au sein de 1.492 maisons environnantes. La couverture moyenne de SID-ULV etait de 64,4%. 53% des maisons cibles ont ete pulverisees lors du premier tour, dont 69,2% ont recu la pulverisation de tout l’espace interieur des habitations. 44,6% ont ete pulverisees lors du second tour, dont 54,7% ont recu la pulverisation de tout l’espace interieur des habitations. Les couts unitaires par cas s’est elevea 705 USD (Intervalle de confiance IC95%: 539–888); 180 USD (IC95%: 150–212) par 10 maisons et 23 USD (IC95%: 17–30) par 100 m2. La majorite des couts unitaires du SID-ULV par cas etait due a la perte de productivite (83,9%) et aux couts recurrents (15,2%). Le cout unitaire du SID-ULV par cas et par maison dans les zones rurales etait 2,8 et 1,6 fois plus faible que dans les zones municipales. Le cout annuel estime des pulverisations d’interieurs SID-ULV pour la periode 2005–2009, du point de vue des soins de sante, variait de 5,3 a 10.300.000 USD. Conclusions: La majorite du cout de la pulverisation d’espace avec SID-ULV etait attribuee a la perte de productivite. La perte potentielle de productivite influence l’atteinte d’une couverture elevee, une bonne planification des strategies de pulverisation d’interieurs avec SID-ULV est necessaire pour reduire les couts. Objetivos: Evaluar los costes del rociado intradomiciliario estandar con volumen ultra bajo (RID-VUB) para controlar vectores de dengue en Tailandia. Metodos: Entre Julio y Diciembre del 2009 se identificaron, midieron y valoraron, desde una perspectiva social, los recursos relacionados con el RID-VUB como metodo para controlar los vectores del dengue. Se recogio informacion sobre los costes de observacion directa, entrevistas y registros contables. La incerteza de los costes unitarios se evaluo utilizando el metodo de bootstrap. Resultados: Se calcularon los costes del RID-VUB de 18 nuevos casos de dengue que cubrian 1,492 casas perifericas. La cobertura promedio de RID-VUB era de 64.4%. Un 53% de las casas se rociaron durante la primera ronda, y de estas un 69.2% recibio un rociado intradomiciliario completo. El 44.6% restante fueron rociadas en la segunda ronda, y de estas un 54.7% recibio un rociado intradomiciliario completo. Los costes unitarios por caso fueron de USD 705 (95% IC 539–888); USD 180 (95% IC 150–212) por 10 casas; y USD 23 (95% IC 17–30) por 100 m2. La mayoria de costes unitarios de RID-VUB por caso eran debidos a la perdida de productividad (83.9%) y a costes recurrentes (15.2%). El coste unitario del RID-VUB por caso y por casa en areas rurales era 2.8 y 1.6 veces menor que en areas municipales. Desde una perspectiva sanitaria, los costes anuales estimados del RID-VUB entre el 2005–2009, estaban en un rango de USD 5.3 a 10.3 millones. Conclusiones: La mayoria de costes del RID-VUB eran atribuibles a la perdida de productividad. La posible perdida de productividad influye sobre la consecucion de una alta cobertura, por lo que se requieren estrategias de RIB-VUB bien planeadas para reducir costes.

Clinical audit of postpartum hemorrhage at district-level and referral-level hospitals in southern Thailand.

Abstract: Objective: Assess the management and clinical outcomes of women diagnosed immediate PPH in three referral hospitals and six district hospitals in southern Thailand. Material and Method: A cross-sectional study was done in participated hospital. Medical records of eligible cases were reviewed for management using evidence-based checklist. The adherence to each item of managements and the association between the management and related morbidities were analyzed. Results: Medical records of 360 cases were assessed. Low adherence of retaining Foley catheter (44%) and close hemodynamic monitoring (67%) was found at district level. Retaining Foley catheter was demonstrated at referral level in 76% but performing uterine massage was documented in 67%. The adherence of managements was more likely to be found in cases with severe blood loss or received blood transfusion. Conclusion: Although low incidence of PPH was reported, incidence of blood transfusion, hypovolemic shock, and hysterectomy were not uncommon. Suboptimal care for hemodynamic monitoring and incomplete documentation of treatment need to be improved. Keywords: Clinical audit, Postpartum hemorrhage, Quality of care, Management

Obstetric care and health system responsiveness for hospital-based delivery in Lao People's Democratic Republic.

Abstract: Objective: To assess obstetric care and health system responsiveness for hospital-based delivery care in Lao PDR, and associated factors. Material and Method: A cross-sectional study was conducted in two provincial hospitals in Lao PDR between June and October 2010. All delivered women were interviewed for their perception of health system responsiveness and their medical records were reviewed for the obstetric care they received. Results: Five hundred eighty one women participated in this study. The mean scores of obstetric care and health system responsiveness were 19.5 ± 2.5 and 31.6 ± 1.5, respectively. The mean score of overall performance was 51.0 ± 2.8. Of the two hospitals, designated as Hospital A and Hospital B, the health responsiveness was rated lower in women undergoing cesarean section and delivering in Hospital B. Male doctor or obstetrician or delivery in Hospital B was significantly associated with higher obstetric care and overall performance. Conclusion: Different health system responsiveness for the delivery care between the two hospitals was found. Strategies to improve obstetric care need to be discussed and studied. Keywords: Health system responsiveness, Hospital-based delivery care, Obstetric care, Essential skills, Skilled birth attendant

Risk Factors for Two Consecutive Preterm Births in Southern Thailand

Abstract: Objective: To identify the r isk factors for two consecutive preterm births in southern Thailand . Materials and Methods: A case-control study was conducted at Songklanagarind Hospital, the tertiary care hospital in the South of Thailand. Medical records of all women who had had a second live birth from 1997 to 2006 were reviewed. Term and preterm birth in both pregnancy were identified. The women having two preterm births were classified as the case group, and the women having preterm/term, term/preterm or term/term births were the control group. Socio-demographic characteristics, obstetric information and pregnancy complications were analyzed using univariate and multivariate analysis with a p-value of 0.05. Results: During the study period, 94 women with two preterm births were included in the cases, and 385 controls were randomly selected from all eligible records. Women aged <20 years had an increased risk of two preterm births compared to those aged 20-34 years. An interpregnancy interval of <12 months was also more frequent in double preterm birth cases in univariate analysis, but not in multivariate analysis. Premature rupture of membranes (adjusted OR 2.1, 95%CI 1.2-3.6), urinary tract infection (adjusted OR 8.7, 95%CI 2.3-33.5) and pregnancy-induced hypertension (adjusted OR 4.0, 95%CI 1.7-9.2) were independent factors in both univariate and multivariate analyses. Conclusions: Maternal age, premature rupture of membranes, urinary tract infection and pregnancy-induced hypertension were the significant factors in women having two consecutive preterm births . It is important for obstetricians to be aware of these risk factors in women who become pregnant after a previous preterm birth.