(TRIAMS) at Subdistrict Health Facilities in Tsunami-Affected Provinces in Thailand

Monitoring of Key Health Indicators (TRIAMS) at Subdistrict Health Facilities in Tsunami-affected Provinces in Thailand

Pratap Singhasivanon

420/6 Ratchawithi Rd., Bangkok 10400, Thailand Tel: 66 (0) 2644 7483; Fax: 66 (0) 2644 4436 Email: [email protected]

Irwin F. Chavez Tanapat Chupraphawan Wanchai Maneebunyang Sutthiporn Prommongkol Samrerng Prommongkol Phiraphon Chusongsang Surapon Yimsamran

Faculty of Tropical Medicine Mahidol University

Faculty of Tropical Medicine, Mahidol University ...REPORT INTRODUCTION

he South Asian tsunami of 2004 claimed thousands of lives and left thousands of families homeless. In the affected countries, the respective governments and local and Tinternational non-governmental organizations have initiated numerous programs for the reconstruction and rehabilitation of the affected areas. Recovery activities remain ongoing and several are still being planned.

Tsunami-affected Villages : Thailand

Figure 1. Location Map of Villages & Health Centers in the 6 Tsunami-affected Provinces in Southern Thailand.

REPORT... Monitoring of Key Health Indicators (TRIAMS) at Subdistrict Health Facilities in Tsunami-affected Provinces in Thailand Of major interest now is an evaluation of the recovery process in the affected areas. The Tsunami Recovery Impact Assessment and Monitoring Systems (TRIAMS) have been set up to initiate processes and strengthen regional and national mechanisms to facilitate planning for further recovery activities; hence, numerous core and country-specific impact assessment and monitoring indicators have been formulated under 4 major headings: 1) vital needs, 2) basic social services, 3) infrastructure, and 4) livelihoods. But, in order to succeed in monitoring such indicators, the existence of a detailed and reliable database is critical. This need prompted the conduct of this survey.

The contents of this report are based on a survey of health-related TRIAMS indicators carried out November 2006-January 2007 in the 6 tsunami-affected areas in southern Thailand (Fig 1).

SPECIFIC OBJECTIVES

1. To measure the impact of the tsunami on health, using key indicators derived from the TRIAMS.

2. To generate a baseline database of health-related indicators in the tsunami-affected villages.

MATERIALS AND METHODS

Study area and data collection

he areas selected for this survey were confined to the tsunami-affected provinces of Phangnga, Krabi, Phuket, Ranong, Trang, and Satun, wherein 408 of the total 1,946 Tvillages were affected1. The proportions of the affected districts and subdistricts are listed in Table 1, below. Plates 1 & 2 show the district and subdistrict boundaries of the tsunami- affected areas.

Table 1. Distribution of Tsunami-affected Areas by Administrative Level1

District Subdistrict Village Province Total Affected % Total Affected % Total Affected %

Krabi 8 5 62.5 61 22 36.1 379 4 30.1

Phangnga 8 5 62.5 49 6 32.7 317 66 20.8

Phuket 3 3 00.0 7 64.7 96 59 61.5

Ranong 5 3 60.0 30 9 30.0 74 47 27.0

Satun 1 0 4 40.0 95 6 6.8 713 70 9.8

Trang 7 4 57.1 36 3 36.1 267 52 9.5

Total 41 24 58.5 288 87 30.2 ,946 408 21.0

Faculty of Tropical Medicine, Mahidol University ...REPORT District Boundaries of Tsunami-affected Areas in Thailand

ID DISTRICT Muang Krabi 2 Ko Lanta 3 Khlong Thom 4 Ao Luk 5 Nua Khlong 6 Ko Yao 7 Takua Thung 8 Takua Pa 9 Khura Buri 0 Thai Muang Muang Phuket 2 Kathu 3 Thalang 4 Muang Ranong 5 Kapoe 6 Suk Samran 7 Muang Satun 8 Tha Phae 9 Langu 20 Thung Wa 21 Kantrang 22 Palian 23 Sikao 24 Hat Samran

REPORT... Monitoring of Key Health Indicators (TRIAMS) at Subdistrict Health Facilities in Tsunami-affected Provinces in Thailand Subdistrict Boundaries of Tsunami-affected Areas in Thailand

ID SUBDISTRICT ID SUBDISTRICT Sai Daeng 45 Khlong Prasong 2 Pak Nam 46 Nua Khlong 3 Ngao 47 Khlong Khamot 4 Ko Phayam 48 Talingchan 5 Ratchakrut 49 Khlong Khanan 6 Kapoe 50 Ko Sriboya 7 Muang Kluang 51 Khlong Thom Tai 8 Bang Hin 52 Huai Nam Khao 9 Na Kha 53 Khlong Yang 0 Kamphuan 54 Ko Klang Khura 55 Ko Lanta Noi 2 Ko Phra Thong 56 Saladan 3 Bang Wan 57 Ko Lanta Yai 4 Ko Kho Khao 58 Khlong Phon 5 Bang Muang 59 Sai Khao 6 Khukkhak 60 Khao Mai Kaeo 7 Lam Kaen 61 Bo Hin 8 Thung Maphrao 62 Mai Fat 9 Thai Muang 63 Bang Sak 20 Na Toei 64 Ko Libong 21 Khok Kloi 65 Na Klua 22 Lo Yung 66 Kan Tang Tai 23 Khlong Khian 67 Ban Na 24 Ko Yao Noi 68 Hat Samran 25 Ko Yao Yai 69 Tase 26 Phru Nai 70 Suso 27 Mai Khao 71 Ko Sukon 28 Sa Khu 72 Tha Kham 29 Choeng Tale 73 Na Thon 30 Kammala 74 Thung Bu Lang 31 Karon 75 Khon Khlan 32 Rawai 76 Laem Son 33 Chalong 77 Kamphaeng 34 Wichit 78 Pak Nam 35 Ratsada 79 La Ngu 36 Ko Kaeo 80 Ko Sarai 37 Pa Khlok 81 Sakhon 38 Laem Sak 82 Tha Phae 39 Ao Luk Noi 83 Chebilang 40 Khao Khram 84 Ban Khuan 41 Khao Thong 85 Tanyongpo 42 Nong Tale 86 Khlong Khut 43 Ao Nang 87 Puyu 44 Sai Thai - -

Faculty of Tropical Medicine, Mahidol University ...REPORT Data on specific key health indicators were collected from local health facilities/offices. As annexed in the TRIAMS workshop report2, data for country indicators vary in terms of their geographic scale (i.e. subdistrict or district levels). To address this, subdistrict data were collected from health centers, while district data were taken from each district’s respective health office and community hospital. Table 2 shows the list of identified indicators and their respective sources.

Table 2. Sources of Data for Key Health-related Indicators

Area of Indicator Health Community District Recovery Center Hospital Health Office

Demographic indices Crude mortality rate + + Under 5 mortality rate + + Vital needs % population with access to water from + + an improved source % population without basic sanitation + + facilities Measles immunization coverage + + % of low birthweight (LBW) newborns + + % of children <5 who are underweight + + % children <5 who are wasting + + (moderate & severe) Access to basic No. of hospital beds per 10,000 + social services population (in-patient and maternity) No. of outpatient + consultations/person/year % children 12-23 months who are fully + + immunized against all antigens No. of health facilities with Emergency + Obstetric Care per 10,000 population Adequate antenatal coverage + + (at least 4 visits during a pregnancy) % subdistrict covered by outreach + psychological support by community workers % of births attended by a skilled + + birth attendant Infrastructure % destroyed/damaged health facilities + rebuilt or rehabilitated

Data collection instruments

tandardized checklists and record forms translated into the Thai language were used to extract the relevant information on the listed health indicators from health centers, Sdistrict health offices, and community hospitals (Annexes I-VI).

REPORT... Monitoring of Key Health Indicators (TRIAMS) at Subdistrict Health Facilities in Tsunami-affected Provinces in Thailand Data management and analysis

he data collected were organized and processed using Microsoft® Access and Microsoft® Excel. Maps were created with ArcView® 3.3 using the ESRI shapefile Tspecification *.shp( ). Spatial analysis was performed using GeoDa™ 0.95i. The results are presented through thematic maps and summary statistics.

Spatial analyses of the various indicators were conducted, including identification of local clusters using Moran’s I for spatial autocorrelation at the subdistrict level. The analysis considers the attribute values of each subdistrict and compares it with the same attribute values of other adjacent areas considered as “neighbors”. A “neighbor” in this case is an affected subdistrict that shares a common border with one or more other affected subdistricts. This manner of identifying neighbors is called the rook contiguity. Evaluation of how each subdistrict is related to each other in terms of location and contiguity gives rise to numeric spatial weights essential for calculating the relevant statistics.

The presence of global or overall clustering is given by Moran’s I with p-values calculated based on conditional permutation as implemented in GeoDa. The level of significance was set at 0.05 with 999 permutations. Moreover, significant local clustering was assessed using local Moran statistics calculated through randomization (using 999 permutations). Subdistricts were then classified into 5 cluster categories: not statistically significant, HIGH-HIGH, LOW-LOW, HIGH-LOW, and LOW-HIGH.

In the analysis, a subdistrict with a high attribute value contiguous to one or more neighboring areas with similarly high values were classified as HIGH-HIGH clusters. Conversely, areas with low values in proximity to neighboring areas with similarly low values were classified as LOW-LOW clusters. HIGH-LOW clusters are areas with high values surrounded by areas with low values, while LOW-HIGH clusters are areas with low values surrounded by areas with high values. HIGH-LOW and LOW-HIGH clusters are also known as spatial outliers, since the neighboring values do not agree with the local values. HIGH-HIGH and LOW-LOW locations indicate positive local spatial autocorrelation (spatial clusters) while HIGH-LOW and LOW-HIGH locations indicate negative local spatial autocorrelation (spatial outliers)4. While spatial clusters may highlight areas where recovery activities need to be strengthened, spatial outliers may also provide insights where the levels of the specific indicators are not distributed homogeneously.

Faculty of Tropical Medicine, Mahidol University ...REPORT DEMOGRAPHIC INDICES

ndicators, such as crude and under 5 death rates, give an overall picture of the current standards of health in the surveyed areas. Crude death rates in the tsunami-affected Idistricts ranged from 1.8 per 1,000 population in Nua Khlong, Krabi to 17 per 1,000 in Muang Ranong, Ranong. On average, the crude death rate in the affected district was 4.63 ± 2.95 per 1,000 (Table 3). The mortality rates for children under 5 years of age were highest in Hat Samran, Trang, at 5 per 1,000, followed by Muang Ranong, Ranong with 4.6 per 1,000, and 11 other districts with rates <5 per 1,000. The remaining districts recorded zero < 5 death rates (Fig 2). Plates 3-10 illustrate the subdistrict-level demographic indices in detail.

Table 3. Summary Statistics for District-Level Demographic Indices Thailand, 2006

Demographic indices No. of districts Mean SD Min Max

Crude death rate 23 4.63 2.95 .80 7.00

Under 5 death rate 20 0.89 .47 0 5.00

Figure 2. Demographic Indices in Tsunami-affected Districts in Thailand, 2006

REPORT... Monitoring of Key Health Indicators (TRIAMS) at Subdistrict Health Facilities in Tsunami-affected Provinces in Thailand Crude Death Rate in Tsunami-affected Subdistricts in Thailand, 2006

Faculty of Tropical Medicine, Mahidol University ...REPORT Under 5 Death Rate in Tsunami-affected Subdistricts in Thailand, 2006

10 REPORT... Monitoring of Key Health Indicators (TRIAMS) at Subdistrict Health Facilities in Tsunami-affected Provinces in Thailand DEMOGRAPHIC INDICES Ranong Province, 2006

Crude Death Under 5 Death ID Subdistrict Population Rate (/1,000) Rate (/1,000) Sai Daeng 4459 5.34 0.00 2 Pak Nam 7455 6.82 0.00 3 Ngao 6941 1.46 0.00 4 Ko Phayam 521 5.17 0.00 5 Ratchakrut 7663 4.38 0.00 6 Kapoe 6832 2.40 0.15 7 Muang Kluang 2997 2.10 0.00 8 Bang Hin 3888 2.39 - 9 Na Kha 4985 0.41 - 0 Kamphuan 4861 2.69 4.20 MEAN 3.32 0.54 SD 2.01 1.48 MIN-MAX 0.41-6.82 0-4.20

Faculty of Tropical Medicine, Mahidol University ...REPORT 11 DEMOGRAPHIC INDICES Phangnga Province, 2006

Crude Death Under 5 Death ID Subdistrict Population Rate (/1,000) Rate (/1,000) Khura 10745 1.61 - 2 Ko Phra Thong 898 4.69 33.00 3 Bang Wan 6193 0.15 0.00 4 Ko Kho Khao 833 2.35 - 5 Bang Muang 9980 11.35 - 6 Khukkhak 4127 3.86 0.00 7 Lam Kaen 5390 4.37 1.63 8 Thung Maphrao 8483 2.99 - 9 Thai Muang 11661 3.10 1.15 20 Na Toei 8365 2.53 - 21 Khok Kloi 10985 6.52 - 22 Lo Yung 5522 2.87 0.00 23 Khlong Khian 4009 2.98 - 24 Ko Yao Noi 4493 2.40 0.83 25 Ko Yao Yai 2408 2.40 0.00 26 Phru Nai 5528 2.70 0.37 MEAN 3.55 4.11 SD 2.5 0.85 MIN-MAX 0.15-11.35 0-33

12 REPORT... Monitoring of Key Health Indicators (TRIAMS) at Subdistrict Health Facilities in Tsunami-affected Provinces in Thailand DEMOGRAPHIC INDICES Phuket Province, 2006

Crude Death Under 5 Death ID Subdistrict Population Rate (/1,000) Rate (/1,000) 27 Mai Khao 10181 2.87 0.00 28 Sa Khu 3642 2.87 0.00 29 Choeng Tale 10921 4.57 8.50 30 Kammala 3750 4.00 0.00 31 Karon 5112 5.91 0.32 32 Rawai 9902 4.49 0.64 33 Chalong 9585 5.15 0.88 34 Wichit 27401 4.49 0.88 35 Ratsada 20198 4.43 0.64 36 Ko Kaeo 7387 6.40 0.76 37 Pa Khlok 9007 3.34 0.00 MEAN 4.41 1.15 SD 1.13 2.47 MIN-MAX 2.87-6.40 0-8.50

Faculty of Tropical Medicine, Mahidol University ...REPORT 13 DEMOGRAPHIC INDICES Krabi Province, 2006

Crude Death Under 5 Death ID Subdistrict Population Rate (/1,000) Rate (/1,000) 38 Laem Sak 5313 3.38 0.00 39 Ao Luk Noi 5143 2.08 0.55 40 Khao Khram 8480 2.95 0.86 41 Khao Thong 5092 4.15 0.00 42 Nong Tale 7616 3.63 0.00 43 Ao Nang 5911 2.10 1.90 44 Sai Thai 10482 1.51 0.00 45 Khlong Prasong 4150 3.00 0.50 46 Nua Khlong 10778 - - 47 Khlong Khamot 4597 2.44 0.98 48 Talingchan 5191 3.07 0.33 49 Khlong Khanan 7342 3.07 - 50 Ko Sriboya 4221 1.66 0.00 51 Khlong Thom Tai 9731 3.98 1.34 52 Huai Nam Khao 7371 3.03 0.00 53 Khlong Yang 4777 - - 54 Ko Klang 6376 - - 55 Ko Lanta Noi 4204 - - 56 Saladan 3237 - - 57 Ko Lanta Yai 5220 - - 58 Khlong Phon 15814 5.00 - 59 Sai Khao 8721 1.80 0.00 MEAN 2.93 0.46 SD 0.97 0.61 MIN-MAX 1.51-4.15 0-1.90

14 REPORT... Monitoring of Key Health Indicators (TRIAMS) at Subdistrict Health Facilities in Tsunami-affected Provinces in Thailand DEMOGRAPHIC INDICES Trang Province, 2006

Crude Death Under 5 Death ID Subdistrict Population Rate (/1,000) Rate (/1,000) 60 Khao Mai Kaeo 5439 3.47 0.00 61 Bo Hin 7211 3.46 0.00 62 Mai Fat 6484 1.77 0.00 63 Bang Sak 4548 0.00 0.00 64 Ko Libong 5794 3.87 6.45 65 Na Klua 4097 6.10 0.00 66 Kan Tang Tai 6784 4.70 3.94 67 Ban Na 8996 6.41 0.00 68 Hat Samran 7769 1.99 0.00 69 Tase 3964 5.00 5.00 70 Suso 6021 4.72 0.00 71 Ko Sukon 2435 1.99 0.00 72 Tha Kham 8980 6.32 0.00 MEAN 3.83 1.18 SD 1.98 2.31 MIN-MAX 0-6.41 0-6.45

Faculty of Tropical Medicine, Mahidol University ...REPORT 15 DEMOGRAPHIC INDICES Satun Province, 2006

Crude Death Under 5 Death ID Subdistrict Population Rate (/1,000) Rate (/1,000) 73 Na Thon 5489 1.55 0.00 74 Thung Bu Lang 2164 3.04 0.00 75 Khon Khlan 2009 4.22 0.00 76 Laem Son 3288 30.52 0.20 77 Kamphaeng 15897 - - 78 Pak Nam 8719 7.20 0.00 79 La Ngu 17983 4.03 0.03 80 Ko Sarai 4807 - - 81 Sakhon 6294 6.00 - 82 Tha Phae 8197 1.36 - 83 Chebilang 7940 - - 84 Ban Khuan 8951 - - 85 Tanyongpo 2767 - - 86 Khlong Khut 14565 - - 87 Puyu 2782 - - MEAN 7.24 0.04 SD 9.62 0.08 MIN-MAX .36-30.52 0-0.20

16 REPORT... Monitoring of Key Health Indicators (TRIAMS) at Subdistrict Health Facilities in Tsunami-affected Provinces in Thailand VITAL NEEDS

hese indicators focus on specific and basic needs, such as food, water, and sanitation, which require immediate responses2, along with several nutritional indicators. The Tfollowing table and figures show the baseline data for these vital needs indicators.

Table 4. Summary Statistics for District-level Vital Needs Indicators Thailand, 2006

Vital needs No. of districts Mean SD Min Max

% Population with access to water from 24 97.80 6.04 74.4 00.00 an improved source % Population without basic sanitation 21 1.17 2.88 0 2.20 facilities Measles immunization coverage 24 98.80 2.41 90.00 00.00 % Low birthweight (LBW) newborns 24 5.29 2.59 .20 0.70 % of children <5 who are underweight 24 5.96 7.66 0.10 38.10 % of children <5 who are wasting 17 5.23 6.17 0 25.20

Figure 3a. Vital Needs Indicators in Tsunami-affected Districts of Thailand, 2006

Faculty of Tropical Medicine, Mahidol University ...REPORT 17 Percent population with access to water from an improved source was lowest in Ko Lanta District, Krabi with 74.4%, followed by Kathu District, Phuket, with 83.6%. In the rest of the affected districts, 90-100% of the population had access to water. Incidentally, the highest percentage of the population without basic sanitation facilities was in Ko Lanta, Krabi (12.2%). Khlong Thom and Nua Khlong districts in Krabi Province both had 1%, while Hat Samran and Kantrang districts in Trang had 1.2 and 4.2%, respectively. In Khura Buri, Phangnga, 5% of the population had no basic sanitation facilities, while the remaining affected districts had such facilities (Fig 3a).

Figure 3b. Vital Needs Indicators in Tsunami-affected Districts of Thailand, 2006

Ko Lanta, Krabi had the lowest measles immunization coverage (90%), followed by Thai Muang, Phangnga, at 95%. The remaining affected districts had > 95% coverage, as shown in Figure 3b. Figure 3b also shows the proportion of low birthweight (LBW) outcomes in each district. Percent LBW was highest in Ko Lanta, Krabi (10.7%), closely followed by Hat Samran, Trang (9.5%), and 8.3% in both Palian, Trang and Ko Yao, Phangnga. On the other hand, the lowest percentage of LBW outcomes was in Nua Khlong, Krabi.

18 REPORT... Monitoring of Key Health Indicators (TRIAMS) at Subdistrict Health Facilities in Tsunami-affected Provinces in Thailand Figure 3c. Vital Needs Indicators in Tsunami-affected Districts of Thailand, 2006

The proportion of underweight children aged < 5 years was highest in Ko Lanta, Krabi (38.1%), followed by Hat Samran, Trang (13.6%) and Kapoe, Ranong (11.3%). The remaining affected districts had <10% underweight children, as shown in Fig 3c. From the same population of children under 5, the reported percentage of wasting was highest in Ko Lanta, Krabi (25.2%), Kapoe, Ranong (11.3%), Hat Samran, Krabi (10.7%), and the remaining districts with < 10%. Suk Samran District in Ranong had no reported occurrence of wasting (Fig 3c).

Plates 11-22 illustrate detailed subdistrict-level data for the various vital-needs indicators.

Faculty of Tropical Medicine, Mahidol University ...REPORT 19 % Population with Access to Water from an Improved Source in Tsunami-affected Subdistricts in Thailand, 2006

20 REPORT... Monitoring of Key Health Indicators (TRIAMS) at Subdistrict Health Facilities in Tsunami-affected Provinces in Thailand % Population Without Basic Sanitation in Tsunami-affected Subdistricts in Thailand, 2006

Faculty of Tropical Medicine, Mahidol University ...REPORT 21 Measles Immunization Coverage in Tsunami-affected Subdistricts in Thailand, 2006

22 REPORT... Monitoring of Key Health Indicators (TRIAMS) at Subdistrict Health Facilities in Tsunami-affected Provinces in Thailand % Low Birthweight Newborns in Tsunami-affected Subdistricts in Thailand, 2006

Faculty of Tropical Medicine, Mahidol University ...REPORT 23 % Children Under 5 Who Are Underweight in Tsunami-affected Subditricts in Thailand, 2006

24 REPORT... Monitoring of Key Health Indicators (TRIAMS) at Subdistrict Health Facilities in Tsunami-affected Provinces in Thailand % Children Under 5 Who Are Wasting in Tsunami-affected Subdistricts in Thailand, 2006

Faculty of Tropical Medicine, Mahidol University ...REPORT 25 VITAL NEEDS Ranong Province, 2006

% With % Without % Measles % Under ID Subdistrict Population Access To Basic Immunization % LBW Weight % Wasting Water Sanitation Coverage Sai Daeng 4459 00.00 0.00 00.00 0.00 5.90 0.00 2 Pak Nam 7455 00.00 0.00 00 .00 0.00 1.23 0.00 3 Ngao 694 00.00 0.00 00.00 0.00 13.33 0.00 4 Ko Phayam 52 00.00 0.00 00.00 0.00 5.88 0.00 5 Ratchakrut 7663 00.00 0.00 98.82 0.00 3.20 0.00 6 Kapoe 6832 96.84 0.00 90.00 5.08 1.81 2.00 7 Muang Kluang 2997 95.00 0.00 00.00 0.00 4.90 0.00 8 Bang Hin 3888 00.00 0.00 00.00 4.60 5.40 0.00 9 Na Kha 4985 00.00 0.00 00.00 3.12 10.42 0.00 0 Kamphuan 486 00.00 0.00 00.00 2.50 5.80 4.00 MEAN 99.18 0.00 98.88 2.53 5.79 .60 SD 1.77 0.00 3.14 4.07 3.69 3.24 MIN-MAX 95-100 0.00 90-100 0-12.5 .23-13.33 0-10

26 REPORT... Monitoring of Key Health Indicators (TRIAMS) at Subdistrict Health Facilities in Tsunami-affected Provinces in Thailand VITAL NEEDS Phangnga Province, 2006

% With % Without % Measles % Under ID Subdistrict Population Access To Basic Immunization % LBW Weight % Wasting Water Sanitation Coverage Khura 10745 95.00 5.00 00.00 7.18 6.85 7.00 2 Ko Phra Thong 898 16.43 0.00 83.33 6.66 3.33 - 3 Bang Wan 6193 100.00 0.00 00.00 8.06 2.08 4.00 4 Ko Kho Khao 833 100.00 0.00 00.00 0.00 0.00 0.00 5 Bang Muang 9980 95.00 0.00 00.00 5.37 5.42 - 6 Khukkhak 4127 90.14 0.00 00.00 5.06 2.26 0.00 7 Lam Kaen 5390 100.00 0.00 95.00 2.22 5.22 9.00 8 Thung Maphrao 8483 100.00 0.00 96.00 3.60 4.80 7.00 9 Thai Muang 661 100.00 0.00 00.00 8.71 4.60 0.00 20 Na Toei 8365 100.00 0.00 97.00 0.95 4.46 6.00 21 Khok Kloi 0985 100.00 0.00 00.00 4.44 3.24 - 22 Lo Yung 5522 100.00 0.00 00.00 - 6.63 - 23 Khlong Khian 4009 100.00 0.00 00.00 6.52 4.76 5.00 24 Ko Yao Noi 4493 100.00 0.00 00.00 2.38 0.12 0.00 25 Ko Yao Yai 2408 100.00 0.00 00.00 .54 0.34 - 26 Phru Nai 5528 100.00 0.00 00.00 0.45 .23 - MEAN 93.54 0.31 98.21 7.54 4.08 3.8 SD 20.76 .25 4.29 4.34 3.33 3.52 MIN-MAX 6.43-100.00 0-5 83.33-100.00 0-16.66 0-13.33 0-9

Faculty of Tropical Medicine, Mahidol University ...REPORT 27 VITAL NEEDS Phuket Province, 2006

% With % Without % Measles % Under ID Subdistrict Population Access To Basic Immunization % LBW Weight % Wasting Water Sanitation Coverage 27 Mai Khao 0181 100.00 0.00 00.00 5.00 .60 .00 28 Sa Khu 3642 100.00 0.00 00.00 6.30 3.90 2.00 29 Choeng Tale 0921 100.00 0.00 00.00 4.20 0.53 0.00 30 Kammala 3750 67.20 0.00 98.00 6.20 0.63 .00 31 Karon 5112 100.00 0.00 00.00 6.25 2.01 2.00 32 Rawai 9902 100.00 0.00 00.00 3.57 .67 2.00 33 Chalong 9585 100.00 0.00 00.00 6.15 .35 .00 34 Wichit 27401 100.00 0.00 00.00 3.12 0.77 .00 35 Ratsada 20198 100.00 0.00 00.00 4.75 0.86 .00 36 Ko Kaeo 7387 100.00 0.00 00.00 5.00 .54 2.00 37 Pa Khlok 9007 100.00 0.00 00.00 9.20 0.02 0.00 MEAN 97.02 0.00 99.82 6.34 2.26 2.09 SD 9.89 0.00 0.60 3.24 3.03 3.05 MIN-MAX 67.20-100.00 0.00 98-100 3.12-14.75 0.02-10.86 0-11

28 REPORT... Monitoring of Key Health Indicators (TRIAMS) at Subdistrict Health Facilities in Tsunami-affected Provinces in Thailand VITAL NEEDS Krabi Province, 2006

% With % Without % Measles % Under ID Subdistrict Population Access To Basic Immunization % LBW Weight % Wasting Water Sanitation Coverage 38 Laem Sak 5313 98.00 0.20 00.00 0.00 6.13 7.00 39 Ao Luk Noi 5143 00.00 0.00 00.00 98.00 4.34 4.00 40 Khao Khram 8480 00.00 0.00 00.00 5.00 0.30 0.00 41 Khao Thong 5092 00.00 0.00 98.36 6.32 4.46 2.00 42 Nong Tale 7616 00.00 0.00 00.00 0.13 2.70 0.00 43 Ao Nang 59 00.00 0.00 00.00 0.00 0.00 0.00 44 Sai Thai 0482 00.00 0.00 00.00 4.26 0.90 0.00 45 Khlong Prasong 4150 00.00 0.00 97.18 4.76 0.30 0.00 46 Nua Khlong 0778 00.00 0.00 99.48 8.19 0.93 0.00 47 Khlong Khamot 4597 92.00 0.00 98.00 5.90 6.10 4.00 48 Talingchan 519 00.00 0.00 00.00 3.85 2.46 5.00 49 Khlong Khanan 7342 00.00 0.00 00.00 .59 2.76 0.00 50 Ko Sriboya 422 00.00 0.00 00.00 0.00 0.93 0.00 51 Khlong Thom Tai 9731 96.20 .59 00.00 5.47 2.36 2.00 52 Huai Nam Khao 7371 72.10 0.00 00.00 0.00 2.30 0.00 53 Khlong Yang 4777 73.46 69.07 73.44 5.87 .98 3.00 54 Ko Klang 6376 74.18 7.39 84.19 5.12 .19 2.00 55 Ko Lanta Noi 4204 74.26 29.16 88.34 8.75 6.55 5.00 56 Saladan 3237 74.54 21.19 69.36 . .51 5.00 57 Ko Lanta Yai 5220 71.33 9.08 77.11 6.25 .51 9.00 58 Khlong Phon 5814 00.00 0.00 00.00 0.00 .22 2.00 59 Sai Khao 8721 95.00 0.00 00.00 6.00 .60 1.00 MEAN 91.87 6.71 94.79 9.39 2.39 2.32 SD 11.82 6.18 9.69 20.4 .95 2.63 Min-Max 71.33-100 0-69.07 69.36-100 0-98 0-6.55 0-9

Faculty of Tropical Medicine, Mahidol University ...REPORT 29 VITAL NEEDS Trang Province, 2006

% With % Without % Measles % Under ID Subdistrict Population Access To Basic Immunization % LBW Weight % Wasting Water Sanitation Coverage 60 Khao Mai Kaeo 5439 00.00 0.00 00.00 .00 8.00 5.00 61 Bo Hin 72 00.00 0.00 00.00 5.88 5.29 2.00 62 Mai Fat 6484 97.79 0.00 00.00 8.16 2.99 0.00 63 Bang Sak 4548 00.00 0.00 00.00 2.69 .94 - 64 Ko Libong 5794 97.80 9.13 92.10 4.54 4.51 5.00 65 Na Klua 4097 00.00 0.00 00.00 4.61 0.48 - 66 Kan Tang Tai 6784 95.95 9.02 00.00 3.45 .57 - 67 Ban Na 8996 00.00 0.00 00.00 0.00 0.00 6.00 68 Hat Samran 7769 00.00 0.00 00.00 0.00 8.80 9.00 69 Tase 3964 00.00 .15 00.00 9.52 4.81 2.00 70 Suso 602 00.00 0.00 00.00 0.00 2.07 2.00 71 Ko Sukon 2435 00.00 0.00 00.00 0.00 5.00 0.00 72 Tha Kham 8980 00.00 0.00 00.00 0.00 22.50 5.00 MEAN 99.35 .48 99.39 3.83 6.76 4.60 SD 1.31 3.38 2.19 4.25 7.24 3.20 Min-Max 95.95-100 0-9.13 92.1-100 0-12.69 0-22.5 0-10

30 REPORT... Monitoring of Key Health Indicators (TRIAMS) at Subdistrict Health Facilities in Tsunami-affected Provinces in Thailand VITAL NEEDS Satun Province, 2006

% With % Without % Measles % Under ID Subdistrict Population Access To Basic Immunization % LBW Weight % Wasting Water Sanitation Coverage 73 Na Thon 5489 00.00 0.00 00.00 2.22 7.67 8.00 74 Thung Bu Lang 2164 00.00 0.00 00.00 3.70 1.08 .00 75 Khon Khlan 2009 00.00 0.00 00.00 2.94 7.50 .00 76 Laem Son 3288 00.00 0.00 95.00 9.75 4.53 8.00 77 Kamphaeng 5897 00.00 0.00 00.00 0.00 1.50 .00 78 Pak Nam 8719 00.00 0.00 00.00 0.00 4.23 6.00 79 La Ngu 17983 00.00 0.00 00.00 4.44 5.83 9.00 80 Ko Sarai 4807 00.00 0.00 00.00 8.82 6.10 .00 81 Sakhon 6294 00.00 0.00 00.00 2.50 1.60 .00 82 Tha Phae 8197 00.00 0.00 00.00 3.30 1.08 0.00 83 Chebilang 7940 00.00 0.00 00.00 0.94 2.69 0.00 84 Ban Khuan 895 00.00 0.00 00.00 7.09 5.57 3.00 85 Tanyongpo 2767 00.00 0.00 00.00 - 3.12 .00 86 Khlong Khut 4565 00.00 0.00 00.00 5.74 1.76 4.00 87 Puyu 2782 00.00 0.00 00.00 4.35 6.77 2.00 MEAN 100.00 0.00 99.67 4.69 4.74 3.73 SD 100.00 0.00 .29 3.39 3.62 5.01 Min-Max 100.00 0.00 95-100 0-10.94 .08-14.53 0-19

Faculty of Tropical Medicine, Mahidol University ...REPORT 31 Table 5. Spatial Autocorrelation of Subdistrict-level Vital Needs Indicators in Thailand, 2006

Vital needs Moran’s I* p-value

% Population with access to water from an improved source 0.283 0.015

% Population without basic sanitation facilities 0.305 0.009

Measles immunization coverage 0.696 0.001

% of children <5 who are underweight 0.040 0.276

* using rook contiguity

Figure 4a. Cluster Maps of Vital Needs Indicators in Tsunami-affected Subdistricts of Thailand, 2006

Table 5 shows the Moran’s I and the corresponding p-value for each indicator. Positive Moran’s I values indicate that attributes of areas and their neighbors tend to be similar. On the other hand, negative Moran’s I values suggest that the attributes of the areas under study differ from the attributes of neighboring areas. From the same table, it can be seen that at the subdistrict level, there is significant global clustering (p < 0.05) of 3 vital needs indicators (% population with access to water from an improved source, % population without basic sanitation facilities, and measles immunization coverage).

32 REPORT... Monitoring of Key Health Indicators (TRIAMS) at Subdistrict Health Facilities in Tsunami-affected Provinces in Thailand Looking at the local clusters for % population with access to water (Fig 4a), Khlong Yang and Saladan subdistricts in Krabi show significant LOW-LOW clustering with the adjacent subdistricts. Raw data can be seen on Plate 18. Choeng Tale Subdistrict in Phuket showed significant HIGH- LOW clustering, since its indicator measured 100% while its neighbor Kammala had only 67.2%. It also follows that Kammala is a LOW-HIGH cluster. Other significant LOW-HIGH clusters are present in Khura, Ko Phra Thong, Bang Wan, Ko Kho Khao & Ko Yao Noi (Phangnga), Pa Khlok (Phuket), Ko Sriboya, Khlong Prasong & Laem Sak (Krabi), Kan Tang Tai & Ko Sukon (Trang), and Ko Sarai Subdistrict (Satun), as shown in Fig 4a.

Significant HIGH-HIGH clusters for percent population without basic sanitation facilities occurred in 4 subdistricts of Krabi: Ko Klang (7.39%), Ko Lanta Noi (29.16%), Saladan (21.19%), and Ko Lanta Yai (19.08%). It is noteworthy that the highest value for this indicator is in Khlong Yang Subdistrict, Krabi, with 69.07% (Plate 18). The HIGH-LOW clusters are in Ko Libong, Trang and Khura subdistrict, Phangnga. Conversely, the number of LOW-HIGH clusters is more dominant, with 11 subdistricts in all (Fig 4a).

Figure 4b. Cluster Maps of Vital Needs Indicators in Tsunami-affected Subdistricts of Thailand, 2006

Faculty of Tropical Medicine, Mahidol University ...REPORT 33 Measles immunization coverage show significant LOW-LOW clustering in Ko Klang (84.19%), Ko Lanta Noi (88.34%), Saladan (69.36%), and Ko Lanta Yai (77.11%) subdistricts in Krabi. The remaining significant clusters were LOW-HIGH clusters in 14 subdistricts: Ko Phra Thong, Bang Wan, Ko Kho Khao, Na Toei & Ko Yao Noi (Phangnga), Kammala & Pa Khlok (Phuket), Laem Sak & Ko Sriboya (Krabi), Ko Libong, Kan Tang Tai & Ko Sukon (Trang), and Laem Son & Ko Sarai (Satun).

For the percentage of underweight children aged < 5 years, despite the lack of global clustering (Table 5), a HIGH-HIGH cluster was detected in Bo Hin, Trang along with 10 other LOW-HIGH clusters.

ACCESS TO BASIC SOCIAL SERVICES

n the aftermath of the tsunami, the delivery of health and other basic services have been affected. The following section summarizes baseline indicators related to access to basic Isocial services, at district and subdistrict levels.

Table 6. Summary Statistics for District-level Access to Basic Social Services in Thailand, 2006

Access to basic social services No. of districts Mean SD Min Max

No. of hospital beds per 10,000 population 23 8.14 8.58 0 67.33 (in-patient and maternity)

No. of outpatient consultations/person/year 23 3.43 2.23 .05 9.04

% Children 12-23 months fully immunized 24 98.64 2.01 92.50 00.00 against all antigens

Adequate antenatal coverage (at least 24 92.29 0.05 58.90 00.00 4 visits during a pregnancy)

No. of health facilities with Emergency Obstetric 23 0.23 0.20 0 0.80 Care per 10,000 population

% Births attended by skilled birth attendant 24 99.91 0.29 98.70 00.00

% of Subdistrict covered by outreach psychological 24 58.56 40.45 0 00.00 support by community workers

34 REPORT... Monitoring of Key Health Indicators (TRIAMS) at Subdistrict Health Facilities in Tsunami-affected Provinces in Thailand Figure 5a. Access to Basic Social Services in Tsunami-affected Districts of Thailand, 2006

The district-level distribution of categorized hospital beds per 10,000 population is shown in Figure 5a. The highest ratio was observed in Muang District, Phuket, with 67.33 per 10,000. It also had the greatest number of hospital beds (503). Khura Buri and Takua Thung districts in Phangnga followed, with a bed ratio of almost 50 per 10,000. Five other districts fell into the 20-50 beds per 10,000 category; Ko Yao & Thai Muang (Phangnga), Muang Ranong (Ranong), and Langu & Tha Phae (Satun). The remaining districts had <20 beds per 10,000, with the lowest in Ko Lanta, Krabi (3.57 beds per 10,000).

Faculty of Tropical Medicine, Mahidol University ...REPORT 35 Figure 5b. Access to Basic Social Services in Tsunami-affected Districts of Thailand, 2006

The number of outpatient consultations per person/year averaged 3.43 ± 2.23; the lowest was in Takua Pa, Phangnga (1.05) and the highest Takua Thung, Phangnga (9.04), followed by Nua Khlong, Krabi (8.51) and Kathu, Phuket (8.05). The percentage of children aged 12-23 months fully immunized against all antigens reflected the high coverage in all districts, averaging 98.64%. Two districts had < 95% coverage (Fig 5b) -- 92.5% in Kantrang, Trang and Ko Lanta, Krabi (94.9%). Exactly half of the affected districts had recorded full coverage: Ao Luk, Khlong Thom, and Nua Khlong in Krabi; Ko Yao, Phangnga; Tha Lang and Muang Phuket in Phuket; Kapoe, Ranong; Muang Satun, Langu, and Tha Phae in Satun; and Hat Samran & Sikao in Trang.

36 REPORT... Monitoring of Key Health Indicators (TRIAMS) at Subdistrict Health Facilities in Tsunami-affected Provinces in Thailand Figure 5c. Access to Basic Social Services in Tsunami-affected Districts of Thailand, 2006

Availability of emergency obstetric care in the affected districts is illustrated in Figure 5c. The districts of Khura Buri (Phangnga), Ko Lanta (Krabi), Langu (Satun), and Suk Samran (Ranong) reported no emergency obstetric care services. For all affected districts, the percentage of women who received adequate antenatal care was 92.29% ±10.05. Four districts, i.e. Khura Buri (Phangnga), Ko Lanta (Krabi), Muang Satun (Satun), and Suk Samran (Ranong) had < 90% antenatal coverage (Fig 5b), while Ao Luk, Krabi and Muang Phuket, Phuket reported 100%.

Faculty of Tropical Medicine, Mahidol University ...REPORT 37 Figure 5d. Access to Basic Social Services in Tsunami-affected Districts of Thailand, 2006

Five districts in Phangnga, 2 in Ranong, and 1 each in Phuket and Satun, reported 100% subdistrict coverage with outreach psychological support provided by community workers (Fig 5d). However, 4 districts--Ko Lanta (Krabi), Langu (Satun), Muang Ranong (Ranong), and Kathu (Phuket)--reported the lack of this basic social service in all subdistricts. Meanwhile, almost all districts reported 100% births delivered by skilled birth attendants, except for Palian, Trang (98.7%), followed by Tha Phae (99.3%), and Muang Satun, Satun (99.9%).

Plates 23-31 show detailed data for the indicators of basic social services at the subdistrict level.

38 REPORT... Monitoring of Key Health Indicators (TRIAMS) at Subdistrict Health Facilities in Tsunami-affected Provinces in Thailand % Children 12-23 Months Who Are Fully Immunized in Tsunami-affected Subdistricts in Thailand, 2006

Faculty of Tropical Medicine, Mahidol University ...REPORT 39 Adequate Antenatal Care Coverage in Tsunami-affected Subdistricts in Thailand, 2006

40 REPORT... Monitoring of Key Health Indicators (TRIAMS) at Subdistrict Health Facilities in Tsunami-affected Provinces in Thailand Births by Skilled Birth Attendants in Tsunami-affected Subdistricts in Thailand, 2006

Faculty of Tropical Medicine, Mahidol University ...REPORT 41 ACCESS TO BASIC SOCIAL SERVICES Ranong Province, 2006

% 12-23 Months Who % With Adequate % Births By Skilled ID Subdistrict Population Are Immunized Antenatal Care Birth Attendants Sai Daeng 4459 00.00 00.00 00.00 2 Pak Nam 7455 92.3 00.00 00.00 3 Ngao 6941 75.00 00.00 00.00 4 Ko Phayam 52 00.00 00.00 00.00 5 Ratchakrut 7663 87.74 96.88 00.00 6 Kapoe 6832 90.00 96.95 00.00 7 Muang Kluang 2997 00.00 86.00 00.00 8 Bang Hin 3888 00.00 00.00 00.00 9 Na Kha 4985 00.00 68.75 00.00 0 Kamphuan 486 00.00 87.50 00.00 MEAN 94.51 93.6 00.00 SD 8.38 10.22 00.00 Min-Max 75-100 68.75-100 00.00

42 REPORT... Monitoring of Key Health Indicators (TRIAMS) at Subdistrict Health Facilities in Tsunami-affected Provinces in Thailand ACCESS TO BASIC SOCIAL SERVICES Phangnga Province, 2006

% 12-23 Months Who % With Adequate % Births By Skilled ID Subdistrict Population Are Immunized Antenatal Care Birth Attendants Khura 10745 00.00 00.00 00.00 2 Ko Phra Thong 898 80.00 00.00 00.00 3 Bang Wan 6193 00.00 95.16 00.00 4 Ko Kho Khao 833 00.00 90.00 00.00 5 Bang Muang 9980 00.00 96.77 00.00 6 Khukkhak 4127 00.00 91.14 00.00 7 Lam Kaen 5390 97.00 92.22 00.00 8 Thung Maphrao 8483 94.00 95.45 00.00 9 Thai Muang 11661 99.20 94.00 00.00 20 Na Toei 8365 96.00 83.0 00.00 21 Khok Kloi 10985 98.00 95.35 00.00 22 Lo Yung 5522 00.00 00.00 00.00 23 Khlong Khian 4009 00.00 00.00 00.00 24 Ko Yao Noi 4493 00.00 97.50 00.00 25 Ko Yao Yai 2408 00.00 00.00 00.00 26 Phru Nai 5528 00.00 95.24 00.00 MEAN 97.76 95.37 00.00 SD 5.07 4.66 00.00 Min-Max 80-100 83.01-100 00.00

Faculty of Tropical Medicine, Mahidol University ...REPORT 43 ACCESS TO BASIC SOCIAL SERVICES Phuket Province, 2006

% 12-23 Months Who % With Adequate % Births By Skilled ID Subdistrict Population Are Immunized Antenatal Care Birth Attendants 27 Mai Khao 1018 00.00 98.00 00.00 28 Sa Khu 3642 00.00 00.00 00.00 29 Choeng Tale 1092 00.00 95.00 00.00 30 Kammala 3750 98.00 90.00 00.00 31 Karon 5112 00.00 00.00 00.00 32 Rawai 9902 00.00 00.00 00.00 33 Chalong 9585 00.00 00.00 00.00 34 Wichit 2740 00.00 00.00 00.00 35 Ratsada 20198 00.00 00.00 00.00 36 Ko Kaeo 7387 00.00 00.00 00.00 37 Pa Khlok 9007 00.00 97.00 00.00 MEAN 99.82 98.18 00.00 SD 0.60 3.19 00.00 Min-Max 98-100 90-100 00.00

44 REPORT... Monitoring of Key Health Indicators (TRIAMS) at Subdistrict Health Facilities in Tsunami-affected Provinces in Thailand ACCESS TO BASIC SOCIAL SERVICES Krabi Province, 2006

% 12-23 Months Who % With Adequate % Births By Skilled ID Subdistrict Population Are Immunized Antenatal Care Birth Attendants 38 Laem Sak 5313 00.00 00.00 00.00 39 Ao Luk Noi 5143 00.00 98.00 00.00 40 Khao Khram 8480 00.00 00.00 00.00 41 Khao Thong 5092 96.45 90.53 00.00 42 Nong Tale 7616 00.00 00.00 00.00 43 Ao Nang 59 00.00 00.00 00.00 44 Sai Thai 10482 00.00 00.00 00.00 45 Khlong Prasong 4150 97.30 90.48 00.00 46 Nua Khlong 10778 99.47 91.89 00.00 47 Khlong Khamot 4597 98.00 00.00 00.00 48 Talingchan 519 00.00 00.00 00.00 49 Khlong Khanan 7342 00.00 00.00 00.00 50 Ko Sriboya 422 00.00 00.00 00.00 51 Khlong Thom Tai 973 00.00 95.89 00.00 52 Huai Nam Khao 737 00.00 00.00 00.00 53 Khlong Yang 4777 87.34 61.53 82.14 54 Ko Klang 6376 79.67 64.28 00.00 55 Ko Lanta Noi 4204 92.04 91.66 97.02 56 Saladan 3237 68.36 89.7 00.00 57 Ko Lanta Yai 5220 84.34 92.59 00.00 58 Khlong Phon 15814 00.00 00.00 00.00 59 Sai Khao 872 00.00 99.00 99.00 MEAN 95.59 93.89 99.01 SD 8.39 10.76 3.82 Min-Max 68.36-100 61.53-100 82.14-100

Faculty of Tropical Medicine, Mahidol University ...REPORT 45 ACCESS TO BASIC SOCIAL SERVICES Trang Province, 2006

% 12-23 Months Who % With Adequate % Births By Skilled ID Subdistrict Population Are Immunized Antenatal Care Birth Attendants 60 Khao Mai Kaeo 5439 00.00 98.00 00.00 61 Bo Hin 7211 94.73 94.73 00.00 62 Mai Fat 6484 00.00 00.00 00.00 63 Bang Sak 4548 00.00 90.32 98.38 64 Ko Libong 5794 00.00 90.90 00.00 65 Na Klua 4097 00.00 00.00 00.00 66 Kan Tang Tai 6784 97.88 00.00 00.00 67 Ban Na 8996 00.00 00.00 00.00 68 Hat Samran 7769 00.00 00.00 00.00 69 Tase 3964 00.00 98.00 00.00 70 Suso 602 00.00 00.00 00.00 71 Ko Sukon 2435 00.00 95.00 00.00 72 Tha Kham 8980 00.00 00.00 00.00 MEAN 99.43 97.46 99.88 SD 1.53 3.57 0.45 Min-Max 94.73-100 90.32-100 98.38-100

46 REPORT... Monitoring of Key Health Indicators (TRIAMS) at Subdistrict Health Facilities in Tsunami-affected Provinces in Thailand ACCESS TO BASIC SOCIAL SERVICES Satun Province, 2006

% 12-23 Months Who % With Adequate % Births By Skilled ID Subdistrict Population Are Immunized Antenatal Care Birth Attendants 73 Na Thon 5489 00.00 84.44 00.00 74 Thung Bu Lang 2164 00.00 00.00 00.00 75 Khon Khlan 2009 00.00 91.18 00.00 76 Laem Son 3288 00.00 00.00 00.00 77 Kamphaeng 15897 00.00 00.00 00.00 78 Pak Nam 8719 00.00 00.00 00.00 79 La Ngu 17983 00.00 00.00 00.00 80 Ko Sarai 4807 00.00 82.35 97.06 81 Sakhon 6294 00.00 00.00 00.00 82 Tha Phae 8197 00.00 92.13 00.00 83 Chebilang 7940 00.00 94.53 00.00 84 Ban Khuan 895 00.00 92.9 00.00 85 Tanyongpo 2767 00.00 97.96 00.00 86 Khlong Khut 14565 00.00 51.67 00.00 87 Puyu 2782 00.00 86.96 00.00 MEAN 100.00 91.61 99.80 SD 100.00 12.61 0.76 Min-Max 100.00 51.67-100 97.06-100

Faculty of Tropical Medicine, Mahidol University ...REPORT 47 Table 7. Spatial Autocorrelation of Subdistrict-level Access to Basic Social Services Indicators in Thailand, 2006

Access to basic social services Moran’s I* p-value

% of children 12-23 months who are fully immunized against all antigens 0.489 0.001

Adequate antenatal coverage (at least 4 visits during a pregnancy) 0.380 0.005

% Birth attended by skilled birth attendant -0.026 0.280

* using rook contiguity

The global Moran’s I for % of children aged 12-23 months fully immunized against all antigens and adequate antenatal coverage showed a highly significant positive spatial autocorrelation (Table 7), which indicated clustering of the said attributes in the surveyed areas. To verify this, Figures 6a and 6b illustrate the local clusters for these indicators. Figure 6a shows four LOW-LOW clusters detected in Ratchakrut (Ranong), Ko Lanta Noi, and Saladan & Ko Lanta Yai (Krabi). One HIGH-LOW cluster was also detected in Muang Kluang, Ranong. LOW-HIGH clusters again show predominance, with 12 subdistricts.

Figure 6a. Cluster Maps of Access to Basic Social Services in Tsunami-affected Subdistricts of Thailand, 2006

48 REPORT... Monitoring of Key Health Indicators (TRIAMS) at Subdistrict Health Facilities in Tsunami-affected Provinces in Thailand Figure 6b. Cluster Maps of Access to Basic Social Services in Tsunami-affected Subdistricts of Thailand, 2006

Spatial analysis of adequate antenatal coverage detected LOW-LOW clusters in Ko Klang (Krabi), and Ban Khuan & Puyu subdistricts, in Satun. The remaining local clusters were LOW-HIGH (11 subdistricts).

Although the percentage of births attended by skilled birth attendants were 100% in almost all subdistricts, only two HIGH-HIGH clusters were detected: Khura, Phangnga and Tha Kham, Trang. HIGH-LOW clusters were detected in Huai Nam Khao, Ko Klang and Saladan subdistricts, in Krabi. Adjacent to these areas were two significant HIGH-LOW clusters, in Khlong Yang and Ko Lanta Noi, also in Krabi. Other HIGH-LOW clusters were in Ko Phra Thong, Bang Wan, Ko Kho Khao & Ko Yao Noi (Phangnga), Pa Khlok (Phuket), Laem Sak, Ko Sriboya & Sai Khao (Krabi), Bang Sak, Kan Tang Tai & Ko Sukon (Trang), and Ko Sarai (Satun) (Fig 6b).

Faculty of Tropical Medicine, Mahidol University ...REPORT 49 INFRASTRUCTURE

ealth facilities and services are vital for ensuring the well-being of the population within the catchment area. Several of these health facilities were affected by the Htsunami. The following section summarizes the extent of the damage and the current status of these facilities.

Table 8. Summary Statistics for District-level Health-related Infrastructure Indicators in Thailand, 2006

Rehabilitation and reconstruction No. of districts Mean SD Min Max

% Damaged/destroyed health facilities 24 6.9 2.08 0 50.00

% Health facilities rebuilt or rehabilitated 9 77.78 44.09 0 00.00

Figure 7. Rehabilitation and Reconstruction in Tsunami-affected Districts of Thailand, 2006

A total of 9 districts reported having at least one health center damaged or destroyed by the tsunami (Figure 7)--Muang Ranong (6.67%), Kapoe (14.29%) & Suk Samran (25%) in Ranong, Takua Pa (11.11%) and Khura Buri (16.67%) in Phangnga, Muang Phuket (22.22%) & Kathu (50%) in Phuket, Palian (5.56%) in Trang, and Thung Wa (14.29%) in Satun. Among these districts, all damaged or destroyed health centers have been repaired or rehabilitated, except those in Muang Ranong, Ranong and Kathu, Phuket (Fig 7).

50 REPORT... Monitoring of Key Health Indicators (TRIAMS) at Subdistrict Health Facilities in Tsunami-affected Provinces in Thailand PROBLEMS ENCOUNTERED & LIMITATIONS

Data collection

he biggest challenge encountered by our team of surveyors was the unavailability of some data at the time of the survey. To solve this, appropriate checklists were given to Tlocal health personnel for completion; the forms were then sent by priority mail to the Faculty of Tropical Medicine, Mahidol University. Some failed to forward the required information, which resulted in incomplete data for a few indicators.

Spatial analysis

Indicators with missing values were withdrawn from analysis, since the existing methods and computer packages did not enable adjustment for missing observations. Thus, only those with complete data could be analyzed. Furthermore, the results of the spatial analyses were purely exploratory and require more data for further in-depth and sophisticated analyses.

CONCLUSIONS AND RECOMMENDATIONS

ince the data presented in this report show baseline statistics for various health indicators, constant surveillance of such variables is vital for monitoring the progress of the recovery Sactivities. While all efforts have been made to collect data for all areas of interest, some information was either inaccessible or unavailable, which resulted in incomplete information in some areas of investigation. The presence of capable local personnel who can manage and analyze such data efficiently and promptly, with a surveillance system to monitor all indicators of interest (both health and non-health), will assure a constant flow of high-quality data.

ACKNOWLEDGEMENT

e would like to express our deepest gratitude to the following organizations that generously supported and contributed to the success of the project “Monitoring of WKey Health Indicators (TRIAMS) at Subdistrict Health Facilities in Tsunami-affected Provinces in Thailand”: • All the Local Government Units of the provinces of Krabi, Phangnga, Phuket, Ranong, Satun, and Trang; • Directors and staff of all the Provincial Health Offices, Provincial & Community Hospitals, and Health centers of the provinces of Krabi, Phangnga, Phuket, Ranong, Satun, and Trang; • Department of Disaster Prevention and Mitigation, Ministry of Interior; • World Health Organization; and • The people of Southern Thailand.

REFERENCES

. Faculty of Tropical Medicine, Mahidol University. GIS Mapping of Health Facilities in the 6 Tsunami-affected Provinces in Southern Thailand. 2005. 2. United Nations, World Health Organization, and International Federation of Red Cross and Red Crescent Societies. Tsunami Recovery Impact Assessment and Monitoring System. 2006. 3. Anselin L. An Introduction to Spatial Autocorrelation Analysis with GeoDa. 2003. 4. Anselin L. Exploring Spatial Data with GeoDa™: A Workbook. Revised version. 2005.

Faculty of Tropical Medicine, Mahidol University ...REPORT 51 A ANNEX I

Checklist for District Health Office (DHO)

District Health Office......

Address......

......

Tel...... Fax ......

Recent health indicators in the population under responsibility of this DHO

) Crude mortality rate (per 1000)

2) Children <5 mortality rate (per 1000)

3) % population with access to water from improved sources

4) % population without basic sanitation facilities

5) Measles immunization coverage (%)

6) % of children <5 who are underweight

7) % of children <5 who are wasting

8) % of low birthweight (LBW) newborns

9) % of children 12-23 months who are fully immunized against all antigens

0) Adequate antenatal coverage (at least 4 visits during pregnancy)

) % birth attended by skilled birth attendants

2) Number of subdistricts in this district

3) Number of subdistricts covered by outreach psychological support

by community workers

4) Number of Health Centers under supervision of this DHO

5) Number of Health Centers destroyed/damaged by tsunami

6) Number of Health Centers rebuilt of rehabilitated

Collector......

Position......

Date...... B ANNEX II

Checklist for Health Center

Health Center ......

Address......

......

Tel ...... Fax ......

Recent health indicators in the population under responsibility of this Health Center

) Crude mortality rate (per 1000)

2) Children <5 mortality rate (per 1000)

3) % population with access to water from improved sources

4) % population without basic sanitation facilities

5) Measles immunization coverage (%)

6) % of children <5 who are underweight

7) % of children <5 who are wasting

8) % of low birth weight (LBW) newborns

9) % of children 12-23 months who are fully immunized against all antigens

0) Adequate antenatal coverage (at least 4 visits during pregnancy) (%)

) % birth attended by skilled birth attendants

Collector......

Position......

Date...... C ANNEX III

Checklist for Hospital

Hospital ......

Address......

......

Tel ...... Fax ......

Recent health indicators in the population under responsibility of this Hospital

) Number of population in the catchment area of this hospital

2) Number of hospital beds (in-patient and maternity)

3) Number of outpatient consultations per year

4) Availability of Emergency Obstetric Care in this hospital ❍ Yes

❍ No

5) % of low birthweight (LBW) newborns

6) Adequate antenatal coverage (at least 4 visits during pregnancy) (%)

Collector......

Position......

Date...... A ANNEX IV

แบบบันทึกข้อมูลจากสำนักงานสาธารณสุขอำเภอ โครงการสำรวจคุณภาพชีวิตของประชาชนในพื้นที่ประสบภัยคลื่นสึนามิ

สำนักงานสาธารณสุขอำเภอ...... ที่อยู่ : เลขที่...... หมู่ที่...... บ้าน...... ตำบล...... อำเภอ...... จังหวัด...... โทรศัพท์...... โทรสาร......

ดัชนีสาธารณสุขปัจจุบันในประชากรที่อยู่ในความรับผิดชอบของสำนักงานสาธารณสุขอำเภอนี้ 1. อัตราตายอย่างหยาบ (Crude mortality rate) _____ /1,000 ปชก. 2. อัตราตายในเด็กอายุต่ำกว่า 5 ปี ____ /1,000 ปชก. เด็ก <5 ปี 3. ร้อยละของประชากรที่มีน้ำใช้จากแหล่งน้ำที่สะอาด ร้อยละ 4. ร้อยละของประชากรที่ไม่ได้รับการบริการพื้นฐานด้านสุขาภิบาล ร้อยละ 5. อัตราครอบคลุมของการได้รับวัคซีนป้องกันโรคหัด ร้อยละ 6. ร้อยละของเด็กต่ำกว่า 5 ปีที่มีภาวะน้ำหนักต่ำกว่าเกณฑ์อายุ ร้อยละ 7. ร้อยละของเด็กต่ำกว่า 5 ปีที่มีภาวะน้ำหนักต่ำกว่าเกณฑ์ความสูง ร้อยละ 8. ร้อยละของเด็กเกิดใหม่ที่มีน้ำหนัก <2500 กรัม ร้อยละ 9. ร้อยละของเด็กอายุ 12-23 เดือน ที่ได้รับภูมิคุ้มกันโรคครบทุกชนิดที่กำหนด ร้อยละ 10. ร้อยละของหญิงฝากครรภ์ที่ได้รับการตรวจก่อนคลอดครบ 4 ครั้ง ร้อยละ 11. ร้อยละของการคลอดโดยแพทย์/พยาบาล/ผดุงครรภ์ที่ได้รับการอบรมแล้ว ร้อยละ 12. จำนวนตำบลที่อยู่ในอำเภอนี้ ตำบล 13. จำนวนตำบลที่มีทีมงานจิตวิทยาให้ความช่วยเหลือหลังเกิดสึนามิ ตำบล 14. จำนวนสถานีอนามัย ที่อยู่ในความรับผิดชอบของ สสอ. นี้ แห่ง 15. จำนวนสถานีอนามัย ที่เสียหายจากคลื่นสึนามิ แห่ง 16. จำนวนสถานีอนามัย ที่ได้รับการสร้างใหม่หรือฟื้นฟูแล้ว แห่ง

ผู้บันทึก...... ตำแหน่ง...... วันที่...... B ANNEX V

แบบบันทึกข้อมูลจากสถานีอนามัย โครงการสำรวจคุณภาพชีวิตของประชาชนในพื้นที่ประสบภัยคลื่นสึนามิ

ชื่อสถานีอนามัย...... ที่อยู่ : เลขที่...... หมู่ที่...... บ้าน...... ตำบล...... อำเภอ...... จังหวัด...... โทรศัพท์...... โทรสาร......

ดัชนีสาธารณสุขปัจจุบันในประชากรที่อยู่ในความรับผิดชอบของอนามัยนี้

1. อัตราตายอย่างหยาบ _____ /1,000 ปชก. 2. อัตราตายในเด็กอายุต่ำกว่า 5 ปี ____ /1,000 ปชก. เด็ก <5 ปี 3. ร้อยละของประชากรที่มีน้ำใช้จากแหล่งน้ำที่สะอาด ร้อยละ 4. ร้อยละของประชากรที่ไม่ได้รับการบริการพื้นฐานด้านสุขาภิบาล ร้อยละ 5. อัตราครอบคลุมของการได้รับวัคซีนป้องกันโรคหัด ร้อยละ 6. ร้อยละของเด็กต่ำกว่า 5 ปีที่มีภาวะน้ำหนักต่ำกว่าเกณฑ์อายุ ร้อยละ 7. ร้อยละของเด็กต่ำกว่า 5 ปีที่มีภาวะน้ำหนักต่ำกว่าเกณฑ์ความสูง ร้อยละ 8. ร้อยละของเด็กเกิดใหม่ที่มีน้ำหนัก < 2500 กรัม ร้อยละ 9. ร้อยละของเด็กอายุ 12-23 เดือน ที่ได้รับภูมิคุ้มกันโรคครบทุกชนิดที่กำหนด ร้อยละ 10. ร้อยละของหญิงฝากครรภ์ที่ได้รับการตรวจก่อนคลอดครบ 4 ครั้ง ร้อยละ 11. ร้อยละของการคลอดโดยแพทย์/พยาบาล/ผดุงครรภ์ที่ได้รับการอบรมแล้ว ร้อยละ

ผู้บันทึก...... ตำแหน่ง...... วันที่...... C ANNEX VI

แบบบันทึกข้อมูลจากโรงพยาบาลชุมชน โครงการสำรวจคุณภาพชีวิตของประชาชนในพื้นที่ประสบภัยคลื่นสึนามิ

ชื่อโรงพยาบาล...... ที่อยู่ : เลขที่...... หมู่ที่...... บ้าน...... ตำบล...... อำเภอ...... จังหวัด...... โทรศัพท์...... โทรสาร......

ดัชนีสาธารณสุขปัจจุบันในประชากรที่อยู่ในความรับผิดชอบของโรงพยาบาลชุมชนนี้

1. จำนวนประชากรที่อยู่ในเขตรับผิดชอบของโรงพยาบาลนี้ คน 2. จำนวนเตียงผู้ป่วยในและเตียงคลอด เตียง 3. จำนวนผู้ป่วยนอกต่อปี รายต่อปี 4. โรงพยาบาลนี้มีบริการผู้ป่วยภาวะฉุกเฉินทางด้านสูติศาสตร์หรือไม่? ❍ มี ❍ ไม่มี 5. ร้อยละของเด็กเกิดใหม่ (ที่คลอดในร.พ.นี้) ที่มีน้ำหนัก <2500 กรัม ร้อยละ 6. ร้อยละของหญิงฝากครรภ์ที่ได้รับการตรวจก่อนคลอดตั้งแต่ 4 ครั้งขึ้นไป ร้อยละ

ผู้บันทึก...... ตำแหน่ง...... วันที่...... Production and Design by:

Pornpimon Adams Ronnachai Rarerng Phaibul Vasanakomut

Research and Academic Affairs Unit Faculty of Tropical Medicine, Mahidol University August 2007