REPORT

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

Prepared by

Pratap Singhasivanon Irwin F. Chavez Tanapat Chupraphawan Wanchai Maneebunyang Sutthiporn Prommongkol Sumrerng Prommongkol Phiraphon Chusongsang Surapon Yimsamran

Faculty of Tropical Medicine Mahidol University

INTRODUCTION The South Asian tsunami of 2004 has claimed thousands of lives and left thousands of families homeless. Affected countries and their respective governments alongside local and international non-governmental organizations have initiated numerous programs for the reconstruction and rehabilitation of the affected areas. Recovery activities are still ongoing and several are still being planned.

Figure 1. Tsunami-affected areas in Thailand

Of major interest now is to evaluate the progress of recovery 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, the formulation of numerous core and country-specific impact assessment and monitoring indicators 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, a detailed and reliable database is critical which necessitated the conduct of this survey. The contents of this report are based on the survey of health-related TRIAMS indicators. The survey was carried out from Nov 2006 to 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 Areas for this survey were confined to the tsunami affected of provinces of Phangnga, , Phuket, Ranong, Trang and Satun wherein 408 out of the total 1,946 villages were affected1. The proportion of affected districts and subdistricts are listed on the table 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 62.561 22 36.1 379 11430.1 Phangnga 8 5 62.5 49 16 32.7 317 66 20.8 Phuket 3 3 100.0 17 11 64.7 96 59 61.5 Ranong 5 3 60.030 9 30.0 174 47 27.0 Satun 10 4 40.095 16 16.8 713 70 9.8 Trang 7 4 57.136 13 36.1 267 52 19.5 Total 41 24 58.5288 87 30.2 1,946 408 21.0

ID DISTRICT 1 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 10 Thai Muang 11 Muang Phuket 12 Kathu 13 Thalang 14 Muang Ranong 15 Kapoe 16 Suk Samran 17 Muang Satun 18 Tha Phae 19 Langu 20 Thung Wa 21 Kantrang 22 Palian 23 Sikao 24 Hat Samran

Plate 1

ID SUBDISTRICT ID SUBDISTRICT 1 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 10 Kamphuan 54 11 Khura 55 Ko Lanta Noi 12 Ko Phra Thong 56 Saladan 13 Bang Wan 57 Ko Lanta Yai 14 Ko Kho Khao 58 Khlong Phon 15 Bang Muang 59 Sai Khao 16 Khukkhak 60 Khao Mai Kaeo 17 Lam Kaen 61 Bo Hin 18 Thung Maphrao 62 Mai Fat 19 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 - -

Plate 2 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. The table below shows the list of identified indicators and their respective sources.

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

DISTRICT AREA of HEALTH COMMUNITY INDICATOR HEALTH RECOVERY CENTER HOSPITAL OFFICE Demographic Crude mortality rate + + indices Under 5 mortality rate + + % population with access to water from + + an improved source % population without basic sanitation + + facilities Vital needs Measles immunization coverage + + % of low birth weight (LBW) newborns + + % of children <5 who are underweight + + % children <5 who are wasting + + (moderate & severe) No. of hospital beds per 10,000 + 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 Access to basic + Obstetric Care per 10,000 population social services Adequate antenatal coverage (at least 4 + + visits during a pregnancy) % subdistrict covered by outreach psychological support by community + workers % birth attended by skilled birth + + attendant % destroyed/damaged health facilities Infrastructure + rebuilt or rehabilitated

Data collection instruments Standardized checklists and record forms translated into Thai language were used to extract the relevant information on the listed health indicators from health centers, district health offices, and community hospitals (ANNEXES I to VI).

Data management and analysis Collected data were organized and processed using Microsoft® Access and Microsoft® Excel. Maps were created with ArcView® 3.3 using the ESRI shapefile specification (*.shp). Spatial analysis was performed using GeoDa™ 0.95i. Results are presented through thematic maps and summary statistics. Spatial analyses of the various indicators were carried out. These include the 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. Through the evaluation of how each subdistrict is related to each other in terms of location and contiguity gives rise to numeric spatial weights essential in the calculation of the relevant statistics. Presence of global or overall clustering is given by the Moran’s I with p-values calculated based on conditional permutation as implemented in GeoDa. The level of significance was set at 0.05 under 999 permutations. Moreover, significant local clustering was assessed using local Moran statistics calculated through randomization (using 999 permutations). Subdistricts are then classified into 5 categories: not statistically significant, HIGH-HIGH, LOW-LOW, HIGH-LOW, and LOW-HIGH clusters. In the analysis, a subdistrict with high attribute value contiguous to one or more neighboring areas with similarly high values are classified as HIGH-HIGH clusters. Conversely, areas with low values in proximity to neighboring areas with similarly low values are 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 don’t 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 levels of specific indicators are not distributed homogeneously. DEMOGRAPHIC INDICES Indicators 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 districts range 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 is at 4.63 + 2.95 per 1,000 (Table 3). Mortality rates of children under 5 years were highest in Hat Samran, Trang with 5 per 1,000. Followed by Muang Ranong, Ranong with 4.6 per 1,000 along with 11 other districts with rates <5 per 1,000. Other remaining districts recorded zero under 5 death rates (Fig 2). Plates 3 to 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 1.80 17.00 Under 5 death rate 20 0.89 1.47 0 5.00

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

Plate 3

Plate 4

CRUDE DEATH UNDER 5 DEATH ID SUBDISTRICT POPULATION RATE (/1,000) RATE (/1,000) 1 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 - 10 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

Plate 5

CRUDE DEATH UNDER 5 DEATH ID SUBDISTRICT POPULATION RATE (/1,000) RATE (/1,000) 11 Khura 10745 1.61 - 12 Ko Phra Thong 898 4.69 33.00 13 Bang Wan 6193 0.15 0.00 14 Ko Kho Khao 833 2.35 - 15 Bang Muang 9980 11.35 - 16 Khukkhak 4127 3.86 0.00 17 Lam Kaen 5390 4.37 1.63 18 Thung Maphrao 8483 2.99 - 19 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 2.51 10.85 MIN-MAX 0.15-11.35 0-33

Plate 6

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

Plate 7

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

Plate 8

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

Plate 9

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 1.36-30.52 0-0.20

Plate 10 VITAL NEEDS These indicators focus on specific and basic needs such as food, water, and sanitation which require immediate responses2 along with several nutritional indicators. The following 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 an 24 97.80 6.04 74.4 100.00 improved source % Population without basic sanitation 21 1.17 2.88 0 12.20 facilities Measles immunization coverage 24 98.80 2.41 90.00 100.00 % Low birth weight (LBW) newborns 24 5.29 2.59 1.20 10.70 % Children <5 who are underweight 24 5.96 7.66 0.10 38.10 % Children <5 who are wasting 17 5.23 6.17 0 25.20

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

Percent population with access to water from an improved source was lowest in , Krabi with 74.4% followed by Kathu district, Phuket with 83.6%. The rest of the affected districts have 90%-100% of its population with access to water. Incidentally, the highest percentage of population without basic sanitation facilities was highest in Ko Lanta, Krabi with 12.2%. Khlong Thom and Nua Khlong districts in both have 1% while Hat Samran and Kantrang districts of Trang have 1.2% and 4.2%, respectively. Khura Buri, Phangnga have 5% of its population without basic sanitation facilities while the rest of the affected districts have such facilities (Fig 3a).

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

Ko Lanta, Krabi have the lowest measles immunization coverage with 90% followed by Thai Muang, Phangnga with 95%. Rest of the other affected districts has more than 95% coverage as shown in Figure 3b. In the same figure, the proportion of low birth weight (LBW) outcomes in each district is also illustrated. Percent LBW is highest in Ko Lanta, Krabi with 10.7% closely followed by Hat Samran, Trang with 9.5% and 8.3% in both Palian, Trang and Ko Yao, Phangnga. On the other hand, the lowest percentage of LBW outcomes is in Nua Khlong, Krabi.

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

Proportion of children under 5 years who are underweight was highest in Ko Lanta, Krabi with 38.1% followed by Hat Samran, Trang (13.6%) and Kapoe, Ranong (11.3%). The rest of the affected districts have <10% underweight children as shown in Fig 3c above. From the same population of children under 5, the reported percentage of wasting is highest in Ko Lanta, Krabi with 25.2%, Kapoe, Ranong with 11.3%, Hat Samran, Krabi with 10.7%, and the remaining districts with less than 10%. Suk Samran district in Ranong has no reported occurrence of wasting (Fig 3c). Plates 11 to 22 illustrate detailed subdistrict-level data on the various vital needs indicators. Plate 11 Plate 12 Plate 13 Plate 14 Plate 15 Plate 16

% WITH % WITHOUT % MEASLES % % UNDER % ID SUBDISTRICT POPULATION ACCESS TO BASIC IMMUNIZATION LBW WEIGHT WASTING WATER SANITATION COVERAGE 1 Sai Daeng 4459 100.00 0.00 100.00 0.00 5.90 0.00 2 Pak Nam 7455 100.00 0.00 100.00 0.00 1.23 0.00 3 Ngao 6941 100.00 0.00 100.00 0.00 13.33 0.00 4 Ko Phayam 521 100.00 0.00 100.00 0.00 5.88 0.00 5 Ratchakrut 7663 100.00 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 0.00 100.00 0.00 4.90 0.00 8 Bang Hin 3888 100.00 0.00 100.00 4.60 5.40 0.00 9 Na Kha 4985 100.00 0.00 100.00 3.12 10.42 10.00 10 Kamphuan 4861 100.00 0.00 100.00 12.50 5.80 4.00 MEAN 99.18 0.00 98.88 2.53 5.79 1.60 SD 1.77 0.00 3.14 4.07 3.69 3.24 MIN-MAX 95-100 0.00 90-100 0-12.5 1.23-13.33 0-10

Plate 17

% WITH % WITHOUT % MEASLES % % % ID SUBDISTRICT POPULATION ACCESS TO BASIC IMMUNIZATION UNDER LBW WASTING WATER SANITATION COVERAGE WEIGHT 11 Khura 10745 95.00 5.00 100.00 7.18 6.85 7.00 12 Ko Phra Thong 898 16.43 0.00 83.33 16.66 13.33 - 13 Bang Wan 6193 100.00 0.00 100.00 8.06 2.08 4.00 14 Ko Kho Khao 833 100.00 0.00 100.00 0.00 0.00 0.00 15 Bang Muang 9980 95.00 0.00 100.00 5.37 5.42 - 16 Khukkhak 4127 90.14 0.00 100.00 5.06 2.26 0.00 17 Lam Kaen 5390 100.00 0.00 95.00 12.22 5.22 9.00 18 Thung Maphrao 8483 100.00 0.00 96.00 3.60 4.80 7.00 19 Thai Muang 11661 100.00 0.00 100.00 8.71 4.60 0.00 20 Na Toei 8365 100.00 0.00 97.00 10.95 4.46 6.00 21 Khok Kloi 10985 100.00 0.00 100.00 4.44 3.24 - 22 Lo Yung 5522 100.00 0.00 100.00 - 6.63 - 23 Khlong Khian 4009 100.00 0.00 100.00 6.52 4.76 5.00 24 Ko Yao Noi 4493 100.00 0.00 100.00 2.38 0.12 0.00 25 Ko Yao Yai 2408 100.00 0.00 100.00 11.54 0.34 - 26 Phru Nai 5528 100.00 0.00 100.00 10.45 1.23 - MEAN 93.54 0.31 98.21 7.54 4.08 3.8 SD 20.76 1.25 4.29 4.34 3.33 3.52 MIN-MAX 16.43-100.00 0-5 83.33-100.00 0-16.66 0-13.33 0-9

Plate 18

% WITH % WITHOUT % MEASLES % UNDER % ID SUBDISTRICT POPULATION ACCESS TO BASIC IMMUNIZATION % LBW WEIGHT WASTING WATER SANITATION COVERAGE 27 Mai Khao 10181 100.00 0.00 100.00 5.00 1.60 1.00 28 Sa Khu 3642 100.00 0.00 100.00 6.30 3.90 2.00 29 Choeng Tale 10921 100.00 0.00 100.00 4.20 0.53 0.00 30 Kammala 3750 67.20 0.00 98.00 6.20 0.63 1.00 31 Karon 5112 100.00 0.00 100.00 6.25 2.01 2.00 32 Rawai 9902 100.00 0.00 100.00 3.57 1.67 2.00 33 Chalong 9585 100.00 0.00 100.00 6.15 1.35 1.00 34 Wichit 27401 100.00 0.00 100.00 3.12 0.77 1.00 35 Ratsada 20198 100.00 0.00 100.00 14.75 10.86 11.00 36 Ko Kaeo 7387 100.00 0.00 100.00 5.00 1.54 2.00 37 Pa Khlok 9007 100.00 0.00 100.00 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

Plate 19

% WITH % WITHOUT % MEASLES % % % ID SUBDISTRICT POPULATION ACCESS TO BASIC IMMUNIZATION UNDER LBW WASTING WATER SANITATION COVERAGE WEIGHT 38 Laem Sak 5313 98.00 0.20 100.00 0.00 6.13 7.00 39 Ao Luk Noi 5143 100.00 0.00 100.00 98.00 4.34 4.00 40 Khao Khram 8480 100.00 0.00 100.00 5.00 0.30 0.00 41 Khao Thong 5092 100.00 0.00 98.36 6.32 4.46 2.00 42 Nong Tale 7616 100.00 0.00 100.00 0.13 2.70 0.00 43 Ao Nang 5911 100.00 0.00 100.00 0.00 0.00 0.00 44 Sai Thai 10482 100.00 0.00 100.00 4.26 0.90 0.00 45 Khlong Prasong 4150 100.00 0.00 97.18 4.76 0.30 0.00 46 Nua Khlong 10778 100.00 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 5191 100.00 0.00 100.00 3.85 2.46 5.00 49 Khlong Khanan 7342 100.00 0.00 100.00 1.59 2.76 0.00 50 Ko Sriboya 4221 100.00 0.00 100.00 0.00 0.93 0.00 51 Khlong Thom Tai 9731 96.20 1.59 100.00 5.47 2.36 2.00 52 Huai Nam Khao 7371 72.10 0.00 100.00 0.00 2.30 0.00 53 Khlong Yang 4777 73.46 69.07 73.44 15.87 1.98 3.00 54 Ko Klang 6376 74.18 7.39 84.19 5.12 1.19 2.00 55 Ko Lanta Noi 4204 74.26 29.16 88.34 18.75 6.55 5.00 56 Saladan 3237 74.54 21.19 69.36 11.11 1.51 5.00 57 Ko Lanta Yai 5220 71.33 19.08 77.11 6.25 1.51 9.00 58 Khlong Phon 15814 100.00 0.00 100.00 0.00 1.22 2.00 59 Sai Khao 8721 95.00 0.00 100.00 6.00 1.60 1.00 MEAN 91.87 6.71 94.79 9.39 2.39 2.32 SD 11.82 16.18 9.69 20.41 1.95 2.63 Min-Max 71.33-100 0-69.07 69.36-100 0-98 0-6.55 0-9

Plate 20

% WITH % WITHOUT % MEASLES % % % ID SUBDISTRICT POPULATION ACCESS TO BASIC IMMUNIZATION UNDER LBW WASTING WATER SANITATION COVERAGE WEIGHT 60 Khao Mai Kaeo 5439 100.00 0.00 100.00 1.00 18.00 5.00 61 Bo Hin 7211 100.00 0.00 100.00 5.88 5.29 2.00 62 Mai Fat 6484 97.79 0.00 100.00 8.16 2.99 0.00 63 Bang Sak 4548 100.00 0.00 100.00 12.69 1.94 - 64 Ko Libong 5794 97.80 9.13 92.10 4.54 4.51 5.00 65 Na Klua 4097 100.00 0.00 100.00 4.61 0.48 - 66 Kan Tang Tai 6784 95.95 9.02 100.00 3.45 1.57 - 67 Ban Na 8996 100.00 0.00 100.00 0.00 0.00 6.00 68 Hat Samran 7769 100.00 0.00 100.00 0.00 8.80 9.00 69 Tase 3964 100.00 1.15 100.00 9.52 4.81 2.00 70 Suso 6021 100.00 0.00 100.00 0.00 2.07 2.00 71 Ko Sukon 2435 100.00 0.00 100.00 0.00 15.00 10.00 72 Tha Kham 8980 100.00 0.00 100.00 0.00 22.50 5.00 MEAN 99.35 1.48 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

Plate 21

% WITH % WITHOUT % MEASLES % % UNDER % ID SUBDISTRICT POPULATION ACCESS TO BASIC IMMUNIZATION LBW WEIGHT WASTING WATER SANITATION COVERAGE 73 Na Thon 5489 100.00 0.00 100.00 2.22 7.67 8.00 74 Thung Bu Lang 2164 100.00 0.00 100.00 3.70 1.08 1.00 75 Khon Khlan 2009 100.00 0.00 100.00 2.94 7.50 1.00 76 Laem Son 3288 100.00 0.00 95.00 9.75 14.53 8.00 77 Kamphaeng 15897 100.00 0.00 100.00 0.00 1.50 1.00 78 Pak Nam 8719 100.00 0.00 100.00 0.00 4.23 6.00 79 La Ngu 17983 100.00 0.00 100.00 4.44 5.83 19.00 80 Ko Sarai 4807 100.00 0.00 100.00 8.82 6.10 1.00 81 Sakhon 6294 100.00 0.00 100.00 2.50 1.60 1.00 82 Tha Phae 8197 100.00 0.00 100.00 3.30 1.08 0.00 83 Chebilang 7940 100.00 0.00 100.00 10.94 2.69 0.00 84 Ban Khuan 8951 100.00 0.00 100.00 7.09 5.57 3.00 85 Tanyongpo 2767 100.00 0.00 100.00 - 3.12 1.00 86 Khlong Khut 14565 100.00 0.00 100.00 5.74 1.76 4.00 87 Puyu 2782 100.00 0.00 100.00 4.35 6.77 2.00 MEAN 100.00 0.00 99.67 4.69 4.74 3.73 SD 100.00 0.00 1.29 3.39 3.62 5.01 Min-Max 100.00 0.00 95-100 0-10.94 1.08-14.53 0-19

Plate 22 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 0.283 0.015 improved source % Population without basic sanitation facilities 0.305 0.009 Measles immunization coverage 0.696 0.001 % Children <5 who are underweight 0.040 0.276 * using rook contiguity

Figure 4a. Cluster Maps of Vital Needs Indicators in Tsunami-affected Subdistricts 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 attribute 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). 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 has 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 illustrated in Fig 4a. Significant HIGH-HIGH clusters for percent population without basic sanitation facilities occur in 4 subdistricts in Krabi: Ko Klang (7.39%), Ko Lanta Noi (29.16%), Saladan (21.19%), and Ko Lanta Yai (19.08%). It’s worth to note that the highest 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 predominant with 11 subdistricts in all (Fig 4a).

Figure 4b. Cluster Maps of Vital Needs Indicators in Tsunami-affected Subdistricts Thailand, 2006 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 rest of the significant clusters are 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 under 5, 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 In the aftermath of the tsunami, the delivery of health and other basic services have been affected. The following section summarizes the baseline levels of indicators related to access to basic social services at the district and subdistrict scales.

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 23 18.14 18.58 0 67.33 population (in-patient and maternity) No. of outpatient 23 3.43 2.23 1.05 9.04 consultations/person/year % Children 12-23 months who are fully 24 98.64 2.01 92.50 100.00 immunized against all antigens Adequate antenatal coverage (at least 4 24 92.29 10.05 58.90 100.00 visits during a pregnancy) No. of health facilities with Emergency 23 0.23 0.20 0 0.80 Obstetric Care per 10,000 population % Birth attended by skilled birth 24 99.91 0.29 98.70 100.00 attendant % Subdistrict covered by outreach psychological support by community 24 58.56 40.45 0 100.00 workers

Figure 5a. Access to Basic Social Services in Tsunami-affected Districts Thailand, 2006

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

Figure 5b. Access to Basic Social Services in Tsunami-affected Districts Thailand, 2006

The number of outpatient consultations per person/year average at 3.43+2.23; lowest in Takua Pa, Phangnga with 1.05; highest in Takua Thung, Phangnga with 9.04 followed by Nua Khlong, Krabi with 8.51 and Kathu, Phuket with 8.05 consultations per person/year. The percentage of children 12-23 months fully immunized against all antigens reflect high coverage in all districts averaging 98.64% with two districts below 95% coverage (Fig 5b) wherein the lowest is 92.5% in Kantrang, Trang followed by Ko Lanta, Krabi with 94.9%. Exactly half of the affected districts have 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.

Figure 5c. Access to Basic Social Services in Tsunami-affected Districts Thailand, 2006

The 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 to having no emergency obstetric care services. In all the affected districts, percentage of women who received adequate antenatal care average at 92.29% +10.05. Four districts, namely Khura Buri (Phangnga), Ko Lanta (Krabi), Muang Satun (Satun), and Suk Samran (Ranong) have antenatal coverage less than 90% (Fig 5b) while Ao Luk, Krabi and Muang Phuket, Phuket reported 100% antenatal

coverage.

Figure 5d. Access to Basic Social Services in Tsunami-affected Districts Thailand, 2006

The percentage of subdistricts covered by outreach psychological support by community workers reported 100% coverage in 5 districts in Phangnga, 2 districts in Ranong, and 1 each in Phuket and Satun (Fig 5d). However, 4 districts namely, Ko Lanta (Krabi), Langu (Satun), Muang Ranong (Ranong), and Kathu (Phuket) reported not having this basic social service in any of their subdistricts. Meanwhile, almost all districts reported 100% births delivered by skilled birth attendants with the exception of Palian, Trang with 98.7% followed by Tha Phae with 99.3%, and Muang Satun, Satun with 99.9%. The following plates (Plates 23 to 31) show detailed data on the indicators for basic social services at the subdistrict level.

Plate 23

Plate 24

Plate 25

% 12-23 MONTHS WHO % WITH ADEQUATE % BIRTHS BY SKILLED ID SUBDISTRICT POPULATION ARE IMMUNIZED ANTENATAL CARE BIRTH ATTENDANTS 1 Sai Daeng 4459 100.00 100.00 100.00 2 Pak Nam 7455 92.31 100.00 100.00 3 Ngao 6941 75.00 100.00 100.00 4 Ko Phayam 521 100.00 100.00 100.00 5 Ratchakrut 7663 87.74 96.88 100.00 6 Kapoe 6832 90.00 96.95 100.00 7 Muang Kluang 2997 100.00 86.00 100.00 8 Bang Hin 3888 100.00 100.00 100.00 9 Na Kha 4985 100.00 68.75 100.00 10 Kamphuan 4861 100.00 87.50 100.00 MEAN 94.51 93.61 100.00 SD 8.38 10.22 100.00 Min-Max 75-100 68.75-100 100.00

Plate 26

% 12-23 MONTHS WHO % WITH ADEQUATE % BIRTHS BY SKILLED ID SUBDISTRICT POPULATION ARE IMMUNIZED ANTENATAL CARE BIRTH ATTENDANTS 11 Khura 10745 100.00 100.00 100.00 12 Ko Phra Thong 898 80.00 100.00 100.00 13 Bang Wan 6193 100.00 95.16 100.00 14 Ko Kho Khao 833 100.00 90.00 100.00 15 Bang Muang 9980 100.00 96.77 100.00 16 Khukkhak 4127 100.00 91.14 100.00 17 Lam Kaen 5390 97.00 92.22 100.00 18 Thung Maphrao 8483 94.00 95.45 100.00 19 Thai Muang 11661 99.20 94.00 100.00 20 Na Toei 8365 96.00 83.01 100.00 21 Khok Kloi 10985 98.00 95.35 100.00 22 Lo Yung 5522 100.00 100.00 100.00 23 Khlong Khian 4009 100.00 100.00 100.00 24 Ko Yao Noi 4493 100.00 97.50 100.00 25 Ko Yao Yai 2408 100.00 100.00 100.00 26 Phru Nai 5528 100.00 95.24 100.00 MEAN 97.76 95.37 100.00 SD 5.07 4.66 100.00 Min-Max 80-100 83.01-100 100.00

Plate 27

% 12-23 MONTHS WHO % WITH ADEQUATE % BIRTHS BY SKILLED ID SUBDISTRICT POPULATION ARE IMMUNIZED ANTENATAL CARE BIRTH ATTENDANTS 27 Mai Khao 10181 100.00 98.00 100.00 28 Sa Khu 3642 100.00 100.00 100.00 29 Choeng Tale 10921 100.00 95.00 100.00 30 Kammala 3750 98.00 90.00 100.00 31 Karon 5112 100.00 100.00 100.00 32 Rawai 9902 100.00 100.00 100.00 33 Chalong 9585 100.00 100.00 100.00 34 Wichit 27401 100.00 100.00 100.00 35 Ratsada 20198 100.00 100.00 100.00 36 Ko Kaeo 7387 100.00 100.00 100.00 37 Pa Khlok 9007 100.00 97.00 100.00 MEAN 99.82 98.18 100.00 SD 0.60 3.19 100.00 Min-Max 98-100 90-100 100.00

Plate 28

% 12-23 MONTHS WHO % WITH ADEQUATE % BIRTHS BY SKILLED ID SUBDISTRICT POPULATION ARE IMMUNIZED ANTENATAL CARE BIRTH ATTENDANTS 38 Laem Sak 5313 100.00 100.00 100.00 39 Ao Luk Noi 5143 100.00 98.00 100.00 40 Khao Khram 8480 100.00 100.00 100.00 41 Khao Thong 5092 96.45 90.53 100.00 42 Nong Tale 7616 100.00 100.00 100.00 43 Ao Nang 5911 100.00 100.00 100.00 44 Sai Thai 10482 100.00 100.00 100.00 45 Khlong Prasong 4150 97.30 90.48 100.00 46 Nua Khlong 10778 99.47 91.89 100.00 47 Khlong Khamot 4597 98.00 100.00 100.00 48 Talingchan 5191 100.00 100.00 100.00 49 Khlong Khanan 7342 100.00 100.00 100.00 50 Ko Sriboya 4221 100.00 100.00 100.00 51 Khlong Thom Tai 9731 100.00 95.89 100.00 52 Huai Nam Khao 7371 100.00 100.00 100.00 53 Khlong Yang 4777 87.34 61.53 82.14 54 Ko Klang 6376 79.67 64.28 100.00 55 Ko Lanta Noi 4204 92.04 91.66 97.02 56 Saladan 3237 68.36 89.71 100.00 57 Ko Lanta Yai 5220 84.34 92.59 100.00 58 Khlong Phon 15814 100.00 100.00 100.00 59 Sai Khao 8721 100.00 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

Plate 29

% 12-23 MONTHS WHO % WITH ADEQUATE % BIRTHS BY SKILLED ID SUBDISTRICT POPULATION ARE IMMUNIZED ANTENATAL CARE BIRTH ATTENDANTS 60 Khao Mai Kaeo 5439 100.00 98.00 100.00 61 Bo Hin 7211 94.73 94.73 100.00 62 Mai Fat 6484 100.00 100.00 100.00 63 Bang Sak 4548 100.00 90.32 98.38 64 Ko Libong 5794 100.00 90.90 100.00 65 Na Klua 4097 100.00 100.00 100.00 66 Kan Tang Tai 6784 97.88 100.00 100.00 67 Ban Na 8996 100.00 100.00 100.00 68 Hat Samran 7769 100.00 100.00 100.00 69 Tase 3964 100.00 98.00 100.00 70 Suso 6021 100.00 100.00 100.00 71 Ko Sukon 2435 100.00 95.00 100.00 72 Tha Kham 8980 100.00 100.00 100.00 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

Plate 30

% 12-23 MONTHS WHO % WITH ADEQUATE % BIRTHS BY SKILLED ID SUBDISTRICT POPULATION ARE IMMUNIZED ANTENATAL CARE BIRTH ATTENDANTS 73 Na Thon 5489 100.00 84.44 100.00 74 Thung Bu Lang 2164 100.00 100.00 100.00 75 Khon Khlan 2009 100.00 91.18 100.00 76 Laem Son 3288 100.00 100.00 100.00 77 Kamphaeng 15897 100.00 100.00 100.00 78 Pak Nam 8719 100.00 100.00 100.00 79 La Ngu 17983 100.00 100.00 100.00 80 Ko Sarai 4807 100.00 82.35 97.06 81 Sakhon 6294 100.00 100.00 100.00 82 Tha Phae 8197 100.00 92.13 100.00 83 Chebilang 7940 100.00 94.53 100.00 84 Ban Khuan 8951 100.00 92.91 100.00 85 Tanyongpo 2767 100.00 97.96 100.00 86 Khlong Khut 14565 100.00 51.67 100.00 87 Puyu 2782 100.00 86.96 100.00 MEAN 100.00 91.61 99.80 SD 100.00 12.61 0.76 Min-Max 100.00 51.67-100 97.06-100

Plate 31 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 % Children 12-23 months who are fully 0.489 0.001 immunized against all antigens Adequate antenatal coverage (at least 4 visits 0.380 0.005 during a pregnancy) % Birth attended by skilled birth attendant -0.026 0.280 * using rook contiguity

The global Moran’s I for the % children 12-23 months fully immunized against all antigens and adequate antenatal coverage show highly significant positive spatial autocorrelation (Table 7) which indicates the presence of 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 below shows four LOW-LOW clusters were detected in Ratchakrut (Ranong), Ko Lanta Noi, 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 Thailand, 2006

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

Spatial analysis of adequate antenatal coverage has detected LOW-LOW clusters in Ko Klang (Krabi), and Ban Khuan & Puyu subdistricts in Satun. The rest of the local clusters identified were LOW-HIGH clusters in 11 subdistricts. Although the percentage of births attended by skilled birth attendants are 100% in almost all subdistricts, only 2 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 are 2 significant HIGH-LOW clusters in Khlong Yang and Ko Lanta Noi also in Krabi. Other HIGH-LOW clusters identified are 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). INFRASTRUCTURE Health facilities and its services are vital in ensuring the well-being of the population within its catchment area. Several of these health facilities have been affected by the tsunami. The succeeding section summarizes the extent of the damage as well as the current state of these facilities.

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

Rehabilitation and No. of districts Mean SD Min Max reconstruction % Damaged/destroyed health 24 6.91 12.08 0 50.00 facilities % Health facilities rebuilt or 9 77.78 44.09 0 100.00 rehabilitated

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

A total of 9 districts have reported to have at least one health center under their supervision have been damaged or destroyed by the tsunami as seen in Figure 7. These districts include 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 the ones in Muang Ranong, Ranong and Kathu, Phuket (Fig 7).

PROBLEMS ENCOUNTERED & LIMITATIONS Data collection The biggest challenged encountered by our team of surveyors was the unavailability of some data at the time of the survey. To solve this, the appropriate checklists were given to local health personnel and subsequently have them sent as priority mail to the Faculty of Tropical Medicine, Mahidol University. However, some still failed to forward the information needed which resulted to a few indicators having missing data.

Spatial analysis Indicators with missing values have been dropped from the analysis since existing methods and computer packages do not have adjustments for missing observations. So only those with complete data can be analyzed. Furthermore, results of the spatial analyses are purely exploratory and require more data to carry out more in-depth and sophisticated analyses.

CONCLUSIONS AND RECOMMENDATIONS Since data presented in this report shows baseline statistics for various health indicators, constant surveillance of such variables is vital in monitoring the progress of recovery activities. While all efforts have been made to collect data for all areas of interest, some information were either inaccessible or not available which resulted to missing information. The presence of capable local personnel who can manage and analyze such data efficiently and promptly alongside a surveillance system to monitor all indicators of interest (both health and non-health) will assure constant flow of high quality data.

REFERENCES

1. 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

ANNEX I

Checklist for DISTRICT HEALTH OFFICE (DHO) A District Health Office ………………………………………. Address.………………………………………. ………………………………………. ………………………………………. ………………………………………. ………………… Tel ………………………………………. Fax ……………………………………….

Recent health indicators in the population under responsibility of this DHO

1) 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 10) Adequate antenatal coverage (at least 4 visits during pregnancy) 11) % birth attended by skilled birth attendants 12) Number of subdistricts in this district 13) Number of subdistricts covered by outreach psychological support by community workers 14) Number of Health Centers under supervision of this DHO 15) Number of Health Centers destroyed/damaged by tsunami 16) Number of Health Centers rebuilt of rehabilitated

Collector______Position______Date______ANNEX II

Checklist for HEALTH CENTER B Health Center ………………………………………. Address.………………………………………. ………………………………………. ………………………………………. ………………………………………. ………………… Tel ………………………………………. Fax ……………………………………….

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

1) 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 10) Adequate antenatal coverage (at least 4 visits during pregnancy) (%) 11) % birth attended by skilled birth attendants

Collector______Position______Date______ANNEX III

Checklist for HOSPITAL C Hospital ………………………………………. Address.………………………………………. ………………………………………. ………………………………………. ………………………………………. ………………… Tel ………………………………………. Fax ……………………………………….

Recent health indicators in the population under responsibility of this Hospital

1) 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 { Yes 4) Availability of Emergency Obstetric Care in this hospital { No 5) % of low birth weight (LBW) newborns 6) Adequate antenatal coverage (at least 4 visits during pregnancy)

(%)

Collector______Position______Date______ANNEX IV

แบบบันทึกขอมูลจากสํานักงานสาธารณสุขอําเภอ โครงการสํารวจคุณภาพชีวิตของประชาชนในพื้นที่ประสบภัยคลื่นสึนามิ A สํานักงานสาธารณสุขอําเภอ......

ที่อยู : เลขที่...... หมูที่...... บาน...... ตําบล......

อําเภอ...... จังหวัด......

โทรศัพท...... โทรสาร...... ดัชนีสาธารณสุขปจจุบันในประชากรที่อยูในความรับผิดชอบของสํานักงานสาธารณสุขอําเ ภอนี้

1. อัตราตายอยางหยาบ (Crude mortality rate) _____ /1,000 ปชก.

____ /1,000 ปชก. เด็ก 2. อัตราตายในเด็กอายุต่ํากวา 5 ป <5 ป

3. รอยละของประชากรที่มีน้ําใชจากแหลงน้ําที่สะอาด รอยละ

4. รอยละของประชากรที่ไมไดรับการบริการพื้นฐานดานสุขาภิบาล รอยละ

5. อัตราครอบคลุมของการไดรับวัคซีนปองกันโรคหัด รอยละ

6. รอยละของเด็กต่ํากวา 5 ปที่มีภาวะน้ําหนักต่ํากวาเกณฑอายุ รอยละ

7. รอยละของเด็กต่ํากวา 5 ปที่มีภาวะน้ําหนักต่ํากวาเกณฑความสูง รอยละ

8. รอยละของเด็กเกิดใหมทมี่ ีน้ําหนัก <2500 กรัม รอยละ

9. รอยละของเด็กอายุ 12-23 เดือน รอยละ ที่ไดรับภูมิคุมกันโรคครบทุกชนิดที่กําหนด

10. รอยละของหญิงฝากครรภที่ไดรับการตรวจกอนคลอดครบ 4 ครั้ง รอยละ

11. รอยละของการคลอดโดยแพทย/พยาบาล/ผดุงครรภทไดี่ รับการอบรม รอยละ แลว

12. จํานวนตําบลที่อยูในอําเภอนี้ ตําบล

13. จํานวนตําบลที่มีทีมงานจิตวิทยาใหความชวยเหลือหลังเกิดสึนามิ ตําบล

14. จํานวนสถานีอนามัย ที่อยูในความรับผิดชอบของ สสอ. นี้ แหง

15. จํานวนสถานีอนามัย ที่เสียหายจากคลื่นสึนามิ แหง

16. จํานวนสถานีอนามัย ที่ไดรับการสรางใหมหรือฟนฟูแลว แหง

ผูบันทึก......

ตําแหนง...... วันที่...... ANNEX V

แบบบันทกขึ อมูลจากสถานีอนามัย โครงการสารวจคํ ุณภาพชีวิตของประชาชนในพื้นที่ประสบภัยคลื่นสึนาม ิ B

ชื่อสถานีอนามัย......

ที่อยู : เลขที่...... หมูที่...... บาน...... ตําบล......

อําเภอ...... จังหวัด......

โทรศัพท...... โทรสาร......

ดัชนีสาธารณสุขปจจุบันในประชากรที่อยูในความรับผิดชอบของอนามัยนี้

1. อัตราตายอยางหยาบ _____ /1,000 ปชก.

2. อัตราตายในเด็กอายุต่ํากวา 5 ป ____ /1,000 ปชก. เด็ก <5 ป

3. รอยละของประชากรที่มีน้ําใชจากแหลงน้ําที่สะอาด รอยละ

4. รอยละของประชากรที่ไมไดรับการบริการพื้นฐานดานสุขาภิบาล รอยละ

5. อัตราครอบคลุมของการไดรับวัคซีนปองกันโรคหัด รอยละ

6. รอยละของเด็กต่ํากวา 5 ปที่มีภาวะน้ําหนักต่ํากวาเกณฑอายุ รอยละ

7. รอยละของเด็กต่ํากวา 5 ปที่มีภาวะน้ําหนักต่ํากวาเกณฑความสูง รอยละ

8. รอยละของเด็กเกิดใหมทมี่ ีน้ําหนัก < 2500 กรัม รอยละ

9. รอยละของเด็กอายุ 12-23 เดือน รอยละ ที่ไดรับภูมิคุมกันโรคครบทุกชนิดที่กําหนด

10. รอยละของหญิงฝากครรภที่ไดรับการตรวจกอนคลอดครบ 4 ครั้ง รอยละ

11. รอยละ รอยละของการคลอดโดยแพทย/พยาบาล/ผดุงครรภทไดี่ รับการอบรม แลว

ผูบันทึก......

ตําแหนง......

วันที่...... ANNEX VI

แบบบันทกขึ อมูลจากโรงพยาบาลชมชนุ โครงการสารวจคํ ุณภาพชีวิตของประชาชนในพื้นที่ประสบภัยคลื่นสึนาม ิ C

ชื่อโรงพยาบาล......

ที่อยู : เลขที่...... หมูที่...... บาน...... ตําบล......

อําเภอ...... จังหวัด......

โทรศัพท...... โทรสาร......

ดัชนีสาธารณสุขปจจุบันในประชากรที่อยูในความรับผิดชอบของโรงพยาบาลชุมชนนี้

1. จํานวนประชากรที่อยูในเขตรับผิดชอบของโรงพยาบาลนี้ คน

2. จํานวนเตียงผูปวยในและเตียงคลอด เตียง

3. จํานวนผูปวยนอกตอป รายตอป

4. โรงพยาบาลนี้มีบริการผูปวยภาวะฉุกเฉินทางดานสูติศาสตรหรือไม? { มี

{ ไมม ี

5. รอยละของเด็กเกิดใหม (ที่คลอดในร.พ.นี้) ที่มีน้ําหนัก <2500 กรัม รอยละ

6. รอยละของหญิงฝากครรภที่ไดรับการตรวจกอนคลอดตั้งแต 4 รอยละ ครั้งขึ้นไป

ผูบันทึก......

ตําแหนง......

วันที่......