Monitoring of Key Health Indicators (TRIAMS) at Subdistrict Health Facilities Level in Tsunamiaffected Provinces in Thailand

Transcription

1 REPORT Monitoring of Key Health Indicators (TRIAMS) at Subdistrict Health Facilities Level in Tsunamiaffected Provinces in Thailand 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

2 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

3 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 tsunamiaffected 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 tsunamiaffected villages. MATERIALS AND METHODS Study area and data collection Areas for this survey were confined to the tsunami affected of provinces of Phangnga, Krabi, Phuket, Ranong, Trang and Satun wherein 408 out of the total 1,946 villages were affected 1. The proportion of affected districts and subdistricts are listed on the table below. Plates 1 & 2 show the district and subdistrict boundaries of the tsunamiaffected areas. Table 1. Distribution of Tsunami-affected Areas by Administrative Level 1 Province District Subdistrict Village Total Affected % Total Affected % Total Affected % Krabi Phangnga Phuket Ranong Satun Trang Total ,

4 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

5 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 Ko Klang 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

6 Data on specific key health indicators were collected from local health facilities/offices. As annexed in the TRIAMS workshop report 2, 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. AREA of RECOVERY Table 2. Sources of Data for Key Health-related Indicators INDICATOR HEALTH CENTER COMMUNITY HOSPITAL DISTRICT HEALTH 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 + + Access to basic social services Infrastructure % 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 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 % birth attended by skilled birth attendant % destroyed/damaged health facilities 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).

7 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.

8 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 tsunamiaffected 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 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 subdistrictlevel 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 Under 5 death rate Figure 2. Demographic Indices in Tsunami-affected Districts Thailand, 2006

9 Plate 3

10 Plate 4

11 ID SUBDISTRICT POPULATION CRUDE DEATH UNDER 5 DEATH RATE (/1,000) RATE (/1,000) 1 Sai Daeng Pak Nam Ngao Ko Phayam Ratchakrut Kapoe Muang Kluang Bang Hin Na Kha Kamphuan MEAN SD MIN-MAX Plate 5

12 ID SUBDISTRICT POPULATION CRUDE DEATH UNDER 5 DEATH RATE (/1,000) RATE (/1,000) 11 Khura Ko Phra Thong Bang Wan Ko Kho Khao Bang Muang Khukkhak Lam Kaen Thung Maphrao Thai Muang Na Toei Khok Kloi Lo Yung Khlong Khian Ko Yao Noi Ko Yao Yai Phru Nai MEAN SD MIN-MAX Plate 6

13 ID SUBDISTRICT POPULATION CRUDE DEATH UNDER 5 DEATH RATE (/1,000) RATE (/1,000) 27 Mai Khao Sa Khu Choeng Tale Kammala Karon Rawai Chalong Wichit Ratsada Ko Kaeo Pa Khlok MEAN SD MIN-MAX Plate 7

14 ID SUBDISTRICT POPULATION CRUDE DEATH UNDER 5 DEATH RATE (/1,000) RATE (/1,000) 38 Laem Sak Ao Luk Noi Khao Khram Khao Thong Nong Tale Ao Nang Sai Thai Khlong Prasong Nua Khlong Khlong Khamot Talingchan Khlong Khanan Ko Sriboya Khlong Thom Tai Huai Nam Khao Khlong Yang Ko Klang Ko Lanta Noi Saladan Ko Lanta Yai Khlong Phon Sai Khao MEAN SD MIN-MAX Plate 8

15 ID SUBDISTRICT POPULATION CRUDE DEATH UNDER 5 DEATH RATE (/1,000) RATE (/1,000) 60 Khao Mai Kaeo Bo Hin Mai Fat Bang Sak Ko Libong Na Klua Kan Tang Tai Ban Na Hat Samran Tase Suso Ko Sukon Tha Kham MEAN SD MIN-MAX Plate 9

16 ID SUBDISTRICT POPULATION CRUDE DEATH UNDER 5 DEATH RATE (/1,000) RATE (/1,000) 73 Na Thon Thung Bu Lang Khon Khlan Laem Son Kamphaeng Pak Nam La Ngu Ko Sarai Sakhon Tha Phae Chebilang Ban Khuan Tanyongpo Khlong Khut Puyu MEAN SD MIN-MAX Plate 10

17 VITAL NEEDS These indicators focus on specific and basic needs such as food, water, and sanitation which require immediate responses 2 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 improved source % Population without basic sanitation facilities Measles immunization coverage % Low birth weight (LBW) newborns % Children <5 who are underweight % Children <5 who are wasting Figure 3a. Vital Needs Indicators in Tsunami-affected Districts Thailand, 2006

18 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%. 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 Krabi province 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.

19 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.

20 Plate 11

21 Plate 12

22 Plate 13

23 Plate 14

24 Plate 15

25 Plate 16

26 ID SUBDISTRICT POPULATION % WITH ACCESS TO WATER % WITHOUT BASIC SANITATION % MEASLES IMMUNIZATION COVERAGE % LBW % UNDER WEIGHT % WASTING 1 Sai Daeng Pak Nam Ngao Ko Phayam Ratchakrut Kapoe Muang Kluang Bang Hin Na Kha Kamphuan MEAN SD MIN-MAX Plate 17

27 ID SUBDISTRICT POPULATION % WITH ACCESS TO WATER % WITHOUT BASIC SANITATION % MEASLES IMMUNIZATION COVERAGE % LBW % UNDER WEIGHT % WASTING 11 Khura Ko Phra Thong Bang Wan Ko Kho Khao Bang Muang Khukkhak Lam Kaen Thung Maphrao Thai Muang Na Toei Khok Kloi Lo Yung Khlong Khian Ko Yao Noi Ko Yao Yai Phru Nai MEAN SD MIN-MAX Plate 18

28 ID SUBDISTRICT POPULATION % WITH ACCESS TO WATER % WITHOUT BASIC SANITATION % MEASLES IMMUNIZATION COVERAGE % LBW % UNDER WEIGHT % WASTING 27 Mai Khao Sa Khu Choeng Tale Kammala Karon Rawai Chalong Wichit Ratsada Ko Kaeo Pa Khlok MEAN SD MIN-MAX Plate 19

29 ID SUBDISTRICT POPULATION % WITH ACCESS TO WATER % WITHOUT BASIC SANITATION % MEASLES IMMUNIZATION COVERAGE % LBW % UNDER WEIGHT % WASTING 38 Laem Sak Ao Luk Noi Khao Khram Khao Thong Nong Tale Ao Nang Sai Thai Khlong Prasong Nua Khlong Khlong Khamot Talingchan Khlong Khanan Ko Sriboya Khlong Thom Tai Huai Nam Khao Khlong Yang Ko Klang Ko Lanta Noi Saladan Ko Lanta Yai Khlong Phon Sai Khao MEAN SD Min-Max Plate 20

30 ID SUBDISTRICT POPULATION % WITH ACCESS TO WATER % WITHOUT BASIC SANITATION % MEASLES IMMUNIZATION COVERAGE % LBW % UNDER WEIGHT % WASTING 60 Khao Mai Kaeo Bo Hin Mai Fat Bang Sak Ko Libong Na Klua Kan Tang Tai Ban Na Hat Samran Tase Suso Ko Sukon Tha Kham MEAN SD Min-Max Plate 21

31 ID SUBDISTRICT POPULATION % WITH ACCESS TO WATER % WITHOUT BASIC SANITATION % MEASLES IMMUNIZATION COVERAGE % LBW % UNDER WEIGHT % WASTING 73 Na Thon Thung Bu Lang Khon Khlan Laem Son Kamphaeng Pak Nam La Ngu Ko Sarai Sakhon Tha Phae Chebilang Ban Khuan Tanyongpo Khlong Khut Puyu MEAN SD Min-Max Plate 22

32 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 % Population without basic sanitation facilities Measles immunization coverage % Children <5 who are underweight * 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).

33 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

34 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 population (in-patient and maternity) No. of outpatient consultations/person/year % Children months who are fully immunized against all antigens Adequate antenatal coverage (at least 4 visits during a pregnancy) No. of health facilities with Emergency Obstetric Care per 10,000 population % Birth attended by skilled birth attendant % Subdistrict covered by outreach psychological support by community workers

35 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 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 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.

36 Figure 5b. Access to Basic Social Services in Tsunami-affected Districts Thailand, 2006 The number of outpatient consultations per person/year average at ; 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 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.

37 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% 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.

38 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.

39 Plate 23

40 Plate 24

41 Plate 25

42 ID SUBDISTRICT POPULATION % MONTHS WHO % WITH ADEQUATE % BIRTHS BY SKILLED ARE IMMUNIZED ANTENATAL CARE BIRTH ATTENDANTS 1 Sai Daeng Pak Nam Ngao Ko Phayam Ratchakrut Kapoe Muang Kluang Bang Hin Na Kha Kamphuan MEAN SD Min-Max Plate 26

43 ID SUBDISTRICT POPULATION % MONTHS WHO % WITH ADEQUATE % BIRTHS BY SKILLED ARE IMMUNIZED ANTENATAL CARE BIRTH ATTENDANTS 11 Khura Ko Phra Thong Bang Wan Ko Kho Khao Bang Muang Khukkhak Lam Kaen Thung Maphrao Thai Muang Na Toei Khok Kloi Lo Yung Khlong Khian Ko Yao Noi Ko Yao Yai Phru Nai MEAN SD Min-Max Plate 27

44 ID SUBDISTRICT POPULATION % MONTHS WHO % WITH ADEQUATE % BIRTHS BY SKILLED ARE IMMUNIZED ANTENATAL CARE BIRTH ATTENDANTS 27 Mai Khao Sa Khu Choeng Tale Kammala Karon Rawai Chalong Wichit Ratsada Ko Kaeo Pa Khlok MEAN SD Min-Max Plate 28

45 ID SUBDISTRICT POPULATION % MONTHS WHO % WITH ADEQUATE % BIRTHS BY SKILLED ARE IMMUNIZED ANTENATAL CARE BIRTH ATTENDANTS 38 Laem Sak Ao Luk Noi Khao Khram Khao Thong Nong Tale Ao Nang Sai Thai Khlong Prasong Nua Khlong Khlong Khamot Talingchan Khlong Khanan Ko Sriboya Khlong Thom Tai Huai Nam Khao Khlong Yang Ko Klang Ko Lanta Noi Saladan Ko Lanta Yai Khlong Phon Sai Khao MEAN SD Min-Max Plate 29

46 ID SUBDISTRICT POPULATION % MONTHS WHO % WITH ADEQUATE % BIRTHS BY SKILLED ARE IMMUNIZED ANTENATAL CARE BIRTH ATTENDANTS 60 Khao Mai Kaeo Bo Hin Mai Fat Bang Sak Ko Libong Na Klua Kan Tang Tai Ban Na Hat Samran Tase Suso Ko Sukon Tha Kham MEAN SD Min-Max Plate 30

47 ID SUBDISTRICT POPULATION % MONTHS WHO % WITH ADEQUATE % BIRTHS BY SKILLED ARE IMMUNIZED ANTENATAL CARE BIRTH ATTENDANTS 73 Na Thon Thung Bu Lang Khon Khlan Laem Son Kamphaeng Pak Nam La Ngu Ko Sarai Sakhon Tha Phae Chebilang Ban Khuan Tanyongpo Khlong Khut Puyu MEAN SD Min-Max Plate 31

48 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 months who are fully immunized against all antigens Adequate antenatal coverage (at least 4 visits during a pregnancy) % Birth attended by skilled birth attendant * using rook contiguity The global Moran s I for the % children 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

49 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).

50 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 reconstruction % Damaged/destroyed health facilities % Health facilities rebuilt or rehabilitated No. of districts Mean SD Min Max 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

51 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.

52 REFERENCES 1. Faculty of Tropical Medicine, Mahidol University. GIS Mapping of Health Facilities in the 6 Tsunami-affected Provinces in Southern Thailand United Nations, World Health Organization, and International Federation of Red Cross and Red Crescent Societies. Tsunami Recovery Impact Assessment and Monitoring System Anselin L. An Introduction to Spatial Autocorrelation Analysis with GeoDa Anselin L. Exploring Spatial Data with GeoDa : A Workbook. Revised version. 2005

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

54 ANNEX II Checklist for HEALTH CENTER Health Center. Address..... Tel. Fax. B 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 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

55 ANNEX III Checklist for HOSPITAL Hospital. Address..... Tel. Fax. C 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 4) Availability of Emergency Obstetric Care in this hospital 5) % of low birth weight (LBW) newborns 6) Adequate antenatal coverage (at least 4 visits during pregnancy) (%) Yes No Collector Position Date

56 ANNEX IV แบบบ นท กข อม ลจากส าน กงานสาธารณส ขอ าเภอ โครงการส ารวจค ณภาพช ว ตของประชาชนในพ นท ประสบภ ยคล นส นาม ส าน กงานสาธารณส ขอ าเภอ... A ท อย : เลขท หม ท... บ าน... ต าบล... อ าเภอ... จ งหว ด... โทรศ พท... โทรสาร... ด ชน สาธารณส ขป จจ บ นในประชากรท อย ในความร บผ ดชอบของส าน กงานสาธารณส ขอ าเ ภอน 1. อ ตราตายอย างหยาบ (Crude mortality rate) /1,000 ปชก. 2. อ ตราตายในเด กอาย ต ากว า 5 ป /1,000 ปชก. เด ก <5 ป 3. ร อยละของประชากรท ม น าใช จากแหล งน าท สะอาด ร อยละ 4. ร อยละของประชากรท ไม ได ร บการบร การพ นฐานด านส ขาภ บาล ร อยละ 5. อ ตราครอบคล มของการได ร บว คซ นป องก นโรคห ด ร อยละ 6. ร อยละของเด กต ากว า 5 ป ท ม ภาวะน าหน กต ากว าเกณฑ อาย ร อยละ 7. ร อยละของเด กต ากว า 5 ป ท ม ภาวะน าหน กต ากว าเกณฑ ความส ง ร อยละ 8. ร อยละของเด กเก ดใหม ท ม น าหน ก <2500 กร ม ร อยละ 9. ร อยละของเด กอาย เด อน ท ได ร บภ ม ค มก นโรคครบท กชน ดท ก าหนด ร อยละ 10. ร อยละของหญ งฝากครรภ ท ได ร บการตรวจก อนคลอดครบ 4 คร ง ร อยละ 11. ร อยละของการคลอดโดยแพทย /พยาบาล/ผด งครรภ ท ได ร บการอบรม แล ว ร อยละ 12. จ านวนต าบลท อย ในอ าเภอน ต าบล 13. จ านวนต าบลท ม ท มงานจ ตว ทยาให ความช วยเหล อหล งเก ดส นาม ต าบล 14. จ านวนสถาน อนาม ย ท อย ในความร บผ ดชอบของ สสอ. น แห ง 15. จ านวนสถาน อนาม ย ท เส ยหายจากคล นส นาม แห ง 16. จ านวนสถาน อนาม ย ท ได ร บการสร างใหม หร อฟ นฟ แล ว แห ง ผ บ นท ก... ต าแหน ง...

57 ว นท...

58 ANNEX V แบบบ นท กข อม ลจากสถาน อนาม ย โครงการส ารวจค ณภาพช ว ตของประชาชนในพ นท ประสบภ ยคล นส นาม B ช อสถาน อนาม ย... ท อย : เลขท หม ท... บ าน... ต าบล... อ าเภอ... จ งหว ด... โทรศ พท... โทรสาร... ด ชน สาธารณส ขป จจ บ นในประชากรท อย ในความร บผ ดชอบของอนาม ยน 1. อ ตราตายอย างหยาบ /1,000 ปชก. 2. อ ตราตายในเด กอาย ต ากว า 5 ป /1,000 ปชก. เด ก <5 ป 3. ร อยละของประชากรท ม น าใช จากแหล งน าท สะอาด ร อยละ 4. ร อยละของประชากรท ไม ได ร บการบร การพ นฐานด านส ขาภ บาล ร อยละ 5. อ ตราครอบคล มของการได ร บว คซ นป องก นโรคห ด ร อยละ 6. ร อยละของเด กต ากว า 5 ป ท ม ภาวะน าหน กต ากว าเกณฑ อาย ร อยละ 7. ร อยละของเด กต ากว า 5 ป ท ม ภาวะน าหน กต ากว าเกณฑ ความส ง ร อยละ 8. ร อยละของเด กเก ดใหม ท ม น าหน ก < 2500 กร ม ร อยละ 9. ร อยละของเด กอาย เด อน ท ได ร บภ ม ค มก นโรคครบท กชน ดท ก าหนด ร อยละ 10. ร อยละของหญ งฝากครรภ ท ได ร บการตรวจก อนคลอดครบ 4 คร ง ร อยละ 11. ร อยละของการคลอดโดยแพทย /พยาบาล/ผด งครรภ ท ได ร บการอบรม แล ว ร อยละ ผ บ นท ก... ต าแหน ง... ว นท...

59 ANNEX VI แบบบ นท กข อม ลจากโรงพยาบาลช มชน โครงการส ารวจค ณภาพช ว ตของประชาชนในพ นท ประสบภ ยคล นส นาม C ช อโรงพยาบาล... ท อย : เลขท หม ท... บ าน... ต าบล... อ าเภอ... จ งหว ด... โทรศ พท... โทรสาร... ด ชน สาธารณส ขป จจ บ นในประชากรท อย ในความร บผ ดชอบของโรงพยาบาลช มชนน 1. จ านวนประชากรท อย ในเขตร บผ ดชอบของโรงพยาบาลน คน 2. จ านวนเต ยงผ ป วยในและเต ยงคลอด เต ยง 3. จ านวนผ ป วยนอกต อป รายต อป 4. โรงพยาบาลน ม บร การผ ป วยภาวะฉ กเฉ นทางด านส ต ศาสตร หร อไม? ม ไม ม 5. ร อยละของเด กเก ดใหม (ท คลอดในร.พ.น ) ท ม น าหน ก <2500 กร ม ร อยละ 6. ร อยละของหญ งฝากครรภ ท ได ร บการตรวจก อนคลอดต งแต 4 คร งข นไป ร อยละ ผ บ นท ก... ต าแหน ง... ว นท...