Background:Violence against children remains a substantial public health concern in Thailand. We evaluated whether a blended in-person and online messaging-based parenting programme could reduce child maltreatment. Methods:We conducted a parallel, two-arm, cluster-randomised, assessor-blinded trial in 12 sub-district health-promoting hospitals in Udon Thani, Thailand. Primary caregivers aged 18 years or older living with a child aged 2-17 were enrolled and randomised 1:1 to intervention or control (n = 240; approximately 20 per cluster). The nine-week intervention combined two brief in-person meetings with facilitated LINE™ (a widely used messaging application in Thailand) group chats. The primary outcome was the frequency of physical or emotional abuse in the past four weeks, assessed at one-month post-programme. Analyses were conducted on an intention-to-treat (ITT) basis using mixed-effects negative binomial models. Registered with the Open Science Framework (May 18, 2024; DOI 10.17605/OSF.IO/AB7GR; protocol available at https://osf.io/ysrku/overview?view_only=f0165cd340ef40e7ba2b0c5c79b6cbbf). Findings:Between 18 May and 2 June 2024, 240 caregivers were enrolled (120 per arm; 97.1% women). One-month follow-up was 90.0% (108/120) in the intervention and 91.7% (110/120) in the control arms. Overall child maltreatment showed no significant differences between groups (incidence rate ratio [IRR] 1.46, 95% confidence interval [CI] 0.83-2.57). No differences were observed for physical abuse (IRR 0.70, 95% CI 0.30-1.62). The relative estimates for emotional abuse was higher in the intervention arm (IRR 2.57, 95% CI 1.27-5.20). Interpretation:Results suggest no reductions in child maltreatment in the intervention group at one-month follow-up. The higher estimate for emotional abuse may reflect differential reporting or changes in awareness between groups. These findings suggest areas for refinement in intervention content and delivery. Future trials should target higher-risk participants and assess longer-term outcomes. Funding:The LEGO Foundation, Oak Foundation, and World Childhood Foundation via the Global Parenting Initiative.

Thailand introduced medical cannabis in February 2019. This study aims to monitor cannabis-related healthcare utilisation after this introduction. A three-year surveillance system was established in 2021, comprising: (1) monitoring cannabis-related healthcare visits within the medical cannabis-service system and (2) assessing cannabis use outside of this system in psychiatric hospitals, youth detention centres, and emergency departments. During the first surveillance year (June 2021–May 2022), the Thai healthcare system rapidly expanded cannabis services, with 90.4

BACKGROUND:Violence against children poses short- and long-term risks to health, society and economy. The Parenting for Lifelong Health for Young Children (PLH-YC) programme has been shown to be effective in reducing child maltreatment for 2- to 9-year-old children in Thailand. We assessed the costs and budget requirements across multiple scenarios for scaling up the PLH-YC programme in Thailand. METHODS:Five scaling-up scenarios at varying levels were identified through a consultative workshop and semistructured interviews, with implementation planned via existing infrastructures. A bottom-up costing approach was employed to estimate the cost and budget impact using data collected through document review, website search and interviews. Costing was performed using the provider's and societal perspectives. RESULTS:The cost per caregiver based on the societal perspective ranged from 262 to 300 USD (1 USD = 35.36 THB in 2024). From the provider's perspective, the cost per caregiver trained was estimated at 82-195 USD. Assuming nationwide programme implementation, the estimated total budget impact for 1 year ranged from 50 to 76 million USD. CONCLUSIONS:Scaling-up PLH-YC incurs different unit costs per caregiver depending on the levels of programme delivery. However, budget requirements for all scenarios can be prohibitively high. To increase financial feasibility, programme modifications while maintaining quality, such as fewer parenting sessions or hybrid implementation, should be explored. Strong political commitment and financial support by key stakeholders are necessary for programme adoption and scaling up.

The COVID-19 pandemic constituted a public health emergency in Thailand from March 2020 to October 2022, testing the resilience of the health financing system. This study establishes an analytical framework to examine Thailand’s public health financing arrangements and their subsequent impacts on public hospital financial reserves during this crisis. This mixed-methods study developed an analytical framework to examine Thailand’s public health financing response. The study analyzed COVID-19 public health expenditure data (Fiscal Years (FY) 2020–2022) and financial data from 866 Ministry of Public Health hospitals (FY 2015–2022) using descriptive statistics and trend analysis. These quantitative findings were integrated with a thematic analysis of 21 key informant interviews. Thailand enhanced health financing resilience through adaptive revenue mobilization and flexible resource allocation. Between FY 2020 and 2022, the government expanded fiscal space by mobilizing approximately US13.78 billion via the Emergency Loan Decrees, Central Budget, and Social Security Fund. Universal Health Coverage (UHC) mechanisms expanded service coverage and expedited provider reimbursement. During delayed loan disbursements, public hospitals used internal financial reserves to bridge funding gaps and maintain service continuity. Consequently, net hospital reserves increased substantially by the pandemic’s end compared to pre-pandemic baselines. Thailand strategically leveraged its UHC system and mobilized emergency and pre-existing public funds to secure fiscal space and maintain system resilience. However, temporary funding influxes may mask localized resource strains on hospital financial reserves. To enhance future resilience, Thailand should establish a dedicated health emergency reserve fund, streamline extra-budgetary mechanisms, and adopt flexible procurement regulations.

Background With the influx of data, researchers, public health specialists and policymakers have been able to monitor disease trends and evaluate health services worldwide. However, in the member states of the Association of Southeast Asian Nations (ASEAN) countries, the current circumstances around data availability and related issues are not widely discussed.Objectives This study will review and compare the availability, accessibility and ownership of nationally representative individual-level quantitative health-related datasets in the ASEAN countries. Moreover, the author affiliation patterns of the first, last and corresponding authors of relevant articles will also be reviewed.Methodology A scoping review will be conducted via a literature review and a website search. Relevant literature will be identified through the PubMed search engine and screened using the Covidence software. The websites of governmental and international organisations, as well as institutional data repositories, will be screened. The data extraction will be carried out in a pre-structured framework in an Excel sheet. The extracted data will be analysed using a content analysis approach. The review protocol was registered on Open Science Framework with registration Digital Object Identifier: https://doi.org/10.17605/OSF.IO/4T8AK.Ethical consideration As this review will only collect data from published literature, no ethical approval is required.Dissemination plan The findings will be published in an international journal and be disseminated at public health conferences and workshops.Duration of the study August 2024 to April 2025.

Strengthening primary health care (PHC) is essential for achieving universal health coverage, with effective financing playing a critical role in its success. Despite the increasing emphasis on PHC investment, securing sustainable public financing remains a significant challenge in the countries of the South-East Asia (SEA) Region. This study provides an overview of PHC financing arrangements in Bangladesh, Indonesia, Maldives, and Nepal, highlighting key challenges in these four countries. Data sources included the document review (87 documents included across the four countries) and key informant interviews (21 in total). Findings highlight the diverse approaches to PHC financing across the four countries, bringing out common and country-specific challenges. Our findings suggest that while PHC has been receiving more attention in policy agendas, underlying PHC financing functions still face many challenges. Some constraints stem from the existing health financing models within these countries, indicating a need for targeted reforms. Funding:WHO South-East Asia Regional Office.

Background Despite commitment to Primary Health Care (PHC), financing has been a persistent challenge in Southeast Asia, with limited discussions. To address this knowledge gap, this study explores three key financing mechanisms: revenue mobilization, pooling, and purchasing across the region. Methods A scoping review, with searches in PubMed, Scopus, Embase, and Google Scholar, was conducted. Screening was done via Covidence, with data extracted and analyzed in Excel using a framework analysis. Results Of 2521 sources, 171 were included. Limited information specific to PHC was found. Revenue mobilization mainly includes out-of-pocket payment, government funding, social insurance contributions, and a mix of government and external funding. Pooling for PHC financing was seen in Thailand, while other countries showed multiple levels of pooling under general health financing. The prevalent purchasing method for public facilities is line-item budgeting, with salaries as the primary payment method for healthcare providers. Some countries employ performance-linked methods and capitation for provider payments. Significant challenges include inadequate budget allocations, financial flow fragmentation, and poor coordination and low capacity for financial management. Conclusion Financing for PHC is found to be insufficient and inefficient, mainly using traditional mechanisms. Cross-country learning and collaboration can support the development of strategic PHC financing mechanisms.

The COVID-19 pandemic severely disrupted the delivery of essential health services (EHS) worldwide, contributing to excess morbidity and mortality from preventable conditions. Some countries employed innovative strategies that may have enabled their health systems to be more resilient than others in responding to COVID-19. This cross-country analysis aimed to identify beneficial practices and policies employed by six low- and middle-income countries (LMICs) in Asia, Sub-Saharan Africa and Latin America to maintain access to EHS while responding to COVID-19. Cross-country research partners (CCRPs) led a mixed methods assessment to identify best practices and strategies for COVID-19 response and continued provision of EHS between April 2021 and September 2022. A cross-country analysis was conducted to extract and thematically code best practices that were reported as beneficial by three or more study countries based on desk reviews, key informant interviews and quantitative and qualitative analyses. Cross-cutting enablers, barriers and lessons learnt were also documented. Cross-country themes include whole-of-government approaches; multisectoral collaboration and decision-making; early outbreak control measures; partnerships with the private sector; innovations in service delivery and health financing; a robust health workforce; adaptation of existing disease response capacities; and community engagement. Long-standing investments in health systems strengthening and preparedness, integrated health systems, public trust in government, leadership and political will, prior experience in responding to epidemics, strong primary healthcare systems, existing health financing mechanisms and provision of social and economic supports were identified as cross-cutting enablers. Lack of context-specific definitions for EHS, inequitable access to technology and lack of access to real-time, high-quality data were identified as challenges in study countries. This study provides valuable insights into the practices that may be considered beneficial and worthy of pursuit by other countries wishing to strengthen health system resilience and preparedness for future health emergencies. Further research is needed to evaluate the effectiveness of these practices in different settings.

Introduction Faced with a backdrop of an increasing chronic disease burden from an ageing global population compounded with rising healthcare costs, health systems are required to implement cost-effective, safe and equitable care through efficient service delivery models. One approach to achieving this is through Starfield’s 4Cs of primary healthcare (PHC), which delineates the key attributes of a high-performing PHC system that upholds the pillars of care coordination, first contact of care, continuity of care and comprehensive care. Therefore, this study aims to explore and elucidate the key themes and subthemes related to and extending beyond Starfield’s 4Cs of PHC by integrating findings from a comprehensive literature review and a qualitative study.Methods In this case study analysis, case studies of PHC systems from 19 countries were purposefully selected to represent a range of income levels and diversity in health systems and PHC landscapes. A review of existing literature of peer-reviewed articles, policy documents and technical reports made publicly available data on PHC was complemented with data obtained from 61 in-depth interviews with health systems experts from a larger study. The research team thematically analysed the data and organised the key themes and subthemes into a conceptual framework that is anchored on Starfield’s 4Cs of PHC.Results Broadly, we developed a conceptual framework with the 4Cs, placing providers and patients at the centre. The key subthemes that manifested from Starfield’s 4Cs included maximising the use of existing fiscal resources, leveraging technology, improving accessibility to health services and task sharing. Other relevant and overarching themes were the deployment of national frameworks, equity, healthcare provider retention, service integration, emergency preparedness and community engagement.Discussion The subthemes derived point health systems in the right direction based on the trialled and tested PHC models of various countries. Their strong points were highlighted in our case studies to depict how Starfield’s 4Cs are leveraged to strengthen PHC, and the themes we identified that went beyond the 4Cs are necessary considerations for modifying PHC policies going forward.Conclusion As the world enters an era of ageing populations and acute system shocks, PHC needs to be fortified and integrated into the more extensive system to protect the health of the population and safeguard the well-being of providers. Our conceptual framework offers health systems a glimpse of how this can be achieved.

ObjectivesEvaluate and compare the efficacy and safety of molnupiravir and favipiravir in outpatients with mild to moderate COVID-19 and at risk of severe COVID-19.MethodsIn an open-label, parallel-group, multicenter trial in Thailand, participants with moderate COVID-19 and at least one factor associated with severe COVID-19 were randomly assigned 1:1 to receive oral molnupiravir or oral favipiravir (standard of care). Phone calls for remote symptom assessment were made on Days 6, 15 and 29. Participants with worsening symptoms were instructed to return to the hospital. The primary endpoint was pulmonary involvement by Day 29, as evidenced by ≥2 of the following: dyspnea, oxygen saturation <92% or imaging.Results977 participants (487 molnupiravir, 490 favipiravir) were enrolled from 8 July 2022 to 19 January 2023. 98% had received ≥1 dose of COVID-19 vaccine and 83% ≥3 doses. By Day 29, pulmonary involvement occurred in 0% (0/483) in molnupiravir arm versus 1% (5/482) in favipiravir arm (-1.0%; Newcombe 95.2% CI: -2.4% to -0.0%; p=0.021); all-cause death in 0% (0/483) and <1% (1/482); COVID-19 related hospitalization in <1% (1/483) and 1% (3/482); treatment-related adverse event in 1% (5/483) and 1% (4/486); and serious adverse event in 1% (4/483) and 1% (4/486).ConclusionsFavipiravir and molnupiravir had a similar efficacy and safety profile. Whether either of the two reduced the risk of complications during the omicron era in this population with a low risk of pulmonary involvement and a high vaccine coverage remains unclear. There were no differences in any of the safety endpoints.Thai Clinical Trials Registry IDTCTR20230111009

In Thailand, there have been significant efforts, both at the organization level and at national level, to foster stronger health promotion in the workplace. Several workplace health promotion (WHP) programs have been implemented at the national level, and several initiatives launched by the entities under the Ministry of Public Health (MOPH). The Table 1 below shows the major national programs in Thailand. Their objectives align with the National Health Reform agenda, which aims to actively enhance health among Thai workers.1MOPH12th Thai national health development plan (2017-2021).2016https://dsic.moph.go.thGoogle Scholar Despite these efforts, WHP in Thailand is still limited,2Yan L.D. Hanvoravongchai P. Aekplakorn W. et al.Universal coverage but unmet need: national and regional estimates of attrition across the diabetes care continuum in Thailand.PLoS One. 2020; 15e0226286https://doi.org/10.1371/journal.pone.0226286Crossref Scopus (12) Google Scholar,3Pongutta S. Suphanchaimat R. Patcharanarumol W. Tangcharoensathien V. Lessons from the Thai health promotion foundation.Bull World Health Organ. 2019; 97: 213-220Crossref Scopus (25) Google Scholar and the country continues to face a rising health burden of non-communicable diseases.4Vichitaksorn N. Alongkorn C. Pimchanok K. Apiwattanakul P. Thanadka K. Report of estimated public health expenditure in the next 15 years. Thailand Development Research Institute.2018Google Scholar While 60–80% of enterprises reported having health promotion policy in the workplace, the majority are large scale enterprises or those in the industrial area,5Sithisarankul P. Punpeng T. Boonchoo S. Baikrai U. Healthy workplace indicators in Thailand: phase 2 (a pilot study).J Med Assoc Thai. 2003; 86: S271-S283Google Scholar, 6Sathumakit J. Chuenim S. Chanpet U. Khanaroek S. Health promotion situation of some workplaces in Krathumban district, Samut Sakhon province.J Public Health Dev. 2012; 10: 63-74Google Scholar, 7Kaewpan W. Kalampakorn S. Health status and health promoting behaviors among aging workers in Thailand.J Med Assoc Thai. 2012; 95: S16-S20Google Scholar with limited engagement of small to medium enterprises.Table 1List of national level WHP programs in the study.Program nameResponsible agenciesHappy workplaceThai Health Promotion FoundationHealthy organizationRaipoong (No tummy) AcademyDisease and Hazard-Free Enterprises with Physical and Mental Well-beingMOPH Department of Disease Control, Division of Occupational and Environmental DiseasesWellness centerMOPH Department of Disease Control, Division of Occupational and Environmental DiseasesHealthy workplace, Happy for lifeMOPH Department of Health, Bureau of Environmental Health"10 Packages" programMOPH Department of Health, Bureau of Health Promotion Open table in a new tab To understand the challenges facing national effort to promote more workplace health promotion, we conducted an extensive review and key informant interviews on these six national-level programs. Our findings revealed four important lessons on the factors contributing to the development of health promotion in the workplace. First, successful WHP requires strong engagement from all actors involved in the welfare and productivity of workers. The Ministry of Labour and the Ministry of Industry are key government agencies responsible for most formal sector employment in Thailand. However, they have not invested adequately in health aspect. Their roles are limited to be mainly in the public relations of the programs, while MOPH's personnel at provincial/regional levels are the main implementors of the interventions. It is imperative for the MOPH to work beyond health sector and engage these two ministries as well as other private stakeholders, such as the Federation of Thai Industries and the Thai Chamber of Commerce. These collaborations can lead to joint funding initiatives and resource pooling to support a common goal of improving employees' health. Second, the lack of coordination between different departments of the MOPH and between the MOPH and other organizations is a major shortcoming. While the MOPH is the national agency responsible for health, a number of divisions and departments have independently initiated their own programs without a clear coordination, resulting in numerous programs with similar policies and activities. This causes confusion among provincial teams implementing the programs with participating enterprises. Suggestions to harmonize these programs in the past had not been successful due to overlapping roles of each division, but it does not mean they should continue as is. The MOPH could define clear roles for each division and develop a harmonized policy, including a unified framework and evaluation criteria. National health reform movement is also a window of opportunity to unite all key players together for synergistic approaches towards a better WHP. Third, even though all six WHP support programs engage with employers and provided technical assistance to strengthen their capacity to deliver customized WHP activities, they fail to emphasize effective feedback mechanisms to collect and use information on health improvement and productivity gains to support enterprises' program evaluation and improvement. For example, none of the WHP programs promote the use of health screening data collected from annual checkups to support WHP efforts. At the enterprise level, some enterprises do not have questionnaires or formal assessment to evaluate health outcomes and productivity gains. Establishing an effective health information exchange between relevant public organizations, such as Social Security Office and the Department of Labour Protection and Welfare, could improve the effectiveness and efficiency of these programs by facilitating targeted health promotion interventions tailored to each enterprise's specific challenges. Fourth, new policy tools or interventions are necessary to shape employers and employees' behaviours. Four of the six national programs conducted performance evaluation of participating enterprises and provided certificates as rewards. Such recognition for enterprises already committed to health promotion is a weak incentive for others. Stronger financial policy by the relevant ministries, such as tax credits or a reduction in Social Security's Workmen Compensation Fund contribution, could be effective in encouraging broader program participation and facilitating more impactful WHP interventions. Countries like France, Germany, Italy, the United Kingdom, and Singapore have successfully provided tax credits related to health and well-being as one of their national level policies.8OECDPromoting health and well-being at work.2022https://www.oecd.org/health/promoting-health-and-well-being-at-work-e179b2a5-en.htmCrossref Google Scholar, 9German Federal Ministry of HealthWorkplace health promotion: tax benefits.2020https://gesund.bund.de/en/workplace-health-promotion-whpGoogle Scholar, 10Lee C.E. International profile of health care systems.2020https://www.commonwealthfund.org/sites/default/files/2020-12/International_Profiles_of_Health_Care_Systems_Dec2020Google Scholar In conclusion, national level WHP programs could be more effective through enhanced collaboration among organizations, leveraging on health information, and implementing new policies and incentives. The creation of harmonized national level WHP policies, new form of financial incentives and support, with better intelligence systems are necessary to incentivize stronger workplace health promotion practices in Thailand. JH and PH were involved in the initial design of the study. JH and CW developed the interview questionnaire and drafted the report. JH were responsible for data collection and drafted the initial manuscript, and all the authors contributed to its development and approved the final version. The data that support the findings of this study are available on request from the corresponding author from the date of publication. All authors have no conflicts of interest regarding this study. This research funding was supported by The National Health Foundation (NHF) as part of a research grant from the Health Systems Research Institute (HSRI) no.64-076. We are thankful for all informants from THPF, Raipoong academy, DOED, (DDC, MOPH), Bureau of Environmental Health, (DOH, MOPH) and Bureau of Health Promotion (DOH, MOPH) who participated in questionnaire surveys and interviews.

The COVID-19 pandemic presented a significant challenge to health systems worldwide, requiring resources to be directed to the pandemic response while also maintaining essential health services. Those with non-communicable diseases (NCDs) are particularly vulnerable to COVID-19, and interrupted care resulting from the pandemic has the potential to worsen morbidity and mortality.We used narrative literature review and key informant interviews between August 2021 and June 2022 to identify how NCD services were impacted during the pandemic and which good practices helped support uninterrupted care.On the background of an existing strong healthcare system, Thailand exhibited strong central coordination of the response, minimised funding interruptions and leveraged existing infrastructure to make efficient use of limited resources, such as through mobilising healthcare workforce. A key intervention has been redesigning NCD systems such as through the ‘New Normal Medical Services’ initiative. This has promoted digital innovations, including remote self-monitoring, patient risk stratification and alternative medication dispensing. Emphasis has been placed on multidisciplinary, patient-centred and community-centred care.NCD service utilisation has been disrupted during the COVID-19 pandemic; however, newly adapted efforts on top of existing robust systems have been critical to mitigating disruptions. Yet challenges remain, including ensuring ongoing evaluation, adaptation and sustainability of redesign initiatives. This learning offers the potential to further positive health systems change on a wider scale, through sharing knowledge, international collaboration and further refinement of the ‘new normal’ model.

BACKGROUND:The COVID-19 pandemic was a health emergency requiring rapid fiscal resource mobilisation to support national responses. The use of effective health financing mechanisms and policies, or lack thereof, affected the impact of the pandemic on the population, particularly vulnerable groups and individuals. We provide an overview and illustrative examples of health financing policies adopted in 15 countries during the pandemic, develop a framework for resilient health financing, and use this pandemic to argue a case to move towards universal health coverage (UHC). METHODS:In this case study, we examined the national health financing policy responses of 15 countries, which were purposefully selected countries to represent all WHO regions and have a range of income levels, UHC index scores, and health system typologies. We did a systematic literature review of peer-reviewed articles, policy documents, technical reports, and publicly available data on policy measures undertaken in response to the pandemic and complemented the data obtained with 61 in-depth interviews with health systems and health financing experts. We did a thematic analysis of our data and organised key themes into a conceptual framework for resilient health financing. FINDINGS:Resilient health financing for health emergencies is characterised by two main phases: (1) absorb and recover, where health systems are required to absorb the initial and subsequent shocks brought about by the pandemic and restabilise from them; and (2) sustain, where health systems need to expand and maintain fiscal space for health to move towards UHC while building on resilient health financing structures that can better prepare health systems for future health emergencies. We observed that five key financing policies were implemented across the countries-namely, use of extra-budgetary funds for a swift initial response, repurposing of existing funds, efficient fund disbursement mechanisms to ensure rapid channelisation to the intended personnel and general population, mobilisation of the private sector to mitigate the gaps in public settings, and expansion of service coverage to enhance the protection of vulnerable groups. Accountability and monitoring are needed at every stage to ensure efficient and accountable movement and use of funds, which can be achieved through strong governance and coordination, information technology, and community engagement. INTERPRETATION:Our findings suggest that health systems need to leverage the COVID-19 pandemic as a window of opportunity to make health financing policies robust and need to politically commit to public financing mechanisms that work to prepare for future emergencies and as a lever for UHC. FUNDING:Bill & Melinda Gates Foundation.

The COVID-19 pandemic had an inequitable and disproportionate impact on vulnerable populations, reversing decades of progress toward healthy populations and poverty alleviation. This study examines various programmatic tools and policy measures used by governments to support vulnerable populations during the pandemic. A comparative case study of 15 countries representing all World Health Organization's regions offers a comprehensive picture of countries with varying income statuses, health system arrangements and COVID-19 public health measures. Through a systematic desk review and key informant interviews, we report a spectrum of mitigation strategies deployed in these countries to address five major types of vulnerabilities (health, economic, social, institutional and communicative). We found a multitude of strategies that supported vulnerable populations such as migrant workers, sex workers, prisoners, older persons and school-going children. Prioritising vulnerable populations during the early phase of COVID-19 vaccination campaigns, direct financial subsidies and food assistance programmes were the most common measures reported. Additionally, framing public health information and implementing culturally sensitive health promotion interventions helped bridge the communication barriers in certain instances. However, these measures remain insufficient to protect vulnerable populations comprehensively. Our findings point to the need to expand fiscal space for health, enlarge healthcare coverage, incorporate equity principles in all policies, leverage technology, multi-stakeholder co-production of policies and tailored community engagement mechanisms.

Probiotics have been used to prevent dental caries in children. In this study we aimed to determine the cost-effectiveness of probiotic milk tablets to prevent dental caries among children who attended 12 selected daycare centers in Phayao Province, Thailand during June 2022-May 2023 in order to determine if probiotic-fortified milk tablets are a reasonable method to prevent dental caries among children aged 2-5 years. Inclusion criteria for study subjects were being aged 2-5 years, attending one of the study daycare centers and having parental consent to participate the study. Exclusion criteria for study subjects were cow's milk allergy, serious medical conditions, such as heart disease or asthma, abnormalities related to the palate or jaw, being unable to undergo an oral health examination or having developmental delay. Study subjects were divided into a control group and a treatment group. Treatment group subjects were given 3 milk tablets daily by the caregiver and oral hygiene instructions. Each milk tablet contained the probiotic Lactobacillus rhamnosus SD11, but the concentration of these organisms in each milk tablet were not recorded by the manufacturer. Each subject was examined by one of two study dentists at the beginning of study initiation and then every 4 months for 12 months to evaluate for the presence of caries. The price of the milk tablets and caregiver cost were recorded. The cost-effectiveness ratio (CER) was calculated as follows: CER = (average cost of caries prevention per child by the milk tablets per year) / (the difference in carious surfaces between the control group and the milk tablet group). The minimum number of study subjects calculated to be needed for the study was 208 based on the estimated prevalence of caries in the study population. A total of 260 subjects were initially enrolled in the study: 130 in the control and 130 in the intervention group. After the 12-month study period, there were a total of 222 participants, with 112 individuals in the control group and 110 individuals in the experimental group. The mean numbers of caries per subject in the control group at 4, 8 and 12 months were 5.69, 5.60 and 7.31, respectively. The mean numbers of caries in the intervention group at 4, 8 and 12 months were 3.04, 3.12 and 3.24 respectively. The p -values for the differences in the mean numbers of caries between the control and intervention groups at 4, 8 and 12 months were p=0.003, p=0.016 and p=0.001, respectively. The cost-effectiveness analysis showed it cost THB 369.93 to prevent one cavity per tooth surface per year. In summary, there were significantly fewer caries among study subjects in the intervention group than the control group but the intervention was costly. We conclude, this intervention can be used effectively to prevent caries in the study population but it was expensive. Further studies are needed to determine if this intervention can be applied to other populations of similar aged children and other ages of children and how the program can be financed or the cost reduced.

Data relating to contact mixing patterns among humans are essential for the accurate modeling of infectious disease transmission dynamics. Here, we describe contact mixing patterns among migrant workers in urban settings in Thailand, based on a survey of 369 migrant workers of three nationalities. Respondents recorded their demographic data, including age, sex, nationality, workplace, income, and education. Each respondent chose a single day to record their contacts; this resulted in a total of more than 8300 contacts. The characteristics of contacts were recorded, including their age, sex, nationality, location of contact, and occurrence of physical contact. More than 75% of all contacts occurred among migrants aged 15 to 39 years. The contacts were highly clustered in this age group among migrant workers of all three nationalities. There were far fewer contacts between migrant workers with younger and older age groups. The pattern varied slightly among different nationalities, which was mostly dependent upon the types of jobs taken. Half of migrant workers always returned to their home country at most once a year and on a seasonal basis. The present study has helped us gain a better understanding of contact mixing patterns among migrant workers in urban settings. This information is useful both when simulating disease epidemics and for guiding optimal disease control strategies among this vulnerable section of the population.

Background Diabetes is a growing challenge in Thailand. Data to assess health system response to diabetes is scarce. We assessed what factors influence diabetes care cascade retention, under universal health coverage. Methods We conducted a cross-sectional analysis of the 2014 Thai National Health Examination Survey. Diabetes was defined as fasting plasma glucose ≥126mg/dL or on treatment. National and regional care cascades were constructed across screening, diagnosis, treatment, and control. Unmet need was defined as the total loss across cascade levels. Logistic regression was used to examine the demographic and healthcare factors associated with cascade attrition. Findings We included 15,663 individuals. Among Thai adults aged 20+ with diabetes, 67.0% (95% CI 60.9% to 73.1%) were screened, 34.0% (95% CI 30.6% to 37.2%) were diagnosed, 33.3% (95% CI 29.9% to 36.7%) were treated, and 26.0% (95% CI 22.9% to 29.1%) were controlled. Total unmet need was 74.0% (95% CI 70.9% to 77.1%), with regional variation ranging from 58.4% (95% CI 45.0% to 71.8%) in South to 78.0% (95% CI 73.0% to 83.0%) in Northeast. Multivariable models indicated older age (OR 1.76), males (OR 0.65), and a higher density of medical staff (OR 2.40) and health centers (OR 1.58) were significantly associated with being diagnosed among people with diabetes. Older age (OR 1.80) and higher geographical density of medical staff (OR 1.82) and health centers (OR 1.56) were significantly associated with being controlled. Conclusions Substantial attrition in the diabetes care continuum was observed at diabetes screening and diagnosis, related to both individual and health system factors. Even with universal health insurance, Thailand still needs effective behavioral and structural interventions, especially in primary health care settings, to address unmet need in diabetes care for its population.

The COVID-19 is disproportionally affecting the poor, minorities and a broad range of vulnerable populations, due to its inequitable spread in areas of dense population and limited mitigation capacity due to high prevalence of chronic conditions or poor access to high quality public health and medical care. Moreover, the collateral effects of the pandemic due to the global economic downturn, and social isolation and movement restriction measures, are unequally affecting those in the lowest power strata of societies. To address the challenges to health equity and describe some of the approaches taken by governments and local organizations, we have compiled 13 country case studies from various regions around the world: China, Brazil, Thailand, Sub Saharan Africa, Nicaragua, Armenia, India, Guatemala, United States of America (USA), Israel, Australia, Colombia, and Belgium. This compilation is by no-means representative or all inclusive, and we encourage researchers to continue advancing global knowledge on COVID-19 health equity related issues, through rigorous research and generation of a strong evidence base of new empirical studies in this field.