I. INTRODUCTION
1.1 Country Profile
Geography
Thailand is the third largest country in Southeast Asia, with a total of 514,000 square kilometers, extends about 1,620 kilometers from north to south and 775 kilometers from east to west. It is bordered by the Lao People’s Democratic Republic to the northeast. The Union of Myanmar to the north and west. The Kingdom of Cambodian and the gulf of Thailand to the east and Malaysia to the South. The population is about 63 million, of which 7 million live in Bangkok.
Thailand is roughly divided into four main regions and it is blessed with outstanding geological features. In the North, the high mountains give rise to several rivers and streams. In the Northeast, a high plateau represents what is known as "Isan," while an enormous plain covers the Central region. The South is bordered on both sides by seas, which facilitate communication with other countries.
Map of Thailand
Climate
Thailand is a warm and rather humid tropical country with three distinct seasons:
Summer: from March - May.
Rainy: from June - October.
Cool Season: from November - February
The average annual temperature is 28 degrees Celsius, with the north typically cooler than the south at most times of the year.
Religion
Thai society provides religious freedom. Buddhism is the national religion of Thailand and is practiced by 95 percent of the population. Muslims accounts for 3.7 percent, Christianity accounts for 0.6 percent, Hindus accounts for 0.1 percent, Sikhs, Baha’i Faith and others accounts for 0.6 percent.
Language
The national and official language is Thai while English is widely spoken and understood in major cities and particularly in Bangkok and business circles. Ethnic and regional dialects also are spoken, as are various dialects of Chinese.
Government
Thailand is governed by a constitutional monarchy with His Majesty King Bhumibol Adulyadej as Head of State. Official power rests with the government, personified by the Prime Minister, the Parliament, and a bureaucratic system that reaches down to the village level.
Legislation
Legislative power is vested in the Parliament, and exercised through a bicameral National Assembly consisting of the publicly elected House of Representatives and the Senate. The Parliament must approve all legislative matters of national policy, which then require the King's signature before becoming the law of the land.
Administrative Divisions
Thailand has 76 provinces (changwat), including Bangkok Municipality. The provinces are divided into 769 districts (amphoe), 81 subdistricts (kingamphoe), 7,255 rural administrative subdistricts (tambon), and 76,865 villages (muban).
Current Administrative System (Figure 1)
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Figure 1: Current Administrative System in Thailand
Central Administration
The King is the Head of State, who exercise the legislative power through the parliament, the administrative of executive power through the cabinet, and the judicial power through the courts.
The Thai government has been a constitutional monarchy, national polls elect the Prime Minister, and members of the Lower House or the House of Representatives, with four years term. The senators of the Upper House, with six years term are appointed by the Prime Minister. The House of Representatives is responsible for the legislation, while the Senate votes on constitutional changes. The King appoints all judges who sit on Thailand’s Supreme Court.
The central administrative system consists of 20 ministries as shown in figure1. In each ministry, there are several departments or agencies equivalent to a department. Totally, there are 156 departments in all ministries.
Provincial Administration
The provincial government function means functions of various ministries and departments as delegated to the regional or provincial level, under the regional or provincial level, under the supervision of the provincial governor which assigned officials from various central administrative agencies. Only some provincial administrative functions are carried out by the provincial level officials with delegations from the central administration. Such functions, however, are subject to scrutiny and revision by the central level agencies who have the final decision-making authority.
Local Administration
Local Administration means autonomous administrative authority of the people in each administrative locality, under the law, with at least four characteristics as follows:
· Being a juristic person
· Local administrators or local council members are all or partially elected by the people
· Having their own revenue and budget
· Having administrative autonomy under the laws.
In Thailand, there are four types of local administrative bodies, namely, Provincial Administrative Organizations, Municipalities, Sanitary Districts, and other types of local authorities as designated by laws, i.e., Bangkok Metropolitan Administration, Pattaya City, and Tambon (Subdistricts) Administrative Organizations.
Welfare
Thailand has social welfare and social insurance systems. Social welfare involves welfare services aimed at the poor, persons with disabilities, children, the elderly, women, minority hill tribes, and other disadvantaged individuals. The social insurance system provides sickness, maternity, disability, death, dependent child, old age, and unemployment benefits. There also is a social security system for private-sector employees and medical security and pension systems for public-service employees, employees of national enterprises, and military personnel.
1.2 Overview of past and present health
Generally, the health of Thai people has been improving significantly. Life expectancy at birth has improved from 55.9 to 69.9 years for males, and from 62.0 to 74.9 years for females. In year 2020, it is projected that the life expectancy will be 72.2 years and 76.5 years, for males and females, respectively (Table 1). However, important causes of infant deaths continue to be infectious diseases (respiratory system), congenital malformations, deformation and chromosomal abnormalities and certain conditions originating in the prenatal period. The major causes of death among Thai people of all ages are external causes and other accidents, communicable diseases which include cardiovascular diseases, malignant neoplasms (cancers) and respiratory diseases.
Over the years, the paradigm of health development in Thailand has shifted from the routine needs of a developing country to the multi-dimensional concerns of an advancing developing country. While there is ample evidence suggesting that some chronic conditions like lung cancer or ischemic heart diseases could be prevented in the medium period through life-style changes, short term likelihood of cure is strongly related to proper medical, surgical or radiation needed. Furthermore, Thailand has been facing the shortage of qualified medical personnel needed for accomplishing the quality services.
In addition, micronutrient deficiency is also one of the main healthcare problems in Thailand. Much effort has been made to solve this problem through various methods such as supplementation, campaign to consume food rich in the problem element, food fortification or food-food fortification.
Table 1. Life expectancy at birth (Year)Year / Male / Female
1964-65 / 55.9 / 62.0
1974-76 / 58.0 / 63.8
1985-86 / 63.8 / 68.9
1990-95 / 68.6 / 73.4
1995-96 / 69.9 / 74.9
1995-2000 / 69.4 / 74.1
2000-05 / 70.2 / 74.7
2005-10 / 71.0 / 75.4
2010-15 / 71.6 / 75.9
2015-20 / 72.2 / 76.5
Source: Report on Population Change Survey 1995-1996, National
Statistical Office, MICT.
As shown in Figure 2, there has been a markedly decreasing trend in infant mortality from 1964 to 1996, infant deaths per 1,000 live birth was recorded as high as 84.3 in 1964, and 26.1 in 1996, and is estimated to decrease as low as 22.8 in 2014.
Figure 2. Infant mortality rate: 1964-2014
The mortality rate of children per 1,000 population under the age of five was also on a decreasing trend from 4.0% in 1983 to 1.5% in 1997, but during the 1997 economic crisis, the rate had increased to 2.8%, and continuously decreased in 2001 to 1.9% (Figure 3).
Figure 3. Mortality rate of under five years old children: 1983-2001
Moreover, overweight has become an emerging concern in the country. As revealed during September 1999 to May 2000 surveillance of 12 health promotion centers, 13.6%, 13.8% and 12.9% school children, grade 1-6 pupils, and kindergarten, respectively, were overweight. While there has been improvement in the life expectancy of the Thais, epidemiological evidences have shown (Figure 4) that lifestyle-and diet-related disorders such as heart diseases and cancer are the leading and increasing causes of death from 1967 to 2001. Death rate caused by cardiovascular disease increased tremendously, from 16.5% in 1967 to as high as 79.5% in 1996, and by 30.29% in 2001. Similarly, cancer death toll had increased from the figure of 1967 (12.6%) to 68.44% in 2001. AIDS is becoming an emerging public health concern since 1989. Estimates of number of people with HIV/AIDS in Thailand using the
Asian Epidemic Model (AEM) suggested that in 2001, there were 984,000 HIV infected case among Thai population, of whom 289,000 had died. The AIDS death rate per 100,000 population was recorded 9.21 in 1996.
Figure 4. Death rates due to major causes among Thai population: 1967-2001
Pneumonia, the first leading cause of death among children, had dropped significantly from 1967 to 1987, but increased in 2000 and 2001.
Death as caused by diarrhea has a significant declining trend, the figure decreased from 27.6% in 1967 to 0.32% in 2001. However, the effect of crisis could also be seen when looking at the incidence rate of acute diarrhea (Figure 5), which recorded highest in 1998.
Figure 5. Incidence rate of acute diarrhea among Thai population: 1990-2002
II. CONCEPTUAL FRAMEWORK
Nutritional surveillance system is established to monitor the food and nutrition conditions of the disadvantaged groups of the population at risk. Since the initial specification of a general strategy for nutritional surveillance in the mid seventies, a number of specialized systems have evolved to address particular application areas (Mason et al., Rothe & Habicht, in press). There are as followings: policy and planning in the medium-to-long term; timely warning and intervention for famine prevention; and programme management and evaluation.
The nutritional surveillance system in Thailand has been developed from the country’s experience in solving malnutrition of Thai children during the fifth national food and nutrition plan (1982-1986). Growth of malnourished children (under five years old) are initiated and monitored by responsible organizations of MoPH, nutrition division and 71 provincial health offices from 1982. Coordination among nutritionists, health officers, village health communicators (VHCs) and village health volunteers (VHVs) were developed for this purposes. The growth monitoring was set as one of surveillance system tools. Weight by age is one of the significant indicators, interpreted by growth chart which was applied from Gomez classification. At that time, data can be collected from 800,623 children, 71 provinces. The result presented that 51.23% of Thai children were affected from undernutrition.
Hence this concept of surveillance system was seriously taken under national food and nutrition plan. Malnutrition eradication programs were conducted in many nutrition promotion and nutrition education programs such as breast feeding, complementary food, food coupon, nutritious diet via day care centers and school lunch program etc. Finally, Thailand has been succeeded in the nutrition programs for decreasing prevalence rate of undernutrition (see annex 1 figure 9). On the other hand, the overnutrition are rapidly emerged. This challenging lead Thai nutritional teams to seek an effective nutrition surveillance system for covering these double burden (over and under nutrition).
Nutrition surveillance system
Thailand nutritional surveillance system started from a simple problem- identification procedure at village level. It has been launched and has successfully initiated community participation. The outstanding nutrition surveillance system is conducted among Thai children under five years old.
Thailand nutritional surveillance system consists of many activities, run by health officers, caregivers, village health volunteers (VHVs). It can be shown in figure 6.
Figure 6 Nutrition surveillance system in Thailand
III. OBJECTIVES OF THE FOOD AND NUTRITION SURVEILLANCE SYSTEM
· To monitor the growth of Thai children under five years old
· To monitor and evaluate intervention outcomes of nutrition programs
· To identify trends in nutrition status over time
· To build capacity to health officers for growth monitoring programs
· To facilitate information sharing at national and international levels
· To formulate of food and nutrition policies and plans
IV. IMPLEMENTATION PROCEDURES
· Indicators Collected
Nutritional Status Indicators
The child’s age, sex, and measurements of weight and length or height will be used to interpret nutritional status as described in following table:
Table 2 Nutritional Status Indicators (WHO)
Indicators / Cut of points / Nutritional Status InterpretationWeight-for-age / > + 2 SD / overweight
+ 2 SD to > + 1.5 SD / Rather high standard
+ 1.5 SD to - 1.5 SD / Normal or standard weight
> -1.5 SD to -2 SD / Rather low standard
<- 2 SD / underweight
Height-for-age / > + 2 SD / Higher than standard
+ 2 SD to > + 1.5 SD / Rather high standard
+ 1.5 SD to - 1.5 SD / Normal or standard height
> -1.5 SD to -2 SD / Rather low standard
<- 2 SD / stunting
Weight-for-height / > + 2 SD / obesity
+ 2 SD to > + 1.5 SD / Rather high standard
+ 1.5 SD to - 1.5 SD / Normal or standard level
> -1.5 SD to -2 SD / Rather low standard
<- 2 SD / wasting
Generally, trends in weight-for-length or weight-for-age in children (especially between 6 months and two years) will be more sensitive to stress resulting from inadequate food consumption and/or infection in the short run, while trends in length-for-age (2-5 year olds) provide information on long-term changes in the environment and their nutritional consequences. At the present, anthropometry will continue to be used for monitoring the health and well-being of populations vulnerable to food insecurity and famine.
A simple weighing technique and growth references were found to be very good tools for problem identification and led to community participation in other nutrition activities, such as nutrition education, locally produced supplementary food, self- monitoring feeding stations, etc.
· Data Collection, Analysis and Reporting
At the first period of nutritional surveillance in Thailand, regular home visit of village health volunteers (VHVs) is effective method to data collection. Once per three months, data can be flow to health system. However, clinical based data is other strong one for data collection. Well child clinic for immunization and growth monitoring are strengthen activities for health care system.