SUCHAT HONGSIRIWON
REPORT FROM THAILAND
Thailand is a kingdom in Southeast Asia having an area of about 513,000 square kilometers and a population of 60 million. The main religion is Buddhism. Bangkok is the capital city. There are about 18 million children under 15 years old. The main child-health problems are respiratory, gastrointestinal, nutritional and infectious diseases. One of the main problems now is vertical transmission of HIV infection which will be presented later. The child health status of Thailand is as follows:
1. Neonatal death rate = 3.5 per 1000 live births.
2. Infant death rate = 7.4 per 1000 live births.
3. Under five years death rate = 1.9 per 1000 population
These statistics came from the Public Health Statistics 1993, Ministry of Public Health, Thailand. This was an under-estimation of about five fold when compared to the survey statistics (because this data was received from registered cases), and it represents the trend.
Chonburi is one of the provinces in the eastern (seaboard) area which is about 80 kilometers from Bangkok. It is an industrial, agricultural and a tourism province with beautiful scenery, such as Bangsaen and Pattaya beach, The Marine Science Aquarium, Khao Keay (Green Mountain) Open Zoo, Crocodile Farm and many Buddhist temples. The population is about one million.
Chonburi Regional Hospital and Medical Center, being one of 17 regional hospitals, was established in 1935. There are 727 beds, of which 100 beds are paediatric. They are divided into six sections; a sick newborn unit (25 beds); neonatal intensive care unit (nine beds); paediatric intensive care unit (six beds); non-contagious wards (20 beds); contagious wards (30 beds), and private wards ( 10 beds). There are eight paediatricians in the department of Paediatrics who respond to child health service and academic work. All of them work as general paediatricians together with subspecialists in Paediatrics.
In the academic role, there are instructors and teaching staff of medical students who study in the pre-clinical part for three years from Chulalongkorn Medical School, and the clinical part for three years at Chonburi Hospital. For the post-graduate-programme is divided into two groups; The Affinity Programme coupled with Chulalongkorn Medical School, consisting of one year at Chonburi Hospital and two years at Chulalongkorn Medical School; and the programme for doctors who work as residents of The Department of Paediatrics of Chonburi Hospital for 42 months. Both groups must complete the same evaluation of the Committee of Paediatrics in order to obtain the Diploma.
I work as a general paediatrician and infectious paediatric doctor and have worked in the paediatric infectious clinic since 1991 when I first established it for the purpose of caring for anti-HIV antibody positive children, The Poliomyelitis Eradication Programme of Thailand (Chonburi), and other infectious diseases such as meningitis, mellioidosis, tuberculosis, etc. The majority of patients being anti-HIV antibody positive are followed up by clinically base on the modified WHO criteria for diagnosis of symptomatic HIV infection in Thailand as follows:
Major signs
Weight loss or failure to thrive
Chronic diarrhea > one month
Chronic fever > one month
Persistent or severe lower respiratory tract infection
Minor signs
Generalized lymphadenopathy/Hepatosplenomegaly
Oral thrush
Repeated common infections (otitis, pharyngitis)
Generalized dermatitis
Confirmed maternal/children HIV infection
Paediatric AIDS is suspected in a child who presents at least two major signs associated with two minor signs in the absence of a known cause of immunodeficiency.
Laboratory investigations are limited to only CBC, CXR, anti HIV test by ELISA and gelatin particle agglutination technique and occasionally CD4 and CD8 count.
The clinical pictures of 993 cases of paediatric AIDS in Thailand up to the first half of 1994 by the modified WHO criteria is as follows:
Major signs
Weight loss 41%
Pneumonia 34%
Diarrhoea > one month 27%
Fever > one month 26%
Minor signs
Maternal HIV infection 46%
Lymphadenopathy / Hepatosplenomegaly 35%
Oral thrush 33%
Repeated common infections 14%
Dermatitis 12%
Most of these are from vertical transmission the rate of which is about 25-42%. And the national median ANC seroprevalence has increased from zero in 1989 to about 1.5% by the first half of 1994. Therefore the way to halt this increase cases is to decrease the paediatric AIDS via heterosexual and vertical transmission which is prevalent in Thailand now.
Finally I am going to show you some slides about my interesting cases from Chonburi.
