Journal of Medicine and Urban Health

Capitation Payment Schemes for Primary Health Care in Low- and Middle-Income Countries: A Scoping Review

2026-05-01T10:39:07+07:00

Objectives: This study aimed to examine the implementation and evaluation of capitation payment schemes in primary health care (PHC) across low- and middle-income countries (LMICs). In particular, it focused on how these schemes are being implemented in real-world settings where data in LMICs are limited. The study also aimed to identify challenges in implementation and assess the contextual factors that influence the sustainability of capitation-based health financing strategies.
Materials and Methods: A scoping review was conducted using the PRISMA extension for scoping reviews (PRISMA-ScR) framework to systematically gather and synthesize the existing literature in the Sustainable Development Goals period published between 2015 and 2024. A comprehensive search was carried out in PubMed, OvidSP, and Scopus using strategic keywords related to capitation payments, PHC, and LMICs. After 456 initial records were scrutinized, 40 full-text articles were included. The literature were evaluated for implementation attributes, effectiveness, contextual challenges, and policy characteristics. Data extraction and analysis followed the Population, Concept, Context framework and were validated by an independent evaluator.
Results: This research identified 12 LMICs across four continents that have adopted capitation payment schemes for PHC. A wide range of implementation strategies was observed, depending on the context of each country. Significant challenges were identified in data reliability, politically, budget allocation, and policy planning. Evidence gaps were particularly evident in low-income countries, particularly during the pre-implementation phase of policy design, and the lack of diverse outcome evaluations or policy assessments.
Conclusion: Capitation payment schemes present promising opportunities to strengthen PHC and advance universal health coverage goals in LMICs. However, their success is highly dependent on local political, economic, and institutional contexts. Tailored implementation strategies, robust monitoring systems, and improved pre-implementation planning are essential to enhance policy effectiveness and sustainability. Future research should focus on standardized evaluation frameworks throughout the implementation process and on distinguishing policy effects from implementation fidelity.

Epidemiological Status of Opisthorchis viverrini Metacercariae in Freshwater Fish Across the Greater Mekong Subregion

2026-06-10T15:52:31+07:00

Opisthorchis viverrini (a Group 1 biological carcinogen) remains a major public health problem in the Greater Mekong Subregion because of its strong association with cholangiocarcinoma. Given that human infection mainly occurs through the consumption of raw or undercooked cyprinoid fish containing infective metacercariae. This review summarizes the epidemiological status, geographical distribution, host specificity, and transmission dynamics of O. viverrini metacercariae in cyprinoid fish across Thailand, Lao People’s Democratic Republic (Lao PDR), Cambodia, Myanmar, and Vietnam. The reviewed studies demonstrated considerable geographical variation in O. viverrini metacercariae prevalence throughout the Greater Mekong Subregion, with particularly high endemicity reported in Cambodia and Lao PDR, especially within Mekong River-associated ecosystems. In Cambodia, prevalence reached 90.2% in cyprinoid fish from Kandal Province, whereas substantially lower prevalence levels were generally observed in inland regions of Thailand. Species-specific variation was also evident, with Cyclocheilichthys spp., Hampala dispar, and Systomus orphoides identified as important second intermediate hosts in the transmission cycle of O. viverrini. Seasonal fluctuations, aquatic ecology, environmental contamination, and inadequate sanitation were consistently associated with transmission intensity. The available evidence indicates that O. viverrini metacercariae remain widely distributed in freshwater ecosystems across the region, reflecting the persistent risk of fish-borne transmission in endemic communities. Strengthened surveillance of high-risk cyprinoid fish species, improved sanitation, and sustained behavioral interventions remain essential for reducing transmission and the long-term burden of cholangiocarcinoma in the region.

A Qualitative Study of the Practice Preferences for Low and Minimal Fresh Gas Flow Anesthesia Using In-Depth Interviews

2026-04-22T13:56:19+07:00

Objectives: This study primarily aimed to explore the preferences of anesthesia personnel for low (0.5–1.0 L·min−1) and minimal (< 0.5 L·min−1) fresh gas flow (FGF) techniques. The secondary objective was to identify factors influencing their decision-making.
Materials and Methods: After ethics approval, data were collected through in-depth interviews and nonparticipant observation over a 2-month period—from December 2022 to January 2023. This study included four anesthesiologists and six nurse anesthetists.
Results: All participants were females, and 30% were aged 31–40 years. Moreover, 40% had < 5 years of experience in anesthesiology. The duration of clinical practice ranged from 3 months to 28 years (median and mean of 6 years and 10.7 years, respectively). Additionally, 60% were not permanently assigned to a specific anesthesia service. Regarding FGF, 50% used 1.0–1.5 L·min−1, only 30% used 0.5–1.0 L·min−1, and none used < 500 mL·min−1. Five key factors influenced decision-making: personal factors (clinical knowledge and previous hand-on experience), equipment factors (appropriate equipment and monitoring support), patient factors (patient safety concerns and characteristics of the individual patient), institutional factors (practices, policies, and norms of the department), and environmental awareness factor (climate concern).
Conclusion: Low and minimal FGF anesthesia are not yet widely favored by anesthetic personnel in Vajira Hospital. This study shows that the routine use of low and minimal FGF anesthetic technique is influenced by various factors. Although knowledge and hands-on experience are crucial, decisions are also influenced by opinions of coworkers, hospital policies, standard practices, availability of monitoring and equipment, and healthcare financing models such as impact of fix-payment system. All of the abovementioned pose significant barriers to promote the safe and sustainable use of low and minimal FGF techniques.

Association between Frailty and All-Cause In-hospital Mortality in Elderly Patients in Internal Medicine Wards, Vajira Hospital

2026-06-10T15:52:33+07:00

Objectives: Geriatric syndromes such as frailty are becoming more significant in healthcare. Frailty is characterized by increased vulnerability to stressors and decreased physiological reserve in elderly people. Studies in the community and hospice care settings have shown relationships between frailty and morbidity, hospitalization, and mortality. This study aimed to investigate the association between frailty and short-term outcomes in hospitalized Thai older adults.
Materials and Methods: This prospective cohort study included 140 inpatient department patients aged ≥ 60. The patients or their close relatives were interviewed and assessed for frailty using the Thai version of the FRAIL scale within the first 48 hours of admission, and the patients were followed up at 2 and 4 months for in-hospital mortality. The evaluated secondary outcomes comprised 30-day readmission, length of stay, and hospital costs per day. Results were expressed using risk ratios and mean differences, with p < 0.05 indicating statistical significance.
Results: Among the 140 patients examined, 77 (55%) were determined to be frail according to the Thai FRAIL scale, and 63 (45%) were non-frail. In-hospital mortality rates were higher in the frail group than in the non-frail group 13 (16.9%) vs. 3 (4.8%). Multivariate analysis revealed that frail patients were 3.32 times more likely to die during admission than non-frail patients (adjusted risk ratios: 3.32; 95% confidence intervals: 1.12–9.86; p = 0.031).
Conclusion: Frailty was associated with higher short-term mortality among older adults admitted to a Thai hospital. Larger, multicenter studies are needed to confirm these findings.

Highly Effective Postpartum Contraceptive Use among Urban Thai Women with and without Gestational Diabetes Mellitus: A Comparative Cross-Sectional Study

2026-04-23T10:10:57+07:00

Objectives: Gestational diabetes mellitus (GDM) is associated with increased risks in subsequent pregnancies, making effective postpartum contraception essential. This study compared the use of highly effective contraceptive methods at 6 weeks postpartum in urban Thai women with and without GDM. The use of other contraceptive methods in both groups was also examined.
Materials and Methods: This comparative cross-sectional study was conducted at a tertiary care hospital in Bangkok, Thailand. Postpartum women attending routine 6-week follow-up visits between February 5, 2021, and July 7, 2021, were enrolled. Women with recent GDM were compared with women without GDM. The primary outcome was the proportion of women using highly effective contraception (female or male sterilization, or long-acting reversible contraception) at 6 weeks postpartum. Secondary outcomes included the use of non-highly effective contraceptive methods. Multivariable logistic regression evaluated associations between GDM status and contraceptive choice while adjusting for potential confounders.
Results: A total of 156 women were included (78 with GDM and 78 without GDM). The use of highly effective contraceptive methods did not differ significantly between the GDM and non-GDM groups (44.9% vs. 32.1%, p = 0.100). However, female sterilization was more frequently selected by women with GDM than by women without GDM (39.8% vs. 18%, p = 0.003). The use of non–highly effective contraceptive methods tended to be lower in the GDM group, although the difference did not reach statistical significance (39.8% vs. 55.1%, p = 0.054). After adjustment, GDM was independently associated with female sterilization selection (adjusted odds ratio, 1.96; 95% confidence interval, 1.03–4.72).
Conclusion: The overall use of highly effective contraception at 6 weeks postpartum did not differ significantly between urban Thai women with and without GDM. However, women with GDM more frequently selected female sterilization. The use of non-highly effective contraceptive methods was similar between the two groups.

Halving Sugar Intake Increases Sweet Taste Intensity in Thai Adults with Moderate to High Sugar Consumption: A Randomized Controlled Trial

2026-04-22T13:56:17+07:00

Objectives: To determine whether a 50% reduction in daily sugar intake increases sweet taste intensity among Thai adults, and whether changes in taste perception and dietary sugar intake persist after the restriction period ends.
Materials and Methods: A randomized, double-blind, controlled trial was conducted over 12 weeks among 52 healthy Thai adults. Participants were assigned to either a sugar-reduction group instructed to halve their daily sugar intake (n = 25) or a control group that maintained their usual diet (n = 27). Sweet taste intensity was evaluated using the general labeled magnitude scale at baseline, week 16 (end of restriction), and week 24 (after resumption of regular diet). The primary outcome was the proportion of participants with increased sweet taste intensity at week 16, while secondary outcomes included sweet taste intensity at week 24 and changes in dietary sugar intake.
Results: At week 16, significantly more participants in the intervention group reported heightened sweet taste intensity compared with the control group (64% vs 33.3%, p = 0.027). After participants resumed their usual diets at week 24, this difference was no longer statistically significant (44% vs 38.5%, p = 0.688). Dietary sugar intake significantly decreased during the intervention period, but partially rebounded after restriction was lifted. No significant between-group differences were observed in total energy intake or anthropometric outcomes.
Conclusion: A 12-week 50% sugar-reduction intervention increased sweet taste intensity. However, both taste perception and dietary behaviors partially reverted after the restriction was lifted, suggesting that sensory adaptation alone may not sustain long-term change.

Effect of Vitamin D Supplementation in Healthy Full-Term Infants: A Randomized, Double-Blind, Placebo-Controlled Trial

2026-04-22T13:56:26+07:00

Objectives: Vitamin D deficiency in infants is a significant global health issue. The aim of this randomized, double-blind, placebo-controlled trial was to assess the effectiveness of vitamin D supplementation in infants at 6 months of age in preventing deficiency or promoting sufficient vitamin D status.
Materials and Methods: Sixty-eight healthy full-term infants were randomly assigned to receive either vitamin D supplementation, 400 international unit (IU)/day (intervention group; n = 34), or placebo (control group; n = 34). Blood samples were collected 48–72 hours after birth to measure serum 25-hydroxyvitamin D (25(OH)D) levels. Supplementation began after blood collection and continued for 6 months. The serum 25(OH)D levels of the two groups were then compared.
Results: After six months, vitamin D supplementation significantly increased mean serum 25(OH)D levels by 7.07 nanograms per milliliter compared to placebo (95% confidence interval (CI): 1.30–12.83; p = 0.016). Among breastfed infants, supplementation with vitamin D 400 IU/day resulted in significantly improved vitamin D status. Notably, 100% of infants in the intervention group achieved vitamin D sufficiency, compared to 77.8% in the control group (p = 0.046). Furthermore, supplemented breastfed infants exhibited significantly higher mean serum 25(OH)D levels at six months (p = 0.019) and a greater increase from baseline (p = 0.010) relative to the control group. In contrast, these effects of supplementation were not observed among formula-fed or mixed-fed infants.
Conclusion: This study highlights the high prevalence of vitamin D insufficiency and deficiency among healthy Thai neonates. Daily supplementation with 400 IU of vitamin D from birth to age 6 months among breastfed infants significantly improved the prevalence of vitamin D sufficiency and elevated serum vitamin D levels by age 6 months without any adverse effects.