Limits...
Capacity of Thailand to contain an emerging influenza pandemic.

Putthasri W, Lertiendumrong J, Chompook P, Tangcharoensathien V, Coker R - Emerging Infect. Dis. (2009)

Bottom Line: We found that gaps exist in many resource categories, even under scenarios in which few cases occur.Such gaps are likely to be profound if a severe pandemic occurs.Alternatively, explicit assumptions must be made regarding allocation of scarce resources, standards of care, and priority setting during a pandemic.

View Article: PubMed Central - PubMed

Affiliation: International Health Policy Programme, Ministry of Public Health, Nonthaburi, Thailand.

ABSTRACT
Southeast Asia will likely be the epicenter of the next influenza pandemic. To determine whether health system resources in Thailand are sufficient to contain an emerging pandemic, we mapped health system resources in 76 provinces. We used 3 prepandemic scenarios of clustered cases and determined resource needs, availability, and gaps. We extended this analysis to a scenario of a modest pandemic and assumed that the same standards of clinical care would be required. We found that gaps exist in many resource categories, even under scenarios in which few cases occur. Such gaps are likely to be profound if a severe pandemic occurs. These gaps exist in infrastructure, personnel and materials, and surveillance capacity. Policy makers must determine whether such resource gaps can realistically be closed, ideally before a pandemic occurs. Alternatively, explicit assumptions must be made regarding allocation of scarce resources, standards of care, and priority setting during a pandemic.

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Related in: MedlinePlus

Gaps in health system resources (oseltamivir tablets) likely to occur for 3 scenarios of prepandemic influenza across provinces, Thailand. A) Scenario 1; B) scenario 2; C) scenario 3.
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Figure 5: Gaps in health system resources (oseltamivir tablets) likely to occur for 3 scenarios of prepandemic influenza across provinces, Thailand. A) Scenario 1; B) scenario 2; C) scenario 3.

Mentions: Gaps in resources existed in some provinces under scenario 1 (and thus for subsequent scenarios). These resource gaps include infrastructure, personnel, and materials and potentially limit capacity in all 4 control areas (surveillance capacity, case-investigation capacity, case-treatment capacity, and capacity to prevent spread of disease in the community) (Technical Appendix ). If care for case-patients is limited to negative-pressure rooms or isolation beds, then bed availability is likely to be problematic, even with a small numbers of cases. However, if beds dedicated to wider use are made available, then shortfalls are unlikely when limited cases occur. Most resource gaps are linked to critical care and include lack of trained personnel and respirators. For example, by scenario 3, 92% of provinces will have insufficient negative-pressure rooms to respond effectively to case-patients, and a severe shortage of critical care nurses will occur. However, if isolation beds are used, the proportion of provinces with insufficient resources falls to ≈75%, and if single occupancy rooms are also used, bed capacity across the country is sufficient. As the number of case-patients and contacts increases through scenarios 2 and 3, the number of provinces with gaps in resources grows. The geographic distribution of resource gaps varies, depending on resource and scenario (Figure 3–Figure 5).


Capacity of Thailand to contain an emerging influenza pandemic.

Putthasri W, Lertiendumrong J, Chompook P, Tangcharoensathien V, Coker R - Emerging Infect. Dis. (2009)

Gaps in health system resources (oseltamivir tablets) likely to occur for 3 scenarios of prepandemic influenza across provinces, Thailand. A) Scenario 1; B) scenario 2; C) scenario 3.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2666290&req=5

Figure 5: Gaps in health system resources (oseltamivir tablets) likely to occur for 3 scenarios of prepandemic influenza across provinces, Thailand. A) Scenario 1; B) scenario 2; C) scenario 3.
Mentions: Gaps in resources existed in some provinces under scenario 1 (and thus for subsequent scenarios). These resource gaps include infrastructure, personnel, and materials and potentially limit capacity in all 4 control areas (surveillance capacity, case-investigation capacity, case-treatment capacity, and capacity to prevent spread of disease in the community) (Technical Appendix ). If care for case-patients is limited to negative-pressure rooms or isolation beds, then bed availability is likely to be problematic, even with a small numbers of cases. However, if beds dedicated to wider use are made available, then shortfalls are unlikely when limited cases occur. Most resource gaps are linked to critical care and include lack of trained personnel and respirators. For example, by scenario 3, 92% of provinces will have insufficient negative-pressure rooms to respond effectively to case-patients, and a severe shortage of critical care nurses will occur. However, if isolation beds are used, the proportion of provinces with insufficient resources falls to ≈75%, and if single occupancy rooms are also used, bed capacity across the country is sufficient. As the number of case-patients and contacts increases through scenarios 2 and 3, the number of provinces with gaps in resources grows. The geographic distribution of resource gaps varies, depending on resource and scenario (Figure 3–Figure 5).

Bottom Line: We found that gaps exist in many resource categories, even under scenarios in which few cases occur.Such gaps are likely to be profound if a severe pandemic occurs.Alternatively, explicit assumptions must be made regarding allocation of scarce resources, standards of care, and priority setting during a pandemic.

View Article: PubMed Central - PubMed

Affiliation: International Health Policy Programme, Ministry of Public Health, Nonthaburi, Thailand.

ABSTRACT
Southeast Asia will likely be the epicenter of the next influenza pandemic. To determine whether health system resources in Thailand are sufficient to contain an emerging pandemic, we mapped health system resources in 76 provinces. We used 3 prepandemic scenarios of clustered cases and determined resource needs, availability, and gaps. We extended this analysis to a scenario of a modest pandemic and assumed that the same standards of clinical care would be required. We found that gaps exist in many resource categories, even under scenarios in which few cases occur. Such gaps are likely to be profound if a severe pandemic occurs. These gaps exist in infrastructure, personnel and materials, and surveillance capacity. Policy makers must determine whether such resource gaps can realistically be closed, ideally before a pandemic occurs. Alternatively, explicit assumptions must be made regarding allocation of scarce resources, standards of care, and priority setting during a pandemic.

Show MeSH
Related in: MedlinePlus