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Christopher B. Estopinal, Somsanguan Ausayakhun, Choeng Jirawison, Todd P. Margolis, Jeremy D. Keenan; Access to Ophthalmologists in Thailand: A District-level Analysis. Invest. Ophthalmol. Vis. Sci. 2012;53(14):1422.
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© ARVO (1962-2015); The Authors (2016-present)
The World Health Organization recommends that countries in Asia have ≥1 ophthalmologist per 100,000 persons. While a country may achieve this target, certain sub-regions may have relative shortages of ophthalmologists. In this study we assess Thailand’s regional patterns of ophthalmologist distribution.
We included all ophthalmologists listed in the 2010 directory of the Royal College of Ophthalmologists of Thailand. We excluded ophthalmologists who were retired, abroad, or unable to be located. We geocoded the work address of each ophthalmologist in Google Maps. If the work address could not be located, we geocoded the city-center, district, or home address. Population data were obtained from the 2000 Thai Population and Housing Census. We determined the number of ophthalmologists per 100,000 persons (O/P ratio) at the country, province, and district level as well as factors associated with low ophthalmologist density.
We successfully located the address of 955 of the 966 ophthalmologists in the directory. At the country level, Thailand has an O/P ratio of 1.52. At the provincial level, 23/76 provinces have an O/P ratio of ≥1. In multivariable linear regression analyses, increasing O/P ratio is associated with increasing population density (P=0.004) and decreasing proportion of agricultural workers (P<0.001). At the district level, 138/925 districts have an O/P ratio of ≥1, 21/925 have an O/P ratio of 0.01 to 0.99, and 766/925 have no ophthalmologists (Figure 1). Assuming population is evenly distributed within each district, the proportions of Thais living within 10km, 25km, and 50km of an ophthalmologist are 54.8%, 81.1%, and 96.9%, respectively. In multivariable logistic regression, presence of an ophthalmologist in a district is associated with increasing proportion of urban areas (P<0.001) and decreasing proportion of population aged <10 years old (P<0.001).
Thailand’s eye health system has reduced preventable blindness rates to <0.3% and surpassed the World Health Organization’s goal for ophthalmologist distribution at the national level. Regional analysis reveals areas with a dearth of ophthalmologists, with less in rural locales, agricultural areas, and regions with a high proportion of children.
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