การเฝ้าระวังโรคขาดสารไอโอดีนแบบบูรณาการ by nontalee verachai

∫ ∑ «‘ ∑ ¬ “ ° “ √

∫ ∑ «‘ ∑ ¬ “ ° “ √ °“√‡ΩÑ“√–«—ß‚√§¢“¥ “√‰Õ‚Õ¥’π ·∫∫∫Ÿ√≥“°“√æ◊Èπ∑’Ë§«“¡√—∫º‘¥™Õ∫ »Ÿπ¬åÕπ“¡—¬∑’Ë 1 °√ÿß‡∑æœ °√¡Õπ“¡—¬ æ.».2554

°“π¥“« ’ ¡“≈’«ß…å »Ÿπ¬åÕπ“¡—¬∑’Ë 1 °√ÿß‡∑æœ °√¡Õπ“¡—¬

¥.(‚¿™π“°“√ “∏“√≥ ÿ¢)

∫∑§—¥¬àÕ °“√‡ΩÑ“√–«—ß¿“«–¢“¥ “√‰Õ‚Õ¥’π·∫∫∫Ÿ√≥“°“√ »Ÿπ¬åÕπ“¡—¬∑’Ë 1 °√ÿß‡∑æœ ªï æ.».2554 ‡ªìπ°“√ ¥”‡π‘π°“√„πªï·√° ¡’«—µ∂ÿª√– ß§å‡æ◊ËÕµ‘¥µ“¡ ∂“π°“√≥å¿“«–¢“¥ “√‰Õ‚Õ¥’π„π√–¥—∫»Ÿπ¬åÕπ“¡—¬Õ¬à“ß ∫Ÿ√≥“°“√·≈–‡ªìπ√–∫∫ ∑”°“√»÷°…“„π®—ßÀ«—¥∑’ Ë ¡ÿà ‡≈◊Õ°‰¥â §◊Õ ®—ßÀ«—¥ª∑ÿ¡∏“π’ ·≈–®—ßÀ«—¥ππ∑∫ÿ√’ ªï 2554 ‰¥â¥”‡π‘π°“√»÷°…“æƒµ‘°√√¡°“√∫√‘‚¿§º≈‘µ¿—≥±å‡ √‘¡‰Õ‚Õ¥’π‚¥¬„™â·∫∫ Õ∫∂“¡ 300 §√—«‡√◊ÕπµàÕ®—ßÀ«—¥ µ√«®§ÿ≥¿“æ‡°≈◊Õ‡ √‘¡‰Õ‚Õ¥’π„π∑ÿ°§√—«‡√◊Õπ‚¥¬„™â I-Kit ·≈– ÿà¡ àßµ√«® titration √âÕ¬≈– 10 ‡°Á∫ µ—«Õ¬à“ßªí “«–‡æ◊ËÕ àßµ√«®√–¥—∫§«“¡‡¢â¡¢âπ¢Õß‰Õ‚Õ¥’π„π°≈ÿà¡‡¥Á°Õ“¬ÿ 3-6 ªï ·≈–°≈ÿà¡ºŸâ ŸßÕ“¬ÿ 60 ªï ¢÷Èπ‰ª ®—ßÀ«—¥≈– 150 §πµàÕ°≈ÿà¡ ·≈–µ√«®æ—≤π“°“√‡¥Á°Õ“¬ÿ 1-3 ªï ®—ßÀ«—¥≈– 90 §π ”À√—∫¢âÕ¡Ÿ≈√–¥—∫ ‰Õ‚Õ¥’π„πªí “«–¢ÕßÀ≠‘ßµ—Èß§√√¿å„™â∞“π¢âÕ¡Ÿ≈√“¬ß“π°“√‡ΩÑ“√–«—ßª√–®”ªï 2554 ¢âÕ¡Ÿ≈√–¥—∫ŒÕ√å‚¡π °√–µÿâπµàÕ¡∏—¬√Õ¬¥å (TSH) „π∑“√°·√°‡°‘¥ „™â®“°∞“π¢âÕ¡Ÿ≈‚§√ß°“√µ√«®§—¥°√Õß¿“«–æ√àÕß∏—¬√Õ¬¥å ŒÕ√å‚¡π„π∑“√°·√°‡°‘¥ ªï 2554 ‚¥¬°√¡«‘∑¬“»“ µ√å°“√·æ∑¬å º≈°“√»÷°…“æ∫«à“ ºŸâµÕ∫·∫∫ Õ∫∂“¡ ∑’Ë‡ªìπ°≈ÿà¡µ—«Õ¬à“ß„π°“√»÷°…“§√—Èßπ’È à«π„À≠àÕ“»—¬Õ¬Ÿà„π‡¢µÕß§å°“√∫√‘À“√ à«πµ”∫≈ (Õ∫µ.) ∑—Èß®—ßÀ«—¥ ª∑ÿ¡∏“π’ ·≈–ππ∑∫ÿ√’ §◊Õ√âÕ¬≈– 76.6 ·≈– 94.3 ‡ªìπ‡æ»À≠‘ß√âÕ¬≈– 75.0 ·≈– 76.7 Õ“¬ÿ¡“°°«à“ 60 ªï √âÕ¬≈– 33.7 ·≈– 42.0 ®∫√–¥—∫ª√–∂¡»÷°…“√âÕ¬≈– 61.7 ·≈– 72.4 ·≈–¡’Õ“™’æ‡ªìπ·¡à∫â“π√âÕ¬≈– 38.0 ·≈– 37.7 µ“¡≈”¥—∫ „π√Õ∫ 1 ‡¥◊Õπ∑’Ëºà“π¡“°àÕπ°“√ Õ∫∂“¡§√—«‡√◊Õπ„π®—ßÀ«—¥ª∑ÿ¡∏“π’ ·≈–ππ∑∫ÿ√’ „™â‡°≈◊Õ ‡ √‘¡‰Õ‚Õ¥’π√âÕ¬≈– 81.0 ·≈–√âÕ¬≈– 87.3 „™âπÈ”ª≈“‡ √‘¡‰Õ‚Õ¥’π√âÕ¬≈– 63.3 ·≈–√âÕ¬≈– 54.3 „™â´’Õ‘È« ‡ √‘¡‰Õ‚Õ¥’π√âÕ¬≈– 58.0 ·≈–√âÕ¬≈– 47.0 „™â´Õ ª√ÿß√ ‡ √‘¡‰Õ‚Õ¥’π√âÕ¬≈– 55.7 ·≈–√âÕ¬≈– 42.7 ·≈–„™â πÈ”‡°≈◊Õª√ÿß√ ‡ √‘¡‰Õ‚Õ¥’π‡æ’¬ß√âÕ¬≈– 7.7 ·≈–√âÕ¬≈– 5.0 ”À√—∫æƒµ‘°√√¡∑—Ë«‰ª¢Õß°“√„™â‡°≈◊Õ‡ √‘¡ ‰Õ‚Õ¥’π„π°“√ª√ÿßª√–°Õ∫Õ“À“√¢Õß®—ßÀ«—¥ª∑ÿ¡∏“π’·≈–ππ∑∫ÿ√’ æ∫«à“¡’°“√„™â Ÿß∂÷ß√âÕ¬≈– 90 ·≈–√âÕ¬≈– 94.3 ‚¥¬ à«π„À≠à„Àâ‡Àµÿº≈∑’Ë‡≈◊Õ°∫√‘‚¿§‡°≈◊Õ‡ √‘¡‰Õ‚Õ¥’π §◊ÕÀ“´◊ÈÕ‰¥âßà“¬„πÀ¡Ÿà∫â“π √âÕ¬≈– 60.3 ·≈– 55.7 ·≈–ªÑÕß°—π‚√§§ÕæÕ°‰¥â√âÕ¬≈– 52.3 ·≈–√âÕ¬≈– 60.0 ·À≈àß∑’Ë´◊ÈÕ‡°≈◊Õ‡ √‘¡‰Õ‚Õ¥’π´◊ÈÕ®“°√â“π§â“„π 102 ¡°√“§¡ - ¡’π“§¡ 2555 °√¡Õπ“¡—¬

àß‡ √‘¡„Àâ§π‰∑¬ ÿ¢¿“æ¥’

°“√‡ΩÑ“√–«—ß‚√§¢“¥ “√‰Õ‚Õ¥’π·∫∫∫Ÿ√≥“°“√æ◊Èπ∑’Ë§«“¡√—∫º‘¥™Õ∫»Ÿπ¬åÕπ“¡—¬∑’Ë Ò °√ÿß‡∑æœ

À¡Ÿà∫â“π√âÕ¬≈– 45.7 ·≈– 47.7 °“√‡≈◊Õ°¬—ßæ‘®“√≥“®“°©≈“°´Õß‡°≈◊Õ‡ªìπ à«π„À≠à«à“‡ªìπ‡°≈◊Õ‡ √‘¡‰Õ‚Õ¥’π √âÕ¬≈– 81.3 ·≈–√âÕ¬≈– 85 ‡¥Á°Õ“¬ÿ 3-6 ªï ·≈–ºŸâ ŸßÕ“¬ÿ„π§√—«‡√◊Õπ à«π„À≠à¢Õß∑—Èß Õß®—ßÀ«—¥¡’°“√∫√‘‚¿§ ‡¡πŸÕ“À“√‡¥’¬«°—π°—∫∑ÿ°§π„π§√—«‡√◊Õπ∫√‘‚¿§ À≠‘ßµ—Èß§√√¿å„π§√—«‡√◊Õπ∑’ËµÕ∫·∫∫ Õ∫∂“¡∫“ß√“¬‰¡à‰¥â√—∫ ¬“‡¡Á¥‡ √‘¡‰Õ‚Õ¥’π ´÷ËßÀ≠‘ßµ—Èß§√√¿å∑ÿ°§π∑’Ë‰¥â√—∫¬“‡¡Á¥‡ √‘¡‰Õ‚Õ¥’π ‰¡à¡’Õ“°“√¢â“ß‡§’¬ßÀ≈—ß°‘π¬“‡¡Á¥‡ √‘¡ ‰Õ‚Õ¥’π·≈–¡’§«“¡µ—Èß„®°‘π¬“‡¡Á¥‡ √‘¡‰Õ‚Õ¥’πµ≈Õ¥Õ“¬ÿ§√√¿å®π∂÷ß„Àâπ¡∫ÿµ√ 6 ‡¥◊Õπ °“√‡¢â“∂÷ß‡°≈◊Õ‡ √‘¡ ‰Õ‚Õ¥’π§ÿ≥¿“æ„π§√—«‡√◊Õπ (≥ 30 æ’æ’‡ÕÁ¡) ‚¥¬„™â™ÿ¥∑¥ Õ∫ I-Kit ¢Õß®—ßÀ«—¥ª∑ÿ¡∏“π’·≈–®—ßÀ«—¥ππ∑∫ÿ√’ √âÕ¬≈– 76.1 ·≈– 77.7 µË”°«à“‡ªÑ“À¡“¬∑’ÕË ß§å°“√Õπ“¡—¬‚≈°°”Àπ¥ (√âÕ¬≈– 90) À≠‘ßµ—ßÈ §√√¿å„π®—ßÀ«—¥ª∑ÿ¡∏“π’ ·≈–®—ßÀ«—¥ππ∑∫ÿ√’ ‰¡à¡’ªí≠À“‚√§¢“¥ “√‰Õ‚Õ¥’πµ“¡‡°≥±åÕß§å°“√Õπ“¡—¬‚≈°°”Àπ¥ §◊Õ æ◊Èπ∑’Ë∑’Ë¡’ —¥ à«π ¢ÕßÀ≠‘ßµ—Èß§√√¿å∑’Ë¡’√–¥—∫‰Õ‚Õ¥’π„πªí “«–πâÕ¬°«à“ 150 µg/L (√–¥—∫¢“¥) ‡°‘π√âÕ¬≈– 50 ‡ªìπæ◊Èπ∑’Ë¢“¥ “√‰Õ‚Õ¥’π ´÷Ëßæ∫«à“ —¥ à«π¢ÕßÀ≠‘ßµ—Èß§√√¿å∑’Ë¡’√–¥—∫‰Õ‚Õ¥’πµË”°«à“ 150 µg/L (√–¥—∫¢“¥) ¢Õß®—ßÀ«—¥ ª∑ÿ¡∏“π’ ·≈–®—ßÀ«—¥ππ∑∫ÿ√’ √âÕ¬≈– 38.7 ·≈–√âÕ¬≈– 42.1 —¥ à«π¢Õß‡¥Á°‡≈Á°Õ“¬ÿ 3-6 ªï ¢Õß®—ßÀ«—¥ª∑ÿ¡∏“π’ ·≈–®—ßÀ«—¥ππ∑∫ÿ√’ ∑’Ë¡’‰Õ‚Õ¥’π„πªí “«–µË”°«à“ 100 µg/L (√–¥—∫¢“¥) ‡æ’¬ß√âÕ¬≈– 7.9 ·≈– 15.9 —¥ à«π ¢ÕßºŸ â ßŸ Õ“¬ÿ∑¡’Ë ‰’ Õ‚Õ¥’π„πªí “«–µË”°«à“ 100 µg/L (√–¥—∫¢“¥) ¢Õß®—ßÀ«—¥ª∑ÿ¡∏“π’·≈–®—ßÀ«—¥ππ∑∫ÿ√’ √âÕ¬ ≈– 38.4 ·≈– 42.1 ‡¥Á°∑“√°·√°‡°‘¥¡’¿“«–¢“¥ “√‰Õ‚Õ¥’π≈¥≈ß æ∫«à“ —¥ à«π‡¥Á°∑“√°·√°‡°‘¥¡’§à“ TSH ¡“°°«à“ 11.2 ¡‘≈≈‘¬Ÿπ‘µµàÕ≈‘µ√ ¢Õß®—ßÀ«—¥ª∑ÿ¡∏“π’·≈–®—ßÀ«—¥ππ∑∫ÿ√’ „πªï 2553 √âÕ¬≈– 10.5 ·≈–√âÕ¬≈– 10.4 „πªï æ.».2554 (µÿ≈“§¡ 2553 - ¡’π“§¡ 2554) √âÕ¬≈– 9.02 ·≈–√âÕ¬≈– 10.23 °“√ª√–‡¡‘πæ—≤π“°“√ ‡¥Á°‡≈Á°Õ“¬ÿ 1-3 ªï ¥â«¬·∫∫∑¥ Õ∫ Denver II æ∫«à“‡¥Á°®—ßÀ«—¥ª∑ÿ¡∏“π’ ·≈–®—ßÀ«—¥ππ∑∫ÿ√’ ¡’æ—≤π“°“√ ¡«—¬√âÕ¬≈– 81.3 ·≈– 93.3 ¢âÕ‡ πÕ·π–‡æ◊ËÕ„Àâ°“√¥”‡π‘π°“√‡ΩÑ“√–«—ß‚√§¢“¥ “√‰Õ‚Õ¥’π·∫∫∫Ÿ√≥“°“√ ¥”‡π‘π‰ªÕ¬à“ß¡’ª√– ‘∑∏‘¿“æ‡ÀÁπ§«√¥”‡π‘π°“√„πæ◊Èπ∑’Ë®—ßÀ«—¥Õ◊Ëπ„Àâ§√Õ∫§≈ÿ¡√–¥—∫»Ÿπ¬åÕπ“¡—¬ ·≈–§«√ µ‘¥µ“¡°“√∫√‘À“√®—¥°“√¬ÿ∑∏»“ µ√å°“√¥”‡π‘πß“π§«∫§ÿ¡·≈–ªÑÕß°—π‚√§¢“¥ “√‰Õ‚Õ¥’π„π√–¥—∫æ◊Èπ∑’Ë„Àâ‡°‘¥ ª√– ‘∑∏‘º≈Õ¬à“ßµàÕ‡π◊ËÕß §” ”§—≠ : °“√‡ΩÑ“√–«—ß ‚√§¢“¥ “√‰Õ‚Õ¥’π ŒÕ√å‚¡π°√–µÿâπµàÕ¡∏—¬√Õ¬¥å

Integrated IDD Surveillance in areas under the responsibility of Health Center I, Bangkok Department of Health, 2011 Kandavasee Maleevong Dr.Public Health Nutrition Health Center I, Bangkok Department of Health

THAILAND JOURNAL OF HEALTH PROMOTION AND ENVIRONMENTAL HEALTH J a n u a r y - M a r c h 2 0 1 2

103

∫ ∑ «‘ ∑ ¬ “ ° “ √ Abstract Integrated IDD surveillance program conducted by the Health Center I Bangkok in 2011, aimed to follow up IDD situation systematically and integratedly at Health Center level. Pathumthani and Nonthaburi provinces were selected randomly for the study. The consumption behavior of domestic Iodine fortification product were studied by means of questionnaire covered 300 households per province. The quality of iodated salt in all studied households were studied by I-kit and titration were performed in 10% of the samples. Urine samples were collected form 150 children aged 3-6 years and 150 elderly over 60 year to determine iodine content. Among children aged 1-3 yrs, child development were examined in 90 children aged 1-3 yrs. per province. Data of urine iodine in pregnant women were derived from annual IDD surveillance program in 2011 by Department of Health, and TSH data in new born babies were derived from the report of neonatal screening for monitoring of iodine deficiency areas in 2011 by the Department of Medial Sciences. The study found that most of the samples lived in Tambon local administration organization areas in Pathumthani and Nonthaburi provinces respectively, 76.6% and 94.3%, 75.0% and 76.7% were female, 33.7% and 42.0% aged over 60 yr, 61.7% and 72.4% finished primary school education, 38.0% and 37.7% were housewives respectively. During the past month prior to the study, 81.0% and 87.3% used iodated salt, 63.3% and 54.3% used iodated fish sauce, 58.0% and 47.0% used iodated soy sauce, 55.7% and 42.7% used iodated seasoning sauce, only 7.7% and 5.0% used iodated salt seasoning water in Pathumthani and Nonthaburi respectively. It was found that the rate of iodated salt usage behavior was high (90.0% and 94.3% respectively). The reasons for the high rate were that it was easy to buy in the village 60.3% and 55.7%, IDD prevention program 52.3% and 60.0%, availability in village 45.7% and 47.7%. Besides, iodated salt label had been the means to consider salt buying at 81.3% and 85% respectively. Most of children 3-6 yr. old and the elderly in both provinces consumed the same meals with family members. Some pregnant women did not receive iodine tablet. For the pregnant women who received the iodine tablet, they mentioned no side effect and intend to take the tablet during pregnancy period and during six months breast feeding. The percentage of household iodated salt availability (≥ 30 ppm) was 76.1% and 77.7% lower than WHO standard (90.0%). No IDD problem in pregnant women in both provinces by WHO criteria i.e. the area with over 50.0% of pregnant women with urine iodine lower than 150 ug/L (deficiency) is IDD area. It was found that in Phatumthani and Nonthaburi, the rate of pregnant women with urine iodine lower than 150 ug/L was 38.7% and 42.1% respectively. It was else found that urine iodine lower then 100 ug/L (deficiency level) in children 3-6 yr. was 7.9% and 15.9% On the other hand in the elderly, It was 38.4% and 42.1% respectively. It was found that decline of IDD in new born baby with TSH higher than 11.2 ml/L was 10.5% and 10.4% in 2010, 9.02% and 10.23% in 2011 (Oct. 2010 - Mar. 2011) respectively. Child development assessment in children aged 1-3 using Denver II, revealed that optimal child development was 81.3% and 93.3% for Pathumthani and Nonthaburi respectively. In order to have efficient integrated IDD surveillance system, The IDD surveillance program should be operated at Health Center level in all provinces responsible by the Center. Follow up and monitoring of IDD control and prevention program should be undertaken at the total levels for more effective outcomes. Key word : Surveillance, Iodine Deficiency Disorder (IDD) , Thyroid stimulating Hormone (TSH)

104 ¡°√“§¡ - ¡’π“§¡ 2555 °√¡Õπ“¡—¬

àß‡ √‘¡„Àâ§π‰∑¬ ÿ¢¿“æ¥’

∫∑π” ¿“«–¢“¥ “√‰Õ‚Õ¥’ π ¡’ º ≈°√–∑∫µà Õ ª√–™“°√„π∑ÿ°°≈ÿà¡«—¬ µ≈Õ¥√–¬–‡«≈“¢Õß«ß®√ ™’«‘µ À≠‘ßµ—Èß§√√¿å À≠‘ß„Àâπ¡∫ÿµ√ À≠‘ß«—¬‡®√‘≠ æ—π∏ÿå ·≈–‡¥Á°ª∞¡«—¬ ‡ªìπ°≈ÿà¡ª√–™“°√∑’Ë¡’§«“¡ ‡ ’Ë¬ß∑’Ë®–‰¥â√—∫º≈°√–∑∫∑’Ë√â“¬·√ß¢Õß¿“«–¢“¥ “√‰Õ‚Õ¥’π‰¥â¡“°∑’Ë ÿ¥ ‡π◊ËÕß®“°‰Õ‚Õ¥’π‡ªìπ à«π ”§—≠„π°√–∫«π°“√ √â“ß∏—¬√Õ¬¥åŒÕ√å‚¡π∑’Ë ®”‡ªìπµàÕ°“√ √â“ß‡´≈≈å ¡Õß·≈–°“√∑”ß“π¢Õß √à“ß°“¬ ‚¥¬‡©æ“–∑“√°∑’ËÕ¬Ÿà„π§√√¿å¡“√¥“ ®π∂÷ßÕ“¬ÿ 3 ªï À“°¢“¥ “√‰Õ‚Õ¥’π®–∑”„Àâ ¡Õß‡®√‘≠‡µ‘∫‚µ‰¡à‡µÁ¡∑’Ë ≈¥§«“¡‡©≈’¬«©≈“¥ À√◊Õ√–¥—∫ µ‘ª≠ í ≠“¢Õß‡¥Á°‰¥â∂ß÷ 10-15 ®ÿ¥ ∑”„Àâ ‡¥Á°¡’ªí≠À“°“√‡√’¬π ·≈–°√–∑∫µàÕ°“√‡®√‘≠ ‡µ‘ ∫ ‚µ ∂â “ ¢“¥‰Õ‚Õ¥’ π √ÿ π ·√ß®–‡ªì π ‚√§‡Õã Õ (WHO/ICCIDD/UNICEF,2007) ®“°°“√ ”√«®‰Õ§‘ « ¢Õß§π‰∑¬ ‚¥¬ ∂“∫—π«‘®—¬√–∫∫ “∏“√≥ ÿ¢ ‡¡◊ËÕ æ.». 2551 2552 æ∫‰Õ§‘«‡©≈’¬Ë 91 ®ÿ¥ (‰Õ§‘«‡©≈’¬Ë ª°µ‘ 90110 ®ÿ¥) ( ∂“∫—π«‘®—¬√–∫∫ “∏“√≥ ÿ¢, 2554) Õ’°∑—ßÈ º≈°“√ ”√«®æ—≤π“°“√„π‡¥Á°Õ“¬ÿµË”°«à“ 5 ªï ¢Õß°√¡Õπ“¡—¬ °√–∑√«ß “∏“√≥ ÿ¢ æ∫ æ— ≤ π“°“√ ¡«— ¬ ≈¥≈ß ‚¥¬„πªï 2542 ¡’ æ—≤π“°“√ ¡«—¬√âÕ¬≈– 72 ªï 2547 √âÕ¬≈– 71 ·≈–ªï 2550 ≈¥≈ß‡À≈◊Õ√âÕ¬≈– 67 “‡ÀµÿÀπ÷Ëß∑’Ë ∑”„Àâ‡¥Á°¡’æ—≤π“°“√‰¡à ¡«—¬ ‡π◊ËÕß®“°¡“√¥“ ‰¥â√∫— “√‰Õ‚Õ¥’π‰¡à‡æ’¬ßæÕ¢≥–µ—ßÈ §√√¿å ‡¡◊ÕË æ.». 2549-2552 æ∫ —¥ à«π¢ÕßÀ≠‘ßµ—Èß§√√¿å∑’Ë√–¥—∫ ‰Õ‚Õ¥’π„πªí “«–µË”°«à“ 150 µg/L √âÕ¬≈– 71.8, 61.3, 58.5 ·≈– 59 µ“¡≈”¥—∫ ( ”π—°‚¿™π“°“√, 2552) (‡°≥±åÕß§å°“√Õπ“¡—¬‚≈°°”Àπ¥§◊Õ æ◊πÈ ∑’Ë ∑’Ë¡’ —¥ à«π¢ÕßÀ≠‘ßµ—Èß§√√¿å∑’Ë¡’√–¥—∫‰Õ‚Õ¥’π„π ªí “«–πâÕ¬°«à“ 150 µg/L ‡°‘π√âÕ¬≈– 50 ‡ªìπ æ◊πÈ ∑’¢Ë “¥ “√‰Õ‚Õ¥’π) ·¡â«“à ∂“π°“√≥å„πªï æ.».

2553 ®–¡’·π«‚πâ¡∑’Ë¥’¢÷Èπ ‚¥¬æ∫«à“ —¥ à«π ¢ÕßÀ≠‘ßµ—Èß§√√¿å∑—Ë«ª√–‡∑»∑’Ë¡’√–¥—∫‰Õ‚Õ¥’π„π ªí “«–µË”°«à“ 150 µg/L √âÕ¬≈– 42.6 ·≈– —¥ à«π¢ÕßÀ≠‘ßµ—Èß§√√¿å„π‡¢µæ◊Èπ∑’Ë§«“¡√—∫º‘¥ ™Õ∫»Ÿπ¬åÕπ“¡—¬∑’Ë 1 §◊Õ ®—ßÀ«—¥ππ∑∫ÿ√’ Õà“ß∑Õß æ√–π§√»√’ Õ ¬ÿ ∏ ¬“ ·≈–ª∑ÿ ¡ ∏“π’ ∑’Ë ¡’ √ –¥— ∫ ‰Õ‚Õ¥’π„πªí “«–µË”°«à“ 150 µg/L √âÕ¬≈– 63.5, 24.6, 49.8 ·≈– 24.6 µ“¡≈”¥— ∫ ( ”π— ° ‚¿™π“°“√,2553) ®“°°“√µ‘¥µ“¡§«“¡°â“«Àπâ“°“√¥”‡π‘π °“√ Ÿà‡ªÑ“À¡“¬°“√¢®—¥‚√§¢“¥ “√‰Õ‚Õ¥’π„π ª√–‡∑»‰∑¬ ªï æ.». 2552 ‚¥¬ºŸâ‡™’Ë¬«™“≠®“° Õß§å°“√Õπ“¡—¬‚≈° Õß§å°“√¬Ÿπ‘‡´ø ·≈– ¿“ π“π“™“µ‘‡æ◊ÕË °“√§«∫§ÿ¡‚√§¢“¥ “√‰Õ‚Õ¥’π √–∫ÿ «à“¡’§«“¡°â“«Àπâ“‡æ’¬ß‡≈Á°πâÕ¬„π°“√¥”‡π‘π°“√ ‡ΩÑ“√–«—ß ∂“π°“√≥å¢“¥ “√‰Õ‚Õ¥’π„π√–¬– 5 ªï ∑’Ëºà“π¡“ ·¡â«à“®– “¡“√∂§«∫§ÿ¡‚√§§ÕæÕ° ª√–®”∂‘Ëπ (endemic goiter) „π°≈ÿà¡‡¥Á°‰¥â·≈â« ·µà¬—ß§ß¡’ªí≠À“°“√¢“¥ “√‰Õ‚Õ¥’π„π°≈ÿà¡À≠‘ß µ—È ß §√√¿å · ≈–∑“√°·√°‡°‘ ¥ ª√–‡¥Á π ªí ≠ À“∑’Ë ”§—≠§◊Õ ¢“¥°“√«“ß·ºπ·≈–¥”‡π‘π°“√Õ¬à“ß ∫Ÿ√≥“°“√ ¢âÕ¡Ÿ≈∑’Ë‰¥â¡‘‰¥âπ”¡“‡™◊ËÕ¡‚¬ß‡æ◊ËÕ∫àß™’È ∂“π°“√≥åæ◊Èπ∑’Ë∑’Ë‡ªìπªí≠À“ ·≈–‰¥â„Àâ¢âÕ‡ πÕ ‰«â«“à °“√¥”‡π‘πß“π∑’®Ë –„Àâª√– ∫º≈ ”‡√Á® Ÿß ÿ¥ µâÕß‰¥â√—∫§«“¡√à«¡¡◊Õ®“°Àπà«¬ß“π∑’Ë‡°’Ë¬«¢âÕß ∑ÿ°¿“§ à«π √«¡∑—Èß„Àâ¢âÕ‡ πÕ·π–‡æ◊ËÕª√—∫ª√ÿß ‚§√ß°“√·≈–∫àß™’Èª√–‡¥Áπ·≈–¬ÿ∑∏»“ µ√å∑’Ë®”‡ªìπ µâÕß·°â‰¢ ( ”π—°‚¿™π“°“√,2553) §≥–Õπÿ ° √√¡°“√®— ¥ √–∫∫‡ΩÑ “ √–«— ß ·≈– µ‘¥µ“¡°“√¢“¥ “√‰Õ‚Õ¥’π ´÷Ëß¡’§≥–∑”ß“π®“° ”π—°‚¿™π“°“√ »Ÿπ¬åÕπ“¡—¬ ”π—° àß‡ √‘¡ ÿ¢ ¿“æ ”π—°Õπ“¡—¬°“√‡®√‘≠æ—π∏ÿå °√¡Õπ“¡—¬ °√¡ «‘∑¬“»“ µ√å°“√·æ∑¬å ∂“∫—π«‘®—¬«‘∑¬“»“ µ√å “∏“√≥ ÿ¢ °Õß§«∫§ÿ¡Õ“À“√ ”π—°ß“π§≥–

THAILAND JOURNAL OF HEALTH PROMOTION AND ENVIRONMENTAL HEALTH J a n u a r y - M a r c h 2 0 1 2

105

∫ ∑ «‘ ∑ ¬ “ ° “ √ °√√¡°“√Õ“À“√·≈–¬“ (Õ¬.) ·≈– ”π—°√–∫“¥ «‘∑¬“ °√¡§«∫§ÿ¡‚√§ ®÷ß‰¥âæ—≤π“√–∫∫‡ΩÑ“√–«—ß ·∫∫∫Ÿ √ ≥“°“√‡æ◊Ë Õ µ‘ ¥ µ“¡ ∂“π°“√≥å · ≈–≈¥ ¿“«–¢“¥ “√‰Õ‚Õ¥’π„π¡“√¥“·≈–∑“√°¢÷Èπ ‚¥¬ “¡“√∂π”¢âÕ¡Ÿ≈¡“· ¥ß§«“¡‡™◊ËÕ¡‚¬ß„Àâ‡ÀÁπ Õ¬à“ß™—¥‡®π∂÷ß “‡Àµÿ·≈–æ◊Èπ∑’Ë∑’Ë‡ªìπªí≠À“ ‡æ◊ËÕ ¥”‡π‘π°“√·°â‰¢ªí≠À“ °àÕ„Àâ‡°‘¥ª√– ‘∑∏‘¿“æ„π °“√§«∫§ÿ ¡ ªÑ Õ ß°— π ‚√§¢“¥ “√‰Õ‚Õ¥’ π ·≈– “¡“√∂„™â„π°“√µ‘¥µ“¡ª√–‡¡‘πº≈°“√¥”‡π‘πß“π

«—µ∂ÿª√– ß§å°“√»÷°…“ ‡æ◊Ë Õ µ‘ ¥ µ“¡ ∂“π°“√≥å ¿ “«–¢“¥ “√

‰Õ‚Õ¥’ π „πª√–™“°√¢Õßæ◊È π ∑’Ë § «“¡√— ∫ º‘ ¥ ™Õ∫ »Ÿπ¬åÕπ“¡—¬∑’Ë 1 Õ¬à“ß∫Ÿ√≥“°“√µ—«™’È«—¥·≈–‡ªìπ √–∫∫Õ¬à“ßµàÕ‡π◊ËÕß

«‘∏’°“√»÷°…“ °“√»÷°…“§√—Èßπ’È µâÕß°“√π”¢âÕ¡Ÿ≈·≈–º≈∑’Ë ‰¥â¡“„™â„π°“√‡ΩÑ“√–«—ß·≈–µ‘¥µ“¡¿“«–¢“¥ “√ ‰Õ‚Õ¥’π »Ÿπ¬åÕπ“¡—¬®÷ß‰¥â¥”‡π‘π°“√‡°Á∫µ—«Õ¬à“ß „Àâ§√Õ∫§≈ÿ¡°≈ÿà¡‡ªÑ“À¡“¬¥—ßπ’È 1. À≠‘ßµ—ßÈ §√√¿å ∑“√°·√°‡°‘¥ ‡¥Á°Õ“¬ÿ 13 ªï ‡¥Á°Õ“¬ÿ 3-6 ªï ·≈–ºŸâ ŸßÕ“¬ÿ 2. ·À≈àßº≈‘µ‡°≈◊Õ‡ √‘¡‰Õ‚Õ¥’π √â“π§â“∑’Ë

µ“√“ß∑’Ë 1 «‘∏’°“√¥”‡π‘πß“π‚§√ß°“√‡ΩÑ“√–«—ß‚√§¢“¥ “√‰Õ‚Õ¥’π·∫∫∫Ÿ√≥“°“√ ªï 2554 °“√¥”‡π‘πß“π 1. Õ∫∂“¡æƒµ‘°√√¡°“√∫√‘‚¿§º≈‘µ¿—≥±å‡ √‘¡‰Õ‚Õ¥’π 2. µ√«®§ÿ≥¿“æ‡°≈◊Õ‡ √‘¡‰Õ‚Õ¥’π„π§√—«‡√◊Õπ 2.1 µ√«®§ÿ≥¿“æ‡°≈◊Õ∫√‘‚¿§‡ √‘¡‰Õ‚Õ¥’π„π§√—«‡√◊Õπ ‚¥¬„™â I-Kit 2.2 ‡°Á∫µ—«Õ¬à“ß‡°≈◊Õ‡ √‘¡‰Õ‚Õ¥’π‡æ◊ËÕ àß titration ∑’Ë ”π—°‚¿™π“°“√ 3. ‡°Á∫µ—«Õ¬à“ßªí “«–‡æ◊ËÕ àßµ√«®√–¥—∫§«“¡‡¢â¡¢âπ ¢Õß‰Õ‚Õ¥’π 3.1 ‡°Á∫µ—«Õ¬à“ßªí “«–„πºŸâ ŸßÕ“¬ÿ 60 ªï¢÷Èπ‰ª 3.2 ‡°Á∫µ—«Õ¬à“ßªí “«–‡¥Á°Õ“¬ÿ 3-6 ªï 4. µ√«®æ—≤π“°“√‡¥Á° 1-3 ªï À¡“¬‡Àµÿ:

®”π«π µàÕÀ¡Ÿà∫â“π

À¡Ÿà∫â“π µàÕ®—ßÀ«—¥

®”π«π√«¡ µàÕ®—ßÀ«—¥

10 §√—«‡√◊Õπ

300 §√—«‡√◊Õπ

10 §√—«‡√◊Õπ (∑ÿ°¬’ËÀâÕ ∑ÿ°¢π“¥) √âÕ¬≈– 10 ¢Õß µ—«Õ¬à“ß‡°≈◊Õ∑’Ë µ√«®„π¢âÕ 2.1

300 §√—«‡√◊Õπ

30 §√—«‡√◊Õπ

5 §π 5 §π 3 §π

30 30 30

150 §π 150 §π 90 §π

„π°√≥’∑’Ë§√—«‡√◊Õπ∑’Ë‡¢â“ Õ∫∂“¡æƒµ‘°√√¡°“√∫√‘‚¿§º≈‘µ¿—≥±å‡ √‘¡‰Õ‚Õ¥’π ·≈–µ√«®§ÿ≥¿“æ ‡°≈◊Õ∫√‘‚¿§π—Èπ ¡’®”π«π‡¥Á° Õ“¬ÿ 1-3 ªï, 3-6 ªï À√◊ÕºŸâÕ“¬ÿ‰¡à§√∫µ“¡‡ªÑ“À¡“¬ ‰¥â ÿà¡µ—«Õ¬à“ß ª√–™“°√¥—ß°≈à“«„Àâ§√∫µ“¡®”π«π‚¥¬‰¡àµâÕß —¡¿“…≥å§√—«‡√◊Õπ„À¡à

106 ¡°√“§¡ - ¡’π“§¡ 2555 °√¡Õπ“¡—¬

àß‡ √‘¡„Àâ§π‰∑¬ ÿ¢¿“æ¥’

®”Àπà“¬‡°≈◊Õ‡ √‘¡‰Õ‚Õ¥’π ·≈–§√—«‡√◊Õπ «‘∏’°“√¥”‡π‘π°“√ 1. ∑∫∑«π¢âÕ¡Ÿ≈ ∂“π°“√≥å¢Õßªí≠À“ °“√¢“¥ “√‰Õ‚Õ¥’π„π»Ÿπ¬åÕπ“¡—¬∑’Ë 1 2. ÿà¡‡≈◊Õ°®—ßÀ«—¥∑’Ë∑”°“√»÷°…“‚¥¬«‘∏’ °“√ ÿ¡à µ—«Õ¬à“ßÕ¬à“ß‡ªìπ√–∫∫ (systematic sampling) ¥”‡π‘π°“√‡ªìπ‡«≈“ 3 ªï „π√Õ∫·√° ªï æ.».2554 ‚¥¬ “¡“√∂‡ªìπµ—«·∑π„π√–¥—∫»Ÿπ¬å Õπ“¡—¬∑’Ë 1 §◊Õ®—ßÀ«—¥ª∑ÿ¡∏“π’ ·≈–®—ßÀ«—¥ππ∑∫ÿ√’ 3. ¥”‡π‘π°“√®—¥µ—Èß§≥–∑”ß“πªØ‘∫—µ‘°“√ ¿“§ π“¡ ·≈–ª√– “πß“π™’È·®ß·π«∑“ß¥”‡π‘π ß“π·°àºŸâ√—∫º‘¥™Õ∫„πÀπà«¬ß“πµà“ßÊ 4. ¥”‡π‘ π °“√‡°Á ∫ ¢â Õ ¡Ÿ ≈ √–∫∫‡ΩÑ “ √–«— ß √–¥—∫®—ßÀ«—¥ ¥—ßµàÕ‰ªπ’È 4.1) °“√¥”‡π‘π°“√‡°Á∫¢âÕ¡Ÿ≈‡°≈◊Õ ‰Õ‚Õ¥’π®“°‚√ßß“π‡°≈◊Õ ‚¥¬®–‡°Á∫®“°‚√ßß“π ∑ÿ°·Ààß„π·µà≈–®—ßÀ«—¥∑’Ë∑”°“√»÷°…“„πªïπ—ÈπÊ (Õ¬. ¥”‡π‘π°“√) 4.2) °“√¥”‡π‘π°“√‡°Á∫¢âÕ¡Ÿ≈‡°≈◊Õ ‰Õ‚Õ¥’π®“° ∂“π∑’Ë®”Àπà“¬ (Õ¬. ¥”‡π‘π°“√) 4.3) °“√¥”‡π‘π°“√‡°Á∫¢âÕ¡Ÿ≈‡°≈◊Õ ‰Õ‚Õ¥’π®“°§√—«‡√◊Õπ ‚¥¬µ√«®§ÿ≥¿“æ‡°≈◊Õ‚¥¬ I-Kit 10 À≈—ß§“‡√◊ÕπµàÕÀ¡Ÿà∫â“π „π 30 À¡Ÿà∫â“π ∑’∑Ë ”°“√ ÿ¡à ‡≈◊Õ°¡“‚¥¬«‘∏°’ “√ ÿ¡à µ—«Õ¬à“ß·∫∫°≈ÿ¡à (Cluster random sampling) „π·µà≈–®—ßÀ«—¥ ∑’Ë∑”°“√»÷°…“„πªïπ—ÈπÊ ·≈–‡°Á∫µ—«Õ¬à“ß‡°≈◊Õ √âÕ¬≈– 10 ®“°§√—«‡√◊Õπ‡æ◊ËÕ àßµ√«® titration „π ÀâÕßªØ‘∫—µ‘°“√ æ√âÕ¡ —¡¿“…≥å„π√–¥—∫§√—«‡√◊Õπ µ“¡·∫∫ Õ∫∂“¡æƒµ‘ ° √√¡°“√∫√‘ ‚ ¿§‡§√◊Ë Õ ß ª√ÿß√ Õ“À“√∑’Ë¡’‰Õ‚Õ¥’π ·≈–¬“‡¡Á¥‡ √‘¡ “√ Õ“À“√ 4.4) °“√¥”‡π‘π°“√‡°Á∫¢âÕ¡Ÿ≈√–¥—∫ ‰Õ‚Õ¥’ π „πªí “«–¢ÕßÀ≠‘ ß µ—È ß §√√¿å ∑’Ë ¡ “Ω“° §√√¿å§√—Èß·√°„π‚√ßæ¬“∫“≈ ‚¥¬®–‡°Á∫µ—«Õ¬à“ß

„πÀ≠‘ßµ—Èß§√√¿å 300 √“¬∑’Ë∑”°“√‡≈◊Õ°¡“‚¥¬«‘∏’ ‡≈◊Õ°·∫∫°”Àπ¥®”π«π‰«â°àÕπ (Quota sampling) „π·µà≈–®—ßÀ«—¥∑’Ë∑”°“√»÷°…“„πªïπ—ÈπÊ (¥”‡π‘π°“√„π‡¥◊Õπ ‘ßÀ“§¡ 2554) 4.5) °“√¥”‡π‘π°“√‡°Á∫¢âÕ¡Ÿ≈√–¥—∫ TSH „π∑“√°·√°‡°‘¥„π·µà≈–®—ßÀ«—¥∑’Ë∑”°“√ »÷°…“„πªïπ—ÈπÊ ‚¥¬ª√– “π¢âÕ¡Ÿ≈‚§√ß°“√µ√«® §—¥°√Õß¿“«–æ√àÕß∏—¬√Õ¬¥åŒÕ√å‚¡π„π∑“√°·√° ‡°‘ ¥ ‚¥¬°√¡«‘ ∑ ¬“»“ µ√å ° “√·æ∑¬å ´÷Ë ß ‡°Á ∫ µ— « Õ¬à “ ß„π∑“√°·√°‡°‘ ¥ ∑ÿ ° √“¬∑’Ë ‚ √ßæ¬“∫“≈ (¡°√“§¡ - ∏—π«“§¡ 2554) 4.6) °“√¥”‡π‘π°“√‡°Á∫¢âÕ¡Ÿ≈¿“«– æ—≤π“°“√¢Õß‡¥Á°Õ“¬ÿ 1-3 ªï ¥â«¬·∫∫∑¥ Õ∫ Denver II ‚¥¬®–ª√–‡¡‘π„π‡¥Á° 3 √“¬µàÕÀ¡Ÿ∫à “â π „π 30 À¡Ÿà∫â“π∑’Ë∑”°“√ ÿà¡‡≈◊Õ°¡“‚¥¬«‘∏’°“√ ÿà¡ µ—«Õ¬à“ß·∫∫°≈ÿà¡ (Cluster random sampling) „π·µà≈–®—ßÀ«—¥∑’Ë∑”°“√»÷°…“„πªïπ—ÈπÊ 4.7) °“√¥”‡π‘π°“√‡°Á∫ªí “«–¢Õß ‡¥Á°«—¬ 3 - 6 ªï ·≈– ºŸâ ŸßÕ“¬ÿ 5 √“¬µàÕÀ¡Ÿà∫â“π „π 30 À¡Ÿà∫â“π ∑’Ë∑”°“√ ÿà¡‡≈◊Õ°¡“‚¥¬«‘∏’°“√ ÿà¡ µ—«Õ¬à“ß·∫∫°≈ÿà¡ (Cluster random sampling) „π·µà≈–®—ßÀ«—¥∑’Ë∑”°“√»÷°…“„πªïπ—ÈπÊ 5. «‘ ‡ §√“–Àå ¢â Õ ¡Ÿ ≈ ª√‘ ¡ “≥‰Õ‚Õ¥’ π „π ‡°≈◊Õ®“°·À≈àßº≈‘µ √â“π§â“ ·≈–§√—«‡√◊Õπ ¢âÕ¡Ÿ≈ √–¥—∫§«“¡‡¢â¡¢âπ¢Õß‰Õ‚Õ¥’π„πªí “«–À≠‘ßµ—Èß §√√¿å ‡¥Á° 3 - 6 ªï·≈–ºŸ â ßŸ Õ“¬ÿ ¢âÕ¡Ÿ≈√–¥—∫ŒÕ√å‚¡π TSH „π‡≈◊Õ¥∑’Ë‡®“–®“° âπ‡∑â“∑“√°·√°‡°‘¥ ·≈– ¢âÕ¡Ÿ≈√–¥—∫æ—≤π“°“√‡¥Á°Õ“¬ÿ 1 - 3 ªï

º≈°“√»÷°…“ ¢âÕ¡Ÿ≈∑—Ë«‰ª¢ÕßºŸâµÕ∫·∫∫ Õ∫∂“¡ ª√–™“°√µ—«Õ¬à“ß„π°“√»÷°…“§√—Èßπ’È à«π „À≠à·≈â«Õ“»—¬Õ¬Ÿà„π‡¢µÕß§å°“√∫√‘À“√ à«πµ”∫≈ (Õ∫µ.) ∑—Èß®—ßÀ«—¥ª∑ÿ¡∏“π’ ·≈–ππ∑∫ÿ√’ §◊Õ√âÕ¬

THAILAND JOURNAL OF HEALTH PROMOTION AND ENVIRONMENTAL HEALTH J a n u a r y - M a r c h 2 0 1 2

107

∫ ∑ «‘ ∑ ¬ “ ° “ √ ≈– 76.6 ·≈– 94.3 ®—ßÀ«—¥ª∑ÿ¡∏“π’ ·≈–ππ∑∫ÿ√’ ¡’ª√–™“°√µ—«Õ¬à“ß‡ªìπ‡æ»À≠‘ß√âÕ¬≈– 75.0 ·≈– 76.7 ·≈–Õ“¬ÿ¡“°°«à“ 60 ªï ∂÷ß√âÕ¬≈– 33.7 ·≈– 42.0 µ“¡≈”¥—∫ ®∫√–¥—∫ª√–∂¡»÷°…“ √âÕ¬≈– 61.7 ·≈– 72.4 ·≈–¡’Õ“™’æ‡ªìπ·¡à∫“â π √âÕ¬≈– 38.0 ·≈– 37.7 µ“¡≈”¥—∫ æƒµ‘°√√¡°“√∫√‘‚¿§º≈‘µ¿—≥±å·≈– ¬“‡¡Á¥‡ √‘¡‰Õ‚Õ¥’π „π√Õ∫ 1 ‡¥◊Õπ∑’Ëºà“π¡“ °àÕπ°“√ Õ∫∂“¡ §√—«‡√◊Õπ¡’°“√‡¢â“∂÷ßº≈‘µ¿—≥±å‡§√◊ËÕßª√ÿß√ ‡ √‘¡ ‰Õ‚Õ¥’πÕ◊ËπÊ „πÕ—µ√“µË”°«à“‡°≈◊Õ‡ √‘¡‰Õ‚Õ¥’π ¡’§√—«‡√◊Õπ„π®—ßÀ«—¥ª∑ÿ¡∏“π’·≈–ππ∑∫ÿ√’ „™â ‡°≈◊Õ‡ √‘¡‰Õ‚Õ¥’π §√Õ∫§≈ÿ¡√âÕ¬≈– 81.0 ·≈– 87.3 ‚¥¬¡’°“√„™â∫√‘‚¿§∑ÿ°«—π√âÕ¬≈– 44.3 ·≈– 47.6 °“√„™âπÈ”‡°≈◊Õª√ÿßÕ“À“√¢Õß∑—Èß®—ßÀ«—¥ ª∑ÿ¡∏“π’ ·≈–ππ∑∫ÿ√’ ‰¡àπ‘¬¡„™â À√◊Õ¡’°“√„™â ‡æ◊ËÕª√ÿßª√–°Õ∫Õ“À“√‡æ’¬ß√âÕ¬≈– 7.7 ·≈– 5.0 „π¢≥–∑’¡Ë °’ “√„™âπÈ”ª≈“‡ √‘¡‰Õ‚Õ¥’π √âÕ¬≈– 63.3 ·≈– 54.3 ·≈–¡’°“√„™â´Õ’ «‘È ‡ √‘¡‰Õ‚Õ¥’π√âÕ¬≈– 58 ·≈– 47 ´Õ ª√ÿß√ ‡ √‘¡‰Õ‚Õ¥’π √âÕ¬≈– 45.7 ·≈– √âÕ¬≈– 42.7 „π°“√ª√ÿß/ª√–°Õ∫Õ“À“√ °“√ ∫√‘‚¿§‰¢à‰°à ·≈–‰¢à‡ªì¥ ‰¥â√—∫§«“¡π‘¬¡„π°“√ ∫√‘‚¿§¡“° ‡À¡◊Õπ°—π∑—ßÈ §√—«‡√◊Õπ®—ßÀ«—¥ª∑ÿ¡∏“π’ ·≈–ππ∑∫ÿ√’ §◊Õ√âÕ¬≈– 98.0 °“√∫√‘‚¿§‰¢à‰°à ‡ √‘¡‰Õ‚Õ¥’π¡’ª√‘¡“≥°“√∫√‘‚¿§„°≈â‡§’¬ß°—π§◊Õ √âÕ¬≈– 12.7 ·≈– 11.0 §«“¡∂’Ë„π°“√∫√‘‚¿§‰¢à ª√–¡“≥ 1-3 «—π/§√—Èß (√âÕ¬≈– 37.7 ·≈– 34.7) „πÕ“À“√¡◊ÈÕ‡™â“‡ªìπ à«π„À≠à (√âÕ¬≈– 61.0 ·≈– 58.4) °“√∫√‘‚¿§∫–À¡’Ë°÷Ëß ”‡√Á®√Ÿª‡ √‘¡‰Õ‚Õ¥’π ¢ÕßºŸâ „ Àâ — ¡ ¿“…≥å „ π®— ß À«— ¥ ª∑ÿ ¡ ∏“π’ ·≈– ππ∑∫ÿ√’æ∫‡æ’¬ß√âÕ¬≈– 21.3 ·≈– 12.7 °“√ ∫√‘‚¿§Õ“À“√∑’Ë¡’‰Õ‚Õ¥’π ‡™àπ ª≈“∑Ÿ Õ“À“√∑–‡≈ “À√à“¬ ¡’°“√∫√‘‚¿§√âÕ¬≈– 91.7 ·≈– 93.0 µ“¡ ≈”¥—∫ §«“¡∂’Ë„π°“√∫√‘‚¿§ 1-3 «—π/§√—Èß (√âÕ¬ 108 ¡°√“§¡ - ¡’π“§¡ 2555 °√¡Õπ“¡—¬

àß‡ √‘¡„Àâ§π‰∑¬ ÿ¢¿“æ¥’

≈– 37.7 ·≈– 40.3) „πÕ“À“√¡◊ÕÈ ‡¬Áπ‡ªìπ à«π„À≠à (√âÕ¬≈– 66.7 ·≈– 55.7) ‡¡◊Ë Õ Õ∫∂“¡æƒµ‘ ° √√¡∑—Ë « ‰ª„π°“√„™â ‡°≈◊Õ‡ √‘¡‰Õ‚Õ¥’π„π°“√ª√ÿß/ª√–°Õ∫Õ“À“√ ¢Õß ®—ßÀ«—¥ª∑ÿ¡∏“π’ ·≈–ππ∑∫ÿ√’ æ∫¡’°“√„™â Ÿß∂÷ß √âÕ¬≈– 90.0 ·≈– 94.3 µ“¡≈”¥—∫ ‚¥¬ à«π„À≠à „Àâ‡Àµÿº≈∑’Ë‡≈◊Õ°∫√‘‚¿§‡°≈◊Õ‡ √‘¡‰Õ‚Õ¥’π §◊Õ À“ ´◊ÕÈ ‰¥âß“à ¬„πÀ¡Ÿ∫à “â π (√âÕ¬≈– 60.3 ·≈– 55.7) ·≈– ªÑÕß°—π‚√§§ÕæÕ°‰¥â (√âÕ¬≈– 52.3 ·≈– 60.0) ·À≈à ß ∑’Ë ´◊È Õ ‡°≈◊ Õ ‡ √‘ ¡ ‰Õ‚Õ¥’ π ´◊È Õ ®“°√â “ π§â “ „π À¡Ÿà∫â“π (√âÕ¬≈– 45.7 ·≈– 47.7) ·≈–Àâ“ß √√æ ‘π§â“ (√âÕ¬≈– 35.7 ·≈– 43.0) °“√‡≈◊Õ°´◊ÈÕ æ‘®“√≥“®“°©≈“°´Õß‡°≈◊Õ‡ªìπ à«π„À≠à«à“‡ªìπ ‡°≈◊Õ‡ √‘¡‰Õ‚Õ¥’π (√âÕ¬≈– 81.3 ·≈– 85) °“√ ‡°Á∫‡°≈◊Õ‡ √‘¡‰Õ‚Õ¥’π ∑’Ë„™â„π°“√ª√ÿßÕ“À“√∑ÿ° «—π®–‡°Á∫„π¿“™π–∑’ªË ¥î ¡‘¥™‘¥‡ªìπ à«π„À≠à (√âÕ¬ ≈– 88.0 ·≈– 86.0) ‚¥¬‡°Á∫Àà“ß®“°‡µ“‰ø ‰¡à µË”°«à“ 1 ‡¡µ√ À√◊Õ®“°§«“¡√âÕπ®“°‡µ“ (√âÕ¬ ≈– 86.0 ·≈– 85.0) „π∑’Ë· ß·¥¥ àÕß‰¡à∂÷ß (√âÕ¬ ≈– 82.0 ·≈– 84.0) ·≈–‰¡à·¢«πÀ√◊Õ«“ß‰«â ‡Àπ◊Õ‡µ“‰ø (√âÕ¬≈– 83.3 ·≈– 81) °“√ Õ∫∂“¡¢âÕ¡Ÿ≈°“√∫√‘‚¿§¢Õß‡¥Á°Õ“¬ÿ 3-6 ªï „π§√—«‡√◊Õπ ®—ßÀ«—¥ª∑ÿ¡∏“π’ ·≈–ππ∑∫ÿ√’ æ∫«à“‡¡πŸÕ“À“√‡¥Á°∫√‘‚¿§„π§√—«‡√◊Õπ à«π„À≠à ‡À¡◊Õπ°—∫‡¡πŸ∑’Ë∑ÿ°§π∫√‘‚¿§ (√âÕ¬≈– 27.7 ·≈– 32.0) º—°∑’Ë‡¥Á°™Õ∫°‘πª√–®”¡“°∑’Ë ÿ¥ §◊Õ §–πâ“ (√âÕ¬≈– 12.0) ·≈–·§√Õ∑ (√âÕ¬≈– 13.9) °“√ ∫√‘‚¿§Õ“À“√∑’Ë¡’ “À√à“¬‡ªìπ à«πª√–°Õ∫ ¡’√âÕ¬ ≈– 19.3 ·≈– 14.3 µ“¡≈”¥—∫ ‡¥Á°√âÕ¬≈– 20.0 ¢Õß∑—ßÈ ®—ßÀ«—¥ª∑ÿ¡∏“π’ ·≈–ππ∑∫ÿ√∫’ √‘‚¿§°ÿßâ ª≈“ ∑–‡≈ ·≈–ª≈“πÈ”®◊¥ ·≈–π‘¬¡∫√‘‚¿§‰¢à‰°à¡“° °«à“‰¢à‡ªì¥ ‚¥¬∫√‘‚¿§‰¢à‰°à∑°ÿ «—π√âÕ¬≈– 11.3 ·≈– 18.7 ª√‘¡“≥«—π≈– 1 øÕß‡ªìπ à«π„À≠à (√âÕ¬≈– 29.0 ·≈– 34.7) °“√∫√‘‚¿§π¡¡’√âÕ¬≈– 38.7 ·≈–

46.7 ‚¥¬∫√‘‚¿§π¡∂ÿßÀ√◊Õπ¡°≈àÕß∑ÿ°«—π√âÕ¬≈– 27.0 ·≈– 33.0 ¢≥–∑’Ë¡’°“√∫√‘‚¿§π¡ºß∏√√¡¥“ ∑ÿ°«—π‡æ’¬ß√âÕ¬≈– 10.0 ¢âÕ¡Ÿ≈°“√ ”√«®¬—ßæ∫ «à“‡¥Á°¢Õß∑—Èß®—ßÀ«—¥ª∑ÿ¡∏“π’ ·≈–ππ∑∫ÿ√’π‘¬¡ ∫√‘‚¿§Õ“À“√«à“ß√ ‡§Á¡¡“°°«à“°“√∫√‘‚¿§≈Ÿ°Õ¡ ‚¥¬π‘¬¡∫√‘‚¿§¢π¡¢∫‡§’È¬«‡ªìπª√–®” (√âÕ¬≈– 23.0 ·≈– 30.3) ¡“°°«à“Õ“À“√«à“ßª√–‡¿∑Õ◊Ëπ ”À√— ∫ “À√à “ ¬ ”‡√Á ® √Ÿ ª ∑’Ë ‡ ªì π ∑’Ë π‘ ¬ ¡„πµ≈“¥ ªí®®ÿ∫π— æ∫¡’°“√∫√‘‚¿§√âÕ¬≈– 10.0 ·≈– 15.7 µ“¡ ≈”¥—∫ ∫–À¡’Ë°÷Ëß ”‡√Á®√Ÿª∑’Ë∫√‘‚¿§‡ªìπª√–®”§◊Õ ¡“¡à“ √âÕ¬≈– 15.7 ·≈– 20.7 ·≈–¡’‡¥Á°∑’Ë‰¡à ∫√‘‚¿§∫–À¡’Ë°÷Ëß ”‡√Á®√Ÿª √âÕ¬≈– 13.7 ·≈–√âÕ¬≈– 9.0 °“√∫√‘‚¿§Õ“À“√¢ÕßºŸâ ŸßÕ“¬ÿ„πæ◊Èπ∑’Ë¢Õß ®—ßÀ«—¥ª∑ÿ¡∏“π’ ·≈–ππ∑∫ÿ√’ æ∫«à“ ‡¡πŸÕ“À“√ºŸâ ŸßÕ“¬ÿ∫√‘‚¿§ à«π„À≠à‡À¡◊Õπ‡¡πŸ∑’Ë∑ÿ°§π„π§√—« ‡√◊Õπ∫√‘‚¿§ (√âÕ¬≈– 56.0 ·≈– 60.7) ‡§√◊ËÕß ª√ÿß√ ∑’ËºŸâ ŸßÕ“¬ÿ„™âª√ÿß√ Õ“À“√¢Õß§√—«‡√◊Õπ„π ®—ßÀ«—¥ª∑ÿ¡∏“π’ ·≈–ππ∑∫ÿ√’ à«π„À≠à§◊Õ πÈ”ª≈“ (√âÕ¬≈– 43.7 ·≈– 51.3) √Õß≈ß¡“§◊Õ ‡°≈◊Õ ∫√‘‚¿§‡ √‘¡‰Õ‚Õ¥’π (√âÕ¬≈– 38.7 ·≈– 46.7) Õ“À“√À¡—°¥Õß∑’Ë¡’°“√∫√‘‚¿§‡ªìπª√–®”§◊Õ°–ªî (√âÕ¬≈– 33.0 ·≈– 49.0) ‰¢à‡§Á¡ (√âÕ¬≈– 14.3 ·≈– 21.7) ·≈–°ÿâß·Àâß (√âÕ¬≈– 11.3 ·≈– 21.7) Õ“À“√∑–‡≈∑’Ë °‘ π ª√–®”§◊ Õ ª≈“∑–‡≈ ¡’ ° “√ ∫√‘‚¿§√âÕ¬≈– 41.0 ·≈– 52.0 ¢âÕ¡Ÿ≈°“√„™â¬“‡¡Á¥‡ √‘¡‰Õ‚Õ¥’π¢ÕßÀ≠‘ß µ—Èß§√√¿å æ∫«à“ °“√√—∫∑√“∫¢âÕ¡Ÿ≈°“√‰¥â√—∫¬“ ‡¡Á¥‡ √‘¡‰Õ‚Õ¥’π¢ÕßÀ≠‘ßµ—Èß§√√¿å∑ÿ°§π∑’ËΩ“° §√√¿å ≥ ∂“π∫√‘°“√ “∏“√≥ ÿ¢ ∑’Ë‡√‘Ë¡µ—Èß·µà«—π ∑’Ë 1 µÿ≈“§¡ 2553 ¢ÕßºŸâ„Àâ —¡¿“…≥å„πæ◊Èπ∑’Ë ®—ßÀ«—¥ª∑ÿ¡∏“π’ ·≈–ππ∑∫ÿ√’ ¡’®”π«π√âÕ¬≈– 38.7 ·≈– 29.3 µ“¡≈”¥—∫ À≠‘ßµ—Èß§√√¿å¢Õß®—ßÀ«—¥ ª∑ÿ¡∏“π’ à«π„À≠à‰¡àÕ¬Ÿà°—∫§√—«‡√◊Õπ ·µàÀ≠‘ßµ—Èß

§√√¿å∑—ÈßÀ¡¥¢Õß®—ßÀ«—¥ππ∑∫ÿ√’Õ“»—¬Õ¬Ÿà„π§√—« ‡√◊Õπ °“√‰¥â√—∫¬“‡¡Á¥‡ √‘¡‰Õ‚Õ¥’π¢ÕßÀ≠‘ßµ—Èß §√√¿å„π®—ßÀ«—¥ª∑ÿ¡∏“π’‰¥â√∫— §√∫∑ÿ°§√—«‡√◊Õπ ·≈– √—∫ª√–∑“π¬“‡¡Á¥∑ÿ°«—π ”À√—∫®—ßÀ«—¥ππ∑∫ÿ√’ æ∫¡’À≠‘ßµ—Èß§√√¿å‰¥â√—∫¬“‡¡Á¥‡ √‘¡‰Õ‚Õ¥’π ·≈– √— ∫ ª√–∑“π∑ÿ ° «— π √â Õ ¬≈– 30.0 ·≈–‰¡à ‰ ¥â √— ∫ ª√–∑“π√âÕ¬≈– 70.0 ™à«ß√–¬–¢Õß°“√µ—Èß§√√¿å ∑’Ë ‡ √‘Ë ¡ √— ∫ ª√–∑“π¬“‡¡Á ¥ ‡ √‘ ¡ ‰Õ‚Õ¥’ π ¢Õß∑—È ß ®—ßÀ«—¥ª∑ÿ¡∏“π’ ·≈–ππ∑∫ÿ√’ §◊Õ °àÕπÕ“¬ÿ§√√¿å 12 —ª¥“Àå À≠‘ßµ—Èß§√√¿å∑ÿ°§π∑’Ë‰¥â√—∫¬“‡¡Á¥ ‡ √‘¡‰Õ‚Õ¥’π ‰¡à¡’Õ“°“√¢â“ß‡§’¬ßÀ≈—ß°‘π¬“‡¡Á¥ ‡ √‘¡‰Õ‚Õ¥’π ·≈–¡’§«“¡µ—Èß„®°‘π¬“‡¡Á¥‡ √‘¡ ‰Õ‚Õ¥’πµ≈Õ¥Õ“¬ÿ§√√¿å ®π∂÷ß„Àâπ¡∫ÿµ√ 6 ‡¥◊Õπ §ÿ≥¿“æ‡°≈◊Õ‡ √‘¡‰Õ‚Õ¥’π„π§√—« ‡√◊Õπ §ÿ≥¿“æ‡°≈◊Õ‡ √‘¡‰Õ‚Õ¥’π∑’Ë ÿà¡µ√«®„π §√—«‡√◊Õπ∑’Ë»÷°…“„π®—ßÀ«—¥ª∑ÿ¡∏“π’ ·≈–ππ∑∫ÿ√’ æ∫«à“ §√—«‡√◊Õππ‘¬¡„™â‡°≈◊Õª√ÿß∑‘æ¬å‡ªìπ à«π„À≠à (√âÕ¬≈– 43.51 ·≈– 41.64) ¢π“¥∫√√®ÿ∑’Ëπ‘¬¡„™â ¢Õß®—ßÀ«—¥ª∑ÿ¡∏“π’ §◊Õ¢π“¥ 500 °√—¡ (√âÕ¬≈– 28.66) ®—ßÀ«—¥ππ∑∫ÿ√’§◊Õ¢π“¥ 60 °√—¡ (√âÕ¬≈– 20.51) ‡¡◊ËÕµ√«®§ÿ≥¿“æ‡°≈◊Õ‡ √‘¡‰Õ‚Õ¥’π¢Õß ®—ßÀ«—¥ª∑ÿ¡∏“π’ ‚¥¬„™â I-Kit æ∫√âÕ¬≈– 32.48 ¡’ª√‘¡“≥‰Õ‚Õ¥’π 30 æ’æ’‡ÕÁ¡ ·≈–√âÕ¬≈– 43.63 ¡’ª√‘¡“≥‰Õ‚Õ¥’π 50 æ’æ’‡ÕÁ¡ ·≈–®—ßÀ«—¥ππ∑∫ÿ√’ æ∫√âÕ¬≈– 43.0 ¡’ª√‘¡“≥‰Õ‚Õ¥’π 30 æ’æ‡’ ÕÁ¡ ·≈– √âÕ¬≈– 32.7 ¡’ª√‘¡“≥‰Õ‚Õ¥’π 50 æ’æ’‡ÕÁ¡ ·≈–‡¡◊Ë Õ ÿà ¡ µ√«®‡°≈◊ Õ ‡ √‘ ¡ ‰Õ‚Õ¥’ π ¢Õß ®— ß À«— ¥ ª∑ÿ ¡ ∏“π’ ·≈–®— ß À«— ¥ ππ∑∫ÿ √’ ‚¥¬„™â Titration æ∫√âÕ¬≈– 17.8 ·≈–√âÕ¬≈– 17.2 ¡’ ª√‘¡“≥‰Õ‚Õ¥’π 20-40 æ’æ’‡ÕÁ¡ µ“¡ª√–°“» °√–∑√«ß “∏“√≥ ÿ¢ ©∫—∫≈à“ ÿ¥ ∑’Ëª√–°“» ≥ «—π ∑’Ë 16 ¡’π“§¡ 2554 ¿“«–¢“¥ “√‰Õ‚Õ¥’π„πÀ≠‘ßµ—ßÈ §√√¿å

THAILAND JOURNAL OF HEALTH PROMOTION AND ENVIRONMENTAL HEALTH J a n u a r y - M a r c h 2 0 1 2

109

∫ ∑ «‘ ∑ ¬ “ ° “ √ „πªï 2553 §à“¡—∏¬∞“π√–¥—∫‰Õ‚Õ¥’π„π ªí “«–À≠‘ßµ—Èß§√√¿å „π®—ßÀ«—¥ª∑ÿ¡∏“π’·≈– ππ∑∫ÿ√’ 260.8 µg/L ·≈– 116.5 µg/L æ∫ —¥ à«π¢ÕßÀ≠‘ßµ—Èß§√√¿å¡’√–¥—∫‰Õ‚Õ¥’πµË”°«à“ 150 µg/L (√–¥—∫¢“¥) √âÕ¬≈– 24.6 ·≈–√âÕ¬≈– 63.5 ·≈– — ¥ à « π¢ÕßÀ≠‘ ß µ—È ß §√√¿å ¡’ √ –¥— ∫ ‰Õ‚Õ¥’πµË”°«à“ 150 µg/L √âÕ¬≈– 9.7 ·≈– 36.8 „πªï 2554 µ“¡≈”¥—∫ (°àÕπªï 2550 Õß§å°“√

Õπ“¡—¬‚≈° °”Àπ¥æ◊Èπ∑’Ë∑’Ë¡’ —¥ à«π¢ÕßÀ≠‘ßµ—Èß §√√¿å∑’Ë¡’√–¥—∫‰Õ‚Õ¥’π„πªí “«–πâÕ¬°«à“ 100 µg/L ‡°‘π√âÕ¬≈– 50.0 ‡ªìπæ◊Èπ∑’Ë¢“¥ “√‰Õ‚Õ¥’π ·≈–µ—Èß·µàªï 2550 Õß§å°“√Õπ“¡—¬‚≈°ª√—∫√–¥—∫ ‰Õ‚Õ¥’π„πªí “«– ´÷Ëß‡ªìπµ—«™’È«—¥√–¥—∫°≈ÿà¡ ª√–™“°√ ∑’Ë∂◊Õ«à“πâÕ¬°«à“ª°µ‘®“° 100 µg/L ‡ªìπ 150 µg/L ‡π◊ËÕß®“°À≠‘ßµ—Èß§√√¿å¡’§«“¡ µâÕß°“√‰Õ‚Õ¥’π¡“°°«à“ª√–™“™π∑—Ë«‰ª)

·ºπ¿Ÿ¡‘∑’Ë 1 §à“¡—∏¬∞“π√–¥—∫‰Õ‚Õ¥’π„πªí “«–À≠‘ßµ—Èß§√√¿å ªï 2553 - 2555 ‰¡‚§√°√—¡/≈‘µ√ (µg/L) 400

371.6

300 200

ª∑ÿ¡∏“π’ ππ∑∫ÿ√’

260.8 196.4 157.3 116.5

96.3

100

æ.».

0 2545

2546

2553

2554

µ“√“ß∑’Ë 2 ª√‘¡“≥ “√‰Õ‚Õ¥’π„πªí “«–¢ÕßÀ≠‘ßµ—Èß§√√¿å æ.». 2554 √–¥—∫‰Õ‚Õ¥’π„πªí “«– ®—ßÀ«—¥ ®”π«π §à“¡—∏¬ §à“æ‘ —¬ µ—«Õ¬à“ß ∞“π µg/L < 150 µg/L 150-246 µg/L 250-499 µg/L ≥ 500 µg/L (¢“¥) (‡°‘π¢π“¥) (‡æ’¬ßæÕ) (‡°‘πæÕ) µg/L ®”π«π √âÕ¬≈– ®”π«π √âÕ¬≈– ®”π«π √âÕ¬≈– ®”π«π √âÕ¬≈– ª∑ÿ¡∏“π’

309

371.6

ππ∑∫ÿ√’

307

196.4

5.7 1,505.0 7.4 1,335.1

110 ¡°√“§¡ - ¡’π“§¡ 2555 °√¡Õπ“¡—¬

9.7

15.9

103

33.3

127

41.1

113

36.8

25.4

24.1

13.7

àß‡ √‘¡„Àâ§π‰∑¬ ÿ¢¿“æ¥’

¿“«–¢“¥ “√‰Õ‚Õ¥’π„π∑“√°·√°

¿“«–¢“¥ “√‰Õ‚Õ¥’π„π‡¥Á°‡≈Á°Õ“¬ÿ

‡°‘¥

3-6 ªï

‡¥Á°∑“√°·√°‡°‘¥¡’§“à TSH ¡“°°«à“ 11.2 ¡‘≈≈‘¬Ÿπ‘µµàÕ≈‘µ√ πâÕ¬°«à“√âÕ¬≈– 3 ´÷Ëß‡ªìπµ—«™’È «—¥√–¥—∫ª√–™“°√ ∑’Ë∂◊Õ«à“‡ªìπæ◊Èπ∑’Ë‰¡à¢“¥ “√ ‰Õ‚Õ¥’π ´÷Ëß —¥ à«π‡¥Á°∑“√°·√°‡°‘¥¡’§à“ TSH ¡“°°«à“ 11.2 ¡‘≈≈‘¬πŸ µ‘ µàÕ≈‘µ√ „π‡¥◊Õπ¡°√“§¡∏—π«“§¡ 2554 ¢Õß®—ßÀ«—¥ª∑ÿ¡∏“π’ ·≈–ππ∑∫ÿ√’ §◊Õ √âÕ¬≈– 9.02 ·≈–√âÕ¬≈– 10.23

§à“¡—∏¬∞“π√–¥—∫‰Õ‚Õ¥’π„πªí “«–¢Õß ‡¥Á°‡≈Á° 3-6 ªï ®—ßÀ«—¥ª∑ÿ¡∏“π’·≈–®—ßÀ«—¥ππ∑∫ÿ√’ 241.0 µg/L ·≈– 196.6 µg/L æ∫ —¥ à«π¢Õß ‡¥Á°‡≈Á° 3-6 ªï ∑’Ë¡’‰Õ‚Õ¥’π„πªí “«–√–¥—∫¢“¥ (< 100 µg/L) √âÕ¬≈– 7.9 ·≈– 15.9 ”À√—∫ — ¥ à « π¢Õß‡¥Á ° ‡≈Á ° 3-6 ªï ∑’Ë ¡’ ‰ Õ‚Õ¥’ π „π ªí “«–√–¥—∫‡°‘πæÕ (200 - 299 µg/L) ·≈– √–¥—∫‡°‘π¢π“¥ (≥300 µg/L) √âÕ¬≈– 60.5 ·≈– 48.3 (µ“√“ß∑’Ë 3)

µ“√“ß∑’Ë 3 √–¥—∫‰Õ‚Õ¥’π„πªí “«–¢Õß‡¥Á°‡≈Á° 3-6 ªï æ.».2554 √–¥—∫‰Õ‚Õ¥’π„πªí “«– ®—ßÀ«—¥ ®”π«π §à“¡—∏¬ §à“æ‘ —¬ µ—«Õ¬à“ß ∞“π µg/L < 100 µg/L 100-199 µg/L 200-299 µg/L ≥ 300 µg/L (¢“¥) (‡°‘πæÕ) (‡°‘π¢π“¥) (‡æ’¬ßæÕ) µg/L ®”π«π √âÕ¬≈– ®”π«π √âÕ¬≈– ®”π«π √âÕ¬≈– ®”π«π √âÕ¬≈– ª∑ÿ¡∏“π’ 152 ππ∑∫ÿ√’ 151

241.0 26-972 196.6 10-780

12 24

7.9 15.9

48 54

31.6 35.8

45 36

29.6 23.8

47 37

30.9 24.5

√â Õ ¬≈– 38.7 ·≈–√â Õ ¬≈– 42.1 πÕ°®“°π—È π —¥ à«π¢ÕßºŸâ ŸßÕ“¬ÿ∑’Ë¡’‰Õ‚Õ¥’π„πªí “«–√–¥—∫ ‡°‘πæÕ (200 - 299 µg/L) ·≈–√–¥—∫‡°‘π¢π“¥ (≥300 µg/L) √âÕ¬≈– 16.9 ·≈– 18.3 (µ“√“ß∑’Ë 4)

¿“«–¢“¥ “√‰Õ‚Õ¥’π„πºŸâ ŸßÕ“¬ÿ §à“¡—∏¬∞“π√–¥—∫‰Õ‚Õ¥’π„πªí “«–¢ÕßºŸâ ŸßÕ“¬ÿ®—ßÀ«—¥ª∑ÿ¡∏“π’ ·≈–®—ßÀ«—¥ππ∑∫ÿ√’ 117.4 µg/L ·≈– 115.1 µg/Læ∫ —¥ à«π¢ÕßºŸâ ŸßÕ“¬ÿ ∑’Ë¡’‰Õ‚Õ¥’π„πªí “«–√–¥—∫¢“¥ (< 100 µg/L)

µ“√“ß∑’Ë 4 √–¥—∫‰Õ‚Õ¥’π„πªí “«–¢ÕßºŸâ ŸßÕ“¬ÿ ªï æ.».2554 √–¥—∫‰Õ‚Õ¥’π„πªí “«– ®—ßÀ«—¥ ®”π«π §à“¡—∏¬ §à“æ‘ —¬ µ—«Õ¬à“ß ∞“π µg/L < 100 µg/L 100-199 µg/L 200-299 µg/L ≥ 300 µg/L (¢“¥) (‡°‘π¢π“¥) (‡æ’¬ßæÕ) (‡°‘πæÕ) µg/L ®”π«π √âÕ¬≈– ®”π«π √âÕ¬≈– ®”π«π √âÕ¬≈– ®”π«π √âÕ¬≈– ª∑ÿ¡∏“π’ 142 ππ∑∫ÿ√’ 148

117.4 9-866 115.1 12-600

55 61

38.7 41.2

63 60

44.4 40.5

14 13

9.9 8.8

10 14

THAILAND JOURNAL OF HEALTH PROMOTION AND ENVIRONMENTAL HEALTH J a n u a r y - M a r c h 2 0 1 2

7.0 9.5

111

∫ ∑ «‘ ∑ ¬ “ ° “ √ ª∑ÿ¡∏“π’ §◊Õ √âÕ¬≈– 93.3 ·≈–√âÕ¬≈– 81.3 ´÷Ëß æ— ≤ π“°“√‡©æ“–¥â “ π¿“…“¡’ æ— ≤ π“°“√ ¡«— ¬ πâÕ¬°«à“¥â“πÕ◊ËπÊ §◊Õ √âÕ¬≈– 85.7 ·≈– 88.7 (µ“√“ß∑’Ë 5 ·≈– 6)

æ—≤π“°“√ ¡«—¬ °“√ª√–‡¡‘πæ—≤π“°“√‡¥Á°‡≈Á°Õ“¬ÿ 1-3 ªï ¥â«¬·∫∫∑¥ Õ∫ Denver II æ∫«à“ ‡¥Á°®—ßÀ«—¥ ππ∑∫ÿ√’ ¡’æ—≤π“°“√ ¡«—¬¡“°°«à“‡¥Á°®—ßÀ«—¥

µ“√“ß∑’Ë 5 · ¥ßæ—≤π“°“√‡¥Á°Õ“¬ÿ 1-3 ªï ®”·π°√“¬®—ßÀ«—¥ ®—ßÀ«—¥

ª°µ‘ ®”π«π

√âÕ¬≈–

74 83

81.3 93.3

ª∑ÿ¡∏“π’ (91 §π) ππ∑∫ÿ√’ (89 §π)

ß —¬≈à“™â“ ®”π«π √âÕ¬≈– 17 6

18.7 6.7

µ“√“ß∑’Ë 6 · ¥ß√âÕ¬≈–æ—≤π“°“√ ¡«—¬‡¥Á°Õ“¬ÿ 1-3 ªï ®”·π°µ“¡¥â“π°“√«—¥ ®—ßÀ«—¥

¥â“π°“√«—¥ ¥â“π —ß§¡·≈–°“√™à«¬‡À≈◊Õµπ‡Õß ¥â“π„™â°≈â“¡‡π◊ÈÕ‡≈Á°·≈–ª√—∫µ—« ¥â“π„™â°≈â“¡‡π◊ÈÕ¡—¥„À≠à ¥â“π¿“…“

Õ¿‘ª√“¬º≈°“√»÷°…“ 1. æƒµ‘°√√¡°“√∫√‘‚¿§º≈‘µ¿—≥±å‡ √‘¡ ‰Õ‚Õ¥’π„π§√—«‡√◊Õπ ·≈–¬“‡¡Á¥‡ √‘¡‰Õ‚Õ¥’π„π À≠‘ßµ—Èß§√√¿å „π√Õ∫ 1 ‡¥◊Õπ∑’Ëºà“π¡“ °àÕπ°“√ Õ∫∂“¡æ∫«à“ §√—«‡√◊Õπ à«π„À≠à∑—Èß¢Õß®—ßÀ«—¥ ª∑ÿ¡∏“π’ ·≈–ππ∑∫ÿ√’ „™â‡°≈◊Õ‡ √‘¡‰Õ‚Õ¥’π„π °“√ª√ÿß·≈–ª√–°Õ∫Õ“À“√¡“°°«à“‡§√◊ËÕßª√ÿß√ ‡ √‘¡‰Õ‚Õ¥’πÕ◊ËπÊ (√âÕ¬≈– 81.0 ·≈– 87.3) ´÷Ëß ·µ°µà “ ß®“°º≈°“√ ”√«®°“√∫√‘ ‚ ¿§‚´‡¥’ ¬ ¡ §≈Õ‰√¥å ¢Õßª√–™“™π„π¿“§°≈“ß ‡¢µæ◊Èπ∑’Ë §«“¡√—∫º‘¥™Õ∫»Ÿπ¬åÕπ“¡—¬∑’Ë 1 °√ÿß‡∑æœ °√¡ Õπ“¡—¬ ´÷Ëß¥”‡π‘π°“√„πªï 2551 ·≈–®“°°“√ »÷°…“°“√„™â “√ª√ÿß√ ‡§Á¡ ·≈–æƒµ‘°√√¡°“√„™â 112 ¡°√“§¡ - ¡’π“§¡ 2555 °√¡Õπ“¡—¬

àß‡ √‘¡„Àâ§π‰∑¬ ÿ¢¿“æ¥’

ª∑ÿ¡∏“π’

ππ∑∫ÿ√’

91.1 89.0 95.6 85.7

95.5 97.7 95.4 88.7

πÈ”ª≈“„π™ÿ¡™π ªï æ.».2540 ‚¥¬°Õß‚¿™π“°“√ °√¡Õπ“¡—¬ æ∫«à“§√—«‡√◊Õπ¡’°“√„™âπÈ”ª≈“¡“° °«à“‡°≈◊Õ∫√‘‚¿§ ·À≈àß∑’Ë´◊ÈÕ‡°≈◊Õ‡ √‘¡‰Õ‚Õ¥’π à«π„À≠à§◊Õ√â“π§â“„πÀ¡Ÿà∫â“π·≈–Àâ“ß √√æ ‘π§â“ · ¥ß„Àâ‡ÀÁπ«à“‡°≈◊Õ‡ √‘¡‰Õ‚Õ¥’π¡’°“√º≈‘µ·≈– ®”Àπà“¬∑’Ë “¡“√∂À“´◊ÈÕ‰¥â –¥«° ¬ÿ∑∏»“ µ√å °“√ª√–™“ —¡æ—π∏å√≥√ß§å·≈–°“√µ≈“¥‡™‘ß —ß§¡ à ß º≈„Àâ ª √–™“™π·≈–‡§√◊ Õ ¢à “ ¬ºŸâ º ≈‘ µ ·≈– ®”Àπà“¬º≈‘µ¿—≥±å‡ √‘¡‰Õ‚Õ¥’πµ√–Àπ—°√Ÿâ·≈– ‡¢â“„® Õ¬à“ß‰√°Áµ“¡°≈ÿà¡µ—«Õ¬à“ß∑’Ë∂Ÿ° Õ∫∂“¡ ∑—Èß®—ßÀ«—¥ª∑ÿ¡∏“π’·≈–ππ∑∫ÿ√’ ¡’°“√√—∫√Ÿâ«à“À≠‘ß µ—È ß §√√¿å ∑ÿ ° §π∑’Ë Ω “°§√√¿å ≥ ∂“π∫√‘ ° “√ “∏“√≥ ÿ¢ ®–‰¥â√—∫¬“‡¡Á¥‡ √‘¡‰Õ‚Õ¥’π §àÕπ

¢â“ßπâÕ¬ (√âÕ¬≈– 38.7 ·≈– 29.3) ´÷ËßÕ“®‡°‘¥ ®“°°“√ª√–™“ —¡æ—π∏å¡“µ√°“√‡ √‘¡¬“‡¡Á¥‡ √‘¡ ‰Õ‚Õ¥’π ‰¥â„Àâ§«“¡ ”§—≠‡®“–®ß‡©æ“–°≈ÿà¡‡ªÑ“ À¡“¬À≠‘ßµ—Èß§√√¿å 2. §ÿ≥¿“æ‡°≈◊Õ‡ √‘¡‰Õ‚Õ¥’π„π§√—«‡√◊Õπ °“√‡¢â “ ∂÷ ß ‡°≈◊ Õ ‡ √‘ ¡ ‰Õ‚Õ¥’ π §ÿ ≥ ¿“æ¢Õß§√— « ‡√◊ÕπµË”°«à“‡ªÑ“À¡“¬∑’ÕË ß§å°“√Õπ“¡—¬‚≈°°”Àπ¥ §◊Õ §«“¡§√Õ∫§≈ÿ¡¢Õß§√—«‡√◊Õπ∑’Ë¡’°“√„™â‡°≈◊Õ ‡ √‘¡‰Õ‚Õ¥’π§ÿ≥¿“æ (≥ 30 æ’æ‡’ ÕÁ¡) √âÕ¬≈– 90.0 ´÷Ëß‡°≈◊Õ‡ √‘¡‰Õ‚Õ¥’π∑’Ë¡’§ÿ≥¿“æ ∑¥ Õ∫‚¥¬ °“√„™â™¥ÿ ∑¥ Õ∫Õ¬à“ßßà“¬ I-Kit (®—ßÀ«—¥ª∑ÿ¡∏“π’ ·≈–ππ∑∫ÿ√’) æ∫‡æ’¬ß√âÕ¬≈– 76.1 ·≈– 75.7 Õ¬à“ß‰√°Áµ“¡§«“¡§√Õ∫§≈ÿ¡‡°≈◊Õ‡ √‘¡‰Õ‚Õ¥’π §ÿ≥¿“æ (≥ 30 æ’æ’‡ÕÁ¡) ¡’ —¥ à«π‡æ‘Ë¡¢÷ÈπÕ¬à“ß ™— ¥ ‡®π‡¡◊Ë Õ ‡ª√’ ¬ ∫‡∑’ ¬ ∫°— ∫ √“¬ß“πº≈°“√‡ΩÑ “ √–«—ß¿“«–¢“¥ “√‰Õ‚Õ¥’π„πÀ≠‘ßµ—Èß§√√¿å¢Õß ®—ßÀ«—¥ª∑ÿ¡∏“π’·≈–ππ∑∫ÿ√’ „πªï æ.».2545 ·≈– 2540 ´÷Ëßæ∫‡æ’¬ß√âÕ¬≈– 44.0 ·≈– 37.7 · ¥ß „Àâ‡ÀÁπ«à“¬ÿ∑∏»“ µ√å°“√º≈‘µ·≈–°√–®“¬‡°≈◊Õ ‡ √‘¡‰Õ‚Õ¥’π∑’Ë¡’§ÿ≥¿“æ¡’°“√∫√‘À“√®—¥°“√∑’ËµàÕ ‡π◊ÕË ß ·≈–‡¡◊ÕË ÿ¡à µ√«®√âÕ¬≈– 10 ¢Õß°≈ÿ¡à µ—«Õ¬à“ß ‚¥¬„™â Titration æ∫‡æ’¬ß√âÕ¬≈– 17.8 ·≈– 17.2 µ“¡≈”¥—∫ ∑’¡Ë ª’ √‘¡“≥‰Õ‚Õ¥’π 20-40 æ’æ‡’ ÕÁ¡ µ“¡ ª√–°“»°√–∑√«ß “∏“√≥ ÿ¢ ≥ «—π∑’Ë 16 ¡’π“§¡ 2554 ¢âÕª√–°“»°√–∑√«ßœ ©∫—∫π’È ‰¥â¡’°“√ ª√–°“»¿“¬À≈—ß°“√√«∫√«¡¢âÕ¡Ÿ≈ ∑”„Àâ‡°≈◊Õ ‡ √‘ ¡ ‰Õ‚Õ¥’ π à « π„À≠à ‰ ¡à ‰ ¥â µ “¡¡“µ√∞“π∑’Ë °”Àπ¥‡ªìπ®”π«π¡“° 3. ¿“«–¢“¥ “√‰Õ‚Õ¥’π„πÀ≠‘ßµ—Èß§√√¿å À≠‘ßµ—Èß§√√¿å¡’¿“«–¢“¥ “√‰Õ‚Õ¥’π≈¥≈ß ‚¥¬ æ∫§à“¡—∏¬∞“π√–¥—∫‰Õ‚Õ¥’π„πªí “«–¢ÕßÀ≠‘ß µ—Èß§√√¿å‡æ‘Ë¡¢÷Èπ ·≈– —¥ à«π¢ÕßÀ≠‘ßµ—Èß§√√¿å∑’Ë¡’ ‰Õ‚Õ¥’π„πªí “«–√–¥—∫¢“¥ (µË”°«à“ 150µg/L) ≈¥≈ß „πªï 2554 —¥ à«π¢ÕßÀ≠‘ßµ—Èß§√√¿å¢Õß

®— ß À«— ¥ ª∑ÿ ¡ ∏“π’ · ≈–ππ∑∫ÿ √’ ∑’Ë ¡’ ‰ Õ‚Õ¥’ π „π ªí “«–√–¥—∫¢“¥‡æ’¬ß√âÕ¬≈– 9.7 ·≈– 36.8 ´÷Ëß · ¥ß„Àâ ‡ ÀÁ π «à “ §à “ ¡— ∏ ¬∞“π√–¥— ∫ ‰Õ‚Õ¥’ π „π ªí “«–¢ÕßÀ≠‘ ß µ—È ß §√√¿å ¡’ · π«‚πâ ¡ ‡æ‘Ë ¡ ¢÷È π Õ¥§≈â Õ ß°— ∫ §«“¡§√Õ∫§≈ÿ ¡ °“√∫√‘ ‚ ¿§‡°≈◊ Õ ‡ √‘¡‰Õ‚Õ¥’π§ÿ≥¿“æ∑’Ë‡æ‘Ë¡¢÷Èπ ´÷Ëß‡ªìπº≈µàÕ ‡π◊ËÕß®“°°“√¡’√–∫∫‡ΩÑ“√–«—ßµ‘¥µ“¡ ∂“π°“√≥å ∑’Ë‡ªìπªí®®ÿ∫—π∑”„Àâ¡’°“√®—¥°“√‰¥â¡’ª√– ‘∑∏‘¿“æ 4. ¿“«–¢“¥ “√‰Õ‚Õ¥’π„π∑“√°·√°‡°‘¥ ‡¥Á°∑“√°·√°‡°‘¥¡’¿“«–¢“¥ “√‰Õ‚Õ¥’π≈¥≈ß ‡¥Á° ∑“√°·√°‡°‘¥¡’§à“ TSH ¡“°°«à“ 11.2 ¡‘≈≈‘¬Ÿπ‘µ µàÕ≈‘µ√ πâÕ¬°«à“√âÕ¬≈– 3 ∂◊Õ«à“‡ªìπæ◊Èπ∑’Ë‰¡à¢“¥ “√‰Õ‚Õ¥’π ´÷ßË —¥ à«π‡¥Á°∑“√°·√°‡°‘¥¡’§“à TSH ¡“°°«à“ 11.2 ¡‘≈≈‘¬Ÿπ‘µµàÕ≈‘µ√ ¡’√–¥—∫≈¥≈ß∑—Èß 2 ®—ßÀ«—¥ ‡¡◊ËÕ‡ª√’¬∫‡∑’¬∫°—∫√–¥—∫¿“«–°“√¢“¥ “√‰Õ‚Õ¥’π¢Õß®—ßÀ«—¥ª∑ÿ¡∏“π’·≈–®—ßÀ«—¥ππ∑∫ÿ√’ ¥â«¬µ—«™’È«—¥π’È„π‡¥◊Õπ¡°√“§¡ - ∏—π«“§¡ 2553 §◊Õ√âÕ¬≈– 13.02 ·≈–√âÕ¬≈– 12.1 (·ºπ¿Ÿ¡‘∑’Ë 2) ´÷Ëß Õ¥§≈âÕß°—∫À≠‘ßµ—Èß§√√¿å∑’Ë¡’¿“«–¢“¥ “√ ‰Õ‚Õ¥’π≈¥≈ß 5. ¿“«–¢“¥ “√‰Õ‚Õ¥’π„πºŸâ ŸßÕ“¬ÿ·≈– ‡¥Á°‡≈Á°Õ“¬ÿ 3-6 ªï §à“¡—∏¬∞“π√–¥—∫‰Õ‚Õ¥’π„π ªí “«–¢Õß°≈ÿà¡‡¥Á°‡≈Á°Õ“¬ÿ 3-6 ªï ¡’§à“ Ÿß°«à“ ¢Õß°≈ÿà¡ºŸâ ŸßÕ“¬ÿ (117.4 µg/L ·≈– 115.1 µg/L) ∑—ßÈ „π®—ßÀ«—¥ª∑ÿ¡∏“π’ ·≈–ππ∑∫ÿ√’ (241.0 µg/L ·≈– 196.6 µg/L) √«¡∑—Èßæ∫«à“ °≈ÿà¡ ‡¥Á°‡≈Á°Õ“¬ÿ 3-6 ªï ∑—Èß Õß®—ßÀ«—¥¡’ —¥ à«π ‰Õ‚Õ¥’π„πªí “«–√–¥—∫‡°‘πæÕ ·≈–‡°‘π¢π“¥ ¡“°°«à“ºŸâ ŸßÕ“¬ÿ ·µà‰¡à¡’√“¬ß“πÕ“°“√‰¡àæ÷ß ª√– ß§å ¥â«¬¡’°“√‡ΩÑ“√–«—ß·≈–µ‘¥µ“¡§«“¡ ª≈Õ¥¿—¬¢Õß°“√‰¥â√—∫ “√‰Õ‚Õ¥’π‡°‘π 6. ‰Õ§‘«·≈–æ—≤π“°“√ ¡«—¬ √–¥—∫ µ‘ªí≠≠“‡¥Á°π—°‡√’¬π ®“°°“√ ”√«®√–¥— ∫ µ‘ ªí ≠ ≠“‡¥Á °

THAILAND JOURNAL OF HEALTH PROMOTION AND ENVIRONMENTAL HEALTH J a n u a r y - M a r c h 2 0 1 2

113

∫ ∑ «‘ ∑ ¬ “ ° “ √ ·ºπ¿Ÿ¡‘∑’Ë 2 √âÕ¬≈–√–¥—∫ŒÕ√å‚¡π°√–µÿπâ µàÕ¡∏—¬√Õ¬¥å (TSH) „π‡¥Á°∑“√°·√°‡°‘¥¡“°°«à“ 11.2 ¡‘≈≈‘¬Ÿπ‘µµàÕ≈‘µ√ 14 13.02

12.1

12 ª∑ÿ¡∏“π’

10.23 10

9.02

ππ∑∫ÿ√’

8 6 4 2 0 2553

2554

42.5 37.4 40.7

ª√–‡∑»‰∑¬ ππ∑∫ÿ√’

ª∑ÿ¡∏“π’

30.3

26.2

20.2

9.5

0 c

Intelle

ient orderline Average Average Average Superior Superior B Ver Low High

efic tual D

114 ¡°√“§¡ - ¡’π“§¡ 2555 °√¡Õπ“¡—¬

àß‡ √‘¡„Àâ§π‰∑¬ ÿ¢¿“æ¥’

5.3

3.3

7.3

5.5

7.0 1.9 3.9

1.4 2.8

10.5

12.6

14.9 6.8 13.8

π— ° ‡√’ ¬ πÕ“¬ÿ 6-18 ªï ∑—Ë « ª√–‡∑» ‚¥¬°√¡ ÿ¢¿“æ®‘µ „™â·∫∫∑¥ Õ∫ SPM Parallel version ´÷Ëß‡°Á∫¢âÕ¡Ÿ≈„π‡¥◊Õπ∏—π«“§¡ 2553 ∂÷ß ¡°√“§¡ 2554 æ∫«à “ ‡¥Á ° π— ° ‡√’ ¬ π®— ß À«— ¥ ª∑ÿ¡∏“π’·≈–®—ßÀ«—¥ππ∑∫ÿ√’ ¡’§–·ππ µ‘ªí≠≠“ ‡©≈’Ë¬‡∑à“°—∫ 103.34 ·≈– 108.91 (§à“‡©≈’Ë¬ª°µ‘ 90-109) ´÷Ëß Ÿß°«à“‡¥Á°π—°‡√’¬π‰∑¬∑—Èßª√–‡∑» ∑’¡Ë §’ –·ππ µ‘ª≠ í ≠“‡©≈’¬Ë ‡∑à“°—∫ 98 ‡¡◊ÕË æ‘®“√≥“ IQ ¢Õß‡¥Á°π—°‡√’¬π®—ßÀ«—¥ª∑ÿ¡∏“π’ ·≈–ππ∑∫ÿ√’ °“√°√–®“¬ÕÕ°‰ª∑“ßµË”·≈–∑“ß Ÿß°«à“‡°≥±å ‡©≈’Ë¬æ∫«à“ ‡¥Á°π—°‡√’¬π®—ßÀ«—¥ª∑ÿ¡∏“π’ ·≈– ππ∑∫ÿ√’ ¡’ IQ µË”°«à“‡°≥±å‡©≈’Ë¬ IQ < 90 √âÕ¬≈– 20.5 ·≈– 10.1 µ“¡≈”¥— ∫ πÕ°®“°π—È π ‡¥Á ° π—°‡√’¬π®—ßÀ«—¥ª∑ÿ¡∏“π’·≈–ππ∑∫ÿ√’ ∑’Ë¡’ IQ Ÿß °«à“‡°≥±å‡©≈’Ë¬ (IQ ≥ 110) √âÕ¬≈– 38.8 ·≈– 52.4 ”À√—∫‡¥Á°π—°‡√’¬π®—ßÀ«—¥ª∑ÿ¡∏“π’·≈– ®—ßÀ«—¥ππ∑∫ÿ√’ ∑’¡Ë ª’ ≠ í À“√–¥—∫ µ‘ª≠ í ≠“∫°æ√àÕß (IQ < 70) √âÕ¬≈– 2.8 ·≈– 1.4 ´÷Ëß‡¡◊ËÕ‡ª√’¬∫ ‡∑’¬∫°—∫¡“µ√∞“π “°≈‰¡à§«√‡°‘π√âÕ¬≈– 2.0 (·ºπ¿Ÿ¡‘∑’Ë 3) ‡¡◊ËÕ®”·π°§à“‡©≈’Ë¬ I.Q ‡¥Á°„π®—ßÀ«—¥ ª∑ÿ¡∏“π’ ·≈–®—ßÀ«—¥ππ∑∫ÿ√’ ‡©æ“–„π™à«ßÕ“¬ÿ 910 ªï ·≈–„π™à«ßÕ“¬ÿ 7-8 ªï (µ“√“ß∑’Ë 7, 8) æ∫ «à “ ‡¥Á ° π— ° ‡√’ ¬ π∑—È ß ‡æ»™“¬·≈–‡æ»À≠‘ ß „π ®— ß À«— ¥ ππ∑∫ÿ √’ ¡’ §à “ ‡©≈’Ë ¬ Ÿ ß °«à “ ·≈–‡¡◊Ë Õ æ‘ ® “√≥“§à “ ¡— ∏ ¬∞“π√–¥— ∫ ‰Õ‚Õ¥’ π „πªí “«– À≠‘ ß µ—È ß §√√¿å „ π®— ß À«— ¥ ª∑ÿ ¡ ∏“π’ ·≈–®— ß À«— ¥ ππ∑∫ÿ√’ ®“°√“¬ß“π°“√‡ΩÑ“√–«—ß¿“«–¢“¥ “√ ‰Õ‚Õ¥’π„πÀ≠‘ßµ—Èß§√√¿å ªï 2545 ·≈–ªï 2546 §◊Õ 157.3 µg/L ·≈–96.3 µg/L ´÷Ëßæ∫«à“§à“¡—∏¬ ∞“π√–¥—∫‰Õ‚Õ¥’π„πªí “«–¢ÕßÀ≠‘ßµ—Èß§√√¿å ®—ßÀ«—¥ππ∑∫ÿ√’ ¡’§à“µË”°«à“ Õ¬à“ß‰√°Áµ“¡√–¥—∫ µ‘ªí≠≠“π—Èπ ¡’ªí®®—¬Õ◊ËπÊ ‡°’Ë¬«¢âÕß¥â«¬ µ—Èß·µà

°“√‡µ√’¬¡µ—«¢Õß·¡à ™à«ß√–¬–‡«≈“°àÕπ·≈–¢≥– µ—Èß§√√¿å √«¡∑—Èß√–¬–‡«≈“§≈Õ¥ À≈—ß§≈Õ¥ °“√ ‡®Á∫ªÉ«¬ °“√‡≈’È¬ß¥Ÿ ·≈– ‘Ëß·«¥≈âÕ¡¢Õß‡¥Á° æ—≤π“°“√ ¡«—¬ °“√ª√–‡¡‘πæ—≤π“°“√‡¥Á°‡≈Á°Õ“¬ÿ 1-3 ªï ¥â«¬·∫∫∑¥ Õ∫ Denver II æ∫«à“ ‡¥Á°®—ßÀ«—¥ ππ∑∫ÿ√’ ¡’æ—≤π“°“√ ¡«—¬¡“°°«à“‡¥Á°®—ßÀ«—¥ ª∑ÿ¡∏“π’ §◊Õ √âÕ¬≈– 93.3 ·≈–√âÕ¬≈– 81.3 ´÷Ëß æ— ≤ π“°“√‡©æ“–¥â “ π¿“…“¡’ æ— ≤ π“°“√ ¡«— ¬ πâÕ¬°«à“¥â“πÕ◊ËπÊ §◊Õ √âÕ¬≈– 85.7 ·≈– 88.7 ´÷Ëß °“√ª√–‡¡‘πæ—≤π“°“√¥â«¬·∫∫ Õ∫∂“¡ Denver II ‰¡à ‰ ¥â ‡ ªì π ·∫∫∑¥ Õ∫‡™“«å ªí ≠ ≠“ ·≈–‰¡à “¡“√∂„™â§“¥°“√≥å√–¥—∫§«“¡ “¡“√∂∑“ß µ‘ ªí ≠ ≠“„πÕπ“§µ‰¥â ·µà ‡ ªì π °“√‡ª√’ ¬ ∫‡∑’ ¬ ∫ §«“¡ “¡“√∂¥â“πµà“ßÊ °—∫‡¥Á°ª°µ‘„π«—¬‡¥’¬«°—π

¢âÕ‡ πÕ·π– ‡æ◊ËÕ„Àâ°“√»÷°…“°“√®—¥∑”√–∫∫‡ΩÑ“√–«—ß ‚√§¢“¥ “√‰Õ‚Õ¥’π·∫∫∫Ÿ√≥“°“√„π√–¥—∫‡¢µ “¡“√∂ª√–‡¡‘π·≈–µ‘¥µ“¡ ∂“π°“√≥å‚√§¢“¥ “√‰Õ‚Õ¥’π ‡æ◊ËÕ§âπÀ“ “‡Àµÿ·≈–·π«∑“ß·°â‰¢ æ√âÕ¡®—¥ª√—∫¬ÿ∑∏»“ µ√å„Àâ‡°‘¥ª√– ‘∑∏‘¿“æ Ÿß ÿ¥ ‡°‘ ¥ §«“¡¬—Ë ß ¬◊ π „π°“√¢®— ¥ ªí ≠ À“‚√§¢“¥ “√ ‰Õ‚Õ¥’π„ÀâÀ¡¥‰ª‡ªìπ°“√æ—≤π“ µ‘ª≠ í ≠“‡¥Á°‰∑¬ ‡ÀÁπ§«√¥”‡π‘π°“√¥—ßµàÕ‰ªπ’È 1. ‡ΩÑ“√–«—ß„Àâ§√Õ∫§≈ÿ¡∑ÿ°æ◊πÈ ∑’√Ë –¥—∫‡¢µ ‡æ◊ÕË √«∫√«¡‡ªìπ√“¬ß“π ∂“π°“√≥å√–¥—∫ª√–‡∑» 2. „πæ◊Èπ∑’Ë∑’Ë¡’ªí≠À“‚√§¢“¥ “√‰Õ‚Õ¥’π §«√‡ΩÑ“√–«—ßÕ¬à“ßµàÕ‡π◊ËÕß¥â«¬§«“¡∂’Ë∑ÿ°ªï 3. π”¢â Õ ¡Ÿ ≈ ∑’Ë ‰ ¥â ¡ “„™â ª √–‚¬™πå „ π°“√ ª√—∫ª√ÿß°“√¥”‡π‘πß“π §«∫§ÿ¡·≈–ªÑÕß°—π‚√§ ¢“¥ “√‰Õ‚Õ¥’π„Àâ‡À¡“– ¡„π√–¥—∫æ◊Èπ∑’Ë

THAILAND JOURNAL OF HEALTH PROMOTION AND ENVIRONMENTAL HEALTH J a n u a r y - M a r c h 2 0 1 2

115

Õ“¬ÿ (ªï) 10 11

112.33 104.39 103.28 101.93 102.62 103.30 104.29 101.00 100.36 103.59 104.79 105.71 104.89 102.95 106.01 105.53 100.40 99.53 98.41 107.02

Õ“¬ÿ (ªï) 10 11

111.59 108.58 109.54 108.98 103.78 109.53 106.89 105.67 107.93 106.43 106.13 110.80 107.85 109.74 105.32 112.04 111.54 113.83 110.24 110.63

‡Õ° “√Õâ“ßÕ‘ß 1. °√¡ ÿ¢¿“æ®‘µ °√–∑√«ß “∏“√≥ ÿ¢. º≈°“√ ”√«® ∂“π°“√≥å√–¥—∫ µ‘ªí≠≠“‡¥Á°π—°‡√’¬π‰∑¬;2554. 2. °Õß‚¿™π“°“√ °√¡Õπ“¡—¬ °√–∑√«ß “∏“√≥ ÿ¢. √“¬ß“πº≈°“√‡ΩÑ“√–«—ß¿“«–¢“¥ “√‰Õ‚Õ¥’π„πÀ≠‘ßµ—Èß §√√¿å ª√–®”ªï 2543 - 2545. °√°Æ“§¡ 2542. 3. °Õß‚¿™π“°“√ °√¡Õπ“¡—¬ °√–∑√«ß “∏“√≥ ÿ¢. °“√»÷°…“§«“¡§√Õ∫§≈ÿ¡°“√„™â‡°≈◊Õ‡ √‘¡‰Õ‚Õ¥’π„π √–¥—∫§√—«‡√◊Õπ¢Õßª√–‡∑»‰∑¬ ªï 2542. 4. °Õß‚¿™π“°“√ °√¡Õπ“¡—¬ °√–∑√«ß “∏“√≥ ÿ¢. °“√®—¥∑”√–∫∫‡ΩÑ“√–«—ß µ‘¥µ“¡ ·≈–ª√–‡¡‘π§«“¡ °â“«Àπâ“„π‚§√ß°“√§«∫§ÿ¡‚√§¢“¥ “√‰Õ‚Õ¥’π·Ààß™“µ‘ ªï 2543-2547 √“¬ß“πº≈°“√‡ΩÑ“√–«—ß ¿“«–¢“¥ “√‰Õ‚Õ¥’π„πÀ≠‘ßµ—Èß§√√¿å ª√–®”ªï 2554 - 2547;°√°Æ“§¡ 2548. 5. §≥–°√√¡°“√®—¥∑”¢âÕ°”Àπ¥ “√Õ“À“√∑’Ë§«√‰¥â√—∫ª√–®”«—π ”À√—∫§π‰∑¬. ª√‘¡“≥ “√Õ“À“√Õâ“ßÕ‘ß∑’Ë §«√‰¥â√—∫ª√–®”«—π ”À√—∫§π‰∑¬ æ.».2546. ·°â‰¢§√—Èß∑’Ë 3. ‚√ßæ‘¡æåÕß§å°“√—∫ àß ‘π§â“·≈– æ— ¥ÿ¿—≥±å °√ÿß‡∑æœ; 2546 6. »Ÿπ¬åªØ‘∫—µ‘°“√µ√«®§—¥°√Õß ÿ¢¿“æ∑“√°·√°‡°‘¥ °√¡«‘∑¬“»“ µ√å°“√·æ∑¬å ¿“«–°“√¢“¥ “√‰Õ‚Õ¥’π ¢Õß∑“√°·√°‡°‘¥ ªï 2553 - 2554. 7. »Ÿπ¬åÕπ“¡—¬∑’Ë 1 °√ÿß‡∑æœ °√¡Õπ“¡—¬. °“√ ”√«®°“√∫√‘‚¿§‚´‡¥’¬¡§≈Õ‰√¥å¢Õßª√–™“™π„π¿“§°≈“ß ‡¢µæ◊Èπ∑’Ë§«“¡√—∫º‘¥™Õ∫»Ÿπ¬åÕπ“¡—¬∑’Ë 1 °√ÿß‡∑æœ °√¡Õπ“¡—¬; 2551. 8. ”π—°ß“π ”√«® ÿ¢¿“æª√–™“™π‰∑¬ ( ∑.) ∂“∫—π«‘®—¬ “∏“√≥ ÿ¢. √“¬ß“π°“√ ”√«® ÿ¢¿“æ ª√–™“™π‰∑¬‚¥¬°“√µ√«®√à“ß°“¬ §√—Èß∑’Ë 1 æ.».2551 - 2552. 9. ”π—°‚¿™π“°“√ °√¡Õπ“¡—¬ °√–∑√«ß “∏“√≥ ÿ¢. √“¬ß“πº≈°“√‡ΩÑ“√–«—ß¿“«–¢“¥ “√‰Õ‚Õ¥’π ªï 25492552. 116 ¡°√“§¡ - ¡’π“§¡ 2555 °√¡Õπ“¡—¬

àß‡ √‘¡„Àâ§π‰∑¬ ÿ¢¿“æ¥’

10. ”π—°‚¿™π“°“√ °√¡Õπ“¡—¬. µ‘¥µ“¡§«“¡°â“«Àπâ“°“√¥”‡π‘π°“√ Ÿà‡ªÑ“À¡“¬°“√¢®—¥ “√‰Õ‚Õ¥’πÕ¬à“ß ¬—Ëß¬◊π„πª√–‡∑»‰∑¬. ”π—°æ‘¡æå Keen Media (Thailand). °√ÿß‡∑æœ;2552 11. ”π—°‚¿™π“°“√ °√¡Õπ“¡—¬. º≈√–¥—∫‰Õ‚Õ¥’π„πªí “«–À≠‘ßµ—Èß§√√¿å ªï 2553 75 ®—ßÀ«—¥. Available form:http://nutrition.anamai.moph.go.th/temp/files/_iodine/ ui%2075%20®—ßÀ«—¥%20ªï%202553.pdf2003. 12. World Health Organization/ International Council for the Control of the Iodine Deficiency Disorders/ United Nations Children Fund (WHO/ ICCIDD/ UNICEF). Assessment of the iodine deficiency disorders and monitoring their elimination. 3rd edition. Geneva: WHO; 2007. HEALTH

THAILAND JOURNAL OF HEALTH PROMOTION AND ENVIRONMENTAL HEALTH J a n u a r y - M a r c h 2 0 1 2

117