การเฝ้าระวังโรคขาดสารไอโอดีนจากระดับไอดอดีนในปัสสาวะของหญิงตั้งครรภ์ by nontalee verachai

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THAILAND JOURNAL OF HEALTH PROMOTION AND ENVIRONMENTAL HEALTH

October - December 2012

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Iodine Deficiency Surveillance by Levels of Urine Iodine in Pregnant Women, of the Upper North Area, in the Year 2010 Pisak Lertruangpanya Medical Physician, Expert Level Pimpaporn Promjai Registered Nurse, Professional Level Atchara Varopas Registered Nurse, Professional Level Kingpikul chamnankong Public Health Officer, Professional Level Watcharachai chaichana Medical Technologist Health Promotion Center Region 10, Department of Health

Abstract The purpose of this study was to study situation of iodine deficiency by testing of urine iodine level in pregnant women, iodised salt consumption behavior, perception of iodine salt usefulness, and to compare medians of urine iodine among 1,598 pregnant women who receive antenatal care prior to 20 weeks of gestational age in region 15,16, northern Thailand, in 2010. The results of this study found that in overall, the pregnant women in region 15-16 has median urine iodine concentration 241.6 µg/L and 182.9 µg/L respectively. (a normal level is 150 - 249 micrograms/liter).By province, Payao has median urine iodine concentration 143.5 micrograms/ liter. It is slightly less than the normal level, therefore Payao is defined as the iodine deficiency area. Four provinces have normal level of urine iodine in pregnancy. On the other hand, Prae, Chiang Mai, and Lampang provinces have medians of urine iodine concentration higher than the normal level which are 323.8, 314.9, and 251.1 micrograms/liter, respectively. The pregnant women used iodised salt 39.23 %. Most of them perceived the usefulness of iodine salt 82.9 % by receiving information from health care providers 33.68 %. The comparison of medians of urine iodine concentration among the pregnant women in region 15 and 16 found statistically significant difference (p-value < 0.001). The results of this study indicated that health care providers should provide information and encourage iodised salt consumption amongst the pregnant women. They should have I-Kit to use for regularly testing the quality of iodised salt at households and grocery-store in a community. They should also prescribe iodine tablets for all pregnant women who live in iodine deficiency provinces.

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THAILAND JOURNAL OF HEALTH PROMOTION AND ENVIRONMENTAL HEALTH

October - December 2012

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2. ·∫∫ —¡¿“…≥å¢âÕ¡Ÿ≈°“√√—∫ª√–∑“π Õ“À“√ °“√‰¥â√—∫‰Õ‚Õ¥’π®“°¬“ ·≈–πÈ”‡ √‘¡ ‰Õ‚Õ¥’π 3. ·∫∫øÕ√å¡°“√√“¬ß“πº≈°“√§—¥°√Õß °“√µ√«®‰Õ‚Õ¥’π„πªí “«–¢ÕßÀ≠‘ßµ—Èß§√√¿å °“√«‘‡§√“–Àå¢âÕ¡Ÿ≈ 1. ∂“π°“√≥å¿“«–¢“¥ “√‰Õ‚Õ¥’π„π ªí “«–¢ÕßÀ≠‘ßµ—ßÈ §√√¿å· ¥ß‚¥¬„™â ∂‘µ§‘ «“¡∂’Ë √âÕ¬≈– 2. æƒµ‘°√√¡°“√∫√‘‚¿§·≈–§«“¡√Ÿâ‡°’Ë¬« °— ∫ °“√∫√‘ ‚ ¿§Õ“À“√∑’Ë ¡’ ‰ Õ‚Õ¥’ π ¢ÕßÀ≠‘ ß µ—È ß §√√¿å„™â ∂‘µ‘§«“¡∂’Ë √âÕ¬≈– 3. °“√«‘‡§√“–Àå‡ª√’¬∫‡∑’¬∫§à“¡—∏¬∞“π √–¥— ∫ ‰Õ‚Õ¥’ π „πªí “«–¢ÕßÀ≠‘ ß µ—È ß §√√¿å √–À«à“ß‡¢µ 15 ·≈–‡¢µ 16 „™â ∂‘µ‘‡ª√’¬∫‡∑’¬∫ Mann Whitney U Test

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à«π∑’Ë 1 ¢âÕ¡Ÿ≈‡°’Ë¬«°—∫æƒµ‘°√√¡°“√ ∫√‘‚¿§Õ“À“√¢ÕßÀ≠‘ßµ—Èß§√√¿å ®“°µ“√“ß∑’Ë 1 æƒµ‘°√√¡°“√∫√‘‚¿§¢Õß À≠‘ßµ—Èß§√√¿å à«π„À≠à®–¡’Õ“°“√·æâ∑âÕß„π√–¥—∫ ª“π°≈“ß √âÕ¬≈– 59.6 ∑’Ë¡’Õ“°“√·æâ∑âÕß¡“°¡’ √âÕ¬≈– 11.6 ‡∑à“π—Èπ ¢≥–∑’Ë¡’Õ“°“√·æâ∑âÕßÀ≠‘ß µ—ßÈ §√√¿å «à π„À≠à®–√—∫ª√–∑“πÕ“À“√‰¥â∫“â ß √âÕ¬ ≈– 57.3 ·≈– à«π∑’Ë√—∫ª√–∑“πÕ“À“√‰¡à‰¥â‡≈¬ √âÕ¬≈– 4.8 „π¥â“π°“√√—∫ª√–∑“πÕ“À“√¢Õß À≠‘ßµ—ßÈ §√√¿å «à π„À≠à√∫— ª√–∑“πÕ“À“√§√∫ 3 ¡◊ÕÈ √âÕ¬≈– 67.6 °“√ª√–°Õ∫Õ“À“√√—∫ª√–∑“π‡Õß à«π„À≠à®–∑” 3 ¡◊ÈÕµàÕ«—π √âÕ¬≈– 50.2 Õ“À“√∑’Ë À≠‘ßµ—Èß§√√¿å‰¡à√—∫ª√–∑“π¢≥–∑’Ëµ—Èß§√√¿å à«π ¡“°®–‡ªìπ¢ÕßÀ«“π ÿ√“ °“·ø √âÕ¬≈– 48.0 Õ“À“√®”æ«°∑’Ë¡’√ ‡§Á¡ √âÕ¬≈– 30.6 √Õß≈ß¡“ Õ“À“√∑–‡≈ √âÕ¬≈– 21.4

µ“√“ß∑’Ë 1 §«“¡∂’Ë √âÕ¬≈–¢Õßæƒµ‘°√√¡°“√∫√‘‚¿§Õ“À“√¢ÕßÀ≠‘ßµ—Èß§√√¿å ¢âÕ§«“¡ 1. Õ“°“√·æâ∑âÕß¢≥–µ—Èß§√√¿å ·æâ¡“° ·æâª“π°≈“ß ‰¡à·æâ Õ◊Ëπ Ê √–∫ÿ....·æâ‡ªìπ∫“ß§√—Èß 2. ∂â“¡’Õ“°“√·æâ∑âÕß√—∫ª√–∑“πÕ“À“√‰¥âÀ√◊Õ‰¡à √—∫ª√–∑“πÕ“À“√‰¡à‰¥â‡≈¬ √—∫ª√–∑“πÕ“À“√‰¥â∫â“ß √—∫ª√–∑“πÕ“À“√‰¥âµ“¡ª°µ‘ Õ◊Ëπ Ê √–∫ÿ...√—∫ª√–∑“π¢Õß‡ª√’È¬« 3. ®”π«π¡◊ÈÕÕ“À“√∑’Ë√—∫ª√–∑“πµàÕ«—π‡ªìπª√–®” 2 ¡◊ÈÕ 3 ¡◊ÈÕ ¡“°°«à“ 3 ¡◊ÈÕ Õ◊Ëπ Ê √–∫ÿ......1 ¡◊ÈÕ 4. §√—«‡√◊Õπ¢Õß∑à“πª√ÿß/ª√–°Õ∫Õ“À“√‡Õß 3 ¡◊ÈÕµàÕ«—π 2 ¡◊ÈÕµàÕ«—π 1 ¡◊ÈÕµàÕ«—π π“π Ê §√—Èß ‰¡à‡§¬ª√—∫ª√ÿß‡Õß 5. Õ“À“√∑’Ë∑à“π‰¡à√—∫ª√–∑“π¢≥–µ—Èß§√√¿å Õ“À“√∑–‡≈ Õ“À“√∑’Ë¡’√ ‡§Á¡ Õ◊ËπÊ √–∫ÿ ‡™àπ ¢ÕßÀ«“π ÿ√“ °“·ø

®“°µ“√“ß∑’Ë 2 °“√√— ∫ ª√–∑“πÕ“À“√ ∑–‡≈ à«π„À≠àÀ≠‘ßµ—ßÈ §√√¿å®–√—∫ª√–∑“π 1-3 «—π µàÕ‡¥◊Õπ √âÕ¬≈– 45.1 ¥â“π°“√ª√ÿßÕ“À“√„Àâ¡’√ ‡§Á ¡ à « π„À≠à ® –„™â ‡ °≈◊ Õ Õπ“¡— ¬ À√◊ Õ ‡°≈◊ Õ ‡ √‘ ¡ ‰Õ‚Õ¥’π√âÕ¬≈– 39.23 „π§«“¡§‘¥‡√◊ËÕß§«“¡·µ° µà “ ß¢Õß‡°≈◊ Õ Õπ“¡— ¬ ·≈–‡°≈◊ Õ ∏√√¡¥“À≠‘ ß µ—È ß §√√¿å¡’§«“¡§‘¥«à“ ‡°≈◊Õ∑—Èß Õß¡’§«“¡·µ°µà“ß

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√âÕ¬≈–

192 989 467 12

11.6 59.6 28.1 0.7

73 874 559 20

4.8 57.3 36.6 1.3

133 1122 386 18

8.0 67.6 23.3 1.1

828 565 153 80 22

50.2 34.3 9.3 4.9 1.3

265 380 595

21.4 30.6 48.0

°—π√âÕ¬≈– 86.0 ·≈–‡°≈◊ÕÕπ“¡—¬¡’ª√–‚¬™πå√Õâ ¬≈– 98.4 °√≥’∑’ËÀ≠‘ßµ—Èß§√√¿å à«π„À≠à‰¡à‰¥â„™â‡°≈◊Õ Õπ“¡—¬‡æ√“–¡’§«“¡‡§Á¡πâÕ¬√âÕ¬≈– 33.05 ‰¡à Õ√àÕ¬√âÕ¬≈– 20.63 √–¬–‡«≈“¢Õß°“√„™â‡°≈◊Õ Õπ“¡—¬ à«π¡“°Õ¬Ÿà„π™à«ß 1-10 ªï √âÕ¬≈– 72.9 °“√„™â‡°≈◊ÕÕπ“¡—¬À√◊Õ‡°≈◊Õ‡ √‘¡‰Õ‚Õ¥’π à«π „À≠à ® –„™â „ π°“√ª√ÿ ß Õ“À“√‡ªì π ª√–®”∑ÿ ° «— π

THAILAND JOURNAL OF HEALTH PROMOTION AND ENVIRONMENTAL HEALTH

October - December 2012

∫ ∑ «‘ ∑ ¬ “ ° “ √ µ“√“ß∑’Ë 2 √âÕ¬≈–¢Õßæƒµ‘°√√¡°“√∫√‘‚¿§Õ“À“√∑’Ë¡’‰Õ‚Õ¥’π·≈–‡°≈◊Õ‡ √‘¡‰Õ‚Õ¥’π¢ÕßÀ≠‘ß µ—ßÈ §√√¿å ¢âÕ§«“¡ 1. ∑à“π√—∫ª√–∑“πÕ“À“√∑–‡≈∫àÕ¬‡æ’¬ß„¥ ¡“°°«à“ 3 «—π/ —ª¥“Àå 1-2 «—π/ —ª¥“Àå ‡¥◊Õπ≈– 1-3 «—π Õ◊Ëπ Ê √–∫ÿ......‰¡à√—∫ª√–∑“π¢Õß∑–‡≈ 2. ∑à“π„™â‡§√◊ËÕßª√ÿßÕ“À“√„Àâ¡’√ ‡§Á¡ ‡°≈◊Õ∏√√¡¥“ ‡°≈◊ÕÕπ“¡—¬À√◊Õ‡°≈◊Õ‡ √‘¡‰Õ‚Õ¥’π „™â∑—Èß‡°≈◊Õ∏√√¡¥“·≈–‡°≈◊ÕÕπ“¡—¬ „™âπÈ”ª≈“À√◊Õ´’Õ‘È« 3. ∑à“π§‘¥«à“‡°≈◊ÕÕπ“¡—¬·≈–‡°≈◊Õ‡¡Á¥/‡°≈◊Õ∏√√¡¥“·µ°µà“ß°—π ·µ°µà“ß ‰¡à·µ°µà“ß 4. ∑à“π§‘¥«à“‡°≈◊ÕÕπ“¡—¬¡’ª√–‚¬™πåÀ√◊Õ‰¡à ¡’ª√–‚¬™πå ‰¡à¡ª’ √–‚¬™πå 5. °√≥’∑’Ë‰¡à‰¥â„™â‡°≈◊ÕÕπ“¡—¬ ‡æ√“–Õ–‰√√–∫ÿ‡Àµÿº≈ ‡§Á¡πâÕ¬ ‰¡àÕ√àÕ¬ À“´◊ÕÈ ¬“° √“§“·æß Õ◊Ëπ Ê √–∫ÿ....‰¡à‰¥â∑”Õ“À“√, ≈–·«°∫â“π‰¡à¡’¢“¬ 6. „™â‡°≈◊ÕÕπ“¡—¬¡“π“π 1-10 ªï 11-20 ªï 21-30 ªï 31-40 ªï 7. „™â‡°≈◊ÕÕπ“¡—¬À√◊Õ‡°≈◊Õ‡ √‘¡‰Õ‚Õ¥’π„π°“√ª√ÿßÕ“À“√ √—∫ª√–∑“π∫àÕ¬‡æ’¬ß„¥ ‡ªìπª√–®”∑ÿ°«—π 2-3 «—π/ —ª¥“Àå ª√–¡“≥ —ª¥“Àå≈–§√—Èß 46

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√âÕ¬≈–

102 574 716 194

6.4 36.2 45.1 12.2

231 933 394 820

9.71 39.23 16.60 34.48

1398 228

86.0 14.0

1613 27

98.4 1.6

306 191 177 62 190

33.05 20.63 19.11 6.70 20.52

767 195 77 13

72.9 18.5 7.3 1.2

971 244 78

60.1 15.1 4.8

µ“√“ß∑’Ë 2 √âÕ¬≈–¢Õßæƒµ‘°√√¡°“√∫√‘‚¿§Õ“À“√∑’Ë¡’‰Õ‚Õ¥’π·≈–‡°≈◊Õ‡ √‘¡‰Õ‚Õ¥’π¢ÕßÀ≠‘ß µ—Èß§√√¿å (µàÕ) ¢âÕ§«“¡

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√âÕ¬≈–

252 70

15.6 4.3

1054 50 236 34 121 49 72

65.2 3.1 14.6 2.1 7.5 3.0 4.5

1509 129

92.1 7.9

π“π Ê §√—Èß Õ◊Ëπ Ê √–∫ÿ....‰¡à‰¥â„™â, √—∫ª√–∑“πÕ“À“√πÕ°∫â“π 8. à«π„À≠à∑à“π´◊ÈÕÀ√◊Õ‰¥â‡°≈◊ÕÕπ“¡—¬®“°∑’Ë„¥ √â“π§â“„πÀ¡Ÿà∫â“π √∂‡√à¢“¬Õ“À“√ µ≈“¥„πµ—«‡¡◊Õß/Õ”‡¿Õ ∫â“π Õ ¡. ∂“π’Õπ“¡—¬ ‚√ßæ¬“∫“≈ Õ◊ËπÊ √–∫ÿÇ.Àâ“ß √√æ ‘π§â“ 9. ∑à“π¡’§«“¡ –¥«°„π°“√´◊ÈÕ‡°≈◊ÕÕπ“¡—¬À√◊Õ‰¡à –¥«° ‰¡à –¥«°

µ“√“ß∑’Ë 3 · ¥ß§«“¡∂’Ë √âÕ¬≈– ‡°’Ë¬«°—∫°“√√—∫√Ÿâ‡√◊ËÕß “√‰Õ‚Õ¥’π¢ÕßÀ≠‘ßµ—Èß§√√¿å ¢âÕ§«“¡

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√âÕ¬≈–

1374 284

82.9 17.1

1115 565 113 135 201 480 232 50 333 87

33.68 17.06 3.41 4.08 6.07 14.5 7.01 1.51 10.06 2.63

1. ∑à“π‡§¬‰¥â√—∫√Ÿâ‡√◊ËÕß “√‰Õ‚Õ¥’πÀ√◊Õ‰¡à ‡§¬ ‰¡à‡§¬ 2. ∑à“π∑√“∫‡√◊ËÕß “√‰Õ‚Õ¥’π®“°„§√ ‡®â“∑’ Ë “∏“√≥ ÿ¢ Õ ¡. ‡æ◊ÕË π∫â“π ≠“µ‘ «‘∑¬ÿ ‚∑√∑—»πå Àπ—ß ◊Õæ‘¡æå ÀÕ°√–®“¬¢à“« ‚ª ‡µÕ√å/·ºàπæ—∫ Õ◊ËπÊ√–∫ÿ.......‡§¬‡√’¬π, ®“° Internet

THAILAND JOURNAL OF HEALTH PROMOTION AND ENVIRONMENTAL HEALTH

October - December 2012

∫ ∑ «‘ ∑ ¬ “ ° “ √ µ“√“ß∑’Ë 3 · ¥ß§«“¡∂’Ë √âÕ¬≈– ‡°’Ë¬«°—∫°“√√—∫√Ÿâ‡√◊ËÕß “√‰Õ‚Õ¥’π¢ÕßÀ≠‘ßµ—Èß§√√¿å(µàÕ) ¢âÕ§«“¡ 3. ∑à“π§‘¥«à“°“√¢“¥ “√‰Õ‚Õ¥’π‡ªìπÕ—πµ√“¬µàÕ√à“ß°“¬ À√◊Õ‰¡à ‡ªìπÕ—πµ√“¬ ‰¡à‡ªìπÕ—πµ√“¬ ‰¡à·πà„® 4. ∑à“π§‘¥«à“À“°À≠‘ßµ—Èß§√√¿å¢“¥ “√‰Õ‚Õ¥’πÕ“®®–‡°‘¥ º≈°√–∑∫Õ¬à“ß‰√ ‰¡à¡’Õ–‰√º‘¥ª°µ‘ À≠‘ßµ—Èß§√√¿å‡ªìπ§ÕæÕ° ·∑âß≈Ÿ° / ≈Ÿ°µ“¬µ—Èß·µàÕ¬Ÿà„π∑âÕß ≈Ÿ°¡’πÈ”Àπ—°µ—«πâÕ¬ ≈Ÿ°æ‘°“√·µà°”‡π‘¥ ≈Ÿ°¡’ µ‘ªí≠≠“µË”/√–∫∫ª√– “∑º‘¥ª°µ‘ ≈Ÿ°‡°‘¥¡“‡ªìπ§ÕæÕ° Õ◊Ëπ Ê √–∫ÿ..............‰¡à·πà„®, ‰¡à∑√“∫ 5. „π¢≥–µ—Èß§√√¿å∑à“π‰¥â√—∫§”·π–π”‡°’Ë¬«°—∫°“√∫√‘‚¿§ ‡°≈◊Õ‡ √‘¡‰Õ‚Õ¥’πÀ√◊Õ‡°≈◊ÕÕπ“¡—¬À√◊Õ‰¡à ‡§¬ ‰¡à‡§¬

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1165 150 314

71.5 9.2 19.3

91 754 161 389 329 753 770 85

2.73 22.63 4.83 11.67 9.87 22.60 23.11 2.55

1176 444

72.6 27.4

§ÕæÕ°√âÕ¬≈– 23.11 √Õß≈ß¡“§◊ÕÀ≠‘ßµ—Èß§√√¿å ‡ªìπ‚√§§ÕæÕ°√âÕ¬≈– 22.63 ·≈–≈Ÿ°¡’√–¥—∫ µ‘ ªí≠≠“µË”À√◊Õ√–∫∫ª√– “∑º‘¥ª°µ‘ √âÕ¬≈– 22.60 „π¢≥–µ—Èß§√√¿å à«π„À≠à®–‰¥â√—∫§”·π–π”‡°’Ë¬« °—∫°“√∫√‘‚¿§‡°≈◊ÕÕπ“¡—¬√âÕ¬≈– 72.6 ®“°µ“√“ß∑’Ë 4 √“¬ß“πº≈°“√µ√«® √–¥—∫‰Õ‚Õ¥’π„πªí “«–¢ÕßÀ≠‘ßµ—Èß§√√¿å„π¿“§ ‡Àπ◊ÕµÕπ∫π (8 ®—ßÀ«—¥) æ∫§à“¡—∏¬∞“π¢Õß ‰Õ‚Õ¥’π„πªí “«–‡ªìπ 217 ‰¡‚§√°√—¡µàÕ≈‘µ√ ´÷Ëß‰¡à¢“¥‰Õ‚Õ¥’π ‡¡◊ËÕ‡ª√’¬∫‡∑’¬∫√“¬®—ßÀ«—¥ æ∫‡æ’¬ß®—ßÀ«—¥æ–‡¬“∑’Ë¡’ªí≠À“°“√ “√‰Õ‚Õ¥’π „πÀ≠‘ ß µ—È ß §√√¿å πÕ°®“°π’È ¬— ß æ∫«à “ ®— ß À«— ¥

µ“√“ß∑’Ë 4 º≈°“√µ√«®√–¥—∫‰Õ‚Õ¥’π„πªí “«–¢ÕßÀ≠‘ßµ—Èß§√√¿å ¿“§‡Àπ◊ÕµÕπ∫π ªï 2553 ®—ßÀ«—¥

®”π«π (N) ‡™’¬ß„À¡à 284 ≈”æŸπ 110 ≈”ª“ß 228 ·¡àŒÕà ß Õπ 156 √«¡‡¢µ 15 778 ‡™’¬ß√“¬ 254 æ–‡¬“ 198 ·æ√à 253 πà“π 115 √«¡‡¢µ 16 820 √«¡ 8 ®—ßÀ«—¥ 1598

median

Range

µg/L

314.9 178.75 251.1 167.6 241.6 169.95 143.45 323.8 180.00 182.90 217.00

16.30-623.10 5.00-602-10 7.70-559.6 13.50-612.90 5.00-623.10 13.20-639.40 24.50-618.00 12.60-542.00 10.50-601.90 10.50-639.40 5.00-639.40

< 150 µg/L ®”π«π √âÕ¬≈– 52 18.2 46 41.8 60 26.3 76 48.7 234 29.9 120 47.1 101 49.8 70 27.2 50 27.3 341 38.1 575 34.3

150-249 µg/L ®”π«π √âÕ¬≈– 70 24.6 23 20.9 53 23.2 31 19.9 177 22.8 56 22.0 57 28.1 34 13.2 27 14.8 174 19.4 351 21.0

250-499 µg/L ≥ 500 µg/L ®”π«π √âÕ¬≈– ®”π«π √âÕ¬≈– 124 43.5 38 13.3 37 33.6 4 3.6 102 44.7 13 5.7 38 24.4 11 7.1 301 38.5 66 8.6 70 27.5 8 3.1 35 17.2 5 2.5 111 43.2 38 14.8 31 16.9 7 3.8 247 27.5 58 6.5 548 32.6 124 7.5

°“√·ª√º≈(5): §à“¡—∏¬∞“π < 150 ‰¡‚§√°√—¡/≈‘µ√ ‡∑à“°—∫ √–¥—∫¢“¥ (Insufficient) §à“¡—∏¬∞“π 150 - 249 ‰¡‚§√°√—¡/≈‘µ√ ‡∑à“°—∫ ‡æ’¬ßæÕ (Adequate) §à“¡—∏¬∞“π 250 - 499 ‰¡‚§√°√—¡/≈‘µ√ ‡∑à“°—∫ ‡°‘π§«“¡µâÕß°“√ (Above requirements) §à“¡—∏¬∞“π¡“°°«à“ 500 ‰¡‚§√°√—¡/≈‘µ√ ‡∑à“°—∫ ¡“°‡°‘π‰ª (Excessive)

‡™’¬ß„À¡à ·æ√à ·≈–≈”ª“ß ¡’§à“¡—∏¬∞“π¢Õß ‰Õ‚Õ¥’π„πªí “«–‡°‘π§à“ª°µ‘ ®“°µ“√“ß∑’Ë 5 §à “ ¡— ∏ ¬∞“π¢Õß√–¥— ∫ ‰Õ‚Õ¥’π„πªí “«–¢ÕßÀ≠‘ßµ—Èß§√√¿å„πªï 2553 ·¬°√“¬®—ßÀ«—¥ æ∫«à“ ®—ßÀ«—¥æ–‡¬“¡’§“à ¡—∏¬∞“π ‡∑à“°—∫ 143.45 ‰¡‚§√°√—¡/≈‘µ√ µË”°«à“‡°≥±å ‡≈Á°πâÕ¬ ®÷ß‡ªìπæ◊Èπ∑’Ë¢“¥ “√‰Õ‚Õ¥’π ´÷Ëß®–µâÕß ‡√à ß √— ¥ °“√¥”‡π‘ π ß“πªÑ Õ ß°— π ·≈–§«∫§ÿ ¡ ¿“«– ¢“¥ “√‰Õ‚Õ¥’πµàÕ‰ª à«πÕ’° 7 ®—ßÀ«—¥ Õ¬Ÿà„π ™à«ß√–¥—∫ª°µ‘ ‚¥¬¡’§à“¡—∏¬∞“π√–À«à“ß 167.6 323.8 ‰¡‚§√°√—¡/≈‘µ√ ¿“æ√«¡ 8 ®—ßÀ«—¥¿“§ ‡Àπ◊ÕµÕπ∫π¡’§“à ¡—∏¬∞“π‡∑à“°—∫ 217 ‰¡‚§√°√—¡/ ≈‘µ√ ‡ª√’¬∫‡∑’¬∫°—∫ ”π—°‚¿™π“°“√(6) ®–‡ÀÁπ «à“¿“«–°“√¢“¥‰Õ‚Õ¥’π‰¥âº≈„°≈â‡§’¬ß°—π ®“°µ“√“ß∑’Ë 6 æ∫«à“§à“¡—∏¬∞“π¢Õß √–¥—∫‰Õ‚Õ¥’π„πªí “«–¢ÕßÀ≠‘ßµ—Èß§√√¿å‡¢µ

µ√«®√“™°“√∑’Ë 15 °—∫ 16 ·µ°µà“ß°—πÕ¬à“ß¡’π—¬ ”§—≠∑“ß ∂‘µ‘ (p value < 0.001)

Õ¿‘ª√“¬º≈ à«π∑’Ë 1 ¢âÕ¡Ÿ≈‡°’Ë¬«°—∫æƒµ‘°√√¡°“√ ∫√‘‚¿§¢ÕßÀ≠‘ßµ—ßÈ §√√¿å ª√–°Õ∫¥â«¬¢âÕ¡Ÿ≈¥—ßπ’È 1.1¢âÕ¡Ÿ≈æƒµ‘°√√¡°“√∫√‘‚¿§Õ“À“√¢Õß À≠‘ ß µ—È ß §√√¿å à « π„À≠à ® –¡’ Õ “°“√·æâ ∑â Õ ß„π √–¥—∫ª“π°≈“ß√âÕ¬≈– 59.6 ¢≥–∑’Ë¡’Õ“°“√·æâ ∑âÕßÀ≠‘ßµ—Èß§√√¿å à«π„À≠à®–√—∫ª√–∑“πÕ“À“√ ‰¥â∫â“ß√âÕ¬≈– 57.3 ·≈– à«π∑’Ë√—∫ª√–∑“πÕ“À“√ ‰¡à‰¥â‡≈¬√âÕ¬≈– 4.8 À≠‘ßµ—Èß§√√¿å√—∫ª√–∑“π Õ“À“√§√∫ 3 ¡◊ÈÕ √âÕ¬≈– 67.6 ª√–°Õ∫Õ“À“√ √—∫ª√–∑“π‡Õß 3 ¡◊ÈÕµàÕ«—π √âÕ¬≈– 50.2 Õ“À“√ ∑’ËÀ≠‘ßµ—Èß§√√¿å‰¡à√—∫ª√–∑“π¢≥–∑’Ëµ—Èß§√√¿å à«π ¡“°®–‡ªìπÕ“À“√®”æ«°¢ÕßÀ«“π ÿ√“ °“·ø √âÕ¬

THAILAND JOURNAL OF HEALTH PROMOTION AND ENVIRONMENTAL HEALTH

October - December 2012

∫ ∑ «‘ ∑ ¬ “ ° “ √ µ“√“ß∑’Ë 5 °√“ø· ¥ß§à“¡—∏¬∞“π·≈–Õ—µ√“°“√¢“¥¢Õß√–¥—∫‰Õ‚Õ¥’π„πªí “«–À≠‘ßµ—Èß§√√¿å ‡¢µ 15 ·≈– 16 ‡ª√’¬∫‡∑’¬∫°—∫¢Õß ”π—°‚¿™π“°“√ ªï 2553

µ“√“ß∑’Ë 6 ‡ª√’¬∫‡∑’¬∫§«“¡·µ°µà“ß§à“¡—∏¬∞“π√–¥—∫‰Õ‚Õ¥’π„πªí “«–¢ÕßÀ≠‘ßµ—Èß§√√¿åªï 2553 √–À«à“ß‡¢µ 15 ·≈–‡¢µ 16

‡¢µµ√«®√“™°“√∑’Ë 15 ‡¢µµ√«®√“™°“√∑’Ë 16

median

Mean Rank

778 820

241.60 182.90

852.71 749.02

≈– 48 √Õß≈ß¡“§◊ÕÕ“À“√∑’¡Ë √’ ‡§Á¡·≈–Õ“À“√∑–‡≈ √âÕ¬≈– 30.6 ·≈–√âÕ¬≈– 21.4 ´÷Ëß‰¡à Õ¥§≈âÕß°—∫ °“√√—∫√Ÿâ‡√◊ËÕß “√‰Õ‚Õ¥’πÀ≠‘ßµ—Èß§√√¿å√—∫√Ÿâ‡√◊ËÕß “√‰Õ‚Õ¥’π√âÕ¬≈– 82.9 ·µà°Á‡≈◊Õ°∑’Ë®–‰¡à∫√‘‚¿§ Õ“À“√∑’Ë¡’‰Õ‚Õ¥’π 1.2¢âÕ¡Ÿ≈æƒµ‘°√√¡°“√∫√‘‚¿§‡°≈◊Õ‡ √‘¡ ‰Õ‚Õ¥’π À≠‘ßµ—Èß§√√¿å à«π¡“°√—∫ª√–∑“πÕ“À“√ ∑–‡≈ 1-3 «—πµàÕ‡¥◊Õπ √âÕ¬≈– 45.1 °“√ª√ÿß Õ“À“√„Àâ ¡’ √ ‡§Á ¡ ®–„™â ‡ °≈◊ Õ Õπ“¡— ¬ À√◊ Õ ‡°≈◊ Õ ‡ √‘¡‰Õ‚Õ¥’π‡æ’¬ß√âÕ¬≈– 39.23 ´÷Ëß·µ°µà“ß°—∫ °“√»÷°…“¢Õß ¡®‘µ√å ®“√ÿ√—µπ»‘√‘°ÿ≈(7)æ∫«à“À≠‘ß 50

µÿ≈“§¡ - ∏—π«“§¡ 2555

°√¡Õπ“¡—¬ àß‡ √‘¡„Àâ§π‰∑¬ ÿ¢¿“æ¥’

P value < .001

µ—Èß§√√¿å„π 3 Õ”‡¿Õ„π®—ßÀ«—¥ ß¢≈“„™â‡°≈◊Õ ‡ √‘¡‰Õ‚Õ¥’π∂÷ß√âÕ¬≈– 79 Õ“®‡æ√“–«à“¿“§ ‡Àπ◊ÕÕ¬Ÿà‰°≈∑–‡≈·≈–«—≤π∏√√¡À√◊Õ§«“¡‡§¬™‘π ¢ÕßÀ≠‘ßµ—ßÈ §√√¿å„π¿“§‡Àπ◊Õ‰¡àπ¬‘ ¡∫√‘‚¿§‡°≈◊Õ ·≈–‰¡à Õ¥§≈âÕß°—∫º≈°“√¢“¥ “√‰Õ‚Õ¥’π∑’Ëæ∫ «à“„π‡¢µ¿“§‡Àπ◊Õ à«π¡“°‰¡à¢“¥ “√‰Õ‚Õ¥’π ¬°‡«âπ®—ßÀ«—¥æ–‡¬“ ∑—Èßπ’ÈÕ“®‡æ√“–«à“À≠‘ßµ—Èß §√√¿å ‰ ¥â √— ∫ °“√‡ √‘ ¡ ‰Õ‚Õ¥’ π ®“°¬“‡¡Á ¥ ‡ √‘ ¡ ‰Õ‚Õ¥’π À√◊ÕπÈ”‡ √‘¡‰Õ‚Õ¥’π°àÕπ°“√ àßµ√«® ªí “«– µ“¡π‚¬∫“¬¢Õß°√–∑√«ß “∏“√≥ ÿ¢∑’Ë „ÀâÀ≠‘ßµ—Èß§√√¿å∑ÿ°§π‰¥â√—∫ ç¬“‡¡Á¥‡ √‘¡ “√

µ“√“ß∑’Ë 7 ‡ª√’¬∫‡∑’¬∫¡“µ√°“√À≈—°„π°“√¥”‡π‘πß“π¢Õß‡¢µµ√«®√“™°“√∑’Ë 15 ·≈– 16 ¡“µ√°“√À≈—°/°‘®°√√¡ 1. ¢¬“¬§«“¡§√Õ∫§≈ÿ ¡ °“√∫√‘ ‚ ¿§ ‡°≈◊Õ‡ √‘¡‰Õ‚Õ¥’π·≈–‡°≈◊Õ∑’Ë¡’§ÿ≥¿“æ µ“¡¡“µ√∞“π 2. π—∫ πÿππÈ”‡ √‘¡‰Õ‚Õ¥’π„π‚√ß‡√’¬π µ”√«®µ√–‡«π™“¬·¥π·≈–»Ÿπ¬å ÿ¢¿“æ ™ÿ¡™π 3. ‡ΩÑ“√–«—ß‚√§¢“¥ “√‰Õ‚Õ¥’π‚¥¬°“√ µ√«®ª√‘¡“≥‰Õ‚Õ¥’π„πªí “«–À≠‘ßµ—Èß §√√¿å

‡¢µµ√«®√“™°“√∑’Ë 15

‡¢µµ√«®√“™°“√∑’Ë 16

¥”‡π‘π°“√Õ¬à“ß‡¢â¡¢âπ„π∑ÿ°Õ”‡¿Õ ¥”‡π‘π°“√‡¢â¡¢âπ„πÕ”‡¿Õ∑’Ëæ∫ªí≠À“ ‚√§¢“¥ “√‰Õ‚Õ¥’π ¥”‡π‘π°“√Õ¬à“ß‡¢â¡¢âπ

¥”‡π‘π°“√Õ¬à“ß‡¢â¡¢âπ

¥”‡π‘π°“√‚¥¬°√¡Õπ“¡—¬, „π∫“ß ¥”‡π‘π°“√‚¥¬°√¡Õπ“¡—¬ æ◊Èπ∑’Ë ‡™àπ Õ”‡¿ÕÕ¡°ãÕ¬ ¡’°“√ ¥”‡π‘π°“√Õ¬à“ß‡¢â¡¢âπ‚¥¬Àπà«¬ ß“π„π¡À“«‘∑¬“≈—¬‡™’¬ß„À¡à‡¢â“‰ª ∑”«‘®—¬„πæ◊Èπ∑’Ë 4. °“√„Àâ¬“‚ø‡≈∑‡ √‘¡‰Õ‚Õ¥’π„πÀ≠‘ß °”Àπ¥„Àâ¬“‚ø‡≈∑‡ √‘¡‰Õ‚Õ¥’π„π „Àâ ‚ √ßæ¬“∫“≈™ÿ ¡ ™πæ‘ ® “√≥“„Àâ ¬ “ µ—Èß§√√¿å À≠‘ßµ—Èß§√√¿å∑ÿ°√“¬ ‚ø‡≈∑‡ √‘¡‰Õ‚Õ¥’π‡©æ“–Õ”‡¿Õ∑’Ë¡’ ¿“«–¢“¥ “√‰Õ‚Õ¥’π ‚¥¬æ‘®“√≥“ ®“°√–¥—∫ TSH „π∑“√°·√°‡°‘¥ ·≈– °“√‡ΩÑ“√–«—ß√–¥—∫‰Õ‚Õ¥’π„πªí “«– ¢ÕßÀ≠‘ßµ—ßÈ §√√¿å 5. °“√°”°—∫ µ‘¥µ“¡ ·≈–ª√–‡¡‘πº≈ - ·µà ß µ—È ß §≥–∑”ß“πªÑ Õ ß°— π °”Àπ¥„Àâ¥”‡π‘π°“√µ“¡§«“¡®”‡ªìπ §«∫§ÿ¡‚√§¢“¥ “√‰Õ‚Õ¥’π√–¥—∫ ¢Õßªí≠À“„πæ◊Èπ∑’ËÕ¬à“ßµàÕ‡π◊ËÕß („Àâ ‡¢µ ‚¥¬¡’ ”π—°ß“π “∏“√≥ ÿ¢ ‡ªìπß“πª√–®”) ®—ßÀ«—¥·¡àŒàÕß Õπ‡ªìπ‡®â“¿“æÀ≈—° ·≈–„Àâ√“¬ß“π§«“¡°â“«Àπâ“„π°“√ ª√–™ÿ¡§≥–°√√¡°“√ª√– “π°“√ æ—≤π“ “∏“√≥ ÿ¢‡¢µ 15 ∑ÿ°‡¥◊Õπ - ªí ≠ À“‚√§¢“¥ “√‰Õ‚Õ¥’ π ‡ªìπªí≠À“ ”§—≠ 1„π 5 ªí≠À“ ¢Õß‡¢µ 15 - °”Àπ¥„Àâª√–‡¥Áπ‚√§¢“¥ “√ ‰Õ‚Õ¥’ π ‡ªì π ªí ≠ À“ ”§— ≠ „π°“√ µ‘ ¥ µ“¡·≈–ª√–‡¡‘ π º≈ß“π à ß ‡ √‘¡ ÿ¢¿“æ·≈–ªÑÕß°—π‚√§ (P&P) ¢Õß‡¢µ 15

THAILAND JOURNAL OF HEALTH PROMOTION AND ENVIRONMENTAL HEALTH

October - December 2012

∫ ∑ «‘ ∑ ¬ “ ° “ √ Õ“À“√ ”§—≠é (ª√–°Õ∫¥â«¬ ‰Õ‚Õ¥’π ‡À≈Á° ·≈– ‚ø‡≈∑) à«π∑’Ë 2 ¢âÕ¡Ÿ≈‡°’Ë¬«°—∫°“√√—∫√Ÿâ‡√◊ËÕß “√‰Õ‚Õ¥’π¢ÕßÀ≠‘ßµ—Èß§√√¿å À≠‘ßµ—Èß§√√¿å à«π„À≠à®–‰¥â√—∫§«“¡√Ÿâ‡√◊ËÕß “√‰Õ‚Õ¥’ π √â Õ ¬≈– 82.9 ·≈–∑√“∫‡√◊Ë Õ ß “√ ‰Õ‚Õ¥’π®“°‡®â“Àπâ“∑’Ë “∏“√≥ ÿ¢√âÕ¬≈– 33.68 √Ÿâ «à“∂â“¢“¥ “√‰Õ‚Õ¥’π®–‡ªìπÕ—πµ√“¬µàÕ√à“ß°“¬ √âÕ¬≈– 69.2 ·≈–®–‡°‘¥º≈°√–∑∫∑”„Àâ≈Ÿ°‡°‘¥¡“ ‡ªìπ‚√§§ÕæÕ°√âÕ¬≈– 23.11 √Õß≈ß¡“§◊ÕÀ≠‘ß µ—Èß§√√¿å‡ªìπ‚√§§ÕæÕ°√âÕ¬≈– 22.63 ·≈–≈Ÿ°¡’ √–¥— ∫ µ‘ ªí ≠ ≠“µË” À√◊ Õ √–∫∫ª√– “∑º‘ ¥ ª°µ‘ √âÕ¬≈– 22.60 À≠‘ßµ—Èß§√√¿å à«π„À≠à®–‰¥â√—∫§” ·π–π”‡°’Ë¬«°—∫°“√∫√‘‚¿§‡°≈◊Õ‡ √‘¡‰Õ‚Õ¥’πÀ√◊Õ ‡°≈◊ÕÕπ“¡—¬√âÕ¬≈– 72.6 ®–‡ÀÁπ«à“À≠‘ßµ—Èß§√√¿å √—∫√Ÿâ‡√◊ËÕß “√‰Õ‚Õ¥’π·µà à«π„À≠à¬—ß¢“¥§«“¡√Ÿâ∂÷ß “‡Àµÿ§«“¡√ÿπ·√ß¢Õß‚√§¢“¥ “√‰Õ‚Õ¥’π √Ÿâ®—° ‡æ’¬ßÕ“°“√§ÕæÕ° à«ππâÕ¬∑’Ë∑√“∫∂÷ßº≈°“√ ‡®√‘≠‡µ‘∫‚µ·≈–æ—≤π“°“√∑“ß µ‘ªí≠≠“¢Õß‡¥Á° „π§√√¿å ¥—ßπ—Èπ∫ÿ§≈“°√∑“ß “∏“√≥ ÿ¢µâÕß‡πâπ „Àâ‡ÀÁπ§«“¡ ”§—≠„π°“√„Àâ§”·π–π”·°àÀ≠‘ßµ—Èß §√√¿å à«π∑’Ë 3 √ “ ¬ ß “ π º ≈ ‰ Õ ‚ Õ ¥’ π „ π ªí “«–¢ÕßÀ≠‘ßµ—Èß§√√¿å ¥—ßπ’È 3.1º≈°“√µ√«®√–¥—∫‰Õ‚Õ¥’π„πªí “«– ¢ÕßÀ≠‘ßµ—Èß§√√¿å‡¢µ 15 ·≈–‡¢µ 16 ªï 2553 √–¥—∫‰Õ‚Õ¥’π„πªí “«–¢ÕßÀ≠‘ßµ—Èß§√√¿å„π¿“æ √«¡‡¢µ 15 ¡’§à“¡—∏¬∞“π‡∑à“°—∫ 241.6 À≠‘ßµ—Èß §√√¿å∑’Ë¡’√–¥—∫‰Õ‚Õ¥’π„πªí “«–µË”°«à“ 150 ‰¡‚§√°√—¡/≈‘µ√ ¡’®”π«π 234 √“¬ §‘¥‡ªìπ√âÕ¬ ≈– 29.9 √–¥—∫‰Õ‚Õ¥’π„πªí “«–¢ÕßÀ≠‘ßµ—Èß §√√¿å„π¿“æ√«¡¢Õß‡¢µ 16 ¡’§à“¡—∏¬∞“π‡∑à“°—∫ 182.9 ·≈–À≠‘ßµ—Èß§√√¿å∑’Ë¡’√–¥—∫‰Õ‚Õ¥’πµË”°«à“ 150 ‰¡‚§√°√—¡/≈‘µ√ ¡’®”π«π 341 √“¬ §‘¥‡ªìπ 52

µÿ≈“§¡ - ∏—π«“§¡ 2555

°√¡Õπ“¡—¬ àß‡ √‘¡„Àâ§π‰∑¬ ÿ¢¿“æ¥’

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‡Õ° “√Õâ“ßÕ‘ß 1.· ß‚ ¡ ’π–«—≤πå. ºŸÕâ ”π«¬°“√°Õß‚¿™π“°“√.°√¡Õπ“¡—¬ °√–∑√«ß “∏“√≥ ÿ¢ www.anamai.moph.go.th/factsheet 2. ”π—°‚¿™π“°“√ °√¡Õπ“¡—¬ °√–∑√«ß “∏“√≥ ÿ¢. √“¬ß“πº≈°“√‡ΩÑ“√–«—ß¿“«–¢“¥ “√‰Õ‚Õ¥’π ªï 2549-2552. 3.®ÿ√‘π∑√å ≈—°…≥«‘»‘…Æå √—∞¡πµ√’«à“°“√°√–∑√«ß “∏“√≥ ÿ¢. »Ÿπ¬å¢âÕ¡Ÿ≈¢à“« “√ªØ‘√Ÿªª√–‡∑»‰∑¬ Available from: http://www.thaireform.in.th/news-health-system/2056-2010-10-05-10-49-28.html 4.Yamane, T. Statistics and Introductory Analysis. 2nd ed. Tokyo : John Weather Hill ; 1970 5.World Health Organization, UNICEF, and ICCIDD. Assessment of iodine deficiency disorders and monitoring their elimination : A Guide for Programme Managers, 3rd Ed.; 2007. 6. ”π—°‚¿™π“°“√ °√¡Õπ“¡—¬. º≈√–¥—∫‰Õ‚Õ¥’π„πªí “«–À≠‘ßµ—Èß§√√¿å ªï 2553 ®”π«π 75 ®—ßÀ«—¥. Available from : http:// nutrition. anamai.moph.go.th/temp/files/_iodine/ui%2075% 20 ®—ßÀ«—¥% 202553.pdf2003. 7. ¡®‘µ√å ®“√ÿ√—µπ»‘√‘°ÿ≈.»÷°…“§«“¡ —¡æ—π∏å¢Õßæƒµ‘°√√¡°“√∫√‘‚¿§‰Õ‚Õ¥’π √–¥—∫‰Õ‚Õ¥’π„πªí “«–¢ÕßÀ≠‘ßµ—Èß §√√¿å·≈–√–¥—∫ THS „π∑“√°. ∂“∫—π«‘®—¬·≈–æ—≤π“ ÿ¢¿“æ¿“§„µâ. Available from : http:// www.rdh.psu.ac.th 8.‡Õ° “√ √ÿª√“¬ß“πº≈°“√µ√«®√“™°“√·≈–π‘‡∑»ß“π “∏“√≥ ÿ¢ ‡¢µ 15 ·≈– 16 ª√–®”ªï 2553. HEALTH

‡ « ∑’ - « “ ∑ – ç§π©≈“¥™Õ∫·°≈âß‚ßà §π‚ßà™Õ∫· ≈âß«à“©≈“¥ à«π π—°ª√“™≠å‡√’¬π√Ÿâ∑’Ë®–©≈“¥·≈–‡√’¬π√Ÿâ∑’Ë®–‚ßàé æ√–¡À“«ÿ≤‘™—¬ «.«™‘√‡¡∏’ ∑’Ë¡“ : http://campus.sanook.com

THAILAND JOURNAL OF HEALTH PROMOTION AND ENVIRONMENTAL HEALTH

October - December 2012