Impact of the 2011 Major Floods in Phra Nakhon Si Ayutthaya District, Phra Nakhon Si Ayutthaya Province on Patients with Chronic Diseases - ผลกระทบจากภาวะมหาอุทกภัยปี 2554 ต่อผู้ป่วยโรคเรื้อรัง อำเภอพระนครศรีอยุธยา จังหวัดพระนครศรีอยุธยา

Abstract

This cross-sectional descriptive research, employing mixed method was to assess the influence
of the 2011 major floods in Phra Nakhon Si Ayutthaya district on health care systems focusing on
patients with chronic diseases in terms of disease conditions, treatment deprivation, and health behaviors.
In a January, 2011 survey, three months after the floods, a set of questionnaire and observation
forms were used in order to assess health care impact on patients with chronic diseases undergoing
treatments provided by Phra Nakhon Si Ayutthaya hospital or primary care units. The samples
were 538 chronic disease cases comprising of 157 hypertension, 119 diabetes mellitus, 37 insulindependent
diabetes, 83 cerebrovascular, 38 end-staged kidney disease and 104 asthma.
In an indepth interview it included 16 hypertension patients, 12 diabetics, 4 insulin-dependent
diabetics, 8 cerebrovascular, 4 end-staged kidney disease, and 11 asthma. As such, they were to
indicate their health problems and impacts, crisis self-management and recommendations on critical
measures needed during the floods.
The results showed that a majority of the patients was living in the area with 2-3 meter deep
flood water. Of the hypertension patients in the areas, 32.5 percent were without medication for
24.1(15.4) days. Whereas 36.9 percent of the diabetes patients ran out of medication for 26.2 (15.4)
days. Yet the blood pressure levels and fasting blood sugar level (FBS) before and after the floods
did not show any differences. On the other hand 21.6 percent of the insulin-dependent diabetics
were deprived of insulin for 19.9 (10.6) days yet without any serious consequences. Reportedly,
18.1 percent of the cerebrovascular patients barely survived without medication resulting in 27.7
percent with complications, 30.0 percent under severe stress and 36.1 percent in need of physical
therapy and rehabilitation. Among those with end-staged chronic kidney disease, their dialysis were
off scheduled in 10.4 percent of the peritoneal dialysis cases and 33.3 percent of the hemodialysis
cases. Therefore, 24.3 percent of those with peritoneal dialysis had abdominal wall infection. After
the floods receded, the uncontrolled asthma (ACT score less than 21) increased from 71.1 to 86.5
percent. Also more unhealthy behaviors were reported in hypertension and diabetes patients.
The target groups suggested that the government sector and local administration should have
been well prepared to cope with the medical deprivation and its consequences. Health care teams
should be in the communities to render medical services. A good network with primary care unit
could bring about better services for chronic disease patients.
Key words: major floods, hypertension, diabetes mellitus, cerebrovascular disease, chronic kidney disease, asthma