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102 °√¡Õπ“¡—¬ à߇ √‘¡„Àâ§π‰∑¬ ÿ¢¿“楒¡°√“§¡ - ¡’π“§¡ 2555

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°“√‡ΩÑ“√–«—ß¿“«–¢“¥ “√‰Õ‚Õ¥’π·∫∫∫Ÿ√≥“°“√ »Ÿπ¬åÕπ“¡—¬∑’Ë 1 °√ÿ߇∑æœ ªï æ.».2554 ‡ªìπ°“√¥”‡π‘π°“√„πªï·√° ¡’«—µ∂ÿª√– ߧå‡æ◊ËÕµ‘¥µ“¡ ∂“π°“√≥å¿“«–¢“¥ “√‰Õ‚Õ¥’π„π√–¥—∫»Ÿπ¬åÕπ“¡—¬Õ¬à“ß∫Ÿ√≥“°“√·≈–‡ªìπ√–∫∫ ∑”°“√»÷°…“„π®—ßÀ«—¥∑’Ë ÿࡇ≈◊Õ°‰¥â §◊Õ ®—ßÀ«—¥ª∑ÿ¡∏“π’ ·≈–®—ßÀ«—¥ππ∑∫ÿ√’ ªï 2554‰¥â¥”‡π‘π°“√»÷°…“惵‘°√√¡°“√∫√‘‚¿§º≈‘µ¿—≥±å‡ √‘¡‰Õ‚Õ¥’π‚¥¬„™â·∫∫ Õ∫∂“¡ 300 §√—«‡√◊ÕπµàÕ®—ßÀ«—¥µ√«®§ÿ≥¿“懰≈◊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¢Õ߉Ղե’π„π°≈ÿࡇ¥Á°Õ“¬ÿ 3-6 ªï ·≈–°≈ÿࡺŸâ 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—Èߧ√√¿å„™â∞“π¢âÕ¡Ÿ≈√“¬ß“π°“√‡ΩÑ“√–«—ߪ√–®”ªï 2554 ¢âÕ¡Ÿ≈√–¥—∫ŒÕ√å‚¡π°√–µÿâπµàÕ¡∏—¬√Õ¬¥å (TSH) „π∑“√°·√°‡°‘¥ „™â®“°∞“π¢âÕ¡Ÿ≈‚§√ß°“√µ√«®§—¥°√Õß¿“«–æ√àÕß∏—¬√Õ¬¥åŒÕ√å‚¡π„π∑“√°·√°‡°‘¥ ªï 2554 ‚¥¬°√¡«‘∑¬“»“ µ√å°“√·æ∑¬å º≈°“√»÷°…“æ∫«à“ ºŸâµÕ∫·∫∫ Õ∫∂“¡∑’ˇªìπ°≈ÿࡵ—«Õ¬à“ß„π°“√»÷°…“§√—Èßπ’È à«π„À≠àÕ“»—¬Õ¬Ÿà„π‡¢µÕߧ尓√∫√‘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“™’懪ìπ·¡à∫â“π√âÕ¬≈– 38.0 ·≈–37.7 µ“¡≈”¥—∫ „π√Õ∫ 1 ‡¥◊Õπ∑’˺à“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 ·≈–„™âπÈ”‡°≈◊Õª√ÿß√ ‡ √‘¡‰Õ‚Õ¥’π‡æ’¬ß√âÕ¬≈– 7.7 ·≈–√âÕ¬≈– 5.0 ”À√—∫惵‘°√√¡∑—Ë«‰ª¢Õß°“√„™â‡°≈◊Õ‡ √‘¡‰Õ‚Õ¥’π„π°“√ª√ÿߪ√–°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≈∑’ˇ≈◊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

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THAILAND JOURNAL OF HEALTH PROMOTION AND ENVIRONMENTAL HEALTH 103J a n u a r y - M a r c h 2 0 1 2

°“√‡ΩÑ“√–«—ß‚√§¢“¥ “√‰Õ‚Õ¥’π·∫∫∫Ÿ√≥“°“√æ◊Èπ∑’˧«“¡√—∫º‘¥™Õ∫»Ÿπ¬åÕπ“¡—¬∑’Ë Ò °√ÿ߇∑æœ

Integrated IDD Surveillance in areas underthe responsibility of Health Center I,Bangkok Department of Health, 2011

Kandavasee Maleevong Dr.Public Health NutritionHealth Center I, Bangkok Department of Health

À¡Ÿà∫â“π√âÕ¬≈– 45.7 ·≈– 47.7 °“√‡≈◊Õ°¬—ßæ‘®“√≥“®“°©≈“°´Õ߇°≈◊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—Èߧ√√¿å„π§√—«‡√◊Õπ∑’˵Õ∫·∫∫ Õ∫∂“¡∫“ß√“¬‰¡à‰¥â√—∫¬“‡¡Á¥‡ √‘¡‰Õ‚Õ¥’π ´÷ËßÀ≠‘ßµ—Èߧ√√¿å∑ÿ°§π∑’ˉ¥â√—∫¬“‡¡Á¥‡ √‘¡‰Õ‚Õ¥’π ‰¡à¡’Õ“°“√¢â“߇§’¬ßÀ≈—ß°‘𬓇¡Á¥‡ √‘¡‰Õ‚Õ¥’π·≈–¡’§«“¡µ—Èß„®°‘𬓇¡Á¥‡ √‘¡‰Õ‚Õ¥’πµ≈Õ¥Õ“¬ÿ§√√¿å®π∂÷ß„Àâπ¡∫ÿµ√ 6 ‡¥◊Õπ °“√‡¢â“∂÷߇°≈◊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¡“¬∑’ËÕߧ尓√Õπ“¡—¬‚≈°°”Àπ¥ (√âÕ¬≈– 90) À≠‘ßµ—Èߧ√√¿å„π®—ßÀ«—¥ª∑ÿ¡∏“π’·≈–®—ßÀ«—¥ππ∑∫ÿ√’ ‰¡à¡’ªí≠À“‚√§¢“¥ “√‰Õ‚Õ¥’πµ“¡‡°≥±åÕߧ尓√Õπ“¡—¬‚≈°°”Àπ¥ §◊Õ æ◊Èπ∑’Ë∑’Ë¡’ —¥ à«π¢ÕßÀ≠‘ßµ—Èߧ√√¿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—Èߧ√√¿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¢Õ߇¥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¢ÕߺŸâ ŸßÕ“¬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„À⇰‘¥ª√– ‘∑∏‘º≈Õ¬à“ßµàÕ‡π◊ËÕߧ” ”§—≠ : °“√‡ΩÑ“√–«—ß ‚√§¢“¥ “√‰Õ‚Õ¥’π ŒÕ√å‚¡π°√–µÿâπµàÕ¡∏—¬√Õ¬¥å

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104 °√¡Õπ“¡—¬ à߇ √‘¡„Àâ§π‰∑¬ ÿ¢¿“楒¡°√“§¡ - ¡’π“§¡ 2555

Integrated IDD surveillance program conducted by the Health Center I Bangkok in 2011, aimed tofollow up IDD situation systematically and integratedly at Health Center level. Pathumthani and Nonthaburiprovinces were selected randomly for the study. The consumption behavior of domestic Iodine fortificationproduct were studied by means of questionnaire covered 300 households per province. The quality ofiodated salt in all studied households were studied by I-kit and titration were performed in 10% of thesamples. Urine samples were collected form 150 children aged 3-6 years and 150 elderly over 60 year todetermine iodine content. Among children aged 1-3 yrs, child development were examined in 90 childrenaged 1-3 yrs. per province. Data of urine iodine in pregnant women were derived from annual IDDsurveillance program in 2011 by Department of Health, and TSH data in new born babies were derivedfrom the report of neonatal screening for monitoring of iodine deficiency areas in 2011 by the Departmentof Medial Sciences. The study found that most of the samples lived in Tambon local administrationorganization areas in Pathumthani and Nonthaburi provinces respectively, 76.6% and 94.3%, 75.0% and76.7% were female, 33.7% and 42.0% aged over 60 yr, 61.7% and 72.4% finished primary school educa-tion, 38.0% and 37.7% were housewives respectively. During the past month prior to the study, 81.0% and87.3% used iodated salt, 63.3% and 54.3% used iodated fish sauce, 58.0% and 47.0% used iodated soysauce, 55.7% and 42.7% used iodated seasoning sauce, only 7.7% and 5.0% used iodated salt seasoningwater in Pathumthani and Nonthaburi respectively. It was found that the rate of iodated salt usage behaviorwas high (90.0% and 94.3% respectively). The reasons for the high rate were that it was easy to buy in thevillage 60.3% and 55.7%, IDD prevention program 52.3% and 60.0%, availability in village 45.7% and47.7%. Besides, iodated salt label had been the means to consider salt buying at 81.3% and 85% respec-tively. Most of children 3-6 yr. old and the elderly in both provinces consumed the same meals with familymembers. Some pregnant women did not receive iodine tablet. For the pregnant women who received theiodine tablet, they mentioned no side effect and intend to take the tablet during pregnancy period andduring six months breast feeding. The percentage of household iodated salt availability (≥ 30 ppm) was76.1% and 77.7% lower than WHO standard (90.0%). No IDD problem in pregnant women in bothprovinces by WHO criteria i.e. the area with over 50.0% of pregnant women with urine iodine lower than150 ug/L (deficiency) is IDD area. It was found that in Phatumthani and Nonthaburi, the rate of pregnantwomen with urine iodine lower than 150 ug/L was 38.7% and 42.1% respectively. It was else found thaturine iodine lower then 100 ug/L (deficiency level) in children 3-6 yr. was 7.9% and 15.9% On the otherhand in the elderly, It was 38.4% and 42.1% respectively. It was found that decline of IDD in new bornbaby 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 respec-tively. In order to have efficient integrated IDD surveillance system, The IDD surveillance program shouldbe operated at Health Center level in all provinces responsible by the Center. Follow up and monitoring ofIDD 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)

Abstract

THAILAND JOURNAL OF HEALTH PROMOTION AND ENVIRONMENTAL HEALTH 105J a n u a r y - M a r c h 2 0 1 2

°“√‡ΩÑ“√–«—ß‚√§¢“¥ “√‰Õ‚Õ¥’π·∫∫∫Ÿ√≥“°“√æ◊Èπ∑’˧«“¡√—∫º‘¥™Õ∫»Ÿπ¬åÕπ“¡—¬∑’Ë Ò °√ÿ߇∑æœ

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ª√–™“°√„π∑ÿ°°≈ÿà¡«—¬ µ≈Õ¥√–¬–‡«≈“¢Õß«ß®√™’«‘µ À≠‘ßµ—Èߧ√√¿å À≠‘ß„Àâπ¡∫ÿµ√ À≠‘ß«—¬‡®√‘≠æ—π∏ÿå ·≈–‡¥Á°ª∞¡«—¬ ‡ªìπ°≈ÿࡪ√–™“°√∑’Ë¡’§«“¡‡ ’ˬß∑’Ë®–‰¥â√—∫º≈°√–∑∫∑’Ë√⓬·√ߢÕß¿“«–¢“¥ “√‰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“߇´≈≈å ¡Õß·≈–°“√∑”ß“π¢Õß√à“ß°“¬ ‚¥¬‡©æ“–∑“√°∑’ËÕ¬Ÿà„π§√√¿å¡“√¥“®π∂÷ßÕ“¬ÿ 3 ªï À“°¢“¥ “√‰Õ‚Õ¥’π®–∑”„Àâ ¡Õ߇®√‘≠‡µ‘∫‚µ‰¡à‡µÁ¡∑’Ë ≈¥§«“¡‡©≈’¬«©≈“¥À√◊Õ√–¥—∫ µ‘ªí≠≠“¢Õ߇¥Á°‰¥â∂÷ß 10-15 ®ÿ¥ ∑”„À⇥Á°¡’ªí≠À“°“√‡√’¬π ·≈–°√–∑∫µàÕ°“√‡®√‘≠‡µ‘∫‚µ ∂â“¢“¥‰Õ‚Õ¥’π√ÿπ·√ß®–‡ªìπ‚√§‡ÕãÕ(WHO/ICCIDD/UNICEF,2007)

®“°°“√ ”√«®‰Õ§‘«¢Õߧπ‰∑¬ ‚¥¬ ∂“∫—π«‘®—¬√–∫∫ “∏“√≥ ÿ¢ ‡¡◊ËÕ æ.». 2551 -2552 æ∫‰Õ§‘«‡©≈’ˬ 91 ®ÿ¥ (‰Õ§‘«‡©≈’ˬª°µ‘ 90-110 ®ÿ¥) ( ∂“∫—π«‘®—¬√–∫∫ “∏“√≥ ÿ¢, 2554)Õ’°∑—Èߺ≈°“√ ”√«®æ—≤π“°“√„π‡¥Á°Õ“¬ÿµË”°«à“ 5ªï ¢Õß°√¡Õπ“¡—¬ °√–∑√«ß “∏“√≥ ÿ¢ æ∫æ—≤π“°“√ ¡«—¬≈¥≈ß ‚¥¬„πªï 2542 ¡’æ—≤π“°“√ ¡«—¬√âÕ¬≈– 72 ªï 2547 √âÕ¬≈– 71·≈–ªï 2550 ≈¥≈߇À≈◊Õ√âÕ¬≈– 67 “‡ÀµÿÀπ÷Ëß∑’Ë∑”„À⇥Á°¡’æ—≤π“°“√‰¡à ¡«—¬ ‡π◊ËÕß®“°¡“√¥“‰¥â√—∫ “√‰Õ‚Õ¥’π‰¡à‡æ’¬ßæÕ¢≥–µ—Èߧ√√¿å ‡¡◊ËÕæ.».2549-2552 æ∫ —¥ à«π¢ÕßÀ≠‘ßµ—Èߧ√√¿å∑’Ë√–¥—∫‰Õ‚Õ¥’π„πªí “«–µË”°«à“ 150µg/L √âÕ¬≈– 71.8,61.3, 58.5 ·≈– 59 µ“¡≈”¥—∫ ( ”π—°‚¿™π“°“√,2552) (‡°≥±åÕߧ尓√Õπ“¡—¬‚≈°°”Àπ¥§◊Õ æ◊Èπ∑’Ë∑’Ë¡’ —¥ à«π¢ÕßÀ≠‘ßµ—Èߧ√√¿å∑’Ë¡’√–¥—∫‰Õ‚Õ¥’π„πªí “«–πâÕ¬°«à“ 150 µg/L ‡°‘π√âÕ¬≈– 50 ‡ªìπæ◊Èπ∑’Ë¢“¥ “√‰Õ‚Õ¥’π) ·¡â«à“ ∂“π°“√≥å„πªï æ.».

2553 ®–¡’·π«‚πâ¡∑’Ë¥’¢÷Èπ ‚¥¬æ∫«à“ —¥ à«π¢ÕßÀ≠‘ßµ—Èߧ√√¿å∑—Ë«ª√–‡∑»∑’Ë¡’√–¥—∫‰Õ‚Õ¥’π„πªí “«–µË”°«à“ 150 µg/L √âÕ¬≈– 42.6 ·≈– —¥ à«π¢ÕßÀ≠‘ßµ—Èߧ√√¿å„π‡¢µæ◊Èπ∑’˧«“¡√—∫º‘¥™Õ∫»Ÿπ¬åÕπ“¡—¬∑’Ë 1 §◊Õ ®—ßÀ«—¥ππ∑∫ÿ√’ Õà“ß∑Õßæ√–π§√»√’Õ¬ÿ∏¬“ ·≈–ª∑ÿ¡∏“π’ ∑’Ë¡’√–¥—∫‰Õ‚Õ¥’π„πªí “«–µË”°«à“ 150µg/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„πª√–‡∑»‰∑¬ ªï æ.». 2552 ‚¥¬ºŸâ‡™’ˬ«™“≠®“°Õߧ尓√Õπ“¡—¬‚≈° Õߧ尓√¬Ÿπ‘‡´ø ·≈– ¿“π“π“™“µ‘‡æ◊ËÕ°“√§«∫§ÿ¡‚√§¢“¥ “√‰Õ‚Õ¥’π √–∫ÿ«à“¡’§«“¡°â“«ÀπⓇ撬߇≈Á°πâÕ¬„π°“√¥”‡π‘π°“√‡ΩÑ“√–«—ß ∂“π°“√≥墓¥ “√‰Õ‚Õ¥’π„π√–¬– 5 ªï∑’˺à“π¡“ ·¡â«à“®– “¡“√∂§«∫§ÿ¡‚√§§ÕæÕ°ª√–®”∂‘Ëπ (endemic goiter) „π°≈ÿࡇ¥Á°‰¥â·≈â«·µà¬—ߧߡ’ªí≠À“°“√¢“¥ “√‰Õ‚Õ¥’π„π°≈ÿà¡À≠‘ßµ—Èߧ√√¿å·≈–∑“√°·√°‡°‘¥ ª√–‡¥Áπªí≠À“∑’Ë ”§—≠§◊Õ ¢“¥°“√«“ß·ºπ·≈–¥”‡π‘π°“√Õ¬à“ß∫Ÿ√≥“°“√ ¢âÕ¡Ÿ≈∑’ˉ¥â¡‘‰¥âπ”¡“‡™◊ËÕ¡‚¬ß‡æ◊ËÕ∫àß™’È ∂“π°“√≥åæ◊Èπ∑’Ë∑’ˇªìπªí≠À“ ·≈–‰¥â„Àâ¢âÕ‡ πÕ‰«â«à“ °“√¥”‡π‘πß“π∑’Ë®–„Àâª√– ∫º≈ ”‡√Á® Ÿß ÿ¥µâÕ߉¥â√—∫§«“¡√à«¡¡◊Õ®“°Àπ૬ߓπ∑’ˇ°’ˬ«¢âÕß∑ÿ°¿“§ à«π √«¡∑—Èß„Àâ¢âÕ‡ πÕ·π–‡æ◊ËÕª√—∫ª√ÿß‚§√ß°“√·≈–∫àß™’Ȫ√–‡¥Áπ·≈–¬ÿ∑∏»“ µ√å∑’Ë®”‡ªìπµâÕß·°â‰¢ ( ”π—°‚¿™π“°“√,2553)

§≥–Õπÿ°√√¡°“√®—¥√–∫∫‡ΩÑ“√–«—ß·≈–µ‘¥µ“¡°“√¢“¥ “√‰Õ‚Õ¥’π ´÷Ëß¡’§≥–∑”ß“π®“° ”π—°‚¿™π“°“√ »Ÿπ¬åÕπ“¡—¬ ”π—° à߇ √‘¡ ÿ¢¿“æ ”π—°Õπ“¡—¬°“√‡®√‘≠æ—π∏ÿå °√¡Õπ“¡—¬ °√¡«‘∑¬“»“ µ√å°“√·æ∑¬å ∂“∫—π«‘®—¬«‘∑¬“»“ µ√å “∏“√≥ ÿ¢ °Õߧ«∫§ÿ¡Õ“À“√ ”π—°ß“π§≥–

∫ ∑ «‘ ∑ ¬ “ ° “ √

106 °√¡Õπ“¡—¬ à߇ √‘¡„Àâ§π‰∑¬ ÿ¢¿“楒¡°√“§¡ - ¡’π“§¡ 2555

°√√¡°“√Õ“À“√·≈–¬“ (Õ¬.) ·≈– ”π—°√–∫“¥«‘∑¬“ °√¡§«∫§ÿ¡‚√§ ®÷߉¥âæ—≤π“√–∫∫‡ΩÑ“√–«—ß·∫∫∫Ÿ√≥“°“√‡æ◊ËÕµ‘¥µ“¡ ∂“π°“√≥å·≈–≈¥¿“«–¢“¥ “√‰Õ‚Õ¥’π„π¡“√¥“·≈–∑“√°¢÷Èπ ‚¥¬ “¡“√∂π”¢âÕ¡Ÿ≈¡“· ¥ß§«“¡‡™◊ËÕ¡‚¬ß„Àâ‡ÀÁπÕ¬à“ß™—¥‡®π∂÷ß “‡Àµÿ·≈–æ◊Èπ∑’Ë∑’ˇªìπªí≠À“ ‡æ◊ËÕ¥”‡π‘π°“√·°â‰¢ªí≠À“ °àÕ„À⇰‘¥ª√– ‘∑∏‘¿“æ„π°“√§«∫§ÿ¡ªÑÕß°—π‚√§¢“¥ “√‰Õ‚Õ¥’π·≈– “¡“√∂„™â„π°“√µ‘¥µ“¡ª√–‡¡‘πº≈°“√¥”‡π‘πß“π

«—µ∂ÿª√– ߧ尓√»÷°…“‡æ◊ËÕµ‘¥µ“¡ ∂“π°“√≥å¿“«–¢“¥ “√

‰Õ‚Õ¥’π„πª√–™“°√¢Õßæ◊Èπ∑’˧«“¡√—∫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“¡—¬®÷߉¥â¥”‡π‘π°“√‡°Á∫µ—«Õ¬à“ß„Àâ§√Õ∫§≈ÿ¡°≈ÿࡇªÑ“À¡“¬¥—ßπ’È

1. À≠‘ßµ—Èߧ√√¿å ∑“√°·√°‡°‘¥ ‡¥Á°Õ“¬ÿ 1-3 ªï ‡¥Á°Õ“¬ÿ 3-6 ªï ·≈–ºŸâ ŸßÕ“¬ÿ

2. ·À≈àߺ≈‘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

1. Õ∫∂“¡æƒµ‘°√√¡°“√∫√‘‚¿§º≈‘µ¿—≥±å‡ √‘¡‰Õ‚Õ¥’π 10 §√—«‡√◊Õπ 30 300 §√—«‡√◊Õπ

2. µ√«®§ÿ≥¿“懰≈◊Õ‡ √‘¡‰Õ‚Õ¥’π„π§√—«‡√◊Õπ

2.1 µ√«®§ÿ≥¿“懰≈◊Õ∫√‘‚¿§‡ √‘¡‰Õ‚Õ¥’π„π§√—«‡√◊Õπ 10 §√—«‡√◊Õπ 30 300 §√—«‡√◊Õπ

‚¥¬„™â I-Kit (∑ÿ°¬’ËÀâÕ

∑ÿ°¢π“¥)

2.2 ‡°Á∫µ—«Õ¬à“߇°≈◊Õ‡ √‘¡‰Õ‚Õ¥’π‡æ◊ËÕ àß titration √âÕ¬≈– 10 ¢Õß 30 30 §√—«‡√◊Õπ

∑’Ë ”π—°‚¿™π“°“√ µ—«Õ¬à“߇°≈◊Õ∑’Ë

µ√«®„π¢âÕ 2.1

3. ‡°Á∫µ—«Õ¬à“ßªí “«–‡æ◊ËÕ àßµ√«®√–¥—∫§«“¡‡¢â¡¢âπ

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3.1 ‡°Á∫µ—«Õ¬à“ßªí “«–„πºŸâ ŸßÕ“¬ÿ 60 ªï¢÷Èπ‰ª 5 §π 30 150 §π

3.2 ‡°Á∫µ—«Õ¬à“ßªí “«–‡¥Á°Õ“¬ÿ 3-6 ªï 5 §π 30 150 §π

4. µ√«®æ—≤π“°“√‡¥Á° 1-3 ªï 3 §π 30 90 §π

À¡“¬‡Àµÿ: „π°√≥’∑’˧√—«‡√◊Õπ∑’ˇ¢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 ÿࡵ—«Õ¬à“ß

ª√–™“°√¥—ß°≈à“«„Àâ§√∫µ“¡®”π«π‚¥¬‰¡àµâÕß —¡¿“…≥å§√—«‡√◊Õπ„À¡à

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THAILAND JOURNAL OF HEALTH PROMOTION AND ENVIRONMENTAL HEALTH 107J a n u a r y - M a r c h 2 0 1 2

°“√‡ΩÑ“√–«—ß‚√§¢“¥ “√‰Õ‚Õ¥’π·∫∫∫Ÿ√≥“°“√æ◊Èπ∑’˧«“¡√—∫º‘¥™Õ∫»Ÿπ¬åÕπ“¡—¬∑’Ë Ò °√ÿ߇∑æœ

®”Àπà“¬‡°≈◊Õ‡ √‘¡‰Õ‚Õ¥’π ·≈–§√—«‡√◊Õπ «‘∏’°“√¥”‡π‘π°“√

1. ∑∫∑«π¢âÕ¡Ÿ≈ ∂“π°“√≥å¢Õߪí≠À“°“√¢“¥ “√‰Õ‚Õ¥’π„π»Ÿπ¬åÕπ“¡—¬∑’Ë 1

2. ÿࡇ≈◊Õ°®—ßÀ«—¥∑’Ë∑”°“√»÷°…“‚¥¬«‘∏’°“√ ÿࡵ—«Õ¬à“ßÕ¬à“߇ªìπ√–∫∫ (systematic sam-pling) ¥”‡π‘π°“√‡ªìπ‡«≈“ 3 ªï „π√Õ∫·√° ªïæ.».2554 ‚¥¬ “¡“√∂‡ªìπµ—«·∑π„π√–¥—∫»Ÿπ¬åÕπ“¡—¬∑’Ë 1 §◊Õ®—ßÀ«—¥ª∑ÿ¡∏“π’ ·≈–®—ßÀ«—¥ππ∑∫ÿ√’

3. ¥”‡π‘π°“√®—¥µ—Èߧ≥–∑”ß“πªØ‘∫—µ‘°“√¿“§ π“¡ ·≈–ª√– “πß“π™’È·®ß·π«∑“ߥ”‡π‘πß“π·°àºŸâ√—∫º‘¥™Õ∫„πÀπ૬ߓπµà“ßÊ

4. ¥”‡π‘π°“√‡°Á∫¢âÕ¡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≥¿“懰≈◊Õ‚¥¬I-Kit 10 À≈—ߧ“‡√◊ÕπµàÕÀ¡Ÿà∫â“π „π 30 À¡Ÿà∫â“π∑’Ë∑”°“√ ÿࡇ≈◊Õ°¡“‚¥¬«‘∏’°“√ ÿࡵ—«Õ¬à“ß·∫∫°≈ÿà¡(Cluster random sampling) „π·µà≈–®—ßÀ«—¥∑’Ë∑”°“√»÷°…“„πªïπ—ÈπÊ ·≈–‡°Á∫µ—«Õ¬à“߇°≈◊Õ√âÕ¬≈– 10 ®“°§√—«‡√◊Õπ‡æ◊ËÕ àßµ√«® titration „πÀâÕߪؑ∫—µ‘°“√ æ√âÕ¡ —¡¿“…≥å„π√–¥—∫§√—«‡√◊Õπµ“¡·∫∫ Õ∫∂“¡æƒµ‘°√√¡°“√∫√‘‚¿§‡§√◊ËÕߪ√ÿß√ Õ“À“√∑’Ë¡’‰Õ‚Õ¥’π ·≈–¬“‡¡Á¥‡ √‘¡ “√Õ“À“√

4.4) °“√¥”‡π‘π°“√‡°Á∫¢âÕ¡Ÿ≈√–¥—∫‰Õ‚Õ¥’π„πªí “«–¢ÕßÀ≠‘ßµ—Èߧ√√¿å∑’Ë¡“Ω“°§√√¿å§√—Èß·√°„π‚√ß欓∫“≈ ‚¥¬®–‡°Á∫µ—«Õ¬à“ß

„πÀ≠‘ßµ—Èߧ√√¿å 300 √“¬∑’Ë∑”°“√‡≈◊Õ°¡“‚¥¬«‘∏’‡≈◊Õ°·∫∫°”Àπ¥®”π«π‰«â°àÕπ (Quota sam-pling) „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 ´÷Ë߇°Á∫µ—«Õ¬à“ß„π∑“√°·√°‡°‘¥∑ÿ°√“¬∑’Ë‚√ß欓∫“≈(¡°√“§¡ - ∏—𫓧¡ 2554)

4.6) °“√¥”‡π‘π°“√‡°Á∫¢âÕ¡Ÿ≈¿“«–æ—≤π“°“√¢Õ߇¥Á°Õ“¬ÿ 1-3 ªï ¥â«¬·∫∫∑¥ Õ∫Denver II ‚¥¬®–ª√–‡¡‘π„π‡¥Á° 3 √“¬µàÕÀ¡Ÿà∫â“π„π 30 À¡Ÿà∫â“π∑’Ë∑”°“√ ÿࡇ≈◊Õ°¡“‚¥¬«‘∏’°“√ ÿࡵ—«Õ¬à“ß·∫∫°≈ÿà¡ (Cluster random sampling)„π·µà≈–®—ßÀ«—¥∑’Ë∑”°“√»÷°…“„πªïπ—ÈπÊ

4.7) °“√¥”‡π‘π°“√‡°Á∫ªí “«–¢Õ߇¥Á°«—¬ 3 - 6 ªï ·≈– ºŸâ ŸßÕ“¬ÿ 5 √“¬µàÕÀ¡Ÿà∫â“π„π 30 À¡Ÿà∫â“π ∑’Ë∑”°“√ ÿࡇ≈◊Õ°¡“‚¥¬«‘∏’°“√ ÿࡵ—«Õ¬à“ß·∫∫°≈ÿà¡ (Cluster random sampling)„π·µà≈–®—ßÀ«—¥∑’Ë∑”°“√»÷°…“„πªïπ—ÈπÊ

5. «‘ ‡§√“–Àå¢âÕ¡Ÿ≈ª√‘¡“≥‰Õ‚Õ¥’π„π‡°≈◊Õ®“°·À≈àߺ≈‘µ √â“π§â“ ·≈–§√—«‡√◊Õπ ¢âÕ¡Ÿ≈√–¥—∫§«“¡‡¢â¡¢âπ¢Õ߉Ղե’π„πªí “«–À≠‘ßµ—Èߧ√√¿å ‡¥Á° 3 - 6 ªï·≈–ºŸâ ŸßÕ“¬ÿ ¢âÕ¡Ÿ≈√–¥—∫ŒÕ√å‚¡πTSH „π‡≈◊Õ¥∑’ˇ®“–®“° âπ‡∑â“∑“√°·√°‡°‘¥ ·≈–¢âÕ¡Ÿ≈√–¥—∫æ—≤π“°“√‡¥Á°Õ“¬ÿ 1 - 3 ªï

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108 °√¡Õπ“¡—¬ à߇ √‘¡„Àâ§π‰∑¬ ÿ¢¿“楒¡°√“§¡ - ¡’π“§¡ 2555

≈– 76.6 ·≈– 94.3 ®—ßÀ«—¥ª∑ÿ¡∏“π’ ·≈–ππ∑∫ÿ√’¡’ª√–™“°√µ—«Õ¬à“߇ªìπ‡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“™’懪ìπ·¡à∫â“π √âÕ¬≈– 38.0 ·≈–37.7 µ“¡≈”¥—∫

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„π√Õ∫ 1 ‡¥◊Õπ∑’˺à“π¡“ °àÕπ°“√ Õ∫∂“¡§√—«‡√◊Õπ¡’°“√‡¢â“∂÷ߺ≈‘µ¿—≥±å‡§√◊ËÕߪ√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√ÿߪ√–°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∑—Èߧ√—«‡√◊Õπ®—ßÀ«—¥ª∑ÿ¡∏“π’·≈–ππ∑∫ÿ√’ §◊Õ√âÕ¬≈– 98.0 °“√∫√‘‚¿§‰¢à‰°à‡ √‘¡‰Õ‚Õ¥’π¡’ª√‘¡“≥°“√∫√‘‚¿§„°≈⇧’¬ß°—π§◊Õ√âÕ¬≈– 12.7 ·≈– 11.0 §«“¡∂’Ë„π°“√∫√‘‚¿§‰¢àª√–¡“≥ 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¢ÕߺŸâ„Àâ —¡¿“…≥å„π®—ßÀ«—¥ª∑ÿ¡∏“π’ ·≈–ππ∑∫ÿ√’æ∫‡æ’¬ß√âÕ¬≈– 21.3 ·≈– 12.7 °“√∫√‘‚¿§Õ“À“√∑’Ë¡’‰Õ‚Õ¥’𠇙àπ ª≈“∑Ÿ Õ“À“√∑–‡≈ “À√à“¬ ¡’°“√∫√‘‚¿§√âÕ¬≈– 91.7 ·≈– 93.0 µ“¡≈”¥—∫ §«“¡∂’Ë„π°“√∫√‘‚¿§ 1-3 «—π/§√—Èß (√âÕ¬

≈– 37.7 ·≈– 40.3) „πÕ“À“√¡◊ÈÕ‡¬Áπ‡ªìπ à«π„À≠à(√âÕ¬≈– 66.7 ·≈– 55.7)

‡¡◊ËÕ 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≈∑’ˇ≈◊Õ°∫√‘‚¿§‡°≈◊Õ‡ √‘¡‰Õ‚Õ¥’π §◊Õ À“´◊ÈÕ‰¥âßà“¬„πÀ¡Ÿà∫â“π (√âÕ¬≈– 60.3 ·≈– 55.7) ·≈–ªÑÕß°—π‚√§§ÕæÕ°‰¥â (√âÕ¬≈– 52.3 ·≈– 60.0)·À≈àß∑’Ë´◊ÈÕ‡°≈◊Õ‡ √‘¡‰Õ‚Õ¥’π´◊ÈÕ®“°√â“π§â“„πÀ¡Ÿà∫â“π (√âÕ¬≈– 45.7 ·≈– 47.7) ·≈–Àâ“ß √√æ ‘π§â“ (√âÕ¬≈– 35.7 ·≈– 43.0) °“√‡≈◊Õ°´◊ÈÕæ‘®“√≥“®“°©≈“°´Õ߇°≈◊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–∑’˪‘¥™‘¥‡ªìπ à«π„À≠à (√âÕ¬≈– 88.0 ·≈– 86.0) ‚¥¬‡°Á∫Àà“ß®“°‡µ“‰ø ‰¡àµË”°«à“ 1 ‡¡µ√ À√◊Õ®“°§«“¡√âÕπ®“°‡µ“ (√âÕ¬≈– 86.0 ·≈– 85.0) „π∑’Ë· ß·¥¥ àÕ߉¡à∂÷ß (√âÕ¬≈– 82.0 ·≈– 84.0) ·≈–‰¡à·¢«πÀ√◊Õ«“߉«â‡Àπ◊Õ‡µ“‰ø (√âÕ¬≈– 83.3 ·≈– 81)

°“√ Õ∫∂“¡¢âÕ¡Ÿ≈°“√∫√‘‚¿§¢Õ߇¥Á°Õ“¬ÿ3-6 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—°∑’ˇ¥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∑—Èß®—ßÀ«—¥ª∑ÿ¡∏“π’ ·≈–ππ∑∫ÿ√’∫√‘‚¿§°ÿâß ª≈“∑–‡≈ ·≈–ª≈“πÈ”®◊¥ ·≈–π‘¬¡∫√‘‚¿§‰¢à‰°à¡“°°«à“‰¢à‡ªì¥ ‚¥¬∫√‘‚¿§‰¢à‰°à∑ÿ°«—π√âÕ¬≈– 11.3 ·≈–18.7 ª√‘¡“≥«—π≈– 1 øÕ߇ªìπ à«π„À≠à (√âÕ¬≈–29.0 ·≈– 34.7) °“√∫√‘‚¿§π¡¡’√âÕ¬≈– 38.7 ·≈–

THAILAND JOURNAL OF HEALTH PROMOTION AND ENVIRONMENTAL HEALTH 109J a n u a r y - M a r c h 2 0 1 2

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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¡¢∫‡§’Ȭ«‡ªìπª√–®” (√âÕ¬≈–23.0 ·≈– 30.3) ¡“°°«à“Õ“À“√«à“ߪ√–‡¿∑Õ◊Ëπ ”À√—∫ “À√à“¬ ”‡√Á®√Ÿª∑’ˇªìπ∑’Ëπ‘¬¡„πµ≈“¥ªí®®ÿ∫—πæ∫¡’°“√∫√‘‚¿§√âÕ¬≈– 10.0 ·≈– 15.7 µ“¡≈”¥—∫ ∫–À¡’Ë°÷Ëß ”‡√Á®√Ÿª∑’Ë∫√‘‚¿§‡ªìπª√–®”§◊Õ¡“¡à“ √âÕ¬≈– 15.7 ·≈– 20.7 ·≈–¡’‡¥Á°∑’ˉ¡à∫√‘‚¿§∫–À¡’Ë°÷Ëß ”‡√Á®√Ÿª √âÕ¬≈– 13.7 ·≈–√âÕ¬≈–9.0

°“√∫√‘‚¿§Õ“À“√¢ÕߺŸâ 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) ‡§√◊ËÕߪ√ÿß√ ∑’˺Ÿâ ŸßÕ“¬ÿ„™âª√ÿß√ Õ“À“√¢Õߧ√—«‡√◊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°‘πª√–®”§◊Õ ª≈“∑–‡≈ ¡’°“√∫√‘‚¿§√âÕ¬≈– 41.0 ·≈– 52.0

¢âÕ¡Ÿ≈°“√„™â¬“‡¡Á¥‡ √‘¡‰Õ‚Õ¥’π¢ÕßÀ≠‘ßµ—Èߧ√√¿å æ∫«à“ °“√√—∫∑√“∫¢âÕ¡Ÿ≈°“√‰¥â√—∫¬“‡¡Á¥‡ √‘¡‰Õ‚Õ¥’π¢ÕßÀ≠‘ßµ—Èߧ√√¿å∑ÿ°§π∑’ËΩ“°§√√¿å ≥ ∂“π∫√‘°“√ “∏“√≥ ÿ¢ ∑’ˇ√‘Ë¡µ—Èß·µà«—π∑’Ë 1 µÿ≈“§¡ 2553 ¢ÕߺŸâ„Àâ —¡¿“…≥å„πæ◊Èπ∑’Ë®—ßÀ«—¥ª∑ÿ¡∏“π’ ·≈–ππ∑∫ÿ√’ ¡’®”π«π√âÕ¬≈– 38.7·≈– 29.3 µ“¡≈”¥—∫ À≠‘ßµ—Èߧ√√¿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—Èߧ√√¿å„π®—ßÀ«—¥ª∑ÿ¡∏“𒉥â√—∫§√∫∑ÿ°§√—«‡√◊Õπ ·≈–√—∫ª√–∑“𬓇¡Á¥∑ÿ°«—π ”À√—∫®—ßÀ«—¥ππ∑∫ÿ√’æ∫¡’À≠‘ßµ—Èߧ√√¿å‰¥â√—∫¬“‡¡Á¥‡ √‘¡‰Õ‚Õ¥’π ·≈–√—∫ª√–∑“π∑ÿ°«—π√âÕ¬≈– 30.0 ·≈–‰¡à‰¥â√—∫ª√–∑“π√âÕ¬≈– 70.0 ™à«ß√–¬–¢Õß°“√µ—Èߧ√√¿å∑’Ë ‡√‘Ë¡√—∫ª√–∑“𬓇¡Á¥‡ √‘¡‰Õ‚Õ¥’π¢Õß∑—Èß®—ßÀ«—¥ª∑ÿ¡∏“π’ ·≈–ππ∑∫ÿ√’ §◊Õ °àÕπÕ“¬ÿ§√√¿å12 —ª¥“Àå À≠‘ßµ—Èߧ√√¿å∑ÿ°§π∑’ˉ¥â√—∫¬“‡¡Á¥‡ √‘¡‰Õ‚Õ¥’π ‰¡à¡’Õ“°“√¢â“߇§’¬ßÀ≈—ß°‘𬓇¡Á¥‡ √‘¡‰Õ‚Õ¥’π ·≈–¡’§«“¡µ—Èß„®°‘𬓇¡Á¥‡ √‘¡‰Õ‚Õ¥’πµ≈Õ¥Õ“¬ÿ§√√¿å ®π∂÷ß„Àâπ¡∫ÿµ√ 6 ‡¥◊Õπ

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110 °√¡Õπ“¡—¬ à߇ √‘¡„Àâ§π‰∑¬ ÿ¢¿“楒¡°√“§¡ - ¡’π“§¡ 2555

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

Õπ“¡—¬‚≈° °”Àπ¥æ◊Èπ∑’Ë∑’Ë¡’ —¥ à«π¢ÕßÀ≠‘ßµ—Èߧ√√¿å∑’Ë¡’√–¥—∫‰Õ‚Õ¥’π„πªí “«–πâÕ¬°«à“ 100µg/L ‡°‘π√âÕ¬≈– 50.0 ‡ªìπæ◊Èπ∑’Ë¢“¥ “√‰Õ‚Õ¥’π·≈–µ—Èß·µàªï 2550 Õߧ尓√Õπ“¡—¬‚≈°ª√—∫√–¥—∫‰Õ‚Õ¥’π„πªí “«– ´÷Ë߇ªìπµ—«™’È«—¥√–¥—∫°≈ÿࡪ√–™“°√ ∑’Ë∂◊Õ«à“πâÕ¬°«à“ª°µ‘®“° 100 µg/L‡ªìπ 150 µg/L ‡π◊ËÕß®“°À≠‘ßµ—Èߧ√√¿å¡’§«“¡µâÕß°“√‰Õ‚Õ¥’π¡“°°«à“ª√–™“™π∑—Ë«‰ª)

·ºπ¿Ÿ¡‘∑’Ë 1 §à“¡—∏¬∞“π√–¥—∫‰Õ‚Õ¥’π„πªí “«–À≠‘ßµ—Èߧ√√¿å ªï 2553 - 2555

400

300

200

100

0

ππ∑∫ÿ√’

ª∑ÿ¡∏“π’

2545 2546 2553 2554

157.3

96.3

260.8

116.5

371.6

196.4

æ.».

µ“√“ß∑’Ë 2 ª√‘¡“≥ “√‰Õ‚Õ¥’π„πªí “«–¢ÕßÀ≠‘ßµ—Èߧ√√¿å æ.». 2554

®—ßÀ«—¥ ®”π«π

µ—«Õ¬à“ß

§à“¡—∏¬

∞“π

µg/L

ª∑ÿ¡∏“π’ 309 371.6 5.7 - 30 9.7 49 15.9 103 33.3 127 41.1

1,505.0

ππ∑∫ÿ√’ 307 196.4 7.4 - 113 36.8 78 25.4 74 24.1 42 13.7

1,335.1

®”π«π √âÕ¬≈– ®”π«π √âÕ¬≈– ®”π«π √âÕ¬≈– ®”π«π √âÕ¬≈–

√–¥—∫‰Õ‚Õ¥’π„πªí “«–

< 150 µg/L

(¢“¥)

150-246 µg/L

(‡æ’¬ßæÕ)

250-499 µg/L

(‡°‘πæÕ)

≥ 500 µg/L

(‡°‘π¢π“¥)

§à“æ‘ —¬

µg/L

‰¡‚§√°√—¡/≈‘µ√ (µg/L)

THAILAND JOURNAL OF HEALTH PROMOTION AND ENVIRONMENTAL HEALTH 111J a n u a r y - M a r c h 2 0 1 2

°“√‡ΩÑ“√–«—ß‚√§¢“¥ “√‰Õ‚Õ¥’π·∫∫∫Ÿ√≥“°“√æ◊Èπ∑’˧«“¡√—∫º‘¥™Õ∫»Ÿπ¬åÕπ“¡—¬∑’Ë Ò °√ÿ߇∑æœ

¿“«–¢“¥ “√‰Õ‚Õ¥’π„π∑“√°·√°

‡°‘¥

‡¥Á°∑“√°·√°‡°‘¥¡’§à“ TSH ¡“°°«à“ 11.2¡‘≈≈‘¬Ÿπ‘µµàÕ≈‘µ√ πâÕ¬°«à“√âÕ¬≈– 3 ´÷Ë߇ªìπµ—«™’È«—¥√–¥—∫ª√–™“°√ ∑’Ë∂◊Õ«à“‡ªìπæ◊Èπ∑’ˉ¡à¢“¥ “√‰Õ‚Õ¥’π ´÷Ëß —¥ à«π‡¥Á°∑“√°·√°‡°‘¥¡’§à“ TSH¡“°°«à“ 11.2 ¡‘≈≈‘¬Ÿπ‘µµàÕ≈‘µ√ „π‡¥◊Õπ¡°√“§¡-∏—𫓧¡ 2554 ¢Õß®—ßÀ«—¥ª∑ÿ¡∏“π’ ·≈–ππ∑∫ÿ√’§◊Õ √âÕ¬≈– 9.02 ·≈–√âÕ¬≈– 10.23

¿“«–¢“¥ “√‰Õ‚Õ¥’π„π‡¥Á°‡≈Á°Õ“¬ÿ

3-6 ªï§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¢Õ߇¥Á°‡≈Á° 3-6 ªï ∑’Ë¡’‰Õ‚Õ¥’π„πªí “«–√–¥—∫¢“¥(< 100 µg/L) √âÕ¬≈– 7.9 ·≈– 15.9 ”À√—∫ —¥ à«π¢Õ߇¥Á°‡≈Á° 3-6 ªï ∑’Ë¡’‰Õ‚Õ¥’π„πªí “«–√–¥—∫‡°‘πæÕ (200 - 299 µg/L) ·≈–√–¥—∫‡°‘π¢π“¥ (≥300 µg/L) √âÕ¬≈– 60.5 ·≈–48.3 (µ“√“ß∑’Ë 3)

¿“«–¢“¥ “√‰Õ‚Õ¥’π„πºŸâ ŸßÕ“¬ÿ

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

√âÕ¬≈– 38.7 ·≈–√âÕ¬≈– 42.1 πÕ°®“°π—Èπ —¥ à«π¢ÕߺŸâ ŸßÕ“¬ÿ∑’Ë¡’‰Õ‚Õ¥’π„πªí “«–√–¥—∫‡°‘πæÕ (200 - 299 µg/L) ·≈–√–¥—∫‡°‘π¢π“¥(≥300 µg/L) √âÕ¬≈– 16.9 ·≈– 18.3 (µ“√“ß∑’Ë4)

µ“√“ß∑’Ë 3 √–¥—∫‰Õ‚Õ¥’π„πªí “«–¢Õ߇¥Á°‡≈Á° 3-6 ªï æ.».2554

®—ßÀ«—¥ ®”π«π

µ—«Õ¬à“ß

§à“¡—∏¬

∞“π

µg/L

ª∑ÿ¡∏“π’ 152 241.0 26-972 12 7.9 48 31.6 45 29.6 47 30.9

ππ∑∫ÿ√’ 151 196.6 10-780 24 15.9 54 35.8 36 23.8 37 24.5

®”π«π √âÕ¬≈– ®”π«π √âÕ¬≈– ®”π«π √âÕ¬≈– ®”π«π √âÕ¬≈–

√–¥—∫‰Õ‚Õ¥’π„πªí “«–

< 100 µg/L

(¢“¥)

100-199 µg/L

(‡æ’¬ßæÕ)

200-299 µg/L

(‡°‘πæÕ)

≥ 300 µg/L

(‡°‘π¢π“¥)

§à“æ‘ —¬

µg/L

µ“√“ß∑’Ë 4 √–¥—∫‰Õ‚Õ¥’π„πªí “«–¢ÕߺŸâ ŸßÕ“¬ÿ ªï æ.».2554

®—ßÀ«—¥ ®”π«π

µ—«Õ¬à“ß

§à“¡—∏¬

∞“π

µg/L

ª∑ÿ¡∏“π’ 142 117.4 9-866 55 38.7 63 44.4 14 9.9 10 7.0

ππ∑∫ÿ√’ 148 115.1 12-600 61 41.2 60 40.5 13 8.8 14 9.5

®”π«π √âÕ¬≈– ®”π«π √âÕ¬≈– ®”π«π √âÕ¬≈– ®”π«π √âÕ¬≈–

√–¥—∫‰Õ‚Õ¥’π„πªí “«–

< 100 µg/L

(¢“¥)

100-199 µg/L

(‡æ’¬ßæÕ)

200-299 µg/L

(‡°‘πæÕ)

≥ 300 µg/L

(‡°‘π¢π“¥)

§à“æ‘ —¬

µg/L

∫ ∑ «‘ ∑ ¬ “ ° “ √

112 °√¡Õπ“¡—¬ à߇ √‘¡„Àâ§π‰∑¬ ÿ¢¿“楒¡°√“§¡ - ¡’π“§¡ 2555

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«—¥

Õ¿‘ª√“¬º≈°“√»÷°…“1. 惵‘°√√¡°“√∫√‘‚¿§º≈‘µ¿—≥±å‡ √‘¡

‰Õ‚Õ¥’π„π§√—«‡√◊Õπ ·≈–¬“‡¡Á¥‡ √‘¡‰Õ‚Õ¥’π„πÀ≠‘ßµ—Èߧ√√¿å „π√Õ∫ 1 ‡¥◊Õπ∑’˺à“π¡“ °àÕπ°“√ Õ∫∂“¡æ∫«à“ §√—«‡√◊Õπ à«π„À≠à∑—ÈߢÕß®—ßÀ«—¥ª∑ÿ¡∏“π’ ·≈–ππ∑∫ÿ√’ „™â‡°≈◊Õ‡ √‘¡‰Õ‚Õ¥’π„π°“√ª√ÿß·≈–ª√–°Õ∫Õ“À“√¡“°°«à“‡§√◊ËÕߪ√ÿß√ ‡ √‘¡‰Õ‚Õ¥’πÕ◊ËπÊ (√âÕ¬≈– 81.0 ·≈– 87.3) ÷Ëß·µ°µà“ß®“°º≈°“√ ”√«®°“√∫√‘‚¿§‚´‡¥’¬¡§≈Õ‰√¥å ¢Õߪ√–™“™π„π¿“§°≈“ß ‡¢µæ◊Èπ∑’˧«“¡√—∫º‘¥™Õ∫»Ÿπ¬åÕπ“¡—¬∑’Ë 1 °√ÿ߇∑æœ °√¡Õπ“¡—¬ ´÷Ëߥ”‡π‘π°“√„πªï 2551 ·≈–®“°°“√»÷°…“°“√„™â “√ª√ÿß√ ‡§Á¡ ·≈–惵‘°√√¡°“√„™â

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

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√≥√ߧå·≈–°“√µ≈“¥‡™‘ß —ߧ¡ àߺ≈„Àâª√–™“™π·≈–‡§√◊Õ¢à“¬ºŸâº≈‘µ·≈–®”Àπà“¬º≈‘µ¿—≥±å‡ √‘¡‰Õ‚Õ¥’πµ√–Àπ—°√Ÿâ·≈–‡¢â“„® Õ¬à“߉√°Áµ“¡°≈ÿࡵ—«Õ¬à“ß∑’Ë∂Ÿ° Õ∫∂“¡∑—Èß®—ßÀ«—¥ª∑ÿ¡∏“π’·≈–ππ∑∫ÿ√’ ¡’°“√√—∫√Ÿâ«à“À≠‘ßµ—Èߧ√√¿å∑ÿ°§π∑’ËΩ“°§√√¿å ≥ ∂“π∫√‘°“√ “∏“√≥ ÿ¢ ®–‰¥â√—∫¬“‡¡Á¥‡ √‘¡‰Õ‚Õ¥’π §àÕπ

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

®—ßÀ«—¥ ª°µ‘ ß —¬≈à“™â“

®”π«π √âÕ¬≈– ®”π«π √âÕ¬≈–

ª∑ÿ¡∏“π’ (91 §π) 74 81.3 17 18.7

ππ∑∫ÿ√’ (89 §π) 83 93.3 6 6.7

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

¥â“π°“√«—¥®—ßÀ«—¥

ª∑ÿ¡∏“π’ ππ∑∫ÿ√’

¥â“π —ߧ¡·≈–°“√™à«¬‡À≈◊Õµπ‡Õß 91.1 95.5

¥â“π„™â°≈â“¡‡π◊ÈÕ‡≈Á°·≈–ª√—∫µ—« 89.0 97.7

¥â“π„™â°≈â“¡‡π◊ÈÕ¡—¥„À≠à 95.6 95.4

¥â“π¿“…“ 85.7 88.7

THAILAND JOURNAL OF HEALTH PROMOTION AND ENVIRONMENTAL HEALTH 113J a n u a r y - M a r c h 2 0 1 2

°“√‡ΩÑ“√–«—ß‚√§¢“¥ “√‰Õ‚Õ¥’π·∫∫∫Ÿ√≥“°“√æ◊Èπ∑’˧«“¡√—∫º‘¥™Õ∫»Ÿπ¬åÕπ“¡—¬∑’Ë Ò °√ÿ߇∑æœ

¢â“ßπâÕ¬ (√âÕ¬≈– 38.7 ·≈– 29.3) ´÷ËßÕ“®‡°‘¥®“°°“√ª√–™“ —¡æ—π∏å¡“µ√°“√‡ √‘¡¬“‡¡Á¥‡ √‘¡‰Õ‚Õ¥’𠉥â„À⧫“¡ ”§—≠‡®“–®ß‡©æ“–°≈ÿࡇªÑ“À¡“¬À≠‘ßµ—Èߧ√√¿å

2. §ÿ≥¿“懰≈◊Õ‡ √‘¡‰Õ‚Õ¥’π„π§√—«‡√◊Õπ°“√‡¢â“∂÷߇°≈◊Õ‡ √‘¡‰Õ‚Õ¥’π§ÿ≥¿“æ¢Õߧ√—«‡√◊ÕπµË”°«à“‡ªÑ“À¡“¬∑’ËÕߧ尓√Õπ“¡—¬‚≈°°”Àπ¥§◊Õ §«“¡§√Õ∫§≈ÿ¡¢Õߧ√—«‡√◊Õπ∑’Ë¡’°“√„™â‡°≈◊Õ‡ √‘¡‰Õ‚Õ¥’π§ÿ≥¿“æ (≥ 30 æ’æ’‡ÕÁ¡) √âÕ¬≈– 90.0´÷Ë߇°≈◊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 ·≈– 75.7Õ¬à“߉√°Áµ“¡§«“¡§√Õ∫§≈ÿ¡‡°≈◊Õ‡ √‘¡‰Õ‚Õ¥’π§ÿ≥¿“æ (≥ 30 æ’æ’‡ÕÁ¡) ¡’ —¥ à«π‡æ‘Ë¡¢÷ÈπÕ¬à“ß™—¥‡®π‡¡◊ËÕ‡ª√’¬∫‡∑’¬∫°—∫√“¬ß“πº≈°“√‡ΩÑ“√–«—ß¿“«–¢“¥ “√‰Õ‚Õ¥’π„πÀ≠‘ßµ—Èߧ√√¿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“√®—¥°“√∑’˵àÕ‡π◊ËÕß ·≈–‡¡◊ËÕ ÿࡵ√«®√âÕ¬≈– 10 ¢Õß°≈ÿࡵ—«Õ¬à“ß‚¥¬„™â Titration æ∫‡æ’¬ß√âÕ¬≈– 17.8 ·≈– 17.2µ“¡≈”¥—∫ ∑’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≈ ∑”„À⇰≈◊Õ‡ √‘¡‰Õ‚Õ¥’π à«π„À≠à‰¡à‰¥âµ“¡¡“µ√∞“π∑’Ë°”À𥇪ìπ®”π«π¡“°

3. ¿“«–¢“¥ “√‰Õ‚Õ¥’π„πÀ≠‘ßµ—Èߧ√√¿åÀ≠‘ßµ—Èߧ√√¿å¡’¿“«–¢“¥ “√‰Õ‚Õ¥’π≈¥≈ß ‚¥¬æ∫§à“¡—∏¬∞“π√–¥—∫‰Õ‚Õ¥’π„πªí “«–¢ÕßÀ≠‘ßµ—Èߧ√√¿å‡æ‘Ë¡¢÷Èπ ·≈– —¥ à«π¢ÕßÀ≠‘ßµ—Èߧ√√¿å∑’Ë¡’‰Õ‚Õ¥’π„πªí “«–√–¥—∫¢“¥ (µË”°«à“ 150µg/L)≈¥≈ß „πªï 2554 —¥ à«π¢ÕßÀ≠‘ßµ—Èߧ√√¿å¢Õß

®—ßÀ«—¥ª∑ÿ¡∏“π’·≈–ππ∑∫ÿ√’∑’Ë¡’ ‰Õ‚Õ¥’π„πªí “«–√–¥—∫¢“¥‡æ’¬ß√âÕ¬≈– 9.7 ·≈– 36.8 ´÷Ëß· ¥ß„Àâ ‡ÀÁπ«à“§à“¡—∏¬∞“π√–¥—∫‰Õ‚Õ¥’π„πªí “«–¢ÕßÀ≠‘ßµ—Èߧ√√¿å¡’·π«‚π⡇æ‘Ë¡¢÷Èπ Õ¥§≈âÕß°—∫§«“¡§√Õ∫§≈ÿ¡°“√∫√‘‚¿§‡°≈◊Õ‡ √‘¡‰Õ‚Õ¥’π§ÿ≥¿“æ∑’ˇæ‘Ë¡¢÷Èπ ´÷Ë߇ªìπº≈µàÕ‡π◊ËÕß®“°°“√¡’√–∫∫‡ΩÑ“√–«—ßµ‘¥µ“¡ ∂“π°“√≥å∑’ˇªìπªí®®ÿ∫—π∑”„Àâ¡’°“√®—¥°“√‰¥â¡’ª√– ‘∑∏‘¿“æ

4. ¿“«–¢“¥ “√‰Õ‚Õ¥’π„π∑“√°·√°‡°‘¥‡¥Á°∑“√°·√°‡°‘¥¡’¿“«–¢“¥ “√‰Õ‚Õ¥’π≈¥≈ß ‡¥Á°∑“√°·√°‡°‘¥¡’§à“ TSH ¡“°°«à“ 11.2 ¡‘≈≈‘¬Ÿπ‘µµàÕ≈‘µ√ πâÕ¬°«à“√âÕ¬≈– 3 ∂◊Õ«à“‡ªìπæ◊Èπ∑’ˉ¡à¢“¥ “√‰Õ‚Õ¥’π ÷Ëß —¥ 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¡°√“§¡ - ∏—𫓧¡ 2553§◊Õ√âÕ¬≈– 13.02 ·≈–√âÕ¬≈– 12.1 (·ºπ¿Ÿ¡‘∑’Ë 2)´÷Ëß Õ¥§≈âÕß°—∫À≠‘ßµ—Èߧ√√¿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„πªí “«–¢Õß°≈ÿࡇ¥Á°‡≈Á°Õ“¬ÿ 3-6 ªï ¡’§à“ Ÿß°«à“¢Õß°≈ÿࡺŸâ ŸßÕ“¬ÿ (117.4 µg/L ·≈– 115.1µg/L) ∑—Èß„π®—ßÀ«—¥ª∑ÿ¡∏“π’ ·≈–ππ∑∫ÿ√’ (241.0µg/L ·≈– 196.6 µg/L) √«¡∑—Èßæ∫«à“ °≈ÿࡇ¥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÷ߪ√– ß§å ¥â«¬¡’°“√‡ΩÑ“√–«—ß·≈–µ‘¥µ“¡§«“¡ª≈Õ¥¿—¬¢Õß°“√‰¥â√—∫ “√‰Õ‚Õ¥’π‡°‘π

6. ‰Õ§‘«·≈–æ—≤π“°“√ ¡«—¬ √–¥—∫ µ‘ªí≠≠“‡¥Á°π—°‡√’¬π

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¡‘≈≈‘¬Ÿπ‘µµàÕ≈‘µ√

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6

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10

12

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20

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35

30

40

45

10

15

1.4 2.8

7.0

1.9 3.9

14.9

6.8

13.8

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37.4

40.7

20.2

30.3

26.2

5.5

12.6

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3.3

9.5

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THAILAND JOURNAL OF HEALTH PROMOTION AND ENVIRONMENTAL HEALTH 115J a n u a r y - M a r c h 2 0 1 2

°“√‡ΩÑ“√–«—ß‚√§¢“¥ “√‰Õ‚Õ¥’π·∫∫∫Ÿ√≥“°“√æ◊Èπ∑’˧«“¡√—∫º‘¥™Õ∫»Ÿπ¬åÕπ“¡—¬∑’Ë Ò °√ÿ߇∑æœ

π—°‡√’¬πÕ“¬ÿ 6-18 ªï ∑—Ë«ª√–‡∑» ‚¥¬°√¡ ÿ¢¿“殑µ „™â·∫∫∑¥ Õ∫ SPM Parallel ver-sion ´÷Ë߇°Á∫¢âÕ¡Ÿ≈„π‡¥◊Õπ∏—𫓧¡ 2553 ∂÷ß¡°√“§¡ 2554 æ∫«à“ ‡¥Á°π—°‡√’¬π®—ßÀ«—¥ª∑ÿ¡∏“π’·≈–®—ßÀ«—¥ππ∑∫ÿ√’ ¡’§–·π𠵑ªí≠≠“‡©≈’ˬ‡∑à“°—∫ 103.34 ·≈– 108.91 (§à“‡©≈’ˬª°µ‘90-109) ÷Ëß Ÿß°«à“‡¥Á°π—°‡√’¬π‰∑¬∑—Èߪ√–‡∑»∑’Ë¡’§–·π𠵑ªí≠≠“‡©≈’ˬ‡∑à“°—∫ 98 ‡¡◊ËÕæ‘®“√≥“IQ ¢Õ߇¥Á°π—°‡√’¬π®—ßÀ«—¥ª∑ÿ¡∏“π’ ·≈–ππ∑∫ÿ√’°“√°√–®“¬ÕÕ°‰ª∑“ߵ˔·≈–∑“ß Ÿß°«à“‡°≥±å‡©≈’ˬæ∫«à“ ‡¥Á°π—°‡√’¬π®—ßÀ«—¥ª∑ÿ¡∏“π’ ·≈–ππ∑∫ÿ√’ ¡’ IQ µË”°«à“‡°≥±å‡©≈’ˬ IQ < 90 √âÕ¬≈–20.5 ·≈– 10.1 µ“¡≈”¥—∫ πÕ°®“°π—Èπ‡¥Á°π—°‡√’¬π®—ßÀ«—¥ª∑ÿ¡∏“π’·≈–ππ∑∫ÿ√’ ∑’Ë¡’ IQ Ÿß°«à“‡°≥±å‡©≈’ˬ (IQ ≥ 110) √âÕ¬≈– 38.8 ·≈–52.4 ”À√—∫‡¥Á°π—°‡√’¬π®—ßÀ«—¥ª∑ÿ¡∏“π’·≈–®—ßÀ«—¥ππ∑∫ÿ√’ ∑’Ë¡’ªí≠À“√–¥—∫ µ‘ªí≠≠“∫°æ√àÕß(IQ < 70) √âÕ¬≈– 2.8 ·≈– 1.4 ´÷Ë߇¡◊ËÕ‡ª√’¬∫‡∑’¬∫°—∫¡“µ√∞“π “°≈‰¡à§«√‡°‘π√âÕ¬≈– 2.0(·ºπ¿Ÿ¡‘∑’Ë 3)

‡¡◊ËÕ®”·π°§à“‡©≈’ˬ I.Q ‡¥Á°„π®—ßÀ«—¥ª∑ÿ¡∏“π’ ·≈–®—ßÀ«—¥ππ∑∫ÿ√’ ‡©æ“–„π™à«ßÕ“¬ÿ 9-10 ªï ·≈–„π™à«ßÕ“¬ÿ 7-8 ªï (µ“√“ß∑’Ë 7, 8) æ∫«à“ ‡¥Á°π—°‡√’¬π∑—È߇滙“¬·≈–‡æ»À≠‘ß„π®—ßÀ«—¥ππ∑∫ÿ√’ ¡’§à“‡©≈’ˬ Ÿß°«à“ ·≈–‡¡◊ËÕæ‘®“√≥“§à“¡—∏¬∞“π√–¥—∫‰Õ‚Õ¥’π„πªí “«–À≠‘ßµ—Èߧ√√¿å„π®—ßÀ«—¥ª∑ÿ¡∏“π’ ·≈–®—ßÀ«—¥ππ∑∫ÿ√’ ®“°√“¬ß“π°“√‡ΩÑ“√–«—ß¿“«–¢“¥ “√‰Õ‚Õ¥’π„πÀ≠‘ßµ—Èߧ√√¿å ªï 2545 ·≈–ªï 2546 §◊Õ157.3 µg/L ·≈–96.3 µg/L ´÷Ëßæ∫«à“§à“¡—∏¬∞“π√–¥—∫‰Õ‚Õ¥’π„πªí “«–¢ÕßÀ≠‘ßµ—Èߧ√√¿å®—ßÀ«—¥ππ∑∫ÿ√’ ¡’§à“µË”°«à“ Õ¬à“߉√°Áµ“¡√–¥—∫ µ‘ªí≠≠“π—Èπ ¡’ªí®®—¬Õ◊ËπÊ ‡°’ˬ«¢âÕߥ⫬ µ—Èß·µà

°“√‡µ√’¬¡µ—«¢Õß·¡à ™à«ß√–¬–‡«≈“°àÕπ·≈–¢≥–µ—Èߧ√√¿å √«¡∑—Èß√–¬–‡«≈“§≈Õ¥ À≈—ߧ≈Õ¥ °“√‡®Á∫ªÉ«¬ °“√‡≈’ȬߥŸ ·≈– ‘Ëß·«¥≈âÕ¡¢Õ߇¥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 ´÷Ëßæ—≤π“°“√‡©æ“–¥â“π¿“…“¡’æ—≤π“°“√ ¡«—¬πâÕ¬°«à“¥â“πÕ◊ËπÊ §◊Õ √âÕ¬≈– 85.7 ·≈– 88.7 ÷Ëß°“√ª√–‡¡‘πæ—≤π“°“√¥â«¬·∫∫ Õ∫∂“¡ DenverII ‰¡à‰¥â‡ªìπ·∫∫∑¥ Õ∫‡™“«åªí≠≠“ ·≈–‰¡à “¡“√∂„™â§“¥°“√≥å√–¥—∫§«“¡ “¡“√∂∑“ß µ‘ªí≠≠“„πÕ𓧵‰¥â ·µà‡ªìπ°“√‡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„À⇰‘¥ª√– ‘∑∏‘¿“æ Ÿß ÿ¥‡°‘¥§«“¡¬—Ë߬◊π„π°“√¢®—¥ªí≠À“‚√§¢“¥ “√‰Õ‚Õ¥’π„ÀâÀ¡¥‰ª‡ªìπ°“√æ—≤π“ µ‘ªí≠≠“‡¥Á°‰∑¬‡ÀÁπ§«√¥”‡π‘π°“√¥—ßµàÕ‰ªπ’È

1. ‡ΩÑ“√–«—ß„Àâ§√Õ∫§≈ÿ¡∑ÿ°æ◊Èπ∑’Ë√–¥—∫‡¢µ‡æ◊ËÕ√«∫√«¡‡ªìπ√“¬ß“π ∂“π°“√≥å√–¥—∫ª√–‡∑»

2. „πæ◊Èπ∑’Ë∑’Ë¡’ªí≠À“‚√§¢“¥ “√‰Õ‚Õ¥’π§«√‡ΩÑ“√–«—ßÕ¬à“ßµàÕ‡π◊ËÕߥ⫬§«“¡∂’Ë∑ÿ°ªï

3. π”¢âÕ¡Ÿ≈∑’ˉ¥â¡“„™âª√–‚¬™πå „π°“√ª√—∫ª√ÿß°“√¥”‡π‘πß“π §«∫§ÿ¡·≈–ªÑÕß°—π‚√§¢“¥ “√‰Õ‚Õ¥’π„Àâ‡À¡“– ¡„π√–¥—∫æ◊Èπ∑’Ë

∫ ∑ «‘ ∑ ¬ “ ° “ √

116 °√¡Õπ“¡—¬ à߇ √‘¡„Àâ§π‰∑¬ ÿ¢¿“楒¡°√“§¡ - ¡’π“§¡ 2555

‡Õ° “√Õâ“ßÕ‘ß1. °√¡ ÿ¢¿“殑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¢Õߪ√–‡∑»‰∑¬ ªï 2542.4. °Õß‚¿™π“°“√ °√¡Õπ“¡—¬ °√–∑√«ß “∏“√≥ ÿ¢. °“√®—¥∑”√–∫∫‡ΩÑ“√–«—ß µ‘¥µ“¡ ·≈–ª√–‡¡‘𧫓¡

°â“«Àπâ“„π‚§√ß°“√§«∫§ÿ¡‚√§¢“¥ “√‰Õ‚Õ¥’π·Ààß™“µ‘ ªï 2543-2547 √“¬ß“πº≈°“√‡ΩÑ“√–«—ß¿“«–¢“¥ “√‰Õ‚Õ¥’π„πÀ≠‘ßµ—Èߧ√√¿å ª√–®”ªï 2554 - 2547;°√°Æ“§¡ 2548.

5. §≥–°√√¡°“√®—¥∑”¢âÕ°”Àπ¥ “√Õ“À“√∑’˧«√‰¥â√—∫ª√–®”«—π ”À√—∫§π‰∑¬. ª√‘¡“≥ “√Õ“À“√Õâ“ßÕ‘ß∑’˧«√‰¥â√—∫ª√–®”«—π ”À√—∫§π‰∑¬ æ.».2546. ·°â‰¢§√—Èß∑’Ë 3. ‚√ßæ‘¡æåÕߧ尓√—∫ àß ‘π§â“·≈–æ— ¥ÿ¿—≥±å °√ÿ߇∑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 °√ÿ߇∑æœ °√¡Õπ“¡—¬. °“√ ”√«®°“√∫√‘‚¿§‚´‡¥’¬¡§≈Õ‰√¥å¢Õߪ√–™“™π„π¿“§°≈“߇¢µæ◊Èπ∑’˧«“¡√—∫º‘¥™Õ∫»Ÿπ¬åÕπ“¡—¬∑’Ë 1 °√ÿ߇∑æœ °√¡Õπ“¡—¬; 2551.

8. ”π—°ß“π ”√«® ÿ¢¿“æª√–™“™π‰∑¬ ( ∑.) ∂“∫—π«‘®—¬ “∏“√≥ ÿ¢. √“¬ß“π°“√ ”√«® ÿ¢¿“æª√–™“™π‰∑¬‚¥¬°“√µ√«®√à“ß°“¬ §√—Èß∑’Ë 1 æ.».2551 - 2552.

9. ”π—°‚¿™π“°“√ °√¡Õπ“¡—¬ °√–∑√«ß “∏“√≥ ÿ¢. √“¬ß“πº≈°“√‡ΩÑ“√–«—ß¿“«–¢“¥ “√‰Õ‚Õ¥’π ªï 2549-2552.

µ“√“ß∑’Ë 7 · ¥ß§à“ IQ ‡©≈’ˬ¢Õ߇¥Á°π—°‡√’¬π®—ßÀ«—¥ª∑ÿ¡∏“π’ ®”·π°µ“¡‡æ»·≈–Õ“¬ÿ

™“¬ 112.33 104.39 103.28 101.93 102.62 103.30 104.29 101.00 100.36 103.59

˭ԧ 104.79 105.71 104.89 102.95 106.01 105.53 100.40 99.53 98.41 107.02

‡æ»Õ“¬ÿ (ªï)

6 7 8 9 10 11 12 13 14 15

µ“√“ß∑’Ë 8 · ¥ß§à“ IQ ‡©≈’ˬ¢Õ߇¥Á°π—°‡√’¬π®—ßÀ«—¥ππ∑∫ÿ√’ ®”·π°µ“¡‡æ»·≈–Õ“¬ÿ

™“¬ 111.59 108.58 109.54 108.98 103.78 109.53 106.89 105.67 107.93 106.43

˭ԧ 106.13 110.80 107.85 109.74 105.32 112.04 111.54 113.83 110.24 110.63

‡æ»Õ“¬ÿ (ªï)

6 7 8 9 10 11 12 13 14 15

THAILAND JOURNAL OF HEALTH PROMOTION AND ENVIRONMENTAL HEALTH 117J a n u a r y - M a r c h 2 0 1 2

°“√‡ΩÑ“√–«—ß‚√§¢“¥ “√‰Õ‚Õ¥’π·∫∫∫Ÿ√≥“°“√æ◊Èπ∑’˧«“¡√—∫º‘¥™Õ∫»Ÿπ¬åÕπ“¡—¬∑’Ë Ò °√ÿ߇∑æœ

H E A L T H

10. ”π—°‚¿™π“°“√ °√¡Õπ“¡—¬. µ‘¥µ“¡§«“¡°â“«Àπâ“°“√¥”‡π‘π°“√ Ÿà‡ªÑ“À¡“¬°“√¢®—¥ “√‰Õ‚Õ¥’πÕ¬à“߬—Ë߬◊π„πª√–‡∑»‰∑¬. ”π—°æ‘¡æå Keen Media (Thailand). °√ÿ߇∑æœ;2552

11. ”π—°‚¿™π“°“√ °√¡Õπ“¡—¬. º≈√–¥—∫‰Õ‚Õ¥’π„πªí “«–À≠‘ßµ—Èߧ√√¿å ªï 2553 75 ®—ßÀ«—¥. Availablef o r m : h t t p : / / n u t r i t i o n . a n a m a i . m o p h . g o . t h / t e m p / f i l e s / _ i o d i n e /ui%2075%20®—ßÀ«—¥%20ªï%202553.pdf2003.

12. World Health Organization/ International Council for the Control of the Iodine DeficiencyDisorders/ United Nations Children Fund (WHO/ ICCIDD/ UNICEF). Assessment ofthe iodine deficiency disorders and monitoring their elimination. 3rd edition. Geneva:WHO; 2007.