Report On The Evaluation

3
Authors

$

$
$
Kriengsak Sueluerm
Sirikul Isaranurug
Jiraporn Chompikul
Pranee Suthisukon
Somchai Viripiromgool
:

3 = Report
on the evaluation of services of quality well child clinic: third round/
, $, , $, $. $ 1.
: , 2554.
-, 194 _
ISBN 978-974-11-1557-0
1. 3. -- 3.
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III. .
WS 440 768 2554

25/25 73170
$ 0 2441 9040 0 2441 9044
www.aihd.mahidol.ac.th

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__ e.. 1945 Gabriela Mistral
__
HIS NAME IS TODAY
We are guilty of many errors and many faults,
but our worse crime is abandoning the children,
neglecting the fountain of life.
Many things we need can wait.
The child cannot.
Right now is the time his bones are being formed,
his blood is being made,
and his senses are being developed.
To him we cannot answer Tomorrow,
his name is TODAY.
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Abstract
1
1.1
1.2
1.3
1.4 &
1.5 &
2
2.1
2.2
2.3 /0
2.4 &
2.5 &
2.6 &
2.7 &
2.8
3
3.1 &&&: & WCC &&
& WCC
3.2 &&
3.3 // (.) / WCC
3.4
3.5 WCC
1
1
3
3
4
5
13
13
14
17
17
17
18
18
18
19
20
104
124
133
151
171
181
183
1
1.1
2
2.1 (/)
2.2 ()
3
3.1 && &&
3.2 && WCC
3.3 && WCC &&
3.4 && WCC

3.5 &&/ WCC
/
3.6 &&&&& WCC
3.7 / WCC &&

3
3.8 &&
WCC
3.9 &&
WCC
3.10 && WCC &
3.11 && WCC
3.12 && WCC
3.13 // WCC
1 2 3
12
13
14
14
19
20
21
22
23
24
28
73
104
105
109
113
116
118
(&)
3.14 __
3.15 _ WCC
3.16 _
3
3.17 _Q_Q
3.18 _QQ
3.19 (.) ./..

Q WCC
3.20 _ . Q WCC
3.21 Q 6 Q
1 2 3
3.22 Q 6 Q
1 2 3
3.23 _Q _
3
3.24 _ _
3.25 _QQQ
3
3.26 __
3.27 _ 0-72 (Q)e
Q Q
3.28 _ 0-72 (Q)e
Q
3.29 QQQQ
4 e 2553
3.30 QQQQQ
4 e 2553
119
120
121
122
123
124
126
134
135
135
136
137
138
139
140
141
142
(&)
3.31 QQQQQ
4 e 2553
3.32 __ Q
3.33 _Q 9-24
( Denver II)
3.34 _ 3
3.35 _ 1
3 Q
3.36 _ 1 3
3.37 _ WCC
3.38 _ WCC
3.39 _ WCC
3.40 __ WCC _
1
2
3
4
_ WCC Q
__Q
_Q
_g WCC
_ WCC
143
144
146
148
149
150
169
160
161
162
183
184
185
186
(&)
5
6
7
8
9
10
11
12
187
_g WCC
__
_g WCC
188
_ WCC
_ WCC
189
_
_ WCC 190
_ WCC $
191
_ WCC 192
_ WCC
193
_ WCC
194
1
1.1 WCC
2
2.1
13
3
3.1 WCC
27
3.2 / WCC
41
( WCC )
3.3 / WCC ()
50
3.4 / WCC () 57
3.5 / WCC
79
( WCC )
3.6 / WCC ()
86
3.7 /; WCC
90
()
3.8 WCC
95
( WCC )
3.9 WCC ()
99
3.10 = WCC
103
()
3.11 ;; (.) ; WCC 132
3.12 FLOW CHART WCC ./. 152

3.13 FLOW CHART WCC .
155
3.14 FLOW CHART WCC ./..158
3.15 (WCC )
163
3.16 (Best Practices) WCC
169
3.17 / WCC
170

3.1
WCC
3.2 WCC
3.3
WCC
65
69
72

5
# 2 % 3
2552
5 6 8 2553 5 12
2554 5 2 % #
5 8 5 1)
#5 = 5
2)
output
5 55 5
55 8 5
5 3)
WCC 1 2 3
5 8
5 5
8 2-3
8
2 53 ./. 6
. 10 .. 37 45 ./. 6
. 9 .. 30
5
5 % 8
55 0-5 %
5 85 6 3-5
555 30 8 262
5 9 2 % 5 Denver II
55 5
3-5 265 85
5
55 = 5 8
5 52 5 115
5 5 5 ./. . 5 5
.. 55 41
.
5 54
= = =
= 5
5 3 5 555 5
5 5 #8
55
55 # 2 5
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5 1.1
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5 1 2 3 55
5
.. 5
5 3
1 2 3 5
5 ./. 2
5 5
(5 88.3) 55
5 (5 77.0) #
#
3 ./.. . WCC
14 WCC . ./. .
WCC 5
.
& Abstract
58 5 6 %5
2 5 5% 2553 8
5 6 262
5 24 5 29 5
5

5
5 5
15.39 5 8.29
5
5 5 29.1 5 15.39 3
5 18.9 5 8.29
= 5
5 # 5
8#5
5 . 5
5 5 #
5 5#
55
5 # 8
5 #5
Abstract
The Quality Well Child Care Clinic (WCC) Project was piloted in five provinces for two
years. The project evaluation was conducted in three rounds by an evaluation team from the
ASEAN Institute of Health Development, Mahidol University: first in May and June, 2009, six
months after the initial launch of the project, next from February to April, 2010, after one year of
implementation, and finally from January to April, 2011, after two years of operation. The
objectives of the project evaluation were: 1) to assess problems and constraints during
implementation including the involvement of village health volunteers in the project (VHV), 2) to
assess the satisfaction of health providers and caregivers in regard to the project and of the
degree to which WCC age-related activities involving childrens health and well-being had been
accomplished, 3) to assess the outcomes in regard to the nutritional status of children under five
years old, exclusive of breast feeding status and child development, and 4) to compare the
results for each round of the evaluation for participating areas with the results from control
provinces.
The five pilot provinces were ChiangRai, Lopburi, Mahasarakham, Kalasin and
Nakhonsrithammarat. The five control provinces were Lampang, Saraburi, Roi-Et, Sakolnakhon
and Suratthani. In each province, the Muang District and two or three randomly-selected
districts were selected. In each district the provincial or regional hospital and community
hospital together with two randomly-selected primary care units (PCU) were study sites. The 53
sites in the study consisted of six provincial/regional hospitals, 10 community hospitals and 37
PCUs and the 45 control sites consisted of six provincial/regional hospitals, nine community
hospitals and 30 PCUs.
The study population was composed of children under five years of age. The objectives
were to assess their nutritional status by using the yearly routine record, to assess the breast
feeding status of 262 children under six months of age by questioning child caregivers, and to
assess child development by means of the Denver II screening test. A group of 265 child
caregivers was interviewed to assess services received and the caregivers satisfaction with WCC
services as measured a structured questionnaire. Health providers (52 heads of WCC clinics and
115 staff members) and 41administrators were interviewed to assess constraints in project
implementation the satisfaction of the project; both an in-depth interview and a focus group
discussion were held. Finally, a focus group discussion was conducted with 54 VHVs to assess
their involvement in WCC activities.
The results show that problems and constraints in implementing the project still exist,
especially a shortage of staff and weak support from directors, but the magnitude of the
problems had been reduced. Fortunately, all providers and administrators had a positive
attitude towards the project because it was a cost-effective way of assuring a childs future.
Nutritional and developmental assessment were found to be more frequently and effectively
provided compared with two previous evaluations, but 22.6 % of children still did not receive
& Abstract
development screening services. Only 1.1 % of children received full and complete WCC services.
When compared with the results of the last two evaluations, the proportion of complete
nutrition assessment had increased significantly, whereas the completeness of anticipatory
guidance had decreased significantly. In regard to overall clients satisfaction, the proportion of
respondents expressing high satisfaction had increased at provincial/regional hospitals, but not
significantly; whereas others levels showed not change. The most satisfactory elements in the
service category were fees (88.3 %) because they are free of charge, and vaccinations (77 %).
This pattern was the same as that of the last two evaluations. VHVs were involved in WCC
activities only at the PCU level. Their main motivation was a spirit of volunteerism.
Only weight for age information was available to assess the nutritional status of children
under five. Unfortunately, the 2010 information was complete only for Lopburi province. The
change in nutritional status in the pilot and control areas was not significant according to
available information. The proportion of children being breast fed exclusive in the pilot areas
had increased to 29%, a significant change from the first evaluation. In the third round of the
evaluation, the rate of exclusive breast feeding did not differ significantly between the pilot and
control areas. However, the rate in the pilot area had increased since the first round, whereas
the rate in the control area had decreased. In the pilot area, 15.39% of children between nine
and 24 months were suspected of having developmental delays as compared to only 8.29 % in
the control area, a significant difference. The suspected rate for developmental delay in the pilot
area had decreased from 29.1% to 15.39 %, and the suspected delay rate in the control area had
decreased from 18.9% to 8.29 %.
Proposed key success factors are the number of staff members and their attitude,
efficient team work, strong support from directors or heads of health units, sufficient budgets,
appropriate points of service, sufficient basic and necessary equipment, efficient management,
strong policy support and strong partnership with the community and with related networks.
In order for the project to expand effectively, a national agenda on the basic rights of
children should be proposed, starting with health units that have potential and are ready in
terms of manpower, material, management, budget and partnerships; services can be gradually
increased. Periodic supervision and knowledge management are also required to exchange ideas
and experience.
( WCC ) 5
5 8 5
# 2 % 5# 3 #
5
#5 WCC 3
55 2554
WCC 3
1. #5 =
5
2. output
5 55 5 5
5 8 5
5
3. WCC 1 2 3
WCC
5 8 (.) 2
(.) 4 (.) 150 1 .
90 5 . 60 1 . 30 5 PCU 18
(.) 18 (= PCU . #
..) 54
WCC 5 PCU #
5 5= ^ WCC

Abstract
PCU WCC 53 *
./. 6 * . 10 * .. 37 *
* 7* 7 ;
* 2 *
** 2 *
* 5 @ ;
1) 7 7
0-5 @ *7;7*
2) 7* ;7* 6
3-5 * 77*7* 30 * ;
262
3) * 9 2 @ 7 Denver II
77 7
3-5 * 265
77 L 7 7
52 7 115
7* 7* 7 ./. . 7 7
.. *77 41
** 7
54
7* 7 WCC
77 ;
7*;77 ;
7 Outcomes *W
*77*7
77
;7* 1 2
3 7;; Z-test, Fisher Exact test Friedman test
7
1. L L* *L
1) L777 7 7777 *
* WCC 777 **77* *
77 ; WCC 77
77* * . *
**7 ..
2) L77 7 77
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3) L7; *;
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7* .. *7;
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4) L77 *7 *W* *W
WCC ./. . *7*W*
*
& Abstract
5) =5 5 =5
5 WCC 5
5 =5
6) =55 5 555
#
7) = =
=5 55=
2. 55 WCC
3 5 5
WCC 5555
55
5
WCC 85 55
55 5
8 55 5# 5
# WCC #5
./.. =55 5
5 #555 #
5 ./..5 WCC #
MCH Board 55
5 5
3. 55
55 5 10.9 55
./.. 5 17.7 5
5 2 5
5 55.8 55 555 #
2 ./..
5 72.8 55
5 5 22.6 5

5 12.8 55 #
5 43.4 55
= ./. 5 9.1 5
5 8 5 11
55
5 1 2
3 55
5 .. 5
5
3
4. 5
5 (5 88.3)
55 5 (5 77.0) #
#
5 ./.. 5 5 55 (5 13.4)
855 (5 14.7)
1 2 3 55
./.
5
5. .
./.. . WCC
14 WCC . ./. . .
WCC 3 #
40-49 % WCC 5
. 55 ./..
=5
. 5 5 #
5 . 5r
s #5
& Abstract
1. + 6 5
555
(% 2552) 3 %#55= 5
6 % % 2553 5
8 55 585
18 t8

555
2. -+
5 6 262
5 24 5 29 5
5
2 5
5 5
1 55 83.3
5 5-6
5 3.9 5
5 # 5
5
5
5
3.
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8.29 5
8 5
5
5 29.1 5 15.39 (5
13.8) 8

55 18.9 5 8.29
(5 10.6)
8 WCC 5
(Man)
1) 5
2)
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5)
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- (Master) 5
(Money) 8 8
(Management)
1)
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(Material)
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3) 8
& Abstract
-
1. 5 5
5 #
5 #
8 5 #5
2. 58 5#
5 WCC 5#
#8
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5. 5 8

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2.2
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2.4 +
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2.6 \
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2.11
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11.
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55.
66. 0
77. ++
.
Intervention 6 12 24
(
3 =)

++ 30
+ + + +
+
5
+ 6 +++ 33-5
+
++ 30 +
Outcomes K
2.2
+ 5
K 5 P +
+ ./. + . ++
+ PCU . (0P ..) + 1 +
54 + P 2.1
2.1 ()
=
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1
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1 . ()
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. () (p)
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1 4
. 2 () 2 (p)
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. 2 (90) (p)
5
. (30) (p)
1 . 2 () (p)
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(p)
3 . (30)
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4 . (90)
(p)
1 5 . () (p)
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. (30)
(p)
3
. (150)
(p)
4
. (90)
(p)
() =
() = 2
(p) = Primary Care Unit (PCU) N PCU

. 2 . 4 . 150 1 .
90 5 . 60 1 . 30 5 PCU 18
18 54
WCC PCU
N V

15
W WCC PCU WCC

53 ./. 6 . 10 ./PCU
37
Z 2553 N (..)
N WCC

. ()
(P)
. () (P)
. (90) (P)
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(P)
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. (30)
- (P)
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. (30) (P)
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. (30)
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16
2.3

1) 5 # outcome ()
44
0-5 # 49
4 94 6
3-5 444 30
9 -2 # 4 30
2) 44 4
3-5 /
3) 44 E 4
4) 4 4
444
4 4 3
5) 4
4 2 5 4
2.4
49 2554
4 2554
49 2554
4 9 2554
4 2554
44
2554
2.5
1) Denver II
2) 4 4
3) 4 4
4 (4)
4) E 4 444
5)
6)
7) 4 3 #

17
2.6
1) 444
2) 4 4 WCC
4.. 44
3) 9 4
4
4) 4 444
WCC
5) 49 4 44
6) 4 4
7) 4
8)
2.7 *
1) 44 WCC 4
4
2) 49449
3) 4 Outcomes
[
444
4 4
4) 94#
499 Z-test, Fisher Exact test Friedman
test 4
2.8
4
(MU-IRB 2008/416.0412)
OA. No. MU_IRB 2008/291.1301
18
WCC 3 /K 5 /

3.11 '''
:: ' WCC '' '
WCC
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32.02 D 72 D 16 D 10.9 20 D
98.1 : ( 75) (
12.8) 38.9 9.1
/
104
2
20 D 8.8 13.2 3 : :

13.96 52 2
32.5 : 0-6 WCC :
54 46 93.1 6.9
2
( 95.8 92.5 )
3.9 WCC
..
186
20 D
9.1
20-29 D
43.5
30-39 D
26.3
40-49 D
11.3
50
9.7
Mean = 32.02 , SD= 11.199 , Min= 16 Max= 72
186
2.7
97.3
6
186
73.7
2.2
14.5
3.8
0.5
4.8
0.5
52
27
13.5
36.5
23.1
17.3
9.6
18.5
33.3
33.3
7.4
7.4
10.9
41.1
26.4
12.1
9.4
52
0
100.0
52
78.8
1.9
9.6
3.8
0
1.9
3.8
27
0
100.0
27
77.8
3.7
7.4
7.4
0
3.7
0
265
1.9
98.1
265
75.0
2.3
12.8
4.2
0.4
4.2
1.1
265
105
3.9 WCC ()
186
52
3.2
1.9
37.1
30.8
36.0
51.9
16.1
3.8
6.5
7.7
1.1
3.8
186
52
44.1
28.8
13.4
13.5
5.4
23.1
/
5.4
7.7
4.8
5.8
26.9
21.2
186
52
0-6
32.3
34.6
7-12
20.4
28.8
13-18
23.7
21.2
19-24
7.0
5.8
24
16.7
9.6
Mean = 13.96 , SD= 11.08 Min= 2 Max=52
186
52
54.3
51.9
45.7
48.1
186
52
94.6
90.0
5.4
10.0
106
..
27
3.7
25.9
33.3
7.4
29.6
0.0
27
40.7
14.8
11.1
14.8
7.4
11.1
27
29.6
25.9
29.6
11.1
3.7
27
55.6
44.4
27
88.9
11.1
265
3.0
34.7
38.9
12.8
9.1
1.5
265
40.8
13.6
9.4
6.8
5.3
24.2
265
32.5
22.6
23.8
7.2
14.0
265
54.0
46.0
265
93.1
6.9
3.2.2
3.10
WCC
: 7

1 2
:
69.6 V 60
V 28.7
. ./. ./..

. ./.
./..
2 D 84
76.2 66.8
./.

..
2
<
49 77.4
72.8 . .
. ./. 2
< ./..
2 V .
./. ()

V: ( 78)
<
WCC ( 85.7) WCC
: 1 D . ./.. WCC
WCC V/
63.8 : WCC

107

E chart V
E chart ( .. .
./. )
/..
< ( 88.2) (
87.5) ( 82.6)
V
( 33) V ( 32.2)
( 34.4)
V
( 41.9) ..
46.6
: :
./.. 39.9 6
108
60.7
56.6
70.8
62.8
60.7
48.3
41.4
145
145
130
145
145
145
145
100
80.9
97.1
145
110
35
58.6
145
31
158
189
189
189
189
189
169
189
189
189
91.2
83.5
98.9
36.0
41.3
55.6
58.2
60.9
52.4
53.4
48.1
24
..
2
42
144
186
186
186
186
186
131
186
186
186
93.3
81.9
98.9
25.8
31.7
48.9
47.8
65.6
50.5
53.8
53.8
19
50
69
48
48
48
48
35
48
48
48
94.7
89.8
100
65.2
58.3
70.8
68.8
77.1
77.1
79.2
75.0
10
45
54
54
54
54
54
42
54
54
54
100.0
88.9
100.0
35.2
48.1
57.4
70.4
76.2
63.0
66.7
59.3
46
52
52
52
52
52
42
52
52
52
85.7
84.8
100
32.7
34.6
59.6
65.4
73.8
73.1
73.1
69.2
1
2
3
43
48
48
48
48
48
35
48
48
48
80.0
95.5
100
65.2
58.3
70.8
68.8
77.1
77.1
79.2
75.0
34
38
38
38
38
38
28
38
38
38
100.0 4
88.2 23
100.0 27
44.7 27
52.6 27
68.4 27
76.3 27
87.5 18
81.6 27
81.6 27
92.1 27
75.0
95.7
100
40.7
37.0
77.8
63.0
88.9
74.1
77.8
63.0
1
2
3
3.10 WCC
59
203
262
262
262
262
262
228
262
262
262
94.9
86.2
100
50.8
55.3
64.5
67.2
74.1
64.9
66.0
60.7
44
237
281
281
281
281
281
239
281
281
281
93.8
85.2
99.3
37.0
44.1
57.7
63.0
67.1
58.4
59.8
56.2
52
213
265
265
265
265
265
265
265
265
265
91.1
84.0
99.2
28.7
32.8
54.0
52.8
69.6
55.5
60.0
57.7
109
110
69.0
89.7
60.4
145
145
144
55.2
143
61.2
29.7
30.3
10.0
36.6
36.8
98
145
145
40
145
144
26.9
145
43.4
33.1
145
145
49.1
53
50.0
96
<
56.3
144

49
189
189
68
189
189
108
188
189
188
72
147
188
188
188
188
188
28.6
28.6
17.6
28.6
27.5
62.0
38.3
22.2
25.5
43.1
38.8
58.0
62.2
59.0
94.7
59.0
..
2
186
186
71
186
186
103
186
186
186
72
136
186
186
186
186
186
33.3
33.3
23.9
29.6
32.8
73.8
52.2
31.2
33.9
48.6
47.8
67.2
71.5
66.1
93.5
71.5
69
69
18
69
69
42
67
69
68
27
41
69
68
69
69
68
58.0
60.9
16.7
33.3
40.6
81.0
68.7
50.7
55.9
48.1
46.3
78.3
79.4
73.9
78.3
79.4
54
54
19
54
53
35
54
54
54
27
44
54
54
54
54
54
38.9
40.7
26.3
50.0
52.8
94.3
66.7
25.9
29.6
51.9
63.6
79.6
81.5
70.4
94.4
61.1
52
52
21
52
52
31
52
52
52
20
44
52
52
52
52
52
30.8
28.8
30.8
36.5
90.3
73.1
36.5
46.2
55.0
100
90.4
96.2
63.5
100
82.7
1
2
3
48
48
25
48
48
24
47
48
48
29
40
48
48
48
48
48
66.7
66.7
24.0
66.7
77.1
75.0
63.8
52.1
68.8
79.3
72.5
93.8
95.8
66.7
93.8
81.3
38
38
38
38
27
38
38
38
14
32
38
38
38
38
37
50.0
57.9
28.6
71.1
73.7
96.3
84.2
55.3
63.2
85.7
75.0
92.1
89.5
84.2
97.4
91.9
27
27
10
27
27
14
27
27
27
20
27
27
27
27
27
59.3
63.0
40.0
74.1
77.8
85.7
63.0
48.1
48.1
77.8
75.0
77.8
81.5
77.8
100
96.3
1
2
3
3.10 WCC ()
261
262
83
262
262
164
259
262
261
109
177
260
260
261
262
261
47.9
48.5
15.7
37.8
41.2
68.3
53.7
37.8
45.6
56.9
54.2
68.5
69.6
65.1
87.4
73.9
281
281
94
281
281
170
280
281
280
113
223
280
280
280
280
279
33.5
34.9
20.2
38.4
38.6
74.1
50.0
27.4
21.4
50.4
48.9
66.8
69.6
64.6
95.0
63.8
265
265
102
265
265
148
265
265
265
101
200
265
265
265
265
265
35.5
35.5
20.6
34.3
38.1
78.4
57.4
34.0
37.7
52.5
53.0
72.8
77.4
66.8
95.5
76.2
<
V /
/
/
WCC
19.2
31.9
25.0
0
16.0
42.1
60.5
76.4
70.6
71.1
72.2
53.5
23.5
54.7
68.8
29.9
40.6
42.7
32.1
79.7
26
94
12
12
25
38
38
144
51
128
144
144
51
139
125
144
143
143
28
138
1
n
182
139
18
189
189
80
170
145
189
188
186
189
88
170
45
34
168
11
11
28
38
76.9
38.8
61.1
68.3
47.6
28.8
64.7
67.6
33.3
43.1
40.3
75.1
84.1
67.6
66.7
29.4
39.9
18.2
18.2
28.6
57.9
..
2
n
186
143
48
186
186
69
148
62
186
186
186
186
100
156
48
38
155
16
14
26
32
84.9
39.9
33.3
79.6
48.9
29.0
71.6
72.6
44.1
33.3
29.6
79.6
86.0
78.2
79.2
36.8
46.5
31.3
7.1
19.2
50.0
3
n
64
69
69
17
62
56
69
69
67
69
33
60
21
10
45
4
4
12
19
90.6
50.0
85.5
65.2
17.6
67.7
83.9
40.6
52.2
56.7
85.5
75.8
76.7
95.2
20.0
42.2
25.0
0
33.3
89.5
48
38
54
53
24
45
38
54
54
54
54
25
43
27
12
51
3
3
9
24
83.3
71.1
50.0
83.3
49.1
54.2
73.3
81.6
44.4
40.7
46.3
90.7
84.0
74.4
85.2
33.3
41.2
0
0
11.1
83.3
52
41
10
52
52
19
40
36
52
52
52
52
27
46
12
12
46
3
2
3
17
90.4
68.3
40.0
80.8
61.5
36.8
85.0
83.3
44.2
53.8
38.5
88.5
88.9
82.6
100
25.0
41.3
0
0
33.3
82.4
1
2
3
n n n
48
48
48
18
38
31
48
48
47
48
27
33
20
4
43
4
3
5
17
91.7
66.7
91.7
72.9
66.7
65.8
83.9
45.8
60.4
63.8
97.9
96.3
93.9
90.0
25.0
58.1
0
0
0
82.4
36
30
38
38
23
34
31
38
38
38
38
13
34
17
6
32
1
1
6
15
94.4
66.7
92.1
65.8
34.8
82.4
96.8
34.2
52.6
42.1
94.7
92.3
91.2
94.1
33.3
71.9
100.0
100.0
16.7
100.0
27
20
27
27
12
19
17
27
27
27
27
17
23
10
3
21
2
1
2
9
100
50.0
33.3
88.9
55.6
50.0
84.2
64.7
22.2
51.9
40.7
92.6
100
91.3
100
33.3
52.4
100
100
100
77.8
1
2
3
n n n
3.10 WCC ()
250
37
261
261
86
239
212
261
260
257
261
111
221
79
40
182
20
19
42
74
84.8
37.8
79.3
60.2
31.4
59.8
75.0
35.6
47.3
50.2
82.8
78.4
76.0
77.2
20.0
40.7
20.0
19.0
63.5
1
n
266
207
23
281
280
127
249
214
281
280
278
281
126
247
89
52
251
15
15
43
77
80.5
48.8
56.5
74.4
50.4
34.6
68.7
74.3
35.6
43.9
41.7
80.8
84.9
72.1
77.5
30.8
44.2
20.0
20.0
23.3
74.0
2
n
265
204
61
265
265
100
207
177
265
265
265
265
144
225
70
53
222
21
17
31
58
87.5
46.6
34.4
80.8
52.1
33.0
75.4
74.0
41.9
39.2
32.2
82.6
88.2
80.4
85.7
34.0
45.9
33.3
5.9
19.4
63.8
3
n
111
3.11 7

WCC
10.9 2
./.. 17.7
55.8
./..
72.8
./.. . ./.

12.8
43.4
3 9.1
2 ./..
1.1 .
3
1 2 3

3
112
184
39.7
60.3
0
0.0287*
188
58.0
4.3
37.8
0.1242
144
43.8
56.3
0
144
53.5
4.9
41.7
P-value of 2 test
P-value of 2 test
*P-value < 0.05
P-value of 2 test
189
23.8
58.7
17.5
0.1365
145
24.1
61.4
14.5
..
186
67.2
4.3
28.5
186
53.2
46.8
0
186
15.6
70.4
14.0
68
76.5
5.9
17.6
68
57.4
42.6
0
69
29.0
65.2
5.8
54
75.9
9.3
14.8
0.1779
53
41.5
58.5
0
0.1794
54
20.4
72.2
7.4
0.8459
52
90.4
5.8
3.8
52
55.8
44.2
0
52
23.1
71.2
5.8
48
93.8
2.1
4.2
48
62.5
37.5
0
48
33.3
62.5
4.2
38
89.5
2.6
7.9
0.3171
37
70.3
29.7
0
0.5446
38
28.9
71.1
0
0.3950
27
77.8
3.7
18.5
27
74.1
25.9
0
27
22.2
77.8
0
3.11 WCC
260
66.9
4.6
28.5
260
50.8
49.2
0
262
27.1
62.6
10.3
265
17.7
71.3
10.9
280
65.7
5.0
29.3
0.4211
265
72.8
4.5
22.6
247
265
44.2
55.8
55.8
44.2
0
0
0.0317*
281
23.8
63.0
13.2
0.0801
113
114
..
1 2 3
144
186
186
12.5
10.2
12.4
86.8
89.2
87.1
0.7
0.5
0.5
0.9568
145
188
186
44.8
38.8
44.6
53.8
61.2
55.4
1.4
0
0
0.1288
133
176
186
3.8
12.5
7.5
95.5
87.5
92.5
0.8
0
0
0.0203*
130
152
186
1.5
1.2
0.5
98.5 100.0
99.5
0
0
0
0.6522
*P-value < 0.05 **P-value < 0.01
<
P-value of 2 test
<
P-value of 2 test
P-value of 2 test
P-value of 2 test
1 2 3 1 2 3
67
53
52
47
38
27
13.4
15.1
15.4
12.8
26.3
11.1
86.6
84.9
84.6
87.2
73.7
88.9
0
0
0
0
0
0
0.9444
0.1663
69
54
52
46
38
27
46.4
37.0
32.7
56.5
63.2
55.6
53.6
63.0
67.3
43.5
36.8
44.4
0
0
0
0
0
0
0.2832
0.7729
62
47
52
42
36
27
8.1
12.8
13.5
11.9
11.1
11.1
91.9
87.2
86.5
88.1
89.9
88.9
0
0
0
0
0
0
0.6079
0.9921
60
47
52
40
35
27
0
4.3
3.8
2.5
2.9
0
100
95.7 96.2 97.5
97.1
100
0
0
0
0
0
0
0.2851
0.6854
3.11 WCC ()
1 2 3
258
277
265
12.8
13.4
12.8
86.8
86.3
86.8
0.4
0.4
0.4
0.9996
260
280
265
47.3
41.8
43.4
51.9
58.2
56.6
0.8
0
0
0.1741
237
259
265
6.3
12.4
9.1
93.2
87.6
90.9
0.4
0
0
0.0655
230
234
265
1.3
2.0
1.1
98.7
98.0
98.9
0
0
0
0.6846
3.2.3
3.12 WCC
( 88.3)
( 77) (
69.1) ./..
( 87.1) ( 75.3) ( 70.4 )
. ( 94.2) (
78.8) ( 71.2) ./.
( 85.2) ( 85.2)
( 77.8) ( 77.8)
:V ./.
3.13
1 2 3 .. ./.
.
2
115
116
52.7
53.2
67.2
186
186
186
186
186
53.2
48.9
186
186
52.7
65
41.9
58.1
186
//
186
56.9
39.8
41.4
36.0
40.3
32.3
40.9
40.9
35.5
27.7
..
58.6
40.3
7.0
16.7
11.3
6.5
.8
10.2
6.5
6.5
15.4
1.1
52
52
52
52
52
52
52
52
32
55.8
53.8
55.8
65.4
71.2
64.4
63.5
55.8
68.8
42.3
38.5
36.5
34.6
28.8
34.6
34.6
42.3
25.0
1.9
7.7
7.7
-
1.9
1.9
6.3
52
50.0 48.1 1.9
27
27
27
27
27
27
27
27
22
27
66.7
51.9
70.4
70.4
77.8
77.8
44.4
51.9
59.1
25.9
33.3
18.5
25.9
18.5
14.8
44.4
33.3
22.7
7.4
14.8
11.1
3.7
3.7
7.4
11.1
14.8
18.2
44.4
51.9
3.7
3.12 WCC
265
265
265
265
265
265
265
265
119
265
55.1
44.5
55.1
57.4
69.1
55.1
54.0
57.0
60.5
55.5
38.9
40.0
34.3
37.7
30.2
37.0
40.0
36.6
26.1
43.0
6.0
14.7
10.6
4.9
.8
7.9
6.0
6.4
13.4
1.5
186
186
186
186
186
186
WCC
1.
2.
3.
4.
70.4
51.6
75.3
59.1
1.6
3.2
1.6
1.1
1.1
52
52
52
52
67.3
46.2
78.8
59.6
28.8
44.2
21.2
40.4
3.8
9.6
-
52
94.2
5.8
52
67.3 30.8 1.9
27
27
27
27
27
27
55.6
25.9
85.2
74.1
37.0
63.0
14.8
22.2
7.4
11.1
3.7
85.2
11.1
3.7
59.3
40.7
-
265
265
265
265
265
265
68.3
47.9
77.0
60.8
88.3
68.3
29.1
46.8
21.9
38.1
11.3
30.6
2.6
5.3
1.1
1.1
.4
1.1
. 121 : 65.1 186

. 20 : 38.5 52
./. 5 : 18.5 27
.. . ./. 146 : 55.1 265
28.0
45.2
23.1
39.8
..
87.1
12.9
69.9
29.0
3.12 WCC ()
117
118
P-value of 2 test
..
1 2 3 1 2 3 1 2 3
145
188
186
68
52
52
48
37
27
50.3
53.7
59.1
58.8
42.3
59.6
45.8
67.6
74.1
46.9
45.2
39.8
39.7
55.8
40.4
52.1
32.4
22.2
2.8
1.1
1.1
1.5
1.9
0
2.1
0.0
3.7
0.3788
0.3037
0.0705
1 2 3
261
277
265
51.7
53.4
60.8
46.0
45.5
38.1
2.3
1.1
1.1
0.0829
3.13 WCC 1 2 3
3.2.4 WCC
3 WCC
78.9 :
23.0 18.9 6.0
..
: :
. : :
./.: : ( 3.14)
3.14
.
.
.
(n = 186)
(n = 52)
(n = 27)
(n = 265)
WCC

4 2.2
1 1.9
1 3.7
6 2.3
14 7.5
2 7.4
16 6.0
46 24.7
12 23.1
3 11.1
61 23.0
31 16.7
13 25.0
6 22.2
50 18.9
4 2.2
5 9.6
9 3.4
7 3.8
4 7.7
4 14.8
15 5.7
148 79.6
44 84.6
17 63.0
209 78.9

119
3.2.5 < WCC

3.15 WCC
( 52 ) ( 50 )
: 3 ( 3.16)
5.
4.
3.
2.
( 40 )
-
-
-
( 50 )
- /
-
-
-
( 52 )
-
- :

( 2 )
-

6< ( 24 )
-

-
1.
3.15 WCC (n=265)
3
4
4
5
2
1
0
3
2
3
2
1
4
5
1
15
16
9
5.66
6.04
3.40
2
3
2
5
0
2
1
5
1
2
6
17
2.26
6.42
2
4
1
4
1
3
2
3
4
3
10
17
3.77
6.42
11
6
1
2
4
3
7
5
5
8
28
24
10.57
9.06
0.76
23
8.68
1
46
0
28
0
22
0
33
0
38
0.38
120
3.16 3

6<
n = 262
38
14.50
56
21.37
37
14.12
6
2.29
23
8.78
n = 281
39
13.88
39
13.88
32
11.39
4
1.42
13
4.62
n = 265
40
15.09
50
18.86
52
19.62
2
0.75
24
9.05
3.2.6 <
() :
6 D :

3 ()
( 64.5)
( 63.4) ( 3.17)
39.2
8.7 29.1
: 37 17.4
18.9 :
45.3 : 20
( 44.5) :
: ( 3.18)
121
3.17

<
1.
2.
.
(n=186)

114
61.3
.
(n=52)

33
63.5
.
(n=27)

21
77.8
(n=265)

168
63.4
28
15.1
11
21.2
22.2
45
17.0
119
64.0
34
65.4
18
66.7
171
64.5
0.5
0.0
3.7
0.8
1.6
1.9
3.7
1.9
33
17.7
11.5
7.4
41
15.5
17
9.1
9.6
14.8
26
9.8
14
7.5
1.9
22.2
24
9.1
3.
4.
5. V
6.
7.
8.
*
122
3.18
..

(n = 186)
(n = 52)
(n = 27)

<<
78
41.9
13
25.0
13
48.1
89
47.8
35
67.3
14
51.9
19
10.2
4
7.7
Plot
:
58
31.2
14
26.9
5
18.5
63
33.9
25
48.1
10
37.0
35
18.8
4
7.7
5
18.5
30
16.1
9
17.3
7
25.9
:
38
20.4
9
17.3
3
11.1
82
44.1
31
59.6
7
25.9
31
16.7
6
11.5
5
18.5
35
18.8
6
11.5
12
44.4
<<
80
43.0
19
36.5
19
70.4
50
26.9
20
38.5
4
14.8

13
7.0
4
7.7
1
3.7
43
23.1
9
17.3
3
11.1
<
(n = 265)

104
138
23
39.2
52.1
8.7
77
98
44
46
29.1
37.0
16.6
17.4
50
120
42
53
18.9
45.3
15.8
20.0
118
74
18
55
44.5
27.9
6.8
20.8
123
3.3
(.) WCC
.
WCC ./.. 5
14 2 1
. 4 WCC ./
.. 1
. . ./..
13
. WCC
13 .
36 ./.. 7 80
.
. 9 ./.. 3
. 7 ./.. 2 .
2 ./.. 1 .
WCC .
( 3.19)
3.19 (.) ./..
WCC
&
. ()
./..()
36
7
*
7
2
2
2
9
3
0
0
54
14
.
WCC 6
1. . WCC
2. . WCC
3. . WCC
4. F WCC
5. H . WCC
6. K WCC
124
3.3.1 & . WCC ( 3.21)

1) .
. WCC ./..
13
./.. 38 K
31.58 . 54 K 52 96
2 ( 4)
. 36 ( 35 1
) . 9 K
. K ( 2 ) . 7 K
6 1
2) .
. WCC 40-49 M 23
( 43) 30-39 M 21 ( 39) .
59 M 2 ( 4) 43 M
8.38 30 M 67 M
. 30-39 M
15 K . 59 M
3) .
. WCC
(.4-.6) (.1-.3) 15 14 (
28 26 ) (.1-.6) 12
( 22) . 2 4
.
. .
.

4) * . WCC
. WCC 1
17 M 1-3 M
35 ( 65) 1 M 4-6 M

125
8 7 ( 15 13 )
. 1 M
9 M 1-3 M 19
. 1-3 M .
1 M 4-6 M
. 1-9 . ./
..
3.20 . WCC
(N=54)

1
1
35
6

(>) (N=54)
30-39 M
15
2
40-49 M
12
5
50-59 M
7
0
60 M
2
0
=43 M =8.38 Min = 30 Max = 67
(N= 54)
(.1-.6)
6
2
(.1-.3)
10
2
(.4-.6)
9
3
.
4
0
.
5
0

2
0
*
WCC (>)
7
0
1 M
19
7
1-3 M
6
0
4-6 M
2
0
7- 9 M
2
0
9 M
= 2.45 M = 38.78 Min =1
126
&
0
2
0
9
0
0
2
52
03.70
96.30
1
1
0
0
3
5
1
0
0
0
0
0
21
23
8
2
38.90
42.59
14.81
03.70
0
0
2
0
0
0
4
2
1
0
2
0
0
0
0
0
0
0
12
14
15
4
7
2
22.20
25.90
27.80
07.40
13.00
03.70
0
2
0
0
0
1
7
1
0
0
0
0
0
0
0
8
35
7
2
2
14.82
64.82
12.96
03.70
03.70
Max= 17 M

3.3.2 & . WCC

. WCC
K 4
1)

2)
3) &
4) && C
6
H
K
3.3.3 . WCC
. WCC K 4
1) &
. ./..
7

. 2

2)

. ./.. 7

127

6
3) D& . ./..
.
./..
./.. . ./
.. 6

. .

8
4) &
K .
V K . ./.. 2
6
6 :
.
6:;

& . WCC K
K K
KH
WCC
128
3.3.4 &G& WCC

. F
WCC K 5
1) &* F

K . ./..
6
2) & 1
2
K . ./..
1
3) &&
K

K K . ./.. 7
4) & CI
XK X

K . ./.. 2
5) &
K K . ./.. 3
. ./.. 1 F
129
3.3.5 J . WCC
. ./.. 1 H
WCC . ./.. 11 H
WCC K 3
1) J . . ./.. 4
(1)
(2) . .
(3) .
. .
. .

2) J&& . ./.. 5
(1) / .

(2) /
(3) /
K K
(4) / V

:
.:
3) J&* . ./.. 4

(1) H
(2)
130
(3)
8 8

3.3.6 & D WCC
. WCC ./.. 3
WCC 3
1)
2)
K
3)
131
3.11 (.) WCC
!"
# '(
$
%
.
*+,! $)#
)#!
,!
-.
#
#
# !
.
2
#) ! 4 0
WCC
.
/0/
# # 3 2
'
* ! # $
% /
! .
WCC
# 8
* -+ .
#
)#$#!)
&- .
!
.
# ' #
5 % $)#!
%)#
.
132
()
$)#!
/$
# 5 % ' /$)#!
' /$)#! , #
!)6
,
'
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!"
#$ %
&'
'7
%
)# ,!
)#
/
)
7
8%. '
2
8# '(
) !6
)#
, ' '
8 !8 *+
, ' '
3.4
3.4.1
6
2

2 .
2 . (
3.21) 3
6
29 1 2 ( 3.22 )
.
( 3.24) 3.25

2
133
134
test
2
50.6
12.7
12.7
6.3
7.6
3.8
6.3
79
100
0.0530
1
56.0
14.0
16.0
4.0
2.0
0.0
8.0
50
100
2.8
11.1
36
100
8.3
19.5
3
30.6
13.9
13.8
5.7
35.8
53
100
11.3
9.4
6.4
12.8
47
100
0.2995
25.5
17.0
24.1
18.5
54
100
3.7
7.4
1
2
3
17.0 10.6 22.2
7.5 25.5 14.8
13.2 2.1 9.3
5.6
13.9
36
100
2.8
22.2
1
27.8
25.0
2.8
15.0
5.0
40
100
0.0210*
17.5
17.5
2
10.0
30.0
5.0
*P-value < 0.05 **P-value < 0.01

Chi-square test 2-7 1
P-value of
n
%
4.2
6.3
48
100
20.8
18.7
3
35.4
10.4
4.2
16.7
11.1
36
100
16.7
38.9
11.9
16.7
42
100
0.0046**
7.1
7.1
10.6
17.0
52
100
12.8
6.4
1
2
3
11.1 45.2 29.8
2.8 9.5 14.9
2.8 2.4 8.5
10.6
17.0
47
100
12.8
6.4
5.9
21.7
69
100
0.2763
8.7
15.9
11.1
13.8
72
100
12.5
0.0
1
2
3
29.8 18.8 29.2
14.9 10.1 13.9
8.5 18.8 19.5
3.21 6 1 2 3
3.22 6
1 2 3
1

46
25.1
20
10.9

8
4.4
51
27.9
29
15.8

17
9.3

12
6.6
183
100.0
2

81
29.2
45
16.2
27
9.7
34
12.3
34
12.3
21
7.6
35
277
12.6
100.0
3

76
29.0
35
13.4
26
9.8
27
10.3
48
18.4
16
6.1
34
262
P-value of
2 test
<0.001*
13.0
100.0
* P-value < 0.01 Chi-square test

1) 2)
3.23
3
P-value of the Chi-square test
1
12
83.3
8.3
8.4
-
2
88
46.6
16.0
14.7
1.1
2.3
1.1
18.2
()
3
4
17
83
29.4
21.7
11.8
15.8
11.8
10.8
17.7
12.0
11.8
16.9
12.0
17.5
10.8
<0.001*
5
10
10.0
10.0
40.0
20.0
20.0
6
51
3.9
7.8
2.0
23.6
49.0
5.9
7.8
* P-value < 0.01

Chi-Square test 1) 2)
135
1.
2.
3.
4.
5.
6.
3.24
8
11
9
2
2
0
14
11
12
2
0
0
9
17
5
3
3
0
11
10
6
2
4
1
9
3
9
1
2
0
(262 )

51
52
41
10
11
1
19.47
19.85
15.65
3.82
4.20
0.38
3
3 .

( 3.25 )
3 ( 3.26)

136
3.25
3

(n)

(36)
30.6 13.9
13.8
19.5
8.3
2.8
11.1
(36)
38.9
0
5.6
33.3
8.3
8.3
5.6
0.4577
p-value (2)
(54)
22.2 14.8
9.3
7.4
3.7
24.1
18.5
(41)
12.2
9.8
14.6
24.4
22.0
12.2
4.9
0.2066
p-value (2)
. (48)
35.4 10.4
4.2
18.7
20.8
4.2
6.3
(31)
19.0 14.3
7.1
16.7
23.8
16.7
2.4
0.1166
p-value (2)
(52) 29.8 14.9
8.5
6.4
12.8
10.6
17.0
(36)
5.6
0
2.8
47.2
25.0
11.1
8.3
0.0065*
p-value (2)
29.2 13.9
19.5
0
12.5
11.1
13.8
(72)
. (41) 30.0 13.3
3.3
13.3
13.3
16.7
10.0
0.9909
p-value (2)
chi-square test 2-7

1
p-value <0.05 Chi-square test
137
3.26
(183)
(262)
(161)
(185)
25.1
32.9
29.0
20.5
10.9
10.6
13.4
7.6
4.4
8.1
9.8
7.0
27.9
23.0
10.3
27.7
15.8
12.4
18.4
18.9
9.3
9.9
6.1
13.0
6.6
3.1
13.0
5.3
P-value
0.2873
<0.001
3.4.2 6 C

5 5
3 \ \ 2549, 2550 2551 ^

\ 2 \ (\ 2552 2553) 4
\ 2552 \ 2553 .
\ 2552 \ 2553
\ .. 2552 2553 ..
3.27 0-72 87 91
\ . \

2 \
138
.
87.3 94.5 \
( 3.28)
3.27 0-72 () \

2545
2546
2547
2552
2549
2550
2551
2552
2553
2546
2549
2550
2552
2549
2550
2551
2552
2545
2550
2551
2552
44,658
33,526
47,785
63,678
87.9
87.2
88.5
79.5
11.1
11.7
4.4
7.6
1.0
1.1
6.2
4.3
0
0
0.5
3.5
0
0
0.4
4.3
42,458
42,037
42,036
40,716
39,832
90.4
89.4
89.9
86.8
87.3
3.1
3.3
3.1
3.7
3.3
1.6
1.8
1.6
1.7
2.0
2.4
2.3
2.4
2.9
2.9
2.5
3.2
3.0
3.9
4.1
62,569
58,373
59,245
71,734
88.9
89.2
88.7
89.4
10.1
7.2
7.1
6.4
1.0
2.2
2.4
2.2
0
1.0
1.1
0.98
0
0.4
0.7
1.0
53,785
56,884
55,055
53,085
56,356
56,875
70,267
84,036
87.3
88.9
88.4
86.7
91.9
90.7
88.9
88.2
6.2
5.2
5.5
6.3
7.7
3.6
3.7
3.5
3.6
2.9
2.9
3.9
0.7
3.6
3.7
2.7
1.6
1.5
1.5
1.8
0.4
2.3
1.9
2.7
1.3
1.5
1.7
2.3
0
1.8
2.9
3.0
P-value
0.5469
0.4545
0.5641
0.3049
0.8964
139
3.28 0-72 () \

**
2545
2546
2547
36,854
33,609
2,279
93.7
94.5
89.9
6.1
5.4
4.4
0.1
0.1
3.4
0
0
1.0
0
0
1.3
*
2548
2549
2550
31,762
31,902
33,993
88.9
87.6
87.5
3.5
4.3
3.0
2.5
2.6
3.4
2.1
2.1
2.6
3.0
3.4
4.5

2549
2550
2551
82,690
70,731
76,127
87.3
87.8
87.3
5.9
5.6
5.9
3.7
3.3
3.6
1.6
1.8
1.8
1.5
1.5
1.5

2549
2550
2551
80,014
79,894
77,355
89.0
87.6
87.5
5.7
5.8
5.4
2.7
3.2
3.2
1.3
1.6
1.8
1.3
1.8
2.1

2549
2550
2551
72,440
63,536
55,498
94.2
93.7
90.7
2.0
1.9
2.9
1.2
1.2
1.6
1.5
1.4
2.1
1.1
1.8
2.7
b 0-72
\
2553 4 (- 2553) 18 b
. . ^
3.29 , 3.30 3.31

140
3.29 4
\ 2553
(n)
(37,376)
63.63
13.95
9.8
5.04
7.59
(17,566)
66.57
13.95
8.83
5.11
5.54
p-value of chi-square
<0.0001
(21,894)
66.84
11.41
7.25
6.07
8.42
(21,277)
67.94
10.02
7.43
6.44
8.17
< 0.0001
. (29,076)
71.26
11.5
8.08
4.63
4.53
(54,859)
61.28
17.14
13.45
3.64
4.49
< 0.0001
(33,326)
65.21
13.94
10.42
5.04
5.38
(56,893)
65.2
14.69
11.72
4.31
4.09
< 0.0001
65.99
12.28
8.83
5.96
6.94
(44,829)
. (20,892)
63.73
11.85
9.01
5.96
9.46
< 0.0001
141
3.30 4
\ 2553

(n)
(34,022)
57.41
12.28
19.37
3.93
7.01
(15,901)
55.52
11.53
23.8
4.02
5.13
< 0.0001
(20,512)
55.05
10.45
21.83
5.14
7.54
(20,152)
64.44
9.81
13.93
5.23
6.60
< 0.0001
. (27,100)
54.22
11.13
22.06
4.18
8.42
(48,922)
56.6
13.92
21.55
3.07
4.86
< 0.0001
(30,019)
61.08
11.25
16.38
4.68
6.61
(51,173)
60.85
11.67
19.29
3.64
4.54
< 0.0001
57.96
11.78
21.05
4.19
5.02
(41,686)
. (19,624)
51.97
12.17
26.15
4.1
5.61
< 0.0001
142
3.31 4
\ 2553
(n)
(25,678)
71.58
4.97
6.45
5.65 5.6
5.74
(12,187)
68.45
4.47
7.03
5.91 6.77
7.37
< 0.0001
(15,477)
63.61
4.57
8.04
5.96 7.32
10.49
(16,191)
69.87
3.67
6.43
6.34 6.03
7.66
< 0.0001
. (20,656)
67.62
4.9
9.35
6.1 5.88
6.15
(37,821)
69.66
6.44
9.91
4.34 4.63
5.02
< 0.0001
(23,957)
68.59
5.75
10.03 5.25 5.3
5.08
(40,846)
72.38
4.79
8.05
5.11 4.81
4.86
< 0.0001
69.45
4.12
5.86
6.24 6.82
7.51
(31,691)
. (14,217)
63.92
3.36
5.49
7.05 8.69
11.49
< 0.0001
3.4.3
9-24
2 e 2553
2554 195 181
3.32

143
3.33 1 3
3 12.0 2
15.39 ^ 8.29 ^
(p-value = 0.0341) .
(Fail) Caution 3.7
5.6 1.1
0.8

3.32
p-value
(C)
< 20
20 29
30 39
> 40
195
180
0.1766
(C)
< 20
20 29
30 39
> 40
9.74
55.38
32.82
2.05
195
10.55
48.33
35.0
6.11
181
0.0773
4.1
50.77
37.43
7.69
195
3.86
39.78
41.98
14.36
180
0.5412
93.33
6.67
191
91.67
8.33
176
0.1265
72.25
27.23
0.53
62.5
36.36
1.14
n

j b
.
144
3.32 ()
p-value

./
.
194
181
0.0052
67.52
31.96
0.52
195
75.69
20.44
3.87
180
0.8341
()
< 2,500
2,500 2,999
3,000 3,499
> 3,500
93.33
6.67
195
92.78
7.22
181
0.1623
7.18
28.72
45.13
18.97
194
7.73
38.12
41.44
12.71
180
0.1151
O 1
j
j
25.77
23.2
51.03
195
18.33
20.56
61.11
180
0.6944
63.08
36.92
195
61.11
38.89
180
0.2095
40.51
54.36
5.13
48.33
48.89
2.78
145
3.33 9-24
( Denver II)
1
3
-
-

(388)
(203)
75.8
24.2
70.9
29.1
P - value
(185)
81.1
18.9
0.019
-
97.7 97.0
98.4
-
2.3
3.0
1.6
P value (Fisher Exact test)
0.507
-
95.6 94.1
-
4.4
5.9
P - value
-
-
90.7
9.3
89.2
10.8
P - value
-
92.5
-
7.5
P - value
146
91.6
8.4
0.480
(376)
(195)
(181)
88.0
84.61
91.71
12.0
15.39
8.29
0.0341
99.2
99.0
0.8
1.0
99.45
0.55
0.6209
97.3
2.7
0.123
98.9
98.46
99.45
1.1
1.54
0.55
92.4
7.6
0.268
96.3
96.41
96.13
3.7
3.59
3.87
93.5
6.5
0.3497
0.8861
94.4
92.82
92.13
5.6
7.18
3.87
0.7998

.
( 3.34)
.
.
1 3 ( 3.35 3.36) .
.

147
148
*p-value < 0.05

NA =Not applicable
-
-
p-value (2)
-
-
p-value (2)

-
-
p-value (2)
-
-
p-value

-
-
p-value
93.0
7.0
90.7
9.3
100
0
97.7
2.3
0.7996
0.0604
NA
0.3598
94.4
5.6
100
0
100
0
100
0
94.4
5.6
83.7
16.3
0.1365
36
43
92.1
7.9
100
0
97.4
2.6
97.4
2.6
81.6
18.4
38
0.6941
0.1391
0.3301
0.3301
0.3774
94.4
5.6
94.4
5.6
100
0
100
0
88.9
11.1
36
88.9
11.1
94.4
5.6
97.2
2.8
100
0
77.8
22.2
0.0397*
1.0000
0.3120
NA
100
0
94.4
5.6
100
0
100
0
94.4
5.6
36
0.0418*
36
3.34 3
36
NA
100
0
100
0
97.2
2.8
1.000
97.2
2.8
97.2
94.4
2.8
5.6
0.5537
100
0
100
0
91.7
94.4
8.3
5.6
0.6524
36
92.9
7.1
100
0
97.6
2.4
100
0
88.1
11.9
0.7564
0.2839
0.9326
0.2839
94.6
5.4
97.3
2.7
97.3
2.7
97.3
2.7
86.5
13.5
37
0.8309
42
*p-value <0.05
-
-
p-value (2)
-
-
p-value (2)

-
-
p-value (2)
-
-
p-value (2)

-
-
p-value (2)
91.0
9.0
88.1
11.9
92.9
8.1
97.6
2.4
0.7338
0.6969
0.0753
0.9757
0.0412*
93.0
7.0
90.7
9.3
100
0
97.7
2.3
0.3108
1.0000
0.0734
0.0226*
100.0
0
87.2
12.8
100.0
0
97.4
2.6
0.9546
92.1
7.9
100
0
97.4
2.6
97.4
2.6
81.6
18.4
82.1
17.9
64.3
35.7
83.7
16.3
1 3
39
38
1 3
42
43
94.6
5.4
78.4
21.6
89.2
10.8
94.6
5.4
51.4
48.6
0.3751
0.0469*
0.1762
0.1574
0.0185*
88.9
11.1
94.4
5.6
97.2
2.8
100
0
77.8
22.2
1
3
37
36
97.2
2.8
91.9
8.1
100.0
0
97.3
2.7
75.7
24.3
1.0000
0.3201
0.3208
0.0650
97.2
2.8
97.2
2.8
100
0
100
0
91.7
8.3
1 3
37
36
3.35 1 3
93.8
6.2
97.9
2.1
89.6
10.4
97.9
2.1
79.2
20.8
0.8640
0.3449
0.1290
0.3449
0.2581
92.9
7.1
100
0
97.6
2.4
100
0
88.1
11.9
1
3
48
42
149
150
*p-value <0.05
-
-
p-value (2)
-
-
p-value (2)

-
-
p-value (2)
-
-
p-value (2)

-
-
p-value (2)
92.5
7.5
87.5
12.5
100
0
95.0
5.0
0.7391
0.0282*
0.1739
0.0367*
94.4
5.6
100
0
100
0
100
0
86.1
13.9
91.7
8.3
94.4
5.6
97.2
2.8
0.2352
0.6524
0.1498
0.3120
0.1372
94.4
5.6
94.4
5.6
100
0
100
0
88.9
11.1
75.5
25.0
77.5
22.5
94.4
5.6
1 3
36
36
1 3
40
36
100.0
0
89.2
10.8
97.3
2.7
100.0
0
86.5
13.5
0.4191
0.3208
0.2521
100
0
94.4
5.6
100
0
100
0
94.4
5.6
1
3
37
36
89.2
10.8
97.2
2.8
94.4
5.6
100.0
0
81.1
13.9
0.1776
0.5537
0.1498
0.0852
97.2
2.8
94.4
5.6
100
0
100
0
94.4
5.6
1 3
36
36
3.36 1 3
91.7
8.3
97.2
2.8
100.0
0
100
0
80.6
19.4
0.6234
0.9792
0.3208
0.3208
0.4962
94.6
5.4
97.3
2.7
97.3
2.7
97.3
2.7
86.5
13.5
1
3
36
37
3.5 WCC
WCC
WCC * 6
3.5.1
3.5.2
3.5.3
3.5.4
3.5.5
3.5.6
WCC ./. ( 3.12)

WCC . ( 3.13)
WCC ./.. ( 3.14)
WCC
(Best Practices) WCC
3.5.1 WCC ./.

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WCC
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6 120 1:6
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3.38 3.39)
3.37 WCC
WCC
M Q.D M Q.D M Q.D

3.5 1.8 3.0 1.8 4.0 1
M
3
Q.D M Q.D M Q.D Min Max

1.8 4.0 1.5 3.0 1.3 1 20
22.5 10.6 37.5 19.4 35
35
12.5 40 12.5 35 13.8
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M Median, Q.D. Quartile Deviation
159
120
3.38 WCC
WCC
WCC
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M
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160
3.39 WCC
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M Min Max M Min Max
3.0
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3.5.5 = WCC
3 WCC
f WCC 52 100%
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(3 4 Q) 3.40
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161
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51
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33
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34
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94.6
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32.4
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10
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100.0
100.0
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100
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40.4
90.4
16
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18.9
10
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70.0
5
4
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80.0
31
18
59.6
34.6
37
37
37
31
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0
100.0
83.8
10
10
10
9
0
0
100.0
90.0
5
5
5
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100.0
52
52
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45
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0
100
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17
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100.0
30
57.7
23
29
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78.4
9
9
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90.0
4
4
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80.0
36
42
69.2
80.8
24
32
64.9
86.5
10
10
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100.0
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5
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100.0
39
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+ (2549). +.
:
(2550). C 2550 Available at
http://www.saiyairakhospital.com/back-office/upload/Accessed June 18, 09.
(2544). C
2542. : .
Berk LE. (2003). Child development. Sixth Edition. Boston: Pearson Education.
Bethell C, Peck C, Schor E. (2001). Assessing health system provision of well-child care:
the promoting healthy development survey. Pediatrics; 107(5): 1084-1094.
Blumberg SJ, Halfon N, Olson LM. (2004). The national survey of early childhood health.
Pediatrics; 113: 1889-1906.
Christie A. (1941). Objectives of regular child health supervision. American Journal of
Public Health; 31697-703.
Dinkevich E, Hupert J, Moyer VA. (2001). Evidence based pediatrics: evidence based well
child
care.
BMJ;
323:
846-849.
(On
line)
available
from
http//:bmj.com/cgi/content/full/323/7317/846. Accessed August 31,2009.
Eagle PL, Black MM, Behrman JR, et al. (2007). Strategies to avoid the loss of
developmental potential in more than 200 million children in the developing
world. The Lancet; 369: 229-242.
GVO Den Haag. (1997). Growth book. Den Haag (The Nather land) : GVO Den Haag.
Grantham-Mcgregor S, Cheung YB, Cueto S, et al. (2007). Developmental potential in the
first 5 years for children in developing countries. The Lancet; 369: 60-70.
Hagan JF, Shaw JS, Duncan PM. Eds. (2008). Bright futures : guidelines for health
supervision of infants, children, and adolescents. Third edition. Elk Grove Village,
IL: American Academy of Pediatrics.
3
Jolly R. (2007). Early childhood development: the global challenge. The Lancet; 369: 8-9.
Maternal and Child Health Service Center, Japan. (No year provided). Maternal and child
health handbook (English version). Tokyo (Japan): Maternal and Child Health
Service Center.
Ministry of Public Health. (2007). Thai Health Profile 2005-2007. Available at
http://www. moph.go.th/ops/thp/ Accessed June 18, 09.
Needlman R, Toker KH, Dreyer BP, Klass P Mendelsohn AL. (2005). Effectiveness of
aprimary care intervention to support reading aloud: a multicenter evaluation.
Ambulatory Pediatrics; 5(4): 209-215.
Norlin C, Crawford MA, Bell CT, et al. (2011). Delivery of well-child care: a look inside the
door. Academic Pediatrics; 11: 18-26.
Paul H, Dworkin MD. (1989). British and American recommendation for developmental
monitoring: the role of surveillance. Pediatrics; 84(6): 1000 1006.
Pediatricabout.com (2009). Pediatric health supervision guidelines. Available at
http://pediatries. about.com/library/blhealthsupervision.htm. Accessed June 19,
2009.
Utah Department of Health. (2005). Baby Your Baby Health Keepsake. Utah (USA): Utah
Department of Health.
Walker SP, Wachs TD, Gardner JM, et al. (2007). Child development: risk factors for
adverse outcomes in developing countries. The Lancet; 369: 145-157.
WHO, UNICEF. (2009). Counsel the family on care for child development. Geneva: WHO.
182
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3

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3.7 / WCC &&

3.11 && WCC

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P-value of the Chi-square test

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chi-square test 2-7

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WCC ./. ( 3.12)

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Q.D M Q.D M Q.D Min Max

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12.5 40 12.5 35 13.8

M Median, Q.D. Quartile Deviation

M Median, Q.D. Quartile

3.5.6 (Best Practices) WCC

(Best Practices) WCC

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