Nutritional problems in children aged 1-24 months: comparison of hill-tribe and Thai children.

A cross-sectional survey was conducted in Maecham district, Chiang Mai. The objective was to determine the magnitude of nutritional problems in children aged 1-24 months, both of hill-tribe and Thai communities, where breast-feeding is highly prevalent. Three hundred and fifty nine children were recruited, 252 were hill-tribe (Karen and Lahu), and 107 were Thai children. Anthropometric measurements were taken and mothers were interviewed. In a group of hill-tribe children, the prevalence of malnutrition (Z score of weight for age < -2) was 25.0 compared with 12.1 per cent for Thai children (p <0.01). The prevalence was highest in children aged between 12-24 months. This corresponded to the time children were weaned. The prevalence of stunting (Z score of height for age < -2) in hill-tribe and Thai children was 25.4 and 12.1 per cent respectively (p <0.01). There was no significant difference of wasting (Z score of weight for height < -2) between hill-tribe and Thai children, 9.1 and 8.4 per cent respectively. The mean (SD) Z scores of weight for age, weight for height, and height for age for both groups declined significantly as the age increased (p <0.001). In conclusion, this study revealed the nutritional problems of young hill-tribe children were more severe than those of Thai children. The factors that could be related with this, were socioeconomic status, as also genetics, as well as cultural beliefs concerning child raising. Such ethnic minorities therefore should be considered as special cases in programs of health and nutrition promotion.

Impacts of training of village health volunteers in reduction of morbidity from acute respiratory infections in childhood in southern Thailand.

In 1990, the Ministry of Public Health of Thailand started a five-year education program on management of cases with acute respiratory infection (ARI). The objective of this-study was to test whether such a program could reduce the average number of sick days of the target children. 30 villages in the study district were randomly allocated into 15 study and 15 control villages. A 2-day training workshop for village health volunteers from the study villages was conducted. The cohort of children age below 5 years in the two areas were followed-up for 19 week in the peak season of the disease. Among the 664 and 649 target children with 67,083 and 67,984 child-days observed in the study and the control villages, 71 and 41 children, respectively, were free from any episode. The preventive odds ratio of treatment adjusted for age and village effects = 0.88, 95% (CI 0.4-1.95). The median of the average sick periods in the individuals were 27 and 34 days, respectively. After adjusting for age, episodes/month and locality, the ratio of average sick days between children in the study and control villages was 0.89 (95% CI 0.76-1.05) or 11% shorter duration without statistical significance. The adjusted odds ratios of visiting the health center, private clinics, the community hospital and provincial hospital were 0.95 (95% CI 0.69-1.25), 1.43 (95% CI 0.98-2.11), 2.01 (95% CI 1.06-3.82) and 4.71 (95% CI 1.50-14.8), respectively. The training program thus had rather little impact on morbidity of the disease but tended to promote utilization of higher level of health services by the affected children.

Effects of piped water supply on the incidence of diarrheal diseases in children in southern Thailand.

Simple piped water supply (PWS) is increasingly popular in rural areas of southern Thailand where diarrheal diseases are quite common. The current study was carried out in 1990 in the southern part of Thailand to determine whether the use of PWS could significantly reduce the incidence rate of diarrheal diseases among the children under two years of age. A dynamic cohort study started in January 1990 in seven Muslim villages where PWS was installed for some time and there was a mixture of PWS users and non-users in each village. The cohorts comprised 126 and 137 children using and not using PWS, respectively. They were followed up weekly for one year. The crude incidence rates of diarrhea episodes for children using and not using PWS were 2.54 (SE = 0.21) and 3.52 (SE = 0.18) episodes per child-year, respectively (p < 0.01). The number of diarrheal attacks in each week was modeled as a Poisson variate using a generalized estimating equation, adjusting for correlation within the child. The analysis was carried out for each village separately and meta-analysis was used to combine these analyses. The rate ratio of PWS, adjusted for concurrent age and season, food supplement and common cold, was 0.74 (95% CI = 0.59-0.93), indicating a statistically significant reduction of one quarter. However, the proportion of users decreased with time due to management failure. It was concluded that diarrheal disease in the study area was mild but the incidence rate was high. The effect of PWS on the incidence rate of diarrhea varied with locality.(ABSTRACT TRUNCATED AT 250 WORDS)