Secular increases in weight, height and body mass index among school children of Hat Yai, Thailand: a 5 years follow-up study.

Upward trend of growth and overweight has been reported from developed countries. As Thailand has been undergoing rapid economic transition over the previous decade, we conducted an analysis to demonstrate the secular changes of growth over five years follow-up. Subjects were a cohort of 2,252 primary school children recruited in 1992 for the Hat Yai childhood obesity study. Baseline demographic and family data were collected by a questionnaire completed by parents. To quantify the cohort effect, a generalized estimating equations analysis for a cross sectional time series data was undertaken with weight, height, and body mass index (BMI, kg/m2) as a dependent variable and containing a quadratic term of age, sex, year of birth and family variables. One thousand and ninety-four (48.5%) children completed 6 anthropometric measurements. Graphs of median weight, height, BMI and overweight prevalence of each birth cohort against age showed secular increases of growth and overweight, and an age effect. For each one-year younger cohort, the median weight, median height and median BMI increased by 1.22 kg, 1.25 cm and 0.23 kg/m2, respectively. An increasing trend of childhood overweight reported here may signify a need for preventing overweight and reducing weight in childhood adolescence in the future.

Calcium and phosphate solubility curves for parenteral nutrient solutions containing Vaminolact.

Calcium and phosphate incompatibility in the total parenteral nutrient (TPN) solutions is a common problem especially in neonates. Their combinations in TPN admixture must be tested before use. We here investigated the compatibility of calcium and phosphate in TPN solutions containing a newborn amino acid product, Vaminolact. The TPN test-solutions contained 10 per cent dextrose, 1, 2, or 3 per cent Vaminolact, 4 mmole/L of magnesium sulphate and various combinations of calcium gluconate and dipotassium phosphate. Precipitations and crystallizations were inspected visually and microscopically after 24 hours standing at room temperature. Solubility curves were made by plotting the maximum concentrations of calcium and phosphate at which both were still compatible in the solution. Such curves are extremely helpful for clinicians and pharmacists to administer maximum calcium and phosphate dose for individual patient requirement.

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.

Goiter in Thai schoolchildren: study in Hat Yai, southern Thailand.

Examination for goiter was performed in 6,035 schoolchildren (2,899 girls, 3,136 boys), aged 8-17 years, from primary and secondary schools in Hat-Yai municipality, Songkhla province. Goiter was detected in 355 children (combined prevalence 6%; 232 or 8% in girls, 123 or 4% in boys). Of the 355 children with goiter, 214 (60%; 148 girls, 66 boys) participated in the study, and had blood drawn for free thyroxine (FT4), triiodothyronine (T3), thyroid stimulating hormone (TSH), and thyroid antibodies. All had urine collected for iodine excretion. The diagnoses of goiter were as follows: simple goiter in 192 (89.8%; 129 girls, 63 boys); juvenile autoimmune thyroiditis in 18 (8.4%; 16 girls, 2 boys); Graves' disease in 2 girls (0.9%); thyroid adenoma in 1 boy (0.45%), and ectopic thyroid in 1 girl (0.45%). Acquired hypothyroidism was found in 4 out of 18 children with juvenile autoimmune thyroiditis (22.2%). Iodine deficiency disorder was not evident in children examined shown by high urinary iodine excretion of more than 50 mcg/gm creatinine (mean 298, range 70-630). In conclusion, simple goiter is a common occurrence in children and adolescents in Southern Thailand. Juvenile autoimmune thyroiditis should be identified and differentiated from simple goiter as it is the most common cause of acquired hypothyroidism. Iodine deficiency is not evident in Southern Thailand, at least in the urban areas of a large city.

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)

Physical fitness of obese school children in Hat Yai, southern Thailand.

259 primary school children (average age 9.2 years) were randomly selected from three groups of children whose weights-for-height were 90-110% (normal 111), > 110-120% (over weight 25), and > 120% (obesity 123) of reference values for Bangkok children. They underwent physical fitness tests which included measurement of speed (50 meters run), flexibility (sit-reach), abdominal strength and endurance (30 seconds sit-up), vital capacity (spirometer), and indirect maximum oxygen uptake (VO2 max-submaximal bicycle ergometer). The results showed that all physical fitness tests were statistically significantly different (p < 0.05) between groups, except for flexibility in boys. But for the girls, only 50 meters run, sit-up and VO2 max showed statistically significant differences (p < 0.05). In the comparison of physical fitness tests between sexes, normal weight boys did better than girls (p < 0.05) for all tests except flexibility. There were no statistically significant differences between sexes in overweight and obese children. This study demonstrated that physical fitness of obese children was worse than that of normal children in both sexes, especially as measured by 50 meters run, sit-up and VO2 max tests. Thus, promotion of exercise in obese children should be stimulated to develop better physical fitness and weight reduction. In comparison of physical fitness between the sexes, boys had better physical fitness than girls, significant in the normal weight group only. There is no definite explanation as to why increase in weight results in no difference of physical fitness between sexes. Lifestyle, physical skills, and genetic determinants should be considered for interpretation of physical fitness.

Evaluation of village piped water: a case study in southern Thailand.

This study was conducted in a district of southern Thailand to evaluate village piped water (VPW) systems with respect to the process of planning and operation. Of 67 villages in the district, 31 were installed with one or more VPW systems using water obtained from artesian wells and distributed through the pipe with neither prior filtering nor chlorination. Seven systems were found to have stopped functioning for more than 6 months. The direct causes of failure were lack of participation from the villagers, mechanical problems and serious conflicts among the leaders. Of the running systems, only 4 were operating with meters for individual households. The charge rates were probably too low to cope with sustainable maintenance costs. The water had rust, unpleasant odors, slightly salty taste and oily surface in 50, 33, 29 and 4% of the systems respectively. Among VPW users, 8% drank water from shallow wells and 77% drank unboiled water. It was concluded that VPW in the study area was not effective for several reason. Prior assessment of management feasibility and proper community education were lacking. The running costs were probable too high, not well recognized and not covered. This led to failure in gaining participation from the villagers, which eventually led to failure or potential failure of the system and waste of capital investment. These pitfalls should be prevented prior to installation of any VPW system in the future.

Calcium and phosphate solubility curves for parenteral nutrient solutions containing aminoplasmal-paed, Aminovenos-N-pad or Moripron-F.

We investigated the calcium and phosphate compatibility in three amino acid products: Aminoplasmal-paed, Aminovenos-N-pad, Moripron-F. The final TPN sample solution contained 10 per cent dextrose, 1-3 per cent amino acids, 4 mmol/L magnesium sulphate and various combinations of calcium gluconate and dipotassium phosphate. Precipitates and crystallization were inspected visually and microscopically after 24 hrs standing at room temperature. Calcium-phosphate solubility curve were drawn. Among the three amino acid products, Moripron-F gave the highest buffer capacity. These curves are extremely helpful to predict the compatibility of a calcium-phosphate dose in the TPN solution using these three amino acid products.

Increasing obesity in school children in a transitional society and the effect of the weight control program.

Childhood obesity is an increasing problem in developed countries. Its persistence into adulthood with accompanied health risks has raised many concerns. In a country with rapid growing economy and changing life styles such as Thailand, the natural history of obesity in school children aged 6-12 years was investigated. Yearly weight and height measurements were performed from 1991 onwards. Of 1,156 primary school children enrolled in 1991, two year follow-up was possible in 1,106 cases. Prevalence of obesity, as diagnosed by weight-for-height > 120% of the Bangkok reference, rose from 12.2% in 1991 to 13.5% in 1992 and 15.6% in 1993. In two years, 74 non-obese children became obese while 28 obese children showed the opposite trend. For those obese children who attended the weight control program, their body mass indices and triceps skinfold thickness increased significantly less than those of the non-attendees in the first year. These findings persisted in the second year but were of a smaller magnitude. Results of this study demonstrate the trend of increasing obesity in school children in the transitional society and the short term benefit of a weight control program.

Breast-feeding and infant growth in the first six months.

Weight and length of 67 breast-fed infants were followed every two weeks from birth to 6 months. All infants were healthy and developed normally. Weight curves were found to be parallel to the NCHS and Bangkok curves up to 4 months then bending slightly but not statistically significant. This supports "the breast-fed infants having a different growth pattern from the mixed (breast-formula) fed" finding observed in studies from developed countries. In comparison to the NCHS and Bangkok length data, rural male infants were significantly (p less than 0.01 and 0.05 respectively) shorter from birth onwards, whereas, median lengths of the rural female infants were significantly shorter (p less than 0.01 and 0.05 respectively) after 4 months. Genetic influence on linear growth was thought to be the cause. The cautious use of the current growth curves on breast-fed infants was emphasized.

Transitional society, health status and international migration of Muslim villagers in the lower part of southern Thailand.

A survey was carried out in a Malay-speaking Muslim community in southern Thailand to obtain baseline data for planning of long term multidisciplinary research and development. By using a 30-cluster sampling technique, 210 households of 1,308 subjects were studied in the post-Ramadan period. It was found that the community was in a social transition. The crude birth rate was 4% and 37.6% of the households had at least one migrant. About half of these migrants had been to Malaysia and mainly worked in rubber plantations. Ninety-five per cent of the households had electricity whereas only 23.8% had a latrine. Boiled or rain water was regularly drunk in only 13.3 per cent of the households. Home-grown agricultural products were not sufficient to provide adequate food. Twenty-six per cent of the adults were unemployed and 24.6% were illiterate. Of the pregnancies 26.7% had no antenatal care and complete tetanus toxoid was given to only 27.8%. Traditional birth attendants conducted 81.1% of the deliveries and only 28.9 and 24.4% of the umbilical cords were correctly cut and correctly dressed, respectively. Breast feeding was still a common (87.8%) practice. However, complete immunization was given to only 10.8%, and 37.8% of the infants had at least one diarrheal episode in the previous month. It was concluded that high birth rate, high migration, low education, low income and bad health of infants are major problems. These problems were interlinked and needed a special multidisciplinary approach. In addition to common obstacles for routine health delivery, migration may create international complications, particularly related to maternal and child care.

TSH secreting pituitary adenoma in children: a case report.

The clinical presentation of TSH-secreting pituitary adenoma in an 11-year-old boy is reported. Hyperthyroidism, signs and symptoms of increased intracranial pressure with the elevation of TSH, T3, T4 were the clues for suspecting this disorder. Bilateral carotid angiogram was performed which disclosed a suprasellar mass, and pituitary surgery was performed. Electron microscopic examination confirmed the diagnosis of TSH secreting pituitary tumor.

Predictors of low birthweight delivery: a study of factors influencing birthweights.

The average birth weight among the 292 infants was 3,028 (+/- 349 g). The incidence of LWB was 8.9 per cent, being predominantly SGA. There were no significant statistical differences of socioeconomic, obstetric and anthropometric variables between the mothers of the LBW and non LBW groups. Maternal height and mid arm circumference seem to be a promising predictors of LBW delivery. The decision of the cut-off points of these variables depends on the objective and the available resources. These variables should be field-tested in a wider scale before being advocated for use as predictors of LBW delivery.

Clinical profile of diarrhoea at Ramathibodi Hospital during 1977.

Restrospective clinical profile of diarrhoeal disease in children admitted to the Pediatric Department, Ramathibodi Hospital during January to December 1977 was studied. A total of 144 medical records (55.6%) could be analysed; Rectal swab culture yielded enteropathogenic organisms in 47.2% of the cases consisting of 26.3% Salmonella, 16.0% sero typing positive E. coli and 3.5% Shigella. Clinical presentation of each group was presented which with the exception of neurological symptoms was in concordant with previous observations of several authors. Convulsion was more frequent in the Salmonella group, although dehydration and frebuency of stools were less severe. These cases seem to be highly infectious and tend to be more chronic with recurrences. It could be seen in all age group. Shigella was seen in infants 6 months old and older. Isolation of Rota-virus was not done, in none specific diarrhoeal groups (52.8%) many of which might have been due to Rota-virus. White blood count and differential count were of little value in differential diagnosis of the aetiology. Stool examination was helpful especially in Shigellosis and E. coli but there were no characteristic findings in Salmonella and non-specific groups. The overall mortality rate was 4.1%.