Comparison of Prevalence of Nutritional Status of Thai Children in the First 2 Years of Life Using National and International Growth Charts.

OBJECTIVE: Identify the difference of the nutritional status of Thai children from birth to 24 months of age using the national and international growth charts. MATERIAL AND METHOD: The analytic sample was of 4,224 children from the Prospective Cohort Study of Thai Children (PCTC). Age-specific prevalence of malnutrition was estimated using the NCHS, WHO, and Thai growth charts. RESULTS: Rapid growth faltering was found in both genders during the first two years, regardless of the reference, but the Thai charts reflected better Thai children. When using the Thai and NCHS charts, a steep fluctuation was observed in infancy, although the prevalence of wasting, underweight, and overweight between the references became narrower at 24 months. Meanwhile, the WHO standards identified a higher number of stunted children and showed a linear increasing trend of overweight with age, compared to the Thai reference. CONCLUSION: Although the Thai growth charts better reflect the Thai children, in consideration of a double burden of stunting and overweight in Thailand, the WHO standards can be used to identify Thai children at risk of stunting and overweight in the first two years of life.

Socioeconomic determinants of infant growth: The Perspective Cohort Study of Thai Children.

AIM: The present study is based on the Prospective Cohort Study of Thai Children (PCTC), and focuses on socioeconomic factors including maternal age, maternal education, living with parents, family size, family income, locality, and sex that affect the growth outcomes of infants at 1 year of age. METHODS: Data was collected among 3679 pairs of mothers and infants in the PCTC cohort in rural and urban locations during 2001-2002. Data collection was performed by interviewing mothers in their 7th to 8th month of pregnancy using family profile questionnaires. The anthropometric measures including weight, length, and head circumference of the infants were later collected at 1 year of age at home. RESULTS: The results show the effects of family socioeconomic status maternal education, living with parents, family size, family income, locality, and sex on their weight (R(2) = 14.2%, P < 0.001) and length (R(2) = 8.7%, P < 0.001) at 1 year of age. The findings suggest that maternal age, maternal education, living with parents, family size, family income, locality, and sex predict infant head circumference (R(2) = 16.8%, P < 0.001) at 1 year of age. CONCLUSION: Infants' growth, including weight, height, and head circumference, are affected by family socioeconomic status factors. It is recommended that the effect of maternal age on growth and development of children among those in the PCTC cohort is examined in the future.

Allergic family history as a protective determinant to helminthic infection.

OBJECTIVE: Investigate the resistance to helminths in children with an allergic family history. MATERIAL AND METHOD: The study was undertaken as part of the Prospective Cohort Study of Thai Children (PCTC) that followed all births in the year 2001 from rural districts in Thailand. The family histories of allergic diseases were validated by the physicians'diagnoses and medical record reviews. Fresh stool examinations were carried out at 18 to 36 months of age. RESULTS: Of 1,076 live births in the cohort, 659 children had complete information. A family history of allergy presented in 5.4% of the children. The prevalence of any helminthic infection, Ascaris lumbricoides, Trichuris trichiura, and hookworm were 25.0%, 18.2%, 9.2%, and 5.3%, respectively. The adjusted odds ratio of a family history of allergy for helminthic infection was 0.28 (95% CI, 0.08-0.95). CONCLUSION: A family history of allergic diseases independently increases resistance to helminthic infection.

Revising the WHO verbal autopsy instrument to facilitate routine cause-of-death monitoring.

OBJECTIVE: Verbal autopsy (VA) is a systematic approach for determining causes of death (CoD) in populations without routine medical certification. It has mainly been used in research contexts and involved relatively lengthy interviews. Our objective here is to describe the process used to shorten, simplify, and standardise the VA process to make it feasible for application on a larger scale such as in routine civil registration and vital statistics (CRVS) systems. METHODS: A literature review of existing VA instruments was undertaken. The World Health Organization (WHO) then facilitated an international consultation process to review experiences with existing VA instruments, including those from WHO, the Demographic Evaluation of Populations and their Health in Developing Countries (INDEPTH) Network, InterVA, and the Population Health Metrics Research Consortium (PHMRC). In an expert meeting, consideration was given to formulating a workable VA CoD list [with mapping to the International Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) CoD] and to the viability and utility of existing VA interview questions, with a view to undertaking systematic simplification. FINDINGS: A revised VA CoD list was compiled enabling mapping of all ICD-10 CoD onto 62 VA cause categories, chosen on the grounds of public health significance as well as potential for ascertainment from VA. A set of 221 indicators for inclusion in the revised VA instrument was developed on the basis of accumulated experience, with appropriate skip patterns for various population sub-groups. The duration of a VA interview was reduced by about 40% with this new approach. CONCLUSIONS: The revised VA instrument resulting from this consultation process is presented here as a means of making it available for widespread use and evaluation. It is envisaged that this will be used in conjunction with automated models for assigning CoD from VA data, rather than involving physicians.

Consistency analysis of parenting styles in Thailand during children's first year.

This descriptive study identifies and examines the consistency of parenting styles during the first year of their children's lives. The data were collected from interviewing 4088 parents or primary care takers of the 6 month old infants during the third wave of data collection of The Prospective Cohort of Thai Children project. The instrument used was the Infant Parenting Styles Questionnaire, developed by the researchers, which reflected parental responses to infant care in five different situations. After the answers were categorized into controlling, reasoning, overprotection, and neglectful parenting styles, the weighted kappa was used for the consistency analysis. The findings revealed that during the first 6 months of life, the overprotection style was the most common, followed by the reasoning style. The controlling and neglectful styles were very seldom used. The consistency of the parental styles in the same care givers using the kappa values showed that agreement between each of the styles was very low (-0.0419 to 0.0688). This suggests that parenting styles during the first year of life seem to occur in random patterns.

Sleep quality in infants with atopic dermatitis: a community-based, birth cohort study.

BACKGROUND: Sleep disturbance has been reported in both pre-school and older children with atopic dermatitis (AD). There have been no studies examining whether sleep disturbance occurs at the onset of the AD, or develops later. OBJECTIVE: To evaluate sleep characteristics in infants with AD. METHODS: A cross-sectional survey based on interviews with parents of infants aged 1 year. AD was diagnosed by showing the parents 3 pictures of typical AD. AD was considered as mild if the rash was a single occurrence or there was only 1 lesion and severe if there were 2 or 3 recurrent or persistent lesions. The infant's sleep behavior was evaluated through information on sleep onset, sleep duration, number of night wakings and the caregivers' perception of problematic sleep behaviors. RESULTS: Of the total sample, 96.2% (4085 of 4245) provided complete AD information and 148 infants (3.6%) had at least one AD skin lesion. Sleep duration was significantly reduced in infants with severe AD when compared to no-AD infants (542+67 vs 569+62 minutes, p 0.02). The percentage of infants who had night waking with parent intervention required to calm them down "often or always" was significantly higher in mild AD infants than in normal infants (61.7 vs 49.8%, p 0.02). No significant differences were noted between infants with or without AD for other infant sleep behavior. CONCLUSION: In AD patients, sleep disturbances can occur early following the onset of the disease. We suggest that clinical assessment of AD infants should take these aspects into consideration.

Effect of helminthic infections together with mite allergen exposure on the risk of wheeze in preschool children.

Although some studies have indicated that helminthic infections and house dust mite exposure may have an alleviating effect on wheeze, an interaction effect of both risk factors has not been examined in Thailand. The objective of this study was to investigate whether exposure to helminthic infections together with house dust mite allergen was associated with wheeze in children aged 18-36 months, living in an area of southem Thailand where helminthic infections are endemic. This study was undertaken as a part of The Prospective Cohort Study of Thai Children which recruited 1,076 children born between December 2000 and November 2001. A home dust sample was collected once when the infants were 12-18 months old to measure house dust mite allergen (Der p1). Questionnaire data on wheeze and a stool specimen for soil-transmitted helminth analysis were collected at age 18-36 months. Prevalence of exposure to house dust mite allergen (Der p1) > 10 microg/g dust was 31.8%. Soil-transmitted helminths were present in 25.0%, predominately Ascaris lumbricoides. Hookworm infection was associated with a physician's diagnosis of wheeze (OR 4.20, 95% CI 1.45-12.10) and hospitalized wheeze (OR 5.40, 95% Cl 1.26-23.01). Hospitalized wheeze was significantly higher in subjects exposed to Der p1 2-10 microg/g dust. Helminthic infections were not associated with a significant interaction effect with mite allergen against a risk of wheeze. Our survey confirms that hookworm infection and mite allergen exposure are independent risk factors for childhood wheeze and there is no evidence of important interaction between the two.

Prevalence and incidence of child stunting from birth to two years of life in Thai children: based on the Prospective Cohort Study of Thai Children (PCTC).

OBJECTIVE: To determine the percentages of prevalence and incidence in child stunting at birth, 6, 12, 18, and 24 months of age and to investigate the association between factors and child stunting outcome MATERIAL AND METHOD: The Prospective Cohort Study of Thai Children (PCTC) was carried out during 2000-2002, data from five districts were examined, and anthropometric measurements were performed by the physician and research assistants. WHO's growth reference standard year 2005 was used. RESULTS: Four thousand two hundred forty five children were included at the start of the present study of which 3,898 were in the final analysis. The prevalence in child stunting presented an increasing percentage at birth 6, 12, 18, and 24 months was 6.0, 6.9, 9.5, 14.6, and 16.6%, and incidence indicated decreasing at birth, 6, 12, 18, and 24 months was 6.0, 4.3, 4.1, 5.2, and 3.2% respectively. The GEE analysis showed that gender mother height, mother education, income, and Nan-Hill Tribe areas were significantly correlated with child stunting (p < 0.001). CONCLUSION: Finding from the present study indicates that to reduce child stunting in Thailand in early infant's life, early nutritional interventions and quality antenatal care are vital.

Television viewing in Thai infants and toddlers: impacts to language development and parental perceptions.

BACKGROUND: Effects of television to language development in infants and toddlers, especially in the Asian children, are inconclusive. This study aimed to (a) study time spent on television in Thai infants and toddlers (age < 2 years), (b) investigate the association between time spent on television (as recommended by the American Academy of Paediatrics (AAP), < 2 hours per day) and language development in Thai 2-year-old children, and (c) explore parental perceptions on television toward their child's development. METHODS: Two hundred and sixty children and their parents were recruited into the study. Time spent on television and parental perceptions on television viewing toward their child's development were recorded during face-to-face and telephone interviews. Language development was assessed at the age of 2 years using the Clinical Linguistic Auditory Milestone Scale (CLAMS), and parents' report. Association between delayed language development and time spent on television viewing, as well as other various parameters such as gender, maternal education and family income, were analysed using a multivariate logistic regression model. RESULTS: Most Thai infants and toddlers watched television at the age of 6 months, 1 year and 2 years old (98.0, 95.3 and 96.7%, respectively). On average, 1-year-old children watched television 1.23 +/- 1.42 hours per day. This increased to 1.69 +/- 1.56 hours per day when they were 2 years old. However, watching television longer than 2 hours per day did not associate with delayed language development. On multivariate logistic regression analysis, gender (male) was the only significant factor associated with delayed language development (OR = 6.9, 95% CI = 1.5-31.3). Moreover, 75%, 71%, and 66% of Thai parents believed that television viewing yielded benefits to children's developments. CONCLUSION: Thai children commenced watching television at an early age and the amount of television viewing time increased by age. Most parents had positive perceptions to television viewing. The study found no association between time spent on television viewing (>or= 2 hours per day) and delayed language development at the age of 2 years. Gender (male) was the only variable associated with delayed language development.

Perinatal death pattern in the four districts of Thailand: findings from the Prospective Cohort Study of Thai Children (PCTC).

OBJECTIVE: To determine the magnitude and investigate causes of perinatal deaths of a cohort of the Prospective Cohort Study of Thai Children. MATERIAL AND METHOD: A semi-structured verbal autopsy questionnaire and review of medical records were used to ascertain the causes of deaths during the perinatal period in four districts of Thailand. RESULTS: The total numbers of 3,522 babies (with 28 pairs of twins) were born from 3,494 pregnant women. The perinatal mortality rate was 10.69 per 1,000 total births, the stillbirth rate was 6.75 per 1,000 births, and the early neonatal mortality rate was 3.97 per 1,000 live-births. About 37.8% of the perinatal deaths were agreed to by two pediatricians and a neonatologist as preventable. About 90% of the preventable stillbirths occurred in the antepartum period. CONCLUSION: Findings from the present study indicates that to further reduce the perinatal death rate, attention should be focused on reducing the stillbirths by a quality antenatal care.

Prevalence and associated factors of passive smoking in Thai infants.

BACKGROUND: Passive smoking or exposure to environmental tobacco smoke (ETS) is associated with an increased risk of several respiratory illnesses for infants. OBJECTIVE: To assess the prevalence and the associated factors of ETS exposure in Thai infants. METHODS: A cross-sectional survey based on interviews with parents of infants aged 1 year old, conducted during October 2001-August 2003, under the Prospective Cohort study of Thai Children. RESULTS: A total of 3256 parents (76.7% of eligible subjects) provided the required information. The prevalences of father or mother smoking in the same room as the infants were 35.1 and 0.3% respectively. Smoking in the presence of an infant was significantly associated with paternal age of 25-34 or more than 44 years, education at or less than secondary school, and a Muslim father. CONCLUSIONS: The results suggest that ETS exposure is common in Thai infants and the main source of exposure is from a smoking father. This finding is different from other studies in Western countries where both the father and mother made substantial contributions to infant exposure to ETS. Interventions should be considered to reduce infant exposure to ETS.

A population-based cohort study of effect of maternal risk factors on low birthweight in Thailand.

OBJECTIVES: To determine the maternal risk factors of low birthweight (LBW) in Thailand and to address the possible activities to reduce the incidence of LBW. MATERIAL AND METHOD: The data were obtained from the Prospective Cohort Study in Thai Children (PCTC). Three thousand five hundred twenty two pregnancies initiated the follow-up in the year 2000 at four districts across Thailand The birthweight was retrieved from the Delivery Summary Sheet of the hospitals. The babies born in the hospital were weighed within the first day of life. The babies born at home were weighed within 3 days after birth by the research assistants. Only singleton live births were included in the present study. RESULTS: Three thousand three hundred twenty two live births with birthweight data, 8.6% were LBW. Maternal factors affecting LBW with high attributable fraction (AF) and moderate population attributable risk (PAR) were maternal extreme age (AF = 45.96, PAR = 16.24) and weight gain during pregnancy less than 10 kg. (AF = 40.12, PAR = 16.05). The factors with moderate AF and PAR were first and more than two parities (AF = 21.9, PAR = 15.51) and less consultation to health personnel (AF = 20.96, PAR = 16.98). CONCLUSIONS: Improving nutritional status of pregnant women is a potential activity to reduce the incidence of LBW. Pregnant women with extreme age, first and more than parity two and less consultation to health personnel should also be closely followed-up.

Differences in socio-economic status, service utilization, and pregnancy outcomes between teenage and adult mothers.

BACKGROUND: Teenage pregnancies put mothers at high-risks to many health-related complications and newborn infants to poor birth-outcomes. OBJECTIVE: The present study aimed to explore the relationship of socio-economic status, service utilization, and pregnancy outcomes between teenage and adult mothers. MATERIAL AND METHOD: The study design was a population-based prospective cohort study conducted in four districts located in different geographical areas of Thailand All pregnancies occurring within one year, in each of the selected districts as of October 2000, were identified and recruited as the study's cohorts. Data was collected by interviewing cohort-respondents and through reviewing medical records. RESULTS: The present study showed that teenage pregnancies accounted for 13.3% of all pregnancies in the study area. Approximately two thirds of the teenage cohort (i.e. 68.8%) were 18-19 years of age, while the remaining cohort members were 14-17 years of age (i.e. 26.1% aged 16-17 years, and 5.1% aged 14-15 years). The percentage of low-birth weights for teenage and adult mothers were 15.1% and 8.8% respectively. A higher percentage of teenage mothers enrolled in or completed secondary or higher levels of education has had more abnormal deliveries in comparison with adult mothers. In comparison with the non-teenage mothers, a greater proportion of teenage mothers had insufficient income, did not own their homes/houses, were single parents, had fewer consultations with health personnel, did not plan their pregnancy, were pregnant for the first time, and delivered infants with low-birth weights. CONCLUSION: The prevalence of teenage pregnancies in Thailand remains high. Most teenage mothers and their newborn infants are vulnerable to a variety of potentially serious health problems, and accordingly need appropriate help and support.