Profiling ultra-processed foods in Thailand: sales trend, consumer expenditure and nutritional quality.

BACKGROUND: Ultra-processed foods (UPF) are associated with adverse health outcomes. This study aimed to analyse the national trends in retail sales, consumer expenditure and nutritional quality of UPFs in Thailand. METHODS: The study used data from the Euromonitor Passport database for analysis of retail sales and consumer expenditure, and from the Mintel Global New Products Database for nutritional analysis using the WHO Southeast Asian Region nutrient profile model. RESULTS: The study found the highest per capita sales volume and value of UPFs in 2021 were sauces, dressings & condiments (8.4 kg/capita) and carbonated soft drinks (27.1 L/capita), respectively. However, functional & flavoured water, ready-made meals and baked goods had the highest observed (2012-2021) and expected (2021-2026) sales growth. Supermarkets were responsible for most of the UPF sales since 2012, but convenience stores had larger growth in retail values. Growth in consumer expenditure per capita on UPFs from 2012 to 2020, ranged between 12.7% and 34%, and till 2026 is forecast to grow between 26% and 30%. More than half of UPFs exceeded at least one nutrient cutoff, 59.3% for total fats, 24.8% for saturated fats, 68.2% for total sugars and 94.3% for sodium. CONCLUSIONS: The findings suggest a need for regulatory and non-regulatory measures such as UPF taxation and marketing restrictions, and market incentives for producing non-UPFs. A system for regularly monitoring and evaluating healthiness (both nutritional and processing aspects) of food products, especially UPFs, is required.

Choosing an effective food classification system for promoting healthy diets in Thailand: a comparative evaluation of three nutrient profiling-based food classification systems (government, WHO, and Healthier Choice Logo) and a food-processing-based food classification system (NOVA).

Introduction: This study aimed to assess the nutritional quality of food and beverage products in Thailand by comparing four different food classification systems: the nutrient profiling-based food classification systems by the Department of Health (DOH), the WHO South-East Asia Region (WHO SEA), the Healthier Choice Logo (HCL), and the food-processing-based food classification system, NOVA. Methods: This study used secondary data from the Mintel Global New Products Database (N = 17,414). Food subgroups were classified differently based on these four systems. The DOH classified food products into three groups: Group A-healthy pass or meeting standard, Group B-not meeting the standard, and Group C-far below standard. The WHO SEA classified food products into two groups: marketing prohibited products and marketing permitted products. The HCL classified food products into two groups: eligible products for the logo; and ineligible products for the logo. The NOVA classified food products into four groups: unprocessed or minimally processed foods (MP), processed culinary ingredients (PCI), processed foods (P), and ultra-processed foods (UPF). Descriptive statistics (percentage and frequency) were used for analysis. Agreement analysis was conducted using Cohen's kappa statistic between each pair of food classification systems. Results: Of the total sample that could be classified by any of the four classification systems (n = 10,486), the DOH, the WHO SEA and the HCL systems classified products as healthy (Group A, marketing permitted or eligible for HCL logo) at 10.4, 11.1, and 10.9%, respectively. Only 5.6% were classified as minimally processed foods using NOVA and 83.1% were ultra-processed foods (UPFs). Over 50% of products classified as healthy by the nutrient profiling systems were classified as UPF according to the NOVA system. Products that were eligible for the HCL had the highest proportion of UPF products (84.4%), followed by the Group A products (69.2%) and the WHO marketing-permitted products (65.0%). Conclusion: A hybrid food classification approach taking both nutrients and food processing into account is needed to comprehensively assess the nutritional quality of food and beverage products in Thailand.

Body-Fat-Percentile Curves for Thai Children and Adolescents.

This study aimed to generate sex-specific percentile curves for the percentage of body fat (PBF) in Thai children using a bioelectrical impedance analysis (BIA). The secondary objective of this study was to determine the association between body fat and other anthropometric measurements. A cross-sectional study was conducted on 3455 Thai school children aged 6-18 years. The body-fat contents were measured using BIA. Smoothed percentile curves of PBF were derived using a scatter plot with a smooth curve fitted by the Loess method. The correlations between the body fat and the anthropometric measurements were assessed using the Spearman's rank correlation. The 50th and lower body-fat-percentile curves of the boys slowly increased until age 12, after which they slightly decreased until age 15 and then slightly increased until age 18. In the higher boys' percentiles, the body fat sharply increased until age 11 and then decreased until age 18. In the girls, the PBF percentiles increased steadily from 6 to 18 years. The body-mass index was strongly correlated with PBF and fat mass in both sexes. The waist-to-height ratios showed strong correlations with PBF and fat mass in the boys but were moderate in the girls. The use of PBF percentile curves can be an additional metric for the evaluation of obesity in Thai children.

Coexisting Iron Deficiency Anemia and Thalassemia Traits in Infants: Implication for an Anemia Screening Program.

OBJECTIVES: To study the prevalence of anemia among healthy infants, and outcomes of giving a therapeutic trial of iron to anemic infants in thalassemia-endemic area. METHODS: A cross sectional study was conducted in 6-9-month-old, full-term healthy infants who attended the well child clinics at 2 tertiary care centers in southern Thailand. Complete blood count and serum ferritin were performed in every infant, and hemoglobin typing was performed only in anemic cases. All anemic infants were given a therapeutic trial of iron and categorized into either; iron responder (hemoglobin increased ≥ 1 g/dL) or iron non-responder (hemoglobin increased <1 g/dL) groups after one month of the therapeutic trial. Mean levels of hematological parameters, including the Mentzer index, were compared within the groups. RESULTS: A total of 620 infants were included in the study. From this, 230 infants (37%) were anemic for which iron deficiency contributed for 80% of the etiology. The iron responder group showed significant improvement in hematological parameters after a trial of iron, while there was no improvement in the iron non-responder group. Among iron responders, there were 31 out of 186 infants (16.6%) who had coexisting abnormal hemoglobin typing, and their post-treatment complete blood count still showed a mean corpuscular volume < 70, with a Mentzer index < 13. CONCLUSION: Iron deficiency remains a major cause of anemia among infants, and a therapeutic trial of iron is beneficial in this age group, even though thalassemia trait/hemoglobinopathy can co-exist.

A Bayesian approach to combining multiple information sources: Estimating and forecasting childhood obesity in Thailand.

We estimate and forecast childhood obesity by age, sex, region, and urban-rural residence in Thailand, using a Bayesian approach to combining multiple source of information. Our main sources of information are survey data and administrative data, but we also make use of informative prior distributions based on international estimates of obesity trends and on expectations about smoothness. Although the final model is complex, the difficulty of building and understanding the model is reduced by the fact that it is composed of many smaller submodels. For instance, the submodel describing trends in prevalences is specified separately from the submodels describing errors in the data sources. None of our Thai data sources has more than 7 time points. However, by combining multiple data sources, we are able to fit relatively complicated time series models. Our results suggest that obesity prevalence has recently starting rising quickly among Thai teenagers throughout the country, but has been stable among children under 5 years old.

Progress towards Achieving the Recommendations of the Commission on Ending Childhood Obesity: A Comprehensive Review and Analysis of Current Policies, Actions and Implementation Gaps in Thailand.

Despite a significant commitment to tackling childhood overweight and obesity, questions remain about the progress the Thai Government has made in implementing childhood obesity prevention policies and actions. This study aimed to review and assess the implementation of the government's policies and actions for childhood obesity prevention in Thailand compared with the recommendations of the Commission on Ending Childhood Obesity and to identify the implementation gaps. Policy data were collected from governmental and NGO websites and publications and via direct contact with government officials. Stakeholder meetings were held to seek further information and advice on implementation gaps and to give recommendations. The analysis of each policy was conducted against pre-determined criteria formulated from literature assessments and stakeholder consultations. The policies and actions that were implemented by the Government were consistent with 33 broad policy actions and 55 specific policy actions. Preconception and pregnancy care was the policy area that was most implemented. Six broad policy actions were assessed as 'high' performance, these were: sugar-sweetened beverage taxation, nutrient labeling, nutrition guidance for preconception and pregnancy care, the International Code of Marketing of Breast-milk Substitutes, regulatory measures for supporting maternal breastfeeding, and regulations on the marketing of complementary foods and beverages. Policy coherence and monitoring and evaluation (M&E) were identified as major implementation gaps. Increasing the effectiveness of childhood obesity prevention in Thailand will require national immediate attention towards building infrastructure to enhance coherence among the policies and to put in place M&E mechanisms for each policy.

Determinants of Lung Function at Age 8.5 Years in a Birth Cohort of Thai Children.

BACKGROUND AND AIMS: Early life factors have reported the associations with impaired lung function in later life. In the present study, the birth cohort was followed up longitudinally to investigate the determinants of lung function in Thai children. METHODS: Cohort subjects were recruited from children born in Songkhla Province in southern Thailand. Data collections were obtained starting from antenatal, at birth, and at 1, 5 and 8.5 years of age. Spirometry was assessed at age 8.5 years. The variables investigated included birth weight, smoke exposure, respiratory diseases during the newborn period and during the first year of life, and asthma diagnosed at age 5 or 8.5 years. RESULTS: Of 1056 subjects, 892 (84.5%) subjects completed the spirometric measurements. The presence of asthma was the only factor that was significantly associated with a lower forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) ratio, forced expiratory flow at 25-75% vital capacity (FEF25-75%VC) and peak expiratory flow rate (PEFR). The regression analysis found that asthma was significantly associated with a lower FEV1/FVC ratio, FEF25-75%VC, and PEFR value with estimated coefficients ± standard error of -1.27 ± 0.55%, p = 0.02; -131.8 ± 48.2 ml/s, p = 0.006; and -166.2 ± 65.0 ml/s, p = 0.01, respectively. Asthma diagnosed at age 5 or 8.5 years was more likely among children who had lower respiratory tract illness during the first year of life. The odds ratio for the association was 4.81 (95% confidence interval 2.14-10.83, p < 0.001). CONCLUSION: The main factor associated with lower lung function in Thai cohort subjects was the present of asthma by age 5 or 8.5 years and early respiratory illness was the risk factor for asthma in childhood period.

Progression from impaired glucose tolerance to type 2 diabetes in obese children and adolescents: a 3-6-year cohort study in southern Thailand.

BACKGROUND: Childhood obesity is associated with abnormal glucose metabolism and type 2 diabetes mellitus (T2DM). This study evaluated the prevalence of abnormal glucose metabolism in asymptomatic obese children and adolescents, and determined the percentage of T2DM development after 3-6 years of follow-up. METHODS: During 2007-2013, 177 obese children and adolescents who had normal fasting plasma glucose (FPG<100 mg/dL) were given an oral glucose tolerance test (OGTT). The participants were classified into four groups: normal glucose tolerance (NGT), NGT-hyperinsulinemia (NGT-HI), impaired glucose tolerance (IGT), and diabetes mellitus (DM). Blood chemistries, including FPG, glycated hemoglobin, and lipid profiles, and liver function test were performed every 6-12 months or when the patient developed any symptom or sign indicative of diabetes. RESULTS: Glucose metabolism alterations were detected in 81.4% of the participants: 63.8% with NGT-HI, 15.3% with IGT, and 2.3% with T2DM. The median levels of homeostasis model assessment-insulin resistance (HOMA-IR) in patients with IGT (8.63) were significantly greater than those in the patients with NGT (4.04) (p<0.01). During the follow-up, 22 patients (14.4%) developed T2DM significantly more from the IGT group (nine of 33 cases, 27.3%) than the NGT-HI group (12 of 108 cases, 11.1%) (p=0.022). The predicting parameters for T2DM conversion were weight status, body mass index (BMI), FBG, fasting insulin, alanine transaminase (ALT) levels, and HOMA-IR. CONCLUSIONS: Glucose metabolism alteration was commonly found among obese adolescents. Factors associated with T2DM development were greater weight status and the severity of insulin resistance as shown by higher HOMA-IR levels.

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.

Computer Game Use and Television Viewing Increased Risk for Overweight among Low Activity Girls: Fourth Thai National Health Examination Survey 2008-2009.

Studies of the relationship between sedentary behaviors and overweight among children and adolescents show mixed results. The fourth Thai National Health Examination Survey data collected between 2008 and 2009 were used to explore this association in 5,999 children aged 6 to 14 years. The prevalence of overweight defined by the age- and gender-specific body mass index cut-points of the International Obesity Task Force was 16%. Using multiple logistic regression, computer game use for more than 1 hour a day was found to be associated with an increased risk of overweight (adjusted odds ratio (AOR) = 1.4; 95% confidence interval: 1.02-1.93). The effect of computer game use and TV viewing on the risk for overweight was significantly pronounced among girls who spent ≤3 days/week in 60 minutes of moderate-intensity physical activity (AOR = 1.99 and 1.72, resp.). On the contrary, these sedentary behaviors did not exert significant risk for overweight among boys. The moderating effect on risk of overweight by physical inactivity and media use should be taken into consideration in designing the interventions for overweight control in children and adolescents. Tracking societal changes is essential for identification of potential areas for targeted interventions.

Prevalence of childhood and adolescent obesity in Thailand: a review.

BACKGROUND: Obesity in children and adolescents is a major public health problem in many countries including Thailand However the use of different growth references applied to the data could contribute to the difference in magnitude of problem. OBJECTIVE: To examine the prevalence rate of overweight and obesity among Thai children and adolescents between 1995 and 2012. MATERIAL AND METHOD: Relevant published articles and nutrition survey reports were obtained by a systematic search through multiple electronic databases published between 1995 and 2012. RESULTS: Of 627 published articles and reports retrieved, six national surveys were examined for the trend of childhood obesity. With the use of Thai growth references, the trends of obesity among preschool, school-age children, and adolescents were found to fluctuate between 1995 and 2009. This might be due to the difference in age categorization and use of dissimilar growth references. The use of the 2000 International Obesity Task Force (IOTF) reference provided a lower estimate of prevalence of obesity when compared to that from Thai growth reference. However similar fluctuating pattern and trends were observed CONCLUSION: A standard protocol using a single set of child growth standard, similar age categorization, obesity indices, and cut-points for defining high-risk children should be applied to track trend of childhood obesity effectively.

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.

Effect of television viewing on social-emotional competence of young Thai children.

Exposure time, program content and cultural context may affect the impact of television (TV) on the social-emotional competence (SEC) of children. This study examined the effects of TV viewing on the SEC of Thai infants. The study was based on a Thai birth cohort study from which duration and content of TV viewing and data from the Modified Infant-Toddler Social and Emotional Assessment instrument at 1 and 3 years of age were available. Generalized estimating equations were used to examine whether scores below the 10th national percentile were associated with TV viewing duration. The relationship between viewing duration and SEC risk was quadratic rather than linear. Viewing duration of 30-120 min/day was associated with a decreased risk of low overall SEC compared to non-viewers after adjustments for confounding factors. However, the beneficial effect diminished when the duration exceeded 120 min/day. Viewing educational programs was associated with a risk reduction of having low overall SEC compared to non-educational programs. These results suggest that a short period of TV viewing may be beneficial for the SEC of Thai infants, especially if the programs are educational.

Duration and practices of television viewing in Thai infants and toddlers.

BACKGROUND: Television viewing is discouraged in infants; however its magnitude and pattern in Thailand is still unknown MATERIAL AND METHOD: Data on magnitude of TV viewing and viewing practices from 4,157 children in Prospective Cohort of Thai Children were obtained between 2001 and 2005. RESULTS: At 1, 2, 2.5, and 3 years of age, the percentage of children watching TV was 77%, 90%, 92%, and 95%, respectively. Viewing duration also increased with age from 10 minutes/day at 1 year to 60 minutes/day at 3 years. Bangkok children spent double the screen time than children in other provinces. The most popular programs were cartoons and entertainment while 4% to 7% watched children programs. CONCLUSION: Most children in this cohort were exposed to TV by three years of age.

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.

Early language delay and predictive factors in children aged 2 years.

OBJECTIVE: To investigate the predictive factors for early language delay (ELD) at age 2 years based on the Prospective Cohort Study of Thai children (PCTC). STUDY DESIGN: A prospective cohort study: secondary data retrieving. SUBJECTS: Three thousand nine hundred five children were recruited from four communities and one hospital in five areas of Thailand. MATERIAL AND METHOD: The Language Development Survey (LDS) was performed to identify children with early language delay (ELD) at age 2 years. Logistic regression analysis was used to investigate the association between possible factors (both biological and environment factors) and ELD. MAIN OUTCOME MEASURE: Number of children with ELD at age of 2 years. RESULTS: The incidence of ELD at age 2 years was 11.68%. Risk factors for ELD were birth weight (Odds Ratio: OR = 2.38, 95% Confidence interval: CI 1.65-3.42), male gender (OR = 2.12, 95% Confidence interval: CI 1.67-2.69), 3rd-4th and 5th child born or more (OR = 1.42, 95% CI = 1.02-1.96; OR = 1.88, 95% CI = 1.08-3.27, respectively), birth weight <2500 grams (OR = 2.38, 95% CI = 1.65-3.42), no first word within 1 year (OR = 2.25, 95% CI = 1.79-2.84), no walking within 1 year (OR = 1.34, 95% CI = 1.05-1.72), and maternal occupation (laborer or none) (OR = 1.36, 95% CI = 1.01-1.82). District living was a protective factor for ELD (OR = 0.42, 95% CI = 0.32- 0.54). There was no clear evidence for a link between breastfeeding and ELD. CONCLUSION: Significant factors identified here raise strong concerns that should be addressed clinically when counseling families and planning treatment. Further study using a longer longitudinal design and more detailed information is recommended to better determine predictive factors for ELD or specific language impairment (SLI).

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.