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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.

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 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.

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&amp, 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&amp, E mechanisms for each policy.

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 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.

Aim The association between adiposity rebound and insulin resistance in middle childhood has seldom been studied. We examined the effect of body mass index (BMI) velocity and early adiposity rebound on the insulin resistance of prepubertal children. Methods BMI data from a longitudinal follow-up of a birth cohort in Thailand were used. The homoeostatic model assessment of insulin resistance (HOMA-IR) was calculated from 12-hour fasting plasma glucose and serum insulin at eight-and-a-half years of age. BMI velocity was calculated from four periods: zero to one, one to three, three to six and six to eight-and-a-half years of age. A multiple linear regression model was used to assess the association of BMI velocity during these four periods and insulin resistance at the age of eight-and-a-half years. Results In 814 children – 76.7% of the initial cohort – BMI velocities between years one to three, three to six and six to eight-and-a-half years were positively associated with HOMA-IR levels after adjusting for demographic, behavioural and socio-economic factors. Children who had BMI gains between three and six years had mean HOMA-IR values that were 43% higher than those who did not. Conclusion BMI velocity during early and middle childhood, and early adiposity rebound between three and six years, was associated with a higher insulin resistance risk at eight-and-a-half years.

This study aimed to investigate the patterns of children’s growth and to fit an appropriate statistical model for children’s growth in South of Thailand. The study included 1,061 children from at birth in the prospective cohort study conducted in Thepa district in Songkhla province, Thailand. Linear regression model by taking reciprocal weight gain was used to analyze the weight gain at the first year of life base on feeding types at aged 21 days, 3 months, 6 months and 12 months as breast, mixed and bottle feeding. Feeding type was significant associated with weight gain in the first years of life. Weight gain in both boys and girls fed with formula feeding at age 21 days, 6 and 12 months were significantly higher than weight gain in breast milk and mixed method. Weight gain fed with mixed methods at aged 3 months was significantly higher weight gain of breast milk and formula feeding for both boys and girls. There was statistical association between type of feeding for one year with weight and height gain at aged 1, 3, 5 and 8.5 years. The height gain of boys at aged 1, 3 and 5 years and girls at aged 3.5, and 8.5 years fed by breast milk for one year were significantly lower than height gain by breast feeding and mixed methods. Infant feeding type is significant factor for determining weight gain at first year of life. Implementation the knowledge of nutrition in infant feeding methods for mothers should be emphasized.

Objective To determine the association between the change in weight status and newly developed snoring in children. Design This was a prospective cohort study. Setting Structured interviews were conducted at participants' homes, and physical examinations were performed at The-pa Community Hospital in Southern Thailand. Participants Cohort subjects (n = 1076) were recruited from children born over a 1-year period between November 2000 and October 2001 in The-pa District of Songkhla Province, Southern Thailand. Data collection was performed when the child was 5 and 8.5 years old. Main outcome measures The child's snoring, weight, height and tonsillar size were examined. The change in weight status was categorised into four groups: not obese, became not obese, became obese and persistently obese. Results Of 1076, 983 subjects (91.4%) completed both surveys. The overall prevalence of habitual snoring decreased from 13% at age 5 to 10.9% at age 8.5 years. Of the 855 children who reported not snoring in the first survey, 61 (7.1%) had become habitual snorers. After adjusting for tonsillar size, children who had become obese or were persistently obese had a significant association with becoming a new snorer with an odds ratio of 5.8 (Confidence interval, CI, 1.3–25.8) and 11.7 (CI, 2.5–54.9), respectively. Conclusions Children with newly developed obesity at 8.5 years old were strongly associated with new snoring occurrence, which is similar to the findings of long-term follow-up studies in adults. Our findings support the idea that the patterns of changes in weight status and snoring development in adults begin as early as the primary school years.

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.

Identify the difference of the nutritional status of Thai children from birth to 24 months of age using the national and international growth charts.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.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.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.

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 (R2 = 14.2%, P

Background and purpose Night waking is common among infants and can create sleep deficit in both parents and infants. Sleep practices are influenced by cultural variations which may affect the prevalence and associated factors of frequent night waking. Our objective was to determine whether differences in parental practices related to infant sleep are associated with frequent night waking in Thai infants. Methods A cross-sectional survey based on interviews with parents of infants aged three months, birth weight greater than 2500 g, conducted under the Prospective Cohort study of Thai Children (PCTC). Results Of the total sample, 82.9% (3172 of 3826) of parents provided completed night waking information. The mean number (±standard deviation [SD]) of awakenings per night was 2.7 ± 1.1, 47.3% awoke 1–2 times per night, and 46.9% awoke 3–4 times per night. The group of frequent night wakers (more than 14 night wakings per week, n = 1634) was compared with the group of infrequent night wakers (n = 1538). Significant and independent associations were present between frequent night waking and male gender (odds ratio [OR] of 1.5; 95% confidence interval [CI], 1.3–1.8), more than three naps per day (OR, 1.3; CI, 1.1–1.5), use of a swinging or rocking cradle (OR, 1.5; CI, 1.2–1.98), falling asleep while feeding (OR, 1.3; CI, 1.1–1.5), and breastfeeding only (OR, 1.2; CI, 1.1–1.4). No significant association was noted between frequent night waking and parental age, education, occupation, household income, type of parental response to infant’s nighttime crying, or type of diaper. Conclusion An association with frequent night waking was demonstrated with various factors of parental practice related to infant sleep, such as number of naps, use of a swinging or rocking cradle, breastfeeding only, and falling asleep while feeding. Further documentation of these associations may be clinically important. Implementing preventive interventions may be able to reduce frequent night waking in early infancy.

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 (FPGResults: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) (pConclusions: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.

We performed a survey to assess the exposure to environmental tobacco smoke (ETS) in 1-year-old infants in Thailand. Of the 725 infants, it was reported that 73.3% had household smoking and 40.7% had detectable urinary cotinine. Twenty-five infants (3.4%) had urinary cotinine in the range of adult heavy smokers. The prevalence of ETS exposure was significantly higher in infants with a father whose education wasor = grade 6 than in those with father's education6 years (44.0% vs. 36.0%, p = 0.039). Data on the exposure to ETS among infants will provide prevalence information and identify population subgroups at increased risk for exposure.

Many studies have reported comparable hemoglobin response in subjects given intermittent and daily iron supplements. However, the effect of intermittent iron supplementation on impaired cognitive function, one of the serious consequences of iron deficiency among children, has not been studied. We investigated the effects of 1 d/wk (weekly) and 5 d/wk (daily) iron supplementation on changes in results of intelligence quotient (IQ), Thai language, and mathematics tests among Thai primary schoolchildren. A double-blind, randomized, placebo-controlled trial was conducted. Primary schoolchildren (n = 397) were randomly assigned to receive iron supplements daily or weekly or placebo. Ferrous sulfate (300 mg) or placebo tablets were given under direct observation by the researcher for 16 wk. Changes in IQ, and Thai language and mathematics scores were then compared. The increases in hemoglobin concentration were comparable in the weekly and daily iron supplementation groups but serum ferritin increased more in the children supplemented daily. Children receiving daily iron supplements, however, had a significantly lower increase in IQ (3 +/- 12 points) than those receiving the supplement weekly (6 +/- 12 points) or placebo (6 +/- 12 points), whereas the last-mentioned two groups did not differ. Z-scores of Thai language and mathematics test results did not differ among the groups. We conclude that weekly iron supplementation is the regimen of choice in this study community.

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.

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.To examine the prevalence rate of overweight and obesity among Thai children and adolescents between 1995 and 2012.Relevant published articles and nutrition survey reports were obtained by a systematic search through multiple electronic databases published between 1995 and 2012.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 observedA 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.

Investigate the resistance to helminths in children with an allergic family history.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.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).A family history of allergic diseases independently increases resistance to helminthic infection.

Television viewing is discouraged in infants; however its magnitude and pattern in Thailand is still unknownData on magnitude of TV viewing and viewing practices from 4,157 children in Prospective Cohort of Thai Children were obtained between 2001 and 2005.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.Most children in this cohort were exposed to TV by three years of age.

Bowel habits were assessed in 400 healthy Thai children aged 1-72 months. The study was undertaken principally because information concerning the bowel habits of children living on a non-Western diet is lacking. Ninety-four percent of the children moved their bowels at least once a day. Mean frequency of bowel actions per day was maximal in the newborn period (3.3 stools) and declined to once a day from ages of 48 to 72 months. Most infants younger than 2 months old produced running stools; however, a change in stool consistency from runny to formed was evident in most children by 4 months of age. With increasing age, children produced larger stools: mean volume of stool was 16.6 +/- 2.3 ml at 1 month of age and increased to 35.4 +/- 7.6 ml at 48-72 months. In comparison with Western children, it seems that Thai children pass larger, softer, and more frequent stools. That difference in the bowel habits between the two ethnic groups may reflect the difference in the amount of natural fiber in their diets.

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.To evaluate sleep characteristics in infants with AD.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.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.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.

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 outcomeThe 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.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 (p0.001).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.

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.

To investigate the predictive factors for early language delay (ELD) at age 2 years based on the Prospective Cohort Study of Thai children (PCTC).A prospective cohort study: secondary data retrieving.Three thousand nine hundred five children were recruited from four communities and one hospital in five areas of Thailand.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.Number of children with ELD at age of 2 years.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 weight2500 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.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).

To determine the magnitude and investigate causes of perinatal deaths of a cohort of the Prospective Cohort Study of Thai Children.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.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.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.

Infant morbidity causes a substantial resource burden, however, its magnitude and pattern in developing countries is still unknown.The authors prospectively followed a cohort of 2,739 children over a one-year period in three rural areas of Thailand to detect the hospitalized infant morbidity.The incidence of morbidity was 454.9/1,000 live births. The top five morbidities were perinatal conditions, respiratory diseases, pneumonia, infectious diarrhea, and disorders related to short gestation/ low birth weight, and had an incidence of 88.7, 35.4, 34.3, 30.3, and 23.0 diagnoses/1,000 live births, respectively. They accounted for 1,973 days (76.6%) of hospital stay Of all morbidities, 34.8% occurred in the early neonatal period and 3.1% occurred in the late neonatal period.The present study confirmed that perinatal conditions in the early neonatal period and pneumonia and diarrhea in the post neonatal period are still an important health problem. Further attempts for prevention and control will be needed.

Sleep in a supine position and in a bed separate from but proximate to adults is recommended in several Western countries to prevent Sudden Infant Death Syndrome (SIDS). Cultural differences and a lower rate of SIDS in Asian populations may affect concern with this problem and thus infant sleeping arrangements. The objective was to study bed sharing and sleep position in Thai neonates and the relationship to infant and maternal characteristics. Methods A cross-sectional survey based on interviews with parents of infants aged 21 days old was conducted under the Prospective Cohort Study of Thai Children. Of the total sample 2236/3692 (60.6%) infants shared a bed with their parents. Sixty per cent of the parents placed their infants to sleep in a supine position 32.2% on their side and 4.9% in a prone position. Bed sharing was associated with older maternal age higher education Muslim mother and with work status of professional career or unemployed. Placing the infants to sleep in a prone position was associated with infant birth weight of greater than 2500 g older maternal age higher education Buddhist mother mother with professional career and middle-class household economic status. Infant bed sharing is a common practice in the Thai culture as in other Asian countries. The prone sleep position is less common than in Western populations. The main factor associated with both bed sharing and putting infants to sleep in the prone position was a higher maternal socioeconomic status (SES) in contrast to previous studies in some Western countries in which both practices were associated with low maternal SES. Cultural differences may play an important role in these different findings. (authors)

To determine the maternal risk factors of low birthweight (LBW) in Thailand and to address the possible activities to reduce the incidence of LBW.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.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).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.

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.

D-lactic acidosis is a rare complication in children with short bowel syndrome. It results from fermentation of dietary carbohydrate by luminal bacteria in the small bowel caused by bacterial overgrowth. We present the case of a 14-year-old boy who had been diagnosed with short bowel syndrome from surgical treatment of midgut volvulus five years previously. His nutritional status was maintained by total parenteral nutrition and enteral feeding as tolerated. During hospitalization, episodic confusion and hyperpnea developed. The investigation showed severe metabolic acidosis with serum bicarbonate of 9 mmol/L and a wide anion gap. The serum D-lactic acid was 11.21 mmol/L. There was no evidence of renal or hepatic failure. Therefore, D-lactic acidosis from enteral carbohydrate overload was diagnosed. The treatment was correction of metabolic acidosis by sodium bicarbonate infusion and carbohydrate restriction. The results of the therapy were satisfactory. Early detection and appropriate treatment is necessary to avoid morbidity and mortality following this complication of short bowel syndrome.

The association between iron deficiency anaemia and cognitive function impairment has been widely reported in young children, but whether the impairment is a result of iron deficiency per se or a combination of iron deficiency and anaemia, and how these conditions interact, is still questionable. Four hundred and twenty-seven school children from two schools in socioeconomically deprived communities were selected in southern Thailand. Iron status was determined by haemoglobin and serum ferritin concentrations. Cognitive function in this study was measured by IQ test and school performance, including Thai language and mathematics scores, using z-scores based on distributions within the same grade and school. Data on demography and socioeconomic status were collected by questionnaire answered by the parents. Linear regression models were used to investigate the effect of anaemia and iron deficiency, reflected by haemoglobin and serum ferritin concentration, on cognitive function and school performance. We found that cognitive function increased with increased haemoglobin concentration in children with iron deficiency, but did not change with haemoglobin concentration in children with normal serum ferritin level. Children with iron deficiency anaemia had consistently the poorest cognitive function (IQ, 74.6 points; Thai language score, 0.3 SD below average; and mathematics score, 0.5 SD below average). Children with non-anaemic iron deficiency but with high haemoglobin levels had significantly high cognitive function (IQ, 86.5 points; Thai language score, 0.8 SD above average; and mathematics score, 1.1 SD above average). This study found a dose–response relationship between haemoglobin and cognitive function in children with iron deficiency, whereas no similar evidence was found in iron sufficient children.

Intermittent iron supplementation has been suggested as a replacement for daily iron supplements for reducing anemia in developing countries. The effects of once weekly and daily iron supplementation on hemoglobin (Hb), serum ferritin (SF), prevalence of anemia, weight and height are compared in this study. Primary schoolchildren (n = 397) from two selected schools in the Hat Yai rural area, southern Thailand, were recruited in 1999. All children received Albendazole and then randomly received ferrous sulfate (300 mg/tablet) either daily or weekly, or a placebo for 16 wk. The average increase in Hb was not significantly different between the daily (mean +/- SD; 6.5 +/- 6.0 g/L) and weekly (5.7 +/- 6.3 g/L) groups. However, the average increase in SF was greater (P < 0.01) in the daily (mean +/- SD; 39.8 +/- 30.3 microg/L) than the weekly (13.4 +/- 17.3 microg/L) group. All cases of iron deficiency anemia were abolished in both daily and weekly groups, whereas no reduction in prevalence occurred in the placebo group. Height gain was greater in children who received weekly (mean +/- SD; 2.6 +/- 0.9 cm) than in those who received daily iron (mean +/- SD; 2.3 +/- 0.8 cm), (P < 0.01). Weight gain, weight-for-age and height-for-age were not significantly different among the intervention groups. It is concluded that a weekly iron dose is more effective than a daily dose in height gain but not in hematological improvement over 16 wk of supplementation.

OBJECTIVE: To study the determinants of overweight tracking from childhood to adolescence of Hat Yai schoolchildren. DESIGN: A longitudinal study. SETTING: Primary and secondary schools of Hat Yai municipality, southern Thailand. SUBJECTS: 2252 schoolchildren recruited in 1992 and follow-up for 5 y. MEASUREMENTS: Child's annual body mass index (BMI, kg/m2) from 1992 to 1997; parental BMIs, parental income, and family history of diseases by a questionnaire completed by parents in 1992. RESULTS: Prevalence of overweight of males using the 85th percentile of the U S First National Health and Nutritional Examination Survey reference for age and sex as a cut-off point increased from 12.4% in 1992 to 21% in 1997, whereas that of females went down from 15.2 to 12.6. At the end of the fifth year, 11.8% of children remained overweight while 4.5% became overweight. Comparing to the non-overweights, the risk for becoming an overweight adolescent of an overweight boy was 8.2 (95% confidence interval (CI)=6, 11.2) whereas that of the overweight girls was 20 (95% CI=12.4, 32.3). The generalized estimating equations model predicted an increase in child BMI associated with having a father or a mother with high BMI, a family history of obesity, a monthly income greater than 5000 baht, and a lower level of exercise than their peers. Secular increase in BMI was also observed. CONCLUSION: Predictors of overweight tracking found in this study would be useful to select children at risk for preventive intervention.

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 (≥ 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.

Childhood obesity is an increasing problem in a transitional society such as Thailand. To study physical growth and puberty in obese children, a cross-sectional survey of growth and age at menarche was carried out in schoolgirls aged between 8 and 16 years old. The 3,120 girls were divided into two groups based on weight-for-height criteria. Girls with weight-for-height between 80 and 120% were classified as normal stature (2,625; 84.1%) and those more than 120% were obese (495; 15.9%). Using probit analysis, age at menarche in obese girls was 0.9 year earlier than normal stature girls (11.5 years vs 12.4 years). At age 12, obese girls were reaching menarche 2.8 times more when compared with the normal stature girls. In terms of growth pattern, obese girls were taller and grew faster during the prepubertal period, and then reached their final height earlier than the normal stature girls (13 years vs 15 years). The final height in obese girls was significantly shorter (153.0 cm and 155.0 cm, p = 0.01). We conclude that: 1) obese girls grow faster, have earlier menarche and then stop growing earlier, and 2) obese girls tend to be shorter as adults, compared with normal stature girls.

OBJECTIVE: To study the association between current or previous weight status and school performance among children and young adolescents of Hat Yai municipality, southern Thailand. DESIGN: Cross-sectional and longitudinal study SETTING: Primary and secondary schools of Hat Yai municipality, southern Thailand. SUBJECTS: 1207 grades 3–6 and 587 grades 7–9 students. MEASUREMENTS: Body mass index (BMI, kg/m2) calculated from weight and height measurement of subjects in 1992 and 1994; parental education level and occupation, and monthly income, by questionnaire performed in 1992; grade-point-average (GPA) and grades of mathematics and Thai language from the school records of final examinations in 1994. RESULTS: Overweight subjects (BMI value >85th percentile of the NHANES-I data for age and gender) in grades 7–9 had a mean GPA 0.20 point (95% confidence internal (CI)=0.04, 0.37) lower than that of the normal weight children after controlling for gender, age, school and grade. They were twice more likely to have low grades (lower than 2 on the scales of 0–4) of mathematics and Thai language than normal weight children. There were no associations between GPA or individual subject grades and previous BMI status in 1992. Children in grades 7–9 who became overweight over the two years, had a mean GPA of 0.48 point lower than those who did not become overweight (95% CI=0.12, 0.84). In grades 3–6 subjects, however, becoming overweight had no effect on GPA and individual subject scores. CONCLUSIONS: Our study showed that being overweight and becoming overweight during adolescence (grades 7–9) was associated with poor school performance, whereas such an association did not exist in children (grades 3–6).