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.

Emotional development and nutritional status of HIV/AIDS orphaned children aged 6-12 years old in Thailand.

OBJECTIVE: To explore the emotional development and nutritional status of HIV/AIDS orphans by their infection status. METHODS: A community-based cross-sectional survey was conducted during January and December 2005 in four provinces and Bangkok Metropolis where the prevalence of HIV/AIDS among pregnant women was high. The study population consisted of 388 HIV/AIDS orphans who were maternal or paternal or double orphans aged 6-12 years old. The orphans' main caregivers gave informed consent to the project and assessed the emotional development of their orphaned children. The children were measured for weight, height, and emotional development by standard instruments. They were divided into three groups regarding their HIV/AIDS infection status reported by their caregivers: infected, non-infected, and unknown. The chi(2) test was used to determine the association between nutritional status and infection status. RESULTS: Regarding HIV/AIDS infected children, 19.1% were infected, 57.5% were not infected, and 23.4% were unknown. The main caregivers of all types of orphans were grandparents. Only 13.7% of infected orphans lived with their mothers. Most caregivers were females and more than 40 years old. Infected orphans had mean scores of overall emotional development and for each domain less than other groups. The mean scores of self-control and quick recovery were significantly different between infected and non-infected groups (P-value < 0.05). Nearly 50% of infected orphans were rather short and approximately 42% were under weight and light. The findings revealed a significant association between height for age, weight for age and infection status of orphans at a P-value of <0.001. CONCLUSIONS: Orphanhood itself is a vulnerable status and HIV/AIDS infected orphans are most vulnerable. Acceptable and friendly services for orphans and their families are crucial. The services should continue and protect stigmatization.

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.

Implications of family protective-risk index for screening cognitive development of children aged 13-15 years.

BACKGROUND: A simple screening tool is essential for priority setting and operating activities in communities. OBJECTIVE: The present study aimed to identify the implications of a family protective-risk index (FPRI) for screening cognitive development of children aged 13-15 years. MATERIAL AND METHOD: The cross-sectional survey among 319 children aged 13-15 years old was conducted in one district. The cognitive development was measured by TONI version 3. Studied family factors consisted of parents' education, parents' occupation, sufficiency of family income, family relationships, stressful life events in the family, family type, and quality of child care. The protective characteristic of each factor was given one point and the risk was given zero point. FPRI was constructed in three models. The FPRI 1 was the cumulative effects of nine family factors mentioned above. The FPRI 2 was the cumulative effects of seven family factors that were significantly associated with cognitive development in the present study by Chi-square test: parents' education, parents' occupation, family relationship, stressful life events and family type. The FPRI 3 was constructed from 4 family factors that were significantly associated with cognitive development by logistic regression analysis: mother's education, mother's occupation, family relationship and stressful life events. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were applied to identify the optimal cut off point of prediction. RESULTS: The present results showed that 52% of the sample had an intellectual level lower than 90. The FPRI 1 at 6 or 7 scores and the FPRI 2 at 4 or 5 scores yielded the same phenomena, high sensitivity but moderate specificity, PPV and NPV The FPRI 3 at 2 scores gave high PPV and moderate for the rest. The FPRI 3 at 3 scores gave high sensitivity and NPV moderate PPV and low specificity. Among three indices, the FPRI 3 was found to be the best index as its Receiver Operating Characteristic (ROC) curve was furthest into the top left corner. CONCLUSION: The FPRI 3 at 3 scores can be used as a preliminary screening tool for health personnel to identity families at risk of having children with slow cognitive development and then, provide urgent support and help.

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.

Factors influencing development of children aged one to under six years old.

The present study aimed at analysing factors influencing the development of children aged one to under six years in four provinces across Thailand. Two sub-districts or communities were selected from each province. The population covered in the present study were 193 children aged one to under three years and 251 children aged three to under six years, and their main caregivers. The data was collected from April to September 2000. Denver II test kit was used to test the child development and a questionnaire was used to collect family and child factors. The results of analysis using Logistic Regression found that risk factors for lower child development among children aged one to under three years were father's education at the primary school level or lower (OR = 3.0 , 95%CI = 1.14, 7.9) and not having good household environments (OR = 2.9, 95%CI = 1.28, 6.8). The risk factors for lower development among children aged three to under six years were father's education at the primary school level or lower (OR = 3.57, 95% CI = 1.74, 7.32) and inappropriate child raising (OR = 2.72, 95%CI = 1.48, 4.99). Families with fathers having a low level of education, inappropriate household environments or inappropriate child raising should receive assistance so that children can have appropriate development for their age level.

Violence against children by parents.

The study aimed to identify the characteristics and frequency of physical and emotional violence against children by their biological parents and the relationship between children's characteristics, family factors and the extent of violent acts against children. The sample consisted of 212 grade six students in Muang District, Amnatcharoen Province. The data were collected from February 8 to 20, 1999. The results showed that 95.3 per cent of respondents perceived being treated violently by their biological parents, as 76.7 per cent were physical violence and 95.0 per cent were emotional violence. The most common physical and emotional acts of violence were beating by a cane or belt and scolding with rude language respectively. However, the violent acts occurred only occasionally. Only the factors of self-esteem and child's gender could predict the violent acts by fathers for 10.5 per cent; whereas family crises, family relations and self-esteem could predict the violent acts by mothers for 13.0 per cent. Therefore, building self-esteem, encouraging a healthy home environment, and creating proper coping skills against family crises are necessary for reducing violent acts.

Family protective-risk index and its implications.

The study aimed to develop an index for differentiating the levels of a family at risk of affecting child development to be applied as a screening tool for primary care workers to identify families that need urgent help. The Family Protective-Risk Index (FPRI) was developed from 8 family factors; i.e. mother's education, father's education, family income sufficiency, type of family, family relations, stressful life events in the family, child rearing and physical environment at home that were related to child development in any age group (1-<3 years, 3-<6 years and 6-12 years). Each factor was given a score of 0 or 1 and the scores of FPRI were between 0-8. The family with a lower FPRI score would have a higher risk while the family with a high FPRI score would have more security. The cut off point of FPRI was determined by calculating the sensitivity, specificity, positive predictive value, and negative predictive value. It was later found that the appropriate cut off point for prediction was 6. The 6th FPRI score had a suitable sensitivity to be used for identifying families that need close assistance in order to prevent the slow growth and development of children.