Establishing of National Birth Defects Registry in Thailand.

BACKGROUND: Deaths attributed to birth defects are a major cause of infant and under-five mortality as well as lifetime disabilities among those who survive. In Thailand, birth defects contribute to 21% of neonatal deaths. There is currently no systematic registry for congenital anomalies in Thailand. Queen Sirikit National Institute of Child Health has initiated a Thailand Birth Defects Registry to capture birth defects among newborn infants. OBJECTIVE: To establish the national birth defects registry in order to determine the burden of birth defects in Thailand. MATERIAL AND METHOD: The birth defects data come from four main sources: National Birth Registry Database; National Health Security Office's reimbursement database; Online Birth Defect Registry Database designed to capture new cases that were detected later; and birth defects data from 20 participated hospitals. All data are linked by unique 13-digit national identification number and International Classification of Diseases (ICD)-10 codes. This registry includes 19 common structural birth defects conditions and pilots in 20 hospitals. The registry is hospital-based, hybrid reporting system, including only live births whose information was collected up to 1 year of age. RESULTS: 3,696 infants out of 67,813 live births (8.28% of total live births in Thailand) were diagnosed with congenital anomalies. The prevalence rate of major anomalies was 26.12 per 1,000 live births. The five most common birth defects were congenital heart defects, limb anomalies, cleft lip/cleft palate, Down syndrome, and congenital hydrocephalus respectively. CONCLUSION: The present study established the Birth Defects Registry by collecting data from four databases in Thailand. Information obtained from this registry and surveillance is essential in the planning for effective intervention programs for birth defects. The authors suggest that this program should be integrated in the existing public health system to ensure sustainability.

Original antigenic sin and apoptosis in the pathogenesis of dengue hemorrhagic fever.

Dengue virus presents a growing threat to public health in the developing world. Four major serotypes of dengue virus have been characterized, and epidemiological evidence shows that dengue hemorrhagic fever (DHF), the more serious manifestation of the disease, occurs more frequently upon reinfection with a second serotype. We have studied dengue virus-specific T-cell responses in Thai children. During acute infection, few dengue-responsive CD8+ T cells were recovered; most of those present showed an activated phenotype and were undergoing programmed cell death. Many dengue-specific T cells were of low affinity for the infecting virus and showed higher affinity for other, probably previously encountered strains. Profound T-cell activation and death may contribute to the systemic disturbances leading to DHF, and original antigenic sin in the T-cell responses may suppress or delay viral elimination, leading to higher viral loads and increased immunopathology.

Are infants exclusively breastfed up to 6 months of age at risk of anemia?

OBJECTIVE: To compare the incidence of anemia between infants who received exclusive breast feeding (EBF) up to the age of 6 months and those who did not. MATERIAL AND METHOD: A cross sectional survey was conducted to examine the physical growth, incidence of anemia, mean hematocrit (Hct) level and other red cell indices among 6-month-old infants visiting a well-child clinic at QSNICH and Ramathibodi Hospital. RESULTS: 63 infants were included in the present study: 24 (38%) EBF group; and 39 (62%) non-EBF group. Mean Hct of EBF group was 34.5 +/- 1.7 and Non-EBF group was 35.1 +/- 2.3% respectively. The prevalence of anemia in the EBF group was 4.2%, non-EBF group was 12.8%. Even though the findings were not statistically significant, the authors found that the red blood cell indices in an anemic infant in the EBF group were not caused by iron deficiency, while the 4 of 5 anemic infants in the Non-EBF group were related to iron deficiency anemia (80%). Other growth parameters were compared between the two groups. CONCLUSION: The present study did not show statistical difference regarding the different hematocrit and other red blood cell indices including other fundamental background but the prevalence of anemia appeared to be higher among Non-EBF compared to EBF up to 6 months. The cause of anemia was not related to iron deficiency anemia in the EBF group compared to those higher and related to iron deficiency anemia in the Non-EBF group. SUGGESTION: EBF up to 6 months should be advocated given its substantial health benefit and does not increase the risk of anemia. Nevertheless, it is essential that mothers receive adequate nutritional supplement including iron during pregnancy and lactation period.

Situation of baby bottle use: is it suitable to recommend weaning by the age of one year?

BACKGROUND: Inappropriate baby bottle use is associated with many adversely health affects such as dental caries, refuse to eat etc. International pediatric institutes suggest weaning by the age of 1 year To establish a practical recommendation for Thai children, needs situation analysis. OBJECTIVE: To determine the percentage of baby bottle use including late night feeding, behavior contributing to baby bottle addiction and chance of adverse health affects. MATERIAL AND METHOD: A cross sectional descriptive study was performed in well child clinic at QSNICH during November 2003-December 2007. One thousand thirty-eight caretakers from 13 groups of children age 1 month-4 years were randomly included. Questionnaires were used and analyzed by SPSS program. RESULTS: A total of 1,038 caretakers were interviewed. Parents comprised 70% of the caretakers. Children aged 1-2 years, 2-3 years, and 3-4 years, are found to remain on the bottle feeding constituted 92%, 70% and 42% respectively and remain on the night feeding comprised 70%, 50%, and 37% respectively. And more specifically, children at the age of six month have night feeding up to 85%. The weaning ages from the bottle were widely distributed, the earliest was one year (1%), the mean age was 2.5 years (SD = 0.612), the mode was at the age of two years (13%). Forty-six percent of children age 6 month-4 years received a bottle to sleep with 34% of caretakers offering bottle feeding when the child just moved the body. After bedtime mouth care, 48% of children were back to bottle-feeding. Eighteen percent of children age 2-4 year who were bottle fed were getting more milk volume than recommended with the maximum amount of 56 ounces a day. Fifty-six percent of children at 2 years and 70% at 4 years, received bottle-feeding more frequently than recommended with the maximum of 11 times a day. Eighty-eight percent of the caretakers did not know the recommended age of weaning. CONCLUSION: The children in this study still use baby bottle and have night feeding far beyond the recommended age including the practice of bottle to sleep, returning to bottle after dental care which will lead to addiction and adverse health affect. The age at which the children can quit and the realization of caretakers of when to quit are scattered. SUGGESTION: Recommendation should be at the age of one year but be flexible to more half a year to the age of 1 omega year, with encourage appropriate using and preparation to the weaning process.

Maternal return to paid work and breastfeeding practices in Bangkok, Thailand.

This study explored the association between mothers' work-related factors and breastfeeding practices in Bangkok, Thailand. Data were collected from 84 working mothers with a child aged 6 to 24 months who visited the breastfeeding mobile clinic at a nursery goods exhibition. Thai interviewers collected data using a structured questionnaire. Analysis of the data showed that exclusive breastfeeding for 3 months was 78.6%, and for 6 months it was 38.1%. Mothers who returned to work 3 months or more after giving birth exclusively breastfed more than the mothers who returned to work in less than 3 months (crude odds ratio [OR] = 4.26, 95% confidence interval [CI] = 1.39-13.05; adjusted OR = 4.15, 95% CI = 1.15-14.95). Moreover, mothers who worked at self-employed or family-owned businesses and some mothers working at private companies showed tendencies of returning to work in less than 3 months. Results suggest that longer maternity leave would help extend the duration of exclusive breastfeeding. In addition, the improvement of a breastfeeding supportive environment in the workplace would be valuable and may be an effective means to improve breastfeeding practices and infant health.