Nutritional Status of Infants and Young Children (0-30 months), Feeding Practices and Care Management of their Mothers among Myanmar Migrant Families in Pattani, Southern Thailand

Abstract

Background: Nutritional status of infants and young children has an important role in growth and development throughout their lives. The majority of growth retardation starts in the first two to three years of a child's life which is the critical period for all forms of growth and development. Thailand has millions of migrant workers working in different sectors. Pattani is one of the southernmost provinces of Thailand having thousands of Myanmar migrants working in fishery industries. Children from those migrant families are vulnerable to poor care and raising by their parents. Objective: This study aimed to estimate the nutritional status of Myanmar migrant infants and young children, to explore their mothers' feeding practices and childcare management and to identify caregiver's factors explaining the reasons for malnutrition of the child under their care. Methods: A community-based cross-sectional survey comprising two components, quantitative and qualitative parts, was conducted among Myanmar migrant infants and young children under 30 months of age, and their mothers/ caregivers in Pattani Province, Southern Thailand, during the period December 2016 to April 2017. Because not all migrant families were registered in the study area, a reliable sampling frame was not available. Therefore, combination of snowball sampling and convenience sampling was used to locate migrant residents with young children. Face- to-face interview including both the quantitative and qualitative parts were conducted at the migrants' residence. The body measurements were converted into anthropometric indices by applying WHO 2006 multi reference growth data using the computer program WHO Anthro version 3.2.2. As the sample size in the study was small to apply the WHO infant and young child feeding indicators, a proposed method of single indicator calculation was used to characterize the overall feeding practices in this population. A total of 100 children were included in statistical analysis after excluding 2 comorbid children. Association between the outcome variables and explanatory variables was analyzed using Chi square test, binary logistic regression analysis, and Cox regression analysis in the survey package. All analyses were done using R software version 3.2.2. Results: Of 102 children surveyed, 49.0% were male and 21.6% were less than 6 months old; 52.0% were of Mon and Dawei ethnicity and the remaining were of Bamar, Rakhing or Kayin. Forty mothers reported having medium level of household income (between 10,000 and 12,000 Baht per month); 85.3% of fathers were working in jobs related with fisheries. Only 21.6% of mothers in the survey were currently working. The prevalence of stunted, underweight and wasted children was 19.6%, 10.8% and 7.8%. Using the single indicator calculation; the proposed method to identify feeding practices in small-scale survey, only 21.6% of children were fed using good feeding practice (exclusive breastfeeding if children aged <6 months, or Infant and Child Feeding Index (ICFI) score 6 if children aged 6 months or older). Only 14.7% of the mothers had knowledge on the timing of starting complementary feeding but 58.8% knew the major food groups which children should be fed. 80.4% of children were reported to have been breastfed within 1 hour after delivery. Among the children less than 6 months old, 81.8% children were not exclusively breastfed and 94.9% of children had already started receiving complementary feeding before 6 months of age. Of the 98 children who were receiving complementary feeding, only 27.6% of children had been given at least 4 of the 7 major food groups, and among the children more than 6 months old, 27.5% had received fewer meals than the recommended frequency on the previous day. 14.7% of children were mainly cared by a relative or paid caregiver while their mothers were working. In binary logistic regression analysis, children who were born of ethnicities other than Mon and Dawei (OR 2.85; 95%CI 1.34, 6.06, p value 0.007) and whose fathers were working in fishery related jobs (OR 8.63; 95%CI 1.94, 38.42, p value 0.005) were more likely to be stunted. In Cox regression analysis, weight-for-age and length-for-age were also lower among children being occupied by fishermen fathers (HR 1.58; 95%CI 1.14, 2.17) and (HR 1.48; 95%CI 1.03, 2.12). Time-varying effect Cox regression revealed that among children whose length-for-age standardized score was greater than -2, the influence of primary caregiver; "not being the mother" and working mother currently working was significantly associated with the probability of having a lower value of length-for-age (HR 1.99; 95%CI 1.71, 2.30) (HR 2.10; 95%CI 1.79, 2.47). A delay in starting breastfeeding adversely affected length-for-age but only among children whose length-for-age standardized score was greater than -2 (HR 1.77; 95%CI 1.54, 2.04) but associated with higher length-for-age in the range less than -2 (HR 0.48; 95%CI 0.31, 0.76). Early initiation of complementary feeding was positively associated with length- for-age but only among children whose length-for-age standardized score was greater than -1 (HR 0.38; 95%CI 0.29, 0.51), but not significantly associated among those whose score ≤ -1. According to data provided from the Pattani provincial hospital, 50-60% of admissions for each year from 2012 to 2016 were child birth deliveries without any complication. 30-40% of total admission was among infants, and the remaining was illness of children within 1-2 years of age. 20% of admitted neonates were having low birth weight. The most common cause of neonatal illness was neonatal jaundice, accounting for 20% to 48% of total neonatal admissions. Conclusion: In this migrant study identifying the nutritional status of infants and young children under 30 months old from Myanmar migrant families, the prevalence of stunting, underweight and wasting was higher than the reported prevalence of stunting, underweight and wasting of one-year-old Thai children from the Prospective Cohort of Thailand Children study. Mon and Dawei children had higher length-for-age than other ethnic children, and children whose fathers were working in fisheries were more likely to be stunted indicating the necessities of family adaptation skills in their new environment and the influence of father's job type on development of children. Health awareness on pregnancy care and improving maternal knowledge on nutrition is mandatory in this migrant population. It is suggested that a migrant-friendly health educational and promotional health program in a more familiar way should be adopted and currently existing migrant health programs should be strengthened in order to achieve better health outcomes in this migrant children population.