Pasuree Sangsupawanich

Time Trends of the Prevalence of Asthma, Rhinitis and Eczema in Thai Children–ISAAC (International Study of Asthma and Allergies in Childhood) Phase Three

Using the same questionnaire as in ISAAC Phase One study conducted in 1995, the ISAAC Phase Three was carried out in Bangkok and Chiang Mai, Thailand, in 2001, among children aged 6–7 and 13–14 years. There was an increase in the prevalence of the three diseases in the younger age group, i.e., current asthma, rhinitis, rhinoconjunctivitis, and flexural eczema. In the older age group, the prevalence of rhinitis and rhinoconjunctivitis increased. There was no change of prevalence of asthma in Bangkok, but prevalence decreased in Chiang Mai. Prevalence of eczema in older children increased in Bangkok, but remained the same in Chiang Mai.

A Population-Based Study of Fish Allergy in the Philippines, Singapore and Thailand

Background: Fish allergy is the third most common food allergy after milk and egg in parts of Europe, but there is little data about prevalence in South East Asia where it is an important part of regular diets. Objective: We aimed to obtain an estimate of the population prevalence of fish allergy among older children in the Philippines, Singapore and Thailand. Methods: The population prevalence of fish allergy in 14- to 16-year-old children in the 3 countries was evaluated using a structured written questionnaire which was distributed to students of randomly selected secondary schools. An extended questionnaire to determine convincing fish allergy on the basis of typical clinical manifestations within 2 h of ingestion was administered to those with positive responses. Results: From acohort of 25,842 students, responses were 81.1% in the Philippines (n = 11,434), 67.9% in Singapore (n = 6,498) and 80.2% (n = 2,034) in Thailand. Using criteria for convincing food allergy, fish allergy was much higher in the Philippines [2.29%, 95% confidence interval (CI) 2.02–2.56] than in Singapore (0.26%, 95% CI 0.14–0.79) and Thailand (0.29%, 95% CI 0.06–0.52). Weighted multiple logistic regression analyses showed that compared to the Philippines, prevalence rates were lower in Singapore [odds ratio (OR) 0.40, 95% CI 0.27–0.60, p < 0.0001] and Thailand (OR 0.13, 95% CI 0.05–0.33, p < 0.0001). Females were more likely to have fish allergy compared to males for all children combined (OR 1.32, 95% CI 1.11–1.58, p = 0.002). Most allergies appeared mild, as only 28% of cases sought medical consultation at the time of the reaction and 31.2% of cases reported continued exposure despite allergic symptoms. Conclusion: Fish allergy in late childhood is more common in the Philippines compared to Singapore and Thailand. Differences in food processing, dietary habits and other cultural practices might be important risk factors for the development of fish allergy in these populations.

Maternal iodine status and neonatal thyroid-stimulating hormone concentration: a community survey in Songkhla, southern Thailand

OBJECTIVE To determine iodine intake and urinary iodine excretion (UIE) in a group of pregnant Thai women and the concentration of thyroid-stimulating hormone (TSH) in their neonates. DESIGN A prospective cohort study. SETTING Three districts of Songkhla, southern Thailand. SUBJECTS Two hundred and thirty-six pregnant women. RESULTS A quarter of the participants lacked knowledge of iodine and the prevention of iodine deficiency, although 70 % used iodized salt. Those who did not use iodized salt stated that they had no knowledge about iodine (57 %) and no iodized salt was sold in their village (36 %). The median iodine intake in the three districts was 205-240 microg/d, with 53-74 % of pregnant women having iodine intake <250 microg/d. The median UIE in the three districts was 51-106 microg/l, with 24-35 % having UIE < 50 microg/l. The mean neonatal TSH was 2.40 (sd 1.56) mU/l, with 8.9 % of neonates having TSH > 5 mU/l. CONCLUSIONS The studied women and their fetuses were at risk of mild iodine deficiency. About a quarter of the participants lacked knowledge of the importance of iodine. Education regarding the importance of iodine supplements and the promotion of iodized salt should be added to national health-care policies in order to prevent iodine-deficiency disorders, diseases that are subclinical but have long-term sequelae.

Revisiting current "barefoot doctors" in border areas of China: system of services, financial issue and clinical practice prior to introducing integrated management of childhood illness (IMCI).

BackgroundUnder-5-years child mortality remains high in rural China. Integrated management of childhood illness (IMCI) was introduced to China in 1998, but only a few rural areas have been included. This study aimed at assessing the current situation of the health system of rural health care and evaluating the clinical competency of village doctors in management of childhood illnesses prior to implementing IMCI programme in remote border rural areas.MethodsThe study was carried out in the border areas of Puer prefecture of Yunnan province. There were 182 village doctors in the list of the health bureau in these border areas. Of these, 154 (84.6%) were recruited into the study. The local health system components were investigated using a qualitative approach and analyzed with triangulation of information from different sources. The clinical component was assessed objectively and quantitatively presented using descriptive statistics.ResultsThe study found that the New Rural Cooperative Medical Scheme (NRCMS) coordinated the health insurance system and the provider service through 3 tiers: village doctor, township and county hospitals. The 30 RMB per person per year premium did not cover the referral cost, and thereby decreased the number of referrals. In contrast to available treatment facilities and drug supply, the level of basic medical education of village doctors and township doctors was low. Discontent among village doctors was common, especially concerning low rates of return from the service, exceptions being procedures such as injections, which in fact may create moral hazards to the patients. Direct observation on the assessment and management of paediatric patients by village doctors revealed inadequate history taking and physical examination, inability to detect potentially serious complications, overprescription of injection and antibiotics, and underprescription of oral rehydration salts and poor quality of counseling.ConclusionThere is a need to improve health finance and clinical competency of the village doctors in the study area.

Influence of maternal nutrient intake and weight gain on neonatal birth weight: a prospective cohort study in southern Thailand.

Objectives. To assess the nutritional intake and gestational weight gain of pregnant women and the relationship between nutritional intake, gestational weight gain, and neonatal birth weight. Methods. A prospective cohort study was carried out in three districts of Songkhla Province in southern Thailand. Nutritional intakes were calculated based on a 24-h food record and a food frequency checklist. The women were followed until delivery and the neonatal birth weight recorded. Results. Two hundred and thirty-six pregnant women with a mean age of 27.2 ± 6.2 years were recruited. The average daily energy intake was 1806 ± 482 kcal. The average gestational weight gain was 12.2 ± 4.6 kg and the average neonatal birth weight was 3054 ± 474 g. Micronutrient intakes were overall inadequate averaging only 50–80% of recommended levels. Neonatal birth weight was significantly positively correlated with gestational weight gain (r = 0.17, p = 0.01), but was not correlated with maternal nutritional intakes. Conclusions. Pregnant women in rural areas of Songkhla Province consume adequate macronutrients with appropriate gestational weight gain, but generally consume inadequate micronutrients. A nutritional education program explaining the importance of micronutrients should be a focus of a public education program.

Recent 5-year trends of asthma severity and allergen sensitization among children in southern Thailand

BACKGROUND Asthma is a major public health issue that affects morbidity. The greater severity of asthma requires more health care resource utilization. OBJECTIVE To investigate the possible changes in disease severity and allergen sensitization of children with asthma in an interim period of 5 years. METHODS We retrospectively reviewed the charts of 200 patients with established asthma in the pediatric allergy clinic. The data were collected in different time periods with 100 consecutive cases in each group starting in January of 2004 and in January of 2009. All patients underwent a skin prick test (SPT) to common allergens, with positive and negative controls. SPTs with a mean wheal diameter 3 mm greater than a negative control were considered test-positive. RESULTS The mean ages of patients in the 2004 and 2009 groups were 7.54 and 7.73 years. Compared with patients in the 2004 group, the 2009 group had more severe asthma (p = 0.006). The distribution of asthma severity was mild (intermittent and mild persistent) 98.0% in 2004 and 87.9% in 2009, and moderate to severe persistent 2.0% in 2004 and 12.1% in 2009. The prevalence of patients sensitized to both house dust (HD) and house dust mites (HDM) increased from 21.2% in 2004 to 34.3% in 2009 (p =0.007). Sensitization to allergens of HD, HDM and cockroach increased to 14.1% in 2009 from 9.1% in 2004 (p =0.021). CONCLUSIONS During the years between 2004 and 2009, asthma severity increased with increasing sensitization to HD, HDM and cockroach. Awareness of these changes and further studies are required.

Endotoxin Levels in Rural Thai and Urban Singaporean Homes

Background: Exposure to dust endotoxin and allergens in early childhood may influence the development of allergic diseases. Aims: This study aimed to evaluate dust endotoxin and dust mite allergens in urban Singapore and rural Thai homes of young children and study potential environmental influences. Methods: Mattress dust endotoxin and Der p 1, Der f 1, group 2 (Der f 2 and Der p 2) and Blo t 5 allergen levels were quantified in 101 infant mattress dust samples, 51 from urban Singapore and 50 from rural Thailand. Comprehensive questionnaires on the home environment and cleaning practices were completed. Results: Endotoxin levels in rural Thailand were significantly higher than in urban Singapore (geometric mean 26,334.12 ± 4.60 and 18,377.85 ± 2.52 endotoxin units/g, respectively; p = 0.032). In contrast, higher levels of Der f 1 (p = 0.02), group 2 (p < 0.01) and Blo t 5 (p < 0.01) allergens were found in Singapore homes compared with rural Thai homes. Multiple logistic regression analysis showed that the use of detergents (p = 0.001) and disinfectants (p = 0.024) to clean floors and mattress protectors (p = 0.021) were independently associated with lower endotoxin levels. Conclusion: Endotoxin levels are higher in rural compared with urban homes in South East Asia. The reverse was true for dust mite allergen levels. Certain identifiable home environmental conditions and practices accounted for the differences in endotoxin levels.

Prospective cohort study on change in weight status and occurrence of habitual snoring in children

To determine the association between the change in weight status and newly developed snoring in children.

Efficacy and safety of Laggera pterodonta in children 3-24 months with acute bronchiolitis: a randomized controlled trial.

Laggera pterodonta, a traditional Chinese medicine, has been commonly used in respiratory tract infections for more than hundreds of years without any randomized controlled trials to evaluate its efficacy and safety.

Adiposity rebound from three to six years of age was associated with a higher insulin resistance risk at eight-and-a-half years in a birth cohort study

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.