Positive news from nutrition study
An analysis of children at the Duang Prateep Kindergarten has shown adequate levels of nutrition. Between 1992 and 1998 over 1,000 measurements were made of children aged between three and six. The measurements have now been collated by American volunteer Dan Handel and compared with the national average.
The analysis shows that the younger children at the Duang Prateep Kindergarten are slightly above the national average for growth, while the older children are below the national average, but at no point is there a wide divergence from the national figures.
Although the news is good, there are several points that require further study. The measurements at the Duang Prateep Kindergarten were made between 1992 and 1998, while the most recent Thai national figures date from 1984. Most of the DPF measurements predate the economic crisis of the last two years and were taken at the height of the economic boom. The national figures predate the rapid economic growth from the late eighties to 1997. It is likely that national height and weight statistics increased after 1984 but we do not know by how much. The trend towards older children in the study having statistics below the national average requires further study. Does this trend continue so that children at primary school are significantly below the national average? Another point that requires further study is why slum boys do better, compared with the national average for boys, than slum girls, compared with the national average for girls.
Within the school, the teachers are concerned that the economic recession has caused malnutrition among the students. However, the children do not exhibit any signs of protein deficiency, which is probably due to the high amount of protein-rich rice that is a staple in the Thai diet.
A more detailed report prepared by Dan Handel of Northwestern University Medical School, USA, appears later in this newsletter.
Sponsored children celebrate Halloween at British Embassy
The British Embassy Social Club invited ten children who receive educational sponsorship from the Duang Prateep Foundation, including four sponsored by the social club, to celebrate Halloween at the embassy. The children from the DPF joined the sons and daughters of embassy staffers in trick or treating at the homes of embassy workers, including a visit to the residence of the ambassador. The embassy staff were well prepared, with treats available everywhere. The photo <Halloween.jpg> shows the Halloween group with British Ambassador Sir James Hodge and Lady Hodge (back centre).
With schools closed in October, eighty children receiving sponsorship from the Duang Prateep Foundation went on a three-day camp as guests of the Thai Navy. The camp was on navy land at Sattahip, east of Bangkok, and was for children aged from twelve to fifteen. The programme for the three days was full of action with an assault course being tackled and plenty of other outdoor activities. The children enjoyed the opportunity for more outdoors physical action than they usually have in Bangkok.
At the end of October, sponsored children were distributed with their second sponsorship sum for the academic year which ends next March. Ceremonies to distribute sponsorship money took place on successive Sundays and were attended by local sponsors and community representatives.
Aids staff take training to Northeast Thailand
Aids staff visited Yasothorn in Northeast Thailand last month, to give training over three days for people suffering from Aids and their families. Fifty families took part in the training programme, which covered the care of people with Aids and all other aspects of living with someone who is HIV+. Foundation staff have visited Yasathorn on several occasions in the past, where they work with a local volunteer network the foundation helped start.
One aspect of the training programme was the use of banana plant leaves to stimulate the growth of white blood cells and generally rejuvenate the patient. To use the banana leaves, the patient is first massaged with olive oil and then wrapped in the banana leaves for a period of four hours. The technique is shown in the attached file <banana leaves.jpg>
Also last month two representatives of the foundation attended the Fifth International Conference on Aids in the Asia Pacific. The foundation staff were sponsored as youth representatives at the conference by the United Nations Drugs Control Programme and they will be submitting a report on the meeting to the UNDCP.
Ramon Magsaysay Foundation trustees and laureates visit DPF
The trustees of the Ramon Magsaysay Foundation visited the Duang Prateep Foundation last month during their annual meeting, which this year took place in Bangkok. The President of the Ramon Magsaysay Foundation, Ms. Carmencita T. Abella, met with Foundation Secretary General Prateep Ungsongtham Hata and Executive Vice-Chairman Vithavas Khongkhakul.
On a separate occasion other Ramon Magsaysay Foundation trustees visited the foundation, where they were entertained by dance performances by children and senior citizens. They also received a report from Prateep Ungsongtham Hata on the work of the foundation and the role of the Ramon Magsaysay Awards Foundation and toured the local community. During their stay in Bangkok the trustees of the Ramon Magsaysay Foundation organised a meeting on the social consequences of the Asian economic crisis. Prateep Ungsongtham Hata joined Magsaysay Foundation trustees and other awardees from Thailand and other countries at the meeting. A report on the discussion is in the News from Thailand section below.
Danish Women’s Group makes donation
A delegation from the Margrethe Clubben, the Danish Women’s Group in Bangkok visited the Duang Prateep Foundation last month. The party met with Dr. Vithavas Khongkhakul to donate money to the New Life Project for Girls at Kanchanaburi Province. The visit followed from a visit many members of the Margrethe Clubben made to the foundation earlier in the year.
Free medical check-ups at DPF
The Tian Fa Foundation, a Chinese-Thai Foundation visited the Duang Prateep Foundation one day in October to provide free medical check-ups and haircuts to slum dwellers. Many people living in the communities close to the foundation availed themselves of the services on offer.
Anti-drugs meet
The Klong Toey Slum anti-drugs volunteer group organised an event at the Chumchon Moo Baan Pattana School next to the DPF last month. There were displays by the DPF and other local community and youth groups showing their anti-drugs activities, with speeches and entertainment performances taking place on a stage in the school yard. The anti-drugs group was originally started by the Duang Prateep Foundation but has been an independent volunteer organisation for over ten years. The group recently received financial support from the Social Investment Fund.
DPF study finds no significant difference between slum children and Thai national standards, but warrants further surveillance
Dan Handel, Northwestern University Medical School and Duang Prateep Volunteer
Previous studies conducted by the Duang Prateep Foundation have shown the positive psychological and behavioural influence that a kindergarten education can have upon the development of a child growing up in a slum community. While there is a genetic component in the growth potential of individuals, environmental factors have been shown to have strong influences as well. This is particularly evident in the offspring of parents who raised their children in an environment different from the one in which they were raised. Children of Japanese ancestry have been observed to develop statures similar to their American counterparts when raised in the United States. Other studies have shown that there is a significant increase in the weight and height for age in children of higher income groups where children are taller and heavier in every age group. However, no study has been done to determine the rate of physical development for children of low socioeconomic status. The question is raised as to what is the health status of children attending schools in the slum communities and how they compare to Thai national standards. While students receive a nutritious lunch during the school day, what these children eat outside of school and on holidays is highly variable.
The purpose of this study is to compare the rate of growth in height and weight gain of children attending kindergarten in the slums of Klong Toey, Bangkok to the Thai national growth chart to determine if there is a significant difference between the two populations. Since children in this community typically come from rural communities all over Thailand, comparisons were not made with studies that determined the standards of height and weight of Bangkok children. While height and weight are only crude methods of determining a child’s physical development, they are still the most reliable and effective method of study.
All children from the Duang Prateep Kindergarten in Klong Toey Slum were eligible for the study. All students were measured by their teachers from 1992 to 1998. Sex, year, age in months, height in centimetres, weight in kilograms, and head circumference in centimetres were recorded. Those with missing age or sex data were not included in the final analysis. For height and weight analysis, data points with respective missing values were excluded as well.
1,128 children were measured over time in the study to create 6,440 data points. 143 (2.2%) of these data points were excluded either due to missing age or sex information. During this time, there were 996 boys (50.1%) and 992 girls (49.9%) enrolled at the kindergarten. Mean, median, and standard percentile scores (3rd, 10th, 25th, 50th, 75th, 90th, and 97th percentiles) were used from the study describing the Thai national chart for a control population. These values were compared to their respective values in the sample population and analysed to determine if there were statistically significant differences. Appropriate statistical tests were then used to determine if there was a true difference between the two populations
There appears to be a general trend among both sexes for weight and height in the sample population to fall below the values of the standard population as there is an increase in age. In a direct plot of the median data points upon the Thai National Chart, all values remain within the normal range except for those at ages of both extremes. The frequencies at these extremes are small enough that there is a distinct possibility that these data points are not an accurate representation of the population as a whole and are merely outliers whose significance must be discounted.
The only group where there are statistically significant differences between the sample and standard populations in the mean and all percentile values is with male height. When excluding the extreme ages where deviations were found due to sampling bias, values of the study population were consistently greater than that of the standard population. Therefore, we can conclude that children enrolled at the Duang Prateep Kindergarten do not suffer from an adverse environment that significantly affects their growth during their years of enrollment at the school. On the contrary, male students were found to have consistently greater weights than the national standard.
Despite the fact that children remain within normal ranges, the question remains as to why there is a gradual decrease of both height and weight relative to the Thai standard values as children age. This conclusion can be substantiated even when data points at either end of the age range of this study are excluded due to small sample sizes.
The gradual decrease may be a sign of mild malnutrition that is delayed in its presentation among this population. Further study may result in a progressive decline in this population to where their values are consistently found in the range of malnutrition and must be explored in this area. Within the school, the teachers are concerned that the economic recession has caused malnutrition among the students. However, the children do not exhibit any signs of protein deficiency, which is probably due to the high amount of protein-rich rice that is a staple in the Thai diet.
Changes in weight are seen as more acute effects of malnutrition as compared to height determinations. However, there are also more variable and the weight of a child at the time of measurement may not truly represent their average weight measurement. The fact that no true difference is seen in the trends of weight and height for boys but is seen in girls is indicative of the fact that boys seem to thrive better in this environment. However, the fact that only 39% of those measured were male, compared to 50.1% of the overall kindergarten being male, raises a question as to why girls were measured significantly more than boys. Are boys less willing to be measured than girls? Furthermore, the question must be raised as to how this uneven sampling of the kindergarten population skews the final results of this study. Even though both genders received the same meals at school, the fact that boys are gaining more than girls points to the fact that boys are being better fed than girls in slum society. Do boys get priority over girls in terms of feeding as a result of cultural norms?
To summarize, it appears that children who attend the Duang Prateep Kindergarten are adequately nourished to fall within normal parameters during their attendance at this school. Follow-up studies should be conducted to see if this trend of a gradual decline continues as they age, and if so, why. Thai national standards must be updated for it is possible that new standards may be higher with economic growth over the past 15 years. If this is the case, then the slum children might be worse off and fall within new levels of malnutrition.
Continuing education efforts should be made to make sure that children are eating nutritious foods and not only the Western junk foods that have invaded the Thai market. Children could be receiving enough calories but not the right nutrients if this is the case. The prevalence of breastfeeding in this community should also be explored to see how this compares to the rest of Thailand. If there is a greater prevalence in the slums, this could explain the positive difference seen early on in development. We now have a snapshot into the nutrition of this community. It is time to complete the picture.
Daniel A. Handel
Northwestern University Medical
School
<dah909@md.nwu.edu>
News from Thailand
Magsaysay laureates pledge to champion poor
Last month Ramon Magsaysay Awards Foundation (RMAF) laureates from Thailand, Malaysia, Pakistan, Japan and the Philippines joined with trustees of the RMAF at a meeting to discuss the social consequences of the economic crisis.
A country report on the situation in Thailand was given by Mechai Viravaidya. He said that when people ask him how the poor are suffering in the economic crisis, he reminds them that the poor were not doing well before the crisis began. Duang Prateep Foundation Secretary General talked on the situation from the viewpoint of Bangkok slum dwellers. She reported on the social consequences of the crisis such as the rising drugs consumption and the increasing incidence of broken-families.
A summary of the situation in Asia was given by Dr. Prawase Wasi. He called for a systematic structural reform to eradicate poverty. He cited twelve areas for reform but named the need to change the social perception of the poor as the most important. Dr. Prawase said that without a basic ethical principle that values every human being, peace is not possible.
Drugs use on the rise in schools
The Office of the Narcotics Control Board reported last month that nearly 700,000 students at state run institutions are involved in illegal drugs. A survey of 5.3 million students, enrolled for study between the final year of primary school and the fourth year of university, discovered that 13% were involved in drugs.
Of the 697,860 students with drugs experience, 293,945 were occasional users, 87,491 were addicts, 56,578 were dealers, 60,156 were addicts and dealers, 46,376 were users and dealers and 153,316 reported some experience of drug use.
Methamphetamines were the preferred drug. Over 50% used it, followed by inhalants and marijuana. Other drugs were used by 3% or less of the students with drugs experience.
Concern over rising youth pregnancies
The chairwoman of the Friends of Women Foundation last month voiced concern over the rising trend of unplanned pregnancies. The foundation reported that, based on its hotline records, the number of unplanned pregnancies among 14 to 17 year-olds have increased considerably this year. The social stigma associated with unplanned teenage pregnancies often means that young women cannot turn to their family for support.
Attempts are now under way to provide proper sex education to children, beginning at the primary school level, to prevent unprepared sex and unwanted pregnancies.
Fall in HIV cases to affect vaccine tests
The decline in the incidence of new HIV infections will make the testing of candidate vaccines more difficult. The rate of new infections in Thailand is now 0.2%, down from 2.5% during the peak years of infection in 1993-94. The reduction in the number of new HIV infections means it will be difficult to measure the effectiveness of a candidate vaccine in a limited target group.
Of eight trials of HIV vaccines in Thailand, one has reached Phase III and is being conducted on 2500 intravenous drug users in Bangkok.
Student loan scheme criticised
Last month an UNESCO report described the 20 billion baht student loan scheme serving some 650,00 students throughout Thailand as ill-conceived, poorly managed and financially unviable, while failing to reach many of those desperately in need of assistance. As the result of poor targeting, a large number of better of students are believed to have taken advantage of the loans at the expense of many needy students. The UNESCO report recommended a radical overhaul of the scheme.
NGOs criticise self-seeking donors
A group of NGOs working on child welfare criticised some donors as seeking to take advantage of children. Senator Wallop Tangkananurak, who chairs the Network for Strengthening Street Children, said that some companies merely used the act of donating as a means to promote their interests. Mr Wallop cited for example the donation of milk that had already expired and had to be thrown away. He also accused some firms of using deprived children as guinea-pigs for new products yet to be launched on the market.
ILO says that Thailand can afford jobless insurance
An International Labour Organisation report suggested that Thailand should consider introducing unemployment insurance sooner rather than later to provide adequate income protection to unemployed workers. The report is the outcome of a study into the financial and administrative feasibility of unemployment insurance, carried out at the request of the government.
It is reported that government policymakers are wary of an early introduction of unemployment insurance, for fear of the costs and because of concern about possible abuse of the system in the absence of effective monitoring mechanisms. Presently workers made redundant are entitled to severance pay and twelve months continued healthcare coverage under the social security scheme. Government agencies have devised a wide range of ad hoc measures to try to relieve some of the worst impacts of unemployment. But these schemes are plagued with problems, from poor targeting to inefficient use of funds.