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Materal and Infant Nutrition Reviews . +- A-A-U~...-+ +. ++/,. Materal and Infant Nutrition~ J~)2C) Reviews . THAILAND an InternationalNutrition Communication Service publication MATERNAL AND INFANT NUTRITION REVIEWS THAILAND A Guide to the Literature Compiled by Ron Israel Senior Editor Joanne Nestor - Editor and Reviewer Steve Wirtz and Ellen Blumensteil - Reviewers December, 1981 An International Nutrition Communication Service (INCS) publication INCS Advisory Board: Derrick B. and E. F. Patrice Jelliffe, Richard K. Manoff, Marian L. Tompson, R. R. N. Tuluhungwa, Joe D. Wray, Marian F. Zeitlin INCS Steering Committee: Phyllis Dobyns, Marcia Griffiths, Charles N. Myers This project has been conducted under ContractA.I.D./DSAN-C-0209, Office ofNutrition, Development Support Bureau, Agency for International Development, Washington, DC CONTENTS Introduction ............ i MINR Classification System........ iii Map ....................... iv Table I: Locations Studied . .. v Review Highlights .. ......... .. vii Review..... ............... ... 1 Bibliography.... ............ .73 References of Interest.......... 94 INTRODUCTION This monograph reviews the available literature on maternal and infant nutritional status, beliefs, and practices in Thailand. It also lists current government, USAID, international agency, and private voluntary organization nutrition-related programs and policies. This is not an all-inclusive listing, but it should provide enough information to enable the health/nutrition planner (our primary target audience) to ascertain quickly what is known (and what needs to be studied) about this subject. The information is chronicled according to a Maternal and Infant Nutrition Review (MINR) system outlined on page iii. The map on page iv and Table 1 on page v show the extent to which various regions and specific locations have been surveyed. Pages vii through ix present the highlights of our findings. Pages I to 71 contain the data categorized according to the MINR classification system with boldface titles within each category to describe specific listings. Pages 73 to 94 contain an annotated bibliography with each entry described in terms of type of study (original data or literature review), with methodology, sample characteristics, and location, where relevant, and a summary, and pages 94 through 96 list other references of interest. These reviews are limited to documents available to us in the United States working under time constraints. We hope that we will be able to obtain further information and to update the reviews. Special thanks are extended to Betsy Brown; Kathy Fogel of the World Bani; Dr. Virginia Hight Laukaran of the Population Council; Dr. John Knodel; Henry Merrill of USAIDj David Radel of the World Bank; Dr. Aree Valyasevi of the Institute of Nutrition, Mahidol University, Thailand; Dr. Penny Van Esterik; and Dr. Joe Wray for reading and commenting on earlier drafts of this report and/or for identifying further resources. Final responsibility for this document rests with us. Ron Israel INCS Project Manager MATERNAL AND INFANT NUTRITION REVIEWS CLASSIFICATION SYSTEM 1. Nutrition and Health Status 1.1 General 1.2 Women, Pregnant 1.3 Women, Lactating 1.4 Infants 0-6 Months 1.5 Infants 6-24 Months 2. Dietary Beliefs 2.1 General 2.2 About Pregnancy 2.3 About Lactation 2.4 About Breast Milk Substitutes (including bottle feeding) 2.5 About Weaning 2.6 About Illness and Cure 3. Dietary Practices 3.1 General 3.2 Women 3.2.1 During Pregnancy 3.2.2 During Lactation 3.3 infants 0-24 Months 3.3.1 Breastfeeding 3.3.2 Weaning 3.3.3 After Weaning 3.4 Health and Medicine 4. Nutrition Status Correlations 5. Nutrition and Health Policies and Programs 5.1 Policies 5.2 Programs 6. Commentaries Bibliography -*iii­ 1-0. • 10414' AUoGu:d f THAILAND 20 BURMA fS JI~NCOYE 'F4 CAPITA1'116 20' 0 S- 4.OI0D 6.000 EJ 4.OU0wI. B U rTEAN'-N TIOAL BIW :ES "- M.10 OC....... /" ON. LAO SU 1( I-4 1E r e-- / N I ) I . ,- - --- ....... k w,,OC,.... L OUo ,e "r / N )1PE OPLE'S - -- CkhIWATPIVNCAIE A- 'O'NAS E V, DEM. REP • ., , 't -.j ,o .,," - ,, O,,,, NB..A ai-'- o' T*O­ ( ..::..J' 0 - r ."- -"-.--' fl ,,' I -IJ ' \ o . / ' / - :,-.-:j ,. >L . " ' .. .,. N Ut,o R.t.,n - - j I a*NE L 00 00 C3, .. -,"---... ' i Gulfsoof~ -hln \ "- 1 0 i kh .KW (prp S . fin a N 3 sbon,0.--0Ur t . .unp., 0I . : .5 i~. /.. AL ¢ YS A % OR.OAd "IKUu'I ~ ' G f Th "i/ad. ',, 0*0 O 10010 0 .0 r \ C 'a e I It ORI. th. 8 100~~~ MA AfSIA ,O1rI TABLE 1 Locations Studied Mentraa% KhHa II W Ro ru 0) ':aDakaet r Cho 00ur r Suha wBur J - wk0( wi-t:- s la Q)a.aagk " 4 U00C Ban (3 villages)3 CaI aNorth .0 a ChanmHal . Reimong &i hil tr1ibes. Mae _ n % O3Nuaio(nH Z 26villagest 0 i IRni C uhlan Chae Chan --Bang aexT - Notheat KhongKan -zSmphan Br Doan Dcnm aIl xI I lon gKua Maa Sn an- -----­ Nakhon atchasa - - x X - gbn athadth ai North _ Chan ~V HIGHLIGHTS 1. NUTRITION AND HEALTH STATUS: Major nutritional problems of Thai people are protein energy malnutrition, Vitamin A deficiency, beri-beri, riboflavin deficiency, endemic goiter and anemia. PEM is the most widespread nutritional problem, especially for infants and preschool children. The highest prevalences were in the Northeast, although the rates among urban slum children (mainly in Bangkok) have been shown to be three times as high as in rural areas. The most recent national sampling showed 57% of children 0-5 years old were suffering some form of PEM with 16% suffering moderate to severe forms of PEM. Nutritional deficiencies were lowest during the harvest season. No progress in reducing PEM rates was made during the Fourth Five Year Plan (1977-1981) according to government surveys. National infant mortality rates (IMRs) declined from about 79-84 deaths per 1000 live births in 1964-7 to about 56-61 per 1000 in 1974-5. IMRs appear to be highest in the North region and lowest in urban areas. Growth rates for rural infants during the first 6 months of life are normal, whereas poor urban irfants show an early pattern of growth failure due in part to improper bottle feedings (e.g. use of sweetened condensed milk). High rates of low birth weight babies of iron deficiency and anemia among pregnant women (reflecting poor maternal status) exist in both urban and rural areas. Poor hygiene is a tactor in 80% of all illness and 40% of all deaths. 2. DIETARY BELIEFS: Meat preterences in Thailand differ by ethnic group: Chinese people preter pork and avoid beef; Muslims prefer fish and avoid pork; and Thais prefer fish. Potentially harmful food restrictions are especially aimed at pregnant and lactating women. For pregnant women, meat and eggs are restricted for fear of a large baby and difficult delivery, but coconut was identified often as a special food. More women avoid certain items than eat special foods. During the post-partum period, the ritual "lying by the fire" involves a very restricted intake (mainly salted baked rice and pork skin) in the belief that this protects the health of both the suckling infant and the mother. Only the indigenous granny midwives (me tam vai) are trained in the technques necessary for interpreting and guiding the process of childbirth and lactation. Breast feeding is an important part of the traditional belief system; successful breast feeding validates the "merit store" of the women and will be paid back by the childl the initial nursing experience is thought crucial for success; there is recognition that both mother and infant need to "learn" how to nurse; the best teacher is laing di (a successful nourisher herself), a wet nurse may nurse a newborn first to help the infant learn to suck and to allow the mother's milk to come in; colostrum may be thought to set a poor start (e.g. of "bad" color and insufficient amount) for the nursing couple. Rural women have confidence in successful breast feedhig and respond to low milk supply by eating KaA Leang (a vegetable curry soup), drinking boiled water and nursing more ofcen. Urban elite women expressed much less confidence in breast feeding, suggesting that only exceptiolially healthy mothers could succeed, had more negative attitudes toward breast feeding, with some suggesting it was "animal-like" and only done for lack of money, and experienced more problems. Bottle feeding was seen by the urban elite as part of a modern technology "package" that was the most appropriate method for them. Aggressive promotion of infant formu*a has been found in urban areas and is cited as significant pressure to bottle feed. No special weaning foods -vii- PREVIOUS PAGE HIGHLIGHTS (Cont.) were recognized in rural areas, where it was thought that large intakes of rice would lead to faster development, that eggs and sometimes fish should be restricted, and that sick children should receive a rest:icted diet. In urban slums, mothers misperceived the health of their children as better than it actually was. 3. DIETARY PRACTICES: Bulky glutinous rice (with its low calorie density) is by far the major staple food, accounting for at least 75% of the total calories and the majority of protein in the traditional diet. Highly milled rice is the preterred form (with a loss of nutrient value),' brown rice is considered unfit for humans. Fish, beef, pork and eggs are the most common high-protein foods. Vegetables are common, but fat and oil intakes are low. Generally, the quality and diversity of diet varies according to income. Rural pregnant and lactating women eat no special supplemental foods, and are much more likely to restrict their diets, especially in the post-partum period of "lying by the fire." There was a continuous decline among both urban and rural women in breast feeding initiation and duration from 1969 to 19793 rural mothers still breast feed at higher rates and for longer periods than urban mothers; the highest rates and duration are found in the rural Northeast and North.
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