Phnom Penh, Cambodia
Phnom Penh, Cambodia

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Knowles J.,Public Nutrition Solutions Ltd | Thurnham D.I.,University of Ulster | Phengdy B.,Ministry of Health | Houamboun K.,Institute of Public Health | And 3 more authors.
British Journal of Nutrition | Year: 2013

Anaemia is prevalent in South East Asia and Fe deficiency (ID) is considered to be the main cause, but the role of subclinical inflammation in the aetiology is uncertain. In the present study, we determined the influence of inflammation on the biomarkers of Fe status in women and children, and herein, we discuss the proportion of anaemia associated with ID. As part of the 2006 Lao People's Democratic Republic (The Lao PDR) National Nutrition Survey, blood collected from 482 young children and 816 non-pregnant women was analysed. Plasma ferritin, transferrin receptor (sTfR), Hb, C-reactive protein (CRP) and α-1-acid glycoprotein (AGP) concentrations were measured. ID was assessed using ferritin concentrations ( < 12 (children) or < 15 (adults) μg/l), sTfR concentrations (>8·3 mg/l) and body Fe stores (BIS < 0). Elevated CRP (>5 mg/l) and/or AGP (>1 g/l) concentrations were used to categorise inflammation status in order to correct the Fe biomarkers for inflammation. Inflammation was present in 14 % of adults and 43 % of children. Anaemia was present in 37·6 % of both women (Hb concentrations < 120 g/l) and children (Hb concentrations < 110 g/l). Correcting ferritin concentrations for inflammation increased the prevalence of ID from 24·3 to 26 % for women and from 18 to 21 % for children (P< 0·001 for both). Ferritin concentrations were more helpful in detecting ID than sTfR concentrations or BIS, but regression analysis found that sTfr concentrations explained more of the variance in Hb concentrations in both women (20 %) and children (17 %) than ferritin concentrations (5 and 1·4 %, respectively). Nevertheless, the total variance in Hb concentrations explained was only 26 and 18 % in women and children, respectively, and other factors may be more important than ID in contributing to anaemia in The Lao PDR. © The Authors 2013.


PubMed | Maternal and Child Health Center, Harvest Technologies, Newborn and Child Health and Nutrition section, IRD Montpellier and ICF International
Type: Journal Article | Journal: Nutrients | Year: 2016

A 2014 national assessment of salt iodization coverage in Cambodia found that 62% of samples were non-iodized, suggesting a significant decline in daily iodine intakes. The Cambodian Micronutrient Survey conducted in 2014 (CMNS-2014) permitted obtaining national data on urinary iodine concentrations (UIC) to assess iodine status and whether iodized salt use had an impact. Urine samples were collected from mothers (n = 736) and children (n = 950). The median UIC was 63 g/L and 72 g/L in mothers and children respectively. More than 60% of mothers and their children had a UIC < 100 g/L, thereby indicating a serious public health problem. Iodine status was significantly lower among mothers and children living in rural areas, belonging to the poorest socioeconomic category, or living in a household not using iodized salt. The limited enforcement of the legislation for iodized salt has resulted in a major decrease in the prevalence of iodized salt, which in turn has compromised iodine status in Cambodia. It is essential for the government to enhance enforcement of the iodized salt legislation, and implement short term strategies, such as iodine supplementation, to prevent an increase of severe complications due to iodine deficiency in the Cambodian population.


PubMed | Harvest Technologies, International Life science Institute, ICF International, University of the Philippines at Diliman and 4 more.
Type: Journal Article | Journal: Nutrients | Year: 2016

Recent studies have shown that in spite of being generally close to the equator; vitamin D deficiency is common in South East Asian countries. In order to quantify micronutrient status for women and children in Cambodia; a nationally-representative survey was conducted in 2014 linked to the Cambodian Demographic Health Survey. The countrywide median of 25(OH)D was, respectively, 64.9 and 91.1 nmol/L for mothers and children. Based on The Endocrine Society cutoffs (>50<75 nmol/L = insufficiency; 50 nmol/L = deficiency); 64.6% of mothers and 34.8% of their children had plasma vitamin D concentrations indicating insufficiency or deficiency. For deficiency alone, 29% of the mothers were found to be vitamin D deficient, but only 13.4% of children. Children who live in urban areas had a 43% higher rate of vitamin D insufficiency versus those who live in rural areas (OR; 1.434; 95% CI: 1.007; 2.041). However, such differences were not observed in their mothers. The high prevalence of vitamin D deficiency is likely in part due to lifestyle choices, including sun avoidance, increasingly predominant indoor work, and covered transport. These survey findings support the need for a broader national Cambodian study incorporating testing of adult men, adolescents and the elderly, and encompassing other parameters such as skeletal health. However, the data presented in this study already show significant deficiencies which need to be addressed and we discuss the benefit of establishing nationally-mandated food fortification programs to enhance the intake of vitamin D.


PubMed | Ministry of Agriculture, Montpellier SupAgro, Maternal Child Health and Nutrition section, World Food Program and 2 more.
Type: Journal Article | Journal: PloS one | Year: 2016

Early identification of children <5 yrs with acute malnutrition is a priority. Acute malnutrition is defined by the World Health Organization as a mid-upper-arm circumference (MUAC) <12.5 cm or a weight-for-height Z-score (WHZ) <-2. MUAC is a simple and low-cost indicator to screen for acute malnutrition in communities, but MUAC cut-offs currently recommended by WHO do not identify the majority of children with weight-for-height Z-score (<-2 (moderate malnourished) or r<-3 (severe malnourished). Also, no cut-offs for MUAC are established for children >5 yrs. Therefore, this study aimed at defining gender and age-specific cut-offs to improve sensitivity of MUAC as an indicator of acute malnutrition.To establish new age and gender-specific MUAC cut-offs, pooled data was obtained for 14,173 children from 5 surveys in Cambodia (2011-2013). Sensitivity, false positive rates, and areas under receiver-operator characteristic curves (AUC) were calculated using wasting for children <5yrs and thinness for children 5yrs as gold standards. Among the highest values of AUC, the cut-off with the highest sensitivity and a false positive rate 33% was selected as the optimal cut-off.Optimal cut-off values increased with age. Boys had higher cut-offs than girls, except in the 8-10.9 yrs age range. In children <2yrs, the cut-off was lower for stunted children compared to non stunted children. Sensitivity of MUAC to identify WHZ<-2 and <-3 z-scores increased from 24.3% and 8.1% to >80% with the new cut-offs in comparison with the current WHO cut-offs.Gender and age specific MUAC cut-offs drastically increased sensitivity to identify children with WHZ-score <-2 z-scores. International reference of MUAC cut-offs by age group and gender should be established to screen for acute malnutrition at the community level.


Phoutthakeo P.,University of Tokyo | Otsuka K.,University of Tokyo | Ito C.,Migration Health Division | Sayamoungkhoun P.,Maternal and Child Health Center | And 2 more authors.
Journal of Paediatrics and Child Health | Year: 2014

Aim This study aims to examine the influence of formula milk promotion via the media from Thailand to Lao People's Democratic Republic (PDR), where a cultural and linguistic proximity are shared. Methods A cross-sectional study was conducted through a structured questionnaire survey and focus group discussion (FGD) with mothers who had children under 2 years of age and lived in Vientiane Capital, Lao PDR. Multivariate logistic regression models were constructed for quantitative data analysis. Content analysis was used for qualitative data analysis. Results Among infants aged 6-23 months, exclusive breastfeeding (EBF) rate for 6 months was 16.1% (n = 106/658). Among infants aged 0-5 months, 17.6% (n = 61/346) was exclusively breastfed at the time of survey (24 h recall). Of 1022 mothers, 89.9% reported frequent exposure to the Thai media's promotion of formula milk through TV commercials and 79.1% identified TV commercial as influential for them to develop a positive attitude towards the use of formula milk. In multivariate logistic regression analyses, mothers who reported a positive attitude towards Thai TV commercial on the formula use (n = 449) were approximately 75% less likely to practice EBF for 6 months than those who reported a negative attitude (n = 64). FGD further revealed that the participants tend to believe in the information in TV commercial for formula milk. Conclusion The promotion of formula milk via media from Thailand negatively affects breastfeeding mothers in Lao PDR. Cross-border impacts of promoting formula milk should be addressed globally. © 2013 The Authors. Journal of Paediatrics and Child Health © 2013 Paediatrics and Child Health Division (Royal Australasian College of Physicians).


Prak S.,Maternal and Child Health Center | Dahl M.I.,11 Health | Oeurn S.,11 Health | Conkle J.,11 Health | And 2 more authors.
Nutrients | Year: 2014

A cross-sectional analysis of the Cambodia Demographic Health Surveys from 2000, 2005 and 2010 was conducted to observe the national trends in infant and young child feeding practices. The results showed that rates of exclusive breastfeeding among infants aged 0-5.9 months have increased substantially since 2000, concurrent with an increase in the rates of early initiation of breastfeeding and a reduction in the giving of pre-lacteal feeds. However, the proportion of infants being fed with breast-milk substitutes (BMS) during 0-5.9 months doubled in 5 years (3.4% to 7.0%) from 2000 to 2005, but then did not increase from 2005, likely due to extensive public health campaigns on exclusive breastfeeding. BMS use increased among children aged 6-23.9 months from 2000 to 2010 (4.8% to 9.3%). 26.1% of women delivering in a private clinic provided their child with breast-milk substitute at 0-5.9 months, which is five times more than women delivering in the public sector(5.1%), and the greatest increase in bottle use happened among the urban poor (5.8% to 21.7%). These findings are discussed with reference to the increased supply and marketing of BMS that is occurring in Cambodia. © 2014 by the authors; licensee MDPI, Basel, Switzerland.


Loke A.L.,Hong Kong Polytechnic University | Lam P.,Maternal and Child Health Center
BMC Pregnancy and Childbirth | Year: 2014

Background: Teenagers are unprepared to face or to deal with an unexpected pregnancy. Adolescents do not necessarily possess the cognitive ability needed to clearly evaluate such a situation or to determine how to resolve their pregnancy. This study seeks to shed light on what pregnant adolescents consider when coming to a decision about what to do about their pregnancy. Methods: In-depth interviews were conducted among a purposive sample of Hong Kong Chinese women recruited from a Maternal and Child Health Centre, who had a history of being pregnant in their teens and out of wedlock. Interviews were conducted to explore the considerations surrounding their decision on how to resolve their pregnancy. Results: A total of nine women were interviewed. An analysis of the interview transcripts revealed that to arrive at a decision on what to do about their pregnancy, pregnant teens took into consideration their relationship with their boyfriend, their family's advice or support, practical considerations, their personal values in life, and views on adoption. Conclusions: The results of this study results highlighted that during this life-altering event for adolescents, an open discussion should take place among all of the parties concerned. A better understanding of each party's perspective would allow for better decision making on the resolution of the pregnancy. Health professionals or social workers are there to help pregnant adolescents, romantic partners, and family members make informed choices on how to resolve the pregnancy. © Loke and Lam.


PubMed | 11 Health, Montpellier SupAgro, Maternal and Child Health Center, Copenhagen University and Inner City Found International
Type: Journal Article | Journal: Nutrients | Year: 2016

The study assessed the trends of nutritional status of children under age five in Cambodia over four DHS surveys from 2000 to 2014 and the contribution of socioeconomic and demographic factors to its changes. Undernutrition was a public health problem in all surveys. Despite consistent improvement over the years, stunting still affected 32.5% of children in 2014. Wasting prevalence did not improve since 2005 and affected 9.6% of children under five in 2014. Low wealth and mother education; and rural residence contributed to undernutrition. In 2014; wealth status was the main socioeconomic factor associated with undernutrition and the nutritional status of children was strongly related to that of their mothers. Anemia prevalence was high and after a decrease between 2000 and 2005 remained at 45%. The prevalence of overweight was less than 10% and did not change over the years despite an increasing trend in the richest households of urban areas. Persistent inequalities in child undernutrition call for action, giving priority to the most vulnerable households to ensure availability and access to nutrient-rich foods for women and children through nutrition-sensitive and nutrition-specific programs. The recent increase of overweight in the richest populations must also be considered in Cambodian health policies.


PubMed | Newborn and Child Health and Nutrition section, Montpellier SupAgro, Maternal and Child Health Center, Copenhagen University and ICF International
Type: Journal Article | Journal: Nutrients | Year: 2016

This study aimed to describe the trends over four nationally representative Demographic Health Surveys (2000, 2005, 2010, and 2014) of the nutritional status of women of reproductive age in Cambodia and to assess the main factors of inequality with regards to nutrition. The prevalence of undernutrition and over-nutrition evolved in opposite trends from 2000 to 2014, with a significant decrease in underweight and a significant increase in overweight women. This results in a shift, with overweight prevalence in women being higher than underweight for the first time in 2014. Anemia was constantly high and still affected 45% of women in 2014. Multivariate analysis showed that age, wealth index, maternal education, number of children, year of survey, and anemia were contributing factors for being underweight. Being overweight was positively related to increase in age, wealth index, number of children, and year of survey; and negatively related to anemia and increase in education level. The risk of anemia was higher in the poorest households and for less-educated women and women living in rural areas. Consequently, policies should target the most vulnerable women, especially the youngest, and support integrated interventions in the health, social, and agriculture sectors to reduce inequalities in nutrition between women.


PubMed | 11 Health, Montpellier SupAgro, Maternal and Child Health Center, Copenhagen University and ICF International
Type: Published Erratum | Journal: Nutrients | Year: 2016

We would like to submit the following as a correction to our recently published paper [1] because of the use of the wrong cut-off for overweight.[...].

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