Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Public Health
Published in: BMC Public Health 1/2019

Open Access 01-12-2019 | Nutrition | Research article

Feeding practices and risk factors for chronic infant undernutrition among refugees and migrants along the Thailand-Myanmar border: a mixed-methods study

Authors: A. H. Hashmi, P. B. Nyein, K. Pilaseng, M. K. Paw, M. C. Darakamon, A. M. Min, P. Charunwatthana, F. Nosten, R. McGready, V. I. Carrara

Published in: BMC Public Health | Issue 1/2019

Login to get access

Abstract

Background

This study aims to provide a comprehensive understanding of maternal risk factors, infant risk factors and maternal infant feeding practices among refugees and migrants along the Thailand-Myanmar border.

Methods

This study employed a mixed-methods approach with two components: (1) cross-sectional survey (n = 390) and (2) focus group discussions (n = 63). Participants were chosen from one of three clinics providing antenatal and delivery services for Karen and Burman refugees and migrants along the border. Participants were pregnant women and mother-infant dyads.

Results

Refugee and migrant mothers demonstrated high rates of suboptimal breastfeeding and low rates of minimum dietary diversity and acceptable diet. Multivariable regression models showed infant stunting (AOR: 2.08, 95% CI: 1.12, 3.84, p = 0.020) and underweight (AOR: 2.26, 95% CI: 1.17, 4.36, p = 0.015) to have increased odds among migrants, while each 5 cm increase in maternal height had decreased odds of stunting (AOR: 0.50, 95% CI: 0.38, 0.66, p < 0.001) and underweight (AOR: 0.64, 95% CI: 0.48, 0.85, p = 0.002). In addition, small-for-gestational-age adjusted for length of gestation, infant age and gender increased odds of infant’s stunting (AOR: 3.42, 95% CI: 1.88, 6.22, p < 0.001) and underweight (AOR: 4.44, 95% CI: 2.36, 8.34, p < 0.001). Using the Integrated Behavioural Model, focus group discussions explained the cross-sectional findings in characterising attitudes, perceived norms, and personal agency as they relate to maternal nutrition, infant malnutrition, and infant feeding practices.

Conclusions

Inadequate infant feeding practices are widespread in refugee and migrant communities along the Thailand-Myanmar border. Risk factors particular to maternal nutrition and infant birth should be considered for future programming to reduce the burden of chronic malnutrition in infants.
Appendix
Available only for authorised users
Literature
1.
Adair LS. Long-term consequences of nutrition and growth in early childhood and possible preventive interventions. In: International nutrition: achieving millenium goals and beyond. Volume 78. Basel: Karger Publishers; 2014. p. 111–20.CrossRef
2.
Grantham-McGregor S, Cheung YB, Cueto S, Glewwe P, Richter L, Strupp B. Developmental potential in the first 5 years for children in developing countries. Lancet. 2007;369(9555):60–70.PubMedPubMedCentralCrossRef
3.
Miller SL, Huppi PS, Mallard C. The consequences of fetal growth restriction on brain structure and neurodevelopmental outcome. J Physiol. 2016;594(4):807–23.PubMedPubMedCentralCrossRef
4.
Victora CG, Adair L, Fall C, Hallal PC, Martorell R, Richter L, et al. Maternal and child undernutrition: consequences for adult health and human capital. Lancet. 2008;371(9609):340–57.PubMedPubMedCentralCrossRef
5.
Black RE, Victora CG, Walker SP, Bhutta ZA, Christian P, de Onis M, et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. 2013;382(9890):427–51.PubMedCrossRef
6.
Mason JB, Shrimpton R, Saldanha LS, Ramakrishnan U, Victora CG, Girard AW, et al. The first 500 days of life: policies to support maternal nutrition. Glob Health Action. 2015;8:23623.
7.
Prendergast AJ, Humphrey JH. Stunting persists despite optimal feeding: are toilets part of the solution? In: Low-birthweight baby: born too soon or too small. Volume 81. Basel: Kargers Publisher; 2015. p. 99–110.CrossRef
8.
Solomons NW, Vossenaar M, Chomat AM, Doak CM, Koski KG, Scott ME. Stunting at birth: recognition of early-life linear growth failure in the western highlands of Guatemala. Public Health Nutr. 2015;18(10):1737–45.PubMedCrossRef
9.
Victora CG, de Onis M, Hallal PC, Blossner M, Shrimpton R. Worldwide timing of growth faltering: revisiting implications for interventions. Pediatrics. 2010;125(3):e473–80.PubMedCrossRef
10.
Patil CL, Turab A, Ambikapathi R, Nesamvuni C, Chandyo RK, Bose A, et al. Early interruption of exclusive breastfeeding: results from the eight-country MAL-ED study. J Health Popul Nutr. 2015;34:10.PubMedPubMedCentralCrossRef
11.
Banjong O, Menefee A, Sranacharoenpong K, Chittchang U, Eg-kantrong P, Boonpraderm A, et al. Dietary assessment of refugees living in camps: a case study of Mae La camp, Thailand. Food Nutr Bull. 2003;24(4):360–7.PubMedCrossRef
12.
The Border Consortium. Nutrition survey report to CCSDPT health agencies. Bangkok: The Border Consortium; 2013.
13.
Dibley MJ, Senarath U, Agho KE. Infant and young child feeding indicators across nine east and southeast Asian countries: an analysis of National Survey Data 2000-2005. Public Health Nutr. 2010;13(9):1296–303.PubMedCrossRef
14.
Ministry of National Planning and Economic Development, Ministry of Health, UNICEF. Myanmar multiple indicator cluster survey 2009-2010. Nay Pyi Taw: Ministry of Health; 2011.
15.
Thet MM, Richards LM, Sudhinaraset M, Paw NE, Diamond-Smith N. Assessing rates of inadequate feeding practices among children 12-24 months: results from a cross-sectional survey in Myanmar. Matern Child Health J. 2016;20(8):1688–95.PubMedCrossRef
16.
Ota E, Haruna M, Suzuki M, Anh DD, Tho LH, Tam NTT, et al. Maternal body mass index and gestational weight gain and their association with perinatal outcomes in Viet Nam. Bull World Health Organ. 2011;89:127–36.PubMedCrossRef
17.
Isaranurug S, Mo-suwan L, Choprapawon C. A population-based cohort study of effect of maternal risk factors on low birthweight in Thailand. J Med Assoc Thai. 2007;12:2559–64.
18.
Liu Y, Dai W, Dai X, Li Z. Prepregnancy body mass index and gestational weight gain with the outcome of pregnancy: a 13-year study of 292,568 cases in China. Arch Gynecol Obstet. 2012;4:905–11.CrossRef
19.
Nohr EA, Vaeth M, Baker JL, Sorensen TI, Olsen J, Rasmussen KM. Pregnancy outcomes related to gestational weight gain in women defined by their body mass index, parity, height, and smoking status. Am J Clin Nutr. 2009;5:1288–94.CrossRef
20.
Bodnar LM, Siega-Riz AM, Simhan HN, Himes KP, Abrams B. Severe obesity, gestational weight gain, and adverse birth outcomes. Am J Clin Nutr. 2010;6:1642–8.CrossRef
21.
Kiel DW, Dodson EA, Artal R, Boehmer TK, Leet TI. Gestational weight gain and pregnancy outcomes in obese women: how much is enough? Obstet Gynecol. 2007;4:752–8.CrossRef
22.
Kozuki N, Katz J, Lee ACC, Vogel JP, Silveira MF, Sania A, et al. Short maternal stature increases risk of small-for-gestational-age and preterm births in low- and middle-income countries: individual participant data meta-analysis and population attributable fraction. J Nutr. 2019;145:2542–50.
23.
24.
25.
Cetthakrikul N, Topothai C, Suphanchaimat R, Tisayaticom K, Limwattananon S, Tangcharoensathien V. Childhood stunting in Thailand: when prolonged breastfeeding interacts with household poverty. BMC Pediatr. 2018;18:395.PubMedPubMedCentralCrossRef
26.
Hazir T, Senarath U, Agho K, Akram D, Kazmi N, Abbasi S, et al. Determinants of inappropriate timing of introducing solid, semi-solid or soft food to infants in Pakistan: secondary data analysis of demographic and health survey 2006-2007. Maternal Child Nutr. 2012;8(S1):78–88.CrossRef
27.
Kabir I, Khanam M, Agho KE, Mihrshahi S, Dibley MJ, Roy SK. Determinants of inappropriate complementary feeding practices in infant and young children in Bangladesh: secondary data analysis of demographic health survey 2007. Matern Child Nutr. 2012;8(S1):11–27.PubMedCrossRef
28.
Patel A, Pusdekar Y, Badhoniya N, Borkar J, Agho KE, Dibley MJ. Determinants of inappropriate complementary feeding practices in young children in Nepal: secondary data analysis of National Family Health Survey 2005-2006. Matern Child Nutr. 2012;8(S1):28–44.PubMedCrossRef
29.
Senarath U, Agho KE, Akram D, Godakandage SSP, Hazir T, Jayawickrama H, et al. Comparisons of complementary feeding indicators and associated factors in children aged 6–23 months across five south Asian countries. Matern Child Nutr. 2012;8(S1):89–106.PubMedCrossRef
30.
Senarath U, Godakandage SSP, Jayawickrama H, Siriwardena I, Dibley MJ. Determinants of inappropriate complementary feeding practices in young children in Sri Lanka: secondary data analysis of demographic and health survey 2006–2007. Matern Child Nutr. 2012;8(S1):60–77.PubMedCrossRef
31.
Joshi N, Agho KE, Dibley MJ, Senarath U, Tiwari K. Determinants of inappropriate complementary feeding practices in young children in Nepal: secondary data analysis of demographic and health survey 2006. Matern Child Nutr. 2012;8(S1):45–59.CrossRef
32.
Carrara VI, Hogan C, de Pree C, Nosten F, McGready R. Improved pregnancy outcome in refugees and migrants despite low literacy on the Thai-Burmese border: results of three cross-sectional surveys. BMC Pregnancy Childbirth. 2011;11:45.PubMedPubMedCentralCrossRef
33.
Luxemburger C, White NJ, ter Kuile F, Singh HM, Allier-Frachon I, Ohn M, et al. Beri-beri: the major cause of infant mortality in Karen refugees. Trans Royal Soc Trop Med Hyg. 2003;97:251–5.CrossRef
34.
Marriott BP, White A, Hadden L, Davies JC, Wallingford JC. World Health Organization (WHO) infant and young child feeding indicators: associations with growth measures in 14 low-income countries. Matern Child Nutr. 2012;8(3):354–70.PubMedCrossRef
35.
White AL, Carrara VI, Paw MK, Malika, Dahbu C, Gross MM, et al. High initiation and long duration of breastfeeding despite absence of early skin-to-skin contact in Karen refugees on the Thai-Myanmar border: a mixed methods study. Int Breastfeeding J. 2012;7:19.CrossRef
36.
Hashmi AH, Solomon N, Lee SJ, Min AM, Gilder ME, Wiladphaingern J, et al. Nutrition in transition: historical cohort analysis summarising trends in under- and over-nutrition among pregnant women in a marginalised population along the Thailand-Myanmar border from 1986 to 2016. Brit J Nutr. 2019;121:1413–23.PubMedCrossRef
37.
The Border Consortium. Myanmar: refugee and IDP Camp populations: Jul 2014. Bangkok: The Border Consortium; 2014.
38.
Carrara V, Lwin K, Phyo A, Ashley E, Wiladphaingern J, Sriprawat K, et al. Malaria burden and artemisinin resistance in the mobile and migrant population on the Thai-Myanmar border, 1999-2011: an observational study. PLoS Med. 2013;10(3):e1001398.PubMedPubMedCentralCrossRef
39.
World Health Organization. Indicators for assessing infant and young child feeding practices: part 2: measurement. Geneva: WHO; 2010.
40.
UNICEF, National Statistical Office. (Thailand), Ministry of Public Health (Thailand): Thailand multiple Indicator cluster survey 2012. Bangkok: National Statistical Office; 2012.
41.
Glanz K, Rimer BK, Viswanath K. Health behavior and health education: theory, research and practice. San Fransisco: Jossey-Bass; 2008.
42.
Montaño DE, Kasprzyk D. Theory of reasoned action, theory of planned behavior, and the integrated behavioral model. In: Glanz K, Rimer BK, Viswanath K, editors. Health behavior and health education: theory, research, and practice. San Fransisco: Jossey-Bass; 2008. p. 67–96.
43.
Jaccard J, Dodge T, Dittus P. Parent-adolescent communication about sex and birth control: a conceptual framework. New Dir Child Adolesc Dev. 2002;97:9–41.CrossRef
44.
Dawson S, Manderson L, Tallo VL. A manual for the use of focus groups. Boston: International Nutrition Foundation for Developing Countries; 1993.
45.
World Health Organization Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363(9403):157–63.CrossRef
46.
World Health Organization. WHO recommendations on antenatal care for a positive pregnancy experience. Geneva: WHO; 2016.
47.
Rijken M, De Livera A, Lee S, Boel M, Rungwilailaekhiri S, Wiladphaingern J, et al. Quantifying low birth weight, preterm birth and small-for-gestational-age effects of malaria in pregnancy: a population cohort study. PLoS One. 2014;9(7):e100247.PubMedPubMedCentralCrossRef
48.
Leung TN, Pang MW, Daljit SS, Leung TY, Poon CF, Wong SM, et al. Fetal biometry in ethnic Chinese: biparietal diameter, head circumference, abdominal circumference and femur length. Ultrasound Obstet Gynecol. 2008;31(3):321–7.PubMedCrossRef
49.
Villar J, Cheikh Ismail L, Staines Urias E, Giuliani F, Ohuma EO, Victora CG, et al. The satisfactory growth and development at 2 years of age of the INTERGROWTH-21st fetal growth standards cohort support its appropriateness for constructing international standards. Am J Obstet Gynecol. 2018;218(2S):S841–54.
50.
WHO Multicentre Growth Reference Study Group. WHO child growth standards based on length/height, weight and age. Acta Paediatrica. 2006;95:76–85.
51.
Malterud K. Qualitative research: standards, challenges, and guidelines. Lancet. 2001;358(9280):483–8.PubMedCrossRef
52.
Hashmi AH, Paw MK, Nosten S, Darakamon MC, Gilder ME, Charunwatthana P, et al. “Because the baby asks for it”: a mixed-methods study on local perceptions toward nutrition during pregnancy among marginalised migrant women along the Myanmar-Thailand border. Glob Health Action. 2018;11(1):1473104.PubMedPubMedCentralCrossRef
53.
Barker M, Dombrowski SU, Colbourn T, Fall CHD, Kriznik NM, Lawrence WT, et al. Intervention strategies to improve nutrition and health behaviours before conception. Lancet. 2018;391:1853–64.PubMedPubMedCentralCrossRef
54.
Bhutta Z, Das JK, Rizvi A, Gaffey M, Walker N, Horton S, et al. Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? Lancet. 2013;382:452–77.CrossRefPubMed
55.
Stephenson J, Heslehurst N, Hall J, Shoenaker DAJM, Hutchinson J, Cade JE, et al. Before the beginning: nutrition and lifestyle in the preconception period and its importance for future health. Lancet. 2018;391:1830–41.PubMedPubMedCentralCrossRef
56.
Myint CY, International Rescue Committee, The Border Consortium. Improving nutrition and health service delivery in refugee camps along the Thailand-Burma/Myanmar border. Bangkok: The Border Consortium; 2014.
57.
de Sa J, Bouttasing N, Sampson L, Perks C, Osrin D, Prost A. Identifying priorities to improve maternal and child nutrition among the Khmu ethnic group, Laos: a formative study. Matern Child Nutr. 2013;9(4):452–66.PubMedCrossRef
58.
Fellmeth G, Plugge E, Paw MK, Charunwatthana P, Nosten F, McGready R. Pregnant migrant and refugee women's perceptions of mental illness on the Thai-Myanmar border: a qualitative study. BMC Pregnancy Childbirth. 2015;15:93.PubMedPubMedCentralCrossRef
59.
Holmes W, Hoy D, Lockley A, Thamavongxay K, Bounnaphol S, Xeuatvongsa A, et al. Influences on maternal and child nutrition in the highlands of teh northern Lao PDR. Asia Pac J Clin Nutr. 2007;16(3):537–45.PubMed
60.
Marriott BP, White AJ, Hadden L, Davies JC, Wallingford JC. How well are infant and young child World Health Organization (WHO) feeding indicators associated with growth outcomes? An example from Cambodia. Matern Child Nutr. 2010;6(4):358–73.PubMedCrossRefPubMedCentral
61.
Mullany LC, Lee CI, Yone L, Paw P, Oo EKS, Maung C, et al. Access to essential maternal health interventions and human rights violations among vulnerable communities in eastern Burma. PLoS Med. 2008;5(12):e242.PubMedCentralCrossRef
62.
Wren H, Chambers L. Breastfeeding in Cambodia: mother knowledge, attitudes and practices. World Health Popul. 2011;13(1):17–29.PubMedCrossRef
63.
Barennes H, Simmala C, Odermatt P, Thaybouavone T, Vallee J, Martinez-Ussel B, et al. Postpartum traditions and nutrition practices among urban Lao women and their infants in Vientiane, Lao PDR. Eur J Clin Nutr. 2009;63(3):323–31.PubMedCrossRef
64.
Chandrashekhar TS, Joshi HS, Binu V, Shankar PR, Rana MS, Ramachandran U. Breast-feeding initiation and determinants of exclusive breast-feeding - a questionnaire survey in an urban population of western Nepal. Public Health Nutr. 2007;10(2):192–7.PubMedCrossRef
65.
Osrin D, Tumbahangphe KM, Shrestha D, Mesko N, Shrestha BP, Manandhar MK, et al. Cross sectional, community based study of care of newborn infants in Nepal. BMJ. 2002;325:1063.PubMedPubMedCentralCrossRef
66.
Rasheed S, Haider R, Hassan N, Pachón H, Islam S, Jalal CSB, et al. Why does nutrition deteriorate rapidly among children under 2 years of age? Using qualitative methods to understand community perspectives on complementary feeding practices in Bangladesh. Food Nutr Bull. 2011;32(3):192–200.PubMedCrossRef
67.
Raven JH, Chen Q, Tolhurst RJ, Garner P. Traditional beliefs and practices in the postpartum period in Fujian Province, China: a qualitative study. BMC Pregnancy Childbirth. 2007;7:8.PubMedPubMedCentralCrossRef
68.
Tarrant M, Dodgson JE, Fei ST. Initiating and sustaining breastfeeding in Hong Kong: contextual influences on new mothers’ experiences. Nurs Health Sci. 2002;4:181–91.PubMedCrossRef
69.
Ambikapathi R, Kosek MN, Lee GO, Mahopo C, Patil CL, Maciel BL, et al. How multiple episodes of exclusive breastfeeding impact estimates of exclusive breastfeeding duration: report from the eight-site MAL-ED birth cohort study. Matern Child Nutr. 2016;12(4):740–56.PubMedPubMedCentralCrossRef
70.
Aubel J, Touré I, Diagne M. Senegalese grandmothers promote improved maternal and child nutrition practices: the guardians of tradition are not averse to change. Social Sci Med. 2004;59(5):945–59.CrossRef
71.
Lassi ZS, Bhutta ZA. Community-based intervention packages for reducing maternal and neonatal morbidity and mortality and improving neonatal outcomes. Cochrane Database Sys Rev. 2015;3:CD007754.
72.
Hashmi A, Carrara VI, Nyein PB, Darakamon MC, Charunwatthana P, McGready R. The healthy baby flipbook: piloting home-based counseling for refugee mothers to improve infant feeding and water, sanitation, and hygiene (WASH) practices. Glob Health Action. 2019;12(1):1560115.PubMedPubMedCentralCrossRef
73.
Imdad A, Yakoob MY, Bhutta ZA. Effect of breastfeeding promotion interventions on breastfeeding rates, with special focus on developing countries. BMC Public Health. 2011;11(Suppl 3):524.
74.
Adegboye ARA, Linne YM. Diet or exercise, or both, for weight reduction in women after childbirth. Cochrane Database Sys Rev. 2013;7:CD004905.
75.
Haider BA, Bhutta ZA. Multiple-micronutrient supplementation for women during pregnancy. Cochrane Database Sys Rev. 2017;4:CD004905.
76.
Abe SK, Balogun OO, Ota E, Takahashi K, Mori R. Supplementation with multiple micronutrients for breastfeeding women for improving outcomes for the mother and baby. Cochrane Database Sys Rev. 2016;2:CD010647.
77.
Imdad A, Bhutta ZA. Maternal nutrition and birth outcomes: effect of balanced protein-energy supplementation. Paediatr Perinat Epidemiol. 2012;26(Suppl 1):178–90.PubMedCrossRef
Metadata
Title
Feeding practices and risk factors for chronic infant undernutrition among refugees and migrants along the Thailand-Myanmar border: a mixed-methods study
Authors
A. H. Hashmi
P. B. Nyein
K. Pilaseng
M. K. Paw
M. C. Darakamon
A. M. Min
P. Charunwatthana
F. Nosten
R. McGready
V. I. Carrara
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2019
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-019-7825-7

Other articles of this Issue 1/2019

BMC Public Health 1/2019 Go to the issue

Research article

Physical rehabilitation in the context of a landslide that occurred in Brazil

Research article

Epidemiological investigation on hand hygiene knowledge and behaviour: a cross-sectional study on gender disparity

Research article

Exploring HIV concern in a population of Dominican American women midlife and older

Research article

Moderating role of job satisfaction on turnover intention and burnout among workers in primary care institutions: a cross-sectional study

Research article

Establishing a theoretical foundation for measuring global health security: a scoping review

Research article

Infancy weight gain, parental socioeconomic position, and childhood overweight and obesity: a Danish register-based cohort study