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Abstract
BackgroundA low-intensity armed conflict has been occurring for nearly a decade in southernmost region of Thailand. However, its impact on child health has not yet been investigated. This study aimed to estimate the prevalence of delayed child growth and development in the affected areas and to determine the association between the violence and health among children aged 1–5 years.MethodsA total of 498 children aged 1–5 years were recruited. Intensity of conflict for each sub-district was calculated as the 6-year average number of incidents per 100,000 population per year and classified into quartiles. Growth indices were weight-for-age, height-for-age, and weight-for-height, while development was measured by the Denver Development Screening Test II (Thai version). Food insecurity, child-rearing practice, health service accessibility, household sanitation, and depression among the caregivers were assessed using screening scales and questionnaires. Contextual information such as average income and numbers of violent events in each sub-district was obtained from external sources.ResultsGrowth retardation was highly prevalent in the area as reported by rates of underweight, stunting, and wasting at 19.3%, 27.6% and 7.4%, respectively. The prevalence of developmental delay was also substantially high (37.1%). Multi-level analysis found no evidence of association between insurgency and health outcomes. However, children in areas with higher intensity of violence had a lower risk of delay in personal-social development (OR = 0.4; 95% CI = 0.2 - 0.9; p-value = 0.05).ConclusionUnlike war refugees and internally-displaced persons in camp-like settings, the relationship between level of armed conflict and growth and developmental delay among children aged 1–5 years could not be demonstrated in the community setting of this study where food supply had been minimally perturbed.
Highlights
A low-intensity armed conflict has been occurring for nearly a decade in southernmost region of Thailand
This study found no association between low-intensity of armed conflict and child growth, other common risk factors for child growth retardation were reported, including birth weight and ethnicity
This study found that children in areas with higher intensity of violence due to the conflict were less likely to have personal-social developmental delay
Summary
A low-intensity armed conflict has been occurring for nearly a decade in southernmost region of Thailand. This study aimed to estimate the prevalence of delayed child growth and development in the affected areas and to determine the association between the violence and health among children aged 1–5 years. Children residing in areas of war or armed conflicts are at high risk of growth. In Thailand, ongoing armed conflicts in the southernmost provinces have affected Thai security officers, health workers, school teachers, and ordinary civilians alike since January 2004, with an injury rate of 1.0 per 100,000 persons per year and mortality rate of 1.2 per. Other surveys have reported a high prevalence of growth retardation and low school achievement among children in the area [13,14,15]
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