Friday, October 26, 2018

How a health and nutritional study is empowering researchers and participants in Cambodia

By Greg Jewell

Yin and his mother Leav Channy on their way
to the longitudinal study data collection site.
© UNICEF Cambodia/2018/Todd Brown

Ratanakiri, Cambodia, October 2018: Two-year-old Yin Ratana and his mother Leav Channy, a rice farmer, are on their way to a health and nutrition data collection site in the Yeak Lom commune in the province of Ratanakiri. Ratanakiri is about a nine-hour drive northeast of Phnom Penh—the nation’s capital—and is located near the Cambodian and Vietnamese/Laos border.

It is the monsoon season in Cambodia, and every day brings the threat of a torrential downpour. Like many of their neighbours, two-year-old Yin and his mother brave the elements to attend the data collection site, filled with eager and hopeful parents and their children.

Families in Yeak Lom are taking part in the UNICEF-supported research, implemented by NGO RACHA (Reproductive and Child Health Alliance), looking into the health and nutritional status of pregnant women, newborns, and young children in Ratanakiri, Kratie, and Phnom Penh.

The ground where Yin and his mother sit by a registration table is still muddy from the previous night’s rain. Two-year-old Yin has been enrolled in the study since his birth, and he appears excited by all the new people he sees in the village. He is the youngest of two children in his family, and this is his fifth follow-up appointment. 

Yin and his mother Leav Channy arrive at the registration table
for the longitudinal study taking place in their village.
© UNICEF Cambodia/2018/Todd Brown

When Yin was one year old, his mother learned from the study that he was malnourished. Malnutrition in children raises the risks of stunting – a condition where growth and development are impaired as a result of poor nutrition. A child is considered “stunted” if he or she is below average height for their age.

According to national data, 32 percent of children under the age of five in Cambodia were stunted as of 2014. This number was down from 45 percent in 2010 but still represents a significant problem as stunting has long-term adverse effects not only on the child but also for a country’s economic growth and development due to increased health care costs and lost productivity. In fact, today, malnutrition is among the most prevalent poverty-inducing factors in Cambodia.

To combat the effects of stunting, studies indicate the vital importance of nutrition between a woman’s pregnancy and her child’s second birthday, a period often referred to as the first 1,000 days of life which is associated with risks of irreversible effect. As such, UNICEF and RACHA’s longitudinal study collects data on women of reproductive age, pregnant women, lactating women, and children up to 24 months old.

Ms. Channy is very grateful for the data collectors coming to her village because without them: “I would have no way to know the status of my child’s health, or whether he is nourished or malnourished. A year ago, my baby was malnourished,” but because of RACHA and UNICEF’s intervention, “now he is healthy,” she added.

Besides taking basic measurements of children’s height and weight, UNICEF also intervenes and provides nutritional supplements in cases where a child is underweight or at risk of being malnourished. After UNICEF intervened and offered dietary supplements for Yin, Ms. Channy noticed an improvement in his appetite: “Before he didn’t like to eat too much rice, only a little bit,” she explains, “but after the intervention, he started to eat a lot of rice, and now he is healthy again.”

Two-year-old Yin Ratana being weighed
as part of the longitudinal study.
© UNICEF Cambodia/2018/Todd Brown

Ms. Channy says that she cannot recall any doctors ever coming to her village, so she always makes sure to attend the study when it comes to her village. The research is so important to her because it is the only way she can monitor her child’s progress and help him grow up healthy like his sister, Sok Rotanaklina, who previously took part in the research.

Ms. Channy’s daughter who also participated
in the longitudinal study, in the doorway of their family home.
© UNICEF Cambodia/2018/Todd Brown

The longitudinal study is not only helpful and empowering for the participants, but also for those conducting the research. Tech Seavyong—a nutrition specialist—is one of eight team leaders in the study that serves about 1,500 women and children in three districts of Ratanakiri. He got involved in the research to share his expertise to support families in rural communities without access to health care facilities. There is a stark difference in the nutritional status of those who live in rural areas compared to those who live in a city, which Mr. Seavyong identifies as a problem. “If we can help those in the rural provinces have a better understanding of their nutritional status, we can help our country reduce the number of children who become stunted,” he explains. “Those in the rural provinces tend not to have enough to eat, so many children become malnourished as a result.”

Team leader Tech Seavyong reviewing documents
for the longitudinal study.
© UNICEF Cambodia/2018/Todd Brown

Mr. Seavyong has been working on the study since its inception two and a half years ago and has noticed that many of the children who were at one time malnourished are much healthier now because of RACHA and UNICEF’s involvement.

Mr. Seavyong knows how important his job is, “Many people in the rural villages are poor, and they cannot access the health care system,” he said, “so by working on this study, I feel that I am helping to provide a form of health check-up, without them having to pay for it themselves.”

UNICEF Cambodia is supporting this study with funding from UNICEF China as well as the Australian, Korean, and Canadian Committees for UNICEF.

The longitudinal study conducted by RACHA and UNICEF is completing vital work to measure the nutritional status of women and infant children in Cambodia. This critical information can be used by the Government and aid organizations to better inform the allocation of resources to improve the lives of Cambodian children. But the study has also changed the lives of the researchers and participants in ways not initially envisaged. While the researchers’ work is not yet complete, much progress has been made. And the central question participants have is: “When will you be back?”

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