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Sulistiyowati N, Tjandrarini DH, Titaley CR, Que BJ, Hidayangsih PS, Suparmi, Sudikno S, Purwatiningsih Y, Indrawati L, Siahaan S, Adyarani WP. Suboptimal child healthcare practices and the development of multiple infectious diseases in children aged 24-59 months. Front Public Health 2024; 12:1340559. [PMID: 38504680 PMCID: PMC10948606 DOI: 10.3389/fpubh.2024.1340559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 01/24/2024] [Indexed: 03/21/2024] Open
Abstract
Background Infections continue to be a major cause of death among children under the age of five worldwide. This study aimed to identify the factors associated with the development of multiple infectious diseases in children aged 24-59 months in Indonesia. Methods Data from the 2018 Basic Health Research conducted by the Ministry of Health, Republic of Indonesia, were used. Information from 39,948 children aged 24-59 months was analyzed. The outcome variable was the development of multiple infectious diseases, that is, acute respiratory infections, pneumonia, pulmonary tuberculosis, diarrhea, and hepatitis, in the month before the survey. Factors significantly associated with multiple types of infectious diseases were examined using logistic regression. Results The study found that 76.6% of children aged 24 to 59 months in Indonesia had at least one type of infectious disease. The likelihood of developing multiple types of infectious diseases increased in children whose parents did not practice appropriate handwashing with soap and running water [adjusted odds ratio (aOR) = 1.16, p < 0.001], those who received supplemental food (aOR = 1.38, p < 0.001), those with poor nutritional status (aOR = 1.12, p < 0.001), and those living in urban areas (aOR = 1.07, p = 0.045). Conclusion Improving caregivers' awareness of adequate child healthcare practices, in addition to nutrition-sensitive and specific interventions to improve children's nutritional status, is required to prevent children from contracting multiple types of infectious diseases.
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Affiliation(s)
- Ning Sulistiyowati
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Bogor, Indonesia
| | - Dwi Hapsari Tjandrarini
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Bogor, Indonesia
| | | | - Bertha J. Que
- Faculty of Medicine, Pattimura University, Ambon, Indonesia
| | - Puti Sari Hidayangsih
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Bogor, Indonesia
| | - Suparmi
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Bogor, Indonesia
| | - Sudikno Sudikno
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Bogor, Indonesia
| | - Yuni Purwatiningsih
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Bogor, Indonesia
| | - Lely Indrawati
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Bogor, Indonesia
| | - Selma Siahaan
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Bogor, Indonesia
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Turton B, Sullivan S, Chher T, Hak S, Sokal-Gutierrez K, Wieringa F, Singh A. Caries Incidence Is Associated with Wasting among Cambodian Children. J Dent Res 2023; 102:157-163. [PMID: 36217721 DOI: 10.1177/00220345221126713] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Evidence suggests that dental caries is associated with chronic and acute malnutrition, manifested as stunting and wasting in children. However, studies have not always appropriately accounted for confounding factors or for the temporal ordering between exposure and outcome. This study examined relationships between the development of caries lesions with subsequent stunting and wasting outcomes using data from a population-based cohort in Cambodia. Caries incidence was assessed based on the presence of a new cavitated carious lesion or a new pulpally involved lesion across a 6-mo observation period. Anthropometric measurements were taken at regular intervals. Effects of carious lesions on stunting and wasting were assessed using inverse probability treatment weighting, adjusting for potential confounders, using z scores for height-for-age (HAZ) and weight-for-height (WHZ) as outcomes. In total, 894 children (mean age 20 mo at baseline) were followed over 2 y. At baseline, 350 (39.1%) were identified as having stunting malnutrition. At follow-up, 58 (6.5%) had a new pulpally involved lesion. There was no association between incidence of cavitated or pulpally involved carious lesions at follow-up and stunting (relative risk [RR] = 1.06; 95% confidence interval [CI]: 0.75, 1.50). The incidence of pulpally involved carious lesions had an effect on wasting prevalence (WHZ <-2; RR = 1.35; 95% CI: 0.70, 2.62) and WHZ scores (average treatment effect = -0.294; 95% CI: -0.538, -0.050). This study offers evidence that the development of pulpally involved carious lesions has an effect on WHZ scores. Oral health promotion and clinical prevention and management of dental caries should be explored as interventions to promote normal growth and development among preschool children, particularly in low-income settings.
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Affiliation(s)
- B Turton
- University of Puthisastra and Boston University, Boston, MA, USA
| | - S Sullivan
- WHO Collaborating Centre for Reference and Research on Influenza, Royal Melbourne Hospital, and Department of Infectious Diseases, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - T Chher
- Oral Health Bureau, Department of Preventive Medicine, Ministry of Health, Phnom Penh, Cambodia
| | - S Hak
- Oral Health Bureau, Department of Preventive Medicine, Ministry of Health, Phnom Penh, Cambodia
| | | | - F Wieringa
- UMR QualiSud (Université Montpellier, Université Avignon, CIRAD, Institut Agro, IRD, Université de la Réunion), French National Research Institute for Sustainable Development (IRD), Montpellier, France
| | - A Singh
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.,Melbourne Dental School, University of Melbourne, Melbourne, Victoria, Australia
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Chowdhury N, Turton B, Chher T, Hak S, Hondru G, Sokal-Gutierrez K. Relationship between Early Childhood Caries and Prolonged Coughing Episodes in a Cohort of Cambodian Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12842. [PMID: 36232141 PMCID: PMC9566348 DOI: 10.3390/ijerph191912842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 06/16/2023]
Abstract
Studies have shown an association between Early Childhood Caries (ECC) and respiratory infections; however, most have been cross-sectional, and all have been in high-income countries. Inverse probability treatment weighting (IPTW) was applied to longitudinal data from the Cambodia Health and Nutrition Monitoring Study. An analytical sample of 1703 Cambodian children between 1- and 4-years old was used to examine the effect of caries incidence (ECC Activity) on the odds of a child subsequently experiencing an episode of prolonged coughing (>14 days) over the subsequent 18 m. ECC activity occurred among 523 children (30.7%) while prolonged coughing was observed among 235 children (13.8%). ECC activity increased the risk of prolonged coughing (RR 1.23; 95% CI 0.95, 1.58; Average treatment effect = 3%). Follow-up investigations are justified in order to examine whether ECC may be a modifiable risk factor for prevention of respiratory illness among young children.
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Affiliation(s)
- Noureen Chowdhury
- Faculty of Dentistry, University of Puthisastra, Phnom Penh 120211, Cambodia
| | - Bathsheba Turton
- Faculty of Dentistry, University of Puthisastra, Phnom Penh 120211, Cambodia
- Office of Global and Population Health, Henry M. Goldman School of Dental Medicine, Boston University, Bostson, MA 02118, USA
| | - Tepirou Chher
- Oral Health Bureau, Department of Preventive Medicine, Ministry of Health, Phnom Penh 12151, Cambodia
| | - Sithan Hak
- Oral Health Bureau, Department of Preventive Medicine, Ministry of Health, Phnom Penh 12151, Cambodia
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Turton B, Chher T, Hak S, Sokal-Gutierrez K, Lopez Peralta D, Laillou A, Singh A. Associations between dental caries and ponderal growth in children: A Cambodian study. J Glob Health 2022; 12:04046. [PMID: 35713031 PMCID: PMC9204672 DOI: 10.7189/jogh.12.04046] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Background The evidence around the relationship between Early Childhood Caries (ECC) and undernutrition is sparse and mostly reported from cross-sectional data sets. This paper aimed to test the relationship between ECC and linear and ponderal growth trajectories. Methods This project involves secondary data analysis from the Cambodia Longitudinal Health and Nutrition Study. The analytical sample included a 2y-cohort of 894 children who were younger than 2 years of age at the time of first height and weight measurement. Statistical analysis used both logistic regression modelling and Latent Class Analysis to examine the effect of exposure to dental caries in the first 1000 days on weight for height Z-score (WHZ) and height for age Z-score (HAZ) trajectory class groups. The presence of any cavity and pulp involvement were examined using multinomial regression adjusting for gender, socioeconomic status, maternal age and education. Findings Within each class groupings (HAZ and WHZ groupings), there was a trend whereby those with one or more cavities had lower Z-scores across the three follow-up time points of observation. There was an association between exposure to caries and WHZ class membership whereby children with caries exposure were more likely belong to WHZ class groups with lower Z-scores over time. Conclusions The study offers evidence that ECC is correlated with less favourable ponderal growth categorized by WHZ trajectory class groups.
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Affiliation(s)
- Bathsheba Turton
- University of Puthisastra, Phnom Penh, Cambodia.,Henry M. Goldman School of Dental Medicine, Boston University, Boston, Massachusetts, USA
| | - Tepirou Chher
- Oral Health Bureau, Department of Preventive Medicine, Ministry of Health, Phnom Penh, Cambodia
| | - Sithan Hak
- Oral Health Bureau, Department of Preventive Medicine, Ministry of Health, Phnom Penh, Cambodia
| | | | - Diego Lopez Peralta
- Centre for Epidemiology and Biostatistics and Melbourne Dental School, University of Melbourne, Melbourne, Australia
| | | | - Ankur Singh
- Centre for Epidemiology and Biostatistics and Melbourne Dental School, University of Melbourne, Melbourne, Australia
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Mutunga M, Rutishauser-Perera A, Laillou A, Prak S, Berger J, Wieringa FT, Bahwere P. The relationship between wasting and stunting in Cambodian children: Secondary analysis of longitudinal data of children below 24 months of age followed up until the age of 59 months. PLoS One 2021; 16:e0259765. [PMID: 34794170 PMCID: PMC8601787 DOI: 10.1371/journal.pone.0259765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 10/27/2021] [Indexed: 01/22/2023] Open
Abstract
The interrelationship between wasting and stunting has been poorly investigated. We assessed the association between two indicators of linear growth, height-for-age Z-score (HAZ) change and occurrence of accelerated linear growth, and selected indicators of wasting and wasting reversal in 5,172 Cambodian children aged less than 24 months at enrolment in the 'MyHealth' study. The specific objectives were to evaluate the relationship between temporal changes in wasting and 1) change in HAZ and 2) episodes of accelerated linear growth. At enrolment, the stunting and wasting prevalence were 22.2 (21.0;23.3) % and 9.1 (8.1;10.1) %, respectively, and reached 41.4 (39.3;43.6) %, and 12.4 (11.5;13.3) % respectively, two years later. Between 14-19% of stunted children were also wasted throughout the whole study period. For each centimetre increase in Mid-Upper Arm Circumference (MUAC) from the previous assessment, the HAZ increased by 0.162 (0.150; 0.174) Z-score. We also observed a delayed positive association between the weight for height Z score (WHZ) unit increase and HAZ change of +0.10 to +0.22 units consistent with a positive relationship between linear growth and an increase in WHZ occurring with a lag of approximately three months. A similar positive correlation was observed for the occurrence of an episode of accelerated linear growth. These results show that interventions to prevent and treat wasting can contribute to stunting reduction and call for integrated wasting and stunting programming.
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Affiliation(s)
- Mueni Mutunga
- United Nations Children’s Fund (UNICEF) East Asia Pacific Regional Office, Bangkok, Thailand
| | | | - Arnaud Laillou
- United Nations Children’s Fund (UNICEF), Addis Ababa, Ethiopia
| | - Sophonneary Prak
- National Nutrition Program, Maternal and Child Health Center, Phnom Penh, Cambodia
| | - Jacques Berger
- Institut de Recherche pour le De´veloppement, Montpellier, France
| | | | - Paluku Bahwere
- Centre de Recherche en Epidémiologie, Biostatistique et Recherche Clinique, Ecole de santé publique, Université Libre de Bruxelles, Brussels, Belgium
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Methun MIH, Kabir A, Islam S, Hossain MI, Darda MA. A machine learning logistic classifier approach for identifying the determinants of Under-5 child morbidity in Bangladesh. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021. [DOI: 10.1016/j.cegh.2021.100812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Windus JL, Burrows TL, Duncanson K, Collins CE, Rollo ME. Scoping review of nutrition intervention and dietary assessment studies in Khmer populations living in Cambodia. J Hum Nutr Diet 2021; 34:953-968. [PMID: 34231266 DOI: 10.1111/jhn.12932] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 06/04/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND This scoping review aims to describe the body of nutrition intervention and dietary assessment research undertaken with Khmer populations in Cambodia, as well as summarise the nutrition knowledge base and highlight priority areas for future research. METHODS Five databases and the grey literature were searched, following PRISMA-ScR guidelines. Studies involving dietary assessment or nutrition interventions published after 1992 were identified using specific search terms and extracted to a customised data extraction table for categorisation and analysis. Study participants were Khmer people of any age and gender, living in rural or urban Cambodia. RESULTS Of the 100 included studies, 58 were dietary assessment only studies, 24 were nutrition interventions only, and 18 studies involved both assessment of intake and an intervention. Sixty-eight percent of study populations were mothers and young children, of which 52 studies focused on children aged under 5 years. Nineteen interventions involved supplementation and six trialled fortification of rice or fish sauce. Anaemia was the most common nutrition condition studied (n = 17), followed by malnutrition (n = 15) and malnutrition risk factors (n = 11). General nutrition status was explored in 25 studies, and individual micronutrients that were studied included iron (n = 27), zinc (n = 6), vitamin A (n = 4) and thiamine (n = 3). CONCLUSIONS Diet-related research in Khmer populations in Cambodia has predominantly focused on dietary assessment or evaluation of interventions aimed at reducing malnutrition and resolving micronutrient deficiencies. Areas identified as emerging needs included non-communicable diseases, the ageing population and non-iron deficiency anaemia.
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Affiliation(s)
- Janelle L Windus
- Faculty of Health and Medicine, School of Health Sciences University of Newcastle, University Drive, Callaghan, NSW, Australia
| | - Tracy L Burrows
- Faculty of Health and Medicine, School of Health Sciences University of Newcastle, University Drive, Callaghan, NSW, Australia
| | - Kerith Duncanson
- Faculty of Health and Medicine, School of Health Sciences University of Newcastle, University Drive, Callaghan, NSW, Australia
| | - Clare E Collins
- Faculty of Health and Medicine, School of Health Sciences University of Newcastle, University Drive, Callaghan, NSW, Australia
| | - Megan E Rollo
- Faculty of Health and Medicine, School of Health Sciences University of Newcastle, University Drive, Callaghan, NSW, Australia
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Odei Obeng-Amoako GA, Karamagi CAS, Nangendo J, Okiring J, Kiirya Y, Aryeetey R, Mupere E, Myatt M, Briend A, Kalyango JN, Wamani H. Factors associated with concurrent wasting and stunting among children 6-59 months in Karamoja, Uganda. MATERNAL AND CHILD NUTRITION 2020; 17:e13074. [PMID: 32830434 PMCID: PMC7729532 DOI: 10.1111/mcn.13074] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 07/25/2020] [Accepted: 08/05/2020] [Indexed: 01/01/2023]
Abstract
Children with concurrent wasting and stunting (WaSt) and children with severe wasting have a similar risk of death. Existing evidence shows that wasting and stunting share similar causal pathways, but evidence on correlates of WaSt remains limited. Research on correlates of WaSt is needed to inform prevention strategies. We investigated the factors associated with WaSt in children 6–59 months in Karamoja Region, Uganda. We examined data for 33,054 children aged 6–59 months using June 2015 to July 2018 Food Security and Nutrition Assessment in Karamoja. We defined WaSt as being concurrently wasted (weight‐for‐height z‐scores <−2.0) and stunted (height‐for‐age z‐score <−2.0). We conducted multivariate mixed‐effect logistic regression to assess factors associated with WaSt. Statistical significance was set at p < 0.05. In multivariate analysis, being male (adjusted odds ratio [aOR] = 1.79; 95% confidence interval [CI] [1.60–2.00]), aged 12–23 months (aOR = 2.25; 95% CI [1.85–2.74]), 36–47 months (aOR = 0.65; 95% CI [0.50–0.84]) and 48–59 months (aOR = 0.71; 95% CI [0.54–0.93]) were associated with WaSt. In addition, acute respiratory infection (aOR = 1.30; 95% CI [1.15–1.48]), diarrhoea (aOR = 1.25; 95% CI [1.06–1.48]) and malaria/fever (aOR = 0.83; 95% CI [0.73–0.96]) episodes were associated with WaSt. WaSt was significantly associated with maternal underweight (body mass index <18.5 kg/m2), short stature (height <160 cm), low mid‐upper arm circumference (MUAC <23 cm) and having ≥4 live‐births. WaSt was prevalent in households without livestock (aOR = 1.30; 95% CI [1.13–1.59]). Preventing the occurrence of WaSt through pragmatic and joint approaches are recommended. Future prospective studies on risk factors of WaSt to inform effective prevention strategies are recommended.
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Affiliation(s)
| | - Charles Amnon Sunday Karamagi
- Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.,Department of Paediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Joanita Nangendo
- Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Jaffer Okiring
- Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Yerusa Kiirya
- Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Ezekial Mupere
- School of Public Health, University of Ghana, Accra, Ghana
| | - Mark Myatt
- Brixton Health, Llawryglyn, Powys, Wales, UK
| | - André Briend
- School of Medicine, Centre for Child Health Research, University of Tampere, Tampere, Finland.,Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Joan Nakayaga Kalyango
- Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.,Department of Pharmacy, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Henry Wamani
- Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
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Kpewou DE, Poirot E, Berger J, Som SV, Laillou A, Belayneh SN, Wieringa FT. Maternal mid-upper arm circumference during pregnancy and linear growth among Cambodian infants during the first months of life. MATERNAL AND CHILD NUTRITION 2020; 16 Suppl 2:e12951. [PMID: 32835455 PMCID: PMC7591302 DOI: 10.1111/mcn.12951] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 12/19/2019] [Accepted: 01/03/2020] [Indexed: 12/28/2022]
Abstract
Stunting prevalence among children under 5 years remains high in Cambodia, affecting about one-third of children. In most low- and middle-income countries, linear growth faltering of young children starts in the womb. The 1,000-days window of opportunity to improve child nutritional status includes pregnancy, as maternal nutritional status is an important determinant of birthweight and child development. In Cambodia, nutritional status of pregnant women is poor, with some studies reporting >20% of pregnant women having a low mid-upper arm circumference (MUAC < 23 cm). Few studies have investigated associations between maternal nutritional status during pregnancy and neonatal growth. Using data from a Cambodian cohort study conducted from 2016 through 2018 in selected districts of Phnom Penh, Kratie, and Ratanakiri provinces, we investigated associations between maternal MUAC during pregnancy as indicator of maternal nutritional status and their offspring linear growth during early life. Multivariate regression models were used to assess the associations between maternal MUAC during the last trimester of pregnancy and infant's length-for-age z-scores during the first 3.5 months of life. Maternal MUAC was significantly associated with infant's length-for-age z-scores (regression coefficient 0.06, 95% CI [0.03, 0.09]). Infants born from mothers with a low MUAC during pregnancy had a 1.6 times higher risk (odds ratio 1.621, 95% CI [0.998, 2.636]) of being stunted during the first 3.5 months of life compared with infants born from mothers with a MUAC >23 cm. This study underlines the importance of optimum maternal MUAC during pregnancy for optimal infant growth. Interventions that aim to tackle stunting in infants should integrate improving maternal MUAC during pregnancy.
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Affiliation(s)
- Daniel Edem Kpewou
- Maternal, Newborn and Child Health and Nutrition Section, United Nations Children's Fund (UNICEF), Phnom Penh, Cambodia
| | - Etienne Poirot
- Maternal, Newborn and Child Health and Nutrition Section, United Nations Children's Fund (UNICEF), Phnom Penh, Cambodia
| | - Jacques Berger
- Institute of Research for Development (IRD), UMR Nutripass IRD-UM2-UM1, Montpellier, France
| | - Somphos Vicheth Som
- Department of Nutrition, Reproductive and Child Health Alliance (RACHA), Phnom Penh, Cambodia
| | - Arnaud Laillou
- Maternal, Newborn and Child Health and Nutrition Section, United Nations Children's Fund (UNICEF), Phnom Penh, Cambodia
| | - Selamawit Negash Belayneh
- Maternal, Newborn and Child Health and Nutrition Section, United Nations Children's Fund (UNICEF), Phnom Penh, Cambodia
| | - Frank T Wieringa
- Institute of Research for Development (IRD), UMR Nutripass IRD-UM2-UM1, Montpellier, France
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