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Somsiri Rungamornrat, Ph.D.*, Apawan Nookong, Ph.D.*, Yuwadee Pongsaranuntakul, M.A.*, Chonlasin
Srilasak, M.S.**
*Faculty of Nursing, Mahidol University, Bangkok 10700, ailand **Bangsai Hospital, Phra Nakhon Si Ayutthaya 13190, ailand.
Factors Inuencing the Quality of Life and
Nutritional Status of 0-2 Years Old Children
ABSTRACT
Objective: To investigate the eects of children factors, family factors, and access to healthcare services on children’s
quality of life as perceived by caregivers and nutritional status of 0 to 2 years old children.
Materials and Methods: is study employed predictive design. e sample group consisted of 106 caregivers with
children aged 0 to 2 years old from ve subdistricts in one province in Central region in ailand. e research
instruments included the Demographic Data of Parents and Children Questionnaire; the Access to Healthcare
Services Questionnaire; the Child-Rearing Practices Questionnaire; the Quality of Life of 0-2-year-old Children
Questionnaire. e data were analyzed by using the Chi-square, Fisher’s exact test, and multivariate logistic regression.
Results: Logistic regression model accounted for 34 % of variance in children’s quality of life (Nagelkerke R
2
= 0.34)
and 35.3% of variance in their nutritional status (Nagelkerke R
2
=.35). Factors predicting the QoL of children were
the maternal age (OR=4.75; 95%CI = 1.16, 19.45, p < .05), and the child-rearing practices (OR=5.68; 95%CI = 1.97,
16.40, p < .05). Factors predicting nutritional status were maternal age (OR=0.088; 95%CI = 0.01, 0.79; OR=0.225;
95%CI=0.02, 2.34, p < .05), and child-rearing practices (OR=7.84; 95%CI = 1.93, 31.84, p < .05). Finally, access to
healthcare services had a signicant association with QoL of children (χ
2
= 9.632, p < .05).
Conclusion: Healthcare personnel should improve children’s quality of life and nutritional status by organizing
programs to promote child-rearing practices and facilitating parents for accessibility to healthcare services.
Keywords: Children aged 0-2; quality of life; nutritional status; child-rearing practice; access to healthcare (Siriraj
Med J 2022; 74: 142-151)
Corresponding author: Apawan Nookong
E-mail: apawan.noo@mahidol.ac.th
Received 5 May 2021 Revised 14 December 2021 Accepted 12 January 2022
ORCID ID: https://orcid.org/0000-0001-9329-6282
http://dx.doi.org/10.33192/Smj.2022.18
All material is licensed under terms of
the Creative Commons Attribution 4.0
International (CC-BY-NC-ND 4.0)
license unless otherwise stated.
Rungamornrat et al.
INTRODUCTION
e rst 0 to 2 years of a child’s life are critical for
future health and development. One of the primary causes
is a rapid change in one’s physical, mental, and emotional
development, which is fundamental for growth and
development. According to a national survey conducted
in 2014, 9.8 percent of ai children aged 1 to 2 years
had severely short stature (height for age < -3 SD.). e
data regarding children in the central region of ailand
demonstrated the highest prevalence of short stature and
obesity (9.2% and 7.3%, respectively).
1
According to a
2019 UNICEF survey, 4.3 percent of ai children under
the age of ve had severely short stature. e highest
prevalence of short stature was found in Bangkok and
Central region (6% and 4.8%, respectively).
2
ese data
demonstrate that ai children in Central region are
malnourished. Malnutrition leads to child morbidity,
which is the underlying cause of about 45 percent of
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Original Article
SMJ
child fatalities worldwide.
3
Young children are more
vulnerable to malnutrition because they require more
protein and energy to grow and are more susceptible to
infections than adults.
3-4
Quality of life has become an essential component
of pediatric outcome evaluation. It is a multi-dimensional
concept with physical, psychological, social, and
environmental dimensions.
5
e concerns about the
QoL require capturing children’s subjective sense of
well-being.
6
Additionally, children are a vulnerable
group because they are not empowered, or are unable
to identify and address their own needs. When it comes
to children, QoL involves their health status, capacity to
participate in daily activities such as play, and other kinds
of interactions and being reared in a healthy environment.
7
However, there are a variety of QoL dimensions in
children, such as, physical, emotion, behavior, somatic,
pain, discomfort, and basic needs of infants.
8-9
ose
denitions are inconsistent with the denition by the
WHO. e PedsQL
TM
Infant Scales for 1 to 12 months
old
6
and TAPQOL for infants
10
(0-1-year-old) are two
tools for assessing young children’s QoL (0–1-year-old).
In the meantime, ailand utilizes the WHOQOL-BREF-
THAI
11
scale to assess ai QoL. is tool, on the other
hand, was developed for adults and inappropriately for
children. As a result, the researchers developed a quality-
of-life assessment tool for children aged 0 to 2, based on
the WHO’s conceptual framework. A child’s nutritional
status and QoL are both essential indicators of a child’s
quality. Determining the relationship between individual
variables and health-related factors in the child population
is necessary to identify the priorities of the quality of
children in the central region in ailand. However,
nutritional status refers to the health outcomes derived
by measuring children’s height and weight, whereas
the QoL refers to caregivers’ perceptions of physical,
emotional, psychological, and social dimensions. As a
result, these two aspects represent the quality of children
from two perspectives.
To confirm the relationship of factors related
to nutritional status and QoL in children aged 0 to 2
years in the central region of ailand.e scoping
literature review presented in this article addresses based
on ecological framework which includes ve levels of
individual, interpersonal, organizational, community, and
policy levels. However, three levels were selected based
on the scope of problems. Factors inuencing nutritional
status and children’s QoL were individual, interpersonal,
and organizational levels. e individual level includes
breastfeeding period and severity of illness; interpersonal
level includes maternal age, maternal education and family
income, child-rearing practices, and organizational level
includes access to healthcare services. e rationale for
selecting these factors was as follows 1) the incidence rate
of breastfeeding in ailand is decreasing
2
while breast
milk can promote child’s growth and signicantly lower
odds of wasting.
12,13,14
2) A healthy child can encounter
an illness such as diarrhea, cold, or pneumonia. e
illness may have an impact on children’s nutritional
status or QoL.
12,14
However, the majority of the research
discuss only the relationship between child with chronic
illness and nutritional status or QoL.
15,16
3-4) According
to the 2019 MICS survey
2
, underweight ai children
were detected in mothers aged 35 to 49 years old and
mothers with less than a primary school education. Lower
maternal education was associated with less healthy food
choices, which could be detrimental to child health.
17
5) Low-income families were associated with underweight
children compared to families with adequate income
owing to a lack of money to purchase adequate meals.
18,19
6) Inappropriate child-rearing practices, such as nutritional
support, child development stimulation, and hygiene care,
impacted children’s growth.
14,18,19
7) Healthcare system
in ailand has been transformed since the adoption
of universal healthcare coverage in 2002.
20
Improving
access to healthcare services may have an impact on
children health. However, some child health issues,
such as child development, have persisted, and there
is no literature on the impact of healthcare access on
healthy young children.
e preceding research investigated the relationships
of the studied variables on nutritional status and QoL of
children as perceived by caregivers. However, there were
few literatures that were specic to children aged 0 to 2
years, and even fewer that were investigated in terms of
predictive study. As a result, the aim of this study is to
investigate the eects of children factors (breastfeeding
period and severity of illness), family factors (maternal
age, maternal education, family income, and child-
rearing practices), and access to healthcare services
on children’s quality of life as perceived by caregivers
and nutritional status of children aged 0 to 2 years. e
ndings of this research will provide vital information
to improve childcare practices and the system of care
for children aged 0 to 2 years in ailand.
MATERIALS AND METHODS
Ethical considerations
is research was approved by the Institutional
Review Board, Faculty of Nursing, Mahidol University
(COA No. IRB-NS2017/15-0506). e participants were
informed about the purpose of the study, data collection
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144
strategies, rights of research participants, including the
right to withdraw at any time without repercussions,
anonymity, and condentiality issues. ose who consented
to participate were asked to complete an informed consent
form.
Methodology
is study is predictive design research. e sample
group consisted of caregivers of children aged 0 to 2 years
from ve sub-districts: Ratchakram, Changyai, Potang,
Chaingraknoi, and Bangsai in Bangsai district, Pranakorn
Sri Ayutthaya, who participated in the project entitled
“e academic advocacy for the well-being of children
through community-based programs in the Central
and Western regions.” e inclusion criteria were that
parents or caregivers be close relatives with children, ages
between 18 and 59 years old, be able to communicate
in ai, live in the same house with children, and have
cared for the children for at least three months. e
sample size was calculated using G*Power, with the
eect size computed from the proportion of nutritional
status in low income (p1 = 0.234) and high income (p2
= 0.0322)
15
, .9 power of test, and .05 errors. A total of 98
caregivers was included in the estimated sample group.
For unanticipated missing questionnaires, the number
of participants increased by 20% (118 samples). A total
of 106 questionnaires were completed. e attrition rate
was 10.17%.
Instruments
Data were collected using questionnaires and a
child health handbook. e questionnaires consisted
of ve parts as follows:
1) e Parental Demographic Questionnaire was
composed of seven items: parents’ age, parents’ academic
level, family type, marital status, family income, and
income suciency.
2) The Children’s Demographics and Medical
History Questionnaire was composed of gender, age,
breastfeeding period, number of siblings, and medical
history. e medical-history was classied into two
categories, ranging from (0) no illness or mild symptoms
(1) moderate or severe symptoms. e total possible
score ranged from 0 to 1.
3) e Access to Healthcare Services Questionnaire
was developed from literature review.
21-22
It consisted of 12
questions divided into two parts. ere were six questions
about access to healthcare services, including patients’
waiting time, expenses, convenience, and availability of
care. ere were six questions on receiving healthcare
services, including receiving information, the rights to
inquiries, and parental participation in childcare. e scale
was a three-level rating scale ranging from (1) sometimes
to (3) regularly. e total possible scores ranged from
12 to 36. e scores were cut by comparing the mean
score to the midpoint score. Scores lower than the median
(< 29 scores) indicated less access to healthcare services.
Good access to healthcare service was dened as scores
equal to or higher than the median (≥ 29 scores).
4) The Child-Rearing Practices Questionnaire,
which included 30 items, was developed based on the
child-rearing practice standard
23
and literature review.
24
ere were ve questions on nutritional status, eight
on hygiene and fundamental care, and seventeen on
growth and development. e scale was a four-level
rating scale, ranging from (0) none to (3) regularly. e
possible scores ranged from 0 to 90. e scores were
cut by comparing the mean score to the median (the
midpoint score). e scores less than the median (< 70
scores) denoted poor child-rearing practices, whereas
scores equal to or more than the median (≥ 70 scores)
indicated good child-rearing practices.
5) e Quality of Life of 0-2-Year-Old Children
Questionnaire consisted of 20 items adapted by the
researchers from the World Health Organization’s short-
form quality-of-life questionnaire in the ai version
(WHOQOL-BREF-THAI).
11
ere were 20 questions:
17 positive and three negative related to four dimensions
of health: physical, mental, social, and environmental
dimensions. One item was asked on general quality of
life. e scale was a ve-level rating scale, ranging from
(1) extremely dissatised to (5) extremely satised. e
scores 20-73 indicated a poor quality of life, while the
scores higher than 73 indicated a good quality of life.
6) e Children’s Health Record includes the child’s
gestational age, birth weight, history of illness, and latest
weight and height. Data were collected from child health
handbook. According to the ai standard growth chart
for children 0 to 5 years old, children’s growth was divided
into three categories: (1) normal, which implies having
an average weight and height, (2) overweight and obese,
and (3), thin and relatively thin.
Instrument quality testing
e questionnaires were all developed by the researchers.
ree specialists evaluated the validity. e CVI of the
questionnaires are as follows: CVI = 1 for e Access
to Healthcare Services Questionnaire; CVI = 0.92 for
e Child-Rearing Practices Questionnaire, and CVI
= 1 for e Quality of Life of Children aged 0-2 Years
Old Questionnaire. e questionnaires’ reliability was
evaluated with 30 subjects who were all comparable to the
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research participants. e Cronbach’s alpha coecients of
the instruments were 0.821, 0.90, and 0.760, respectively.
Data collection methods
Data were collected from November 2017 to February
2018. e researchers requested permission to collect
data from the 5 provincial administrators, as well as
cooperation from administrators of the health promotion
hospitals to introduce the projects to the village volunteers
and survey the names of parents and children aged 0 to
2 years old who met inclusion criteria. e researchers
trained data collection strategies to project sta and village
volunteers who served as research assistants. Village
volunteers visited participants’ homes and requested
permission to present the initiative introduce the project.
e research assistants introduced themselves, explained
the research objectives, data collection processes, rights
protection, and requested permission to utilize data from
child health book. e questionnaire could be completed
by the participants individually or through a 30-minute
interview.
Statistical analysis
Data were analyzed using the SPSS version 18.
Statistical signicance was congured at the level of 0.05.
Descriptive statistics were used to examine demographic
data and variables. e Chi-square and Fisher’s Exact tests
were used to analyze the relationships between parents
and children’s factors, child-rearing practices, and access
to healthcare services, as well as their eects on QoL
and nutritional status. e fundamental assumptions
for binary logistic regression were satised. A multiple
logistic regression analysis was performed to examine
the predicting power of maternal age, child-rearing
practices, and access to healthcare services on children’s
nutritional status and overall QoL.
RESULTS
Descriptive statistics
e majority of mothers with children aged 0 to 2
years were between the ages of 26 and 35 years old (48
percent), had completed high school (55.9 percent); had
an extended family (53.8 percent), and were married
(82.7 percent). e majority of caregivers who raised the
children were parents, followed by grandparents (43.4 and
31.3 percent, respectively). ey had a monthly salary of
10,000-30,000 baht (56.6 percent) and adequate income
(74.2 percent). e majority had only one child (87.7
percent), with a breastfeeding period of 3 to 11 months
(53.0 percent). e prevalence of low birth weight and/or
preterm delivery was 11.3 and 15.1, respectively. Severity
of illness, such as fever and diarrhea, from birth to 2
years old, was 19.8 percent, while those with a normal
weight and height was accounted for 77.4 percent; those
with obesity was accounted for 15.1 percent; and those
with thin weight was accounted for 7.5 percent. Access
to HCS, child-rearing practices, and QoL all received
high scores (Table 1).
Correlational analysis
e maternal age, access to HCS, and child-rearing
practices were associated with the children’s quality of
life. (p < 0.05) (Table 2). e maternal age and child-
rearing practices were also related to children’s nutritional
status. (p < 0.05) (Table 3).
Logistic regression analysis
A multivariate logistic regression analysis was
employed to assess the predictive power of variables
on the QoL as perceived by parents and the nutritional
status of their children. According to the ndings, this
model accounts for 34 percent of the variance in these
children’s QoL (Nagelkerke R
2
= .34) and 35.3 percent
of the variance in the nutritional status of their children
(Nagelkerke R
2
= .35). e maternal age could predict
the children’s QoL (OR=4.75; 95%CI = 1.16, 19.45, p <
0.05). Maternal age of more than 36 years old and less
than 25 years old increased the probability of children
having a high QoL by 4.747 times that of a maternal age
of less than 25 years old. Child-rearing practices could
also predict children’s QoL (OR=5.68; 95%CI = 1.97,
16.40, p < 0.05), indicating that each unit increment in
child-rearing practices will increase a child QoL by 5.677
times.
In addition, the maternal age could predict the
children’s nutritional status (OR=0.088; 95%CI = .01,
0.79, p < 0.05). Maternal age of 26-35 years old reduced
the probability of having a healthy nutritional status by
0.088 times that of maternal age of less than 25 years
old. Child-rearing practices could predict the child
nutritional status (OR=7.84; 95%CI = 1.93, 31.84, p <
0.05), indicating that each unit increment in child-rearing
practice increases their nutritional status by 7.84 times.
(Table 4)
DISCUSSION
Regarding nutritional status, 14.7 percent of the
children in this study were obese, which was higher
than the national average (10 percent).
25
is nding,
however, was consistent with a 2016 survey of children’s
nutritional status at a child development center in the
central region, which revealed that 13.9 percent of children
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TABLE 1. e range, mean, standard deviation, and interpretation of each studied variables.
Variables N Possible Range Mean (S.D) Median Interpretation
(%) score (IQR) by mean
Accessing and receiving HCS 101 12-36 16-36 28.93 (3.94) 29 (4.0) High
Receiving HCS 6-18 8-18 16.06 (2.32) 17 (3.0)
Accessing HCS 6-18 4-18 13.03 (2.47) 12 (2.0)
Child-rearing practices 106 0-90 15-90 67.04 (15.73) 70.5 (19.0) High
Nutrition, 0-15 0-15 10.38 (3.10) 11 (3.0)
Hygiene and basic care 0-24 9-24 20.55 (3.82) 22 (6.0)
Growth and development 0-51 0-51 37.92 (9.12) 40 (11.0)
Quality of life 106 20-100 31-93 72.51 (9.09) 73 (10.0) High
Physical health 1-25 11-22 19.73 (2.17)
Mental health 1-25 12-25 18.24 (2.48)
Social health 1-25 10-25 18.01 (3.23)
Environmental health 1-25 10-25 19.00 (2.90)
Overall quality of life 1-5 1-5 3.52
Low QoL 54 20-100 31-73 66.04 (7.60) 68 (7.0)
High QoL 52 20-100 74-93 79.23 (4.40) 78 (6.0)
Nutritional status 106
Appropriate 82 (77.4)
Obese/ 16 (15.1)
Thin 8 (7.5)
were obese.
26
Since 2000, the prevalence of overweight
children under the age of ve has grown by approximately
24 percent globally, with the highest incidence in low-
and middle-income countries such as ailand.
27
is
situation may be owing to a more convenient lifestyle and
easy availability of high-energy food. Because the data
gathering locations were suburban, there are numerous
factories and marketplaces where families could get a
variety of meals for their children. In addition, parents
and relatives believed that overweight children were
healthy and that youngsters would lose weight as they
grew older.
26
Maternal age and child-rearing practices were potent
predictors of children’s nutritional status. Mothers under
the age of 25 had more children with an adequate nutritional
status than mothers in other age groups. e majority
of mothers under the age of 25 worked in factories and
had a high school diploma. is group of mothers had
easy Internet access to search for childcare information.
Not surprisingly, according to the ndings of a survey
conducted in ailand, persons aged 19-38 years old
were the most likely to utilize the Internet.
28
Income
suciency was not shown to be associated with children’s
nutritional status. e explanation may be the majority
of the participants in this study were middle-income
individuals who could aord the infant food. is nding
contradicts a childhood obesity study, which reported a
positive association between high socioeconomic status
(SES) of families and 2-19 years old childhood obesity in
developing countries. Since high-SES households have
more access to high-energy meals.
29
At the same time,
a study in China reported that high-SES had a positive
eect on the height of 10-15 years old city youngsters.
Because a high-SES family was associated with higher
education, the family had more knowledge to choose
appropriate meals for their children.
30
e discrepancy
may be because the children in this study were between
the ages of 0 to 2. ey consumed breast milk, milk, and
supplementary diet, and children relied on caregivers
for their meals.
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TABLE 2. Factors associated with quality of life of 0–2-year-old children as perceived by caregivers.
Variables N Quality of life of children
χ
2
Test P Value
(%) High Low
Age of mother
Younger than 25 years 31 (31.0) 15 (48.4) 16 (51.6) 6.740 0.034 *
26-35 years 48 (48.0) 18 (37.5) 30 (62.5)
Older than 36 21 (21.0) 15 (71.4) 6 (28.6)
Education of mothers
Primary school 10 (9.8) 6 (60.0) 4 (40.0) 2.537 0.469
High school 57 (55.9) 29 (50.9) 28 (49.1)
Vocational 12 (11.8) 5 (41.7) 7 (58.3)
Bachelor’s degree 23 (22.5) 8 (34.8) 15 (52.9)
Income sufciency
Sufcient income 61 (62.9) 29 (47.5) 32 (52.5) 0.588 0.745
Sufcient income with saving 11 (11.3) 6 (54.5) 5 (45.5)
Insufcient income 25 (25.8) 14 (56.0) 11 (44.0)
Breastfeeding period
Less than 2 months 29 (34.9) 17 (58.6) 12 (41.4) 1.214 0.545
3-11 months 44 (53.0) 20 (45.5) 24 (54.5)
More than 12 months 10 (12.0) 5 (50.0) 5 (50.0)
Severity of illness
No 85 (80.2) 44 (51.8) 41 (48.2) 1.259 0.262
Yes 21 (19.8) 8 (38.1) 13 (61.9)
Access to HCS
Low 55 (51.9) 19 (34.5) 36 (65.5) 9.632 0.002*
High 51 (48.1) 33 (64.7) 18 (35.3)
Child-rearing practices
Low 51 (48.1) 15 (29.4) 36 (70.6) 15.178 < 0.001*
High 55 (51.9) 37 (67.3) 28 (32.7)
f
Fisher’s Exact Test, * P Value < .05
Child-rearing practices also predicted children’s
nutritional status. e scores on child-rearing practices
were high in all dimensions, including nutrition, hygiene
care, and growth and development. When considering
the item score, the parents provided the proper quantity
of meals for their children had a high item score. On the
other hand, the item score of being a parental role model
for dietary behaviors was medium. ese ndings are
consistent with Australian and New Zealand research
of parental feeding practices at 20 months of age. e
highest score was dietary restriction for health. Limiting
unhealthy food consumption in children up to 20 months
old predicted a lower risk of becoming overweight when
they were ve years old.
31
For the growth and development
dimension of child-rearing practices, parents demonstrated
high scores on providing child play and activities as well
as routinely taking children for health check-ups and
vaccinations. ese practices were considered adequate
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TABLE 3. Factors associate with nutritional status of 0–2-year-old children.
N Nutritional status
χ
2
Test P Value
(%) Normal (%) Obese/ thin (%)
Age of mother
Younger than 25 28 (27.5) 27 (96.4) 1 (3.6) 8.798 0.012 *
25-36 52 (51.0) 35 (67.3) 17 (32.7)
Older than 36 22 (21.5) 16 (72.7) 6 (27.3)
Education of mothers
Primary school 9 (8.7) 8 (88.9) 1 (11.1) - 0.781
F
High school 55 (52.9) 43 (78.2) 12 (21.8)
Vocational 15 (14.4) 11 (73.3) 4 (26.7)
Bachelor’s degree 25 (24.0) 18 (72.0) 7 (28.0)
Income sufciency
Sufcient income 59 (61.5) 42 (71.2) 17 (28.8) 4.430 0.109
Sufcient income with saving 10 (10.4) 10 (100.0) 0 (0.0)
Insufcient income 27 (28.1) 22 (81.5) 5 (18.5)
Breastfeeding period
Less than 3 months 31 (35.6) 20 (64.5) 11 (35.5) 4.477 0.107
3-12 months 47 (54.0) 40 (85.1) 7 (14.9)
More than 12 months 9 (10.4) 7 (77.8) 2 (22.2)
Severity of illness
No 85 (80.2) 69 (65.2) 21 (19.8) - 0.777
Yes 21 (19.8) 16 (75.0) 5 (25.0)
Access to HCS
Low 53 (52.0) 40 (78.5) 13 (24.5) 0.571 0.450
High 49 (48.0) 40 (81.6) 9 (18.4)
Child-rearing practices
Low 52 (50.0) 32 (61.5) 20 (38.5) 13.867 < 0.001 *
High 52 (50.0) 48 (92.3) 4 (7.7)
f
Fisher’s Exact Test, * P Value < .05
childcare under the 2003 Act’s minimal requirements for
child-raising. Children’s play and activities will help them
metabolize carbohydrates and energy as well as reduce
fat deposits. Another explanation is that child-rearing
practices are associated with healthcare accessibility.
Caregivers who had a high score for their child-rearing
practices pursued more information about childcare
from healthcare personals, resulting in an appropriate
nutritional status for their children.
e children in this study had a good QoL, with
the highest score for environmental health, followed by
physical health, and the lowest score for social relationships.
is might be because the environmental and physical
health elements included health promotion for children,
such as safety, child health, and developmental care.
Additionally, healthcare personnel encouraged caregivers
to provide health promotion activities upon their visits
to well-baby clinics. ese ndings are consistent with
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TABLE 4. Factors predicting the quality of life and nutritional status of children 0-2 years old.
QOL Nutritional status
OR 95% CI P Value OR 95% CI P Value
Constant 0.205 - 0.004 37.00 - 0.007
Age of mother
Younger than 25 Ref. Ref. - Ref. Ref. -
26-35 0.698 0.24, 2.03 0.509 0.088 0.01, 0.79 0.030 *
Older than 36 4.747 1.16, 19.45 0.030 * 0.225 0.02, 2.43 0.219
Access to HCS
Low Ref. Ref. - - - -
High 2.017 0.74, 5.53 0.172 - - -
Child-rearing practices
Low Ref. Ref. - Ref. Ref. -
High 5.677 1.97, 16.40 0.001 * 7.840 1.93, 31.84 0.004 *
Nagelkerke R
2
0.340 0.353
Hosmer and Lemeshow Test 0.720 0.968
those of the QoL of healthy children aged 0 to 1 year
measured by PedsQL
TM
in the United States6, and the
QoL of healthy children aged 0 to 1 year measured by
TAPQOL in the Netherlands
10
, which caregivers reported
that their children had high scores in both physical and
psychosocial health. Similarly, parents in Europe place a
high value on providing a safe physical environment for
their children.
32
In comparison, parents in the United
States place a high value on social functioning, while
ai parents had a lower score in this dimension. e
discrepancy of QoL domains scores may be attributed
to dierences in caregiving and parenting styles. ai
caregivers become accustomed to responding to children’s
fundamental needs rather than allowing the children to
do it independently. More study is needed to investigate
the factors that dierentiate QoL between Western and
Eastern perceptions.
Maternal age and child-rearing practices were factors
that predicted the QoL of 0–2-year-old children. Maternal
age of more than 36 years old generally resulted in better
parenting since such parents tend to have a higher SES and
can aord better childcare. ese ndings are congruent
with a study on Brazilian parenting practices, which
discovered that mothers with higher education and
economic status organized more activities to promote
their children’s motor development, such as playing,
toy, lap time, and free movement space.
33
Child-rearing practice predicted the QoL of children
aged 0 to 2 years. According to the study, parents over
the age of 36 oered adequate nutrition, hygiene, and
developmental care than younger parents. Parents arranged
play activities, a safe home environment, disease prevention,
health check-ups, and vaccines for their children. ese
health-promoting behaviors can help children avoid
illness and improve their QoL. In Malaysia, parents
from various SES backgrounds provide various types
of child-rearing to stimulate cognition and emotions,
as well as to interact with children, leading to diverse
cognitive and social functioning.
34
Access to healthcare services was associated with
QoL of children, but it did not predict the QoL and
nutritional status in children aged 0 to 2 years. Parents
reported that their children’s access to and receiving
healthcare services was excellent. e explanation might
be universal healthcare coverage for children, under which
children have rights to access care. Moreover, data were
collected in ve sub-districts of a single district. Two
secondary hospitals and one tertiary level hospital are
located near the sub-urban regions. Scores for accessing
healthcare services, such as cost, convenience, time and
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150
availability, were in moderate level. Whereas scores for
receiving healthcare services, such as information on
child growth and development screening, childcare
suggestion, and listening and responding to concerns
were high. e good relationship between caregivers
and healthcare personnel might be attributed to parents’
ability to obtain health services and childcare information,
resulting in improving their child-rearing practices as
well as the children’s QoL. e ndings of this study are
consistent with those of a previous study conducted in the
United States
21
, which discovered that continued access
to essential care was associated with improved health
and QoL scores.
21
Another study in Brazil and Columbia
reported that inequities in access to care between lower
SES and higher SES groups resulting in disparities in
accessing to primary care, outpatient secondary care,
and having health issues in preventable and controlled
diseases, such as caries, and glycemic control.
35
Access to
health services was not associated with nutritional status
of children. It is possible that these children had good
health and development and did not require intensive
healthcare. Similarly in ailand, a study revealed no
statistically signicant relationship between access to
care and nutritional status of preterm migrant children.
As a result of ailand’s low-cost healthcare insurance
for migrant workers and their families to have access to
healthcare services.
13
erefore, no variation in access to
healthcare scores, resulting in non-signicant relationship
between healthcare access and nutritional status.
Regarding children’s factors, breastfeeding period
and severity of illness were not associated with children’s
QoL as perceived by caregivers or nutritional status. ese
children were healthy and their caregivers provided quality
care for them. In contrast, a study in ailand reported
that exclusive breastfeeding from birth to six months of
age, as well as a history of cold in infants predicted growth
in preterm migrant children. e explanation may be
that preterm infants are more susceptible to infections,
resulting in a poorer child growth rate, and unemployed
migrant mothers employed exclusive breastfeeding for
their child.
13
Recommendations and implications
1. Healthcare personnel should assess caregivers’
child-rearing practices, recognize variations in
those practices depending on maternal age, and
design interventions accordingly.
2. e child-rearing practice program should focus
on social functioning activities to help youngsters
develop social skills.
Limitations
e use of the instrument based on WHO denitions
to assess children’s QoL is a strength of this study. e
limitation is that the samples were randomly recruited
from ve suburban sub-districts. e samples might not
be representative of ai children and families. Missing
data from the survey questionnaire were discovered in
both dependent and independent variables.
CONCLUSION
When children are 0 to 2 years old, parental factors
signicantly inuence their nutritional status and quality
of life. Two of these factors are maternal age and child-
rearing practices. Healthcare personnel should encourage
caregivers to use age-appropriate child-rearing practices,
such as using social media with younger parents. Access to
and utilization of healthcare services was solely associated
with children’s quality of life. Caregivers should be assisted
in increasing their access to and receipt of healthcare in
order to improve the quality of life for children aged 0
to two.
ACKNOWLEDGEMENTS
This research was supported from Thai Health
Promotion Foundation.
Conict of interest: ere are no conicts of interest.
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