SOUTHEAST ASIAN J TROP MED PUBLIC HEALTH 152 Vol 42 No. 1 January 2011 Correspondence: Jaranit Kaewkungwal, De- partment of Tropical Hygiene, Faculty of Tropi- cal Medicine, Mahidol University, 420 / 6 Ratchawithi Road, Ratchathewi District, Bangkok 10400, Thailand. Tel: +66 (0) 2354 9100 ext 9188 E-mail: jaranitk@biophics.org MATERNAL AND CHILD HEALTH IN A MARGINALIZED COMMUNITY ALONG THE THAI-MYANMAR BORDER Wit Wichaidit 1 , Jaranit Kaewkungwal 1 , Chukiat Sirivichayakul 2 , Pimsurang Taechaboonsermsak 3 and Visut Suvithayasiri 4 1 Department of Tropical Hygiene; 2 Department of Tropical Pediatrics, Faculty of Tropical Medicine; 3 Department of Family Health, Faculty of Public Health, Mahidol University, Bangkok; 4 Department of Obstetrics, Bangkok Metropolitan Administration Medical College, Bangkok, Thailand Abstract. The objective of this study was to conduct a cross-sectional evaluation of pregnancy indicators, child growth failure, and the effect of antenatal care on birth outcomes in a marginalized community under the care of a health center in Suan Phung District, Ratchaburi Province. Health and socioeconomic data about children born in 2007 and their parents were obtained from the sub-district health center and district hospital were collected and analyzed by univariate and multi- variate methods. Most of the residents in the study were Karen ethnic origin. Data was available for 152 children, of which 136 met study inclusion criteria. Health outcomes of the study population significantly different from the general Thai population included higher average parity (2.53 ± 1.99 vs 1.735; p<0.001), lower average birth weight (2,876.05 ± 399.48 grams vs 3,200 grams, p<0.001), and lower average height-for-age and weight-for-age (p<0.001). The prevalences of stunting, underweight and wasting were higher than the general Thai population (p<0.001). Having fewer than 4 antenatal care (ANC) visits was associated with low birth weight (unadjusted OR 4.88, 95% CI 1.13-21.05; adjusted OR 5.77, 95% CI 1.27- 26.30). Keywords: maternal and child health, birth outcomes, marginalization, Karen people, Thailand INTRODUCTION Maternal and child health (MCH) is a domain of public health which has impli- cations for at least 3 of the 8 Millennium Development Goals (MDGs) of the United Nations, particularly after the 2005 revi- sion when additional targets were added. Health outcomes and utilization of various MCH services are used as indica- tors of the achievement of these revised MDGs. The proportion of births attended by skilled health personnel is an indicator of Goal 5, Target 5.A (reduction in mater- nal mortality), while adolescent birth rate and antenatal care coverage (at least 4 vis- its) are indicators of the revised Goal 5, Target 5.B (achieve by 2015 universal ac- cess to reproductive health). The propor- tion of 1 year old children immunized against measles is used as an indicator of