Factors associated with hand foot mouth disease among children in day care center, Chiang Rai, Thailand

Objective: To determine the factors associated with hand foot mouth disease (HFMD) among children in day care center in Chiang Rai Province, Thailand. Methods: A community based case-control study was conducted to identify the factors associated with HFMD among the children under 6 years old who had been cared for in day care centers in Chiang Rai Province. A 47-item questionnaire had been developed and tested for validity and reliability before use. Index of item-objective congruence (IOC) method was used to evaluate the quality of the questionnaire. The items of questionnaire consisted of various aspects including age, sex, history of vaccination, history of breastfeeding, history of treatment, etc. Data were analyzed in the logistic regression model at alpha = 0.05 to identify the association between variables. Results: Totally, 380 subjects (125 cases and 255 controls) from 40 day care centers were recruited in the present study. Among the parents, 77.1% were female, 76.6% were aged 20-59 years old, 30.1% graduated at primary level, and 87.1% were Buddhist. Among the children, 53.8% were male, 58.7% were aged 3-4 years old, and 13.3% were overweight. After control for all possible confounding factors in the multiple logistic regression, two factors were associated with HFMD: children aged < 2 years old had a greater chance (6.35 times) to develop HFMD than those aged > 5 years old (95% CI = 1.37-29.38), and children who had been breastfed for less than 6 months had a greater chance (1.97 times) to develop HFMD than those who had a history of being breastfed 6 months (95% CI = 1.01-3.81). Conclusions: A specific prevention and control measure for HFMD should be developed and implemented. Breastfeeding young children for more than 6 months should be encouraged.