Báo cáo nghiên cứu khoa học: "Tình trạng suy dinh dưỡng và các yếu tố liên quan ở trẻ em dưới 5 tuổi ở tỉnh Kon Tum năm 2008"

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Nội dung Text: Báo cáo nghiên cứu khoa học: "Tình trạng suy dinh dưỡng và các yếu tố liên quan ở trẻ em dưới 5 tuổi ở tỉnh Kon Tum năm 2008"

JOURNAL OF SCIENCE, Hue University, N0 61, 2010 MALNUTRITION STATUS AND RELATIVE FACTORS IN CHILDREN UNDER 5 YEARS OLD IN KON TUM PROVINCE, 2008 Pham Thi Hai College of Medicine and Pharmacy, Hue University SUMMARY In 2008, a study was conducted in a population of 1500 Children under 5 years old and their mothers in Kon Tum Province using a cross-sectional method with two objectives: identify the malnutrition rate in children under 5 years old in Kon Tum province, 2008 and find out the factors related to the malnutrition situation in children under 5 years old in Kon tum province. Results showed that the malnutrition rate was 30.2%, including 24.2% of malnutrition level I; 5.5% of level II and the remaining of level III. In terms of relative factors of malnutrition in Children. There are many different factors contributing to malnutrition such as low birth- weight (< 2500 gram); children with a history of diarrhea and acute respiratory infections; mothers with low BMI (< less than 18.5); mothers with a poor diet and low weight of the mothers during pregnancy; low education level of the mothers; mother’ age from 36-49 when being pregnant; having a family of more than 3 children; and low family income. Other factors regarding breastfeeding and complementary feeding were: a complete lack of breastfeeding in the first six months of age; early weaning time (< 12 months); early initiation of complementary diet (< 6 months); and a poor complementary diet consisting of only gruel with rice flour and salt. The relationship between malnutrition in children and the factors such as breastfeeding time after giving birth, and mother’s occupation has not been found. Key words: malnutrition, weight, height, breast milk, weaning, related. 1. Introduction Vietnam is not only internationally recognised in the effort to prevent malnutrition, but is also the sole country which has achieved success in reducing the acute malnutrition rate. However, the malnutrition rate in children is still high, this is one of the barriers to the development and integration process of the country. Kon Tum is a highland province in the northern central area. The ethnic minority group makes up more than 54% of the population. They often have low education levels and follow traditional customs. For this reason, the high risk level of malnutrition in children here would be unavoidable. Weight malnutrition rate in children under 5 according to an investigation in 2007 was 31%, which was relatively high in 131
comparison with other provinces. There is a considerable gap between this figure and the required target of national nutrition strategy to be reached by late 2010. Monitoring the annual malnutrition rate along with investigating and evaluating associated risk factors are important activities develop appropriate solutions for preventing malnutrition in the future. As a result, we conduct the study: “Malnutrition status and relative factors in children under 5 years old in Kon Tum province, 2008”. Study objectives is to identify the malnutrition rate in Children under 5 years old in Kon Tum province, 2008 and investigate the factors related to the malnutrition situation in Children under 5 years old in Kon Tum province. 2. Methodology 2.1. Subjects and Research Time Study participants were all under 5-year-old children born from 01/11/2003 to 31/10/2008 and their mothers in Kon Tum. The study was conducted between July 2008 and October 2008 in all 9 suburban districts of the province. 2.2. Research method: The study used a cross-sectional descriptive method 2.2.1 Sample size: The sample size is calculated based on the formula, as following: p(1  p) n  Z 2 / 2 d2 Where: n: Number of researched children Confident interval: 95%, Z /2 =1,96 p: Estimated malnutrition rate, p = 31,5% is malnutrition rate of the year 2007 in Kon Tum3. d: Standard error, d = 0,25 Therefore, the minimum sample size is 1326 children. Adding 15% for refusals and attrition, the study sample size is 1500 children. 2.2.2. Selecting the sample: The study used a multi–stage random sampling method. 2.2.3. Collecting data: - Children: date of birth, gender, birth-weight, breastfeeding status, 132
complementary diet, disease status, and anthropometric measurements - Mother: age, education level, occupation, ethnic group, family income, drinking and eating habit, number of children and anthropometric measurement 2.2.4. Collecting data techniques: - Identifying children under 5 years of age: estimating their age based on the nearest month and year. - Idetifying athropometric measurements: measuring weight and height as normal rule. - Collect information about relative factors by directly interviewing mothers (or guardians) using a structured questionnaire. 2.2.5. Indicators to evaluate nutritional status in children: Three anthropometric measurements are Weight-for-age, Height-for-age and Weight-for-height. The study results were on the basis of reference data of the U.S National Center for Health Statistics (NCHS); A negative standard deviation (-2SD) is considered as malnutrition. 2.3. Data analysis method: The study used EPI INFO and SPSS software to determine the malnutrition rate according to adjusted age and gender. Test 2 was used to compare the indicators. 3. Results 3.1. Malnutrition rate: Table 3.1. Underweight- for-age malnutrition rate Number of Percentage Age (month) n p Children % 0- < 12 332 42 12.7 12 - < 24 354 138 39.0 24- < 36 305 118 38.7
classification. Therefore, to achieve the required target of the national nutrition strategy of 2001-2010, it is necessary for Kon Tum province to improve the economic conditions and education levels in the effort of reducing the malnutrition rate in children to 20% by 2010. Figure 3.1. underweight-for-age malnutrition rate in children. Malnutrition in children often happens in the first year of life (12.7%) and increases in accordance with the age group. The highest malnutrition risk was found in children within the age group of 12 to 36 months, which then continues at a high level until under 60 months (29.3%). This finding is comparable with the investigation of the Nutrition Institution and Phan Van Hai but different with the studies which were implemented in plain areas, which showed that the highest malnutrition rate is at the group of 48 to 60-month old. Table 3.2. Stunting-for-age malnutrition rate Number of Percentage Age (month) n Malnutrition p % case 0- < 12 332 81 24.4 12 - < 24 354 192 54.2 24- < 36 305 143 46.9
classification1. Stunting in children under 5 years old appears early in the first year of life (24.4%) and booms in the age group of 12 to under 24 months, and is then constantly maintained at high levels until under 60 months; There is a significant difference in the stunting malnutrition rate among age groups (figure 3.2). This outcome is similar to the study of Phan Van Hai. The Nutrition Institution, and some other researchers. Figure 3.2. Stunting-for-age malnutrition rate Table 3.3. Wasting-for-age malnutrition rate Number of Malnutrition Age (month) n Percentage % p case 0- < 12 332 28 8.4 12 - < 24 354 39 11.0 24- < 36 305 22 7.2
Figure 3.3.Wasting-for-age malnutrition rate According to Ha Huy Khoi, the wasting malnutrition rate is often at the highest level when children are 2 years old. This is an age group which is weaning and switching to the diet of an adult person. Therefore, poor diet along with diseases can lead to wasting in children. Table 3.4. Classification of malnutrition according to level Malnutrition level Level 1 Level 2 Level 3 Underweight (%) 24.2 5.5 0.5 Stunting (%) 28.8 15.7 Almost malnourished children is in level 1; Malnutrition level is just 0.5%. Table 3.5. Classification of stunting- for-gender malnutrition rate Stunting Underweight Gender n SDD thấp còi % malnutrition malnutrition rate % rate% Male 729 30.3 45.5 8.1 Female 771 30.1 43.6 5.7 p>0.05 The difference between boys and girls in all of three type of malnutrition is insignificant. This result is comparable to the researchers. 136
Table 3.6. Classification of malnutrition rate according to rate Stunting Wasting Underweight Race n malnutritio malnutrition malnutrition rate % n rate% rate % Kinh group 183 18.6 31.7 3.8 Minority ethnic 1317 31.8 46.3 7,.3 group p
No 27.6 72.4 early ( 1 hour) 29.7 70.3 Pre-lacteal feed > 0.05 late (>1 hour ) 31.6 68.4 Completely not 31.3 68.7 Breastfeeding in the < 0.05 first 6 months of age Completely 24.9 75.1
 second 19.5 80.5 school Agriculture 32.0 68.0 Trader 24.6 75.4 Occupation of mother > 0.05 Officer 23.9 76.1 Housewife 27.7 72.3 BMI of mother < 18,5 35.4 64.6
There was indifferences between malnutrition rate of boys and girls (p>0.05). The malnutrition rate was significantly different in statistics between Kinh children and ethnic minority children. The underweight malnutrition rate of Kinh children and ethnic minority children is 18.6% and 31.8% respectively (p
in children and mothers in 2002, Hanoi: Medical Publisher 2003. 4. WHO. Child Growth Standards: Training course on child growth assessment. 5. Phan VH. The study on malnutrition status in children under 5 year olds in Kon Tum province in 2001 [Specialization level I’s thesis] - Hue: Hue Medical university. 2002. 6. Pham TH. Nutrition status and relative factors in children under 5 years old in Hai Chanh commune of Hai Lang district in Quang Tri province [Master’s thesis of Medicine] - Hue: Hue Medical university 2003. 7. Hoang TL. The study on malnutrition status and relative factors in children under 5 years old [Master’s thesis of Medicine] - Hue: Hue Medical university. 2001. 8. National Nutrition Strategy in 2001-2010. Hanoi: Medical Publisher. 2001. 9. Institute of Nutrition - Ministry of Health. The national nutrition conference in 2008. 2008: 12-20. 10. Tu G, Ha HK, Phan TK, Protein - Energy malnutrition, Pathological Encyclopediavol.1. Hanoi: Encyclopedia Publisher 2000: 272 - 273. 11. Nguyen CK, Pham VH, Le DT. The progress of malnutrition in children from 1990 to 2004. Vietnamese medical journal 2007; 337( 1):37. 12. http://www.who.int/childgrowth/en 141