TAP CHi NGHIEN CO'U Y HQC • recommend that children living in areas with high rates of mainutntion and worm infections be
subjected to a combined mteronutrients and deworming supplements to increase normal growth and to reduce stunting rales
Key words: stunting children, micronutrient, early deworming
KI^N THU'C VA THU'C HANH NUOI DU'O'NG, CHAM SOC TR^
CUA BA ME VA TJNH TRANG DINH DU'O'NG CUA TR^ EM TLC 12 - 24 THANG TU6l TAI HUYEN TIEN LU' NAM 2011
Nguydn Anh V u \ Le Thj Huang^, Ph?m Thi Thuy H6a^, Doan Thj Thu Huydn*
' Td chirc Tdm nhm Thd gidi. ^Vidn Ddo tqo Y hqc Dw phdng va Y td cdng cdng.
^Vi$n Dtnh Dw&ng Nghidn cuv cdt ngang dwqc thwc hien tren 330 tre tu 12 - 24 thdng tudi va cac ba mq thudc 8 xd cua huyqn Tien Lw - tinh Hwng Ydn nhdm muc tidu ddnh gia kien thuc, thwc hanh chdm sdc tre cua bd mq va tinh trang dmh dudng cua tre Kdt qud cho thdy cd 83% bd me cd kidn thuc vd 57.6% bd mq thwc hdnh dung cho tre bu trong vdng 1 gid ddu sau khi stnh. 19% bd mq vdt bd sua non tnrdc khi cho trd bu lin ddu.
Ty Iq ba mq cd kidn thwc vd thwc hdnh dung vd thdt gian cho tre bu sua mq hodn toan la 80.8% vd 12.2%
Cd 19,4% tre dirqc an bd sung sau 6 thdng tudi. Sd tre dwqc dn bd sung sdm trwdc 6 thdng chidm 80% Ty le tre bi tieu chdy va ho sdt trong vdng 3 thdng trwdc thdi didm didu tra twang img la 21,2% vd 65.8% Ty Iq suy dmh dwdng the nhe can. thdp cdi vd gdy cdm Idn Iwot la 7.6%. 29.4% vd 3,0%. Tre nam cd ty Iq suy dtnh dudng cao hon so vdi tre nir Thwc hdnh nudi dwdng, chdm sdc cho tre tir 12 - 24 thdng tqi huyen Tien LO' con chwa tdt Ty 1$ tre bi suy dmh dudng the thap cdi khd cao Tre nam cd ty Iq suy dmh dwdng cao hon so vdi tre nir
Td khoa: suy dinh duang, tre em, Tien Lu, Hung Yen
I.DATVANDE ede ehuong trinh phdng ehdng suy dmh Nhidu nghien edu tai cde nude dang phdt ^ ^ ^ " 9 ^^^^^ '^^ 9'am ty Id suy dinh dudng tir men, trong do cd Viet Nam eho thay Ire em ed 5:.5% nam i g s s xudng edn 16,8% nam 2011 nguy co bi suy dinh d u d n g cao nhdt trong giai [6] Mdc dii vdy, Vidl Nam vdn d u o c xdp vdo dogn t u 12 den 24 thdng ludi [1, 7] Suy dinh nhdm cdc n u d c cd ty Id tre suy dinh dudng dudng protein ndng luong d tre em ed the cao tren the gidi va trong khu v y c [8] Nghien ddn ldi tinh tr?ng ehdm phdt tndn vd thd ehdl c u u d u o c t h y c hien lgi 8 xa eua huydn Tidn vd tinh than nghiem trong han cd thd ddn tdi
tu vong cho Ire Trong-nhung ndm gan ddy. Lu - tinh Hung Yen nhdm md la thuc trang suy dinh dudng cua tre em l u 12 - 24 thdng Dia Chilian h$ Li Thi Huong. Vien Ddo tao Y hqc dw *'^°' ^ ^ ^tm hidu mdt sd ydu td Ildn quan Tu dd phong vaYte cdng c6ng. Trudng Dai hqc YHa NQI dd xudt mdt sd giai phdp nhdm cai thidn tinh Email hathuhuong@yahoo com . j . , , , • . > i , Ngdy nhdn 12/01/2013 *'"3"9 ^ ' " ^ du&ng cho Ire em tai ddy De tdi Ngay duqc chap thu$n 26/4/2013 nghien CUU nhdm muc tieu:
TCNCYH 82 (2) - 2013
• TAP CHi NGHIEN CIJU Y HQC 1 Md la kidn thde vd thuc hdnh nudi dudng,
chdm sdc tre ciia bd m? ed eon t u 12 - 24 thdng tudi lai huydn Tidn L d - tinh Hung Ydn nSm2011
2. Ddnh gid tinh lr9ng dinh dudng eua tre em tu 12 - 24 thdng ludi lai huydn Tidn Lu ndm 2011
IJ.OOl TLfONG VA PHU'aNG PHAP 1. Oja ban nghien cii'u: huydn Tidn Lu tinh Hung Yen
2. Ddi t u a n g : Tre t u 12 - 24 thdng tudi vd Ccic bd me
3. Phuang phap
3.1. Thiet ke nghien CIJ'U: Nghien c u u md ta cdt ngang
3.2. C& miu va phuvng phap chgn mau
n - Z (iHi/2) X 1 - p
Trong do Z(i-a/2)= 1,96, Q = 0,05,
£ la do ehinh xde tuong ddi = 17%, p = 30% la ty le Ire bi suy dmh dudng the thap COI d tre em dudi 5 tudi lai huyen Tien Lu theo bao cdo nam 2010 eua linh Hung Ydn,
U'dc tinh 10% bd eudc, co mdu Id 342 Ire.
Danh sdch tre t u 12 - 24 thdng ludi eiing vdi c^c thong tin vd gidi tinh, ngdy thang ndm sinh, ten me da d u o c Idp sdn vd s u dung de chon mdu ngdu nhien hd thdng tai 08 xd dai difintren dia bdn huyen
3,3. Thu thap so lieu: Phong van theo bd cau hoi de thu thdp thdng lin vd kidn thue va thu'c hdnh eija ba me ve ehdm sde vd nudi dirong tre Cdc sd lidu cdn nang chidu eao dirac thu thdp theo ky thudt chuan
3.4. Phan tich so lieu
Cdc sd lidu nhdn trdc duae tinh toan dua theo qudn thd tham khao WHO Tre duae eoi Id gdy edm, thap edi hodc thieu cdn ndu cdn ndng theo chieu eao, ehidu cao theo tudi vd edn ndng theo tudi Idn luot nhd hon -2SD [9]
Sd lidu duoc phdn tieh bdng ehuong trinh Stata vd Anthro 2005 Test x^ vd Anova duae s u dung de ddnh gid s u khde bidl vd cdc ty le vd gid tri trung binh
4. Dao due nghien cuu
Ddi tuong duoe giai thich day du vd muc dich va nbi dung nghidn cdu, ddi tuang hodn todn t u nguydn tham gia nghidn cdu va eo the bd eudc bdt c d liic ndo, edc thdng tin thu thdp chi su dung eho muc dich nghidn cdu III. KJ^T QUA
1. Thdng tin chung v§ ddi tuang nghien euu
Tdng sd ed 330 cap ba me va tre em t u 12 - 24 thang tudi tham gia nghien cdu
Nghd nghiep ehu ydu eua cdc ba me Id ndng nghiep va cdng nhdn vdi ly le chung la 54,6% va 20,3% Hdu hel cdc ba me da hoc hdi cdp 11 (50%) va cdp 111 (33%) Sd ba me eo trinh dd hoe vdn t u trung edp trd len ehidm 12,8% Trong tdng sd 330 tre didu tra cd 184 tre nam, ehidm ty Id 55,8%, 146 tre nd chidm ty Id 44,2% Ty Id hd ngheo theo phdn loai eua dia phuang tai cae xd cum I vd cum 11 tuang ung la 10,8% va 5,5%
2. Kidn thuc va thuc hanh cham sdc, nudi dudng eua ba me
2.1. Kien thiec va thirc hanh nuoi con bu 83% ba me tra ldi ndn cho Ire bii sdm trong vdng gid dau sau sinh Tuy nhien chi cd 57,6% bd me thuc hdnh cho eon bu sdm trong vdng gid ddu sau sinh (bidu dd 1)
TCNCYH 82 (2)-2013 149
TAP CHl NGHlfiN CLPU Y H p C •
KiCi, (lure I l,„o li,nnli
,n,_, I 1, S,iii 11,
Bi4u <]6 1. K i l n thu'c va th\fc h i n h cua b i m^ v l thcri d i l m cho tre bu l i n d i u
a IE
Bidu dd 2. Ty Ie ba me vdt bd sua non t r u d c khi cho tre bu va ly do Kdt qua didu tra cho thdy cd 19% bd m? da tung vdt bd sua non t r u d c khi cho tre bu. Ly do chinh d u a c cde bd me dua ra Id ho quan mdm rdng sua non khdng tdt (31,3%)}, bd me lo s o s i j a lanh (19,4%) vd d u o e ngudi thdn khuydn bao (22,4%)
s o s ^ ^ _
J L
Bieu dd 3. Kidn thuc va thuc hanh cho tre bu hoan todn cua ba me Cd 80,8% ba me cho rdng can eho tre bii m? hodn todn trong 6 thdng ddu. Tuy nhidn ty 1? Ire duoe bu me hodn toan trong vdng 6 thdng ddu rat thdp, khoang 12,2%.
2.2. Kien thirc va thuv hdnh cho tre dn bo sung
v d kidn thdc, cd 1,5% bd me eho rdng ndn cho tre dn s d m t r u d c 6 thang tudi, 68,5%i bd me cho rdng ndn eho Ire dn bd sung t u 6 - 9 thdng tudi vd 30% ba me cho rdng nen cho dn bd sung sau 9 thdng tudi Nhung kdt qua thuc hdnh eho thdy ed 80% bd m$ cho tre dn bd sung trudc 6 thdng ludi So bd me cho Ire dn bd sung sau 6 thdng ludi chidm ly Id 19,4% (bidu do 4),
TCNCYH 82 (2)-2013
• TAP CHl N G H l i N CO'U Y HpC
i"
1.5 U u o i O t h ;
6 8 5
I
3 0 . 0 ' I huv; haiili() 6
<> l l i ; i i i g
Bidu dd 4. Kidn thuc va thM% hdnh ciia ba me cho tre dn bd sung 2.3. Cham sdc tre 6m
Bang 1. Tinh trang mdc mot sd bdnh cdp tinh ciia tre va each x u tri cua ba me
Thong tin n
%
Ty le mac b^nh trong 3 t h i n g qua Tieu ctlay
Hos6t
70 217
21,2 65,8 Cho tre bu khi tieu chay
Binh thifong/nhieu hon binh thi/ong Ctio bu it di/khong cho bu Cho tre an kieng khi tieu chay Cho tre u6ng Oresol
36 6 31 18
85,7 14,3 70,5 4Q,9 XO tri khi con tieu chay
Tlf mua thu6c v l d i l u tn Dira tre toi co so y t l
32 8
66,7 18,2
Bang 1 cho thdy ly Id Ire bi tidu ehay vd ho sdt trong vdng 3 thang trudc thdi diem didu tra ldn lud Id 21,2% vd 65,8% Khi Ire mdc tidu ehay, eae bd me thudng eho tre bii nhu binh Ihudng hoac nhidu hon (85,7%), luy vdn edn khoang 14,3% ba me eho eon bu it hon binh thudng hoac khong cho con bu Da sd edc bd m? kidng khdng cho eon an ehdl lanh: tdm, cd, eua, ddu m d (70,5%) Sd bd me eho tre udng Oresol khi tre mdc lieu ehay Id 40,9%
Ve cdch x u tri khi tre dm cua ede bd me tai Tidn Iiy, kdl qua cho thay cd 66,7% bd me l u mua thudc vd eho con udng, Ty Id ba me dua eon ddn eo s d y td Id 18,2%
3. Tinh tr^ng dinh d u d n g cua tre
Bidu do 5 cho lhay ly 1$ tre 12 - 24 thdng bj suy dinh dudng ehung cua cac the nhe can, thap COI vd gdy cdm lai huydn Tien LCr ldn luot la 7,6%, 29,4% vd 3% Ve gidi tinh, tre nam ed ty Id suy dmh dudng cdc the deu eao hon so vdi tre ntr (p < 0,05, test z^) Cd 10,3% tre nam vd 4,1 % tre ntr mde suy dinh d u d n g thd nhe edn. So Ire nam vd nd mdc suy dinh dudng the thap cdi
TCNCYH 82 (2) -2013
TillP CHl NGHIEN CIJU Y H p C •
c h i l m l l n I w t l i 36,4% v i 20,6%. CO 4,9% tre nam v i 0,7% tre nH m i c suy dinh du-Ong the g i y c6m.
4 0
3 0
1 0 O
3G.4
^B 1
'^rn^s WsmM
N a m
20 6
4 i W H
IKSIZ.
N u -
29.4
H
• M ^ W^m
C h u n g• T h e n h o c a n K T h e t h i i p c 6 i
» T h e g a y c o m
Bidu d d 5. Ty 10 suy d i n h du'd'ng cua t r d 12 - 24 t h d n g
«f S D D d p I
• S D D d o II
T h e nhe T h 6 thap T h e gay can coi c o m Bidu d d 6. Phan loai t i n h t r a n g suy d i n h du'd'ng c u a tre
Kei qua bieu dd 6 cho thay tre suy dmh d u d n g cac thd nhe cdn. thdp c6i, gdy cdm Wiudng bl suy dmh dudng dd I (Zscore < - 2SD): 5,2% d nhdm nhe can, 23,9% d nhdm thap edi vd 2,7% d nhdm gdy edm Sd Ire bi suy dinh dudng dd II eua edc thd trdn tuong ung Id 2,4%>, 5,5%i vd 0,3%
IV. BAN LUAN
Nghidn cdu cua ehung ldi lhay rdng 83%
ede bd m§ tra ldi dung vd Ihdi gian cho Ire bii ldn ddu sau khi smh eao hon so vdi ly Id 58,3% . tai xd Duong Quan (huydn Gia Lam, Hd Ndi) [1].
Mdc dil vdy, sd bd m? thuc hdnh tdt ndi dung khuydn cdo cua chiing tdi chi chidm khoang 58% (bieu dd 1), kdt qua ndy thap hon so vdi ly Id Chung 9ua ca n u d c ndm 2010 Id 6'1,7%
[5] vd thdp hon so vdi didu tra tai tmh Quang Tri (80,4%) [9] Sd bd me khdng vdt bd sua non trudc khi eho tre bii lan dau Irong nghidn cuu eua ehiing tdi Id 8 1 % va cao hon so vdi bdo cao Chung cua lodn qudc ndm 2010 (69,9%) [5]
Cd mdt s u chdnh Idch Idn giua kidn thuc vd thi,rc hdnh eua bd me ve thdi gian eho tre bu hodn todn trong 6 thdng dau. C d 80,8% bd me cho rdng can cho tre bii me hodn todn trong 6 thdng ddu, cao hon so v d i didu tra tgi xd D u a n g Quan [1] Tuy nhidn, ly 1§ thuc hdnh tgi dia bdn nghien euu cue ehiing tdi chi Id 12,2% (bidu dd 3) thap han so vdi ket qua didu tra qude gia Id 19,6% ^5]. Ty Id bd me cho tre bii hodn todn ddn 6 thdng tudi d cde vung ndng thdn I h u d n g thdp md nguyen nhdn chinh Id do bd me t h u d n g phai di Idm sau sinh rat s d m T u o n g t u n h u tren, kidn t h d c vd thuc hdnh cua bd me vd thdi diem cho Ire an bd
152 TCNCYH 82 (2) - 2013
• TjCiP CHi NGHlfeN Cl>U Y H p C sung ed s u khdc bidt rdt ldn Cd 68,5% bd me
cho rdng nen cho tre dn bd sung t u 6 - 9 thdng tudi, Tuy nhidn ly 1? tre d u o c dn bd sung dimg tho'i diem ehl dat 19,4% (bieu dd 4)
sd tre mdc tidu chay trong vdng 3 thdng trudc thdi diem didu tra Id 21,2%, ty 1$ ndy lirong l u nhu kdt qua khao sdt trdn nhdm tre ngudl ddn tde M u d n g , tinh Hda Binh (21,7%) (10], s d tre bj ho sdt chidm 65,6%, eao hon so vdl 54,3% trong khao sdt tai tinh Hda Binh [10], Ty tre duoe bu it hon so vdi binh thudng khi bl lieu ehay ehidm 14,3%, Cd ldi 70,5% bd me tliuc hien ehd do dn kidng thue dn (ldm, cua, cd ) vd ddu m d khi tre bj dm Trong khi 66 chi ed 40,9% tre d u o c cho udng bii nudc va dien giai Oresol Mdt didm ddng luu y nira la ty Id bd me t u mua thudc vd cho tre udng khi bl lieu chay Idn tdi 66,7% (bang 1)
Ty Id tre suy dmh dudng the nhe edn eua huyen Tien Lu Id 7,6%, ty Id ndy thap han so vdl loan qudc giat doan 2009 - 2011 [5, 6] So tre suy dinh dudng the thdp edi eua huyen chidm 29,4%, l u o n g l u nhu khao sdt lai huyen Chiem Hda - linh Tuyen Quang nam 2011 (29,1%) [3], cao hon so vdi loan qude nam 2011 (27,5%) [6] Sd tre mdc suy dinh dudng thd gay edm trong nghidn edu eua chiing ldi ehidm 3%, thdp hon so vdi ly le Chung cua loan qudc Id 6,6% [6] Ty le tre nam bl suy dinh dudng cao han mdt cdch rd ret so vdi tre nCr (bieu dd 5), kdl qua nay tuong tu nhu cde kdt qua t u nhung nghidn cdu khac [1, 6, 9, 11] Nghidn euu eua chiing tdi cOng cho thdy tre thudng mde suy dmh dudng do I (bieu dd 6) Phdt hidn nay cijng phii hop vdi xu thd ehung cua todn qudc [5, 6] vd nghien CifU khae [1 - 3 , a - 1 0 ]
V. K^T LUAN
Cb 83% va 57,6% bd me cd kidn thdc vd thyc hanh dung eho Ire bu trong vdng I h ddu
sau khi sinh, Ty Id bd me vdt bo su'a non trude khi cho tre bu lan ddu Id 19%, Ty le bd me cd kidn thde dung vd thdi gian eho tre bii sua me hodn todn Id 80,8%, ed 12,2% bd me thue hidn tdl khuydn cdo ndy Cd 68,5% ba me cho rdng cdn eho Ire dn bd sung sau 6 thdng tudi Ty Id tre'duoc dn bd sung sau 6 thdng ludi chidm 19,4%, Sd Ire duoc an bd sung sdm trude 6 thdng chidm 80% Ty Id tre bj tidu ehay vd ho sdt trong vdng 3 thdng trudc thdi diem didu tra tuang ung Id 21,2%
vd 65,8%, Ba sd bd me Ihuc hien ehe do an kieng chat tanh, ddu m d khi tre dm vd lua chon phuang thdc t u mua thude didu tn cho tre, Suy dmh dudng dd 1 la the suy dmh dudng ehCi ydu trong qudn thd didu tra. ty le suy dmh duong cua cac the nhe cdn, thdp cdi vd gdy edm ldn luot la 7,6%, 29,4% va 3%- Tre nam cd ty Id suy dinh dudng cao han so vdl tre nu'
Levi cam en
Nhdm nghien cdu xm chdn thanh cam on su h§ ira, hap tac ciia td ehde Tdm nhin Thd gidi, vidn Dmh dudng Qude gia, can bd y td vd cac ba me tai huyen Tien Ltr
TAI LIEU THAM KHAO
1. Le Thj H u a n g , Hoang Thj Hud (2011).
Kidn thue vd thue hanh nuoi dudng va cham soc tre eua cdc bd me tai xa Duong Quan huyen Gia Lam - Hd Ndi nam 2010 Tap chi Y hoc dt/ phdng. 3(121), 165 - 1 7 3
2. Od Thj Lan, Cao Thj Hdng Ha, Nguyen Hanh Nguyen va cong s u (2002) Tim hieu mdt sd ydu td hen quan ddn tinh trang suy dinh duong tre em d Son La f a p chi Y hoc Dwphong, tdp XII, 3 (54), phu ban 113,113 -116
3. Le Thj H u a n g , Le Hdng Phuo-ng, N g u y i n Thiiy Linh, Doan Thj Thu Huydn (2012). Tinh trang dmh dudng vd khau phdn
TCNCYH 82 (2)-2013
T/>P CHl NGHlfeN CI>U Y HQC
thi/c t l cua Ire em 24-69 t h i n g t u l i tai x i 8, World Health Organization (2011) X u i n Quang - huySn C h i i m H6a tinh TuySn World Health Static 2011
Quang n i m 2011 T,p ch, hghl^n cOv Y hpc, ^ , ^ . ^ ^ . ^^^^^ ^_. ^^^^^^ ^ , j ^ ; , , , , s6 phM trirang, 79 (2), 194 - 1 9 9 . • . ^ ^ ^.^ ^.^^ ^^^^
4, Pham VSn Phu, NguySn XuSn Nmh, ' " .
Pham Duy Ti.c.ng v i c^ng s^. (2005). Th^rc """"^ = " ^ '^^ ^"^ ^ " " 9 " " " ^ ' ' ^ ° " * " ""=
h i n h nual du.&ng v4 mOt sA y^u t6 anh hu'dng t h i i u s6 tai ha, huy$n HyOng H6a ^,i OakrSng den tinh trang d,nh du&ng cua tre 1-24 t h i n g • tinh Quang Tn n i m 2010 Tap chl Y hoc dw tu6i tai 2 huyen Nil! T h i n h v i T h i n g Binh, phdng, 2011, t i p XXI, 1 (119), 94 - 1 0 1 Tinh Quang Nam T^p chl Y hgc thvc hinh. .^^ ^^ .^^.^ ^^^^^ ^^^^ j^,^ .^^^ H^,yj„^
3(505), 3 - 7 g ^ . , ^ ^ j ^ Nguyet Minh va cs (2012), Tinh 5, Vien Dinh Du'&ng (2011). Tinh hinh j ^ j . . . • , , • • : . " , , -
tranq dmh dLr&ng cua tre em du-ai 5 tuoi dan dinh duCmg Vl$t Nam n i m 2009 - 2010. Nhii " , . .
. , , , , tOc M u & n g t i n h H6a Binh va m d t s o y e u t o l i e n xfjaf bin Y hgc.
6, Vien Dinh du'dng (2011) B i o c i o tinh 1 " ^ " Tgp ch, nghlih ciru Y hgc. 3PTD(79), trang dmh du'ong tre em v i b i me n i m 2011 1 1 4 - 1 1 8
Nha xuit bin Y hoc ^,1 g g y l§, V i i n Dinh du'&ng (2009), 7, Rosalind S.Gibson (2005) Prmciples of c h i r o n g Irinh muc tieu phong chong suy dmh Nutritional assessment 2nd edition Oxford d j , a „ g ,^4 em o Viet Nam ( 1 9 9 8 - 2 0 0 8 ) . University express
Summary
MOTHER'S KNOWLEDGE, PRACTICE ON CHILD'S FEEDING AND CARING AND NUTRITIONAL STATUS OF CHILDREN FROM 12 TO 24
MONTH IN TIEN LU DISTRICT OF HUNG YEN PROVINCE
Understanding the knov/ledge and children eare of mother are important for ehild-care offieials to produee policies to help mothers to take care of their babies Methods' A cross-sectional study was conducted to assess the knovkfledge and practice of child care and child nulntion of the mothers of 330 children in t i e n Lu distnel. Hung Yen province The age of the children ranged from 1 2 - 2 4 month old We also examined the nutritional status of these children Results, Within the 1^' hour of birth, the number of mothers who possessed good knowledge and practice on giving early breast- feeding were 83 0% and 57 6%, respectively There was 19 0% of mothers had taken off colos- trums before breastfeeding their children The proportion of mothers who had good knowledge on breastfeeding of their child up lo 6 months was 80 8%, whereas, only 12 2 % of mothers had good practice of exclusive breastfeeding during this time frame The percentages of children being given food supplements before and after 6 months old were 80 0% and 19 4 % , respectively During the 3 months of age, 21 2 % and 25.8% children suffered from diarrhea and respiratory infections, respectively The prevalent rale of child malnutrition tn children under 5 years old was 7 6% by WAZ, 29 4 % % by HAZ and 3% by WHZ In conclusion, the knowledge and practice of the mothers on child care in Tien Lu Dislncl of Hung Yen province was high However, their knowl- edge of eh id nutrition was poor as children stunting rale was ralher high in this group of children Keywords: Malnutrition, children, Tien Lu, Hung Yen
^54 TCNCYH 82 (2)-2013
