TiDiP CHi NGHieN CO'U Y H p C — HIEU QUA CUA B 6 S U N G DA VI C H A T DINH DU'QNG VA
T A Y GIUN BtU TiNH TRANG DINH DU'O'NG CUATR^ T H A P COI,
12-36 T H A N G T U 6 | NGU'O'I D A N TOC V A N K I ^ U V A P A K O H Trdn Thj L a n \ Nguydn Xuan Ninh^ Ld Thj Hwang'
'Td chirc Ciru tn? Trd em; ^Vi0n Dinh Dwdng;
^Vidn Ddo tao Y hqc dw phdng - Y te cdng cdng, trwdng Dai hqc YHd Nqi Nghidn ciru nhdm ddnh gid hi^u qud cOa tdy giun sdm vd bd sung da vi chdt tren trd suy dinh dudng thdp cdi. ddn tdc Pakoh vd Vdn Kidu (Qudng Tri). Kdt qud nghidn ciiv cho thdy sau 6 thdng can thlqp Tay giun vd bd sung da vi chdt cho trd suy dmh dwdng thdp cdi cd tdc dqng tdng cdn ndng. chieu cao. giam suy dmh dwong thd nhq can vd thdp cdi cua trd Bd sung da vi chdt cd hidu qud tdt han tdy giun don thuan Can thidp pbdi hop bd sung da vi chdt vd tiy giun cd tdc dung hidp ddng Idm tdng hidu qud tdng cdn ndng, chidu cao cua tr^ vd gidm ty Iq suy dtnh dirong nhq cdn vd thdp cdi. Can thidp cho trd dwdi 24 thdng tuoi cd tdc dqng tdt hon so vdt trd > 24 thdng tudi Chwong trinh phdng chdng suy dinh dwdng tre em cdn quan tam bd sung da vi chdt sdm kdt hqp tdy giun cho trd d nhOng vung nhidm giun vd ty /d suy dinh dw&ng cao.
T u khda; suy dinh duang thSp coi tre em, da vi c h i t , t l y giun sdm I. DAT VAN Ot
Suy dinh dudng d tre em vdn phd bidn d muc y nghTa v d i s u e khoe edng ddng trdn nhieu qude gia tren Thd gidi trong dd cd Vidt Nam Benh suy dinh d u d n g gay nhidu hdu qua khdng tdt ddn phal tndn tri tud vd thd Iyc nhung nam sau ndy [1] Mdt trong nhO'ng nguyen nhdn chu ydu cua thidu dinh d u d n g Id thidu dn Kem theo dn ihidu Ire em d ede nude dang phdt tnen edn hay bi mdc cde n h i i m k h u i n n h u vidm hd hdp, rdi logn lidu hda, tieu ehay, nhidm giun sdn d u d n g rudt cdc bdnh ndy lai cdng Idm ndng thdm van dd suy dmh dudng vd thidu vi ehat dinh dudng [2] Theo thdng kd eua T d chdc Y id The gidi (WHO) ndm 2002, cd den 230 tridu Ire em t d 0 - 4 ludi bl nhidm giun [3], Nhidm ky smh triing dudng ruOt Id yeu td nguy c o cua suy dmh dudng vd thidu vi ehat dmh d u d n g [4]
Biachili&nh^ L6 Thi Huong. Vi$n Ddo tao Y hqc dq phdng va Y tS c6ng cdng. Trudng Dai hqc Y Ha N^i Email hathuhuong@yahoo com
Ngdy nhdn 06/01/2013 Ngdy duqc chap thudn 26/4/2013
Ngodi vide tuydn truyen ndng eao kidn thdc va thue hdnh cho n g u d i me, eho ngudi ehdm sdc tre, tgo ngudn Ihyc pham sdn ed,, nhung nghidn euu ve hidu qua bd sung vi chat dinh d u d n g dd cho thay nhung kdt qua tdt den phal Irien the lue, ehidu cao cua tre, giam ty lg thieu cde vi ehat dinh d u d n g D y a trdn nhung kdt qua nay, ede td c h d c qude td WHO/
UNICEF da d u a ra ede khuydn nghi phdng ehdng cho nhidu n u d c dp dung [2]. Bdn canh vide hudng ddn bd sung vi chat dinh dudng, WHO edn h u d n g ddn lay giun eho Ire d nhung vimg ed ty Id nhidm giun cao. Dd tdi nghidn e u u nhdm m u c t i e u : Ddnh gid hieu qua cua bd sung da vi ehat dmh d u d n g vd tay giun ddn tinh trang dinh d u d n g cua Ire 12 - 36 thdng tudi, bi suy dinh d u d n g Ihap edi, ddn tdc Vdn Kieu vd Pakoh huydn Oakrdng, tinh Quang Tn
II. D 6 | TU'gNG VA PHU'aNG PHAP
1 . Thidt kd nghien cii-u
T h u nghidm can thidp cdng ddng ed ddi chung
• TAP CHI NGHIEN CO'U Y HpC 2. Ddi t u a n g
Tre 12 - 36 thdng ludi bi suy dinh dudng thdp cdi (HAZ < -2SD), khdng bi cde bdnh bam sinh, bdnh mgn tinh, nhidm khudn edp tgi thdi didm tuydn chon, khdng ihidu mdu ndng (Hb > 70 g/L), D u o c bd mg ddng ^ tham gia nghidn edu.
3. Co* mdu
Tinh theo edng thdc n = Z \ . , p, = (2S^)/(pr
|j2)^ Trong dd: n c d mdu, S; dd Idch chudn cuap, a = 0,05, p = 0,1; 2 V i ) ) = 10,5; Pi - p2' Sl/ khde bidt mong mudn so vdi nhdm chdng Vdi chidu cao* S = 0,65 em, s y khde biet pi -
\i2 = 0,38 om => n = 63 Ndu dp dyng cdng thdc tinh cho s u khde bidlh vd Hb S = 9g/dl tJi - M2 = 5,5g/dl => n = 60. Vdy se chon n = 63 de dai dien eho nghidn euu, d u phdng 10% tre bd cudc, n = 70 tre/nhdm nghien c d u
4. Chon mdu
Tu kdl qua sdng loe tren 680 Ire ve nhdn trdc, xet nghidm giun, ed 452 tre suy dmh dudng thdp cdi. trong do 144 tre suy dmh dudng thdp cdi vd bi nhiem giun, 308 tre suy dmh dudng thdp cdi khdng bi n h i l m giun Chpn ngau nhien theo don vi thdn (26 thdn trong sd 36 thdn cua 4 xd thude huydn Dakrong, tinh Quang Tn) duoe 284 Ire, phdn ra 4 nhdm sau
Nhom ehung (CTR, n = 73) suy dinh du&ng thdp edi khdng bi nhidm giun, chi hudng cac chdm sde Ihudng quy tai dia phuong
Nhdm lay giun (TG, n 70) suy dinh dudng thdp edi vd bi nhidm giun, duoc lay giun bdng 1 lieu Mebendazole 500mg khi bdt (Jdu can thidp
Nhdm da vi ehat ( B V C , n = 72) suy dmh dirdng thap edi khdng bi nhidm giun, duoe bd sung gdi da vi ehat Igdi/ngdy x 7 ngdy x 26 ludn
Nhdm Da vi chat + Tay giun (TG + DVC, n
= 69) suy dmh dudng thdp edi vd bi nhidm
giun, duac tdy giun 1 lidu Mebendazole 500mg, d u o c bd sung gdi da vi ehat 1 gdi/
ngdy x 7 ngdy/ludn x 26 tuan
Tre eua 4 nhdm nghidn cdu (kd ca nhbm ehung) d u o c cung edp mdi ngdy 1 gdi chdo dn lien trong sudt thdi gian 26 tudn nghidn cdu
5. Vat lieu nghien cuu
Thudc Mebendazole 500mg (Fugacar) duoc su dung, lidu duy nhdt eho tre 12 - 36 thdng Iheo hudng d i n eua Bd Y td nam 2007 [5],
Da vi chat do vidn Dinh dudng san xudt, dbng gdi 10 gam/gbi, ed thdnh phdn chi'nh"
gdm 4 - 5 g protein, 300 - 400 IU vitamin A, 0,02 - 0,03 mg vilamm B l , 1,5 - 2 mg vitamin C, 100 - 120 mg Calcium, 6 - 9 mg sdt, 3,2 - 3,7 mg kem
Gdi chdo dn hdn do edng ty Hd Ndi Food san xuat trong luong 50 gram/gdi cd 176 KCal, 2,5g Protein, 3g Lipid, 35,5g Glucid
6. Theo ddi va giam sat can thiep Hang tuan edn bd y Id xd phdi hap vdi y td thdn ban id chdc di tham lung hb gia dinh, phdi hop cdp phat mdi tre 7 gdi chdo an lidn, 7 gdi da VI chdt eho tre Y id thon ban vd cdn bd y td xd hudng ddn s d dung gdi da vi chdt, theo ddi sd luong gdi duoe s u dung vd llnh trang bdnh tat eua tre
Hai tudn mdt ldn, nghidn edu vidn cung vdi giam sdt vien tuyen huyen di thdm hd gia dinh, kiem tra ghi chep sd cua y te thon ban, thao ludn vdi edn bd y Id thdn va xd de xde minh cdc thdng tin d u o c ghi chdp vao cdc sd theo ddi Id ehinh xae vd trung thuc, ddng thdi hudng ddn edc y te thdn ban va giam sdt vien tuyen xd va huydn nhung thdng tin cdn chua d u o c rd rang
7. Phan tich s 6 lieu
Nhirng tre sir dyng > 80% sd gdi da vi chat, ed du ede chi sd danh gia ban ddu, kdt thiie nghidn euu duoe dua vdo linh loan hieu
TAP CHi NGHIEN CO'U Y H p C
qua, Chi sd hidu qua (CSHQ, %) = (A-B)/A%, trong dd A Id ty 1$ t r u d c can thidp (To); B Id ty Id sau can thidp (Te). Hidu qud can Ihidp (Hi$u qud thye): HQCT = C S H Q C T - CSHQch^,ng Test ANOVA, lesl z^ vd T-test ghdp cdp d u o c dijng dd kidm dinh s y khde bidt gida ede gid trj trung binh, cdc ty Id % vd s y khde bidl trude vd sau can thidp
8. Dao d u e nghien e u u : dd tdi thyc hidn theo diing hd so eho phdp cua Hdi ddng dao due vidn Dmh dudng
III. KtJ QUA
(. Dde diem cua ddi t u o ' n g khi bdt ddu can thiep
Tai thdi didm TQ, 284 tre suy dmh d u d n g thdp edi d u o c chon vd phdn bd vdo 4 nhdm
nghidn cdu, Tai thdi diem Te, cd 13 Ire bd eudc (8 trd khdng ddng y Idy mdu, 5 tre khdng udng du sd ngdy). Tre bd cude ed ddc didm nhdn trdc, sinh hda tai thdi didm To tuong t y vdl nhung tre cdn lai Sd hdu cua 271 tre hodn Ihidn nghidn c d u d u o c d u a vdo phdn lich hidu qua can Ihidp
Bang 1 cho thay ea 4 nhdm nghidn cuu ddu cd cde ehi sd ve tudi, cdn ndng, chidu eao, WAZ, HAZ, W H Z - score tuang duong nhau (p > 0,05)
Ty Id suy dmh d u d n g theo cde thd cQng khdng khdc bidt ed y nghia thdng kd giua cdc nhdm Ty 1$ suy dmh d u d n g nhg cdn dao ddng l u 6 8 , 1 % ddn 75,4%, 100% duy dinh duong Ihap cdi va ty Id suy dinh dudng gdy cdm dao ddng t u 7,4% den 13,8%.
B a n g 1 . D a c d i d m n h a n t r d c c i i a tre t a i t h d i d i d m bdt d d u c a n t h i e p (To)
C h i s d CTR
( n , = 69)
TG ( n j = 65)
DVC ( n , = 69)
TG + DVC ( n , = 68) Gia trj t m n g binh (X ± SD)
Thang tuoi Can(kg) Cao (om) WAZ HAZ WHZ
27,0 ± 6 , 7 9,4 ± \.2 79,1 ± 4 , 8 -2,37 ± 0 , 7 0 -2,97 + 0,72 -1,07 ± 0 , 7 6
26,1 ± 7 , 0 9,3 ± 1 , 4 78.5 ± 5,4 -2,44 ± 0,74 -3,03 ± 0 , 7 5 - 1 , 1 4 ± 0 , 8 1
27,2 ± 7,0 9,4 ± 1 , 2 78,3 ± 4 , 8 -2,42 ± 0 , 7 0 -3,23 ± 0,70 -0,92 ± 0,81
27,5 ± 6,8 9.4 ± 1 , 3 79,0 ± 5 . 0 -2.40 ± 0.74 -3.05 ± 0.62 -1,03 ± 0 , 7 7 Ty le suy d i n h du'O'ng n {%)
Suy dinh du'&ng nhe oSn Suy dtnh du'&ng thap coi Suy dmh du'&ng gay com
47(68,1) 6 9 ( 1 0 0 ) 8(11,6)
49 (75,4) 65(100)
9(13,8)
50 (72,5) 6 9 ( 1 0 0 )
6 (8,7)
48 (70,6) 68(100)
5(7.4)
• CTR: nhdm chirng, TG. Iiy giun. BVC-da vi chit; TG * DVC tiygiuni p > 0.05 giO'a cac nhom, ANOVA cho X ± SD.x^ lest cho ty I& %
• TAP CHl NGHlfiN CU'U Y HQC 2, Hi?u qua cua can thiep ain tinh trang dinh du'&ng cua tr6
Bang 2, Hi4u qua can thiep d j n thay iii (Ts-To) tinh trang dinh du'ang cua tre
Chisd
Tang cSn Tang cao Tang WAZ TSng HAZ TSng WHZ
CTR ( n , = 69) 0,81 ± 0 . 3 9 3.66 ± 0,94
•0.02 ± 0 , 3 4 0.01 ± 0.32 0.06 ± 0.46
TG ( n , = 65) 0.82 ± 0 . 4 1 3.78 ± 0 , 9 8 0,02 ± 0.42 0.05 ± 0.49 0.05 ± 0,56
DVC ( n , = 69) 1 . 0 6 ± 0 . 5 1 " ' "
5.16 ± 0.99 • " * "
0 . 1 9 ± 0 . 4 1 " ' * 0,43±0.26""'***
0,01 ± 0,62
TG t DVC (n4 = 68) 1 , 3 2 ± 0 , 3 6 ' " ' * " ' "
5 , 2 6 ± 1 , 1 3 ' " * * * 0.40 ± 0 , 2 9 ' " " * ' "
0 . 4 3 ± 0 . 2 9 ~ " * 0.29 ± 0.44'*
"•CTR nhdm chirng: TG: tiy giun; DVC: da vt chit, TG •*• DVC tdy giun +davichdt Sd li$u = X±SD. ": p < 0,01; '"• p < 0.001 vs CTR, *.p< 0,05, **. p < 0,01; * " p < 0.001 vs TG; *p<0.05,'" p<0.01 vs DVC (ANOVA test). ^•p< 0.001 vs. To cung nhdm (T- ghdp cap)
Bang 2 eho thdy nhdm tay giun cd xu hudng tdng cao hon vd chidu cao, ede ehi sd Z score so vdl nhdm chdng, tuy nhidn s u khae biet khdng c6 y nghTa Ihdng ke (p > 0,05),
Nhbm bo sung da vi chat don thudn da tdng edn ndng, tdng ehidu eao, cae chi sd Z score tdt hon cd y nghTa so vdi nhdm chung (p<0,01) Bd sung da vi chdt dan thudn eung cai thien cdc chi sd nhdn trdc tdt hon cd y nghTa so vdi nhdm lay giun don thudn d hdu h^t edc chi sd nhdn trdc, Khdng thdy khde bidt vd lhay ddi ehi sd W H Z score so vdi nhdm chirng vd tay giun
Kdl hop lay giun va da vi chat cai thien edn nang, chidu cao va ede ehi sd Z - Score lot hon nhdm ehdng vd lay giun don thudn a hau hel cdc ehl sd (tru WHZ), tdl hon nhdm da vi chdt don thudn d 3 ehi sd (tang edn ndng, tdng WAZ va WHZ) nhung chua thdy khdc bidl cd y nghTa vdi ehi sd tang ehidu cao va tdng HAZ
110 100 90
^ 80
£ 70
• 0 ,
->, 60
^ 60 40 30
• Nhe can
pi I
I
9Z3 El Thap coi91,3
1 1
CTR TG DVC TG + OVC Bieu d6 1 , Ty le suy sinh du'O'ng nhe can, t h i p coi Ithi l<lt thuc can thiep
TAP CHl NGHlfiN CU'U Y HQC •
BiSu d i 1 cho th^y ty 1$ suy dinh du'&ng t h i p cbi vS suy dmh du'&ng nhe cSn cua cSc nh&m 6 c u i i can thi0p, suy dmh dU'&ng t h i p c6i giSm dugyc 8,3% (nhbm chiing), c4c nhbm khSc giam n h i i u han v4 dat 11,8% (nhbm t i y giun + da vi c h i t ) , tuy nhiSn su' I<h4c bi$t chi^a cb ^ nghta thbng k6 Suy dmh du'&ng nhe can cOng cbn ty 1$ k h ^ cao cho cSc nhbm nghien c i i u , nhbm tay giun + da vi c h i t cb ty 10 t h i p n h i t (45,6%) sau db d i n c4c nhbm da vi c h i t , tay giun vS cao nhit 14 nhbm chiing (71%)
n < 24 thang Q 2 24 t h i n g D C h u n g
10,1 397 60
I 40
a.f 30 S £ 20
I '0
^ 0
B i e u d o 2. Hieu q u a c u a 3 n h o m c a n t h i e p t d i ty le s u y d i n h d u o ' n g n h e c a n , t h e o n h o m t u d i
Bieu dd 2 cho thdy hieu qua can thidp thuc ciJa cdc dang can thidp tdi suy dinh d u d n g thd nhe can theo nhdm tudi Hidu qua can Ihidp ldng ddn t u lay giun don thuan 14,5%, bd sung da vi ehat don thudn 20,3%, eao nhdt Id phdi hap tay giun + da vi chat 39,7%.
Khi so sdnh theo nhdm tudi < 24 thdng vd > 24 thdng, hidu qua can thidp cho thay nhdm tudi nhd ed hieu qua tdt hon ed y nghTa (p < 0,01) so vdi nhdm tudi ldn, hidu qua can thidp edng cao khi tudi cdng nho Nhdm ludi nhd" hieu qua can thidp la 35,6%, 4 0 , 1 % , vd 3 5 . 1 % cho ede nhdm lay giun, da vi chdt vd lay giun + da vi chat, trong khi nhdm tudi ldn hon ed hidu qua can Ihiep la 0,1%, 8,7%, vd 30,9%
D < 24 thdng • > 24 thdng D C h u n g
TG DVC TG + DVC
Bidu d d 3. Hieu qua ciia 3 n h o m c a n thiep t a i le suy d i n h d u a n g t h d p c o i , t h e o n h b m tudi
• TAP CHi N G H l i N CO'U Y HpC
Bieu dd 3 cho thdy hidu qua can thi$p Ihdc cua cdc dgng can Ihidp tdi suy dmh dudng the thap cdi, theo nhdm ludi, Hidu qua can thidp eua ede can thidp tdy giun vd bd sung da vi chat tdt han trdn nhdm tre d u d i 24 thdng tudi so vdi nhdm trdn 24 thdng ludi (tru nhdm tdy giun don thuk). Nhdm tre d u d i 24 thdng tudi ed hidu qua can Ihidp lan luot Id 0,1%, 8,4% vd 16,4% trong khi do nhdm tre trdn 24 thang tudi ed hidu qua can Ihidp Id 8 , 1 % , 4,4% vd 5,9% theo Ihu t u cho cdc nhom lay giun, da vi chat vd lay giun + da vi chdt
IV. BAN LUAN
Chon mdu va phdn n h d m can t h i ^ p : Ddi tirong cho nghidn c u u can thidp cua chiing tdi
\d tre suy dinh d u d n g thap cdi, Ida ludi 1 2 - 3 6 thdng, trong dd ed nhdm tre d lua tudi 12'- 24 thdng Id Ida tudi chua d u o e chi dinh lay giun dai tra d Vidl Nam 284 tre suy dmh dudng thap cdi cua 26 thdn ban, d u o c chia ra 4 nhdm tre ngdu nhidn theo don vi thdn Do vdy c6 2 nhom duoc lay giun Id nhom lay giun i5an thudn vd nhdm lay giun + da vi chdt; 2 nhom khbng bi nhidm giun Id nhdm enung (CTR) vd nhdm bd sung da vi chat don thudn Vdi thidt ke nhu vdy ed the danh gia duae hieu qua eiJa lay giun don thuan, hieu qua cija bo sung da vi chdt don thudn vd hieu qua ciJa phdi hop tay giun va da vi chdt tren tre suy dinh dudng thap edi
vd hieu qua cua tay g i u n : So vdi nhdm chirng, nhdm tay giun don thuan eo xu hudng lot hon ldi tdng cdn ndng, ehidu eao, edc chi so Z score, tuy s u khdc biet chua cd y nghTa thong ke (p > 0,05) T u o n g t u , ehi sd hidu qua ciJa lay giun eung dat 14,5% vdi suy dmh du'dng nhe edn, vd 4,8% vdi suy dinh dudng thap cbi
Hieu qua chua cd y nghTa thdng ke vdi tSng cdn, tdng ehidu cao cua nhdm lay giun so vdi nhbm ehung Dieu nay ed thd giai thieh bdng mdt sd ydu td lien quan' khau phan dn ciJa nhbm lay giun vd nhdm ehung deu trong tinh trang nghdo ndn, thieu nhieu chat dinh dirdng (sd lidu d u o c cdng bd trong bdo cdo
•thdc), do vdy lay giun don thuan chua du thuc
ddy tdng trudng cdn ndng chidu cao cua tre Mdt khdc, tai d|a bdn nghidn cuu, cdc ydu td lidn quan eua nhidm giun mdi trudng, didu kien vd sinh, tdp qudn vd thoi quen dn udng sinh hoat, - eua ngudi ddn cdn lae hdu, tdi nhidm giun xay ra rdt nhanh ehdng, Mdt sd nghidn euu cho thay neu khdng thay ddi didu kidn mdi t r u d n g , ehi 6 tudn sau Ire dd bj tai nhidm nhu t r u d c khi lay giun [6]
Nghien c d u cua ehung tdi cd han ehd Id khdng ddnh gid mdc dd tdi nhidm cua tre sau can thidp, do vdy khdng khdng dmh d u o c sau bao Idu thi tre bi nhidm giun trd lai Tai nhung vung nhidm giun cao, nhu dia bdn nghien euu cua chung tdi, edn thu nghiem dp dung lay giun vdi khoang each gdn han (vi du 4 thdng 1 ldn) nhu WHO dua ra khuyen nghi [3]
Hieu qua cua bd s u n g da vi chdt: Nghien euu eua ehung tdi eho thdy bd sung da vi chdt don thudn cd hieu qua tdl han ed y nghTa (p <
0,01) so vdl nhdm chung, ea vd tdc do tang cdn ndng, ldng chidu cao va cai thien edc ehi sd Z score Bo sung da vi chdt don thudn cljng eho hieu qua tdt hon y nghTa so vdi nhdm lay giun don thudn d hau hdt ede ehi sd nhdn trdc, tru chi sd WHZ score
Kdt qua ndy cua ehung toi, phii hop vdi kel qua eua mdt sd tae gia khde d Viet Nam, bd sung da vi chat tren tre suy dinh dudng thap edi hodc tre nhd nguy ea suy dinh dudng vd thieu VI chdt dinh dudng eao ndi ehung Cae kdt qua nghidn cdu chung minh, gbi da vi chdt s u dung tai gia dinh, trdn vdi bdt bot hodc chao Id mdt giai phap hop ly, cd the phdt trien
TAP CHi NGHieN CU'U Y HQC •
trdn didn rdng d n u d e ta, tgi edc vLing ndng thdn khd khdn [7, 8] Kdt qud cua chung tdi cdn Chung minh, hidu qud eua bd sung da vi chdt tdl hon vdi trd Ida ludi 1 2 - 2 4 thdng so vdl nhdm trd £ 24 thdng Hi$u qud can thidp thdc eua da vi chdt trdn nhdm trd 12 - 24 thdng Id 4 0 , 1 % vd 8,4% trong khi nhdm tudi 24 - 36 thdng chi dgt 8,7% vd 4,4%, eho suy dinh dudng nhe cdn vd suy dmh d u d n g thdp cdi, Kdt qua cua chung tdi ed y nghTa rdt quan trong trong chidn luoe can thidp phdng ehdng suy dmh dudng bdng bd sung vi chdt sdm.
Chlnh sdch can thidp s d m cung d u d c W H O khuydn nghi cho edc n u d c dp dung, cdc can thidp bo sung da vi ehat ed thd lidn hdnh cho tre t u 6 thdng tudi, thdm chi mdt sd vi chat can d u o c bd sung sdm hon ndu cd dau hidu thidu rd rdng. Trong nhung ndm ldi, neu dieu kidn kmh phi chua cho phdp, chuong trinh qude gia ndn ldp trung da vi chat can thidp eho tre d nhung vung khd khan ed ty le suy dinh d u d n g eao, nhdm ha nhanh ty Id suy dinh d u d n g
v d hieu qua cua kdt h a p tdy g i u n vd bd s u n g da vi chdt: Mdt trong nhiJng didm mdi trong nghien edu eua ehung tdi Id ddnh gid hieu qua eua bien phap kdt h o p lay giun vd bd sung da vi chat s d m cho Ire thdp edi (12 - 36 thang tudi), lai viing ddn tde Pakoh vd Vdn Kidu, noi ed ly Id suy dmh d u d n g vd nhidm giun cao, Kdl qua nghidn c d u cua chiing tdi dd cho thdy ket hap 2 bidn phdp eho hidu qua hidp ddng, tdt hon rd rdt so vdi tung bidn phdp can thidp Scfn le lay giun hodc bd sung da vi chat Cdc chi sd ldng cdn ndng, tdng chieu cao, thay ddi cdc chi sd Z-seore WAZ, HAZ, W H Z (bang 3) ddu tdl hon cd y nghTa thdng kd,(p < 0,001) so vdi nhdm ehung vd nhdm tdy giun dan thuan Trong khi so vdi nhdm da vi chdt d a n thudn, nhdm kdt hop 2 bidn phdp lay giun + da vi chat eung tdt hon rd rdt (p < 0,01) d chi sd tang cdn ndng, tdng W A Z vd t u a n g ddng vd
chi sd tdng chidu eao vd tdng HAZ score Tde gid Tran Thuy Nga vd cdng s y ndm 2010 cQng edng bd tdc dyng hidp ddng cua tdy giun vd da vi chdt trdn tre em Ida tudi tidu hoc Cdc tde gia dd bd sung bdnh quy tdng eudng vi chdt trong thdi gian 4 thdng kdt hop vdi tdy giun cho tre 6 - 8 tudi. Tdc gia thdy * rdng bd sung kdl h o p da vi ehdt Idm tdng hidu qua eua tdy giun Ty Id tdi nhiem giun d nhdm kdl hop vdl da vi chdt giam thdp han rd rdt so vdl nhdm khdng duo'c bd sung da vi ehdt, Tir dd tde gia khuyen nghi cd thd s u dung bdnh quy da vi chat trong phdng ehdng Ihidu vi ehdt dinh d u d n g d Ire em hoe d u d n g , ddng thdt gdp phdn giam tdi nhidm giun d Ida tudi ndy ' [5]. Kdt qua nghidn c d u eua ehOng tdi cung phil hop vdl mdt sd nghidn c u u khde tai An Dd, Nepal, Kenya [9, 10, 11]
V. K^T LUAN
Tay giun vd bd sung da vi chat cho tre suy dinh d u d n g thap cdi cd tae dyng tdng edn ndng, chidu eao, giam suy dinh d u d n g thd nhe cdn va thap edi cua tre Bd sung da vi ehdt eo hieu qua tdt hon lay giun d a n thuan.
Can thidp phdi hap bd sung da vi chdt vd lay giun cd ldc dung hidp ddng Idm ldng hieu qua tdng edn ndng, ehieu cao cua tre vd giam ty ie suy dinh d u d n g nhe edn vd thdp edi
Can Ihidp cho Ire d u d i 24 thdng ludi cd tae dyng tdt han so v d i tre trdn 24 thang tudi. 5
Khuyen nghj
C h u o n g trinh phdng chdng suy dmh du&ng tre em edn quan ldm bd sung da vi ehdt s d m kdt hop tdy giun eho Ire d nhdng vung nhidm giun vd ty Id suy dinh d u d n g cao.
Lo'i cam ori
Nhdm nghien c u u chung ldi xin chdn thdnh cam a n edn bd Y id, hd gia dinh vd bd me 146
• TAP CHi NGHIEN CLTU Y HQC huydn Ddk Rdng, tinh Quang Tri dd tgo didu
kien thudn loi vd tInh nguydn tham gia nghidn ciru ndy
TAI LIEU THAM KHAO
1. Black RE, Allen LH, Bhutta ZA et al (2008). Maternal and child undernutntion global and regional exposures and health consequences Lancet. 371(9608), 243 - 260
2. Nguydn Thanh Ha, Nguydn Xuan Ninh, Pham Van Hoan (2010). Hidu qua bd sung kem vd Sprinkles da vi ehat trdn chi sd nhdn trdc cua tre thap cdi 6 - 3 6 thdng tudi, Y hgcdu-phdng, tdpXXI, 1(119). 102 - 1 1 0
3. WHO (2002). Prevention and control of schistosomiasis and soil-transmilled helminthi- asis Report of a W H O Experi Committee Geneva, Teehnieal Report Senes, 912,
H. WHO/CDS/CPE/PVC (2002). Report of the WHO informal consultation on the use of praziquantel during pregnancy/lactation and albendazole/ mebendazole in children under 24 months Geneva 8 - 9 Apnl 2002 Geneva
5. Bo Y td (2007). Hudng ddn bd sung Vitamin A cho tre lir 6 den 60 thang tudi kdt hop lay giun dudng rudt cho tre 12 ddn 60 thang tudi Ban hanh kem theo Quydt
dmh s6l45/QD- BYT ngdy 11 thdng 10 ndm 2007 cua BO trwdng Sd Y td.
6. Nga TT, Wintchagoon P, Dijkhuizen MA et al (2009). Multhmicronutnent-forlified biscuits decreased prevalence of anemia and improved micronutnenl status and effectiveness of deworming in rural Vietnamese school children J Nutr, 139, 1 0 1 3 - 1 0 2 1
7. Nguydn Hai Ha, Nguydn Xuan Ninh, Nguydn Cdng Khdn (2011). Nghidn euu edng nghe san xual gdi da vi chdt vd lyzin bd sung vdo bdt /chdo cho tre em 6 - 24 thdng tudi Y hoe thue hdnh, 2(751), 34 - 38.
8. Stephenson LS et al (1993). Physical fitness, growth and appetite of Kenyan school boys with hookworm, Triehuns tnchiura and Aseans lumbncoides infections are improved four months after a single dose of albenda- zole, J Nutr, 123, 1036-1046
9. Bordignon GP, Shakya DR (2003).
Soil-transmitted helminths in pnmary school children in Narayani, Central Nepal In- DWT Crompton, A Montresor, MC Nesheim, L Savioli (eds) A de-worming programme in Nepal supported by the World Food Pro- gramme World Health Organization, Geneva, 8 7 - 9 2
Summary
THE EFFICACY OF MICRONUTRIENTS SUPPLEMENTATION AND DEWORMING TO NUTRITIONAL STATUS OF STUNTING CHILDREN OF 12 TO 36 MONTHS OLD VAN KIEU AND PAKOH ETHNIC GROUPS
The objective of this study was to evaluate the efficacy of early de-worming and multi- micronutrient supplementation for stunting children who are Pakoh and Van Kieu ethnics in Quang Tn province Results The results showed that children fed wilh deworming and micronu- tnents increased in weights and heights and reduced the rates of undenft'eighl (how many percent reduction"?) and stunting compared with the controls Merely micronutnent supplementa- tion was more efficient than merely deworming Combining both deworming and m,icronutrient supplementation caused a synergy effect to increase the weights and heights and decreased undenjveight and stunting rates of the children The impact of intervention for children under 24 months old was much better than above 24 months old. Conclusions: Based on these results, we
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:
