THI/C TRANG SUY DINH DU'ONG VA THI^U VI CHAT DINH DU'ONG &
TR^ DU'ai 5 TU6l TAI 3 HUYEN, T I N H NGHE AN N A M 2011 Khiic Thi Tuyet Hwdng', Ub Thu Mai^*, Le Thj H9^)^ Pham Thj Thuy H6a^
^Tru&ng cao ddng Yte Thdi Nguyen
^ Vien Dinh du&ng Quoc gia, Hd Npi TOM TAT
Nghien ciJu mo ta cit ngang du'o'c thi/c hi^n nh^m <3^nh gid tinh trang dinh difong vd thi^u vi cheit dmh du-ong cOa tre du'di 5 tuoi tgi 10 xa thu^c 3 huy^n cua tinh Ngh? An ndm 2011. Ket qud nghifin cii'u cho thay ty 10 suy dinh du'ong cdcth^ nh^cdn, thipcbi vd gay c6m ian lupt Id 26,1%; 35,6% vS 7%. T;^l$ suy dinh du'&ng d tre trai cao hon trk gai vS ty 10 suy dinh du'ong cdc thi dlu c6 xu hodng tang din theo thSng tuoi. Thlp nhit IS nhOm <12 thdng tuoi vd cao nhit Id nhom trd to 48-59 thdng tuoi Ty le thilu mau Id 19%, thllu vitamin A la 14,2% vd thilu Item Id 28,5%.
Ttrkhod: Suy dinh du&ng, thilu vi chit dinh du&ng, tre dudi 5 tuoi, Nghe An, 2011.
L D A T V A N 0 E
Theo bao cao cua UNICEF nam 2009, ty Ie ti-e em bi thieu dinh dudng tiep tuc duy tri tren the gidi, trong dd 90% tre em thap cdi sdng d cac nudc chau A va chau Phi [1]. Cd nhi6u loai suy dinh dudng khac nhau trong dd suy dinh dudng thap cdi dugc coi la hien tugng phd bien nhat cua thieu dinh duong. Thieu dinh duong protein - nang Iugng dugc xem la nguyen nhan quan trpng hang dau cua suy dinh dirdng thap cdi. Suy dinh dudng thap cdi va thieu vi chat dinh duong la nhimg van de cd y nghia Slic khoe cdng ddng dang quan tam d nhieu nudc dang phat men. Hau qua cua cac rdi loan do thieu vi chat dinh duong (Vitamin A, Sat, Kem, Canxi) ciing rat nghiem tigng ve mat siic khoe frong giai doan hien tai va ttong tuong lai.
Q Viet Nam, theo ket qua giam sat dinh dudng nam 2011 cho thay, ty le suy dinh dudng the thap cdi ciia tre em tir 2-5 tudi cdn d miic cao (27,5%).
Dac biet d mdt sd vung ty le nay cdn d miic rat cao nhu Tay Nguyen la 37,3%, vung niii phia Bac la 33,6% va Bac Tmng Bd va duyen hai mien Trung la 32%. Trong do ty le thap cdi ciia tinh Nghe An la 31,8% [2]. Theo thdng ke ciia WHO va UNICEF nam 2006, fren toan cau cd 750 trieu ngudi bi thieu mau, khoang fren 30% fre em dudi 5 tudi hi thieu kem. Cac van de thieu vi chat khac nhirthieuvitaminA, thieu selen,.... Cling cdn tirong ddi ttSm frgng d nhimg ntrdc dang phat tiiSn, dac
biet la nudc ngheo [3].
Nghe An la mgt tinh nam d Bac rmen Trung cua nudc ta vdi dac di6m khi hau rSt khic nghiet, khdng thuan Igi cho viec phat tnen kinh te va dia hinh phirc tap c6 ca ddng bang, mien niii va mien bien. Hien nay, Nghe An van dugc xem la mdt frong nhiing tinh ngheo ciia Viet Nam. Theo ket qua dieu tta ve tinh trang va khau phan fre em Viet Nam 2-5 tudi nam 2009 thi ty le suy dinh duong thap cdi cua Nghe an van cdn d muc rat cao:
32,9% so vdi miic trung binh cua toan qudc la 29,1% [4] . Tu thuc te fren chiing tdi tien hanh danh gia "Thuc ttgng suy dinh dudng va diieu vi chat dinh dudng d fre dudi 5 tudi tai 3 huyen, tinh Nghe An" vdi muc tieu cu the la danh gia thuc ttang cua suy dinh duong va thieu mau d tre em dudi 5 tudi tai 3 huyen, tinh Nghe An.
IL PHironVG PHAPNGHIEN ClTU 2.1. Doi hrong nghign cihi:
Tre <5 tudi khdng cd di tat bam sinh, khdng mac cac di tat anh hudng den nhan trie, khdng hi mac cac benh ve mau, khdng mac cac benh man tinh va nhilm tning cap tinh.
LLThiA gian va dia diem nghien cihi:
- Thdl gian: thang 6 nam 2011
- Dia diem nghien cim: 10 xa thudc 3 huyen Tuong Duong, NghTa Dan va Dien Chau ciia tinh Nghe An.
*Tac gia: Hd Thu Mai
Dia chi: Vien Dinh Duong qudc gia Dien thoai: 0904.437.872 Email: [email protected]
Tap chi Y hgc du phdng, Tap XXIII, s6 2 (137) Ngaynhan bai: 20/12/2012 Ngay giii phan bien: 23/12/2012 Ngay dang bai: 28/4/2013
2.3.Thilt k^ nghi§n cmi:
Nghien ciiu md ta cat ngang.
2.4.C0- mau va phu-tfng phdp chpn miu:
Ap dyng cdng thiic tinh cd mau [5]
4.p. [1-p]
n =
- p: Ty 1? suy dinh dudng thap cdi ciia tr6 dudi 5 tuoi cua tinh Ngh? An nam 2010 = 0,329 [6]
- e: sai sd chuan= 0,05(khoang sai l?ch giira mlu va quan th6)
- delT; Hi?u iing thiet kk chgn mau chiim = 2 - 1,1: He sd dir phdng tang them 10% trong trudng hgp bd cugc giura chirng
Sau khi tinh toan va cgng 10% tre bd cugc, tinh dugc cd mlu cho 1 gidi 760 tre
Vay tdng so cd mlu la: 760 tre/gidi x 2 gidi
= 1520 fre
Phuang phap chgn mlu: Trong danh sach fre dudi 5 tudi ciia 10 xa chgn ra 152 fre < 5 tudi d mdi xa de can, do nhan frac va lay mau xet nghiem theo phuang phap chgn mlu nglu nhien he thdng dk chpn du 1520 tre.
2.5. Phu-ffng phap ddnh gia
- Tinh trgng dinh duang: Tinh frang dinh dudng ciia tre dugc danh gia dua vao sd do nhan trac (can nang va chieu cao). Tinh trang dinh dudng cua tre dudi 5 tudi dugc danh gia theo phan loai va quan the tham chieu cua Td chiic Y tk the gidi nam 2005 [I]. Tre dugc coi la suy dinh dudng khi cac chi sd can nang/tiadi, chieu cao/tudi va can nang/chieu cao <-2SD va thira can khi W/H >+2SD.
- Tinh trgng vi chdt vd thieu mdu:
+Ddnh gid tinh trgng kem huyit thanh; Dua
vao hudng dan cua WHO nam 2006 va td chiic tir vkn kem qu6c te [7]: tte dugc coi \k thieu kem khi ndng dg kem huyfit thanh < 10,7 ^mol/L.
+ Ddnh gid tinh trgng vitamin A huyet thanh;
Theo phan lo&i cua WHO nam 2006 [7]: Tre coi la thieu vitamin A nhe khi ndng do retinol huyet thanh hi 0,35 - 0,7 mmol/l. Tre coi la thieu vi- tamin A n§ng khi nong dg retinol huySt thanh
< 0,35 mmol/l
+ Phuang phdp ddnh gid tinh trgng thieu mdu: Theo phan Ioai ciia WHO/UNICEF/UNU nam 2001 [8]. Tr6 dugc coi la thiSu mau khi miic Hb < 11 g/dl.
2.6. Phan tich vd xu- ly so lifu:
- Sd lieu dugc kiem fra, lam sgch trudc khi nhap.
- Phan mfim EPI-INFOR DATA dugc diing de nhap va quan ly sd lieu.
- Phin mem SPSS dugc sir dyng de phan tich cac sd li?u.
- Cac test thdng ke phu hgp se dugc sfr dung dk kiem dinh ve phan bd chuan cua so lieu: test
•)^ de so sanh 2 ty le, test t dung de so sanh cac gia tri trung binh cd phan bd chuan.
2.7. Dao dire nghien cihi:
Ddi tugng dugc giai thich rd ve muc dich, ngi dung thuc hien va quySn lgi khi tham gia nghien ciiu, ddng thdi hg phai ky giay tinh nguy?n tham gia truac khi lay mau. Phuong phap lay mau va ky thugt xet nghicm mau da dugc chuan hda va lay mau dugc th\rc hien tai tram y te xa. Dung cu lay mau cho cac ddi tugng deu dam bao vd triing, an toan tuyet doi theo dung qui dmh va chi su dyng 1 lan.
H I . KET QUA
40-, 30- 20.
10-
n.
27 8 24 6 26 1 I 19.6 313 35 6
BTrai DGdi D Chung
Hinh 1. Ty 1# suy dinh dipang theo gio'i cua tre <5 tu6i (n=1520)
Tap chi Y hoc dir phong, Tap XXIII, s6 2 (137)
KSt qua nghien ciiu d bi6u dd I cho thay ty 18 suy dinh duang cSn nang/tudi va chi8u cao/tudi ciia fre <5 tudi tgi dia ban nghien ciiu cdn d miic cao. Ty Ie suy dinh dudng cua fre frai d ca 3 th6 cao ban so vdi fre gai. Ty 1$ suy dinh duang can nang theo tudi la 26,1% va d fre frai cao hon tre gai (27,8% so vdi 24,6%).
Sir khac bi?t la cd y nghTa thdng ke (p<0,05).
Ty le suy dinh duang thSp cdi chung cho ca 2 gidi la 35,6%i. Ty le nay d fre trai cao hon tre gii va sy khac bi?t co y nghia thdng ke vdi p<0,01 (39,6% vk 31,3%). Ty le suy dinh duang can nang/chieu cao la 7% va khdng cd sy khac bi?t.
D<12 tliang • 1 2 - 2 3 ili^g n24-35thang •36-47lliang Q4S-59 thang
Hlnh 2. Ty le suy dinh d u v n g 6* tre Ty le suy dinh dudng d ca 3 th6 d tre gai cd xu hudng tang dan theo thang tudi. Ty le suy dinh duong the nhe can thap nhat d nhdm
<12 thang tudi (9,2%i) va cao nhat d nhom 48- 59 thang tudi (40,9%). Xu hudng nay tuang tu d suy dinh duong the thlp cdi. Ty Ie suy dinh duang the thap cdi cao nhat d nhdm tre
gai theo nhdm thang tudi (n=1520)
48-59 thang la 37,2% va thlp nhit d nhdm
<12 thang tudi (10,7%). Tuy nhien, ty Ie nay tang han 3 lan tir sau 12 thang tudi va duy tri den 48 thang Ty le suy dmh dudng can nang/chieu cao la 5,3% d nhdm <12 thang tudi nhung ty le nay tang gap 2 lan d nhdm 48-59 thang mdi (11%).
45.6 43 9 43 8 n<12thaiig • 1 2 - 2 3 thang
^9 5 D24-35 thang • 3 6 - 4 7 thang 0 48-59 tliani
CNH" COT CNICC Hlnh 3. Ty I9 suy dinh du'&ng o* tre trai theo nhom thang tudi (n=1520)
Tinh ttang suy dinh duong the nhe can va gay cdm d fre frai cd xu hudng tang dan theo thang tudi. Ty Ie suy dinh duong the nhe can thap nhat d nhdm tre <12 thang (13,6%) va cao nhit d nhdm 48-59 thang (37,2%). Ty le suy dinh dudng the gay cdm cung thap nhat d nhdm tre <12 thang (4,8%) va cao nhit d nhdm 48-59 thang (13,2%). Trong khi dd, ty le suy dinh
dudng the thap cdi d tre trai tang dot bien tu 22,4% d nhdm fre <12 thang len 45,6% d nhdm tudi 24-35 thang va sau do giam dan xudng cdn 39,5% d nhdm fre 48-59 thang (Hinh 3).
Ket qua nghien ciiu a bang 1 cho thay tinh trang thieu mau, thieu vitamin A va thieu kem huy6t thanh cua tre <5 tudi tgi 3 huyen thugc tinh Nghe An.
Tap chi Y hgc du phdng, Tgp XXIII, so 2(137) 23
Bdng 1. Tinh tr?ng thilu vi ch^t dinh dudng d- trd < 5 tudi theo tinh tr?ng thdp cdi (%) SDD thdp cdi (n=200)
Chi tieu Chung (n=400)
Thi^u mSu Thi^u vitamin A Thieu kem
19,0 14,3 28,5
21,5"
19,0*
33,0' ':p<0,01. ":p<0,05 (x2 test)
Ty 1? thieu mau chung la 19% nhung d nhdm tre bj suy dinh dudng thap cdi thi ty I?
thieu mau la 21,5% va sy khac bi?t cd y nghTa thong ke(p<0,05).
Ty I? thieu vitamin A va thicu kem huyet thanh d nhdm tre hi suy dinh dudng the thap cdi cao han cd y nghTa thdng ke so vdi ty 1?
chung (p<0,0l). Ty le thidu vitamin A chung cho cua tre dudi 5 tuoi la 14,3% trong khi dd ty le nay d nhdm fre bi suy dinh dudng the thap cdi la 19%. Gan 1/3 sd tre dudi 5 tudi tai dia ban nghien ciiu bi thieu kem huyet thanh (28,5%.) va d nhdm tre bi suy dinh dudng the thap cdi c6 tdi 33% tre bi thieu kem.
IV. BAN LUAN
Danh gia tinh trang dinh duang ciia tre dudi 5 tudi dugc thyc hien fren 1520 tre tai 3 huyen cua tinh Nghe An nam 2011. Ket qua tai hinh I cho thay ty le suy dinh duong the thap cdi cua tre dudi 5 tudi tai dia ban nghien ciiu la 35,6%. Tre trai cd ty Ie suy dinh dudng the thap cdi cao hon tre gai (39,6% so vdi 31,3%) va sy khac biet c6 y nghia thdng ke vdi p<0,01.
Ty le suy dinh dudng the thap cdi cao nhat d nhdm tre 48-59 thang la 37,2%. Suy dinh dudng thap cdi d tre gai va tre trai deu cd xu hudng tang theo thang tudi. Thap nhat d nhdm
<I2 thang tudi va cao nhit d nhdm 48-59 thang tudl. Ty le suy dinh dudng the thap cdi ciia tre trai dudi 5 tudi tai Nghe An thap nhat d nhom dudl 12 thang (22,4%) va cao nhit d nhdm 12- 23 thang (45,6%). Sau 12 thang tudi ty le suy dinh dudng thap cdi dfiu tang nhanh d ca tre gai va tre trai vdi miic dp cao Nguyen nhan d day CO the la do tre chua dugc cham soc dinh dudng diy du theo diing nhu clu khi dang a 24
giai doan tre phit trien nhanh ve the lyc.'Ngh?
An la mgt trong 22 tinh cd ty le suy dinh dudng chifiu cao theo tudi d tre dudi 5 tudi tren 30%), Ty lc suy dinh duang the Ihap cdi d Nghe An nam 2011 la 31,8%. Ket qua nghien cim cho thay tre dudi 5 tudi tgi 3 huygn dieu tra cao hon so vdi ty 1? chung cua Ngh? An va cao han so vdi toan qudc [2]. Ty I? suy dinh dudng thap cdi tai 2 phudng cua thanh phd Bien Hoa nam 2010 la 14,3% va 29,7% [9] va ciia tre tgi mpt sd xa thugc tinh Ddng Nai nam 2006 la 16,4%
va 31,1% [10] deu thap hon so vdi ket qua nghien ciiu. Nghien ciiu cua Nguyin Thanh Ha tai Bac Ninh cho thay ty le suy dinh dudng thap cdi tgi day cung tuang tir vdi ket qua nghien cuu cua chiing tdi [11].
Tinh trang thieu vi chat dinh dudng nhu sat, kem, vitamin A a tre cung la mgt trong nhung nguyen nhan quan trgng dan den tinh trgng thap cdi cao. Nhirng tre hi suy dinh dudng thap cdi cd ty le thieu mau, thidu vita- min A va thieu kem huyet thanh cao han co y nghTa thdng ke so \ di ty le chung (bang I). Ket qua nghien ciiu cua Nguyin Thanh Ha cho thay tinh trang thilu mau, thieu vitamin A va thieu kem tren fre bi suy dinh dudng the thap cdi deu a miic nang theo phan logi cua WHO.
Tre hi thap cdi cd ty le thieu da vi chat kha cao.
Khoang 1/3 sd tre thap cdi thieu I loai vi chat, tren 1/5 thilu kit hgp 2 vi chit va gin I/IO tdng sd tre thieu ket hgp ca 3 Ioai vi chat [9].
Nhin chung, tinh trgng thieu mau va thieu vi chat dinh duong ciia tre <5 tudi tai 3 huyen cua tinh Nghe An thap han so vdi ty le thieu mau deu d miic trung binh ve mat y nghia siic khoe cgng ddng theo phan logi ciia Td chirc Y te the gidi. Ket qua nghien ciiu nay thlp hem so vdi k6t qua tdng dieu tra vi chat dinh duong nam 2008.
Tap chi Y hgc du phdng. Tap XXIII, sd 2(137)
V. KET LUAN
Ket qua nghien ciiu vl tinh frang dinh duang va vi chit dinh dudng d fre <5 tudi tai 3 huyen Tuang Duong, NghTa Dan va Dien Chau thudc tinh Nghe An nam 2011 cho thay:
- Ty le suy dinh duang thi nhe can la 26,1 % va ty le nay d fre trai cao hon so vdi tre gai cd y nghta thdng ke vdi p<0,05.
- Ty le suy dinh dudng the thap cdi ciia fre dudi 5 tudi tai dia ban nghien cuu cdn d miic cao (35,6%). Ty le suy dinh dudng the thap cdi d tre trai cao hon so vdi tre gai (39,6% so vdi 31,3%) vdi p<0,01.
- Ty le thieu mau, thieu vitamin A va thieu kem huyet thanh deu d mirc trung binh ve mat y nghTa siic khoe cdng ddng. Ty le nay lan lugt la 19%; 14,3% va 28,5%.
TAI LIEU THAM KHAO
1 WHO (2005), Global Database on Child Growth and Malnutrition: methodology and applications, WHO press.
2. Vien Dinh dudng (2012), Ket qua dieu tta ve tinh trang dinh dudng va khau phan fre em Viet Nam 2-5 tudi nam 2011, bao cao ciia Vien Dinh dudng.
3. Global Allliance for Improve Nutrition (2006), Vitamin and mineral deficiencies technical situattion analysis. Global Alliance for nufrition, Geneva press.
4. Vien Dinh duang (2010), Ket qua dieu tra ve tinh trang va khau phin tre em Viet Nam 2-5 tudi nam 2009, bao cao cua Vien Dinh dudng.
5. Ha Huy Khdi (1997), Phucmg phap dich te hpc dinh duong, NXB Y hgc. Ha Npi.
6. Vien Dmh dudng (2011), Kit qua dieu tra ve tinh trang va khau phan tre em Viet Nam 2-5 tudi nam 2010, bao cao cua Vien Dinh dudng.
7. Global Allliance for Improve Nutrition (2006), Vitamin and mineral deficiencies technical situattion analysis. Global Alliance for nutrition, Geneva press.
8. WHO (2001), Iron Deficiency Anemia: As- sessment, Prevention and Control, A guide for programme managers.
9. Hd Thu Mai, Phan Van Huan, Pham Thi Thiiy Hda (2011), Tinh trang dinh dudng, thieu mau va mdt sd yeu td lien quan ciia tre dudi 5 tudi tgi khu cdng nghiep Bien Hda, Ddng Nai nam 2010. Tap chi Y hoc Thuc hanh
lO.Pham Qudc Hilng va CS (2006), Md hinh cham sdc dinh dudng toan dien tgi mgt sd xa phudng diem d tinh Ddng Nai 2004 11 .Nguyen Thanh Ha (2010), Hieu qua bd sung
kem va sprinkles va da vi chat tten tre 6-36 thang tudi suy dinh duong thap coi tgi huyen Gia Binh, tinh Bac Ninh.
CURRENT NUTRITIONAL AND MICRONUTRIENT DEFICIENCY SITUATION AMONG UNDER FIVE CHILDREN IN THREE DISTRICTS, NGHE AN PROVINCE
Khuc Thi Tuyet Huong', Ho Thu IVlai\ Le Thi Hop^ Pham Thi Thuy Hoa^
'Thai Nguyen Medical Collage
^National Institute of Nutrition, Hanoi The cross-sectional sudy on nutritional and micronuttients deficiency status among under five children was carried out in 2011 in 10 communes belong to 3 districts of Nghe An province. The finding shows that the preva- lence of underweight, stunting and wasting are 26,1%; 35,6% and 7%, respectively. The
prevalence of malnutrition in boys is higher than in girls and gradually increases by age group. The prevalence of anemia is 19%, Vi- tamin A deficiency is 14,2% and Zinc defi- ciency is 28,5%.
Key words: Malnuttition, micronutrient de- ficiency, under five children, Nghe An, 2011 .
Tap chi Y hgc dy phdng, Tap XXIII, so 2 (137)
