TC.DD&TP 9 (1)^2013
fflEU,QUA BO SUNG DA VI CHAT DINH D U O N G V A TAY GIUN DEN TINH TRANG VI CHAT DINH DUdNG CUA TRE THAP COI, 12-36 THANG TUOI
NGUdl DAN TOO VAN KIEU VA PAKOH
Trdn Thi Lan', Nguyen Xudn Ninh', Le Tiu Huang' Muc tieu: Danh gia hieu qua ciia lay giun sdm va bo sung da vl chat tren tre suy dinh dudng (SDD) thap coi, dan tpc Pakoh va Van Kieu (Quang Trj). Phuo'ng phap: thir nghiem can thiep cpng dong CO doi chirng; 284 tre bj SDD thap coi, trong do 139 tre co nhiem giun, dupc chia ngau nhien ra 4 nhom vdi 4 can thiep khac nhau. l)Nh6m Chirng (n=73), khong dupc tay giun vauong da vi chat; 2) nhom Tay giun dan thuan (TG. n=70), gom nhirng tre co giun, dupc uong I lieu Mebendazole 500mg khi bat dau can thiep; 3) nhom bo sung da vl chat (DVC, n=72), dugc uong goi da vi chat hang ngay; 4) nh6m Ket hpp TG+DVC (n=69), vCra dupc lay giun, vira uong da vi chat hang ngay trong 6 thang. Ket qua: sau 6 thang can thiep, lay giun va bo sung da vi chat cho tre SDD thap coi co tac dung tang ham lupng vi chat dinh dirong (Hb, Retinol, Kem) va giam ty le thieu mau, tliieu vitamin A, thieu kem. Bo sung da vi chat co hi?u qua tot han tay giun dan thuan. Can thi?p phoi hap bo sung DVC va TG co tac dung hiep dong lam lang hieu qua len tinh trang vi chat dinh dudng (VCDD) tot hon lay giun hoac b6 sung da vi chit dan thuin. Khuyen nghj: De phong thieu vi chat dinh dirdng va SDD d tre em, Bp Y te, cac chuong trinh dinh duong, cin xem xet ban hanh chinh sach b6 sung da vi chit ket hpp lay giun cho tre tir 12 thang tuoi d nhung vimg nhiem giun va ty le SDD cao.
Tir khoa: SDD thdp cdi tre em. da vi chdt, tdy giun sdm.
I- DAT VAN DE
Suy dinh dudng (SDD), thieu vi chat dinh dudng nhu thieu vitamin A, thieu mau thieu sat, thieu kem... d tre em van pho bien d muc y nghia sure khoe cpng dong tren nhleu quoc gia tren the gidi trong do CO Viet Nam. Benh gay nhieu hau qua khong lot den phal trien tri tue va the Iyc nhiing nam sau nay [5].
Tre SDD thudng ket hgp vdi thieu mgl hoac nhieu vi chat dinh dudng (VCDD).
cac VCDD tham gia vao hau hel cac qua trinh chuyen hoa cua ca the, boat dpng cua cac enzym, co chat, cac qua trinh sinh san va phat trien cua te bao, do vay hoac
tryc tiep hoac gian liep co vai tro quan trgng vdi lang trudng ciia c a the. Mpt Irong nhimg nguyen nhan cua thieu VCDD la khau phan an tai cac nudc dang phat trien chii yeu la ngu coc, trong do gao cung cap tdi 60-70% nang lugng khiu phin [5],[10],[II]. Tre hay bi mac cac benh nhiem khuan dudng ho hap, roi loan lieu hoa, lieu chay, nhiem giun san dudng rudt... Iam nang them tinh trang SDD va thilu VCDD [7]. Theo thdng ke cua WHO 2002, co din 230 trieu tre em tir 0-4 tudi bi nhilm giun [9]. Nhiem ky sinh trung dudng rupt la yeu to nguy co cua SDD va thilu VCDD [8].
'Ths. BS. T6 chdc Ciiru trp Tre em.
^PGS. TS. Trung tam Doping & Y hpc Thi thao 'PGS. TS. Vi?n Dao t?o YHDP-YTCC, DH Y Ha Npi
Phan bien 1: GS. TS. Le Thj Hpp- Vien Dinh dudng Phan bi?n 2: TS. Cao Thu Hiroiig-
Vien Dinh dudng Ngay nhan bai: 11/2012 Ngay dang bai: 15/04/2013
55
TC. DD &TP 9(1)-2013 Tuyen laiyen nang cao kien thuc va thuc
hanli cho ngudi me. tao nguon thyc pham san CO tai dia phuong, bo sung VCDD la nhihig bien phap co hieu qua giiip phat trien ihl lye, chieu cao, giam ly lp ihieu VCDD d tre em. Dya tren nhimg ket qua nay, to chirc qu6c tl WHO/UNICEF... da dua ra khuyin nghi phong ch6ng SDD bing bo sung VCDD, tiy giun cho tr^ nho d nhChig
\aing cd ty le nhilm giun cao. Tuy nhien d Viel Nam vipc tiy giun sdm cho Irc tir 12 tliang tudi con chua dugc pho bien ircn cpng dong.
Muc tieu nghien cuu: Danh gia hieu qua ciia bd sung da vi chat dinh dudng va tiy giun din tinh trang thieu vi chat dinh dudng (thilu mau, thieu vilamin A, thieu kem) ciia Ue 12-36 thang moi, bi suy dinh dudng thap coi, dan tpc Van Kieu va Pakoh huyen Dakrong, tinh Quang Tri.
II- DOI TU'ONG, PHLTCfNG PHAP 2.1- Thiet ke nghien cuu: Thir nghiem can thiep cgng dong co doi chirng
2.2- Doi tu'ffng: Tre 12-36 thang tuoi;
SDD thip coi (HAZ<-2SD); Khdng hi cac benh bam sinh, benh man tfnh, nhiem khuan cap tai thai diem tuyen chgn;
khong bi thieu mau nang (Hb>70g/L);
Dugc bo me dong y tham gia nghien cuu.
2.3- Cff mau: tinh theo cong thirc ciia WH0[12]: n= Z^(a,ii)(2Sy(pi- ^,)^ Trong do: n: cd mau; S: dp lech chuan ciia p;
a=0,05; p=0,l; Z=(D.p)=10,5; |^,-p,: sy khac biel giira nhom nghien cuu so vdi nhom chung. Dya vao nghien ciru trudc day [3], udc tinh vdi chieu cao:
S^0,65cm; su khac biet Pi-p,= 0.38cm -> n-63; Vdi Hb: S-9g/l; pi-p,=5,5g/dl
=> n^60. Dy phong 10% Ire bo cugc, n=70 tre/nhom nghien cim.
2.4- Chon mau: Tir kel qua sang lpc tren 680 chau ve nhan trac, xet nghiem
giun, CO 452 tre SDD thap coi. trong do 144 tre SDD thip coi va bi nhilm giun;
308 tre SDD thip cdi khong bi nhilm giun. Chgn ngau nhien theo dan vi thon (26 thdn) dugc 284 tre, phan ra 4 nhom sau:
- Nhom Chumg: (CTR, n=73) SDD Ihap cdi khdng bi nhiem giun, chi hudng cac cham soc thudng quy tai dfa phuang - Nhom Tiy giun: (TG, n=70) SDD thip cdi va bi nhiem giun, dugc lay giun bang 1 lilu Mebendazole 500mg khi bat dau can thiep.
- Nhom Da vi chit: (DVC, n= 72) SDD thip cdi khdng bi nhiem giun, dugc bd sung goi da vi chat I goi/ngay x 7 ngay x 26 tuan.
Nhdm Da vi chat + Tay giun:
(TG+DVC, n=69) SDD thip cdi va bi nhilm giun, dugc tay giun 1 lieu Mebenda- zole 500mg, dugc bd sung gdi da vi chat; I gdi/ngay x 7 ngay/luan x 26 min.
Toan bg tre cua 4 nhdm nghien cihi dugc cap mdi ngay 1 gdi chao an lien Uong 26 tuan.
2.5- Vat lieu nghien cii'u:
Thudc Mebendazole 500mg (Fugacar) dugc sir dyng. Iieu duy nhat cho tre 12- 36 thang theo hudng dan cua Bp Y Te nam 2007 [1].
Da vi chat do Vien Dinh dudng san xuat, ddng gdi 10 gam/gdi, cd thanh phan chinh gdm 4-5g protein; 300-400 IU vi- tamin A; 0,02-0,03 mg vitamin B1; 1,5-2 mg vitamin C; 100-120 mg Canxi; 6-9 mg sat; va 3.2-3,7 mg kem.
Gdi chao an lien do cdng ty Ha Npi Food san xuat trpng lugng 50gam/g6i cung cip 176KCal; 2,5g Protein; 3g Lipid; va 35,5g Glucid.
2.6- Danh gia tinh trang vi chat Lay mau tTnh mach 2 lan, mdi lan 3ml vao budi sang (8h-llh), vao thdi diem trudc khi can thiep (To), va khi ket thuc can thiep (T6). Mau dugc bao quan trong 56
TC.DD&TP 9(1)-2013 phich Ignh, tranh anh sang, ly tam sau 3
gid d tdc dg 3000 vdng/phiit. Cac dung cu phan tach mau, dng nghiem... dugc tt-ang rira bing HCI 1 %, siy khd trudc khi diing de logi trir nhiem vi khoang tir mdi trudng. Cac mau huyet thanh dugc giir d nhiet dp -80'*C cho den khi mau dugc phan tich. Cac xet nghiem dugc thyc hien tai labo - Khoa Vi chat dinh dudng,Vien Dinh Dudng.
Hb dugc danh gia bang phuang phap cyanmethemoglobin. Tre dugc coi la thieu mau khi ndng do Hb < I lOg/L.
Retinol huyet thanh dugc phan lich bang phuang phap sac ky long cao ap (HPLC). Tre coi la thieu vitamin A khi nong dp retinol < 0,7mmol/L.
Kem huyet thanh dugc dinh lugng theo phuang phap quang phd hap phu nguyen tir (AAS). Tre dugc coi la thilu kem khi ndng do kem huylt thanh
<65pg/dL.
2.7- Theo doi va giam sat can thiep:
Hang man can bg y te xa phdi hgp vdi y te thdn ban (YTTB) td chuc di tham timg hp gia dinh, cap phat mdi tre 7 gdi chao an lien, 7 gdi da vi chat cho tre. YTTB &
can bd y te xa hudng dan sir dung gdi DVC, theo doi sd lugng gdi dugc sir dung va tinh trang benh tat ciia tre. Hai tuan mpt ian, nghien cuu vien ciing vdi giam sat vien myen huyen di tham hp gia dinh, Bdng 1. Dgc diim cdc chi so sinh hda
kiem tra ghi chep sd ciia CTV thdn xa, xac minh cac thong tin ghi chep, hudng dan va giai thich nhung thdng tin chua rd.
2.8- Phan tich so li?u: Nhung tre sir dyng >80% sd gdi da vi chat, cd du cac chi sd danh gia ban dau, ket thiic nghien cuu dugc dua vao tinh loan hieu qua. Chi s6 hieu qua (CSHQ, %) = (A-B)/A%, trong dd A la ty le trudc can thiep (To); B la ly le sau can thiep (Te). Hieu qua can Ihiep(HQCT) = CSHQCT CSHQ chimg. Test ANOVA hoac Kruskal_Wal- lis, test x^ va T-test ghep cap dugc dimg de kiem djnh su khac biet giira cac gia tri trung binh, cac ty le % va su khac biet trudc va sau can thiep.
2.9- Dao due nghien cihi: De tai da Ihong qua Hdi ddng dao due - Vien Dinh Dudng.
Ill- KET QUA NGHIEN ClTU 3.1. Dac diem cua doi tirong khi bat dau can thiep
Tai thdi dilm TO, 284 tre SDD thip cdi dugc chpn va phan bd vao 4 nhdm nghien cim. Tai thdi diem T6, cd 13 tre bd cupc (8 tre khdng ddng y lay mau, 5 tre khdng udng dli sd ngay). Tre bd cudc c6 dac diem nhan trac, sinh hda tai thdi diem TO tuong ty vdi nhung tre cdn lai. So lieu ciia 271 tre hoan thien nghien cuu dugc dua vao phan lich hieu qua can thiep.
cua tre tgi thdi diim bdt dau can thiep (To) Chi so CTR (n=69) TG (n=65) DVC (n=69) TG+DVC (n=68) Gii tri trung binh (X±SD)
Thang tuoi Hb(g/L) Retinol (pmol/L)
Kem (ng/dL)
27,0±6,7 I03,4±13,5
0,85±0,29 67,9±9,0
26,1±7,0 103,0±ll,5 0,82±0,40
27,2±7,0 105,01±10,7
0,83±0,21 66,5±ll,9
27,5±6,8 101,2±I0,5 0,81±0,25 66,9±10,7 Ty le thiSu vi ch^t: n (%)
Thi6u mau Tliieu Vit A Thieu kem
48 (69,6) 23 (33,3) 30 (43,5)
45 (69,2) 25 (38,5) 23 (35,4)
46 (66,7) 19(27,5) 29 (42,0)
52 (76,5) 24 (35,3) 27 (39,7) p>0,05 giira cdc nhdm, (ANOVA test vaiX^SD,-^ lest cho ty le %.
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TC. D D & T P 9 ( 1 ) - 2 0 1 3 Bang 1 cho tMy ca 4 nliom nghien ciiu
tai To dSu co cac chi so vS tuoi, nong dg Hb, Retinol, Kem tuong duong nhau (p>0,05). Ty le thieu mau, thiSu vitamin A, thiSu kSni cung khong khic bipt c6 y
nghia giira cac nhom. Ty le thieu mau dao dong til 66,7 den 76,5%; thiju vitamin A dao dpng tir 27,5 dSn 38,5%, thi6u kem dao dpng tir 35,4 dSn 43,5%, thupc miic nang co YNSKCD.
3.2. Hieu quii cua can thifp den tinh trang vl chat dinh du-ffng cua tre Bdng 2. Hifu qud can titifp den lhay ddi (T»-T(i) nong df vi chit dinh du'dng cua Ire
C h i s 6 Tang Hb(g/L)
rang Retinol (nmo!/L) Tang Kgm (ng/dL)
C T R ( n - 6 9 ) 5,76±10,3I
0,06±0,35 6,1±8.0
TG (n=65) 7,43±9,22 0,I2±0,30 7,0±5.3
D V C (n=69) T G + D V C (n=68) 13,77+9,93***,+++ 14,03+6,43***,+++
0,13+0,23 0.19+0,16*
12,4+12,0**,++ 1 3 . 6 = 8 . 2 " " , + + + Xr^SD:*: p<0.05; : p<0.01; : p<0.001 vs. CTR; +: p<0.05; ++: p<0,01;
p<0.001 vs. TG
Bang 2 cho thay can thiep tay giun, bd sung da vl chat va phdi hgp TG+DVC den tinh trang vi chat dinh dudng ciia tre:
Nhdm tay giun cd xu hudng tang ndng do Hb, Retinol, Kem trung binh nhieu hon so vdi nhdm Chung (CTR), tuy nhien su khac biet khdng cd y nghia thdng ke (p>0,05).
Nhdm bo sung DVC don thuan da tang ndng dp Hb rat ro ret, hem nhdm CTR 2,4 lin va han nhdm TG 1,9 lin (p<0,001);
ndng dp kem ciing tang cao cd y nghTa Bdng 3. Chi so hieu qud vd hieu qud
thdng ke so vdi nhdm CTR va nhdm TG (p<0,01): ndng do retinol cd tang cao ban nhdm CTR \ a nhdm TG, nhung muc khac biet chua cd y nghTa thdng ke (p>0,05).
Kit hgp TG+DVC cai ihien cac chi sd sinh hda tdt hon nhdm CTR va TG don thuan d hau het cac chi sd, vdi p<0,001 cho Hb va kem, p<0,05 vdi retinol. So vdi nhdm DVC don thuin, kit hgp TG+DVC cd xu hudng tang Hb, Zn, Retinol nhieu hon, tuy nhien sy khac biet chua cd y nghia thdng kc.
can thiep ciia cdc nhdm nghien ciru Chi so
Thieu m i u (%) C S H Q H Q C T vs. C T R H Q C T vs. TG H Q C T vs. DVC
C T R ( n - 6 9 ) 27,2%
TG ( n - 6 5 ) 26,6%
-0,6%
DVC (n=69) 65,2%
38,0%
38.6%
T G + D V (n-68) 67,3%
4 0 , 1 % 40,7%
2 , 1 % Thieu vitamin A tien Iam sang (%)
C S H Q H Q C T vs. C T R H Q C T vs. TG H Q C T vs. D V C Thieu KSm (%) C S H Q H Q C T vs. C T R H Q C T vs. TG H Q C T vs. DVC
39,0%
70,1%
28,0%
-11,0%
65,3%
-4,8%
42,2%
3,2%
14,2%
76,0%
5,9%
10,7%
79,0%
40,0%
51,0%
36,8%
77,8%
7,7%
12,5%
1,8%
CSHQ: chi sd hieu qud, HQCT: hieu gud can thiep 58
T C . D D & T P 9 ( 1 ) - 2 0 1 3 Bang 3 cho thiy CSHQ ciia nhom phdi
hgp TG-i^VC cao nhit ddi vdi tit ca cac chi sd thieu mau, thieu vitamin A va thilu Kem (67,3%; 79,0% va 77,8%); tilp din la nhdm bd sung DVC don thuin (65,2%;
42,2% va 76,0%) rdi d i n nhdm TG don thuin (26,6%; 28,0% va 65,3%).
Tuong ung, HQCT so vdi nhdm CTR ciia nhdm phdi hgp TG+DVC ciing cao nhat rdi tiep den la nhdm bd sung DVC dan thuan, trong khi nhdm TG don thuan khdng thay rd hieu qua so vdi nhdm CTR.
Bang 4 dudi day cho thay HQCT vdi giam ty le thieu kel hgp cac vi chat d cac nhdm nghien cuu: nhdm cd bd sung VCDD la rat tdt, dac biet la nhdm phdi hgp bd sung DVC+TG:
Sd tre khdng thieu vi chat nao d nhdm TG+DVC cao hem nhdm bo sung DVC don thuan (55,9% so vdi 50,7%), cao hon bin nhdm TG (27,7%) va nhdm CTR (29,0%).
Mirc giam ty I? thieu 1 vi chat d nhdm DVC va nhdm DVC+TG la 20,3% va 11,7%; nhom TG giam 7,7%; nhdm CTR cdn lang ty Ie nay len 4,4%.
Ty le thieu 2 vi chat deu giam di d cac nhdm nghien cim: nhdm DVC+TG giam 33,9%; nhdm DVC giam 24,6%; nhdm TG giam 15,4% va nhdm CTR giam 33,3%.
Ty le thieu 3 vi chat dinh dudng ciing giam 10,3%; 5,8% va 4,6% cho 3 nhdm TG+DVC, DVC, va TG, Uong khi khdng thay ddi d nhdm CTR.
Bdng 4. Hieu qud can thiep din ty le thiiu ket hop cdc vi chdt dinh dw&ng
Chi so Ty l | thieu ket Binh thucmg Thilu IVC ThiSu 2VC Thieu 3VC Ty If thieu ket Binh thirong Thieu IVC ThiSu 2VC
hop
hop CTR (n=69)
TG (n=65) cac vi chat tai thtri diem Tu
9(13,0) 23 (33,3) 33 (47,8) 4 (5,8)
7(10,8) 29 (44,6) 23 (35,4) 6 (9,2) cac vi chat tai thoi diem T6
29 (42,0) 26 (37,7) 10(14,5)
25 (38,5) 24 (36,9) 13(20,0)
DVC (n=69)
10(14,5) 29 (42,0) 25 (36,2) 5 (7,2)
45 (65,2) 15(21,7) 8(11,6)
DVC+TG (n=68)
6 (8,8) 29 (42,6) 25 (36,8) 8(11,8)
44 (64,7) 21 (30,9) 2 (2,9)
Thieu 3VC 4(5,8) 3 (4,6) I (1,4) 1 (1,5)
Mirc tang/giam ty If (%) thieu vi chat sau 6 thang can thiep(Tii-To) Binh thuang
Thieu IVC Thilu 2VC Thilu 3VC
+ 29,0 + 4,4 -33,3
0
+ 27,7 7,7 - 15,4 4,6
+ 50,7 -20,3 -24,6 5,8
+ 55,9
• 11,7 -33,9 - 10,3
« (%); +.- tdng len; -: gidm di so vdi To
TC.DD&TP 9(1)-2013 IV-BAN LUAN
4.1- Ve ch^n mau v^ phan nhom can thiep
Ddi tugng cho nghien ciru can thiep cua chiing loi la ire SDD thap cdi, lua tudl 12-36 thang, trong do cd nhdm tre d lua ludi 12-24 Ihang la lira tuoi chua dugc chi dinh lay giun dai tra d Viet Nam. 284 tre SDD thap cdi ciia 26 thdn ban, dugc chia ra 4 nhdm tre ngau nhien theo don vj thdn. Theo hd so Y due va quy djnh ciia Bd Y Te, chi nhirng tre nhiem giun mdi dugc lay giun. Do vay cd 2 nhdm dugc lay giun la nhdm TG don Ihuan va nhdm TG+DVC; 2 nhdm khdng bi nhiem giun la nhdm chirng (CTR) va nhdm bd sung DVC don thuan. Vdi thiet ke nhu vay cd the danh gia dugc hieu qua ciia lay giun don thuan, hieu qua ciia bd sung da vi chat don thuan va hieu qua ciia phdi hgp tay giun va da vi chat tren tre SDD thap cdi.
4.2- Ve hieu qua ciia tay giun Tac dung ciia tay giun don thuan cd xu hudng tang ndng dp Hb, Retinol, Kem trung binh nhieu hon so vdi nhdm Chirng (CTR), tuy nhien sy khac biet khdng cd y nghTa thdng ke (p>0,05). Tuang ty, mirc tang can nang, chieu cao, cac chi sd Z score d nhdm TG don thuan cd xu hudng tdt ban nhdm CTR nhung su khac biet cung chua cd y nghTa thdng ke (p>0,05). Chi sd hieu qua ciia iiy giun cung dat 14,5% vdi SDD nhe can, va 4,8% vdi SDD thap cdi (sd lieu cdng bd trong bai bao khac).
Chi sd hieu qua ciia tay giun dan thuin den cac chi sd vi chat dinh dudng nhu thilu mau, thilu kem, thilu vilamin A cung khdng khac biet so vdi nhdm CTR.
Dieu nay cd thi giai thichla do khiu phin an ciia nhdm TG va nhdm CTR khdg cd sy khac biet nhilu ca hai nhdm dlu chiu anh hudng ciia dieu kien ve sinh, tap quan 60
va thdi quen an udng sinh boat lac hau.
Mdt sd nghien cuu cho thiy neu khdng lhay ddi dieu kien mdi Irudng, chi 6 tuan sau tre da bi tai nhilm nhu trudc khi tiy giun [6]. Nghien ciiu cua chiing tdi cd han che la khdng danh gia mirc do tai nhiem ciia Irc sau can thiep, do vay khdng khang djnh dugc sau bao lau thi ire bj nhiem giun ird lai. Tai nhihig viing nhiem giun cao, nhu dja ban nghien curu ciia chiing ldi, can thu nghiem ap dung tay giun vdi khoang each gan hon (vf du 4 thang 1 lan) nhu WHO dua ra khuyin nghj [9].
4.3- Ve hieu qua cua bo sung Da vi chat:
Nghien cihi cua chiing tdi cho thay bd sung DVC don thuan cd hieu qua tdt hon cd y nghTa thdng ke so vdi nhdm CTR va nhdm TG don thuan ve tang ndng dp Hb (p<0,001), lang Kem (p<0,01). Mirc tang ndng dp Retinol chua cd y nghTa d nhom bd sung DVC va TG so vdi nhdm chiing (p>0,05).
Ket qua nghien cuu ciia chung toi chi ra rang bd sung DVC cd hieu qua cai thien ty le thieu vi chat tdt han nhdm CTR d tit ca cac chi sd: Giam 38,0% ty le thieu mau, 3,2% ly le thieu vitamin A;
5,9% ty le thilu Kem. So vdi nhdm TG don thuan thi hieu qua can thiep cua nhdm bd sung DVC cung cao hon: Giam 38,6% ty le thilu mau; 14,2% ty le thilu vitamin A; 10,7% ly le thilu Kem.
Ket qua nay cua chting tdi phii hgp vdi ket qua ciia mdt sd tac gia Nga TT [6] va cac nghien cuu ve hieu qua bd sung da vi chat d Viet Nam. Bd sung da vi chit tren Ire SDD thap cdi, hoac tre nhd nguy co SDD va thieu VCDD cao ndi chung co tac dung cai thien ndng dp Hb, Retinol va Kem huyet thanh cung nhu giam ty le thieu mau, thieu vitamin A va thieu kem [2],[3]. Cac ket qua nghien cuu cung chung minh rang gdi da vi chit su dung
T C . D D & T P 9 ( 1 ) - 2 0 1 3 tai gia dinh, trdn vdi bat bpt hoac chao la
mgt giai phap hgp ly, cd the phat trien tren dien rgng d nudc ta, tai cac viing ndng thdn khd khan [2],[3]. Kel qua ciia chiing tdi cd y nghia rat quan trgng trong chiln luge can thiep phdng chdng SDD bang can thiep bd sung vi chat sdm.
Chinh sach can thiep sdm cung dugc WHO khuyen nghi cho cac nudc ap dung, cac can Ihiep bd sung da vi chat cd the lien hanh cho Ire tir 6 tliang ludi. tham chi mpt sd vi chat can dugc bd sung sdm hon neu cd dau hieu thieu ro rang.
4.4- Ve hieu qua ciia ket h o p tay giun va bo sung da \i ehat
Mdt trong nhiJng diem mdi trong nghien cim ciia chung tdi la danh gia hieu qua ciia bien phap ket hgp TG va bd sung DVC sdm cho tre thap cdi (12-36 thang lull), tai vimg dan ldc Pakoh va Van Kieu CO ly le SDD va nhiem giun cao. Ket qua nghien cuu ciia chung tdi da cho thay kel hgp 2 bien phap cho hieu qua hiep ddng, tdt hon rd ret so vdi timg bien phap can thiep don le TG hoac bd sung DVC.
Tac gia T T Nga & CS. 2010 [6] ciing cdng bd tac dung hiep ddng cua tay giun va da vi chat tren tre em lua tudi lieu hgc.
Cac tac gia da bd sung banh quy tang cudng vi chat trong thdi gian 4 thang ket hgp vdi tay giun cho tre 6-8 tudi. Tac gia thiy ring bd sung kel hgp da vi chat lam tang hieu qua cua tay giun. Ty le tai nhilm giun d nhdm ket hgp vdi da vi chat giam thap ban rd ret so vdi nhdm khdng dugc bd sung da vi chat. Tir dd tac gia khuyin nghj cd the sir dung banh quy da vi chit trong phdng chdng ihieu vi chat dinh dudng d tre em hgc dudng, ddng Ihdi gdp phan giam tai nhiem giun d lua tuoi nay. Kit qua nghien cim ciia chung tdi cung phil hgp vdi mdt so nghien ciiu khac tai An do, Nepal, Kenya [4].
V- K E T LUAN
1. Chua thay tac dung rd ret cai thien ndng dp Hb, Retinol. Kem cung nhu ty le thieu mau, thieu vilamin A, thieu kem d tre SDD thap cdi dugc tay giun don thuan Bd sung da vi chat cd hieu qua rd ret cai thien ndng dp Hb, retinol, kem va cd chi sd hieu qua dat 65,2%; 42,2% va 76,0% vdi thieu mau, thieu vitamin A, thieu kem.
2. Phdi hgp bd sung DVC va TG cd tac dung hiep ddng, tdt hon lay giun hoac bd sung da vi chat don thuan, lam tang rd ret ham lugng Hb, retinol, kem va cd chi so hieu qua dat 67,3%; 79,0% va 77,8%
vdi thieu mau, thieu vitamin A, thieu kem.
Khuyin nghi: De nghi vdi Bd Y Te, cac chuang trinh dinh dudng, can xem xet ban hanh chinh sach bd sung da vi chat ket hgp tay giun cho tre tu 12 thang tudi d nhung viing nhiem giun va ty le SDD cao. Nhung nghien cuu ve khoang thdi gian phii hgp giiia cac lan lay giun ciing can dugc tiep tuc.
TAI LIEU THAM K H A O 1. Bp Y tl 2007. Hir&ng ddn bd sung Vita-
min A cho tre tii- 6 din 60 thdng tuoi ket hgp tdy giun dic&ng rugt cho tre 12 den 60 thdng tudi Ban hanh kem theo Quyet dinhsol45/QD- BYT ngay ll thang 10 nam 2007 cua Bp trudng Bg Y tl.
2. Nguyin Hai Ha, Nguyen Xuan Ninh, Nguyin Cong Khin 2011. Nghien ciru cdng nghe sdn xudt gdi da vi chdt vd lyzm bd sung vdo bgt /chdo cho tre em 6-24 thdng tudi Y hpc thuc hanh 2(751)34-3 8.
3. Nguyen Thanh Ha, Nguyin Xuan Ninh, Pham Van Hoan 2010. Hieu qud bo sung kem vd Sprinkles da vi chdt tren chi sd nhdn trdc cua tre thdp cdi 6-36 thdng tuoi. Yhpc du phong, tap XXI, s6 1(119):
102-110
TC.DD&TP9(1)-2Q13 4. Awasthi S, Pande VK 2001. Six-monthly
deworming in infants fo study eflecis on growth, (nd J Pediatr 68: 823-827.
5. Black RE, Allen LH, Bhutta ZA, el al.
2008. Maternal and child undernutrition:
global and regional expo.sures and health consequences. Lancet 37l(9608):243-60 6. NgaTT.WinicliagoonP, Dijkhuizen MAet
al. 2009. Multi-microniitrient-forttfledbi.s- vuitK decrea.sed prevalence of anemia and improved micronutrieiU status and effec- tiveness of deworming in rural Vietnamese schoolchildren. S Nutr 139: 1013-1021.
7. UNICEF 2006 Micronutrient supplemen- tation thought the life cycle. Report of tiie workshop head by the Ministry of Health Brazil and UNICEF.
8. 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 April 2002.
Geneva.
9. WHO 2002. Prevention and control of schistosomiasis and soil-transmitted helminthiasis. Report of a WHO Expert Committee. Geneva, Technical Report Se- ries, No. 912.
lO.WHO/WFP/UNICEF 2007. Joint .state- ment. Preventing and controlling micronu- trient deficiencies in population affectedby an emergency (2007).
11. Vien Dinh Dudng/UNICEF 2011. Tmh Mnh dinh dirang Viet Nam ndm 2009-2010.
Nha xuat ban Y Hpc Ha Npi 12. WHO 1998. Sample size determination in
health studies. Apratical manual. Ver 2.0.21.
Summary
THE EFFICACY OF MICRONUTRIENT SUPPLEMENTATION AND DEWORM- ING ON MICRONUTRIENT DEFICIENCY OF STUNTING CHILDREN 12-36
MONTHS OF VAN KIEU AND PAKOH GROUP
Objective: To evaluate the efficacy of early de-worming and multi-micronutrient supplemen- tation on stunting children who are Pakoh and Van Kieu ethnics in Quang Tri province. Methods:
A cluster randomized, controlled clinical trial was conducted among 284 smnting children, in which had 141 worm infection. The study subjects were divided into 4 groups for different inter- ventions: 1) ConUol group (CTR, n=73), had no dewonning and no micronutrient supplementa- tion; 2) Merely dewormed group (TG, n=70), children with worm infection, received i dose of Mebendazole 500 mg at the beginning of the study; 3) Merely micronutrient supplemented group (DVC, n=72), had no deworming, received daily micronutrient supplement; 4) Combined de- worming and micronuUient supplementing group(TG+DVC, n-69), received I dose of Meben- dazole at the beginning and daily micronutrient supplement in 6 months. Results: After 6 months of intervention, the deworming and micronutrient supplementation interventions increased mi- cronutrients status (Hb, Retinol, and Zinc) as well as reduced the rate of anemia, vitamin A, and Zinc deficiency. Merely micronutrient supplementation is more efTicient than merely deworming.
Combined dewonning and micronutrient supplementation have more effects on micronuUient sit- uation than merely micronutrient supplementation or merely deworming. Recommendations: To prevent micronutrients deficiency and malnutrition for children, MOH, the REM and other nutri- tion program should consider the policies lo support early micronuUient supplementation com- bining with dewonming for children under 12 months old in the areas with high malnuuition and worm infection.
Keywords: Stunting children, micronutrient. early deworming.
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