i NGHIEN c u u KHOA HOC
HAPPY NEW YEAR 2015SUY DINH DUONG O TRE EM 6-59 THANG TUOI SAU BAO LU TAI XA QUANG SON, HUYEN QUANG TRACH, TJNH QUANG BJNH NAM 2013
TOM TAT
Thdng 10 nam 2013, Quang Binh trai qua Iran Iii lich su vd vd la tinh chiu thidt hai nang nd nhat do bao lii trong ca nudc. Mgt nghien cuu ed thidt ke md la edt ngang trdn 355 trd 6-59 thang ludi duac thye hien tai xa Quang Son, huyen Quang Trach, tinh Qudng Binb nham danh gid tinh trang dinh duong cua tre 8 thang sau trdn lii lut lich su ndi trdn. Kdt qua eho thay d thdi didm nghidn euu, ty Id tre SDD the nh? can, com cdi va thdp cdi lan lugt Id 17,5%, 4,8% vd 54,9%.. Ket qud ndy gpi y tde dgng lieu cue ldu dai cua lu lut ldn tinh Irang dinh dudng ciia tre. Day la bang chiing cho cac can thiep mang tinh Idu ddi nhdm dap ling vdi tdc dpng eua Ihien tai, ddm bdo sue khoe eho tre em ndi rieng va cdng ddng ndi chung.
ABSTRACT
Post-flood malnutrition among children aged 6 - 5 9 months old in Quang Son commune, Quang Trach district, Quang Binh province in 2013
In October, 2013, histone flooding occurred in Quang Binh, making il the most flood-affected province in the country of the year. A cross-sectional study was conducted on 355 children aged 6-59 months old in Quang Son commune, Quang Traeh district, Quang Binh province in order to assess the situation of malnutrition among children aged 6-59 months old eight months after the historic flood. The study showed that the proportions of underweight malnutrition, waisting-acute malnutrition and stunting were 17.5%, 4.8%, and 54,9%, respectively.
These results suggest long-term adverse impact of flood on children nutritional status. This can serve as evidence for longer term interventions aimed at responding to natural
Od Th; H^nh Trang', Le Thi Thu Ha\
Luu Qu6c Todn', Nguydn Thj Thu Hod disasters' impacts, ensuring the well-being of children in particular and the community in general.
D^TVANDE
Lii lut CO the gay ra nhiing tde ddng ndng nd vd kinh Id, dnh hudng Idn Idi moi tmdng tu nhidn va xa hgi. Ben canh dd, y van trdn thd gidi da de cap nhieu den tac dpng cua lii lyt ddi vdi siic khoe con ngudi, dua ra cdc bang ehiing ve sy gia tang ty le mac benh, bao gdm cd sue khoe thd chat lan tinh than va gia tang ly Id tu vong. Trong do, tdc dgng ciia lii lut len tinh Irang dinh dudng ciia tre em, dac bidt d tre dudi 5 tuoi, dupc vd ciing nhan manh [1, 2, 3],
Viet Nam Id mgt trong mudi nudc ed tin suat cao xdy ra tham hoa lu nhidn va la nudc cd sd ngudi hi td vong vd dnh hudng bdi lii lyt tren 100.000 dan cao thii 10 tren the gidi[4,5].C} Viet Nam, thdng Im vd anh hudng ciia lu lui luon dupe eung eap ngay sau khi lii lyt xdy ra. Tuy nhidn, nhirng thdng tin nay chi gidi ban d sd tmdng hpp tu vong, mdt tich, bi thuong vd thidt hai chung vd kinh td trong khi ede thdng tin chi lidt vd tac ddng ciia lii lut Idn sue khoe, dac bidt Id tinh trang dinh dudng cua tre em cdn vd ciing ban chd. Hon nua, nhirng thdng tin ndy ehi de cap nhirng tac dgng len siic khoe ngay sau khi lii lui xay ra ma chua dd cap nhieu tdi nhiing thdng tin vd tac dpng lau dai cua lii lyt, trong dd ed tinh trang dinh duong ciia trd em.
Nhiing bang chung khoa hpc vd tac dpng ciia thidn tai, dac bidt la lii lut ldn tinh tr^ng dinh dudng ciia tre em d Viet Nam se gdp phan giup cac nha hoach dinh chinh sach dua ra nhung ean thiep phii hgp nham ddm bao tdi nhat dinh dudng cho trd em trong didu kidn thdi tiet, khi hdu khac nghift, tir dd gdp phdn phdng ngua nhimg hdu qud ldn siic khoe eiing nhu bdo vd siic khoe cua trd em, nhdm dan sd
. lyirdng Dai hoc V te cdng C9ng
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gdp phdn quan trpng vap tuong lai cua ddt nudc, nhdt Id trong bdi cdnh Viet Nam dang chiu anh hudng cua bidn ddi khi h|Lu, vdi thien tai xay ra ngdy cdng nhieu vd mdc dp dnh hudng ngay cdng nang ne.
Mgt nghidn eiru vdi myc dich cung cdp eac bang chung nhu vdy dd dugc thyc hien tai xa Qudng Scm, huyen Quang Trach, tinh Quang Binh, Id mdt trong nhiing tinh ed tan suat xay ra lii lyt cao nhat vd chiu dnh hudng eiia lii lut nang nd nhat ea ve ngudi lan kinh te. Theo thdng kd 10 nam trd lai day, tinh Qudng Binh co 36 dpi lii, trong dd Iran mua lu lich su Iam 151 ngudi chdt, 360.000 ngdi nhd bi sap, hu hdng, Sd ngudi bi dnh hudng den 1.737.000 ngudi. Tdng gid tri thiet hai tdng 10 nam khodng 4.800 ly ddng. Dae bidt trong ndm 2013, tinh Qudng binh da phai gdnh chiu 2 con bao sd 10 va sd 11 kem theo lii lyt gay thidt hai dac biet nghidm trgng. Can bao sd 10 la con bao manh nhdt vd lu nam 2013 ciing Id lu ldn nhat d Quang Binh trong hon 30 nam qua [6]. Xa Quang Son, huyen Qudng Trach Id dia ban chiu anh hudng nang ne nhdt cua bao vd lu nam 2013 tai tinh Qudng Binh. Nghien ciiu cua chiing tdi duac thyc hidn vdi mue tidu xae dinh ty Id suy dinh dudng ciia tre em 6-59 thang tudi d thdi diem 8 thdng sau khi lii lut lieh su ndm 2013 tai tinh Qudng Binh kdl thiic. Theo dd, kdt qua nghien eiru gdp phan cung cdp nhiing bdng chiing ve tac ddng ldu ddi cua lii lut Ien linh trang dinh dudng eua Ire em noi rieng va Idn sire khoe cdng dong ndi chung. Ben canh nhung ddng gdp cho hoach dinh ehinh saeh, bang chung thu dugc tir nghidn eiru nay se dugc su dung nhu mpi nghidn euu trudng hgp ve tdc dpng thien lai ldn siic khoe trong gidng day vd nghidn cuu vd qudn ly tham hoa, mdt ITnh vuc van cdn kha mdi me d Viet Nam.
PHU'CNGPHAP
Nghidn cuu su dyng Ihidt ke md td cat ngang, tren ddi tupng Ire em d do tudi 6-59 thdng vd me eua nhiing Ire nay.
Nghien ciiu sii dung phucmg phdp ehpn mau ngau nhidn don, vdi cd mdu dupe tinh toan thep cdng thuc tinh cd mdu cho mdt ty le
Trpng dd'
p: ly Id SDD tre em 6-59 thang tudi tai xa nghien eihi d thdi diem nghien cim 50% dd cd ed mau Idn nhat
q - l - p
- Zi-„o =1,96 (vdi mire y nghTa a = 0,05) d: dg chinh xac mong mudn (miic sai sd cho phep) Id 0,06
n: sd tre em 6-59 (hay sd bd me cd con 6-59 thdng) tham gia vdo nghidn ciru
Ty Id ude linh ddi tugng nghien ciiu lir chdi hoae khdng tra Idi: 10%
Cd mau linh dupc = 300. Thye Id, tdng sd tre tham gia nghien cuu la 355 tre.
De ddnh gid tinh trang dinh dudng cua tre, eae chi sd nhan trdc dinh dudng va phdng van bd me thdng tin vd ire va dae didm hd gia dinh, su dung bd cdu hdi.
Tidy chuan danh gid cdc chi sd nhan trae dinh dudng:
Sii dyng phdn loai theo WHO 2005 vdi cdc chi sd Z-score. Cdn nang theo ludi (CN/T), chieu cao theo ludi (CC/T), can nang theo chidu cao (CN/CC)[7]. Chi sd Z-score dugc tinh theo cdng thue:
Kich thircrc do dugc - So trung binh ciia quan the tham khao
D o lech chuan cua a
+ Chi sd CN/CC: Su dyng chi lidu ean ndng so vdi chidu eao (CN/CC) de ddnh gia:
Thira can: CN/CC> +2SD
Binh thudng: CN/CC lir -2 SD ddn +2 SD SDD (thd com cdi): CN/CC<-2SD
+ Chi sd CN/T: Su dung chi tieu can nang so vdi tudi dd danh gid:
Binh thudng: CN/T lir -2 SD ddn +2 SD SDD (thd nhe can) • CN/T< -2SD; trong dd:
o dp I: tu<-2SDddn-3SD 0 dp 2: tu <-3 SD ddn -4 SD 0 dd3:<-4SD
+ Chi sd CC/T: Su dung ehi lidu chidu cao SP vdi tudi de ddnh gia:
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^NGHIEN cuu KHOA HOC
HAPPY NEW YEAR 2015Binh thudng: CC/T tir -2 SD ddn +2 SD SDD (thd thdp edi): CC/T < - 2SD ; trong dd 0 dd 1: tir<-2SDddn-3SD
0 dp 2: <-3 SD
Sd lieu dugc xir ly bang phan mem Anthro 2006. Cae thdng tin vd nhdn khau hpc vd tinh trang hd gia dinh dupc nhap ban phan mdm Epi Data. Thdng kd md ta duoc xii ly sd lieu vdi phdn mem SPSS 20.0.
KET QUA
1. Thong tin chung ve doi tugng nghien cuu Ket qud nghidn eim cho thay trong tdng sd 355 trd tham gia nghien ciiu, ty 1? trd nam vd nii khd cdn bdng nhau
(49,6% la nam va 50,4%. la nir). Ty 1? trd dudi 2 tudi chiem 40,8% trong Idng sd tre tham gia nghien ciiu. Ty Id tre da di hge mau gido chiem 60% trong dd hau hdi trd ddu hgc trudng cdng lap. Nghien cihi ciing tim hidu tinh trang m ^ mgt sd b^nh truyen nhiem ciia tre trong vdng mdt thang trudc thdi didm nghidn ciiu. Kdt qua cho thay cd hon 1 niia sd trd mic it nhit mpt benh, trong dd sd tre mac 1 loai benh va hai loai b?nh chidm ty le ldn lupt la 35,5% va 20,0%.
Ty Id trd thude hg gia dinh ngheo ehiem 9% va thudc hg gia dinh c^n ngheo chidm 14,2% (chuan nghdo dya tren quydt dinh 09/2011/QD-TTg cua Thii tudng Chmh phii ban vd vi?c ban hanh ehuan hd ngheo, hp can ngheo ap dyng cho giai doan 2011-2015).
Bdng 1. Thdng tin chung ve tre D$c di^m
Tuoi
Gioi
Can nang khi sinh
Tinh t r ^ g di hpc cija tre
Loai hinh lop hoc ma tre tham gia (N= 142)
Tinh trang m^c benh hien tai
Phan loai ho gia dinh ciia tre
£ 2 tudi
> 2 tuoi Nam Nii
< 2,5 kg S 2,5 kg
Khong nho/khong biet Da di hgc
Chira di hpc Cong lap T u thuc Khong mdc benh gi Mac 1 loai benh Mac 2 loai htnh Mac tir 3 loai benh tri/ l£n Ngheo
Can ngheo Tren can nghdo
n ( % ) 145 (40.8) 210(59.2) 176 (49.6) 179 (50.4) 46 (13.0) 301 (84.8) 8 (2.3) 142 (40.0) 213 (60.0) 136(95.8) 6 (4.2) 144 (40.5) 126 (35.5) 71 (20.0) 14 (4,0) 32 (9.0) 74 (20.8) 249 (70.2)
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2. Tinh trang suy dinh dirong ciia tre
Tinh trang SDD theo chi so can ndng theo tudi (the nhe can), sd lieu bdng 2 cho thdy ty Id trd SDD iheo thd nay chidm 17,5%, phdn ldn trong sd ndy la SDD dp 1 (14,4%).
Bdng 2. Tinh trgng suy dinh dir&ng cdn ngng theo tuoi (the nhf can) Muc do SDD
Binhthirong SDD dp 1 SDD do 2 SDD dp 3
N(%) 293 (82.5) 51 (14.4) 10 (2.8) 1 (0.3)
Ty le suy dinh dudng the chidu cao so vdi tudi (thap cdi) trong mau nghien eiiu rat cao, tdi 55,9%i, trong do cd 22,5% suy dinh duong dp 1, va tdi 32,4% suy dinh dudng do 2. Day Id nhiing con sd rat ddng bdo dgng.
Bdng 3. Tinh trgng suy dinh dtr&ng chieu cao so v&i tuoi (the thdp coi) Miic dp SDD
Binh thuang SDD dpi SDD dp 2
N(%) 160(45.1) 80 (22.5) 115(32.4)
Bdng 4 cho thdy ty le tre SDD the can nang/chieu eao (the cdm cdi) ehiem 17,2 % Irong do ty Id trd thua can la 12,4%. Ty Id tre suy dinh dudng ihd thap cdi nhu da ndu d trdn la rat cao nen cd thd hieu dugc ty le tre thira can d tren cao Id do sd tre cd chieu cao thap chidm sd lupng Idn.
Bdng 4. Tinh trgng SDD can ttang theo chieu cao (the cdm cdi) Muc dp SDD
Thua can Binh thircmg SDD dp 1 SDD dp 2 SDD dp 3
N(%) 44(12.4) 294 (82.8) 10 (2.8) 4(1.1)
3 (0.8)
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HAPPY NEW YEAR 2015BAN LUAN VA KET LUAN
Suy dinh dudng (SDD) Id tinh trang co thd thidu protein-ndng lugng vd vi chat dinh duong dnh hudng iruc tiep den qud trinh lang trudng va phat tridn cua tre em, giam nang lire tri tue, the luc; lam bdnh tat de phdt sinh hay mae bdnh lau khdi va didn bidn nang hem. Dae bidl.
Ire em dudi 5 tudi la thdi ky phat tridn quan trong va tang trpng lugng nhanh nhat, nhieu he thdng eo quan trong CO the dugc hodn chinh, nhdt Id he thdng than kinh trung uang va he van dgng; do do viee ddm bdo eung cap day du dinh dudng cho tre trong giai doan nay la van de het sue can thidt.
Ket qua nghien eiiu cho thay vdi the nhe cdn (CN/T), ty le tre suy dinh duang chiem 17,5% trong dd da sd tre SDD dp 1. Ty Id ndy cao han so vdi ty Id SDD chung cua ed nude trong nam 2013 (15,3%) nhung Ihap ban ty Ie nay ciia cd tinh Qudng Binh (19,8%) [8]. Le Danh Tuydn va cdng s\r [9]ciing tien hdnh mpt ddnh gid vd tinh irang suy dinh dudng sau lii lut eiia tre em lai hai xa thude tinh Qudng Binh va cho thay 1 Ihang sau khi lii lut xdy ra, ty Id SDD the nhe can cua tre dudi 5 mdi d miic rdt cao, ldn lugt Id 51,7% vd 44,9% d hai xa vd ly Id nay cao gap 2 lan sd lieu chung cua toan tinh nam 2010. Vide ty Id SDD the nhe can eua trd d dia ban nghien ciiu cua chiing tdi thdp ban rat nhidu so vdi ty IS trong nghien euu eua Ld Danh Tuydn cd thd dugc gidi thich do nghidn cuu nay dugc thuc hidn tai hai huyen Tuydn Hoa va Minh Hod Id hai huyen ngheo nhat eiia tinh Qudng Binh vd ty Id SDD trude lu lui cua hai huyen nay vdn da rdt cao.
Bdn canh dd, nghien cuu edng xae dinh dugc ty le SDD thd cdm coi (CN/CC) cua tre 6-59 thdng mdi 8 thang sau lu lich su. SDD thd cdm coi phdn anh tinh trang suy dinh dudng cdp tinh. Ty le ndy d xa Quang San tai thdi didm nghidn ciru Id 4,8%. Ty Id nay so vdi ty Ie chung ndm 2013 cua toan quoc (6,6%) vd ciia todn tinh Qudng Binh (6,5%) thi d miic thdp hon [8]. So vdi nghien ciiu ciia Le Danh Tuydn vd cdng sir [9]tai 2xa d linh Quang Binh, ty Id suy dinh duang the cdm edi cua trd tsii xa Qudng Son d mue thdp hon (4,8% so vdi 19,2% vd 18,6%). SDD thd cdm cdi
phdn anh tinh irang dinh dudng edp tinh. 6 thdi diem ngay sau khi lii lyt xay ra (nhu d trong nghidn cua eua Ld Danh Tuyen), nhirng lac dpng ciia lii lut ldn SDD the cdm coi ciia tre eon rat ro rdng so vdi thdi ddm lu lyt da ket thuc dugc 8 thang nhu trong nghien ciru cua chung tdi.
Ket qua nghien cuu ciing cho thay ty Id SDD the Ihdp cdi ciia trd d dia bdn nghien ciiu la (54,1%). Day Id ty i^
rdt cao, eao hon nhieu so vdi ty Id nam 2013 ciia todn qudc (25,9%) va cua todn tinh Qudng Binh (30,8%). Ty Id nay thap chi edn eao hon so vdi ty Id trong nghien cuu nam 2011 cua Ld Danh Tuydn va cdng s\r (43,7%. vd 38,2%) [9]. Do SDD thd thdp edi la Ihd SDD man tinh. Id hdu qua sau thdi gian ddi trd phoi nhiem vdi cac yeu to nguy ca ndn kdt qud nghien euu vdi ty le SDD thd thap cdi rat cao sau khi lu lut da kdt thiic dugc 8 thdng eiing phdn nao goi y vd tac ddng tidu c\rc lau ddi eua lii lut ldn chieu cao ciia tre, nhdt la vdi nhdm tre em lir 6-59 thang tudi - la do tudi cd chieu cao phdt tridn nhanh.
Day Id mgt trong sd rat it nhimg nghien cuu d Viet Nam tim hidu tinh trang dinh duong ciia tre su dung phuang phdp chpn mau ngau nhien. Nhung danh gid vd linh trang dinh dudng sau thien lai da thue hidn d Viet Nam chii yfiu dugc thuc hidn vdi quy md nhd, chpn man thuan tidn va duge thue hidn ngay sau khi ihien tai xdy ra, thudng phuc vy eho nhirng cuu trp khan cdp. Nhu vdy co the thay rang, ben canh cac nghien euu dua ra nhirng bang ehiing ve tac ddng tlie thdi cua thidn lai ldn siic khoe cdng ddng noi chung va linh trang dinh dudng tre em ndi ndng, nghien ciiu cua chiing tdi da gop phan dua ra bang chiing vd tac dpng ldu ddi cualti lut Ien tinh trang dinh dudng eua tre, lam eo sd cho cdc ean thiep ddi hoi hon sau lii lut chang han nhu: 1. Y td dja phucmg truyen thdng tich cue vd rpng rai ddn cdc hd gia dinh kien thirc vd dinh dudng, an toan thuc pham, khuyen khich ba me cho con bii sira me va co che do dn bd sung hpp ly, ddm bdo an toan cho siic khoe;
2. Chinh quyen dia phuong tim kiem nhiing hd Irg ve ky thudt vd ddu tu tai chinh cho cae boat ddng nghidn ciru nhiing loai vdt nudi, edy trdng thieh hgp cho dia bdn hay xay ra bao lii.
TAI LI$U THAM KHAO
1. Hd Van Mao vacs (QuanY vidn 108). Dodn Thi Nhu vd cs (Vien Dupc lidu Viet Nam) (1991). "Nghien ciiu lac dung eiia vien Kim truat dieu Iri loet da day td trdng", Thdng tin Y hgc ed truydn Viet Nam, 64, tr. 37-42 2. Banerjee L (2009). "Effect of flood on agricultural wages in Bangladesh: an empirical analysis". Epidemiology, 27, tr. 36-46
3. World Food Program (WFP) (2010). Pakistan flood impact assessment.
4. Bd tai nguyen vd mdi trudng (2011). Kieh bdn bidn ddi khi h^u, nudc bien dang cho Viet Nam, Bd tdi nguydn vd moi trudng, Hd Ngi.
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5. Ngan hang phat trien chdu A (2006). Du an tdng quan vd ngdnh thuy lpi. Bdo cao "thidn tai vd nhirng thidt hai do thidn tai tai Vidt Nam".
6. Trang thdng tin dien tii tinh Quang Binh (2013). Gidi thi?u Qudng Binh, tai trang web http://www.quangbinh.
gov. vn/3ems/?emd=r30&art=l384824961463&cat=l 179730730237.
7. WHO (1983). Measuring change in nutrition status. Geneva.
8. Vidn dinh dudng qudc gia (2013). Ty Id suy dinh duang tre em dudi 5 tudi theo cac muc khde nhau, tai trang web http://viendinhduong.vii/news/vi/106/6l/0/a/so-lieu-thong-ke-ve-tinh-trang-dinh-duong-tre-em-qua-cae- nam.aspx. (truy eap ngay 10/12/2014)
9. Ld Thi Hgp Ld Danh Tuydn, Nguydn Hdng Trudng (2012). "Anh hudng ciia Iii lut den tinh trang dinh dudng vd khau phan an trd em d tinh Qudng Binh ", Tap chi y hpc thyc hanh, 815(4/2012).
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