TC.DD & TP6 (3+4) - 2010
XU HirdNG TIEN TRIEN SUY DINH
D U Q N GTHAP COI VA CAC GIAI PHAP CAN THIEP TRONG GIAI DOAN MCtt
2011-2020
Le Danh Tuyen', Le Thi Hffp\ Nguyin Cong Khdn\ Hd Huy Khoi*
DAT VAN DE
Suy dinh duang thap coi dugc coi la chi tieu phan anh trung thuc nhat su phat trien noi chung a tre em. To chiic Y te the giai khang dinh rang viec mac cac benh nhiem khuan va nuoi duang tre em kem - hoac phoi hgp ca hai nguyen nhan tren - la nguyen nhan quan trgng nhat dan den thap coi a tre em va hau qua la sir kem phat trien ca ve the luc va tri tue a tre [6,8].
Suy dinh duang thap coi la mpt hien tugng pho bien nhat cua thieu dinh duang tren the giai. Thieu dinh duang protein - nang lugng dugc xem la nguyen nhan quan trpng hang dau cua thap coi (con gpi la stunting).
Theo so lieu cila To chiic Y te the giai, hien nay c6 khoang 29,5% tre em duoi 5 tuoi a cac nuac dang phat trien bi SDD thap coi [9,11]. uac tinh hien nay co khoang 154 trieu tre em bi SDD the coi a cac nuac dang phat trien tren the gioi. Hau het cac tnrong hgp thap coi xay ra truac khi tre dugc 3 tuoi. Nguai ta da thay mgt each ro rang la tre em bi thap coi thi sau nay tra thanh nhiing nguai lan ciing co chieu cao thap. Han niia, nhiiTig nguoi bi SDD thap coi thuang co nguy ca tii vong cao, de mac benh hon so vai nguai binh thuang, dong thai kha nang lao dgng ciing kem ban so ' TS.BS - Vien Dinh duong
2. PGS.TS - Vien Dinh duong 3. GS.TS - Cue An toan VSTP,
". GS.TSKH - Hoi Dinh duong Viet nam.
vai nguai binh thuang [3,9].
Theo mo hinh chu trinh dinh duang - vong dai do Tieu ban dinh duang ciia Lien Hiep Qu6c dua ra tai Hgi nghi dinh duang vl nhiing thach thirc cho the ky XXI thi tre em thip coi ve sau tier thanh nhiing nguai lan ciing co chieu cao thap. Tre em gai bi SDD thap coi lan len tra thanh nguai phu nii thap coi va khi de con thi nguy ca SDD thap coi cho con cao ban [6].
Thieu dinh duang protein - nang lugng dugc xem la nguyen nhan quan trgng hang dau ciia thap coi [5,9].
Cho den nay, ca che benh sinh cua suy dinh duang thap coi chua dugc sang to nhung nguai ta da thong nhat ca cac yeu to di tmyen va cac yeu to ngoai canh deu co vai tro quan trgng trong sir phat trien chieu cao. Yeu to di truyen qui dinh tiem nang cho su phat trien, nhung neu cac yeu to ngoai canh trong do quan trgng nhat la dinh duang khong thoa man thi se khong dat den miic phat trien chieu cao theo tiem nang qui dinh [3].
De gop phan xac dinh nhom uu tien cho can thiep dinh duang a cpng dong, viec theo doi tien trien va miic thay doi cu the cua ty le SDD thap coi a tre em duoi 5 tuoi la mpt cong viec can thiet cho phep danh gia tinh hinh tir do phuc vu cho cac
chiin lugc can thiep cpng dong dat dugc hieu qua t i t Dong thai, tim hieu va phan tich cac yiu t l nguy ca ciia suy dinh duong thap coi (bao gom cac yeu to ve kinh te, xa hpi...) se cung cip nhiing thong tin can thiet phuc vu chiin lugc can tliiep phong chong suy dinh duong va dac biet la gop phan nang cao the tiang ve chieu cao cho tre em nuac ta.
H. PHirONG PHAP DANH GIA 2.1. Ngu6n s6 lieu trong nude:
Phan loai SDD thap coi theo chi so chieu cao theo tuoi: lay diem nguang -2 SD Zscores. Duod -2 SD Zscores bi coi la SDD thap coi.
So lieu dieu tia dich te hpc toan quoc qua chgn mau hg gia dinh dai dien cho cac vung sinh thai, bao gom 4 cugc dieu tia toan quoc:
-Tong dieu tra dinh duong nam 1981-1985.
- Tong dieu tra dinh duong nam 1987-1990.
- Dieu tra danh gia thiiu vitamin A va SDD protein-nang lugng nam 1994.
- Tong dieu tra dinh duang nam 2000.
- Diiu tra danh gia Muc tieu phong chong SDD tre em nam 2004: cung cip cac phan tich ve cac yeu t l nguy ca ve kinh te xa hpi hp gia dinh doi vai suy dinh duang thap coi.
- Tong dieu tra dinh duang nam 2009 2.2. Nguon so lieu nude ngoai:
Tham khao cac nghien ciiu da dugc cac tac gia Mercedes de Onis, Edward A. Frongillo va Monika Blossner phan tich theo ciing phuang phap ciia To chiic Y te the giai [10].
m . MOT s o KET QUA CfflNH 3.1. Diem qua dien bien ty le suy dinh duong thap coi tre em tren the gioi.
Theo cac ket qua phan tich cua Mer- cedes de Onis, Edward A. Frongillo va Mo- nika Blossner {1] thi xu huang tien trien suy dinh duang thap coi a tie em duai 5 taoi dupe trinh bay theo bang sau day:
Bang 1. Khuynh hirdng tien trien cua ty Ie suy dinh dir&ng thap coi is tre em duoi 5 tuoi o cac Ichu vuc tren the gidi (%).
Nam 1980 1985 1990 1995 2000 2008
Chau Phi
Chau A
Chau My Latin va vung Caribbean
Trung My
Chung cac nuoc dang phat trien
40.5 39,2 37,8 36,5 35,2 33,2 (36,2^M,8) (35,4-43,0) (34,2-41,4) (32,8-40,2) (31,1-39,3) (28,6-37,8)
52,2 47,7 43,3 38,8 34,4 29,9 (47,6-56,8) (43,3-52,2) (38,8-47,7) (34,4-43,3) (29,8-39,0) (25,2-34,7)
25.6 22,3 19,1 15,8 12,6 9 3
(21,4-29,7) (18,4-26,3) (15,1-23,1) (11,6-20,1) (7,9-17,3) (4,1-14,6) 26,1 25,6 25,0 24,5 24,0 23,5 (15,9-36,2) (15,7-35,4) (14,5-35,5) (12,5-36,5) (9,9-38,0) (7.0-39,9)
47,1 43,4 39,8 36,0 32,5 29,0
(42,7-51,6) (39,1^7,7) (35,6-44,1) (31,7-40,3) (28,0-37.0) (24.2-33.7)
Ket qua tinh toan cho thay trong thai gian tii nam 1980 din 2008 thi ty le suy dinh duang thap coi giam di trung
binh la 0,7%/nam chung cho tit ca cac nuoc dang phat trien. Trong do khu \arc giam nhanh nhat la chau A (dat miic giam 16
TC.DD & TP6 (3+4) - 2010 0,9%)/nam), khu vuc chau My Latin va viing Caribbean dat miic giam 0,6%)/nam va khu vuc chau Phi chi dat dugc miic giam 0,3%/nam [10].
Bdng 2. S6 luong tre em suy dinh duong thap coi o tre em duoi 5 tuoi ff cac khu vuc tren the gioi tu 1980 din 2008 (trieu).
Nam 1980 1985 1990 1995 2000 2008
Chau Phi Chau A
Chau My Latin va vung Caribbean Trung My
Chung cac nuoc dang phat trien*
34,8 173,4
13,2 3,9 - 221,3
38,5 169,7
11,9 3,8 220,1
41,7 167,7
10,4 3,9 219,7
44,5 143,5
8,6 3,9 196,6
47,3 127,8
6,8 3,9 181,9
44,4 104,2
4,1 3,8 154,7
* Tinh chung cho cac nuoc dang phat trien, gom ca
So lugng tre em suy dinh duang thap coi hien nay tren the giai van kha lan.
Vao nam 2000, rieng cac nuac dang phat trien eo 182 trieu tre em thap coi, giam di 40 trieu so vai nam 1980. Phan bo tre suy dinh duang thap coi : 70%) a chau A.
Khoang 26% a chau Phi va khoang 4%) a Chau My Latin va viing Caribbean.
Dien bien ty le SDD thap coi cho thay toe do giam suy SDD khong nhat thiet song hanh vai miic tang truang kinh te, a mpt so quoc gia SDD thap coi giam nhanh do tien hanh cac can thiep c6 bieu qua. Mat khac, nguai ta thay hien tagng phat tiien nhanh ban thuang xay ra nhu mpt quy luat doi vai cac nuac sau thai ky chien tranh hoac khung khoang kinh te keo dai va gpi do la "thai ky phat trien bii" [3] . Thai ky nay dai hay ngan tay theo tiing
Bdng 3: So tre em duoi 5 tuoi duoc dieu
mpt so nuoc d khu vuc khac voi 4 vung tren.
quoc gia khac nhau trong mpt khoang thai gian nhat dinh. Khi ty le SDD thap coi cang xuong thap thi toe dp giam se cang cham lai [10].
3.2. Dien bien ty le suy dinh duong thap coi ff tre em Viet Nam qua mot so nam Theo doi dien bien ty le SDD thap coi trong nhiing nam qua a Viet Nam cho thay ty le SDD thap coi tre em a tat ca cac vung giam di theo thai gian.
Nam 1985, ty le nay la 59,7% a tie em duai 5 taoi, den nam 1995 la 46,9%, giam trung binh 1,28%/nam (1985 -
1995). Nam 2000, ty le thip coi con 36,5%, giam dugc 2,08%)/nam tinh trong 5 nam gan day [7]. Den nam 2002, ty le SDD thip coi la 33% [7]. Nam 2009 ty le suy dinh duang thap coi con la 31,9%.
tra cac nam chia theo thang tuoi Thang tuoi
! - 6 7 - 1 2 1 3 - 2 4 2 5 - 3 6 3 7 - 4 8 4 9 - 6 0 Chung
Nam 1990*
4.394 4.646 7.046 6.961 7.110 7.815 37.972
Nam 1994*
4.368 4.618 6.987 6.897 7.038 7.746 37.654
Nam 2000**
7.734 12.957 20.515 19.125 17.511 16.627 94.469
Nam 2002**
5.775 13.936 21.549 19.379 15.665 15.617 91.921
Nam 2005**
6.052 14.280 22.097 19.939 16.318 16413 95.099
Nam 2009**
6.068 14.323 22.163 19.998 16.367 16.461 95.380
*. Di8u tra nam 1990 va 1994 chpn 24 tinh
**. TCr nam 2000 dieu tra toan bp cac tinh, thanh ph6 ca nuoc.
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Hinh 1. Ty le suy dinh duong thap coi ff tre
Theo danh gia cua UNICEF, tinh trong ca thap ky 90 thi Viet Nam la nuac duy nhat trong kliu vuc Dong Nam A va Thai Binh Duong c6 miic giam SDD thap coi la 1,8%/nam, dat dugc yeu cau dat ra tai Hgi nghi Thugng dinh ve Dinh duang nam 1990 [9]. Trong khi do, miic giam chung cho cac nuac khu vuc Dong Nam A la 0,9%/nam trong thai gian tir nam
1990 din nay [32]. Miic 0,9%/nam a khu vuc nay dugc xep la nhanh nhat so vai tat ca cac khu vuc khac tren the giai. Tuy nhien, do ty le SDD thap coi a thai diem
Bang 4: Ty Ie SDD thip coi (%) theo
em duoi 5 tuoi qua cac nam dieu tra
xuat phat ban dau (nam 1990) cua khu vuc Dong Nam A la cao nhat nen du da dat miic giam cao nhat thi ty le SDD thap coi cua khu vuc Dong Nam A van con cao ban so vai cac khu vuc khac tren the giai.
Dau nbiiTig nam 90, cac chuyen gia Ngan bang The giai du doan vao nam 2000 ty le SDD thap coi tre em nuac ta se la 45%), den nam 2013 se duai 35%> vai dieu kien dat miic tang truang kinh te lien tuc cac nam la 9%[ 1 ]. Nhu vay, SDD thip coi a tre em da giam dang ke va nhanh ban so vai du bao cua cac chuyen gia.
nhom thang tuoi va theo nam
Thang tuoi 1990 1994 2000 2005 2006 2009
l - 6 ( C . l . ) 22,4 9,8 11,7 9,1 I I 4 9 1 (25,8-32,6) (6,6-12,0) (9,9-13,5) (7.0-11.2) (9,6-13.2) (7,0-11,0) 7 - 1 2 (C.I.) 40,5 25,6 29,0 21,8 23,4 22 6
(37,3-43,7) (22.8-28,4) (27,1-30,9) (20.8-22.8) (21.5-25.3) (20,5-24,7) 1 3 - 2 4 (C.I.) 55,8 52,4 48,8 38,5 44.6 3 9 5 '
(52.7-58,9) (49,5-55.3) (47.3-50.3) (37.4-39.6) (42.5-46.7) (37.7-41.5) 2 5 - 3 6 (C.I.) 53,2 49,0 44,4 38,2 42,8 3 9 2 '
(50.1-56.3) (46.4-51.6) (42.2-46.6) (37,1-39.3) (40,6-45.0) (37,2-41,2) 37-48 (C.I.) 58,7 57,8 43,0 38,4 41,7 38 6 '
(55,3-56,6) (54,9-60.7) (41.1-44,9) (37.2-39.6) (39,8-43.6) (36,4-40,8) 4 9 - 6 0 ( C . I . ) 62,3 61,4 43,2 38,5 40,4 38 7 '
(59,1-65.5) (58.6-64.2) (41.1-45.3) (37,2-39,8) (38,4-42,4) (36.6-40.8) Chung (C.I.) 53,4 47,6 36,5 29,6 33,0 3 1 9 '
(50,4-56,4) (45.2-50.0) (35,3-37,7) (28,7-30,5) (31,7-34,3) (29,4-32,0)
TC.DD & TP6 (3+4) - 2010 Bang 4 trinh bay dien bien cua tinh
trang SDD thip coi a tre em duai 5 taoi qua so lieu 5 cugc dieu tra toan quoc. Ty le SDD thap coi giam dan va giam deu a tat ca cac nhom thang tuoi. Ty le SDD thap coi a tre em duai 5 taoi nam 1990 la 53,4%, din nam 2000 con 36,5% (giam trung binh 1,69%)/ nam trong thap ky 90).
Tir nam 2000 din 2005, ty le SDD thip coi giam tu 36,5% xuong con 31,9%
(giam tmng binh 1,3%/nam). Neu so sanh giiia 2 cugc dieu tra gan nliau thi kha nang giam ty le SDD a tirng nhom thang taoi (khong co khoang tning CI) it xay ra ban so vai tinh giiia 2 cugc dieu tra each nhau mgt khoang thai gian nhat dinh (tren 5 nam). Tuy vay, tinh chung cho toan bp tre em duai 5 taoi thi ngoai so lieu nam 2005 va 2009 van con klioang chung trong miic CI, con so vai cac eupc dieu tra truac cho thay SDD thap coi nam 2005 giam va khoang tin cay CI khong con trdng nhau. Viet Nam, dieu quan trpng la SDD thap coi giam nhanh vao nhiing thai diem ma nen kinh te dat dugc nhung thanh tim to lan trong ban mpt
thap ky gan day. Du la nhiing chuyen bien tat yeu do tac dpng cua thofi ky chuyen tiep kinh te xay ra manh me nhung da chiing to rang chieu cao cua tre em Viet Nam tang len ro ret khi dieu kien kinh te dupe cai thien mpt each toan dien a tat ea cac cap tu cap hp gia dinh den cap quoc gia. Mat khac, co the thay ro SDD thap coi giam di kha deu a tat ca cac viing nghien ciiu. Dieu nay chiing to rang tiem nang phat trien ve chieu cao ciia tre em Viet Nam co the dat den miic trung binh cua quan the tham khao quoc te NCHS va trai vai nhan dinh rang nguai Viet Nam thupe dien di truyen thap be nhe can nhu mpt so tac gia da neu ra truac day [9] [90].
Sir dong gop cua cac yeu to kinh te xa hpi lam giam ty le SDD noi chung va dac biet SDD thap coi noi rieng ngay cang dugc thay ro. Hinh 2 cho thay sir chuyen dieh ciia trung binh Z-scores chieu cao/taoi (HAZ) eiia tre em nuac ta qua mgt so nam gan day. Xu huang chuyen dich tien gan den quan the NCHS dugc quan sat thay kha ro rang.
Hinh 2. Phan ph6i gia tri can/tu6i tinh theo zscores nam 1999 va 2009
3.3. Mot so ban luan
Du tinh den nam 2009 dan so Viet Nam la 87 tneu nguai, trong do 74%o sing a khu vuc nong thon va chi co 26%
sing a khu vuc thanh thi (TCTK, 2008).
Theo uac tinh, tong so tie em duai 5 taoi nam 2009 la 7,8 trieu tie. Trong vong 10 nam qua, ty le suy dinh duang, ke ea suy dinh duang the thap coi, giam dang ke nhung toe do giam a cac khu virc khong giong nhau. Khu vuc thanh thi co toe do giam suy dinh duang nhanh nhat, tren 47% a ca ba the suy dinh duang (Bang 5). Khu vuc mien niii eo toe do giam cham nhat. So tie suy dinh duang phuc hoi tang hang nam ke tir nam 2000. Tuy nhien, nhin chung ty le suy dinh duang thap coi van con cao a tat ca cac khu vuc, dac biet la khu vuc mien niii va nong thon.
Tinh hinh dinh duang a nhiing khu vuc nay chiu anh huang bai nhieu yeu to.
Thanh cong ciia chuang trinh ke hoaeh hoa gia dinh (ha thap ty le sinh tir 3,1%) nam 1994 xuong 2,28% vao nam 2002 (Uy ban dan so va ke hoaeh hoa gia dinh, 2001)) CO the da tao ra co hgi cho cac gia dinh dau ta tot ban vao cham soc siic khoe va dinh duang tre em. Cac boat dgng cham soc siic khoe, bao gom tiem chung ma rong, phong ching tieu chay, phong chong nhiem khuan duang ho hip va cac chuang trinh cham soc siic khoe ba me va tie em khac eo the ciing dong gop vao viee ha thap ty le suy dinh duang tre em. K I tir nam 1999, chinh phii Viet Nam da eo chinh sach "ho trg nguai ngheo" thong qua mpt s6 chuang trinh giam ngheo nhu "chuang trinh 135" bao phu 2.374 xa dac biet kho khan tien toan quoc, ehii yeu a cac vung xau viing xa, viing mien niii va bien giai. Cac chuang
trinh xoa doi giam ngheo co tac dgng rat lan den viec ha thip ty le suy dinh duong tre em a Viet Nam trong nbiiTig nam qua (Dollar, 1998).
Co thi nhan thiy cac boat dpng can thiep dinh duang a Viet Nam giii mpt vai tro quan trpng trong viec ha thip suy dinh duang (Dollar, 1998). K I tu nam 2000 den nay, vai sir diu ta ciia chinh phu bang nam ngay cang tang (NIN, 2007), chuang trinh phong chong suy dinh duang tre em da bao phu bet tat ca cae xa trong toan quoc. Vai tro ciia cae chuang trinh dinh duang a Viet Nam khong nhiing nham vao viec cham soc ba me va tre em ma con nang cao nhan thiic va cam ket ciia cac ca quan co tham quyen a tat ca cac cap. Muc tieu giam suy dinh duong da dugc dua vao chuang trinh phat trien kinh te xa hgi cua chinh phii. Nhieu to chiic nhu Hgi phu nii, Doan thanh nien va Hpi nong dan da tham gia tich cue vao chuang trinh phong chong suy dinh duang tie em trong nam nam qua. Cung vai chuang trinh giam ngheo, chuang tiinh phong chong suy dinh duang tie em da dong gop dang ke vao viee tang nhanh toe dp giam suy dinh duang trong giai doan 2000 - 2009.
Cac yeu to nguy ca cua suy dinh duang tie em dugc phan tich tii so lieu dieu tra quoc gia nam 2009. Ket qua phan tich cho thay tinh trang kinh te va diiu kien song cua tre co anh huang rit lan din tinh trang dinh duang (Bang 6). Hg ngheo va hg song a viing kinh t l kem co nguy ca suy dinh duang cao. Diiu nay ggi y rang hien nay cae khu vuc a Viet Nam CO khoang each ve kinh tl. Ty le suy dinh duang thap coi khong co su khac biet giiia tre trai va tre gai nhung c6 su khae biet giiia cac viing va tinh trang kinli
TC.DD & TP6 (3+4) - 2010 te. So lieu tir Tong cue Thong ke (GSO,
2004 va 2006) va s6 lieu tir Diiu tra y t l quoc gia (MOH, 2003) ciing chi ra xu huang tuang tu nhu nghien ciiu ciia chiing toi.
Nguyen nhan chinh ciia suy dinh duang la doi ngheo. Doi ngheo lam anh huang den nhiing hg gia dinh co cac thanh vien co trinh do van boa thap, nhiing nguai nay thuang gap kho khan trong viec tiep can cac ky nang, thong tin va dich vu cham soc siic khoe (Lisa, 2006). That nghiep la tinh trang rat pho bien a khu vuc nong thon va vung xau vimg xa. 80% nguai ngheo la nhirng nguai nong dan luon chiu anh huang true tiep bai thien tai, trong khi a khu vuc thanh thi, miic song nhin chung thuang cao ban thi d6i ngheo lai chiu anh huang cua that nghiep do c6 su phan phoi lgi ich khong dong deu tii phat trien kinh te va/hoac thieu ca hgi (Dollar, 2002).
De nang cao tinh trang dinh duang tre so sinh thi tinh tiang siic khoe va dinh duang cua ba me phai dugc coi tigng bai vi tinh tiang dinh duang ba me va tie so sinh CO lien quan chat che vai nhau.
Trong nghien ciru nay, nhiing yeu to noi tien khong dugc kiem dinh tiong mo hinh hoi quy do da dugc chiing minh a mgt nghien euu khae rang tinh trang dinh duang ciia ba me co vai tro quan tigng doi vai suy dinh duong thap coi a Viet Nam.
Cac thong tin ve tiep can nuac sach va ho xi hgp ve sinh a bang 6 cho thay chat lugng cham soc tre em eon yeu kem.
Thue hanh cham soc tre phu thugc vao nhieu yeu to nhu van boa, tap quan, tinh trang kinh te gia dinh, kien thiic ciia ba me va nguai cham soc tre. Ty le tre den nha tre mau giao a khu vuc nong thon va mien mii con thap (Bg Giao due va dao tao, 2004). Cac nha tre man giao can dugc nang cao kien thiic ve thuc hanh cham soc tre. Thuc hanh nuoi duang tre doi khi van con la mgt van de can quan tam. So lieu tir nghien ciiu nay chi ra rang (khong trinh bay a day) ty le tre an bo sung sam (truac 6 thang taoi) a cac khu vuc khoang tir 30%) den 70% va ty le ba me CO nhan thiic diing ve thai gian cho tie a n b l sung chi tii 21,2%) den 42,7%). Kien thiic ciia ba me ve viec lira chgn va che bien thiic an va each cho tre an nhin chung con yeu.
Tom lai, ty le suy dinh duang tie em, ke ca suy dinh duang the thap coi, a Viet Nam giam dang ke trong thap ky qua.
Cac yeu to lien quan den suy dinh duang nhu doi ngheo, tiinh do giao due cua bo me va yeu to moi truong can dugc dac biet chii y de co the ha thap ty le suy dinh duang tre em trong nhiiTig nam tai mac du nhiing yeu to nay khong phai luon luon giai quyet dugc mgt each de dang.
Nam 1990
Bdng 5 . Ty Ie
Nhe can Thap coi Gay com
suy dinh duong theo Thanh pho
40.6 44.4 9.2
viing tir 1990 den 2008.
Nong thon 47.5 60.1 14.2
Mien niii 54.7 61.8 16.8 2009
Nhe can Thap coi Gay com
16.5 23.2 4.8
23.2 3 4 4 7 4
27.9 36.6 7.9
Bdng 6. Thieu nhieu vi chat dinh duong anh huffng den phat triln chiiu cao
Bien so Bo sung da vi chit
n=168
Nhom Thang tu6i 22,9 ±3,1
Chiiu dai nSm chung (cm) 79,5 ± 3,7 Chiiu dai nim cua tre a hp KT ngheo va trung binh (*) 79,2 ±3,1 Chiiu dai n§m cua tre a hp KT giau 79,4 ± 3,2 Chiiu cao/tuoi Z score (*) -1,36 ± 1,0
22,9 ± 2 , 8 78,9 ± 4 , 7 78,3 ± 4 , 2 79,6 ± 3 , 8 1,68 ± 1,1
Nghien ciiu bo sung vien da vi chat dinh duang nam 2006 eho thay a nhom dugc bo sung da vi chit dinh duong doi vai hg ngheo va trung binh (can ngheo) chieu cao tre em tang len sau 1 nam b l sung vien da vi chat dinh duang do UNICEF cung cap. Ro rang, thieu cac vi chat dinh duang la mpt trong nhirng nguyen nhan quan trpng dan den suy dinh duang thap coi a tie em.
Bang 7. Mo ta mot so yeu to dinh duong anh huffng den suy dinh duffng thap coi.
Bien so Nhom ho Nhom ho Nhom ho Nhom Nhom ho
ngheo can ngheo trung binh ho kha giau An ninh luong thuc
Nang lupng sin CO (% so voi nhu ciu) 76,2 82,3 88,4 112,0 120,6
% ba me liic CO thai tieu thu >60 gr protein 50,3 58,4 74,6 92,6 94,4 done vat/neav
Ty le suy dinh duong thip coi (%) 44,2 38,0 30,2 24,1 13,1
Phan tiam nang lugng tir luong thuc thuc pham san co a hg gia dinh theo 5 nhom chi tieu cho thay a nhiing nh6m hg ngheo thi nang lugng san CO thap ban so vai cac nhom tren. Dong thai phan tram ba me tieu thu protein dgng vat trong thai ky co thai eiing tang dan theo nhom chi tieu.
Kiem dinh Khi binh phuang cho thay co moi lien quan ve cac yeu to dugc phan tich tren.
Bdng 8: Phan tich hoi qui cac yeu to nguy co ciia SDD thap coi (cac yeu to chfnh) dua vao Ket qua dieu tra nam 2006.
Mo hinh : Ham sinh hpc Probit Bien phu thuoc O neu tre bi SDD thap coi. Khac =1.
Bien so Constant C o h p
% nguoi ldn TDVH nam TDVH nil Chu hp nii N p h e nnnfj Dien tich dat trong San lupng LTTP Gia siic
Dien tich nha 6 Ho xi dpi nuoc Nuoc may Co dien Co dai (Radio) Vo tuyen
He so 0.1883 -0.1543 0.7049 0.0496 -0.0340 -0.1967 -0.3532 0.0002 0.2103 0.0006 0.0219 0.0069 0.3252 0.0833 0.0854 0.3218
He so bien thien/SE
1.314 -11.537
6.169 -5.671 -0.425 -3.181 -5 068 5.349 2.088 5.922 -
1.882 4.539 5.348 1.389 1.373 5.660
Xac suat de he so =0
0.1887 0.0000 0.0000 0.0000 0.6711 0.0015
onnno
0.0000 0.0368 0.0000 0.0598 0.0000 0.0000 0.1648 0.1699 0.0000
22
TC.DD & TP6 (3+4) - 2010
IV. KET LUAN:
Ty le suy dinh duang thap coi a tre em duai 5 taoi a nuac ta dang giam nhanh va giam ben viing. Mu'C giam suy dinh duong thap coi trong nhiing nam qua nhanh hon so vdi du bao cua cac chuyen gia [1,4,10]. Toe do giam trung binh hang nam tir nam 1985 den nay la 1,4%, dac biet tii nam 1996 din 2009 dat miic giam trung binh hang nam xap xi
1,5%/nam.
Cac yeu to anh huang den suy dinh duang thap coi gom co: nang lugng binh quan dau nguai tieu thu a hg gia dinh thap, khau phan an eiia ba me khi mang thai co miic tieu thu protein dgng vat binh quan duai 60 gram/ ngay, tre khong dugc nuoi bang sii-a me... Ngoai ra, mgt so cae yeu to kinh te xa hpi khac a cap hp gia dinh nhu trinh dp van boa ciia bo me thap, khong co dieu kien tiep can nuac sach, cae cong trinh ve sinh khong dat yeu cau... ciing lien quan den suy dinh duong thap coi a tre duai 5 taoi.
V. KHUYEN NGHI:
Uu tien cao cac chuang trinh cham soc y te va siic khoe nham phong chong suy dinh duong bao thai. Muon phong suy dinh duang bao thai co hieu qua nham tianh cho tre bi suy dinh duang bao thai tbi can phai cham soc siic khoe ngay tu taoi vi thanh nien, dac biet chii trpng cho tie em gai. Qua trinh cham soc va nang cao kien thiic y te va dinh duong can keo dai cho den khi hp tra thanh nhiing phu nii taoi sinh de, buac vao thai ky mang thai can CO nhiing eham soc dac biet ve an uong va bo sung eae chat dinh duang can thiet theo cac chuang trinh boat dpng hien nay nhu bo sung vien sat...
Thuc hien that tot viec thuc hanh nuoi con bang siia me. Cac nghien ciiu cho thay tie khong bii me c6 nguy ca cao ban vai suy dinh duong thap eoi. Tre dugc bii me
hoan toan den 6 thang dau sau sinh it bi mac cac benh nhiem khuan ban, do do tranh bi suy dinh duang nhe can va qua trinh phat trien chieu cao dugc bao ve tot ban.
Day manh cac boat dgng ciia chuang trinh phong chong suy dinh duang tie em va ba me a egng dong.
Cac chuang trinh ve sinh moi truang, tiep can nuoc sach ... dugc thuc hien tot dong vai tro quan tigng nham tranh tie em bi mac cac benh nhiem khuan, tir do phong chong suy dinh duang thap coi.
Phoi hgp vai cac chuang trinh xoa d6i giam ngheo, nang cao kien thiic nguai dan, dac biet la cung cap kien thiic y te va dinh duong cho phu nii taoi sinh de va phu nii' mang thai, eho con bii.
TAI LIEU THAIM KHAO
1. Dollar D., Paul Gewwe and Jennie Lit- vack, 1998. Household welfare and Viet- nam's transition: Will Vietnam Grow Out of malnutrition? Worid Bank, Washington DC.
2. Chinh phii Viet Nam, 2001. Chiin lugc Dinh duong quIc gia 2001-2010.
3. Frongillo E. A. Jr; de Onis M.; Hanson K.
M. P (1997). Socioeconomic and demo- graphic factors are associated with world- wide pattems of stunting and wasting.
Joumal Nutrition, 127, pp. 2302 - 2309.
4. Ha Huy Khoi, Nguyen Cong Khin, 2000.
Tinh hinh va cac thach thiic dii voi chuang trinh phong ching suy dinh duong 6 Viet Nam. Tap chi Khoa hgc va Cong nghe, Sl 4, 2000, trang 13-15.
5. Khoi H. H (1990). Protein - Energy nu- tritional status of rural people in some re- gions of Vietnam. Prace IZZ No. 53, Warsaw.
6. Lisa C.Smith and Lawrence Haddad, 2000. Overcoming Child Malnutrition in Developing Countries: Past achieve- ments and future choices. Intemational Food Policy Research Institute, Washing-
9.
ton DC, 2/2000.
Vien Dinh Duong, 2006. Vietnam: Tinh hinh dinh duong nam 2006.
UNICEF, 1990. Strategy for improved nutrition of children and women in de- veloping countries. New York, pp. 3-4.
UNICEF/EAPRO, 2003. Strategy to re- duce matemal and child undemutrition.
UNICEF, Health and Nutrition working
10.
11.
paper.
UNDP- Ting cue Thing ke: Miic song trong thai ky kinh tl biing no. Nha xuat ban Thing ke 12/2001. trang 73-88.
Worid Health Organization (WHO), 2009. Global database on child growth and mahiutrition. WHO, Geneva, pp.
75-80.
Summary
TREND OF STUNTING REDUCTION AND PRIORITIES IN CHILD MALNUTRI- TION INTERVENTION STRATEGY IN VIETNAM
Reduction in childhood malnutrition in Vietnam between 1985; 2005 and 2009 was examined using data of some national surveys. The prevalence of mahiutrition, including stunting, reduced significantly for underweight from 59.7% in 1985 to 31.9% in 2009 with an average reduction of 1.2 % per year in the period from 1985 to 2009. There were clear differences in the decrease in malnutrition prevalence between urban, mral and mountainous areas, the reduction being highest in the urban regions and lowest in the mountainous areas. Regression analysis showed that the nu- trition status of the child is positively related to better household living condition and educational level of the fathers, but not the mothers. Stunting is higher in children whose parents are farmers and higher Ln households with more children. Stunting prevalence is lower in households with safe water access and hygienic toilets. For the years to come, the dramatic reduction is childhood mahiutrition as seen in the period 1994 to 2009 might be difficult to match. More comprehensive actions are needed to lower childhood malnutrition in Vietnam fiirther.
Key words: Malnutrition; Vietnam, Stunting, Poverty.
* Bdi todn vdn se ddng tren tgp chi DD&TP, 2011
„ TiNHT^tANG^DINHpTr^NGyAXUHird^G TANG TRlTCfNG CUA TRE LlTA TUOI HOC DUONG
Ba muai nam truac, the giai da chiing kien cugc vat Ion cua hang trieu tre sa sinh de dugc ky niem sinh nhat dau tien tiong cugc dai ciia chiing. Liic do chi khoang 83% tie so sinh sing qua 12 thang taoi [1]. Ngay nay, theo thing ke cua UNICEF trong mgt thap ky qua co tai tren 90% tre em tren the giai da song qua 5 taoi va dat tai taoi den trucmg. Ty le tre dugc den truang tang dan bang nam,
'TS.BS - V i e n Dinh duang
Le Nguyen Bdo Khanh' tham chi cao ban bat cii giai doan nao trong lich sir nhan loai [2]. Dieu nay phan anh su thanh cong ciia cac chuang trinh
"vi sir song ciia tre em", dong thai ciing dat ra nhiing nhiem vu cap bach d i i vai cong tac cham soc dinh duang va siic khoe doi voi tre em liia taoi hgc duang.
C) Viet Nam, tre liia tali hoc ducmg chiem khoang 1/3 dan so. Tre lu'a tali hpc duang (tir 6-17 taoi) trai qua hai m i c
