TAP CHi NGHIEN CU'U Y H p C • •
SU KHAC BIET Giai TJNH V& PHAT TRI^N TAM LY - VAN DONG VA TiNH TRANG DINH DU'O'NG (y TR^ TIJ 1 D^N 3 TU6l
TAI HAI DU'aNG NAM 2009
Nguydn Dd H u y \ Trdn Quang Binh^. N g u y i n Thi Hdng Ha^
'Vipn Dinh du&ng Qudc gia. ^Vipn Vp smh Dich ti Trung wang. ^Trung tam nghien cuv vdn hda im thwc va dinh du&ng. dpi hpc Jumonji. Nhdt Ban
Nghidn cuu ntiim so sdnh sw khde bipt theo gi&i & trd tw 1 din 3 tudi vi swphat tnin tam ly -vdn dpn^
va tmh trpng dmh dudng & viing ndng thon va thdnh thi. tinh Hdi Duo'ng ndm 2009 Thiit ki nghien cuv cdt ngang chpn c6 chO dmh todn bp 492 cdp doi tup'ng nguoi mp vd can cd tudi tw 1 den 3 tai 1 xa nong thon vd 1 phu&ng thanh pho de danh gid sw phdt triin tam ly - vpn dpng bdng test Denver II va phdn lopi tinh trpng dmh du&ng Iheo ti§u chuin cua Td ehirc Y ti Thi gi&i Kit qua cho thiy. Ty Ip nghi nga chpm phdt tnin tdm ly - vpn ding eao han a nh&m tre gdi so vai tre trai a khu vuc vdn dpng tho va v$n dpng tmh te va eao hon & & ndng thdn so v&i thanh thi a khu vwc phdt triin vpn dpng tho vd phdt tnen ca nhan - xa hpi (p < 0.05) Khong cd sw khde bipt vi gi&i a ca ba the suy dinh dw&ng nhp can, thip cdi vd giy com tp > 0.05)
Tir khoa' phat tnen tam ly • van dpng, suy dinh du'ffng
I. DAT VAN 0£
S u phat tnen tam ly - van ddng va tinh trang dinh dudng cua tre trong giai doan phat tnen d i u ddi cd y nghTa rat quan trong cho ca cudc sdng lau dai ve sau eua mdt con ngudi [1] Vide phat hidn s d m cde rdi loan gay trd ngai eho s u phat tnen cua tre nho trong giai doan nay se giiip cho cdc nha chuyen mdn va gia dlnh ap dung nhCrng bien phap can thidp sdm de tre ed the phdt tnen tdt han
T r i e nghidm Denver, eon ggi Id t r i e nghidm danh gid s u phat tnen tdm ly - van ddng d tre nho t d sa smh den 6 tuoi, dup'c dp dung dau hdn tai Hoa Ky [2, 3], sau dd la tai Cuba vd nhieu nude khde tren the gidi Tai Vidt Nam, t r i e nghiem da duae ap dung d i u tidn tai khoa T h i n kmh. benh vien Bach Mai
Dia chi lien he Nguyen Do Huy. Vien Dmh Du&ng Quoc gia,
Email nguyendohuy1965@yahoo com Ngaynhan 2/11/2012 Ngay duoc chap thuan 15/3/2013
nam 1977 T d ndm 2000, khoa Tdm than, benh vien Nhi Trung u o n g tidp tuc nghidn eiru vd c h u i n hoa test Denver II [4], t u do ddn nay da cd nhidu dan vi khac trong nydc tilp tuc tnen khai thuc hidn [5] Do ddi hoi tinh ehuyen mdn cao trong p h u a n g phdp danh gid. muc dd phat tnen tdm ly - van ddng eua tre nho tai eong dong vdn chua d u a e nghidn ciru rong rdi
Thdng tm vd s u khac biet gidi trong ca sy phat tnen tdm ty - vdn ddng vd tinh trang dmh dudng tai vung thdnh thi va ndng thon cdn rat han c h l . Do vdy. nghidn edu ndy duae tidn hanh nhdm xac dmh va so sdnh theo gidi tinh ve s u phdt tnen tam ly-vdn ddng vd tinh trang dmh d u d n g cua tre em t u 1 d i n 3 tuoi tai mdt xa ndng thdn va mot p h u d n g thanh thj thuoc tinh Hai D u a n g ndm 2009,
II. D O I TU'gNG VA PHU'aNG PHAP
1. Thdi gian va dja didm: nghidn cuu tidn hdnh t u thang 10 den thdng 12 nam 2009 tai phudng Trdn Phu vd xa Tan Hung, tfnh Hai Duong.
TCNCYH 81 (1)-2013
• TAP CHi NGHIEN CLPU Y HOC 2. Thiet ke nghien ciru: Nghien c d u cat
ngang, chon dia bdn nghidn cdu ed chu djnh 3. Ddi tu'ang nghien CLPU: Tre t d 1 d i n 3 tuoi de du thdng, khdng cd di tat b i m smh, bdnh man tinh vd bat t h y d n g v l phdt tnen tri tue va ngydi me/ngudi chdm sde ede tre ndy
4. Co* m l u du'ac tinh t h e o c o n g thu'c
Z',.„/3P(1-P)
Vdl p la ty Id u'dc tinh ty Id chdm phdt tnen tam - van ddng vd suy dmh d u d n g d tre t u 1 din 3 tuof 18% d la dd ehinh xac tuydt ddt lay blng 0,05 Z,.0^2 la hd so tin edy, b l n g 1,96 vdi a = 0.05 C d m l u tinh d u a e la 230 tre/nhdm Udc tinh so tre t u 1 den 3 tuoi ciia mdi xa/
phudng Id 220 - 250 tre Do vdy, nghien cuu nay lly t i t ca so tre t u 1 - 3 tuoi dat tieu chuan va ba me/ngudi cham sde tre trong xd/
phudng tham gia nghidn c u u
Su phat tridn tam ly - van ddng eua tre t u 1 - 3 tuoi duae ddnh gia b l n g test Denver II [4]
vdl 4 khu khu vuc phdt tnen ciia tre duoc danh gia,- do Id
Khu v y c van ddng thd s a ddnh gid kha nang phdt tnen ede vdn ddng toan thdn va kha ndng giCr thdng bdng cua ea the
Khu vue van ddng tmh td - thich ung ddnh gia kha ndng van dong kheo ldo cua ddi tay vd kha nang quan sdt tmh td cua ddi m l t
Khu vuc ca nhan - xa hdi danh gia kha nang nhan bidt ban than, chdm soc ban thdn va thidt Idp quan he t u a n g tac vdi ngudi khac
Khu v y c ngdn n g d danh gia kha ndng l i n g
nghe va ddp dng vdi am thanh, kha nang phat dm, va sau CLjng la kha nang phat tnen ngdn ngu (nghe hieu va ndi)
Tinh trang dmh dudng eiia tre t d 1 ddn 3 tuoi d u o c phdn loai theo cdn nang vd chidu eao theo tuoi. so sdnh vdi q u i n the tham chieu W H O - 2005
5. Phan t i c h t h d n g ke
S6 lieu nhdn t r i e duae kiem tra phdn bd c h u i n trudc khi so sdnh S u dung kidm dmh Student T test de so sanh b i l n dmh luang gida hai nhdm va s u dung kidm dmh Chi- Square hoac Fisher's Exact Test dd so sanh eac ty Id Y nghTa thdng kd dat duae vdi gia tn p < 0,05 cho 2 phia Gia tn p nhan duoc tu Chl - Square test (hode Fisher's exact test) cho cae ty Id hoac kiem dmh Independent T- test cho hai bidn dmh luang S6 lieu duoc phan tich b l n g p h l n mdm SPSS 16 0
III. K^TQUA
Bang 1 trinh bay dae didm cua ddi tuang nghien ciru theo tudi, gidi, chidu cao. edn nang, chi so khdi ca the (BMI) va kmh t l ho gia dinh d thanh thi va ndng thdn Khdng cd s u khac biet co y nghTa thdng kd khi so sanh giCra tre trai va gdi theo tuoi, chidu cao va kmh te hd gia dlnh ( p > 0.05)
Tren toan mdu, tudi trung bmh ciia cdc ddi tuang Id 23,4 thang tudi, ty le tre trai tham gia nghidn c u u Id 53.7%, s y khac biet khdng co y nghTa thdng ke vd tudi vd gidi giua nhom tre ndng thdn vd thanh thi (p > 0,05) Can ndng vd BMI cua tre trai eao han tre gdi (p > 0,05).
TCNCYH81 (1)-2013
TAP CHl NGHIEN CU'U Y HQC
Bang 1 . Oac diem cua ddi t i r a n g nghien cii'u ThSnh thj Nong thon Nam Nu' P Nam Nu- (n = 122) (n = 105) (n = 142) (n = 123) ThSng tu6i
Chieu cao (cm) Can nang (kg) BMI (kg/m^) Kmh te h6 gia dinh
Gi4u Trung binh Ngheo
Bang 2.
22,4 ± 7,2 83,9 ± 7 , 0 11,8 + 2,0 16,7± 1,5 n (%)
16(13,1) 105(86,1) 1 (0,8)
23,3 ± 6 , 9 82,9 ± 6 , 5 11,1 ± 2 , 0 16,2 ± 1,8
18(17,1) 84 (80,0) 3 (2.9)
> 0 , 0 5
> 0 , 0 5
> 0 . 0 5
> 0 , 0 5
0,05
So sanh ty le suy dinh du-ong theo g 23,7 ± 6 , 7 82,3 ± 5 , 9 1 1 , 0 ± 1,6 16,3 ± 1,7
12(8,5) 122 (85,9)
8 (5,6)
io-i & thanh thj 23,8 ± 7,2 80,9 ± 6 , 5 10,4 ± 1,6 15,9 ± 1,6
11 (8,9) 106(86,2) 6 ( 4 , 9 )
>0,05
>0,05
>0,05
>0.05
0,05
va nong thon Ndng thon Cae the suy
dinh du'dng Nam NO' P Nam N d P (n = 122) (n = 105) (n = 142) (n = 123)
T h l p COI (%) Nhe can (%) GSy com (%)
13,9 9,0 4,1
10,5 12,4 4,8
> 0 , 0 5
> 0 , 0 5
> 0 , 0 5 30,3 21,8 5,6
29,3 17,1 4.9
>0,05
>0.05
>a,05 Ph6i hffp cac the suy dmh duong
C h i i t h i Ph6i hffp 2 the Ph6i hffp 3 the
9,8 7,4 0,8
11,4 6,7 1,0
> 0 , 0 5 25,4 16,2 0
23,6 11,4 1 6
>0,05
Khdng co s u cd khde biet ed y nghJa thong kd ve gidi tinh (giua tre trai va tre gai), nhung lidn quan chat ehe vdi didu kidn kmh te xd hOi (thdnh thi vd ndng thdn) dde biet vdi suy dmh dudng t h l p COI va suy dmh d u d n g nhe can: Ty Id suy dmh dudng d ca ba thd suy dmh dudng (nhe can, t h l p COI va gay com) ciia tre trai khdng khac bidt c6 y nghTa thong ke so vdi tre gdi (p > 0,05).
Theo tung gidi va trdn todn mau, ty Id suy dinh d u d n g cua tre d thdnh thi t h l p hon ty le nay d tre em ndng thdn va cd s u khac bidt cd y nghTa thong kd vdi p < 0,05 ddt vdi suy dmh dudng thlp COI vd suy dmh d u d n g nhe can (bang 2, 3).
TCNCYH 81 (1) - 2013
— TAP CHi NGHIEN Cl^U Y HpC Bang 3. So sanh ty le suy dinh du'dng theo gidi va theo thanh thj va ndng thon
Cac thd suy Thap COI Nhe can G&y com
Th&p coi Nhe can Gly com
dinh du'd-ng Nam (n = 264) 60 (22.7%) 42(15,9%) 13(4,9%) Thanh thi (n = 227)
28(12,4) 23(10,5) 10(4,4)
N0'(n = 228) 47 (20.6%) 34(14,9%) 11 (4,8%) NSng then (n = 265)
79 (29,8) 52(19,7) 14(5,3)
P
>0,05
>0.05
>0,05
<0,05
<0,05
>0,05
Bang 4. So sanh ty le nghi n g d cham s\y phat trien tam ly - van ddng theo gidi d rieng thanh thi va ndng thdn
Cac khu vyc nghi n g d cham phat trien tam ly -
van dong
Ndng thdn Nam Nii'
(n = 122) (n = 105)
Nam (n = 142)
Nd 1 = 123) VSn dong tho
Van dong tmh te Phat t n i n ca nhan - xa h6i Phat tnen ngon ngu
4,9 12,3 17,2 29,5
10,5 22,9 17,1 27,5
>0,05
<0,06
> 0.05
>0.05 12,7 19,7 23,9 27,5
21,1 27,6 27,6 30,1
>0,05
>0,05
>0,05
>0,05
Ty ie nghi ngo cham phat t r i l n tam van dong co s u khac biet c6 y nghTa t h i n g ke theo gioi tinh (giua tre trai va tre gai) va d i l u kien kmh t l xa hoi (giOa thanh thi va nong then), o khu vuc phat t n i n van ddng tho va van dong tmh te (bang 4, 5), TrO khu vuc phat triln ngon ngu, ty ie nghi ngo cham phat t n i n tam van dong o ca 3 khu vuc (van dong tho, van dong tmh t l va ca nhan xa hoi) cua tre trai d i u thap hon tre gai, s u khac biet cua gidi tinh v l phat triln tam iy - van aong ro ret n h l t voi van dong tho va van dong tmh te (p < 0,05) Trong khi do, ty ie nghi ngo Cham phat t n i n tam iy - van ddng ff ca 4 khu vuc (van dong tho, van dong tmh t l , ca nhan - xa hoi, va ngdn ngu) cua tre em nong thdn d i u cao hon tre em thanh thi, su khac biet cua tinh trang kinh t l xa hoi voi phat trien tam van dong ro ret n h l t vol van dong thd va phat t r i l n ca nhan - xa tiot (p < 0,05)-
TCNCYH81 (lj-2013
TAP CHl NGHIEN CLTU Y HQC •
Bdng 5. So sanh ty 1$ nghi n g d ch^m si^ phdt t r i l n tam ly-van d p n g theo gidi vd theo thanh thj vd ndng thdn
Cac khu vifc nghi ngd*
Cham phat tri^n tam ly - van dpng v a n ddng tha V^n ddng tmh t l Phat t r i l n ca nhan-xa hOi Phat t n i n ngdn ngO
v a n dong thd Phat tnen ca nhan-xa hdi v a n dong tmh t l Phat t r i l n ngon ngu'
Nam (n = 264)
24(9,1) 43(16,3) 55 (20,8) 75 (28,4) Thanh th| (n = 227)
17(7,5) 188(17,2)
39(17,2) 63 (27,8)
N0>(n = 228)
37(16,2) 58 (26,4) 52(22,8) ' 64(28.1) Ndng than (n = 265)
44(16,6) 197(25,7) 62 (23.4) 76 (28,7)
P
<0,05
<0.05
>0,05
>0.06
<0,05
<0.05
>0,05
>,0,05
IV. BAN LUAN
Nghidn cuu dd s d dung test Denver II duae c h u i n hda tai Vtet Nam [4] de danh gta s u phdt tnen tdm ly - van ddng, ket qua cho phdp xac dmh nhung tre nghi ngd cham phat tnen tam ly - van ddng Nghien c d u sir dung test Denver II danh gia khu vuc phdt tnen ca nhan-xa hdi va ngdn ngy ciia tre. nhung can phdn dmh rd ddy khdng phai la test kiem tra tri thdng mmh cua tre Test cd gia tn phdt hidn sdm nhung tre nghi ngd chdm phat tnen tam ly-van ddng so vdi nhung tre eung Ida. t d dd giiip eho nhung nhd chuydn mdn vd gia dlnh dp dung nhung bidn phdp can thidp s d m de tre ed the phdt t r i l n tot han
Kdt qua nghidn c d u eho t h l y ty Id dang ke cdc tre d cdng dong t u 1 den 3 tuoi cd nghi ngd chdm phdt tnen tam ly - vdn ddng cd tren 20% so tre d ca trai va gdi cd nghi ngd chdm phat tnen ea nhdn-xa hdi vd ngdn ngd 0ieu nay phan anh anh hudng cua mdi trudng gia dinh vd xa hot doi vdi s u phdt tnen ciia tre K i t qua cung tuang dng vdi ty Id nghi ngd
chdm phat tnen ca nhdn - xa hdi d nhung tre sdng trong mdi trudng ndng thdn (25.7%) eao han ro ret so vdi tre sdng d mdi trudng thanh thi (17.2%)
Nghien c u u tai ndt va ngoai thanh Ha Ndi [6] ndm 2003 - 2005 tren 614 tre ed tuoi tCr 1 thdng ddn 2 tuoi eho thdy cd 10,4% tre nghi ngd cham phdt tnen tdm ly - van dpng theo Test Denver II Cac tde gia eho r i n g cdc yeu td v§n hda, tdp qudn nudi day, each chdm soc tdp luyen, trinh dd vdn hda cha me, su g i n bd me con, yeu to the luc ddu anh hudng ddn su' phdt tnen tam ly - vdn ddng eua tre Nghien edu eua H Abigail Raikes ndm 2005 [7] cho thay anh h u d n g cua mdi trudng gia dlnh (s6 tre d u d i 5 tuoi trong gia dinh. tinh hlnh du trir thuc pham, mat dd hd gia dinh) va suy dinh dudng nhe can theo tuoi ddi vdi s u phdt trien cua tre Nicanagua t d 2 thang ddn 5 tuoi, anh h u d n g nay manh han d khu vuc phdt tnen ngdn n g u vd van ddng tmh td.
Trong nghien cdu nay, ty Id nghi ngd cham
130 TCNCYH 81 (1) - 2013
• TAP CHI NGHIEN CU'U Y HQC phdt tnen tam ly - van ddng d khu vye phdt
then vdn ddng thd vd vgn ddng tinh t l c6 s u khac biet CO y nghTa t h i n g kd vdi gidi tinh.
trong do ty Id nay d tre trai t h l p han tre gdi C/
tre gai cung cd ty Id phdi hap gida nghi ngd ehdm phat then tam ly - van ddng vd cde the suy dinh dudng eao han d tre trat. Tuy nhien, 0 khu vuc phdt tnen ngdn ngu khdng thay s u khac biet v l gtdi. giu'a thdnh thi va ndng thdn Ty Id suy dinh dudng d ca ba the suy dmh dudng (nhe can. t h l p cdi vd gdy cdm) ciia tre trai khdng khac bidt cd y nghTa thdng kd so vdi tre gai trong nghien cuu ndy Bieu nay cho thly su khac nhau ve gidi d cac khu vuc phdt tnen tdm ly - vdn ddng vd dmh dudng chiu anh hudng cua nhidu ydu td phue tap va edn ed cac nghien c d u sdu han vd cde ydu td gay ndn cac anh hudng khde nhau nay
V. K^T LUAN
Ty Id nghi ngd cham phdt then tam ly-van ddng d khu v y c phat tnen van ddng tho va vdn ddng tinh td cd s u khde biet cd y nghTa thing kd vdi gidi tinh (giua tre trai va tre gai) va dieu kien kinh td xa hdi (giua thanh thi va ndng thdn)
Ty Id suy dmh d u d n g khdng eo s u khae biet vd gidl tinh (giua tre trai vd tre gai), nhung cd lien quan chat che vdi didu kidn kmh te xa hdi (thdnh thi vd ndng thdn) dde biet vdi suy dinh dudng t h l p cdi va suy dinh dudng nhe can
KHUYEN NGH!
Ben canh vide phdng chdng suy dmh dydng tre em, can uu tien cdc can thidp nham phat tridn tdm ly vdn ddng tre em gat d vung ndng thdn
Vdi tre em suy dmh d u d n g , vide giao due phdt tnen tam ly - van dOng c i n tap trung nhieu, uu tien phat tnen ca nhdn xa hdi. phat tnen tmh te thich ung vd ngdn ngCr
TAI LIEU THAM KHAO
1. Christopher N.M. et al (1989). Growth in utero and cognitive function in adult life follow up study of people born 1920 and 1943, BMJ, 312, 1 3 9 3 - 1 3 9 6
2. Frankenburg, William K.; Dobbs, J.B (1967). The Denver Developmental Screening Test The Journal of Pediatrics, 71(2), 181 -191
3. Frankenburg, W.K., Dodds, J., Archer, P. et al (1992). The DENVER H: A major revi- sion and restandardization of the Denver Developmental Screening Test Pediatnes. 89, 91 - 9 7
4. Quach Thuy Minh, Hoang C i m T u , N g u y i n Thj Hdng Thuy va cdng sir (2000).
Ap dung Test Denver danh gia su phat triln tam van ddng cua tre em dudi 6 tu6i, Vien Nhi Khoa, Ky ydu edng trinh nghien cdu khoa hoc nam 2000. 354 - 360
5. Vien khoa hoc giao due- Trung tam nghien c d u giao due mdm non (2000).
Nghien euu doc dac diem phat tnen co thd va tam vdn ddng eua tre t d sa sinh den 36 thang tai Ha Ndi, Od tai B98-49-58, 1 1 - 2 3
6. Quach Thuy Wlinh, Nguyen Thj Hdng Thuy, Hoang Cdm T i i , va Quynh Kieu (2005). Ap dung Test Denver 11 danh gia su phat tnen tdm van ddng d tre em Tap chi nghien cuu y hoc, 35, 5
7. Abigail Raikes H (2005). Family Envi- ronments and Early Development in Low- Income Nicaraguan Children Interamencan Joumal of Psychology, 39(3), 399 - 412
TCNCYH81 (1)-2013
TAP CHi NGHIEN CLFU Y HQC •
Summary
DIFFERENCES ON MENTAL AND IVIOTOR DEVELOPMENT AND NUTRITION STATUS OF CHILDREN AGED 1 TO 3 YEARS IN HAI
DUONG PROVINCE, 2009
The purpose of the study was to examine the mental and motor development status and nutn- tion status based on the sex of children aged from 1 to 3 years old in rural commune and urban ward of Hai Duong province in 2009 A cross-sectional study was conducted on 492 couples of mother and child aged from 1 to 3 years old The results showed that the prevalence' of suspected mental retardation and delayed motor development were significantly higher in girls than boys Delay of Fine motor-Adaptive and Gross motor areas, and suspected retardation of personal and social development were more prevalent in the rural area in than m the urban area (p < 0 05) There was no significant difference between girls and boys m malnutrition status including underweight, stunting and wasting (p > 0 05)
Key words: Malnutrition, mental and motor development
ROI L O A N CHU'C NANG NHAN THl>C 6" NGU'O'I CAO TUOI
Le Van Tuan\ Le Dur: Hinh'
^Vu Cdng tde hpc smb. sinh vien. Bd Gido due va Dao tao, 'Benh vien Bach Mai Ngw&i cao tuoi thu&ng hay gpp mdt sd bieu hipn nhw giam chii y. kem tdp tmng. kho ghi nh&. hay quen.
vv ,, Day la hdu qua cua qua trmh lao hda nao Suy giam nhpn thirc vi tri nh& cd thi do nguyen nhan thoai hda, benh mpch mdu nao, bpnh npi khoa hope bpnh tam than Suy giam nhpn thdc nhp cd lien quan tdi nhom CO nguy co tien tnin sang sa sdt tri tup v&i nhiiu bpnh canh Idm sang khac nhau, dac bipt la b$nh Alzheimer Nhw vay. khi tham kham bpnh nhdn. cung v&i kiim tra lam sang todn dipn cdn phai tiin hanh cac trac nghipm thin kmh - tdm ly vd mpt sd xdt nghipm c$n lam sang cung nhw tham dd chuc nang quan trpng di giup cho chuin dodn lam sdng
Td khoa: ngudi cao tuoi; rdi loan chdc nang nhgn thdc; suy giam nh?n thdc nh?; sa sut tri tue
DAT V A N D E Id su gia tdng dang kd sd ngudi cao tudi Od
