T C . D D & T P 9 ( 1 ) - 2 0 1 3
THirC TRANG KIEN THlTC, THlTC HANH VE DINIf D U Q N G ^ V A PHONG CHONG THIEU MAU THIEU SAT
CUA PHU N 0 CO THAI DAN TOC MTjClNG 6 HOA BINH
Huynh Nam Phuang', Trdn Thj Gidng Huffng^
Thieu mau thieu sat la van d6 si'rc khde cpng ddng con pho bien a Viet Nam, Ty I? m5c con cao d phy nQ co thai va can thi?p co hi?u qua la bo sung vien sat. Nghien cuu nh5m tim hieu kien thuc, thirc hanh dinh duong va phong chong thieu mau thieu sat ciia phy nu cd thai dan tpc Mudng va nhimg yeu to anh hudng den bd sung sat, lir do xay dung can lhi?p co hieu qua cho doi tugng nay. Thiet ke nghien ciru: dieu tra cat ngang mo ta vdi ca mau la 238 phu nu co thai 6 6 xa thupc linh Hoa Binh. Nghien cixu su dung bp cau hoi danh gia kien thiic-thirc hanh-dp bao phii (KPC) va kl thuat Thir nghiem cai thien thirc hanh (TIP) bang each phong vSn phu nil co thai sau khi uong thu vien sat 3 tuan. Ket qua cho thay: Phu nu' cd thai dan tgc Mudng a Hoa Binh co kien thuc tuong doi tot ve cdc dieu ki^n chSm sdc thai nhung thirc hanh khong day du. Hp co nhCrng hieu biel ca ban ve phdng chong thieu mau thieu sat {doi tirgng hay mac, trieu chung, anh hudng, each phdng chong). tac dung ciia vien sat nhung chi cd 62,2% doi tirgng uong vien sat va so uong hang ngay chi chiem 72,3%. Mgt so yeu td anh hudng den uong vien sat bo sung dung la nguon thuoc cd thudng xuyen (anh hudng den 97% doi tupng), thuoc de udng (40%), gia ca phiJ hgp (60%), anh hirdng tdt den siic khoe (47%) va it tac dung phu (24%). CSn xay dung cac hoat dgng truyen thdng vdi nhung thdng diep phu hpp vdi cac giai doan thay ddi hanh vi va dam bao cac yeu to cua chucmg trinh bd sung sat (nguon cung, lo^i thudc va gia ca phii hgp.)
TiJr khoa: ihieu mdu thieu sat, phu nCt cd that, kien thirc, thuc hdnh
d Viet Nam, trong nhiJng nam gan day thieu mau dinh duang cd xu hudng giam, nhung van d muc cao cd y nghia Slic khde cpng ddng (YNSKCD). Theo I - D A T VAN D E :
Trong cac van de dinh dudng d phu nft Ilia tudi sinh de dac biet la phu nQ cd thai, thidu mau thieu sal la van de sue khde phd bien. Tren the gidi da cd r i t n h i l u no luc trong hang thap ky qua dk tridn khai cac chuang trinh nham cai thien tinh trang nay. Tuy nhien so vdi cac chuang trinh phdng chdng thieu vi chdt dinh duorng khac (nhu Vilamin A va Idt) thi nhung cai thien trong ITnh vuc nay cdn chua nhieu. Mdt trong nhiJng nguyen nhan cua su han che la do thi6u su t r i l n khai cac can thiep cd hieu qua va hoat dpng truyen thdng cdn chua dap umg d u a c nhu cku thuc te.
ket qua cua hai cudc dieu tra d u a c thuc hien tren quy md loan qudc nam 1995 va 2000 [1], [2] ty le thieu mau ciia phu nil d n u a c ta van d miic vua va nang ve YNSKCD. Ty le thieu mau cua phu nii phd bien d cac viing mien Trung, Me kdng, Tay Nguyen, Nui phia Bac. Ddng bang sdng Hdng va vimg thanh phd cd ly le Ihieu mau thap hon cac viing khac, tuy nhien van d miic tren 20%.
Tai Hda Binh, dan ldc Mudng chiem ty le 6 3 % dan sd. Nhiing khd khan ve TS. Vien Dinh dudng
Email: [email protected] DT; 01228392273
^TS. Bp Y ti
Phan bien 1; PGS. TS. Nguyen Thj Lam - Vien Dinh dudng Phan bi?n 2: TS. Cao Thj Thu Huong -
Vien Dinh duang Ngay nhan bai: 24/12/2012 Ngay dang bai: 15/04/2013
T C . D D & T P 9 ( 1 ) - 2 0 1 3 dieu kien dia ly, kinh td xa hpi va cac yeu to
van hoa da anh huong den linh trang dinh duong cua ngudi Mudng ndi chung va ciia phu nu cd thai (PNCT), tre em dudi 5 Uidi ndi rieng. Vi vay, cac chuang hinh can thiep dinli dudng quoc gia can cd sy quan tam dSc biet den nhdm ddi lucmg nay.
Trong cac giai phap thuc iiien cho cac can thiep dinh dudng ndi chung va phdng chdng thieu mau ihieu sit ndi rieng, truyen thdng giao due dinh dudng duac coi la hoat dpng trpng tam va dam bao tinh ben vung ciia can tiiiep. Diem nhan manh la cdng tac nay can dupc thirc hien theo dSc thu ciia vimg dja ly, dan tpc va dua vao cac bang chumg hoac nghien cuu ve dinh duong va tap quan dinh duong ciia timg dja phuang va dan ldc. Do do, can tim hieu thuc trang ve kien thiic, thuc hanh dinh duong va phdng chdng thieu mau ciia nhung ddi tupng nay cijng nhu cac yeu td anh hudng den viec tuan thu phac dd dieu tri, dua tren so dd ly thuyet ve cac budc thay ddi hanh vi de tir do xay dimg dugc chuang trinh can thiep phdng chdng thieu mau cho phu nir cd thai dan tpc Mudng mot each phii hpp nhat.
Vi vay, nghien cim danh gia thuc trang nay dugc tien hanh nham muc tieu:
- 77m hieu kien thiic thicc hdnh ve dinh duang vd phong chong thieu mdu thieu sdt ciia phu nir co thai ddn tgc Mudng,
- Tim hieu cdc yiu to dnh hudng den thicc hdnh bo sung sdt cita phu nu co thai ddn tgc Mudng.
II- DOI TUONG VA PHU'CNG PHAP NGHIEN c t r u
2.1. Dia diem nghien cihi De tai dugc trien khai nghien cim tai 6 xa thudc Huyen Tan Lac - tinh Hda Binh.
2.2. Doi tuxmg nghien ciiu PNCT dan tpc Mudng dang sinh sdng tten dia ban cac xa thupc huyen Tan Lac - tinh Hda Binh.
2.3. Phuomg phap nghien cum
Thi^t ke nghien cihi: Nghien cihimd ta cat ngang
C& m^u va each chon m a u - Dilu tra Kien thiic - Thuc hanh - Do bao phu (KPC) cua phu nO- co thai (PNCT):
Cd mau didu tra dugc tinh theo cong thiic sau [3]:
n = z^(i-a/2).p(l-p)/e^
Trong dd:
z(i-a/'2) Id do tin cgy d nguong xdc sudl a = 5%(z=},96)
p Id ty le PNCT dang su dung vlin sdt (dira tren cdc nghien cthi tnrdc Id 44%[4J)
e Id sai so cho phep (chgn Id 10%) Tir do tinh dugc n=95, du phdng 5% bd cudc, nhan ddi ca mau, long sd can 200 PNCT
- Thir nghiem cai thien thuc hanh (TIP - Trials for Improved Practices) cua PNCT:
Chpn 30 PNCT nglu nhien tai 3 xa, mdi xa 10 ngudi, cho uong thir vien sat trong didi gian 4 tuan rdi tien hanh phdng van sau toan bp sd phu nu: da tham gia Ihu nghiem. Vien sat dugc cung cap mien phi vai Heu 1 vien/ngay trong 1 thang, dugc hudng dan udng va ngoai ra khdng cd can thiep gi khac.
Cac phuong phap va cong cu thu thap thdng tin
- Dieu tra KPC: sii dung bp cau hdi dugc xay dung dua tren bp kit KPC2000 [5] cd tham khao cac dieu tra KAP ve thieu mau thieu sat, cd bd sung them thanh Id dp bao phu (coverage) ciia can thiep phdng chdng thieu mau. Bp cau hdi dugc thir nghiem trudc khi lien hanh dieu tra chinh thiic.
- Thu nghiem cai Ihien thuc hanh (TIP):
Ky thuat TIP ket hgp each tidp can ve quang cao - thiel ke de thir nghiem cac khai niem va san pham de dieu chinh thuc hanh hay '"san phSm" cua tiep thi xa hpi trudc khi dua ra thi trudng, dua tren nhihig phan hdi ciia mdt nhdm nhd tir nguyen sir dung "san pham" do trong mpt thai gian nhat dinh trong cupc song hang ngay [6]. Trong nghien ciiu nay, phuong phap TIP dugc ap
T C . D D & T P 9 ( I ) - 2 0 1 3 dung n h a m tim hieu nhiing gi ma
PNCT trai qua khi sii dung vien s4l (ca diem tdt lan diem xau), xem hp cd tiep tuc udng vien sat trong mdt thai gian dai hon (sudt ca thai ky) hay khdng, va hp cd gidi thieu/khuyen nhirng ngudi khac ciing udng hay k h d n g . . . Phuong phap nay giup tim hieu nhiing can trd Cling nhu cac yeu to tao dieu kien cho viec bd sung sat trong mpt thdi gian keo dai. Ky thuat sir dung chinh la phdng van sau ddi t u g n g sau Ihir nghiem [7], [8]. Vien sat d u g c cung cap mien phi va gidng nhau giua cac ddi tugng de khdng che yeu td ngudn cung (la mdt trong cac yeu td gay can trd den thuc hanh cua ddi lugng theo cac nghien ciiu/can thiep trudc day [9]). Thir nghiem nay ciing nham muc dich iham dd viec sii dung mpt loai vien sat du kien se dua vao chuong trinh can thiep sau nghien ciiu nay.
2.4. X u Iy va p h a n tich so lieu Sd lieu cua bp cau hdi KPC d u g c nhap bang phan m e m SPSS 15.0. Sir
dung cac phep linh gia trj Irung binh, ly le %, cac lest thdng ke iing dung trong nghien ciiu y sinh hpc de phan tich kel qua. Cac ket qua lir Thir nghiem cai thien ihuc hanh TIP dugc tinh toan theo ly le % va dugc ddi chieu, md rdng va minh hpa tir tra ldi cac cau hdi md dinh tinh.
III. K E T Q U A
1. Kien thirc va thirc hanh ve dinh d u d n g va p h d n g c h o n g thieu m a u thieu sat
Da sd PNCT cd trinh dp lieu hpc va trung hgc c a sd, ty le khdng di hpc rat thap (1,3%), chii yeu lam ndng nghiep tai dia p h u a n g (88,7%), ly le cd thai lan 1 va tir 2 lan trd len tuong ddi bang nhau. Chia theo 3 thai ky Ihi chiem sd ddng van la qui 2, sau dd la qui 3 va qui 1 phan anh dung thuc trang ve phan bo tudi thai d nhirng phu nil thudng den tram y te (do hp thudng den dang ki thai mudn va phu nii gan sinh khdng mudn di lai nhieu).
Bdng 1: Kien thirc cua phu niicd thai ve chdm sdc thai
Kien thirc dung So lu-omg (n=238)
Can di kham thai
Can an them khi cd thai
c i n lao dpng nghi ngai hpp ly
Theo bang 1. nhin chung, PNCT tai dia ban nghien ciiu cd kien thiic ve cac dieu kien cham sdc Ihai d miic tdt: cd ddn 89%) cho la c^n di kham thai, 93,7%o cho la cSn an them va 9 1 % cho
la can dugc nghi ngoi hop ly.
Tuy nhien, khi hdi ve thuc hanh nhiing hanh vi nay thi thay rd la hp cd thuc hanh nhung khdng day dii.
T C . D D & T P 9 ( 1 ) - 2 0 1 3 Bdng 2: Thuc hdnh cua phu nii- co thai vi chdm sdc thai
Thirc hanh diing So \vttfng (n=238) Ty ie %
Co di kham thai 219 92,0
Di kham thai it nhat 3 lan 100
Cd an them trong 3 th^ng dau Cd an them trong 3 thang giQ-a Lao dgng nghi ngai hgp li trong 3 thang dau Lao dgng nglii ngai hpp li trong 3 thang giua
Kin qua bang 2 cho thay cd 92%» da di kham thai nhung chi cd 4 2 % kham dil 3 lan khi da d 3 thang cudi. Trong sd PNCT 3 thang giii'a va cudi chi cd 2 9 , 8 % an them vao 3 thang dau
110 177
120 50,4
46,2%i an them vao 3 thang giiia. Trong so PNCT 3 thang giu:a va cudi chi co 74,4%. d u g c lao ddng nghi ngoi hgp ly trong 3 thang dau va 50,4% trong 3 thang giu:a.
Bdng 3: Kiin thdc cua phu nd' cd thai ve thieu mdu
So lirgmg (n=238) Ty le % Ddi tugng hay
mac thieu mau Bieu hien ciia thieu mau
Phu nii lira tuoi sinh de Tre em dudi 5 tudi
20,2
PNCT va cho con bii Khdng biet
Biet 1 trieu chiing diing 83,6
Hoa mat chong mat 87,0
Khong biet Anh hirong cua Biet mpt anh hirong thieu mau Anh hucmg d6n phat Irien thai
Anh huong nang suat lao dpng Khong biet
Biet mpt bien phap
Tat ca phu nir LTSD phai uong vien sat
„ , i .,.: , Tat ca PNCT phai uong vien sat An thirc an giau sat
31 207 184 170 20 218 129 190 154
13,0 87,0 77,3 71,4 8,4 91,6 54,2 79.8 64,7 An du 4 nhom thirc a
Kiem tra siic khoe thuong xuyen 64,7
Kiit qua bang 3 cho tha> hi^u bi6t v6 TMTS cua PNCT dan tpc Mucmg 6 muc kha. Phin lan (61,8%) cho ring chi co PNCT va cho con bii la hay mSc benh thiju mau con nhung d6i tupng khac it mac hon. Trieu chiing thiju mau dugc 87% doi lucmg nhan biet do la hoa m i t
chong mat; co 77,3% biet thieu mau co anh hucmg iin thai va 71,4% bift thieu mau anh hucmg den nang suat lao dpng ciia ba me. Co dSn 91,6%i s6 ba me biet duac it nhat mpt bien phap phong chong thiau mau, trong do 79,8% biet dSn viec - can bo sung sat cho PNCT.
TC.DD&TP9(1)-2013 Bdng 4; Kien thirc cua phif «/?• cd thai ve vien sdt
Kien thiic Phan loai D < . - •- I B i j t
Khdng biet Ti.;^: .^-^ - - Khong biet ,^, Ngay khl biet CO thai
Sau 3 thang dau Khong biet
Tac dung cua vien sat Phong ch6ng thi6u man cho m?
Phong chong thieu man cho con IChong biel
Bien phap tang cuong An them rau qua hap thu sat An them dam dpng vat
Sai (an them dau mo, uong tra ca phe)
So luong (n=238) 214
2^""
42 Hi 42 50 160 IOO 41 180 133 102
Ty le % 89,9 10,1 17,6 61,3 17,6 21,0 67,2 42,4 17,2 75,6 55,9 42,9 Ket qua d Bang 4 md ta nhirng kien lir trudc khi cd thai va cd tdi 17,6% ddi thiic cua PNCT ve vien sat, cd den 89,9% tugng cdn cho rang sau 3 thang mdi cSn ddi tugng biet ve vien sat nhung ch! cd udng vien sat. Hieu biet cua hp ve lac 61,3%. eho rang nen udng sau khi phat dung ciia vien sat va bien phap de tang hien cd thai, khdng ai cho rang nen udng cudng hap thu sat d mirc trung binh.
Bdng 5: Thuv hdnh bo sung vien sdt cua phu nu cd thai Thuc hanh
Da timg uong vien sat
Then gian/ thai di uong vien sat
Loai vien sat
Nguon vien sat
Tac dung phu khi 8m
uong Phan ioai Co Kliong Hien tai dang uong Khi CO thai lan nay Uong hang ngay Uong tir 1-3 thang Vien nen Vien nang mem Cap phat Mua tai CO so y te Mua hieu thuoc Khong CO
; Buon non Tao bon
So luong (n=238) 200
38 149 180 172 90 156 44 27 74 108 115 56 43
Ty le % 84,0 16,0 62,6 75,6 72,3 37,8 65,5 18,5 11,3 31,1 45,3 48.3 23,5 18,1 Ve thuc hanh phdng chdng thieu mau timg udng vien sat nhung hien tai thi chi thieu sat, kel qua Bang 5 cho lhay mac dii cd 62,6% dang udng va trong sd do chi cd I cd den 84% phu nii dugc phdng van da 72,3% la udng hang ngay. Hp chu yeu sir
TC.DD&TP 9(1)-2013 dung vien nen (65,5%). Vien s5t dugc mua
nhidu tir hieu tliuoc (45,3%) rdi mdi den co sdy l§ (31,1%), chi cd 11,3%) la dugc cap phal. Yd lac dung phu klii udng vien sat, cd d^n 23.5% sd phu nir dugc hdi bj budn ndn va 18,1% bi tao bdn.
Dd tim hi^u ky han vc hanh vi phong chdng ihieu mau hay cy the hon la viec mua va sir dung vicn sat, chung tdi tien hanh nghien ciru cac yeu td anh hudng den dp bao phii va luan thu phac dd bd sung sat tiep sau dieu Ira ban dau.
2. Cac yeu to anh hud'ng den dp bao phli \a tuan thii phac do bo sung sat
Bang phuong phap TIP, nghien ciiu da lidn hanh thir nghiem cai thien thuc hanh bang each hudng dan cho 34 PNCT sir dung vien sat du dinh diing cho can thiep trong vdng 4 tuan. Vien sat dugc phal mien phi cho ddi tugng. Ket thiic thir nghiem, dua vao ket qua phdng van, chung tdi thu dugc nhirng ket qua rat dang khich le.
Cd den 97% sd phu nti: nay trong thdi gian 4 tuan da dimg vien sat lien tuc hang ngay va mong muon se dugc tiep tuc sii dung cho tdi liic sinh con. Chi cd 1 ddi tugng bd khdng sir dung do thay dau bung va ban than da sir dung tren 6 thang nen cho rang the la du. Tat ca (100%) ddi tugng udng vien sat ciing nudc lpc. 70%) thudng udng trudc khi di ngii, 30% cdn lai thudng udng trudc khi an cam tdi. Cd ldi 94% cho rang sau khi udng vien sal thay khde len, an nhieu hon, bdt hoa mat chdng mat. tang can va thai cua manh hon. Van cd mpt s6 it ddi tugng cam thay buon ndn, tao bdn (9%),_vi thudc tanh (6%), dau dhu (6%).
Co den 20% keu dau bung nhung khdng chac chan la do udng vien s4t hay li do khac (mdt so cd tien sii viem dai trang, dpa say thai...). Cd den 62% ndi r4ng viec udng thuoc hang ngay khdng khd khan gi, udng deu thi se quen dan, tuy nhien van cd 23%o
ndi rang hay quen (nen phai udng bii them ngay hom sau), vien thuoc to khd udng va lac dung phu ciia thudc.
Vai nhihig ngudi da limg udng vien sil, hp so sanh l4n uong nay vdi nhimg l^n trudc thi Ihdy vi?c cung cap vien sat dku dan va de tiep can han (97%), vien sSt lan nay cd hi?u qua hon (cd anh hudng tot din Slic khde - 47%)), de udng han (40%), gia ca phil hgp hon (60%)), it lac dung phu hon (24%). Chi CO mpt sd it cho la tanh hon (5%) va dat hon (3%.).
Ve gia ca thi cd 65% cho la gia lO.OOOd/30 vien/thang la phu hgp, cd lh£
dat hon so vdi vien sat dang nen ddng ig cu nhung chat lugng lot hon Ihi van cii mua dugc, va "lien nao ciia nay", "quan trpng la chat lugng tdt'". Chi cd mdt ddi tugng (3%) mong mudn dugc phal mien phi va 4 doi tugng (12%) mong muon dugc trg gia mdt phan. Ve kenh phan phdi: cd gan 60% ndi rang cd the lu den tram y te mua dugc, neu tram het thuoc thi se ra hieu thude mua, cdn khoang gan 40% do nha xa tram hon thi mong mudn cd ngudi mang thudc den tan nha. Hg mong muon dugc tram y te hd trg, tu van cho hp ve each sii dung thudc va khac phue nhihig tac dung phu ciia thudc.
Trong thdi gian thu nghiem, cd den 82%) phu nir ndi rang chdng la ngudi co anh hudng nhieu nhat den viec uong thudc ciia hp thdng qua viec nhac nhd hp udng thudc hang ngay, cho lien hp mua thudc va tham chi di mua giiip cho hp. Co 74%i ddi tugng dugc bo me chdng hoac me de dpng vien nhac nhd udng thudc, va 15% cho rSng hp chiu anh hudng ciia can bd y le luyen truyen. Chi cd mol phu nft ndi rang chdng keu "Udng gi ma uong nhieu thi, udng lam Ihudc khdng tot dau"
va mpt phu nir ndi rang hang xdm nghi ngd thudc loai nay khdng tdt bang Ioai trudc day hp da dung. Tuy nhien ca hai
TC.DD&TP 9(1)-2013 doi tugng nay deu ndi la hp da dugc ean
bp y te tu vin nen da giai thich vdi nhtmg ngudi phan ddi de biet duge lgi ich ciia vien sit.
Tat ca cac ddi tugng dSu mong mudn dugc du cac ldp hpc "Lam me" do tram y te td chirc vi hp r4l thieu kiin thiic. Hp mudn dugc du 1-2 Mn/thang. to chirc tai tram y te hoac nha van hda thdn trong thai gian thuan tien.
IV. BAN LUAN
Mong mudn ciia mdt ba me Mudng khi mang thai la sinh dugc diia tre khoe manh va hp mudn danh nhihig gi tdt nhat cho tre. Dieu nay thi hau nhu dan tpc nao ciing vay. Hp deu nhan thiic dirge tam quan trpng cua viec an udng day du va nghi ngoi hgp ly ciing nhu san sang thuc hien nhiing hanh vi siie khoe nham mang lai lgi ich cho diia tre trong bung. Nhan thirc nay la mdt khdi dau tdt cho ean thiep truyen thdng lhay ddi hanh vi.
Mac dil hp cd kien thiic tuong ddi tdt ve cac dieu kien cham sdc thai (can kham thai, can an them va lao ddng nghi ngoi hgp ly), tuy nhien cd mpt khoang each nhdt dinh giua kien thiic va thuc hanh ve cham sdc dinh dudng khi mang thai, cu thd la khi chuydn sang thuc hanh thi hp chi cd thd dam bao cd th\rc hanh nhung khdng dam bao thuc hanh day dii. Van cdn nhirng rao ean khien chi cd 42%
PNCT di kham thai 3 ihn, 29,8% cd an them trong 3 thang dau, 46,2%o an them 3 thang giiia, 50,4%) dugc lao ddng nghi ngoi hgp ly trong 3 thang giiia.
Ddi vdi phdng chdng thieu mau dinh duang, kien thiic ve phdng chdng thieu mau d PNCT dan tdc Mudng nghien cim d mirc kha, vdi da sd bidt den benh thieu mau, kd dugc it nhat mdt bieu hien cua thiiu mau, biit dugc it nhat mpt bien phap phdng thiiu mau cung nhu biit
dugc lac dung cua vien s5l. Mirc dp kien thirc ve phdng chdng thieu mau nhu vay cd cao hon so vdi mot sd nghien ciiu trudc day nhu nghien ciiu ciia Nguyen Van Hoa tren phu nil liia tudi sinh de tai Hue [10], hay nghien ciru cua Ta Qudc Ban tren PNCT tai Thai Nguyen [11].
Nhu vay, edng tac truyen thdng ve phdng chdng thieu mau cho PNCT tren dja ban dugc thuc hien bdi tram y te va y te thdn ban/cdng tac vien dinh dudng ve co ban tuong ddi tdt, da giiip cac ddi tugng dat dugc nhiing hieu biet nhat dinh trong cac budc lien tdi thay ddi hanh vi. Mac dii nhu vay, khi chuyen sang thuc hanh thi chi cd mpt sd nhat dinh da timg udng sal (84%), dang udng (62,6%) va udng deu dan hang ngay (45%)).
Yeu td tao dieu kien eho viec udng vien sat la thay tac dung tren sire khoe ciia me va con, va ngudn cung cap vien sat cd deu dan, thudng xuyen, tuong tu nhu ket qua nghien ciiu trudc day cua Aikawa tai Nghe An [9], hay cua Dang Oanh tai Tay Nguyen [4].
Yeu td can trd chinh dan den viec tuan thli dieu tri kem trong trudng hgp mua va sir dung vien sat cd the lhay d day bao gdm:
- Nhan thiic cua ddi tugng chua day dil. Day la diem quan trpng nhat vi neu dugc truyen thdng va tu van tdt thi doi tugng se cd dii kha nang de vugt qua dugc nhiing rao can khac de tuan thu dieu tri. Nghien ciiu d cac nudc khac ciing nhan thay tam quan trpng ciia yeu td nay [12].
- Tac dung phu: tuy thudc vao each liep can ddi tirgng ma la cd nhihig con sd khac nhau ve anh hudng cua tac dung phu, tir 20 den ban 40%. Tac dung phu thudng cd bieu hien khdng dac thii va de nham vdi dau hieu ciia nghen. Tac dung phu gan lien vdi lo^i thudc sii dung ciing nhu lieu dung thudc. Vien nang mem it tac dung phu han, diing each tuan it tac
T C . D D & T P 9 ( 1 ) - 2 0 1 3 dung phu han dimg hang ngay, dieu nay
ciing dugc khang dinh ttong cac nghien ciiu so sanh hai phac do nay cho PNCT [13].
Tac dung phy cung giam di neu ddi tugng dugc tu van va hudng dan cdch sir dung thudc diing each (thdi diem udng thudc, bd sung them rau va Vitamin C). Trong nghien Cliu cua Aikawa d Nghe An ciing cho thay d nhiing ddi tugng bd sung sSt thai gian ngin thudng gap nhieu tac dung phu hon d nhung ngudi da dimg thdi gian dai [14].
Dieu dd chimg td vi$c tu van ban dau rat quan trpng, can theo ddi tdt trong il nhat thang dku tien khi udng vien sat de hd trg doi tugng vugt dugc qua nhimg khd chiu ciia tac dung phu neu cd.
- Cae hoat ddng xiic lien hay dich vu kem theo la rat can thiet de duy tri hanh vi ciia doi tugng. Bdi hoat dpng tuyen Iruyen bd sung sat phdng chdng thieu mau da nam trong chuong trinh cham sdc siic khoe sinh san va dinh duong ciia nganh y te cung nhu duge de cap den trong chuong trinh hanh dpng ciia hdi phu nir va chinh quyen cac cap. Vien sat ciing san cd tren thi trudng.
Tuy nhien tren thuc te, dp bao phii va quan trpng hon ca la su tuan thii phac dd dieu tri chua cao. Dd la thieu su xuc tac ciia cac yeu td ben ngoai nham tang cudng sd ngudi
"hanh ddng" - tiic la thir hanh vi mdi (d giai doan thli 3 ciia 5 giai doan thay ddi hanh vi [15]) va sd ngudi da thir, chap nhan va duy tri hanh vi mdi (d giai doan 5 ciia 5 giai doan thay ddi hanh vi).
V. KET LUAN - KHUYEN NGHI Phu nir cd thai dan tdc Mudng d Hoa Binh cd kien thirc Orong ddi tdt ve cac dieu kien cham sdc thai nhung thuc hanh khdng day du. Hp cd nhiing hieu biet co ban ve phdng chdng thieu mau thiiu sit (61,8%
biet phu nii cd thai va cho con bii la ddi tugng hay mic thiiu mau, 83,6%) biit mot hieu chiing dung cua thiiu mau, 87,0%) biit
it nhit mpt anh hudng ciia thieu mau, 91,6%) biit it nhdt mpt bi?n phap phdng chdng thiiu mau), lac dyng ciia vien sit (cd 89,9%o biit v i vien sit va 79,8%) biet tit ca phu nit cd thai nen udng vien sat) nhung chi cd 62,2%) udng vien sit va so udng hang ngay chi chiem 72,3%.
Mpt sd yiu td anh huong den udng vien sit bd sung dung la ngudn thuoc cd thudng xuyen (dnh hudng den 97% ddi tugng), thudc de udng (40%)), gia ca phii hgp (60%)), anh hudng tdt den sue khde (47%) va it tac dung phu (24%).
Khuyen nghi
Cac chucmg trinh dinh dudng va cham sdc sire khoe sinh san qudc gia can tiep tuc cd nhihig can thiep de cai thien tmh Irai^
dinh dudng cho phu nii trudc khi mang diai, va khi cd thai. Can chii trpng truyen thdng giao due de tang cudng che dp an cho phu nil, bd sung cac vi chat dinh dudng, dac biel la sat de cd du trir sat tdl cho me va con.
Can thiep bd sung sat cho phu nir cd thai nen tiep tuc duy tri va de dam bao cd hieu qua thi can chii trpng den van de ngudn cung cap thudc, chpn loai thudc it tac dung phu va cd gia ca phii hgp.
TAI LIEU THAM KHAO 1. Nguyen Chi Tam, Nguyin Cdng Khan,
Nguyin Xuan Ninh (2007). Tmh hinh thieu mdu dinh dirdng d Viet Nam qua dieu tra dgi di^n cho cdc vimg sinh thdi trong toan qudc nam 2000. Y hpc tiiyc hanh, 2002.7.
2. NIN/UNICEF/ CDC/PAMM (1995). Re- port of the national anemia and nutrition.
Risk factor survey. 1995: Vietnam.
3. Trudng Dai hpc Y te cdng cpng (2005), Tinh ca mdu, trong Gido trinh Thong keyte cong cp«g.Nha.\u5t ban Yhpc, 2005. p. 164-165.
4 Dang Oanh va cpng su (2009). Tinh trgng thieu mdu dinh dmmg ciia phu nie co thai ngirai ddn tgc thieu so tgi tinh Dak Ldk nam 2008. Dinh dudng va Thuc phSm, 2009.
5(2).
T C . D D & T P 9 ( 1 ) - 2 0 1 3 5. Child Survival Technical Support,
KPC2000+ Qiiestionaire and rapid Catch 2004 Documents. 2004, http://www.chi Id- survival.coin/kpc2000/kpc2000.cfm.
6. The ManofF Group (2011) Trials of Im- proved Practices (TlPs): Giving Partici- pants a Voice in Program Design.
http://www.manoffgroup.com/resources/su mmarytips.pdf.
7. Stone L and Campbell JG (1984). The use and misuse of surveys in intemational de- velopment: an experiment from Nepal. J Hum Organ, 1984. 43(1): p. 27-37.
8. Jones S, Depth interview, in Applied Qual- itative Research, Walker R, Editor. 1985, Ashgate: Dartmouth.
9. Aikawa R, et al. (2006). Why do aduh women in Viemam take iron tablets? BMC Public Health, VoI6: p. 144.
lO.Nguyen Van Hoa (2007). Kiin thirc va cdch phong chong ve thiiu mdu a phu nCr lira luoi sinh de 15-49 tgi xa Thuy Bang, huyen Hirang Thuy, tinh Thira Thien - Hue.
Y hpc thuc hanh, 2007. Vol4(569+570): p.
58-60.
U.Ta Qudc Ban va Le Minh Chinh (2010).
Ddnh gid thuc trgng vd hi^u qud can thl^p bdng Iruyen thong vd uong vien .•idl cho phu nir CO thai thiiu mdu ngirdi ddn tgc Sdn Diu lgi huyC'n Dong Hy - Thdi Nguyen. Tap chl NghiencimYhpc, 2010.68(3): p. 113-117.
12. Earl R and Wateki CE (1993). Iron deficient anemia, recommendation guidelines for the prevention, detection and management among U.S. children cmd women of child- bearing age. 1993, Washington DC Na- tional Academy Press.
n.Tommaso CS, et al. (2005). Weekly Iron- Folic Acid Supplementation of Women of Reproductive Age: Impact Oven'iew. Les- sons Learned. Expansion Plans, and Con- tributions Toward Achievement of the Millennium Development Goals. Nutr Rev, 2005.63(l2Pt2):p.S52-l58.
14 Aikawa R, et ai. (2006). Risk factors for iron-deficiency anaemia among pregnatU women living in rural Vietnam. Public Health Nutr, 2006.9(4): p. 443-8.
l5.Prochaska JO and Velicer WF (1997). The transtheoretical model of health behavior change. Am J Health Promot 1997. 12(1):
p. 38-48.
Summary
CURRENT KNOWLEDGE AND PRACTICES ON NUTRITION AND ANEMIA PRE- VENTION OF PREGNANT WOMEN FROM MUONG MINORITV GROUP IN HOA BINH
Iron deficiency anemia is still a common public health concern in several regions of Vietnam.
The prevalence is high in pregnant women and one of effective interventions is iron supplemen- tation This study aims to investigate knowledge and practices on nutrition and anemia prevention of pregnant women from Muong minority group, as well as relevant factors affecting iron supple- mentation scheme, from which to develop an effective intervention program for this target group.
It was a cross-sectional survey done in 238 pregnant women in 6 communes of Hoa Binh. Methods:
questionnaires to assess knowledge-practice-coverage (KPC) and Trial for Improved Practice (TIP) (interviewing pregnant women after they were supplemented with iron tables for 3 weeks). The results showed that: pregnant women in Hoa Binh had relatively good knowledge on good condi- tions for good pregnancy outcomes but they did not practice optimally. They had basic knowledge on anemia control (at-risk groups, signs, affects, how to prevent), on the benefits of iron supple- mentation but only 62.2% took iron and 72.3% ofthem took it daily. Factors influencing the com- pliance to iron supplementation scheme include un-intemipted supply (97%), easy-to-take tablets (40%), affordable price (60%), perceived benefits (47%), and less side effects (24%). The inter- vention program should include communication activities with nutrition messages appropriate to specific stages of behavior change and address all factors influencing iron supplementation, such as supply, type of supplements and price.
Keywords: iron deficiency anemia, pregnant women, knowledge, practices.
