HIEU QUA BO SUNG KEM VA SPRINKLES OA VI CHAT TREN BENH TIEU CHAY VA NHIEM K H U A N HO H A P O TRE SDD T H A P COI 6-36 THANG TUOI
Nguyen rhanh Ila, Nguyen Xuan Ninh*, Pham \'an Hoan*
Trudng dgi hgc Y te cdng cdng , Hd ngi
* Vien Dinh dudng quoc gia, Hd ngi
l O M T . \ I
Nghien ciiu thir nghiem cong dong co doi chirng va danh gia truoc sau da duoc trien khai tren 448 tre thip coi 6-36 thang thupc 6 xa ciia huyen Gia Binh tinh Bac Ninh, Muc tieu danh gia hieu qua ciia bo sung kem va spnnkles ddi vol tieu chay va viem duong ho hap, Phuong phap: Tre tham gia nghien cii'u duoc chia vao 3 nhom nhom chung gdm 146 tre (khong duoc can thiep), nhdm kem gom 141 tre du'oc bo sung 2 vien kem sulfat lOmg/tuan trong 25 tuin va nhdm spnnkles gdm 161 tre du'O'c bd sung 5 gdi spnnkles da vi chlt/tuan trong 25 tuin, Toan bo tre du'oc theo ddi benh tieu chay va viem duong hd hap trong thoi gian can thiep T0-T6, Kit qua: bd sung kem cd hieu qua tdt doi voi benh tieu chay va viem dud'ng hd hip. giam s i ngay mic benh trung binh, sd lln mic benh. ty le mic tieu chay >2 lan trong 6 thang Nhdm bd sung sprinkles cung cd hieu qua rd ret vd'i benh tieu chay (giam sd ngay mac benh va ty le mic benh tren 2 lan trong 6 thang) nhung chua thiy hieu qua rd rang doi vd'i benh hd hap
TIP khoa: SDD thip edi. bd sung kem, bo sung sprinkles da vi chat, tieu chay viem du'dng hd hap,
'I". DAT V.\N DK tu vong cua tre. 54%) tu vong cd lidn quan vdi SDD sd liin mac Irung binh/n;im ki 3,2, ty Ic lir xong lii 4.9 phan nghin 111.
Kem lii mdt x du td xi lugng dugc cluing minh lii cd x ai trd quan trong trong tiing truong X ii giam ty Ic miic benh. miic do miic benh lieu cha\ o tre em. I hdng ke nhung nghien cuu cluinsi tren the siidi thiix bd siiim kem kim uiam Sux dinh dudng thiip edi, thidu vi chiit dinh
dudng x'a benh nhiem trung. dac biet lii tieu chax d' tre em lii mdt trong nhung xiin dd cd y nghia sire khoe cdng ddng diing quan tiim d nhidu nude dang phiit tridii. 1 hiip edi iinh hudng ddn khoang
178 trieu Ire em dudi 5 tudi (khoang 43%). gdp phan xao nguxdn nhan giix ra 3.5 trieu lu xong
aire em, 35% giiiih niing benh tat aire em dudi -^'0-60% sd lan miic benh tieu chay. muc do 5 tudi vii 11% gi'mh niing benh tiit toiin cau.iieu "^^^i^ ^^^''^ '''?"'i cung giam cd y nghia. tiic dung chiiy tre em xiui la mdt trong nhiing nguyen nhiin ^^''^ '^o ^Ling kem liim giiim sd kin miic benji giix su\ dinh dudng x ii lu vong a tre cm. So tre ^''-''-i chax cdn keo did sau 2-3 thiing bd sung.
<5 tudi tu xong do tieu chiix bimg niim cd xu BcMi canh dd nhidu nliii khoa hoc d;i hudng ha thiip (tir 4.5 trieu (niim 1979) xtidnii cluing minh sir tuong tiic giiia cac x i cluil dinh 1.6 trieu (niim 2003). I heo thdng ke niim 2003 dudng. Nghidn cuu su dung hot giim nfmg cuaWHO. tidu chiix ddng gdp 15%) nguxen nhiin lugng xi chiit cua Cao ihi 1 hu Huong trdn 'liic gia: Nguxen fhanh llii
Dia chi: Irirdng DH Y td cdng cdng. 138 Giang Vd. I lii ndi Dien thoai: 0913.311.604
limail: nth I di hsph.cdu.vn
22 -j-ap chi Y hgc du phong. Tap XX. so 10 (118)
Ire 5-8 thiing t;ii luixcn Dong I Ix I hiii Ngigcn Vdi benh tieu chax |4|: udc tinh sir khac cho thax nhdm tre dugc bd sung bdt giau nang biet giiia 2 nhdm 0.35: SD 0.65: xdm 0.05.
lugng da x i chat cd ty le thap edi thap hon cd x P 0.1: n 73 ddi tirgng/nhdm
nghia thdng kd so vdi nhdm chung. dong thdi Vdi benh nhiem khuiin hd hiip|5|: uoc so ngiix tidu chax va nhiem khuan hd hap it linh su khde biet giii'a 2 nhdm 0.23. SD 0.55.
hon so vdi nhdm chimg |2|. Nghien cuu tren vdi « 0.05; P 0.1; n 121 ddi tirgng/nhdm.
tre dudi 1 tudi cua Nguxen Ouang frung tai Dir phdng 15% tre bo cudc trong thdi gian Que Vd. Biic Ninh cho thiiy bd sung kem liim t^an thiep. 140-150 trc/nhdm cim dirge chon.
ngiiy bj sdtdon lhuan|3|. 2.2. Chon mau: loiin bd sd Ire 6-36 thang cua 6 Xii cd didu kien kinh tc tuong ddng dugc khiim siing loc, ciin do. xiic djnh linh trimu dinh mam so lan xa so
0 Vict Nam. chuong trinh phdng chdng sux dinh dudng va phdng chdng benh tat d
tre em trong nhiing nam g^n day da dat dugc dudng theo phan loai cua Wl 10 2006. chgn ra nhiing ket qua dang kd trong vice giam t\ le nlning tre suy dinh dudng thd thiip coi (chidu mac vii tu vong. Tuy nhien it cd chuong trinh cao/tudi<-2SD). ciing cdc didu kien "khiic:
can thiep dua tren thue phiim nhrim danh giii "^'lo'ig ^j dj tat biim sinh. khdng miic ciic benh hieu qua bd sung kem hoac sprinkles da x i ch5t ^''P l''^'^' ^-''i'' "'"^ ^"^ ^^'^^ >' '''' ^^' "'^'^^^" ^'^'''^
ddi vdi benh tieu chax vii x iem dudng hd htip ^''' ^''" nghien cuu.
ircn ire thiip edi. Mgt nghien cuu thii nghiem ^.i. Phiin nhdm nghien cii'u: Liip danh siich can thiep cdng ddng trong 25 tuiin dii duoc thuc ^'^-^ ^^'^ ^''"'^ ^^'"'i- ^'^''P " ' ' ^'^"' '"^^ ("^"' ^'' '^' hien tai 6 xa thudc huvcn Gia Binh tinh Bac ' cum-clustcr), sau dd kip trinh cho miiy tinh Ninh, nhiim diinh giii hieu qua bd sung kem xii ^'^''' "'lom ngiiu nhidn (cluster ranckimix) ra 3 sprinkles da vi chiit ddn tinh trang dinh dudng.
thieu miui, thieu vitamin A vii thieu kem. tinh
^ , , I , .- I , - Nhom chii'n" (n=146): khdni! duoc iin traiui mac benh nhiem khuan CT tre. , " '
nhdm, cd tinh toiin si,r tuong ddng xd ciic chi sd nhiin triic, sinh hda vii Ida tudi:
Muc tieu:
Nghien cuu hieu qua cua vice bd sung kem vii sprinkles da vi chat ddi vdi benh tieu chay Vii viem dudng hd hiip d tre 6-36 thiing ludi bi suy dinh dudng thiip coi.
iCde ket qiiu ve nhdn true vii sinh hod (luge trinh hiiy trong mdt huo cdo khde)
hoiic bd sung loai chiit dinh dudng niio.
Nhom kem (n=141): Ddi lugng dugc udng 50 vidn kem diing glucoiuite (/n nguyen td
lOmg/vidn, FAZINCOL. Pharmedic Ltd.) udng trong vdng 6 thiing (25 tuiin), 2 vien/tuiin viio mgt ngiiy nhat dinh. Nhung lie niiy neu bj tieu chay SC dugc phiit them 28 x icn dting trong 14 ngiiy. 2 x'ien/ngiix (chi dimg 1 dgl 28 x idn).
11. P I l l l O N ( ; PlIAP NCFIIKN Cl'jU ^hom sprinkles (n =161): Ire dtigc su dung 125 gdi sprinlkcs. trong 25 tiuin. I gdi/
Nghidn cdu can thiep cdng ddng cd ddi ngiiy x 5 ngiiy/tui\n. Sau khi tlu'rc im cua tie da cluing, dtrgc tidn hiinh tren tre em tir 6-36 thiing dugc niiti chin, liiy ra biit x tra du iin 1 bua cho ludi. suy dinh dirdng the thiip edi. thudc 6 xii tre, lie 01 gdi sprinkle viio mdt gdc biit hoiic ca cua huyen Gia Binh- Biic Ninh biit. Iron ddu vii cho tre tin. (neu chi trdn xiui 1 2.1. Cfy nuiu: duoc tinh toiin biing phiin mem phan bill, thi cho tre iin phiin thirc iin dugc trdn SPSS, vdi mong mudn sir khiic biet vc so kin trudc de dam bao tre dugc iin het sprinkles), mi'ic benh nhiem khuiin giiia nhdm can thiep X a fhtinh phi\n trong moi gdi sprinkles nhdm chung Uong quii trinh can thiC:p. 120 mg bao gom 10 x ilaniin xii 7 khoimg chill
Lap chi Y hgc du phong. Lap XX, so 10(118) 23
(gdm Vit B1: 0.09mg; Vit A: 705,601U; Vit D3:
44.661U: Vh L: 8.16IU; axk Folic: 17,76mcg;
Niaxin: 2.04mg; Vh B12: 0,22mcg: Vit B2:
0.1 Img: Vit B6: 0.1 Img; Vit C: ll,23mg:
Dong: 0.08mg: iod: 0.09mg: siit: ll.38mg:
magic: 12.48mg; mangan: 0,15mg: sclcn:
7.20mcg; kem: 3.46ing) dugc bd sung huong vi cdm. thjt gii. mau sac va miii vj phii hgp (man hoac nggt). dc su dung, ddng gdi 3g x ii mdt hop chua 20 gdi.
2.4. Phan phoi siin pham va theo ddi can thiep:
Cdng tiic X idn (CIV) phiit thudc ddn ddi tugng can ihicp bimg thiing. frung binh mdi CIV phu tiiich 10 tre d cung thdn vdi minh.
I limg tuiin C f V ddn thtim hd gia dinh phiit vidn kem hoiic gdi sprinkles va hudng diin cha me tre su dung theo diing phac dd. theo ddi Xii ghi chep tinh hinh su dung vien kem hoac gdi sprinkles xiio sd ghi chep dugc thiet ke siin trong sudi ihivi gian can thiep.
2.5. Phu'img phiip vii cdng cu thu thap so lieu: : Cdng tiic X idn true tiep theo ddi bang hoi true tiep bd mc ddi tugng 2 ngay/1 kin nluing trieu chirng nlur sd lan dai lien, tinh chiit phiin.
ho sdt.... Xii ghi xiio phidu theo ddi benh tat.
Khi cd diiu hieu x iem hd hiip, tidu chiiy... biic sy truong tram x te khiim true tiep vii ghi chiin doim X iio phieu theo ddi. Nghien ciru vidn giiim Siit 1-2 ttiiin / kill, kiem tra vii .xi'ic djnh sd liin xii sd ngay mac benh nhiem khuan tren co' so' ghi chep cua C'fV X'a bac sy.
lie dugc coi ki tidu chiiy khi ngiix tre di
ngoiii phiin long hoiic cd nuiu x ii di 3 kin tm Icn trong 1 ngiiy. Cac bidu hien dd het irong hai ngax lien tuc thi dugc coi nlur chiim dirt mdt dgt tieu chax. lie dugc coi lii lieu chax keo did khi ciic diiu hieu cua benh keo diii tren 3 ngiix.
lie dugc coi ki vidm dudng hd hiip khi cd Ciic diiu hieu sau: so nuii. ho. sdt. khd tho...
Ciic bidu hien dd het trong hai ngiix lien tuc thi dugc coi nlur cluim dirt mdt dot x idm duivng hd hiip. lie dugc coi lii NK hd hiip keo i.\i\\ khi ciic diiu hieu cua benh keo dai tren 3 ngiix.
2.6. Xii' ly sd lieu: Chi nluing ddi tugng tham gia du trdn 8()"'o thdi gian can thiep. du sd lieu tnrd'c x'ii sau can thiep mdi dugc dtr;i viio pluiii tich diinh gia hieu qua. Sd lieu dugc nhiip biing phan mem cpidata. tinh triing dinh dudng tinh biing phan mem Anthro cua WHO 2006, sau dd dugc cluixdn vii phiin tich bang phiin mem SPSS 15.0. Ciic lest f- ghep cap, ANOVA, x' duoc su dung dc so simli.
2.7. Dao dii'c nghicMi ciru: Nghidn ciru dugc thuc hien theo dung hd str xet duyet cua Hdi ddng dao dire Vien Dinh Dudng. Nluing Ire miic cac dj tiit biim sinh. nhidm khiuin iiiing hoac thieu miui iiiing se khdng dua xiio can thiep X a gidi thieu ddn ccr sd y tc dicu trj. I re o' nhdm cluing ndu phiit hien bj lieu chay sc dugc tu viin sir dung ORS hgp ly va hudng diin den CO' SO' y tc khi ciin thiet. Khi ket tlitic nghien cuu. loan bd tre SDD thd edi o' nhdm cluing dugc Ciip 01 lidu kc'in.
24 Tap chi Y hgc du phong, 'Lap XX, so 10 (1 18)
i n . K K T Q l J A
3. 1. Thdng tin chung vc nhdm nghien ciru
Bang 1. Dac d i i m nhan trie va sinh hoa cua cac nhom tai thdi diem bat dau nghien c i i u
Cac chi so
Tu6i # (tliang) Can nang # (l<g) Chieu cao# (cm) Hb (g/l) # Re{\no\(pmol/l) #
Kem (gmol/t) # Hb<110g/L(%) Retlnol<0,7 pmol/L (%) Zn<10,7pmol/L(%)
Nhom chirng (n=134) 24.4 ±7,2
9,5±1,5 78,4 ± 5 , 5 118,35±13,72
0,99 +0,28 11,32 ±2,38
41,4 26,7 37,7
Nhom kem (n=140) 25,0±7,0
9 , 4 + i ,2 78,4 ±5,6 118,04 ±12,82
0,98 ±0,34 11,16 ±2,60
39,0 25,5 36,9
Nhom sprinkles (n=142) 245±7,3 9,4 ±1,2 78.5 ±5,7 118,12±14,5
1,01 ±0,25 11,08±1,84
40,4 28,0 44,7
P-
>0,05
>0,05
>0,05
>0,05
>0,05
>0,05
>0,05
>0,05 •
>0,05
//.• si) lieu hieu du.V LSD: * ,• .4Ni)l'.i test cho giii iri irung hinh. y; vdi ty le %
I dug cdng cd 41 6 tre duoc dua Xiio phiin huyet (p>0.05) khi b;il diiu nghien ciru. ly le tich tai khi ket thuc 6 ihimg can thiep (16) thieu mini o'ciic nhdm khoang 40%). ihieu \ ila- Bang I cho thiix khdng cd sir khiic biet gitia min A tu 25,5-28%) xii thieu kem Vin 35'/'i) deu 3 nhdm nghien ciru ve thiing tudi. cim niing. o'nuic niing vd y nghia sire khoe cdng ddng.
chieu cao Cling nlur ndng do 1 lb. retinol x ii kem 3.2. Hieu qua can thiep trcnbcnh tieu chay
Bang 2. So lan va so ngay mac benh tieu chay trung binh /tre trong thoi gian 6 thang
Nhom chii'ng Nhom kem Nhom sprinkles
(n=134) (n=140) (n=142) S6 ngay mlc/tre/6 thang 4,42±2,40 3,80±2,02* 3.43±2,10*
So lan m i c benh/6 thang 2,23±1,16 2,02±1,29 1,60±1,19
So lieu hieu ihi \ 'SD
*. p<<).05 vs. nhdm chiing. .lA'OLI lesi
'Lap chi Y hgc du phong. Tap XX, so 10 (118)
Bang 2 cho thiix sd kin xii so ngiix nuic sau do den nhom kC-in (3.80: 2.02) x ii cao iduit benh trung binh cua mdi tre thudc cac nhom o nhom chuim (4 42 :2 40)
nghien cuu trong ihdi gian 6 thiing: sd ngiix Sd lan nuic benh trung binh trong 6 ihiing miic benh lieu chax trung binh trong 6 thiing o cting cd xu hudng thiip hon a 2 nhdm can thiep 2 nhom can thiep lluip hon cd >' nghia (p<().05) x a cao hon a nhdm chuim, str khac bict chua co so X di nhdm cluing, trong dd. sd ngiix miic benh y nglua thdng ke x di p>0.()5.
o' nhdm sprinkles thiip nluil (3.43 12.10 ngiix).
Bang 3. Ty le mac benh tieu chay phan theo so lan mac trong 6 thang nghien cd'u
Nhom chirng Nhom kem Nhom sprinkles Khong b\ lan nao
1 lan bi tieu chay 2 lan bj tieu chay
> 2 lan bi tieu chay
Ty le tre bi tieu chay keo dai (>3 ngay/ dot)trong 6thang
71 (55,0) 21(16,3) 14(10,9) 23(17,8)
90(68,1) 20(15,1) 14(10,6) 10(7,6)'
84(62,2) 27(20,0) 13(9,6) 11(8,1)'
25(17,1) 15(10,6) 19(11,8)
So lieu trinh bax n("()) p<0.05 so xoi iihoni cluing
Bang 3 cho thiix. chua cd su khiic bict thdng ke (p<0.05) so xdi nhdm cluing (1 7.8%).
gitia 3 nhom nghien cuu xe tx le nhung tre 1\ le tre bj lieu chax keo did (tren 3 ngiix/dgt) khdng bj nuic benh tieu chax. bj niiic benh I cting cd xu hudng thap hon o nhom kem xii kin X ii 2 kill tning 6 lluing can thiep. Iiix nhien. sprinkles (kui lugt ki 10.6% x ii II .8%) so vdi l_x Ic ire bi lidu chiix > 2 kin o nhdm kem (7.6%) nhdm cluing (17.1%). tux nhien sir kluic biet Xii nhdm sprinkles (8.1%) thiip hon cd y nghia chua cd x nghia thoim kd.
26 Lap chi Y hgc du phong, 'Lap XX, sd 10(118)
•ra
•ra O) c
•o CO
5 4.5 -
4 - 3.5 - 3 2.5 2 - 1.5 -
1
- CTR Zn+ Sp+
1 2 3 4 5 6 Bieu do 1. So ngay mac benh tieu chay theo tirng thang
*.' /; • 0.05 so vdi nhdm chirng, ANOVA lest
Bieu dd I trinh biiy sd ngiix nuic benh lieu chax theo thiing cua 3 nhdm nghien cuu. Ket qua cho tha\' nhdm cluing cd xu hudng tiing sd ngax mac tieu chay tir thiing thir ba cua can lliicp (3.1 ngiix) X ii tiing tnr kd o' thimg tlui 6 (3.1 ngiix). frong khi dd. o' 2 nhdm kem x ii sprinkles sd ngiix hi benh giam _x nghia (p<0.05) o'thiing llui 5 & 6 so xdi nhdm chirng.
5.5. Hieu quii can thiep tren benh nhiem khuiin hd hiip
Bang 4. So lan va so ngay mac benh NK ho hap trung binh /tre/6 thang
Nhom chirng (n=134)
Nhom kem (n=140)
Nhom sprinkles (n=142)
Sd ngay mac/tre/6 thang 9,53±9,11 4,87±2,95**## 9,46±8,71
So lan mac benh/ 6 thang 325±3,00 1,87±1,25**## 3,10±2.92
**, p 0.001 vs. nhdm cluing. .INOVA lest liii p 0.001 vs. sprinkles. .INOV.l test
Ket qua bang 4 cho thiix. cd sir khiic bict xa nhdm sprinkles (9.53:9.11 xa 9.46:8." I rd ret (p<0.01 )xe sd ngiiy xii sd kin nuic nhiem ngiix). 1 uong ttr. sd kin nuic benh cting chiem khiiiin hd hiip a nhdm kem so x di 2 nhdm cdn un the o nhdm kem (1.87: j .25 kin 6 thang) x a kd. Sd ngiix nuic benh dulp nhiit o nhdm kem mac khoang 3 kuvd thang o nhom chung \a (4.8712.95 ngiix) xii cao hon o' nlumi chtnig sprinkles.
'Lap chi Y hgc du phong. fiip XX. sd 10(118)
n
Bang 5. Ty le mac benh NK ho h4p theo s6 \kn m i c trong 6 thang nghien cuu
Nhom chii'ng Khong bi lan nao
1 lan bj NK ho hap 2 lan bj NK ho hap
> 2 lan b| NK ho hap
Ty le % tre bi NK ho h i p keo dai (>3
ngay/dgt) trong 6 thang 65(44,5)
Nhom kem
46(32,6)'
Nhom sprinkles 54(41,5)
23(17,7) 18(13,8) 35(26,9)
74(56,1) 31(23,5) 13(9,8) 14(10,6)"'"'
56(41,5) 22(16,3) 23(17,0) 34(25,2) 65(40,4)
.Si) lic'ii trinh hiiv n/%1
'* : p-' 0,05: " p< 0.01 so vdi nhom chirng. /-test tilt : /;•' 0.1)1 so vdi nhdm chirng. /test
ve sd kin nuic benh. chua thiix cd sir kles. fx le tie bj NK hd hiip kdo did (>3 ngiix/
khiic biel gitia 3 nhdm ve ty Ic tre khdng bj dgt) cting thiip nhiit o nhdm kem (32.6%). sau nuic benh. bj nuic I kin vii 2 kin trong 6 thdng dd den nhdm sprinkles (40,4%) va cao nhiit d can thiep. I ux nhien. tx Ic tre bj miic benh tren nhdm chiing (44,5%)). Sir khiic bict cd y nghia 2 liin thiip nhiit xii cdx'nghia thdng kdpO.O I a thong ke o nhdm kem so vdi nhdm chung nhdm kem so xdi nhdm chirng va nhdm sprin- (p<0,05).
- - • • - C T R — • - -Zn+
-o
1 2 3 4 5 6 Bi§u d6 2. S6 ngay m i c benh NK ho h i p theo td'ng thang can thiep
*: p < 0,05 so vdi nhdm chimg. ANOVA test
28 'Lap chi Y hgc du phong. Tap XX, so 10(118)
Vc so ngax nuic benh NK hd hap theo nghidn cuu niix cting dugc dua xiio phim lich tung thang. o nhdm cluing, so ngax mk benh chung cung 20 nghien cuu khac tren the gidi dao ddng trong thdi iiian can thiep. tu> nhien. x ii ddu cho thax. nhiin djnh chung quan trgng la so ngax nuic benh a thiing diiu va cuoi can thiep bd sung kem kim giam cd x nghia ngux ca mac hiiu nhir khdng ddi (khoang 3,9 ngiix). Vdi benh tieu chay a tre cm. Chinh xi xiix L'Nl- nhdm kem. so ngax' inSc benh,trung binh cd Ci;F/WliO(2003) dii dua ra kluixen ciui nen xu hudng giam diin xii giam khoang 1.3 ngax dimg kem ket hgp xdi Oresol trong dieu trj lieu o ihiing thu 6 .so x di thiing tlui nhat. Cdn x di chax o tre cm. Nghien cuu bd sung sprinkles da nhdm sprinkles, sci ngiix mflc benh trung binh vi chiit trong thdi gian 2 thiing uen tre em 6-12 h^u nhu khdng thiix ddi tning 6 thang can thiep lli^'iiJi l^idi tai Pakistan cho tluix. tx Ic miic tieu (trong khoang 4 den 4.5 ngay). Sir khac bict chax ngudi- ngiix khi kdt thuc can thiep lii 15%
cd y nghia thdng kc vd sd ngay m^c benh giiia (^'^ ' 0%) "• nhdm sprinkles, trong khi o nhdm nhdm kem vii nhdm chimg o thang 3 xii thiing chimg lii 26% (SD 20%). sir khiic bict chua 6 (vdi p<0.05. ANOVA test). "'' > "S^'i'^ ^'"'""M. I<c | 7 | . I heo y viin. bd sung sprinkles da vi chiit khdng nhung cd tiic ddng IV. BAN LUAN ngay tire thi (tidu chax'. thieu miiu) nui cdn cd Kdt qua nghien cuu cua chung tdi cho tiic dung liiu diii (giam ttr x ting tre em x ii cd tac
di,mg den khi truong thiinh) 181.
thiix, hieu qua bd sung kem kha rd rana ddi " . , i ; • " - i - i . - i ' '^ , ^ Ve so ngax mac benh tieu chax trung xdi benh tieu chax xii viem dirdna hd hiip o'ire i - , ., ,, • " i - ,- • .i - • .i'^ j - ~ "
'^ , bmh theo thang. bieu do co the cho thax dien SDD thiip edi: sd imiiv nuic bdnh tninii binh. sd u~ u- i ,\ Ti • / • . - ,.• • i •
, ' '- •, • ^, bicn benh theo thang/mua tning nam (tu mua he liin miic benh, ty Ic miic tieu chay >2 lan tronu - j - ,i • ,i •- i , •- i i •
•' • •' - sansi mua dong. thu VI can thiep duoc tncn khai 6 thang va ty le miic lieu chay keo dai tren 3 ,.. ^j; .,^„ , ^ j . , ^ ^.^ .,^„ ^ ,. j,^ .,,• ^-^^ ^^^^^ ^., ngiix cung thiip hon so vdi nhdm chung. frong |^^ ^,„^„ ^^,^„ ,^^,^ j^^,^,^ ^j-^, ^,^,,^, ^-,^„ ^^^ ^^,^
khi do hieu qua bd sung sprinkles cung cho ket j ^ ^ ,^|^j^j j ^ j ^ ^,^1^, 1^^^.,^, ^^^ ^1^.^ ^-,^ l,-,, qua ttnrng ddi kha quan ddi xdi benh lieu chax cua bieu dd cung cho tluix hieu qua ciin thiep (sd ngay miic benh x ii tx' le miic benh tren 2 liin ^r^^ ,.5 ^,,^| 4 j|^y|^„ ^^,^ ^^i^p (^,, (i,.,,^^ (|,^,. 5 ^^
trong 6 thiing) tluip hon so vdi nhdm cluing. ,,,.-,_^ ^^^. h^.,,,^ ^. o ^^\,(,n^ ,|^,.^,,. .-an ihicp giam nliirng chua tluix hieu qua rd rang doi x di benh ,|^,\p |^o-,i y nghia so vdi nhom cluing.
"" ^''P- I ieti chay keo did thudng phdi hop x di Hieu qua eau thiep vdi henh tieu chay ^ux dinh dudng. Ket qua nghien cuu x e viin dc Ket qua nghien cuu cua chiing tdi khii n^y a Bangladesh. An do. Pakistan x ii Peru cho tuong ddng vdi Nghien cim cua Ngux'en Xuiin tluix t\ Ic mk tieu chiix miin linh o nluing tic Ninh vii CS da chi ra riing. bd sung kem kim ehroc bd sung kem giam khoang 16%. (dao ddng giam giin 60% sd lan nuic lidu chax xa x iem tir 21-26%). Ngudi la cho i-iiiig xai trd cua x ice dudng hd hiip o irc cm thiip coi. Mdt nghien bd sung kem trong dieu tri lieu chax nuiii linh cuu khiic Cling cua Ngux en Xuiin Ninh Xii cdng i-g hon trong tieu chax c;ip xi lieu ch;i_x nuiii sir dii bd sung kem cho 146 tre 4-36 thimg bj thudng ket hgp xdi sux dinh dudng |9|.
sux dinh dudng o' Vict Nam. ket qua cho tluix Hieu qua can thiep vdi henh NK hd hup lie a nhom can ihicp khdng nhirng cai ihien long hgp so lieu id 12 nghien cuu xdi xc can nang- chieu cao nui tx le nuic tieu chax igng so 12.144 tre lir 9 den -19 thang. so sanh Cling thap hon so xoi nhom chung |6|. Ket qua hieu qua cua bd sung da x 1 clult (co kC-m hoiic
Tap chi Y hgc du phong. 'Liip XX, so 10 (1 18) 29
khdng cd kem. x itamin A vdi Cik vi chiit khac tac dung liim giam v nuhia so ngax nuic bcnli nhu siit. axil folic, xitamin B2) vdi nhdm xii ly Ic nuic benh lieu chax tren 3 ngiix. tux chirng. Ken qua cho thiiy, bd sung da x i chiit nhidn chua thiix hieu qua rd ning ddi x oi benh giam tx Ic miic xidm d u d n g hd hiip dudi ciip hd hiip.
tinh nhieu hon tren nhiing tre bi thiip edi so
vdi nhdm chimg cd y nghia thdng kd (ndu '^^1 I^^KU T H A M K I I A O
chan doan viem dudng hd hSp dudi cap tinh , ,^^^^^^,.^ j.- j ^ . ^ , ^ , ^ ^^ ^, ^^^^^^^ Maiernal and boi nhan vien \' tc xii cd du ciic trieu chung ho. ^.j^-jj ^^^,j^,^. „,,„.,,^•,,„. „/„/,,,/ , , „ j ,v<,'/ri//<//
khd tho'. sdt. li bi) ( R R - 0,79, 9 5 % C\ 0.67- exposes and health eonseqiienees. fhe l.an- 0.94: p 0.013). fuy nhidn n^u chi chiin doan ^^^_ Maternal and Cdiild under nutrition.
viem dircmg hd hiip dudi ciip tinh (khdng do .januarx. 2008. paac 5 - 1 1 .
nhan vidn x te chiin doiin) vdi hai trieu chimg -,. Cao 1 hj I hu 1 luong (2004). Ddnh gid hieu tho nhanh hoac khd t h a thi khdng thiix cd sir ^^^^^, ^.^,^, /,^;, ,^,-„, ,,^-,,,„ /„.,^.„,, ,,^- ,,, ^.j^f, khiic bict X e tx Ic miic benh giiia nhdm benh vii ,^.^^,,^^^ ,,,^;^, ^,/,^-^,,, ^./,,-'„„ //„-^;,, ^/,„/, ^/,,.,^.„^, nhdm chimg (RR 0.99; 9 5 % Cl 0,91 1.08: ^^.-^^ i^.^, 3_,y ,/,^;„,, ,,,^j, //,„,;^, /„„.^;„ ,)^],^^
p- 0.78) | 8 | . Tuong lir nghidn cim cuaNguxdn //^, j,^-^j Xanyen- Luiin iin lien si Y hoc, Quang frung tren tre dudi 1 tudi tiii Qui Vd. y-^,^ VSD'f FW 2004
Bac Ninh cho ihAx bd sung kem kim giam sd . Nguyen Quang i r u n g (2003). Hien qua hd kin sot don thuiin x ii sd ngiiy bj sot dan tluuin ^,,,,,,^, ^, j ^ ^^,^„ /,.,^„,^, ^,/,-^^,^, ^./,,;,,^, //„^;,, ,„^;„
o tre. nlumg khdng liim giam sd kin. sd ngiix ,,^. ,/,,;^, ^/^-^. ,^-,,,, ,,.,,.^^.„_^, ,^.^, ^,,„ j , , , ; . , / „„;, X iem du'dng hd hiip | 3 | . ^,. g^^j ,-^3 y^^-;^. \-,-„/, , ^.y,, ,^,^' (j^,,^ ^y y |^^,^,_
Nhidu tiic gia cho riing so dl vice bd sung , ,.~,.^,^„ ^^.^•^ 1,^^^ Y I la Ndi.
kem hoiic da x i cluit cd clu'ra kem cd liic dung kim giam tx le nuic benh nhiem triing o tre cm ki do kem liim tiing kha luing mien djch cua co' the thdng qua cai lliicn ca mien djch trung gian
4. Bluitta / A . Black RI-. Ninh NX (2000).
Therupeiitie effects of orul zinc in uciite and persistent diurrhoea in children in devel- oping countries: pooled uiiulysis of ruiid- te biio vii mien djch djch thd. Shankar nhan thiix omizedeonirolled triuls. Am .1 (Tin Ntitr 72:
thieu kem cd anh huong xfui tdi sir phiil irien xii chirc luinti cua luiu het ciic te biio mien dich
1516-1522.
5. Kenneth 11. Bnixxn cl al (2007). Preventive (bao gdm le bao f. te bao B vi. dai thuc biio) ^,,,^, ,,,;,^,h'inentution among iiifunt.s. pres-
\9\. Prasad AS ciing nhan thiiy iinh hudng ciia choolers and older prepubertal children.
thieu kem ddi xdi quii trinh diip img midn dich ,:^,^^j ^,^j ,^^,^,,jj.^,,, j , ^ , , , ^ . ^ . , ^ ^ ^,^,1^,,^^^, ^_^_
trung gian te bao. fhieti kem lliudng phdi hgp xdi uiam chuc luiiui mien djch, nluit lii mien
number 4. December 2007, United Nation IJnixcrsitx press,
djch te biio I 10|. ^ ^.|^l^ ^ ^ _ ibisscn .IP. Collelle 1,(1996). /.iiie . / .^•'"•^ I II i ». siiiipleinentution increased growth uiuleireii- V. KK I LIJ.'V.N
luting Insulin-like Growth Laetor-I flGL-li Bd sung kem cd cho hieu qua rd riing /// I'ietnuinesegrowlh-returdedehildren. Nm ddi vdi benh lieu chax vii viem dudng hd hap: J Clin N u t r 6 3 : 514-519
giam sd ngiix miic benh trung binh va ty le miic 7. Sharicff W el al (2006). Lcoiunnic guin ol benh tren 3 ngiix. Bd sung sprinkles cting cd a home fortification progrum: cvuhuiiion 3 0 'Lap chi Y hoc d u phiing. '1 "iip X X . sd 1 0 ( 1 1 8 )
of -Sprinkles • from Ihe providers perspee- 9. Shankar All. Prasad AS (1998). Zinc und tive. Can .1 Public Health. 2006 .lan- Feb. immune function: the hiologieul husis oful-
9 7 ( 1 ) : 20-3. , . • . • . , r^r x
teredresistunce to infection. .Am .1 t Im Nutr 8. /inc Inxe.stigator's Collaborative group.
Bulla / A . Black RF;. Ninh NX cl al (1999). '9'^*^- ^8: 447S-63S
I hcrapeulic effects of oral /inc in acute and 1 O.Prasad AS et al (1993). Ilomeostusis of zinc persistent diarrehca in children index loping -^^ niurginal human zinc deficiency: role countries: Poollcd analxsis of randomized
controlled trials. Am J Clin Nutr 2000: 72:
1516-22.
of uhsoption und endogenous excretion ol zinc. .1 Lab Clin Med 1993: 122:549-561.
EFFECT OF ZINC AND SPRINKLES SUPPLEMENTATION ON DIARRHHOEA AND RESPIRATORY OF STUNTED CHIDREN AGED 6-36 MONTHS
Nguyen Thanh Ha, Nguyen Xuan Ninh*, Pham Van Hoan'^
Hanoi School of Public Health National Insthute of Nutrition, Ila.
A community controlled trial xxas im- plemented in 448 stunted children aged 6-36 months in Gia Binh district. Bac Ninh prox- ince. Objective: to evaluate the effectixe- ness of /inc and mtiiti micronutrient sprinkle suplcmentalion on diarrhhoca and respirator) diseases. Method: All selected children xxcre divided into 3 groups, namclx: control group of 146 children. Zinc group of 141 children xxho received 2 tablets of /inc gluconate (Zn lOmg/tablet) per xveek xvithin 25 xxceks and sprinkles group of 161 children xvho reccix ed 5 packs of multi-micronutrient xxithin 25 xxceks.
All sxmptoms of diarrhhoca and rcspiraloi'x di- Noi
seascs xxere monitored and recorded. Resiills:
the morbidity period (in dax s and time) iind the rate of children suffering from the diarrhhoca and respiratory diseases more than 2 times xx i- thin 6 months xxcre loxxcr compared to those in the control group. Miiiti micninutricnt sprinkle stiplcmentation also shoxxcd significant effect for diarrhhoca (the moibidilx period (in diixs) and the rate of children stiffening 2 limes x\ ith- in 6 months), but no signihcant effect obscrx cd for respiratory diseases.
Keywords: stimtcd children, /inc siip- plemctalion. sprinkles, diarrhhoca. icspiralorx
Tap chi Y hgc du phong. Tap XX, so 10 (118) 31