Y HQC VigT NAM T H A N G 9 • s 6 B A C BlgT/2012
TY L i MAC VA M O T SO Y I U TO NGUY COT SUY DINH OU0NG ( T T R E E M D A N T O C T H A I
T6M TAT:
Ty 1$ suy dinh du-Cng 6tr6 em 3& giSm nhi^u trong nhOng ndm qua nhu'ng khOng d i n g Shu giC^ cdc vCing mi4n vd giOa cdc tOc ngu-d't.
Nghifin ci>u du-vc ti4n hdnh nhSm mgc dich xdc flnh ty 1$ suy dinh dir&ng ci3a tr6 em ddn tOc ThSi difdi 5 tufii t^i Ngh$ An. o 6 i tu-g-ng p h y a n g phdp: 421 cap bd me vd tr6 du'Q'c li/a chQn khdm vd hii. K4t qua: T J 1$ suy dinh du'&ng(cdn n^ng, chilu cao, cdn n^ng / chi^u cao) trS em ddn tOc Thdi t^i Ngh$ an Id f39.8%, 48,6%, 8,8%). TJ 1$
thu nh$p tnjng binh thAp tdm tdngnguy c c suy dinh d u * n g cua trS ISn 2 llin(OR= 1,3), trinh dO van h6a cua bd m^ du^t^i cSp 2 tdng nguy c(y suy dinh dif&ng cOa tr§ Ifin 2 \kn {OR~).Kk lu$n:T9 1$ suy dinh dirOng tre em ddn t^c Thdi t^i Qu) H^p chi6m tJ t$ cao 6- tre e m . Nh6m tu6i mSc suy dinh du'dng cao Id 1-3 tufii, trinh d$ vdn h6a cjja bd m$, m^c thu nhdp trung binh cua gia dtnh Id nguy ca c£ia suy dinh du'dng.
ABSTRACT:
RATiS AND RISK FACTORS OF MALNUTRITION IN CHILDREN OF THA) MINORITT Objectives: This study was conducted to assess the nutritional status and characteristics related to malnutrition in minority Thdi's children under five years in Nghe A n province. Vietnam.
Study Method: A cross-sectional study was conducted among foummother-child pairs in Qui Hp'p Nghe An Vietnam. Weight and height of the children were measured and referred to data J from the WHO/CDC/NCHS. Results: The ' prevalence of underweight, stunting and wasting
was 39,8%, 48,6%, 8,8%, respectively. The
* B$nh vi$n Nhl trung ucmg, ** Bei 1>0C Y khoa Vlnti
Nguyin Cdnh Phu**, Trin Thanh Tii*, Tdn Thf Huyin Trang*, Trin Minh T&n*
incidence of diarrhea and acute respiratory infections (ARIs) during the last 14 days of the interview was 12.2% and 20.2%, respectively.
Although 99% of the children were breastfed, the prevalence of exclusive. Conclusion:
Undernutrition is highly prevalent in the study site and non-exclusive breast feeding is one of the risk factors.
I. Oi^T V X N OE:
Suy dinh du5ng la linh trgng tr6 c6 can n$ng thdp hon so voi chuin. Theo WHO nguySn nhan cua suy dinh du5ng b tr6 em du6i 5 tuoi la do thiSu an va do b?nh t^t. H^i nghj thu(?ng dinh tai Roma nguyen nhan suy dinh du6ng la do doi ngheo va thiiu kien thuc. Theo Tir Giiy v^ H^ Huy Khoi nguygn nhan suy dinh duOng d tre em Vi^t Nam Id do thieu an, thieu chSm soc va b$nh t$t. DS CO nhieu nghien ciiu tren the gioi va trong nuoc tim hieu ve cac yeu to nguy ca ciia suy dinh dudng cho thay tinh trang kinh te x3 hpi, kien thiic cham soc con cua b^ m^, tinh tr^g siJTc khoe ba me phong tuc t$p q u ^ sinh hoEit... anh huong d€n t^ 1$ suy dinh dudng cua tck em. Nhu vay thi ty 1? suy dinh dudng d tr6 em duoi 5 tu6i plian dnh dugrc gidn tiSp nin kinh te va dan tri tai c^ng d6ng nghien cihi. Da c6 nhilu chuong trinh, d\r dn, nham Idm gidm t^ 1? mic va tii vong do suy dinh duSng dat dugc ket qud t6t.
Tgi Vi^t Nam t^ I? suy dmh dudng is trfi em da giam nliilu trong nhilu ndm qua, ty 1§
suy dinh dudng gidm tir 1985 (51,5%) din
355
C H U Y E N BJ: Hpl NGH| KHOA HQC N G A N H NHI KHOA T O A N Q U 6 C LJtl THO IX
1995 (44,9%) m8i nSm gito trung binh 0,66%. Tir n t a bat d k KHQGDD (1995), chi sau 4 n t a tj li SDD dS gito xu6ng cdn 36,7% (1999), trung binh m8i n t a gito 2%, 14 t6c dO dugic qu6c ti ctag nh$n 14 gito nhanh, d^n n t o 2010 tJ 1? suy dinh dudng chiing cila tr6 em 14 xu6ng c6n tuy nhidn mile dO c4i thifn tinh trying suy sinh du9ng khdng d6ng Aiu giOa cic vilng mi4n, n6ng thdn v4 th4nh ph6, d6ng bang, v4 mi^n nui, giOa tri em din tOc It ngudi v4 ngudi kinh. Theo nghi6n cihi ciia vi$n dinh dufing nSm 2010 Ngh? An 14 tinh c6 tj 1$ suy dinh dudng tri em dudi 5 tu8i chi^m 30% cao nhSt trong c4 nude. Ngh? An cflng 14 ncri t4p trung nhiSu dong b4o din t$c thieu s6 chu yeu 14 ngudi Thii, H' Mdng, Mudng,.. s6ng tren dja bin din cu trii rpng, vi$c quin lj vi tiep cin thong tin chta sdc txi cdn nhieu hjin chl Tj 1? suy dinh dudng d txi em din tdc cd khic bi?t vdi tj 1? suy dinh dudng cila tre em tren ci nude ndi chung hay tr6 em tai tinh Ngh?
An ndi rieng hay khdng. Chung tdi tien hinh nghien curu "Ty 1? mic vi mpt sd yeu td nguy CO suy dinh dudng d tre em dan tpc thii".
Vdi muc tieu: 1) Xic djnh ty I? suy dinh dudng cua txi emdin tdc Thii t?i tinh Nghf An; 2) Tim hieu nhthig yeu to nguy ca lidn quan den suy dinh dudng cua trd em din tfc Thii t?i Tinh Nghf An.
II. Odl TlfQNG VA PHUONG PHAP NGHllN COU:
Phuong ph^: Nghien cilu cit ngang, md ti Ap dyng bing hdi phdng vin bi m? vi thta khta I t a sing dinh gii tinh trying suy dinh dudng.
D6i tupng; Trd em dudi 1 thing den 60 thing tu6i ngudi din tdc Thii t^i huydn Qui Hpp tinh Nghd An.
D6i tupng dupc chpn l4y tir hd ngudi dil tdc nim bdn tay phii tr\i sd dy ban xS lay cic nhi theo phucmg phip cila li^n cua, cho Ska khi dil s6 trd ngudi din tOc Thii dudi 5 tuii
C d m l u n = ''-'-Pf-P^ =323 , Cdng thdm 10%360trdl d ^ 60 thing tu4L Tid sd dupc khto dinh gii suy dinh duSng, Tidu chuin dinh gii so sinh vdi chu^ WHO.
III. Kil QUA NGHliN CCfU:
Md tii chung nhdm doi tugng nghien cAn T6ng so doi tupng dupc di^u Ua:
T6ng so doi tupng diiu Ua 513 c ^ ba m? vi trd tu6i tir Odin 15trd.
S6 trd 0 din 60 thing 14 trd 421 T^ Id nam/nil
Tuli trung binh ciia b4 m? 27,1± 5,1 s l ngudi trung binh sinh sing bong gia dinh: 4,6± 1,3(2-9)
s l con trung binh trong mli gia dinh 1,7±0,8,
Ty 1? b4 m? cho con b i ngay sau sini 304/409 (77,9%).
3.1. T^ If say dinh duOng
Ty If trd suy dinh dudng cin njng so voi tuli chilm 28,9%. Khdng gip suy dinh dudng d nhdm trd 0-5 thing, suy dmh duSng cin ning so vdi tuli xuit hifn d nhdm tu6i trdn 6 thing, ty If suy dmh dudng ting dan theo tit 2 din 5 tuli. Suy dinh dudng ning chl xuit hifn 6 nhdm trd tren 1 tuli, tang cao trong n t a thit 2 v4 n t a thiit 3 cila tid.
Y HQC V I 6 T N A M T H A N G 9 • S 6 SAC BieT/2012 s Bani
Age groups
Total:
(0-5) (6-11) (12-23) (24-35) (36-47) (48-60)
il.Tj N
418 8 15 58 112 94 131
? suy d i n h d u d n g c i n nSnK Weight-for-age (%)
% <-3SD 7.7
0 0 15.5 11.6 6.3 3.8
(95% Cl) (6%, 10,3%)
(0%, 6.3%) (0%, 3.3%) (5.3%. 25.7%)
(5.2%, 18%) (0,3%. 10,4%)
(0,2%, 7.5%) so v d i t u o i
% < -2SD 28,9
0 13,3 25,9 31.3 27.7 32,8
(95% Cl) (24,6%, 33,4%)
(0%, 6,3%) (0%, 33,9%) (13,7%, 38%) (22,2%, 40,3%) (18.1%. 37,2%) (24,4%, 41,2%)
Mean -1,63 0,12 -0,6 -1,64 -1.67 -1,46 -1.76
SD 1,06 1.69 1,27 1,24 1.2 0,84 0,74 Phan loji suy dinh dudng chieu cao so vdi tuli
Ty 1? suy dinh dudng chidu cao so vdi mli li 48,6%. T^ If suy dudng chilu cao so vdi tuoi cd tit ngay nhihig thing diu sau sinh (suy dinh dudng bio thai), suy dinh dudng chilu cao miic df ning xuit hifn ngay tir thing thil nhit. Suy dinh dudng chilu cao cao nhit li vao nim 3 tuli.
Ban Age groups Total:
(0-5) (6-11) (12-23) (24-35) (36-47) (4M0)
f Z l y N 414 8 15 58 112 93 128
1? suy dinh Len
% < -3SD 19.6
0 13.3 24.1 27.7 16.1 14.8
dudng chieu cao so vdi tudi gth/height-for-aqe
(95% Cl) (15.6%, 23.5%)
(0%, 6,3%) (0%, 33,9%) (12,3%, 36%) (18,9%, 36,4%) (8,1%, 24,1%) (8,3%, 21,4%)
(%)
% < -2SD 48 6 12,5 40 44,8 63,6 46,2 50.8
(95% Cl) (43.6%, 53.6%)
(0%, 41.7%) (11.9%, 68.1%) (31.2%, 68,6%) (43.9%, 63.3%) (35.6%, 56.9%) (41.7%, 59.8%)
Mean -1,94 1,36 -1.2 -1.91 -2.07 -2.02 -2.07
SD 1.61 2,49 2,23 1.61 1.78 1.16 0.89 Suy dinh duong can ndng so voi chieu cao
T^ 1$ suy dinh duQng cdn ndng so voi chieu cao la 8,8%, danh gia chat luong s6ng ciia quan the nghidn cuu
Bang 3. Ty lg suy dinh dirong can ndng so voi chilu cao
Total:
:o-5)
;6-ii) :i2-23) 24-36) 36-47) 48-60)
N 420
8 16 68 112 94 129
WeJE
% < -3SD 1.9 12.5 0 0 4.5 2.1 0
ht-for-length/helght (%) (95% Cl) (0.6%, 3.3%)
(0%.41.7%) (0%, 3.3%) (0%, 0,9%) (0.2%, 8,7%)
(0%, 5.6%) (0%. 0.4%)
% < -2SD 8,8 12,6 6.7 13.8 13.4 6.4 4.7
(95% Cl) (6%, 11,6%) (0%,41,7%) (0%, 22.6%) (4.1%, 23.6%) (6.6%, 20.1%) (0.9%, 11.9%) (0.6%, 8.7%)
CHUY6N Bg: HQI NGHj KHOA HQC NGANH NHI KHOA TOAN QUfic \JM THO IX P 3.2. Mft sl yiu t l nguy cff
Llln quan gtOa suy dinh du&ng & Iri vi trinh df vin hda cia mf
Trinh df vin hda cila bi m? 2,5% bi m? mil chO, 75% bi m? trinh df vin hda hit cip II, Kit qui nghidn ciJru cho thiy con cila bi m? cd trinh df vin hda < cip 2 cd nguy co suy dinh dudng cin ning so vdi tuli 2,1 lin, suy dinh dudng chilu oao so vdi tuli cao gip 1,9 lin. Kit qu4 dupc trinh b4y trong bing
Suv dinh du^ng cin ning/tudi KoSdd chidu cao/tudi KoSdd Chidu cao/cin ning KG SDD
Hoc hit cip 2 101 207 168 148 33 273
Hoc trdn cip 2 19 81 35 65 5 94
OR 2,1
1,9
2,3
95% Cl 1,2-3,7
1,2-3,1
0,9-5,9 Mil liin quan giiia suy dinh du&ng vi Ihu nhfp Mnh quin/thing
Kit qui nghien cHu bing 5 cho thiy ttd trong gia dhih cd thu nhfp trung binh thing <
500,000 dong /thing cd nguy co suy dinh dudng cin ning so vdi tuli vi suy dinh duSng chilu cao/ cin njng cao hon nhdm trd gia dinh cd thu nhSp> 500,000 ding/ thing. S\i khic bift cd y nghia thong kd.
Bing 5: Moi lien quan giita suy dinh dudng d trd vi mile thu nhjp binh quan thing Suy dinh diFd'ng
Sdd cdn ning/tudi KoSdd Sdd chiSu cao/tudi KoSdd
Sdd chiiu cao/cin ning KoSDD
Thu nhip <500,000 39 49 49 37 17 68
Thu nh(p >500,000 42 118 79 81 13 147
OR 2,2
1,4
2,8 Cl 1,3-3,9
0,8-2,3
1.3-6,1
IV. B A N L U ^ N :
Ty If suy dinh dirdng
Ty If mic suy dinh dudng gita din hing nim, s^ phin bl suy dinh dudng trdn bin dl dinh dudng khdng ding deu cho din n t a 2010 ty If suy dinh dudng can ning so vdi tuoi chung cila trd em tren toin quic Ii 17%
thip nhit t?i thinh phi Hi Chi Minh vi H4 Npi cao nhit d Nghf An li 30%
Kit qui nghidn cihi t^ If suy dinh dudng trd dudi 5 tuli t»i Nghf An thing 11/ 2007 cho kit quigii trj tnmg binh ciia cin njng vdi hili, chilu cao vdi tuoi vi can n|ng vdi chilu cao 14 -1.46 (95% CI=-1.57, -1.35),;?
1.44 (95% CI=-1.56, -1.32) v4-0.71 (95%
CI—0.82, -0.60)[1]. Kit qui nghifn ciiu cia chiing tdi cho thiy ty If suy dmh dudng d trS din tfc Thii t?i Qui hpp n t o 10/2011 cho
Y HQC V l | T NAM T H A N G 9 • SO" B A C B I $ T / 2 0 1 2
kit qui t^ if suy dinh dudng tfnh theo can ning vdi tuoi, chilu cao vdi tuoi v4 cin ning voi chilu cao 14 28,6%, 48,6% v4 8,6% cao hon t^ If suy dinh dudng cua trd em tiii vimg nui flnh Bic Giang 2010 (19,7%, 23,4% v4 5,5%)[2]. Kit qu4 nghidn cil cOa chiing tdi tuong t\r kdt qui nghien cilu tai Kenya 7/2002 ty If (30%, 47%,7%). Kit qu4 n4y cho thiy ty If suy dinh dudng trd em din tpc Thii tju Qui Hpp hifn t^ cdn rit cao nd tuong tv nhu kit qu4 cich day 10 n t o eda Kenya mpt nude Chiu Phi.
Cd thd giii thich s\r khic bift niy li do hong nghidn cilu cua Nakamori Bic Giang li mpt tinh gin Thil dd, phuong tidn giao thdng, trinh df vin hda chung d diy ciing cao hem tai Qui Hpp.
YIU to nguy cor
Tuiu Kit qua nghidn ciiu eda chiing tdi cho thiy d nhdm trd 0 den 6 thing tudi khdng CO hifn tuong thip cin hem so vdi chuin tuli, tuy nhien ty 1? thip chieu cao hom so vdi chuin tali, li 12,5% ty if thip hon chilu cao SO vdi can ning 14 12,5%. Kit qui nghidn Clhl cua chung tdi tuong tu kdt qu4 nghidn Clhl t?i Chiang Mai Thii Lannhdm ted 0 din 6 thing tali khdng cd hien tuong thip can hon so vdi chuin tuli, ty if thap chidu cao hon so vdi chuin tuli li 7,7% Jy If thip hon chilu cao so vdi can ning la 1,9% Cd thd giii tiiich hifn tupng niy 14 thudng cic ba m? cd chd df an them thudng chi tap ttung vio ba thing culi cua thdi kj thai nghen, vi thdi dilm niy sd chi cd thi thay doi dupc chi sl g ^ n$ng cdn chi sd chilu cao ddi hdi dupc bl xung ttong ba thing giiia cua thai k^.
Nghidn ciiu cua chung tdi cho thiy cic bi m?
^ thudng chi cd chl dd in b l xung them vio ba thing culi chilm khoing 90%.
Tj If thip can, thip chieu cao, gita ty 1?
chilu cao so vdi can n$ng cd ty I? tliap nhat
ttong khoing tit 6 den 11 thing tali. T^ If thip can /tali, thip chilu cao/tuli gita tj If cin ning/chieu cao ting sau 12 thing tali v4 die bift sau 24 thing duy tri dmilo dp cao.
Cd thi giii thich hifn tapng niy li do cai sHa cho ttd thudng bit diu tir 12 fliing tali vi hau hit kit thiic cai stta vio 24 thing tali. Vi viy sau hai tali ty if suy dinh dudng ting nhanh vi duy tri vdi mft t^ If gin tacmg t\f nhu sau d nhthig n t a tilp theo tir 2 din 4 tali.
Git^: Trong nghidn curu cua chiing tdi khdng cd sv khic bift ty If mic suy dinh dudng gitta hai gidi nam vi ntt.
Trinh df vdn hda cia bd mf: Ty If bi m? cd trinh dp vin hda hpc hit cip 2 ttong nghidn ciru eda ehiing tdi li 75,7%, Ket qui nghidn cilu cila chiing tdi cho thiy ty If bi m? cd trinh dd hpc vin chua hit cip 2 cd con thip can so vdi tali vi thip chilu cao so vdi tali cao gip 2 lin so vdi tte 14 con cila nhttng b4 me cd trinh dp vin hda ttdn cip 2.(S\r khic bift cd y nghia thdng ke)
Nhiim tring kd hip: Tj if nhiem trimg dudng hd hip ttong nghidn cilu eda chiing tdi i i 72,3%, khdng cd su khic bift cd y nghia flilng kd gitta nhdm suy dinh dudng vi nhttng nhdm khdng suy dmh dudng.
Tiiu ch^: Ty If tidu chiy trong nghidn cihi ciia chimg tdi 14 60,5%, khdng cd su khic bift ed j nghia thing kd giiia nhdm suy dmh dudng vi nhihig nhdm khdng suy dinh dudng.
Can nfng khi sinh: Tj if ttd sinh cd cin ning < 2500g ttong nghidn cuu ciia ehiing tdi la 12,9%, khong ed sv khic bift cd j ngMa thing kd gitta nhdm suy dmh dudng va nhttng nhdm khdng suy dinh dudng. Kit qui nghidn cilu cua chimg tdi cho thiy ty Id sinh tlSp can d ttd gita hon so vdi nghidn cilu t?i Bic Kan t^ If ttd so sinh cin ning lile smh <
2500 g li 40% cd ty If mic suy dinh dudng
359
C H U Y E N fl6: HQI NGHj K H O A H Q C N G A N H NHI KHOA T O A N QUgC LAN T H O IX
cao hon nhdm ttd cd trpng lupng khi sinh >
2500 g (12,3%).
Thu nhfp binh guin: Kit qui nghidn Cllu eda chiing tdi cho thiy ttd l i con c u i nhthig gia dinh ed thu nhip trung binh hing thing <500,000 ding/ thing sd ed nguy c o mic suy dinh dudng ein ning so vdi tuli v i chilu cao so vdi ein ning cao hon nhdm ttd trong cic gia dinh cd thu nhfp trdn 500,000 ding/thing l i 2,2-2,8 lin. Sv khic bift niy cd j nghia thdng ke.
Th&i gian cho con bi ngay sau ill: Theo nghidn eim t^ tinhBicK^ thdi gian cho con bu sau sinh tii 30 phdt din 2 h chidm 60,2%.
Kit qui nghidn eim eda chdng tli cho thiy ty If trd bu m? sau sinh ttt 30 phut din 2h l i 77,9%
Cai s&a: Kit qui nghidn cmA:ua chiing tdi cho thay ty 1? ttd thdi bu m? trudc 6 thing li 0% ty if ttd cai stta 12thirig 14 8,2% ty If ttd cai stta tir 12 din 17 thing l i 49,9%.Duy tri ngudn stta m? I t o g i t o ty If suy sinh dudng cin ning teong n t a diu tidn cua ted da dupc ehung minh qua nhilu nghien cdu trong v i ngo4i nude.
V. KlT LUiJN:
Ty 1? suy dinh dudng ted em din tpc Thii tai Qui Hpp chilm ty If eao d ttd em. Nhdm tali mic suy dinh dudng cao l i 1-3 tali, trinh dp vin hda ciia b i m?, mire thu nhfp trung binh eda gia dinh l i nguy c o eda suy dinh dudng.
TAI U|U THAM KHAO:
I. Hien NN, Kam S. Nuttitional status and the characteristics related to malnuttition in children under five years of age in Nghean, Vietaam.J Prev Med Public Health. 2008 Jul;41(4):232-40.
2. Nakamori M, Nguyen XN,J4guycn CK et al. Nutritional status, feeding practice and Incidence of infectious diseases among children aged 6 to 18 months in nordiem mountainous Viemam.J Med Invest. 2010 Feb;S7(l-2):45-53. '
3. Bless E, Wainaina F, Bailey RC. Prevalence and predictors of underweight, stunting, and wasting among children aged 5 and under in western Kenya.J Trop Pediatr. 2004 Oct;50(5):260-70.
4. Panpanich R, Vitsupakorn K, Brabin B.
Breastfeeding and its relation to child nutrition in rural Chiang Mai, ThailandJ Med Assoc Thai.2003 May;86(5):415-9.
5. Vesel L, Bahl R, Martines J, Penny M et aL Use of new World Health Organization child growth standards to assess how infant malnutntion relates to breastfeeding and moitality.Bull World Healdi Organ. 2010 Jan;88(l):39-48. Epub 2009 Oct 13.
6. Sawa SC, Tomaritis M, Chadjigeor^l C et alPrevalence and socio-demographic associations of undernutrition and obesity among preschool children in Cypms^ur J Clin Nutt. 2005 Nov;59(l 1): 1259-65.
7. Marquis GS, Habicht JP, Laaata CF et al Association of breastfeeding and stunting in Pemvian toddlers: an example of reverse causality.Int J 'Epidemiol. 1997 Apr;26(2):349-56.
8. Maia MM, Fausto MA, Vieira EL et aLTtx prevalence of malnuttition and hs risk factois in children aUending outpatient clinics in tlie city of Manaus, Amazonas, Brazi].Arcli Latinoam Nutt. 2008 Sep;58(3):234-40.
9. WHO Multicentre Growth Reference Stedy Group. Geneva: WHO; 2006. WHO Child Growth Standards: Length/height-for-age, weight-for-age, weight-for-length, weight-for- height and body mass index-for-age: Methods and development, p. 314.
10. Aurangzeb B, Whitten KE, Harrison B et al-Prevalence of malnutrition and risk of under-nutrition in hospitalized childienClin Nutt.2011 Sep 24. [Epub ahead of print].
