Assessment of nutritional status among primary schoolchildren in Krong Bong district, Daklak province

CERTIFICATION I certify this thesis has entirely done by myself Within my knowledge quotations and data used in the thesis are cited and surveyed by highest precision sources Phan Thi Ngoc Ngan TABLE OF CONTENTS CERTIFICATION TABLE OF CONTENTS LIST OF ABBREVIATIONS LIST OF TABLES LIST OF FIGURES ABSTRACT CHAPTER 1: PROBLEM STATEMENT 1 Research backround 1.1 Nutritional status in children in the world 1.2 Nutritional status in children in Vietnam 1.3 Current nutritional status in children in Krong Bong 1.4 Objective of the thesis 1.4.1 General objective 1.4.2 Specific objectives 1.4.3 Research questions 1.5 Scope of the research 1.7 Structure of the thesis 10 CHAPTER 2: LITERATURE REVIEW 11 2.1 Measurement of nutritional status 11 2.2 Anthropometric Indicators 12 2.3 Situation of nutritional status in the world 14 2.3.1 Characteristics of individuals children 15 2.3.2 Characteristics of mothers/caregivers 16 2.3.3 Characteristics of households 18 2.4 Situation of nutritional status in Vietnam 20 2.5 Analytical Framework 22 CHAPTER 3: STUDY SUBJECTIVES AND METHODOLOGY 24 3.1 Ge neral information about Krong Bong District 24 3.2 Study design 25 3.2.1 Study setting 25 3.2.2 Sample size 26 3.2.3 Study subjects 27 3.3 Statistical analysis 27 3.4 Empirical Model 29 3.5 Variables in the model 31 3.5.1 Dependence variable 33 3.5.2 Independence variable 34 CHAPTER 4: DESCRIPTION OF NUTRITIONAL STATUS IN KRONG BONG, DAK LAK 35 4.1 Characteristics of child nutritional status 35 4.1.1 Prevalence of current nutritional status in children 36 4.1.2 Prevalence of nutritional status in children by chronic, delivery status and place of birth 39 4.1.3 Prevalence of nutrition status in children by mother/caregiver education and occupation 40 4.1.4 Prevalence of factors related family 41 4.2 Risk factors of nutritional status 46 4.2.1 Univariate analysis 46 4.2.2 Multivariate analysis 50 CHAPTER 5: CONCLUSION AND RECOMMENDATION 54 5.1 Conclusion 54 5.1.1 Conclusion of situation of nutritional status 54 5.1.2 Conclusion of risk factors of nutritional status 55 5.2 Recommendations 55 5.3 Researchers and developments 56 REFERENCES APPENDICIES LIST OF ABBREVIATIONS BMI Body Mass Index CDC Centers for Disease Control and Prevention IOTF International Obesity Task Force FAO Food and Agriculture Organization HAZ Height for age z-score (stunting) MDGs Millennium Development Goals OR Odd Ratio PHC Primary Health Care SD Standard deviation UNICEF United Nations International Children’s Emergency Fund WAZ Weight for age z-score (underweight) WB World Bank WHO World Health Organization WHZ Weight for height z-score (wasting) LIST OF TABLES Table 1.2.3 The statistics on the nutritional status of children in Dak Lak province over the years (2005-2014) Table 2.2.1 Overview of indicators and cut offs that are considered appropriate to assess malnutrition in school-aged children 13 Table 2.2.2 Mean (± SD) prevalence (%) of malnutrition in school-aged children, by WHO region, weighted for quality score 14 Table 3.4 Summarizes the variables in this study 31 Table 4.1 Summary of children's BMI-for-Age 35 Table 4.1.1 Prevalence of nutrition status in children by commune, sex, age, number of children and ethnicity 36 Table 4.1.1 Prevalence of nutrition status in children by commune, sex, age, number of children and ethnicity (con’t) 37 Table 4.1.2 Prevalence of nutritional status in children by chronic, delivery status and place of birth 39 Table 4.1.3 Prevalence of nutrition status in children by mother/caregiver education and occupation 40 Table 4.1.4a Prevalence of nutritional status in children by boil drinking water, mosquito-net, latrine and garbage 41 Table 4.1.4b Prevalence of nutritional status in children by family factors 43 Table 4.2.1a Group variables of children 46 Table 4.2.1b Group variables of mother/caregiver 47 Table 4.2.1c Group variables of households 48 Table 4.2.2a Group variables of children .50 Table 4.2.2b Group variables of mother/caregiver 50 Table 4.2.2c Group variables of households 51 LIST OF FIGURES Figure Map of Dak Lak province showing Krong Bong district 24 Figure 2: Krong Bong District Map 25 Figure 1.2.2 The statistics on the nutritional status of children over the years (19992014) (National Institute of Nutrition) Figure 2.5: Conceptual framework on the causes of malnutrition (UNICEF, 1997) .23 Figure 3.1.3 Analytical framework: illustration of hypotheses related to the relationship between nutritional status in children and related factors 27 Figure 4.1 Prevalence of nutritional status in school-age children 35 ABSTRACT Background: The nutritional status of children reflects the socioecomy of family and community as well as the efficiency of the health system Malnutrition and overweight in school-age children are an important public health problem of the Ministry of Health and the Government of Vietnam Within the country, Dak Lak province has the highest levels of malnutrition Objectives: The aim of this study was to assess the nutritional status of primary school children and to find out factors associated with childhood malnutrition and overweight/obesity Methods: A cross-sectional household survey was carried out on five primary schools th th of five communes in Krong Bong district, Dak Lak provinces during 30 March to 28 April, 2015 by interviewing 321 children and their mothers/caregivers by using questionnaire Anthropometric measurement such as body weight (kg), and height of children (m ) was collected by using standard techniques Body Mass index was used to define nutritional status according the WHO guideline Result: Prevalence of malnutrition in Krong Bong district was 26.5% School boys were more malnourished than school girls Prevalence of overweight was 8.4% and school girls were more overweight than school boys The occurrence of malnuttrition was dependence associated with commune and boil drinking water Furthermore, the occurrence of overweight were dependence associated with gender of children, mother’s occupation, facility of birth, land-owning households - mlogit nusta Commune -nusta | Coef Std Err z P>|z| [95% Conf Interval] -+ -0 | (base outcome) -+ -1 | Commune | 5730894 1320342 _cons | -2.760438 475242 4.34 0.000 -5.81 0.000 3143072 8318717 -3.691895 -1.828981 -+ -2 | Commune | -.176476 1465782 _cons | -1.578469 4229196 -1.20 0.229 -3.73 0.000 -.4637639 110812 -2.407376 -.7495618 - mlogit nusta Ethnic -nusta | Coef Std Err z P>|z| [95% Conf Interval] -+ -0 | (base outcome) -+ -1 | Ethnic | -.3331598 1807147 -1.84 0.065 -.6873542 0210346 _cons | -.760569 1457548 -5.22 0.000 -1.046243 -.4748949 -+ -2 | Ethnic | 0026741 2510997 0.01 0.992 -.4894722 4948204 _cons | -2.047882 2424056 -8.45 0.000 -2.522988 -1.572775 - mlogit nusta Chronic -nusta | Coef Std Err z P>|z| [95% Conf Interval] -+ -0 | (base outcome) -+ -1 | Chronic | -1.091751 7672059 _cons | -.854159 1310588 -1.42 0.155 -6.52 0.000 -2.595447 4119448 -1.111029 -.5972885 -+ -2 | Chronic | -.6241543 1.055944 _cons | -2.014903 2087816 -0.59 0.554 -9.65 0.000 -2.693767 1.445458 -2.424107 -1.605699 - mlogit nusta Destat -nusta | Coef Std Err z P>|z| [95% Conf Interval] -+ -0 | (base outcome) -+ -1 | Destat | 3285041 5732461 0.57 0.567 _cons | -.9162907 1322876 -6.93 0.000 -.7950377 1.452046 -1.17557 -.6570119 -+ -2 | Destat | 1.351893 6399917 2.11 0.035 0975323 2.606254 _cons | -2.162823 2201778 -9.82 0.000 -2.594364 -1.731283 - mlogit nusta pob -nusta | Coef Std Err z P>|z| [95% Conf Interval] -+ -0 | (base outcome) -+ -1 | pob | 4130315 5332448 0.77 0.439 -.6321091 1.458172 _cons | -.923857 1329788 -6.95 0.000 -1.184491 -.6632234 -+ -2 | pob | 1.940898 5457859 3.56 0.000 _cons | -2.297573 2345743 -9.79 0.000 8711769 3.010618 -2.75733 -1.837815 - mlogit nusta medu -nusta | Coef Std Err z P>|z| [95% Conf Interval] -+ -0 | (base outcome) -+ -1 | medu | 1671273 3635354 0.46 0.646 _cons | -1.041454 3357754 -3.10 0.002 -.545389 8796437 -1.699562 -.3833462 -+ | medu | 1107744 5732402 0.19 0.847 _cons | -2.140066 5285941 -4.05 0.000 -1.012756 1.234305 -3.176092 -1.104041 - mlogit nusta mojob -nusta | Coef Std Err z P>|z| [95% Conf Interval] -+ -0 | (base outcome) -+ -1 | mojob | 1964531 3651623 0.54 0.591 -.5192519 912158 _cons | -.9273406 1392243 -6.66 0.000 -1.200215 -.654466 -+ -2 | mojob | 8583477 4851687 1.77 0.077 -.0925655 1.809261 _cons | -2.208274 2355727 -9.37 0.000 -2.669988 -1.74656 - mlogit nusta lstand -nusta | Coef Std Err z P>|z| [95% Conf Interval] -+ -0 | (base outcome) -+ -1 | lstand | -.1896086 2316456 -0.82 0.413 -.6436256 2644084 _cons | -.7446622 2266835 -3.29 0.001 -1.188954 -.3003707 -+ -2 | lstand | 2568601 3696843 _cons | -2.27419 0.69 0.487 395963 -5.74 0.000 -.4677079 981428 -3.050263 -1.498117 - mlogit nusta Land -nusta | Coef Std Err z P>|z| [95% Conf Interval] -+ -0 | (base outcome) -+ -1 | Land | 0799072 2505795 0.32 0.750 _cons | -.969347 2544983 -3.81 0.000 -.4112195 5710339 -1.468154 -.4705396 -+ -2 | Land | 6769267 4071015 1.66 0.096 -.1209775 1.474831 _cons | -2.689271 4618634 -5.82 0.000 -3.594506 -1.784035 - mlogit nusta ptree -nusta | Coef Std Err z P>|z| [95% Conf Interval] -+ -0 | (base outcome) -+ -1 | ptree | -.0350124 3079409 -0.11 0.909 -.6385655 5685407 _cons | -.8917496 1461598 -6.10 0.000 -1.178218 -.6052816 -+ -2 | ptree | -.8692382 6340698 -1.37 0.170 _cons | -1.903351 2188101 -8.70 0.000 -2.111992 3735158 -2.33221 -1.474491 - mlogit nusta ranim -nusta | Coef Std Err z P>|z| [95% Conf Interval] -+ -0 | (base outcome) -+ -1 | ranim | -.2601232 2840579 -0.92 0.360 -.8168664 29662 _cons | -.7121954 2394357 -2.97 0.003 -1.181481 -.24291 -+ -2 | ranim | 1731989 4894526 0.35 0.723 -.7861107 1.132508 _cons | -2.178532 4307373 -5.06 0.000 -3.022762 -1.334303 - mlogit nusta asset -nusta | Coef Std Err z P>|z| [95% Conf Interval] -+ -0 | (base outcome) -+ -1 | asset | 0173919 606106 0.03 0.977 _cons | -.9162493 5916027 -1.55 0.121 -1.170554 -2.075769 1.205338 2432707 -+ -2 | asset | 14.57547 1255.409 0.01 0.991 _cons | -16.57301 1255.409 -0.01 0.989 -2445.98 -2477.129 2475.131 2443.983 - mlogit nusta bdwat -nusta | Coef Std Err z P>|z| [95% Conf Interval] -+ -0 | (base outcome) -+ -1 | bdwat | 8257453 3482572 2.37 0.018 1431738 1.508317 _cons | -1.026416 1423832 -7.21 0.000 -1.305482 -.7473501 -+ -2 | bdwat | 0606246 6525352 0.09 0.926 -1.218321 1.33957 _cons | -2.053055 2168277 -9.47 0.000 -2.478029 -1.62808 - mlogit nusta monet -nusta | Coef Std Err z P>|z| [95% Conf Interval] -+ -0 | (base outcome) -+ | monet | -.002 383346 -0.01 0.996 _cons | -.8979416 3576956 -.7533443 -2.51 0.012 7493443 -1.599012 -.1968711 -+ -2 | monet | 6175578 7632372 0.81 0.418 _cons | -2.602689 7328278 -3.55 0.000 -.8783597 2.113475 -4.039005 -1.166373 - mlogit nusta latrin -nusta | Coef Std Err z P>|z| [95% Conf Interval] -+ -0 | (base outcome) -+ -1 | latrin | -.1668776 1988376 -0.84 0.401 -.5565922 _cons | -.8035022 -4.72 0.000 -1.137384 -.4696205 170351 2228369 -+ -2 | latrin | -.0452276 3098955 -0.15 0.884 _cons | -2.019248 2753259 -7.33 0.000 -.6526117 -2.558877 5621564 -1.47962 - mlogit nusta kitch -nusta | Coef Std Err z P>|z| [95% Conf Interval] -+ -0 | (base outcome) -+ -1 | kitch | 047006 2927809 0.16 0.872 _cons | -.9343092 2516181 -3.71 0.000 -.526834 620846 -1.427472 -.4411467 -+ -2 | kitch | -.1400888 4494715 -0.31 0.755 -1.021037 7408592 _cons | -1.94591 3779645 -5.15 0.000 -2.686707 -1.205113 - mlogit nusta garba -nusta | Coef Std Err z P>|z| [95% Conf Interval] -+ -0 | (base outcome) -+ -1 | garba | 0247894 1298495 0.19 0.849 -.2297108 2792897 _cons | -.9305868 2072996 -4.49 0.000 -1.336887 -.5242871 -+ QUESTIONNAIRE ON HOUSEHOLD Date of survey: ……./………… /…………… Code: …………………… A General Information (Priority for mother/care givers of children will be an interviewee) Household Information No Full name Sex DOB Ethnicity Relative with Education Career Notes:  Education: Illiteracy Reading, writing Primary High school College * Career: Farmer Knitting Salary work Trading Housewife Other ………… Please self access your living standard: Secondary University/higher Religion Poor Enough Middle class Excess Total expenditure of your family in previous month (dong) < 1.000.000 1.000.000-2.000.000 2.000.000-3.000.000 >3.000.000 Total food expenditure of your family in previous month (dong) < 1.000.000 1.000.000-2.000.000 2.000.000-3.000.000 >3.000.000 Do you own any land? No  Yes If yes, how much you own? (ha) 