Food consumption pattern among lactating mothers during 2019 in vientiane capital lao p d r

MINISTRY OF HEALTH UNIVERSITY OF HEALTH SCIENCES, FACULTY OF PUBLIC HEALTH and MINISTRY OF EDUCATION AND TRAINING - MINISTRY OF HEALTH HANOI UNIVERSITY OF PUBLIC HEALTH H P Phonepaseuth SOUTHALACK U FOOD CONSUMPTION PATTERN AMONG LACTATING MOTHERS DURING 2019 IN VIENTIANE CAPITAL, H LAO P.D.R MASTER OF PUBLIC HEALTH CODE: 8720701 Hanoi 2019 MINISTRY OF HEALTH UNIVERSITY OF HEALTH SCIENCES, FACULTY OF PUBLIC HEALTH and MINISTRY OF EDUCATION AND TRAINING - MINISTRY OF HEALTH HANOI UNIVERSITY OF PUBLIC HEALTH Mr Phonepaseuth SOUTHALACK H P FOOD CONSUMPTION PATTERN AMONG LACTATING MOTHERS DURING 2019 IN VIENTIANE CAPITAL, U LAO P.D.R H MASTER OF PUBLIC HEALTH CODE: 8720701 Supervisors: Assoc Prof Nguyen Thanh Ha Dr Sengchanh Kounnavong Hanoi 2019 i Acknowledgements This independent study would not have been possible without the help and support of many people I thank the Lord Buddha who made it possible for me to come to the end of this program I am very thankful to the Ministry of Health of the Lao PDR and to the Lao Equity through Policy Analysis and Research Networks (LEARN) Program Office, led H P by Lao TPHI, MCNV and EU for funding my study at the University of Health Sciences (UHS) and the Hanoi University of Public Health (HUPH) The help of the Hatxayfong District Health Office is also gratefully acknowledged for allowing me to study at the UHS and HUPH My sincere and deep gratitude goes to my principal advisors, Assoc Prof U Nguyen Thanh Ha and Dr Sengchanh Kounnavong, for their constructive suggestions, guidance and encouragement in the course of my study I am most grateful to the directors and staff of three district hospitals who kindly H accepted to help and participate in this research This study could not have been completed without their generous assistance I am grateful to all the lecturers, teachers and staff of the UHS and HUPH for their continuous assistance and helpful advice I would like to thank my classmates for their kindness during the period of my studies at the UHS and HUPH Finally, I would like to thank my family for love, understanding, support, and encouragement during the time I studied in Vietnam and Laos ii Table of Contents Acknowledgements i Table of Contents .ii Abbreviations vi List of Table vii ABSTRACT viii INTRODUCTION OBJECTIVES H P CHAPTER 1: LITERATURE REVIEW 1.1 Definition of food, food consumption, food consumption pattern, and food restriction 1.2 Food consumption guidelines 1.3 Recommended foods for lactating mothers‟ consumption U Balanced diet Extra calorie needs Impact on baby 11 H Drink up 11 Summary - the best diet 12 1.4 Food consumption assessment 12 1.5 Food taboos/restrictions and their effect on health 13 1.6 Potential related factors for food consumption patterns 13 1.6.1 Food consumption patterns 13 1.6.2 Factors associated with food consumption patterns 14 1.6.2.1 Income 14 1.6.2.2 Education 15 1.6.2.3 Occupation 15 1.6.2.4 Ethnicity 15 iii 1.6.3 Family factors 15 1.6.3.1 Role of spouse in food consumption decisions 16 1.6.3.2 Family members affecting food consumption 16 1.6.4 Cultural and religious diets 16 1.6.5 Access to food 17 1.6.5.1 Home garden 17 1.6.5.2 Animal husbandry 17 1.6.5.3 Wild foods collection 18 1.6.6 Health service factors 18 H P 1.6.7 Health education 18 1.6.8 Social environment factors 18 1.6.8.1 Available food 19 1.6.8.2 Food adverting 19 1.6.8.3 Markets 19 U 1.6.9 Socio-cultural factors 19 1.6.10 Food culture 19 Conceptual framework 21 H CHAPTER 2: METHODOLOGY 22 Materials and Methods 22 2.1 Study subjects: 22 2.2 Time and setting for study 22 2.3 Research design 23 2.4 Sampling 23 2.4.1 Sampling selection method 23 2.5 Data collection method: 24 2.5.1 Tools 24 2.5.2 Measurement of dependent variables 24 2.5.2.1 Food frequency 24 iv 2.5.2.2 Food choices 25 2.5.2.3 Eating habits 25 2.5.3 Measurement of independent variables 26 2.5.3.1 Individual factors 26 2.5.3.2 Family factors 26 2.5.3.3 Health services 27 2.5.3.4 Social environment 27 2.5.3.5 Socio-cultural factors 27 2.6 Data analysis method 28 H P 2.7 Ethical considerations 28 CHAPTER 3: RESULTS 29 3.1 General characteristics of lactating women 29 3.2 Potential factors for food consumption for lactating women 31 3.2.1 Family factors 31 U 3.3 Health services/socio environment 32 3.3.2 Environmental factors 33 3.4 Food consumption of lactating mothers 34 H 3.4.1 Food frequency 34 3.4.2 Food choices, food preferences and frequency of consumption 35 3.4.3 Eating habits 36 3.4.4 Food restrictions 36 3.4.5 Food preferences 37 3.5 Factors affecting food consumption patterns 39 CHAPTER 4: DISCUSSION 42 Limitations and bias 47 CONCLUSION 48 REFERENCES 51 Annex 1: English version questionnaire 54 v Annex 2: Information sheet and consent form (English version) 65 Annex 3: Format for participant information sheet 66 Annex 4: Budget, equipment and tools for the research 69 Annex 5: Research plan 70 Annex 6: Certificate of approval 71 Annex 7: Biography 73 Annex 8: Thesis comment 74 Annex 9: Minute of explanation 82 H P H U vi Abbreviations ADD Attention Deficit Disorder DHA Docosahexaenoic Acid DNA Deoxyribonucleic Acid EFSAs Emergency Food Security Assessments FA Fatty Acids FAO Food and Agricultural Organization FFQ Food Frequency Questionnaire IYCF Infant and Young Child Feeding Lao PDR Lao People's Democratic Republic MCH Maternal and Child Health MoHME Ministry of Health and Medical Education MOH Ministry of Health PHC Primary Health Care UNICEF United Nations Children‟s Education Fund WFP World Food Program WHO World Health Organization H U H P vii List of Table Table 1: General characteristics of lactating women…………….………………… 32 Table 1: General characteristics of lactating women (cont.)……………………… 33 Table 2: Potential factors for food consumption among lactating women 33 Table 3: Health service factors………………… …………………………………35 Table 4: Environmental factors for food consumption among lactating women……35 H P Table 5: The frequency of eating particular food items………………………….… 37 Table 6: Food choices grouped in food groups … 37 Table 7: Eating habits among lactating women …………………………………… 38 Table 8: Food restrictions among lactating women … 38 Table 9: Food preferences among lactating women …………………………….… 39 U Table 10: Eating four food groups by lactating mothers … 41 Table 11: Univarate analysis of potential factors for food consumption patterns…….42 H viii ABSTRACT Background: The period of mother‟s lactation is a relatively brief and very special time with her newborn baby as well as a good memory in a women's life In the Lao PDR it has been observed from various nutritional surveys that the nutritional status of lactating mothers and infants is not satisfactory, due to practicing certain food restrictions Objective: The study aimed to describe the food consumption patterns and to determine their potential influencing factors among lactating mothers during 2019 in H P Vientiane Capital Method: A cross-sectional study was applied to 420 lactating mothers who attend the Child Well Clinics in three district hospitals of Vientiane Capital Data on food consumption patterns and potential factors including socio-demographic characteristics, and the individual and family factors of lactating mothers were U collected using a structured questionnaire and analyzed by utilizing STATA software Descriptive and inferential statistics were generated Results: The study found that 62.6% of family members made decisions about buying H foods for family consumption More than half of the participants claimed that they ate whenever they felt like All women reported that they followed the MCH guidebook and had positive perceptions of health care providers‟ education and counseling Just under half (46.9%) of the respondents reported eating more than four food groups Family income and following the MCH guidebook are positively associated with the consumption of a variety of food groups (P-value 0.022) Conclusion: Information on existing food consumption patterns, their associated socio-demographic and health service factors can be useful for public health efforts to improve lactating mothers‟ nutrition and diet Intervention may be more effective if they are targeted in specific socio-demographic subgroups such as focusing on lowincome mothers 72 H P H U 73 Annex 7: Biography Name: Mr.Phonepaseuth SOUTHALACK Date of birth: November 12th 1989 Address: Phoxay Village Sisattanak District Vientiane Capital Work experience: Hatxayfong District Hospital Office Telephone: 020 77811966, 030 5345802 H P E-mail: phonepaseuth8993@yahoo.com H U 74 Annex 8: Thesis comment HANOI UNIVERSITY OF PUBLIC HEALTH THESIS COMMENT FORM OF MASTER PROGRAM (For reviewer of thesis defence committee – Master Program) Thesis topic: Food consumption pattern among lactating mothers in H P Vientiane capital, Lao PDR Thesis code: page) (Written on the right corner of thesis cover U Hanoi, Date 14th October, 2019 Thesis topic has correct orientation and specialized codes (Master of public health applied science orientation/ Master of public health applied research orientation) Yes H In general, the thesis is poorly written, with lots of spelling and gramma mistakes Sentences are difficult to be understood Student should have proved reading carefully for the thesis Thesis title: Comments: The thesis is on track and inline with Master of public health - applied science track Which part need to be edited, (if any): ……………………………………………… Research summary: Comments: The abstract already summarise main content of the thesis Which part need to be edited, (if any): ……………………………………………… 75 Add abstract of the thesis Introduction: Comments: ………………………………………………………………………… Introduction was revised and used research during the past 10 year (updated compared to the last version) You should consider whether or not keep the second paragraph in page as it does not link with what in following paragraphs Which part need to be edited, (if any): …………………………………………… Research Objectives: Comments: H P Objectives are relevant to research topic Which part need to be edited, (if any): ……………… Literature review: Student already restructured the literature review, with new and appropriate headings  1.3 Student should summarise advised diet for lactating mothers so that you can use that to assess whether or not consumption is appropriate U  1.5 No reference yet, you should also move this content to definition 1.1  1.6.2 should be “factors associated with food consumption pattern” H  contents of 1.6.2.1 – 1.6.3.2 are not relevant to the headings and not reflect how those factors are associated with food consumption pattern Which part need to be edited, (if any): ……………………………………………… As above… Subjects and research methods: Comments: (i) Subjects are suitable to objectives; (ii) Sample size and sample selection are appropriate and feasible; (iii) Variables/contents are suitable to objectives, orientation and specialized codes; (iv) Data collection is clear, feasible and appropriate with research content; (v) Data analysis and research ethic are written clearly and appropriately; (vi) Other comments (if any):  Study already conducted so please use past tense for all part of methodology, not “will be” as in the proposal 76  This study is designed for Vientiane capital, so sample should represent the whole Vientiane Why did you choose same sample size for hospitals? You should describe more about Vientiane and those hospitals Which part need to be edited, (if any): ……………………………………………… As above…… Research results: Comments: (i) Research results are suitable with objectives, orientation and specialized codes; (ii) Research result is presented clearly and followed by objectives; (iii) Using data analysis appropriately and ensuring confidence of these methods; and other comments (if any): ……….………………………………………………………… H P  The questionnaire was not well designed (or translated), so there are many problems with results regarding the consistencies between results and questionnaire  F1: why bamboo shoot is an example of wild food?  Also, As I read in the questionnaire, you did not state clearly that you asked the mothers about their diet habits, and factors DURING lactating period, so people might answered you about their habit in general, but what you really want to know is food patter during their lactating period U H => Those comments already given during the first review, student The new results part already presented based on objective and Student should check table 11 (page 38) , number should not be NA Which part need to be edited, (if any): ………………………………………………… As above Discussion: Comments: (i) Structure/Content of this part are suitable to objective and research results; (ii) Reference citation is correct: ………………………………………………… 77 Poor discussion Do not repeat literatures review Add more part to discuss about similarity and/or differences with other studies => Still poor discussion but improved compare to the first version Which part need to ………………………………………………… be edited, (if any): …As above… 10 Conclusion: Comments: (The main research result are given in this part and suitable to objectives) H P Short discussion, not need “according to…” or “this study found…” Which part need to be edited, (if any): ……………………………………………… As above 11 Recommendations U Comments: The recommendation is given appropriately and based on research results: No comment………… Which part need to ………………………………………………… be edited, H (if any): 12 FINAL CONCLUSION: (NEED TO BE CLEARLY STATE): [ ] Approval [ x] Approval with some conditions [] Reject (Notes: Please not WRITE your name because this is a hidden comment round) Reviewer Nguyên Ngọc Bich 78 H P H U 79 H P H U 80 H P H U 81 H P U H Reviewer 82 Annex 9: Minute of explanation MINISTRY OF HEALTH HANOI UNIVERSITY OF PUBLIC HEALTH FORM MINUTES OF EXPLANATION AFTER THESIS/PROPOSAL DEFENCE Full name: Mr Phonepaseuth Southalack H P Thesis title: Food consumption pattern among lactating mother during 2019 in Vientiane Capital, Lao PDR TT Student’s explanations detail Comments (List all comments followed by outline/dissertation/thesis/thematic structure) U Orientation and specialized codes …… Thesis topic … Abstract … (Clearly state how, which part, page that student edits if students disagree, reasons should be indicated) H Introduction - Introduction was revised and used - I keeped the second paragraph in page research during the past 10 year (updated compared to the last version) Should consider whether or not to keep the second paragraph in page as it does not link with what 83 in following paragraphs Objectives - Objectives: you don‟t need general General objective deleted (page 3) objective, just delete it Review of framework Literature/Theoretical - 1.3 Student should summarise - I added summary (page 12) advised diet for lactating mothers so International bodies recommend a that you can use that to assess whether or not consumption is balanced diet that incorporates fresh appropriate vegetables and fruits, whole grains, - 1.5 No reference yet, you should protein foods and small quantities of also move this content to definition fat…… The energy cost of milk 1.1 production in the first six months of - 1.6.2 should be “factors associated exclusive breastfeeding increases with food consumption pattern” women„s daily energy needs by 30% or - Contents of 1.6.2.1 – 1.6.3.2 are 1260 kJ/day above the pregnancy energy not relevant to the headings and requirement (page 12) not reflect how those factors are associated with food consumption - I added reference and added some information (page 13) pattern H P U H - I changed “Maternal factors” to “Factors associated with food consumption pattern” in 1.6.2 (page 14) - I changed the paragraph (1.6.2.1 page 14 and 1.6.3.2 page 16) … Objects and research methods The study was conducted in out of - This study is designed for Vientiane capital, so sample should districts in Vientiane Capital, Laos PDR, represent the whole Vientiane Why representing urban area (Sisattanack did you choose same sample size for district hospital), peri-urban (Hard Xaiy Fong district hospital), and suburb area 84 hospitals? You should describe (Santhong district hospital) more about Vientiane and those Vientiane Capital has districts with hospitals population 196,731 people It divides in zones: districts belong to urban zone, districts belong to semi urban and districts belong to rural zone We selected represent district from zones (page 22) - The method: write this section in past simple tense rather than present or future tense Page 26 Ethical approval decision numbers were mixed up between HUPH and Vientiane  please change accordingly 2.6 Data analysis method Stata version 13 Statistical package was used to generate descriptive and inferential statistics such as mean, median, standard deviation and standard errors Univariate analysis was used to describe factors associate with food consumption pattern and p value less than 0.05 and 95% Confidence Interval for statistical significance 2.7 Ethic consideration H P H U For ethical considerations, research protocols and collection tools, these were submitted to the UHS Ethics Committee for Health Research, the Ministry of Health (Approval number: 112/19, Vientiane, 16/01/2019), and the HUPH Ethical Committee (Approval number: 477/2018/YTCC-HD3, Hanoi, 26/12/2018) The ethical consideration was based on the concepts in the Belmont report such as respect to patients, respect to anonymity and privacy, beneficence and doing no harm The participants were voluntary and could withdraw from the research at any time and the information 85 acquired was kept confidential and was only used in the research work This study interviewed lactating mothers by using a questionnaire only (Page 28 ) Study results  Student should check table 11 - I checked and new analysis (page 40) (page 38) , number should not be NA H P Discuss … 10 Conclusions … 11 Recommendations U … 12 References … 13 Questionnaire … 14 H Other comments - Limitation and bias: I added information (page 47) - Conceptual framework: Only food preferences were used as a dependent variable and utilized in the univariate analysis in Conceptual framework (page 20) … 86 Notes: - Use lines to separate each comments and explanations Comments and equivalent explanations stay at the same row Explanations should be written by following thesis structure (if any) Students not mention the examiners‟ name Day month year 2019 Student (Sign and full name) H P 1st supervisor 2nd supervisor (Sign and full name) (Sign and full name) H U Examiners’ comments (if any): …………………………………………………………………………………………