Parental dietary practices and asscoiated factors for children aged 3 5 years in rural districts, vientiane povince, lao pdr

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 PHOUTHAY SYSOUPHANE H P PARENTAL DIETARY PRACTICES AND ASSOCIATED FACTORS FOR CHILDREN AGED 3-5 YEARS IN RURAL DISTRICTS, VIENTIANE PROVINCE, LAO P.D.R U H MASTER OF PUBLIC HEALTH CODE: 8720701 HANOI, 2020 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 PHOUTHAY SYSOUPHANE H P PARENTAL DIETARY PRACTICES AND ASSOCIATED FACTORS FOR CHILDREN AGED 3-5 YEARS IN RURAL DISTRICTS, VIENTIANE PROVINCE, LAO P.D.R U MASTER OF PUBLIC HEALTH H CODE: 8720701 SUPERVISOR: CHANDAVONE PHOXAY, MD, PhD DIRECTOR OF NATIONAL NUTRITION CENTER HANOI, 2020 ACKNOWLEDGMENTS I wish to acknowledge the support of the Medical Committeesfrom the Netherlands and Vietnam, the Hanoi University of Public Health, the Lao Tropical Public Health Institute and the University of Health Sciences in producing this work To my parents: both of you are my first role models I hope that you will be blessed with a long life Your relentless belief in my capabilities has allowed me to dare dream You have shown me that hard work brings results Thank you for being my never-ending supporters and also helping me to believe in myself H P I would like to express my sincerest gratitude to my supervisors, Professors Chandavone Phoxay, MD, PhD and Nguyen Thi Kim Ngan, MSc for their kindly offered suggestions throughout my research and thus helping me to complete this dissertation Thank you for never letting me quit and for believing that I could obtain a Masters degree Your professional support and personal friendship have U meant more than gold to me Finally, I would like to acknowledge all the parents who participated in this study and made its findings possible May you overcomewith strenght every H challenge you face in raising your children Thanks to all of you who have supported me and given me inspiration in the pursuit of my research goal i CONTENTS ACKNOWLEDGMENTS i CONTENTS ii ABBREVIATIONS iv LIST OF TABLES AND FIGURES v SUMMARY vi INTRODUCTION RESEARCH OBJECTIVES CHAPTER 1: REVIEW OF LITERATURE 1.1 Definitions 1.2 Proper dietary practices for children aged 3-5 years old H P 1.3 Overview of the problems caused by inadequate parental dietary practices for their children 1.4 Factors associated with dietary practices: 12 1.5 Overview of areas intended to implement research 16 1.6 Overview of methods 16 1.6.1 Food frequency questionnaire (FFQ) 16 U 1.6.2 Food security (FS) 17 Conceptual framework 18 CHAPTER 2: SUBJECTS AND METHODS 19 H 2.1 Subjects 19 2.1.1 Inclusion criteria: 19 2.1.2 Exclusion criteria: 19 2.2 Study site and duration 19 2.2.1 Study site 19 2.2.2 Study duration 19 2.3 Study design 19 2.4 Sample size 20 2.5 Sampling method 20 2.6 Data collection method 21 2.6.1 Questionnaires 21 2.7 Study variables 23 2.8 Data analysis methods 23 ii 2.9 Ethical issues 24 CHAPTER 3: RESULTS 25 3.1 Socio-demographic characteristics of parents 25 3.2 Parental dietary practices for children aged 3-5 years 27 3.3 Parental knowledge of dietary practices for children aged 3-5 years 29 3.4 Parental perception of food security 31 3.5 Social and neighborhood characteristics 32 3.6 Bivariate analysis for factors associated with parental dietary practices for children aged 3-5 years 33 3.7 Factors associated with parental dietary practices for children aged to years 34 CHAPTER 4: DISCUSSIONS 37 H P 4.1 Summary of results and comparison with previous research 37 4.2 Limitation of the study 42 CONCLUSION 43 RECOMMENDATIONS 43 REFERENCE 44 ANNEX 1: MEASUREMENT OF STUDY VARIABLES 53 U ANNEX 2: QUESTIONNAIRE (ENGLISH VERSION) 58 ANNEX 3: QUESTIONNAIRE (LAO VERSION) 63 ANNEX 4: INFORMATION SHEET FOR PARTICIPANTS 69 H ANNEX 5: INFORMED CONSENT FORM FOR PARTICIPANTS 71 ANNEX 6: ETHICAL APPROVAL 72 ANNEX 7: THESIS COMMENTS 74 ANNEX 8: MINUTES OF EXPLANATION AFTER THESIS DEFENCE 80 iii ABBREVIATIONS BMI Body Mass Index CVD Cardiovascular Disease CFPQ Comprehensive Feeding Practices Questionnaire CU5 Children Under The Age Of Five Years old FS Food Security FFQ Food Frequency Questionnaire HFSSM Household Food Security Survey Module LSIS Lao Social Indicators Survey LSB Lao Statistics Bureau MDG Millennium Development Gold NNS National Nutrition Strategy NCCN National Comprehensive Cancer Network NHANES SDG UNL US H P U H National Health and Nutrition Examination Survey Sustainable Development Goals United Nations Lao United States USDA United States Department of Agriculture WB World Bank WHO Word Health Organization iv LIST OF TABLES AND FIGURES Table 3.1 Socio-demographic charateristics of parents Table 3.2 Parental dietary practices for children aged 3-5 years Table 3.3 Level of parental dietary practices for children aged 3-5 years Table 3.4 Knowledge of parents about dietary practices for children Table 3.5 Level of knowledge about dietary practices Table 3.6 Parentsperception about food security Table 3.7 Level of perception about food security of parents Table 3.8 Social and neigbourhood among parents Table 3.9 Bivarite analysis for factors associated with parental dietary H P practice for children aged 3-5 years Table 3.10 Multiple regression analysis for factors associated with parental dietary practices for children aged 3-5 years U H v SUMMARY Nutrition plays an important role in childhood growth and development Preschool-aged children have nutritional problems due to their environmental preferences and inability to choose healthy food Good nutrition is thus crucial as the body needs the promotion of growth and development Inappropriate and insufficient provision of food and the five food groups will cause a halt in children‟s growth, deficient intelligence and frequent illness Accordingly, children should be given the five food groups with various kinds of food in each group for three meals a day and milk as a supplementary food Parental dietary practices have been H P highlighted as an important psychometric factor for improving the nutritional outcomes of children However, parental dietary practices have not been extensively studied in Laos Thus this study was carried out to assess parental dietary practices and the related factors of parental dietary practices among children aged 3-5 years in rural districts, Vientiane province, Lao P.D.R in 2019 U A cross-sectional study was conducted from January to December 2019 A sample of 400 parents who had children aged 3-5 years old and living in four districts in Vientiane Province participated in this study The data were collected H through face-to-face interviews with the parents using a structured questionnaire The data were analyzed using STATA software Descriptive statistics, univariate analysis, and multiple logistic regressions were used The dietary practices among 72.7.% of the parents of children aged 3-5 years old were poor, and the practices among 27.2% of them was good Most parents allowed children to eat candy and cakes But they provided cheese less than animal milk to their children More than 90% of parents prepared green vegetables and fruit, almost 90% prepared eggs, more than 70% prepared meat, but only 16% of parents prepared milk for their children More than one-third provided for their children three or more meals a day Factors associated with dietary practices of parents were religion (p-value =0.041), household members (p-value =0.001), monthly allowance (p-value < 0.001) and knowledge (p-value < 0.001) vi More than two-third of parents had poor dietary practices for feeding children aged 3-5 years old Most parents gave children candy and cakesbut little animal milk Religion, household allowance, household members and knowledge were associated with parental dietary practices for feeding children aged 3-5 years old in rural districts in the Lao P.D.R There is an urgent need to provide a nutrition education program for parents in school and communities to raise their knowledge and awareness about proper dietary practices in order to improve children‟s nutrition levels H P U H vii INTRODUCTION Nutrition is the most important condition for the preservation of health, normal growth and development of the human body Nutrition is food intake in accordance with the dietary needs of the organism The food should contain all the necessary nutrients to maintain the normal functioning and development of the organism, such as proteins, fats, carbohydrates, vitamins, minerals and water in the required quantities At the same time, the needs are individual and depend on age, type of employment, living conditions and so on Proper nutrition is a well-balanced diet combined with regular physical activity, which is the basis of good health H P (Allagulova, 2016) According to the World Health Organization, in 2018, the mortality rate of children under five years of age (CU5) in low-income countries was 68 per 1000 live births Half of these CU5 deaths took place in sub-Saharan Africa, and another 30% in Southern Asia The CU5 death rate was almost 14 times that in high-income U countries (5 per 1000 live births) (WHO, 2018a) In sub-Saharan Africa, in 13 children died before their fifth birthday In high-income countries, that number was in 185 (WHO, 2018b) Globally, 85 percent of deaths among children and young H adolescents in 2018 occurred in the first five years of life, accounting for 5.3 million deaths, of which 2.5 million (47%) occurred in the first month of life, 1.5 million (29%) at age 1–11 months, and 1.3 million (25%) at age 1-4 years An additional 0.9 million deaths occurred among children aged 5-14 years (WHO, 2019a) Approximately 3.1 million children die from undernutrition each year Hunger and undernutrition cont ibute to more than half of global child deaths; undernutrition can make children more vulnerable to illness and exacerbate disease (WHO, 2019b) In 2018, globally there were 149 million CU5 who were stunted, 49 million who were wasted and 40 million who were overweight (WHO, 2019c) ANNEX 4: INFORMATION SHEET FOR PARTICIPANTS Study Title: Parental dietary practices and associated factors for children aged 3-5 years in rural districts, Vientiane Province, Lao P.D.R Investigator: Phouthay SYSOUPHANE Thank you very much for your participation The objective of this study is to assess parental dietary practices for children aged 3-5 years, in rural districts, Vientiane province, Lao P.D.R in 2019 In this study, we would like you to take part in an interview It takes about 20 to 30 minutes of your time If you agree to participate, we would like you to give us your name and telephone number In the H P interview, we will ask you 36 questions related to your background , dietary practices, knowledge about food, household food security and social/neighbourhood characteristics The identity of the participants will not be disclosed to the public What we learn from you will help us to improve our understanding of parental dietary practices for children aged 3-5 years in rural districts This study has been approved by the Ethics Committee of the University of Health U Sciences Laos Your participation to this study is entirely voluntary and you may refuse to answer any question whatsoever Furthermore, you may withdraw your consent to participate at any time without penalty and neither is there any risk for your health H because we not take any samples from you (blood or tissue etc.) However, there are some sensitive questions to be asked in this questionnaire All the information we obtain will remain strictly confidential and your answers will never be revealed.We will tell you the correct answers regarding the knowledge- and parental dietary practices segments at the end of the interview In addition, you will receive a small gift after finishing the interview You may ask questions about the study at any time If necessary, please not hesitate to contact Mr Phouthay SYSOUPHANE, Office address: Vientiane Province School of Nursing, Lao PDR Telephone: 856 20 5404 5679 email: sphouthay@yahoo.com If the researcher has new information regarding benefits or risks/harm, participants will be informed as soon as possible 69 Contact address for answering questions/complaints about Research ethics (information of the Ethics Council: IRB HUPH, 1A Duc Thang street, Bac Tu Liem district, Hanoi, Vietnam; email: irb@huph.edu.vn) Tel: 02462663024 H P U H 70 ANNEX 5: INFORMED CONSENT FORM FOR PARTICIPANTS Lao People’s Democratic Republic Peace Independence Democracy Unity Prosperity Informed Consent Form for Participants To: Ethical Committee of the University of Health Sciences Laos and Institutional Ethical H P Review Board of Hanoi University of Public Health Study Title: Associated factors and parental dietary practices for children aged 3-5 years in rural districts, Vientiane Province, Lao P.D.R U Investigator: Phouthay SYSOUPHANE This study is about parental dietary practices If you agree to participate you H will be asked to attend a brief introductory session and two additional sessions, both 30 minutes in length, as well as fill out surveys about your feeding practices in regard to your child between the ages of three to five years You may skip any questions that make you feel uncomfortable and may discontinue your participation in the research study at any time without penalty Your participation in this research is purely voluntary There are no known risks associated with this research Do you agree to take part in this study? Yes Participant’s signature Date:…./……/…… No Thank you 71 ANNEX 6: ETHICAL APPROVAL H P U H 72 H P U H 73 ANNEX 7: THESIS COMMENTS HANOI UNIVERSITY OF PUBLIC HEALTH THESIS COMMENT FORM OF MASTER PROGRAM (For reviewer of thesis defence committee – Master Program) Thesis topic: Parental dietary practices for children aged 3-5 years in rural districts, Vientiane Province, Lao PDR in 2019 Thesis code: page) Public Health (Written on the right corner of thesis cover H P Vientiane Capitlal, Date 24 January 2020 Thesis topic has correct orientation and specialized codes (Master of public health applied science orientation/ Master of public health applied research orientation) Yes Thesis topic: Comments - Year specified in the title may not be appropriate since the dietary practices did not start and occur in 2019 This came from the behaviour of parents which last for long time ago U H Which part need to be edited, (if any): delete 2019 Research summary: Comments: The result and conclusion are almost the same Which part need to be edited, (if any): Need to revise the conclusion part Introduction: Comments: In page 1, paragraph 2, describe about the death of the children in general, is it possible to add information about the death of children aged 3-5 related to nutrition? 74 Are there any information about the death related to nutrition of Lao children, especially aged 3- years Since the title is about Vientiane province, the author need to add the information about it, are there any problems related to the nutritional status of children? How important is it? Which part need to be edited, (if any): Add more information about death related to nutrition of children age 3-5 years, global, rational and Laos Research Objectives: Comments None Which part need to be edited, (if any): None Literature review: Comments: (structure and content of literature review are coherent with objectives and research topic, use updated reference and citation correctly, and other comments (if any): Need to be revised and reorganized some of the reviews in 1.3 Some are not relevant with the objective The objective is identify the factors related to dietary practices, but some reviews are about the factors related to nutritional status of children These information should be moved to 1.2 H P Which part need to be edited, (if any): need to reorganized some information and add more related literature reviews U The operational definition should be added in order to understand the variables using in this thesis 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): - The exclusion criteria should not be opposite of the inclusion criteria It should be something that the same as inclusion criteria but there are some factors that are not able to include it - Need to explain why the author choose Vientiane province - The coefficient of reliability is quite low 0.59, please add some explanation - Need to explain how to choose independent variables into multivariate analysis and which method used H Which part need to be edited, (if any): revise and explain as comments above 75 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): Is there information about the gender of parents since the author included both mother and father to be the study subjects How’s the educational level classified into low and high education? Which part need to be edited, (if any): revise and explain as comments above Discussion: Comments: (i) Structure/Content of this part are suitable to objective and research results; (ii) Reference citation is correct: The author should explain what kind of bias that probably occur and how it impacts to the results of the study and are there any confounding factors in this study? H P Which part need to be edited, (if any): Add discussion about bias and confounding in 4.2 Conclusion: U Comments: (The main research result are given in this part and suitable to objectives) The conclusion is mixed up with recommendation H Which part need to be edited, (if any): need to revised, should be clear between conclusion and recommendation 10 Recommendations Comments: The recommendation is given appropriately and based on research results: Recommendation should base on the finding Which part need to be edited, (if any): ……………………………………………………………………………………… 11 FINAL CONCLUSION: (NEED TO BE CLEARLY STATE): [ ] Approval [  ] Approval with some conditions [ ] Reject The author need to consider revise some point based on comments (Notes: Please not WRITE your name because this is a hidden comment round) 76 HANOI UNIVERSITY OF PUBLIC HEALTH THESIS COMMENT FORM OF MASTER PROGRAM (For reviewer of thesis defence committee – Master Program) Thesis topic: Parental dietary practices for children aged – years in rural districts , Vientiene province, 2019 Thesis code: page) (Written on the right corner of thesis cover H P Hanoi, Date 29 Month 01 year 2020 12 Thesis topic has correct orientation and specialized codes (Master of public health applied science orientation/ Master of public health applied research orientation) U Yes 13 Thesis topic: Comments H Topic is relevant to Public Health major…… Which part need to be edited, (if any): No……… General comment: - There are many spelling and grammar mistakes Name of thesis should add “and associated factors” 14 Research summary: Comments: No summary yet, need to prepare summary 15 Introduction: Comments: Too long, should be only – 1.5 page 77 16 Research Objectives: Comments………………………………………………………………………… Objectives are clear and appropriate 17 Literature review: Comments: (structure and content of literature review are coherent with objectives and research topic, use updated reference and citation correctly, and other comments (if any): - Structure should be: - Definition - Proper dietary for children aged - - Problems cased by poor dietary for children - Situation of parental dietary practice - Factors associated with dietary practice - Tools to measure food frequency H P Conceptual framework might be revised: - Social and neighbourhood together with food security can be: environmental factors U 18 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): H Withdraw exclusion criteria: Parents who failed to provide consent for any reason Describe how to select districts, village 19 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): Structure revision is needed Present results by objective General information Practice of parents 78 Factors (including knowledge and perception) For objective 2: should present by factors: individual, environmental factors 20 Discussion: Comments: (i) Structure/Content of this part are suitable to objective and research results; (ii) Reference citation is correct: ………………………………………………… Discussions should follow the two objectives Discussions were not prepared appropriately, please see the instructions especially for objective Discussion should be atleast 25% of the thesis 21 Conclusion: Comments: (The main research result are given in this part and suitable to objectives) H P Conclusion should follow the two study objectives 22 Recommendations Need to be more specific based on research results and should be to improve K and P of health workers, not to improve the immunization (change schedule etc.) U 23 FINAL CONCLUSION: (NEED TO BE CLEARLY STATE): [ ] Approval [x] Approval with some conditions [] Reject ……………………………………………………………………………………… H ……………………………………………………………………………………… ……………………………………………………………………………………… (Notes: Please not WRITE your name because this is a hidden comment round) 79 ANNEX 8: MINUTES OF EXPLANATION AFTER THESIS DEFENCE H P U H 80 H P U H 81 H P U H 82 H P U H 83