Luận văn 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 PARENTAL DIETARY PRACTICES AND ASSOCIATED FACTORS FOR CHILDREN AGED 3-5 YEARS IN RURAL DISTRICTS, VIENTIANE PROVINCE, LAO P.D.R 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 PARENTAL DIETARY PRACTICES AND ASSOCIATED FACTORS FOR CHILDREN AGED 3-5 YEARS IN RURAL DISTRICTS, VIENTIANE PROVINCE, LAO P.D.R MASTER OF PUBLIC HEALTH 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 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 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 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 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 1.6.2 Food security (FS) 17 Conceptual framework 18 CHAPTER 2: SUBJECTS AND METHODS 19 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 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 ANNEX 2: QUESTIONNAIRE (ENGLISH VERSION) 58 ANNEX 3: QUESTIONNAIRE (LAO VERSION) 63 ANNEX 4: INFORMATION SHEET FOR PARTICIPANTS 69 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 National Health and Nutrition Examination Survey SDG Sustainable Development Goals UNL United Nations Lao US 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 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 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 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 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 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 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 (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 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 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)