a study on malnutritional situation, some relevant factors and proposed solutions to under fives children at viet yen district - bac giang province, 2006-2008

BACKGROUND Assessing nutrition status of children provides accurate and update information not only for malnutrition in children but also for policy making process. Malnourished children usually suffer from illness and have longer time being with the diseases. Malnutrition increases the risk of suffering from diseases, especially measles and parasitological diseases. Malnutrition contributes to 61% of diarrhoea mortality, 57% of pneumonia mortality and 45% of measles mortality (Black 2005, Bryce 2007) [6], [9]. In return, malnutrition is a consequence of diarrhoea and acute respitory infection. Malnutrition remains as a severe public health problem, particular in the poor and vulnerable areas such as Bac Giang province. Although achieved successes in socio-economy and health care for community, the Bac Giang province still face difficulties and challenges inclduing malnutrition in children. In order to contribute to building strategies to address malnutrition in the poor areas in the future, we propose the study named “Malnutrition situation, related factors and solutions for children under 5 years old in Viet Yen district, Bac Giang province in 2006-2008” to assess the malnutrition status of children in some mountainous districts, describe relationships between nutrition status and diet, and determine 1 relationships of nutrition status and intestinal parasitological infection in children. Then, the appropriate solutions will be suggested contributing to the malnutrition prevention and control initiatives in Vietnam. OBJECTIVES 1. Describe malnutrition status, diet, intestinal parasitological infections and some usual infections in children. 2. Determine relationships between malnutrition, diet and intestinal parasitological infection in children. 3. Assess effectiveness of nutritional interventions in children under 5 years old in Viet Yen district, Bac Giang province. HYPOTHESIS Poor diets cause malnutrition, and malnutrition and nutritional anemia are related to the intestinal parasitological infection in children under 5 years old. 2 CHAPTER 1 LITERATURE REVIEW 1.1. Malnutrition in children Consequence of hunger is malnutrition [39]. Hunger affects firstly the vulnerable subjects such as pregnant women, lactating women and preschool children. These are reflected by the anthropometric indicators [101]. In field work, researchers mainly use the anthropometric indicators including weight for age, height for age and mid-upper arm circumference to classify the nutritional status [101], [121], [127]. Infants who were born in term with weight under 2,500g are fetal malnutrition. Fetal malnutrition is the earliest malnutrition category. In these children, organs such as skin, muscle, bone, brain, liver and kidney are affected, especially in low birth weight infants. 1.2. Trend of malnutrition in the world According to the WHO [227], the current underweight prevalence of children under 5 years old decreases. From 1975 to 1995, this figure went down from 42.6 % to 34.6%, from 1995 to present (2010) it is at 25%. Decreasing malnutrition in children under 5 years old was recorded in all regions in the world. The decrease in Asia is higher than that of other regions and has significant effect as the most quantity of malnutrition children used to distribute in the highest density of population. There is at least two third of malnutrition children residents in 3 Asia a half among them live in 8 countries of Southest Asia is malnutrition either based on weight for age or weight for height [73], [132], [157]. Table 1.1. Underweight prevalence by regions among developing countries from 1975 to 2010 [200]. Regions 1975 1990 1995 2010 % Mil % Mil % Mil % Mil Africa America Asia 30.4 15.6 47.8 22.9 7.5 164.6 27.3 11.5 41.3 31.6 6.4 154.6 27.0 10.8 40.0 34 6. 158 28.5 8.0 24.0 24.8 5.4 88.3 Under development countries 42.6 195.6 35.8 193.4 34.6 199.8 33.6 105.9 Global 34.6 198.6 31.3 195.8 - - 26.0 167.0 The decrease average in 5 year for protein energy malnutrition in developing countries % decreasei n next 5 years Period 1975- 1980 1980- 1985 1985- 1990 1990- 1995 1995- 2010 2010- 2015 Decrease 5.2 % 6.2 % 5.5% 3.4% 3.2% 4.3 % 1.3. Trend of malnutrition in children in Vietnam Table 1.2. Malnutrition of children under 5 years old in Vietnam in two national nutrition surveys [35], [42] Time Underweight Stunting 1981-1985 51.5 % 60.9 % 1994 44.9 % 46.9 % 2000 33.8 % 36.5 % 2010 17.5% 29.,3 % The table 1.2 shows the decrease trend of the malnutrition in children in Vietnam. 4 Recently, partly as a result from the development of economy and achievements of the nutrition and health promotion programs, the rapid decrease in malnutrition prevalence was determined in many cross sectional studies, particularly in major cities. However, protein energy malnutrition in children is still a major challenge for public health in Vietnam. By 1990, prevalence of malnutrition in children went down significantly, the pace of decrease is remarkable. Although, to date, malnutrition is still at the high level, especially stunting and the difference between geographic areas is wide [39]. Additionally, subclinical vitamin A deficiency, iron anemia are challenging which is more serious in the poor areas [43], [44]. Table 1.4. Recommendation for minerals and vitamins for children [11]: Age Minerals Vitamin (mcg) Calci Fe A B1 B2 PP C Under 6 months 300 10 325 0,3 0,3 5 30 6-12 months 500 11 350 0,4 0,5 5,4 30 1-3 years 500 6 400 0,8 0,8 9 35 Addressing engery deficiency of these subjects needs to concern of the capacity of local areas and households which are the self-supply ability from the VAC model, the low average income in poor families in rural areas (approximately over 30%). In conclusion, poverty is the main reason of malnutrition and the relationship between poverty and malnutrition is complicated. Nutrition status is both reason and result for the 5 increasing income. Additionally, other factors such as imbalance diet, poor practice in cooking and preparing foods, low food hygiene and safety, limited access clean water resources and health care services are also important. Malnutrition in children is also affected by other factors. 6 CHAPTER 2 METHODOLOGY The study was conducted in two stages: - First stage: Cross-sectional study - Second stage: Community based intervention 2.1. Subjects: Inclusion criteria for the cross-sectional study - Chidlren under 5 years old (0 - 59 months). - The owners of households and parents of the children selected. - Living in the 03 communes selected. - Willing to particiapte in the study. 2.2. Study site, time of the study: - The study was conducted in 3 communes (Bich Son, Nghia Trung and Van Trung) Viet Yen district, Bac Giang province. - Time: 03 years, from 2006 to 2008 The study was conducted in Viet Yen district where is bordered with Bac Ninh provine at the South, Hiep Hoa district at the West, Yen Dung district at the East, Tan Yen district at the North. 2.3. Study design The analytical cross sectional study: determine malnutrition in children under 5 years old according to places and time, check blood and check for worm infection. 7 The study was implemented at the household level including interview the owners, parents of children under 5, and anthropometric measures for children and their parents. Simultaneously, check blood and detect for worm infection for the children selected. Intervention: community based intervention with case and control groups for pre and post evaluations. After conducting the cross sectional study for nutrition status assessment, the intervention was implemented based on the results of the previous study in order to select the control and intervention groups. 2.4. Sample size: 2.4.1. Sample size for cross sectional study * Sample size for the nutrition status, anemia, intestinal parasitological infection study: The number of children need for the cross sectional study was calculated by the fomular as below [1]: n = Z 2 * p * (1-p)/ e 2 Including: n: The number of children needed Z: level of confidence, with 95%; Z=1.96 p: prevalence of children with infection (malnutrition; anemia; or intestinal parasitological infection) e: precision, select 5%. 8 The number of children needed as shown in the table 2.1. * Sample size for the dietary study: The fomular: t 2 * σ 2 * N n = e 2 * N + t 2 * σ 2 Including: n: sample size t : standard unit (=2 with probability = 0,954) σ: standard deviation of the estimate energy 300 Kcal e: deviation (select e=100 Kcal) N: total children of schools (approximately 600 children/school) Applying these values into the fomular we had the number of children need for the dietary survey was 58 children for each commune. The total number of children for 3 communes was 174. Sampling Select 3 communes for the study, thus the total number of children for i) Nutrition status survey: 1,200 children; ii) Aneamia survey: 300 children; iii) Intestinal parasitological infection survey: 300 children and iv) Diet survey: 174 children. 2.4.2. Sample size for intervention study: Apply the fomular for difference of mean of observations pre and post intervention [10] 9 N = 2s 2 (d 1 -d 2 ) 2 Including: + s: standard deviation of Hb concentration before and after the intervention. Reference from a study of NIN 2009, s = 7,3 g/L [17]. + α: Statistical mean, is the probability to get the errors type 1, select α:= 0.05, coresponding to the precision is 95%. + β: probability to get errors type 2, select β = 0,1. + Z(α , β ) = 10,5 (coresponding to α = 0.05 and β = 0.1). + d1 - d2: the difference of the mean of Hb concentration between the control and intervention groups, according to a study of NIN this was d1 - d2: = 4 g/L [17]. Therefore, the sample size needed was 70 children aged 2 - 5 years old for each group. Estimate 20% for lost to follow up we had the total ò 84 children for each group. Sampling process and stratification: After the crosss sectional study stage we conducted the intervention. The process for sampling and stratification as below: - Stratification: Stratification was based on the commune unit. The study was devided into two groups: - The control group: Children were supplemented the sugar condensed milk. 10 [...]... micronutrients reduces the aneamia and improves the iron status indicators in children 25 RECOMMENDATION 1 Improve knowledge, attitude, and practice in parasitological infection prevention by nutritional and health care education and communication programs 2 Integrate, coordinate the parasitological infection prevention programs with health care, clean water supply, nutritional, children and maternal... (2011), “Mother who aware of nutrition care and her children under 5 years of age in Viet Yen district - Bac Giang , Journal of Vietnam Medicine, Volum 383, July, No 2/2011, pp.25 - 28 3 Nguyen Thi Ngoc Bao, Nguyen Manh Hung, Le Danh Tuyen (2011), “Relationship between malnutrition and anemia and worming infection of the children under 5 years of age in Viet Yen district - Bac Giang , Journal of Preventive... quantity of nutrients and balanced quality, particularly for micronutrients Improving height of the Vietnamese is a challenged target as the meeting of the 17 recommendations for iron of children aged 2 4-3 5 months was at 56% and it was 87% for the children aged 3 6-5 9 months 18 Table 3.9 The average of energy intake compared to the recommendations for children 2 4-5 9 months calssified by malnutrition... the control group was 11.84± 1.28 g/dl after the intervention time, has no significance (p>0.05) Thus, we can conclude that supplementation of milk fortified with micronutrients may improve anemia indicators for children CONCLUSION The results of the study show that: 1 Nutritional status and related factors - The prevalence of underweight, stunting and wasting of children under five years old were at. .. particualrly micronutrients - Knowledge of people about anemia was limited Approximate a half mothers could indicate one of the reasons for anemia was malnutrition 24 - The prevalence of worm infection was 28.7% for 3 communes Worm infection closely related to malnutrition and anemia 2 Effectiveness of the intervention - The HAZ-scores statistically significant increased Similarly, WAZ-score rose much... months was 202g/day (figure 3.3) Average of bean nuts intake was 10g/day Soy bean which is one of the good sources of protein with cheap price, but was not paid attention on diet for children (5.11 g/day) 15 - Animal food (excluding milk) intake on average was 110g/child/day, which was mainly from meat (42.2g/capita/day), fish (42 g/day) and egg (15.9g/child/day) - Milk was consumed by children aged... health facilities for diarrhoea treatment; and 11.3% mothers treated their children at home 3.3 Risk factors of malnutrition in children 3.4 Effectiveness of the intervention (As the intervention was conducted in a short time, the sutdy only assess the mean of change of the WAZ scores and HAZscores as below) Table 3.26 Nutrition status before the intervention Contents Average WAZscore Average HAZscore... Book 2008 The prevalence of malnutrition in children under five years old in three communes in Viet Yen district is at severe level as that of Bac Giang province a) Malnutrition status of children under 5 according to communes Table 3.3 Malnutrition in children under 5 years old based on communes Places Malnutrition Bích Sơn Vân Ngh a Total commune (n=400) Weight/age (%) CI 95% Height/age (%) CI 95% Weight/height... serious anemia during the 6 month duration of the study were also treated and excluded to the study then inform to the local health department to continuing monitor The control and intervention groups were supplied with 200 ml milk daily, the intervention children (NNC) were supplied 4.1 mg iron, 450 IU vitamin A and 4.6 mg zinc and other micronutrients such as group B vitamins, vitamin C and deworming each... children aged 2-5 years old at the level of 143.5 ml/day The protein provided 17% the total energy from diet and met the recommendations - Oil and fat consumption was 3.6 g/day on average Table 3.6: Nutritional value of diet Contents Energy (Kcal) Protein (g) + Total + Animal Lipit (g) + Total Nutrients Ca (mg) P (mg) Fe (mg) Zn (mg) Vitamin A (mcg) Vitamin B1(mg) Vitamin B2 (mg) Vitamin PP (mg) Vitamin C . malnutrition in the poor areas in the future, we propose the study named “Malnutrition situation, related factors and solutions for children under 5 years old in Viet Yen district, Bac Giang. intervention. The process for sampling and stratification as below: - Stratification: Stratification was based on the commune unit. The study was devided into two groups: - The control group: Children. malnutrition status, diet, intestinal parasitological infections and some usual infections in children. 2. Determine relationships between malnutrition, diet and intestinal parasitological