Muc tieu; Xac dinh ti le thilu mau, thieu sat va cac yeu to lien quan vdi tinh trang thieu vi chat nay d PNMT, phu nii cho con bu va tre em < 5 tuoi.. PNCT dugc liy mau xet nghiem Hb, fe
Trang 1TINH TRANG THIEU MAU D|NH D U Q N G 6 PHU NX? CO THAJ,
BA ME CHO CON BU VA T;11E Dir6l 5 TUOI TAI THANH PHO
HO c m MINH
Nguyen Nhan Thanli', Trdn Thi Minti Hanh\ Phan Nguyen Thanh Binh',
Le Nguyen Trung Due Son^, Pham Ngoc Oanh', Do Thi Ngoc Diep\ Le Thi Kim Qui •'
Khao sat tinh trang thilu mau d phu nii' cd thai (PNCT) nam 2006, tinh trang thieu mau d phu nii' cho con bii va tre em < 5 hili nam 2008 tai thanh pho Ho Chi Minh (TP.HCM) Muc tieu; Xac dinh
ti le thilu mau, thieu sat va cac yeu to lien quan vdi tinh trang thieu vi chat nay d PNMT, phu nii cho con bu va tre em < 5 tuoi Phuong phap; Dieu tra cat ngang; 776 PNCT, 711 ba me cho con bii (2-12 thang) va 644 tre < 5 tuoi tai TP.HCM PNCT dugc liy mau xet nghiem Hb, fenitin, CRP; Ba me cho con bii va tre < 5 tuoi dugc lay mau xet nghiem cong thiic mau; Bang cau hoi soan sin dugc dung de phong van kien thiic & thuc hanh cua PNCT, ba me cho con bii va tre < 5 tuli vl phong chong thieu vi chat Ket qua; Hb & ferritin huyet thanh tmng binh cua PNCT lan lugt la ll,9g/dl & 46ng/ml Ti le thieu mau & thieu sat va du trii sat thap lan lugt la 17,5%, 7.9%
va 34,7% PNCT uong sat it nhat 3 thang trong thai ky co ti le thieu mau thap hon PNCT khong uIng sit du 3 thang (14,5% so vdi 21,0%, p<0,05) PNCT uong sat it nhat 2 thang trong thai ky
CO ti le thieu sat thap hon PNCT khong uong sat du 2 thang (6,0% so vdi 10,6%, p<0,05) Ti le PNCT biet each phong ngira thieu mau (an du dinh duong ket hgp uong sat bo sung) la 26,6% Ti
le PNCT biet tac hai cua thieu mau la 41,3% Ti le thieu mau ciia ba me cho con bu va tre < 5 tuoi lin lugt la 9,6% va 11,6%
Tir khoa: Thieu mdu, hemoglobin (Hb),ferritn huyet thanh
L DAT VAN DE
Thieu mlu thieu sat la van de su'c
khoe cdng ddng anh hudng den >50%
PNMT d cic nudc Ddng Nam Chau A [1 ],
llm tang nguy ea tie cham phat trien ngay
tu trong bung me, sinh ra nhe can, sinh
non, suy dinh dudng, hole tu vong chu
sinh d me & con [2,3] Theo kit qua dilu
tra do Vien Dinh Dudng tien hanh nam
1988-1990 tren 2471 phu nii taoi sinh de
thi ti le thieu mau d thai phu vung ndng
thdn la 49% (3 thing cudi 11 59%), va d
Ha Ngi 1141% (3 thing culi la 48%) [
4-6] Ti le thieu mlu d PNCT toan qudc nim
2000 la 32,2%, d vung Ddng Nam Bg la
34,3% [7] Ket qua dieu tra do Vien Dinh Dudng thuc hien nam 2006 cho thay ti le thieu mau d PNCT, phu nii tadi sinh de
va tre < 5 tadi van cd y nghia sue khoe cdng ddng d muc do trung binh, lan lugt
la 37,6%, 26,7% va 36,7%
Chuang tiinh phdng chdng thieu mlu dinh dudng la chuang trinh qudc gia, dugc trien khai tren toln TP.HCM tu' nim
2005 vdi boat ddng chu yeu 11 bd sung vien sat & truyen thdng ve kien thuc phdng chdng thieu mlu cho thai phu Tuy nhien, den nay van chua cd sd lieu cu the
vl tinh trang thieu mau & kiln thuc vl phdng chdng thieu mau ctia PNCT, phu
' BS - Tmng tam dinh duong TPHCM
^ TS, BS - Trung tam dmh duong TPHCM
' BSCKII - Trung tam dinh duong TPHCM
" BSCKI - Trung tam dmh duo'ng TPHCM
Trang 2nu' cho con bu vl tre < 5 tadi tai TP.HCM
De cd ca sd djnh hudng cho chien lugc
can thiep nham cai thien tinh trang thieu
mlu d thai phu, phu nu' cho con bu v l tre
< 5 tadi gdp phan cai thien tam vdc ctia
gidng ndi bat dau tu sir phat trien cua bao
thai, Trung tam Dinh dudng (TTDD) da
tien hanh "nghien cu'u vdi muc tieu khao
sat tinh trang thieu mlu & thieu sat d
PNCT tai TPHCM nam 2007, tinh trang
thieu mlu d phu nu' cho con bu va tre < 5
tadi nam 2008": vdi muc dich xay dung
chien lugc can thiep phdng chdng thieu
mau hieu qua tai TP.HCM
II DOI TLTONG VA P H L T O N G PHAP
NGHIEN Ctru
1 Doi tu'O'ng
- Phu nir co thai: Tdng sd 776 thai phu
(25-30 thai phu d mdi PX) tham gia dieu
tra Cac ddi tagng dugc khim tdng quit,
danh gia thieu mau tren lam sang, can
bang can dien ta' TANITA sai sd 200g
Phdng van mgt sd thdng tin ve kinh te xa
hdi, chieu cao & can nang trudc mang
thai, bd sung sat, khim thai, & kien thuc
phdng ngua thieu mau luc mang thai dua
vao bang cau hdi soan san
Dinh lugng Ferritin & CRP: Mdi ddi
tagng dugc lay 5 ml mau tinh mach khi
ddi vio luc 6-8h cua budi sing tiong ngay
dieu tra Mau tTnh mach dugc bao quan
trong thung lanh va dugc quay ly tam vdi
tdc do 3000 vdng/phut trong 5 phut de
tich huyet thanh sau 3 - 4 gid lay mau hi
thuc dia Mau huyet thanh dugc tach de
cho ket qua cdng thuc mlu, djnh lugng
Ferritin, & CRP Cdng thuc mlu dugc
djnh lugng bang phuong phip tin xa Inh
sang laser (thude thti' cua hang Abbott,
miy phan tich CellDyn 3500 - 3700)
Ferritin dugc dinh lugng blng phuang
phip boa phat quang miin dich CMIA
(thude thu' cua hang Abbott, may
Archi-tect) CRP dugc dinh lugng bang phuong phip mien dich do do due Turbidimetric immunoassay (thude thti Wako ctia hang Abbott, miy Architect) Cdng thuc mlu, ferritin va CRP dugc phan tich tai labo cua Medic
- Ba me cho con bii va tre < 5 tuoi: chgn
ngau nhien 30 phudng xa (PX), tai mdi phudng xa da chgn neu tren, chgn 22 tre tti danh sleh tre dudi 5 tadi & 25 b l me tti' danh sich ba me cho con bu (2-12 thing) theo phuang phip ngau nhien he thdng Cudi cting, tdng sd 644 tre & 711
b l me tham gia nghien ciin cd day dti thdng tin hgp le
Lay 1ml mlu tmh mach cua tre va
1 ml mlu tinh mach ctia ba me cho vao 2 dng thuy tinh cd chua chat chdng ddng EDTA, lac deu nhe tay de tranh vd hdng cau, blo quin mit (thung da) tai thuc dia
de xet nghiem CTM tai Trung tam Y khoa Qudc tl (Diag Center) d TPHCM
2 Phucng phap nghien cu'u
Dieu tia cat ngang dugc thuc hien tai
30 phudng/xa (PX) thugc TPHCM dugc chgn ngau nhien theo phuang phap PPS
- Tieu chuan chan doan
Phu nif mang thai: Tinh trang thieu
mau dugc xlc dinh khi Hb<llg/dl; thieu sat khi Ferritin<12ng/ml; du trii sat thap khi Ferritin trong khoang 12-<30ng/ml [8], va cd tinh trang viem khi CRP>10mg/l [9] BMI trudc mang thai dugc tinh bang can nang (kg)/ binh phuang chieu cao (m^) (can nang & chieu cao do ddi tugng cung cap qua phdng van)
Bd me cho con bu vd tre < 5 tuoi:
Danh gia thieu mau ''°^:
Me : Hb < 120 g/L
T r e < 5 t a o i : H b < 110 g/L
- Xii- ly so lieu Sd lieu dugc nhap blng
57
Trang 3phin mim EPl-lNFO 6.0 & xu ly blng
phin mim SPSS 11.0 Test Chi binh
phuong dugc sti' dung de sg sanh cic ti le
General Linear Model (GLM) dugc su
dung de so sinh cic sd trung binh giu'a
cic nhdm dugc phan theo 3 thai ky Phan
tich cic mdi taong quan bang phep kiem
tuong quan Pearson trudc va sau khi hieu
chinh cho cic yeu td gay nhieu (tadi, BMI
Bang 1 Dac diem dich te, Iam sang
tm'dc mang thai) Hoi qui da bien dugc su dung de tim cac yiu td lien quan Gil trj p<0.05 dugc xem nhu cd y nghia thdng ke
HL KET QUA
Dac dilm ctia PNCT tham gia dieu tra dugc md ta trong Blng 1 Han 50% PNCT tham gia dilu tra d nhdm 20-29 tudi PNCT d 3 thing cudi & 3 thing giua thai ky chilm lin lugt la 64%o & 32%
ciia doi tuong tham gia dieu tra
Tan so Ti le (%) Nhom tuoi (nam) < 20
20-29 30-39
> 4 0
3 Ky thai 3 thang dau
3 thang giiia
3 thang cuoi Noi cu ngu Npi thanh
Ngoai thanh & ven (ghi chung la "ngoai thanh") Toan bo
47
420
299
10
29
248
499
449
327
776
6,1 54,1 38,5 1,3 3,7 32,0 64,3 57,9
42,1
100
Bdng 2 Dac diem tre < 5 tuoi tham gia nghien cun
%
Bdng 3 Dac diem ba me cho con bii tham gia
nghien ciru
So doi tuong
I j i l O l
Noi cir ngu
Nhom tuoi
Toan bo
Trai
Gai
Noi thanh
Ngoai thanh
<6 thang
6-<12 thang
12-<23 thang
24-<36 thang
36-<48 thang
48-<60 thang
644
322
322
547
97
60
101
131
128
107
117 100,0
50,0 50,0 84,9 15,1
9,3 15,7 20,3 19,9 16,6 18,2
Vuns cu ngu Dan toe
Nhom tuoi
Miic BMI
Noi thanh Ngoai thanh Kinh
H o a • Khac
< 2 5 25-34
> 3 5
<18,5 (gay) ,
>18,5 (khong say) Trinh do van hoa
Kinh te gia
< Lop 6
> L 6 p 6 dinh*
1
2
3
4
5
n
589
122
693
14
4 : 187
420
104
59
650
114
595
189
131
116
151
124
% 82,8 17,2 97,5 2,0 0,6 26,3 59,1 14,6 8,3 91,7 16,1 83,9 26,6 18,4 16,3 21,2 17,4
Kinh ti gia dinh: tu- thdp din cao (tinh theo cde vdt dung trong gia dinh)
Trang 4N i n g lugng, dudng chat & cac
nhdm thuc phim tieu thu 24h cua PNCT
d 6 thing sau thai ky dugc trinh biy
trong Blng 5 Do PNCT hay bi nghen
trong 3 thing dau thai ky anh budng den
che do an udng that su nen sd lieu khdng
dugc trinh bay trong bang nay Nang
lugng, chat sit, vitamin C, thit, rau, &
trai cay tieu thu trong 24h d nhdm
khdng thieu mlu & khdng thieu sat deu
cao ban so vdi nhdm cd thieu mau hole
thieu sat Tuy nhien, khac biet niy
khdng cd y nghia thdng ke, rieng ddi vdi
nhdm trii cay thi khic biet nay d
ngudng cd y nghia thdng ke (p=0,098)
giua 2 nhdm thieu & khdng thieu mau
Thai phu tieu thu nang lugng dat gan
80% so vdi RDA Lugng protein tieu
thu cua PNCT deu dat muc nhu cau
khuyen nghi Tuy nhien, lugng sat tieu
thu so vdi khuyen nghi d PNCT la rat
thip (chi khoang 40% so vdi RDA)
Tuang quan giu'a ndng do Hb hole
g i l tri logarit cua Ferritin huyet thanh vdi tdng sd ngly udng vien sat tinh den thdi diem dieu tra theo tung giai doan thai ky dugc the hien trong Bieu dd 1 -6
Hb cd khuynh hudng tuong quan nghich vdi ngay udng vien sat trong 3 thing dau & 3 thing giua thai ky (lan lugt la r
= -0,25 & r = -0,14), tuy nhien mdi tuang quan cd y nghTa thdng ke chi quan sat dugc ddi vdi 3 thing giua thai
ky (p<0,05) Trong 3 thing cudi, viec udng vien sat lam tang Hb rd ret (r=0,26, p<0,01) Logarit ctia ferritin Cling cd khuynh hudng tuang tir nhu Hb ddi vdi sd ngly udng vien sat Tuy nhien, mdi tuong quan yeu ban & chi cd
y nghia thdng ke d 3 thing cudi (r=0,17, p<0,01) Cac mdi tuang quan nay van cdn y nghia thdng ke sau khi dugc hieu chinh cho BMI trudc khi mang thai & cho tadi
Bang 4 Mirc tang can, Hb, Het, ferritin huyet thanh trung binh, ti le thieu mau, ti Ie thieu sat & ti Ie
sat dy trir thap cua P N C T theo 3 giai doan cua thai ky
Bien so
Tang can (kg)
BMI truoc mang thai
Hb (g/dl)
Het (%)
Ferritin huyet thanh (ng/ml)
Ti le thieu mau
Ti le thieu sat
Ti le du tru' sat thap
3 thang dau (n=29)
1,2 ± 3 , 3 20,2 ± 2,5 12,5 ± 1,2a 36,7 ± 3,4a
101,0 ± 52,6a
2 (6,9%)
0 (0,0%)
1 (3,7%)
3 thang giii'a n=248)
4,5 ± 3 , 3 19,9 ± 2 , 6 11,8 ± 0 , 9 35,3 ± 2 , 7 63,0 ± 46,8b 44(17,7%)
8 (3,4%) 38(16,2%)
3 thang cuoi n=499)
9,4 ± 3,9 19,7 ± 2 , 4 11,9±1,0 35,6 ± 2 , 6 33,7 ± 3 2 , 1 90(18,0%) 52(10,7%)
221 (45,4%)
Toan bo (n=776)
7,5 ± 4 , 5 19,8 ± 2 , 5 11,9±1,0 35,6 ± 2 , 7 45,4 ± 4 1 , 9 136(17,5%)
60 (8,0%)
260 (34,7%)
Gia tri
P*
NS
<0,01
<0,05
<0,01
NS
<0,01
<0,01
So liiu trinh bdy: trung binh ± do lich chudn hoac n (%)
', thiec hien bdi GLM (ddi vdi sd trung binh) hogc Chi hinh phuang (doi vdi ti le, chi so 3 thdng giUa & 3 thdng cudi) NS: khdc biet khdng coy nghia thong ke
', khdc hiet so vdi 3 thdng giiea & 3 thdng cudi: p< 0.01 (Post-hoc t-test)
*, khdc biit so vdi 3 thdng cudi: p<0,01 (Post-hoc t-test)
59
Trang 5Theo Bang 4, mu'c ting can trung
binh ctia PNCT d tung giai doan cua thai
ky diu dat so vdi muc tang can khuyen
nghi (gin 1kg d 3 thing dau, 4kg d 3
thing giiia, & 9 kg d 3 thing cudi)
Khdng cd su khic biet ve BMI trudc
mang thai giiia 3 nhdm theo tadi thai
He-moglobin (Hb) & ndng do ferritin huyet
thanh trung binh cd su khic biet qua 3 ky
thai De xac dinh chieu hudng cua su
Bdng 5 So sanh nang lirong, duo'ng chat & cac nhom
giira nhom thieu mau & khong thieu mau va ^
khic biet niy, so sinh Post-hoc t-test dugc ap dung, chung tdi nhan thay Hb & ferritin cua PNCT d 3 thing giua & 3 thing cuoi thai ky diu thip ban bin so vdi 3 thing diu Ti le thilu mau PNCT 3 thing giiia & 3 thing cudi cao Ti le du tru' sat thap cua PNCT 3 thing cudi cao gan gap 3 lan so vdi 3 thing giua (P<0,01)
thye pham tieu thu 24h it 6 thang sau thai ky
iiia nhom thieu sat & khong thieu sat
Tinh trang thieu mau Tinh trang thieu sat a Khong thieu mau Thieu mau
(n=290) (n=58)
Khong thieu sat (n=313)
Thieu sat (n=27)
Nang luong (kcal)
Protein (g)
sat (mg)
Vitamin C (mg) *•
Thit(g)''
Ca(g)^
Rau(g)''
Trai cay(g)''
2130,2 ±733,3 2083,9 ±799,7 89,5 ± 3 8 , 0 89,9 ± 5 1 , 2 18,1 ± 8 , 4 16,8 ± 1 0 , 5 90,3 (47,5-160,3) 63,8 (43,7-121,1) 107,5 (49,4-207,8) 86,1 (44,0-200,0) 14,3 (0,0-83,2) 28,4 (0,0-94,7) 205,3 (125,0-317,3) 189,5 (148,3-275,0) 180,0(54,5-401,0) 124,8 (0,0-257,7)
So voi nhu cau khuyen nghi ciia 'Vien Dinh duong (RDA)*^
Nang lugng (%) 78,9 (26,8) 77,3 (30,2)
Protein (%) 101,8 (43,0) 102,5 (59,1)
S5t(%) 40,3(18,6) 37,3(23,3)
2143,0 ± 7 4 5 , 7 1955,3 ±735,7 90,6 ± 4 0 , 7 81,9 ± 4 0 , 0 18,1 ± 8 , 8 16,3 ± 8 , 5 89,9 (48,9-155,7) 63,8 (32,9-115,8) 108,0 (47,8-202,8) 93,8 (55,5-238,9) 16,5(0,0-92,0) 0,0(0-85,7) 205,4(126,2-313,1) 179,3 (123,4-257,1) 180,0(38,0-400,0) 83,0(0-199,5)
79,5(27,4) 71,5(26,5) 103,2 (46,3) 92,3 (44,4)
40,2(19,5) 36,1(18,9)
.S'o lieu trinh bdy: trung binh (do lech chudn) hogc trung vi (25''' - 75''' bdch phdn vi)
" Sd lieu phdn tich sau khi logi trie 27 trudng hap co tinh trgng viem
* S'o lieu duac phdn tich bdng gid tri logarit ciia biin qua t-test
'' Nhu cdu khuyin nghi ndng luang & protein cho thai phu theo tieng giai dogn thai ky & hogt ddng thi liec viea Nhu cdu khuyin nghi chdt sat cho thai phu vdi chi do sdt gid tri sinh hoc cao [10]
Trang 6Cac thdng tin ve noi khim thai & kien
thuc phdng chdng thieu mlu kliong trinh
bay d day Han 50% PNCT khu vuc ndi
thanh chgn benh vien la noi kham thai
Trong khi dd, PNCT d vung ngoai thanh
di khim thai chu yeu d tram y te
(56,4%) Chi cd 41,3% PNCT bilt dugc
tic hai cua thieu mlu ddi vdi thai ky Ti
le PNCT biet cleh phdng ngua thieu mlu
day du (an dti dinh dudng ket hgp udng
sit bd sung) la 26,6% Ti le PNCT biet thuc pham giau chat sat 11 64,0% Gan 50% PNCT biet dugc nhu'ng thdng tin tren 11 tu benh vien, Trung tam y te hole phdng mach Ti le PNCT biet thdng tin niy tii tram y te la 38,0% Khdng quan sit dugc mdi taang quan giu'a kien thuc phdng ngua thieu mlu vdi tinh trang thieu mau cua PNCT
Bang 6 Hemoglobin huyet thanh trung binh & ti Ie thieu mau ciia tre theo nhom thang tuoi
Nhom thang tuoi
<6 thang
6-< 12 thang
12-<23 thang
24-<36 thang
36-<48 thang
48-<60 thang
Toan bo
n
60
101
131
128
107
117
644
Hb huyet thanh (X ± SD)
11,4 ± 0 , 9
11,5 ± 1 , 1
12,1 ± 1 , 2 * 12,4 ± 1 , 0 * 12,6 ± 0 , 9 * 12,8 ± 0 , 9 * 12,2 ± 1 , 1
Thieu mau
n (%)a
30,0% [18]
31,7% [32]
16,8% [22]**
7,8% [10]**
3,7% [4]**
3,4% [4]**
14,0% [90]
Thieu mau
%b
30,2
3 U 16,6 7,8 3,6 3,4 11,6
" Sd lieu thd
' Hiiu chinh theo tudi & gidi (theo ddn sd thvec ndm 2004)
'p< 0,001 vs nhdm < 6 thdng & 6-<12 thdng, t-test
"p<0,001 vs nhdm < 6 thdng & 6-<12 thdng, x2 test
Tinh trang thieu mdu cua tre
Bang 6 cho thay Hemoglobin huyet thanh trung binh & ti le thieu mlu ctia tre theo nhdm thing tadi Ti le thieu mlu cua tie tham gia dieu tia la 14,0% (sd lieu thd) Ti le thieu mlu giam dan theo thing tadi Hb huyet thanh trung binh & ti le thieu mlu d tiing nhdm tadi tren 12 thing khic biet cd y nghia thdng ke so vdi nhdm < 6 thing & nhdm 6-12 thing Ti le thieu mlu cao nhat d nhdm tre dudi 12 thing (30,0% d tie < 6 thing & 31,7%
d tre 6-< 12 thing) Sau khi hieu chinh cho tadi & gidi thi ti le thieu mlu d tie la 11,6%
Bdng 7 Ti Ie thieu mau cOa ba me cho con bu
%
Phuk luc: Bieu do 1-6 Tuong quan giiira nong do
Hb (Bieu do 1-3) hoac logarit cua Ferritin (Bieu
do 4-6) voi so ngay uong vien sat den luc dieu tra Kliong thieu mau
Thieu mau
Tong cong
643
68
711
90,4 9,6 100,0
Ti le thilu mau cua ba me cho con bu la
9,6%), d muc do nhe theo phan loai y
nghia sue khde cdng ddng (blng 7)
61
Trang 7Bieu d5 2 3 thang giua
,x<?;vy??s
1 15
i •>
S 0
„ i k 3 thang cuoi
S ' « " ' 3 ° f - ' ' ^ r = -0.26;p<0.01
/ , - 5 - - • • • • - ; ; • r ^
^ • • • • ' " " " •
tiifi^
| - # — , f c - - • - » « h n i i » » • •.-h,.J.|
5 5 1
5 P
* 5
g 0
1
-Bieu do 4 D
I •
~ - ~ - l ^ •
',°
'
D la 3 ]
3 thang (3au
r = - 0.24; NS
5 0 TD
6
*
£• 3'
.2
c „
K;-& s
e D •
=
I
0
„ Bieu do 5
o "
1 /=i "
S i 1° 1
S ? " " = " H
0 o B o
°
eo
3 thang gi&a
r = -0.01;NS
=
D
1 C
130 200
6 '
Bieu d6 6
0 60
3 thang cuoi r=0.17; p<0.01
140 Z20 KX)
IV BAN LUAN
Ti le thilu m l u cua PNCT-TP.HCM nam 2007 la 17,5% (Blng 2), nghia la thieu mlu cd y nghTa sue khde cdng ddng theo phan loai ciia Td chuc Y te The gidi [8] Ti le nay chi bang khoang mdt nua so vdi ti le thieu mau PNCT toan qudc nim
2000 (32,2%) & virng Ddng Nam Bg (34,3%), thap ban so vdi vimg ddng bang sdng Hdng (23,7%))[7] So vdi cic nudc trong khu -vuc thi ti le thieu m l u d PNCT-TP.HCM cao ban so vdi ti le nay d Singa-pore (15,3%)) [12], nhung hai thap ban so vdi Thii Lan (19,2%) [13], & chi khoing mgt nira so vdi Malaysia (35%)) [14]
Ti le thilu sit d PNCT-TP.HCM la 8,0%) (Blng 2), ti le nay d 3 thing cudi thai ky cao gap 3 lan so vdi 3 thing giira (10,7% so vdi 3,4%, p<0,01), Khoing 1/3 thai phu (34,7%) cd du trQ' sat thap, ti le nay kha cao d 3 thing cudi thai ky (45,4%) (Bang 2) Nhu clu ve chit sit d l tao mlu thudng tang cao liic mang thai, nhat 11 trong 3 thing cudi thai ky nham dap ling sir phat trien nhanh ciia thai nhi, tuy nhien, che do an thudng khd dip ung
du nen d l dan den thieu m l u trong giai doan nay Mac du lugng dam ciia PNCT tieu thu -vugt RDA & nang lugng dat gin 80% RDA (Bang 3), tuang ung vdi muc tang can trung binli d cac giai doan thai
ky diu dat kliuyin nghi (Bang 2), lugng thit tieu thu trung binh cung khdng thip
Trang 8(khoang lOOg/ngay, thugc loai chl do an
cd gil tri sinh hgc cao, sit hip thu khoing
15%) [11], nhung lugng sit tii' chl do In
cGng chi dat khoang 40% so vdi nhu clu
khuyin nghi (Bang 3) Nang lugng tieu
thu, chat dam, sit, vitamin C, thit, rau &
trai cay tieu thu trong 24h d nhdm khdng
thieu mlu cd khuynh hudng cao han
nhdm thieu mau, d nhdm khdng thilu sit
cd khuynh hudng cao ban so vdi nhdm
thieu sat nhung su khic biet chua cd y
nghia thdng ke cd the do chl do an chi thu
thap dugc trong 1 ngly, chua dii dai dien
cho che do an thudng xuyen ciia PNCT
Ket qua nghien cuu cho thiy bo
sung sit trong thai ky cd tuang quan
nghich trong 3 thing diu (du chua cd y
nghia thing ke) (Biiu dd 1-6) cd thi do
tinh frang Hb & ferritin hr horde khi mang
thai khic biet giira cac PNCT hole do tinh
trang nghen trong 3 thing dau anh hudng
den hieu qui ciia viec udng sit Tuy
nhien, do so lugng PNCT kha it trong 3
thing dau nen cic ket qua trong giai doan
nay rat khd dien giai Hb cd tuang quan
nghich vdi tdng sd ngay udng sit trong 3
thing giira (r=-0,14, p<0,05) Mdi tuong
quan theo chieu thuan giira tong so ngay
udng sit vdi Hb (r=0,26, p<0,01) &
fer-ritin (r=0,17, p<0,01) chi quan sit dugc d
ba thing cudi thai ky Mdi tuang quan
van cdn y nghia thing ke khi hieu chinh
cho tudi & BMI trudc mang thai Dilu
niy cho thiy thdi dilm bd sung sit thich
hgp cd the nen bit dau tu' 3 thing giiia dl
dat hieu qua trong 3 thing cuoi Day 11
giai doan thieu mau cao nhit trong thai
ky Theo Chuang trinh phdng ching
thieu mlu qudc gia, thai phu nen su dung
vien sit ket hgp acid folic rit sdm ngay
tir khi mdi phit hien cd thai Tuy nhien,
viec bd sung sat sdm tir 3 thing diu thai
ky cd the cdn biy thugc tinh trang sit tir
trudc khi mang thai Dilu nay cin dugc xlc dinh til' cic nghien ciiu sau han ve hieu qui bd sung sat giUa cic nhdm cd tinh trang sit khac nhau tir trudc klii mang thai ddi vdi sir tang Hb & du trQ' sit trong cic giai doan thai ky, cung nhu la thdi diem bit dau udng sit Do thdng tin thu dugc trong nghien cu'u nay chi 11 tdng
sd ngly udng sit chii khdng cd ham lugng & lieu thude nen phin bien luan
nay nham dua ra cic gil thuyit &h budng
den cic nghien ciiu sau ban v l thdi dilm, liiu lugng sat bd sung thich hgp nhit de phdng ngua dugc thieu mau trong thai ky Dac diem tre < 5 tudi va ba me cho con bii tham gia nghien ciiu dugc trinh bay d blng 4 v l blng 5 Ti le tre nam : nu
la 1:1, chia llm 6 nhdm tuoi Ba me cho con bu cu ngu d ndi thanh chilm ti le 82,8%, d ngoai thinh la 17,2%, chia lam
3 nhdm tuoi < 25 tudi (26,3%), 25-34 tudi (59,1%), > 35 tuoi (14,6%)
Ti le thieu mlu cua tre < 5 tudi la 11,6%), d muc do nhe theo phan loai y nghia sii'c khde cdng ddng cua WHO
2001 Ti le tre thieu mlu cao nhit d nhdm tre < 23 thing, lin lugt la 30,2%, 31,2%
va 16,6%o theo cic nhdm tudi < 6 thing, 6-<12 thing va 12-<23 thing Nhdm tre <
23 thing thudng cd cac vin dh ve benh ly
va dinh dudng, lugng thiic an tre an vio khdng du nen khdng cung cip dii vi chit dinh dudng, dac biet la chit sit cho tre Tre trong do tudi nay thudng hay bi nhiem tning dudng tieu hda va hd hip dan den tre bieng an v l thilu hut chit sit
Ti le thieu mlu cua b l me cho con bii
la 9,6%o, d miic do nhe theo phan loai y nghia siic khde cdng dong ciia WHO
2001 PNCT nen dugc bd sung vien sit theo phic do cua Vien Dinh Dudng, mdi ngay 1 vien sit chua 60 mg sit nguyen td
63
Trang 9va 0,4 mg acid folic tu' klii phit hien cd
thai din I thing sau sinli
V KET LUAN
Ti le thilu mlu ciia PNCT, b l me cho con
bu v l tre < 5 mdi tai TP.HCM nim 2007,
2008 lin lugt la 17,5%, 9,6% va 11,6%,
vin 11 vin de sire khde cdng ddng tai
TRHCM
PNCT udng sit it nhat 3 thing trong thai
ky cd ti le thieu mlu thap ban PNCT
khdng uIng sit du 3 thing (14,5% so vdi
21,0%, p=0,024) PNMT uong sit it nhit
2 thing trong thai ky cd ti le thieu sit thap
ban PNCT khdng udng sit du 2 thing
(6,0% so vdi 10,6%, p=0,042) Bd sung
sit tir 3 thing giua se llm tang Hb &
fer-ritin d 3 thing cudi Lugng sat In vao cua
PNCT d 3 thing giua & 3 thing cudi rat
thap (khoing 40%) so vdi nhu cau
khuyen nghi
TAI LIEU THAM KHAO
1 Seshadri, S Prevalence of micronutrient
de-jiciancy particularly of iron, zince and folic
acid in pregnant women in South East Asia
Br.J.Nutr 2001; 85: S87-S92
2 Rasmussen, K.M Is there a causal
relation-ship between iron deficiency anemia and
weight at birth, length of gestation and
weight at birth, length of gestation and
peri-natal mortality? J Nutr 2001; 131; 590S-603S
3 Scholl, TO & Hediger, M.L Anaemia and
iron deficiency anaemia; compilation of data
on pregnancy outcome Am J Clin Nutr
1994: 59; 492S-501S
4 Gidy T Khdi HH, Nhdn BT Ninh NX Tinh
hinh thiiu mdu dinh dieang ciia phu nie cd
thai a mot sd vimg ndng thon Viit Nam
Tuyin tap cong trinh nghiin ciru khoa hoc
dinh dudng Viin Dinh Duang, Hd Ndi
1989; 1:30-34
5 Gidy T Klidi HH Nhdn BT Quyen DT Hiin
VT, Ninh NX Mdt vdi dgc diim dich ti hoc ciia thiiu mdu thiiu sdt tren phu nir cd thai a
:,, ndng thdn & thdnh pho Hd Noi Y hoc thuc
hdnh 1990; 3; 17-21
6 Klidi HH Nhdn BT Ninh NX Thu nghiim hiiu qud bd sung sdt/folat tren phu nie cd thai
bj thiiu mdu Tuyen tap cong trinh nghiin ciru kJioa hoc dinh dudng Vien Dinh Dudng, HdNdi 1989; 96-101
7 Ninh NX, Khdn NC Khuynh hudng thay ddi berth thiiu vitamin A, thiiu mdu dinh dudng
a Viet Nam trong nhieng ndm gdn day, mdt sd khuyin nghi mdi ve Men phdp phdng chdng Tgp chi Y hoc Viet Nam 2003; 285(6);
22-31
8 WHO 200L Iron deficiency aneamia; assess-ment, prevention, and control A guide for programme managers WHO/NHD /01.3;
1-114 http;//www fda.gov/cdrh /oivd/guid-ance/1246.html
9 WHO 2001 Iron Deficiency Anaemia; As-sessment Prevention, and Control A guide for programme managers P 33
10 Bd Yti Nhu cdu dinh dudng khuyen nghi clio ngudi Viet Nam NXB Yhoc HdNdi 2007
11 Singh K, Fong YF, Arulkumaran S Anaemia in pregnancy—a cross-sectional study in Singapore Eur J Clin Nutr 1998 Jan;52(I):65-70
12 Chotnopparatpattara P, Limpongsanu-rak S, Charnngam P The prevalence and risk factors of anemia in pregnant women J Med Assoc Thai 2003 Nov:86(I I); 1001-7
13 HanijfJ Das A, Onn LT Sun CW, Nordin
NM, Rampal S Bahrin S Ganeslingam
M Kularatnam KJ, Zaher ZM Anemia in pregnancy in Malaysia; a cross-sectional survey Asia Pac J Clin Nutr 2007;I6(3);527-36
Trang 10Summary
IRON DEFICIENCY ANEMIA STATUS OF PREGNANT WOMEN, LACTATING
WOMEN AND CHILDREN UNDER 5 YEARS OLD IN HCMC
A survey on anemia status in pregnant women (PW) in 2006, lactating women and children under
5 years old in 2008 was conducted in HCMC Objectives: To identify prevalence of anemia, iron deficiency, low iron storage and related factors to anemia & iron deficiency in PW, lactating women and children under 5 years to detennine proper intervention approaches Methods: A cross sectional survey; 776 PW, 711 lactating women and 644 children under 5 years old were weighted, and col-lected fasting blood to analyze Hb, ferritin & CRP Lactating women and children under 5 years old were weighted, and collected fasting blood to analyze Hb A stmctured questionnaire was used
to collect information on socio-economic condition, iron supplement and knowledge on anemia prevention A sub-group of 406 PW was randomly selected for 24h dietary recall Results: Mean values of Hb and Ferritin of PW were 11.9 g/dl and 46ng/ml, respectively; The prevalence of ane-mia, iron deficiency, low iron storage of PW were 17.5%, 7.9% and 34.7%, respectively The prevalence of anemia in PW, who taking iron supplement at least 3 months during pregnancy du-ration was lower compared with those taking iron supplement less than 3 months (14.5% vs 21.0%, p<0.05) The prevalence of iron deficiency was also lower in iron supplement PW at least
2 months taking comparing to those taking iron supplement less than 2 months in pregnancy du-ration (6.0% vs 10.6%, p<0.05) The prevalence of PW having adequate knowledge on anemia pre-vention was 26.6% The prevalence of PW knowing the effects of anemia was 41.3% The prevalence of anemia in lactating women and children under 5 years old were 9.6% and 11.6%, respectively
K-CyworAs: iron deficiency anemia Hemoglobin (Hb), ferritin [•• ,
THIEU VITAMIN A,TIEN LAM SANG, THIEU MAU 6 TRE EM
< 5 TUOI TAI VIET NAM - NAM 2 0 0 8
Nguyen Xudn Ninh', Nguyen Thanh Huffng^,Pham Thi Ngdn \ Nguyen Anh Tudn '', Dang Trw&ng Duy ^, Le Danh Tuyen^
Dieu tra thieu vitamin A tien lam sang va thieu mau d 8152 tre em < 5 tuoi, ciia 56 tinh thanh, dugc tien hanh vao cuoi nam 2008 Ket qua cho thay ty le thieu vitamin A tien lam sang (retinol huyet thanh <0,7pmol/L) la 14,2%; ty le thilu mau (Hb<110g/L) la 29,2%, thuoc muc tmng binh vl y nghia sire khoe cong dong Ty le thieu vitamin A va thieu mau c6 dao dgng nhieu theo viing sinh thai, theo tinh trong moi vung sinh thai; nhom tre <24 thang tuoi cd ty le thieu vitamin A va thieu mau cao nhat Can co nhung bien phap can thiep dac liieu, nliam ha thap ty le nay ti'ong nhiing nam toi
Til' khoa: thieu vitamin A, thieu mdu, tre em tien hoc du&ng, retinol, hemoglobin
' PGS, TS - Vien Dinh du-ong • • ; ; : ,
- Cn - Vien Dinh duong
^ KTV - Vien Dinh duong
''BS Vien Dinh duong • >, :
-5 TS, BS - Vien Dinh duo'ng
65