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Therefore, we conducted the topic: Nutritional status and effectiveness of iron and zinc fortified rice in children aged from 36 to 2 under 60 months in Vu Thu district, Thai Binh province with the following objectives: To determine the rate of malnutrition, the prevalence of anemia, in children aged from 36 to under 60 months and some related factors in Vu Thu district, Thai Binh province. To analyzie characteristics of diets and prevalence of iron and zinc deficiency in children aged from 36 to under 60 months;
1 INTRODUCTION Children’s growth is governed by many factors: genetic and external factors including nutrition Proper nutrition is an important environmental factor for the growth and control of health and disease in the life cycle stages Investing in nutrition and diet throughout the life cycle brings about not only economic benefits but also practical social meaning such as saving the cost of medical care, increasing the intellectual capacity and productivity of adults Nutrition is the foundation for the development of strength, health, wisdom, stature of children When it comes to malnutrition, experts say it's not just about hunger but also implies the notion of "latent hunger" or lack of essential micronutrients such as Vitamin D, A, iron and zinc This is a meaningful public health issue, in which high-risk groups of getting malnutrition are women and children, especially children under Survey data from the National Institute of Nutrition show that the rate of micronutrient deficiency in children is over 30% Micronutrient deficiencies can be completely prevented and eliminated if those with high risk of malnutrition are constantly exposed to a small amount of micronutrients To prevent micronutrient deficiency, many solutions can be implemented including solutions to enhance the micronutrients in food Foods that are fortified with micronutrients are often foods that are often used by people Micronutrient Intake is a viable and sustainable intervention to improve micronutrient deficiency Thai Binh is an agricultural province and rice is the main source of food for the people So far, there have been no studies to evaluate the effect of multi-micronutrient fortified rice on the health status of people in general and children in particular The assessment of the effectiveness of multimicronutrient fortified rice use for children is essential as a basis for the development of appropriate policies on multi-micronutrient enhancement in rice in Vietnam Therefore, we conducted the topic: "Nutritional status and effectiveness of iron and zinc fortified rice in children aged from 36 to under 60 months in Vu Thu district, Thai Binh province" with the following objectives: To determine the rate of malnutrition, the prevalence of anemia, in children aged from 36 to under 60 months and some related factors in Vu Thu district, Thai Binh province To analyzie characteristics of diets and prevalence of iron and zinc deficiency in children aged from 36 to under 60 months To evaluate the effectiveness of iron and zinc fortified rice to improve nutritional status in children aged from 36 to under 60 months NEW CONTRIBUTIONS OF THE DISSERTATION - The dissertation has provided additional data on child malnutrition situation in Thai Binh province and identified the prevalence of zinc, iron deficiency and low iron stores in children aged 36-60 months, which are the basis for proposing interventions to improve childhood micronutrient deficiencies - Rice is the staple food of Vietnamese people Iron and zinc fortified rice is a solution that can accessible to all populations - Research has shown that the use of iron and zinc fortified rice in children's diets has improved their diets, increased serum zinc levels, increased iron status and reduced the incidence of iron and zinc deficiency These factors contributed to the rapid improvement of the child's physical development and served as a basis for confirming the Government's Regulation No 09/2016 ND-CP dated January 28, 2016 on the promotion of micronutrient fortified in food is very important and needs to be developed on a nationwide scale LAYOUT OF THE DISSERTATION The dissertation consists of 115 pages, 31 tables, charts, and 139 references including Vietnamese ones and foreign ones There are page backgound, Literature review 31 page, Research methodology 23 pages, research results 28 page, discussion 28 pages, conclusion and page recommendations 3 CHAPTER LITERATURE REVIEW 1.1 Current situation of child malnutrition and some related factors 1.1.1 Malnutrition status of children in the world From 576 representative surveys of the countries and territories between 1990 and 2010, it is shown that in 1990 the world rate of stunted children under age accounted for about 40% This rate in Latin America and the Caribbean was 24.6% The stunting rate in Asia in 1990 was 48.4%; developing countries 44.6%; developed countries 6.1% By 2010, the stunting rate in children worldwide has dropped from 39.7% to 26.7% However, there is a significant difference in the rate of stunting among regions In Africa, the stunting rate is almost unchanged that after 20 years, the stunting rate has fluctuated around 40%, while Asia has experienced dramatic changes, the stunting rate reduced significantly 49% in 1990 to 28% in 2010 However, in most developing countries, stunting rate remains a significant public health problem in the present About 80 percent of stunting children under the age of five are in 14 countries, of which the countries with the highest rate of stunting children under five are East Timor, Burundi, Niger and Madagascar, Bangladesh, Cambodia, Camarun, Ethiopia By 2012, the overall stunting rate worldwide was around 25.0%, of which 56% is in Asia and 36% in Africa By 2015, 156 million children suffered from stunting, accounting for 23% of all children under years of age There is evidence that although the number of under-five children with stunting is high, the rates are unevenly distributed across regions of the world Stunting is more severe than underweight In developing countries, rural children are 1.5 times more likely to develop stunting than urban children It is predicted that by 2020, stunting worldwide will continue to decline 1.1.2 Malnutrition status of children in Vietnam Research results of the National Institute for Nutrition until 2014 showed that: Distribution of malnutrition in our country is uneven among ecological regions; many mountainous areas have higher rates of malnutrition than delta areas The highest malnutrition rate was in the Central Highlands (22.6% for underweight and 34.9% for stunting) In the South East, the prevalence of malnutrition was lower than in other regions (8.4% for underweight and 18.3% for stunting), lowest among ecological regions of the country The highest rate of stunting was recorded in the Central Highlands (34.9%), the Northern Midlands and Mountains (20.3%) The stunting rate was uneven among ecological regions The Northern Highlands and Mountains and the Central and North Central Coast remained at a high level of public health significance (> 30%) Results of the study by Nguyen Thanh Ha on the micronutrient status of stunting children aged 6-36 months in Gia Binh district, Bac Ninh province showed that anemia, vitamin A deficiency and zinc deficiency in stunting children was all severe according to the WHO classification Stunted children have high rates of micronutrient deficiency 37.6% of stunted children are lack of kind of micronutrient, 23.5% of children lack combined micronutrients and 8.2% of total stunted children are deficient in the combination of micronutrients 1.1.3 Several factors related to malnutrition The three most important factors that affect malnutrition are food security, poor nutrition practices and illnesses, which are largely influenced by poverty 1.1.3.1 Household food insecurity: That the food security of households not guarantee is the key factor leading to food shortages in both quantity and quality - including lack of energy, protein and micronutrients At present, the rate of poor households in remote and disadvantaged areas remains high This is a potential cause of individual malnutrition In addition, the level of influence of each factor depends on the accessibility of food in each household, and depends very much on nutrition knowledge, customs and habits of each ethnic group 1.1.3.2 Poor nutritional practice: Poor nutritional practices related to food imbalances and preference for children and pregnant mothers Even if the household ensures food security, there may be food shortages for individuals, especially for high risk individuals such as children under or pregnant women etc which is mainly due to poor nutritional practice 1.1.3.3 Role of illnesses: Illness is considered to be one of two direct causes of child malnutrition Infections increase the loss of nutrients, anorexia and eating in smaller amounts due to decreased appetite Studies estimate that infection affects 30% of the decrease in height in children 5 1.2 Micronutrient deficiencies in children Results of the national micronutrient census in 2014 and 2015 showed that the younger the child, the higher the risk of anemia: children in the groups of 0-12 months and 12-24 months had the highest rates of anemia with 45.0% and 42.7%, respectively; whereas in the group of children aged 24-35 months this proportion was 23.0%; the group of 36-47 month children was 18.8%; the group of 48-60 months 14.3% The prevalence of anemia in urban children was 22.2%; in rural areas: 28.4%; in mountainous areas was 31.2% A study on micronutrient deficiencies in six northern mountainous provinces showed that the prevalence of anemia in children was 29.1%, which was in the mean of public health significance The low iron stores ratio (Ferritin 0.05 < 0.05 < 0.05 < 0.05 The table above shows that children's iron stores have improved significantly after intervention Intervention effectiveness in improving children's iron stores is 40.8% 18 CHAPTER DISCUSSIONS 4.1 Characteristics of malnutrition, anemia in children aged 36 to under 60 months and some related factors The results of the study conducted in communes of Vu Thu district, Thai Binh province showed that: The prevalence of underweight children among children aged 36 to under 60 months was 12.7% with 14.3% in male children, higher than in female children (11.0%), the difference was statistically significant with p