Nutritional status and some related factors among primary school children in Thai Nguyen and Nghe An provinces in 2020

1 MINISTRY OF MINISTRY OF HEALTH EDUCATION AND TRAINING HANOI MEDICAL UNIVERSITY NGUYEN THI PHUONG ANH NUTRITIONAL STATUS AND SOME RELATED FACTORS AMONG PRIM ARY SC HOOL CHILDREN IN THAI NGUYEN AND NGHE AN PROVINCES IN 2020 Specialization: Doctor of Preventive Medicine Code: D720302 THESIS OF GRADUATION MEDICAL DOC TOR COURSE 2015-2021 Mentors' Assoc.Prof.PhD Pham Van Phu Assoc.Prof.PhD Tran Thuv Nga HANOI-2021 -■c -ÍM Qỉ ugc V Hl ãĩi CONTENTS 1.3.1 Eating habits 11 1.3.2 Physical activities 1.3.3 Socio-economic factors 13 12 CHAPTER 2: RESE.ARCH SUBJECTS AND METHODOLOGY 16 2.1 S „ 16 2.2 S tudy location Subjects tudy and study time 2.3 Research Methodology 2.3.1 Study design 16 r-u -ÍM Qỉ ugc V Hl RECOM MENDATION REFERE NCES 2.3.2 The sample size and sampling method 16 Sample size 16 2.3.3 Variablesand indicators 17 2.3.4 Data collection 18 2.5 Potential Errors and Solutions 20 2.6 Data management and analysis 2.7 Ethical issues 20 21 CHAPTE R 3: R ESU LTS 22 3.1 Characteristics of research subjects 22 3.2 Nutritional status of students 26 33 Some factors related to nutritional status of students 29 CHAPTE R 4: DISCUSSION 4.1 Nutritional status of students 4.2 Some related factors to the nutritional status of students 42 4.2.1 Socio-demographv factors 42 4.2.2 Environmental factors 47 4.2.3 Eating habits factors CONCLUSION ABBRE MATION BMI Body Mass Index FAO Food and Agriculture Organization UNICEF United Nations Children’s Emergency Fund WHO World Health Organization NCHS National Center for Health Statistics r-u -ÍM CỊỈ ugc V Hl •■•••••a 53 SD Standard deviations BAZ BMI-for-Age z-score HAZ MUAC Height-for-Age z-score Mid-Upper-Arm c ircumference X'ND Vietnamese Dong LIST OF TABLES LIST OF FIGURES r-u -ÍM CỊỈ ugc V Hl ACKNOWLEDGEM ENT First and foremost, I would like to express my deep sense of gratitude and appreciation towards Assoc Prof Pham Van Phu from the Department of Nutrition and Food Safety, Institute for Preventive Medicine and Public Health for his invaluable guidance, constant encouragement, expert suggestions, constnictive criticism, and supervision which was most crucial in completing this thesis work I am extremely grateful to Assoc Prof Tran Thuy Nga head of Department of Micronutrient Research and Application National Institute of Nutrition, for her keen interest, guidance, supervision, and valuable advice for thesis improvement I would like to express my deep thanks to the Managing Board Department of Training, Hanoi Medical University who had created a welcoming and wonderful environment in the school for the past six years I wish to thank all the teachers in the Department of Nutrition Institute for Preventive Medicine and Public Health Hanoi Medical University for their valuable information provided by them in their respective fields I am grateful for their cooperation during the period of my assignment Finally, I want to express my gratitude to my wonderful family and friends who have stood by my side throughout this ordeal Your unwavering love and unwavering support inspired me to keep going Student Nguyen Thi Ph uong Anh COMMITMENT To: - Management Board of Hanoi Medical University - Department of Undergraduate Training Management and Department of Student Affairs Hanoi Medical University - Institute for Preventive Medicine and Public Health Hanoi Medical University - Department of Nutrition and Food Safety Hanoi Medical University - Examination Committee for Graduation Thesis 2020-2021 I hereby declare that I am the author of this research The data collection and analysis were carried out objectively and truthfully These findings in this study have yet to be published May 202 in Hanoi Student Nguyen Thi Ph uong Anh r-u -ÍM CỊỈ ugc V Hl ABSTRACT Background & Objectives: A cross-sectional study was conducted with the objectives to describe the nutritional status of primary school children (7-10 years) in Thai Nguyen and Nghe An provinces: to analyze some related factors to the nutritional status of students Methods: The study period was from November 2020 to December 2020 A total of 262 students from two provinces comprise the study population Probability proportional to size sampling method was used Data entry and statistical analysis were performed with the help of STATA version 15.0 Height-for-Age Z-score (HAZ) and BMI-for-Age Zscore (BAZ) were calculated using WHO Anthroplus Software and using WHO Reference 2007 values Results: The prevalence of overweight and obesity was 25.6% (in which overweight was 16.8% obesity was 8.8%) The prevalence of stunting was 8.0% and wasting was 6.5% Some factors related to the nutritional status of primary school students were BMI of parents, education level of parents, the care of mother; family size (>5 people): total household income: habit of drinking soft drinks, eating instant noodles, eating outside the home, eating at fast-food restaurants Interpretation & Conclusion: The present study showed the prevalence of malnutrition was relatively high Socioeconomic factors, parental factors and eating habits were associated with the nutritional status of students Prompt integrated efforts should be made to improve the nutritional status of primary school students Keywords: nutritional malnutrition, primary status, school children related factors Thai Nguyen to Nghe An -ÍM CỊỈ ugc V Hl INTRODUCTION Malnutrition has been a global public health problem In 2019 : there still were 144 million children under with stunting and almost 50 million with wasting; at the same time, overweight and obesity in chi Idren and young people were continuing to rise [1] In Vietnam the stuntingrate for children under was 19 6% in 2020 meaning that one out of every five Vietnamese children under the age of five was stunted The rate of stunting malnutrition among school children (5-19 years old) was 14.8% in 2020 (this rate was 23.4% in 2010) [2] On the other hand, overweight and obesity had increased rapidly National Institute of Nutrition research during 2017- 2018 revealed the overweight obesity rate of 5.000 sampled school children in a variety of provinces was 29% [3] Every’ country in the world has been affected by one or more forms of malnutrition and should consider combating these as one of the greatest global health challenges Socio-economic determinants such as income, ethnicity, geographical location, and intra-household parental factors could be related to a child's nutrition level When children's nutritional status deteriorated, a vicious cycle of chronic disease and growth failure developed As a result, having a comprehensive understanding of children's nutritional status had far-reaching consequences for future generations' wellbeing [4] The primary school years were the time of rapid physical and mental developirent Low school attendance, high absenteeism, early dropout and unsatisfactory classroom performance had all been related to poor nuưitional status (5] [6], Children who were well-fed did well in school andreached their full physical and mental capacity Malnutrition was an associated cause in about half of all deaths occurring among children in developing counưies and also slowed economic growth and perpetuated poverty [7] According to estimates, malnutrition in all types could cost society up to 3.5 ưillion dollars each year, with overweight and obesity costing 500 billion dollars [8], Many studies have been conducted worldwide on the nutritional status of children of all ages Studies done in rural and utban areas in different parts of Vietnam r-u -ÍM -ÍM Qỉ Qỉ ugc ugc V V Hl Hl have reported a high prevalence of malnutrition among children but most of these focused on the age under five [9] [10][12] There has been a paucity of information based on nutritional status in primary schools from the northern and centra provinces of Vietnam In order to provide more data to improving many nutrition-related problems, research named "Nutritional status and some related factors among primary school children in Thai Nguyen and Nghe An provinces in 2020" was conducted with two specific aims: To describe the nutritional status of primary’ school children in Thai Nguyen and Nghe An provinces in 2020 ToAn status analyse among primary somein factors schoolrelated children toin the Thai nuưitional Nguyen and Nghe provinces 2020 -ÍM Qỉ ugc V Hl CHAPTER 1: LITERATURE REVIEW 1.1 Nutritional status and some methods of assessment of the nutritional status 1.1.1 Definition of nutritional status Nutritional status refers to an individual's physiological state as a result of the interaction between nutrient intake and needs, as well as the body's ability to digest, absorb, and utilize these nutrients When the human body absorbs all of the nutrients in adequate quantities to satisfy its needs Jn a state of good nutrition, which implies normal nutritional status However, when the nutrients in the diet are insufficient or are not adequately used, the body becomes unbalanced If this persists for an extended period of time it could become a serious issue peihaps fatal [12] A state of imbalance in die body occurs when there is a deficiency or excess intake of one or more nutrients, as well as faulty nutrient utilization Malnutrition or a poor nutritional state, is the term for this condition Malnutrition can be classified into two groups Undemutrition is a disorder in which a person's wellbeing suffers as a consequence of a lack of one or more nutrients Overnutrition on the other hand, occurs when nutrients areconsumed in abundance [13] 1.1.2 Brief reviews about methods of assessment of the nutritional status Nutritional status assessment can be defined as the process of the collection and analysis of information and data on nutritional status and assessing the situation on the basis of such information and data [14] 1.1.2.1 Anthropometric methods Anthropometry is the measurement of the size weight, and proportions of the body Common anthropometric measurements 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I in or rick at space provided only ONE answer can be selected for each question Province: Schoo! COUPLE TION DATE: I _Ỉ Contact person for this project: • Name: _ • Relationship with child: Father Mother Caregivers Others, please specify: _ • Cell Phone No: • Home Address: Child’s details ■ Name • Date of birth: Solar calender Chinese calendar _I _Ỉ _ ■ Birth Weight: (gam) ■ Race: Muong Tay ■ Gender: Male Female Kinh Other, please specify: Parent's Details Mother Father ■ Dateo/bữth: ■ Date of birth: / / / / • Height: _(cm) • Height: _(cm) • Weight: _fkg> • Weight: • Highest Education Lexel ft# Non-schooling Primary ■ Highest Education Lex el Non-schooling school Secondary school High school College Unixersity/higher • Occupation: Primary school Secondary school High school College UnixersityFnigher • • Occupation: Total household monthly income: _(Unit: thousands VND) • How much does your household spend on food per month? _(Unit: thousands VND) ■ How mam people are staying in the same household7 (incl uding the child participating in rhis study) • Who takes care of the child most of time? 74 Health Status And Environmental Factors • hl general how would you rate your child's health? Good • Fair Poor Does your child have any health problems/diseases (such as asthma, congenital heart disease, acute respiratory infection and othersf? • What are the main sources of drmking/cooking water in your home? Running water Bottled water Well water Surface water (river, lake, ) Rain water Others, please specify: • What type of toilet facilities members of your household use? Flush (tandaspam)flush) Pit latrine (tandas lubangs Digged holes around the house area River Others, please specify’: Eating habits • In a typical week, how often does your child drink sweetened beverages (such as carbonated drink, cordinal drink, sports drink and others/? Never Once a week times per week -c -ÍM Qỉ ugc V Hl 75 > times per week ■ In a ty pical week, how often does your child eat confectionery (such as cake, candy , chocolate, biscuit, ice cream and others)? Never Once a week times per week > times per week • In a typical week, how often does your child eat instant noodles (such as Hao Hao Omachi Tien Vua cup noodle and others)? Never Once a week times per week > times per week • In a ty pical week, how often does y our child eat packet snack food (such as potato chips, popcorn, snack and others)? Never Once a week times per week > times per w eek • In rhe past one month, does your child have main meal(s) outside of home? Yes No • In the past one month, does your child have food from fastfood restaurant (such as KFC, Me Donald, Loteria Burger King, Pizza Hut and others)? Yes No Physical activities When does you child study in school? -c -ÍM Qỉ ugc V Hl 76 Morning Afternoon In rhe last days, on how many days was your child engaged in moderate to vigorous physical activity for at least 60 minutes each day? (This can be accumulated over the entire day by any physical activity done more than IO minutes) Moderate to vigorous activity is any activity that increases the heart rate, gets your child out of breath some of the time and increased sw eating, (i.e w alking briskly, dancing, jogging hiking, cycling swimming, others) None day s I day day s days days day s days Has your child done any of the following activities in the past days? If YES how many times heJshe did these activities? -c -ÍM Qỉ ugc V Hl 77 Frequency None Activities 1-2 3-4 5-6 >7 times times times times a Badminton b Footbail (Soccer) c Bicycling d Basketball/Netball e Tag (children chasing each other) f Walking for exercise g In-line skatmg/Roller blading h Jogging or running i Swimming j Dance k Skipping Rowing/ Canoeing/ Kayaking m Skateboarding n Volleyball Tennis p Table tennis/ Ping pong a Martial arts (silat/taekwondo/karateAvushu r Others please specify: In the last days, during physical education /PE) classes, haw often was your child very active? a.e running, jumping, throwing, playing hard, others/ -c -ÍM Qỉ ugc V Hl 78 My child doesn 'I PE Hardly ever active Sometimes active Often quite active Always active In the last days, what did your child most of the time during school recess? /besides eating and drinking) Sardown (i.e chatting, reading, doing schoolwork, others) Stood around or walked around Ran or played a little bit Ran around and play ed quite a bit Ran and played hard most of the time In the last days, whai did your child nght after lunch? Sat down (i.e chatting, reading, doing schoolwork, others) Stood around or walked around Ran or played a little bit Ran around and played quire a bit Ran and played hard most of the time In the last days, on how many days right BEFORE FTF.R school (2 6pm), did your child sports, dance, or play games in which he/she was very active? s In the last days, on how many EVENINGS (6 - 8pm), did your child sports, dance, or play games in which he/she was very active? No days I day days days days On the last ft EEKEND haw many times did your child sports, dance, or play games in which he/she was very active? No -c -ÍM Qỉ ugc V Hl 79 J time 2-3 times 4-5 times >5 times 10 one of die following describes your child best for the last days? Read all five statements before deciding on the one answer that describes your child Alt or most of my child's free time was spent doing things that involve little physical effort My child sometimes (Ỉ ‘ times per week/ did physical things in his/her free time (i.e sports, running, swimming, cycling, aerobics, others) My child often (3 - times per week) did physical things in his/her free time My child quite often (5-6 times per week/ did physical things in free time -VẠ child very often