1 MINISTRY OF EDUCATION AND TRAINING MINISTRY OF HEALTH NATIONAL INSTITUTE OF NUTRITION DINH PHUONG HOA NUTRITIONAL STATUS, ANEMIA AND EFFECTIVENESS OF WEEKLY IRON SUPPLEMENTATION OF WOMEN AT THE AGE OF 20-35 IN LUC NAM DISTRICT, BAC GIANG PROVINCE SUMMARY OF PhD. THESIS 2 Specification: Nutrition Code: 62.72.03.03 HA NOI, 2013 THIS WORK IS COMPLETED AT THE NATIONAL INSTITUTE OF NUTRITION Scientific Advisors: 1. Prof. Le Thi Hop, MD, PhD 2. PhD. Pham Thi Thuý Hoa, MD, PhD 3 Reviewer 1: Reviewer 2 Reviewer 3: This thesis shall be defended in front of the Doctoral Thesis Committee at The Institute Level in the National Institute of Nutrition At , The thesis can be found at: - National Library - National Institute of Nutrition Library 4 LIST OF ABBREVIATIONS BMI Body Mass Index CED Chronic Energy Deficiency CTR Control group FAO Food Agriculture Organization Hb Hemoglobin IDA Iron Deficiency Anemia IFA Iron Folic Acid INACG International Nutritional Anemia Consultative Group SD Standard Deviation T0 The start of intervention T16 Intervention at 16 weeks T28 Intervention at 28 weeks UNICEF United Nations International Children’s Emergency Fund WHO World Health Organization 5 PHS Public health significances EI Effectiveness index 6 INTRODUCTION Undernutrition and anemia are the main causes affecting the health status of millions of people around the world. In developing countries, the prevalence of anemia in women in general is 42% and in pregnant women is 52%. Iron Deficiency Anemia is the most common nutritional anemia in almost every countries around the world. Like other developing countries, anemia in Vietnamese mothers and children is identified as an important public health significance. According to the report of the Institute of Nutrition in 2009-2010, the prevalence of anemia in women of reproductive age is 28.8% and in pregnant women is 36.5%, while this prevelance in the northern and central mountains is up to 60%. The main cause of anemia in women Vietnam is also because of the iron deficiency, which accounts for 22% to 86.3% in rural and mountainous areas. Iron / folic acid supplementation is considered to be one of the key solutions to solve the problem of iron deficiency anemia. Vietnam currently applied treatment regimens for anemia by supplementing iron daily for children and pregnant women. However, the effectiveness of using iron tablets according to daily 7 regimen method is limited by side effects on the gastrointestinal tract, the difficulties of propaganda and maintaining compliances with medication as directed. Weekly iron supplementation is one of the effective solutions similar to daily iron supplementation. Moreover, weekly iron supplementation reduces significantly the rate of side effects and also helps save the iron tablet, so that we can expand for more objects, especially for women who are not pregnant. Based on the above reasons, we conduct testing consecutive weekly iron supplementation and intermittent weekly iron supplementation for women aged 20-35 in Luc Nam, which is a mountainous district located in the North-East of Bac Giang province. Objectives 1. To evaluate the nutritional status, anemia, worm infection rate and dietary intakes among women aged 20-35 in six communes in Luc Nam district, Bac Giang province. 2. To compare the effectiveness of consecutive weekly iron supplementation and intermittent weekly iron supplementation to anemia status of women aged 20-35. 8 NEW CONTRIBUTIONS OF THE THESIS Provide more data for the Chronic Energy Deficiency (CED), the prevalence of anemia, worm infection and dietary intakes of women aged 20-35 in six communes of Luc Nam district, Bac Giang province. Suggest new weekly iron supplementation regimen. This regimen is highly valuable in selecting the solutions for anemia prevention for reproductive aged women and can be applied in a larger scale. Suggest for further researches on intermittent weekly iron supplementation trial at 16th, 18th and 20 th week for reproductive aged women, especially those at the areas that have high CED, anemia and worm infection rate. STRUCTURE OF THE THESIS The thesis consists of 114 pages in which the main content is presented within 105 pages, including: Introduction (3 pages) Overview (30 pages); Subjects and Methods (21 pages); Results (34 pages) Discussion (22 pages); Conclusions and Recommendations (4pages). There are 36 tables, 12 figures and 148 references documents, in which 36 documents are in Vietnamese and 112 documents are in English. CHAPTER 1. LITERATURE REVIEW 9 1.1. NUTRITIONAL STATUS OF WOMEN IN REPRODUCTIVE AGE 1.1.1. Worldwide According to the statistics of Safe the Children in 2012, there is 10%-20% of women in sub-Saharan Africa and 25%-35% of women in South Asia who suffer from severe chronic energy deficiency. The data in 2008 shows that there are 1.5 billion people overweight (BMI≥ 25), in which nearly 200 million women are obese (≥30). In developing countries such as ThaiLan, Trung Quoc, Indonesia and Malaysia, the overweight rates are 37,4%, 25,4%, 25,0% and 46,3%, respectively and obese rates are 12,2%, 6,7%, 6,9% and 17,6%, respectively. 1.1.2. In VietNam Resuls of the nutrition survey in the period of 2009-2010 show that CED rate in women over 19 is 18.5%. The rate of overweight and obesity of people at the age of 20 and older is 5.6%, which accounts for 4.9% in male and 6.3% in female. Nutritional anemia due to iron deficiency 1.1.1. Worldwide: According to WHO’s statistics on 192 countries from 1993 to 2005, there were 56.4 million pregnant women who were anemic, accounting for 41.8%, of which the prevalence of anemia is 10 highest in Africa (57,1%), followed by Southeast Asia (48,2%). The prevalence of anemia in European and America was lower (25,1% and 24,1%). There are approximately 468.4 million pregnant women having anemia worldwide, accounting for 30.2%. Africa is still the continent with the highest rate of anemia (47.5%), South East Asia has a lower rate of anemia (45.7%). Europe and America anemia rates are nearly the lowest (19% and 17.8%). 1.2.2.2. Anemia of reproductive aged women in Vietnam According to the latest figures, anemia among Vietnamese women at childbearing age is 28.8%, which has a moderate public health significance. CHAPTER 2. STUDYING OBJECT AND METHODOLOGY 2.1. Location and time of research: 2.1.1. Location: The study was conducted in 6 poor communes: Bac Lung, Cam Ly, Bao Dai, Dong Hung, Kham Lang and Truong Giang, Luc Nam district, Bac Giang province. 2.1.2. Time: Screening Survey: June 2008 [...]... Luc Nam district Stage 2 (select commune): intentionally selected Bac Lung, Bao Dai, Dong Hung, Truong Giang and Kham Lang 13 Stage 3 (select studying object): randomly selected the system through the list of women aged 20-35 of chosen communes 2.3.2.2 Phase 2: Community- based controlled intervention study The intervention was implemented in Dong Hung, Truong Giang and Bac Lung communes, Luc Nam. .. women aged 20-35 The survey’s result on 650 women aged 20-35 showed that 94.9% of women working in the fields Most of them were literate (99.7%), the majority (64.0%) of women had education level at secondary school About half of the surveyed households were in poverty (50.9%) 21 3.1.1 The nutritional status of the PN 20-35 age 6 communes Figure 3.1 CED prevalence (BMI0,05 22 Total 650 13,0 ± 1,2 Mean Hb concentration of women aged 20-35 is 13.0 g/dl Hb concentration was similar between two age groups 20-24 and 25-29... Objects: Women aged 20-35 from cross-sectional study + Excluding criteria: Women who suffer from severe anemia (Hb 0,05) 3.2.2.2 Effectiveness on improving nutritional status and anemia of intermitten weekly iron/acid folic supplementation Figure 3.4 CED rate of women aged 20-35 at T0 và T28 30 After 28 weeks intervening, CED rate decreases 14.6% at group CT2 (from 35,4% to 20,8%) and 1,9% at control group (from 39,6% to 37,7%) The difference in 2 groups before and after intervention... (11.0%) At control group, there is not much decrease in anemia rate, from 28.3% to 24.5% (3.8%) The difference has no statistical meaning (p>0,05) Table 3.7 Effectiveness on anemia status of women aged 20-35 after 16 weeks intervention Studying groups Control group Before CT 28,3 After CT EI 24,5 13,4 CT effect 28 Group CT1 25,5 14,5 43,1 29,7 Table 3.7 shows that the effectiveness intervention on anemia... concentration: Hb < 12g/dL and Ferritin serum concentration: Ferritin serum < 15 µg/L Dietary intakes assessment: Base on the energy intakes, assess the responses to the recommended dietary allowances for Vietnamese Economics, social and cultural condition: Base on educational status, physiological state, job, religion, nation Worm infection status: assesss based on the number of worm egg/1g stool Intervention... increases 0,8g/dl statiscally (p0,05) (table 3.9) 31 Figure 3.5 Anemia rate of women aged 20-35 after 28 weeks intervention Anemia rate after 28 weeks intervening decreases in both groups Anemia rate decreases more at group CT2 (12.5%) ( from 27,1% to 14,6%) compared to control group (3,8%) . INSTITUTE OF NUTRITION DINH PHUONG HOA NUTRITIONAL STATUS, ANEMIA AND EFFECTIVENESS OF WEEKLY IRON SUPPLEMENTATION OF WOMEN AT THE AGE OF 20-35 IN LUC NAM DISTRICT, BAC GIANG PROVINCE SUMMARY. Lang and Truong Giang, Luc Nam district, Bac Giang province. 2.1.2. Time: Screening Survey: June 2008 11 Intervention study: 6/2008 to 1/2009 2.2. Studying object: Women aged 20-35 (the age group. status, anemia, worm infection rate and dietary intakes among women aged 20-35 in six communes in Luc Nam district, Bac Giang province. 2. To compare the effectiveness of consecutive weekly iron