Nutritional status and effectiveness of interventions to reduce stunting malnutrition among children under 5 years old in the costal plain area, nghe an province

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Nutritional status and effectiveness of interventions to reduce stunting malnutrition among children under 5 years old in the costal plain area, nghe an province

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i MINISTRY OF EDUCATION AND TRAINING MINISTRY OF HEALTH NATIONAL INSTITUE OF HYGIENE AND EPIDEMIOLOGY * CHU TRONG TRANG NUTRITIONAL STATUS AND EFFECTIVENESS OF INTERVENTIONS TO REDUCE STUNTING MALNUTRITIO IN CHILDREN UNDER 5 YEARS OLD IN COASTAL PLAIN AREA NGHE AN PROVINCE Speciality: Hygiene Sociology and Health Organization Code: 62 72 01 64 SUMMARY OF DOCTORAL THESIS HA NOI – 2015 ii The work was completed at: NATIONAL INSTITUE OF HYGIENE AND EPIDEMIOLOGY * Supervisors : 1. Associate Prof. PhD. Le Bach Mai 2. Associate Prof. PhD. Tran Nhu Duong Reviewer 1: Prof. PhD. Chu Van Thang - HaNoi Medical University Reviewer 2: Prof. PhD. Pham Ngoc Chau- Military Medical University Reviewer 3: Prof. PhD. Nguyen Thi Lam - National Institute of Nutrition Thesis will be put before the Council to protect thesis of State held in National Institute of Hygiene and Epidemiology. On the back: at , date… month…….year 2015 Thesis could be founded in: 1. National Library of Vietnam Library of National Institute of Hygiene and Epidemiology iii LIST OF AUTHOR’S PUBLICATIONS RELATED TO THESIS - “Nutritional status in children under 5 years in coastal plain area, NgheAn province, 2011.” Journal of Preventive Medicine, Volume XXIV, No 8 (157). Ha Noi pp.166-170. - Factors related to status of stunting malnutrition in children under 5 years in coastal plain area, Nghe An province, 2011. Journal of Preventive Medicine, Volume XXIV, No 8 (157). Ha Noi pp. 171-176. iv ABBREVIATIONS BMI : Body Mass Index HWs : Health workers EI : Effective Index Ms : Micronutrients HFA : Height for age HIV : Human Imuno Virus IE : Intervention Effect KST : Parasites NCHS : National centre health statistic F : Fellow ARI : Acute Respiratory Infections SD : Standard deviation M : Malnutrition De : Deworming UNICEF : United Nations’Children Fund WFA : Weight for age WFH : Weight for height RI : Respiratory Illness WHO : World Health Organization 1 INTRODUCTION Nutritional status of children has been always the primary concern in all countries of the world. Investing in nutrition is the key to develop the quality human resources. Malnutrition prevention should be an integral part of each national strategy for economic and social development to increase the stature, strength and wisdom of the human. According to estimates by the World Health Organization and the United Nations Children's Fund, the situation of malnutrition in worldwide children has been changed positively in recent years. Underweight malnutrition has fallen rapidly from 25% in 1990 to 15% in 2012. However, in the period from 2000 to 2005, the ratio of stunting was still highland and should be paid attention to. In this period, this rate reduced only from 33% to 25%. This situation will influence to achieve the Millennium Development Goals of halving the proportion of undernourished in developing countries from 20% in 1990 to 10% in 2015.” In Vietnam, over the years, along with the socio-economic development and the correct policies of the Party and State, the effort of the Health sector as well as the active participation of the whole society, we have achieved the significant results in improving nutritional status and health status of people. The underweight malnutrition proportion in children under 5 years in our country has declined continuously, about 16.2% in 2012. However, the proportion of malnutrition has also considerable difference among regions, between urban and rural areas, especially the underweight malnutrition in children under 5 years has remained at a high level of 26.7%. Nghe An province in the North Central region has a large area where the terrain is very diverse, with the geographic region, from mountain, midland to coastal plain. According to survey data of National Institute of Nutrition, Nghe An province always has the high malnutrition rate in children under 5 years. In 2005, the prevalence was 28.9% underweight, 34.6% stunting and 6.3% wasting in children under 5 years, respectively. In 2010, it was 21.7%, 32.9% and 8.2%, 2 respectively. Until now, beside the National Program of Malnutrition Prevention, Nghe An province has never had any intervention programs or studies on nutritional status in specific local area. Nghe An’s coastal plain area associated with the marine economy is the strategic location with some properties such as crowded population and small land, environmental sanitation is not good and people’s income mostly depends on offshore fishing, which makes parents have a few chances to take care of their children. It’s the above issues that influences on the nutritional status in children in general and children under 5 years old in particular. So, the question will be made: how is the nutritional status in children under 5 years old in this area? What factors related to malnutrition, especially stunting and what are the best measures to reduce malnutrition? The answers for these questions will contribute significantly to support managers and field professionals to improve the health status of people in the coastal plain in general and children under 5 years in particular. Especially, Nghe An province has been actively implementing Directive No 20-CT/TW dated 1997, September 22 of Politburo and policies of the provincial Party Committee on accelerating development of marine economy towards industrialization and modernization, in which focuses on the improvement of people’s health. For these above reasons, the study “Nutritional status and effectiveness of interventions to reduce stunting malnutrition in children under 5 years old in the coastal plain area Nghe An province” was conducted with the following objectives: 1. To describe the nutritional status and identify some related factors of stunting malnutrition in children under 5 years in the coastal plain area, Nghe An province. 2. To evaluate the effectiveness of an intervention to reduce stunting malnutrition from September, 2011 to September, 2012.  Contribution of the thesis - Several anthropometric indicators and malnutrition classification were integrated with comprehensive assessment test for the malnutrition status in children under 5 years in the coastal plain area, 3 Nghe An province. The rate of stunting malnutrition integrated with several anthropometric indicators in children under 5 years have firstly been developed. - Through the analysis, factors related to the rate of stunting have been identified. - It’s proven that deworming treatment, Iron supplement associated with communication and education for mothers on child-care methods to reduce the rate of stunting malnutrition and anemia, height improvement.  Structure of the thesis: the thesis consists of 134 pages including Introduction (3 pages); Chapter 1. Overview (44 pages); Chapter 2. Subjects and research methods (20 pages); Chapter 3. Research results (35 pages); Chapter 4. Discussion (27 pages); Conclusion (2 pages) and Recommendation (1 page). The thesis has 41 tables, 12 charts, 2 diagrams. References: 165 documents. Chapter1. OVERVIEW 1.1. NUTRITIONAL STATUS IN CHILDREN UNDER 5 YEARS OLD AND FACTORS RELATED TO STUNTING MALNUTRITION.  Evaluation method. a) To evaluate malnutrion based on the standard of weight for age (WFA). - Children whose weight is in the range of -2SD (Standard deviation) or more are normal. Correspondingly the body weight > 90% of the average weight for age. - Malnutrition level I: weight below - 2SD to - 3SD, correspondingly the body weight from 90% to 75% of the average weight for age. - Malnutrition level II: weight below - 2SD to - 3SD correspondingly the body weight from 75% to 60% of the average weight for age. - Malnutrition level III: weight below -4SD corresponding the body weight < 60% of the average weight for age. 4 b) To evaluate malnutrion based on the standard of height for age (HFA) - Height for age from -2SD or more: are normal - Height for age from -2SD to -3SD: malnutrition level I - Height for age below -3SD: malnutrition level II Children are considered stunting malnutrition when their height is below -2SD of National centre health statistic (NCHS) population compared with the average height for age. c) To evaluate malnutrition based on height for weight - Below -2SD: malnutrition - From -2SD to below +2SD: normal children - From +2SD or more : Over-weight and obesity. 1.1.2 Child malnutrition situation under 5 years old a) In the world. According to estimates by the World Health Organization and the United Nations Children's Fund, the situation of malnutrition in worldwide children has been changed positively in recent years. However, in the period from 2000 to 2005, the ratio of stunting is still high and should be paid attention to. In this period, this rate reduced only from 33% to 25%. According to data of National Institute of Nutrition, in 2012, the prevalence of malnutrition remaining 16.2% underweight, 26.7% stunting and 6.7% wasting. The prevalence of malnutrition in the Central Highland is highest (25.0% underweight, 36.8% stunting) and lowest in the South-eastern region (11.3% underweight, 20.7 stunting). The prevalence of malnutrition in children under 5 years old varies with age. There has been difference between urban and rural area. c)The status of child malnutrition under 5 years in Nghe An According to the survey data of National Institute of Nutrition, Nghe An provinces has the highest prevalence of child malnutrition under 5 years old. In 2005, the prevalence of child malnutrition under 5 years was 28.9% underweight, 34.6% stunting and 6.3% wasting and in 2010 was 21.7%, 32.9% and 8.2%, respectively. 5 1.1.3. Related factors of underweight malnutrition in children under 5 years old. Energy intake. Nutrition is obviously a key factor, total energy intake is not enough that often related to food restriction can cause stunting, because energy intake is usually enough for child to maintain its healthy weight for height. The quality of dietary intake should be paid more attention than the quantity, in which the role of animal protein, fats and micronutrients, vitamins, amino acids and fatty acids are essential.  Micronutrients. Micronutrients are substances that our body needs only in small amounts, however, if it’s for the shortage, it will cause very serious consequences for health. There are about 90 various micronutrients necessary for the body and divided into some following groups: - Group 1: Vitamins - Group 2: Minerals - Some infectious factors affecting stunting malnutrition in children under 5 years old: pathological spiral between infectious diseases in children and malnutrition has been proved. Infectious diseases may lead to malnutrition, malnutrition may cause infectious diseases and the pathological spiral repeats continuously without any intervention or appropriate treatment.  Factors of child care, maternal and child issue affecting stunting malnutrition in children under 5 years old. The model for analyzing the causes of stunting malnutrition including prenatal and postnatal factors. The prenatal factors including internal factors and external factors; a few studies on prenatal stage. 1.2 SOLUTIONS TO STUNTING MALNUTRITION PREVENTION IN CHILDREN UNDER 5 YEARS OLD In the world, the solutions to stunting malnutrition prevention currently focus on three solution groups. Increasing intake of nutrients, supplementing micronutrients and reducing disease burden. 6 - Solution group 1: Increasing intake of nutrients (both quality and quantity), including energy and protein supplements for pregnant women, educational strategies and the knowledge of breast-feeding, improvement of dietary supplement. - Solution group 2: Supplementing micronutrients (vitamins and minerals) including supplementing Iron, folic acid, vitamin A, calcium for pregnant women; iodized salt, vitamin A and Zinc for children. - Solution group 3: Reducing disease burden. In Vietnam, the Prime Minister approved the National Strategy on Nutrition and concretized the above solution groups as follows: Chapter 2 SUBJECTS AND METHODS 2. 1. STUDY DESIGN : 2 steps in conducting the study. Step 1: A cross-sectional descriptive study to describe the child malnutrition status under 5 years and case-control design to identify factors related to stunting malnutrition. Step 2: A controlled before and after intervention study to evaluate the effectiveness of some intervention solutions to reduce stunting malnutrition. 2.2. SUBJECTS a) Study subject of objective 1: Describing the nutritional status and identifying factors related to stunting malnutrition in children under 5 years old in the coastal plain, Nghe An province, 2011. - Study subject to describe nutritional status: Children under 5 years old (from 1 to under 60 months old) - Study subject to identify factors related to stunting malnutrition: + Children under 5 years old were suffered from stunting malnutrition (disease cases) and corresponding controlled cases. + Mothers of disease and controlled cases. b) Study subject of objective 2: Evaluating the effectiveness of some intervention solutions to reduce stunting malnutrition. + Children suffered from stunting malnutrition from 24 – 47 months old. + Mothers or primary caregivers of children. [...]... version 19.0 to process The algorithm used to analyze the data: paired T-test, KruskalWallis Test and Test χ2 Chapter 3 RESEARCH RESULTS 10 3.1 NUTRITIONAL STATUS AND IDENTIFICATION OF FACTORS RELATED TO STUNTING MALNUTRITION IN CHILDREN UNDER 5 YEARS OLD IN THE COASTAL PLAIN AREA, NGHE AN PROVINCE, 2011 3.1.1 Nutritional status in children under 5 years old in the coastal plain area, Nghe An province, 2011... underweight malnutrition in children under 5 years in the coastal plain, Nghe An province, 2011 (18.9%) was higher than the average rate of the whole country at the same time (16.8%) The older age children were, the higher the underweight malnutrition rate was  The rate of stunting malnutrition ( 35. 5%) was higher than the average rate of the whole country (27 .5% ) Stunting malnutrition had the tendency to increase... % Quantity % 123 17,3 104 14,6 19 2,7 713 929 374 40,3 281 30,2 93 10,0 855 3 45 40,4 266 31,1 79 9,2 763 318 41,7 254 33,3 64 8,4 716 252 35, 2 214 29,9 38 5, 3 35, 5 1119 28,1 293 7,4 Total 3976 1412 The results showed that the prevalence of stunting malnutrition in children under 5 years old in the coastal plain area, Nghe An province was 35. 5%, stunting malnutrition tended to increase at the age of. .. lower than the average rate of the whole country in 2010 was 5. 6% 4.1.2 Factors related to stunting malnutrition in children under 5 years 4.1.2.1 Factors of mother related to nutrition of children Relationship between the age of mothers and child malnutrition By analyzing the results of chart 3 .5 showed that mothers aged over 40 related to stunting malnutrition (p . For these above reasons, the study Nutritional status and effectiveness of interventions to reduce stunting malnutrition in children under 5 years old in the coastal plain area Nghe An province . NUTRITIONAL STATUS AND IDENTIFICATION OF FACTORS RELATED TO STUNTING MALNUTRITION IN CHILDREN UNDER 5 YEARS OLD IN THE COASTAL PLAIN AREA, NGHE AN PROVINCE, 2011. 3.1.1 Nutritional status in children. identifying factors related to stunting malnutrition in children under 5 years old in the coastal plain, Nghe An province, 2011. - Study subject to describe nutritional status: Children under 5 years

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