491 JOURNAL OF SCIENCE, Hue University, N 0 61, 2010 USING THE MODEL “MEALS SEEN AND PRACTISED” FOR THE PREVENTION AND CONTROL OF MALNUTRITION OF ETHNIC MINORITY CHILDREN UNDER 5 YEARS OLD IN PHU DO COMMUNE, PHU LUONG DISTRICT,THAI NGUYEN PROVINCE Nguyen Minh Tuan Thai Nguyen University of Medicine and Pharmacy SUMMARY An intervention using the model “Meals seen and practised” was organized regularly at San Chay households with children under 5 years old in Thai Nguyen Province. The results showed that families with children under 5 years old contributed their time and efforts actively, as well as sharing resources such as 652.9 kg of foods for preparation of complementary food for children. Mother’s nutrient knowledge and practice was clearly improved (Good knowledge: 44.3%, good practice: 35.4%). The prevalence rate of underweight malnutrition in San Chay children under 5 years old decreased to 32.1% from 41.6% as found in the previous survey. (p<0,05). Key words: Malnutrition, San Chay ethnic minority, complementary food, “Meals seen and practised”. 1. Introduction Guiding preparation of complementary food for children is one of the key contents in prevention and control of children’s malnutrition in the community. Normally, this activity is deployed in the style of a demonstration at the community health center. Therefore, the information of caring for and bringing up children is transmitted to the mothers by health staff. However, this did not stimulate the creative ability of families and the community. In the San Chay minority ethnic group, a deep relationship between the population and supporting the food are still commonly in many ways. Based on these characteristics, the study has selected a solution by organizing “meals seen and practised” at households to mobilize the participation of the San Chay minority ethnic community in prevention and control of malnutrition in the children under 5 years old. 2. Methods 2.1. Study subject and scope The research was conducted for all children under 5 years and their mothers at Phu 492 Do commune, Phu Lương district, Thai Nguyên province, during a period of 18 months. 2.2. Study design: intervention study with a before and after comparison. - Sample size: - Sample selection: The San Chay minority ethnic mothers and their children under 5 years old were selected under the study, based on a list of children managed at the community health center. 2.3. Intervention contents The practices of “Meals seen and practised” are alternately organized at households with children under 5 years old. The model utilized items available in the family such as fuel, tools for cooking, dishes, vegetable and fruit. The mothers voluntarily contribute materials, food, and their time in preparation of a meal and feeding their children. The meal was estimated to provide about 300 - 350 kcal. The energy rate supplied by protein was from 12% - 14%. The table 1 below was an example of a ration and nutrient value of “Meals seen and practised”. Depending on the food source available in the area, we can increase or decrease particular kinds of food to maintain the diversity of the ration. Table 1. Nutrient value of “Meal seen and practised” for one child Food Amount Protein (g) Lipid (g) Glucose (g) Energy (kcal) Ordinary rice (g) 50 3.95 0.50 38.10 172.0 Pork (g) 20 3.80 1.40 0.00 27.8 Sauropus (g) 20 1.06 0.00 0.68 7.0 Fat (g) 10 0.00 9.96 0.00 89.6 Fish sauce (ml) 10 0.71 0.00 0.00 2.8 Papaya (g) 100 1.00 0.00 7.70 35.0 Total 10.52 11.86 46.48 334.2 Percentage (%) 12.6 31.9 55.5 100.0 2.4. Data collection methods Mothers were directly interviewed using a set of questionnaires regarding KPC (Knowledge, Practice, Coverage) and to sort out knowledge and practice basing on the cut-off of 75% of total points. 493 To measure the anthropometry of children under 5 years old and then to compare with the reference population of NCHS. 2.5. Data processing and analysis: Anthropometry data were processed by Epinut and then exported to SPSS 13.0 to analyze interventional effectiveness with  2 test and Mann - Whitney U test. 3. Result The activity of the model “Meals seen and practised” was organized monthly at each household in the village. The household who organized this meal would supply all food including cereals, vegetable and fruit as well as vegetable oil and fat. The remaining households would bring other ingredients depending on their capacity and food available in their area. Table 2. Amount of food contributed by the San Chay households during a period of 18 months Food contributed by households (n = 237 households) Total Rice (kg) 171.8 Kinds of vegetable (kg) 68.7 Vegetable oil and fat (litre) 34.4 Fish sauce (litre) 34.4 Ripe fruit (kg) 343.6 Total (kg) 652.9 During 18 months of intervention, the San Chay households in the commune had contributed the total of 652.9kg of cereals, and other food to practice “Meals seen and practised”. These food sources was used to improve the quality of a complementary meal for their children. Table 3. Result to practice “Meals seen and practiced” on a complementary meal with different foods during a period of 18 months of intervention Complementary food No of practice No of times attended by mothers and children Average number of times/ 1 mother and child (n = 237) Egg boiled rice flour/porridge 45 640 2.7 Meat boiled rice flour/ porridge 54 735 3.1 Fish boiled rice flour/gruel 32 521 2.2 494 Crab boiled rice flour/ porridge 26 379 1.6 Shrimp boiled rice flour/ porridge 21 308 1.3 Soya curd boiled rice flour/ porridge 19 332 1.4 Liver boiled rice flour/porridge 16 213 0.9 China squash boiled rice flour/porridge 13 166 0.7 Peanut boiled rice flour/ porridge 9 142 0.6 Total 235 3436 14.5 Note: Every practice, rice flour or porridge were cooked with the same materials The kinds of complementary food were varied, and the highest number of children attending a meal was when boiled rice flour/ meat porridge, egg porridge, fish porridge were prepared. On average, every mother practised preparation of complimentary meals 14.5 times with different materials. Regardless of the number of times “Meal seen and practised” was practiced, it contributed to improving the San Chay children’s daily meals. Table 4. Change in quality of complementary meal in children over 6 months old Ration of 24 h Before intervention After intervention p (n =207) (%) (n =208) (%) Children eaten protein - rich plant foods 148 71.5 178 85.6 <0.01 * Children eaten β-caroten- rich plant foods 122 58.9 164 78.8 <0.01 * Children eaten a complementary meal enough times recommended 79 38.2 121 58.2 <0.01 * Average dietary diversity 3.24  1.11 4.18  1.48 <0.01 ** *  2 tets. **Mann - Whitney U test The quantity and quality of children’s complementary meals were improved much more than before the intervention (p<0.01). The meal was processed with many kinds of plant foods. The average dietary diversity increased 4.18  1.48 scores (p<0.01). 495 Table 5. Change in the San Chay mother’s young child feeding practices and knowledge Norm Before intervention After intervention p ( 2 test) (n = 231) (%) (n =237) (%) Mother with good knowledge 62 26.8 105 44.3 <0.01 Mother with good practice 51 22.1 84 35.4 <0.01 Through practising “Meal seen and practised”, the rate of mothers with good knowledge on nutrition increased to 44.3% from 22.1% (p<0.01). Table 6. Malnutrition prevalence rate in the San Chay children under 5 years old before and after intervention Malnutrition form Before intervention After intervention p ( 2 test) (n =231) (%) (n =237) (%) Underweight 96 41.6 75 32.1 <0.05 Stunting 101 43.7 100 42.2 >0.05 Wasting 25 10.8 17 7.2 >0.05 After intervention, the malnutrition prevalence of underweight type decreased to 32.1% from 41.6% (p<0.05). The stunting and wasting types were also dropped, but a statistically significant difference was not found when compared with before the intervention. 4. Discussion One of the orientations of the National Strategy on Nutrition in the 2001-2010 period is “ The socialization of nutrition task needs to be considered as a strategically solution with participation of many social sectors”. Based on the viewpoint of socialization, the author Phạm Mạnh Hùng said that it was necessary to create an appropriate environment for the community’s participation. Each individual’s health care from an unprompted activity only became a self-conscious activity when it had an impact on the whole community through collective activities. “Meals seen and practised” organized at households was a way to develop the community’s participation in children under five years old care activities. The results presented in Table 2 and 3 shown that the San Chay households had contributed 652.9 kg of cereals, plant foods including meat, fish, eggs, shrimp, crab, liver, Soya curd, peanut, sesame, China squash and the kinds of vegetables available in the families, which were used to prepare a complementary meal. The effectiveness of this development was not only the amount of plant foods contributed by households, but also had an educational significance on the 496 nutrient value of local food source in prevention and control of malnutrition in children. In the model of “Meal seen and practiced,” the mothers were not only seen, but also listened, exchanged, prepared foods by themselves and combined foods appropriately, according to the recommendations of the National Institute of Nutrition. This was a way of visually providing nutrient education that was suitable for the San Chay mother’s level of understanding. The mothers were provided not only information about child feeding and care, but also practices of child feeding and care. So that after intervention, the mother’s knowledge and practices were clearly improved. The knowledge of the mothers on nutrition increased to 44.3% from 26.8% and a good child feeding practices increased to 35.4% from 22.1% (table 5). Through “Meals seen and practiced,” the mothers directly saw their children were fed better, and therefore the mothers adopted these child feeding practices at home using these foods. The survey of rations in 24 hours showed that the quantity and quality of children’s complementary meals had improved since before the intervention. The number of times a minimum complementary meal was given according to recommendation for each age-group reached 58.2%. The meal was prepared from kinds of plant foods, and foods derived from protein- rich animals and β-caroten- rich vegetables and fruits. The average dietary diversity increased to 4.181.48 from 3.241.11 among 8 food groups recommended by the WHO. The final efficacy and the importance was that the malnutrition prevalence in children under 5 years old was remarkably reduced in the underweight type, from 41.6% to 32.1% (p<0.05), while the stunting and wasting types were changed less than before intervention. The mean decrease of 6.3% of underweight type malnutrition per year in this study were consistent with the laws of malnutrition, decreasing quickly in the area with the high malnutrition rate like the studies conducted by Hoang Khai Lap (8%/year), and Pham Van Hoan (6.3%/year). The practices of “Meals seen and practised” werealternately organized at households, the activities were equitable and improved participant’s responsibility. This approach was advantageous because it used the household’s material resources such as a place, fuel, tools for nutrient practices and food sources available. Therefore, it overcame some existing difficulties of the nutrition program which has been deployed commonly in the commune level, the program’s activities depended wholly on the state budget and so that the program activities only were conducted at the commune health center under a form “performance of complementary meal”. The appropriate utilization of human resources available not only broke participant’s dependence but also improved the community’s awareness about child feeding and care as well as considering sustainability 5. Conclusion 5.1. The model “Meals seen and practised” alternately organized at households was a way tof increasing the community’s effective participation in childfeeding and 497 care: working day, place, tools and 652.9kg of plant foods. 5.2. “Meals seen and practised” was a very effective form of nutrient education: the good maternal knowledge on nutrition increased to 44.3% from 26.8% and good child feeding practices increased to 35.4% from 22.1% (p<0.05). 5.3. The malnutrition prevalence in the San Chay children under 5 years old reduced over all 3 types, especially, the underweight type malnutrition dropped to 32.1% from 41.6% after 18 months of intervention (p<0.05). REFERENCES 1. Khong Dien. The San Chay ethnic minority in Viet Nam, Ethnic- Cultural Housing, Ha Noi, (2003), 11-18, 119-130, 259-266, 301-319, 374-377. 2. Donna Espeut. Knowledge, Practices, and Coverage Survey 2000 + Field Guide, Child survival Technical Support Projject, CORE, CSTS, USAID, (2001), 10-16. 3. The Government. The National strategy on nutrition in the 2001-2010 period (approved by PM in the Decision No 21/2001/QĐ-TTg issued in 22/2/2001, Medical Housing, Ha Noi, (2001), 1-5, 12-33. 4. Pham Manh Hung. Socialization of health activities: tasks reached and challenge in the short term. Journal of Medico- Pharmaceutical Information, (10), (2005), 2-5. 5. Hoang Khai Lap, Ha Xuan Son, Nguyen Minh Tuan. Efficacy of nutrient status improvement by the community nutrition education for mothers at Nga My commune, Phu Binh district,Thai Nguyen province, Journal of Nutrition and Food, 2 (3+4), (2006), 29-35. 6. Pham Van Hoan. Improvement of caregiver’s knowledge, practices and children’s nutrition status through a feasible intervention in disadvantaged, rural area in Quang Binh”, Journal of Nutrition and Food, 4(2), (2008), 33-39. . sauce (ml) 10 0.71 0.00 0.00 2.8 Papaya (g) 100 1.00 0.00 7.70 35. 0 Total 10 .52 11.86 46.48 334.2 Percentage (%) 12.6 31.9 55 .5 100.0 2.4. Data collection methods Mothers were directly interviewed. children under 5 years old. 2. Methods 2.1. Study subject and scope The research was conducted for all children under 5 years and their mothers at Phu 492 Do commune, Phu Lương district,. child (n = 237) Egg boiled rice flour/porridge 45 640 2.7 Meat boiled rice flour/ porridge 54 7 35 3.1 Fish boiled rice flour/gruel 32 52 1 2.2 494 Crab boiled rice flour/ porridge 26