MINISTRY OF HEALTH HAI PHONG UNIVERSITY OF MEDICINE AND PHARMACY VU THI NGOC ANEMIA STATUS AMONG CHILDREN UNDER YEARS OLD WITH ACUTE RESPIRATORY INFECTIONS AT HAI PHONG CHILDREN HOSPITAL IN 2015 GRADUATION ESSAY BACHELOR OF NURSING COURSE 2012-2016 MAJOR ADVISOR : dr THAI LAN ANH PhD CO-ADVISOR : HOANG THI OANH M.S HAI PHONG 2016 ACKNOWLEDGEMENTS I am grateful for the school administrators, University training rooms, Nursing faculty, Community Nursing Department in Hai Phong University of Medicine and Pharmacy who have facilitated me to complete this thesis I am grateful for dr Thai Lan Anh PhD - Dean of Nursing faculty, Head of Community nursing department in Hai phong University of Medicine and Pharmacy and Hoang Thi Oanh M.S., who heartedly guide me during the study and completing thesis My particular thank are for the staffs in Haiphong Children Hospital, who facilitated me during data collection Last but not least, thank my parents, my teachers and my friends who have been close, encouraging and helping me during learning process and completing my study I gratefully acknowledge! Student Vu Thi Ngoc SOCIALIST REPUBLIC OF VIETNAM Independence - Freedom – Happiness -o0o - THE ASSURING I hereby declare my results presented in the thesis are my own, not copied from any other research The process of collecting and processing data is completely honest and objective Haiphong, June 5th, 2016 Student Vu Thi Ngoc ABBREVIATIONS ACD Anemia of chronic disease ACI Chronic inflammation A.D.A.M American Accreditation Health Care Commission ALRTI Acute lower respiratory tract infections AURTI Acute upper respiratory tract infections ARI Acute respiratory infections CBC Complete blood count EPO The hormone erythropoietin MCH Mean corpuscular hemoglobin IDA Iron deficiency anemia MCHC Mean corpuscular hemoglobin concentration MCV Mean corpuscular volume MEDS The monitoring, evaluation, and design support NHLBI National Heart Lung And Blood Institute NIH National Institutes of Health NSAIDs Anti-inflammatory drugs PHNI The population, health and nutrition information TIBC Total iron binding capacity UNICEF The United Nations Children’s Fund WHO World Health Organization CONTENTS ACKNOWLEDGEMENT THE ASSURING ABBREVIATIONS CONTENTS TABLE LIST 1.10 The relation between ARI with anemia 21 CHAPPTER 3: THE RESULT OF STUDY 26 4.1 General characteristics of the subjects 33 4.2.1 The average Hb concentration 34 4.2.2 Anemia prevalence .35 4.2.3 Degree of anemia 37 4.2.4 The distribution of anemia 38 REFERENCES APPENDIX TABLE LIST Table 1.1 Prevalence of anemia in children under years old by aged groups 2008………… Table 1.2 Hemoglobin values defining anemia for population groups…………… Table 1.3 Recommendations of WHO: Hemoglobin levels to diagnose anemia at sea level (g/L)………………………………………………………………………… 17 Table 1.4 Guidelines for iron supplementation to children 6- 24 months of age…… 20 Table 1.5 Guidelines for iron supplementation to other population groups……….21 Table 3.1 General characteristics……………………………………… …………26 Table 3.2 Anemia prevalence of the population………………………………… 27 Table 3.3 Anemia prevalence in age group……………………………………… 27 Table 3.4 Anemia prevalence by gender………………………………………… 28 Table 3.5 Anemia prevalence by residence……………………………………… 28 Table 3.6 Degree of anemia by age group…………………………………………29 Table 3.7 The Hb average concentration by age groups………………………… 29 Table 3.8 The Hb average concentration by types of ARI classification according to anatomy…………………………………………… .30 Table 3.9 The Hb average concentration by types of ARI according to disease classification……………………………………………………………………… 30 Table 3.10 Hematological indices by age group……………………………….… 31 Table 3.11 Hematological indicator by residence and gender …………………….31 Table 3.12 Diagnosis of IDA by aged groups…………………………………… 32 Table 3.13 Diagnosis of IDA in the community following residence and gender…32 Table 3.14 Diagnosis of IDA by aged groups……………………………………33 INTRODUCTION Anemia, a public health problem that affects low-, middle- and high-income countries and has significant adverse health consequences, as well as adverse impacts on social and economic development [45] The numbers are staggering: billion people – over 30% of the world’s population – are anemia, many due to iron deficiency, and in resource-poor areas, this is frequently exacerbated by infectious diseases Malaria, HIV/AIDS, hookworm infestation, schistosomiasis, and other infections such as tuberculosis are particularly important factors contributing to the high prevalence of anemia in some areas [46] Anemia may result from a number of causes, with the most significant contributor being iron deficiency Approximately 50% of cases of anemia are considered to be due to iron deficiency, but the proportion probably varies among population groups and in different areas, according to the local conditions Anemia resulting from iron deficiency adversely affects cognitive and motor development, causes fatigue and low productivity and, when it occurs in pregnancy, may be associated with low birth weight and increased risk of maternal and perinatal mortality In developing regions, maternal and neonatal mortality were responsible for 3.0 million deaths in 2013 and are important contributors to overall global mortality It has been further estimated that 90 000 deaths in both sexes and all age groups are due to iron deficiency anemia (IDA) alone Other causes of anemia include other micronutrient deficiencies (folic, riboflavin, vitamins A and B12), acute and chronic infections (malaria, cancer, tuberculosis and HIV), and inherited or acquired disorders that affect hemoglobin synthesis, red blood cell production or red blood cell survival [45] In Vietnam, recent year the prevalence of anemia among children under 5, pregnant women and non- pregnant women in Vietnam has decreased but remained high The prevalence of anemia 1995 and 2000: children under years old, pregnant women and non-pregnant women in nationwide has decreased respectively as follows: 45.3% down 34.1%; 52.7% down 32.2%; 40.2% down 24.3% [15] In 2010 prevalence of anemia among children under years old 29.2%, pregnant women 36.5%, non-pregnant women 28.8% According eco-region, anemia was highest in the Central Highlands, the Southeast, the North in Central, the South Central and Northern Mountains, the lowest was in the Red River Delta and Mekong Delta [6] Other hand, acute respiratory infections (ARI) is a major in three cause of death in children under years old ARI with high morbidity and recur several times a year In developing countries, ARI including pneumonia, that is one of the major fatal diseases in children under years old Statistics show that the average per child per year caught from 4- times Estimated globally every year, about billion children caught ARI, of which approximately 40 million are pneumonia Recently in Vietnam ARI still cause high morbidity and mortality in children under years old ARI in children now account for about 40.6% in the community and the highest proportion (40 -50%) of children come to care and treatment in the health facilities [1] So far, studies of anemia in children ARI under years old have not been many authors performed For more information about relation between anemia and acute respiratory infections among children under years old, I would like to implement the study: "Anemia status among children with ARI under years at Haiphong Children Hospital in 2015" Objective of the study is to determine the anemia status among children under years with ARI at Haiphong Children Hospital in 2015 CHAPTER 1: LITERATURE REVIEW 1.1.Anemia status among children under years old in the world and in Vietnam 1.1.1 In the world Anemia is a public health problem, affecting both developed countries and developing countries, causing severe consequences for the health people as well as for economic development and social Anemia occurs at all stages of the life cycle, but is most common in pregnancy women and children The WHO (2008) has estimated the worldwide prevalence of anemia by regions and population groups Women and young children are the most vulnerable to anemia The highest prevalence of anemia was 47.4% in preschool-aged children (293 million preschool-aged children) The proportion of children is the highest in the Africa region where 67.6% of pre-school children (83.5 millions) are anemic While the proportion of people with anemia is lower in South-East Asia, the number of people with anemia is higher than in the Africa region In Southeast Asia, 65.5% of preschool children (115.3millions) suffer from anemia [29] The WHO (2011) has estimated the worldwide prevalence of anemia by regions and population groups The highest prevalence of anemia was in children 42,6 % ( 273.2 million children Of these, 9.6 million children had severe anemia, with severe anemia was highest in Africa Region, with 3.6% of children affected Children in the Africa Region represented the highest proportion of individuals affected with anemia, at 62.3% (95% CI: 59.6-64.8), while the greatest number of children with anemia resided in the South-East Asia Region, including 96.7 million (95% CI: 71.7-115.0) children in 2011 The Eastern Mediterranean Region had the next highest anemia burden for children, accounting for 35.7 million (95% CI: 29.741.9) children with anemia [45] 1.1.2 In Vietnam Like many other developing countries, anemia in Vietnam is considered to be public health problems Although anemia has improved in the past few decades, but the decease is slow According to National Institute of Nutrition - UNICEF in report "review of the nutrition situation in Vietnam 2009-2010" (2011), the prevalence of anemia by ecological region in of children under years old in 2000 was 34.1% and 29.4% (7509 children) in 2008 The prevalence of anemia among children was markedly different between regions: The highest was Northern Midlands and Mountain areas with 35.5 % (1872 children), the second was North Central areas and Central coastal area: 34.7 %(1288 children), the next ones were in Mekong River Delta with 32%(1545 children), Southeast with 30.2% (597 children), Red River Delta with 23.9 % (1505 children), Central Highlands with 23.1% (702 children) [6] Table 1.1 The prevalence of anemia in children under years old by aged groups 2008 Month [...]... about anemia at Haiphong children Hospital 2006-2007 showed that the prevalence of anemia in rural children accounted for 62.4 % [3] Another study Anemia status among children aged under 5 years old who were admitted to Haiphong children hospital in 20 15 of Thai Lan Anh the results showed that: 7 Prevalence of anemia was 25. 3%, mostly was mild anemia The rate decreases with ages With 42.8% of children. .. district in Quangnam province and Phu Rieng commune, Phuoc Long district in Binhphuoc province in 2 years 1999-2000 The results showed that the general rate of anemia of children is 21.6% in Tra Mai commune (group ≤ 5 years old: 16 .5% , 6-13 years: 25. 1%),the general rate of anemia of children in Phu Rieng commune is 33 .5% (group 5 years old: 25. 6%, 6-13 years: 40.4%) As for degree of anemia: mostly mild anemia. .. children under 5 years old in Thua Thien Hue province by random sample method, some remarks as follow: the prevalence of anemia in under 5 years old is 35. 4%, in mild anemia and severe anemia: 22.3% and 13.1%, respectively Especially, the prevalence of anemia in children under 12 months is very high: 62% [10] 6 In research Anemia situation in children and women in reproductive age in 6 representative... among children 5 years old by age group, gender, residence - The degree of anemia of children under age 5 years old infected ARI -The related between gender, residence with anemia prevalence among children under 5 years old infected ARI -The related between the severe conditional of ARI with anemia prevalence  25 2 .5 Data collection techniques Randomized retrospective from medical records of children under. .. Daclak 25. 6%; Hanoi 32 .5% , Hue 38.6% Anemia prevalence is the highest in infant age of 6-12 months (56 .9%), then reduced: 45% in 12-24 months, 38% in 24-36months, 29% in 36-48months, and 19.7% in 48 -59 months The prevalence of anemia is 32 ,5% in cities and 38,4% in sub-urban for children [31] In Haiphong, the research “Nutritional anemia status and its determinant factors among infants aged 0-9 months in. .. 150 32 21.3 118 Gender Total Male Female 78.6 (X ± SD) 118 .5 ± 14.0 119 .5 ± 13.1 28 p p>0. 05 p >0. 05 Table 3.4 indicated that there is no significant difference in anemia in gender: 25. 6% anemia in boy children, 21.3% anemia in girl children Table 3 .5 Anemia prevalence by residence Anemia Hb (g/L) Urban 155 Yes Frequency 39 Rural 2 45 57 23.3 188 76.0 Total 400 96 24 304 76.0 Residence Total p % 25. 2... show that there is a correlation between anemia and infection with malaria parasites and anemia is prevalent in most areas endemic malaria [8] 1.10 The relation between ARI with anemia Lower respiratory tract infections (LRTI) include all infections of the lungs and the large airways below the larynx [30] Acute lower respiratory tract infections (ALRTI) are responsible for 19% of all deaths in children. .. provinces in Vietnam, year 2006” of Nguyen Xuan Ninh, Nguyen Anh Tuan, Nguyen Chi Tam and et al Transversal study was carried out in 11 75 children under 5 years old, 934 pregnancy women and 1120 non-pregnant women, during March 2006 (mild term of the National Strategy on Nutrition, 2001-2010) in order to determine the prevalence of anemia in children under 5 years old, women in reproductive age in 6... location of research 2.1.1 Subjects: The children under age 5 with ARI - Selection criteria: Selection of patients: All children under 5 years old were diagnosed ARI in 20 15 The study subjects have taken at random 400 cases from medical records Excluding survey forms without information: Date of birth of children, CBC test 2.1.2 Time: From February to May in 2016 2.1.3 Location: Research performed at. .. "Describe nutritional anemia in children under 5 years old at the Consultation Department in Pediatrics Hospital 2013" by Nguyen Thi Kim Phung shows around 33% of children suffered from anemia, of which about 27% of children suffer moderate and severe anemia [16] According to the research conducted by Ta Thi Vinh and Nguyen Thi Viet Hoa performed on 1,206 children younger than 13 years old in two communes: