The criteria of right practices were - Using breast milk as the first food after birth - The child is breast-fed - Breast feeding begin within the first hour of birth - Feeding a baby "o
Trang 1JOURNAL OF SCIENCE, Hue University, N 0 61, 2010
STUDY ON PHYSICAL AND PSYCHOMOTOR DEVELOPMENT AND SOME RELATED FACTORS OF INFANTS IN HUE CITY - VIETNAM, 2009-2010
Hoang Thi Bach Yen, Hoang Anh Tien , Nguyen Van Dat, Dinh Thanh Hue
College of Medicine and Pharmacy, Hue University
SUMMARY
Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity For children, good health is very important because it is the foundation for physical, psychomotor development Nutrition for children in the first years plays
an important role in the development process and quality of life of each individual Insufficient nutrition in this period can lead to poor physical and mental development, and even diseases This study was conducted with two objectives: To assess the physical, psychomotor development
of infants in Hue City in 2009-2010; and to identify factors relating to physical, psychomotor
development of infants Methodology: A cross-sectional study was implemented with a combination of quantitative and qualitative methods Results: The prevalence of underweight,
stunting, and wasting malnutrition were 2.07%, 1.55% and 4.39%, respectively Prevalence of delayed psychomotor development was 8.27% There was a correlation between the time of having complementary feeding and weight-for-length (r= - 0.156, p<0.01) and length-for-age
(r=0.108, p<0.05) Conclusion: Physical, psychomotor development of children should be
assessed and monitored regularly, using WHO Anthro software and Denver 2 test
Key words: physical, psychomotor development, breastfeeding, complementary feeding
1 Introduction
Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity For children, good health is very important because it is the foundation for the physical, psychomotor development in the future Brain cells increase the most rapidly before birth and during the first 5 or 6 months of a baby To achieve maximum brain growth, the baby needs optimal nutrition Severe protein- energy malnutrition in the last trimester of pregnant mother may decrease the number of brain cells by as much as 20 percent in the first 6 months of life of a baby Nutrition for children in the first years play an important role in the development process and quality of life of each individual Lack of breast-feeding, especially in the first 6 months of the life, and inadequate complementary feeding are common causes of
Trang 2diseases and death of infants Long-term consequences include bad results at school, low working productivity and delayed mental development Moreover, during the first year of life, the immune system has not been fully developed Insufficient nutrition in this period can lead to poor physical and mental development and even diseases
The Denver test has been applied in community in Vietnam But in Hue city, it was just used to assess and follow the psychomotor development for children with health problems, not in community
The objectives of study are to assess the physical, psychomotor development of infants in Hue City in 2009-2010 and to identify factors in the relation with physical, psychomotor development of infants
2 Methodology
2.1 Study design: This is a cross- sectional study with a combination of
quantitative and qualitative methods
2.2 The setting: Hue city -Vietnam
2.3 Study subjects: Infants live in Hue city and their mothers
2.3.1 Sample size:
With the 95% confidence level, Z/2=1.96
p =0.9: Estimated prevalence of normal physical and psychomotor development
of infants
e = 0.03
Then n = 385 The sample size in this study is 387 infants and 387 mothers
2.3.2 Sampling method: cluster random sampling
Classify 27 precints of Hue city into North and South of Perfume River, then select randomly 4 clusters for sampling (2 precints from the North and 2 precints from the South) The selected four precints were Huong Long, Phu Thuan from the North and Phu Hoi, Thuy Xuan from the South All of the infants within each cluster (about
80-110 infants/precint) were study subjects
2.4 Measurement procedures
- Quantitative method: Interview mothers using questionnaire, measuring weight, length, head circumference of the infants Assess psychomotor development by Denver
2 test
2 2
2
) 1 (
e
p p
Z
Trang 3- Qualitative method: 2 focus group discussions of mothers and 2 key informant interviews of head of commune health center were implemented at Huong Long and Phu Hoi
2.5 Statistical methods
Using SPSS 15.0 and Medcal to calculate p, 2,mean
Using WHO Anthro software for assessment of physical development
To assess breast feeding practice of mothers, we used a score scale with 1 mark for each right practice The criteria of right practices were
- Using breast milk as the first food after birth
- The child is breast-fed
- Breast feeding begin within the first hour of birth
- Feeding a baby "on demand"
- Technique of feeding is right (observed and assessed by investigator)
- Exclusive breast feeding from 4-6 months
3 Ethical issues
Respondents will be informed the aims of the study and the results will be published anonymously
4 Results
This study was conducted on 387 infants (208 males (53.7%), 179 females (46.3%)) and 387 mothers All of them were Kinh
4.1 Physical and psychomotor development of infants in Hue City in
2009-2010
4.1.1 Physical development
Table 1 Classification of undernutrition
Underweight 8 25.81
<0.0001
There were 31 (8.01%) infants were malnutrition of 3 classifications, detailed as table 5.1
Trang 44.1.2 Psychomotor development
Table 2 Psychomotor development of infants
< 0.0001
Table 3 Number of delayed domains of psychomotor development by gender
Gender
Number
p (1,2)
Among 4 domains, gross motor and language accounted for the highest prevalence of the delay (51.16% and 23.26% respectively) Except for the personal – social domain, the rest ones showed the delay on male rather than female A statistically-significant difference was observed between genders for all delayed domains
4.2 Factors relating to physical and psychomotor development of infants
4.2.1 Characteristics of the infants during neonatal period
Table 4 Characteristics of the infants during the neonatal period
Trang 5period No 346 89.41
Weight at birth
There were 24 (6.20%) of infants with a birth weight under 2500gr Among of them 9 (2.33%) was pre-term The weight at birth was 3100 ± 400 grams
4.2.2 Feeding practice
4.2.2.1 Breastfeeding
Table 5 Breastfeeding practice
The first food after
birth
Reasons for not breast
feeding
Insufficient supply of milk 7 77.78
Time of first breast
feeding
60 minutes - <1 day 137 36.24
Trang 6>1 day 133 35.19
Feeding time
Duration of exclusive
breastfeeding (month)
Stopping of breast
feeding
Time of stopping
(months)
Reasons for stopping
breast feeding
Mother do not know feeding
Infants stopped themselves 12 57.14
- Prevalence of breastfeeding and exclusive breast feeding for the first 4-6 months for the children according to head of Huong Long and Phu Hoi CHCs’ estimation were 95% - 40% and 30% - 0%, respectively The results from quantitative data was 97.67% and 9.52%
- There were some local conceptions that can be barriers to breastfeeding such as early complementary feeding, and hard-work of mother, as reported by head of CHCs
- Time of first breast feeding was within 2 hours after birth (females, 36,39,23
years old -Huong Long; female, 24 years old, Phu Hoi), “I breastfed my daughter right
after I came back to postnatal room, I did not care the time” (female, 34 years old,
Huong Long), “ Breastfeeding after 2 hours because the mother is very tired after
Trang 7delivery, she need time to rest before giving breastfeeding” (female, 35 years old, Huong
Long) “Infants of mothers who had caesareans were often breast-fed after 1 day as the
mother was isolated from the child” (females, 22, 32 years old, Phu Hoi) During that
day, the child was fed by infant formula milk
Time of stopping breastfeeding for most mothers was from 1.5 to 2 years
“normally 2 years as theory but it is not always true in reality because of work and the child” (female, 35 years old, Huong Long) “My two children stopped breastfeeding after 1.5 years because of my work and their starting of kindergarten I had to work in the field,under the sun directly, so I thought that my breast milk was not good enough for my baby therefore I stopped early After stopping breastfeeding, my baby accepted
to have complementary food and formula milk” (female, 34 years old, Huong Long)
4.2.3 Complementary feeding
Table 6 Complementary feeding
When (month)
First
complementary
food
Current food
Trang 8By spoon, cup 237 95.56
About the half of mothers introduced complementary food when their infants were 4-5 month-of age (Huong Long, Phu Hoi) Some others were at 6 month-age as suggested by mothers-in-law (Huong Long) A few infants were fed with
complementary food before 3 months because “my baby cried all day and all night
because he was starved” (female, 22 years old, Huong Long; female, 29 years old, Phu
Hoi) or “The economical status of family did not allow us to buy infant formula milk, we
have to feed him complementary food when breast milk is not enough for him” (female,
24 years old, Phu Hoi)
- Most of mothers used cereals as the first complementary food
- Preparation of complementary foods: stewing bones, beef, pork or boiling fish and mixing with rice; most of mothers added salt, red onion, fish sauce, and oil Some
of them also added monosodium glutamate, or dehydrated broth However, some other
mothers were against adding monosodium glutamate as “the food will be taste enough if
we stew many things, the only thing to do is to add some salt” (female, 34 years old,
Huong Long)
4.2.4 Knowledge of mothers about delayed psychomotor development
Some mothers gave attention to the psychomotor development of their baby
“The delay means not to pronounce as fluently as usual It will be good if the baby can repeat what the mother said” (female, 28 years old, Phu Hoi) or “The delay means not
to reach some standards, based on the time For instance, if a one year old baby can not walk, he is considered as having delayed development These are applied for the height, weight, and intelligence” (male, 36 years old, Phu Hoi)
“If a child can fight over the toys of other children, it will be good because he is
active” (female, 35 years old, Huong Long)
Addressing psychomotor development was a new area for even heads of the CHCs Hence the CHCs do not have any activities for this
Some factors relating to infant’s development
In term of factors relating to infant’s development, mothers gave the opinions of
“everyday caring”, “many influenced factors such as genes, hygiene, nutrition, teaching environment; for example, inadequate diet in quantity and quality will affect the child’s development” (male, 36 years old, Phu Hoi), “enough and timely sleeping”
(female, 27 years old, Phu Hoi)
Some mothers thought that the child had delayed development because of adults’
thinking “They did not allow their children to go out in order to avoid wind and dust,
Trang 9which were considered reasons for sickness of a child Therefore, we should bring them
to the park to play with other children to be more active” (female, 26 years old, Phu
Hoi)
- According to mothers, “thin and stunting” (female, 32 years old, Phu Hoi),
“low weight”, “low weight and short in height” (female, 27 years old, Phu Hoi)., “big
head, small bottom, and swelling abdomen” (female, 34 years old, Huong Long) were
signs of malnutrition To prevent malnutrition, they suggested that the babies should be fed well and mỏnitoring continuously, prevented from illness and immunized as scheduled
4.2.5 Caring the infant
Most mothers fed their child directly Some infants also were fed by their
grandmothers “The child will eat more if he was fed by his mother because she is
patient enough to feed him” (female, 39 years old, Huong Long)., “It is really very hard
to feed my baby, it takes me about 1.5 to 2 hours for a meal” (female, 24 years old, Phu
Hoi) Sometimes but it was very rare that the child was fed by his father as “he came
home late after work”, “My husband said that I can ask him to do everything except for feeding the baby” (female, 24 years old, Phu Hoi) Mothers also were the one who
played and chatted to the infants The others sometimes played with them
4.2.6 Gender issue
Table 5.7 Influence of gender issue on caring of the infant
Discriminating between boy
and girl
Know gender of fetal before
birth
Gender of fetal as desired
Trang 10No reaction 135 35.72
Most mothers knew the gender of their child before birth A few of them felt sad knowing having a girl while the others considered that boys or girls was the same
However, most of them cared for girls as much as boys, “Males and female are equal” ((female, 27 years old, Phu Hoi) , “Boys or girl is my child” (female, 24 years old, Phu Hoi) Many families at Huong Long still wanted to have son, “Males or females are
the same but males are preferred in rural areas” (female, 39 years old, Huong Long) ,
“everybody discriminates in favour of males” This concept often derived from the
husband, “depending on the husband’s family, if the husband is the first son of the
family, the gender of infant will be a problem” (female, 24 years old, Phu Hoi)
According to two heads of CHCs, gender discrimination was still.a problem “the
elders in feudal, backward or single-sex-child families often consider gender as an important issue” (Female, 52 years old, Huong Long)
4.3 Relationship
There was relationship between weight-for-length, length-for-age and psychomotor development (χ2=3.688; p=0.055 and χ2 = 4.57; p<0.05; respectively)
There was relationship between weight-for-age and weight-for-length, length-for-age (p<0.001)
The time of introducing complementary food was significantly correlated with weight-for-length (r= - 0.156,; p<0.01), and length-for-age (r=0.108’ p<0.05)
A negative statistically significant correlation between mother’s level of education and breastfeeding practice was found (r=-0.15; p<0.01)
There were no significant differences between:
- Weight at birth and weight-for-age, weight-for-length, length-for-age
- Diseases of infants during neonatal period and psychomotor development
- Breast feeding and psychomotor development
- Gender discrimination and psychomotor development
5 Discussions
5.1 Physical, psychomotor development of infants in Hue City in 2009-2010
5.1.1 Physical development
Comparing our results to other study